Gender orientation and alcohol-related weight control behavior among male and female college students

Unification of the food and alcohol disturbance literature: A systematic review

Food and alcohol disturbance (FAD) reflects the functional relationship between disordered eating and alcohol use. There are two motivations underlying FAD - to enhance the effects of alcohol and/or to compensate for alcohol-related calories. Yet, most FAD studies have failed to adequately measure the motives underlying these behaviors, leading to inconsistent and imprecise findings. The aim of the current systematic review was to thematically consolidate FAD research findings by motive, identify limitations of the existing literature, and highlight next steps for FAD researchers. Eighty-one publications, presenting data from 38,536 participants, were included in the current review. Prevalence rates for the caloric compensation and alcohol enhancement motives range from 5.6% - 88.7% and 4.7% - 81.7%, respectively. Alcohol use and disordered eating were the primary correlates of FAD for both motives, and alcohol-related consequences were positively associated with both FAD motives cross-sectionally. Major limitations of the literature include inconsistent operationalization and imprecise measurement of FAD. Primary recommendations include adopting the terminology of and operationalization of FAD presented here, ensuring attention to FAD motive in developing and testing research questions, and moving beyond cross-sectional studies. Findings from this review can be used to contribute to more rigorous and unified FAD research.

Failure to confirm the factor structure of the CEBRACS: An assessment of food and alcohol disturbance

Objectives: Food and Alcohol Disturbance (FAD) is the phenomenon in which individuals exhibit co-occurring hazardous alcohol and eating behaviors to either negate caloric intake associated with alcohol and/or maximize intoxication. While the Compensatory Eating and Behaviors in Response to Alcohol Scale (CEBRACS) is the most widely used measure to assess FAD to date, its factor-structure has yet to be confirmed. Methods: The current study utilized confirmatory factor analysis (CFA) to examine the CEBRACS' four factor subscales as well as recently proposed alternative scoring structures. Participants: Participants (N = 582) were American college students from seven universities (18-24 years; 67% cisgender women; 70% non-Hispanic White). Results: The CFA failed to provide optimal fit for all models tested. Results of invariance testing found no measurement variance by sex, suggesting the failure of the four-factor solution was not due to noninvariance. Conclusions: Overall, findings do not support continued use of the original 21-item CEBRACS.

Examining the mediating effect of real and cyber self-control on cyberbullying and health risk behaviors among secondary vocational students in China: a cross-sectional study

BACKGROUND

Cyberbullying and health risk behaviors are pervasive issues for secondary vocational students that not only detrimentally impact their academic achievement but also pose a significant threat to overall health. The purpose of this study was to understand the current situation of cyberbullying and health risk behaviors among secondary vocational students in China and to explore the relationships among cyberbullying, self-control, self-control over internet usage, and health risk behaviors through a mediation model.

METHODS

This was a cross-sectional study. From March to April 2023, a self-administered questionnaire was completed by a cluster sample of 1184 students from grades 1 to 3 at three secondary vocational schools in Jilin Province. The researchers utilized a sociodemographic questionnaire, the Cyberbullying and Cybervictimization Scale (CAV), the Adolescent Health Related Risky Behavior Inventory (AHRBI), the Self-Control Scale (SCS), and the Internet Usage Self-Control Scale (IUSCS-CS) to assess the prevalence and impact of cyberbullying and health risk behaviors. Descriptive statistics, spearman correlation analyses. Finally, the Process plug-in V2.16.3 was used to analyze a mediation model for the data.

RESULTS

Among secondary vocational students, 839 individuals (70.86%) experienced cyberbullying and 1036 individuals (87.50%) had one or more health risk behaviors. A chi-square test showed that the differences in cyberbullying incidence were statistically significant (P < 0.05) for being children, type of accommodation, residence, ethnicity, purpose of using the internet, and family composition. Statistically significant differences in health risk behaviors were observed based on gender, type of accommodation, residence, ethnicity, academic achievement, classmate relationships, purpose of using the internet, and family composition (P < 0.05). Health risk behaviors and cyberbullying were correlated (r = 0.60), health risk behaviors and self-control and internet usage self-control were negatively correlated (r = -0.42, -0.50). Mediation analysis indicated that self-control (0.02, 0.08) and internet usage self-control (0.08, 0.17) partially mediated the association between cyberbullying and health risk behaviors.

CONCLUSIONS

Secondary vocational students exhibit a high prevalence of cyberbullying and health risk behaviors. The study confirmed that self-control and internet usage self-control has an important role in mediating cybeibullying and health risk behaviors. Adolescent health promoters should develop targeted strategies to enhance the self-control of secondary vocational school students to mitigate their engagement in health risk behaviors.

Weight-control compensatory behaviors patterns and correlates: a scoping review

Objective

Weight-control compensatory behaviors appear to be a commonly utilized strategy for health management. Individuals engaging in such behaviors believe that the negative consequences from unhealthy behaviors will be neutralized by the positive consequences of healthy behaviors. Existing research has not reached a consensus on whether such behaviors are beneficial to health. This review aims to (1) summarize the patterns of weight-control compensatory health behaviors in different populations, (2) highlight correlates, predictors, and consequences of compensatory health behaviors, and (3) identify gaps for future research.

Method

This review identified existing literature using online databases, CINAHL and PubMed. Primary research articles published after 2000 with non-clinical participants of 12 years or older who engaged in compensatory behaviors for weight control purposes were selected. Descriptive statistics were extracted from 35 studies.

Results

Different patterns for weight-control compensatory behaviors emerged between the female and male sexes. Meanwhile, no clear association of such behaviors was found across weight status. Studies reviewed also highlighted three main areas of compensatory behaviors for weight management, namely dietary behaviors, physical activity, and alcohol consumption. Weight-control compensatory behaviors had significant negative correlations with mental health indicators, such as psychosocial functioning, emotional differentiation ability, and body esteem.

Conclusion

Weight-control compensatory behaviors may be a widely used weight management strategy and can be presented in diverse ways. Although believed to be promoting health, such behaviors appear to be associated with poor psychological well-being. This emerging topic warrants more in-depth investigation to establish the direction of causation. Future research may investigate the relationship between weight-control compensatory behaviors and various aspects of health over longer time periods, examine the engagement of multiple weight-control compensatory behaviors, and focus on high-risk populations.

Drunkorexia and trait mindfulness among college students

Objective: Combined alcohol and disordered eating (drunkorexia) are alcohol fueled weight management behaviors. Mindfulness negatively relates to both disordered eating and alcohol use. Participants: Participants (n = 344, average age 20) were primarily female (85.2%, n = 293), and Caucasian (82.6%, n = 284). Methods: Students reported drunkorexia and mindfulness. Results: Drunkorexia behaviors were negatively correlated with Acting with Awareness (AA; full attention to a present moment; r = -.21, p < .001) and Nonjudgment (NJ; understanding and leniency toward oneself; r = -.22, p < .001). Drunkorexia motivations are significantly correlated with AA (r = -.13, p = .01) and NJ (r = -.18, p = .001). Structural equation modeling revealed higher levels of NJ related to higher levels of drunkorexia. Conclusion: The objective was to determine a potential relationship between drunkorexia behaviors and motivations, and trait mindfulness. Findings suggest a nonjudgmental disposition relates to lower levels of drunkorexia.

Food and alcohol disturbance among US college students: a mixed methods scoping review

OBJECTIVE

Conduct a scoping review of food and alcohol disturbance (FAD) in US college students to overview the literature within this population and identify research opportunities.

METHODS

Studies (n = 39) were selected using systematic searches of databases and references. Search terms included: drunkorexia, "food and alcohol disturbance," and "compensatory behavior" AND alcohol AND eating.

RESULTS

Issues with methodological quality were noted. Most studies used quantitative methods and cross-sectional designs with small, biased samples. Terminologies, conceptualizations, and measures varied; however, 30% of studies neglected enhanced intoxication effects. Prevalence ranged from approximately 10-55%, with greater risk for women. Alcohol use and disordered eating were primary predictors. Personality, affective, and social factors are potential correlates. Alcohol-related consequences were higher for those with FAD.

CONCLUSIONS

While the literature is inconsistent and unclear, FAD appears to be common among college students and associated with negative consequences. Suggestions and considerations for future research are provided.

Examining gender and the longitudinal effect of weight conscious drinking dimensions on body mass index among a college freshman cohort

Objective: This study aims to: (1) examine gender differences for weight conscious drinking among college students accounting for the broader phenomenon (e.g. including the Alcohol Effects dimension); and (2) longitudinally examine the effect of weight conscious drinking behaviors on body mass index (BMI). Participants: United States freshmen students from eight participating universities (N= 1,149). Methods: Structural equation modeling was used to model the effect of gender on weight conscious drinking dimensions at 7-month follow-up. Results: Findings suggest a significant effect of gender on Alcohol Effects (β = -.15, SE = .05, p = .005) at 7-month follow-up among college freshmen. Weight conscious drinking dimensions predicted no significant change in BMI at 7-month follow-up among college freshmen. Conclusion: Findings contribute to weight conscious drinking theory and provide campus weight conscious drinking prevention initiatives with evidence to tailor their programming to address female tendencies to engage in compensatory strategies to enhance the psychoactive effects of alcohol.

Food and alcohol disturbance among young adults during the COVID-19 lockdown in Italy: risk and protective factors

PURPOSE

The COVID-19 lockdown measures have had a significant impact on risk behaviors as alcohol use and disordered eating. However, little is known about a serious health-risk-behavior named "food and alcohol disturbance" (FAD), characterized by engaging in dysfunctional eating on days of planned alcohol consumption. The aim of the present study was to investigate potential factors that may have put young adults at risk or protected against FAD during the COVID-19 lockdown.

METHODS

A sample of 447 young adults (280 females, 167 males; range 18-26) completed an online survey during the country's nationwide lockdown composed of self-reported measures assessing FAD behaviors, alcohol consumption, compensatory behaviors, eating and weight concerns, social support, emotion regulation strategies, and living arrangement.

RESULTS

Our findings showed that FAD was significantly and positively correlated to alcohol consumption, use of laxatives, self-induced vomiting, eating and weight concerns, and expressive suppression, and negatively correlated to social support and living with family. Hierarchical regression analysis revealed that alcohol consumption, eating concern, and expression suppression positively predicted FAD, while social support and living with family were negative predictors.

CONCLUSIONS

Our results suggest that during the COVID-19 lockdown, preoccupation with eating and the use of expressive suppression may have increased vulnerability to FAD; conversely, perceived social support and living with family may have been a source of protection against this dysfunctional behavior.

LEVEL OF EVIDENCE

Level V, descriptive study.

Compensatory physical activity: Impact on type of physical activity and physical activity habits among female young adults

Engaging in physical activity (PA) to compensate for drinking-related calories is common among female college students. The objective was to test whether frequency of compensatory PA was associated with type of PA (Study 1) and PA habit strength (Study 2). Study 1 utilized a cross-sectional design. Female undergraduates (N = 198) completed questionnaires assessing frequency of compensatory PA and PA types. In Study 2, female undergraduates (N = 280) were assessed on frequency of compensatory PA at Time 1 and PA habit strength at Time 2, 4-weeks later. Study 1 revealed that frequency of compensatory PA was significantly related to high intensity PA but was unrelated to low or moderate intensity PA. Study 2 revealed that frequency of compensatory PA at Time 1 was a significant predictor of PA habit strength at Time 2. The studies advance our understanding of the immediate and long-lasting impact of compensatory PA on behaviors and habits.

Dietary self-monitoring is associated with increased likelihood of problematic alcohol use among college students

Objective: To assess the relationship between dietary self-monitoring and problematic alcohol use including binge drinking, increased body confidence while drinking, and restricting food intake to compensate for alcohol consumption, among college students. Participants: Undergraduate and graduate students from 12 US colleges participating in the Healthy Bodies Study in 2013-2014 and 2014-2015 school years (n = 10,133). Methods: Weighted prevalence was calculated for dietary self-monitoring and problematic alcohol use. Gender-stratified logistic regressions were used to assess relationships. Results: Knowing nutrition facts was associated with restricting to compensate for alcohol consumption among women (OR = 2.42, p < .0001) and men (OR = 1.64, p = .002). Among women, knowing and counting calories predicted all problematic alcohol use behaviors. Among men, knowing calories was associated with restricting to compensate (OR = 2.69, p < .0001) and counting calories was associated with restricting to compensate (OR = 5.10, p < .0001) and increased body confidence while drinking (OR = 2.25, p < .0001). Conclusions: Dietary self-monitoring predicts problematic alcohol use among college students, particularly women.

'Joining the Dots': Individual, Sociocultural and Environmental Links between Alcohol Consumption, Dietary Intake and Body Weight-A Narrative Review

Alcohol is energy-dense, elicits weak satiety responses relative to solid food, inhibits dietary fat oxidation, and may stimulate food intake. It has, therefore, been proposed as a contributor to weight gain and obesity. The aim of this narrative review was to consolidate and critically appraise the evidence on the relationship of alcohol consumption with dietary intake and body weight, within mainstream (non-treatment) populations. Publications were identified from a PubMed keyword search using the terms 'alcohol', 'food', 'eating', 'weight', 'body mass index', 'obesity', 'food reward', 'inhibition', 'attentional bias', 'appetite', 'culture', 'social'. A snowball method and citation searches were used to identify additional relevant publications. Reference lists of relevant publications were also consulted. While limited by statistical heterogeneity, pooled results of experimental studies showed a relatively robust association between acute alcohol intake and greater food and total energy intake. This appears to occur via metabolic and psychological mechanisms that have not yet been fully elucidated. Evidence on the relationship between alcohol intake and weight is equivocal. Most evidence was derived from cross-sectional survey data which does not allow for a cause-effect relationship to be established. Observational research evidence was limited by heterogeneity and methodological issues, reducing the certainty of the evidence. We found very little qualitative work regarding the social, cultural, and environmental links between concurrent alcohol intake and eating behaviours. That the evidence of alcohol intake and body weight remains uncertain despite no shortage of research over the years, indicates that more innovative research methodologies and nuanced analyses are needed to capture what is clearly a complex and dynamic relationship. Also, given synergies between 'Big Food' and 'Big Alcohol' industries, effective policy solutions are likely to overlap and a unified approach to policy change may be more effective than isolated efforts. However, joint action may not occur until stronger evidence on the relationship between alcohol intake, food intake and weight is established.

Drunkorexia: is it really "just" a university lifestyle choice?

PURPOSE

The current study investigated the prevalence of compensatory behaviours (caloric restriction, increased exercise and bulimic tendencies) in response to alcohol consumption (also known as Drunkorexia) in students, non-students and previous students, as well as beginning to understand the presence of possible predictors of these behaviours (body esteem, sensation seeking).

METHODS

A volunteer sample of students, non-students and previous students (n = 95) completed the Compensatory Eating and Behaviours in Response to Alcohol Consumption Scale, a questionnaire which measures overall Drunkorexia engagement. The participants also completed the Body Esteem Scale for Adolescents and Adults Scale (BESAA) and the Brief Sensation Seeking Scale (BSSS) to investigate predictors of Drunkorexia.

RESULTS

The results indicated that there was no significant difference in Drunkorexia engagement and behaviours between students, non-students and previous students. It was also found that both low body esteem and high sensation seeking tendencies were significant predictors of Drunkorexia; specifically, the appearance esteem factor of the BESAA and the disinhibition factor of the BSSS.

CONCLUSIONS

Findings suggest that Drunkorexia is also present outside of student populations, and therefore, future interventions and research should include non-students in samples. In addition, findings support the idea that Drunkorexia cannot be classified solely as an eating disorder or a substance abuse disorder. As a result of this, further research should be conducted to fully understand why this complex behaviour exists.

EVIDENCE-BASED MEDICINE LEVEL

III (Evidence obtained from case-control analytic study).

Baseline cortisol predicts drunkorexia in female but not male college students

"Drunkorexia" or compensatory eating behaviors in response to alcohol consumption, resembles a subclinical eating disorder, and is a current public health concern. Eating disorders and alcohol abuse are associated with dysfunction of the hypothalamic-pituitary-adrenal axis (HPA). One index of HPA function is cortisol. As causes of drunkorexia remain elusive, the present study examined cortisol function as it relates to drunkorexia. Participants:n = 73 (49 women) college students. Method: Participants provided daytime saliva samples for cortisol analyses prior to completing an online survey measuring alcohol consumption, drunkorexia, and alcohol problems as measured by the Rutgers Alcohol Problem Index (RAPI). Results: Multiple regressions indicated that baseline cortisol significantly positively correlated with drunkorexia behaviors in women but not men. Higher baseline cortisol and aspects of drunkorexia related to alcohol problems. Conclusion: Programs educating about stress management and health risks of drunkorexia may decrease engagement in drunkorexia behaviors among college students.

Reexamination of the psychometric properties of the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) and exploration of alternative scoring

OBJECTIVE

The primary aims of this paper were to reexamine the factor structure of the 21-item Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS), a measure of Food and Alcohol Disturbance (FAD), and investigate an alternative scoring structure. FAD is the use of disordered eating behaviors within an alcohol use episode to compensate for alcohol-related calories and/or increase effects of alcohol. The new scoring approach captures FAD behaviors based on whether they occurred before, during, or after alcohol use.

METHOD

Participants were 586 young adults (18-30 years; 77.6% female; 55.8% non-Hispanic White) who completed online questionnaires on alcohol use, disordered eating behaviors, and FAD.

RESULTS

Confirmatory factor analyses did not provide unequivocal evidence for any previously proposed factor structures of the CEBRACS. Exploratory factor analysis suggested items capturing FAD "Before" drinking had a two-factor structure (i.e., Alcohol Effects and Compensatory Behaviors), items capturing FAD "During" drinking had a three-factor structure (i.e., Alcohol Effects, Diet & Exercise, and Extreme Weight Control Behaviors [EWCB]), and items capturing FAD "After" drinking had a two-factor structure (i.e., Diet & Exercise & EWCB).

DISCUSSION

The CEBRACS factor structure is not consistent across samples; however, despite suboptimal fit, the original structure remains the best approach to capture FAD behaviors. The alternative scoring reflects FAD behaviors based on when they occur relative to alcohol use. The two scoring approaches provide researchers and clinicians flexibility to describe FAD behaviors in multiple ways using the CEBRACS.

Emotion dysregulation as a correlate of food and alcohol disturbance in undergraduate students

Disordered eating behaviors (e.g., binge eating, food restriction, self-induced vomiting, and laxative use) as well as alcohol use and related issues are prevalent in undergraduate students and are often comorbid with one another. Recently, the unique combination of these behaviors, termed food and alcohol disturbance (FAD), has received empirical attention. FAD involves compensatory behaviors performed in preparation for, or in response to, alcohol use in order to counteract calories consumed from alcohol and/or to increase intoxication. Research on FAD is sparse; in particular, there is a lack of consensus regarding potential gender differences in FAD and a lack of knowledge concerning psychological correlates of these behaviors. Emotion dysregulation is a transdiagnostic correlate of psychopathology, including disordered eating and alcohol use, and therefore may relate to FAD. The present study used a cross-sectional design to examine associations between emotion dysregulation and FAD, as well as gender differences in this relationship, in a sample of male and female undergraduate students (N = 417; 51.8% female). There were no gender differences in FAD, and the associations between emotion dysregulation and FAD did not vary among men and women. FAD was positively associated with emotion dysregulation at the bivariate level, but emotion dysregulation was not uniquely associated with FAD after accounting for disordered eating, alcohol use and problems, and body mass index. Future research should extend the current findings by examining temporal associations between emotions, emotion dysregulation, and FAD.

Young Adult Women and Alcohol-Related Problems: The Key Role of Multidimensional Feminine Norms

Young adult college women are closing the gender gap with respect to heavy episodic drinking and alcohol-related problems. Accordingly, it is important to understand and examine the factors that help explain within-group differences in problematic drinking patterns among this vulnerable population. One promising theoretically-relevant factor that appears to explain problematic alcohol use among young adult women is conformity to multidimensional feminine norms. Feminine norms are the beliefs and/or expectations of what it means to be a woman. This review paper identifies the current trends and limitations of research examining the role of feminine norms on alcohol use among young adult women in college. The review of the literature suggests that relationship between feminine norms and alcohol problems is complex in that there are costs and benefits for endorsing and opposing different feminine norms. Women who endorse appearance and relational feminine norms such as striving to be thin, focusing on their appearance, and maintaining relationships are at heighten risk of engaging in heavy episodic drinking and alcohol problems. Women who endorse feminine norms including maintaining sexual relationships with one partner, endorse the belief that one should be modest, and sweet, and nice, and upholding domestic values are less likely to report alcohol problems. Clinical and future research recommendations are provided.

Exploring the links between unhealthy eating behaviour and heavy alcohol use in the social, emotional and cultural lives of young adults (aged 18-25): A qualitative research study

Alcohol use peaks in early adulthood and can contribute both directly and indirectly to unhealthy weight gain. This is the first qualitative study to explore the links between unhealthy eating behaviour and heavy alcohol use in the social, emotional and cultural lives of young adults. We conducted 45 in-depth interviews with 18-25-year-olds in North-East England to inform development of a dual-focused intervention to reduce health risk due to excess weight gain and alcohol use. Data were analysed thematically, following the principles of constant comparison, resulting in three intersecting themes: (1) how food and alcohol consumption currently link together for this population group; (2) influences upon linked eating and drinking behaviours and (3) young adults' feelings and concerns about linked eating and drinking behaviours. Socio-cultural, physical and emotional links between food and alcohol consumption were an unquestioned norm among young adults. Eating patterns linked to alcohol use were not tied only to hunger, but also to sociability, traditions and identity. Young adults conceptualised and calculated risks to weight, appearance and social status, rather than to long-term health. This study is the first to evidence the deeply interconnected nature of food and alcohol consumption for many young adults. Findings have important implications for intervention development, UK public health policy and practice, and point to a need for similar research in other countries.

Drunkorexia: A new term and diagnostic criteria

Individuals who restrict their caloric intake and/or exercise excessively to mitigate the calories from alcohol consumption may suffer from an eating disorder, substance abuse disorder, or both. While the term "drunkorexia" has been used in both academic articles and popular culture, issues persist with respect to diagnosing and treating this condition. Classifying the behavior as a subcategory of Other Specified Feeding and Eating Disorders (OSFED) would provide patients with an increased likelihood of receiving insurance coverage for this condition. A consistent definition of this behavior and a more medically accurate/appropriate term-such as "alcoholimia"-are both needed to advance treatment and prevention efforts.

The association between Food and Alcohol Disturbance (FAD), race, and ethnic identity belonging

PURPOSE

A growing body of literature has established that food and alcohol disturbance (FAD: decreasing one's caloric intake in preparation for alcohol consumption) is a specific health risk that endangers health and wellbeing. Recent research on trends in FAD has revealed ethno-racial disparities. A sociological analysis is helpful to center race and examine the role of ethnic identity in reproducing health disparities. The current study is guided by theories of socialization into ideal body types by race.

METHODS

Study uses data from a cross-sectional survey conducted among college students. The sample includes White and Black American college students, ages 18-25, and uses ordinal logistic regression to test for the impact of race and ethnic identity on engagement in FAD using the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS).

RESULTS

FAD prevalence was lower among Black Americans than among White Americans in the sample. Results from ordered logistic regression models indicate that stronger ethnic ties reduce likelihood of FAD among Black Americans but have the opposite effect among White Americans. This modification effect provides evidence that ethnic identity belonging protects against FAD for Black Americans but acts as a risk factor for FAD among White Americans.

CONCLUSIONS

Findings shed light on the documented racial disparities in FAD and weight control behavior more broadly. Ethnic identity modifies the relationship between race and FAD in our sample.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Gender differences in relations between alcohol-related compensatory behavior and eating pathology

PURPOSE

Concerns about caloric intake associated with alcohol use (e.g., fear of weight gain) are positively associated with compensatory eating behaviors (e.g., caloric restriction, self-induced vomiting), a phenomenon that has been identified across gender. Specific motivations for compensatory behaviors differ; some relate to eating disorder (ED) pathology (e.g., shape and weight concerns), and others to alcohol (e.g., enhancing effects). Research examining motivations for alcohol-related compensatory behaviors in men is limited to date. The current study sought to assess how specific types of alcohol-related compensatory behaviors and their association with ED pathology present differently by gender.

METHODS

Undergraduates (N = 530, 48% female) completed the Compensatory Eating Behaviors in Response to Alcohol Consumption Scale (CEBRACS), Eating Disorders Diagnostic Scale (EDDS), and reported height, weight, and frequency and quantity of alcohol consumption. Data were examined using linear regression, and relations between CEBRACS behaviors and eating pathology were compared across gender.

RESULTS

Factors that were positively associated with EDDS scores for both men and women included alcohol-related dietary restraint, and exercise. For women, but not men, alcohol-related bulimic behavior also contributed to elevations in EDDS scores.

CONCLUSIONS

Findings indicate that specific types of alcohol-related compensatory eating behaviors (i.e., dietary restraint and exercise) are positively related to ED pathology for both male and female participants. In contrast, bulimic behaviors' association with ED pathology is gender specific. Understanding gender differences in alcohol-related compensatory behaviors and ED risk may inform gender-specific intervention targets.

LEVEL OF EVIDENCE

Cross-sectional descriptive study, Level V.

A study on the interplay between emerging adulthood and eating disorder symptomatology in young adults

PURPOSE

The primary aim of this study was to investigate the interplay between Arnett's five features of emerging adulthood and ED symptomatology. The secondary aim of the study was to investigate possible gender differences concerning the relation between emerging adulthood and ED symptomatology.

METHODS

337 university students (252 females and 85 males) participated in this study. Each participant was asked to anonymously complete the following questionnaires: Inventory of the Dimensions of Emerging Adulthood (IDEA), Eating Attitudes Test (EAT-26), and Social Physique Anxiety Scale (SPAS).

RESULTS

The female group scored higher in the EAT-26 diet, SPAS, IDEA self-focus and IDEA total score measurements. Additionally, in the female group, identity exploration was correlated with EAT-26 total and bulimia, experimentation/possibilities with EAT-26 total and diet, and negativity/instability with EAT-26 total, diet and bulimia as well as SPAS score. In the male groups, the only significant correlation was between SPAS and instability/negativity. Finally, identity exploration could predict a higher probability of developing ED (EAT ≥ 20) for both the female and male groups.

CONCLUSIONS

Emerging adulthood and ED were found to have a close relationship, especially for females. Identity exploration was the emerging adulthood factor that showed the highest relation to ED symptomatology in both the male and female groups. More research is necessary to investigate the specifics of this relationship.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Alcohol research with transgender populations: A systematic review and recommendations to strengthen future studies

BACKGROUND

There is a recent and growing research literature on alcohol use and related harms among transgender and other gender minority populations; however, current definitions and measures of hazardous drinking do not consider the complexity of physiological sex characteristics and socially constructed gender, raising doubts regarding their validity, applicability, and use with these populations. To address this, we reviewed current research on alcohol-related outcomes in transgender populations and critically summarized key issues for consideration in future research.

METHODS

We conducted a systematic review of transgender alcohol research in English language, peer-reviewed journals, published 1990-2017, and extracted key details (e.g., sample composition, alcohol measures, results).

RESULTS

Forty-four studies met all inclusion criteria for the review, the majority of which were conducted in the United States. The prevalence of hazardous drinking was high; however, estimates varied widely across studies. We noted frequent methodological weaknesses, including few attempts to differentiate sex and gender, poor attention to appropriate definitions of hazardous drinking, and reliance on cross-sectional study designs and non-probability sampling methods.

CONCLUSION

Given findings that suggest high need for ongoing public health attention, we offer recommendations to improve future alcohol studies with transgender and other gender minority populations, such as being explicit as to whether and how sex and/or gender are operationalized and relevant for the research question, expanding the repertoire of alcohol measures to include those not contingent on sex or gender, testing the psychometric performance of established screening instruments with transgender populations, and shifting from descriptive to analytic study designs.