The Association between Neighborhood Social Cohesion and Sleep in Latinos, As Moderated By Nativity Status and English Language Proficiency

Introduction: Neighborhood social cohesion (NSC) has been linked to sleep health in United States (US)-born samples, but the association remains unclear in immigrant groups. Though immigrants tend to experience better health compared to US-born counterparts and some have hypothesized this may be due to greater NSC, this association has been found primarily in studies conducted in the southwest and predominantly Mexican ethnic enclaves. Additionally, the literature is mixed on how different levels of acculturation affect this association between NSC and health. We investigated the moderating role of acculturation markers (nativity status and English language proficiency[ELP]) on the relationship between NSC and sleep (insomnia symptoms and sleep quality).

Methods: Using cross-sectional data from 198 healthy Latino adults enrolled in the Latino Sleep and Health Study from 2016 to 2019, we regressed NSC (continuous) on insomnia and sleep quality to assess the relationship between NSC and sleep. Interaction terms—nativity status (dichotomous) x NSC and ELP (dichotomous, good/excellent vs. fair/poor) x NSC—were added with four covariates (i.e. age, gender, education, Cohen Perceived Stress Scale [PSS]). These models were repeated using dichotomized NSC (high cohesion vs. low) to assess possible threshold effects. Lastly, if significant interactions were found, regression analyses stratifying by the acculturation proxy were performed

Results: Participants were 65.15% female with a Mean age of 37.80 (SE=0.99), and 33.83% completed less than a bachelor’s degree. Main effects for fully adjusted models including ELP and nativity status for both sleep outcomes and models testing for threshold effects of high NSC (dichotomous) were not statistically significant. The interaction term NSC x nativity was marginally significant in the fully adjusted model for sleep quality (p=0.092). In the model including US-born only, for every point increase in NSC there was a 0.071 decrease in poor sleep quality in the fully adjusted model (SE =0.029, p=0.017). The association between NSC and sleep quality was not significant in the immigrant only models. Models that included NSC x ELP interactions had no significant interaction effect for either sleep outcome. Models with interaction terms that included high NSC (dichotomous) x nativity status for both sleep outcomes were not statistically significant.

Conclusion and Implications: The effects of NSC on sleep quality differ by nativity status, but not for insomnia or by ELP. These results for the effects of NSC on sleep quality suggest that neighborhoods may play a role in facilitating access to resources or reducing stress for US-born Latinos, whereas immigrants may rely more heavily on other social ties not captured here. Conversely, ELP had no significant impact on the main effect, a departure from the literature. This may be due in part to sorting, where those with poor ELP may choose to live in ethnic enclaves that do not require English in order to benefit from social connections in the neighborhood. Future research should also explore differences in protective effects of NSC on sleep quality by individual level characteristics (e.g. country of origin, length of stay in US) and neighborhood characteristics (e.g. ethnic density, neighborhood turnover).