An evaluation of a body image intervention in adolescent girls delivered in single-sex versus co-educational classroom settings

The effect of an educational peer-based intervention program on sexual and reproductive health behavior

INTRODUCTION

The fact that adolescent people experience risky sexual behavior and have insufficient knowledge of sexual and reproductive health (SRH) indicates the need for SRH education. This study investigates the impact of peer-educated SRH programs on the knowledge and behaviors of adolescents.

METHOD

This study was conducted as a randomized controlled trial on 275 university students. The subjects were randomly assigned to the peer educators (n = 25), intervention (n = 125) and control (n = 125) groups using systematic random sampling. Peer educators provided face-to-face SRH education to the intervention group. The researcher provided the same education to the control group via the online conference method. SRH knowledge and behavior evaluated with scales before, after, and 3 and 6 months after the SRH education. The obtained data were analyzed using SPSS version 25 through statistical tests and analysis of covariance.

RESULTS

The female and male ratio of the participants was almost equal (49.4%, 50.6%). The mean age was found to be 20.42 ± 1.14 years. The mean scores of the students in the intervention group increased from 21.20 ± 0.14 to 35.20 ± 0.07 for sexual health knowledge questionnaire (SHKQ), and from 130.56 ± 0.55 to 147,90 ± 0,25 for reproductive health scale (RHS) after the education. Compared with the control group, these increases in the mean scores of SHKQ and RHS were found to be statistically significant.

CONCLUSION

The findings show the important role of the SRH peer education method on the effect of transferring knowledge about sexual behaviors. Health and education policy-makers are advised to implicate SRH peer education.

Enhancing understanding of social media literacy to better inform prevention of body image and eating disorders

Research has revealed an important role for appearance-focused, and in particular photo-based, social media in the development of body image and eating pathology. Social media literacy is a multifaceted construct involving purposeful selection and exposure to social media content and use of protective filtering (deliberately screening and interpreting information in a protective manner), as well as implementing critical skills related to understanding the unrealistic nature of social media content, limiting appearance comparisons with images, and contributing to social media (comments and images) in ways that limit the pursuit of appearance ideals. Previous work has provided partial support for these facets as related to lower levels of body image and eating concerns. However, additional conceptual and measurement work is needed to advance understanding of this protective role and how to foster social media literacy. Although data are scarce, targeting social media literacy in prevention and intervention programs may also be valuable. In this perspective piece, key features that we identify as priorities for future prevention and intervention efforts include developing interventions that target the implementation of social media skills beyond their acquisition. In addition, leveraging social media user generated content for prevention purposes would likely be useful, as would embedding micro-skill delivery within platforms.

Independent pragmatic replication of the Dove Confident Me body image program in an Australian Girls Independent Secondary School

Following calls for the independent replication of universal body image programs under diverse conditions, this research aimed to investigate whether the universal co-educational prevention program developed for audiences in the United Kingdom (Dove Confident Me, DCM), was an acceptable and effective intervention when delivered by teachers to adolescent girls attending a single-sex Australian school. Comprising two studies, Study 1, evaluated DCM among Grade 8 students (N = 198) at a single-sex private school, and compared the results with students (N = 208) s from a matched comparison group. No improvements were observed on outcome measures between the comparison and intervention girls over the three time points. Study 2 involved minor modifications to the aesthetics and content of the program, as well as the logistics of delivery. Delivered by teachers to Grade 8 students (N = 242 intervention and N = 354 comparison), there were significant improvements in acceptability of the modified DCM program, yet no interaction effects observed on outcome measures. While the program did no harm, it is possible that there are adjustments to the methods utilized and content of programs that are trialed in efforts to prevent body image concerns and eating disorders in the school setting.

Prevention and early intervention in eating disorders: findings from a rapid review

BACKGROUND

Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs.

METHODS

This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review.

RESULTS

In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist.

CONCLUSIONS

Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.

Prevention of eating disorders: 2022 in review

This review of 17 prevention-related publications in Eating Disorders during 2022 is framed by three models: (1) Mental Health Intervention Spectrum: health promotion ➔ types of prevention ➔ case identification/referral ➔ treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews ➔ clarifying risk and protective factors ➔ program innovation and feasibility studies ➔ efficacy and effectiveness research ➔ program dissemination; and (3) definitions of and links between disordered eating (DE) and eating disorders (EDs). Five articles fell into the category of prevention rationale, theory, and critical analyses, while seven articles addressed risk factors (RFs) for various aspects of DE. Eating Disorders also published two pilot studies, two prevention efficacy trials, and one effectiveness study in 2022. One implication of the 17 articles reviewed is that RF research toward construction of selective and indicated prevention programs for diverse at-risk groups should address a broad range of factors beyond negative body image and internalization of beauty ideals. Another implication is that, to expand and improve current and forthcoming prevention programs, and to shape effective advocacy for prevention-oriented social policy, the field in general and Eating Disorders in particular need more scholarship in the form of critical reviews and meta-analyses, protective factor research, and case studies of multi-step activism at the local, state (province, region), and national levels.

Negative comments and social media: How cognitive biases relate to body image concerns

Body image concern (BIC) is a prevalent issue thought to be exacerbated by social media. In addition to sociocultural factors, cognitive biases may also contribute to BIC. We explore whether cognitive biases in memory for body image-related words, presented in a mock social-media context, are associated with BIC in young adult women. A sample of 150 University students was presented with a series of body image-related comments aimed at either themselves, a close friend, or a celebrity in a recognisable social media context. Afterwards, a surprise memory task was completed that assessed the participant's memory for body image-related words (item memory), their insight (metamemory), and to whom a specific word was directed (source memory). Self-referential biases were identified for both item memory and source memory. Individuals with greater BIC displayed a greater self-referential bias for correctly and incorrectly sourcing negative words to themselves compared with both friend and celebrity. A greater self-referential effect in metacognitive sensitivity was also associated with higher BIC. We provide novel evidence for a cognitive bias in sourcing negative body image-related information to the self in individuals with higher BIC. The results should inform cognitive remediation programmes aimed at treating individuals with body and eating-related disorders.

Eating disorders prevention programs in Latin American countries: A systematic review

OBJECTIVE

This systematic review evaluates and summarizes existing eating disorder (ED) prevention programs in Latin American countries.

METHODS

A systematic literature search was conducted using the Cochrane Controlled Trial Register, PubMed, and Virtual Health Library databases up to and including July 31, 2022. All ED prevention studies published in English, Spanish or Portuguese were eligible, regardless of the study design, sample characteristics, and type of prevention programs. The Cochrane Collaboration Risk of Bias criteria were used to evaluate the quality of the included studies.

RESULTS

Twenty-two studies were included. Most were pilot studies that were nonrandomized, had a high risk of bias, were from Mexico and Brazil, and employed selective interventions. Dissonance-based programs and social cognitive theory were the commonly used approaches in interventions, and most of them were tested in adolescent girls and women. Short follow-ups were used, varying from 1 to 6 months. Many found significant decreases after the intervention and/or at follow-up in ED/disordered eating risk behaviors/symptoms, negative affect, body-ideal internalization, and body image disturbances.

CONCLUSIONS

This review highlights promising efforts to prevent EDs among Latin American countries. Some barriers in conducting research include funding restrictions, laws that do not allow remuneration or compensation for participants, and high costs of training. Nonetheless, the outcomes of the programs developed and evaluated so far are positive enough to merit further work on ED prevention. Efforts for future researchers should recruit samples with diverse characteristics, use robust designs and data analysis techniques, and expand the accessibility of prevention programs.

PUBLIC SIGNIFICANCE STATEMENT

The development of effective eating disorder (ED) prevention programs that can be broadly implemented is a public health priority. Nevertheless, there is limited evidence regarding the characteristics of ED prevention programs and their efficacy among Latin American countries. In the present study, we reviewed existing ED prevention programs adopted in Latin America, described their characteristics and outcomes, noted the limitations of available programs, and discussed the implications of these findings for efforts to prevent the development of EDs in Latin America. The outcomes of the programs developed and evaluated so far are positive enough to merit the development and rigorous evaluation of future programs and their broad dissemination in Latin American countries. PROSPERO registration number CRD42021275245.

Disparities in HIV Testing, Condom Use, and HIV Education Between Transgender and Not Transgender High School-Aged Youth: Findings From the 2019 Youth Risk Behavior Survey

Transgender individuals are disproportionately affected by HIV in the United States. Given increased risk of HIV among youth, there is a need to understand HIV risk and protective factors among transgender individuals who are 18 years and younger. Patterns of HIV testing, HIV education, and condom use have known associations with HIV outcomes among youth in general, but are understudied among transgender youth. This study assessed these outcomes by developing a series of sex-stratified multivariable logistic regression models using pooled Youth Risk Behavior Survey data. Results indicate female and male transgender youth as well as males who were not sure they were transgender were more likely have tested for HIV compared with their not transgender peers. Male transgender youth were significantly less likely to have received HIV education compared with not transgender males. Females not sure if they were transgender and male transgender youth were significantly less likely to have used condoms compared with, respectively, not transgender female and not transgender male counterparts. In sum, condom use and HIV education both remain lower among transgender individuals relative to their not-transgender peers. This highlights the need for the promotion of culturally appropriate HIV education and HIV prevention supports among transgender youth.

Sexualized Images on Social Media and Adolescent Girls' Mental Health: Qualitative Insights from Parents, School Support Service Staff and Youth Mental Health Service Providers

This research explored adults' perceptions of how sexualized images typically found on social media might influence adolescent girls' mental health, what support girls might need should they experience mental health difficulties, and how such difficulties could be prevented or reduced. Qualitative data were collected using semi-structured in-depth interviews with parents of adolescent girls (n = 11) and those who provide support to them: school support service staff (n = 7) and youth mental health service providers (n = 10) located in Perth, Western Australia. All three participant groups perceived sexualized images typically found on social media as exacerbating poor mental health among adolescent girls. Two interrelated themes, emerged with participants describing the 'potential for comparison' and 'pressure to conform' they believed girls encounter on social media that influences their mental health. Participants also explained how they perceived 'counteracting negative influences' related to sexualized images on social media could prevent or reduce the potential for mental health harms among girls, and the importance of adults and services 'keeping up to date' and being 'approachable and trustworthy' when describing the support they believed girls might need. The findings of this study have important implications for the development of health promotion programs focused on social media use and mental health among adolescent girls.

“Why don’t I look like her?” How adolescent girls view social media and its connection to body image

Background

Adolescent girls appear more vulnerable to experiencing mental health difficulties from social media use than boys. The presence of sexualized images online is thought to contribute, through increasing body dissatisfaction among adolescent girls. Sexual objectification through images may reinforce to adolescent girls that their value is based on their appearance. This study explored how sexualized images typically found on social media might influence adolescent girls’ mental health, in positive and/or negative ways.

Methods

In-depth interviews were conducted with girls aged 14–17 years (n = 24) in Perth, Western Australia. Data were analyzed using thematic analysis.

Results

Participants identified body image as a major concern, reporting negative appearance comparisons when viewing images on social media. Appearance comparisons were perceived to exacerbate adolescent girls’ appearance-based concerns. Comparisons also influenced adolescent girls’ efforts to change their appearance and seek validation on social media. The importance of awareness and education from a younger age about social media and its influence on body image was emphasized, as was the need for strategies to promote positive body image and counteract negative body image.

Conclusion

The findings of this study have important implications for professionals working with adolescent girls and for the development of health promotion programs addressing social media use and body image concerns.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01845-4.

Feasibility and acceptability of video-based microinterventions for eating disorder prevention among adolescents in secondary schools

OBJECTIVE

Eating disorders (EDs) often emerge in late adolescence. Schools are ideal settings for prevention programs; however, cost and time limit implementation. Microinterventions may overcome these challenges. This study adapted two microinterventions (cognitive dissonance, self-compassion) and assessed feasibility and acceptability among mid-adolescents to provide proof-of-concept for further investigation.

METHOD

Feedback from staff (n = 5) and student (n = 15) focus groups contributed iteratively to the adaptation of intervention materials. Students in Grade 10 and 11 (N = 101, M_age  = 15.80, SD = 0.68) were then randomly allocated by class to a 20-min video-based cognitive-dissonance or self-compassion intervention, accessed on their school devices. ED risk and protective factors were assessed at baseline, immediate postintervention (state outcomes), and 1-week follow-up (trait outcomes). Acceptability items were included at both timepoints.

RESULTS

Implementation was deemed feasible. Girls generally reported greater acceptability than boys. Among girls, the self-compassion intervention demonstrated greater acceptability. Among boys, some aspects of acceptability (e.g., lesson endorsement, utilization of techniques) were rated higher in the cognitive dissonance group whereas other aspects (e.g., understanding, interest) were greater in the self-compassion group. All groups exhibited favorable changes in most state outcomes, however trait outcome change was varied.

DISCUSSION

Microinterventions provide a feasible way of implementing prevention strategies in a time-poor educational context. Future large-scale evaluation is warranted to determine efficacy, following modifications based on current findings.

PUBLIC SIGNIFICANCE

This study shows promising feasibility and acceptability of two brief, self-guided video-based lessons (microinterventions) for adolescents in school classrooms, that use psychological techniques to target appearance pressures as a key risk factor for eating disorders. Such interventions are easier to implement in school settings than longer, facilitator-led interventions, to encourage greater uptake and ongoing use. Findings support further research to evaluate effectiveness, to ultimately provide accessible and gender-inclusive tools for busy schools.

The Effects of a Physical Activity, Nutrition, and Body Image Intervention on Girls in Intermediate Schools in Saudi Arabia

BACKGROUND

This cluster-randomized study aimed to evaluate the effects of an intervention focused on physical activity, nutrition, and body image perception among girls in intermediate schools in Saudi Arabia. A seminar was delivered to the mothers of the girls in the experimental group. The experimental group then attended six interactive sessions within 3 months featuring physical activity, nutrition, and body image perception, followed by a 3-month follow-up period. A total of 138 respondents (68 in the experimental group and 70 in the control group) completed the intervention. Each participant's body mass index-for-age z-score and waist circumference were measured, and they completed a physical activity, sedentary behavior, and body image perception questionnaires before and after the intervention and at the follow-up. The intervention was evaluated using within- and between-groups generalized estimating equations. There were no significant changes in the respondents' body mass index-for-age z-score or waist circumference (p > 0.05). However, immediate significant improvements were seen in physical activity, sedentary behavior, and body image satisfaction among the experimental group, and these improvements remained at follow-up (p < 0.001). These differences were more significant among the experimental group than among the control group. We found this intervention effective. Future studies can adapt this intervention for adolescent boys and extend its duration to improve the body mass index outcome.

Nurse Mentorship to Support Healthy Growth of Adolescent Girls

Adolescent girls from many urban communities are a vulnerable population, with high rates of school dropout, pregnancy, sexually transmitted infections, and substance use disorders. Mentorship programs can support the growth and development of this at-risk population. We report on the content of a pilot girls' empowerment program created by nurse faculty to promote health and self-awareness among underserved adolescent girls. Pre/post program scores of 15 participants using the Harter Self-Perception Profile for Adolescents found positive changes in seven of eight domains: scholastic (p = 0.001), social (p = 0.001), appearance (p = 0.001), job competence (p = 0.003), conduct (p = 0.02), close friendship (p = 0.006), and self-worth (p = 0.001). Nurse faculty and students might consider the development of similar mentorship programs for adolescent girls. [Journal of Psychosocial Nursing and Mental Health Services, 60(5), 15-18.].

Mediating Effects of Intimacy Between Body Talk and Girls' Body Dissatisfaction: The Forgotten Sibling Relationship

Teasing and pressure from family members influences the development of body dissatisfaction. Body dissatisfaction is a common experience for girls and can lead to eating disorders. However, most body image disturbance research to date neglects the possible influence of siblings. In light of this, the present study investigated the associations between sibling negative appearance-based talk, intimacy, and body dissatisfaction. The sample consisted of 113 mostly White, female adolescents, whose ages ranged from 12 to 19 years with a mean age of 14.85 (SD = 1.62). This study first examined direct associations between negative body talk, including appearance related teasing and pressure from siblings, and girls' body dissatisfaction. Second, indirect effects models with intimacy included were examined. There were significant direct links between appearance related pressure from siblings and body dissatisfaction, and significant indirect effects such that sibling teasing and pressure were associated with sibling intimacy, which was associated with body dissatisfaction. These results indicate that siblings play an important role in the development of girls' body dissatisfaction.

"My critical filter buffers your app filter": Social media literacy as a protective factor for body image

Exposure to idealized appearance images on social media is recognized as having a damaging effect on body image. Identifying and harnessing protective factors are, therefore, important research foci. Building on traditional media literacy concepts, one proposed protective factor is social media literacy, that is, the application of a critical analysis of motivations behind social media posts and the constructed, generally unrealistic nature of images, when viewing appearance-focused images on social media. This article describes theoretical models of social media literacy and current measurement approaches. In addition, it examines empirical support for a protective role for social media literacy, before considering directions for future research. It was concluded that, although there is still much that needs to be understood, there is modest preliminary support for a protective role for social media literacy, especially in girls and young women.

Can more people be "Happy Being Me"? Testing the delivery of a universal body satisfaction program by clinicians and school staff

The research presented here evaluates the delivery of Happy Being Me (HBM; Dunstan, Paxton & McLean, 2017) with boys and girls in their first year of secondary school in the UK (Year 7 and after comparisons aged 11-12). HBM is a manualised universal prevention programme which aims to improve body dissatisfaction and associated risk factors. Risk factors studied here were internalization of the thin ideal, physical appearance comparisons, appearance conversations. Secondary outcomes measured were self-esteem and eating disorder symptomsStudy 1 tested the effectiveness of HBM (n = 172) compared to a control group (n = 197) who received curriculum as usual. HBM resulted in significantly improved body satisfaction post-intervention which was maintained at follow up. There were no significant changes in risk factors.Study 2 compared clinician (n = 172) and teacher (n = 174) delivery. Students who received clinician-led, but not teacher-led, HBM had improved body satisfaction and this was maintained at follow up. Internalization of the thin ideal and self-esteem, improved in both clinician and teacher-led groups with small to medium sized effects. HBM can be delivered by clinicians independent of programme developers in a heterogeneous sample with positive effects on body satisfaction. Issues arising for wider delivery are discussed.

Effects of Media Health Literacy School-Based Interventions on Adolescents' Body Image Concerns, Eating Concerns, and Thin-Internalization Attitudes: A Systematic Review and Meta-Analysis

This systematic and meta-analytic review investigated the effects of media health literacy (MHL) interventions in school settings on adolescents' body image. Twenty one intervention-control comparisons reported in 16 studies were identified. The following attributes were extracted from each study for a systematic review: Study time-period and country location, sample composition, school atmosphere, unit of random assignment, theoretical perspective, intervention-control comparison, co-interventions, number of overall and MHL sessions, length of MHL sessions, and outcomes measured. The meta-analysis of effect sizes for three outcomes of interest related to body image showed consistent changes in the desired negative direction as expected: body image concerns (g = -0.25, k = 19); eating concerns (g = -0.18, k = 19); thin-internalization attitudes (g = -0.40, k = 12); and combined (g = -0.25, k = 21). Homogeneity analysis for the combined effect size and moderator analyses for gender composition of intervention group, number of overall intervention sessions, number of MHL specific intervention sessions within the overall intervention, and time length of MHL intervention session all showed absence of moderators. However, all study samples except one were of European origin and so caution should be exercised when generalizing to other cultures that may have different standards of female ideal body type.

School-Based Interventions Improve Body Image and Media Literacy in Youth: A Systematic Review and Meta-Analysis

Body ideals conveyed by the media and by body comparisons often result in body dissatisfaction, which can cause risky health behaviours and eating disorders, especially in adolescents. We conducted a meta-analytic review of existing school-based interventions designed to enhance media literacy in order to reduce body dissatisfaction and to promote a positive body image. We included controlled trials examining children and adolescents from grade five to nine (age 10-15 years) after a manual search and a comprehensive literature search using PsycINFO, Medline, Web of Science, and CENTRAL. We computed average weighted effect sizes (Hedges' g) with the help of a random effects model and identified seventeen different programme evaluations with 7392 participants. We found a significantly larger effect on positive body image and media literacy in the intervention compared to control groups. However, heterogeneity was substantial for both outcomes. Results suggest that media literacy interventions have the potential to improve media literacy and reduce body dissatisfaction. Interventions that worked with the principle of induction of cognitive dissonance were the most effective.

[The Effects of Programs on Body-Image Improvement in Adolescents: A Systematic Review and Meta-Analysis]

PURPOSE

This study's objective was to investigate the effects of programs that improve adolescents' body image, using a systematic review and meta-analysis.

METHODS

A literature search was performed in eleven electronic databases, using preferred reporting items for systematic reviews and meta-analysis guidelines. Population characteristics, contents of the programs, and measured outcomes were systematically reviewed from 21 selected studies. To estimate the size of the effects, meta-analysis was conducted using Comprehensive Meta-Analysis software.

RESULTS

The contents of the programs that aimed to improve body image included physical, psychological, interpersonal, and sociocultural interventions. Sixteen studies were meta-analyzed to estimate the effect size of body-image improvement programs. Results showed that the program for body-image improvement had significant effects on body satisfaction (effect size [ES] = 0.56, 95% confidence interval [CI] = 0.23 to 0.89), and body dissatisfaction (ES = - 0.15, 95% CI = - 0.23 to - 0.08).

CONCLUSION

The program for body image improvement in adolescents includes a combination of physical, psychological, interpersonal relationship, and socio-cultural dimensions. The program that seeks to improve body image appears to be effective at increasing body satisfaction, and at reducing body dissatisfaction in adolescents. Thus, it is necessary to develop and apply multidimensional programs for adolescents to have a positive body image.

Outcomes of a Cluster Randomized Controlled Trial of the SoMe Social Media Literacy Program for Improving Body Image-Related Outcomes in Adolescent Boys and Girls

Although the negative effect of social media use among youth on body image and eating concerns has been established, few classroom-based resources that can decrease these effects through targeting social media literacy skills have been developed. This study aimed to test the efficacy of SoMe, a social media literacy body image, dieting, and wellbeing program for adolescents, through a cluster randomized controlled trial. Participants (n = 892; M_age = 12.77, SD = 0.74; range 11–15; 49.5% male) were randomized by school (n = 8) to receive either weekly SoMe (n = 483) or control sessions (lessons as usual; n = 409) over 4 weeks in their classroom. Participants completed surveys at four timepoints (baseline, 1-week post-intervention, and 6- and 12-month follow-up) assessing body dissatisfaction, dietary restraint, strategies to increase muscles (primary outcomes), self-esteem and depressive symptoms (secondary outcomes), and internalization of appearance ideals and appearance comparison (exploratory outcomes). Modest positive intervention effects were found in dietary restraint and depressive symptoms at 6-month follow-up in girls but few positive effects emerged for boys. The findings provide only preliminary support for a social media literacy intervention, but suggest the usefulness of both identifying those who benefit most from a universally delivered intervention and the need to refine the intervention to maximize intervention effects.

Investigating the Linkages between BMI, Body Image, and SATAQ among Young Asian Females

Sociocultural attitudes toward appearance and its linkage to body mass index (BMI) and body image is a relationship worth studying, especially in Asia, where the idealization of thinness can be prominent. The Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ) developed by Heinberg et al. in 1995 was used in this study to examine whether these beliefs have been internalized. Furthermore, the Body Esteem Scale (BES) was used to quantify body image. The formal in-person survey was administered in Taipei, Taiwan. There were 301 valid samples out of 330 surveyed respondents. To enhance the representativeness of the samples, a stratified sampling technique was applied to generate survey data with valid samples following gender and age distributions of the population between the ages of 14 and 28. The internalization dimension represented how strongly the respondents considered the importance of the socially accepted concept of appearance based on personal perceived social norms. The other dimension, awareness, represented the sociocultural pressures from the outside world, such as from the image of slimness illustrated in the media or group, in comparison to personal beliefs. Our results demonstrated that respondents with above-normal BMIs internalized the socially preferred standards of thinness more than respondents with normal or under-normal BMIs. Furthermore, results also revealed, overall, a negative relationship between SATAQ and body image and between body image and BMI. The study highlights the need to emphasize “fitness over thinness” to help improve negative body image among young Asian females.

Body talk in the digital age: A controlled evaluation of a classroom-based intervention to reduce appearance commentary and improve body image

This research evaluates the efficacy of a classroom-based intervention - Body Talk in the Digital Age (BTIDA) - in reducing adolescents' appearance commentary and improving body image. British adolescents (N = 314; Age Range = 12-14) were cluster randomised to intervention or waiting-list control groups. Measures of appearance commentary, appearance ideal internalisation, self-objectification and body satisfaction were completed at baseline (T1), then one-week (T2) and eight-week (T3) post-intervention. Multi-level modelling showed girls who received BTIDA reported less appearance commentary engagement and thin ideal internalisation at T2 and T3, than the control, supporting the partial efficacy of BTIDA for girls. No intervention effects were found among boys.

Evaluating the "Dove Confident Me" Five-Session Body Image Intervention Delivered by Teachers in Schools: A Cluster Randomized Controlled Effectiveness Trial

PURPOSE

Body dissatisfaction is common during adolescence and predicts poor psychological and physical health. Interventions have traditionally overrelied on delivery by external providers (e.g., researchers and psychologists), preventing scalability. This study evaluated the acceptability and effectiveness of a school-based body image intervention delivered by schoolteachers.

METHODS

Six British schools participated in a pragmatic cluster randomized controlled trial. Girls and boys aged 11-13 years received the five-session intervention delivered by their teachers (n = 848) or lessons-as-usual control (n = 647) and were assessed at baseline, postintervention, and 2-, 6-, 12-, 24- and 36-month follow-up. The primary outcome was body image (body esteem), secondary outcomes included risk factors for body image (internalization of appearance ideals, sociocultural pressures, social comparisons, appearance-related teasing, and conversations), and tertiary outcomes included psychosocial well-being (negative affect, self-esteem, dietary restraint, and life engagement).

RESULTS

Compared with the control group, intervention students demonstrated improvements in the primary outcome of body esteem at postintervention (Cohen's d = .15), 2-month (d = .26), and 6-month follow-up (d = .15). For girls, there was also a significant reduction in experienced appearance-related teasing at 6-month (d = .24) and 12-month (d = .30) follow-up. No other significant intervention effects were observed. The intervention was acceptable to students.

CONCLUSIONS

These findings present the longest sustained improvements in a cognitive-affective body image outcome observed among girls and boys during a teacher-led universal body image program to date. Intervention refinement and improved teacher training may further improve outcomes. Task-shifting intervention delivery to community providers to scale up interventions is a promising strategy.

Three Decades of Research: The Case for Comprehensive Sex Education

PURPOSE

School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive sex education.

METHODS

Researchers searched the ERIC, PsycINFO, and MEDLINE. The research team identified papers meeting the systematic literature review criteria. Of 8,058 relevant articles, 218 met specific review criteria. More than 80% focused solely on pregnancy and disease prevention and were excluded, leaving 39. In the next phase, researchers expanded criteria to studies outside the U.S. to identify evidence reflecting the full range of topic areas. Eighty articles constituted the final review.

RESULTS

Outcomes include appreciation of sexual diversity, dating and intimate partner violence prevention, development of healthy relationships, prevention of child sex abuse, improved social/emotional learning, and increased media literacy. Substantial evidence supports sex education beginning in elementary school, that is scaffolded and of longer duration, as well as LGBTQ-inclusive education across the school curriculum and a social justice approach to healthy sexuality.

CONCLUSIONS

Review of the literature of the past three decades provides strong support for comprehensive sex education across a range of topics and grade levels. Results provide evidence for the effectiveness of approaches that address a broad definition of sexual health and take positive, affirming, inclusive approaches to human sexuality. Findings strengthen justification for the widespread adoption of the National Sex Education Standards.

Emotional Eating in Adolescence: Effects of Emotion Regulation, Weight Status and Negative Body Image

Emotional eating is associated with an increased risk of binge eating, eating in the absence of hunger and obesity risk. While previous studies with children and adolescents suggest that emotion regulation may be a key predictor of this dysregulated eating behavior, little is known about what other factors may be influencing the link between emotional regulation and emotional eating in adolescence. This multi-method longitudinal study (n = 138) utilized linear regression models to examine associations between childhood emotion regulation, adolescent weight status and negative body image, and emotional eating at age 17. Emotion regulation predicted adolescent emotional eating and this link was moderated by weight status (β = 1.19, p < 0.01) and negative body image (β = -0.34, p < 0.01). Higher engagement in emotional eating was predicted by lower emotional regulation scores among normal-weight teens (β = -0.46, p < 0.001) but not among overweight/obese teens (β = 0.32, p > 0.10). Higher scores on emotion regulation were significantly associated with lower emotional eating at high (β = -1.59, p < 0.001) and low (β = -1.00, p < 0.01) levels of negative body image. Engagement in emotional eating was predicted by higher negative body image among overweight/obese teens only (β = 0.70, p < 0.001). Our findings show that while better childhood emotion regulation skills are associated with lower emotional eating, weight status and negative body image influence this link and should be considered as important foci in future interventions that aim to reduce emotional eating in adolescence.

A cluster randomized controlled trial of the SoMe social media literacy body image and wellbeing program for adolescent boys and girls: Study protocol

Youth spend substantial time on social media, which can foster self-critical processes that increase risk of body dissatisfaction, disordered eating, and depressed mood. To date, there have been few investigations of interventions to decrease the negative impacts of social media engagement in adolescent boys and girls. This paper outlines the protocol for a cluster randomized controlled trial (RCT) of a four-lesson social media literacy program that was developed based on pilot results and aims to decrease body dissatisfaction, dietary restraint, and strategies to increase muscles. The RCT will be conducted with grades 7-8 students from Australian secondary schools. Using block randomization, grade levels within schools will be assigned to either the SoMe program (intervention) or health lessons as usual (control). Primary outcomes will be body satisfaction, dietary restraint, and strategies to increase muscles. Secondary outcomes will be self-esteem and depressed mood. Participants will complete assessments on four occasions - baseline, five-weeks post-baseline, and six- and 12-month post-baseline. Analyses will compare outcomes in the intervention compared to the control group. This study will be the first to implement a RCT design to evaluate the impact of a school-based social media literacy program designed to mitigate negative impacts of social media.

Research Review: Effectiveness of universal eating disorder prevention interventions in improving body image among children: a systematic review and meta-analysis

BACKGROUND

Increasingly, children are at risk of developing eating disorders. A systematic review and a meta-analysis were conducted to examine the effectiveness of universal eating disorder prevention interventions in improving body image, internalization of appearance ideals, and self-esteem among children aged 5-17 years old.

METHODS

Nine electronic databases were systematically searched from each database's point of inception to March 2019. The Cochrane Risk of Bias tool assessed each study's risk of bias, while the GRADE approach judged the overall evidence for each review outcome. A meta-analysis was conducted using the random-effect model to obtain standardized mean differences with 95% confidence intervals under the inverse variance method. Heterogeneity was assessed using I² statistic and Cochran's Q chi-squared test. Publication bias was assessed using funnel plots.

RESULTS

A total of 24 studies (22 trials) were included in this review. Universal interventions were found to be effective in improving children's body esteem, self-esteem, and internalization of appearance ideals at postintervention and at follow-up timepoints. Subgroup analyses found that girls benefited more from these interventions than boys. Multisessional interventions with an optimal duration of approximately one month were found to be more effective.

CONCLUSIONS

The findings encourage the incorporation of universal preventive interventions into school curricula to benefit most children. Laypeople such as teachers can deliver these interventions, but content experts should address topics on body dissatisfaction. Due to the low quality of evidence, as accorded by the GRADE approach, current findings should be validated by future research.

Cognitive-behavioral roots of body image therapy and prevention

The existing array of evidence-based body image prevention and intervention approaches has evolved over time. However, the majority originated directly or indirectly from a cognitive-behavioral conceptualisation of body image pioneered by Thomas F. Cash. In this way, it is difficult to overstate the impact Tom Cash has had on body image intervention research and practice. His ground-breaking work, building on the work of Schilder and Fisher, was the first to provide a comprehensive model of body image that reflected the broad range of influences and consequences of body image. His differentiation of the components of body image as a construct and between body image traits and states allowed us to identify and influence targets for intervention. Moreover, the intervention strategies that Tom Cash employed are still used today and laid the foundations for contemporary intervention programs. There is a gap of more than 15 years between the first and last of us receiving our PhDs, yet Cash's work has been an important influence on us all. We are extremely grateful for the theoretical and practical tools that he has given to our field. In this paper, we will outline how Cash's work has informed contemporary body image intervention and prevention. We will describe Cash's theory and intervention tools before discussing how this work paved the way for subsequent research and practice.

Body Image in the Context of Eating Disorders

Body dissatisfaction is a risk factor for development of eating disorders and represents a core psychopathologic feature of eating disorders. Prevention and treatment interventions address established risk and maintaining factors for body dissatisfaction: appearance pressures, internalization of appearance ideals, upward appearance comparison, avoidance and checking, and body disparagement. It is essential to address body dissatisfaction within eating disorders treatment to improve outcomes and reduce risk of relapse. Future directions in research and treatment aim to reach populations increasingly recognized as in need, including children, men, and individuals at higher weights, with the ultimate goal of reducing the significant distress associated with body dissatisfaction.

Girls-only vs. mixed-gender groups in the delivery of a universal wellness programme among adolescents: A cluster-randomized controlled trial

BACKGROUND

Investigation of the optimal setting for body image prevention programmes is important to maximize the outcomes of such programmes.

OBJECTIVES

We examined the preferred setting for a school-based wellness programme called "In Favour of Myself".

METHODS

A total of 259 girls (mean 13.82±0.64 years) were divided into a girls-only intervention group, a mixed-gender intervention and a waiting list control group. The participants completed self-report questionnaires at baseline, post-intervention (2 months) and at follow-up (3 months) examining changes in self-esteem, media literacy, body image and risk factors for eating disorders. The intervention group participants also completed a satisfaction questionnaire.

RESULTS

Both intervention groups demonstrated statistically significant improvements in identifying advertising strategies (p<0.01) compared with the controls, with the girls-only arm (p<0.001) showing better results. Compared with the girls-only arm and the control group, the mixed-gender group demonstrated statistically significantly greater improvements in the internalization of pressure for thinness (p<0.004), the body-esteem appearance subscale (p<0.025) and body-esteem body-weight subscale (p<0.012) as well as reductions in their perceived current body silhouettes and in the gap between their current and ideal body image (p<0.003). Body dissatisfaction was increased following the programme, although not in a statistically significant manner, with the worst negative effect observed in the girls-only arm. All other differences among the study arms did not show statistically significant differences. Mediation models revealed that body-esteem was directly mediated by group, with statistically significant mediation only in the mixed group. Current body image was mediated indirectly by group through media literacy (i.e., recognizing advertisement strategies and internalization of pressure for thinness), with statistical significance only in the mixed-gender arm compared with the girls-only arm. Higher programme satisfaction was reported in the mixed-gender group (91%) vs. the girls-only groups (79%).

CONCLUSIONS

These outcomes provide preliminary evidence indicating the superiority of a mixed-gender setting compared with a girls-only setting for delivering prevention programmes to 13- to 14-year-old adolescents to enhance their media literacy, positive self-esteem and body image.

TRIAL REGISTRATION

NCT02653586.

Obesity and eating disorders in integrative prevention programmes for adolescents: protocol for a systematic review and meta-analysis

INTRODUCTION

Obesity and eating disorders are public health problems that have lifelong financial and personal costs and common risk factors, for example, body dissatisfaction, weight teasing and disordered eating. Obesity prevention interventions might lead to the development of an eating disorder since focusing on weight may contribute to excessive concern with diet and weight. Therefore, the proposed research will assess whether integrating obesity and eating disorder prevention procedures ('integrated approach') do better than single approach interventions in preventing obesity among adolescents, and if integrated approaches influence weight-related outcomes.

METHODS AND ANALYSIS

Integrated obesity and eating disorder prevention interventions will be identified. Randomised controlled trials and quasi-experimental trials reporting data on adolescents ranging from 10 to 19 years of age from both sexes will be included. Outcomes of interest include body composition, unhealthy weight control behaviours and body satisfaction measurements. MEDLINE/PubMed, PsycINFO, Web of Science and SciELO will be searched. Data will be extracted independently by two reviewers using a standardised data extraction form. Trial quality will be assessed using the Cochrane Collaboration criteria. The effects of integrated versus single approach intervention studies will be compared using systematic review procedures. If an adequate number of studies report data on integrated interventions among similar populations (k>5), a meta-analysis with random effects will be conducted. Sensitivity analyses and meta-regression will be performed only if between-study heterogeneity is high (I² ≥75%).

ETHICS AND DISSEMINATION

Ethics approval will not be required as this is a systematic review of published studies. The findings will be disseminated through conference presentations and peer-reviewed journals.

Efficacy of a prevention program for eating disorders in schools: a cluster-randomized controlled trial

BACKGROUND

Previous prevention programs in the school context have not addressed both genders, have been time-consuming, or have had deficits in the evaluation method. The aim of the present study was to evaluate the impact of a universal prevention program for female and male adolescents on eating disorder pathology and related risk factors.

METHODS

Between February 2012 and July 2014, 2515 students in 23 schools from 8th or 11th grade were assessed for eligibility in this longitudinal cluster-randomized controlled trial with a six months follow-up. Of those students, 2342 were cluster-randomized to the intervention condition which received a six school hours universal prevention program or to the no treatment control condition.

RESULTS

The complete case population comprised 724 students in the intervention (54.3% female, M = 14.3 years, SD = 1.61) and 728 in the control condition (57.0% female, M = 14.7 years, SD = 1.63). Random-effects analysis of covariance on the primary outcome showed no significant differences between the intervention and control groups in their eating disorder pathology change scores six months after the intervention. Regarding secondary outcomes, participants in the intervention group showed a greater increase in knowledge about eating disorders both after the intervention (p < .001, ES = 1.06) and six months later (p = .01, ES = 0.40). Greater reductions in anxiety severity were observed in the intervention group post-intervention (p = .02, ES = 0.22) which was not maintained at the six months follow-up. Results differed between participants from grade 8 and 11.

CONCLUSION

The present universal prevention program can be particularly recommended for adolescents from grade 11.

TRIAL REGISTRATION

ISRCTN 97989348.

Dismantling prevention: Comparison of outcomes following media literacy and appearance comparison modules in a randomised controlled trial

A dismantling study of body dissatisfaction prevention was conducted. Adolescent girls ( N = 260) were randomly allocated to a media literacy (Happy Being Me – Media Literacy) or appearance comparison (Happy Being Me – Appearance Comparison) intervention or healthy eating behaviour control (Happy Being Me – Healthy Eating Behaviour) condition. In the Happy Being Me – Appearance Comparison condition, improvements from baseline to post-programme and follow-up for upward appearance comparison and fear of negative appearance evaluation were observed. In the Happy Being Me – Media Literacy condition, improvements were observed from baseline to post-programme for upward appearance comparison and realism scepticism. Findings were similar in a high-risk subsample and overall are moderately supportive of appearance comparison-based interventions, but less supportive of a stand-alone media literacy intervention.