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Jiménez-Morcillo J, Ramos-Campo DJ, Rodríguez-Besteiro S, Clemente-Suárez VJ. The Association of Body Image Perceptions with Behavioral and Health Outcomes among Young Adults. Nutrients 2024; 16:1281. [PMID: 38732530 PMCID: PMC11085562 DOI: 10.3390/nu16091281] [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] [Received: 03/21/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
This study was conducted on 5 March 2024, by the Universidad Europea de Madrid. This study aims to explore how body image perceptions influence health behaviors and mental and physical health outcomes among a specific group of 605 young adults aged 20 to 35 engaged in strength training regimes. To measure these perceptions, the Multidimensional Body-Self Relations Questionnaire (MBSRQ) was employed, an advanced tool that assesses multiple dimensions of body image through its subscales, including feelings of physical attractiveness, investment in one's appearance, and satisfaction with different body areas. Participants were segmented into two groups based on a median split of their self-reported body image. The survey assessed a diverse array of variables, including demographic details, physiological data, resistance training routines, and psychological attributes. In this revision, we consistently use the term 'dietary habits' to ensure clear and uniform language when discussing eating patterns. Notable differences were observed in dietary habits and exercise engagement, influenced significantly by body image perceptions. Negative body image was linked to less healthy dietary habits, diminished physical activity, and worse psychological outcomes, such as increased anxiety and depression. Conversely, a positive body image was associated with healthier dietary habits, more frequent physical activity, and better psychological health. The findings suggest that interventions aimed at improving body image could be crucial for enhancing overall health within this specific demographic. Due to the non-representative nature of the study group, conclusions are cautiously presented as applicable only to similar populations engaged in strength training. This study underscores the need for holistic strategies that encourage positive body image to improve both physical and psychological health outcomes in young adults.
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Affiliation(s)
- Jorge Jiménez-Morcillo
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (J.J.-M.); (S.R.-B.); (V.J.C.-S.)
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain
| | - Stephanie Rodríguez-Besteiro
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (J.J.-M.); (S.R.-B.); (V.J.C.-S.)
| | - Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Tajo Street, s/n, 28670 Madrid, Spain; (J.J.-M.); (S.R.-B.); (V.J.C.-S.)
- Grupo de Investigación en Cultura, Educación y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia
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Mueller VM, Forrer F, Meyer AH, Munsch S. Psychological correlates of body dissatisfaction in Swiss youth over a one-year study-period. Front Psychol 2024; 14:1269364. [PMID: 38259526 PMCID: PMC10802120 DOI: 10.3389/fpsyg.2023.1269364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction It is well known that young individuals often report pronounced negative perceptions and attitudes towards their own body or intense fear of being not muscular enough. There is much less data available, however, on the role of psychological mechanisms on these perceptions and attitudes, such as emotion regulation difficulties, correlates of alexithymia, and appearance-related rejection sensitivity. Methods We therefore set out to assess associations between these psychological mechanisms, and body image as well as muscle dysmorphic symptoms. Our sample was recruited as part of a larger-scale study aiming at assessing correlates of mental health (with a focus on eating disorder symptoms) in German speaking Switzerland. The first wave (T1), starting in April 2021, included 605 participants (80% female, 19.6 ± 2.5 years) who completed the online-questionnaire and were reassessed in a second wave (T2), one year later. Results Results indicated that at both waves, emotion regulation difficulties [DERS-SF] and appearance-based rejection sensitivity [ARS-D] were both positively cross-sectionally associated with body dissatisfaction [BSQ-8C] and muscle dysmorphic symptoms [MDDI] at the first assessment time-point and one year later at follow-up assessment. Moreover, alexithymia [TAS-20] was positively cross-sectionally associated with muscle dysmorphic symptoms at both waves. We further observed high absolute and relative level stabilities for all variables involved across the one-year study period. Discussion/Conclusion Even though the effects for some associations were rather small, our findings underline the relevance of such mechanisms in the development of body dissatisfaction and to a lesser extent of muscle dysmorphia symptoms over the period of one year. Additional research is necessary to replicate these findings in other youth samples.
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Affiliation(s)
- Verena M. Mueller
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Felicitas Forrer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Andrea H. Meyer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
- Department of Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
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Baker S, Maïano C, Houle SA, Nadon L, Aimé A, Morin AJS. Profiles of body image concerns and their associations with disordered eating behaviors. Appetite 2023; 191:107082. [PMID: 37832721 DOI: 10.1016/j.appet.2023.107082] [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] [Received: 05/30/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
Although body image concerns (BIC) are recognized as a core driver in the development of disordered eating behaviors, the combined role of various types of BIC remains underexamined. This study relied on latent profile analysis to identify the main configurations of self-reported BIC (i.e., body checking and avoidance, perceived physical appearance, and fear of negative appearance evaluation) observed in a sample of 419 French-Canadian individuals (Mage = 26.59, SDage = 9.23). The role of body mass index, sex, and age on profile membership was also examined, as well as the relation between profile membership and disordered eating behaviors (i.e., dieting, bulimia and food preoccupation, and oral control). Six distinct BIC profiles differing in terms of shape and level were identified, with women being more likely to display a profile characterized by higher levels of BIC. In turn, profiles characterized by higher levels of BIC were associated with more disordered eating behaviors. The present study can broaden our understanding of the onset and maintenance of disordered eating behaviors and inspire the development of more tailored body-image interventions.
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Affiliation(s)
- Sarah Baker
- Substantive-Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, Canada
| | - Christophe Maïano
- Cyberpsychology Laboratory, Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO|Campus de Saint-Jérôme), Saint-Jérôme, Canada.
| | - Simon A Houle
- Substantive-Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, Canada
| | - Lindsey Nadon
- Substantive-Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, Canada
| | - Annie Aimé
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais (UQO|Campus de Saint-Jérôme), Saint-Jérôme, Canada
| | - Alexandre J S Morin
- Substantive-Methodological Synergy Research Laboratory, Department of Psychology, Concordia University, Montreal, Canada
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Raspovic A, Prichard I, Salim A, Yager Z, Hart L. Body image profiles combining body shame, body appreciation and body mass index differentiate dietary restraint and exercise amount in women. Body Image 2023; 46:117-122. [PMID: 37290141 DOI: 10.1016/j.bodyim.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/10/2023]
Abstract
This project aimed to establish whether meaningful body image profiles (BIPs) could be identified across measures of body shame, body appreciation, and body mass index (BMI), and whether these profiles could differentiate key health behaviours. Data came from 1200 adult women who responded to an online body image survey. Latent profile analysis was used to identify BIPs based on relative levels of body shame, body appreciation and BMI. Differences in dietary restraint and weekly exercise amount were investigated according to BIP membership. Latent profile analysis revealed four unique BIPs; 1. Appreciative BIP (AP-BIP); 2. Medium Shame BIP (MS-BIP); 3. High Shame BIP (HS-BIP) and 4. Average BIP (AV-BIP). Dietary restraint and exercise amount differed significantly according to BIP in most comparisons. Women in the High Shame BIP exhibited the highest dietary restraint and lowest exercise. Women in the Appreciative BIP exhibited the lowest dietary restraint and highest exercise. Body shame and body appreciation intersect with BMI to form unique profiles (BIPs) that differentiate dietary restraint and exercise. Using BIPs to tailor interventions designed to promote healthful diet and exercise should be considered in public health initiatives.
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Affiliation(s)
- Anita Raspovic
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia.
| | - Ivanka Prichard
- Health & Exercise Science, College of Nursing & Health Sciences, Flinders University, Adelaide 5001, Australia; SHAPE Research Centre, Flinders University, Adelaide 5001, Australia; Caring Futures Institute, Flinders University, Adelaide 5001, Australia
| | - Agus Salim
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia
| | - Zali Yager
- Institute for Health and Sport, Victoria University, Melbourne 3001, Australia
| | - Laura Hart
- School of Psychology and Public Health, La Trobe University, Melbourne 3086, Australia; Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia
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Kwon M, Li M, Chang OD. Examining the Role of Body Image Instability in Young Adult Women: Conceptualization, Development, and Psychometric Evaluation of the Vacillating Body Image Scale (VBIS). J Pers Assess 2023; 105:266-282. [PMID: 35377772 DOI: 10.1080/00223891.2022.2051532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The current study conceptualized body image instability as a maladaptive tendency to vacillate between different self-perceptions of one's overall body image and developed a corresponding measure to assess body image instability. Results from a series of studies of young adult women demonstrated the validity, reliability, and utility of the Vacillating Body Image Scale (VBIS) as a meaningful measure of body image instability. In Study 1, we found that body image instability, as assessed by the VBIS, represents a unidimensional and reliable construct. In Study 2, we found evidence for both the convergent and discriminant validity of the VBIS in relation to other individual differences measures (i.e., self-concept schema, broad personality factors). In Study 3, the concurrent criterion validity of the VBIS was supported for young adult women in relation to a range of adjustment measures. Finally, in Study 4, we found consistent evidence for the incremental validity of the VBIS in predicting subsequent variations in eating disturbances, even after controlling for global self-esteem and self-concept instability. Overall, our findings offer promising support for our contention that body image instability, as measured by the VBIS, represents an important construct for understanding eating-related disturbances and other health outcomes in young adult women.
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Affiliation(s)
- Misu Kwon
- Department of Psychology, Yonsei University, Seodaemun-gu, Korea (the Republic of)
| | - Mingqi Li
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| | - Olivia D Chang
- Department of Psychology, University of Michigan, Ann Arbor, USA
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Associations between body image patterns and body image-related pathology in sexual minority individuals: A mixture-modeling approach. Body Image 2023; 45:73-85. [PMID: 36842423 DOI: 10.1016/j.bodyim.2023.02.003] [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: 04/03/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 02/27/2023]
Abstract
Body image concerns are associated with disordered eating, body dysmorphic disorder (BDD), and illicit appearance and performance enhancing drug (APED) misuse. Sexual minority individuals are a vulnerable population for body image concerns. Latent profile analyses were used to identify body image patterns in sexual minority men (n = 479) and women (n = 483) and to investigate associations between latent profiles and body image-related pathology. A 5-profile solution demonstrated best fit for men and a 4-profile solution for women. Among women, co-occurring high thinness/muscularity concerns had higher probability of vomiting and dietary restriction than the high thinness/low muscularity concerns profile. The probability of driven exercise did not differ across latent profiles for men and only differed between low thinness/low muscularity and high thinness/high muscularity concerns profiles in women. Men with low thinness/high muscularity concerns had significantly lower probability of vomiting and laxative misuse than all other profiles but did not significantly differ from co-occurring high or moderate thinness/muscularity concerns profiles in binge eating and illicit APED misuse. This study may have implications for future research, treatment, and prevention of body image-related pathology in sexual minority individuals.
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Body image and eating behaviors: A latent profile analysis. Body Image 2022; 41:396-405. [PMID: 35533520 DOI: 10.1016/j.bodyim.2022.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/21/2022]
Abstract
Body image is multidimensional and less is known about how the combination of positive and negative body image relates to eating behaviors. We used a person-centered approach to identify profiles of body image and explore the relationship between profile membership, sex, age, race, and current marital status, and eating behaviors in a community sample of adults. We recruited 288 adults 18 and older living in the United States using Prolific Academic. Participants completed an online survey assessing body appreciation, functionality appreciation, body dissatisfaction, weight bias internalization, and adaptive and maladaptive eating behaviors. We used latent profile analysis to identify four distinct body image profiles: appreciation & mild dissatisfaction, functional appreciation & moderate dissatisfaction, strong dissatisfaction, and strong appreciation. Profile membership differed by sex with more women and younger adults in profiles higher in negative body image. The relationships between profiles and eating behaviors differed; the three profiles including negative body image had the lowest adaptive and highest maladaptive eating behaviors. The identification of clinically relevant profiles: (1) confirm positive and negative body image coexist, (2) identify high- and low-risk profiles of body image and eating behavior, and (3) offer preliminary suggestions for screening and tailoring preventive interventions.
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Riboli G, Borlimi R, Caselli G. A qualitative approach – delineates changes on pubertal body image after menarche. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2022. [DOI: 10.1080/02673843.2022.2032219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Greta Riboli
- Department of Psychology, Sigmund Freud University, Wien, Austria
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Rosita Borlimi
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Gabriele Caselli
- Department of Psychology, Sigmund Freud University, Milan, Italy
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9
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Ornelas M, Rodríguez-Villalobos JM, Viciana J, Guedea JC, Blanco JR, Mayorga-Vega D. Composition Factor Analysis and Factor Invariance of the Physical Appearance State and Trait Anxiety Scale (PASTAS) in Sports and Non-Sports Practitioner Mexican Adolescents. JOURNAL OF SPORTS SCIENCE AND MEDICINE 2021; 20:525-534. [PMID: 34267593 DOI: 10.52082/jssm.2021.525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/03/2021] [Indexed: 11/24/2022]
Abstract
The purpose of the present study was to adapt and validate the Physical Appearance State and Trait Anxiety Scale (PASTAS) for Mexican adolescents, verifying the factor invariance by sports and non-sports practitioners. A sample of 930 Mexican adolescents (46.0% females), aged 11-15 years old, voluntarily participated in the study. A total of 415 participants regularly played sports in a club and/or regularly participated in sports competitions and 515 were non-sports practitioners. The adolescents filled out the trait version of the PASTAS questionnaire, which was previously translated and adapted for Mexican-speaking adolescents following the International Test Commission guidelines. The results of the confirmatory factor analyses showed an adequate measurement model for the original two-factor structure (e.g., GFI = 0.913; RMSEA = 0.078; CFI = 0.943). The internal consistency of the two dimensions was excellent (α and Ω = 0.92-0.93). Additionally, the results of the factorial invariance analyses showed an appropriate fit of the two-structure model (e.g., GFI = 0.96; CFI = 0.98; RMSEA = 0.04) among both sports and non-sports practitioners. The proposed trait version of the PASTAS questionnaire adapted to a Mexican-speaking population shows adequate psychometric properties among Mexican adolescents. The Mexican version of the PASTAS questionnaire supports the original two-factor structure (i.e., factor related to the body weight and factor not related to body weight) among adolescents. Additionally, the factorial invariance analyses support the equivalence of the two-factor structure among both sports and non-sports practitioners.
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Affiliation(s)
- Martha Ornelas
- Faculty of Physical Culture Sciences, Autonomous University of Chihuahua, Mexica
| | | | - Jesús Viciana
- Department of Physical Education and Sport, University of Granada, Spain
| | - Julio César Guedea
- Faculty of Physical Culture Sciences, Autonomous University of Chihuahua, Mexica
| | - José René Blanco
- Faculty of Physical Culture Sciences, Autonomous University of Chihuahua, Mexica
| | - Daniel Mayorga-Vega
- Department of Didactic of Musical, Plastic and Corporal Expression, University of Jaen, Spain
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Ruiz MJ, Sáez G, Villanueva-Moya L, Expósito F. Adolescent Sexting: The Role of Body Shame, Social Physique Anxiety, and Social Networking Site Addiction. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2021; 24:799-805. [PMID: 34191601 DOI: 10.1089/cyber.2020.0719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The aim of this study was to analyze the relationship between body shame and participation in sexting among adolescents by examining the mediational roles of social physique anxiety and misuse of social networking sites (SNSs). Four hundred thirty-nine adolescents completed self-report measures for assessing their levels of body shame, social physique anxiety, SNS addiction symptoms, and sexting participation. Female adolescents reported higher scores in body shame, social physique anxiety, and SNS addiction symptoms, whereas male adolescents reported higher participation in sexting behaviors. In addition, gender did not moderate the relationship between body shame and higher sexting behaviors. Finally, the results showed an indirect (but not a direct) association between body shame and sexting behaviors through social physique anxiety and SNS addiction symptoms. These findings provide empirical evidence for the development of sexting prevention programs that are focused on body acceptance with the aim of reducing body shame, social physique anxiety, and SNS addiction.
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Affiliation(s)
- Manuel J Ruiz
- Department of Psychology and Anthropology, University of Extremadura, Badajoz, Spain
| | - Gemma Sáez
- Department of Psychology and Anthropology, University of Extremadura, Badajoz, Spain
| | - Laura Villanueva-Moya
- Department of Social Psychology, Mind, Brain and Behavioral Research Center (CIMCYC), Faculty of Psychology, University of Granada, Granada, Spain
| | - Francisca Expósito
- Department of Social Psychology, Mind, Brain and Behavioral Research Center (CIMCYC), Faculty of Psychology, University of Granada, Granada, Spain
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Raspovic AM, Hart LM, Zali Y, Prichard I. Body image profiles and exercise behaviours in early motherhood. A latent profile analysis. J Health Psychol 2021; 27:2056-2067. [PMID: 34030494 DOI: 10.1177/13591053211019114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early motherhood may impact body image, and its relationship to exercise, potentially affecting mother and infant wellbeing. This study examined whether duration of weekly exercise differed according to body image profile (BIP) based on relative levels of body dissatisfaction and body appreciation. Survey data from 262 women, 0-5 years postpartum, were analysed. Latent profile analysis identified "average", "dissatisfied" and "appreciative" BIPs. Significantly lower exercise was found in the dissatisfied compared to the appreciative BIP (p = 0.005), with marginally lower exercise in the dissatisfied compared to the average BIP (p = 0.029 with adjusted α = 0.02). This research has implications for designing targeted interventions supporting postpartum wellbeing.
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Affiliation(s)
| | - Laura M Hart
- La Trobe University, Australia.,University of Melbourne, Australia
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Yusuf H, Agwu A. Adolescents and young adults with early acquired HIV infection in the united states: unique challenges in treatment and secondary prevention. Expert Rev Anti Infect Ther 2021; 19:457-471. [PMID: 32990092 PMCID: PMC8084860 DOI: 10.1080/14787210.2021.1829473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Worldwide, children who acquired human immunodeficiency virus (HIV) at an early age, either perinatally or through blood transfusion, are reaching adolescence and adulthood due to successful antiretroviral treatment (ART). While many are thriving, a significant proportion face unprecedented multilevel challenges that can affect their long-term outcomes. Specifically, longstanding and poorly controlled HIV resulting from inadequate early regimens and nonadherence, along with the toxicities of some ART agents, can predispose them to sequelae including HIV-associated complications and other comorbidities. AREAS COVERED This paper reviews and summarizes the unique issues facing adolescents and young adults with early acquired HIV (AYA-EAHIV), including ART challenges, emerging comorbidities, and complications, including mental health comorbidities, secondary prevention, and transition from pediatric/adolescent to adult care. EXPERT OPINION AYA-EAHIV are a special population that have lived their entire lives with the physical and psychological toll of HIV mandating targeted and purposeful approaches to optimize their management and outcomes. Multifaceted inclusive and context-specific approaches focusing on heightened research, risk reduction interventions, and 'outside the box' thinking will be required to optimize treatment and reduce morbidity and mortality.
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Affiliation(s)
- Hasiya Yusuf
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison Agwu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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