The Pinking of Drinking: Understanding Women's Alcohol

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

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

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

ii 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.

iii

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.

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

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

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

viii

List of Appendices

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

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

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). 1

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

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.

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

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

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,

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

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

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

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.

(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.

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

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),

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

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

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

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

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.

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

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.

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,

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).

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).

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):

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

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

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

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

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)

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

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).

Figure 5. Proposed protective factor model for risky drinking

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

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)

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 89 (38.7) diploma 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)

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 49 (21.3) serious relationship Not currently dating, have had a serious 32 (13.9) relationship in the past Casually dating, have never had a serious 8 (3.5) relationship Casually dating, have had a serious 27 (11.7) relationship in the past 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

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).

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-

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

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

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 &

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)

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.

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

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

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

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).

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).

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)

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

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.

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 .814 or nervous 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 .791 drinking 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 .596 .331 sure of yourself 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 .396 .580 friendships Note. Bolded items reflect proposed items for bonding/connection drinking motives.

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.

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,

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

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,

2 2 χ diff = 155.815, dfdiff = 1. The change in χ 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

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

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.

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

2 regression model was significant, F(2, 227) = 3.614, p = .029, R adj = .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

2 significant, F(2, 227) = 6.164, p = .002, R adj = .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.

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

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

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 2.674 1.338 .046 .110 Drinking Self-Efficacy 3. Protective Strategies – Behavioural Strategies .082 .015 *** .507 4. Protective Strategies – Controlled Drinking 12.195 2.234 *** .749 Self-Efficacy 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

2 2 χ diff = 27.1, dfdiff = 1. The change in χ 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).

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.

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

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

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

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

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

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

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

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

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

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).

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.

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-

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

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.

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.

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

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

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.

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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: [email protected]

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: [email protected]

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: [email protected]

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