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Nagata JM, Ganson KT, Griffiths S, Mitchison D, Garber AK, Vittinghoff E, Bibbins-Domingo K, Murray SB. Prevalence and correlates of muscle-enhancing behaviors among adolescents and young adults in the United States. Int J Adolesc Med Health 2020; 34:119-129. [PMID: 32549173 PMCID: PMC9972881 DOI: 10.1515/ijamh-2020-0001] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 02/16/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To determine the prevalence of muscle-enhancing behaviors in adolescents and young adults using a nationally representative sample in the USA and to examine differences by sex, race/ethnicity, age, socioeconomic status, body mass index, and participation in team sports. METHODS Prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I through III (1994-2002) were analyzed. Engagement in muscle-enhancing behaviors including dietary changes, exercise and weightlifting, supplement use, performance-enhancing substances, and anabolic androgenic steroids were recorded. Multiple logistic regression models using generalized estimating equations, incorporating robust standard errors with clustering by school and within persons, and using national sample weighting, were used to determine associations with muscle-enhancing behaviors across three data collection waves. RESULTS Of the 18,924 adolescents at baseline, 29.2% of males and 7.0% of females reported weight gain attempts, while 25.2% of males and 3.8% of females reported any muscle-enhancing behavior. All muscle-enhancing behaviors were more common in males compared to females (p<0.001). Among young men 18-26 years old, 15.6% reported using legal performance enhancing substances and 2.7% reported using androgenic anabolic steroids. Factors that were associated with muscle-enhancing behaviors in males across three data collection waves included Black or Hispanic/Latino race/ethnicity, age over 14 years, higher parental education, lower body mass index, and participation in team sports. CONCLUSIONS Muscle-enhancing behaviors ranging from dietary changes to supplement and androgenic anabolic steroid use are common among adolescent and young adult males. Clinicians should consider screening for muscle-enhancing behaviors in these populations.
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Affiliation(s)
- Jason M. Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | | | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia,Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andrea K. Garber
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA,Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Stuart B. Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
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Nagata JM, Domingue BW, Darmstadt GL, Weber AM, Meausoone V, Cislaghi B, Shakya HB. Gender Norms and Weight Control Behaviors in U.S. Adolescents: A Prospective Cohort Study (1994-2002). J Adolesc Health 2020; 66:S34-S41. [PMID: 31866036 PMCID: PMC6928570 DOI: 10.1016/j.jadohealth.2019.08.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this article was to determine the relationship between gender norms and weight control behaviors in U.S. adolescents. METHODS We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health (N = 9,861), at baseline in 1994-1995 (ages 11-18 years, Wave I), 1-year follow-up (ages 12-19 years, Wave II), and 7-year follow-up (ages 18-26 years, Wave III). The primary exposure variable was a measure of one's gender normativity based on the degree to which males and females behave in ways that are similar to the behaviors of their same-gender peers. The outcome variable was an individual's weight control attempts (trying to lose or gain weight) and behaviors (dieting, fasting/skipping meals, vomiting, or weight-loss pills/laxatives/diuretics to lose weight or ate different/more foods than usual or taking supplements to gain weight). RESULTS In logistic regression analyses controlling for potential confounders, a higher baseline individual gender normativity score (higher femininity in females and higher masculinity in males) was associated with weight loss attempts (β = .10; p = .01) and weight loss behaviors (β = .18; p < .001) in girls but was associated with weight gain attempts (β = .18; p < .001) and behaviors (β = .16; p < .001) in boys at 1-year follow-up. Higher individual gender normativity score was protective of weight loss attempts (β = -.15; p < .001) and weight loss behaviors (β = -.17; p < .001) in males but not females at 7-year follow-up. Loess plots provided visualizations of significant relationships. CONCLUSIONS Gender norms may reinforce a thinner body ideal for girls but a larger ideal for boys.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | | | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Ann M Weber
- School of Community Health Sciences, University of Nevada, Reno, Nevada
| | - Valerie Meausoone
- Stanford Center for Population Health Sciences, Stanford University, Stanford, California
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Holly B Shakya
- Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, California
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De Souza MJ, Koltun KJ, Williams NI. The Role of Energy Availability in Reproductive Function in the Female Athlete Triad and Extension of its Effects to Men: An Initial Working Model of a Similar Syndrome in Male Athletes. Sports Med 2019; 49:125-137. [PMID: 31696452 PMCID: PMC6901401 DOI: 10.1007/s40279-019-01217-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The Female Athlete Triad represents three interrelated conditions of (i) low energy availability (energy deficiency), presenting with or without disordered eating, (ii) menstrual dysfunction, and (iii) poor bone health, each of which can exist along a continuum of severity ranging from mild and moderate subclinical health concerns to severe clinical outcomes, including eating disorders, amenorrhea, and osteoporosis. This review provides a brief overview of the Female Athlete Triad, including updating the current thinking regarding energy availability and how it relates to reproductive function, and sets the stage for an initial working model of a similar syndrome in males that will be based on currently available evidence and will later be defined and referred to as a Male Athlete Triad by the newly re-named Female and Male Athlete Triad Coalition. A primary focus of this paper will be on the physiology of each Triad model with an emphasis on low energy availability and its role in reproductive function, with a brief introduction on its effects on bone health in men. From the data reviewed, (i) a specific threshold of energy availability below which menstrual disturbances are induced is not supported; (ii) it appears that the energetic, reproductive, and bone systems in men are more resilient to the effects of low energy availability compared to those of women, requiring more severe energetic perturbations before alterations are observed; and (iii) it appears that recovery of the hypothalamic pituitary gonadal axis can be observed more quickly in men than in women.
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Affiliation(s)
- Mary Jane De Souza
- Women’s Health and Exercise Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
| | - Kristen J. Koltun
- Women’s Health and Exercise Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
| | - Nancy I. Williams
- Women’s Health and Exercise Laboratory, Department of Kinesiology, The Pennsylvania State University, University Park, PA 16802 USA
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Nagata JM, Palar K, Gooding HC, Garber AK, Whittle HJ, Bibbins-Domingo K, Weiser SD. Food Insecurity Is Associated With Poorer Mental Health and Sleep Outcomes in Young Adults. J Adolesc Health 2019; 65:805-811. [PMID: 31587956 PMCID: PMC6874757 DOI: 10.1016/j.jadohealth.2019.08.010] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/15/2019] [Accepted: 08/10/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE The aim of the study was to determine the association between food insecurity, mental health, and sleep outcomes among young adults. Young adulthood represents an important developmental period when educational and economic transitions may increase the risk for food insecurity; however, little is known about associations between food insecurity and health outcomes in this period. METHODS Cross-sectional nationally representative data of U.S. young adults aged 24-32 years from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2018. Multiple logistic regression analysis was conducted with food insecurity as the independent variable and self-reported mental health (depression, anxiety, and suicidality) and sleep (trouble falling and staying asleep) outcomes as the dependent variables. RESULTS Of the 14,786 young adults in the sample, 11% were food insecure. Food-insecure young adults had greater odds of mental health problems including a depression diagnosis (1.67, 95% confidence interval [CI] 1.39-2.01), anxiety or panic disorder diagnosis (1.47, 95% CI 1.16-1.87), and suicidal ideation in the past 12 months (2.76, 95% CI 2.14-3.55). Food insecurity was also associated with poorer sleep outcomes including trouble falling (adjusted odds ratio 1.78, 95% CI 1.52-2.08) and staying (adjusted odds ratio 1.67, 95% CI 1.42-1.97) asleep. CONCLUSIONS Food insecurity is associated with poorer mental and sleep health in young adulthood. Health care providers should screen for food insecurity in young adults and provide referrals when appropriate. Future research should test interventions to simultaneously combat food insecurity and mental health problems in young adulthood.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California.
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Holly C Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Andrea K Garber
- Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Henry J Whittle
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California, San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Sheri D Weiser
- Department of Medicine, University of California, San Francisco, San Francisco, California
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Murray SB, Griffiths S, Lavender JM. Introduction to a special issue on eating disorders and related symptomatology in male populations. Int J Eat Disord 2019; 52:1339-1342. [PMID: 31609019 DOI: 10.1002/eat.23184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 09/28/2019] [Accepted: 09/29/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE It is our sincere pleasure to introduce a special issue of the International Journal of Eating Disorders focused on eating disorders and related symptoms in male populations. METHOD Contributions focused on three main themes among male populations: (a) the nature of eating disorder symptoms and recovery; (b) long-term outcomes following eating disorders treatment; and (c) muscularity-oriented symptoms of eating pathology. RESULTS The contributions to this special issue highlight the importance of better understanding how eating disorder symptoms manifest, may be maintained, and respond to treatment among male populations. Findings across the articles demonstrate some similarities between male and female samples with respect to core eating disorder symptoms, as well as important differences, particularly with respect to muscularity-oriented disordered eating. Findings related to treatment outcome also highlight the suboptimal long-term remission rates and elevated mortality among male inpatients with eating disorders. DISCUSSION The diverse range of samples, methodologies, and research questions addressed within this collection of papers demonstrates the breadth of the important scientific work on this topic. As eating disorders and related symptoms in male populations continue to be underrecognized and underserved, we hope that this special issue will encourage further high-quality clinical research in this area.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Military Cardiovascular Outcomes Research Program (MiCOR), Uniformed Services University of the Health Sciences, Bethesda, Maryland.,Metis Foundation, San Antonio, Texas
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Ganson KT, Murray SB, Nagata JM. A call for public policy and research to reduce use of appearance and performance enhancing drugs and substances among adolescents. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 4:13-14. [PMID: 31676196 DOI: 10.1016/s2352-4642(19)30345-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Kyle T Ganson
- School of Social Work, Simmons University, Boston, MA 02115, USA.
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; University of California, San Francisco, San Francisco, CA, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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