Racism-Related Experiences, Expectations, and Mothers’ Concern about Children’s Exposure to Racism Associated with Poor Sleep Quality in African American Women Open Access

Oo, Khin Hnit (Spring 2022)

Permanent URL: https://etd.library.emory.edu/concern/etds/ng451j83z?locale=en


Rationale: Research linking racism-related stressors to sleep quality in African Americans have typically focused on single stressors despite the fact that multiple stressors often co-occur. Objective: We sought to examine associations between three racism-related stressors and sleep quality in a cohort of African American women, and to explore whether depressive symptoms severity and trait-based worry attenuated these associations.

Methods: Cross-sectional data from 406 African American women aged 30-46 years in the southeastern US. Stressors were racism-related experiences, expectations of racism, and mothers’ concern for their children’s exposure to racism measured by the Racism and Life Experiences Scale – Daily Life Experiences, Race-Based Rejection Sensitivity Scale, and Telephone-Administered Perceived Racism Scale – Concern for Children, respectively. Sleep quality was measured using the global sleep quality score of the Pittsburgh Sleep Quality Index. We performed logistic regression analyses of dichotomized sleep quality (cutoff at a score of 5). We further conducted linear regression analyses of continuous sleep quality and standardized coefficients to enable comparison across stressors. We compared associations in the full sample and in a sample restricted to mothers in the cohort to conduct sensitivity analyses.

Results: Daily life experiences (OR=1.74, 95% CI: 1.25, 2.42), expectations of racism (OR=1.20, 95% CI: 1.00, 1.44), and concern for children (OR=1.35, 95% CI: 1.03, 1.75) were positively associated with poor sleep quality in analyses adjusted for sociodemographic factors, body mass index, and current smoking status. The coefficient relating daily life experiences with continuous sleep quality (standardized β=0.20, SE=0.26) was nearly double that of expectations (standardized β=0.10, SE=0.15) and concern for children (standardized β=0.13, SE=0.23). The association of all racism-related stressors with poor sleep was attenuated after accounting for depressive symptoms and worry, leaving daily life experiences as the sole correlate of poor sleep. Between the full and mothers-only samples in the sensitivity analyses, associations differed only for expectations of racism.

Conclusion: We observed strong positive associations of all racism-related stressors with poor sleep quality. Comparative analyses suggested that exposure to racism-related events may be more harmful to sleep quality than stressors due to anticipating such events happening to oneself or one’s children.

Table of Contents

Chapter 1


Chapter 2

Literature Review

Chapter 3


Study Participants


Race-Related Stressors

Psychological Risk Factors: Depression Symptom Severity and Worry

Other Covariates

Statistical Analyses


Participant Characteristics

Associations between All Exposures and Global Sleep Quality Scores

Associations between All Exposures and Poor Sleep Quality

Chapter 4


Conclusion and Public Health Implications


Tables and Figures

Table 1

Table 2

Table 3

Table 4

Table 5

Figure 1

Figure 2

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