Publications by Author:

2016
Buxton OM, Lee S, Beverly C, Berkman LF, Moen P, Kelly EL, Hammer LB, Almeida DM. Work-Family Conflict and Employee Sleep: Evidence from IT Workers in the Work, Family and Health Study. Sleep. 2016.Abstract
STUDY OBJECTIVES: Work-family conflict is a threat to healthy sleep behaviors among employees. This study aimed to examine how Work-to-Family Conflict (demands from work that interfere with one's family/ personal life; WTFC) and Family-to-Work Conflict (demands from family/ personal life that interfere with work; FTWC) are associated with several dimensions of sleep among information technology workers. METHODS: Employees at a U.S. IT firm (N=799) provided self-reports of sleep sufficiency (feeling rested upon waking), sleep quality, and sleep maintenance insomnia symptoms (waking up in the middle of the night or early morning) in the last month. They also provided a week of actigraphy for nighttime sleep duration, napping, sleep timing, and a novel sleep inconsistency measure. Analyses adjusted for work conditions (job demands, decision authority, schedule control, and family-supportive supervisor behavior), and household and sociodemographic characteristics. RESULTS: Employees who experienced higher WTFC reported less sleep sufficiency, poorer sleep quality, and more insomnia symptoms. Higher WTFC also predicted shorter nighttime sleep duration, greater likelihood of napping, and longer nap duration. Furthermore, higher WTFC was linked to greater inconsistency of nighttime sleep duration and sleep clock times, whereas higher FTWC was associated with more rigidity of sleep timing mostly driven by wake time. CONCLUSION: Results highlight the unique associations of WTFC/ FTWC with employee sleep independent of other work conditions and household and sociodemographic characteristics. Our novel methodological approach demonstrates differential associations of WTFC and FTWC with inconsistency of sleep timing. Given the strong associations between WTFC and poor sleep, future research should focus on reducing WTFC.
Lippold MA, Davis KD, McHale SM, Buxton OM, Almeida DM. Daily Stressor Reactivity During Adolescence: The Buffering Role of Parental Warmth. Health Psychology [Internet]. 2016. Publisher's VersionAbstract

Objective: This study examined youth stressor reactivity in the form of links between daily stressors and adolescents’ negative affect, physical health symptoms, and cortisol patterns. We also tested whether youth gender and parental warmth moderated these linkages. Method: Participants were the children of employees in the information technology division of a large company (N = 132, mean age = 13.39 years, 55% female). Youth completed daily diary telephone interviews on 8 consecutive evenings and provided saliva samples at 4 time points over 4 days to assess daily stressors and youth physiological and affective functioning. Parental warmth was assessed during in-home interviews. Multilevel modeling was used to account for interdependencies in the data. Results: Youth who experienced more daily stressors, on average, reported more negative affect and physical health symptoms, on average. Furthermore, on days youth reported more stressors than usual (compared to their own across-day average), they also exhibited more physical health symptoms, reduced evening cortisol decline (e.g., flatter slopes), higher bedtime cortisol, and more negative affect. Girls had stronger within-person linkages between daily stressors and daily negative affect than boys. Parental warmth moderated these within-person linkages: Youth who experienced more parental warmth had lower negative affect and steeper cortisol decline than usual on less stressful days. However, youth who experienced less parental warmth had higher negative affect and their cortisol levels declined less, even on days with lower-than-usual stress. Conclusions: Daily stressors are associated with youth’s affective and physiological functioning, but parental warmth can support youth’s stress recovery. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Hurtado DA, Okechukwu CA, Buxton OM, Hammer L, Hanson GC, Moen P, Klein LC, Berkman LF. Effects on cigarette consumption of a work–family supportive organisational intervention: 6-month results from the work, family and health network study. Journal of Epidemiology and Community Health [Internet]. 2016. Publisher's VersionAbstract
Background Observational studies have linked work–family issues with cigarette consumption. This study examined the 6-month effects on cigarette consumption of a work–family supportive organisational intervention among nursing home workers.Methods Group randomised controlled trial where 30 nursing homes across New England states were randomly assigned to either usual practice or to a 4-month intervention aimed at reducing work–family conflict via increased schedule control and family supportive supervisory behaviours (FSSB). Cigarette consumption was based on self-reported number of cigarettes per week, measured at the individual level.Results A total of 1524 direct-care workers were enrolled in the trial. Cigarette consumption was prevalent in 30% of the sample, consuming an average of 77 cigarettes/week. Smokers at intervention sites reduced cigarette consumption by 7.12 cigarettes, while no reduction was observed among smokers at usual practice sites (b=−7.12, 95% CI −13.83 to −0.40, p<0.05) (d=−0.15). The majority of smokers were US-born White nursing assistants, and among this subgroup, the reduction in cigarette consumption was stronger (b=−12.77, 95% CI −22.31 to −3.22, p<0.05) (d=−0.27). Although the intervention prevented a decline in FSSB (d=0.08), effects on cigarette consumption were not mediated by FSSB.Conclusions Cigarette consumption was reduced among smokers at organisations where a work–family supportive intervention was implemented. This effect, however, was not explained by specific targets of the intervention, but other psychosocial pathways related to the work–family interface.Trial registration number NCT02050204; results.
Moen P, Kelly EL, Lee S-R, Almeida DM, Kossek EE, Buxton OM. Does a Flexibility/Support Organizational Initiative Improve High-Tech Employees’ Well-Being? Evidence from the Work, Family, and Health Network. American Sociological Review [Internet]. 2016;81 (1) :134-164. Publisher's VersionAbstract

This study tests a central theoretical assumption of stress process and job strain models, namely that increases in employees’ control and support at work should promote well-being. To do so, we use a group-randomized field trial with longitudinal data from 867 information technology (IT) workers to investigate the well-being effects of STAR, an organizational intervention designed to promote greater employee control over work time and greater supervisor support for workers’ personal lives. We also offer a unique analysis of an unexpected field effect—a company merger—among workers surveyed earlier versus later in the study period, before or after the merger announcement. We find few STAR effects for the latter group, but over 12 months, STAR reduced burnout, perceived stress, and psychological distress, and increased job satisfaction, for the early survey group. STAR effects are partially mediated by increases in schedule control and declines in family-to-work conflict and burnout (an outcome and mediator) by six months. Moderating effects show that STAR benefits women in reducing psychological distress and perceived stress, and increases non-supervisory employees’ job satisfaction. This study demonstrates, with a rigorous design, that organizational-level initiatives can promote employee well-being.

2015
Olson R, Crain TL, Bodner T, King RB, Hammer LB, Klein LC, Erikson L, Moen P, Berkman LF, Buxton OM. A workplace intervention improves sleep: results from the randomized controlled Work, Family & Health Study. Sleep Health [Internet]. 2015;1 (1) :55-65. Publisher's VersionAbstract

Study objectives: The Work, Family, and Health Network Study tested the hypothesis that a workplace intervention designed to increase family-supportive supervision and employee control over work time improves actigraphic measures of sleep quantity and quality.

Design: Cluster-randomized trial.

Setting: A global information technology firm.

Participants: US employees at an information technology firm.

Interventions: Randomly selected clusters of managers and employees participated in a 3-month, social, and organizational change process intended to reduce work-family conflict. The intervention included interactive sessions with facilitated discussions, role playing, and games. Managers completed training in family-supportive supervision.

Measurements and results: Primary outcomes of total sleep time (sleep duration) and wake after sleep onset (sleep quality) were collected from week-long actigraphy recordings at baseline and 12 months. Secondary outcomes included self-reported sleep insufficiency and insomnia symptoms. Twelve-month interviews were completed by 701 (93% retention), of whom 595 (85%) completed actigraphy. Restricting analyses to participants with ≥3 valid days of actigraphy yielded a sample of 473-474 for intervention effectiveness analyses. Actigraphy-measured sleep duration was 8 min/d greater among intervention employees relative to controls (P < .05). Sleep insufficiency was reduced among intervention employees (P = .002). Wake after sleep onset and insomnia symptoms were not different between groups. Path models indicated that increased control over work hours and subsequent reductions in work-family conflict mediated the improvement in sleep sufficiency.

Conclusions: The workplace intervention did not overtly address sleep, yet intervention employees slept 8 min/d more and reported greater sleep sufficiency. Interventions should address environmental and psychosocial causes of sleep deficiency, including workplace factors

Erikson L, Mierzwa F, With SK, Karuntzos GT, Fox K, McHale SM, Buxton OM. Implementation Strategies for Workplace Data Collection: A Case Study. Survey Practice [Internet]. 2015;8 (5). Publisher's VersionAbstract

In this paper, we describe the methods used for the successful implementation of a longitudinal survey in a workplace setting. Data for the Work, Family & Health Study (WFHS) were collected at baseline and 6, 12, and 18 months post-baseline, and consisted of computer-assisted interviews, basic health measures, dried blood spot collection, and collection of sleep data via an actigraph watch. Data collection in the workplace presents unique logistical and operational challenges. Based on our experience, we discuss these challenges and offer key suggestions for successfully planning and implementing in-person data collection in a workplace setting.

Hammer LB, Johnson RC, Crain TL, Bodner T, Kossek EE, Davis KD, Kelly EL, Buxton OM, Karuntzos GT, Chosewood LC, et al. Intervention Effects on Safety Compliance and Citizenship Behaviors: Evidence From the Work, Family, and Health Study. Journal of Applied Psychology [Internet]. 2015. Publisher's VersionAbstract

We tested the effects of a work–family intervention on employee reports of safety compliance and organizational citizenship behaviors in 30 health care facilities using a group-randomized trial. Based on conservation of resources theory and the work–home resources model, we hypothesized that implementing a work–family intervention aimed at increasing contextual resources via supervisor support for work and family, and employee control over work time, would lead to improved personal resources and increased employee performance on the job in the form of self-reported safety compliance and organizational citizenship behaviors. Multilevel analyses used survey data from 1,524 employees at baseline and at 6-month and 12-month postintervention follow-ups. Significant intervention effects were observed for safety compliance at the 6-month, and organizational citizenship behaviors at the 12-month, follow-ups. More specifically, results demonstrate that the intervention protected against declines in employee self-reported safety compliance and organizational citizenship behaviors compared with employees in the control facilities. The hypothesized mediators of perceptions of family-supportive supervisor behaviors, control over work time, and work–family conflict (work-to-family conflict, family-to-work conflict) were not significantly improved by the intervention. However, baseline perceptions of family-supportive supervisor behaviors, control over work time, and work–family climate were significant moderators of the intervention effect on the self-reported safety compliance and organizational citizenship behavior outcomes. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

McHale SM, Lawson KM, Davis KD, Casper LM, Kelly EL, Buxton OM. Effects of a Workplace Intervention on Sleep in Employees' Children. Journal of Adolescent Health [Internet]. 2015;56 (6) : 672–677. Publisher's VersionAbstract

Purpose
The implications of sleep patterns for adolescent health are well established, but we know less about larger contextual influences on youth sleep. We focused on parents' workplace experiences as extrafamilial forces that may affect youth sleep.
Methods
In a group-randomized trial focused on employee work groups in the information technology division of a Fortune 500 company, we tested whether a workplace intervention improved sleep latency, duration, night-to-night variability in duration, and quality of sleep of employees' offspring, aged 9–17 years. The intervention was aimed at promoting employees' schedule control and supervisor support for personal and family life to decrease employees' work–family conflict and thereby promote the health of employees, their families, and the work organization. Analyses focused on 93 parent–adolescent dyads (57 dyads in the intervention and 46 in the comparison group) that completed baseline and 12-month follow-up home interviews and a series of telephone diary interviews that were conducted on eight consecutive evenings at each wave.
Results
Intent-to-treat analyses of the diary interview data revealed main effects of the intervention on youth's sleep latency, night-to-night variability in sleep duration, and sleep quality, but not sleep duration.
Conclusions

The intervention focused on parents' work conditions, not on their parenting or parent–child relationships, attesting to the role of larger contextual influences on youth sleep and the importance of parents' work experiences in the health of their children.

Berkman LF, Liu SY, Hammer LB, Moen P, Klein LC, Kelly EL, Fay M, Davis KD, Durham M, Karuntzos GT, et al. Work–Family Conflict, Cardiometabolic Risk, and Sleep Duration in Nursing Employees. Journal of Occupational Health Psychology [Internet]. 2015. Publisher's VersionAbstract

We investigated associations of work–family conflict and work and family conditions with objectively measured cardiometabolic risk and sleep. Multilevel analyses assessed cross-sectional associations between employee and job characteristics and health in analyses of 1,524 employees in 30 extended-care facilities in a single company. We examined work and family conditions in relation to: (a) validated, cardiometabolic risk score based on measured blood pressure, cholesterol, glycosylated hemoglobin, body mass index, and self-reported tobacco consumption and (b) wrist actigraphy–based sleep duration. In fully adjusted multilevel models, work-to-family conflict but not family-to-work conflict was positively associated with cardiometabolic risk. Having a lower level occupation (nursing assistant vs. nurse) was associated with increased cardiometabolic risk, whereas being married and having younger children at home was protective. A significant Age × Work-to-Family Conflict interaction revealed that higher work-to-family conflict was more strongly associated with increased cardiometabolic risk in younger employees. High family-to-work conflict was significantly associated with shorter sleep duration. Working long hours and having children at home were both independently associated with shorter sleep duration. High work-to-family conflict was associated with longer sleep duration. These results indicate that different dimensions of work–family conflict may pose threats to cardiometabolic health and sleep duration for employees. This study contributes to the research on work–family conflict, suggesting that work-to-family and family-to-work conflict are associated with specific health outcomes. Translating theory and findings to preventive interventions entails recognition of the dimensionality of work and family dynamics and the need to target specific work and family conditions.

Moen P, Kaduk A, Kossek EE, Hammer LB, Buxton OM, O'Donnell EM, Almeida DM, Fox K, Tranby E, Oakes MJ, et al. Is Work-family Conflict a Multilevel Stressor Linking Job Conditions to Mental Health? Evidence from the Work, Family and Health Network. In: Research in the Sociology of Work. Vol. 26. Bingley, West Yorkshire, England: Emerald Group Publishing Limited ; 2015. pp. pp.177 - 217. Publisher's VersionAbstract

Purpose: Most research on the work conditions and family responsibilities associated with work-family conflict and other measures of mental health uses the individual employee as the unit of analysis. We argue that work conditions are both individual psychosocial assessments and objective characteristics of the proximal work environment, necessitating multilevel analyses of both individual- and team-level work conditions on mental health.
Methodology/approach: This study uses multilevel data on 748 high-tech professionals in 120 teams to investigate relationships between team- and individual-level job conditions, work-family conflict, and four mental health outcomes (job satisfaction, emotional exhaustion, perceived stress, and psychological distress).
Findings: We find that work-to-family conflict is socially patterned across teams, as are job satisfaction and emotional exhaustion. Team-level job conditions predict team-level outcomes, while individuals’ perceptions of their job conditions are better predictors of individuals’ work-to-family conflict and mental health. Work-to-family conflict operates as a partial mediator between job demands and mental health outcomes.
Practical implications: Our findings suggest that organizational leaders concerned about presenteeism, sickness absences, and productivity would do well to focus on changing job conditions in ways that reduce job demands and work-to-family conflict in order to promote employees’ mental health.
Originality/value of the chapter: We show that both work-to-family conflict and job conditions can be fruitfully framed as team characteristics, shared appraisals held in common by team members. This challenges the framing of work-to-family conflict as a “private trouble” and provides support for work-to-family conflict as a structural mismatch grounded in the social and temporal organization of work.

2014
Lawson KM, Davis KD, McHale SM, Hammer LB, Buxton OM. Daily positive spillover and crossover from mothers’ work to youth health. Journal of Family Psychology [Internet]. 2014;28 (6) :897-907. Publisher's VersionAbstract

Prior research shows that employees’ work experiences can “spill over” into their family lives and “cross over” to affect family members. Expanding on studies that emphasize negative implications of work for family life, this study examined positive work-to-family spillover and positive and negative crossover between mothers and their children. Participants were 174 mothers in the extended care (nursing home) industry and their children (ages 9–17), both of whom completed daily diaries on the same 8 consecutive evenings. On each workday, mothers reported whether they had a positive experience at work, youth reported on their mothers’ positive and negative mood after work, and youth rated their own mental (positive and negative affect) and physical health (physical health symptoms, sleep quality, sleep duration). Results of 2-level models showed that mothers’ positive mood after work, on average, was directly related to youth reports of more positive affect, better sleep quality, and longer sleep duration. In addition, mothers with more positive work experiences, on average, displayed less negative mood after work, and in turn, adolescents reported less negative affect and fewer physical health symptoms. Results are discussed in terms of daily family system dynamics.

Hurtado DA, Berkman LF, Buxton OM, Okechukwu CA. Schedule Control and Nursing Home Quality; Exploratory Evidence of a Psychosocial Predictor of Resident Care. Journal of Applied Gerontology [Internet]. 2014. Publisher's VersionAbstract

Aim: To examine whether nursing homes’ quality of care was predicted by schedule control (workers’ ability to decide work hours), independently of other staffing characteristics. Method: Prospective ecological study of 30 nursing homes in New England. Schedule control was self-reported via survey in 2011-2012 (N = 1,045). Quality measures included the prevalence of decline in activities of daily living, residents’ weight loss, and pressure ulcers, indicators systematically linked with staffing characteristics. Outcomes data for 2012 were retrieved from Medicare.gov. Results: Robust Linear Regressions showed that higher schedule control predicted lower prevalence of pressure ulcers (β = −0.51, p < .05). This association was independent of staff mix, staffing ratios, job satisfaction, and turnover intentions. Conclusion: Higher schedule control might enhance the planning and delivery of strategies to prevent or cure pressure ulcers. Further research is needed to identify potential causal mechanisms by which schedule control could improve quality of care.

Crain TL, Hammer LB, Bodner T, Kossek EE, Moen P, Lilienthal R, Buxton OM. Work–family conflict, family-supportive supervisor behaviors (FSSB), and sleep outcomes. Journal of Occupational Health Psychology [Internet]. 2014;19 (2) :155-167. Publisher's VersionAbstract

Although critical to health and well-being, relatively little research has been conducted in the organizational literature on linkages between the work–family interface and sleep. Drawing on conservation of resources theory, we use a sample of 623 information technology workers to examine the relationships between work–family conflict, family-supportive supervisor behaviors (FSSB), and sleep quality and quantity. Validated wrist actigraphy methods were used to collect objective sleep quality and quantity data over a 1 week period of time, and survey methods were used to collect information on self-reported work–family conflict, FSSB, and sleep quality and quantity. Results demonstrated that the combination of predictors (i.e., work-to-family conflict, family-to-work conflict, FSSB) was significantly related to both objective and self-report measures of sleep quantity and quality. Future research should further examine the work–family interface to sleep link and make use of interventions targeting the work–family interface as a means for improving sleep health.

Ostler M, Porter J, Buxton O. Dried blood spot collection of health biomarkers to maximize participation in population studies. Journal of visualized experiments: JoVE [Internet]. 2014;83. Publisher's VersionAbstract

Biomarkers are directly-measured biological indicators of disease or health. In population and social sciences, biomarkers need to be easy to obtain, transport, and analyze. Dried Blood Spot (DBS) collection meets this need, can be collected in the field with high response rates and analyzed for a variety of biomarkers.

2013
Buxton OM, Klein LC, Whinnery J, Williams S, MCDADE TW. Biomarkers in Work and Family Research. In: New frontiers in work and family research. East Sussex, UK: Psychology Press LTD ; 2013. pp. 170-190.
Marino M, Li Y, Rueschman M, Winkelman JW, Ellenbogen JM, Solet JM, Dulin H, Berkman LF, Buxton OM. Measuring Sleep: Accuracy, Sensitivity, and Specificity of Wrist Actigraphy Compared to Polysomnography. SLEEP [Internet]. 2013;36 (11) :1747-1755. Publisher's VersionAbstract

Objectives: We validated actigraphy for detecting sleep and wakefulness versus polysomnography (PSG).

Design: Actigraphy and polysomnography were simultaneously collected during sleep laboratory admissions. All studies involved 8.5 h time in bed, except for sleep restriction studies. Epochs (30-sec; n = 232,849) were characterized for sensitivity (actigraphy = sleep when PSG = sleep), specificity (actigraphy = wake when PSG = wake), and accuracy (total proportion correct); the amount of wakefulness after sleep onset (WASO) was also assessed. A generalized estimating equation (GEE) model included age, gender, insomnia diagnosis, and daytime/nighttime sleep timing factors.

Setting: Controlled sleep laboratory conditions.

Participants: Young and older adults, healthy or chronic primary insomniac (PI) patients, and daytime sleep of 23 night-workers (n = 77, age 35.0 ± 12.5, 30F, mean nights = 3.2).

Interventions: N/A.

Measurements and Results: Overall, sensitivity (0.965) and accuracy (0.863) were high, whereas specificity (0.329) was low; each was only slightly modified by gender, insomnia, day/night sleep timing (magnitude of change < 0.04). Increasing age slightly reduced specificity. Mean WASO/night was 49.1 min by PSG compared to 36.8 min/night by actigraphy (β = 0.81; CI = 0.42, 1.21), unbiased when WASO < 30 min/night, and overestimated when WASO > 30 min/night.

Conclusions: This validation quantifies strengths and weaknesses of actigraphy as a tool measuring sleep in clinical and population studies. Overall, the participant-specific accuracy is relatively high, and for most participants, above 80%. We validate this finding across multiple nights and a variety of adults across much of the young to midlife years, in both men and women, in those with and without insomnia, and in 77 participants. We conclude that actigraphy is overall a useful and valid means for estimating total sleep time and wakefulness after sleep onset in field and workplace studies, with some limitations in specificity.

Citation: Marino M; Li Y; Rueschman MN; Winkelman JW; Ellenbogen JM; Solet JM; Dulin H; Berkman LF; Buxton OM. Measuring sleep: accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. SLEEP 2013;36(11):1747-1755.

Bray J, Kelly EL, Hammer LB, Almeida DM, Dearing JW, King RB, Buxton OM. An integrative, multilevel, and transdisciplinary research approach to challenges of work, family, and health. RTI Press. 2013;March.
2012
Hurtado DA, Sabbath EL, Ertel KA, Buxton OM, Berkman LF. Racial disparities in job strain among American and immigrant long-term care workers. Int Nurs Rev. 2012;59 (2) :237-44.Abstract

BACKGROUND: Nursing homes are occupational settings, with an increasing minority and immigrant workforce where several psychosocial stressors intersect. AIM: This study aimed to examine racial/ethnic differences in job strain between Black (n = 127) and White (n = 110) immigrant and American direct-care workers at nursing homes (total n = 237). METHODS: Cross-sectional study with data collected at four nursing homes in Massachusetts during 2006-2007. We contrasted Black and White workers within higher-skilled occupations such as registered nurses or licensed practical nurses (n = 82) and lower-skilled staff such as certified nursing assistants (CNAs, n = 155). RESULTS: Almost all Black workers (96%) were immigrants. After adjusting for demographic and occupational characteristics, Black employees were more likely to report job strain, compared with Whites [relative risk (RR): 2.9, 95% confidence interval (CI) 1.3 to 6.6]. Analyses stratified by occupation showed that Black CNAs were more likely to report job strain, compared with White CNAs (RR: 3.1, 95% CI: 1.0 to 9.4). Black workers were also more likely to report low control (RR: 2.1, 95% CI: 1.1 to 4.0). Additionally, Black workers earned $2.58 less per hour and worked 7.1 more hours per week on average, controlling for potential confounders. CONCLUSION: Black immigrant workers were 2.9 times more likely to report job strain than White workers, with greater differences among CNAs. These findings may reflect differential organizational or individual characteristics but also interpersonal or institutional racial/ethnic discrimination. Further research should consider the role of race/ethnicity in shaping patterns of occupational stress.

Buxton OM, Okechukwu CA. Author's Response. Journal of Occupational and Environmental Medicine [Internet]. 2012;54 (11) :1322-3. Publisher's Version
2011
Ertel KA, Berkman LF, Buxton OM. Socioeconomic status, occupational characteristics, and sleep duration in African/Caribbean immigrants and US White health care workers. Sleep. 2011;34 (4) :509-18.Abstract
STUDY OBJECTIVES: o advance our understanding of the interplay of socioeconomic factors, occupational exposures, and race/ethnicity as they relate to sleep duration. We hypothesize that non Hispanic African/Caribbean immigrant employees in long term health care have shorter sleep duration than non Hispanic white employees, and that low education, low income, and occupational exposures including night work and job strain account for some of the African/Caribbean immigrant-white difference in sleep duration. DESIGN: Cross sectional SETTING: Four extended care facilities in Massachusetts, United States PARTICIPANTS: 340 employees in extended care facilities MEASUREMENTS AND RESULTS: Sleep duration was assessed with wrist actigraphy for a mean of 6.3 days. In multivariable regression modeling controlling for gender and age, African/Caribbean immigrants slept 64.4 fewer minutes (95% CI: -81.0, -47.9) per night than white participants; additional control for education and income reduced the racial gap to 50.9 minutes (-69.2, -32.5); additional control for the occupational factors of hours worked per week and working the night shift reduced the racial gap to 37.7 minutes (-57.8, -17.6). CONCLUSIONS: his study provides support for the hypothesis that socioeconomic and occupational characteristics explain some of the African/ Caribbean immigrant-white difference in sleep duration in the United States, especially among health care workers.

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