Changes in self-esteem in black and white girls between the ages of 9 and 14 years. The NHLBI Growth and Health Study

The Clinical Relevance of a Socioecological Conceptualization of Self-Worth

Low self-worth pervades discussions of psychopathology, is a central feature of many psychiatric disorders, and appears in conceptions of psychological distress in a range of cultural contexts . Explication of this aspect of self-evaluation offers clinical utility especially when adequate attention is paid to social and cultural aspects of the self. In this paper, we propose that refining the conceptualization of self-worth as felt perceptions of one’s mattering and deservingness of equity and psychological, social, and material resources offers a unique clinical utility. We present an argument for this definition of self-worth, building on existing literature, as a relativistic construct informed and reinforced by dynamic feedback from intrapersonal, interpersonal, sociocultural, and structural socioecological levels. To highlight that self-worth has been an implied but under-examined concept, we follow with a selective review of psychological and sociological perspectives of self-esteem and related constructs. We conclude with a discussion of our conceptualization’s implications for measurement and treatment, including the potential transdiagnostic utility of self-worth.

Body image perception and body composition in early adolescents: a longitudinal study of an Italian cohort

BACKGROUND

Adolescence is a sensitive period of life in which everyone faces physical and psychological changes. No longitudinal studies considering changes in body image perception and body composition in Italian adolescents have been carried out. The aims of this study were to evaluate the longitudinal change in body composition and weight status in a sample of Italian students of both sexes over the 3 years of middle school and to analyse the influence of these parameters on the perception and satisfaction of one's own body image.

METHODS

Sixty-four males and seventy females were followed longitudinally from 11 to 14. Age at first measurement was 11.8 ± 0.3 yrs. in males and 11.9 ± 0.3 yrs. in females, then the students were measured again after 1 year and 2 years. Anthropometric measurements were collected and body composition was assessed by skinfolds. Maturity status was detected by age at menarche in females and by estimated age at peak height velocity in males; sports practice was assessed by a questionnaire. Body Silhouette Charts were used to assess body image perception. The degree of body image dissatisfaction and improper perception of weight status were evaluated. Univariate and multivariate analyses were applied.

RESULTS

Height, sitting height, leg length, and weight increments were higher in males than in females, and in both sexes the sitting height increment was higher than that of leg length. Skinfold thicknesses and percentage of body fat, showed a decrease in males and an increase in females over the 3 years. About 90% of the sample practiced sport during the 3 years. No significant variations in body image perception were observed among repeated measures but significantly differences were observed between sexes. Although the girls showed a lower incidence of overweight and obesity than boys, girls had a higher dissatisfaction than males. Males were less accurate in one's perception of one's own weight status.

CONCLUSIONS

The changes in body composition observed in the sample of the present study were in accordance with their maturity stage. An increase in parameters connected with adiposity is observed in females and a decrease in males. Body image perception did not seem to change with growth, but associations were found between body image perception and BMI and sex. Monitoring body image perception in young adolescents, especially in females and in overweight/obese subjects, is a priority to prevent nutritional disorders.

A Review of the Promotion of Fitness Measures and Health Outcomes in Youth

The relationship between physical fitness and health in adults is well established, yet until recently, empirical support for the impact of physical fitness levels on health markers in children has not been thoroughly documented. The aim of this review was to provide a summary of current literature that has examined the linkage between measures of health-related physical fitness (ie, cardiorespiratory fitness, musculoskeletal fitness, flexibility, and body composition) and health markers in youth. Specifically, this review focused on the findings from the recent 2012 Institutes of Medicine report on Fitness Measures in Youth as well as other subsequent review articles related to the topic. In addition, recommendations for health-related fitness assessments in youth populations are presented.

(How) Does Obesity Harm Academic Performance? Stratification at the Intersection of Race, Sex, and Body Size in Elementary and High School

In this study I hypothesize a larger penalty of obesity on teacher-assessed academic performance for white girls in English, where femininity is privileged, than in math, where stereotypical femininity is perceived to be a detriment. This pattern of associations would be expected if obesity largely influences academic performance through social pathways such as discrimination and stigma. In the Fragile Families and Child Wellbeing Study (~age 9) and the National Longitudinal Study of Youth 1997 (~age 18), I find obesity to be associated with a penalty on academic performance among white girls in English but not in math, while no association is found in either subject for white boys or for black students net of controls. Findings suggest that the relationship between obesity and academic performance may result largely from how educational institutions interact with bodies of different sizes, rather than primarily via constraints on physical health.

Self-concept, Self-esteem and Body Weight in Adolescent Females

Eighty girls aged 12.8 (0.6) years, completed self-concept, depression and anxiety scales over three years and had their height and weight measured. All nine self-concept domains were lower in the Highest BMI group, compared to the Lower BMI group and this trend was stable over three years. Highest BMI girls were substantially lower than population norms on all nine scales. Over three years, the Physical Appearance and Close Friendship scores of Highest BMI girls decreased compared to Lower BMI girls. This pattern was similar for all of the other self-concept domains. Several aspects of early adolescent girls' self-image may be adversely influenced by a heavy weight status.

Do body-related shame and guilt mediate the association between weight status and self-esteem?

Individuals who are overweight or obese report body image concerns and lower self-esteem. However, little is known about the mechanisms underpinning these associations. The objective of this study was to test body-related shame and guilt as mediators in the association between weight status and self-esteem. Young adult participants (n = 790) completed assessments of self-esteem and body-related guilt and shame, and weight status indicators were measured by trained technicians. Findings from multiple mediation analyses suggest that body-related shame mediates the relationship between weight status and self-esteem. If replicated in longitudinal studies, these findings suggest that reducing body-related emotions may have important implications for improving self-esteem in clinical weight management.

More Overweight Adolescents Think They Are Just Fine: Generational Shift in Body Weight Perceptions Among Adolescents in the U.S

INTRODUCTION

As obesity prevalence has increased, adolescents' self-perceived body weight might have shifted accordingly. This study aims to investigate the generational shift in adolescents' perception of their body weight.

METHODS

We used data from adolescents aged 12-16 years who participated in the National Health and Nutrition Examination Survey in 1988-1994 (early, n=1,720) or 2007-2012 (recent, n=2,518). Self-perceived weight status was assessed by face-to-face interviews, and BMI z-scores were calculated using directly measured weight and height with the 2000 CDC Growth Charts as the reference. The analysis was conducted in 2013.

RESULTS

The median BMI z-score of self-perceived overweight adolescents increased from 1.32 (95% CI=1.18, 1.46) among adolescents interviewed early to 1.82 (1.74, 1.90) among adolescents interviewed recently. After adjusting for age, race/ethnicity, sex, and family income, the probability of self-perceiving as "overweight" declined by 29% for overweight/obese adolescents interviewed recently (probability ratio [PR]=0.71 [0.62, 0.82]) compared with adolescents with the same z-scores but interviewed early. The declining tendency of accurately self-perceiving as overweight was most pronounced among whites (PR=0.64 [0.48, 0.85]), and least among blacks (PR=0.76 [0.58, 0.99]). Both boys and girls interviewed recently were significantly less likely to accurately self-perceive as overweight (PR=0.70 [0.56, 0.89] and 0.73 [0.61, 0.87], respectively) compared with their counterparts who were interviewed early.

CONCLUSIONS

Fewer overweight/obese adolescents self-perceived as such in the 2007-2012 survey compared with the 1988-1994 survey. The declining tendency among overweight or obese adolescents may be indicative of a generational shift in body weight perceptions.

Early pubertal timing as a vulnerability to depression symptoms: differential effects of race and sex

Robust evidence supports that girls and boys who experience early pubertal timing, maturing earlier than one's peers, are vulnerable to developing symptoms of depression. However, it has yet to be clarified whether early pubertal timing confers vulnerability to African American as well as to Caucasian adolescents and whether this vulnerability is specific to depressive symptoms or can be generalized to symptoms of social anxiety. In previous studies, one race or one sex was examined in isolation or sample sizes were too small to examine racial differences. Our longitudinal study consisted of a sample of 223 adolescents (Mage = 12.42, 54.3 % female, 50.2 % African American, and 49.8 % Caucasian). At baseline, depressive symptoms, social anxiety symptoms, and pubertal timing were assessed by self-report. Nine months later, we assessed depressive symptoms, social anxiety symptoms, body esteem, and stressful life events that occurred between baseline and follow-up. Analyses indicated that early pubertal timing interacted with stressful life events to predict increased symptoms of depression, but only for Caucasian girls and African American boys. Results were found to be specific to depressive symptoms and did not generalize to symptoms of social anxiety. Additionally, there was a significant positive indirect effect of pubertal timing on symptoms of depression through body esteem for Caucasian females.

Prospective associations between the family environment, family cohesion, and psychiatric symptoms among adolescent girls

The present study used a longitudinal design to investigate whether parental values, interests, and the perceived level of expressiveness, cohesiveness and control in the family were associated with changes in psychiatric symptoms during early adolescence. We used data gathered at ages 12, 14 and 17 from 1,600 adolescent girls in the National Heart, Lung and Blood Institute Growth and Health Study. Using a novel approach we found significant informant effects of family cohesion on psychiatric symptoms, with stronger associations for adolescent ratings than parental ratings. Multivariate modelling adjusting for family cohesion (from parents and adolescents perspective), and parents' depressive and eating disorder symptoms indicated parental ratings on the intellectual and cultural orientation of the family predicted small but significant increases in eating disorder symptoms, anxiety and a reduction in self-worth 2-years later. Parental control also predicted a reduction in anxiety and family expressiveness was related to increases in self-worth.

Body weight has no impact on self-esteem of minority children living in inner city, low-income neighborhoods: a cross-sectional study

BACKGROUND

The relationship between body weight and self-esteem among underserved minority children is not well documented.

METHODS

We measured the self-esteem profile using the Self-Perception Profile for Children among 910 minority children at 17 Houston community centers.

RESULTS

Weight status had no effect on any of the self-esteem scores among the minority children (P ≥ 0.21). Black children had higher scholastic competence than Hispanic children (P = 0.05). Social acceptance was not affected by age, gender, and race/ethnicity (P ≥ 0.13). Significant age x gender (P = 0.006) and race x gender (P = 0.005) interactions were detected on athletic competence. The younger boys had higher athletic competence than the younger and older girls (P ≤ 0.01). The older boys had higher athletic competence than the older girls (P = 0.008) but their scores were not different from those of the younger girls (P = 0.07). Within each race/ethnicity group, boys had higher athletic competence than girls (P ≤ 0.03). Black boys had higher athletic competence than Hispanic girls (P = 0.007) but their scores were not different from those of the Hispanic boys (P = 0.08). Age and gender had no effect on physical appearance but black children had higher scores than Hispanic children (P = 0.05). Behavioral conduct was not affected by age, gender, or race/ethnicity (P ≥ 0.11). There was an age x gender interaction on global self-worth (P = 0.02) with boys having similar scores regardless of ages (P = 0.40) or ethnicity (P = 0.98). However, boys from both age groups had higher global self-worth than the older girls (P ≤ 0.04) but their scores were not different from those of the younger girls (P ≥ 0.07).

CONCLUSIONS

For the first time, we documented that being normal weight did not necessarily guarantee positive self-esteem among minority children. Their self-esteem scores were similar to those found among children who were diagnosed with obesity and obesity-related co-morbidities and lower than those reported among normal-weight white children. Therefore, activities to promote self-esteem are important when working with underserved minority children in order to promote a healthy lifestyle.

Myopia, contact lens use and self-esteem

PURPOSE

To evaluate whether contact lens (CL) use was associated with self-esteem in myopic children originally enrolled in the Correction of Myopia Evaluation Trial (COMET), that after 5 years continued as an observational study of myopia progression with CL use permitted.

METHODS

Usable data at the 6-year visit, one year after CL use was allowed (n = 423/469, age 12-17 years), included questions on CL use, refractive error measurements and self-reported self-esteem in several areas (scholastic/athletic competence, physical appearance, social acceptance, behavioural conduct and global self-worth). Self-esteem, scored from 1 (low) to 4 (high), was measured by the Self-Perception Profile for Children in participants under 14 years or the Self-Perception Profile for Adolescents, in those 14 years and older. Multiple regression analyses were used to evaluate associations between self-esteem and relevant factors identified by univariate analyses (e.g., CL use, gender, ethnicity), while adjusting for baseline self-esteem prior to CL use.

RESULTS

Mean (±S.D.) self-esteem scores at the 6-year visit (mean age = 15.3 ± 1.3 years; mean refractive error = -4.6 ± 1.5 D) ranged from 2.74 (± 0.76) on athletic competence to 3.33 (± 0.53) on global self-worth. CL wearers (n = 224) compared to eyeglass wearers (n = 199) were more likely to be female (p < 0.0001). Those who chose to wear CLs had higher social acceptance, athletic competence and behavioural conduct scores (p < 0.05) at baseline compared to eyeglass users. CL users continued to report higher social acceptance scores at the 6-year visit (p = 0.03), after adjusting for baseline scores and other covariates. Ethnicity was also independently associated with social acceptance in the multivariable analyses (p = 0.011); African-Americans had higher scores than Asians, Whites and Hispanics. Age and refractive error were not associated with self-esteem or CL use.

CONCLUSIONS

COMET participants who chose to wear CLs after 5 years of eyeglass use had higher self-esteem compared to those who remained in glasses both preceding and following CL use. This suggests that self-esteem may influence the decision to wear CLs and that CLs in turn are associated with higher self-esteem in individuals most likely to wear them.

Physical, Behavioral, and Body Image Characteristics in a Tri-Racial Group of Adolescent Girls

OBJECTIVES

The purpose of this study was to evaluate physical characteristics, nutrient intake, physical activity level, and body image in white (CC), African-American (AA), and Hispanic-American (HA) female adolescents.

RESEARCH METHODS AND PROCEDURES

High school volunteers were solicited for this study. Self-reported information was used to determine subject characteristics, family income, physical activity, body image, and nutrient intake. Physical evaluations were used to determine body mass index, percent body fat, fat distribution, resting heart rate, and blood pressure (BP).

RESULTS

Results showed that AA girls displayed significantly higher diastolic BP than HA girls (p = 0.029). CC adolescents showed greater physical activity (p = 0.010) and lower adiposity than HA adolescents (p = 0.048), as well as lower subscapular skinfold than AA adolescents (p = 0.018). AA adolescents selected a higher ideal body size than CC girls (p = 0.038). There was also a significant difference in percentage carbohydrates (p < 0.034) and cholesterol consumed (p < 0.016) among groups, with CC girls showing the highest values for carbohydrates and lowest values for cholesterol intake among groups.

DISCUSSION

Given our findings of higher adiposity and lower physical activity levels in HA adolescents and greater diastolic BP levels and subscapular skinfold in AA adolescents, more interventions should be targeted toward improving health-related variables among minority populations.

Ethnic differences in perceptions of body satisfaction and body appearance among U.S. schoolchildren: a cross-sectional study

BACKGROUND

Perceived body appearance and body satisfaction are potentially related to weight problems and poor health. The purpose of this study was to examine how gender, and ethnic differences in body satisfaction, perceived body appearance and weight status change by age in a representative sample of U.S. adolescents 11-17 years old.

METHODS

We used the US Health Behavior in School-Aged Children (HBSC) 2001 survey which assessed perceived body appearance, body satisfaction, self-reported body mass index (BMI) and socio-demographic indicators. The associations between age and perceived appearance, age and body satisfaction, and between z-transformed BMI and body satisfaction were analyzed using separate non-parametric regression models for both genders and the three ethnic groups.

RESULTS

Body satisfaction did not vary significantly by age except for an increase with age in the proportion of Non-Hispanic White girls who perceived themselves as too fat. Although boys did not report being too fat unless their BMI was above the age- and gender-specific median, one third of Non-Hispanic White girls felt too fat at or below the age- and gender-specific median. Compared to other ethnicities, African-American students' perceived appearance was significantly more positive and they were less likely to perceive themselves overweight at higher BMI scores. However, during adolescence, the positive self-reported perceived appearance of African-American boys dropped substantially while it remained relatively stable in African-American girls.

CONCLUSIONS

There were substantial differences in body satisfaction and perceived appearance across the three largest ethnic groups of school-age children in the U.S. Stability across age indicates that these perceptions are most likely established before the age of 10 and underline the importance of primary schools and parents in prevention. Special attention should be directed to the dramatic loss of positive perceived appearance among African-American boys.

Psychological vulnerability among overweight/obese minority adolescents

Depression is associated with obesity among adolescents, with racial/ethnic variability noted. Psychological correlates that may influence this relationship have not been adequately explored. The primary objective of this secondary analysis was to compare levels of stress, self-esteem, coping, social support, and depressive mood between normal weight and overweight/obese minority adolescents (as defined using Centers for Disease Control and Prevention standards). Adolescents (n = 101) aged 14-18 years who were largely minority (87%) were recruited from two Midwestern-area high schools. Using a descriptive comparative design, individuals were grouped into normal weight (>5th to <85th percentile) and overweight/obese (≥ 85 th percentile) for comparison on measures. Self-reported levels of stress, coping, self-esteem, social support, depressive mood, and body mass index were obtained. Obese/overweight adolescents reported significantly lower self-esteem than did those with normal weight (p < .05). Although stress was a significant predictor of depressive mood in both groups (p < .001), low self-esteem was also a significant predictor of depressive mood in the overweight/obese group (p = .001). Strategies to manage stress and improve self-esteem may help alleviate depressive mood in high school adolescents.

Developmental and contextual risks of social physique anxiety among female athletes

In the present study, we examined developmental and contextual factors that may increase the odds of reporting higher social physique anxiety (SPA) among 404 adolescent athletes 11 to 16 years old. Findings showed older, later maturing athletes past peak height velocity and with greater body mass index (BMI) reported higher SPA. Individual aesthetic sport athletes were older at menarche, had lower BMI, and reported higher SPA. The odds of reporting higher SPA were 4.5 times higher (odds ratio = 4.61) for individual aesthetic sport athletes than for nonaesthetic sport athletes. Team aesthetic sport contexts were not implicated in SPA risk. Results are discussed in terms of self-selection away from individual aesthetic sports and the relevance of physical size and puberty in the SPA construct.

Body mass index and victimization during adolescence: the mediation role of depressive symptoms and self-esteem

OBJECTIVE

This study applied a multi-method approach to examine the relationship between body mass index (BMI) and the experience of victimization during adolescence by investigating the role of intrapersonal feelings.

METHODS

The sample consisted of 2051 adolescents (M=13.8 years, S.D.=0.7; 51% male) from seven high schools in the Netherlands. Participants' weight and height were measured and they completed self-report questionnaires on victimization, depressive symptoms and self-esteem. Self-reported and peer-reported measures of victimization were collected and combined to create three different victimization types (i.e., self/peer-identified, self-identified, and peer-identified).

RESULTS

Hierarchical logistic regression analyses revealed that higher BMI was associated with both self/peer-identified victimization and self-identified victimization. Intrapersonal feelings (i.e., depressive symptoms and self-esteem) were found to mediate these associations. However, BMI was not associated with peer-identified victimization.

CONCLUSION

These findings suggest that the association between BMI and victimization might be exclusively related to the self-perception of high BMI adolescents. Moreover, the mediation effects indicate that the perception of victimization might be linked to psychological difficulties of adolescents with high BMI. Thus, to fully understand the associations between weight status and victimization, intrapersonal mechanisms need to be examined.

Concurrent and longitudinal predictors of self-esteem in elementary and middle school girls

BACKGROUND

The purpose of this study was to analyze the effects of factors related to self-esteem, both cross-sectionally and longitudinally, among 2 cohorts of girls over a period of 4 years, from elementary through middle school.

METHODS

A multiethnic sample of 656 elementary school girls recruited from 13 schools in Hayward, CA, and Tucson, AZ, was evaluated annually over a 4-year period. The McKnight Risk Factor Survey IV was administered, which consists of 103 questions that assess self-esteem, appearance appraisal, effect of body changes, depressed mood, teasing, school performance, and other factors. In addition, participants' heights and weights were measured.

RESULTS

The most important predictor of self-esteem in each grade was appearance appraisal, and, in all grades but the eighth, weight-related teasing by either boys or girls was also a predictor of self-esteem. Teasing about weight was more important than body weight itself in predicting self-esteem. Self-esteem was lower in girls who were teased about their weight, even if they believed that it had no effect on how they felt about themselves. School performance predicted self-esteem in grades 6 and 8. In longitudinal analyses, the participant's current perception of her appearance was more important than her previous level of self-esteem in predicting current self-esteem.

CONCLUSIONS

The results of this study support the need to allocate funding to address the issue of teasing as 1 of the stressors in the school environment, and to explore further the important relationship between school performance and self-esteem.

Characteristics associated with low self-esteem among US adolescents

OBJECTIVE

Low self-esteem in adolescents has been associated with a number of risk and protective factors in previous studies, but results have been mixed. Our objective was to examine characteristics associated with low self-esteem in a large national sample of young adolescents.

METHODS

We conducted a population-based correlational study. A sample of 6522 adolescents aged 12 to 16 years was surveyed by phone as part of a national study of media and substance use. Self-esteem was measured with 3 questions that assessed global self-worth and physical appearance. Multivariate logistic regression was used to examine the relationship between self-esteem and sociodemographics, child personality characteristics,weight status, daily TV time, parenting style, school performance,and team sports participation. Interactions among gender, race, and weight status were examined.

RESULTS

In multivariate analysis, female gender, Hispanic race, overweight and obesity, sensation seeking, rebelliousness, and daily TV time were each independently associated with lower self-esteem. Teens of black race, with higher parental responsiveness and demandingness, better school performance, or involvement in team sports were less likely to report low self-esteem. Black females were at lower risk and Hispanic males were at higher risk for low esteem than peers of similar gender of other races.

CONCLUSIONS

Low self-esteem was associated with a number of modifiable risk factors, including obesity, TV time, team sports participation, school performance, and parenting style, that should be discussed with teens and parents at health supervision visits. Further research examining race and gender-specific factors that serve to moderate risk for poor self-esteem in adolescents is warranted.

Exploring the relationship among weight, race, and sexual behaviors among girls

OBJECTIVE

The relationship between weight and sexual behavior among adolescents is poorly understood. We examined this relationship in a nationally representative sample of high school girls.

METHODS

We performed a cross-sectional analysis of self-reported data from 7193 high school girls who completed the 2005 Youth Risk Behavior Surveillance survey. We used multivariate logistic regression to examine associations among 3 weight indices (BMI calculated from self-reported weight and height, perceived weight, and weight misperception) and 6 sexual behaviors (ever had vaginal sex; sex before age 13; >or=4 sexual partners; and alcohol, condom, and oral contraceptive use at last sex) adjusting for age, race/ethnicity, and a history of intimate partner violence.

RESULTS

There were no differences in the likelihood of ever having sex on the basis of BMI or weight perception accuracy; however, girls who perceived themselves as overweight were less likely to have ever had sex. Among sexually active girls, those who had low BMI and perceived themselves as overweight or had overweight misperceptions were less likely to report condom use at last sex. Sexually active girls who perceived themselves as overweight were also more likely to have had sex before age 13. Associations between the 3 weight indices and sexual risk behaviors varied across racial/ethnic groups.

CONCLUSIONS

Sexual risk behaviors may be more common among girls who are underweight or perceive themselves (accurately or not) to be overweight and vary by racial/ethnic group. This suggests that girls at weight extremes and those from different racial backgrounds may have unique sexual health education and prevention needs.

Symptoms of depression and anxiety in adolescents with sickle cell disease: the role of intrapersonal characteristics and stress processing variables

Sickle cell disease (SCD) complications place patients at risk for poor psychosocial adaptation, including depression and anxiety symptoms. This study aimed to test a mediator model based on the Risk and Resistance model to explore the role of intrapersonal characteristics and stress processing variables in psychosocial functioning. Participants were 44 adolescents with SCD, 15 healthy siblings, and 43 primary caregivers, recruited from an East Coast comprehensive sickle cell center. The participants completed paper and pencil measures of resilience factors (attributional style, hope, coping) and internalizing symptoms (depression, anxiety). Internalizing symptoms among adolescents with SCD and healthy siblings did not differ and were within non-clinical ranges. Self-esteem of adolescents with SCD was correlated with less depression and anxiety and sense of inadequacy was associated with poorer functioning. There were no findings to support the role of coping in psychosocial adjustment. Although the mediation hypothesis was not supported, findings highlighted the resilience of this sample of adolescents with SCD. Determining how these resilience factors protect adolescents with SCD may aid in the development of psychosocial interventions. In particular, interventions should focus on improving intrapersonal skills and coping with stress and investigate ways to tailor these interventions to African-American populations.

Self-perception in overweight and obese children: a cross-sectional study

AIM

The aim of this study was to examine the relationship between obesity and self-esteem in children in relation to specific domains of their self-perception, and further to explore the extent to which this may vary by gender and economic circumstances.

METHOD

A total of 211 children aged 8-9 years drawn from both advantaged and disadvantaged areas of Belfast completed the Harter Self-Perception Profile for Children and measures of body mass index were obtained.

RESULTS

Overweight, impoverished children had significantly reduced social acceptance and physical competence scores. Boys had significantly lower scores than girls in the behavioural conduct domain. Girls had significantly lower scores than boys for the athletic competence.

CONCLUSION

These results suggest that risk factors of increased weight and impoverished backgrounds have a combined negative effect, placing some children at increased risk of having lower self-perceptions in some, but not all domains. Health interventions for childhood obesity should consider the likelihood of specific relationships between physical and psychosocial factors.

Validation of a parent-proxy, obesity-specific quality-of-life measure: sizing them up

The aims of the present study were to develop and validate a new obesity-specific, parent-proxy measure of health-related quality of life (HRQOL), Sizing Them Up. Participants included 220 obese youth (M(age) = 11.6 years, 68% female, 53% African American, M(BMI) = 36.7) and their primary caregivers (88% mothers). Primary caregivers completed a demographics questionnaire and two HRQOL measures: Sizing Them Up (obesity-specific) and PedsQL (generic). Youth height and weight were measured. Psychometric evaluation of Sizing Them Up was completed by conducting a factor analysis and determining internal consistency coefficients, test-retest reliability, convergent and discriminant validity, predictive validity, responsiveness to change, and minimal clinically important difference (MCID) scores. Sizing Them Up is a 22-item measure with six scales (i.e., Emotional Functioning, Physical Functioning, Teasing/Marginalization, Positive Social Attributes, Mealtime Challenges, and School Functioning) that account for 66% of the variance. The measure also includes an Adolescent Developmental Adaptation module. Sizing Them Up had internal consistency coefficients ranging from 0.59 to 0.91 and test-retest reliabilities ranging from 0.57 to 0.80. Validity was demonstrated by significant relations between a majority of Sizing Them Up scales and BMI z-scores. Sizing Them Up also demonstrated good convergent validity with other HRQOL measures and responsiveness to change related to weight loss for adolescents who had undergone bariatric surgery. Overall, Sizing Them Up is a reliable and valid parent-proxy measure of obesity-specific HRQOL that can be used in both clinical and research settings.

Weight-specific health-related quality of life in adolescents with extreme obesity

The objectives of this multisite study were to: (i) examine differences by gender and race on generic and weight- specific health-related quality of life (HRQOL) in adolescents with extreme obesity (BMI > or = 40 kg/m(2)) and (ii) explore HRQOL differences based on treatment pursued (behavioral vs. bariatric surgery). Study participants included 145 obese adolescents (mean age = 15.3 years; 68% female; 46% black; mean BMI = 50.6) referred to pediatric weight management programs. Participants completed generic (PedsQL) and weight-specific (Impact of Weight on Quality of Life-Kids (IWQOL-Kids)) HRQOL measures. Generic and weight-specific measures indicated global (e.g., all domains) HRQOL impairment and significant differences by race. Physical, emotional, and social scores of the PedsQL (Ps < 0.01) and the physical comfort and body esteem scores of the IWQOL-Kids (Ps < 0.001) were significantly higher for black compared to white adolescents with extreme obesity. Extremely obese adolescents pursuing bariatric surgery reported similar HRQOL to adolescents pursuing behavioral treatment (n = 30 matched pairs). HRQOL did not differ for extremely obese adolescents based on type of treatment sought, but race/ethnicity should be considered when characterizing these youth. Although racial differences in adolescent body image/esteem have been reported, it is unknown why black adolescents with extreme obesity would report less impact of weight on their physical functioning. Overall, these data suggest that HRQOL is not homogenous in adolescents with extreme obesity.

Exploring the impact of group work and mentoring for multiple heritage children's self-esteem, well-being and behaviour

Findings are reported from a study of an innovative Multiple Heritage Service in Sheffield (UK) which provides, inter alia, individual mentoring for young people and school-based group sessions on cultural heritage, dealing with racism and enhancing well-being. Group work, undertaken between November 2005 and December 2006, was evaluated by a before/after design with 43 children aged from 8 to 15 attending five different groups (response rate 77%), using three well-established and validated measures. There were improvements on the Rosenberg Self-esteem Scale from 31.4 to 33.0 (P = 0.005) with more improvement among younger children and boys (P = 0.004 and P = 0.001); and well-being as measured by the GHQ12 improved from 1.5 to 0.8 (P = 0.111) with more improvement among older children (P = 0.026). On the third measure of problem behaviour (the Strengths and Difficulties Questionnaire), there was an improvement from 12.4 to 12.1 (P = 0.716), but there was no improvement at all for girls. Mentoring was evaluated by telephone interviews between June and October 2006 with 14 mothers whose children had just completed, or were nearing completion of, mentoring (response rate 70%). Overall, the mothers' evaluations were highly positive: two-thirds commended the service on the positive impact on their children's well-being and happiness (including all the mothers of daughters); a half reported positive impacts on identity; mothers commended the positive role model effect same-sex mentors had on their children's behaviour; but only a third said mentoring had boosted their children's self-esteem.

The Effects of Weight Management Programs on Self-Esteem in Pediatric Overweight Populations

OBJECTIVE

Review published findings on self-esteem and pediatric overweight, and changes in self-esteem subsequent to weight management programs.

METHODS

We used PsycInfo and MedLine searches to identify peer-reviewed journal articles examining self-esteem changes following participation in weight management programs.

RESULTS

Data regarding the relationship between self-esteem and obesity is mixed. Factors that place overweight children "at-risk" for low self-esteem include early adolescence, female gender, identification with majority cultural standards of body shape, exposure to teasing and peer victimization, a history of greater parental control over feeding, and internal attributions about weight status. Data from intervention studies suggest positive effects on self-esteem across settings. Components related to self-esteem improvements include weight change, parent involvement, and group intervention format.

CONCLUSIONS

Well-designed, longitudinal studies using multidimensional measures of self-esteem, and following CONSORT guidelines are needed to confirm and expand these findings. Emphasis should be placed on examining mediators and moderators of self-esteem change.

Comparisons between African American girls' and parents' perceptions of girls' weight concerns and weight control behaviors

Weight concerns and weight control behaviors were evaluated among sixty 8-10 year-old African American girls and their parents/caregivers. Girls completed the McKnight Risk Factor Survey and parents completed a modified version regarding perceptions of their daughters' concerns and behaviors. Significant correlations between girls' and parents' were seen for Overconcern with Weight and Shape (r = .56) and Weight Control Behaviors (r = .33). Parents' correctly identified 72% of girls' responses for Overconcern with Weight and Shape, 60% for Binge, 85% for Purging and 58% for Weight Control Behaviors scales using clinical cutoffs. However, more stringent agreement coefficients indicated generally poor concordance between girls and parents. The modified McKnight may be useful for assessing awareness of these issues.

Self-esteem in adolescent females

PURPOSE

Self-esteem is a major "predictor" of satisfaction with life. This longitudinal study examined mean and individual changes in self-esteem, and how self-esteem is affected by race and body mass.

METHODS

Girls were recruited at ages 9 and 10 years, and followed to age 22 years. The Harter Self-Perception Profile was administered every other year, analyzing scores from the Global Self-Worth Scale, by age or developmental phase: ages 9-12 (I), 13-16 (II), and 17-22 (III). Regression modeling included main effects and interactions between age/phase, race, and body mass index (BMI).

RESULTS

Self-worth was greater in black than white women, and greater with lower BMI in both races. In the model with age ("traditional model") (with race and BMI), significant variables included BMI (inverse relationship) and the interactions between age and race, race and BMI, and the triple interaction between age, race, and BMI. In the model with phase ("transitional model") (with race and BMI), BMI, and the interactions between BMI and race, and race and phase, were significant. For example, self-worth was generally lower in Phase II (middle adolescence) for white women. Self-esteem tracked significantly (correlation 0.22, p < .001). An individual's self-worth during any given phase of adolescence was correlated significantly with the other two phases.

CONCLUSIONS

In this longitudinal analysis of self-esteem in adolescent girls, race and BMI are important predictors of self-esteem. Self-esteem is consistent across the phases of adolescence, and comparable with other personality traits. As noted by others, lower levels of self-esteem may increase the vulnerability of adolescents to risky behaviors.

Body mass, weight control behaviours, weight perception and emotional well being in a multiethnic sample of early adolescents

OBJECTIVE

To investigate weight perception, dieting and emotional well being across the range of body mass index (BMI) in a population-based multiethnic sample of early adolescents.

DESIGN

Cross-sectional population-based survey.

SUBJECTS

In total, 2789 adolescents 11-14 years of age from three highly deprived regional authorities in East London, in 2001.

MEASUREMENTS

Data were collected by student-completed questionnaire on weight perception, dieting history, mental and physical health, health behaviours, social capital and sociodemographic factors. Height and weight were measured by trained researchers. Overweight was defined as BMI > or =85th centile and obesity as BMI > or =98th centile. Underweight was defined as BMI< or =15th centile.

RESULTS

In all, 73% were from ethnic groups other than white British. Valid BMI were available for 2522 subjects (90.4%) of whom 14% were obese. Only 20% of overweight boys and 51% of overweight girls assessed their weight accurately. Accuracy of weight perception did not vary between ethnic groups. In all, 42% of girls and 26% of boys reported current dieting to lose weight. Compared with white British teenagers, a history of dieting was more common among Bangladeshi, Indian and mixed ethnicity boys and less likely among Pakistani girls. Self-esteem was not associated with BMI in girls but was significantly lower in obese boys than those of normal weight (P=0.02). Within ethnic subgroups, self-esteem was significantly lower in overweight white British boys (P=0.03) and obese Bangladeshi boys (P=0.01) and Bangladeshi girls (P=0.04), but significantly higher in obese black African girls (P=0.01) than those of normal weight. Obese young people had a higher prevalence of psychological distress (P=0.04), except among Bangladeshi teenagers, where overweight and obese young people had less psychological distress than those of normal weight (P=0.02). Birth outside the UK was associated with reduced risk of obesity in girls (P=0.02) but not with history of dieting, weight perception or psychological factors in either gender.

CONCLUSION

High levels of current dieting for weight control and inaccurate perception of body mass are common across all ethnic groups. However, dieting history and the associations of obesity with self-esteem and psychological distress vary between ethnic groups. Interventions to prevent or treat obesity in black or minority ethnicity groups must consider cultural differences in the relationship between body mass, self-esteem and psychological distress.

Relationships of psychosocial factors to dietary intakes of preadolescent girls from diverse backgrounds

Family and personal factors that might be related to the development of food selection and eating patterns have not been well studied in children. The aim of this study was to examine whether such psychosocial factors differ in girls from four culturally diverse Girl Scout troops and how these factors are associated with dietary intakes. The social measures and dietary assessments were all obtained at baseline on subjects who were participating in a small nutrition education programme. The programme enrolled girls and one parent for each girl from four Girl Scout troops in Detroit, Michigan. The social factors assessed included girls' emotionality and use of food to regulate emotions, their general attitudes about health, eating and body image, and self-perceptions of their competence. Dietary intakes also were assessed in both the girls and their parents. There were large differences between troops in ethnicity and parent education level, and there were differences in dietary intakes as well. The psychosocial factors assessed in this study, however, did not differ significantly by troop. When the psychosocial factors were examined for their relationships to dietary factors, there was an indication that families which reported higher self-competence and academic competence in their daughters also had healthier eating patterns in their daughters. This was a small study, but the data suggest that simple comparisons between ethnic groups may not adequately capture the complexity of family and psychosocial factors contributing to good dietary practices.

Who changes body mass between adolescence and adulthood? Factors predicting change in BMI between 16 year and 30 years in the 1970 British Birth Cohort

OBJECTIVE

To examine whether factors common to obesity prevention programmes in adolescence, namely exercise, sedentary activities, eating behaviours and psychological factors, predict change in BMI in 'free-living' adolescents followed into adulthood.

DESIGN

Longitudinal national birth cohort study.

SUBJECTS

1970 British Birth Cohort: 4461 subjects with data on BMI at 16 years (1986) and 30 years (2000).

MEASUREMENTS AND ANALYSIS

BMI z-score (zBMI) at 16 years (measured) and 30 years (self-reported). Obesity defined as BMI exceeding 95th British centile and 28.5 kg/m2, respectively. Self-report data on exercise, eating behaviours, dieting and measures of psychological function (depression, psychological distress, self-esteem) at 16 years. Models were produced for the regression of zBMI at 30 years on each variable at 16 years, adjusted for socioeconomic status, sex and zBMI at 16 years.

RESULTS

In all, 467 (8.2%) were obese at 16 years and 730 (16.4%) were obese at 30 years. Of those obese at 16 years, 60.7% were also obese at 30 years. Loss of zBMI between 16 and 30 years was predicted by female sex (P=0.01), higher social class (P<0.0001) and higher frequency of playing sport, although this was of borderline significance (P=0.05). Increase in zBMI between 16 and 30 years was predicted by 4 or more hours per day of sedentary activities (P=0.01), eating takeaway meals twice or more per week (P=0.009), consuming two or more carbonated drinks per day (P=0.04) and a history of dieting to lose weight (P=0.04).

CONCLUSION

These data from 'free-living' adolescents followed into adult life support the importance of known risk factors such as reduction of sedentary behaviours and reduction of unhealthy eating patterns (consumption of carbonated drinks and takeaway foods, dieting) in the prevention of the persistence of obesity from childhood into adult life.

Classroom Racial Proportion: Influence on Self-Concept and Social Competence in Zimbabwean Adolescents

The authors measured self-concept and social competence relationships in 372 Zimbabwean adolescents (41% Black, 59% White) who attended classrooms in which they were either a racial minority or a racial majority (M age = 12.95 years, SD = 1.47). The authors used self-, peer-, and teacher-rating scale sociometric measures of social competence and a multidimensional measure of self-concept. The regression analysis predicted self-concept from social competence measures. Teacher-rated social competence predicted physical appearance self-concept in the Black adolescents and reading self-concept in White adolescents in White-majority classrooms. Self-rated social competence and peer-rated social competence predicted school self-concept in Black adolescents attending Black-majority classrooms. The authors concluded that classroom racial proportions influence aspects of social perception of Black and White adolescents.

The Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) Study Design and Baseline Data

PURPOSE

The purpose of this study was to describe the baseline characteristics of subjects and methods for a multicenter, randomized clinical trial to compare the effects of contact lens wear and spectacle wear on children's self-perception.

METHODS

Eligible subjects are randomly assigned to wear glasses or contact lenses throughout the 3-year study. Self-perceptions are measured 1 month after randomization and every 6 months using the Self-Perception Profile for Children (SPPC). Children's satisfaction with spectacles and refractive error-related visual quality of life are also measured using surveys developed for the study. Visual acuity, cycloplegic autorefraction, corneal curvature, and axial dimensions are measured annually.

RESULTS

Five clinical sites enrolled 484 subjects with a mean (+/- standard deviation [SD]) age of 10.4 +/- 1.1 years. Approximately three-fifths of the subjects are girls, 47.1% of the subjects are white, 21.5% are black, and 21.5% are Hispanic. The mean (+/- SD) cycloplegic spherical equivalent autorefraction of the right eye is -2.38 +/- 1.04 D, and the average (+/- SD) axial length of the right eye is 24.32 +/- 0.77 mm. The average (+/- SD) Global Self-Worth score on the SPPC is 3.20 +/- 0.62 on a scale from one (low perceived competence) to 4 (high perceived competence). The average (+/- SD) spectacle satisfaction is 59.1 +/- 26.6 on a scale from zero (no satisfaction) to 100 (perfect satisfaction). The average refractive error-related quality of life score is 63.5 +/- 12.8 on a scale from zero (poor quality of life) to 100 (excellent quality of life).

CONCLUSIONS

Subjects enrolling in the ACHIEVE Study are an ethnically diverse group of young myopic children. Ocular characteristics of the sample are consistent with data presented in other randomized clinical trials evaluating treatments for myopic children. The data reported here represent the baseline data for a 3-year randomized clinical trial to investigate the effects of contact lens vs. spectacle wear on children's self-perceptions.

Occlusal perceptions of children seeking orthodontic treatment: Impact of ethnicity and socioeconomic status

INTRODUCTION

With the growth of orthodontic intervention at younger ages and increased interest in improving dentofacial appearance among the general public, it is important to assess whether demand for treatment is uniform across ethnic and socioeconomic groups.

METHODS

This study compared 3 groups of children who varied by location, payment source, and ethnicity. The sample consisted of 150 children in the Bronx, NY, and 100 in Seattle, Wash, who were undergoing or anticipating orthodontic treatment in publicly funded dental clinics. Ethnic minorities comprised 69% and 92%, respectively, of these groups. The third group consisted of 84 children in Seattle, Anchorage (Alaska), and Chicago who had sought treatment by private practitioners; ethnic minorities comprised 22% of this group. Data were collected from children and parents or guardians by questionnaires.

RESULTS

Desire for treatment was higher among children in the publicly funded clinics and among black children than whites or Asian Americans. Children in publicly funded clinics rated themselves as having worse occlusions as determined by anterior crowding, overbite, overjet, diastema, and open bite. Children in the Bronx clinic accepted a wider range of occlusion as attractive. Stage of treatment affected judgments of attractiveness. Vicarious experience with orthodontics through parents or siblings made children more tolerant of dentofacial disharmony, with more favorable ratings of malocclusion in this group than among children who had no family experience with orthodontics. Hispanic and mixed-ethnicity children rated themselves more negatively on all dimensions.

CONCLUSIONS

These results suggest that both socioeconomic status and ethnicity play roles in children's desire for treatment, self-assessed need, and judgments of esthetics. A clinician's sensitivity to such differences can improve patient cooperation with treatment.

Physical Activity, Aerobic Fitness, Self-Perception, and Dietary Intake in At Risk of Overweight and Normal Weight Children

Differences in physical activity, aerobic fitness, self-perception, and dietary intake were examined in a sample of six- to ten-year-olds at risk of overweight, and in normal weight boys and girls. Participants (n=20 at risk of overweight [BMI ≥85th percentile]; n=115 normal weight [BMI <85th percentile]; n=68 boys; n=67 girls) had anthropometric, physical activity, aerobic fitness, self-perception, and dietary intake measurements at zero, three, six, and 12 months. Over the 12-month period, normal weight children were more physically active (F=4.1, p<0.05) and aerobically fit (F=14.3, p<0.001), and possessed higher self-perceptions of social acceptance (F=7.3, p<0.01) than their at risk of overweight peers. Fitness differences between the sexes were not apparent at baseline, but emerged over the long term (F=7.9, p<0.01). Overall, boys consumed more total energy, fat, carbohydrate, and protein than did girls, while the entire sample consumed diets low in vegetables and fruits and meat and alternatives, and high in “other” foods. These observations highlight key disparities in lifestyle-related behaviours and perceptions between groups of children according to overweight status and sex. The findings underscore the importance of longitudinal studies in youth because cross-sectional studies may reflect transient differences.

The impact of obesity on psychological well-being

Children and adolescents with obesity face stigmatization and discrimination in many areas of their lives, and it has been assumed that their psychological well-being will be compromised as a result. This chapter examines the most recent empirical evidence on the relationship between childhood obesity and body dissatisfaction, self-esteem and depression. Studies of clinical samples typically report poorer psychological well-being in treatment seekers when compared with population-based obese and normal weight controls. However, research in community samples suggests that despite moderate levels of body dissatisfaction, few obese children are depressed or have low self-esteem. A number of important moderators and mediators of the association between obesity and well-being have emerged, with females, Caucasians and adolescents being particularly at risk. Implications for treatment and future research priorities are suggested.

High self-esteem among adolescents: longitudinal trends, sex differences, and protective factors

PURPOSE

To better characterize self-esteem and to identify factors in early adolescence associated with high self-esteem in later adolescence.

METHODS

The National Education Longitudinal Study provided a random, nationally representative sample of 8th grade adolescents who completed surveys in grades 8, 10, and 12 (n = 16,489). We measured changes in self-esteem, and high versus low self-esteem. By using the Developmental Assets Model, predictor variables were selected to include intrinsic developmental assets (e.g., decision making) and extrinsic assets (e.g., safety). Logistic regression with separate modeling for sex identified assets that were predictive of high self-esteem, controlling for sociodemographic factors.

RESULTS

Boys versus girls were more likely to report high self-esteem in all grades (all p < .001). For girls, factors predictive of high self-esteem in grade 12 were as follows: African-American (odds ratio [OR] = 2.06) or Hispanic (OR = 1.52) race/ethnicity, positive family communication (OR = 3.03), safety (OR = 1.50), and high self-esteem (OR = 3.03). For boys, factors were family income being above the federal poverty level (OR = 1.50), positive family communication (OR = 2.40), safety (OR = 1.41), religious community (OR = 1.21), and high self-esteem (OR = 3.01) (all p < .05).

CONCLUSIONS

Fewer adolescent girls than boys report high self-esteem. Adults may foster self-esteem in adolescents by providing positive communication through supportive and caring relationships.

Impact of the media on adolescent body image

The mass media have become a powerful force throughout the world and strongly influence how people see themselves and others. This is particularly true for adolescents. This article discusses how the media affect body image and self-esteem and why the media seem to have such strong effects on adolescents. The differences in responses to the media in adolescents of different ethnic, racial, and cultural backgrounds are discussed. Although this article focuses primarily on teenage girls, the data for adolescent boys is reviewed as well. Finally, this article discusses possible ways to help adolescents become more active viewers of the media and help prevent the decrease in body esteem that so often occurs during adolescence.

Evaluating the Self-esteem of Myopic Children Over a Three-Year Period: The COMET Experience

PURPOSE

The purposes of this study were to evaluate self-esteem over 3 years in the 469 myopic children participating in the Correction of Myopia Evaluation Trial (COMET), and to examine its relationship with lens assignment (progressive addition lenses [PALs] vs. single-vision lenses [SVLs]), myopia progression, and several other ocular and demographic characteristics.

METHODS

Data collection included refractive error measurements, child-reported visual symptoms, attitude toward glasses, adherence, and self-esteem as measured by the Self-Perception Profile for Children (SPPC). A two-way analysis of variance (treatment group x time) was performed to examine whether PAL and SVL wearers differed in self-esteem over time. Multiple regression analyses were used to evaluate associations between self-esteem at follow-up and relevant factors identified by univariate analyses.

RESULTS

Regardless of lens assignment or myopia progression, COMET children reported moderate to high levels of self-esteem at follow-up in the areas of scholastic and athletic competence, physical appearance, social acceptance, behavioral conduct, and global self-worth. Mean scores ranged from 2.87 (+/- 0.68) on athletic competence to 3.40 (+/- 0.56) on global self-worth. Self-esteem changed significantly (p < 0.05) over 3 years in the domains of scholastic competence, social acceptance, and physical appearance. Self-esteem at follow-up was associated with visual symptoms, attitude toward glasses, age, gender, and ethnicity.

CONCLUSIONS

Lens assignment and myopia progression were not associated with self-esteem in the COMET cohort. These children had high levels of self-esteem, suggesting that having myopia does not negatively impact self-esteem. Follow-up reports will monitor self-esteem and related factors in this cohort of myopic children over the course of adolescence and early adulthood.