• Joseph S Tan, Annahir N Cariello, Mickeal Pugh, Richard S Henry, Paul B Perrin, Natalie D Dautovich, and Bruce Rybarczyk.
• Hunter Holmes McGuire Veterans Affairs Medical Center; Richmond, VA, USA.
• Fam Pract. 2020 Mar 25; 37 (2): 263-268.

BackgroundThe 3P model proposes that predisposing, precipitating, and perpetuating factors all play a role in sleep disturbance.ObjectiveThe purpose of the current study is to investigate social determinants of sleep disturbance by applying the 3P model to a safety-net primary care setting, specifically by evaluating the role of classism and unmet needs as precipitating factors for sleep disturbance, and anxiety as a perpetuating factor for sleep disturbance.MethodsParticipants (N = 210) were a convenience sample of racially/ethnically diverse adults over the age of 18 (age M = 44.7 years) recruited from a safety-net primary care clinic in an urban area. The study employed a cross-sectional design. Participants completed a survey assessing sleep disturbances, anxiety, unmet needs, classism, social support, and a researcher-generated demographic form.Results And ConclusionsThe unmet need for affordable long-term housing and greater experiences of classism were associated with more sleep disturbance, suggesting that both acted as precipitating factors. In a structural equation model with adequate fit indices, anxiety mediated the relationships with sleep disturbance for both the unmet need for affordable long-term housing and classism, suggesting that it serves as a perpetuating factor. Medical providers are recommended to explore these potential needs in safety-net primary care when patients present with sleep disturbance or anxiety. Assisting with connections to long-term housing and helping patients counteract and cope with classist discrimination may be effective in improving sleep in safety-net primary care.© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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