The association between food insecurity and poor sleep quality among transgender women of color: The TURNNT cohort study.

Introduction: The purpose of this study is to quantify the longitudinal association between food insecurity and sleep health among transgender women of color (TWOC). Methods: We used longitudinal survey data from 314 TWOC (2020 to 2023). Our sleep variables were short sleep (sleeping for less than seven hours), poor sleep quality (self-rated sleep quality as "Very" or "Fairly bad"), and long sleep onset latency (experiencing sleep onset latency at least three times a week). We conducted bivariate analyses to identify correlates of food insecurity. We used Targeted Maximum Likelihood Estimation to estimate the adjusted risk ratios, adjusting for age, education, income, US-born nativity, sex work history, and incarceration history. Results: Among the 314 participants, 59.9% reported experiencing food insecurity, 54.5% had short sleep, 35.0% had poor sleep quality, and 25.2% experienced long sleep onset latency. Those with lower income and less education were more likely to experience food insecurity. We found that food insecurity measured at baseline was associated with poor sleep quality measured at six-month follow-up (Adjusted Risk Ratio: 2.03; 95% Confidence Interval: 1.26, 3.29). Conclusion: These findings underscore the need for sleep interventions that address the structural determinants of food insecurity among TWOC.