Exploring the Association between Income inequality and Sleep in Canadian Teens

• Author / Creator

  Patel, Priya

• Background: Sleep deprivation is a substantial public health concern with 30% of Canadian adolescents not getting the recommended eight to ten hours of sleep. In addition to individual level risk factors for teen sleep deprivation such as increased use of electronic devices and greater sedentary time, according to the Social Determinants of Health Framework, characteristics of the social environment may play a role in sleep. One such characteristic is income inequality, the gap between rich and poor within a society. Existing research has found an association between income inequality and sleep among adults, especially women. However, no prior study has examined the role of income inequality in adolescence. Considering the prevalence of sleep deprivation among teens and income inequality in Canada, describing the association between income inequality and sleep deprivation is of paramount importance.Objective: The aim of my thesis was to examine the association between income inequality and sleep duration among Canadian adolescents, how depression, anxiety and social cohesion mediate this relationship, and how these associations differ by gender.Methods: Using cross-sectional data of 74,501 secondary school students from wave 7 (year 2018-2019) of the Cohort on Obesity, Marijuana use, Physical activity, Alcohol use, Smoking, and Sedentary behavior (COMPASS) study, multilevel modelling analysis and multilevel path analysis were conducted. Income inequality (Gini index) was measured at the census division level and self-reported sleep duration, gender, depression (measured using the CESD), anxiety (measured using the GAD7), and social cohesion (operationalized as school connectedness) were measured at the individual level.Results: Greater income inequality (Gini index) was associated with lower sleep duration (β=-3.65 minutes sleep per 1% increase in income inequality, p<0.001, 95% CI=-5.63 to -1.68) and increased odds of short sleep (<8 hours) vs. normal sleep (8-10 hours) (OR=1.08, p<0.001, 95% CI=1.04 to 1.13). The cross-level interactions between income and gender were significant, suggesting that the income inequality has more adverse effects on the sleep of females than males. A full mediation effect of depression (β=-3.09, p=0.003, 95% CI=-5.15 to -1.03) and anxiety (β=-3.64, p=0.001, 95% CI=-5.88 to -1.41) wherein greater income inequality was associated with higher levels of depression and anxiety,which were in turn, associated with a shorter sleep duration was also found. The mediation effect of depression was slightly stronger in males than females and the mediation effect of anxiety was stronger in females than males. Moreover, a full mediation effect of social cohesion, wherein greater income inequality was associated with a lower level of social cohesion, which was in turn, associated with a shorter sleep duration, was observed in both the female and male stratified samples (with a stronger effect in the former), but not in the whole sample.Conclusion: The results provide further reasoning for policy makers to focus on decreasing income inequality to improve the health of society members, such as through progressive taxation policies. Findings suggest that reducing societal income gaps may improve adolescent sleep especially in those attending school in high income inequality areas, females, and those experiencing depression and anxiety. This research also highlights the need for tailored approaches to improving adolescent sleep. Greater investment and research in school-based sleep health promotion should be done in areas with greater income inequality.

• Subjects / Keywords

  • income inequality
  • sleep
  • adolescents
  • teens
  • epidemiology
  • depression
  • anxiety
  • social cohesion
  • mental health

• Graduation date

  Fall 2023

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-tkye-ke17

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.