PROJECT SUMMARY
An estimated eleven million individuals are released from U.S. jails and prisons each year. Individuals with a
history of incarceration have higher rates of cardiovascular events and mortality compared to the general
population, especially in the weeks following release. An especially underexplored factor in the epidemiology of
cardiovascular disease in this population is sleep health. Incarcerated people may have unique reasons for
being sleep deficient at the individual, environmental, and institutional policy levels. They have higher rates of
mood disorders and chronic pain, which amplify sleep deficiency. Exposure to extreme temperatures, noise,
and light within correctional facilities and halfway houses may impact sleep. Exposure to violence and the
conditions of confinement are associated with increased rates of psychosocial stress or post-traumatic stress
disorder, contributing to sleep-disrupting nightmares and insomnia. The overarching aim of this study is to
understand how incarceration, especially correctional and post-release social and physical environments,
contribute to sleep deficiency and cardiovascular disease risk. The central hypothesis of this study is that sleep
deficiency is associated with the factors in the social and physical environment during incarceration and after
release. I propose a mixed methods study with the following aims: 1) Identify population-specific risk factors in
the social and physical environment that contribute to sleep deficiency during and after incarceration and
potential opportunities to improve sleep health; 2) Characterize using geospatial analysis the environmental
factors during incarceration and post-release that may contribute to sleep deficiencies; 3) Develop and pilot
instruments to assess sleep deficiency and sleep environment among people with a history of incarceration. To
achieve these aims, I will leverage the existing infrastructure of an ongoing NHLBI R01 study (JUSTICE,
1R01HL137696-01A1) and the expertise of the SEICHE Center for Health and Justice, the Yale Program in
Sleep Medicine, the Sleep and Health Research Program and Behavioral Sleep Medicine Program at the
University of Arizona, and the National
Environmental
Institute of Environmental Health Sciences (NIEHS) Social and
Determinants of Health Group.The proposed research and training in sleep medicine and
cardiometabolic outcomes, environmental factors in sleep health, and intervention development will facilitate
my transition to a career as an independent researcher in sleep health disparities among people with a history
of incarceration and position my research to impact public health interventions and policies.