All ETDs from UAB

Advisory Committee Chair

Stephen J Thomas

Advisory Committee Members

Olivio Clay

Virginia Howard

Document Type

Dissertation

Date of Award

2023

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

The first study used data (n=14,609) from the REasons for Geographic and Racial Differences in Stroke (REGARDS) to test the associations among Area Deprivation Index (ADI) and self-reported total sleep time (TST), sleep efficiency (SE), and number of restless nights within the last week. The second study (n=12,496) tested the associations among ADI, shift work status, and restlessness.Regression models were fit to examine associations between ADI and SE or TST or restlessness, as well as assess the relation between ADI and SE in clinically meaningful categories. Moderation analyses indicated whether sex or race impact the association between ADI and sleep. Regression also determined how ADI predicts shift work status and restlessness. Mann-Whitney U compared restlessness between shift-work groups. Moderation analyses indicated whether shift work status, sex, or race impacted the association between ADI and the primary outcomes. ADI negatively predicted SE after controlling for demographics; higher neighborhood disadvantage was associated with lower SE. For each one-point increase in ADI, the log-odds ratio of having low SE compared with high SE increases significantly. There were no significant relations observed between ADI and TST or restlessness. Sex and race did not moderate associations. ADI positively predicted shift work years. Higher ADI was associated with increased odds of ever working shift work but not with currently working shift work. ADI accounted for a significant portion of the variance in restlessness. There was no significant difference in the means of restlessness between the currently/not currently working shift groups nor the ever/never working shift groups. Sex moderated the interaction between ADI and shift work years and ever working shift work. Race moderated the interaction between ADI and currently and ever working shift work. Shift work status did not moderate the association between ADI and restlessness. Findings suggest higher ADI is related to lower SE, particularly at clinically meaningful levels. Additionally, male participants are more sensitive to the relation between ADI and shift work. Further investigation is required to identify the impacts of neighborhood disadvantage on sleep quality, as well as determine whether restlessness is a valid measure of sleep quality.

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