Abstract
Abstract
Introduction:
Food insecurity (inability to afford enough healthy food) is a socioeconomic stressor with profound health consequences, including increased obesity (perhaps through replacing nutritious food with cheap alternatives). The present study examines the direct associations between food insecurity and both sleep duration and an insomnia index. Further we investigated the potentially mediating role of sleep duration and insomnia in the association between food insecurity and obesity.
Methods:
Data were collected as part of the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) Study, a diverse, community-based survey of adults aged 22–60 (N=1,007). Food insecurity was assessed as the frequency over the past 12 months of the following: worry that food would run out, food actually running out, and inability to afford balanced meals. Items were scored as “0=never (reference),” “1=sometimes,” or “2=often” and summed as a total score (0=6). Sleep duration was assessed using the NHANES question and categorized as very short (≤4h), short (5-6h), normal (7-8h, reference), or long (≥9h). Insomnia was assessed with the Insomnia Severity Index and categorized as none (≤7, reference), mild (8–14), and moderate-severe (≥15). Obesity reflected BMI≥30 based on self-reported height and weight. Multinomial logistic regressions were adjusted for demographic (age, sex, and race/ethnicity) and socioeconomic factors (education, income, and shiftwork).
Results:
Each individual food-insecurity item was associated with both short and very short sleep duration, as well as both mild and moderate-severe insomnia, even after adjustment for demographic and socioeconomic factors. In the full model, total food-insecurity score was associated with both very short (OR=1.23/pt,p=0.002) and short (OR=1.15/pt,p=0.001) sleep duration, as well as both mild (OR=1.28/pt,p<0.0001) and moderate-severe (OR=1.38/pt,p<0.0001) insomnia. Insomnia accounted for 16% of the relationship between food insecurity and obesity (Sobel p=0.009).
Conclusion:
Food insecurity is associated with insufficient sleep and insomnia, which may be part of the pathway to increased obesity among the food insecure. Future sleep research and public health interventions should consider the critical role of financial and nutritional security in achieving regular restorative sleep.
Support (If Any):
K23HL110216 and R21ES022931