14 A ccording to the National Heart, Lung and Blood Institute, it is recommended that adults get 7 to 8 hours of sleep each day. 1 Despite these recommendations, approximately 1 in 3 US adults are sleeping less than 7 hours a night. 2 Additionally, approximately 50 to 70 million US adults report sleep problems, 3 the prevalence of which increases with age. 4 The inability to obtain the required amount of sleep results in sleep debt, and although it is common for individuals to take naps to make up for missed sleep, once sleep has been lost it can never be regained. 1 Sleep inadequacy is a term used to refer to poor sleep quality or shorter sleep duration, which may or may not occur as a result of a sleep disorder. 5 Sleep quality and duration are important variables to consider given that sleep is a vital component in human functioning that may affect both men- tal and physical health. 6 Sleep inadequacy is hy- pothesized to be associated with negative health outcomes through effects on mood, cognition, and energy 7-9 as well as physiological systems (eg, in- fammation). 10-13 Previous studies have supported that sleep inadequacy increases one’s risk for de- veloping many chronic health conditions, such as diabetes, hypertension, asthma, and arthirits. 14-16 Sleep inadequacy also has been linked to poorer self-rated health. 6,17,18 Self-rated health is the sub- jective perception of one’s own health status and is a strong predictor of mortality, functional disabili- ty, risk behavior, and morbidity. 19,20 It is also one of the most frequently used health indicators in epi- demiological studies. 21 In one study, participants who reported receiving less than 6 hours of sleep a night were at greater odds for poor/very poor self- rated health relative to those who received more than 6 hours of sleep a night. 22 Moreover, sleep in- adequacy has been associated with poor self-rated health in both men and women of varying ages and race/ethnicities. 18,23,24 The environment in which one sleeps infuenc- es the amount and quality of sleep obtained. 24-26 Therefore, a group that may be at risk for poor sleep quality and shortened sleep duration is one comprised of homeless individuals. For homeless individuals, sleep may be disrupted by harsh envi- ronmental conditions (eg, bad weather), and given that sleep often takes place in open, public areas, one may have to remain vigilant even while sleep- ing to guard against theft or assault. Moreover, even the sheltered homeless may face challenges Hui-Ling Chang, Undergraduate Research Assistant, and Fe- licia D. Fisher, Doctoral Candidate, Lorraine R. Reitzel, As- sociate Professor, and Minh Anh H. Nguyen, Undergraduate Research Assistant, The University of Houston, College of Education, Department of Educational Psychology, Houston, TX. Darla E. Kendzor, Assistant Professor, and Michael S. Businelle, Assistant Professor, The University of Texas Health Science Center, School of Public Health, Dallas, TX. Lorraine R. Reitzel, Darla E. Kendzor, and Michael S. Businelle are the joint senior scientists on this work. Lorraine R. Reitzel was affliated with The University of Texas MD Anderson Cancer Center in Houston, TX at the time of data collection. Correspondence Dr Reitzel; lrreitzel@uh.edu Subjective Sleep Inadequacy and Self-rated Health among Homeless Adults Hui-Ling Chang; Felicia D. Fisher, MS; Lorraine R. Reitzel, PhD; Darla E. Kendzor, PhD; Minh Anh H. Nguyen; Michael S. Businelle, PhD Objective: To examine the association between subjective sleep inadequacy and self-rated health in a sample of 244 home- less adults. Methods: Logistic regression analyses were conducted to assess asso- ciations among 4 sleep inadequacy items (days of inadequate rest or sleep, hours of sleep, days unintentionally falling asleep during daytime, and snoring) and self-rated health in analyses adjusted for age, sex, race, education, lifetime home- lessness, lifetime serious mental illness, and current depression. Results: Days of inadequate rest or sleep, fewer hours of sleep, and days unintentionally falling asleep were each signifcantly associated with higher odds of poor/fair self-rated health. Conclusion: Because both inad- equate sleep and poor self-rated health independently predict mortality, inter- ventions targeting sleep quality among homeless adults are needed. Key words: sleep inadequacy; self-rated health; homelessness Am J Health Behav. 2015;39(1):14-21 DOI: http://dx.doi.org/10.5993/AJHB.39.1.2