The Association Between Body Image and Behavioral Misperception (BIBM) and Alcohol Use Among High School Girls: Results From the 2013 Youth Risk Behavioral Survey.

OBJECTIVE: The need to be thin is pervasive in adolescent culture and is associated with increased risk outcomes among adolescent girls. Body image and behavioral misperception (BIBM) exists when there is a disconnect between body weight perception and actions taken related to perceived weight status. To understand this further, we examined the relationship between BIBM and alcohol use among high school girls in the United States.

METHOD: Using 2013 Youth Risk Behavior Survey data, we ran survey-weighted multivariable logistic regression analyses to examine BIBM and (a) lifetime alcohol use, (b) current alcohol use, and (c) current heavy episodic drinking (≥5 drinks in a few hours) among female high school students (N = 6,579).

RESULTS: A total of 37.5% of high school females screened positive for BIBM, and 67.7%, 32.9%, and 17.8% reported lifetime alcohol use, current alcohol use, and heavy episodic drinking, respectively. In the final model, controlling for demographics, reporting a BIBM was associated with a 1.29 (95% CI [1.10, 1.51], p = .002) greater odds of lifetime alcohol use compared with those who did not; however, reporting BIBM was not significantly associated with current alcohol use. BIBM was also associated with a 1.22 (95% CI [1.02, 1.47], p = .03) greater odds of heavy episodic drinking compared with those without BIBM.

CONCLUSIONS: The phenomenon of BIBM was associated with lifetime and heavy episodic drinking, but not current alcohol use, indicating that timing of alcohol use and onset of BIBM may be related. Potential explanations include shared underlying risk factors and using alcohol excessively as a coping mechanism, weight-gain strategy, or weight-loss strategy.