Exploring Social-Ecological Pathways From Sexual Identity to Sleep Among Chinese Women: Structural Equation Modeling Analysis

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 sleep quality and social support for Chinese women with varied sexual identities, and then investigate the in-depth relationships between sexual identity and sleep. Methods: This was a cross-sectional web-based survey. All participants completed a structured questionnaire containing a set of sociodemographic items referring to the social-ecological model of sleep health, the Pittsburgh Sleep Quality Index, the Social Support Rating Scale, and social relationships and environment domains of the World Health Organization Quality of Life-abbreviated short version. Pearson correlation coefficients were used to examine the relationship between sleep quality and social support as well as the two domains of quality of life. 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. A total of 241 (47.3%) women experienced poor sleep quality and the rate was significantly higher in SMW than in CHW (55.2% vs 39.2%, P<.001). Around one-fifth of SMW reported low levels of social support, which was significantly higher than that of CHW (21.6% vs 5.6%, P<.001). Pearson correlations showed that overall sleep quality was significantly negatively associated with social support with weak correlations (r=-0.26, P<.001). The final structural equation modeling analysis with satisfactory fit indices identified 6 social-ecological pathways, showing that alcohol use, objective support, utilization of support, and 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.