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. Author manuscript; available in PMC: 2022 Jul 1.
Published in final edited form as: J Prev Health Promot. 2021 Dec 23;3(1):68–96. doi: 10.1177/26320770211054359

The Role of Objectification in College Women’s Substance Misuse and Sexual Risk

Melissa M Ertl 1,2, Jacob S Sawyer 3, Jessica L Martin 4, Rachel E Brenner 5
PMCID: PMC9017399  NIHMSID: NIHMS1767201  PMID: 35450297

Abstract

Sexism and objectification present major challenges for mental and physical health among women. Scholars have called for research to identify mechanisms that underlie these associations as well as to delineate factors to target in prevention and intervention efforts. This study aimed to build on central tenets of objectification theory through its examination of sexist experiences in relation to body surveillance, body shame, depressive symptoms, and the health risk behaviors of substance use (i.e., alcohol and drug misuse) and sexual risk (i.e., condom use and number of sexual partners) among a large sample of college student women. We also examined whether body surveillance, body shame, and depressive symptoms would mediate theorized pathways extended to substance use and sexual risk. A sample of 505 full-time college student women ages 18–26 completed an online survey that assessed their health and behaviors. We used structural equation modeling to test mediation hypotheses. Results largely supported hypotheses, extended objectification theory to sexual risk, and expanded upon past research on objectification in relation to substance use. Notably, results of this study provided a more nuanced knowledge of how objectification may lead to increases in sexual risk when assessed by number of sexual partners (but not condom use). Further research is warranted to understand potential explanatory pathways between sexism, objectification, and sexual risk. Findings can inform prevention and intervention efforts to target body surveillance, body shame, and depressive symptoms to attempt to reduce the burden of sexist experiences on women’s health.

Keywords: substance abuse and use, sexual health, college students, women, sexism

Objectification is linked with psychological consequences and mental health risks that adversely impact women’s health and well-being (Szymanski et al., 2011). College student women experience objectification at high rates (Davis, 2018) and may engage in health risk behaviors of substance use and sexual risk in response (Centers for Disease Control and Prevention [CDC], 2017; Turchik et al., 2010). Preventionists have described the prevention and treatment of the impacts of objectification in women and girls as a colossal challenge (Tylka & Augustus-Horvath, 2011). Research must elucidate the mechanisms that underlie links between objectification and women’s health to build targeted prevention and intervention efforts to reduce substance misuse and sexual risk in college women. This study put forth a model to test theorized mediators according to objectification theory.

Objectification theory (Fredrickson & Roberts, 1997; Szymanski et al., 2011) is a framework that describes the lived experiences of women under patriarchy and the impact of gender oppression. Objectification theory posits that women are sexually objectified and treated as objects for use by others (Szymanski et al., 2011). A review of studies found that women are often sexualized, objectified, and portrayed in ways that emphasize their body parts and sexual readiness (American Psychological Association, 2007). Moreover, women are frequently recipients of sexist comments or behaviors by men, including derogatory sexual remarks and harassment. Through frequent objectification, women come to internalize an observer’s perspective as a primary view of themselves and engage in self-objectification. For example, in attempts to meet sociocultural standards of beauty and avoid negative judgments from others, women commonly engage in body surveillance, defined as a constant self-surveillance in which individuals view themselves from an external perspective (McKinley & Hyde, 1996). Women also may consider what others might think of certain parts of their body or focus on the extent to which their physical appearance aligns with societal beauty standards.

Through the internalization of objectification, self-objectification increases women’s body shame and decreases their internal awareness of bodily states (Fredrickson & Roberts, 1997). Instead of a focus on internal body cues (e.g., sensations and needs), women self-objectify, self-surveil, and focus on their body from the hypothetical viewpoint of others. Women who engage in body surveillance often perceive that their bodies do not meet internalized sociocultural ideals of beauty, which leads them to experience body shame or painful feelings of humiliation and distress toward themselves and their own bodies (Noll & Fredrickson, 1998). In college student women, body surveillance and body shame have consistently been associated with the mental health risks of depression, disordered eating, and sexual dysfunction (e.g., Noll & Fredrickson, 1998). Thus, women’s self-objectification is one consequence of sexually objectifying experiences that may lead to body shame and account for poor mental and physical health among women (McKinley, 1995; McKinley & Hyde, 1996).

Objectification Theory and Women’s Health Risk Behaviors

Substance Use

The mental health concerns that women experience from body surveillance and body shame may further contribute to their engagement in health risk behaviors. Researchers have found comorbidity among depression, disordered eating, and substance use among college student women (Piran & Robinson, 2006). Accordingly, researchers have extended objectification theory from its primary focus on mental health risks alone to include women’s engagement in the health risk behavior of substance use. Szymanski and colleagues assert that sexually objectifying environments and experiences may lead women to misuse substances (Carr & Szymanski, 2011; Szymanski et al., 2011); that is, experiences of sexual objectification may increase women’s likelihood of substance use due to the internalization of sociocultural messages that women should engage in substance use to be sexy, attractive, thin, powerful, and worthy of attention from men (Szymanski et al., 2011). Additionally, women may engage in substance use to cope with the stress and depressive symptoms associated with experiences of gender oppression (Zucker & Landry, 2007). While body surveillance and body shame may lead to depression and engagement in health risk behaviors, depression might also partially mediate this association.

In their extension of objectification theory to substance use, Carr and Szymanski (2011) found evidence of this hypothesized serial mediation. Self-objectification and body shame, and in turn, depressive symptoms, mediated associations between objectification and substance use, operationalized as a latent variable comprised of three distinct indices: tobacco, alcohol, and illicit drug misuse. This work provided an important contribution in its extension of objectification theory. However, these indices of substance use are not unidimensional and can vary widely in prevalence among women (Substance Abuse and Mental Health Services Administration, 2020). In response, this study will further explore and illuminate the associations examined by Carr and Szymanski (2011). This study aimed to disentangle how alcohol and drug misuse may separately and differentially correlate with factors within an objectification theory framework. For example, alcohol use involves the consumption of “empty calories” (Eisenberg et al., 2018), which may lead women to avoid heavy alcohol use in order to minimize weight gain (Wannamethee et al., 2004). Conversely, adolescent girls who perceived themselves as overweight, who tried to lose weight, or who had dieted in the past were more likely to use drugs like amphetamines or cocaine as a weight control strategy (Parkes et al., 2008). Because alcohol and other drug use may differ in their association with weight gain or loss, and women may vary their use of either substance based on their appearance concerns, we expected that the separate assessment of these constructs would illuminate a different pattern of results.

Sexual Risk

Substance use is associated with risky sexual behaviors among college student women, such as the use of substances before sex, sex with multiple uncommitted partners, and inconsistent condom use (Turchik et al., 2010). Although studies have demonstrated the influence of objectification on the health risk behavior of substance use (Carr & Szymanski, 2011) as well as sexual dysfunction (e.g., lack of desire and arousal, low sexual satisfaction, and inability to achieve orgasm; Tiggemann, 2011), little research has examined objectification theory in relation to sexual risk (Muehlenkamp et al., 2005; Watson et al., 2013). Past research suggests that forms of societal oppression like objectification may perpetuate sexual health disparities (e.g., sexually transmitted infections [STIs] and unintended pregnancies) via the reproduction of social inequalities that diminish well-being (Bowleg et al., 2008). Objectification theory may provide a framework to understand women’s engagement in sexual risk behaviors. For example, women who experience objectification, self-surveil and view their body from an external perspective, and feel shame about the way their body looks may use condoms less consistently with sexual partners due to decreased confidence, security, and assertiveness in sexual interactions and relationships (Lustig, 2012). Scholars have called for more research in this area (Littleton et al., 2005), particularly with college student women who are at high risk for STIs and unintended pregnancy (CDC, 2017).

No studies have comprehensively examined sexual risk behaviors within the full objectification theory framework. Nevertheless, studies that examined individual associations demonstrated nascent support for this extension. Researchers have found that body surveillance and body shame among college student women are linked with decreased condom use self-efficacy, operationalized as decreased confidence to obtain condoms, use them properly, and to insist on their use during sex (Parent & Moradi, 2015). The same study also found associations between body surveillance and decreased perceived control over sexual activity (Parent & Moradi, 2015). Of note, this research mostly focused on sexual self-efficacy or perceived control, as opposed to sexual risk behaviors. The few studies in this area that measured sexual risk have documented that decreased condom use frequency is associated with greater self-objectification among adolescent girls (Impett et al., 2006), decreased body comfort and body modesty among college student women (Schooler et al., 2005), and increased body shame (but not body surveillance) in a sample of adult women at a family planning clinic (Littleton et al., 2005). Increased body self-consciousness, another construct akin to body shame, has also been linked with less overall sexual experience, as assessed by number of sexual partners and engagement in a range of sexual behaviors, such as kissing and oral sex (Schooler et al., 2005). Importantly, these studies did not examine sexual health behaviors within the theoretical framework of objectification theory. No researchers to date have tested the theoretical extension we assert in this research: that objectification theory variables of self-objectification (i.e., body surveillance and body shame) and the mental health risk of depression would mediate associations between gender oppression (i.e., sexism) and health risk outcomes (i.e., sexual risk).

The one available study that examined a metric of sexual risk within a mediational objectification theory framework remains an unpublished dissertation that defined sexual risk as sex with uncommitted partners (Lustig, 2012). Results did not support mediation and did not find that sex with uncommitted partners correlated with key constructs in the objectification theory framework, including body surveillance and body shame (Lustig, 2012). Additionally, this research did not account for condom use, which meaningfully assesses risk within the context of sex with uncommitted partners. It is possible for an individual to use condoms during sex with an uncommitted partner to mitigate risk. The model also did not test for serial mediation or account for depression as a potential mediator. This study builds on the nonsignificant findings of Lustig (2012) to comprehensively examine sexual risk with two metrics (i.e., condom use and number of sexual partners) and to test hypotheses within a mediational objectification theory framework.

Sexist Experiences, Self-Objectification, Mental Health Risks, and Health Risk Behaviors

Most research on objectification theory has examined sexual objectification and sexually objectifying environments as precursors to self-objectification and mental health risks among women (Moradi & Huang, 2008). Theorists also acknowledge that sexual objectification is but one form of gender oppression (Fredrickson & Roberts, 1997). Feminist theorists note that sexist discrimination encompasses many oppressive behaviors toward women that may occur daily, which over one’s lifetime may have a cumulative detrimental impact. Examples of sexist events include unfair treatment; sexist name-calling; negative perceptions due to gender; discrimination; and sexual objectification, harassment, or victimization (Klonoff & Landrine, 1995).

Researchers have extensively examined such forms of sexist discrimination in relation to psychological distress and diminished health among women (Moradi & Subich, 2002), including depressive symptoms (Swim et al., 2001), substance use (Zucker & Landry, 2007), and sexual risk (Choi et al., 2011). Sexist experiences have been found to lead to diminished mental health and increased engagement in health risk behaviors among women, similar to how sexual objectification can impact mental health and health risks among women (Szymanski et al., 2011). It is unclear if general sexist experiences contribute to internalized self-objectification (i.e., body surveillance and body shame), similar to sexually objectifying experiences (e.g., Fredrickson & Roberts, 1997). Few studies have synthesized this theoretical and empirical knowledge to examine objectification in relation to the broader construct of sexist discrimination in the same study. Further, it remains unknown as to whether indices of internalized self-objectification (i.e., body surveillance and body shame) mediate links between sexist experiences and health risks. This examination has potential to advance objectification theory and reveal how broader sexist processes can similarly contribute to the internalization of objectification.

The Present Study

The present study, which aimed to replicate and build on central tenets of objectification theory, assessed if body surveillance, body shame, and depressive symptoms mediated theorized pathways in objectification theory to problematic alcohol use, drug misuse, and sexual risk. We aimed to examine associations between sexist experiences and body surveillance, body shame, and mental and physical health risks among college student women. Of note, this study is the first to examine alcohol and drug misuse among college women separately in the objectification theory framework and to test multiple theorized mediators linked with two sexual risk outcomes according to objectification theory: condom use and number of sexual partners. Specifically, we tested whether (a) greater general experiences of sexism correlated with increased depressive symptoms, problematic alcohol use, drug misuse, inconsistent condom use, and number of sexual partners; (b) body surveillance and body shame mediated associations between experiences of sexism and depressive symptoms; (c) body surveillance, body shame, and depressive symptoms mediated the associations between experiences of sexism and increased sexual risk (i.e., inconsistent condom use and greater number of sexual partners); and (d) body surveillance, body shame, and depressive symptoms mediated associations between experiences of sexism and alcohol and drug misuse. The present study sought to extend objectification theory to sexual risk and provide a more nuanced knowledge of how the sequelae of objectification may distinctly explain alcohol and drug misuse among college women. Findings may inform efforts to prevent health risk behaviors and illuminate factors to target in interventions for women at risk for substance misuse and adverse sexual health outcomes (e.g., STIs and unintended pregnancy).

Method

Participants

Participants were 505 full-time college student women who ranged in age from 18 to 26 years (M = 20.30, SD = 1.71) and identified as White/European American (n = 310; 61.39%), Black/African American (n = 74; 14.65%), Latina/Hispanic American (n = 67; 13.27%), Asian/Asian American (n = 63; 12.48%), Middle Eastern/North African (n = 12; 2.38%), Native American/Indigenous (n = 1; 0.20%), Native Hawaiian/Pacific Islander (n = 1; 0.20%), and other (n = 14; 2.77%). Of note, responses do not sum to 100% because some participants identified as biracial or multiracial. Participants were first years (n = 98; 19.41%), sophomores (n = 93; 18.42%), juniors (n = 164; 32.48%), seniors (n = 137; 27.13%), and fifth-year seniors (n = 13; 2.57%). Participants identified as heterosexual (n = 390; 77.23%), bisexual (n = 77; 15.25%), lesbian (n = 17; 3.37%), and other (n = 21; 4.16%). Participants were predominantly from the Northeastern United States (n = 484; 95.84%), followed by the Midwest (n = 12; 2.38%), West (n = 3; 0.59%), Southeast (n = 2; 0.40%), and Southwest (n = 1; 0.20%).

Measures

Experiences of Sexism.

The 20-item Schedule of Sexist Events Scale (SSE; Klonoff & Landrine, 1995) assessed the frequency of sexist experiences in participants’ lifetimes. Participants indicated the frequency of lifetime sexist experiences endured (e.g., “How many times in your entire life have people failed to show you the respect you deserve because you are a woman?”) on a 6-point Likert-type scale (1 = Never to 6 = Almost all of the time). Higher scores indicate a greater frequency of perceived sexist experiences. Validity of the SSE has been supported via correlations between subscale scores and instances of stressful life events (Klonoff & Landrine, 1995). Reliability for the Lifetime subscale has been demonstrated with a culturally diverse sample of adult women (α = .92; Klonoff & Landrine, 1995) and college student women (α = .91; Moradi & Subich, 2002). Cronbach’s alpha for the current sample demonstrated strong internal consistency (α = .93).

Body Surveillance and Body Shame.

Two subscales of the Objectified Body Consciousness Scale (McKinley & Hyde, 1996) measured body surveillance and body shame. The surveillance and body shame subscales of the Objectified Body Consciousness Scale each contain eight items, for a total of 16 items. Participants completed a 6-point Likert-type scale (1 = Strongly disagree to 6 = Strongly agree) to indicate experiences of body surveillance (e.g., “During the day, I think about how I look many times”) and body shame (e.g., “When I can’t control my weight, I feel like something must be wrong with me”). We reverse scored appropriate items. Higher scores indicate higher body surveillance and body shame. Negative correlations between body surveillance and body shame with body esteem have supported subscale validity (McKinley & Hyde, 1996). A prior study with college women provided evidence of internal consistency (i.e., body surveillance α = .79, body shame α = .85; Sinclair & Myers, 2004). Cronbach’s alpha in this sample indicated adequate internal consistency (body surveillance α = .82, body shame α = .88).

Depressive Symptoms.

The 20-item Center for Epidemiologic Studies Depression Scale Revised (CESD-R; Eaton et al., 2004) assessed depressive symptoms. The CESD-R assesses depression via the nine symptom groups outlined in DSM-5 (American Psychiatric Association, 2013) on a 5-point Likert-type scale (0 = Not at all or less than 1 day to 4 = Nearly every day for 4 weeks). A sample items is, “Nothing made me happy” (anhedonia). Higher scores indicate more depressive symptoms. Past research supported the validity and reliability of the CESD-R with undergraduates (α = .93; Van Dam & Earleywine, 2011). Cronbach’s alpha in this sample demonstrated strong internal consistency (α = .95).

Alcohol Use.

The 10-item Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993) assessed harmful/problematic alcohol use and associated behaviors and consequences. Each question is scored from 0 to 4 and summed into a total score. Higher scores indicate greater levels of problematic alcohol use or hazardous alcohol use behaviors (e.g., “How many standard drinks containing alcohol do you have on a typical day when drinking?”). Scores above 7 suggest hazardous or harmful use; a score of 15 or more indicates the likelihood of alcohol dependence (Saunders et al., 1993). The AUDIT has been found to accurately distinguish between those with hazardous alcohol consumption and those without (Saunders et al., 1993). Prior studies supported reliability of the AUDITwith college students (i.e., α = .94; O’Hare & Sheerer, 1999). Cronbach’s alpha for the current sample suggested adequate internal consistency (α = .80).

Drug Misuse.

The 10-item Drug Abuse Screening Test (DAST-10; Skinner, 1982) assessed drug misuse and associated consequences with a dichotomous response format (0 = No or 1 = Yes). Instructions define “drug abuse” as the use of prescribed or over-the-counter medications or drugs in excess of directions or any non-medical use of drugs, not including alcohol or tobacco. Total scores range from 0–10. Higher scores indicate more drug misuse (e.g., “Have you had “blackouts” or “flashbacks” as a result of drug use?”). Scores of 6–10 suggest the need for intensive assessment and treatment (Skinner, 1982). Prior studies supported its validity (Skinner, 1982) and its reliability with undergraduates (e.g., α = .69; McCabe, 2008), though alpha values are lower than those of general samples. Reliability of this sample was acceptable (α = .70).

Sexual Risk Behaviors.

Five items from the Youth Risk Behavior Surveillance Survey (CDC, 1997) assessed sexual risk on a 5-point Likert-type scale (1 = Never to 5 = Always). One item asked participants their number of lifetime sexual partners, and four items inquired about how often they used a barrier method (e.g., condom/dental dam) during oral, vaginal, and anal sex during their lifetime (e.g., How frequently did you use a condom/dental dam while your partner performed oral sex on you?). Higher scores indicate more frequent lifetime condom use (i.e., less lifetime sexual risk), whereas a greater number of partners suggested increased lifetime sexual risk. Cronbach’s alpha reliability for condom use in this sample suggested relatively low internal consistency (α = .68), similar to low estimates in past research on sexual risk in young adults (Schwartz et al., 2011).

Procedure

We recruited participants with flyers posted on the campus of the university that provided study Institutional Review Board (IRB) approval, online social media posts (e.g., Facebook and Instagram), and emails on professional listservs to faculty who may have shared the study with students. We advertised the online study, hosted with Qualtrics survey software, as focused on health and risk behaviors in college student women. Participants confirmed they met inclusion criteria to proceed to the survey items: (a) were 18–26 years of age, (b) identified as a woman, and (c) had full-time college student status. Incentives included the chance to receive an Apple iPad or two $25 Amazon gift cards. The survey took 18–20 min to complete.

The first page of the survey included written informed consent to participate. Participants could choose to consent to begin the study. A total of 620 individuals consented to the survey. We removed 115 total individuals, 33 of whom did not meet study inclusionary criteria (i.e., did not identify as women enrolled as full-time college students between ages 18–26) and 82 of whom missed more than 20% of the survey items (Parent, 2013). We retained participants who missed up to 19% of survey items in the sample. This resulted in the final sample of 505.

Data Analytic Plan

Prior to analysis via structural equation modeling (SEM), we screened data to ensure they met requisite assumptions of univariate and multivariate normality (Martens, 2005). We examined all continuous variables for violations of assumptions of multivariate normality. No study variable exceeded suggested cutoff values of 3.0 for skewness and 8.0 for kurtosis (Kline, 2010). We computed descriptive statistics and correlations (see Table 1). Statisticians recommend correlation coefficients of r < .70 to avoid multicollinearity (Tabachnick & Fidell, 2013), a threshold no study variables exceeded. Finally, we used Mplus 8.0 to test hypothesized mediation and compared both partially and fully mediated models.

Table 1.

Correlations Among Study Variables for All Participants.

Variable M SD 1 2 3 4 5 6 7
1. Experiences of sexism 44.66 15.84 –
2. Body surveillance 4.09 0.90 .17*** –
3. Body shame 3.27 1.18 .26*** .56*** –
4. Depressive symptoms 1.10 0.87 .34*** .26*** .42*** –
5. Problematic alcohol use 5.26 5.03 .10* .13** .09 .15***– –
6. Drug misuse 2.38 1.72 .31*** .17*** .17*** .26*** .48*** –
7. Condom use 1.86 0.91 .11* .05 .06 .01 −.01 .01 –
8. Number of partners 5.66 7.55 .10* .11* .02 .08 .37* .30* .11*
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Note.

*

p <.05,

**

p < .01,

***

p < .001.

We examined data missingness to detect any potential patterned occurrences (Schlomer et al., 2010). Results of Little’s MCAR test (Little et al., 2002) revealed missingness completely at random (MCAR), χ2 (37) = 39.39, p = .36. This indicates the absence of a pattern or variable(s) underlying missing cases, which are thus equivalent to a random subset of the sample (Schlomer et al., 2010). Analyses employed the estimator of maximum likelihood with robust standard errors and fit indices (MLR), which are robust to non-normality and non-independence of observations. MLR is appropriate to handle missing data with the use of full information maximum likelihood (FIML) estimation, which consistently outperforms listwise deletion and multiple imputation and produces less biased parameter estimates (Enders & Bandalos, 2001). We evaluated model fit with several different criteria. As some suggest that the chi-square goodness-offit statistic is biased with large sample sizes (Kline, 2010), we considered additional model fit indices, such as the comparative fit index (CFI), the Tucker Lewis Index (TLI), the root mean square error of approximation (RMSEA), and the standardized root mean square residual (SRMR).

Suggested cutoff values that indicate adequate model fit include CFI ≥ .90 and RMSEA ≤ .10 (Kline, 2010). More stringent recommendations that suggest excellent model fit to the data include CFI > .95, TLI > .95, RMSEA ≤ .05, and SRMR ≤ .08 (Hu & Bentler, 1999).

A bias-corrected bootstrap procedure evaluated significance of the hypothesized indirect effects (Mallinckrodt et al., 2006). Bootstrap procedure computed 10,000 bootstrap samples with the model that provided the best fit to the data (i.e., partially or fully mediated model). The bias-corrected percentile method estimated bias-corrected path coefficients, point estimates of the magnitude of the mediation effect and 95% confidence intervals. The mediation effect is considered significant (p < .05) if the confidence interval excludes zero (Shrout & Bolger, 2002).

Results

Descriptive Statistics and Correlations Among Study Variables

College women in this study reported relatively high levels of alcohol use (AUDIT score M = 5.26, SD = 5.03). Approximately 12.08% (n = 61) of participants abstained from alcohol use, which is lower than in past research [e.g., 19.0%; American College Health Association (ACHA), 2016]. A sizable portion of participants reported alcohol use in the hazardous or harmful range (n = 97; 19.21%), and a small number (n = 28; 5.54%) reported use consistent with alcohol dependence. Similarly, drug misuse (M = 2.38, SD = 1.72) represented a normative behavior in this sample; the majority of participants reported that they misused illicit drugs on at least one prior occasion (n = 498; 98.8%). Almost two-thirds of women reported drug use in the low or minimal range (i.e., scores of 1–2; n = 319; 63.17%). The remainder reported moderate misuse (n = 145; 28.71%), substantial misuse (n = 30; 5.94%), or severe misuse (n = 4; 0.80%), which are higher rates than found in past research with college women (e.g., McCabe et al., 2006). Participants reported lower levels of condom use (M = 1.86, SD = 0.91) than in past research (Fair & Vanyur, 2011). Nearly one-quarter (n = 124; 24.55%) reported never using condoms across oral, vaginal, and anal sexual acts. Only 1.8% reported always using condoms (n = 9; 1.78%). Participants reported an average of 5.66 sexual partners (SD = 7.55), consistent with studies conducted previously with college students (e.g., Ashenhurst et al., 2017).

In accordance with hypotheses, participants who reported greater experiences of sexism tended to report significantly greater body surveillance (r = .17; p < .001), body shame (r = .26; p < .001), depressive symptoms (r = .34; p < .001), problematic alcohol use (r = .10; p = .025), drug misuse (r = .31; p < .001), and number of sexual partners (r = .10; p = .029). Against expectations, experiences of sexism were positively linked with condom use (r = .11; p = .021), such that participants who reported more sexism reported more consistent condom use (instead of less). See Table 1 for a visual presentation of descriptive statistics and correlations.

Measurement Model of Latent Constructs

We constructed a measurement model of latent variables that represented the following constructs: experiences of sexism, body surveillance, body shame, depressive symptoms, and condom use. We generated item parcels to construct the measurement model (Little et al., 2002), with the exception of condom use, which used the four items that assessed condom use across oral, anal, and vaginal sex. First, confirmatory factory analysis examined the item set that comprised each variable (i.e., experiences of sexism, body surveillance, body shame, depressive symptoms) in the a priori unidimensional model. Parcels included rank ordered items based on the magnitude of the items’ standardized factor loadings. This process allocated each item to one of three parcels in the suggested countervailing order (Little et al., 2002). We evaluated the measurement model, comprised of the five latent variables, via SEM with maximum likelihood estimation with robust standard errors. The measurement model yielded excellent fit to the data, with the anticipated exception of a significant chi-square statistic due to large sample size: χ2(94)= 231.72, p < .001; CFI = .97; TLI = .96; RMSEA = .05, 90% C.I. [.05, .06]; SRMR = .05. All items loaded significantly onto their respective constructs (.38 ≤ βs ≤ .96; all ps < .001).

Structural Model Test of Mediation Based on Objectification Theory

We constructed a structural model to test the full mediation hypothesis. This model yielded adequate fit despite a significant chi-square statistic, χ2(142)= 386.09, p < .001; CFI = .95; TLI = .94; RMSEA = .06, 90% C.I. [.05, .07]; SRMR = .08. We then constructed and evaluated a second structural model that tested partial mediation. This partial mediation model also demonstrated adequate fit to the data, χ2(134)= 349.68, p < .001; CFI = .96; TLI = .94; RMSEA = .06, 90% C.I. [.05, .06]; SRMR = .07. The more parsimonious full mediation model was nested in the partial mediation model. A comparison of the nested models with the Strictly Positive Satorra-Bentler Chi-Square Difference Test (Satorra & Bentler, 2010) indicated which model provided a better fit to the data; the partial mediation model fit significantly better, χ2(8) = 36.69, p < .001. As such, we reported results from the partial mediation model below and used the partial mediation model to test the indirect effects with the bootstrap procedure.

As illustrated in Figure 1, greater experiences of sexism were positively associated with body surveillance (β = .24, p < .001). Body surveillance was, in turn, positively associated with body shame (β = .70, p < .001). Body shame was positively associated with depressive symptoms (β = .46, p < .001). Depressive symptoms were positively associated with drug misuse (β = .17, p = .001) with experiences of sexism held constant. Experiences of sexism were positively associated with drug misuse (β = .26, p < .001) with depressive symptoms held constant. Neither sexism nor depressive symptoms were uniquely linked with alcohol use.

Figure 1.

Figure 1.

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Structural Model Test of Mediation for Substance Misuse and Sexual Risk Based on Objectification Theory Note. Sample of U.S. undergraduate women (N = 505). Scaled X2 (134) = 349.68, p < .001; CFI = .96, TLI = .94, RMSEA = .06 [.05, .06], SRMR = .07. All path coefficients are standardized.

For sexual risk, body surveillance (β = .15, p = .006) was positively associated with number of sexual partners with experiences of sexism, body shame, and depressive symptoms held constant. Conversely, body shame (β = .15, p = .048) was negatively linked with number of sexual partners with experiences of sexism, body surveillance, and depressive symptoms held constant. Experiences of sexism and depressive symptoms were not associated with number of partners with body surveillance and body shame held constant. Condom use was not uniquely associated with experiences of sexism, body surveillance, body shame, or depressive symptoms. Predictor variables explained 5.9% of body surveillance (p = .014), 48.7% of body shame (p < .001), 21.2% of depressive symptoms (p < .001), 1.9% of alcohol use (p = ns), 10.2% of drug misuse (p < .001), and 0.3% of condom use (p = ns).

Bootstrap procedure tested the significance of hypothesized indirect mediational effects. Consistent with expectations, body surveillance and shame partially mediated the positive association between experiences of sexism and depressive symptoms (β = .08, p < .001, 95% C.I. [.04, .12]). In terms of alcohol and drug misuse, body surveillance, body shame, and depressive symptoms partially mediated the positive association between experiences of sexism and drug misuse (β = .01, p = .013, 95% C.I. [.01, .03]), in accordance with expectations. Conversely, body surveillance, body shame, and depressive symptoms did not mediate the association between experiences of sexism and alcohol use. Body surveillance, but not body shame or depressive symptoms, partially mediated the positive association between experiences of sexism and number of sexual partners (β = .04, p = .020, 95% C.I. [.01, .08]). Contrary to hypotheses, body surveillance, body shame, and depressive symptoms did not mediate the link between experiences of sexism and condom use. See Figure 1 for a depiction of the model.

Discussion

The present study aimed to replicate and expand upon the theoretical model of objectification theory to examine how the broader construct of sexist experiences influenced college student women mental health risks (i.e., depressive symptoms) via increased body surveillance and body shame. Additionally, a novel contribution of this study is its examination of how sexist experiences influenced engagement in health risk behaviors (i.e., problematic alcohol use, drug misuse, condom use, and number of sexual partners) through increased body surveillance, body shame, and depressive symptoms. Beyond a replication of central tenets of objectification theory, results extend objectification theory to sexual risk (when assessed by number of sexual partners but not condom use). Findings illuminate body surveillance, shame, and depressive symptoms as factors to target in health prevention efforts to reduce substance use and sexual risk among college women and underscore the need to address the adverse consequences of sexism and objectification in the lives of women.

We predicted positive associations between sexist experiences and deleterious mental health risks and health risk behavior outcomes. Results mostly supported these hypotheses. Sexist experiences were positively linked with depressive symptoms via correlations, problematic alcohol use, drug misuse, condom use, and number of sexual partners. Results of the partial mediation model found that experiences of sexism were directly and indirectly related to increased depressive symptoms, drug misuse, and number of sexual partners. Contrary to hypotheses, experiences of sexism were unrelated to condom use and alcohol use with other variables in the model held constant, perhaps due to notably low levels of condom use and relatively high, normative levels of alcohol use participants reported in this study. Taken together, these results are broadly consistent with prior research on the negative effects of sexist experiences (e.g., Moradi & Subich, 2002; Zucker & Landry, 2007). Findings partially support limited research that suggested that sexist experiences increase sexual risk (Choi et al., 2011).

Results also found that sexist experiences were related to higher body surveillance and shame among college student women. Previous studies primarily focused on blatant incidents of sexual objectification, such as body evaluation or unwanted explicit sexual advances. However, women more commonly report general sexist experiences, such as traditional gender role stereotypes or demeaning behaviors, as opposed to more specific, “relatively blatant” incidents of sexual objectification (Swim et al., 2001, p. 32). Therefore, we used a measure that assesses broader sexist experiences. Findings empirically supported associations between sexist experiences and internalization of objectification via increased body surveillance and body shame. This indicates that sexist experiences beyond only those that are sexually objectifying, such as those measured in this study, may lead women to self-objectify. In turn, the negative health outcomes associated with self-objectification may occur as a consequence of more general sexist experiences such as those assessed in this study. Results underscore and broaden the relevance of objectification theory to women’s health given the ubiquity of sexism in women’s lives (e.g., “everyday sexism”; Swim et al., 2001, p. 31).

In accordance with expectations and with past research (McKinley & Hyde, 1996; Moradi & Huang, 2008), body surveillance and body shame were positively associated with depressive symptoms. In terms of the serial mediators of body surveillance and body shame in relation to depression, results supported this hypothesis; both body surveillance and body shame partially accounted for the association between experiences of sexism and depressive symptoms, consistent with prior research (McKinley & Hyde, 1996; Moradi & Huang, 2008; Muehlenkamp et al., 2005). Findings extend objectification theory principles, including the serial mediators of body surveillance and shame, to experiences of sexism in relation to depressive symptoms. Results build on the literature that documented how self-objectification mediated associations between sexually objectifying experiences and mental health risks (Szymanski et al., 2011).

Findings supported the hypothesis that body surveillance, body shame, and depressive symptoms would serially mediate associations between sexist experiences and drug misuse. Specifically, the link between sexist experiences and drug misuse was partially mediated by body shame and depressive symptoms. Similar hypotheses for alcohol use were not supported. Bivariate correlations demonstrated small associations between alcohol use and both sexist experiences (r = .10, p = .025) and depressive symptoms (r = .34, p < .001); however, the indirect pathways through these associations did not hold up within the overall model. Past research found that young women with appearance concerns may engage in drug misuse as a weight management strategy (e.g., Parkes et al., 2008), whereas alcohol use may exacerbate concerns about weight gain (Eisenberg et al., 2018). Perhaps drug misuse demonstrated stronger associations than alcohol use with objectification theory variables in this study due to motivations for drug use related to weight management. Because alcohol use is a behavior determined by a multitude of factors, sexism is but one potential factor that influences alcohol consumption. It is likely that other factors not assessed in this study (e.g., campus norms and culture related to alcohol use) may better account for college women’s alcohol use.

Prior research that extended objectification theory to substance use assessed similar mediation hypotheses, but operationalized substance use as a latent variable of tobacco, alcohol, and drug misuse (Carr & Szymanski, 2011). It is possible that past research that examined these indices jointly as a latent variable of substance use obfuscated unique associations revealed in this study. Through separate examination, we delineated distinct associations between alcohol and drug misuse with objectification theory variables, such that the sequelae of objectification explained drug misuse (and not problematic alcohol use) in part. Future research should continue to examine substances separately with different forms of measurement.

It is useful to compare correlations across this study and the study by Carr and Szymanski (2011) to discern differential associations by type of substance use. In this study, the magnitude of the correlation between experiences of sexism and drug misuse was stronger than the correlation between experiences of sexism and alcohol use. Similar patterns were demonstrated among correlations between body surveillance and alcohol and drug misuse, whereby body surveillance and drug misuse correlated more strongly than the association with alcohol use. Finally, body shame correlated with drug misuse in the present study but not alcohol use. In comparison, in the study by Carr and Szymanski (2011), correlations of the separate indices of substance use demonstrated that body surveillance and body shame were significantly associated with alcohol use but not nicotine use or drug use, and sexually objectifying experiences were associated with all three. Thus, findings contrast with previous research (Carr & Szymanski, 2011).

Regarding differences between this study and prior research, it is important to note that this study assessed general sexist experiences, whereas Carr and Szymanski’s (2011) study assessed a more specific form of sexism (sexual objectification [e.g., body evaluation and unwanted explicit sexual advances]) as an independent variable. It is possible that the more blatant sexism of sexual objectification demonstrates stronger associations with substance use as participants may drink to cope with more severe harassment or abuse. Other sample differences may have also contributed to differential findings. This sample included 505 undergraduate college students (61% White) who were predominantly from the Northeast (95.8%), whereas the study by Carr and Szymanski (2011) included a less racially diverse (89% White) sample of 289 participants from the Southern United States. College students’ problematic alcohol use has been found to vary by geographic region of the United States, with the highest rates found in the Northeastern United States [e.g., Lipari et al., 2017; National Institute on Alcohol Abuse and Alcoholism (NIAAA), 2002]. It is possible that relatively high levels of alcohol use reported in this study led to lack of significant findings. Nevertheless, these disparate results warrant further research to clarify the role of sexism and objectification in women’s alcohol use.

This study is the first to support the extension of mediational objectification theory tenets (via self-objectification) to sexual risk. Firstly, findings revealed that body surveillance and body shame were associated with number of sexual partners, such that increased body surveillance and decreased body shame were linked with a higher number of partners. Contrary to hypotheses, body surveillance, body shame, and depressive symptoms were not associated with condom use. These findings are somewhat consistent with past research, which has found a significant positive association between body surveillance and sexual risk when assessed by a composite variable comprised of six items, including number of partners in the past month and lifetime condom use frequency (Muehlenkamp et al., 2005), as well as a significant negative association between body self-consciousness and sexual experience when assessed by a composite of eight sexual behaviors and lifetime number of partners (Schooler et al., 2005).

Our findings build on results of Muehlenkamp et al. (2005), which examined whether self-objectification and negative body regard would directly and indirectly lead to increased risk behaviors (measured by a composite variable of sexual risk, alcohol and drug use, self-harm, and injury-related behaviors). However, their findings were nonsignificant and failed to extend objectification theory tenets to sexual risk. On the contrary, this study found that body surveillance mediated the positive association between sexist experiences and number of sexual partners, which supports the use of objectification theory to understand how women may engage in sexual risk behaviors. Through sexist experiences and subsequent self-objectification (McKinley & Hyde, 1996; Szymanski et al., 2011), women may take more sexual risks (via increased number of partners), which has implications for sexual health due to the potential for adverse sexual health outcomes (e.g., STIs and unintended pregnancy).

Notably, condom use was not associated with sexist experiences in this study. The present study’s support for differential associations between objectification theory variables and sexual risk when assessed separately by number of sexual partners and condom use, as opposed to a composite variable that is more difficult to interpret, adds nuance to the understanding of the role of objectification in sexual risk. As such, results of the present study provide clarity to prior study findings by Muehlenkamp et al. (2005), which used a composite variable of multiple indices of risk. As for the lack of association between objectification theory variables and condom use, future research on other constructs that may explain more variability in condom use among young adult college student women is warranted. Results of the present study contrast with prior research that found support for objectification-related variables in relation to condom use with other samples (e.g., self-objectification among adolescent girls [Impett et al., 2006]; body comfort and modesty among college student women [Schooler et al., 2005]; and body shame [but not body surveillance] in a sample of adult women [Littleton et al., 2005]).

The extremely low rates of condom use reported by participants may potentially explain the lack of associations between condom use and other variables. For specific sexual acts, 4.55% of participants reported always using a condom or dental dam when their partner(s) performed oral sex on them; 2.77% of participants when they performed oral sex on their partner(s); 19.21% of participants during vaginal sex; and 18.81% of participants during anal sex. Taken together, results revealed quite low levels of condom use in this study compared to prior research with college women, which found that approximately half of students used condoms during vaginal sex in the last 30 days (46%; ACHA, 2016) or during their most recent hookup (47%; Lewis et al., 2012). It is possible that condom use was unassociated with other variables as hypothesized due to floor effects (i.e., lack of variability in participants’ reported condom use).

This study spurs several pathways for future research. Future studies should longitudinally investigate college students’ condom use over time to discern the patterns and trajectories of condom use. In addition, researchers could use other temporal periods to examine associations between objectification theory variables and sexual risk (e.g., condom use for the last sexual encounter, past month, or past year) and include more comprehensive measures of sexual risk beyond number of sexual partners and condom use (e.g., sex with uncommitted partners, number of unknown partners, sex under the influence of substances, regretted sexual encounters, and sex with untrustworthy partners). It is also possible that other related variables, like condom use self-efficacy and sexual coercion, associate more proximally to objectification theory variables than a more distal outcome of condom use (Fair & Vanyur, 2011).

Implications for Health Prevention and Intervention Efforts

This study has important implications for practice with young adult college student women of diverse backgrounds. Findings suggest that this population experiences the deleterious mental health and behavioral impacts of experiences of sexism. Furthermore, this study highlights the impact of body surveillance and body shame as explanatory factors for certain mental health and behavioral outcomes (e.g., depressive symptoms, drug misuse, and number of sexual partners). As the incidence and severity of psychological distress and health risk behaviors in college students have increased in recent decades (e.g., Smith et al., 2008), such empirical assessments of factors that influence mental and physical health risks are needed.

College health professionals should consider organizational prevention efforts to reduce substance use and sexual risk. In the context of sexist experiences that may increase health risk behaviors, prevention programs that target students in extracurricular clubs and organizations, sports teams, and Greek organizations could endeavor to change social norms that promote paternalistic or misogynistic treatment of women and encourage risky behaviors (Bosson et al., 2020). Some scholars have identified social justice initiatives that increase students’ advocacy skills as powerful organizational interventions (e.g., Szymanski & Carr, 2011).

Colleges and universities should also invest in institutional prevention efforts that may reduce systemic influences of sexism, objectification, substance use, and sexual risk. Notably, scholars have called for efforts to challenge oppressive cultures and practices that may persist on college campuses (e.g., rape culture and everyday sexism; Lewis et al., 2018). Prior studies have suggested that women’s attitudes and social environment at the university work together to shape sexual well-being (Fitz & Zucker, 2014). University-wide empowerment interventions that foster interpersonal egalitarianism and activism may reduce incidences of sexism and its consequences (Stake, 2007). Bystander interventions to reduce sexist behavior and abuse may also foster safer university climates for women (McMahon & Banyard, 2012). Given the prevalence of alcohol and drug misuse, as most participants reported some level of use, comprehensive institutional prevention efforts with individual- and environmental-level strategies would be most effective (e.g., social norms re-education with personalized normative feedback and campus-wide campaigns, skills training, and enforcement of drinking age 21 on- and off-campus; NIAAA, 2019).

In individual-level interventions, clinicians can use this information to better understand and address the experiences of college student women who experience the adverse consequences of objectification. One example would include the use of screener questions that assess for the individual’s experiences with feeling objectified and the potential presence of body surveillance and/or body shame. Clinicians should assess for body surveillance and body shame, which, based on results, may exacerbate or lead to depressive symptoms, substance use, and sexual risk.

As this study found that body surveillance may contribute to an increased number of sexual partners among women, mental health professionals should discuss body positivity, sex positivity, and sexual health prevention in their work with clients. Notably, despite the common use of number of partners to assess sexual risk, and despite empirical support for increased number of partners as associated with increased opportunity for transmission of STIs due to multiple partner–partner contact (e.g., Ashenhurst et al., 2017), an increased number of partners is not inherently risky given that individuals may use protection to mitigate risk (e.g., barrier methods like condoms/dental dams). Mental health professionals should participate in efforts to promote sex positivity, consistent with liberational approaches to understand, accept, and embrace diverse perspectives in sexuality (Burnes et al., 2017).

In addition, clinicians can consider how to increase clients’ awareness of how women and men are socialized differently and how gender role norms and expectations may underlie self-objectification (Szymanski et al., 2011). Furthermore, clinicians can use these findings in prevention and psychoeducation efforts to inform college student women about the prevalence and impact of sexist experiences on self-objectification processes. Prevention messages that target a broader audience of college men and women may increase all students’ awareness of the deleterious effects of sexism to reduce sexist behaviors. Because sexist behaviors may lead to internalization of objectification (e.g., body surveillance and body shame), the reduction of sexist behaviors where possible is of urgent importance; interventions with this aim are in critical need.

Limitations and Directions for Future Research

There are several limitations of this study. This study collected data with an online survey. Though many college students are likely to have internet access, those without consistent or reliable internet access may not have been as likely to complete the questionnaire. Another limitation includes the cross-sectional design. While we assessed for associations between variables of interest and explored mediation, one cannot interpret results as causal. Findings may build a foundation to explore causal relationships in future longitudinal studies. We did not assess participants’ relationship status (e.g., single vs. engaged in a casual or committed relationship) or other contextual relationship factors. As a result, we cannot assess potential differences in condom use or number of sexual partners based on relationship status or context (e.g., relationship duration, relationship quality, frequency of sex, cohabitation vs. noncohabitation, and monogamy vs. nonmonogamy). Future research should examine such partner-specific data to more comprehensively assess for other risk and protective factors.

The restricted geographical diversity of this sample is another limitation. Participants were predominantly from the Northeastern United States, and the majority identified as White heterosexual women, which limits the generalizability of results. There are likely unique contextual factors that influence college student women’s experiences of objectification and associated/health outcomes based on their intersectional social locations of race, ethnicity, and sexual orientation, which warrant future research with a more racially and ethnically diverse sample that is more inclusive of lesbian, gay, bisexual, and queer individuals. Given the predominantly Northeastern sample and how recruitment procedures primarily targeted those at the Northeastern University from which we received IRB approval (e.g., campus flyers), it is likely that participants were mostly from this Northeastern university. Although participants reported the state and region of the country in which they attended university, researchers failed to gather information on the specific university attended and its campus culture or climate. This precluded examination of important contextual factors that may have contributed to the prevalence of health risk behaviors at a given university, as well as examination of potential differential engagement in risk behaviors between participants across universities.

Additionally, Cronbach’s reliability estimates were low for the drug misuse (α = .70) and condom use (α = .68) variables (though comparable to values in prior research with young adults and college students; McCabe, 2008; Schwartz et al., 2011). This may be due to the nature of drug misuse and condom use as heterogeneous behavioral constructs that are measured variables (as opposed to latent constructs of an underlying homogenous scale; Streiner, 2003). That said, lower alphas increase error and decrease power to detect a significant effect (Osborne & Waters, 2002). Of note, condom use was unassociated with sexist experiences, body surveillance, or body shame in this sample. Future studies on condom use within objectification theory should consider condom use across more recent sexual encounters than this lifetime measure used.

Conclusion

Results of the present study highlighted links between experiences of sexism, self-objectification, and adverse health outcomes in women (i.e., increased depressive symptoms, drug misuse, and sexual risk via greater number of sexual partners). These findings positioned body surveillance and body shame as potential explanatory factors that underlie women’s deteriorated health through the experience of sexism. Findings suggest that experiences of sexism may contribute to heightened body surveillance and shame, which in turn have the potential to affect women’s health via mental health risks and health risk behaviors. Whereas prior research and theory suggested that sexually objectifying experiences may lead to the sequelae of health consequences of self-objectification in women, this study sheds light on how more general experiences of sexism may operate similarly to sexually objectifying experiences and influence negative mental and physical health risks among college student women. Results built on objectification theory and spur pathways for future research. Findings may inform prevention efforts to address the insidious influence of sexism and self-objectification on women’s health.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The project described was supported by Award Number T32 MH019139 (Principal Investigator, Theodorus Sandfort, Ph.D.) from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of National Institute of Mental Health or the National Institutes of Health.

Author Biographies

Melissa M. Ertl, Ph.D. is trained as a counseling psychologist and is currently a Postdoctoral Fellow at Columbia University and New York State Psychiatric Institute in the HIV Center for Clinical and Behavioral Studies. Melissa’s research focuses on the prevention of health disparities and health risk behaviors among marginalized populations.

Jacob S. Sawyer, Ph.D. is an Assistant Professor of Psychology at the Pennsylvania State University, Mont Alto campus. His research interests include psychological factors related to grief and bereavement, experiences of nonreligious and atheist individuals, and college student mental health.

Jessica L. Martin, Ph.D. is a New York State licensed psychologist and an Associate Professor of Counseling Psychology at the University at Albany-SUNY. Dr. Martin’s research expertise is in college student drinking and other health-risk behaviors. She investigates individual, psychosocial, cultural, and contextual risk and protective factors for substance use and co-occurring health-risk behaviors and health disparities as they relate to substance use.

Rachel E. Brenner, Ph.D. received her doctorate in Counseling Psychology from Iowa State University in 2018. She is currently an Assistant Professor in the Department of Psychology at Colorado State University. Her research focuses on stigma, self-compassion, help-seeking, and LGBTQ+ mental health.

Footnotes

Ethics Approval

A university in the Northeastern United States granted Institutional Review Board approval for this study. All participants received full informed consent prior to their voluntary participation.

Availability of Data and Material

Data and material are available on request as permitted by Institutional Review Board approval.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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