Journal of Environmental and Public Health Table 6: Association between insuﬃcient rest/sleep and poor SRH, by race-ethnicity. No. at risk No. with poor SRH Unadjusted odds ratio (95% conﬁdence intervals) Multivariable odds ratio (95% conﬁdence intervals)∗ 1 (referent) 0.51 (0.48–.53) 0.76 (0.71–.81) 1.29 (1.22–1.37) 1.55 (1.42–1.70) 2.59 (2.45–2.74) <0.0001 1 (referent) 0.83 (.72–.96) 1.09 (.90–1.32) 1.67 (1.40–2.00) 1.75 (1.29–2.39) 2.39 (2.05–2.79) <0.0001 1 (referent) 1.10 (.95–1.27) 1.38 (1.12–1.69) 1.57 (1.31–1.88) 1.39 (1.01–1.91) 2.51 (2.12–2.98) <0.0001 1 (referent) 0.62 (.49–.77) 1.17 (.86–1.59) 1.53 (1.21–1.93) 2.19 (1.56–3.06) 2.66 (2.13–3.33) <0.0001 1 (referent) 0.89 (0.84–.95) 1.35 (1.25–1.46) 2.10 (1.95–2.26) 2.39 (2.13–2.69) 2.85 (2.64–3.06) <0.0001 1 (referent) 1.27 (1.06–1.51) 1.56 (1.25–1.95) 2.53 (2.04–3.14) 2.88 (2.08–3.99) 2.75 (2.28–3.32) <0.0001 1 (referent) 1.42 (1.20–1.68) 1.82 (1.45–2.28) 2.21 (1.80–2.72) 1.78 (1.25–2.55) 2.54 (2.07–3.12) <0.0001 1 (referent) 0.89 (.69–1.13) 1.69 (1.19–2.39) 1.85 (1.39–2.47) 2.55 (1.72–3.77) 2.42 (1.84–3.19) <0.0001 6 Categories of insuﬃcient rest/sleep Non-Hispanic white 0 days 1–6 days 7–13 days 14–20 days 21–29 days 30 days P-trend Non-Hispanic black 0 days 1–6 days 7–13 days 14–20 days 21–29 days 30 days P-trend Hispanic 0 days 1–6 days 7–13 days 14–20 days 21–29 days 30 days P-trend Other 0 days 1–6 days 7–13 days 14–20 days 21–29 days 30 days P-trend 299905 106395 86387 32055 35899 9884 29285 28966 9916 7822 3090 3357 889 3892 24810 9707 6361 2305 2723 612 3102 20556 7280 5346 2051 2515 664 2700 50401 17161 8197 4565 7756 2405 10317 7727 2312 1547 800 1123 324 1621 7542 2547 1560 739 978 230 1488 4361 1268 763 408 631 236 1055 ∗ Adjusted for sex (men, women), age (years), race-ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, other), education categories (<high school, high school, >high school), (employed, unemployed, retired, unable to work, homemaker, student), income category (quintiles), marital status, smoker (never, former, current), heavy drinker (no, yes), no regular exercise (yes, no), body mass index categories (<25, 25–29, ≥30 kg/m2), CVD (no, yes), depression (no, yes), and anxiety (no, yes). ﬁndings, a corollary observation is that at least part of the association between poor SRH and mortality may be medi- ated by insuﬃcient sleep. Also, insuﬃcient rest/sleep may be related to sleep deﬁciency, which has been recently shown by Sorensen et al. to be related to multiple health outcomes as well as poor SRH [20]. The sleep deﬁciency/sleep adequacy constructs are similar to insuﬃcient sleep but have histori- cally been assessed using the Medical Outcomes Study sleep scale [21]. There is a need for future studies to examine the relation between similar measures of insuﬃcient sleep and sleep adequacy and how they may jointly inﬂuence multiple health and well-being outcomes. Strengths of the study include its large sample size, stan- dardized data collection methods, and the availability of data on potentially confounding conditions such as BMI, depres- sion, and anxiety. Also, the sample is nationally representa- tive, with study samples from all 50 US states, the District of Columbia, and the three territories, men and women, and all race-ethnicities, which increases the study’s generalizability. The ﬁrst limitation of the study is its cross-sectional nature. Therefore, assertions about temporality or causation such as a sleep duration recommendations cannot be established here. Second, all BRFSS data are self-reported, which may lead to misclassiﬁcation and therefore biased estimates. Third, the 2008 BRFSS did not include items on potential confounders such as shift work, sleep disorders, or relevant medication usage, which therefore were not controlled in this analysis. Fourth, the insuﬃcient rest/sleep variable