Measurement invariance and psychometric properties of three positive body image measures among cisgender sexual minority and heterosexual women

Positive body image is a multidimensional construct consisting of various facets including body appreciation, body image flexibility, and functionality appreciation measured via the Body Appreciation Scale-2 (BAS-2), Body Image-Acceptance and Action Questionnaire-5 (BI-AAQ-5), and Functionality Appreciation Scale (FAS), respectively. Research has supported the unidimensional factor structure of these measures; however, invariance testing based on sexual identity has yet to be conducted. The study's primary aim was to assess the measurement invariance of the BAS-2, BI-AAQ-5, and FAS between sexual minority and heterosexual women. The secondary aim was to assess the psychometric properties of each positive body image measure among each sample. Participants were predominantly White, cisgender women who identified as a sexual minority (n = 310) or heterosexual (n = 360) and completed online questionnaires of positive body image, eating behaviors, and mental and physical health. Results supported invariance with no differences in BAS-2 or BI-AAQ-5 scores. A significant difference with a small effect size was found in FAS scores, with sexual minority women reporting lower FAS scores. Findings supported the BI-AAQ-5 and FAS's incremental validity on perceived mental health. Overall, results suggest that the BAS-2, BI-AAQ-5, and FAS scores can be compared among women of varying sexual identities.

Weight bias reduction among first-year medical students: A quasi-randomized, controlled trial

Implicit and explicit weight bias is prevalent among healthcare professionals and results in negative outcomes, including weak physician-patient rapport, low patient trust in physicians, and avoidance of healthcare. This study aimed to decrease weight bias in medical students via a one-session, curriculum-based intervention founded on the elaboration likelihood model (ELM). First-year medical students (N = 101) were quasi-randomly assigned to a group-based experimental or education-based control intervention. Data collected included measures of implicit and explicit weight bias and empathy (pre-intervention and up to 2 days post-intervention), and thoughts regarding weight bias (collected at the end of the intervention). Social desirability was identified as an important covariate. After controlling for social desirability, the intervention group showed no greater reduction in multi-item explicit bias rating scales or a computerized implicit bias task than the control group. Both groups showed less discomfort when near individuals with obesity (p < 0.01). The intervention group wrote a greater number of statements about weight bias and obesity (p < 0.05) and a greater number of statements about the harms of weight bias (p < 0.001) than the control group on a thought-listing task. Results highlight use of the ELM and the importance of controlling for social desirability in weight bias interventions. A thought-listing task captured unique intervention effects, highlighting potential gaps in the assessment of weight bias.

Construct validity of the Levels of Emotional Awareness Scale among women high in eating disorder symptoms: a cross-sectional study

PURPOSE

The Levels of Emotional Awareness Scale (LEAS), a measure of the ability to identify and describe one's own and others' emotions, may complement work with women with disordered eating symptoms. The study purpose was to (a) examine differences in hand (LEAS) versus computerized (e-LEAS) scoring methods and (b) examine the e-LEAS' psychometric properties, including convergent and discriminant validity, among women endorsing eating disorder symptoms.

METHODS

Forty women (ages 18-21) scoring high on a self-report measure of disordered eating symptoms completed the LEAS and measures of convergent validity including a self-report measure of alexithymia (the perceived ability to identify and describe one's own emotions) and a measure of facial affect recognition as well as discriminant validity, including affect and facial memory. Inter-rater reliability was assessed via a two-way mixed effects model and correlations between the LEAS and the study constructs were examined.

RESULTS

Computerized scoring (e-LEAS) offered benefits over hand scoring and correlations between LEAS and e-LEAS were statistically significant. Better total emotional awareness scores on the e-LEAS were significantly associated with more perceived difficulty identifying and describing emotions. Better total emotional awareness scores were also significantly associated with better facial memory and greater depression scores. The e-LEAS showed weak associations with facial affect recognition.

CONCLUSION

The e-LEAS offers practical advantages over the LEAS in the assessment of emotional awareness among women endorsing eating disorder symptoms. Results suggest that the e-LEAS measures the ability to describe emotional experiences in oneself and others, but not facial affect recognition.

LEVEL OF EVIDENCE

Level V: Evidence obtained from a cross-sectional descriptive study.

Factor structure and psychometric properties of the clinical impairment assessment 3.0 (CIA) in a clinical eating disorder sample

PURPOSE

The aim of this study was to investigate the psychometric properties and the factor structure of the Clinical Impairment Assessment 3.0 (CIA) utilizing a confirmatory factor analysis in a large clinical sample of ED patients.

METHODS

A total of 260 patients between the ages of 18 and 45 who completed assessments in a partial hospitalization or residential treatment program at an ED treatment facility between December 2012 and December 2016 were included in the analyses. Assessment measures included the CIA, EDE-Q, BDI-II, WHODAS, and a demographic questionnaire.

RESULTS

Results favored a bifactor model with a strong general factor and three unreliable subfactors. The CIA showed strong construct validity with other measures of ED pathology (EDE-Q) and health-related QoL (WHODAS). Furthermore, admission CIA scores were predictive of treatment outcomes.

CONCLUSIONS

The CIA assesses general psychosocial impairment, supporting the use of a total, but not subscale scores, among symptomatic ED samples in the United States.

Differences in alexithymia, emotional awareness, and facial emotion recognition under conditions of self-focused attention among women with high and low eating disorder symptoms: a 2 x 2 experimental study

BACKGROUND

Women with eating disorders generally perform more poorly on measures of alexithymia, defined as difficulty identifying and describing emotions, and theory of mind, or the ability to infer what others are thinking and feeling. The extent to which these abilities may be influenced by variables such as self-focused attention, or directing attention toward internally generated information, has yet to be investigated. Thus, the purpose of the present study was to examine differences between women high and low in disordered eating symptoms on measures of emotional awareness and facial affect recognition under conditions of high and low self-focused attention.

METHODS

University women scoring high or low on a measure of disordered eating (n = 79) were randomly assigned to a condition of high or low self-focused attention. Outcomes included alexithymia (self-rated ability to identify and describe emotions), emotional awareness (ability to describe the emotions of oneself and others), and facial affect recognition. Scores on a measure of negative affect were statistically controlled.

RESULTS

Women with high disordered eating symptom scores rated themselves as having more difficulties identifying, but not describing emotions after controlling for negative affect, but demonstrated greater difficulties describing their own and others' emotions on a measure of emotional awareness. In the self-focused attention condition, women scored lower on self emotional awareness and were quicker to identify expressions of negative facial affect regardless of eating disorder symptom status than women in the non-self-focused attention condition. There were no significant interactions between eating disorder status and self-focused attention.

CONCLUSIONS

Further examination of different types of emotion recognition and description in oneself and others as well as processes that may influence these abilities is warranted.

Validation of the Body Appreciation Scale-2 and relationships to eating behaviors and health among sexual minorities

Although the study of positive body image continues to expand, researchers have predominantly focused the study of this newer construct among presumed heterosexual participants. The purpose of the present study was to examine the factor structure of a measure of positive body image, the Body Appreciation Scale-2 (BAS-2), among sexual minority participants. The present study also sought to psychometrically validate the BAS-2 among sexual minorities by assessing its relationship with other facets of positive body image, including functionality appreciation and body image flexibility, as well as other related constructs, such as body dissatisfaction, disordered eating behaviors, intuitive eating behaviors, and physical and mental health. Results from a confirmatory factor analysis of 223 sexual minority adults (M_age = 32.45, SD = 10.07) indicated that the BAS-2 displayed strong factorial validity with a unitary factor structure. Furthermore, the BAS-2's construct validity was supported based on correlations with other measures of positive body image, body dissatisfaction, and disordered eating behavior. Results from this cross-sectional study supported a relationship between body appreciation and intuitive eating behaviors, as well as physical and mental health among sexual minority participants. These findings provide an initial understanding of body appreciation and other related constructs among sexual minority individuals.

Neuropsychological predictors of health and safety abilities in dementia

The Independent Living Scales Health and Safety (ILS HS) scale is commonly used by neuropsychologists when evaluating older adults' instrumental activities of daily living (IADLs). However, there is a minimal amount of research on its use in dementia populations and, specifically, its relationship to other neuropsychological measures. The present study investigated relationships between the ILS HS scale and measures of cognition and depression. The study utilized archival data from a sample (N = 142) of older adults (mean age = 77.85) diagnosed with dementia, who were evaluated at Saint Louis University Medical Center and administered the ILS HS scale as part of a larger clinical neuropsychological evaluation. Multiple regression analyses demonstrated that up to 37% of the variance in ILS HS performance was accounted for by demographic variables, premorbid intelligence, and cognitive functioning (e.g., global cognition, delayed verbal recall, and executive functioning), and regression models demonstrated medium to large effect sizes. Depression and self- or informant-reported IADLs were unrelated to the ILS HS scale. Results suggest that older adults' ability to function in health and safety-related situations requires a range of cognitive abilities. Performance on these measures may help guide clinical decision making regarding independent living and treatment planning.

The Professionalism and Integrity in Research Program: Description and Preliminary Outcomes

Violations of rules and regulations in research can cause significant problems for human participants, animal subjects, data integrity, institutions, and investigators. The Professionalism and Integrity in Research Program (PI Program) provides remediation training that addresses the root causes of violations of rules and regulations in research. Through assessments, a three-day workshop, and follow-up coaching calls, the PI Program teaches evidence-based decision-making strategies designed to help researchers to compensate for bias, uncertainty, and work-related stress, and foster the skills needed to oversee research projects in today's complex regulatory environments. Across its first three years (2013-2015), the program trained 39 researchers from 24 different institutions in the United States. Participant evaluations of the program's faculty and workshop content were highly positive (4.7-4.8 and 4.5-4.6, respectively, on a 5-point scale). Preliminary program outcome assessment using validated measures of professional decision making and cognitive distortions in a pre- and postworkshop design indicated significant improvements. A follow-up survey of participants found statistically significant increases in a variety of target behaviors, including training research staff members to foster compliance and research quality, using standard operating procedures to support compliance and research integrity, performing self-audits of research operations, reducing job stressors, actively overseeing the work of the research team, and seeking help when experiencing uncertainty. Assessment of the PI Program was conducted with modest sample sizes, yet evaluation, outcome assessment, and self-reported survey data provided statistically significant evidence of effectiveness in achieving program goals.

A factor analytic investigation of the Mercy Evaluation of Multiple Sclerosis

OBJECTIVE

Neurocognitive deficits commonly are an accompanying feature of Multiple Sclerosis (MS). A brief, yet comprehensive neuropsychological battery is desirable for assessing the extent of these deficits. Therefore, the present study examined the validity of the Mercy Evaluation of Multiple Sclerosis (MEMS) for use with the MS population.

METHODS

Archival data from individuals diagnosed with MS (N = 378) by independent neurologists was examined. Cognitive domains assessed included processing speed and attention, learning, and memory, visuospatial, language, and executive functioning. A mean battery index was calculated to provide a general indicator of cognitive impairment within the current sample.

RESULTS

Overall performance across participants was found to be in the lower limits of the average range. Results of factor analytic statistical procedures yielded a four-factor solution, accounting for 67% of total variance within the MEMS. Four neurocognitive measures exhibited the highest sensitivity in detecting cognitive impairment, constituting a psychometrically established brief cognitive screening battery, which accounted for 83% of total variance within the mean battery index score.

CONCLUSION

Overall, the results of the current study suggest appropriate construct validity of the MEMS for use with individuals with MS, as well as provide support for previously established cognitive batteries.

Making Professional Decisions in Research: Measurement and Key Predictors

The professional decision-making in research (PDR) measure was administered to 400 National Institutes of Health (NIH)-funded and industry-funded investigators, along with measures of cynicism, moral disengagement, compliance disengagement, impulsivity, work stressors, knowledge of responsible conduct of research (RCR), and socially desirable response tendencies. Negative associations were found for the PDR and measures of cynicism, moral disengagement, and compliance disengagement, while positive associations were found for the PDR and RCR knowledge and positive urgency, an impulsivity subscale. PDR scores were not related to socially desirable responding, or to measures of work stressors and the remaining impulsivity subscales. In a multivariate logistic regression analysis, lower moral disengagement scores, higher RCR knowledge, and identifying the United States as one's nation of origin emerged as key predictors of stronger performance on the PDR. The implications of these findings for understanding the measurement of decision-making in research and future directions for research and RCR education are discussed.

Replication and extension of the dual pathway model of disordered eating: The role of fear of negative evaluation, suggestibility, rumination, and self-compassion

OBJECTIVE

The dual pathway model, a theoretical model of eating disorder development, suggests that thin ideal internalization leads to body dissatisfaction which leads to disordered eating via the dual pathways of negative affect and dietary restraint. While the dual pathway model has been a valuable guide for eating disorder prevention, greater knowledge of characteristics that predict thin ideal internalization is needed.

METHOD

The present study replicated and extended the dual pathway model by considering the addition of fear of negative evaluation, suggestibility, rumination, and self-compassion in a sample of community women and female university students.

RESULTS

Results showed that fear of negative evaluation and suggestibility predicted thin ideal internalization whereas rumination and self-compassion (inversely) predicted body dissatisfaction. Negative affect was predicted by fear of negative evaluation, rumination, and self-compassion (inversely).

DISCUSSION

The extended model fit the data well in both samples. Analogue and longitudinal study of these constructs is warranted in future research.

Professional Decision-Making in Research (PDR): The Validity of a New Measure

In this paper, we report on the development and validity of the Professional Decision-Making in Research (PDR) measure, a vignette-based test that examines decision-making strategies used by investigators when confronted with challenging situations in the context of empirical research. The PDR was administered online with a battery of validity measures to a group of NIH-funded researchers and research trainees who were diverse in terms of age, years of experience, types of research, and race. The PDR demonstrated adequate reliability (alpha = .84) and parallel form correlation (r = .70). As hypothesized, the PDR was significantly negatively correlated with narcissism, cynicism, moral disengagement, and compliance disengagement; it was not correlated with socially desirable responding. In regression analysis, the strongest predictors of higher PDR scores were low compliance disengagement, speaking English as a native language, conducting clinical research with human subjects, and low levels of narcissism. Given that the PDR was written at an eighth grade reading level to be suitable for use with English as a second language participants and that only one-fourth of items focused on clinical research, further research into the possible roles of culture and research ethics training across specialties is warranted. This initial validity study demonstrates the potential usefulness of the PDR as an educational outcome assessment measure and a research instrument for studies on professionalism and integrity in research.

Examining the role of negative urgency in a predictive model of bulimic symptoms

The etiological dual pathway model of bulimia nervosa suggests that dietary restraint and negative affect are significant predictors of this disorder. Negative urgency, or the tendency to act rashly in response to negative emotionality, is also associated with bulimia nervosa; however, no study has examined the role of negative urgency within the context of the dual pathway model. The purpose of this study was to investigate the relationship between bulimic symptomatology and negative urgency in the context of dietary restraint and depressive affect. Participants (N=166) were college women recruited from a private mid-western university through an online participant registry. A self-report battery assessed depressive affect, dietary restraint, negative urgency, and bulimic symptoms. Participants' height and weight were measured in-person to determine body mass index. A significant main effect of negative urgency was found after controlling for depressive affect and dietary restraint. The interaction between depressive affect and negative urgency to predict bulimic symptoms approached significance; however, no statistically significant interaction between dietary restraint and negative urgency was observed. These results provide support for the inclusion of negative urgency as a significant factor in etiological frameworks of bulimia nervosa.

The Treatment of Night Eating Syndrome: A Review and Theoretical Model

The treatment of night eating syndrome, a disorder characterized by evening hyperphagia, morning anorexia, and insomnia, continues to gain attention with its inclusion in the DSM-V. Known treatments for NES include pharmacological, phototherapy, weight loss and dietary, and psychological interventions, which, together with the syndrome's clinical characteristics, support a treatment guiding biobehavioral model. The biobehavioral model proposes that a genetic predisposition, coupled with stress, enhances midbrain serotonin transporter (SERT) binding, which results in lower post-synaptic serotonin, dysregulating circadian rhythms and decreasing satiety. Selective serotonin reuptake inhibitors should therefore decrease SERT binding, increase postsynaptic serotonin, and restore circadian function and satiety regulation. Psychological interventions may be used to decrease stress as well as address insomnia and circadian rhythm disruptions. Dietary and behavioral interventions may produce beneficial changes in satiety as well as dysregulated eating. Avenues for future treatment outcome studies, including alternative pharmacological and combination therapies, are discussed.

An observational study of the association between adenovirus 36 antibody status and weight loss among youth

OBJECTIVE

Although the human adenovirus 36 (Ad-36) is associated with obesity and relative hypolipidemia, its role in pediatric weight loss treatment response is uncertain. Therefore, the primary study objective was to determine whether Ad-36 antibody (AB) status was associated with response to a pediatric weight loss program. The secondary objective was to assess the association between Ad-36 AB status and baseline lipid values.

METHODS

Participants included 73 youth aged 10-17 years in a residential camp-based weight loss program. The study examined differences in baseline lipid values between Ad-36 AB+ and AB- youth as well as differences in response to treatment, including indices of body size and fitness.

RESULTS

At baseline, results showed that Ad-36 AB+ youth evidenced significantly lower levels of total cholesterol and triglycerides than Ad-36 AB- youth (all p < 0.05). After 4 weeks of treatment, the Ad-36 AB+ youth showed a smaller reduction in BMI percentile than the Ad-36 AB- youth (p < 0.05), a difference of about 0.48 kg.

CONCLUSION

Ad-36 AB status showed a weak association with treatment response, but was associated with a better lipid profile. Ad-36 AB status should be assessed in studies of pediatric obesity treatment and prevention.

The relationship between body mass index and unhealthy weight control behaviors among adolescents: the role of family and peer social support

Adolescents classified as overweight or obese are more likely to use unhealthy weight control behaviors such as skipping meals or fasting than their healthy weight peers. Adolescents with low perceived social support may be at particular risk. Therefore, the purpose of the present study was to investigate the association between adolescent overweight and obesity, indices of perceived peer and family social support, and their interaction in the use of unhealthy weight control behaviors among adolescents. The present study used data from the 2001-2002 Health Behavior in School-Aged Children collaborative survey. Participants included 4598 adolescent girls and boys in the ninth and tenth grades. Results of binary logistic regression analyses showed that obese boys and girls were more likely to use unhealthy weight control behaviors than their healthy weight peers. Boys and girls who endorsed difficult communication with their parents, low levels of parent school support, or frequent bullying were more likely to engage in unhealthy weight control behaviors than relevant comparison groups. Among girls, poor classmate relationships were associated with increased use of unhealthy weight control behaviors whereas fewer friendships were associated with decreased use. Results suggest that adolescents are at high risk for use of unhealthy weight control behaviors and would benefit from interventions to increase knowledge and social support for achieving and maintaining a healthy weight.

Posttraumatic Growth Inventory: Factor Structure in the Context of DSM-IV Traumatic Events

Studies examining the dimensionality of the Posttraumatic Growth Inventory (PTGI) have yielded varying results. To date, no study has investigated the measure's factor structure in the context of DSM-defined traumatic events. The present study examined the structure in an undergraduate student sample (N = 379) reporting DSM-IV Criterion-A potentially traumatic events. Confirmatory factor analysis (CFA) did not support the original five-factor structure. Follow-up exploratory factor analysis and CFA on random halves of the sample showed poor model fit for 1-, 3-, and 7-factor models. Results suggest that the PTGI factor structure is unclear amongst individuals with DSM-IV traumatic events, and continued use of the total score is most appropriate. Future directions including the utility of the PTGI factors are discussed.

Psychological complications of pediatric obesity

Psychological complications associated with pediatric obesity include low self-esteem, depression, body dissatisfaction, loss-of-control eating, unhealthy and extreme weight control behaviors, impaired social relationships, obesity stigma, and decreased health-related quality of life. Bioecological models offer a framework for understanding the interaction between pediatric obesity and psychological complications and illustrate system-level approaches for prevention and intervention. As the medical setting is often the first point of contact for families, pediatricians are instrumental in the identification and referral of children with psychological complications. Motivational interviewing, patient talking points, brief screening measures, and referral resources are important tools in this process.

The EDE-Q, BULIT-R, and BEDT as self-report measures of binge eating disorder

Binge eating disorder, currently classified as an eating disorder not otherwise specified, is a valid and clinically useful psychiatric diagnosis. Given its probable inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), identification of self-report measures with high levels of diagnostic utility should improve the likelihood and accuracy of screening. The aim of the current study was to assess the diagnostic utility of two widely used measures of eating disorder symptoms, namely the Eating Disorder Examination-Questionnaire (EDEQ) and the Bulimia Test-Revised (BULIT-R), as well as a factor of the BULIT-R (coined the Binge Eating Disorder Test or BEDT), newly created specifically for the assessment of BED. Participants included 15 individuals with BED and 26 non-BED controls, as determined via the diagnostic section of the Eating Disorder Examination, who met criteria for being overweight or obese. Results showed that the BEDT achieved 100% sensitivity, specificity, positive and negative predictive values. The BULIT-R and Eating Concern subscale of the EDE-Q evidenced strong sensitivity (100 vs 87), specificity (96 vs 100), positive predictive values (94 vs 100), and negative predictive values (100 vs 93), respectively. Results suggest that the BEDT is an excellent overall measure of BED in obese populations. The BULIT-R affords the advantage of ruling out compensatory behaviors, particularly of the non-purging variety (e.g., severe restriction outside of binges), while the brevity of the Eating Concern subscale of the EDE-Q makes it optimal for use in brief screening situations.

Night eating syndrome: a critical review of the literature

Clinical psychologists are increasingly called to participate in the treatment of obesity, a condition that affects about one-third of adults in the United States. A disorder gaining increased recognition for its role in the development and maintenance of obesity is Night Eating Syndrome (NES), a relatively novel disorder involving morning anorexia, evening hyperphagia and/or nocturnal ingestions, and insomnia. NES affects men and women from various racial groups and tends to run in families. NES tends to co-occur with mood, anxiety, eating, sleep, and substance use disorders and may have implications for weight and diabetes management. Relatively little is known about the successful treatment of NES. Limited evidence suggests that serotonergic-based pharmacological treatments may be beneficial. Psychological interventions, such as psychoeducation, eating modification, relaxation strategies, sleep hygiene, cognitive restructuring, physical activity, and social support facilitation may also yield beneficial results. The purpose of the present paper is to provide an introduction to NES, including diagnosis, clinical presentation, assessment, comorbidities, clinical implications, and pharmacological and psychological treatment approaches. Areas for further study and development are discussed. NES is an emerging area for clinical description, evaluation, and intervention.

A Survey of Psychological Assessment on Interdisciplinary Craniofacial Teams

Objective

To explore the role of mental health professionals on craniofacial teams and determine how craniofacial teams assess for psychological concerns in their patient populations.

Design

Online and paper surveys.

Participants

A total of 55 craniofacial team coordinators and 40 mental health professionals who are team members participated in this study.

Results

Results indicated that teams in 2007 generally viewed psychological services on their teams similarly to teams assessed in 1987. Most teams do not use formal measures in their assessment of psychological concerns, and they provide feedback via discussions with the families. Mental health professionals assess a wide variety of potential areas of concern and are generally satisfied with the referral sources available to their patients.

Conclusions

Craniofacial teams appear to practice in a manner consistent with professional standards, and these teams seem to value the inclusion of mental health professionals as part of the interdisciplinary team. Implications and limitations including response rate are discussed.

Unhealthy weight control behaviors among adolescents

This article examined moderators of the association between BMI and unhealthy weight control behaviors suggested by the Dual Pathway Model among 4,529 adolescents from the Health Behavior in School-Aged Children survey. An obese classification was associated with unhealthy weight control behaviors for boys and girls. Low life satisfaction, high negative affect, and body size dissatisfaction were associated with unhealthy weight control behaviors among boys as was low life satisfaction for girls. Among girls, healthy weight classification, coupled with low negative affect or body size satisfaction, was protective against unhealthy weight control behaviors. Improved self-care may decrease obesity and unhealthy weight control behaviors.

Examining health-related quality of life, adaptive skills, and psychological functioning in children and adolescents with epilepsy presenting for a neuropsychological evaluation

The purpose of this study was to characterize 132 children and adolescents (mean age = 10 years, 11 months) with epilepsy in terms of psychosocial functioning and to determine the extent to which adaptive skills and psychological functioning predict health-related quality of life (HRQOL), above and beyond demographic and epilepsy-specific characteristics. A chart review was conducted to obtain demographic and epilepsy-specific information as well as caregiver responses on the Behavior Assessment System for Children, Second Edition (BASC-2) Parent Report and the Quality of Life in Childhood Epilepsy Questionnaire (QOLCE). In addition to Full Scale IQ and age at seizure onset, the BASC-2 Clinical and Adaptive Skills subscales also predicted HRQOL, indicating that this measure may be particularly helpful in predicting HRQOL above and beyond information routinely collected in a medical setting. It is imperative to evaluate children with epilepsy for psychosocial difficulties and diminished HRQOL to ensure the provision of comprehensive quality care and intervention services.

The effects of social support and coping on the relationship between social anxiety and eating disorders

The current study examined the hypotheses that social support and coping moderate and or mediate the relationship between a broad and a narrow form of social anxiety and eating disorder symptoms. One hundred sixty-nine female undergraduates at a private Midwestern university, completed measures of social support, coping, social anxiety, fear of negative evaluation, and disordered eating attitudes and behaviors. Results of hierarchical multiple regression analyses indicated that higher levels of social support are associated with a weaker association between social anxiety and eating disorder symptomatology. Low use of task- and avoidant-oriented (distraction) coping and increased use of emotion-oriented coping are associated with a stronger association between social anxiety and eating disorder symptomatology. Implications for research and clinical intervention are discussed.

The role of body image dissatisfaction and depression on HAART adherence in HIV positive men: tests of mediation models

The current study examined the role of body image dissatisfaction and depression on HAART adherence in a sample of HIV positive men. Participants were 124 HIV positive gay and bisexual men, who responded to an online survey. Results from moderated mediation models revealed that depression mediated the relationship between body dissatisfaction and HAART non-adherence for men who possessed elevated levels of body dissatisfaction, but not for those men who reported moderate or low levels. Additionally, depression was found to mediate the relationship between body dissatisfaction and HAART non-adherence for men with a self-reported AIDS diagnosis. Results suggest the importance of addressing both body dissatisfaction and depression in men who are living with HIV/AIDS.

Components of body image in gay men with HIV/AIDS

The current study examined group differences in various components of body image within a group of gay men. Three groups of gay men were compared: AIDS diagnosed, HIV positive (without an AIDS diagnosis), and HIV negative. Participants were 254 men who responded to an online survey. Results revealed significant group differences on the components of illness orientation and fitness/health evaluation. These results indicated that participants in the AIDS and HIV positive groups reported more awareness of and vulnerability to illness compared with the HIV negative group. Furthermore, men in the AIDS group reported being less fit and in poorer health than HIV positive and HIV negative men. Surprisingly, there were no significant differences between groups on appearance evaluation, suggesting that previous reports of high levels of body dissatisfaction among men living with HIV/AIDS may be because of disproportionate rates of gay (or MSM) men affected by the disease.

The relationship between religion and religious coping: religious coping as a moderator between religion and adjustment

This study examined the relationship between and among religion, religious coping, and positive/negative psychological adjustment and investigated whether the four religious coping styles of Self-Directing, Deferring, Collaborative, and Turning to Religion would significantly moderate the relationship between religion and psychological adjustment. Each of the four religious coping measures were significant moderators between religion and positive and negative adjustment. However, the high self-directing and high religion group showed opposite results from the other three coping styles, in that they were the most maladjusted and least satisfied with life compared to the other three integration and religious coping groups. The participants high on religion and high deferring, high collaborative, and high turning to religion groups were less maladjusted and more satisfied than the other three groups in each of these religious coping styles.

The Male Body Attitudes Scale: A confirmatory factor analysis with a sample of gay men

The Male Body Attitudes Scale (MBAS; Tylka, Bergeron, & Schwartz, 2005) is a recently created instrument which assesses males' attitudes regarding their muscularity, body fat, and height. Although the MBAS was created via exploratory and confirmatory factor analyses, its factor structure has yet to be replicated with more diverse samples. The aim of the current study was to conduct a confirmatory factor analysis of the MBAS with a sample of gay men. Results from an online sample of 207 self-identified gay men revealed that the original three-factor structure of the MBAS, as well as a two-factor structure, consisting of muscularity and body fat, displayed strong factorial validity. These findings suggest that either a two- or three-factor structure may be used when assessing body image concerns in gay men.

Moderate-carbohydrate low-fat versus low-carbohydrate high-fat meal replacements for weight loss

OBJECTIVES

To compare the efficacy of a low-carbohydrate high-fat versus a moderate-carbohydrate low-fat diet for weight loss and cardiovascular risk reduction.

METHODS

In a prospective clinical trial, 137 participants (body mass index >or=25 kg/m2) were randomly assigned to Control (46 randomized, 44 completed), Low Carbohydrate (45 randomized, 42 completed), or Moderate Carbohydrate (46 randomized, 40 completed) groups. Outcomes included measures of body size and composition and blood chemistries.

RESULTS

Both the Low and Moderate Carbohydrate groups lost significantly more weight as well as inches from their waists and thighs than the Control group, while the Low Carbohydrate group lost a greater percentage of body fat. Although the Moderate Carbohydrate group showed significant reductions in serum cholesterol, the Low Carbohydrate group showed the greatest improvements in serum cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, and very-low-density lipoprotein.

CONCLUSIONS

Moderate approaches to weight loss such as a moderate-carbohydrate low-fat diet may be prudent.

Interpersonal sensitivity predicts bulimic symptomatology cross-sectionally and longitudinally

Individuals who experience interpersonal sensitivity (IPS) may be at an increased risk for developing eating disorder symptomatology. The purpose of the present study was to assess the predictive capacity of IPS and related constructs in the development of bulimic symptomatology both cross-sectionally and longitudinally while controlling for depressive symptoms. Participants were 119 female undergraduate psychology students attending a private mid-size Midwestern university. Data were collected at both the beginning and end of the academic semester. Participants completed the Center for Epidemiological Study - Depression Scale, Brief Fear of Negative Evaluation Scale, Interpersonal Sensitivity Measure, and the Bulimia Test - Revised. The Fragile Inner Self subscale of the IPSM was found to significantly account for additional variability in BULIT-R scores after controlling for depression both cross-sectionally and longitudinally (8% and 2%, respectively). IPS is a suitable candidate for inclusion in the dual pathway model of bulimic symptomatology.

Effect of impaired cognition on hypertension outcomes in older urban African Americans

The Fuld Object Memory Evaluation and MacNeill Lichtenberg Decision Tree are useful screening tools to detect cognitive impairments that may be associated with difficulty in hypertension-related self-care and blood pressure outcomes. The results of a pilot study exploring the effect of cognition on hypertension-related self-care and blood pressure outcomes among African-American elders are described.

The sociocultural model of eating disorder development: application to a Guatemalan sample

Exposure to Western ideals of appearance along with rapid societal change appears to be salient risk factors for eating disorder development. According to the sociocultural model, internalization of the thin ideal leads to body dissatisfaction and subsequent negative affect and dieting behaviors which increase the risk for eating disorder development. An expanded version of the sociocultural model was examined among an economically stratified sample of 347 girls in grades 5 and 6 from Guatemala City. Questionnaires used to measure disturbed eating attitudes and behaviors, body dissatisfaction, social sensitivity, and internalization of the thin ideal were administered and BMI was calculated following measurement of height and weight. Path analyses showed that the expanded sociocultural model was an excellent fit to the data. Both elevated adiposity and social sensitivity led to increased body dissatisfaction and thin ideal internalization. Thin ideal internalization led to body dissatisfaction and to disturbed eating attitudes and behaviors. Results suggest that developing countries are not immune to the influence of sociocultural risk factors for eating disorders.

The role of stress and social support in predicting depression among a hypertensive African American sample

OBJECTIVE

We examined social support, stress, and selected demographic variables as predictors of depression among African Americans with hypertension.

METHODS

Archival data collected on 194 hypertensive African Americans ranging in age from 30 to 88 years (mean age = 58.3 years, standard deviation = 12.2; 63% were female) were analyzed in the present study. Hierarchic regression analyses were conducted using two models of depression. The first model included basic demographic characteristics of the sample, including age, sex, educational attainment, income, and employment status. In the second model, the psychosocial variables of stress and social support were added to determine their predictive value.

RESULTS

The first model accounted for 14% of the variance in depression and identified sex and age as significant predictors. The second model, in which two psychosocial variables were added, accounted for 45.2% of the total variance, with age, stress, and social support as significant predictors.

CONCLUSIONS

Stress and social support are significant predictors of depression in a hypertensive African American population, beyond the influence of various demographic variables. These results have implications for prevention and intervention strategies with the target population.

The role of emotional intelligence and negative affect in bulimic symptomatology

Emotions, particularly emotion dysregulation, play an important role in the development and maintenance of eating disorders as evidenced by the emphasis given to addressing emotions in a number of psychotherapeutic approaches that have been adapted for the treatment of women with disordered eating. The purpose of this study was to assess the role of emotional intelligence and other emotion regulation variables in the relationship between negative affect and bulimic symptomatology. One hundred fifty undergraduate females were assessed via a packet of self-report questionnaires that included measures of emotion regulation, including emotional intelligence (BarOn Emotional Quotient Inventory -- Short Form), alexithymia (Twenty-Item Toronto Alexithymia Scale), and coping (Brief COPE Inventory), negative affect (Positive and Negative Affect Schedule -- Expanded Form and Affect Intensity Measure), and bulimic symptomatology (Bulimia Test -- Revised). Results of multiple regression analyses indicated that each conceptual area of interest contributed to the prediction of bulimic symptomatology. In addition, the measures of emotion regulation accounted for significant variance in bulimic symptomatology even after controlling for negative affect. Emotional intelligence and other emotion regulation variables did not moderate the relationship between negative affect and bulimic symptomatology. However, results highlight the role of emotion in disordered eating behaviors and support the negative affect and emotion dysregulation theories of eating disorders.

Health service use in Russian immigrant and nonimmigrant older persons

Health service use was compared in Russian immigrant (n=105) and White nonimmigrant (n=101) older persons. Study participants completed a health utilization questionnaire, the Short-Form-36 Health Survey, and a health behavior diary. Controlling for health status and demographic variables, Russians reported significantly more service use, fewer physical access problems, and lower appointment availability, but nonimmigrants reported significantly more provider problems. Significant predictors of service use for the total sample included symptom self-care, health status, and age. In group-specific analyses, health status and age were significant for both groups and education was also significant for Russians.

Measuring elders' symptoms with daily diaries and retrospective reports

The current study investigated the sufficiency of symptom data collected for 7 days from a daily diary and the comparability and validity of data obtained from daily diaries and retrospective reports. Three hundred and five older persons completed a daily symptom diary, a retrospective symptom questionnaire, and a measure of health status. The number of symptoms endorsed each day on the diary declined, F(6, 214) = 13.51, p< .0001. New symptoms were endorsed 15%, and previous symptoms were no longer endorsed 1.9% of the time. More symptoms were endorsed on retrospective reports than on daily diaries, t(304) = 8.48, p < .0001. Symptoms from both methods were significantly correlated with health status (p <.0001) and differences in the correlations were not statistically significant, t(304) = 1.62, p = ns . Because of comparable criterion validity, less burdensome retrospective reports should be used, unless the focus is new symptoms or how symptoms unfold over time.

Psychometric properties of the State and Trait Food Cravings Questionnaires among overweight and obese persons

A crucial problem in studies involving food cravings is the lack of a psychometrically sound measure for use among overweight and obese populations. The degree to which the Food Cravings Questionnaires-Trait (FCQ-T) and State (FCQ-S) evidenced acceptable psychometric properties among overweight and obese participants was assessed. In study 1, 109 participants completed the FCQ-T and FCQ-S. Item-total correlations, test-retest reliability, internal consistency, and factor structures were examined. Results indicate good internal consistency and partially support the factor structures. In study 2, the construct and predictive validity of the FCQ-S were examined. Twenty-eight women completed the FCQ-S 15 min after finishing a standardized breakfast and then twice more, 90 min apart. Subsequent ad libitum food intake was recorded. Results suggest that the FCQ-S is sensitive to state changes in food cravings, but that the magnitude of the changes was moderate. The FCQ-S was not a good predictor of subsequent food intake. The FCQ-T and FCQ-S may be useful in studies that examine triggers of and interventions for excessive food intake.

Effect of a post-dinner snack and partial meal replacement program on weight loss

The objectives of this study were to examine whether providing a structured post-dinner snack would enhance weight loss among obese night snackers participating in a novel partial meal replacement (PMR) program and to examine the efficacy of that program. Sixty adults (age 18-65 years; body mass index >or=30 kg/m2), 29 randomized to the 'post-dinner snack' and 32 to the 'no snack' groups, completed the 8-week program. Both groups showed improvements in weight (-4.23 kg, P < 0.0001), body mass index (-1.48 kg/m2, P < 0.0001), body fat (-1.36%, P < 00.0001), waist circumference (-6.40 cm, P < 0.0001), and high-density lipoprotein-cholesterol (-2.72 mmol/l, P < 0.01), and on a night snacking question (-1.31, P < 0.0001). The 'post-dinner snack' group did not show significantly greater weight loss outcomes than the 'no snack' group either before or after taking compliance into consideration. Providing a structured post-dinner snack along with a PMR program did not enhance weight loss treatment outcomes; however, the PMR program produced beneficial weight loss changes for obese night snackers.

Short-Term Effect of Eggs on Satiety in Overweight and Obese Subjects

OBJECTIVE

To test the hypotheses that among overweight and obese participants, a breakfast consisting of eggs, in comparison to an isocaloric equal-weight bagel-based breakfast, would induce greater satiety, reduce perceived cravings, and reduce subsequent short-term energy intake.

SUBJECTS

Thirty women with BMI's of at least 25 kg/M2 between the ages of 25 to 60 y were recruited to participate in a randomized crossover design study in an outpatient clinic setting.

DESIGN

Following an overnight fast, subjects consumed either an egg or bagel-based breakfast followed by lunch 3.5 h later, in random order two weeks apart. Food intake was weighed at breakfast and lunch and recorded via dietary recall up to 36 h post breakfast. Satiety was assessed using the Fullness Questionnaire and the State-Trait Food Cravings Questionnaire, state version.

RESULTS

During the pre-lunch period, participants had greater feelings of satiety after the egg breakfast, and consumed significantly less energy (kJ; 2405.6 +/- 550.0 vs 3091.3 +/- 445.5, Egg vs Bagel breakfasts, p < 0.0001), grams of protein (16.8 +/- 4.2 vs 22.3 +/- 3.4, Egg vs Bagel breakfasts, p < 0.0001), carbohydrate 83.1 +/- 20.2 vs 110.9 +/- 18.7, Egg vs Bagel breakfasts, p < 0.0001), and fat 19.4 +/- 5.1 vs 22.8 +/- 3.2, Egg vs Bagel breakfasts, p < 0.0001) for lunch. Energy intake following the egg breakfast remained lower for the entire day (p < 0.05) as well as for the next 36 hours (p < 0.001).

CONCLUSIONS

Compared to an isocaloric, equal weight bagel-based breakfast, the egg-breakfast induced greater satiety and significantly reduced short-term food intake. The potential role of a routine egg breakfast in producing a sustained caloric deficit and consequent weight loss, should be determined.

Evening ready-to-eat cereal consumption contributes to weight management

OBJECTIVES

Post dinner snacking may constitute a significant proportion of total daily energy intake and contribute to overweight and obesity in some individuals (night snackers). This study tested the hypothesis that providing a structured snack in the form of a "ready-to-eat" breakfast cereal would help regulate excess energy intake and contribute to weight loss in night snackers.

METHODS

Adults (18 to 65 years of age, BMI kg/m2 > or = 25), with self-reported night snacking behaviors, were randomized into a cereal group (CR) and a no-cereal group (NC). During a period of 4 weeks, the cereal group was instructed to consume a serving of ready-to-eat cereal with low-fat milk 90 minutes after their evening meal. Concurrently, the non-cereal group continued their regular diet ad libitum.

RESULTS

At baseline, there were no significant differences between groups for age, body weight, body mass index, daily caloric intake, or evening caloric intake. There was a correlation between number of days of compliance with post-dinner cereal consumption and weight loss (r = -0.36, p = 0.057). After 4 weeks, the compliant subjects (cereal intake > or = 20 d) lost -1.85 +/- 3.56 lbs vs. -0.39 +/- 3.1 lb for the NC group (p = 0.06). Compared to baseline, the compliant CR group reduced their total daily caloric intake by -396.50 +/- 641.6 kcal (p < 0.02), whereas, the NC group experienced a reduction of -23.22 +/- 889.60 kcal/day during the same period (p = ns). Reduction in post-dinner calorie intake for the compliant CR group was significantly greater compared to the NC group (-141.74 +/- 385.58 kcal vs. 85.82 +/- 374.70 kcal; p = 0.042).

CONCLUSION

Eating ready-to-eat cereal after the evening meal may attenuate caloric intake in night snackers and promote weight loss in compliant individuals.

Night eating syndrome: evaluation of two screening instruments

The purpose of the present study was to determine whether night eating syndrome was associated with treatment outcomes during a brief weight loss intervention for self-identified night snackers, and to evaluate the diagnostic utility of a screening question and the Night Eating Syndrome Questionnaire (NESQ) for the detection of night eating syndrome. Participants enrolled in a 4-week randomized clinical trial for obese and overweight persons who self-identified as night snackers were administered a structured clinical interview, a night eating screening question, and the NESQ. Treatment outcomes included adherence and weight loss. Results showed that night eating syndrome diagnoses were not associated with treatment outcomes. The screening question had adequate sensitivity but poor specificity. The night eating questionnaire was positively correlated with increasingly stringent definitions of night eating syndrome. Night eating syndrome is not the equivalent of night snacking. The definition of night eating syndrome must be expanded to include a sleep disturbance component accompanied by night eating.

Adherence Across Behavioral Domains in Treatment Promoting Smoking Cessation Plus Weight Control

The authors tested whether adherence to simultaneous health behavior changes was unitary or domain specific among 76 women who modified smoking, eating, and physical activity to accomplish smoking cessation plus weight control. Random-effects regression analyses showed that adherence to both smoking and diet plans declined linearly and covaried positively; their association tended to grow stronger over time. In contrast, physical activity plan adherence did not change over time and was unrelated to other domains. At the end of treatment, 65%, 30.5%, and 25% adhered well or excellently to smoking, diet, and activity treatments, respectively. Findings support both unitary and domain-specific aspects of adherence and suggest that among smokers, smoking and eating behaviors may have similarities unshared by physical activity.