Objective: The transition from adolescence to young adulthood, a period marked with changes to one's biology and social context, may be an important period for establishing long-term sleep behaviors. The present study identified changes in weekday and weekend sleep duration, trouble sleeping, and fatigue from adolescence to young adulthood, and evaluated sex and socioeconomic status differences in these sleep measures. Methods: Study participants (N = 1559) completed surveys in adolescence (2010; Mage = 14.3) and young adulthood (2018; Mage = 22.0). Mixed linear and logistic regression models were used to assess differences in sleep metrics at each time point and over time, and differences based on sex and socioeconomic status. Results: Around 43% of adolescents were not meeting minimum weekday sleep recommendations and average weekday sleep duration was shorter in adolescence (8.1 hours) compared to young adulthood (8.3 hours). During adolescence, the low socioeconomic status group had the shortest weekday sleep duration compared to other socioeconomic status groups, but by young adulthood, all socioeconomic status groups slept for similar durations. Although longer sleep duration was reported on average in young adulthood, a greater proportion of young adults, compared to adolescents, reported fatigue and trouble sleeping. The low socioeconomic status group and females reported more fatigue and trouble sleeping than their counterparts at both adolescence and in young adulthood. Conclusions: Findings suggest a need for sleep interventions that prioritize weekday sleep duration in adolescence, particularly among low socioeconomic status groups, and in young adulthood, there is a need to address fatigue and trouble sleeping, particularly among females.

Objective: The transition from adolescence to young adulthood, a period marked with changes to one's biology and social context, may be an important period for establishing long-term sleep behaviors. The present study identified changes in weekday and weekend sleep duration, trouble sleeping, and fatigue from adolescence to young adulthood, and evaluated sex and socioeconomic status differences in these sleep measures. Methods: Study participants (N = 1559) completed surveys in adolescence (2010; Mage = 14.3) and young adulthood (2018; Mage = 22.0). Mixed linear and logistic regression models were used to assess differences in sleep metrics at each time point and over time, and differences based on sex and socioeconomic status. Results: Around 43% of adolescents were not meeting minimum weekday sleep recommendations and average weekday sleep duration was shorter in adolescence (8.1 hours) compared to young adulthood (8.3 hours). During adolescence, the low socioeconomic status group had the shortest weekday sleep duration compared to other socioeconomic status groups, but by young adulthood, all socioeconomic status groups slept for similar durations. Although longer sleep duration was reported on average in young adulthood, a greater proportion of young adults, compared to adolescents, reported fatigue and trouble sleeping. The low socioeconomic status group and females reported more fatigue and trouble sleeping than their counterparts at both adolescence and in young adulthood. Conclusions: Findings suggest a need for sleep interventions that prioritize weekday sleep duration in adolescence, particularly among low socioeconomic status groups, and in young adulthood, there is a need to address fatigue and trouble sleeping, particularly among females.

Objective: The transition from adolescence to young adulthood, a period marked with changes to one's biology and social context, may be an important period for establishing long-term sleep behaviors. The present study identified changes in weekday and weekend sleep duration, trouble sleeping, and fatigue from adolescence to young adulthood, and evaluated sex and socioeconomic status differences in these sleep measures. Methods: Study participants (N = 1559) completed surveys in adolescence (2010; Mage = 14.3) and young adulthood (2018; Mage = 22.0). Mixed linear and logistic regression models were used to assess differences in sleep metrics at each time point and over time, and differences based on sex and socioeconomic status. Results: Around 43% of adolescents were not meeting minimum weekday sleep recommendations and average weekday sleep duration was shorter in adolescence (8.1 hours) compared to young adulthood (8.3 hours). During adolescence, the low socioeconomic status group had the shortest weekday sleep duration compared to other socioeconomic status groups, but by young adulthood, all socioeconomic status groups slept for similar durations. Although longer sleep duration was reported on average in young adulthood, a greater proportion of young adults, compared to adolescents, reported fatigue and trouble sleeping. The low socioeconomic status group and females reported more fatigue and trouble sleeping than their counterparts at both adolescence and in young adulthood. Conclusions: Findings suggest a need for sleep interventions that prioritize weekday sleep duration in adolescence, particularly among low socioeconomic status groups, and in young adulthood, there is a need to address fatigue and trouble sleeping, particularly among females.

Background: Migraine is the second most disabling illness in the world. Research has largely focused on pharmacological treatments, with limited studies evaluating behavioral interventions. The aim of this study was to evaluate the acceptability of a novel behavioral intervention targeting exercise and sleep among sedentary people with migraine. Method: Nineteen participants engaged in a randomized controlled trial assigned to either a phone-delivered educational intervention for best sleep practices and exercise tailored to people with migraine or a no-treatment control group. Participants tracked their migraine frequency, duration, intensity, sleep, and physical activity using ecological momentary assessment over a 4-week study period. Depression, anxiety, and quality of life were measured pre- and post-intervention. Results: Results showed 93% and 94% adherence to the ecological momentary assessment procedure and exercise intervention, respectively, with 57.1 more minutes of physical activity in week 2 [CI 51.4, 62.7], 57.7 in week 3 [CI 52.0, 63.3], and 56.6 in week 4 [CI 50.9, 62.2], compared to week 1 for the intervention group. Preliminary efficacy results showed sleep duration improved over time for the intervention group, with 0.77 more hours in week 3 [0.22, 1.31] and 0.95 more hours in week 4 [0.40, 1.49], compared to baseline. Anxiety symptoms significantly decreased over time for the intervention group compared to the control group (p <.021, d = 0.25). Other results were null. Conclusion: This study demonstrates the acceptability of a multicomponent lifestyle intervention, suggesting its potential for large-scale implementation to address behavioral and psychological comorbidities in migraine management.

Delaying high school start times prolongs weekday sleep. However, it is not clear if longer sleep reduces depression symptoms and if the impact of such policy change is the same across groups of adolescents. We examined how gains in weekday sleep impact depression symptoms in 2,134 high school students (mean age 15.16 ± 0.35 years) from the Minneapolis metropolitan area. Leveraging a natural experiment design, we used the policy change to delay school start times as an instrument to estimate the effect of a sustained gain in weekday sleep on repeatedly measured Kandel-Davies depression symptoms. We also evaluated whether allocating the policy change to subgroups with expected benefit could improve the impact of the policy. Over 2 years, a sustained half-hour gain in weekday sleep expected as a result of the policy change to delay start times decreased depression symptoms by 0.78 points, 95%CI (-1.32,-0.28), or 15.6% of a standard deviation. The benefit was driven by a decrease in fatigue and sleep-related symptoms. While symptoms of low mood, hopelessness, and worry were not affected by the policy on average, older students with greater daily screen use and higher BMI experienced greater improvements in mood symptoms than would be expected on average, signaling heterogeneity. Nevertheless, universal implementation outperformed prescriptive strategies. High school start time delays are likely to universally decrease fatigue and overall depression symptoms in adolescents. Students who benefit most with respect to mood are older, spend more time on screens and have higher BMI.

Surveillance data indicate that food security rates increased among Supplemental Nutrition Assistance Program (SNAP) participants during the COVID-19 pandemic (2020 and 2021) compared with pre-pandemic (2019), but this could have been due to increased participation from better resourced households. Our objective was to examine if demographic differences between SNAP-participating households in each year were responsible for the increased prevalence of food secure households. We calculated the observed 30-d food security prevalence among SNAP-participating households for each year. We used indirect standardisation to produce expected 2020 and 2021 prevalences with 2019 as the standard population using household size, income, age, sex, race, Hispanic ethnicity, presence of children, single parent household, metropolitan status and census region. We calculated standardised prevalence ratios (SPRs) to understand if the observed prevalence was higher than expected given any changes in the demographic profile compared to 2019. The Current Population Survey data were collected by the United States Census Bureau and Department of Agriculture. Our sample included 5,245 SNAP-participating households. The observed prevalence of food secure households increased by 3⋅6 percentage points comparing 2019 to 2020 (SPR = 1⋅06, 95 % confidence interval = 1⋅00, 1⋅11) and by 8⋅6 percentage comparing 2019 to 2021 (SPR = 1⋅13, 95 % confidence interval = 1⋅07, 1⋅18). The greater prevalence of food secure SNAP households during the pandemic did not appear to be attributable to socio-demographic differences compared to pre-pandemic. Despite hesitance among policymakers to expand or enhance social safety net programmes, permanently incorporating COVID-19-related policy interventions could lessen food insecurity in years to come.

Purpose: Smokers can spend a substantial amount on cigarettes, potentially constraining their ability to purchase food. We tested the association of smoking cessation and household food security. Methods: Using the Current Population Survey (2001–2019), we longitudinally linked the Tobacco Use Supplement and the Food Security Supplement (n = 71,278). Among adult smokers (n = 13,144), we used modified Poisson regression to model household food insecurity as a function of quit status (continuing smokers vs. recent quitters), adjusting for sex, age, household size, children in the household, and other household smokers. We also used multinomial logistic regression to examine more detailed food security status (high, marginal, low, very low). Results: The adjusted probability of household food insecurity at follow-up was 11% (95% CI: 8.7%–13%) for recent quitters and 20% (95% CI: 19%–21%) for continuing smokers. Continuing smokers had a lower adjusted probability of high food security (69% vs. 80%) and a higher adjusted probability of marginal (11% vs. 9.8%), low (12% vs. 7%), and very low food security (7.8% vs. 3.6%) compared to recent quitters. Conclusions: Cigarette cessation is associated with a lower risk of household food insecurity. Therefore, promoting tobacco cessation alongside food assistance and poverty reduction policies may help alleviate food insecurity.

Introduction: Innovative smoking cessation approaches that overcome barriers such as traveling

The emergency food system (EFS) is a critical part of the United States’ social safety net. Using 2015–2020 Current Population Survey Food Security Supplement data, we identified trends in EFS use among food insecure, low-income households by estimating the probability of EFS use adjusting for demographics using multivariable logistic regression. From 2015 to 2019, between 31.0% and 34.4% of households received emergency food, while 42.4% did in 2020. EFS use did not increase in 2020 compared to prior years for older adults and non-metropolitan households. Targeted outreach should be used to expand the reach of this resource to underserved and marginalized populations.”.

<p>Despite a dramatic reduction in commercial cigarette smoking prevalence in the US, children are still commonly exposed to secondhand smoke (SHS), which is a cause of various pediatric health problems. Further, SHS exposure is patterned by race and class, exacting an inequitable toll on children from families with lesser social and economic advantage. In this issue, Titus and colleagues’ (Am J Epidemiol. XXXX;XXX(XX):XXXX–XXXX) used natural experiment evaluation methods (difference-in-difference) to test whether the recently implemented HUD policy which forbade smoking in and around New York City Housing Authority (NYCHA) buildings impacted child respiratory health. The results from their work remind us that policies do not always impact outcomes as we might expect. Given that policy is one of the most potent tools for population health promotion, this work underlines the need for epidemiology to engage in policy evaluation at all stages of the policy lifecycle, in order to discover comprehensive approaches to policy development and implementation that prioritize equity and address structural racism.</p>

<p>Racism is embedded in society, and higher education is an important structure for patterning economic and health outcomes. Historically Black Colleges and Universities (HBCUs) were founded on anti-racism while predominantly white institutions (PWIs) were often founded on white supremacy. This contrast provides an opportunity to study the association between structural racism and health among Black Americans. We used the National Longitudinal Study of Adolescent to Adult Health (Add Health) to estimate the long-term causal effect of attending an HBCU (vs. PWI) on depressive symptoms among Black students in the United States from 1994-2018. While we found no overall association with attending an HBCU (vs. PWI) on depressive symptoms, we found that this association varied by baseline mental health and region, and across time. For example, among those who attended high school outside of the South, HBCU attendance was protective against depressive symptoms 7 years later, and the association was strongest for those with higher baseline depressive symptoms. We recommend equitable state and federal funding for HBCUs, and that PWIs implement and evaluate antiracist policies to improve mental health of Black students.</p>

BACKGROUND Cancer survivors are at increased risk of pain due to their either cancer and/or treatments. Substances like alcohol may be used to self-medicate cancer pain; however, these substances pose their own health risks that may be more pronounced for cancer survivors. METHODS We used cross-sectional data from the Behavioral Risk Factor Surveillance System (BRFSS) 2012-2019 to quantify the association between cancer pain and alcohol use. We used negative binomial regression, with interaction terms added to examine variations across age, sex, and race. We also examined whether alcohol use relates to cancer pain control status. RESULTS Cancer survivors with cancer pain were more likely to be younger, female, Black, and to have been diagnosed with breast cancer. Cancer pain was associated with lower alcohol consumption (incidence rate ratio (IRR): 0.88, confidence interval (CI): 0.77, 0.99). This association was primarily among people 65 and older, women, and white and Hispanic people. Cancer pain control status was not related to alcohol use. CONCLUSIONS Lower alcohol use among cancer survivors with pain has many possible explanations, including several alternative pain management strategies or a decrease in social engagement. Our findings of racial and gender disparities in cancer pain are consistent with the broader evidence on disparities in pain. IMPLICATIONS FOR CANCER SURVIVORS Cancer pain management for marginalized groups should be improved. Healthcare providers should screen cancer survivors for both pain and substance use, to prevent unhealthy self-medication behaviors.

Purpose: Few adolescents spend enough time asleep on school nights. This problem could be addressed by delaying high school start times, but does this translate to reduced prevalence of sleep–wake problems like awakening too early or feeling sleepy during the day? Methods: The START study (n = 2,414) followed a cohort of students from five Minnesota high schools to evaluate impacts of school start time delays. Participants were enrolled in ninth grade (Baseline) when all schools started early (7:30 or 7:45 A.M.). At Follow-Up 1 (10th grade) and Follow-Up 2 (11th grade), two schools had delayed their start times by 50 and 65 minutes while three comparison schools started at 7:30 A.M. Six sleep–wake behaviors were assessed at all three time points via survey. Generalized estimating equation models were used to investigate changes in sleep–wake problems between policy change and comparison schools. Results: The prevalence of sleep–wake problems at Baseline ranged from 11% for being late to class due to oversleeping to 48% for needing to be told to wake multiple times in the morning. Compared to students from comparison schools, students at policy change schools reported smaller increases in the prevalence of feeling sleepy daily and oversleeping and being late to class between 9th and 11th grade. After implementation of the delayed start, awakening too early was more common among students at policy change schools compared to the comparison schools. Conclusions: This longitudinal study provides evidence that delaying high school start times reduces daytime sleepiness and school tardiness.

Background: A steep rise in food insecurity is among the most pressing US public health problems that has resulted from the COVID-19 pandemic. Objective: This study aimed to (1) describe how food-insecure emerging adults are adapting their eating and child-feeding behaviors during COVID-19 and (2) identify barriers and opportunities to improve local food access and access to food assistance. Design: The COVID-19 Eating and Activity Over Time study collected survey data from emerging adults during April to October 2020 and completed interviews with a diverse subset of food-insecure respondents. Participants/setting: A total of 720 emerging adults (mean age: 24.7 ± 2.0 years; 62% female; 90% living in Minnesota) completed an online survey, and a predominately female subsample (n = 33) completed an interview by telephone or videoconference. Main outcome measures: Survey measures included the short-form of the US Household Food Security Survey Module and 2 items to assess food insufficiency. Interviews assessed eating and feeding behaviors along with barriers to healthy food access. Analyses performed: Descriptive statistics and a hybrid deductive and inductive content analysis. Results: Nearly one-third of survey respondents had experienced food insecurity in the past year. Interviews with food-insecure participants identified 6 themes with regard to changes in eating and feeding behavior (eg, more processed food, sporadic eating), 5 themes regarding local food access barriers (eg, limited enforcement of COVID-19 safety practices, experiencing discrimination), and 4 themes regarding barriers to accessing food assistance (eg, lack of eligibility, difficulty in locating pantries). Identified recommendations include (1) expanding the distribution of information about food pantries and meal distribution sites, and (2) increasing fresh fruit and vegetable offerings at these sites. Conclusions: Interventions of specific relevance to COVID-19 (eg, stronger implementation of safety practices) and expanded food assistance services are needed to improve the accessibility of healthy food for emerging adults.