Health Disparities
Racial/Ethnic Disparities in the Neighborhood Walking Environment and Sleep Health: A Nationally Representative Sample of the United States Dzifa Adjaye-Gbewonyo* Dzifa Adjaye-Gbewonyo Amanda E. Ng Dayna A. Johnson Chandra L. Jackson
Background: Access to walkable environments and amenities that may improve sleep health varies by race/ethnicity. Thus, identifying associations between neighborhood walkability and sleep can inform interventions and policies and address disparities.
Methods: Data from the 2020 National Health Interview Survey (N=27,521) assessed neighborhood measures (pedestrian access: walking paths, sidewalks; amenities: shops, transit stops, entertainment/services, places to relax; unsafe walking conditions: traffic, crime) and sleep measures (short (<7 hours/day) and long (9+ hours/day) duration; the frequency of waking up not well-rested; trouble falling asleep; trouble staying asleep; and sleep medication use). Adjusted for sociodemographic and health covariates, we estimated PRs assessing associations between neighborhood characteristics and sleep stratified by racial/ethnic group (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic) from multivariable logistic regression models with robust variance.
Results: For White adults, neighborhood was associated with favorable (e.g. places to relax, waking up not well-rested, PR=0.93; 95% CI 0.89-0.97) and unfavorable sleep health (e.g. walking paths, sleep medication, PR=1.24;95% CI 1.05-1.46). Among Black adults, sidewalks were associated with favorable outcomes (e.g. short sleep duration, PR=0.85; 95% CI 0.74-0.97). For Asian adults, neighborhood was related to both favorable (e.g. places to relax, long sleep duration, PR=0.53; 95% CI 0.31-0.91) and unfavorable (e.g. traffic, short sleep duration, PR=1.32; 95% CI 1.05-1.66) sleep health. Among Hispanic adults, walking paths were associated with favorable sleep health (e.g. short sleep duration PR=0.80; 95% CI: 0.65-0.99) while unsafe walking conditions were related to unfavorable sleep health.
Conclusion: Features of the neighborhood environment have differing associations with sleep by race/ethnicity. Future research may identify the determinants.