Understanding sleep facilitators, barriers, and cultural dimensions in Native American urban youth

Objectives: American Indian/Alaska Native (Al/AN) youth are a high-risk group for sleep problems and associated chronic conditions. Urban Al/AN youth may face certain challenges, including specific psychosocial stressors (e.g., discrimination) and environmental factors (e.g., noise, light) that render them particularly vulnerable to poor sleep health. However, few studies have explored Al/AN adolescent sleep. To our knowledge, this is the first study to use systematic qualitative methods with Al/AN youth to explore their sleep environment and sleep behaviors. Design: In-depth interviews with 26 youth. Setting: Two urban areas in Central and Southern California. Participants: Urban-dwelling Al/AN youth, age 12-16 years. Intervention: N/A. Measurement: N/A. Results: We identified five main themes, each with subthemes: sleep patterns and desired sleep, sleep barriers inside the home, environmental factors, sleep facilitators, and cultural dimensions. Key concerns discussed were poor sleep hygiene, excessive use of electronics prior to bedtime, issues with temperature regulation, and noise both within and outside the home. Parents can be an important vehicle for messaging around sleep health and for behavior management. Participating adolescents also indicated differing levels of attachment to Native identity, suggesting that culturally-targeted sleep interventions should build in openness and flexibility to a range of identity starting points. Further, we identified cultural practices, such as sweat lodges and dreamcatchers, that could be incorporated in future sleep interventions for this population. Conclusion: Findings increase our understanding of urban Al/AN youth's sleep environments and behaviors, thus potentially informing program development around sleep health for this vulnerable population. (C) 2020 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.