Exposure to area-level police use of deadly force as a cause of poor sleep health across the life course

ABSTRACT Numerous studies have documented adverse influences on population sleep health, some of the effects of which are thought to be explained partially by experiences of unfair treatment. What remains lacking is knowledge of the causal mechanisms linking poor sleep health to area-level exposure to unfair treatment. The long-term goal of this research program is to improve population health. The scientific objective of this application is to determine the extent to which differential area-level exposure to police use of deadly force against unarmed people from specific population subgroups leads to poor sleep among other people in the general population. This application focuses on police use of deadly force on unarmed people from specific subpopulations as a cardinal manifestation of an area-level exposure to unfair treatment. The central hypothesis is that police use of deadly force on unarmed people from specific subpopulations leads to unhealthy sleep among other people in the general population. This hypothesis has been formulated on the basis of strong preliminary data showing that police use of deadly force on unarmed people from specific subpopulations leads to poor mental health among other people in the general population. The rationale for this R01 application is that detailed understanding of the causal mechanisms linking poor sleep health with area-level exposures to unfair treatment is likely to offer a strong scientific framework for developing and targeting effective interventions to improve population sleep health, along with other cardiometabolic and health outcomes. The central hypothesis will be tested by pursuing three specific aims: 1) Estimate the extent to which police use of deadly force on unarmed people is causally associated with poor sleep health among other adults in the general population. 2) Estimate the extent to which police use of deadly force on unarmed people is causally associated with poor sleep health among other children and adolescents in the general population. 3) Elaborate a conceptual framework identifying the mechanisms that link police use of deadly force to population sleep health. In Aims 1 & 2, population-based survey data from 2013-18 will be merged with novel, high-resolution geocoded data on police killings and analyzed using quasi-experimental regression models. In Aim 3, qualitative interviews will be conducted to build a grounded theory about unfair treatment and sleep health. Potential mediating pathways, and effect modification by age and sex, will be explored in all aims. The key innovation of the proposed research is to pair quasi-experimental, population-based studies with qualitative research to investigate a novel area-level contributor to population sleep health. The findings will have significant public health impact because they will provide proof of principle for development and targeting of interventions to improve population sleep health.