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Inequalities in Emerging Adult College Students' Sleep Quality during the COVID-19 Pandemic

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Title: Inequalities in Emerging Adult College Students' Sleep Quality during the COVID-19 Pandemic
Language: English
Authors: Neshat Yazdani (ORCID 0000-0002-0354-1481), Lindsay Till Hoyt (ORCID 0000-0001-5465-4876), Ayurda Pathak, Lauren Breitstone, Alison K. Cohen (ORCID 0000-0001-9848-934X)
Source: Journal of American College Health. 2025 73(4):1538-1548.
Availability: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 11
Publication Date: 2025
Sponsoring Agency: Health Resources and Services Administration (HRSA) (DHHS)
National Institutes of Health (NIH) (DHHS)
Contract Number: UA6MC27378
R01HL16070301A1
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Sleep, COVID-19, College Students, Gender Differences, Sexual Orientation, Racial Differences, Ethnicity, Socioeconomic Status, Correlation
DOI: 10.1080/07448481.2024.2317178
ISSN: 0744-8481
1940-3208
Abstract: Objective: To examine inequalities in sleep quality during the COVID-19 pandemic by gender, sexual orientation, race/ethnicity, and socioeconomic position (SEP), and test associations between discrimination and sleep quality in a national longitudinal cohort of emerging adult college students. Participants: Participants were enrolled in college full-time and were aged 18-22 at baseline. Methods Participants completed online surveys in spring 2020 (N = 707) and summer 2021 (n = 313). Measures included the Pittsburgh Sleep Quality Index (PSQI) and the Everyday Discrimination Scale. Results: Most students reported poor sleep quality (78% in 2020; 82% in 2021) and those from marginalized groups generally experienced worse sleep quality. Discrimination was associated with poorer concurrent sleep quality at both time points. Conclusions: Sleep inequalities among college students continued to manifest during the pandemic, even when students were not necessarily on campus. Colleges should take a multi-pronged approach to promote sleep quality through individual, community, and institutional interventions.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1473223
Database: ERIC
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  Value: <anid>AN0184444270;acl01apr.25;2025Apr15.05:17;v2.2.500</anid> <title id="AN0184444270-1">Inequalities in emerging adult college students' sleep quality during the COVID-19 pandemic </title> <p>Objective: To examine inequalities in sleep quality during the COVID-19 pandemic by gender, sexual orientation, race/ethnicity, and socioeconomic position (SEP), and test associations between discrimination and sleep quality in a national longitudinal cohort of emerging adult college students. Participants: Participants were enrolled in college full-time and were aged 18–22 at baseline. Methods: Participants completed online surveys in spring 2020 (N = 707) and summer 2021 (n = 313). Measures included the Pittsburgh Sleep Quality Index (PSQI) and the Everyday Discrimination Scale. Results: Most students reported poor sleep quality (78% in 2020; 82% in 2021) and those from marginalized groups generally experienced worse sleep quality. Discrimination was associated with poorer concurrent sleep quality at both time points. Conclusions: Sleep inequalities among college students continued to manifest during the pandemic, even when students were not necessarily on campus. Colleges should take a multi-pronged approach to promote sleep quality through individual, community, and institutional interventions.</p> <p>Keywords: College students; COVID-19; discrimination; health disparities; sleep</p> <hd id="AN0184444270-2">Introduction</hd> <p>Along with the uncertainty and dramatic transformation of daily life caused by the COVID-19 pandemic, emerging adult college students were also impacted by campus closures across institutions of higher education, leading many to move to home environments that had the potential to shift sleep patterns. Before the pandemic, sleep inequalities in college students were evident based on race/ethnicity,[<reflink idref="bib1" id="ref1">1</reflink>]<sups>,</sups>[<reflink idref="bib2" id="ref2">2</reflink>] socioeconomic position (SEP),[<reflink idref="bib3" id="ref3">3</reflink>] gender,[<reflink idref="bib2" id="ref4">2</reflink>]<sups>,</sups>[<reflink idref="bib4" id="ref5">4</reflink>] and sexual orientation.[<reflink idref="bib5" id="ref6">5</reflink>] These preexisting sleep inequalities suggest that certain emerging adult college students experienced heightened risk for poor sleep during the COVID-19 pandemic.</p> <hd id="AN0184444270-3">Sleep in college students</hd> <p>Insufficient sleep is an epidemic occurring on college campuses. Research using the Pittsburgh Sleep Quality Index (PSQI)[<reflink idref="bib6" id="ref7">6</reflink>] reports that up to 62% of college students experience poor sleep,[<reflink idref="bib4" id="ref8">4</reflink>] most frequently attributed to stress (35%) and excess noise (33%).[<reflink idref="bib7" id="ref9">7</reflink>] Other college-related experiences, such as increased autonomy and technology use, have also been found to contribute to poor sleep.[<reflink idref="bib8" id="ref10">8</reflink>] The PSQI assesses seven components: sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction.[<reflink idref="bib6" id="ref11">6</reflink>] Large studies of college students report considerable variability across scores on these seven components. Becker et al., for example, found that college students, on average, reported high sleep latency and sleep disturbances and low sleep quality, but little use of sleep medication and moderately high sleep efficiency.[<reflink idref="bib4" id="ref12">4</reflink>] This variability highlights the importance of studying the individual components of sleep health alongside overall sleep quality to fully understand the impacts of the COVID-19 pandemic on emerging adult college students' sleep.</p> <p>Existing research underscores the importance of high-quality sleep for emerging adults college students' well-being. College students with lower sleep quality have significantly more physical and mental health problems than peers with higher sleep quality.[<reflink idref="bib7" id="ref13">7</reflink>] For example, low sleep quality among college students predicts depression,[<reflink idref="bib9" id="ref14">9</reflink>] and students who experience greater sleep disturbances are more likely to engage in other risky health behaviors, including physical inactivity, smoking, and, among men, heavy drinking.[<reflink idref="bib10" id="ref15">10</reflink>] Sleep disturbances and poor sleep quality also have negative impacts on academic performance, course progress, and academic self-efficacy.[<reflink idref="bib11" id="ref16">11</reflink>] Importantly, sleep deprivation can lead to impaired immune function and increased risk of illness,[<reflink idref="bib12" id="ref17">12</reflink>] which can put students at a higher risk of contracting diseases like COVID-19.[<reflink idref="bib13" id="ref18">13</reflink>]</p> <hd id="AN0184444270-4">Sleep quality in the context of the COVID-19 pandemic</hd> <p>Pre-pandemic research found that large-scale social stressors[<reflink idref="bib14" id="ref19">14</reflink>] and traumatic events[<reflink idref="bib15" id="ref20">15</reflink>] can lead to declines in sleep quality and greater sleep disturbances. College students, in particular, may be at higher risk of experiencing sleep problems because their media consumption increased over the course of the pandemic,[<reflink idref="bib16" id="ref21">16</reflink>] and exposure to media coverage of the pandemic is linked to a greater number of sleep problems.[<reflink idref="bib17" id="ref22">17</reflink>] Increased media consumption, along with the increased reliance on technology to maintain social connections, also heightened exposure to electronic devices during the COVID-19 pandemic.[<reflink idref="bib18" id="ref23">18</reflink>]<sups>,</sups>[<reflink idref="bib19" id="ref24">19</reflink>] Exposure to electronic devices, particularly in the hour before sleeping, has negative consequences for sleep quality, such as shorter sleep duration and longer sleep latency,[<reflink idref="bib20" id="ref25">20</reflink>] due to the blue light emitted from device screens.[<reflink idref="bib21" id="ref26">21</reflink>]<sups>,</sups>[<reflink idref="bib22" id="ref27">22</reflink>]</p> <p>Indeed, recent research suggests that the COVID-19 pandemic has had broad impacts on sleep health among college students. A study of U.S. students conducted in the spring of 2020 found greater sleep disruptions and lower sleep quality, with 86% of students reporting disruptions to their sleep patterns and 38% describing these disruptions as severe.[<reflink idref="bib9" id="ref28">9</reflink>] Others found significant changes in sleep duration, bedtimes, wake times,[<reflink idref="bib23" id="ref29">23</reflink>]<sups>,</sups>[<reflink idref="bib24" id="ref30">24</reflink>] daytime dysfunction, and subjective sleep quality[<reflink idref="bib25" id="ref31">25</reflink>] as compared to before the pandemic. Declines in sleep quality at the start of the COVID-19 pandemic may be explained by campus closures, which contributed to a sense of loss of independence among students who returned to their familial homes,[<reflink idref="bib9" id="ref32">9</reflink>] potentially increasing interpersonal conflict which is associated with worse sleep quality.[<reflink idref="bib26" id="ref33">26</reflink>] Furthermore, the COVID-19 pandemic introduced additional stressors into the lives of college students, including financial insecurity,[<reflink idref="bib27" id="ref34">27</reflink>] increased fear for their health and the health of their loved ones,[<reflink idref="bib9" id="ref35">9</reflink>] and increased stress and anxiety,[<reflink idref="bib27" id="ref36">27</reflink>] all of which are known to impact sleep quality.[<reflink idref="bib9" id="ref37">9</reflink>] It is worth noting, however, that other research reported no pandemic-related changes in college students' sleep quality,[<reflink idref="bib23" id="ref38">23</reflink>] or even increases in sleep duration.[<reflink idref="bib28" id="ref39">28</reflink>] Given these inconsistent findings, it is important to further examine new and widening inequalities in college students' sleep health during the pandemic, both in terms of overall sleep quality and the components of sleep.</p> <p>Pandemic-era inequalities in sleep health may have been further exacerbated by changing support for public health measures and other sociopolitical events occurring against the backdrop of the COVID-19 pandemic. In the early days of the pandemic, lockdowns were firmly in place throughout the USA and mask-wearing and social distancing measures were at a peak. Support for these measures, however, steadily decreased between spring and winter 2020[<reflink idref="bib29" id="ref40">29</reflink>] and the majority of U.S. states with mask mandates had lifted these orders by July 2021.[<reflink idref="bib30" id="ref41">30</reflink>] In the early summer of 2020, shortly after many states issued mask mandates and lockdown restrictions, the murder of George Floyd and subsequent protests in support of the Movement for Black Lives increased awareness of social inequality.[<reflink idref="bib31" id="ref42">31</reflink>] The pandemic also corresponded with a rise in anti-Asian sentiment, which was intensified by discriminatory rhetoric in the public discourse about COVID-19, such as the use of "Wuhan virus" and "China virus" to refer to the illness.[<reflink idref="bib32" id="ref43">32</reflink>] This culminated in a sharp increase in hate incidents against Asian Americans and Pacific Islanders between spring 2020 and fall 2021, with women and young adults aged 26–35 most often victims of these incidents.[<reflink idref="bib33" id="ref44">33</reflink>] In sum, the pandemic, along with subsequent sociopolitical stressors, created a unique context in which to study new and emerging inequalities in sleep health among emerging adult college students.</p> <hd id="AN0184444270-5">Inequalities in sleep among college students</hd> <p>Inequalities in college students' sleep were well-documented prior to the pandemic. There is evidence that college-going women experience worse sleep quality than college-going men;[<reflink idref="bib2" id="ref45">2</reflink>]<sups>,</sups>[<reflink idref="bib4" id="ref46">4</reflink>]<sups>,</sups>[<reflink idref="bib34" id="ref47">34</reflink>] however, both men and women report PSQI global scores that indicate poor sleep quality.[<reflink idref="bib34" id="ref48">34</reflink>] When comparing the components of sleep quality, women report longer sleep latency, lower sleep efficiency, and more frequent sleep disturbances, use of sleep medication, and daytime dysfunction than men.[<reflink idref="bib4" id="ref49">4</reflink>] Possible explanations for these inequalities include higher stress among college-going women than men[<reflink idref="bib7" id="ref50">7</reflink>] and more frequent use of maladaptive coping methods such as rumination among women.[<reflink idref="bib35" id="ref51">35</reflink>] Findings regarding gender differences in sleep quality, however, are mixed, as others report no significant pre-pandemic differences.[<reflink idref="bib36" id="ref52">36</reflink>] The COVID-19 pandemic may also have widened preexisting gendered sleep inequalities; one study of nursing students in Spain found that women and men reported similar sleep quality, but that stay-at-home orders caused significant decreases in sleep quality only among women.[<reflink idref="bib37" id="ref53">37</reflink>]</p> <p>Transgender and gender diverse (TGD) individuals are shown to be at a greater risk of experiencing disrupted sleep than their cisgender peers, with 60% reporting using medications as a way to cope with their sleep problems.[<reflink idref="bib38" id="ref54">38</reflink>] Poor sleep quality among TGD college students may be exacerbated by experiences of gender-identity discrimination and stigmatization.[<reflink idref="bib39" id="ref55">39</reflink>] Lesbian, gay, bisexual, queer, and other sexual minority (LGBQ+) young adults are also at a higher risk for sleep problems than their heterosexual counterparts.[<reflink idref="bib5" id="ref56">5</reflink>] Lack of parental support[<reflink idref="bib40" id="ref57">40</reflink>] and poor social relationships[<reflink idref="bib41" id="ref58">41</reflink>] are associated with poor sleep health in LGBQ + young adults. Thus, campus closures may have worsened sleep health among TGD and LGBQ + students who may have returned to unsupportive households or lost access to supportive on-campus relationships.</p> <p>Sleep disparities also exist by SEP. On average, lower-SEP students have a higher rate of sleep problems than middle- or higher-SEP students.[<reflink idref="bib3" id="ref59">3</reflink>] Lower-SEP college students are also more likely to encounter various environmental factors that negatively affect sleep, such as excess noise or household crowding.[<reflink idref="bib42" id="ref60">42</reflink>] Lower-SEP students may also experience greater financial stress, which can further impede sleep quality.[<reflink idref="bib3" id="ref61">3</reflink>]</p> <p>There is mixed evidence of racial/ethnic differences in pre-pandemic sleep quality among college students. Some research has found that racial/ethnic minority students report greater sleep difficulties than their White[<reflink idref="bib2" id="ref62">2</reflink>] or Asian peers[<reflink idref="bib43" id="ref63">43</reflink>] and that Black college students report poorer sleep outcomes compared to White students.[<reflink idref="bib1" id="ref64">1</reflink>]<sups>,</sups>[<reflink idref="bib2" id="ref65">2</reflink>] These inequalities are often attributed to Black students' experiences of institutional and interpersonal discrimination[<reflink idref="bib44" id="ref66">44</reflink>] and Asian-American students' experiences of racial microaggressions.[<reflink idref="bib45" id="ref67">45</reflink>] Meanwhile, other work has found no significant differences in sleep duration between White, Asian, and Hispanic/Latino/a/x/e students and no differences in insomnia symptoms across groups.[<reflink idref="bib1" id="ref68">1</reflink>] People of color, however, were disproportionately affected by the COVID-19 pandemic,[<reflink idref="bib46" id="ref69">46</reflink>] which may have created or further exacerbated sleep inequalities between racial/ethnic minority college students and their White peers.</p> <hd id="AN0184444270-6">The current study</hd> <p>This study examines perceived sleep quality in a diverse, national sample of U.S. college students during the first peak of the COVID-19 pandemic in late April 2020 and again 16 months later in summer 2021. We examine inequalities in overall sleep quality and seven components of sleep health across gender, sexual orientation, race/ethnicity, and SEP. To explore potential mechanisms of these observed inequalities, we also test the associations between subjective experiences of discrimination at each timepoint and concurrent sleep health.</p> <hd id="AN0184444270-7">Materials and methods</hd> <p></p> <hd id="AN0184444270-8">Participants and procedure</hd> <p>Data for this study were drawn from a larger study documenting the experiences and perspectives of emerging adult college students in the USA. The purpose of the larger study was to gain insight into the health and psychosocial implications of the COVID-19 pandemic for college students, and to use these data to inform how public health officials and institutions of higher education responded to the pandemic.[<reflink idref="bib47" id="ref70">47</reflink>] Full-time college students aged 18–22 were recruited in the Spring of 2020 through targeted advertisements on Instagram. In 2019, 67% of adults ages 18–29 and over 80% of college students used Instagram,[<reflink idref="bib48" id="ref71">48</reflink>]<sups>,</sups>[<reflink idref="bib49" id="ref72">49</reflink>] and paid advertisements on Instagram have been shown to be highly successful in recruiting harder-to-reach participants, such as gender or sexual minority young adults,[<reflink idref="bib50" id="ref73">50</reflink>] making Instagram an effective tool for reaching diverse emerging adults. Baseline data were collected between 25 and 30 April 2020, before parts of the USA began reopening. All participants were invited to participate in a follow-up survey during the summer of 2021; these data were collected between 16 July and 31 August 2021. Participants received a $10 Amazon.com gift card upon completion of the baseline survey and a $5 Amazon.com gift card upon completion of the follow-up survey. The Fordham University Institutional Review Board approved the study. An extensive description of the larger study design, along with a comparison of the sociodemographic characteristics of the study sample at baseline to national data on full-time college students in the USA, can be found elsewhere.[<reflink idref="bib47" id="ref74">47</reflink>]</p> <p>The baseline sample consisted of 707 students (<emph>M</emph><subs>age </subs>= 20.0, SD = 1.3) from 374 different U.S. colleges. The majority of participants identified as women (61.0%); the rest identified as men (34.4%) or TGD (4.7%). The sample was also predominantly heterosexual (71.1%), with 28.9% identifying as LGBQ+. In terms of race/ethnicity, participants were instructed to select all racial/ethnic identities that applied from a list; we collapsed responses into five groups: White (including Middle Eastern/North African) which comprised the majority of the sample (55.4%), Black/African American (5.2%), Hispanic/Latinx (8.9%), Asian/Asian American/Pacific Islander (AAPI; 20.4%), and multiracial (those who identified with two or more racial/ethnic groups; 10.0%).</p> <p>We used participants' pre-COVID-19 household income as a proxy for SEP. Participants reported household income by choosing one of five options (less than $26,000, $26,000–$53,999, $54,000–$99,999, $100,000–$249,999, $250,000 and above). Income ranges were divided for analysis purposes as follows: 33.8% of the sample was classified as lower-SEP (household income less than $54,000, or approximately 200% of the federal poverty level (FPL) for a family of four in 2020), 28.7% were middle-SEP (between $54,000 and $99,999), and 37.5% were higher-SEP (household income of $100,000 higher).</p> <p>Almost half of the baseline sample participated in the summer 2021 follow-up survey (<emph>n</emph> = 352; 49.8%), however, only 313 of these participants (44.3% of the baseline sample) provided sleep data and were included in the current study. Attrition analyses of the longitudinal sample revealed no differences between the baseline and follow-up samples in terms of sexual orientation, race/ethnicity, SEP, or baseline sleep quality. There were, however, significantly fewer men in the follow-up sample. Demographic characteristics of the baseline and follow-up samples are presented in Table 1.</p> <p>Table 1. Participant characteristics.</p> <p> <ephtml> <table><thead><tr><td /><td>Baseline (<italic>N</italic> = 707)</td><td>Follow-up (<italic>n</italic> = 313)</td></tr><tr><td><italic>N</italic></td><td>%</td><td><italic>n</italic></td><td>%</td></tr></thead><tbody valign="top"><tr><td>Gender</td><td /><td /><td /><td /></tr><tr><td> Man</td><td char=".">243</td><td char=".">34.4</td><td char=".">91</td><td char=".">29.1</td></tr><tr><td> Woman</td><td char=".">431</td><td char=".">61.0</td><td char=".">205</td><td char=".">65.5</td></tr><tr><td> TGD<sup>a</sup></td><td char=".">33</td><td char=".">4.7</td><td char=".">17</td><td char=".">5.4</td></tr><tr><td>Sexual orientation</td><td /><td /><td /><td /></tr><tr><td> Straight/heterosexual</td><td char=".">503</td><td char=".">71.1</td><td char=".">214</td><td char=".">68.4</td></tr><tr><td> LGBQ+<sup>b</sup></td><td char=".">204</td><td char=".">28.9</td><td char=".">99</td><td char=".">31.6</td></tr><tr><td>Race/ethnicity</td><td /><td /><td /><td /></tr><tr><td> White<sup>c</sup></td><td char=".">392</td><td char=".">55.4</td><td char=".">170</td><td char=".">54.3</td></tr><tr><td> Black</td><td char=".">37</td><td char=".">5.2</td><td char=".">12</td><td char=".">3.8</td></tr><tr><td> AAPI<sup>d</sup></td><td char=".">144</td><td char=".">20.4</td><td char=".">68</td><td char=".">21.7</td></tr><tr><td> Hispanic/Latinx</td><td char=".">63</td><td char=".">8.9</td><td char=".">29</td><td char=".">9.3</td></tr><tr><td> Multiracial<sup>e</sup></td><td char=".">71</td><td char=".">10.0</td><td char=".">34</td><td char=".">10.9</td></tr><tr><td>SEP (pre-COVID-19 household income)<sup>f</sup></td><td /><td /><td /><td /></tr><tr><td> Lower-SEP (< $54,000)</td><td char=".">239</td><td char=".">33.8</td><td char=".">97</td><td char=".">31.0</td></tr><tr><td> Middle-SEP ($54,000–99,999)</td><td char=".">203</td><td char=".">28.7</td><td char=".">99</td><td char=".">31.6</td></tr><tr><td> Higher-SEP ($100,000 and over)</td><td char=".">265</td><td char=".">37.5</td><td char=".">117</td><td char=".">37.4</td></tr><tr><td>Student status at baseline</td><td /><td /><td /><td /></tr><tr><td> First-year</td><td char=".">196</td><td char=".">27.7</td><td>–</td><td>–</td></tr><tr><td> Sophomore</td><td char=".">186</td><td char=".">26.3</td><td>–</td><td>–</td></tr><tr><td> Junior</td><td char=".">161</td><td char=".">22.8</td><td>–</td><td>–</td></tr><tr><td> Senior</td><td char=".">158</td><td char=".">22.3</td><td>–</td><td>–</td></tr><tr><td> Other</td><td char=".">6</td><td char=".">0.8</td><td>–</td><td>–</td></tr><tr><td>Student status at follow-up</td><td /><td /><td /><td /></tr><tr><td> Not a student</td><td>–</td><td>–</td><td char=".">61</td><td char=".">19.5</td></tr><tr><td> Undergraduate</td><td>–</td><td>–</td><td char=".">218</td><td char=".">69.6</td></tr><tr><td> Graduate</td><td>–</td><td>–</td><td char=".">34</td><td char=".">10.9</td></tr></tbody></table> </ephtml> </p> <p>1 TGD includes gender non-binary, genderqueer, and transgender; <sups>b</sups>LGBQ + includes bisexual, gay/lesbian, questioning, pansexual, asexual, or another sexual identity; <sups>c</sups>White includes Middle Eastern/North African participants; <sups>d</sups>AAPI is Asian/Asian American or Pacific Islander; <sups>e</sups>Multiracial includes all students who reported two or more racial and/or ethnic groups; <sups>f</sups>SEP refers to socioeconomic position.</p> <hd id="AN0184444270-9">Measures</hd> <p>We used the PSQI[<reflink idref="bib6" id="ref75">6</reflink>] to measure participants' total perceived sleep quality. The PSQI is a widely-used measure that assesses various dimensions of sleep over the past month and has been validated for use with college students.[<reflink idref="bib36" id="ref76">36</reflink>] The PSQI measures seven components of sleep: sleep quality, sleep latency (i.e., minutes to fall asleep), sleep duration, sleep efficiency, sleep disturbance, use of sleep medication, and daytime dysfunction. Responses for each component are scored on a scale of zero to three, with higher scores indicating worse sleep. Component scores are then tallied, yielding a global score that can range from 0 to 21. A global score greater than 5 indicates poor sleep quality.[<reflink idref="bib4" id="ref77">4</reflink>]</p> <p>A modified version of the Everyday Discrimination Scale[<reflink idref="bib51" id="ref78">51</reflink>] was used to measure participants' subjective experiences of daily discrimination, given public health restrictions during the pandemic (e.g., social distancing). We excluded three of the nine original items ("You receive worse service than other people in restaurants or stores," "People act as though they think you are not intelligent," and "People act as though they think you are dishonest"). Thus, participants were asked to report how frequently they experienced six forms of discrimination in day-to-day life on a scale of "never" (coded as 0) to "almost every day" (coded as 4); we used the mean scores in analyses. In the current sample, Cronbach's alpha was equal to 0.86 at baseline and 0.90 at follow-up. Participants were also asked to report the main reason for these experiences of discrimination by selecting one of the following options: race or ethnicity, language, gender, religion, coughing or showing other signs of illness, face mask or clothing, and another reason.</p> <p>Participants self-reported their gender identity, sexual orientation, race/ethnicity, and SEP (see Table 1 for categories).</p> <hd id="AN0184444270-10">Data analysis</hd> <p>Multiple regression analysis was used to predict global PSQI scores from sociodemographic variables and subjective experiences of discrimination at both baseline and follow-up. Ordered logistic regressions were used to examine differences between sociodemographic groups in the seven components of sleep, and to test whether experiences of discrimination predicted scores on the components of sleep at both timepoints. We controlled for sociodemographic variables in analyses predicting sleep health from subjective experiences of discrimination, and covaried for participants' baseline score on the outcome variable in all analyses using data from the follow-up survey. We also conducted two-way ANOVAs using data from the subset of participants who completed both the baseline and follow-up survey (<emph>n</emph> = 313) to test whether mean PSQI global and component scores differed across demographic groups, and ANCOVAs to test for group differences in mean PSQI global and component scores after controlling for subjective experiences of discrimination. Both ANOVAs and ANCOVAs were conducted with the Bonferroni correction given the large number of pairwise comparisons required.</p> <hd id="AN0184444270-11">Results</hd> <p>The PSQI global score mean for the baseline sample was 8.30 (SD = 3.57), with 78% of participants meeting the cutoff for poor sleep quality (global PSQI score >5). At follow-up, 82% of participants were classified as poor sleepers, with a PSQI global score mean of 8.56 (SD = 3.41). Descriptive statistics for the PSQI global and component scores are provided in Table 2, and Supplementary Table A1 presents results from chi square tests of independence examining differences in the proportion of participants classified as good and poor sleepers based on a global PSQI score > 5, stratified by participant sociodemographic characteristics. Results showed that a significantly larger proportion of women were classified as poor sleepers (80.4%) than men (71.7%) at baseline. At both baseline and follow-up, a larger proportion of LGBQ + participants were classified as poor sleepers (88.2% and 91.6%, respectively) than their heterosexual peers (73.5% and 78.0%, respectively). And, at baseline, a significantly larger proportion of participants from lower-SEP households (81.2%) were classified as poor sleepers than those from higher-SEP households (72.5%).</p> <p>Table 2. Descriptive statistics for all study variables.</p> <p> <ephtml> <table><thead><tr><td /><td>Baseline</td><td>Follow-up</td></tr><tr><td><italic>N</italic></td><td><italic>M (SD)</italic></td><td>Min–max</td><td><italic>n</italic></td><td><italic>%</italic></td><td><italic>N</italic></td><td><italic>M (SD)</italic></td><td>Min–max</td><td><italic>n</italic></td><td><italic>%</italic></td></tr></thead><tbody valign="top"><tr><td>Pittsburgh Sleep Quality Index (PSQI) components</td></tr><tr><td> Subjective sleep quality</td><td char=".">707</td><td char=".">1.38 (0.74)</td><td char=".">0–3</td><td /><td /><td char=".">313</td><td char=".">1.34 (0.70)</td><td char=".">0–3</td><td /><td /></tr><tr><td> 0</td><td /><td /><td /><td char=".">58</td><td char=".">8.2</td><td /><td /><td /><td char=".">25</td><td char=".">8.0</td></tr><tr><td> 1</td><td /><td /><td /><td char=".">375</td><td char=".">53.0</td><td /><td /><td /><td char=".">172</td><td char=".">55.0</td></tr><tr><td> 2</td><td /><td /><td /><td char=".">222</td><td char=".">31.4</td><td /><td /><td /><td char=".">100</td><td char=".">31.9</td></tr><tr><td> 3</td><td /><td /><td /><td char=".">52</td><td char=".">7.4</td><td /><td /><td /><td char=".">16</td><td char=".">5.1</td></tr><tr><td> Sleep latency</td><td char=".">707</td><td char=".">1.67 (1.02)</td><td char=".">0–3</td><td /><td /><td char=".">313</td><td char=".">1.48 (0.95)</td><td char=".">0–3</td><td /><td /></tr><tr><td> 0</td><td /><td /><td /><td char=".">110</td><td char=".">15.6</td><td /><td /><td /><td char=".">50</td><td char=".">16.0</td></tr><tr><td> 1</td><td /><td /><td /><td char=".">195</td><td char=".">27.6</td><td /><td /><td /><td char=".">115</td><td char=".">36.7</td></tr><tr><td> 2</td><td /><td /><td /><td char=".">220</td><td char=".">31.1</td><td /><td /><td /><td char=".">97</td><td char=".">31.0</td></tr><tr><td> 3</td><td /><td /><td /><td char=".">182</td><td char=".">25.7</td><td /><td /><td /><td char=".">51</td><td char=".">16.3</td></tr><tr><td> Sleep duration<sup>a</sup></td><td char=".">702</td><td char=".">0.43 (0.77)</td><td char=".">0–3</td><td /><td /><td char=".">304</td><td char=".">0.52 (0.77)</td><td char=".">0–3</td><td /><td /></tr><tr><td> 0</td><td /><td /><td /><td char=".">499</td><td char=".">71.1</td><td /><td /><td /><td char=".">192</td><td char=".">63.2</td></tr><tr><td> 1</td><td /><td /><td /><td char=".">126</td><td char=".">17.9</td><td /><td /><td /><td char=".">73</td><td char=".">24.0</td></tr><tr><td> 2</td><td /><td /><td /><td char=".">54</td><td char=".">7.7</td><td /><td /><td /><td char=".">33</td><td char=".">10.9</td></tr><tr><td> 3</td><td /><td /><td /><td char=".">23</td><td char=".">3.3</td><td /><td /><td /><td char=".">6</td><td char=".">2.0</td></tr><tr><td> Sleep efficiency<sup>a</sup></td><td char=".">702</td><td char=".">0.61 (0.89)</td><td char=".">0–3</td><td /><td /><td char=".">304</td><td char=".">0.58 (0.82)</td><td char=".">0–3</td><td /><td /></tr><tr><td> 0</td><td /><td /><td /><td char=".">433</td><td char=".">61.7</td><td /><td /><td /><td char=".">179</td><td char=".">58.9</td></tr><tr><td> 1</td><td /><td /><td /><td char=".">151</td><td char=".">21.5</td><td /><td /><td /><td char=".">85</td><td char=".">28.0</td></tr><tr><td> 2</td><td /><td /><td /><td char=".">79</td><td char=".">11.3</td><td /><td /><td /><td char=".">28</td><td char=".">9.2</td></tr><tr><td> 3</td><td /><td /><td /><td char=".">39</td><td char=".">5.6</td><td /><td /><td /><td char=".">12</td><td char=".">3.9</td></tr><tr><td> Sleep disturbances</td><td char=".">707</td><td char=".">1.26 (0.61)</td><td char=".">0–3</td><td /><td /><td char=".">313</td><td char=".">1.31 (0.57)</td><td char=".">0–3</td><td /><td /></tr><tr><td> 0</td><td /><td /><td /><td char=".">43</td><td char=".">6.1</td><td /><td /><td /><td char=".">7</td><td char=".">2.2</td></tr><tr><td> 1</td><td /><td /><td /><td char=".">455</td><td char=".">64.4</td><td /><td /><td /><td char=".">214</td><td char=".">68.4</td></tr><tr><td> 2</td><td /><td /><td /><td char=".">189</td><td char=".">26.7</td><td /><td /><td /><td char=".">81</td><td char=".">25.9</td></tr><tr><td> 3</td><td /><td /><td /><td char=".">20</td><td char=".">2.8</td><td /><td /><td /><td char=".">11</td><td char=".">3.5</td></tr><tr><td> Sleep medication use</td><td char=".">707</td><td char=".">0.52 (0.87)</td><td char=".">0–3</td><td /><td /><td char=".">313</td><td char=".">0.82 (0.93)</td><td char=".">0–3</td><td /><td /></tr><tr><td> 0</td><td /><td /><td /><td char=".">483</td><td char=".">68.3</td><td /><td /><td /><td char=".">147</td><td char=".">47.0</td></tr><tr><td> 1</td><td /><td /><td /><td char=".">121</td><td char=".">17.1</td><td /><td /><td /><td char=".">94</td><td char=".">30.0</td></tr><tr><td> 2</td><td /><td /><td /><td char=".">64</td><td char=".">9.1</td><td /><td /><td /><td char=".">52</td><td char=".">16.6</td></tr><tr><td> 3</td><td /><td /><td /><td char=".">39</td><td char=".">5.5</td><td /><td /><td /><td char=".">20</td><td char=".">6.4</td></tr><tr><td> Daytime dysfunction</td><td char=".">702</td><td char=".">2.43 (0.91)</td><td char=".">0–3</td><td /><td /><td char=".">313</td><td char=".">2.58 (0.74)</td><td char=".">0–3</td><td /><td /></tr><tr><td> 0</td><td /><td /><td /><td char=".">8</td><td char=".">1.1</td><td /><td /><td /><td char=".">7</td><td char=".">2.2</td></tr><tr><td> 1</td><td /><td /><td /><td char=".">19</td><td char=".">2.7</td><td /><td /><td /><td char=".">27</td><td char=".">8.6</td></tr><tr><td> 2</td><td /><td /><td /><td char=".">71</td><td char=".">10.1</td><td /><td /><td /><td char=".">58</td><td char=".">18.5</td></tr><tr><td> 3</td><td /><td /><td /><td char=".">604</td><td char=".">86.0</td><td /><td /><td /><td char=".">221</td><td char=".">70.6</td></tr><tr><td> Global sleep quality<sup>b</sup></td><td char=".">702</td><td char=".">8.30 (3.57)</td><td char=".">0–20</td><td /><td /><td char=".">304</td><td char=".">8.56 (3.41)</td><td char=".">0–18</td><td /><td /></tr><tr><td> Poor sleep<sup>b,c</sup></td><td char=".">702</td><td char=".">0.78 (0.42)</td><td char=".">0–1</td><td /><td /><td char=".">304</td><td char=".">0.82 (0.38)</td><td char=".">0–1</td><td /><td /></tr><tr><td> Yes</td><td /><td /><td /><td char=".">546</td><td char=".">77.8</td><td /><td /><td /><td char=".">250</td><td char=".">82.2</td></tr><tr><td> No</td><td /><td /><td /><td char=".">156</td><td char=".">22.2</td><td /><td /><td /><td char=".">54</td><td char=".">17.8</td></tr><tr><td>Everyday Discrimination Scale</td><td char=".">707</td><td char=".">0.52 (0.73)</td><td char=".">0–4</td><td /><td /><td char=".">313</td><td char=".">0.93 (0.84)</td><td char=".">0–4</td><td /><td /></tr></tbody></table> </ephtml> </p> <p>2 Frequency counts and percentages reported for each level of the PSQI components and PSQI sleep classification.<sups>a</sups>Participants reporting that they slept less than 4 hours per night during the last month were excluded from analyses examining sleep duration and efficiency. <sups>b</sups>Global sleep quality and poor sleep were not calculated for participants missing scores on any of the PSQI components. <sups>c</sups>Refers to participants with PSQI global score > 5.</p> <hd id="AN0184444270-12">Group differences in sleep quality</hd> <p>Detailed results from the regressions at baseline and follow-up are presented in Tables 3 and [<reflink idref="bib4" id="ref79">4</reflink>], respectively. Overall, sleep inequalities were more pronounced at baseline and most of the inequalities in the components of sleep quality at follow-up became non-significant after accounting for baseline sleep quality (c.f. Supplementary Table A2, which presents inequalities in the components of sleep quality at follow-up without covarying for baseline sleep quality).</p> <p>Table 3. Regressions predicting Pittsburgh Sleep Quality Index (PSQI) global and component scores from demographic characteristics at baseline.</p> <p> <ephtml> <table><thead><tr><td /><td>Poor global sleep quality (b)</td><td>Poor subjective sleep quality (OR)</td><td>Longer sleep latency (OR)</td><td>Short sleep duration (OR)</td><td>Poor sleep efficiency (OR)</td><td>Frequent sleep disturbances (OR)</td><td>Frequent medication use (OR)</td><td>Greater daytime dysfunction (OR)</td></tr></thead><tbody valign="top"><tr><td><italic>n</italic></td><td char=".">702</td><td char=".">707</td><td char=".">707</td><td char=".">702</td><td char=".">702</td><td char=".">707</td><td char=".">707</td><td char=".">707</td></tr><tr><td>Gender</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Woman</td><td char=".">1.14 (0.28)***</td><td char=".">1.46 (0.23)*</td><td char=".">1.55 (0.23)**</td><td char=".">0.98 (0.18)</td><td char=".">1.17 (0.19)</td><td char=".">1.95 (0.35)***</td><td char=".">1.42 (0.25)</td><td char=".">1.83 (0.31)***</td></tr><tr><td> TGD<sup>a</sup></td><td char=".">2.42 (0.68)***</td><td char=".">2.77 (1.08)**</td><td char=".">1.62 (0.29)</td><td char=".">2.17 (0.81)*</td><td char=".">2.93 (1.08)**</td><td char=".">1.84 (0.75)</td><td char=".">2.38 (0.92)*</td><td char=".">1.83 (0.93)</td></tr><tr><td> (Man)</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td></tr><tr><td>Sexual orientation</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> LGBQ+<sup>b</sup></td><td char=".">1.14 (0.31)***</td><td char=".">1.64 (0.28)**</td><td char=".">1.67 (0.27)**</td><td char=".">1.40 (0.27)</td><td char=".">1.39 (0.24)</td><td char=".">1.90 (0.35)**</td><td char=".">1.46 (0.27)*</td><td char=".">1.82 (0.38)**</td></tr><tr><td> (Heterosexual)</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td></tr><tr><td>Race/ethnicity</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Black</td><td char=".">0.43 (0.59)</td><td char=".">1.80 (0.59)</td><td char=".">0.68 (0.21)</td><td char=".">1.79 (0.65)</td><td char=".">2.55 (0.85)**</td><td char=".">0.63 (0.24)</td><td char=".">0.81 (0.31)</td><td char=".">0.77 (0.28)</td></tr><tr><td> AAPI<sup>c</sup></td><td char=".">−0.71 (0.34)*</td><td char=".">0.88 (0.17)</td><td char=".">0.76 (0.14)</td><td char=".">0.98 (0.22)</td><td char=".">1.17 (0.24)</td><td char=".">0.52 (0.11)**</td><td char=".">1.00 (0.21)</td><td char=".">0.38 (0.08)***</td></tr><tr><td> Hispanic/Latinx</td><td char=".">−0.60 (0.48)</td><td char=".">1.00 (0.27)</td><td char=".">0.72 (0.19)</td><td char=".">0.93 (0.28)</td><td char=".">1.16 (0.33)</td><td char=".">0.57 (0.17)</td><td char=".">0.89 (0.27)</td><td char=".">0.64 (0.19)</td></tr><tr><td> Multiracial<sup>d</sup></td><td char=".">−0.51 (0.44)</td><td char=".">0.91 (0.23)</td><td char=".">0.71 (0.71)</td><td char=".">0.83 (0.24)</td><td char=".">0.83 (0.22)</td><td char=".">0.87 (0.23)</td><td char=".">0.90 (0.25)</td><td char=".">0.72 (0.20)</td></tr><tr><td> (White<sup>e</sup>)</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td></tr><tr><td>SEP (pre-COVID-19 household income)<sup>f</sup></td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Lower-SEP (<$54,000)</td><td char=".">1.02 (0.31)**</td><td char=".">1.05 (0.18)</td><td char=".">1.20 (0.20)</td><td char=".">1.47 (0.30)</td><td char=".">1.11 (0.20)</td><td char=".">2.38 (0.47)***</td><td char=".">1.46 (0.29)</td><td char=".">1.94 (0.30)**</td></tr><tr><td> Middle-SEP ($54,000–99,999)</td><td char=".">0.72 (0.32)*</td><td char=".">0.89 (0.16)</td><td char=".">1.10 (0.19)</td><td char=".">1.29 (0.27)</td><td char=".">0.96 (0.18)</td><td char=".">2.00 (0.40)**</td><td char=".">1.70 (0.34)**</td><td char=".">1.60 (0.32)*</td></tr><tr><td> (Higher-SEP; $100,000 and over)</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td></tr><tr><td>R-squared<sup>g</sup></td><td char=".">0.08</td><td char=".">0.02</td><td char=".">0.02</td><td char=".">0.02</td><td char=".">0.02</td><td char=".">0.05</td><td char=".">0.02</td><td char=".">0.04</td></tr></tbody></table> </ephtml> </p> <p>3 <emph>p</emph> <.05, **<emph>p</emph> <.01, ***<emph>p</emph> <.001. Multivariable linear regression was used for PSQI global sleep quality score (reported in unstandardized beta coefficients) and multivariable ordered logistic regression was used for PSQI component scores (reported in ORs); reference group in parentheses. Standard errors are reported alongside coefficients and odds ratios in parentheses. <sups>a</sups>TGD includes gender non-binary, genderqueer, and transgender; <sups>b</sups>LGBQ + includes bisexual, gay/lesbian, questioning, pansexual, asexual, or another sexual identity; <sups>c</sups>AAPI is Asian/Asian American or Pacific Islander; <sups>d</sups>Multiracial includes all students who reported two or more racial and/or ethnic groups; <sups>e</sups>White includes Middle Eastern/North African participants; <sups>f</sups>SEP refers to socioeconomic position; <sups>g</sups>Adjusted R-squared values reported for multivariable linear regression and pseudo-R-squared values reported for multivariable ordered logistic regressions.</p> <p>We also examined mean differences in PSQI global and component scores across demographic groups using ANOVAs, reported in Table A3. Results from ANCOVAs examining mean differences in PSQI global and component scores, controlling for Everyday Discrimination Scale scores, across demographic groups are also described below and presented in Table A7.</p> <p> <bold> <emph>Gender.</emph> </bold> At baseline, women (<emph>b</emph> = 1.14, <emph>p</emph> <.001) and TGD participants (<emph>b</emph> = 2.42, <emph>p</emph> <.001) reported poorer global sleep quality than men. Women also had higher odds of reporting poorer subjective sleep quality (odds ratio [OR] = 1.46, <emph>p</emph> <.05), longer sleep latency (OR = 1.55, <emph>p</emph> <.01), more frequent sleep disturbances (OR = 1.95, <emph>p</emph> <.001), and greater daytime dysfunction (OR = 1.83, <emph>p</emph> <.001) at baseline as compared to men. TGD participants had more than twice the odds of reporting poor subjective sleep quality (OR = 2.77, <emph>p</emph> <.01), shorter sleep duration (OR = 2.17, <emph>p</emph> <.05), poor sleep efficiency (OR = 2.93, <emph>p</emph> <.05), and more frequent use of sleep medication (OR = 2.38, <emph>p</emph> <.05) as compared to men at baseline. These baseline inequalities were not observed at follow-up, however, a new inequality emerged: TGD participants had almost three times the odds of reporting longer sleep latency than participants identifying as men (OR = 2.99, <emph>p</emph> <.05).</p> <p>ANCOVAs examining mean differences in PSQI global scores similarly showed that women (<emph>M</emph> = 8.50, SD = 3.55) and TGD participants (<emph>M</emph> = 10.80, SD = 3.72) had significantly higher mean global sleep quality scores, which are indicative of poorer sleep health, than men (<emph>M</emph> = 7.31, SD = 3.09) at baseline; at follow-up men's global sleep quality scores (<emph>M</emph> = 7.82, SD = 3.30) were only significantly different from those of TGD participants (<emph>M</emph> = 10.60, SD = 3.26). There were also significant gender differences in PSQI component scores for subjective sleep quality, sleep latency, sleep disturbances, and sleep medication use (see Appendix Table A7).</p> <p> <bold> <emph>Sexual orientation</emph> </bold>. We observed several inequalities in the components of sleep that were only present at baseline: LGBQ + participants had greater odds of reporting longer sleep latency (OR = 1.67, <emph>p</emph> <.01), more frequent sleep disturbances (OR = 1.90, <emph>p</emph> < 0.01) and greater daytime dysfunction (OR = 1.82, <emph>p</emph> <.01) than heterosexual participants. At both timepoints, LGBQ + participants reported poorer global sleep quality than their heterosexual peers (baseline: <emph>b</emph> = 1.14, <emph>p</emph> <.001; follow-up: <emph>b</emph> = 0.87, <emph>p</emph> <.05). They also rated subjective sleep quality as poorer at both baseline (OR = 1.64, <emph>p</emph> <.01) and follow-up (OR = 1.84, <emph>p</emph> <.01), when compared to heterosexual participants. LGBQ + participants were also more likely than heterosexual participants to be using sleep medication more frequently at both baseline (OR = 1.46, <emph>p</emph> <.05) and follow-up (OR = 1.73, <emph>p</emph> <.05).</p> <p>Global sleep quality mean scores were also significantly higher among LGBQ + participants at both baseline (<emph>M</emph> = 9.63, <emph>SD</emph> = 3.56) and follow-up (<emph>M</emph> = 9.75, SD = 3.27), as compared to heterosexual participants (baseline: <emph>M</emph> = 7.65, SD = 3.32; follow-up: <emph>M</emph> = 8.01, <emph>SD</emph> = 3.34). LGBQ + participants also reported poorer subjective sleep quality, greater sleep latency, and greater sleep disturbances at both baseline and follow-up, as well as greater sleep medication use at baseline and greater daytime dysfunction at follow-up.</p> <p> <bold> <emph>Race/ethnicity.</emph> </bold> Overall, there were few statistically significant differences in sleep quality based on race/ethnicity. Notably, AAPI participants reported significantly better global sleep quality than White participants at baseline (<emph>b</emph> = −0.71, <emph>p</emph> <.05), but at follow-up, AAPI participants reported poorer global sleep quality than White participants (<emph>b</emph> = 1.23, <emph>p</emph> <.01). Similarly, AAPI participants had lower odds of reporting daytime dysfunction at baseline (OR = 0.38, <emph>p</emph> <.001), but had over twice the odds of reporting daytime dysfunction at follow-up (OR = 2.39, <emph>p</emph> <.05). Neither ANOVAs nor ANCOVAs identified any significant mean differences in PSQI global or component scores across racial/ethnic groups at either time point.</p> <p> <bold> <emph>Socioeconomic position.</emph> </bold> Differences in overall sleep quality emerged by baseline SEP such that both lower-SEP (<emph>b</emph> = 1.02, <emph>p</emph> <.01) and middle-SEP (<emph>b</emph> = 0.72, <emph>p</emph> <.05) participants had poorer global sleep quality than high-SEP participants at baseline. Both lower- (OR = 2.38, <emph>p</emph> <.001) and middle-SEP (OR = 2.00, <emph>p</emph> <.01) participants also had over twice the odds of reporting more frequent sleep disturbances as compared to higher-SEP participants at baseline. And, the odds of experiencing daytime dysfunction were greater among lower-SEP (OR = 1.94, <emph>p</emph> <.01) and middle-SEP (OR = 1.60, <emph>p</emph> <.05) participants at baseline than higher-SEP participants. Although all of the inequalities observed at baseline were non-significant at follow-up, a new inequality emerged: those from lower-SEP households had higher odds of reporting poor subjective sleep quality (OR = 1.81, <emph>p</emph> <.05).</p> <p>At baseline, there was a significant difference in global sleep quality scores between lower-SEP (<emph>M</emph> = 9.25, SD = 3.40) and higher-SEP participants (<emph>M</emph> = 8.31, SD = 3.72). In terms of PSQI components, lower-SEP participants also reported shorter sleep duration than higher-SEP participants,</p> <hd id="AN0184444270-13">Associations between experiences of discrimination and sleep quality</hd> <p>Participants reported relatively infrequent experiences of discrimination at baseline (<emph>M</emph> = 0.52, SD = 0.73), but the mean score at follow-up was 0.93 (SD = 0.84), or roughly the equivalent of "less than once a month". When asked to report the main reason they believed they had experienced discrimination, the most common reasons were their face mask/clothing (16.3%) or race/ethnicity (13.3%) at baseline, and their gender (25.6%) or race/ethnicity (19.8%) at follow-up (see Supplementary Table A4 for all responses).</p> <p>Table 4. Regressions predicting Pittsburgh Sleep Quality Index (PSQI) global and component scores at follow-up from demographic characteristics, controlling for baseline scores.</p> <p> <ephtml> <table><thead><tr><td /><td>Poor global sleep quality (b)</td><td>Poor subjective sleep quality (OR)</td><td>Longer sleep latency (OR)</td><td>Short sleep duration (OR)</td><td>Poor sleep efficiency (OR)</td><td>Frequent sleep disturbances (OR)</td><td>Frequent medication use (OR)</td><td>Greater daytime dysfunction (OR)</td></tr></thead><tbody valign="top"><tr><td><italic>n</italic></td><td char=".">303</td><td char=".">313</td><td char=".">313</td><td char=".">303</td><td char=".">303</td><td char=".">313</td><td char=".">313</td><td char=".">313</td></tr><tr><td>Gender</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Woman</td><td char=".">0.10 (0.37)</td><td char=".">1.05 (0.28)</td><td char=".">1.31 (0.32)</td><td char=".">1.07 (0.29)</td><td char=".">0.99 (0.26)</td><td char=".">1.51 (0.47)</td><td char=".">0.91 (0.22)</td><td char=".">1.06 (0.31)</td></tr><tr><td> TGD<sup>a</sup></td><td char=".">0.69 (0.82)</td><td char=".">1.65 (0.96)</td><td char=".">2.99 (1.65)*</td><td char=".">1.14 (0.66)</td><td char=".">1.39 (0.80)</td><td char=".">2.63 (1.57)</td><td char=".">0.58 (0.31)</td><td char=".">1.60 (1.22)</td></tr><tr><td> (Man)</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td></tr><tr><td>Sexual orientation</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> LGBQ+<sup>b</sup></td><td char=".">0.87 (0.39)*</td><td char=".">1.84 (0.49)*</td><td char=".">1.60 (0.41)</td><td char=".">1.50 (0.42)</td><td char=".">1.34 (0.36)</td><td char=".">1.52 (0.45)</td><td char=".">1.73 (0.44)*</td><td char=".">1.82 (0.62)</td></tr><tr><td> (Heterosexual)</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td></tr><tr><td>Race/ethnicity</td><td /><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Black</td><td char=".">0.51 (0.93)</td><td char=".">0.98 (0.60)</td><td char=".">0.50 (0.30)</td><td char=".">1.18 (0.83)</td><td char=".">2.29 (1.58)</td><td char=".">2.49 (1.54)</td><td char=".">1.04 (0.58)</td><td char=".">5.11 (5.54)</td></tr><tr><td> AAPI<sup>c</sup></td><td char=".">1.23 (0.43)**</td><td char=".">1.76 (0.52)</td><td char=".">1.46 (0.40)</td><td char=".">1.60 (0.50)</td><td char=".">1.57 (0.47)</td><td char=".">1.79 (0.60)</td><td char=".">1.55 (0.43)</td><td char=".">2.39 (0.88)*</td></tr><tr><td> Hispanic/Latinx</td><td char=".">0.84 (0.60)</td><td char=".">1.91 (0.79)</td><td char=".">1.84 (0.73)</td><td char=".">1.16 (0.51)</td><td char=".">1.62 (0.68)</td><td char=".">1.08 (0.51)</td><td char=".">0.85 (0.33)</td><td char=".">1.56 (0.76)</td></tr><tr><td> Multiracial<sup>d</sup></td><td char=".">0.22 (0.54)</td><td char=".">1.12 (0.43)</td><td char=".">0.87 (0.30)</td><td char=".">1.03 (0.40)</td><td char=".">1.53 (0.58)</td><td char=".">1.09 (0.46)</td><td char=".">0.99 (0.38)</td><td char=".">0.94 (0.39)</td></tr><tr><td> (White<sup>e</sup>)</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td></tr><tr><td>SEP (pre-COVID-19 household income)<sup>f</sup></td><td /><td /><td /><td /><td /><td /><td /></tr><tr><td> Lower-SEP (<$54,000)</td><td char=".">0.55 (0.42)</td><td char=".">1.81 (0.52)*</td><td char=".">1.07 (0.28)</td><td char=".">1.63 (0.49)</td><td char=".">1.67 (0.48)</td><td char=".">1.04 (0.34)</td><td char=".">1.28 (0.35)</td><td char=".">1.36 (0.48)</td></tr><tr><td> Middle-SEP ($54,000–99,999)</td><td char=".">−0.43 (0.40)</td><td char=".">0.95 (0.26)</td><td char=".">0.69 (0.18)</td><td char=".">0.98 (0.30)</td><td char=".">1.02 (0.29)</td><td char=".">0.85 (0.27)</td><td char=".">1.00 (0.27)</td><td char=".">0.85 (0.26)</td></tr><tr><td> (Higher-SEP; $100,000 and over)</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td></tr><tr><td>Baseline Score</td><td char=".">0.49 (0.05)***</td><td char=".">2.64 (0.43)***</td><td char=".">2.78 (0.33)***</td><td char=".">2.28 (0.38)***</td><td char=".">1.64 (0.21)***</td><td char=".">4.46 (1.05)***</td><td char=".">1.82 (0.23)***</td><td char=".">2.48 (0.37)***</td></tr><tr><td>R-squared<sup>g</sup></td><td char=".">0.31</td><td char=".">0.10</td><td char=".">0.14</td><td char=".">0.07</td><td char=".">0.05</td><td char=".">0.13</td><td char=".">0.05</td><td char=".">0.11</td></tr></tbody></table> </ephtml> </p> <p>4 <emph>p</emph> <.05, **<emph>p</emph> <.01, ***<emph>p</emph> <.001. Multivariable linear regression was used for PSQI global sleep quality score (reported in unstandardized beta coefficients) and multivariable ordered logistic regression was used for PSQI component scores (reported in ORs); reference group in parentheses. Standard errors are reported alongside coefficients and ORs in parentheses. <sups>a</sups>TGD includes gender non-binary, genderqueer, and transgender; <sups>b</sups>LGBQ + includes bisexual, gay/lesbian, questioning, pansexual, asexual, or another sexual identity; <sups>c</sups>AAPI is Asian/Asian American or Pacific Islander; <sups>d</sups>Multiracial includes all students who reported two or more racial and/or ethnic groups; <sups>e</sups>White includes Middle Eastern/North African participants; <sups>f</sups>SEP refers to socioeconomic position; <sups>g</sups>Adjusted R-squared values reported for multivariable linear regression and pseudo-R-squared values reported for multivariable ordered logistic regressions.</p> <p>At both baseline and follow-up, participants' subjective experiences of discrimination were significantly associated with poorer global sleep quality (<emph>b</emph> = 0.83 at baseline and <emph>b</emph> = 1.21 at follow-up, ps <.001), as well as individual components of sleep health (see Supplemental Table A5 for baseline and Table A6 for follow-up). At follow-up, discrimination was associated with poorer sleep quality across all seven components of sleep, even after accounting for baseline scores. Notably, participants who reported more frequent experiences of discrimination had more than two and a half times the odds of reporting frequent sleep disturbances (OR = 2.64, <emph>p</emph> <.01), more than twice the odds of using sleep medication more frequently (OR = 2.20, <emph>p</emph> <.001), and twice the odds of experiencing greater daytime dysfunction (OR = 2.00, <emph>p</emph> <.01).</p> <hd id="AN0184444270-14">Discussion</hd> <p>Emerging work has identified reduced sleep quality in college students as a result of the COVID-19 pandemic.[<reflink idref="bib9" id="ref80">9</reflink>]<sups>,</sups>[<reflink idref="bib23" id="ref81">23</reflink>]<sups>,</sups>[<reflink idref="bib24" id="ref82">24</reflink>] Our results support these findings: the vast majority of students in our sample had poor sleep quality in both 2020 and 2021, and those from marginalized backgrounds tended to experience worse sleep quality, particularly during the first peak of the COVID-19 pandemic in the USA in the spring of 2020. We also found evidence that experiences of discrimination contributed to these poor sleep outcomes. This association was particularly strong in 2021, perhaps because the COVID-19 pandemic and other sociopolitical events in the USA (e.g., anti-Black police violence; January 6 Capitol attack; debates around trans rights and women's health) occurring during this time heightened young adult college students' awareness of discrimination and inequality between spring 2020 and summer 2021.</p> <p>In spring 2020, women reported worse sleep quality, longer sleep latency, and more frequent sleep disturbances than men, as well as more frequent medication use and daytime dysfunction, which aligns with previous research finding that women college students may be experiencing more significant disturbances in sleep quality than men during the COVID-19 pandemic.[<reflink idref="bib37" id="ref83">37</reflink>] Interestingly, we did not observe these inequalities 16 months later in summer 2021. Pre-pandemic research has found that women are significantly more likely to report stress-related sleep troubles than men,[<reflink idref="bib7" id="ref84">7</reflink>]<sups>,</sups>[<reflink idref="bib35" id="ref85">35</reflink>] and other work drawing from our cohort found that women disproportionately experienced increased household responsibilities and domestic workloads at the onset of the pandemic.[<reflink idref="bib27" id="ref86">27</reflink>] Collectively, this suggests that the immediate changes to daily life caused by the pandemic and measures designed to mitigate the spread of COVID-19 disproportionately affected women's sleep during spring 2020.</p> <p>TGD students reported lower sleep quality, duration, and efficiency, and more frequent medication use than their cisgender peers in 2020, aligning with trends before the COVID-19 pandemic.[<reflink idref="bib38" id="ref87">38</reflink>] This may be due to the fact that college closure led to many TGD students returning to unsupportive households,[<reflink idref="bib40" id="ref88">40</reflink>] while simultaneously losing access to supportive staff and peer networks from their college campuses.[<reflink idref="bib52" id="ref89">52</reflink>] And, in 2021, a new inequality emerged: TGD participants were almost three times more likely to report longer sleep latency than men, suggesting that TGD college students' experiences over the course of 16 months during the pandemic may have contributed to changes in their ability to fall asleep. Our data indicate that experiences of discrimination may have contributed to this: in the summer of 2021, the most common reason for discrimination reported by participants was their gender identity (reported by 25.6% of all participants and 52.9% of TGD participants in 2021) and the odds of reporting longer sleep latency were 40% higher among those who reported more frequent experiences of discrimination. Compared to their cis-gender peers, TGD students also reported greater disruption in mental health services, meaning that they were dealing with a greater amount of stress with less support,[<reflink idref="bib53" id="ref90">53</reflink>] which may have also contributed to the widening of sleep inequalities over the course of the pandemic.</p> <p>In 2020, LGBQ + students in our study also experienced poor sleep quality and latency, as well as more frequent sleep disturbances, medication use, and daytime dysfunction than their heterosexual peers. This is consistent with work predating the pandemic, which found that LGBQ + young adults are at high risk for sleep problems.[<reflink idref="bib5" id="ref91">5</reflink>] In spring 2020, LGBQ + students in our sample also presented higher levels of perceived stress and anxiety compared to their heterosexual peers,[<reflink idref="bib27" id="ref92">27</reflink>] much of which may have been exacerbated by shelter-in-place experiences with parents who are unaffirming of LGBQ + young adults' identities.[<reflink idref="bib52" id="ref93">52</reflink>] These experiences may have worsened sleep inequalities, as we observed in summer 2021 that LGBQ + participants had higher odds of reporting poor subjective sleep quality and more frequent medication use than they did in 2020.</p> <p>Consistent with previous research,[<reflink idref="bib3" id="ref94">3</reflink>] both low- and middle-SEP students in our cohort reported worse sleep quality, more frequent sleep disturbances, and greater daytime dysfunction than higher-SEP students in the spring of 2020. Middle-SEP students were also more likely to be using sleep medication – perhaps a reflection of their relative advantage compared to their lower-SEP peers, who may have more difficulty accessing mental health services,[<reflink idref="bib54" id="ref95">54</reflink>] especially after being separated from college campuses where these services are somewhat more accessible. These inequalities may also have been compounded by experiences of financial stress which are known to be detrimental to sleep quality.[<reflink idref="bib3" id="ref96">3</reflink>] Low-SEP participants in our sample also described physical barriers to good sleep (e.g., lack of designated sleeping space) during the COVID-19 pandemic,[<reflink idref="bib27" id="ref97">27</reflink>] which is known to negatively impact sleep quality.[<reflink idref="bib3" id="ref98">3</reflink>] None of the inequalities observed in the spring of 2020 worsened over the course of the pandemic, however a new inequality emerged in summer 2021: lower-SEP participants were 81% more likely to report poor subjective sleep quality, perhaps reflecting the impact of prolonged and/or worsening experiences of financial stress over the course of this 16-month study.</p> <p>We observed few racial/ethnic differences in sleep quality over the course of this study. Notably, AAPI participants experienced better sleep quality, fewer sleep disturbances, and less daytime dysfunction than White peers in the spring of 2020, yet, by summer 2021, AAPI participants reported worse sleep quality and over twice the odds of experiencing greater daytime dysfunction than White peers. This drastic change in sleep health among AAPI participants over the first 16 months of the pandemic may be due to the increasingly common experiences of racism, discrimination, xenophobia, and hate incidents against AAPI communities during the pandemic,[<reflink idref="bib33" id="ref99">33</reflink>]<sups>,</sups>[<reflink idref="bib55" id="ref100">55</reflink>] as these experiences have well-documented negative impacts on sleep health.[<reflink idref="bib45" id="ref101">45</reflink>] Indeed, participants in our sample reported that their race or ethnicity was one of the most common reasons for experiences of discrimination at both baseline and follow-up.</p> <p>Black students reported lower sleep efficiency than White peers in the spring of 2020. This is consistent with pre-pandemic research finding that Black college students report worse sleep compared to their White peers,[<reflink idref="bib1" id="ref102">1</reflink>]<sups>,</sups>[<reflink idref="bib2" id="ref103">2</reflink>]<sups>,</sups>[<reflink idref="bib4" id="ref104">4</reflink>] a finding often attributed to the impact of experiences of discrimination.[<reflink idref="bib44" id="ref105">44</reflink>] There were no significant differences in sleep health between Black and White participants in 2021; this was inconsistent with prior literature [<reflink idref="bib1" id="ref106">1</reflink>]<sups>,</sups>[<reflink idref="bib2" id="ref107">2</reflink>] and unexpected given heightened public awareness and discourse around injustice and inequality during this time due to the protests in support of the Movement for Black Lives.</p> <hd id="AN0184444270-15">Limitations</hd> <p>Some limitations to our study should be noted. First, the PSQI is one of the most widely utilized measures of sleep quality in research; however, it relies on self-report measures and may therefore be susceptible to recall bias. Furthermore, the PSQI is used to measure symptoms, not to offer an official diagnosis. Second, there are also limitations in our sampling design. While our sample consisted of a diverse set of college students from across the country, it is not necessarily representative of all college students. For example, our sample was restricted to full-time college students aged 18–22. Third, our data do not include measures of pre-pandemic sleep quality in this sample. Therefore, we cannot infer directly the extent to which the inequalities observed in our sample existed pre-COVID-19, and if and how severely they were exacerbated by the COVID-19 pandemic. However, we are able to compare similar research done by others pre-COVID-19 pandemic. In a pre-pandemic study of 7,626 U.S. college students, men had a total PSQI score of 6.44 and women 7.05;[<reflink idref="bib4" id="ref108">4</reflink>] our study found higher PSQI scores for men and women (indicative of worse sleep quality) at both timepoints. Other studies comparing pre-pandemic data on sleep quality with data obtained during the pandemic provide similar evidence of changing sleep behaviors,[<reflink idref="bib23" id="ref109">23</reflink>] and support that the pandemic had a greater impact on women's sleep health.[<reflink idref="bib56" id="ref110">56</reflink>] Our findings contribute to a body of evidence on the emergence of widening gendered inequalities due to the COVID-19 pandemic.</p> <p>Although several of our findings aligned with the well-established literature on sleep inequalities, our finding that there were no inequalities in sleep health between Black and White college students during summer 2021 is inconsistent with the extant literature and likely due to limited statistical power (<emph>n</emph> = 37 Black participants in April 2020 and <emph>n</emph> = 12 Black participants in summer 2021). It is important for future research to have large numbers of participants from all racial/ethnic groups in order to be able to investigate any racial/ethnic inequities in sleep more closely.</p> <hd id="AN0184444270-16">Conclusion</hd> <p>Many of the interventions and prevention mechanisms used to curb the spread of COVID-19 significantly altered college students' ability to maintain adequate sleep, as they dramatically upended prior routines and created new sources of stress. Some students left campus and returned to family environments that were less health-promotive than their college residence, and/or were separated from in-person peer support networks on campus. Many students experienced dramatic shifts in daily life, such as those who took on additional work hours or household responsibilities that, in turn, affected their sleep schedules. And, others experienced discrimination which has consistently been found to disrupt sleep.[<reflink idref="bib57" id="ref111">57</reflink>] This study provides novel data about the sleep inequalities experienced by emerging adult college students over the course of 16 months during the peak of the COVID-19 pandemic, documenting, on average, worse sleep quality among marginalized college students. As emerging adult college students continue to cope with the challenges caused by the pandemic and the co-occurring social stressors that have collectively increased their awareness of social inequalities, it is important that researchers continue to investigate sleep inequalities among young people and disentangle the relationship between discrimination and sleep health.</p> <p>Furthermore, sleep plays a vital role in students' mental and physical health[<reflink idref="bib7" id="ref112">7</reflink>]<sups>,</sups>[<reflink idref="bib12" id="ref113">12</reflink>] and can buffer against the negative impacts of discrimination on well-being.[<reflink idref="bib58" id="ref114">58</reflink>] Therefore, it is important that colleges proactively seek to promote the sleep quality of their students, for example by offering a range of class start times that fit students' unique sleep patterns, and offering direct support and resources during stressful periods (e.g., final exams, health issues, family emergencies) so that students do not sacrifice their sleep. And, as colleges seek to more equitably serve students, it is essential that they focus on supporting the sleep health of marginalized college students, who were disproportionately burdened by the impacts of the pandemic[<reflink idref="bib46" id="ref115">46</reflink>] and, in our study, reported poor sleep quality. To do so, colleges should ensure that students have access to counseling and mental health services to help them cope with experiences of discrimination. These services should outreach directly to marginalized college students, who often do not get the same level of care due to lack of awareness of campus services, stigmatization, anxiety, or lack of time (or fear) to reach out for help,[<reflink idref="bib59" id="ref116">59</reflink>]<sups>,</sups>[<reflink idref="bib60" id="ref117">60</reflink>] and be staffed by counselors and psychologists who have the training necessary to support students through experiences of discrimination and resulting distress.</p> <p>Students' sleep health warrants attention given the high rates of stress, depression, and anxiety reported by college students during the COVID-19 pandemic[<reflink idref="bib9" id="ref118">9</reflink>]<sups>,</sups>[<reflink idref="bib27" id="ref119">27</reflink>]<sups>,</sups>[<reflink idref="bib61" id="ref120">61</reflink>] and the well-documented bidirectional associations between sleep and well-being.[<reflink idref="bib62" id="ref121">62</reflink>]<sups>,</sups>[<reflink idref="bib63" id="ref122">63</reflink>] Thus, colleges and stakeholders in the healthcare sector should continue to monitor the presence of sleep disturbances disproportionality experienced by those of marginalized communities and the role of discrimination in these sleep disturbances, particularly among those most likely to suffer from poor sleep quality based on our findings: women, TGD, LGBQ+, and lower-SEP students.</p> <hd id="AN0184444270-17">Acknowledgments</hd> <p>We thank all of the study participants for their engagement in this study during this important time. Miranda Dotson, Taina Quiles, Elena Maker Castro, and Nina Magid provided useful feedback on the manuscript.</p> <hd id="AN0184444270-18">Conflict of interest disclosure</hd> <p>The authors have no conflicts of interest to report. The authors confirm that the research presented in this article met the ethical guidelines, including adherence to the legal requirements, of the United States and received approval from the Institutional Review Board of Fordham University.</p> <ref id="AN0184444270-19"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2024.2317178.</bibtext> </blist> </ref> <ref id="AN0184444270-20"> <title> References </title> <blist> <bibtext> Jones RD, Jackson WB, 2nd, Mazzei A, Chang AM, Buxton OM, Jackson CL. 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  Data: Inequalities in Emerging Adult College Students' Sleep Quality during the COVID-19 Pandemic
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  Label: Language
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  Data: English
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  Data: <searchLink fieldCode="AR" term="%22Neshat+Yazdani%22">Neshat Yazdani</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0002-0354-1481">0000-0002-0354-1481</externalLink>)<br /><searchLink fieldCode="AR" term="%22Lindsay+Till+Hoyt%22">Lindsay Till Hoyt</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-5465-4876">0000-0001-5465-4876</externalLink>)<br /><searchLink fieldCode="AR" term="%22Ayurda+Pathak%22">Ayurda Pathak</searchLink><br /><searchLink fieldCode="AR" term="%22Lauren+Breitstone%22">Lauren Breitstone</searchLink><br /><searchLink fieldCode="AR" term="%22Alison+K%2E+Cohen%22">Alison K. Cohen</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-9848-934X">0000-0001-9848-934X</externalLink>)
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  Data: <searchLink fieldCode="SO" term="%22Journal+of+American+College+Health%22"><i>Journal of American College Health</i></searchLink>. 2025 73(4):1538-1548.
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  Data: Taylor & Francis. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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– Name: Pages
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  Data: 11
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  Label: Publication Date
  Group: Date
  Data: 2025
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  Data: Health Resources and Services Administration (HRSA) (DHHS)<br />National Institutes of Health (NIH) (DHHS)
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  Data: UA6MC27378<br />R01HL16070301A1
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  Data: Journal Articles<br />Reports - Research
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  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Sleep%22">Sleep</searchLink><br /><searchLink fieldCode="DE" term="%22COVID-19%22">COVID-19</searchLink><br /><searchLink fieldCode="DE" term="%22College+Students%22">College Students</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Sexual+Orientation%22">Sexual Orientation</searchLink><br /><searchLink fieldCode="DE" term="%22Racial+Differences%22">Racial Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Ethnicity%22">Ethnicity</searchLink><br /><searchLink fieldCode="DE" term="%22Socioeconomic+Status%22">Socioeconomic Status</searchLink><br /><searchLink fieldCode="DE" term="%22Correlation%22">Correlation</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/07448481.2024.2317178
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 0744-8481<br />1940-3208
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objective: To examine inequalities in sleep quality during the COVID-19 pandemic by gender, sexual orientation, race/ethnicity, and socioeconomic position (SEP), and test associations between discrimination and sleep quality in a national longitudinal cohort of emerging adult college students. Participants: Participants were enrolled in college full-time and were aged 18-22 at baseline. Methods Participants completed online surveys in spring 2020 (N = 707) and summer 2021 (n = 313). Measures included the Pittsburgh Sleep Quality Index (PSQI) and the Everyday Discrimination Scale. Results: Most students reported poor sleep quality (78% in 2020; 82% in 2021) and those from marginalized groups generally experienced worse sleep quality. Discrimination was associated with poorer concurrent sleep quality at both time points. Conclusions: Sleep inequalities among college students continued to manifest during the pandemic, even when students were not necessarily on campus. Colleges should take a multi-pronged approach to promote sleep quality through individual, community, and institutional interventions.
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  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1473223
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      – Type: doi
        Value: 10.1080/07448481.2024.2317178
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 1538
    Subjects:
      – SubjectFull: Sleep
        Type: general
      – SubjectFull: COVID-19
        Type: general
      – SubjectFull: College Students
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Sexual Orientation
        Type: general
      – SubjectFull: Racial Differences
        Type: general
      – SubjectFull: Ethnicity
        Type: general
      – SubjectFull: Socioeconomic Status
        Type: general
      – SubjectFull: Correlation
        Type: general
    Titles:
      – TitleFull: Inequalities in Emerging Adult College Students' Sleep Quality during the COVID-19 Pandemic
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      – PersonEntity:
          Name:
            NameFull: Neshat Yazdani
      – PersonEntity:
          Name:
            NameFull: Lindsay Till Hoyt
      – PersonEntity:
          Name:
            NameFull: Ayurda Pathak
      – PersonEntity:
          Name:
            NameFull: Lauren Breitstone
      – PersonEntity:
          Name:
            NameFull: Alison K. Cohen
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2025
          Identifiers:
            – Type: issn-print
              Value: 0744-8481
            – Type: issn-electronic
              Value: 1940-3208
          Numbering:
            – Type: volume
              Value: 73
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Journal of American College Health
              Type: main
ResultId 1