"You can sleep when you die": How culture, race, gender, and migration shape sleep health among women of color in Utah.

BACKGROUND: Women of color face disproportionately high rates of cardiometabolic disease, partly due to inadequate sleep. Culturally tailored sleep health interventions are urgently needed to address these disparities. Community health workers as trusted community members offer valuable insight to inform intervention development. We sought to examine female community health worker perspectives on individual and sociocultural influences shape sleep health within African Immigrant/Refugee, Black/African American, Hispanic/Latinx(a), and Native Hawaiian or other Pacific Islander communities in Utah. METHODS: Eight focus groups were conducted with 77 female community health workers, stratified by racial/ethnic community. Using Grounded Theory, we employed inductive and deductive coding and iterative analysis informed by community advisors and socio-ecological behavior change models. RESULTS: Participants described prioritizing caregiving, family, and community obligations over sleep health, reflecting intersecting gender and occupational expectations. Perceived consequences of poor sleep included cognitive impairment, emotional dysregulation, diabetes, headaches, unsafe driving, and weight gain. "Hustle culture" emerged as a central theme characterizing the confluence of work, family, and community obligations compounded by racial and acculturation stressors. Sleep-related stigma and culturally rooted practices provided important context for culturally responsive interventions. CONCLUSION: Findings highlight how structural and cultural factors shape sleep trade-offs within communities of color and provide insight to inform the development of targeted, sleep health interventions.