The Way Forward for Sleep Health Disparities Research

By Nancy Jones, Ph.D., M.A.
Scientific Program Officer, Community Health and Population Sciences
National Institute on Minority Health and Health Disparities

Populations that experience health disparities also experience sleep deficiencies, such as insufficient or long sleep duration, poor sleep quality, and irregular timing of sleep. These sleep experiences are associated with a wide range of suboptimal health outcomes, high risk health behaviors, and poorer overall functioning and wellbeing. In 2018, the National Institute on Minority Health and Health Disparities, along with our NIH colleagues at the National Heart, Lung, and Blood Institute, and the Office of Behavioral and Social Sciences Research convened a workshop with experts in sleep, circadian rhythms and health disparities to stimulate research that would address two questions, 1) what are the underlying health disparity causal pathways contributing to sleep health disparities (SHDs) and 2) could SHDs, at least in part, explain disparities in other health outcomes for these populations?

The Workshop Report¹ published in the Sleep journal is the distillation of hundreds of ideas into five areas and nine strategies.

The first sleep disparities research strategy, Develop and Promote Integrative Research on SHDs, highlights the need for a concerted effort to bring together those professionals that understand what happens in the sociocultural context, outside the body, with those that know how sleep and circadian rhythm operates within the body and cells. Ultimate success depends on tackling head-on the challenge of merging two very different theoretical and methodological scientific worlds.

The next strategy, Investigate the Causes and Consequences of SHDs, calls out key approaches to examine what causes health disparities, such as the role of racism and other forms of discrimination, recognizing the importance of examining multi-factorial causes, and not forgetting to examine protective factors, as well as risk factors. Further, because SHDs appear to share many of the same determinants and causal pathways observed for health outcomes with well-known disparities, this reinforces the need for exploring the association between SHDs and other health disparities.

The third strategy, Develop Interventions to Address SHDs, exhorts the researcher to begin thinking about how interventions need to be designed to reach health disparity communities—it is never too early to start designing interventions to address SHDs. Many existing interventions for sleep are at the level of the individual; thus, beginning to design interventions that incorporate social and environmental factors early on is essential. Interestingly, one strategy that came up was to develop interventions that will promote general sleep health (not just intervening when someone already has a sleep deficiency). This really captures an important opportunity to address the public health burden of chronic sleep problems before it manifests as a disease. Even more importantly, this strategy of designing interventions to promote sleep health may provide a novel health promotion approach for populations that experience health disparities.

The next strategy, Build the Research Infrastructure and Training Opportunities for SHDs, highlights ways to leverage current research efforts to address SHDS. For example, studies can be cross pollenated by including both sleep and health disparities measures to key epidemiological studies and incorporating representation of underrepresented populations in more sleep research studies.

Lastly, Promote Integrative Training Opportunities, addresses the importance of developing a diverse workforce that can conduct transdisciplinary research on SHDs. Infrastructure and support for transdisciplinary research covering multiple areas, including clinical, public health, dissemination and implementation science training is needed.

On behalf of the program officials responsible for the NIH sleep health disparities research portfolio, and the team of experts that informed on the nine strategies, we hope this report will help stimulate exciting interdisciplinary research to address sleep health disparities. Here at NIMHD, we believe research on sleep disparities will contribute to identifying common causal health disparity pathways and common sleep and circadian-related mechanisms that underline multiple well-known health disparities and thus help improve minority health and reduce health disparities more broadly.

References

1. Jackson, C.L., Walker, J.R., Brown, M.K., Das, R., & Jones, N.L. (2020) A Workshop Report on the Causes and Consequences of Sleep Health Disparities. Sleep. https://doi.org/10.1093/sleep/zsaa037.