Targeting of low ALK antigen density neuroblastoma using AND logic-gate engineered CAR-T cells

BACKGROUND AIMS

The targeting of solid cancers with chimeric antigen receptor (CAR) T cells faces many technological hurdles, including selection of optimal target antigens. Promising pre-clinical and clinical data of CAR T-cell activity have emerged from targeting surface antigens such as GD2 and B7H3 in childhood cancer neuroblastoma. Anaplastic lymphoma kinase (ALK) is expressed in a majority of neuroblastomas at low antigen density but is largely absent from healthy tissues.

METHODS

To explore an alternate target antigen for neuroblastoma CAR T-cell therapy, the authors generated and screened a single-chain variable fragment library targeting ALK extracellular domain to make a panel of new anti-ALK CAR T-cell constructs.

RESULTS

A lead novel CAR T-cell construct was capable of specific cytotoxicity against neuroblastoma cells expressing low levels of ALK, but with only weak cytokine and proliferative T-cell responses. To explore strategies for amplifying ALK CAR T cells, the authors generated a co-CAR approach in which T cells received signal 1 from a first-generation ALK construct and signal 2 from anti-B7H3 or GD2 chimeric co-stimulatory receptors. The co-CAR approach successfully demonstrated the ability to avoid targeting single-antigen-positive targets as a strategy for mitigating on-target off-tumor toxicity.

CONCLUSIONS

These data provide further proof of concept for ALK as a neuroblastoma CAR T-cell target.

A systematic review of interventions aiming to promote positive body image in children and adolescents

Evidence shows interventions can improve positive body image in adult women. This systematic review examined the evidence of efficacy of interventions that aimed to increase positive body image in children and young people aged under 18 years. The authors followed PRISMA guidelines for the review. Searches of CINAHL Plus, Medline, PsychINFO, Wiley Online Library, SCOPUS and grey literature were conducted up to February 2021 and identified 4171 papers. Thirteen studies evaluating 12 interventions, designed for children/adolescents aged 9-18 years, were eligible and evaluated using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. The studies evaluated body appreciation, body-esteem, and embodiment. Studies using cognitive dissonance, peer support, and psychoeducation had evidence of improving body appreciation and body-esteem in adolescent girls. However, evidence of efficacy for younger children and boys was lacking and the studies ranged in methodological quality. Further research should rigorously evaluate positive body image interventions using second-generation measures that assess specific components of positive body image and consider how to promote positive body image in young children and boys.

Optimising the use of cell salvage in revision hip arthroplasty

BACKGROUND

Intraoperative cell salvage is an established method to reduce the requirement for and the volume of allogenic blood transfusion but adds to the financial cost of performing surgery.

AIMS

The primary aim of this study was to determine which patients and what type of revision hip surgery benefit most from intraoperative cell salvage.

METHODS

This observational study included patients who underwent revision hip surgery performed by the senior author at a single orthopaedic unit. The cohort was divided into single and two-component revision groups; then, the transfusion requirement combined with analysis of patient factors was used to create a decision-making protocol.

FINDINGS

The two-component group had a significantly higher number of cases using cell salvage and a higher total transfusion volume. Patients who required postoperative allogenic blood transfusions had a higher mean age, were less likely to have received tranexamic acid and had a lower preoperative haemoglobin level.

CONCLUSION

Based on these results, a decision-making protocol was developed for when to use cell salvage in revision hip surgery.

"I didn't want to say something and them to go outside and tell everyone": The acceptability of a dissonance-based body image intervention among adolescent girls in the UK

Cognitive dissonance-based interventions (CDIs) have been well established as effective programs for the prevention of eating disorders. However, limited research has qualitatively explored adolescent girls experience of such interventions. The present study examined the acceptability of a cognitive dissonance-based body image intervention among adolescent girls in UK secondary schools. Adolescent girls aged 14-18 years (N = 99; M_age = 14.87, SD = 0.97) who opted to participate in the intervention were invited to provide intervention feedback via open-ended questions and small focus groups. The findings suggest that the intervention was largely acceptable among adolescent girls. Peers played an important role. Despite initial concerns about sharing within the group, the groups provided a sense of belonging and participants no longer felt alone in their experience of body dissatisfaction. Participants discussed a transition from negative to positive body image following the intervention. Although acceptability was generally high, the data provides some interesting insights into potential considerations and modifications which may be advantageous in future CDIs. These include enhancing authenticity through reduced reliance on the script, inclusion of more personal content from the peer-leaders, and more interactive activities and physical movement.

TLR9 expression in chronic lymphocytic leukemia identifies a promigratory subpopulation and novel therapeutic target

Chronic lymphocytic leukemia (CLL) remains incurable despite B-cell receptor-targeted inhibitors revolutionizing treatment. This suggests that other signaling molecules are involved in disease escape mechanisms and resistance. Toll-like receptor 9 (TLR9) is a promising candidate that is activated by unmethylated cytosine guanine dinucleotide-DNA. Here, we show that plasma from patients with CLL contains significantly more unmethylated DNA than plasma from healthy control subjects (P < .0001) and that cell-free DNA levels correlate with the prognostic markers CD38, β2-microglobulin, and lymphocyte doubling time. Furthermore, elevated cell-free DNA was associated with shorter time to first treatment (hazard ratio, 4.0; P = .003). We also show that TLR9 expression was associated with in vitro CLL cell migration (P < .001), and intracellular endosomal TLR9 strongly correlated with aberrant surface expression (sTLR9; r = 0.9). In addition, lymph node-derived CLL cells exhibited increased sTLR9 (P = .016), and RNA-sequencing of paired sTLR9hi and sTLR9lo CLL cells revealed differential transcription of genes involved in TLR signaling, adhesion, motility, and inflammation in sTLR9hi cells. Mechanistically, a TLR9 agonist, ODN2006, promoted CLL cell migration (P < .001) that was mediated by p65 NF-κB and STAT3 transcription factor activation. Importantly, autologous plasma induced the same effects, which were reversed by a TLR9 antagonist. Furthermore, high TLR9 expression promoted engraftment and rapid disease progression in a NOD/Shi-scid/IL-2Rγnull mouse xenograft model. Finally, we showed that dual targeting of TLR9 and Bruton's tyrosine kinase (BTK) was strongly synergistic (median combination index, 0.2 at half maximal effective dose), which highlights the distinct role for TLR9 signaling in CLL and the potential for combined targeting of TLR9 and BTK as a more effective treatment strategy in this incurable disease.

Does body appreciation or satisfaction buffer against idealised functionality-focused images of models?

Research suggests that greater levels of body appreciation and body satisfaction may protect women from negative outcomes when viewing media images of the thin-ideal. In this study, we compared the effectiveness of body appreciation and body satisfaction in ameliorating negative effects from viewing images of the traditional thin-ideal and the newer functional-ideal (i.e., models presented in active stances with a focus on the function of their body). A sample of 122 women (M_age = 24.43 years) from a regional university and the general community was recruited to complete an online study. Participants were randomly allocated to view images of models presented in either an active or posed stance, or images of scenery. Participants completed pre- and post-test measures of appearance and functionality satisfaction, as well as trait measures of body appreciation and satisfaction. Results showed that women had poorer outcomes after viewing the active but not the posed or scenery images. Neither body appreciation nor body satisfaction moderated effects. Active, functional images may be particularly insidious and further research is needed to identify effective protective strategies.

Engineering Solutions for Mitigation of Chimeric Antigen Receptor T-Cell Dysfunction

The clinical successes of chimeric antigen receptor (CAR)-T-cell therapy targeting cell surface antigens in B cell leukaemias and lymphomas has demonstrated the proof of concept that appropriately engineered T-cells have the capacity to destroy advanced cancer with long term remissions ensuing. Nevertheless, it has been significantly more problematic to effect long term clinical benefit in a solid tumour context. A major contributing factor to the clinical failure of CAR-T-cells in solid tumours has been named, almost interchangeably, as T-cell "dysfunction" or "exhaustion". While unhelpful ambiguity surrounds the term "dysfunction", "exhaustion" is canonically regarded as a pejorative term for T-cells. Recent understanding of T-cell developmental biology now identifies exhausted cells as vital for effective immune responses in the context of ongoing antigenic challenge. The purpose of this review is to explore the critical stages in the CAR-T-cell life-cycle and their various contributions to T-cell exhaustion. Through an appreciation of the predominant mechanisms of CAR-T-cell exhaustion and resultant dysfunction, we describe a range of engineering approaches to improve CAR-T-cell function.

Cognitive-behavioral roots of body image therapy and prevention

The existing array of evidence-based body image prevention and intervention approaches has evolved over time. However, the majority originated directly or indirectly from a cognitive-behavioral conceptualisation of body image pioneered by Thomas F. Cash. In this way, it is difficult to overstate the impact Tom Cash has had on body image intervention research and practice. His ground-breaking work, building on the work of Schilder and Fisher, was the first to provide a comprehensive model of body image that reflected the broad range of influences and consequences of body image. His differentiation of the components of body image as a construct and between body image traits and states allowed us to identify and influence targets for intervention. Moreover, the intervention strategies that Tom Cash employed are still used today and laid the foundations for contemporary intervention programs. There is a gap of more than 15 years between the first and last of us receiving our PhDs, yet Cash's work has been an important influence on us all. We are extremely grateful for the theoretical and practical tools that he has given to our field. In this paper, we will outline how Cash's work has informed contemporary body image intervention and prevention. We will describe Cash's theory and intervention tools before discussing how this work paved the way for subsequent research and practice.

Can big business foster positive body image? Qualitative insights from industry leaders walking the talk

The fashion, beauty, and advertising industries have been positioned as key contributors to body dissatisfaction through the promotion of unrealistic and homogenous appearance ideals. Recently, some businesses within these industries have started to disrupt the status quo by taking actions that can be seen to be fostering positive body image (e.g., through representative and diverse imagery, body acceptance messages, and inclusive product ranges). The aim of this study was to explore the opportunities and challenges to foster positive body image from a business perspective. Participants were purposively selected based on their experience of leading business actions to foster positive body image in fashion, beauty, and/or advertising. In total, 45 individuals (82% women) took part in semi-structured interviews, which were transcribed and then analysed using thematic analysis. Four themes were identified: (1) Personal motivations for championing change, (2) Industry ingrained appearance standards, (3) Business barriers to fostering positive body image, and (4) Fostering positive body image as an effective corporate social responsibility (CSR) strategy. This study provides future directions for research aimed at creating healthier body image environments in addition to considerations for businesses seeking to foster positive body image.

The effectiveness of interventions aiming to promote positive body image in adults: A systematic review

Theory suggests promoting positive body image (PBI) through interventions would have a significant impact on health and well-being. However, little is known about the effectiveness of existing interventions. This review aimed to identify and assess the evidence of effectiveness of interventions to increase PBI in adults. Database searches were conducted using CINAHL Plus, Medline, PsychINFO, Wiley Online Library, and SCOPUS. Application of inclusion criteria and data extraction were conducted by two reviewers. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and narrative synthesis was conducted. Fifteen studies, evaluating 13 interventions, were included. Three studies, evaluating one online writing-based functionality intervention, were judged to have strong methodological quality and had evidence of improving body appreciation, body esteem, and functionality satisfaction. Six moderate quality studies found interventions using intuitive eating, CBT, self-compassion, and exercise improved PBI. There was limited evidence of effectiveness of interventions for men, suggesting future research is needed to better understand PBI mechanisms in men. Lack of heterogeneity of outcome measures is discussed as a limitation. Findings suggest existing interventions are effective at increasing aspects of PBI among women and support the development of interventions that target multiple components of PBI.

A randomized experimental evaluation of a yoga-based body image intervention

Recent literature argues that body image interventions need to become more embodied. This paper evaluates a brief yoga-based body image intervention which incorporates themes specifically tailored to focus on positive body image. Young women (M_age = 20.21, SD_age = 2.15) were randomly allocated to a four-session yoga intervention (n = 22) or a control condition (n = 22). Compared to controls, participants in the yoga condition reported significant increases in body appreciation, body connectedness, body satisfaction, and positive mood at posttest and at 4-week follow-up. There were no significant changes in negative mood or body surveillance. These findings add to existing evidence that yoga can improve women's body image and positive mood. In addition, they suggest that a strong thematic focus on positive body image can achieve benefits at relatively low yoga doses. These findings are important as intervention length impacts the potential for dissemination.

Evaluating the impact of a brief yoga intervention on preadolescents' body image and mood

Yoga is an embodying activity that promotes body awareness, body connection, body responsiveness, and appreciation of body functionality, and it therefore may be a beneficial school-based intervention for children's body image. The present study examined the impact of a 4-week yoga intervention on pre-adolescent girls' and boys' body image (body appreciation, body esteem, and body surveillance) and mood (positive and negative affect) 1-week post-intervention and at 6-week follow-up. British children (N = 344; 54.4% female) aged 9-11 years were recruited from four schools, two of which were randomly assigned to the yoga intervention and two to a physical education control condition. Overall, girls reported greater body image concern and negative mood than boys. Unexpectedly, both groups reported increased body appreciation, body esteem, and positive mood, and decreased body surveillance and negative affect from baseline to post-intervention and/or follow-up. Both girls and boys in the yoga intervention evaluated the sessions very favourably; the majority desired to participate in more lessons. Potential explanations for these findings are discussed.

A randomised-controlled trial investigating potential underlying mechanisms of a functionality-based approach to improving women's body image

Focusing on body functionality is a promising technique for improving women's body image. This study replicates prior research in a large novel sample, tests longer-term follow-up effects, and investigates underlying mechanisms of these effects (body complexity and body-self integration). British women (N = 261) aged 18-30 who wanted to improve their body image were randomised to Expand Your Horizon (three online body functionality writing exercises) or an active control. Trait body image was assessed at Pretest, Posttest, 1-week, and 1-month Follow-Up. To explore whether changes in body complexity and body-self integration 'buffer' the impact of negative body-related experiences, participants also completed beauty-ideal media exposure. Relative to the control, intervention participants experienced improved appearance satisfaction, functionality satisfaction, body appreciation, and body complexity at Posttest, and at both Follow-Ups. Neither body complexity nor body-self integration mediated intervention effects. Media exposure decreased state body satisfaction among intervention and control participants, but neither body complexity nor body-self integration moderated these effects. The findings underscore the value of focusing on body functionality for improving body image and show that effects persist one month post-intervention.

Social Rank and Rejection Sensitivity as Mediators of the Relationship between Insecure Attachment and Disordered Eating

AIM

The current study assessed a new interpersonal model for eating disorders (EDs), in which interpersonal rejection sensitivity (RS), appearance-based RS and social rank were hypothesised to mediate the relationship between insecure attachment and disordered eating.

METHOD

The sample comprised a clinical ED group (N = 122) and a control group (N = 622). Participants were asked to complete a number of self-report measures related to the variables of interest.

RESULTS

Invariance testing indicated that the model was structurally non-invariant (different across groups). For the ED group, appearance-based RS and social rank were significant mediators of the relationship between insecure attachment and disordered eating. For the controls, the relationship between insecure attachment and disordered eating was mediated through multiple pathways involving interpersonal RS, appearance-based RS and social rank.

CONCLUSION

These findings may inform existing therapies such as interpersonal psychotherapy for EDs, by emphasising the role of sensitivity to rejection in the development and maintenance of disordered eating. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Adapting the Body Appreciation Scale-2 for Children: A psychometric analysis of the BAS-2C

Positive body image among adults is related to numerous indicators of well-being. However, no research has explored body appreciation among children. To facilitate our understanding of children's positive body image, the current study adapts and validates the Body Appreciation Scale-2 (BAS-2; Tylka & Wood-Barcalow, 2015a) for use with children. Three hundred and forty-four children (54.4% girls) aged 9-11 completed the adapted Body Appreciation Scale-2 for Children (BAS-2C) alongside measures of body esteem, media influence, body surveillance, mood, and dieting. A sub-sample of 154 participants (62.3% girls) completed the questionnaire 6-weeks later to examine stability (test-retest) reliability. The BAS-2C displayed a unidimensional factor structure and evidence of internal consistency, test-retest reliability, and construct, criterion-related, and incremental validity. Additionally, the results suggest adaptive properties of body appreciation for body-related and emotional well-being among children. The BAS-2C could serve as an essential component within research to understand and estimate children's positive body image.

More than Just Child's Play?: An Experimental Investigation of the Impact of an Appearance-Focused Internet Game on Body Image and Career Aspirations of Young Girls

In recent years, elements of the modern environment (such as television, Internet, toys and clothes) have been criticized for having an increasingly sexualized or appearance focus, which has been suggested to be detrimental to girls’ development. The current study examined the impact of an appearance-focused Internet game on young girls’ body image and career cognitions and aspirations. Eighty British girls aged 8–9 years were randomly assigned to play an appearance-focused or a non-appearance focused game for 10 minutes. Girls in the appearance-focused game condition displayed greater body dissatisfaction compared to the control condition. Type of game did not impact girls’ perceived capacity to do various jobs. However, girls who played the appearance-focused game reported a greater preference for feminine careers compared to the control group. This provides preliminary evidence that appearance-focused Internet games may be detrimental to young girls’ body image and aspirations. Internet games should be included in our consideration of influential messages for young girls.

Associations Between Appearance-Related Self-Discrepancies and Young Women's and Men's Affect, Body Satisfaction, and Emotional Eating: A Comparison of Fixed-Item and Participant-Generated Self-Discrepancies

This study examines the associations between appearancerelated, actual-ideal self-discrepancies—from both own and romantic partner's standpoints—and negative affect, body satisfaction, and eating behavior. It extends previous research through studying both genders and the romantic partner standpoint, but its main novel contribution is a systematic comparison between idiographic, participant-generated, and nomothetic, fixed-item measures of appearance-related selfdiscrepancies. The findings show that these measures cannot be, and should not be, treated as equivalent. The idiographic measures were superior in predicting outcome variables when considering the own standpoint. Nomothetic measures did demonstrate some gender-specific associations, but only from the romantic partner standpoint, and only for women. These findings can be explained with respect to the assessment of accessible, versus available, self-discrepancies. Implications for selfdiscrepancy and body image theory and research are discussed.

Randomized controlled trial of an online mother-daughter body image and well-being intervention

OBJECTIVE

Poor body image is a public health issue. Mothers are a key influence on adolescent girls' body image. This study evaluated an accessible, scalable, low-intensity internet-based intervention delivered to mothers (Dove Self Esteem Project Website for Parents) on mothers' and their adolescent daughters' body image and psychosocial well-being.

METHOD

British mother-daughter dyads (N = 235) participated in a cluster randomized controlled trial (assessment-only control; mothers viewed the website without structured guidance [website-unstructured]; mothers viewed the website via a tailored pathway [website-tailored]). Dyads completed standardized self-report measures of body image, related risk factors, and psychosocial outcomes at baseline, 2 weeks post-exposure, 6-week, and 12-month follow-up.

RESULTS

Dyadic models showed that relative to the control, mothers who viewed the website reported significantly higher self-esteem at post-exposure (website-tailored), higher weight esteem at 6-week follow-up (website-tailored), lower negative affect at 12-month follow-up (website-tailored), engaged in more self-reported conversations with their daughters about body image at post-exposure and 6-week follow-up, and were 3-4.66 times more likely to report seeking additional support for body image issues at post-exposure (website-tailored), 6-week, and 12-month (website-tailored) follow-up. Daughters whose mothers viewed the website had higher self-esteem and reduced negative affect at 6-week follow-up. There were no differences on daughters' body image, and risk factors among mothers or daughters, at post-exposure or follow-up. Tailoring website content appeared beneficial.

CONCLUSIONS

This intervention offers a promising 'first-step' toward improving psychosocial well-being among mothers and daughters. In order to further optimize the intervention, future research to improve body image-related outcomes and to understand mechanisms for change would be beneficial. (PsycINFO Database Record

Effectiveness of a brief school-based body image intervention 'Dove Confident Me: Single Session' when delivered by teachers and researchers: Results from a cluster randomised controlled trial

This study evaluated a 90-min single session school-based body image intervention (Dove Confident Me: Single Session), and investigated if delivery could be task-shifted to teachers. British adolescents (N = 1707; 11-13 years; 50.83% girls) participated in a cluster randomised controlled trial [lessons as usual control; intervention teacher-led (TL); intervention researcher-led (RL)]. Body image, risk factors, and psychosocial and disordered eating outcomes were assessed 1-week pre-intervention, immediate post-intervention, and 4-9.5 weeks follow-up. Multilevel mixed-models showed post-intervention improvements for intervention students relative to control in body esteem (TL; girls only), negative affect (TL), dietary restraint (TL; girls only), eating disorder symptoms (TL), and life engagement (TL; RL). Awareness of sociocultural pressures increased at post-intervention (TL). Effects were small-medium in size (ds 0.19-0.76) and were not maintained at follow-up. There were no significant differences between conditions at post or follow-up on body satisfaction, appearance comparisons, teasing, appearance conversations and self-esteem. The intervention had short-term benefits for girls' body image and dietary restraint, and for eating disorder symptoms and some psychosocial outcomes among girls and boys. A multi-session version of the intervention is likely to be necessary for sustained improvements. Teachers can deliver this intervention effectively with minimal training, indicating broader scale dissemination is feasible.

TRIAL REGISTRATION

ISRCTN16782819.

Future directions for positive body image research

The emergence of positive body image research during the last 10 years represents an important shift in the body image literature. The existing evidence provides a strong empirical basis for the study of positive body image and research has begun to address issues of age, gender, ethnicity, culture, development, and intervention in relation to positive body image. This article briefly reviews the existing evidence before outlining directions for future research. Specifically, six areas for future positive body image research are outlined: (a) conceptualization, (b) models, (c) developmental factors, (d) social interactions, (e) cognitive processing style, and (f) interventions. Finally, the potential role of positive body image as a protective factor within the broader body image literature is discussed.

The Mediating Role of Appearance Comparisons in the Relationship Between Media Usage and Self-Objectification in Young Women

The media’s portrayal of women is often sexually objectifying, and greater exposure to objectifying media is associated with higher levels of self-objectification among young women. One reason why media usage may be associated with self-objectification is because women may be comparing their appearance to others in the media. The present study examined (a) the relationship between the usage of different media types (online social media [Facebook], Internet, television, music videos, and magazines) and self-objectification among young women, (b) whether appearance comparison tendencies in general mediated any observed relationships, and (c) whether appearance comparisons to specific types of women on Facebook (self, family, close friends, distant peers, and celebrities) mediated any relationship between Facebook usage and self-objectification. Female participants ( N = 150) aged 17–25 years completed questionnaires about their media usage, appearance comparison tendency in general, appearance comparisons to specific target groups on Facebook, and self-objectification. Results showed that Facebook usage and magazine usage were positively correlated with self-objectification and that these relationships were mediated by appearance comparisons in general. In addition, the relationship between Facebook usage and self-objectification was mediated by comparisons to one’s peers on Facebook. These findings suggest that appearance comparisons can play an important role in self-objectification among young women.

Social comparisons on social media: the impact of Facebook on young women's body image concerns and mood

The present study experimentally investigated the effect of Facebook usage on women's mood and body image, whether these effects differ from an online fashion magazine, and whether appearance comparison tendency moderates any of these effects. Female participants (N=112) were randomly assigned to spend 10min browsing their Facebook account, a magazine website, or an appearance-neutral control website before completing state measures of mood, body dissatisfaction, and appearance discrepancies (weight-related, and face, hair, and skin-related). Participants also completed a trait measure of appearance comparison tendency. Participants who spent time on Facebook reported being in a more negative mood than those who spent time on the control website. Furthermore, women high in appearance comparison tendency reported more facial, hair, and skin-related discrepancies after Facebook exposure than exposure to the control website. Given its popularity, more research is needed to better understand the impact that Facebook has on appearance concerns.

An Examination of the Tripartite Influence Model of Body Image

According to the tripartite influence model of body image, appearance pressures from family, friends, partners, and the media lead to body dissatisfaction and restrained eating behaviours. There is strong support for this model among young, White heterosexual women. Evidence suggests that women who identified as lesbian as bisexual (LB) may be protected from sociocultural pressures around thinness, but no known research has tested the tripartite model among LB women. The current research tests this model with 264 heterosexual and 208 LB adult women. Heterosexual women reported more thin-ideal internalization than LB women. For both groups of women, pressures from the media, male romantic partners, and family were most strongly associated with weight satisfaction and thin-ideal internalization. However, the impact of these pressures differed for the two groups; the heterosexual women’s model included significant pathways from these pressures to weight satisfaction and restrained eating, which were not significant for the LB women. Differences also emerged between our findings and previous research with younger women; pressure from friends was not related to body image in the model for either group. These findings suggest that further research is needed to explore how diverse groups of women experience sociocultural pressures around thinness.

Bisexual women’s understandings of social marginalisation: ‘The heterosexuals don’t understand us but nor do the lesbians’

Drawing on interviews with 20 self-identified bisexual women, this paper contributes to the limited psychological literature on bisexual women by exploring their experiences of social marginalisation. These (mainly white and middle class) British bisexual women reported that they did not feel at home in either lesbian or lesbian, gay, bisexual and transgender communities, nor in the wider (heteronormative) society. They identified a number of understandings – bisexuality as a temporary phase on the path to a fully realised lesbian or heterosexual identity and bisexuals as immature, confused, greedy, untrustworthy, highly sexual and incapable of monogamy – which they reported as arising from lesbian, gay, bisexual and transgender communities and the wider society. The women refuted these accounts which they stated did not reflect their experiences of bisexual identity and which positioned bisexuality as invisible and invalid.

The impact of thin idealized media images on body satisfaction: does body appreciation protect women from negative effects?

This article examines whether positive body image can protect women from negative media exposure effects. University women (N=112) were randomly allocated to view advertisements featuring ultra-thin models or control images. Women who reported high levels of body appreciation did not report negative media exposure effects. Furthermore, the protective role of body appreciation was also evident among women known to be vulnerable to media exposure. Women high on thin-ideal internalization and low on body appreciation reported appearance-discrepancies that were more salient and larger when they viewed models compared to the control group. However, women high on thin-ideal internalization and also high on body appreciation rated appearance-discrepancies as less important and no difference in size than the control group. The results support the notion that positive body image protects women from negative environmental appearance messages and suggests that promoting positive body image may be an effective intervention strategy.

What works in secondary schools? A systematic review of classroom-based body image programs

Governments, schools, and curriculum authorities are increasingly recognizing that body image during adolescence is a public health issue that warrants attention in the school setting. After 30 years of eating disorder prevention research, and given the current interest in this area, it seems timely to review the research on interventions to improve body image in schools. We reviewed universal-selective, classroom-based programs that have been conducted since the year 2000, among adolescents, and found 16 eligible intervention programs. Seven of these programs were effective in improving body image on at least one measure, from pre to post test, though effect sizes were small (d=0.22-0.48). These effective programs were conducted among younger adolescents 12.33-13.62 years, and included activities focusing on media literacy, self esteem, and the influence of peers. Implications for school personnel and curriculum authorities are discussed, and we provide recommendations for a strategic approach to future research in this area.

Happy Being Me in the UK: a controlled evaluation of a school-based body image intervention with pre-adolescent children

This study evaluated an adapted version of 'Happy Being Me', a school-based body image intervention, with girls and boys aged 10-11 years. Forty-three children participated in a three-week intervention, and 45 children formed a control group. Both groups completed measures of body satisfaction, risk factors for negative body image, eating behaviors, self-esteem, and intervention topic knowledge, at baseline, post-intervention, and 3-month follow-up. For girls, participation in the intervention resulted in significant improvements in body satisfaction, appearance-related conversations, appearance comparisons, eating behaviors and intervention topic knowledge at post-intervention, although only the change in body satisfaction was maintained. There was also a significant decrease in internalization of cultural appearance ideals from baseline to follow-up. For boys, participation in the intervention resulted in significant improvements in internalization and appearance comparisons at post-intervention; however, neither of these changes were sustained at follow-up. There were no improvements in the control group over time.

Testing a dissonance body image intervention among young girls

OBJECTIVE

Body image and eating disorder interventions based on cognitive dissonance have been shown to be effective among girls and women aged 14 and above. This article reports a preliminary examination of whether a dissonance intervention is also effective when delivered in a school setting to 12- and 13-year-old girls in the United Kingdom.

METHOD

Girls (N = 106, mean age = 12.07 years, SD = .27) were allocated to the intervention condition or a waitlist control.

RESULTS

In contrast to the control group, girls in the intervention condition reported significant reductions in body dissatisfaction and internalization of a thin body ideal post-intervention. There was no significant change in self-reported dietary restraint for either condition. In addition, compared with the control group, girls in the intervention condition showed increased resilience to negative media effects 1-month post-intervention.

CONCLUSIONS

Results suggests that dissonance based programs can reduce body dissatisfaction, internalization and negative media effects among a younger group of girls than previously examined and in a United Kingdom school setting.

A qualitative exploration of whether lesbian and bisexual women are ‘protected’ from sociocultural pressure to be thin

Heterosexual women in Western cultures are known to experience body image concerns, dieting and disordered eating as a result of intense social pressures to be thin. However, it is theorised that lesbian and bisexual women belong to a subculture that is ‘protective’ of such demands. Fifteen non-heterosexual women were interviewed about their experiences of social pressure. Thematic analysis of their accounts suggests that such theorising may be inaccurate, because these lesbian and bisexual women did not feel ‘protected’ from social pressures and experienced body dissatisfaction. While they might attempt to resist thin idealisation, resistance is not centred around their sexuality.

“It’s a Comparison Thing, Isn’t It?”

Women’s feelings about their body and their appearance are an important aspect of their lives, yet little is known about the ways in which partner relationships shape these feelings. There has been some debate about whether or not same-sex relationships offer protection to nonheterosexual (lesbian and bisexual) women from potentially harmful social appearance pressures, but there has been little empirical exploration of this issue. We contribute to the debate by presenting findings from a British qualitative study based on interviews with 15 nonheterosexual women talking about their feelings about their bodies and their appearance in the context of partner relationships. These accounts were analyzed using a phenomenologically oriented form of thematic analysis (TA) and seven main themes were generated. The women suggested that same-sex relationships were both positive and negative influences in shaping their feelings about their body and appearance, highlighting the complexity of this issue. However, positive descriptions of empathy toward body and appearance concerns as well as diversity within same-sex attractions suggest that same-sex relationships have the potential to encourage women to feel happier with their bodies. This analysis also suggests that the theoretical debate is too simplistic and that a synthesized explanation should be explored in future research.

Are Contemporary Media Images Which Seem to Display Women as Sexually Empowered Actually Harmful to Women?

There has been a shift in the depiction of women in advertising from objectifying representations of women as passive sex objects to agentic sexual representations where the women appear powerful and in control (Gill, 2007a, 2008), and there is substantial evidence that these representations have a negative impact on women’s body image. However, to our knowledge, this study is the first experimental research that aims to compare passively objectifying and more recent sexually agentic representations. British undergraduate women ( N = 122) participated in an experiment in which they were randomly assigned to view sexually passive, sexually agentic, or control print advertisements. Exposure to both types of representations of women, compared to viewing control images, was associated with increased weight dissatisfaction. The sexually agentic representations were singularly associated with increased state self-objectification. Media exposure research tends to focus on the models (e.g., their thinness) shown in advertising and pay little attention to the framing of the image. Our results highlight the powerful impact different framings can have on women’s body image concerns as well as suggest that recent shifts in advertising may be particularly problematic because contemporary images increased both weight concern and self-objectification. Therefore, these images may have a more powerful impact on psychological well-being and disordered eating behaviors than traditional images.

Examination of a sociocultural model of disordered eating among male and female adolescents

OBJECTIVES

The study tests a version of Stice's (1994) sociocultural model of disordered eating that was modified to incorporate social comparisons. Additionally, it examines how self-reported body-mass index and perceived weight status influence associations within the model.

METHOD

Questionnaires were administered in a state secondary school; the sample consisted of 250 female and 257 male adolescents aged 11-16 years.

RESULTS

The results supported the sociocultural model among both male and female adolescents. Perceived pressure to lose weight was directly associated with eating behaviour, as well as indirectly associated through social comparisons, internalization and body dissatisfaction. However, social comparisons were most strongly related to body dissatisfaction among adolescents who perceived themselves as overweight.

CONCLUSIONS

The findings indicate that models of eating disordered behaviour, developed for adolescent girls, are also appropriate for understanding this behaviour among male adolescents. The results suggest that social comparisons represent a useful addition to Stice's (1994) original model and a potentially fruitful target for interventions.

Post-feminist advertising laid bare: Young women’s talk about the sexually agentic woman of ‘midriff ’ advertising

This paper presents a feminist Foucauldian analysis of women’s interpretations of images of women in post-feminist advertising. Building on Ros Gill’s analysis of post-feminist advertising images of women, and more specifically the figure of ‘the midriff ’, the paper presents an analysis of focus group discussions with seven young women who were asked to discuss ‘midriff’ advertising images. Whilst participants sometimes construed these images positively as ‘sexy’ and independent, midriff figures were more frequently constituted negatively as ‘bimbos’ and/or ‘slutty’ ‘sex objects’ whose seeming independence was achieved through or limited only to attracting men. In interpreting midriff figures negatively, participants, we suggest, constituted the midriff as other; as different and distant from themselves and ‘normal’ women. Where occasionally participants interpreted images more favourably, the midriff figure was, in contrast, constituted as ‘normal’ and ‘natural’ and as being about ‘what she likes, not what he likes’. Participants did not identify themselves or their arguments as feminist. Nevertheless, they articulated critiques of these images which often converged significantly with critical feminist analyses. Our analysis suggests, therefore, that young women read these images in complex ways. These complexities of interpretation, we argue, should be central in understanding the relationships between women, bodies and post-feminist images of women’s bodies.

Examination of a sociocultural model of excessive exercise among male and female adolescents

There is substantial evidence that sociocultural pressures and body image disturbances can lead to disordered eating, yet few studies have examined their impact on excessive exercise. The study adapted a sociocultural model for disordered eating to predict excessive exercise using data from boys and girls in early adolescence (N=421). Perceived sociocultural pressures to lose weight and build muscle, body image disturbance and appearance investment were associated with a compulsive need to exercise. Adolescents' investment in appearance and body image disturbance fully mediated the relationship between sociocultural pressures and a compulsive need for exercise. There was no support for the meditational model in predicting adolescents' frequency or duration of exercise. Results support the sociocultural model as an explanatory model for excessive exercise, but suggest appearance investment and body image disturbance are important mediators of sociocultural pressures.

Alcohol and Tobacco Use during Adolescence

Despite evidence that frequent family meals are associated with low levels of substance use during adolescence, prior studies have not examined the role of how adolescents perceive mealtimes. We examined family meal frequency, family connectedness, perceived priority, atmosphere and structure of mealtimes as predictors of alcohol and tobacco consumption, using data from 550 adolescents (50% boys; age range 11—16). Frequent family meals were significantly associated with a lower likelihood of alcohol and tobacco use. However, this association was explained by adolescents’ perception of the atmosphere at mealtimes. These findings suggest adolescents’ perception of the mealtime environment contributes to family meals’ protective effect.

Adolescents' and parents' experiences of managing the psychosocial impact of appearance change during cancer treatment

Using combined qualitative data from multiple case study interviews and an online survey, this study explored the impact of appearance change on 22 adolescents receiving cancer treatment aged 13 to 18 years and six of their parents. Data were analyzed using template analysis. Appearance changes were a major concern. Adolescents typically struggled to adapt to new experiences and concerns related to this highly sensitive issue. Many felt anxious and self-conscious and were reluctant to reveal appearance changes in public. These feelings were compounded by the negative reactions of others (e.g., staring, teasing, and inappropriate questioning), which sometimes lead to avoidance of social activity and threats of noncompliance. Parents of these children felt ill-prepared to manage appearance-related anxieties. Adolescents wanted support to develop the practical and social skills necessary to maintain a "normal" appearance and manage the negative responses of others. However, some adolescents showed resilience and, with support from friends and family, developed strategies to manage their altered appearance and its social consequences. These strategies are explored, which can inform interventions to support adolescents and parents.

The effects of exposure to muscular male models among men: exploring the moderating role of gym use and exercise motivation

This study examines the effects of exposure to the muscular male body ideal on body-focused negative affect among male gym users and non-exercisers. As hypothesized, the impact of media exposure depended on men's exercise status. Non-exercisers (n = 58) reported greater body-focused negative affect after exposure to images of muscular male models than after neutral images (no model controls), whereas gym users (n = 58) showed a tendency for less body-focused negative affect after the model images than after the control images. Furthermore, the extent to which gym users were motivated to increase strength and muscularity moderated these exposure effects; men who reported stronger strength and muscularity exercise motivation reported a greater degree of self-enhancement after exposure to the muscular ideal. The findings are interpreted with respect to likely differences in motives for social comparisons.

Does Barbie make girls want to be thin? The effect of experimental exposure to images of dolls on the body image of 5- to 8-year-old girls

The ubiquitous Barbie doll was examined in the present study as a possible cause for young girls' body dissatisfaction. A total of 162 girls, from age 5 to age 8, were exposed to images of either Barbie dolls, Emme dolls (U.S. size 16), or no dolls (baseline control) and then completed assessments of body image. Girls exposed to Barbie reported lower body esteem and greater desire for a thinner body shape than girls in the other exposure conditions. However, this immediate negative impact of Barbie doll was no longer evident in the oldest girls. These findings imply that, even if dolls cease to function as aspirational role models for older girls, early exposure to dolls epitomizing an unrealistically thin body ideal may damage girls' body image, which would contribute to an increased risk of disordered eating and weight cycling.

The role of self-improvement and self-evaluation motives in social comparisons with idealised female bodies in the media

This study investigates the effect of social comparisons with media models on women's body image based on either self-evaluation or self-improvement motives. Ninety-eight women, for whom appearance was a relevant comparison dimension, viewed advertisements that did, or did not, feature idealised models, after being prompted to engage in self-evaluation or self-improvement comparisons. The results indicate that, when focusing on self-evaluation, comparisons with thin models are associated with higher body-focused anxiety than viewing no model advertisements. In contrast, when focusing on self-improvement, comparisons with thin models are not associated with higher body-focused anxiety than viewing no models. Furthermore, women's general tendency to engage in social comparisons moderated the effects of self-evaluative comparisons with models, so that women who did not habitually engage in social comparisons were most strongly affected. It is suggested that motive for social comparison may explain previous inconsistencies in the experimental exposure literature and warrants more careful attention in future research.