The Pinking of Drinking: Understanding Women’s Alcohol Use in Emerging Adulthood by Julia Belenzon Hussman A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Department of Applied Psychology and Human Development Ontario Institute for Studies in Education University of Toronto © Copyright by Julia Belenzon Hussman 2018 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. iv 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 v 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 vi 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 vii 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 ix 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