Letitia Presley-Cantrell

Relationships between hours of sleep and health-risk behaviors in US adolescent students

OBJECTIVE To examine associations between insufficient sleep (<8h on average school nights) and health-risk behaviors. METHODS 2007 national Youth Risk Behavior Survey data of U.S. high school students (n=12,154) were analyzed. Associations were examined on weighted data using multivariate logistic regression. RESULTS Insufficient sleep on an average school night was reported by 68.9% of students. Insufficient sleep was associated with higher odds of current use of cigarettes (age-adjusted odds ratio [AOR], 1.67; 95% confidence interval [CI], 1.45-1.93), marijuana (AOR, 1.52; 95% CI, 1.31-1.76), and alcohol (AOR, 1.64; 95% CI, 1.46-1.84); current sexual activity (AOR, 1.41; 95% CI, 1.25-1.59); seriously considered attempting suicide (AOR, 1.86; 95% CI, 1.60-2.16); feeling sad or hopeless (AOR, 1.62; 95% CI, 1.43-1.84); physical fighting (AOR, 1.40; 95% CI, 1.24-1.60), not being physically active at least 60min ≥ 5days in the past 7days (AOR, 1.16; 95% CI, 1.04-1.29), using the computer ≥3h/day (AOR, 1.58; 95% CI, 1.38-1.80), and drinking soda/pop > 1time/day (AOR, 1.14; 95% CI, 1.03-1.28). CONCLUSION Two-thirds of adolescent students reported insufficient sleep, which was associated with many health-risk behaviors. Greater awareness of the impact of sleep insufficiency is vital.

Prevalence of insufficient, borderline, and optimal hours of sleep among high school students - United States, 2007.

We describe the prevalence of insufficient, borderline, and optimal sleep hours among U.S. high school students on an average school night. Most students (68.9%) reported insufficient sleep, whereas few (7.6%) reported optimal sleep. The prevalence of insufficient sleep was highest among female and black students, and students in grades 11 and 12.

Trends in the Prevalence of Obstructive and Restrictive Lung Function Among Adults in the United States: Findings From the National Health and Nutrition Examination Surveys From 1988-1994 to 2007-2010

BACKGROUND National spirometric surveillance data in the United States were last collected during 1988-1994. The objective of this study was to provide current estimates for obstructive and restrictive impairment of lung function and to examine changes since 1988-1994. METHODS We used data from 14,360 participants aged 20 to 79 years from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) and 9,024 participants from NHANES 2007-2010. Spirometry was conducted using the same spirometers and generally similar protocols. RESULTS During 2007-2010, 13.5% (SE, 0.6) of participants had evidence of airway obstruction (FEV1/FVC < 0.70): 79.9% of adults had normal lung function, 6.5% had a restrictive impairment, 7.5% had mild obstruction, 5.4% had moderate obstruction, and 0.7% had severe obstruction. Although the overall age-adjusted prevalence of any obstruction did not change significantly from 1988-1994 (14.6%) to 2007-2010 (13.5%) (P = .178), significant decreases were noted for participants aged 60 to 79 years and for Mexican Americans. The prevalence of current smoking remained high among participants with moderate (48.4%) and severe (37.9%) obstructive impairments. A significant decline in current smoking occurred only among those with normal lung function (P < .05). CONCLUSION Spirometry revealed little change in the prevalence of any obstructive and restrictive impairment in lung function during 2007-2010, compared with 1988-1994.

Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system.

BackgroundAlthough evidence suggests that poor sleep is associated with chronic disease, little research has been conducted to assess the relationships between insufficient sleep, frequent mental distress (FMD ≥14 days during the past 30 days), obesity, and chronic disease including diabetes mellitus, coronary heart disease, stroke, high blood pressure, asthma, and arthritis.MethodsData from 375,653 US adults aged ≥ 18 years in the 2009 Behavioral Risk Factor Surveillance System were used to assess the relationships between insufficient sleep and chronic disease. The relationships were further examined using a multivariate logistic regression model after controlling for age, sex, race/ethnicity, education, and potential mediators (FMD and obesity).ResultsThe overall prevalence of insufficient sleep during the past 30 days was 10.4% for all 30 days, 17.0% for 14–29 days, 42.0% for 1–13 days, and 30.6% for zero day. The positive relationships between insufficient sleep and each of the six chronic disease were significant (p < 0.0001) after adjustment for covariates and were modestly attenuated but not fully explained by FMD. The relationships between insufficient sleep and both diabetes and high blood pressure were also modestly attenuated but not fully explained by obesity.ConclusionsAssessment of sleep quantity and quality and additional efforts to encourage optimal sleep and sleep health should be considered in routine medical examinations. Ongoing research designed to test treatments for obesity, mental distress, or various chronic diseases should also consider assessing the impact of these treatments on sleep health.

Adverse childhood experiences and frequent insufficient sleep in 5 U.S. States, 2009: a retrospective cohort study

BackgroundAlthough adverse childhood experiences (ACEs) have previously been demonstrated to be adversely associated with a variety of health outcomes in adulthood, their specific association with sleep among adults has not been examined. To better address this issue, this study examines the relationship between eight self-reported ACEs and frequent insufficient sleep among community-dwelling adults residing in 5 U.S. states in 2009.MethodsTo assess whether ACEs were associated with frequent insufficient sleep (respondent did not get sufficient rest or sleep ≥14 days in past 30 days) in adulthood, we analyzed ACE data collected in the 2009 Behavioral Risk Factor Surveillance System, a random-digit-dialed telephone survey in Arkansas, Louisiana, New Mexico, Tennessee, and Washington. ACEs included physical abuse, sexual abuse, verbal abuse, household mental illness, incarcerated household members, household substance abuse, parental separation/divorce, and witnessing domestic violence before age 18. Smoking status and frequent mental distress (FMD) (≥14 days in past 30 days when self-perceived mental health was not good) were assessed as potential mediators in multivariate logistic regression analyses of frequent insufficient sleep by ACEs adjusted for race/ethnicity, gender, education, and body mass index.ResultsOverall, 28.8% of 25,810 respondents reported frequent insufficient sleep, 18.8% were current smokers, 10.8% reported frequent mental distress, 59.5% percent reported ≥1 ACE, and 8.7% reported ≥ 5 ACEs. Each ACE was associated with frequent insufficient sleep in multivariate analyses. Odds of frequent insufficient sleep were 2.5 (95% CI, 2.1-3.1) times higher in persons with ≥5 ACEs compared to those with no ACEs. Most relationships were modestly attenuated by smoking and FMD, but remained significant.ConclusionsChildhood exposures to eight indicators of child maltreatment and household dysfunction were significantly associated with frequent insufficient sleep during adulthood in this population. ACEs could be potential indicators promoting further investigation of sleep insufficiency, along with consideration of FMD and smoking.

Geographic disparities in chronic obstructive pulmonary disease (COPD) hospitalization among Medicare beneficiaries in the United States

Background: Hospitalizations for persons with chronic obstructive pulmonary disease (COPD) result in significant health care resource use and excess expenditures. Despite well-documented sociodemographic disparities in COPD outcomes, no study has characterized geographic variations in COPD hospitalization across the US. Methods: Almost 3.8 million COPD hospitalization records were extracted from Medicare claims for 1995–2006, and the total population of eligible Medicare beneficiaries was extracted from the Medicare enrollment records to calculate COPD hospitalization rates by Health Service Area (HSA), (n = 949). Spatial cluster analysis and Bayesian hierarchical spatial modeling were used to characterize the geography of COPD hospitalizations. Results: The overall COPD hospitalization rate was 11.30 per 1,000 beneficiaries for the aggregated period 1995–2006. HSA-level COPD hospitalization rates had a median of 11.7 and a range of 3.0 (Cache, UT) to 76.3 (Pike, KY). Excessive hospitalization risk was concentrated in Appalachia, the southern Great Lakes, the Mississippi Delta, the Deep South, and west Texas. In the Bayesian spatial mixture model, 73% of variability of COPD hospitalization relative risk was attributed to unidentified regional social and physical environments shared by HSAs rather than to unique local HSA factors (27%). Conclusion: We discovered distinct geographic patterns in COPD hospitalization rates and risks attributed to both regionally-shared environmental risk factors and HSA-unique environmental contexts. The correlates of these geographic patterns remain to be determined. Geographic comparisons of COPD hospitalization risk provide insights for better public health practice, policies, and programs for COPD prevention.

Prevalence and Correlates of Current Depressive Symptomatology and Lifetime Diagnosis of Depression in Black Women

BACKGROUND There is a paucity of research on depressive symptoms and their correlates among Black women, which may contribute to underdiagnosis, misdiagnosis, and inappropriate treatment. METHODS Data were analyzed from the 2006 Behavioral Risk Factor Surveillance System, an ongoing, state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. population aged > or =18 years. A total of 10,783 Black women aged 18 to 64 years were interviewed from 38 states, 2 U.S. territories, and the District of Columbia (DC). There were 8,412 (78.0%) women who provided complete responses to questions regarding demographic characteristics, psychosocial variables, current depressive symptomatology, and a lifetime diagnosis of a depressive disorder. Weighted prevalence estimates and 95% confidence limits of current depressive symptomatology and self-reported lifetime diagnosis of depression were derived. Multiple logistic regression models were used to examine the association of each correlate with the depression outcomes. RESULTS Overall, 13.8% of Black women reported current depressive symptoms, and 14.9% reported a lifetime diagnosis of a depressive disorder by a health care provider. Significant correlates of both outcomes included rarely/never receiving social support, being unable to work, having physical health problems for 14 or more days in the past month, and dissatisfaction with life. CONCLUSIONS This study indicates that a substantial number of Black women suffer from significant symptoms of depression and report that they have been diagnosed with depressive disorders in their lifetime. Health care providers should assess Black women with poor physical health and life dissatisfaction for depressive disorders and not dismiss somatic complaints as solely physically based.

Elevated cardiovascular risk among adults with obstructive and restrictive airway functioning in the United States: a cross-sectional study of the National Health and Nutrition Examination Survey from 2007-2010.

BackgroundReasons for the excess risk for cardiovascular disease among people with chronic obstructive pulmonary disease remain unclear. Our objective was to examine the cardiovascular risk profile for adults with obstructive and restrictive impairments of lung functioning in a representative sample of adults from the United States.MethodsWe used data from adults aged 20–79 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2010 and had a pulmonary function test. The severity of obstructive impairment was defined by adapting the Global Initiative for Chronic Obstructive Lung Disease criteria.ResultsAmong 7249 participants, 80.9% had a normal pulmonary function test, 5.7% had a restrictive impairment, 7.9% had mild obstructive impairment, and 5.5% had moderate or severe/very severe obstructive impairment. Participants with obstructive impairment had high rates of smoking and increased serum concentrations of cotinine. Compared to participants with normal pulmonary functioning, participants with at least moderate obstructive impairment had elevated concentrations of C-reactive protein but lower concentrations of total cholesterol and non-high-density lipoprotein cholesterol. Among participants aged 50–74 years, participants with at least a moderate obstructive impairment or a restrictive impairment had an elevated predicted 10-year risk for cardiovascular disease.ConclusionsThe high rates of smoking among adults with impaired pulmonary functioning, particularly those with obstructive impairment, point to a need for aggressive efforts to promote smoking cessation in these adults. In addition, adults with restrictive impairment may require increased attention to and fine-tuning of their cardiovascular risk profile.

Addressing Mental Health Promotion in Chronic Disease Prevention and Health Promotion

The authors discuss mental health promotion and its underlying importance to prevention of chronic diseases and overall health promotion. The authors compare World Health Organization (WHO) definitions of mental health and mental illness, while noting WHOs definition of health, in total. The authors also discuss a so-called two-continuum model of mental health and mental illness.

Frequent Insufficient Sleep and Anxiety and Depressive Disorders Among U.S. Community Dwellers in 20 States, 2010

OBJECTIVE This investigation examined the association of anxiety or depressive disorder and frequent insufficient sleep. METHODS Data were obtained from a 2010 telephone survey of a population-based sample of 113,936 adults in 20 states. Respondents were asked how often they did not get enough rest or sleep and if they had ever received a diagnosis of an anxiety or depressive disorder. Frequent insufficient sleep was defined as insufficient rest or sleep during ≥ 14 of the past 30 days. RESULTS Frequent insufficient sleep was reported by 27.0% of the sample and was significantly more common (p<.05) among respondents who reported both anxiety and depressive disorders (48.6%), depressive disorders only (39.0%), or anxiety only (37.5%) than among adults who reported neither disorder (23.1%). CONCLUSIONS Frequent insufficient sleep is associated with depressive and anxiety disorders, and the odds of the sleep disorder are increased when both classes of psychiatric disorders are diagnosed.