title: Social context factors, refusal self-efficacy, and alcohol use among female sex workers in China.
abstract: Excessive alcohol use is considered as a health-risk behavior that may produce negative health outcomes. Examining predictors of alcohol use in social and individual contexts can advance understanding of why people indulge in alcohol use. Our research on female sex workers (FSWs) examined associations among several social context factors (alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence), refusal self-efficacy, and alcohol use. Seven hundred FSWs were recruited from two cities in southern China. Structural equation modeling (SEM) was used to analyze the direct effects of alcohol use by family members, alcohol use by peers, and client-perpetrated pressure or violence on FSWs' alcohol use. In addition, the mediation effects of refusal self-efficacy were also examined in the SEM model. Results showed that alcohol use by family members and alcohol use by peers significantly predicted FSWs' alcohol use; the prediction effect of alcohol use by peers on FSWs' alcohol use was stronger than that of alcohol use by family members; client-perpetrated pressure or violence directly predicted FSWs' alcohol use and indirectly influenced FSWs' alcohol use through refusal self-efficacy; refusal self-efficacy directly predicted FSWs' alcohol use. Administrators of effective intervention programs focused on alcohol use in China should adopt a multilevel approach to reduce negative social influences, particularly the influence from peer and sex work establishments on FSWs' alcohol use. Meanwhile, training to improve refusal self-efficacy should also be included in the intervention programs to reduce FSWs' alcohol use.
authors.affiliation: a Eliot-Pearson Department of Child and Human Development , Tufts University , Medford , MA , USA.
authors.forename: Shaobing
authors.initials: S
authors.lastname: Su
authors.affiliation: b Carman and Ann Adams Department of Pediatrics Prevention Research Center , Wayne State University School of Medicine , Detroit , MI , USA.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Li
authors.affiliation: c Institute of Developmental Psychology, Beijing Normal University , Beijing , China.
authors.forename: Danhua
authors.initials: D
authors.lastname: Lin
authors.affiliation: d Division of Epidemiology , Vanderbilt Institute of Global Health , Nashville , TN , USA.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.affiliation: b Carman and Ann Adams Department of Pediatrics Prevention Research Center , Wayne State University School of Medicine , Detroit , MI , USA.
authors.forename: Shan
authors.initials: S
authors.lastname: Qiao
authors.affiliation: e Center for Disease Control and Prevention , Guangxi , China.
authors.forename: Yeujiao
authors.initials: Y
authors.lastname: Zhou
mesh_terms: D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D002681:China; D005260:Female; D006801:Humans; D020377:Self Efficacy; D011477:Sex Work / Q000706:statistics & numerical data*; D060386:Sex Workers / Q000706:statistics & numerical data*; D012931:Social Environment; D055815:Young Adult
keywords: alcohol use; female sex worker; refusal self-efficacy; social context factors