Journal of Deaf Studies and Deaf Education, 2019, 11–24

doi:10.1093/deafed/eny028
Advance Access publication September 12, 2018
Empirical Manuscript

Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
EMPIRICAL MANUSCRIPT

Culture and Deaf Women’s Body Image

Aileen Aldalur* and Deborah Schooler
Gallaudet University
*Correspondence should be sent to Aileen Aldalur, Department of Psychology, Gallaudet University, 5356 Stevely Ave., Lakewood, CA 90713, USA
(e-mail: aileen.aldalur@gallaudet.edu)

Abstract
The sociocultural model of eating disorders highlights the role of internalization of the thin ideal in the development of
negative body image and disordered eating. Considering the limited diversity of models in mainstream media, individuals
belonging to minoritized cultural groups may resist identifying with and internalizing mainstream beauty messages.
The extent of internalization may also depend on an individual’s acculturation status and experiences of acculturative
stress. This study applied the sociocultural model to culturally Deaf women. Data were collected from 96 deaf, female,
undergraduate students. Results support the sociocultural model; higher rates of internalization were associated with
negative body image and disordered eating behaviors. However, neither Deaf nor Hearing acculturation predicted
internalization. Despite this finding, stronger acculturation with either Deaf or Hearing culture predicted more positive body
image, and higher rates of acculturative stress predicted negative body image and disordered eating behaviors. Implications
for clinical practice are discussed.

Body image concerns are found among girls and women across
the lifespan (Dohnt & Tiggeman, 2005; Runfola et al., 2013) and
are cause for concern due to the association between body dis-
satisfaction (BD) and psychological disturbances (Mond et al.,
2013; Rosenstrom et al., 2013). Collectively, research on body
image primarily focuses on White women and girls; however,
varying rates of negative body image and disordered eating be-
haviors are reported across ethnic, racial, and other diverse cul-
tural groups (Greenwood & Dal Cin, 2012; Mussap, 2009; Nouri,
Hill, & Orrell-Valente, 2011; Schooler, 2008). Research has identi-
fied several unique variables associated with body image among
culturally diverse individuals that may serve as either protec-
tive or risk factors depending on the unique circumstances. For
instance, people of color may reject dominant sociocultural in-
fluences and internalization of the Western thin ideal, provid-
ing some buffering against negative body image (Austin &
Smith, 2008; Mussap, 2009; Rogers Wood & Petrie, 2010;
Schooler, Ward, Merriweather, & Caruthers, 2004). On the other
hand, cultural identity confusion and the stress associated with
acculturation may have negative impacts on body image and
eating behaviors among culturally minoritized women (Gordon,
Castro, Sitnikov, & Holm-Denoma, 2010; Menon & Harter, 2012).
Thus, factors including an individual’s acculturation status and
their levels of acculturative stress are important to consider
when examining body image among culturally minoritized
women (Gordon et al., 2010; Schooler, 2008). Researchers are
taking a keen interest in furthering investigations of body image
among various cultural groups to identify the impact of these
factors, individually and collectively, on body image. This may
aid in understanding, preventing, and treating body image con-
cerns and related disorders among various cultural populations.
Deaf individuals represent one such cultural group. Many
deaf individuals consider themselves as part of a separate cul-
ture with its own language, belief systems, values, standards,
and community (Andrews, Leigh, & Weiner, 2004). The Deaf
community contains schools, clubs, organizations, traditions
and customs, all of which depict a Deaf way of life separate
from the Hearing world or the English language (Edwards, 2005;
Holcomb, Holcomb, & Holcomb, 2011). Not all deaf individuals
share this experience of deafness, however, and differences
exist in the extent to which deaf individuals adopt the cultural
norms and identity inherent in Deaf culture and the extent to
which they participate in the Deaf community (Maxwell-McCaw &
Zea, 2011).

Received December 22, 2017; revisions received July 25, 2018; editorial decision July 26, 2018; accepted August 22, 2018
© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

11
 12 | Journal of Deaf Studies and Deaf Education, 2019, Vol. 24, No. 1
Few studies have examined deaf women and body image,
even though an initial investigation concluded that negative
body image and disordered eating behaviors were a serious con-
cern for deaf women (Hills, Rappold, & Rendon, 1991). The cur-
rent study seeks to examine the relationships between deaf
women’s acculturation status, levels of acculturative stress,
internalization of the Western thin ideal, body image, and disor-
dered eating behaviors to further research on how cultural dif-
ferences may interact with dominant sociocultural influences
and impact the body image of culturally minoritized women.
Deaf Acculturation
Acculturation is a process involving a sequence of psychological
and behavioral adaptations which occur as individuals negotiate
the adoption of various strategies that will allow a successful
adaptation to a multicultural environment (Berry, Phinney, Sam,
& Vedder, 2006; Schwartz & Zamboanga, 2008). Many scholars in
cultural psychology use a bidirectional model to represent the
process of acculturation as individuals navigate between the
dominant culture of a society and various minoritized cultures.
This bidirectional model includes adoption of the dominant
culture on one end and adoption of a minoritized culture on
the other end (Berry et al., 2006; Schwartz & Zamboanga, 2008).
Parallels may be drawn between the cultural experiences of
deaf individuals and those of ethnic, racial, and other culturally
minoritized groups in the United States. For example, culturally
minoritized individuals in the United States experience dual
and conflicting pressures from the dominant society to assimi-
late into American culture and fully adopt the language, values,
customs, and behaviors of the U.S. people and from their minor-
itized cultural communities to avoid fully assimilating and
retain their unique cultural background (Castillo, Zahn, & Cano,
2012; Rodriguez, Myers, Mira, Flores, & Garcia-Hernandez, 2002;
Thompson, Lightfoot, Castillo, & Hurst, 2010). These pressures
parallel those experienced by deaf individuals regarding
whether they should correct their hearing, claim English as
their primary language, and adopt the values, behaviors, and
mannerisms of mainstream Hearing culture or whether they
should use American Sign Language (ASL) and be active within
the Deaf community (Edwards, 2005; Leigh & Lewis, 2010;
Mitchiner, 2015). Considering the similarities in the processes of
cultural adaptation, Maxwell-McCaw and Zea (2011) developed
a scale that could reliably assess acculturation patterns among
deaf individuals. The researchers note that like any other min-
oritized cultural group within the larger society, all deaf indivi-
duals must, to varying extents, interact with the hearing
majority around them (Maxwell-McCaw & Zea, 2011). Through
their interactions within both the Hearing and Deaf worlds, deaf
individuals develop a unique acculturation strategy in which
they have the option of acculturating into Hearing society,
acculturating into Deaf culture, or adopting aspects of both cul-
tures. Based on the various acculturative experiences of deaf in-
dividuals in the United States, Maxwell-McCaw and Zea (2011)
identified four Deaf acculturation strategies. Similar to Berry’s
(1997) model of acculturation, deaf individuals may be classified
as Deaf Acculturated, primarily identifying with and adhering
to Deaf cultural values; Hearing Acculturated, primarily identi-
fying with and adhering to Hearing cultural values; Bicultural,
identifying with and adhering to both Deaf and Hearing cultural
values; or Marginal, feeling disconnected from both Deaf and
Hearing cultures.
Acculturation is an important factor to consider when con-
ducting research on body image as an individual’s acculturation
status plays a role in determining which set of cultural values
are most salient to a given individual. Standards of beauty and
body shape ideals differ among various cultural groups (Gordon
et al., 2010; Smart & Tsong, 2014) and cultural groups differ in
the amount of emphasis given to the body or individual accom-
plishments (Austin & Smith, 2008; Hesse-Biber, Livingstone,
Ramirez, Barko, & Johnson, 2010). The sociocultural model of BD
and eating disorders presumes that internalization of cultural
messages regarding body shape plays a causal role in the devel-
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
opment of negative body image and disordered eating behaviors
(Thompson & Stice, 2001). Individuals that prescribe to a differ-
ent set of cultural norms may differ in the extent to which they
internalize, or personally subscribe to, the Western thin ideal
(Austin & Smith, 2008). For instance, findings from research sug-
gest that Black women largely reject comparison with White
characters in the media, and their body image is generally unre-
lated to mainstream media usage which primarily portrays
White models (Greenwood & Dal Cin, 2012; Schooler et al., 2004).
Results from the two studies conducted on body image and
disordered eating among deaf women are decidedly mixed
regarding the benefits of Deaf acculturation. Dewalt (1998)
explored eating-disordered attitudes and behaviors among a
sample of eighty–nine 12–17-year-old, deaf, adolescent females
attending a Deaf residential school. All the girls included in the
sample were involved in Deaf culture to some extent. The girls
were administered the Eating Disorders Inventory (EDI) and in-
terviewed about their feelings regarding their bodies, personal
strengths and weaknesses, membership in the Deaf commu-
nity, and Deaf cultural knowledge. Results from this study indi-
cated that overall the deaf girls reported less eating disorder
attitudes than a normed sample of similarly-aged hearing girls.
Further analyses confirmed that of the deaf girls included in the
sample, those that were closely affiliated with Deaf culture re-
ported less eating-disordered attitudes than those who were
less affiliated. The author suggested that Deaf culture instills
self-esteem in deaf girls which in turn helps prevent the devel-
opment of eating-disordered attitudes and behaviors. This is in
line with findings from research among Muslim women that
demonstrated that self-esteem mediated the positive relation-
ship between acculturation to Muslim culture and positive body
image (Mussap, 2009), as well as findings from research among
Black women that indicated that those who scored higher in
ethnic identity and self-esteem had significantly lower at-risk
eating-disordered scores (Rhea & Thatcher, 2013).
Despite the significant findings for the protective benefit of
affiliation with Deaf culture, it is important to note that Dewalt
(1998) used a unidirectional measure for affiliation by assessing
knowledge of Deaf culture and participation in the Deaf com-
munity. The study did not account for the degree to which the
deaf adolescents were affiliated with Hearing culture. Building
on this study, Moradi and Rottenstein (2007) examined the rela-
tionships between internalization of the thin ideal, body sur-
veillance, body shame, and eating disorder symptoms among a
sample of deaf women aged 17–73. This study measured an
important aspect of acculturation, Deaf identity, using the
revised Deaf Identity Development Scale (DIDS; Fischer &
McWhirter, 2001), which measures both identification with Deaf
culture and identification with Hearing culture. Results from
this study supported the generalizability of objectification the-
ory (Fredrickson & Roberts, 1997) to deaf women as positive re-
lations between internalization of the thin ideal, body
surveillance, body shame, and eating disorder symptoms were
found. In terms of Deaf identity, Deaf, Hearing, and Bicultural
identities were not uniquely associated with the body image or

eating disorder variables, but feeling disconnected from both
Deaf and Hearing cultures was indirectly or directly associated
with greater internalization, body shame, body surveillance,
and eating disorder symptoms. This is in line with research on
the various Deaf acculturation statuses that has found that feel-
ing disconnected from both Deaf and Hearing cultures is associ-
ated with greater negative mental health outcomes than
maintaining a Deaf, Hearing, or Bicultural acculturation status
(Andrews et al., 2004). Deaf individuals that do not strongly
identify with either culture or actively participate in either com-
munity are likely to experience more pressures from people
within both communities to acquire the “appropriate” language,
values, behavioral roles, and customs. Moradi and Rottenstein
(2007) suggest that rather than the specific acculturation strat-
egy chosen by deaf women, it may be the extent to which they
experience conflict due to their acculturation status, combined
with the internalization of the thin ideal, that may be the corre-
late of body image and disordered eating behaviors. Previous
research with ethnic, racial, and other minoritized cultural
groups obtained similar results such that among Black and
Latina women, greater feelings of acculturative stress, rather
than a particular acculturation status, was predictive of more
negative body image and disordered eating behaviors (Gordon
et al., 2010).
Acculturative Stress
Acculturative stress represents the effects of the struggles
involved in acculturation, including pressures from community
members to retain aspects of the minoritized culture as well as
pressures from the larger society to acquire aspects of the domi-
nant culture (Rodriguez et al., 2002; Schwartz & Zamboanga,
2008). Similar to other diverse cultural groups living in North
America, many deaf individuals experience competing pres-
sures from the Hearing society and the Deaf community regard-
ing which language, behavioral roles, values, and customs they
should adopt (Leigh & Lewis, 2010; Mitchiner, 2015).
As mentioned above, some evidence suggests that rather
than an individual’s specific acculturation status, it may be the
amount of stress they feel due to the pressures of acculturation
that is associated with negative body image and disordered eat-
ing behaviors (Gordon et al., 2010; Moradi & Rottenstein, 2007).
Several theories provide explanations about the relationship
between acculturative stress and negative body image. First, re-
searchers suggest that the strain associated with perceived
pressures to acculturate may place an individual in a height-
ened state of sensitivity and vulnerability rendering them more
likely to accept sociocultural pressures to conform and ulti-
mately internalize the thin ideal (Menon & Harter, 2012). A
cross-sectional study conducted among a sample of 399 male
and female Hispanic University students in West Texas found
that acculturative stress predicted greater internalization of the
thin ideal (Menon & Harter, 2012). Furthermore, acculturative
stress was associated with negative body image and this rela-
tionship was mediated by internalization of the thin ideal
(Menon & Harter, 2012).
Second, acculturative stress may lead to maladaptive coping
behaviors (Gowen, Hayward, Killen, Robinson, & Taylor, 1999).
Evidence from research suggests that coping with the pressures
of acculturation and experiencing higher levels of associated
stress is linked to bulimic behaviors and a drive for thinness
(DFT) among Black and Latina women, respectively (Gordon
et al., 2010). The researchers suggest that these behaviors may
function as escape behaviors or maladaptive coping strategies
A. Aldalur and D. Schooler | 13
to alleviate the psychological distress associated with accultura-
tive stress and fit in with the dominant society by attainment of
the Western thin ideal (Gordon et al., 2010).
Lastly, examining the associations between acculturative
stress, negative body image, and disordered eating through
uses and gratification theory allows the integration of an addi-
tional factor, namely that of mass media. According to uses and
gratification theory, individuals use mass media in a goal-
directed manner such that they seek out media that will provide
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
gratification by satisfying their psychological and social needs
(Johnson, 1996; Yang, Wu, Zhu, Brian, & Southwell., 2004). The
process of acculturation often involves feelings of unfamiliarity
and uncertainty as individuals are exposed to various cultural
perspectives and negotiate their identities within differing cul-
tural contexts. Furthermore, as mentioned above, individuals
often experience acculturative stress as they are pressured to
learn specific languages or adopt specific behavioral norms to
fit-in. As Yang et al. (2004) explain, one possible avenue for
reducing these feelings of uncertainty is to turn to mass media
to acquire knowledge and familiarity of a specific culture. In
fact, research demonstrates that individuals with strong desires
to acculturate into the dominant culture or learn English, have a
greater tendency to select English-based or mainstream media,
and they perceive this media as a good source of information
about the dominant culture, and an avenue to adjust to the
dominant society and improve their English (Tudsri & Hebbani,
2015; Yang et al., 2004). Furthermore, evidence from research
suggests that people often use television in times of stress and
that using mass media may assist people in altering prevailing
mood states (Johnson, 1996; Shao, 2009). Lack of social support
is associated with acculturative stress among ethnically and
racially minoritized individuals (Hovey, 2000); thus, an individ-
ual who is experiencing acculturative stress and struggling to
fit-in with others in their environment may turn to mass media
to satisfy their internal need for relationships and a sense of
connection. The recurring nature of television series allows in-
dividuals to develop a sense of intimacy with specific charac-
ters, similar to real-life acquaintances (Te’eni-Harari & Eyal,
2015). This connection creates a perceived sense of similarity,
affinity, and identification with the characters. These characters
then become common targets for comparisons on physical at-
tributes and have a greater potential to impact viewer’s lives
(Te’eni-Harari & Eyal, 2015). Results from research suggest that
identification with characters in the media and making compar-
isons to those characters is associated with negative body
image (Bell & Dittmar, 2011; Te’eni-Harari & Eyal, 2015).
Therefore, acculturative stress may be a key factor in the links
between media exposure, internalization, and negative body
image.
Media Use and Internalization
Media in Western societies uniformly idealizes and promotes
an image of female beauty that is extremely thin, well below
the average weight of women in society (Bell & Dittmar, 2011;
Fouts & Burgaff, 2000; Tucci & Peters, 2008). As mentioned
above, the sociocultural model of BD and eating disorders high-
lights the role of internalization of the thin ideal in the develop-
ment of negative body image and disordered eating behaviors
(Thompson & Stice, 2001), and mainstream media is a major
vehicle through which the cultural message of the thin ideal is
distributed. Research examining the relationship between
media influences and negative body image among women and
girls indicates that higher rates of exposure to mass media are
 14 | Journal of Deaf Studies and Deaf Education, 2019, Vol. 24, No. 1
associated with greater BD, DFT, and disordered eating beha-
viors (Ashikali, Dittmar, & Ayers, 2014; Bell & Dittmar, 2011;
Dohnt & Tiggeman, 2006; Grabe, Ward, & Hyde, 2008; Groesz,
Levine, & Murnen, 2002). Internalization of the thin ideal is
believed to be one of the processes through which exposure to
mainstream media asserts its influence on body image and dis-
ordered eating (Fauquet, Sánchez-carracedo, Levine, & López-
Guimerà, 2010; Jones, Vigfusdottir, & Lee, 2004). In addition,
social comparison theory states that individuals are likely to
make upward comparisons to similar others that are faring bet-
ter on the given dimension of comparison (Festinger, 1954).
Models in mainstream media provide sources for upward com-
parisons in terms of appearance and body shape as they repre-
sent the cultural ideal, and appearance-based comparisons
with characters in mainstream media is a primary correlate of
negative body image (Myers & Crowther, 2009; Pinkasavage,
Arigo, & Schumacher, 2015).
Representations of women in media are not only unrealisti-
cally thin, but they also primarily represent the dominant
American cultural ideals. According to social comparison the-
ory, the tendency to compare oneself with another person de-
creases as the difference between the two persons increases
(Festinger, 1954). Thus, culturally minoritized women may be
less likely to compare themselves to images of women in the
media who do not represent their cultural identities and values
(Greenwood & Dal Cin, 2012; Schooler et al., 2004). Whether an
individual considers the characters in mainstream media as
accurate sources for comparisons depends on their accultura-
tion status. For instance, research suggests that Latina adoles-
cents who are more acculturated into American culture are
more likely to turn to mainstream media as a source of cultural
values, norms, and ideals, while those more acculturated with
their Latin culture are less likely to accept these sources as a
guide to their beliefs (Schooler, 2008). In addition, acculturative
stress may render individual’s more likely to accept characters
in the media as accurate sources of comparison due to constant
pressures from the dominant society and a lack of fulfilling
social relationships. Thus, it is important to consider accultura-
tion status, acculturative stress, and internalization of sociocul-
tural values such as the thin ideal, when conducting research
among culturally diverse groups. Research has yet to consider
the relationships between these factors to body image and dis-
ordered eating behaviors among deaf women.
The Current Study
The primary goal of the current study was to further research
examining the body image of culturally diverse women.
Specifically, this study examined the extent to which accultura-
tion status, acculturative stress, and internalization of the
Western thin ideal predict deaf women’s body image and eating
behaviors.
Hypothesis 1
First, we examined whether deaf women’s acculturation status
in both Deaf and Hearing cultures, as well as their levels of
acculturative stress, are associated with internalization of the
thin ideal. Under the premises of social comparison theory
(Festinger, 1954) and considering previous research findings
among Black women (Rogers et al., 2010; Schooler et al., 2004)
and Latina women (Austin & Smith, 2008; Schooler, 2008) sug-
gesting that acculturation with one’s ethnic or racial culture via
identification and adoption of important values provides a
buffer against internalization of the thin ideal, we predicted
that Deaf acculturation would negatively predict internaliza-
tion. As for Hearing acculturation, previous research among
diverse ethnic, racial, and other cultural groups has primarily
utilized unidirectional measures of acculturation (Austin &
Smith, 2008; Schooler et al., 2004); thus, the hypothesis that
stronger acculturation with the dominant culture is associated
to greater internalization of the Western thin ideal has not been
frequently tested. Under the tenants of social comparison the-
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
ory, however, it would be expected that Hearing acculturation
would predict greater internalization of the thin ideal as the
deaf women would be more likely to make upward comparisons
to the hearing women in mainstream media. Thus, we hypothe-
sized that Hearing acculturation would positively predict inter-
nalization. Also, based on Menon and Harter’s (2012) findings
among Hispanic individuals that acculturative stress positively
predicted internalization of the thin ideal, we predicted that
acculturative stress would positively predict internalization
among the sample of deaf women.
Hypothesis 2
Next, we examined the associations between internalization of
the thin ideal and body image and disordered eating. Based on
the wealth of previous research documenting the associations
between internalization of the thin ideal and negative body
image and disordered eating behaviors among a variety of po-
pulations (Cafri, Yamamiya, Brannick, & Thompson, 2005; Jones
et al., 2004; Nouri et al., 2011; Rogers et al., 2010; Vartanian,
2009), we predicted that internalization would positively predict
negative body image and disordered eating behaviors among
the deaf women.
Hypothesis 3
Lastly, we examined whether deaf women’s acculturation sta-
tus in both Deaf and Hearing cultures, as well as their levels of
acculturative stress would be associated with their body image
and eating behaviors. Based on previous findings with diverse
cultural populations (Hesse-biber et al., 2010; Mussap, 2009), as
well as findings among deaf female adolescents (Dewalt, 1998)
that acculturation with a different ethnic, racial, or cultural
group is associated with a more positive body image and less
disordered eating behaviors, we predicted that Deaf accultura-
tion would predict a more positive body image and less disor-
dered eating behaviors. As for Hearing acculturation, the one
previous study that examined the relationship did not find a
significant association between maintaining a Hearing identity
and body image or disordered eating behaviors (Moradi &
Rottenstein, 2007). As mentioned previously, research among
diverse ethnic and racial groups has primarily utilized unidirec-
tional measures of acculturation (Lau, Lum, Chronister, &
Forrest, 2006; Rogers et al., 2010; Schooler, 2008); thus, the
hypothesis that stronger acculturation to the dominant culture
is associated with a more negative body image has not been fre-
quently tested; however, one study that assessed acculturation
among Muslim women bidirectionally found that stronger
acculturation with the dominant Australian culture was associ-
ated with BD and disordered eating (Mussap, 2009). Considering
these findings, we did not have a specific hypothesis regarding
the association between Hearing acculturation and body image
or disordered eating. In terms of acculturative stress, however,
considering previous findings of the association between accul-
turative stress and negative body image (Menon & Harter, 2012)

and disordered eating behaviors (Gordon et al., 2010), we pre-
dicted that acculturative stress would predict negative body
image and disordered eating behaviors among the sample of
deaf women.
Methods
Procedure
This study was approved by the Institutional Review Board at
Gallaudet University in Washington, DC.
Data were collected through an anonymous online survey
throughout the fall semester of 2012. Students were recruited
from undergraduate psychology courses and select courses
from other departments offering extra credit for participation,
as well as via flyers posted in campus buildings. Participants
were told that the purpose of the study was to examine how
deaf individuals think about themselves and mass media and
were given the URL to access the survey on their own time. The
data collected from the male participants was retained for
future investigations. Upon accessing the survey, participants
viewed the informed consent form and indicated their agree-
ment to participate by clicking “Yes” before continuing to the
survey. Participants then answered questions regarding their
background, Deaf acculturation status, acculturative stress,
body satisfaction, and eating behaviors.
Participants
A total of 175 survey responses were collected from male and
female students during the data collection period. The initial
data was screened to eliminate responses from hearing stu-
dents (n = 16). After the initial screening, a total of 159 partici-
pants remained. Due to the focus of the current study, however,
only the responses from female participants (n = 96) were
included in the data analyses.
Participants consisted of 96 deaf, female, undergraduate
students, aged 18–54 (M = 21.99) at Gallaudet University. 71%
were White, 10% were Hispanic/Latino, 7% were Black/African
American, and 12% were classified as multiracial. In terms of
hearing loss, ~64% reported a profound hearing loss of
90–120 dB, 14% a severe loss of 70–89 dB, 14% a moderate loss
of 40–69 dB, 1% a mild loss of 10–39 dB, and 8% reported that
they did not know their degree of hearing loss or did not
respond to the question. The body mass index (BMI) scores
⎡ (Weight in pounds) ⎤ cifically with regard to Hearing and Deaf cultures, several modi-
⎢ × 703⎥ for this sample ranged from 16.3
⎣ (Height in inches)2 ⎦ fications were made to the scale including, word and phrase
(underweight) to 44.9 (obesity; M = 24.62, SD = 4.93).
Measures
Several steps were taken to maximize the applicability of the
English survey measures for use with deaf participants. First, a
professor at Gallaudet University with expertize in Deaf culture,
identity, communication, and research, served as a consultant
and reviewed the survey. The survey was evaluated in terms of
its readability and modifications were recommended to
increase the clarity of the survey items. Recommended modifi-
cations included slight changes to diction, format, and syntax of
the survey items and directions to reduce possible misinterpre-
tations. Resultant changes are described in the individual de-
scriptions of measures. In addition, the researchers used
Microsoft Word to calculate the Flesch–Kincaid grade level score
of the survey and the result indicated that the survey
A. Aldalur and D. Schooler | 15
approximated a sixth-grade reading level. Although, the re-
ported median reading level achieved by deaf high school grad-
uates is approximately the fourth-grade level (Cawthon, 2004;
Traxler, 2000), the current sample consisted of college educated
deaf students that are more likely to fall within the top 50th per-
centile of deaf students reading above the fourth-grade level.
Deaf acculturation status
The 58-item DAS (Maxwell-McCaw & Zea, 2011) was used to
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
measure levels of acculturation to both Deaf and Hearing cul-
tures. The DAS measures the strength of acculturation to Deaf
and Hearing cultures on two separate acculturation scales; the
DASd (Deaf) and the DASh (Hearing). Items on both accultura-
tion scales (DASd and DASh) measure acculturation across five
domains including cultural identification, cultural involvement,
cultural preferences, cultural knowledge, and language compe-
tence. Responses are rated on a Likert-type scale ranging from 1
(strongly disagree) to 5 (strongly agree). Participants were given
a separate acculturation score (scored as a continuous variable)
for each culture. The acculturation scores were obtained by
totaling the average scores of each of the individual subscales
within the DASd and DASh and then dividing them by the num-
ber of subscales (5). The acculturation scores indicate partici-
pants’ level of acculturation to both Deaf and Hearing cultures
in which higher numbers indicate higher cultural involvement.
Strong internal reliability for the DAS has been established;
Maxwell-McCaw and Zea (2011) reported Cronbach alphas rang-
ing from 0.88 to 0.92 for the subscales of the DASd with an alpha
of 0.95 for the overall scale, and Cronbach alphas ranging from
0.71 to 0.85 for the subscales of the DASh with an alpha of 0.91
for the overall scale. Validity has been established for the DAS
through factor analysis and the demonstration of its ability to
discriminate between groups based on school background,
parental hearing status, and the use of self-labels. For the cur-
rent sample, Cronbach alphas for the subscales of the DASd
ranged from 0.75 to 0.93 with an alpha of 0.92 for the overall
scale and the Cronbach alphas for the subscales of the DASh
ranged from 0.63 to 0.86 with an alpha of 0.88 for the overall
scale.
Acculturative stress
Levels of acculturative stress were measured by a modified ver-
sion of the 24-item Societal, Attitudinal, Familial, and
Environmental Acculturative Stress Scale (SAFE; Fuertes, &
Westbrook, 1996). In order to measure acculturative stress spe-
substitutions, removal of two irrelevant items, and the addition
of one item regarding ASL. For example, the word “ethnicity”
was substituted with “hearing status” and references to “cul-
tural background” were substituted with references to impor-
tant values in Deaf culture (educational background) to avoid
confusion with ethnic/racial cultures, the item “It bothers me to
think that so many people use drugs” was deemed irrelevant to
Deaf culture and thus omitted from the scale, and an item
related to the use of ASL “People think I am unsociable when in
fact I have trouble communicating in ASL” was added to parallel
the item related to English “People think I am unsociable when
in fact I have trouble communicating in English.” The resultant
23 items measured participants’ acculturative stress in social,
attitudinal, familial, and environmental contexts, as well as per-
ceived discrimination towards one’s identity as a deaf individ-
ual. Using a five-point Likert-type scale ranging from 1 (not
stressful) to 5 (extremely stressful), participants rated how
 16 | Journal of Deaf Studies and Deaf Education, 2019, Vol. 24, No. 1
stressful certain situations were for them, such as “I often feel
ignored by people who are supposed to assist me.” The addi-
tional response of (not applicable) was also an available choice.
Those items that were not applicable to subjects were assigned
a score of 0. Scores were summed across the items for each par-
ticipant with higher scores indicating higher levels of stress.
In terms of reliability, the modified SAFE scale demonstrated
excellent internal reliability among the sample of deaf women
with a Cronbach alpha of 0.93, and this is comparable to the reli-
ability of the original scale among a large sample of Asian
American (α = 0.91), African American (α = 0.87), and Latina (α =
0.91) undergraduate college students (Van Diest, Tartakovsky,
Stachon, Pettit, & Perez, 2014). The validity of the modified SAFE
scale has been established via factor analysis and demonstra-
tion of the linkage between the observed factors and accultura-
tion scores on the DAS among the sample of male and female
participants from which the current data was obtained (Aldalur,
2017).
Internalization of the western thin ideal
Participants’ internalization of mainstream societal influences
was measured by the Internalization: General subscale of the
Sociocultural Attitudes Towards Appearance Scale-3 (SATAQ-3;
Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004).
The Internalization: General subscale contains nine items, such
as “I compare my body to the bodies of people who are on TV”;
and respondents indicated how strongly they agreed with each
item from 1 (definitely disagree) to 5 (definitely agree). For
emphasis, the consultant recommended capitalizing the nega-
tive words in items in which double negatives were created by
disagreeing with the item such as, “It does NOT matter if my
body looks like the body of people who are on TV.” Appropriate
items were reverse scored, and item ratings were summed
across the subscale, with higher scores indicating greater levels
of internalization.
The Internalization: general subscale has established reli-
ability, and a reported high Cronbach alpha of 0.92. In regards of
validity, construct validity has been established for the sub-
scales of the SATAQ-3 by demonstrating their ability to discrim-
inate between known groups of eating-disordered inpatients,
eating disturbed nonpatients and a control group of individuals
showing no signs of disturbed eating or body image disturbance
(Thompson et al., 2004). The Cronbach alpha for the subscale in
the present sample was 0.91.
Body image
Two subscales of the EDI (Garner, Olmstead, & Polivy, 1983), DFT
and BD, along with the Body Shape Questionnaire (BSQ; Cooper,
Taylor, Cooper, & Fairbum, 1987) were used to assess psycholog-
ical and cognitive aspects of the participants’ body image.
The DFT subscale measures preoccupation with weight,
excessive dieting, and entrenchment in the pursuit of thinness.
The subscale contains seven items such as “I feel extremely
guilty after overeating,” and responses are rated on a Likert
scale ranging from 1 (never) to 6 (always). The BD subscale mea-
sures the belief that specific parts of the body are disproportion-
ate. The subscale contains nine items such as “I think my
thighs are too large.” Responses for this subscale were rated on
a scale of 1 (never) to 5 (always) due to a technical error which
limited the response options to 1–5 rather than 1–6. For both
subscales, appropriate items were reverse coded and item rat-
ings were summed across the subscale with higher scores indic-
ating more negative body image. Both subscales have reported
uniformly high Cronbach alphas (DFT: 0.85; BD: 91; Garner et al.,
1983) establishing their internal reliability. Validity for the EDI
has been constructed through a cross-validation procedure of
anorexia patients and a female comparison group, comparison
of female self-report and clinician’s ratings, and the establish-
ment of convergent and discriminative validity (Garner et al.,
1983). The Cronbach alphas for the EDI subscales in this sample
were DFT 0.91 and BD 0.92.
The BSQ measured cognitive aspects of body image such as
concerns about body shape. The scale contains 34 items such
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
as, “Has feeling bored made you brood about your shape?”
Items are rated on a six-point Likert scale ranging from 1 (never)
to 6 (always), and respondents indicated how often each state-
ment had applied to them over the previous four weeks. Scores
were summed across the items for each participant, with higher
scores indicating a more negative body image. Previous studies
have reported high Cronbach alphas such as .98 for the BSQ
(Schooler et al., 2004), and validity for the BSQ has been demon-
strated through its correlation with the BD subscale of the EDI
and by its ability to discriminate between known groups,
including women who fulfilled the self-report diagnostic criteria
for bulimia nervosa classified as “probable cases” and a control
group of women classified as “definite noncases” (Cooper et al.,
1987). The Cronbach alpha for the BSQ in the present sample
was 0.98.
Disordered eating behaviors
The Bulimia subscale of the EDI (Garner et al., 1983) was used to
assess the participant’s disordered eating behaviors. The sub-
scale measures the tendency towards episodes of bingeing and
towards the impulse to engage in compensatory behaviors. The
subscale contains seven items such as “I eat when I’m upset,”
and responses are rated on a Likert scale ranging from 1 (never)
to 6 (always). Scores were summed across the items for each
participant, with higher scores indicating more disordered eat-
ing behaviors. The Bulimia subscale has a reported high
Cronbach alpha of 0.83, establishing its internal reliability
(Garner et al., 1983). Evidence for the validity of the Bulimia sub-
scale has been demonstrated through its ability to discriminate
between known groups, including between a group of female
controls and a group of women who met the diagnostic criteria
for bulimia, as well as between groups of patients with bulimic
type anorexia and those with restrictive type anorexia (Garner
et al., 1983). The Cronbach alpha for the Bulimia subscale in the
present sample was 0.86.
Data Analyses
Missing data were handled via pairwise deletion for each analy-
sis. First, the researchers examined the partial correlations
among the main study variables, namely Deaf and Hearing
acculturation, acculturative stress, internalization of the thin
ideal, body image, and disordered eating behaviors. The re-
searchers controlled for age, BMI, and ethnicity as previous
studies demonstrated the associations between these variables
and body image and disordered eating behaviors (e.g., Moradi &
Rottenstein, 2007; Nouri et al., 2011; Schooler et al., 2004). Next,
a hierarchical regression was run to investigate the first hypoth-
esis that Hearing acculturation and acculturative stress would
positively predict internalization of the thin ideal, and that
Deaf acculturation would negatively predict internalization.
Internalization was designated the dependent variable, age,
BMI, and ethnicity were included as covariates in the first step,
and Deaf acculturation, Hearing acculturation, and accultura-
tive stress were included as predictors in the second step.

Following this analysis, the researchers ran four hierarchical
regressions to investigate the second and third sets of hypothe-
ses, which combined, stated that internalization of the thin
ideal, Hearing acculturation, and acculturative stress would pre-
dict a more negative body image and disordered eating beha-
viors, while Deaf acculturation would predict a more positive
body image and less disordered eating behaviors. The three
body image variables and the disordered eating variable served
as the dependent variables in the separate regression analyses.
Age, BMI, and ethnicity were included as covariates in the first
step, Deaf acculturation, Hearing acculturation, and accultura-
tive stress were included as predictors in the second step, and
internalization was included as a predictor in the third step.
The decision to include internalization in the final step of the
regression analyses was made based on previous research find-
ings that have suggested that internalization may mediate the
relationship between acculturation and negative body image
and disordered eating behaviors (Austin & Smith, 2008; Menon
& Harter, 2012; Rogers et al., 2010). Including internalization in
the final step of the regression analyses allows for an examina-
tion of the possible mediating role of this variable between the
cultural variables (Deaf acculturation, Hearing acculturation,
and acculturative stress) and body image and disordered eating
behaviors. If the data indicated that (1) internalization was
associated with negative body image and disordered eating be-
haviors among the deaf women, (2) the cultural variables were
associated with both internalization and negative body image
and disordered eating behaviors, and (3) the associations
between the cultural variables and body image and disordered
eating behaviors became nonsignificant after controlling for
internalization, this would suggest that internalization may
serve as a mediator. If this was found to be the case for any of
the associations between the cultural variables, internalization,
and body image and disordered eating, the researchers planned
to conduct further analyses to test directly for the mediating
role of internalization.
Results
Descriptive Statistics
The mean scores and partial correlations between the variables
of interest are shown in Table 1. The sample’s mean scores on
the separate acculturation subscales of the DAS (DASd and
DASh) were comparable to those obtained by Maxwell-McCaw
and Zea (2011). The sample’s mean level of acculturative stress
on the modified SAFE scale is not directly comparable to the
means reported in previous studies with samples consisting of
hearing participants due to the modifications made to the scale
and the different possible ranges of scores (0–115 for the
Table 1 Summary statistics and partial intercorrelations between variables of Interest with age, BMI, and ethnicity controlled
Measure 1 2
1. DASd — 3.90
2. DASh −0.379*** — 2.92
3. Modified SAFE −0.214 0.067
4. Internalization: general 0.051 −0.111
5. DFT −0.087 −0.069
6. BD −0.128 −0.160
7. BSQ −0.224 −0.087
8. Bulimia 0.000 −0.079
Note: *p < 0.05, **p < 0.01, ***p < 0.001.
A. Aldalur and D. Schooler | 17
modified SAFE scale and 0–120 for the original 24-item SAFE
scale). However, considering the means obtained in previous
studies, the levels of acculturative stress in the current sample
are similar to those reported among samples of late immigrant
college students (Mena, Padilla, & Maldonado, 1987) or English
as a Second Language students (Hovey, 2000). The sample’s
mean score on the Internalization: general subscale is close to
the mean score reported by Thompson et al. (2004) for the con-
trol group of undergraduate University students and the mean
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
reported by the deaf participants in Moradi and Rottenstein’s
(2007) study. In terms of body image and disordered eating, the
sample’s mean scores on the DFT and the Bulimia subscales of
the EDI, as well as on the BSQ were close to the mean scores of
the female control groups included in the development and val-
idation of the respective scales (Cooper et al., 1987; Garner et al.,
1983). Scores on the BD subscale, however, cannot be compared
to scores from previous studies due to the technical error men-
tioned above that resulted in a different scoring range as com-
pared to previous studies.
Assumptions
Prior to interpreting each multiple regression analysis, correlation
matrixes, plots of standardized residuals, and various test statis-
tics were examined to determine whether the assumptions—
linearity, homoscedasticity, independent errors, multicollinearity,
and normally distributed errors—were met. Examining the plot of
standardized residuals against standardized predicted values for
each model, it was determined that the assumptions of linearity
and homoscedasticity were met as the points were randomly and
evenly dispersed throughout the plots and there were no curvilin-
ear relationships between the variables. The Durbin–Watson test
was used to examine the assumption of independent errors. The
values for the models ranged from 1.557 to 2.324, remaining close
to the desired value of 2, indicating that the assumption of inde-
pendent errors was met. The assumption of multicollinearity was
assessed by visually inspecting the correlation matrixes for highly
correlated variables, as well as interpreting the variance inflation
factor (VIF). None of the predictor variables exhibited correlations
above 0.80 and the average VIF statistic for each model was close
to the desired value of 1 indicating there was no problem with
multicollinearity among the predictor variables entered in the
models. Lastly, the assumption of normally distributed errors was
assessed by examining the distribution of the standardized resi-
duals. An examination of the histogram and P–P Plots for each
model revealed some deviations from normality, but the distribu-
tions of errors for the models predicting the Internalization:
General, DFT, and BSQ scales did not deviate substantially from
the normal distribution. The model predicting the BD and Bulimia
subscales, however, deviated from the normal distribution more
3 4 5 6 7 8 M SD
0.59
0.55
— 42.90 20.01
0.117 — 23.43 8.91
0.172 0.626*** — 21.56 8.93
0.279* 0.764*** 0.699*** — 24.71 9.39
0.251* 0.758*** 0.823*** 0.781*** — 86.69 38.60
0.249* 0.375*** 0.512*** 0.526*** 0.633*** — 14.25 6.27
 18 | Journal of Deaf Studies and Deaf Education, 2019, Vol. 24, No. 1

substantially with a platykurtic distribution for the BD scale and a Hypothesis 3

leptokurtic and positively skewed distribution for the Bulimia
scale. Attempts to achieve normality through transformation
were unsuccessful, and accordingly the researchers decided to
proceed with the planned analyses. Although regression analyses
are often robust enough to withstand small violations of assump-
tions, the results of these analyses should be interpreted with
more caution.
Partial correlations indicated significant, positive associations
between acculturative stress and scores on the BD, BSQ, and
Bulimia measures. As can be seen in Tables 4 and 5, when con-
sidered together, the cultural variables accounted for significant
variance, beyond age, BMI, and ethnicity, in the BD and BSQ
measures. Deaf acculturation emerged as a significant predictor
of scores on the BD and BSQ only after controlling for internali-
zation, and consistent with the stated hypothesis, stronger Deaf

Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
acculturation was associated with a more positive body image.
Hypothesis 1
Similarly, Hearing acculturation emerged as a significant predic-
As shown in Table 1, partial correlations controlling for age, tor of BD only after controlling for internalization, such that
BMI, and ethnicity, did not indicate any significant relationships stronger Hearing acculturation was associated with a more pos-
between the cultural variables (Deaf/Hearing acculturation and itive body image. Acculturative stress was a significant predictor
acculturative stress) and internalization. As can be seen from of scores on the BD and the Bulimia subscale, such that higher
the results of the regression analysis provided in Table 2, when levels of acculturative stress were predictive of a more negative
considered together, the cultural variables did not account for
significant variance in internalization. Neither Deaf/Hearing Table 3 Hierarchical multiple regression analysis predicting scores
acculturation nor acculturative stress were significant in pre- on the drive for thinness subscale
dicting levels of internalization among the deaf women.
Model 3
Identifying as Black/African American, however, was predictive
of lower levels of internalization among the deaf women
Variable Model 1 B Model 2 B B 95% CI
included in this sample.
Constant 13.84* 23.63 3.15 (−18.59, 24.88)
Age −0.25 −0.26 −0.06 (−0.36, 0.23)
Hypothesis 2 BMI 0.57** 0.52* 0.56** (0.22, 0.90)
Hispanic/Latina −3.82 −4.50 −3.53 (−8.77, 1.70)
Partial correlations (Table 1) indicated significant and positive Black/African −3.42 −3.99 1.43 (−4.96, 7.81)
relations between internalization and scores on the body image American
measures (DFT, BD, and BSQ) and disordered eating measure Multiracial −1.57 −2.49 0.39 (−5.00, 5.78)
(Bulimia). The results of the regression analyses predicting the DASd −1.49 −1.86 (−4.99, 1.28)
three body image measures are presented in Tables 3–5 and the DASh −1.83 −0.80 (−3.96, 2.36)
results of the regression predicting the disordered eating mea- Modified SAFE 0.07 0.03 (−0.05, 0.12)
sure are presented in Table 6. The final model in each analysis Internalization 0.62*** (0.43, 0.81)
was significant, and combined, the predictor variables ac- R2 0.11 0.15 0.48
counted for 41–68% of the body image variables and 20% of the F 1.78 1.51 6.94***
R2 Change 0.04 0.33
disordered eating variable. Consistent with the stated hypothe-
F Change 1.06 43.02***
sis, internalization accounted for significant variance, beyond
all the variables, in scores for all the body image and disordered
Note: *p < .05. **p < .01. ***p < .001.
eating behaviors measures, such that greater internalization
was predictive of a more negative body image and more disor-
dered eating behaviors. Table 4 Hierarchical multiple regression analysis predicting scores
on the body dissatisfaction subscale
Table 2 Hierarchical multiple regression analyses predicting deaf
women’s internalization Model 3

Model 2 Variable Model 1 B Model 2 B B 95% CI

Variable Model 1 B B 95% CI Constant 7.57 26.96* 1.95 (−15.20, 19.09)

Age 0.05 0.03 0.27* (0.04, 0.50)
Constant 31.30*** 33.13* (6.92, 59.33) BMI 0.68** 0.59** 0.63*** (0.36, 0.90)
Age −0.29 −0.32 (−0.68, 0.05) Hispanic/Latina −4.69 −5.75 −4.57* (−8.70, −0.44)
BMI −0.01 −0.06 (−0.49, 0.37) Black/African −0.89 −2.05 4.56 (−0.48, 9.60)
Hispanic/Latina −1.32 −1.56 (−0.8.14, 5.02) American
Black/African American −8.39* −8.75* (−16.52, −0.99) Multiracial −0.49 −2.12 1.40 (−2.85, 5.65)
Multiracial −4.932 −4.658 (−11.35, 2.03) DASd −2.57 −3.02* (−5.49, −0.55)
DASd 0.602 (−3.34, 4.54) DASh −3.86 −2.61* (−5.10, −0.11)
DASh −1.65 (−5.61, 2.31) Modified SAFE 0.12* 0.07* (0.01, 0.14)
Modified SAFE 0.058 (−0.01, 0.16) Internalization 0.76*** (0.61, 0.90)
R2 0.11 0.13 R2 0.16 0.27 0.71
F 1.77 1.36 F 2.60* 3.08** 18.32***
R2 Change 0.03 R2 Change 0.11 0.45
F Change 0.71 F Change 3.44* 103.24***

Note: *p < .05, **p < .01, ***p < .001. Note: *p < .05. **p < .01. ***p < .001.
 A. Aldalur and D. Schooler | 19

Table 5 Hierarchical multiple regression analysis predicting scores internalization of the thin ideal and negative body image and
on the body shape questionnaire scale disordered eating behaviors among various populations
(Fauquet et al., 2010; Jones et al., 2004; Rogers et al., 2010), and
Model 3
results of the current study extend the application of the model
Variable Model 1 B Model 2 B B 95% CI to deaf women. Internalization was consistently associated
with scores on the body image and disordered eating behavior
Constant 24.01 116.68* 13.85 (−60.13, 87.83) measures. This finding is in line with the results from Moradi
Age −0.44 −0.41 0.57 (−0.43, 1.57) and Rottenstein’s (2007) study that found positive relations
BMI 3.10** 2.81** 2.99*** (1.82, 4.15) between internalization of the thin ideal and body shame, body
−24.75 −29.51* −24.66** (−42.47, −6.84)

Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
Hispanic/Latina surveillance, and eating disorder symptomology among a sam-
Black/African −14.67 −19.41 7.77 (−13.98, 29.51) ple of deaf women.
American
In contrast to previous findings among other cultural popu-
Multiracial −2.20 −12.64 1.82 (−16.52, 20.15)
lations, however, acculturation with Deaf culture was not asso-
DASd −16.12 −17.99*** (−28.65, −7.32)
ciated with less internalization of the thin ideal. Previous
DASh −12.87 −7.74 (−18.50, 3.02)
research has suggested that among minoritized ethnic and
Modified SAFE 0.38 0.20 (−0.08, 0.49)
racial groups, stronger acculturation with one’s ethnic or racial
Internalization 3.10*** (2.46, 3.74)
culture may provide a buffer against internalization of the thin
R2 0.177 0.28 0.73
F 2.66* 2.88** 17.08*** ideal presented in mainstream media, as women are likely to
R2 Change 0.10 0.45 reject identification and comparisons with characters in main-
F Change 2.85* 94.25*** stream media that do not reflect their cultural norms (Austin &
Smith, 2008; Greenwood & Dal Cin, 2012; Rogers et al., 2010;
Note: *p < .05, **p < .01, ***p < .001. Schooler et al., 2004; Schooler, 2008). This does not seem to be
the case for Deaf cultural standards, however, as neither Deaf
acculturation nor Hearing acculturation was associated with
Table 6 Hierarchical multiple regression analysis predicting scores
on the Bulimia subscale internalization. Thus, regardless of their acculturation status,
deaf women may be likely to internalize the thin ideal pre-
Model 3 sented in mainstream media and make upward comparisons
with the hearing characters presented in the media.
Variable Model 1 B Model 2 B B 95% CI Although, Deaf acculturation was not associated with less
internalization of the thin ideal, consistent with previous
Constant 7.34 7.62 −0.24 (−18.07, 17.59)
Age −0.19 −0.21 −0.13 (−0.37, 0.11)
research findings (Rogers et al., 2010), identifying as Black/
BMI 0.47** 0.42** 0.43** (0.15, 0.71) African American was significantly associated with less inter-
Hispanic/Latina −1.98 −2.55 −2.18 (−6.47, 2.12) nalization among the deaf women. Deaf individuals come from
Black/African −3.05 −3.79 −1.71 (−6.95, 3.53) a variety of diverse backgrounds and this creates a unique inter-
American sectionality of cultural identities. Deaf individuals belonging to
Multiracial −0.73 −0.64 0.46 (−3.96, 4.88) minoritized ethnic or racial groups simultaneously experience
DASd 0.23 0.09 (−2.48, 2.66) multiple acculturation processes, and their status in each can
DASh −0.95 −0.56 (−3.15, 2.03) impact how they relate to mainstream media. Among deaf
Modified SAFE 0.08* 0.06 (−0.00, 0.13) women, it appears that in terms of internalizing beauty mes-
Internalization 0.24** (0.08, 0.39) sages from mainstream media, ethnic and racial identity may
R2 0.14 0.20 0.30 supersede Deaf acculturation. Previous research has not investi-
F 2.27 2.12* 3.17** gated beauty standards or body shape ideals within Deaf culture
R2 Change 0.06 0.10 and thus, it is unknown whether a cohesive standard of beauty
F Change 1.75 9.44** exists within the Deaf community. It may be the case that the
appearances, beauty standards, and body shape ideals of deaf
Note: *p< .05, **p < .01, ***p < .001.
individuals vary, reflecting the diverse standards of various eth-
nic and racial cultures rather than a single cohesive Deaf stan-
body image and more disordered eating behaviors. After con- dard of beauty. Or, it may be the case that despite the existence
trolling for internalization, however, acculturative stress re- of beauty standards within Deaf culture, the intersectionality of
mained a significant predictor for scores on the BD subscale, but identities creates unique experiences for deaf women of color.
became nonsignificant for the Bulimia subscale [B = 0.06, p = Research indicates that deaf people of color face unique chal-
0.064]. lenges within a predominately White Deaf community (Foster &
Kinuthia, 2003; Parasnis, Samar, & Fischer, 2005; Stapleton,
2015) and these experiences in combination with their cultural
Discussion
experiences in minoritized ethnic or racial groups likely impacts
This study examined the relationships between Deaf accultura- their acceptance of Deaf cultural values and standards.
tion, acculturative stress, internalization of the Western thin In line with the hypothesis that ethnic or racial identity may
ideal and body image and disordered eating behaviors among a supersede Deaf acculturation in terms of internalizing the thin
sample of deaf women. In addition, the study examined ideal, reported levels of Deaf acculturative stress were not associ-
whether Deaf acculturation and acculturative stress are associ- ated with internalization. Results from previous research suggest
ated with internalization of the Western thin ideal. The results the strain associated with perceived pressures to acculturate
of this study provide further support for the sociocultural model may place an individual in a heightened state of sensitivity and
of body image and eating disorders. A wealth of research has vulnerability rendering them more likely to accept sociocultural
documented a strong and consistent relationship between pressures to conform and ultimately internalize the thin ideal
 20 | Journal of Deaf Studies and Deaf Education, 2019, Vol. 24, No. 1
(Menon & Harter, 2012). This finding does not appear to extend to
acculturative stress arising from the Deaf acculturation process.
Again, this finding may be due to the fact that Deaf culture may
not necessarily have a unified set of beauty standards to serve as
a key cultural difference or that beauty standards from ethnic or
racial cultures may predominate in terms of beauty ideals.
Therefore, when seeking to reduce stress or alleviate pressures
from the larger society to conform to Hearing cultural standards,
rather than focusing on the physical attributes of media char-
acters to alleviate their feelings of acculturative stress, Deaf
women may focus on characteristics that are sources of key
cultural differences between Hearing and Deaf cultures such
as the characters’ language use, social, educational, and
employment experiences, interests, and hobbies.
Although the cultural variables were not significantly related
to internalization of the thin ideal, Deaf acculturation, Hearing
acculturation, and acculturative stress all demonstrated associa-
tions with either the body image or disordered eating behaviors
variables. Specifically, both Deaf and Hearing acculturation were
predictive of a more positive body image among the deaf women
such that they were associated with greater body satisfaction and
holding fewer negative thoughts about one’s body. Notably, the
associations between Deaf and Hearing acculturation and the
body image variables were only significant after controlling for
internalization. This result suggests that Deaf and Hearing accul-
turation may have a small and direct influence on the body image
of deaf women and this influence is only visible after accounting
for the large influence of internalization. Furthermore, this sug-
gests that stronger acculturation does not promote a more posi-
tive body image by reducing internalization of the thin ideal, but
instead maintaining a strong cultural identity may provide direct
protective benefits to deaf women despite internalization of the
thin ideal. The finding that both Deaf and Hearing acculturation
were associated with a more positive body image is in line with
the results reported by Moradi and Rottenstein (2007) that cultural
identification, regardless of whether it was with Deaf or Hearing
culture was beneficial, and feeling disconnected was associated to
several eating disorder constructs. Thus, this pattern of results
suggests that for deaf women, rather than a specific acculturation
status, maintaining strong acculturation to either Deaf or Hearing
culture can be beneficial in terms of body image and eating beha-
viors. This contrasts with previous results among Muslim women
which found that only acculturation to Muslim culture was associ-
ated with more positive body image, while acculturation to the
dominant Australian culture was associated with more negative
body image and disordered eating behaviors (Mussap, 2009).
Again, the unique intersectionality among deaf women may pro-
vide an explanation for this contradiction. For the Muslim women
in Mussap’s (2009) study, acculturation with the dominant
Australian culture likely implied changes in beauty standards and
values among the Muslim women to fit the dominant ideal; how-
ever, for deaf women, acculturation with Hearing culture, although
a dominant culture in terms of Deaf acculturation statuses, does
not mean that one is acculturated with the dominant ethnic or
racial group. Thus, a deaf woman who is Hearing acculturated
may also be predominately acculturated into a Latin culture rather
than American culture, and the woman’s ethnic or racial accultur-
ation may be more influential in determining to which set of
beauty ideals she adheres.
Rather than operating through body shape ideals, the influ-
ence of Deaf acculturation status may operate through self-
esteem. While a few studies have found Deaf and Bicultural
identities to be associated with higher self-esteem among deaf
individuals (Bat-Chava, 2000; Jambor & Elliott, 2005), others
have noted that aligning with the larger Hearing society or
aligning with Deaf culture does not have differential effects on
psychosocial outcomes such as self-esteem (Leigh, Maxwell-
McCaw, Bat-Chava, & Christiansen, 2009). Within the larger
Hearing society, deafness is seen as a disability and adopting
this perspective may have negative effects on a deaf person’s
self-esteem. Within Deaf culture, however, the medical per-
spective of deafness as a disability is lost and many Deaf indivi-
duals do not consider themselves as disabled. Instead, they
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
simply consider themselves as belonging to a separate culture.
Thus, acculturation with Deaf culture may facilitate a positive
view of oneself as a deaf individual and thereby increase a deaf
individual’s self-esteem. Despite the fact that deafness is con-
sidered a disability within a Hearing society, a deaf individual
may successfully navigate their disability by mastering various
strategies to overcome barriers and successfully integrate them-
selves within the Hearing world, and these individuals are likely
to be those who maintain strong acculturation to Hearing cul-
ture. Thus, it may be said that successfully navigating the pro-
cess of acculturation and finding a comfortable place within the
Deaf and Hearing worlds may benefit the self-esteem of deaf in-
dividuals. Previous research has established that high self-
esteem is associated with a more positive body image (Grogan,
2010). Therefore, a strong Deaf acculturation status may assist
deaf women in maintaining a positive view of themselves as
deaf individuals and a higher self-esteem which may in turn
protect them against the development of negative body image
and disordered eating behaviors.
In line with this explanation, higher levels of acculturative
stress were predictive of more negative body image and disor-
dered eating behaviors among the deaf women. Previous
research has noted that rather than a specific acculturation sta-
tus, it is the amount of stress that an individual feels in relation
to the acculturation process that is predictive of negative body
image and disordered eating (Gordon et al., 2010). This fits with
the current pattern of results such that those with weaker
acculturation to either Deaf or Hearing culture and higher levels
of acculturative stress were more likely to report a negative
body image and more disordered eating behaviors. The path
through which acculturative stress may influence body image
and disordered eating, whether it be through greater exposure
to mainstream media and comparison with popular media
characters for the purposes of cultural learning, greater vulnera-
bility to sociocultural pressures and higher rates of internaliza-
tion, or the development of maladaptive coping behaviors, is
unclear. The significance of the association between accultura-
tive stress and disordered eating behaviors disappeared after
controlling for internalization which suggests that internaliza-
tion may serve as a mediator of the relationship between accul-
turative stress and disordered eating. However, the results also
suggest that acculturative stress may have some direct influence
on body image as the association between BD and acculturative
stress remained significant after controlling for internalization.
Overall, this pattern of findings suggests that internalization
of the Western thin ideal, Deaf acculturation status, and levels
of acculturative stress are important factors when considering
body image and disordered eating among deaf women. The
findings from this study may inform clinical practice with deaf
women. For instance, because internalization is central to the
body image of deaf women, strategies that focus on the evalua-
tion and critique of the female body standards presented in
mainstream media and help women adopt healthier and more
realistic perspectives on beauty and self-evaluation are likely to
be as beneficial with deaf women as they are with other groups.

However, because Deaf acculturation status and acculturative
stress are also important correlates of body image and disor-
dered eating behaviors, it is critical that these factors are
included in clinical practice with deaf women. Therefore, facili-
tating open discussions of Deaf identity, culture, and feelings of
marginalization, as well as adopting healthy strategies for
reducing levels of acculturative stress may be critical in the
treatment of body image issues and disordered eating among
deaf women.
Limitations and Directions for Future Research
The current study addresses an important gap in the body of lit-
erature examining the body image and disordered eating beha-
viors of culturally diverse women; however, the findings must be
interpreted in light of several limitations. First, generalization of
the findings from this study to the American deaf population as
a whole is limited by the small sample size and the homogeneity
of the participants in terms of age, education, ethnic/racial back-
grounds, and Deaf acculturation statuses. The current sample
was drawn from a culturally Deaf university and thus, represents
a unique sub-group of deaf individuals in the United States. The
experiences of this mostly young and higher educated sample
cannot be assumed to be a representative sample of deaf indivi-
duals in the United States. Similarly, the majority of the partici-
pants identified as White. The cultural experiences of ethnically
and racially minoritized deaf individuals differ from those of
White deaf individuals (Foster & Kinuthia, 2003; Parasnis et al.,
2005; Stapleton, 2015) and this must be taken into consideration
when interpreting the results of research. Although a significant
difference was identified for the Black deaf participants in terms
of internalization, some other differences may not have been
identified due to the low numbers of ethnically and racially min-
oritized participants. Lastly, as the sample was drawn from a
Deaf cultural environment, the vast majority of the participants
were classified as Deaf acculturated or Bicultural. There was lim-
ited representativeness of deaf individuals with Hearing accul-
turation statuses or of individuals not identifying with either
Hearing or Deaf culture. Due to the limited diversity of accultura-
tion experiences, specific investigations of the influence of the
separate acculturation statuses was not possible. The Deaf and
Hearing acculturation processes occur simultaneously within in-
dividuals and thus, investigations that account for these simulta-
neous processes are important to make distinctions between
those deaf individuals with unidirectional strong acculturation
and Bicultural identities and those with unidirectional weak
acculturation or disconnection from both cultures. Replication of
the current findings with larger and more diverse samples that
include deaf individuals from both Deaf cultural and Hearing cul-
tural environments and those with diverse ethnic and racial
backgrounds is critical for evaluating the generalizability of the
results.
Second, the acculturative stress measure was adapted spe-
cifically for this study and although preliminary analyses indi-
cate that the modified SAFE demonstrated good reliability and
validity for this sample, a structured and formal measure of
acculturative stress specific to the Deaf acculturation process is
needed. It is possible that in this study, the reports of accultura-
tive stress collected from the ethnically and racially minoritized
participants overlapped with their experiences of acculturative
stress stemming from their ethnic and racial cultures.
The measures in the current study were also provided only
in English. Although all participants were undergraduate stu-
dents who likely use academic English on a regular basis, ASL
A. Aldalur and D. Schooler | 21
may still have been the preferred language for many partici-
pants. Indeed, some individuals in the population of interest
may have chosen not to take the survey because it was only
provided in English, thus creating a response bias. Providing
future surveys in both ASL and English would be more accessi-
ble and culturally affirming to a diverse population of deaf
individuals.
A possible avenue for future research could be to examine
the interaction of Deaf acculturation status and ethnic/racial
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
acculturation as they relate to the body image and disordered
eating behaviors among a culturally diverse population of
women. In addition, although no standards of female beauty or
body shape ideals are easily identifiable within Deaf culture, it
is possible that they do exist among Deaf women. Further
research could examine the beauty standards that Deaf women
use to define their body shape ideals and how they relate to
body image. Lastly, to the authors’ knowledge, no study has
examined how deaf women interact with mainstream media
and how exposure to such media influences their body image or
eating behaviors. Deaf women are beginning to appear more
frequently in various forms of media and knowing the potential
effects of such exposure is beneficial to our understanding of
body image development and the treatment and prevention of
related disorders.
Despite these limitations, the current study expands the lit-
erature on deaf women’s body image in important ways. Very
few studies of body image and disordered eating have been con-
ducted with deaf women and this is the first study to examine
how Deaf acculturation status and acculturative stress relate to
the body image and eating behaviors of deaf women. This study
opens the door for future investigations of culture, body image,
and disordered eating among various samples of deaf indivi-
duals. The importance of considering Deaf acculturation status
and acculturative stress when examining the body image of
deaf women was highlighted and this could have important im-
plications for clinical interventions with deaf individuals.
Conflict of Interest
No conflicts of interest were reported.
References
Aldalur, A. (2017). Deaf Acculturative Stress: Preliminary
Psychometric Properties of an Acculturative Stress Measure for
Deaf Individuals (Unpublished pre-dissertation). Gallaudet
University, Washington, D.C.
Andrews, J. F., Leigh, I. W., & Weiner, M. I. (2004). The deaf com-
munity: a diverse entity. Deaf people: evolving perspectives from
psychology, education, and sociology (pp. 15–35). Boston, MA:
Pearson Education.
Ashikali, E., Dittmar, H., & Ayers, S. (2014). The effect of cosmetic
surgery reality TV shows on adolescent girls’ body image.
Psychology of Popular Media Culture, 3, 141–153. doi:10.1037/
ppm0000022
Austin, J. L., & Smith, J. E. (2008). Thin ideal internalization in
Mexican girls: a test of the sociocultural model of eating dis-
orders. International Journal of Eating Disorders, 41, 448–457.
doi:10.1002/eat.20529
Bat-Chava, Y. (2000). Diversity of deaf identities. American
Annals of the Deaf, 145, 420–428. doi:10.1353/aad.2012.0176
Bell, B. T., & Dittmar, H. (2011). Does media type matter? The
role of identification in adolescent girls’ media consumption
 22 | Journal of Deaf Studies and Deaf Education, 2019, Vol. 24, No. 1
and the impact of different thin-ideal media on body image.
Sex Roles, 65, 478–490. doi:10.1007/s11199-011-9964-x
Berry, J. W. (1997). Immigration acculturation and adaptation.
Applied Psychology: An International Review, 46, 5–68. doi:10.
1093/deafed/ent001
Berry, J. W., Phinney, J. S., Sam, D. L., & Vedder, P. (2006).
Immigrant youth: acculturation, identity, and adaptation.
Applied Psychology, 55, 303–332. doi:10.1111/j.1464-0597.2006.
00256.x
Cafri, G., Yamamiya, Y., Brannick, M., & Thompson, J. K. (2005).
The influence of sociocultural factors on body image: a meta-
analysis. Clinical Psychology: Science and Practice, 12, 421. doi:10.
1093/clipsy/bpi053
Castillo, L. G., Zahn, M. P., & Cano, M. A. (2012). Predictors of
familial acculturative stress in Asian American college stu-
dents. Journal of College Counseling, 15, 52–64. doi:10.1002/j.
2161-1882.2012.00005.x
Cawthon, S. (2004). Schools for the deaf and the no child left
behind act. American Annals of the Deaf, 149, 314–323. doi:10.
1353/aad.2005.0002
Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairbum, C. G. (1987). The
development and validation of the Body Shape Questionnaire.
International Journal of eating disorders, 6, 485–494. doi:10.1002/
1098-108X(198707)6:4<485::AID-EAT2260060405>3.0.CO;2-O
Dewalt, J. L. R. (1998). I’m proud that I’m deaf: Deaf culture as a pre-
ventive factor against eating-disordered attitudes and behaviors for
adolescent females. (Doctoral Dissertation), University of
California, Berkeley, CA.
Dohnt, H. K., & Tiggeman, M. (2005). Peer influences on body dis-
satisfaction and dieting awareness in young girls. British
Journal of Developmental Psychology, 23, 103–116. doi:10.1348/
026151004X20658
Dohnt, H., & Tiggeman, M. (2006). The contribution of peer and
media influences to the development of body satisfaction
and self-esteem in young girls: a prospective study.
Developmental Psychology, 134, 929–936. doi:10.1037/0012-1649.
42.5.929
Edwards, R. A. R. (2005). Sound and fury: or, much ado about
nothing? Cochlear implants in historical perspective. The
Journal of American History, 92, 892–920. doi:10.2307/3659972
Fauquet, J., Sánchez-carracedo, D., Levine, M., & López-Guimerà,
G. (2010). Influence of mass media on body image and eating
disordered attitudes and behaviors in females: a review of ef-
fects and processes. Media Psychology, 13, 387–416. doi:10.
1080/15213269.2010.525737
Festinger, L. (1954). A theory of social comparison processes.
Human Relations, 7, 117–140. doi:10.1177/001872675400700202
Fischer, L. C., & McWhirter, J. J. (2001). The Deaf Identity
Development Scale: a revision and validation. Journal of
Counseling Psychology, 48, 355. doi:10.1037//0022-0167.48.3.355
Foster, S., & Kinuthia, W. (2003). Deaf persons of Asian
American, Hispanic American, and African American back-
grounds: A study of intraindividual diversity and identity.
Journal of Deaf Studies and Deaf Education, 8, 271–290. doi:10.
1093/deafed/eng015
Fouts, G., & Burggraf, K. (2000). Television situation comedies:
female weight, male negative comments and audience reac-
tions. Sex Roles, 42, 925–932. doi:10.1023/A:1007054618340
Fredrickson, B. L., & Roberts, T. A. (1997). Objectification theory:
toward understanding women’s lived experiences and men-
tal health risks. Psychology of Women Quarterly, 21, 173–206.
doi:10.1111/j.1471-6402.1997.tb00108.x
Fuertes, J. N., & Westbrook, F. D. (1996). Using the social, attitu-
dinal, familial and environmental (S. A. F. E.) acculturation
stress scale. Measurement and Evaluation in Counseling and
Development, 29, 67–76. Retrieved from http://journals.
sagepub.com/home/mecb (last accessed: 22/08/2018).
Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development
and validation of a multidimensional eating disorder inven-
tory for anorexia nervosa and bulimia. International Journal of
Eating Disorders, 2, 15–34. doi:10.1002/1098-108X(198321)
2:2<15::AID-EAT2260020203>3.0.CO;2-6
Gordon, K. H., Castro, Y., Sitnikov, L., & Holm-Denoma, J. M.
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
(2010). Cultural body shape ideals and eating disorder symp-
toms among White, Latina, and Black college women.
Cultural Diversity and Ethnic Minority Psychology, 16, 135–143.
doi:10.1037/a0018671
Gowen, K. L., Hayward, C., Killen, J. D., Robinson, N., & Taylor, B. C.
(1999). Acculturation and eating disorder symptoms in adoles-
cent girls. Journal of Research on Adolescence, 9, 67–83. doi:10.1207/
s15327795jra0901_4
Grabe, S., Ward, M. L., & Hyde, J. S. (2008). The role of the media
in body image concerns among women: a meta-analysis of
experimental and correlational studies. Psychological Bulletin,
134, 460–476. doi:10.1037/0033-2909.134.3.460
Greenwood, D. N., & DalCin, S. (2012). Ethnicity and body con-
sciousness: Black and white American women’s negotiation
of media ideals and other’s approval. Psychology of Popular
Media Culture, 1, 220–235. doi:10.1037/a0029411
Groesz, L. M., Levine, M. P., & Murnen, S. K. (2002). The effect of
experimental presentation of thin media images on body
satisfaction: a meta‐analytic review. International Journal of
Eating Disorders, 31, 1–16. doi:10.1002/eat.1000
Grogan, S. (2010). Promoting positive body image in males and
females: contemporary issues and future directions. Sex
Roles, 63, 757–765. doi:10.1007/s11199-010-9894-z
Hesse-Biber, S., Livingstone, S., Ramirez, D., Barko, E. B., &
Johnson, A. L. (2010). Racial identity and body image among
Black female college students attending predominately
White colleges. Sex Roles, 63, 697–711. doi:10.1007/s11199-010-
9862-7
Hills, C. G., Rappold, E. S., & Rendon, M. E. (1991). Binge eating
and body image in a sample of the deaf college population.
Journal of the American Deafness & Rehabilitation Association, 25,
20–28. Retrieved from https://repository.wcsu.edu/jadara/
(last accessed: 22/08/2018).
Holcomb, R. K., Holcomb, S. K., & Holcomb, T. K. (2011). Deaf cul-
ture: our way (4th ed). San Diego, CA: Dawnsign press.
Hovey, J. D. (2000). Psychosocial predictors of acculturative
stress in Mexican immigrants. The Journal of Psychology, 134,
490–502. doi:10.1080/00223980009598231
Jambor, E., & Elliott, M. (2005). Self-esteem and coping strategies
among deaf students. Journal of Deaf Studies and Deaf
Education, 10, 63–81. doi:10.1093/deafed/eni004
Johnson, M. A. (1996). Latinas and television in the United
States: relationships among genere identification, accultura-
tion, and acculturative stress. The Howard Journal of
Communications, 7, 289–313. doi:1064-6175/96
Jones, D. C., Vigfusdottir, T. H., & Lee, Y. (2004). Body image and
the appearance culture among adolescent girls and boys: an
examination of friend conversations, peer criticism, appear-
ance magazines, and the internalization of appearance
ideals. Journal of Adolescent Research, 19, 323–339. doi:10.1177/
0743558403258847
Lau, A. S. M., Lum, S. K., Chronister, K. M., & Forrest, L. (2006).
Asian American college women’s body image: a pilot study.
Cultural Diversity and Ethnic Minority Psychology, 12, 259–274.
doi:10.1037/1099-9809.12.2.259

Leigh, I. W., & Lewis, J. W. (2010). Deaf therapists and the deaf
community: issues to consider. In I. W. Leigh (Ed.),
Psychotherapy with deaf clients from diverse groups (pp. 39–64).
Washington, DC: Gallaudet University Press.
Leigh, I. W., Maxwell-McCaw, D., Bat-Chava, Y., & Christiansen,
J. B. (2009). Correlates of psychosocial adjustment in deaf
adolescents with and without cochlear implants: a prelimi-
nary investigation. Journal of Deaf Studies and Deaf Education,
14, 244–259. doi:10.1093/deafed/enn038
Maxwell-McCaw, D., & Zea, M. C. (2011). The deaf acculturation
scale (DAS): development and validation of a 58-item mea-
sure. Journal of Deaf Studies and Deaf Education, 16, 325–342.
doi:10.1093/deafed/enq061
Mena, F. J., Padilla, A. M., & Maldonado, M. (1987). Acculturative
stress and specific coping strategies among immigrant and
later generation college students. Hispanic Journal of Behavioral
Sciences, 9, 207–225. doi:10.1037/1099-9809.13.4.347
Menon, C. V., & Harter, S. L. (2012). Examining the impact of
acculturative stress on body image disturbance among his-
panic college students. Cultural Diversity and Ethnic Minority
Psychology, 18, 239–246. doi:10.1037/a0028638
Mitchiner, J. C. (2015). Deaf parents of cochlear-implanted chil-
dren: beliefs on bimodal bilingualism. Deaf Studies and Deaf
Education, 20, 51–66. doi:10.1093/deafed/enu028
Mond, J., Mitchison, D., Latner, J., Hay, P., Owen, C., & Rodgers, B.
(2013). Quality of life impairment associated with body dis-
satisfaction in a general population sample of women. BMC
Public Health, 13, 920–931. doi:10.1037/a0028638
Moradi, B., & Rottenstein, A. (2007). Objectification theory and
deaf cultural identity attitudes: roles in deaf women’s eating
disorder symptamology. Journal of Counseling Psychology, 54,
178–188. doi:10.1037/0022-0167.54.2.178
Mussap, A. J. (2009). Acculturation, body-image, and eating be-
haviours in Muslim-Australian women. Health & Place, 15,
532–539. doi:10.1016/j.healthplace.2008.08.008
Myers, T. A., & Crowther, J. H. (2009). Social comparison as a pre-
dictor of body dissatisfaction: A meta-analytic review. doi:
10.1037/a0016763
Nouri, M., Hill, L. G., & Orrell-Valente, J. K. (2011). Media expo-
sure, internalization of the thin ideal, and body dissatisfac-
tion: comparing Asian American and European American
college females. Body Image, 8, 366–372. doi:10.1016/j.bodyim.
2011.05.008
Parasnis, I., Samar, V. J., & Fischer, S. D. (2005). Deaf college stu-
dents’ attitudes toward racial/ethnic diversity, campus cli-
mate, and role models. American Annals of the Deaf, 150, 47–58.
doi:10.1353/aad.2005.0022
Pinkasavage, E., Arigo, D., & Schumacher, L. M. (2015). Social
comparison, negative body image, and disordered eating
behavior: the moderating role of coping style. Eating
Behaviors, 16, 72–77. doi:10.1016/j.eatbeh.2014.10.014
Rhea, D. J., & Thatcher, W. G. (2013). Ethnicity, ethnic identity,
self-esteem, and at-risk eating disordered behavior differ-
ences of urban adolescent females. Eating Disorders, 21,
223–237. doi:10.1080/10640266.2013.779177
Rodriguez, N., Myers, H. F., Mira, C. B., Flores, T., & Garcia-
Hernandez, L. (2002). Development of the multidimensional
acculturative stress inventory for adults of Mexican origin.
Psychological Assessment, 14, 451–461. doi:10.1037//1040-3590.
14.4.451
Rogers Wood, N. A., & Petrie, T. A. (2010). Body dissatisfaction,
ethnic identity, and disordered eating among African
American women. Journal of Counseling Psychology, 57, 141.
doi:10.1037/a0018922
A. Aldalur and D. Schooler | 23
Rosenstrom, T., Jokela, M., Hintsanen, M., Josefsson, K., Juonala,
M., Kivimaki, M., …Keltikangas-Jarvinen, L. (2013). Body-
image dissatisfaction is strongly associated with chronic
dysphoria. Journal of Affective Disorders, 150, 253–260. doi:10.
1016/j.jad.2013.04.003
Runfola, C. D., Von Holle, A., Trace, S. E., Brownley, K. A.,
Hofmeier, S. M., Gagne, D. A., & Bulik, C. M. (2013). Body dis-
satisfaction in women across the lifespan: results of the
UNC-SELF and gender and body image (GABI) studies.
Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021
European Eating Disorders Review, 21, 52–59. doi:10.1002/erv.
2201
Schooler, D. (2008). Real women have curves: a longitudinal
investigation of TV and the body image development of
latina adolescents. Journal of Adolescent Research, 23, 132–153.
doi:10.1177/0743558407310712
Schooler, D., Ward, M. L., Merriweather, A., & Caruthers, A.
(2004). Who’s that girl: television’s role in the body image
development of young white and black women. Psychology of
Women Quarterly, 28, 38–47. doi:10.1111/j.1471-6402.2004.
00121.x
Schwartz, S. J., & Zamboanga, B. L. (2008). Testing berry’s model
of acculturation: a confirmatory latent class approach.
Cultural Diversity and Ethnic Minority Psychology, 14, 275–285.
doi:10.1037/a0012818
Shao, G. (2009). Understanding the appeal of user-generated
media: a uses and gratification perspective. Internet Research,
19, 7–25. doi:10.1108/10662240910927795
Smart, R., & Tsong, Y. (2014). Weight, body dissatisfaction, and
disordered eating: Asian American women’s perspectives.
Asian American Journal of Psychology, 5, 344–352. doi:10.1037/
a0035599
Stapleton, L. (2015). When being deaf is centered: d/deaf women
of color’s experiences with racial/ethnic and d/deaf identities
in college. Journal of College Student Development, 56, 570–586.
doi:10.1353/csd.2015.0061
Te’eni-Harari, T., & Eyal, K. (2015). Liking them thin: adoles-
cents’ favorite television characters and body image. Journal
of Health Communication, 20, 607–615. doi:10.1080/10810730.
2015.1012241
Thompson, J. K., & Stice, E. (2001). Thin-ideal internalization:
mounting evidence for a new risk factor for body-image dis-
turbance and eating pathology. Current directions in psychologi-
cal science, 10, 181–183. doi:10.1111/1467-8721.00144
Thompson, J. K., van den Berg, P., Roehrig, M., Guarda, A. S., &
Heinberg, L. G. (2004). The sociocultural attitudes towards
appearance scale-3 (SATAQ-3): development and validation.
Wiley Periodicals, 293–304. doi:10.1002/eat.10257
Thompson, K. V., Lightfoot, N. L., Castillo, L. G., & Hurst, M. L.
(2010). Influence of family perceptions of acting white on
acculturative stress in African American college students.
International Journal for the Advancement of Counselling, 32,
144–152. doi:10.1007/s10447-010-9095-z
Traxler, C. B. (2000). The Stanford Achievement Test, 9th edi-
tion: national norming and performance standards for deaf
and hard-of-hearing students. Journal of Deaf Studies and Deaf
Education, 5, 337–348. doi:10.1093/deafed/5.4.337
Tucci, S., & Peters, J. (2008). Media influences on body satisfac-
tion in female students. Psicothema, 20, 521–524. Retrieved
from http://www.psicothema.com/pdf/3517.pdf (last ac-
cessed: 22/08/2018).
Tudsri, P., & Hebbani, A. (2015). ‘Now I’m Part of Australia
and I Need to Know What Is Happening Here’: case of
Hazara male former refugees in Brisbane strategically se-
lecting media to aid acculturation. Journal of International
 24 | Journal of Deaf Studies and Deaf Education, 2019, Vol. 24, No. 1

Migration and Integration, 16, 1273–1289. doi:10.1007/
s12134-014-0373-1
Van Diest, A. M. K., Tartakovsky, M., Stachon, C., Pettit, J. W., &
Perez, M. (2014). The relationship between acculturative
stress and eating disorder symptoms: is it unique from gen-
eral life stress? Journal of Behavioral Medicine, 37, 445–457.
doi:10.1007/s10865-013-9498-5
Vartanian, L. R. (2009). When the body defines the self: self-
concept clarity, internalization, and body image. Journal of Social
and Clinical Psychology, 28, 94–126. doi10.1521/jscp.2009.28.1.94
Yang, C., Wu, H., Zhu, M., Brian, G., & Southwell, G. (2004).
Tuning in to fit in? Acculturation and media use among
Chinese students in the United States. Asian Journal of
Communication, 14, 81–94. doi:10.1080/01292980420001951512

Downloaded from https://academic.oup.com/jdsde/article/24/1/11/5095366 by Instituto Federal da Paraíba (IFPB) user on 04 July 2021