The Role of Culture and Masculine Honor Ideology in Substance Use and Outcome Expectancies.

Background: A cultural construct that has rarely been investigated in substance use research is the culture of honor. In honor cultures, masculine honor ideology (the expectation that men display toughness, defend their manliness, and protect female family members) is prevalent and can influence people's health behaviors. In this study, we predicted that substance use will be positively associated with masculine honor ideology among South Asian Americans (an understudied honor culture), because as a risky health behavior, substance use can solidify one's reputation of invincibility and fearlessness. We did not expect this association in the comparison group - European Americans from the Northern states of the U.S. (a dignity culture). Methods: South Asian American (n = 111; 50 women, 61 men) and European American participants (n = 110; 74 women, 33 men, 2 non-binary individuals, 1 gender not disclosed) completed an online survey about their tobacco, alcohol, and cannabis use, outcome expectancies from these substances, endorsement of the masculine honor ideology, and demographic background. Results: Linear regression analyses showed that in the South Asian sample, masculine honor was positively associated with positive outcome expectancies from tobacco (β = 0.27, p = 0.024) and somewhat alcohol use (β = 0.25, p = 0.058) and with the frequency of alcohol (β = 0.26, p = 0.047) and somewhat cannabis use (β = 0.26, p = 0.051). These associations were not found among European Americans. Conclusions: Findings can have implications for the development of culturally tailored interventions to reduce substance use in diverse societies.