Journal of Preventive Medicine

Introduction
Adolescence is the most important and sensitive period of development and is associated with significant biological, cognitive and psychosocial changes. In adolescence, one of the important aspects that shape a person’s identity is physical appearance or body image. Sensitivity to body image is more prominent during adolescence. Body image refers to thoughts and feelings about body. The prevalence of body image concern is a major problem, because it is associated with psychological disorders and defects such as low self-esteem, depression, social anxiety, eating disorders, substance abuse, and cosmetic surgeries. In adolescents, self-efficacy plays an essential role in how they think and behave, and ultimately affects their quality of life (QoL) and mental health. People with high self-efficacy feel less stress and have more mental health. In this research, we aim to determine the relationship between social self-efficacy and fear of body image in Iranian female adolescents.

Methods
This is a descriptive correlational study with a cross-sectional design. The study population consists of second-grade high school female students in Kavar County, Fars Province, Iran in 2016-2017. Sampling was conducted using multistage cluster sampling. First, two girls’ high schools in Kavar County were selected as samples. Then, five classes from each high school and 17 students from each class were selected as the study sample (n=117). The data collection tools included Littleton’s body image concern inventory and Connolly’s adolescent social self-efficacy scale. The data were analyzed in SPSS software, version 26 using descriptive statistics (Mean±SD, median, first quartile and third quartile) and inferential statistics including Spearman’s correlation test, one-way analysis of variance, Kruskal-Wallis, multiple linear regression, and chi-square test. To check the normality of the data, skewness and kurtosis methods, Q-Q plot, histogram, and Kolmogorov-Smirnov test were used.

Results
Among 117 students, 41% were in the second grade and 34.2% were studying in the field of humanities. The mean score of social self-efficacy was 64.91±22.10, and the median, first quartile, and third quartile of body image concern were 72, 61.5, and 78.5, respectively. The social self-efficacy in the majority of students was at a moderate level (61.5%), and the body concern was at a high level (60.7%). The results of Spearman’s correlation test showed the good or very good negative significant correlation of body image concern and its dimensions with social self-efficacy and its dimensions (P<0.05). The chi-square test results showed a significant difference in social self-efficacy based on the severity of body image concern (P<0.001). In students with low body image concern, 56.3% had high social self-efficacy and in those with high body image concern, 45.1% had low social self-efficacy.

Conclusion
There is a negative and significant relationship between social self-efficacy and body image concern in Iranian female adolescents; those with lower body image concern have higher social self-efficacy. Also, the domains of dysmorphic appearance concern and interference in social functioning due to appearance concerns have a negative significant relationship with social self-efficacy of female adolescents. Therefore, The officials and decision-makers in the field of mental health and education in Iran should design educational programs related to proper nutrition and physical activity for female adolescents to maintain body weight within the normal range and consequently reduce their body image concern and increase their self-efficacy. Considering the limitations of this study, it is recommended for future studies to conduct research at a provincial level or in other groups (college students) and investigate the difference between males and females. 

Ethical Considerations
Compliance with ethical guidelines
This study was ethically approved by Shiraz University of Medical Sciences (Code: 95-01-42-11837).

Funding
This article was conducted with financial support from Shiraz University of Medical Sciences.

Authors' contributions
Conceptualization: Mahin Nazari, and Rokhsare Abul Hasan Begi; Methodology: Mahin Nazari, Mohamad Hossein kave, Leila Gharamani, and Masoud Karimi; Investigation: Mahin Nazari; Writing the original draft: Rokhsare Abul Hasan Begi; Review and editing: Mahin Nazari, and Fateme Sadat Hosseini; Funding acquisition: Mahin Nazari; Resources: Mahin Nazari, and Fateme Sadat Hosseini; Supervision: Mahin Nazari, Mohamad Hossein kave, Leila Gharamani, and Masoud Karimi.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors deem it necessary to express their sincere gratitude to the officials of the Kavar City Education Department.


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