Disordered eating behaviors in young adult Mexican American women: Prevalence and associations with health risks
Introduction
Recent findings suggest that disordered eating behaviors such as food/calorie restricting, binge eating, self-induced vomiting, laxative and diet pill use for the purpose of weight control are at least as prevalent in Latinas living in the United States as in non-Hispanic white women. For example, a statewide study of middle school students in Massachusetts showed that a greater percentage of Latinas reported severe weight control behaviors (e.g. diet pill, laxative use, and vomiting) in the last month compared to both White and Asian same-sex age mates (Austin et al., 2011). The Minnesota Student Survey showed that Hispanic high school freshman and senior level females had higher rates of disordered eating behaviors compared to all other racial and ethnic groups including Whites, Blacks, Asian and Native American students (Croll, Neumark-Sztainer, Story, & Ireland, 2002). National epidemiological data both from Latina women residing in the United States and women residing in Mexico found high rates of binge eating and binge eating disorders and showed a steady progression from adolescent to young adulthood (Alegria et al., 2007, Barriguete-Melendez et al., 2009, Marques et al., 2011). However, one limitation of these studies is that most studies completed to date have included heterogenous samples of Latinas despite evidence that significant variability exists among subpopulations in health outcomes (Fortmann et al., 2012, George et al., 2007), care seeking behaviors (Getrich et al., 2012) and access to treatment (Gonzalez et al., 2010).
In addition to lack of specificity in Latina sample definition, studies that focus on disordered eating behaviors across all racial and ethnic groups tend to measure target behaviors using a single question over a relatively long interval of time (e.g. last month, last year, lifetime). Although this approach provides molar level evidence of the prevalence of the behaviors, the severity of the level of behavioral involvement remain unknown. In addition, the more molar levels of behavioral measurement limit ability to explore patterns of correspondence among varying levels of behaviors.
In this study, Creando Posibilidades (Creating Possibilities) we address these gaps by focusing on women of Mexican origin who are college-enrolled and living in the United States. We report on disordered eating and related health risks including alcohol, tobacco use and body mass index collected at baseline. We use ecological momentary assessment (EMA) to capture the prevalence and rates of disordered eating behaviors in the context of their daily activities.
Until fairly recently, the focus of research on disordered eating behaviors has been primarily within the context of the eating disorders of anorexia, bulimia nervosa and binge eating disorder. However, over the last five years, there has been a rapid increase in research that has examined the prevalence, persistence and consequences of subclinical levels of these behaviors. Studies have shown that disordered eating behaviors are prevalent in community based samples of adolescent and young adult females and that these behavioral patterns, once established, tend to be stable across time periods as long as ten years (Neumark-Sztainer, Wall, Story, & Standish, 2012). In addition, disordered eating behaviors are predictive of significant behavioral, emotional and physical health consequences (Crow et al., 2008, Ginty et al., 2012, Goldschmidt et al., 2008, Hay et al., 2012, Mond et al., 2006, Napolitano and Himes, 2011) For example, Project EAT followed two age-cohorts of male and female adolescents (cohort 1 = early adolescents with mean age of 12.8 years and cohort 2 = middle adolescents with mean age of 15.9 years) in a 10 year longitudinal study (see Neumark-Sztainer, Wall, Larson, Eisenberg, & Loth, 2011). At the 5-year follow-up, girls who engaged in unhealthy and extreme weight control behaviors at baseline were more likely to have an increase in BMI compared to those with no behaviors at baseline (Neumark-Sztainer et al., 2006).
Ten-year follow-up results showed significant stability of behaviors with dieting and unhealthy eating behaviors persisting in both the younger and older cohorts and the extreme behaviors persisting for the older cohort girls. In addition, at the 10-year follow-up for both normal weight and overweight females, dieting or disordered eating behaviors at baseline predicted greater increases in BMI (Neumark-Sztainer et al., 2012). Using the same data set, Crow showed that females engaging in extreme weight control behaviors at baseline were more likely to report suicide ideation and suicide attempts at a 5-year follow-up compared to females who were not engaging in those behaviors at baseline (Crow et al., 2008).
Other studies have shown that women who engaged in subclinical levels of disordered eating behavior have significantly blunted cortisol reactivity, attenuated vasodilation, and changes in cardiac output, heart rate and stroke volume in reaction to an acute stressor compared to controls (Ginty et al., 2012) and higher usage of alcohol, tobacco, cocaine, amphetamine and prescription drugs (Piran and Robinson, 2006, Piran and Robinson, 2011). Disordered eating behaviors are a modifiable source of health risk, and understanding the prevalence and patterns of co-occurrence of these behaviors in subpopulations of Latinas is a critical prelude to the development of interventions that target reductions in health risks and health disparities that impact a particularly vulnerable group.
In this study, we focus on college-enrolled MA women for several reasons. First studies have shown that stress contributes to increases in disordered eating behaviors (Ball and Lee, 2000, Epel et al., 2001, Smyth et al., 2007). For young adult women of Mexican origin, the transition to college is a major developmental transition that is particularly stressful due to financial difficulties, role demands, cultural values conflicts, exposure to ethnic biases, discrimination and significant changes in perceived family support (Castillo and Hill, 2004, Niemann, 2000). A recent qualitative study of Mexican American women in academia highlighted the denigrating and marginalizing interactions reflecting exclusion, ascriptions of inferiority and disconnection from their ethnic identity that make the college transition and experience particularly stressful for this population of women (Briscoe, 2012). Second, although patterns of disordered eating and related risk behaviors typically are established earlier in adolescence, evidence suggests that rates increase during the transition to college (Delinsky and Wilson, 2008, Eisenberg et al., 2011, LaBrie et al., 2007, Raffaelli et al., 2007).
The primary purpose of this study, referred to as Creando Posibilidades, is to describe the prevalence and rates of eight disordered eating behaviors including binge eating, self-induced vomiting, diet pill, diuretic and laxative use, restricting, fasting and excessive exercise in young adult college enrolled Mexican American women. In addition, patterns of associations among the disordered eating behaviors and with other health risk factors including alcohol and tobacco use and obesity are examined.
Section snippets
Design
In Creando Posibilidades, a 12-month repeated measures longitudinal design was used to examine the effects of self-cognitions on patterns of disordered eating behavior during the life transition period of college-enrollment in young adult women of Mexican origin. Data was collected at five time points including baseline, 3, 6, 9 and 12 months after enrollment. The project was conducted at two sites, Michigan and Arizona. Data was collected during the period of 2006 to 2011.
Participants
The sample included
Data analysis
We first conducted descriptive statistical analysis. For continuous outcomes, we report the total number of observations, mean and standard deviation, and for categorical outcomes, we report the frequencies. In addition, we examined the data distributions before we employed statistical regression. From this examination, we found that the behavior outcomes were highly skewed with a high number of zeros. To deal with the distributional skewness, we tested several statistical models including the
Participant characteristics
Of the 482 women enrolled in the study, a total of 5 women (Arizona n = 2 and Michigan n = 3) dropped out of the study before completing baseline data collection. In addition, five women completed fewer than 7 days for EMA recordings and their data was also eliminated from the analyses. Therefore, the sample size for the analyses reported in this paper is 472 women. Women enrolled at the Arizona site were significantly younger [M = 19.4 (1.4) years] compared to women enrolled at the Michigan sites [M =
Discussion
Results of this study showed that in a community-based sample of college-enrolled young adult women of Mexican origin recruited based only on ethnicity, gender, age, and college matriculation, disordered eating behaviors were comparable, or for some behaviors slightly lower, than those found in other college enrolled female samples. Furthermore, among those who engaged in the behaviors, significant variability in severity was found with a few women reporting very high frequency of the behaviors
Conclusions
These finding suggest that for Mexican American college-enrolled women, engaging in DE behaviors – even at subclinical levels – is pernicious, and may paradoxically lead to obesity and substance use/problems. Young college women, particularly those who are descended from cultural subgroups that have values and family traditions that influence women's roles in the family and society, as were our sample of primarily first and second generation MA women, may be uniquely vulnerable to developmental
Role of funding sources
Funding for this study was provided by NINR Grant R01NR009691-01A2. NINR had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Example: Authors Stein, Corte, and Keller designed the study and wrote the protocol. Authors Stein, Chen and Corte were involved in data analysis and interpretation. Author Stein wrote the first draft of the manuscript and all authors contributed to the writing and editing of the final manuscript and have approved the final manuscript for submission.
Conflict of interest
There are no conflicts of interest to report.
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