Running Head: NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP 1

Neighborhood Disorder, Psychological Stress, and Sleep ID # 9718257 TA: Daniel Sparks Concordia University

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP

Neighborhood Disorder, Psychological Stress and Sleep Sleep, a sine qua non of life, regulates neurogenesis, memory consolidation, cell growth and repair. Despite this, poor sleep hygiene in modern-day society has become commonplace. It is estimated that nearly 70% of undergraduate students manifest sleep problems (i.e., insomnia, sleep deprivation, or poor sleep quality) daily (Buboltz, Brown, & Soper, 2001). Such sleep disturbances inevitably have dire physiological ramifications later in life. Indeed, sleep problems are linked to cardiovascular disease, hypertension, and even earlier mortality (Hale, Hill, & Burdette, 2010). Sleep is governed by homeostatic mechanisms that establish a dynamic equilibrium for proper physiological functioning. Circadian rhythms calibrate these mechanisms by way of zeitgebers. Psychological stress, however, can disrupt this rhythmicity, which may culminate in poorer quality and shorter duration of sleep (Van Reeth et al., 2000). Though the aetiology of psychological stress is multifarious, contemporary research has postulated that disadvantaged and disordered neighbourhoods may engender such stress through the degradation of perceived control (Hill, Burdette & Hale, 2009). The aforementioned neighbourhood characteristics are inextricably linked to lower socioeconomic status (Johnson et al., 2009; Ross & Mirowsky, 2001). In turn, lower socioeconomic status is indicative of an array of negative health outcomes, including lower sleep latency and poorer sleep efficiency as assessed by actigraphy (Lauderdale et al., 2006). Similarly, research conducted in Montreal contends that such neighbourhoods are risk factors for developing sleep problems in children (Brouillette, Horwood, Constantin, Brown & Ross, 2011). Further, Hale and Do (2007) have shown that both residential context and lower socioeconomic status are linked to greater sleep depravity and poorer sleep quality.

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP Although the relationship between neighborhood disorder and greater levels of psychological stress has been punctiliously examined (Hill, Burdette & Hale, 2009; Ross & Mirowsky, 2009), what mediates an individuals vulnerability to disordered residential conditions and, in turn, psychological stress is unclear. The model of structural amplification (Ross, Mirowsky, & Pribesh, 2001) delineates how social or environmental conditions may climax in psycho-physiological outcomes. This model espouses the notion that deleterious sequelae from environmental or social contexts strike through individual personal attributes that

otherwise buffer the impact of such noxious effects. In light of this model, poor sleep quality has been posited to both mediate as well as amplify the interaction between ones place of residence and psychological distress (Hill, Burdette, & Hale, 2009). Conceptually congruent with the model of structural amplification, the present study seeks to elucidate the influence of the disordered neighbourhoods and psychological stress on sleep problems. It is predicted overall that individuals residing in neighbourhoods, characterized by more subjective or objective disorder, as well as those who display greater psychological stress, will experience greater sleep problems. Method Materials Actiwatch. Participants wore an Actiwatch (Respironics, Inc.,) on either wrist continuously for a period of 24 hours. The Actiwatch (Respironics, Inc.,) records motion and light in order to discriminate sleep activity from wakefulness. It provides data on the total duration of hours spent sleeping, sleep latency, amount of time in bed spent sleeping, number of awakenings and number of minutes awake. The actiwatch weighs approximately 21 grams and measures 31 mm x 28 mm x 10 mm. The actiwatch has shown convergent validity as compared

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP

to Polysomnography in assessing total sleep time (r = .85), and sleep efficiency (r = .65) (Sadeh, 2011). Test-retest reliability for sleep start time, minutes spent awake and sleep efficiency is adequate (r = .70) (Sadeh, 2011). Measures Perceived Stress Scale (PSS). The PSS (Cohen, Kamarck, & Mermelstein, 1983) is ten item self-report instrument evaluates the level of perceived stress during the last month. Participants were asked to rate each item on a 5-point likert scale ranging from 0 (never) to 4 (very often). The total score of the PSS is obtained by reversing the scores of the four positive items and then summing across all ten items. A higher score indicates a higher level of perceived stress. The PSS-10 item questionnaire demonstrates adequate test-retest reliability (r = .77) (Remor, 2006). Moreover, it is strongly positive correlated to similar measures of stress, such as the state anxiety trait inventory (STAI; r = .73) (Roberti, Harrington, & Storch, 2006). Perceived Neighborhood Disorder Scale (NDS). The NDS (Ross & Mirowsky, 1999) is a 15item scale that assesses perceived social and physical disorder of the participantsneighborhood. Each item was a statement related how participants worried perceived their neighborhoods, e.g., My neighborhood is noisy. Participants indicated the degree to which each statement accurately described their perception of their neighbor on a 4-point likert scale. The response options ranged from 1 (strongly agree) to 4 (strongly disagree). High scores were indicative of greater perceived neighborhood disorder. The NDS has demonstrated strong internal consistency ( = .91). Comparison between neighborhood disorder and neighborhood decay factors was used to demonstrate construct validity; disorder and decay shared many indicators and were highly correlated (r = .78) (Ross & Mirowsky, 1999).

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP Collective Efficacy Scale (CES). The CES (Sampson, Raudenbush & Earls, 1997) is a five item scale that measures perceived neighborhood control, as well as social cohesion and trust among neighbors. Participants were asked five statements referring to neighborhood characteristics, e.g., this is a close-knit neighborhood. Participants indicated the level of agreement of these statements on a 4-point likert scale ranging from 1 (strongly agree) to 4 (strongly disagree). The CES has good test-retest reliability (r = .80) (Sampson et al., 1997) as

well as good internal consistency ( = .85) (Burdette, Wadden & Whitaker, 2006). The CES also has displayed discriminant validity with standardized measures of friendship and kinship (r = .49), organizational measures (r = .45) and neighborhood services (r = .21) (Sampson et al., 1997). Perceived Neighborhood Safety Survey (PNS). The PNS (King County Community Health Survey, 2001; 2004) is a six-item questionnaire that assesses how safe participants feel in their respective neighborhoods. Each item was a statement related how often participants worried about particular situations in their neighborhoods, e.g., Being physically attacked by someone you dont know. Participants indicated the degree to which each statement accurately described their perception of their neighbor on a 5-point likert scale. The response options ranged from 0 (never) to 4 (all the time). The PNS shows good internal consistency ( = .83) (Schulz et al., 2006). Pittsburgh Sleep Quality Index (PSQI). The PSQI (Buysse, Reynolds, Monk, Berman, & Kupfer, 1989) assesses sleep quality and disturbances over one-month period. 19 individual items produce seven specific component scores: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. The sum of these component scores generates one positive global score with a

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP maximum of 21. Higher scores indicate worse sleep quality and scores greater than five indicate poor sleep quality. The PSQI has good internal consistency ( = .83) and good test-retest

reliability (r = .87) (Goodin, Mcguire, & Smith, 2010). The PSQI also displays criterion validity with the PSQI global score correlating positively with a global score on sleep diary data (r = .31) (Grandner, Kripke, Yoon, & Youngstedt, 2006). Sleep hygiene index (SHI). The SHI (Mastin, Bryson, & Corwyn, 2006) is a 13-item questionnaire that assesses participants sleep behaviors, for example, I take daytime naps lasting 2 or more hours. Participants indicated the accuracy of the statement on a 5-point likert scale. The responses were always, frequently, sometimes, rarely and never. The SHI was found to have adequate testretest reliability (r = .71) and good internal consistency ( = .83) (Mastin, et al., 2006). Further, the sleep hygiene index also displays adequate convergent validity, correlating positively with PSQI total scores (r = .48) (Mastin et al., 2006). Objective neighborhood data. Objective neighborhood data (Montreal Crime Index, 2006; Census Canada, 2006) was collected by using participants postal code to obtain data on their respective census tract. These data included the total population in 2006, average number persons in private households, proportion of movers in last 5 years, pre-1960 constructed buildings, prevalence of low income before tax in 2005, median household income, unemployment rate, residents with high school education or less, residents with master education or higher, as well as the prevalence of violent and drug related crime in the particular census tract. Further, participants were asked to complete a 4-item questionnaire pertaining to possible confounds, such as house overcrowding and sleeping conditions. All items were then aggregated to produce an objective measure of neighborhood disorder. Procedure

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP 45 participants from an Advanced Research Methods class at Concordia University were recruited to participate in this study. Participants were instructed to schedule an appointment for the calibration of an Actiwatch (Respironics, Inc.,). Participants wore the Actiwatch (Respironics, Inc.,) continuously for a period of 24 hours. Participants were also instructed to complete a 16-question survey online on the day they received the Actiwatch (www.surveymonkey.com). This survey was the amalgamation of several separate surveys that

assessed perceived stress, neighbourhood disorder, cohesion, safety, sleep behaviour. The postal code of participants was also requested to gather information pertinent to their respective census tracts. On the Actiwatchs return, participants received details outlining their sleep behaviour. Study Design The present study used a cross-sectional, quasi-experimental design to test whether psychological stress or neighbourhood characteristics can predict subjective or objective sleep problems. The independent variables are psychological stress and neighbourhood characteristics. Neighbourhood characteristics consisted of three levels: aggregated neighbourhood census and crime data, perceived neighbourhood disorder, and neighbourhood socioeconomic status. The dependent variable of this study is subjective or objective sleep problems. First, it is predicted that greater neighbourhood disorder or psychological stress would result in greater subjective sleep problems. Second, it is predicted that greater neighbourhood disorder or psychological stress would result in greater objective sleep problems. Data Analyses Data was prepared by transforming all variables into the same experimental units. To streamline data and reduce experimental wise error, data was condensed into five aggregated factor scores based on identified measured variables.

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP Objective neighborhood disorder (factor loading) was based on the percent of homes constructed before 1960 (.141), percent of neighborhood population that moved within the prior five years (.620), total population of the census tract in 2006 (-.033), number of people in household (-.733), crime index for drug related crimes (.546), crime index for violent crimes (.736), and finally total crime index (.830). Higher scores on this factor illustrate census tracts with older homes, more movers, fewer people, less crowding and greater crime. Subjective neighborhood disorder (factor loading) was based on the percent of population with masters education or more (-.604), the percent of individuals with high school education or less (.729), the median household income in dollars (-.793), the percent of low income individuals before tax in 2005 (.718), as well as the unemployment rate of the total population (.724). Higher scores on this factor indicate census tracts with a lower percentage of people with masters education or more, a greater percentage of people with high school

education or less, a lower median income, a greater amount of low income individuals, as well as greater level of unemployment. Objective sleep scores were based on Actigraphy and included data on the number of awakenings (.898), total number of hours sleeping (.024), amount of time in bed spent sleeping percentage (-.865), amount of time in bed before falling asleep (.550) and number of minutes awake (.926). Higher scores on this factor indicated a greater number of awakenings, a longer duration of total time spent sleeping, a greater amount of time spent in bed, lower sleep latency, and a lower amount of minutes awake. Perceived sleep (factor loading) was based on sleep quality (PSQI component 1; .832), Sleep latency (PSQI component 2; .642), sleep duration (PSQI component 3; .729), sleep efficiency (PSQI component 4, .406), Sleep disturbances, (PSQI Component 5; .638), Sleep

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP

medication use (PSQI Component 6; .492), Daytime dysfunction (PSQI component 7; .647), and the sum of these scores (PSQI global score; .997). Higher scores indicate poorer sleep, longer latency, lower duration, less efficiency, more disturbances, more medication use, more dysfunction, and overall poorer sleep. The predictive ability of neighbourhood disorder and psychological stress on subjective and objective sleep parameters was tested individually using multiple linear regression models that included the aforementioned aggregated factors, as well as perceived stress scale scores and sleep hygiene index scores as covariate predictors. Results Descriptive Analyses Means and standard deviations were calculated for variables pertinent to objective and subjective measures of neighbourhood and sleep, as well as subjective measures of stress. Of particular interest to this study, the results demonstrated that the mean sleep latency in minutes was shorter for the objective measure of sleep (Mtime = 9.4) as compared to the subjective measure of sleep (Mtime = 21). Further, the results indicated that total duration spent sleeping in hours on weeknights differed between objective (Mtime = 8.29) and subjective (Mtime = 6.98) measures of sleep. See table 1 for all means and standard deviations performed in this study. Hypotheses Testing First, multiple linear regression was performed to test whether neighborhood disorder or psychological stress predicted subjective sleep problems. The model was adjusted to control for the influence of neighborhood socioeconomic status, sleep hygiene. The regression model demonstrated that these variables significantly predicted subjective sleep problems, F (5, 39) = 7.86, p < . 001. This model accounted for 43.8% of the total variance. Further, it was found that

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP perceived stress (t = 3.38, p = .002), sleep hygiene (t = 3.00, p = .005) significantly predicted subjective sleep problems, such that an increase in perceived stress or poorer sleep hygiene increased subjective sleep problems by .43 and .39 units, respectively. Neighborhood Socioeconomic status (t = 1.91, p = .063) was also a marginally significant predictor, such that

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for each unit lowered of socioeconomic status, subjective sleep problems increased by .29 units. Overall, perceived stress was the greatest predictor of subjective sleep problems. Subjective (t = .530, p = .599) and objective (t = -.373, p = .711) measures of neighborhood disorder did not significantly predict subjective sleep problems. See table 2 for the regression models used in this study. Second, multiple linear regression was performed to test whether neighborhood disorder or psychological stress predicted objective sleep problems. The regression model demonstrated these variables did not significantly predict objective sleep problems F (5, 39) = 2.20, p = .074. This model accounted for 12.0% of the total variance. The model was adjusted to control for the influence of neighborhood socioeconomic status, sleep hygiene. Further, neighborhood socioeconomic status (t = 2.31, p = .034) was a significant predictor of objective sleep problems, such that for each unit lowering of neighborhood socioeconomic status, objective sleep problems increased by .42 units. Sleep Hygeine (t = -2.57, p = .020) significantly predicts greater objective sleep problems, such that for each unit increase in better sleep hygiene, objective sleep problems increased by .40 units. Objective (t = -1.89, p = .067) and perceived (t = 1.69, p = .099) neighbourhood disorder as well as perceived stress (t = 1.12, p = .268) were not significant predictors of objective sleep problems. See table 2 for the regression models used in this study. Discussion

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The present study investigated whether neighbourhood characteristics, such as disorder or disadvantage, and psychological stress could predict subjective or objective sleep problems. The results partially supported this hypothesis. Indeed, it was found that neighbourhood characteristics, coupled with psychological stress, significantly predicted subjective sleep problems. Congruent with these findings, Hill et al. (2009) have suggested that there may be a relationship between the psychological stress and neighbourhood disorder and that this is mediated by sleep quality. However, since neither factor analysis, nor main effect analyses were performed in this study, the present results cannot fully ascertain whether sleep mediates or moderates this relationship. Nonetheless, this studys results demonstrate that the unique variance of psychological stress may be used to predict subjective sleep problems. Further, in contrast to previous findings, the results demonstrate the neighborhood disorder (Ross & Mirowsky, 2001) is not a significant predictor of sleep problems. Future research should perhaps investigate the interaction between neighborhood disorder and psychological stress to accurately determine the mediating and moderating effects of sleep. This study has several limitations. First, the participants used in this study were psychology undergraduate students. It can be argued that this population is rather homogenous in terms of demographic attributes such as socioeconomic status and education level. Since this study indirectly examined the impact of socioeconomic status through neighborhood socioeconomic status, it can be argued that the results lack population validity. On the other hand, it can also be argued that if the sample were to be more representative in terms of demographics, the present study would have found an even greater effect. Neighbourhood Socioeconomic status was not used as a main predictor in this study, but it can be argued that it is inextricably linked to elements of neighbourhood disorder (Johnson et al., 2009). Given that

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP socioeconomic status is a strong predictor of sleep problems (Goodin et al., 2010), the present study could perhaps combine these two components into one predictor. The strongest predictor for both subjective sleep problems was perceived stress. This

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finding is consistent with research demonstrating that stress adversely impacts sleep (Van Reeth et al., 2000). Future research should clarify the impact of objective stress on sleep with the use of precise and accurate sleep recording material, such as polysomnography (Blackwell et al., 2008). It is important to note that this study did not establish a baseline for objectively measuring sleep. The fact that participants only had used the actiwatch for one day suggests that the data is vulnerable to considerable fluctuations in variation. Indeed, research contends that participants must be worn Actiwatch for at least one week to measure objective sleep reliably (Sadeh, 2011). Given the time constraints for the present study, this was not possible. Interestingly, the current study found that better sleep hygiene predicted greater objective sleep problems. This paradoxical finding may be the inevitable manifestation of poor criterion validity demonstrated by the Actiwatch. Accordingly, in order to clarify the predictive ability of neighborhood disorder and stress it would necessitate a valid measure of objective sleep with an adequate baseline so that confounding variables do not influence the results. Given the multifarious and interconnected nature of psychological stress, neighborhood disorder and sleep, this study has undoubtedly important practical implications. Indeed, research has demonstrated that neighborhoods in Montreal can significantly affect health outcomes over and beyond individual health behaviors (Ross, Tremblay, & Graham, 2004). In light of the pervasive devaluation of sleep hygiene in modern day society, the pioneering nature of this study posits a theoretical framework upon which future studies should aim to substantiate. Taken

NEIGHBORHOOD DISORDER, PSYCHOLOGICAL STRESS, AND SLEEP together, the relationship between neighborhood disorder, psychological sleep and sleep problems may not be linear as hypothesized, but rather multidimensional.

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