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Hochgraf AK, Berge JM, Lanza ST. Age-varying associations between attempts to change weight and suicidal ideation among adolescents in the United States. Prev Med 2024; 182:107946. [PMID: 38574970 PMCID: PMC11084873 DOI: 10.1016/j.ypmed.2024.107946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/20/2024] [Accepted: 04/01/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE The goal of this study was to inform theory and suicide prevention efforts by examining how the link between attempts to change weight and suicidal ideation varies across adolescence, when it is strongest, and whether there are sex differences. METHODS Data were from 13,518 youth ages 14-18 years who participated in the 2019 Youth Risk Behavior Survey, a nationally representative study of U.S. high school students. Time-varying effect modeling was used to estimate associations between attempts to change weight and suicidal ideation as continuous functions of age and to test sex differences in these links. RESULTS The link between attempts to lose weight and suicidal ideation was positive and significant between ages 14.0-17.3 years, with the strongest association at age 15.0 (OR = 2.07). There were no sex differences in this age-varying association. The association between attempts to gain weight and suicidal ideation was positive and age-varying for girls, with the strongest association at age 17.2 years (OR = 2.79). This association was not significant for boys at any age. CONCLUSIONS Girls and boys who are trying to lose weight and girls who are trying to gain weight may be at elevated risk for suicidal ideation between ages 14 and 18 years. Findings illuminate patterns of association during adolescence and have implications for suicide prevention.
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Affiliation(s)
- Anna K Hochgraf
- Division of Epidemiology and Community Health, School of Public Health, The University of Minnesota, Minneapolis, MN, USA.
| | - Jerica M Berge
- Department of Family Medicine and Community Health, Medical School, The University of Minnesota, Minneapolis, MN, USA
| | - Stephanie T Lanza
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
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Goldman DM, Warbeck CB, Karlsen MC. Completely Plant-Based Diets That Meet Energy Requirements for Resistance Training Can Supply Enough Protein and Leucine to Maximize Hypertrophy and Strength in Male Bodybuilders: A Modeling Study. Nutrients 2024; 16:1122. [PMID: 38674813 PMCID: PMC11054926 DOI: 10.3390/nu16081122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Despite increasing awareness of plant-based diets for health and athletic performance, athletes are cautioned that careful dietary monitoring is necessary. Whether commonly consumed plant-based diets are nutritionally adequate for maximal muscular hypertrophy remains unknown. This modeling study assessed the nutrient composition of completely plant-based diets scaled to the caloric demands of maximal muscle mass and strength development in adult male bodybuilders. To model calorie requirements, anthropometric data from bodybuilders were input into the Tinsley resting metabolic rate prediction equation, and an appropriate physical activity factor and calorie surplus were applied. Dietary data from a large cohort following completely plant-based diets were then scaled to meet these needs. Modeled intakes for nutrients of interest were calculated as 1.8 g/kg/day of protein and 2.75 g/meal of leucine, which surpass mean requirements for maximal increases in muscle mass and strength and muscle protein synthesis, respectively. Daily levels for all micronutrients, except vitamin D, also exceeded requirements. Saturated fat levels were aligned with dietary guidelines, although sodium levels exceeded recommended limits. Consumption of larger portions of commonplace plant-based diets, scaled to meet the energy demands of maximal accrual of muscle mass and strength, satisfied protein and leucine requirements without the need for additional planning.
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Affiliation(s)
- David M. Goldman
- Department of Public Health, University of Helsinki, 00014 Helsinki, Finland
- Department of Research and Development, Metabite Inc., New York, NY 10036, USA
| | - Cassandra B. Warbeck
- Department of Family Medicine, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Micaela C. Karlsen
- Department of Research, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA;
- Departments of Applied Nutrition and Global Public Health, Adjunct Faculty, University of New England, Biddeford, ME 04005, USA
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Ganson KT, Pang N, Testa A, Jackson DB, Nagata JM. Associations between muscle dysmorphia symptomatology and sleep duration and difficulty in the Canadian Study of Adolescent Health Behaviors. Sleep Health 2024; 10:205-208. [PMID: 38413332 DOI: 10.1016/j.sleh.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/20/2023] [Accepted: 12/13/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Prior research has shown links between mental health symptomatology and poor sleep. However, associations between muscle dysmorphia symptomatology and poor sleep remain unknown, which was the aim of this study. METHODS Data from the Canadian Study of Adolescent Health Behaviors (2021-2022) were analyzed (N = 912). Multinomial logistic regression analyses and logistic regression analyses were used to determine the association between muscle dysmorphia symptomatology and average sleep duration (5 hours or less, 6 hours, 7 hours, and 8 or more hours) and difficulty falling or staying asleep over a 2-week period. RESULTS Findings indicated significant associations between muscle dysmorphia symptomatology and shorter sleep duration and greater sleep difficulty in both cross-sectional and prospective analyses. CONCLUSIONS The findings from this study underscore poor sleep as a correlate of muscle dysmorphia symptomatology among adolescents and young adults, emphasizing the need for screening and interventions in healthcare settings.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
| | - Nelson Pang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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Buchan MC, Richmond SA, Skinner K, Leatherdale ST. Identifying latent classes of physical activity profiles over time among adolescents in Ontario, Canada. BMC Public Health 2024; 24:856. [PMID: 38504203 PMCID: PMC10953222 DOI: 10.1186/s12889-024-18280-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Physical activity behaviours are known to be highly correlated. Adolescents who participate in one type of physical activity (e.g., physical education) have a greater likelihood of participating in other physical activities (e.g., organized sports); however, little research has examined participation rates in various physical activity behaviours concurrently. This study identified longitudinal physical activity profiles among secondary school aged youth in Ontario, Canada. METHODS We used data from the COMPASS Study, a school-based prospective cohort study of adolescents in Canada. Using a repeated measures latent class analysis, Ontario students who participated in grade 9 PE in 2015-16 were analysed through to 2018-19 (n = 1,917). Latent classes were defined by: PE participation, guideline adherence (≥ 60 min/day of moderate to vigorous activity over the last 7 days), and sport participation (varsity, community, and/or intramural). Multinomial logistic regression models were used to examine associations between latent class membership and student characteristics. RESULTS Three distinct latent classes were identified for females and four were identified for males. These classes were: (1) Guidelines (high probability of guideline adherence; females: 44%; males: 16%), (2) PE & Sports (high probability of PE and sport participation; females: 33%; males: 43%), (3) Guidelines & Sports (high probability of guideline adherence and sport participation; females: 23%; males: 23%;), and (4) Inactive (low probability of all physical activity indicators; males: 18%). Strength training, sleep, and English grade were associated with class membership among females. Ethno-racial identity, weekly spending money, strength training, and English and math grades were associated with class membership among males. CONCLUSIONS Findings suggest that latent physical activity profiles differ by sex. Guideline adherence was the most common class among females, indicating high levels of independent physical activity, whereas PE & Sport participation was the most common class among males, indicating greater tendency towards organized activities. Additionally, a substantial number of male students were not engaging in any physical activity. Participation in both PE and sports did not necessarily lead to meeting physical activity guidelines, highlighting that these activities alone may not be providing sufficient levels of physical activity that align with current recommendations for Canadian youth.
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Affiliation(s)
- M Claire Buchan
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G5, Canada.
| | - Sarah A Richmond
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T 3M7, Canada
- Public Health Ontario, Toronto, ON, M5G 1V2, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G5, Canada
| | - Scott T Leatherdale
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G5, Canada
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Ganson KT, Sinicropi E, Nagata JM. Analyzing Social Media Policies on Muscle-Building Drugs and Dietary Supplements. Subst Use Misuse 2024; 59:380-387. [PMID: 37919881 DOI: 10.1080/10826084.2023.2275557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
BACKGROUND Use of legal and illegal muscle-building drugs and dietary supplements has been linked to many adverse health and social outcomes. Research has shown that social media use is associated with the use of these drugs and dietary supplements; however, it remains unknown whether social media companies have specific policies related to the content and advertising of muscle-building drugs and dietary supplements on their platforms. Therefore, this study aimed to assess the content and advertising policies of eight popular social media companies related to muscle-building drugs and dietary supplements. METHODS Content and advertising policies for YouTube, TikTok, Instagram, Snapchat, Facebook, Twitter, Twitch, and Reddit were analyzed in November 2022 to determine whether there were any provisions related to legal (e.g., whey protein) and illegal (e.g., anabolic-androgenic steroids) muscle-building drugs and dietary supplements. Policies were classified as either none, restricted, or prohibited. RESULTS All eight social media platforms had explicit policies prohibiting user-generated content and advertising of illicit drugs and substances (e.g., anabolic-androgenic steroids). User-generated content and advertising policies related to legal muscle-building dietary supplements across the platforms varied; however, none of the eight social media companies had a specific policy regarding user content. CONCLUSIONS Findings underscore the need for stronger social media content and advertising policies related to legal muscle-building dietary supplements.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Eliana Sinicropi
- Munk School of Global Affairs and Public Policy, University of Toronto, Toronto, ON, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Mueller VM, Forrer F, Meyer AH, Munsch S. Psychological correlates of body dissatisfaction in Swiss youth over a one-year study-period. Front Psychol 2024; 14:1269364. [PMID: 38259526 PMCID: PMC10802120 DOI: 10.3389/fpsyg.2023.1269364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction It is well known that young individuals often report pronounced negative perceptions and attitudes towards their own body or intense fear of being not muscular enough. There is much less data available, however, on the role of psychological mechanisms on these perceptions and attitudes, such as emotion regulation difficulties, correlates of alexithymia, and appearance-related rejection sensitivity. Methods We therefore set out to assess associations between these psychological mechanisms, and body image as well as muscle dysmorphic symptoms. Our sample was recruited as part of a larger-scale study aiming at assessing correlates of mental health (with a focus on eating disorder symptoms) in German speaking Switzerland. The first wave (T1), starting in April 2021, included 605 participants (80% female, 19.6 ± 2.5 years) who completed the online-questionnaire and were reassessed in a second wave (T2), one year later. Results Results indicated that at both waves, emotion regulation difficulties [DERS-SF] and appearance-based rejection sensitivity [ARS-D] were both positively cross-sectionally associated with body dissatisfaction [BSQ-8C] and muscle dysmorphic symptoms [MDDI] at the first assessment time-point and one year later at follow-up assessment. Moreover, alexithymia [TAS-20] was positively cross-sectionally associated with muscle dysmorphic symptoms at both waves. We further observed high absolute and relative level stabilities for all variables involved across the one-year study period. Discussion/Conclusion Even though the effects for some associations were rather small, our findings underline the relevance of such mechanisms in the development of body dissatisfaction and to a lesser extent of muscle dysmorphia symptoms over the period of one year. Additional research is necessary to replicate these findings in other youth samples.
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Affiliation(s)
- Verena M. Mueller
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Felicitas Forrer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Andrea H. Meyer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
- Department of Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
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Ganson KT, Nagata JM. Surveys on androgen abuse: a review of recent research. Curr Opin Endocrinol Diabetes Obes 2023; 30:291-299. [PMID: 37603040 DOI: 10.1097/med.0000000000000833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
PURPOSE OF REVIEW To summarize recent survey research on androgen abuse [i.e., anabolic-androgenic steroids (AAS)], including prevalence among international samples, risk factors for use, associated impairments of use, and treatment and interventions for abusers. RECENT FINDINGS Recent research has documented the prevalence of androgens abuse remains most common among boys and men compared to girls and women, which was stable across nations. However, fewer studies have focused on population-based samples and instead focused on convenience or high-risk samples (i.e., gym goers). Androgen abusers commonly report a history of violent victimization, including adverse childhood experiences. Research continues to document many adverse biological, psychological, and social effects related to androgen abuse, including more than 50% of abusers reporting at least one side effect. Mental health problems and polysubstance use continues to be highly prevalent among androgen abusers. Despite these adverse effects from use, there remains little survey research on treatment and interventions for androgen abusers, representing an important area of future investigation. SUMMARY Androgen abuse remains relatively common, particularly among boys and men, with adverse health effects regularly occurring. Healthcare professionals and systems can adapt their treatment approaches to focus on reducing harms associated with androgen abuse.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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8
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Nagata JM, Smith-Russack Z, Paul A, Saldana GA, Shao IY, Al-Shoaibi AAA, Chaphekar AV, Downey AE, He J, Murray SB, Baker FC, Ganson KT. The social epidemiology of binge-eating disorder and behaviors in early adolescents. J Eat Disord 2023; 11:182. [PMID: 37833810 PMCID: PMC10571438 DOI: 10.1186/s40337-023-00904-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Binge-eating disorder (BED) is the most common eating disorder phenotype and is linked to several negative health outcomes. Yet, little is known about the social epidemiology of BED, particularly in early adolescence. The objective of this study was to examine the associations between sociodemographic characteristics and BED and binge-eating behaviors in a large, national cohort of 10-14-year-old adolescents in the United States (U.S.) METHODS: We conducted a cross-sectional analysis of two-year follow-up data from the Adolescent Brain Cognitive Development (ABCD) Study (2018 - 2020) that included 10,197 early adolescents (10 - 14 years, mean 12 years) in the U.S. Multivariable logistic regression models were used to assess the associations between sociodemographic characteristics and BED and binge-eating behaviors, defined based on the Kiddie Schedule for Affective Disorders and Schizophrenia. RESULTS In this early adolescent sample (48.8% female, 54.0% White, 19.8% Latino/Hispanic, 16.1% Black, 5.4% Asian, 3.2% Native American, 1.5% Other), the prevalence of BED and binge-eating behaviors were 1.0% and 6.3%, respectively. Identifying as gay or bisexual (compared to heterosexual; adjusted odds ratio [AOR]: 2.25, 95% CI 1.01-5.01) and having a household income of less than $75,000 (AOR: 2.05, 95% CI: 1.21-3.46) were associated with greater odds of BED. Being male (AOR: 1.28, 95% CI: 1.06-1.55), of Native American (AOR: 1.60, 95% CI: 1.01-2.55) descent, having a household income less than $75,000 (AOR: 1.34, 95% CI: 1.08-1.65), or identifying as gay or bisexual (AOR for 'Yes' Response: 1.95, 95% CI: 1.31-2.91 and AOR for 'Maybe' Response: 1.81, 95% CI: 1.19-2.76) were all associated with higher odds of binge-eating behaviors. CONCLUSION Several sociodemographic variables showed significant associations with binge-eating behaviors, which can inform targeted screening, prevention, and education campaigns for BED among early adolescents.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA.
| | - Zacariah Smith-Russack
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Angel Paul
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Geomarie Ashley Saldana
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Iris Y Shao
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Abubakr A A Al-Shoaibi
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Anita V Chaphekar
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Amanda E Downey
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
- Department of Psychiatry and Behavioral Sciences, University of California, 675 18th Street, San Francisco, CA, 94143, USA
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, 2001 Longxiang Boulevard, Longgang District, Shenzhen, 518172, China
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA
| | - Fiona C Baker
- Center for Health Sciences, SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025, USA
- School of Physiology, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
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Nagata JM, Lee CM, Lin F, Ganson KT, Pettee Gabriel K, Testa A, Jackson DB, Dooley EE, Gooding HC, Vittinghoff E. Screen Time from Adolescence to Adulthood and Cardiometabolic Disease: a Prospective Cohort Study. J Gen Intern Med 2023; 38:1821-1827. [PMID: 36627526 PMCID: PMC10272026 DOI: 10.1007/s11606-022-07984-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous studies have analyzed the relationship between screen time and cardiometabolic disease risk factors among adolescents, but few have examined the longitudinal effects of screen time on cardiometabolic health into adulthood using nationally representative data. OBJECTIVE To determine prospective associations between screen time and later cardiometabolic disease over a 24-year period using a nationally representative adolescent cohort. DESIGN Longitudinal prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) collected from 1994 to 2018. PARTICIPANTS Adolescents aged 11-18 years old at baseline (1994-1995) followed for 24 years. MAIN MEASURES Predictors: screen time (five repeated measures of self-reported television and video watching from adolescence to adulthood). OUTCOMES Five repeated measures of body mass index (BMI); two repeated measures of waist circumference, hypertension, hyperlipidemia, and diabetes collected at 15- and 24-year follow-up exams. KEY RESULTS For the 7105 adolescents in the sample (49.7% female, 35.0% non-white), the baseline adolescent average screen time per day was 2.86 ± 0.08 hours per day, which generally declined through 24-year follow-up. Average BMI at baseline was 22.57 ± 0.13 kg/m2, which increased to 30.27 ± 0.18 kg/m2 through follow-up. By 24-year follow-up, 43.4% of participants had obesity, 8.4% had diabetes, 31.8% had hypertension, and 14.9% had hyperlipidemia. In mixed-effects generalized linear models, each additional hour of screen time per day was associated with 0.06 (95% CI 0.04-0.09) within-person increase in BMI. Each additional hour of screen time per day was associated with higher within-person odds of high waist circumference (AOR 1.17, 95% CI 1.09-1.26), obesity (AOR 1.09, 95% CI 1.03-1.15), and diabetes (AOR 1.17, 95% CI 1.07-1.28). Screen time was not significantly associated with hypertension or hyperlipidemia. CONCLUSIONS In this prospective cohort study, higher screen time in adolescence was associated with higher odds of select indicators of cardiometabolic disease in adulthood.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA.
| | - Christopher M Lee
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Erin E Dooley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Holly C Gooding
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Eric Vittinghoff
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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Ganson KT, Hallward L, Rodgers RF, Testa A, Jackson DB, Nagata JM. Contemporary screen use and symptoms of muscle dysmorphia among a national sample of Canadian adolescents and young adults. Eat Weight Disord 2023; 28:10. [PMID: 36790649 PMCID: PMC9930713 DOI: 10.1007/s40519-023-01550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/02/2023] [Indexed: 02/16/2023] Open
Abstract
PURPOSE Screen time has been previously linked to body dissatisfaction and eating disorder behaviors. However, less is known about whether use of common forms of screen technology is associated with symptoms of muscle dysmorphia (MD), which was the aim of this study. METHODS Data from the Canadian Study of Adolescent Health Behaviors (N = 2538) were analyzed. Associations between hours of use of six contemporary forms of recreational screen time, as well as total screen time, and symptoms of MD were determined using multiple linear regression models, stratified by gender, and adjusting for potential confounders. RESULTS Among both men and women, greater total screen time and texting were associated with greater symptoms of MD; however, differences emerged across the screen time modalities by gender. Among women, video chatting was most strongly associated with symptoms of MD, while social media use was most strongly associated with symptoms of MD among men. CONCLUSION Findings add to the growing literature documenting the potentially harmful correlates of screen time by including MD symptomatology. Findings have important implications for health care, public health, and policymaking professionals. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | - Laura Hallward
- School of Kinesiology, Western University, London, ON, Canada
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
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11
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Ganson KT, Testa A, Rodgers RF, Jackson DB, Nagata JM. Muscle-Building Exercise and Weapon Carrying and Physical Fighting Among U.S. Adolescent Boys. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:2566-2584. [PMID: 35546543 PMCID: PMC9850380 DOI: 10.1177/08862605221101192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study aimed to determine the association between engagement in muscle-building exercise and weapon carrying and physical fighting among adolescent boys. Cross-sectional data from the 2019 Youth Risk Behavior Survey (U.S.) were analyzed (N = 4120). Muscle-building exercise was assessed based on the number of days reported in the past 7 days, recategorized into four levels of engagement (no engagement [0 days], low engagement [1-2 days], moderate engagement [3-5 days], and high engagement [6-7 days]). Three forms of weapon carrying (general, on school grounds, gun carrying) and two forms of physical fighting (general, on school grounds) were assessed. Five logistic regression analyses with adjusted odds ratios (AOR) and 95% confidence intervals (CI) were used to determine the association between engagement in muscle-building exercise and weapon carrying and physical fighting, while adjusting for relevant demographic and control variables. Over 75% of participants reported engaging in muscle-building exercise. One in five (19.8%) participants reported any general weapon carrying in the past 30 days, 3.3% reported any weapon carrying at school in the past 30 days, 6.5% reported any gun carrying in the past 12 months, 28.0% reported any general physical fighting in the past 12 months, and 10.7% reported any physical fighting at school in the past 12 months. Logistic regressions showed that, compared to no engagement, participants who reported high engagement of muscle-building exercise had higher odds of general weapon carrying (AOR 2.18, 95% CI 1.54-3.07), gun carrying (AOR 2.12, 95% CI 1.23-3.64), and general physical fighting (AOR 2.07, 95% CI 1.53-2.79). These are novel findings that add to a growing literature related to engagement in muscularity-oriented behaviors among males. Prevention and intervention efforts are needed to ensure that adolescent boys engage in muscle-building exercise in ways that are not harmful and to reduce weapon carrying and physical fighting.
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Affiliation(s)
| | - Alexander Testa
- University of Texas Health Science Center at
Houston, Houston, TX, USA
| | - Rachel F. Rodgers
- Northeastern
University, Boston, MA, USA
- Lapeyronie
Hospital, CHRU Montpellier, France
| | - Dylan B. Jackson
- Johns Hopkins Bloomberg School of Public
Health, Baltimore, MD, USA
| | - Jason M. Nagata
- University of
California, San Francisco, San Francisco,
CA, USA
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12
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Ganson KT, Cunningham ML, Pila E, Rodgers RF, Murray SB, Nagata JM. "Bulking and cutting" among a national sample of Canadian adolescents and young adults. Eat Weight Disord 2022; 27:3759-3765. [PMID: 36085408 PMCID: PMC9462603 DOI: 10.1007/s40519-022-01470-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/21/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE First, to characterize the prevalence and incidence of "bulk" and "cut" cycles among Canadian adolescents and young adults. Second, to determine the associations between bulk and cut cycle engagement and drive for muscularity and eating disorder and muscle dysmorphia psychopathology. METHODS Data were from the Canadian Study of Adolescent Health Behaviors (2021; N = 2762), a national study of Canadian adolescents and young adults aged 16-30 years (M = 22.9, SD = 3.9). Prevalence and mean incidence of bulk and cut cycles in both the past 12 months and 30 days were estimated. Modified Poisson regressions were estimated to determine the associations between bulk and cut cycle engagement and levels of drive for muscularity and eating disorder and muscle dysmorphia psychopathology. RESULTS The sample comprised of 53.5% women, 38.4% men, and 8.1% transgender/gender non-conforming (TGNC) individuals. Nearly half (48.9%) of men and one in five women (21.2%) and TGNC (21.9%) participants reported bulk and cut cycles in the past 12 months. TGNC participants and women reported a greater mean number of bulk and cut cycles completed compared to men. Engagement in bulk and cut cycles was associated with stronger drive for muscularity across the sample, and more severe eating disorder and muscle dysmorphia psychopathology among men and women. CONCLUSION Findings underscore the common incidence and accompanying psychopathology of bulk and cut cycles among a community sample of adolescents and young adults in Canada, indicating the need for future research, as well as clinical and public health efforts. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | | | - Eva Pila
- School of Kinesiology, Western University, London, ON, Canada
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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13
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Ganson KT, Jackson DB, Testa A, Nagata JM. Performance-Enhancing Substance Use and Intimate Partner Violence: A Prospective Cohort Study. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22944-NP22965. [PMID: 35119318 PMCID: PMC9679551 DOI: 10.1177/08862605211073097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Research has shown that performance-enhancing substance (PES) use, including anabolic-androgenic steroids (AAS), is associated with interpersonal violence (e.g., fighting). This study aimed to determine whether legal PES use and AAS use are associated with intimate partner violence (IPV) involvement cross-sectionally and over seven-year follow-up in a nationally representative prospective cohort study. Data from the National Longitudinal Study of Adolescent to Adult Health (N = 12,288) were analyzed (2021). Logistic regression analyses were conducted to determine the associations between legal PES use and AAS use at Wave III (2001-2002; ages 18-26) and IPV victimization (five variables) and IPV perpetration (five variables) at Wave III and Wave IV (2008-2009; ages 24-32), adjusting for relevant demographic and confounding variables. Results from cross-sectional analyses showed that legal PES use and AAS use were associated with higher odds of both any IPV victimization and sexual IPV victimization, and both any IPV perpetration and physical IPV perpetration by pushing or shoving a partner. Results from prospective analyses showed that AAS use, but not legal PES use, was associated with higher odds of all five IPV victimization variables (any IPV victimization: adjusted odds ratio [AOR] 1.72, 95% confidence interval [CI]1.04-2.84; two forms of physical abuse: 1: AOR 2.01, 95% CI 1.15-3.50; 2: AOR 2.11, 95% CI 1.06-4.21; incurring an injury from IPV victimization: AOR 4.90, 95% CI 1.71-14.01; and sexual IPV victimization AOR 2.44, 95% CI 1.05-5.65), as well as three IPV perpetration variables (any IPV perpetration: AOR 2.11, 95% CI 105-4.23; one form of physical abuse perpetration: AOR 2.58, 95% CI 1.06-6.27; and sexual IPV perpetration: AOR 3.80, 95% CI 1.44-10.02). These results emphasize the adverse social and interpersonal risks associated with PES use. Continued research, health care, and public health prevention and intervention efforts to reduce the use of PES and occurrence of IPV are warranted.
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Affiliation(s)
- Kyle T. Ganson
- Factor-Inwentash Faculty of Social
Work, University of Toronto, Toronto, ON, Canada
| | - Dylan B. Jackson
- Department of Population, Family,
and Reproductive Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
| | - Alexander Testa
- Department of Criminology &
Criminal Justice, University of Texas at San
Antonio, San Antonio, TX, USA
| | - Jason M. Nagata
- Department of Pediatrics, University of
California, San Francisco, San Francisco, CA, USA
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14
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Tie B, Tang C, Ren Y, Cui S, He J. Internalized Homophobia, Body Dissatisfaction, Psychological Distress, and Nonsuicidal Self-Injury Among Young Sexual Minority Men in China. LGBT Health 2022; 9:555-563. [PMID: 35708638 DOI: 10.1089/lgbt.2022.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: Sexual minority men (SMM) have been shown to be at high risk of nonsuicidal self-injury (NSSI). Internalized homophobia, body dissatisfaction, and psychological distress have been found to be related to NSSI among SMM, but few studies have focused on the mechanisms underlying these associations. Thus, the current study was conducted to examine the association between internalized homophobia and NSSI, and whether body dissatisfaction and psychological distress mediate this relationship among young SMM in China. Methods: In total, 264 young SMM (mean age, 22.00 ± 2.86 years) in Henan Province, China, participated in the study. A set of questionnaires were used to assess participants' internalized homophobia, body fat dissatisfaction, muscularity dissatisfaction, psychological distress, and NSSI. Correlation and mediation analyses were used to examine the data. Results: Internalized homophobia correlated positively with NSSI (r = 0.24, p < 0.001) among young SMM in China. This relationship was partly mediated by body fat dissatisfaction, muscularity dissatisfaction, and psychological distress. Conclusion: The study findings suggest that internalized homophobia is a risk factor for NSSI among young SMM in China, and that body fat and muscle dissatisfaction and psychological distress underlie the association between internalized homophobia and NSSI. In developing interventions targeting NSSI among SMM, the findings of the current study should be considered to improve intervention outcomes.
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Affiliation(s)
- Bijie Tie
- Department of Psychology, School of Education, Zhengzhou University, Zhengzhou, China
| | - Chanyuan Tang
- Department of Applied Psychology, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Shenzhen, China
| | - Yaoxiang Ren
- Department of Applied Psychology, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Shenzhen, China
| | - Shuqi Cui
- Department of Applied Psychology, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Shenzhen, China
| | - Jinbo He
- Department of Applied Psychology, School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Shenzhen, China
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15
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Mitchison D, Mond J, Griffiths S, Hay P, Nagata JM, Bussey K, Trompeter N, Lonergan A, Murray SB. Prevalence of muscle dysmorphia in adolescents: findings from the EveryBODY study. Psychol Med 2022; 52:3142-3149. [PMID: 33722325 DOI: 10.1017/s0033291720005206] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND We sought to provide the first point prevalence estimates of muscle dysmorphia (MD), a form of body dysmorphic disorder characterized by a preoccupation with perceived insufficient muscularity, in adolescents. METHODS Data were taken from a survey of 3618 Australian adolescents (11.172-19.76 years; 49.3% girls). Measures captured demographic characteristics, symptoms of MD and eating disorders, psychological distress and functional impairment. Diagnostic criteria for MD developed by Pope et al. (1997, Psychosomatics, 38(6), 548-557) were applied, entailing preoccupation with insufficient muscularity causing significant levels of distress or disability that cannot be better accounted for by an eating disorder. RESULTS The point prevalence of MD was 2.2% [95% confidence interval (CI) 1.6-3.0%] among boys and 1.4% (95% CI 0.9-2.0%) among girls. Prevalence was not associated with gender (V = 0.031) or socioeconomic status (SES) (partial η2< 0.001), but was marginally associated with older age (partial η2 = 0.001). Boys with MD were more likely than girls with MD to report severe preoccupation with muscularity (V = 0.259) and a weight-lifting regime that interfered with their life (V = 0.286), whereas girls with MD were more likely to report discomfort with body exposure (V = 0.380). CONCLUSIONS While future epidemiological research using diagnostic interviews is needed to verify these estimates, the findings suggest that MD is relatively common from early to late adolescence. Gender differences in MD prevalence may be minimal; however, the symptom profile appears to diverge between boys and girls. These findings provide a platform for future, analytical research designed to inform clinical and public health interventions.
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Affiliation(s)
- Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, TAS, Australia
| | - Scott Griffiths
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
- Camden and Campbelltown Hospitals, SWSLHD, Camden and Campbelltown, NSW, Australia
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Kay Bussey
- Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
| | - Nora Trompeter
- Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
| | - Alexandra Lonergan
- Department of Psychology, Centre for Emotional Health, North Ryde, NSW, Australia
| | - Stuart B Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
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16
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Ganson KT, Cunningham ML, Pila E, Rodgers RF, Murray SB, Nagata JM. Characterizing cheat meals among a national sample of Canadian adolescents and young adults. J Eat Disord 2022; 10:113. [PMID: 35933394 PMCID: PMC9357326 DOI: 10.1186/s40337-022-00642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND "Cheat meals", described as brief eating episodes that depart from established dietary practices to consume prohibited foods, represent a novel and increasingly common eating behavior with particular salience in adolescence and young adulthood. However, knowledge gaps remain regarding the frequency and characterization of foods and calories consumed during cheat meals, and their associations with eating disorder behaviors and psychopathology. Thus, the aims of this study were to delineate engagement in cheat meals among a large, national sample of Canadian adolescents and young adults. METHODS Participants (N = 2,717) were from the Canadian Study of Adolescent Health Behaviors. Frequencies of engagement in cheat meals, and associated foods and calories consumed, in the past 12 months and 30 days were determined. The associations between engagement in cheat meals and eating disorder behaviors and psychopathology were determined using modified Poisson regression analyses. RESULTS Engagement in cheat meals in the past 12 months was highest among men (60.9%) compared to women (53.7%) and transgender/gender non-conforming (TGNC; 52.5%) participants. Cheat meals consisting between 1,000 and 1,499 cal were those most frequently reported among all participants. Mean number of cheat meals in the past 12 months was equivalent to > 1 per week, which was similar to engagement in the past 30 days. Finally, engagement in cheat meals in the past 12 months and 30 days was associated with patterns of eating disorder behaviors and psychopathology among all participants, including binge-eating-related behaviors. CONCLUSIONS This study further characterized and extended knowledge of cheat meal engagement across genders, aligning with prior research by demonstrating that engagement is associated with greater eating disorder psychopathology. Findings from this study add to the growing characterization of the novel behavioral phenomenon of cheat meals. Specifically, over half of adolescents and young adults across all 13 provinces and territories in Canada reported engaging in > 1 cal dense cheat meal per week, over the past 12 months. Despite the normalization and promotion of cheat meal engagement among the general public and unique fitness communities, engagement in this behavior is linked to greater eating disorder behaviors and psychopathology, including binge-eating episodes. Our findings emphasize the need for further research, public awareness, and clinical interventions aimed at addressing this potentially harmful eating behavior.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | | | - Eva Pila
- School of Kinesiology, Western University, London, ON, Canada
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, MA, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA
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17
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Ganson KT, Cunningham ML, Murray SB, Nagata JM. Use of appearance- and performance-enhancing drugs and substances is associated with eating disorder symptomatology among U.S. college students. Eat Weight Disord 2022; 27:2245-2250. [PMID: 35066818 PMCID: PMC11378749 DOI: 10.1007/s40519-022-01364-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/11/2022] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Body ideals for both men and women are continuing to emphasize muscularity and leanness, which has resulted in the high prevalence of appearance- and performance-enhancing drugs and substances (APEDS) use, particularly among young men. Overall, little research has investigated the individual associations between specific APEDS use and eating disorder symptomatology, including among the high-risk population of young adult college students, which was the aim of this study. METHODS Data from the 2020-2021 Healthy Minds Study (N = 7394) were analyzed. Five indicators of lifetime APEDS use were assessed, and a cumulative sum score was constructed. Eating disorder symptomatology was assessed via the SCOFF questionnaire. A total of 14 modified Poisson regression analyses were estimated to determine the association between APEDS use and a positive eating disorder screen among women and men. RESULTS Lifetime use of protein supplements and diuretics or water pills were associated with a positive eating disorder screen among both women and men, while use of non-steroid synthetic muscle enhancers was associated with a positive eating disorder screen among men and creatine supplement use was associated with a positive eating disorder screen among women. The risk of a positive eating disorder screen was highest among men who reported use of five APEDS in their lifetime. CONCLUSIONS Lifetime use of APEDS is associated with eating disorder symptomatology among a national sample of U.S. college and university students. Prevention and intervention efforts are needed to address the link between these potentially harmful behaviors. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | | | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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18
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Nagata JM, Grandis A, Bojorquez-Ramirez P, Nguyen A, Downey AE, Ganson KT, Patel KP, Machen VI, Buckelew SM, Garber AK. Assessment of vitamin D among male adolescents and young adults hospitalized with eating disorders. J Eat Disord 2022; 10:104. [PMID: 35851069 PMCID: PMC9295348 DOI: 10.1186/s40337-022-00627-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Medical complications of eating disorders in males are understudied compared to females, as is the case of vitamin D deficiency. The aim of this study was to assess vitamin D levels among male and female adolescents and young adults hospitalized for medical complications of eating disorders. METHODS We retrospectively reviewed electronic medical records of patients aged 9-25 years (N = 565) admitted to the University of California, San Francisco Eating Disorders Program for medical instability, between May 2012 and August 2020. Serum vitamin D (25-hydroxy) level was assessed at admission as was history of prior calcium, vitamin D, or multivitamin supplementation. Linear regression was used to assess factors associated with vitamin D levels. RESULTS A total of 93 males and 472 females met eligibility criteria (age 15.5 ± 2.8, 58.8% anorexia nervosa; admission body mass index 17.6 ± 2.91). Among male participants, 44.1% had 25-hydroxyvitamin D levels < 30 ng/mL, 18.3% had 25-hydroxyvitamin D levels < 20 ng/mL, and 8.6% had 25-hydroxyvitamin D levels < 12 ng/mL. There were no significant differences in 25-hydroxyvitamin D levels in males compared to females, except that a lower proportion (1.9%) of female participants had 25-hydroxyvitamin D levels < 12 ng/mL (p = 0.001). Only 3.2% of males reported calcium or vitamin D-specific supplementation prior to hospital admission, while 8.6% reported taking multivitamins. White race, prior calcium/vitamin D supplementation, and higher calcium levels were associated with higher vitamin D levels on admission. CONCLUSIONS Nearly half of patients admitted to the hospital for malnutrition secondary to eating disorders presented with low 25-hydroxyvitamin D levels; males were more likely than females to have severe vitamin D deficiency. These findings support vitamin D assessment as part of the routine medical/nutritional evaluation for hospitalized eating disorder patients, with particular attention on male populations.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94143, USA.
| | - Anna Grandis
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94143, USA
| | | | - Anthony Nguyen
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94143, USA
| | - Amanda E Downey
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94143, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Khushi P Patel
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94143, USA
| | - Vanessa I Machen
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94143, USA
| | - Sara M Buckelew
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94143, USA
| | - Andrea K Garber
- Department of Pediatrics, University of California, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94143, USA
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19
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Ganson KT, Jackson DB, Testa A, Murnane PM, Nagata JM. Associations Between Anabolic-Androgenic Steroid Use and Sexual Health Behaviors Among Adolescent Boys: Results From the 2019 Youth Risk Behavior Survey. Am J Mens Health 2022; 16:15579883221110350. [PMID: 35996359 PMCID: PMC9421234 DOI: 10.1177/15579883221110350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to determine the association between lifetime anabolic-androgenic steroid (AAS) use and seven indicators of sexual health behaviors among a nationally representative sample of adolescent boys in the United States. Multiple modified Poisson regression analyses were conducted to determine the associations between any lifetime AAS use and seven indicators of sexual health behaviors among 2,095 sexually active adolescent boys from the 2019 National Youth Risk Behavior Survey. Sexually active boys who reported lifetime AAS use were at greater risk of having sexual intercourse before the age of 13 years (adjusted risk ratio [aRR] = 2.73, 95% confidence interval [CI] = [1.44, 5.17]), reporting ≥4 sexual partners in their lifetime (aRR = 1.96, 95% CI = [1.34, 2.89]) and in the past 3 months (aRR = 6.77, 95% CI = [3.19, 14.37]), having been tested for HIV in their lifetime (aRR = 2.49, 95% CI = [1.13, 4.73]), and having been tested for any sexually transmitted infection in the past 12 months (aRR = 3.14, 95% CI = [1.63, 6.03]). These findings align with prior research among adult men and have implications for public health and health care prevention efforts to reduce the use of AAS, as well as support the engagement in safe sexual health behaviors among adolescent boys.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexander Testa
- Department of Criminology and Criminal Justice, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Pamela M Murnane
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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20
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Ganson KT, Jackson DB, Testa A, Murnane PM, Nagata JM. Performance-Enhancing Substance Use and Sexual Risk Behaviors among U.S. Men: Results from a Prospective Cohort Study. JOURNAL OF SEX RESEARCH 2022; 59:758-764. [PMID: 34860634 PMCID: PMC9163206 DOI: 10.1080/00224499.2021.2012114] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Performance-enhancing substance (PES) use is common among young men and prior research has documented cross-sectional associations between anabolic-androgenic steroid (AAS) use and sexual risk behaviors. However, this relationship remains understudied among a longitudinal cohort of young adult men, and research on prospective associations between legal PES (e.g., creatine) use and sexual risk behaviors is lacking. The current study addressed these oversights using data from the National Longitudinal Study of Adolescent to Adult Health (N = 5,451). AAS use and legal PES use were assessed at Wave III (ages 18-26) and 10 indicators of sexual risk behavior were assessed at seven-year follow up (Wave IV; ages 24-32). Linear and logistic regression analyses were conducted adjusting for demographic and behavioral confounders. Participants who reported AAS use and legal PES use had significantly higher number of one-time sexual partners and higher odds of multiple sex partners around the same time in the past 12 months. Participants who reported AAS use had higher odds of any STI in the past 12 months. These results extend prior research on the risk behaviors and adverse effects of PES use. Health care professionals should assess for PES use among young adult men and provide guidance on healthful sexual behaviors.
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Affiliation(s)
- Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Dylan B. Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA
| | - Pamela M. Murnane
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
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21
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Nagata JM, DeBenedetto AM, Brown TA, Lavender JM, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Cattle CJ, Obedin-Maliver J, Lunn MR. Associations among romantic and sexual partner history and muscle dysmorphia symptoms, disordered eating, and appearance- and performance-enhancing drugs and supplement use among cisgender gay men. Body Image 2022; 41:67-73. [PMID: 35228105 PMCID: PMC9997419 DOI: 10.1016/j.bodyim.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/01/2022] [Accepted: 02/06/2022] [Indexed: 01/12/2023]
Abstract
This study examined relationship status (e.g., single versus not single) and number of sexual partners in relation to muscularity- and disordered eating-related attitudes and behaviors among 1090 cisgender gay men enrolled in The PRIDE Study in 2018. Participants completed measures assessing muscle dysmorphia (MD) symptoms, disordered eating attitudes and behaviors, and appearance- and performance-enhancing drug or supplement (APEDS) use. In linear regression models adjusting for theoretically relevant covariates, neither relationship status nor number of past-month sexual partners was associated with disordered eating attitudes. In terms of MD symptoms, single (versus not single) relationship status was associated with greater appearance intolerance, and a greater number of sexual partners was associated with greater drive for size and functional impairment. In adjusted logistic regression models, a greater number of past-month sexual partners was associated with use of anabolic-androgenic steroids, synthetic performance-enhancing substances, protein supplements, and creatine supplements, as well as greater likelihood of engaging in compelled/driven exercise. Across all associations, effect sizes were generally small. Overall, results support that inquiring about sexual partners may have utility in evaluating risk for muscularity-oriented attitudes and behaviors among cisgender gay men. Future work will need to replicate these findings, particularly in more diverse samples.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, CA, USA.
| | | | - Tiffany A Brown
- Department of Psychology, Auburn University, Auburn, AL, USA; Department of Psychiatry, University of California, San Diego, CA, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Lavender
- San Diego State University Research Foundation, San Diego, CA, USA; Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | | | - Matthew R Capriotti
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA; Department of Psychology, San José State University, San Jose, CA, USA
| | - Annesa Flentje
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA; Department of Community Health Systems, University of California, San Francisco, CA, USA
| | - Micah E Lubensky
- Department of Psychology, San José State University, San Jose, CA, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- Department of Psychology, San José State University, San Jose, CA, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- Department of Psychology, San José State University, San Jose, CA, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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22
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Ganson KT, Rodgers RF. Problematic muscularity-oriented behaviors: Overview, key gaps, and ideas for future research. Body Image 2022; 41:262-266. [PMID: 35325664 DOI: 10.1016/j.bodyim.2022.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Problematic muscularity-oriented behaviors, such as excessive weightlifting and muscle-building supplement and substance use (e.g., creatine, steroids), are common among young people, particularly boys and men. Theoretical models of eating disorders, and their constructs, are helpful in conceptualizing a number of risk factors that may increase the likelihood of developing problematic muscularity-oriented behaviors; however, these models lack a clear delineation of the factors that may specifically lead to the initiation and pursuit of these behaviors. This paper provides a brief overview of the theoretical models that have usefully framed research on problematic muscularity-oriented behaviors and the risk factors that been identified through this work. In addition, it identifies gaps related to understanding the factors leading to the initiation and continued or discontinued engagement in these behaviors, and it provides ideas for future research to help fill these gaps. Understanding the ways in which risk factors combine sequentially and interactively, to produce pathways to problematic muscularity-oriented behaviors is crucial for researchers to strengthen theoretical understandings of these behaviors, to inform intervention efforts, and guide policy and practice to decrease their rates among youth.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada.
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, USA; Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, France
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23
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Nagata JM, McGuire FH, Lavender JM, Brown TA, Murray SB, Greene RE, Compte EJ, Flentje A, Lubensky ME, Obedin‐Maliver J, Lunn MR. Appearance and performance-enhancing drugs and supplements, eating disorders, and muscle dysmorphia among gender minority people. Int J Eat Disord 2022; 55:678-687. [PMID: 35352378 PMCID: PMC9106876 DOI: 10.1002/eat.23708] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Appearance and performance-enhancing drugs and supplements (APEDS) can be used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among gender minority people. METHOD Participants were 1653 gender minority individuals (1120 gender-expansive [defined as a broad range of gender identities that are generally situated outside of the woman-man gender binary, e.g., genderqueer, nonbinary] people, 352 transgender men, and 181 transgender women) recruited from The Population Research in Identity and Disparities for Equality Study in 2018. Regression analyses stratified by gender identity examined associations of any APEDS use with eating disorder and muscle dysmorphia symptom scores. RESULTS Lifetime APEDS use was common across groups (30.7% of gender-expansive people, 45.2% of transgender men, and 14.9% of transgender women). Protein supplements and creatine supplements were the most commonly used APEDS. Among gender-expansive people and transgender men, lifetime use of any APEDS was significantly associated with higher eating disorder scores, dietary restraint, binge eating, compelled/driven exercise, and muscle dysmorphia symptoms. Any APEDS use was additionally associated with laxative use among gender-expansive people. Among transgender women, use of any APEDS was not significantly associated with eating disorder or muscle dysmorphia symptoms. DISCUSSION APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in gender-expansive people and transgender men, thus highlighting the importance of assessing for these behaviors and symptoms among these populations, particularly in clinical settings. PUBLIC SIGNIFICANCE This study aimed to examine APEDS use among gender minority people. We found that 30.7% of gender-expansive (e.g., nonbinary) people, 45.2% of transgender men, and 14.9% of transgender women reported lifetime APEDS use, which was associated with eating disorder and muscle dysmorphia symptoms in transgender men and gender-expansive people. Clinicians should assess for these behaviors in gender minority populations.
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Affiliation(s)
- Jason M. Nagata
- Department of PediatricsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - F. Hunter McGuire
- The Brown SchoolWashington University in St. LouisSt. LouisMissouriUSA
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of MedicineUniformed Services University of the Health SciencesBethesdaMarylandUSA
- The Metis FoundationSan AntonioTexasUSA
| | - Tiffany A. Brown
- Department of Psychological SciencesAuburn UniversityAuburnAlabamaUSA
| | - Stuart B. Murray
- Department of Psychiatry and Behavioral SciencesUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Emilio J. Compte
- Eating Behavior Research Center, School of PsychologyUniversidad Adolfo IbáñezSantiagoChile
- Research DepartmentComenzar de Nuevo Treatment CenterMonterreyMexico
| | - Annesa Flentje
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Alliance Health Project, Department of Psychiatry and Behavioral SciencesUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
| | - Micah E. Lubensky
- Department of Community Health SystemsUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
| | - Juno Obedin‐Maliver
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
- Department of Obstetrics and GynecologyStanford University School of MedicineStanfordCaliforniaUSA
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnetStanford University School of MedicineStanfordCaliforniaUSA
- Department of Epidemiology and Population HealthStanford University School of MedicineStanfordCaliforniaUSA
- Division of Nephrology, Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
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24
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Ganson KT, Testa A, Rodgers RF, Jackson DB, Nagata JM. Associations between muscle-building exercise and alcohol use behaviors among adolescent boys: Results from the 2019 Youth Risk Behavior Survey. Am J Addict 2022; 31:251-255. [PMID: 35347808 DOI: 10.1111/ajad.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To explore the association between muscle-building exercise (MBE) and alcohol use behaviors among adolescent boys. METHODS Data from the 2019 Youth Risk Behavior Survey (N = 4120) were analyzed using multiple logistic regressions. RESULTS A greater number of days of MBE in the past week was associated with higher odds of four alcohol use behaviors, including recent alcohol use and binge drinking. DISCUSSION AND CONCLUSIONS Findings extend prior research showing relationships between team sports participation and alcohol use behaviors. SCIENTIFIC SIGNIFICANCE This study is the first to examine associations between MBE and alcohol use behaviors among adolescent boys.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Testa
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU, Montpellier, France
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, California, USA
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25
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Ganson KT, Mitchison D, Rodgers RF, Cunningham ML, Murray SB, Nagata JM. Compulsive exercise among college students: 5-year time trends in prevalence and demographic, substance use, and mental health correlates. Eat Weight Disord 2022; 27:717-728. [PMID: 34024038 DOI: 10.1007/s40519-021-01210-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/08/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To provide 5-year time trends in prevalence and demographic, substance use, and mental health correlates of compulsive exercise among a national sample of college men and women. METHODS We analyzed 4 academic survey years (2016-2020; N = 8251) of the national (USA) Healthy Minds Study. Compulsive exercise was measured by self-report of any occurrence of "compulsive" exercise in the past 4 weeks. Unadjusted prevalence of compulsive exercise in the past 4 weeks was estimated across the 4 survey years by sex. Multiple logistic regression analyses were conducted among the pooled sample and stratified by sex to estimate the associations between compulsive exercise in the past 4 weeks and demographic, substance use, and mental health correlates. RESULTS Among the pooled sample, 11% (95% confidence interval [CI] 9.60-12.42%) of men and 17% (95% CI 15.86-18.24%) of women reported compulsive exercise in the past 4 weeks. Prevalence across the 4 survey years remained stable among men and women. Higher body mass index was associated with greater odds of any compulsive exercise in the past 4 weeks among men, while any sports participation was associated with greater odds of any compulsive exercise in the past 4 weeks among women. Compulsive exercise in the past 4 weeks was associated with greater odds of all mental health symptoms and illicit drug use among men and women, and higher odds of alcohol use among women. CONCLUSION Compulsive exercise is relatively common among college men and women and is associated with substance use behaviors and poor mental health symptoms. LEVEL OF EVIDENCE V, cross-sectional descriptive study.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.
| | - Deborah Mitchison
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, Australia
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU, Montpellier, France
| | | | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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26
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Nagata JM, Hazzard VM, Ganson KT, Bryn Austin S, Neumark-Sztainerx D, Eisenberg ME. Muscle-building behaviors from adolescence to emerging adulthood: a prospective cohort study. Prev Med Rep 2022; 27:101778. [PMID: 35402151 PMCID: PMC8987401 DOI: 10.1016/j.pmedr.2022.101778] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 12/28/2022] Open
Abstract
Muscle-building behaviors in adolescence to emerging adulthood were studied. Starting muscle-building behaviors is common from adolescence to emerging adulthood. Prevalence of any protein powder/shakes use was 55.1% in males and 33.0% in females. Prevalence of any steroids use was 6.7% in males and 5.4% in females. Protein powder consumption was associated with future use of steroids.
This study aimed to identify patterns of change in muscle-building behaviors from adolescence to emerging adulthood and determine what adolescent factors predict new-onset muscle-building behavior in emerging adulthood. Prospective cohort data from a diverse sample of 1,535 participants followed from adolescence (baseline, Mage = 14.4 ± 2.0 years) to emerging adulthood (follow-up, Mage = 22.1 ± 2.0 years) from the population-based EAT 2010–2018 (Eating and Activity over Time) study were analyzed. Changes in muscle-building behavior were identified (starting, stopping, persistent use, or never use). Log-binomial regression models examined adolescent predictors of starting (i.e., new-onset) muscle-building behaviors in emerging adulthood. Prevalence of any use in adolescence (EAT 2010) and/or emerging adulthood (EAT 2018) was 55.1% (males) and 33.0% (females) for protein powder/shakes, 6.7% (males) and 5.4% (females) for steroids, and 19.4% (males) and 6.5% (females) for other muscle-building substances (e.g., creatine, amino acids). In particular, 22.6% (males) and 13.7% (females) started protein powder/shakes, 2.2% (males) and 1.0% (females) started steroid use, and 9.0% (males) and 2.0% (females) started other muscle-building substances during emerging adulthood. Adolescent protein powder/shake consumption was associated with starting steroids/other muscle-building substances use in emerging adulthood in males (adjusted risk ratio [ARR] 2.09, 95% confidence interval [CI] 1.29–3.39) and females (ARR 4.81, 95% CI 2.01–11.48). Adolescent use of protein powders/shakes may lead to a two- to five-fold higher risk of new use of steroids and other muscle-building products in emerging adulthood. Clinicians, parents, and coaches should assess for use of muscle-building behaviors in adolescents and emerging adults and discourage use of harmful products.
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27
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Nagata JM, Hazzard VM, Ganson KT, Hahn SL, Neumark-Sztainer D, Eisenberg ME. Digital technology use and muscle-building behaviors in young adults. Int J Eat Disord 2022; 55:207-214. [PMID: 34904744 PMCID: PMC9023317 DOI: 10.1002/eat.23656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/01/2021] [Accepted: 12/04/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Digital technology use and muscle-building behaviors reflect a wide range of behaviors with associated health risks. However, links between digital technology use and muscle-building behaviors remain unknown and this study aimed to address this gap. METHOD Data were collected from a diverse sample of 1,483 young adults (mean age 22.2 ± 2.0 years) participating in the population-based Eating and Activity over Time 2018 study. Gender-stratified-modified Poisson regression models were used to determine cross-sectional associations between three types of digital technology use (screen time, social media, weight-related self-monitoring apps) and five types of muscle-building behaviors (changing eating, exercise, protein powders/shakes, pre-workout drinks, steroids/growth hormone/creatine/amino acids) in young adulthood, adjusted for sociodemographic characteristics and body mass index. RESULTS Screen time and social media were either not found to be associated with muscle-building behaviors or in a few instances, associated with less use of these behaviors (e.g., screen time and pre-workout drinks in men). In contrast, the use of weight-related self-monitoring apps was positively associated with all muscle-building behaviors, including steroids/growth hormone/creatine/amino acids in men (prevalence ratio [PR] = 1.83; 95% confidence interval [CI]: 1.13-2.97) and women (PR = 4.43; 95% CI: 1.68-11.68). DISCUSSION While most recreational screen time may represent sedentary behaviors not related to muscle-building behaviors, weight-related self-monitoring apps are highly associated with more muscle-building behaviors and could be a future target for interventions to discourage the use of steroids and other harmful muscle-building substances.
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Affiliation(s)
- Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Vivienne M Hazzard
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Samantha L Hahn
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marla E Eisenberg
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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28
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Nagata JM, McGuire FH, Lavender JM, Brown TA, Murray SB, Compte EJ, Cattle CJ, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR. Appearance and performance-enhancing drugs and supplements (APEDS): Lifetime use and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. Eat Behav 2022; 44:101595. [PMID: 35066385 PMCID: PMC9359347 DOI: 10.1016/j.eatbeh.2022.101595] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 01/14/2023]
Abstract
PURPOSE Appearance and performance-enhancing drugs and supplements (APEDS) are used to enhance muscle growth, athletic performance, and physical appearance. The aim of this study was to examine the lifetime use of APEDS and associations with eating disorder and muscle dysmorphia symptoms among cisgender sexual minority people. METHODS Participants were cisgender sexual minority people (1090 gay men, 100 bisexual plus men, 564 lesbian women, and 507 bisexual plus women) recruited from The PRIDE Study in 2018 who reported lifetime APEDS use and completed the Eating Disorder Examination-Questionnaire (EDE-Q) and the Muscle Dysmorphic Disorder Inventory (MDDI). Regression analyses stratified by gender and sexual orientation examined associations of any APEDS use with EDE-Q and MDDI scores. RESULTS Lifetime APEDS use was common across the four groups of cisgender sexual minority people (44% of gay men, 42% of bisexual plus men, 29% of lesbian women, and 30% of bisexual plus women). Protein supplements and creatine supplements were the most commonly used APEDS. Any APEDS use was associated with higher EDE-Q scores on one or more subscales in all sexual minority groups. Further, any APEDS use was associated with higher MDDI Total Scores in all groups; any APEDS use was associated with all MDDI subscale scores in cisgender gay men only. DISCUSSION APEDS use is common and associated with eating disorder and muscle dysmorphia symptoms in sexual minority men and women, thus highlighting the importance of assessing for these behaviors and symptoms among these populations in clinical settings.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA.
| | - F Hunter McGuire
- The Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130, USA.
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA; The Metis Foundation, 300 Convent St #1330, San Antonio, TX 78205, USA.
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA; San Diego State University Research Foundation, 5250 Campanile Dr, San Diego, CA 92182, USA.
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar St #2200, Los Angeles, CA 90033, USA.
| | - Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Diagonal Las Torres 2640, Santiago, Peñalolén, Región Metropolitana, Chile; Research Department, Comenzar de Nuevo Treatment Center, Avenida Humberto Lobo 1001, Del Valle, 66220 San Pedro Garza García, N.L., Mexico.
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, Box 0110, San Francisco, CA 94143, USA.
| | - Annesa Flentje
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way San Francisco, CA 94143, USA; Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1930 Market Street, San Francisco, CA 94102, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA.
| | - Micah E Lubensky
- Department of Community Health Systems, University of California, San Francisco, 2 Koret Way San Francisco, CA 94143, USA; The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA.
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, 150 Governor's Lane, HRP Redwood Building, Stanford, CA 94305-5405, USA.
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA; Department of Epidemiology and Population Health, Stanford University School of Medicine, 150 Governor's Lane, HRP Redwood Building, Stanford, CA 94305-5405, USA; Division of Nephrology, Department of Medicine, Stanford University School of Medicine, 300 Pasteur Dr, Palo Alto, CA 94304, USA.
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29
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Svantorp-Tveiten KME, Friborg O, Torstveit MK, Mathisen TF, Sundgot-Borgen C, Rosenvinge JH, Bratland-Sanda S, Pettersen G, Sundgot-Borgen J. Protein, Creatine, and Dieting Supplements Among Adolescents: Use and Associations With Eating Disorder Risk Factors, Exercise-, and Sports Participation, and Immigrant Status. Front Sports Act Living 2021; 3:727372. [PMID: 34723179 PMCID: PMC8548763 DOI: 10.3389/fspor.2021.727372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/13/2021] [Indexed: 01/19/2023] Open
Abstract
Objective: This study aimed to estimate the number of weekly users of protein, creatine, and dieting supplements and to explore whether weekly use was related to eating disorder (ED) risk factors, exercise, sports participation, and immigrant status. Methods: In total, 629 and 1,060 high school boys and girls, respectively, self-reported weekly frequency of protein, creatine, and dieting supplement use, and weight and shape concerns, appearance internalization and pressure, self-esteem, mental distress, physical activity level, exercise context, and the type and weekly frequency of sport played. Multiple hierarchical regression analyses were performed to investigate explanatory factors for supplement use. Results: More boys than girls used protein and creatine supplements. Immigrant boys had more frequent use of all supplements than non-immigrant boys, and immigrant girls used creatine supplements more frequently than non-immigrant girls. In total, 23–40 and 5–6% of the variation in the weekly frequency of supplement use in boys and girls, respectively, was explained by immigrant status, ED risk factors, and exercise and sports participation. More frequent use of protein, creatine and dieting supplements in boys was significantly explained by more weight and shape concerns, fitness center exercise, and weight-sensitive sports participation. Depending on the type of supplement, more frequent use of supplements in girls was significantly explained by lower self-esteem, more engagement in weight-sensitive sports, and less engagement in general sport and exercise activities. Conclusion: Weekly supplement use was common and more frequent among boys than girls. The weekly use of protein, creatine, and dieting supplements was related to ED risk factors, exercise and sports participation, and immigrant status in boys but not in girls.
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Affiliation(s)
| | - Oddgeir Friborg
- Department of Psychology, UiT -The Arctic University of Norway, Tromsø, Norway
| | | | | | | | | | - Solfrid Bratland-Sanda
- Department of Sports, Physical Education and Outdoor Studies, University of South-Eastern Norway, Kongsberg, Norway
| | - Gunn Pettersen
- Department of Health and Care Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
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30
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Cunningham ML, Rodgers RF, Pinkus RT, Nagata JM, Trompeter N, Mitchison D, Murray SB, Szabo M, Lavender JM. Factor structure and psychometric properties of the Muscularity-Oriented Eating Test in university women in Australia. Int J Eat Disord 2021; 54:1956-1966. [PMID: 34661291 DOI: 10.1002/eat.23621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Toned muscularity continues to emerge as a salient aspect of women's body image. However, there is a dearth of research investigating the potentially maladaptive eating practices and related cognitions that accompany the drive for muscularity in women. This may be attributable to the limited empirical and clinical attention previously given to muscularity-oriented disordered eating and, accordingly, the lack of validated measures assessing these concerns. To address this knowledge gap, our study aimed to provide a preliminary evaluation of the factor structure and core psychometric properties of a recently developed measure of muscularity-oriented disordered eating, the Muscularity-Oriented Eating Test (MOET), in university women in Australia. METHOD Participants included 419 university women who completed the 15-item MOET and other self-report measures for validity evaluation as part of an online survey. Data from split-half samples were used to undertake an exploratory factor analysis and subsequent confirmatory factor analysis. RESULTS Factor analytic results supported a briefer (12-item), one-factor scale in this sample of university women. The internal consistency reliability and validity (convergent and discriminant) of this 12-item unidimensional MOET was supported. DISCUSSION Our study provides preliminary support for this modified MOET as a psychometrically sound self-report measure of muscularity-oriented disordered eating in university women in Australia, providing a useful tool for understanding maladaptive eating behaviors and cognitions concomitant to the pursuit of muscularity in this population.
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Affiliation(s)
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Rebecca T Pinkus
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, California, USA
| | - Nora Trompeter
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.,Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Marianna Szabo
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research (MiCOR) Program, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,The Metis Foundation, San Antonio, Texas, USA
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31
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Ganson KT, Nagata JM, Lavender JM, Rodgers RF, L Cunningham M, Murray SB, Hammond D. Prevalence and correlates of weight gain attempts across five countries. Int J Eat Disord 2021; 54:1829-1842. [PMID: 34415082 DOI: 10.1002/eat.23595] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the prevalence and correlates of weight gain attempts in a pooled sample of adults aged 18 and older from Canada, Australia, the United Kingdom, the United States, and Mexico. METHOD Data collected during 2 years (2018 and 2019) of the International Food Policy Study (N = 42,108) were analyzed. Unadjusted 12-month prevalence of weight gain attempts was estimated based on body mass index (BMI; kg/m2 ), weight perception, country, survey year, and sex. Logistic regression analyses were estimated to determine the sociodemographic correlates (age, race/ethnicity, education, BMI, weight perception, weight perception accuracy, and self-rated mental health) of weight gain attempts among the pooled sample stratified by sex. RESULTS Men (10.4%) were significantly more likely than women (5.4%) to report weight gain attempts (p < .001). Nearly one in five (17.1%) men with a BMI in the "normal" range (≥18.5 to <25.0) reported weight gain attempts. Among both men and women, minority group identity was associated with higher odds, while older age and higher BMI category were associated with lower odds, of reporting weight gain attempts. Country differences over the two survey years showed the prevalence of weight gain attempts in 2019 (vs. 2018) was higher among women in Australia (p < .05) and men in the United States (p < .01). DISCUSSION Weight gain attempts are more common among men, compared to women, across five countries, potentially reflecting the global salience of the pursuit of a muscular body.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University, Bethesda, Maryland, USA.,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, Maryland, USA.,Metis Foundation, San Antonio, Texas, USA
| | - Rachel F Rodgers
- Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, Montpellier, France
| | | | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Coelho JS, Suen J, Marshall S, Burns A, Geller J, Lam PY. Gender differences in symptom presentation and treatment outcome in children and youths with eating disorders. J Eat Disord 2021; 9:113. [PMID: 34526146 PMCID: PMC8441244 DOI: 10.1186/s40337-021-00468-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To address the gaps in the literature examining eating disorders among males and gender minority youths, a prospective study was designed to assess gender differences in eating disorder symptom presentation and outcomes. Muscularity concerns may be particularly relevant for male youths with eating disorders, and were included in assessment of eating disorder symptom presentation. METHODS All cisgender male youths who presented for specialized eating disorder treatment at one of two sites were invited to participate, along with a group of matched cisgender females, and all youths who did not identify with the sex assigned to them at birth. Youths completed measures of eating disorder symptoms, including muscularity concerns, and other psychiatric symptoms at baseline and end of treatment. RESULTS A total of 27 males, 28 females and 6 trans youths took part in the study. At baseline, Kruskal-Wallis tests demonstrated that trans youths reported higher scores than cisgender male and female youths on measures of eating pathology (Eating disorder examination-questionnaire (EDE-Q) and the body fat subscale of the male body attitudes scale (MBAS)). These analyses demonstrated that there were no differences between cisgender male and female youths on eating disorder symptoms at baseline. However, repeated measures ANOVA demonstrated that males had greater decreases in eating pathology at discharge than did females, based on self-reported scores on the EDE-Q, MBAS, and Body Change Inventory. CONCLUSIONS Gender differences in eating pathology appeared at baseline, with trans youths reporting higher levels of eating pathology than cisgender youths, though no differences between cisgender males and females emerged at baseline for eating disorder symptom presentation. Contrary to expectations, there were no gender differences in measures of muscularity concerns. Males demonstrated greater eating disorder symptom improvements than females, suggesting that male adolescents may have better treatment outcomes than females in some domains.
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Affiliation(s)
- Jennifer S Coelho
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada. .,Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
| | - Janet Suen
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Sheila Marshall
- School of Social Work, University of British Columbia, 2080 West Mall, Vancouver, BC, V6T 1Z2, Canada.,Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Alex Burns
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Josie Geller
- Department of Psychiatry, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.,Eating Disorders Program, St. Paul's Hospital, Vancouver, BC, Canada
| | - Pei-Yoong Lam
- Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children's Hospital, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada.,Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Ganson KT, Testa A, Jackson DB, Nagata JM. Performance-enhancing substance use and criminal offending: A 15-year prospective cohort study. Drug Alcohol Depend 2021; 226:108832. [PMID: 34186290 DOI: 10.1016/j.drugalcdep.2021.108832] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Research has documented an association between anabolic-androgenic steroid (AAS) use and criminal offending. Still, whether legal performance-enhancing substance (e.g., creatine; PES) use is similarly associated with criminal offending is unknown. The aim of the present study was to determine the prospective associations between legal PES use and AAS use and criminal offending among U.S. adults. METHODS Data from three waves over 15 years of the National Longitudinal Study of Adolescent to Adult Health, a prospective cohort study, were analyzed. Legal PES use and AAS use were assessed at Wave III (ages 18-26) and criminal offending was assessed at Wave IV (ages 24-32; N = 10,861) and Wave V (ages 33-43; N = 9,451). Criminal offending was measured using a summed score of six items (range 0-6). Multiple negative binominal regressions were conducted, transformed to incident rate ratios (IRR), adjusting for biological sex, age, race/ethnicity, household income, body mass index, depression, smoking, alcohol, and prior victimization and offending. MAIN FINDINGS Among the sample (51.3 % male; 68.8 % White), legal PES use (Wave IV: IRR 1.46, 95 % confidence interval [CI] 1.15-1.85; Wave V: IRR 1.52, 95 % CI 1.02-2.27) and AAS use (Wave IV: IRR 1.73, 95 % CI 1.09-2.76; Wave V: IRR 2.36, 95 % CI 1.33-4.19) were prospectively associated with criminal offending during young and middle adulthood, while adjusting for demographic and behavioral factors. CONCLUSIONS These results confirm and expand upon prior research by describing the prospective associations between both legal PES use and AAS use and criminal offending among a nationally representative sample of U.S. adults.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
| | - Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Weight Goals, Disordered Eating Behaviors, and BMI Trajectories in US Young Adults. J Gen Intern Med 2021; 36:2622-2630. [PMID: 33876378 PMCID: PMC8390712 DOI: 10.1007/s11606-021-06702-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 03/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Community sample data indicate that weight control efforts in young adulthood may have associations with greater increases in body mass index (BMI) over time. OBJECTIVE To determine the prospective associations between weight goals and behaviors in young adults and BMI trajectories over 15-year follow-up using a nationally representative sample. DESIGN Longitudinal cohort data collected from 2001 to 2018 of the National Longitudinal Study of Adolescent to Adult Health. PARTICIPANTS Young adults aged 18-26 years old at baseline stratified by gender and BMI category. MAIN MEASURES Predictors: weight goals, any weight loss/maintenance behaviors, dieting, exercise, disordered eating behaviors. OUTCOMES BMI at 7- and 15-year follow-up. KEY RESULTS Of the 12,155 young adults in the sample (54% female, 32% non-White), 33.2% reported a goal to lose weight, 15.7% to gain weight, and 14.6% to maintain weight. In unadjusted models, all groups have higher mean BMI at 7- and 15-year follow-up. In mixed effect models, goals to lose weight in men with BMI < 18.5 (5.94 kg/m2; 95% CI 2.58, 9.30) and goals to maintain weight in men with BMI ≥ 25 (0.44; 95% CI 0.15, 0.72) were associated with greater BMI increase compared to no weight goal. Engaging in disordered eating behaviors was associated with greater BMI increase in men with BMI < 18.5 (5.91; 2.96, 8.86) and women with 18.5 ≤ BMI < 25 (0.40; 0.16, 0.63). Dieting (- 0.24; - 0.41, - 0.06) and exercise (- 0.31; - 0.45, - 0.17) were associated with lower BMI increase in women with 18.5 ≤ BMI < 25. In women with BMI < 18.5, dieting was associated with greater BMI increase (1.35; 0.33, 2.37). CONCLUSIONS Weight control efforts may have variable effects on BMI over time by gender and BMI category. These findings underscore the need to counsel patients on the effectiveness of weight control efforts and long-term weight management.
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Ganson KT, Rodgers RF, Murray SB, Nagata JM. Prevalence and demographic, substance use, and mental health correlates of fasting among U.S. college students. J Eat Disord 2021; 9:88. [PMID: 34289904 PMCID: PMC8293526 DOI: 10.1186/s40337-021-00443-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Fasting is an unhealthy behavior that has been frequently used as part of weight loss attempts. To date, little research has been conducted to determine the prevalence and substance use and mental health correlates of fasting among college students. Therefore, the aim of this study was to estimate the prevalence and associations between any (≥ 1 time) and regular (≥ 13 times) occurrences of fasting in the past 4 weeks and substance use and mental health correlates among a large sample of college students from 2016 to 2020. METHODS Data from four academic survey years (2016-2020; N = 8255) of the national (USA) Healthy Minds Study were analyzed. Unadjusted prevalence of any and regular fasting by survey year and gender was estimated. Multiple logistic regression analyses were conducted to estimate the associations between any and regular fasting and the demographic (age, body mass index, race/ethnicity, sexual orientation, highest parental education), substance use (cigarette use, marijuana use, other illicit drug use, alcohol use), and mental health (depression, anxiety, eating disorder symptoms, suicidal ideation, non-suicidal self-injury) correlates. RESULTS Any fasting in the past 4 weeks was common among both men (14.77%) and women (18.12%) and significantly increased from 2016 (10.30%) to 2020 (19.81%) only among men. Regular fasting significantly increased among both men and women from 2016 (men: 1.46%; women: 1.79%) to 2020 (men: 3.53%; women: 6.19%). Among men and women, both any and regular fasting in the past 4 weeks were associated with higher odds of all mental health symptoms, including a positive depression, anxiety, and eating disorder screen, suicidal ideation, and non-suicidal self-injury. Among women, but not men, any and regular fasting in the past 4 weeks were associated with higher odds of marijuana use and other illicit drug use (e.g., cocaine, ecstasy). CONCLUSIONS The results from this study underscore both the high and increasing prevalence of fasting among a national sample of college students, as well as the substance use and mental health symptoms associated with this behavior. Healthcare professionals both on and off campus should consider screening for fasting behaviors among college students and provide appropriate intervention when needed.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, MA, USA.,Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, 550 16th Street, Box 0110, San Francisco, San Francisco, CA, 94158, USA.
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Eisenberg ME, Wall MM, Larson N, Arlinghaus KR, Neumark-Sztainer D. Do emerging adults know what their friends are doing and does it really matter? Methodologic challenges and associations of perceived and actual friend behaviors with emerging adults' disordered eating and muscle building behaviors. Soc Sci Med 2021; 284:114224. [PMID: 34303935 DOI: 10.1016/j.socscimed.2021.114224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/14/2021] [Accepted: 07/10/2021] [Indexed: 11/27/2022]
Abstract
Disordered eating and muscle building behaviors are common among emerging adults, and friends may be a particularly salient social influence. Epidemiologic research often includes questions about participants' perceptions of their friends. A less common approach, with greater logistical challenges, is to ask for friend nominations and then survey friends about their actual behaviors. The comparability of these different approaches is unknown. This study addresses the following research questions: 1) What is the feasibility of collecting data from emerging adults' friends in epidemiologic research? 2) Do perceptions of friends' weight- and shape-related behaviors align with friends' actual behaviors? and 3) Are perceptions or friends' actual behaviors more strongly and consistently associated with emerging adults' behaviors? Participants (N = 2383) in the EAT (Eating and Activity over Time)-2018 study in Minnesota, USA, were asked to nominate up to three friends and provide data about those friends' weight- and shape-related behaviors (i.e. perceptions); nominated friends were invited to complete an abbreviated survey and report on their own same behaviors (i.e. actual). Among the invited friends, 191 responded and were linked to the 152 EAT 2018 participants who nominated them. Descriptive statistics, Spearman's correlations, and logistic regression were used to address the research questions. The response rate for nominated friends was very low (9.9%), suggesting this approach may have low feasibility for epidemiologic studies of emerging adults. Emerging adults' perceptions of their nominated friends' weight and shape-related behaviors generally did not align well with the behaviors reported by those friends. Furthermore, analytic models found different associations between friends' behavior and EAT 2018 participant behaviors, depending on the measure of friends' behavior used (perceived or actual). Careful consideration of the pros and cons of each study design is essential to build an evidence base and support interventions regarding emerging adults' weight- and shape-related health.
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Affiliation(s)
- Marla E Eisenberg
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Melanie M Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Nicole Larson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Katherine R Arlinghaus
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Dianne Neumark-Sztainer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
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Ganson KT, Murray SB, Nagata JM. Associations between eating disorders and illicit drug use among college students. Int J Eat Disord 2021; 54:1127-1134. [PMID: 33638571 DOI: 10.1002/eat.23493] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To estimate the associations between a positive eating disorder screen and any lifetime eating disorder diagnosis and illicit drug use among a large, diverse sample of college students. METHOD We analyzed data from the national (United States), cross-sectional 2018-2019 Healthy Minds Study (HMS; n = 42,618; response rate: 16%). HMS collects information on the physical, mental, and social health of college students. Multiple logistic regression analyses were used to estimate the association between a positive eating disorder screen (measured using the SCOFF) and any self-reported lifetime eating disorder diagnosis and self-reported illicit drug use in the past 30 days (any illicit drug use and use of marijuana, cocaine, heroin, methamphetamines, stimulants, ecstasy, opioids, benzodiazepines), while adjusting for potential confounders. RESULTS Among the sample, 54.34% (n = 28,608) were female and the mean age of participants was 23.30 (SE ± 0.05) years. Logistic regression analyses revealed unique associations between a positive eating disorder screen and any lifetime eating disorder diagnosis and illicit drug use among the sample of college student participants. A positive eating disorder screen was most strongly associated with methamphetamine use (adjusted odds ratio [AOR] 3.93, 95% confidence interval [CI] 1.43-10.78), and any lifetime eating disorder diagnosis was most strongly associated with benzodiazepine use (AOR 3.42, 95% CI 2.28-5.13). DISCUSSION Illicit drug use is common among college students who screen positive for an eating disorder and report any lifetime eating disorder diagnosis. The co-occurring nature of eating disorders and illicit drug use may complicate treatment and lead to compounded adverse health outcomes.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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Ganson KT, Murray SB, Mitchison D, Hawkins MAW, Layman H, Tabler J, Nagata JM. Associations between Adverse Childhood Experiences and Performance-Enhancing Substance Use among Young Adults. Subst Use Misuse 2021; 56:854-860. [PMID: 33726612 PMCID: PMC11385237 DOI: 10.1080/10826084.2021.1899230] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND OBJECTIVE Adverse childhood experiences (ACEs) are associated with negative health outcomes, yet their associations with performance-enhancing substance (PES) use are unclear. This study aimed to determine whether ACEs predict greater use of legal and illegal PES in young adults. METHODS We analyzed data from the National Longitudinal Study of Adolescent to Adult Health (n = 14,322), Waves I (1994-1995) and III (2001-2002). ACEs included childhood sexual abuse, physical abuse, two neglect indicators, and cumulative ACEs. Legal (e.g. creatine monohydrate) and illegal (e.g. non-prescription anabolic-androgenic steroids; AAS) PES use was assessed. RESULTS Sexual abuse had the greatest effect and predicted higher odds of legal PES use (men: adjusted odds ratio [AOR] 1.66, 95% confidence interval [CI] 1.06-2.59; women: AOR 3.74, 95% CI 1.63-8.59) and AAS use (men: AOR 8.89, 95% CI 5.37-14.72; women: AOR 5.73, 95% CI 2.31-14.18). Among men, a history of physical abuse (AOR 3.04, 95% CI 2.05-4.52), being left alone by a parent/guardian (AOR 2.33, 95% CI 1.50-3.60), and basic needs not being met (AOR 3.47, 95% CI 2.30-5.23) predicted higher odds of AAS use. Among women, basic needs not being met (AOR 2.94, 95% CI 1.43-6.04) predicted higher odds of AAS use. Among both men and women, greater number of cumulative ACEs predicted higher odds of both legal and illegal PES use. CONCLUSIONS ACEs predict greater PES use among young adults. Clinicians should monitor for PES use among those who have experienced ACEs and provide psychoeducation on the adverse effects associated with PES use.
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Affiliation(s)
- Kyle T Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Misty A W Hawkins
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Harley Layman
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Jennifer Tabler
- Department of Criminal Justice and Sociology, College of Arts and Sciences, University of Wyoming, Laramie, Wyoming, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
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Nagata JM, Ganson KT, Cunningham ML, Mitchison D, Lavender JM, Blashill AJ, Gooding HC, Murray SB. Associations between legal performance-enhancing substance use and future cardiovascular disease risk factors in young adults: A prospective cohort study. PLoS One 2020; 15:e0244018. [PMID: 33320903 PMCID: PMC7737961 DOI: 10.1371/journal.pone.0244018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Legal performance-enhancing substances (PES), such as creatine, are commonly used by adolescents and young adults. As PES are mostly unregulated by the US Food and Drug Administration, there has been limited empirical attention devoted to examining their long-term safety and health outcomes. Preliminary studies have demonstrated associations between PES use and severe medical events, including hospitalizations and death. PES could be linked to cardiovascular disease (CVD), the most common cause of mortality in the US, by altering the myocardium, vasculature, or metabolism. The objective of this study was to examine prospective associations between the use of legal PES in young adulthood and CVD risk factors at seven-year follow-up. MATERIALS AND METHODS Nationally representative longitudinal cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves III (2001-2002) and IV (2008), were analyzed. Regression models determined the prospective association between the use of legal PES (e.g. creatine monohydrate) and CVD risk factors (e.g. body mass index, diabetes, hypertension, hyperlipidemia), adjusting for relevant covariates. RESULTS Among the diverse sample of 11,996 male and female participants, no significant differences by PES use in body mass index, diabetes, hypertension, or hyperlipidemia were noted at Wave III. In unadjusted comparisons, legal PES users (versus non-users) were more likely to be White, be male, be college educated, drink alcohol, and engage in weightlifting, exercise, individual sports, team sports, and other strength training. There were no significant prospective associations between legal PES use at Wave III and body mass index, hemoglobin A1c, systolic and diastolic blood pressure, and cholesterol (total, HDL, LDL, triglycerides) deciles at seven-year follow-up (Wave IV), adjusting for demographics, health behaviors, and Wave III CVD risk factors. Similarly, there were no significant prospective associations between legal PES use and diabetes, hypertension, or hyperlipidemia based on objective measures or self-reported medications and diagnoses, adjusting for demographics, health behaviors, and Wave III CVD risk. CONCLUSIONS We do not find evidence for a prospective association between legal PES use and CVD risk factors in young adults over seven years of follow-up, including BMI, diabetes, hypertension, or hyperlipidemia. It should be noted that legal PES use was operationalized dichotomously and as one broad category, which did not account for frequency, amount, or duration of use. Given the lack of regulation and clinical trials data, observational studies can provide much needed data to inform the safety and long-term health associations of legal PES use and, in turn, inform clinical guidance and policy.
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Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, United States of America
| | - Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jason M. Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Metis Foundation, San Antonio, Texas, United States of America
| | - Aaron J. Blashill
- Department of Psychology, San Diego State University, San Diego, California, United States of America
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University, San Diego, California, United States of America
- San Diego Joint Doctoral Program in Clinical Psychology, University of California, San Diego, California, United States of America
| | - Holly C. Gooding
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Stuart B. Murray
- Department of Psychiatry & Behavioral Sciences, University of Southern California, Los Angeles, California, United States of America
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Ganson KT, Mitchison D, Murray SB, Nagata JM. Legal Performance-Enhancing Substances and Substance Use Problems Among Young Adults. Pediatrics 2020; 146:peds.2020-0409. [PMID: 32868471 PMCID: PMC7461208 DOI: 10.1542/peds.2020-0409] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Legal performance-enhancing substance(s) (PES) (eg, creatine) are widely used among adolescent boys and young men; however, little is known about their temporal associations with substance use behaviors. METHODS We analyzed prospective cohort data from the National Longitudinal Study of Adolescent to Adult Health, Waves I to IV (1994-2008). Logistic regressions were used to first assess adolescent substance use (Wave I) and use of legal PES (Wave III) and second to assess use of legal PES (Wave III) and subsequent substance use-associated risk behaviors (Wave IV), adjusting for potential confounders. RESULTS Among the sample of 12 133 young adults aged 18 to 26 years, 16.1% of young men and 1.2% of young women reported using legal PES in the past year. Adolescent alcohol use was prospectively associated with legal PES use in young men (odds ratio 1.39; 95% confidence interval [CI] 1.13-1.70). Among young men, legal PES use was prospectively associated with higher odds of problematic alcohol use and drinking-related risk behaviors, including binge drinking (adjusted odds ratio [aOR] 1.35; 95% CI 1.07-1.71), injurious and risky behaviors (aOR 1.78; 95% CI 1.43-2.21), legal problems (aOR 1.52; 95% CI 1.08-2.13), cutting down on activities and socialization (aOR 1.91; 95% CI 1.36-2.78), and emotional or physical health problems (aOR 1.44; 95% CI 1.04-1.99). Among young women, legal PES use was prospectively associated with higher odds of emotional or physical health problems (aOR 3.00; 95% CI 1.20-7.44). CONCLUSIONS Use of legal PES should be considered a gateway to future problematic alcohol use and drinking-related risk behaviors, particularly among young men.
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Affiliation(s)
- Kyle T. Ganson
- Factor-Inwentash Faculty of Social Work, University
of Toronto, Toronto, Ontario, Canada
| | - Deborah Mitchison
- Translational Health Research Institute, School of
Medicine, Western Sydney University, Sydney, New South Wales, Australia;,Department of Psychology, Macquarie University,
Sydney, New South Wales, Australia
| | - Stuart B. Murray
- Department of Psychiatry and the Behavioral Sciences,
University of Southern California, Los Angeles, California; and
| | - Jason M. Nagata
- Division of Adolescent and Young Adult Medicine,
Department of Pediatrics, University of California, San Francisco, San
Francisco, California
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Abstract
PURPOSE OF REVIEW To review the recent literature on eating disorders and disordered eating behaviors among adolescent boys and young men, including epidemiology, assessment, medical complications, treatment outcomes, and special populations. RECENT FINDINGS Body image concerns in men may involve muscularity, and muscle-enhancing goals and behaviors are common among adolescent boys and young men. Recent measures, such as the Muscularity Oriented Eating Test (MOET) have been developed and validated to assess for muscularity-oriented disordered eating. Medical complications of eating disorders can affect all organ systems in male populations. Eating disorders treatment guidance may lack specificity to boys and men, leading to worse treatment outcomes in these population. Male populations that may have elevated risk of eating disorders and disordered eating behaviors include athletes and racial/ethnic, sexual, and gender minorities. SUMMARY Eating disorders and disordered eating behaviors in boys and men may present differently than in girls and women, particularly with muscularity-oriented disordered eating. Treatment of eating disorders in boys and men may be adapted to address their unique concerns.
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Affiliation(s)
- Jason M. Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Kyle T. Ganson
- School of Social Work, Simmons University, Boston, MA, USA
| | - Stuart B. Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
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