Health Effects for Adolescent Girls
The fundamental dilemma conveyed to adolescent girls is that if they develop their own autonomy and agency—and thus refuse to participate in the quest for beauty—they may risk their social acceptance and eventually jeopardize future social roles as wives and mothers. In general, these roles depend on the affirmation of a man who finds them attractive and who will choose them as a partner. Messages about the importance of attractiveness begin early, and even elementary school girls have definite ideas about how women should look (e. g., tall, thin, blonde, matching clothes) and, thus, be. Girls learn early that the most important part of who they are is their physical appearance. Magazines such as Seventeen continue to assume that teenage girls are, or ought to be, concerned with their physical appearance, devoting 50% of their editorial to beauty and fashion (Peirce, 1990). The result of these messages is an increasingly objectified body consciousness among young women that promotes viewing one’s own body as an outside observer and that fosters the development of body shame (McKinley & Hyde, 1996).
One ethnographic study (Bell, 1989) revealed that ideals of beauty, as portrayed in the media, constitute a major theme that may block girls’ success. As young women enter college, they are reminded, for example, of the importance placed, not on their education, but on their bodies. Few college women have not heard of the “freshman 15,” the myth that students, especially women, gain fifteen pounds during their freshman year of college (Hodges, Jackson, & Sullivan, 1993). This myth reflects the polarity for women between attractiveness on the one hand and empowerment and independence on the other. The underlying threat is that women who choose to go to college should most fear sudden and mysterious weight gain, not academic failure. Such a myth not only warns women against losing sight of their most valued asset (i. e., their physical appearance), but also may persuade women to begin to monitor and worry about their weight, even though it had never been a problem.
Internalizing beauty ideals by merging one’s sense of self-worth with physical attractiveness in order to obtain social rewards creates the potential for serious health problems for adolescent girls. Intensified focus on the body may increase the risk of eating problems and compulsive weight- management behavior. Eating disorders are alarmingly prevalent among adolescent girls (Fallon, Katzman, & Wooley, 1994), and a substantial portion of these girls will require hospitalization because they are dangerously starved.
National data indicate that 34% of girls age 12-13 perceived themselves as overweight, whereas 42% of those age 14-17 and 49% of those age 18-21 believed they were overweight (Adams, Schoenbom, Moss, Warren, & Kann, 1992). These figures compare with roughly 25% of boys in each age group who thought they were overweight. In the same survey, 50% of girls were actively trying to lose weight, and half of these were relying on restricting food to do so. By focusing on restraint and deprivation, dieting symbolically replicates messages to girls that they must deny or restrict their needs and that, ultimately, they are not entitled to nourishment or nurturance.
As are all complex behaviors, eating disorders are multiply determined, and depending on the constellation of relationships, the disorder may represent either acquiescence or resistance. In some instances an eating disorder may represent the efforts of a young girl to retain her connection to her parents, even if it means rejecting physical maturation. In other instances, the phenomenon may reflect the last means available to the girl by which she can express any form of resistance to control. Psychoanalytic assessments of eating disorders suggest that girls seek to maintain emotional and psychological attachment to their parents by perpetuating their role as a dependent child (Crisp, 1983). In this model, pubescence and associated implications of sexuality are seen as threats to the parent-child connection; girls cannot be adult, autonomous, and sexual without sacrificing the emotional bond with their parents. In this scenario, it surely is not the girls’ dependency that is problematic, but rather the parents’ inability to relate to daughters who are gaining authority and selfhood. Thus, eating disorders may be understood as a form of acquiescence to parental demands and needs. In this case, the adolescent negotiates with her body for continued acceptance in the role of lovable daughter.
Other models suggest that eating disorders reflect the last bastion of control for adolescent girls when parental and social pressures demand conformity in all other areas (Boskind-Lodahl, 1976). In this model, eating disorders are a form of resistance to parental and societal demands for conformity to rigid roles. Much like prisoners who become preoccupied with bodybuilding and tattooing, adolescent girls are like societal captives who restrict their self-assertion to the corporeal boundary of their own body because it is the only thing left to them. The fact that there are few other outlets for self-assertion and identity may be what makes the eating disorder so fierce. The current prevalence of tattoos among adolescent girls may be a similar kind of phenomena that provides girls a sense of assertion and autonomy.
Smoking is another health risk behavior that often coexists with dieting and efforts to control weight. Tobacco companies have associated smoking with freedom, adulthood, and sexual allure. Ad slogans such as “slim and sassy” are used to promote smoking among adolescent girls. The result is that 19% of 14-17-year-old girls are regular smokers (Adams et al.,
1992) . Since nicotine dependence is one of the most pernicious addictions, it is likely that girls who become regular smokers in adolescence will carry throughout their lives significant increased risks for low birth weight babies, heart disease, and lung cancer.
The ubiquitous message that external beauty is the sin qua non of sexual allure sends a parallel message to girls that the proof of their sexuality lies not in their own experience so much as the experience of others (i. e., boys and men). In some respects, girls are not considered sexual until they elicit sexual desire in others. This dynamic leads one to question who possesses girls’ sexuality—girls themselves or those who are attracted to them? Contributing to this ambiguity is the fact that many girls are discouraged from masturbating. A healthy exploration of one’s body for personal pleasure is often condemned in spite of the fact that initiations to erotic stimulation with boys is expected and culturally condoned. Hyde (1996) has suggested that since girls’ erotic awareness often emerges within interpersonal contexts, a blurring of boundaries occurs with regard to the ownership of sexual arousal and sexuality in general.
This blurring of boundaries creates implications for health with regard to sexual behavior. Sexual experimentation and intercourse is common among teens, and national data indicate that 30% of 14-15-year-old girls and 58% of 16-17-year-old girls have had intercourse (Adams et ah, 1992). Less than half of adolescent girls report condom use, and nearly one third report using no contraception at all. The normative model that seems to be operative is that sex involves little or no planning and little or no talking. The popular image is that people are swept away by the lure of romance and interpersonal intimacy. Such encounters, however, do not always represent the idyllic consummation of young love, as is indicated by the fact that approximately 20% of adolescents age 14-17 reported having between 3 and 5 partners (Adams et al., 1992).
Consequences of unprotected intercourse for adolescent girls involve high rates of sexually transmitted disease, rates that are higher in the United States than in any other industrialized country. The highest rates of gonorrhea and chlamydia are among teen females, approximately 2 million cases each year (Centers for Disease Control, 1997). Unprotected intercourse results in approximately 1 million pregnancies to unmarried teen girls annually (Ventura, Martin, Curtin, & Mathews, 1998). Some of the highest teen pregnancy rates are among southern states, where the role of demure, but seductive female is perhaps more salient (U. S. Department of Health & Human Services, 1998). Although the rate of teen pregnancy has been declining in recent years, the proportion of unmarried teens remains at 80% (Wingert, 1998). Of most concern is the fact that 39% of 15-year-old mothers say the fathers of their babies are age 20 or older (Shapiro, 1995). These disturbing statistics lead us to question the social construction of adolescent sexuality. What is negotiated in these arrangements? What are the implicit assumptions of sexuality and identity? Whose version of reality is constructed that fosters these destructive outcomes?