Associations of cumulative violence and structural vulnerability with restless sleep among female sex workers in Baltimore, Maryland

Published:November 18, 2020DOI:



      To investigate correlates of restless sleep among street-based female sex workers (FSW) in the United States, an understudied population experiencing high rates of structural vulnerabilities (eg, homelessness, food insecurity) and trauma.


      Using data from a cohort of street-based cisgender FSW (n = 236; median age = 35 years, 68% non-Hispanic White), we examined cross-sectional associations of individual, interpersonal, and structural factors with frequent restless sleep over the past week (5-7 Vs <5 days).


      Participants reported a high prevalence of homelessness (62%), food insecurity (61%), daily heroin injection (53%), lifetime sexual or physical violence (81%), and frequent restless sleep (53%). Older age, food insecurity, poor self-rated health, and cumulative violence exposure were independently associated with frequent restless sleep.


      Frequent restless sleep was prevalent among FSW with higher odds among those experiencing intersecting vulnerabilities and multiple exposures to violence. Further research on sleep health in this population is needed to understand its role in health risks.


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