Body Image and Media Survey

Gender

Male

Female

Age

About how much time do you spend looking at media daily?

What type of media do you most use to obtain information?

What are major influences in the way you see your body? (Check all that apply)

How often do you deliberately check your features?

How often do you think about your body or weight?

How often do you you feel pressure from the media, your peers, or your parents to look a certain way?

How often does your feature(s) currently lead you to avoid social situations?

Always avoid

Avoid about 3/4 of the time

Avoid about 1/2 of the time

Avoid about 1/4 of the time

Never avoid

Do you feel media creates an unrealistic/unattainable body image for men?

Yes

No