Asian American Midlife Women s Sleep Related Symptoms and Physical Activity

Transcription

1 Asian American Midlife Women s Sleep Related Symptoms and Physical Activity A Secondary Analysis Yaelim Lee, PhD, MSN, RN 1 ; Helen Teng, MSN, CRNP 2 ; Ok Kyung Ham, PhD, MCHES, RN 3 ; Youjeong Kang, PhD, MPH, CCRN 4 ; Eun-Ok Im, PhD, MPH, RN, CNS, FAAN 2 1 Yeouido St. Mary s Hospital, Korea 2 School of Nursing, University of Pennsylvania, USA 3 Department of Nursing, INHA University, Korea 4 School of Nursing, University of Washington, USA

2 Contents 1. Introduction 2. Purpose and Aims 3. Definitions 4. Theoretical Framework 5. Methods 6. Results 7. Discussion & Conclusion

3 1. Introduction Women in menopausal transition Varying degrees of symptoms (e.g. physical and psychological) depending on one s individual and cultural influences Sleep-related symptoms Women s reports increase as menopausal transition progresses» Premenopausal women: 16-42%» Menopausal women: 35-60%

4 1. Introduction Physical activities Frequently reported to improve sleep-related symptoms However, lack in consistency Negatively/positively associated with sleep quality Not a significant predictor for sleep quality Increasing number of studies reporting racial/ethnic differences in physical activities Asian tend to be more sedentary and in fair or poor health Still, majority of the studies are on white adults Gap in the literature

5 2. Purpose and Aims The study

6 2. Purpose and Aims To explore the relationships between Asian-American midlife women s physical activities and their sleeprelated symptoms, while considering other covariates in the study. Aim 1: Explore frequencies and severities of the sleep related symptoms among Asian American women Aim 2: Identify relationship between physical activities and frequencies and severities of sleep related symptoms Aim 3: Identify the relationship, while considering other covariates in the study

7 3. Definitions Sleep-related symptoms Any symptoms due to sleep disorders Sleep disorders: Problems with sleeping, including trouble falling or staying asleep, falling asleep at the wrong times, too much sleep, or abnormal behaviors during sleep Focused on self-reports of symptoms, rather than emphasizing the pathophysiological aspects of sleep disorders

8 4. Theoretical Framework 기초

9 4. Theoretical Framework UCSF Symptom Management Model Three domains: Person Health and Illness Environments Three major concepts: Symptom experience Symptom management strategies Outcomes Each major concepts has several sub-concepts

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11 5. Methods 1) Settings and Participants This is a secondary analysis on data from a cross-sectional descriptive national Internet survey. The original study Settings: Internet communities and groups for racial or ethnic minorities in the U.S. across various geographic areas Participants:» Sampling methods: quota sampling by ethnicity and socioeconomic status through internet announcement process» Inclusion criteria: midlife women aged 40 to 60 years who could read and write English; identified themselves as Hispanic, NH White, NH African American, or NH Asian; could participate in all forms of physical activity; and were online» Sample size: based on a power analysis with an effect size of.20 [informed by previous study], an alpha level of.05 with power of participants were recruited (127 Hispanics, 157 NH Whites, 135 NH African Americans, and 123 NH Asian)

12 5. Methods 2) Instruments a) Questions on sociodemographic characteristics, perceived health, and menopausal status Sociodemographic characteristics: Age, level of education, marital status, degree of difficulty paying for basic needs, employment status, number of children, country of birth, length of stay (LOS) in the U.S. and level of acculturation (five questions adopted from Suinn- Lew Asian Self-Identity Acculturation Scale foods, music, customs, language, and close friends) Perceived health: Self-reported body weight and height, dichotomous measures on disease diagnosis (yes/no) and use of prescribed medication (yes/no), and a 5-point Likert scaled question on perceived general health Menopausal status: Pre-, early peri-, late peri-, and postmenopausal stages (based on criteria used in the longitudinal, epidemiologic Study of Women s Health Across the Nation (SWAN) Cronbach s alpha:.86 in this study

13 5. Methods 2) Instruments b) The Sleep Index for Midlife Women (SIMW): Developed for the study based on the Midlife Women s Symptom Index (MSI) 24 items on sleep-related symptoms were selected, out of 73 items in the MSI (based on extensive literature search on symptoms related to sleep disorders) Cronbach s alpha of SIMW:.89 in this study

14 5. Methods 2) Instruments c) The Kaiser Physical Activity Survey (KPAS) Used to measure women s physical activity 5-point Likert scale questionnaire on four indexes: household/family care, occupational activity, active living habit, and sports/exercise Items in each index were averaged and a total physical activity score was calculated by summing the four index averages (range = 4 to 20) for each participant Higher scores mean greater physical activity in each category Cronbach s alpha of KPAS:.81 in this study

15 5. Methods 3) Data Collection Procedures Data collection procedure used a project website that complied with: Health Insurance Portability and Accountability Act (HIPAA) and SysAdmin, Audit, Network, Security (SANS)/Federal Bureau of Investigation (FBI) recommendations. Data management: De-identified study data downloaded onto a compact disc was stored in a locked file cabinet inside a locked research office

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17 5. Methods 4) Data Analysis SPSS 20.0 for Windows Preparation for analysis Data screened for data-entry accuracy: To ensure that the assumptions of the statistical tests were met Missing data: Multiple imputation procedure known as PROC MI (through SAS) and analyzed using PROC MIANALYZE Aim 1. To explore frequencies and severities of the sleep related symptoms among Asian American women Descriptive statistics: mean, percentile Aim 2. To identify relationship between physical activities and frequencies and severities sleep-related symptoms Bivariate correlation analyses

18 5. Methods 4) Data Analysis Aim 3. To identify the relationship, while considering other covariates in the study Hierarchical multiple regression analyses Potential variables that would affect sleep-related symptoms were entered into three steps, base on the theoretical framework of the UCSF symptom management model Step 1. Sociodemographic characteristics, BMI, perceived general health Step 2. Menopausal stage, disease diagnosis, use of prescribed medication Step 3. Four types of physical activity (household/family care, occupational activity, active living habit, and sports/exercise)

19 6. Results Characteristics of Participants (N=123) Characteristics n (%) Characteristics n (%) Age (years) Perceived General Health Education (> college) 92 (74.8%) Very unhealthy 1 (0.8%) Marital status (married/partnered) 101 (82.1%) Unhealthy 12 (9.8%) Degree of difficulty paying for basics Don t know 13 (10.6%) Very hard 10 (8.1%) Healthy 71 (57.7%) Somewhat 47 (38.2%) Very healthy 26 (21.1%) Not hard 66 (53.7%) Menopausal stage Employment (yes) 82 (66.7%) No 26 (21.1%) BMI (kg/m 2 ) Early 11 (8.9%) Number of Children (>1) 102 (82.9%) Late 54 (44%) Country of birth (U.S.) 34 (27.6%) Post 32 (26.0%) LOS in U.S. (years) Disease Diagnosis (Yes) 33 (26.8%) Level of Acculturation Use of Prescribed Medication (Yes) 76 (59.8%)

20 6. Results Frequencies and Severities of Sleep-related Symptoms (Aim 1) (N=123) Sleep Related Symptoms Frequencies n (%) Severities M (SD) Painfully swollen joint 16 (11.9) 0.15 (0.71) Night sweats 37 (27.4) 0.25 ( 0.90) Exhaustion or fatigue 44 (32.6) 0.88 (1.49) Difficulty in falling or staying asleep 3 69 (51.1) (1.77) Nighttime urination 2 71 (52.6) 0.76 (1.43) Feeling clumsy 29 (21.5) 0.38 (1.05) Feeling unhappy 33 (24.4) 0.70 (1.34) Crying 19 (14.1) 0.81 (1.42) Worrying gets you down 34 (25.2) (1.48) Worrying about body 1 73 (54.1) (1.60) Problem concentrating 35 (25.9) 0.48 (1.17)

21 6. Results Relationship between Physical activity and Sleep-related Symptoms (Aim 2) (N=123) Physical Activity Sleep-related Symptoms (r) Frequencies Severities Household/ Family care activity.243**.269** Occupational activity.244**.254** Active living habit -.179* Sports/ Exercise Total *p <.05, **p <.01

22 Relationship between physical activities and frequencies of sleep-related symptoms, while considering other covariates in the study (Aim3) Variables Step 1 B p Intercept Age (years) Education (> college) Marital status (married/partnered) Degree of difficulty paying for basics (not hard) Employment (yes) BMI (kg/m 2 ) Number of children (> 1) Country of birth (U.S.) LOS in U.S. (years) Level of acculturation Perceived general health (>healthy) ** R 2 F * Step 2 B p Step 3 B p

23 Variables Step 1 B p Step 2 B Menopausal stage (no) Early Late Post Disease Diagnosis (Yes) Use of Prescribed Medication (Yes) R 2 /ΔR 2.20/ p Step 3 B p F Household/ Family care activity * Occupational activity Active living habit ** Sports/ Exercise *p <.05, **p <.01 R 2 /ΔR 2 F.30/ **

24 Relationship between physical activities and severities of sleep-related symptoms, while considering other covariates in the study (Aim3) Variables Step 1 Intercept Age (years) Education (> college) Marital status (married/partnered) Degree of difficulty paying for basics (not hard) Employment (yes) BMI (kg/m 2 ) Number of children (> 1) Country of birth (U.S.) LOS in U.S. (years) Level of acculturation Perceived general health (>healthy) ** R 2 F B ** p Step 2 B p Step 3 B p

25 Variables Step 1 B p Step 2 B Menopausal stage (no) Early Late Post Disease Diagnosis (Yes) Use of Prescribed Medication (Yes) R 2 /ΔR 2 p.242/ * Step 3 B p F Household/ Family care activity * Occupational activity Active living habit * Sports/ Exercise R 2 /ΔR 2 F.33/ *** *p <.05, **p <.01

26 7. Discussion & Conclusion High prevalence of sleep related symptoms Over 90% of the Asian American women reported of having at least one sleep related symptom. Different types of physical activity showed different associations with sleep related symptoms Frequencies of sleep related symptoms: Household/family care activity (+), Occupational activity (+), Active living habit (-) Severities of sleep related symptoms: Household/family care activity (+), Occupational activity (+) Considering other covariates Perceived general health Women with better perceived general health have less sleep-related symptoms Household/family care activity, active living habit Women with more household and caregiving activities have more sleeprelated symptoms, whereas women with more active living habit have less sleep-related symptoms

27 7. Discussion & Conclusion For nursing practice and future research Differences in sub-ethnic groups Culturally sensitive approach

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