Elsevier

Addictive Behaviors

Volume 114, March 2021, 106718
Addictive Behaviors

Social interaction anxiety and perceived coping efficacy: Mechanisms of the association between minority stress and drinking consequences among sexual minority women

https://doi.org/10.1016/j.addbeh.2020.106718Get rights and content

Highlights

  • Minority stress was associated with lower same day coping efficacy.

  • Minority stress was associated with higher same day social anxiety.

  • Minority stress was not associated with same day number of drinks consumed.

  • Minority stress was associated with more same day alcohol consequences.

  • Coping efficacy and social anxiety mediated the minority stress/consequences association.

Abstract

Sexual minority women (SMW; individuals who identify as women and as lesbian, bisexual, or with another sexual minority identity) are at increased risk for problematic alcohol use compared to their heterosexual counterparts. This increased risk has been attributed to minority stress. However, longitudinal research examining associations between minority stress and alcohol use outcomes is extremely limited and examinations of these associations at the daily level are nearly non-existent. Further, few longitudinal studies have examined mechanisms through which minority stress may impact alcohol use. We utilized data from a 14-day daily diary study of 98 SMW to examine daily-level associations between experiences of minority stress, alcohol consumption and consequences, and two proposed mediators of these associations (perceived coping efficacy, social interaction anxiety). Results indicated that on days when participants experienced minority stress events, they experienced lower coping efficacy, higher social interaction anxiety, and more drinking consequences than usual. Minority stress was not associated with same-day alcohol consumption. Perceived coping efficacy and social interaction anxiety mediated the same-day association between minority stress and drinking consequences. No prospective associations were significant, suggesting that studies with multiple assessments per day may be necessary to detect immediate effects of minority stress. Findings highlight the potential impact of daily experiences of minority stress on alcohol consequences and provide evidence that two general psychological processes may be mechanisms through which minority stress impacts alcohol consequences. These results provide evidence of a need for interventions that teach SMW skills for coping with minority stress and its psychological consequences.

Introduction

Sexual minority women (SMW) are at increased risk for alcohol use disorders compared to their heterosexual counterparts (Drabble et al., 2018, Kerridge et al., 2017), and this has been attributed to minority stress – unique stressors experienced by SMW due to stigmatization (Meyer, 2003). While a growing body of research has provided support for this theory (Kidd, Jackman, Wolff, Veldhuis, & Hughes, 2018), this research has two major limitations. First, research has been predominately cross-sectional and few studies have examined day-to-day associations between minority stress and alcohol use (Livingston, 2017, Talley et al., 2016). Second, little research has examined psychological processes through which minority stress may contribute to problematic alcohol use (Kidd et al., 2018). The current study aims to address these limitations by examining associations between minority stress and alcohol consumption and consequences in a daily diary study of SMW and by testing two mechanisms through which minority stress may impact alcohol consumption and consequences (perceived coping efficacy, social interaction anxiety).

While most research on associations between minority stressors and alcohol use has been cross-sectional (Kidd et al., 2018, Talley et al., 2016), a few recent semi-annual longitudinal studies have examined these associations among SMW. Findings indicate that when SMW experienced more sexual-orientation-based victimization, they concurrently drank more (Newcomb, Heinz, & Mustanski, 2012), experienced more concurrent alcohol consequences (Dyar, Sarno, Newcomb, & Whitton, 2020), and experienced subsequent increases in binge drinking (Dermody, Marshal, Burton, & Chisolm, 2016). Another study found that, when SMW experienced more minority stressors, they experienced subsequent increases in alcohol consequences, but not greater consumption (Wilson, Gilmore, Rhew, Hodge, & Kaysen, 2016). Together, these findings indicate that minority stress is associated with increased risk for drinking consequences, but evidence for a longitudinal association between minority stress and alcohol consumption is less clear.

While traditional longitudinal studies are critical for advancing our understanding of associations between minority stress and alcohol use, multi-month lags between assessments do not allow for examination of how these processes unfold in real or near-real time and may capture the cumulative impact of stressors rather than the effect of any specific stressful event. Daily diary studies can contribute to a more temporally precise and detailed understanding of associations between minority stress events and drinking in near-real time and can identify mechanisms by which minority stress events may confer risk for problematic alcohol use on a daily basis (Bolger and Laurenceau, 2013, Shiffman, 2009). Such methods are critical for identifying targets for just-in-time interventions that aim to reduce problematic alcohol use among SMW.

We are aware of only one study that has examined associations between minority stressors and alcohol use at the daily level among sexual minorities. Livingston, Flentje, Heck, Szalda-Petree, and Cochran (2017) found that, when participants experienced minority stress, they were more likely to use substances at the same time or later that day. However, this study did not examine the number of drinks consumed or drinking consequences. More daily diary studies are needed to examine temporally proximal associations between minority stress and alcohol use and consequences as well as mechanisms through which minority stress may impact alcohol use.

Hatzenbuehler (2009) proposed that minority stress depletes sexual minorities’ coping resources, which is theorized to increase the likelihood of using substances to cope and developing problematic alcohol use (Hatzenbuehler, Corbin, & Fromme, 2011). Consistent with Hatzenbuehler (2009) conceptualization of strained or overburdened coping resources, low perceived coping efficacy refers to perceptions that one is currently unable to effectively manage negative emotions arising from stressful experiences (Bandura et al., 1999, Chesney et al., 2006). Some cross-sectional evidence suggests that experiencing more discrimination is associated with lower perceived coping efficacy (Denton et al., 2014, Ouch and Moradi, 2019). Although we are unaware of any research linking perceived coping efficacy and alcohol use among sexual minorities, research with heterosexuals indicates that low coping efficacy mediates the association between stressful experiences and alcohol use disorder onset (Asselmann, Wittchen, Lieb, Höfler, & Beesdo-Baum, 2016). This suggests that low coping efficacy may be one mechanism through which minority stress may contribute to problematic alcohol use.

Another potential mechanism through which minority stress may impact problematic alcohol use is social interaction anxiety – feelings of distress when interacting with other people. Pachankis and Goldfried (2006) proposed that experiences of stigma and awareness of stigma contribute to the development of social interaction anxiety and social anxiety more broadly among sexual minorities. Cross-sectional and longitudinal studies have provided support for this theory by demonstrating associations between minority stress and social interaction anxiety (Burns et al., 2012, Cathey et al., 2014, Pachankis et al., 2018). Although research with sexual minorities has not examined associations between social interaction anxiety and alcohol use, research with predominately heterosexual college students has demonstrated that higher social interaction anxiety is associated with more alcohol problems (Buckner et al., 2006, Schry and White, 2013) ; Terlecki, Ecker, & Buckner, 2014). Evidence for a link between social anxiety and alcohol consumption is mixed (Buckner et al., 2006, Neighbors et al., 2007, Stewart et al., 2006). However, these mixed findings may be explained by contextual factors, with social interaction anxiety predicting higher alcohol consumption in negative emotional contexts but not necessarily in convivial social contexts (Terlecki et al., 2014). Given this evidence, it is possible that social interaction anxiety may act as a mediator of the association between minority stress and alcohol consumption/problems.

The goals of the current study are to address gaps in the existing literature by: 1) examining associations between minority stress and alcohol consumption and consequences at the daily level and 2) testing two potential mechanisms through which minority stress may impact alcohol consumption and consequences: perceived coping efficacy and social interaction anxiety in a sample of SMW. We hypothesized that at the within-person level, SMW would consume more alcohol and report more alcohol consequences than usual on days when they experienced minority stress. We also hypothesized that on days when SMW experienced minority stress, they would also experience lower perceived coping efficacy and higher social interaction anxiety than usual, which we expected would predict more alcohol consumption and consequences than usual. We hypothesized that the indirect effects of minority stress on alcohol consumption and consequences through coping efficacy and social interaction anxiety would be significant. We aimed to examine both same-day (concurrent) and next-day (prospective) effects.

Section snippets

Participants and procedures

Current analyses used data from a larger longitudinal study of substance use among young adult SMW (see Litt, Lewis, Rhew, Hodge, & Kaysen, 2015). Participants were recruited via online advertisements. Eligible participants were U.S. residents, 18 to 25 years old at recruitment, identified as lesbian or bisexual, and had been assigned female at birth.1

Results

Participants experienced minority stress events on 14.6% of days and reported drinking on 51.1% of days. They consumed an average of 4.36 drinks (SD = 3.28) and experienced 0.72 drinking consequences (SD = 1.20) on drinking days. Table 1 includes means, variances, intraclass correlations, and bivariate associations.

Discussion

This study is one of the first to examine associations between minority stress and alcohol use at the daily level among SMW. Further, it is, to our knowledge, the first daily diary study to examine mechanisms through which minority stress may impact drinking behaviors. Results indicate that on days when SMW experienced minority stress, they experienced more drinking consequences, but did not necessarily consume more alcohol. These within-day associations were mediated by perceived coping

Role of funding sources

This research was supported by a grant from the National Institute of Alcohol Abuse and Alcoholism (R01AA018292; PI: Kaysen). Manuscript preparation was supported by grants from the National Institute on Drug Abuse (K01DA046716; PI: Dyar) and the National Institute on Alcohol Abuse and Alcoholism (R00AA026317; PI: Dworkin). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

CRediT authorship contribution statement

Christina Dyar: Conceptualization, Formal analysis, Writing - original draft, Writing - review & editing. Emily R. Dworkin: Writing - original draft, Writing - review & editing. Sophia Pirog: Writing - review & editing. Debra Kaysen: Funding acquisition, Investigation, Resources, Writing - review & editing.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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