Does investing in low-income urban neighborhoods improve sleep?

Tamara Dubowitz, Ann Haas, Bonnie Ghosh-Dastidar, Rebecca L. Collins, Robin Beckman, Stephanie Brooks Holliday, Andrea S. Richardson, Lauren Hale, Daniel J. Buysse, Matthew P. Buman, Wendy M. Troxel

Research output: Contribution to journalArticlepeer-review

Abstract

Study Objectives: Neighborhood disadvantage is associated with poor sleep, which may contribute to and exacerbate racial and socioeconomic health disparities. Most prior work has been cross-sectional and thus it has not been possible to estimate causal effects. Methods: We leveraged a natural experiment opportunity in two low-income, predominantly African American Pittsburgh, PA neighborhoods, following a randomly selected cohort of households (n = 676) between 2013 and 2016. One of the neighborhoods received substantial public and private investments (housing, commercial) over the study period, while the other socio-demographically similar neighborhood received far fewer investments. Primary analyses used a difference-in-difference analysis based on neighborhood, to examine changes in actigraphy-assessed sleep duration, efficiency, and wakefulness after sleep onset (WASO), and self-reported sleep quality. Secondary analyses examined whether residents' proximity to investments, regardless of neighborhood, was associated with changes in sleep outcomes. Results: Resident sleep worsened over time in both neighborhoods with no significant differences among residents between the two neighborhoods. Secondary analyses, including covariate adjustment and propensity score weighting to improve comparability, indicated that regardless of neighborhood, those who lived in closer proximity to investments (<0.1 mile) were significantly less likely to experience decreases in sleep duration, efficiency, and quality, or increases in WASO, compared to those who lived farther away. Conclusions: While we did not observe sleep differences among residents between neighborhoods, living closer to a neighborhood investment was associated with better sleep outcomes. Findings have relevance for public health and policy efforts focused on investing in historically disinvested neighborhoods.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalSleep
Volume44
Issue number6
DOIs
StatePublished - Jun 1 2021

Keywords

  • disparities
  • natural experiment
  • neighborhoods
  • sleep
  • social determinants
  • socioeconomic status

ASJC Scopus subject areas

  • Clinical Neurology
  • Physiology (medical)

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