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Eating attitudes in ethnic minority adolescents : sociocultural and psychological correlates Bhimani, Farah 2001

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E A T I N G A T T I T U D E S I N E T H N I C M I N O R I T Y A D O L E S C E N T S : S O C I O C U L T U R A L A N D P S Y C H O L O G I C A L C O R R E L A T E S by F A R A H B H I M A N I B . S c , M c G i l l University, 1996 A T H E S I S S U B M I T T E D I N P A R T I A L F U L F I L L M E N T O F T H E R E Q U I R E M E N T S F O R T H E D E G R E E O F M A S T E R O F A R T S i n T H E F A C U L T Y O F G R A D U A T E S T U D I E S Faculty o f Educat ion ; Department o f Educational and Counsel l ing Psychology, and Special Educat ion; School Psychology W e accept this thesis as conforming to the required standard T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A August , 2001 © Farah B h i m a n i , 2001 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of JSHucteh'amf <W (Tbofij<r///j^ /h/tt/e/ogcf, fyxfr/ The University of British Columbia Vancouver, Canada DE-6 (2/88) Abstract Hi ther incidences o f eating disorders and related pathology are reported in Caucas ian-European adolescent girls as compared to adolescent boys or individuals f r o m other ethnic populations ( O s v o l d & S o d o w s k y , 1993). Consequently, research has principal ly uti l ized European-Caucasian girls to develop the current understanding of eating pathology in adolescent populations (Striegel-Moore & Smolak, 2000). T h u s , our knowledge of the characteristics and correlates of eating pathology is l imited to this exclusive population. T o alleviate this shortcoming, recent literature has assessed eating pathology among European-Caucasian adolescent boys, as well as adolescent girls and boys across various ethnic populations (Crago, Shisslak, & Estes, 1996; D o l a n , 1991). Unfortunately, despite this increase in empirical attention, the understanding of eating pathology among ethnic minority adolescents l i v i n g among a European-Caucasian majority population remains l imited. Specifical ly , the intention of this study was to expanded our understanding of the relations among eating attitudes and sociocultural attitudes towards appearance, acculturation, depression, self-esteem, self-consciousness and adolescent egocentrism in a sample of ethnic minority adolescent girls and boys. T h i s study also expanded current literature across Results f o u n d no overall significant difference in eating pathology between minori ty adolescent girls and boys. A l t h o u g h , adolescent girls reported a desire for overall weight loss and adolescent boys desired overall weight gain. In addition, adolescent girls, as compared to boys, were less l ikely to exercise or describe the f o o d their family eats as healthy. Results further indicated that girls are less aware o f western sociocultural attitudes towards appearance and were more l ikely than to acculturate to the western culture as compared to adolescent boys. ii Correlational analysis for adolescent girls and boys revealed several significant relations among eating pathology and many of the sociocultural and psychological variables examined in this study. Nevertheless, when entered into a simultaneous regression analysis a single significant predictor was found with for each gender. Public self-consciousness was found to be the only predictor of eating pathology for adolescent girls and private self-consciousness was found to be the only significant predictor of eating pathology in adolescent boys . Overal l results support the importance of self-consciousness as a risk factor in the development of eating pathology among ethnic minority adolescent girls and boys. iii T a b l e of Contents Abstract i i L is t of Tables v i i Introduction 1 O v e r v i e w 1 Def ini t ion of T e r m s and Prevalence Rates 2 C l i n i c a l Eat ing Pathology 2 Subclinical Eat ing Pathology 6 Adolescence and Eat ing Pathology: A Developmental F r a m e w o r k 7 Eat ing Pathology in Ethnic M i n o r i t y Populations 8 R i s k Factors in the Development of Eat ing Pathology 12 R i s k Factor M o d e l of Ea t ing Pathology 14 Sociocultural Beliefs 16 Acculturation 21 Psychological Correlates of Eat ing Pathology : 23 Depression 23 Self -Esteem 25 Adolescent Egocentr ism and Self-Consciousness 27 Statement of P r o b l e m 30 Preliminary Hypotheses and Rationale 32 Primary Research Question 35 M e t h o d 36 Participants 36 Procedures 40 Recruitment of Participants 40 D a t a Col lec t ion 41 Measures 43 Demographic Questionnaire 44 B o d y M a s s Index 44 Eat ing Attitudes Test - 2 6 44 Sociocultural Attitudes Towards Appearance Questionnaire 46 Aberystwyth Acculturation Scale 47 Reynolds Adolescent Depression Scale 48 Rosenberg Self -Esteem Scale 49 T h e Revised Self-Consciousness Scale 50 Imaginary A u d i e n c e Scale 51 Results 54 Initial Analyses 54 Gender Differences in Eat ing Pathology, Sociocultural Variables , Psychological W e l l B e i n g , and Social Cogni t ion 56 Gender Differences in Eat ing Attitudes and Related Behaviours 56 iv Gender Differences in Sociocultural Attitudes T o w a r d Appearance and Acculturation 60 Gender Differences in Depression and Self -Esteem 61 Gender Differences in Dimensions of Self-Consciousness and Adolescent Egocentr ism 62 Relations A m o n g Eat ing Attitudes, Sociocultural Attitudes Towards Appearance, Depression, Self -Esteem, Self-Consciousness , and Adolescent Egocentr ism 64 Intercorrelations A m o n g Variables for Adolescent G i r l s 64 Intercorrelations A m o n g Variables for Adolescent B o y s 64 Similarities and Differences across Gender 64 M u l t i p l e Regression A n a l y s i s ...68 Predictors of Eat ing Attitudes in Adolescent G i r l s 68 Predictors of Eat ing Attitudes in Adolescent B o y s 69 Summary and Conclusions 70 Discussion 72 Ov e rvi ew 72 Eating Attitudes and Eat ing Related Behaviours in Adolescent G i r l s and B o y s 73 Sociocultural Considerations in Adolescent G i r l s and B o y s 75 Gender differences in Depression and Self -Esteem 77 Gender differences in Self-Consciousness and Adolescent Egocentr ism 78 Correlations and Predictors of Eat ing Attitudes in Adolescent G i r l s 79 Correlations and Predictors of Eat ing Attitudes in Adolescent B o y s 81 Implications of results 83 Theoretical Implications 84 Implications for Research 85 A p p l i e d Implications 86 Strengths of study 87 Theoretical D e s i g n 87 M e t h o d o l o g y 88 Limitations of study 88 D e s i g n 88 M e t h o d o l o g y 90 Participants 90 Measures 91 External V a l i d i t y 92 Statistical A n a l y s i s 93 Directions for future research 93 S u m m a r y . . . . .94 References 97 A p p e n d i x A : D S M - I V Criteria for A n o r e x i a Nervosa 112 v A p p e n d i x B : D S M T V Criteria for B u l i m i a Nervosa 113 A p p e n d i x C : Student Recruitment Letter . 114 A p p e n d i x D : Guardian Consent F o r m 116 A p p e n d i x E : Student Assent F o r m 120 A p p e n d i x F : Research Assistant's Instructions for Administrat ion 123 A p p e n d i x G : Def ini t ion of T e r m s 126 A p p e n d i x H : R e c o r d Sheet 128 A p p e n d i x I: Questionnaire C o v e r Page 130 A p p e n d i x J : Demographic Questionnaire 132 A p p e n d i x K : T h e Eat ing Attitudes Test -26 . . .137 A p p e n d i x L : Sociocultural Attitudes Towards Appearance Questionnaire -Orig inal 139 A p p e n d i x M : Sociocultural Attitudes Towards Appearance Questionnaire - A d j u s t e d G i r l s V e r s i o n 140 A p p e n d i x N : Sociocultural Attitudes Towards Appearance Questionnaire - A d j u s t e d B o y s V e r s i o n 142 A p p e n d i x O : Aberystwyth Acculturation Scale - O r i g i n a l 144 A p p e n d i x P: Aberystwyth Acculturation Scale (Adjusted) 145 A p p e n d i x Q : T h e Rosenberg Self -Esteem Scale 148 A p p e n d i x R : R e v i s e d Self-Consciousness Scale 150 A p p e n d i x S: T h e Imaginary A u d i e n c e Scale 152 A p p e n d i x T : S u m m a r y o f 2 (Ethnicity) x 2 (Gender) Analys is of Variance 155 A p p e n d i x U : Simultaneous Regression A n a l y s i s of Eat ing Pathology: Ethnici ty Considered for Adolescent G i r l s and B o y s 156 vi L i s t o f Tables and Figures Table 1. Descriptive Characteristics o f Participants 38 Table 2. Gender Comparisons o f Ea t ing Related Behaviours 59 Table 3. Gender Comparisons o f Sociocultural Variables 61 Table 4. Gender Comparisons o f Depression and Self -Esteem 62 Table 5. Gender Comparisons o f Sociocultural and Psychological Var iables . . 63 Table 6. Intercorrelations A m o n g Eat ing Attitudes, Sociocultural, and Psychological Variables for Gir ls 66 Table 7. Intercorrelations A m o n g Eat ing Attitudes, Sociocultural, and Psychological Variables for B o y s 67 Table 8. Simultaneous Regression Analys is o f Eat ing Pathology in G i r l s 69 Table 9. Simultaneous Regression Analys is o f Eat ing Pathology in B o y s 70 Figure 1: R i s k Factor M o d e l o f Eat ing Pathology 15 vii 1 Introduction O v e r v i e w O v e r the years, many western industrialized countries have become the permanent residences for immigrants f r o m across the globe. T h e once homogeneous population of countries such as Canada , E n g l a n d and the U n i t e d States are now a mosaic of ethnic and cultural groups. T h e immigration o f minority populations to westernized countries such as C a n a d a has exposed them to the ideals, attitudes and behaviours of the majority European-Caucasian culture. T h i s has consequently lead to the creation of unique populations whose characteristics vary f r o m members of the majority population, as well as f r o m people in their countries of origin (Keats, 1996). Despite the sociocultural repercussions of their immigration to western countries, little is understood about the changing needs of these ethnic minority populations. O f particular interest for this study are the psychological correlates of eating pathology among ethnic minority adolescents in western Canada . In westernized countries, schools above all other environments, provide a range o f exposure to a variety o f sociocultural characteristics. T h i s increases the vulnerability of sociocultural change in school-aged minority populations (Harris & K u b a , 1997). T h e impact of this exposure on ethnic minority adolescents' cultural beliefs about appearance is of particular interest in understanding the development of eating pathology among these populations ( A k a n & G r i l o , 1995). A t present, little is understood about the development of eating pathology in minority adolescents, however they are generally considered to be at a lower risk for the development of eating pathology when compared with their European-Caucasian counterparts (Crago, Shisslak, & Estes, 1996; D o l a n , 1991). Unfortunately, because current research on eating pathology in minority adolescent populations is l imited, such conclusions m a y be premature and requires further evaluation. 2 T h i s section begins with a description of the cl inical and subclinical characteristics of eating pathology, inc luding their respective prevalence rates. A s the onset of eating and dieting related difficulties often coincide with adolescence, a brief review of developmental characteristics that m a y contribute to the emergence o f eating pathology are delineated. T h i s is fo l lowed by a review of our current understanding of eating pathology among various ethnic minority populations. F o l l o w i n g this, a multidimensional model of the development of eating disorders described by Striegel-Moore and S m o l a k (2000) is presented in order to understand the sociocultural and psychological correlates considered as risk factors in the development of eating pathology among ethnic minority populations. Variables in this model identified to be directly associated with the aetiology of eating pathology, such as the adoption of sociocultural beliefs, depression, and self-esteem are then discussed. A d d i t i o n a l social cognitive characteristics specific to adolescence that are not identified in the model , but m a y contribute to the development of eating pathology, are then addressed. T h i s section concludes with a review of the purpose of this study, including a description of the preliminary and primary research questions, hypotheses and rationale. F inal ly , because research findings of the development of eating pathology differ for adolescent girls and boys, gender differences are noted throughout this section. Def ini t ion of T e r m s and Prevalence Rates Eat ing pathology is a general term used to refer to the acquisition of behaviours associated with eating disorder symptomology including, weight dissatisfaction, dieting, binge eating, f o o d preoccupation, and excessive exercise or other compensatory behaviours ( A l l i s o n , 1995). A cl inical diagnosis of an "eating disorder" is applied when these behaviours increase in severity and frequency as defined b y the Diagnost ic and Statistical M a n u a l - F o u r t h E d i t i o n ( D S M - I V ; A m e r i c a n Psychiatric Associat ion, 1994). C l i n i c a l Eat ing Pathology O n the continuum o f eating pathology, the development o f a specific eating disorder is considered the consequence of extreme pre-occupation with food, excessive exercise or other compensatory behaviours (e.g., laxative use, purging), and body image concerns (Striegel-Moore & Smolak , 2000). These characteristics are reflected in the D S M - I V (American Psychiatric Associat ion, 1994) diagnostic criteria for anorexia nervosa (see A p p e n d i x A ) and b u l i m i a nervosa (see A p p e n d i x B ) , which are the two most c o m m o n subtypes of eating disorders. These disorders differ with regard to the relationship the diagnosed individual has with f o o d ; this is evidenced in their literal translations w h i c h are " lack of appetite" for anorexia nervosa, and "ox appetite" for bul imia nervosa (Blinder & C h a o , 1994). Specif ical ly , anorexia nervosa is diagnosed when the f o l l o w i n g four criteria are met ( D S M - I V ; A m e r i c a n Psychological Associat ion, 1994): A . Refusal to maintain body weight at or above a m i n i m a l l y normal weight for age and height (weighing less than 85% of that expected). B . Intense fears of gaining weight or b e c o m i n g fat even though underweight. C . Disturbance in the w a y in w h i c h one's b o d y weight or shape is experienced, undue influence of b o d y weight on self-evaluation, or denial of the seriousness of the current low b o d y weight. D . In postmenarcheal females, amenorrhea (i.e., the absence o f at least three consecutive menstrual cycles). A diagnosis of b u l i m i a nervosa is applied when the f o l l o w i n g five criteria are met: A . Recurrent episodes o f binge eating. A n episode o f binge eating is characterized b y both of the f o l l o w i n g : a) eating in a discrete period of time (e.g., within any 2-hour period), an amount of f o o d that is definitely larger than most people w o u l d eat during a similar period of time and under similar circumstances, b) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how m u c h one is eating) B . Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomit ing; misuse of laxatives, diuretics, enemas or other medications; fasting or excessive exercise. C . T h e binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for three months. D . Self-evaluation is unduly influenced by body shape and weight. E . T h e disturbance does not occur exclusively during episodes o f A n o r e x i a Nervosa . A n o r e x i a and b u l i m i a nervosa have been described by some sufferers as very addictive and shameful disorders (Haggiag, 2000). A l t h o u g h individuals are often very aware o f the inappropriateness of their behaviours, their obsessive relation with f o o d c o m b i n e d with their drive for thinness and distorted b o d y image, serve as their motivation to perpetuate the disorder. In order to continue this cycle , many refuse support and deny their tendencies in order to continue towards their perceived goal of weight loss (Neiderman, 2000). T h i s stable tolerance of eating disorder symptomology over time m a y lead to serious, long-term physical and mental health problems such as infertility, heart disease, severe malnutrition, depression, and anxiety 5 (Crisp, Callender, H a l e k , & H s u , 1992). A l s o , as many individuals with eating disorders do not seek treatment or support, perpetual starvation may lead to death for individuals with anorexia or b u l i m i a nervosa (Garner & Needleman, 1997). In fact anorexia nervosa has the highest mortality rate of any psychiatric disorder, w h i c h affects approximately 10% of those diagnosed (Crow, Praus, & Thuras , 1999). W i t h i n the last decade, clinicians have reported an increase in the demand for services for individuals with eating and dieting related psychopathology (Hartley, 1996). H o w e v e r , due to the difficulties with diagnostic criteria for adolescents (Bryant -Waugh & L a s k , 1996; Steiner & L o c k , 1998), prevalence rates that accurately reflect the current incidence of anorexia and b u l i m i a nervosa are difficult to ascertain. F o r example, young adolescent girls m a y not meet diagnostic criteria related to amenorrhea (Bryant-Waugh & L a s k , 1996), similarly, adolescent boys may not present with a fear of weight gain (Cohane & Pope, 2001). A l s o , adolescents exhibiting eating pathology m a y not be recognized as underweight because body weight m a y naturally fluctuate during puberty or be impaired due to poor nutrition as a result of the eating disorder (Bryant-Waugh & Lask , 1996). F inal ly , prevalence rates in adolescents are also difficult to ascertain due to the secretive and surreptitious nature of eating disorders (Bryant-W a u g h & L a s k , 1996). Nevertheless, for adolescents the reported prevalence rates o f anorexia nervosa are estimated to be in the range of 0.1-0.2% compared with 1-2% in the adult population (Bryant-W a u g h & L a s k , 1995). Prevalence rates for b u l i m i a nervosa i n adolescents are in the range o f 0.2-1.1% compared with 3-4% of the adult population. Adolescent and adult males account for approximately 5-10% o f all the cases of eating disorders reported and more often meet diagnostic criteria for b u l i m i a nervosa (Bryant -Waugh & Lask , 1995; Steiner & L o c k , 1998; Str iegel -Moore & Smolak, 2000). Interestingly, in Canadian studies, prevalence rates for adolescent girls have been found to be as high as 1% for anorexia nervosa of and 6% for b u l i m i a nervosa (Geist, D a v i s , & H e i n m a a , 1998). Subclinical Eat ing Pathology A s the overall prevalence of eating disorders in adolescent populations is quite low, research has devoted time to understanding the characteristics and attributes of subclinical populations who exhibit elevated levels of eating pathology v ia reports of unhealthy eating behaviours and attitudes similar to those described in cl inical patients (Lask, 2000). A s eating disorders are diagnosed in accordance with the severity o f the symptoms, those individuals exhibiting subclinical ranges of eating and dieting concerns are considered to be at a high risk for developing anorexia or b u l i m i a nervosa (Steiner & L o c k , 1998; Str iegel-Moore & Smolak , 2000). Individuals in subclinical populations therefore, are considered to have similar psychological characteristics when compared with those who are diagnosed with eating disorders (Smolak & L e v i n e , 1996). Hence , m u c h of the available literature describing eating pathology utilizes subclinical and non-cl inical populations. T h e prevalence of subclinical eating pathology among adolescents has been w i d e l y reported. F o r example, Casper and O f f e r (1990) assessed weight and dieting concerns in a sample of 497 adolescents and found that 63% of females and 35% of males were not satisfied with their current weight and 60% of females and 14% males were terrified about gaining weight. In another recent health study conducted by the M c C r e a r y Society o f Bri t ish C o l u m b i a (1999), researchers assessed the overall well being o f 26,000 adolescents in grades 7 to 12 residing in Bri t ish C o l u m b i a . T h e i r results indicated that 41% of girls expressed concern about being overweight and 27% of boys were concerned about being underweight. S imilar ly , i n a 7 recent literature review of b o d y image in adolescent males, Cohane and Pope (2001) concluded that boys frequently wanted to be bigger and more muscular whereas females typically desired thinness. O v e r a l l , the prevalence of subclinical eating pathology among adolescent girls and boys is expansive. Adolescence and Eat ing Pathology: A Developmental Framework D u e to the pervasive nature of eating pathology and the difficulty in treating eating disorders it is important to intervene at the first sign of symptomology, w h i c h most often coincides with adolescence ( W o o d , Waller , & G o w e r s , 1994). Adolescence is considered a time of special risk for the development of psychopathology as it is a period of transition between chi ldhood and adulthood i n v o l v i n g changes in the understanding of oneself, others, and one's environment (Johnson & Roberts, 1999; S m o l a k & L e v i n e , 1996). T h e c o m m o n onset of eating pathology during adolescence is thought to be a result of the unique psychological , cognitive and physical characteristics of this developmental period ( E l k i n d , 1985; Johnson & Roberts ; S m o l a k & Levine) . S m o l a k and L e v i n e explain that accompanying adolescence is a change in the meaning of heterosexual relationships, an increase in the importance of peer acceptance and approval, and the development of adolescent egocentrism. These changes influence the genesis of eating pathology b y increasing the concern adolescents place on themselves and their physical appearance ( M u k a i , 1996). E l k i n d explains that these desires are heightened b y the development o f adolescent egocentrism, w h i c h m a y exacerbate feelings o f insecurity and low self-esteem. A d d i n g further risk to the development of eating pathology in adolescents, particularly for girls, is the onset o f puberty. A plethora o f research has demonstrated that the onset o f puberty and the physical changes that result (e.g., increase in adipose tissue) promotes feelings of body image and weight discontent in adolescents (Smolak & L e v i n e , 1996). T h i s has been 8 shown to be particularly difficult for adolescent girls who mature and develop earlier than their peers ( K o f f & Rierdan, 1993). In adolescent boys , M o o r e (1990) found that although equal numbers of boys believed they were overweight and underweight, the most c o m m o n concern across both groups was having an underdeveloped b o d y shape. In sum, adolescence provides a critical period for understanding the mechanisms that may underly the onset of eating pathology. T h u s , it is important that this population be reviewed when assessing risk factors in the development o f eating pathology among all adolescent populations. Eat ing Pathology in Ethnic M i n o r i t y Populations A n ethnic group, as it relates to the study of psychology, is defined as "any group with c o m m o n cultural traditions and a sense of identity. T h u s , ethnic groups m a y be b o u n d together by a sense of history and tradition, language, geography, a sociological definition of race, or re l ig ion" (Reber, 1995, p. 262). Ethnici ty then, m a y refer to a racial group and/or a culturally similar population. F o r the purpose of this study, ethnic minority groups are identified as any population that does not exclusively identify with a European-Caucasian ethnic heritage. Eat ing disorders have historically been considered a culture-bound phenomenon rooted in westernized sociocultural environments where f o o d is plentiful and physical appearance is valued (Crago, Shisslak, & Estes, 1996; D a v i s & Yager , 1992; Lask , 2000; M u m f o r d , 1993). Countries in w h i c h famine is c o m m o n have almost no cases of anorexia or b u l i m i a nervosa, and obesity is actually considered desirable (Bruch, 1973; L e o n & F i n n , 1984). H o w e v e r , due to the growing ethnic diversity in western countries, ethnic minority populations are exposed to similar sociocultural expectations regarding appearance compared with those in the majority western culture (Dolan , 1991; O s v o l d & S o d o w s k y , 1993). T h e effect these expectations have on the 9 eating and dieting concerns across these minori ty populations l i v i n g within western sociocultural environments is not entirely understood ( V a n ' t H o f , 1994). Consequently, there has been increased empirical interest in assessing the roles of acculturation, as wel l as sociocultural and psychological variables associated with the development of eating pathology, in ethnic minority populations (Chamorro & F l o r e s - O r i z , 2000). W i t h regard to eating pathology, until recently nearly all research had focused on females of European-Caucasian decent ( O s v o l d & S o d o w s k y , 1993). H o w e v e r , the rise in incidence of eating pathology among minority populations has warranted further investigation into the mental health of these populations (Root, 1990). M u c h o f our current understanding among ethnic minority adolescents relies heavily on research assessing ethnic populations residing i n the U n i t e d States (i.e., those of A f r i c a n , H i s p a n i c , A b o r i g i n a l , and Chinese/South East A s i a n decent), or f r o m individuals l i v i n g in countries in the A s i a n subcontinent (e.g., India, C h i n a , Japan). Despite this burgeoning o f empirical attention, research has demonstrated lack o f clarity regarding the characteristic features and prevalence rates of eating pathology among different ethnic minority populations (Crago, Shisslak, & Estes, 1996; D o l a n , 1991; D o r i a n & G a r f i n k e l , 1999). In addition, because no large-scale c o m m u n i t y studies have included sufficient numbers of minority populations, prevalence rates for eating pathology in these populations cannot be accurately ascertained (Pike & W a l s h , 1996). In a recent literature review, Crago , Shisslak, and Estes (1996) assessed the frequency o f eating pathology in ethnic minority groups c o m m o n to the U n i t e d States. T h e y concluded that compared to European-Caucasian females, eating related disturbances were equally as c o m m o n in females o f H i s p a n i c decent, least frequent a m o n g A f r i c a n - A m e r i c a n and A s i a n females, and more c o m m o n in Native A m e r i c a n females. Similar ly , P o w e l and K a h n (1995) found that 10 A f r i c a n - A m e r i c a n w o m e n experienced less pressure to be thin as compared to their European-Caucasian peers. Results indicate that Caucasian w o m e n chose a significantly thinner ideal b o d y size and expressed more concern with weight and dieting than A f r i c a n - A m e r i c a n females. F e w studies exist that have assessed eating pathology among A s i a n s residing in westernized countries. In a study comparing South East A s i a n and European-Caucasian adolescent girls, results indicated higher prevalence of eating pathology in the European-Caucasian than the South East A s i a n adolescent girls (Johnson, L e w i s , L o v e , L e w i s , & Stuckey, 1984). Conversely , a study by Gross and Rosen (1988) found that 14% of South East A s i a n adolescent females compared with 11% of Caucasian females exhibited significant levels of eating pathology. In a comparative study of A f r o - C a r i b b e a n , South A s i a n , and Caucasian w o m e n in Britain, D o l a n , L a c e y , and E v a n s (1990) found South A s i a n w o m e n to have significantly more disordered eating attitudes than Caucasian w o m e n , but no overall difference across all three populations in their concern with their body weight and shape. Conversely , i n a study comparing Bri t ish-Caucasian and South A s i a n females, no significant differences in overall eating pathology were found (Furnham & Patel, 1994). Furthermore, Ratan, G a n d h i , and Palmer (1998) found that South Asians l i v i n g in a small Bri t ish city were significantly less l ikely to exhibit pathological eating behaviours. However , the South A s i a n females who d i d exhibit eating pathology "resembled their n o n - A s i a n counterparts in age and cl inical characteristics" (p. 105). Sjostedt, Schumaker, and Nathawat (1998) compared eating pathology among female and male South A s i a n university students in India to European-Caucasian university students in Austral ia and found significantly higher levels of eating pathology in South A s i a n females compared to the females f r o m Australia . In addition, results indicated no overall difference in 11 eating pathology between both groups o f females and South A s i a n males, whereas Australian males exhibited significantly few symptoms than all others. Unfortunately, l imited research was found assessing eating pathology among minority adolescent boys residing in westernized countries. A s described, eating pathology in ethnic minority female populations demonstrates variable results within and between specific ethnic populations. T h u s , further research evaluating ethnic minority adolescent girls and boys is needed. In a review of the literature, D o l a n (1991) concluded that the diversity within and among ethnic populations demands consideration of individual characteristics of members across ethnic populations. F o r example, the m o r b i d fear of fat characteristic of European-Caucasian individuals with anorexia nervosa has been found to be absent among anorexic patients in H o n g K o n g (Lee, H o , & H s u 1993). H o w e v e r , H s u and L e e (1993) more recently found that as Chinese society adopts western standards for female beauty, Chinese w o m e n in H o n g K o n g acknowledged feeling overweight and demonstrated a fear of b e c o m i n g overweight. T o account for possible diversity within and among ethnic populations, research has attempted to assess the internalization of western sociocultural beliefs and acculturation, w h i c h are addressed later in this review. In the l imited research investigating sociocultural beliefs, acculturation and related psychological correlates in non-western ethnic minority populations, results have varied depending on the ethnic population investigated. D o l a n (1991) has suggested that the variability in the prevalence and symptomology of disordered eating among ethnic groups may be related to the degree to w h i c h an individual in that ethnic group accepts the majority culture's beliefs about appearances, as well as the individual ' s attempt to seek professional support. Similar ly , Crago , Shisslak, and Estes (1996), suggest that additional variables directly related to the status of an 12 ethnic minority within a different cultural majority m a y enhance eating pathology and adversely affect self-esteem a m o n g these populations. F o r example, immigration status, number o f years in host country, religious beliefs, language fluency, exposure to western sociocultural ideals, and, racial or ethnic discrimination, m a y exacerbate the risk of eating pathology in minority populations. A l t h o u g h overall results of this literature support the relation between societal westernization, acculturation and eating pathology (Chamorro & Flores-Ort iz , 2000; L e e & L e e , 2000), little is understood about the role of the other c o m m o n psychological and sociocultural variables in the development of eating pathology among adolescents of minority ethnic backgrounds ( D o l a n , 1991). In order to further our understanding of the development o f eating pathology among minority adolescents, additional research assessing the risk factors and prevalence of eating pathology among these populations is necessary. R i s k Factors in the Development of Eat ing Pathology D u e to the critical and serious nature of eating disorders and its growing prevalence over the past three decades, there has been an expansion of research devoted to understanding the development of eating pathology and identifying its predictive risk factors (Steiner & L o c k , 1998; W o o d , W a l l e r , & G o w e r s , 1994). O f the m y r i a d o f factors that m a y contribute to the development of eating disorders, several areas have consistently demonstrated significant relations with the onset of eating pathology. These include sociocultural beliefs, biological and physiological constitution, and a variety of individual psychological vulnerabilities (Striegel-M o o r e & Smolak , 2000). A c c o r d i n g to a recent review of the literature, Str iegel-Moore and C a c h e l i n (1999) have explained that the aetiology of eating disorders involves a complex interaction among social, 13 cultural, famil ia l , personal, and biological attributes. O f these factors, the contribution o f western sociocultural characteristics has received the most attention due to the higher incidence rates of disordered eating in European-Caucasian females residing in western countries where a thin beauty ideal is valued (Dolan , 1991). Consequently, eating disorders have often been considered a culture b o u n d syndrome (Crago, Shisslak, & Estes, 1996) affecting this homogenous population almost exclusively (Striegel-Moore & Smolak , 1996). T h u s , until recently, m u c h of our knowledge regarding the prevalence and development of eating pathology has come f r o m research in western countries (Crago, Shisslak, & Estes; Dolan) . H o w e v e r , the present heterogeneous ethnic composit ion of many westernized countries has demanded a more comprehensive understanding of the risk factors contributing to the development of eating disorders across all cultural groups. In support of this, many researchers have begun to study the relation of national and ethnic origin with eating pathology (e.g., A b o u - S a l e h , Y o u n i s , & K a r i m , 1998; D a v i s & K a t z m a n , 1999; D o l a n , L a c e y , & Evans , 1990; Jane, Hunter, & L o z z i , 1999). A l t h o u g h recent research has attempted to further our understanding of eating pathology in ethnic minority populations, an understanding o f the relation o f eating pathology with dimensions o f psychological adjustment has been neglected. That is, little is understood about the psychological and sociocultural correlates generally associated with eating pathology, such as the exposure to western sociocultural beliefs, acculturation, depression, self-esteem, and self-consciousness (Phinney, Cantu , & K u r t z , 1997; Siegel , Aneshensel , T a u b , Cantwel l & D r i s c o l l 1998). T h u s , the purpose of this study is to examine specific sociocultural and psychological risk factors associated with eating pathology among European-Caucasian females in a mul t i -ethnic minority sample of adolescent girls and boys. 14 R i s k Factor M o d e l of Eat ing Pathology Str iegel -Moore and S m o l a k (2000) provide a model that considers the way in w h i c h established areas of risk contribute to the development of eating disorders in females across cultural groups (see Figure 1). In reviewing the literature, the authors created this schematic model to represent our current understanding o f the relation of these variables to each other, as well as to the development of eating disorders, as defined by the D S M - I V (American Psychiatric Associa t ion ; 1994). Researchers and clinicians concur that these characteristics taken together provide the best understanding o f risk domains contributing to the development of eating disorders within westernized countries (Fairburn, C o w e n , & Harr ison, 1999; Iancu, Spivak, Ratzoni , Apter , & W e i z m a n , 1994). Str iegel-Moore and S m o l a k (1999) caution that, although their model provides a useful framework on which to continue risk factor research, its validity with use for all ethnic minority populations needs further evaluation. A s our current knowledge of the development of eating disorders is based almost exclusively on European-Caucasian populations, understanding the way in w h i c h this model relates to eating pathology in other female and male minority ethnic populations m a y provide insight into the validity of our application of current theories and diagnostic criteria across cultures. 15 Figure 1. R i s k Factor M o d e l for Ea t ing Pathology A r r o w s indicate significant relations have been found among these variables and boxes shaded in grey identify variables within the domains that have demonstrated a direct relation to heightened eating pathology, or disordered body image (Striegel-Moore & Smolak , p. 235). Sociocultural Context discrimination racial prejudice Sociocultural Context - thin ideal - beauty = success - beauty - femininity Family Context - inadequate parenting - parental psychopathology - physical/sexual abuse Family Context - parental obesity - parental weight concern Self Deficits • ,,• - low self-esteem - poor interoceptive awareness , - social self disturbance Body Image Concerns .'- thin beauty ideal - importance of weight/shape - beliefs aboufattractiveness r- body; image, dissatisfaction BINGE EATING EATING PATHOLOGY - dieting, purging - excessive exercise Constitutional Vulnerability - obesity - early onset menarche (girls) - perfectionism ANOREXIA NERVOSA BULIMIA NERVOSA 16 T h e risk factor model presented b y Str iegel-Moore and S m o l a k (2000) identifies multiple variables within general domains that may contribute to the development of eating disorders. A c c o r d i n g to the model , specific risk factors emerge f r o m an individual ' s sociocultural environment and psychological characteristics. F o r the purpose of this study, emphasis was placed on variables that have demonstrated a direct relation with heightened body image dissatisfaction and weight-control behaviours (the variables of interest are within the domain areas highlighted in grey in Figure 1). Specifical ly , this study assessed the relations of awareness and internalization of western sociocultural beliefs about appearance, acculturation, depressive symptomology and global self-esteem to eating attitudes in adolescent girls and boys. In addition, the relation of self-consciousness and adolescent egocentrism to eating attitudes was assessed in order to consider the relation of unique cognitive developmental characteristics of adolescence to eating attitudes. T o this author's knowledge, analyses of the variables selected in this study had not been previously assessed with respect to eating pathology. That is, specific research assessing this combination of variables across any ethnic adolescent population is unavailable. T h u s , the evaluation of this combination of sociocultural and psychological variables to eating pathology provides a unique contribution to our current understanding of eating attitudes in adolescent girls and boys. Consequently, a review of the research assessing the relations of the individual variables to eating pathology, as described in the model , is presented next. Literature assessing ethnic minority populations is provided within the f o l l o w i n g discussions when available. Sociocultural Beliefs A s evidenced by western society's support of b i l l i o n dollar industries built around weight loss and fitness programs, adults and adolescents are increasingly concerned with their diet, 17 physical health, and appearance (Wolf , 1991). Messages and images offer constant reminders of narrow beliefs about appearance (Levine & Smolak , 1996). F o r example, a recent bil lboard advertisement for a large Canadian fitness chain displayed a cartoon drawing of an alien landing on earth, with the caption reading " W h e n they come, they ' l l take the fat ones first". Y o u n g children and adolescents in western countries, regardless of ethnicity are affected by this constant exposure to very defined sociocultural standards of weight and physical appearance presented in the media (Striegel-Moore & Smolak , 1999). Berzins (1997) reported that young girls are more afraid of b e c o m i n g fat that they are of cancer, a nuclear war, or losing their parents. A s depicted earlier in Figure 1, the influences o f western sociocultural beliefs about physical attractiveness have been found to have a direct relation with feelings of body and weight dissatisfaction (Davis & Yager , 1992). L e v i n e and S m o l a k (1996) explain how media advocates for this ideal of physical appearance b y equating happiness and financial success with physical beauty and exposing the liabilities of unattractiveness. T o assess this theory, L a v i n and C a s h (2000) examined the immediate effects of exposure of information about appearance stereotyping and discrimination on w o m e n ' s body images in a multi-ethnic sample of college w o m e n . Participants either received audiotaped discussions about appearance biases and physical discrimination or about an unrelated media topic on television violence and aggression. L a v i n and C a s h found that w o m e n in the experimental group exposed to appearance related information, compared with those in the control group, produced significantly less favourable body image evaluations, regardless of ethnicity. Popular magazines and T . V . shows also depict a visually homogenous selection o f models , actors, musicians, athletes and other individuals as role models of "success". A l l of these factors contribute to and encourage feelings of physical inadequacy in our youth (Levine & 18 Smolak , 1996). Specif ical ly , western culture's unrealistic expectations of a thin beauty ideal for females, and a muscular ideal for males, have resulted in many adolescents feeling discontented with their bodies (Iancu, Spivak, Ratzoni , Apter , & W e i z m a n , 1994). A c c o r d i n g to L e v i n e and Smolak, (1996), children and adolescents spend more time watching television than any other activity except sleeping as compared to adults, and thus are exposed to large amounts of socially defined images of physical appearance. S imilar ly , Shaw (1995) found that adolescent girls demonstrated greater b o d y dissatisfaction when compared to adult females after v i e w i n g magazine photographs of thin adult fashion models . U s i n g semi-structured interviews, Wertheim, Paxton, Schutz, and M u i r (1997) also assessed w h y female adolescents are motivated to watch their weight. F indings revealed that adolescent girls identified the media portrayal of a thin beauty ideal as the major force in fostering their b o d y image concerns, even when compared with peer and f a m i l y influences. A paucity of research exists that has examined the effects of exposure to western sociocultural environments on the development of eating pathology in ethnic minority samples residing in North A m e r i c a (Furukawa, 1994; L a k e , Staiger, & G l o w i n s k i , 2000; L e e , 1996). However , international cross-cultural research has attempted to assess western sociocultural influences on eating pathology. F o r example, F u r n h a m and A l i b h a i (1983) assessed cross-cultural differences in the perception of female body shapes in a sample of Bri t ish, K e n y a n Brit ish, and K e n y a n A f r i c a n residents. T h e y found that K e n y a n Brit ish w o m e n selected a preference for thinner b o d y types that were more similar to those selected b y the Bri t ish group when compared to their peers in K e n y a , who 's ideal b o d y shape was significantly larger. T h e authors concluded that exposure to Western culture has led individuals in this particular minority sample to reject their o w n cultural values of physical appearance and accept those of the host 19 culture. S imilar ly , using self-report measures, a recent study assessed the prevalence o f eating pathology in Fi j ian female adolescents before and f o l l o w i n g the arrival of Western television programming (Becker, 1999). Results found a significant increase in overall levels of eating pathology such as vomit ing, b o d y dissatisfaction, and dieting in females after the onset of western television exposure. Results also indicated that those girls who watched television at least three nights per week were 50% more l ikely than those who watched less television to identify themselves as fat and 30% more like to diet, despite no differences in B M I between the two populations. Conversely , in a study assessing the sociocultural correlates of eating pathology among South A s i a n female adolescents l i v i n g in Britain, results found that heightened levels of eating pathology were associated in those with a more traditional cultural orientation not with greater levels o f westernization ( M u m f o r d , Whitehouse, & Platts, 1991). T o explain the inconsistency in sociocultural influences on eating pathology, some researchers have explained that the exposure to western beliefs is not entirely predictive of eating pathology. Heinberg , T h o m p s o n , and Stormer (1995), for example, report that there must be the awareness of this exposure to western ideals of physical appearance as well as the internalization of these beliefs as one's o w n values in order for ideals to have adverse consequences upon eating behaviour. T h i s theoretical framework was used in constructing their Sociocultural Attitudes Towards Appearance Questionnaire ( S A T A Q ; Heinberg , T h o m p s o n , & Stormer, 1995). T h e S A T A Q assesses two independent constructs regarding attitudes towards western sociocultural beliefs about physical appearance (see A p p e n d i x L ) . Specif ical ly , H e i n b e r g et al . describes the awareness of sociocultural beliefs as the degree to w h i c h an adolescent is aware of the value and characteristics of physical attractiveness in western society. T h e degree to w h i c h these beliefs 20 and attitudes have been adopted as one's o w n standards and values is a measure o f internalization. Three studies have used the S A T A Q thus far, and have found significant relations between the awareness of sociocultural attitudes towards appearance and the internalization of sociocultural attitudes towards appearance and eating pathology. Griffi ths et al . (1999a) used the S A T A Q to assess the relation between eating pathology and the awareness and internalization of western sociocultural attitudes towards appearance in a sample of female Australian-born Universi ty students. T h e y found significant positive relations between eating pathology and the awareness and internalization of sociocultural beliefs about appearance. H o w e v e r , this relation did depend on the participants' acceptance of western definitions of physical attractiveness. A l s o using the S A T A Q , the relation between eating pathology and the awareness and internalization of sociocultural attitudes towards appearance were assessed in dieting and non-dieting females with eating disorders and those females without eating disorders. Griffi ths et al . (1999b) found that dieting disordered patients internalized social attitudes of appearance more than the n o n -dieting disordered population, however both populations exhibited significantly more awareness of these attitudes than did females without eating disorders. F inal ly , Smolak , L e v i n e , and T h o m p s o n (2001) used the S A T A Q to assess the relation between eating pathology and the awareness and internalization of sociocultural attitudes towards appearance i n a sample o f adolescent girls and boys. T h e i r results f o u n d that the awareness and internalization of sociocultural influences contributed to muscular bui lding techniques in boys and weight control behaviours i n girls, suggesting significant sociocultural influences in eating pathology. S m o l a k et al . also found that adolescent girls reported greater awareness and internalization of sociocultural standards compared to adolescent boys. 21 Disordered eating pathology i n individuals among minori ty populations, i f related to western beliefs about physical appearance, m a y be a consequence of the internalization of western values as their o w n beliefs about physical appearance. Unfortunately, the S A T A Q has not been util ized with an ethnic minority sample of adolescents or adults, so the relation between the awareness and internalization of sociocultural standards among these populations is unknown. A l s o , no other measure has attempted to assess the awareness and internalization of western sociocultural beliefs about appearance, thus little is understood about the relation of these constructs to eating pathology among minority ethnic populations residing in a western majority culture. H o w e v e r , the impact of the westernization of minority populations has been assessed using measures of acculturation examining various aspects of integration and assimilation. A summary of these findings is presented next. Acculturation A c c o r d i n g to Joiner and Kashubeck (1996), acculturation is defined as an "adaptive process of cultural adjustment and adoption of a new culture that begins as the result of contact and interaction between two distinct cultures" (p. 421). Acculturation then, explores the overall influence of immigration, assimilation and integration of a minority ethnic population to a majority culture. Assess ing the process of acculturation extends our understanding o f the influence western culture has on the development of eating pathology in ethnic minority adolescents. A s described recently b y D o y l e and B r y a n t - W a u g h (2000), "cultural changes that bring about an identification with western values m a y be associated with increased rates of eating disorders" (p. 55). Researchers have given recent attention to the process of acculturation and cultural identity in evaluating eating pathology in minority samples. In a review o f the literature, 22 Harris and K u b a (1997) reported a significant relation between ethnocultural identity and eating pathology across cultural populations. These authors suggest that "eating disorders m a y be symptomatic of conflict ing cultural demand for beauty and acceptance (and that) the suppression of these conflict ing demands through internalized oppression m a y result in specific disordered eating symptoms" (p. 341). Similar ly , several other authors have demonstrated that identity confusion resulting f r o m a clash in values between one's o w n culture and that of the host culture as well as the physical separation f r o m one's primary culture, correlates with eating pathology (Furnham & A l i b h a i , 1983; H o l d e n & R o b i n s o n , 1988). Pumariega (1986) assessed the relation of culture to eating pathology in a sample of H i s p a n i c - A m e r i c a n and European-Caucasian adolescent girls. A l t h o u g h no overall differences in eating pathology were found across ethnic groups, a significant correlation between levels of acculturation and eating pathology was identified for the Hispanic girls. That is, Hispanic adolescent girls w h o exhibited characteristics similar to the dominant European-Caucasian culture (i.e., less traditional girls) demonstrated higher levels of eating pathology. In a prospective study, F u r u k a w a (1994) assessed eating pathology i n a sample o f Japanese exchange students before and after they spent one year with a host family in another country. A l t h o u g h students d id not report a greater prevalence of abnormal attitudes towards eating upon returning f r o m their host country, they showed a statistically significant gain in b o d y weight, and a greater number of girls and boys met diagnostic criteria for anorexia and b u l i m i a nervosa after returning f r o m their host country. Acculturative stress was not directly assessed thus gender differences were not reported in this study. G h u m a n (1997) evaluated the acculturation of South A s i a n adolescent girls and boys l i v i n g in E n g l a n d using the Aberystwyth Acculturation Scale. Overal l results indicate that South A s i a n girls reported more favourable 23 attitudes towards acculturation compared to South A s i a n boys. F i n a l l y , i n an assessment of the relation between acculturation and eating pathology, G o w e n , H a y w a r d , K i l l e n , and T h o m a s (1999) found a statistically significant positive relation between acculturation and eating pathology in Hispanic girls, but not in A s i a n or E u r o p e a n - A m e r i c a n girls. Overa l l results of the research assessing acculturation beliefs has found significant relations among acculturation and eating pathology (Epel , Spanakos, K a s l - G o d l e y , & B r o w n e l l , 1996; Furukawa, 1994; L a k e , Staiger, & G l o w i n s k i , 2000). However , due to the inconsistency of these findings across ethnic populations, further research is required. Psychological Correlates of Eat ing Pathology Individuals with eating disorders may exhibit several emotional disturbances and distortions in their psychological well being (Rosen, Gross , & V a r a , 1987), inc luding depression, low self-esteem, and heightened self-consciousness (E lkind , 1985, Str iegel -Moore & Smolak, 1996). Relations between these variables and the development of eating pathology across European-Caucasian populations have been established and are presented in the f o l l o w i n g sections. Research assessing the nature and strength of these relations across gender as well as in minority ethnic populations is presented when available. Depression T h e term 'depression' can be considered as a symptom or a syndrome. Depression as a symptom refers to a m o o d state where one m a y exhibit temporarily feelings of sadness, hopelessness or a loss of self-worth ( H a m m e n & R u d o l p h , 1996). Depression as a syndrome refers to sustained feelings of sadness and unhappiness over a length of time, resulting in a clinical diagnosis (Merrel l , 1994). Research assessing depressive symptomology and cl inical 24 depression in females with eating pathology has consistently demonstrated significant positive relations, although this relation with males is less clear. In a review of gender differences in depressed adolescents, N o l e n - H o e k s e m a and G r i g u s (1994) report that females between the ages of thirteen and fourteen begin to exhibit higher prevalence rates of depression at age fifteen and are twice as l ikely to be depressed when compared to males. Similar ly , Whitaker et al . (1990) reported adolescent girls were significantly more l ikely than adolescent boys to experience major depression, with prevalence rates being 4.5% and 2.9% respectively. Interestingly, prior to adolescence, gender differences in depression are not found, suggesting that the developmental period of adolescence presents a unique opportunity to understand the relation between eating pathology and depression across gender. Results f rom a study investigating 1,084 Caucasian female adolescents in Switzerland, D e v a u d , Jeannin, Narr ing , Ferron, and M i c h a u d (1998) found that adolescents who exhibited high weight and image concerns and problematic eating concerns reported significantly more m o o d problems, suicidal conducts, or violent and aggressive behaviours. In an evaluation o f eating disorder symptomology in male and female depressed outpatients before and after pharmacological treatment, F a v a et al . (1997) found a significant relation between eating disorder symptomology and depression before and after treatment. Interestingly, their findings also indicated that depressed outpatients exhibited significantly lower rates of eating disorder symptomology after receiving treatment for their major depressive disorder, suggesting a l ink between symptoms characteristic of both disorders for females and males. Significant positive relations between incidents of c h i l d h o o d trauma, particularly sexual abuse, and the development of depression and eating pathology have also been reported (de 25 Groot & R o d i n , 1999). M c C a b e and M a r w i t (1993) found a statistically significant correlation between depressive symptomology, as measured by the C h i l d r e n ' s Depression Inventory, and dimensions of attractiveness and b o d y image in prepubescent girls and boys ages 9 through 12. Further stepwise regression analysis f o u n d feelings of b o d y dissatisfaction as the only significant predictor of dysphoria across gender. Similar ly , T o m o r i , and R u s - M a k o v e c (2000) assessed eating behaviour, depression, and self-esteem in high school students and found that b o d y weight dissatisfaction was significantly related to higher levels of depression and lower-self esteem for both females and males. A l t h o u g h ethnic differences in depressed m o o d among adolescents have been recently reported (Siegel, Aneshensel , T a u b , Cantwel l , & D r i s c o l l , 1998), little is understood about the relation of eating pathology and depression in ethnic minority youth. T h u s , further research assessing the relation of eating pathology to depressive sympt omol ogy among minority adolescents is necessary to adequately understand the role of depression in eating disorders. A s individuals exhibiting depressive symptomology are considered at a high risk for the development of eating pathology, depression should consequently be considered a potential risk factor for minority ethnic adolescents. Self -Esteem Self-esteem is generally regarded as an evaluation that an individual makes about them that expresses self-judgement of approval, disapproval, and personal worth ( D e m o & S a v i n -W i l l i a m s , 1992; Rosenberg, 1965). L o w levels of self-esteem have been associated with a variety o f social-emotional and behavioural maladies throughout adolescence ( Z i m m e r m a n , C o p e l a n d , Shope, & D i e l m a n , 1997). In a longitudinal study evaluating predominantly European-Caucasian adolescents, Z i m m e r m a n et al. assessed the development of self-esteem 26 throughout adolescence. F o u r possible developmental trends were established: consistently low, moderate and rising, steadily decreasing, and consistently low. Results of their study found that adolescent girls were significantly more l ikely to be in the steadily decreasing self-esteem group, while adolescent boys were more l ikely to be in the moderate and rising group. These findings are consistent with other data supporting gender differences in self-esteem. F o r example, Ecc les and M i d g l e y (1990) found that females were more l ikely than males to report a decline in self-esteem as a consequence to school transition during adolescence. A negative relation between self-esteem and eating pathology has been demonstrated across a variety of studies (Striegel-Moore & Smolak , 2000). Findings suggest a relation between low self-esteem and a high incidence o f weight and body image concerns (Button, L o a n , Davies , & Sonuga-Barke, 1997), as well as a relation between low self-esteem and eating disorders (Davis & K a t z m a n , 1998). O n e prospective study found that baseline measures of low self-esteem and negative affect significantly predicted problem eating behaviours i n adolescent girls at a three year f o l l o w - u p (Leon, Fulkerson, Perry, & E a r l y - Z a l d , 1995). A c c o r d i n g to Str iegel -Moore and S m o l a k (2000), l imited research has addressed the relation between eating pathology and self-esteem in ethnic minority populations. D a v i s and K a t z m a n (1998) compared eating pathology and self-esteem in Chinese w o m e n and men l i v i n g in the U n i t e d States to those l iv ing in H o n g K o n g . Results indicated a significant negative relation between eating pathology and self-esteem for Chinese females and males f r o m H o n g K o n g and the U . S . H o w e v e r , Chinese females and males l iv ing in H o n g K o n g reported significantly more b o d y and weight dissatisfaction and lower self-esteem than d i d Chinese adults l i v i n g in the U n i t e d States. G i v e n the relation between self-esteem and eating pathology, as 27 depicted previously in Figure 1, it is important to further our understanding of the relation of self-esteem and eating disorders in ethnic minori ty adolescents. Adolescent Egocentr ism and Self-Consciousness A s the onset of eating disorders typically occurs during adolescence, it is important that risk factor research consider developmental characteristics that m a y contribute to eating pathology in this population (Woodside & G a r f i n k e l , 1992). T h u s , an evaluation of the biological , psychological , and cognitive changes that m a y contribute to the development of eating problems during adolescence is necessary (Smolak & L e v i n e , 1996). H o w e v e r , among these changes, the relation of social cognition to eating pathology is the least understood. T h e development of social cognitive thought allows adolescents to think about characteristics i n their social environment as well as their relation with this social environment as a result of the development of formal operational thought, as defined b y Piaget (Lapsley, 1985). T h e exclusion o f this variable i n the risk factor model presented earlier in Figure 1 limits the appropriate assessment of eating pathology in adolescents, and as a result it was assessed in this study. A s children emerge into adolescence and move into Piaget's cognitive stage o f formal operational thought, adolescents develop the ability to think about their o w n thinking as wel l as the thoughts of others ( E l k i n d , 1985). H o w e v e r , in the early stage of formal operational thought development, the adolescent "fai ls to differentiate between the objects toward w h i c h the thoughts o f others are directed and those which are the focus o f his o w n concern" ( E l k i n d , 1967, p. 1029). E l k i n d describes that this inability to differentiate leads many adolescents to believe that others are as concerned with their o w n thoughts, feelings, and behaviour as they are themselves, namely, adolescent egocentrism. A s a result, adolescents develop a heightened self-consciousness, which leads to the belief that they are the objects of other people 's constant 28 attention and evaluation, or playing to an " imaginary audience". In addition, this failure to differentiate their experiences f r o m their reality convinces the adolescent that they must be very special and unique to be receiving such attention, or "personal fable" ( E l k i n d , 1985). Specif ical ly then, imaginary audience is defined as the belief that others in the adolescent's immediate vicinity are as concerned with her/his thoughts and behaviour as she/he is ( E l k i n d & B o w e n , 1979). Personal fable refers to the convict ion that the adolescent is special and unique and immune to the laws that apply to others ( E l k i n d , 1985). E l k i n d (1985) hypothesized that these maladaptive thought patterns m a y be associated with problem behaviours during adolescence. Research that has specifically assessed the relation between imaginary audience and other maladaptive adolescent behaviours have suggested a positive relation between pathology and heightened belief in the imaginary audience. F o r example, in a study assessing egocentrism and contraceptive use, H o l m b e c k , Crossman, Wandrei , and Gasiewski (1994) found a significant negative relation between levels of egocentrism and knowledge about sexuality and contraception. Results also f o u n d that adolescents w h o reported lower scores on the imaginary audience were more l ikely to use contraceptives. Similar ly , Schonert-Reichl (1994) found a positive relation between depressive symptomology and imaginary audience for female adolescents. Interestingly, however, depressive symptomology was not related to imaginary audience beliefs i n adolescent males. F inal ly , in a study of French adolescents, heightened private (inward) and public (outward) self-consciousness were significantly correlated with social anxiety (Mallet & R o d r i g u e z - T o m e , 1999). A l t h o u g h patterns of cognitive development are thought to be consistent across ethnic groups, differences between ethnic groups in the development of the imaginary audience 29 construct were found in a study of Native A m e r i c a n Sioux and Caucasian adolescents (Markstrom & M u l l i s , 1986). In this study, the authors concluded that older Caucasian adolescent have lower overall scores as compared with the Sioux adolescents in established, as compared to transient, beliefs in the imaginary audience Scale. Consequently , adolescents across all ethnic groups m a y not have similar experiences with beliefs in the imaginary audience and should be further explored. Adolescent egocentrism m a y also contribute to our understanding of the development of eating pathology in adolescents. A l t h o u g h the relation between belief in the imaginary audience and eating pathology has not been examined empirically , E l k i n d (1985) theorized that heightened awareness of one's place in their social environment results in an inflated self-consciousness, w h i c h may explain the development of eating pathology during adolescence. Specif ical ly , E l k i n d (1985) stated that "the obese adolescent and the anorexic are very concerned about the impression they convey to the audience" (p. 87). There is a fear of slight imperfections in appearance, or other valued attributes being scrutinized by the audience, w h i c h results in the heightened awareness of one's behaviour, or self-consciousness. Despite these assertions, research exploring the relation among eating pathology and imaginary audience or self-consciousness in adolescence is l imited. Consequently, the relation between adolescent social cognitive thought and eating pathology was assessed in this study. A c c o r d i n g to Fenigstein, Scheier, and Buss (1975), self-consciousness can refer to the tendency to think about personal characteristics that are matters of public display, "publ ic self-consciousness", or as the tendency to think about one's o w n aspects of the self which are personal in nature, "private self-consciousness". Despite this theoretical similarity between self-consciousness and imaginary audience, the studies that have directly assessed the relation of 30 private and public self-consciousness with eating pathology have not examined adolescents or males. Nevertheless, the research that has been devoted to assessing the relation of self-consciousness to the development of eating pathology has demonstrated an association between increased public and private self-consciousness with symptoms of eating pathology. F o r example, Jostes, Pook, and F l o r i n (1999) found that female patients diagnosed with b u l i m i a nervosa presented with an elevated public self-consciousness, but with average levels of private self-consciousness. S imilar results were found in a multi-ethnic sample of European-Caucasian, A s i a n - A m e r i c a n and A f r i c a n - A m e r i c a n w o m e n ( A k a n & G r i l o , 1995). Regardless of ethnicity, high public self-consciousness was associated with greater levels of problematic eating behaviours, attitudes towards eating, and body image dissatisfaction. Further research is needed to understand the relation of imaginary audience beliefs and public and private self-consciousness in the development of eating pathology in adolescents. A l t h o u g h E l k i n d (1965) associated these constructs with early adolescence, Lapsley , Fitzgerald, R i c e , and Jackson (1989) found that increases in egocentrism during adolescence m a y be related to changes in self-understanding, and argued that the imaginary audience and personal fable m a y not necessarily be an early adolescent phenomenon. T h u s , the examination of these variables in a population of middle adolescents was considered appropriate for this study. Statement of P r o b l e m Despite the myriad of research devoted to understanding the development of eating pathology, at present, there are no k n o w n definitive causal factors that contribute to the onset of eating pathology (Walsh & Garner, 1997). However , as presented in the literature review, a plethora of research has attempted to establish possible variables that demonstrate consistently significant relations with eating pathology in order to identify possible risk factors in the 31 development of eating disorders. Unfortunately, most of the research contributing to our current understanding o f eating pathology has utilized relatively homogenous population (Crago, Shisslak, & Estes, 1996; L e Grange, T e l c h , & T i b b s , 1998; S m o l a k & L e v i n e , 2000). That is, most of our understanding comes f rom research assessing the European-Caucasian female populations in Westernized countries (Striegel-Moore & Smolak , 1996). A l t h o u g h this is largely a consequence o f the imbalance in incidence rates of eating pathology favouring this population, recent cross-cultural and ethnic studies have demonstrated that eating pathology is no longer confined to this homogenous population (Dolan, 1991). T h u s , it is imperative that research devoted to the understanding of eating pathology be extended to include more heterogeneous populations. T h e risk factors identified in the model presented by Str iegel-Moore and S m o l a k (2000) have demonstrated significant relations with eating pathology. Several of the risk factors in this model are psychological and sociocultural variables that have exhibited strong relations to behaviours and attitudes considered under the umbrella term of "eating pathology." These variables include depression, self-esteem, and sociocultural attitudes towards appearance and physical attractiveness. In addition, as the onset of eating pathology often occurs during adolescence adolescent egocentrism, specifically imaginary audience and heightened self-consciousness, were examined in the present study. O f the established risk factors of eating pathology, research has been largely devoted to sociocultural variables that review the impact of western ideals of physical appearance. A s Canada 's population increases in its cultural diversity, it is important to recognize the impact that these western sociocultural beliefs have on the cognitions and behaviours of adolescent populations f r o m minority ethnic backgrounds. A c c o r d i n g to Statistics Canada (1996), 32 approximately 11.3% of all Canadians, and approximately 18.9% of Bri t ish C o l u m b i a n s can be identified as a visible ethnic minority. T h u s , as C a n a d a grows in ethnic diversity, it is critical that we further our understanding of how to support the psychological well being of all youth. Unfortunately, at present, little is understood about the relation between sociocultural and psychological risk factors of eating pathology among members of these minority populations. Moreover , the constructs assessed in this study had not been considered together across any adolescent population. Clear ly then, further research is necessary to understand the risk factors in the development of eating pathology among all ethnic adolescent populations. A s wel l , because of the serious physical and emotional consequences eating disorders have on inflicted individuals , risk factor research for this population is invaluable in establishing appropriate prevention and treatment programs. T h e purpose of this study then, was to further an understanding of the relation of sociocultural and psychological risk factors to eating pathology in ethnic minority adolescents l i v i n g in western Canada . T h i s study aims to identify the variables that best predict eating attitudes in a sample of ethnic minority adolescent girls and boys, respectively. Specif ic variables include the awareness and internalization of sociocultural attitudes towards appearance, acculturation, depression, self-esteem, self-consciousness and belief in the imaginary audience. Preliminary Hypotheses and Rationale T h i s study initially investigated differences in eating pathology a m o n g ethnic minority adolescent girls and boys . Eat ing pathology was evaluated using a standardized measure of eating attitudes as w e l l as several general demographic questions related to eating and weight-related issues. O v e r a l l performance on the Eat ing Attitudes Test - 2 6 ( E A T - 2 6 ; Garner , Olmsted , B o h r , & G a r f i n k e l , 1982) were compared across gender in order to investigate potential 33 differences in overall eating attitudes and behaviours. A n evaluation of gender differences in overall B o d y M a s s Index, measures of ideal weight, frequency of exercise, home eating habits, and parental feedback about weight were also compared across gender. Research assessing eating pathology in ethnic minority adolescents is l imited. However , as described in the literature review, available research has demonstrated significant gender differences in reported levels of eating pathology in adolescents (Dolan, 1991; le Grange, T e l c h , & T i b b s , 1998; S m o l a k & L e v i n e , 2000). Consistent with previous research, adolescent girls were expected to exhibit greater levels of eating pathology as compared to adolescent boys. A c c o r d i n g l y , it was hypothesized that adolescent girls w o u l d exhibit significantly higher levels of eating pathology as measured by the E A T - 2 6 (Garner, Olmsted, B o h r & G a r f i n k e l , 1982) when compared with adolescent boys (Striegel-Moore & Cachel in , 1999; W o r e l l & T o d d , 1996). It was further hypothesized that adolescent girls w o u l d report an overall desire to loose weight, and adolescent boys w o u l d report an overall desire to gain weight (Cohane & Pope, 2001). Gender differences across the sociocultural and psychological risk factors were also assessed. A s presented in the literature review, l imited research has been conducted with minority adolescents across m a n y o f these constructs. H o w e v e r , for certain constructs, consistent gender trends have been established with adolescents of European-Caucasian ethnicity. T h u s , for these variables, particular gender differences were hypothesized. Specifical ly , with respect to psychological correlates, it was hypothesized that adolescent girls w o u l d exhibit higher levels of depressive symptomology and lower overall levels o f self-esteem ( N o l e n - H o e k s e m a & Grigus , 1994; Rosenberg, 1965). A s wel l , in accordance with previous research adolescent girls were expected to exhibit higher levels of public self-consciousness and 34 belief in the imaginary audience when compared to boys, although no significant gender differences were expected in measures of private self-consciousness and social anxiety ( E l k i n d & B o w e n , 1979; Scheier. & Carver , 1985). Despite there being scant literature assessing sociocultural beliefs and acculturation in males, according to theoretical assumption, it w o u l d fol low that adolescent girls w o u l d exhibit increased awareness and internalization of sociocultural beliefs about appearance when compared to boys. A l s o , in accordance with the hypothesis conf i rmed by G h u m a n (1997), author of the acculturation measure used in this study, adolescent girls were predicted to exhibit greater acceptance of acculturation when compared to boys. T h e nature o f the relations among eating pathology and all psychological and sociocultural variables for adolescent girls and boys respectively were then assessed. Specifical ly , the relations among eating pathology, awareness of sociocultural attitudes towards appearance, internalization o f sociocultural attitudes towards appearance, acculturation, depressive symptomology, self-esteem, public self-consciousness, private self-consciousness, social anxiety, and imaginary audience beliefs were considered for adolescent girls and boys , respectively. A s described in the literature review, eating pathology has been found to be significantly related to various psychological and sociocultural characteristics (Striegel-Moore & Smolak , 2000). F o r example, research has demonstrated strong positive relations between eating attitudes and depressive symptomology (Neiderman, 2000). Similar ly , low self-esteem has been correlated with eating pathology among adolescents (Button, L o a n , Davies , & Sonuga-Barke, 1997). M a n y o f these findings, however, have emerged f r o m research studies examining eating pathology in the European-Caucasian majority western culture. T h u s , very little is understood 35 about the psychological correlates o f eating pathology among ethnic minority adolescents. Therefore, assessing the relation of eating attitudes to the various sociocultural and psychological constructs addressed is necessary to further our understanding of risk factors i n the development of eating pathology among ethnic minority adolescent girls and boys. S imilar ly , evaluating the nature of the relations of eating pathology to psychological and sociocultural variables w i l l extend current understanding of eating pathology ethnic minority adolescents. Pr imary Research Question T h e primary purpose of this study was to determine sociocultural and psychological predictors of eating attitudes in a sample o f ethnic minority adolescent girls and boys. Identifying the variables that best predict eating pathology in adolescent girls and boys aids in the identification o f potential risk factors for the development of eating pathology i n western Canadian minority youth. A s disordered eating attitudes have often been considered a " W h i t e " concern (Striegel-M o o r e & Smolak , 2000), it is important to evaluate the rate at w h i c h it is becoming a " m u l t i -cultural" concern (Dolan , 1991). T o this author's knowledge, there are no extant studies that have specifically evaluated the relation of psychological and sociocultural factors to eating pathology among adolescents. T h u s , it is hoped that the results o f this study w i l l provide new insights into the predictive model of eating attitudes for ethnic minority youth. 36 M e t h o d Participants Participants were students in grades 8 through 10 attending secondary school in a large western Canadian city. O f the 274 students solicited for participation, 175 students returned guardian consent forms, f r o m which 151 received guardian consent to participate. F r o m this sample, three adolescents d i d not sign student assent forms, thus decl ining participation and one student was absent at the time of data collection. Consequently, a total of 147 students completed questionnaire packages resulting in a participation rate o f 53.6%. F r o m this sample, 19 students (11 females, 8 males) were removed f r o m further analysis for the reasons outlined below. T o identify the adolescents belonging to ethnic minority populations, the 147 participants were categorized into six general cultural categories according to the specific ethnic origin with w h i c h they identified. T e r m i n o l o g y for a l l ethnic variations presented to the participants were selected in accordance with Census Canada classifications (Statistics Canada, 1996). T h e resulting ethnic categories included, European-Caucasian, South A s i a n , South East A s i a n , Hispanic /South A m e r i c a n , M i x e d Ethnici ty and all "other" minority populations. T h o s e classified as European-Caucasian indicated their ethnic background as Australian, Pol ish , G e r m a n , French, Italian, D u t c h , Scottish, Ukrainian , Portuguese, Greek, Bri t ish, Jewish or Irish exclusively or in combination with each other. Students who selected their ethnic origin as East Indian, Pakistani, F i j ian or Sri L a n k a n were categorized as South A s i a n . Adolescents who identified their ethnic origin as Chinese , K o r e a n , Vietnamese, Japanese, or F i l i p i n o were considered South East A s i a n . Hispanic /South A m e r i c a n students were categorized as South A m e r i c a n . T h o s e students who identified themselves as belonging to two or more distinct ethnic 37 considered of " m i x e d ethnicity" and all other minority ethnic populations were considered as an "other". In total, 11 participants, (6 girls, 5 boys) were categorized as European-Caucasian and were removed f r o m subsequent analyses in order to isolate only those adolescents who identified with minority ethnic cultures. F r o m the remaining 136 participants, f ive participants were removed due to insufficient data. T w o additional participants received scores identified as statistical outliers (as described later in the results section), hence were removed f r o m further analysis. F i n a l l y , an eleventh grade student (age = 1 7 years) was removed f rom the sample in order to maintain the target age range for the participants. T h u s , the final sample was composed of 128 ethnic minority adolescents including 90 females and 38 males ranging in age f r o m 13 to 16 years with a mean 14.45 years ( S D = 0.74). A s can be seen in Table 1, most of the participants reported their ethnic origin as South A s i a n and South East A s i a n . M o s t participants also reported that they were presently l i v i n g in a home with both of their biological parents. W i t h respect to parental level of education, many students reported that they were unaware o f the m a x i m u m level o f education achieved b y their mothers and fathers. H o w e v e r , of the participants that d i d respond, almost equal numbers reported that their mothers and fathers had either graduated f r o m high school or graduated f r o m a college or university. F i n a l l y , with respect to religious affiliation, most of the sample reported belonging to S i k h i s m , fo l lowed by Christianity, H i n d u i s m , B u d d h i s m , and Islam. O n l y a small number of participants reported that they did not belong to any particular religion. 38 T a b l e 1 Descriptive Characteristics of Participants Gender Characteristic Tota l Female M a l e Cultural B a c k g r o u n d (%) South A s i a n South East A s i a n Hispanic /South A m e r i c a n M i x e d Ethnici ty Other F a m i l y C o m p o s i t i o n (%) B o t h parents M o t h e r only Father only M o t h e r and Stepfather/Boyfriend Father and Stepmother/Girlfriend Grandparents also i n the home M o t h e r ' s level of education (%) S o m e high school Graduated f r o m high school 128 90 38 55.4 54.4 57.9 35.4 37.8 31.6 2.3 2.2 2.6 4.6 3.3 5.3 2.3 2.2 2.6 77.7 80.0 73.7 16.9 12.3 26.3 2.3 3.3 0.0 3.1 4.4 0.0 0.0 0.0 0.0 18.5 22.0 10.5 14.6 16.7 7.9 22.3 20.0 28.9 39 Vocat ional or technical school 0.0 0.0 0.0 S o m e college or university 10.0 8.9 13.2 Graduated f r o m college or university 20.8 18.9 23.7 Attended graduate or professional school 4.6 6.7 0.0 D o n ' t K n o w 27.7 28.9 26.3 Father's level of education (%) S o m e high school 12.3 13.3 7.9 Graduated f rom high school 21.5 18.9 28.9 Vocat ional or technical school 1.5 2.2 0.0 S o m e college or university 6.2 6.7 5.3 Graduated f r o m college or university 20.8 21.1 21.1 Attended graduate or professional school 5.4 6.7 2.6 D o n ' t K n o w 32.3 31.1 34.2 Rel igious Aff i l ia t ion (%) H i n d u i s m 13.8 10.0 23.7 S i k h 36.9 36.7 36.8 Islam 5.4 7.8 0.0 Christianity 23.1 26.7 13.2 B u d d h i s m 12.3 10.0 18.4 N o n e 7.7 7.8 7.9 Other 0.8 1.1 0.0 40 Procedures Recruitment o f Participants T h e researcher initially arranged to meet with the principal o f the participating secondary school in order to review the purpose and methodology of the study. Subsequent to the meeting, the principal introduced the study to the teachers of students in grades 8-10. A total of four teachers volunteered 13 classes for participation in the study. T h e researcher then met with the four teachers to outline the purpose of the study and specific methodological obligations that w o u l d be required of them. A t this time, student recruitment letters (see A p p e n d i x C ) , guardian consent and student assent letters (see Appendices D and E , respectively), and questionnaire packages were distributed and reviewed with the teachers and concerns were addressed. T h e researcher then approached students in their respective classrooms in order to extend an invitation to participate and to outline the study's purpose and procedures. A total of 274 students across core academic and elective classes were solicited for participation in this study. E a c h of the 13 collaborating classrooms were visited and presented with a short description of the purpose and methods of the study and students f r o m all ethnic populations were encouraged to participate. A t this time, student recruitment letters (see A p p e n d i x C ) and parental consent forms (see A p p e n d i x D ) were distributed to all students and discussed in detail with the class. T h e conditions of confidentiality were specifically highlighted and discussed. T h e students were encouraged to ask questions and raise any concerns regarding their participation in the study. T h e content of the measures uti l ized in this study required a m i n i m u m third grade level o f comprehension of written and spoken E n g l i s h . Consequently, prior to data collection, c lassroom teachers were asked to identify all " E n g l i s h as a Second Language" learners so that those 41 participants who d i d not meet this criterion c o u l d be identified. N o n e of the participating students were removed f r o m the analysis due to limitations in their language abilities. In addition to written guardian consent, students were required to complete informed student assent forms (see A p p e n d i x E ) on the day of data collection. O n l y those students w h o had both received guardian consent and w h o had agreed to participate were given a questionnaire package and permitted to participate in the study. Regardless of signed consent and assent forms however, students were reminded that they could refuse participation at any time during the study, w h i c h was the case for three students. N o other additional selection criteria were utilized to determine participation. T o promote the return of parental consent forms, a method that has been shown to be successful in encouraging m a x i m u m participation f r o m adolescents in this age group was incurred (personal communicat ion, Schonert-Reichl , February 26, 2001). Students who returned completed permission forms (accepting or declining participation) were entered into a random draw to w i n a $15.00 gift certificate to the A & B S o u n d music store. O n e winner was drawn in each of the 13 participating classrooms. Data Col lec t ion Data collection was conducted by four trained research assistants and the student investigator of this study. Research assistants were graduate students in the department of Educational and Counsel l ing Pscyhology , and Special Educat ion at the Universi ty of Brit ish C o l u m b i a . A two-hour training session for the research assistants was conducted 3 days prior to data collection. A t this time, an overview of the purpose and objectives of the study, exact details of the assessment procedures, and contents of the questionnaire package were reviewed. E a c h research assistant received an assessment package which included the data collection 42 schedule, class lists, instructions for administration (see A p p e n d i x F ) , definitions of terms (see A p p e n d i x G ) , and a record sheet for any comments or observations noted during the assessment process (seel A p p e n d i x H ) . U p o n completion of the training session research assistants were knowledgable of all aspects of the assessment process and were confident addressing possible student concerns. Data collection began 8-10 days after guardian consent forms were distributed to each class. Prior to data collection, classes were re-visited and teachers were contacted to address any concerns regarding participation and to encourage the return of consent forms. A l l data were then collected during scheduled class time. Students took approximately 25 minutes to complete the questionnaire package. A m i n i m u m of two research assistants were always present during the data collection process. U p o n arriving to the class, research assistants reminded students of the purpose and objectives of the study, and placed particular emphasis on the importance o f honesty and confidentiallity of the student's responses. A t this time, the students who had received parental consent for participation were provided with a student assent f o r m (see A p p e n d i x E ) reviewing the objectives and terms of the study. O n l y those students w h o signed the assent f o r m , w h i c h provide their written agreement to these terms, were administered the questionnaires. T h o s e who d i d not participate in the study were provided with an activity that was related to a topic being covered in their regular class and were supervised by the classroom teacher. Confidentiali ty of the questionnaires was maintained by the use of identification numbers. E a c h participant received a large envelope, a questionnaire package and a class list with identification numbers assigned to all students. O n the right hand corner o f each envelope was a space for the student to print the identification number located next to their name on the 43 class list. Participants were instructed not to write their name anywhere on the envelope or questionnaire. A master identification list was c o m p i l e d and kept in a locked f i l i n g cabinet in the custody of the investigator and all additional copies were collected and later destroyed. D u r i n g the assessment process, research assistants were available to answer student concerns regarding the content of the questionnaires and supervise the data collection process. A s students completed the assessment, questionnaire packages were collected by the research assistants, checked for completion, and immediately sealed in the envelopes. W h e n all participants had completed the survey, the draw for the A & B S o u n d gift certifficate was conducted. A l l students who returned signed parental consent forms, with either a " y e s " or a " n o " , were included in the draw. A $15.00 gift certificate was awarded to one student in each of the 13 participating classes. Teachers were asked to randomly draw the winner of the gift certificate for their respective classes. Measures T h e participant questionnaire package consists of fourteen pages in total, inc luding a cover page (see A p p e n d i x I), a demographic questionnaire (see A p p e n d i x J), and seven measurement instruments designed to assess various sociocultural and psychological constructs. T h e questionnaires were administered in the f o l l o w i n g order: 1) Demographic questionnaire; 2) Aberystwyth Acculturation Scale ( G h u m a n , 1975); 3) Sociocultural Attitudes Towards Appearance Questionnaire Female and M a l e Versions (Heinberg, T h o m p s o n , & Stormer, 1995); 4) Eat ing Attitudes Test-26 (Garner, Olmsted , B o h r , & G a r f i n k e l , 1982); 5) Rosenberg Self -Esteem Scale (Rosenberg, 1965); 6) T h e Self-Consciousness Scale-Revised (Scheier & Carver , 1985); 7) Reynolds Adolescent Depression Scale (Reynolds, 1987); 8) Imaginary A u d i e n c e Scale ( E l k i n d & B o w e n , 1979). Separate packages were designed for girls and boys due to the 44 gender specific versions of the Sociocultural Attitudes Towards Appearance Questionnaire. T h e measurement instruments are described in f o l l o w i n g sections. Demographic Questionnaire T h e purpose of the four-page demographic questionnaire (see A p p e n d i x J) was to provide descriptive information about the sample. General information, such as birthdate, place of birth, language spoken at home, religious affiliation, and f a m i l y composit ion, provided an understanding of the general characteristics of the population assessed. In addition, items related to eating pathology were assessed, such as current weight, highest weight, and f a m i l y eating style. F inal ly , the socioeconomic status of participants was estimated using information obtained f r o m adolescents regarding their guardians' occupation and level of education (Editors Consort ium, 1996). B o d y M a s s Index B o d y mass index ( B M I ) , w h i c h is one's weight in kilograms/height in meters 2 , was calculated to determine whether an individual is at an appropriate weight for their age. Appropriate B M I levels for adolescents ages 14 to 15 years are considered to fall between 17 -20 (Touyz & Beumont , 1997). Eat ing Attitudes Test -26 T h e Eat ing Attitudes Test ( E A T - 2 6 ; Garner, Olmsted, B o h r , & G a r f i n k e l , 1982) was used to assess attitudes towards eating and eating pathology. T h e E A T - 2 6 (see A p p e n d i x K ) is a 26-item self-report measure designed to assess eating attitudes and behaviours characteristic of eating disorder symptomology typical in anorexia and bul imia nervosa. T h e E A T - 2 6 is an abbreviated version of the original 40-item Eat ing Attitudes Test by Garner and Garf inkel (1979); Garner et al . eliminated 14 items f r o m the original scale after identifying redundant items 45 that d i d not contribute to the predictive validity of the instrument. T h e E A T - 2 6 was f o u n d to be highly correlated with total scores on the original E A T (r = .98). T h e E A T - 2 6 (Garner et al . , 1982) consists o f three factors: dieting, b u l i m i a and f o o d preoccupation, and oral control. Garner et al . f o u n d that all 26-items were moderately correlated with the total score ( r ' s > .44). Items were answered according to a 6-point, forced-choice, scale ranging f r o m "never" to "a lways" . Scores were computed b y assigning values f r o m 0-3 for each of the six choices provided per item. A score of 3 is indicative of extreme anorexic response, 2 is assigned to its adjacent alternative, and 1 for the next alternative. A score of 0 is assigned to the remaining three response choices. T h u s , all items, with the exception of i tem 25 w h i c h was reverse scored, were scored as fol lows: i tem 1=3, 2=2, 3=1, and 4, 5, and 6=0. Scores on the E A T - 2 6 range f r o m 0 - 78. H i g h e r total scale raw scores are indicative of greater occurrence of disordered eating attitudes and behaviours. A c c o r d i n g to the authors, a cut-off score of 20 or above warrants further investigation; consequently, those participants who scored above 20 on this measure were referred to the school counsellor for further assessment. W i l l i a m s o n , A n d e r s o n , Jackson, and Jackson (1995) have cautioned that the items on the E A T - 2 6 have face validity, and consequently can be easily manipulated to m i n i m i z e or maximize symptomology. Nevertheless, the E A T - 2 6 has been found to differentiate between eating disorder symptomology characterized by anorexia nervosa, b u l i m i a nervosa, and binge eating disorder and non-cl inical controls ( W i l l i a m s o n , C u b i c , & Gleaves , 1993). T h e E A T - 2 6 is a widely used measure for a variety of populations, requires approximately five minutes for administration, and has a readability at the fifth grade level (Wil l iamson, A n d e r s o n , Jackson, & Jackson, 1995). T h e E A T - 2 6 has been shown to be a statistically reliable and val id measure of eating disturbances across various ethnic populations 46 reporting internal consistency coefficients ranging f r o m a = 0.70 - 0.87 (Chamorro & Flores-Ort iz , 2000; F u r n h a m & Patel, 1994; L e e & L e e , 2000; M u k a i , Crago , & Shisslak, 1994). F o r the present sample, Cronbach 's coefficient alpha calculated for the E A T - 2 6 was 0.68, and thus was f o u n d to be comparable to previous findings (Chamorro & Flores -Ort iz , 2000; F u r n h a m & Patel, 1994). Sociocultural Attitudes Towards Appearance Questionnaire T h e Sociocultural Attitudes Towards Appearance Questionnaire ( S A T A Q ; Heinberg , T h o m p s o n , & Stormer, 1995) was used to assess adolescents awareness and internalization of the social standards of appearance characteristic of westernized countries, such as Canada and the U n i t e d States. A s the original scale (see A p p e n d i x L ) was designed for adult w o m e n residing in the U . S . , several items were reworded for this study to render it appropriate for use with Canadian adolescent girls and boys (see Appendices M and N respectively). T h e S A T A Q is a 14-item self-report questionnaire designed to assess w o m e n ' s awareness and acceptance of sociocultural influences regarding appearance. T h e S A T A Q contains two factors designed to assess an individual ' s awareness and internalization of Western beauty ideals: T h e 6-item Awareness scale (items 6, 8, 9, 10, 11, and 12) assesses one's awareness or recognition of the socially defined standards of appearance, and the 8-item Internalization scale (items 1-5, 7, 13, and 14) measures the acceptance of socially defined standards of appearance. Respondents were asked to indicate the extent to which each item applies to them using a 5-point Likert - type scale ranging f r o m "completely disagree" to "completely agree". Scores of 1-5 were allocated to each response with certain items reversed scored (4, 6 ,10 , and 12), resulting in a range of possible scores f r o m 14-70. H i g h e r scores were indicative of greater awareness and internalization of socially prescribed standards of physical appearance. 47 T h e S A T A Q demonstrates g o o d psychometric properties (Heinberg et al . , 1995). Internal consistency (alpha) ranged f r o m 0.71 - 0.81 for the Awareness scale, and 0.88 - 0.93 for the Internalization scale. Internal correlations between the two subscales have been reported as 0.34 and thus it is suggested that the scores be interpreted independently (Heinberg et al.). H e i n b e r g et al . also reported correlations reflect good convergence with other scales, such as the Eat ing Disorder Inventory, with values ranging f r o m 0.36 - 0.61 for the Internalization scale, and 0.28 -0.44 for the Awareness scale. C r o n b a c h ' s alphas for the present sample were 0.62 and 0.78 for the Awareness and Internalization scales, respectively. Aberystwyth Acculturation Scale T h e Aberystwyth Acculturation Scale ( G h u m a n , 1997) is designed to measure the level of acculturation of minority ethnic groups into the majority western culture. T h e original acculturation scale (see A p p e n d i x O ) is designed to assess the levels of acculturation in adolescents of South A s i a n decent. H o w e v e r , for the purposes of this study, the items were adjusted to apply to all minority ethnic populations (see A p p e n d i x P) . Participants were instructed to answer the items with reference to their specific cultural beliefs. T h e Aberystwyth Acculturation Scale in its original publication ( G h u m a n , 1975) consisted of 30 items. In hopes of extending the scope of the scale, two items were recently added to the measure ( G h u m a n , 1997). Response to each item consisted of a 6-point, forced choice Likert- type format that ranged f r o m "strongly agree" to "strongly disagree". T h i s scale contains 16 items reflecting western cultural beliefs, and 16 items reflecting adherence to n o n -western cultural beliefs. Items favouring a western lifestyle (i.e., items 1,4, 5, 8 , 1 0 , 1 3 , 1 5 , 1 6 , 18, 20, 22, 24, 27, 28, 30, and 32) were scored in a numerically descending order f rom 5-1, with strongly agree receiving a score of 5, and strongly disagree receiving a score of 1. Conversely , 48 items reflecting non-western cultural beliefs (i.e., items 2, 3, 6, 7, 9, 11, 12, 14, 17, 19, 21, 23, 25, 26, 29, and 31) were reversed scored in a numerically ascending order f r o m 1-5. Tota l scores ranged f r o m 32-160; high scores on this scale reflected a greater level of acculturation, and low scores indicated greater levels of traditionalism. A c c o r d i n g to G h u m a n (1997), this scale has been used in E n g l a n d and in C a n a d a with adolescents of A s i a n ethnicity, and has proven to be a reliable measure of acculturation, reporting reliability coefficients ranging f r o m 0.75 - 0.81. F o r the present study, C r o n b a c h ' s alpha was 0.68. Reynolds Adolescent Depression Scale T h e Reynolds Adolescent Depression Scale ( R A D S ; Reynolds , 1987) is a 30-item self-report questionnaire that is designed to assess current levels of depressive symptomology i n adolescents aged 13 to 18 years. T h e R A D S uses a four-point Likert-style scale describing various levels of prevalence. F o r each item, respondents selected f r o m "almost never" , "hardly ever", "sometimes" , or "most o f the t ime" . A score o f 1-4 was assigned for each response choice, with several items requiring reverse scoring. Tota l scores were calculated by s u m m i n g the item scores and range f r o m 30-120. Higher scores are indicative of greater levels of depressive symptomology. T h e R A D S is often used as a screening measure to identify adolescents w h o m a y be experiencing symptoms of cl inical depression. Reynolds (1987) suggests that a score of 77 or above is indicative o f levels o f depressive symptomology associated with c l inical depression and warrants further assessment. Therefore, the participants w h o obtained a score of 77 or above were referred to the school counsellor for further evaluation. 49 T h e initial standardization sample for the R A D S included 2,460 adolescents aged 12 - 1 8 years f r o m the U S . T h e sample consisted of comparable U S proportions of racial origin, socio-economic status, gender and age. A l t h o u g h ethnic and racial denominations in Canada are different than the U S , the R A D S has been successfully used in other Canadian studies with a multi-cultural populations (Schonert-Reichl , 1994). Strong psychometric properties of the R A D S are reported in the manual , w h i c h support of the reliability and validity o f the measure. Reynolds (1987) reports high internal consistency reliability (Cronbach's alpha = 0.92), and identified several other measures offering similar findings. Similar ly , a reliability coefficient of 0.79 was found in a measure of test-retest reliability of 415 adolescents after three-month period. Internal consistency, as measured by Cronbach 's alpha, for the present study was 0.94 supporting the strong psychometric characteristics of this measure for a multi-ethnic sample. F inal ly , several measures of validity of the R A D S are reported in the manual identifying strong evidence for content, criterion-related, construct, and clinical validity. Rosenberg Self -Esteem Scale T h e Rosenberg Self -Esteem Scale ( R S E ; Rosenberg, 1965; see A p p e n d i x Q ) is a ten-item measure of global self-esteem that is considered the most widely used measure of self-esteem (Alfonso , 1995). Respondents were asked to rate each item on a 4-point Likert-style scale ranging f rom "strongly agree" to "strongly disagree". E a c h response was allocated a score f r o m 1-4, resulting in a total score range of 10-40. L o w e r scores were indicative of greater self-esteem. W i t h respect to reliability, Rosenberg (1965) reported a coefficient alpha of 0.77 for a sample of over 5000 adolescents. Test-retest reliability coefficients of 0.73 have been reported 50 for a sample o f 990 Canadian adolescents ( W y l i e , 1989). T h e R S E has received extensive psychometric support as a unidimensional scale of self-esteem. A l t h o u g h criticisms of its validity compared with multidimensional constructs of self-concept have been reported, B l a s c o v i c h and T o m a k a (1991) highly recommend the R S E as a unidimensional measure of self-esteem. Furthermore, Griff i ths et al . (1999) recommends that the R S E , as compared with the Coopersmith Self -Esteem Inventory, is a more appropriate measure o f self-esteem for use with dieting disordered populations. Internal consistency (Cronbach's alpha) for the present study was 0.85. Revised Self-Consciousness Scale T h e R e v i s e d Self-Consciousness Scale (Scheier & Carver , 1985) is a revised version of the Self-Consciousness Scale (Fenigstein, Scheier, & Buss , 1975). A c c o r d i n g to Scheier and Carver, the intention of the revision was to create a scale that w o u l d be suitable for use with populations other than college students due to issues of item comprehension and difficulties with the previous response format. T h e R e v i s e d Self-Consciousness Scale ( S C S ; see A p p e n d i x R ) is a 22-item Likert-style self-response measure in w h i c h respondents were asked to indicate the extent to w h i c h each of the 22 statements was most like them by selecting one of four choices: " a lot like m e " , "somewhat like m e " , " a little like m e " , and "not at all l ike m e " . Scores of 3-0 were allocated to each of the responses above, with some items reversed scored, resulting in a total score range of 0-66 with higher scores indicating greater association with self-consciousness. T h e S C S consists of three subscales, public self-consciousness ( P U S C ; items 2, 5, 10, 13, 16,18, and 20), private self-consciousness ( P R S C ; items 1, 4, 6, 8 , 1 2 , 1 4 , 1 7 , 19, and 21), and social anxiety ( S A ; items 3, 7, 9, 11, 15, and 22). A c c o r d i n g to Scheier and Carver (1985), P U S C "refers to the tendency to think about those self-aspects that are matters of public display, 51 qualities of the self f r o m which impressions are formed in other people 's eyes" (p. 687). Conversely , P R S C is the "tendency to think about and attend to the more covert, hidden aspects of the self, aspects that are personal in nature and not easily accessible to the scrutiny other persons" (p. 687). F inal ly , Social anxiety is a measure of the subject's response to focusing on attributes identified in the P U S C scale. That is, it is a measure o f the respondent's anxiety about their evaluation b y their peers and others in their social context. Because the three subscales represent independent constructs, they were scored and evaluated independently, as suggested b y the authors (Scheier & Carver) . Scheier and Carver (1985) reported internal consistency coefficients for P R S C , P U S C , and social anxiety as 0.75, 0.84, and 0.79, respectively. Test-retest reliability over a 4-week period for a sample of 135 respondents was 0.76 for the private scale, 0.74 for the public scale, and 0.77 for social anxiety. Internal consistency (Cronbach's alpha) for the present sample across P R S C , P U S C , social anxiety were 0.61, 0.83, and 0.74, respectively. T h e Imaginary A u d i e n c e Scale A c c o r d i n g to E l k i n d and B o w e n (1979), the Imaginary A u d i e n c e Scale ( I A S ; see A p p e n d i x S) is designed to "assess young people 's willingness to reveal different facets of themselves to an audience" (p. 38). T h e I A S consists of two subscales, the Transient Self (TS) and the A b i d i n g Self ( A S ) . T h e T S subscale consists of six items (1, 3, 5, 7, 9, and 10) describing potentially embarrassing situations (e.g., having your picture taken with a swollen face) and is meant to reflect momentary behaviours. T h e A S subscale consists o f six items (2, 4, 6, 8, 11, and 12) describing self-revealing situations (e.g., having someone watch y o u work) that are meant to identify personality traits, or long-time characteristics. F o r all twelve items, 52 participants selected one of three responses that best described how they w o u l d respond to each situation. E l k i n d and B o w e n (1979) reported scores for the total I A S as wel l as for the two subscales, T S and A S . A l t h o u g h the authors suggested that the T S and A S represent independent constructs, they reported reasonable reliability and construct validity for the I A S and supported its utility as a measure of the imaginary audience belief. S i m i l a r l y the I A S total score as wel l as the T S and A S subscale scores have been used in the literature (Markstrom & M u l l i s , 1986). A s the relation between adolescent egocentrism, as measured b y the imaginary audience belief, was of interest for this study, only the I A S total scores was reported. Items were scored f r o m a range of 0-2 depending on the level of involvement selected by the adolescent.. A score of 2 reflected an unwillingness to participate, a score of 1 indicated indifference/to participation, and a score of 0 indicated willingness to participate. Tota l scores for the I A S range f r o m 0 - 2 4 with higher scores suggesting that the adolescent is less w i l l i n g to reveal their transient or abiding self to an audience. T h e I A S was standardized on a sample of 697 students in grades 4, 6, 8, and 12. Authors describe the sample as comparable across socioeconomic status, although no reference was made to the ethnic composit ion of the sample. Test-retest reliability was assessed after a four-month delay between administrations and demonstrated reasonable results. Reliabil i ty coefficients for the subscales ranged f r o m 0.63 - 0.68 for the T S scale and 0.50 - 0.72 for the A S scale across all four grades. Internal consistency reliability coefficients for the T S and A S subscales ranged f r o m 0.51 - 0.80 across grade levels. Construct validity of the I A S subscales was also reasonably w e l l demonstrated with two measures of self-esteem. In the present study, internal consistency (Cronbach's alpha) for the I A S was 0.74. O v e r a l l , the subscales of the I A S are reasonable measures of adolescent social-cognitive thought in accordance with E l k i n d ' s (1976) theory of the Imaginary A u d i e n c e . Results T h e results of this research are presented in four sections. T h e first section describes the initial analyses conducted. T h e next section describes the results of the preliminary analyses used to identify gender differences in eating pathology and various sociocultural and psychological variables. T h i s is f o l l o w e d by a presentation of the results of the correlational analyses used to examine relations among eating attitudes, sociocultural influences, and psychological wel l -being for adolescent girls and boys, respectively. T h e final section presents the results of the regression analyses examining specific sociocultural and psychological variables as predictors of eating attitudes in adolescent girls and boys, respectively. A s theory and research have consistently demonstrated gender differences in eating pathology (Bryant -Waugh & L a s k , 1995; Steiner & L o c k , 1998; Str iegel-Moore & Smolak , 2000) and related psychological functioning (Nolen-Hoeksema & Grigus , 1994; Z i m m e r m a n , C o p e l a n d , Shope, & D i e l m a n , 1997), adolescent girls and boys were analysed separately. Initial Analyses A s described earlier in the methods section, two of the measures selected for this study were screening tools designed to assess the presence of psychopathology in adolescent populations. That is, the Eat ing Attitudes Test-26 ( E A T - 2 6 ) and Reynolds Adolescent Depression Scale ( R A D S ) were designed to identify adolescents who may be at risk for the development of eating disorders and depression, respectively. Therefore, because the responses on these measures for some participants may have warranted further professional investigation, scores on the E A T - 2 6 and R A D S were calculated for all participants in the initial sample (N=147). T h e critical cut off scores used were in accordance with those suggested in the E A T -26 (Garner, Olmsted , B o h r , & G a r f i n k e l , 1982) and R A D S (Reynolds, 1987) manuals, 55 respectively. A total of 7 participants (6 girls, 1 boy) on the E A T - 2 6 and 12 participants (9 girls, 3 boys) on the R A D S obtained critical scores indicative of possible pathology. T h e names o f these students were reported to the school principal and school counsellor for further investigation. T h i s sample was then reviewed in order to identify participants w h o d i d not satisfy predetermined inclusion criteria for data analysis. Specif ical ly , E n g l i s h speaking adolescent boys and girls in grades 8 - 1 0 w h o identified themselves with a non-European minority ethnic population and who had successfully completed all measures in their questionnaire package were included in the data analysis. R e c a l l f r o m the methods section, that 19 adolescents (11 girls, 8 boys) d i d not satisfy inclusion criteria for data analysis and were consequently removed f r o m the final sample. Details regarding this process are described below. T h e sample of 147 participants (101 girls, 46 boys) was initially classified into one o f six different cultural categories. A total of I T adolescents (6 girls, 5 boys) classified as European-Caucasian were removed f r o m further analyses as the purpose of this study was to focus on ethnic minority adolescent girls and boys. F r o m the remaining 136 participants, total and subscale scores across all seven measures were calculated. A s recommended by Reynolds (1986), summary scores were prorated i f a m i n i m u m of 80% of the items within a measure were answered in order to maintain adequate reliability and validity o f the measures. Subsequent to this analysis, f ive participants (3 girls, 2 boys) missing one or more total or subscale scores were removed f rom further analysis. A n eleventh grade participant (age = 17 years) was also eliminated because she exceeded the age range of this study, resulting in 130 participants remaining in the sample. 56 F inal ly , using S P S S , an exploratory analysis of the distributions of E A T - 2 6 scores for adolescent girls and boys individually , detected two distinct outliers. A s recommended by S P S S (2000), outliers were defined as any score that was three standard deviations f r o m the mean. O n e adolescent girl and boy representing approximately 1.5% of the sample obtained scores of 39 and 33, respectively. A l t h o u g h these scores represented statistical outliers, they were l ikely to be true scores on the E A T - 2 6 representing extreme eating pathology. H o w e v e r , when included in the analysis, the scores of these two individuals effected the generalizability of the results and misrepresented the distribution of the remaining sample of participants. Consequently, these two participants were removed f r o m any further analysis. T h e final sample of 128 participants inc luded in further analyses described below, consisted of 90 female and 38 male ethnic minority adolescents. Gender Differences in Eat ing Pathology, Sociocultural Variables , Psychological W e i l - B e i n g , and Social C o g n i t i o n A s described in the introduction, the objective of the primary analysis was to determine whether minority adolescent girls and boys differed with regard to their reports of eating pathology or their reports on measures of sociocultural and psychological variables. Specifical ly , adolescent girls and boys were compared across measures of eating attitudes, eating related behaviours, the awareness and internalization of sociocultural standards of appearance, depressive symptomology, self-esteem, self-consciousness and adolescent egocentrism. These results are presented in detail in the sections to fo l low. Gender Differences in Eat ing Attitudes and Eat ing Related Behaviours O n e of the preliminary questions of this study was to assess whether or not minority adolescent girls and boys differed in reported eating attitudes and eating related behaviours. 57 Recal l , it was hypothesized that adolescent girls when compared to boys w o u l d report increased levels of eating pathology. T o address this question, an independent t-test analysis was performed. O v e r a l l mean scores for adolescent girls and boys on the E A T - 2 6 (Garner et al . , 1982) were 6.78 ( S D = 5.98), and 7.55 ( S D = 7.18), respectively. A l t h o u g h no significant gender difference was found (t(126) = 0.50, p_ = ns.), the overall mean for adolescent girls was slightly lower than the mean for boys. In addition, 5.6% of adolescent girls as compared to 0% of adolescent boys scored above the recommend cut off range of 20 (Garner et. al.) thus, exhibiting high risk for developing eating disorders. T o assess whether adolescent boys and girls differed with regard to eating related behaviours, t-test and chi-square analyses were performed across five variables. A s described in the methods, B o d y M a s s Index ( B M I ) was a calculation of the ratio of one's weight as it compares to height and was used to determine whether an individual is at an appropriate weight for their age. A s can be seen in Table 2, no significant gender difference was f o u n d on B M I . Therefore, the B M I for both adolescent girls and boys fell within the expected range for their age, which was between 17-20 k g / m 2 ( T o u y z & Beumont , 1997). Despite this, adolescent girls and boys reported significantly different ideal body weights. F o r adolescent girls, overall weight loss was desirable, whereas adolescent boys reported an overall desire for weight gain. A s seen in T a b l e 2, significant gender differences in the distribution of responses to other eating related behaviours was found. Specif ical ly , when asked about their frequency of exercise, more adolescent boys, as compared to girls, reported exercising "of ten" . In addition, more adolescent boys than girls reported that they strongly considered the f o o d eaten at home to be healthy. F i n a l l y , a greater number of adolescent boys than girls strongly agreed that their families were concerned about their current weight. However , the majority of the adolescent 58 girls and boys disagreed when asked i f their families were concerned with their weight. T h u s , although no significant gender difference was found in eating pathology, minority adolescent girls and boys d i d report differences with respect to some of the eating related behaviours. 59 T a b l e 2 Gender Comparisons of Eat ing Related Behaviours Characteristic G i r l s B o y s B o d y M a s s Index (kg/m ) M 19.68 20.12 1(103) = -0.58, p_ = ns. S D 3.27 3.96 Ideal weight loss/gain M -4.18 3.39 t(108) = - 3 . 0 5 , D < . 0 1 S D 10.85 13.71 Frequency of exercise (%) Often 23.6 47.4 X 2 (3) = 65.85, p < .001 Sometimes 52.8 47.4 Occasional ly 19.1 5.3 N e v e r 4.5 0.0 T h e f o o d at home is healthy (%) Strongly agree 21.1 34.2 % 2 (2) = 82.80, p. < .001 A g r e e 73.3 60.5 Disagree 5.6 5.3 F a m i l y is concerned with weight (%) Strongly agree 8.9 13.2 X 2 (3) = 39.06, p. < .001 A g r e e 28.9 26.3 Disagree 44.4 50.0 Strongly Disagree 17.8 10.5 60 Gender Differences in Sociocultural Attitudes T o w a r d Appearance and Acculturat ion Another preliminary question in this study was whether or not minority adolescent girls and boys w o u l d differ across measures of sociocultural attitudes towards appearance and attitudes towards acculturation. It was hypothesized that adolescent girls, in comparison to adolescent boys, w o u l d report increased awareness and internalization of sociocultural beliefs about appearance, and more favourable attitudes towards acculturation. In order to assess these variables, independent t-tests were performed. A s reported in T a b l e 3, adolescent boys, as compared to girls, reported higher levels of awareness of western sociocultural beliefs toward physical appearance. Despite this, significant gender differences were not found with regard to the internalization of these western sociocultural standards. F i n a l l y , as predicted, adolescent females reported more favourable attitudes towards the process of acculturation when compared with boys. T h u s , significant gender differences were f o u n d among aspects of these sociocultural variables for minority adolescent girls and boys. 61 Table 3 Gender Comparisons of Sociocultural Variables Variable G i r l s B o y s S A T A Q Awareness Subscale M 16.46 18.53 t(126) = = -2.80, p_ < .01 S D 3.98 3.45 Range 6-27 1 2 - 2 5 S A T A Q Internalization Subscale M 21.50 22.63 t(126) = = -1.01, p = ns. S D / 5.94 5.5 Range 9 - 3 8 1 2 - 3 5 Acculturation Scale M 111.23 105.61 t(126) = = 3 . 0 6 , p < . 0 1 S D 9.39 9.84 Range 8 9 - 1 3 1 74 - 124 Gender Differences i n Depression and Self -Esteem A s reviewed in the introduction, gender differences in depression and self-esteem have been consistently reported in the research literature (Eccles & M i d g l e y , 1990; N o l e n - H o e k s e m a & Grigus , 1994). A s such, another objective of the preliminary analysis of this study was to assess whether gender differences existed across measures of depressive symptomology and self-esteem. A s stated in the introduction, it was hypothesized that minori ty adolescent girls w o u l d report greater depressive symptomology, and lower self-esteem than w o u l d minority adolescent 62 boys . T o address this question, independent t-tests were performed for each variable. A s seen in T a b l e 4 below, no significant gender differences emerged in depressive symptomology or self-esteem. T a b l e 4 Gender Comparisons of Depression and Self -Esteem Variable G i r l s B o y s R A D S M 57.09 55.21 t(126) = 0.69, p = ns. S D 14.26 13.84 Range 3 2 - 9 3 3 4 - 8 5 Rosenberg self-esteem scale M 19.57 18.08 t(126) = 1.62, p = ns. S D 5.05 3.97 Range 1 0 - 3 7 1 0 - 2 6 Gender Differences in D i m e n s i o n s of Self-Consciousness and Adolescent Egocentr ism A final question considered with regard to the assessment of gender differences was whether adolescent girls and boys w o u l d differ on dimensions of self-consciousness and adolescent egocentrism. R e c a l l , it was hypothesized that adolescent females w o u l d exhibit heightened levels of public self-consciousness and imaginary audience belief in comparison to adolescent boys. T o examine this hypothesis, independent t-tests were performed. 63 T a b l e 5 Gender Comparisons of Sociocultural and Psychological Variables Variable G i r l s B o y s Public self-consciousness M 12.40 12.55 t(126) = -0 .17 ,p = ns. S D 5.01 3.65 Range 0 - 2 1 5 - 1 9 Private self-consciousness M 14.02 12.79 t(126)= 1.49, p = ns. S D 4.47 3.82 Range 5 - 2 5 6 - 2 2 Social A n x i e t y M 9.88 9.26 t(126) = 0.75, p = ns. S D 4.40 3.93 Range 0 - 1 8 1 - 1 7 Imaginary A u d i e n c e Scale M 11.33 11.32 t(126) = 0.02, E = ns. S D 4.38 4.33 Range 1 - 2 4 4 - 2 1 A s summarized in T a b l e 5 above, no significant gender differences were found across variables assessing private or public self-consciousness, social anxiety, or belief in the imaginary audience. 64 Relations A m o n g Eat ing Attitudes, Sociocultural Attitudes T o w a r d Appearance, Depression, Self -Esteem, Self-Consciousness , and Adolescent Egocentr ism Another preliminary question in this study was to assess the nature of the relations among eating attitudes and the sociocultural and psychological variables for adolescent girls and boys, respectively. T o address this question, Pearson correlation coefficients were computed for all variables for adolescent boys and girls separately, resulting in two inter-correlation matrices. Intercorrelations A m o n g Variables for Adolescent G i r l s A s seen in T a b l e 6, many o f the variables assessed in this study demonstrated significant relations with each other. Ea t ing attitudes was f o u n d to be significantly related to the awareness and internalization of sociocultural attitudes towards appearance, depressive symptomology and public and private self-consciousness. Interestingly, acculturation was not significantly related to any of the variables assessed. Intercorrelations among Variables for Adolescent B o y s A s with the adolescent girls, several significant intercorrelations among variables were found for adolescent boys (see T a b l e 7). Eat ing attitudes was significantly related to the awareness and internalization of sociocultural attitudes towards appearance, and to public and private self-consciousness. Acculturation was not significantly related to any of the other variables. F i n a l l y , social anxiety was significantly related to self-esteem. Similarities and Differences across Gender Overa l l , results for adolescent girls and boys were variable. Eat ing attitudes for girls and boys demonstrated significant relations to sociocultural attitudes towards appearance and to public and private self-consciousness. Interestingly however, depression only demonstrated a significant relation with eating attitudes in adolescent girls. F o r adolescent boys, depression was 65 significantly related to the S A T A Q internalization scale, self-esteem and imaginary audience beliefs. Conversely , for adolescent girls, depression was significantly related to all variables, with the exception of acculturation. Similar ly , the S A T A Q awareness and internalization scales for adolescent girls, demonstrated significant relations with many of the other variables, whereas, they were f o u n d to be less related to the other variables in adolescent boys. In addition, private and public self-consciousness and imaginary audience demonstrated significant relations with many of the other variables for adolescent girls, but not for boys. In general, the variables assessed in this study demonstrated high intercorrelations with each other and particularly with eating attitudes in adolescent girls as compared to adolescent boys. Despite these differences however, the eating attitudes of both adolescent boys and girls demonstrated consistent relations with the sociocultural awareness and internalization scales, as well as with public and private self-consciousness, w h i c h suggests that these four variables m a y be significant risk factors in the development of eating pathology. In order to assess the value o f some of variables in predicting eating pathology in adolescent boys and girls, separate regression analyses were conducted next. 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D u e to the l imited number of participants in relation to the number of constructs assessed in this study, all variables could not be entered into the regression analysis without increasing vulnerability to T y p e I error. A l t h o u g h H a m m o n d (2000) recommended that there should be approximately 20 subjects for every variable added into the regression model , he further suggested that a m i n i m u m of 10 subjects might be used with smaller samples. Regression analyses were conducted separately for minority adolescent girls and boys to evaluate the best model for predicting eating attitudes across gender. T h u s , variables demonstrating statistically significant zero-order correlations with eating attitudes for adolescent girls or boys, respectively, were included in the regression analysis. Consequently, for the adolescent girls, f ive variables were entered into the multiple regression analysis, which included the awareness and internalization of sociocultural attitudes towards appearance, private and public self-consciousness, and depression. F o r the adolescent boys, four variables were entered into the regression analysis including the awareness and internalization of sociocultural attitudes towards appearance and private and public self-consciousness. T h i s approach has been demonstrated b y H a m m o n d to be an adequate method of variable selection. Predictors of Eat ing Attitudes in Adolescent G i r l s In order to evaluate the final question in this study, a simultaneous linear multiple regression analysis was conducted. A s shown below in T a b l e 8, results identified public self-consciousness as the only significant predictor of eating attitudes in the present sample of 69 minority adolescent girls. Recal l f r o m the methods section that public self-consciousness is defined as the tendency to think about the aspects of oneself that are matters of public display, or can be used by others to f o r m impressions of one's self (Scheier & Carver , 1985). O v e r a l l , the results indicated that the model accounted for 23.5% of the variance in minority adolescent girls ' eating attitudes (F(5, 84) = 6.46, p < .001). T a b l e 8 Simultaneous Regression A n a l y s i s of Eat ing Pathology in G i r l s Measure B S E B 6 p-value S A T A Q Awareness subscale .010 .155 .065 .528 S A T A Q Internalization subscale .010 .113 .098 .385 Public self-consciousness .390 .159 .327 .016* Private self-consciousness .250 .164 .187 .130 R A D S .002 .046 -.052 ' .640 Predictors of Eat ing Attitudes in Adolescent B o y s Table 9, summarizes the results of the regression analysis for adolescent boys. Results of the analysis identified private self-consciousness as the only significant predictor of eating attitudes in the present sample of minority adolescent boys. A s described previously in the methods section, private self-consciousness is defined as the tendency to think about and attend to the aspects of the self that are personal in nature and not as vulnerable to the scrutiny of others (Scheier & Carver , 1985). O v e r a l l , the results indicated that the model accounted for 38.1% of the variance in minority adolescent boys ' eating attitudes (F(4, 33) = 6.68, p_ < .001). 70 T a b l e 9 Simultaneous Regression Analvs is of Eat ing Pathology in B o y s Measure B S E B 6 p_-value S A T A Q Awareness subscale .231 .255 .133 .371 S A T A Q Internalization subscale .135 .161 .124 .410 Public self-consciousness .321 .265 .196 .234 Private self-consciousness .649 .247 .414 .013* S u m m a r y and Conclusions T h e purpose of this study was to examine eating pathology and related sociocultural and psychological risk factors for minority adolescent girls and boys, respectively. Participants were 90 female and 38 male adolescents in grades 8-10 primarily f r o m South A s i a n and South East A s i a n cultural backgrounds. Preliminary analyses of eating attitudes and eating related behaviours among adolescent girls and boys indicated no significant difference in overall eating pathology as measured by the E A T - 2 6 . In addition, both adolescent girls and boys expressed dissatisfaction with their current body weight, although, girls indicated an overall desire for weight loss, and boys indicated an overall desire to gain weight. Across sociocultural and psychological variables, statistically significant gender differences were found in two measures. Adolescent girls demonstrated significantly less awareness of sociocultural attitudes towards appearance in comparison to adolescent boys. Conversely , adolescent girls demonstrated more favourable attitudes toward acculturation when compared to adolescent boys who reported more traditional beliefs, that is subscribing to the values and beliefs of their o w n culture. Significant differences were not found on measures of 71 internalization of sociocultural beliefs about appearance, depressive symptomology, self-esteem, self-consciousness, or imaginary audience beliefs. Correlational analyses were then conducted for adolescent girls and boys assessing the relation among eating attitudes to sociocultural and psychological variables. F o r girls, eating pathology was significantly correlated with the awareness and internalization o f sociocultural attitudes towards appearance, depressive symptomology, and public and private self-consciousness. Ea t ing pathology in adolescent boys was shown to significantly correlate with the internalization of sociocultural attitudes towards appearance, and public and private self-consciousness. F inal ly , the primary analyses revealed the predictive value of specific variables in determining eating attitudes for adolescent girls and boys was evaluated using a simultaneous regression analysis. Public self-consciousness was the only significant predictor of eating attitudes in girls and private self-consciousness was the only significant predictor of eating attitudes in boys. T h u s , the self-consciousness construct demonstrated statistically significant predictive value for eating pathology in ethnic minority adolescent girls and boys. Discuss ion O v e r v i e w A s described in the introduction, the current understanding of eating pathology among adolescents has been primarily derived f r o m research on European-Caucasian adolescent girls f r o m westernized countries (Striegel-Moore & Smolak , 1999). Because this research m a y not appropriately describe eating pathology in adolescents of other ethnic and cultural backgrounds, researchers have recently been concerned with assessing eating pathology among more diverse adolescent populations (Crago, Shisslak, & Estes, 1996; D o l a n , 1991; Smolak , L e v i n e , & T h o m p s o n , 2001). T h e purpose of the present study was to extend the literature by evaluating sociocultural and psychological correlates of eating pathology among ethnic minority adolescent girls and boys residing in a large urban city in western Canada. T h e primary intention of this study was to determine the manner in w h i c h these various sociocultural and psychological constructs predict eating attitudes among girls and boys. Preliminary analyses examining gender differences across the sociocultural and psychological constructs suggested that minority adolescent girls and boys d id not significantly differ in levels of eating attitudes, despite girls reporting an overall desire for weight loss and boys reporting a desire for weight gain. W h e n taking into consideration certain sociocultural and psychological constructs in combination, results indicated that public self-consciousness was the only significant predictor for eating attitudes in minority adolescent girls, and private self-consciousness was the only significant predictor of eating pathology in boys. O v e r a l l , results suggest the need further research in eating pathology among adolescents f r o m diverse ethnic and cultural backgrounds 73 Results are discussed in five sections. T h e first section provides a summary, interpretation, and appraisal of the present findings in relation to previous research and theory. T h e theoretical, empirical , and applied implications of the present findings are discussed in the second section. T h e strengths of this study are then presented in the third section of this discussion. T h e fourth section fol lows with a review of the limitations of this study, with specific attention devoted to shortcomings in the design, methodology and external validity of this study. F i n a l l y , in view of the present research findings, possible directions for future research are put forth. Eat ing Attitudes and Eat ing Related Behaviours in Adolescent G i r l s and B o y s In accordance with previous literature based on research examining eating pathology among European-Caucasian adolescents, significant gender differences i n eating attitudes among minority adolescent girls and boys were predicted (Striegel-Moore & C a c h e l i n , 1999; W o r e l l & T o d d , 1996). Specif ical ly , adolescent girls were expected to report elevated levels of disordered eating attitudes when compared with adolescent boys. Contrary to the hypothesis, results indicated no significant difference in overall attitudes towards eating between minority adolescent girls and boys. Interestingly, despite non-significant gender differences, 5.6% ( N = 5) of the adolescent girls, compared to none of the boys, reported levels of eating attitudes warranting further investigation according to criteria established by Garner, Olmsted , B o h r , and Garf inkel (1982). T h u s , despite the lack of support for gender differences in eating attitudes, the present study d i d f i n d that girls might be more l ikely to exhibit c l inical levels of eating pathology. There m a y be several reasons w h y gender differences in eating attitudes were not found in the present sample of minority ethnic youth. First, due to the l imited number of participants in 74 this study, there m a y not have been the statistical power necessary to detect gender differences. Second, Str iegel-Moore and S m o l a k (1999) suggested that ethnic minority adolescents m a y have psychological stresses that are unique to their minority status, such as poor development of their ethnic identity, racial prejudice, or varying religious beliefs that m a y result in increased levels of eating pathology when compared to the majority ethnic population. T h i s could be o f particular relevance to adolescent boys w h o have been found to have unfavourable attitudes towards acculturation, and prefer to maintain the beliefs of their ethnic culture ( G h u m a n , 1997). Interestingly, both adolescent girls and boys in the present sample reported elevated levels of eating pathology with mean scores on the E A T - 2 6 similar to other studies assessing European-Caucasian girls (Lachenmeyer & M u n i - B r a n d e r , 1998; Sjostedt, Schumaker, & Nathawat, 1998). A final explanation for w h y gender differences were not found c o u l d be that the E A T - 2 6 (Garner et al . , 1982) is not suitable for ethnic minority adolescents. A l t h o u g h the E A T - 2 6 has been demonstrated as a va l id measure for use across many minority ethnic populations (Chamorro & Flores-Ort iz , 2000, F u r n h a m & Patel, 1994), some items m a y be misinterpreted among adolescents f r o m non-western cultures. That is, certain items that are meant to describe eating pathology might describe appropriate behaviour i n some ethnic populations. F o r example, "I avoid eating when I a m h u n g r y " m a y be socially appropriate among some ethnic groups and m a y not be motivated b y disordered eating attitudes. A s the E A T - 2 6 has not been used extensively with South A s i a n and South East A s i a n adolescents, further research m a y be necessary to assess its validity with these populations. In this study, it was predicted that adolescent girls w o u l d report an overall desire for weight loss, whereas boys w o u l d report an overall desire for weight gain. Results supported this hypothesis. Specifical ly , significant gender differences were found in ideal weight change for 75 adolescent girls compared to boys. That is, adolescent girls reported an overall desire for weight loss and adolescent boys reported an overall desire for weight gain. A l t h o u g h it is unclear whether a muscular or heavier physique is desired for adolescent boys, results are consistent with reported sociocultural b o d y ideals for adolescents (Cohane & Pope, 2001). However , when asked about frequency of exercise, more minority adolescent boys compared with girls reported going to the g y m "of ten" . A l t h o u g h , the question d i d not specify the factors underlying their exercising, it m a y have been to encourage muscle growth to achieve their overall desire for weight gain. T h i s is consistent with findings f r o m M o o r e ' s study (1990) indicating that boys most c o m m o n concern regarding b o d y shape was being underdeveloped. Clear ly , further research assessing body image in minority adolescent boys is needed to determine their underlying motivation for exercising. Sociocultural Considerations in Adolescent G i r l s and B o y s Gender differences in the awareness of sociocultural beliefs about appearance, the internalization of sociocultural beliefs about appearance, and acculturation were considered in association with eating pathology in this study. It was predicted that minority adolescent girls w o u l d report greater awareness and internalization of sociocultural attitudes towards appearance and report more favourable beliefs towards acculturation than w o u l d adolescent boys. Adolescent boys reported significantly greater awareness of sociocultural attitudes towards appearance when compared with girls. These results suggest that adolescent boys are more aware of the muscular appearance ideal ascribed to males, the sociocultural pressures to be muscular, and the association between physical attractiveness and success, than adolescent girls were aware of the sociocultural standards ascribed to females. Conversely , gender differences were not found in the internalization of these beliefs. 76 In a similar study, Smolak , L e v i n e , and T h o m p s o n (2001) found that European-Caucasian adolescent girls exhibited greater awareness and internalization of sociocultural attitudes towards appearance than adolescent boys. A l t h o u g h no gender differences were f o u n d in this study the mean scores on the S A T A Q awareness and internalization scales reported for adolescent girls b y S m o l a k et al. were similar to the mean scores for the sample o f minority adolescent girls and boys in the present sample. T h i s m a y support A n d e r s o n ' s (1990) argument that media images of muscular men contribute to male b o d y image dissatisfaction as equally as female media images do. However , further research with ethnic minority adolescents is necessary to establish whether the awareness and internalization of these beliefs are due to exposure to western ideals, or whether these are consistent with their own cultural beliefs. Similarly , further evaluation of the effects of western media on the awareness and internalization of sociocultural beliefs is necessary to identify possible reasons for the gender differences found in this study. W i t h regard to acculturation, results supported the prediction that minority adolescent girls w o u l d report more favourable attitudes towards acculturation when compared to boys. G h u m a n (1997) reported similar findings with South A s i a n adolescent girls and boys l i v i n g in E n g l a n d . H e found that South A s i a n girls were more l ikely to accept the beliefs and ideals of the western culture whereas boys w o u l d be more l ikely to retain their o w n cultural beliefs. G h u m a n explained these gender differences by hypothesising that "girls have the most to gain by accepting the norms and practice of gender equality" (p. 32), thus are more w i l l i n g to adapt to western beliefs when compared with boys. Furthermore, in a study of race relations, F u r n h a m and Gunter (1989) f o u n d that Brit ish adolescent girls were more tolerant towards ethnic minority populations and expressed less negative racial prejudice than adolescent boys, hence were more 77 accepting of ethnic differences. O f interest for further research, is the association of race relations to acculturation and eating pathology among minori ty adolescent girls and boys. Gender Differences in Depression and Self -Esteem Consistent with previous findings, adolescent girls were expected to report greater levels of depressive symptomology and lower self-esteem when compared to boys. Contrary to what was predicted, minority adolescent girls and boys d i d not differ in their reported levels of depressive symptomology or self-esteem. W i t h respect to depression,, according to the R A D S manual (Reynolds, 1985), the overall mean score for minority adolescent girls fell in the 38 t h percentile, whereas the overall mean score for adolescent boys fell at the 47 t h percentile. Consequently, although gender differences in depressive symptomology were not found in this study, there was a tendency for females to report more symptomology when compared to boys. T h i s absence of a significant difference m a y have been due to the small sample size, particularly with regard to boys. Extant research in the area of gender and self-esteem has consistently demonstrated significantly higher self-esteem in adolescent boys compared to adolescent girls (Eccles & M i d g l e y , 1990; Z i m m e r m a n , Copeland, Shope, & D i e l m a n , 1997). Nevertheless, the findings of the present investigation are inconsistent with previous research (Rosenberg, 1965; Z i m m e r m a n et al.). A l t h o u g h no significant gender differences were found in the self-esteem of minori ty adolescent girls in comparison to boys, adolescent girls reported slightly lower overall self-esteem in comparison to adolescent boys. T h e discrepancy in these findings in comparison with research assessing gender differences in the majority Caucasian population supports the need to further evaluate possible 78 ethnic differences in the psychopathology of minority adolescents, particularly with adolescent boys. O n l y research using a larger sample size may shed some light on the present findings. Gender Differences in Self-consciousness and Adolescent Egocentr ism In accord with previous research, it was hypothesized that gender differences w o u l d exist on public self-consciousness, and imaginary audience, but w o u l d not be f o u n d on private self-consciousness and social anxiety. T h e present results d i d not support these predictions. Specifical ly , no significant gender differences emerged. D u e to the small sample size in this study, it is possible that there was not enough power to detect differences between adolescent girls and boys across these variables. Another reason as to w h y significant gender differences were not detected m a y be due to the validity of the S C S for use in an ethnically diverse adolescent population due to the language of some of the items on the Self-Consciousness Scale. F o r example, adolescents whose first language was not E n g l i s h m a y have misunderstood terms such as " d a y d r e a m " and "take a hard look at m y s e l f (Scheier & Carver , 1985). T h u s , additional evaluation of the utility o f the Self-Consciousness Scale with minority adolescents. Similar ly , with reference to adolescent egocentrism, contrary to the prediction, results demonstrated no overall gender difference i n the belief o f the imaginary audience as measured by the Imaginary A u d i e n c e Scale ( E l k i n d & B o w e n , 1979). A c c o r d i n g to E l k i n d and B o w e n , significant gender differences in imaginary audience behaviour are expected as girls have been shown to demonstrate heightened self-awareness when compared to adolescent boys. T h u s , further evaluation of this construct and the use of the Imaginary A u d i e n c e Scale with mult i -ethnic populations is needed 79 Correlates and Predictors of Eat ing Attitudes in Adolescent G i r l s Correlational analyses revealed that eating attitudes in minority adolescent girls were significantly related to the awareness and internalization of sociocultural beliefs about appearance, depressive symptomology, and public and private self-consciousness. Results were somewhat consistent with the literature on European-Caucasian females and provide moderate support for the risk factor model presented by Str iegel-Moore and S m o l a k (2000). Reca l l , in Figure 1 that there are three areas specifically identified as having significant direct relations with the development of eating pathology, w h i c h include sociocultural context, body image concerns, and self-deficits. Results of this study provide support for the relation of all three areas to eating pathology in ethnic minority adolescent females. Specifical ly , the significant relation between eating pathology and the awareness of western attitudes towards appearance supports the relation of sociocultural context to eating pathology. A s wel l , the internalization of western ideals of physical beauty provides support for the relation of body image concerns to eating pathology. F inal ly , the relation of depressive symptomology with eating pathology demonstrates the relation of self-deficits to eating pathology. A l t h o u g h self-consciousness was not considered specifically in the model , this construct is associated with adolescence, providing a developmental framework to the original Str iegel-Moore and S m o l a k m o d e l . A c c o r d i n g to Striegel-Moore and Smolak, previous research have used depression, self-esteem, self-concept, interceptive awareness, social-self disturbance, and social anxiety to assess self-deficits relating to eating pathology. Ov e r a l l , with the exception of self-esteem, the sociocultural and psychological correlates of eating pathology identified in this study are similar to those found in research with European Caucasian adolescents (Dolan, 1991; Str iegel -Moore & Smolak , 1996). Self-esteem m a y not be significantly related to eating pathology in this sample due to the use of the Rosenberg Self -Esteem Scale (Rosenberg, 1965), w h i c h is a measure of global self-esteem. T h i s scale is not designed to differences across domains of self-esteem (e.g., physical , academic, and social). A d d i t i o n a l research should assess the relation of eating pathology to alternative measures of self-esteem or self-concept to establish a measure of self-esteem that is appropriate for use with ethnic minority populations, and with relation to eating pathology. F inal ly , as private and public self-consciousness were both significantly related to eating pathology in adolescent girls, it m a y provide additional support to the contribution of self-deficits to eating pathology. Research assessing self-consciousness across larger samples of ethnic minority and majority adolescent girls m a y provide evidence for another relevant risk factor to be included in the Str iegel -Moore and S m o l a k (2000) model . F i n a l l y , further evaluation of the role of imaginary audience in the development of eating pathology is required to adequately assess gender and cultural differences in these constructs. Because research specifically assessing relations between imaginary audience and other maladaptive adolescent behaviours have suggested positive relations between pathology and heightened self-consciousness and belief in the imaginary audience ( A k a n & G r i l o , 1995; Jostes, Pook, & F l o r i n , 1999), specific evaluation of these variables in the development of eating pathology is necessary. T o examine how constructs in combination predicted eating attitudes, the five constructs demonstrating significant relations with eating attitudes in the sample of minority adolescent girls in this study were entered into a simultaneous multiple regression analysis with eating attitudes as a dependent variable. O f the five variables entered, public self-consciousness ( P U S C ) was the only significant predictor of eating pathology identified for this sample after taking into consideration all o f the other variables in the model . A s a result, this construct should 81 be further evaluated to determine its utility as a potential risk factor. H o w e v e r , multicollinearity of the predictor variables of eating attitudes used in this study was a concern. Specif ical ly , P U S C was significantly related to all the other variables entered into the regression analysis. Consequently, the variables entered into the regression analysis were not independent constructs, l imit ing the results of this study. Nevertheless, results of this analysis suggest that P U S C requires further evaluation as a risk factor in the development of eating pathology for ethnic minority adolescent girls. Reca l l , public self-consciousness is defined as the tendency to think about personal characteristics that are matters of public display, such as one's physical appearance. T h e use of this construct in the identification of eating pathology among minority adolescent girls should be evaluated further in order to establish the significance of this variable as a risk factor. Correlates and Predictors of Eat ing Attitudes in Adolescent B o y s F o r the ethnic minority adolescent boys in this study, eating attitudes were significantly related to the awareness and internalization of sociocultural standards of appearance, and private and public self-consciousness. Present results are somewhat consistent with the findings reported for females, as well as with the risk factor model described by Str iegel-Moore and S m o l a k (1999). In comparison to the adolescent girls, eating attitudes in boys were significantly related to the same variables, with the exception of depression. That is, eating attitudes for adolescent boys was significantly related to the awareness and internalization of sociocultural beliefs towards appearance, and public and private self-consciousness. T h i s is inconsistent with previous findings in the literature indicating significant relations between depressive symptomology and eating pathology among adolescent girls and boys (Fava et al , 1997; 82 Reynolds , 1996). T h u s , ethnic differences i n the relation of eating pathology to depressive symptomology should be further explored. Overal l results among ethnic minority adolescent boys provide moderate support for the Striegel-Moore and Smolak . Significant findings were f o u n d in the relation of eating attitudes to the awareness of sociocultural beliefs, the internalization of sociocultural standards of b o d y image, and heightened public and private self-consciousness. A l t h o u g h self-esteem and depression were not significantly related to eating attitudes in this population, these constructs should be further explored as potential risk factors in their development of eating pathology among minority adolescent boys. A s with adolescent girls, alternative measures of self-esteem and self-concept should be evaluated. Overa l l however, results support further research exploring eating pathology among ethnic minority adolescents. T h e relations of the awareness and internalization of sociocultural standards and expectations of physical appearance to eating attitudes demonstrated the importance of the sociocultural environment to eating pathology in minority adolescent boys. A n addition to the model for boys might include measures that identified the desire for a muscular and developed physique. T h e S A T A Q (boys version) for example, may be an important tool to use to understand the relation between the internalization of muscular ideals and eating attitudes (Smolak, L e v i n e , & T h o m p s o n , 2001). In order to assess the predictive value the awareness and internalization of sociocultural attitudes towards appearance and public and private self-consciousness to eating pathology in combination a simultaneous regression analysis was conducted for adolescent boys. Results indicated private self-consciousness ( P R S C ) was the only significant predictor of eating attitudes among minority adolescent boys after taking into account the other variables entered into the 83 regression analysis. Recal l P R S C is the tendency to think about one's o w n aspects of the self, which are personal in nature. T h e issue of multicollinearity was a limitation of this analysis. Specif ical ly , P R S C was significantly correlated with the internalization of sociocultural beliefs about appearance, and public self-consciousness. H a m m o n d (2000) recommends that the variables entered into a regression analysis should be statistically independent to accurately assess the c o m b i n e d contribution of a set of unique constructs, thus multicolinarity of these variables entered into the regression limits the results of the analysis. Nevertheless, results of this analysis suggest that P R S C requires further evaluation as a risk factor in the development of eating pathology for ethnic minority adolescent boys. Implications of Results In review of the findings described above, three major results of this study can be identified. First, no gender differences in eating attitudes were demonstrated and reported levels of eating pathology in minority adolescent girls and boys were not significantly different. Second, adolescent girls desired overall weight loss, whereas boys desired overall weight gain, suggesting significant gender differences ideal weight. F i n a l l y , in examining the predictive variables in combination, public and private self-consciousness emerged as significant predictors of disordered eating attitudes for ethnic minority adolescent girls and boys, respectively. T h e results of this study have implications to our theoretical, empirical , and applied understanding of eating pathology among minority adolescent populations. These implications are discussed in detail below. 84 Theoretical Implications In general, results of this study supported the need for further evaluation of eating pathology among minority adolescent girls and boys . Because no significant gender differences were found, and no comparative European-Caucasian population was assessed in the present study, more research is clearly needed. Inconsistent with the literature, gender differences in eating attitudes, and certain sociocultural and psychological variables f o u n d among European-Caucasian adolescents, were not found among ethnic minority adolescents in this study ( E l k i n d & B o w e n , 1979; N o l e n - H o e k s e m a & Grigus , 1994; Rosenberg, 1965; Sjostedt, Schumaker, & Nathawat, 1998; Str iegel-Moore & Smolak , 1996). A s such, eating pathology in minority adolescents should be compared to adolescents f r o m the majority European-Caucasian ethnic population to assess ethnic and cultural differences. Str iegel-Moore and S m o l a k (2000) suggested that psychological stresses related to ethnic minority status, such as racial prejudice and discrimination, be included in future research assessing eating pathology with minority populations. O f additional theoretical concern is the role of media in the development of eating pathology among ethnic minority adolescents. In the present study, ethnic minori ty adolescent boys reported heightened awareness of the western sociocultural standards of appearance as compared with adolescent girls. A s wel l , adolescent boys and girls reported similar levels of internalizing these standards. Because western media often depicts sociocultural standards of appearance, the relation of media to the awareness and acceptance of sociocultural beliefs for ethnic minority adolescents with regard to eating pathology should be evaluated. A t present however, the role of the media in the development of eating pathology in ethnic minority adolescents is underestimated due to the lack of minority representation in the media (Striegel-M o o r e & Smolak , 1996). Clear ly , further research in this area is needed Another important theoretical concern with regard to the development of eating pathology among minority adolescents is the relation of public and private self-consciousness to eating pathology among adolescent girls and boys. Results of this study assessed the relation of self-consciousness to eating attitudes to apply a developmental framework to the Str iegel-Moore and S m o l a k (1999) model . Results of the present study found self-consciousness to be a significant predictor of eating attitudes for ethnic minority girls and boys . T h u s , a developmental model for adolescent eating pathology that includes self-consciousness might provide further insight into the critical period of adolescence for the development of eating pathology. In general, results support the need to continue research in the development of eating pathology across and within ethnic groups in order to expand our current understanding of eating pathology among adolescents (Crago, Shisslak, & Estes, 1996; D o l a n , 1991; L e e , 1996). Implications for Research There are several implications for research that have emerged f r o m the present study. Firstly, results f o u n d no significant differences in this sample of minority ethnic adolescent girls and boys across most dependent measures. A l t h o u g h no comparative European-Caucasian sample was used in this study, the present results were inconsistent with previous research that has reported gender differences among European-Caucasian adolescents. T h u s , further research should clearly evaluate ethnic and cultural differences in eating pathology among a variety of adolescent populations. Second, the desire for weight gain and muscular development for minority adolescent boys was an important distinction when compared with adolescent girls ' desire to loose weight 86 (Cohane & Pope, 2001). T h e relation between eating pathology and the desire for weight gain in boys requires further exploration. A s eating pathology is generally associated with the desire for thinness (Lee, 1996), research assessing possible methods of weight gain, such as the use of steroids, f o o d supplements, exercise and weight training and dietary restrictions is necessary. T h i s may be a more appropriate framework in evaluating eating pathology in adolescent boys than the model of thinness currently util ized (Moore , 1999). A final empirical implication of this study relates to the use of self-consciousness as a significant predictor of eating attitudes among minority adolescents. T h e development of self-consciousness in relation to eating pathology should be considered across a variety o f populations. T h e implications of the present findings found self-consciousness to be a significant predictor of eating attitudes among ethnic minority adolescents. T o accurately assess this implication across other populations, self-consciousness should be further explored in relation to eating pathology. A p p l i e d Implications Current D S M - I V criteria for the diagnosis of eating disorders m a y be l imited for adolescent boys due to the criteria requiring a desire for thinness and weight loss, or the prevention of weight gain, to be supported across all diagnostic categories, such as anorexia nervosa and bul imia nervosa. A l t h o u g h 5-10% of those diagnosed with eating disorders are male, additional consideration for those with a desire to gain weight is required. Currently, all diagnostic and screening tools for eating pathology focus primari ly around the desire for thinness and weight loss. However , these screening tools m a y be inappropriate for use with adolescent boys who m a y exhibit a pathological association with food, but see their ultimate objective as weight gain. Cohane and Pope (2001) described a growing concern among muscular men who 87 perceive themselves as thin and underdeveloped, referred to as "muscular dysmorphia" . Unfortunately, at present, little is understood about the development of this disorder in adolescent boys. In addition, diagnostic and screening instruments m a y benefit f r o m the consideration of self-consciousness as a possible predictor of eating pathology among adolescent girls and boys . T h e onset of eating pathology in association with adolescent egocentrism and self-consciousness should be further evaluated to establish assessment methodologies for adolescents. Strengths of the Study A l t h o u g h there are several limitations of this study, there are notable strengths worth discussing related to the theoretical design and the methodology used in this study. Theoretical D e s i g n B e y o n d extending the literature of eating pathology to consider gender differences in ethnic minority adolescents, this study expanded the understanding of the relation of self-consciousness and imaginary audience in eating pathology. T h i s study considered the role of adolescent egocentrism in eating pathology, a limitation in the Str iegel-Moore and S m o l a k (2000) model , and tested E l k i n d ' s theory relating egocentrism to eating pathology for adolescents. Results suggest that self-consciousness, a dimension of adolescent egocentrism, was significantly related to eating pathology among this sample of ethnic minority girls and boys. In addition to considering a developmental framework to eating pathology in adolescents, this study also expanded our l imited understanding of the c o m b i n e d relations of the sociocultural and psychological correlates identified by Str iegel-Moore and S m o l a k (2000). A s described in 88 the introduction, unique to this study was the model of variables selected in relation to eating pathology among adolescent girls and boys. M e t h o d o l o g y A methodological strength of this study was the ethnic distribution of the present sample. A l t h o u g h this sample consisted largely of South A s i a n and South East A s i a n adolescents, these ethnic groups are the least studied minority populations and represent the two largest ethnic minority groups in Canada . In addition, internal consistency reliability, as measured b y Cronbach 's alpha, across all of the measures uti l ized in this study were appropriate and comparable to previous research findings. Limitations of Study Several limitations of the present study have already been mentioned throughout this section. A detailed discussion of these and several other limitations are provided next. Specifically , limitations in the design, external validity, measurement, and statistical analyses are reviewed. D e s i g n A primary limitation of this study is the failure to separate or differentiate among ethnic minority adolescents. W h e n research has attempted to assess ethnic differences, minority populations are often separated based on ethnicity or racial catergorization. Unfortunately, due to variability within ethnic populations, (e.g., language, level of education, and number of years in Canada), these distinctions may result in inappropriate and unreliable conclusions and as a consequence, is no longer recommended best practice (Doucette-Gates, B r o o k s - G u n n , & Chase-Lansdale , 1998; G h u m a n , 1997). A l t h o u g h little is understood about the most appropriate w a y to assess differences due to ethnic and cultural heritage, qualitative methods of distinction are 89 suggested depending on the objective of the research, such as religious status and length of time in host country. T o explore ethnic and gender differences in this sample, an exploratory assessment of gender and ethnicity in eating attitudes and all related sociocultural and psychological variables among South A s i a n and South East A s i a n adolescent girls and boys, a 2 (ethnicity) x 2 (gender) between group analyses was conducted (see A p p e n d i x T ) . Ethnici ty was then added into the previously conducted regression analyses for boys and for girls to assess the contribution of ethnicity to the predictive model for eating attitudes (see A p p e n d i x TJ). Another limitation of this study was the absence o f a sample o f European-Caucasian ethnic majority adolescents. T o appropriately assess eating pathology among ethnic minority adolescents, a comparison with ethnic majority adolescents was necessary to adequately interpret the present f indings. T o restore this limitation, results of this study were interpreted in relation to previous findings in the literature assessing gender differences found in other ethnic populations, including that of the European-Caucasian majority population. Future research should utilize a comparative sample of European-Caucasian adolescent girls and boys. A final limitation to the design of this study was with regard to the assessment of the B o d y M a s s Index ( B M I ) . Because research has demonstrated the relation between the ratio of an adolescent's weight to height, or B M I , and eating pathology, it is important to accurately evaluate this ratio. Unfortunately, only 82% of the sample in this study reported their current weight and height, w h i c h were needed to calculate B M I . Consequently, because of this resulting reduction in sample size, the relation of B M I to eating pathology c o u l d not be established in this study. T h u s , any variance in eating pathology, or other psychological and sociocultural variables due to significant differences in B M I , could not be assessed. T o avoid this situation in the future 90 evaluation of eating pathology in adolescents should incorporate standardized measurements of each participant's weight and height and should not rely on the use of adolescent self-report. M e t h o d o l o g y Participants O n l y 64% o f the 274 adolescents invited to participate in this study returned signed consent forms, wither either a " y e s " or a " n o " marked on the f o r m . Despite waiting 8-12 days for the return of guardian consent forms the return rate was limited, consequently confining the representativeness of the final sample. T h i s m a y have been a result of the responsibility of the return of consent forms placed entirely on the adolescent who must remember to bring the f o r m to their parents, and return in back to the school within a specified time frame. Furthermore, some adolescents m a y have decided against participation and refused to deliver consent forms to their guardian due to issues of confidentiality presented in this study. A l t h o u g h the content of the study was not specifically described to the participants, they were notified that some of the questionnaires were designed to detect adolescents who were in need of further support, and that those adolescents w o u l d consequently be reported to the school counsellor. T h u s , some adolescents m a y have declined participation to avoid this occurrence. F i n a l l y , adolescents may not have returned guardian consent forms due to the language in w h i c h the f o r m was written. A s a school with a high ethnic population was selected, several of the students and parents may not have been comfortable signing the consent and assent forms. T h e disproportionate number of minority adolescent boys, compared to adolescent girls who participated i n the study, limits the generalizability of these results across other adolescent populations. T h i s intern limits the validity and reliability of the comparative analyses between boys and girls. T h e small sample of minority adolescent boys is a primary concern when 91 considering statistical power; that is, a small sample reduces the power of the analyses conducted. T o increase the participation of adolescent boys, classes with high concentrations of boys should be targeted. F inal ly , the ethnic variation in the sample o f minority adolescents was also disproportionately distributed. T h e majority of adolescents that participated were of South A s i a n and South East A s i a n ethnicity. A l t h o u g h these are the largest minority populations represented in Western Canada (Census Canada, 1996), a more diverse ethnic sample w o u l d have increased the generalizability of these findings to other ethnic minority populations. Measures T h e use of measures utilized in this study for ethnic minority adolescents requires further evaluation empirical investigation. A s described in previous sections, certain items in these scales might be misinterpreted across ethnicity due to differences in language and cultural attributes. T h u s , to appropriately assess eating pathology and various sociocultural and psychological risk factors among ethnic minority adolescent populations, further evaluation of these measures is needed. A s suggested in the introduction, little is understood about the development of eating pathology in ethnic minority adolescents and the applicability of current research to these populations (Harris & K u b a , 1997). M o r e o v e r , the importance of further investigation to understanding this population is essential. There was an additional concern with regard to the use of the Aberystwyth Acculturation Scale. A l t h o u g h the reliability of the scale was consistent with those previously reported ( G h u m a n , 1997), this scale was modif ied f r o m an original scale constructed for South A s i a n adolescent immigrants residing in E n g l a n d . T h u s , some items m a y have been appropriate for use with only South A s i a n adolescents, thus, m a y have been misinterpreted by adolescents f r o m 92 other cultures. F o r example, "Students should accept the clothing f r o m m y culture" m a y not have been appropriate for ethnic minority populations who do not have traditional clothing and "marriage should be arranged by the f a m i l y " m a y be inapplicable for cultures that do not condone this practice. Perhaps, culture specific scales of acculturation should be considered in order to identify the rates at which particular ethnic groups adapt into the western dominant culture. External V a l i d i t y F o r several reasons, the generalizability of these findings to other ethnic minority populations is l imited. Firstly, as described in the methods section, participants were selected f r o m a highly ethnic suburb in a large Western Canadian city. O f the initial participants, only 11 adolescents identified themselves as European-Caucasian, w h i c h represents only 7% of the total sample. O f the remaining sample, 55.4% were South A s i a n and 35.4% were South East A s i a n . D u e to the larger distribution of ethnic adolescents in comparison to the non-ethnic sample, this sample m a y not exhibit the sociocultural and psychological characteristics typical of ethnic minority populations in Canada. In fact, as South A s i a n and South East A s i a n adolescents comprised the majority ethnic distribution in their school, whereas European-Caucasian adolescents represented the ethnic minority. Similar ly , the disproportionate number o f South A s i a n and South East A s i a n adolescents in the final sample restricted the generalizability of these findings to other ethnic populations. W i t h i n group differences have also been found among South A s i a n adolescents of different religious affiliations. Consequently, the results of this study m a y be l imited and not applicable to other ethnic populations. 93 Statistical Analyses T h e overall disproportionate number o f minority adolescents that participated in this study l imited several statistical procedures performed. Specif ical ly , the independent t-tests that were conducted to identify gender differences, as wel l as the simultaneous regression analyses may have been compromised due to the small number of adolescent boys w h o participated. That is, the number of participants util ized in this study l imited the power of the statistical analyses. D u e to this l imited power, there was a loss of the statistical strength needed to discern possible differences between the populations. In addition, with regard to the multiple regression analyses, there was a possibili ty for T y p e I error due to the number of predictor variables entered in comparison with the number of subjects in the sample ( H a m m o n d , 2000). F i n a l l y , the multicollinearity of the predictor variables limits the validity of the statistical model established for both adolescent girls and boys. Directions for Future Research There are many areas upon w h i c h to expand and improve the current study. O f initial interest w o u l d be to further evaluate differences in eating pathology across ethnic and cultural populations. O f specific interest are the similarities and differences in eating pathology among ethnic adolescents residing in western countries. Future research w o u l d benefit f rom further evaluation o f ethnic minority adolescents l i v i n g within a western majority culture as compared with their peers l i v i n g in their country of ethnic origin. In addition, the relation of acculturation, immigration, and racial prejudice to eating pathology m a y provide greater insight into these populations. T o understand eating pathology among adolescent boys, it m a y be appropriate to assess whether eating pathology is a "fat p h o b i c " disorder across gender. Perhaps prevalence rates in 94 boys are lower as compared with girls due to established D S M - I V diagnostic criteria for eating disorders, and not due to true prevalence rates. Research in eating pathology i n adolescent boys across ethnicity w o u l d benefit f r o m a consideration of behaviours that promote the desire to be muscular. Behaviours that m a y contribute to pathology m a y include steroid use, use of dietary supplements, and intense exercise. Future studies should also assess the relation of self-consciousness to eating pathology. T h e relation of self-consciousness and adolescent egocentrism to other areas of psychopathology in adolescents should also be considered. F inal ly , consideration of appropriate methods to assess ethnic and cultural differences among adolescent populations should be established. S u m m a r y D u e to increased vulnerability and prevalence rates of eating pathology in European-Caucasian females, research has relied largely on this population in developing our current understanding of eating related behaviours ( O s v o l d & Sodowsky , 1993). A s a consequence, our current knowledge of the characteristics and correlates of eating pathology, inc luding our diagnostic criteria and treatment options for patients with anorexia and b u l i m i a nervosa, are inherently l imited. Recent literature has begun to assess eating pathology in males, as w e l l as i n individuals of varying ethnic decent in attempt to alleviate this shortcoming (Crago, Shisslak, & Estes, 1996; D o l a n , 1991). Despite the increase in empirical attention however, our understanding of eating pathology among ethnic minority adolescents l i v i n g among a European-Caucasian majority culture is l imited. Therefore, the intention of this study was to further our understanding o f the sociocultural and psychological risk factors as predictors of eating pathology i n ethnic minority 95 adolescent girls and boys l i v i n g i n western Canada. Specif ical ly , this study aimed to expand our understanding of the relation of eating attitudes to sociocultural factors, depression, self-esteem, self-consciousness and adolescent egocentrism in a sample of ethnic minority adolescent girls and boys respectively. Results found no overall differences in eating attitudes among ethnic minority adolescent girls and boys. Interestingly however, adolescent girls reported a desire for overall weight loss and adolescent boys desired overall weight gain. G i r l s were also less l ikely to exercise or describe the f o o d their f a m i l y eats as healthy. Results also indicated that girls are less aware o f western sociocultural beliefs about appearance, although are more l ikely to acculturate to the western culture when compared to boys. x Correlational analysis for adolescent girls and boys revealed several significant relations among eating pathology and many of the sociocultural and psychological variables examined in this study. Nevertheless, when entered into a simultaneous regression analysis a single significant predictor was found with for each gender. Public self-consciousness was found to be the only predictor of eating pathology for adolescent girls and private self-consciousness was found to be the only significant predictor of eating pathology in adolescent boys. O v e r a l l results supported the importance of self-consciousness as a risk factor in the development of eating pathology for ethnic minority adolescent girls and boys. T h e intention of this study was to assess the relation of eating attitudes to the sociocultural and psychological risk factors of eating pathology as identified by Str iegel -Moore and S m o l a k (1999) as well as to further our understanding o f eating pathology in ethnic minority adolescent girls and boys. 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Journal of Y o u t h and Adolescence , 26, 117-141. 112 A p p e n d i x A : D S M - I V Criteria for A n o r e x i a N e r v o s a T h e f o l l o w i n g four criteria must be met: A . Refusal to maintain b o d y weight at or above a m i n i m a l l y normal weight for age and height. B . Intense fear of gaining weight or b e c o m i n g fat, even though underweight. C . Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight on self-evaluation, or denial of the seriousness of the current low body weight. D . In postmenarcheal females, amenorrhea (i.e., the absence of at least three consecutive menstrual cycles. A n o r e x i a Nervosa can be further classified into two subtypes: ' 1. Restricting T y p e : D u r i n g the current episode of A n o r e x i a Nervosa , the person has not regularly engaged in binge-eating or purging behaviour (i.e., self-induced vomit ing or the misuse of laxatives, diuretics, or enemas). 2. Binge-Eat ing/Purging T y p e : D u r i n g the current episode of A n o r e x i a Nervosa , the person has been engaged in binge-eating or purging behaviour (i.e., self-induced vomit ing or the misuse of laxatives, diuretics, or enemas). 113 A p p e n d i x B : D S M - I V Criteria for B u l i m i a N e r v o s a T h e f o l l o w i n g five criteria must be met: A . Recurrent episodes of binge eating. A n episode of binge eating is characterized by both of the fo l lowing : c) eating in a discrete period of time (e.g., within any 2-hour period), and amount of f o o d that is definitely larger than most people w o u l d eat during a similar period of time and under similar circumstances, d) a sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how m u c h one is eating) B . Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomit ing: misuse of laxatives, diuretics, enemas, or other medications: fasting; or excessive exercise. C . T h e binge eating and inappropriate compensatory behaviours both occur, on average, at least twice a week for three months. D . Self-evaluation is unduly influenced by body shape and weight. E . T h e disturbance does not occur exclusively during episodes of A n o r e x i a Nervosa . B u l i m i a Nervosa can be further classified into two subtypes: 1. Purging T y p e : D u r i n g the current episode of B u l i m i a Nervosa , the person has regularly engaged in self-induced vomit ing or the misuse of laxatives, diuretics, or enemas. 2. N o n p u r g i n g T y p e : D u r i n g the current episode of B u l i m i a Nervosa , the person has used other compensatory inappropriate behaviours, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomit ing or the misuse of laxatives, diuretics, or enemas. A p p e n d i x C : Student Recruitment Letter T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A up Department of Educational and Counselling Psychology, and Special Education Faculty of Education 2125 Main Mall Vancouver, B .C. Canada V 6 T 1Z4 Main Office Tel: (604) 822-8229 Fax: (604) 822-3302 Program Areas Special Education School Psychology Measurement, Evaluation & Research Methodology Human Learning, Development, & Instruction Counselling Psychology Tel: (604) 822-5259 Fax: (604) 822-2328 Dear Student, You have been invited to be a participant in a research project that we are conducting at your school entitled "Understanding Adolescent Health". Dr. Kimberly Schonert-Reichl and Farah Bhimani from the University of British Columbia are organizing this study. The purpose of this study is to investigate the relation of culture to eating attitudes and other psychological characteristics in students in grades 8 through 10. Since there is very little on this topic from Canadian students, your participation in this study can help us better understand the needs of other Canadian teenagers just like you. We also hope that the results of this study will help teachers and parents better understand the needs of students across Canada. If you decide to participate in this study, you will be asked to fill out a set of questionnaires that will take you approximately 30 minutes to complete. One of the questionnaires will ask you about your background, which will tell us more about you and your family. The others will ask you questions about your thoughts and feelings towards food, your beliefs about appearances, how you feel about yourself and how you feel in certain situations. There are no right or wrong answers; the only answers we are looking for are your honest ones. Your name will not be recorded anywhere on the questionnaire, so all of your answers will be completely confidential. This means that your answers will not be available to anyone at school, including your teachers, or your parents. It is important to note however, that although your specific answers will not be available to anyone, they may exhibit levels of well being and attitudes towards eating that warrant further investigation. In this case, you and your family will be notified individually and suggestions for further evaluation will be offered to you. Additionally, the school counsellor will be prepared to work with you and provide you with appropriate follow-up information if you and your family choose to do so. Those of you who decide not to participate in this study will be given something else to do in your class related to your regular classroom instruction. For those of you who return your permission slip, you will have a chance of winning a $15.00 gift certificate for A & B Sound. One student, whose name will be randomly drawn from each class, will be awarded the certificate. In order for you to participate in this study, you need to take home the attached permission slip and give it to your parent or guardian, so that they may sign it. Please do your best to return the permission slip to your teacher by tomorrow. Thank you for considering this request. We hope that you agree to participate! Sincerely, Kimberly Schonert-Reichl, Ph.D. & Farah Bhimani Version: January, 2001 A p p e n d i x D : Guardian Consent F o r m Study Procedures: Students who participate in this study, will be asked to fill out a set of questionnaires in their classrooms, which will require approximately 30 minutes to complete. One set of questions asks students to provide information about their background, such as their birth date and place of birth. A s well, this questionnaire also asks students about their guardian's level of education, occupation, and general health and activity level. The other questionnaires will assess the students' attitudes towards food and eating, beliefs about appearance, overall self-esteem, feelings about themselves and others, and general emotional well being. Students who do not to participate in this study will be given an activity to do that is related to a topic being covered in their regular class. Due to the nature of this study, a small number of students may exhibit levels of well being and eating behaviours that warrant further investigation. These students will be notified individually and suggestions for further evaluation will be offered. Your child's scores and original questionnaires however, will not be made available to anyone. Additionally, the school counsellor will be prepared to work with these individuals and provide the student with appropriate follow-up information if the student and family choose to do so. Confidentiality: Participation in this study is entirely voluntary and withdrawal from the research study or refusal to participate will not jeopardize the student in any way. All information collected will be strictly confidential and will not be available to students, teachers, parents or any other school personnel. No names will appear on any of the questionnaires; instead numerical codes will be assigned to each student. This is done in order to ensure that students who may benefit from further evaluation can be identified. No individuals other than the investigators of this study will have access to the information collected from the students. Remuneration / Compensation: All students who return consent forms, whether guardian consent is provided or not, will have the opportunity to win a $15.00 gift certificate for A & B sound. One student from each participating class will be randomly selected as the winner. Needless to say, we would be extremely pleased if your son or daughter decides to participate and if you are willing to give him or her permission to do so. Thank you very much for your time and consideration of this request. Consent Form Version: February, 2001 Page 2 of 3 A p p e n d i x E : Student Assent F o r m A p p e n d i x F : Research Assistant 's Instruction for Administrat ion 124 INSTRUCTIONS FOR THE ADMINISTRATION OF QUESTIONNAIRES EATING ATTITUDES STUDY GENERAL REMINDERS • Arrive at the classroom a few minutes B E F O R E the scheduled testing time to introduce yourself to the teacher, organize the permission slips, and make note of any absentees • Have all testing materials ready. Testing times are limited, so do not waste time between tasks • Ask the teacher to remain in the classroom (this will help reduce behaviour problems and increase students' attention to the task). Also, remind the teacher that work needs to be prepared for the non-participating students. • Some students are in more than one participating classroom. For these students, please find out if they have already completed the survey before beginning. BEFORE YOU BEGIN • Check with the teacher about any students who might need additional support. Questions may need to be read aloud to these students • Remember that students can participate O N L Y if he/she has received parental consent. Participating students however, may drop out A T A N Y TIME if he/she wishes to do so. • Ask the teacher what work the students can do if they finish the questionnaire E A R L Y TIME (MiN) RESK Afttu ASSISTANT M: R K S K A K I . I L A N S I S 1 A N ' I #2 1 1. Introduction to students Hello my name is , and this is . We came here today from U B C to give you a survey about teenagers living in Canada. For our project we want to find out more about how students your age think about themselves, so we really appreciate your help. For all of you who remembered to return your permission slips, we will be announcing the winner of the A & B sound gift certificate at the end of the survey. Prepare for data collection • Collect all permission slips from the teacher and any new ones that come in at the beginning of class. • On the class list in this package, check off the students who received parental consent • Make a note of any absentees • Place student packages in B O Y and GIRL piles on the front desk • Keep student ID lists ready for administration • Place permission slips in large envelope 1 2. Non-Participating Students For those of vou who will N O T be filling out the survey, your teacher will explain to you what you will be doing during the next Vi hour. 1 3. Before you start, there are a few things you need to know • THIS IS N O T A TEST. Even though there are no right or wrong answers, this is a very serious survey. We need to make sure that we get accurate results in our study. No one but the researcher will see your questionnaire, so please answer honestly. • Y O U R ANSWERS A R E C O M P L E T E L Y CONFIDENTIAL. This means that vour answers will be kept private. Your parents or teachers will not see your answers. N O T A L K I N G . Because this is serious, we would like you to keep your answers to yourself. Please do not discuss the survey with your friends. 125 TJMV RrSFAKf.ll ASMSI AN r #t: Rvw vRCir ASSIST o a #2 3 4 Explain student assent form Even though we already have your parents' permission for you to complete the survey, we also need your permission to do so. The form that is handing out now tells you about the study and about your promise to keep your answers private. If you do not want to participate, that's okay. Since we really need your help on this project, we hope that you do decide to participate. Does anyone have any questions? If not, please sign the form and put it on the RIGHT HAND CORNER OF YOUR DESK and will come and collect them. Hand out student assent form 2 5. FIRST: Hand out student packages and class lists with student identification numbers to BOYS. Ask all the participating boys to raise their hands. SECOND: Hand out student packages and class lists with student identification numbers to GIRLS. After the boys have received their packages, ask all the participating girls to raise their hands. 5 6. Monitor students and be available for questions • Collect all student ID class lists • When questions are asked: FIRST, re-read the question to them again saying, "what would you say if I said...". See list of definitions for common confusions. If it is not on the list do the best you can to define the term • Make notes of anything that you observe during the assessment process and any questions asked. • Circulate the room to see if students are having any problems and offer your assistance. • As students finish up COLLECT their questionnaires \ Administration Before we start, could everyone please clear off your desks? Please raise your hand if you need a pen? • Read the first page of the questionnaire package directions carefully. Stress that the students may answer the multiple-choice questions by either marking it with a check or a cross. • Read the first three questions of the demographic questionnaire aloud so that the students get the idea. For #2: Even though we are all Canadian, we want to know your ethnic background. If you have more than one, check all the cultural groups that apply. Okay, go ahead and continue filling out the rest of the form. If you have any questions, \please ask one of us for help. 25-30 7. Continue to monitor students and be available for questions Monitor students and be available for questions (see opposite box for instructions) 1 8. Thank all students Draw and announce the name of the A & B sound gift certificate winner 1 9. Collect Questionnaires Hand out Candy 10. SAY GOODBYE AND THANK STUDENTS AND TEACHER FOR THEIR TIME! IlIIIIII^  45 MINI , n;s 126 A p p e n d i x G : Defini t ion of T e r m s 127 R A GUIDELINES T O STUDENT ASSESSMENT P A C K A G E DEFINITIONS TO CRITICAL T E R M I N O L O G Y 1. B I N G E Rapidly eating tremendous amounts of high-calorie food, often with little chewing. This is often a desire that cannot be controlled. 2. SELF-CONSCIOUS A sense of embarrassment or unease that you may feel when you believe that other people are evaluating or judging you about something. 3. F A M I L Y The people you live with most of the time. 128 A p p e n d i x H : R e c o r d Sheet - R A Observations 129 R E C O R D SHEET - R A OBSERVATIONS R A Reporting: T E A C H E R B L O C K NOTES/QUESTIONS A S K E D A p p e n d i x I: Questionnaire Package C o v e r Page u ft) o U L. a L. £30 4-a cs ft) I" o Za a cn S co co o o o co — C L I _ . 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O u_ >0 r n 137 A p p e n d i x K : Eat ing Attitudes Test -26 u 1 • *J • CJ • 0 • - • 0 • • O • 3 • 0 • • • 0 • • £ • • • • • • • • n • a • • • O • O • • • o • • • a Sometimes • • • • • 0 • • • • • o • • • P • • • • • D\ • o • D i • n • • o • n • o • n • • • • • • • 0] • a • a Usually • o • • • • • o • o • • tJ • • • • • D • a Always • o • • • fj • • • • • o • • • O • o • • • 3 • a 1 am terrified about being overweight 1 avoid eating when 1 am hunqiv 1 find myself preoccupied with food 1 have gone on eating binges wheie 1 feel 1 may not be able to stop 1 cut my food into small pieces 1 am aware of the calorie content of foods 1 eat 1 particularly avoid food with high carbohydrate content 1 feel that others would prefer if 1 ate more 1 vomit after 1 have eaten 1 feci extremely guilty attrti eating 1 am preoccupied with a desire to be thinner 1 think about burning up calories when 1 exercise Other people think I'm too thin 1 am pieoccupied with the thought cf having fat on my body 1 take longer than others to eat my meals 1 avoid foods with Migai in them 1 eat diet foods 1 teel thai food controls my life 1 display self-control around food 1 feel that others pressure me to eat 1 give too much time and thought to food 1 feel uncomfortable after eating sweets 1 engage in dieting behaviour 1 like my stomach to be empty 1 have the impulse to vomit after meals 1 enjoy tiyiny new rich too-Is CO m CO o CM c o m CO 00 CD o T — CM CM CN c o C\l CM i n CM CO CM 139 A p p e n d i x L : Sociocultural Attitude Towards Appearance Questionnaire J oiii;>kl«l\ \ !•! IT \gree NMIIH-I iii Disagree i)is;:t;i'i-c t'ompli'U-b Disagree 1. G i r l s who appear in T . V . shows and movies project the type of appearance (or the " l o o k " ) that I see as m y goal 0 0 0 0 0 2. , I believe that clothes look better on thin models • 0 \ • 0 ! o O O 3. M u s i c videos that show thin girls make me wish that I were thin 0 0 0 0 0 4. I do not wish lo look like llic models in the maea/ines <; o () () () 5. I tend to compare m y body to people in magazines and on T . V O 0 0 o 0 6. In A m e r i c a n society, fat people are regarded as attractive (pretty; cute) ^ 0 o o o 7. Photographs of thin girls make me wish that I were thin 0 o 0 0 0 8. Attractiveness is very important if \ o u want lo get ahead in American.culture n () () () n 9. It's important for people to work hard on their figures / physiques i f they want to succeed in today's A m e r i c a n culture 0 0 0 o () I". ft "Most Americans do not believe thai the thinner you are. the better YOU look. < > () () o 0 11. Americans think that the thinner y o u are, the better you look in clothes. 0 o 0 0 0 12. In today's A m e r i c a n society, it's not important lo a lwa\s look attractive '- 0 0 0 • o O 13. I wish I looked l ike a swimsuit model 0 0 0 0 0 1 1. 1 o l l cn read m a i M / m o like Cosmopol i tan . Younsz M i s s ( Y M ) . and T e e n o 0 o () () O CO SI o CO CO CO o o CO X o X I CD i CD Z J cr CO CJ) c: T J C o CL CO CD t o o c CO E xi co E CD —• CO 5 o 0 CO o CL CO CD o CO o TJ C CD CO CO CD CO z o o ZJ a. 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CO O > CO SZ CD X I f » CD TJ SZ CO III • il g H c D J CD E o > o co _co J2 I CO cm CO No CJ) O: CM CM CM CM O CD CD CM I 140 A p p e n d i x M : Sociocultural Attitudes Towards Appearance Questionnaire - G i r l s V e r s i o n 0 JZ -4—« '0 x o JZl 0 l _ CO =3 cr CO CO cz TJ £Z o C L co CD L _ L _ O o CD CO c 1*: CO E JO. co E CD CO CZ > o 0 0 co c o CL CO 0 =J O >, 0 "co O ^< 1 ^ 0 o 58 CD CO 0 u CL CU J - . is 3 ° O ) re a* ai to ai S i _ co J = TJ 1 = cv £ < P CO z g i -o CC I-co z CO co co o o CO «> ?> o U P P P P CD CO J Z O !z to C L ro CO CD CD CD > to o — E * -a £ c CO . 5 o o — w » > r i _ o .E co 3 I C L CO w a s 5 o CM p p p p p CO J Z J Z CO 0) E CD co E jo i CD tz CO o CD T J > Z o i i CO p p to co tt "R co, co P P P P • to CD c ' N CO O ) CO E J O C L O CD Cl T J O J 3 E CO C L E o o •a LO to ca "D CD •E co O ) CD £ CO SS. a. o CD a. ca o W : c co CO cr CO _ Qj o CD P to CO f o JZ TJ co to J Z to "5 O ) o cz CO 3 O c ca •c o Q. 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I w o u l d like to know your own views on these topics. There are no write or wrong answers. Please answer b y c i rc l ing O N E response for each question. S A means Strongly Agree , A means Agree , U means U n s u r e / D o n ' t K n o w , D means Disagree, and S D means Strongly Disagree. 1. Girls and boys should be treated the same S A A U D SD 2. Schools should accept our traditional clothes S A A U D SD 3. We should attend our places of religious worship (e.g., S A A U D SD Gurudwara) 4. I have no wish to go back to live in the country my parents came S A A U D S D from 5. I would like to see boys and girls from our own community going SA A U D SD with English boys and girls 6. I would rather eat Asian food all the time S A A U D SD 7. We should always try to fulfil our parents' wishes S A A U D SD 8. We should celebrate Christmas as we celebrate our own religious S A A U D S D festivals 9. We are better off living with people from our own ethnic community S A A U D SD 10. Parents and children should live on their own and not with S A A U D SD grandparents and uncles 11. A women's place is in the home (house) SA A U D SD 12. Only Asian doctors can understand our illnesses SA A U D SD 13. We should learn something about Christianity SA A U D SD 14. We should learn to write our own language S A A U D SD 15. Sometimes we should cook English food in our own homes S A A U D SD 16. We should alter our names so that our teachers can say them S A A U D SD easily 17. I would only like to make friends with young people from our own S A A U D SD community 18. Boys and girls should be allowed to meet each other in youth SA A U D SD clubs 19. I would prefer to live in an area where there are families from our SA A U D SD community 20. We should visit the homes of our English friends SA A U D SD 21. Asian films are more entertaining than English language films S A A U D SD 22. We should ignore our own language if we want to get ahead in this S A A U D SD country 23. I feel very uneasy with the English S A A U D SD 24. There should be more marriages between our people and the S A A U D SD English 25. Men should make all the decisions about the affairs of the family SA A U D SD 26. I would not like our women to behave like English women SA A U D SD 27. We should be allowed to choose our own clothes S A A U D S D 28. We should visit English language cinemas and playhouses S A A u D SD 29. Marriage should be arranged by the family S A A u D SD 30. Our women should wear English (European) clothes S A A u D SD 31. The interest of the family should come before the individual S A A u D SD 32. The quality of English life is better than that of Asian S A A u D SD A p p e n d i x P : Aberystwyth Acculturat ion Scale (Adjusted) •sw-ot £ « Q a • • m o St 3 j « **[ 3 o Q • • O o > < I — CO • a • • • • ro 0 0) i n 3 o JZ (/) CO , o T J C ro C D to Jz "col c o \ r-g TJ CO 3 o o i l ol ro =j , o JZ CO »1 JZ o 0 0 3 o T J C Q) -4—* ro T J ZJ o JZ tfl CD CO • • • • o c JZ CD >. E ! «*— o £ • c Z J o o CD JZ c CD > o u o o> O i JZ CO : O c CD _ > ,S, OOF CB| — o • • o • to i f o ro ° C^ E -Q 2 c i : ro to T J — ro » g T> O c ro CO o JD CD to o JZ 0 ZJ o o L O • • • • ro § | E E S T J O CO CD CO • • • • • • • in to ,> to co 3 O o> I CO E 3 -t—* 3 O c $ o s ZJ o E 2 *— 0 C L O 0 C L C O c o 1 cu -»—' -4—' 0 J3 CO 0 o • O J JZ tz T J c ro * l i l l 11 > IP pp c 11! H T J • • o • • • • • • • b • • CO 0 > I 0> XT! o o to S ro CL o TJ CD < CO 0 co co 0 c Zf i o !1 •121 to . ® TJ SZ I = > | C Si MS 0 >l El o § [•01 >»l c O oi CO O +-» 3 O JD ro C D C CO JD T J 3 O JZ CO 0 CO o> ro (Z ro o 3 1 O I c IT?! ro ro 0 ra 0 T J 3 o to 0 : ! • Strongly Disagree • • • • • • • • • • o • • • a • • • Disagree • • • • • • n • • • • • Unsure/ Don't Know • • • 0 • • • • • • • • • Agree • • • • • • • • • • • • • • Strongly Agree D • • • • • • • • • • • • G 15. Sometimes we should cook Canadian food in our own homes 16 We should alter or translate our names so that our teachers can say them easily 17.1 would only like to make friends with young people from our own cultural community o a> -a in =J o CD o JC o CO CD 0) <o E o TJ 1 o ro a> TJ o CO 14 xz TJ c ™ o St <» 03 cn ai 1.9.1 would prefer to live in an area where there are families from our cultural community 20. We should visit the homes of our Caucasian-Canadian friends 21. Films from my culture or country are more entertaining than English language films 22. We should ignore our own language if we want to get ahead in this country 23.1 feel very uneasy with Caucasian-Canadian people 24. There should be more marriages between our people and Caucasian-Canadians 25. Men should make all the decisions about the affairs of the family 26.1 would not like women and girls from my culture to behave like Caucasian-Canadian women and girls 27. We should be allowed to choose our own clothes 28. We should visit English language movie theatres 29. Marriage should be arranged by the family 30. Girls and women from my culture should wear English (Canadian) clothes 31. The interest of the family should come before the individual >. E c cu Ui o . 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XI XI o 3 o C L 3 CD CO CD 5 3 o CN 155 A p p e n d i x T : Summary of 2 (Ethnicity) x 2 (Gender) A n a l y s i s of Variance S u m m a r y of Dependent Variables by Ethnici ty and Gender South A s i a n South East A s i a n G i r l s B o y s G i r l s B o y s N 49 22 34 12 Variable M , S D M , S D M , S D M , S D Eat ing attitudes 6.78, 6.07 8.59, 6.67 6.18, 5.49 5.25,4.31 Sociocultural Awareness 16.39, 3.90 18.50,3.80 16.79, 4.00 19.17,2.59 Sociocultural Internalization 20.00, 5.68 23.82, 5.84 23.38, 5.40 21.67, 3.20 Acculturation 110.92, 9.84 104.82,11.75 111.97,8.50 107.25, 7.36 Depressive S y m p t o m o l o g y 52.37, 11.85 53.77, 13.40 63.91, 15.89 56.17, 13.80 Self-esteem 18.71,4.63 18.00,3.61 21.06,5.34 18.42, 4.56 Public Self-Consciousness 11.35,5.09 12.77, 3.64 13.88,4.59 11.67, 4.08 Private Self-Consciousness 13.16, 4.65 13.36, 4.15 14.74, 3.96 12.17,3.56 Social A n x i e t y 8.94, 4.22 9.82, 4.09 11.32, 4.35 8.92, 3.34 Imaginary Audience 10.69, 3.88 12.18,4.63 12.71, 5.04 10.50,3.81 S u m m a r y of A n a l y s i s of Variance Significant ethnic effects were found for depressive symptomology F ( l , 117) = 5.870, p_ < .05. Significant gender effects were found for acculturation, F ( l , 117) = 7.042, p_ < .01 and sociocultural awareness, F ( l , 117) = 7.777, p_ < .01. Significant ethnicity x gender interaction effects were found for sociocultural internalization, F ( l , 117) = 5.797, p. < .05 and imaginary audience, F ( l , 117) = 3.975, p. < .05. 156 A p p e n d i x U : Simultaneous Regression A n a l y s i s of Eat ing Pathology: Ethnici ty Considered for Adolescent G i r l s and B o y s Simultaneous Regression Analvs is of Eat ing Pathology in G i r l s Measure B S E B 8 p_-value S A T A Q Awareness subscale .121 .153 .081 .432 S A T A Q Internalization subscale .001 .116 .001 .991 Public self-consciousness .406 .153 .351 .010* Private self-consciousness .344 .164 .262 .040* R A D S .005 .046 -.013 .909 Ethnici ty -2.285 1.204 -.195 -.062 F(6, 83) = 6.621, p < . 0 0 1 R 2 = .291 Simultaneous Regression Analvs is of Eat ing Pathology in B o y s Measure B S E B 6 p_-value S A T A Q Awareness subscale .301 .258 .163 .254 S A T A Q Internalization subscale .385 .180 .324 .041* Public self-consciousness .007 .269 .041 .805 Private self-consciousness .600 .248 .388 .022* Ethnicity -1.920 1.628 -.153 .248 F(5 , 34) = 7.578, p < .001 R 2 = .499 

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