Multidimensional Health Research Articles

Sustainable adaptation planning strategies for the medical care integrated community in the context of normalized pandemic

In the context of active aging, this research explores the spatial paradigm of medical and care community and the implementation path of sustainable adaptation to solve the mismatch between supply and demand in the practice of medical and care integration. Firstly, the HBSI theoretical model was constructed based on Maslow’s demand-ERG demand theory. Secondly, the study uses NVivo qualitative analysis and SPSS to analyze the multidimensional needs of the healthcare population for community space and services. Then, based on KANO model, the hierarchy of complex needs was classified and prioritized to achieve spatial fitting and control inference. Finally, a supply strategy was constructed to promote multidimensional health of users, realizing harmonious transformation of epidemic control and sustainable adaptation to changes.

Rapid screening for suicide risk: An algorithmic approach.

In the United States, primary medical care settings are the first accessed resource for both medical and behavioral health care. Thus, there is a clear need for accurate and efficient behavioral health screening in this setting, including routine surveillance screening for suicide risk. The Multidimensional Behavioral Health Screen (MBHS), a broadband but very brief screening tool developed specifically for primary care, has been updated to include an algorithm that classifies suicide risk based on the interpersonal-psychological theory of suicide, and associated interview and decision framework. This study aims to evaluate the predictive accuracy of the new MBHS 2.0 suicide risk algorithm, with actual risk determined by clinical suicide risk interview. Data were collected as part of a larger study that, overall, included 551 college student participants. Of these, 309 completed the MBHS 2.0 and the clinical suicide risk interview, the two measures reported here. The final participant count was 299 following the removal of incomplete or invalid cases. Predicted suicide risk as determined by the MBHS 2.0 (Low, Mild, At least Moderate) was compared to actual risk as determined by clinical interview (Low, Moderate, Severe, Extreme). Utilizing chi-square analyses, data show a significant association between the predicted suicide risk category based on the MBHS 2.0 algorithm and the actual risk category based on the semi-structured clinical interview. Furthermore, classification analyses suggest that primary care providers will be able to confidently assess the suicide risk level for the majority of their patients when using the MBHS. Findings suggest that the MBHS 2.0 can be an accurate and efficient tool for use by primary care providers in classifying suicide risk. Future research will be useful to evaluate the utility of the suicide risk algorithm among primary care populations.

Exploring Social Support, Pain Self-Efficacy and Health Beliefs in Older Adults with Musculoskeletal Disorders

Background: During the last decades, many studies have explored social support, pain self-efficacy, and health beliefs in older adults with musculoskeletal disorders. Aim: The purpose of the research is to investigate the beliefs of elderly people with musculoskeletal disorders regarding social support, self-efficacy in pain, and health locus of control. Methods: The research was carried out based on 3 questionnaires. The first questionnaire involved the Multidimensional Scale of Perceived Social Support, the second involved the Pain Self Efficacy Questionnaire, and the third included the Multidimensional Health Locus of Control (MHLC) scale. The research was conducted from April–June 2023 among 106 elderly people, of which 32 (30.2%) were men and 74 (69.8%) were women, members of long-term care services and others who visited the Open Care Center of Patras. Results: The mean age of the participants was 76.1 years and the majority were females, primary school graduates, and retired. Furthermore, most of them had moderate/mild manual labor, average financial status, and received medication for musculoskeletal problems. The results showed that there is a statistically significant positive correlation between pain self-efficacy and the support from the significant others (r = .370, p < .01), family support (r = .517, p < .01), overall social support (r = .435, p < .01), and financial status (r = .353, p < .01). Conclusion: The research showed that social support is positively related to pain self-efficacy in the elderly with musculoskeletal diseases.

Health literacy of forcibly displaced (migrant) women during the COVID-19 pandemic: a grounded theory study

PurposeThe unexpected and rapid outbreak of the COVID-19 pandemic increased the vulnerability of forcibly displaced (migrant) women, who were a social group already at risk of health inequities and poorer health outcomes. This study aims to examine the health literacy of forcibly displaced (migrant) women during the COVID-19 pandemic in Germany using a multidimensional health literacy model as a framework.Design/methodology/approachA grounded theory methodology was implemented including interviews with 33 forcibly displaced (migrant) women from July to September 2021. An experienced female researcher interviewed all forcibly displaced (migrant) women, and apart from one telephone interview, all interviews were conducted in person.FindingsFollowing data analysis, the category, “Use of health information in the context of the COVID-19 pandemic of forcibly displaced (migrant) women”, was identified as a core category. The findings provide valuable insight into the health literacy of forcibly displaced (migrant) women during the COVID-19 pandemic. Societal and environmental determinants, personal determinants and situational determinants were identified as factors impacting health literacy. Furthermore, health literacy was distinguished as competence to make informed decisions in the health domains “health care” and “disease prevention”.Originality/valueAlthough previous research often focuses on the deficits of forcibly displaced (migrants), this study highlights the resources forcibly displaced (migrant) women use to deal with health-related difficulties, especially during a crisis such as the COVID-19 pandemic. Importantly, such resources were available even if the study participants did not speak the language of the immigration country.

Embracing African Traditional Knowledge Health Systems in a HIV/AIDS and COVID-19 Pandemic Era

This article engages the perpetual denigration of African Traditional Knowledge System (ATKS) by African governments in favor of western biomedical approaches during the COVID-19 pandemic. We demonstrate that the COVID-19 pandemic has once again put the spotlight on the alternative approaches to health and the need for a holistic and broader understanding of these practices in Africa. Using a literature review on health sectors across Africa and cases of traditional health medicines and use in selected countries, we show the Afro-cosmo vision and understanding of health, and we make a case for a non-western health approach that is holistic, endogenous, and community-centered. We argue that health approaches need to be anchored on proper understanding of African societies, whose approach to health encompasses the spiritual, emotional, and physical aspect of one’s existence. Our work lends support for the importance of having a multidimensional holistic health system and approach for universal health coverage (UHC) toward the achievement of sustainable development goals (SDGs) in Africa which encompasses ATKS in dealing with pandemics.

Multidimensional Analysis of Health Factors and Their Association With Food Insecurity

Objectives: In Mexico, food insecurity is one of the main problems identified as factors that intervene in the decline of population health. For this reason, an analysis of this relationship between food insecurity and loss of health is imperative. The objective of this work can be divided into 2 elements: (1) the analysis of the relationship between food insecurity and factors associated with loss of health, and (2) promoting an alternative methodological tool based on the use of fuzzy inference system. Methods: Two multidimensional indices were calculated: (1) the multidimensional health index, constructed using 6 factors ‐ excess weight, diabetes, high blood pressure, symptoms of depression, kidney problems and heart problems, and (2) the food insecurity index with 3 levels ‐ mild, moderate, and severe. The multidimensional health index is constructed with the use of fuzzy sets, through the National Health and Nutrition Survey (ENSANUT 2019 its acronym in Spanish) in Mexico. Results: There is a close relationship between these indices and a specific profile of individuals in which there is a higher prevalence of health loss in relation to severe food insecurity. Conclusions: This study aims to elucidate the current state of health of the population in Mexico using the most up-to-date data provided by the autonomous public body for statistics and geography to build a multidimensional panorama, as well as the close relationship between food security and the loss of health.

Multidimensional Sleep Health Problems Across Middle and Older Adulthood Predict Early Mortality.

Having multiple sleep problems is common in adulthood. Yet, most studies have assessed single sleep variables at one timepoint, potentially misinterpreting health consequences of co-occurring sleep problems that may change over time. We investigated the relationship between multidimensional sleep health across adulthood and mortality. Participants from the Midlife in the United States Study reported sleep characteristics in 2004-2006 (MIDUS-2; M2) and in 2013-2014 (MIDUS-3; M3). We calculated a composite score of sleep health problems across 5 dimensions: Regularity, Satisfaction, Alertness, Efficiency, and Duration (higher = more problems). Two separate models for baseline sleep health (n = 5 140; median follow-up time = 15.3 years) and change in sleep health (n = 2 991; median follow-up time = 6.4 years) to mortality were conducted. Cox regression models controlled for sociodemographics and key health risk factors (body mass index, smoking, depressive symptoms, diabetes, and hypertension). On average, 88% of the sample reported having one or more sleep health problems at M2. Each additional sleep health problem at M2 was associated with 12% greater risk of all-cause mortality (hazard ratio [HR] = 1.12, 95% confidence interval [CI] = 1.04-1.21), but not heart disease-related mortality (HR = 1.14, 95% CI = 0.99-1.31). An increase in sleep health problems from M2 to M3 was associated with 27% greater risk of all-cause mortality (HR = 1.27, 95% CI = 1.005-1.59), and 153% greater risk of heart disease mortality (HR = 2.53, 95% CI = 1.37-4.68). More sleep health problems may increase the risk of early mortality. Sleep health in middle and older adulthood is a vital sign that can be assessed at medical checkups to identify those at greater risk.

Cardio-Cancer Risks Cross-Validation by Gaidai-Yakimov Reliability Method

This study validates novel biological and health systems reliability method, in particular suitable for complex multi-dimensional public health and biological systems, versus the well-established bivariate bio-reliability method, being known to accurately assess bivariate dynamic systems extreme contours

Abstract 13353: Sleep Health Phenotypes Predict Symptoms, Cognitive Function, and Adverse Events in Patients With Heart Failure

Introduction: Poor sleep contributes to outcomes in heart failure (HF). Phenotypes reflecting multi-dimensional sleep health may better predict outcomes and support more precise interventions than single measures, but few studies have used this approach. Aims: 1) Describe phenotypes of sleep health and 2) Evaluate whether sleep health phenotypes predict symptoms, cognitive function, and time to first hospitalization and emergency department (ED) visits among HF patients. Methods: We performed secondary analysis of a randomized controlled trial of cognitive behavioral therapy for insomnia compared with HF self-management education with HF patients. We measured sleep [rest-activity rhythms, sleep duration, and efficiency (2-week wrist actigraphy/follow-ups); insomnia; CPAP use; and daytime sleepiness (Epworth Scale)]; perceived stress; fatigue; anxiety; depression; pain; and cognitive ability (Patient-Reported Outcomes Measurement System: PROMIS) at baseline and 3, 6, and 12 months post-intervention and tracked hospitalizations and ED visits. We used K-means clustering to identify sleep phenotypes and generalized linear mixed models and Cox models to predict outcomes, adjusted for demographic factors. Results: Among 166 participants (M age = 63.2 (SD = 12.8) years; 57% female; 23% NYHA Class 3/4 HF; 35% EF less than 45%), there were 4 phenotypes [poor sleep (14%); short sleep/high sleep efficiency (39%); long sleep/low sleep efficiency (25%); and healthy sleep (21%)] at baseline. The healthy sleep group was older and had lower BMIs and less comorbidity and had better outcomes compared to all other phenotypes. In particular, this group had better fatigue (-2.43±0.87), pain (-1.86±1.05), anxiety (-1.50±0.89), stress (-1.46±0.69), and cognitive ability (1.76±0.80) than the poor sleep group. The poor sleep group had shorter time to adverse events compared to the other phenotypes (Hazard ratios of 0.41 to 0.56 for hospitalizations and 0.35 to 0.60 for ED visits). Conclusions: Multidimensional aspects of sleep predict HF outcomes and may improve on prediction with single measures. Future tailored sleep interventions focused on phenotypes may more precisely improve outcomes among HF patients than traditional approaches.

Multidimensional health heterogeneity of Chinese older adults and its determinants

BackgroundNowadays, the “Healthy China” and “Actively Addressing Population Aging” are two important national strategies in China. Promoting high-quality development of demand-driven older adults health services is an important way to achieve these strategies. From the perspective of active ageing, assessing the health status of older adults from multiple dimensions becomes crucial as it helps identify their specific health service needs, intervention measures, and health policies tailored to this population. MethodsData were derived from the China Health and Retirement Longitudinal Study (CHARLS) wave 4 (2018). A total of 4190 older adults (aged ≥60 years) were included as the analysis sample. Latent class analysis was performed to categorize older adults based on 6 health indicators, including Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), doctor diagnosed chronic diseases, depressive symptoms, cognitive function, and social participation. Multinomial logistic model was used to explore determinants associated with the various patterns of multidimensional health of older adults. ResultsThe multidimensional health of older people was classified into three latent classes: Relatively Healthy (Class 1, n = 2806, 66.97%), Highly Depressed and Relatively Health Risk (Class 2, n = 1189, 28.38%), and Functional Impairment (Class 3, n = 195, 4.65%). Gender, age, education, marital status, number of children, alcohol consumption, physical activity, savings, residence, air quality satisfaction, and medical service satisfaction had significant effects on the attribution of all multidimensional health latent classes. ConclusionHeterogeneous and multidimensional health classes exist in China's older population, and these classes are influenced by a variety of factors and to varying degrees. Policymakers and healthcare providers can use these evidence to further address the diverse needs of older adults and improve older-care health services, ultimately achieving the goal of Active Ageing and Healthy China.

Longitudinal impacts of adverse childhood experiences on multidimensional health outcomes: Predicting trajectories in mental, physical, and behavioral health

BackgroundAdverse childhood experiences (ACEs) elevate the risk of poor health later in life. ObjectiveThis study aims to provide a more comprehensive investigation of the multidimensional health risks associated with ACEs, to address a gap in the understanding of their longitudinal impact on mental, physical, and behavioral health domains. Participants and settingThis study included 6, 504 participants (51.61 % females) from the National Longitudinal Study of Adolescent to Adult Health (1994–2018). MethodsWe utilized latent class growth analysis to identify trajectories from adolescence to adulthood in three health domains: depression (Mental Health, MH), self-report physical health (SRH), and binge drinking frequency (BDF). Binary logistic regression was then used to assess the unique contributions of different types of ACEs to these longitudinal health trajectories. ResultsThree to four trajectories were identified for MH (consistently low, decreasing, increasing), SRH (consistently low, decreasing, increasing, consistently high), and BDF (consistently low, decreasing, moderate). Regression results showed that experience of emotional abuse and witnessed community violence elevated the risk associated with unfavorable trajectories in the mental health and behavioral health domains, respectively. ConclusionsIndividual ACEs differentially predicted mental, physical, and behavioral health trajectories, potentially through various pathways. Prevention of ACEs could mitigate health risks for adolescents and young adults across these domains.

Multimorbidity Patterns and Rheumatoid Arthritis Disease Outcomes: Findings From a Multicenter, Prospective Cohort.

To determine whether unique multimorbidity patterns are associated with long-term rheumatoid arthritis (RA) disease severity. We conducted a cohort study within the Veterans Affairs Rheumatoid Arthritis registry. We applied previously derived multimorbidity patterns based on the presence of diagnostic codes for relevant conditions prior to enrollment using linked administrative data. Disease activity and functional status were assessed longitudinally up to 5 years after enrollment. The association of multimorbidity patterns with disease activity and functional status were assessed using generalized estimating equations models adjusting for relevant confounders. We studied 2,956 participants, of which 88.2% were male, 76.9% reported white race, and 79.3% had a smoking history. Mental health and substance abuse (β 0.12 [95% confidence interval {CI} 0.00, 0.23]), cardiovascular (β 0.25 [95% CI 0.12, 0.38]), and chronic pain (β 0.21 [95% CI 0.11, 0.31]) multimorbidity were associated with higher Disease Activity Score in 28 joints (DAS28) scores. Mental health and substance abuse (β 0.09 [0.03, 0.15]), cardiovascular (β 0.11 [95% CI 0.04, 0.17]), and chronic pain multimorbidity (β 0.15 [95% CI 0.10, 0.20]) were also associated with higher Multidimensional Health Assessment Questionnaire (MDHAQ) scores. The metabolic pattern of multimorbidity was not associated with DAS28 or MDHAQ. The number of multimorbidity patterns present was highly associated with DAS28 and MDHAQ (P trend < 0.001), and patients with all four multimorbidity patterns had the highest DAS28 (β 0.59 [95% CI 0.36, 0.83]) and MDHAQ (β 0.27 [95% CI 0.16, 0.39]) scores. Mental health and substance abuse, chronic pain, and cardiovascular multimorbidity patterns are associated with increased RA disease activity and poorer functional status. Identifying and addressing these multimorbidity patterns may facilitate achieving RA treatment targets.

Psychological Associations of Stress with the Level of Health Locus of Control and Self-Efficacy in Patients with Ovarian Cancer.

The aim of this study was to analyze the locus of health control, self-efficacy and stress coping styles of female patients treated for ovarian cancer. Learning the styles of coping with stress in patients with ovarian cancer may contribute to improve their quality of life after cancer diagnosis. A series of Pearson's r-analyses was performed in the order to evaluate the hypotheses regarding the relationship between styles of coping with stress, the locus of health control and self-efficacy. A total of 151 female patients participated in this study. Standardized psychological questionnaires were used: the General Self-Efficacy Scale (GSES) to measure coping with difficult situations and obstacles, the Multi-Dimensional Health Locus of Control Scale (MHLC) to measure health control and the Convergence Insufficiency Symptom Survey (CISS) to measure stress coping styles. All questionnaires had an adaptation in Polish. Patients using task-focused and socializing styles had higher self-efficacy, whereas focusing on negative emotions resulted in lower self-efficacy. External locus of health control was related to a task-focused approach to treatment. On the other hand, the focus on negative emotions was related to the feeling that the fate of patients was decided by chance. Self-efficacy was positively associated with internal locus of health control and with external control, which means the influence of others. The results of our study indicate the need for a multidimensional approach to the treatment of female patients with ovarian cancer. The psychological condition of female patients has an ongoing relationship with their physical health.

Psychometric Properties and Factor Structure of the Multidimensional Behavioral Health Screen (MBHS) With a University Sample.

The Multidimensional Behavioral Health Screen (MBHS) is a brief screening measure of behavioral health symptoms. Although the measure was first developed for primary care, it is likely to have clinical utility in other settings. This study examined the MBHS's factor structure and psychometric properties with a university undergraduate and graduate student sample (n = 602, 58.6% female, 75.9% White, primarily aged 20-24) during the COVID-19 pandemic. MBHS subscale scores demonstrated internal consistency reliability and both convergent and discriminant relations with external, criterion variables. Confirmatory factor analyses supported a 7-subscale factor structure of the MBHS and did not find evidence of higher order factors. Clinical and theoretical implications, as well as future research directions, are discussed.

Multidimensional Sleep Health and Long-Term Cognitive Decline in Community-Dwelling Older Men.

Specific sleep characteristics have been associated with cognitive decline, Alzheimer's disease, and related dementias; however, studies examining the association between multidimensional sleep (a more comprehensive integration of sleep parameters) and cognitive decline are lacking. Among 2,811 older men without dementia, those with none, 1-2, and 3-5 "poor" self-reported sleep health dimensions had an adjusted 10-year change score of global cognition (3MS) of 2.9, 4.0 and 3.5 points (p-trend = 0.05), and in executive function (Trails B) completion time of 36.7, 42.7, and 46.7 seconds (p-trend < 0.01), respectively. In conclusion, a multidimensional measure of sleep health was associated with greater cognitive decline.

The nexus of food and nutrition security in youth: linking a Canadian survey and administrative data

Abstract Background Food insecurity is impacted by social determinants of health and is a risk factor for poor nutrition. Simultaneously, nutrition insecurity remains a pervasive public health concern in wealthy countries, especially for children. This study describes characteristics of youth that may increase risk of food and nutrition insecurity. Methods A cross-sectional study of grade nine students took place in 37 schools in Manitoba, Canada. Students completed a web-based survey on food security, diet, and nutrition-related behaviours. When consenting, parents/guardians could provide their child's health number. This sub-sample (n = 943) was linked with social and health variables through a de-identified data repository and used for this study. Bivariate associations explored relationships between sociodemographic information, diet quality, eating behaviours, mental health, and food security. A multivariable logistic regression model determined adjusted odds ratios and 95% confidence limits for food security, and a general linear model for diet quality. Significance was set at p &amp;lt; 0.05 for all analyses. Results Twenty percent of participants were food insecure and 70% had sub-optimal diets. Food security was positively associated with living in a rural area, in higher income neighbourhoods and eating family dinner more frequently, while living in a northern area or in social housing, were negatively associated. Food security was not significantly related to diet quality; however, better nutrition was associated with being female, higher self-rated health, absence of a mental health diagnosis, and more frequent breakfast consumption, while receiving social assistance and living in a northern area were negatively associated with diet. Conclusions While results show a socioeconomic and geographic vulnerability to food insecurity, the diet quality of most adolescents was low. A multidimensional public health approach is needed to resolve these connected yet different issues. Key messages • Food insecurity and nutrition insecurity are public health concerns that require distinct but related interventions. • Scaling up income supports to resolve food insecurity is insufficient to improve dietary quality across adolescent populations.

The role of multidimensional health patterns over time in older workers' labor force participation

Abstract Background A non-negligible share of workers is affected by adverse health at the end of their careers. While many of them drop out of the labor force, others remain, prompting the question of how various health indicators interact to influence these different pathways. Therefore, we investigate the effect of multidimensional health patterns on labor force participation among older workers. Methods We used six-year-longitudinal data from 5007 older workers (Mean age: 55.8 years; 55.9 % female) from the Survey of Health, Ageing and Retirement in Europe. First, we conducted a latent transition analysis with four indicators (chronic diseases, limitations with activities, perceived health, and depression) to identify multidimensional health patterns. Second, we examined individual change in these patterns over time and their association with workers’ job situations and changes in work hours four years later using Wald-tests. Results We identified four multidimensional health patterns with high structural stability over time (ranging from &amp;lt;.005 to .25): (1) Overall healthy workers, (2) workers with moderate activity limitations and low perceived health, (3) overall unhealthy workers, and (4) physically healthy workers with low perceived health and depressive symptoms. Furthermore, individuals predominantly remain in the same pattern over time, except for pattern (4), where 56% of the individuals transition to pattern (1). Moreover, we found differences between the patterns in job situation (p &amp;lt; .001) and changes in work hours (p &amp;lt; .001) four years later with patterns (2) and (4) showing the greatest reduction in working hours. Conclusions The high rate of transitions from the pattern (4) to the more favorable pattern (1) may be explained by the relatively high potential for recovery from depression. Our findings suggest that interventions among older workers with depressive symptoms and moderate activity limitations may improve their chances to remain in the labor force. Key messages • We identified four largely stable multidimensional health patterns over time. • Older workers with moderate activity limitations and low perceived health reduced their work hours most strongly.

Health behaviors and problems in Polish homeless men.

Homelessness is considered to be a global problem, independent of the material situation of a given country and occurring in most societies around the world. Assessment of the preferred health behaviors of homeless people. The study covered 153 men who are homeless and 312 men who are not homeless. The original questionnaire of homeless, and validated the Satisfaction with Life Scale (SWLS), the Health Behavior Inventory (HBI), the General Self-Efficacy Scale (GSES) and the Multidimensional Health Locus of Control (MHLC) Scale were used. The research covered fully completed questionnaires from 153 homeless men staying in Białystok and Gdańsk homelss centers. On average, the homeless men assessed their health at 6.0 ± 2.7 points, and the non-homeless at 7.8 ± 2.2 points (p < 0.001). Significant differences were found between people experiencing a homelessness crisis and the control group in selected aspects concerning the everyday life hygiene of the respondents, health self-assessment, declarations of visits to a specialist and carrying out check-ups, level of satisfaction with life, coping with difficult situations, preferred pro-health behaviors and dimensions of health control. In the used scales, SWLS, HBI, GES, and MHCL, the majority of homeless men obtained average scores. They were rather dissatisfied with their lives, with a low level of effectiveness in coping with difficult situations and obstacles, a low level of health behaviors, and in the scope of health, control increasing the impact of chance. The level of the presented health behaviors showed statistically significant diversification with all dimensions of the health locus of control, and its internal dimension with age, homelessness phase, the respondents' criminal history, being under constant medical care, and self-assessment of health.

Race and sex differences in the longitudinal changes in multidimensional self-reported sleep health characteristics in aging older adults

ObjectivesWe examined within-individual changes in self-reported sleep health as community-dwelling older adults age as well as potential differences in these changes by self-reported sex and racial identity. MethodsParticipants were from the United States and enrolled in the Rush Memory and Aging Project, Minority Aging Research Study, or Religious Orders Study (N = 3539, 20% Black, 75% female, mean 78years [range 65-103]), and they received annual, in-person clinical evaluations (median 5 visits [range 1-27]). A sleep health composite score measured the number of poor sleep characteristics among satisfaction, daytime sleepiness, efficiency, and duration. Mixed effects models estimated associations of age, race, sex, and their interactions on the composite and individual sleep measures, accounting for key confounders. ResultsAs they aged, Black participants shifted from reporting two poor sleep characteristics to one poor sleep characteristic, while White participants shifted from one poor characteristic to two. Regardless of age, sex, and race, participants reported that they “often” felt satisfied with their sleep and “sometimes” had trouble staying asleep. Females over age 85 and males of all ages reported the most daytime sleepiness, and older White participants (>age 90) reported the most difficulty falling asleep. ConclusionsAlthough self-reported sleep characteristics were typically stable across age, identifying race and sex differences in self-reported sleep health can help guide future research to understand the mechanisms that underlie these differences.

Social and built neighborhood environments and sleep health: The Hispanic Community Health Study/Study of Latinos Community and Surrounding Areas and Sueño Ancillary Studies.

To test associations between neighborhood social, built, and ambient environment characteristics and multidimensional sleep health in Hispanic/Latino adults. Data were from San Diego-based Hispanic/Latino adults mostly of Mexican heritage enrolled in the Hispanic Community Health Study/Study of Latinos (N = 342). Home addresses were geocoded to ascertain neighborhood characteristics of greenness, walkability (density of intersections, retail spaces, and residences), socioeconomic deprivation (e.g. lower income, lower education), social disorder (e.g. vacant buildings, crime), traffic density, and air pollution (PM 2.5) in the Study of Latinos Communities and Surrounding Areas Study. Sleep dimensions of regularity, satisfaction, alertness, timing, efficiency, and duration were measured by self-report or actigraphy approximately 2 years later. Multivariable regression models accounting for study design (stratification and clustering) were used to examine associations of neighborhood variables with individual sleep dimensions and a multidimensional sleep health composite score. Neighborhood characteristics were not significantly associated with the multidimensional sleep health composite, and there were few significant associations with individual sleep dimensions. Greater levels of air pollution (B = 9.03, 95% CI: 1.16, 16.91) were associated with later sleep midpoint, while greater social disorder (B = -6.90, 95% CI: -13.12, -0.67) was associated with earlier sleep midpoint. Lower walkability was associated with more wake after sleep onset (B = -3.58, 95% CI: -7.07, -0.09). Living in neighborhoods with lower walkability and greater air pollution was associated with worse sleep health, but otherwise findings were largely null. Future research should test these hypotheses in settings with greater variability and investigate mechanisms of these associations.