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.
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at:
- 1a Eliot-Pearson Department of Child and Human Development , Tufts University , Medford , MA , USA.
- 2b Carman and Ann Adams Department of Pediatrics Prevention Research Center , Wayne State University School of Medicine , Detroit , MI , USA.
- 3c Institute of Developmental Psychology, Beijing Normal University , Beijing , China.
- 4d Division of Epidemiology , Vanderbilt Institute of Global Health , Nashville , TN , USA.
- 5e Center for Disease Control and Prevention , Guangxi , China.
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