P3.010: Food Insecurity and Housing Instability Associated with Poor Sleep Regularity in Adolescents

Background: Background
Sleep is critical for optimal health and well-being, yet less than one-third of US adolescents report healthy sleep patterns. Sleep irregularity, defined as highly variable day-to-day sleep and wake times, is a significant parameter of sleep health; in adolescents, it has been associated with negative physical and mental health outcomes. While previous research has demonstrated the existence of sleep health disparities across sleep health outcomes, a gap remains in literature that investigates the relationship between sleep regularity and social context. Using the Social Contextual Model of Health Behavior Change, we aimed to evaluate the association between socio-contextual measures of material hardship and neighborhood environment and sleep regularity.

Methods: Methods
Data was derived from the baseline assessment of adolescents aged 12-14 years enrolled in SHEETS (Sustainable Habits for Encouraging Even Teen Sleep), a 6-week pilot clinical trial assessing the acceptability and feasibility of a digital sleep intervention among healthy adolescents followed in primary care (Clinical Trial ID: NCT05378373). At baseline, primary caregivers completed surveys on socio-contextual factors; youth then completed 7-day sleep diary and actigraphy measurements. Social factors included: cut-off utilities, food insecurity, housing insecurity, neighborhood social cohesion, amenities, and perceived safety. The primary outcome of interest was sleep regularity quantified via actigraphy. Multivariable linear regression, adjusted for sex and age or pubertal status, was performed to examine the relationship between socio-contextual measures and sleep regularity.

Results: Results
The sample population comprised 61 adolescents (42.62% sex assigned female at birth, mean age 13.02, six adolescents had not yet entered puberty). In the multivariable model, food insecurity was significantly associated with decreased sleep regularity in measures of both worry that food would run out (β = -9.23, 95% CI: -13.62 to -4.84, P < 0.001) and food running out (β = -10.56, 95% CI: -15.12 to -5.99, P < 0.001). A significant negative relationship was identified between housing instability and sleep regularity (β = -17.04, 95% CI: -31.26 to -2.82, P < 0.05). No significant associations were found between other contextual factors examined at baseline and sleep regularity.

Conclusion: Conclusion
In a population of healthy adolescents recruited from the primary care setting, adolescents living in food and housing insecure households experienced greater sleep irregularity. Further understanding of the interplay between socio-contextual factors and sleep underscores the importance of incorporating measures of social context into sleep interventions and clinical guidelines to better fit diverse populations of teens.