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Objective: Limited research incorporates an intersectional approach when evaluating disordered eating behaviors among those holding minoritized social positions, such as lesbian, gay, bisexual, queer, questioning, and/or transgender/gender diverse (LGBTQ) adolescents. The current study assessed stigma experiences from peers at school, self‐esteem, LGBTQ pride, and overlapping social positions as they relate to disordered eating behaviors among LGBTQ adolescents. Method: Participants included 11,083 adolescents (Mage = 15.6, SD = 1.3; 34.8% transgender/gender diverse) from a large national survey study of LGBTQ adolescents from 2017. Exhaustive Chi‐square Automatic Interaction Detection analysis was used to identify bias‐based bullying experiences (i.e., weight‐based, identity‐based), self‐esteem, LGBTQ pride, and overlapping social positions (i.e., gender identity, sexual identity, race/ethnicity, body mass index (BMI) percentile) associated with the highest prevalence of unhealthy weight control behaviors, extreme unhealthy weight control behaviors, and past year binge eating. Results: Adolescents in the 28 identified groups with a high prevalence of disordered eating behavior held at least one structurally marginalized social position (e.g., high BMI), bias‐based bullying experience, low self‐esteem, or low LGBTQ pride in addition to being LGBTQ. Weight‐based bullying was a salient risk‐factor for disordered eating across social positions. Among adolescents with the same social positions, levels of self‐esteem, LGBTQ pride, but no bias‐based bullying experience, prevalence estimates of disordered eating were, on average, 23% lower. Discussion: LGBTQ adolescents with multiple marginalized social positions and related factors engage in disproportionately high prevalence disordered eating. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents. Public significance: Multiply marginalized LGBTQ adolescents, most of whom also reported experiencing bias‐based bullying from peers at school, reported disproportionately high prevalence disordered eating. In comparison groups of adolescents with no bias‐based bullying experience, prevalence of disordered eating was, on average, 24% lower. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents. [ABSTRACT FROM AUTHOR]

Objective: Digital technology use and muscle‐building behaviors reflect a wide range of behaviors with associated health risks. However, links between digital technology use and muscle‐building behaviors remain unknown and this study aimed to address this gap. Method: Data were collected from a diverse sample of 1,483 young adults (mean age 22.2 ± 2.0 years) participating in the population‐based Eating and Activity over Time 2018 study. Gender‐stratified‐modified Poisson regression models were used to determine cross‐sectional associations between three types of digital technology use (screen time, social media, weight‐related self‐monitoring apps) and five types of muscle‐building behaviors (changing eating, exercise, protein powders/shakes, pre‐workout drinks, steroids/growth hormone/creatine/amino acids) in young adulthood, adjusted for sociodemographic characteristics and body mass index. Results: Screen time and social media were either not found to be associated with muscle‐building behaviors or in a few instances, associated with less use of these behaviors (e.g., screen time and pre‐workout drinks in men). In contrast, the use of weight‐related self‐monitoring apps was positively associated with all muscle‐building behaviors, including steroids/growth hormone/creatine/amino acids in men (prevalence ratio [PR] = 1.83; 95% confidence interval [CI]: 1.13–2.97) and women (PR = 4.43; 95% CI: 1.68–11.68). Discussion: While most recreational screen time may represent sedentary behaviors not related to muscle‐building behaviors, weight‐related self‐monitoring apps are highly associated with more muscle‐building behaviors and could be a future target for interventions to discourage the use of steroids and other harmful muscle‐building substances. [ABSTRACT FROM AUTHOR]

Objective: This study assessed cross‐sectional and longitudinal relationships between weight teasing and disordered eating in an ethnically/racially and socioeconomically diverse sample of young people and examined these relationships across sociodemographic characteristics. Method: The EAT 2010–2018 study surveyed adolescents (n = 1,534) in the Minneapolis/St. Paul public schools (mean age = 14.4 years) and 8 years later (mean age = 22.2 years). Results: Weight teasing was prevalent in adolescence (34.1%) and young adulthood (41.5%). In analyses adjusted for sociodemographic characteristics and body mass index, weight teasing was cross‐sectionally associated with a higher prevalence of all disordered eating behaviors during both adolescence and young adulthood. For example, 64.5% of young adults who reported being teased about their weight engaged in unhealthy weight control behaviors, compared with 47.9% among those not teased (p <.001). There were fewer observed associations in longitudinal analyses, although weight teasing still predicted prevalent overeating and both prevalent and incident dieting (incident dieting—teased: 48.4% vs. not teased: 38.0%, p =.016). Weight teasing and disordered eating were more prevalent among Black, Indigenous, and People of Color (BIPOC) young people and those from low socioeconomic backgrounds, and the relationship between weight teasing and disordered eating was similar across ethnic/racial, socioeconomic, and gender demographic groups. Discussion: Results indicate that weight teasing is strongly correlated with disordered eating in both adolescence and young adulthood regardless of ethnicity/race, socioeconomic status, or gender. Finding suggest that future research and policy interventions should address weight stigma and prioritize the needs of BIPOC young people and young people from low socioeconomic backgrounds. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to describe the experience of, and factors associated with, disordered eating in a population‐based sample of emerging adults during the COVID‐19 outbreak. Method: Participants in the EAT 2010–2018 (Eating and Activity over Time) study were invited to complete the C‐EAT (COVID‐19 EAT) survey in April–May 2020. There were 720 respondents to the survey (age: 24.7 ± 2.0 years). Psychological distress, stress, stress management, financial difficulties, and food insecurity during the COVID‐19 pandemic were examined as cross‐sectional correlates of disordered eating in 2020. Open‐ended questions assessed the perceived impact of the pandemic on eating behaviors. Results: Low stress management was significantly associated with a higher count of extreme unhealthy weight control behaviors (UWCBs). Food insecurity, higher depressive symptoms, and financial difficulties were significantly associated with a higher count of less extreme UWCBs. Higher stress and depressive symptoms were significantly associated with greater odds of binge eating. Six themes pertaining to disordered eating during the pandemic emerged: (a) mindless eating and snacking; (b) increased food consumption; (c) generalized decrease in appetite or dietary intake; (d) eating to cope; (e) pandemic‐related reductions in dietary intake; and (f) re‐emergence or marked increase in eating disorder symptoms. Discussion: Psychological distress, stress management, financial difficulties, and abrupt schedule changes may have contributed to disordered eating during the COVID‐19 pandemic. Interventions that target stress management, depressive symptoms, and financial strain and provide tools to develop a routine may be particularly effective for emerging adults at risk of developing disordered eating during public health crises. [ABSTRACT FROM AUTHOR]

Objective: Sociocultural theories hold that family and peer weight‐related teasing increases the risk for unhealthy weight control behaviors (UWCBs) by negatively impacting body image. Although much cross‐sectional support exists for these pathways, longitudinal data are lacking. This study tested the longitudinal relationships among peer and family teasing (occurrence and perceived impact) in early adolescence, body satisfaction in late adolescence, and UWCBs in young adulthood among a racially/ethnically and socioeconomically diverse population. Method: Data were drawn from three waves of Project EAT over a 15‐year period (Eating and Activity in Teens and Young Adults), and included responses from 1,902 young adults (57% female). Results: Among female participants, a mediated indirect pathway emerged with family weight‐related teasing predicting increased engagement in UWCBs in early adulthood via poorer body image in late adolescence. In contrast, peer teasing did not predict body image or UWCBs. Among boys, the mediated indirect pathways were not significant. However, poor body image in late adolescent males predicted higher likelihood of engaging in UCWBs in early adulthood. Discussion: These findings support the long‐term impact of family weight‐related teasing on greater risk for UWCBs among girls and young women, and poor body image as a mechanism accounting for this relationship. Moreover, the results highlight the poor body image among adolescent boys as a factor for increased risk of engaging in UWCBs in early adulthood. Pending replication in current cohorts, health promotion and prevention involving family members of early adolescents that address family weight teasing and body image are needed. [ABSTRACT FROM AUTHOR]

Background: This study explores cross‐sectional associations between yoga and body image, mindful eating, disordered eating, and muscle‐enhancing behaviors among a population‐based sample of ethnically/racially diverse emerging adults. Method: An ethnically/racially diverse population‐based sample of 1,568 emerging adults (18–26 years) completed surveys as part of EAT 2010–2018 (Eating and Activity over Time). Models were adjusted for sociodemographic characteristics and body mass index (BMI). Results: Practicing yoga at least 30 min/week was reported by 12.7% (n = 210) of the sample. Yoga practitioners had higher levels of mindful eating than those not practicing yoga. Although effect sizes were small, yoga practitioners were more likely than non‐yoga practitioners to use steroids (3.8 vs. 0.7%, p <.001, h = 0.22) or protein powder/shakes (35.1 vs. 25.3%, p <.010, h = 0.21) to increase their muscle size/tone. Body satisfaction, unhealthy weight control behaviors, and binge eating tended to be similar among yoga practitioners and non‐yoga practitioners. There was a significant interaction between BMI and yoga in predicting body satisfaction with a trend toward a positive impact among yoga practitioners at higher BMI values. Interactions between yoga practice and all body image attitudes and behaviors across gender and ethnicity/race were not statistically significant. Discussion: Young people from diverse ethnic/racial backgrounds who practice yoga are more likely to engage in mindful eating but have equal or elevated levels of unhealthy body image attitudes and behaviors as compared to non‐yoga practitioners. Further research should explore how yoga is best taught and practiced to ensure that it is beneficial for body image and related behaviors. [ABSTRACT FROM AUTHOR]

CONTEXT: Transgender and gender‐diverse youth experience significant health disparities across numerous domains of health, including sexual health. Among general populations, parent connectedness has been strongly associated with youth sexual health. METHODS: The relationships between parent connectedness and sexual health indicators were investigated among 2,168 transgender and gender‐diverse youth who participated in the 2016 Minnesota Student Survey, a statewide population‐based survey of ninth‐ and 11th‐grade students. Multivariate logistic regression models, stratified by sex assigned at birth, tested associations between parent connectedness—youth's perceptions of parent caring and parent–youth communication—and eight sexual health indicators: ever having had sex, having multiple sexual partners in the past year, pregnancy involvement, substance use at last sex, partner communication about STI prevention, partner communication about pregnancy prevention, condom use at last sex and pregnancy prevention methods at last sex. RESULTS: The level of parent connectedness was inversely associated with ever having had sex, regardless of sex assigned at birth (odds ratios, 0.6–0.8). Although level of connectedness was inversely associated with having multiple sexual partners in the past year and pregnancy involvement among transgender and gender‐diverse youth assigned male at birth (0.6–0.7), these relationships were nonsignificant among transgender and gender‐diverse youth assigned female at birth. Further differences in associations between parent connectedness and four sexual risk–reduction behaviors were found between youth assigned male at birth and those assigned female. CONCLUSIONS: As with other populations, parent connectedness promotes sexual health among transgender and gender‐diverse youth and may provide a point of intervention. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the current study was threefold: (a) compare rates of self‐reported anorexia nervosa (AN), self‐reported bulimia nervosa (BN), and eating pathology‐specific academic impairment (EAI) by gender identity (cisgender men, cisgender women, transgender or genderqueer) and sexual orientation (gay or lesbian, bisexual, unsure, other), (b) examine associations between gender identity, sexual orientation, and eating outcomes, and (c) identify for whom rates of eating disorder diagnosis and impairment is greatest. Method: The study includes a sample of Minnesota students (n = 13,906) who participated in the College Student Health Survey from 2015 to 2018. Chi‐square tests with bootstrapping examined differences in eating pathology rates between groups. Adjusted logistic regressions tested the association between gender identity, sexual orientation, and self‐reported eating outcomes. Results: Chi‐square results revealed heightened rates of self‐reported AN, self‐reported BN, and EAI in cisgender women, transgender or genderqueer, and sexual minority (e.g., lesbian or bisexual) students. Logistic regression analyses in cisgender men and cisgender women revealed higher odds of self‐reported AN, self‐reported BN, and EAI in sexual minority students relative their heterosexual peers. Chi‐square analyses indicated that bisexual cisgender women reported heightened rates of all three eating pathology measures relative to other sexual and/or gender (e.g., transgender) minority students. Discussion: Individuals with marginalized gender and/or sexual orientation identities report heightened rates of eating pathology, with cisgender bisexual women reporting the poorest outcomes relative to individuals from other marginalized identities. Preventive efforts and more research are needed to understand the mechanisms driving this disparity and to reduce prevalence among marginalized groups. [ABSTRACT FROM AUTHOR]

Purpose: Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations. Methods: Data come from a statewide school‐based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments. Findings: Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students. Conclusions: Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine the relative importance of dissatisfaction, overvaluation, and preoccupation with body weight and shape in predicting increases in disordered eating behaviors and depressive symptoms from adolescence through to early adulthood. Method: The study involved 1,830 participants (60% female) who completed the Project EAT survey during adolescence (mean age = 14.90 years, SD = 1.65 years) and again, 15 years later, in early adulthood. Participants provided assessments of dissatisfaction, overvaluation and preoccupation with weight and shape, as well as disordered eating and depressive symptoms at both time points. Results: The three aspects of body image had distinct patterns of association with the outcomes both concurrently and longitudinally. Dissatisfaction predicted depressive symptoms as well as a wide range of disordered eating outcomes, including dieting, unhealthy weight control behaviors (UWCBs), and binge eating, particularly in female participants. Preoccupation was associated with all of these disordered eating behaviors (but not with depressive symptoms) and was notably the strongest predictor of dieting and UWCBs in female participants. Overvaluation was associated with both disordered eating and depressive symptoms, although typically was a less potent predictor of difficulties than the other aspects of body image. Discussion Dissatisfaction, overvaluation, and preoccupation are related but make distinct contributions to clinically significant outcomes. Models of eating disorders should move beyond focusing exclusively on dissatisfaction or overvaluation toward a broader conceptualisation of body image. Findings from this study particularly suggest the importance of considering preoccupation with weight and shape. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Sexual minority young people have demonstrated higher rates of emotional distress and suicidality in comparison to heterosexual peers. Research to date has not examined trends in these disparities, specifically, whether there have been disparity reductions or increases and how outcomes have differed over time by sex and sexual orientation group. METHODS: Minnesota Student Survey data, collected from 9th and 12th graders in 3 cohorts (1998, 2004, 2010) were used to examine emotional distress and suicidality rates. Logistic regression analyses were completed to examine outcome changes over time within and across sexual orientation/sex groups. RESULTS: With few exceptions, sexual minority youth are at increased risk of endorsing emotional distress and suicidality indicators in each surveyed year between 1998 and 2010. Young people with both‐sex partners reported more emotional distress across all health indicators compared to their opposite‐sex partnered peers. With a few exceptions, gaps in disparities between heterosexual and sexual minority have not changed from 2004 to 2010. CONCLUSIONS: Disparities in emotional health persist among youth. Research is needed to advance understanding of mental health disparities, with consideration of sexual orientation differences and contextualized to sociocultural status and changes over time. Personalized prevention strategies are needed to promote adolescent mental health. [ABSTRACT FROM AUTHOR]

We examined the variations of adolescent health status and risk involvement- prevalence of mental health disabilities, chronic health conditions, substance use, and exposure to tobacco-between 6 family structures in a school-based sample of Latino, Somali, Hmong, and White students and whether ethnicity moderated these associations. Data were collected from the 2013 Minnesota Student Survey, comprising a sample of 29,345 from 8th, 9th, and 11th grades. Logistic regression investigated relationships between family structure and health variables. Adolescents in nuclear families reported better health outcomes in most models; odds of mental disabilities were 1.64 for single parent and 2.45 for other family structures. Significant effect modification was noted for all health outcomes; extended families were consistently protective for Hmong youth and offered some protection for Latino and Somali youth. Policies and programs that support parents and guardians are essential, and may be especially beneficial for ethnic minority youth in single-parent, grandparent-only, and other family structures. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Peer harassment can have serious implications for students' success and well-being, and prevention programs need to consider the school context. This study aimed to: (1) identify groups of similar schools based on their risk and protective factors and demographic characteristics and (2) examine associations between school profiles and students' bullying involvement. METHODS Data came from 505 schools and 122,106 students who completed the 2013 Minnesota Student Survey. School-level risk and protective factors and demographic characteristics were included in a latent profile analysis ( LPA) to identify profiles of schools. Multilevel logistic regression was used to assess associations between school profiles and peer harassment. RESULTS Six qualitatively different school profiles were identified. Unadjusted models showed that schools with higher levels of risk had greater odds of peer harassment. However, after controlling for student-level risk and protection, regardless of school-level risk, students in metro-area schools with a more diverse student body reported lower odds of bullying involvement. CONCLUSIONS These findings highlight the importance of the social environment into peer harassment. In addition to addressing student-level risk and protection, larger community factors and norms also need to be taken into account for developing, selecting, and implementing the most effective approaches to bullying prevention. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Gay-Straight Alliances ( GSAs) are school-based clubs that can contribute to a healthy school climate for lesbian, gay, bisexual, transgender, and questioning ( LGBTQ) youth. While positive associations between health behaviors and GSAs have been documented, less is known about how youth perceive GSAs. METHODS A total of 58 LGBTQ youth (14-19 years old) mentioned GSAs during go-along interviews in 3 states/provinces in North America. These 446 comments about GSAs were thematically coded and organized using Atlas.ti software by a multidisciplinary research team. RESULTS A total of 3 themes describe youth-perceived attributes of GSAs. First, youth identified GSAs as an opportunity to be members of a community, evidenced by their sense of emotional connection, support and belonging, opportunities for leadership, and fulfillment of needs. Second, GSAs served as a gateway to resources outside of the GSA, such as supportive adults and informal social locations. Third, GSAs represented safety. CONCLUSIONS GSAs positively influence the physical, social, emotional, and academic well-being of LGBTQ young people and their allies. School administrators and staff are positioned to advocate for comprehensive GSAs. Study findings offer insights about the mechanisms by which GSAs benefit youth health and well-being. [ABSTRACT FROM AUTHOR]

Objective: Examine relationships between weight-related factors and weight status, body dissatisfaction, chronic health conditions, and quality of life across sexual orientation and gender.Methods: Two- and four-year college students participated in the College Student Health Survey (n = 28,703; 2009-2013). Risk differences were calculated to estimate relationships between behavioral profiles and weight status, body satisfaction, diagnosis of a chronic condition, and quality of life, stratified by gender and sexual orientation. Four behavioral profiles, characterized as "healthier eating habits, more physically active," "healthier eating habits," "moderate eating habits," and "unhealthy weight control," were utilized based on latent class analyses, estimated from nine weight-related behavioral survey items.Results: Sexual orientation differences in weight and quality of life were identified. For example, sexual minority groups reported significantly poorer quality of life than their heterosexual counterparts (females: 22.5%-38.6% (sexual minority) vs. 19.8% (heterosexual); males: 14.3%-26.7% (sexual minority) vs. 11.8% (heterosexual)). Compared with the "healthier eating habits, more physically active" profile, the "unhealthy weight control" profile was associated with obesity, poor body satisfaction, and poor quality of life in multiple gender/sexual orientation subgroups.Conclusions: Interventions are needed to address obesity, body dissatisfaction, and poor quality of life among sexual minority college students. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective This study provides updated information regarding the prevalence and characteristics of weight stigma in popular adolescent television programming, using a sample of favorite shows named by diverse adolescents. Method Participants in a large, population-based study of Minnesota adolescents ( N = 2,793, mean age = 14.4) listed their top three favorite television shows. A coding instrument was developed to analyze randomly selected episodes from the most popular 10 programs. Weight-stigmatizing incidents were compared across television show characteristics and characters' gender and weight status. Results Half (50%) of the 30 episodes analyzed contained at least one weight-stigmatizing incident. Both youth- and adult-targeted shows contained weight-stigmatizing comments, but the percent of these comments was much higher for youth-targeted (55.6%) than general audience-targeted shows (8.3%). Male characters were more likely than females to engage in (72.7% vs. 27.3%), and be the targets of, weight stigma (63.6% vs. 36.4%), and there was no difference in the amount of weight stigmatizing directed at average weight females compared to overweight females. Targets of these instances showed a negative response in only about one-third of cases, but audience laughter followed 40.9% of cases. Discussion The portrayal of weight stigmatization on popular television shows-including targeting women of average weight-sends signals to adolescents about the wide acceptability of this behavior and the expected response, which may be harmful. Prevention of weight stigmatization should take a multi-faceted approach and include the media. Future research should explore the impact that weight-related stigma in television content has on viewers. © 2014 Wiley Periodicals, (Inc. Int J Eat Disord 2015; 48:759-766) [ABSTRACT FROM AUTHOR]

Using the National Longitudinal Study of Adolescent to Adult Health and multilevel modeling, this study investigates the role high school social contexts play in the development of adolescents' weight-loss behaviors and overweight self-perceptions. Overall, the results indicate that there is an important association between adolescents' weight-loss behaviors and self-perceptions of overweight and the weight-related context of their school. For example, both adolescent boys and girls are less likely to engage in weight-loss behaviors when overweight is prevalent among their same-sex schoolmates. However, gender differences are also found. For example, while adolescent boys' self-perceptions of overweight are significantly associated with their same-sex schoolmates' characteristics and behaviors, this is not the case for adolescent girls. Overall, these findings suggest that meso-level social contexts-such as schools-may be particularly important to how individuals incorporate macro-level beliefs or values-such as gendered body ideals-into their own behaviors and self-concepts. [ABSTRACT FROM AUTHOR]