Measuring cancer caregiver health literacy: Validation of the Health Literacy of Caregivers Scale-Cancer (HLCS-C) in an Australian population

Caregivers have been largely neglected in health literacy measurement. We assess the construct validity, and internal consistency of the Health Literacy of Caregivers Scale-Cancer (HLCS-C), and present a revised, psychometrically robust scale. Using data from 297 cancer caregivers (12.4% response rate) recruited from Melbourne, Australia between January-July 2014, confirmatory factor analysis (CFA) was conducted to evaluate the HLCS-C's proposed factor structure. Items were evaluated for: item difficulty, unidimensionality and overall item fit within their domain. Item-threshold-ordering was examined though one-parameter Item Response Theory models. Internal consistency was assessed using Raykov's reliability coefficient. CFA results identified 42 poorly performing/redundant items which were subsequently removed. A 10-factor model was fitted to 46 acceptable items with no correlated residuals or factor cross-loadings accepted. Adequate fit was revealed (χ²_WLSMV  = 1463.807[df = 944], p < .001, RMSEA = 0.043, CFI = 0.980, TLI = 0.978, WRMR = 1.00). Ten domains were identified: Proactivity and determination to seek information; Adequate information about cancer and cancer management; Supported by healthcare providers (HCP) to understand information; Social support; Cancer-related communication with the care recipient (CR); Understanding CR needs and preferences; Self-care; Understanding the healthcare system; Capacity to process health information; and Active engagement with HCP. Internal consistency was adequate across domains (0.78-0.92). The revised HLCS-C demonstrated good structural, convergent, and discriminant validity, and high internal consistency. The scale may be useful for the development and evaluation of caregiver interventions.

Health literacy of caregivers of adult care recipients: A systematic scoping review

Caregivers play a vital role in providing support to adults with a chronic condition, or cognitive or physical impairment. Low health literacy in caregivers has the potential to impact adequate care provision, and consequently, care recipient health outcomes. The aim of the study was to systematically review literature related to health literacy of caregivers of adult care recipients, and examine its relationship with care recipient, and caregiver, health outcomes. Electronic databases were searched for relevant English-language publications that assessed health literacy in caregivers. Included studies were abstracted into evidence tables and assessed using an eight-item quality scale. The search identified 2717 new titles and abstracts, with 67 shortlisted for full review. Twelve papers from 2003 to 2015 met the inclusion criteria. The prevalence of limited health literacy in caregivers ranged from 0% to 52.5% depending on the measure and cut-off criteria used. Associations were found between low caregiver health literacy and (i) poorer care recipient self-management behaviours; (ii) increased care recipient use of health services; and (iii) increased caregiver burden. The quality of the studies ranged from fair to excellent. Low health literacy in caregivers differed depending on the measures and scoring criteria used. Evidence to support the relationship between caregiver health literacy and care recipient, and caregiver health outcomes was limited to single studies. Recommendations for further research include: the development of caregiver health literacy measures across different populations; examination of associations between caregiver health literacy and care recipient outcomes; and the development of interventions designed to improve caregiver health literacy.

Factors That Influence Women's Disclosures of Substance Use during Pregnancy: A Qualitative Study of Ten Midwives and Ten Pregnant Women

The present study was designed to examine the factors that motivate or act as barriers to disclosure of substance use by pregnant women. Participants included 10 midwives and 10 pregnant women who attended two ante-natal clinics at an Australian maternity hospital. One clinic specialized in women who were substance users and one clinic was specifically for young women (under 19 years of age). Midwives and pregnant women were interviewed in-depth about disclosure of substance use. Interview transcripts were analyzed, and the results revealed six main themes: practice style, assessment of substance use, practice environment and privacy, child protection issues, health of the baby, and continuity of care. The findings are discussed in relation to recommendations for best practice in midwifery care when working with pregnant women who use substances.

Successful Aging: Perceptions of Adults Aged between 70 and 101 Years

In this research, content analysis was employed to investigate older adults' perceptions of successful aging and the relationship of these perceptions to definitions given in the literature to date. Participants were 18 males and 42 females between the ages of 70 and 101 years. Analyses revealed older adults mentioned only 1 or 2 criteria of successful aging if asked for a definition; however, when prompted, they rated almost all the criteria emerging from the literature as highly important. Participants reported adjusting to the situations they were in by compensating for losses that occurred and selecting activities that best suited their capabilities. Overall, older adults' perceptions of successful aging were similar to aspects identified in the literature. Not all aspects, however, were seen as important by all participants, and only low to moderate correlations were found between some aspects of successful aging.

The Construction of the Adolescent Male Body through Sport

The present study examined the role played by sport in understanding adolescent males' views about their body. Semi-structured interviews were conducted with 40 adolescent boys aged between 15 and 17 years. An inductive thematic analysis of boys' narratives showed that sport provided adolescent males with a context for discussing their body image. Attributes which males liked about their body were synonymous with those associated with being successful at sport. In addition, sport was used as a forum for competing with other males both through playing sport and by using sport performance to make favourable social comparisons about their body size.

Evaluation of a Prevention Program to Address Body Focus and Negative Affect among Children

The current study evaluated a program to improve the body image and positive and negative affect of children. Participants were 368 children aged 8–12 years. The results demonstrated that boys placed more importance on and were less satisfied with their muscles; girls were less satisfied with their weight and the importance of weight increased with increasing age. Children with a large BMI were less satisfied with their weight. Boys in the intervention group showed reduced levels of negative affect over time. Further research is required to develop prevention and intervention programs to lower the effects of body dissatisfaction and negative affect among children.

Children’s body image and social comparisons with peers and the media

Social comparisons are related to the development of body dissatisfaction among adolescents and adults, yet this relationship remains relatively unexamined among children. This study examines children’s peer and media-related social comparisons, and how this impacts on their body image. Children aged 8–10 years completed interviews (17 girls and 19 boys in individual interviews, and 16 girls and 16 boys in focus groups). Analyses revealed that appearance-related comparisons were more common among girls, whereas sports/ability-related comparisons were more common for boys. In addition, boys viewed media comparisons as inspiring, whereas girls reported negative emotions. Implications for future research and prevention programmes are discussed.

A systematic review of the psychosocial correlates of intuitive eating among adult women

Intuitive eating has been proposed as an eating style that fosters a positive attitude towards food, the body, and physical activity. A systematic review of the literature was undertaken to examine intuitive eating in relation to disordered eating, body image, emotional functioning, and other psychosocial correlates in adult women. Articles were identified through Academic Search Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Source (Nursing and Academic Edition), Medline Complete, PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, PubMed and Scopus. Eligible studies were those that examined women aged 18 years and older, measured intuitive eating, and assessed a psychosocial correlate of intuitive eating. Twenty-four cross-sectional studies, published between 2006 and September 2015, met eligibility criteria. Intuitive eating was associated with less disordered eating, a more positive body image, greater emotional functioning, and a number of other psychosocial correlates that have been examined less extensively. However, given that all studies used cross-sectional designs, no conclusions regarding the direction of the relationship between intuitive eating and psychosocial correlates can be drawn. Participants in the majority of studies were university students in the United States so findings cannot be generalised to the wider population of female adults. Prospective studies are now needed to verify these cross-sectional findings, and show if intuitive eating may reduce disordered eating and body image concerns, and promote women's psychological health and well-being.

Internalization as a mediator of the relationship between conformity to masculine norms and body image attitudes and behaviors among young men in Sweden, US, UK, and Australia

We examined whether internalization of sociocultural body ideals mediated the relationship between conformity to masculine norms and drive for muscularity, leanness, and thinness in a sample of males from Sweden, US, UK, and Australia. Over six hundred young men [n=142 (Sweden); n=192 (US); n=141 (UK); n=160 (Australia)] completed an online survey that included assessments of masculine role norms, body image, and internalization of sociocultural body ideals. Path analyses confirmed internalization as a mediator between greater conformity to masculine norms and body image measures (drive for thinness, desire for leanness, and desire for muscularity) across the sample. However, significant cross-country differences in the strength of these mediation effects were found. Mediation effects among US, Australian, and Swedish males were comparable, whereas these effects were weaker in the UK sample. Findings confirmed the importance of internalization of sociocultural body ideals in the tested models.

Media internalization and conformity to traditional masculine norms in relation to body image concerns among men

Previous studies have separately examined conformity to masculine norms and internalization of body ideals in the media in relation to the drive for muscularity (DM). This study was designed to examine these factors together in relation to DM, and further examine how they may differ in relation to drive for thinness (DT) and drive for leanness (DL). Participants were 284 Australian males between ages 18 and 42. They completed validated measures that assessed DM, DT, DL, male gender role norms, and internalization of body ideals. The findings showed that internalization of body ideals mediated the relationship between masculine role norms and body image in the case of both DM and DL. However, masculine norms and internalization were independent predictors of DT. Our findings contribute to further understanding of the roles that the media and masculine norms have in shaping men's drive for muscularity, leanness, and thinness. Longitudinal research is needed to confirm the nature and direction of these relationships.

Ecological Model of Australian Indigenous Men's Health

This study was designed to examine the health behaviors as well as the enablers and barriers to health behaviors among Indigenous Australian men. One hundred and fifty Indigenous Australian men in rural, regional, and urban locations were interviewed about their health behaviors. The results revealed several themes of importance: (a) role of community activities, (b) the Indigenous man as a leader and role model, (c) negative impact of discrimination/racism, (d) importance of partner and family, (e) positive and negative role of peer relationships, (f) central role of culturally appropriate health care facilities, and (g) association between employment and health care problems. These findings highlight the importance of broad community-based (rather than individualistic) approaches to promoting health behavior in Indigenous men.

Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis

OBJECTIVE

The aim of this study is to examine the relationships among demographic, medical, and psychosocial factors and post-traumatic stress symptoms (PTSS) and post-traumatic growth (PTG) in oncology populations.

METHOD

A systematic search identified k = 116 relevant studies published between 1990 and 2012. Meta-analyses synthesized results from studies that reported data on correlates of PTSS (k = 26) or PTG (k = 48). A meta-analysis was performed for k = 5 studies reporting the correlation between PTSS and PTG.

RESULTS

Post-traumatic stress symptoms were associated with depression (r = 0.56), anxiety (r = 0.65), distress (r = 0.62), social support (r = -0.33), and physical quality of life (r = -0.44). PTG was associated with age (r = -0.08), gender (r = -0.15), distress (r = -0.16), depression (r = -0.06), social support (r = 0.30), optimism (r = 0.27), positive reappraisal (r = 0.46), spirituality (r = 0.33), and religious coping (r = 0.36). There was a small positive relationship between PTSS and PTG (r = 0.13).

CONCLUSIONS

Post-traumatic stress symptoms and PTG appear to be independent constructs, rather than opposite ends of a single dimension. This is reflected in a small relationship between these variables and different psychosocial correlates. PTSS were strongly associated with variables reflecting a general state of negative affect. Optimism, spirituality, and positive coping styles were associated with PTG. It remains unclear how they are associated with PTSS, given the lack of relevant studies. Longitudinal research is required to examine how psychosocial factors influence the relationship between PTSS and PTG.

Anxiety in the management of localised prostate cancer by active surveillance

OBJECTIVES

To describe a range of anxieties in men on active surveillance (AS) for prostate cancer and determine which of these anxieties predicted health-related quality of life (HRQL).

PATIENTS AND METHODS

In all, 260 men with prostate cancer on AS were invited to complete psychological measures including the Hospital and Anxiety Depression Scale; the State-Trait Anxiety Inventory-Trait Scale; the Memorial Anxiety Scale for Prostate Cancer; and the Functional Assessment of Cancer Therapy Scale-Prostate. Overall, 86 men with a mean (sd, range) age of 65.7 (5.4, 51-75) years returned data, yielding a response rate of 33%. Outcome measures were standardised psychological measures. Pearson's correlations were used to examine bivariate relationships, while regression analyses were used to describe predictors of dependent variables.

RESULTS

When compared with the findings of prior research, the men in our cohort had normal levels of general anxiety and illness-specific anxiety and high prostate cancer-related HRQL. Age, trait anxiety and fear of recurrence (FoR) were significant predictors of prostate cancer-related HRQL; trait anxiety and FoR were significant predictors of total HRQL. Results should be interpreted in context of sample characteristics and the correlational design of the study.

CONCLUSIONS

Participants reported low levels of anxiety and high HRQL. Trait anxiety and FoR were significant predictors of both prostate cancer-related and total HRQL. The administration of a short trait-anxiety screening tool may help identify men with clinically significant levels of anxiety and those at risk of reduced HRQL.

Symptoms of posttraumatic stress in Australian women with ovarian cancer

OBJECTIVE

The aim of the study was to assess the prevalence and nature of symptoms of posttraumatic stress disorder (PTSD) in women with ovarian cancer. A further aim was to examine the demographic, medical and psychosocial factors associated with PTSD symptoms.

METHOD

One hundred and eight women with ovarian cancer were assessed for PTSD, quality of life, depression, anxiety, posttraumatic growth, optimism, coping and social support.

RESULTS

Clinically significant symptoms were experienced by 9.25% of participants for PTSD, 5.6% for depression and 13.9% for anxiety. Poorer quality of life was associated with total PTSD symptoms, and avoidance and intrusive symptoms. Depression was associated with avoidance and intrusive symptoms. Anxiety was associated with total, avoidance, intrusive and hyperarousal symptoms. Finally, coping by substance use/self-blame was associated with total, avoidance and hyperarousal PTSD symptoms.

CONCLUSIONS

Levels of PTSD in women with ovarian cancer were equivalent to that of the general population. Poorer quality of life, depression, anxiety and maladaptive coping, characterised by avoidance, substance use and self-blame, were associated with increased symptoms of PTSD.

Binge eating partially mediates the relationship between body image dissatisfaction and psychological distress in obese treatment seeking individuals

INTRODUCTION

We compared the binge eating pathway linking body image dissatisfaction (BID) and psychological distress of obese adults entering and not entering psychological treatment for their weight problems.

METHOD

90 obese participants seeking an integrated treatment (OB-IT) and 87 obese participants seeking only medical treatment (OB-MT) for their weight problems completed questionnaires on BID, binge eating and psychological well-being.

RESULTS

Only in the OB-IT group, binge eating behaviors mediated the relationship between BID and psychological distress.

CONCLUSIONS

Both BID and binge eating behaviors need to be addressed in the psychological and medical treatment for obesity to enhance psychological well-being.

A test of the resource security and the body mass index reference point hypotheses of body dissatisfaction amongst adolescents in eight countries

OBJECTIVE

This study aimed to identify cultural-level variables that may influence the extent to which adolescents from different cultural groups are dissatisfied with their bodies.

DESIGN

A sample of 1730 male and 2000 female adolescents from Australia, Fiji, Malaysia, Tonga, Tongans in New Zealand, China, Chile, and Greece completed measures of body satisfaction, and the sociocultural influences on body image and body change questionnaire, and self-reported height and weight. Country gross domestic product and national obesity were recorded using global databases.

RESULTS

Prevalence of obesity/overweight and cultural endorsement of appearance standards explained variance in individual-level body dissatisfaction (BD) scores, even after controlling for the influence of individual differences in body mass index and internalization of appearance standards.

CONCLUSIONS

Cultural-level variables may account for the development of adolescent BD.

A qualitative study of preadolescent boys' and girls' body image: gendered ideals and sociocultural influences

This qualitative study examined preadolescent boys' and girls' body ideals, and peer and media factors that shape these ideals. Sixty-eight children aged 8-10 participated in semi-structured interviews: 19 boys and 17 girls in individual interviews and 16 boys and 16 girls in eight group interviews. Techniques from grounded theory were used to analyze the data. Findings demonstrated that fitness was an important element of boys' and girls' body ideals. For boys the emphasis was on sport, and this was promoted by their peer interactions and the sportsmen they admired. For girls the focus was on looking good, and this was reinforced by their peer conversations, and the actresses and singers they admired. Focus groups further highlighted how peers both reinforced media messages, yet also helped children critique media messages. Implications are discussed for prevention programs that need to be specifically tailored for boys and girls.

Evaluation of an alcohol intervention training program for nurses in rural Australia

Aim

This paper reports on the development, implementation and evaluation of the Alcohol Intervention Training Program (AITP) designed to enhance nurses’ capacity to work with farming men and women who misuse alcohol.

Background

In rural and regional areas where alcohol-related behaviours and problems are relatively elevated, nurses may be the key health professionals dealing with individuals who misuse alcohol. However, they are often ill-equipped to do this, have low confidence in their ability to do so, and perceive numerous barriers. Training is required for these nurses.

Methods

We developed the AITP to enhance nurses’ capacity to work with people with alcohol-related problems. The data were collected during 2010. An intervention group of 15 rural nurses completed the AITP. Nurses’ perceived barriers, attitudes, and perceived performance in working with clients with alcohol problems, and the frequency of engaging with this client group were evaluated. Scores on these measures were compared to those of a control group of 17 nurses’ pre-treatment, post-treatment and at 3-month follow-up.

Results

Participation in the AITP resulted in initial improvements in attitudes to working with alcohol problems, but no change in perceived barriers to doing so. The level of engagement with clients having alcohol-related problems increased, as did perceptions of work performance.

Conclusion

The AITP enhances the ability of rural nurses to address the alcohol and associated health issues of clients in rural and regional areas. However, the program needs refinement and further evaluation.

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.

Training and experience of nurses in responding to alcohol misuse in rural communities

OBJECTIVE

Alcohol misuse by farmers continues to challenge rural nurses. This article reports on the experiences of Australian nurses participating in the Alcohol Intervention Training Program (AITP).

DESIGN AND SAMPLE

Qualitative interviews of 15 rural and remote nurses.

MEASURES

Semi-structured phone interviews were utilized to assess the response to and implementation of the AITP-an intervention designed to build nurses' knowledge, confidence and skills when responding to alcohol misuse. It comprises practical and theoretical components and was designed for rural and remote settings where nurses encounter alcohol misuse.

RESULTS

Nurses found the training provided new-or built on existing-knowledge of alcohol misuse and offered practical hands-on "real life" skills. A range of workplace and personal situations where the content of the training was now being utilized were identified, and future use anticipated. Barriers to using the new knowledge and skills included both rural and generic issues. Constructive feedback to increasingly target the training to rural settings was recommended.

CONCLUSIONS

The AITP is an effective training program. It can be further tailored to meet common needs of rural and remote nurses working with farmers who misuse alcohol, while recognizing diversity in rural practice.

Physical activity guidelines for preschoolers: a call for research to inform public health policy

There are many challenges in developing evidence-based physical activity guidelines for preschoolers that can ensure health benefits for children. Guidelines for the preschool years have recently been developed in several countries, but there are notable inconsistencies in the amount of physical activity regarded as sufficient for this age group. Given the currently high prevalence of childhood obesity, there is an urgent need for evidence-based studies to inform the development of community-targeted programs to ensure healthy levels of physical activity in young children. Our article outlines the global recommendations for physical activity for children ≤ 5 years of age. We identify gaps in the literature and suggest recommendations for future research and public health policy.

Promoting fit bodies, healthy eating and physical activity among Indigenous Australian men: a study protocol

BACKGROUND

Overall the physical health of Indigenous men is among the worst in Australia. Research has indicated that modifiable lifestyle factors, such as poor nutrition and physical inactivity, appear to contribute strongly to these poor health conditions. To effectively develop and implement strategies to improve the health of Australia's Indigenous peoples, a greater understanding is needed of how Indigenous men perceive health, and how they view and care for their bodies. Further, a more systematic understanding of how sociocultural factors affect their health attitudes and behaviours is needed. This article presents the study protocol of a community-based investigation into the factors surrounding the health and body image of Indigenous Australian men.

METHODS AND DESIGN

The study will be conducted in a collaborative manner with Indigenous Australian men using a participatory action research framework. Men will be recruited from three locations around Australia (metropolitan, regional, and rural) and interviewed to understand their experiences and perspectives on a number of issues related to health and health behaviour. The information that is collected will be analysed using modified grounded theory and thematic analysis. The results will then be used to develop and implement community events in each location to provide feedback on the findings to the community, promote health enhancing strategies, and determine future action and collaboration.

DISCUSSION

This study will explore both risk and protective factors that affect the health of Indigenous Australian men. This knowledge will be disseminated to the wider Indigenous community and can be used to inform future health promotion strategies. The expected outcome of this study is therefore an increased understanding of health and health change in Indigenous Australian men, the development of strategies that promote healthy eating and positive patterns of physical activity and, in the longer term, more effective and culturally-appropriate interventions to improve health.

Socio-cultural agents and their impact on body image and body change strategies among adolescents in Fiji, Tonga, Tongans in New Zealand and Australia

This paper reports on the findings of studies that were conducted as part of the Pacific Obesity Prevention in Communities project. The studies evaluated the types of messages that adolescents received in relation to body image, physical activity and eating. The participants were male and female adolescents from Fiji (two cultural groups), Tonga, New Zealand (Tongans) and Australia (European Australians). Three studies were conducted: interviews with 48 adolescents (24 male, 24 female) from each cultural group, questionnaires with 600 adolescents (300 male, 300 female) from each cultural group and the perceptual distortion study with 100 adolescents (50 male, 50 female) from the two cultural groups in Fiji and European Australians. The results demonstrate that parents, peers, the media, as well as religious influences impact on the type of body valued by adolescents in each of the cultural groups, as well as their levels of body satisfaction. These influences also shape the type and volume of food consumed, and the type and frequency of physical activity. The results of these studies highlight the major role played by the broader societal values in shaping the nature of the messages that adolescents receive in relation to their body size, eating and physical activity.

Maternal correlates of preschool child eating behaviours and body mass index: a cross-sectional study

To the authors' knowledge, this is the first study to evaluate maternal child feeding practices, maternal parenting characteristics and mother-child interactions as cross-sectional predictors of child eating and/or weight within the one sample. Maternal pressure for her child to eat was a significant positive correlate of fussiness and a negative correlate of enjoyment. Maternal parenting warmth was associated negatively with child BMIz, while mother-child dysfunctional interaction was associated positively with child BMIz. Our findings suggest that childhood obesity research may be better informed by evaluating not just what mothers do (feeding practices) but also how they parent (parenting behaviours and interactions with their child). Longitudinal studies are needed to identify causal influences of parenting on preschool child eating and weight.

The Alcohol Intervention Training Program (AITP): a response to alcohol misuse in the farming community

BACKGROUND

Farm men and women in Australia have higher levels of problematic alcohol use than their urban counterparts and experience elevated health risks associated with excessive alcohol consumption. The Sustainable Farm Families (SFF) program has worked successfully with farm men and women to address health, well- being and safety and has identified that further research and training is required to understand and address alcohol misuse behaviours. This project will add an innovative component to the program by training health professionals working with farm men and women to discuss and respond to alcohol-related physical and mental health problems.

METHODS/DESIGN

A mixed method design with multi-level evaluation will be implemented following the development and delivery of a training program (The Alcohol Intervention Training Program {AITP}) for Sustainable Farm Families health professionals. Pre-, post- and follow-up surveys will be used to assess both the impact of the training on the knowledge, confidence and skills of the health professionals to work with alcohol misuse and associated problems, and the impact of the training on the attitudes, behaviour and mental health of farm men and women who participate in the SFF project. Evaluations will take a range of forms including self-rated outcome measures and interviews.

DISCUSSION

The success of this project will enhance the health and well-being of a critical population, the farm men and women of Australia, by producing an evidence-based strategy to assist them to adopt more positive alcohol-related behaviours that will lead to better physical and mental health.

Are there different sociocultural influences on body image and body change strategies for overweight adolescent boys and girls?

This study examined how sociocultural messages differ for overweight and normal weight adolescents and how these messages predict body image and body change strategies. In total, 590 adolescents participated in the study. Overweight adolescents experienced greater body dissatisfaction, engaged in more strategies to lose weight, and experienced greater sociocultural messages to lose weight. Body dissatisfaction and sociocultural pressures predicted weight loss among overweight boys. Body image importance, and sociocultural pressures predicted increasing muscle bulk for normal and overweight boys. Weight loss for overweight girls was predicted by sociocultural pressures. Sociocultural pressures also predicted muscle increase for overweight and normal weight girls. Implications for intervention and prevention programs for overweight adolescent boys and girls are discussed.

The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: results of the international body project I

This study reports results from the first International Body Project (IBP-I), which surveyed 7,434 individuals in 10 major world regions about body weight ideals and body dissatisfaction. Participants completed the female Contour Drawing Figure Rating Scale (CDFRS) and self-reported their exposure to Western and local media. Results indicated there were significant cross-regional differences in the ideal female figure and body dissatisfaction, but effect sizes were small across high-socioeconomic-status (SES) sites. Within cultures, heavier bodies were preferred in low-SES sites compared to high-SES sites in Malaysia and South Africa (ds = 1.94-2.49) but not in Austria. Participant age, body mass index (BMI), and Western media exposure predicted body weight ideals. BMI and Western media exposure predicted body dissatisfaction among women. Our results show that body dissatisfaction and desire for thinness is commonplace in high-SES settings across world regions, highlighting the need for international attention to this problem.

Impact of a healthy body image program among adolescent boys on body image, negative affect, and body change strategies

This study evaluated the effectiveness of a healthy body image program. In total, 421 adolescent boys completed a five-session intervention program or a wait list control group. There were no differences between the intervention and the control group at post-intervention or any of the follow-up times. Boys in the intervention group who were one standard deviation above the mean on body dissatisfaction at baseline, demonstrated a reduction in negative affect in the intervention group at post-test and 6 months follow-up. Prevention programs need to target boys who are at risk of adopting health risk behaviors, rather than being universally applied.

Body dissatisfaction, engagement in body change behaviors and sociocultural influences on body image among Chinese adolescents

Body dissatisfaction and body image disorders are becoming increasingly prevalent in developing non-Western countries such as China, but there is a lack of research examining the sociocultural factors that in other contexts have been associated with these problems. The current study investigated body dissatisfaction, engagement in body change behaviors, and sociocultural pressures on body image, and the relationships between these variables among 517 adolescent males (N=219) and females (N=298) in China. Females reported greater body dissatisfaction than males, and males reported using strategies to increase their muscle bulk more often than females. Males reported pressure from a variety of sociocultural sources to increase their muscles or weight, while females reported pressure from the media to lose weight. For males body dissatisfaction was predicted by pressure from peers to increase their muscle bulk, while for females pressure to lose weight from peers, adult relatives, and the media was likely to increase body dissatisfaction. Pressure from the media and adult relatives was also predictive of body change behaviors in both males and females. The findings are discussed in relation to previous research in both Western and non-Western contexts.

Appearance-based comments, body dissatisfaction and drive for muscularity in males

This study examined the role of positive and negative appearance-based comments on body dissatisfaction and drive for muscularity among young adult males. The direct and moderating effect of self-esteem were also investigated; and BMI, age, and social desirability were included as covariates. The participants were 214 males aged between 18 and 30 years. More frequent negative comments were associated with higher body dissatisfaction whilst more frequent positive comments were associated with lower body dissatisfaction. However, both frequent negative and positive commentary were associated with higher drive for muscularity. Self-esteem was also associated with both body dissatisfaction and the drive for muscularity, but it did not moderate that influence of either positive or negative messages. Longitudinal research is now needed to determine the directionality of these relationships. Further research is required to establish the contexts in which positive and negative messages are associated with body dissatisfaction and the drive for muscularity.

Weight concerns among elementary school children: a review of prevention programs

There is increasing evidence that children display high levels of weight and muscle concerns, which include body dissatisfaction and problem eating. In order to address these issues, researchers have designed and implemented prevention programs for this age group. Thirteen published studies were located and reviewed, with children aged 8-12 years from elementary schools, or equivalent. Overall, the programs were shown to be effective in improving children's knowledge at post-test and at follow-up assessments. However, there is limited evidence to show that the programs reduced or prevented body image concerns and/or problem eating. Too few studies have examined muscle concerns so no conclusions can yet be drawn about this domain. Limitations of the studies and suggestions for future prevention efforts are discussed.

Implications of accuracy, sensitivity, and variability of body size estimations to disordered eating

The current study was conducted to investigate the relationships between body size estimations and disordered eating symptomatology. The method of constant stimuli was used to derive three measures of self-perceived body size in 93 women: (1) accuracy of body size estimations (body image distortion); (2) sensitivity in discriminating body size within blocks of trials (body image sensitivity); and (3) variability in making body size estimations between blocks of trials (body image variability). Participants also completed measures of disordered eating. Although body image distortion correlated with dietary restraint and eating concern, body image variability accounted for additional variance in these variables, as well as variance in binge eating. The relationships involving body image variability were found to be mediated by body dissatisfaction and internalization of the thin ideal. Together, these results are consistent with the proposition that body image variability is a significant factor in disordered eating.

University students' perceptions of the alcohol campaign: "Is Getting Pissed Getting Pathetic? (Just Ask Your Friends)"

The present study examined students' understanding and perceived effectiveness of a recent Australian alcohol campaign designed to increase students' awareness of excessive and harmful drinking. Six hundred and seventy one university students (51% females), who had seen the campaign posters, with the tagline "Is Getting Pissed Getting Pathetic? (Just Ask You Friends)", were asked to comment on the messages that the campaign was communicating and how informative, relevant, and effective they perceived the campaign. Many students were positive in their evaluations and described the messages as "truth and realistic", "clear and to the point", and that the campaign made them think about their own drinking. However, other views were more negative and indicative of psychological reactance. These included concerns that students "won't listen" or "don't care" about media campaigns, and that "they don't what to be told what to do". The findings highlight how media campaigns can help an audience contemplate behavioral change, however, they can also alienate students and promote counterproductive attitudes.

A longitudinal study of body change strategies of fitness center attendees

This study evaluated predictors of strategies to change weight and muscles among men and women who attend fitness centers. A questionnaire was completed by 107 men (mean age=39.17, SD=13.14), and 151 women (mean age=35.31, SD=11.38) who regularly attended fitness centers at two points in time, one year apart. The only unique predictor of body change strategies over time for men was body dissatisfaction predicting drive for thinness; for women, body dissatisfaction predicted strategies to lose weight, drive for thinness, use of food supplements to lose weight and levels of bulimia. Media messages also predicted drive for thinness and bulimia among women. These findings would suggest that attendance body dissatisfaction is an important factor predicting other normative and health risk behaviors among fitness center attendees, particularly women at a fitness center over a 12 month period was not generally associated with adverse health risk behaviors.

The role of ethnicity and culture in body image and disordered eating among males

An increasing number of researchers have examined body image concerns, disordered eating, and other behaviors associated with increasing muscle size among men from different cultural groups. However, to date there has been no synthesis or evaluation of these studies. In this paper we specifically review studies which have included a comparison between males from different cultural groups with White males on body image concerns or other related behaviors. The groups include Blacks, Hispanic Americans, Asians, Native Americans, Pacific Islanders, and men from Middle Eastern countries. Overall, evidence suggests that males from a range of cultural groups engage in more extreme body change strategies and binge eating than Whites. On the other hand, there is no consistent pattern which summarizes the nature of body image concerns across the different cultures. Mediating and/or moderating variables are proposed to account for the inconsistent findings. These include body build, levels of acculturation, socio-economic status, media exposure, and internalization of the muscular and lean body ideal.

Where is all the pressure coming from? Messages from mothers and teachers about preschool children's appearance, diet and exercise

This study used interviews and qualitative analyses to investigate the nature of the messages that preschool children receive from mothers and teachers about their bodies, general appearance, exercise and eating practices. Participants were 10 female teachers and 53 mothers. The behaviours of the 53 children (24 boys, 29 girls) were also observed to determine the nature of their eating and exercise behaviours. The results demonstrated that both mothers and teachers expressed concerns about their own bodies. Mothers also communicated messages to their daughters about losing weight and messages to their sons about increasing their muscles. Both girls and boys were concerned about their appearance, particularly their clothes and hair. Girls also demonstrated some concerns about losing weight, and boys with increasing muscles. Implications of these results are discussed in terms of designing education programs for mothers, teachers and children to prevent the development of body image concerns and disordered eating among children.

Body image attitudes and concerns among indigenous Fijian and European Australian adolescent girls

Research on body image has primarily been conducted among Western women who highly value the thin ideal body size. There has been limited research that has examined body image attitudes among Fijian adolescent girls who are exposed to both traditional sociocultural pressures that promote a larger body size and Western pressures that promote slimness. Using in-depth semi-structured interviews, we examined the factors associated with body image attitudes and concerns among a sample of 16 indigenous Fijian and 16 European Australian adolescent girls aged between 13-18 years. An inductive analysis of girls' responses indicated that both groups of girls experienced body image concerns including body dissatisfaction, a preference for thinness and concerns associated with weight gain. These findings have implications for our understanding of the role of culture in shaping body image among girls and may prove useful in the development of future survey research that can be implemented among both Fijian and Western adolescents.