The Association of Acculturative Stress with Self-reported Sleep Disturbance and Sleep Duration among Asian Americans.

STUDY OBJECTIVES This study aims to examine associations between acculturative stress- defined as the psychological impact, or stress reaction, of adapting to a new cultural context -and self-reported sleep outcomes among Chinese and Korean immigrants in the United States. METHODS In this cross-sectional study, acculturative stress was assessed using a 9-item scale, and sleep disturbance was measured using the 8-item scale. Sleep duration was self-reported. Poisson and linear regression analyses were conducted to examine the associations between acculturative stress, sleep disturbance, and sleep duration. RESULTS Our sample consists of 400 participants (females: 52%, Chinese: 50%, Koreans: 50%, the mean of age=58.4). 81.8% of them were classified as having no sleep disturbance, while 18.2% were classified as having sleep disturbance. Poisson models revealed that greater acculturative stress was associated with a higher prevalence of sleep disturbance (Prevalence Ratio (PR): 1.18, 95% confidence interval (CI): 1.06-1.31). In linear models, a one-unit increase in acculturative stress was associated with 0.08 hours less sleep (p <0.05). Interaction tests indicated effect modification for sleep disturbance by sex and ethnic identity: only women had a significant association between acculturative stress and sleep disturbance (PR: 1.30; 95% CI: 1.13-1.49), while the association was significant for individuals identifying as "very Asian" (PR: 1.21; 95% CI: 1.08-1.35), but not for those identifying as "mostly Asian" or "bicultural/western". CONCLUSIONS If findings are replicated, we suggest developing intervention programs for Asian immigrants to minimize acculturative stress and bolster protective factors that decrease the risk for poor sleep outcomes.