It is important to note that the financial crisis

It is important to note that the 2009 financial crisis brought about one of the highest unemployment rates in Western Europe (Arpaia & Curci, 2010). According to the most recent estimates, the unemployment rate in France is still above 10%, which is more than double that of the rate in the United Kingdom) (). The recession was also accompanied by an increase in income inequality over the past decade (Dreger, López-Bazo, Ramos, Royuela, & Suriñach, 2015), which may have exacerbated existing income differences between heterosexual and sexual minority individuals.
Data and methods In October 2016, we used broadcast advertisements on a popular geosocial-networking smartphone application for MSM to recruit our sample. We limited the advertisements to users in the Paris (France) metropolitan area. As done in previous research (Duncan et al., 2016a; Duncan et al., 2016b; Goedel & Duncan, 2015), users were shown an advertisement with text encouraging them to click through the advertisement to complete an anonymous web-based survey. The advertisement described that users who completed the survey were entered in a chance to win €65, which is approximately $US70. We provided the incentive to encourage participation. The advertisement was placed during three consecutive 24-hour weekday periods. After implementing precautions to avoid and eliminate duplicate responses (Duncan et al., 2016a), we found no apparent duplicate responses. Our survey included 52 items and was translated from English into French using an gamma-Secretase inhibitor IX of the TRAPD (Translate, Review, Adjudicate, Pretest, Document) translation protocol, which others has been described in detail previously (Harkness, Van de Vijver, & Mohler, 2003). Five French speakers assisted with survey translation. The survey was offered in French and English. Most participants (94.3%) took the survey in French. At the end of the recruitment period, 5206 users had clicked on the advertisement and reached the landing page of the survey and 935 users provided informed consent and began the survey. In total, 580 users provided informed consent and completed the survey. This represents a completion rate of 62.0% and an overall completion rate of 11.1%. Our completion rate is comparable to other studies of MSM recruited from geosocial-networking smartphone applications (Duncan et al., 2016a; Duncan et al., 2016b; Goedel and Duncan, 2015). The New York University School of Medicine Institutional Review Board approved all protocols before any data collection.
Measures
Results Table 1 shows socio-demographic characteristics of the sample according to poor sleep health. The mean age of the sample was 35.2 (SD = 9.9) years. Most participants reported their sexual orientation as gay (84%). Over three-fourths of the sample was born in France (77.6%). Approximately two-thirds were currently employed and approximately two-thirds were not in a relationship. Almost half of the sample (45.5%) reported high financial hardship, whereby 31.6% reported that Operator was somewhat difficult to pay monthly bills, 9.8% reported that it was very difficult to pay monthly bills, and 4.1% reported that it was extremely difficult to pay monthly bills. In our sample, 30.1% rated their sleep as fairly bad or very bad (referred to as “poor sleep quality”). No differences in poor sleep health were found based on the socio-demographic variables, except age and employment status (data not shown). Among students, for example, more than half (59.3%) reported they had problems falling asleep (Chi-square p-value < .05).
Discussion The objective of the present study was to examine the association between financial hardship and poor sleep health among a sample of MSM in the Paris (France) metropolitan area. This is the first study to examine financial hardship among a sample of MSM in the European Union, a sample that differs from general populations and MSM in the US (where most previous research on socioeconomic status and sleep has been focused). Additionally, this is the first study to examine the association among financial hardship and sleep health independently in any sample of MSM. Overall, though, there is relatively little work on socioeconomic status among sexual minority populations, including as it relates to sleep health (Downing Jr et al., 2016). While it has been suggested that same-sex couples are wealthier than their heterosexual counterparts (e.g., the “double income no children” stereotype of gay men), evidence is suggesting that gay and bisexual men individuals may be more likely to be in poverty (; Badgett & Frank, 2007; Badgett, Lau, Sears, & Ho, 2007). This study therefore advances the literature on socioeconomic status and health in this population, especially regarding the dimension of financial hardship. Almost half of the sample (46%) reported high financial hardship. In addition, individuals reporting high financial hardship were more likely to report poor sleep quality, short sleep duration and sleep problems compared those individuals reporting low financial hardship, highlighting compounding effects of experiencing multiple forms of marginalization on health. There was a lack of association with sleep duration in the multivariate model with the dichotomous financial hardship variable and the results overall show that effects were primarily isolated to those where the highest levels of financial hardship (reporting that it is very difficult or extremely difficult to pay monthly bills).