Original Article Perceived neighborhood safety and sleep quality: a global analysis of six countries Terrence D. Hill a , Ha Ngoc Trinh b,c , Ming Wen b , Lauren Hale d, * a School of Sociology, The University of Arizona, P.O. Box 210027, Tucson, AZ 85721-0027, USA b Department of Sociology, University of Utah, 380 S 1530 E Rm 301, Salt Lake City, UT 84112-0250, USA c Department of Sociology, Vietnam National University, 336 Nguyen Trai, Thanh Xuan, Hanoi 10000, Viet Nam d Program in Public Health, Department of Preventive Medicine, Stony Brook Medicine, Level 3, Room 071, Stony Brook, NY 11794-8338, USA ARTICLE INFO Article history: Received 7 July 2014 Received in revised form 1 October 2014 Accepted 5 December 2014 Available online Keywords: Neighborhood Sleep Mexico Africa Asia A B ST R AC T Objective: Building on previous North American and European studies of neighborhood context and sleep quality, we tested whether several self-reported sleep outcomes (sleep duration, insomnia symptoms, sleepiness, lethargy, and overall sleep quality) vary according to the level of perceived neighborhood safety in six countries: Mexico, Ghana, South Africa, India, China, and Russia. Methods: Using data (n = 39,590) from Wave I of the World Health Organization’s Longitudinal Study on Global Ageing and Adult Health (2007–2010), we estimated a series of multinomial and binary logistic regression equations to model each sleep outcome within each country. Results: Taken together, our results show that respondents who feel safe from crime and violence in their neighborhoods tend to exhibit more favorable sleep outcomes than respondents who feel less safe. This general pattern is especially pronounced in China and Russia, moderately evident in Mexico, Ghana, and South Africa, and sporadic in India. Perceptions of neighborhood safety are strongly associated with in- somnia symptoms and poor sleep quality (past 30 days), moderately associated with sleepiness, lethargy, and poor sleep quality (past 2 days), and inconsistently associated with sleep duration (past two days). Conclusions: We show that perceived neighborhood safety is associated with more favorable self- reported sleep outcomes in six understudied countries. Additional research is needed to replicate our findings using longitudinal data, more reliable neighborhood measures, and more direct measures of sleep quality in these and other regions of the world. © 2014 Elsevier B.V. All rights reserved. 1. Introduction Studies consistently show that living in a disadvantaged neigh- borhood that is characterized by poverty, social disorganization, and disorder is associated with a range of adverse sleep outcomes [1–13]. This growing body of work is impressive because it is remarkably stable across studies of younger and older populations, objective (census indicators of neighborhood socioeconomic disadvantage) and perceived (fear of crime in the neighborhood) neighborhood characteristics, and clinical (obstructive sleep apnea) and self- reported (sleep duration and sleep problems) sleep outcomes. Although previous research has made significant contributions to our understanding of neighborhood contextual variations in sleep outcomes, it is unclear whether these general patterns extend beyond the United States. Some studies in Canada [2,3], England [13], and Germany [11] have been conducted, but regions of the world beyond North America and Europe remain largely unexamined. In this paper, we build on previous research by testing whether several self-reported sleep outcomes (sleep duration, insomnia symp- toms, sleepiness, lethargy, and overall sleep quality) vary according to the level of perceived neighborhood safety (PNS) in six coun- tries: Mexico, Ghana, South Africa, India, China, and Russia. PNS refers to the subjective experience of security and vulnerability to crime and violence in the neighborhood environment. Researchers spec- ulate that, because sleep is an adaptive behavior, neighborhoods that are characterized by noise (from neighbors, busy streets, and crowd- ing), dilapidation (substandard housing), and crime (fear of victimization) may directly undermine the ability of residents to initiate and/or maintain sleep [4–6,12]. Studies also suggest that stressful neighborhood conditions could contribute to poor sleep quality through various psychological and physiological path- ways. For example, perceptions of noise and crime could elicit short- term feelings of annoyance, fear, and hopelessness [5,6,12]. These feelings could effectively activate the stress response and trigger the release of stress hormones (epinephrine and cortisol) that promote * Corresponding author. Program in Public Health, Department of Preventive Medicine, Stony Brook Medicine. Health Sciences Center, Level 3, Room 071, Stony Brook, NY 11794-8338, USA. Tel.: +1 631 444 1007; fax: +1 631 444-3480. E-mail address: lauren.hale@stonybrook.edu (L. Hale). http://dx.doi.org/10.1016/j.sleep.2014.12.003 1389-9457/© 2014 Elsevier B.V. All rights reserved. Sleep Medicine ■■ (2015) ■■–■■ ARTICLE IN PRESS Please cite this article in press as: Terrence D. Hill, Ha Ngoc Trinh, Ming Wen, Lauren Hale, Perceived neighborhood safety and sleep quality: a global analysis of six countries, Sleep Medicine (2015), doi: 10.1016/j.sleep.2014.12.003 Contents lists available at ScienceDirect Sleep Medicine journal homepage: www.elsevier.com/locate/sleep