Body image and risky sexual behaviors: An investigation in a tri-ethnic sample

Abstract

The impact of negative body image on risky sexual behaviors has not been extensively investigated. The present study examined the relationship between two aspects of body image, appearance shame and appearance investment, and potentially risky behaviors. The study employed a tri-ethnic sample of 1547 women seeking services at two family planning clinics. Logistic regression was utilized to examine the relationship between potential risk behaviors and shame and investment. Results supported that these aspects of body image were significant predictors of inconsistent condom use, having multiple sex partners in the past year, and having sex after drinking alcohol or using drugs, and that demographic variables (e.g., age, marital status, ethnicity) could not fully account for these relationships. The importance of future research investigating the relationships among body image, perceived relationship security, affect-management strategies, and risky sexual behaviors is emphasized.

Introduction

Body dissatisfaction is so prevalent among women in the U.S. that it has been termed a normative discontent (e.g., Cash & Henry, 1995). Despite the prevalence of body dissatisfaction, few studies have examined the impact of body dissatisfaction and other aspects of body image on young women's intimate relationships and enactment of risky sexual behaviors. Identification of factors that may impact these behaviors seems imperative given the prevalence of sexually transmitted infections (STIs) and their potential health consequences for women. For example, it is estimated that 15 million individuals in the U.S. contract an STI each year and 65 million are currently infected with an incurable STI (Centers for Disease Control, 2000). The potential health consequences of an STI for women include infertility, ectopic pregnancy, chronic pelvic pain, and cervical cancer (Centers for Disease Control, 2000).

Body image could impact sexual risk behaviors in a number of ways. First, body image appears to play a role in women's sense of confidence and security with sexual interactions and romantic relationships. Women who are dissatisfied with their physical appearance report being less comfortable and confident in sexual interactions, as well as more self-conscious about their body during sex (Ackard, Kearney-Cooke, & Peterson, 2000; Cash, Maikkula, & Yamamiya, 2004; Wiederman and Hurst, 1997, Wiederman and Hurst, 1998). Women with a negative body image also report more anxiety about intimacy and are more likely to have a romantic attachment style characterized by concerns about being judged as worthy by significant others (Brennan & Shaver, 1995; Cash, Thériault, & Annis, 2004).

Insecurity or anxiety about relationships and sexual interactions could serve to increase concern about the impact of condom use negotiation on a relationship. Indeed, Wingood, DiClemente, Harrington, and Davies (2002) found that body dissatisfaction was associated with unprotected sex and fear of the consequences of negotiating condom use among African American adolescents. Anxiety about perceived worthiness by partners could also lead to women to utilize sexual activity as a strategy to obtain or secure a relationship. In fact, Wild, Flisher, Bhana, and Lombard (2004) found that among high school girls in South Africa, low body esteem was associated with having sex with multiple partners or having sex early in a relationship.

Having a negative evaluation of one's appearance can also produce negative affect (Cash et al., 2004a). One way that women may cope with this negative affect is through substance use, particularly alcohol (Cooper, Frone, Russell, & Mudar, 1995). Supporting that there is a relationship between body image and substance use, Wild et al. (2004) as well as Striegel-Moore and Huydic (1993) found that body dissatisfaction was a predictor of substance use in adolescents in South Africa and the U.S., respectively. Alcohol use, especially before sexual activity, is clearly associated with sexual risk behaviors including having sex with multiple or causal partners (Santelli, Robin, Brener, & Lowry, 2001) and using condoms inconsistently (Wingood & DiClemente, 1998).

Given the potential impact of body image on risky behaviors, the present study sought to investigate this relationship in a tri-ethnic sample of women. The role of appearance investment (e.g., perceived importance of physical appearance and behaviors related to modifying or improving appearance) and one type of appearance-related affect, appearance shame, were examined in predicting risk behaviors (Cash et al., 2004b). In addition, the interaction between appearance investment and shame was examined. It was hypothesized that appearance investment and shame would be related to engaging in potentially risky behaviors including inconsistent use of condoms, engaging in sex after using alcohol or drugs, problematic substance use, and having multiple sexual partners. Further, it was hypothesized that the combination of elevated appearance shame and appearance investment would be related to risky behaviors. Finally, it was hypothesized that body image would contribute to the prediction of risky behaviors after accounting for the effects of education level, age, ethnicity, and marital/relationship status.