"I would rather be size 10 than have straight A's": a focus group study of adolescent girls' wish to be thinner

Boarding versus day-students: A mixed-methods analysis of sleep and its relationship with psychological distress

BACKGROUND

Boarding students face unique challenges when entering school, including: adapting to a novel environment, where they are separated from family, friends and culture, for up to 40 weeks per year. A particular challenge is sleep. A further challenge is coping with the demands of boarding with its potential impact on psychological well-being.

AIMS

To explore how boarders' sleep differs from that of their day-student peers, and how this relates to psychological well-being.

SAMPLE AND METHODS

309 students (59 boarding students and 250 day-students, at one Adelaide school) completed the School Sleep Habits Survey, Depression-Anxiety-Stress-Scale-21 (DASS-21), and Flourishing Scale. Boarding students additionally completed the Utrecht Homesickness Scale. Thirteen boarding students described experiences of sleeping in boarding through focus groups.

RESULTS

Boarding students, compared to day-students reported 40 minutes more sleep per weeknight (p < .001), with earlier sleep onset (p = .026), and later wake-up (p = .008) times. No significant differences were observed between boarding' and day-students' DASS-21 scores. Hierarchical regression revealed longer total weekday sleep time predicted higher psychological well-being in both boarding and day-students. Additionally, in boarding students, low homesickness-loneliness and homesickness-ruminations further predicted psychological well-being. Thematic analysis of boarding students' focus group responses revealed that night-time routine, and restricting technology use at night facilitated sleep.

CONCLUSIONS

This study supports - in both boarding and day-students - the importance of sleep for adolescent well-being. Sleep hygiene can play an important role in boarding student sleep, especially: regular night-time routine and restricting technology use at night. Finally, these findings suggest that poor sleep and homesickness have an adverse effect on boarding student psychological well-being. This study highlights the importance of strategies which promote sleep hygiene and minimize homesickness, in boarding school students.

A scoping literature review of the associations between highly visual social media use and eating disorders and disordered eating: a changing landscape

BACKGROUND

Although the etiology of eating disorders (ED) and disorder eating (DE) is multifactorial, exposure to highly visual social media (HVSM) may be an important contributor to the onset or worsening of DE and ED symptoms. We aim to understand HVSM use, ED, and DE with a particular focus on gender differences, as well as details of engagement on "selfies" in adolescents and young adults (AYA) through a scoping review of the literature.

METHODS

We conducted a literature search in Psycho ED, PubMed, MEDLINE of articles, including participants with DE/ED and users of HVSM, focused on AYA. Studies in which the study population did not include AYA, the SM platforms used did not include HVSM platforms, and the methodology to assess ED/HVSM use was not robust were excluded.

RESULTS

We found a strong relationship between HVSM and ED and DE with existing gender differences related to the nature of engagement and preference of content. The literature also shows effects of the specific mechanisms of use of these platforms involving "selfie" preparation and posting. Existing research is limited and consists of mostly cross-sectional studies with no uniform methodology and with participant populations that are not well-defined.

CONCLUSIONS

The use of unregulated and profit-driven SM platforms can increase risk for ED. To use these HVSM platforms for positive influence, there is a need to have more transparency, and involvement of clinicians, researchers, and educators.

PUBLIC SIGNIFICANCE

Due to HVSM's popularity among the AYA population, it is important to identify its effects on the development of DE and ED, as well as recognize any gender differences. Clinicians, parents, and other adults working with youth should be aware of HVSM's impact on DE/ED, as described in this review.

Are you looking at me? A longitudinal vignette study of adolescent appearance rejection sensitivity and coping with peer evaluation

Appearance rejection sensitivity (ARS) refers to anxiously over-expecting rejection because of perceived appearance flaws. ARS has been associated with poorer mental health, which suggests coping with stress may be negatively affected by ARS. In this study, we investigated if ARS was related to adolescents' emotions and ways of coping with negative appearance evaluation two years later (T2). Other potential correlates of emotions and ways of coping were also tested, including peer appearance teasing, social anxiety, and gender, as well as reports of victimization, social status, and attractiveness gathered from peers. At Time 1 (T1), 329 adolescents (M = 13.9 years, 54% girls) self-reported their ARS, experience of appearance teasing, and social anxiety. T1 appearance victimization, popularity, and attractiveness were measured using peer nominations, and peer likeability was measured with peer ratings. At T2, participants' emotions and coping were measured using vignettes portraying appearance evaluation by peers. In regression models, T1 ARS, appearance teasing, social anxiety and female gender were associated with more T2 negative emotions, social withdrawal, rumination, and (except for social anxiety) thoughts about appearance change. ARS was not significantly associated with T2 positive thinking or support seeking. No peer-report measure was significantly associated with T2 outcomes.

Relationship between body dissatisfaction, insufficient physical activity, and disordered eating behaviors among university students in southern China

Background

With an increasing incidence of obesity, the relationship between obesity and body image has become a hot research topic worldwide. From high school to university, young people experience changes in their social environment. University students have a high incidence of eating disorders and insufficient physical activity. The purpose of this study was to explore the relationship between body dissatisfaction, insufficient physical activity, and disordered eating behaviors among university students in southern China.

Methods

In total, 1296 university students aged 18–23 years were recruited for this study. The participants completed anthropometric measurements, the Physical Activity Rating scale-3 (PARS-3), and the Chinese-Dutch Eating Behavior Questionnaire (C-DEBQ). The ideal weight and silhouette were reported by university students using a questionnaire.

Results

Compared with men, young women had a higher level of body dissatisfaction. For men, body mass index (BMI; β = 0.76, P <  0.01), physical activity score (β = − 0.11, P <  0.01), and restrained eating score (β = 0.10, P <  0.01) were the significant factors predictive of body dissatisfaction. For women, BMI (β = 0.57, P <  0.01), muscle mass (β = 0.12, P <  0.01), physical activity score (β = − 0.11, P <  0.01), and restrained eating score (β = 0.09, P <  0.01) were the significant factors predictive of body dissatisfaction.

Conclusions

University students with high body dissatisfaction had lower physical activity scores and higher restrained eating scores. The data presented here highlight the impact of university students’ body dissatisfaction on physical activity deficiency and disordered eating behaviors in China.

Exposure to Risk Information Detail (RID) in News Coverage of Anorexia Increases Self-Efficacy to Perform Risky Behaviors

In an online randomized experiment with 419 Israeli adult women using two rounds of data collected at a one-month interval, we test the effects of exposure to messages with greater and lesser detail about behaviors that increase personal risk (RID: Risk Information Detail) on women's self-efficacy to perform the risky behaviors. Participants viewed news media videos about anorexia (or a control video about vaccination). Video messages varied according to the amount of detail provided regarding the specific risky behaviors (High vs. low RID), and message format (narrative or expository). Effects of exposure to RID on self-efficacy were mediated through response efficacy, both immediately after exposure and at one-month follow-up. The indirect effects of RID were not moderated by participants' risk of developing an eating disorder, or identification with the protagonist (messages with a narrative format). Implications for social cognitive theory, social learning processes, and unintended media effects are discussed.

A comprehensive model of disordered eating among aesthetic athletic girls: Exploring the role of body image-related cognitive fusion and perfectionistic self- presentation

The incidence of disordered eating among athlete populations is considerably higher than in the general population. Less well understood is the body image-related emotional processes that might lead to disordered eating attitudes and behaviours, specifically among aesthetic athletic girls. Thus, the aim of the present study was to explore the role that body image-related cognitive fusion plays in disordered eating, and the mediating role of body image-related perfectionist self-presentation on this relationship, in aesthetic athletic girls. This study comprised 142 young female athletes from aesthetic sports, who completed self-report measures. A path analysis was conducted to explore the proposed theoretical model, while controlling for age and zBMI. The path model revealed an excellent fit and explained 71% of the severity of disordered eating. Results showed that body image-related cognitive fusion influences disordered eating behaviours, through the mechanism of body image-related perfectionist self-presentation, even when controlling for age and zBMI. Findings suggested that, in aesthetic athletic girls, the entanglement in body image-related thoughts may be associated with the need to present a perfect body image to others, which may lead to disordered eating attitudes and behaviours, adopted as a means to control weight and body shape. The present study highlights the relevance of body image-related processes in disordered eating and suggests the importance of educational programmes that target the development of more adaptive emotion regulation strategies concerning body image in athletes, particularly from aesthetic sports.

The Role of Body Image in Internalizing Mental Health Problems in Spanish Adolescents: An Analysis According to Sex, Age, and Socioeconomic Status

During adolescence there is a relatively high prevalence of weight problems and eating disorders. Furthermore, body image plays an important role in weight control and eating behaviors as well as in mental health. This study analyses the influence of body mass index, perception of being overweight, and body image satisfaction (BIS) on internalizing symptoms related to mental health in adolescents. In addition, sex, age, socioeconomic status (SES), dieting, and physical activity are taken into consideration. This research is based on the international study Health Behaviour in School-aged Children (HBSC). The sample consists of 4531 Spanish adolescents from 13 to 18 years old. Participants were selected through random multi-stage sampling stratified by conglomerates. Two instruments were employed: the HBSC questionnaire and the Youth Self-Report (Achenbach System of Empirically Based Assessment, ASEBA). Results demonstrated that BIS –the emotional component related to body image– was the main predictor of adolescent internalizing symptoms. In addition, results show double-inequalities according to the interaction effects of sex, age, and SES. Likewise, interesting results are shown regarding how dieting behaviors to lose or gain weight/volume and physical activity relate to body image perception and satisfaction, as well as with internalizing symptoms. This study highlights important body image aspects relevant to intervention and prevention of internalized mental health problems in adolescence.

Body Mass Index and Nationality (Argentine vs. Spanish) Moderate the Relationship Between Internalization of the Thin Ideal and Body Dissatisfaction: A Conditional Mediation Model

It is believed that Women’s exposure to Western sociocultural pressures to attain a “thin-ideal” results in the internalization of a desire to be thin that consequently leads to body dissatisfaction (BD). It is also well documented that body mass index (BMI; kg/m²) correlates with BD. We tested for the first time a conditional mediation model where thin-ideal Awareness predicted BD through Internalization of the thin ideal and the path from Internalization to BD was hypothesized to be moderated by BMI and Nationality (Argentine vs. Spanish). The model was tested with a sample of 499 young women (age = 18 to 29) from Argentina (n = 290) and Spain (n = 209). Awareness and internalization were measured with the SATAQ-4 (Schaefer et al., 2015) and BD was measured with the BSQ (Cooper et al., 1987). The model was analyzed using PROCESSv3.1 (Hayes, 2018). As hypothesized, thin-ideal awareness predicted BD through internalization and the path from internalization to BD was moderated by BMI and nationality. Specifically, internalization predicted BD at all level of BMI and in both samples, but the relationship between internalization and BD increased with BMI and was also stronger among Spaniards than Argentines. We argue that the findings are congruent with theories that predict that economic development and modernization contribute to normative female BD through internalization of the thin ideal and that upward social comparisons or cognitive discrepancy between self-perceived body image and the sociocultural thin ideal interacts synergistically with thin-ideal internalization to increase BD.

"I Can/Should Look Like a Media Figure": The Association Between Direct and Indirect Media Exposure and Teens' Sexualizing Appearance Behaviors

Prior research has examined the influence of media exposure on adolescents' sexualized self-concept, but engagement in sexualizing appearance behaviors remains understudied, especially among a younger age group (i.e., early adolescents). This three-wave panel study among 971 nine- to 14-year-olds (M_age = 12.99, SD = 1.03) showed that discussing media content with friends (i.e., indirect media exposure) was indirectly related to sexualizing appearance behaviors through perceived attainability of the appearance ideal. Direct media exposure was not significantly related to sexualizing appearance behaviors, nor to perceived pressure or perceived attainability. Direct and indirect media exposure influenced boys and girls in similar ways, although the model showed a better fit among the girls. In addition, reward sensitivity did not moderate the examined relations.

Body size estimation of self and others in females varying in BMI

Previous literature suggests that a disturbed ability to accurately identify own body size may contribute to overweight. Here, we investigated the influence of personal body size, indexed by body mass index (BMI), on body size estimation in a non-clinical population of females varying in BMI. We attempted to disentangle general biases in body size estimates and attitudinal influences by manipulating whether participants believed the body stimuli (personalized avatars with realistic weight variations) represented their own body or that of another person. Our results show that the accuracy of own body size estimation is predicted by personal BMI, such that participants with lower BMI underestimated their body size and participants with higher BMI overestimated their body size. Further, participants with higher BMI were less likely to notice the same percentage of weight gain than participants with lower BMI. Importantly, these results were only apparent when participants were judging a virtual body that was their own identity (Experiment 1), but not when they estimated the size of a body with another identity and the same underlying body shape (Experiment 2a). The different influences of BMI on accuracy of body size estimation and sensitivity to weight change for self and other identity suggests that effects of BMI on visual body size estimation are self-specific and not generalizable to other bodies.

"I don't need people to tell me I'm pretty on social media:" A qualitative study of social media and body image in early adolescent girls

Social media appear to contribute to body dissatisfaction in adolescents, although few empirical studies exist. This study used six focus groups (total N=38) to explore relations between social media use and body image in early adolescent girls (ages 12-14). Thematic analysis identified patterns in the data. In this sample, social media use was high. Girls endorsed some appearance concerns and social comparison, particularly with peers. However, they displayed high media literacy, appreciation of differences, and confidence, strategies that appeared helpful in mitigating the potential negative association between social media exposure and body image. Girls reported these characteristics were nurtured by positive parental influence and a supportive school environment. Results support an ecological approach to the prevention of body dissatisfaction. Although peer influence strengthens throughout adolescence, current findings suggest that parents and the school environment are associated with girls' attitudes and behaviors regarding social media and body image.

Swedish women's perceptions of and conformity to feminine norms

The relatively high gender equality in the Swedish society is likely to exert an influence on gender role construction. Hence, the present research aimed to investigate Swedish women's perceptions of and conformity to feminine norms. A mixed methods approach with two studies was used. In Study 1, young Swedish women's gender role conformity, as measured by the Conformity to Feminine Norms Inventory 45 (CFNI-45), was compared to the results from previously published studies in Canada, the United States, and Slovakia. Overall, Swedish women displayed less conformity than their foreign counterparts, with the largest difference on the subscale Sexual fidelity. In Study 2, focus group interviews with young Swedish women added a more complex picture of feminine norms in the Swedish society. For instance the results indicated that Swedish women, while living in a society with a strong gender equality discourse, are torn between the perceived need to invest in their appearances and the risk of being viewed as non-equal when doing so. In sum, despite the fact that traditional gender roles are less pronounced in Sweden, gender role conformity is still a pressing issue. Since attending to the potential roles of feminine norms in women's lives previously has been proposed to be useful in counseling and therapeutic work, the present research also offers valuable information for both researchers and practitioners. [Correction added on 5 May 2017, after first online publication in April 2017: An incorrect Abstract was inadvertently captured in the published article and has been corrected in this current version.].

Peer Influences on Adolescent Body Image: Friends or Foes?

The aim of this study was to investigate how peers influence adolescent body image, and whether this influence was positive and/or negative from young peoples’ perspectives. One hundred and eleven adolescents aged 13 to 18 years from the Republic of Ireland participated in this study, in 17 focus groups. Data were analyzed using a thematic analysis approach. Findings demonstrated that peers have an overwhelming negative impact on adolescent body image, and consequently, health. Both boys and girls revealed that the peer environment is characterized by a significant pressure to conform to appearance expectations, and deviations from such expectations lead to negative peer experiences. Positive peer influences were also revealed but to a far lesser extent.

Exploring the Appearance Culture in Early Adolescence

Despite the heightened awareness of body image concerns in early adolescence, there has been little research in Ireland regarding young people’s own perspectives on associated factors. Eight focus groups with young adolescents were conducted to explore common perceptions and influential processes occurring within the current Irish appearance culture. Three main themes emerged reflecting (a) appearance-related norms and processes operating in young adolescents’ immediate environment, (b) means by which more distal levels of sociocultural influences are transmitted, and (c) individual characteristics that shape the experience of the appearance culture. On the whole, the appearance-related values and behaviors of significant others were highly influential, especially those of peers. Cultural norms were evident in the young adolescents’ conceptions of the ideal body, and these appeared to be further negotiated and reinforced in proximal contexts. The collective interaction in the focus group discussions allowed alternative perspectives to be considered and generated new insights and perceptions. Outcomes indicate that the transmission of processes from distal and proximal environments are often interrelated and highlight the need to place greater emphasis on the interactive nature of sociocultural influences and the multiple processes by which appearance-related messages are transmitted.

Educating women about normal female genital appearance variation

The study investigated the effectiveness of two online resources aimed at improving women's knowledge of the variation in normal female genital appearance and their attitudes towards their own genitals. The first consisted of a photographic array of normal female genitals and the second consisted of a video addressing digital airbrushing of women's genitals in media images. A sample of 136 female undergraduate students were randomly assigned to view the photographs, video, both the photographs and video, or neither. The video significantly increased women's perceptions of genital appearance diversity as well as awareness of digital airbrushing of genital images. Owing to relatively low levels of genital appearance concern, there was no effect of either resource on women's attitudes towards their own genitals; however, women who viewed the video indicated they would pass on their knowledge to help other women. Our results suggest that an educational video could be a useful tool.

"How Should I Be?" A Photovoice Exploration Into Body Image Messaging for Young Women Across Ethnicities and Cultures

Photovoice, a community-based participatory research method that allows participants to inform research questions in an intimate way, has proven successful with youth. A diverse group of teenage girls living in New York City were asked to take photographs and reflect on what messages they received and from whom, how these messages translate across cultures and ethnicities, and how these messages are internalized and acted on. The group selected specific photographs to discuss together and themes emerged to answer the research questions; themes were reinforced by journal responses and agreed on by the group at the concluding session. The participants identified the media, peers, and family as cultural influencers on body image but noted that these messages change depending on the delivering medium. Participants not only offered recommendations with policy implications for advertising and media giants but also urged public health practitioners, teachers, and other key stakeholders working with young women of color to simply provide them with more space for talking. While Photovoice served as an effective methodology for gaining a more expansive understanding of how body image messages are received with young women of color, the tool should be considered for youth development interventions that take a community-based participatory approach.

Relationships between body image, nutritional supplement use, and attitudes towards doping in sport among adolescent boys: implications for prevention programs

Background

Reports of high levels of use of protein powders and nutritional supplements among young men is a concern because these substances may act as a gateway for the use of drugs and illegal substances to enhance appearance or sports performance. The aim of this study was to investigate the relationship between body dissatisfaction, weight change behaviors, supplement use, and attitudes towards doping in sport among an adolescent male sample.

Methods

Participants were 1148 male adolescents (age range 11-21 years) in Australia who completed a self-report questionnaire that measured weight change behaviors, supplement use, body dissatisfaction (Male Body Attitudes Scale; MBAS) and attitudes towards doping in sport (Performance Enhancing Attitudes Survey; PEAS).

Results

There was a positive correlation between MBAS total and PEAS scores (r = .19, p < .001), indicating that the young men who were more dissatisfied with their bodies were more likely to support the use of doping in sport. Young men who were currently attempting weight loss or weight gain, and those currently consuming energy drinks (ηp² = .01, p < .01) and vitamin/mineral supplements (ηp² = .01, p < .01) were also significantly more supportive of doping in sport. However, those involved in weight lifting, and using protein powders were not (p > .05).

Conclusions

These findings suggest that body dissatisfaction, weight change behaviors, and supplement use are related to more lenient attitudes towards doping in sport among adolescent boys. Future research might examine whether combining educational content for the prevention of body dissatisfaction and the use of drugs in sport may have a greater preventive impact than current programs aimed at young men.

Positive fantasies or negative contrasts: the effect of media body ideals on restrained eaters' mood, weight satisfaction, and food intake

Although viewing media body ideals promotes body dissatisfaction and problematic eating among women (e.g., extreme restraint/overeating), some argue that women only report such negative effects because they think that they are meant to (i.e., demand characteristics). Because restrained eaters are trying to lose weight, they might be vulnerable to such media exposure. However, because of demand characteristics, evidence is mixed. Therefore, we minimized demand characteristics and explored whether media body ideals would trigger restrained eaters to report negative (negative mood, weight dissatisfaction) or positive (positive mood, weight satisfaction) effects. We also hypothesized that this change (negative or positive) would encourage food intake. Restrained and unrestrained eaters (n=107) memorized media or control images. Restrained eaters exposed to media images reported decreased weight satisfaction and increased negative mood, but their food intake was not significantly affected. Perhaps paying advertent attention to the images caused goal-related negative affect, which triggered restraint.

What are adolescents' experiences of body dissatisfaction and dieting, and what do they recommend for prevention? A qualitative study

Body dissatisfaction and dieting are risk factors for eating disorders. Understanding young people's views about factors underlying body dissatisfaction and dieting may be helpful for those designing preventative interventions. This study explored adolescents' views on causes of body dissatisfaction and dieting and recommendations for prevention. Four 1-h focus groups were conducted with 22 female adolescents (aged 13-15 years). Transcripts were explored using thematic analysis. Body dissatisfaction and dieting was explained by four themes: peer acceptance; social comparison online; pressure from family; and pressure from the media and fashion industries. There were seven areas of recommendation for prevention: building sources of support; learning to be critical of the media; monitoring the school gym; working with parents; educating about signs and symptoms of eating disorders; working with people who have suffered from eating disorders; and providing help from professionals. Implications of these findings for the development of prevention programmes are discussed.

Do you see what I see?: An exploration of inter-ethnic ideal body size comparisons among college women

The present study explored African American (n=16) and European American (n=19) college women's ideal body size perceptions for their own and the other ethnic group along with reasons behind their selections. Respondents completed an ethnically-neutral figure rating scale and then participated in ethnically-homogenous focus groups. European Americans mostly preferred a curvy-thin or athletic ideal body while most African American students resisted notions of a singular ideal body. European Americans suggested that African Americans' larger ideal body sizes were based on greater body acceptance and the preferences of African American men. African Americans used extreme terms when discussing their perceptions of European Americans' thin idealization, celebrity role models, and weight management behaviors. African Americans' perceptions of European Americans' body dissatisfaction were also attributed to the frequent fat talk they engaged in. Implications for promoting the psychosocial well-being of ethnically-diverse emerging adult females attending college are discussed.

Aesthetic Sports as High-Risk Contexts for Eating Disorders — Young Elite Dancers and Gymnasts Perspectives

This is the first study developed in Portugal which investigates specific characteristics of dance and gymnastics environments that make them high-risk contexts for the development of eating disorders. Four focus groups were conducted with thirteen ballet students from a professional dance school and nine gymnasts from a gymnastics club (aged 12 to 17 years old), which were subjected to an inductive-deductive analysis procedure. Specific risk and protective factors were identified. Among their respective sources of influence, teachers and coaches are those who exert a stronger influence upon young athletes. We also explored some themes related to the influence of peers, parents, and environmental characteristics, which could have an important role on the development or prevention of disordered eating.

Disclaimer labels on fashion magazine advertisements: effects on social comparison and body dissatisfaction

Recent proposals across a number of Western countries have suggested that idealised media images should carry some sort of disclaimer informing readers when these images have been digitally enhanced. The present studies aimed to experimentally investigate the impact on women's body dissatisfaction of the addition of such warning labels to fashion magazine advertisements. Participants were 120 and 114 female undergraduate students in Experiment 1 and Experiment 2 respectively. In both experiments, participants viewed fashion magazine advertisements with either no warning label, a generic warning label, or a specific more detailed warning label. In neither experiment was there a significant effect of type of label. However, state appearance comparison was found to predict change in body dissatisfaction irrespective of condition. Unexpectedly, trait appearance comparison moderated the effect of label on body dissatisfaction, such that for women high on trait appearance comparison, exposure to specific warning labels actually resulted in increased body dissatisfaction. In sum, the present results showed no benefit of warning labels in ameliorating the known negative effect of viewing thin-ideal media images, and even suggested that one form of warning (specific) might be harmful for some individuals. Accordingly, it was concluded that more extensive research is required to guide the most effective use of disclaimer labels.

Thinking big: the effect of sexually objectifying music videos on bodily self-perception in young women

The present study investigated the effect of sexually objectifying music video exposure on young women's implicit bodily self-perception and the moderating role of self-esteem. Fifty-six college women of normal weight were either exposed to three sexually objectifying music videos or three neutral music videos. Perceived and ideal body size were measured both before and after video exposure, using horizontally stretched and compressed photographs of the participant's own body in swimming garment. As expected, only women low (but not high) in self-esteem were negatively affected by the sexually objectifying content of the music videos: they perceived themselves as bigger and showed an increased discrepancy between their perceived and ideal body size after video exposure. The neutral music videos did not influence women's bodily self-perceptions. These findings suggest that body image is a flexible construct, and that high self-esteem can protect women against the adverse effects of sexually objectifying media.

Exploring Middle-Eastern mothers' perceptions and experiences of breastfeeding in Canada: an ethnographic study

The aim of this study was to explore from the Middle-Eastern mothers' perspective, the experience of breastfeeding and their perceptions of attributes of the health care system, community and society on their feeding decisions after migration to Canada. New immigrant mothers from the Middle East (n = 22) were recruited from community agencies in Edmonton, Canada. Qualitative data were collected through four focus groups using an ethnographic approach to guide concurrent data collection and analysis. Survey data were collected on socio-demographic characteristics via pre-tested questionnaires. All mothers, but one who was medically exempt, breastfed their infants from birth and intended to continue for at least 2 years. Through constant comparison of data, five layers of influence emerged which described mothers' process of decision making: culture/society, community, health care system, family/friends and mother-infant dyad. Religious belief was an umbrella theme that was woven throughout all discussions and it was the strongest determining factor for choosing to breastfeed. However, cultural practices promoted pre-lacteal feeding and hence, jeopardising breastfeeding exclusivity. Although contradicted in Islamic tradition, most mothers practised fasting during breastfeeding because of misbeliefs about interpretations regarding these rules. Despite high rates of breastfeeding, there is a concern of lack of breastfeeding exclusivity among Middle-Eastern settlers in Canada. To promote successful breastfeeding in Muslim migrant communities, interventions must occur at different levels of influence and should consider religious beliefs to ensure cultural acceptability. Practitioners may support exclusive breastfeeding through cultural competency, and respectfully acknowledging Islamic beliefs and cultural practices.

A longitudinal study of motives for wishing to be thinner and weight-control practices in 7- to 18-year-old Swedish girls

The main aim of this seven-year longitudinal study, of 411 Swedish pre-adolescent girls (aged 7-11 years, Year 1), was to examine a wish to be thinner, dieting attempts, described motives for wishing to be thinner and weight-control practices. A further aim was to examine to what extent body mass index (BMI) accounted for motives for wishing to be thinner and weight-control practices. A wish to be thinner and dieting attempts increased significantly with increasing age between the ages of 9 and 18. The most frequently reported motive for wishing to be thinner was to 'feel better about yourself'. Categories that emerged from the qualitative analysis of self-described motives for the wish to be thinner were, for example, to 'correspond to the societal ideal' and to 'wear particular clothes'. A majority of the girls adopted weight-control practices that would be considered as healthy, but extreme weight-control practices increased with age. Girls with BMIs over the 75th percentile reported a greater number of motives for wishing to be thinner and used extreme weight-control practices significantly more often than the other girls. However, of the girls who changed BMI from above the 75th percentile to under the 75th percentile, 34.1% reported that they had not used any weight-control practices at all. Our results show that girls at a very early age are aware of the 'thin' ideal in our society, wish to be thinner and try to lose weight. The results point to the importance of detecting girls who wish to be thinner as early as possible. If we can employ preventive action in time, it is possible that dieting behaviour will never develop.

A Qualitative Exploration of Young Women’s Attitudes towards the Thin Ideal

The thin ideal has been identified as playing a central role in female body dissatisfaction. However, research into idealization of thinness in young women tends to focus on quantitative measures that can mask the complexity of attitudes and experiences. This article describes a series of focus groups with 41 females aged 16—26 and explores the multifaceted relationship young women have with the thin ideal. Thematic qualitative analysis revealed differences between individuals in the construct of the thin ideal and explored the conflict and ambivalence experienced by young women who are confronted by these ideals on a daily basis.

A mídia e o corpo: o que o jovem tem a dizer?

O objetivo deste estudo é verificar a percepção do jovem quanto à relação entre a mídia, especialmente o acesso à televisão e revistas e o corpo do adolescente. Trata-se de um estudo transversal, realizado com 121 adolescentes em uma instituição particular de ensino do ABC paulista. Aplicou-se uma entrevista individual semiestruturada gravada em fita magnética. Estas foram avaliadas utilizando-se a metodologia do discurso do sujeito coletivo, embasada no conceito das representações sociais. A tabulação dos dados ocorreu por meio da utilização de três figuras metodológicas: idéia central, expressões chave e o discurso do sujeito coletivo. Nos discursos dos jovens, foram registradas em 95% das idéias centrais relações entre a TV, revistas e o corpo, sendo as mais frequentes relacionadas ao estímulo a um ideal físico de magreza e à influência negativa com experiências de humilhação e desencadeamento de doenças. Em 5% das idéias centrais, não se registrou relação entre a TV, revistas e o corpo. Conclui-se que os jovens revelaram conhecimento acerca da intensa interferência da mídia em relação ao corpo do adolescente.

Reconsidering the role of interaction in analyzing and reporting focus groups

In the two sections of this article, I examine aspects of the analysis and reporting of interaction in focus groups. In both sections, I argue that the essential importance of interaction for producing the data in focus groups does not correspond to any requirement that the analysis or the reporting of that data should emphasize interaction. With regard to analyzing interaction, the goals of the research should guide the analysis of the data, and those goals might or might not emphasize interaction. In particular, a great deal of focus group research is conducted for substantive and practical purposes, where the analysis typically requires little attention to the dynamics of interaction in those groups. With regard to reporting interaction, quotations from single individuals can often be the most efficient and effectives ways to accomplish an article's goals; however, I also discuss the kinds of situations where there are good reasons to report interaction among the participants. I conclude by briefly describing a different agenda for examining the importance of interaction in focus groups.

Androgenetic alopecia in the paediatric population: a retrospective review of 57 patients

BACKGROUND

Hair loss is an unwelcome event at any age, but it can be particularly distressing for adolescents and their families. While androgenetic alopecia (AGA) is the most common form of hair loss in adults, little is known about its prevalence, clinical features and response to treatments in the paediatric population.

OBJECTIVES

To better characterize the causes of alopecia in a paediatric population.

METHODS

We performed a retrospective chart review to identify all patients with hair loss seen in an academic paediatric dermatology practice at New York University over a 12-year period to better characterize the causes of alopecia in this population. We review the clinical and histological features, natural progression and associated laboratory abnormalities of AGA in 57 paediatric patients.

RESULTS

AGA was identified as the most frequent cause of hair loss in adolescents and the second most common diagnosis overall. The male to female ratio was 2 : 1 and the average age at initial presentation with AGA was 14.8 years. Adolescent girls had diffuse thinning or thinning at the crown, and boys frequently presented with female pattern hair loss. When biopsies were performed, perifollicular inflammation was a common finding. A family history of AGA was reported in 83% of patients. Laboratory evaluation for androgens revealed polycystic ovarian syndrome in three girls and late-onset congenital adrenal hyperplasia in one boy.

CONCLUSIONS

AGA is the most common form of hair loss in adolescents, and can be the presenting sign of an underlying endocrine disorder. An accurate and timely diagnosis is essential for appropriate medical and psychosocial intervention when warranted.

Cross-cultural adaptation, validation and reliability of the Body Area Scale for Brazilian adolescents

The aim of this study was to translate, validate and verify the reliability of the Body Area Scale (BAS). Participants were 386 teenagers, enrolled in a private school. Translation into Portuguese was conducted. The instrument was evaluated for internal consistency and construct validation analysis. Reproducibility was evaluated using the Wilcoxon test and the coefficient of interclass correlation. The BAS demonstrated good values for internal consistency (0.90 and 0.88) and was able to discriminate boys and girls according to nutritional state (p = 0.020 and p = 0.026, respectively). BAS scores correlated with adolescents' BMI (r = 0.14, p = 0.055; r = 0.23, p = 0.001) and WC (r =0.13, p = 0.083; r = 0.22, 0.002). Reliability was confirmed by the coefficient of inter-class correlation (0.35, p < 0.001; 0.60, p < 0.001) for boys and girls, respectively. The instrument performed well in terms of understanding and time of completion. BAS was successfully translated into Portuguese and presented good validity when applied to adolescents.

Beyond muscles: unexplored parts of men's body image

Thus far the study of men's body image has been largely restricted to the dimensions of adiposity and muscularity. The aim of this study was to investigate in a systematic way multiple aspects of men's body images, in particular, head hair, body hair, height and penis size, in addition to body weight and muscularity. Questionnaires were completed online by 200 heterosexual men. It was found that men were dissatisfied with all six aspects of their bodies, and worried primarily about body weight, penis size and height. In addition, aspects of weight, muscularity, height and penis size, but not head or body hair, were related to overall appearance self-esteem. It was concluded that men's body image is both multi-faceted and complex.

A qualitative investigation into the opinions of adolescent females regarding their body image concerns and dieting practices in the Republic of Ireland (ROI)

The aim of this study was to investigate the opinions of female adolescents living in the ROI on issues relating to body image and dietary practice. A qualitative study was selected to enable the issues to be explored in depth. Sixteen focus groups were executed with adolescent females (n=124) aged 15-16 years. Data collection took place during class time in both rural and urban schools in the ROI. Data were analysed using a qualitative thematic methodology, namely framework analysis. High levels of body dissatisfaction existed and dieting was found to be prevalent. The influence of media celebrities was significant. The girls not only aspired to be like them in terms of physique but also followed their alleged dieting regimes in detail. Peers also influenced body dissatisfaction and dieting practices. Consequently, eating habits were altered to accommodate this quest for thinness with a tendency to skip main meals as part of the dieting practice while maintaining an unhealthy snacking pattern. The results are of concern as the adolescent females were utilising unhealthy methods of weight control such as skipping meals and fasting in their quest to obtain a thin physique. A slim body image was deemed important for peer acceptance; hence 'crash' dieting was in existence. This mindset and the resultant dietary practices may have negative health consequences during both adolescence and later life. School interventions targeting adolescent females and focusing on healthy eating and body image are therefore urgently required.

Dialysis access and the impact on body image: role of the nephrology nurse

End-stage renal disease is a chronic condition, without cure, requiring dialysis therapy to maintain life or transplantation for those fortunate enough to receive a kidney. To commence dialysis (peritoneal dialysis or haemodialysis), access is required in the form of a fistula, vascular catheter or peritoneal catheter, and changes in body image will ensue, no matter what treatment option is selected. Renal transplantation, the treatment of choice for many patients, is also associated with body image issues. Despite these problems, the role of the nurse in managing body image problems in the renal population is rarely discussed. The aim of this article is to outline the concepts of dialysis and body image, and discuss the role of the nephrology nurse at the authors' current place of work. It highlights suggestions on how renal nurses can prepare and educate patients regarding changes in body image following a diagnosis of end-stage renal disease, and emphasizes the need for future research in this area.

Young Women's Experiences of Social Physique Anxiety

It is well documented that young women's social physique anxiety is associated with a number of health-compromising behaviors. The bulk of this research has used the Social Physique Anxiety Scale (SPAS); however, the use of questionnaires in the body domain has been critiqued because of the assumption that women's experiences are singular and static. Therefore, the purpose of this study was to try to better understand young women's experiences of social physique anxiety. Feminist theory was used as a guiding perspective for this case study. Four young women participated (all 15 years old) and multiple methods (i.e. focus group, interviews, abstract photography task) were employed. The four themes developed were: (1) web of emotion; (2) uncertainty; (3) beyond physique; and (4) resignation. The stories of the young women suggest that their experiences are not easily reduced to this singular construct, and that, as a construct, social physique anxiety is limited in helping us to understand women's diverse experiences.

Relationships amongst body dissatisfaction, internalisation of the media body ideal and perceived pressure from media in adolescent girls and boys

Sociocultural factors that underpin gender differences in body dissatisfaction have not frequently been explored. We examined the relative contribution of internalization of media body ideals and perceived pressure to achieve this ideal in explaining body dissatisfaction in adolescent boys and girls. A sample of 819 boys and 791 girls completed measures of internalization of body ideals, perceived pressure, body mass index (BMI) and body dissatisfaction. As expected, girls showed higher body dissatisfaction, internalization and pressure than boys. Internalization, pressure and BMI contributed to the prediction of body dissatisfaction in boys and in girls although these variables explained less variance in body dissatisfaction in boys. In addition, for girls the strongest predictor of body dissatisfaction was internalization, whilst for boys the strongest predictor was pressure. Differences in extent of internalization and pressure may contribute to higher body dissatisfaction in girls than boys. These sociocultural factors may affect girls and boys differently.

Crossing multidisciplinary divides: exploring professional hierarchies and boundaries in focus groups

Focus groups are an important element of qualitative health research, valued for the forms of knowledge and understanding that emerge from interactions among participants. Common advice for focus groups within health research is to limit the level of variation among respondents to generate comprehensive discussion and shared knowledge. In this article, the authors critically examine this advice, proposing instead that it is useful to acknowledge and, at times, consciously build in heterogeneity across categories of those present. The benefit of doing this is that the interaction thus generated can be used as a space within which to explore differing professional positions and interpretations of issues under discussion. Using research they have done, they explore the practical issues involved in getting different health and social care professionals together and go on to discuss the value and significance of using focus groups to explore the production of professional hierarchies and boundaries.