Associations of Perceived Stress and Social Support on Health Behavior Changes in Sexual Minoritized Women during the COVID-19 Pandemic

Purpose: We examined how perceived stress and social support were associated with changes in health behaviors during the COVID-19 pandemic among sexual minoritized women (SMW). Methods: In an online convenience sample of SMW (N = 501, Mage = 23.6), we used multinomial logistic regression models to estimate associations of perceived stress and social support (emotional, material, virtual, in-person) with self-reported changes (increased or decreased vs. no change) in fruit and vegetable intake, physical activity, sleep, tobacco, alcohol, and substance use during the pandemic. We also tested whether social support modified associations between perceived stress and changes in health behaviors. Models controlled for sexual orientation, age, race and ethnicity, and income. Results: Perceived stress and social support were associated with changes in health and risk behaviors. Specifically, increased perceived stress was associated with decrease (odds ratio [OR] = 1.20, p = 0.01) and increase (OR = 1.12, p = 0.04) in fruit and vegetable intake, and increase in substance use (OR = 1.19, p = 0.04). Receiving in-person social support was associated with changes in decrease (OR = 10.10, p < 0.001) and increase (OR = 7.35, p < 0.01) in combustible tobacco use and increase in alcohol use (OR = 2.63, p = 0.01). Among SMW who never received material social support during the pandemic, increased perceived stress was associated with increased alcohol use (OR = 1.25, p < 0.01). Conclusions: Perceived stress and social support were associated with SMW's health behavior changes during the pandemic. Future research may explore interventions to mitigate the effects of perceived stress and appropriately increase social support to promote health equity among SMW.