RESUMO
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.
Assuntos
Pobreza , Características de Residência , Negro ou Afro-Americano , Estudos Transversais , Humanos , SonoRESUMO
OBJECTIVE: Obesity is preventable and yet continues to be a major risk factor for chronic disease. Multiple prevention approaches have been proposed across multiple settings where people live, work, learn, worship, and play. This review searched the vast literature on obesity prevention interventions to assess their effects on daily energy consumed and energy expended. METHODS: This systematic review (PROSPERO registration CRD42017077083) searched seven databases for systematic reviews and studies reporting energy intake and expenditure. Two independent reviewers screened 5,977 citations; data abstraction supported an evidence map, comprehensive evidence tables, and meta-analysis; critical appraisal assessed risk of bias; and the quality of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Hundreds of published reviews were identified. However, few studies reported on energy intake and expenditure to determine intervention success. Ninety-nine studies across all intervention domains were identified. Few areas demonstrated statistically significant effects across studies; school-based approaches and health care initiatives reduced energy consumed, education reduced energy consumed and increased energy expended, and social-group approaches increased energy expenditure. CONCLUSIONS: Despite the amount of research on obesity prevention interventions, very few studies have provided relevant information on energy intake and expenditure, two factors determining weight gain. Future research needs to fill this gap to identify successful public health policies.
Assuntos
Metabolismo Energético/fisiologia , Obesidade/prevenção & controle , Doença Crônica , Humanos , México , Fatores de Risco , Estados UnidosRESUMO
Study Objectives: Neighborhood disadvantage has been linked to poor sleep. However, the extant research has primarily focused on self-reported assessments of sleep and neighborhood characteristics. The current study examines the association between objective and perceived neighborhood characteristics and actigraphy-assessed sleep duration, efficiency, and wakefulness after sleep onset (WASO) in an urban sample of African American adults. Methods: We examined data from predominantly African American adults (n = 788, mean age 55 years; 77% female) living in two low-income neighborhoods. Perceived neighborhood characteristics included safety, social cohesion, and satisfaction with one's neighborhood as a place to live. Objective neighborhood conditions included walkability, disorder, street lighting, and crime levels. Sleep duration, efficiency, and WASO were measured via 7 days of wrist-worn actigraphy. Analyses estimated each of the sleep outcomes as a function of perceived and objective neighborhood characteristics. Individual-level sociodemographics, body mass index, and psychological distress were included as covariates. Results: Greater perceived safety was associated with higher sleep efficiency and shorter WASO. Greater neighborhood disorder and street lighting were associated with poorer sleep efficiency and longer WASO and greater likelihood of short sleep duration (<7 versus 7-9 hr as referent). Higher levels of crime were associated with poorer sleep efficiency and longer WASO, but these associations were only evident in one of the neighborhoods. Conclusions: Both how residents perceive their neighborhood and their exposure to objectively measured neighborhood disorder, lighting, and crime have implications for sleep continuity. These findings suggest that neighborhood conditions may contribute to disparities in sleep health.