Self-efficacy beliefs and eating behavior in adolescent girls at-risk for excess weight gain and binge eating disorder

Psychosocial correlates in patterns of adolescent emotional eating and dietary consumption

Unhealthy eating behaviors, such as consumption of unhealthy diet and emotional eating, are common in adolescence and tend to co-occur. However, how these behaviors are patterned may vary among adolescents. This study identified patterns of dietary consumption and emotional eating behaviors in adolescents and examined the sociodemographic and psychosocial (e.g., self-efficacy beliefs and motivation) covariates associated with these eating patterns. Data were from the Family Life, Activity, Sun, Health and Eating study. Latent class analysis was used to estimate adolescent dietary patterns from dietary consumption (i.e., fruits, vegetables, sugar-sweetened beverages, junk food, etc.) and emotional eating variables (i.e., eating when feeling sad or anxious). The sample included 1,568 adolescents (Mean age = 14.48-years-old, 49% girls, 55% White). A four-class solution best fit the data (e.g., Bayesian Information Criteria [BIC] = 12263.568, three-class model BIC = 12271.622). Four unhealthy eating behavior patterns were identified: poor diet/high emotional eating, mixed diet/high emotional eating, poor diet/low emotional eating, and mixed diet/low emotional eating. Compared to the poor diet/high emotional eating group, the other groups were less likely to include older adolescents, girls, and adolescents who experienced food insecurity, and more likely to have higher self-efficacy for eating fruits and vegetables and limiting junk foods as well as motivation for consuming fruits and vegetables and limiting junk foods. Our findings highlight adolescents' complex dietary patterns that include dietary consumption and emotional eating behaviors. Future studies should examine other potential dietary patterns that include emotional eating. Efforts to address unhealthy patterns of adolescents' dietary consumption and emotional eating behaviors should be expanded.

Change in parent and child psychopathology following obesity treatment and maintenance: A secondary data analysis

BACKGROUND

General and eating disorder (ED) psychopathology are common among children and adults with overweight/obesity; few studies have examined their course of change throughout family-based behavioural obesity treatment (FBT) and maintenance.

OBJECTIVES

Examine: (1) the changes in the parent and child general and ED psychopathology during FBT and maintenance interventions; (2) the associations between change in psychopathology and change in weight among children or parents; (3) the associations between change in psychopathology within parent-child dyads.

METHODS

172 parent-child dyads participated in 4-month FBT and were subsequently randomized to one of three 8-month maintenance interventions. General psychopathology (child anxiety/depressive symptoms, parent severity of global psychological distress), ED psychopathology (shape/weight concern), and percent overweight were assessed at baseline, post-FBT, and post-maintenance. Separate linear mixed-effects models evaluated change in general and ED psychopathology, including an interaction between maintenance condition and time. Partial correlations examined associations between change in psychopathology and percent overweight among children or parents, and associations between change in psychopathology within parent-child dyads.

RESULTS

Among children, significant reductions were observed from baseline to post-FBT in all forms of psychopathology and from post-FBT to post-maintenance in general psychopathology. Among parents, significant reductions were observed from baseline to post-FBT in all forms of psychopathology; reductions were maintained from post-FBT to post-maintenance. There was no significant interaction between maintenance condition and time. Correlations between change in most forms of parent or child psychopathology and percent overweight were observed.

CONCLUSIONS

Participation in FBT and maintenance was associated with improvements in general and ED psychopathology in both parents and children.

Current Status and Influencing Factors of Eating Behavior in Residents at the Age of 18~60: A Cross-Sectional Study in China

As eating behavior is important to health, this cross-sectional study was conducted to analyze the factors influencing the eating behavior related to overweight and obesity of Chinese residents aged 18~60 based on the Ecological Model of Health Behavior. The short-form of the Eating Behavior Scale (EBS-SF) was applied to evaluate eating behavior. The multivariable linear stepwise regression analysis was used to identify and analyze the influence factors, and the receiver operating characteristic curves analysis to validate the predictive capability of the EBS-SF score in differentiating overweight and obesity. A total of 8623 participants were enrolled. In the personal characteristics, male (β = −0.03), older [36–45 years (β = −0.06) or 46–60 years (β = −0.07)], higher scores of Agreeableness (β = −0.04), Conscientiousness (β = −0.14) or Openness (β = −0.03) contributed to healthy eating behavior. In the individual behaviors, those who smoked (β = 0.04), drank alcohol (β = 0.05), exercised frequently (β = 0.07), had higher PHQ-9 scores (β = 0.29) may have improper eating habits. As for the interpersonal networks, the residents who were married (β = −0.04) behaved well when eating, while those who had offspring or siblings tended to have unhealthy eating behavior. At the community level, living in Western China (β = −0.03), having a monthly household income of 6001–9000 yuan per capita (β = −0.04), having no debt (β = −0.02), being retired (β = −0.03), or having lower PSSS scores (β = −0.03) led to lower EBS-SF scores. And the EBS-SF score demonstrated a moderate-high accuracy in predicting overweight and obesity.

Influence of a Nutrigenetic Intervention on Self-Efficacy, Emotions, and Rewarding Behaviors in Unhealthy Eating among Mexicans: An Exploratory Pilot Study

The Genome-based Mexican (GENOMEX) diet is a strategy for preventing and managing obesity. Emotion and eating behavior in the context of a nutrigenetic intervention have not been thoroughly studied. We aimed to explore the influence of the GENOMEX diet on emotions, self-efficacy, and rewarding behaviors in unhealthy eating among subjects with risk factors for obesity-related chronic diseases. Twenty-eight subjects included in the six-month GENOMEX intervention answered questions regarding emotions that influence food consumption. Additionally, the Patient Health Questionnaire (PHQ-9) and the Reward-based eating drive scale (RED) were applied. In the study, minimal, mild, moderate, and severe depression were present in 46.4%, 39.3%, 10.7%, and 3.6%, respectively. RED did not change, but it correlated with a higher intake of fats (r² = 0.684, β = 2.066, p = 0.003). Mood influenced unhealthy eating in 71.7% of subjects, and 76.9% experienced binge episodes triggered by anxiety. Sugars were the most consumed foods during binge episodes (42.2%). Both low self-efficacy levels and binge episodes were associated with high consumption of unhealthy foods. After the intervention, 10.7% of subjects reported a high level of self-efficacy. In conclusion, a culturally acceptable and genetically compatible regional Mexican food diet reduced negative emotions and unhealthy eating while increasing self-efficacy.

Autoeficácia alimentar em crianças e adolescentes com sobrepeso ou obesidade: revisão integrativa de instrumentos

RESUMO Objetivo: Descrever as características dos instrumentos para avaliação da autoeficácia alimentar no sobrepeso e na obesidade em crianças e adolescentes. Métodos: Revisão integrativa da literatura, realizada em maio de 2020, em seis bases de dados (PubMed; Web of Science; Scopus; CINAHL, ADOLEC e PsycINFO) com a seguinte estratégia de busca: self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Resultados: Incluíram-se 35 artigos e 21 instrumentos aplicados às crianças de 6 a 9 anos (n=2), em adolescentes de 10 a 19 anos (n=9) e em crianças e adolescentes de 7 a 18 anos (n=10). Os instrumentos têm de 4 a 30 itens e variaram de duas a cinco dimensões, sendo as mais frequentes “alimentação saudável” e “atividade física”. Conclusão: Existem diferentes instrumentos confiáveis destinados à avaliação da autoeficácia alimentar do público adolescente e infantil, o que sinaliza a importância desse construto para prevenção e controle da obesidade e sobrepeso.

Eating self- efficacy in overweight and obese children and adolescents: integrative review of instruments

ABSTRACT Objective: To describe the characteristics of instruments to assess eating self-efficacy in overweight and obesity in children and adolescents. Methods: Integrative literature review, conducted in May 2020, in six databases (PubMed; Web of Science; Scopus; CINAHL, ADOLEC, and PsycINFO) with the following search strategy: Self-efficacy and (Overweight OR Obesity) and (Child* OR Adolescent). Results: The inclusion of thirty-five articles and twenty-one instruments was applied to children 6 to 9 years old (n=2), adolescents 10 to 19 years old (n=9), and children and adolescents 7 to 18 years old (n=10). The instruments have 4 to 30 items and vary from two to five dimensions, the most frequent being “healthy eating” and “physical activity.” Conclusion: There are different reliable instruments designed to assess eating self-efficacy in adolescents and children, indicating the importance of this construct for preventing and controlling obesity and overweight.

Adolescent Self-Efficacy for Diet and Exercise Following a School-Based Multicomponent Lifestyle Intervention

Self-efficacy is perhaps the most important parameter associated with behavioral changes. The main aim of this study was to provide insight into the diet and exercise self-efficacy of Greek adolescents and how they could be modified via a multilevel multicomponent school-based lifestyle intervention. Secondary aims were to study the associations of students’ dietary and exercise self-efficacy indices with their anthropometric and sociodemographic parameters. A representative sample of the adolescent population in Attica, consisting of 1610 adolescents aged 12–17 years, recruited from 23 public high schools in three municipalities of the Attica area in Greece, received a three-component lifestyle educational intervention for health promotion and underwent screening for characteristics of metabolic syndrome with the use of portable telemedicine. All assessments and anthropometric measurements were performed at baseline and after the 6-month intervention. Anthropometric measurements included body mass index, waist circumference (WC), waist-to-height ratio (WHtR) and waist-to-hip ratio (WHR). Assessment tools included the Self-efficacy for Diet and the Self-efficacy for Exercise questionnaires, as well as the Mediterranean Diet Quality Index in Children and Adolescents (KIDMED). Analysis included 1020 adolescent students (421 males and 599 females), who completed the self-efficacy questionnaires pre- and post-intervention. Overall, the dietary (p < 0.001) and exercise (p < 0.001) self-efficacy increased significantly post-intervention. Post-intervention, all adolescents decreased their abdominal obesity indices (WC, WHtR, WHR), and this improvement was even more pronounced and significant (p = 0.019, p = 0.019, p = 0.023 respectively) in the adolescents with overweight/obesity. Post-intervention, the proportion of adolescents with normal weight increased from 73.9% to 78.6%, whereas the proportion of adolescents with overweight and obesity decreased from 20.4% to 15.9% and from 5.7% to 5.5%, respectively. Abdominal obesity also decreased from 10.4% to 9.0%. Female adolescents achieved significantly (p = 0.010) higher changes in diet self-efficacy than males. Other sociodemographic characteristics such as family structure, parental age, parental educational level and family income showed non-significant differences. Adolescents with higher KIDMED scores manifested significantly higher dietary and exercise self-efficacy than those with lower KIDMED scores. Both adolescents with normal weight and overweight/obesity manifested a reciprocal relation between diet and exercise self-efficacy. Multicomponent lifestyle interventions in the school environment may provide a first step in students’ behavior changes and provide grounds for future prevention programs in youth.

Eating Disorders Screening Tools: The Psychometric Properties of the Persian version of Eating Attitude Test

Background:

Screening for eating disorders via reliable instruments is of high importance for clinical and preventive purposes. Examining the psychometric properties of tools in societies with differing dynamics can help with their external validity. This research specifically aimed at standardization and validation of the eating attitude test (EAT-16) in Iran.

Methods:

The Persian version of the EAT-16 was produced through forward translation, reconciliation, and back translation. The current research design was descriptive cross-sectional (factor analysis). A total of 302 nonclinical students were selected through the convenience sampling method and completed a set of questionnaires. The questionnaires included, the EAT-16, eating beliefs questionnaire-18 (EBQ-18), difficulties in emotion regulation scale-16 (DERS-16), weight efficacy lifestyle questionnaire-short form, self-esteem scale, and self-compassion scale short-form. The construct validity of the EAT-16 was assessed using confirmatory factor analysis and divergent and convergent validity. Internal consistency and test–retest reliability (2 weeks’ interval) were used to evaluate the reliability. Data analysis was conducted using LISREL (version 8.8) and SSPS (version 22) software.

Results:

EAT-16 and subscales were found to be valid and reliable, with good internal consistency and good, test–retest reliability in a non-clinical sample. In terms of convergent validity, EAT-16 and subscales showed a positive correlation with the selfreport measures of EBQ-18 and DERS-16. EAT-16 and subscales showed a negative correlation with self-compassion, self-esteem and eating self-efficacy., Therefore, it demonstrated divergent validity with these constructs. The results of this study support the EAT-16 four-factor model.

Conclusions:

The EAT-16 showed good validity and reliability and could be useful in assessing eating disorders in Iranian populations. The EAT-16 is an efficient instrument that is suitable for screening purposes in the nonclinical samples.

The Effect of Learning Module Program on Mothers’ Ability to Adapt to New Foods, Feeding Styles, and Self-efficacy to Their Children with Avoidant Restrictive Food Intake Disorder

BACKGROUND: The education to improve a mother’s knowledge is deemed to be important because it may improve children’s nutritional status. AIM: The aim of this study was to examine the effects of learning module program on the mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with avoidant restrictive food intake disorder (ARFID). METHODS: Quasi-experimental design was used to evaluate the effectiveness of learning module program. Fifteen mothers of experimental group were given four meetings within 4 weeks. Each meeting ran about 50 min. Fifteen mothers of control group were conducted home visit and received twice education about the health principals of feeding children. Both experimental group and control group had pre-test and post-test. The data were analyzed using Chi-square test, Fisher’s exact test, and Mann–Whitney U-test. RESULTS: The participants of the experimental group have shown bigger surge of new foods adaptation (t = –2.973, p < 0.003), feeding style (t = –4.646, p < 0.001), self-efficacy (t = –3.652, p = 0.001) than the control group has. CONCLUSION: The findings indicated that the learning module program was deemed to be effective to improve mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with ARFID.

Measuring perfectionism, impulsivity, self-esteem and social anxiety: Cross-national study in emerging adults from eight countries

This study assessed the measurement invariance of selected self-report measures of perfectionism, impulsivity, self-esteem and social anxiety in samples of emerging adults from eight different countries. Participants (N = 6272) completed the Multidimensional Perfectionism Scale (MPS), the UPPS-P Impulsive Behavior Scale, the 5-item Rosenberg Self-Esteem Scale (5-item RSES) and the Social Interaction Anxiety Scale (SIAS-6). Multigroup confirmatory factor analysis was run to examine cross-measure equivalence. Evidence for structural invariance was found for all questionnaires, while weak invariance was supported only for the 5-item RSES and the SIAS-6, and a partial weak invariance was found for the MPS and the UPPS-P. No measure achieved strong invariance. Strict invariance was achieved for the 5-item RSES, whereas only a partial strict invariance was supported for the MPS, UPPS-P and SIAS-6. These results suggest that perfectionism, impulsivity, self-esteem, and social anxiety are subjected to linguistic/cultural influence as well as to the effects of socio-demographic variables and can be evaluated by using the selected measures in eight different countries worldwide - but results should be interpreted with caution.

Eating control and eating behavior modification to reduce abdominal obesity: a 12-month randomized controlled trial

BACKGROUND/OBJECTIVES

Abdominal obesity is associated with metabolic disorders, and, in recent years, its prevalence in Korea has continuously increased. The change of lifestyle, particularly diet, is critical for the reduction of abdominal obesity. This study evaluated the effectiveness of an intervention focused on dietary self-efficacy and behaviors on the improvement of abdominal obesity.

SUBJECTS/METHODS

Abdominally obese adults with additional cardiovascular risk factors were recruited through 16 medical facilities in South Korea from the year 2013 to 2014. The participants were randomly divided into 2 groups: an intensive intervention group (IG) that received a multi-component intervention to reduce abdominal obesity, by mainly focusing on dietary attitude and dietary behavior change, and a minimal information intervention group (MG) that received a brief explanation of health status and a simple recommendation for a lifestyle change. The interventions were provided for 6 mon, and health examinations were conducted at baseline, 3-, 6-, and 12-mon follow-ups. A path analysis was conducted to identify the process governing the changes in abdominal obesity.

RESULTS

The IG showed an improvement in self-efficacy for eating control and diet quality at 6-mon follow-up. Abdominal obesity improved in both groups. Waist circumference was observed to be decreased through the path of “improved self-efficacy for eating control in food availability—eating restriction—improved dietary quality” in IG. Most changes in follow-ups were not significantly different between two groups.

CONCLUSIONS

The intensive program targeting the modification of dietary behavior influenced management of abdominal obesity, and the effect occurred through a step-by-step process of change in attitude and behavior. Generally, improvements were also seen in the MG, which supports the necessity of regular health check-ups and brief consultation. The results can be used for further development and implementation of more successful interventions.

Trial Registration

Clinical Research Information Service Identifier: KCT0000762

Associations between latent trait negative affect and patterns of food-intake among girls with loss-of-control eating

OBJECTIVE

Momentary negative affect (NA) has been shown to predict eating patterns in the laboratory, yet, more stable mood states have not been studied in relation to eating patterns in the laboratory among youth at high risk for binge-eating disorder and obesity.

METHOD

One-hundred-eight adolescent girls (14.5 ± 1.7 years) with BMI between the 75th-97th percentile who reported loss-of-control (LOC)-eating completed measures of trait anxiety and depressive symptoms. Food-intake patterns were measured from a laboratory test meal (9,385 kcal). Latent factor analysis of depressive symptoms and trait anxiety was used to compute latent trait NA. Multivariate general linear models predicted total energy, snacks, and macronutrient intake from trait NA, adjusting for age, race, height, lean-mass, and percentage fat-mass.

RESULTS

Trait NA was significantly positively related to total energy-intake, and, specifically, snacks, sweet snacks, and percentage sweet fats (ps ≤ .03), and negatively related to percentage protein consumed (p = .04).

DISCUSSION

Expanding on affect theory, trait NA may relate to palatable food-intake among girls with LOC-eating. Further data are needed to determine whether those with LOC-eating and trait NA are at heightened risk for the development of binge-eating disorder and obesity.

The Influence of Parents and Schools on Adolescents' Perceived Diet and Exercise Self-Efficacy: A School-Based Sample From the United Arab Emirates

Introduction: In the United Arab Emirates, an alarming rate of 19% obesity among adolescents, associated with poor lifestyle, is apparent. Diet and exercise self-efficacy could influence adolescents' engagement in healthy behaviors. This study evaluates adolescents' perceptions of diet and exercise self-efficacy and explores the impact of parents and schools on self-efficacy. Method: A cluster sampling approach in cross-sectional design was used to recruit 610 school adolescents (Grades 7-12) over a 6-month period. Information on sociodemographics, lifestyle, parents, and schools was explored. Self-efficacy was assessed using The Eating Habits and Exercise Confidence Survey. Results: Participants reported moderate diet and exercise self-efficacy. Diet self-efficacy was predicted by parental support, eating breakfast and meals regularly at home, and prohibiting soft drinks. School support and frequency of weekly exercise classes predicted exercise self-efficacy; p values ≤.05. Discussion: Cultural knowledge and collaboration are essential to promote self-efficacy in multiethnic adolescents in the United Arab Emirates.

Approach bias modification training in bulimia nervosa and binge-eating disorder: A pilot randomized controlled trial

OBJECTIVE

Bulimia nervosa (BN) and binge-eating disorder (BED) are associated with poorly controlled approach behavior toward food resulting in binge eating. Approach bias modification (ABM) may reduce these automatic action tendencies (i.e., approach bias) toward food and may thus decrease binge eating and related symptoms.

METHOD

A total of 56 patients with BN/BED participated in this double-blind, randomized controlled trial (RCT) comparing real and sham ABM. The real ABM condition adopted an implicit learning paradigm in which participants were trained to show avoidance behavior in response to food cues. Participants in the sham condition used a similar task but were not trained to avoid food cues. Both conditions comprised 10 training sessions within 4 weeks.

RESULTS

Participants in both groups experienced significant reductions in binge eating, eating disorder symptoms, trait food craving, and food cue reactivity. Real ABM tended to result in greater reductions in eating disorder symptoms than sham ABM. Food intake, approach bias, and attention bias toward food did not change.

DISCUSSION

This is the first RCT on ABM in eating disorders. The findings provide limited support for the efficacy of ABM in BN/BED and pose questions regarding its active ingredients and its usefulness as a stand-alone treatment for eating disorders.

The self and eating disorders

In our review, we focus on self-related constructs in the context of eating disorders with four aims. First, we examine a variety of self-related constructs that have been theoretically and empirically linked to the development and course of eating disorders. In addition to the more well-researched constructs of self-esteem and self-efficacy, we also report on findings related to selflessness, contingent self-worth, self-objectification, ego-syntonicity, self-concept clarity, self-compassion, social comparison, self-oriented perfectionism/self-criticism, and narcissism. Second, we discuss self-related constructs that may be especially relevant to comorbidities common among those with eating disorders. Third, we review intervention and prevention programs where self-related constructs play a prominent role. Lastly, we share future research directions regarding self-related constructs and eating disorders that we believe will advance a deeper understanding of the role of the self in the eating disorders.

Perceived Family Functioning in Relation to Energy Intake in Adolescent Girls with Loss of Control Eating

Family functioning is hypothesized to influence the development, maintenance, and treatment of obesity and eating disorders. However, there are limited data examining family functioning in relation to energy intake in the laboratory among youth at high-risk for eating disorders and excess weight gain. Therefore, we examined the relationship between perceived family functioning and energy intake during a laboratory test meal designed to model a binge episode. We performed hierarchical multiple regression analyses among 108 adolescent girls in an excess weight gain prevention trial. Participants were at high-risk for eating disorders and excess weight gain due to reports of loss of control eating (LOC) and high body mass index (BMI). Participants completed the Family Adaptability and Cohesion Scale III to assess family adaptability and cohesion. Following an overnight fast, girls consumed lunch from a laboratory test meal. Poorer family adaptability, but not cohesion, was associated with lower percentage of total energy intake from protein and greater percentage of total energy intake from carbohydrates. Neither adaptability nor cohesion were significantly associated with total intake. We conclude that among girls with LOC eating and high BMI, poor reported family adaptability is associated with greater consumption of obesity-promoting macronutrients during binge episodes. Directionality and temporality of this association between unhealthy consumption and family rigidity requires further study.

Self-efficacy and emotionally dysregulated behaviour: An exploratory test of the role of emotion regulatory and behaviour-specific beliefs

We examined the relationship between self-efficacy and three behaviours that can serve similar affect-regulatory functions (self-injury, risky alcohol use, disordered eating). We proposed that general self-efficacy would be indirectly related to each outcome, operating via emotion regulatory self-efficacy and behaviour-specific self-efficacy. A path analysis confirmed this proposal in a sample of 490 university students, who completed questionnaires assessing the constructs of interest. Emotion regulatory self-efficacy was a salient predictor of self-injury and disordered eating, evidencing both direct and indirect relationships. Self-efficacy to resist each of the behaviours was uniquely related to its target behaviour. We discuss these findings, outlining the implications for a theoretical understanding of emotion-regulatory behaviours, and offer suggestions for prevention and early intervention initiatives.

The role of perceived barrier in the postpartum women's health promoting lifestyle: A partial mediator between self-efficacy and health promoting lifestyle

INTRODUCTION

In recent decades, the focuses of health studies were mostly in middle-aged women, and few studies have investigated the lifestyle of women after delivery. The aim of this study was to determine the effects of both self-efficacy and perceived barriers on Iranian women health-promoting lifestyle (HPL) in the first 1 year after childbirth.

MATERIALS AND METHODS

Using a cross-sectional design, 310 women at first-year postpartum were surveyed in Zanjan (Iran) in 2016. The proportionate stratified random sampling method was carried out to select a participant. HPL has assessed with HPL profile II questionnaire. Self-efficacy was assessed using self-rated abilities for health practices scale. Perceived barriers were assessed by Barriers to Health-promoting Activities for Disabled Person scale. A meditational model was used to examine whether perceived barriers mediates between perceived self-efficacy and HPL.

RESULTS

The participants mean age was 29.82 (5.1) years, 53.9% were primiparous, and most of them were homemakers (82.9%). The mean total score of HPL was 2.50 (0.29). The relationship between HPL and self-efficacy was mediated by perceived barriers partially.

DISCUSSION

Self-efficacy, not only promotes women's HPL but also indirectly affect the women's lifestyle by reducing perceived barriers.

Self-efficacy as a predictor of treatment outcome in an outpatient eating disorder program

This prospective pilot study examined the relationship between self-efficacy and treatment outcome in an adult outpatient eating disorder program. Data from 59 eating disorder outpatients were collected, including measures of self-efficacy, eating disorder symptom severity, negative emotions (depression, anxiety, and stress), body mass index, and duration of illness. Hierarchical regression was used to examine the impact of baseline self-efficacy, and early treatment changes in self-efficacy (i.e., baseline to 6 weeks), on end-of-treatment (EoT) eating disorder symptom severity and treatment dropout. Early change in self-efficacy during the course of treatment was found to predict EoT symptom severity when controlling for confounding variables. Furthermore, baseline self-efficacy was found to predict treatment dropout, but not end-of-treatment symptom severity. This is the first study (using a validated scale) to show that self-efficacy, and early changes in self-efficacy, may be an important predictor of treatment outcome for eating disorder outpatients. Implications and suggestions for future research are discussed.

The effect of weight controllability beliefs on prejudice and self-efficacy

An experiment was conducted to test for the presence of prejudice towards obesity and whether weight controllability beliefs information reduces this prejudice and impacts on a person’s own healthy eating self-efficacy. The experiment randomly allocated 346 participants (49 males) into one of three conditions: controllable contributors toward obesity condition (e.g., information about personal control about diet and exercise); uncontrollable contributors toward obesity condition (e.g., information about genes, factors in society); and a control condition with no information given. Prejudice was present in 81% of the sample. High prejudice was predicted by low self-efficacy for exercise and weight. Weight controllability beliefs information had no significant effect on prejudice levels or exercise or healthy eating self-efficacy levels. Future research directions are discussed.

Differential Impact of Message Appeals, Food Healthiness, and Poverty Status on Evaluative Responses to Nutrient-Content Claimed Food Advertisements

A 2 × 3 × 2 mixed factorial experimental design was used to examine how three message appeals (benefit-seeking vs. risk-avoidance vs. taste appeals), food healthiness (healthy vs. unhealthy foods), and consumer poverty status (poverty vs. nonpoverty groups) impact evaluative responses to nutrient-content claimed food advertisements. Subjects were partitioned into two groups, those below and those above the poverty line, and exposed to nutrient-content claimed advertisement treatments for healthy and unhealthy foods featuring the three appeals. The findings reaffirmed the interaction effects between perceivably healthy and unhealthy foods and different appeals reported in previous studies, and found interaction effects between consumer poverty level and response to the message appeals featured in the experimental food advertisements. Age, body mass index, current dieting status, education, and gender were examined as covariates.

Self-efficacy as a mediator of the relationship between subjective well-being and general health of military cadets

The objective of this study is to investigate the role of self-efficacy beliefs as a mediator of the relationship between the subjective well-being and general health of military cadets (police and firefighters). For this study, 228 cadets participated, the majority being Military Police officer candidates (65%), male (79%), between 17 and 34 years of age (99%), and unmarried (74%). They responded to questionnaires on general health (GHQ-12), perceived general self-efficacy, to the multiple scales that cover subjective well-being, and demographic questions. Initial regression analyses indicate the predictive power of subject well-being regarding general health. Subsequently, the mediation analyses provide satisfactory evidence for the role of perceived self-efficacy as a mediator of the relationship between the subjective well-being variables and the overall health of military cadets. The implications of these results for the professional training of the cadets are discussed.

The impact of web-based HOT (Healthy Outcomes for Teens) Project on risk for type 2 diabetes: a randomized controlled trial

BACKGROUND

The HOT (Healthy Outcome for Teens) Project is an innovative online educational intervention for middle school children for prevention of diabetes and obesity by balancing food intake with physical activity. The objective was to improve knowledge, outcome expectations, self-efficacy, and self-reported food intake and skills and to compare a passive online learning (POL) control group with an active online learning (AOL) treatment group by implementing a social cognitive theory (SCT)-grounded online intervention.

SUBJECTS AND METHODS

In total, 214 participants were recruited from three middle schools. Full data were secured for 181 students. Six valid, reliable questionnaires were administered online, pre/post, to both the AOL and POL groups to assess knowledge gain, self-reported intake, and meal planning skills, as well as change in SCT constructs.

RESULTS

Subjects in the AOL group improved significantly for all five categories of planning a meal questionnaire (P=0.001) and also for outcome expectations for exercise (P=0.001). At postintervention, no significant differences were found for composite scores of exercise self-efficacy, weight efficacy lifestyle, and rapid eating assessment plan questionnaires between AOL versus POL (by Mann-Whitney test).

CONCLUSIONS

We conclude that teens participating in the AOL version of the HOT Project intervention acquired skills for planning a meal and improved outcome expectations for exercise.

Correlations between self-efficacy in resisting six temptations and dietary energy and macronutrient intake at each meal

Self-efficacy in relation to eating behavior for weight control is commonly defined as having the confidence to control urges to overeat in high-risk situations. Prior researchers have suggested that self-efficacy plays a mediating role in eating behavior for weight loss and maintenance. The current study examined the relationship between self-efficacy in resisting certain temptations and daily dietary intake at each meal. Participants were 83 men and 122 women registered at the health management website "Asken". They administered questionnaires about self-efficacy and dietary records. As results of multiple regression analysis, self-efficacy in resisting negative emotions was negatively related to lunch energy intake in men (β=-0.308, p=0.023) and total (β=-0.302, p=0.003), breakfast (β=-0.334, p=0.004), and snacking (β=-0.232, p=0.022) energy intake in women. Also, self-efficacy in resisting rewards was negatively related to lunch energy intake in men (β=-0.218, p=0.040). In men, self-efficacy in resisting hunger was positively related to protein intake (β=0.148, p=0.021) and relaxation was negatively related to lipid intake (β=-0.211, p=0.009). Self-efficacy in resisting some temptations, especially negative emotions, and dietary intakes were negatively related. Future research is needed to confirm these results and assess the prospective effects of self-efficacy.

High self-efficacy predicts adherence to surveillance colonoscopy in inflammatory bowel disease

BACKGROUND

Patients with extensive ulcerative colitis or Crohn's disease of the colon have an increased risk of colon cancer and require colonoscopic surveillance. In this study, we assessed individual self-efficacy (SE) to estimate the probability of adherence to surveillance colonoscopies.

METHODS

Three hundred seventy-eight patients with ulcerative colitis or Crohn's disease of the colon for at least 7 years and with at least one third of the colon involved participated in this cross-sectional questionnaire study performed at 3 tertiary referral inflammatory bowel disease clinics. Medical charts were abstracted for demographic and clinical variables. The questionnaire contained a group of items assessing SE for undergoing colonoscopy.

RESULTS

We validated our 20-question SE scale and used 8 of the items that highlighted scheduling, preparation, and postprocedure recovery, to develop 2 shorter SE scales. All 3 scales were reliable with Cronbach's α ranging from 0.845 to 0.905 and correlated with chart-documented adherence to surveillance colonoscopy (P < 0.001). We then developed logistic regression models to predict adherence to surveillance colonoscopy using each scale separately along with other key variables (i.e., disease location, knowledge of correct adherence intervals, and information sources of patients consulted regarding Crohn's disease and ulcerative colitis) and demonstrated model accuracy up to 74%.

CONCLUSIONS

SE, as measured by our validated scales, correlates with chart-adherence to surveillance colonoscopy. Our adherence model, which includes SE, predicts adherence with 74% certainty. An 8-item validated clinical questionnaire can be administered to assess whether patients in this population may require further intervention for adherence.

Rasch analysis of the General Self-Efficacy Scale in a sample of persons with morbid obesity

Background

Self-efficacy is needed for effectuating lifestyle changes, and it is therefore an important target related to health. The purpose of this study was to evaluate the psychometric properties of the General Self-Efficacy Scale (GSE) using Rasch analysis in a sample of adults with morbid obesity.

Methods

A convenience sample of adults with morbid obesity was recruited from patient education courses. A total of 141 participants completed the GSE and a demographic questionnaire at the beginning of the course. The statistical approach included analysis of rating scale function, item fit to the Rasch partial credit model, unidimensionality, aspects of person-response validity, person-separation reliability, and differential item function. A version omitting items with poor fit to the Rasch model was also evaluated.

Results

The rating scale did not advance monotonically for item #2 in the original 10-item version, and the first three GSE items did not demonstrate acceptable goodness-of-fit to the Rasch model. In a 7-item version omitting these three items, the rating scale functioned well for all items, and all items demonstrated good fit to the Rasch model. Both the 10-item and 7-item versions of the GSE partially met the criteria for unidimensionality. Neither version met the criterion for person response validity, although the results were slightly better for the 7-item than for the 10-item version. Both versions of the GSE demonstrated the ability to separate the respondents into three distinct levels of general self-efficacy. Several items had differential item function in relation to age, education or work status, but there were fewer in the 7-item version.

Conclusions

For adults with morbid obesity, a 7-item version of the GSE seems to have better psychometric properties than the original 10-item version.