Supplement: Sleeping Well in a Changing Climate: The Effects of Rising Temperatures and Extreme Weather Events on Sleep and Other Aspects of Health in Rural Appalachia

Insufficient sleep (habitual sleep duration of ≤6 hours), is a costly public health problem that is more prevalent among health disparity populations (e.g., racial minorities, adults of low socioeconomic status). Climate change and climate-related disasters demonstrate a detrimental impact on sleep and associated downstream health outcomes. Increasing temperatures are linked to diminished sleep time and quality, and negative impacts are heightened among populations with fewer economic resources. Extreme weather events due to climate change often result in displacement, trauma, and economic instability; these stressors directly impair sleep. The fast-growing burden of climate-related disaster recovery disproportionately disadvantages populations with existing health disparities. These data hold direct relevance to our parent R01: Researching Equitable Sleep Time in Appalachia (REST-KY; MD016236). REST-KY focuses on rural Appalachian adults, whose serious health inequities include multiple health morbidities, premature mortality, and high rates of insufficient sleep. While our project was designed to evaluate mechanisms contributing to pre-existing regional sleep and health deficiencies over a two-year period, Appalachian Kentucky’s July 2022 climate-change related catastrophic flood event has led us to broaden the scope of our research. We will recruit a cohort of 400 adults from 6 insufficient sleep “hotspot” counties (n=200) in Appalachian KY (where 25-58% of adults report insufficient sleep 15+ nights/month), and 6 similarly rural and economically distressed non-“hotspot” counties. Five of the 12 counties suffered widespread flood damage. Use of a mixed methods, longitudinal burst design in the parent R01 will allow us to evaluate mechanisms contributing to both sleep deficiencies and health over two years in this rural community. The present supplement is responsive to the NOT-HD-23-006 NOSI and addresses three of the four core pillars of the NIH Climate Change and Health Initiative (Health Effects Research, Health Equity, and Training and Capacity Building) by expanding our multidisciplinary team to bring together climate and health scientists to execute the following aims: 1) Integrate temperature and humidity measurements at the community- (county-level outdoor recordings) and individual-level (indoor ambient measurements from smartphones) into our ongoing study evaluating mechanisms driving disparities in sleep and other health outcomes over time; and 2) examine how both subjective (e.g., beliefs about climate change and health, perceived drinking water quality) and objective (e.g., county water boil advisories and shut offs), measurements of how climate-sensitive hazards relate to sleep and other health outcomes (particularly indicators of mental health). Our findings will offer unprecedented insight into the intersections of climate change, sleep and health in an understudied rural health disparity population. Results will inform strategies to increase health equity, and thus have strong potential for public health impact.