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Boswell RG, Launius KN, Lydecker JA. Multiple marginalization, discrimination, and disordered eating among youth aged 10-11. Int J Eat Disord 2024. [PMID: 38572625 DOI: 10.1002/eat.24211] [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: 11/17/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Although rates of weight discrimination are on-par with racial, ethnic, and gender discrimination, comparatively less work has examined impacts of weight-based discrimination in youth, including on disordered eating. Knowing whether experiences of weight-based discrimination, including in youth with multiply-marginalized identities, are associated with disordered eating could identify vulnerable youth and inform intervention efforts. METHOD Youth (N = 11,875) ages 10-11 were recruited through the Adolescent Brain Cognitive Development (ABCD) study. Logistic regressions using cross-sectional data examined discrimination experiences (weight, perceived sexual orientation, race/ethnicity, national origin) and disordered eating (binge-eating, vomiting, weight-gain fear, weight self-worth). Models included race/ethnicity, age, sex, parental income, and degree of elevated weight. Raked poststratification weights were used. RESULTS Rates of weight-based discrimination (6.2%) were similar to rates of race/ethnicity (4.4%) and sexual orientation discrimination (4.5%). Weight-based discrimination was associated with more disordered eating. Youth reporting multiple experiences of discrimination had significantly increased disordered eating compared to youth who did not report discrimination. DISCUSSION Weight-based discrimination is common in youth and associated with disordered eating. Youth with elevated weight are more likely to be multiply marginalized and experience disordered eating. These findings suggest discrimination, including weight-based discrimination, is a critical intervention target to prevent and treat eating disorders. PUBLIC SIGNIFICANCE Experiences of discrimination contribute to poorer health; however, weight-based discrimination is relatively understudied. Data from a large sample of youth ages 10-11 showed that youth with elevated weight reported experiencing multiple types of discrimination, and multiply-marginalized youth had increased odds of disordered eating with each additional type of discrimination. Together, this suggests that weight-based discrimination is a critical target to prevent and treat eating disorders, especially in multiply-marginalized youth.
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Affiliation(s)
- Rebecca G Boswell
- Department of Psychiatry, Penn Medicine Princeton Center for Eating Disorders, Princeton, New Jersey, USA
- Department of Psychology, Princeton University, Princeton, New Jersey, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Kellsey N Launius
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Janet A Lydecker
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Hotez E, Rava J, Russ S, Ware A, Halfon N. Using a life course health development framework to combat stigma-related health disparities for individuals with intellectual and/or developmental disability (I/DD). Curr Probl Pediatr Adolesc Health Care 2023; 53:101433. [PMID: 37867057 DOI: 10.1016/j.cppeds.2023.101433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
In the U.S., 1 in 6 children has an intellectual and/or developmental disability (I/DD). This population experiences a multitude of negative health outcomes across the life course, relative to the general population. Stigma-the social devaluation of individuals with certain characteristics, identities, or statuses within interpersonal, educational, healthcare, and policy contexts-is a potentially preventable contributor to health disparities. To date, existing approaches for addressing and preventing stigma are limited to discrete and siloed interventions that often fail to address the lifelong, cumulative impacts of the specific types of stigma experienced by the I/DD population. In the current paper, we describe three elements of Life Course Health Development (LCHD)-a novel translational framework that draws on evidence from biology, sociology, epidemiology, and psychology-that healthcare providers can use to prevent stigma-related health disparities and improve outcomes for individuals with I//DDs. We discuss the utility of targeting prevention to sensitive periods; prioritizing interventions for the most damaging types of stigmas; and leveraging supports from multiple service systems and sectors. By incorporating evidence from life course science into efforts to address stigma-related health disparities, providers can more effectively and strategically prevent and combat stigma-related health disparities for the I/DD population in childhood and across the life course.
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Affiliation(s)
- Emily Hotez
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States.
| | - Julianna Rava
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Shirley Russ
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of General Internal Medicine / Health Services Research, 911 Broxton Ave, Los Angeles, CA, 90095, United States; University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States
| | - Allysa Ware
- Family Voices, 110 Hartwell Avenue, Lexington, MA, 02421, United States
| | - Neal Halfon
- University of California, Los Angeles (UCLA), David Geffen School of Medicine, Department of Pediatrics, Center for Healthier Children, Families, & Communities, 10960 Wilshire Blvd., Suite 960, Los Angeles, CA 90024-3913, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, United States
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Jetelina KK, Reingle Gonzalez JM, Cuccaro PM, Peskin MF, Pompeii L, Atem F, Elliott MN, Earnshaw VA, Davies SL, Schuster MA. Mechanisms and Frequency of Violent Injuries Among Victims and Perpetrators of Bullying. J Adolesc Health 2019; 64:664-670. [PMID: 30612808 DOI: 10.1016/j.jadohealth.2018.10.295] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/02/2018] [Accepted: 10/26/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE This article aims to (1) evaluate whether bullying typology predicts violent injury; (2) longitudinally examine whether violent injury trajectories differ across bullying typology as children age; and (3) longitudinally determine whether children who consistently reported perpetration or victimization (i.e., reported bullying at fifth, seventh, and 10th grade) were different from children who inconsistently reported perpetration or victimization. METHODS Longitudinal data were obtained from 4,297 children at three waves (fifth, seventh, and 10th grade) in three United States communities. Children were categorized into four mutually exclusive bullying typologies: neither victim nor perpetrator; victim only; perpetrator only; victim-perpetrator. Children self-reported mechanisms of violent injuries that needed medical attention in the past year. Regression models were used to evaluate the relationship between bullying group and the likelihood of violent injury over time. RESULTS Seventeen percent (n=857) of children in fifth grade reported a violent injury. Prevalence of overall violent injuries, and specifically firearm and knife injuries, increased over time. Children who reported perpetration in the absence of victimization were at increased odds for violent injury (adjusted odds ratio = 1.41, 95% confidence interval: 1.24, 1.60) compared with children who reported neither victimization nor perpetration, while children who reported victimization in the absence of perpetration were at decreased odds (adjusted odds ratio=.84, 95% confidence interval: .73, .97). A significant linear dose-response relationship was observed between duration of bullying perpetration and violent injury. CONCLUSIONS The relationship between bullying perpetration and violent injury over time was strong. Future research should investigate potential mediating behaviors, such as weapon access, which might explain the observed relationship.
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Affiliation(s)
- Katelyn K Jetelina
- University of Texas Health Science Center, School of Public Health, Dallas Campus, Dallas, Texas.
| | | | - Paula M Cuccaro
- University of Texas Health Science Center, School of Public Health, Houston, Texas
| | - Melissa F Peskin
- University of Texas Health Science Center, School of Public Health, Houston, Texas
| | - Lisa Pompeii
- University of Texas Health Science Center, School of Public Health, Houston, Texas
| | - Folefac Atem
- University of Texas Health Science Center, School of Public Health, Dallas Campus, Dallas, Texas
| | | | | | - Susan L Davies
- Department of Health Behavior, UAB Center for the Study of Community Health, Birmingham, Alabama
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Jetelina KK, Reingle Gonzalez JM, Cuccaro PM, Peskin MF, Pompeii L, Atem F, Elliott MN, Earnshaw VA, Davies SL, Schuster MA. Self-reporting discrepancies of bullying victimization and perpetration measures. Ann Epidemiol 2019; 32:58-63. [DOI: 10.1016/j.annepidem.2019.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 10/27/2022]
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Teacher Authority in Long-Lasting Cases of Bullying: A Qualitative Study from Norway and Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071163. [PMID: 30935153 PMCID: PMC6480765 DOI: 10.3390/ijerph16071163] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 11/24/2022]
Abstract
A growing body of research shows a correlation between an authoritative school climate and lower levels of bullying. One objective of this study is to conceptualize authoritative intervention in bullying cases. A second goal is to explore whether, and how, the pupils, having experienced traditional and/or cyber victimization, perceive that the class teacher is demonstrating authoritative leadership when intervening in long-lasting cases of bullying. Class teacher refers to the teacher that has a special responsibility for the class. The article presents the findings from nine semi-structured interviews with four Irish and five Norwegian pupils. The informants were between 12 to 18 years of age and had experienced either traditional victimization or both traditional and cyber victimization for 1 to 7 years. The informants were selected because their cases had been reported as resolved. The findings showed no descriptions of the class teacher that appeared to fit with the authoritative style of leadership, both high on warmth and control. The possible practical implications of these findings are discussed.
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Earnshaw VA, Bogart LM, Poteat VP, Reisner SL, Schuster MA. Bullying Among Lesbian, Gay, Bisexual, and Transgender Youth. Pediatr Clin North Am 2016; 63:999-1010. [PMID: 27865341 PMCID: PMC8941671 DOI: 10.1016/j.pcl.2016.07.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Bullying of lesbian, gay, bisexual, and transgender (LGBT) youth is prevalent in the United States, and represents LGBT stigma when tied to sexual orientation and/or gender identity or expression. LGBT youth commonly report verbal, relational, and physical bullying, and damage to property. Bullying undermines the well-being of LGBT youth, with implications for risky health behaviors, poor mental health, and poor physical health that may last into adulthood. Pediatricians can play a vital role in preventing and identifying bullying, providing counseling to youth and their parents, and advocating for programs and policies to address LGBT bullying.
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Affiliation(s)
- Valerie A. Earnshaw
- Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA,Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA,Corresponding author. Boston Children’s Hospital, 21 Autumn Street, Room 212.1, Boston, MA 02115.
| | - Laura M. Bogart
- Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA,Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA,Health Unit, RAND Corporation, 1776 Main Street, P.O. Box 2138 Santa Monica, CA 90407-2138, USA
| | - V. Paul Poteat
- Counseling, Developmental, and Educational Psychology Department, Boston College, 140 Commonwealth Ave, Campion Hall 307, Chestnut Hill, MA 02467, USA
| | - Sari L. Reisner
- Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA,Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA,The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
| | - Mark A. Schuster
- Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115, USA,Department of Pediatrics, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA
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Schuster MA, Bogart LM, Elliott MN, Klein DJ, Feng JY, Tortolero SR, Mrug S, Lewis TH. A longitudinal study of bullying of sexual-minority youth. N Engl J Med 2015; 372:1872-4. [PMID: 25946302 DOI: 10.1056/nejmc1413064] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Schuster MA, Elliott MN, Bogart LM, Klein DJ, Feng JY, Wallander JL, Cuccaro P, Tortolero SR. Changes in obesity between fifth and tenth grades: a longitudinal study in three metropolitan areas. Pediatrics 2014; 134:1051-8. [PMID: 25384494 DOI: 10.1542/peds.2014-2195] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Despite epidemic childhood obesity levels, we know little about how BMI changes from preadolescence to adolescence and what factors influence changes. METHODS We studied 3961 randomly selected public school students and 1 parent per student in 3 US metropolitan areas in fifth and again in tenth grades. In each grade, we measured child and parent height/weight and calculated BMI category. We examined whether baseline sociodemographic characteristics, child health-related factors, and parental obesity were significantly associated with exit from and entry into obesity from fifth to tenth grade. RESULTS Fifth- and tenth-graders were 1%/2% underweight, 53%/60% normal weight, 19%/18% overweight, and 26%/20% obese, respectively. Among obese tenth-graders, 83% had been obese as fifth-graders and 13% had been overweight. Sixty-five percent of obese fifth-graders remained obese as tenth-graders, and 23% transitioned to overweight. Multivariately, obese fifth-graders who perceived themselves to be much heavier than ideal (P = .01) and those who had lower household education (P = .006) were less likely to exit obesity; by contrast, overweight fifth-graders were more likely to become obese if they had an obese parent (P < .001) or watched more television (P = .02). CONCLUSIONS Obese fifth-graders face challenges in reducing obesity, especially when they lack advantages associated with higher socioeconomic status or when they have a negative body image. Clinicians and others should educate parents on the importance of preventing obesity very early in development. Children who are not yet obese by fifth grade but who have an obese parent or who watch considerable television might benefit from monitoring, as might children who have negative body images.
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Affiliation(s)
- Mark A Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; RAND Corporation, Santa Monica, California;
| | | | - Laura M Bogart
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - David J Klein
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Jeremy Y Feng
- Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jan L Wallander
- Psychological Sciences, University of California, Merced, California; and
| | - Paula Cuccaro
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
| | - Susan R Tortolero
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas
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Bogart LM, Elliott MN, Klein DJ, Tortolero SR, Mrug S, Peskin MF, Davies SL, Schink ET, Schuster MA. Peer victimization in fifth grade and health in tenth grade. Pediatrics 2014; 133:440-7. [PMID: 24534401 PMCID: PMC4530298 DOI: 10.1542/peds.2013-3510] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children who experience bullying, a type of peer victimization, show worse mental and physical health cross-sectionally. Few studies have assessed these relationships longitudinally. We examined longitudinal associations of bullying with mental and physical health from elementary to high school, comparing effects of different bullying histories. METHODS We analyzed data from 4297 children surveyed at 3 time points (fifth, seventh, and tenth grades) in 3 cities. We used multivariable regressions to test longitudinal associations of bullying with mental and physical health by comparing youth who experienced bullying in both the past and present, experienced bullying in the present only, experienced bullying in the past only, or did not experience bullying. RESULTS Bullying was associated with worse mental and physical health, greater depression symptoms, and lower self-worth over time. Health was significantly worse for children with both past and present bullying experiences, followed by children with present-only experiences, children with past-only experiences, and children with no experiences. For example, 44.6% of children bullied in both the past and present were at the lowest decile of psychosocial health, compared with 30.7% of those bullied in the present only (P = .005), 12.1% of those bullied in the past only (P < .001), and 6.5% of those who had not been bullied (P < .001). CONCLUSIONS Both chronic and current bullying are associated with substantially worse health. Clinicians who recognize bullying when it first starts could intervene to reverse the downward health trajectory experienced by youth who are repeated targets.
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Affiliation(s)
- Laura M. Bogart
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - David J. Klein
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Susan R. Tortolero
- The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas; and
| | - Sylvie Mrug
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Melissa F. Peskin
- The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas; and
| | | | - Elizabeth T. Schink
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Abstract
PURPOSE OF REVIEW This article addresses three areas in which new research demonstrates the potential to impact the health of children and adolescents: bullying, adverse childhood experiences (ACEs) and texting to promote behavior change. RECENT FINDINGS Recent research on bullying emphasizes its impact on children with chronic medical conditions, and highlights cyber bullying as a rising issue. ACEs are now recognized as risk factors for many health issues, particularly mental health problems. Text messaging is a promising new method to communicate with parents and adolescent patients. SUMMARY Pediatric healthcare providers can help patients with chronic medical problems by addressing bullying at well child visits. Screening for ACEs may identify children at risk for mental health issues. Incorporating text messaging into clinical practice can improve disease management and patient education.
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