(PS11-C54) Stress-buffering Model of Social Support on Substance Use Severity in a Sample of Cambodian Female Entertainment Workers

Posttraumatic stress disorder is associated with negative outcomes, including significant behavioral health concerns. However, limited PTSD research has been conducted examining populations in other regions of the World including Southeast Asia. In particular, Cambodian Female Entertainment Workers (FEWs) commonly experience significant trauma and ongoing chronic stressors including poverty and other environmental stressors. However, FEWs are underrepresented in extent literature. The current study aims to address this research gap by examining the applicability of the stress-buffering model of social support as it relates to substance use severity in FEWs. According to this model, social support is hypothesized to reduce the deleterious impacts of posttraumatic stress symptom (PTSS) severity on substance use severity. 
Participants were 160 Cambodian women who worked in the entertainment/sex industry in Phnom Penh, Cambodia. PTSS severity was assessed using the PTSD Checklist-5. Analyses were conducted with bootstrapped data from FEWs who endorsed traumatic childhood experiences (n = 112; psychological abuse/fears that an adult in the household may physically harm them, physical abuse (n = 63), living with someone with a mental illness or who attempted suicide (n = 46), domestic violence (n = 41), and sexual abuse (n = 40). Of the FEWs who endorsed a trauma history, experiencing two traumas was most common (n = 35), followed by one (n = 30), and four (n = 21). Total social support and PTSS severity were significantly associated with cannabis use (F(3, 104) = 10.18, ΔR2 = 0.24, p < 0.0001). Results indicate that total social support significantly moderated the relationship between PTSS severity and levels of cannabis use (F(1, 104) = 22.07, ΔR2 = 0.16, p < 0.0001). Thus, at low levels of support, increased PTSS severity was associated with increased cannabis use severity, while, at high levels of support, increased PTSS severity was associated with lower cannabis use severity. Other significant buffers to this relationship include support from a significant other (F(2, 102) = 19.59, ΔR2 = 0.254, p < 0.0001), family (F(2, 102) = 9.64, ΔR2 = 0.15, p = 0.001), and friends (F(2, 102) = 8.54, ΔR2 = 0.13, p < 0.0005). Interestingly, at moderate and high levels of social support, cannabis use severity remained relatively stable regardless of PTSS severity. No form of social support was found to moderate the association between PTSS severity and alcohol use severity. Thus, social support appears to buffer the negative impacts of PTSS severity on substance use severity of specific substances, but not others. Clinical implications as well as possible cultural and social beliefs within Cambodia and this population will be discussed.