Sustained impacts of neighborhood investments on sleep health over a 5-year period: Insights from a natural experiment in two urban neighborhoods in the United States.

Abstract

Study objectives: Neighborhood disinvestment is a downstream impact of structural racism, especially afflicting minoritized communities. Thus, neighborhood reinvestment may serve as a policy-level intervention to mitigate sleep and other health disparities. This study builds on previous work by leveraging a natural experimental design to evaluate the 5-year effects of neighborhood investments on residents' sleep.

Methods: Data are from the PHRESH Zzz study, a natural experiment conducted in two low-income, predominantly Black American, urban neighborhoods in Pittsburgh, Pennsylvania, with a randomly selected cohort [n=567; mean age=54.8 (SD=14.8); 77.6% female; 96% Black]. Sleep duration, wakefulness after sleep onset, and sleep efficiency were assessed via actigraphy and sleep quality via survey in 2013, 2016, and 2018. All publicly funded neighborhood investments between 2013 and 2016 were recorded and geocoded to calculate the distance from each respondent's residence to the investment. The primary exposure variable was residents' proximity to neighborhood investments (<0.1 of a mile).

Results: The overall pattern of results showed worsening sleep over time, regardless of exposure to investments. However, over the 5-year period, those who lived physically close to investments (<0.1 mile) experienced significantly smaller decreases in sleep efficiency and smaller increases in wakefulness after sleep onset, relative to those who lived farther away.

Conclusions: Previously, we found that living near a neighborhood investment improved sleep outcomes over a short-term period of 3years. Current results indicate that improvements were partially sustained over 5years. Findings have implications for policy initiatives targeting upstream, structural determinants of sleep health disparities.