"Racial Disparities in Sleep Health: Epidemiology, Potential Mechanisms, and Implications" Lauren Hale (9.16.2020)

September 18, 2020

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00:00Can you guys see this?
00:02Thanks so will start from the beginning.
00:06OK, you guys got this alright.
00:07I'm going to hit somebody
00:09from the waiting room.
00:10OK. I so Lauren.
00:14Thank you so much for the.
00:17A warm introduction.
00:18The overstatement about my accomplishments,
00:21but more importantly,
00:23for the opportunity to talk to
00:27you about racial disparities
00:29in sleep health during this.
00:33Really important time in American history.
00:36I have been studying disparities and
00:39sleep really for almost 20 years,
00:4318 years or so.
00:45But it's never been more relevant
00:49or important than now and I also.
00:53I'm I'm pushing myself in this talk.
00:56I've added some new slides because we all
00:59have opportunities to learn and grow,
01:02and when we think about anti
01:04racism and other things,
01:05so a lot of what I'll be talking
01:08about today is what I typically do.
01:11Epidemiology mechanisms, consequences,
01:13a lot of it maybe seem familiar
01:16to you or what you're used too.
01:18And then I gotta go off a little bit,
01:21but I hope I hope.
01:23You'll enjoy the ride with me.
01:26So let's see I move this forward.
01:29I have people joining the
01:30waiting room right now.
01:32How do I do that?
01:34In Middle.
01:36And just so you know,
01:37Debbie will
01:38let everybody in you don't have met people
01:40from now on. OK, I'm just going to close it,
01:42but the problem is it's popping
01:44up on my screen so I can't do
01:46anything else but OK, I'll try.
01:48I'll try to ignore those messages.
01:51So this is a short talk.
01:53It's hard for me to get.
01:56My highlight in 45 minutes,
01:58but after my introductions I'll
02:01spend a little bit about or I would
02:04say 15 to 20 minutes talking about
02:07sleep health as a social justice
02:10issue and why we need to embrace.
02:13Social justice in our practice
02:16and study of sleep health.
02:19Then because it's my most active
02:21research project right now,
02:23I'm going to go into talking about
02:25disparities in sleep in a study that
02:28I'm doing among teenagers across the
02:30country known as the fragile families study.
02:33And I'll tell you that we're about
02:36to go into the field for age 22,
02:39so that's pretty exciting as well.
02:41And then I'll conclude with a summary
02:44in future directions on this topic.
02:47So as many of you have already heard,
02:50I'm located here at Stony Brook across
02:53the Long Island Sound from you.
02:55I was just reading about some flesh
02:57eating bacteria in the Long Island Sound.
03:00So don't go swimming this week,
03:02but I miss Stony Brook.
03:04I'm also received funding from
03:06NIH as Lauren mentioned.
03:08I was involved in the founding and
03:10execution of this great Journal,
03:12sleep health and a Mayor Krieger,
03:14who's in the room with us is.
03:17It was the founding art editor and
03:20remains on on staff is that are
03:22tender and we love him for that man.
03:25I'm feeling with the National
03:27Sleep Foundation.
03:28I also serve in two advisory panels,
03:30one for the pajama program,
03:32which provides pajamas and books for
03:34low income kids across the country.
03:37So great program,
03:38and I'm also an advisory panel of a
03:40organization called children and screens.
03:42If we have time for it,
03:45I'm going to veer from the topic
03:48of racial disparities and talk
03:49about a fun study I did.
03:51Using Twitter data to see if we could
03:54predict NBA basketball players performance,
03:57that's just a good one
03:59for Thanksgiving dinner.
04:00If we're able to have Thanksgiving this year.
04:05Sleep matters,
04:06that's my take home message.
04:08OK,
04:08and as usual,
04:10the typical disclosure,
04:11the content reflects my own ideas and not
04:14necessarily thought that these organizations.
04:17So one other plug and just kind of
04:21detail about what I'm up to now,
04:24because this is a weird weird time.
04:28I am of course working from home
04:30and as a public health professor.
04:32I have teamed up with a.
04:35Sponge almost a dozen female scientists.
04:38We run a social media site called
04:41dear pandemic were on Instagram,
04:44Facebook and Twitter.
04:45Currently we have over 30,000 followers.
04:48We post two to three translations
04:51of the current science on the
04:54pandemic and how that relates to
04:56how to live during the pandemic
04:59and it has been really wonderful
05:02experience for me in terms of.
05:05Coming to terms with what's going on
05:08in the pandemic and helping others,
05:11friends and families,
05:13and generally the public get reliable.
05:15Good advice during this info
05:18demik period that we live in so I
05:22know this is a little off topic
05:24from this issue of racial disparities,
05:28but we're we have to acknowledge
05:31that we're living in a period
05:34of really twin pandemics of.
05:37Racial injustice as well as the pandemic
05:41of kovid, so they are related in that
05:45way because as we know, minorities have
05:49a dish feel disproportionate burden.
05:52Of the COVID-19 pandemic.
05:55So that's it for me in
05:57terms of introductions.
05:58Oh, this is my team.
06:00These are my peeps.
06:01Talk with him every week or so.
06:03We getting so many names the words
06:06are getting squished together.
06:07Most of the people that I work with
06:09are Penn State, Wisconsin Princeton,
06:11but were spreading out and growing
06:13role almost all over the world now.
06:15So I want to acknowledge when I get to
06:18the part on my work and fragile families.
06:21This is a team effort.
06:22It's not just me and a bunch of.
06:25Actigraphy devices,
06:26it's it's a huge group of us,
06:28and I'm lucky to be working with them.
06:31And you might hear My 5 year old in the
06:33background 'cause you just yelled for me.
06:35So my apologies. OK.
06:38So why are we here?
06:40Let's talk about this issue whi.
06:43Is sleep health a social justice issue?
06:47Shouldn't sleep health just be for everyone?
06:50And sure it is.
06:52That's my answer.
06:53Sleep health is for everyone,
06:56but it is especially necessary and
06:59important for disadvantaged populations.
07:01So I have three reasons why sleep health
07:05goes beyond just a public health disorder.
07:08Concern and should be social justice concern.
07:11The number one reason is sleep
07:14deficiency in sleep disorders are common
07:17for the number that NIH throws out.
07:19You know 50 to 70 million Americans
07:22and I think they're referring
07:25to adults suffer from sleep
07:27deficiency or sleep disorder.
07:30Pens which groups are talking about.
07:31Some have more, some of less,
07:33but that's a lot,
07:34and so it's a public health
07:36problem and it's been recognized
07:37as such for at least 15 years.
07:39I would say the apj could do more,
07:41but it's a public health issue.
07:45When I want to convey to you if
07:48you didn't already know it is that
07:50it's also a social justice issue,
07:53because it's unequally distributed,
07:54sleep health is or sleep disorders and
07:57sleep deficiency or more prevalent
07:59among disadvantaged populations.
08:00So those two would have been enough, right?
08:03This is enough to say it's a
08:06social justice issue, maybe,
08:07but the real kicker in the real
08:10reason why we should care is
08:12because of the decades of research.
08:15They have shown time and again that
08:18the consequences of inadequate sleep,
08:20irregular sleep, poorly time,
08:22sleep, interrupted sleep disorder
08:24sleep is linked to all of these
08:27outcomes in multiple domains.
08:29Physical health, psychological well being,
08:31cognitive functioning,
08:33public safety so.
08:35You know?
08:36These three combined make it just
08:39clear as day that we need to be
08:41thinking about sleep health as not
08:44only a public health issue but is
08:46a social justice issue and to me,
08:48and I've been saying this for years.
08:51Based on the data that I've been looking at,
08:54there are three big dimensions
08:57that we care about most.
08:59Lots of little dimensions,
09:01but the three biggest ones I see.
09:04Our education associate conomique
09:06status time and again population
09:08based studies show individuals with
09:10lower levels of education or at the
09:13highest risk of especially short sleep,
09:16but also sleeping too much and
09:18also a range of sleep disorders.
09:21The next dimension is neighborhood context.
09:24Alot of what we see in looking at.
09:30Social and physical environment is that.
09:33Living in urban area, too noisy,
09:36too bright, culturali too awake.
09:38Those types of neighborhoods are
09:40associated with worse sleep behaviors,
09:43and there's a huge Epidemiology literature
09:46on the link between health and place in
09:50these studies show people who live in.
09:53Urban and low income neighborhoods
09:56have worse health outcomes.
09:58My work in Texas.
10:00In Wisconsin, show that about 20% of
10:03the reason or the mechanism between
10:06poor health and poor neighborhoods.
10:09Is mediated through the
10:11pathway of poor sleep.
10:12Poor sleep can be part of that and what's
10:15nice about sleep compared to, you know,
10:17move out of the neighborhood is sleeping.
10:19You can modify sleep in some ways.
10:21Not.
10:22Not always.
10:22Not everything about sleep is modifiable,
10:24but there are steps you can take
10:27to help improve sleep health.
10:29And we've also shown this with my
10:33work with Wendy Troxel in Pitts burg.
10:36We've looked at data acta
10:39graphic data of sleep,
10:41and objective measures of neighborhood
10:44context, including household.
10:47Factors like broken windows and pests,
10:49those types of things are also
10:52predictive of poor sleep,
10:53but you know,
10:54like 50 poor sleep and shorter like
10:5715 to 20 minutes less per night sleep
11:00actigraph Exley when you live in a
11:02household where you report maintenance
11:04problems in litter and graffiti.
11:07So those things matter why I think
11:10probably many of you were here today
11:13is to talk about this much bigger.
11:17An pressing and very relevant
11:19challenge of what do we know about
11:22race and sleep or bigger than that?
11:25Racism in sleep and.
11:27I could go on for a long time about this,
11:30but I'm trying to cover a lot at one time.
11:34And I'm going to go back to one
11:36of the very first actor graphics
11:39studies on race and sleep,
11:41and this was a study done by
11:44a Diane Lauderdale.
11:45The Cardia study in Chicago of young adults,
11:48and they show early on that.
11:51As I already mentioned,
11:52income or socioeconomic status is
11:54associated with longer sleep duration.
11:56At the time I said,
11:58what about sleeping too long or highly
12:02educated people sleeping too long?
12:04Or or vice versa,
12:05and she said we don't have anybody
12:08sleeping over 9 hours at that point.
12:11So and that wasn't really
12:13a problem in this sample.
12:15But even after adjusting
12:16for socioeconomic status,
12:18what this important study showed
12:19is that compared to whites,
12:21Blacks had shorter sleep duration,
12:23lower sleep efficiency took longer to
12:26fall asleep and spent less time in bed.
12:29So on all of those dimensions you
12:31know now we think about sleep.
12:34Health is a multidimensional concept.
12:36All of those dimensions we're
12:38seeing kind of worse outcomes
12:40for Blacks compared to whites.
12:41And here's the figure to show it in
12:45case you like to see actual numbers.
12:48Between white women and African American men,
12:51which I know,
12:52it's kind of a weird comparison,
12:54but we see on a nightly basis.
12:571.4 fewer hours per night to huge difference.
13:00Let me. It's like you know,
13:02over 10 hours less sleep per week
13:05between black men and white women.
13:07And then if sleep efficiency
13:09we see a similar big drop.
13:11Almost 9 percentage point drop in sleep
13:14efficiency or difference, not a drop.
13:18Between white women in African American
13:21men and in my work using NHIS,
13:24another nationally representative studies,
13:26we found time and again that minorities,
13:30especially Blacks compared to whites
13:32see shorter sleep duration than whites.
13:35And here's a summary article written
13:38by my colleagues, Dana Johnson,
13:41Shandra Jackson.
13:42This was in the journal Nature
13:46and science of sleep.
13:48It's hard to summarize the
13:50entire field in a few slides,
13:52but I wanted to just go across this row.
13:55Don't know if you can see my cursor if
13:58you look at Blacks compared to whites,
14:01they have lower sleep duration.
14:03These numbers are just the references,
14:05so they're not going to be able
14:08to interpret them.
14:09Lower shorter sleep duration,
14:11lower sleep quality more and more sleepiness.
14:14And mixed results on sleep complaints.
14:17What we see for Hispanics compared
14:19to whites as shorter sleep duration.
14:23But Interestingly, fewer sleep complaints.
14:25And then I just want to highlight what
14:29we really don't know a lot about at all.
14:33Insufficient evidence is the Native
14:36American populations and Native
14:38Hawaiian and Pacific Islanders.
14:40There's really not a lot
14:42of information on these,
14:44but we have enough kind of consistent and
14:48replicated data showing that especially
14:50Blacks and Hispanics are as a population.
14:54Not every individual,
14:55but as a population getting
14:58insufficient sleep and just
15:00come back to my original slide.
15:02We know that these factors that sleep
15:05matters for a huge range of life outcomes,
15:08health,
15:09economic outcomes and beyond.
15:10So I care about these.
15:15The question is.
15:16And this is a big question.
15:19What are the underlying causes?
15:21Why do we see that?
15:23And I'll say that we know
15:25some of these reasons.
15:27We know that there are some compositional
15:29differences in populations between
15:31African Americans and whites.
15:33For example,
15:33we know that Blacks are more likely
15:36to work night shifts or irregular hours.
15:39We know that there may be lower levels
15:42of education or more urban living.
15:44A higher percentage living
15:46in urban environments,
15:47and so we have some.
15:49Account for that we can say some
15:51of the differences between Blacks
15:53and whites in sleep might be
15:55related to where they live or
15:57their educational differences.
15:58But even when we adjust for that,
16:01we don't fully adjust for it.
16:02The effects don't go away,
16:04and that's a key point we adjust.
16:06Friend doesn't go away.
16:07And then a good statistician would
16:09rightly come back to me and say,
16:11Yeah,
16:11but the measures you are using their
16:14crappy measures you know look at education.
16:16Just grab their course measures what
16:18is graduating high school mean for a
16:21black person versus a white person doesn't?
16:23It doesn't mean the same thing that
16:25doesn't get into quality or skills learned.
16:27It just tells you whether their credentials
16:30you have the degree and I agree with it.
16:33I agree that some of these
16:35measures are not good enough,
16:36but I still believe and you
16:38know others support this.
16:40Other studies support this,
16:41that there's enough evidence
16:42to say that there are.
16:44There's a cloud of other things
16:47that kind of fall under this.
16:49Immeasurable category of discrimination.
16:51ISM discrimination,
16:52racism,
16:53chronic vigilance,
16:54that cluster together and you can't measure
16:57that in a nationally representative study.
17:01That's that's too hard.
17:03It's there's.
17:04You can try,
17:05and I'm encouraged us to try and
17:09figure it out,
17:10but it's not easy to do,
17:13and I would say that.
17:17This is a moment for us as a field
17:21sleep researchers to listen to our.
17:24Our colleagues and friends outside
17:27of sleep health who are talking
17:30about anti racism and talking about
17:33being black in America to think
17:36about how we as asleep field can
17:39excuse the expression wake up.
17:42To incorporate these ideas in our research,
17:45because I think.
17:47They are.
17:49Totally playing a role in
17:52understanding why sleep is harder,
17:56harder to achieve.
17:59For some people,
18:00some populations than for other populations,
18:02so this is the part of my talk where I
18:05say I'm going outside of my comfort zone
18:08and I'm going to talk about this expression.
18:11What does it mean to be woke now?
18:14Granted,
18:14this is not what you know.
18:17Usually when I say woke is
18:19the opposite of sleep, but.
18:21For now,
18:21let's listen to my friends on YouTube
18:25to talk about what it means to be woke,
18:28and I, you know.
18:29If you guys want to comment on it
18:31later or right in the chat section
18:33about what it means to be woke,
18:35I'd love to hear your thoughts.
18:37Let's see if this works.
19:34Hi Lauren, I think it's a little
19:36hard for us to hear it hears
19:38any way for you to turn out.
19:39Darn it, I know you know what this is.
19:41My hold on. OK, hold on a second I'm gonna.
19:45I do know how to do this.
19:47Share computer sound I'm sorry for
19:49that awkwardness we were here.
19:50You're hearing it but I think
19:52we're hearing out of your speakers.
19:53So which would be junkie?
19:54And I'm being quiet.
19:56So let me just start it back.
19:57Will just lose a minute hold up
19:59is not a. Replace that,
20:01everything is not all equal.
20:02That justice has not happened
20:04yet for everyone, and that there
20:05is a lot of work to be done.
20:11Your eyes are wide opening.
20:13You're paying attention and you're
20:14reaching out and speaking to people
20:16along the way and bringing them on.
20:18And to increase the amount of Wokeness
20:20in your community being woke is like
20:23as wide open everything is clear.
20:24You can always see things that other
20:27people can just ignore or they just
20:29don't know well for me is just being
20:31outraged all the time and being able
20:33to stay human and feel outraged about
20:36injustice that is happening around me.
20:37It's being uncomfortable all the time.
20:39And making sure that I'm speaking on behalf
20:41of those that can't speak up for themselves.
20:44Some people know what's happening around
20:45them, but they're not doing anything there,
20:47just like, well, it is what it is.
20:49Yeah, that's not what woke means that you
20:51actually take it upon yourself to be like.
20:53This is something I need to
20:55fix any part of the solution.
20:56I mean, The thing is to do that,
20:58knowing that you can fix it
21:00whatever your level or platform is,
21:02because there's always an opportunity
21:03for you to do just a little
21:05something to support them.
21:06I also think about what words actually
21:08mean and how we give them power,
21:09right?
21:10Are you just going to wear it across
21:12your chest but actually not live it out?
21:14Or are you going to give this word a meaning
21:16with your actions with your daily commitment?
21:19And I think in order for
21:20us to really progress,
21:21we're going to need people to really
21:23step out of their comfort zones and
21:25have those uncomfortable conversations
21:26and not just live in a space where they
21:29get to preach to the people who already
21:30understands what it means can agree more.
21:32I think to be woke means that you are aware
21:35of the issues and the world around you.
21:37I believe it means that you
21:39are engaged in the work.
21:41Just as this is a time where we just,
21:43we can't afford to be asleep,
21:45we have to be all the way alert without
21:48action on the knowledge that we have now.
21:50Our world will never change and
21:52we need that more than ever.
21:58OK, thank you for bearing with me and
22:00I'm sorry for the technical difficulties.
22:02Can you hear me now?
22:05Yes, that's perfect. Thank you.
22:07OK great, so that was really my first
22:10time in bedding at YouTube in a video
22:14and especially video about being woke,
22:17but I think.
22:19It's relevant and especially interesting.
22:22You know this expression.
22:24Is asleep term being away?
22:27I mean, it's it's not the term we might use,
22:32but being awake means it kind of or
22:36being well recognizes that everyday
22:39racism and structural racism.
22:41Affects sleep health,
22:42they're saying in order to be present.
22:45An engaged in the injustice of the world.
22:48You cannot be asleep.
22:50You can afford to be asleep and I mean,
22:53I think that's that's really powerful.
22:56I've until recently.
22:57I've never really thought about how.
23:00Sleep disparities was like embed
23:04or implicated in that expression,
23:07and I think there's more
23:10more to think about there.
23:16As we try to tease apart how to make
23:19the world a better place so we don't.
23:22So it's not that we.
23:26So we don't have to wake up to disparities or
23:29be be chronically vigilant to disparities.
23:33We can or discrimination.
23:34We can all sleep better in a better world,
23:38and that would ultimately be my goal.
23:42I know I'm a bit of an Optimist, But.
23:46But there I am. Did anybody?
23:48It's a It's about halfway through it.
23:50Does anybody have any thoughts or any type?
23:52I can't see the chat,
23:54but if anybody wants to say something about.
23:57That expression I'd love to hear more.
24:00Maybe in the end,
24:01because to me it's kind of a new direction
24:04for thinking about sleep disparities.
24:09So my last comment on kind of mechanisms
24:13and pathways through which we see
24:16differences in sleep among adults, is.
24:20Through the these key kind of
24:24socially social demographic.
24:26Categories that really end behaviors.
24:28The first is social and
24:30marital relationships.
24:31Many of you may know Wendy Troxel's work,
24:35showing that being married is
24:37associated with better sleep.
24:38There comes a lot of economic
24:41security and emotional security,
24:42but it's gotta be a good relationship.
24:45Employment matters again.
24:47Economic securities very helpful
24:49for being able to sleep at night.
24:51But 15% of people have
24:53irregular hours or night shifts,
24:55and those are obviously.
24:58Stressful and disruptive.
24:59The work on American lifestyle
25:02and sleep is fascinating.
25:04It fits right in line with the work of
25:07sociologists on negative acculturation,
25:10immigrants to the US tend
25:12to have the best sleep,
25:15and then they and their offspring as
25:18they assimilate to take an American
25:20behaviors tend to deteriorate in terms
25:23of Bedtimes and other sleep outcomes.
25:26And then of course the close links.
25:30Between sleep and mental health,
25:32which many of you know about.
25:35And of course how we're spending
25:38our time screen, social media,
25:41sedentary behavior,
25:42all interrelated with sleep outcomes.
25:46So I'm going to move on because of
25:48course I only have 15 or so minutes
25:51left to describe my life's work.
25:54Not really to describe this project
25:56that I am so engaged with the
25:59fragile families study and it's.
26:01Consistent with the theme of
26:03thinking about racial disparities,
26:05because what we've identified our
26:07pediatric disparities in sleep starting
26:09at an early age and then of course,
26:12moving into active graphic
26:13disparities in sleep among teenagers.
26:15And then I go into some other stuff on
26:19sleep in teens that are kind of key.
26:22Findings of our study.
26:25So as I mentioned,
26:27the beginning of my research
26:28on sleep disparities,
26:30I was primarily looking at
26:31adults and I I was asking the
26:34question whether the mechanisms?
26:36How do we get there,
26:38why or black men sleeping an hour
26:41point for less than white women?
26:44What's going on?
26:45He said, well,
26:46we have to figure out what
26:48happens across the life course.
26:50What's the trajectory of
26:51these sleep disparities?
26:53When do they begin?
26:54And that's when I got
26:56involved with the study,
26:57called the fragile families
26:59and child well being study.
27:01It's an excellent resource for many social
27:03scientists and in more recent years,
27:06sleep researchers too.
27:08Longitudinal birth cohort where they've
27:10been following individuals who,
27:12since they were they,
27:13were enrolled in the hospital.
27:15Their mothers were enrolled
27:16when they were born.
27:18The kids were born,
27:19and they've been followed at ages.
27:21Of course,
27:22at birth,
27:231359 and 15 were about to next
27:25month about to go back into the
27:27field and collect information
27:29on them as young adults.
27:31The young adult age 22 study and
27:33the study was designed to have
27:36enough power to look at disparities.
27:38By income and race and parents
27:41with low levels of Education.
27:43So it's really well suited
27:45to address some of the
27:47concerns that I have.
27:49I won't spend time here,
27:51but these are some of our aims to look
27:54at trajectory's multiple levels of.
27:57Predictors and determinants of sleep
27:59and then of course the outcomes of
28:02obesity and depression, which I'll just.
28:04Touch on slightly today.
28:07So we had about 3500 teens in the
28:10full survey in the full study,
28:12but in terms of who we actually
28:14got into the homes of,
28:16there was a random subset
28:18of about 1000 teens,
28:19800 of whom we were able to get actigraphy,
28:22and anybody who we got actigraphy on.
28:25We also collected a daily diary where they
28:27were asked questions about their behaviors,
28:30their screen use,
28:31their diet, etc that day,
28:32so this was the timing already.
28:34It's been almost five years since.
28:37Or more than that,
28:38for the early waves you know.
28:40Soon these data will be outdated,
28:42but we're having the ability to
28:44track them overtime where where their
28:46sleep patterns at age 15 predictive
28:48of their outcomes at age 22.
28:50I'll ask me in a few years.
28:54Here's the distribution of
28:55for whom we got actigraphy on.
28:57I would say they were pretty
28:59good at following directions.
29:00We said may lack the devices in seven days.
29:03Almost all of them did it in six,
29:067 or 8 besides the group who decided not to.
29:11And they were scored at or fail
29:15Buxtons Actigraphy lab in Penn State.
29:19So the key variables we look at,
29:22our sleep duration, sleep quality,
29:23and sleep timing.
29:24There are other things we might be
29:27looking at regularity and beyond,
29:29but it's it goes on and on.
29:31We are enjoying the richness of these data.
29:34This is a cartoon of what the
29:36actigraph output looks like.
29:37We used builds respironics watch
29:39is and we use the actigraph device
29:41on the hip to also simultaneously
29:43measure physical activity.
29:45Not going to go into all of the
29:47rest of the study, but.
29:49For the topic we are discussing,
29:52or so when did this study show
29:55about racial differences in sleep?
29:57First thing they showed in the age 9?
30:00Data when it was parent reported data
30:03is that there were disparities early in life.
30:06At age 9 or measure asleep was where
30:10they getting sufficient sleep at age 9.
30:13Recommended at least nine hours
30:15and there's about 60% fewer odds
30:18of black kids getting nine or more
30:21hours per night than white kids.
30:24An also reduced odds of Hispanic
30:27children getting sufficient sleep,
30:29so this is to me quite telling.
30:32I have some ideas in the next slide on.
30:36On what's happening,
30:37but at age 9 even we see differences
30:40in sleep.
30:41These were self reported that
30:43self reported parent reported.
30:44When we get to the age 15 data.
30:48We see much bigger differences and
30:50we have it reported in minutes
30:53from Acta graphic sleep we see a
30:5532 minute difference between black
30:58and white sleep between black and
31:01white teens on weeknights,
31:03and 41 minutes on weekends.
31:05Now, uh,
31:06two other studies,
31:07one in Pitts Burg by Karen
31:10Matthews and the other one in
31:12Cleveland that use actix graphics.
31:14Lee also show black white differences
31:16in sleep among teenagers.
31:18Ours is a national study.
31:20We had 20 cities involved in our study,
31:23but those other two community
31:25studies also showed about 20 minutes
31:28different per per night for the kids.
31:31What I think is really interesting
31:33is we were able to code for napping.
31:36And what we found is that.
31:38There was competitior E napping between
31:42black and white children in that.
31:45Night time sleep was shorter for black teens,
31:48but they often made up for
31:51it during a daytime nap.
31:53So if you look at 24 hours sleep,
31:56you don't get the same racial
31:58differences in sleep and what's
32:00particularly interesting is there's
32:02work in preschoolers showing
32:04the same thing that night time
32:07sleep among black preschoolers is
32:09shorter than white preschoolers,
32:11but there's Compens Atory,
32:13and happening, so this may not.
32:15Translate to the same outcomes that we
32:18see in adults where there may not be.
32:20This can pensa Tori napping,
32:22but it is interesting that these
32:24disparities exist early in life.
32:26At ages 9 and 15.
32:29Here's some more results from the age 9,
32:33just highlighting that caregiver
32:36routines are extremely important for.
32:39Predicting sufficient sleep duration
32:41almost these are odds ratios.
32:42You almost never see odds ratios
32:45it sevenfold 7 times higher odds
32:478 times higher odds.
32:49If you have an early bedtime
32:519:00 PM or earlier,
32:53an regularly enforced for a night
32:55for more nights per week compared
32:58to know better huge difference
33:00is huge importance of having
33:02and enforcing bedtime routines.
33:04And in the same data same population.
33:08We showed that bedtime routines are
33:11disproportionately not enforced among
33:13my children of minority mothers,
33:15and we also show that the benefit
33:19of bedtime routines,
33:20especially language based bedtime routines.
33:24Pay off in terms of better
33:26cognitive outcomes.
33:27This specifically that Pvt test of
33:29verbal skills goes up so there there
33:32may be structural reasons behind that.
33:34If if mom or dad is working in multiple
33:37second job and working at night,
33:40it's harder to enforce routines
33:41and have that,
33:42but that may be part of what's explaining
33:45some of these early disparities.
33:47We also found that respect to the
33:50age 15 and I should have clarified
33:53that in the age 15 data.
33:55Remember,
33:55the field investigators went into
33:58these peoples homes to give them the
34:00devices and they took notes they recorded.
34:03If they if when they were doing
34:05their one hour long interview.
34:07If they were interrupted and
34:09interruption could be allowed.
34:11Television was on,
34:12dog was barking,
34:13the phone kept ringing and if they
34:16if they reported that they were
34:18interrupted at least three times that
34:21was associated with an increased.
34:24Decrement decrement asleep by
34:26about 21 minutes.
34:28We didn't see that household
34:30chaos was more common,
34:31or this interviewer interruption was
34:33more common among minority families,
34:35so it probably doesn't,
34:37or it doesn't attenuate racial disparities
34:40in sleep, but it is another dimension
34:42of what could be going on in some
34:45households to affect negatively
34:47affect sleep quality. Interesting Lee.
34:49So no Association between bedroom sharing
34:52or a self reported in measure of chaos.
34:56So what else is going on
34:59with teenagers, of course.
35:00Here's this beautiful graphic of an school.
35:03Start times. This is using data
35:05from 20 cities worth of schools.
35:08Active graphic measures of sleep.
35:10The only kids who were in bed enough time
35:13to get the minimum 8 hours overnight.
35:16'cause these are 15 year olds.
35:19The minimum recommended amount
35:20of time in bed were those whose
35:23high schools start after 8:30 AM.
35:25And there's just this beautiful
35:28dose response.
35:29Of course,
35:30actor graphics sleep in the square
35:32is shorter than time in bed.
35:34That makes perfect sense,
35:36but if your school starts later you get
35:39more time in bed and more time asleep,
35:42so that's the structural factor.
35:44Of course,
35:45we all know about the physiological
35:47phase delay that occurs during puberty.
35:49Pushing kids to stay up later and
35:51then there are all these other factors
35:54that happened during adolescence,
35:56specially screentime caffeine
35:57consumption and a whole range of other.
36:00High school pressures.
36:03I'm going to show here some results from
36:07our study on neighborhood disadvantage,
36:10showing that more disadvantaged neighborhoods
36:13have more waso and lower sleep efficiency.
36:16Not huge effects, but there's something and
36:20also we have data showing that kids who
36:25had consistent enforced routines early in
36:29life ages 5 and nine were more likely to.
36:33Have lower body mass index.
36:35That's Group One group.
36:37The green group is Group 4 is the reference
36:42group and the people who had no bedtime
36:46routine had shorter sleep duration by
36:50about .3 hours and higher body mass index.
36:56I don't really have a huge amount of time,
37:00but I I do want to touch on a few of
37:03my data points about screens because
37:06I think that's such a key issue,
37:09especially during the pandemic when
37:11we are relying on screens to basically
37:14get all of our social interactions
37:16and our schooling interactions.
37:18Here's a figure of this is from Jenn Twinkies
37:21work looking at short sleep among teenagers.
37:24How it's gone up.
37:26Since to that between 2009 and
37:282015 you may say that's old news,
37:31why are you telling me that the
37:34reason is because there is a kink
37:37up in 2012 and 20's work nicely?
37:39Medicine shows the only thing that changed.
37:42Basically between 2000 eleven 2013 is
37:45the pervasiveness of smartphone use.
37:47So more and more teens,
37:49especially as we're bringing our
37:51devices not just to our bedrooms,
37:54but into our beds with us,
37:57using them as alarm clocks and
37:59goodnight pillows and all of that
38:02is affecting our ability to sleep.
38:04I won't go into great detail on this,
38:08but I'm fascinated by the literature
38:10and work showing that our reliance on
38:14screens is interfering with our sleep,
38:16especially among teenagers.
38:17Over 90% of studies that look at screens
38:20and sleep show this adverse Association
38:22and the remaining 8% shown a neutral.
38:24Nobody's saying screens are
38:26good for your sleep.
38:27Maybe if you're doing a meditation app,
38:29but that's not really why
38:31people are using them.
38:32And as I said,
38:34people are using these devices.
38:35Not only is alarm clocks,
38:37but they check them in
38:39the middle of the night.
38:41Is pervasive and our data from the age
38:4415 show that screen use is associated
38:47with worse problems falling asleep,
38:50staying asleep in shorter sleep duration?
38:54Above and beyond depressed
38:55depressive symptoms.
38:56So I know I'm going off the topic
38:58of fragile families, but this is.
39:01This is the fun one for your.
39:04Your Thanksgiving,
39:05whatever form it may be in this year.
39:08If somebody says to you, you know.
39:10Why should I care about sleep?
39:12Why should I get off of my screens,
39:15especially on thinking of your nephew?
39:17What your high school age and after he says,
39:21say,
39:21do you know that professional
39:23athletes do better when they put
39:25their phones away and they're off
39:27Twitter at night and this is proven.
39:29This is published in sleep health.
39:31We looked my colleague Jason
39:33Jones who is a sociologist.
39:35Stony Brook looked at two public datasets.
39:37We merged the Twitter records
39:39of 112 verified NBA players.
39:41And we merged 30,000 tweets with
39:44their performance on next days
39:47games an what we are able to show.
39:50It's kind of amazing is that if they were
39:54up late at night tweeting after 11:00 PM.
39:58They performed worse the next day.
40:00By about one point and they don't.
40:03If you add up all the players
40:06on team for everybody's.
40:08Staying up late,
40:10they're going to have.
40:12Fewer points scored an also
40:14fewer minutes on the court,
40:16so and I would say the most powerful effect
40:19that we saw was a drop in shooting accuracy.
40:23The amount of shots that they got.
40:25Here's I think Mrs points per game
40:28from about 10 1/2 points per game down
40:30to nine and a half with some slight
40:33variation between home and away games.
40:36Actually there are similar.
40:38But here's the one for shooting accuracy.
40:42If you were a late night Twitter,
40:45which means tweeting after 11:00 PM,
40:48your shooting accuracy dropped
40:50from about 45% down to 43 1/2%.
40:53So that's a pretty significant drop.
40:55And if you are infrequent,
40:58late night Twitter tweeting
40:59headed even bigger effect on you.
41:02And it also had a big effect on you.
41:06If it was an away game.
41:08So this is the message that I say.
41:13Speak to your audience.
41:15Figure out how how you can meet them
41:18with something they care about.
41:20Teenage boys don't care about
41:22the effects on metabolism,
41:24but they might care about if they're going
41:27to do better in their basketball game.
41:30And so that's that's my message on
41:33using big data to help understand
41:36the power of sleep.
41:38I have one other follow up.
41:41We're still in the process
41:43of collecting some data.
41:44What's happened to sleep
41:46among teenagers since covid?
41:47I'm involved in the study down and
41:50Elana suburbs schools that actually
41:52opened and closed within one week.
41:54But we collected data from them before
41:57the lock down and then in the month
42:00after the lockdown so March and May,
42:03and in both of these counties are
42:05two SIM County to high schools.
42:08We saw an increase in sleep duration,
42:10which is pretty cool.
42:12They were going to going to bed later,
42:14but also waking up later so
42:16there's a shift in timing,
42:18which is consistent with
42:20what we would expect.
42:21But unfortunately we also saw increases in
42:23insomnia symptoms and napping behaviors,
42:25which I don't have as much of a problem with.
42:29But this this is actually paralleled
42:31in some studies in adults too,
42:33but these are kind of hot off the
42:36presses from our study in Georgia, so.
42:39I know I'm running a little long,
42:41I'm just going to end on with some
42:44summary in future directions to get
42:46back to this topic about racial disparities.
42:49We know that they begin early in life.
42:52Do they begin in infancy?
42:54Maybe,
42:54but they definitely persist in
42:56preschool school age years.
42:57An adolescence through adulthood,
42:59and we know that they are
43:01linked to sleep, is linked,
43:03or inadequate sleep is linked
43:05to depression and obesity.
43:07Among youth, I think the most important
43:10modifiable behavior is focusing on bedtimes,
43:12bedtime routines, and cutting out screen use.
43:15I think this place somewhat of a
43:17role in explaining disparities.
43:19Not all of it, and some of it's beyond
43:22the scope of what's addressable.
43:24If it's a structural reason for heart,
43:27difficult to enforce bedtime routines,
43:29but it is an important one because
43:31it's kind of a low hanging fruit.
43:34And then there are some more
43:36complicated structural problems with.
43:38Insufficient sleep among younger people,
43:40such as household chaos in school start
43:43times, these are not easy to change.
43:46They may.
43:46They probably play less of
43:48a role in disparities,
43:50but they're still very important.
43:52And then I'll just kind of conclude
43:55with what I think are some really
43:59key areas for thinking about.
44:01Disparities and sleep.
44:03As I said,
44:05We need to embrace this idea of
44:08understanding how discrimination affect
44:10sleep and what we can do about it.
44:13We need to think about causal and
44:15modifiable mechanisms through doing
44:17experimental work with in person
44:19work and then thinking more about the
44:22consequences of sleep disparities.
44:24I think we have a pretty good grasp
44:27of the consequences for health.
44:31But less work has focused on kind of
44:33socioeconomic and performance outcomes,
44:35and I'd love to see more on that.
44:38And then finally,
44:39the big work is translating
44:40all of this to the public.
44:42How can we develop, implement, evaluate,
44:44culturally tailored interventions,
44:45and that's kind of the long term goal.
44:48I hope for all of us.
44:50Here's a figure that Dan Buysse
44:52beautifully put together for a review
44:54article of here in the layers and levels
44:57in the sociological model of sleep.
44:59And each of these levels
45:01carries with it kind of.
45:03A set of opportunities for
45:06intervention and we should.
45:09Be considering and thinking at all
45:11these levels as much as we can,
45:13because these are big, complicated problems,
45:15and that's that's the plan.
45:17So thank you all. I'd love to hear from you.
45:20I one thing I don't like about this
45:23format is I don't get to see all your faces,
45:26but at least mayor kept his on so
45:29I could see his most of the time.
45:32So let's open it up.
45:33I don't know how this works,
45:35but Lauren you can lead us.
45:39Yes,
45:39thank you so much for a really
45:41fantastic talk or and we can open it
45:44up to questions and anyone is welcome
45:47to unmute themselves an ask away there.
45:50I don't think there are any
45:52questions in the chat just yet,
45:54OK.
45:55So
45:55I'd like to make a comment warn that
45:59that I got a communication about a month
46:03and a half ago from a professor at MIT.
46:07Covid Anne was using an oximeter,
46:10and she asked me a very simple question.
46:15Are oximeters accurate in black people?
46:19And when you think about an oximeter,
46:22you know it fits on the finger.
46:25It shines a light through the finger,
46:28and yeah. And so I didn't know I didn't
46:31know the answer to the question.
46:34Fascinating, so so I contacted two
46:37engineers working for companies
46:39that actually build these things,
46:41and I said are they accurate in
46:44black people and they said, well,
46:46the standards.
46:47These are called ISO standards,
46:50you only have to get data on 12 people.
46:54Four of whom have to be dark skinned.
46:58So there are millions of people
47:00out there that are that are using
47:03oximeters and we don't really know
47:05how accurate they are in people with
47:08different amounts of pigmentation,
47:10both in you know, both in their finger.
47:13On their ring finger there some
47:15now that are on the rings.
47:18An Apple just came out with
47:20one that's on their watch.
47:22I read about that and so this is an example
47:25where the data just isn't available.
47:28But there must be some indication if
47:31if oximeters aren't working in darker
47:33skinned people, that this is, uh, I.
47:36I mean, I've never thought of
47:39this before, but it seems like,
47:41wouldn't somebody who's a clinician
47:43have noticed something before?
47:45If it wasn't working well, I
47:48mean, this is The thing is.
47:52We don't know, and since covid you'll
47:54remember that with kovid there are
47:56all these things in the media about
47:58oxygen saturation's going into
48:00the 50s and how terrible it was.
48:02It turns out that the standards
48:04are such that nobody has any
48:06data for these things below 70%.
48:09Well so anyway so,
48:11but the the fact that they there's
48:15almost no data published in darker
48:17skin people to me is like mindboggling.
48:23It is an I hope somebody on this call
48:26comes up with the study design for it
48:29to test that out. I mean 12 people.
48:31That mean that is way too small sample size
48:35you would think, or 444. That's not.
48:37Yeah, thank you for illuminating that for me.
48:45Any other comments or thoughts?
48:51I know we're all tired of zoom is tough.
48:57Or I'll just
48:58comment about your question awhile
49:00ago about the woke comment.
49:02You know the bulk idea and I do really,
49:06really like that.
49:07My connection and the video,
49:09but I'm also, you know,
49:11increasingly fascinating,
49:11fascinated with like this sort of.
49:15Community idea and late people at
49:18persons idea sleep duration that we
49:21you know that we're behind and talking
49:24about sleep as a multidimensional.
49:27Aspect in it,
49:28so so far in in my research with toddlers,
49:31the variability is where I'm really
49:34seeing that the race ethnicity
49:36differences and makes me very
49:38concerned that you know how much
49:41variability we're seeing and that
49:42works like a missed opportunity.
49:44Having worked in primary care for years,
49:47you know I don't.
49:49I don't think I ever asked before
49:51I became a sleep researcher.
49:54You know how regular is the bedtime?
49:57Alright, and what influences that?
49:58And so it's a. It's a really.
50:00In terms of sleep health,
50:02especially in young children and
50:04setting up habits, and you know.
50:07Yeah, I guess so.
50:09I love the idea of Oak and I,
50:11but I I challenges all to
50:13be talking about sleep.
50:14Health and that would you mentioned.
50:16And I mean obviously everybody
50:18on this call knows that.
50:20But I I try not to miss any
50:22opportunity I can to tell to say
50:24to somebody you know we need to
50:27do more than ask about duration.
50:29You know 'cause it said I did
50:31term woke is like just the
50:33simplicity of sleep, right?
50:34Absolutely? And I'm sure many
50:36of you if you aren't already.
50:38Check out damn bicis work on are you
50:40stated it's and also of new research on
50:43the sleep regularity index, that regularity.
50:45Is extremely important,
50:47and it's harder to measure.
50:49First of all, it's.
50:50It's not easy, but I think that may be
50:54going on in in our racial differences.
50:57In adolescents data,
50:58we're seeing that 24 hours sleep
51:01doesn't vary by race ethnicity,
51:03but night time sleep does, which means.
51:06Probably you know I'm not in the room,
51:09but probably there's a a
51:11nap at the first chance.
51:13The team can get it, you know,
51:15like Oh, I got home from school.
51:17Now I can take a nap.
51:18Oh I got home from my after school job.
51:20Now I can take a nap.
51:22They're catching up and it might.
51:24Be extremely irregular,
51:25or it might be in the middle of
51:29school that's hard to measure,
51:32but if it's micro nap.
51:34But yes,
51:35I think we need to embrace the
51:38multidimensionality aspect completely.
51:43And with that pair connection
51:45that teens would I just in sleep
51:48clinic what I hear a lot is that.
51:50Depending on work schedules
51:52such as shift work,
51:53alot of adolescents are self regulating
51:55themselves at night and so you know
51:58there's that perhaps more variability.
52:00My work is not in teams,
52:02but I would imagine that among
52:04those who are who are who are self
52:08regulating home alone at night.
52:11There's going to be more variability.
52:13Absolutely thank you.
52:17David. You're on mute.
52:25You're still here with David.
52:31I can't hear you. Can you type it in?
52:39Let's see.
52:47While he's doing that,
52:48I I have an obligatory hat to put on.
52:50My husband was like you're going
52:52to speak at Yale, so I got.
52:54I got my baseball cap.
52:56It's really nice.
52:57Where'd you get that hat?
52:58He went there is class tonight.
53:03I like I won't do it for the talk,
53:06but I'll put it on during the question
53:09and answer, so David's question is,
53:11has there been a move given zoom
53:13to postpone school start times?
53:16Out schools in the US or such a
53:20decentralized process I I cannot speak
53:23for all of schools or all of zoom,
53:26but what an opportunity root Gruber
53:28wrote an article just last week
53:31or two saying yes, now we should.
53:34Now we should have school
53:36starting at 10:00 AM on zoom.
53:38Absolutely, I can say anecdotally.
53:42I don't think that's happening.
53:43I think the default position is.
53:45Have them signed on at.
53:48At 8:05 or whatever time
53:49there school typically starts,
53:51because that's what's known as the work day.
53:53On the other hand,
53:55there's not the morning commute.
53:57My kids got up and did
53:59virtual school this morning,
54:00and we didn't have to hustle and
54:02bustle to get them out the door.
54:05They were no shoes.
54:06My kids are not in high school.
54:09It's a little bit of a different thing,
54:11but the elimination route.
54:13Sorry, Gruber,
54:13Gruber.
54:16The elimination of commute time
54:18may also be reducing disparities,
54:21because in some communities,
54:23particularly rural communities,
54:24maybe the poorest students living furthest
54:27away and having to wake up just even a tiny.
54:32You know 20 minutes earlier every night could
54:36could lead to a clinically significant.
54:40Difference in sleep duration
54:42so that may be a benefit.
54:44I would say a slight benefit of
54:46the zoom schooling academically.
54:49I am not a fan, but at least sleep
54:53wise we may have some some perks.
54:56Oh, more and yeah,
54:58you can read David's comment
54:59in the chat.
55:02American Academy of Pediatrics
55:04recommendations for school reopening or tried
55:06to insert a recommendation about it,
55:08but it was not well received.
55:11It sounds like I'm so disappointed
55:13to hear that, but how fantastic that
55:16you were fighting the good fight.
55:19That's crazy, AP should
55:21totally be on board with that.
55:24They already have a position statement on it,
55:27so I don't know why they wouldn't so.
55:31That stinks, I can say I
55:34helped fight for the.
55:36AP's position statement on screen use
55:38in children to advocate that don't
55:41use screens in the hour before bed,
55:43and they did accept that even though really
55:46the science and that's a little fuzzy,
55:49but it's just generally good advice.
55:53On the weather, it's one hour or two hours,
55:55or what the right duration is.
55:57But one hours, so that's a bummer.
55:59So let me read the ship.
56:00Probably wrap up 'cause it.
56:03Hey Mr second question,
56:05David David tried to text me.
56:07If you are email me if you want.
56:09Thank you so much and thanks to
56:11everybody who's been a conference
56:13today and I want to just let people
56:16know about our speaker for next week.
56:18We're going to be hearing from Fatima,
56:20Cody Stanford who is at Harvard and
56:23she's going to be giving a talk
56:25relevant to many of our patients.
56:27It's going to be entitled obesity
56:28and its management.
56:30What you need to know is a Sleep
56:32Medicine physician and provider.
56:34So please join us for that,
56:35then have a great week take care.
56:40I wrote to your response to me. I.
56:47Thanks all bye.