Sleep and health disparities among Asian Americans: roles of stressors and protective factors

PROJECT SUMMARY Asian Americans have more sleep deficiencies compared to Whites or Hispanics. However, most studies of sleep disparities have focused on African Americans and Hispanics, and research on Asians remains scarce. Our preliminary study among Chinese, Korean, and Vietnamese Americans found that acculturative stress was inversely associated with sleep duration and positively associated with sleep disturbance and risk of sleep apnea. Importantly, COVID-19 has adversely affected health, including sleep, with minority populations being disproportionately affected. Additionally, increasing hate speech and racist attacks against Asians have been reported, leading to increased mental and emotional toll in this population. Findings from the preliminary study also demonstrated that sleep duration was inversely associated with diabetes, and sleep apnea was positively associated with hypertension and obesity. The overarching goal of this innovative longitudinal study is to understand: (1) mechanisms of sleep disparities in relation to immigrant stressors and protective factors; and (2) consequences of sleep disparities on health outcomes, in a sample of community-dwelling Chinese, Korean, and Vietnamese adults (n=750). This study includes several innovations such as novel measures on anti-Asian racism due to COVID-19, the adverse impact of COVID-19, and multi-dimensional sleep health; use of dried blood spots; purposive sampling of 3 Asian subgroups; and considering ethnic enclaves as a protective factor. Over the 5-year project period, the investigators will collect and analyze two waves of data in order to: (1) Determine the longitudinal association between immigrant stressors (e.g., acculturative stress, psychological stress and adverse impact of COVID-19, anti-Asian racism, and neighborhood disadvantage) and sleep health (a multi- dimensional assessment of sleep health and disturbance); (2) Evaluate the moderating effect of potential protective factors (e.g., social support, religious involvement, ethnic enclaves, and neighborhood social cohesion) on the associations between immigrant stressors and sleep health; (3) Examine the longitudinal association between sleep health and markers of cardiometabolic risk; and (4) Test whether specific dimensions of sleep health will mediate the association between immigrant stressors and health outcomes. This will be one of the first longitudinal studies to investigate mechanisms of sleep disparities in relation to immigrant stressors and the consequences of sleep disparities on health outcomes among Asians, an understudied minority population which displays poorer sleep outcomes relative to other groups. This study is timely considering the rapid growth of Asians in the U.S., and the current hostile environment for Asians and immigrants, including COVID-19. This innovative study will elucidate health issues of this understudied group and identify modifiable factors that will serve as targets for intervention to reduce sleep disparities among Asians.