Addressing sleep health disparities from within: A community-engaged study to understanding sleep and cardiometabolic disease risk among women of color

Women from communities with greater challenges to health and healthcare, including Black/African American, Hispanic, Native Hawaiian/Pacific Islander, and African communities, have increased rates of cardiometabolic disorders (e.g., cardiovascular disease, diabetes, hypertension). Although epidemiologic studies demonstrate short sleep duration and poor sleep quality increase cardiometabolic disease risk, few studies have examined mechanisms of short sleep duration and poor sleep quality from the perspectives of women from these four communities. This project builds on our team’s collaboration with Community Faces of Utah, an organization that links the University of Utah and Utah Department of Health with four local communities (Black/African American, Hispanic, Native Hawaiian/Pacific Islander and African). Our team previously completed a 12-month community health worker (CHW) delivered wellness intervention in 485 women that improved diet and physical activity; however, results indicated sleep was an unmet need (41% reported sleep duration <7 hours but only 12% were interested in sleep improvement). Our results and others suggest that more research is needed to understand how sleep is traded off for other responsibilities and demands in the lives of women, particularly in communities facing increased challenges to health. To address this gap, we are proposing a community engaged mixed-methods study to advance the understanding of how time use affects sleep and cardiometabolic disease risk among women from these four participating communities in our research partnership. Our study will utilize a 3-step process: In Aim 1, we will begin by collecting qualitative data (focus groups) among CHWs for an in-depth understanding of how women balance sleep and other demands, both from their perspectives as community members and as trusted front-line public-health workers; In Aim 2, we will utilize results from the focus groups to conduct a field study among 400 women from Black/African American, Hispanic, Native Hawaiian/Pacific Islander, and African communities to examine the relationships between time use, sleep, diet, physical activity, and cardiometabolic health and use innovative statistical modeling techniques to understand the impact of time trade-offs on sleep and cardiometabolic health; and in Aim 3, we will use an intervention mapping framework to integrate the results of the focus groups and field study, and plan the next step interventions with our community advisory board. This study is innovative in exploration of an understudied mechanism in sleep, evaluation of sleep health in communities often not included in sleep research, and in our collaboration with CHWs, front-line public health workers who are underutilized in sleep research. Our long-standing partnerships support feasibility, usefulness to the community and our ability to rapidly translate results into interventions to improve sleep and cardiometabolic disease risk.