The Pinking of Drinking: Understanding Women’s Alcohol Use in Emerging Adulthood

by

Julia Belenzon Hussman

A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy

Department of Applied Psychology and Human Development Ontario Institute for Studies in Education

University of Toronto

© Copyright by Julia Belenzon Hussman 2018

ii

The Pinking of Drinking: Understanding Women’s Alcohol Use in Emerging Adulthood

Julia Belenzon Hussman

Doctor of Philosophy

Department of Applied Psychology and Human Development Ontario Institute for Studies in Education

University of Toronto

2018

Abstract

The current study applies a sociocultural lens to understanding emerging adult

women’s alcohol use and related problems in light of the recent gender convergence in rates

of alcohol use. Grounded in the developmental framework of emerging adulthood, which

typically characterizes those between the ages of 18-25 years old, this research aimed to

establish a more comprehensive model of young women’s drinking through addressing

several gaps in the current literature and focusing on both risk and protective factors. A

sample of predominantly White, heterosexual emerging adult women (N = 230) participated

in an online study that assessed drinking behaviours and motives, domains of socialized

conventional femininity and resistance of such scripts, and efforts to mitigate risky drinking

behaviours. Greater endorsement of conformity to ideal constructions of femininity dictating

appearance preoccupation (striving to attain a thin body, augmenting one’s appearance, and

relating negatively to one’s body through objectification) was associated with coping

motives, and in turn, risky drinking (binge drinking, alcohol problems), whereas body

objectification was associated with conformity motives, and in turn, alcohol problems.

Greater inauthenticity in relationships was positively associated with conformity motives.

Furthermore, body appreciation was positively associated with protective behavioural

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strategies against risky drinking, including controlled drinking self-efficacy, and was

associated with reduced risky drinking; relationship authenticity was positively associated

with controlled drinking self-efficacy, which was related to reduced levels of risky drinking.

Findings are interpreted within a gender socialization framework and highlight mechanisms

that are associated with unique drinking practices among women; specifically, how women’s

relationships with their bodies are connected with their drinking behaviours. The impact of

adherence/resistance to sociocultural norms on risk and wellness behaviours for emerging

adult women, who are navigating a formative, transitional time in their lives, is discussed.

Clinical implications of these findings are addressed for both prevention and intervention.

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Acknowledgments

First and foremost, I am grateful to my outstanding supervisor, Dr. Abby Goldstein, who has helped shape my growth over the past six years in so many ways. Thank you for encouraging me to retain my own research lens within your lab and for your constant support and mentorship. My passion for emerging adulthood was born as a result of working with you, and has been instrumental in shaping my professional endeavours. Abby, you are a never-ending source of inspiration, and your influence will continue to guide me in the years ahead. I’d like to thank my wonderful committee members Dr. Lana Stermac and Dr. Marg Schneider, both of whom provided meaningful feedback at each stage of my project, challenged me from different perspectives and encouraged me throughout. As well, I appreciate the insightful comments from Dr. Jeanne Watson and the thoughtful feedback from my external examiner, Dr. Robert Peralta, who travelled all the way from Ohio to attend my defense. I’m also indebted to my incredible clinical supervisors throughout my practica and residency: Dr. Judy Silver, Dr. Helen Chagigiorgis, Dr. Susan Vettor, Dr. Mariève Hurtubise, Dr. Kylie Francis and Dr. Susan Farrell, who collectively provided invaluable mentorship and helped form my identity as a clinician. I am grateful to each of you for nurturing my growth and professional development during this process, and for imparting all of your clinical wisdom, which will remain with me always. I owe a very special mention to Dr. Natalie Vilhena-Churchill. Thank you, literally, for everything. I truly could not be where I am today without the unwavering support from my family and friends, who believed in me from the beginning and patiently supported me until the end. Thank you to my parents for teaching me the value of education and hard work, for always advising me and helping me overcome each challenge. Your love and support throughout this entire journey has been integral to my success. To Mara and Zeev, thank you for your love and encouragement from afar. To my two grandparents, Eva and Gub, you are still my heroes and always will be. Finally, I am eternally grateful to Liran. Thank you for helping me reach this milestone by empowering me, staying by my side at each step of the way and always encouraging me with conviction to reach my full potential. You inspire me every single day. I couldn’t be luckier.

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Table of Contents

Acknowledgements………………………………………………………………...………..iv

List of Tables………………………………………………………………………………..vii

List of Figures………………………………………………...…………………………....viii

List of Appendices……………………………………………………………………...……ix

Chapter 1: Introduction ………………………………………………………………………1

Chapter 2: Literature Review ………………………………………………………………...4

Substance Use in Emerging Adulthood……………………………………...…….....4

The Social Organization of Gender…………………………………...……………...5

Conventional and Contemporary Models of Gender-Based Drinking …...………….8

Traditional Femininity Norms and Alcohol Behaviours…………...……………….10

Other Femininity Scripts and Health Behaviours………………………….……..…12

Women’s Relationships with Themselves: Appearance Preoccupation…………….14

Women’s Relationships with Others: Relational Femininity………...…...………...16

Motives to Drink Alcohol……………………………………………..…..………...19

Protective Factors: Body Appreciation and Relationship Authenticity………...…...23

Summary and Hypotheses.…...………………………………………...…….……..28

Risk Factor Models……………………………………………………….…29

Protective Factor Model………………………………...………………..…31

Chapter 3: Method…………………………………...…………………………..……….....33

Participants…………………………………...……………………………….…….33

Procedures………………………………………………………………...………...36

Measures………………………………………………………………………….....38

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Statistical Analyses…………………………………………………………….…....44

Chapter 4: Results…………………………………………………………………………...48

Sample Characteristics of Drinking Behaviours and Alcohol Problems…………....48

Exploratory Factor Analysis for DMQ-R with Bonding/Connection Subscale...…..50

Appearance Preoccupation Risk Factor Model…………………………...…..….....53

Relational Femininity Risk Factor Model…………………………….……...…......57

Protective Factor Model………………………………………...…………..……....59

Chapter 5: Discussion…………………….............................................................................63

General Discussion……………………………………………………………….…70

Study Limitations and Future Directions……….……………………………….…..75

Clinical Implications……………………………………………..………………….79

References………………………………………………………………………………..….82

Appendices……………………………………………………………………...……..…..108

vii

List of Tables

Table 1 Demographic Information for Emerging Adult Women (N=230)……...……….…34

Table 2 Drinking Behaviours for the Current Sample of Emerging Adult Women………...49

Table 3 Exploratory Factor Analysis for a Five-Factor Structure of the Drinking Motives

Questionnaire – Revised……………………………………………………..……...52

Table 4 Bivariate Correlations for the Appearance Preoccupation Risk Factor Model….....54

Table 5 Results from Structural Equation Modeling for the Appearance Preoccupation

Risk Factor Final Model………………………………………………………….……..…56

Table 6 Bivariate Correlations for the Relational Risk Factor Model………………..……..58

Table 7 Bivariate Correlations for the Protective Factor Model……………………………60

Table 8 Results from Structural Equation Modeling for the Protective Factor Final

Model………………………………………...……………………………………...62

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List of Figures

Figure 1 Proposed overall conceptual model of risk factors associated with femininity

scripts and risky drinking……………………………………………………….….29

Figure 2 Proposed appearance preoccupation model of risky drinking ………....................30

Figure 3 Proposed relationship-based model of risky drinking……………………..……...30

Figure 4 Proposed overall conceptual model of protective factors associated with

resistance of internalized femininity scripts and risky drinking……………….…...31

Figure 5 Proposed protective factor model for risky drinking.……………….…….…...........32

Figure 6 Originally proposed appearance preoccupation model of risky drinking ……..…..54

Figure 7 Final appearance preoccupation risk factor model with standardized estimates…..55

Figure 8 Originally proposed relationship-based model of risky drinking …………………57

Figure 9 Originally proposed protective factor model for risky drinking …………………..60

Figure 10 Final protective factor model with standardized estimates …..…………….….…61

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List of Appendices

Appendix A Study Recruitment Ad………………………………………………………..108

Appendix B Informed Consent Form………………………………………………………109

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Chapter 1: Introduction

Women’s alcohol use has been a growing concern in recent decades, in part due to

compelling evidence that rates of women’s drinking are increasing. Although alcohol use and

related problems have typically been – and still are – more prevalent among men, recent

evidence suggests that women’s drinking rates (i.e., frequency of drinking, quantity of drinks

consumed, rates of binge drinking) are approaching those of men (Dawson, Goldstein, Saha,

& Grant, 2015; Johnston, O’Malley, Bachman, Schulenberg, & Miech, 2016; Keyes, Grant &

Hasin, 2008; Slade et al., 2016; White et al., 2015); this is referred to as convergence. The

narrowing of the gender gap in alcohol use is evident in national survey data from Canada,

the United States, and other industrialized nations. For example, the 2015 Canadian Tobacco

Alcohol and Drugs Survey indicates that women are engaging in risky drinking at similar

levels to men: approximately 18% of women (compared to 22% of men) past-week drinkers

aged 15 and older exceeded the gender-specific low risk drinking guidelines (Statistics

Canada, 2016).1 Another largescale report showed a significant increase in rates of binge

drinking among young adults in Canada for women, but not men, between 2003 and 2010

(Thomas, 2012). In the United States, the Centers for Disease Control and Prevention (CDC)

identified young women as an especially high risk group for alcohol-related health problems,

with 24.4% of women aged 18-24 classified as binge drinkers (i.e., consuming 4 or more

drinks in a single occasion) in a national sample (McGuire, 2013). Moreover, gender-based

1 chronic low risk guidelines specify risk for women as drinking more than 10 drinks a week, with no more than 2 drinks a day, and for men as drinking more than 15 drinks a week, with no more than 3 drinks a day (Canadian Centre on Substance Abuse, 2014).

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risk factors associated with substance use have been highlighted within the empirical

literature, noting specific risks for women (Tuchman, 2010; Wilsnack, Wilsnack, & Kantor,

2013), especially young women (Foster, Hicks, Iacono, & McGue, 2015; Schlissel, Schwartz,

& Skeer, 2017; Squeglia, Schweinsburg, Pulido, & Tapert, 2011).

Earlier research on gender differences in alcohol use and problems tended to focus on

sex differences, which suggested an increased sensitivity to the physiological effects of

alcohol for women compared to men. For example, women have a higher blood alcohol

concentration than men after consuming the same amount of alcohol (Frezza, et al., 1990;

Taylor, Dolhert, Friedman, Mumenthaler, & Yesavage, 1996), and are more susceptible to

health complications as a result of drinking, including heart and liver disease (Becker et al.,

1996; Hanna, Chou, & Grant, 1997). Women also have a quicker succession from initial

alcohol use to problematic drinking (i.e., alcohol use disorder) compared to men, a

phenomenon referred to as ‘telescoping’ (Piazza, Vrbka, & Yeager, 1989; Randall et al.,

1999). Accordingly, a gendered definition of binge drinking was created that designated a

binge drinking episode as five or more drinks on a single occasion for men, versus four or

more drinks on a single occasion for women (Wechsler, Dowdall, Davenport, & Rimm,

1995).

Although the narrowing of the gender gap in drinking has been well documented in

epidemiological studies, there is a lack of research on the social and cultural factors that have

contributed to this change (Brady, Iwamoto, Grivel, Kaya, & Clinton, 2016). That is, there is

a need to move beyond identifying convergence (the what) to understanding the underlying

mechanisms involved (the why). The focus on sociocultural factors that shape gender-specific

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drinking patterns therefore becomes pertinent instead of highlighting biological or

physiological differences. In particular, the literature in this area lacks representation of the

ways in which gender socialization, including gender-based norms and ideologies,

contributes to young women's drinking. Although there have been some gains in applying a

sociocultural lens to this field of study in recent years, the research that has been conducted is

limited in three critical ways. First, the focus on femininity, as applied to young women’s

alcohol use, has been restricted by only considering aspects of the traditional feminine role

(i.e., norms) that are apparent and recognized by society. Other aspects of femininity that are

more covert and less acknowledged, such as having an objectified relationship with one’s

body and presenting an inauthentic self in relationships, have been identified by feminist

scholars as powerful aspects of gender socialization, and are absent from this field of study.

Second, previous researchers have focused primarily on distal factors (i.e., traditional

femininity norms), while neglecting more proximal factors such as drinking motives, which

are often theorized as the final pathway to alcohol use and subsequent consequences. Third,

the literature on young women’s drinking has been predominantly framed in terms of risk

factors, whereas protective factors have received less attention. The purpose of the current

study is to address these gaps in the literature by establishing a more comprehensive

sociocultural model of young women’s alcohol use that considers both risk and protective

factors and expands on the assessment of the feminine role, while also including drinking

motives.

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Chapter 2: Literature Review

Substance Use in Emerging Adulthood

The current study operates from a developmental lens that focuses on the period of

emerging adulthood (EA; Arnett, 2000), which typically includes individuals between the

ages of 18-25 years. Compared to previous generations, the average age of adopting what are

typically considered ‘adult’ roles has increased, resulting in an elongation of this particular

time of life (Arnett, 2000; 2004). Theoretically, EA has been identified as a time of identity

exploration, experimentation and possibilities, instability, feeling in-between, and focusing

on one’s self (Arnett, 2004).

In applying the developmental theory of EA to substance use, Arnett (2005) posits

that each of these developmental tasks play a contributory role. With respect to identity

exploration, emerging adults may want to experiment with several identities before they

settle into adulthood, which may include experiencing the mind-altering effects of

substances. Emerging adults may also use substances to cope with the difficulties and

confusions around shaping their own identity. EA is also a time of possibilities, an optimistic

time associated with invincibility, which may encourage substance use without the threat of

risk. Emerging adults may deny the negative consequences of substance use in an effort to

focus on the optimistic present. Moreover, EA has been identified as a time of instability; it is

a time of significant transition (i.e., changes in career, partner, peers, residence, education)

and substance use may take on the form of self-medication as a result of the negative affect

experienced due to chronic instability. Emerging adults are also ‘in-between’ adolescence

and adulthood, and involvement in risky behaviours may reflect an attempt to hold onto their

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adolescence before having to take on the responsibility of adult roles. Given that the average

ages for marriage and parenthood have increased in the past 40 years (Eichler, 2017;

Statistics Canada, 2014), self-focus prevails during EA, affording emerging adults greater

freedom to make decisions regarding how they spend their time. Social networks mainly

involve peers as opposed to family, who may influence patterns of substance use.

The tasks of emerging adulthood contribute to the increase in substance use during

this time of life (Arnett, 2005), which includes risky drinking. National survey data of current

drinkers from the United States reflects a peak in prevalence rates of binge drinking among

young adults aged 18-24 compared to other age cohorts across the lifespan (Kanny, Naimi,

Liu, Lu, & Brewer, 2018). This was mirrored in Canada, where this age group also

demonstrated the highest rates of risky drinking, defined by exceeding the low risk drinking

guidelines (Statistics Canada, 2016). Furthermore, within the current culture of increased

drinking in EA, rates of alcohol use (i.e., binge drinking) among women are noteworthy, as

reflected by the convergence trend. Although the theoretical model of EA provides some

context for understanding increases in drinking during this time of life, a focus on gender-

specific mechanisms is needed to better explain the recent pattern of gender convergence.

The Social Organization of Gender

In establishing a gender-specific sociocultural model of young women’s alcohol use,

it is essential to first explain how gender, as an organizing principle in society, is

conceptualized within the current research. In the late 1980s, seminal work on the

conceptualization of gender emerged, including West and Zimmerman’s (1987) argument

that individuals are constantly doing gender. This and other key contributions resulted in a

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shift away from the notion of gender remaining fixed within the individual – from something

one is to something one does – a fluid social practice that changes depending on the situation

(Nentwich & Kelan, 2014). Social construction theory provides an important framework for

understanding how individuals account for their realities in the world, illuminating the

underlying assumptions in their constructions of knowledge, including the categorical gender

duality (Freud, 1994; Lorber, 1994).

Prominent theorists such as Lorber (1994) described gender as an ‘institution’ that is

deeply entrenched in all aspects of life. She described gender as a stratification system that

positions men above women – a structural imbalance that is upheld by socialized ways of

being in the world that are ascribed based on gender (Lorber, 1994). Consequently, norms

pertaining to traditional masculinity and femininity have been socially dictated for men and

women, respectively, within the dominant Western culture (Mahalik et al., 2003; 2005), with

rewards associated with conformity, and penalties with nonconformity (Levant, 2011).

Feminist-informed researchers have argued that these scripts are oppressive because they

restrict the scope of permissible behaviours within society and reinforce the assumed gender

differences that assign greater power to men and masculinity (Levant, 1996; Parent &

Moradi, 2010). Given that gender norms are embedded within the hierarchical social order

and carry different weights, ‘doing femininity’ is therefore subject to different interpretation

from ‘doing masculinity’ (Nentwich & Kelan, 2014). As such, the current research is

concerned with examining social constructions of the traditional feminine, but not masculine

role, in hoping to further our understanding of young women’s drinking patterns. It also

highlights the importance of distinguishing gender (i.e., gender role orientation) from sex,

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which Peralta, Steele, Nofziger, and Rickles (2010) argue plays a crucial role in considering

differences in men and women’s drinking behaviours.

From a feminist sociocultural perspective, externally produced gender ideologies (i.e.,

ideal femininities) become internalized by women, who come to believe that these ideologies

originate from themselves (Bartky, 1990; Kilbourne, 1994), with a parallel process among

men concerning the internalization of traditional masculinity (Levant, 1996; Thompson &

Pleck, 1995). Indeed, a considerable amount of empirical work has highlighted the adverse

effects of conventional femininity internalization for women on their socioemotional

functioning and sense of selves (e.g., McKinley & Hyde, 1996; Moradi, Dirks, & Matteson,

2005; Noll & Fredrickson, 1998; Richmond, Levant, Smalley, & Cook, 2015; Tolman &

Porche, 2000; Zucker & Landry, 2007). By broadening the assessment of the traditional

feminine role in the context of young women’s drinking patterns, the current study includes

both norms and ideologies, each representing the degree to which conventional femininities

have been internalized by women. Levant, Richmond, Cook, House, and Aupont (2007)

provide the following distinction between conventional femininity norms and ideologies:

conformity to femininity norms measure an individual’s self-report of the degree to which

they identify with behaviours, actions or feelings that are prescribed as feminine (Mahalik et

al., 2005), whereas adherence to femininity ideologies represent an individual’s attitudes

about how women in society ‘should’ act, think, or feel. Thus, it is important to examine a

broader scope of women’s attitudes and behaviours associated with the traditional feminine

role to determine how they impact drinking behaviours in emerging adult women. This is

particularly relevant as within the social organization of gender, traditional femininity scripts

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disempower women and privilege men (Levant, 1996; Levant et al., 2007; Parent & Moradi,

2010; Tolman & Porche, 2000). This draws parallel to the unequal distributions of power

embedded in drinking contexts, including those in EA, as researchers have argued that

drinking and heavy alcohol use among college men are expressions of ‘embodied

masculinity’ (Peralta, 2007).

Conventional and Contemporary Models of Gender-Based Drinking

In order to contextualize women’s drinking from a sociocultural standpoint, it is

important to understand the relationship between gender socialization and women’s alcohol

use. Such an undertaking requires an evaluation of the ways in which aspects of the feminine

role, in relation to drinking norms, have changed over time, including their status at present.

It also invites for a location of drinking norms for women alongside those that have been

prescribed for men. Researchers in the late 1980s and early 1990s began examining the

effects of gender role conformity (as separate from biological sex) on drinking behaviours in

order to account for differences in men’s and women’s drinking rates. In one of the first

studies on this topic, Chomak and Collins (1987) found that masculine-stereotyped behaviour

was positively associated with alcohol use for men, whereas feminine-stereotyped behaviour

was negatively associated with alcohol use for both men and women. Shortly after, Huselid

and Cooper (1992) demonstrated that differences in men and women’s drinking were

partially mediated by gender role orientation (endorsing traditional attitudes about gender

roles) after controlling for biological sex. In addition, certain masculine-stereotyped traits,

such as controlling one’s emotions, was positively related to alcohol use, while endorsing

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stereotyped feminine traits of expressivity was negatively related to drinking (Huselid &

Cooper, 1992).

Taken together, earlier research offered preliminary support for a conventionality

model of gendered drinking norms; generally speaking, men’s and women’s drinking

differed such that alcohol use was a way for men to embody expressions of masculinity, and

was inversely related to expressions of femininity for women. Perhaps reinforcing the

conventionality model is that greater social sanctions exist for women drinkers compared to

men. Women who drink heavily are subject to negative stereotypes of promiscuity and

societal stigma reflecting the antithesis to what Skeggs (1997; 2004) calls ‘respectable

femininity’ (Atkinson & Sumnall, 2016; Day, Gough, & McFadden, 2004; De Visser &

McDonnell, 2012; Griffin, Szmigin, Bengry-Howell, Hackley & Mistry, 2013). The notion of

respectability has been argued as a product of gender- and class-based judgments of groups,

and has been tightly woven into the social fabric of femininity through a sense of morality

(Skeggs, 1997; 2004). Therefore, women who drink heavily are perceived as violating the

norm of moral respectability, and consequently, femininity.

In considering changes in gender-based drinking norms over time, it is important to

note that the positive relationship between socially constructed masculinity and men’s

drinking has remained relatively stable (e.g., Giaccardi, Ward, Seabrook, Manago, &

Lippman, 2017; Iwamoto, Cheng, Lee, Takamatsu & Gordon, 2011; Iwamoto & Smiler,

2013; Peralta, 2007, Wilkinson, Fleming, Halpern, Herring, & Harris, 2018; Zamboanga,

Audley, Iwamoto, Martin, & Tomaso, 2017). However, the narrowing of the gender gap in

drinking calls into question whether femininity is still inversely related to drinking

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behaviours for women. It is also unclear whether current masculinity and femininity norms

have shifted to become more similar as a result of the advancement of women’s social

positions over time, which may play a role in the increase in women’s drinking rates (Young,

Morales, McCabe, Boyd, & D’arcy, 2005). For example, Clinkinbeard and Barnum (2017)

found that endorsing traits associated with the socialized feminine role (i.e., being

sympathetic, compassionate, and gentle) was unrelated to binge drinking and alcohol

problems for young women, whereas certain ‘masculine’ traits representing dominance (i.e.,

being aggressive, forceful) predicted alcohol outcomes for emerging adult women (as well as

men). These findings are consistent with other research demonstrating that a masculine role

orientation is predictive of binge drinking among both young men and women (Peralta et al.,

2010; Peralta, Mulhollem, Blue, & Stewart, 2018). However, these studies examined gender

identities via stereotyped traits instead of norms. Although current drinking norms for women

remain unclear, the gender convergence in drinking patterns indicates a shift from traditional

norms that equated femininity with reduced alcohol use, towards a new set of contemporary

norms.

Traditional Femininity Norms and Alcohol Behaviours

In order to better understand how femininity norms influence women’s drinking from

a quantitative perspective, researchers use measures of norm adherence and evaluate the

extent to which they are associated with drinking. The most often used measure of

multidimensional femininity norms, as applied to the study of alcohol use, is the Conformity

to Femininity Norms Inventory-45 (CFNI-45, Parent & Moradi, 2010). This measure

assesses traditional femininity across nine domains originally proposed by Mahalik et al.

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(2005), including: investing in one’s appearance; maintaining a thin body; being nice; being

modest; being domestic; caring for children; preserving social relationships, valuing romantic

relationships; and sexual fidelity. The CFNI was created to address criticisms of existing

measures that conceptualized femininity as a single dimension or as stereotypically feminine

personality traits (e.g. being compassionate, soft spoken; Bem, 1974), instead assessing

several theorized domains of traditional femininity (Mahalik et al., 2003; 2005). The CFNI-

45 reflects traditional guidelines for ‘what it means to be feminine’ within dominant Western

culture (Mahalik et al., 2005), with individuals conforming to traditional femininity domains

separately, and at varying degrees.

The small body of research using the CFNI-45, which spans Canadian, American and

European contexts, portrays a fragmented pattern among women drinkers wherein rejecting

some traditional femininity norms, but endorsing others, is associated with drinking. This is

consistent with the complexities inherent in the relationship between traditional femininity

and drinking behaviours. To date, researchers have found that most femininity norms

(modesty, domestic, being nice, involvement with children, valuing romantic relationships,

sexual fidelity) are negatively associated with alcohol use and/or alcohol problems among

women (Brabete & Sánchez-López, 2012; Brabete, Sánchez-López, Cuéllar-Flores, & Rivas-

Diez, 2012; Hussman & Goldstein, 2015; Iwamoto, Corbin, Takamatsu, & Castellanos, 2018;

Iwamoto, Grivel, Cheng, Clinton, & Kaya, 2016; Kaya, Iwamoto, Grivel, Clinton, & Brady,

2016; Sánchez-López, Cuéllar-Flores, & Dresch, 2012; Wells et al., 2014). That is, the

majority of traditional femininity scripts support the conventional model of gender norms

where femininity is inversely related to drinking.

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However, researchers have also found that a specific few traditional femininity norms

(appearance investment, desire to be thin, social relationship maintenance) are positively

associated with binge drinking frequency and/or subsequent harms among young women

(Hussman & Goldstein, 2015; Iwamoto et al., 2016; 2018; Kaya et al., 2016). Femininity

norms that positively predict women’s drinking challenge the conventional model of

gendered drinking norms, and may offer exploratory mechanisms for the convergence trend.

One aim of the current study is to better understand these positive pathways by further

examining how these specific domains of femininity contribute to greater binge drinking and

alcohol problems. Although the current evidence suggests that specific representations of

traditional femininity are related to increased alcohol use, there is a need to provide a more

extensive assessment of femininity by examining other internalized scripts to clarify how

they relate to drinking.

Other Femininity Scripts and Health Behaviours

The research on femininity norms and women’s drinking is limited in its focus on

measures of traditional femininity (i.e., norms acknowledged within mainstream society),

without considering conventional ideologies that are more covert. Earlier efforts of feminist

psychologists (i.e., Brown & Gilligan, 1992; Gilligan, Rogers, & Tolman, 1991; Jordan,

Kaplan, Miller, Stiver, & Surrey, 1991; Miller, 1976) recognized the central role

relationships play in young women’s constructions of themselves and experiences in the

world, highlighting the ways that conventional gendered scripts for young women become

internalized. Since then, other feminist researchers have articulated the deleterious effects of

gender role socialization on women’s identities, with two theories in particular paving the

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way for future research. The first, Objectification Theory (Fredrickson & Roberts, 1997),

maintains that the objectification of women’s bodies within mainstream culture results in

self-objectification, meaning that women adopt an external gaze in their primary

conceptualization of their physical selves, and learn to evaluate themselves as objects. States

of objectified body consciousness emerge out of self-objectifying practices, which

encompass the interplay between negative feelings about the self and the ongoing

surveillance of one’s appearance (McKinley & Hyde, 1996). The second, Silencing the Self

Theory (Jack, 1991, 2011; Jack & Ali, 2010; Jack & Dill, 1992), encompasses women’s

socialized tendency to silence their own needs, thoughts and feelings in the context, and in

favour of, relationships, thereby hindering the development of their true sense of selves

(Brown & Gilligan, 1992; Gilligan et al., 1991).

Together, the above feminist-informed work evolved into a body of research that is

concerned with how young women acquire an internalized sense of self, both through their

own experiences and through relationships with others (e.g., Impett, Breines, & Strachman,

2010; Impett, Henson, Breines, Schooler, & Tolman, 2011; Impett, Schooler, & Tolman,

2006; Impett, Sorsoli, Schooler, Henson, & Tolman, 2008; Tolman, Impett, Tracy, &

Michael, 2006; Tolman & Porche, 2000). In particular, Tolman and Porche (2000)

highlighted two critical scripts that guide women’s experiences in the world beginning in

adolescence: objectifying one’s body and being inauthentic in relationships (not presenting

one’s true self, a form of self-silencing). Feminist researchers have found that adherence to

these conventional scripts predicts negative health outcomes for adolescent girls, including

diminished sexual self-efficacy via reduced use of sexual protection (Impett et al., 2006),

14

poorer self-esteem, and greater depression (Tolman et al., 2006). In addition, researchers

have found that women continue to negotiate these conventional femininity scripts beyond

adolescence and into EA (Noll & Fredrickson, 1998; Szymanski, Gupta, Carr, & Stewart,

2009; Tiggemann & Kuring, 2004; Tiggemann & Lynch, 2001; Tiggemann & Slater, 2001).

Although traditional femininity norms are pertinent to the study of socially

constructed gender roles (Mahalik et al., 2005; Parent & Moradi, 2010), body objectification

and inauthenticity in relationships are important additions to the current study as they

represent more covert aspects of conventional femininity that are developmentally relevant to

EA. Further, previous researchers have found that these particular scripts are related to

substance use (e.g., Carr & Szymanski, 2011; Eisenberg, Johnson, & Zucker, 2018;

Hussman, Goldstein & Piran, 2014), rendering them important in understanding young

women’s alcohol use. Accordingly, the present research adds to the literature on gender

norms for drinking by including important aspects of internalized femininity (having an

objectified relationship with one’s body and being inauthentic in relationships) that have so

far been neglected in this area of research.

Women’s Relationships with Themselves: Appearance Preoccupation

As noted above, the majority of research on traditional femininity norms and alcohol

use using the CFNI-45 has found that women’s adherence to norms of desiring thinness and

appearance investment positively predicts alcohol outcomes. Assessing women’s focus on

appearance involves several related, but distinct, femininity norms. For example, appearance

investment and thinness norms have both been linked with binge drinking and/or alcohol

problems (Hussman & Goldstein, 2015; Iwamoto et al., 2016; 2018; Kaya e al., 2016), but

15

these norms are conceptually different. Appearance investment encompasses the degree to

which one sees value in participating in daily beauty practices such as wearing makeup or

hair styling to increase self-esteem, whereas thinness is specific to striving to attain (and

maintain) a thin body, and the anticipated benefits associated with weight loss (Mahalik et al.

2005; Parent & Moradi, 2010). One other area of internalized femininity related to this

dimension is body objectification. Although strongly related to traditional femininity norms

concerning desiring thinness and appearance investment, body objectification represents at a

broader level the dysfunctional ways that women relate to their bodies. As articulated by

Fredrickson and Roberts (1997), women self-objectify and view their physical selves

negatively through an external perspective. Having an objectified relationship with one’s

body is both an outcome of, and contributor to, desiring thinness and appearance investment

practices, and therefore aligns closely with these conventional norms. As a whole, investing

in one’s appearance, desiring thinness and having an objectified relationship with one’s body

are interrelated within the umbrella of appearance preoccupation scripts that are internalized

by young women.

It is somewhat paradoxical to suggest that appearance preoccupation and alcohol use

are positively related, given the media focus on the detrimental effects of alcohol on

women’s appearance, including weight gain and complexion problems (Atkinson, Kirton, &

Sumnall, 2012; Day et al., 2004). Although body image preoccupation is also a concerning

and prevalent issue among men (Grogan, 2016), abstaining from alcohol in the interest of

vanity can be considered a gendered behaviour in that dieting, or restricting one’s calorie

intake, is generally constructed as a feminine practice (Bordo, 2003), and therefore viewed as

16

socially inappropriate for men (Gough, 2007). Research shows that women dieters often wish

to avoid drinking due to alcohol’s high calorie content (Stinson, 2001), reflecting the

perception that alcohol impedes their chances of attaining thinness. However, emergent

research supports a unique relationship between heavy alcohol use and the ‘ideal’ feminine

look. For example, among young, college-attending women in the United States, high-risk

drinkers prioritized their physical appearance and appearing attractive to men, and were more

likely to value acts that maintained their appearance, compared to low-risk drinkers (Likis-

Werle & Borders, 2017). Previous work by Peralta (2002) highlights that sociocultural

pressures to drink alcohol often co-occur with those related to appearance preoccupation

among young people. College-attending men and women engage in excessive weight control

practices (including modifying their alcohol and food intake, purging, or excessive exercise)

to counteract the expected weight gain attributed to their drinking (Peralta, 2002; Peralta &

Barr, 2017). While these behaviours also occur among men, they are more salient among

young women (Barry, Whiteman, Piazza-Gardner, & Jensen, 2013; Bryant, Darkes & Rahal,

2012; Peralta, 2002). One of the goals of the current study is to better understand the

relationship between appearance preoccupation and alcohol use among young women and

broaden this understanding through the inclusion of femininity scripts related to appearance

and body objectification.

Women’s Relationships with Others: Relational Femininity

In addition to appearance preoccupation norms, social relationship maintenance has

also been associated with young women’s alcohol use, based on research using the CFNI-45

(Hussman & Goldstein, 2015; Iwamoto et al., 2016; 2018; Kaya et al., 2016). Women

17

drinkers who value maintaining their friendships also report greater alcohol use, suggesting

that they may assign social value to their drinking. This is expected given that both men and

women endorse social reasons for drinking alcohol, particularly in the developmental context

of EA (Kuntsche, Knibbe, Gmel & Engels, 2005; LaBrie, Hummer & Pedersen, 2007).

Emerging adults assign benefits to the effects of alcohol in facilitating social interactions,

including the perception that alcohol is a ‘social lubricant’ (Monahan & Lannutti, 2000), and

that alcohol-related socializing may be used for relationship development (Borsari & Carey,

2006). However, social facilitation differs from social relationship maintenance. While social

facilitation encompasses developmentally appropriate socialization processes, including

meeting new friends and spending time with peers, social relationship maintenance implies a

combination of healthy (developmentally appropriate) and unhealthy behaviours (socialized

acts performed out of ‘necessity’ to maintain relationships).

Because social relationship maintenance has been constructed as part of traditional

feminine, but not masculine roles (Mahalik et al., 2003; 2005), it is implied that women

should cherish their social relationships more than men. Historically, an ethic of care

(Gilligan, 1982; 1995), demonstrated through women’s roles as mothers and primary

caretakers, has been conceptualized as one of the most definitive aspects of femininity

(Chodorow, 1978; Laslett & Brenner, 1989). Although women’s roles have evolved over

time as they have gained more access to the public sphere, research throughout the past

decade has corroborated that the caretaking ideology assigned to women is still chiefly

relevant (Levant et al., 2007; Richmond et al., 2015). Inherent in this role are gendered ideals

including the ‘good wife’ and ‘good mother’ (Moen & Roehling, 2005) that are measured

18

through adherence to caretaking, thereby causing gender role stress in women who diverge

from this role (Levant et al., 2007; Richmond et al., 2015). Akin to ideal portrayals of mother

and wife, exemplary femininity may also include the notion of the ‘good friend’, and this

may be especially pertinent to EA when emerging adults typically focus on peer relationships

(Arnett, 2000). With respect to the social relationship maintenance norm, Parent and Moradi

(2010) assert that while it reflects the benefits of having a solid peer network, concerns about

the potential for broken bonds within one’s social web may cause strain and can be

detrimental to one’s functioning. The social relationship maintenance norm is intricate, and

research that provides greater context in its relation to women’s drinking is necessary in

order to understand how conformity promotes women’s drinking in EA.

If women are subscribing to the social relationship maintenance norm out of

‘obligation’ linked to conventional femininity, it can be argued that they are putting forth to

others an inauthentic self; what they say and do is different from what they wish and desire

(Impett et al., 2008; Tolman & Porche, 2000) in order to conform to conventional feminine

ideals. This socialized notion of bringing an inauthentic self into relationships is harmful to

women’s self-concept (Impett et al., 2006; Tolman et al., 2006). Relationship inauthenticity

may therefore serve as another aspect of relational femininity that contributes to the link

between socialized femininity and women’s drinking.

In summary, the primary femininity norms that have been positively associated with

drinking include those pertaining to appearance investment, desiring thinness and social

relationship maintenance. Despite efforts toward furthering our understanding of a

sociocultural perspective of gender-based drinking, the literature is limited in some respects.

19

First, there is a need for an expansion of traditional femininity norms by including related

ideologies that are more covert, to help shine light on women’s relationships with themselves

(their bodies) and their relational dynamics within EA. Second, although the emergent

research on traditional gender norms and drinking has found that certain aspects of the

feminine role predict alcohol use and alcohol problems, the underlying mechanisms that

elucidate how these norms impact drinking are unclear. Therefore, in order to better

conceptualize the gender-based risks associated with heavy drinking in EA, additional factors

need to be considered.

Motives to Drink Alcohol

Drinking motives also play an important role in furthering our understanding of the

relationships between socially constructed femininity and alcohol outcomes, and have yet to

be considered in this context. Drinking motives are thought to be the final pathway to alcohol

use and alcohol problems and have been well studied, typically using a four-factor model

proposed by Cooper (1994) that distinguishes between positively (social, enhancement) and

negatively reinforcing (coping, conformity) motives. Social motives relate to the social

benefits of drinking, whereas enhancement motives relate to increases in pleasant emotional

states; coping motives involve reducing negative affect, whereas conformity motives

encompass conforming to social pressures to avoid social rejection (Cooper, 1994).

With respect to the current research, motives are important to consider because they

represent distinct pathways to drinking behaviours, with some motives predicting drinking

and others predicting both drinking and drinking consequences. In general, previous

researchers have found that social and/or enhancement motives are the most important

20

predictors of alcohol use (Read, Wood, Kahler, Maddock, & Palfai, 2003; Kuntsche, Stewart,

& Cooper, 2008; Kuntsche & Cooper, 2010), whereas coping motives are important

predictors of alcohol problems (Carey & Correia, 1997; Kuntsche et al., 2008; Merrill,

Wardell, & Read, 2014; Read et al., 2003). Further, in a cross-national study, Kuntsche et al.

(2008) found a positive relationship between conformity motives and alcohol problems in

Canadian and American, but not Swiss adolescents, suggesting a unique cultural salience of

the role of social pressures in North American young people’s lives. In considering a more

comprehensive model of young women’s alcohol use, the current study will include drinking

motives as a final pathway to drinking, and will explore the ways in which motives emerge

within the sociocultural context of femininity.

Drinking motives will be examined as mediators of the relationship between

traditional femininity scripts and alcohol outcomes. Within the appearance preoccupation

domain, it is anticipated that coping motives will be an important mediator. Appearance

preoccupation and disordered eating behaviours have been associated with negative affect

and body dissatisfaction in girls and young women (Brechan & Kvalem, 2015; Stice & Shaw,

2002). In this case, negative affect may be attributable to a discrepancy between a woman’s

perceived bodily appearance and that of an ‘ideal’ woman (i.e., glamorized portrayals of uber

thin, made-up women within mass media), which is reinforced by social and environmental

factors (Groesz, Levine, & Murnen, 2002; Thompson & Stice, 2001). It is therefore implied

that negative affect is relevant to appearance preoccupation, in turn reflecting a conceptual

link to coping motives, or drinking to relieve negative affect.

21

Researchers have found a connection between disordered eating and the use of

alcohol to cope with negative affect among women with bulimia nervosa and binge eating

disorder (Luce, Engler, & Crowther, 2007). One study of emerging adult women found that

relative to the other drinking motives, coping motives was the strongest predictor of

problematic eating behaviours (dieting, bulimia and food preoccupation, and self-control of

eating), which suggests that both excessive alcohol use and disordered eating serve

negatively reinforcing coping functions (Anderson, Simmons, Martens, Ferrier, & Sheehy,

2006). In addition, researchers have found that coping, and to a greater degree, conformity

motives, were associated with ‘drunkorexia' (Ward & Galante, 2015), a non-medical term

which involves restrictive eating practices or excessive exercise to counteract the effects of

drinking on one’s body mass (Barry & Piazza-Gardner, 2012; Chambers, 2008). Researchers

have also found a link between conformity motives and young women’s use of compensatory

exercise behaviour in the context of drinking (Buchholz & Crowther, 2014). These findings

support negative reinforcement drinking motives (coping, conformity) as proximal predictors

of drinking among women who engage in various forms of disordered eating practices. This

is consistent with research that reflects a strong link between appearance (i.e., weight)

preoccupation and depression (Rawana, Morgan, Nguyen, & Craig, 2010).

The present study will extend previous research on drinking motives to the

sociocultural context by considering pathways from internalized femininity to motives for

alcohol use. Based on previous research on the relationship between disordered eating and

drinking motives, it is anticipated that women who conform to norms of appearance

investment and desire for thinness, and who have an objectified relationship with their body,

22

will endorse reasons for drinking that are concerned with attempts to reduce negative affect

and to conform to pressures to fit in with others and, in turn, these motives will be associated

with risky drinking and alcohol problems.

The second theme of the current study explores women’s relational dynamics,

including the degree to which they preserve their friendship groups and suppress aspects of

their true selves in the interest of others. Using alcohol to preserve or maintain social

relationships is tied to social drinking motives, which encompass drinking to be sociable or to

enhance peer-related events and celebrations. Emerging adults, particularly college students,

largely equate drinking with social motives (Kuntsche et al., 2005; 2008; LaBrie et al., 2007;

Read et al., 2003). While social drinking motives are theoretically relevant in explaining

domains of relational femininity, social motives (i.e., drinking to make social gatherings

more fun) are different from motives to bond and connect with others, which imply a sense of

group belongingness and cohesion through shared drinking practices. A growing body of

qualitative research suggests a symbolic role of alcohol within friendship groups of women,

particularly in preserving and maintaining women’s same-gender peer groups through

bonding (Atkinson & Sumnall, 2016; Brown & Gregg, 2012; Griffin, Bengry-Howell,

Hackley, Mistral, & Szmigin, 2009; Likis-Werle & Borders, 2017; Lyons & Willott, 2008;

Nicholls, 2016; Szmigin et al., 2008).

Furthermore, the role of relationship inauthenticity will also be examined within the

relational domain. Because emerging adults use alcohol to facilitate social interactions

(Borsari & Carey, 2006), difficulty presenting an authentic self may contribute to alcohol use

through motives to use alcohol as a vehicle for connection (Covington & Surrey, 1997).

23

Therefore, it is hypothesized that domains of relational femininity (social relationship

maintenance, relationship inauthenticity) will be associated with social motives, as well as a

proposed set of bonding/connection motives, and in turn, will be related to risky drinking.

Protective Factors: Body Appreciation and Relationship Authenticity

While the identification of risk factors for women’s alcohol use is essential, and has

received extensive attention in the research literature, far less attention has been paid to the

important role of protective factors. This may reflect that previous research has found that

risk factors are stronger predictors of substance use than protective factors (Cleveland,

Feinberg, Bontempo, & Greenberg, 2008). Despite this, evidence suggests that some factors

are protective against young adults’ heavy alcohol use, which include those relevant to the

social and developmental demands associated with EA (Stone, Becker, Huber & Catalano,

2012). For example, researchers have found that certain living arrangements in EA may

protect against substance use behaviours. Living with parents while attending college was

associated with reduced alcohol frequency (White et al., 2006), and living with a significant

other (cohabitation) was associated with reduced binge drinking and marijuana use, although

the effects for marriage were stronger than for cohabitation (Duncan, Wilkerson, & England,

2006). Stone et al. (2012) point out that some factors, such as college attendance, have

complex relationships with substance use behaviours: while attending college posed a greater

risk for alcohol use (Slutske et al., 2004), particularly among those who moved away from

home (White et al., 2006), college degree completion was associated with a reduced

likelihood of developing an alcohol use disorder later in young adulthood (Sher & Gotham,

1999).

24

While these findings shed light on factors that have the potential to protect against

heavy or harmful drinking in EA, they are not gender specific. In addition, where gender

specific protective effects have been claimed (i.e., traditional femininity norms such as

modesty, sexual fidelity and being domestic associated with reduced alcohol use or alcohol

problems; Iwamoto et al., 2016; 2018; Kaya et al., 2016), they reflect representations of

gender socialization that are oppressive for women, which serve to maintain gender

inequality. Therefore, other gender-based protective factors for women that exist outside of

prescribed domains of conventional femininity need to be identified.

Although the research on sociocultural protective factors for young women against

harmful health consequences is still in the development phase compared to risk factors, there

have been some gains throughout the past few decades; for example, prevention work in the

field of eating disorders (Piran, 2010; 2015). Rooted in feminist psychodynamic theory,

Impett and colleagues (2008; 2010; 2011) found that resistance to internalized scripts of

conventional femininity was related to positive health outcomes in young women. One

longitudinal study that followed adolescent girls from age 13 to 18 demonstrated that girls

who reported positive relationships with their bodies experienced greater self-esteem and

fewer depressive symptoms during this developmental period (Impett et al., 2011). Further,

the paucity of research on the adaptive functions of body image led to research on the

positive aspects of women’s relationships with their bodies, such as body appreciation

(Avalos, Tylka, & Wood-Barcalow, 2005).

As a construct, body appreciation encompasses several domains derived from

previous work (i.e., Cash, 1997; Freedman, 2002; Levine & Smolak, 2001; Maine, 2000):

25

positive opinions of one’s body, acceptance and respect for one’s body regardless of physical

appearance, attending to the needs of one’s body in a healthy manner, and protection against

idealistic portrayals of bodies within popular media (Avalos et al., 2005). Young women with

greater body appreciation also report greater self-esteem, optimism, life satisfaction and

coping, as well as more favourable appearance evaluations (Avalos et al., 2005). These

outcomes have stronger relationships with body appreciation compared to body

dissatisfaction (Avalos et al., 2005), indicating that body appreciation is a separate construct

from low negative body image (Wood-Barcalow, Tylka, & Augustus-Horvath, 2010). Body

appreciation has also been associated with several other indicators of women’s health,

including healthy intuitive eating or eating based on physiological hunger cues (Avalos &

Tylka, 2006; Tylka & Kroon Van Diest, 2013), increased self-reported physical health status

(Ramseyer Winter, O’Neill, & Omary, 2017), and lower symptoms of depression and anxiety

(Ramseyer Winter, Gillen, Cahill, Jones, & Ward, 2017). Additionally, body appreciation is

associated with positive sexual functioning including arousal, orgasm and sexual satisfaction

(Satinsky, Reece, Dennis, Sanders, & Bardzell, 2012), and increased use of sexual protection

(Ramseyer Winter & Ruhr, 2017). Despite the accumulation of research identifying body

appreciation as an important factor for a range of positive healthy behaviours, to date, there

have been no investigations on the protective effects of body appreciation against risky

drinking for young women, and experts in the field have called for an extension beyond the

field of eating disorders to other “disruptions in the body domain, such as substance abuse”

(Piran, 2015, p. 153). Accordingly, it is hypothesized that body appreciation will be

associated with efforts to moderate drinking through a commitment to caring for the body by

26

mitigating bodily harm, including heavy or dysfunctional alcohol use.

Another protective factor that has been examined within feminist-informed work on

women’s health outcomes pertains to relationship authenticity, or the experience of being

one’s true self in relationships, as defined by a high degree of correspondence between what

a woman thinks and feels and what she says and does within her relationships (Impett et al.,

2008). The idea of being authentic with others directly opposes conventional, oppressive

femininities that dictate self-silencing in relationships (Brown & Gilligan, 1992; Gilligan et

al., 1991; Jack, 1991; Jack & Dill, 1992). In their five-year longitudinal study, Impett et al.

(2008) found that adolescent girls who endorsed high levels of relationship authenticity in

early adolescence experienced greater self-esteem in later adolescence compared to those

who were inauthentic in relationships, and those who experienced growth in authenticity also

experienced growth in self-esteem. Yet, the reverse did not hold true: self-esteem did not

predict authenticity in relationships, which supports a unidirectional relationship for

relationship authenticity on self-esteem (Impett et al., 2008). Impett et al. (2010) also found

that being authentic in intimate dating relationships was associated with an increased

likelihood of sexual protection use in young adult women aged 18-31 years. Being authentic

and expressing one’s true thoughts and desires to others has positive effects on multiple

domains of young women’s wellbeing, including increased self-worth and safer sexual health

behaviours. This may be attributable to an authentic woman’s capacity to advocate for herself

and communicate her needs, thereby rejecting conventional femininity scripts of passivity

and compliance.

The current study is first in applying this framework to investigating protective

27

effects against risky drinking. Being one’s true self in relationships through the articulation

of needs and desires is relevant to drinking given that contexts associated with drinking often

encompass interpersonal dynamics (i.e., drinking in social settings are typical in EA). Thus,

being authentic in relationships may facilitate one’s ability to make healthier choices or resist

social pressures concerning drinking, if and when it aligns with a woman’s intention to do so.

It is therefore posited that having a positive relationship with one’s body and being authentic

in relationships will result in healthier drinking behaviours. Expanding on the literature that

supports the link between endorsing ideologies that are inconsistent with conventional

femininities and positive health outcomes for young women, another goal of the proposed

study is to explore protective effects of traditional femininity resistance (i.e., body

appreciation and relationship authenticity) on harmful alcohol use for young women.

Specialized measures have been developed to assess efforts to moderate one’s

drinking or implement active strategies to mitigate harms associated with risky drinking. For

example, researchers have found that controlled drinking self-efficacy (Sitharthan,

Kavanagh, & Sayer, 1996; Sitharthan, Sitharthan, Hough, & Kavanagh, 1997), or one’s

perceived confidence in their ability to reduce their alcohol quantity/frequency or resist the

urge to drink in high-risk situations, is associated with lower alcohol use (Kavanagh,

Sitharthan, Spilsbury, & Vignaendra, 1999). In addition, the implementation of behavioural

strategies that protect against risky drinking, such as avoiding drinking shots of liquor,

alternating alcoholic beverages with water, or designating a time to cut off one’s drinking,

was associated with reduced alcohol use and fewer alcohol problems in freshmen-aged

women (LaBrie, Kenney, Lac, Garcia, & Ferraiolo, 2009) and these strategies were more

28

protective against binge drinking and alcohol problems for young (White) women compared

to men (Kenney & LaBrie, 2013). To better understand how resisting traditional femininity

norms protects against alcohol use and problems, it is hypothesized that greater adherence to

body appreciation and relationship authenticity will be associated with protective behaviours

against risky drinking (controlled drinking self-efficacy and protective behavioural

strategies), which, in turn, will be negatively related to risky drinking outcomes (binge

drinking, alcohol problems).

Summary and Hypotheses

The examination of socially constructed gender roles is critical for a sociocultural

analysis of the gendered pattern of convergence in drinking. The present research aims to

contextualize the positive relationship between adherence to traditional femininity norms

(desire to be thin, invest in appearance, social relationship maintenance) and risky drinking

(binge drinking frequency and alcohol problems) by developing a more comprehensive

model of young women’s drinking that extends beyond norms of traditional femininity and

includes other internalized ideologies that are relevant in emerging adulthood (body

objectification, relationship inauthenticity), as well as motives to drink alcohol. It is

anticipated that these variables together will be associated with risky drinking among young

women. In addition, given that motives to drink alcohol in order to bond with others are

relevant to women’s alcohol use, but are not captured within current measures of drinking

motives, the current study seeks to better measure these motives by piloting additional

motives items and assessing their coherence using exploratory factor analysis. Finally,

research that identifies protective factors against risky drinking behaviours for young women

29

is lacking, and this is particularly salient in light of the public attention being paid to rising

drinking rates among women. Based on previous research indicating that rejecting oppressive

femininity scripts (thereby endorsing body appreciation and relationship authenticity) is

associated with positive health outcomes for women, it is anticipated that these factors will

be positively associated with controlled drinking self-efficacy and protective behavioural

strategies, and in turn, less involvement in risky drinking behaviours.

Risk Factor Models

As illustrated in Figure 1, the overall conceptual risk factor model specifies that

endorsing internalized femininity scripts will be associated with drinking motives, and

subsequently, risky drinking (binge drinking frequency, alcohol problems).

Figure 1. Proposed overall conceptual model of risk factors associated with femininity scripts

and risky drinking

Within this model, specific pathways will be tested, as demonstrated in Figure 2 and

Figure 3. Based on the above and consistent with previous research, it is hypothesized that:

1. Adherence to appearance-related femininity scripts pertaining to women’s

relationships with their bodies (thinness, invest in appearance, body objectification)

30

will be associated with coping and conformity drinking motives, and ultimately, risky

drinking (binge drinking frequency, alcohol problems).

Figure 2. Proposed appearance preoccupation model of risky drinking

2. Domains of conventional femininity pertaining to women’s relationships with others,

including social relationship maintenance and relationship inauthenticity, will be

associated with social and bonding/connection drinking motives, and finally, risky

drinking.

Figure 3. Proposed relationship-based model of risky drinking

31

Protective Factor Model

The overall protective factor model (Figure 4) is exploratory in nature given the dearth of

research concerning gender-specific protective factors against risky drinking for women from

a sociocultural perspective. The model hypothesizes that resisting conventional femininity

scripts will be associated with increased protective strategies against risky drinking, and

consequently, reduced levels of risky drinking.

Figure 4. Proposed overall conceptual model of protective factors associated with resistance

of internalized femininity scripts and risky drinking

3. As illustrated in Figure 5, based on feminist-informed research that has examined

other women’s health outcomes, it is hypothesized that endorsing positive aspects of

body image (body appreciation) and being one’s true self in relationships

(relationship authenticity) will be associated with protective factors for risky drinking

(controlled drinking self-efficacy and protective behavioural strategies), and

negatively related to risky drinking (binge drinking frequency, alcohol problems).

32

Figure 5. Proposed protective factor model for risky drinking

33

Chapter 3: Method

Participants

A total of 327 women were recruited online across Canada to participate in the

current study. Participants completed an online survey with a total of 230 young women

completing at least 80% of survey items. Of the 327 women who were recruited, 16 provided

their consent to participate in the study, but did not complete any survey items thereafter. The

remaining 81 women either filled out too few survey questions to be considered reliable

participants (i.e. filled out the first couple pages of the survey and did not continue) or did not

have at least 80% complete data. The final sample of women (N= 230) ranged in age from

19-25 years old (M = 21.97; SD = 2.19).

Women responded to an electronic study advertisement, which directed them to the

link for the survey. In order to participate, women had to self-identify as women, but not

necessarily female; however, those who self-identified as male were excluded from

participation, given the nature of the study. Women were also required to meet the age

criteria that typically characterize the developmental stage of EA (18-25 years old) as

proposed by Arnett (2000; 2004). As the legal drinking age in Ontario (as well as many other

provinces in Canada) is 19, the lower limit of the age-based criterion was modified

accordingly. Women were eligible if they identified as a current drinker, as defined by

having had at least one drink of alcohol within the past 30 days. Other eligibility criteria

included living in Canada at the time of survey completion, being fluent in written English,

and being able to provide a valid email address for the purpose of reimbursement. The study

34

advertisement also specified that women had a chance to win one of five online $100 gift

cards to Amazon.ca to thank them for their participation.

The majority of the sample identified as women (97%), single race (84.8%),

Caucasian/White (74.8%), and straight/heterosexual (71.3%). Most women had either

completed some university/college (43%) or had already obtained a university Bachelor’s

degree or college diploma (38.7%) or a master’s/graduate degree (10.9%). Socioeconomic

status varied among women, with the majority describing their family’s financial status as

either average (32.2%) or somewhat above average (37.8%). Women also reported a range of

relationship statuses at the time of survey completion: the highest proportion reported that

they were in a serious relationship, but not living with their partner (32.3%). Full

demographics for the sample are reported below in Table 1.

Table 1

Demographic Information for Emerging Adult Women (N=230)

Variable N (%)

Age 19 49 (21.3) 20 29 (12.6) 21 19 (8.3) 22 27 (11.7) 23 33 (14.3) 24 34 (14.8) 25 39 (17.0) Gender Identity Woman 223 (97) Transgender 1 (0.4) Genderqueer 2 (0.9) Unsure 1 (0.4)

35

Questioning 3 (1.3) Race Single race 195 (84.8) Bi-racial 26 (11.3) Multi-racial (3 or more) 8 (3.5) Racial Identity Aboriginal or First Nations 3 (1.3) African-Canadian/Black 13 (5.7) Arab/West Asian 6 (2.6) Caucasian/White 172 (74.8) Chinese 28 (12.2) Filipino 5 (2.2) Korean 4 (1.7) Latin American 7 (3.0) South Asian 15 (6.5) South East Asian 12 (5.2) Other 12 (5.2) Highest level of education completed Some high school 1 (0.4) High school diploma 15 (6.5) Some university/college 99 (43.0) University Bachelor’s degree or College diploma

89 (38.7)

Master’s/Graduate degree 25 (10.9) Professional degree 1 (0.4) Family’s financial status Well below average 6 (2.6) Somewhat below average 40 (17.4) About average 74 (32.2) Somewhat above average 87 (37.8) Well above average 23 (10.0) Sexual Orientation Straight/heterosexual 164 (71.3) Lesbian 5 (2.2) Bisexual 29 (12.6) Queer 13 (5.7)

36

Polysexual 2 (0.9) Questioning 5 (2.2) Asexual 2 (0.9) Autosexual 1 (0.4) Unsure 5 (2.2) Prefer not to answer 1 (0.4) Other 3 (1.3) Relationship status Not currently dating, have never had a serious relationship

49 (21.3)

Not currently dating, have had a serious relationship in the past

32 (13.9)

Casually dating, have never had a serious relationship

8 (3.5)

Casually dating, have had a serious relationship in the past

27 (11.7)

Seriously dating, not living together 74 (32.2) Seriously dating, living together 27 (11.7) Common law 8 (3.5) Married 4 (1.7) Other 1 (0.4)

Note. Only those response options that were endorsed are included in the table.

Procedures

Women were recruited through various social media platforms, including Facebook

and Reddit over a three-month time span (between August and October 2016). This study

focused specifically on the age range of emerging adulthood, which often aligns with college

and university attendance. Therefore, college and university-based groups were targeted for

recruitment, as were community-based groups to increase the likelihood of a more

representative sample. In the case of closed or private online spaces (e.g., private Facebook

groups), permission was first granted from the group administrator to post the study

37

advertisement. On Facebook, the study advertisement was posted in various Facebook groups

that consisted of university-specific (e.g., University of Toronto undergraduate classes,

Psychology Student Associations at the University of Toronto, Dalhousie University, and

Queens University) and community demographics (e.g., Bunz Helping Zone in Toronto and

Vancouver, a community-based group organized around helping people). The study

advertisement was also posted publicly on the student investigator’s Facebook page, and

others who were interested in the study were invited to share the advertisement with others in

their personal networks. Targeted forums on Reddit included those specific to universities

and colleges across Canada, whereas general, community-based forums within Canada were

unavailable or inaccessible on Reddit. All study procedures were reviewed and approved by

the Research Ethics Board at the University of Toronto.

Upon accessing the survey link (powered by FluidSurveys, a secure, Canadian-based

survey platform), women were directed to the informed consent page, which outlined

potential risks and benefits associated with study participation. After providing consent,

participants completed the 30-minute online survey and were then directed to a printable

resource sheet, which outlined the contact information for national and provincial mental

health and substance use resources. They also had the option of entering the study raffle to

thank them for their participation in the study. Although reporting on one’s substance use can

be considered a sensitive topic, data suggest that self-report measures of alcohol use are

reliable and valid (Del Boca & Darkes, 2003).

38

Measures

Women completed a series of demographic questions assessing age, gender identity,

sexual orientation, race/ethnicity, family income, highest level of education completed, and

relationship status.

Alcohol use. To assess binge drinking, women were asked how many times they

drank four or more drinks on one occasion within the past two weeks, as defined by the

gender-based criteria for binge drinking proposed by Wechsler et al. (1995). Women were

provided with a definition of a standard drink (e.g., A drink means one bottle of beer, one can

of cider, one cooler, one glass of wine or champagne, or a single shot of liquor (double shots

of liquor count as two drinks). Response options ranged from never to daily or almost daily.

Further, women were asked to report on the maximum number of drinks they consumed

within a 24-hour period during the past two weeks. Response options ranged from 0 drinks to

36 or more drinks. Quantity and frequency of alcohol use were also assessed using items

modified from the Alcohol Use Disorders Identification Test (AUDIT-C; Bush, Kivlahan,

McDonnell, Fihn, & Bradley, 1998). To assess alcohol quantity, women were asked to

estimate how many drinks they typically consume on each day of the week and response

options ranged from 0 drinks to 10 or more drinks; frequency response options ranged from

never to 4+ times per week.

Alcohol problems. Past year alcohol problems were assessed using the Brief Young

Adult Alcohol Consequences Questionnaire (BYAACQ; Kahler Strong, & Read, 2005). The

BYAACQ is a brief, 24-item version of the Young Adult Alcohol Consequences

Questionnaire (Read, Kahler, Strong, & Colder, 2004), which reflects the following eight-

39

factor structure of alcohol problems: social-interpersonal consequences, impaired control,

self-perception, self-care, risk behaviors, academic/occupational consequences, excessive

drinking, and physical dependence (Kahler et al., 2005). The BYAACQ assesses alcohol

problems among emerging adults along a continuum of severity ranging from mild (e.g.,

While drinking, I have said or done embarrassing things; I have had a hangover [headache,

sick stomach] the morning after I had been drinking) to more severe (e.g., I have woken up in

an unexpected place after heavy drinking; I have felt like I needed a drink after I’d gotten up

[that is, before breakfast]). Importantly, for the purposes of the current study, the BYAACQ

was not intended to assess clinical forms of alcohol use (i.e., an alcohol use disorder), but to

reflect the range of alcohol problems typically experienced by young women in the context

of alcohol use. Participants respond either yes or no to items measuring alcohol problems,

with higher scores indicative of more problems. The BYAACQ has demonstrated good

psychometric properties, including a reliability estimate of .82 on a Rasch model in a sample

of college students (Kahler et al., 2005). With respect to cut-off scores on the BYAACQ, a

score of 10 indicates that individuals are likely to report at least some psychosocial

consequences associated with their alcohol use, while a score of 15 suggests that symptoms

associated with alcohol abuse and dependence may be present (Kahler et al., 2005). Internal

consistency of scale items in the current study was high (Cronbach’s α = .87).

Adherence to Traditional Femininity Norms. Women reported on traditional

femininity norm adherence using the Conformity to Femininity Norms Inventory-45 (CNFI-

45; Parent & Moradi, 2010), a 45-item scale that measures the degree to which women

endorse traditional feminine roles. This measure contains nine factors, each representing a

40

distinct subscale: thinness (e.g., I would be happier if I was thinner), domestic (e.g., It is

important to keep your living space clean), invest in appearance (e.g., I regularly wear

makeup), modesty (e.g., I hate telling people about my accomplishments), relational (e.g., I

believe that my friendships should be maintained at all costs), involvement with children

(e.g., Taking care of children is extremely fulfilling), sexual fidelity (e.g., It is not necessary

to be in a committed relationship to have sex [reverse scored]), romantic relationship (e.g.,

Having a romantic relationship is essential in life), and sweet and nice (e.g., I always try to

make people feel special). Response options range across a 4-point scale from Strongly

Disagree to Strongly Agree. The CFNI-45 has demonstrated strong reliability and validity

across subscales with Cronbach’s α coefficients ranging from .69 to .92 (Parent & Moradi,

2010). Similarly, in the current study, Cronbach’s α’s ranged from .68 (sweet and nice

subscale) to .89 (involvement with children subscale).

Body Objectification. Body objectification was assessed with the 10-item

Objectified Relationship with Body subscale of the Adolescent Femininity Ideology Scale

(AFIS; Tolman & Porche, 2000), which measures the degree to which young women

internalize or resist two negative domains of femininity: body objectification and relationship

inauthenticity. Within this subscale, women respond to items that reflect having an

objectified relationship with their body (e.g., I often wish my body were different) on a 6-

point scale ranging from strongly disagree to strongly agree. Several items are reverse coded,

and mean scores are calculated, with higher scores indicating greater levels of self-

objectification. Internal consistency for this subscale has been deemed good, as reflected by

41

Cronbach’s α = .81 (Impett et al., 2006). In the current study, internal consistency for the

objectified relationship with body subscale was also good (Cronbach’s α = .84).

Inauthentic and Authentic Self in Relationships. Relationship

inauthenticity/authenticity was assessed with the Inauthentic Self in Relationships subscale of

the AFIS (Tolman & Porche, 2000). Responses to 10 items (e.g., Often I look happy on the

outside in order to please others, even if I don’t feel happy on the inside) range from strongly

disagree to strongly agree. Mean inauthenticity scores are calculated with higher scores

reflecting greater levels of relationship inauthenticity. Consistent with other research that has

examined relationship authenticity using the Inauthentic Self in Relationships subscale of the

AFIS (e.g., Impett et al., 2008; 2010), authentic self in relationships was calculated (for the

protective factor model) by reverse coding items. Reliability was reported as adequate for

this subscale: Cronbach’s α = .77 (Impett et al., 2006). In the current study, internal

consistency for the inauthentic self in relationships subscale was also adequate (α = .73).

Body Appreciation. Body Appreciation was assessed with the Body Appreciation

Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015a), a 10-item scale that assesses positive

perceptions of one’s body (e.g., I appreciate the different and unique characteristics of my

body). Response options range on a 5-point scale from never to always. Scores are averaged

across items with higher scores indicating greater appreciation for one’s body. Psychometric

properties were found to be robust: subscales demonstrated excellent internal consistency

with α’s between .94 and .97 for women, three-week test re-test reliability was high, and

construct, criterion-related and incremental validity for the BAS-2 were supported (Tylka &

42

Wood-Barcalow, 2015a). In the current study, reliability was deemed excellent (Cronbach’s

α = .94).

Drinking Motives. Motives to drink alcohol were assessed using the Drinking

Motives Questionnaire-Revised (DMQ-R; Cooper, 1994), a 20-item scale that captures

different reasons for consuming alcohol. Participants are asked to indicate the frequency with

which they drink for various reasons and items reflect four domains: social (e.g., To be

sociable) coping (e.g., To forget your worries), enhancement (e.g., Because it’s exciting), and

social pressure or conformity motives (e.g., To fit in with a group you like). Responses range

on a 5-point scale from almost never/never to almost always/always. Scale scores are

summed, with higher scores indicating greater endorsement of motives. Good reliability

estimates for the DMQ-R were supported beyond Cooper’s (1994) initial validation study

(e.g., Kuntsche, Knibbe, Engels & Gmel, 2010; LaBrie, Hummer, Pedersen, Lac, &

Chithambo, 2012). In the current study, reliability coefficients as assessed by Cronbach’s α

for the drinking motives subscales, were as follows: social (.89), coping (.82), enhancement

(.86), and conformity (.86), thereby demonstrating good internal consistency.

In addition, as one of the goals of the current study is to ascertain an additional factor

of drinking motives pertaining to bonding and connection, a piloted subscale of these motives

was administered based on the rationale that drinking motives to bond and connect with

others (e.g., To feel closer to others), are conceptually different than motives pertaining to

being sociable (spending time with friends). The piloted bonding/connection subscale

consisted of five items that were derived based on theoretical considerations from the

empirical literature in this area (qualitative studies on young women’s drinking behaviours)

43

and were later refined through feedback from piloting with a small group of emerging adult

women. The final five items for the bonding/connection subscale were as follows: 1) to feel

connected to others; 2) to bond with others; 3) to feel closer to others; 4) to have a shared

experience with others; 5) to deepen or improve the quality of your friendships. Internal

consistency for the proposed bonding/connection subscale was excellent (α = .90).

Controlled Drinking Self-Efficacy. The Controlled Drinking Self-Efficacy Scale

(CDSES; Sitharthan, Soames Job, Kavanagh, Sitharthan, & Hough, 2003) assesses self-

efficacy in relation to moderate drinking across 20 items. Participants rate their perceived

confidence to control their drinking across moods (e.g., When you’re angry), social contexts

(i.e., When you’re at a party with friends) and within set limits of quantity (e.g., Can you

make sure that you do not have more than three drinks at any time that you have a drink?)

and frequency (e.g., Can you stop yourself from drinking alcohol at least one day a week?).

Items are rated on a scale from 0 (not at all confident) to 100 (very confident). In the current

study, the definition of heavy drinking was modified to four or more drinks per occasion, in

line with the gender-based definition of binge drinking for women, proposed by Wechsler et

al. (1995). Furthermore, one item (when you’re in a “shout situation”) was omitted due to

lack of relevance in a North American context (i.e., the word “shout” is specific to Australian

drinking contexts). The total score reflects the average across the 19 items, with higher scores

reflecting greater self-efficacy to moderate one’s drinking. The CDSES was found to have

sound psychometric properties, demonstrating excellent internal consistency (Cronbach’s α =

.95) and good two-week test-retest reliability (r = .90) (Sitharthan et al., 2003). In the current

study, internal consistency for the scale was excellent, Cronbach’s α = .90.

44

Protective Behavioural Strategies. Behavioural strategies to mitigate the risks of

harmful drinking were assessed using the 15-item Protective Behavioral Strategy Scale

(PBSS; Martens et al., 2005). Participants rate the frequency with which they employ

different protective strategies while drinking alcohol, ranging from 1 (never) to 5 (always).

Three subscales are captured within the PBSS: stopping/limiting drinking (e.g., alternate

alcoholic and nonalcoholic drinks) manner of drinking (e.g., avoid drinking games), and

serious negative consequences (e.g., use a designated driver) (Martens et al., 2005).

However, researchers have also used a total protective behavioural strategies score in

relevant studies, for which internal consistency was deemed good (Cronbach’s α = 0.81;

Arterberry, Smith, Martens, Cadigan, & Murphy, 2014). In the current study, the full scale

PBSS was used, and internal consistency was also good (Cronbach’s α = .83).

Statistical Analyses

To examine the factor structure of the newly developed bonding/connection subscale

of the DMQ-R, an exploratory factor analysis using principal components analysis was

conducted. Exploratory factor analysis was selected to explore underlying factors, or groups,

within the data (Field, 2009). Eigenvalues were used to determine the ideal number of

factors, and Kaiser’s (1960) criterion was applied, which involves retaining eigenvalues

greater than one (Yong & Pearce, 2013). In addition to the eigenvalue threshold, scree plots

were used to determine cut-off points for the factor structure. Scree plots graphically

represent each eigenvalue plotted against its associated factor, highlighting a specific point of

inflexion that illustrates the appropriate number of factors (Yong & Pearce, 2013). Following

the extraction of factors, a varimax rotation was used to examine the extent to which items

45

loaded onto the factor structure. Varimax rotation was chosen as it assumes that factors are

independent, which is consistent with the hypothesized notion of bonding/connection items

constituting a separate factor on the DMQ-R. Items with low correlation coefficients (less

than r = 0.30) were suppressed, as correlations less than this value are representative of weak

relationships (Tabachnick & Fidell, 2007). Bartlett’s test of Sphericity and the Kaiser-Meyer-

Olkin (KMO) measure of sampling adequacy (Kaiser, 1970) were also selected to help

improve reliability of the factor analysis. KMO values range from 0 to 1, with higher values

signifying that patterns of correlations are concise, thereby rendering separate and reliable

factors (Field, 2009). Hutcheson and Sofroniou (1999) specify the following qualifiers for

KMO values: mediocre (between 0.5 and 0.7) good (between 0.7 and 0.8), great (between 0.8

and 0.9) and superb (above 0.9).

Next, bivariate relationships between variables were examined to identify patterns

pertaining to each hypothesis. Subsequently, the hypothesized risk factor and protective

factor models outlined in Figures 1-5 were tested using Structural Equation Modelling (SEM)

in AMOS (Arbuckle, 2006), which allows for the examination of relationships between

observed variables simultaneously. The current study utilized a model-generating framework

(Jöreskog, 1993) to test whether the hypothesized models (as illustrated in Figure 2 and

Figure 5) fit the sample data. When fit was poor, modifications were made in an exploratory

way in order to re-estimate and improve the model fit. The goal was to locate the origin of

poor fit within the model in order to recreate an alternative model that is both conceptually

relevant and statistically sound (Byrne, 2001). Data pertaining to those with an 80% survey

completion rate or higher were used in analyses. To address missing data, maximum

46

likelihood estimation was used to test for paths within models using the ‘estimate means and

intercepts’ function, which provides estimates for missing data.

Model fit was assessed using several goodness-of-fit indices including: Chi-square

(χ2), its associated degrees of freedom and probability value (p), comparative fit index (CFI),

and root mean square error of approximation (RMSEA) and its associated confidence

interval. As an initial goodness-of-fit index, a Chi-square test was conducted. The Chi-square

statistic indicates an overall (absolute) model fit index through the probability of deriving a

value greater than χ2 when the null hypothesis is true, meaning the higher the probability, the

closer the fit between the hypothesized model and a perfect fit (Bollen, 1989; Byrne, 2001).

Hu and Bentler (1999) describe the Chi-square statistic as reflecting the “magnitude of

discrepancy between the sample and fitted covariance matrices” (p. 2). Consequently, a non-

significant (p > .05) Chi-square test is one indication that the model fits the data (Byrne,

2001). It is important to note, however, that the Chi-square test is not without limitations.

Jöreskog and Sörbom (1993) explain that a significant Chi-square probability value may

occur when the model does not fit the data and the sample size is large, despite a large

sample size being beneficial to SEM, as increased statistical power helps to distinguish a

good model fit (Kenny & McCoach, 2003). Thus, in addition to the Chi-square statistic, its

degrees of freedom and probability value, it is essential to provide alternative, supplemental

goodness-of-fit indices.

The following goodness-of-fit indices are commonly used in SEM and are among

those recommended by Hooper, Coughlan, and Mullen (2008), who explain that these

particular indices are more resistant to sample size fluctuations, model misspecifications and

47

parameter estimates: CFI and RMSEA and its associated confidence interval. The CFI is an

incremental fit index and one of the most commonly reported fit indices in SEM that serves

as a comparison between the Chi-square statistic and the baseline model (typically a null

hypothesis model) (Byrne, 2001; Hooper et al., 2008). The RMSEA, like the Chi-square

statistic, is another absolute fit index that indicates how well the model would fit the

population covariance matrix if the parameter estimates were chosen in the most

parsimonious manner (Byrne, 1998; Hooper et al., 2008). MacCallum, Browne, and

Sugawara (1996) note that one of the benefits of the RMSEA is that its confidence interval is

derived based on its value, which enables increased accuracy of the null hypothesis testing

process (McQuitty, 2004). In considering threshold values, general consensus reflects that

CFI > 0.95, RMSEA < 0.06 and an associated confidence interval of close to zero (lower

limit) and < 0.08 (upper limit) indicates a good model fit of the data (Byrne, 1998; 2001;

Hooper et al., 2008; Hu & Bentler, 1999).

48

Chapter 4: Results

Sample Characteristics of Drinking Behaviours and Alcohol Problems

Women in the current sample reported drinking habits that were typical of emerging

adult drinkers (see Table 2). Although women were recruited based on being current drinkers

(i.e., have had at least one drink within the past month), one participant responded that she

had never consumed alcohol within the past month on the AUDIT-C. Most women reported

drinking 2-4 times during the past month (53.5%), and drinking, on average, just under 1-2

drinks on a typical drinking week. Drinking behaviours were mostly concentrated on the

weekends (Friday and Saturday nights) where the average number of drinks ranged between

1-2 drinks and 3-4 drinks. The number of times women binge drank (defined as 4 or more

drinks in one occasion) throughout the past two weeks ranged from never (37.4%) to daily or

almost daily (0.9%), with the highest proportion reporting that they binge drank once

(32.2%). The highest proportion of women reported that their maximum number of drinks

consumed in a 24-hour period in the past two weeks was 5-7 drinks (33%). Many women

experienced alcohol consequences (M = 7.21; SD = 4.90), although to a lesser degree than

the validation sample of regularly drinking (consumed alcohol at least once a week for the

past three months) American college students (Kahler et al., 2005).

49

Table 2 Drinking Behaviours for the Current Sample of Emerging Adult Women Variable N (%)

Alcohol frequency (past month) Never 1 (0.4) Monthly or less 31 (13.5) 2-4 times/month 123 (53.5) 2-3 times/week 57 (24.8) 4+ times/week 18 (7.8)

Binge drinking frequency (past two weeks) Never 86 (37.4) Once 74 (32.2) Twice 37 (16.1) 3-4 times 24 (10.4) 5-6 times 7 (3.0) Daily or almost daily 2 (0.9)

Maximum alcohol quantity (past two weeks) 0 drinks 13 (5.7) 1 drink 22 (9.6) 2 drinks 31 (13.5) 3 drinks 28 (12.2) 4 drinks 30 (13.0) 5-7 drinks 76 (33.0) 8-11 drinks 27 (11.7) 12-17 drinks 2 (0.9) 18-23 drinks 1 (0.4)

50

Exploratory Factor Analysis for DMQ-R with Bonding/Connection Subscale

In order to determine whether bonding/connection motives mediated the relationship

between relational femininity domains and risky drinking, the factor structure of the DMQ-R

with the proposed bonding/connection items was investigated. To examine the proposed five-

factor structure of the DMQ-R, an exploratory factor analysis with principal component

analysis and varimax rotation was performed. Factors with Eigenvalues greater than one were

extracted in line with the Kaiser criterion (Field, 2009), and scree plots were also examined.

To test for issues of multicollinearity, the determinant score was examined, which indicated a

value above 0.00001, indicating that multicollinearity was not an issue (Yong & Pearce,

2013). Bartlett’s test of Sphericity was significant, p < .01, indicating that patterned

relationships exist within the data (Yong & Pearce, 2013), and the KMO statistic was .904,

which is qualified as ‘superb’ (Hutcheson & Sofroniou, 1999). The factor analysis resulted in

a four-factor structure and explained 66.4% of the variance in the dependent data. Based on

examination of the reproduced correlation matrix, it was determined that the model was a

good fit, as evidenced by 27% of the non-redundant residuals with absolute values above 0.5,

which is in line with the threshold of < 50% (Yong & Pearce, 2013). Examination of the

factor loadings in the pattern matrix indicated that bonding/connection items did not load

onto an independent factor.

The proposed items were examined at the individual level, and it was deemed that in

some cases, items were likely measuring similar constructs (e.g., “to bond with others”, “to

feel connected to others”, “to feel closer to others”). Further, results demonstrated that

bonding/connection items overlapped with other DMQ-R factors (both social and conformity

51

drinking motives), indicating that the underlying constructs pertaining to bonding/connection

drinking motives are conceptually similar to drinking motives of sociability and fitting in

with one’s peer group. Given that the evidence for the bonding/connection subscale as a

distinct factor was weak, it was not included as such in the current study. The original four-

factor structure of the DMQ-R was retained and the bonding/connection subscale was not

used in subsequent analyses. Table 3 demonstrates items and factor loadings of the proposed

five-factor structure of the DMQ-R.

52

Table 3

Exploratory Factor Analysis for a Five-Factor Structure of the Drinking Motives Questionnaire – Revised Factor 1 2 3 4

DMQ-R 1. To forget your worries .825 DMQ-R 2. Because your friends pressure you to drink .646 DMQ-R 3. Because it helps you enjoy a party .733 DMQ-R 4. Because it helps you when you feel depressed

or nervous .814

DMQ-R 5. To feel connected to others .579 .560 DMQ-R 6. To be sociable .697 .361 DMQ-R 7. To cheer up when you are in a bad mood .710 DMQ-R 8. Because you like the feeling .817 DMQ-R-9. To bond with others .580 .502 DMQ-R 10. So that others won’t kid you about not

drinking .791

DMQ-R 11. Because it’s exciting .741 DMQ-R 12. To get high .635 DMQ-R 13. Because it makes social gatherings more fun .780 .368 DMQ-R 14. To fit in with a group you like .694 DMQ-R 15. To feel closer to others .560 .539 DMQ-R 16. Because it gives you a pleasant feeling .323 .811 DMQ-R 17. Because it improves parties and celebrations .798 .303 DMQ-R 18. Because you feel more self-confident and

sure of yourself .596 .331

DMQ-R 19. To have a shared experience with others .738 .347 DMQ-R 20. To celebrate a special occasion with friends .720 DMQ-R 21. To forget your problems .834 DMQ-R 22. Because it’s fun .536 .675 DMQ-R 23. To be liked .826 DMQ-R 24. So you won’t feel left out .799 DMQ-R 25. To deepen or improve the quality of your

friendships .396 .580

Note. Bolded items reflect proposed items for bonding/connection drinking motives.

53

Appearance Preoccupation Risk Factor Model

The first hypothesis for the current study was to examine whether coping and

conformity motives mediated the relationship between appearance preoccupation femininity

scripts (thinness, appearance investment, body objectification) and risky drinking. Prior to

conducting multivariate analyses, bivariate relationships between variables were examined

for the Appearance Preoccupation Risk Factor Model. Bivariate correlations for appearance

preoccupation norms (thinness, invest in appearance), body objectification, drinking motives,

binge drinking frequency, and alcohol problems are presented in Table 4. Consistent with the

first hypothesis, the feminine norm of desiring thinness was significantly and positively

correlated with investing in one’s appearance, body objectification, coping motives,

conformity motives, and alcohol problems. Investing in one’s appearance was significantly

and positively associated with body objectification, coping motives, and alcohol problems.

Body objectification was positively and significantly associated with coping motives,

conformity motives, and alcohol problems. Coping motives was significantly and positively

associated with conformity motives, binge drinking, and alcohol problems. Conformity

motives was significantly and positively associated with alcohol problems.

54

Table 4

Bivariate Correlations for the Appearance Preoccupation Risk Factor Model 1 2 3 4 5 6

1. Desire for thinness – – – – – –

2. Invest in appearance .23** – – – – – 3. Objectified relationship with body .68** .21** – – – – 4. Coping motives .31** .26** .26** – – – 5. Conformity motives .24** .09 .39** .40** – – 6. Binge drinking (past 2 weeks) .05 .11 .02 .25** .05 – 7. Alcohol problems .17** .15* .16* .40** .39** .34**

* p < .05; ** p < .01.

Figure 6. Originally proposed appearance preoccupation model of risky drinking

Based on the criteria for establishing model fit, the initial Appearance Preoccupation

model, as illustrated in Figure 6, was a poor fit for the data, χ2 = 166.849, df = 11, p = .000,

CFI = .538, RMSEA = .249, CI .216 – .283. Modifications to the model were made based

on theoretical and statistical considerations, including re-consulting the literature to

determine whether changes in the model were justified, and modification indices in AMOS,

55

which provided statistical recommendations (i.e., the addition or omission of specific paths

within the model; combining variables into a latent construct) to improve model fit. The

following modifications were made to create an alternative model: 1) An appearance

preoccupation latent variable was created that included body objectification, thinness, and

appearance investment; 2) an additional path between body objectification and conformity

motives was added; 3) error terms for coping motives and conformity motives were allowed

to covary within the model, given that they are highly correlated; 4) the risky drinking latent

outcome variable was separated into individual outcome variables (binge drinking and

alcohol problems, respectively); 5) an additional path was added between binge drinking

and alcohol problems; 6) a path between conformity motives and binge drinking was

removed. Following these modifications, the alternative model (see Figure 7) provided a

good fit for the data, χ2 = 11.034, df = 10, p = .355, CFI = .997, RMSEA = .021, CI 0.00 –

.077. Consistent with the first hypothesis, all paths, with the exception of appearance

preoccupation to conformity motives, were significant, p < .001 (see Table 5).

Figure 7. Final appearance preoccupation risk factor model with standardized estimates

56

Table 5

Results from Structural Equation Modeling for the Appearance Preoccupation Risk Factor Final Model Pathway UE SE p Standard

Est.

1. Appearance preoccupation – Coping motives .329 .065 *** .359

2. Appearance preoccupation – Body objectification .666 .065 *** .777 3. Body Objectification – Conformity motives .490 .126 *** .474 4. Appearance Preoccupation – Conformity motives -.089 .118 .450 -.101 5. Coping motives – Binge drinking .316 .081 *** .249 6. Appearance preoccupation – Invest in appearance .188 .047 *** .283 7. Appearance preoccupation – Thinness .582 .052 *** .876 8. Binge drinking – Alcohol problems 1.169 .241 *** .277 9. Coping motives – Alcohol problems 1.126 .333 *** .210 10. Conformity motives – Alcohol problems 1.619 .336 *** .291

Notes. UE = Unstandardized Estimates; SE = Standard Error; Standard. Est. = Standardized Estimates *** p < .001

To assess whether the final model represented a significantly better fit than the

proposed model, a Chi-square likelihood ratio difference test was conducted that subtracted

the values of χ2 and the dfs of the revised (alternative) model from the hypothesized model,

χ2diff = 155.815, dfdiff = 1. The change in χ2 was significant (p < .001) meaning that from a

statistical standpoint the revised model fits better than the original hypothesized model

(Werner & Schermelleh-Engel, 2010).

Indirect Effects

Additional analyses were conducted using a bootstrapped estimation approach (2000

samples) to determine whether drinking motives (coping, conformity) mediated the

57

relationships between appearance preoccupation and binge drinking (frequency)/alcohol

problems. Appearance preoccupation had a significant indirect effect on both binge drinking

(B = .104, SE = .037, 95% CI .043, .189, p = .000) and alcohol problems (B = .371, SE =

.143, 95% CI = .150, .719, p = .000) through coping motives. A significant indirect effect

was also found for the relationship between coping motives and alcohol problems through

binge drinking (B = .369, SE = .137, 95% CI = .155, .703, p = .001). In addition, a significant

indirect effect was found for the relationship between body objectification and alcohol

problems through conformity motives (B = .792, SE = .293, 95% CI = .347, 1.498, p = .001).

Relational Femininity Risk Factor Model

The second hypothesis was to examine whether social and the proposed set of

bonding/connection motives mediated the relationship between relational femininity (social

relationship maintenance, relationship inauthenticity) and risky drinking (see Figure 8). Prior

to conducting multivariate analyses, bivariate relationships between variables were examined

for the Relational Femininity Risk Factor Model.

Figure 8. Originally proposed relationship-based model of risky drinking

58

Based on the exploratory factor analysis described above, the proposed

bonding/connection items were not used in the analyses. Instead, conformity motives, which

are conceptually relevant to the relational risk factor model, were used in the subsequent

analyses in addition to social motives. Bivariate correlations for relational femininity

domains (social relationship maintenance, relationship inauthenticity), drinking motives,

binge drinking frequency and alcohol problems are presented in Table 6. With respect to

alcohol use, binge drinking did not yield any significant relationships with independent

variables, which does not support the second hypothesis; thus, other risky alcohol use

variables were explored. Social relationship maintenance was significantly and positively

related to maximum alcohol quantity (past 2 weeks). In addition, although not hypothesized,

presenting an inauthentic self in relationships was significantly and positively associated with

conformity motives.

Table 6

Bivariate Correlations for the Relational Risk Factor Model 1 2 3 4 5 6

1. Social relationship maintenance – – – – – –

2. Inauthentic self in relationship -.07 – – – – – 3. Social motives .04 -.04 – – – – 4. Conformity motives -.08 .22** .44** – 5. Binge drinking (past 2 weeks) .09 -.04 .30** .05 – – 6. Alc. Max Quantity (past 2 weeks) .13* -.13 .36** -.01 .67** – 7. Alcohol problems -.09 -.05 .33** .39** .34** .33**

* p < .05; ** p < .01.

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Examination of the correlation matrix indicated that in general, the proposed variables

were not significantly correlated with each other. Therefore, the plan to continue with the

proposed SEM analysis was terminated. Instead, two linear regression analyses were

performed separately based on the significant correlations: social relationship maintenance

and inauthenticity in relationships were regressed onto 1) maximum alcohol quantity

consumed in the past two weeks; and 2) conformity motives. In the first analysis, the

regression model was significant, F(2, 227) = 3.614, p = .029, R2adj

= .022. However, neither

social relationship maintenance (B = .424, SE = .226, β = .123, p = .062) nor relationship

inauthenticity (B = -.297, SE = .167, β = -.117, p = .076) were significantly associated with

maximum alcohol use in the past two weeks. The second regression model was also

significant, F(2, 227) = 6.164, p = .002, R2adj

= .043. Social relationship maintenance was not

significantly associated with conformity motives (B = -.116, SE = .108, β = -.070, p = .285),

whereas inauthenticity in relationships was significantly and positively associated with

conformity motives (B = .261, SE = .080, β = .211, p = .001). While the second hypothesis

was not supported, the inclusion of conformity motives, although not initially hypothesized,

yielded a significant relationship with relationship inauthenticity.

Protective Factor Model

The third hypothesis was to examine whether protective strategies against risky

drinking (controlled drinking self-efficacy and protective behavioural strategies) mediated

the relationship between conventional femininity resistance (body appreciation and

relationship authenticity) and risky drinking. Prior to conducting multivariate analyses,

bivariate relationships between variables were examined for the Protective Factor Model.

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Bivariate correlations between proposed variables are illustrated in Table 7. In line with the

third hypothesis, body appreciation was significantly and positively related to being authentic

in relationships, controlled drinking self-efficacy, protective behavioural strategies, and

negatively associated with alcohol problems. Controlled drinking self-efficacy and protective

behavioural strategies were significantly and positively correlated, and both were

significantly and negatively related to binge drinking frequency and alcohol problems.

Table 7 Bivariate Correlations for the Protective Factor Model 1 2 3 4 5

1. Body appreciation – – – – –

2. Authentic self in relationships .31** – – – – 3. Controlled drinking self-efficacy .15* .10 – – – 4. PBSS Total Score .17** -.05 .38** – – 5. Binge drinking -.04 .04 -.40** -.21** – 6. Alcohol problems -.17** .05 -.43** -.31** .34**

* p < .05; ** p < .01.

Figure 9. Originally proposed protective factor model for risky drinking

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To investigate the originally proposed Protective Factor Model, as illustrated in

Figure 9, SEM was utilized. The hypothesized model did not demonstrate adequate fit to the

data as reflected by the significant Chi-square value (p < .05) and RMSEA value > 0.06, χ2 =

37.640, df = 8, p = .000, CFI = .826, RMSEA = .127, CI 0.088 – .169. The path between

authentic self in relationships and the protective strategies latent outcome variable (p = .517)

was non-significant. Next, modifications to the model were made based on both conceptual

(consulting the empirical literature) and statistical considerations (modification indices in

AMOS) in order to improve the model fit. The modifications included: 1) allowing the

exogenous variables (body appreciation and authentic self in relationships) to covary; 2)

removing the path between authentic self in relationships and the protective strategies latent

outcome variable; 3) adding a path between authentic self in relationships and controlled

drinking self-efficacy. The final protective factor model (see Figure 10) demonstrated an

excellent fit to the data, χ2 = 10.540, df = 7, p = .160, CFI = .979, RMSEA = .047, CI .00 –

.101. All paths were significant, p < .05 (see Table 8). The third hypothesis was confirmed.

Figure 10. Final protective factor model with standardized estimates

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Table 8 Results from Structural Equation Modeling for the Protective Factor Final Model

UE SE p Standard Est.

1. Body Appreciation – Protective Strategies .265 .111 .016 .197 2. Authentic Self in Relationships – Controlled

Drinking Self-Efficacy 2.674 1.338 .046 .110

3. Protective Strategies – Behavioural Strategies .082 .015 *** .507 4. Protective Strategies – Controlled Drinking

Self-Efficacy 12.195 2.234 *** .749

5. Risky Drinking – Binge Drinking .203 .036 *** .543 6. Risky Drinking – Alcohol Problems 4.916 .859 *** .635 7. Protective Strategies – Risky Drinking -2.725 .510 *** -.935

Notes. UE = Unstandardized Estimates; SE = Standard Error; Standard. Est. = Standardized Estimates *** p < .001

To assess whether the final model represented a significantly better fit than the

proposed model, a Chi-square likelihood ratio difference test was conducted that subtracted

the values of χ2 and the dfs of the revised (alternative) model from the hypothesized model,

χ2diff = 27.1, dfdiff = 1. The change in χ2 was significant (p < .001), indicating that the revised

model fits better than the original hypothesized model (Werner & Schermelleh-Engel, 2010).

Indirect Effects

Indirect effects were examined using a bootstrap estimation approach (2000 samples).

A significant indirect effect was found for the relationship between body appreciation and

risky drinking through protective strategies (B = -.147, SE = .065, 95% CI = -.278, -.020, p =

.026).

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Chapter 5: Discussion

The purpose of the current study was to extend previous research examining socially

constructed traditional femininity and binge drinking and alcohol problems among emerging

adult women through the consideration of both risk and protective factors. Given that the

research in this area is predominantly qualitative, the current study aimed to add to the

literature from a quantitative approach in order to further our understanding of the

relationships among variables, and investigate mediating mechanisms. The first research

question examined whether internalized appearance preoccupation femininity scripts

contributed to negative reinforcement drinking motives (coping and conformity), and in turn,

risky drinking (binge drinking frequency and alcohol problems). Results suggest that

although both coping and conformity motives were relevant in the model, associations with

coping motives were particularly strong. Women who are concerned with thinness and

appearance investment, and who have an objectified relationship with their body, drank more

to relieve negative affect, and in turn, drank excessively (binge drank more often) and

experienced greater consequences related to their drinking. In addition, indirect effects were

found for the relationships between appearance preoccupation and binge drinking and alcohol

problems, respectively, through coping motives. Thus, the first hypothesis was supported,

particularly with respect to coping motives. Although these findings are consistent with

previous research that supports a positive association between thinness and appearance

investment norms and binge drinking and/or alcohol problems (Hussman & Goldstein, 2015;

Iwamoto et al., 2016; 2018; Kaya et al., 2016), they are extended through the addition of

body objectification, and the important role of coping motives.

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Body objectification encompasses a dysfunctional relationship with one’s body,

including shame directed at oneself (McKinley & Hyde, 1996), which may help explain the

strong relationship with coping motives (i.e., drinking to relieve negative affect) and risky

drinking. In essence, young women who are preoccupied with their appearance and the

management of their body experience negative affect, such as stress, anxiety, or sadness, in

part due to sociocultural pressures and gendered body ideals, which alcohol may temporarily

alleviate. While this serves as an unhealthy way to address negative emotional problems,

research shows how young women believe alcohol to ‘take the edge off’, thereby facilitating

perceived relaxation and confidence in social situations (Watts, Linke, Murray, & Barker,

2015). The tendency to self-medicate with alcohol can also be understood as a way of dealing

with negativity and instability during EA (Arnett, 2005).

Although there was no evidence for an association between appearance preoccupation

and conformity motives, consistent with the first hypothesis, there was a positive relationship

between body objectification and conformity motives, indicating that women who have an

objectified relationship with their bodies are motivated to drink to gain acceptance from

others and avoid rejection. Both body objectification and conformity motives involve a

preoccupation with the perception of others (i.e., concern with being evaluated by others) and

a response to social pressures. Objectification involves viewing oneself through the lens of

others and then internalizing this external view. Using alcohol to conform to social pressure

also suggests heightened concern with negative evaluation from others, and conformity

motives are maintained through negative reinforcement where drinking is motivated by a

desire to avoid social consequences and gain acceptance from others. In this way, women’s

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embodied experiences of drinking alcohol may be a way to gain social capital (Piran, 2017),

despite having harmful effects on their health and sense of selves.

It is somewhat surprising that thinness and appearance investment norms, which also

reflect internalized pressures to conform, were not associated with conformity motives. It

may be the case that body objectification is a more general and complex process compared to

the other norms, since it encompasses not only ongoing body surveillance, but also negative

ways of relating to oneself and other women’s bodies. To a degree, this is captured with the

body objectification subscale in which some items related to oneself (i.e., I often wish my

body were different), while others reflected ideologies about women in general (i.e., I think a

girl has to have a light complexion and delicate features to be thought of as beautiful)

(Impett et al., 2011). Taken together, these items may prime for greater conformity through

facilitating a more direct comparison between oneself and others (i.e. ‘ideal’ women),

compared to thinness and appearance investment norms, which reflect self-reported levels of

norm endorsement (Levant et al., 2007).

The current findings suggest that women who adopt an objectifying stance towards

their bodies are motivated to drink due to self-medication (i.e. escape negative affect) and

due to social pressures. Together, these findings support strong and unique relationships for

body objectification, as it relates to both coping and conformity motives in the context of

risky drinking. However, drinking motives demonstrate different relationships with outcome

variables wherein the body objectification-conformity motives link is only associated with

alcohol problems, but coping motives is associated with both binge drinking and alcohol

problems. Thus, women who have an objectified relationship with their bodies and who drink

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to conform to social pressures may drink differently (i.e., consume less alcohol), but still

experience alcohol problems.

The second hypothesis examined constructions of socialized femininity regarding

how young women relate to others, and how these may impact drinking patterns. Based on

previous findings in this area (Hussman & Goldstein, 2015; Iwamoto et al., 2016; 2018; Kaya

et al., 2016), and research on relational femininity and other women’s health outcomes

(Impett et al., 2006; 2008; Tolman et al., 2006), it was thought that social relationship

maintenance and being inauthentic in relationships would be associated with social and

bonding/connection motives, and in turn risky drinking. In addition, it was proposed that a

distinct set of motives concerning drinking to bond and connect with others was missing

from the literature and may be important for understanding the relationship between alcohol

use and relational femininity. Although previous feminist-informed qualitative research has

highlighted the perceived benefits of collective identities derived from drinking and the

symbolic role of alcohol within women’s friendships (e.g., Brown & Gregg, 2012; Griffin et

al., 2009; Lyons & Willott, 2008; Nicholls, 2016; Szmigin et al., 2008), bonding/connection

motives did not emerge as a distinct set of motives in the current study, and were not

included in the analyses. Instead, conformity motives were included due to theoretical links

between relational femininity (being concerned about preserving friendships, presenting an

inauthentic self in relationships) and drinking to gain acceptance from others.

While overall the second hypothesis was not supported by the data, being inauthentic

in relationships was positively associated with conformity motives, which suggests that the

more women mask their true selves in relationships, the more they endorse drinking to avoid

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social rejection. Presenting an inauthentic self in relationships or trying to put on a ‘front’

which may be perceived as socially desirable to others (i.e., agreeing with the status quo even

if it is incongruent with one’s true thoughts or values) reflects a general preoccupation with

the perception of others. Drinking to fit in with peers can therefore be understood as efforts to

gain social power to avoid being typecasted as an ‘outsider’ at the expense of suppressing

aspects of women’s true selves. Exploring one’s social identity falls under one of the core

tasks of EA when peer and intimate relationships deepen (Arnett, 2004). Thus, young women

may use alcohol use as a means of experimenting with different identities. This

experimentation may be influenced by particular beliefs about the effects of alcohol (i.e.,

alcohol helps to facilitate social interactions; Monahan & Lannutti, 2000), which may shape

the way women present themselves to others in drinking contexts. Although this finding is

preliminary, it warrants further research on (in)authenticity in relation to alcohol use from a

developmental perspective, which scholars have pointed out is a surprising omission from the

literature (Conroy & De Visser, 2015).

The third hypothesis was concerned with factors that may protect against risky

drinking based on pre-established links between body appreciation and authenticity in

relationships and other positive indicators of women’s health and wellbeing (Avalos et al.,

2005; Avalos & Tylka, 2006; Impett et al., 2008; 2010; 2011; Ramseyer Winter et al., 2017a;

2017b; Ramseyer Winter & Ruhr, 2017; Satinsky et al., 2012; Tylka & Kroon Van Diest,

2013). The current study is the first to examine the protective effects of body appreciation

and relationship authenticity on risky drinking. Although there is some research claiming

protective effects of typical representations of femininity (i.e., modesty, domestic, and sexual

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fidelity norms; Iwamoto et al., 2016; 2018; Kaya et al., 2016), it is important to also identify

protective factors that are outside the scope of traditional femininity, or that represent

resistance of conventional, oppressive scripts (Tolman & Porche, 2000).

The third hypothesis, which posited that resistance of conventional femininity scripts

would be associated with greater protective strategies against risky drinking, and

consequently reduced levels of risky drinking, was confirmed, particularly for body

appreciation. Having appreciation for one’s body had the strongest relationship with

protective strategies against risky drinking (self-confidence to moderate drinking; taking

action to avoid dangerous alcohol-related behaviours), and in turn, was associated with less

involvement in risky drinking (binge drinking frequency, alcohol problems). An indirect

effect was also found for the relationship between body appreciation and risky drinking

through protective strategies. Body appreciation encompasses valuing one’s physical body,

despite cultural ideals, as well as appreciating the many functions and capabilities the body

can provide (Tylka & Wood-Barcalow, 2015b). It also highlights the mere possibility of

women appreciating their bodies within a culture that dictates strong norms of dissatisfaction

and objectification (Fredrickson & Roberts, 1997). For example, scholars have argued that

‘positive body image’ was relatively non-existent as an area of study until recent years

(Tylka & Wood-Barcalow, 2015b).

Women who appreciate their bodies are essentially rejecting social conventions and

oppressive norms concerning body objectification, and may also reject norms that dictate

excessive or dangerous drinking in EA. In valuing and respecting their mental and physical

bodies, women may recognize the harmful effects of risky drinking practices (i.e., taking

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shots of liquor or trying to “out drink” their peers) or habits (i.e., drinking when sad or

anxious) and take action to mitigate these risks, while still participating in the drinking

culture of EA. Future research should focus on more nuanced mechanisms that help account

for the connection between such positive ways of relating to oneself. This can include self-

compassion (Neff, 2003), which entails practicing a compassionate stance towards oneself,

including amidst ‘failure’ to live up to self-prescribed ideals. This is relevant to the

appearance preoccupation domain for young women, in which social norms prescribing a

narrow definition of beauty and ideal body types is prevalent (American Psychological

Association; APA, Task Force on the Sexualization of Girls, 2007).

Another interesting finding from the current study is that relationship authenticity was

associated with controlled drinking self-efficacy, and in turn, reduced levels of risky

drinking. In essence, women who are able to speak their minds and articulate their true

thoughts and desires to others, have greater self-efficacy in their ability to moderate their

drinking in high-risk situations. One qualitative study highlighted the significance of

authenticity among student non-drinkers in the United Kingdom (Conroy & De Visser,

2015). For some of the young adults interviewed in the study, abstaining from alcohol was a

way to retain their personal authenticity, as they believed the effects of alcohol could cloud

their authentic life experiences or facilitate misrepresentations of their ‘true’ selves (Conroy

& De Visser, 2015). Although this study examined personal (as opposed to relational)

authenticity in the context of alcohol abstinence (rather than moderation), the interpretation

offered by Conroy and De Visser (2015) remains relevant: a social power imbalance exists in

young adulthood wherein those who abstain from drinking are considered a minority, and

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this special status may contribute to the development of resiliency and agency, even a sense

of pride (Seaman & Ikegwuonu, 2010). Women in the current study still participated in the

drinking culture, but being authentic in their relationships may have enhanced their ability to

be more agentic and resilient in challenging situations, including those pertaining to risky

drinking (i.e., moderating their drinking when anxious in social settings, thereby binge

drinking less often and experiencing less alcohol problems). As a whole, these findings

warrant additional research to better explain the associations between body appreciation and

relationship authenticity and healthier, more empowered choices about drinking for young

women.

General Discussion

The current findings advance the literature on young (White, heterosexual) women’s

drinking from a sociocultural perspective by examining how externally produced social and

cultural messages regarding femininity are internalized by young women, and how these

internalized scripts impact their drinking behaviours. The current examination of

conventional femininities is contextualized by a gendered power imbalance that is reinforced

by internalized ‘expectations’ for women that are oppressive and disempowering (Levant et

al., 2007; Parent & Moradi, 2010; Tolman & Porche, 2000).

The most salient findings emphasize how women’s relationships with their bodies

impact risky drinking behaviours and subsequent problems. This is consistent with previous

sociocultural research on conventional femininity internalization that highlights how body

objectification, when compared to relationship inauthenticity, had the strongest association

with negative health outcomes in adolescent girls (Tolman et al., 2006). This offers important

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theoretical implications, as it illuminates a powerful connection between body image and

substance use for emerging adult women. The current findings suggest that disruptions in one

domain may then transfer to the other, meaning that holding a negative, objectifying

perception of one’s body may be a marker of risk for other harmful health behaviours,

including binge drinking. This adds to the theoretical literature, which considers how

sociocultural factors, such as gender norms, influence health-related behaviours during

critical developmental periods of life. In particular, the current study adds to a growing body

of literature on the developmental theory of embodiment (e.g., Piran, 2015; 2016; 2017; Piran

& Teall, 2012), where excessive or harmful alcohol use represents a disrupted relationship

with one’s body. This may exacerbate an already dysfunctional relationship rooted in

socialized femininity norms, which promote body dissatisfaction (i.e., normative discontent;

Rodin, Silberstein, & Streigel-Moore, 1985) and objectification (Smolak & Murnen, 2011) as

‘normative’ ways of relating to one’s body for young women. This occurs within a culture

that sexually objectifies young women’s bodies and equates their primary definition of self-

worth with their appearance and body (APA, Task Force on the Sexualization of Girls, 2007;

Szymanski, Moffitt, & Carr, 2011).

At the same time, however, the current findings emphasize how the transfer between

domains may work in the opposite direction: positive body image may be protective against

risky drinking behaviours. The ability to make healthier, more empowered choices to protect

against harmful drinking outcomes may be a benefit of body connection, embodied agency

and attuned self-care (Impett et al., 2011; Piran, 2015; 2016) and a function of conventional

femininity resistance (Tolman & Porche, 2000). This underscores the importance of

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considering the many complexities of the body, including those that are positive and

adaptive, when studying drinking patterns specific to young women.

The current findings also offer some important theoretical insights on the status of

traditional femininity norms in the context of young women’s drinking. Although gender

roles have shifted for women in recent decades, which questions the relevance of traditional

femininities within the modern drinking culture in EA, the present study emphasizes that

traditional norms of desiring thinness and investing in one’s appearance are still powerful

ideals that are both relevant and disempowering to women. Young women may enact

appearance and body preoccupation norms as ways to ‘do femininity’ and maintain

respectability (Skeggs, 1997; 2004) while drinking heavily, which may reflect new

femininities expressed in drinking contexts. Yet, it is also apparent that women are motivated

to binge drink to reduce stress, which may reflect the harmful effects associated with

conventional feminine role internalization (i.e. body ideals). This is consistent with the work

of feminist researchers who have examined the negative impacts of internalization for young

women as they relate to their own bodies and to others (e.g., Impett et al., 2006; 2008; 2010;

Tolman & Porche, 2000; Tolman et al., 2006). Internalization encompasses ongoing

governance of one’s appearance and sexual desirability framed as active efforts of

individualism and control (Gill, 2007; McRobbie, 2007), and this extends even to leisure

situations such as drinking contexts. Although young women may construe the heavy

drinking culture of EA as a gender-equal opportunity, in reality this is not the case, as they

still define and appraise their drinking practices based on those of men and through the lens

of the ‘male gaze’ (Lyons & Willott, 2008). Similarly, Young et al. (2005) highlighted how

73

young women aimed to drink ‘like men’ in order to increase their attractiveness to men,

thereby reinforcing their (hetero)sexual desirability. Thus, young women’s adherence to

conventional femininity scripts of appearance preoccupation in drinking contexts may

reinforce hierarchical power structures that benefit men and masculinity (Lyons & Willott,

2008).

It is also crucial to locate the current findings within the appropriate developmental

framework, given that they speak to a specific demographic of women aged 19-25, all of

whom are experiencing significant life transitions (Arnett, 2000; 2004). Piran and colleagues

(Piran, 2017; Piran & Teall, 2012) contend that during puberty, body disconnection occurs

among girls, resulting in shame and gender-socialized restriction, and young women may

then ‘reinhabit’ their bodies later in adulthood. This is consistent with feminist-

developmental research documenting an overall decrease in body objectification among girls

over the course of adolescence, which coincides with improved self-esteem (Impett et al.,

2011). Certain periods throughout the lifespan are seen as critical for women’s relationships

with their bodies, including early adulthood (Piran, 2015; 2017). Therefore, it is possible that

in EA, following the transition out of adolescence, women are only beginning to reconnect

with their bodies. This reconnection may be associated with both positive and negative

behaviours towards the body as women learn to relate to their bodies as adults, and may

include greater internalization and/or resistance of oppressive femininity scripts (Impett et al.,

2011; Tolman et al., 2006). It also aligns with the developmental theory of EA, which

includes a mix of opportunities (i.e., a time of possibilities and optimism) and challenges

(i.e., negativity and instability) (Arnett, 2000; 2004).

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Furthermore, it is imperative to critically evaluate how gender intersects with other

social identities in understanding women’s perceptions of EA. Important work by Bay-Cheng

and Zucker (2017) highlights both commonalities and differences among emerging adult

women based on social class (socioeconomic status; SES, and university status) in

identifying their goals for the future and their perceptions of whether these goals were

attainable. While all three groups of women in Bay-Cheng and Zucker’s study (affluent

students, low-SES students, low-SES nonstudents) endorsed some shared goals, there were

several class-based differences wherein, compared to the other groups, low-SES nonstudents

prioritized financial goals and did not aspire to establish solid relational networks. In

addition, while there were no group differences in perceived ability to achieve their identified

goals, levels of optimism differed in favour of affluent students (Bay-Cheng & Zucker,

2017). These findings draw attention to the relevance of social class, a crucial yet often

neglected part of EA, as findings suggest that social and financial resources play a role in

shaping the construction of future goals (Bay-Cheng & Zucker, 2017). Social class may

therefore be an important moderator to include in future studies (i.e., examining whether

social class moderates the current mediation models). This speaks to the levels of power and

privilege inherent in the sample of young women in the current study, who were primarily

upper-middle class (as assessed by family income). The vast majority of women were also

highly educated, having completed at least some university or more. Therefore, it is

important to note that the current research findings are located within a sample of emerging

adult women who hold many privileges within society.

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The results of the current study advance our theoretical knowledge of White,

heterosexual, emerging adult women’s drinking patterns. By applying a sociocultural

approach, a deeper understanding of drinking practices is gained through the lens of

traditional feminine role internalization that includes mediating mechanisms (drinking

motives), which help fill in some of the gaps in previous links between femininity norms and

drinking. By examining some of the intricacies of combined drinking and femininity norms,

the current study supports the notion that externally produced social norms are influential in

constructing women’s drinking practices in EA.

Study Limitations and Future Directions

Although the current study advances our knowledge concerning socially constructed

femininity and drinking among White, heterosexual emerging adult women, it is limited in

some respects. The most notable limitation is the lack of diversity within the current sample

of women, which restricts the generalizability of findings. As such, the lack of heterogeneity

precluded the ability to consider more diverse social identities and their intersections, and

consequently, an intersectional lens in the analyses. It is important to note that the analysis of

gender is part of a broader intersecting system of social locations, such as race, social class,

and sexual orientation, and these intersections represent important advancements to the field.

However, the current study focused solely on examining traditional feminine role conformity

as a function of gender identity. Future research in this area should follow the guidelines

offered by Else-Quest and Hyde (2016a; 2016b) for conducting quantitative research from an

intersectional approach (see also Bowleg & Bauer, 2016, and Del Toro & Yoshikawa, 2016).

Given that the majority of the sample identified as White, cis-gender, heterosexual, upper-

76

middle class (as assessed by family income) and highly educated, generalizability cannot

extend beyond these positions of privilege. Based on these sample characteristics, efforts to

compare groups based on racial identity, for example, were not carried out due to insufficient

statistical power (Else-Quest & Hyde, 2016b). It was also intentional not to compare White

women with non-White women in the current study, which due to the “lumping error” would

mistake minority women as homogenous, and could remarginalize certain groups (Else-Quest

& Hyde, 2016b).

In addition, while online surveys have been shown to be reliable and valid methods of

data collection in substance use research among emerging adults (Ramo, Liu & Prochaska,

2012), they have the potential to exclude marginalized populations who do not have internet

access. The recruitment strategy, although intended to recruit women from both post-

secondary school and community contexts, resulted in increased exposure of the study

advertisement in student-based online groups due to increased accessibility. It is likely that

this strategy contributed to the higher-SES sample of women.

There are also some limitations with assessing gender role conformity using

objective, quantitative scales. Findings from qualitative research (e.g., Bailey, Griffin, &

Shankar, 2015; Griffin et al., 2009; 2013; Hutton, Griffin, Lyons, Niland, & McCreanor,

2016; Likis-Werle & Borders, 2017; Lyons & Willott, 2008; Nicholls, 2016; Rolfe, Orford,

& Dalton, 2009; Young et al., 2005) complement the current work by providing a more

nuanced understanding of the lived experiences of young women who participate in the

heavy drinking culture and the ways in which they navigate gender and cultural norms. The

measures of traditional femininity adherence used in the current study capture norm or

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ideology adherence during a single point in time, while individual levels of conformity

fluctuate, given that gender is a dynamic by-product of situational factors (West &

Zimmerman, 1987). Thus, future research could benefit from examining how conformity to

gender norms varies as a function of specific drinking contexts. Furthermore, the current

study only focused on traditional femininity norms and did not assess traditional masculinity

norms. Measuring multidimensional aspects of the masculine role is an important direction

for future work given the convergence hypothesis, which would add to Kaya et al. (2016),

who measured masculine norm conformity among emerging adult women and found that

specific norms were positively associated with heavy episodic drinking (risk-taking,

emotional control) and alcohol problems (risk-taking).

In addition, some measures employed in the current study, such as the CFNI-45 and

BAS-2, were normed on samples of predominantly White college students (Parent & Moradi,

2010; Tylka & Wood-Barcalow, 2015a), which again restricts generalizability. Else-Quest

and Hyde (2016b) draw attention to the idea of conceptual equivalence, meaning that

individuals from different groups (i.e., race, social class) may ascribe different meanings to

the same ratings of items or constructs within quantitative measures. This has implications in

determining whether women across social locations attribute different meanings to the

constructs assessed in the current study, including those pertaining to positive or negative

relationships with one’s body or articulating one’s true thoughts and desires, even if ratings

appear consistent at the surface. Future research should attend to this issue carefully, perhaps

through a mixed-methods design.

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In a similar vein, due to lack of resources, the assessment of young women’s drinking

patterns did not utilize some of the more recent, technological advances in the field of

alcohol use research, such as daily diary studies. Such methods enable researchers to collect a

wider range of data points before, during, and after an alcohol-related event in real time,

including greater detail about one’s location, mood, who they were with while drinking, and

their perceived quality of these relationships. This information would help fill some of the

gaps that emerged within the present findings (i.e., more detail about specific drinking

contexts) and may also provide the chance for a longitudinal study design, unlike that of the

current study, which was cross-sectional.

Finally, the approach taken for statistical analyses reflects the theoretical assumption

that self-identifications or de-identifications with aspects of traditional femininity are more

established individual difference variables than drinking outcomes. Consistent with previous

feminist-developmental research and theory (e.g., Impett et al., 2006; 2011; Tolman et al.,

2006), directionality was assumed; it was hypothesized that negative health outcomes, such

as risky drinking, are consequences of internalized femininity norms, whereas resistance of

such scripts are facilitators of health and wellbeing. It was therefore assumed that levels of

conventional femininity (non)conformity would be associated with alcohol use and problems,

drinking motives, and protective strategies against risky drinking, which are thought to be

more proximal and less stable. Yet, the proposed directionality between these variables needs

to be confirmed through additional research.

79

Clinical Implications

The current research identified preliminary sociocultural risk and protective factors

for young (White, heterosexual) women’s drinking, and thus has clinical implications for

prevention and treatment. Overall, the main findings emphasize that the way women relate to

their bodies is important in conceptualizing clinical issues beyond those traditionally linked

to the body, such as disordered eating. This is consistent with new clinical phenomena that

have emerged at the intersection of substance use and eating disorders, in which dangerous

compensatory behaviours are practiced by young women to avoid the anticipated weight gain

due to their drinking (Barry et al., 2013; Bryant et al., 2012; Eisenberg et al., 2018; Peralta,

2002). It is therefore important to call attention to the overlap of these clinical issues, which

are conceptualized as separate within medical models (i.e. in the Diagnostic and Statistic

Manual of Mental Disorders – Fifth Edition; DSM-5, American Psychiatric Association,

2013), but should be incorporated into treatment for young women in an integrated way.

It is also imperative to apply a sociocultural lens to treatment and prevention, which

acknowledges the role of socialized aspects of conventional femininity, and encourages

young women to critically evaluate these constructions and their internalized forms (Tolman

et al., 2006). At the prevention level, this can occur through programs such as media literacy,

which have been demonstrated as effective programs for reducing weight and body shape

concerns in adolescent girls and boys through teaching them to adopt more critical attitudes

towards media (i.e., discussing media-related pressures, tactics, and constructions of ‘ideal’

bodies) and to take an active stance to combat these influences (Wilksch, Tiggemann &

Wade, 2006, Wilksch & Wade, 2009). Media literacy therefore offers promising potential for

80

a new direction in the prevention of problematic substance use behaviours. This can include

critically evaluating the alcohol advertising industry and the types of messages presented to

young people (i.e., how binge drinking may be associated with an elevated social status),

how messages are gendered, and how they overlap with body ideals (i.e., the promotion of

‘Skinnygirl’ cocktails to young women).

Furthermore, the salience of coping motives supported through the current study can

be incorporated into treatment programs. Drinking to cope with negative affect is a behaviour

characteristic of young women in Canada who are predominantly White, educated, and

upper-middle class, and may be a marker of risk for binge drinking and alcohol problems.

This may serve as an important intervention target, given that behaviours are changeable.

Treatment programs may see value in exploring the underlying issues pertaining to negative

affect (and learning how to identify and express negative affect appropriately early on in the

developmental trajectory), and in providing young women with alternative and healthier

coping strategies that can remain into adulthood.

An important contribution of the current study is the recognition of positive, agentic

factors (i.e., appreciating one’s body, being authentic to others) in the context of young

women’s drinking patterns. This has implications for promoting health and wellbeing, and

can be harnessed by clinicians and those in health promotion to empower young women to

make healthier lifestyle choices (i.e., drinking in moderation as a goal for behavioural

change, if this aligns with a woman’s treatment goals). Clinicians may also wish to teach

young women to appreciate their bodies (i.e., focus on the functions of the body as opposed

to its appearance) and encourage them to leverage some of the core features of EA, such as

81

identity exploration, as ways to experiment with healthier lifestyle choices and connect with

like-minded peers as their friendships deepen in EA. This can include supportive networks in

which alcohol moderation (or abstinence), body attunement, authenticity, and self-care are

shared visions that are mutually reinforced.

82

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Appendix A: Study Recruitment Ad

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Appendix B: Informed Consent Form

Research Title: The ‘Pinking’ of Drinking: Understanding Women’s Alcohol Use in Emerging Adulthood Short title: Exploring Drinking Patterns in Young Women Consent to Participate in a Research Study Thank you for your interest in this survey! As you may be aware, women are using alcohol more than they did in previous decades. This is an interesting phenomenon. My interest is in exploring how different expressions of gender relate to alcohol use among women, and I am inviting you to participate in my study. As a reminder, in order to participate in this study you must identify as a woman and be between the ages of 19 – 25 (inclusive). As I am interested in understanding women’s experiences related to alcohol use, to participate you must also have consumed at least one drink of alcohol within the past 30 days. The purpose of an informed consent form is to ensure that you understand why this study is being conducted and the nature of your involvement. Your participation in this study is voluntary, meaning it is up to you. Please read over the informed consent form, which describes the details of the study, to help you decide if you would like to participate. Investigator Julia B. Hussman, MA, PhD Student, Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education (OISE), University of Toronto This study is being conducted as part of my doctoral dissertation research project. Supervisor Abby Goldstein, PhD, C. Psych., Associate Professor, Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education (OISE), University of Toronto Purpose • You are being asked to agree to participate in a study examining the relationship between

gender-based attitudes and perceptions and alcohol use among women

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• The goal of this study is to better understand how different expressions of gender relate to alcohol related behaviours for young women in Canada

• By investigating these relationships, we hope to improve methods of working with women who are seeking help for issues associated with problematic alcohol use

• We hope that a total of 300 young women will participate Procedure • If you agree to participate in this research study, you will be asked to complete an online

survey • The entire online survey will take approximately 30 minutes to complete • You may only complete the survey once • Participation in the study will involve answering background information questions, in

addition to questions about: o Your drinking patterns, and experiences you may have had related to your drinking o Your attitudes towards different expressions of gender, and different experiences you

may have had related to being a woman o Your attitudes about this particular stage of your life

• You will have the option to enter your e-mail address into a raffle to win one of five online $100 gift cards to Amazon.ca for your participation

Right to Refuse • Participation is completely voluntary and you are under no obligation to agree to

participate in this study • You have the right to withdraw from the research without penalty, at any time during

completion of the online survey • You may choose to skip questions you do not want to answer for any reason without

penalty • If you choose to withdraw from the study at any time during completion of the online

survey, simply click on the “Withdraw” button at the bottom of each screen (you will still have the option to enter into the study raffle)

• Because your data is anonymous, once you have completed the survey and submitted it online, you will no longer be able to withdraw your data

Risks • Although there are no known risks with participating in this study, completing the online

survey may result in your reflecting on your drinking patterns and related experiences you may have had

• For some, these issues are sensitive, and may cause you to feel uncomfortable or upset • We will provide you with the contact information of various resources that you may

access if you would like to discuss any of these issues Benefits • Sharing your experiences may lead to an increase in your self-understanding, including

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your own expressions of gender as well as factors associated with your drinking patterns • By sharing your experiences, you will provide us with a better understanding of how

different gender-based attitudes and perceptions influence alcohol use for women • This information will help us to develop better practices for working with young women

who have feelings and experiences similar to yours • You will also receive a printable list of helpful resources for future reference

Compensation • You will have the option to enter your e-mail address into a raffle to win one of five $100

online gift cards to Amazon.ca (towards the purchase of books, electronics, music, movies, TV shows, software, video games, etc.) in appreciation of your participation

• The winners will be notified and forwarded their $100 gift card to Amazon.ca to the e-mail address provided during the survey

Confidentiality • All information will be kept confidential • Your email address (if provided) will not be directly connected with your survey

responses, as they will be stored in two separate password-protected databases • The goal is to publish findings pertaining to this study in academic journals and

conference presentations. However, none of your identifying information will appear in any of these publications.

Other Information If you are interested in obtaining a brief report of the study results, please feel free to contact me at the email address below. Questions Should you have any questions or concerns about this study, or if any issues arise because of your participation, please feel free to contact me or my supervisor. Investigator: Julia B. Hussman, MA, PhD Student, Department of Applied Psychology & Human Development, Ontario Institute for Studies in Education (OISE), University of Toronto 252 Bloor Street West, Toronto, ON, Canada, M5S 1V6. Tel.: (416) 978-0702 E-mail: julia.hussman@mail.utoronto.ca Supervisor: Dr. Abby Goldstein, PhD, C. Psych., Department of Applied Psychology & Human Development, Ontario Institute for Studies in Education (OISE), University of Toronto 252 Bloor Street West, Toronto, Ontario, Canada, M5S 1V6. Tel.: (416) 978-0703 E-mail: abbyl.goldstein@utoronto.ca Should you have any questions about your rights as a research participant, please feel free to contact the Office of Research Ethics at the University of Toronto. Office of Research Ethics, University of Toronto. Tel: (416) 946-3273

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E-mail: ethics.review@utoronto.ca I have read the above form and understand the conditions of my participation. Please print this screen if you would like a copy of this page for your own records. Clicking the “I consent” button indicates that you agree to participate in the online survey.

I consent