Race and Social Problems

, Volume 5, Issue 2, pp 100–112 | Cite as

“Every Shut Eye, Ain’t Sleep”: The Role of Racism-Related Vigilance in Racial/Ethnic Disparities in Sleep Difficulty

  • Margaret T. HickenEmail author
  • Hedwig Lee
  • Jennifer Ailshire
  • Sarah A. Burgard
  • David R. Williams


Although racial/ethnic disparities in health have been well characterized in biomedical, public health, and social science research, the determinants of these disparities are still not well understood. Chronic psychosocial stress related specifically to the American experience of institutional and interpersonal racial discrimination may be an important determinant of these disparities, as a growing literature in separate scientific disciplines documents the adverse health effects of stress and the greater levels of stress experienced by non-white compared to white Americans. However, the empirical literature on the importance of stress for health and health disparities specifically due to racial discrimination, using population-representative data, is still small and mixed. In this paper, we explore the association between a novel measure of racially salient chronic stress—“racism-related vigilance”—and sleep difficulty. We found that, compared to the white adults in our sample, black (but not Hispanic) adults reported greater levels of vigilance. This vigilance was positively associated with sleep difficulty to similar degrees for all racial/ethnic groups in our sample (white, black, Hispanic). Black adults reported greater levels of sleep difficulty compared to white adults. This disparity was slightly attenuated after adjustment for education and income. However, this disparity was completely attenuated after adjustment for racism-related vigilance. We found similar patterns of results for Hispanic compared to white adults, however, the disparities in sleep difficulty were smaller and not statistically significant. Because of the importance of sleep quality to health, our results suggest that the anticipation of and perseveration about racial discrimination is an important determinant of racial disparities in health.


Health disparities Sleep difficulty Anticipatory stress Racism-related stress Discrimination 

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  1. Adler, N. E., & Rehkopf, D. H. (2008). US disparities in health: Descriptions, causes, and mechanisms. Annual Review of Public Health, 29, 235–252.CrossRefGoogle Scholar
  2. Akerstedt, T. (2006). Psychosocial stress and impaired sleep. Scandinavian Journal of Work, Environment & Health, 32(6), 493–501.CrossRefGoogle Scholar
  3. Akerstedt, T., Kecklund, G., et al. (2007). Impaired sleep after bedtime stress and worries. Biological Psychology, 76(3), 170–173.CrossRefGoogle Scholar
  4. Åkerstedt, T., Nordin, M., et al. (2012). Predicting changes in sleep complaints from baseline values and changes in work demands, work control, and work preoccupation–the WOLF-project. Sleep Medicine, 13(1), 73–80.CrossRefGoogle Scholar
  5. Ayas, N. T., White, D. P., et al. (2003a). A prospective study of self-reported sleep duration and incident diabetes in women. Diabetes Care, 26(2), 380–384.CrossRefGoogle Scholar
  6. Ayas, N. T., White, D. P., et al. (2003b). A prospective study of sleep duration and coronary heart disease in women. Archives of Internal Medicine, 163(2), 205.CrossRefGoogle Scholar
  7. Baldwin, C. M., Ervin, A.-M., et al. (2010). Sleep disturbances, quality of life, and ethnicity: the sleep heart health study. Journal of clinical sleep medicine: JCSM: Official Publication of the American Academy of Sleep Medicine, 6(2), 176.Google Scholar
  8. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.CrossRefGoogle Scholar
  9. Beatty, D. L., Hall, M. H., et al. (2011). Unfair treatment is associated with poor sleep in African American and Caucasian adults: Pittsburgh SleepSCORE project. Health Psychology, 30(3), 351–359.CrossRefGoogle Scholar
  10. Bertrand, M., & Mullainathan, S. (2004). Are Emily and Greg more employable than Lakisha and Jamal? A field experiment on labor market discrimination. American Economic Review, 94(4), 991–1013.CrossRefGoogle Scholar
  11. Bonilla-Silva, E. (2010). Racism without racists: Color-blind racism and the persistence of racial inequality in America. Lanham, MD: Rowman & Littlefield.Google Scholar
  12. Borrell, L. N., & Kiefe C. I. et al. (2012). “Racial discrimination, racial/ethnic segregation, and health behaviors in the CARDIA study.” Ethnicity and Health. doi: 10.1080/13557858.2012.713092.
  13. Brissette, I. (2002). The contribution of individual differences in hostility to the associations between daily interpersonal conflict, affect, and sleep. Personality and Social Psychology Bulletin, 28(9), 1265–1274.CrossRefGoogle Scholar
  14. Brosschot, J. F. (2010). Markers of chronic stress: Prolonged physiological activation and (un)conscious perseverative cognition. Neuroscience and Biobehavioral Reviews, 35(1), 46–50.CrossRefGoogle Scholar
  15. Brosschot, J. F., Gerin, W., et al. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and health. Journal of Psychosomatic Research, 60(2), 113–124.CrossRefGoogle Scholar
  16. Brosschot, J. F., Pieper, S., et al. (2005). Expanding stress theory: Prolonged activation and perseverative cognition. Psychoneuroendocrinology, 30(10), 1043–1049.CrossRefGoogle Scholar
  17. Burgard, S. A., & Ailshire, J. A. (2009). Putting work to bed: Stressful experiences on the job and sleep quality. Journal of Health and Social Behavior, 50(4), 476–492.CrossRefGoogle Scholar
  18. Buxton, O. M., & Marcelli, E. (2010). Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Social Science and Medicine, 71(5), 1027–1036.CrossRefGoogle Scholar
  19. Cappuccio, F. P., D’Elia, L., et al. (2010a). Sleep duration and all-cause mortality: A systematic review and meta-analysis of prospective studies. Sleep, 33(5), 585–592.Google Scholar
  20. Cappuccio, F. P., D’Elia, L., et al. (2010b). Quantity and quality of sleep and incidence of type 2 diabetes: A systematic review and meta-analysis. Diabetes Care, 33(2), 414–420.CrossRefGoogle Scholar
  21. Clark, R., Anderson, N. B., et al. (1999). Racism as a stressor for African Americans—a biopsychosocial model. American Psychologist, 54(10), 805–816.CrossRefGoogle Scholar
  22. Clark, R., Benkert, R. A., et al. (2006). Large arterial elasticity varies as a function of gender and racism-related vigilance in black youth. Journal of Adolescent Health, 39(4), 562–569.CrossRefGoogle Scholar
  23. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care (with CD). Washington, DC: The National Academies Press.Google Scholar
  24. Crosby, B., LeBourgeois, M. K., et al. (2005). Racial differences in reported napping and nocturnal sleep in 2-to 8-year-old children. Pediatrics, 115(Supplement 1), 225–232.CrossRefGoogle Scholar
  25. Davis, S. K., Liu, Y., et al. (2005). Stress-related racial discrimination and hypertension likelihood in a population-based sample of African Americans: The Metro Atlanta Heart Disease Study. Ethnicity and Disease, 15(4), 585–593.Google Scholar
  26. de Lange, A. H., Kompier, M. A., et al. (2009). A hard day’s night: A longitudinal study on the relationships among job demands and job control, sleep quality and fatigue. Journal of Sleep Research, 18(3), 374–383.CrossRefGoogle Scholar
  27. Dimsdale, J. E. (2008). Psychological stress and cardiovascular disease. Journal of the American College of Cardiology, 51(13), 1237–1246.CrossRefGoogle Scholar
  28. Du Bois, W. E. B., & Eaton, I. (1899). The Philadelphia Negro : A social study. Philadelphia: Published for the University.Google Scholar
  29. Essed, P. (1990). Everyday racism: Reports from women of two cultures. CA, Hunter House: Claremont.Google Scholar
  30. Feagin, J. R. (1991). The continuing significance of race—antiblack discrimination in public places. American Sociological Review, 56(1), 101–116.CrossRefGoogle Scholar
  31. Feagin, J. R., & Sikes, M. P. (1994). Living with racism: The black middle-class experience. Boston: Beacon Press.Google Scholar
  32. Fiscella, K., & Holt, K. (2008). Racial disparity in hypertension control: Tallying the death toll. The Annals of Family Medicine, 6(6), 497–502.CrossRefGoogle Scholar
  33. Frisbie, W. P., Song, S. E., et al. (2004). The increasing racial disparity in infant mortality: Respiratory distress syndrome and other causes. Demography, 41(4), 773–800.CrossRefGoogle Scholar
  34. Gainous, J. (2012). The new “new racism” thesis limited government values and race-conscious policy attitudes. Journal of Black Studies, 43(3), 251–273.CrossRefGoogle Scholar
  35. Galster, G. (1990). Racial steering by real estate agents: Mechanisms and motives. The Review of Black Political Economy, 19(1), 39–63.CrossRefGoogle Scholar
  36. Geronimus, A. T., Bound, J., et al. (1996). Excess mortality among blacks and whites in the United States. New England Journal of Medicine, 335(21), 1552–1558.CrossRefGoogle Scholar
  37. Geronimus, A. T., Bound, J., et al. (2001). Inequality in life expectancy, functional status, and active life expectancy across selected black and white populations in the United States. Demography, 38(2), 227–251.CrossRefGoogle Scholar
  38. Geronimus, A., M. T., & Hicken, et al. (2010). “Do US Black women experience stress-related accelerated biological aging?”. Human Nature, 21(1), 19–38.Google Scholar
  39. Hale, L., & Do, D. P. (2007). Racial differences in self-reports of sleep duration in a population-based study. Sleep, 30(9), 1096.Google Scholar
  40. Hall, M., Buysse, D. J., et al. (1997). Intrusive thoughts and avoidance behaviors are associated with sleep disturbances in bereavement-related depression. Depression and Anxiety, 6(3), 106–112.CrossRefGoogle Scholar
  41. Hall, M., Buysse, D. J., et al. (2000). Symptoms of stress and depression as correlates of sleep in primary insomnia. Psychosomatic Medicine, 62(2), 227–230.Google Scholar
  42. Hall, M., Buysse, D. J., et al. (2008). Financial strain is a significant correlate of sleep continuity disturbances in late-life. Biological Psychology, 77(2), 217–222.CrossRefGoogle Scholar
  43. Hall, M. H., Matthews, K. A., et al. (2009). Race and financial strain are independent correlates of sleep in midlife women: The SWAN sleep study. Sleep, 32(1), 73–82.Google Scholar
  44. Harrell, S. P. (2000). A multidimensional conceptualization of racism-related stress: Implications for the well-being of people of color. American Journal of Orthopsychiatry, 70(1), 42–57.CrossRefGoogle Scholar
  45. Harrell, C. J., Burford, T. I., et al. (2011). Multiple pathways linking racism to health outcomes. Du Bois Review, 8(1), 143–157.CrossRefGoogle Scholar
  46. Heraclides, A., Chandola, T., et al. (2009). Psychosocial stress at work doubles the risk of type 2 diabetes in middle-aged women: Evidence from the Whitehall II study. Diabetes Care, 32(12), 2230–2235.CrossRefGoogle Scholar
  47. Hertz, R. P., Unger, A. N., et al. (2005). Racial disparities in hypertension prevalence, awareness, and management. Archives of Internal Medicine, 165(18), 2098–2104.CrossRefGoogle Scholar
  48. Hicken, M., Gragg, R., et al. (2011). How cumulative risks warrant a shift in our approach to racial health disparities: The case of lead, stress, and hypertension. Health Affairs (Millwood), 30(10), 1895–1901.CrossRefGoogle Scholar
  49. Hicken, M. T., & Lee, H. et al. “Racial/ethnic disparities in hypertension prevalence: Reconsidering the role of chronic stress.” American Journal of Public Health.Google Scholar
  50. Hughes, D. (2003). Correlates of African American and Latino parents’ messages to children about ethnicity and race: A comparative study of racial socialization. American Journal of Community Psychology, 31(1), 15–33.CrossRefGoogle Scholar
  51. Hughes, D., & Chen, L. (1997). When and what parents tell children about race: An examination of race-related socialization among African American families. Applied Developmental Science, 1(4), 200–214.CrossRefGoogle Scholar
  52. Hughes, D., & DuMont, K. (1993). Using focus groups to facilitate culturally anchored research. American Journal of Community Psychology, 21(6), 775–806.CrossRefGoogle Scholar
  53. Jackson, P. B. (2005). Health inequalities among minority populations. Journals of Gerontology Series B-Psychological Sciences and Social Sciences, 60, 63–67.CrossRefGoogle Scholar
  54. Jackson, J. S., Knight, K. M., et al. (2010). Race and unhealthy behaviors: Chronic stress, the HPA axis, and physical and mental health disparities over the life course. American Journal of Public Health, 100(5), 933–939.CrossRefGoogle Scholar
  55. James, S. A. (1993). Racial and ethnic differences in infant mortality and low birth weight. A psychosocial critique. Annals of Epidemiology, 3(2), 130–136.CrossRefGoogle Scholar
  56. Kaplan, M. S., & Nunes, A. (2003). The psychosocial determinants of hypertension. Nutrition Metabolism and Cardiovascular Diseases, 13(1), 52–59.CrossRefGoogle Scholar
  57. Kessler, R. C., Mickelson, K. D., et al. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior, 40(3), 208–230.CrossRefGoogle Scholar
  58. Knudsen, H. K., Ducharme, L. J., et al. (2007). Job stress and poor sleep quality: Data from an American sample of full-time workers. Social Science and Medicine, 64(10), 1997–2007.CrossRefGoogle Scholar
  59. Knutson, K. L. (2013). Sociodemographic and cultural determinants of sleep deficiency: Implications for cardiometabolic disease risk. Social Science and Medicine, 79, 7–15.CrossRefGoogle Scholar
  60. Knutson, K. L., & Van Cauter, E. (2008). Associations between sleep loss and increased risk of obesity and diabetes. Annals of the New York Academy of Sciences, 1129, 287–304.CrossRefGoogle Scholar
  61. Knutson, K. L., Van Cauter, E., et al. (2011). Cross-sectional associations between measures of sleep and markers of glucose metabolism among subjects with and without diabetes: The coronary artery risk development in young adults (CARDIA) sleep study. Diabetes Care, 34(5), 1171–1176.CrossRefGoogle Scholar
  62. Kramer, M. R., & Hogue, C. R. (2009). What causes racial disparities in very preterm birth? A biosocial perspective. Epidemiology Reviews, 31, 84–98.CrossRefGoogle Scholar
  63. Krieger, N. (1990). Racial and gender discrimination: Risk factors for high blood pressure? Social Science and Medicine, 30(12), 1273–1281.CrossRefGoogle Scholar
  64. Lewis, T. T., Troxel, W. M., et al. (2012). Chronic exposure to everyday discrimination and sleep in a multiethnic sample of middle-aged women. Health Psychology,. doi: 10.1037/a0029938.Google Scholar
  65. Lindstrom, M. (2008). Social capital, anticipated ethnic discrimination and self-reported psychological health: A population-based study. Social Science and Medicine, 66(1), 1–13.CrossRefGoogle Scholar
  66. Mallon, L., Broman, J. E., et al. (2002). Sleep complaints predict coronary artery disease mortality in males: A 12-year follow-up study of a middle-aged Swedish population. Journal of Internal Medicine, 251(3), 207–216.CrossRefGoogle Scholar
  67. McEwen, B. S. (2003). Mood disorders and allostatic load. Biological Psychiatry, 54(3), 200–207.CrossRefGoogle Scholar
  68. McEwen, B. S., & Sapolsky, R. M. (1995). Stress and cognitive function. Current Opinion in Neurobiology, 5(2), 205–216.CrossRefGoogle Scholar
  69. McLaughlin Crabtree, V., Beal Korhonen, J., et al. (2005). Cultural influences on the bedtime behaviors of young children. Sleep Medicine, 6(4), 319–324.CrossRefGoogle Scholar
  70. Mensah, G. A., Mokdad, A. H., et al. (2005). State of disparities in cardiovascular health in the United States. Circulation, 111(10), 1233–1241.CrossRefGoogle Scholar
  71. Mezick, E. J., Matthews, K. A., et al. (2008). Influence of race and socioeconomic status on sleep: Pittsburgh SleepSCORE project. Psychosomatic Medicine, 70(4), 410–416.CrossRefGoogle Scholar
  72. Mezick, E. J., Matthews, K. A., et al. (2009). Intra-individual variability in sleep duration and fragmentation: Associations with stress. Psychoneuroendocrinology, 34(9), 1346–1354.CrossRefGoogle Scholar
  73. Milan, S., Snow, S., et al. (2007). The context of preschool children’s sleep: Racial/ethnic differences in sleep locations, routines, and concerns. Journal of Family Psychology, 21(1), 20–28.CrossRefGoogle Scholar
  74. Mirowsky, J., & Ross, C. E. (2003). Social causes of psychological distress. New York: Aldine de Gruyter.Google Scholar
  75. Mohseni, M., & Lindstrom, M. (2008). Ethnic differences in anticipated discrimination, generalised trust in other people and self-rated health: A population-based study in Sweden. Ethnicity and Health, 13(5), 417–434.CrossRefGoogle Scholar
  76. Morenoff, J. D., House, J. S., et al. (2007). Understanding social disparities in hypertension prevalence, awareness, treatment, and control: The role of neighborhood context. Social Science and Medicine, 65(9), 1853–1866.CrossRefGoogle Scholar
  77. National Center for Health Statistics. (2012). Healthy people 2010 final review. Hyattsville, MD: Centers for Disease Control and Prevention.Google Scholar
  78. Omi, M., & Winant, H. A. (1994). Racial formation in the United States: From the 1960s to the 1990s. Psychology Press: New York.Google Scholar
  79. Paradies, Y. (2006). A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology, 35(4), 888–901.CrossRefGoogle Scholar
  80. Patel, S. R., Ayas, N. T., et al. (2004). A prospective study of sleep duration and mortality risk in women. Sleep, 27(3), 440–444.Google Scholar
  81. Pearlin, L., & Bierman, A. (2013). Current issues and future directions in research into the stress process. In C. S. Aneshensel & J. C. Phelan (Eds.), Handbook of the sociology of mental health (2nd ed., pp. 325–340). New York: Springer.Google Scholar
  82. Phillips, B., & Mannino, D. M. (2007). Do insomnia complaints cause hypertension or cardiovascular disease? Journal of Clinical Sleep Medicine, 3(5), 489–494.Google Scholar
  83. Prahlad, A. (1996). African-American proverbs in context. Jackson: University Press of Mississippi.Google Scholar
  84. Press, Stata. (2011). STATA multiple imputation reference manual college station. TX: StataCorp.Google Scholar
  85. Ribet, C., & Derriennic, F. (1999). “Age, working conditions, and sleep disorders: A longitudinal analysis in the French cohort ESTEV.” Sleep: Journal of Sleep Research & Sleep Medicine, 22(4), 491–504.Google Scholar
  86. Rowe, M. A., McCrae, C. S., et al. (2008). Sleep pattern differences between older adult dementia caregivers and older adult noncaregivers using objective and subjective measures. Journal of Clinical Sleep Medicine, 4(4), 362–369.Google Scholar
  87. Rubin, D. B. (1987). Multiple imputation for nonresponse in surveys. New York: Wiley.CrossRefGoogle Scholar
  88. Sawyer, P. J., Major, B., et al. (2012). Discrimination and the stress response: Psychological and physiological consequences of anticipating prejudice in interethnic interactions. American Journal of Public Health, 102(5), 1020–1026.CrossRefGoogle Scholar
  89. Schulman, K. A., Berlin, J. A., et al. (1999). The effect of race and sex on physicians’ recommendations for cardiac catheterization. New England Journal of Medicine, 340(8), 618–626.CrossRefGoogle Scholar
  90. Seeman, T. E., Singer, B. H., et al. (1997). Price of adaptation–allostatic load and its health consequences. MacArthur studies of successful aging. Archives of Internal Medicine, 157(19), 2259–2268.CrossRefGoogle Scholar
  91. Steffen, P. R., & Bowden, M. (2006). Sleep disturbance mediates the relationship between perceived racism and depressive symptoms. Ethnicity and Disease, 16(Winter), 16–21.Google Scholar
  92. Sternthal, M. J., Slopen, N., et al. (2011). Racial disparities in health: How much does stress really matter? Du Bois Review, 8(01), 95–113.CrossRefGoogle Scholar
  93. Sue, D. W., Capodilupo, C. M., et al. (2007). Racial microaggressions in everyday life: implications for clinical practice. American Psychologist, 62(4), 271–286.CrossRefGoogle Scholar
  94. Surwit, R. S., Schneider, M. S., et al. (1992). Stress and diabetes mellitus. Diabetes Care, 15(10), 1413–1422.CrossRefGoogle Scholar
  95. Thomas, K. S., Bardwell, W. A., et al. (2006). The toll of ethnic discrimination on sleep architecture and fatigue. Health Psychology, 25(5), 635–642.CrossRefGoogle Scholar
  96. Tomfohr, L., Pung, M. A., et al. (2012). Racial differences in sleep architecture: The role of ethnic discrimination. Biological Psychology, 89(1), 34–38.CrossRefGoogle Scholar
  97. Turner, J. R. (2009). Understanding health disparities: The promise of the stress process model. In W. R. Avison (Ed.), Advances in the conceptualization of the stress process (pp. 3–21). New York: Springer.CrossRefGoogle Scholar
  98. Williams, D. R. (1997). Race and health: Basic questions, emerging directions. Annals of Epidemiology, 7(5), 322–333.CrossRefGoogle Scholar
  99. Williams, D. R. (1999). Race, socioeconomic status, and health. The added effects of racism and discrimination. Annals of the New York Academy of Sciences, 896, 173–188.CrossRefGoogle Scholar
  100. Williams, D. R., & Jackson, P. B. (2005). Social sources of racial disparities in health—Policies in societal domains, far removed from traditional health policy, can have decisive consequences for health. Health Affairs, 24(2), 325–334.CrossRefGoogle Scholar
  101. Williams, D. R., John, D. A., et al. (2012). Research on discrimination and health: An exploratory study of unresolved conceptual and measurement issues. American Journal of Public Health, 102(5), 975–978.CrossRefGoogle Scholar
  102. Williams, D. R., & Mohammed, S. A. (2009). Discrimination and racial disparities in health: Evidence and needed research. Journal of Behavioral Medicine, 32(1), 20–47.CrossRefGoogle Scholar
  103. Williams, D. R., Mohammed, S., et al. (2010). Race, socioeconomic status, and health: Complexities, ongoing challenges, and research opportunities. Annals of the New York Academy of Sciences (The Biology of Disadvantage: Socioeconomic Status and Health), 1186, 69–101.CrossRefGoogle Scholar
  104. Williams, D. R., Yan, Y., et al. (1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2(3), 335–351.CrossRefGoogle Scholar
  105. Wyatt, S. B., Williams, D. R., et al. (2003). Racism and cardiovascular disease in African Americans. American Journal of the Medical Sciences, 325(6), 315–331.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Margaret T. Hicken
    • 1
    Email author
  • Hedwig Lee
    • 2
  • Jennifer Ailshire
    • 3
  • Sarah A. Burgard
    • 4
  • David R. Williams
    • 5
  1. 1.Department of EpidemiologyUniversity of MichiganAnn ArborUSA
  2. 2.Department of SociologyUniversity of WashingtonSeattleUSA
  3. 3.Center for Biodemography and Population HealthUniversity of Southern CaliforniaLos AngelesUSA
  4. 4.Department of SociologyUniversity of MichiganAnn ArborUSA
  5. 5.Department of Society, Human Development and Health 615Harvard UniversityBostonUSA

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