Eating attitudes, health-risk behaviors, self-esteem, and anxiety among adolescent females in a suburban high school

Self-Esteem and Anxiety as Mediators in the Relationship Between Emotional Intelligence and Eating Disorder Symptoms

This study investigated the relationship between emotional intelligence (EI) and eating disorder symptoms (EDS) by testing the serial mediation model, with self-esteem and anxiety as mediators. A total of 923 participants (61.9% female) aged 15-60 years completed questionnaires assessing their EI, self-esteem, anxiety, and EDS. Correlational analyses were conducted to assess the relationship between the study variables, and a serial mediation analysis was conducted to test the possible mediating role of self-esteem and anxiety in the relationship between EI and EDS. Correlation analyses revealed significant bivariate relationships between EI, self-esteem, and anxiety, but no significant correlation between EI and EDS. The relationship between EI and EDS was serially mediated by self-esteem and anxiety. High levels of EI were associated with higher self-esteem, which, in turn, was associated with lower anxiety and less EDS. The results offer potential mechanisms that could explain the relationship between EI and EDS and highlight the importance of EI in regulating eating behavior through self-esteem and anxiety.

Impact of Metacognition on Health-Related Behavior: A Mediation Model Study

Objective

The study aims to explore the correlation mechanism among metacognition, attitude toward physical exercise, and health-related behavior in high school students.

Methods

A total of 869 students (17 ± 1.70) from Anhui, Zhejiang, Shandong, and Fujian provinces were selected by stratified sampling to complete the Metacognition Questionnaire, Health-Related Behavior Self-Rating Scale, Attitude Toward Physical Exercise Scale, and Depression-Anxiety-Stress Scale (Simplified Chinese version, DASS-21).

Results

(1) Metacognition was negatively predictive of attitude toward physical exercise and health-related behavior (β = -0.236, P < 0.01; β = -0.239, P < 0.01) but positively predictive of negative emotion (β = 0.496, P < 0.01); (2) attitude toward physical exercise was positively predictive of health-related behavior (β = 0.533, P < 0.01) but negatively predictive of negative emotion (β = -0.336, P < 0.01); and (3) negative emotion was negatively predictive of health-related behavior (β = -0.389, P < 0.01).

Conclusions

Metacognition not only has a directly predictive effect on health-related behavior but also predicts it through attitude toward physical exercise. Negative emotion also mediates the relationship between metacognition and attitude toward physical exercise.

The prevalence and nutritional status of adolescent Saudi girls with disordered eating

This study on adolescents was intended to assess the prevalence of disordered eating attitudes and the nutritional status of adolescent girls in Saudi Arabia. Disordered eating attitudes and behaviour were assessed using the EAT-26. The type of eating disorder (ED) was determined using Diagnostic statistical manual of mental disorders, fifth edition. The nutritional status of the adolescent girls was determined by measuring their weight and height twice using standard protocols. The BMI-for-age and height-for-age were defined using WHO growth charts. Comparisons between adolescent girls with and without EDs were conducted using SPSS version 26. Eating disorders (EDs) were prevalent among 10⋅2 % of these girls. Other specified feeding or EDs were the most prevalent ED (7⋅6 %), followed by unspecified feeding or eating disorder (2⋅4 %). Anorexia nervosa was common among 0⋅3 % of the girls. The eating disordered adolescents were either overweight (7⋅7 %), obese (10⋅3 %), stunted (7⋅7 %) or severely stunted (2⋅6 %). ANOVA revealed that the BMI-for-age was influenced by age (P = 0⋅028), the type of ED (P = 0⋅019) and the EAT-26 (P < 0⋅0001). Pearson's correlation showed that the EAT-26 score increased significantly with the BMI (r 0⋅22, P = 0⋅0001), height (r 0⋅12, P = 0⋅019) and weight (r 0⋅22, P = 0⋅0001). The early detection of EDs among adolescents is highly recommended to reduce the risk associated with future impaired health status. Nutrition professionals must target adolescents, teachers and parents and provide nutritional education about the early signs and symptoms of ED and the benefits of following a healthy dietary pattern.

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.

Relationships between eating disorder psychopathology, sexual hormones and sexual behaviours

A growing body of evidences demonstrated that sexuality is an important topic in the clinical research of eating disorders (EDs), due to its association with specific psychopathological features, and etiological factors. The present review took into consideration the complex relationship between sexual behaviours, hormonal alterations and EDs psychopathology. Studies pertaining sexual behaviours in EDs were divided into those focusing on sexual dysfunctions, and those related to risky sexual behaviours. The limited number of studies on sexual dysfunctions, reported a controversial association with weight status and hormonal alterations, and a clear relationship with severity of specific psychopathology (e.g. body image disturbance). Risky sexual behaviours have been associated with impulsivity and dissociation, as well as with abnormal stress response. Finally, both restriction and uncontrolled eating have been found to be responsible for several complex metabolic alterations, determining varied sexual and gynecologic problems, such as amenorrhea, hypogonadism, genital vascular problems, infertility, and miscarriage, although it is also possible that alterations in feeding and stress hormones contribute to altered eating behaviour.

Identifying Risk Factors for Disordered Eating among Female Youth in Primary Care

Eating disorders are a serious, life-threating condition impacting adolescents and young adults. Providers in primary care settings have an important role in identifying disordered eating (DE) symptoms. Unfortunately, symptoms go undetected in 50% of patients in medical settings. Using the behavioral health screen, this study identified DE risk profiles in a sample of 3620 female adolescents and young adults (ages 14-24), presenting in primary care. A latent class analysis with twenty psychosocial factors identified three DE risk groups. The group at highest risk for DE was characterized by endorsement of internalizing symptoms and a history of trauma. The next risk group consisted of those with externalizing symptoms, particularly substance use. The group at lowest risk for DE reported more time spent with friends compared to their peers. Primary care providers and psychiatric teams can benefit from knowing the psychosocial risk patterns affiliated with DE, and using brief, comprehensive screening tools to identify these symptoms.

The Triality of Strain, Self-Control, and Eating Disorders

This study examines the potential relationship between eating disorders and antisocial behaviors through the lenses of the general theory of crime and general strain theory. We utilized the data from the National Longitudinal Study of Adolescent to Adult Health, a longitudinal study of a nationally representative sample of juveniles in grades 7 to 12 in the United States between 1994 and 2008. We constructed three separate measures of eating disorders and examined their relationships with both petty theft and aggressive behaviors. Results indicated that previous traumatic experiences (such as sexual abuse) are consistent risk factors for eating disorders, and that eating disorders can increase antisocial involvements. Moreover, eating disorders can diminish self-control and agitate depressed moods, which may increase the likelihood of both petty theft and violent conduct, and this effect can extend to later adulthood as well.

Protective Effect of Biculturalism for Health Amongst Minority Youth: The Case of Pacific Islander Migrant Youths in Hawai'i

This study investigates the mechanisms by which biculturalism impacts various health outcomes amongst youth migrants to Hawai'i who are from the US-Affiliated Pacific Islands jurisdictions. Using purposive sampling, 284 males and females (twelve to nineteen years old) of Pacific Islander ethnicities in Hawai'i completed a survey. Results from path analysis showed that biculturalism significantly and positively affected self-esteem that, in turn, improved eating attitude, body satisfaction and perceived well-being. Further, eating attitude increased healthy eating behaviour and body satisfaction that, in turn, positively affected general health perception and body satisfaction. Positive smoking attitudes increased smoking activities, which negatively affect general health perception. The study demonstrated that self-esteem impacted overall health through its influence on enhancing positive perceptions about the importance of healthy eating, body satisfaction and well-being. Biculturalism indirectly led to increased self-esteem, which in turn directly influenced attitudes about healthy eating, body satisfaction and perceived well-being. Our study provides strong evidence that addressing the problem of health disparities for minority populations in the USA has to start with reaffirming the value of diversity and multiculturalism and embracing an individual's historic cultural identity. Specific implications for funding agencies and researchers of minority health programs are discussed.

Death Anxiety, Perfectionism and Disordered Eating

Recently, death anxiety, or dread of death, has been proposed as a key transdiagnostic process underlying the anxiety disorders, depressive disorders, somatic disorders, and trauma and stressor-related disorders. In fact, it has been argued that death anxiety underlies all psychopathology, and is more fundamental than perfectionism, a process which was previously considered the root of mental illness. However, there has been a paucity of research examining the relationship between death anxiety and the eating disorders, although these conditions have been found to be strongly related to perfectionism. The present study therefore aimed to examine whether death anxiety is related to disordered eating, and whether death anxiety is a better predictor of disordered eating than perfectionism. A sample of 164 participants (132 female), average age 33.55 years (SD= 15.45 years), completed an online survey comprising background questions (age, sex, diagnosed psychiatric disorder), the Eating Attitudes Test — 26 item version (EAT-26), the Almost Perfect Scale — Revised (APS-R), the Rosenberg Self-Esteem Scale (RSES), and the Death Anxiety Scale (DAS). The findings of a hierarchical multiple regression analysis with EAT-26 as the dependent variable, age entered at Step 1, the RSES and APS-R entered at Step 2, and the DAS entered at Step 3 showed that only death anxiety and self-esteem were independent predictors of disordered eating at Step 3. A simultaneous multiple regression analysis was subsequently run with age and the APS-R alone as predictors of EAT-26 scores. This analysis showed that perfectionism was only a predictor of disordered eating when death anxiety and self-esteem were not included in the regression model. Death anxiety and self-esteem both appear to be important transdiagnostic processes.

A Meta-Analysis of Heavyweight and Self-Esteem

This study is a meta-analysis of the relation of heavyweight and self-esteem. We examined this relation in studies thatfocused on participants' actual body weight (assessed by physical measures or self-reports of weight and height) and studies thatfocused on self-perceived degree of heavyweight or body dissatisfaction. The overall mean effect size was moderate (r = -.18, d = -.36), with lower self-esteem associated with heavier weight. The correlation between self-esteem and weight was higher for studies of self-perceived weight than for studies of actual weight. Consistent with predictions about cultural and group differences, effect sizes were smaller for low socioeconomic status (SES) samples, ethnic minority samples, and nonclinical samples than for high SES, nonminority, and clinical samples, respectively. In addition, effect sizes were larger for women than for men and for high school and college students than for children. Discussion centered on cultural, group, and individual differences that may influence the consequences on self-esteem of violating standards for appropriate body weight.

Gender, Race, Childhood Abuse, and Body Image among Adolescents

The research presented in this article examines the influences of race, gender, and sexual or physical abuse on unhealthy eating and dieting practices among Black and White adolescents. Specifically, the project considers the intersection of race and gender on actual and perceived body size. The impact of past sexual or physical abuse emerges as a significant predictor of unhealthy dieting and eating behaviors for Whites but not for Blacks. Although girls are more likely to have distorted body images and to engage in disordered eating and dieting, these differences are further explained with race and past sexual or physical abuse.

Self-Esteem and Theoretical Mediators of Safer Sex Among African American Female Adolescents: Implications for Sexual Risk Reduction Interventions

Theories of health behavior posit that change is accomplished by modifying factors deemed as mediators. A set of mediators from several theoretical models used in sexual risk reduction programs was assessed among a sample of 522 African American female adolescents. The goal was to determine whether self-esteem was associated with sexually transmitted disease (STD), pregnancy, and the set of theoretical mediators controlling for covariates. Bivariate analyses showed no relationship between self-esteem and STD or pregnancy; multivariate regression analysis revealed a significant relation between self-esteem and the set of mediators. Girls higher in self-esteem were more likely to hold positive condom attitudes, felt more efficacious in negotiating condom use, had more frequent communication with sex partners and parents, perceived fewer barriers to using condoms, and were less fearful of negotiating condom use. Self-esteem should be considered when designing and evaluating sexual risk reduction programs for this population.

A Mediational Model of Autonomy, Self-Esteem, and Eating Disordered Attitudes and Behaviors

This study expands upon existing literature by examining how the relationship between autonomy deficits and low self-esteem may create a psychological environment conducive to the development of eating disordered behaviors. Findings supported a mediational model to account for eating disordered behaviors in 71 college women. In this model, lack of autonomy was related to decreased global self-esteem, which in turn was associated with bulimia, body dissatisfaction, and drive for thinness. Although only tentative and cross-sectional in nature, this study is of particular importance because it links autonomy and self-esteem in a coherent model predictive of eating disordered behaviors in college women. Developmental aspects of eating disorders and treatment implications are discussed.

Outcomes of a Comprehensive Youth Program for HIV-infected Adolescents in Thailand

We developed an intervention program for HIV-infected Thai adolescents with two group sessions and two individual sessions, focusing on four strategies: health knowledge, coping skills, sexual risk reduction, and life goals. An audio computer-assisted self-interview (ACASI) was administered to assess knowledge, attitudes, and practices (KAP) regarding antiretroviral therapy management, reproductive health, and HIV-associated risk behavior. The program was implemented in two HIV clinics; 165 (84%) adolescents (intervention group) participated in the program; 32 (16%) completed the ACASI without participating in the group or individual sessions (nonintervention group). The median age was 14 years, and 56% were female. Baseline KAP scores of the intervention and nonintervention groups were similar. Two months after the intervention, knowledge and attitude scores increased (p < .01) in the intervention group, and the increase was sustained at 6 months. KAP scores did not change from baseline in the nonintervention group at 6 or 12 months after enrollment.

An exploratory analysis of associations between eating disordered symptoms, perceived weight changes, and oral contraceptive discontinuation among young minority women

PURPOSE

To explore associations between eating-disordered (ED) symptoms, perceived oral contraceptive (OC)-related weight changes, and OC discontinuation among young minority women.

METHODS

We conducted a prospective substudy of a randomized controlled trial evaluating the impact of a pill pack supply (3 vs. 7 months) on OC continuation among young urban women presenting to a university-affiliated community-based family planning clinic for OC management. Participants (n = 354) were adolescent (n = 173) and young adult (n = 181) women aged 13-24 years, predominantly underinsured and largely Hispanic (92%). We conducted a structured baseline interview that included an ED screening instrument. At the 6-month follow-up, we conducted a telephone interview to determine OC continuation and dimensions of perceived OC-related weight changes during the study period.

RESULTS

At baseline, 24% of the subjects fulfilled the moderate/severe ED symptom screen criteria (n = 60). By 6 months, 57% of the subjects (n = 200) reported weight changes and 62% (n = 218) had discontinued OC use. Unadjusted discontinuation rates were similar across age- and ED symptom groups. In multivariate analysis, both ED symptoms (odds ratio = .49, 95% confidence interval = .25-.96, p = .04) and perceived weight changes (odds ratio = .60, 95% confidence interval = .38-.94, p = .03) were negatively associated with OC continuation.

CONCLUSIONS

ED symptoms and perceived weight changes were associated with an increased likelihood of OC discontinuation among these young women. Reproductive health practitioners should consider psychological symptoms when managing OC.

The association between overweight and illegal drug consumption in adolescents: is there an underlying influence of the sociocultural environment?

Background

The aims of the study were to: a) Examine the distribution of gender-stratified body mass index (BMI), eating attitudes and use of addictive substances, under the hypothesis of a confluent prevalence of weight abnormalities, eating disorders and substance abuse. b) Demonstrate the extent to which family, peer-related and psychosocial factors are common elements in categories of compulsive behaviour.

Methodology/Principal Findings

In the present cross-sectional study, data were collected through self reported questionnaires administered to a large sample of 33,185 15–19 years old adolescents (ESPAD®Italia), divided into weight categories based on the BMI percentile distribution. Multinomial analyses were adopted to address the influence of social, family, leisure time factors, Eating Attitude Test (EAT26) on the association between weight categories and drug use.

Recent drugs use was more frequent in overweight and underweight adolescents (p<0.05), especially in females. An EAT26 score ≥20 was more common in overweight adolescents. Multinomial analysis abolished the relationship between overweight and the use of most drugs, implicating self-esteem, parents' educational level, and friendships as mediators of the association. Within the overweight category, adolescents reporting recent drug use, showed greater frequency of having drug-abusing friends (∼80%), and severe problems with parents and school (∼30%) compared to overweight adolescents without recent drug use.

Conclusion

The frequent association of overweight and substance use and the presence of common underlying social factors, highlights the need for an interdisciplinary approach involving individual-focused treatment models as well as public health, social and environmental changes to reduce food- and substances-related problems.

Condom use among young women: modeling the theory of gender and power

OBJECTIVE

This study sought to articulate pathways between constructs from the theory of gender and power and their associations with sexual behavior.

DESIGN

The data were collected preintervention during a randomized controlled HIV prevention trial. Participants were 701 sexually active, unmarried African American females, aged 14-20, who were not pregnant, and were recruited from three health clinics in a southeastern US city. Structural equation modeling was used for the analyses.

MAIN OUTCOME MEASURE

Self-reported condom use.

RESULTS

Theoretical associations yielded a well-fitting structural model across initial and cross-validation samples. A significant amount of variance was explained for the variables of condom use (R2 = .31, .18), partner communication (R2 = .30, .26), substance use during sex (R2 = .32, .51), and negative personal affect (R2 = .36, .48). Partner communication (.35, .38) was the strongest predictor of condom use, negative personal affect (-.41, -.37) was the strongest predictor of partner communication, and physical risk (.54, .54) was the strongest predictor of negative personal affect.

CONCLUSION

This model provides evidence to support both direct and indirect associations between social and behavioral risk factors and condom use. Associations between theory of gender and power constructs and condom use can facilitate future development and analyses of interventions based on this theory.

Toothbrushing and smoking among adolescents--aggregation of health damaging behaviours

AIM

The aim of this study was to determine whether an association exists between daily smoking and infrequent toothbrushing habits among adolescents.

MATERIALS AND METHODS

Nationally representative samples of 14-, 16- and 18-year-old Finns (N=5643) took part in the survey. A 12-page structured questionnaire was posted to the adolescents, asking them to complete it and return it in an enclosed pre-paid envelope. The χ(2)-test and a logistic regression model were used for analyses.

RESULTS

At the age of 14 years, 8.5% reported smoking daily, at 16 years 25.0% and at 18 years 33.2%. Only 28.3-54.7% of the adolescents reported brushing their teeth more than once a day. Among 14-year-olds, 6.5% of the adolescents reported both smoking daily and brushing less than twice a day. The respective figures were 17.7% for the 16-year-olds and 21.6% for the 18-year-olds. Among the 14-year-olds, the strongest association with smoking daily and brushing less than twice a day was found with low school performance (OR=8.2), and among 16- and 18-year-olds school career (studying at a vocational school, OR=3.4).

CONCLUSION

Daily smoking and infrequent toothbrushing are strongly associated in adolescence.

Pathways to sexual risk taking among female adolescent detainees

Sexual risk taking among female delinquents represents a significant public health problem. Research is needed to understand the pathways leading to sexual risk taking among this population. This study sought to address this issue by identifying and testing two pathways from child maltreatment to non-condom use among 329 White and 484 African American female adolescent detainees: a relational pathway and a substance use coping pathway. The relational pathway indicated that child maltreatment would be related to non-condom use via depressive self-concept and condom use self-efficacy. The substance use coping pathway suggested that depressive self-concept and alcohol-based expectancies for sexual enhancement would mediate the relationship between child maltreatment and non-condom use. As hypothesized, the relational pathway variables were associated with one another in the expected directions; however, evidence of mediation was not found. Support for mediation was found for the substance use coping pathway. Exploratory across group comparison analysis indicated that the relational pathway was significant for White girls whereas the substance use coping pathway was significant for African American girls. Limitations and implications for future research are discussed.

'I want to lose weight': Early risk for disordered eating?

The present study examined the risk of disordered eating and its relation to attempts to lose weight by surveying a Maritime Canadian sample of 247 girls and boys in grades 6, 7 and 8. Current attempts to lose weight were highest in grade 8 girls (41% of girls and 9% of boys) compared with grade 6 (14% of girls and 24% of boys) and grade 7 (21% of girls and 13% of boys) children. Of those trying to lose weight, 71.4% were in the average range for weight and height, 12.2% were overweight and 16.3% were obese. The Children's version of the Eating Attitudes Test (ChEAT) was used to assess eating attitudes and behaviours, and the Rosenberg Self-Esteem Scale was used as a measure of self-esteem. The results showed that 8.5% of the children fell in the high-risk group for disordered eating (ChEAT score 20 or higher). Those in the high-risk group were significantly more likely to fear being overweight (90%), to have tried to lose weight in the past (81%), to be currently trying to lose weight (76%), and to have engaged in binge eating (38%) and self-induced vomiting (24%). The best predictor of membership in the high-risk group for girls was current attempts at weight loss and having lower self-esteem. Only two boys fell in the high-risk group. Body mass index and current weight category (underweight, average, overweight and obese) could not explain the differences between the low- and high-risk groups. Knowing that a child is trying to lose weight can aid in identifying youth at risk for disordered eating, and can provide an opportunity for preventive education.

Human immunodeficiency virus prevention with youth

For years, the HIV pandemic was seemingly mysterious and uncontrollable. However, it is now known that with technology, this virus can be stopped from becoming fatal, and with prevention further infection can be stopped. With the application of certain principles and knowledge, this pandemic can be turned into something much less nocuous and pervasive. Various researchers and programs have effectively demonstrated this reality, showing the possibilities of ameliorating the propagation of this virus through prevention. This article reviews the risk and protective factors associated with HIV-related behaviors and describes various effective prevention programs.

Weight perception, substance use, and disordered eating behaviors: comparing normal weight and overweight high-school students

Disordered eating behaviors and substance use are two risk factors for the development of serious psychopathology and health concerns in adulthood. Despite the negative outcomes associated with these risky behaviors, few studies have examined potential associations between these risk factors as they occur during adolescence. The importance of accurate or inaccurate weight perception among adolescents has received increased interest given documented associations with nutritional beliefs and weight management strategies. This study examined the associations among the perceptions of weight and substance use with disordered eating behaviors among a diverse sample of normal weight and overweight adolescent males and females. Data came from the 2007 National Youth Risk Behavior Survey (YRBS). The sample consisted of 11,103 adolescents (53.4% female; 44% Caucasian, 21% African American; 13% Hispanic; age responses ranged from 12 and under to 18 and over), with 31.5% meeting criteria for being either at-risk for obesity or already obese (i.e., overweight). As hypothesized, overestimation of weight among normal weight adolescents and accurate perceptions of weight among overweight adolescents were associated with higher rates of disordered eating behaviors. In normal weight adolescents, use of all three substances (tobacco, binge drinking, and cocaine) was associated with each disordered eating behavior. In contrast, findings revealed differences for overweight adolescents between the type of substance use and disordered eating behavior. Post hoc analyses revealed that gender moderated some of these relationships among overweight individuals. Implications for the development and implementation of secondary prevention programs aimed at reducing disordered eating behaviors, substance use, and obesity risk among normal and overweight adolescents are considered.

Psychosocial characteristics in relation to disordered eating attitudes in greek adolescents

The study explores possible links between eating attitudes in Greek adolescents and certain psychosocial characteristics such as self-esteem, empathy and anxiety. A total of 202 students (109 boys and 93 girls), 15-18 years old, have been recruited. The following questionnaires were used: the Eating Attitudes Test (EAT-26), the State-Trait Anxiety Inventory, the Self-Perception Profile for Adolescents, the Multidimensional Body-Self-Questionnaire-Overweight Preoccupation and the Index of Empathy of Children and Adolescents. The EAT-26 revealed that 18.3% of the total sample of students (12.8% of boys and 24.7% of girls) reported having disordered eating attitudes. Adolescents with disordered eating attitudes had significantly higher levels of anxiety and scored less in self-reported physical appearance and romantic appeal. Empathy and global self-esteem did not differ significantly between the two groups. Adolescents with disordered eating attitudes have certain psychosocial characteristics which differentiate them from the students with healthier eating attitudes.

Is depression associated with health risk-related behaviour clusters in adults?

BACKGROUND

Depressive disorders have been linked to health risk-related behaviours (HRBs) considered separately. Our objective was to study whether depression is associated with the co-occurrence of HRBs in adults.

METHODS

A sample of 17 355 subjects aged > or =18 years, derived from the 2002-03 cross-sectional Decennial Health Survey; probable depression was assessed with the CES-D scale. A cluster analysis of various HRBs (tobacco use, alcohol use, binge drinking, physical inactivity, certain eating habits) was used to study their co-occurrence. Multiple regressions adjusted on demographic and socio-economic characteristics, Body Mass Index and chronic illnesses were performed to study associations between probable depression and the HRBs clusters obtained.

RESULTS

Five clusters were observed evidencing a gradient of cumulative exposure to HRBs: 'healthy lifestyles (Cluster 1), 'non-daily-consumers-fruit-and-green-vegetables' (Cluster 2), 'regular alcohol users' (Cluster 3), 'daily smokers' (Cluster 4) and 'cumulate risk takers' (Cluster 5). Compared with Cluster 1, positive associations were found between probable depression and Clusters 2, 4 and 5: OR 1.49 (95% CI 1.26-1.76) for Cluster 2; OR 1.81 (95% CI 1.54-2.12) for Cluster 4; OR 2.05 (95% CI 1.68-2.51) for Cluster 5. For Cluster 3, no association was found: OR 1.01 (95% CI 0.84-1.21).

CONCLUSIONS

HRBs tend to co-occur in the general population, more frequently in case of probable depression. Further research is necessary to disentangle the direction of the links between depression and HRB clusters. Nonetheless, these results question the classic design of education campaigns considering HRBs separately. Moreover, screening for depression should be systematic during prevention consultations and various HRBs should be monitored when treating depressive patients.

Psychiatric comorbidities among female adolescents with anorexia nervosa

This study investigated current comorbid Axis I diagnoses associated with Anorexia Nervosa (AN) in adolescents. The sample included 101 female adolescents treated at a psychiatric unit for primary DSM-IV diagnoses of AN. 73.3% of the AN patients were diagnosed as having a current comorbidity of at least one comorbid Axis I diagnosis, with no differences across AN subtypes. Mood disorders (60.4%) were most commonly identified, followed by the category anxiety disorders without obsessive-compulsive disorders (OCD) (25.7%), OCD (16.8%) and substance use disorders (7.9%). Two specific diagnoses differed across the two subtypes of AN. Substance use disorder was 18 times, and the category anxiety disorder without OCD was three times as likely to co-occur with AN binge-eating disorder and purging type than with AN restricting type. Clinicians should be alerted to the particularly high rate of psychiatric comorbidities in adolescents suffering from AN.

Health behavior and academic achievement among adolescents: the relative contribution of dietary habits, physical activity, body mass index, and self-esteem

This study tested a structural equation model to estimate the relationship between health behaviors, body mass index (BMI), and self-esteem and the academic achievement of adolescents. The authors analyzed survey data from the 2000 study of Youth in Iceland , a population-based, cross-sectional sample of 6,346 adolescents in Iceland. The model demonstrated good fit with chi-square of 2685 (n = 5,810, df = 180), p < .001, Comparative Fit Index value of .94, and a root mean square error of approximation of .049. Lower BMI, physical activity, and good dietary habits were all associated with higher academic achievement; however, health behavior was positively and robustly associated with greater self-esteem. Self-esteem was positively influenced both through physical activity (beta = .16) and the consumption of fruits and vegetables (beta = .14). In contrast, poor dietary habits negatively influenced self-esteem and academic achievement, and self-esteem was negatively influenced by increasing levels of BMI (beta = -.05).

Prediction of disturbed eating attitudes in adolescent girls: a 3-year longitudinal study of eating patterns, self-esteem and coping

OBJECTIVE

The purpose was to examine the extent to which yearly assessments of eating patterns and attitudes, self-esteem and coping strategies over a 3-year period among adolescent girls predicted the degree of disturbed eating attitudes at the year 3-assessment. Our main hypothesis was that such attitudes year 3 would be predicted by eating attitudes, restrained, emotional, and external eating behaviour, as well as by low self-esteem and coping by acting out or avoidance.

METHOD

Three-hundred and seventy- eight Swedish adolescent girls were assessed once a year for three years.

RESULTS

The results suggest that eating patterns and attitudes were the strongest predictors of disturbed eating attitudes year 3. Self-esteem and coping had a limited predictive value for eating attitudes year 3, and the effect of self-esteem appeared to be mediated by coping.

DISCUSSION

The results suggest that early eating patterns (e.g., more disturbed eating attitudes and restrained eating behaviors) and attitudes are potentially important predictors for the development of more serious eating disturbances among adolescent girls.

Comparison of eating disorders and body image disturbances between Eastern and Western countries

Factors associated with the development of eating disorders in countries with non-Western cultures have not been adequately investigated in relation to Westernized countries. We therefore studied 243 girls [age =16.5+/-1.2 (SD)], recruited from schools in India, Tibet, the US and France. They completed the Figure Rating Scale (FRS), the Eating Attitudes Test (EAT), and the Beck Depression Inventory (BDI). The Tibetan group had a lower body mass index (BMI) than the other groups (p<0.0001), which did not differ from each other. All groups differed significantly on socio-economic status (SES), with those living in India having the highest (p<0.0001). Prior to controlling for age, SES, and BMI, there were no significant differences on any psychological measure between the individual countries, or when collapsed by East vs. West. However, after controlling for the same covariates, the Tibetan group selected a significantly larger current (p<0.0001) and ideal body size (p=0.03), compared to all the other countries, and had more body image discrepancy than the American group (p=0.04). After controlling only for BMI, the girls from the East had a larger current and ideal, but no difference on body image discrepancy. Body image discrepancy scores were best predicted by EAT scores and BMI, accounting for 35% of the variance (p<0.0001). EAT scores themselves were best predicted by mother's education, BDI, body image discrepancy, and drug and tobacco use, accounting for 33% of the variance (p<0.0001). Unlike some other studies, we did not observe greater body image discrepancy and eating pathology in Western cultures, whether or not controlling for age, SES, and BMI. There were no differences in eating and depression pathology between those in the US, France, or India. Indeed, the Tibetans, after controlling for their low BMI and SES, had the greatest body image discrepancy.

Gender, school and academic year differences among Spanish university students at high-risk for developing an eating disorder: an epidemiologic study

BACKGROUND

The aim of this study was to assess the magnitude of the university population at high-risk of developing an eating disorder and the prevalence of unhealthy eating attitudes and behaviours amongst groups at risk; gender, school or academic year differences were also explored.

METHODS

A cross-sectional study based on self-report was used to screen university students at high-risk for an eating disorder. The sample size was of 2551 university students enrolled in 13 schools between the ages of 18 and 26 years. The instruments included: a social-demographic questionnaire, the Eating Disorders Inventory (EDI), the Body Shape Questionnaire (BSQ), the Symptom Check List 90-R (SCL-90-R), and the Self-Esteem Scale (RSE). The sample design is a non-proportional stratified sample by academic year and school. The prevalence rate was estimated controlling academic year and school. Logistic regression analysis was used to investigate adjusted associations between gender, school and academic year.

RESULTS

Female students presented unhealthy weight-control behaviours as dieting, laxatives use or self-induced vomiting to lose weight than males. A total of 6% of the females had a BMI of 17.5 or less or 2.5% had amenorrhea for 3 or more months. In contrast, a higher proportion of males (11.6%) reported binge eating behaviour. The prevalence rate of students at high-risk for an eating disorder was 14.9% (11.6-18) for males and 20.8% (18.7-22.8) for females, according to an overall cut-off point on the EDI questionnaire. Prevalence rates presented statistically significant differences by gender (p < 0.001) but not by school or academic year.

CONCLUSION

The prevalence of eating disorder risk in university students is high and is associated with unhealthy weight-control practices, similar results have been found in previous studies using cut-off points in questionnaires. These results may be taken into account to encourage early detection and a greater awareness for seeking treatment in order to improve the diagnosis, among students on university campuses.

A study of the relationship between parental bonding, self-concept and eating disturbances in Norwegian and American college populations

This study investigated the relationship between bonding patterns and self-concept, and the influence of these constructs on a measure of sub-clinical eating disturbances. Undergraduate students from the United States (N=166) and Norway (N=233) were given self-report questionnaires that included measures of parental bonding, locus of control, self-concept clarity, self-esteem, and disturbed cognitions associated with eating. A structural equation model showed the expected pattern, with bonding predicting self-concept and self-concept predicting eating disturbances. The model fit equally well for samples from both countries and for both genders. This model links the pattern of low care and overprotective parental bonding indicators mediated through a self-concept defined by a lack of self-understanding, low self-esteem, and external locus of control to increased risk of eating disturbances for college aged men and women.

Eating disturbances in a school population of preteen girls: assessment and screening

OBJECTIVE

To assess the utility of the Children's Eating Attitudes Test (cEAT) questionnaire in screening for interview-ascertained eating disturbances.

METHOD

A total of 409 girls, 9-13 years of age, completed a cEDE interview and cEAT questionnaire.

RESULTS

14.7% of girls reported eating disturbances in the past month on the cEDE. Mean cEDE score was 0.3 +/- 0.6 and mean cEAT score was 5.9 +/- 5.9. The cEAT demonstrated low sensitivity but high specificity at a cutoff score of 20, and poor positive predictive value when lower cutoff scores were used.

CONCLUSION

Eating disturbances were common but mild in this preteen group. The cEAT was not an efficient screening tool for interview-ascertained mild eating disturbances in preteen girls.

Weight-related concerns associated with smoking in young children

Studies have shown that weight concern is associated with smoking in adolescents. However, little is known about the relationship between weight concern and smoking in younger children. Analyses were conducted to determine whether children in elementary school who had tried smoking would possess greater weight concern than those who had not tried smoking. Results indicated that smokers possessed more general weight concern, F(1, 640)=5.619, p=.018, reported more dieting, F(1, 707)=11.757, p=.001, and endorsed greater concern with body size, F(1, 707)=4.113, p=.043, than non-smokers. Similar to adolescents, these results suggest that young children who have tried smoking are more concerned about weight than children who have not tried smoking.

Associations between disordered eating behaviors and licit and illicit substance use and abuse in a university sample

OBJECTIVES

To examine associations between discrete eating disordered behaviors as well as clusters of eating disordered behaviors in relation to the use and abuse of a wide spectrum of substance classes, both licit and illicit, in a female university sample.

METHODS

Women with particular types of eating disordered behaviors were selected from a pool of 526 students who completed the Women's Health Survey. Analyses compared the frequencies of lifetime engagement in a wide range of licit and illicit substances between each of the eating disorder groups and the normal control group.

RESULTS

Associations were found between severe levels of alcohol consumption and binge eating, dieting with purging and the use of central nervous stimulants, and bingeing with dieting and tobacco use and the abuse of prescription medications.

CONCLUSION

Examining a broad range of substance classes, with differing physiological properties and effects, in relation to specific disordered eating behaviors, could contribute to theory development regarding the functions of the specific co-occurring behaviors.

Comparative study of attitudes to eating between male and female students in the People's Republic of China

OBJECTIVE

This study was conducted to compare eating attitudes and lifestyles of male and female college students in China (Beijing).

SUBJECTS AND METHODS

The subjects of this study consisted of 217 male and 177 female college students. They were asked to fill out the Eating Attitudes Test-26 (EAT-26) and a lifestyle questionnaire.

RESULTS

The percentages of those above the cutoff point on the EAT-26 for abnormal eating attitudes were 4.7% of male and 6.2% of female students. Body perception of being fat (distorted body image) was the factor most associated with abnormal eating attitudes.

DISCUSSION

Weight related concern was prevalent amongst the Chinese students. This suggests that the culture of the beauty of thinness is common among young students in Beijing, particularly female students.

Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males

PURPOSE

This study addresses the question, "Does body satisfaction matter?" by examining longitudinal associations between body satisfaction and weight-related health-promoting and health-compromising behaviors five years later among adolescents.

METHODS

Project EAT-II followed an ethnically and socioeconomically diverse sample of 2516 adolescents from 1999 (Time 1) to 2004 (Time 2). Associations between body satisfaction at Time 1 and health behaviors at Time 2 were examined, adjusting for sociodemographic characteristics and Time 1 health behaviors, with and without adjustment for body mass index (BMI).

RESULTS

In females, lower body satisfaction predicted higher levels of dieting, unhealthy and very unhealthy weight control behaviors and binge eating, and lower levels of physical activity and fruit and vegetable intake. After adjusting for BMI, associations between body satisfaction and dieting, very unhealthy weight control behaviors, and physical activity remained statistically significant. In males, lower body satisfaction predicted higher levels of dieting, healthy, unhealthy, and very unhealthy weight control behaviors, binge eating, and smoking, and lower levels of physical activity. After adjusting for BMI, associations between body satisfaction and dieting, unhealthy weight control behavior, and binge eating remained statistically significant.

CONCLUSIONS

The study findings indicate that, in general, lower body satisfaction does not serve as a motivator for engaging in healthy weight management behaviors, but rather predicts the use of behaviors that may place adolescents at risk for weight gain and poorer overall health. Interventions with adolescents should strive to enhance body satisfaction and avoid messages likely to lead to decreases in body satisfaction.

Alcohol-related consequences among women who want to lose weight

Previous research has identified a positive relationship between disordered eating behaviors and heavy alcohol use, demonstrating that alcohol use is heavier among individuals with eating disorders or who demonstrate significant symptoms of disordered eating. The purpose of this study was to examine whether this relationship also exists among women displaying milder disordered eating attitudes, defined by a stated desire to lose weight despite maintaining a healthy body weight. Participants in this study were 255 female college students at a large public university in the northeast region of the United States who were either under- or of normal body weight. Results indicated that women who reported a desire to lose weight were significantly more likely to experience several negative alcohol-related consequences, including doing something later regretted and having forced intercourse than those without a desire to lose weight. Results also indicated that the use of protective behavioral strategies was associated with fewer alcohol-related problems among this group. Implications for interventions and future research studies are discussed.

Self-esteem and adolescent sexual behaviors, attitudes, and intentions: a systematic review

PURPOSE

This review systematically examined the relationship between self-esteem and adolescents' sexual behaviors, attitudes, and intentions, as empirically investigated by researchers over the last 20 years.

METHODS

Based on the Matrix Method for systematic reviews, five electronic databases and reference lists of published studies were searched. Thirty-eight (n = 38) publications met specific inclusion and exclusion criteria and comprised the final sample. Each study was assigned a methodological quality score (MQS; maximum = 20 points). Each study's empirical test of the relationship between self-esteem and sexual behaviors/attitudes/intentions was counted as a single finding and was classified as exhibiting an inverse linear relationship, no statistically significant linear relationship, or a positive linear relationship.

RESULTS

A total of 189 findings (average = 4.97/publication, range 1-28) were analyzed. Most findings (n = 138, 73%) consisted of tests of self-esteem and sexual behaviors. Regarding the nature of the relationship between self-esteem and the various behavior/attitude/intention variables, 62% of behavior findings and 72% of the attitudinal findings exhibited no statistically significant association. All of the intention-related findings exhibited some type of relationship (either positive or inverse). Studies' average MQS was 11.71 (SD = 1.60). Higher quality studies yielded findings of positive or absence of relationship (Cramer's V = .329, p = .001).

CONCLUSIONS

If most findings exhibit no association between self-esteem and adolescent sexual behaviors/attitudes/intentions, questions are inevitably raised whether the emphasis placed on self-esteem by public health professionals is innocuous. Recommendations for methodological improvement of this body of research are also presented.

Partial eating disorders among adolescents: a review

PURPOSE

Many adolescents do not fulfill all the DSM-IV criteria's for anorexia nervosa and bulimia, but do nevertheless suffer from partial eating disorders (EDs). This review focuses on the definition, epidemiology and clinical aspects of these disorders.

METHODS

Search on Medline & PsycINFO, review of websites, screening of bibliographies of articles and book chapters.

RESULTS

There is still no consensus on the definition of these disorders, which cover a wide range of severity. Affected adolescents often suffer from physical and psychological problems owing to co-morbidity or as a consequence of their eating patterns: chronic constipation, dyspeptic symptoms, nausea, abdominal pain, fatigue, headaches, hypotension, menstrual dysfunction as well as dysthymia, depressive and anxiety disorders, or substance misuse and abuse. In comparison with those who are unaffected, adolescents with partial ED are at higher risk of evolving into full ED. However, most of them evolve into spontaneous remission. Adolescents with partial ED engaged, over a period of several months, in potentially unhealthy weight-control practices, suffering from intense fear of gaining weight and a disturbed body weight/image should be offered therapeutic support.

CONCLUSION

Future research should focus on the exact delineation of various subtypes of clinical presentations in partial ED and on evidence-based treatment and follow-up of these various situations.

Vegetarianism and eating disorders: association between eating attitudes and other psychological factors among Turkish adolescents

The purpose of this study was to determine whether differences exist in eating attitudes, self-esteem, social trait anxiety and social physique anxiety of self-reported vegetarian and nonvegetarian Turkish adolescents. The sample for the Turkish University' students is designed to provide the estimates of vegetarian indicators and prevalence. The participants were 608 females and 597 males, in total 1205 adolescents aged between 17 and 21 years. Disturbed eating behaviors (EAT-26> or =20) was found in 45.2% (14 of vegetarian) of the total vegetarian sample; which included two of the male vegetarians and 12 of the female vegetarians. The mean BMI was 19.78+/-1.49 kg/m(2) for female vegetarians and 20.78+/-2.46 kg/m(2) for female nonvegetarians (p<0.05). Male vegetarians had significantly higher score than male nonvegetarians on EAT-26 (17.25+/-11.18 for male vegetarians and 9.38+/-6.60 for male nonvegetarians), dieting (6.50+/-7.65 for male vegetarians and 2.55+/-3.87 for male nonvegetarians) and oral control (6.13+/-4.67 for male vegetarians and 3.20+/-3.19 for male nonvegetarians) scores (p<0.05). Besides, female vegetarians had significantly higher score than female nonvegetarians on EAT-26 (22.04+/-13.62 for female vegetarians and 11.38+/-8.28 for female nonvegetarians), dieting (10.35+/-9.58 for female vegetarians and 4.41+/-5.30 for female nonvegetarians), oral control (7.78+/-5.13 for female vegetarians and 3.33+/-3.51 for female nonvegetarians) and STAI (51.39+/-7.28 for female vegetarians and 47.29+/-5.13 for female nonvegetarians) scores (p<0.05). As a conclusion, the present study indicated abnormal eating attitudes, low self-esteem, high social physique anxiety, and high trait anxiety in Turkish vegetarian adolescents. The vegetarian adolescents may be more likely to display disordered eating attitudes and behaviors than nonvegetarians.

Older boyfriends of adolescent girls: the cause or a sign of the problem?

PURPOSE

There were two aims of this study: (a) to determine the causal relationship between adolescent girls' early sexual activity and the presence of an older boyfriend, and (b) theoretically and empirically contextualize the relationship between these two variables within a model of adolescent problem behavior.

METHODS

Secondary analysis was conducted with the 670 adolescent girls of Waves I and II of the public use version of the National Longitudinal Study of Adolescent Health. Girls included in the analyses had not already had an older romantic partner in Wave I but did have a romantic partner in the 18 months before Wave II. Four alternative causal models are proposed and tested using structural equation modeling and a nested model comparison analysis strategy.

RESULTS

The model with the best fit to the data depicted the presence of an older partner as a mediator of psychosocial risk factors and adolescent problem behaviors (including early sexual activity). Psychosocial characteristics of adolescent girls in Wave I predicted whether they would enter romantic relationships with older boyfriends by Wave II. In turn, though, the presence of an older boyfriend increased problem behavior in Wave II above and beyond the effects of the psychosocial risk factors.

CONCLUSIONS

These findings are discussed in terms of the need for a more comprehensive understanding of the unions between adolescent girls and older boyfriends before statutory rape policies are modified.

An analysis of health promotion and risk behaviors of freshman college students in a rural southern setting

This study described health promotion and risk behaviors of entering college students in a rural southern setting. A sample of 251 students completed the Health Promotion and Health Risk Survey during a testing period that included other academic surveys. Results indicated that participants believe they are in control of their health. In addition, participants reported that happiness and health were the most important personal values for them. When compared with the National College Health Risk Behavior data, participants in this study were significantly lower in many of the health risk behaviors.

Body mass index, academic achievement, and school context: examining the educational experiences of adolescents at risk of obesity

Reflected self-appraisal suggests that individual functioning is related to the fit between individual characteristics and the norms of their primary contexts. To apply this social psychological concept to the study of obesity, we hypothesized that adolescents at risk of obesity would have lower academic achievement overall than other students, especially in schools in which their weight status was most likely to elicit negative evaluations. Multi-level modeling of nationally representative data revealed that the negative longitudinal association between risk of obesity and achievement was stronger in schools with higher rates of romantic activity and lower average body size among students, two school contexts in which obesity was likely to be stigmatized, but weaker in schools with higher rates of athletic participation, a school context in which such stigmatization was also likely. Additional analyses suggested that this last, unexpected finding reflected a process of niche-picking.

Defense mechanisms in a community-based sample of female adolescents with partial eating disorders

OBJECTIVES

The purpose of this study is to assess whether female adolescents diagnosed with partial eating disorders (EDs) will show less adaptive defense mechanisms compared to female controls with no-ED.

METHODS

The following questionnaires were administered to 423 female high-school students: The Eating Attitudes Test (EAT-26), the Defense Style Questionnaire (DSQ), and Life Style Index (LSI) (both tapping defense mechanisms), and a structured questionnaire assessing eating-related issues. Weight and height were also recorded. Partial anorexia nervosa (AN) and bulimia nervosa (BN) were defined with the combination of a maladaptive EAT score and fulfillment of adapted DSM-IV criteria.

RESULTS

Compared to non-ED controls, participants with partial AN and partial BN used more immature defenses, including the DSQ-immature defense style (only those with partial BN) and LSI-regression, as well as more neurotic defenses, namely the DSQ-neurotic defense style, and LSI-compensation and displacement.

CONCLUSIONS

The combined use of immature and neurotic defenses may be associated with a greater risk to develop a partial ED in adolescent females.

Disordered eating attitudes: an emerging health problem among Mediterranean adolescents

Aim of the present study was to investigate eating attitudes in a group of Mediterranean high school students. One hundred and twenty high school students participated in this survey. The Eating Attitudes Test (EAT-26) was used for evaluating symptoms and attitudes associated with disordered eating. Body composition and dietary intake were also assessed. Using the cut-off point of 20 in the total EAT, 13 females (20.3%) and 4 males (7.3%) exhibited disordered eating behavior. Overweight students had significantly higher scores in the dieting scale than those in the normal BMI range. Percent fat mass was positively related to the total EAT (r=0.326, p<0.001) and the dieting scale (r=0.489, p<0.001). Waist/hip ratio was negatively related to total EAT and its scales. In conclusion, a significant percentage of students in this urban Mediterranean adolescent population found to have abnormal eating attitudes. This finding may be partly explained by the effect of cultural transition.

Eating attitudes and the use of alcohol, tobacco, and exercise among male and female adolescents

OBJECTIVES

To determine the differences between male and female adolescents in the associations of disturbed eating attitudes with the use of smoking, alcohol, and exercise.

METHOD

Nonclinical adolescents-174 males and 157 females-completed the Eating Disorders Inventory (EDI) and a measure of engagement in the use of smoking, alcohol, and exercise. An analysis of variance (ANOVA) was used to determine the impact of Gender x Use of the behaviour upon eating and related attitudes.

RESULTS

Gender and use of smoking and alcohol were each related to eating attitudes. However, in the case of exercise, there were strong interactions of the behaviour and gender. Women who exercised regularly had higher levels of restriction, body dissatisfaction, and interoceptive awareness, whereas men did not.

CONCLUSIONS

It appears that men and women exercise for different reasons, in relation to their eating and related attitudes. It is possible that men exercise for positive goals (e.g., fitness), whereas women exercise to escape perceived negative consequences (e.g., weight gain). This is not the case for alcohol and tobacco use. These findings are discussed, and further research is proposed.

Perceived importance of being thin and smoking initiation among young girls

BACKGROUND

Smoking among adolescents remains unacceptably high and the difference in potential risk factors for smoking initiation between male and female adolescents has been explored. Although the association between smoking initiation and dieting behaviour has been observed among girls, the mechanism of the association is unknown.

OBJECTIVE

To examine prospectively the association between perceived importance of being thin at baseline and smoking initiation among girls.

DESIGN

A four year prospective cohort survey including perceived importance of being thin at baseline and smoking behaviour, conducted in 1993 and 1996.

SETTING AND PARTICIPANTS

273 Massachusetts female adolescents aged 12-15 years at baseline who reported having smoked no more than one cigarette by the time of the baseline survey, drawn from households sampled by random digit dialing.

MAIN OUTCOME MEASURE

Progression to established smoking, defined as having smoked 100 or more cigarettes in their lifetime.

RESULTS

After adjusting for age, smoking status at baseline, and race/ethnicity, girls who valued thinness most strongly and somewhat strongly were both more likely to have become established smokers, compared to the girls who valued thinness least strongly. The odds ratios are 4.5 (95% confidence interval (CI), 1.4 to 16.7) and 3.4 (95% CI 1.04 to 10.9), respectively.

CONCLUSIONS

The level of perceived importance of being thin among young female adolescents predicts future smoking initiation. Smoking prevention programmes designed for female adolescents may therefore benefit from the inclusion of content related to importance of being thin.

Associates of obesity and weight dissatisfaction among Finnish adolescents

OBJECTIVE

We investigated behavioural and socio-economic factors associated with obesity and weight dissatisfaction among Finnish adolescents.

DESIGN

A total of 60,252 Finnish adolescents aged 14 to 16 years filled in a questionnaire about their health, health behaviour and socio-economic background. Food choices were obtained by using a short food-frequency questionnaire. Obesity was defined as a weight at least 120% of the sex- and height-specific mean weight for subjects.

RESULTS

Of girls and boys, 54% and 66%, respectively, were satisfied with their weight. Among dissatisfied normal-weight adolescents, 81% of girls but only 48% of boys thought they were overweight. Of obese boys, 25% were satisfied with their weight. For both genders, obesity and weight dissatisfaction were associated with economic problems in the family. In girls, an association was also found with poor school performance, low educational level of parents and not having evening meals at home; and in boys, with physical inactivity and not eating school lunch. Smoking was more common among girls who were dissatisfied with their weight. Differences in food choices were small between different weight and weight satisfaction categories.

CONCLUSIONS

Having normal weight and being satisfied with that weight are favourable for an adolescent. Obesity and weight dissatisfaction are associated mostly with disadvantageous health behaviours and low socio-economic status. Health behaviour seems to be associated more with weight satisfaction than with actual weight.