Abstract
BACKGROUND: Poor sleep quality (PSQ) is disproportionately prevalent among LGBTQ+ individuals and has been linked to substance use, sexual dysfunction and sexual risk-taking (SRT). However, the interplay between sleep health, substance use, SRT, and sexual dysfunction remains underexplored in diverse LGBTQ+ populations. This study investigates whether substance use mediates the relationship between PSQ and SRT among LGBTQ+ individuals in Turkey. METHODS: A cross-sectional survey, using snowball sampling was conducted among 249 LGBTQ+ individuals in Turkey. Measures included the Pittsburgh Sleep Quality Index (PSQI), Index of Sexual Risk-Taking (ISRT), Arizona Sexual Experiences Scale (ASEX), AUDIT-C for alcohol use, and self-reported recent substance use. Logistic and linear regression analyses were used to assess associations between PSQ, substance use, and SRT. Mediation analysis was conducted using structural equation modeling (SEM). RESULTS: PSQ was highly prevalent (80.7%) and significantly associated with alcohol use and chemsex-related substance use (CRSU). CRSU was strongly linked to increased SRT (β = 1.489, p <.001) and served as a significant mediator in the PSQ-SRT relationship (β = 1.045, p = .047). No significant mediation effect was found for alcohol use. CONCLUSION: Poor sleep quality indirectly contributes to higher sexual risk-taking among LGBTQ+ individuals by increasing the likelihood of engaging in chemsex-related substance use. These findings highlight the need for integrated public health interventions addressing sleep health, substance use, and sexual risk-taking in LGBTQ+ communities, particularly in settings with rising substance use rates.