COSMETICS, SELF-ESTEEM, AND ATTRACTIVENESS 49 Kernaleguen add that facial attractiveness provides the applier satisfaction and profes- sional success (2). Religion is also considered as an important element of culture (17). It is also the main factor that controls the consumer behavior and the purchasing decision of different prod- ucts (18). Therefore, individuals select their cosmetics according to the opinions provided by the religious state they belong to (19). Consumer behavior is also found to be related to demographic variables. Young women between 19 and 23 years of age are more likely to use makeup than men of the same age. This usage of cosmetic supplements undergoes a signifi cant decrease after marriage (20). The purpose of this study was to assess the variables related to the usage of cosmetic prod- ucts among a representative sample of the Lebanese population to see if the cosmetic us- age is affected by factors similar to that in Western countries. This includes self-perception, facial attractiveness satisfaction, body image, and self-esteem. METHODS SAMPLING AND DATA COLLECTION This is a cross-sectional study, conducted between January 2018 and June 2018, which enrolled 2,072 female participants using a proportionate random sample from all Leba- nese Mohafazat (Beirut, Mount Lebanon, North, South, and Bekaa). Each Mohafaza is divided into Caza (stratum) two villages were randomly selected from the list of villages provided by the Central Agency of Statistics in Lebanon. Participants were randomly se- lected from each village. This population is appropriate for this research, as women are the primary users of cosmetics. All participants older than 15 years were eligible to par- ticipate late teens and early twenties are years when women are still developing cosmetic habits and patterns. Excluded were the participants with self-reported psychiatric prob- lems, mental retardation, dementia, or who refused to fi ll the questionnaire. Data collection was performed through personal interviews with participants by trained, study-independent personnel. ETHICAL APPROVAL The Psychiatric Hospital of the Cross Ethics and Research Committee, in compliance with the Hospital’s Regulatory Research Protocol, approved this study protocol (HPC- 018-2018). The purpose and requirement of the study was informed to each participant. Consent was obtained as written approval on the ethical consent form. QUESTIONNAIRE An Arabic questionnaire was used during the interview, Arabic being the native language of Lebanon. The fi rst part assessed the sociodemographic characteristics of the partici- pants (age, education level, marital status, socioeconomic level, and ideology). The other parts included the different scales used in this study as follows:

JOURNAL OF COSMETIC SCIENCE 50 Questionnaire on customary cosmetic usage. The scale contains nine items, which identify the frequency of using makeup. It consists of fi ve-point Likert scales (1 = strongly disagree and 5 = strongly agree) (21). Questions 3, 4, 5, and 6 were reversed. The customary cos- metic usage total score was calculated by summing the answers to all nine items. Higher scores would indicate higher makeup usage. Rosenberg self-esteem scale. This 10-item scale measures both positive and negative feelings about the self to evaluate self-worth (22). The answers were rated as follows: 1 (strongly agree), 2 (agree), 3 (disagree), and 4 (strongly disagree). Five questions (3, 5, 8, 9, and 10) were reversed while doing the score calculation. Higher scores indicated higher self- esteem. In our study, the Cronbach alpha was 0.802. Multidimensional body self-relations questionnaire (MBSRQ). Body image was measured using two subscales from the MBSRQ questionnaire: the appearance orientation (AO) question- naire that evaluates how attractive or unattractive and how happy or unhappy the person feels with his physical appearance and the appearance evaluation (AE) questionnaire (23) to assess the time and efforts spent by the person to “look good.” The AO and AE ques- tionnaires consist of fi ve-point Likert scales (1 = strongly disagree and 5 = strongly agree). The AO questionnaire contains 12 items, which identify the degree to which subjects consider appearance to be important. The AE questionnaire contains seven items, which identify the subjects’ attitudes regarding their appearance (23). In our study, the Cronbach alpha for AE and AO were 0.827 and 0.852, respectively. Modifi ed body areas satisfaction scale (BASS). The BASS, a subscale of the MBSRQ, identi- fi es subjects’ satisfaction with various areas of their body (23). For this study, the BASS has been modifi ed to include items on areas of the face and to eliminate areas of the body that are not included. BASS subjects are asked to indicate on a fi ve-point, Likert-type scale (1 = very dissatisfi ed and 5 = very satisfi ed). This scale was used as a measure of facial satisfaction with and without cosmetics use. It includes nine items on overall facial satis- faction. Subjects were asked to fi ll out this scale twice, one time to assess satisfaction while wearing cosmetics and a second time to assess satisfaction while not wearing makeup (23). In our study, the Cronbach alpha for the fi rst time questions while wearing cosmetics was 0.931 and for the second time while not wearing makeup was 0.922. STATISTICAL ANALYSES SPSS software version 23 (Statistical Package for Social Science, IBM Corp., Armonk, NY) was used to conduct data analysis. When comparing two means, we used the inde- pendent sample Student t-test. The Pearson correlation coeffi cient was used to assess the association between two continuous variables. A linear regression was conducted tak- ing the customary cosmetic usage score as the dependent variable. All variables that showed a p 0.1 value in the bivariate analysis were taken as independent variables in the model. Moreover, Cronbach’s alpha was recorded for reliability analysis for all the scales. A p-value less than 0.05 was considered signifi cant. RESULTS The sociodemographic characteristics of the participants are summarized in Table I. The mean age of the participants was 24.84 ± 9.75 years, with the majority being single