Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Natalie Dautovich, PhD


Nearly half of all premature deaths in the United States are attributable to preventable and modifiable health risk behaviors. For decades, the leading behavioral health contributors to morbidity and mortality are tobacco use, physical inactivity, and alcohol consumption. Medication adherence is a relatively less studied yet critical interrelated health behavior that is tied to health and treatment outcomes. Sleep, an important pillar of health, is a daily and modifiable behavior that shows promise as a health behavior facilitator. Better understanding the dynamics of these modifiable health behaviors is essential for the improvement of health promotion, particularly among underserved populations (e.g., racial/ethnic minorities and low-income individuals) who are disproportionately at high risk for adverse health outcomes. As such, the purpose of the current study is to characterize the associations between sociodemographic factors, sleep disturbance, and several health behaviors in a safety-net primary care clinic. Primary care clinics––the largest platform of healthcare delivery in the U.S.––show elevated rates of adverse health behaviors and disturbed sleep. Safety-net clinics are a particularly critical access point given the underserved communities that they serve. As mental health frequently co-occurs with disturbed sleep, we also aimed to examine the unique predictive values of sleep disturbance above and beyond mental health in order to tease apart these two highly comorbid variables. Social support, a key protective factor, was also examined as both a predictor and a moderator of the sleep disturbance—health behaviors associations. Participants (N = 210) were a predominantly low-income, diverse patient sample recruited from an urban safety-net primary care clinic. Findings revealed elevated rates of risky health behaviors among the patient sample. Sleep disturbance was a strong unique predictor of alcohol use, physical inactivity, and medication nonadherence. With the addition of mental health, the unique associations of sleep disturbance and mental health were suppressed for alcohol use. For other health behaviors (e.g., physical activity; medication nonadherence), sleep disturbance either stood alone or with mental health as a significant, unique predictor. Lastly, social support was strongly associated with medication adherence and was not found to moderate any of the sleep––health behaviors associations. Findings highlight sleep’s potential as a critical target for health promotion and health behavior change. Reducing the high prevalence of these health risk behaviors has the potential to improve quality of life, promote health, and extend the lives of many. Future work is needed to further disentangle the bidirectional associations between sleep, mental health, and health behaviors. Study implications and possible explanations of the findings are discussed.


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