Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Oct 10, 2023
Date Accepted: Oct 29, 2024
Exploring Social-Ecological Pathways from Sexual Identity to Sleep among Chinese Women: Structural Equation Modeling Analysis
ABSTRACT
Background:
Women and sexual minority individuals have been found to be at higher risk for experiencing poor sleep health compared to their counterparts. However, research on the sleep health of sexual minority women (SMW) is lacking in China.
Objective:
This study aimed to examine the sleep quality and social support in Chinese women with varied sexual identities, then investigate the in-depth relationships between sexual identity and sleep.
Methods:
This was a cross-sectional online survey. All participants completed a structured questionnaire containing a set of socio-demographic items referring to the social-ecological model of sleep health, the Pittsburgh Sleep Quality Index, and the Social Support Rating Scale. Structural equation modeling analysis was used to explore the social-ecological relationships.
Results:
A total of 250 cisgender heterosexual women (CHW) and 259 SMW were recruited from July to September 2021. The rate of poor sleep quality was significantly higher in SMW than in CHW (55.2% vs. 39.2%, P<.001). Pearson correlations showed that the overall sleep quality was significantly negatively associated with social support with weak correlations (r=-0.26, P<.001). The final model with satisfactory fit indices identified six social-ecological pathways, showing that alcohol use, objective support, utilization of support, perceived social relationship and environment quality of life played important roles in the sleep quality of individuals from their sexual identity.
Conclusions:
SMW experienced poorer sleep quality compared to CHW. Further research is recommended to address the modifiable factors affecting sleep and then implement tailored sleep improvement programs.
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