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Broken Windows, Broken Zzs: Poor Housing and Neighborhood Conditions Are Associated with Objective Measures of Sleep Health

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Abstract

African Americans and socioeconomically disadvantaged individuals have higher rates of a variety of sleep disturbances, including short sleep duration, poor sleep quality, and fragmented sleep. Such sleep disturbances may contribute to pervasive and widening racial and socioeconomic (SES) disparities in health. A growing body of literature demonstrates that over and above individual-level SES, indicators of neighborhood disadvantage are associated with poor sleep. However, there has been scant investigation of the association between sleep and the most proximal environments, the home and residential block. This is the first study to examine the association between objective and self-reported measures of housing and block conditions and sleep. The sample included 634 adults (mean age = 58.7 years; 95% African American) from two low-income urban neighborhoods. Study participants reported whether they experienced problems with any of seven different housing problems (e.g., broken windows) and rated the overall condition of their home. Trained data collectors rated residential block quality. Seven days of wrist actigraphy were used to measure average sleep duration, efficiency, and wakefulness after sleep onset (WASO), and a sleep diary assessed sleep quality. Multivariate regression analyses were conducted for each sleep outcome with housing or block conditions as predictors in separate models. Participants reporting “fair” or “poor” housing conditions had an adjusted average sleep duration that was 15.4 min shorter than that of participants reporting “good” or “excellent” conditions. Those reporting any home distress had 15.9 min shorter sleep and .19 units lower mean sleep quality as compared with participants who did not report home distress. Poor objectively measured block quality was associated with 14.0 min shorter sleep duration, 1.95% lower sleep efficiency, and 10.7 additional minutes of WASO. Adverse housing and proximal neighborhood conditions are independently associated with poor sleep health. Findings highlight the importance of considering strategies that target upstream determinants of sleep health disparities.

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Notes

  1. We ran sensitivity analyses excluding the N = 35 participants who did not self-report race/ethnicity or who reported a race/ethnicity other than African American, and results were similar as with the full sample. Therefore, we present the analyses in the full sample.

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Acknowledgments

Funding was provided by the National Heart Lung Blood Institute (Grant No. R01 HL122460 and HL131531). The authors express sincere appreciation and gratitude to La’Vette Wagner, study field coordinator, the data collection staff, our project coordinator, Jennifer Sloan, and our research assistant, Alvin Nugroho. The authors thank our community partners, including Hill House Association, Operation Better Block, and Homewood Children’s Village, and most importantly, our participants, who make this work possible.

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Authors and Affiliations

  1. Behavior and Policy Sciences, RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA

    Wendy M. Troxel, Stephanie Brooks Holliday, Andrea S. Richardson & Tamara Dubowitz

  2. Economics, Sociology and Statistics, RAND Corporation, Pittsburgh, PA, 15213, USA

    Ann Haas, Bonnie Ghosh-Dastidar & Heather Schwartz

  3. Departments of Behavioral and Community Health Sciences and Epidemiology, University of Pittsburgh, Pittsburgh, PA, 15261, USA

    Tiffany L. Gary-Webb

  4. Department of Family, Population, and Preventive Medicine, Program in Public Health, Stony Brook University, Stony Brook, NY, 11794-8338, USA

    Lauren Hale

  5. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Daniel J. Buysse

  6. College of Health Solutions, Arizona State University, Phoenix, AZ, 85004, USA

    Matthew P. Buman

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  1. Wendy M. Troxel
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Correspondence to Wendy M. Troxel.

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Troxel, W.M., Haas, A., Ghosh-Dastidar, B. et al. Broken Windows, Broken Zzs: Poor Housing and Neighborhood Conditions Are Associated with Objective Measures of Sleep Health. J Urban Health 97, 230–238 (2020). https://doi.org/10.1007/s11524-019-00418-5

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  • DOI: https://doi.org/10.1007/s11524-019-00418-5

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