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Tie B, Xu Y, Cui S, He J. Gay Dating Apps Usage, Body Dissatisfaction, and Disordered Eating in Chinese Young Gay Men. JOURNAL OF HOMOSEXUALITY 2024; 71:2617-2637. [PMID: 37643388 DOI: 10.1080/00918369.2023.2250501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
There is a paucity of research on the links between gay dating apps usage and body dissatisfaction and disordered eating, especially for muscularity dissatisfaction and muscularity-oriented disordered eating in non-Western contexts. Thus, this study aimed to evaluate the associations between gay dating apps usage, body image inflexibility, body dissatisfaction, and disordered eating with the inclusion of both body fat and muscularity dissatisfaction and both thinness-and muscularity-oriented disordered eating in a sample of Chinese young gay men. A total of 247 Chinese young gay men (mean age: 21.92 ± 2.74 years) were recruited. Gay dating apps usage, body fat dissatisfaction, muscularity dissatisfaction, body image inflexibility, and thinness-and muscularity-oriented disordered eating were evaluated. Pearson correlation and mediation analyses were conducted. Gay dating apps usage was positively correlated with body fat dissatisfaction (r = .20, p = .002), muscularity dissatisfaction (r = .17, p = .006), thinness-oriented disordered eating (r = .21, p < .001), and muscularity-oriented disordered eating (r = .29, p < .001), and these relationships could be mediated by body image inflexibility. Findings support technologically-informed prevention and intervention strategies for eating and body image disturbances in gay men in the Chinese context.
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Affiliation(s)
- Bijie Tie
- Center for Studies of Education and Psychology of Ethnic Minorities in Southwest China, Southwest University, Chongqing, China
- School of Education, Zhengzhou University, Zhengzhou, Henan, China
| | - Yinuo Xu
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
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2
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Levinson CA, Osborn K, Hooper M, Vanzhula I, Ralph-Nearman C. Evidence-Based Assessments for Transdiagnostic Eating Disorder Symptoms: Guidelines for Current Use and Future Directions. Assessment 2024; 31:145-167. [PMID: 37997290 DOI: 10.1177/10731911231201150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Eating disorders are severe and often chronic mental illnesses that are associated with high impairment and mortality rates. Recent estimates suggest that eating disorder prevalence rates are on the rise, indicating an increased need for accurate assessment and detection. The current review provides an overview of transdiagnostic eating disorder assessments, including interview, self-report, health and primary care screeners, and technology-based and objective assessments. We focused on assessments that are transdiagnostic in nature and exhibit high impact in the field. We provide recommendations for how these assessments should be used in research and clinical settings. We also discuss considerations that are crucial for assessment, including the use of a categorical versus dimensional diagnostic framework, assessment of eating disorders in related fields (i.e., anxiety and depression), and measurement-based care for eating disorders. Finally, we provide suggestions for future research, including the need for more research on short transdiagnostic screeners for use in health care settings, standardized assessments for ecological momentary assessment, development of state-based assessment of eating disorder symptoms, and consideration of assessment across multiple timescales.
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Affiliation(s)
| | - Kimberly Osborn
- University of Louisville, KY, USA
- Oklahoma State University, Stillwater, USA
| | - Madison Hooper
- University of Louisville, KY, USA
- Vanderbilt University, Nashville, TN, USA
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3
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Yesildemir O, Akbulut G. Gender-Affirming Nutrition: An Overview of Eating Disorders in the Transgender Population. Curr Nutr Rep 2023; 12:877-892. [PMID: 37864747 DOI: 10.1007/s13668-023-00504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW Transgender individuals are vulnerable to many nutrition-related conditions, especially eating disorders due to gender dysphoria. This review aims to summarize the current literature on eating disorders in transgender individuals. The issues that should be considered in nutrition care for the transgender population are discussed regarding public health. RECENT FINDINGS Transgender individuals can exhibit disordered eating behaviors to overcome the stress they experience due to stigma, discrimination, social exclusion, and abuse. Recent studies showed that disordered eating and clinical eating disorders are more prevalent among transgender than cisgender people. It is very important for a multidisciplinary team working in the clinic to understand the epidemiology, etiology, diagnostic criteria, and treatment of eating disorders in the transgender population. However, multidisciplinary nutritional care is limited due to the lack of transgender-specific nutrition guidelines. It is safe to say that adhering to a generally healthy nutritional pattern and using standardized nutrition guidelines. We recommend that health professionals working with patients/clients with eating disorders receive continuing education in transgender health, be empowering and inclusive, address patients/clients with their gender identity nouns and pronouns, and develop nutritional treatment plans that are not gender-specific. Eating disorders are a significant public health problem in the transgender population. Therefore, clinical screening and early intervention are necessary to identify and treat eating disorders in transgender people. Eating disorders in the transgender population should be monitored routinely, and gender-affirming care should be provided as well as treatment of eating disorders.
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Affiliation(s)
- Ozge Yesildemir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bursa Uludag University, Bursa, 16059, Turkey.
| | - Gamze Akbulut
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Istanbul Kent University, Istanbul, 34433, Turkey
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4
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Touma DA, Quinn ME, Freeman VE, Meyer EG. Eating Disorders in U.S. Active Duty Military Members and Veterans: A Systematic Review. Mil Med 2023; 188:1637-1648. [PMID: 35788384 DOI: 10.1093/milmed/usac180] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Feeding and eating disorders can be difficult to treat and frequently co-occur with other mental health conditions. The last systematic review of eating disorders in a military and veteran population was published in 2015. An updated review is warranted to re-examine the current literature on eating disorders in the active duty and veteran populations. MATERIALS AND METHODS A systematic review that described the prevalence, co-occurrence of other disorders and/or events, and health care utilization of U.S. active duty members and veterans was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases and Medical Subject Headings (MeSH) terms used are listed in Appendix A. Each category of the literature was extracted and graded using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Twenty-one studies revealed prevalence estimates with varying rates based on demographic information. Trauma exposure is consistently associated with eating disorder development. Individuals diagnosed with eating disorders had greater health care utilization. CONCLUSIONS Research on eating disorders in the military and veteran populations has expanded in recent years. Limitations of the evidence included in this review stem from the use of self-reported questionnaires, changes to medical record systems, and limited generalizability to the overall population of patients with eating disorders. Further research should investigate the impact of demographic factors and trauma exposure on the development of an eating disorder within the military and veteran populations.
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Affiliation(s)
- Danielle A Touma
- Department of Psychiatry, Uniformed Services University, Bethesda, MD 20814, USA
| | - Meghan E Quinn
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Vanessa E Freeman
- Department of Psychiatry, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Eric G Meyer
- Department of Psychiatry, Uniformed Services University, Bethesda, MD 20814, USA
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Oblea PN, Siaki LA. Looking Back, a View to the Future of the Health and Readiness of Gender and Sexual Diverse U.S. Service Members. Mil Med 2023; 188:77-81. [PMID: 36208213 DOI: 10.1093/milmed/usac288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/30/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
The objective is to provide a brief overview of the history of gender and sexual diverse service members, health utilization rates, outcomes, and disparities, as well as perceived challenges accessing health care and gaps in the evidence base underpinning sex- and gender-appropriate care. The article also provides strategies going forward to address these issues and optimize health care delivery.
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Affiliation(s)
- Pedro N Oblea
- Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI 96859, USA
| | - Leilani A Siaki
- Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, HI 96859, USA
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Gaviria D, Ammerman A. Eating disorders and disordered eating in servicemen and women: A narrative review. J Clin Psychol 2023; 79:316-373. [PMID: 35938917 DOI: 10.1002/jclp.23424] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/09/2022] [Accepted: 07/14/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Eating disorders (EDs) are mental illnesses impacting all aspects of an individual's life. Recent research has examined EDs and disordered-eating behaviors in the military, a population subject to body composition standards, fitness requirements, and extreme stress. The purpose of this narrative review was to investigate ED and disordered-eating prevalence and their risk factors in ROTC (reserve officers' training corps), active-duty, and veteran servicemembers. The secondary purpose was to provide policy recommendations to reduce the burden of these conditions in the military. METHODS PubMed and PsycINFO were reviewed for relevant articles. All studies including data on EDs or disordered eating in U.S. active-duty, ROTC, or veteran populations were considered. RESULTS Results revealed a high burden of EDs and disordered eating with bulimic- and binge-type behaviors being the most common. Servicemembers exposed to trauma, including military sexual assault, and those with comorbidities like PTSD showed a higher prevalence. Body composition and fitness testing were also associated with a higher risk. Qualitative studies suggest these conditions serve as coping mechanisms for aspects of military life. CONCLUSIONS The high prevalence of EDs and disordered eating in the military points toward the importance of identification, treatment, and prevention. Policy change is necessary to protect servicemembers.
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Affiliation(s)
- David Gaviria
- Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alice Ammerman
- Center for Health Promotion and Disease Prevention, Department of Nutrition, Schools of Public Health and Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Knight R, Carey M, Jenkinson P, Preston C. The impact of sexual orientation on how men experience disordered eating and drive for muscularity. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2118921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Ruth Knight
- Department of Psychology, University of York, York, United Kingdom
| | - Mark Carey
- Department of Psychology, University of York, York, United Kingdom
| | - Paul Jenkinson
- Department of Psychology, Centre for Research in Psychology and Sport Sciences, University of Hertfordshire, Hertfordshire, United Kingdom
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Simone M, Hazzard VM, Askew A, Tebbe EA, Lipson SK, Pisetsky EM. Variability in Eating Disorder Risk and Diagnosis in Transgender and Gender Diverse College Students. Ann Epidemiol 2022; 70:53-60. [PMID: 35472489 DOI: 10.1016/j.annepidem.2022.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/15/2022] [Accepted: 04/15/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To examine differences in elevated eating disorder risk and self-reported eating disorder diagnosis across subgroups of transgender and gender diverse (TGD) college students. METHODS Data from 5057 TGD college students participating in the national Healthy Minds Study between 2014-2019 were analyzed. Chi-square tests and logistic regression analyses examined heterogeneity in prevalence and odds of elevated eating disorder risk, as measured by the SCOFF, and self-reported eating disorder diagnosis by gender, as well as by intersecting gender and sexual orientation identities. RESULTS Genderqueer/non-conforming college students reported the highest prevalence of elevated eating disorder risk (38.8%) relative to gender expansive students. Genderqueer/non-conforming (11.1%), gender expansive (12.3%), and trans men/transmasculine students (10.5%) reported higher prevalence of a self-reported eating disorder diagnosis relative to trans women/transfeminine students (6.3%). Heterosexual or straight trans men had lower odds of eating disorder risk and self-reported diagnosis relative to trans men with a minoritized sexual orientation. CONCLUSIONS Genderqueer/non-conforming college students may be at heightened eating disorder risk. Moreover, a heterosexual/straight sexual orientation was associated with lower odds of elevated eating disorder risk and self-reported eating disorder diagnoses among trans men and genderqueer/non-conforming college students, but this finding did not hold for other groups. College campuses should aim to reduce eating disorder risk among TGD students.
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Affiliation(s)
- Melissa Simone
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Vivienne M Hazzard
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Autumn Askew
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA, 92182
| | - Elliot A Tebbe
- School of Nursing, University of Wisconsin-Madison, Madison, WI, 53705
| | - Sarah K Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA, 02118
| | - Emily M Pisetsky
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA, 55454
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9
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Ruiz de Assin Varela PM, Caperos JM, Gismero-González E. Sexual attraction to men as a risk factor for eating disorders: the role of mating expectancies and drive for thinness. J Eat Disord 2022; 10:52. [PMID: 35428366 PMCID: PMC9013141 DOI: 10.1186/s40337-022-00576-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/06/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Men tend to give more importance than women to physical aspects when selecting a partner; thus, the internalization of beauty standards and the ideal of thinness may be greater in populations attracted to men, placing them at a higher risk of eating disorders. METHODS In a sample (n = 398) of heterosexual and gay men and women, we evaluated the drive for thinness, body dissatisfaction, and bulimic symptomatology. Using ANCOVAs, we analyzed the differences in symptoms score according to sex, sexual orientation and relational status including body mass index (BMI) as covariate; we also evaluated the mediating role of drive for thinness in the relationship between sexual orientation and body dissatisfaction. RESULTS We found an increased drive for thinness and body dissatisfaction in men-attracted compared with women-attracted participants; also, body dissatisfaction was greater in women than in men. Heterosexual women presented higher bulimia scores than lesbian women. Gay men open to relationships presented higher drive for thinness and body dissatisfaction scores than those not-open to relationships. Finally, differences in body dissatisfaction between gay and heterosexual men were fully explained by drive for thinness, while, in the case of women, drive for thinness only partially explained these differences. CONCLUSIONS Attraction to men seems to be a risk factor for EDs in the case of gay men and heterosexual women. In addition, in the case of heterosexual women, other factors independent of the desire to attract men seem to be important.
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Affiliation(s)
| | - Jose Manuel Caperos
- UNINPSI Clinical Psychology Center, and Psychology Department, Comillas Pontifical University, Madrid, Spain.
| | - Elena Gismero-González
- UNINPSI Clinical Psychology Center, and Psychology Department, Comillas Pontifical University, Madrid, Spain
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10
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Serier KN, Smith BN, Cooper Z, Vogt D, Mitchell KS. Disordered eating in sexual minority post-9/11 United States veterans. Int J Eat Disord 2022; 55:470-480. [PMID: 35092637 DOI: 10.1002/eat.23680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/12/2022] [Accepted: 01/12/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE It is well documented that sexual minority individuals are more likely to report disordered eating (DE) than those identifying as heterosexual. Although DE is prevalent in veterans, investigation of potential disparities in DE among sexual minority veterans is limited. This study examined rates of DE in post-9/11 United States (U.S.) veterans identifying as sexual minorities and explored their association with discrimination because of marginalized identities. METHODS A national sample of recently separated post-9/11 U.S. veterans were recruited. Women (N = 805; heterosexual [n = 656]; lesbian [n = 51]; bisexual [n = 98]) and men (N = 558; heterosexual [n = 540]; gay [n = 11]; bisexual [n = 7]) completed a survey assessing eating behaviors, mental health, and military experiences. Weighted correlational and regression analyses were conducted. Analyses in men were exploratory. RESULTS DE was prevalent across gender and sexual orientation identity groups. Women identifying as bisexual and men identifying as gay reported higher rates of DE and consequent impairment compared to veterans who identified as heterosexual. There were no differences in DE between heterosexual and lesbian female veterans, but lesbian women reported lower DE-related impairment. Experiencing any discrimination in the military was positively related to DE. DISCUSSION This study found evidence of disparities in DE among sexual minority U.S. military veterans. While the factors contributing to these differences, such as the role of discrimination, are not completely understood, DE is a health concern for sexual minority veterans and requires continued investigation. PUBLIC SIGNIFICANCE Sexual minority individuals experience disparities in disordered eating; yet, this has not been explored in military veterans. This study found that disordered eating is a significant health concerns for veteran women and men, especially among those identifying as sexual minorities. More research is needed to explore why these disparities exist, such as the role of minority stress, in order to address the unique healthcare needs of these veterans.
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Affiliation(s)
- Kelsey N Serier
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Brian N Smith
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Zafra Cooper
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dawne Vogt
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Karen S Mitchell
- National Center for PTSD at VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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11
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López Castillo H, Blackwell CW, Schrimshaw EW. Paradoxical Obesity and Overweight Disparities Among Sexual Minority Men: A Meta-Analysis. Am J Mens Health 2022; 16:15579883221095387. [PMID: 35485875 PMCID: PMC9067055 DOI: 10.1177/15579883221095387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
This study aims to analyze the prevalence and likelihood of overweight, obesity, and elevated body mass index (BMI) among sexual minority men (i.e., men who have sex with men [MSM], men who have sex with men and women [MSMW], and all sexual minority men), using men who have sex with women (MSW) as the reference group. Studies reporting mean BMIs or prevalence or likelihood of obesity, overweight, or elevated BMI categorized by sexual orientation were included. Data were pooled and analyzed to report mean differences (MDs) of BMIs, prevalence rates, odds ratios (ORs), and their respective 95% confidence intervals (CIs). Forty-three studies were included, with a median of 26,507 participants (median 3.37% sexual minority men). The respective mean overweight, obesity, and elevated BMI prevalence rates among MSM (36%, 23%, and 39%) and MSMW (33%, 27%, and 47%) were lower than those of MSW (44%, 26%, and 55%). This finding was consistent with a significantly lower BMI (MD −1.50 [−1.93, −1.08] kg/m2) and a decreased likelihood of overweight (OR 0.75 [0.64, 0.88]) and obesity (OR 0.84 [0.78, 0.90]). Sexual minority men present with a lower prevalence and likelihood of obesity and overweight than their heterosexual counterparts. The obesity paradox—a sustained catabolic state presenting with lower BMI—is a feasible explanation for this phenomenon, although further research exploring paradoxical cardiovascular findings is granted.
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Affiliation(s)
- Humberto López Castillo
- Department of Health Sciences, College of Health Professions and Sciences, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA.,Department of Population Health Sciences, College of Medicine, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| | - Christopher W Blackwell
- Department of Nursing Practice, College of Nursing, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
| | - Eric W Schrimshaw
- Department of Population Health Sciences, College of Medicine, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
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- Department of Health Sciences, College of Health Professions and Sciences, Academic Health Sciences Center, University of Central Florida, Orlando, FL, USA
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12
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Community norms for the eating disorder examination questionnaire (EDE-Q) among cisgender bisexual plus women and men. Eat Weight Disord 2021; 26:2227-2239. [PMID: 33270173 PMCID: PMC8437880 DOI: 10.1007/s40519-020-01070-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Cisgender bisexual plus (including bisexual, pansexual, and polysexual) women and men experience unique health concerns including eating disorders. The purpose of this study was to develop community norms for eating disorder attitudes and disordered eating behaviors in cisgender bisexual plus women and men using the Eating Disorders Examination Questionnaire (EDE-Q). METHODS Participants were cisgender bisexual plus women (n = 462) and men (n = 93) participants in The PRIDE Study, an existing study of sexual and gender minority people. RESULTS Mean and standard deviation of EDE-Q scores among cisgender bisexual plus women and men, respectively, were: Global (1.75 ± 1.26, 1.56 ± 1.18), Restraint (1.34 ± 1.44, 1.42 ± 1.53), Eating Concern (0.96 ± 1.13, 0.63 ± 0.96), Weight Concern 2.27 ± 1.55, 1.89 ± 1.46), and Shape Concern 42 ± 1.62, 2.30 ± 1.57). Among cisgender bisexual plus women and men, respectively, 27.5% and 22.6% scored in the clinically significant range on the Global score. Bisexual plus women and men reported any occurrence (≥ 1/28 days) of dietary restraint (19.3%, 23.7%), objective binge episodes (11.1%, 10.8%), excessive exercise (4.5%, 5.4%), self-induced vomiting (1.7%, 0.0%), and laxative misuse (0.4%, 1.1%), respectively. A lower percentage of age-matched cisgender bisexual plus women (18-25 years) reported any occurrence of objective binge episodes, self-induced vomiting, laxative misuse, and excessive exercise than previously published in young women. Age-matched cisgender bisexual plus men (18-26 years) reported higher weight concern subscale scores than previously published in young men. CONCLUSIONS These norms should aid clinicians in applying and interpreting the EDE-Q scores of cisgender bisexual plus women and men. LEVEL OF EVIDENCE Level V: cross-sectional descriptive study.
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13
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Donahue JM, Simone M, Scharmer C, Anderson LM, Anderson D. Differential item functioning analysis for the Eating Disorder Examination Questionnaire among heterosexual and sexual minority men. Eat Weight Disord 2021; 26:2071-2076. [PMID: 33025524 PMCID: PMC8021598 DOI: 10.1007/s40519-020-01035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/25/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Sexual minority (SM) men are at a higher risk for eating disorders and related issues, relative to heterosexual men. However, it is currently unknown whether commonly used measures of eating pathology are appropriate to use among diverse groups of men. Determining the unique functioning of existing assessments may help better and more accurately understand eating disorder pathology within this population. The present study examined differences in item endorsement between sexual orientation in the Eating Disorder Examination Questionnaire (EDE-Q) through differential item functioning (DIF). METHODS Heterosexual and SM men (N = 703) completed the EDE-Q and a demographic questionnaire. EDE-Q scores were examined for clinically significant DIF based on participants' self-reported sexual orientation (e.g., heterosexual men vs SM men). RESULTS SM men reported higher EDE-Q symptom composite scores than heterosexual men. DIF was observed for all EDE-Q items relative to the global score; however, only one item met clinical significance (EDE-Q #19; ∆R2 ≥ 0.13). CONCLUSION Results suggest that SM men experience greater levels of ED pathology than heterosexual men. While the EDE-Q is a commonly used measure of eating pathology, findings suggest that sexual orientation bias may impact many items on the EDE-Q. However, results from this study indicated that only one item introduces bias that has clinical implications. Additional research is needed to further explore and replicate this finding among more diverse samples of SM and heterosexual men. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Joseph M Donahue
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, USA.
| | - Melissa Simone
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Christina Scharmer
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, USA
| | - Lisa M Anderson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Drew Anderson
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, USA
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14
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Rambarran N, Maule-O'Brien S, Naidoo K. My body. My politics. An exploration of body image and health in Barbadian sexual minority women. JOURNAL OF LESBIAN STUDIES 2021; 25:377-391. [PMID: 34157963 DOI: 10.1080/10894160.2021.1940755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is a dearth of research on how pervasive Western stereotypes of the ideal body affect non-heterosexual women, and this body of research shrinks even further when considering sexual minority women in the Caribbean. This study aimed to uncover how negotiations between identity, desire, and body politics are being navigated and experienced by sexual minority women in Barbados, along with examining concerns about body image, the impact of societal expectations, and the consequences of these expectations on physical and mental health. Using a qualitative methodology that employed a semi-structured guide, thirteen women were interviewed over the course of a year. Thematic analysis revealed three major themes that centered around the interconnectivity of desire and presentation as it related to body image; distancing from Western influences and grappling with local body ideals; and the ways in which layered events and identities have resulted in complicated relationships with food. A selection of identified community needs is also offered in conclusion.
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Affiliation(s)
| | - Skye Maule-O'Brien
- Willem de Kooning Academy, Rotterdam University of Applied Sciences, Rotterdam, Netherlands
| | - Karen Naidoo
- The Chang School of Continuing Education, Ryerson University, Ontario, Toronto, Canada
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15
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Donahue JM, DeBenedetto AM, Wierenga CE, Kaye WH, Brown TA. Examining day hospital treatment outcomes for sexual minority patients with eating disorders. Int J Eat Disord 2020; 53:1657-1666. [PMID: 32808329 DOI: 10.1002/eat.23362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Epidemiological data support that sexual minorities (SM) report higher levels of eating pathology. Theories suggest these disparities exist due to stressors specific to belonging to a minority group; however, few studies have specifically explored differences between SM and heterosexual individuals in clinical eating disorder samples. Thus, the present study compared SM and heterosexual patients with eating disorders on demographic characteristics and eating disorder and psychological outcomes during day hospital treatment. METHOD Patients (N = 389) completed surveys of eating pathology, mood, anxiety, and skills use at treatment admission, 1-month post-admission, discharge, and 6-month follow-up. Overall, 19.8% of patients (n = 79) identified as SM, while 8.0% (n = 32) reported not identifying with any sexual orientation. SM were more likely to present across genders (17.7% of females, 24.2% of males, 33.3% of transgender patients, and 87.5% of nonbinary patients). RESULTS SM patients were significantly more likely to endorse major depressive disorder, panic disorder, and self-harm at admission than their heterosexual counterparts. Multilevel models demonstrated that across time, SM patients demonstrated greater eating pathology, emotion dysregulation, depressive symptoms, and anxiety symptoms. Significant interactions between sexual orientation and time were found for eating pathology and emotion dysregulation, such that although SM patients started treatment with higher scores, they improved at a faster rate compared to heterosexual patients. DISCUSSION Consistent with minority stress theory, SM patients report greater overall eating disorder and comorbid symptoms. Importantly, results do not support that there appear to be significant disparities in treatment outcome for SM patients in this sample of day hospital patients.
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Affiliation(s)
- Joseph M Donahue
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Anthony M DeBenedetto
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Christina E Wierenga
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, San Diego, California, USA
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Cuthbert K, Hardin S, Zelkowitz R, Mitchell K. Eating Disorders and Overweight/Obesity in Veterans: Prevalence, Risk Factors, and Treatment Considerations. Curr Obes Rep 2020; 9:98-108. [PMID: 32361915 DOI: 10.1007/s13679-020-00374-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Eating disorders (EDs) and overweight/obesity (OW/OB) have a significant impact on veterans. This review highlights current research on EDs and OW/OB in this population. RECENT FINDINGS Prevalence estimates for both EDs and OW/OB among veterans remain consistent with and possibly higher than those in the general population. Both diagnoses share multiple risk factors, including trauma history, and mental health comorbidities. Although weight loss treatments have been fairly well studied among veteran samples, there are no published investigations on psychotherapies for EDs in this population. The Veterans Healthcare Administration is working to train providers in ED treatments. VHA treatments for OW/OB show some benefits and areas for improvement. Areas for future research include structured assessments for EDs and disordered eating behaviors in veterans to clarify prevalence estimates. There is a need for interventions that consider common mechanisms for ED and OW/OB, and there is a need for more research on the associations between different types of trauma and ED/OW/OB in veterans.
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Affiliation(s)
- Kristy Cuthbert
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Sabrina Hardin
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Rachel Zelkowitz
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA
| | - Karen Mitchell
- National Center for PTSD at the VA Boston Healthcare System, Boston, MA, 02130, USA.
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA.
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Simone M, Askew A, Lust K, Eisenberg ME, Pisetsky EM. Disparities in self-reported eating disorders and academic impairment in sexual and gender minority college students relative to their heterosexual and cisgender peers. Int J Eat Disord 2020; 53:513-524. [PMID: 31943285 PMCID: PMC7156314 DOI: 10.1002/eat.23226] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 12/16/2019] [Accepted: 01/05/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of the current study was threefold: (a) compare rates of self-reported anorexia nervosa (AN), self-reported bulimia nervosa (BN), and eating pathology-specific academic impairment (EAI) by gender identity (cisgender men, cisgender women, transgender or genderqueer) and sexual orientation (gay or lesbian, bisexual, unsure, other), (b) examine associations between gender identity, sexual orientation, and eating outcomes, and (c) identify for whom rates of eating disorder diagnosis and impairment is greatest. METHOD The study includes a sample of Minnesota students (n = 13,906) who participated in the College Student Health Survey from 2015 to 2018. Chi-square tests with bootstrapping examined differences in eating pathology rates between groups. Adjusted logistic regressions tested the association between gender identity, sexual orientation, and self-reported eating outcomes. RESULTS Chi-square results revealed heightened rates of self-reported AN, self-reported BN, and EAI in cisgender women, transgender or genderqueer, and sexual minority (e.g., lesbian or bisexual) students. Logistic regression analyses in cisgender men and cisgender women revealed higher odds of self-reported AN, self-reported BN, and EAI in sexual minority students relative their heterosexual peers. Chi-square analyses indicated that bisexual cisgender women reported heightened rates of all three eating pathology measures relative to other sexual and/or gender (e.g., transgender) minority students. DISCUSSION Individuals with marginalized gender and/or sexual orientation identities report heightened rates of eating pathology, with cisgender bisexual women reporting the poorest outcomes relative to individuals from other marginalized identities. Preventive efforts and more research are needed to understand the mechanisms driving this disparity and to reduce prevalence among marginalized groups.
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Affiliation(s)
- Melissa Simone
- Department of Psychiatry and Behavioral Sciences; University of Minnesota, Minneapolis, MN, 55454
| | - Autumn Askew
- Department of Psychiatry and Behavioral Sciences; University of Minnesota, Minneapolis, MN, 55454
| | - Katherine Lust
- Boynton Health, University of Minnesota, Minneapolis, MN, 55455
| | - Marla E. Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, 55414
| | - Emily M. Pisetsky
- Department of Psychiatry and Behavioral Sciences; University of Minnesota, Minneapolis, MN, 55454
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Kamody RC, Grilo CM, Udo T. Disparities in DSM-5 defined eating disorders by sexual orientation among U.S. adults. Int J Eat Disord 2020; 53:278-287. [PMID: 31670848 DOI: 10.1002/eat.23193] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The increased occurrence of disordered eating behaviors among sexual minorities is well established; however, few studies have examined disparities in eating disorder diagnoses among this population. This study sought to examine lifetime prevalence estimates of DSM-5 defined EDs, including anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) as a function of sexual orientation. We then compared prevalence of EDs based on experiences with perceived discrimination. METHOD A nationally representative sample of U.S. adults (N = 35,995) participating in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III completed structured diagnostic interviews. RESULTS Prevalence rates were significantly higher among sexual minorities than heterosexual respondents for all EDs: AN = 1.71% (SE = 0.50) versus 0.77% (SE = 0.07), BN = 1.25% (SE = 0.37) versus 0.24% (SE = 0.03), BED = 2.17% (SE = 0.52) versus 0.81% (SE = 0.05). Odds of lifetime diagnosis were significantly greater among sexual minorities for AN (adjusted odds ratio [AOR] = 1.93), BN (AOR = 3.69), and BED (AOR = 2.32), after adjusting for sociodemographic variables. Sexual minorities reporting experiences with perceived discrimination had significantly higher prevalence of AN than those not endorsing perceived discrimination: 3.78% (SE = 1.43) versus 0.82% (SE = 0.33); AOR = 5.06. There were no significant differences in prevalence of BN or BED by perceived discrimination. DISCUSSION Findings indicate that sexual minorities are disproportionately affected by EDs. Further research is needed to better understand mechanisms contributing to these disparities and heightened risk for EDs.
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Affiliation(s)
- Rebecca C Kamody
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University of Albany, State University of New York, Albany, New York
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Parker LL, Harriger JA. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. J Eat Disord 2020; 8:51. [PMID: 33088566 PMCID: PMC7566158 DOI: 10.1186/s40337-020-00327-y] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND According to past research, lesbian, gay, bisexual, and transgender (LGBT) individuals experience a higher prevalence of psychopathology, which is attributable to the increased stress (i.e., stigma and prejudice) that they experience, as detailed by the minority stress model (MSM). MAIN This current literature review examined the empirical literature regarding the rates and types of, and risk factors for eating disorders and disordered eating behaviors in LGBT adults and adolescents, in addition to each individual subgroup (i.e., lesbians, gay males, bisexuals, transgender and gender-nonconforming individuals). CONCLUSION LGBT adults and adolescents experience greater incidence of eating disorders and disordered eating behaviors than their heterosexual and cisgender counterparts. Additionally, gay, bisexual, and transgender adults and adolescents were all at increased risk for eating disorders and disordered eating behaviors. Mixed results were found for lesbian adults and adolescents. Results are discussed within the framework of the MSM.
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Affiliation(s)
- Lacie L Parker
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Suite 106, Loma Linda, CA 92350 USA
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Abstract
The concept of food addiction is currently a highly debated subject within both the general public and the scientific communities. The term food addiction suggests that individuals may experience addictive-like responses to food, similar to those seen with classic substances of abuse. An increasing number of studies have established the prevalence and correlates of food addiction. Moreover, food addiction may be associated with obesity and disordered eating. Thus, intervening on food addiction may be helpful in the prevention and therapy of obesity and eating disorders. However, controversy exists about if this phenomenon is best defined through paradigms reflective of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) substance-related disorders (e.g. food addiction) or non-substance-related disorders (e.g. eating addiction) criteria. This review paper will give a brief summarisation of the current state of research on food addiction, a more precise definition of its classification, its differentiation from eating addiction and an overview on potential overlaps with eating disorders. Based on this review, there is evidence that food addiction may represent a distinct phenomenon from established eating disorders such as bulimia nervosa or binge-eating disorder. Future studies are needed to further examine and establish orthogonal diagnostic criteria specific to food addiction. Such criteria must differentiate the patterns of eating and symptoms that may be similar to those of eating disorders to further characterise food addiction and develop therapy options. To date, it is too premature to draw conclusions about the clinical significance of the concept of food addiction.
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Chaney MP. LGBTQ+ Addiction Research: An Analysis of the
Journal of Addictions & Offender Counseling. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2019. [DOI: 10.1002/jaoc.12053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Penzenstadler L, Soares C, Karila L, Khazaal Y. Systematic Review of Food Addiction as Measured with the Yale Food Addiction Scale: Implications for the Food Addiction Construct. Curr Neuropharmacol 2019; 17:526-538. [PMID: 30406740 PMCID: PMC6712300 DOI: 10.2174/1570159x16666181108093520] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/03/2018] [Accepted: 10/30/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The concept of food addiction attracts much interest in the scientific community. Research is mainly based on the Yale Food Addiction Scale (YFAS), a tool developed to assess food addiction. Substance use disorder criteria have been used to develop this scale. OBJECTIVE The aim of this paper was to review the clinical significance of food addiction diagnoses made with the YFAS and to discuss the results in light of the current debate on behavioral addictions. METHODS We performed a systematic review of the studies that assessed food addiction with the YFAS published between January 2014 and July 2017 by searching the electronic databases PsycINFO, MEDLINE, and PsycARTICLES. RESULTS Sixty publications were included in the analysis. Thirty-three studies examined nonclinical samples and 27 examined clinical samples. All studies used YFAS scoring results to define food addiction. The prevalence of food addiction according to the YFAS varied largely by the studied samples. In general, a higher body mass index and the presence of eating disorders (EDs), especially binge eating disorder (BED), were associated with higher YFAS scores. CONCLUSION The concept of food addiction has not been established to this day although it can be grouped with other EDs such as BED. More research is needed to understand this behavior and the differences between food addiction and other EDs. The criteria for food addiction should be revisited in light of the concepts currently used to examine behavioral addictions.
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Affiliation(s)
- Louise Penzenstadler
- Address correspondence to this author at the Geneva University Hospitals, Rue de Grand-Pré, 70 C, 1202 Geneva, Switzerland; Tel: +41 22 372 57 50; Fax: +41 22 372 55 70; E-mail:
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Rainey JC, Furman CR, Gearhardt AN. Food addiction among sexual minorities. Appetite 2018; 120:16-22. [PMID: 28830721 DOI: 10.1016/j.appet.2017.08.019] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/20/2017] [Accepted: 08/19/2017] [Indexed: 12/01/2022]
Abstract
Although sexual minorities represent a small proportion of the general population, this group has been observed to be at an increased risk of developing various pathologies, including substance use and eating disorders. Research suggests that foods high in added fat and refined carbohydrates may trigger an addictive response, especially in at-risk individuals. Consequently, food addiction is associated with elevated risk for obesity, diet-related disease, and psychological distress. However, there is limited research on whether food addiction, like substance use, may be elevated among sexual minorities, and whether self-compassion may be a protective factor. Thus, the current study aims to test whether food addiction is elevated in sexual minorities (relative to heterosexuals) and if discrimination and self-compassion may be related to food addiction among sexual minorities. In a community sample of 356 participants (43.3% sexual minority), sexual minorities had almost twice the prevalence of food addiction (16.9%) as heterosexuals (8.9%). Also, sexual minorities on average experienced more food addiction symptoms (M = 2.73, SD = 1.76) than heterosexuals (M = 1.95, SD = 1.59). For sexual minorities, heterosexist harassment was associated with increased food addiction, while self-compassion appeared to be a protective factor. Further research needs to examine between-group differences among sexual minorities for better treatment and interventions for food addiction.
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Calzo JP, Blashill AJ, Brown TA, Argenal RL. Eating Disorders and Disordered Weight and Shape Control Behaviors in Sexual Minority Populations. Curr Psychiatry Rep 2017; 19:49. [PMID: 28660475 PMCID: PMC5555626 DOI: 10.1007/s11920-017-0801-y] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE OF REVIEW This review summarized trends and key findings from empirical studies conducted between 2011 and 2017 regarding eating disorders and disordered weight and shape control behaviors among lesbian, gay, bisexual, and other sexual minority (i.e., non-heterosexual) populations. RECENT FINDINGS Recent research has examined disparities through sociocultural and minority stress approaches. Sexual minorities continue to demonstrate higher rates of disordered eating; disparities are more pronounced among males. Emerging data indicates elevated risk for disordered eating pathology among sexual minorities who are transgender or ethnic minorities. Dissonance-based eating disorder prevention programs may hold promise for sexual minority males. Continued research must examine the intersections of sexual orientation, gender, and ethnic identities, given emergent data that eating disorder risk may be most prominent among specific subgroups. More research is needed within sexual minorities across the lifespan. There is still a lack of eating disorder treatment and prevention studies for sexual minorities.
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Affiliation(s)
- Jerel P Calzo
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182-4162, USA.
- Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, CA, USA.
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, CA, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Tiffany A Brown
- Eating Disorders Center for Treatment and Research, Department of Psychiatry, University of California, San Diego, CA, USA
| | - Russell L Argenal
- Graduate School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA, 92182-4162, USA
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