Relationship Between Financial Stress and Overall Dietary Risk Behaviors Mediated by Sleep Quality and Duration

OBJECTIVES: Higher financial stress (FS) is associated with undesirable dietary behaviors. However, the relationships are not well characterized among higher education students, and investigations into why these relationships exist are lacking. As FS influences sleep while sleep influences dietary behaviors, sleep may serve as a mediator in these relationships. The current study examined whether poor sleep quality and short sleep duration mediate the relationship between FS and overall dietary risk behavior (ODRB) among higher education students in the U.S during the COVID-19 pandemic. METHODS: This cross-sectional study enrolled students at three large universities in the U.S. between April-May 2020. Eligible students filled out online surveys comprised of validated tools to assess FS, sleep quality and duration, and ODRB. ODRB was measured using the Starting the Conversation questionnaire, which measures eating frequencies of fast foods, fruits, vegetables, soda and sweet tea, high quality proteins, chips and crackers, dessert, and solid fat and provides a global score of ODRB. A higher score indicates more risk behaviors. Multivariate linear regressions were conducted for unadjusted and adjusted estimates, and mediation analysis was conducted using the PROCESS Macro in SPSS 26. RESULTS: A total of 1280 students completed the survey. Higher FS was associated with higher ODRB scores (P = 0.002). The mediation analyses revealed that higher FS was associated with poorer sleep quality (P < 0.001) and shorter sleep duration (P = 0.043). In addition, poorer sleep quality (P = 0.013) and shorter sleep duration (P = 0.005) were both associated with higher ODRB scores. Further, poor sleep quality (B = 0.012, 95% CI 0.002, 0.022) and short sleep duration (B = −0.011, 95% CI −0.007 to −0.0003) mediated the relationship between FS and ODRB scores. CONCLUSIONS: FS and ODRB scores were positively correlated, and this relationship was associated with poor sleep quality and short sleep duration. These results suggest that improving sleep quality and duration may serve as key components of interventions that reduce dietary risk behaviors among U.S. higher education students when experiencing high FS. FUNDING SOURCES: The USDA National Institute of Food and Agriculture, Michigan AgBioResearch, and the Indiana University of Pennsylvania Faculty Incidental Research Support award.