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Ethnicity as a Protective Factor against Internalization of a Thin Ideal and Body Dissatisfaction

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REGULAR ARTICLE Ethnicity as a Protective Factor against Internalization of a Thin Ideal and Body Dissatisfaction Cortney S. Warren, MS 1 David H. Gleaves, PhD 1 * Antonio Cepeda-Benito, PhD 1 Maria del
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REGULAR ARTICLE Ethnicity as a Protective Factor against Internalization of a Thin Ideal and Body Dissatisfaction Cortney S. Warren, MS 1 David H. Gleaves, PhD 1 * Antonio Cepeda-Benito, PhD 1 Maria del Carmen Fernandez, PhD 2 Sonia Rodriguez-Ruiz, MS 2 ABSTRACT Objective: We examined the potential for ethnicity to moderate the relationships between awareness and internalization of sociocultural ideals of appearance and between internalization and body dissatisfaction. Method: Spanish (n ¼ 100), Mexican American (n ¼ 100), and European American (n ¼ 100) female participants completed measures of sociocultural attitudes and body dissatisfaction. Path analysis using maximum likelihood with robust standard errors tested the relationships across and within ethnic groups. Results: There was evidence for the mediational effect of internalization on the relationship between awareness and body dissatisfaction. Furthermore, both relationships were significantly stronger for European American women than for Mexican American or Spanish women (the predicted moderator effect). Discussion: Results demonstrate how ethnicity may protect against the development of eating disorder symptoms and suggest that eating disorder prevention should involve denouncing the thin ideal, minimizing appearance as an indicator of value, and emphasizing traits other than appearance as determinants of worth. ª 2005 by Wiley Periodicals, Inc. Keywords: ethnicity; thin ideal; body dissatisfaction; eating disorders (Int J Eat Disord 2005; 37: ) Introduction Body dissatisfaction is one of the most well-established, empirically supported risk factors for the development of eating disorders. Defined as a negative subjective evaluation of one s physical appearance, body dissatisfaction has been found to predict dieting, binge eating, purging, excessive laxative use, and cessation of all eating (e.g., Attie & Brooks-Gunn, 1989; Stice, Mazotti, Krebs, & Martin, 1998). It is prevalent in both eating-disordered and nonclinical females to the degree that a moderate amount of body dissatisfaction is considered normative among women (Rodin, Silberstein, & Striegel-Moore, 1984). For example, rates as high as 80% have been reported in female college samples (Silberstein, Striegel- Moore, Timko, & Rodin, 1988). Accepted 4 July 2004 Portions of this manuscript were presented at the conference of the Association for Advancement of Behavior Therapy in Boston, November 20 23, *Correspondence to: David H. Gleaves, PhD, Department of Psychology, Texas, University of Canterbury, Private Bag 4800, Christchurch, New Zealand. 1 Department of Psychology, Texas A&M University, College Station, Texas 2 Department of Psychology, Universidad de Granada, Granada, Spain Published online in Wiley InterScience ( com). DOI: /eat ª 2005 Wiley Periodicals, Inc. Given the prevalence and potential consequences of body dissatisfaction, researchers have tried to identify factors that influence its development. Sociocultural theorists contend that Western cultural values occupy a principal role in the etiology of eating disorders and their concomitants, such as body dissatisfaction. Culture is generally conceptualized as the belief systems and value orientations that influence customs, norms, practices, and social institutions, including psychological processes (language, caretaking practices, media, educational systems) and organizations (media, educational systems) (American Psychological Association, 2003, p. 380). Western culture (or European American/White culture), broadly refers to first-world, economically stable cultures, such as the majority culture in the United States, that value individualism, competition, rational thinking, economic displays of status and power, a patriarchal family structure, and a thin female physique (Katz, 1985). For women, Western cultural values stipulate that appearance is central to one s value and role in society, a thin body is ideal, and thinness assures success and life satisfaction (Rodin et al., 1984; Stice, 1994). An ultrathin body is presented as normative and attainable for women. Theoretically, Western values predispose women to be dissatisfied with their bodies through a process of social comparison whereby women compare themselves to the socially esteemed female ideal and, because few (if any) Int J Eat Disord 37: WARREN ET AL. attain this ideal, deem themselves as failing to meet cultural expectations. Empiric research supports this theory. A meta-analysis of 25 experimental studies that examined the effect of viewing thinness-idealizing media on women s body image found participants were significantly more dissatisfied with their bodies after viewing thin models than after viewing average-sized models, plus-sized models, or inanimate objects (overall effect size, d ¼.31; Groesz, Levine, & Murnen, 2002). Sociocultural Model: Awareness, Internalization, and Body Dissatisfaction One way to assess the influence of Western cultural values on the development of body dissatisfaction is to measure the extent to which an individual (a) is aware of the importance placed on appearance and thinness in Western culture and (b) internalizes these values by endorsing and desiring to emulate appearance-related social standards (Cusumano & Thompson, 1997). According to one aspect of the sociocultural model proposed by Stice (1994), internalization of the societal physical ideal mediates the relationship between awareness of cultural pressure to be thin and body dissatisfaction. Multiple studies have supported this model (e.g., Fingeret & Gleaves, 2004; Stice, 2002; Stice, Shaw, & Nemeroff, 1998; Twamley & Davis, 1999). If internalization of Western ideals and awareness of social pressure to be thin are pivotal in the development of eating disorders, as the sociocultural model suggests, one preventive goal may be to identify factors (e.g., peer socialization, family dynamics, self-esteem, personality traits) that can protect against such internalization (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). That is, are there moderators of the relationship between awareness and internalization or between internalization and body dissatisfaction? Researchers have indeed begun testing for moderators of these relationships. Twamley and Davis (1999) found that high nonconformityandlowfamilypressuretodietweakenedthe relationship between awareness and internalization. Fingeret, Lee, and Gleaves (2002) found that high levels of self-deceptive enhancement and low levels of past family emphasis on weight control weakened the relationship between awareness and internalization. Low et al. (2003) found high body mass index (BMI ¼ kg/m 2 ) strengthened the relationship between internalization and body dissatisfaction. Other factors initially hypothesized as potentially providing protective influences, such as a strong feminist ideology, have produced insignificant or mixed results (e.g., Fingeret & Gleaves, 2004; Twamley & Davis, 1999). Protective Factors: Non-Western Culture and Ethnicity To appropriately evaluate sociocultural influences on eating disorders, researchers must determine whether diverse ethnic groups with distinct value orientations and physical ideals display different prevalence rates, etiologies, and manifestations of unhealthy eating (Altabe, 1996; Joiner & Kashubeck, 1996). Ethnicity is generally defined as the acceptance of the norms, mores, and practices of one s culture of origin and the concomitant sense of belonging to that cultural group (American Psychological Association, 2003). Individuals are typically categorized into ethnic groups based on race, the socially constructed characterization of individuals by visible traits (e.g., skin color, hair color and texture, facial features, and stature), and culture of origin (Katz, 1985; Phinney, 1996). Ethnicity may be protective against body dissatisfaction in at least two ways. First, ethnic groups with a non-western culture of origin may not idealize an ultrathin figure and thereby provide individuals with larger, more realistic and attainable physical ideals. Second, less value may be placed on physical appearance as a defining feature of a woman s worth, role in society, and indicator of success. In these ways, ethnic minorities living in a dominant Western culture may have comparable levels of awareness of the thin ideal but may not internalize such information because of an affiliation with a culture of origin that does not esteem or support such values and ideals. Mexican Americans and Eating Disorder Symptomatology In contrast to mainstream Western culture, Mexican culture traditionally idealizes a larger, curvy physique (Chamorro & Flores-Ortiz, 2000) and values interdependent, close family relationships (familismo),communality, collectivism, deterministic thinking (fatalismo), and sociability (personalismo; Santiago-Rivera, Arredondo, & Gallardo-Cooper, 2002). Mexican American culture comprises aspects of Mexican and Western (i.e., American) culture. Mexican Americans are likely aware of Western cultural values and the thin ideal (because part of their culture is, indeed, Western) but may be protected against internalization and body dissatisfaction because of an affiliation to a culture of origin that does not idealize a thin physique and places less value on appearance as a determinant of worth and social roles. Data on eating disorders and their concomitants in Mexican Americans are particularly sparse. For example, of the 17,781 participants utilized in a 242 Int J Eat Disord 37: ETHNICITY AS A PROTECTIVE FACTOR meta-analysis of 35 studies examining the role of ethnicity and culture in the development of eating disturbances (Wildes, Emery, & Simons, 2001), only 138 were Hispanic. Furthermore, instead of isolating data from Mexican Americans in research analyses, these data are generally integrated into a Hispanic category. Although this information is important, the Hispanic population technically comprises any American of Mexican, Puerto Rican, Cuban, Central American, South American, or other Spanish culture of origin (Santiago-Rivera et al., 2002; Ramirez & de la Cruz, 2003). Grouping Mexican Americans into a Hispanic group overlooks group heterogeneity and thereby may limit the detection of differences based on unique characteristics of a specific culture of origin. The lack of research on Mexican Americans is particularly problematic because the Hispanic population is the most rapidly growing ethnic minority group in the United States (Valdez, 2000). Furthermore, according to the 2002 census, individuals of Mexican descent (an estimated 20 million) are the largest Hispanic subgroup (Ramirez & de la Cruz, 2003). A few studies have examined eating disorder symptoms in Mexican American women (e.g., Kuba & Harris, 2001; Lester & 1995) but no studies, to our knowledge, have compared the strength of the relationships between awareness, internalization, and body dissatisfaction in Mexican Americans with other ethnic groups. Spain and Eating Disorder Symptomatology There is a significant historic and cultural link among Spanish, Mexican, and Mexican American culture (for a review see Pontón & León-Carrión, 2001). For example, Mexican culture involves primarily the merging of various indigenous Mexican cultures (e.g., Aztec, Mayan, Incan) and Spanish culture. Mexican American culture, then, is a fusion of Spanish, indigenous Mexican, and European American cultures. Spanish culture is characterized by patriarchal family structures, collectivist values, distinct gender roles, male dominance, female subordination, and self-sacrifice for the needs of others (marianismo), social order, and tradition (Gouveia, de Albuquerque, Clemente, & Espinosa, 2002; Santiago-Rivera et al., 2002). Given the cultural affiliation between Spanish and Mexican American cultures, it is important to compare Mexican Americans not only with other American ethnic groups but also to Spaniards. In addition, published research on eating disorders and body dissatisfaction in Spain is sparse in English journals. Existing research comparing Spanish, Mexican, Mexican American, and European American women on eating disorder symptoms, body dissatisfaction, and physical ideals has yielded mixed results. In a comparison of eating disorder symptoms in Spain and Mexico, Raich et al. (2001) found eating disorder symptoms and body dissatisfaction to be more prevalent and severe in Spanish women than in Mexican women. Peresmitre and Garcia (2000) found that Mexican women selected a thinner ideal figure and assigned more importance to physical appearance in social situations with men and at work than Spanish women. However, being judged as being physically attractive from family members and at parties was rated significantly less important to Mexican women than to Spanish women. Comparing Spanish and American women, Gleaves et al., (2000) reported similar body size ideals and body dissatisfaction, although in normal weight individuals (BMI ¼ 20 25) there was a tendency for Americans to be more dissatisfied with their body size than were Spaniards. Similarly, in a study comparing adolescents in the United States and Spain, there was a greater interest in losing weight and more eating disorder symptoms in American girls than Spanish girls (Raich et al., 1992). Generally, data suggest that European American women have higher levels of eating disorder symptomatology than Spanish, Mexican American, or Mexican women, with inconclusive findings comparing Spanish, Mexican, and Mexican American women. Study Objectives and Predictions In the current study, we explored the potential for ethnicity to protect against internalization of Western physical ideals and body dissatisfaction. Our goal was to examine two intertwined issues. First, we evaluated the sociocultural model by testing the mediational effect of internalization on the relationship between awareness and body dissatisfaction in three ethnic groups. Second, we investigated the potential for ethnicity to moderate these relationships (Figure 1). To explore these issues, we recruited female participants from three ethnic groups: European American, Mexican American, and Spanish. The primary research questions were: Is the relationship between awareness and internalization and between internalization and body dissatisfaction the same across European American, Mexican American, and Spanish women? If not, how does each relationship differ? We hypothesized that the relationships would be stronger for European American women than for Mexican American women, with no specific predictions regarding the Spanish group. Int J Eat Disord 37: WARREN ET AL. FIGURE 1. Effect of ethnicity as a moderating variable on the sociocultural model. Method Participants Mexican American (n ¼ 103), European American (n ¼ 101), and Spanish (n ¼ 115) female students attending large universities in the southwestern United States and Spain participated in the study. In this article, the term Mexican American refers to persons of Mexican descent who are living in the United States (i.e., either because they are American citizens [n ¼ 92] or because they are Mexican citizens living in the United States [n ¼ 8]). Participants were divided into ethnic groups based on their self-identified ethnicity. Data from 19 participants were eliminated because of missing data, leaving analyses with 100 participants per group. The majority of Mexican American participants were second generation (n ¼ 50), followed by fourth generation (n ¼ 20), third generation (n ¼ 13), first generation (n ¼ 9), fifth generation and above (n ¼ 7), and other (n ¼ 1). European American participants were recruited from undergraduate psychology courses whereas Mexican American participants came from both undergraduate psychology courses and various student organizations comprising Mexican Americans (e.g., the Mexican Student Association). Participants recruited from psychology classes received research credit in exchange for participation whereas those recruited from student organizations participated voluntarily. Spanish participants volunteered from undergraduate psychology classes. Measures European American and Mexican American participants completed all measures in English whereas Spanish participants completed them in Spanish. When available, we used preexisting Spanish versions of a measure. When not available, we translated the English version and evaluated its psychometric properties. Based on results described by Warren, Gleaves, Cepeda-Benito, and Fernandez (2002), we concluded that all Spanish translations were appropriate for use. The Sociocultural Attitudes Towards Appearance Questionnaire-Revised (SATAQ-R; Cusumano & Thompson, 1997; Thompson et al., 1999) is a 21-item questionnaire designed to measure recognition and acceptance of culturally and socially endorsed appearance standards. The SATAQ-R has two reported factors an 11-item awareness subscale (AWARE), indicating the extent to which an individual acknowledges a cultural emphasis on appearance and thinness, and a 10-item internalization subscale (INTERN), indicating the extent to which an individual personally accepts these standards (Heinberg, Thompson, & Stormer, 1995). In the current European American sample, Cronbach s alpha value was.90 using all items,.85 in the AWARE subscale, and.85 in the INTERN subscale. In the Mexican American sample, Cronbach s alpha value was.86 using all items,.81 in the AWARE subscale, and.83 in the INTERN subscale. A Spanish version was not available. Consequently, the measure was translated, examined psychometrically, and cross-validated with the English version (see Warren et al., 2002). In the current sample, Cronbach s alpha value was.87 using all items,.83 in the AWARE subscale, and.89 in the INTERN subscale. The Body Shape Questionnaire (BSQ; Cooper, Taylor, Cooper & Fairburn, 1987) is a 34-item measure that assesses general satisfaction with one s body shape and weight (Cooper et al., 1987). In the current data, Cronbach s alpha value was.97 in both the European American and the Mexican American groups. A translated Spanish version (Raich et al., 1996) was used, yielding a Cronbach s alpha value of.97 in the current sample. A demographic questionnaire asked questions regarding one s self-identified age, weight, height, and ethnicity. From these data, we calculated each participant s BMI. Results Analyses were conducted using Statistics Package for the Social Sciences (SPSS for Windows Version 244 Int J Eat Disord 37: ETHNICITY AS A PROTECTIVE FACTOR TABLE 1. Descriptive information by ethnic group European American Mexican American Spanish F p 2 Age (years) (3.05) a (2.04) b (2.20) a 5.96 BMI (3.08) a (3.88) b (2.68) c SATAQ-R AWARE (5.85) a (6.23) b (6.38) a 8.86 INTERN (7.22) a (7.03) b (8.04) c BSQ (37.67) a (33.76) b (30.85) b Note: Means in the same row that do not share subscripts differ at p .05 on Tukey s honestly significant difference comparison. BMI ¼ body mass index; SATAQ-R ¼ Sociocultural Attitudes Towards Appearance Questionnaire-Revised; AWARE ¼ Awareness subscale; INTERN ¼ Internalization subscale; BSQ ¼ Body Shape Questionnaire. 11.0, 2001) and LISREL 8.5 (Jöreskog & Sörbom, 2001). Descriptive Information Descriptive information for the samples is presented in Table 1. Univariate analyses of variance (ANOVAs) indicated significant differences across ethnic groups on age, BMI, awareness, internalization, and body dissatisfaction. Tukey s post-hoc tests indicated that the Mexican American group was significantlyolderthantheeuropeanamericanandspanish groups, who did not differ significantly. In addition, the Mexican American group had a significantly higher BMI than the European American, which had a significantly higher BMI than the Spanish group. According to Cohen (1977), effect sizes were small to medium for age and B
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