Wendy M Troxel

• PhD
• Researcher at RAND Corporation

Background Sleep disturbance is common and problematic among both patients with cancer and their bedpartner caregivers. Although one’s sleep affects the partner’s sleep, existing cognitive-behavioral interventions have rarely targeted sleep problems of patients and caregivers simultaneously. Methods This protocol is to test the feasibility and acc...

Introduction Obstructive sleep apnea (OSA) is a prevalent disorder, affecting approximately 34% of Hispanic/Latino men and 18% of Hispanic/Latino women. Despite the proven effectiveness of Positive Airway Pressure (PAP) therapy, treatment disparities persist, particularly among Spanish-speaking patients. These disparities are often linked to langua...

Introduction Neighborhood disinvestment is a downstream impact of structural racism, especially afflicting minoritized communities. Thus, neighborhood reinvestment may serve as a policy-level intervention to mitigate sleep and other health disparities. This study builds on previous work by leveraging a natural experimental design to evaluate the 5-...

Introduction Domestic violence exposure (DVE) is a pervasive public health issue with profound effects on physical and mental health. Emerging evidence highlights the significant impact of DVE on sleep health, a critical determinant of overall well-being. This abstract examines the relationship between DVE and current sleep health. Methods Data we...

Social safety theory suggests that individuals from minoritized racial and ethnic groups or sexual and gender diverse (SGD) groups are exposed to multilevel and interacting stressors, which can set the stage for adverse health outcomes. Using a social safety framework, we examine interactions between discrimination and adverse childhood experiences...

Study objectives: Poor sleep quality is a global public health issue. Technology approaches are desirable to patients and offer a potentially scalable solution to improve sleep health. The goal of this study was to test the effects of a novel wearable device for improving sleep. Methods: Participants with elevated scores on the Insomnia Severity...

This article describes change in health status by analyzing key health domains at two time points before and during the COVID-19 pandemic among a sample of American Indian/Alaska Native (AI/AN) adolescents living outside of tribal land (n = 114) throughout California. Data were analyzed from a longitudinal study, Native American Youth Sleep Health...

The life expectancy gap between Black and White Americans has narrowed, but progress remains slow due to the persistent consequences of lifetime exposure to structural and interpersonal experiences of racism and discrimination in various settings, for example, disadvantaged housing, neighborhood, and economic conditions. It is important to understa...

Background Neighborhood walkability may affect cognitive impairment through promotion of physical activity. However, most studies are conducted in urban, predominantly White samples. We assessed how walkability is related to presence of cognitive impairment and whether the relation differs by neighborhood population density (differences in likeliho...

INTRODUCTION We examined whether the Performance Assessment of Self‐Care Skills (PASS) and Everyday Cognition Scale‐12 (ECog‐12) dichotomized cognitive groups in a sample of predominantly Black adults. METHODS Two hundred forty‐six community‐dwelling adults (95% Black, age 50+) completed cognitive testing, the PASS, and the ECog. Cognitive groups...

Background The combination of exposure to multiple stressors and psychological distress may contribute to the disproportionate burden of dementia risk among Black Americans. This study estimates the effect of an index of stress and psychological distress (i.e., “stress burden”) on cognitive function and clinically-adjudicated cognitive outcomes amo...

Background and Objectives Limited research has examined how discrimination in young adulthood relates to substance use. We examined how multiple and specific types (e.g., race‐based) of experiences of unfair treatment are related to problematic alcohol and cannabis use. Methods We analyzed cross‐sectional data from a diverse cohort of young adults...

Importance Adolescent sleep problems are prevalent, particularly among racial and ethnic minority groups, and can increase morbidity. Despite the numerous strengths of their racial and ethnic group, urban American Indian and Alaska Native adolescents face significant health disparities but are rarely included in health research. Understanding how s...

Background Urban American Indian/Alaska Native (AI/AN) adolescents are vulnerable to sleep and other health‐related disparities due to numerous social drivers, including historical trauma and relocation to urban areas. This study aims to identify strategies to increase protective factors and culturally tailor sleep health interventions for this pop...

Introduction The goal of this study was to examine feasibility, acceptability, and preliminary efficacy of WePAP, a novel, couples-based treatment to promote positive airway pressure (PAP) adherence in patients with obstructive sleep apnea (OSA) and sleep quality in patients and partners. Methods Patients who were recently diagnosed with OSA and s...

Introduction Emerging research highlights the interdependence of sleep within couples and the impact of sleep and sleep disorders on couples’ relationship quality. The current study examines how adherence to positive airway pressure (PAP) as well as sleep duration and efficiency associates with both patient and partners’ relationship quality, among...

Introduction Sleep health is defined as a multidimensional pattern of sleep and wakefulness that is adapted to individual, societal, and environmental demands, and that fosters mental and physical well-being. Prior research demonstrates that social determinants, operating at the household, interpersonal, and community levels, associate with individ...

Objective The purpose of this study was to evaluate the psychometric properties of the Couples' Sleep Conflict Scale, a new measure designed to identify the extent of conflict around sleep in romantic relationships. Methods Data from an individual sample (N = 158) and dyadic sample (N = 143 mixed-gender couples) in romantic relationships were used...

Background: Sleep problems may contribute to the disproportionate burden of Alzheimer’s disease and related dementias (ADRD) among African Americans (AAs). Objective: To examine the role of sleep problems in contributing to cognitive function and clinically adjudicated cognitive impairment in a predominantly AA sample. Methods: This study (n = 216,...

Objective Mild decline in independent functioning is a core diagnostic criterion for Mild Cognitive Impairment. Performance-based assessments have been considered the gold standard to identify subtle deficits in functioning. Existing assessments were largely designed using demographically homogenous samples (white, highly educated, middle class) an...

Racial residential segregation is a complex socio-economic phenomenon that affects many communities across the U.S. Such residential segregation is a result of historic policies in the United States including redlining and inequitable urban redevelopment. Black adults who live in segregated areas face challenges and experience psychosocial stressor...

Exposure to discrimination has been associated with poorer cognitive function but this association may be influenced by broader social factors, such as neighborhood social cohesion. We investigated the associations between unfair treatment, social cohesion, and cognitive function in 234 participants ≥50 years, recruited from urban, primarily Black...

Objetivo: Este estudio examinó la asociación entre el entorno social del vecindario y el sueño entre adolescentes urbanos Indios Americanos y Nativos de Alaska (AI/AN, por sus siglas en inglés), así como el papel moderador de los factores culturales en esta asociación. Métodos: La muestra analítica incluyó a 133 adolescentes AI/AN urbanos (edad 12–...

Purpose This is the first study to examine daily, bidirectional associations between sleep and wake behaviors/mood in urban American Indian/Alaska Native (AI/AN) adolescents. Methods Participants were 142 urban AI/AN adolescents (mean age = 14 years, 58% female). Sleep was measured with actigraphy (total sleep time [TST] and sleep efficiency) and d...

Although prior research demonstrates the interdependence of sleep quality within couples (i.e., the sleep of one partner affects the sleep of the other), little is known about the degree to which couples’ sleep hygiene behaviours are concordant or discordant, and if one's own sleep hygiene or their report of their partners’ sleep hygiene is related...

Purpose of Review Poor sleep health in adolescence has long-lasting, and adverse effects on many aspects of health and functioning. Multiple factors impact sleep in adolescence including individual and family-level factors. However, early school start times are the one policy-level, and possibly the most salient environmental factor that constrains...

Introduction Increasing evidence suggests the neighborhood social environment may be an important predictor of sleep, yet this has not been explored among urban American Indian and Alaska Native (AI/AN) adolescents, a population that faces significant health disparities due to exposure to historic and contemporary stressors. This study aimed to exa...

Introduction Although there is considerable sleep concordance between partners in couple relationships, less is known about sleep practices between them and if there is conflict around sleep habits, preferences, and behaviors. Past empirical work suggests that couples who share the same sleep-wake preferences (i.e., morning vs. night people) report...

Introduction Despite research exploring sleep concordance between partners in couple relationships, some variability exists between partners’ sleep quality because of the social and relational context. One such mechanism that may help to explain the variability is sleep hygiene and if couples are similar or different in their sleep hygiene and if o...

Background Black Americans have disproportionately higher rates and earlier onset of Alzheimer’s disease and related dementias (ADRD) relative to White Americans. We currently lack a comprehensive understanding of how the lived experience and broader societal factors, including cumulative exposure to structural racism and the mechanisms underlying...

The present study examined the associations between physical characteristics of neighborhoods and sleep health outcomes and assessed the mediating role of physical activity on these associations. A longitudinal study (PHRESH Zzz, n=1,051) was conducted in two low-income, predominately African-American neighborhoods with repeated measures of neighbo...

Gentrification often leads to changes within urban neighbourhoods. While redevelopment and investment may improve the built environment in gentrifying neighbourhoods, there may be disruptive impacts that affect health and wellbeing for existing residents. A growing body of literature explores the impact of gentrification on the psychosocial wellbei...

This study examines alcohol and cannabis use within emerging adults’ committed romantic relationships and its association with relationship functioning (satisfaction, stability) and well-being (life satisfaction, anxiety, depression). Participants completed surveys in 2020 and 2021 ( N = 1214). Latent profile analysis identified four classes of cou...

Disproportionate exposure to adverse neighborhood conditions and greater discrimination may contribute to health disparities among African Americans (AAs). We examined whether adverse neighborhood conditions, alone or in conjunction with discrimination, associate with shorter leukocyte telomere length among a predominantly AA cohort. The sample inc...

Background Acculturation is a complex multidimensional construct that plays an important role in various outcomes across many domains (e.g., psychological, behavioral, social, and developmental). While there are many acculturation measures for specific racial/ethnic groups, few multigroup measures exists. Even fewer have been psychometrically evalu...

Objective Black individuals and those experiencing socioeconomic disadvantage are at increased risk for sleep problems and obesity. This study adds to the limited extant literature examining longitudinal associations between objectively measured sleep and changes in body mass index (BMI) in Black Americans. Design We focused on individuals with at...

Objectives Food insecurity contributes to racial/ethnic disparities in health. This is the first study to examine associations among food insecurity, sleep, and cardiometabolic outcomes in urban American Indian/Alaska Native (AI/AN) youth. Design Participants were 142 urban AI/AN youth (mean age = 14 years, 58% female). Food insecurity and self-re...

Multi-level risk factors underlie disproportionate obesity rates among Black women. Latent class analysis of multi-level risk and protective factors among low-income Black women (n = 917) in 2011 (Pittsburgh, PA). Data were collected via in-person survey, interviewer-assisted online dietary recalls, and from 2011 crime records. Multinomial logistic...

Background Obstructive sleep apnea (OSA) is a serious health condition that affects approximately 30-50% of older adults and contributes to risk for cardiometabolic disorders and dementia. Despite the well-documented role of partners in treatment seeking and adherence to positive airway pressure (PAP), treatments for OSA have nearly exclusively foc...

Study objectives: Bed partners play a critical role in the treatment of obstructive sleep apnea (OSA) and are affected by the treatment (or lack thereof) of their partner's OSA, but few studies have included partners formally in treatment. In this qualitative study, we examine key stakeholder perspectives (patient, bedpartner, and sleep medicine p...

Posttraumatic stress disorder (PTSD) is a condition that can emerge after exposure to a traumatic event. It involves several symptoms, including distressing memories or dreams and/or dissociative reactions; psychological distress at exposure to trauma cues; physiologic reactions to cues; avoidance of stimuli associated with the event; negative alte...

Objective: Sleep is a multi-dimensional health behavior associated with elevated risk of substance use. This is the first study to utilize a latent class approach to characterize sleep health across multiple dimensions and across time from late adolescence to emerging adulthood, and to examine associations with alcohol and cannabis use trajectorie...

While psychological distress is a common sequelae of job loss, how that relationship continued during the COVID‐19 pandemic is unclear, for example, given higher health risk to working due to disease exposure. This paper examines changes in psychological distress depending on job loss among a cohort of randomly selected residents living in nine pre...

Introduction Obstructive sleep apnea (OSA) and its treatment (positive airway pressure; PAP) impacts both patient and bedpartner health and their respective quality of life. Despite the effectiveness of PAP at treating OSA and evidence that PAP adherence benefits both patient and partner, over half of OSA patients are not adherent. Thus, non-adhere...

Introduction American Indian/Alaska Native (AI/AN) individuals experience health disparities that emerge early in life. This is the first study to prospectively examine associations between sleep and daily behaviors in urban AI/AN adolescents. Methods Participants were 142 urban AI/AN adolescents (mean age = 14 years, 58% female). Sleep health cha...

Introduction Patients with Mild Cognitive Impairment (MCI) have an increased risk of Obstructive Sleep Apnea (OSA) which may have implications for their cognitive function. Sleeping is often a shared behavior among couples, and for couples with MCI, partners often assume the role of caregiver. The goal of this study is to examine the role of bedpar...

Background Sleep problems may contribute to the disproportionate burden of Alzheimer’s disease and related dementias (ADRD) among African Americans (AAs). Objective To examine the role of sleep problems in contributing to cognitive function and clinically adjudicated cognitive impairment in a predominantly AA sample. Methods This study (n = 216,...

Objectives: Since the beginning of the COVID-19 pandemic, there has been concern that the pandemic and associated mitigation efforts would have a particularly adverse effect on communities that are marginalized. This study examined disparities in the perceived impacts of the pandemic on sleep, mental and physical health, social functioning, and su...

This study examines associations of changes in perceived and objective (census-based) neighborhood social environment variables during adolescence with alcohol and marijuana outcomes in emerging adulthood using two waves of data (2013–14 and 2019–20) from a cohort in Southern California (n = 1249). Increasing perceived disorganization predicted gre...

Objective: Although most people in romantic relationships co-sleep, biosocial modulators of sleep quality have only recently come into focus. Oxytocin (OT) might be one such modulator, as it had been shown to increase social attachment and safety. We investigated the association between everyday life couple interaction and sleep quality, as well a...

Study Objectives Characteristics of neighborhood social environments, such as safety and social cohesion, have been examined as determinants of poor sleep. The current study investigates associations between neighborhood social characteristics and sleep health, as well as the mediating role of psychological distress on these possible associations....

Objective Sleep is an important determinant of various health outcomes, and insufficient sleep and sleep disorders are a public health crisis in the United States. The objective of this review is to provide an update on scientific contributions to our understanding of the social/built environmental determinants of sleep health. In particular, this...

Objective To evaluate whether sleep disturbances vary along a continuum of functional limitations in a large nationally representative sample of US adults. Methods Using 2014-2015 National Health Interview Survey data (n = 33,424), we considered associations between each of 5 sleep disturbance measures (duration, trouble falling asleep, trouble st...

Objective: Sleep changes over the human lifespan, and it does so across multiple dimensions. We used individual-level cross-sectional data to characterize age trends and sex differences in actigraphy and self-report sleep dimensions across the healthy human lifespan. Methods: The Pittsburgh Lifespan Sleep Databank (PLSD) consists of harmonized p...

Study Objectives African Americans have faced disproportionate socioeconomic and health consequences associated with the COVID-19 pandemic. The current study examines employment and its association with sleep quality during the initial months of the pandemic in a low-income, predominantly African American adult sample. Methods In the early months...

Background COVID-19 has profoundly affected sleep, although little research has focused on high-risk populations for poor sleep health, including American Indian/Alaska Native (AI/AN) adolescents. Methods This is the first longitudinal study to examine changes in sleep with surveys completed before the pandemic and during the early months of COVID...

In fall 2019, California passed and signed into law SB328, the first US statewide legislation explicitly designed to protect adolescent sleep health by requiring most California public school districts to start no earlier than 8:00 AM for middle schools and 8:30 AM for high schools. Recognizing the unique opportunity presented by the bill's 3-year...

Emerging adults (18–25 years), particularly racially/ethnically diverse and sexual and gender minority populations, may experience loneliness following major life transitions. How loneliness relates to health and health disparities during this developmental period is not well understood. We examine associations of loneliness with physical (self-rat...

Co-author Review: All authors have seen and approved the final version of the manuscript. Previous Presentations: None. Lt Col Matthew S. Brock, LTC Jennifer L. Creamer, Emmanuel P. Espejo, Rachel R. Markwald, CAPT Gregory N. Matwiyoff, John T. Peachey, Brian M. O’Reilly, Nita L. Shattuck are military service member or employee of the U.S. Governme...

African Americans (AA) are more likely to experience stressors due to racial discrimination and segregated neighborhoods, potentially contributing to higher risk for dementia. We investigated the association between stressors and cognitive function in older AA adults through cumulative stress burden (CSB) indices. Stressors and cognitive domains we...

As the function of advising has shifted across the higher education landscape, the role of the academic advisor has also evolved. This chapter explores historic and emerging trends in the roles, functions, and professionalization of academic advising, while stressing the need for institutions to situate academic advising within their learning and t...

Mental health problems contribute significantly to the global burden of disease. Driven in part by family stressors and insufficient sleep, mental health disproportionately affects low SES urban adolescents. In the United States, American Indian/Alaska Native (AI/AN) youth exhibit excessively high rates of mental health problems. Family functioning...

Objectives: This study sought to: 1) understand how the perceived food environment (availability, accessibility, and affordability) is associated with cardiometabolic health outcomes in predominately low-income Black residents in urban neighborhoods with limited healthy food access; and 2) examine the association of shopping at specific store type...

Black Americans have been disproportionately affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) pandemic. Since the pandemic’s start, we have observed compounded health, social, and economic impacts for communities of color, fueled in part by profound residential segregation in the United States that, for centu...

Background Obstructive sleep apnea (OSA) is a serious health condition that affects approximately 30–50% of older adults and contributes to risk for cardiometabolic disorders and dementia. Despite the well-documented role of partners in treatment seeking and adherence to positive airway pressure (PAP), treatments for OSA have nearly exclusively foc...

Objective Post-traumatic stress disorder (PTSD) can lead to many negative secondary outcomes for patients, including sleep disturbances. The objective of this meta-analysis is (1) to evaluate the effect of interventions for adults with PTSD on sleep outcomes, PTSD outcomes, and adverse events, and (2) to evaluate the differential effectiveness of i...

Introduction: Despite the growing recognition of the importance of neighborhood conditions for cardiometabolic health, causal relationships have been difficult to establish owing to a reliance on cross-sectional designs and selection bias. This is the first natural experiment to examine the impact of neighborhood revitalization on cardiometabolic...

Study objectives: Black individuals and individuals of low socioeconomic status are at increased risk for obstructive sleep apnea (OSA). The Berlin Questionnaire is one of the most widely used screening tools for OSA; however, there is limited research on its diagnostic accuracy in low-income, Black populations. Methods: This study analyzed data...

Background Black adults in the U.S. experience significant health disparities related to tobacco use and obesity. Conducting observational studies of the associations between smoking and other health behaviors and indicators among Black adults may contribute to the development of tailored interventions. Purpose We examined associations between cha...

Introduction Sleep continuously changes over the human lifespan and it does so across multiple dimensions, including duration, timing, efficiency, and variability. Although studies focused on specific developmental periods have shown age-related changes in sleep, methodological differences make it difficult to synthesize information across studies...

Introduction American Indian/Alaska Native (AI/AN) individuals experience significant health disparities, including poor sleep health and cardiometabolic disease, and these risks emerge early in life. Food insecurity (lack of consistent access to healthy foods) is an important social determinant of health, and AI/AN people are one of the highest ri...

Military personnel rely on caffeinated products such as coffee or energy drinks (ED) to maintain a maximal level of vigilance and performance under sleep-deprived and combat situations. While chronic caffeine intake is associated with decreased sleep duration and non-restful sleep in the general population, these relationships are understudied in t...

Study objectives: This study examined longitudinal associations of sleep problems with alcohol and cannabis use across six annual waves of data from adolescence to emerging adulthood. Methods: Participants were 3,265 youth from California (ages 16 to 22 across waves). At each wave, past-month alcohol use and cannabis use, mental health, and seve...

Background Little is known on how greenspace redevelopment—creating or improving existing parks and trails—targeted for low-income and/or majority Black neighborhoods could amplify existing social environmental stressors, increase residents’ susceptibility to displacement, and impact their sleep quality. Objective To examine the relationship betwe...

There is a recognised lack of international literature on advising and tutoring in Higher Education (HE). In an international context, advising and tutoring is of great importance and, in that regard, global research helps to build a credible evidence base for our practice and to acknowledge the centrality of high quality advising and tutoring to t...

Study Objectives To estimate the effect of housing insecurity on sleep duration and sleep quality. Methods Using longitudinal data from a sample of 1,046 welfare recipients in the state of California followed from 2015–2016 through 2017–2018, we regressed self-reported measures of sleep duration and sleep quality recorded in 2017–2018 on experienc...

Objectives. To examine the impact of COVID-19 shutdowns on food insecurity among a predominantly African American cohort residing in low-income racially isolated neighborhoods. Methods. Residents of 2 low-income African American food desert neighborhoods in Pittsburgh, Pennsylvania, were surveyed from March 23 to May 22, 2020, drawing on a longitud...

Objective We and others have found that couples’ sleep is a shared and dyadic process. Couples’ sleep-wake concordance (whether couples are awake or asleep at the same time) is associated with couples’ relationship factors; however, we know little of the temporal associations between concordance and daily relationship characteristics. The purpose o...

Study Objectives Neighborhood disadvantage is associated with poor sleep, which may contribute to and exacerbate racial and socioeconomic health disparities. Most prior work has been cross-sectional and thus it has not been possible to estimate causal effects. Methods We leveraged a natural experiment opportunity in two low-income, predominantly A...

Introduction: The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. Methods: The American Academy of Sleep Medicine commissioned a task force of nine experts in sleep medicine. A systematic...

Introduction: This guideline establishes clinical practice recommendations for the use of behavioral and psychological treatments for chronic insomnia disorder in adults. Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine to develop recommendations and assign strengths based on a systema...

Neighborhood socioeconomic conditions (NSEC) are associated with resident diet, but most research has been cross-sectional. We capitalize on a natural experiment where one neighborhood experienced substantial investments, compared to a sociodemographically similar neighborhood that did not, in order to examine pathways from neighborhood investments...

Background: Improving the neighborhood environment may help address chronic disease and mortality. To identify neighborhood features that are predictors of health, objective assessments of the environment are used. Multiple studies have reported on cross-sectional assessments of health-related neighborhood features using direct observation. As stu...

Objective To examine violent crime in relation to sleep and explore pathways, including psychological distress, safety perceptions and perceived police presence, that may account for associations. Methods In 2018, 515 predominantly Black American (94%) adults (Pittsburgh, Pennsylvania, USA) provided survey data: actigraphy-assessed sleep duration...

This study examined the effect of neighborhood investments on neighborhood walkability, presence of incivilities, and crime in two low-income, primarily African American neighborhoods in Pittsburgh, USA. During the study period, one of the neighborhoods (the intervention neighborhood) received substantially more publicly-funded investments than a d...

Study objectives The current study examined the prevalence and correlates of obstructive sleep apnea in a sample of low-income, predominantly African-American women using two waves of data. Methods Participants were adults from two urban neighborhoods who enrolled in the PHRESH Zzz Study (N = 828; Pittsburgh Hill/Homewood Research on Neighborhoods...

Objectives American Indian/Alaska Native (AI/AN) youth are a high-risk group for sleep problems and associated chronic conditions. Urban AI/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 healt...

Background: Neighborhood disadvantage is a robust and independent risk factor for poor cardiometabolic health, however, causal relationships have been difficult to establish. We used a natural experiment design to examine neighborhood investment on cardiometabolic risk factors among a randomly selected cohort of residents from two, low-income, urba...

Aims: Nocturia (getting up at night to urinate, where each urination being followed by sleep or intention to sleep) is a bothersome symptom with potentially negative consequences for individual health and daytime functioning. This study assessed the burden of nocturia in the workplace by investigating associations between nocturia and subjective we...