Other articles in the series include: Are Utahns Uniquely Drawn to Pornography?, Do Utahns Struggle With Body Image More Than Others?, Are Religious LGBT Youth in Utah More (or Less) Prone to Suicidality?

One final favorite Scary Story people love telling about Utah centers around just how depressed people are in the state! Much of this was initially generated by an oft cited Deseret News story from 2007, referring to Utah as the most depressed state in the country.  A year earlier, the Deseret News reported that a pharmacy benefits company released a study claiming that Utahns took more anti-depressants in 2000 than any other state.  (2019 statistics reported that Utah ranked 16th in antidepressant use). 

Since then, many nod knowingly when this tale of rampant depression in Utah is invoked. Some go on to sermonize about perfectionism and guilt among the state’s dominant religious community as presumably one of the factors fueling heightened depression. That, of course, fits nicely with those who see religion generally (and the Church of Jesus Christ of Latter-day Saints specifically) as somehow exacerbating many of the various emotional and behavioral struggles increasingly epidemic in modern society. 

There will always be a handful of studies or “scholarly analyses” that can be used to claim scientific backing for one’s own world view. It becomes problematic, however, when a broader picture of research goes directly counter to deeply held views and assumptions.  Just as we have witnessed in this series with popular narratives of addiction, plastic surgery, and youth suicide being challenged, you might be surprised how much the prevailing scary story of depression in Utah is contradicted by available evidence. 

When it comes to mental health, the evidence is similarly compelling in confirming a generally positive association with faith and religious adherence. For instance: 

 A 2012 large scale review of religious and spiritual factors influencing depression concluded “Of the 178 most methodologically rigorous studies, 119 (67%) find inverse relationships between religiosity and depression, while in contrast, only 6% report greater depression. Religious beliefs and practices may help people to cope better with stressful life circumstances, give meaning and hope, and surround depressed persons with a supportive community.”

• A 2014 study in the Journal of Religion and Health “of nearly 2,500 young women finds that across all participants, more frequent religious attendance and a strong prayer life were significant predictors of lower rates of depression.”
• In a 2016 study of religion and depression in adolescence, the researchers concluded “Using a nationally representative sample of adolescents in the US, we find robust effects of religiosity on depression that are particularly strong for the most depressed. These effects are not a result of social context. Instead, we find that religiosity buffers against stressors, possibly through improved social and psychological resources.”
• In a 2021 study just released regarding community connectedness during the COVID-19 pandemic, study co-author Dan Cox referred to Latter-day Saints in relating that, “In terms of their social connectedness, they’re doing way better than than your average American. This has a whole host of benefits. We know that loneliness is incredibly damaging to your emotional health, to physical health, so being rooted in these communities, having people they can rely on to weather something like a pandemic, which for many folks was socially isolating, is just an incredibly good position to be in.”

This same positive religion-mental health pattern also shows up in specific studies aimed at members of the Church of Jesus Christ of Latter-day Saints also. For instance: 

• One earlier analysis of 1990’s data showed that the suicide rate among active Latter-day Saint youth was lower than it was for peers from 1991-1995.
• Another study using 1996 data showed that active Latter-day Saints had the best health status compared with other populations, and consequently, the lowest levels of mental illness.
• A Gallup “Well Being Survey” conducted in 2012 documented that in the United States at the time, “Jews and [Latter-day Saints] have the highest well-being of any of the faith groups examined in this analysis.”
• A 2016 study with a survey size of 1.3 million people showed that members of the Church in the United States report a high number of positive emotional experiences and relatively high life satisfaction. 

None of this is to suggest that people of faith, and more specifically members of the predominant religion in Utah, don’t also struggle (even mightily) with depression and anxiety—as also shows up clearly in other studies. For instance more recently in 2019, the Center for Disease Control reported that Utah had the 6th-highest suicide rate.  

But as a whole, this broader scope of evidence counters much of the popular perception that somehow faith and religious observance are core causes of depression, and act as negative risk factors for mental health. Based on the preponderance of available evidence, that’s simply not an honest scientific story.  

Different mental health outcomes according to how faith is practiced. So why do some people insist that their experience with faith was so emotionally unsettling and burdensome? A fair question to explore is how certain kinds of personal approaches to faith relate to healthy or unhealthy emotional outcomes.  

Many years ago, Albert Ellis famously claimed at the American Psychological Association convention that religious commitment led people towards worse mental health when compared with the general population. At the time, he was debated by Latter-day Saint psychologist Allen Bergin—who began conducting research over the next decade that would eventually force Ellis to back off his blanket generalization.    

It was actually more complicated than either man acknowledged. Rather than religiosity helping or hurting mental health in a simplistic, blanket sense, deeper analysis showed that mental health outcomes depended on how, why, and to what extent people participated in their faith. For people “intrinsically committed” (finding living their faith as personally rewarding), the research was clear:  that faith commitment was most often beneficial to mental health overall. 

For purposes here, instead of focusing alone on whether someone is spiritual or religious, it may be more relevant to ask someone more personally: how am I spiritual or religious? Why am I practicing my faith the way I do? Does how I adhere to my faith influence how I feel? Am I being religious for external reasons—or to keep up a certain appearance?  Or are there deeper reasons for my religious practices?  

This distinction shows up in other research too.  For instance, a study of older residents of Cache County in the late 1990s suggested higher depression rates among Latter-day Saints compared with non-Latter-day Saints, but found church attendance was correlated with lower depression. And in the analysis of 1996 Utah data referenced above, active Latter-day Saints were measurably healthier than non-Latter-day Saints and less active Latter-day Saints. 

It’s not hard to imagine how inner turmoil, which often manifests itself as emotional struggle, could arise for someone who has, at one stage, exhibited strong commitments practicing core teachings of a faith. When these practices are later ignored, or a person moves toward a more “extrinsic” way of practicing faith in their life, it would make sense this might create a dissonance that is not without precedent, and is described throughout scripture. For example, King Benjamin raises concern with those who “cometh out in open rebellion against God”—noting that “if that man repenteth not … the demands of divine justice do awaken his immortal soul to a lively sense of his own guilt, which doth cause him to shrink from the presence of the Lord, and doth fill his breast with guilt, and pain, and anguish, which is like an unquenchable fire.” The results of open rebellion, as opposed to a lessening of commitment to one’s faith, may be open to debate here—but it should surprise no one to see challenging emotions arise in both cases.  

Faith interacts with other strong variables in influencing mental health. According to the broader picture of evidence then, a foundation of faith is generally protective against mental health problems, particularly when practiced actively and lived intrinsically.    

Clearly, there are many more, wide-ranging influences on emotional health—including some that may uniquely operate in and out of Utah (and explain some of the state-level differences).  

One of the most commonly cited factors, for instance, is Utah’s high elevation (third highest average elevation in the US at ~6,100 feet above sea level)—with studies often connecting depression and suicide rates with elevation, and similar correlations showing up in other high-altitude states. As just one example, a 2011 study shows a positive association between altitude and suicide rates (a helpful discussion as to possible reasons why is found here). 

There is another factor at play here—far less commonly cited—but which there is good reason to believe may be playing a unique role in Utah’s mental health trends. As stated above, Utah is currently ranked 16th in the nation for antidepressant use per capita (with studies a decade earlier placing the state as first in antidepressant usage per capita).  

If it’s true that Utah has a relatively high antidepressant usage rate, it raises some important questions, with the first of them being why? 

Whereas most people leverage this data as easy evidence that Utahns are just more depressed (widely seen as a proxy judgment on Latter-day Saint teaching), that once again, simply does not account for all this other data above. Even more specific statistics by locality unsettles that story even more. For instance, geographic studies indicate that many areas in Utah with significant Latter-day Saint populations are less likely to use antidepressants. For example, Utah County has one of the highest Latter-day Saint populations in the state, but the Utah Department of Health reports that Provo—the largest city in Utah County—has the lowest antidepressant usage in Utah. Idaho also has a large per capita Latter-day Saint population, but it is below average for antidepressant usage.

Rather than making blanket inferences concerning religiosity and depression in connection with antidepressant use, could the higher use of antidepressants be considered a potential variable in increased rates of depression and suicide? There is some surprisingly robust data suggesting the answer is yes—especially these three findings: 

1. A growing and sizable amount of research confirms unique levels of risk in young, developing, teenage brains when they are prescribed antidepressants—with a roughly doubling of suicidality showing up across many controlled trials (summary review here).  
2. There are also seven different lines of evidence that confirm a linkage between antidepressant use and uncharacteristic suicidality generally
3. Finally, twenty-two long-term studies document a trend of worsening depression over time for those taking antidepressants 5, 10, and 15 years in a row—when compared with those who never take them (complicated by the fact that these medications can be difficult to taper off, as the New York Times investigated in 2018).  

A logical conclusion to this information may be that whatever short-term benefit one may continue receiving from an antidepressant initially, it’s hard to deny a more complicated picture  emerges over time. Unfortunately, it seems increasingly clear from population level data that the more a population embraces these treatments as the primary response to depression—the more their burden of suicidality and chronic depression will grow.  

All of this raises some challenging questions about the overall approach we continue to take in responding to mental health challenges. It was respected scholars Allan Horowitz and Jerome Wakefield who raised concern in their 2012 book Loss of Sadness with “medicating normal sadness” for the way it often “treats as pathological what is actually an inherent and valuable part of the human condition.” As they summarized:

For thousands of years, people have used religion, spirituality, and philosophy to understand how their unhappiness is tied into larger questions about life. Such questioning allows people to comprehend how their emotions are related to basic aspects of human existence and to gain a deeper appreciation of their feelings ….Quite aside from philosophical issues, there may be psychological benefits of normal sadness that treatment would nullify. We do not as yet fully understand why we are biologically designed to experience sadness in response to loss, and, until we do, it is possible that there are benefits of withdrawing into a sad state after a major loss that are not immediately apparent but that are nonetheless real and important to long-term psychological functioning.

Having said all this, let’s be clear that antidepressants have helped millions of people, and untold numbers of people in Utah. I am certainly not advocating that those taking antidepressants immediately stop taking the medication. (When that is the right step, it needs to happen very, very gradually—and ideally with lots of support and some medical supervision). So, this is not an anti-medication message—it’s about being thoughtful in our use of medication and cautioning against over-relying on this as our long-term solution, including for youth. What research is showing is that they may not necessarily be the best first choice, and that there are other options which can and should be explored for those suffering from depression.

1. Believing there was hope in the possibility of deeper healing                            
2. Making small and large life adjustments in their lifestyles
3. Prioritizing the big three—nutrition, physical activity, and sleep
4. Not neglecting the ‘other big three’—mental diet, mental activity, and mental rest
5. Working through issues of trauma, healing and forgiveness                            
6. Learning to work with thoughts and emotions in a new way
7. Nourishing community & emotional support
8. Seeing your own self and life as having true worth, meaning, and purpose 
9. Deepening or realigning your spiritual connection 
10. Growing freedom through less emotional dependence on substances or behaviors. 

It’s worth pointing out that all ten of these shifts are well-represented in the teachings of every major faith—including the Church of Jesus Christ of Latter-day Saints. Rather than targeting faith as somehow detrimental to emotional health overall, then, maybe it’s time to recognize the profound salutary and preventive effect faith can and does play for so many—in and out of Utah.  

So, is Utah more depressed than other places? You’d have to try really hard to make that case based on the available scientific data. Let’s stop pretending that Scary Story is somehow research-based and backed by good evidence. 

It’s not. The story that is backed by the broader picture of evidence is much more encouraging about Utah and the strong influence of faith than many have been led to believe.

The post Are Utahns More Depressed Than Everyone Else? appeared first on Public Square Magazine.

Other articles in the series include: Are Utahns Uniquely Drawn to Pornography?, Do Utahns Struggle With Body Image More Than Others?, Are Utahns More Depressed than Everyone Else?

Are LGBT Latter-day Saint youth in Utah at a higher risk of suicidal thoughts, plans, and attempts than their non-Latter-day Saint peers? According to two recent studies making use of a large, representative dataset, the answer is no. In fact, researchers find that LGBT youth in Utah who are not Latter-day Saints show almost twice the incidence of suicidal thoughts and behaviors than those who are Latter-day Saints. These effects are significant, persist after controlling for demographic variables, and appear to be partly mediated through lower levels of family conflict, depression, and substance abuse among Latter-day Saints. 

Before digging into these findings, it’s worth taking a step back to place them in context. In December 2014, a national media outlet printed an off-the-cuff remark from an LGBT advocate, who claimed that “Mormons have the highest rate of gay suicide in the country,” along with several other statistical claims about LGBT youth suicide in the Church. This interview understandably sparked alarm and gave additional shape to an existing narrative about gay youth suicide in Utah that dated at least to 2012, following a nationally publicized suicide in Utah. The idea that there was an “epidemic,” as some put it, of gay youth in Utah committing suicide because of the Church’s conservative beliefs became widely accepted.

It’s hard to overstate just how entrenched this narrative became online during the 2010s. Conversations among Church members and critics online that touched on sexuality or same-sex marriage would inevitably arrive at the topic of youth suicide. Church members who attempted to engage on these questions, however meekly, were accused of raising suicide rates simply by believing in and affirming Church teachings.

The Church of Jesus Christ of Latter-day Saints itself felt compelled to take these claims of epidemic suicide seriously, responding both through numerous private meetings with advocates and through public gestures, such as donating to an LGBT support group for suicide prevention training.

Michael Staley, who works at the Utah Office of the Medical Examiner and is himself gay, and not a member of the Church, has repeatedly thrown cold water on key claims of the narrative:

Despite a general perception that many of Utah’s youth suicides arise from intolerance toward LGBT people promulgated (though not necessarily intentionally) by teachings of The Church of Jesus Christ of Latter-day Saints, the state’s suicide prevention research coordinator says that may not be the case.

“There’s no data to show that, period,” says Michael Staley, who works in the Utah Office of the Medical Examiner and is the first person who would know, since he leads an effort to collect, compile and analyze suicide information from around the state. …

While the Centers for Disease Control and Prevention reported in 2016 that LGBT youth die by suicide at double the rate of their non-LGBT peers, Staley says data specific to Utah so far doesn’t validate the sexuality-religion narrative. “The people who are driving that narrative are going to be disappointed,” Staley says, while at the same time recognizing that “theoretically, it makes sense.”

Proponents of the narrative point to a 2009 study finding that LGBT youth from “highly rejecting” families are more likely to have attempted suicide. No doubt this is true. But the study, conducted on a small convenience sample from California, makes no attempt to study the effect of religion or the Church of Jesus Christ specifically, never mentioning religion at all. Others have offered circumstantial evidence, pointing out, for example, that the suicide rate among youth in Utah rose steeply beginning in 2013. This is true, but these data cover all youth, and it is unknown whether the increase was driven by LGBT youth, straight youth, or both. Nor do Church teachings seem a likely explanation for the sudden rise: the Church’s purportedly suicide-causing teachings long predate 2013, while California Proposition 8 (2008) and the November 2015 handbook policy, both purported to be triggers, were either too early or too late. 

While the key claims of the Latter-day Saint LGBT suicide narrative are unsupported and in some cases, as new research suggests, roughly the opposite of the truth, there has been at least one salutary effect of such sustained attention to the problem: Utah is becoming a leader in data collection on youth suicide.

“We’re building the most comprehensive database of information about suicide decedents around. That’s huge,” Staley says in an interview with QSaltLake Magazine. In fact, it’s the first undertaking of its kind in the country and, because of the organization of the state’s medical examiner’s office, it’s possible in Utah and only a handful of other states. Staley calls the effort “progressive” and “pioneering.”

The new research I referred to at the beginning of this article makes use of excellent survey data collected by Utah state agencies: the large and representative 2019 SHARP dataset covering youth in middle school and high school.

The first paper, by James McGraw, Meagan Docherty, Jay Chinn, and Annette Mahoney, published in Psychology of Sexual Orientation and Gender Diversity, investigates the extent to which LGBT and Latter-day Saint identity predict suicidal thoughts and behaviors (STB) among young people in Utah. STB is an aggregate measure, summing up indicators for the presence of suicidal thoughts, plans, and attempts in the previous 12 months (the maximum value of STB is thus 3).

The relevant figures from the paper are surprisingly stark. Latter-day Saint LGBT youth had an average STB value of 0.57, while non-Latter-day Saint LGBT youth had an average of 1.09—nearly twice as high. The difference between these two means was highly statistically significant. For reference, non-Latter-day Saint heterosexual youth had an average STB value of 0.42, while Latter-day Saint heterosexual youth had an average of 0.23.

The paper also found statistically significant differences between Latter-day Saint LGBT youth and their non-Latter-day Saint peers on several other markers: the Latter-day Saint youth were less likely to be experiencing familial conflict, depression, substance abuse, or self-harm, and reported being closer to their parents, on average. All these differences, thanks to the large sample, were statistically significant. These findings are descriptive, however, and are not controlling for other variables such as race or sex.

Perhaps most striking, though not emphasized by the researchers, are findings on depression revealed by an interaction effects model. Interaction effects can reveal how the size and direction of the effect of one variable on the outcome varies with another variable. The effect of LGBT identity on depression, controlling for demographics, family connections, substance abuse, and community connections, was estimated to be positive for all religious groups, but this effect was significantly smaller among Latter-day Saint youth compared to youth who indicated their religion as “none.” To put it another way, when it came to depression, LGBT youth benefited more from being Latter-day Saints, relative to having no religion, than straight youth did. In fact, straight Latter-day Saint youth had higher estimated rates of depression than Catholics and Protestants, once controls were included—the same was not true of gay Latter-day Saints.

One possible explanation of these findings is that the LGBT youth most likely to be harmed by Church teachings are also those most likely to have already left the Church, thus pushing rates of suicidal thoughts and behaviors lower in the Latter-day Saint group and higher in the non-Latter-day Saint groups (in other words, introducing what is called “survivorship bias”). The authors of the BYU study investigate this possibility using a second survey dataset that includes information about suicidality among LGBT youth who have disaffiliated from the Church. They conclude that their main findings hold even after adjusting for this information.

There remain limitations and potential sources of statistical bias in these papers, as is always the case with observational, cross-sectional studies. Inferring causation in the social sciences can only be done cautiously and provisionally. It should also be kept in mind that suicidal thoughts, plans, and attempts, the subjects of these studies, are distinct from completed suicides.

A final caution is that population measures cannot tell individual stories. For illustration, consider vaccines that are, on the population level, very safe. The overall safety of a vaccine doesn’t mean no one has ever been harmed by it. Similarly, even if it turns out participation in the Church has a protective effect against suicide for gay youth overall, there would still be some youth for whom this is not the case, or for whom the effect is opposite, for a variety of reasons specific to family, ward, and individual circumstances. On the other hand, individual stories, while valid, cannot tell us about rates of suicidal behavior across different religious groups, just as an individual’s adverse reaction to a vaccine does not prove that vaccines are unsafe. Statistics and individual stories are both valid and should be seen for what they are. Both rules and exceptions exist.  

Despite these caveats and cautions, the findings of these two studies tell us something important about the experiences of LGBT youth in Utah. They refute claims that higher rates of suicidal thoughts and behaviors among LGBT youth in Utah are uniquely or disproportionately Latter-day Saint phenomena. And the negative statistical relationship observed between Latter-day Saint identity and suicidality among LGBT youth, even after accounting for demographic variables, makes the narrative of Church-caused youth suicide much less plausible than before.

Other, more plausible, conjectures could be made. Perhaps rapid secularization has contributed to rising suicide rates among American youth, including LGBT youth. Perhaps the rise in youth suicides in Utah over the last decade is partially explained by a rapid cultural shift, within the Church (as with society as a whole), toward prescribing antidepressants to minors (black box warnings on antidepressants prescribed in the US warn of increased risk of suicidal thoughts and behaviors in young people relative to placebo). Maybe progressive secular ideology, which has been growing in popularity, is harmful to young people, causing depression and suicidality. These conjectures are, I would argue, worth investigating, but they remain conjectures. They shouldn’t be asserted without caveats, let alone repeated without verification by national media outlets—there has been enough of that.

The post Are Religious LGBT Youth in Utah More (or Less) Prone to Suicidality? appeared first on Public Square Magazine.

Other articles in the series include: Are Utahns Uniquely Drawn to Pornography?, Are Religious LGBT Youth in Utah More (or Less) Prone to Suicidality?, Are Utahns More Depressed than Everyone Else?

Body image is a difficult issue for so many women in society today—all around the world, as consistently confirmed by international surveys. One 2020 survey in the UK, for instance, found that “the majority of people feel negatively about their body image most of the time.”

But rather than acknowledging this as a tragically universal issue, we all have to grapple with, others have propounded other stories—for instance, attempting to tie these struggles to particularities of a certain locale and faith.  

The Utah Women & Leadership Project (UWLP) is doing some important work on many issues.  But many of us were disappointed by the implied message in their recently released “Infographic on Cosmetic Surgery in Utah Women” and associated research snapshot, particularly in the ways both feed negative stereotypes about people of faith, especially women. The infographic suggests Latter-day Saint women in Utah are disproportionately preoccupied with beauty because of teachings about marriage and family in the Church of Jesus Christ. Though candidly admitting that the data cannot support such a conclusion, the authors have promoted a graphic and research brief that insinuates women in the Church are driving up the market for plastic surgery in Utah.

Advancing a certain narrative about Utah women. Of course, if this is what the data plainly and objectively confirmed, even unflattering messages ought to be welcomed and shared openly. Yet this Cosmetic Surgery Among Utah Women infographic is riddled with errors and questionable sources. For instance, the “Money Spent on Beauty Products” graphic claims Salt Lake City spends ten times as much money on beauty products as other similarly sized “cities.” This comparison comes from a 14-year-old Forbes article citing only a single city (Oklahoma City). Surely, claiming that Salt Lake City is particularly focused on beauty spending requires it to outstrip more than just one other city.

The research paper concludes that “Utah is among the top states in the nation for [cosmetic surgery] procedures,” but it fails to supply any supporting data. The American Society of Plastic Surgeons only shares total numbers of procedures by region, not state. Utah’s region contains 12 other states, including California, which consistently ranks in the top ten for plastic surgery-related searches, according to data from Google Trends. Concluding from this data that Utah is a top state for plastic surgery is a fallacy of division—the fact that the region Utah is included in accounts for the largest total number of procedures does not mean Utah itself has higher than average rates of plastic surgery. It may simply be the case that Utah is geographically lumped in with other states that do. 

The authors commit a similar fallacy when they suggest that, since “69% of people who undergo plastic surgery are white” and “87.6% of the population identifies as white” in Utah, this somehow means Utahns are more likely to opt for plastic surgery. It’s also true that most people from Scandinavia are white, but no one would suggest this means Utah, therefore, has a surplus of Scandinavians.

However, as the research snapshot points out, Utah does have a relatively high number of plastic surgeons relative to the size of its population. It’s also true that Utah ranks first in searches for breast augmentation. One important consideration missing from the UWLP’s provocative infographic is that Utah may have so many plastic surgeons per capita because we have a top-ranked plastic and reconstructive residency program at the University of Utah School of Medicine. Additionally, the world-class Huntsman Cancer Institute performs thousands of plastic and reconstructive surgeries per year. This might go a long way to explain the relative difference in spending on plastic surgery in Salt Lake City versus elsewhere—and perhaps even some of the differences in search results. 

Renato Saltz, a plastic surgeon with practices in Salt Lake City and Park City, pushed back on this narrative of Latter-day Saint women being more likely to get plastic surgery because of the expectations of Utah culture—insisting that would be “painting far too broad a stroke” and doesn’t “offer a full picture of why so many operations are performed in the city.”

Undoubtedly, these factors above significantly skew the data in such a relatively low population state—yet failing to mention any of this wider context creates another perception entirely.  

And what is the story that is implied? Once again, that the teachings and ideals fostered by the dominant culture in Utah—especially by The Church of Jesus Christ of Latter-day Saint—are somehow to blame for any relative difference. That’s the “smoking gun” that receives the most attention in the research snapshot. As they argue: 

Researchers have found that homogenous societies, such as Utah, can have a contagion effect that pressures individuals into cosmetic surgery. In Utah, 87.6% of the population identifies as white, and Utah tops all the states in having the highest population of one religion: 57% are Mormon. These factors may be linked to high plastic surgery rates. The American Society for Plastic Surgeons reports that 69% of people who undergo plastic surgery are white. The Mormon Church strongly emphasizes marriage and motherhood, and Utah leads the nation in several categories relating to marriage and maternity: the highest percentage of its population being married and the earliest median age for marriage (24.0 for women and 26.2 for men). Utah has the highest fertility rate and stands among the highest in breastfeeding rates. Perhaps it is no surprise that, according to one researcher, many Utah mothers respond to cultural pressure to undergo the Mommy Makeover, which local doctors advertise as a solution to young mothers’ bodies “trashed” by motherhood.

The authors of the infographic also point towards “competition for a desirable spouse” as a possible driver of plastic surgery in Utah because it’s “a state that puts a high priority on marriage, a key concern for Mormon women specifically since self-identified Mormon women outnumber Mormon men in Utah by a ratio of 3:2.”

According to the American Society of Plastic Surgeons’ 2018 statistics, however, the vast majority of women undergoing plastic surgery procedures are well over the median age of marriage which the authors cited for women in Utah (24). Half of all cosmetic procedures for women were in the 40-54-year-old age group—constituting about 7.8 million total procedures. By comparison, women in the 20-29 year age group account for the second smallest number of procedures. Given national statistics for the age range during which most women undergo plastic surgery, it seems unlikely that Utah’s own statistics are driven largely by young, unmarried Latter-day Saint women using plastic surgery to attract a spouse. 

Among other things, the foregoing narrative feeds the perception that “Utah is all about image,” and “obsessed with appearance” as two people said in reference to the stats on plastic surgeons per capita.  As another individual asserted online, “Women in the Church are very pressured to be the picture of perfection.”

But is this what the research actually suggests?  Most of the data used to suggest that Utah women have a plastic surgery problem—including a bolded graphic showing that 67% of Latter-day Saint women know someone in their faith community who has had cosmetic surgery—comes from a single study done by Joylin Namie at UVU in 2013. The quantitative sample included 100 Latter-day Saint women, most of whom (but not all) lived in Utah, with two focus groups of 20-30 participants each as well. Only four of the women sampled had, themselves, undergone a cosmetic surgery procedure and it is never made clear whether the person they know of (who has had plastic surgery) actually lives in Utah.  What all this means is that, of the Latter-day Saint women sampled in this one study, the results point to lower than average rates of plastic surgery (4% vs. a national average of 7%).

The UWLP research snapshot focuses heavily on this specific research study for establishing the narrative that Latter-day Saint women use plastic surgery to compete for spouses and remain culturally relevant after having large numbers of children. That narrative being advanced by these authors depends on the idea that these women of faith undergo plastic surgery more often than average, which Namie’s own sample contradicts. The authors do admit in passing that “one recent survey that seems to contradict other studies and indicators found that Mormon women in Utah self-reported having cosmetic surgery at rates slightly lower than the national average.”

That survey was conducted by Jana Reiss in 2017. Drawing upon her own sample of 1,115 Latter-day Saint adults and a Pew Research study of nearly 5,000 U.S. adults, Reiss found Latter-day Saint women in Utah report lower than average rates of plastic surgery: 5.6% compared with a national average of 7%.

Disregarding broader research patterns.  Research is not ambiguous when it comes to the relationship between religiosity and body image.  A 2015 review across twenty-two studies found that “strong and internalized religious beliefs coupled with having a secure and satisfying relationship with God were associated with lower levels of disordered eating, psychopathology, and body image concern.” Interestingly enough, this same team found that “Conversely, a superficial faith coupled with a doubtful and anxious relationship with God were associated with greater levels of disordered eating, psychopathology, and body image concern.”

Here are just a sampling of the surprisingly large number of studies confirming that faith is providing a safe haven for many women who incessantly hear secular culture demanding they look a certain way:

1. A 2014  study of nearly 2,500 young women in the Journal of Religion and Health is just one example of the large body of U.S. and international research suggesting religion is very often a countercultural force in promoting healthy body images. According to lead author, sociologist Andrea Henderson of the University of South Carolina, being part of a community that lifts up the message “God made me, and he doesn’t make anything bad” appears to help moderate the impact of the “body loathing” promoted by popular culture. As Dr. Henderson put it, “intuitively, it makes sense.”  The study found that across all women surveyed, those who considered religion important in their lives and prayed regularly felt better about themselves—with a particularly strong effect on self-worth. Their message to people of faith? “Continue what you’re doing” in terms of providing an environment where young women are valued for who they are, not what they look like, the lead researcher said. 
2. One study at Bucknell College had college-age women review scriptural images such as the body being a temple of the spirit, right before being exposed to pictures of thin fashion models. Compared with a control group who reviewed neutral texts before the same experience, women in the scripture-oriented group were far more likely to feel good about their appearance. As the researcher noted in the Journal for the Scientific Study of Religion, “It seems plausible that women’s beliefs and feelings about their looks could become more positive from reading a set of affirmations … that espouse a vision of one’s body as divinely loved and accepted.”
3. Another study conducted by researchers at Hope College found women who were highly committed to their faith were more likely to report higher body esteem and body satisfaction. 
4. In a University of Hong Kong study of 124 Asian college women, 23 percent of participants with no religion reported being extremely dissatisfied with their weight; just 6 percent of religious women expressed the same dissatisfaction. As one participant in the University of Hong Kong study put it: “My identity is in Christ and that is what matters most. I am happy with myself and what I look like, mainly because of my faith.”
5. Researchers from Osnabruck University in Germany, analyzing data from 669 women, found that that veiled Muslim women perceived themselves as more attractive than did unveiled Muslim women, Christian women, and atheist women.
6. In a study exploring body image among 483 Jewish women ages 18 to 30, Israeli researchers found that ultra-Orthodox and Modern Orthodox women were more likely than secular Jewish women to be comfortable with their appearance. By comparison, ultra-Orthodox participants were less likely than secular and Modern Orthodox Jews to repeatedly check their mirrors or avoid social situations due to an unhealthy focus on perceived abnormalities in their appearance.
7. A 2019 study in the Journal Body Image based on a survey of 345 women found that both organized religion and spirituality were associated with positive body image. In particular, those with a strong belief in the importance of spirituality and the sense that everything is connected reported higher levels of gratitude and lower levels of self-objectification. These factors in turn were strongly correlated with body satisfaction. As the researchers report, “The findings suggest that religion and spirituality may enable women to experience a loving, appreciative, and respectful relationship with their bodies.” 

This research aligns with the actual experience so many Latter-day Saint women have had.  As one popular Latter-day Saint influencer Charlie Scott interviewed by VICE said, she’s never felt pressured by the Church to get plastic surgery done: “In my personal experience, it’s been the complete opposite. I’ve been taught I was created in God’s image and I am the way I am for a reason. I should love my body just the way it is, and so should all women and men.” 

The Latter-day Saint women I know who have undergone cosmetic surgery are neither vain, desperate, nor conforming to religiously motivated expectations. Most of them are already married, have given years of thought to the procedure, and have never undergone any other kind of procedure. In other words, the idea that they are somehow preoccupied with beauty—especially to an extent that’s uncharacteristic of other women—is totally inaccurate. 

It also seems perverse to insist that Latter-day Saint women undergo cosmetic procedures because of their religious culture when the increasing popularity of cosmetic procedures in the wider population escapes scrutiny. Why is there something shameful about a religious woman getting plastic surgery when women in the general population are told “you do you?” 

This isn’t to say that women in Utah don’t have their particular struggles with beauty culture, nor that it’s never related to Church culture. As is true of women everywhere, women in the Church face pressures to conform to certain standards, including physical ones. It’s also fair to say that Latter-day Saint women face unique pressures relating to dating and marriage within a culture so heavily focused on family formation.

But the narrative being propounded about Latter-day Saint women is different from the story revealed by a closer look at the data. And it’s irresponsible, in my view, to assert that Latter-day Saint women partake in cosmetic procedures because of their religiously informed beliefs about marriage and family. While the UWLP authors insist that women in the Church are victims of cultural pressures to marry and have children at the expense of careers and higher education, Utah women are still more likely than women in the general U.S. populace to obtain a bachelor’s degree, despite having much higher fertility rates. Perhaps some of the pressures to conform to certain beauty standards are not coming from the Church, but from belonging to socioeconomic classes where large families—and the bodies that come with them—are increasingly countercultural.

In sum, the idea that ‘white Latter-day Saint women want to attract men, be married, drop out of school and have babies, and therefore they want cosmetic surgery’ is an unhelpful caricature.  It’s fine to have this hypothesis, but it’s unhelpful to attempt to cobble together data that supports your theory, ignore data that directly contradicts it, and publish it as if it’s valid.

To reiterate:  so much of what the Utah Women & Leadership Project (UWLP) is doing is helpful, but I draw attention here to what will hopefully be an anomaly—data formulated to tell a particularly negative story about people of faith based on questionable data. Statements like, “Some Latter-day Saint women believe that physical beauty is key in securing status, particularly as marriage and motherhood are often prioritized above educational or career achievement,” are vague, unsourced, and inflammatory and do nothing but reinforce a negative stereotype of Latter-day Saint women.

Women in the Church are, by and large, doing a remarkable job balancing messages about beauty and achievement against the more lasting happiness of cherished family bonds. We don’t always get it right, but many of us are consciously striving for a more transcendent identity than our looks—or even our educational and professional attainments—can provide. I too have felt the sting of realizing I’ve fallen short of cultural beauty expectations, but I’m similarly gutted when my successes as a wife and mother are discounted; when my sacrifices register in the larger cultural conversation only as a failed educational or professional statistic among women. My beautiful family and my relationship with Christ as a member of The Church of Jesus Christ of Latter-day Saints have been my safe haven from the world’s relentless campaign to tie my value to my image. Religious devotion is not a liability on this front; it’s our greatest weapon in our common struggle to find lasting self-worth. 

The post Do Utahns Struggle with Body Image More Than Others? appeared first on Public Square Magazine.

Other articles in the series include: Do Utahns Struggle With Body Image More Than Others?, Are Religious LGBT Youth in Utah More (or Less) Prone to Suicidality?, Are Utahns More Depressed than Everyone Else?

People love to say things about Utah, don’t they? As a proxy punching bag for The Church of Jesus Christ of Latter-day Saints, it’s remarkable how robust and long a life some Tall (and Terrifying) Tales about the state enjoy.

For instance, there’s that story about Utahns being more depressed than everyone else—or LGBT+ identifying youth in the state being more likely to experience suicidal ideation—in each case presumably due to teachings about covenants, sexuality, and identity. Other stories seem to take on added popularity every year—about, for instance, Utah women having a peculiar affinity for plastic surgery (and associated poor body image), and Utah men having an equally singular predilection to pornography (all of which, as the story goes, is made worse by ongoing encouragement towards moral purity and relishing our identity as sons and daughters of a living God). 

This week, we’ve decided to commemorate our Scariest Holiday by spending some time diving deeper into each of these Scary Stories, starting with some popular local mythologies about pornography that just don’t seem to die. In none of these forays, of course, are we denying the seriousness of these problems—in Utah and beyond. The first step in knowing what to do about a problem, though, is getting clear on its true scope and nature—trying our best to see “things as they really are.” No one is served by inflated, deformed, and exaggerated accounts of what’s going on—certainly not the people in Utah, and not even those who seem to revel in any added bit of “evidence” that feeds and keeps alive their own dark view of the state’s dominant faith.  

I had the good pleasure of knowing personally the nation’s foremost expert in pornography research, Gary Wilson. Drawing on the fruits of his life’s work, we take up in what follows the most popular pillars of the Scary Story (about Sex) some people still love to tell about Utah—highlighting how deeply at odds both elements are with consensus conclusions of the research literature itself.  We begin exploring the fashionable hand-wringing over “fear-mongering” and shaming supposedly rampant throughout the state. 

Misrepresenting the science of pornography. In a Salt Lake Tribune feature on pornography recently, a young man was interviewed as suggesting the Church had made things “harder for people” by its “harmful teachings about sex”—which he claimed had “really messed with my life.”  

What was harmful about teachings this man had grown up being exposed to in the Church of Jesus Christ?  Warnings about the addictive nature of pornography itself are highlighted in the article as being potentially damaging. With credit to Tribune reporter Kaitlyn Bancroft for attempting to represent a spectrum of views in her piece, the article relies centrally on one mental health professional, in particular, to represent a more “scientific” position on pornography. 

Latter-day Saint clinical psychologist Cameron Staley was quoted as arguing that the label of addiction “isn’t clinical or scientific when applied to a person’s pornography viewing.” Remarkably, Staley claimed that—in contrast with the substance abuse literature—the body did not change in any substantial way from seeing sexual images: “What’s different about viewing sexual images,” he suggested, “is you’re not really ingesting anything in your body that would change neural transmission or how you would metabolize anything.”

Hmmm. It’s certainly fair to point out meaningful differences in how people understand the word “addiction”—and to be sensitive about how we use it. Staley and others are not wrong to raise concern with how some can over-identify with addiction in a way that eschews responsibility. And they are equally right to call for more attention to the broad array of life burdens (trauma, grief, isolation, sorrow, anxiety, health problems) that can make someone more drawn to anything to make the pain stop.  

All this is wise to consider. But none of them are contradictory on either a conceptual or practical level to the reality of compulsive-addiction patterns where someone’s freedom can become severely limited for a time (at least in a certain area). As the Fortify training emphasizes, even for someone struggling to stay away from pornography, there is a lot they can still choose. Research has confirmed that small and large adjustments in lifestyle can, over time, help grow someone’s  sense of control and power to resist and overcome compulsive-addictive patterns. For instance, simple improvements in stress reduction, mindfulness training, deeper spiritual connection, better sleep, and physical activity, can all help grow “willpower” over time.

And the reality is that for many, acknowledging a real limitation in agency is the first step needed to take seriously the needed adjustments of heart, mind, and life, that allow them to finally move out of the morass. That’s what the 12-steps do so well.

Given all this and the state of the research on pornography overall, to suggest widespread agreement that the “addiction model is not effective” is so fallacious—and so contrary to academic reality—that it borders on being worthy of the tabloid pages. What the journalist and Dr. Staley both failed to mention was that of all 57 neuroscience studies done on porn users and sex addicts (MRI, fMRI, EEG, neuropsychological, hormonal), ALL BUT ONE provides support for the addiction model. (See for yourself—this page links to every relevant brain study). 

The larger consensus of the literature is clear: rather than a seeming contrast with the substance abuse literature, pornography research mirrors it. This is not a controversial statement—not according to these many brain researchers OR to some of the top researchers in the world who authored 32 recent literature reviews & commentaries all of which support the idea that pornography is addictive (Many of these same experts, by the way, have robustly critiqued outlier studies by Dr. Staley and others that claim otherwise). 

Why reference this single outlier scholar, while disregarding what the bulk of scholarship is saying? At one point in the article, Staley references the body’s physical tolerance to toxic drugs that can build up and set the stage for painful withdrawal symptoms—arguing that no such physical reactions happen with pornography. Yet once again, there are over 60 studies reporting findings consistent with escalation of porn use (tolerance), and habituation to porn (as you would expect with addiction), as well as at least 15 studies demonstrating clear withdrawal symptoms in porn users.

One of the main takeaways of the Tribune piece is that pornography addiction—if it occurs at all—happens in a “very small number of individuals” and that, even then, the effects of porn are simply not as concerning as religious teaching might suggest (certainly not something to get people frightened about!) And yet once more, the article and its scholarly sources simply disregard overwhelming evidence to the contrary. See for yourself—checking out summaries below of available literature on the stirring scope of porn’s impact on body, heart, and relationships:    

• Impact on sexual problems. Over 40 studies link porn use/porn addiction to sexual problems and lower arousal to sexual stimuli. (Gary Wilson points out “the first 7 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions”).
• Impact on relationship satisfaction. Over 80 studies link porn use to less sexual and relationship satisfaction. Wilson notes, “As far as we know all studies involving males have reported more porn use linked to poorer outcomes [with] either sexual or relationship satisfaction. While a few studies report little effect of women’s porn use on women’s sexual and relationship satisfaction, many do report negative effects”—see Porn studies involving female subjects: Negative effects on arousal, sexual satisfaction, and relationships
• Impact on mental health. Over 85 studies link porn use to poorer mental-emotional health and poorer cognitive outcomes.
• Impact on sexist views. Over 40 studies link porn use to “un-egalitarian attitudes” toward women and sexist views. 
• Impact on sexual aggression.  Over 100 studies link porn use to sexual aggression, coercion, and violence. (But, wait doesn’t porn reduce rape in a country? That popular notion is flatly refuted by the full scope of research, see here). 

Some may wonder whether the foregoing patterns are merely correlative. No. Over 90 studies demonstrate compulsive porn use is causing negative symptoms and brain changes.

The bottom line is this:  It’s far past time to dispense with this dishonest and damaging notion about porn not being addictive, not impacting the body, not leading to withdrawal effects, and not being harmful to real lives and relationships.   

In the same moment, let’s thank heaven there are still some institutions and leaders raising a warning cry— the Church of Jesus Christ among them. (Certainly, we can all do so while better ministering with love to those seeking deeper freedom from the same).  

After years of working to support thousands of people in finding deeper freedom from pornography, I can say this: among the most harmful things you can do to someone in the grips of compulsive pornography use is to convince them that the problem isn’t porn—it’s the people concerned about the porn! I’ve watched close-up how people’s healing journeys can be derailed almost entirely by such facile and caustic messages. 

A myth that just won’t die. One person’s post in an online forum is reflective of this popular sentiment, “I can’t remember where I heard it, but I think Utah is #1 in online [porn us] as well.”

You’ve likely heard that too—maybe more than once. But is it true?  

Not even remotely.  

I wondered about the same awhile back, until this same agnostic researcher, Gary Wilson, pointed out how dubious this oft-repeated claim is. With credit to his own analysis from which much of this is adapted and another deep dive from economist Tom Stringham, let’s review below what you need to know about this well-worn trope. 

The claim of Utah’s purportedly higher porn use centers around a single study with viral fame. That often-repeated meme arose from Benjamin Edelman’s 2009 economics paper “Red Light States: Who Buys Online Adult Entertainment?” 

There’s a lot to be said about this study and its significant complexities (see notes at the bottom), but of even greater interest here is how little critical scrutiny the study has received over the last decade. Instead, as Tom Stringham notes historically:  

The Latter-day Saint blogosphere lit up with commentary after the release of the famous original study, and the conclusions of the paper became a focal point of the growing discourse about sexuality among Latter-day Saints online. … After a few months, the Utah porn statistic became entrenched in conventional wisdom. Blogs would make reference to the statistic, and having drawn their conclusions, move on to provide explanations and accusations regarding the phenomenon.

One reason this study achieved such infamy is how well it appears to reinforce the idea that religious people are actually deeply hypocritical—hiding their own sexual obsession right underneath their sermonizing about the sacredness of sex. 

That would be quite a story if it were generally true. (It is true, of course, in too many instances). But once again, something very inconvenient is not being acknowledged here: that when we zoom out from this single study, there are 23 other studies that tell the opposite story—namely, that religious people are substantially less likely to use pornography than non-religious folks. That is the conclusion of every single one of these studies hyperlinked below, in order of publication date:  

1. Adult Social Bonds and Use of Internet Pornography (2004)
2. Generation XXX: Pornography Acceptance and Use Among Emerging Adults (2008) 
3. Internet pornography use in the context of external and internal religiosity (2010) 
4. “I believe it is wrong but I still do it”: A comparison of religious young men who do versus do not use pornography (2010)
5. Viewing Sexually-Explicit Materials Alone or Together: Associations with Relationship Quality (2011) 
6. Pornography Use: Who Uses It and How It Is Associated with Couple Outcomes (2012)
7. U.S. males and pornography, 1973-2010: consumption, predictors, correlates (2013)
8. Adolescent religiousness as a protective factor against pornography use (2013)
9. Religiosity, Parent and Peer Attachment, and Sexual Media Use in Emerging Adults (2013)
10. United States women and pornography through four decades: Exposure, attitudes, behaviors, individual differences (2013)
11. The Relationship Between Religiosity and Internet Pornography Use (2015)
12. How does religious attendance shape trajectories of pornography use across adolescence? (2016)
13. Spousal Religiosity, Religious Bonding, and Pornography Consumption (2016)
14. How Much More XXX is Generation X Consuming? Evidence of Changing Attitudes and Behaviors Related to Pornography Since 1973. (2016)
15. Religious and Community Hurdles to Pornography Consumption: A National Study of Emerging Adults (2017)
16. The Influence of Religiosity and Risk-Taking on Cybersex Engagement among Postgraduate Students: A Study in Malaysian Universities (2017)
17. Explicit Sexual Movie Viewing in the United States According to Selected Marriage and Lifestyle, Work and Financial, Religion and Political Factors (2017)
18. Pornography Use and Loneliness: A Bi-Directional Recursive Model and Pilot Investigation (2017)
19. Seeing is (Not) Believing: How Viewing Pornography Shapes the Religious Lives of Young Americans (2017)
20. Sexual Attitudes of Classes of College Students Who Use Pornography (2017)
21. Predicting pornography use over time: Does self-reported “addiction” matter? (2018)
22. The Use of Online Pornography as Compensation for Loneliness and Lack of Social Ties Among Israeli Adolescents (2018)
23. Individual differences in women’s pornography use, perceptions of pornography, and unprotected sex: Preliminary results from South Korea (2019)

As demonstrated here, the preponderance of studies reports far lower rates of porn use in religious individuals compared with non-religious individuals. In fact, comparisons between religious and non-religious rates are not even close. 

While this may be true of secular and religious populations generally, could Utah somehow be an exception? Not if you’re paying attention to other relevant evidence specific to Utah. In at least three more recent analyses, Utah’s porn use ranks between 40th and 50th among states: 

1. This peer-reviewed paper confirms the more consistent finding of Utah porn use: “A review of pornography use research: Methodology and results from four sources.” Cyberpsychology: Journal of Psychosocial Research on Cyberspace (2015) [see summary chart copied from the paper below]
2. Per capita page views, taken from Pornhub in 2014, with Utah listed as 40th (graph available here). Tom Stringham’s own analysis of these same statistics demonstrated that after controlling for a number of additional variables, there is a negative association between porn use in a state and the population of Latter-day Saints (in other words, the higher the Latter-day Saint population in a given locale, the lower the average rate of porn use).  
3. Researcher Stephen Cranney also provided additional documentation in 2013 of Utah’s low ranking in google trend searches for porn-related topics—with, for instance, the state being dead last in searches for “porn” that year.

Overall, Stringham’s broader summary has stood the test of time: 

If critics of Latter-day Saint teachings on porn and sexuality would like to continue promoting the idea that a conservative sexual culture has backfired on itself, then they will have to confront a less convenient set of data. Here is another narrative, that perhaps time and further analysis will prove: Latter-day Saints view less porn than others, and those conservative sexual teachings are working.  

That’s precisely what further research and analysis have continued to prove. You wouldn’t know it by hearing from certain experts—but that doesn’t make it any less true.

But in comparison to the rest of the country, Utahns tend to take this problem very seriously, and are doing a lot about it—both preventatively and when people need help to find freedom. That’s undoubtedly a reason people in this state enjoy relatively more freedom from this issue than most—in large part thanks to the ennobling influence of faith permeating our climate.  

That’s something to celebrate—and a (true) story to share far and wide to benefit the many others still seeking deeper freedom from the corrosive effects of pornography use in their lives and family. (You can do it! Step by step, moment by moment. Don’t give up!) 

Simply put:  Life is better without pornography. And Utahns know that better than most. 

Notes: 

I. None of the foregoing suggests that scientific knowledge is a simple “disclosing” of reality—with individual and collective interpretation relevant from top to bottom, from study conceptualization, to data generation, to analysis and public presentation (see “The Fantasy Story Americans Love to Tell about Science“). What is summarized above is rightly considered the interpretations best warranted by the available data—as concluded by the community of relevant scientific opinion.

II. How, then, are we to make sense of the results of that single study 12 years ago that seems to suggest Utah has a relatively higher rate of porn subscriptions? A couple of factors received far less attention than the scandalous headline.  Namely:

1. Sampling questions. As Gary Wilson points out, “The original author relied entirely on subscription data from a single top-ten provider of pay-to-view content when he ranked states on porn consumption—ignoring hundreds of other such websites. Why did he choose that one to analyze?” Wilson adds, “We do know that Edelman’s analysis was conducted circa 2007, after free, streaming ‘tube sites’ were operational, and porn viewers were increasingly turning to them. So, Edelman’s single data point out of thousands (of free and subscription sites) cannot be presumed to be representative of all US porn users.” Tom Stringham likewise notes that since the vendor is unnamed in the study, it is “difficult to know if it was a random cross-section of the entire United States.”

As reflected above, it’s likely not. Subscriptions are also not as direct a metric as pageviews when measuring consumption.

2. Relative differences. As Stringham and others have pointed out, the relative difference between state rates in the study is slim enough that Utah’s rating (5.47 users per 1,000 people) was not so far above even the lowest state (Montana at 1.92) in the number of subscriptions. 

It should also be noted that the zip codes listed in the study with most subscribers do not include those with the highest number of Latter-day Saints, as might be expected if this were predominantly a Latter-day Saint problem. And Stringham also points out that “Idaho (25% Latter-day Saints) had the lowest rate of porn subscriptions per thousand broadband users in the U.S.”—another inconvenient figure only rarely cited.

It’s also relevant to remind people that Utah is hardly a monolithically Latter-day Saint state anymore—with less than 60% of the state identifying with the faith (and a substantial number of those not active).  

This visual from the 2015 peer-reviewed paper cited earlier demonstrates how the study above remains an outlier among other reviews.

Referring to this outlier 2009 study, the authors of that 2015 review conclude:

Rankings based on data from a single large paid subscription pornography website have no significant correlation with rankings based on the other three data sources. Since so much of online pornography is accessed for free, research based solely on paid subscription data may yield misleading conclusions.

The post Are Utahns Uniquely Drawn to Pornography? appeared first on Public Square Magazine.