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Racial and ethnic disparities in insufficient sleep among US in infants and preschoolers

  • Author Footnotes
    † Yuanyuan Li and Susan Lin contributed equally to this work.
    Yuanyuan Li
    † Yuanyuan Li and Susan Lin contributed equally to this work.
    Department of Psychology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

    Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, China

    Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
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  • Author Footnotes
    † Yuanyuan Li and Susan Lin contributed equally to this work.
    Susan Lin
    † Yuanyuan Li and Susan Lin contributed equally to this work.
    Center for Family and Community Medicine, Columbia University Irving Medical Center, New York, New York, USA
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  • Keely Cheslack-Postava
    Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
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  • Huilan Tang
    Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA
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  • Fang Fan
    Key Laboratory of Brain, School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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  • Christina W. Hoven
    Corresponding author: Christina W. Hoven, DrPH, Columbia University-NYSPI, 1051 Riverside Dr., New York, NY, 10032, USA
    Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, New York, USA

    Department of Epidemiology, Mailman School of Public Health, Columbia Univresity, USA
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  • Author Footnotes
    † Yuanyuan Li and Susan Lin contributed equally to this work.
Published:February 20, 2023DOI:



      To examine racial and ethnic disparities and associated factors of insufficient sleep among children from infancy to preschool-aged.


      We analyzed parent-reported data on US children ages 4 months-5 years (n = 13,975) from the 2018 and 2019 National Survey of Children's Health. Children who slept less than the age-specific minimum hours recommended by the American Academy of Sleep Medicine were classified as having insufficient sleep. Logistic regression was used to estimate unadjusted and adjusted odds ratios (AOR).


      An estimated 34.3% of children from infancy to preschool-aged experienced insufficient sleep. Socioeconomic factors (poverty [AOR] = 1.5, parents’ education level [AORs] from 1.3 to 1.5); parent-child interaction variables (AORs from 1.4 to 1.6); breast feeding status (AOR = 1.5); family structure (AORs from 1.5 to 4.4); and weeknight bedtime regularity (AORs from 1.3 to 3.0) were significantly associated with having insufficient sleep. Non-Hispanic Black (OR = 3.2) and Hispanic children (OR = 1.6) had significantly higher odds of insufficient sleep compared to non-Hispanic White children. Racial and ethnic disparities in insufficient sleep between non-Hispanic White children and Hispanic children were largely attenuated by adjusting for social economic factors. However, the difference in insufficient sleep between non-Hispanic Black and non-Hispanic White children remains (AOR = 1.6) after adjusting socioeconomic and other factors.


      More than one-third of the sample reported insufficient sleep. After adjusting for socio-demographic variables, racial disparities in insufficient sleep decreased but persistent disparities existed. Further research is warranted to examine other factors and develop interventions to address multilevel factors and improve sleep health among racial and ethnic minority group children.


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