Acculturation and disordered eating patterns among Mexican American women

Risk and resilience in eating disorders: differentiating pathways among psychosocial predictors

OBJECTIVE

Eating disorders (EDs) represent a rising global health concern. The current study takes a multivariate approach to examine psychological (i.e., perfectionism, anxiety sensitivity [AS], emotion dysregulation) and sociocultural factors (i.e., body dissatisfaction) that may relate to risk and resilience in EDs.

METHODS

Participants were 698 undergraduate students (Mage = 21, SDage = 4.02), mainly female (71%) and Hispanic (61.6%), who participated in an online survey assessing perfectionism, emotion dysregulation, AS, body dissatisfaction, and eating behaviors.

RESULTS

The results from structural equation model analyses revealed differential associations with disordered eating (DE) outcomes. Self-oriented perfectionism and dysmorphic appearance concerns were associated with increased dieting/carb restriction, desire for thinness, and binging tendencies. Specifically, emotional nonacceptance and lack of emotional awareness showed associations with elevated risk for dieting/carb restriction and purging tendencies, respectively. Conversely, lack of emotional clarity showed a protective pathway to these risk behaviors. Anxiety sensitivity cognitive concerns related to higher purging tendencies, while AS social concerns related to lower purging and binging tendencies.

DISCUSSION

Findings highlight the differential pathways of psychosocial risk and resilience for EDs. Subscales of emotional dysregulation and AS showed risk as well as resilience associations with DE outcomes. This information is key for advancing transdiagnostic prevention and intervention to reduce the rising rates of EDs.

The Measurement of Acculturation in Neuropsychological Evaluations of Hispanic/Latino Individuals across the Lifespan: A Scoping Review of the Literature

OBJECTIVE

Acculturation has been linked to health outcomes in Hispanics/Latinos (H/Ls). However, there is equivocal evidence of a relationship between acculturation and neuropsychological outcomes. Various factors limit the ability to subject the evidence to systematic/meta-analytic review. We sought to examine the current state of the literature in the context of H/Ls and neuropsychology and describe the various limitations of measuring acculturation across the lifespan.

METHOD

Applying a scoping review approach, we identified unique stand-alone (e.g., questionnaires) measures of acculturation. We focused on psychometric (e.g., internal consistency) and other characteristics (e.g., language, structure/format) and description of the validation samples (e.g., cultural background/country of origin).

RESULTS

A total of 40 unique acculturation measures were identified. Measures spanned various domains (e.g., language proficiency, food preference, music choice), and relied heavily on linguistic behavioral characteristics. Internal consistency varied from unacceptable to clinically acceptable ranges. Variable approaches to development and validation were reported. Validation samples varied from 22 to 2,048 respondents (median = 380), most of which represented a general adult population. Only eight measures were validated for use in pediatric populations; none were developed specifically for use with older adults.

CONCLUSIONS

Published measures are outdated, evidence highly variable psychometric and methodological weaknesses, and lack a lifespan perspective. Several themes in the types of items considered elemental to the acculturative process are revealed and findings are summarized via an "ABC" framework, categorizing items as antecedents, behaviors, and consequent acculturative changes, that lends itself to clinical and research settings.

Body dissatisfaction among ethnic subgroups of Latin women: An examination of acculturative stress and ethnic identity

This study investigated (1) ethnic group differences in body dissatisfaction (BD) among specific Latina subgroups, (2) acculturative stress as a mediator between ethnic group and BD, and (3) ethnic identification as a moderator between 3a) ethnic group and BD and 3b) acculturative stress and BD. Mexican (n = 30), Puerto Rican (n = 31), Cuban (n = 29), and non-Hispanic, White (n = 30) women in the US completed self-report questionnaires. Group comparisons indicated Mexicans reported greater BD compared to Whites, while Puerto Ricans and Cubans did not differ from Whites. A significant indirect effect indicated that acculturative stress mediated the association between ethnic group and BD. Acculturative stress predicted BD at low and average levels of ethnic identification. Additionally, there were significant differences comparing Cubans to Mexicans and Puerto Ricans, which were dependent on ethnic identification. Thus, higher ethnic identification may serve as a protective factor for Cubans. Findings support separating subgroups of Latinas and that higher ethnic identification may protect against the development of BD in Latinas experiencing acculturative stress. Assessments and interventions should address acculturative stress since higher levels were associated with higher levels of BD, and the combination of ethnic group, acculturative stress, and ethnic identification may help explain differences in BD among Latinas.

Enculturation and acculturation's relationship to suicidal ideation in Hispanic/Latinx individuals with psychotic spectrum disorders

Suicide is a leading cause of premature death in people with schizophrenia (Inoue et al., 2020). Hispanic/Latinx (H/L) individuals, the largest ethnic minority group in the U.S., face potential hurdles (e.g., discrimination, language barriers) when trying to receive care for psychotic spectrum disorders, which may increase their risk for suicidal ideation. Drawing from prior literature, we tested the hypotheses that greater acculturation and lower enculturation would be associated with increased suicidal ideation in a sample of 45 H/L individuals with psychotic spectrum disorders using a linear regression analysis controlling for gender and education. As hypothesized, greater acculturation and lower enculturation were associated with greater suicidal ideation. In line with prior research, results of this study suggest that maintaining beliefs and traditions from one's home culture may be beneficial to H/Ls with psychotic spectrum disorders and may reduce suicidal ideation whereas there may be detrimental aspects of mainstream United States culture on one's desire to live. Thus, encouraging H/L patients with psychotic spectrum disorders to maintain a sense of ethnic pride and stay engaged with practices and values from their culture of origin may help reduce suicidal ideation in this vulnerable population.

Individual and Family Factors in Disordered Eating Patterns of Mexican-American Women

OBJECTIVE

In this study, we examined the contribution of individual- (acculturation, body mass index, and body size satisfaction) and family- (maternal weight-related messages and disordered eating patterns) level factors in predicting bulimic and dieting behaviors in young Mexican-American women with overweight or obesity.

METHODS

We recruited adult Mexican- American mother-daughter dyads from the community. We conducted correlational analysis and hierarchical regression.

RESULTS

Daughters who were less satisfied with their body size reported higher symptoms of bulimic (r = -.34, p < .01) or dieting behavior (r = -.36, p < .01). Daughters who received more positive maternal messages on eating and weight had mothers with lower symptoms of bulimic (r = -.43, p < .01) or dieting behavior (r = -.30, p < .05). Maternal symptoms of bulimic behavior were the strongest predictor of daughters' bulimic behavior (ß = .379, p = .007), and body size satisfaction was the strongest predictor of daughters' dieting behavior (ß = -.372, p = .008) in adjusted models.

CONCLUSION

Mexican-American women who are less satisfied with their body size and have mothers with elevated symptoms of bulimic behavior are at risk for disordered eating patterns. Intervening at the individual level on body image and family level on maternal modeling of eating behavior may help support healthy weight management behaviors.

Cultural efficacy predicts body satisfaction for Māori

This paper examines the relationship between body mass index (BMI), self-esteem and self-reported confidence and capability in expressing oneself culturally as Māori (cultural efficacy) for 5,470 Māori who participated in Te Rangahau o Te Tuakiri Māori me Ngā Waiaro ā-Pūtea | The Māori Identity and Financial Attitudes Study (MIFAS) in 2017. Adjusting for demographics, self-reported health, education and socio-economic status, we found that a higher BMI was associated with lower body satisfaction and self-esteem. However, higher scores on cultural efficacy were associated with higher levels of body satisfaction and self-esteem for respondents. Furthermore, the negative association between BMI and both body satisfaction and self-esteem was weaker for those with higher cultural efficacy. This held for BMI scores of 25, 30, and 35+. While our data suggest higher cultural efficacy may directly or interactively shield Māori from developing lowered self-esteem typically associated with higher BMI in Western populations, further research, using more comprehensive measures of body satisfaction should explore the extent to which Māori may find the Western "thin ideal" personally desirable for their own bodies.

Body weight, perceived weight stigma and mental health among women at the intersection of race/ethnicity and socioeconomic status: insights from the modified labelling approach

With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight-based discrimination has also intensified. While research has demonstrated the negative effects of weight-based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self-perceived weight-based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi-stage probability sample of non-institutional, English-speaking adults, ages 35 to 89 in 2005-2006. Our findings demonstrate that the effect of weight-based discrimination on psychological well-being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self-rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well-being.

Do Hispanic Girls Develop Eating Disorders? A Critical Review of the Literature

INTRODUCTION

Eating disorders have become increasingly prevalent in North America. Anorexia nervosa, bulimia nervosa, and binge eating disorder were previously thought to solely affect Caucasian women. However, contemporary research has studied the occurrence of this phenomenon in ethnic minority women, such as Latinas.

METHODS

This article presents a critical review of 12 quantitative, prospective psychological research studies from the past 17 years.

RESULTS

The authors in the reviewed literature identified bodily dissatisfaction, environmental influences, and acculturation as significant risk factors in the development of eating disorders in Hispanic girls and women.

CONCLUSION

The methodology and empirical findings from these studies are discussed, and suggestions for future research and culturally sensitive clinical treatment are considered.

The moderating effects of acculturation on the relation of parenting strategies to unhealthy weight control behaviors in Hispanic daughters

There is a dearth of research regarding the association of child and parent traits to the use of unhealthy weight control behaviors among minority girls with obesity. This study examined the moderating effects of mothers' and daughters' acculturation in the relation of parenting strategies (setting limits, monitoring and discipline) to unhealthy weight control behaviors in Hispanic girls with obesity. Participants included 148 Hispanic mother-daughter dyads (M_age = 39.1, SD = 6.4 years; M_age = 11.3, SD = 1.5 years, respectively). Two-thirds of the mothers were born in Mexico and 46% of them reported low levels of acculturation. In contrast, almost all daughters (90%) were born in the United States and reported high levels of acculturation. Participants were recruited through school nurses and social agencies community coordinators. Mothers and daughters completed surveys on demographic, acculturation, unhealthy weight control behaviors (daughters only) and parenting strategies (mothers only), and had their height, weight, and adiposity assessed. Results from a hierarchical regression analysis revealed that daughters' acculturation, but not mothers' acculturation, moderated the relation of parenting limit setting to daughters' reported engagement in unhealthy weight control behaviors (β = 1.12, p = 0.007). That is, mothers who used more limit setting were less likely to have daughters engaging in unhealthy weight control behavior and this association was stronger among low acculturated girls than among their highly acculturated counterparts. Future research should assess cultural influences and parenting practices in a sample of Hispanic mothers and their adolescent daughters of varied weight statuses and acculturation levels.

Hispanic maternal influences on daughters' unhealthy weight control behaviors: The role of maternal acculturation, adiposity, and body image disturbances

This study examined whether maternal adiposity, acculturation, and perceived-ideal body size discrepancy for daughters were associated with daughters' engagement in unhealthy weight control behaviors. A total of 97 Hispanic mother-daughter dyads completed surveys, rated a figure scale, and had their height, weight, and adiposity assessed. Mothers (M_age=39.00, SD=6.20 years) selected larger ideal body sizes for their daughters (M_age=11.12, SD=1.53 years) than their daughters selected for themselves. Mothers had a smaller difference between their perception of their daughters' body size and ideal body size compared to the difference between their daughters' selection of their perceived and ideal body size. More acculturated mothers and those mothers with larger waist-to-hip ratios were more likely to have daughters who engaged in unhealthy weight control behaviors. These findings highlight the relevant role that maternal acculturation and adiposity may have in influencing daughters' unhealthy weight control behaviors.

Acculturation and Eating Disorders in a Mexican American Community Sample

Our purpose was to investigate acculturation and eating disorders by examining the role of ethnic identity and by utilizing a bidimensional perspective toward two cultures. We predicted that orientation toward European American culture and lower ethnic identity would be positively associated with eating disorders. Participants were 188 Mexican American women recruited from the community (79 with eating disorders and 109 control women). The Structured Clinical Interview for DSM-IV-TR and Eating Disorder Examination were used to establish diagnoses. The Acculturation Rating Scale for Mexican Americans–II and the Multigroup Ethnic Identity Measure assessed Anglo orientation, Mexican orientation, and ethnic identity. Orientation toward Anglo American culture was significantly associated with eating disorders, whereas orientation toward Mexican culture and strength of ethnic identity were not associated with eating disorder status. Findings point to the role of Anglo cultural orientation in the development of eating disorders and underscore the need for future research to utilize bidimensional models.

Factorial and Construct Validity of the Body Parts Satisfaction Scale-Revised: An Examination of Minority and Nonminority Women

In this two-part study, the psychometric properties of the Body Parts Satisfaction Scale, an extensively used body image attitudes measure, were tested. In Study 1-A, the two-factor structure of the Body Parts Satisfaction Scale-Revised (BPSS-R)—Satisfaction With Body and Satisfaction With Face—was established through exploratory procedures with a racially diverse sample of women (66.7% White American, 17.6% African American, 6.3% Mexican American, 5% Asian American, 0.6% Native American, and 3.8% unreported). In Study 1-B, the two-factors were validated through confirmatory procedures with a matched racially diverse sample of women (71.9% White American, 14.0% African American, 5.3% Mexican American, 4.7% Asian American, 1.2% Native American, and 2.9% unreported). Correlational analyses supported the construct and concurrent validity of the factors. To learn more about body image attitudes within racial/ethnic minorities, Study 2 examined the two-factor solution and psychometric properties in an independent sample of Mexican American women. Confirmatory factor analysis demonstrated that the two-factor solution fit the data, and correlations with other psychological and eating disorder measures supported the factor's construct and concurrent validity. Further, the two factors were unrelated to a measure of acculturation and to generational level living in the U. S., which suggests that body satisfaction may be independent of the acculturation process.

Becoming Overweight Without Gaining a Pound: Weight Evaluations and the Social Integration of Mexicans in the United States

Mexican women gain weight with increasing duration in the United States. In the United States, body dissatisfaction tends to be associated with depression, disordered eating, and incongruent weight evaluations, particularly among white women and women of higher socioeconomic status. However, it remains unclear how overweight and obesity is interpreted by Mexican women. Using comparable data of women ages 20-64 from both Mexico (the 2006 Encuesta Nacional de Salud y Nutricion; N=17,012) and the United States (the 1999-2009 National Health and Nutrition Examination Surveys; N=8,487), we compare weight status evaluations among Mexican nationals, Mexican immigrants, U.S.-born Mexicans, U.S.-born non-Hispanic Whites, and U.S.-born non-Hispanic blacks. Logistic regression analyses, which control for demographic and social-economic variables and measured body mass index and adjust for the likelihood of migration for Mexican nationals, indicate that the tendency to self-evaluate as overweight among Mexicans converges with levels among non-Hispanic whites and diverges from blacks over time in the United States. Overall, the results suggest a U.S. integration process in which Mexican-American women's less critical self-evaluations originate in Mexico but fade with time in the United States as they gradually adopt U.S. white norms for thinner body sizes. These results are discussed in light of social comparison and negative health assimilation.

Measurement of body dissatisfaction in college-enrolled Mexican American Women: A Rasch-based examination of the validity and reliability of the EDI-III

Measures of body dissatisfaction have not been validated for Mexican American (MA) women, who evaluate their bodies differently than Caucasian women. In this study, the psychometric properties of the EDI-III, Body Dissatisfaction Subscale (BDS) were examined in a sample of college-enrolled MA women using the Rasch Rating Scale Model. Criterion validity was also addressed. BDS evidenced good item fit, person and item reliability, once poorly correlated items were removed. Two qualitatively distinct dimensions of body dissatisfaction were identified: (1) overall body shape and stomach, and (2) the lower body. Validity of the scales was supported. Results suggest: MA women's satisfaction with overall body shape is not synonymous with attitudes toward their lower body.

Mexican American women's perspectives on a culturally adapted cognitive-behavioral therapy guided self-help program for binge eating

The prevalence of bulimia nervosa (BN) and binge eating disorder (BED) among Latinas is comparable to those of the general population; however, few interventions and treatment trial research have focused on this group. Cognitive-behavioral therapy (CBT) is the treatment of choice for binge eating related disorders. CBT-based guided self-help (CBTgsh)-a low-cost minimal intervention-has also been shown effective in improving binge eating related symptom, but the effectiveness of the CBTgsh among ethnic minority women is not well understood. Cultural adaptation of evidence-based treatments can be an important step for promoting treatment accessibility and engagement among underserved groups. This qualitative study was part of a larger investigation that examined the feasibility and efficacy of a culturally adapted CBTgsh program among Mexican American women with binge eating disorders. Posttreatment focus groups were conducted with 12 Mexican American women with BN or BED who participated in the intervention. Data were analyzed with the grounded theory methodology (Corbin & Strauss, 2008). Three themes emerged from the data: (a) eating behavior and body ideals are socially and culturally constructed, (b) multifaceted support system is crucial to Mexican American women's treatment engagement and success, and (c) the culturally adapted CBTgsh program is feasible and relevant to Mexican American women's experience, but it can be strengthened with increased family and peer involvement. The findings provide suggestions for further adaptation and refinement of the CBTgsh, and implications for future research as well as early intervention for disordered eating in organized care settings.

Is cultural change associated with eating disorders? A systematic review of the literature

BACKGROUND

There is debate as to whether the development of an eating disorder (ED) may be triggered by acculturation to Western culture. While there is evidence to suggest that acculturation to Western culture is associated with risk of having an ED, these findings are limited, vary significantly, and are sometimes conflicting.

AIMS

To review the literature and empirical data on the association between ED symptoms and acculturation in the context of Western culture.

METHODS

A systematic search of peer-reviewed publications using a combination of the keywords "Culture", "Acculturation" and "Eating disorders" was first performed in August 2014 and updated in February 2015 with the following databases: PubMed and SCOPUS. Reference lists were also hand searched. In total, the search provided more than 50 studies. Following screening (as stated in the PRISMA guidelines) of the titles and abstracts by inclusion and exclusion criteria and quality assessment of the full text, 25 studies were identified to be appropriate for the review. Articles were examined in relation to the findings, as well as the ED and acculturation measures used.

RESULTS

Eleven studies suggested considerable association between ED and culture change/acculturation. Six studies suggested little or no association between ED and culture change/acculturation. Eight studies did not primarily examine association, yet generated valuable insight. While there was relative consistency across studies in terms of the ED measures selected, measures of acculturation varied significantly.

CONCLUSIONS

The majority of the evidence reviewed here suggests that there is a substantial association between culture change and ED psychopathology. However, both greater and lesser acculturation have been identified as risk factors for the development of an ED, and this varies depending on the group studied as well as how acculturation and culture change are conceptualized and measured. Further research is warranted to form cross-culturally acceptable definitions and measures of problematic eating, and healthy and high acculturation, to study the relationship between EDs and the process of acculturation to Western culture.

Ethnic identity, thin-ideal internalization, and eating pathology in ethnically diverse college women

Although much research suggests that ethnic identity is positively correlated with psychological health for ethnic minority women, research examining ethnic identity's relationships to thin-ideal internalization, weight concerns, and eating concerns is sparse. Consequently, this study examined these relationships in European American, African American, Latina, and Asian American college women (N=816). As expected, univariate analyses of variance indicated that European American women scored lowest on ethnic identity and highest on eating and weight concerns, whereas African American women scored lowest on thin-ideal internalization. Hierarchical regression analyses indicated that ethnic identity was negatively associated with eating and weight concerns, while body mass index and thin-ideal internalization were positively associated. Ethnic identity moderated the relationship between thin-ideal internalization and eating concerns such that the relationship was stronger for participants with lower ethnic identity. These results suggest ethnic identity may be a direct or interactive protective factor against eating concerns in ethnically diverse college women.

"I am not a skinny toothpick and proud of it": Latina adolescents' ethnic identity and responses to mainstream media images

Using a quasi-experimental design, 118 Latina girls, ages 13-18, viewed five color photographs of White women. Girls viewed either images of sexualized women or images of non-sexualized women. After viewing the images, girls were asked to complete the sentence stem, "I am…" 20 times. Thirty percent of girls spontaneously described their ethnicity in one of their sentence completions. Spontaneous use of ethnicity was taken as an indicator of the salience of ethnic identity. Among girls who viewed sexualized, thin-ideal White media images, spontaneously using an ethnic descriptor was related to more positive descriptions of one's own body and appearance. Analyses supported the premise that ethnic identity may act as a protective factor, buffering Latina girls from the negative effects of viewing sexualized, thin-ideal White media images.

A review of eating disorders research in Mexico

The objective of this paper is to summarize research findings on eating disorders and the current state of the field in Mexico. Papers published in indexed journals and graduate dissertations were retrieved, using "eating disorders," "anorexia nervosa," "bulimia nervosa," "body image," "binge eating," "restrained eating," "weight and shape concern," and "dieting" as keywords. These were combined with the Boolean operator "AND" with "Mexico" and "Latin America." Findings are presented for epidemiology, the validity of assessment instruments, comorbidity, and risk factors. A national representative survey found a prevalence of 1.8% for bulimia nervosa, and no cases of anorexia nervosa. However, the lack of studies with confirmatory clinical interview and other national or regional representative samples makes it difficult to reach conclusions about the actual prevalence. A number of instruments for the detection of eating disorders and disordered eating have been validated for the Mexican population. The comorbidity of eating disorders in Mexico includes drug and alcohol abuse, obesity, and borderline personality disorder. Risk factors found included body weight and cultural pressure to be thin. Future lines of research should include epidemiological studies with representative samples and diagnosis confirmation, longitudinal studies, and the exploration of protective and risk factors specific to this population. We want to acknowledge Dr Richard A. Gordon's encouragement to write this manuscript and his accurate comments on its preliminary and final versions. We also want to thank the participants of the seminar on publications held at the Office of Epidemiological and Psychosocial Studies of the National Institute of Psychiatry for the comments they made to this article. El objetivo de este trabajo es el de resumir los hallazgos de investigación sobre los trastornos alimentarios y el estado actual del campo en México. Se recuperó la obra publicada en revistas indizadas y tesis de grado, mediante los descriptores "trastorno alimentario," anorexia nervosa," bulimia nervosa," "imagen corporal," "atracones," "restricción alimentaria," "preocupación por el peso y la figura," y "conducta de dieta." Éstos se combinaron con el operador Booleano "AND" con "México" y "América Latina." Se presentan los hallazgos para la epidemiología, la validez de los instrumentos de medición, comorbilidad, y factores de riesgo. Una encuesta nacional representativa encontró una prevalencia de 1.8% para la bulimia nervosa, y ningún caso de anorexia nervosa. No obstante, la carencia de estudios con una entrevista clínica confirmatoria y de otras muestras nacionales o regionales dificulta el arribo a conclusiones acerca de la prevalencia real. Varios instrumentos para la detección de los trastornos alimentarios y de la alimentación desordenada se han validado en población mexicana. La comorbilidad de los trastornos alimentarios en México incluye el uso y abuso de alcohol, la obesidad y el trastorno de personalidad limítrofe. Los factores de riesgo referidos incluyen el peso corporal y la presión cultural para estar delgado. Las líneas de investigación futuras deberán incluir estudios epidemiológicos con muestras representativas y la confirmación del diagnóstico, estudios longitudinales, y la exploración de factores de riesgo y protectores específicos a esta población. L'objectif de cet article est de résumer les résultats de recherche et l'état actuel des connaissances sur les troubles alimentaires au Mexique. Les articles publiés dans des revues indexées et les thèses de doctorat ont été recensés en utilisant les mots-clés « eating disorders », « anorexia nervosa », « bulimia nervosa », « body image », « binge eating », « restrained eating », « weight and shape concern » et « dieting ». Ceux-ci furent combinés, en utilisant la conjonction « AND », avec les termes « Mexico » et « Latin America ». Les résultats sont présentés de façon à décrire l'épidémiologie, la validité des instruments d'évaluation, la comorbidité et les facteurs de risque. Une enquête normative nationale a indiqué un taux de prévalence de 1,8% pour la névrose boulimique et aucun cas de névrose anorexique. Cependant, le manque d'études utilisant des entrevues cliniques confirmatoires et d'autres échantillons normatifs nationaux et régionaux limite les conclusions sur la prévalence actuelle. Un nombre important d'instruments pour dépister les troubles alimentaires et l'alimentation inadéquate ont été validés auprès de la population mexicaine. Les principaux problèmes de comorbidité avec les troubles alimentaires au Mexique incluent l'abus de drogue ou d'alcool, l'obésité et le trouble de personnalité état-limite. Les facteurs de risque incluent le poids corporel et la pression culturelle à être mince. Les avenues de recherche futures devraient inclure des études épidémiologiques auprès d'échantillons représentatifs, de la confirmation de diagnostic, des études longitudinales et de l'exploration de facteurs de protection et de facteurs de risque spécifiques à cette population.

Language spoken at home and parental birthplace moderate the association of race/ethnicity and distorted weight perception

Distorted weight perception (DWP), specifically overestimating weight status, is common in adolescents and may lead to eating disorders. The authors examined the role of acculturation proxies as effect modifiers of the relationship between race/ethnicity and DWP in a diverse adolescent population. Analysis of the 2005 California Health Interview Survey showed that of 2955 adolescents with underweight or healthy weight status, 10.6% reported DWP. Latino adolescents had increased odds of DWP compared with white adolescents (adjusted odds ratio [aOR] = 3.02; 95% confidence interval [CI] = 2.00, 4.57). Latinos who spoke English and other language(s) at home (aOR = 3.38; 95% CI = 2.11, 5.41) and Latino (aOR = 5.00; 95% CI = 2.34, 10.72) and Asian (aOR = 3.10, 95% CI = 1.15, 8.35) adolescents who spoke no English at home had increased odds of DWP compared with white, English-only speakers. Latino adolescents had increased odds (aOR = 3.98, 95% CI = 2.45, 6.47) of DWP if neither parent was US born. Assessing acculturation proxies may help identify adolescents at risk of DWP.

Weighing in on the issue: a longitudinal analysis of the influence of selected individual factors and the sports context on the developmental trajectories of eating pathology among adolescents

Eating disorders, and related issues (e.g., body dissatisfaction, weight control behaviors), represent pressing and prevalent health problems that affect American adolescents with alarming frequency and potentially chronic consequences. However, more longitudinal research is needed to elucidate the developmental processes that increase or maintain risk for, and that protect against, eating- and weight-related problems among adolescents. Accordingly, the current study used longitudinal data from 1,050 male and female (68.0 %) adolescents (Grades 9-11)-the majority of whom were European Americans (72.2 %)-who participated in the 4-H Study of Positive Youth Development to (a) describe trajectories of adolescents' eating pathology and body dissatisfaction, (b) identify individual and contextual correlates of these pathways, (c) examine whether trajectories of eating pathology and body dissatisfaction related to adolescents' depressive symptoms, and (d) elucidate whether sports participation moderated associations between specific trajectories of eating pathology and body dissatisfaction and adolescents' depressive symptoms. Results suggest that the diverse pathways of eating pathology and body dissatisfaction that exist across middle adolescence, in combination with adolescents' sports participation, have important implications for the positive and problematic development of our youth. In addition, the findings underscore the need to evaluate the interindividual differences that exist in regard to how sports participation may relate positively and negatively to developmental outcomes.

Considering J.Lo and Ugly Betty: a qualitative examination of risk factors and prevention targets for body dissatisfaction, eating disorders, and obesity in young Latina women

Latina women are vulnerable to poor body image, eating disorders, and obesity, particularly during the college years. This study sought to identify common cultural antecedents of these concerns in order to inform the development of prevention programs for this population. Six groups of university students who identified as Latina (N=27) discussed cultural aspects of body image, eating disorders, and obesity. Thematic analysis identified four main themes: (a) cultural disparities in body-ideal, including the influence of the media and acculturation issues; (b) messages about body shape and weight received by family, peers, and society; (c) difficulties making healthy eating and physical activity choices as a function of college life; and (d) the influence of peers and potential male partners on body satisfaction and body-ideals. These results have implications for the development of programs targeting body dissatisfaction and risk for eating disorders and obesity in Latina college women.

Weight misperceptions and racial and ethnic disparities in adolescent female body mass index

This paper investigated weight misperceptions as determinants of racial/ethnic disparities in body mass index (BMI) among adolescent females using data from the National Survey of Youth 1997. Compared to their white counterparts, higher proportions of black and Hispanic adolescent females underperceived their weight status; that is, they misperceived themselves to have lower weight status compared to their clinically defined weight status. Compared to their black counterparts, higher proportions of white and Hispanic adolescent females misperceived themselves to be heavier than their clinical weight status. Oaxaca-Blinder decomposition analysis showed that accounting for weight misperceptions, in addition to individual and contextual factors, increased the total explained portion of the black-white female BMI gap from 44.7% to 54.3% but only slightly increased the total explained portion of the Hispanic-white gap from 62.8% to 63.1%. Weight misperceptions explained 13.0% of the black-white female BMI gap and 3.3% of the Hispanic-white female BMI gap. The regression estimates showed that weight underperceptions were important determinants of adolescent female BMI, particularly among black and Hispanic adolescents. Education regarding identification and interpretation of weight status may play an important role to help reduce the incidence and racial disparity of female adolescent obesity.

Racial/ethnic differences in adults in randomized clinical trials of binge eating disorder

OBJECTIVE

Recent studies suggest that binge eating disorder (BED) is as prevalent among African American and Hispanic Americans as among Caucasian Americans; however, data regarding the characteristics of treatment-seeking individuals from racial and ethnic minority groups are scarce. The purpose of this study was to investigate racial/ethnic differences in demographic characteristics and eating disorder symptoms in participants enrolled in treatment trials for BED.

METHOD

Data from 11 completed randomized, controlled trials were aggregated in a single database, the Clinical Trials of Binge Eating Disorder (CT-BED) database, which included 1,204 Caucasian, 120 African American, and 64 Hispanic participants assessed at baseline. Age, gender, race/ethnicity, education, body mass index (BMI), binge eating frequency, and Eating Disorder Examination (EDE) Restraint, Shape, Weight, and Eating Concern subscale scores were examined.

RESULTS

Mixed model analyses indicated that African American participants in BED treatment trials had higher mean BMI than Caucasian participants, and Hispanic participants had significantly greater EDE shape, weight, and eating concerns than Caucasian participants. No racial or ethnic group differences were found on the frequency of binge eating episodes. Observed racial/ethnic differences in BED symptoms were not substantially reduced after adjusting for BMI and education. Comparisons between the CT-BED database and epidemiological data suggest limitations to the generalizability of data from treatment-seeking samples to the BED community population, particularly regarding the population with lower levels of education.

CONCLUSIONS

Further research is needed to assess alternative demographic, psychological, and culturally specific variables to better understand the diversity of treatment-seeking individuals with BED.

Effects of a culturally tailored intervention on changes in body mass index and health-related quality of life of Latino children and their parents

PURPOSE

To evaluate the effects of a multicomponent, family-based, culturally tailored intervention for overweight Latino children and their parents.

DESIGN

One group pretest/posttest with clinic comparison group.

SETTING

Community health center in Milwaukee, Wisconsin.

SUBJECTS

54 Spanish-speaking, Latino families with children 8 to 11 years of age at enrollment and a body mass index (BMI) > 85th percentile. Thirty-one completed the 12-month follow-up.

MAIN OUTCOME

Measures. BMI, fitness measures, self-reported eating patterns, sedentary behaviors, and quality of life scales.

INTERVENTION

Index child and one (index) parent participated in interactive sessions and physical activity reinforced by family goal-setting, staff support, and supplemental activities.

RESULTS

Small but statistically significant changes in child BMI z score (Δ = .13 SD, p < .001) and parent fitness (Δ = .74, p < .04) were documented by paired t-test. Quality of life increased significantly for children (combined Pediatric Quality of Life Inventory score Δ = 10.7, p < .001) and parents (Short Form Health Survey12 mental composite score Δ = 8, p < .022; Wilcoxon rank sum test). BMI z score for clinic comparison children (n = 31) increased significantly during the same time period (Δ = .23 SD, paired t = 4.32, p < .0002).

CONCLUSIONS

A culturally tailored program for Latino families reduced BMI for enrolled children and significantly enhanced quality of life for children and parents. Intervention approaches that integrate cultural and social circumstances and emphasize goal setting and life style changes may be fruitful for this population of at-risk children.

Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement

CONTEXT

Eating disorders are severe conditions, but little is known about the prevalence or correlates of these disorders from population-based surveys of adolescents.

OBJECTIVES

To examine the prevalence and correlates of eating disorders in a large, reprefentative sample of US adolescents.

DESIGN

Cross-sectional survey of adolescents with face-to-face interviews using a modified version of the Composite International Diagnostic Interview.

SETTING

Combined household and school adolescent samples.

PARTICIPANTS

Nationally representative sample of 10,123 adolescents aged 13 to 18 years.

MAIN OUTCOME MEASURES

Prevalence and correlates of eating disorders and subthreshold conditions.

RESULTS

Lifetime prevalence estimates of anorexia nervosa, bulimia nervosa, and binge-eating disorder were 0.3%, 0.9%, and 1.6%, respectively. Important differences were observed between eating disorder subtypes concerning sociodemographic correlates, psychiatric comorbidity, role impairment, and suicidality. Although the majority of adolescents with an eating disorder sought some form of treatment, only a minority received treatment specifically for their eating or weight problems. Analyses of 2 related subthreshold conditions suggest that these conditions are often clinically significant.

CONCLUSIONS

Eating disorders and subthreshold eating conditions are prevalent in the general adolescent population. Their impact is demonstrated by generally strong associations with other psychiatric disorders, role impairment, and suicidality. The unmet treatment needs in the adolescent population place these disorders as important public health concerns.

Development of a measure of "acculturation" for ethnic Fijians: methodologic and conceptual considerations for application to eating disorders research

Acculturation has been examined as a risk factor for eating disorders, but interpretation of findings has been limited by inconsistent operationalization of this construct across studies. The study aim was to develop and evaluate a population-specific measure of acculturation for ethnic Fijian adolescent schoolgirls, to use in future analyses related to eating disorders. Our findings suggest that acculturation is a multidimensional construct characterized by distinct, though related, dimensions of orientation to ethnic Fijian and/or western/global culture with respect to a range of behaviors and attitudes. In contrast to theoretical models positing uni-dimensional, orthogonal, or oblique relations between cultural identities in individuals undergoing acculturation, our study findings support a heterogeneous pattern among correlations of dimensions across contrasting cultural identities. We suggest multidimensional measures of acculturation are optimal--and socio-demographic proxies inadequate--for characterization of this complex process for health research.

Maternal perceptions of early childhood ideal body weight differ among Mexican-origin mothers residing in Mexico compared to California

OBJECTIVE

To assess maternal perceptions of children's current and ideal body sizes, and the meaning of and factors contributing to overweight in infancy and early childhood among Mexican-origin mothers living in Mexico and in California.

DESIGN

A quali-quantitative study combining focus groups and a self-administered questionnaire.

SUBJECTS/SETTING

A purposive sample of 84 low-income, Mexican-origin mothers of 4- to 6-year-old children recruited between March 2006 and January 2008 from rural and urban communities in Mexico and California.

STATISTICAL ANALYSES

Bivariate, multivariate, and qualitative analyses of maternal perceptions of children's actual and ideal body size supplemented by qualitative analyses of meaning of and factors contributing to childhood overweight/obesity.

RESULTS

Ideal child body size was considerably lower among Mexican-origin mothers living in California (3.86+/-0.56) than it was among mothers living in Mexico (4.32+/-0.83), and this difference was significant (P=0.001) after adjusting for sociodemographic covariates. Among mothers of overweight children, 82% of mothers in California were dissatisfied with their child's weight compared with 29% of mothers in Mexico (P=0.003). Focus-group results suggest that these differences in the perception of children's ideal body size can be attributable to differences in body size norms among mothers and awareness of the negative effects of obesity that occur after migration to California.

CONCLUSIONS

Maternal perceptions of early childhood overweight appear to differ among Mexican-origin women living in Mexico and California. Recognition of the negative health consequences of obesity and identification of barriers to achieving weight control are important first steps toward childhood obesity prevention. Interventions directed at Mexican-origin mothers should focus on culturally acceptable ways of transmitting weight-control information.

Correlates of weight concern and control in a Hispanic college student sample

This study examined the relationships between weight concern and control and theoretically and empirically relevant correlates in a Hispanic college student sample. Participants were 163 Hispanic college students who completed measures assessing demographics, willingness to put health at risk to lose weight, unhealthy weight loss methods, acculturation, body weight and fitness happiness and importance, and sociocultural attitudes toward appearance. Body mass index was also assessed. Females internalized sociocultural attitudes toward appearance more and found personal attractiveness more important than males, while males were less happy with their personal attractiveness. Internalization of sociocultural attitudes toward appearance and BMI predicted the degree to which individuals were willing to put their health at risk to lose weight. The previous factors, as well as the importance of body weight and fitness and being female, were significant predictors of number of unhealthy weight loss methods employed to lose weight. These data indicate that within a Hispanic college student population, weight concern and control issues are relevant considerations for future studies and the development and assessment of weight loss interventions.

The sociocultural model of eating disorders in Mexican American women: behavioral acculturation and cognitive marginalization as moderators

White American cultural values of appearance are implicated in the development of body dissatisfaction. This study examined whether the relationships between awareness of White American appearance ideals, internalization of such ideals, and body dissatisfaction are moderated by behavioral acculturation and attitudinal marginalization in a sample of 94 Mexican American women. Results indicated that behavioral acculturation moderated the relationship between awareness and internalization and cognitive marginalization moderated the relationship between internalization and body dissatisfaction. Body size was positively correlated with body dissatisfaction and negatively correlated with behavioral acculturation. These findings have important implications for clinical practice and research with Mexican American women.

Effect of gender and school level on disordered eating behaviours and attitudes in Mexican adolescents

The aim of this study was to assess eating behaviours and attitudes in a community sample of 615 adolescent Mexican students recruited at a middle school (192 boys and 226 girls; mean age +/- standard deviation 13.56+/-0.09) and high school (90 boys and 107 girls; mean age 16.04+/-0.12 years), who completed the Eating Attitudes Test (EAT), the Bulimia Test (BULIT) and the Body Shape Questionnaire (BSQ). Multiple analysis of variance revealed the significant effect of gender on the negative feelings, body dissatisfaction, drive of thinness and perceived social pressure subscales, and school level on the body dissatisfaction and food preoccupation subscales. Among the high school girls, the gender x school level interaction had a significant effect on negative feelings, body dissatisfaction, drive of thinness, food preoccupation and perceived social pressure subscales. These data support previous findings concerning gender, and also suggest that perceived social pressure in the case of girls and food preoccupation in the case of boys could be important factors in the natural development of eating disorders.

Health status of Mexican-origin persons: do proxy measures of acculturation advance our understanding of health disparities?

OBJECTIVES

This paper compares select health status indicators between the U.S. and Mexico, and within the Mexican-origin population using proxy measures of acculturation.

METHODS

Statistical data were abstracted and a Medline literature review conducted of English-language epidemiologic articles on Mexican-origin groups published during 1976-2005.

RESULTS

U.S.-born Mexican-Americans have higher morbidity and mortality compared to Mexico-born immigrants. Mexico has lower healthcare resources, life expectancy, and circulatory system and cancer mortality rates, but similar infant immunization rates compared to the U.S. Along the U.S.-Mexico border, the population on the U.S. side has better health status than the Mexican side. The longer in the U.S., the more likely Mexican-born immigrants engage in behaviors that are not health promoting. Conclusions Researchers should consider SEP, community norms, behavioral risk and protective factors when studying Mexican-origin groups. It is not spending-time in the U.S. that worsens health outcomes but rather changes in health promoting behaviors.

Eating Attitudes, Self-Dissatisfaction and Emotional Distress Among Early Adolescents in Hawai'i: A Gender Comparison

The present study examines whether there are gender differences in eating attitudes among a sample of early adolescents in Hawai'i. A total of 79 female and 65 male 7th graders completed a survey that included measures of eating attitudes and other psychological constructs. Contrary to our prediction, males reported higher levels of disordered eating attitudes and body dissatisfaction than females. However, there were no gender differences in symptom levels of anxiety and depression. Eating attitudes were associated with symptoms of depression, anxiety and self-dissatisfaction among females, while only self-dissatisfaction was associated with eating attitudes among males. The findings fail to support past studies that suggest females report more disordered eating attitudes than males.

Effects of a cognitive dissonance-based eating disorder prevention program are similar for Asian American, Hispanic, and White participants

OBJECTIVE

This study explored the effects of participating in a dissonance-based eating disorder prevention program on changes in thin ideal internalization, body dissatisfaction, and eating symptoms among White, Asian American, and Hispanic participants.

METHOD

Participants were (n = 394), 13 to 20-year-old adolescent girls and young women who reported being White (n = 311), Hispanic/Latina (n = 61), or Asian-American/Hawaiian/Pacific Islander (n = 33). The current study used data drawn from the pre- and post assessments of an efficacy trial and an effectiveness trial of this eating disorder prevention program.

RESULTS

The intervention reduced disordered eating behaviors and eating disorder risk factors for all three ethnic groups at post-intervention assessment; there was no evidence of significantly stronger effects in any particular ethnic group.

CONCLUSION

Results suggest that a cognitive dissonance-based prevention program for eating disorders may be equally effective for Asian American, Hispanic, and White adolescent women.

Thin ideal internalization in Mexican girls: a test of the sociocultural model of eating disorders

OBJECTIVE

We examined the influence of thin ideal internalization on body dissatisfaction and disordered eating in Mexican girls.

METHOD

We sampled 137 public school girls aged 12-15 from a small city in Mexico. Participants were given Spanish versions of the sociocultural attitudes toward appearance scale, two measures of body dissatisfaction, the eating attitudes test, and the attitudinal familism scale.

RESULTS

Thin ideal internalization mediated the relationship between thin ideal awareness and body dissatisfaction, and the relationship between thin ideal awareness and eating disorder symptoms. Attitudinal familism was negatively correlated with thin ideal internalization for girls outside of the normal weight range.

CONCLUSION

Mexican girls are at risk of eating disorder symptoms, and there is support for the sociocultural model of disordered eating in this population. Hispanic family values may mark protection from thin ideal internalization in Mexican girls outside of the normal weight range.

Correlates of problematic eating behaviors in less acculturated Latinas

We examined whether body weight, depression, and body dissatisfaction could predict problematic eating behaviors in a community sample of less acculturated adult Latina women. Three hundred and forty-nine Latina women ages 20-40 were classified as non-overeater (n=244), eating disorder not otherwise specified-binge eating disorder features (EDNOS-BED) (n=65), or eating disorder not otherwise specified-bulimia nervosa features (EDNOS-BN) (n=40). Participants completed measures of problematic eating behaviors, depression, and body image. Results revealed that normal weight and overweight women were at a higher risk only for EDNOS-BN, while obese women were at a higher risk for either EDNOS-BN or EDNOS-BED. Women with high depression scores were 16 times more likely to be assigned to the EDNOS-BN group than women with lower depression scores. Results illustrate the important role of depression and body weight in predicting problematic eating in less acculturated Latinas.

Real Women Have Curves

Contextualizing Latina girls' body image development requires an appreciation of mainstream body ideals, Latino/a cultural values, and the process by which Latina girls traverse the borders between them. The current study examines how media use and acculturation act across adolescence to shape the development of body image among Latina girls. Eighty-one Latina girls (ages 11 to 17) reported on their body satisfaction, acculturation, and use of mainstream, Black-oriented, and Spanish-language television. Fifty-two of these girls participated in a longitudinal follow-up 2 years later. Frequent viewing of mainstream television was associated with decreases in body image across adolescence. Frequent viewing of Black-oriented television was associated with greater body satisfaction, specifically among more acculturated girls. Illustrative quotes from a subset of participants are included.

Household income, maternal acculturation, maternal education level and health behaviors of Chinese-American children and mothers

OBJECTIVE

A cross-sectional study was conducted to examine factors associated with health behaviors, including physical activity and dietary intake, of Chinese women who have immigrated to the United States and their children.

PARTICIPANTS

Using convenience sampling, a total of 65 Chinese-American children and their mothers in the San Francisco Bay Area participated in the study.

MEASURES

Information related to children's weight, height, level of physical activity (Caltrac accelerometer), and dietary intake (Kids' food frequency questionnaire) was collected using standardized instruments. Mothers completed questionnaires regarding household income, their levels of education and acculturation (Suinn-Lew Asian Self-Identity Acculturation Scale), dietary intake (SWAN Food Frequency Questionnaire), and level of physical activity (Seven-day physical activity recall).

RESULTS

36.9% (n = 24) of the children were overweight (body mass index higher than the 85th percentile). A high household income was related to low maternal body mass index (R(2) = .08, P = .04), high maternal fat intake (R(2) = .21, P = .0001), and high maternal intake of sweets (R(2) = .08, P = .033), and a high level of maternal acculturation was related to low body mass index in children (R(2) = .07, P = .034).

CONCLUSIONS

The results suggest that an intervention aimed at reducing obesity and promoting health behaviors must be appropriate for different ethnic groups with various incomes and levels of acculturation.

The association between acculturation and needle sharing among Puerto Rican injection drug users

BACKGROUND

Base-line data from a community-based HIV outreach effort serving Puerto Rican injection drug users (IDUs) in Massachusetts identified that approximately half of their clients were born on the mainland and half on the island.

METHODS

Logistic regression methods examined the relationship between place of birth, primary language spoken, primary residence of family and needle sharing for a sample of 200 Puerto Rican IDUs residing in Massachusetts. Focus groups were used to interpret quantitative findings.

RESULTS

A logistic regression model indicated that Puerto Rican IDUs born on mainland USA were 2.1 times more likely to share needles than IDUs born in Puerto Rico, after controlling for gender, age, education, drug overdose, incarceration history and psychiatric status. Also, Puerto Rican IDUs who were older had overdosed on drugs in the past year, had been incarcerated in their lifetime, and were homeless were significantly more likely to report having shared needles in the past 6 months compared to their counterparts. Focus group interviews with Puerto Rican outreach workers and individuals in recovery suggested that differences in needle sharing by mainland versus island born IDUs may be due to cultural differences in interpretation of the interview questions.

IMPLICATIONS

Researchers examining HIV risk behaviors among culturally diverse substance abusers need to conduct more mixed-method studies to identify if different cultural groups understand quantitative measures differently. Incarceration may be a significant risk factor in the continued spread of HIV among IDUs and expanded HIV prevention efforts need to be developed that specifically target this high-risk group.