Fiction or not? Fifty Shades is associated with health risks in adolescent and young adult females.

Background: No prior study has empirically characterized the association between health risks and reading popular fiction depicting violence against women. Fifty Shades--a blockbuster fiction series--depicts pervasive violence against women, perpetuating a broader social narrative that normalizes these types of risks and behaviors in women's lives. The present study characterized the association between health risks in women who read and did not read Fifty Shades; while our cross-sectional study design precluded causal determinations, an empirical representation of the health risks in women consuming the problematic messages in Fifty Shades is made.

Methods: Females ages 18 to 24 (n=715), who were enrolled in a large Midwestern university, completed a cross-sectional online survey about their health behaviors and Fifty Shades' readership. The analysis included 655 females (219 who read at least the first Fifty Shades novel and 436 who did not read any part of Fifty Shades). Age- and race-adjusted multivariable models characterized Fifty Shades' readers and nonreaders on intimate partner violence victimization (experiencing physical, sexual and psychological abuse, including cyber-abuse, at some point during their lifetime); binge drinking (consuming five or more alcoholic beverages on six or more days in the last month); sexual practices (having five or more intercourse partners and/or one or more anal sex partner during their lifetime); and using diet aids or fasting for 24 or more hours at some point during their lifetime.

Results: One-third of subjects read Fifty Shades (18.6%, or 122/655, read all three novels, and 14.8%, or 97/655, read at least the first novel but not all three). In age- and race-adjusted models, compared with nonreaders, females who read at least the first novel (but not all three) were more likely than nonreaders to have had, during their lifetime, a partner who shouted, yelled, or swore at them (relative risk [RR]=1.25) and who delivered unwanted calls/text messages (RR=1.34); they were also more likely to report fasting (RR=1.80) and using diet aids (RR=1.77) at some point during their lifetime. Compared with nonreaders, females who read all three novels were more likely to report binge drinking in the last month (RR=1.65) and to report using diet aids (RR=1.65) and having five or more intercourse partners during their lifetime (RR=1.63).

Conclusions: Problematic depictions of violence against women in popular culture-such as in film, novels, music, or pornography-create a broader social narrative that normalizes these risks and behaviors in women's lives. Our study showed strong correlations between health risks in women's lives-including violence victimization-and consumption of Fifty Shades, a fiction series that portrays violence against women. While our cross-sectional study cannot determine temporality, the order of the relationship may be inconsequential; for example, if women experienced adverse health behaviors first (e.g., disordered eating), reading Fifty Shades might reaffirm those experiences and potentially aggravate related trauma. Likewise, if women read Fifty Shades before experiencing the health behaviors assessed in our study, it is possible that the book influenced the onset of these behaviors by creating an underlying context for the behaviors.