Mounting evidence suggests that multiracial adolescents may be at greater risk than their monoracial peers for both sleep problems and alcohol use. However, mechanisms underlying these uniquely-heightened risky health behaviors among multiracial adolescents remain a gap in the literature. This cross-sectional study examined a risk pathway involving discrimination experiences and negative mood underlying racial disparities in concurrent sleep problems and drinking frequency. Students at an urban, socioeconomically-disadvantaged high school (N = 414; grades 9–11, Mage = 16.00 [SD = 1.08]; 57% female; 17% multiracial, 41% Black, 22% White, 18% Asian, 2% Other; 12% Hispanic/Latinx) completed a survey. Path analysis demonstrated that associations of multiracial status with sleep problems (insomnia symptom severity and insufficient weekday sleep duration), but not drinking frequencies (past-year drinking or past-2-week binge-drinking frequencies), were explained by discrimination experiences and, in turn, negative mood. In ancillary analysis excluding White students, the serial indirect risk pathway was significant for both insomnia symptom severity and past-year drinking frequency outcomes. Discrimination experiences and negative mood may function as intermediate factors contributing to racial disparities in adolescent sleep problems, although longitudinal replication is needed.
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American Psychiatric Association. (2013). Diagnostic and statistical manual of mental health disorders: DSM-5. 5th edn. Washington, DC: American Psychiatric Publishing.
Arthur, M. W., Hawkins, J. D., Pollard, J. A., Catalano, R. F., & Baglioni, Jr, A. (2002). Measuring risk and protective factors for use, delinquency, and other adolescent problem behaviors: the Communities That Care Youth Survey. Evaluation Review, 26(6), 575–601.
Bastien, C. H., Vallieres, A., & Morin, C. M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2(4), 297–307.
Becker, S. P., Sidol, C. A., Van Dyk, T. R., Epstein, J. N., & Beebe, D. W. (2017). Intraindividual variability of sleep/wake patterns in relation to child and adolescent functioning: A systematic review. Sleep Medicine Reviews, 34, 94–121. https://doi.org/10.1016/j.smrv.2016.07.004.
Beebe, D. W., Rose, D., & Amin, R. (2010). Attention, learning, and arousal of experimentally sleep-restricted adolescents in a simulated classroom. Journal of Adolescent Health, 47(5), 523–525. https://doi.org/10.1016/j.jadohealth.2010.03.005.
Blake, M. J., Trinder, J. A., & Allen, N. B. (2018). Mechanisms underlying the association between insomnia, anxiety, and depression in adolescence: implications for behavioral sleep interventions. Clinical Psychology Review, 63, 25–40. https://doi.org/10.1016/j.cpr.2018.05.006.
Blank, M., Zhang, J., Lamers, F., Taylor, A. D., Hickie, I. B., & Merikangas, K. R. (2015). Health correlates of insomnia symptoms and comorbid mental disorders in a nationally representative sample of US adolescents. Sleep: Journal of Sleep and Sleep Disorders Research, 38(2), 197–204. https://doi.org/10.5665/sleep.4396.
Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Lichstein, K. L., & Morin, C. M. (2006). Recommendations for a standard research assessment of insomnia. Sleep, 29(9), 1155–1173.
Carney, C. E., Buysse, D. J., Ancoli-Israel, S., Edinger, J. D., Krystal, A. D., & Lichstein, K. L., et al. (2012). The Consensus Sleep Diary: standardizing prospective sleep self-monitoring. Sleep, 35(2), 287–302.
Centers for Disease Control and Prevention (CDC). (2013). National Health and Nutrition Examination Survey (NHANES), Demographics Module. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. 2014.
Chan, J. K. M., Trinder, J., Andrewes, H. E., Colrain, I. M., & Nicholas, C. L. (2013). The acute effects of alcohol on sleep architecture in late. Adolescence. Alcoholism: Clinical & Experimental Research, 37(10), 1720–1728. https://doi.org/10.1111/acer.12141.
Charmaraman, L., Woo, M., Quach, A., & Erkut, S. (2014). How have researchers studied multiracial populations? A content and methodological review of 20 years of research. Cultural Diversity and Ethnic Minority Psychology, 20(3), 336–352. https://doi.org/10.1037/a0035437.
Chung, T., Smith, G. T., Donovan, J. E., Windle, M., Faden, V. B., & Chen, C. M., et al. (2012). Drinking frequency as a brief screen for adolescent alcohol problems. Pediatrics, 129(2), 205–212. https://doi.org/10.1542/peds.2011-1828.
Clark, T. T., Nguyen, A. B., & Kropko, J. (2013). Epidemiology of drug use among biracial/ethnic youth and young adults: results from a U.S. population-based survey. Journal of Psychoactive Drugs, 45(2), 99–111. https://doi.org/10.1080/02791072.2013.785804.
Delker, E., Brown, Q., & Hasin, D. S. (2016). Alcohol consumption in demographic subpopulations: an epidemiologic overview. Alcohol Research: Current Reviews, 38(1), 7–15.
Dewald-Kaufmann, J., de Bruin, E., & Michael, G. (2019). Cognitive behavioral therapy for insomnia (CBT-i) in school-aged children and adolescents. Sleep Medicine Clinics, 14(2), 155–165. https://doi.org/10.1016/j.jsmc.2019.02.002.
Douglass, S., Mirpuri, S., English, D., & Yip, T. (2016). ‘They were just making jokes’: ethnic/racial teasing and discrimination among adolescents. Cultural Diversity and Ethnic Minority Psychology, 22(1), 69–82. https://doi.org/10.1037/cdp0000041.
Edwards, S., Reeves, G. M., & Fishbein, D. (2015). Integrative model of the relationship between sleep problems and risk for youth substance use. Current Addiction Reports, 2(2), 130–140. https://doi.org/10.1007/s40429-015-0052-0.
Franco, M., Katz, R., Pickens, J., & Brunsma, D.L. (2018). From my own flesh and blood: an exploratory examination of discrimination from family for Black/White Multiracial people. Qualitative Social Work, 1473325018815734.
Fucito, L. M., DeMartini, K. S., Hanrahan, T. H., Whittemore, R., Yaggi, H. K., & Redeker, N. S. (2015). Perceptions of heavy-drinking college students about a sleep and alcohol health intervention. Behavioral Sleep Medicine, 13(5), 395–411. https://doi.org/10.1080/15402002.2014.919919.
Fuller-Rowell, T. E., Cogburn, C. D., Brodish, A. B., Peck, S. C., Malanchuk, O., & Eccles, J. S. (2012). Racial discrimination and substance use: longitudinal associations and identity moderators. Journal of Behavioral Medicine, 35(6), 581–590. https://doi.org/10.1007/s10865-011-9388-7.
Fuller-Rowell, T. E., Curtis, D. S., Chae, D. H., & Ryff, C. D. (2018). Longitudinal health consequences of socioeconomic disadvantage: examining perceived discrimination as a mediator. Health Psychology, 37(5), 491–500. https://doi.org/10.1037/hea0000616.
Gardner, W., Mulvey, E. P., & Shaw, E. C. (1995). Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models. Psychological Bulletin, 118(3), 392–404.
Geers, A. L., Van Wasshenova, E., Murray, A. B., Mahas, R., Fahlman, M., & Boardley, D. (2017). Affective associations as predictors of health behavior in urban minority youth. Health Psychology, 36(10), 996–1005. https://doi.org/10.1037/hea0000546.
Gellis, L. A. (2011). Children’s sleep in the context of socioeconomic status, race, and ethnicity. In M. El-Sheikh (Ed.), Sleep and development: familial and socio-cultural considerations. (pp. 219–244). New York, NY, US: Oxford University Press.
Goings, T. C., Howard, M. O., Salas-Wright, C. P., & Vaughn, M. G. (2018). Substance use among bi/multiracial youth in the United States: profiles of psychosocial risk and protection. American Journal of Drug & Alcohol Abuse, 44(2), 206–214. https://doi.org/10.1080/00952990.2017.1359617.
Goosby, B. J., Cheadle, J. E., & Mitchell, C. (2018). Stress-related biosocial mechanisms of discrimination and African American health inequities. Annual Review of Sociology, 44, 319–340. https://doi.org/10.1146/annurev-soc-060116-053403.
Graham, J. W., Cumsille, P. E., & Elek-Fisk, E. (2003). Methods for handling missing data. In J. A. Schinka & W. F. Velicer (Eds), Handbook of psychology: research methods in psychology 2, (87–114). Hoboken, NJ, US: John Wiley & Sons Inc.
Grandner, M. A., Patel, N. P., Jean-Louis, G., Jackson, N., Gehrman, P. R., & Perlis, M. L., et al. (2013). Sleep-related behaviors and beliefs associated with race/ethnicity in women. Journal of the National Medical Association, 105(1), 4–15. https://doi.org/10.1016/S0027-9684(15)30080-8.
Guglielmo, D., Gazmararian, J. A., Chung, J., Rogers, A. E., & Hale, L. (2018). Racial/ethnic sleep disparities in US school-aged children and adolescents: a review of the literature. Sleep Health, 4(1), 68–80. https://doi.org/10.1016/j.sleh.2017.09.005.
Haario, P., Rahkonen, O., Laaksonen, M., Lahelma, E., & Lallukka, T. (2013). Bidirectional associations between insomnia symptoms and unhealthy behaviours. Journal of Sleep Research, 22(1), 89–95. https://doi.org/10.1111/j.1365-2869.2012.01043.x.
Harris, B., Ravert, R. D., & Sullivan, A. L. (2017). Adolescent racial identity: self-identification of multiple and ‘Other’ race/ethnicities. Urban Education, 52(6), 775–794. https://doi.org/10.1177/0042085915574527.
Hasler, B. P., Martin, C. S., Wood, D. S., Rosario, B., & Clark, D. B. (2014). A longitudinal study of insomnia and other sleep complaints in adolescents with and without alcohol use disorders. Alcoholism: Clinical and Experimental Research, 38(8), 2225–2233. https://doi.org/10.1111/acer.12474.
Hawkins, S. S., & Takeuchi, D. T. (2016). Social determinants of inadequate sleep in US children and adolescents. Public Health, 138, 119–126. https://doi.org/10.1016/j.puhe.2016.03.036.
Hirshkowitz, M., Whiton, K., Albert, S. M., Alessi, C., Bruni, O., & DonCarlos, L., et al. (2015). National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health, 1(4), 233–243. https://doi.org/10.1016/j.sleh.2015.10.004.
Huynh, V. W., & Fuligni, A. J. (2010). Discrimination hurts: the academic, psychological, and physical well-being of adolescents. Journal of Research on Adolescence, 20(4), 916–941. https://doi.org/10.1111/j.1532-7795.2010.00670.x.
IBM Corp. (2016). IBM SPSS statistics for windows. Armonk, NY: IBM Corp. 24.0.
Jackson, K. F., Yoo, H. C., Guevarra, Jr., R., & Harrington, B. A. (2012). Role of identity integration on the relationship between perceived racial discrimination and psychological adjustment of multiracial people. Journal of Counseling Psychology, 59(2), 240–250. https://doi.org/10.1037/a0027639.
Johnston, L. D., Bachman, J. G., & O’Malley, P. M. (2016). Monitoring the future: a continuing study of american youth (12th-Grade Survey), 1995. Ann Arbor: Inter-university Consortium for Political and Social Research, The University of Michigan.
Johnston, M. P., & Nadal, K. L. (2010). Multiracial microaggressions: exposing monoracism in everyday life and clinical practice. In D. W. Sue (Ed.), Microaggressions and marginality: manifestation, dynamics, and impact. (pp. 123–144). Hoboken, NJ: John Wiley & Sons Inc.
Keyes, K. M., Hatzenbuehler, M. L., Grant, B. F., & Hasin, D. S. (2012). Stress and alcohol: epidemiologic evidence. Alcohol Research: Current Reviews, 34(4), 391–400.
Koob, G.F., & Colrain, I.M. (2019). Alcohol use disorder and sleep disturbances: a feed-forward allostatic framework. Neuropsychopharmacology, https://doi.org/10.1038/s41386-019-0446-0.
Krieger, N. (2001). A glossary for social epidemiology. Journal of Epidemiology & Community Health, 55(10), 693–700. https://doi.org/10.1136/jech.55.10.693.
Kroenke, K., Spitzer, R. L., Williams, J. B. W., & Löwe, B. (2009). An ultra-brief screening scale for anxiety and depression: the PHQ-4. Psychosomatics, 50(6), 613–621.
Littlefield, A. K., Sher, K. J., & Wood, P. K. (2010). Do changes in drinking motives mediate the relation between personality change and ‘maturing out’ of problem drinking? Journal of Abnormal Psychology, 119(1), 93–105. https://doi.org/10.1037/a0017512.
Majeno, A., Tsai, K. M., Huynh, V. W., McCreath, H., & Fuligni, A. J. (2018). Discrimination and sleep difficulties during adolescence: the mediating roles of loneliness and perceived stress. Journal of Youth and Adolescence, 47(1), 135–147. https://doi.org/10.1007/s10964-017-0755-8.
Mason, M. J., Light, J. M., Mennis, J., Rusby, J. C., Westling, E., & Crewe, S., et al. (2017). Neighborhood disorder, peer network health, and substance use among young urban adolescents. Drug & Alcohol Dependence, 178, 208–214. https://doi.org/10.1016/j.drugalcdep.2017.05.005.
Meldrum, R. C., & Restivo, E. (2014). The behavioral and health consequences of sleep deprivation among U.S. high school students: relative deprivation matters. Preventive Medicine: An International Journal Devoted to Practice and Theory, 63, 24–28. https://doi.org/10.1016/j.ypmed.2014.03.006.
Miech, R. A., Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2020). Monitoring the Future national survey results on drug use, 1975-2019: Volume 1, Secondary school students. Ann Arbor: Institute for Social Research: The University of Michigan.
Muthén, L. K., & Muthén, B. O. (1998–2017). Mplus user’s guide. 7th edn. Los Angeles, CA: Muthén & Muthén.
Muthén, L. K., & Muthén, B. O. (2018). Mplus. Los Angeles, CA: Muthén & Muthén. 8.1.
Nadal, K. L., Wong, Y., Griffin, K., Sriken, J., Vargas, V., & Wideman, M., et al. (2011). Microaggressions and the multiracial experience. International Journal of Humanities and Social Sciences, 1(7), 36–44.
Nicholson, L. M., Slater, S. J., Chriqui, J. F., & Chaloupka, F. (2014). Validating adolescent socioeconomic status: comparing school free or reduced price lunch with community measures. Spatial Demography, 2, 55–65. https://doi.org/10.1007/BF03354904.
National Institutes of Health (2015). Racial and ethnic categories and definitions for NIH diversity programs and for other reporting purposes (NOT-OD-15-089). Bethesda, MD: National Institutes of Health. Retreived from https://grants.nih.gov/grants/guide/notice-files/not-od-15-089.html.
National Institute on Alcohol Abuse Alcoholism. (2017). Underage drinking. Rockville, MD: NIAAA.
Office of Management and Budget. (1997). Revisions to the standards for the classification of federal data on race and ethnicity. Washington, D.C.: Executive Office of the President.
Orchard, F., Gregory, A. M., Gradisar, M., & Reynolds, S. (2020). Self‐reported sleep patterns and quality amongst adolescents: cross‐sectional and prospective associations with anxiety and depression. Journal of Child Psychology and Psychiatry, https://doi.org/10.1111/jcpp.13288.
Pasman, J. A., Smit, D. J. A., Kingma, L., Vink, J. M., Treur, J. L., & Verweij, K. J. H. (2020). Causal relationships between substance use and insomnia. Drug & Alcohol Dependence, https://doi.org/10.1101/2020.04.06.027003.
Petrov, M. E., & Lichstein, K. L. (2016). Differences in sleep between Black and White adults: an update and future directions. Sleep Medicine, 18, 74–81. https://doi.org/10.1016/j.sleep.2015.01.011.
Phinney, J. S., & Ong, A. D. (2007). Conceptualization and measurement of ethnic identity: current status and future directions. Journal of Counseling Psychology, 54(3), 271–281. https://doi.org/10.1037/0022-0188.8.131.521.
Pieterse, A. L., Todd, N. R., Neville, H. A., & Carter, R. T. (2012). Perceived racism and mental health among Black American adults: a meta-analytic review. Journal of Counseling Psychology, 59(1), 1–9. https://doi.org/10.1037/a0026208.
Pompili, S., & Laghi, F. (2019). Binge eating and binge drinking among adolescents: the role of drinking and eating motives. Journal of Health Psychology, 24(11), 1505–1516. https://doi.org/10.1177/1359105317713359.
Preacher, K. J., & Selig, J. P. (2012). Advantages of Monte Carlo confidence intervals for indirect effects. [Article]. Communication Methods & Measures, 6(2), 77–98. https://doi.org/10.1080/19312458.2012.679848.
Schleider, J. L., Ye, F., Wang, F., Hipwell, A. E., Chung, T., & Sartor, C. E. (2019). Longitudinal reciprocal associations between anxiety,depression, and alcohol use in adolescent girls. Alcoholism: Clinical and Experimental Research, 43(1), 98–107. https://doi.org/10.1111/acer.13913.
Shih, M., & Sanchez, D. T. (2009). When race becomes even more complex: toward understanding the landscape of multiracial identity and experiences. Journal of Social Issues, 65(1), 1–11. https://doi.org/10.1111/j.1540-4560.2008.01584.x.
Smith, M. T., & Wegener, S. T. (2003). Measures of Sleep: the Insomnia Severity Index, Medical Outcomes Study (MOS) Sleep Scale, Pittsburgh Sleep Diary (PSD), and Pittsburgh Sleep Quality Index (PSQI). Arthritis & Rheumatism, 49(5S), S184–S196. https://doi.org/10.1002/art.11409.
Sobell, L. C., & Sobell, M. B. (1992). Timeline follow-back: a technique for assessing self-reported alcohol consumption. In R. Z. Litten, & J. P. Allen (Eds), Measuring alcohol consumption: psychosocial and biochemical methods. (pp. 41–72). Totowa, NJ, US: Humana Press.
Spilsbury, J. C., Storfer-Isser, A., Drotar, D., Rosen, C. L., Kirchner, L. H., & Benham, H., et al. (2004). Sleep behavior in an urban US sample of school-aged children. Archives of Pediatrics & Adolescent Medicine, 158(10), 988–994.
Stepanski, E. J., & Wyatt, J. K. (2003). Use of sleep hygiene in the treatment of insomnia. Sleep Medicine Reviews, 7(3), 215–225.
Stock, M. L., Gibbons, F. X., Gerrard, M., Houlihan, A. E., Weng, C.-Y., & Lorenz, F. O., et al. (2013). Racial identification, racial composition, and substance use vulnerability among African American adolescents and young adults. Health Psychology, 32(3), 237–247. https://doi.org/10.1037/a0030149.
Stride, C. B., Gardner, S. E., Catley, N., & Thomas, F. (2015). Mplus code for mediation, moderation and moderated mediation models. http://www.figureitout.org.uk.
Substance Abuse and Mental Health Services Administration (2018). 2017 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
Terry-McElrath, Y. M., & Patrick, M. E. (2018). U.S. adolescent alcohol use by race/ethnicity: consumption and perceived need to reduce/stop use. Journal of Ethnicity in Substance Abuse, 1–25, https://doi.org/10.1080/15332640.2018.1433094.
Trent, M., Dooley, D. G., & Dougé, J. (2019). The impact of racism on child and adolescent health. Pediatrics, 144(2), 1–14. https://doi.org/10.1542/peds.2019-1765.
Udry, J. R., Li, R. M., & Hendrickson-Smith, J. (2003). Health and behavior risks of adolescents with mixed-race identity. American Journal of Public Health, 93(11), 1865–1870. https://doi.org/10.2105/AJPH.93.11.1865.
Umaña‐Taylor, A. J., Quintana, S. M., Lee, R. M., Cross, W. E., Rivas‐Drake, D., & Schwartz, S. J., et al. (2014). Ethnic and racial identity during adolescence and into young adulthood: an integrated conceptualization. Child Development, 85(1), 21–39. https://doi.org/10.1111/cdev.12196.
United States Census Bureau (2012). The two or more races population: 2010. United States: U.S. Department of Commerce, Economics and Statistics Administration. Retrieved from https://www.census.gov/prod/cen2010/briefs/c2010br-13.pdf.
United States Census Bureau (2017). Census Data. United States: U.S. Department of Commerce. Retrieved from https://www.census.gov/data.html.
Wang, Y., & Yip, T. (2019). Sleep facilitates coping: moderated mediation of daily sleep, ethnic/racial discrimination, stress responses, and adolescent well‐being. Child Development, https://doi.org/10.1111/cdev.13324.
Wheaton, A. G., Olsen, E. O., Miller, G. F., & Croft, J. B. (2016). Sleep duration and injury-related risk behaviors among high school students-United States, 2007–2013. Morbidity and Mortality Weekly Report, 65(13), 337–341. https://doi.org/10.15585/mmwr.mm6513a1.
Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: socio-economic status, stress and discrimination. Journal of Health Psychology, 2(3), 335–351. https://doi.org/10.1177/135910539700200305.
Wilson, W. J. (1987). The truly disadvantaged: the inner city, the underclass, and public policy. Chicago, IL: University of Chicago Press.
Windle, M. (2016). Drinking over the lifespan: focus on early adolescents and youth. Alcohol Research: Current Reviews, 38(1), 95–101.
Wong, M. M., Robertson, G. C., & Dyson, R. B. (2015). Prospective relationship between poor sleep and substance‐related problems in a national sample of adolescents. Alcoholism: Clinical and Experimental Research, 39(2), 355–362. https://doi.org/10.1111/acer.12618.
World Health Organization (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva, Switzerland: World Health Organization.
Yip, T., Cheon, Y. M., Wang, Y., Cham, H., Tryon, W., & El‐Sheikh, M. (2019). Racial disparities in sleep: associations with discrimination among ethnic/racial minority adolescents. Child Development, https://doi.org/10.1111/cdev.13234.
Zhang, J., Chan, N. Y., Lam, S. P., Li, S. X., Liu, Y., & Chan, J. W. Y., et al. (2016). Emergence of sex differences in insomnia symptoms in adolescents: a large-scale school-based study. Sleep: Journal of Sleep and Sleep Disorders Research, 39(8), 1563–1570. https://doi.org/10.5665/sleep.6022.
P.A.G. participated in study coordination, conducted data analyses, and drafted the paper; J.M.D. and M.J.Z. assisted in study coordination, data interpretation, and paper drafting; L.G. participated in study design and coordination, and assisted in data interpretation and paper drafting; A.P. conceived of and designed the study, supervised data collection, analyses and interpretation, and assisted in paper drafting. All authors read and approved the final paper.
This research was supported by NIAAA grants R15 AA022496 and R01 AA027677 awarded to Aesoon Park. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Goodhines, P.A., Desalu, J.M., Zaso, M.J. et al. Sleep Problems and Drinking Frequency among Urban Multiracial and Monoracial Adolescents: Role of Discrimination Experiences and Negative Mood. J Youth Adolescence 49, 2109–2123 (2020). https://doi.org/10.1007/s10964-020-01310-1