Abstract
Gay, bisexual, and queer (GBQ) men are at higher risk of negative body image. As having a negative body image is related to negative mood, sexual, and health outcomes, identifying and providing community-friendly tools for GBQ men is important. This paper describes the creation and evaluation of Rainbow Reflections, a comic anthology developed to promote awareness of and communication about body image. Rainbow Reflections includes comics from 38 trans- and cis-GBQ artists who drew inspiration from personal narratives based on pre-determined themes in the empirical literature and interactive inserts based on evidence-based practice. To evaluate Rainbow Reflections, 167 trans- and cis-GBQ men completed pre-post measures before/after viewing a selection of comics and responded to an open-ended question about their experience. Overall, participants rated the comic book positively, with a majority (61.1%) indicating that they would recommend the book to a friend. After viewing the comics, participants reported greater comfort with initiating conversations about body image, greater satisfaction with their bodies, and reported higher estimates of how common body image concerns are for queer men. Themes that emerged from open-ended responses included participants reflecting on personal struggles (~ 30%), relating with the stories of others (~ 22%), reflecting on the standards of queer men (~ 18%), recognizing cis-privilege (~ 11%), reflecting on others’ struggles (~ 9%), negative feedback about the comics (~ 7%), and balancing masculine and feminine (~ 3%). Results of the study provide preliminary evidence for Rainbow Reflections as an effective community-friendly tool to promote awareness of and communication about body image for GBQ men.
Similar content being viewed by others
Notes
Queer is a contested term and we recognize that language and identities are complex, diverse, and hold different meanings for different people. In this paper, we use the term queer in its reclaimed form.
References
Alessi, E. J., Dillon, F. R., & Kim, H. M. S. (2015). Determinants of lesbian and gay affirmative practice among heterosexual therapists. Psychotherapy, 52(3), 298–307. https://doi.org/10.1037/a0038580
Andersen, A., Cohen, L., & Holbrook, T. (2000). Making weight: Men’s conflict with food, weight, shape, and appearance. Carlsbad, CA: Gurze Books.
Archibald, M. M., & Scott, S. D. (2019). Learning from usability testing of an arts-based knowledge translation tool for parents of a child with asthma. Nursing Open, 6(4), 1615–1625. https://doi.org/10.1002/nop2.369
Ashwal, G., & Thomas, A. (2018). Are comic books appropriate health education formats to offer adult patients? AMA Journal of Ethics, 20(2), 134–140. https://doi.org/10.1001/journalofethics.2018.20.2.ecas1-1802
Atkins, D. (1998). Looking queer: Body image and identity in lesbian, bisexual, gay, and transgender communities. New York: Harrington Park Press.
Bell, K., & McNaughton, D. (2007). Feminism and the invisible fat man. Body & Society, 13(1), 107–131. https://doi.org/10.1177/1357034X07074780
Blashill, A. J., & Vander Wal, J. S. (2009). Mediation of gender role conflict and eating pathology in gay men. Psychology of Men & Masculinity, 10(3), 204–217. https://doi.org/10.1037/a0016000
Blashill, A. J., Mayer, K. H., Crane, H. M., Baker, J. S., Willig, J. H., Willig, A. L., et al. (2014). Body mass index, depression, and condom use among HIV-infected men who have sex with men: A longitudinal moderation analysis. Archives of Sexual Behavior, 43(4), 729–734. https://doi.org/10.1007/s10508-013-0155-4
Bordo, S. (1999). The male body: A new look at men in public and in private. New York: Farrar, Straus, and Giroux.
Brady, J. P., Nogg, K. A., Rozzell, K. N., Rodriguez-Diaz, C. E., Horvath, K. J., Safren, S. A., & Blashill, A. J. (2019). Body image and condomless anal sex among young Latino sexual minority men. Behaviour Research and Therapy, 115, 129–134. https://doi.org/10.1016/j.brat.2018.10.017
Brennan, D. J., Crath, R., Hart, T. A., Gadalla, T., & Gillis, L. (2011). Body dissatisfaction and disordered eating among men who have sex with men in Canada. International Journal of Men’s Health, 10(3), 253–268. https://doi.org/10.3149/jmh.1003.253
Cafri, G., Strauss, J., & Thompson, J. K. (2002). Male body image: Satisfaction and its relationship to well-being using the somatomorphic matrix. International Journal of Men’s Health, 1(2), 215–231. https://doi.org/10.3149/jmh.0102.215
Carabez, R., Pellegrini, M., Mankovitz, A., Eliason, M., Ciano, M., & Scott, M. (2015). “Never in all my years…”: Nurses’ education about LGBT health. Journal of Professional Nursing, 31(4), 323–329. https://doi.org/10.1016/j.profnurs.2015.01.003
Cash, T. F., Fleming, E. C., Alindogan, J., Steadman, L., & Whitehead, A. (2002). Beyond body image as a trait: The development and validation of the Body Image States scale. Eating Disorders, 10(2), 103–113. https://doi.org/10.1080/10640260290081678
Cash, T. F., Maikkula, C. L., & Yamamiya, Y. (2004). “Baring the body in the bedroom”: Body image, sexual self-schemas, and sexual functioning among college women and men. Electronic Journal of Human Sexuality, 7, 1–9. http://mail.ejhs.org/volume7/bodyimage.html
Chaney, M. P. (2008). Muscle dysmorphia, self-esteem, and loneliness among gay and bisexual men. International Journal of Men’s Health, 7(2), 157–170. https://doi.org/10.3140/jmh0702.57
Citrome, L. (2018). Summer reading: Medicine, psychoanalysis and the zombie apocalypse in comic books. International Journal of Clinical Practice, 72(7), e13221. https://doi.org/10.1111/ijcp.13221
Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57(2), 144–149. https://doi.org/10.1016/j.jadohealth.2015.03.003
Dworkin, M. S., Peterson, C. E., Gao, W., Mayor, A., Hunter, R., Negron, E., et al. (2013). Efficacy of a food safety comic book on knowledge and self-reported behavior for persons living with AIDS. PLoS ONE, 8(10), e72874. https://doi.org/10.1371/journal.pone.0072874
Edmonds, S. E., & Zieff, S. G. (2015). Bearing bodies: Physical activity, obesity stigma, and sexuality in the bear community. Sociology of Sport Journal, 32(4), 415–435. https://doi.org/10.1123/ssj.2014-0166
Feldman, M. B., & Meyer, I. H. (2007). Eating disorders in diverse lesbian, gay, and bisexual populations. International Journal of Eating Disorders, 40(3), 218–226. https://doi.org/10.1002/eat.20360
Frederick, D. A., & Essayli, J. H. (2016). Male body image: The roles of sexual orientation and body mass index across five national US studies. Psychology of Men & Masculinity, 17(4), 336–351. https://doi.org/10.1037/men0000031
Gauvin, S. (2019). Rainbow reflections: Mobilizing knowledge on body image for queer men! SexLab.ca monthly blog. Retrieved from https://www.sexlab.ca/blog/2019/7/16/rainbow-reflections-mobilizing-knowledge-on-body-image-for-queer-men.
Gauvin, S. E. M., Joy, P., & Lee, M. (2019). Rainbow reflections: Body image comics for queer men. Kanata, ON: Ad Astra Comix.
Glynn, R. W., Byrne, N., O’Dea, S., Shanley, A., Codd, M., Keenan, E., et al. (2018). Chemsex, risk behaviours and sexually transmitted infections among men who have sex with men in Dublin, Ireland. International Journal of Drug Policy, 52, 9–15. https://doi.org/10.1016/j.drugpo.2017.10.008
Gonzalez de Armas, A., Archibald, M., & Scott, S. D. (2017). Developing an inventory of ongoing/unpublished arts and narrative-based approaches as knowledge translation strategies in health care. Arts & Health, 9(2), 111–122. https://doi.org/10.1080/17533015.2016.1206947
González-Baeza, A., Dolengevich-Segal, H., Pérez-Valero, I., Cabello, A., Téllez, M. J., Sanz, J., et al. (2018). Sexualized drug use (Chemsex) is associated with high-risk sexual behaviors and sexually transmitted infections in HIV-positive men who have sex with men: Data from the U-SEX GESIDA 9416 study. AIDS Patient Care and STDs, 32(3), 112–118. https://doi.org/10.1089/apc.2017.0263
Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., et al. (2006). Lost in knowledge translation: Time for a map? Journal of Continuing Education in the Health Professions, 26(1), 13–24. https://doi.org/10.1002/chp.47
Greenhalgh, T., & Wieringa, S. (2011). Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. Journal of the Royal Society of Medicine, 104(12), 501–509. https://doi.org/10.1258/jrsm.2011.110285
Haimovitz, D., Lansky, L. M., & O’reilly, P. (1993). Fluctuations in body satisfaction across situations. International Journal of Eating Disorders, 13(1), 77–84. https://doi.org/10.1002/1098-108X(199301)13:1%3c77::AID-EAT2260130110%3e3.0.CO;2-N
Harvey, J. (1997). Design of a comic book intervention for gay male youth at risk for HIV. Journal of Biocommunication, 24(2), 16–24.
Hospers, H. J., & Jansen, A. (2005). Why homosexuality is a risk factor for eating disorders in males. Journal of Social and Clinical Psychology, 24(8), 1188–1201. https://doi.org/10.1521/jscp.2005.24.8.1188
Israel, T., Gorcheva, R., Walther, W. A., Sulzner, J. M., & Cohen, J. (2008). Therapists' helpful and unhelpful situations with LGBT clients: An exploratory study. Professional Psychology: Research and Practice, 39(3), 361–368
Joy, P., Gauvin, S. E. M., Aston, M., & Numer, M. (2020). Reflections in comics: How comics can improve body image for queer men. Journal of Graphic Novels and Comics. https://doi.org/10.1080/21504857.2020.1806891
Joy, P., & Numer, M. (2018a). Constituting the ideal body: A poststructural analysis of “obesity” discourses among gay men. Journal of Critical Dietetics, 4(1), 47–58.
Joy, P., & Numer, M. (2018b). Queering educational practices in dietetics training: A critical review of LGBTQ inclusion strategies. Canadian Journal of Dietetic Practice and Research, 79, 1–6. https://doi.org/10.3148/cjdpr-2018-006
Joy, P., Numer, M., Aston, M., & Gauvin, S. E. M. (2019). Pow! Comics are a way to improve queer men’s body image. The Conversation Retrieved from https://theconversation.com/pow-comics-are-a-way-to-improve-queer-mens-body-image-119582.
Kaminski, P. L., Chapman, B. P., Haynes, S. D., & Own, L. (2005). Body image, eating behaviors, and attitudes toward exercise among gay and straight men. Eating Behaviors, 6(3), 179–187. https://doi.org/10.1016/j.eatbeh.2004.11.003
Lacefield, K., & Negy, C. (2012). Non-erotic cognitive distractions during sexual activity in sexual minority and heterosexual young adults. Archives of Sexual Behavior, 41(2), 391–400. https://doi.org/10.1007/s10508-011-9792-7
Lee, R. (2000). Health care problems of lesbian, gay, bisexual, and transgender patients. Western Journal of Medicine, 172(6), 403–408. https://doi.org/10.1136/ewjm.172.6.403
Levesque, M. J., & Vichesky, D. R. (2006). Raising the bar on the body beautiful: An analysis of the body image concerns of homosexual men. Body Image, 3(1), 45–55. https://doi.org/10.1016/j.bodyim.2005.10.007
Levitan, J., Quinn-Nilas, C., Milhausen, R., & Breuer, R. (2019). The relationship between body image and sexual functioning among gay and bisexual men. Journal of Homosexuality, 66(13), 1856–1881. https://doi.org/10.1080/00918369.2018.1519301
Lim, F. A., Brown, D. V., Jr., & Kim, S. M. J. (2014). Addressing health care disparities in the lesbian, gay, bisexual, and transgender population: A review of best practices. American Journal of Nursing, 114(6), 24–34. https://doi.org/10.1097/01.NAJ.0000450423.89759.36
Logie, C., Bridge, T. J., & Bridge, P. D. (2007). Evaluating the phobias, attitudes, and cultural competence of master of social work students toward the LGBT populations. Journal of Homosexuality, 53(4), 201–221. https://doi.org/10.1080/00918360802103472
Lyons, H. Z., Bieschke, K. J., Dendy, A. K., Worthington, R. L., & Georgemiller, R. (2010). Psychologists’ competence to treat lesbian, gay and bisexual clients: State of the field and strategies for improvement. Professional Psychology: Research and Practice, 41(5), 424–434. https://doi.org/10.1037/a0021121
Maguire, M., & Delahunt, B. (2017). Doing a thematic analysis: A practical, step-by-step guide for learning and teaching scholars. The All Ireland Journal of Teaching and Learning in Higher Education, 9(3). http://ojs.aishe.org/index.php/aishe-j/article/view/335/553
Manley, E., Levitt, H., & Mosher, C. (2007). Understanding the bear movement in gay male culture: Redefining masculinity. Journal of Homosexuality, 53(4), 89–112. https://doi.org/10.1080/00918360802103365
Marchetto, M. A. (2014). Cancer vixen: A true story. New York: Knopf.
McArdle, K. A., & Hill, M. S. (2009). Understanding body dissatisfaction in gay and heterosexual men: The roles of self-esteem, media, and peer influence. Men and Masculinities, 11(5), 511–532. https://doi.org/10.1177/1097184X07303728
McCabe, M., & Ricciardelli, L. (2001). Parent, peer and media influences on body image and strategies to both increase and decrease body size among adolescent boys and girls. Adolescence, 36(142), 225–240.
McDonagh, L. K., Morrison, T. G., & McGuire, B. E. (2009). The naked truth: Development of a scale designed to measure male body image self-consciousness during physical intimacy. Journal of Men’s Studies, 16(3), 253–265. https://doi.org/10.3149/jms.1603.253
McNair, R., Szalacha, L. A., & Hughes, T. L. (2011). Health status, health service use, and satisfaction according to sexual identity of young Australian women. Women's Health Issues, 21(1), 40–47.
McNicol, S. (2017). The potential of educational comics as a health information medium. Health Information & Libraries Journal, 34(1), 20–31. https://doi.org/10.1111/hir.12145
Meana, M., & Nunnink, S. E. (2006). Gender differences in the content of cognitive distraction during sex. Journal of Sex Research, 43(1), 59–67. https://doi.org/10.1080/00224490609552299
Mental Health Commission of Canada. (2016). Innovation to implementation: A practical guide to knowledge translation in healthcare. Retrieved from http://proxy.library.carleton.ca/loginurl=https://www.deslibris.ca/ID/10065538.
Milhausen, R. R., Buchholz, A. C., Opperman, E. A., & Benson, L. E. (2015). Relationships between body image, body composition, sexual functioning, and sexual satisfaction among heterosexual young adults. Archives of Sexual Behavior, 44(6), 1621–1633. https://doi.org/10.1007/s10508-014-0328-9
Morris, Z. S., Wooding, S., & Grant, J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Journal of the Royal Society of Medicine, 104(12), 510–520. https://doi.org/10.1258/jrsm.2011.110180
Morrison, M. A., Morrison, T. G., & Sager, C. L. (2004). Does body satisfaction differ between gay men and lesbian women and heterosexual men and women?: A meta-analytic review. Body Image, 1(2), 127–138. https://doi.org/10.1016/j.bodyim.2004.01.002
Morrison, T. G., Morrison, M. A., & Hopkins, C. (2003). Striving for bodily perfection? An exploration of the drive for muscularity in Canadian men. Psychology of Men & Masculinity, 4(2), 111. https://doi.org/10.1037/1524-9220.4.2.111
Olivardia, R., Pope, H. G., Jr., Borowiecki, J. J., III, & Cohane, G. H. (2004). Biceps and body image: The relationship between muscularity and self-esteem, depression, and eating disorder symptoms. Psychology of Men & Masculinity, 5(2), 112–120. https://doi.org/10.1037/1524-9220.5.2.112
Pakianathan, M. R., Lee, M. J., Kelly, B., & Hegazi, A. (2016). How to assess gay, bisexual and other men who have sex with men for chemsex. Sexually Transmitted Infections, 92(8), 568–570.
Parameshwaran, V., Cockbain, B. C., Hillyard, M., & Price, J. R. (2017). Is the lack of specific lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) health care education in medical school a cause for concern? Evidence from a survey of knowledge and practice among UK medical students. Journal of Homosexuality, 64(3), 367–381. https://doi.org/10.1080/00918369.2016.1190218
Penhollow, T. M., & Young, M. (2008). Predictors of sexual satisfaction: The role of body image and fitness. Electronic Journal of Human Sexuality, 11(15). https://uta-ir.tdl.org/uta-ir/handle/10106/24331
Peplau, L. A., Frederick, D. A., Yee, C., Maisel, N., Lever, J., & Ghavami, N. (2009). Body image satisfaction in heterosexual, gay, and lesbian adults. Archives of Sexual Behavior, 38(5), 713–725. https://doi.org/10.1007/s10508-008-9378-1
Pieper, C., & Homobono, A. (2000). Comic as an education method for diabetic patients and general population. Diabetes Research and Clinical Practice, 50, 31. https://doi.org/10.1016/S0168-8227(00)81563-6
Sanchez, D. T., & Kiefer, A. K. (2007). Body concerns in and out of the bedroom: Implications for sexual pleasure and problems. Archives of Sexual Behavior, 36(6), 808–820. https://doi.org/10.1007/s10508-007-9205-0
Santoro, P. (2012). Relationally bare/bear: Bodies of loss and love. Cultural Studies ↔ Critical Methodologies, 12(2), 118–131. https://doi.org/10.1177/1532708611435213
Sherry, A., Whilde, M. R., & Patton, J. (2005). Gay, lesbian, and bisexual training competencies in american psychological association accredited graduate programs. Psychotherapy: Theory, Research, Practice, Training, 42(1), 116–120.
Soulliard, Z. A., & Vander Wal, J. S. (2019). Validation of the Body Appreciation Scale-2 and relationships to eating behaviors and health among sexual minorities. Body Image, 31, 120–130. https://doi.org/10.1016/j.bodyim.2019.09.003
Stanford, J. N., & Mccabe, M. P. (2002). Body image ideal among males and females: Sociocultural influences and focus on different body parts. Journal of Health Psychology, 7(6), 675–684. https://doi.org/10.1177/1359105302007006871
Steer, C. (2019) Rainbow reflections: Body image comics for queer men. Grad Chat. Retrieved from https://podcast.cfrc.ca/2019/09/stephanie-gauvin-phd-student-in-clinical-psychology-supervised-by-dr-caroline-pukall/.
Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of Psychosomatic Research, 53(5), 985–993. https://doi.org/10.1016/s0022-3999(02)00488-9
Sudsawad, P. (2007). Knowledge translation: Introduction to models, strategies, and measures (pp. 1–44). Austin, TX: Southwest Educational Development Laboratory, National Center for the Dissemination of Disability Research.
Tarver, T., Woodson, D., Fechter, N., Vanchiere, J., Olmstadt, W., & Tudor, C. (2016). A novel tool for health literacy: Using comic books to combat childhood obesity. Journal of Hospital Librarianship, 16(2), 152–159. https://doi.org/10.1080/15323269.2016.1154768
Thompson, J. K. (2004). The (mis) measurement of body image: Ten strategies to improve assessment for applied and research purposes. Body Image, 1(1), 7–14. https://doi.org/10.1016/S1740-1445(03)00004-4
Tylka, T. L., & Wood-Barcalow, N. L. (2015). The Body Appreciation Scale-2: Item refinement and psychometric evaluation. Body Image, 12, 53–67. https://doi.org/10.1016/j.bodyim.2014.09.006
Varangis, E., Lanzieri, N., Hildebrandt, T., & Feldman, M. (2012). Gay male attraction toward muscular men: Does mating context matter? Body Image, 9(2), 270–278. https://doi.org/10.1016/j.bodyim.2012.01.003
Watson, R. J., Adjei, J., Saewyc, E., Homma, Y., & Goodenow, C. (2017). Trends and disparities in disordered eating among heterosexual and sexual minority adolescents: LGB eating disorders. International Journal of Eating Disorders, 50(1), 22–31. https://doi.org/10.1002/eat.22576
Wentzell, S (2019). New comic book celebrates the queer male body and sexuality. The Dalhousie Gazette. Retrieved from https://dalgazette.com/arts-culture/new-comic-book-celebrates-the-queer-male-body-and-sexuality/.
Williams, I. C. (2012). Graphic medicine: Comics as medical narrative. Medical Humanities, 38(1), 21–27. https://doi.org/10.1136/medhum-2011-010093
Yelland, C., & Tiggemann, M. (2003). Muscularity and the gay ideal: Body dissatisfaction and disordered eating in homosexual men. Eating Behaviors, 4(2), 107–116. https://doi.org/10.1016/S1471-0153(03)00014-X
Acknowledgements
We would like to thank Cynthia Sedlezky, Danielle Catenacci, Victoria Jackman, Kaitlin Derbyshire, Michaela Young, Yasmina Leveille, and Zwetlana Rajesh for their assistance with mobilizing Rainbow Reflections to health centers across Canada (Canadian Institutes of Health Research Garnt Nos. CIHR ICS 155506, CIHR Dalhousie ICS-155510, CIHR Dalhousie 155509).
Funding
The knowledge translation product and research described in this manuscript were supported by three independent Hacking the Knowledge Gap Trainee Awards for Innovative Thinking to Support LGBTQI2S Health and Wellness, funded by the Canadian Institutes of Health Research (Institute of Gender and Health), which were awarded to Stéphanie Gauvin, Phillip Joy, and Matthew Lee. This manuscript received recognition by the Society for Sex Therapy & Research through the Sandra J. Leiblum Student Research Award, awarded to Stéphanie Gauvin.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Three of the authors of this manuscript, Stéphanie Gauvin, Phillip Joy, and Matthew Lee, are co-editors of ‘Rainbow Reflections: Body Image Comics for Queer Men’, the comic book discussed in this manuscript. Although Rainbow Reflections is for sale by Ad Astra Comix, a for-profit publishing company, the three co-editors are donating 100% of royalties to Queer Health organizations in Canada. As such, authors of this manuscript have no financial conflicts of interest to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Gauvin, S.E.M., Joy, P., Dunn, B.L. et al. Empirical Evaluation of Rainbow Reflections: A Comic Book Anthology on Body Image for Queer Men. Arch Sex Behav 50, 69–82 (2021). https://doi.org/10.1007/s10508-020-01876-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-020-01876-8