Relationship of Acculturation to Self-Reported Insomnia Among Mexican-Americans

Tuesday, 14 July 2009: 10:30 AM

Carol M. Baldwin, PhD, RN, AHN-BC
College of Nursing & Healthcare Innovation; Southwest Borderlands Scholar; Director, Office of International Health, Arizona State University, Phoenix, AZ
Mary Z. Mays, PhD
Arizona State University College of Nursing and Health Innovation, Phoenix, AZ
Cipriana Caudillo-Cisneros, RN, MS
Departamento de Enfermeria y Obstetricia de Leon, Universidad de Guanajuato Campus Leon, Leon, Guanajuato, Mexico
Sergio Marquez-Gamino, MD, PhD
Research Institute on Human Work, University of Guanajuato, Leon, Guanajuato, Mexico
Luxana Reynaga-Ornelas, MN, RN
Departamento de Enfermería y Obstetricia de León, Universidad de Guanajuato Campus León, Division de Ciencias de la Salud, Leon. Guanajuato, Mexico
Stuart F. Quan, MD
Sleep Medicine, University of Arizona and Harvard University, Tucson, AZ

Learning Objective 1: identify associations between levels of acculturation and insomnia reported by Mexican Americans

Learning Objective 2: understand the role of acculturation in sleep health and health care delivery among immigrant populations globally

Purpose: High U.S. acculturation among Mexican Americans has been associated with higher rates of chronic conditions, including diabetes and obesity. Limited access to care, however, contributes to significant disparities. This study extends examination of these issues to difficulty initiating and maintaining sleep (insomnia).

Methods: Bilingual Mexican Americans (24 men/26 women) participated in the cross-language validation of a Spanish version of the Sleep Heart Health Study (SHHS) Sleep Habits Questionnaire (SHQ). The Spanish version of the ARSMA II acculturation measure identified participants as “Bicultural” (n=11; both Mexican and U.S. identification), “Traditional” (n=25; predominant Mexican identification), and “Assimilated” (n=12; predominant U.S. identification).

Results: Biculturals were the youngest (M=37.5, SD=12.5 years), had the most education (M=15.3, SD=3.6 years), were the most obese (55% with BMI>29), with the most comorbid conditions (M=2.5, SD=2.5). Traditionals were the oldest (M=39.1, SD=13.2 years), had the lowest educational level (M=13.9, SD=3.0 years), were the least obese (20% with BMI>29), with the fewest comorbid conditions (M=1.8, SD=2.0). Biculturals, however, reported the least severe insomnia (M=6.8, SD=2.9), while Traditionals reported the most severe insomnia (M=7.9, SD=3.1). Biculturals were more likely to have difficulty falling asleep compared to Traditionals (27% versus 20% OR=1.50), but less likely to have difficulty staying sleep (18% versus 20% OR=0.70), and less likely to report early morning awakening with difficulty returning to sleep compared to Traditionals (9% versus 16% OR=0.53). Assimilated were more likely than Biculturals to report difficulty staying asleep (18% versus 33% OR=2.25). Assimilated and Biculturals, however, were equally likely to report difficulty falling asleep (each 25%) and difficulty with early morning awakening (each 8%).

Conclusion: The relationship of acculturation to insomnia did not follow patterns typically observed with other chronic illnesses among Mexican Americans. Findings indicate the need to study the role of acculturation in sleep health among immigrant populations globally.