Arch Sex Behav DOI 10.1007/s10508-014-0384-1

ORIGINAL PAPER

Self-Objectification and Condom Use Self-Efficacy in Women University Students Mike C. Parent • Bonnie Moradi

Received: 19 December 2013 / Revised: 5 June 2014 / Accepted: 27 June 2014 Ó Springer Science+Business Media New York 2014

Abstract This study investigated the roles of indicators of the self-objectification process in women’s condom use selfefficacy. Data were collected from 595 college women. Selfobjectification variables were assessed with measures of internalization of cultural standards of beauty, body surveillance, and body shame. Participants also completed measures of perceived control over sexual activity, acceptance of sexuality, and condom use self-efficacy. Measurement and structural invariance were supported, indicating that the measurement model and hypothesized structural model did not differ across participants who were or were not sexually active. Structural equation modeling results were consistent with hypotheses and prior evidence indicating that body surveillance partially mediated the link between internalization of cultural standards of beauty and body shame. Results also indicated that body shame was associated with lower condom use self-efficacy both directly and indirectly through the partial mediation of perceived control over sexual activity; acceptance of sexuality was not a significant mediator of this link but was associated directly with greater condom use self-efficacy.These results connect the substantial literature on the self-objectification process with women’s condom use self-efficacy. Specifically, these results point to interrupting the self-objectification process and reducing body shame as well as to enhancing acceptance of sexuality and control over sexual activity as potentially fruitful targets for interventions to promote women’s condom use self-efficacy.

M. C. Parent (&) Department of Psychological Sciences, Texas Tech University, Lubbock, TX 79409-2051, USA e-mail: [email protected] B. Moradi Department of Psychology, University of Florida, Gainesville, FL, USA

Keywords Body image  Condom use  Sexual health  Sexual objectification  Women

Introduction Sexually transmitted infections (STIs) are a public health concern in the United States and worldwide (Centers for Disease Control and Prevention, 2011; World Health Organization, 2013) and present myriad health risks for women. For example, chlamydia and gonorrhea can promote pelvic inflammatory disease, reproductive tract scarring, infertility, and chronic pain (Westrom, Joesoef, Reynolds, Hagdu, & Thompson, 1992); human papilloma virus (genital warts) can heighten risk for cervical cancer (de Freitas, Gurgel, Chagas, Coimbra, & do Amaral, 2012); herpes simplex virus can cause breaks in tissue barriers and greater likelihood of acquiring other STIs, including up to three times greater risk of acquiring HIV (Freeman et al., 2006). Correct and consistent condom use reduces risk of STIs significantly (Weller & Davis-Beaty, 2002). Therefore, condom use self-efficacy, including confidence in obtaining condoms, using them properly, and insisting on their use during sex, is an important focus of STI prevention research (Bryan, Aiken, & West, 1997). Understanding women’s condom use self-efficacy is important because the likelihood of condom use is higher when women make decisions about condom use than when men make such decisions (Amaro, Raj, & Reed, 2001; Osmond et al., 1993). Moreover, in the context of sexual relations with men, women may need a high level of condom use self-efficacy to overcome heterosexual men’s potential disinclination toward condom use (Newton, Newton, Windisch, & Ewing, 2013; Pulerwitz & Dworkin, 2006; Yoder, 2013). Thus, understanding factors linked with women’s condom use self-efficacy is important to helping women engage in successful negotiation of condom use in

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sexual relations with men. However, cultural sexual objectification of women and internalization of such sexual objectification via the self-objectification process (Fredrickson & Roberts, 1997; Moradi, 2010) is thought to impede women’s sexual agency (APA Task Force on the Sexualization of Girls, 2010). Building on objectification theory and research on women’s condom use self-efficacy, the present study investigated the roles of key indicators of the self-objectification process (i.e., internalization of cultural standards of beauty, body surveillance, body shame) in women’s condom use self-efficacy. Objectification Theory, Women’s Sexuality, and Condom Use Self-efficacy The ubiquitous sexual objectification of women’s bodies is widely documented (Fairchild, 2012; Moradi & Huang, 2008). Fredrickson and Roberts (1997) proposed objectification theory as a model to explain the processes by which sexual objectification may be translated into risk factors for health problems. Specifically, self-objectification involves the internalization of cultural standards of beauty and habitual body surveillance focusing on how the body looks, rather than how it feels or functions. Such internalization and body surveillance can promote body shame given that the cultural standards are difficult or impossible to meet (e.g.,Brownell & Napolitano, 1995). This set of relations from internalization, mediated by body surveillance, to body shame has been replicated across samples of women and linked with mental and behavioral health problems including anxiety,disorderedeating,anddepressivesymptoms(forareview, see Moradi & Huang, 2008). Objectification theory also posits that this set of relations impedes women’s sexual functioning. Research with girls and women links body image problems with lower levels of sexual agency, affirmative engagement with sex, and satisfaction with sex (Calogero & Thompson, 2009; Satinsky, Reece, Sanders, Dennis, & Bardzell, 2012; Weinberg & Williams, 2010; Woertman & van den Brink, 2012). Moreover, variables similar to body shame, including negative body evaluation and low body esteem, have been linked with lower assertiveness in sexual decision-making and lower condom use self-efficacy among college women (Auslander, Baker, & Short, 2012; Gillen, Lefkowitz, & Shearer, 2006). Three studies examined objectification theory variables and condom use variables more directly. In one study, a variable comprising internalization and body shame was linked negatively to adolescent girls’ reports of sexual decision-making self-efficacy and condom use frequency (Impett, Schooler, & Tolman, 2006). In another study with college women, body shame was associated directly and indirectly, through the mediating role of sexual decision-making assertiveness, with an indicator of sexual risk behaviors that was comprised of reported self-efficacy in using, and actual use of, condoms and other contraception (Schooler, Ward, Merriwether, & Caruthers, 2005). In a third study with women visiting family

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planning clinics, body shame but not body surveillance was associated uniquely and positively with inconsistent condom use (Littleton, Breitkopf, & Berenson, 2005). These studies did not test specific relations outlined in objectification theory; however, taken together, their findings suggest that internalization and body surveillance may be associated with lower condom use self-efficacy through the mediating role of body shame. Moreover, these findings suggest that body shame may have additional indirect links with lower condom use self-efficacy through its association with greater sexual agency. This possibility is consistent with Bryan et al.’s (1997) findings that acceptance of sexuality and control over sexual encounters were precursors to condom use self-efficacy. Thus, objectification theory variables may impede perceived acceptance and control over sexual encounters, and acceptance and control may mediate the relations of objectification theory variables with condom use self-efficacy. An additional consideration in examining the relations of objectification theory constructs with condom use self-efficacy is whether there are differences between women who are sexually active and women who are not sexually active. Condom use selfefficacy is a key precursor to condom use (Ajzen, 1991; Albarracin, Johnson, Fishbein, & Muellerleile, 2001; Bryan et al., 1997; Harvey et al., 2006). However, unlike condom use, which is predicated upon individuals being sexually active, condom use self-efficacy can be promoted among individuals who are and are not sexually active. Most studies on condom use selfefficacy have grouped sexually active and not sexually active participants together in analyses or exclusively sampled sexuallyactiveparticipants.Toclarifywhetherthepracticeofcombining sexually active and not sexually active participants in research on condom use self-efficacy is warranted, the present study explored the stability of hypothesized relations across these two groups. Such evidence can also inform the need for targeted or universal condom use self-efficacy interventions across these groups.

Present Study In the present study, we used structural equation modeling to test a model grounded in an integration of research on objectification theory with research on women’s condom use selfefficacy. The model (see Fig. 1) tests the following hypotheses: (1)

(2) (3)

Internalization will relate positively with body surveillance and body shame and body surveillance will partially mediate the link between internalization and body shame. Body shame will mediate the links of internalization (2a) and body surveillance (2b) with condom use self-efficacy. Body shame will be linked with lower condom use selfefficacy directly and indirectly through the mediating roles of acceptance of sexuality (3a) and sense of control in sexual decision-making (3b)

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Fig. 1 Standardized path coefficients and standard errors across the full sample. All factor loadings are significant at p\.05. *p\.05, **p\.05

In addition to testing the above hypotheses, we will explore whether the associations in the hypothesized model are invariant across participants who are sexually active and participants who are not sexually active.

Method Participants and Procedure Data from 595 college women were analyzed in the present study. The mean age of the sample was 19.00 years (SD = 1.65). Participants identified as White/Caucasian (56 %), Hispanic/Latina (15 %), African American/Black (14 %), Asian American/Pacific Islander (8 %), Biracial/Multiracial (4 %), Arabic American/Middle Eastern (1 %), or American Indian/ Native American (less than 1 %), a different identity (1 %), or declined to respond (1 %). Most participants reported being exclusively heterosexual (87 %), with other participants identifying as mostly heterosexual (10 %), bisexual (2 %), or mostly lesbian (1 %). Regarding the question, ‘‘Have you had consensual sex (sex as you define it) with persons of your own sex, the other sex, or both sexes?’’ about a third of the sample reported that they had not had sex (37 %); 48 % reported that they had had sex exclusively with men; 1 % reported that they had had sex with men and women, but mostly with men; and 6 % reported that they had had sex with men and women about equally (8 % declined to respond). As none of the participants identified as exclusively lesbian and all sexually active participants reported some sexual activity with men, all participants were included in the analyses.

Individuals were recruited from the participant pool and psychology classes at a large public university in the southeast United States for participation in a study of college women’s experiences. The study was approved by the Institutional Review Board (IRB). A prior publication from the larger study focused on psychometric properties of a measure of gender norm conformity (Parent & Moradi, 2011a). Individuals who elected to participate in this study were linked to the study web site where they could indicate their consent to participate and complete the survey. Participants earned course credit as allowed by their course instructors. The initial data set contained responses from 598 women. Three women were identified as multivariate outliers (described in the results section) and were removed from the present analysis (Tabachnick & Fidell, 2007) resulting in the final data set of 595 women. Measures Internalization of Cultural Standards of Beauty The 8-item Internalization subscale of the Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ) (Heinberg, Thompson, & Stormer, 1995) was used to measure internalization of social standards of beauty (sample item: ‘‘I wish I looked like a swimsuit model’’). Items were rated on a 5-point scale (0 = completely disagree, 4 = completely agree). Appropriate items were reverse coded and scale mean scores calculated; higher scores indicated greater internalization. In terms of validity, internalization scores have been correlated positively with body image concerns in many samples (Moradi & Huang, 2008). In the instrument development study, Heinberg et al.

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Arch Sex Behav Table 1 Intercorrelations and descriptive statistics for the entire sample 1

2

3

4

5

1. SATAQa 2. Body surv.b

.56***

3. Body shamec

.55***

.49***

4. Acceptance

d

.01

-.06

.09*

5. Controle

-.12**

-.21***

-.01

.37***

6. CUSEf

-.14**

-.09*

-.09*

.38***

.23***

M

SD

a

1.95 (n = 595)

0.93

0.91

1.98 (n = 595)

0.97

0.84

3.18 (n = 595)

0.85

0.85

4.05 (n = 595)

1.10

0.73

4.69 (n = 595)

0.94

0.71

1.89 (n = 595)

0.43

0.87

Note. Body Surv. = Body Surveillance. CUSE = Condom use self-efficacy Variable ranges: a(0-5) b(0-6) c(0-6) d(0-6) e(0-6) f(0-4) * p\.05, ** p\.01, *** p\.001

(1995) reported a Cronbach’s alpha of .88 for responses to SATAQ items in a sample of college women. Tables 1 and 2 show alphas for the present study.

Body Shame items yielded a Cronbach’s alpha of .75 (McKinley & Hyde, 1996). Tables 1 and 2 show alphas for the present study. Acceptance of Sexuality

Body Surveillance The 8-item Body Surveillance subscale of the Objectified Body Consciousness Scale (McKinley & Hyde, 1996) was used to measure preoccupation with how the body looks over how it feels or functions (sample item: ‘‘I think more about how my body feels than how my body looks,’’reverse coded). Items were rated on a 7-point scale (0 = strongly disagree, 6 = strongly agree). Participants could also select a‘‘not applicable’’option if an item did not apply to them. Appropriate items were reverse coded and scale mean score calculated; higher scores indicated greater body surveillance. In terms of validity, Body Surveillance scores have been correlated with greater appearance anxiety and shown to emerge as a separate factor from body shame (McKinley & Hyde, 1996; Moradi & Huang, 2008). In the instrument development sample of college women, responses to Body Surveillance items yielded a Cronbach’s alpha of .89 (McKinley & Hyde, 1996). Tables 1 and 2 show alphas for the present study. Body Shame The 8-item Body Shame subscale of the Objectified Body Consciousness Scale (McKinley & Hyde, 1996) was used to measure shame felt for falling short of internalized standards of beauty (sample item: ‘‘I would be ashamed for people to know what I really weigh’’). Items were rated on the same scale as Body Surveillance. Appropriate items were reverse scored and scale mean scores calculated; higher scores indicated greater levels of body shame. In terms of validity, scores on Body Shame have been correlated with disconnection from body functions and shown to emerge as a separate factor from body surveillance (McKinley & Hyde, 1996; Moradi & Huang, 2008). In the instrument development sample of college women, responses to

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Acceptance of sexuality was measured using Bryan et al.’s (1997)5-item measure ofthesame name (sampleitem:‘‘I feel sex is a natural part of my life’’). Items were rated on a 7-point scale (0 = strongly disagree, 6 = strongly agree). Appropriate items were reverse coded and scale mean scores calculated; higher scores reflected greater acceptance of sexuality. In terms of validity, Bryan et al. found that Acceptance scores were positively correlated with perceived assertiveness in discussing use of condoms. In Bryan et al.’s two samples of college women, Cronbach’s alphas for responses to the Acceptance items were .69 and .65. Tables 1 and 2 show alphas for the present study. Control Over Sexual Encounters Control over sexual encounters was measured using Bryan et al.’s (1997) 4-item measure of the same name (sample item:‘‘I believe I can decide when in the relationship we will have sex’’). Items were rated on a 7-point scale (0 = strongly disagree, 6 = strongly agree). Appropriate items were reverse coded and scale mean scores calculated; higher scores reflected greater feelings of control over sexual encounters. In terms of validity, Control scores were negatively correlated with perceived susceptibility to STIs (Bryan et al., 1997). In Bryan et al.’s two samples of college women,Cronbach’salphasforresponsestotheControlitemswere .59 and .62. Tables 1 and 2 show alphas for the present study. Condom Use Self-Efficacy Condom use self-efficacy was measured using the instrument of the same name developed by Bryan et al. (1997) and based on priorwork (Brafford & Beck,1991; Brien, Thombs, Mahoney,& Wallnau, 1994). The instrument contains four domains: Assertiveness (three items; sample item:‘‘I feel confident in my ability

0.59 .83 0.46 1.74 (n = 218)

As a preliminary step, data were examined for univariate and multivariate normality. Skewness and kurtosis were not problematic (i.e., p[.001; Tabachnick & Fidell, 2007). Three cases were identified as multivariate outliers based on Mahalanobis distances significant at p\.001. Screening of the data for these cases revealed a pattern of extreme responses; thus, these three cases were removed from analyses. The remaining participants provided at least 75 % complete data on each of the measures included in this study. Thus, scale or subscale mean scores were computed based on available item responses (Parent, 2013). Table 1showscorrelationsamongthevariablesofinterest,descriptive statistics, and alphas using Available Item Analysis Alpha (Parent, 2013) for the entire sample. Table 2 shows this information separately for sexually active (n = 321) and not sexually active (n = 218) participants.

Variable ranges a(0–5) b(0–6) c(0–6) d(0–6) e(0–6) f(0–4)

Measurement Model and Invariance Across Sexually Active and Non-active Groups

* p\.05; ** p\.01; *** p\.001

.09 (n = 218) .26*** (n = 218) -.26*** (n = 218) -.27*** (n = 218) 6. CUSEf

-.16* (n = 218)

-.06 (n = 218) 5. Controle

Results

Body Surv. body surveillance, CUSE condom use self-efficacy

0.38 1.99 (n = 321)

.86

0.90 4.88 (n = 321) .24*** (n = 321) .25*** (n = 218) -.08 (n = 218)

-.02 (n = 218) 4. Acceptanced

-.09 (n = 218)

to suggest using condoms with a new partner’’), Partner Dissatisfaction, (five items; sample item:‘‘If I were to suggest using a condom to a partner, I would feel afraid that he would reject me’’ [reverse coded]), Condom Use Mechanics (‘‘I feel confident in my ability to put a condom on my partner’’), and Obtaining (two items; sample item: I feel confident I could purchase condoms without feeling embarrassed’’). Responses were made on a 5-point scale (0 = strongly disagree, 4 = strongly agree). Appropriate items were reverse scored and scale mean scores calculated; higher scores reflected greater endorsement of the constructs. Bryan et al. found that Condom Use Self-efficacy subscale scores were correlated positively with acceptance of sexuality and control over sexual encounters and that Cronbach’s alphas were in the .70 s for Partner Dissatisfaction and Assertiveness,.80 sforCondomUseMechanics,and.50and.60 s for Obtaining. Tables 1 and 2 show alphas for the present study.

Correlations for sexually active participants are above the diagonal, and for not sexually active participants are below the diagonal

0.97

0.51 .65 0.93 4.41 (n = 218)

0.06

1.01 4.47 (n = 321)

.61*** (n = 218) 3. Body shamec

-.07 (n = 218)

.59*** (n = 218)

.03 (n = 218)

.39*** (n = 321)

.37*** (n = 321)

.74

.61 0.96 3.51 (n = 218)

0.06

0.86 .05 (n = 321) .10 (n = 321)

3.21 (n = 321)

.71

.87 0.86 3.16 (n = 218)

0.12

.01 (n = 321)

.85

.85

.91 0.90

1.01 2.03 (n = 218)

1.92 (n = 218)

0.96 1.97 (n = 321)

.85

0.92 2.03 (n = 321)

-.04 (n = 321) -.27*** (n = 321) -.04 (n = 321) .44*** (n = 321)

1. SATAQa

.57*** (n = 218)

.56*** (n = 321)

-.17** (n = 321) -.03 (n = 321) .51*** (n = 321)

-.11 (n = 321)

.90

Cohen’s d SD M SD M

2. Body surv.b

2 1 Measure

Table 2 Intercorrelations and descriptive statistics by sexual activity status

5 4 3

6

Sexually active

a

Not sexually active

a

Difference

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Next, a measurement model was specified with item parcels or subscale scores used as indicators for each latent variable. To model internalization, body surveillance, and body shame, the item set for each of these variables was subjected to a confirmatory factor analysis of the a priori unidimensional model using Mplus, version 6.11 (Muthe´n & Muthe´n, 2010). Items were then rank ordered by the magnitude of their standardized factor loadings and assigned across three parcels in countervailing order (Little, Cunningham, & Shahar, 2002). Internalization, body surveillance, and body shame were modeled with three parcels each. The same procedure was used to create two parcels (given that there were fewer items on each measure) for the acceptance and control measures (in the analysis, loadings for the two parcels were constrained to equality within their

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latent constructs to prevent the model from being locally underidentified [Kenny, 2011]). Finally, consistent with recommendations to use subscale parcels with multidimensional measures (Little et al., 2002), condom use self-efficacy was modeled with three subscale scores: Mechanics, Obtaining, and combined Assertiveness and Partner Dissatisfaction. Assertiveness and Partner Dissatisfaction subscales were combined because of the shared conceptual focus of these items on partner relations and their moderately large correlations in Bryan et al.’s (1997) samples (rs = .45 and .49 in their two samples) and in the present sample (.60 in the entire sample; .43 among those who reported not being sexually active and .71 among those who reported being sexually active). The measurement model was evaluated using structural equation modeling with maximum likelihood estimation. We report the comparative fit index (CFI), the root mean square error of approximation (RMSEA) with 90 % confidence interval, and the standardized root mean square residual (SRMR) (Martens, 2005; Weston & Gore, 2006). Criteria for acceptable fit range from CFI[.90 and RMSEA and SRMR\.10 to more conservative criteria of CFI [.95, RMSEA \.06, and SRMR \.08 (Weston & Gore, 2006). The measurement model fit well, v2(89) = 242.62, p\.001; CFI = 0.97; RMSEA = 0.05 (0.05-0.06); SRMR = 0.04. Standardized indicator-to-construct loadings ranged from .52 and .90 (|M| = .78, |Mdn| = .81) and were significant at p\.001. Next, the measurement model was tested in the two groups. The model fit well both among participants who were sexually active, v2(89) = 220.75, p\.001; CFI = 0.95; RMSEA = 0.07 (0.060.08); SRMR = 0.05, and who were not, v(89)2 = 152.44, p\ .001; CFI = 0.96; RMSEA = 0.06 (0.04-0.07); SRMR = 0.05. As the measurement model fit well in both groups, we began invariance testing (Vandenberg & Lance, 2000) to test whether aspects of the measurement model differed between participants who were sexually active and not sexually active. Invariance testing occurs in multiple steps, wherein each step is compared to the prior step with a Chi square difference test; a significant Chi square difference suggests the need to examine modification indices to free some parameters and test partial rather than full invariance. Throughout invariance testing, Chen’s (2007) criteria were used to determine whether invariance is supported and thus fit statistics are reported to three decimal places to avoid confusing substantive changes with rounding. The first step (configural invariance) indicated whether the factors and pattern of item-to-factor loadings held across groups; this was tested by evaluating the fit of the measurement model in both groups simultaneously, without equality constraints. This model fit well, v(178)2 = 373.183, p\.001; CFI = 0.952; RMSEA = 0.064 (0.055–0.073); SRMR = 0.050, indicating that the configuration of the measurement model did not differ between the two groups. Next, we tested metric invariance, which indicated whether the magnitudes of factor loadings differed across groups. Metric

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invariance was tested by imposing between-group equality constraints on factor loadings. This model fit well, v(188)2 = 384.384, p\.001; CFI = 0.952; RMSEA = 0.062 (0.053–0.071); SRMR = 0.053. Relative to configural invariance, changes in fit indices for the metric invariance model were CFID = .000, RMSEAD = .002, and SRMRD = .003, vDIFF(10)2 = 11.201, not significant at p\.001. Thus, the measurement model demonstrated full metric invariance indicating that factor loadings did not differ between the two groups. Next, we tested for scalar invariance, which indicated whether intercepts of the regressions for the manifest variables onto their intended latent variables differed across groups. Scalar invariance was tested by retaining metric invariance constraints and adding between-group equality constraints on the manifest variable intercepts. This model fit well, v(196)2 = 411.224, p\.001; CFI = 0.947; RMSEA = 0.064 (0.055–0.072); SRMR = 0.057. Changes in fit indices were CFID = .005, RMSEAD = .002, and SRMRD = .004, vDIFF(8)2 = 26.840, not significant at p\.001. Thus, the measurement model demonstrated full scalar invariance across groups. Next, we tested for invariance of factor variances and covariances, which indicated whether the variances of and the interrelations among factors differed across groups. Invariance of variance and covariance was tested by retaining metric and scalar invariance constraints and adding between-group equality constraints on the latent variable variances and covariances. This model fit well; v(217)2 = 455.231, p\.001; CFI = 0.942; RMSEA = 0.064 (0.056–0.072); SRMR = 0.073. Changes in fit indices were CFID = .005, RMSEAD = .000, and SRMRD = .016, vDIFF(21)2 = 44.007, not significant at p\.001. Thus, the measurement model demonstrated full variance and covariance invariance. Finally, we tested for invariance of factor means, which indicated whether the means of the latent variables differed across groups. Mean invariance was tested by retaining the metric, scalar, and variance and covariance constraints, and adding constraints on the latent means. Model fit dropped for this test, v(223)2 = 619.657, p\.001; CFI = 0.903; RMSEA = 0.081 (0.074–0.089); SRMR = 0.110, representing a change from the variance and covariance invariance model of CFID = .039, RMSEAD = .017, and SRMRD = .037, and the v2DIFF was (6) = 164.426, p\.001. Modification indices suggested relaxations of between-group equality constraints on two latent variable means: acceptance (MI = 28.246) and condom use self-efficacy (MI = 27.907). Relaxing the equality constraint on acceptance and condom use self-efficacy improved model fit significantly, v(221)2 = 502.424, p\.001; CFI = 0.931; RMSEA = 0.069 (0.061–0.077); SRMR = 0.073. However, the resultant model still represented a difference from the variance and covariance invariance model of CFID = .011, RMSEAD = .005, and SRMRD = .000, v2DIFF(6) = 47.193, p\ .!001. Modification indices suggested relaxing the equality constraint for control as well (MI = 38.522). Relaxing this

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constraint improved model fit significantly, v(220)2 = 459.548, p\.001; CFI = 0.942; RMSEA = 0.064 (0.055–0.072), SRMR = 0.073. Compared to the variance and covariance invariance model, this was a difference of CFID = .000, RMSEAD = .000, andSRMRD = .000,v2DIFF(7) = 4.317,not significant atp\.001. Thus, relaxing the between-group equality constraints on the means for acceptance, control, and condom use self-efficacy achieved partial mean invariance. Overall, the measurement model demonstrated full metric, scalar, and variance and covariance invariance, and partial mean invariance. Partial mean invariance was localized to the three sexuality variables. Thus, the measurement model–including the factor loadings, variances, and covariances–was similar across sexually active and not sexually active women, though sexually active women had higher latent means on acceptance, control, and condom use self-efficacy relative to sexually not active participants. Structural Model and Invariance Across Sexually Active and Non-active Groups Given the measurement invariance results, we next tested invariance of path coefficients in the structural model. A model with full metric, scalar, and variance and covariance constraints, and partial mean constraints (equality constraints relaxed on the acceptance, control, and condom use self-efficacy latent variables) was analyzed using the structural model (Fig. 1). Model fit was acceptable, v(219)2 = 537.565, p\.001; CFI = 0.922; RMSEA = 0.073(0.066–0.081);SRMR = 0.084.Next,themodel was analyzed imposing between-group equality constraints on the hypothesized path coefficients. This model also fit, v(228)2 = 553.780, p\.001; CFI = 0.920; RMSEA = 0.073 (0.065–0.081); SRMR = 0.090. The difference between the structural models with and without between-group equality constraints was CFID = .002, RMSEAD = .000, and SRMRD = .006, v2DIFF(9) = 16.215, not significant at p\.001. Thus, the model demonstrated full path invariance, supporting the model in the entire sample and in both groups. The structural model indicated good fit to the data for the full sample, v(96)2 = 362.96, p\.001; CFI = 0.94; RMSEA = 0.07 (0.06–0.08); SRMR = 0.07. Standardized path coefficients are shown in Fig. 1. This model indicated that internalization, body surveillance, and body shame were associated significantly and positively with one another; acceptance, control, and condom use self-efficacy were associated significantly and positively with one another; and body shame was associated significantly andpositively with control and condom use self-efficacy, but not with acceptance. Next, we tested the pattern of hypothesized mediations reflected in the structural model using bootstrap procedures. We used 1,000 bootstrapped samples of the full sample data. We report the 95 % bias-corrected confidence intervals of indirect paths in Table 3. If a confidence interval does not

include zero, then the indirect path is significant and mediation is supported (Mallinckrodt et al. 2006). The first hypothesis was that internalization would be associated positively with body surveillance and body shame, with body surveillance partially mediating the link between internalization and body shame. This hypothesis was supported, such that internalization was associated with body shame positively and directly, and positively and indirectly through the mediating role of body surveillance. The second hypothesis was that body shame would mediate the links of internalization (2a) and body surveillance (2b) with condom use self-efficacy. Consistent with this hypothesis, internalization and body surveillance both had significant negative indirect relations with condom use self-efficacy through the mediating role of body shame. The third hypothesis was that body shame would be linked with lower condom use self-efficacy directly and indirectly through the mediating roles of acceptance of sexuality (3a) and sense of control in sexual decision-making (3b). As hypothesized body shame had a significant negative direct link with condom use self-efficacy. The indirect relation from body shame through acceptance to condom use self-efficacy was not supported, though the indirect relation from body shame through control to condom use self-efficacy was supported. Thus, the results did not support a mediating role for acceptance of sexuality, but did support a mediating role for control in the relation of body shame with condom use self-efficacy. In addition to the tests of the hypotheses, we conducted auxiliary analyses to test the additional indirect paths reflected in the hypothesized model (see Table 3). Similar to above, indirect relations involving control, but not acceptance, were significant.

Discussion This study connects the substantial literature on objectification theory with the understanding of women’s condom use selfefficacy. We first demonstrated measurement invariance at the configural, metric, scalar, variance and covariance levels, and structural levels, and partial invariance at the mean level between sexually active and not sexually active participants. Results indicated support for a model in which self-objectification variables were linked with condom use self-efficacy, through the mediating role of perceived control over sexual encounters. Although acceptanceof sexualitywasrelated to condom use selfefficacy, it was not related to objectification theory variables and did not serve as a mediator in the present investigation. First, consistent with hypotheses, internalization of cultural standardsofbeauty wasassociatedwith greater bodyshame and this relation was partially mediated by body surveillance. This pattern of mediation, from internalization to body shame, through body surveillance was consistent with prior findings

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Arch Sex Behav Table 3 Summary of hypothesized indirect effects Hypothesis

Predictor

Mediator

Criterion

Standardized indirect estimate

Bootstrap estimate

b

B

SE

95 % Bias-corrected CI SE

Lower bound

Upper bound

1

Internalization

Body surv.

Body Shame

0.185

0.038

0.190

0.040

0.116

0.269*

2a

Internalization

Body shame

CUSE

-0.055

0.025

-0.043

0.019

-0.085

-0.010*

2b

Body surv.

Body shame

CUSE

-0.036

0.017

-0.035

0.016

-0.072

-0.008*

3a

Body shame

Acceptance

CUSE

-0.042

0.036

-0.032

0.028

-0.092

0.020

3b

Body shame

Control

CUSE

-0.087

0.029

-0.067

0.021

-0.117

-0.033*

Auxiliary tests Aux 1

Internalization

Body surv.?body shame

CUSE

-0.023

0.011

-0.018

0.008

-0.036

-0.004*

Aux 2

Internalization

Body surv.?body shame

Control

-0.048

0.013

-0.045

0.013

-0.078

-0.027*

Aux 3

Internalization

Body surv.?body shame?control

CUSE

-0.016

0.006

-0.013

0.004

-0.025

-0.006*

Aux 4

Internalization

Body shame

Control

-0.116

0.030

-0.110

0.029

-0.180

-0.063*

Aux 5

Internalization

Body shame?control

CUSE

-0.039

0.014

-0.031

0.011

-0.060

-0.015*

Aux 6

Body Surv.

Body shame

Control

-0.077

0.021

-0.088

0.025

-0.149

-0.049*

Aux 7

Body Surv.

Body shame?control

CUSE

-0.026

0.009

-0.025

0.009

-0.048

-0.012*

Aux 8

Internalization

Body surv.?body shame

Acceptance

-0.013

0.011

-0.013

0.011

-0.039

0.008

Aux 9

Internalization

Body surv.?body shame?acceptance

CUSE

-0.008

0.007

-0.006

0.005

-0.018

0.004

Aux 10

Internalization

Body shame

Acceptance

-0.031

0.028

-0.033

0.029

-0.100

0.021

Aux 11

Internalization

Body shame?acceptance

CUSE

-0.019

0.017

-0.015

0.013

-0.046

0.008

Aux 12

Body surv.

Body shame

Acceptance

-0.020

0.017

-0.026

0.023

-0.076

0.017

Aux 13

Body surv.

Body shame?acceptance

CUSE

-0.012

0.011

-0.012

0.010

-0.035

0.007

Body surv. body surveillance, CUSE condom use self-efficacy, CI confidence interval * p\.05

with women (Moradi & Huang, 2008) and adds to robust support for this aspect of objectification theory. Second, as hypothesized, the objectification theory variables were also related to condom use self-efficacy. Specifically, body shame was associated directly with lower condom use self-efficacy. Moreover, body shame significantly mediated indirect negative relations from internalization and body surveillance to condom use self-efficacy. These findings add to prior evidence linking objectification theory variables with sexual health and sexual behaviors in women and girls (e.g., Impett et al., 2006; Schooler et al., 2005) and suggest that the self-objectification process, reflected in greater internalization of cultural standards of beauty, body surveillance, and body shame, may hinder women’s condom use self-efficacy. The mediating role of body shame suggests that interrupting the translation of internalization and body surveillance into body shame and reducing body shame itself may be fruitful components of efforts to enhance women’s condom use self-efficacy. Third, the present findings revealed that, in addition to the direct association of body shame with lower condom use selfefficacy, this link was partially mediated through perceived control over sexual encounters. Moreover, acceptance of one’s sexuality was linked with greater condom use self-efficacy, but it was not a significant mediator in the association of body

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shame with condom use self-efficacy. However, the findings from the present tests of hypotheses and auxiliary analyses also suggest that women experiencing high levels of the selfobjectification process culminating in body shame may be at particular risk for low sense of control over sexual encounters and, in turn, low condom use self-efficacy. Thus, interrupting the self-objectification process, reducing body shame, and interrupting the link between body shame and low sense of control in sexual encounters may be helpful avenues for enhancing women’s condom use self-efficacy. Importantly, the results of measurement and structural model invariance testing indicated that the hypothesized relations did not differ statistically between sexually active participants and not sexually active participants. This evidence of similarly suggests that the aforementioned relations and intervention possibilities are applicable across sexually active and not sexually active women. The exception to the pattern of invariance was the finding that relative to women who were not sexually active, women who were sexually active had higher latent variable means on acceptance of sexuality, sense of control in sexual encounters, and condom use self-efficacy. Though these latent variable mean differences between sexually active and not sexually active women did not translate into group differences in interrelations of the variables of interest, attending to these baseline differences is important in future

Arch Sex Behav

clinical trials or tests of interventions targeting these variables in sexually active versus not sexually active women. Clinically, although intervention studies focused on body image have often focused on eating disorders (e.g., Paxton, 2012), intervention studies related to safer sex practices have begun including body image as an important factor to include in interventions (Brown, Webb-Bradley, Cobb, Spaw, & Aldridge, 2014). The present study suggests value in continuing to examine the role of body image in such intervention studies. As well, clinicians who observe women patients to be struggling with safer sex negotiations might explore the roles of body-image-related variables, perceived control over sexual encounters, and acceptance of sexuality for such patients in negotiating and maintaining safer sex practices with their partners. Limitations and Future Directions Several limitations of the present study should form the boundaries for interpretation of the results. The sample was composed of mostly young college women anddifferent factors may be salient in shaping condom use self-efficacy among women of diverse backgrounds; the present study was not designed to assess for differences by various demographic characteristics, and analysis by factors including socioeconomic status, ethnicity, religiosity, and acculturation may be important in future work. For example, cost and access to obtaining condoms may be salient factors for women in lowincome communities. Continued attention to additional risk factors is needed to address the experiences of women from diverse backgrounds. As well, the present study might be extended to men. Some prior work has foundsupportfor aspects of objectification theory among samples of mostly heterosexual men (Daniel & Bridges, 2010; Parent & Moradi, 2011b) and more support amongsamples ofgayand bisexual men (Martins, Tiggemann, & Kirkbride, 2007; Wiseman & Moradi, 2010). Addressing safer sex behaviors among heterosexual men, sexual minority men, and transgender people are all important compliments to research with heterosexual women in promoting better safer sex negotiation and behaviors. An additional consideration is the relatively low internal consistency reliability observed for responses to the Acceptance scale, Control scale, and Condom Use Self-efficacy Obtaining subscale items (Bryan et al., 1997). However, in the present study, all Cronabach’s alphas were in the acceptable range for the full sample. Alphas for Acceptance and Control were in the .60 s for the not sexually active participants, but the overall pattern of measurement invariance alleviated differential measurement concerns across groups. Nevertheless, it may be important for future research to specifically address how individuals who are not sexually active (whether due to a choice to be abstinent, inability to find partners, asexual identity, medical concerns, or other issues) define and negotiate sexuality.

Finally, the present data were cross-sectional; thus, temporal precedence and causality cannot be directly inferred from the results. Longitudinal studies can evaluate the extent to which the present cross-sectional relations hold prospectively. Moreover, understanding causal mechanisms can be enhanced by research that evaluates whether interventions that target the posited predictors or mediators (e.g., body shame, control over sexual encounters) ultimately enhance condom use self-efficacy. Self-objectification and body image problems are a major presenting or auxiliary concern among women in counseling (APA Task Force on the Sexualization of Girls, 2010). The present results connect the substantial literature on the selfobjectification process with women’s condom use self-efficacy. These findings point to interrupting the self-objectification process, reducing body shame, and enhancing acceptance of sexuality and control over sexual encounters as potentially fruitful targets for interventions to promote women’s condom use selfefficacy.

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Self-objectification and condom use self-efficacy in women university students.

This study investigated the roles of indicators of the self-objectification process in women's condom use self-efficacy. Data were collected from 595 ...
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