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Simone M, Askew A, Lust K, Eisenberg ME, Pisetsky EM. Disparities in self-reported eating disorders and academic impairment in sexual and gender minority college students relative to their heterosexual and cisgender peers. Int J Eat Disord 2020; 53:513-524. [PMID: 31943285 PMCID: PMC7156314 DOI: 10.1002/eat.23226] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/16/2019] [Accepted: 01/05/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of the current study was threefold: (a) compare rates of self-reported anorexia nervosa (AN), self-reported bulimia nervosa (BN), and eating pathology-specific academic impairment (EAI) by gender identity (cisgender men, cisgender women, transgender or genderqueer) and sexual orientation (gay or lesbian, bisexual, unsure, other), (b) examine associations between gender identity, sexual orientation, and eating outcomes, and (c) identify for whom rates of eating disorder diagnosis and impairment is greatest. METHOD The study includes a sample of Minnesota students (n = 13,906) who participated in the College Student Health Survey from 2015 to 2018. Chi-square tests with bootstrapping examined differences in eating pathology rates between groups. Adjusted logistic regressions tested the association between gender identity, sexual orientation, and self-reported eating outcomes. RESULTS Chi-square results revealed heightened rates of self-reported AN, self-reported BN, and EAI in cisgender women, transgender or genderqueer, and sexual minority (e.g., lesbian or bisexual) students. Logistic regression analyses in cisgender men and cisgender women revealed higher odds of self-reported AN, self-reported BN, and EAI in sexual minority students relative their heterosexual peers. Chi-square analyses indicated that bisexual cisgender women reported heightened rates of all three eating pathology measures relative to other sexual and/or gender (e.g., transgender) minority students. DISCUSSION Individuals with marginalized gender and/or sexual orientation identities report heightened rates of eating pathology, with cisgender bisexual women reporting the poorest outcomes relative to individuals from other marginalized identities. Preventive efforts and more research are needed to understand the mechanisms driving this disparity and to reduce prevalence among marginalized groups.
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Affiliation(s)
- Melissa Simone
- Department of Psychiatry and Behavioral Sciences; University of Minnesota, Minneapolis, MN, 55454
| | - Autumn Askew
- Department of Psychiatry and Behavioral Sciences; University of Minnesota, Minneapolis, MN, 55454
| | - Katherine Lust
- Boynton Health, University of Minnesota, Minneapolis, MN, 55455
| | - Marla E. Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55414
| | - Emily M. Pisetsky
- Department of Psychiatry and Behavioral Sciences; University of Minnesota, Minneapolis, MN, 55454
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152
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Community norms for the Eating Disorder Examination Questionnaire (EDE-Q) among transgender men and women. Eat Behav 2020; 37:101381. [PMID: 32416588 PMCID: PMC7447532 DOI: 10.1016/j.eatbeh.2020.101381] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 03/24/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022]
Abstract
Transgender men and women may be at risk for eating disorders, but prior community norms of the Eating Disorders Examination Questionnaire (EDE-Q) are based on presumed cisgender men and woman and have not intentionally included transgender people. The objective of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in transgender men and women using the EDE-Q. Participants were 312 transgender men and 172 transgender women participants in The PRIDE Study, an existing cohort study of sexual and gender minority people. We present mean scores, standard deviations, and percentile ranks for the Global score and four subscale scores of the EDE-Q in transgender men and women. Transgender men and women reported any occurrence (≥1/week) of dietary restraint (25.0% and 27.9%), objective binge episodes (11.2% and 12.8%), excessive exercise (8.0% and 8.1%), self-induced vomiting (1.6% and 1.7%), and laxative misuse (.3% and .6%), respectively. Compared to a prior study of presumed cisgender men 18-26 years (Lavender, De Young, & Anderson, 2010), our age-matched subsample of transgender men reported lower rates of objective binge episodes and excessive exercise. Compared to a prior study of presumed cisgender women 18-42 years (Mond, Hay, Rodgers, & Owen, 2006), we found that an age-matched sample of transgender women reported higher rates of dietary restraint but lower rates of excessive exercise. These norms should aid clinicians in applying and researchers in investigating and interpreting the EDE-Q scores of transgender men and women.
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153
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Mitchison D, Mond J, Bussey K, Griffiths S, Trompeter N, Lonergan A, Pike KM, Murray SB, Hay P. DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychol Med 2020; 50:981-990. [PMID: 31043181 DOI: 10.1017/s0033291719000898] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little information is available on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 eating disorders in adolescence, and eating disorders remain unique in the DSM for not systematically including a criterion for clinical significance. This study aimed to provide the first prevalence report of the full suite of DSM-5 eating disorders in adolescence, and to examine the impact of applying a criterion for clinical significance. METHODS In total, 5191 (participation rate: 70%) Australian adolescents completed a survey measuring 1-month prevalence of eating disorder symptoms for all criterial, 'other specified' and unspecified eating disorders, as well as health-related quality of life and psychological distress. RESULTS The point prevalence of any eating disorder was 22.2% (12.8% in boys, 32.9% in girls), and 'other specified' disorders (11.2%) were more common than full criterial disorders (6.2%). Probable bulimia nervosa and binge eating disorder, but not anorexia nervosa (AN), were more likely to be experienced by older adolescents. Most disorders were associated with an increased odds for being at a higher weight. The prevalence of eating disorders was reduced by 40% (to 13.6%) when a criterion for clinical significance was applied. CONCLUSIONS Eating disorders, particularly 'other specified' syndromes, are common in adolescence, and are experienced across age, weight, socioeconomic and migrant status. The merit of adding a criterion for clinical significance to the eating disorders, similar to other DSM-5 disorders, warrants consideration. At the least, screening tools should measure distress and impairment associated with eating disorder symptoms in order to capture adolescents in greatest need for intervention.
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Affiliation(s)
- Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Kay Bussey
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Scott Griffiths
- School for Psychological Sciences, University of Melbourne, Sydney, Australia
| | - Nora Trompeter
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Alexandra Lonergan
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Kathleen M Pike
- Departments of Psychiatry and Epidemiology, Columbia University, New York, USA
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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154
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Mensinger JL, Granche JL, Cox SA, Henretty JR. Sexual and gender minority individuals report higher rates of abuse and more severe eating disorder symptoms than cisgender heterosexual individuals at admission to eating disorder treatment. Int J Eat Disord 2020; 53:541-554. [PMID: 32167198 PMCID: PMC7187146 DOI: 10.1002/eat.23257] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 12/20/2022]
Abstract
Eating disorders (EDs) occur at higher rates among sexual/gender minorities (SGMs). We currently know little about the risk factor profile of SGMs entering ED specialty care. OBJECTIVE To (a) compare history of abuse-related risk in SGMs to cisgender heterosexuals (CHs) when entering treatment, (b) determine if SGMs enter and exit treatment with more severe ED symptoms than CHs, and (c) determine if SGMs have different rates of improvement in ED symptoms during treatment compared to CHs. METHOD We analyzed data from 2,818 individuals treated at a large, US-based, ED center, 471 (17%) of whom identified as SGM. Objective 1 was tested using logistic regression and Objectives 2 and 3 used mixed-effects models. RESULTS SGMs had higher prevalence of sexual abuse (OR = 2.10, 95% CI = 1.71, 2.58), other trauma (e.g., verbal/physical/emotional abuse; OR = 2.07, 95% CI = 1.68, 2.54), and bullying (OR = 2.13, 95% CI = 1.73, 2.62) histories. SGMs had higher global EDE-Q scores than CHs at admission (γ = 0.42, SE = 0.08, p < .001) but improved faster early in treatment (γ = 0.316, SE = 0.12, p = .008). By discharge, EDE-Q scores did not differ between SGMs and CHs. DISCUSSION Our main hypothesis of greater abuse histories among SGMs was supported and could be one explanation of their more severe ED symptoms at treatment admission compared to CHs. In addition, elevated symptom severity in SGMs at admission coincides with greater delay between ED onset and treatment initiation among SGMs-possibly a consequence of difficulties with ED recognition in SGMs by healthcare providers. We recommend increased training for providers on identifying EDs in SGMs to reduce barriers to early intervention.
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Affiliation(s)
- Janell L. Mensinger
- M. Louise Fitzpatrick College of NursingVillanova UniversityVillanovaPennsylvaniaUSA
- Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Janeway L. Granche
- Department of Epidemiology and Biostatistics, Dornsife School of Public HealthDrexel UniversityPhiladelphiaPennsylvaniaUSA
| | - Shelbi A. Cox
- Center For DiscoveryDiscovery Behavioral HealthLos AlamitosCaliforniaUSA
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155
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Bishop A, Overcash F, McGuire J, Reicks M. Diet and Physical Activity Behaviors Among Adolescent Transgender Students: School Survey Results. J Adolesc Health 2020; 66:484-490. [PMID: 31959401 DOI: 10.1016/j.jadohealth.2019.10.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/10/2019] [Accepted: 10/13/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE Diet and physical activity behaviors are determinants of health for adolescents; however, few studies have assessed these behaviors among transgender youth. This study examined dietary behaviors, physical activity, weight-based bullying, and weight status among four groups based on transgender and gender nonconforming (TGNC) status and birth-assigned sex. METHODS Data were from a large cross-sectional, population-based, statewide survey of high school students (n = 80,794, Minnesota Student Survey, 2016). Comparisons were made for dietary and physical activity behaviors among TGNC and cisgender youth and among TGNC birth-assigned males and females and cisgender males and females. RESULTS About 2.7% of the total survey respondents identified as TGNC. TGNC students were more likely to be ethnically diverse, not living with a biological parent, participating in free or reduced-price school meals, and skipping meals compared with cisgender students. TGNC youth reported less frequent intake of fruit and milk and more frequent intake of fast food and soft drinks than cisgender students. TGNC students were also more likely to be overweight or obese, bullied for weight or size, and less likely to be physically active compared with cisgender youth. TGNC birth-assigned males reported more frequent intake of fast food and soft drinks and less physical activity compared with TGNC birth-assigned females and cisgender boys and girls. CONCLUSIONS TGNC students reported more negative health behaviors than cisgender students. Programs to address disparities in diet and physical activity behaviors may need to be tailored by gender identity and gender identity subgroups.
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Affiliation(s)
- Anna Bishop
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota
| | - Francine Overcash
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota
| | - Jenifer McGuire
- Department of Family Social Sciences, University of Minnesota, St. Paul, Minnesota
| | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota.
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156
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Kirby SR, Linde JA. Understanding the Nutritional Needs of Transgender and Gender-Nonconforming Students at a Large Public Midwestern University. Transgend Health 2020; 5:33-41. [PMID: 32322686 PMCID: PMC7173688 DOI: 10.1089/trgh.2019.0071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: The purpose of this research was to generate knowledge of the nutrition-related health disparities and barriers to adequate nutrition and health that transgender and gender-nonconforming (GNC) university students experience. Methods: A needs assessment was conducted with 26 transgender/GNC students enrolled at a large public Midwestern university from November 2017 through February 2018. Interviews and surveys were used to collect qualitative and quantitative data regarding nutrition-related health disparities and barriers, and to identify potential interventions to reduce the disparities or barriers. Results: Major themes emerged around food insecurity, body image, nutrition knowledge and skills, dietary intake, and barriers to healthy eating and positive body image. Other themes included inclusiveness of existing resources and resource needs and preferences. Conclusion: Participants identified interventions that could be introduced on campus to improve their health and nutrition status. Comparisons between study participants and LGBTQ (lesbian, gay, bisexual, transgender, queer) populations in the Midwest and with the general student population at the same university show poorer results for dietary intake, body image behaviors, and food security among transgender/GNC study participants. Overall, this study provides a deeper understanding of nutrition-related needs among transgender/GNC university students.
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Affiliation(s)
- Sierra R Kirby
- Desert Farming Initiative, College of Agriculture Biotechnology and Natural Resources, University of Nevada, Reno, Reno, Nevada
| | - Jennifer A Linde
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota-Twin Cities, Minneapolis, Minnesota
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157
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Comiskey A, Parent MC, Tebbe EA. An Inhospitable World: Exploring a Model of Objectification Theory With Trans Women. PSYCHOLOGY OF WOMEN QUARTERLY 2020; 44:105-116. [PMID: 38283398 PMCID: PMC10817723 DOI: 10.1177/0361684319889595] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
In this study, we investigated key tenets of objectification theory, a prominent model of body image disturbance, as it relates to trans women's disordered eating and intention to obtain silicone injections-a specific health risk for this population. We also incorporated appearance congruence, or the degree to which an individual personally feels that their gender expression matches their gender identity, into the objectification theory model. Results of a structural equation model using data from a sample of 173 trans women from the United States indicated that the basic objectification theory model held among this sample and that appearance congruence was associated negatively with body surveillance. However, appearance congruence did not have significant direct or indirect links (via body surveillance and body shame) with disordered eating or intention to obtain silicone injections. Thus, disordered eating and intention to obtain silicone injections are potential negative outcomes of the process of objectification among trans women, and appearance congruence does not appear to be uniquely linked to health risks associated with internalization of cultural standards of attractiveness, body surveillance, and body shame. Our findings support the application of the tenets of objectification theory with trans women as they apply to disordered eating and intention to obtain silicone injections and also indicate the need to identify other positive influences on trans women's body image to counteract internalization of cultural standards of attractiveness.
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Affiliation(s)
- Allison Comiskey
- Department of Psychology and Philosophy, Texas Woman’s University, Denton, TX, USA
| | - Mike C. Parent
- Department of Educational Psychology, University of Texas at Austin, TX, USA
| | - Elliot A. Tebbe
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA
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158
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Shaw H, Rohde P, Desjardins CD, Stice E. Sexual orientation correlates with baseline characteristics but shows no moderating effects of dissonance-based eating disorder prevention programs for women. Body Image 2020; 32:94-102. [PMID: 31841780 PMCID: PMC8765481 DOI: 10.1016/j.bodyim.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 11/17/2022]
Abstract
This study provided the first test of whether sexual orientation (categorized as heterosexual vs. sexual minority) is associated with baseline eating disorder risk factors and symptoms, moderated the intervention effects of variants of the dissonance-based Body Project, or moderated the relation of baseline risk factors to future change in eating disorder symptoms. A total of 680 women with body image concerns were randomized to clinician-or peer-led Body Project groups, the eBody Project, or educational video control and completed assessment of eating disorder risk factors and symptoms at pretest, posttest, and at six-, 12-, 24-, and 36-month follow-up. Results indicated that sexual minority women had significantly higher negative affect and impaired psychosocial functioning at baseline, but did not differ on other eating disorder risk factors or symptoms. We found no evidence that sexual orientation moderates the effects of the Body Project on risk factor or symptom change over follow-up or the relation of baseline risk factors to future change in eating disorder symptoms. Overall, sexual minority and heterosexual women differ on two, less specific eating disorder-related risk factors at baseline, but did not differ in response to different versions of the Body Project or the relations of risk factors to future symptom change.
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Affiliation(s)
| | - Paul Rohde
- Oregon Research Institute, United States
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159
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Kamody RC, Grilo CM, Udo T. Disparities in DSM-5 defined eating disorders by sexual orientation among U.S. adults. Int J Eat Disord 2020; 53:278-287. [PMID: 31670848 DOI: 10.1002/eat.23193] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The increased occurrence of disordered eating behaviors among sexual minorities is well established; however, few studies have examined disparities in eating disorder diagnoses among this population. This study sought to examine lifetime prevalence estimates of DSM-5 defined EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) as a function of sexual orientation. We then compared prevalence of EDs based on experiences with perceived discrimination. METHOD A nationally representative sample of U.S. adults (N = 35,995) participating in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III completed structured diagnostic interviews. RESULTS Prevalence rates were significantly higher among sexual minorities than heterosexual respondents for all EDs: AN = 1.71% (SE = 0.50) versus 0.77% (SE = 0.07), BN = 1.25% (SE = 0.37) versus 0.24% (SE = 0.03), BED = 2.17% (SE = 0.52) versus 0.81% (SE = 0.05). Odds of lifetime diagnosis were significantly greater among sexual minorities for AN (adjusted odds ratio [AOR] = 1.93), BN (AOR = 3.69), and BED (AOR = 2.32), after adjusting for sociodemographic variables. Sexual minorities reporting experiences with perceived discrimination had significantly higher prevalence of AN than those not endorsing perceived discrimination: 3.78% (SE = 1.43) versus 0.82% (SE = 0.33); AOR = 5.06. There were no significant differences in prevalence of BN or BED by perceived discrimination. DISCUSSION Findings indicate that sexual minorities are disproportionately affected by EDs. Further research is needed to better understand mechanisms contributing to these disparities and heightened risk for EDs.
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Affiliation(s)
- Rebecca C Kamody
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University of Albany, State University of New York, Albany, New York
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160
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Kaltiala-Heino R, Lindberg N. Gender identities in adolescent population: Methodological issues and prevalence across age groups. Eur Psychiatry 2020; 55:61-66. [DOI: 10.1016/j.eurpsy.2018.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 01/16/2023] Open
Abstract
AbstractBackground:Increasing numbers of adolescents are seeking treatment from gender identity services, particularly natal girls. It is known from survey studies some adolescents exaggerate their belonging to minorities, thereby distorting prevalence estimates and findings on related problems. The aim of the present study was to explore the susceptibility of gender identity to mischievous responding, and prevalences of cis-gender, opposite-sex and other/ non-binary gender identities as corrected for likely mischievous responding among Finnish adolescents.Method:The School Health Promotion Survey 2017 data was used, comprising data on 135,760 adolescents under 21 years (mean 15.73, ds 1.3 years), 50.6% females and 49.4% males. Sex and perceived gender were elicited and gender identities classified based thereon. Likely mischievous responding was analysed using inappropriate responses to biodata and handicaps.Results:Of the participants, 3.5% had most likely given facetious responses, boys more commonly than girls, and younger adolescents more commonly than older. This particularly concerned reporting of non-binary gender identity. Corrected prevalence of opposite-sex identification was 0.6% and that of non-binary identification was 3.3%. In boys, displaying non-binary gender identity increased from early to late adolescence, while among girls, opposite-sex and non-binary identifications decreased in prevalence from younger to older age groups.Conclusion:Prevalence of gender identities contrary to one’s natal sex was more common than expected.
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161
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Parker LL, Harriger JA. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. J Eat Disord 2020; 8:51. [PMID: 33088566 PMCID: PMC7566158 DOI: 10.1186/s40337-020-00327-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND According to past research, lesbian, gay, bisexual, and transgender (LGBT) individuals experience a higher prevalence of psychopathology, which is attributable to the increased stress (i.e., stigma and prejudice) that they experience, as detailed by the minority stress model (MSM). MAIN This current literature review examined the empirical literature regarding the rates and types of, and risk factors for eating disorders and disordered eating behaviors in LGBT adults and adolescents, in addition to each individual subgroup (i.e., lesbians, gay males, bisexuals, transgender and gender-nonconforming individuals). CONCLUSION LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Additionally, gay, bisexual, and transgender adults and adolescents were all at increased risk for eating disorders and disordered eating behaviors. Mixed results were found for lesbian adults and adolescents. Results are discussed within the framework of the MSM.
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Affiliation(s)
- Lacie L Parker
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Suite 106, Loma Linda, CA 92350 USA
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162
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Nagata JM, Capriotti MR, Murray SB, Compte EJ, Griffiths S, Bibbins-Domingo K, Obedin-Maliver J, Flentje A, Lubensky M, Lunn MR. Community norms for the Eating Disorder Examination Questionnaire among cisgender gay men. EUROPEAN EATING DISORDERS REVIEW 2020; 28:92-101. [PMID: 31793119 PMCID: PMC7275693 DOI: 10.1002/erv.2708] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/07/2019] [Accepted: 09/15/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Prior norms of the Eating Disorders Examination Questionnaire (EDE-Q) among men have not considered sexual orientation. This study's objective was to assess EDE-Q community norms among cisgender gay men. METHOD Participants were 978 self-identified cisgender gay men from The PRIDE Study recruited in 2018. RESULTS We present mean scores and standard deviations for the EDE-Q among cisgender gay men ages 18-82. Among cisgender gay men, 4.0% scored in the clinically significant range on the global score, 5.7% on the restraint, 2.1% on the eating concern, 10.5% on the weight concern, and 21.4% on the shape concern subscales of the EDE-Q. The global score as well as weight and shape concerns in a young adult subsample (18-26 years) from The PRIDE Study were higher than previously reported norms in young men (Lavender, 2010). Participants reported any occurrence (≥1/28 days) of dietary restraint (19.8%), objective binge episodes (10.9%), excessive exercise (10.1%), laxative misuse (1.1%), and self-induced vomiting (0.6%). Binge eating, excessive exercise, and self-induced vomiting in The PRIDE Study subsample were lower than previously reported in young men. DISCUSSION We provide EDE-Q norms among cisgender gay men, which should aid clinicians and researchers to interpret the EDE-Q scores of cisgender gay men.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Matthew R. Capriotti
- Department of Psychology, San José State University, San Jose, CA
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
| | - Stuart B. Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Emilio J Compte
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
- School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina
- DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
| | - Kirsten Bibbins-Domingo
- Department of Medicine, University of California, San Francisco, San Francisco, CA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA
| | - Micah Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA
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163
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Durbeej N, Abrahamsson N, Papadopoulos FC, Beijer K, Salari R, Sarkadi A. Outside the norm: Mental health, school adjustment and community engagement in non-binary youth. Scand J Public Health 2019; 49:529-538. [PMID: 31868564 DOI: 10.1177/1403494819890994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims: The aim of this study was to explore the role of self-reported non-binary gender identity in mental health problems, school adjustment, and wish to exert influence on municipal issues in a community sample of adolescents. Methods: In a cross-sectional design, data were collected through an anonymous survey in Uppsala County, Sweden, among 8385 students (response rate 58.2%) in grades 7, 9, and 11, aged 13-17 years. The Strengths and Difficulties Questionnaire (SDQ) self-report was used to assess mental health problems. Gender identity was measured with one item and youth were categorized into those who identified as male or female (i.e. binary youth), and those who did or could not identify with either gender (i.e. non-binary youth). Logistic regressions and qualitative content analysis were used to analyse data. Results: Youth with non-binary gender identity (n = 137; 1.6%) had higher odds of having mental problems according to the SDQ total score (OR=3.05; 1.77-5.25). The association between non-binary gender identity and mental health problems remained significant after adjusting for confounders. Additionally, compared to their binary peers, the non-binary youth reported more truancy (36.5% vs 49.6%), more often failed a subject (21.5% vs 36.5%), and were more interested in exerting influence on municipal issues such as sociopolitical development, education, municipal services, and drug and alcohol policies (25.3% vs 38.0%). Conclusions: Youth with non-binary gender identity constitute a vulnerable population regarding mental health problems and school adjustment. The willingness to exert influence on municipal issues suggests a possible pathway to engagement.
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Affiliation(s)
- Natalie Durbeej
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Ninnie Abrahamsson
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | | | - Karin Beijer
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Raziye Salari
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
| | - Anna Sarkadi
- Child Health and Parenting (CHAP), Department of Public Health and Caring Sciences, Uppsala University, Sweden
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164
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Schier HE, Linsenmeyer WR. Nutrition-Related Messages Shared Among the Online Transgender Community: A Netnography of YouTube Vloggers. Transgend Health 2019; 4:340-349. [PMID: 31872063 PMCID: PMC6918534 DOI: 10.1089/trgh.2019.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose: Nutrition care guidelines for the transgender population do not exist, despite significant nutrition-related clinical and psychosocial considerations. Social networking sites (SNSs) provide multidirectional communication and have expanded in popularity among transgender users as a resource for health information and support. The nature of the content shared among the online transgender community is unknown, but may suggest the nutrition-related areas that are of most importance to the transgender population. The objective of this qualitative netnography was to describe the food and nutrition messages shared among the transgender community using video blogs (vlogs) on the SNS, YouTube. Methods: Public vlogs were assessed using the constant comparative method. Pseudoquantitative methods were used to capture the prevalence of each subtheme; quotes were documented verbatim. Data were collected from transgender users' public vlogs (n=30) self-published on YouTube from 2013 to 2018. Results: Six major themes were generated from the data analysis. These included the following: functions of diet and exercise; diet and exercise philosophies; "how to" vlogs; advice for success; using dietary supplements; and effects of hormone therapy. Conclusions: Nutrition-related messages are widely shared among the online transgender community through YouTube. The identified themes reflect topics of interest and expressed needs of transgender individuals. SNSs provide health care providers with a platform to improve patient education and health literacy. Health care providers may actively engage in online discussions to build trust, answer questions, and provide a source of accurate and evidence-based information.
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Affiliation(s)
- Heather E. Schier
- Department of Nutrition and Dietetics, Saint Louis University, St. Louis, Missouri
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165
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Avila JT, Golden NH, Aye T. Eating Disorder Screening in Transgender Youth. J Adolesc Health 2019; 65:815-817. [PMID: 31500946 DOI: 10.1016/j.jadohealth.2019.06.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/22/2019] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Body dissatisfaction in transgender youth (TY) may increase the risk for eating disorders. This is the first study using the Eating Disorders Examination Questionnaire (EDE-Q) to assess for eating disorder psychopathology in TY. METHODS Youth aged 13-22 years (n = 106) presenting to a gender clinic from January 2018 to January 2019 completed the EDE-Q and answered questions on weight manipulation for gender-affirming purposes. RESULTS Respondents identified as transmasculine (61%), transfeminine (28%), or nonbinary (11%). Mean age was 16.5 years (standard deviation = 2.0), mean weight was 119.9% median body mass index (standard deviation = 32.9), and 32% were on hormonal therapy. Of the participants, 15% had elevated EDE-Q scores. Most (63%) disclosed weight manipulation for gender-affirming purposes, with 11% of assigned females doing so for menstrual suppression. These behaviors had poor concordance with elevated EDE-Q scores (κ = .137 and .148). CONCLUSIONS Disordered eating behaviors are relatively common among TY. Further studies are needed to validate the EDE-Q in TY and establish meaningful cutoff score values.
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Affiliation(s)
- Jonathan T Avila
- Division of Adolescent Medicine, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California.
| | - Neville H Golden
- Division of Adolescent Medicine, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
| | - Tandy Aye
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Lucile Packard Children's Hospital, Stanford University School of Medicine, Palo Alto, California
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166
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Kant RMN, Wong-Chung A, Evans EH, Stanton EC, Boothroyd LG. The Impact of a Dissonance-Based Eating Disorders Intervention on Implicit Attitudes to Thinness in Women of Diverse Sexual Orientations. Front Psychol 2019; 10:2611. [PMID: 31849745 PMCID: PMC6895132 DOI: 10.3389/fpsyg.2019.02611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 11/18/2022] Open
Abstract
Dissonance-based body image programs have shown long-term effectiveness in preventing eating disorders and reducing risk factors for eating disorders in women. Here we report on the potential for one such intervention to impact on implicit attitudes toward thinness as well as an explicit measure of eating attitudes, across a sexually diverse group of young women. The Succeed Body Image Programme was adapted to remove heteronormative assumptions and was delivered to a final sample of 56 undergraduate women who reported their sexual orientation as either “predominantly heterosexual” (our term; 1 or 2 on a 7-point Kinsey scale, n = 38) or non-heterosexual (3–7 on the Kinsey scale, n = 18). Before and after the intervention, they completed the Eating Attitudes Test-26, and an associative reaction time task based on the Implicit Association Test, in which bodies of low and higher weight were paired with socially desirable or undesirable traits. A total of 37 predominantly heterosexual women completed a control intervention in which they read NHS leaflets on eating disorders and healthy weight. Results showed that the intervention made predominantly heterosexual participants less prone, versus control, to associating thinness with positive traits on the IAT and all women completing the intervention reported a lower level of disordered eating attitudes at post- than pre-test. Non-heterosexual women, however, showed a non-significant increase in thin-bias on the IAT, perhaps due to their low baseline. These results imply that intensive dissonance-based programs can change attitudes at the automatic, implicit level as well as merely giving women tools to overcome those implicit attitudes.
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Affiliation(s)
- R M Naina Kant
- Department of Psychology, Durham University, Durham, United Kingdom
| | - Agnes Wong-Chung
- Department of Psychology, Durham University, Durham, United Kingdom
| | - Elizabeth H Evans
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elaine C Stanton
- Department of Psychology, Durham University, Durham, United Kingdom
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167
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Handler T, Hojilla JC, Varghese R, Wellenstein W, Satre DD, Zaritsky E. Trends in Referrals to a Pediatric Transgender Clinic. Pediatrics 2019; 144:peds.2019-1368. [PMID: 31619510 PMCID: PMC6855897 DOI: 10.1542/peds.2019-1368] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES We characterized referral trends over time at a transgender clinic within an integrated health system in Northern California. We identified the transition-related requests of pediatric transgender and gender-nonconforming patients and evaluated differences in referrals by age group. METHODS Medical records were analyzed for all patients <18 years of age in the Kaiser Permanente Northern California health system who were referred to a specialty transgender clinic between February 2015 and June 2018. Trends in treatment demand, demographic data, service requests, and surgical history were abstracted from medical charts and analyzed by using descriptive statistics. RESULTS We identified 417 unique transgender and gender-nonconforming pediatric patients. The median age at time of referral was 15 years (range 3-17). Most (62%) identified on the masculine spectrum. Of the 203 patients with available ethnicity data, 68% were non-Hispanic. During the study period, the clinic received a total of 506 referrals with a significant increase over time (P < .001). Most referrals were for requests to start cross-sex hormones and/or blockers (34%), gender-affirming surgery (32%), and mental health (27%). Transition-related requests varied by age group: younger patients sought more mental health services, and older patients sought hormonal and surgical services. Eighty-nine patients underwent gender-affirming surgeries, mostly before age 18 and most frequently mastectomies (77%). CONCLUSIONS The increase in referrals supports the need for expanded and accessible health care services for this population. The transition-related care of patients in this large sample varied by age group, underscoring the need for an individualized approach to gender-affirming care.
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Affiliation(s)
| | - J. Carlo Hojilla
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California; and,Division of Research and
| | - Reshma Varghese
- Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California
| | - Whitney Wellenstein
- Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California
| | - Derek D. Satre
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, California; and,Division of Research and
| | - Eve Zaritsky
- Obstetrics and Gynecology, Kaiser Permanente Northern California, Oakland, California
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168
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Bonifacio JH, Maser C, Stadelman K, Palmert M. Management of gender dysphoria in adolescents in primary care. CMAJ 2019; 191:E69-E75. [PMID: 30665976 DOI: 10.1503/cmaj.180672] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Joseph H Bonifacio
- Department of Pediatrics (Bonifacio), St. Michael's Hospital; Departments of Pediatric Endocrinology (Palmert) and of Adolescent Medicine (Maser, Stadelman), The Hospital for Sick Children; Lawrence S. Bloomberg Faculty of Nursing (Maser), University of Toronto, Toronto, Ont.
| | - Catherine Maser
- Department of Pediatrics (Bonifacio), St. Michael's Hospital; Departments of Pediatric Endocrinology (Palmert) and of Adolescent Medicine (Maser, Stadelman), The Hospital for Sick Children; Lawrence S. Bloomberg Faculty of Nursing (Maser), University of Toronto, Toronto, Ont
| | - Katie Stadelman
- Department of Pediatrics (Bonifacio), St. Michael's Hospital; Departments of Pediatric Endocrinology (Palmert) and of Adolescent Medicine (Maser, Stadelman), The Hospital for Sick Children; Lawrence S. Bloomberg Faculty of Nursing (Maser), University of Toronto, Toronto, Ont
| | - Mark Palmert
- Department of Pediatrics (Bonifacio), St. Michael's Hospital; Departments of Pediatric Endocrinology (Palmert) and of Adolescent Medicine (Maser, Stadelman), The Hospital for Sick Children; Lawrence S. Bloomberg Faculty of Nursing (Maser), University of Toronto, Toronto, Ont.
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169
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Epidemiologic Characteristics and Postoperative Complications following Augmentation Mammaplasty: Comparison of Transgender and Cisgender Females. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2461. [PMID: 31772890 PMCID: PMC6846310 DOI: 10.1097/gox.0000000000002461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022]
Abstract
Breast augmentation in transgender women can be an important first step in addressing gender incongruence and improving psychosocial functioning. The aim of this study was to compare postoperative outcomes of augmentation mammoplasty in transgender and cisgender females.
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170
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Coelho JS, Suen J, Clark BA, Marshall SK, Geller J, Lam PY. Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review. Curr Psychiatry Rep 2019; 21:107. [PMID: 31617014 DOI: 10.1007/s11920-019-1097-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW This scoping review includes recent literature on eating disorder diagnoses and evaluation of eating disorder symptom presentation among transgender youth (ages 8-25). RECENT FINDINGS A total of 20 publications from the previous 5 years were identified, including case reports, retrospective chart reviews, and surveys. Significantly higher rates of eating disorder symptoms were documented in transgender youth compared to cisgender youth. Similarly, some studies reported transgender youth were more likely to be diagnosed with an eating disorder than cisgender youth, though the proportion of youth with eating disorder diagnoses varied across studies. A consistent theme across case studies was engagement in food restriction and/or compensatory eating behaviors to prevent puberty onset or progression, suggesting that for some transgender youth, these behaviors may be understood as a means of coping with gender-related distress. Clinical care could be enhanced through establishment of best practices for screening in settings offering eating disorder treatment and gender-affirming care, as well as greater collaboration among these programs. Research is needed to validate eating disorder measures for use with transgender youth and evaluate the effects of eating disorder treatment and gender-affirming medical interventions on the well-being of transgender youth.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Healthy Minds Centre, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada.
| | - Janet Suen
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Healthy Minds Centre, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Beth A Clark
- Allen-Berenson Fellow in Women's, Gender, and Sexuality Studies, Brandeis University, Waltham, MA, 02453, USA
| | - Sheila K Marshall
- School of Social Work, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
- Eating Disorders Program, St. Paul's Hospital, Vancouver, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children & Adolescents, BC Children's Hospital, Healthy Minds Centre, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- Division of Adolescent Health & Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, V6T 1Z4, Canada
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171
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Grammer AC, Byrne ME, Pearlman AT, Klein DA, Schvey NA. Overweight and obesity in sexual and gender minority adolescents: A systematic review. Obes Rev 2019; 20:1350-1366. [PMID: 31334601 DOI: 10.1111/obr.12906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/14/2019] [Accepted: 05/15/2019] [Indexed: 12/21/2022]
Abstract
Population data indicate that sexual and gender minority adolescents may be at increased risk for excess weight gain compared with cisgender, heterosexual youth. However, no studies, to our knowledge, have systematically reviewed the literature on weight disparities in this population nor explored risk for overweight and obesity by sexual and gender minority subgroup across studies. The current systematic review, therefore, identified 21 studies that assessed the relationship between sexual and gender minority status and weight among adolescents. Results indicated an overall greater prevalence of overweight and obesity among sexual and gender minority adolescents compared with cisgender, heterosexual youth. However, cisgender sexual minority males demonstrated lower or no added risk for overweight and obesity, whereas cisgender sexual minority females demonstrated greater risk for overweight and obesity. Findings were mixed among gender minority adolescents. This study highlights weight disparities in sexual and gender minority youth, although important subgroup differences exist. Additional research is needed to elucidate the mechanisms that may contribute to differential weight trajectories in this population and to develop tailored approaches for prevention and treatment.
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Affiliation(s)
- Anne Claire Grammer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, 63110
| | - Meghan E Byrne
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814.,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892
| | - Arielle T Pearlman
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814
| | - David A Klein
- Department of Family Medicine, Fort Belvoir Community Hospital (FBCH), Fort Belvoir, Virginia, 22032.,Department of Family Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814.,Department of Pediatrics, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland, 20814.,Section on Growth and Obesity, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), DHHS, Bethesda, Maryland, 20892
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172
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Bowling J, Schoebel V, Vercruysse C. Perceptions of Resilience and Coping Among Gender-Diverse Individuals Using Photography. Transgend Health 2019; 4:176-187. [PMID: 31482133 PMCID: PMC6716192 DOI: 10.1089/trgh.2019.0015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Gender-diverse individuals (those whose gender and/or sex differ from societal expectations, such as trans or genderqueer) face stigma and discrimination, which can translate into negative health outcomes. Resilience describes the process of overcoming adversity that can mitigate these negative effects. Previous work has focused on trans individuals only or measured resilience without first exploring subjective understandings. Purpose: We sought to explore subjective perceptions of resilience among gender-diverse individuals. Methods: This qualitative study uses longitudinal photo-elicited interviews (in which participants' photos prompt interview discussion) with 21 gender diverse individuals (35 total interviews or a 66% retention rate). Interviews were separated by 6 months and transcripts were analyzed using Dedoose software, with each coded twice by separate coders. Results: Participants' strategies to foster resilience included proactive approaches at both the internal and external levels and distracting/temporary approaches. Two themes, flexibility and awareness, emerged as central facets of resilience trajectories. Flexibility took several forms and was intrinsic to cognitive processes, as well as coping choices, and sought through mental training techniques, such as meditation. Participants demonstrated high levels of awareness by incorporating trauma and health outcomes in gender-diverse populations within their narratives, and through the recognition of the unhelpful aspect of avoidant strategies in building resilience. Conclusions: The diverse ways that individuals perceive their own resilience have implications for resilience research in this group and have the potential to inform the development of strength-based interventions tailored to gender-diverse individuals. Public health interventions targeting resilience have the potential to break the pathway linking adversity to ill health among gender-diverse individuals, thereby reducing health disparities in this group.
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Affiliation(s)
- Jessamyn Bowling
- Department of Public Health Sciences, UNC Charlotte, Charlotte, North Carolina
| | - Victoria Schoebel
- Department of Public Health Sciences, UNC Charlotte, Charlotte, North Carolina
| | - Chloe Vercruysse
- Department of Public Health Sciences, UNC Charlotte, Charlotte, North Carolina
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173
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Tanner D. The body politic: The changing face of psychotherapy and transgender. PSYCHOTHERAPY AND POLITICS INTERNATIONAL 2019. [DOI: 10.1002/ppi.1507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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174
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Using body neutrality to inform eating disorder management in a gender diverse world. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:597-598. [DOI: 10.1016/s2352-4642(19)30237-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/22/2019] [Accepted: 07/15/2019] [Indexed: 01/14/2023]
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175
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Schaefer LM, Anderson LM, Simone M, O’Connor SM, Zickgraf H, Anderson DA, Rodgers RF, Thompson JK. Gender-based differential item functioning in measures of eating pathology. Int J Eat Disord 2019; 52:1047-1051. [PMID: 31233228 PMCID: PMC6815513 DOI: 10.1002/eat.23126] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 05/10/2019] [Accepted: 06/07/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Eating disorder (ED) symptoms are common and impairing in males, despite their perception as "female" disorders. As existing self-report symptom measures were developed and primarily validated in women, there is a need to establish the utility of these measures in men. The present study used differential item functioning (DIF) analyses to explore whether item endorsement differed by gender for three commonly used ED symptom measures. METHOD Participants were undergraduate men (n = 1,083) and women (n = 2,424) from three universities in the United States. Global scores on the Eating Attitudes Test-26 (EAT-26), Eating Disorder Examination Questionnaire (EDEQ), and Eating Disorder Diagnostic Scale for DSM-IV (EDDS) were examined. Tests of DIF were conducted by regressing each item against its composite scale score, and then comparing fit and variance explained (R2 ) to a model with the interaction of item*gender. The clinical significance threshold for DIF is ΔR2 ≥ 0.13. RESULTS There was no evidence of clinically significant DIF within the EAT-26, EDEQ, or EDDS. DISCUSSION Findings suggest that the examined measures perform similarly for undergraduate men and women, supporting their use in nonclinical male samples. However, development and testing of items reflecting ED symptoms that more commonly occur in males (e.g., muscularity-oriented behaviors) is encouraged.
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Affiliation(s)
- Lauren M. Schaefer
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota
| | - Lisa M. Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota
| | - Melissa Simone
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota
| | - Shannon M. O’Connor
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Hana Zickgraf
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois
| | - Drew A. Anderson
- Department of Psychology, University at Albany-State University of New York, Albany, New York
| | - Rachel F. Rodgers
- Northeastern University, Boston, Massachusetts,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
| | - J. Kevin Thompson
- Department of Psychology, University of South Florida, Tampa, Florida
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176
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Weiselberg EC, Shadianloo S, Fisher M. Overview of care for transgender children and youth. Curr Probl Pediatr Adolesc Health Care 2019; 49:100682. [PMID: 31706835 DOI: 10.1016/j.cppeds.2019.100682] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Over the past decade, more and more children and adolescents are identifying as transgender and gender diverse (TGD). Often, they and their parents first turn to their primary care pediatrician for guidance and support. Therefore, in 2018, the American Academy of Pediatrics (AAP) released a policy statement focusing on the health care of TGD youth.4 The AAP acknowledges that many pediatricians have a lack of training in this area and therefore need to increase their knowledge base and expertise in order to provide culturally competent care. While most sexual and gender minority individuals are healthy and well adjusted, some TGD youth are at an increased risk of mental health concerns, including anxiety, depression, substance abuse, eating disorders and suicidality. This is theorized to be due to the experienced or internalized marginalization, stigmatization, victimization, harassment or rejection and not inherent in having gender dysphoria or being transgender. The pediatrician therefore needs to be knowledgeable of, and skilled to screen for, the health disparities that may exist, as well as to be able to support the individual who may disclose their gender identity status during treatment. Parents and guardians may also turn to the pediatrician for guidance when faced with their child who presents with gender non-conforming behaviors or gender dysphoria. Therefore the pediatrician needs to be able to guide the parents as well, as their acceptance and support of their child's journey to gender identity is probably the most important protective factor against health disparities encountered. To deliver optimum care for TGD children and youth, the pediatrician needs to establish an office setting that is inclusive, gender-neutral and TGD friendly. By becoming familiar with the diversity of gender expression and identities, use of gender-appropriate terminology, health disparities often encountered and the importance of providing a safe and welcoming environment, issues that are all covered in this article, the primary care pediatrician will be in position to provide comprehensive health care to this often marginalized population.
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Affiliation(s)
- Eric C Weiselberg
- Division of Adolescent Medicine, Department of Pediatrics, Cohen Children's Medical Center, Northwell Health System, 410 Lakeville Road, Suite 108, New Hyde Park, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States.
| | - Shervin Shadianloo
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States; Division of Child and Adolescent Psychiatry, Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, New Hyde Park, NY, United States
| | - Martin Fisher
- Division of Adolescent Medicine, Department of Pediatrics, Cohen Children's Medical Center, Northwell Health System, 410 Lakeville Road, Suite 108, New Hyde Park, NY, United States; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
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177
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Carretta RF, Szymanski DM, DeVore E. Predictors of disordered eating and acceptance of cosmetic surgery among drag queen performers. Body Image 2019; 30:64-74. [PMID: 31174082 DOI: 10.1016/j.bodyim.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 01/25/2023]
Abstract
In this study, we examined the relations between drag queens' gendered performance styles and body change attitudes and behaviors. We also examined potential mediating and moderating variables in these links via two moderated mediation models. Participants consisted of 192 drag queen performers who completed a web-based survey. Hyper-feminine but not gender fluid drag was positively related to disordered eating, acceptance of cosmetic surgery, internalization of cultural standards of beauty, and upward appearance comparison. Both internalization of cultural standards of beauty and upward appearance comparison mediated the hyper-feminine drag and disordered eating link. Beauty internalization also mediated the hyper-feminine drag and acceptance of cosmetic surgery link but upward appearance comparison did not. We discovered two significant conditional indirect effects, in which the indirect effect of the hyper-feminine drag on both disordered eating and acceptance of cosmetic surgery via internalization of cultural standards of beauty were stronger for those with high levels of drag identity salience. Finally, we found a conditional direct effect, where hyper-feminine drag predicted acceptance of cosmetic surgery among drag queens with high and average levels of drag identity salience but not low levels.
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Affiliation(s)
| | - Dawn M Szymanski
- Department of Psychology, University of Tennessee, United States
| | - Elliott DeVore
- Department of Psychology, University of Tennessee, United States
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178
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Bell K, Rieger E, Hirsch JK. Corrigendum: Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Gender Non-conforming Adults: Comparative Levels and a Proposed Mediational Model. Front Psychol 2019; 10:1540. [PMID: 31354571 PMCID: PMC6635763 DOI: 10.3389/fpsyg.2019.01540] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/01/2019] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyg.2018.02692.].
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Affiliation(s)
- Kathryn Bell
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
| | - Elizabeth Rieger
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
| | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, TN, United States
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179
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McDowell A, Progovac AM, Cook BL, Rose S. Estimating the Health Status of Privately Insured Gender Minority Children and Adults. LGBT Health 2019; 6:289-296. [PMID: 31314674 DOI: 10.1089/lgbt.2018.0238] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Purpose: The purpose of this study was to characterize the health status of privately insured gender minority individuals. Methods: We created a diagnosis-based algorithm to identify gender minority children and adults in the 2009-2015 IBM® MarketScan® Commercial Database. We compared the age-adjusted health status among individuals with and without gender minority-related diagnosis codes. Results: The percentage of the privately insured population with gender minority-related diagnosis codes increased from 0.004% in 2009 to 0.026% in 2015. Age-adjusted analyses demonstrated that individuals with gender minority-related diagnosis codes were more likely to have diagnoses for mental health disorders (odds ratio [OR] = 8.5; 95% confidence interval [CI] = 8.1-9.0), substance use disorders (OR = 3.4; 95% CI = 2.9-3.9), and diabetes (OR = 1.4; 95% CI = 1.2-1.6), driven by high prevalence of these conditions among individuals younger than 18 years. Conclusions: Our findings highlight a markedly greater prevalence of mental health and substance use disorder diagnoses among privately insured gender minority individuals. These results establish a reference point for evaluating the impact of federal- and state-level policies that ban health insurance discrimination based on gender identity on the health and health care use of gender minority individuals.
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Affiliation(s)
- Alex McDowell
- PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts.,Department of Health Care Policy and Harvard Medical School, Boston, Massachusetts
| | - Ana M Progovac
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Benjamin Lê Cook
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Health Equity Research Lab, Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Sherri Rose
- Department of Health Care Policy and Harvard Medical School, Boston, Massachusetts
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180
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Abstract
Although sexual minority women (SMW) and transgender women have become increasingly visible in recent years and have made progress in achieving civil rights, they continue to face significant levels of discrimination, stigma, and physical violence. As a result, each group faces a wide variety of health disparities, including mental illness and substance use disorders. Overall, both SMW and transgender women experience higher rates of mood and anxiety disorders, suicidality, and substance use disorders than their heterosexual and cisgender counterparts. This article is a general introduction to these issues and concludes with recommendations for working with sexual minority and transgender women.
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Affiliation(s)
- Julie K Schulman
- Department of Psychiatry, Allen Hospital, 5141 Broadway, 3 River East, New York, NY 10034, USA.
| | - Laura Erickson-Schroth
- Department of Psychiatry, Mount Sinai Beth Israel, 10 Nathan D. Perlman Place, New York, NY 10003, USA
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181
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Abstract
Extensive research demonstrates unequivocally that nutrition plays a fundamental role in maintaining health and preventing disease. In parallel nutrition research provides evidence that the risks and benefits of diet and lifestyle choices do not affect people equally, as people are inherently variable in their responses to nutrition and associated interventions to maintain health and prevent disease. To simplify the inherent complexity of human subjects and their nutrition, with the aim of managing expectations for dietary guidance required to ensure healthy populations and individuals, nutrition researchers often seek to group individuals based on commonly used criteria. This strategy relies on demonstrating meaningful conclusions based on comparison of group mean responses of assigned groups. Such studies are often confounded by the heterogeneous nutrition response. Commonly used criteria applied in grouping study populations and individuals to identify mechanisms and determinants of responses to nutrition often contribute to the problem of interpreting the results of group comparisons. Challenges of interpreting the group mean using diverse populations will be discussed with respect to studies in human subjects, in vivo and in vitro model systems. Future advances in nutrition research to tackle inter-individual variation require a coordinated approach from funders, learned societies, nutrition scientists, publishers and reviewers of the scientific literature. This will be essential to develop and implement improved study design, data recording, analysis and reporting to facilitate more insightful interpretation of the group mean with respect to population diversity and the heterogeneous nutrition response.
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182
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Body size and weight, and the nutrition and activity behaviours of sexual and gender minority youth: findings and implications from New Zealand. Public Health Nutr 2019; 22:2346-2356. [PMID: 31159912 DOI: 10.1017/s1368980019001149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To describe the body size and weight, and the nutrition and activity behaviours of sexual and gender minority (SGM) students and compare them with those of exclusively opposite-sex-attracted cisgender students. Male and female SGM students were also compared. DESIGN Data were from a nationally representative health survey. SETTING Secondary schools in New Zealand, 2012. PARTICIPANTS A total of 7769 students, 9 % were SGM individuals. RESULTS Overall, weight-control behaviours, poor nutrition and inactivity were common and, in many cases, more so for SGM students. Specifically, male SGM students (adjusted OR; 95 % CI) were significantly more likely to have tried to lose weight (1·95; 1·47, 2·59), engage in unhealthy weight control (2·17; 1·48, 3·19), consume fast food/takeaways (2·89; 2·01, 4·15) and be physically inactive (2·54; 1·65, 3·92), and were less likely to participate in a school sports team (0·57; 0·44, 0·75), compared with other males. Female SGM students (adjusted OR; 95 % CI) were significantly more likely to engage in unhealthy weight control (1·58; 1·20, 2·08), be overweight or obese (1·24; 1·01, 1·53) and consume fast food/takeaways (2·19; 1·59, 3·03), and were less likely to participate in a school sports team (0·62; 0·50, 0·76), compared with other females. Generally, female SGM students were more negatively affected than comparable males, except they were less likely to consume fast food/takeaways frequently (adjusted OR; 95 % CI: 0·62; 0·40, 0·96). CONCLUSIONS SGM students reported increased weight-control behaviours, poor nutrition and inactivity. Professionals, including public health nutritionists, must recognize and help to address the challenges facing sexual and gender minorities.
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183
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Miller JM, Luk JW. A Systematic Review of Sexual Orientation Disparities in Disordered Eating and Weight-Related Behaviors among Adolescents and Young Adults: Toward a Developmental Model. ADOLESCENT RESEARCH REVIEW 2019; 4:187-208. [PMID: 31602392 PMCID: PMC6786790 DOI: 10.1007/s40894-018-0079-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 01/05/2018] [Indexed: 06/01/2023]
Abstract
Adolescence is a sensitive period for the development of disordered eating and weight-related behaviors, and sexual minorities may be particularly at risk due to heightened minority stress and challenges related to sexual identity development. This review synthesized findings from 32 articles that examined sexual orientation disparities (each with a heterosexual referent group) in four disordered eating behaviors (binging, purging, restrictive dieting, diet pill use) and four weight-related behaviors (eating behaviors, physical activity, body image, and Body Mass Index [BMI]). Potential variations by outcome, sex, race/ethnicity, and developmental stage were systematically reviewed. Evidence supporting sexual orientation disparities in disordered eating and weight-related behaviors was more consistent among males than females. Among females, sexual orientation disparities in disordered eating behaviors appeared to be more pronounced during adolescence than in young adulthood. Sexual minority females generally reported more positive body image than heterosexual females but experienced disparities in BMI. Sexual orientation differences in eating behaviors and physical activity were especially understudied. Incorporating objectification and minority stress theory, a developmental model was devised where body image was conceptualized as a key mechanism leading to disordered eating behaviors. To advance understanding of sexual orientation disparities and tailor intervention efforts, research in this field should utilize longitudinal study designs to examine developmental variations and incorporate multi-dimensional measurements of sexual orientation and body image.
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Affiliation(s)
- Jacob M Miller
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20817, USA
- Colorado College, WB#1195, 902 N Cascade Ave, Colorado Springs, CO 80946, USA
| | - Jeremy W Luk
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20817, USA
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184
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Simone M, Hooper L, Eisenberg ME, Neumark-Sztainer D. Unhealthy weight control behaviors and substance use among adolescent girls: The harms of weight stigma. Soc Sci Med 2019; 233:64-70. [PMID: 31181470 DOI: 10.1016/j.socscimed.2019.05.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/14/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023]
Abstract
RATIONALE Unhealthy weight control behaviors (UWCBs) often predict future substance use, resulting in a comorbidity that predicts later health consequences. OBJECTIVE The current study aimed to examine whether weight stigma and its associated harms magnify or attenuate the effect of UWCBs at baseline on substance use at 10-year follow-up among girls and to elucidate factors related to the perceived harms of weight stigma. METHODS Data from 1147 adolescent girls from Project EAT (Eating and Activity in Teens and Young Adults) were analyzed at baseline and 10-year follow-up. Participants were split into three groups at baseline: no weight stigma; weight stigma only (being teased by peers or parents); and weight stigma with perceived harms (e.g., being bothered by teasing). Moderation and stratified regression analyses examined the role of weight stigma and its perceived harms on the relationship between UWCBs and substance use. ANOVA models aimed to elucidate factors related to the perceived harms of weight stigma. RESULTS Moderation analyses revealed marginally significant effects of group membership on the effect of UWCB on substance use (p = .08). Stratified regression results indicated that UWCBs at baseline predicted substance use at 10-year follow-up among girls in the weight stigma with perceived harms group (p = .005), but not in the no weight stigma or weight stigma only groups. Girls in the weight stigma with perceived harms group reported higher weight concern, depressive symptoms and BMIs than girls who report no weight stigma or weight stigma only. CONCLUSIONS Health initiatives should seek to reduce weight stigma and its associated harms to prevent substance use in girls and women. Clinicians working with adolescent girls with UWCB should inquire about experiences with weight stigma with its harms to assess substance use risk. Due to the marginally significant moderation, results should be interpreted with caution. CONCLUSIONS Health initiatives should seek to reduce weight stigma and its associated harms to prevent substance use in girls and women. Clinicians working with adolescent girls with UWCB should inquire about experiences with weight stigma with its harms to assess substance use risk. Due to the marginally significant moderation, results should be interpreted with caution.
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Affiliation(s)
- Melissa Simone
- University of Minnesota, Minneapolis, MN, USA; Department of Psychiatry, 2450 Riverside Avenue, F227, Minneapolis, MN, 55454, USA.
| | - Laura Hooper
- University of Minnesota, Minneapolis, MN, USA; Division of Epidemiology and Community Health, School of Public Health, 1300 South 2nd Street, Minneapolis, MN, 55454, USA
| | - Marla E Eisenberg
- University of Minnesota, Minneapolis, MN, USA; Department of Pediatrics, 717 Delaware Street SE, Minneapolis, MN, 55455, USA
| | - Dianne Neumark-Sztainer
- University of Minnesota, Minneapolis, MN, USA; Division of Epidemiology and Community Health, School of Public Health, 1300 South 2nd Street, Minneapolis, MN, 55454, USA
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185
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Duffy ME, Henkel KE, Joiner TE. Prevalence of Self-Injurious Thoughts and Behaviors in Transgender Individuals With Eating Disorders: A National Study. J Adolesc Health 2019; 64:461-466. [PMID: 30314865 DOI: 10.1016/j.jadohealth.2018.07.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/18/2018] [Accepted: 07/18/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE This study examined prevalence of self-injurious thoughts and behaviors (SITBs) in transgender individuals with eating disorders, as compared to cisgender individuals with eating disorders and transgender individuals without eating disorders. METHODS Data were analyzed from 365,749 individuals (median age 21 years, 71.8% White/Caucasian, 34.9% male, 64.9% female, and 0.2% transgender) who participated in American College Health Association-National College Health Assessment, an annual national assessment of college student health, from 2008 to 2011. RESULTS Rates of past-year nonsuicidal self-injury, suicidal ideation, and suicide attempts were elevated in transgender participants with eating disorders (74.8%, 75.2%, and 74.8%, respectively), as compared to cisgender participants with eating disorders and transgender participants without eating disorders. Follow-up logistic regression analyses indicated these differences were statistically significant above and beyond the effects of demographic variables and depression. CONCLUSIONS Results found extremely high rates of SITBs in transgender individuals with eating disorders. This combination of identities, each associated with SITBs, may have a compounding effect.
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Affiliation(s)
- Mary E Duffy
- Department of Psychology, Florida State University, Tallahassee, Florida; Department of Psychology, University of Saint Joseph, West Hartford, Connecticut.
| | - Kristin E Henkel
- Department of Psychology, University of Saint Joseph, West Hartford, Connecticut
| | - Thomas E Joiner
- Department of Psychology, Florida State University, Tallahassee, Florida
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186
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Kaltiala-Heino R, Työläjärvi M, Lindberg N. Gender dysphoria in adolescent population: A 5-year replication study. Clin Child Psychol Psychiatry 2019; 24:379-387. [PMID: 30968719 DOI: 10.1177/1359104519838593] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to explore whether there has been an increase in prevalence and changes in sex ratio in feelings of gender dysphoria (GD) in an adolescent population in Northern Europe, and to study the impact of invalid responding on this topic. We replicated an earlier survey among junior high school students in Tampere, Finland. All first and second year students, aged 16-18, in the participating schools were invited to respond to an anonymous classroom survey on gender experience during the 2012-2013 school year and in the spring and autumn terms of 2017. Gender identity/GD was measured using the GIDYQ-A. A total of 318 male and 401 female youth participated in 2012-2013, and 326 male and 701 female youth in 2017. In the earlier survey, the GIDYQ-A scores, both among males and females, were strongly skewed toward a cis-gender experience with very narrow interquartile ranges. Of males, 2.2%, and of females, 0.5% nevertheless reported possibly clinically significant GD. The 2017 GIDYQ-A distribution was similarly skewed. The proportion of those reporting potentially clinically significant GD was 3.6% among males and 2.3% among females. Validity screening proved to have a considerable impact on conclusions. GD seems to have increased in prevalence in the adolescent population.
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Affiliation(s)
- Riittakerttu Kaltiala-Heino
- 1 Department of Adolescent Psychiatry, Tampere University Hospital, Finland.,2 Vanha Vaasa Hospital, Finland.,3 Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Marja Työläjärvi
- 1 Department of Adolescent Psychiatry, Tampere University Hospital, Finland
| | - Nina Lindberg
- 4 Forensic Psychiatry, Helsinki University and Helsinki University Hospital, Finland
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187
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Luk JW, Miller JM, Lipsky LM, Gilman SE, Haynie DL, Simons-Morton BG. A longitudinal investigation of perceived weight status as a mediator of sexual orientation disparities in maladaptive eating behaviors. Eat Behav 2019; 33:85-90. [PMID: 31030007 PMCID: PMC6535347 DOI: 10.1016/j.eatbeh.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 03/20/2019] [Accepted: 04/17/2019] [Indexed: 10/27/2022]
Abstract
Sexual minority adolescents are more likely than heterosexual peers to engage in maladaptive eating behaviors such as restrictive dieting. However, prior studies relied on cross-sectional data and did not test potential mechanisms. This study examined longitudinal associations between adolescent sexual minority status and three maladaptive eating behaviors (restrictive dieting, diet pill use, and drug-related dieting) in young adulthood and tested higher perceived weight status as a mediator of observed disparities. Data were drawn from Waves 2 (11th grade in 2010/2011) to 7 (4 years post high school in 2015/2016) of the NEXT Generation Health Study, a U.S. national longitudinal cohort of adolescents (n = 1925). Logistic regression analyses revealed that, relative to heterosexual females, sexual minority females were more likely to report any restrictive dieting (extreme food intake restriction) in the past year (62.9% vs. 37.0%; Adjusted Odds Ratio = 2.26, 95% CI = 1.07, 4.76). Associations between sexual minority status and diet pills use or drug-related dieting were not found. Results from structural equation modeling indicated that higher perceived weight status was a significant mediator of the association between sexual minority status and restrictive dieting among females. These findings highlight higher perceived weight status as an important cognitive mechanism explaining why sexual minority females are at heightened risk for restrictive dieting in young adulthood. To optimally inform prevention efforts, additional research is needed to test the extent to which minority stressors may shape weight perceptions and their contribution to maladaptive and disordered eating behaviors among sexual minority adolescents.
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Affiliation(s)
- Jeremy W Luk
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20817, USA.
| | - Jacob M Miller
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20817, USA; Colorado College, WB#1195, 902 N Cascade Ave, Colorado Springs, CO 80946, USA
| | - Leah M Lipsky
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20817, USA
| | - Stephen E Gilman
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20817, USA; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Denise L Haynie
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20817, USA
| | - Bruce G Simons-Morton
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6710B Rockledge Drive, MSC 7004, Bethesda, MD 20817, USA
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188
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Sharma A, Kahle E, Todd K, Peitzmeier S, Stephenson R. Variations in Testing for HIV and Other Sexually Transmitted Infections Across Gender Identity Among Transgender Youth. Transgend Health 2019; 4:46-57. [PMID: 30805557 PMCID: PMC6386078 DOI: 10.1089/trgh.2018.0047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Purpose: Transgender youth are at high risk for human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), but their rates of screening are unknown. This study sought to quantify HIV and other STI testing levels and to examine variations in testing levels across three categories of gender identity: transgender men, transgender women, and nonbinary individuals. Methods: Between June 2017 and June 2018, 186 transgender youth aged 15–24 years were recruited into a randomized trial of home HIV testing supplemented with telehealth-based counseling. Information on sociodemographics, health care utilization, sexual activity, stress and resilience, and history of HIV and other STI testing was obtained. Multivariable logistic regression models were formulated to identify variations in testing for HIV and other STIs across gender identities. Results: Twenty-eight of 186 participants (15.1%) reported testing for HIV in the past year, and 42 (22.6%) reported testing for other STIs. Transgender women were less likely to have been tested for HIV (adjusted odds ratio [aOR]: 0.15, 95% confidence interval [CI]: 0.03–0.78) and other STIs (aOR: 0.33, 95% CI: 0.11–0.99), but nonbinary individuals were equally likely to have been tested compared with transgender men. Participants who agreed that their health care provider is knowledgeable about transgender health issues were thrice as likely to have been tested for HIV (aOR: 3.29, 95% CI: 1.36–7.97) and other STIs (aOR: 3.05, 95% CI: 1.40–6.63) compared with those who disagreed. Conclusion: Low levels of testing among transgender youth highlight the exigency of improving gender- and age-appropriate HIV and other STI prevention services. Given that provider knowledge of transgender health issues was strongly associated with testing, training health care providers in transgender-related care could prove beneficial.
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Affiliation(s)
- Akshay Sharma
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan
- Address correspondence to: Akshay Sharma, MBBS, MPH, PhD, Department of Health Behavior and Biological Sciences, Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, 400 N Ingalls Street, Ann Arbor, MI 48109,
| | - Erin Kahle
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Kieran Todd
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Sarah Peitzmeier
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, Michigan
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, Michigan
- Department of Systems, Population and Leadership, School of Nursing, University of Michigan, Ann Arbor, Michigan
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189
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Goldhammer HB, Maston ED, Keuroghlian AS. Addressing Eating Disorders and Body Dissatisfaction in Sexual and Gender Minority Youth. Am J Prev Med 2019; 56:318-322. [PMID: 30554976 DOI: 10.1016/j.amepre.2018.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Hilary B Goldhammer
- National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Essence D Maston
- National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Alex S Keuroghlian
- National LGBT Health Education Center at The Fenway Institute, Fenway Health, Boston, Massachusetts; Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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190
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Calzo JP, Turner BC, Marro R, Phillips GL. Alcohol Use and Disordered Eating in a US Sample of Heterosexual and Sexual Minority Adolescents. J Am Acad Child Adolesc Psychiatry 2019; 58:200-210. [PMID: 30738547 PMCID: PMC6369698 DOI: 10.1016/j.jaac.2018.09.437] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 08/29/2018] [Accepted: 09/13/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To expand knowledge of co-occurring alcohol use and disordered eating behaviors (DEB) among sexual minority (ie, nonheterosexual) youth. METHOD Using pooled 2009 to 2015 US Youth Risk Behavior Surveys (322,687 students; 7.3% lesbian, gay, bisexual), multivariable logistic regression models examined the following: (1) associations of age of onset of drinking and past month binge drinking with past year DEB (fasting, diet pill use, purging, steroid use); and (2) effect modification by sexual orientation. RESULTS Alcohol use and sexual minority identity were independently associated with elevated odds for diet pill use and purging among female adolescents, and with fasting and steroid use among male adolescents. Odds of fasting increased with greater frequency of monthly binge drinking among heterosexual adolescent female youth, and odds of diet pill use increased with greater frequency of monthly binge drinking among heterosexual adolescent male youth. DEB prevalence was particularly pronounced among adolescents who binge drank and who were not sure of their sexual orientation identity. Among male adolescents not sure of their sexual orientation identity, those who binge drank more than 1 day in the past month had 8.63 to 23.62 times the odds of using diet pills relative to those who did not binge drink, and 13.37 to 26.42 times the odds of purging relative to those who did not binge drink. CONCLUSION More research is needed on psychosocial factors underlying alcohol use and DEB in youth of all sexual orientations.
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Affiliation(s)
- Jerel P. Calzo
- the Division of Health Promotion and Behavioral Science, San Diego State University Graduate School of Public Health, CA, and the Institute for Behavioral and Community Health, San Diego State University Research Foundation, CA
| | - Blair C. Turner
- the Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Rachel Marro
- the Feinberg School of Medicine, Northwestern University, Chicago, IL
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191
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Zelkowitz RL, Cole DA. Self-Criticism as a Transdiagnostic Process in Nonsuicidal Self-Injury and Disordered Eating: Systematic Review and Meta-Analysis. Suicide Life Threat Behav 2019; 49:310-327. [PMID: 29504147 PMCID: PMC6123292 DOI: 10.1111/sltb.12436] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 09/21/2017] [Indexed: 12/14/2022]
Abstract
Nonsuicidal self-injury (NSSI) and disordered eating (DE) are highly comorbid and may be regarded as belonging to a spectrum of self-harm behaviors. We investigated self-criticism as a transdiagnostic correlate of these behaviors, in keeping with etiological theories of both NSSI and DE. We reviewed the literature and meta-analyzed the relation of self-criticism to both NSSI (15 studies; 17 effect sizes) and DE (24 studies; 29 effect sizes). Results showed equivalent, moderate-to-large effects for the relation of self-criticism to NSSI (r = .38; CI: .29-.46) and DE (r = .40; CI: .34-.45). The relation of NSSI to self-criticism generalized across multiple potential moderators. DE behavior type moderated the relation of self-criticism to DE, with a stronger relation emerging for purging than restriction. Findings support self-criticism as a possible candidate for transdiagnostic pathways to self-harm.
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Affiliation(s)
- Rachel L. Zelkowitz
- Department of Psychology and Human Development; Vanderbilt University; Nashville TN USA
| | - David A. Cole
- Department of Psychology and Human Development; Vanderbilt University; Nashville TN USA
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192
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Bell K, Rieger E, Hirsch JK. Eating Disorder Symptoms and Proneness in Gay Men, Lesbian Women, and Transgender and Non-conforming Adults: Comparative Levels and a Proposed Mediational Model. Front Psychol 2019; 9:2692. [PMID: 30671007 PMCID: PMC6331421 DOI: 10.3389/fpsyg.2018.02692] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/14/2018] [Indexed: 11/13/2022] Open
Abstract
In this study we sought to compare eating disorder attitudes and behaviors, and proneness to an eating disorder (“ED proneness”), between gay men, lesbian women, and transgender and gender non-conforming (TGNC) adults. A further aim was to identify and compare risk and protective factors, and examine a mediational model based on the interpersonal theory of eating disorders (IPT-ED), whereby the association between interpersonal factors and ED proneness would be mediated by psychological constructs pertaining to the self and negative affect. Data was obtained from a larger national study of health risk and protective factors among sexual minority and gender diverse populations. The sample included 97 gay men, 82 lesbian women, and 138 TGNC adults. Participants completed the National College Health Assessment, Eating Disorders Screen for Primary Care, Patient Health Questionnaire Depression scale, Generalized Anxiety Disorder 7 scale, Self-Compassion Scale-Short Form, Negative Social Exchange subscale of the Multidimensional Health Profile, Interpersonal Needs Questionnaire, and Perceived Stigma Scale. There was a significant difference between groups in ED proneness, with lesbian women (66.7%) having a significantly higher percentage than gay men (47.6%). There was also a significant difference between groups in weight-based self-worth, with the lowest percentage in gay men (63%) and the highest percentage in lesbian women (82%), as well as dissatisfaction with eating patterns, with the highest percentage in TGNC adults (69.8%) and the lowest percentage in gay men (47.7%). There was a low percentage of inappropriate compensatory behaviors, with no significant difference between groups. Logistic regression analyses showed that the predictor variables of ED proneness were depression, perceived stigma, and self-compassion in gay men; depression in lesbian women; and self-compassion in the TGNC adults. Mediation analyses showed that thwarted belongingness (i.e., an unmet to belong) and perceived stigma had an indirect association with ED proneness that was mediated by self-compassion and depression (for perceived stigma alone) in gay men, depression in lesbian women, and self-compassion in TGNC adults. The interpersonal theory of eating disorders therefore extends to sexual minority and gender diverse populations; however, the results suggest a broadening of theoretical models and intervention programs to include the role of stigma and self-compassion.
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Affiliation(s)
- Kathryn Bell
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
| | - Elizabeth Rieger
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
| | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, TN, United States
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193
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Stigma control model of dysregulated eating: A momentary maintenance model of dysregulated eating among marginalized/stigmatized individuals. Appetite 2019; 132:67-72. [DOI: 10.1016/j.appet.2018.09.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/18/2022]
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194
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Abstract
Trans women are a key, yet under-researched, population in the HIV epidemic. However, there remains a paucity of data on the health and wellbeing of trans women at risk of, or living with, HIV in the United Kingdom. This article provides a narrative review of key empirical research into HIV among trans women. In an effort to explore individual and social factors in relation to HIV in this population, we outline key tenets of identity process theory from social psychology and the concept of structural violence from medical anthropology. We focus on published studies around the following themes: (1) epidemiological data, (2) syndemic factors (3) barriers to social support, (4) HIV and gender transitioning, and (5) access to and engagement with health care. We identify lacunae and thus call for United Kingdom-based research in the following areas: (1) the prevalence and incidence of HIV in trans women, (2) the impact of syndemic factors on HIV risk and acquisition in trans women, (3) the nature of social support for coping with syndemic factors, (4) the interface of gender transitioning and HIV, and (5) barriers to accessing HIV prevention and care services. There is great scope (and urgency) for research into HIV among trans women, especially in the United Kingdom, to reduce incidence in this group, to enhance engagement in HIV care across the care continuum, and to improve the health and wellbeing of those living with HIV. A tentative model for HIV prevention and care is presented in this article.
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Affiliation(s)
- Rusi Jaspal
- Faculty of Health & Life Sciences, De Montfort University, Leicester, United Kingdom.,Minority Research Profile, Åbo Akademi University, Turku, Finland
| | - Lauren Kennedy
- Faculty of Health & Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Shema Tariq
- Centre for Clinical Research in Infection and Sexual Health, University College London, London, United Kingdom
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195
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Corella D, Coltell O, Portolés O, Sotos-Prieto M, Fernández-Carrión R, Ramirez-Sabio JB, Zanón-Moreno V, Mattei J, Sorlí JV, Ordovas JM. A Guide to Applying the Sex-Gender Perspective to Nutritional Genomics. Nutrients 2018; 11:E4. [PMID: 30577445 PMCID: PMC6357147 DOI: 10.3390/nu11010004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023] Open
Abstract
Precision nutrition aims to make dietary recommendations of a more personalized nature possible, to optimize the prevention or delay of a disease and to improve health. Therefore, the characteristics (including sex) of an individual have to be taken into account as well as a series of omics markers. The results of nutritional genomics studies are crucial to generate the evidence needed so that precision nutrition can be applied. Although sex is one of the fundamental variables for making recommendations, at present, the nutritional genomics studies undertaken have not analyzed, systematically and with a gender perspective, the heterogeneity/homogeneity in gene-diet interactions on the different phenotypes studied, thus there is little information available on this issue and needs to be improved. Here we argue for the need to incorporate the gender perspective in nutritional genomics studies, present the general context, analyze the differences between sex and gender, as well as the limitations to measuring them and to detecting specific sex-gene or sex-phenotype associations, both at the specific gene level or in genome-wide-association studies. We analyzed the main sex-specific gene-diet interactions published to date and their main limitations and present guidelines with recommendations to be followed when undertaking new nutritional genomics studies incorporating the gender perspective.
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Affiliation(s)
- Dolores Corella
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain.
| | - Oscar Coltell
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Department of Computer Languages and Systems, Universitat Jaume I, 12071 Castellón, Spain.
| | - Olga Portolés
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain.
| | - Mercedes Sotos-Prieto
- School of Applied Health Sciences and Wellness, Ohio University, Athens, OH 45701, USA.
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Rebeca Fernández-Carrión
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain.
| | | | - Vicente Zanón-Moreno
- Ophthalmology Research Unit "Santiago Grisolia", Dr. Peset University Hospital, 46017 Valencia, Spain.
- Red Temática de Investigación Cooperativa OftaRed, Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Josiemer Mattei
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - José V Sorlí
- CIBER Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, 46010 Valencia, Spain.
| | - Jose M Ordovas
- Nutrition and Genomics Laboratory, JM-USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA 02111 USA.
- Department of Cardiovascular Epidemiology and Population Genetics, Centro Nacional de Investigaciones Cardiovasculares (CNIC), 28029 Madrid, Spain.
- IMDEA Alimentación, 28049 Madrid, Spain.
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196
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Chiniara LN, Bonifacio HJ, Palmert MR. Characteristics of Adolescents Referred to a Gender Clinic: Are Youth Seen Now Different from Those in Initial Reports? Horm Res Paediatr 2018; 89:434-441. [PMID: 29920505 DOI: 10.1159/000489608] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 04/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To examine characteristics, including mental health comorbidities, among adolescents presenting to a transgender clinic and to compare these data to previous reports. METHODS Retrospective chart review among youth seen at The Hospital for Sick Children between January 2014 and June 2016. Demographic data, clinical characteristics, and mental health comorbidities were assessed. Baseline and repeat blood work were also examined. RESULTS Charts from 203 adolescents aged 12-18 years were reviewed (156 assigned female at birth [AFAB] (77%) aged 16.3 ± 1.63 years, 47 assigned male at birth [AMAB] aged 16.1 ± 1.70 years). There was no statistically significant difference between gender groups except for Tanner stage (AFAB, mean 4.42 ± 0.8 and AMAB, mean 4.03 ± 1.1, p = 0.040). Individuals from racial/ethnic minority populations were under-represented compared to the background population. Self-report and baseline psychological questionnaires showed high levels of gender dysphoria, mood disorders, and suicidal ideation, with higher levels of anxiety detected on questionnaires among AFAB (p = 0.03). Laboratory abnormalities identified on baseline and repeat testing were minor; on cross-sex hormones, hemoglobin levels increased slightly in AFAB (p = 0.002, highest = 166 g/L) and decreased among AMAB (p = 0.02, lowest = 132 g/L). CONCLUSION Our study supports an evolving demographic trend with more AFAB than AMAB youth now presenting to gender clinics. The data also corroborate studies indicating that extensive laboratory testing may not be a necessary part of caring for these youths. Why more AFAB are now presenting to clinic and racial/ethnic minorities are underrepresented is not clear, but these trends have important implications for clinical care and warrant further study.
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Affiliation(s)
- Lyne N Chiniara
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Herbert J Bonifacio
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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197
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Becker I, Auer M, Barkmann C, Fuss J, Möller B, Nieder TO, Fahrenkrug S, Hildebrandt T, Richter-Appelt H. A Cross-Sectional Multicenter Study of Multidimensional Body Image in Adolescents and Adults with Gender Dysphoria Before and After Transition-Related Medical Interventions. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2335-2347. [PMID: 30088234 DOI: 10.1007/s10508-018-1278-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 03/15/2018] [Accepted: 07/15/2018] [Indexed: 05/28/2023]
Abstract
Persistent feelings of gender dysphoria (GD) are accompanied by distress and body dissatisfaction in most clinically referred adolescents and adults. Transition-related medical interventions (e.g., puberty suppression, hormones, or surgery) may alleviate body dissatisfaction. The aim of the present cross-sectional study was to compare multidimensional body image across clinically referred adolescents and adults undergoing different transition-related medical interventions. Two clinical samples of adolescents (n = 82) and adults (n = 120) referred to specialized departments of four different transgender health services in Germany participated in the study. In total, 202 individuals from the female-to-male (FtM individuals) and male-to-female (MtF individuals) spectrum aged 14-74 years were included at different stages of their transition. Four scales assessing multidimensional aspects of body image (measured by the Body Image Assessment Questionnaire, FBeK) were compared across three groups: sample, gender, and medical interventions (while controlling for age and treatment duration). The results indicated less favorable body image scores compared with the norm in both adolescents and adults with GD. Individuals who had undergone transition-related medical interventions presented a significantly better body image on two of the four scales. Differences according to gender and age were also present. These findings suggest that medical interventions, especially gender-affirming hormones and surgery, are generally beneficial to the body image in individuals with GD. However, not all of the less favorable outcomes in multidimensional body image were positively influenced by the treatment conditions and may thus benefit from additional integrative counseling before and during transition.
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Affiliation(s)
- Inga Becker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany.
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Matthias Auer
- RG Clinical Neuroendocrinology, Max Planck Institute for Psychiatry, Munich, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Johannes Fuss
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Birgit Möller
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Münster, Münster, Germany
| | - Timo O Nieder
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Saskia Fahrenkrug
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Hertha Richter-Appelt
- Institute for Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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198
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Turan Ş, Aksoy Poyraz C, Usta Sağlam NG, Demirel ÖF, Haliloğlu Ö, Kadıoğlu P, Duran A. Alterations in Body Uneasiness, Eating Attitudes, and Psychopathology Before and After Cross-Sex Hormonal Treatment in Patients with Female-to-Male Gender Dysphoria. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2349-2361. [PMID: 29594702 DOI: 10.1007/s10508-018-1189-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/28/2018] [Accepted: 03/02/2018] [Indexed: 05/28/2023]
Abstract
Body dissatisfaction plays an important role in the development of psychiatric problems such as eating disorders as well as gender dysphoria (GD). Cross-sex hormonal treatment (CHT) alleviates the dissatisfaction by making various changes in the body. We examined the alteration of body uneasiness, eating attitudes and behaviors, and psychological symptoms longitudinally in Turkish participants with female-to-male gender dysphoria (FtM GD) after CHT. Thirty-seven participants with FtM GD and 40 female controls were asked to complete the Body Uneasiness Test to explore different areas of body-related psychopathology, the Eating Attitudes Test to assess eating disturbances, and the Symptom Checklist-90 Revised to measure psychological state, both before CHT and after 6 months of CHT administration. The baseline mean body weight, BMI scores, body uneasiness scores, and general psychopathological symptoms of participants with FtM GD were significantly higher than female controls, whereas baseline eating attitudes and behaviors were not significantly different. Over time, FtM GD participants' mean body weight and BMI scores increased, body uneasiness and general psychopathological symptoms decreased, and eating attitudes and behaviors had not changed at 24th weeks following CHT administration compared to baseline. CHT may have a positive impact on body uneasiness and general psychopathological symptoms in participants with FtM GD. However, CHT does not have an impact on eating attitudes and behaviors.
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Affiliation(s)
- Şenol Turan
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University, 34303, Kocamustafapaşa-Fatih/Istanbul, Turkey.
| | - Cana Aksoy Poyraz
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University, 34303, Kocamustafapaşa-Fatih/Istanbul, Turkey
| | - Nazife Gamze Usta Sağlam
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University, 34303, Kocamustafapaşa-Fatih/Istanbul, Turkey
| | - Ömer Faruk Demirel
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University, 34303, Kocamustafapaşa-Fatih/Istanbul, Turkey
| | - Özlem Haliloğlu
- Department of Endocrinology and Metabolism, Cerrahpaşa School of Medicine, Istanbul University, 34303, Kocamustafapaşa-Fatih/Istanbul, Turkey
| | - Pınar Kadıoğlu
- Department of Endocrinology and Metabolism, Cerrahpaşa School of Medicine, Istanbul University, 34303, Kocamustafapaşa-Fatih/Istanbul, Turkey
| | - Alaattin Duran
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University, 34303, Kocamustafapaşa-Fatih/Istanbul, Turkey
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199
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Linsenmeyer WR, Rahman R. Diet and nutritional considerations for a FtM transgender male: A case report. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:533-536. [PMID: 29405884 DOI: 10.1080/07448481.2018.1431917] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/02/2018] [Accepted: 01/16/2018] [Indexed: 06/07/2023]
Affiliation(s)
- Whitney R Linsenmeyer
- a Department of Nutrition and Dietetics , Saint Louis University , St Louis , Missouri , USA
| | - Rabia Rahman
- a Department of Nutrition and Dietetics , Saint Louis University , St Louis , Missouri , USA
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200
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Masuda A, Marshall RD, Latner JD. Mindfulness as a Moderator of the Association Between Eating Disorder Cognition and Eating Disorder Behavior Among a Non-clinical Sample of Female College Students: A Role of Ethnicity. Front Psychol 2018; 9:700. [PMID: 29988519 PMCID: PMC6026804 DOI: 10.3389/fpsyg.2018.00700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022] Open
Abstract
The present cross-sectional study examined whether mindfulness moderated the association between eating disorder cognition and eating disorder behaviors among Asian American, Black American, and White American female college students in the United States. Participants (N = 463, age range = 18–25 years) completed self-report measures online. Results revealed that mindfulness moderated the association between eating disorder cognition and eating disorder behavior in the White American group, but not in Asian American or Black American samples. Future research should replicate these differential findings across ethnic groups and investigate the factors that may contribute to this group difference.
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Affiliation(s)
- Akihiko Masuda
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Rachel D Marshall
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | - Janet D Latner
- Department of Psychology, University of Hawai'i at Mānoa, Honolulu, HI, United States
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