Archives: 2020

A blog featuring research, resources and people who are diligently working to improve minority health and eliminate health disparities.

A blog featuring research, resources and people who are diligently working to improve minority health and eliminate health disparities.

  • The Way Forward for Sleep Health Disparities Research

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    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.


    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.
  • The Future of Minority Health and Health Disparities Research Blog Series

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    A Lesson from Alice and the Cheshire Cat in Health Disparities Wonderland

    Yukiko Asada, Ph.D.
    Associate Professor, Department of Community Health and
    Epidemiology, Faculty of Medicine
    Dalhousie University
    Nova Scotia, Canada

    “Would you tell me, please, which way I ought to go from here?”
    “That depends a good deal on where you want to get to,” said the Cat.
    “I don’t much care where—” said Alice.
    “Then it doesn’t matter which way you go,” said the Cat.
    “—so long as I get somewhere,” Alice added as an explanation.
    Oh, you’re sure to do that,” said the Cat, “if you only walk long enough.”
    (Alice’s Adventure in Wonderland1)

    Dr. Yukiko Asada

    Expressing truth about life, this conversation between Alice and the Cheshire Cat is beloved and used in many contexts. Its profound power as a metaphor can also be applied to the science of measurement of health disparities. In Health Disparities Wonderland, Alice might ask, “Would you tell me, please, which way I ought to go from here to put an end to health disparities?” “That depends a good deal on what you mean by health disparities and how you measure and understand them,” would reply the Cat.

    In “Harmonizing health disparities measurement” in the special issue of American Journal of Public Health,2 we argued for the science of measurement of health disparities. We believed by now few health disparities researchers and policy-makers would actually answer as Alice would, “I don’t much care about measurement.” But it is not enough for each of us to care. In the article, we urged all of us in the field of health disparities to engage in a community-wide consensus building for harmonization in measurement practice.

    One area we highlighted in need of harmonization is health disparity outcome indicators. Health disparities researchers have many indicators to choose from. Advances in medicine and epidemiology have generated numerous indicators of health outcomes beyond mortality, including those related to disease incidence, prevalence, and health status. The large number of health outcome measures in health research generally has led to a situation sometimes called “indicator chaos.”3 For health disparities researchers, the volume of health indicators necessitates separate, focused analysis to ascertain key patterns and trends of health disparities (e.g., Healthy People 2010 with more than 1, 300 indicators4 and 2016 National Healthcare Quality and Disparities Report with 189 indicators5). Only recently has there been guidance on what constitutes an appropriate “health disparity outcome,” and that guidance is not consistently applied.6-8 What we need now is a community-wide consensus building on identifying common health disparity outcome indicators, a relatively small number of indicators of health outcomes consistently measured over multiple years and across multiple studies.

    Back to Health Disparities Wonderland, we do not believe Alice would get to where she wants to go even if she walked long enough as the Cat suggested. To put an end to health disparities, if we were the Cat, we would advise Alice to work with others to map and prioritize the current potpourri of measurement practice.


    1. Carroll L. Alice’s Adventures in Wonderland. Penguin Group; 1998. p. 56. (Original work published 1865).
    2. Duran D, Asada Y, Millum J, Gezmu M. Harmonizing health disparities measurement. American Journal of Public Health 2019; 109: S25-S27.
    3. Saskatchewan Health Quality Council. Think Big, Start Small, Act Now: Tackling Indicator Chaos. A Report on a National Summit. Saskatoon, SK: Saskatchewan Health Quality Council; 2011.
    4. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. About Healthy People. Accessed August 7, 2019.
    5. Agency for Healthcare Research and Quality. 2016 National Healthcare Quality and Disparities Report. Rockville, MD; 2017. Accessed August 7, 2019.
    6. Pérez-Stable EJ. NIMHD vision and agenda. Accessed August 7, 2019.
    7. National Institute on Minority Health and Health Disparities. NIMHD research framework. Accessed August 7, 2019.
    8. Thomson GE, Mitchell F, Williams MB, eds. Examining the Health Disparities Research Plan of the National Institutes of Health. Unfinished Business. Washington, DC: National Academies Press; 2006.
Page last updated: 23 Feb 2023, 03:13 PM