Association of masking policies with mask adherence and distancing during the SARS-COV-2 pandemic.

BACKGROUND: Quantification of the impact of local masking policies may help guide future policy interventions to reduce SARS-COV-2 disease transmission. This study's objective was to identify factors associated with adherence to masking and social distancing guidelines. METHODS: Faculty from 16 U.S. colleges and universities trained 231 students in systematic direct observation. They assessed correct mask use and distancing in public settings in 126 US cities from September 2020 through August 2021. RESULTS: Of 109,999 individuals observed in 126 US cities, 48% wore masks correctly with highest adherence among females, teens and seniors and lowest among non-Hispanic whites, those in vigorous physical activity, and in larger groups (P < .0001). Having a local mask mandate increased the odds of wearing a mask by nearly 3-fold (OR = 2.99, P = .0003) compared to no recommendation. People observed in non-commercial areas were least likely to wear masks. Correct mask use was greatest in December 2020 and remained high until June 2021 (P < .0001). Masking policy requirements were not associated with distancing. DISCUSSION: The strong association between mask mandates and correct mask use suggests that public policy has a powerful influence on individual behavior. CONCLUSIONS: Mask mandates should be considered in future pandemics to increase adherence.

Neighborhood Economic Deprivation and Social Fragmentation: Associations With Children's Sleep.

BACKGROUND & OBJECTIVE: A growing body of work indicates that experiences of neighborhood disadvantage place children at risk for poor sleep. This study aimed to examine how both neighborhood economic deprivation (a measure of poverty) and social fragmentation (an index of instability) are associated with objective measures of the length and quality of children's sleep. PARTICIPANTS: Participants were 210 children (54.3% boys) living predominantly in small towns and semirural communities in Alabama. On average children were 11.3 years old (SD = .63); 66.7% of the children were European American and 33.3% were African American. The sample was socioeconomically diverse with 67.9% of the participants living at or below the poverty line and 32.1% from lower-middle-class or middle-class families. METHODS: Indicators of neighborhood characteristics were derived from the 2012 American Community Survey and composited to create two variables representing neighborhood economic deprivation and social fragmentation. Child sleep period, actual sleep minutes, and efficiency were examined using actigraphy. RESULTS: Higher levels of neighborhood economic deprivation were associated with fewer sleep minutes and poorer sleep efficiency. More neighborhood social fragmentation was also linked with poorer sleep efficiency. Analyses controlled for demographic characteristics, child health, and family socioeconomic status. CONCLUSIONS: Findings indicate that living in economically and socially disadvantaged neighborhoods predicts risk for shorter and lower-quality sleep in children. Examination of community context in addition to family and individual characteristics may provide a more comprehensive understanding of the factors shaping child sleep.

Community violence concerns and adolescent sleep.

OBJECTIVE: The goal of this study was to examine links between concerns about community violence and objective and subjective sleep parameters in an adolescent sample. Sex was considered as a moderator of effects. DESIGN: The study used a cross-sectional design. PARTICIPANTS: The community-based sample included 252 adolescents (53% girls) with an average age of 15.79 years (SD = 0.81) from the Southeastern United States. The sample included 34% African American and 66% European American adolescents from a wide range of socioeconomic backgrounds. MEASUREMENTS: Adolescent-reported community violence concerns were assessed using a composite of 3 separate subscales that measured perceived community safety and threats of community and school violence. Sleep duration and quality were assessed using actigraphy, and subjective sleep problems and daytime sleepiness were measured with subscales of the School Sleep Habits Survey. RESULTS: Community violence predicted lower sleep efficiency, more long-wake episodes, and more sleep/wake problems and sleepiness. Sex-related moderation effects revealed that girls in the sample were more vulnerable to the effects of violence concerns on their objective sleep quality. CONCLUSIONS: Findings highlight the role of community violence concerns on adolescents' sleep, revealing that greater community violence concerns are linked with lower levels of actigraphy-based and subjective reports of sleep quality, particularly for adolescent girls. Consideration of the mechanisms by which violence concerns may affect sleep is discussed.

What keeps low-SES children from sleeping well: the role of presleep worries and sleep environment.

OBJECTIVES: Children in families of low socioeconomic status (SES) have been found to have poor sleep, yet the reasons for this finding are unclear. Two possible mediators, presleep worries and home environment conditions, were investigated as indirect pathways between SES and children's sleep. PARTICIPANTS/METHODS: The participants consisted of 271 children (M (age) = 11.33 years; standard deviation (SD) = 7.74 months) from families varying in SES as indexed by the income-to-needs ratio. Sleep was assessed with actigraphy (sleep minutes, night waking duration, and variability in sleep schedule) and child self-reported sleep/wake problems (e.g., oversleeping and trouble falling asleep) and sleepiness (e.g., sleeping in class and falling asleep while doing homework). Presleep worries and home environment conditions were assessed with questionnaires. RESULTS: Lower SES was associated with more subjective sleep/wake problems and daytime sleepiness, and increased exposure to disruptive sleep conditions and greater presleep worries were mediators of these associations. In addition, environmental conditions served as an intervening variable linking SES to variability in an actigraphy-derived sleep schedule, and, similarly, presleep worry was an intervening variable linking SES to actigraphy-based night waking duration. Across sleep parameters, the model explained 5-29% of variance. CONCLUSIONS: Sleep environment and psychological factors are associated with socioeconomic disparities, which affect children's sleep.

Socioeconomic Adversity and Women's Sleep: Stress and Chaos as Mediators.

We examined income-to-needs ratio, perceived economic well-being, and education and their relations with European and African American women's sleep (n = 219). Sleep was examined through actigraphy and self-reports. Income-to-needs ratio was related to sleep minutes. Perceived economic well-being and education were associated with subjective sleep problems. Perceived stress mediated relations between both income-to-needs ratio and economic well-being and subjective sleep problems. Chaos emerged as a mediator linking income-to-needs ratio and subjective sleep problems. African American women had fewer sleep minutes and lower sleep efficiency than European Americans, and more robust relations between economic well-being and stress was observed for European Americans. Findings highlight the importance of economic adversity for women's sleep and explicate some pathways of risk.

Relations between daytime pre-ejection period reactivity and sleep in late childhood.

The sympathetic nervous system and children's sleep serve critical arousal regulation functions. Shortened pre-ejection period, a reliable indirect index of greater sympathetic nervous system activity, has been associated with reduced sleep duration and quality in adults, but limited evidence exists in children regarding associations between pre-ejection period and sleep. We examined relations between pre-ejection period reactivity in response to a laboratory-based stressor and multiple parameters of actigraphy-based sleep duration and quality in children. The sample included 123 boys and 112 girls [mean age = 11.31 years, standard deviation (SD) = 0.63 years]. Controlling for body mass index, sex and pre-ejection period baseline, increased sympathetic nervous system reactivity, indexed by a lower level of pre-ejection period during the challenge than the baseline, was associated with worse sleep quality indicated by lower sleep efficiency, greater sleep activity and greater long wake episodes. The findings add to a small literature on relations between sympathetic nervous system functioning and children's sleep, suggesting that poor sleep quality is related to dysregulation of this stress response system.

Familial risk moderates the association between sleep and zBMI in children.

OBJECTIVE: A cumulative risk approach was used to examine the moderating effect of familial risk factors on relations between actigraphy-based sleep quantity (minutes) and quality (efficiency) and sex- and age-standardized body mass index (zBMI). METHODS: The sample included 124 boys and 104 girls with a mean age of 10.41 years (SD = 0.67). Children wore actigraphs for 1 week, and their height and weight were assessed in the lab. RESULTS: After controlling for potential confounds, multiple regression analyses indicated that sleep minutes predicted children's zBMI and that both sleep minutes and efficiency interacted with family risk in the prediction of zBMI. The association between poor sleep and zBMI was especially evident for children exposed to higher levels of family risk. CONCLUSIONS: Findings suggest that not all children who exhibit poor sleep are at equal risk for higher zBMI and that familial and contextual conditions need to be considered in this link.

Parasympathetic nervous system activity and children's sleep.

We examined indices of children's parasympathetic nervous system activity (PNS), including respiratory sinus arrhythmia during baseline (RSAB) and RSA reactivity (RSAR), to a laboratory challenge, and importantly the interaction between RSAB and RSAR as predictors of multiple parameters of children's sleep. Lower RSAR denotes increased vagal withdrawal (reductions in RSA between baseline and task) and higher RSAR represents decreased vagal withdrawal or augmentation (increases in RSA between baseline and task). A community sample of school-attending children (121 boys and 103 girls) participated [mean age = 10.41 years; standard deviation (SD) = 0.67]. Children's sleep parameters were examined through actigraphy for 7 consecutive nights. Findings demonstrate that RSAB and RSAR interact to predict multiple sleep quality parameters (activity, minutes awake after sleep onset and long wake episodes). The overall pattern of effects illustrates that children who exhibit more disrupted sleep (increased activity, more minutes awake after sleep onset and more frequent long wake episodes) are those with lower RSAB in conjunction with lower RSAR. This combination of low RSAB and low RSAR probably reflects increased autonomic nervous system arousal, which interferes with sleep. Results illustrate the importance of individual differences in physiological regulation indexed by interactions between PNS baseline activity and PNS reactivity for a better understanding of children's sleep quality.

Economic adversity and children's sleep problems: multiple indicators and moderation of effects.

OBJECTIVE: Toward explicating relations between economic adversity and children's sleep, we examined associations between multiple indicators of socioeconomic status (SES)/adversity and children's objectively and subjectively derived sleep parameters; ethnicity was examined as potential moderator. METHODS: Participants were 276 third- and fourth-grade children and their families (133 girls; M age = 9.44 years; SD = .71): 66% European American (EA) and 34% African American (AA). Four SES indicators were used: income-to-needs ratio, perceived economic well-being, maternal education, and community poverty. Children wore actigraphs for 7 nights and completed a self-report measure to assess sleep problems. RESULTS: Objectively and subjectively assessed sleep parameters were related to different SES indicators, and overall worse sleep was evident for children from lower SES homes. Specifically, children from homes with lower income-to-needs ratios had higher levels of reported sleep/wake problems. Parental perceived economic well-being was associated with shorter sleep minutes and greater variability in sleep onset for children. Lower mother's education was associated with lower sleep efficiency. Children who attended Title 1 schools had shorter sleep minutes. Ethnicity was a significant moderator of effects in the link between some SES indicators and children's sleep. AA children's sleep was more negatively affected by income-to-needs ratio and mother's education than was the sleep of EA children. CONCLUSIONS: The results advocate for the importance of specifying particular SES and sleep variables used because they may affect the ability to detect associations between sleep and economic adversity.

Parental depressive symptoms and children's sleep: the role of family conflict.

BACKGROUND: We used a multi-method and multi-informant design to identify developmental pathways through which parental depressive symptoms contribute to children's sleep problems. Environmental factors including adult inter-partner conflict and parent-child conflict were considered as process variables of this relation. METHODS: An ethnically and socioeconomically diverse sample of children (n = 268) participated (M age = 9.44 years, SD = 8.61 months). Children wore actigraphs for 7 consecutive nights and also reported on their sleep problems. RESULTS: Higher levels of maternal depressive symptoms were associated with children's sleep/wake problems. Higher levels of paternal depressive symptoms were associated with shorter time in bed and fewer sleep minutes. Inter-partner conflict and parent-child conflict were mechanisms of effects in the associations between maternal depressive symptoms and children's actigraphy-based and self-reported sleep problems. CONCLUSIONS: Findings build on this scant literature and highlight the importance of identifying pathways of risk and familial and environmental influences on children's sleep problems.