Examining the Mechanisms and Consequences of Sleep Health Inequities Affecting Black SexualMinority Men

PROJECT SUMMARY/ABSTRACT Black sexual minority men (SMM) suffer disproportionately from health inequities, including high rates of HIV, mental health issues, and poor physical health. Intersectional stigma and discrimination contribute significantly to these health inequities. Sleep health, an understudied factor, may play a crucial role in mediating these

health inequities. Based on emerging evidence from cross-sectional data indicating that self-reported sleep may be compromised in Black and SMM populations, we propose to conduct a community-based participatory study using a longitudinal mixed-methods design to investigate sleep health as a pathway linking intersectional

stigma and discrimination and health consequences in Black SMM. We will collect three waves (baseline, 6- month, and 12-month follow-ups) of quantitative data using questionnaires/surveys, daily diary, and actigraphy (objective sleep monitoring) from 300 Black SMM. In a subsample of 60 participants, we will conduct in-depth

qualitative interviews at baseline and 12-month follow-up. The proposed longitudinal mixed-methods study will: 1) examine quantitatively the proximal (daily) and longitudinal associations between intersectional stigma/discrimination and poor sleep health among Black SMM and the extent to which coping with the stress

of discrimination mediates the longitudinal effect; 2) examine quantitatively the role of sleep health as a mediating pathway between upstream determinants (intersectional stigma and discrimination) and health consequences longitudinally, and the proximal associations of poor sleep on next day’s mood and substance

use; and 3) to explore qualitatively how individual/interpersonal-level (e.g., sleep behaviors, experiences of discrimination, coping strategies) and structural-level (e.g., housing condition, neighborhood characteristics) factors influence sleep health and how sleep is related to other health outcomes (e.g., mental and physical

health) over time. Qualitative interviews will also explore possible solutions to address the barriers identified. Input from community members and stakeholders will be sought and incorporated throughout the study. The mixed-methods results and community input will serve as a basis to inform sleep health promoting policies and

intervention strategies for this group. Drawing upon an established community-academic partnership, this study will be the first longitudinal mixed-methods community-based participatory research to illuminate how sleep health inequities contribute to health inequities affecting Black SMM. The proposed study aligns with the

goals of Healthy People 2030 and the NIH Sleep Research Plan, and addresses the needs of sexual minority individuals highlighted in NOT-MD-22-012. Findings from this comprehensive investigation will pave the way for tailored intervention efforts and help advance health equity for Black SMM.