@prefix vivo: . @prefix edm: . @prefix ns0: . @prefix dcterms: . @prefix dc: . @prefix skos: . vivo:departmentOrSchool "Education, Faculty of"@en, "Educational and Counselling Psychology, and Special Education (ECPS), Department of"@en ; edm:dataProvider "DSpace"@en ; ns0:degreeCampus "UBCV"@en ; dcterms:creator "Hyland, Colleen Anne"@en ; dcterms:issued "2009-01-21T23:11:05Z"@en, "1995"@en ; vivo:relatedDegree "Master of Arts - MA"@en ; ns0:degreeGrantor "University of British Columbia"@en ; dcterms:description """The purpose of this study was to examine the role of sociocultural factors in the occurrence of pathological eating attitudes and behaviours by determining the relationship between acculturation to Canada, as a Western culture , and eating attitudes and behaviours in a nonclinical sample of female Chinese and Caucasian university students. In addition , as an exploratory goal any possible relationship between acculuturative stress and eating attitudes and behaviours was also explored. One hundred female Caucasian and 131 female Chinese undergraduate students were recruited from the University of British Columbia. Each subject was asked to complete a Demographic Questionnaire as well as the 26 item Eating Attitudes Test (EAT; Garner, Olmsted, Bohr, & Garfinkel, 1982). Additionally , the Chinese subjects were asked to complete the Suinn-Lew Asian Self-Identity Acculturation Scale (SL-ASIA; Suinn, Rickard-Figueroa, Lew, & Vigil, 1987) and the 24 item SAFE Acculturative Stress Scale (SAFE; Mean, Padilla, & Maldonado, 1987)."""@en ; edm:aggregatedCHO "https://circle.library.ubc.ca/rest/handle/2429/3837?expand=metadata"@en ; dcterms:extent "4739733 bytes"@en ; dc:format "application/pdf"@en ; skos:note "ACCULTURATION AND EATING ATTITUDES AND BEHAVIOURS IN FEMALE CHINESE AND CAUCASIAN UNIVERSITY STUDENTS: A CORRELATIONAL AND COMPARATIVE STUDY By Colleen Anne Hyland B.A., The University of B r i t i s h Columbia, 1990 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA July 1995 © Colleen A. Hyland, 1995 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 The University of British Columbia r \\ J Vancouver, Canada v ' Da* 3,A.» \\~\\\\Ca DE-6 (2/88) A b s t r a c t The purpose of t h i s study was to examine the r o l e of s o c i o c u l t u r a l f a c t o r s i n the occurrence of p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours by determining the r e l a t i o n s h i p between a c c u l t u r a t i o n to Canada, as a Western c u l t u r e , and e a t i n g a t t i t u d e s and behaviours i n a n o n c l i n i c a l sample of female Chinese and Caucasian u n i v e r s i t y students. In a d d i t i o n , as an e x p l o r a t o r y goal any p o s s i b l e r e l a t i o n s h i p between a c c u l u t u r a t i v e s t r e s s and e a t i n g a t t i t u d e s and behaviours was a l s o explored. One hundred female Caucasian and 131 female Chinese undergraduate students were r e c r u i t e d from the U n i v e r s i t y of B r i t i s h Columbia. Each subject was asked to complete a Demographic Questionnaire as w e l l as the 2 6 item E a t i n g A t t i t u d e s Test (EAT; Garner, Olmsted, Bohr, & G a r f i n k e l , 1982). A d d i t i o n a l l y , the Chinese subjects were asked to complete the Suinn-Lew A s i a n S e l f - I d e n t i t y A c c u l t u r a t i o n Scale (SL-ASIA; Suinn, Rickard-Figueroa, Lew, & V i g i l , 1987) and the 24 item SAFE A c c u l t u r a t i v e Stress Scale (SAFE; Mean, P a d i l l a , & Ma'ldonado, 1987) . S t a t i s t i c a l analyses revealed no difference i n EAT scores across the two c u l t u r a l groups. Correlational analyses indicated negative relationships between l e v e l of acculturation and pathological eating attitudes and behaviours for the Chinese subjects, suggesting that the less acculturated Chinese subjects experience more pathological eating attitudes and behaviours. Correlational analyses also found p o s i t i v e relationships between acculturative stress and eating attitudes and behaviours for the Chinese subjects,-suggesting the higher acculturative stress, the greater eating pathology. F i n a l l y , the results of regressive analyses revealed that, i n general, acculturative stress was the best predictor of pathological eating attitudes and behaviours for the Chinese subjects. Implications for these results and suggestions for future research are discussed. i v Table of Contents A b s t r a c t . ' i i Table of Contents.. i v L i s t of Tables v i i i Acknowledgments x Chapter I: I n t r o d u c t i o n 1 Overview . . . . 1 Purpose of t h i s Study 4 S i g n i f i c a n c e and I m p l i c a t i o n s 6 D e f i n i t i o n of Terms 7 Chapter I I : L i t e r a t u r e Review 10 The Diagnosis of E a t i n g Disorders i n Reseach 10 The Role of S o c i o c u l t u r a l Factors i n the Occurrence of E a t i n g Disorders 14 A c c u l t u r a t i o n , Body Image, & the Occurrence of E a t i n g Disorders 24 Summary 34 Chapter I I I : Method 37 Design 37 Sample 37 Procedure 4 0 Instrumentation 41 Demographic Questionnaire 42 V E a t i n g A t t i t u d e s Test 43 Suinn-Lew A s i a n S e l f - I d e n t i t y A c c u l t u r a t i o n Scale 44 SAFE A c c u l t u r a t i v e Stress Scales 47 Hypothesis 51 S t a t i s t i c a l A n a l y s i s . . 52 Chapter IV: Results 54 Demographic D e s c r i p t i o n of the Sample 54 Hypothesis 1: E a t i n g A t t i t u d e s and Behaviours across C u l t u r a l Groups. 62 Hypothesis 2 & 3: C o r r e l a t i o n a l A n a l y s i s 65 I n t e r c o r r e l a t i o n a l a n a l y s i s of of the EAT and SL-ASIA 67 Level of a c c u l t u r a t i o n and e a t i n g a t t i t u d e s and behaviours f o r the Chinese s u b j e c t s . . 68 A c c u l t u r a t i v e s t r e s s and e a t i n g a t t i t u d e s and behaviours f o r the Chinese subjects 71 Hypothesis 4: Regression A n a l y s i s 73 Chapter V: D i s c u s s i o n 84 Review of the Research Findings 84 C u l t u r a l group d i f f e r e n c e s 84 v i Level of a c c u l t u r a t i o n and e a t i n g a t t i t u d e s and behaviours 88 A c c u l t u r a t i v e s t r e s s and e a t i n g a t t i t u d e s and behaviours 91 Regression a n a l y s i s 93 C r o s s - C u l t u r a l V a l i d i t y of the EAT 94 L i m i t a t i o n s 97 Suggestions f o r Future Research .99 I m p l i c a t i o n s f o r C o u n s e l l i n g 101 Conclusions 104 References 106 Appendices 117 Appendix A. Demographic Questionnaire 117 Appendix B. EAT Questionnaire 119 Appendix C. SL-ASIA Questionnaire.... 121 Appendix D. SAFE Questionnaire 12 6 Appendix E. Introductory L e t t e r to Professors 129 Appendix F. Intr o d u c t o r y L e t t e r to Subjects and L e t t e r of Consent 131 Appendix G. Follow-up L e t t e r 133 Appendix H. I n t e r c o r r e l a t i o n s of the E a t i n g A t t i t u d e s Test (EAT) 135 v i i Appendix I. Intercorrelations of Level of Acculturation (SL-ASIA) 137 v i i i L i s t of Tables Table 1. Break Down of Subjects i n each Sample • • • • 56 Table 2. Means and Standard Deviations f o r Age, Years L i v i n g i n North America, EAT, & SL-ASIA between Samples 57 Table 3. Demographic Data f o r a l l Subjects i n c l u d i n g S i b l i n g Order, Department, Program, Place of B i r t h and Generation Level 59 Table 4. Means and Standard Deviations f o r Demographic Data i n c l u d i n g Age, Years L i v i n g i n North America, and Years i n School i n North America 61 Table 5. Means and Standard Deviations f o r f u l l Scale and Subscale EAT Scores across C u l t u r a l Groups 64 Table 6. Contingency Table of Chinese and Caucasian Subjects who D i s p l a y E a t i n g Pathology (EAT > 20) or no E a t i n g Pathology (EAT < 21) 66 Table 7. C o r r e l a t i o n M a t r i x of F u l l Scale and Subscale EAT and SL-ASIA Scores f o r the Chinese Subjects 69 i x Table 8. One-way A n a l y s i s of Variance f o r F u l l EAT Scale Scores across Level of A c c u l t u r a t i o n 72 Table 9. C o r r e l a t i o n M a t r i x of F u l l Scale and Subscale EAT Scores w i t h SAFE.... '..74 Table 10. C o r r e l a t i o n M a t r i x of F u l l Scale and Subscale SL-ASIA Scores w i t h SAFE 75 Table 11. M u l t i p l e Regression A n a l y s i s of P r e d i c t o r s of P a t h o l o g i c a l E a t i n g A t t i t u d e s and Behaviours.... 77 Table 12. Stepwise Regression of the F u l l Scale EAT on a l l of the P r e d i c t o r V a r i a b l e s 79 Table 13. Stepwise Regression of the Diet Subscale on a l l of the P r e d i c t o r V a r i a b l e s 80 Table 14. Stepwise Regression of the B u l i m i a Subscale on a l l of the P r e d i c t o r V a r i a b l e s 81 Table 15. Stepwise Regression of the Oral C o n t r o l Subscale on a l l of the P r e d i c t o r V a r i a b l e s 82 X Acknowledgments I would l i k e to express my deepest appreciation to my committee members for sharing t h e i r time, support, and wisdom. In p a r t i c u l a r , I wish to thank my supervisor, Dr. Ishu Ishiyama, for his assistance and guidance throughout th i s study. I would also l i k e to thank Dr. Beth Haverkamp for her d i r e c t i o n on s t a t i s t i c a l matters, as well as her warmth and support. Thanks also to Dr. E l l i o t Goldner for sharing his expertise i n eating disorders, and for always taking time from his very busy schedule for consultation and to attend my thesis defence. Thanks you to family and friends for t h e i r encouragement and unending support during the writing of t h i s thesis. F i n a l l y , a special thanks to my partner for being a p i l l a r of support and strength, and for putting up with my craziness during t h i s process. 1 Chapter I In t r o d u c t i o n Overview Preoccupation w i t h body weight and the chase p r e s e n t a t i o n of e a t i n g d i s o r d e r s such as anorexia nervosa and b u l i m i a nervosa are commonly recognized phenomena f o r women l i v i n g i n Western c u l t u r e s . Some researchers have hypothesized that the occurrence of ea t i n g d i s o r d e r s may be l i n k e d to Western values i n r e l a t i o n to the emphasis on thinness as the d e s i r e d female shape (Garner & G a r f i n k e l , 1980; Nasser, 1988a, 1988b). For instance, research i n t o c e r t a i n sub-c u l t u r e s , where the demand f o r thinness i s heightened, gives support to the c u l t u r a l determination of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s (Garner & G a r f i n k e l , 1980). In t h e i r i n v e s t i g a t i o n of e a t i n g a t t i t u d e s and behaviours , Garner and G a r f i n k e l found that female models and dancers had an over-r e p r e s e n t a t i o n of e a t i n g d i s o r d e r s and excessive d i e t i n g concerns. A d d i t i o n a l l y , two l i n e s of e p i d e m i o l o g i c a l research have examined the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s i n •2 n o n t r a d i t i o n a l populations such as non-Western c u l t u r e s and e t h n i c m i n o r i t i e s l i v i n g i n Western c u l t u r e s . F i r s t , c r o s s - c u l t u r a l research has suggested that e a t i n g d i s o r d e r s are most common amongst Western c u l t u r e s , or amongst .those c u l t u r e s , l i k e Japan, who have r e c e n t l y introduced Western values and i d e a l s i n t o t h e i r s o c i e t y (Kamata, Nogarni, & Momma, 1987; Nasser, 1988a, 1988b; Suematsu, 1985). S i m i l a r l y , non-Western c u l t u r e s that do not i d e a l i z e thinness, such as China, r a r e l y report cases of e a t i n g d i s o r d e r s (Lee, 1991; Lee, 1993; Lee, Ho, & Hsu, 1993; Lee, Chui, & Chen, 1989; McCarthy, 1990). The r e s u l t s of e p i d e m i o l o g i c a l c r o s s - c u l t u r a l s t u d i e s should, however, be i n t e r p r e t e d w i t h c a u t i o n as some c u l t u r e s do not recognize e a t i n g d i s o r d e r s as d i s t i n c t e n t i t i e s . Therefore, i t i s p o s s i b l e that behaviour which may be diagnosed as anorexia or b u l i m i a i n Western c u l t u r e s i s diagnosed as h y s t e r i a or a n x i e t y i n other c u l t u r e s . The second area of e p i d e m i o l o g i c a l research has explored the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s i n non-white i n d i v i d u a l s l i v i n g i n Western c u l t u r e s ( i e . C r i s p , Palmer, K a l l l u c y , 1976; Gray, Ford, K e l l y , 1987; Gross & Rosen, 3 1988; Hsu, 1987; Lacey & Dolan, 1988'; Lucero, Hicks, Bramlette, Brassington, & Welter, 1992; Nevo, 1985). The r e s u l t s of these s t u d i e s appear to i n d i c a t e that e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours occur l e s s f r e q u e n t l y i n non-white i n d i v i d u a l s . These s t u d i e s , however, simply address r a c i a l d i f f e r e n c e s , r a t h e r than d i f f e r e n c e s i n c u l t u r a l o r i e n t a t i o n . Thus, as Dolan (1991) discussed, inferences as to the r o l e of s o c i o c u l t u r a l f a c t o r s must be made t e n t a t i v e l y . In an attempt to address some of the methodological l i m i t a t i o n s of the above c i t e d research while c o n t i n u i n g to i n v e s t i g a t e the r o l e of s o c i o c u l t u r a l f a c t o r s i n the occurrence of e a t i n g d i s o r d e r s , researchers have begun e x p l o r i n g the r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n to Western c u l t u r e s and the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s i n non-white women. These research s t u d i e s are based on the premise that Western c u l t u r e s ' values, such as the i d e a l i z a t i o n of thinness f o r women, i s r e l a t e d to repor t s of anorexia and b u l i m i a . Thus, the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s should vary according 4 to the degree to which i n d i v i d u a l s a s c r i b e to and i n t e r n a l i z e Western values and i d e a l s . Work i n t h i s area however i s s t i l l i n i t s infancy. To date, only four s t u d i e s have attempted to determine the r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n to a Western c u l t u r e and occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s (Abrams, A l l e n , Gray, 1993; Furnham & P a t e l , 1994; Mumford, Whitehouse, & P'latts, 1991; Pumariega, 1986). Unfortunately, the r e s u l t s of these stud i e s are somewhat c o n t r a d i c t o r y , l e a v i n g many questions unanswered. I t i s hoped that t h i s study may help address some of these questions. Purpose of t h i s Study The purpose of t h i s study i s to i n v e s t i g a t e the r o l e of s o c i o c u l t u r a l f a c t o r s i n the occurrence of p a t h o l o g i c a l e a t i n g a t t i t u d e s by determining the r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n to a Western c u l t u r e and e a t i n g a t t i t u d e s i n a n o n c l i n i c a l sample of female Chinese and Caucasian u n i v e r s i t y students from the U n i v e r s i t y of B r i t i s h Columbia. S p e c i f i c a l l y , t h i s study w i l l attempt to address the f o l l o w i n g research questions: 1. Is there a s i g n i f i c a n t d i f f e r e n c e i n the ea t i n g a t t i t u d e s of Chinese female u n i v e r s i t y 5 students and Caucasian female university-students? 2. Is there a relationship between l e v e l of acculturation to a Canada, as a Western culture, and eating attitudes i n Chinese female un i v e r s i t y students? In addition, because i t has been suggested that a relationship between acculturative stress and eating attitudes may exist which could function to obstruct a true understanding of the rela t i o n s h i p between l e v e l of acculturation and the occurrence of pathological eating attitudes (DiNicola, 1990a, 1990b; Mumford, Whitehouse, & Choudry, 1992; Mumford et a l . , 1991), th i s study w i l l also explore the p o s s i b i l i t y of a rela t i o n s h i p between acculturative stress and eating attitudes. Thus, the following exploratory research questions w i l l be addressed: 3. Is there a rela t i o n s h i p between personal and f a m i l i a l acculturative stress.and eating attitudes i n Chinese female un i v e r s i t y students? 4. Is there a relationship between l e v e l of acculturation to Canada, as a Western Culture, and eating attitudes i n Chinese 6 fe m a l e . u n i v e r s i t y students independent of the e f f e c t s of a c c u l t u r a t i v e s t r e s s ? S i g n i f i c a n c e and I m p l i c a t i o n s of t h i s Study E a t i n g d i s o r d e r s d i s r u p t the l i v e s of many i n d i v i d u a l s , most of whom are women. They create chronic f a t i g u e , depression and s o c i a l withdrawal, l e a d i n g to severe personal unhappiness (Crisp, Hsu, Harding, Hartshorn, 1980). As w e l l , many p h y s i o l o g i c a l complications r e s u l t from e a t i n g d i s o r d e r s , i n c l u d i n g a l t e r a t i o n s to c a r d i o v a s c u l a r f u n c t i o n s , lowered blood pressure and heart r a t e s , g a s t r o i n t e s t i n a l complications, and even death ( C u e l l a r , Van T h i e l , 1986 Hsu, 1990; Isner, Roberts, Heymsfield, 1985). The s e v e r i t y of these d i s o r d e r s as w e l l as t h e i r prevelence i n Western c u l t u r e s has st i m u l a t e d a l o t of research i n t o the areas of both e t i o l o g y and treatment. C u r r e n t l y , however, many questions remain unanswered. S o c i o c u l t u r a l t h e o r i s t s have emphasized the importance of s o c i o c u l t u r a l l y d r i v e n f a c t o r s , f o r example the i d e a l i z a t i o n of thinness, i n the development of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s . Although r e c o g n i z i n g and acknowledging the r o l e of s o c i o c u l t u r a l f a c t o r s i n the occurrence of ea t i n g d i s o r d e r s provides no simple answers, i t i s a 7 f i r s t and necessary step. However, beyond recognition, more research i s needed to better understand the role of culture i n the development of eating disorders and pathological eating attitudes. Only then can change begin. It i s hoped th i s research study w i l l make an important contribution to the scant research available i n t h i s area. Additionally, i t i s hoped that t h i s study w i l l shed some l i g h t on the s p e c i f i c populations at r i s k for developing pathological eating attitudes and behaviours. Once i t i s known which populations are at greatest r i s k , education, prevention, and treatment programs can be modified accordingly. D e f i n i t i o n s of the Terms There are several terms which are u t i l i z e d throughout t h i s study. Because there i s often controversy as to what d e f i n i t i o n s are appropriate for many of these terms, i t i s necessary to define the following terms i n the ways that are relevant for the current study. Acculturation or Level of Acculturation: the degree to which an immigrant adopts or shares the same values, attitudes, and 8 Acculturative Stress: Race: Culture: behaviours of the receiving society; culture change which results from continuous contact between two d i s t i n c t c u l t u r a l groups, refers to one kind of stress, that i n which the stressors are i d e n t i f i e d as having t h e i r source i n the process of acculturation. a b i o l o g i c a l term r e f e r r i n g to the genetic differences between groups within a species (Dolan, 1991). an anthropological term, defining a complex whole that includes the knowledge, behavior, morals, customs, and often r e l i g i o n . Referring to something a r b i t r a r y and variable which i s acquired by being and/or growing up as a member of a society (Dolan, 1991) . 9 Eating Disorders: Pathological eating attitudes & behaviours or eating pathology: Caucasian: Chinese: refers to c l i n i c a l case of anorexia nervosa and bulimia nervosa as defined by the D i a g n o s t i c and S t a t i s t i c a l Manual of Mental Disorders, Fourth Revised (DSM-IV,1994). a broad range of attitudes and behaviours c h a r a c t e r i s t i c of anorexia nervosa and bulimia nervosa. Attitudes and behaviours which may indicate someone i s at r i s k of developing an eating disorder, an i n d i v i d u a l of Western European background who was born i n North America, an i n d i v i d u a l who i s s e l f -referred as Chinese. 10 Chapter I I L i t e r a t u r e Review The l a s t s e v e r a l decades have witnessed an upsurge of research i n v e s t i g a t i n g the e t i o l o g y of e a t i n g d i s o r d e r s such as anorexia nervosa and b u l i m i a nervosa. In t h i s chapter, I w i l l review some of t h i s l i t e r a t u r e beginning w i t h an o u t l i n e of some general d i a g n o s t i c i n f o r m a t i o n concerning e a t i n g d i s o r d e r s . Next, I w i l l review the l i t e r a t u r e e x p l o r i n g the r o l e of s o c i o c u l t u r a l f a c t o r s i n the development of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s . F i n a l l y , I w i l l explore the current research u t i l i z i n g the concept of l e v e l of a c c u l t u r a t i o n as a measure to tap i n t o the r o l e played by s o c i o c u l t u r a l f a c t o r s . The Diagnosis of E a t i n g Disorders i n Research The two most commonly recognized e a t i n g d i s o r d e r s are anorexia nervosa and b u l i m i a nervosa. Anorexia nervosa was f i r s t d escribed as a d i s t i n c t e n t i t y i n the 1860's by p h y s i c i a n s i n England, France and Russia (Prince, 1985). In 1874 S i r W i l l i a m Withey G u l l p u b l i s h e d a f u l l paper on an i l l n e s s he c a l l e d anorexia nervosa. G u l l ' s general d e s c r i p t i o n . h o l d s up i n c r e d i b l y w e l l i n i t s c l i n i c a l d e t a i l ; over one hundred years l a t e r a l l that has been added i s a 11 d i f f e r e n t i a t i o n of subtypes ( i n 1979, R u s s e l l d i s t i n g u i s h e d b u l i m i a nervosa from anorexia nervosa), and more d e t a i l s , which, i n general, served only to confirm G u l l ' s i n i t i a l d e s c r i p t i o n . G u l l ' s e a r l y d e s c r i p t i o n s i n c l u d e d body image disturbance, an intense d e s i r e f o r thinness to the p o i n t of emaciation ( i n a n o r e x i c s ) , and periods of abstinence from food followed by consumption of enormous q u a n t i t i e s of food and subsequent s e l f - i n d u c e d vomiting and/or l a x a t i v e abuse ( i n b u l i m i c s ) . I t i s i n t e r e s t i n g to compare these e a r l y d e s c r i p t i o n s w i t h that provided i n DSM IV (1994), the current d i a g n o s t i c manual of the American P s y c h i a t r i c A s s o c i a t i o n . The D i a g n o s t i c and S t a t i c a l Manual of Mental Disorders, Fourth Revised (DSM-IV, 1994) recognizes both anorexia nervosa and b u l i m i a nervosa as d i s t i n c t d i s o r d e r s . A c c o r d i n g l y , the DSM-IV d i a g n o s t i c c r i t e r i a f o r anorexia nervosa are: (a) maintenance of body weight 15% below that expected; (b) intense f e a r of gain i n g weight even though underweight; (c) disturbance i n the way i n which one's body weight, s i z e , or shape i s experienced; and (d) absence of at l e a s t three consecutive menstrual c y c l e s i n females when otherwise expected to occur. S i m i l a r l y , the d i a g n o s t i c c r i t e r i a 12 for bulimia nervosa are: (a) recurrent episodes of binge eating i n which large amounts of food are consumed i n a discrete period of time (e.g. within any 2 hour period); (b) a sense of lack of control during the binges; (c) recurrent inappropriate compensatory behaviour such as vomiting, use of laxatives or di u r e t i c s , s t r i c t d i e t i n g of fasting, or vigorous exercise; (d) binge eating and Inappropriate compensatory behaviour which occurs, on average, at least twice a week for 3 months; (e) self-evaluation unduly influenced by body shape and weight; and (f) when such disturbances which do not occur exclusively during episodes of anorexia nerovsa (DSM-IV, 1994). Currently, most researchers, theorists, and c l i n i c i a n s working i n the area of eating disorders agree that the only way to accurately i d e n t i f y a case of anorexia nervosa or bulimia nervosa i s by personal interview using c l i n i c a l assessment measures such as the DSM-IV c r i t e r i a . C l i n i c a l interviews are required for two reasons. F i r s t , a wide spectrum of pathological eating behaviours and attitudes occur i n the population, ranging from c u l t u r a l l y accepted d i e t i n g to acute cases of eating disorders, and as i t stands no objective measure i s sensitive enough to 13 d i f f e r e n t i a t e the r i g i d i t y i n b e l i e f s , a t t i t u d e s , and behaviours that represent a c l i n i c a l e a t i n g d i s o r d e r . Second, despite the i n c r e a s i n g prevelence of e a t i n g d i s o r d e r s , they are s t i l l a r e l a t i v e l y uncommon phenomenon. Ac c o r d i n g l y , W i l l i a m s , Hand, and Tarnaplosky (1982) suggest that because the prevelence of e a t i n g d i s o r d e r s remains r e l a t i v e l y low, the p o s i t i v e p r e d i c t i v e value of any s e l f - r e p o r t instrument i s l i k e l y to be qu i t e low regardless of the s e n s i t i v i t y or s p e c i f i c i t y of the instrument u t i l i z e d . In other words, i t i s l i k e l y that many i n d i v i d u a l s who score p a t h o l o g i c a l l y on a questionnaire may i n f a c t not have a c l i n i c a l e a t i n g d i s o r d e r . For both of these reasons the most widely accepted s t r a t e g y of i d e n t i f y i n g c l i n i c a l cases of e a t i n g d i s o r d e r s i n research s t u d i e s has become the two-stage screening survey (Williams et a l . , 1982) i n which a questionnaire i s used i n conjunction w i t h , r a t h e r than as a s u b s t i t u t e f o r , c l i n i c a l judgment. Thus, i n s i t u a t i o n s where o b j e c t i v e measures are used alone, without f u r t h e r v a l i d a t i o n of c l i n i c a l assessments, researchers are only able to i d e n t i f y p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours commonly a s s o c i a t e d w i t h e a t i n g d i s o r d e r s , and not e a t i n g d i s o r d e r s per se. 14 The Role of S o c i o c u l t u r a l Factors i n the Occurrence of E a t i n g Disorders E a t i n g d i s o r d e r s such as anorexia nervosa and b u l i m i a nervosa are most f r e q u e n t l y conceptualized as multidetermined d i s o r d e r s (Anderson, 1985; G a r f i n k e l & Garner, 1982). G a r f i n k e l and Garner (1982) s t a t e that an e a t i n g d i s o r d e r such as anorexia or b u l i m i a i s a \"syndrome that i s the product of an i n t e r p l a y of a number of f o r c e s \" (p. 188). These forces i n c l u d e : (a) personal f o r c e s ; (b) f a m i l i a l f o r c e s ; (c). b i o l o g i c a l f o r c e s ; and (d) s o c i o c u l t u r a l forces.. Although a l l of these forces are complexly interwoven, the purpose of t h i s study to b e t t e r understand the e f f e c t s of s o c i o c u l t u r a l f a c t o r s . Since the e a r l i e s t d e s c r i p t i o n s of e a t i n g d i s o r d e r s made over a century ago by G u l l and Lasegue, the s o c i o c u l t u r a l importance of f a c t o r s such as gender, age, and s o c i a l status have been i n v e s t i g a t e d (Anderson & Hay, 1985; Bruch, 1973; C r i s p & Toms, 1972; Gibbs, 1985; Rastam, G i l l b e r g , & Garton, 1989). Despite the abundance of research addressing the p o s s i b l e s o c i o c u l t u r a l importance of these i s s u e s , fewer s t u d i e s have attempted to address s p e c i f i c c u l t u r a l 15 determinants of e a t i n g d i s o r d e r s i n the form of c u l t u r a l values, b e l i e f s , and i d e a l s . One c u l t u r a l i d e a l which has been a s s o c i a t e d w i t h the higher prevelence of ea t i n g d i s o r d e r s i n Western c u l t u r e s i s the i d e a l i z a t i o n of thinness advocated i n the West (Garner & G a r f i n k e l , 1980/ Garner, G a r f i n k e l , Schwartz, & Thompson, 1980; Nasser, 1988a, 1988b). The research team of Garner and G a r f i n k e l (1980) was one of the f i r s t to address t h i s c u l t u r a l i d e a l i n t h e i r i n v e s t i g a t i o n of the r e l a t i o n s h i p between a t t e n t i o n to Western c u l t u r e ' s thinness i d e a l and the occurrence of ea t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s . A c c o r d i n g l y , they i n v e s t i g a t e d the e a t i n g a t t i t u d e s and behaviours of female dancers and models. I t was t h e i r assumption that because of t h e i r career choice these women would be more focused on t h e i r appearance and body shape and thus be more a t t e n t i v e to the thinness i d e a l than a normative sample of women. Their r e s u l t s i n d i c a t e d that anorexia nervosa and excessive d i e t i n g concerns were overrepresented i n the dance and modelling students, l e a v i n g the authors to conclude that those i n d i v i d u a l s under s o c i e t a l pressures to be s l i m are at greater r i s k of developing e a t i n g d i s o r d e r . The authors went on to suggest that t h e i r \"observations 16 underscore the p o s s i b l e importance of our s o c i e t y ' s current value of thinness i n women as a determinant of the purported increase i n the prevelence of anorexia nervosa\" (Garner & G a r f i n k e l , 1980, p. 655). In l i g h t of the re p o r t s suggesting t h a t the i d e a l i z a t i o n of thinness may c o n t r i b u t e to the prevelence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s (Garner & G a r f i n k e l , 1980), Garner, G a r f i n k e l , Schwartz, and Thompson (1-98 0) attempted to gauge Western c u l t u r e ' s expectations regarding body image and shape f o r women. They found t h a t , during the 20-year p e r i o d from 1959-1978, Miss America Contestants and Playboy c e n t e r f o l d s had become p r o g r e s s i v e l y t h i n n e r . Garner and h i s a s s o c i a t e s a l s o discovered a s i g n i f i c a n t increase i n the number of d i e t a r t i c l e s i n s i x popular women's magazines during t h i s same 20 year p e r i o d . More r e c e n t l y , Wiseman, Gray, Mosimann, and Ahrens (1992) have attempted to r e p l i c a t e Garner et a l . ' s study (1980) f o r the p e r i o d of 1979-1988. Once again the i d e a l body shape i n Western s o c i e t y , as represented by Miss America Contestants and Playboy c e n t e r f o l d s , has continued to decrease i n s i z e . Wiseman et a l . , a l s o noted an increase i n d i e t a r t i c l e s , as w e l l as 17 e x e r c i s e advertisements, f o r t h e i r h i s t o r i c a l p e r i o d . In a s i m i l a r study of magazine advertisements, Anderson and DiDomenico (1992) found that women's magazines contain 10.5 times the number of d i e t promotions as do men's magazines. This trend has not been noted only i n the p r i n t media. In t h e i r h i s t o r i c a l look at TV commercials, Wiseman, Gunning, and Grey (1993) found a s i g n i f i c a n t increase i n the amount of TV commercials f o r d i e t foods and d i e t products shown on the three major American networks over the years 1973-1991. Thus, these stud i e s appear to i n d i c a t e that while e a t i n g d i s o r d e r s continue to pervade Western c u l t u r e s , so does Western c u l t u r e ' s i d e a l i z a t i o n of the u l t r a t h i n body shape f o r females. Whereas t h i s trend appears to be q u i t e prevalent i n Western c u l t u r e s , i t i s i n no way u n i v e r s a l . In f a c t , o b e s i t y i s o f t e n admired as a s i g n of wealth, success and beauty i n non-Western c u l t u r e s (Furnham & A l i b h a i , 1983; Nasser, 1986) . The Chinese, f o r example, a s s o c i a t e fatness w i t h p r o s p e r i t y and l o n g e v i t y , and t h e i r Gods are o f t e n depicted as being f a t (Lee, 1991; Lee, Chiu, & Chen, 1989; Nasser, 1988a; 1988b). S i m i l a r l y , China does not 18 s t i g m a t i z e the obese as having p h y s i c a l , mental or moral impairments as i s f r e q u e n t l y done i n Western c u l t u r e s (Lee, Chiu & Chen, 1989). A d d i t i o n a l l y , the Chinese o f t e n a s s o c i a t e thinness w i t h i l l - h e a l t h and bad luck and not, as i n the West, wi t h s e l f - d i s c i p l i n e , a t t r a c t i v e n e s s or economic w e l l - b e i n g (Lee, 1992). Popular Chinese b e l i e f s are that \"being able to eat i s to have luck\", \"gaining weight means good fortune\". S i m i l a r l y , to greet somebody w i t h \"You have put on weight\" i s viewed as a complement, e s p e c i a l l y amongst the o l d e r generation of Chinese (Lee, 1991; Lee et a l . , 1989). I t appears, however, that these b e l i e f s , are not l i m i t e d simply to t r a d i t i o n a l values and customs, as the media i n Hong Kong has r e c e n t l y conveyed the message that a number of current female s i n g i n g s t a r s should be g a i n i n g weight (Lee, 1991). Given the d i f f e r e n t value placed on thinness i n China, one might p r e d i c t that the prevalence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours i n that country may be lower than i n Western c u l t u r e s . Unfortunately, very l i t t l e has been noted about the prevalence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s i n China. In t h e i r 1989 a r t i c l e , Lee, Chui, & Chen d e t a i l e d an unpublished 19 survey conducted by the P s y c h i a t r i c Epidemiology U n i t of the Department of P s y c h i a t r y at the U n i v e r s i t y of China i n Hong Kong. This survey, using the D i a g n o s t i c Interview Schedule, revealed only one p o s s i b l e case of anorexia nervosa out of a community sample p o p u l a t i o n of 7229 subjects during the period'from 1984-1986. More r e c e n t l y , a study e x p l o r i n g the prevalence of anorexia and b u l i m i a i n China was conducted by Chun and h i s team of colleagues (1992). This study employed s e l f - r e p o r t measures, as w e l l as s e l e c t i v e f o l l o w up i n t e r v i e w s , to examine the prevalence of e a t i n g d i s o r d e r s among 509 .(108 males, 401 females) freshman medical students i n two u n i v e r s i t i e s i n China. The r e s u l t s i n d i c a t e d 1.1% of the sample ( a l l female) met the domestic and DSM-III-R c r i t e r i o n f o r b u l i m i a ; however, none were binge e a t i n g and purging on a r e g u l a r b a s i s and none met the purposed DSM-IV c r i t e r i a f o r b u l i m i a nervosa. None of the subjects met the d i a g n o s t i c c r i t e r i a f o r anorexia nervosa. F i n a l l y , i n h i s 1993 study Lee employed the 40 item E a t i n g A t t i t u d e s Test i n a two-stage screening of 1020 (646 female and 374 male) Chinese b i l i n g u a l u n i v e r s i t y students i n China. Lee found that although the female students were c o g n i t i v e l y i n c l i n e d to d i e t 20 and weigh l e s s , few were d r i v e n to a c t u a l weight c o n t r o l behaviours. S p e c i f i c a l l y , the mean EAT scores f o r the female students was report as 11.33 (SD=6.71) f o r the 4 0 item EAT. This score i s lower than the f i g u r e of 15.60 (SD=9.30) reported by Garner & G a r f i n k e l (1979) f o r t h e i r c o n t r o l sample of female Western u n i v e r s i t y students. A d d i t i o n a l l y , f o l l o w i n g personal i n t e r v i e w s w i t h the subjects s c o r i n g over the c u t - o f f p o i n t on the EAT, Lee found no cases of anorexia nervosa or b u l i m i a nervosa and only three cases ( a l l female) of p a r t i a l syndrome b u l i m i a nervosa, y i e l d i n g a low prevalence of 0.4 6% f o r the spectrum of ea t i n g d i s o r d e r s . The prevalence r a t e s noted by Chen et a l . (1992) and Lee (1993) are lower than the ra t e s commonly reported i n Western c u l t u r e s . E a r l i e r research, conducted i n the mid-1980s, reported the p o i n t prevalence of anorexia nervosa amongst females ranged from 0.7%-2.1% (Morgan & S y l v e s t e r , 1977; Pope, Hudson, Jonas, & Yurgelum-Todd, 1983) while the prevalence of b u l i m i a nervosa ranged from 2%-4.5% ( i . e . , Cooper & Fairburn, 1983; Johnson, Lewis, Love, Lewis, & Studkey, 1983; Katzman, Wolchik, & Braver, 1984; Pope, Hudson, Jonas, & Yurgelum-Todd, 1983; Pyle, Halvorson, Neuman, 21 & M i t c h e l l , 1986). More recent s t u d i e s , using more s e n s i t i v e instruments and methodology, have reported p o i n t prevalence r a t e s ranging from l % - 2 % f o r b u l i m i a nervosa (Goldbloom & G a r f i n k e l ; 1993, Hoek, 1993; King, 1989; Pyle, Neuman, Halvorson, & M i t c h e l l , 1991) and 0.5%-1.3% f o r anorexia nervosa (Goldbloom & G a r f i n k e l , 1993; Rathner & Messner, 1993). While these s t u d i e s appear to i n d i c a t e that p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours as w e l l as cases of e a t i n g d i s o r d e r s such as anorexia nervosa and b u l i m i a nervosa are l e s s common in.China than i n Western c u l t u r e s or those c u l t u r e s , such as Japan, who have r e c e n t l y introduced Western values and i d e a l s i n t o t h e i r s o c i e t y (Kamata et a l . , 1987; Nasser, 1988a, 1988b; Suematsu, Ishikawa, Kuboke, & I t o , 1985) such conclusions must be made w i t h c a u t i o n . I t i s p o s s i b l e that behaviours which may be diagnosed as anorexia or b u l i m i a i n Western c u l t u r e s are diagnosed as h y s t e r i a or a n x i e t y i n other c u l t u r e s (Dolan, 1991; Nasser, 1986; Pate, Pumariega, Hester, & Garner, 1992). A d d i t i o n a l l y , even i f e a t i n g d i s o r d e r s do occur l e s s f r e q u e n t l y i n China compared to other more Westernized c u l t u r e s , i t would be premature to a t t r i b u t e such f i n d i n g s to d i f f e r e n c e s i n s o c i o c u l t u r a l values, such 22 as the i d e a l i z a t i o n of thinness, without f u r t h e r i n v e s t i g a t i o n . In an e f f o r t to b e t t e r understand the r o l e of s o c i o c u l t u r a l f a c t o r s such as the thinness i d e a l , McCarthy (1990) compared the absence or presence of e a t i n g d i s o r d e r s w i t h the absence or presence of the thinness i d e a l i n s e v e r a l c u l t u r e s . She reported that of the seven c u l t u r e s f o r which i n f o r m a t i o n on both e a t i n g d i s o r d e r s and body image were a v a i l a b l e , a l l c u l t u r e s r e p o r t i n g e a t i n g d i s o r d e r s a l s o reported advocating the thinness i d e a l . A d d i t i o n a l l y , no c u l t u r e that d i d not advocate the thinness i d e a l reported cases of e a t i n g d i s o r d e r s . Thus, McCarthy concluded that her r e s u l t s suggest that \"exposure to middle-class values i n the west, which i n c l u d e the i d e a l i z a t i o n of thinness i n women, increases the r i s k of e a t i n g d i s o r d e r s \" (p. 210). Another body of research that has explored the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s i n n o n t r a d i t i o n a l populations has focused on non-white i n d i v i d u a l s l i v i n g i n Western c u l t u r e s ( i e . C r i s p , Palmer, K a l l l u c y , 1976; Gray, Ford, K e l l y , 1987; Gross & Rosen, 1988; Hsu, 1987; Lacey & Dolan, 1988; Lucero et a l . , 1992, Nevo, 1985). The r e s u l t s of these 23 s t u d i e s appear to i n d i c a t e that the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s are more prevalent amongst white or Caucasian i n d i v i d u a l s . These s t u d i e s , however, simply use race as t h e i r d i f f e r e n t i a t i n g f a c t o r , and i n c l u d e no measure of c u l t u r a l o r i e n t a t i o n . A c c o r d i n g l y , the r o l e of s o c i o c u l t u r a l f a c t o r s i n the e t i o l o g y of e a t i n g d i s o r d e r s i s l i m i t e d . In a review of c r o s s - c u l t u r a l research on e a t i n g d i s o r d e r s Dolan (1991) encouraged researchers to c a r e f u l l y d e l i n e a t e which v a r i a b l e they are addressing, race or c u l t u r e , and urged that conclusions be l i m i t e d a c c o r d i n g l y . Thus, Dolan defined race as a \" b i o l o g i c a l term r e f e r r i n g to the genetic d i f f e r e n c e s between groups w i t h i n a s p e c i e s \" (p.74), and culture as an \" a n t h r o p o l o g i c a l term, d e f i n i n g a complex whole of knowledge, behavior, morals, customs, and o f t e n r e l i g i o n \" (p.75). Dolan continued that one's c u l t u r a l o r i e n t a t i o n i s a r b i t r a r y and v a r i a b l e , and i s acquired by being and/or growing up as a member of s o c i a l group. Thus, i f the goal i s to i d e n t i f y the r o l e of s o c i o c u l t u r a l f a c t o r s , such as the i d e a l i z a t i o n of thinness, i n the occurrence of e a t i n g d i s o r d e r and p a t h o l o g i c a l e a t i n g a t t i t u d e s (as i s the goal of t h i s 24 paper), i t may be more appropriate to address and i n v e s t i g a t e one's c u l t u r a l o r i e n t a t i o n r a t h e r than simply t h e i r race. Recently, a new l i n e of research has attempted to explore the r e l a t i o n s h i p between s o c i o c u l t u r a l f a c t o r s and the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s i n more d e t a i l by i n v e s t i g a t i n g the e a t i n g a t t i t u d e s and behaviours of non-Western women at d i f f e r e n t stages of a c c u l t u r a t i o n to Western c u l t u r e s . A c c u l t u r a t i o n . Body Image, and the Occurrence E a t i n g Disorders and P a t h o l o g i c a l E a t i n g A t t i t u d e s A c c u l t u r a t i o n i s d e f i n e d as c u l t u r a l change which r e s u l t s from continuous f i r s t hand contact between two d i s t i n c t c u l t u r a l groups (Berry, Kim, Powers, Young, & B u j a k i , 1989). A c c u l t u r a t i o n occurs at both the group l e v e l and the i n d i v i d u a l or p s y c h o l o g i c a l l e v e l . The kind of changes that i n d i v i d u a l s w i t h i n an a c c u l t u r a t i n g group may undergo can be c a t e g o r i z e d i n t o f i v e d i f f e r e n t types: p h y s i c a l , b i o l o g i c a l , c u l t u r a l , s o c i a l and p s y c h o l o g i c a l (Berry, Kim, Minde, Mok, 1987). In t h e i r 1986 a r t i c l e , Kim and Berry d e t a i l e d these f i v e changes: F i r s t l y , p h y s i c a l changes may occur, such as a new place to l i v e , new housing, and a new c l i m a t e . 25 Secondly, b i o l o g i c a l changes may occur, such as new n u t r i t i o n s t a t u s and new diseases. T h i r d l y , a new set of s o c i a l r e l a t i o n s h i p s may be formed i n c l u d i n g a r e c l a s s i f i c a t i o n of ingroup and outgroup. Four t h l y , c u l t u r a l changes may occur, wi t h the o r i g i n a l p o l i t i c a l , economic, r e l i g i o u s and s o c i a l i n s t i t u t i o n s becoming a l t e r e d or replaced. F i n a l l y , p s y c h o l o g i c a l changes may occur, i n c l u d i n g s h i f t s i n a t t i t u d e s , values, b e l i e f s and mental h e a l t h s t a t u s , (p.159) T h e o r e t i c a l l y , a c c u l t u r a t i v e changes can occur i n e i t h e r of the two groups i n contact; however, i n p r a c t i c e one group comes to dominate another and exerts greater c u l t u r a l i n f l u e n c e (Berry et a l . , 1987). The dominant group provides a context of a c c u l t u r a t i o n by c r e a t i n g a norm of what i s to be accepted, t o l e r a t e d and encouraged. Thus, the dominant group sets up l i m i t a t i o n s , boundaries, goals and the end-point of a c c u l t u r a t i o n . A c c o r d i n g l y , the members of the a c c u l t u r a t i n g group must choose to adjust, adapt, reject„or change the given context. A c c u l t u r a t i v e a t t i t u d e s r e s u l t when i n d i v i d u a l s d i f f e r i n the way that they choose to become i n v o l v e d w i t h other persons 26 and groups i n s o c i e t y (Berry et a l . , 1987; Berry et a l . , 1989; Kim & Berry, 1986). A c c u l t u r a t i o n i s by no means an easy process f o r those members of the a c c u l t u r a t i n g group. In f a c t , researchers have found that a c c u l t u r a t i n g i n d i v i d u a l s s u f f e r from s e v e r a l forms of p s y c h o l o g i c a l d i s t r e s s and dys f u n c t i o n such as, \"lowered mental h e a l t h s t a t u s ( p a r t i c u l a r l y confusion, anxiety, depression), f e e l i n g s of m a r g i n a l i t y and a l i e n a t i o n , a heightened psychosomatic symptom l e v e l , and i d e n t i t y confusion\" (Berry et a l . , 1987, p. 492). The q u a n t i t a t i v e measurement of a c c u l t u r a t i o n has been hindered by the complexity of the phenomena that have c o g n i t i v e , behavioural, and a t t i t u d i n a l components, each of which i s composed of m u l t i p l e c o n s t r u c t s and f a c t o r s ( C u e l l a r , H a r r i s , Jasso, 1980). Thus, the challenge has become developing s e l f report measures which, while b r i e f and p r a c t i c a l , are a l s o comprehensive i n t h e i r scope. A c c o r d i n g l y , research and instrument development i n the area of a c c u l t u r a t i o n has progressed from the use of s i n g l e item indexes, such as generat i o n a l l e v e l , to m u l t i p l e s o c i o c u l t u r a l . c h a r a c t e r i s t i c s such as n a t i o n a l i t y , language, occupational s t a t u s . F i n a l l y , b e havioural, 27 p s y c h o l o g i c a l and a t t i t u d i n a l measures have a l s o been inco r p o r a t e d i n e f f o r t s to measure a c c u l t u r a t i o n . Recently, researchers have begun to u t i l i z e the concept of a c c u l t u r a t i o n to i n v e s t i g a t e the r o l e of s o c i o c u l t u r a l f a c t o r s i n the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s . I f one accepts that Western c u l t u r e s ' i d e a l i z a t i o n of thinness f o r women i s r e l a t e d to repor t s of anorexia and b u l i m i a , then the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s should vary according to the degree to which i n d i v i d u a l s a s c r i b e to and i n t e r n a l i z e Western values and i d e a l s . Furnham and A l i b h a i (1983) were one of the f i r s t research teams to i n v e s t i g a t e the e f f e c t s of a c c u l t u r a t i o n to a Western c u l t u r e by i n v e s t i g a t i n g how Kenyan Asians i n B r i t a i n and Kenya, as w e l l as Caucasian B r i t a i n s , perceive female body shapes. Their r e s u l t s seemed to suggest that when non-Western women are placed i n a Western c u l t u r e they soon lose the i d e a l of feminine beauty h e l d i n t h e i r home c u l t u r e s and begin to i n t e r n a l i z e the thinness i d e a l h e l d i n the West. In h i s 198 6 study, Pumariega developed h i s own 15 item a c c u l t u r a t i o n s c a l e to survey the a c c u l t u r a t i o n 28 l e v e l , as w e l l as the e a t i n g a t t i t u d e s , of Hispanic s c h o o l g i r l s l i v i n g i n the US. His r e s u l t s detected a s i g n i f i c a n t c o r r e l a t i o n between l e v e l of a c c u l t u r a t i o n to a Western c u l t u r e and e a t i n g a t t i t u d e s as measured by the E a t i n g A t t i t u d e s Test (Garner & G a r f i n k e l , 1979). Pumariega.concluded \"that e a t i n g a t t i t u d e s v a r i e d d i r e c t l y i n the anorexic d i r e c t i o n w i t h i n c r e a s i n g a c c u l t u r a t i o n to American c u l t u r e \" (p. 278). A more recent study, examining the e a t i n g a t t i t u d e s and behaviours of b l a c k and white female c o l l e g e students l i v i n g the United States, helped to s u b s t a n t i a t e Pumariega's r e s u l t s . Abrams, A l l e n and Gray (1993) surveyed the a c c u l t u r a t i o n l e v e l and e a t i n g a t t i t u d e s of 100 black female and 100 white female c o l l e g e students. For the purpose of t h e i r study the authors u t i l i z e d the R a c i a l I d e n t i t y A t t i t u d e Scale f o r Blacks (RIAS-B; Helms, 1990) to measure l e v e l of a c c u l t u r a t i o n . In an e f f o r t to measure e a t i n g a t t i t u d e s and behaviours, the f o l l o w i n g s c a l e s were u t i l i z e d : Hawkins' and Clement's Binge Scale (1980); The R e s t r a i n t Scale (Herman & Mack, 1975); the Drive of Thinness and the Body D i s s a t i s f a c t i o n subscales from the E a t i n g Disorder Inventory (EDI; Garner, Olmsted, & P o l i v y , 1983); the Goldfarb Fear of Fat Scale (GFFS; 29 Goldfarb, Dykens, & Gerard, 1985); as w e l l as f i v e items taken from Johnson's (1984) Diagnostic Survey of E a t i n g Disorders. A n a l y s i s of covariance and c o r r e l a t i o n a l t e s t s revealed that the white females demonstrated s i g n i f i c a n t l y greater disordered e a t i n g a t t i t u d e s and behaviours than the b l a c k female. A d d i t i o n a l l y , the researcher found that among the black s u b j e c t s , higher l e v e l s of a s s i m i l a t i o n to Western c u l t u r e were s i g n i f i c a n t l y p o s i t i v e l y r e l a t e d to d i e t a r y R e s t r a i n t , Fear of Fat, and Drive f o r Thinness. The t h i r d study to u t i l i z e l e v e l of a c c u l t u r a t i o n as a v a r i a b l e i n an attempt to address the r o l e of s o c i o c u l t u r a l f a c t o r s i n the prevelence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s was conducted i n B r i t a i n by Mumford, Whitehouse, and P l a t t s (1991). The r e s u l t s of t h i s study, however, are mixed and f a i l to unequivocably support Pumariega's & Abrams et a l . ' s f i n d i n g s . Mumford et al.(1991) addressed the r o l e of s o c i o c u l t u r a l f a c t o r s i n the prevelence of e a t i n g d i s o r d e r s by i n v e s t i g a t i n g the a c c u l t u r a t i o n l e v e l and the e a t i n g a t t i t u d e s of A s i a n (Indian subcontinent) and Caucasian school g i r l s l i v i n g i n Bradford, London. 30 Although the authors hypothesized that the prevelence of eating disorders would be lower amongst the Asian sc h o o l g i r l s and that eating disorders would only be found amongst the most 'Westernized' of the Asian students, t h e i r results indicated that the Asian s c h o o l g i r l s ' eating attitudes were more pathological than those of the Caucasian s c h o o l g i r l s . Similarly, the Asian g i r l s diagnosed with an eating disorder had s i g n i f i c a n t l y higher ' t r a d i t i o n a l ' scores than the rest the Asian g i r l s ; however t h e i r 'Western' scores were not s i g n i f i c a n t l y d i f f e r e n t . In an attempt to make meaning of t h e i r unexpected results the researcher purposed several possible explanations. One possible methodological explanation i s that the measure of l e v e l of acculturation employed by Mumford and his associates was not v a l i d . The authors noted that because no available acculturation scale was appropriate for use with Asians, they attempted to measure the Western and Asian c u l t u r a l orientation of each Asian student with four questions, two targeting a Western orientation and two targeting an Asian orientation. • Thus, i t i s possible that the means i n which Mumford et a l . chose to operationalize l e v e l of acculturation f a i l e d to adequately address the 31 complex, m u l t i f a c e t e d nature of a c c u l t u r a t i o n . In t h e i r c o n c l u s i o n , the authors themselves s t a t e d that a c c u l t u r a t i o n i s a complex phenomenon and agreed that \"there i s a need to develop a more s o p h i s t i c a t e d measure of these c u l t u r a l dimensions\" (Mumford et a l . , 1991, p. 227). A d d i t i o n a l l y , the authors encouraged f u r t h e r research i n t o the r e l a t i o n s h i p between a c c u l t u r a t i o n to Western c u l t u r e and the occurrence of e a t i n g d i s o r d e r s i n an attempt to help c l a r i f y the r o l e of s o c i o c u l t u r a l f a c t o r s i n the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s . In t h e i r f u r t h e r attempt to address t h e i r unexpected f i n d i n g s Mumford and h i s a s s o c i a t e s explored the r o l e of a c c u l t u r a t i v e s t r e s s i n the occurrence of p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours (Mumford et a l . , 1991; Mumford, Whitehouse & Choudry, 1992). Correspondingly, G i l , Vega and Dimas (1994) have st r e s s e d the importance of r e c o g n i z i n g a c c u l t u r a t i v e s t r e s s as an important concept i n research; one d i s t i n c t from l e v e l of a c c u l t u r a t i o n . A c c u l t u r a t i v e s t r e s s i s d e f i n e d as, \"one k i n d of s t r e s s , that i n which the s t r e s s o r s are i d e n t i f i e d as having t h e i r source i n the process of a c c u l t u r a t i o n \" (Berry, Kim, Minde, & Mok, 1987, p. 492') . According to 32 s o c i a l - s t r e s s models of acculturative stress, negative outcomes occur when stressors exceed the individual's coping resources, or mediators (Gil et a l . , 1994). Several types of acculturative stressors exist including language problems, perceived discrimination, perceived c u l t u r a l i n c o m p a t i b i l i t i e s , commitment or lack of commitment to c u l t u r a l l y prescribed protective values and behaviours as well as acculturation gaps i n which differences i n acculturation levels between children and t h e i r parents produce or exacerbate family communication problems and child-parent c o n f l i c t s (Gil et a l . , 1994). Thus, Mumford and his associates speculated that the higher EAT scores found amongst the Asian g i r l s with the higher ' t r a d i t i o n a l ' scores (and sim i l a r 'Western' scores) may r e f l e c t the fact that they were experiencing the greatest i n t e r n a l and f a m i l i a l c o n f l i c t and i d e n t i t y confusion as they grew up with two sets of c o n f l i c t i n g c u l t u r a l values. The authors went on to suggest that t h e i r results may indicate that these same Asian g i r l s , because of t h e i r exposure to Western values and ideals, adopted Western patterns of reacting to t h e i r personal and f a m i l i a l c o n f l i c t and 33 s t r e s s , thus r e s u l t i n g i n t h e i r more p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours. A recent study conducted by Furnham and P a t e l (1994) supports Mumford et a l . 1 s f i n d i n g s . Furnham and P a t e l (1994) u t i l i z e d a s i m i l a r methodology as Mumford et a l . (1991) to i n v e s t i g a t e the e a t i n g a t t i t u d e s and behaviours of A s i a n (Indian subcontinent) s c h o o l g i r l s l i v i n g i n London. Ac c o r d i n g l y , they u t i l i z e d the EAT-2 6, BSQ, as w e l l as t h e i r own q uestionnaire devised to i n v e s t i g a t e the l e v e l of i n t e g r a t i o n of A s i a n s c h o o l g i r l s i n t o B r i t i s h s o c i e t y and t h e i r l e v e l of resentment towards t h e i r f a m i l i e s f o r m a i ntaining t h e i r t r a d i t i o n a l values and customs. L i k e Mumford et a l . (1991), the questionnaire addressing l e v e l of i n t e g r a t i o n was developed s p e c i f i c a l l y f o r t h e i r study and had not been p r e v i o u s l y v a l i d a t e d . Although Furnham and P a t e l hypothesized that t h e i r r e s u l t s would support Pumariega (1986) and Abrams et a l . * s (1993) f i n d i n g s , t h e i r r e s u l t s i n s t e a d supported Mumford et a l . ' s (1991) f i n d i n g s . A c c o r d i n g l y , the l e s s i n t e g r a t e d A s i a n s c h o o l g i r l s d i s p l a y e d higher EAT scores. Furnham and P a t e l a l s o noted that there was some support f o r t h e i r hypothesis that A s i a n s c h o o l g i r l s experiencing greater resentment towards 34 the i r families, display greater eating pathology, however the results did not reach s i g n i f i c a n c e . In conclusion, i t appears that any attempt to further investigate the role of l e v e l of acculturation to a Western culture i n the occurrence of pathological eating attitudes must not only take care to appropriately operationalize l e v e l of acculturation, but also recognize the role of possible confounding or mitigating factors such as acculturative stress. Summary A review of the l i t e r a t u r e indicates that researchers have just begun to address the role of soc i o c u l t u r a l factors, such as c u l t u r a l ideals and values, i n the occurrence of eating disorders and pathological eating attitudes by investigating the relationship between l e v e l of acculturation to a Western culture and eating attitudes and behaviours of non-Western women. Such research, however, i s s t i l l i n i t s infancy and requires much more attention. One issue the l i t e r a t u r e has i d e n t i f i e d as requiring additional attention i s improving the means in which important constructs, such as l e v e l of acculturation, are operationalized and d i f f e r e n t i a t e d from possible confounding or mitigating factors such as 35 a c c u l t u r a t i v e s t r e s s . This study w i l l attempt to address t h i s concern i n two ways. '. F i r s t , a more ps y c h o m e t r i c a l l y sound measure of l e v e l of a c c u l t u r a t i o n w i l l be u t i l i z e d . Second, as an ex p l o r a t o r y goal, any p o s s i b l e r e l a t i o n s h i p between a c c u l t u r a t i v e s t r e s s and e a t i n g a t t i t u d e s w i l l be addressed i n an e f f o r t to b e t t e r understand the r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n and p a t h o l o g i c a l e a t i n g a t t i t u d e s . A d d i t i o n a l y , a l l of the previous l i t e r a t u r e i n v e s t i g a t i n g the e a t i n g a t t i t u d e s and behaviours of Asians has employed a very s e l e c t A s i a n p o p u l a t i o n of Indian subcontinent s c h o o l g i r l s l i v i n g i n the UK. Thus, i t would seem b e n e f i c i a l to i n v e s t i g a t e the e a t i n g a t t i t u d e s and behaviours of other A s i a n groups. Thus, the purpose of t h i s study i s to i n v e s t i g a t e the r o l e of s o c i o c u l t u r a l f a c t o r s i n the occurrence, of e a t i n g d i s o r d e r s by determining the r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n to Canada and e a t i n g a t t i t u d e s i n a n o n c l i n i c a l sample of Chinese u n i v e r s i t y students. In a d d i t i o n , i n l i g h t of previous research (Furnham & P a t e l , 1994; Mumford et a l . , 1991; Mumford et a l . , 1992) an a d d i t i o n a l e x p l o r a t o r y goal i s to 36 examine the rela t i o n s h i p between acculturative stress and eating attitudes and behaviours. 37 Chapter III Methodology In t h i s chapter I w i l l attempt to d e t a i l the methodology employed to conduct th i s study and answer the relevant research questions. Design A c o r r e l a t i o n a l design was employed to investigate the relationships between l e v e l of acculturation and acculturative stress, and eating attitudes. This design was chosen because there was no desire to manipulate subjects or variables, rather the purpose of th i s study was simply to document the nature and frequency of these p a r t i c u l a r variables and determine i f any r e l a t i o n s h i p e x i s t s . A l l subjects were administered a questionnaire package including a demographic questionnaire as well as various psychological questionnaires (refer to the. section on instrumentation). Sample One hundred and thirty-one female Chinese and 100 female Caucasian u n i v e r s i t y students from the University of B r i t i s h Columbia were recruited for the purpose of t h i s study. The rather s p e c i f i c population 38 was s e l e c t e d f o r s e v e r a l reasons. F i r s t , i t was decided to ta r g e t only one gender because gender, i t s e l f , has long been recognized as a p o s s i b l e s o c i o c u l t u r a l f a c t o r c o n t r i b u t i n g to the di s p r o p o r t i o n a t e d i s t r i b u t i o n of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s . A d d i t i o n a l l y , a female p o p u l a t i o n was chosen because the m a j o r i t y of Western s o c i o c u l t u r a l pressures f o r thinness are d i r e c t e d towards women (Anderson & DiDomenico, 1992). S i m i l a r l y , approximately 90% of those i n d i v i d u a l s w i t h e a t i n g d i s o r d e r s are women. Thus, because the purpose of t h i s study was not to i n v e s t i g a t e gender d i f f e r e n c e s , but to examine any p o s s i b l e r e l a t i o n s h i p s between a c c u l t u r a t i o n to a Western c u l t u r e and the occurrence of p a t h o l o g i c a l e a t i n g a t t i t u d e s , a female po p u l a t i o n was chosen as i t appears to be the popul a t i o n most at r i s k of e a t i n g pathology. A Chinese p o p u l a t i o n was chosen because the Chinese c u l t u r e t r a d i t i o n a l l y does not advocate the i d e a l i z a t i o n of thinness, nor are ea t i n g d i s o r d e r s f r e q u e n t l y reported i n China (Chun et a l . , 1992; Lee et a l . , 1989; Nasser, 1988a; Zheng, 1982). Thus, i t was hoped that t h i s p o p u l a t i o n w i l l provide a wide spectrum of e a t i n g a t t i t u d e s as w e l l as a c c u l t u r a t i o n l e v e l s . 39 A d d i t i o n a l l y , a Chinese p o p u l a t i o n was chosen because a l l of the previous l i t e r a t u r e i n v e s t i g a t i n g the r e l a t i o n s h i p between e a t i n g pathology and l e v e l of a c c u l t u r a t i o n amongst Asians has employed a p o p u l a t i o n of Indian subcontinent s c h o o l g i r l s l i v i n g i n the UK (Furnham & P a t e l , 1994; Mumford et a l . 1991; Mumford et a l . 1992). Thus, i t was hoped that u t i l i z i n g a Chinese p o p u l a t i o n would help extend the knowledge regarding e a t i n g a t t i t u d e s and behaviours i n A s i a n p o p u l a t i o n s . In an e f f o r t to access Chinese students w i t h a wide range of a c c u l t u r a t i o n l e v e l s subjects were s o l i c i t e d from a v a r i e t y of d i f f e r e n t departments and f a c u l t i e s i n c l u d i n g Science, A r t s and A s i a n Studies. A d d i t i o n a l l y , no e x t e r n a l parameters were placed on the d e f i n i t i o n of Chinese. Thus, a l l female student who s e l f - r e f e r r e d as Chinese were welcome to p a r t i c i p a t e . F i n a l l y , a u n i v e r s i t y p o p u l a t i o n was chosen because i t i s considered a high r i s k s e t t i n g f o r the occurrence of e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s (Halmi, Jones, & Schwertz, 1981). As w e l l , a l l of the measures employed i n t h i s study were developed and v a l i d a t e d on u n i v e r s i t y populations, t h e r e f o r e the measures are considered most appropriate f o r t h i s p o p u l a t i o n . 40 Procedure Subjects were r e c r u i t e d from v a r i o u s i n t a c t c l a s s e s throughout the campus. This researcher approached s e v e r a l p r o f e s s o r s , f i r s t by l e t t e r and then by phone requesting t h e i r p a r t i c i p a t i o n . A l l pro f e s s o r s teaching 100-level Anthropology and Sociology, Family and N u t r i t i o n a l Science and A s i a n Studies course were sent a l e t t e r e x p l a i n i n g t h i s study and requesting the use of 15 minutes of c l a s s time to i n v i t e t h e i r students to p a r t i c i p a t e . During follow-up c a l l s , t h e i r i n t e r e s t and a v a i l a b i l i t y was confirmed, and, i f necessary, a time to attend t h e i r c l a s s and conduct my research was arranged. A d d i t i o n a l subjects were r e c r u i t e d as p a r t of a l a r g e r study i n v e s t i g a t i n g help seeking behaviours, of Asian u n i v e r s i t y students c a r r i e d out by Dr. Ishu Ishiyama. A c c o r d i n g l y , i f time permitted, the EAT and the Suinn-Lew A s i a n S e l f - I d e n t i t y A c c u l t u r a t i o n Scale were i n c l u d e i n Dr. Ishiyama's t e s t packages. Acc o r d i n g l y , a d d i t i o n a l subjects were r e c r u i t e d from 100-level Chemistry, Biochemistry, Fine A r t s , H i s t o r y , and Psychology c l a s s e s . In a l l cases, t h i s researcher was present during the a c t u a l data c o l l e c t i o n . A d d i t i o n a l l y , a l l 41 pot e n t i a l subjects were reminded that a l l materials would be kept c o n f i d e n t i a l , that t h e i r p a r t i c i p a t i o n was voluntary, and that they could choose to discontinue p a r t i c i p a t i o n at any point. If time permitted the questionnaires were completed during class time and returned to me immediately. However, i n some instances professors could not allocate enough class time for students to complete the questionnaire packages; i n these instances, p a r t i c i p a t i n g subjects were asked to complete the questionnaires at t h e i r e a r l i e s t convenience and mail them back v i a campus mail i n provided s e l f addressed envelops. The f i n a l page of the questionnaire package contained a tear o f f page so that interested subjects could contact t h i s author for further information regarding the goals and outcomes of t h i s study. Additionally, because examining one's eating attitudes and behaviours may bring up issues for some subjects, e s p e c i a l l y those with eating disorders, phone numbers of l o c a l resources were also be made available on the tear o f f page. Intrumentation The instruments used i n t h i s research study included: a demographic questionnaire e n t i t l e d 42 \"Background Questionnaire\", the Suinn-Lew A s i a n S e l f -I d e n t i t y A c c u l t u r a t i o n Scale (SL-ASIA) , the short form of the Ea t i n g A t t i t u d e s Test (EAT-26), as w e l l as the short form of the SAFE A c c u l t u r a t i v e Stress Scale (SAFE-24). A l l of the subjects r e c e i v e d the demographic questionnaire and the EAT-26; i n a d d i t i o n , the Chinese subjects were asked to complete the SL-ASIA and the SAFE-24. Demographic Questionnaire. The f i r s t s e c t i o n of the questionnaire was developed by the current i n v e s t i g a t o r and includes questions about generation l e v e l , e t h n i c o r i g i n , age, f a m i l i a l background, as w e l l as other d e s c r i p t i v e d e t a i l s . Other question t o p i c s i n c l u d e those which previous researchers, f o r instance Berry et a l . (1987, 1989) and Suinn, Rickard-Figueroa, Lew, & V i g i l (1987), have shown to be r e l e v a n t to l e v e l of a c c u l t u r a t i o n and a c c u l t u r a t i v e s t r e s s . As s t a t e d e a r l i e r , some subjects were r e c r u i t e d as p a r t of a l a r g e r research study conducted by Dr. Ishiyama. While these subjects were a l s o asked to complete a Demographic Questionnaire, they r e c e i v e d a b r i e f e r v e r s i o n of the questionnaire designed by t h i s researcher and thus some of the questions were omitted. 43 E a t i n g A t t i t u d e s Test (EAT-2 6)• The\"short form of the E a t i n g A t t i t u d e s Test (EAT-26) c o n s i s t s of 26 items designed to evaluate a broad range of behaviours and a t t i t u d e s c h a r a c t e r i s t i c of anorexia nervosa and b u l i m i a nervosa (Garner, Olmsted, Bohr, & G a r f i n k e l , 1982). The EAT-26 was developed a f t e r f a c t o r a n a l y s i s of the o r i g i n a l EAT (Garner & G a r f i n k e l , 1979) i n d i c a t e d 14 of the o r i g i n a l 40 items could be d e l e t e d and s t i l l maintain a high c o r r e l a t i o n (r=.98) between the two measures (Garner et a l . , 1982). The EAT-26, l i k e i t s predecessor, asks subjects to respond to items on a 6-point L i k e r t s c a l e ranging from 'always' to 'never'. The items are summed f o r a t o t a l score which can then be compared to the c u t - o f f score of 20, which Garner and h i s coworker found to maximally d i f f e r e n t i a t e anorexic subjects from female c o n t r o l subjects (Garner et a l . , 1982). Factor a n a l y s i s of the o r i g i n a l 40 item EAT a l s o i d e n t i f i e d three sub-scales c u r r e n t l y recognized by the EAT-2 6. These subscale are: (a) d i e t i n g (13 items), (b) b u l i m i a and food preoccupation (6 items), and (c) o r a l c o n t r o l (7 items). The standardized r e l i a b i l i t y c o e f f i c i e n t s f o r the three subscales range from 0.83 to 0.90 f o r the 44 e a t i n g d i s ordered group and from 0.4 6 to 0.8 6 f o r t h e i r female comparison group (Garner et a l . , 1982). The EAT-2 6 was f i r s t developed and v a l i d a t e d . o n a Canadian u n i v e r s i t y p o p u l a t i o n , s i m i l a r to the one to be used i n t h i s study. A d d i t i o n a l l y , Mumford et a l . (1991) employed f a c t o r a n a l y s i s to i n v e s t i g a t e the v a l i d i t y of the EAT-2 6 w i t h an A s i a n p o p u l a t i o n . Their r e s u l t s i n d i c a t e d that the f a c t o r s t r u c t u r e of the EAT-26 f o r t h e i r sample of A s i a n students c l o s e l y resembled that from a previous study of Caucasian s c h o o l g i r l s . Thus,. Mumford and h i s coworkers concluded that the EAT-26 i s a v a l i d measure of e a t i n g a t t i t u d e s and behaviours f o r A s i a n women l i v i n g i n Western c u l t u r e s . Suinn-Lew A s i a n S e l f - I d e n t i t y A c c u l t u r a t i o n Scale. The Suinn-Lew A s i a n S e l f - I d e n t i t y A c c u l t u r a t i o n Scale (SL-ASIA) i s an instrument s p e c i f i c a l l y designed to measure l e v e l of a c c u l t u r a t i o n i n Asians (Suinn et a l . , 1987). Despite i t s r e l a t i v e newness, the measure has already been adopted by researchers (e.g., Atkinson & Gim, 1989; Atkinson, Whitely, & Gim, 1990). I t was modeled a f t e r the s u c c e s s f u l A c c u l t u r a t i o n R a t i n g Scale f o r Mexican Americans ( C u e l l a r , H a r r i s , & Jasso, 1980) a f t e r a review of the l i t e r a t u r e revealed no o b j e c t i v e measure of a c c u l t u r a t i o n f o r t h i s p o p u l a t i o n . The SL-45 ASIA i s based on the t h e o r e t i c a l assumption that a c c u l t u r a t i o n i s a m u l t i f a c e t e d phenomenon. Accordingly, the s c a l e attempts to address numerous,. a l b e i t not exhaustive, dimensions r e l e v a n t to a c c u l t u r a t i o n ranging from c o g n i t i v e and a t t i t u d i n a l b e l i e f s to behavioural c h a r a c t e r i s t i c s . S p e c i f i c items assessed f a l l i n t o four f a c t o r analyzed content areas: (a) language f a m i l i a r i t y , usage and preference; (b) e t h n i c i d e n t i t y ; ( c ) c u l t u r a l behaviours; and (d)ethnic i n t e r a c t i o n . The SL-ASIA c o n s i s t s of 21 m u l t i p l e choice items t h a t assess language preference (4 q u e s t i o n s ) , i d e n t i t y (4 q u e s t i o n s ) , f r i e n d s h i p choice (4 questions)., behaviours (5 q u e s t i o n s ) , generation and geography h i s t o r y (3 q u e s t i o n s ) , and a t t i t u d e s (1 q u e s t i o n ) . Each response i s recorded on a 5-point s c a l e where \"1\" i n d i c a t e s low a c c u l t u r a t i o n and \"5\" i n d i c a t e s high a c c u l t u r a t i o n . 'The t o t a l score i s obtained by summing across a l l 21 items and d i v i d i n g the t o t a l by 21; thus a t o t a l score can range from 1.0G (low a c c u l t u r a t i o n or Asian i d e n t i f i e d ) to 5.00 (high a c c u l t u r a t i o n or Western i d e n t i f i e d ) . The s c a l e a l s o recognizes a t h i r d i n t e r p r e t a t i o n , b i c u l t u r a l (with an SL-ASIA score of \"3\"), which the authors suggest represents the a b i l i t y 46 to i n t e g r a t e the best of both worlds without d e n i a l to e i t h e r . As such, the SL-ASIA addresses only three of the four a c c u l t u r a t i o n options suggested by Berry (1989). The o p t i o n of m a r g i n a l i z a t i o n , i n which n e i t h e r one's home c u l t u r e nor the host c u l t u r e i s embraced, i s not recognized by the SL-ASIA. Although t h i s i s a l i m i t a t i o n of the SL-ASIA, the l a c k of an appropriate instrument based on Berry's model n e c e s s i t a t e s i t s use. In a d d i t i o n , given that one of the goals of t h i s study i s t o o p e r a t i o n a l l y d e f i n e l e v e l of a c c u l t u r a t i o n , the SL-ASIA, while not addressing a l l a c c u l t u r a t i o n options, does appear to address the degree to which one i n t e r n a l i z e s Western values. Although Suinn, Rickard-Figueroa, Lew, and V i g i l (1987) provided i n i t i a l psychometric values f o r the SL-ASIA, the instrument has r e c e n t l y undergone more extensive s c r u t i n y . Suinn, Ahuna, an Khoo (1992) i n d i c a t e d that the r e l i a b i l i t y c o e f f i c i e n t (Cronbach's alpha) f o r the SL-ASAI i s . 9 1 . This estimate i s comparable to the alpha c o e f f i c i e n t of .88 reported i n the o r i g i n a l study (Suinn et a l . , 1987) and to the estimate of .89 reported by Atkinson and Gim (1989). C o r r e l a t i o n a l a n a l y s i s and a n a l y s i s of variance were 47 a l s o c a r r i e d out on the SL-ASIA (Suinn et a l . , 1992). Higher SL-ASIA scores were found to have s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n w i t h : (a) t o t a l years attending school i n the US; (b) age upon attending school i n the US; (c) years l i v i n g i n the US; (d) age upon a r r i v i n g i n the US; (e) years l i v e d i n a non-Asian neighborhood; and (f) s e l f - r a t i n g of a c c u l t u r a t i o n . In a d d i t i o n , the r e s u l t s of the f a c t o r a n a l y s i s i n d i c a t e that the SL-ASIA has a s t r u c t u r e s i m i l a r to that of the s c a l e i t was modelled a f t e r . - ' Even though the SL-ASIA i s s t i l l a r e l a t i v e l y new measure, and would most l i k e l y b e n e f i t from f u r t h e r a n a l y s i s , the l a c k of a more r e l i a b l e o b j e c t i v e measure of l e v e l of a c c u l t u r a t i o n f o r a Chinese' p o p u l a t i o n n e c e s s i t a t e s i t s use. SAFE A c c u l t u r a t i v e Stress Scale (SAFE-24). A.M. P a d i l l a and h i s a s s o c i a t e s developed the o r i g i n a l SAFE as a means of \"assessing the sources of s t r e s s that (immigrant) u n i v e r s i t y students f r e q u e n t l y encounter and the cumulative degree of s t r e s s f u l n e s s that these d i f f i c u l t i e s induce\" ( P a d i l l a , A l v a r e z , & Lindholm, 1986, p. 280). The o r i g i n a l s c a l e i n c l u d e d 66 items de r i v e d from a review of the l i t e r a t u r e as w e l l as from a s e r i e s of p r e l i m i n a r y semi-structured i n t e r v i e w s i n 48 which immigrant u n i v e r s i t y students were asked to r e l a t e d i f f i c u l t i e s they experienced as immigrants or had been aware of as o f f s p r i n g of immigrants. Accordingly, the o r i g i n a l s c a l e c o n s i s t e d of 66 items measuring s t r e s s o r s i n the S o c i a l , A t t i t u d i n a l , F a m i l i a l , and Environmental domains (SAFE). The sc a l e was i n i t i a l l y used w i t h a sample of 247 u n i v e r s i t y students ( P a d i l l a , 1985; P a d i l l a et a l . , 1986). Subjects i n c l u d e d 99 f i r s t - g e n e r a t i o n immigrants, 47 second-generation i n d i v i d u a l s , and 101 t h i r d or l a t e r - g e n e r a t i o n students. W i t h i n the immigrant group, 60 were of Asia n o r i g i n , 20 were of div e r s e European background, and the remainder were from L a t i n America or A f r i c a . A l l subjects were asked to r a t e each item on a 5 p o i n t L i k e r t s c a l e ranging from \"NOT STRESSFUL\" (rated as 1) to \"EXTREMELY STRESSFUL\" (rated as 5). Discri m i n a n t a n a l y s i s of the SAFE confirmed the authors' o r i g i n a l preconceptions of the cate g o r i e s of s t r e s s o r s experienced by immigrants. A c c o r d i n g l y , P a d i l l a and h i s as s o c i a t e s found that the best d i s c r i m i n a t e s of ge n e r a t i o n a l s t a t u s was a C u l t u r a l / F a m i l i a l f u n c t i o n (accounting f o r 63% of the p r e d i c t e d variance) and a Social/Environmental f u n c t i o n 49 (accounting f o r another 2 6% of the p r e d i c t e d v a r i a n c e ) . Together both functions c o r r e c t l y c l a s s i f i e d 91% of l a t e immigrants and 82% of the t o t a l subjects i n t o four g e n e r a t i o n a l groups ( P a d i l l a et a l . , 1986). Following t h i s i n i t i a l t r i a l , m o d i f i c a t i o n s were made to the SAFE to improve wording problems and e l i m i n a t e questions which f a i l e d to d i s c r i m i n a t e between the ge n e r a t i o n a l status of the s u b j e c t s . A c c o r d i n g l y , 6 items were delete d from the que s t i o n n a i r e . The modified 60 item SAFE has since, been u t i l i z e d w i t h a sample of 114 Japanese and Japanese American, and 114 Mexican and Mexican American u n i v e r s i t y students ( P a d i l l a , Wagatsuma, & Lindholm, 1985a; 1985b). Once again, d i s c r i m i n a n t a n a l y s i s confirmed that 90% of the subjects were c o r r e c t l y grouped i n t o g e n e r a t i o n a l l e v e l s on the b a s i s of t h e i r responses on the SAFE ( P a d i l l a et a l . , 1985b). More r e c e n t l y Mena, P a d i l l a , & Maldonado (1987) u t i l i z e d a modified 24 item v e r s i o n of the SAFE (SAFE-24) . Seventeen of the items were taken from the 60 item SAFE. These items were found i n an e a r l i e r study ( P a d i l l a et a l . , 1985b) to d i s c r i m i n a t e between generations f o r both Japanese and Mexican American students. An a d d i t i o n a l 7 new statements were added 50 which p e r t a i n e d to perceiv e d d i s c r i m i n a t i o n or m a j o r i t y group stereotypes towards immigrant p o p u l a t i o n s . L i k e i n the o r i g i n a l SAFE, a l l items were ra t e d on a 5 p o i n t L i k e r t s c a l e ranging from \"NOT STRESSFUL\" (1) to \"EXTREMELY STRESSFUL\" (5). I f an item was not a p p l i c a b l e to a subject i t was assigned a score of 0. Thus the p o s s i b l e scores f o r the 24 item SAFE range from 0 to 120. Although there i s l i m i t e d psychometric i n f o r m a t i o n concerning the SAFE-24, the i n i t i a l i n f o r m a t i o n i s promising. F i r s t , a r e l i a b i l i t y check on the sc a l e w i t h a subject p o p u l a t i o n of 214 m u l t i c u l t u r a l u n i v e r s i t y students r e s u l t e d i n a Cronbach Alpha C o e f f i c i e n t of .89 (Mena et a l . , 1987). Thus the s c a l e appears to be h i g h l y r e l i a b l e . A d d i t i o n a l l y , l e v e l s of a c c u l t u r a t i v e s t r e s s as measured by the SAFE-24 d i f f e r e d s i g n i f i c a n t l y among the four g e n e r a t i o n a l groups. While the SAFE-24 i s s t i l l a r e l a t i v e l y new measure and l a c k s i n t e n s i v e psychometric a n a l y s i s , the la c k of a more r e l i a b l e b r i e f measure of a c c u l t u r a t i v e s t r e s s n e c e s s i t a t e s i t s use. A d d i t i o n a l l y , the o r i g i n a l SAFE, as w e l l as the SAFE-24, was developed and v a l i d a t e d on a u n i v e r s i t y p o p u l a t i o n , s i m i l a r to 51 the p o p u l a t i o n to be used i n t h i s study. Furthermore, a s i g n i f i c a n t p r o p o r t i o n of the more, recent research u t i l i z i n g the SAFE-24 has u t i l i z e d various A s i a n populations, yet another c h a r a c t e r i s t i c of the pop u l a t i o n t h i s study attempts to access. Hypothesis The f o l l o w i n g r e l a t i o n s h i p s are hypothesized i n t h i s study: 1) an e t h n i c d i f f e r e n c e i n e a t i n g a t t i t u d e s and behaviours as f o l l o w s : the mean EAT score f o r the Caucasian subjects w i l l be higher (more, p a t h o l o g i c a l ) than the mean EAT score f o r the Chinese s u b j e c t s ; 2) a d i r e c t r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n and ea t i n g a t t i t u d e s as f o l l o w s : As the Chinese s u b j e c t s ' SL-ASIA scores increase ( i n d i c a t i n g a higher degree of Westernization or a s s i m i l a t i o n ) so w i l l t h e i r EAT scores ( i n d i c a t i n g more p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours. A d d i t i o n a l l y , the f o l l o w i n g t e n t a t i v e hypothesis w i l l be address: 3) a d i r e c t r e l a t i o n s h i p between a c c u l t u r a t i v e s t r e s s and e a t i n g a t t i t u d e s as f o l l o w s : As 52 the Chinese s u b j e c t s ' SAFE score increase ( i n d i c a t i n g more personal and f a m i l i a l s t r e s s ) so w i l l t h e i r EAT scores ( i n d i c a t i n g more p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours). 4) a d i r e c t r e l a t i o n s h i p between l e v e l of • a c c u l t u r a t i o n and e a t i n g a t t i t u d e s , independent of the e f f e c t s of a c c u l t u r a t i v e s t r e s s , as f o l l o w s : Amongst the Chinese subjects, l e v e l of a c c u l t u r a t i o n as measured by the SL-ASIA, w i l l be found to be the best p r e d i c t o r of p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours. S t a t i s t i c a l A n a l y s i s F i r s t , t - t e s t s were conducted to determine any s i g n i f i c a n t d i f f e r e n c e s across the two c u l t u r a l groups survey i n t h i s study. A s i g n i f i c a n c e l e v e l of p <.05 l e v e l was used unless otherwise s p e c i f i e d . Next, pearson product moment c o r r e l a t i o n a l a n a l y s i s was used to determine the nature of the r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n and e a t i n g a t t i t u d e s as w e l l as the nature of the r e l a t i o n s h i p between a c c u l t u r a t i v e s t r e s s and e a t i n g a t t i t u d e s . 53 F i n a l l y , m u l t i p l e r e g r e s s i o n a n a l y s i s was performed to t e s t the hypothesis that l e v e l of a c c u l t u r a t i o n i n f l u e n c e s e a t i n g pathology and behaviour independently of a c c u l t u r a t i v e s t r e s s . A stepwise m u l t i p l e - r e g r e s s i o n equation was then constructed w i t h EAT scores as the dependent v a r i a b l e and l e v e l of a c c u l t u r a t i o n , a c c u l t u r a t i v e s t r e s s and age as the p r e d i c t o r v a r i a b l e s . 54 Chapter.IV Results E a r l i e r i n t h i s paper,•four hypotheses were proposed. B r i e f l y , they s t a t e d (a) that female Caucasian subjects would e x h i b i t more p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours than the Chinese s u b j e c t s ; and (b) that h i g h l y a c c u l t u r a t e d female Chinese subjects would e x h i b i t more p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours than l e s s a c c u l t u r a t e d female Chinese s u b j e c t s . Two e x p l o r a t o r y hypotheses were al s o s t a t e d , p r e d i c t i n g (a) that Chinese subjects experiencing a high amount of a c c u l t u r a t i v e s t r e s s would show more p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours; and (b) t h a t l e v e l of a c c u l t u r a t i o n would be the strongest p r e d i c t o r of the Chinese s u b j e c t s ' e a t i n g a t t i t u d e s and behaviours. These hypotheses were t e s t e d s t a t i s t i c a l l y and the r e s u l t s of those analyses are presented i n t h i s chapter.' To begin, however, a d e t a i l e d d e s c r i p t i o n , of the sample i s presented. Demographic D e s c r i p t i o n of the Sample As o u t l i n e d i n the Chapter Three, subjects f o r t h i s study were r e c r u i t e d by two primary researchers. Approximately h a l f of the subjects were r e c r u i t e d by t h i s researcher (Sample 1) , while the remaining 55 subjects were r e c r u i t e d w i t h the a s s i s t a n c e of Dr. Ishiyama i n conjunction w i t h a l a r g e r research study (Sample 2). In a l l cases, t h i s researcher was present during the a c t u a l data c o l l e c t i o n . Table 1 o u t l i n e s the number of subjects r e c r u i t e d i n each sample as w e l l as the questionnaire items completed by each subject. As Table 1 i n d i c a t e s , Sample 1 c o n s i s t e d of 115 subjects (48 Caucasian and 67 Chinese s u b j e c t s ) , while Sample 2 c o n s i s t e d of an a d d i t i o n a l 116 subjects (52 Caucasian and 64 Chinese s u b j e c t s ) . In t o t a l , 231 subjects were r e c r u i t e d f o r t h i s study. A l l of the subjects i n Sample 1 completed the e n t i r e questionnaire package o u t l i n e d i n Chapter 3. Forty-nine of the 64 Chinese subjects i n Sample 2 r e c e i v e d and completed the Suinn-Lew A s i a n S e l f - I d e n t i t y A c c u l t u r a t i o n Scale (SL-ASIA) , and none r e c e i v e d the SAFE A c c u l t u r a t i v e Stress Scale (SAFE). To ensure that there were no s i g n i f i c a n t d i f f e r e n c e s between the two samples, the means and standard d e v i a t i o n s of key v a r i a b l e s were compared. As Table 2 i n d i c a t e s , no s i g n i f i c a n t d i f f e r e n c e s were found across the two samples. Ac c o r d i n g l y , the data was c o l l a p s e d across samples f o r a l l subsequent a n a l y s i s . 56 Table 1 Break Down of Subjects i n each Sample E t h n i c i t y Sample 1 Sample 2 To t a l ( a l l scales) (EAT only) (EAT+SL-ASIA) Caucasian 48 52 0 100 Chinese 67 15 49 131 Tot a l 115 67 49 231 57 Table 2 Means and Standard Deviations f o r Age r Years L i v i n g i n North America, E a t i n g A t t i t u d e s and Behaviours (EAT) and Level of A c c u l t u r a t i o n (SL-ASIA) between Samples Category Samplel a Sample2 b i . l e v e l of Mean Mean s i g n i f i c a n c e (SD) (SD) AGE ( y r ) c 19.97 20.13 0.51 ns (2.24) (2.51) L I F E ( y r ) d 16.06 17.12 -1.13 ns (6.71) (6.68) EAT e 8.82 9.39 -0.46 ns (8.96) (10.21) SL-ASIA f 2.74 2.71 . 30 ns (0.59) (0.56) Note: Life= years l i v i n g i n North America; EAT = f u l l s c a l e EAT; SL-ASIA =. f u l l s c a l e SL -ASIA a n = 115. b I l = 116. c d f = 222. d c l f = 204. e t h e higher the score , the greater the e a t i n g pathology; f i t = 229. ^low scores i n d i c a t e Chinese i d e n t i f i e d , high scores i n d i c a t e Western i d e n t i f i e d ; d f = 114. 58 Table 3 presents some of the demographic inf o r m a t i o n obtained i n the f i r s t s e c t i o n of a l l the questi o n n a i r e packages. F o r t y - s i x percent of the Chinese subjects (n = 131) i n d i c a t e d that they were the ol d e s t s i b l i n g i n t h e i r f a m i l y , while 50% of the Caucasian subjects (n = 100) i n d i c a t e d t h a t they were the e l d e s t s i b l i n g . Another 24% of the Chinese subjects and 28% of the Caucasian subjects i n d i c a t e d t h a t they were the youngest s i b l i n g i n t h e i r f a m i l i e s , suggesting that the m a j o r i t y of the subjects came from two s i b l i n g f a m i l i e s . Ninety-seven percent of a l l the subjects were undergraduate students working towards t h e i r Bachelor degrees. Of the 131 Chinese students r e c r u i t e d f o r t h i s study, 47% were Science majors, 24% were from the Fa c u l t y of A r t s ( i n c l u d i n g H i s t o r y , Psychology and Soc i o l o g y ) , and the remaining 29% were A s i a n Studies students. Of the 100 Caucasian s u b j e c t s , more than h a l f (64%) were from the F a c u l t y of A r t s , while the remaining subjects were majors i n e i t h e r Science (31%) or A s i a n Studies (5%) . As place of b i r t h was a c r i t e r i o n f o r i n c l u s i o n i n t h i s study f o r the Caucasian subjects, i t i s not 59 Table 3 Demographic Data f o r a l l Subjects i n c l u d i n g S i b l i n g Order, Department, Program,' Place of B i r t h , and Generation Level Category- D e s c r i p t i o n Chinese Caucasian T o t a l n ('%) n (%) M '(%) 131 • 100 231 S i b l i n g Oldest 60(46%) 50 (50%) 110 (48%) Order Youngest 31(24%) 28 (28%) 59 (26%) Only 5-( '4%) 6 ( 6%) .11( 5%) Middle 24 (18%) 11 (11%) 35(15%) Other 1 (15%) 4 ( 4%) 5 ( 2 % ) Unknown •10 ( 8%) 1 ( 1%) 11 ( 5%) Dept. BioChem/Chem. 62(47%) 31 (31%) 93 (.40%) A r t s 31(24%) 64 (64%) 95 (41%) A s i a n Studies 38(29%) 5 ( 5%) 43 (19%) Program Bachelors 127(97%) 97 (97%) 224(97%) Diploma 0( 0%) 0 ( 0%) 0 ( 0%) Masters 0 ( 0%) 1 ( 1%) 1 C.4%) Doctoral 1(.8%) 0 ( 0%) 1(.4%) Unclass. 0 (05%) 2 ( 2%) 2(.9%) Unknown 3 ( 2%) 0 ( 0%) 3 ( 1%) . Place Canada 53(40%) 96 (96%) 149(65%) of North America 1(.8%) 4 ( 4%) 5( 2%). B i r t h Other 54 (41%) 0 ( 0%) 54 (23%) No Answered 23 (18%) .0 ( 0%) 23 (10%) Generation L e v e l a 1st. 65(54%) N/A N/A 2nd. 51 (44%) 3rd. 0 C 0%) 4th. 0 ( 0%) 5th. 0 ( 0 % ) a Taken from Question 12 of the SL-ASIA: generation 1 s t . = I was born i n Asia or other; generation 2 n d . = I was born i n Canada, ei t h e r parent was born i n Asia or other. 60 s u r p r i s i n g that 100% of the Caucasian subjects were born i n North America, w i t h 96% i f them i n d i c a t i n g that they were born i n Canada. A l t e r n a t i v e l y , of the 108 Chinese subjects who i n d i c a t e d t h e i r place of b i r t h , 40% were born i n Canada while 41% were born abroad. Eighteen percent of the Chinese subjects d i d not i n d i c a t e where they were they were born. Of the 54 Chinese subjects born abroad, 95% i n d i c a t e d that they were born i n e i t h e r Hong Kong, China or T a i p a i , Taiwan. Five percent of the Chinese subjects born abroad d i d not i n d i c a t e where they were born. According to Question 12 from the Suinn-Lew A s i a n S e l f - I d e n t i t y A c c u l t u r a t i o n Scale (SL-ASIA), 56% of the Chinese subjects c l a s s i f i e d themselves as f i r s t generation, i n d i c a t i n g that they were born i n A s i a or other. The remaining 44% Chinese students c l a s s i f y i n g themselves as second generation, i n d i c a t i n g that they were born i n Canada while at l e a s t one of t h e i r parents was born i n A s i a or other. No subjects c l a s s i f i e d themselves as t h i r d , f o u r t h , or f i f t h generation. Table 4 presents a d d i t i o n a l demographic info r m a t i o n , i n c l u d i n g the means and standard d e v i a t i o n s f o r age, number of years l i v i n g i n North 61 Table 4 Means and Standard Deviations f o r Demographic Data i n c l u d i n g Age, Years L i v i n g i n North America, and Years i n School i n North America Category- Chinese 8 Mean (SD) Caucasian 1 Mean (SD) Age L i f e Schooling 19. 61 (1.75) 12.81 (7.12) 10.09 (5.71) 20.59 (2.86) 20.47 (2.93) N/A 3.15* 9.98** Note: L i f e = Number of years l i v i n g i n North America; Schooling = Number of years attending school i n North America. aH = 131. b n = 100. *p_<.05. **p_<.001. 62 America, and number of years attending school i n North America across the two c u l t u r a l groups. The mean age v a r i e d s i g n i f i c a n t l y between groups £(222) = 3.14, p_ <.05, w i t h a mean of 19.61 years {SB. - 1.75 years) f o r the Chinese subjects and 20.59 years (SD = 2.86 years) f o r the Caucasian s u b j e c t s . As a n t i c i p a t e d , there was al s o a s i g n i f i c a n t d i f f e r e n c e i n the number of years each group i n d i c a t e d they had l i v e d i n North America £(204) = 9.96, £ <.001, wi t h a mean of 12.81 years {SB. = 7.12 years) f o r the Chinese subjects and 20.47 years (SD = 2.8 6 years) f o r the Caucasian s u b j e c t s . Information regarding the number of years the Caucasian subjects attended school i n North America was not c o l l e c t e d . However, t h i s i n f o r m a t i o n was c o l l e c t e d f o r the Chinese s u b j e c t s . A c c o r d i n g l y , the mean number of years the Chinese subjects attended school i n North America was 10.09 years {SB = 5.71 y e a r s ) . Hypothesis One: E a t i n g A t t i t u d e s and Behaviours across C u l t u r a l Groups Although i t was hypothesized that the Caucasian subjects would d i s p l a y s i g n i f i c a n t l y more p a t h o l o g i c a l tendencies i n t h e i r e a t i n g a t t i t u d e s and behaviours than the Chinese s u b j e c t s , s t a t i s t i c a l analyses d i d not support t h i s p r e d i c t i o n . These analyses assessed 63 whether the two c u l t u r a l groups under c o n s i d e r a t i o n i n t h i s study d i f f e r e d from each other on the scores of the f u l l s c a l e EAT, as w e l l as i t s three subscales. Table 5 presents the means and standard d e v i a t i o n s across groups f o r a l l the s c a l e s . Only the o r a l c o n t r o l subscale approached a s i g n i f i c a n t l e v e l w i t h p_ = .058 [£(229) = -1.90]. While there were no s i g n i f i c a n t d i f f e r e n c e s i n EAT scores across the Chinese and Caucasian s u b j e c t s , the Chinese s u b j e c t s ' mean f u l l s c a l e EAT score appears higher on v i s u a l examination than the mean EAT score of 5.93 (SD=5.46) reported by Lee (1993) f o r h i s sample of 646 female Chinese u n i v e r s i t y students s t i l l l i v i n g i n China. U t i l i z i n g the inf o r m a t i o n provided by Lee (1993), a £ t e s t f o r independent samples was conducted employing the f o l l o w i n g formula: £ = X 1 - X 2 While the r e s u l t s of t h i s procedure must be viewed w i t h c a u t i o n as the s i m i l a r i t y of sample c h a r a c t e r i s t i c s and study methodology can not be ensured, the present study's sample of Chinese students appears to have 64 Table 5 Means and Standard Deviations f o r the f u l l Scale and Subscale EAT Scores across C u l t u r a l Groups Category Chinese 3 Mean (SD) Caucasian* 3 Mean (SD) £. • (dj£=229 l e v e l of ) s i g n i f i c a n c e EAT 9.51 (8.92) 8.59 (10.43) -.72 ns -Diet 5.51 (6.39) 5.45 (7.35) -.05 ns -Bulimia 1.22 (2.27) 1.17 (2.38) -.17 ns - O r a l C o n t r o l 2.79 (3.64) 1. 97 (2.61) -1. 90 p_=. 058 Note: EAT = f u l l s c a l e EAT;'Diet = d i e t subscale; B u l i m i a = b u l i m i a subscale; O r a l C o n t r o l = o r a l c o n t r o l subscale. a n = 131. b n = 100. 65 scored s i g n i f i c a n t l y higher on the EAT than Lee's sample of Chinese students £(773) = 6.05, p_ < .001. Accordingly, i t appears that the female Chinese subjects surveyed i n t h i s study d i s p l a y e d more e a t i n g pathology than the female Chinese subjects surveyed i n China. As suggested by Garner, Olmsted, Bohr, & G a r f i n k e l (1982), a t o t a l EAT score of 20 was used as the c u t - o f f p o i n t between p a t h o l o g i c a l and non-pathological e a t i n g a t t i t u d e s and behaviours. A c c o r d i n g l y , the percentage of students i n each c u l t u r a l group s c o r i n g over the c u t - o f f p o i n t was compared. As Table 6 presents, 12% of the Chinese students and 10% of the Caucasian students scored over the c u t - o f f p o i n t . Chi-squared a n a l y s i s was conducted and revealed that the d i f f e r e n c e across groups was i n s i g n i f i c a n t , X2(1,N_=231) = 0.502 p_ >.50. Hypothesis Two and Three: C o r r e l a t i o n a l A n a l y s i s One of the primary o b j e c t i v e s of t h i s study was to examine any p o s s i b l e c o r r e l a t i o n s between l e v e l of a c c u l t u r a t i o n , a c c u l t u r a t i v e s t r e s s , and e a t i n g pathology amongst the Chinese s u b j e c t s . In t h i s s e c t i o n I w i l l present and analyze the c o r r e l a t i o n 66 Table 6 Contingency Table of Chinese and Caucasian Subjects who Displayed E a t i n g Pathology (EAT > 20) or no Ea t i n g Pathology (EAT < 21) Category Chinese N (%) Caucasian N (%.) To t a l EAT>2 0 16 (12.21%) 10 (10.00%) 26 EAT<21 115 (87.79%) 90 (90.00%) 205 T o t a l n = 131 100 231 X 2 = 0.552, p_ > .50 67 c o e f f i c i e n t s obtained f o r l e v e l of a c c u l t u r a t i o n , a c c u l t u r a t i v e s t r e s s and e a t i n g a t t i t u d e s and behaviours as w e l l as the i n t e r c o r r e l a t i o n s f o r the measures of l e v e l of a c c u l t u r a t i o n (SL-ASIA) and e a t i n g a t t i t u d e s and behaviours (EAT). I n t e r c o r r e l a t i o n s of the EAT and SL-ASIA. To explore the v a l i d i t y of the EAT w i t h Chinese su b j e c t s , i n t e r c o r r e l a t i o n a l a n a l y s i s was conducted (see Appendix H). Thus, the i n t e r c o r r e l a t i o n s between the f u l l s c a l e and subscale EAT scores f o r a l l subjects combined, Caucasian subjects, and Chinese subjects were i n v e s t i g a t e d . The i n t e r c o r r e l a t i o n s of the f u l l s c a l e and subscale EAT scores f o r the Chinese subjects c l o s e l y resembled those of the Caucasian subjects, w i t h the exception of the o r a l c o n t r o l subscale. While the o r a l c o n t r o l subscale was p o s i t i v e l y c o r r e l a t e d to the d i e t subscale (r_ = .364) f o r the Caucasian su b j e c t s , i t was not s i g n i f i c a n t l y c o r r e l a t e d to the d i e t subscale f o r the Chinese subjects (r = .037). This f i n d i n g echoes Lee's (1993) r e s u l t s which i n d i c a t e d that the o r a l c o n t r o l subscale f a i l e d to be s i g n i f i c a n t l y c o r r e l a t e d w i t h the d i e t subscale f o r h i s sample of Chinese subjects l i v i n g i n China. Aside from the o r a l 68 c o n t r o l subscale, however, the i n t e r c o r r e l a t i o n s appear s i m i l a r across both groups. S i m i l a r l y , i n t e r c o r r e l a t i o n a l a n a l y s i s of the l e v e l of a c c u l t u r a t i o n measure (SL-ASIA) f o r the Chinese subjects was conducted (see Appendix I ) . The r e s u l t s revealed that a l l of the subscales were h i g h l y c o r r e l a t e d to each other as w e l l as the f u l l s c a l e score. Level of A c c u l t u r a t i o n and E a t i n g A t t i t u d e s and Behaviours Amongst the Chinese Subjects. In t h i s s e c t i o n I w i l l present and analyze the c o r r e l a t i o n c o e f f i c i e n t s obtained f o r l e v e l of a c c u l t u r a t i o n , as measured by the SL-ASIA, and e a t i n g a t t i t u d e s and behaviours, as measured by EAT. Although s i g n i f i c a n t p o s i t i v e c o r r e l a t i o n s were hypothesized, no s i g n i f i c a n t r e l a t i o n s h i p s were observed on the f u l l s c a l e l e v e l (Table 7). On the subscale l e v e l , however, the EAT subscale addressing o r a l c o n t r o l was s i g n i f i c a n t l y r e l a t e d to the f u l l SL-ASIA as w e l l as three of the f i v e subscales i n c l u d i n g , language preference and usage, e t h n i c i n t e r a c t i o n , and a f f i n i t y f o r e t h n i c i d e n t i t y and p r i d e i n the negative d i r e c t i o n . These r e s u l t s appear to i n d i c a t e that l e s s a c c u l t u r a t e d Chinese su b j e c t s , as measured by the above. 69 Table 7 C o r r e l a t i o n M a t r i x of F u l l Scale and Subscale EAT and SL-ASIA Scores f o r the Chinese Subjects EAT Diet B u l i m i a O r a l C o n t r o l SL-ASIA -0.15 -0.06 -0.10 -0.20* -Language -0.14 -0.02 -0.10 • -0.23* - F r i e n d -0.16 -0.05 -0.14 -0.22* - A f f i n i t y -0.21* -0.10 -0.19* -0.22* -Generation -0.05 -0.06. -0.01 -0.01 -Food -0.03 -0.001 -0.06 -0.11 Note: SL-ASIA = f u l l s c a l e SL-ASIA; Language = language preference subscale; F r i e n d =ethnic i n t e r a c t i o n subscale; A f f i n i t y = a f f i n i t y f o r et h n i c i d e n t i t y and p r i d e subscale; Generation = gen e r a t i o n a l i d e n t i t y subscale; Food = food preference subscale. Negative r. i n d i c a t e s a tendency that the l e s s a c c u l t u r a t e d , the more e a t i n g pathology. . n = 116. *p_<.05, t w o - t a i l e d . 70 subscales, d i s p l a y more s e l f - c o n t r o l around food and perceive more pressure from others to gain weight than the more a c c u l t u r a t e d s u b j e c t s . S i m i l a r l y , the SL-ASIA subscale measuring a f f i n i t y f o r e t h n i c i d e n t i t y and p r i d e proved to be s i g n i f i c a n t l y r e l a t e d to the f u l l EAT s c a l e as w e l l as the b u l i m i a and o r a l c o n t r o l subscales, again i n d i c a t i n g that those subjects d i s p l a y i n g greater a f f i n i t y f o r the Chinese c u l t u r e d i s p l a y more p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours. EAT scores were p l o t t e d against SL-ASIA scores to i n v e s t i g a t e a p o s s i b l e c u r v i l i n e a r r e l a t i o n s h i p between these two v a r i a b l e s . No s i g n i f i c a n t c u r v i l i n e a r r e l a t i o n s h i p was found. In a post hoc a n a l y s i s , Suinn et a l . ' s (1987) suggested procedure of d i v i d i n g the f u l l s c a l e SL-ASIA scores i n t o low (1-2), medium (3) and high (4-5) categ o r i e s was followed. A c c o r d i n g l y , the Chinese su b j e c t s ' f u l l s c a l e SL-ASIA scores were c a t e g o r i z e d and t h e i r mean f u l l s c a l e EAT scores were compared across the three groups. U t i l i z i n g this.procedure r e s u l t e d i n only 9 cases i n the \"high\" a c c u l t u r a t i o n category. Therefore, data from two SL-ASIA questions (Questions #3 and #20) that d i r e c t l y asked subjects to i n d i c a t e t h e i r l e v e l of a c c u l t u r a t i o n were a l s o d i v i d e d 71 i n t o low, medium and high scores and the mean f u l l s c a l e EAT scores were compared across groups. This procedure r e s u l t e d i n a b e t t e r d i s t r i b u t i o n of cases across the three l e v e l s of a c c u l t u r a t i o n . Table 8 presents the r e s u l t s of the one-way analyses of variance (ANOVAs). These analyses i n d i c a t e d that the d i f f e r e n c e s across the three l e v e l s of a c c u l t u r a t i o n were s i g n i f i c a n t regardless of the measure of l e v e l of a c c u l t u r a t i o n . Subsequent a n a l y s i s u t i l i z i n g the Scheffe method determined that only the d i f f e r e n c e s between the low and medium l e v e l s of a c c u l t u r a t i o n were s i g n i f i c a n t . A c c o r d i n g l y , while i n s p e c t i o n of the means presented i n Table 8 suggest that i n d i v i d u a l s who i n d i c a t e a high l e v e l of a c c u l t u r a t i o n have a tendency'to d i s p l a y greater e a t i n g pathology than the those who i n d i c a t e a medium l e v e l of a c c u l t u r a t i o n , the d i f f e r e n c e s were found not to be s i g n i f i c a n t . A c c u l t u r a t i v e Stress and E a t i n g A t t i t u d e s and Behaviours f o r the Chinese Subjects. One of the e x p l o r a t o r y goals of t h i s study was to address the r e l a t i o n s h i p between a c c u l t u r a t i v e s t r e s s , as measured by the SAFE, and e a t i n g a t t i t u d e s and behaviours. As p r e d i c t e d , a c c u l t u r a t i v e s t r e s s was s i g n i f i c a n t l y 72 Table 8 Qne-wav A n a l y s i s of Variance of F u l l Scale EAT Scores across Level of A m i l t n r a r i n n Level of A c c u l t u r a t i o n EAT Mean (SD) F (d£=2,113) SL-ASIA ( t o t a l ) a Low ii=33 12. 62 . (10.86) Medium n=77 7.61 (7.51) High ii=6 12.67 (10.54) 4.29* SL-ASIA #3b Low ii=47 •11.32 (9.83) Medium n=50 6.76- (7.67) High n=19 11.01 (8.74) 3. 69* SL-ASIA #20c Low n=43 12.49 (10.18) Medium n=57 7.21 (8.13) High n=16 8.19 (5.83) 4.65* Note: low SL-ASIA scores i n d i c a t e Chinese- i d e n t i f i e d , high scores i n d i c a t e Western i d e n t i f i e d . a F u l l s c a l e SL-ASIA ^How do you i d e n t i f y y o u r s e l f ? cHow would you rat e y o u r s e l f ? *p_ < .05 73 r e l a t e d to the f u l l s c a l e EAT as w e l l as the d i e t and b u l i m i a subscales, i n d i c a t i n g that subjects experiencing greater a c c u l t u r a t i v e s t r e s s d i s p l a y more ea t i n g pathology (see Table 9). In a post hoc a n a l y s i s , the SAFE was al s o found to be s i g n i f i c a n t l y r e l a t e d to the f u l l s c a l e SL-ASIA, as w e l l as a l l but one of the subscales, i n d i c a t i n g that s u b j e c t s ' d i s p l a y i n g lower l e v e l s of a c c u l t u r a t i o n experience more a c c u l t u r a t i v e s t r e s s (see Table 10). Hypothesis Four: Regression A n a l y s i s In t h i s s e c t i o n , I w i l l examine and analyze the r e s u l t s of the re g r e s s i o n a n a l y s i s . F i r s t , a simultaneous m u l t i p l e r e g r e s s i o n was conducted. Level of a c c u l t u r a t i o n (SL-ASIA subscales), a c c u l t u r a t i v e s t r e s s (SAFE), and age were used as p r e d i c t o r v a r i a b l e s . P a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours ( f u l l s c a l e EAT) was the c r i t e r i o n v a r i a b l e . Next, a model of the r e g r e s s i o n of the f u l l s c a l e and subscale EAT scores on a l l the p r e d i c t o r v a r i a b l e s was conducted wi t h the use of a stepwise r e g r e s s i o n . Analyses were performed using SPSS* REGRESSION w i t h an a s s i s t from SPSS* FREQUENCIES f o r e v a l u a t i o n of assumptions. 74 Table 9 C o r r e l a t i o n M a t r i x of F u l l Scale and Subscale EAT Scores wi t h SAFE EAT Diet B u l i m i a O r a l C o n t r o l SAFE .45** .37* .36* .24 n = 67. *p<.01, t w o - t a i l e d . **p_<.001, t w o - t a i l e d . 75 Table 10 C o r r e l a t i o n M a t r i x of F u l l Scale and Subscale SL-ASIA Scores w i t h SAFE SAFE SL-ASIA (Total) -0.42** language -0.35** - f r i e n d -0.31* - A f f i n i t y • -0.39** -Generation -0.23 -Food -0.29* n = 67. *p.<.05, t w o - t a i l e d . **p_<.6l, t w o - t a i l e d 76 Results of e v a l u a t i o n of assumptions l e d to square root transformation of the EAT v a r i a b l e s to reduce a s l i g h t skewness i n t h e i r d i s t r i b u t i o n , reduce the number of o u t l i e r s , and improve the normality, l i n e a r i t y , and homoscedasticity of r e s i d u a l s . With the use of a p_ < .001 c r i t e r i o n f o r Mahalanobis di s t a n c e no o u t l i e r s among cases were found. No cases had missing data. Table 11 presents a summary of the f i n d i n g s from the m u l t i p l e r e g r e s s i o n a n a l y s i s p r e d i c t i n g e a t i n g a t t i t u d e s and behaviours. The equation p r e d i c t i n g e a t i n g a t t i t u d e s and behaviours reached s i g n i f i c a n c e , F(7, 59) = 2.285, p_ < .05. Only one v a r i a b l e , a c c u l t u r a t i v e s t r e s s , was s i g n i f i c a n t l y r e l a t e d to ea t i n g a t t i t u d e s and behaviours> £(1, 65) = 2.985, p_< .01. Contrary to Hypothesis four o u t l i n e d i n Chapter 3, l e v e l of a c c u l t u r a t i o n , as measured by the f u l l s c a l e SL-ASIA, was not s i g n i f i c a n t l y r e l a t e d to e a t i n g a t t i t u d e s and behaviours. E n t e r i n g the f i v e p r e d i c t o r v a r i a b l e s i n the r e g r e s s i o n equation produced an R-squared of .21, wit h an adjusted R-squared of .12 (see Table 9). Therefore, a modest amount of variance (12%) i n e a t i n g a t t i t u d e s and behaviours i s accounted f o r , almost wholly by a c c u l t u r a t i v e s t r e s s . 77 Table 11 M u l t i p l e Regression A n a l y s i s of P r e d i c t o r s of P a t h o l o g i c a l E a t i n g A t t i t u d e s and Behaviours (n=67) Source Beta £ l e v e l of s i g n i f i c a n c e Age -.072 -.585 ns SL-language .039 .224 ns S L - f r i e n d -.111 -.768 ns SL-generation -.037 -.267 ns SL-food .112 .767 ns S L - a f f i n i t y -.109 -.716 ns SAFE .401 2.985 p_=. 0041 Note:Beta i s the standardized r e g r e s s i o n c o e f f i e n t . Percentage of variance i n e a t i n g a t t i t u d e s and behaviours accounted f o r by the r e g r e s s i o n equation (R 2 i s .21 (Adjusted .12). O v e r a l l £(7,59) = 2.285, p <.05. 78 Second, a model of the r e g r e s s i o n of the f u l l s c a l e EAT on a l l of the p r e d i c t o r v a r i a b l e s was conducted w i t h the use of a stepwise r e g r e s s i o n (see Table 12). Again, only a c c u l t u r a t i v e s t r e s s , as measured by the SAFE, proved to be s i g n i f i c a n t , accounting f o r almost a l l of the varia n c e . Despite the recent controversy regarding the v a l i d i t y of employing stepwise methods (Thompson, 1989/ Wampold & Freud, 1987) the s i m i l a r i t y of f i n d i n g s across both methods of re g r e s s i o n support the v a l i d i t y of the r e g r e s s i o n p a t t e r n noted i n the stepwise procedure. F i n a l l y , a model of the r e g r e s s i o n of the three EAT subscales on a l l of the p r e d i c t o r v a r i a b l e s was conducted w i t h the use of a stepwise r e g r e s s i o n (see Tables 13-15). Both the d i e t and b u l i m i a subscales regressed i n as s i m i l a r manner as the f u l l s c a l e EAT, i d e n t i f y i n g a c c u l t u r a t i v e s t r e s s as the best p r e d i c t o r of e a t i n g pathology. The o r a l c o n t r o l subscale, however, i n d i c a t e d that the l e v e l o f . a c c u l t u r a t i o n subscale measuring a f f i n i t y f o r e t h n i c i d e n t i t y and p r i d e was the best p r e d i c t o r of e a t i n g pathology. The r e s i d u a l s of a l l of the above regressions were p l o t t e d against the p r e d i c t e d values. These analyses showed that over 95% of the. r e s i d u a l s f e l l w i t h i n +/-79 Table 12 Stepwise Regression of the F u l l Scale EAT on a l l of the P r e d i c t o r V a r i a b l e s Source Beta Weight t R' Step One: SAFE .423 3.760** .18 Step Two; SAFE .401 2.985* Age -.072 -.585 SL-generation -.037 -.267 SL-food .112 .767 S L - f r i e n d -.111 -.768 S L - a f f i n i t y -.101 -.716 SL-language .039 .224 .21 n = 67. *p_<.05. **p_<.001 80 Table 13 Stepwise Regression of the Diet Subscale on a l l , of the P r e d i c t o r V a r i a b l e s Source Beta Weight t E' Step One; SAFE Step Two; SAFE Age SL-generation SL-food S L - f r i e n d S L - a f f i n i t y SL-language 371 .505 .204 ,068 ,080 ,057 ,194 ,140 3.218* 3.773** •1.500 -.494 .549 -.396 1.281 .3 60 14 ,21 II = 67. *p<.005. **p<.001 81 Table 14 Stepwise Regression of the B u l i m i a Subscale on a l l of the P r e d i c t o r V a r i a b l e s Source Beta Weight t R' Step One: SAFE .288 2.368* .09 Step Two; SAFE .2 61 1.950* Age .048 .376 SL-generation -.099 -.689 SL-food .219 1.439 S L - f r i e n d -.157 -1.014 S L - a f f i n i t y -.110 -.696 SL-language . 084 .463 .15 n = 67. *p_.05. **p<.001. 82 Table 15 Stepwise Regression of the Oral C o n t r o l Subscale on a l l of the P r e d i c t o r V a r i a b l e s Source Beta Weight t Rj Step One; S L - a f f i n i t y -.468 -4.265** .22 Step Two: S L - a f f i n i t y -.448 -3.039* Age .195 1.626 SAFE -.049 -.379 SL-food -.018 -.127 SL-generation .067 .512 S L - f r i e n d -.076 -.544 SL-language -.048 -.565 .25 n = 67. *p_<.01. ** p<.001. 83 2.00 SD. ( a l l w i t h i n +/- 3.00 SJQ) . Again, a n a l y s i s of Cook and Mahalanobis distances i n d i c a t e d no s i g n i f i c a n t o u t l i e r s . A d d i t i o n a l l y , e n t e r i n g scores which had been transformed to account f o r the p o s s i b i l i t y of a quadratic e f f e c t d i d not c o n t r i b u t e s i g n i f i c a n t l y to the r e g r e s s i o n . Thus, i t appears that no s i g n i f i c a n t c u r v i l i n e a r r e l a t i o n s h i p e x i s t s . 84 Chapter V Dis c u s s i o n The primary purpose of t h i s research study was to compare the e a t i n g a t t i t u d e s and behaviours of Chinese and Caucasian female u n i v e r s i t y students. A d d i t i o n a l l y , t h i s study i n v e s t i g a t e d whether a r e l a t i o n s h i p e x i s t s between l e v e l of a c c u l t u r a t i o n , a c c u l t u r a t i v e s t r e s s , and p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours amongst Chinese female u n i v e r s i t y students. No such studie s had p r e v i o u s l y been c a r r i e d out w i t h A s i a n subjects who do not have o r i g i n s i n the Indian subcontinent, nor have any st u d i e s i n c l u d e d both a measure of l e v e l of a c c u l t u r a t i o n and a c c u l t u r a t i v e s t r e s s . In t h i s chapter the r e s u l t s obtained i n t h i s study are discussed and compared w i t h e x i s t i n g research f i n d i n g s . The l i m i t a t i o n s of the study are st a t e d , along w i t h suggestions f o r f u r t h e r research. F i n a l l y / the c o u n s e l l i n g i m p l i c a t i o n s of the current study' r e s u l t s are o u t l i n e d . Review of the Research Findings C u l t u r a l group d i f f e r e n c e s . This study found no s i g n i f i c a n t d i f f e r e n c e s between the Chinese and Caucasian subjects i n e a t i n g a t t i t u d e s and behaviours. 85 Both groups scored s i m i l a r l y on the E a t i n g A t t i t u d e s Test (EAT) and the percentage of subjects who scored 20 or more p o i n t s on the EAT (the c u t - o f f score f o r an e a t i n g disorder) was a l s o roughly the same across groups. Such f i n d i n g s were not a n t i c i p a t e d or hypothesized. However, they are i n keeping w i t h Pumariega's f i n d i n g s of no s i g n i f i c a n t d i f f e r e n c e s between h i s sample of Hispanic and Caucasian s u b j e c t s . In a d d i t i o n , although the d i f f e r e n c e s were not s i g n i f i c a n t , the f a c t that more Chinese than Caucasian subjects scored over the c u t - o f f p o i n t on the EAT i s c o n s i s t e n t w i t h Mumford et a l . ' s (1991; 1992) f i n d i n g s . A c l o s e r look at the demographic data of the Chinese subjects may help e x p l a i n the s i m i l a r i t y across groups on EAT scores. The demographic data revealed that more than h a l f of the Chinese subjects were born i n North America. A d d i t i o n a l l y , of those subjects born abroad, 95% i n d i c a t e d that they were born i n Hong Kong or T a i p a i , Taiwan. Lee, Chiu and Chen (1989) s t a t e d that people i n i n d u s t r i a l i z e d urban c i t i e s such as Hong Kong and Taiwan have r e c e n t l y begun to f e e l the e f f e c t s of W e s t e r n i z a t i o n as evidenced by the development of f a s t food restaurants and aerobic gyms. Thus, the m a j o r i t y 86 of Chinese subjects who i n d i c a t e d t h e i r place of b i r t h were e i t h e r North America or urban c i t i e s c u r r e n t l y undergoing W e s t e r n i z a t i o n . S i m i l a r l y , the mean number of years a l l of the Chinese subjects i n d i c a t e d they had l i v e d i n North America was 12.81 years, and t h e i r mean number of years attending school i n North America was 10.09 years. Thus, i n general, the Chinese subjects surveyed i n t h i s study had a high degree of exposure to Western c u l t u r e at the time of the study. I t i s t h e r e f o r e p o s s i b l e that the Chinese subjects surveyed i n t h i s study already had enough exposure to Western i d e a l s and values to put them at s i m i l a r r i s k as t h e i r Caucasian counterparts of developing p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours. Such an i n t e r p r e t a t i o n of the r e s u l t s i s supported by Furnham and A l i b h a i ' s (1983) study of Kenyan women's p r e f e r r e d body shape. Their r e s u l t s found that when non-Western women are placed i n a Western c u l t u r e they q u i c k l y a s s i m i l a t e Western i d e a l s and values, such as • the thinness i d e a l , and surrender the t r a d i t i o n a l i d e a l of feminine beauty h e l d i n t h e i r home c u l t u r e . While no s i g n i f i c a n t d i f f e r e n c e s were found between the two c u l t u r a l groups survey i n t h i s study, 87 the Chinese s u b j e c t s ' mean score on the f u l l s c a l e EAT was s i g n i f i c a n t l y higher than that reported by Lee (1993) f o r h i s sample of female Chinese' u n i v e r s i t y students l i v i n g i n China. While t h i s f i n d i n g must be i n t e r p r e t e d w i t h c a u t i o n as the s i m i l a r i t y of sample c h a r a c t e r i s t i c s and study methodology can -not be ensured, i t does appear to m i r r o r Mumford et a l . ' s (1992) f i n d i n g that A s i a n subjects l i v i n g i n Bradford, London d i s p l a y e d higher EAT scores and more cases of anorexia and b u l i m i a compared to As i a n subjects l i v i n g i n t h e i r home co u n t r i e s of Lahore (Mumford et a l . , 1992) and Mirpur (Choudry & Mumford, 1992). Thus, the f i n d i n g s of t h i s study support Mumford and h i s c o l l e g u e s ' (Choudry & Mumford, 1992; Mumford et a l . , 1991, 1992) c l a i m that non-white women l i v i n g i n Western c o u n t r i e s and exposed to Western values and i d e a l s are at higher r i s k of developing p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours than s i m i l a r non-white women s t i l l l i v i n g i n t h e i r country of o r i g i n . A d d i t i o n a l l y , the f i n d i n g s of t h i s study suggest that female Chinese u n i v e r s i t y students l i v i n g i n B r i t i s h Columbia, Canada (as an example of Western c u l t u r e ) , d i s p l a y a s i m i l a r l e v e l of e a t i n g pathology as t h e i r Caucasian counterparts. Without f u r t h e r a n a l y s i s , 88 however, i t i s d i f f i c u l t to determine whether these findings, are due simply to l e v e l of a c c u l t u r a t i o n and a s s i m i l a t i o n of Western c u l t u r e , i d e a l s , and values or the a c c u l t u r a t i v e s t r e s s o f t e n a s s o c i a t e d w i t h the r e l o c a t i o n process., This query i s addressed i n the f o l l o w i n g s e c t i o n s of t h i s chapter. Level of a c c u l t u r a t i o n and e a t i n g a t t i t u d e s and behaviours. C o r r e l a t i o n a l a n a l y s i s revealed s e v e r a l negative r e l a t i o n s h i p s between l e v e l of a c c u l t u r a t i o n and e a t i n g a t t i t u d e s and behaviours amongst the Chinese s u b j e c t s . S p e c i f i c a l l y , the EAT subscale addressing o r a l c o n t r o l was s i g n i f i c a n t l y r e l a t e d to the f u l l s c a l e measure of l e v e l of a c c u l t u r a t i o n (SL-ASIA) as w e l l as three of i t s f i v e subscales.. This f i n d i n g suggests that the l e s s a c c u l t u r a t e d Chinese subjects d i s p l a y e d more p a t h o l o g i c a l c o n t r o l around food and perceive more pressure from others to gain weight than the more a c c u l t u r a t e d s u b j e c t s . S i m i l a r l y , the SL-ASIA subscale measuring a f f i n i t y f o r e t h n i c i d e n t i t y and p r i d e was n e g a t i v e l y r e l a t e d to the f u l l s c a l e EAT as w e l l as the b u l i m i a and o r a l c o n t r o l subscales i n d i c a t i n g that those subjects d i s p l a y i n g greater a f f i n i t y and p r i d e f o r t h e i r Chinese c u l t u r e d i s p l a y e d more p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours. 89 While these f i n d i n g s were not hypothesized, they do support Mumford et a l . ' s (1991) f i n d i n g that t h e i r more \" t r a d i t i o n a l \" A s i a n subjects l i v i n g i n B r i t a i n d i s p l a y e d more e a t i n g pathology than the r e s t of t h e i r A sian subjects l i v i n g i n B r i t a i n . While c o r r e l a t i o n a l a n a l y s i s of l e v e l . o f a c c u l t u r a t i o n and e a t i n g pathology i d e n t i f i e d only negative r e l a t i o n s h i p s , one-way a n a l y s i s of variance across low, medium and high l e v e l s of a c c u l t u r a t i o n , provided a d d i t i o n a l i n s i g h t . S p e c i f i c a l l y , there was a s i g n i f i c a n t d i f f e r e n c e i n f u l l s c a l e EAT scores across the low and medium l e v e l s of a c c u l t u r a t i o n w i t h i n d i v i d u a l s i n d i c a t i n g a low l e v e l of a c c u l t u r a t i o n d i s p l a y i n g more p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours than i n d i v i d u a l s i n d i c a t i n g a medium l e v e l of a c c u l t u r a t i o n . A d d i t i o n a l l y , although the r e s u l t s were not s i g n i f i c a n t , there a l s o seemed to be a tendency f o r i n d i v i d u a l s i n d i c a t i n g a high l e v e l of a c c u l t u r a t i o n to d i s p l a y more e a t i n g pathology than i n d i v i d u a l s i n d i c a t i n g a medium l e v e l of a c c u l t u r a t i o n . Thus, the r e s u l t s of the one-way ANOVAs riot only revealed which of the Chinese subjects may be at greatest r i s k f o r developing p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours, they a l s o suggest who may be 90 at l e a s t r i s k f o r e a t i n g pathology. A c c o r d i n g l y , i t appears that those Chinese subjects who i n d i c a t e d a medium l e v e l of a c c u l t u r a t i o n d i s p l a y e d the h e a l t h i e s t e a t i n g a t t i t u d e s and behaviours. According to Suinn et a l . (1987), t h i s \" b i c u l t u r a l \" s t a t u s may r e f l e c t the a b i l i t y to s u c c e s s f u l l y i n t e g r a t e the best of both the host and t r a d i t i o n a l culture's without d e n i a l to e i t h e r . Although s t a t i s t i c a l analyses revealed no s i g n i f i c a n t quadratic r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n and e a t i n g pathology i n t h i s study, the f i n d i n g that a b i c u l t u r a l l e v e l of a c c u l t u r a t i o n ' i s r e l a t e d to h e a l t h i e r e a t i n g a t t i t u d e s and behaviours o f f e r s some support to G i l , Vega, and Dimas' (1994) p r e d i c t i o n of a c u r v i l i n e a r r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n and mental h e a l t h s t a t u s . Thus, i n accordance wi t h G i l et a l . ' s p r e d i c t i o n s , the f i n d i n g s of t h i s study may suggest that b i c u l t u r a l subjects experience b e t t e r p s y c h o l o g i c a l outcomes ( i . e . , h e a l t h i e r e a t i n g a t t i t u d e s and behaviours) due to t h e i r knowledge of and p a r t i c i p a t i o n i n the host c u l t u r e , while r e t a i n i n g the p o s i t i v e , p r o t e c t i v e f a c t o r s of t h e i r t r a d i t i o n a l c u l t u r e ( i . e . , l e s s i d e a l i z a t i o n of t h i n n e s s ) . 91 A c c u l t u r a t i v e s t r e s s and e a t i n g a t t i t u d e s and behaviours. Although examining the r e l a t i o n s h i p between a c c u l t u r a t i v e s t r e s s and e a t i n g a t t i t u d e s and behaviours was done f o r an e x p l o r a t o r y purpose, the r e s u l t s of t h i s study revealed a much stronger r e l a t i o n s h i p between a c c u l t u r a t i v e s t r e s s and e a t i n g pathology than the r e l a t i o n s h i p noted between l e v e l of a c c u l t u r a t i o n and e a t i n g pathology. C o r r e l a t i o n a l analyses revealed that a c c u l t u r a t i v e s t r e s s , as measured by the SAFE, was p o s i t i v e l y r e l a t e d to the f u l l s c a l e EAT as w e l l as the d i e t i n g and b u l i m i a subscales. A d d i t i o n a l l y , post hoc a n a l y s i s i n d i c a t e d that a c c u l t u r a t i v e s t r e s s was n e g a t i v e l y ' r e l a t e d to l e v e l of a c c u l t u r a t i o n , i n d i c a t i n g that more a c c u l t u r a t i v e s t r e s s i s a s s o c i a t e d w i t h lower l e v e l s of a c c u l t u r a t i o n . Thus, i t appears that those i n d i v i d u a l s experiencing greater a c c u l t u r a t i v e s t r e s s d i s p l a y lower l e v e l s of a c c u l t u r a t i o n as w e l l as more e a t i n g pathology. One p o s s i b l e I n t e r p r e t a t i o n of t h i s f i n d i n g may be that the elevated e a t i n g pathology noted amongst Chinese subjects d i s p l a y i n g low l e v e l of a c c u l t u r a t i o n may be due to the e f f e c t s of a c c u l t u r a t i v e s t r e s s . The strong r e l a t i o n s h i p between a c c u l t u r a t i v e s t r e s s and e a t i n g pathology, noted i n t h i s study i s 92 c o n s i s t e n t w i t h the r e s u l t s of a recent s e r i e s of a r t i c l e s s p e c i f i c a l l y i n v e s t i g a t i n g the r e l a t i o n s h i p between e a t i n g pathology and a c c u l t u r a t i v e s t r e s s (Ahmad, Waller, & Verduyn, 1994/ H i l l & B h a t t i , 1995; McCourt & Waller, 1995). These st u d i e s concluded that i n t e r p e r s o n a l and i n t r a f a m i l i a l c u l t u r a l c o n f l i c t was s i g n i f i c a n t l y r e l a t e d to the occurrence of p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours. F i n a l l y , t h i s r e l a t i o n s h i p i s f u r t h e r supported by a s e r i e s of case repo r t s of g i r l s of A s i a n o r i g i n l i v i n g i n Western c u l t u r e s who presented w i t h anorexia nervosa ( i . e . , Bryant-Waugh & Lask, 1991; B u l i k , 1987/ Bhadrinath, 1990/ Ford, 1992/ Schmidt, 1993). Bryant-Waugh & Lask (1991), f o r example, noted c l e a r evidence of c u l t u r a l c o n f l i c t i n a l l of t h e i r cases, c o n f l i c t that was.central to the onset and progress of the di s o r d e r . They made the p o i n t that f o r a t r a d i t i o n a l f a m i l y , s o c i o c u l t u r a l c o n f l i c t may a r i s e over a range of i s s u e s , i n c l u d i n g arranged marriages, norms regarding dress, contact w i t h the opposite sex, the r o l e of women, mealtimes, and cooking. Thus, given one has some f a m i l i a r i t y w i t h Western c u l t u r e , i t s norms and i d e a l s , t h i s s t r e s s and c o n f l i c t may i n tu r n increase one's chances of developing an ea t i n g d i s o r d e r 93 or p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours as they s t r u g g l e to f i n d a way to cope. Regression a n a l y s i s . The r e g r e s s i v e a n a l y s i s conducted i n t h i s study revealed that a c c u l t u r a t i v e s t r e s s was the only v a r i a b l e accounting f o r any s i g n i f i c a n t variance i n the e a t i n g a t t i t u d e s and behaviours amongst the Chinese students. This f i n d i n g was true f o r the f u l l s c a l e EAT, as w e l l as the d i e t and b u l i m i a subscales. Only the o r a l c o n t r o l subscale r e s u l t e d i n a d i f f e r e n t r e g r e s s i o n p a t t e r n ; one which found l e v e l of a c c u l t u r a t i o n as the only v a r i a b l e accounting f o r any s i g n i f i c a n t v a r i a n c e . One p o s s i b l e explanation may be that these r e s u l t s r e f l e c t the f a c t t h a t , on average, the Chinese subjects surveyed i n t h i s study already had a high degree of exposure to Western values and i d e a l s at the time of the study and t h e r e f o r e may have already achieved the minimum l e v e l of a c c u l t u r a t i o n necessary to put them at r i s k of p a t h o l o g i c a l e a t i n g a t t i t u d e s or behaviours. Thus, as Mumford et a l . (1991) suggested, those i n d i v i d u a l s d i s p l a y i n g p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours may be those who encountered a s t r e s s , such as a c c u l t u r a t i v e s t r e s s , and responded by t u r n i n g to a Western coping mechanism such as e a t i n g pathology. 94 Thus, Mumford et a l . ' s conclusions that \" i t i s probable that these A s i a n g i r l s [those d i s p l a y i n g e a t i n g pathology] are i n c r e a s i n g l y adopting 'Western' patterns of r e a c t i n g to personal c o n f l i c t s and s t r e s s f u l l i f e circumstances\"(p. 226), may be e q u a l l y c o n c l u s i v e of t h i s study's f i n d i n g s . Review of the C r o s s - C u l t u r a l V a l i d i t y of the E a t i n g A t t i t u d e s Test (EAT) This study d i d not purport to c a r r y out a f u l l f a c t o r a n a l y s i s of the EAT because previous research found the twenty-six item EAT to be a v a l i d measure of e a t i n g a t t i t u d e s and behaviours f o r A s i a n women l i v i n g i n Western c u l t u r e s (Choudry & Mumford, 1992; Mumford et a l . , 1991, 1992). I n t e r c o r r e l a t i o n a l a n a l y s i s was conducted, however, and revealed that the EAT subscales were c o r r e l a t e d to each other and the f u l l s c a l e EAT i n a s i m i l a r manner f o r both the Chinese and Caucasian s u b j e c t s . The only i n c o n s i s t e n c y to t h i s f i n d i n g was the o r a l c o n t r o l subscale which proved to be p o s i t i v e l y c o r r e l a t e d to the d i e t subscale f o r the Caucasian subjects but not the Chinese s u b j e c t s . This f i n d i n g i s echoed by the f i n d i n g that the o r a l c o n t r o l subscale was the only i n d i c a t o r of e a t i n g pathology i n t h i s study which came c l o s e to being s i g n i f i c a n t l y d i f f e r e n t 95 across c u l t u r a l groups w i t h the Chinese subjects d i s p l a y e d s l i g h t l y more unhealthy a t t i t u d e s regarding o r a l c o n t r o l . A d d i t i o n a l l y , when a model of stepwise r e g r e s s i o n was conducted f o r the f u l l s c a l e and subscale EAT s c a l e s , the o r a l c o n t r o l subscale was the only s c a l e found not to be r e l a t e d to a c c u l t u r a t i v e s t r e s s . While these f i n d i n g have not been p r e v i o u s l y noted by.researchers i n v e s t i g a t i n g e a t i n g a t t i t u d e s and behaviours i n non-white females l i v i n g i n Western c u l t u r e s , Lee (1993), In h i s survey of Chinese u n i v e r s i t y student l i v i n g i n China, noted that both men as w e l l as women scored r e l a t i v e l y high on the o r a l c o n t r o l subscale. Consistent w i t h t h i s study's f i n d i n g s , Lee a l s o reported that the o r a l c o n t r o l subscale was not s i g n i f i c a n t l y r e l a t e d w i t h the d i e t subscale i n h i s sample of Chinese women. Thus, the r e s u l t s of t h i s study seem to support Lee's spec u l a t i o n s that some items on the o r a l c o n t r o l subscale ( i . e . , \"Other people t h i n k that I am too th i n \" , . \"Feel that others pressure me to eat\", and \"Feel that other would p r e f e r i f I ate more\") may simply r e f l e c t Chinese women's smaller, t h i n n e r b u i l d and the 96 normal c u l t u r a l pressure on women to eat more and may not n e c e s s a r i l y r e f l e c t e a t i n g pathology. In t h e i r o r i g i n a l f a c t o r a n a l y s i s of the 26-item EAT, Garner, Olmsted, Bohr, and G a r f i n k e l (1982) found that the o r a l c o n t r o l subscale accounted f o r only 5.0% of the f u l l s c a l e EAT's variance, while the two remaining subscales accounted f o r s u b s t a n t i a l l y more of the variance (diet accounted f o r 26.4% of the variance and b u l i m i a accounted f o r 10.8% of the v a r i a n c e ) . Accordingly, while the f i n d i n g s of t h i s study suggest that some of the items on the o r a l c o n t r o l subscale may have had d i f f e r e n t connotations to the Chinese subjects and may not r e f l e c t e a t i n g pathology f o r t h i s p o p u l a t i o n , t h i s does not n e c e s s a r i l y r e f l e c t on the v a l i d i t y of the e n t i r e measure. Moreover, the i n t e r c o r r e l a t i o n a l a n a l y s i s of the EAT conducted i n t h i s study appears to supports Mumford et a l . ' s (1991, 1992) and Lee's (1993) f i n d i n g s that the f u l l s c a l e EAT as w e l l as the d i e t and b u l i m i a subscales appear to be v a l i d measures of e a t i n g pathology f o r Chinese women l i v i n g Western c u l t u r e s . As research i n t h i s area i s s t i l l i n i t infancy, however, any con c l u s i o n must be made wit h c a u t i o n . Further i n v e s t i g a t i o n of the cr o s s -97 c u l t u r a l v a l i d i t y of the EAT i s r e q u i r e d before any c o n c l u s i v e statement can be made. L i m i t a t i o n s F i r s t , i t important to remember that the c r i t e r i a which s p e c i f y the p o p u l a t i o n and the sample examined i n t h i s study r e s t r i c t to whom the r e s u l t s may be g e n e r a l i z e d . Thus, the f i n d i n g s of t h i s study may only be g e n e r a l i z e d to female Chinese and Caucasian u n i v e r s i t y students i n B r i t i s h Columbia, Canada. A d d i t i o n a l l y , as the m a j o r i t y of the Chinese subjects surveyed i n t h i s study were from Hong Kong or T a i p a i , Taiwan, the r e s u l t s of t h i s study are f u r t h e r l i m i t e d to those female Chinese u n i v e r s i t y students from Hong Kong or T a i p a i , Taiwan, as opposed to Mainland China. The f a c t that p a r t i c i p a t i o n i n t h i s study was v o l u n t a r y may have added an a d d i t i o n c o n s t r a i n t on the r e s u l t s . D e n i al and shame have long been recognized as common c h a r a c t e r i s t i c s of i n d i v i d u a l s w i t h e a t i n g d i s o r d e r s and p a t h o l o g i c a l e a t i n g a t t i t u d e s and b e h a v i o i u r s ( G a r f i n k e l & Garner, 1982). Consequently those i n d i v i d u a l s w i t h the most extreme e a t i n g problems may have chosen not to p a r t i c i p a t e i n t h i s study. Since, t h i s study r e q u i r e d t h a t the Chinese subjects be u n i v e r s i t y students and p r o f i c i e n t enough 98 i n E n g l i s h i n order to complete the questionnaire on t h e i r own, the range of the l e v e l of a c c u l t u r a t i o n scores may have been r e s t r i c t e d , and t h i s may have l i m i t e d the degree to which the r e l a t i o n s h i p s ( p a r t i c u l a r l y between l e v e l of a c c u l t u r a t i o n and e a t i n g a t t i t u d e s and behaviours) could be t e s t e d . A sample wit h a broader range of a c c u l t u r a t i o n might demonstrate more s i g n i f i c a n t r e s u l t s . The r e s u l t s of t h i s study are a l s o l i m i t e d by the c o r r e c t i o n a l design, t h e r e f o r e cause and e f f e c t cannot be i n f e r r e d . S i m i l a r l y , there may be unknown, unmeasured, v a r i a b l e s that account f o r the r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n , a c c u l t u r a t i v e s t r e s s , and e a t i n g a t t i t u d e s and behaviours. I t should be r e i t e r a t e d that without doing c l i n i c a l assessments i t i s not p o s s i b l e to i d e n t i f y c l i n i c a l cases of e a t i n g d i s o r d e r s . Therefore, i t i s not w i t h i n the parameters of t h i s study to address the existence of e a t i n g d i s o r d e r s per se, but r a t h e r those e a t i n g a t t i t u d e s and behaviours found to be c h a r a c t e r i s t i c of e a t i n g d i s o r d e r s . F i n a l l y , the r e s u l t s of t h i s study r e i n f o r c e the ca u t i o n r e q u i r e d when employing a measure that was designed and v a l i d a t e d i n one c u l t u r e to study r e l a t e d 99 phenomena i n another c u l t u r e . Thus, notwithstanding the apparent o v e r a l l v a l i d i t y of the f u l l s c a l e EAT and the d i e t and b u l i m i a subscales f o r t h i s study's sample of female Chinese u n i v e r s i t y students, the r e s u l t s of t h i s study a l s o suggest that p a r t i c u l a r c a u t i o n must be taken w i t h the i n t e r p r e t a t i o n of o r a l c o n t r o l subscale scores f o r Chinese s u b j e c t s . Review of the Chinese su b j e c t s ' scores as w e l l as previous l i t e r a t u r e (Lee, 1993) and Chinese c u l t u r e suggest that some items on t h i s s c a l e may r e f l e c t Chinese women's smaller, t h i n n e r b u i l d s and normal c u l t u r a l pressure on women to eat, and not e a t i n g pathology. Thus, much more i n v e s t i g a t i o n and item a n a l y s i s of the o r a l c o n t r o l subscale i s r e q u i r e i f i t i s to be employed w i t h f u r t h e r Chinese pop u l a t i o n s . Suggestions f o r Future Research There i s much scope f o r f u r t h e r research. F i r s t , more a t t e n t i o n needs to be p a i d to the instruments u t i l i z e d i n st u d i e s such as t h i s one. A d d i t i o n a l research i n v e s t i g a t i n g the c r o s s - c u l t u r a l v a l i d i t y of the EAT, e s p e c i a l l y i t s o r a l c o n t r o l subscale, i s e s s e n t i a l to the meaningfulness of futu r e research i n t h i s area. 100 S i m i l a r l y , as the r e s u l t s of t h i s study revealed • a strong r e l a t i o n s h i p between a c c u l t u r a t i v e s t r e s s and e a t i n g pathology, f u r t h e r research i n t o t h i s area would be prudent. S p e c i f i c a l l y , the development of a more d e t a i l e d measure of a c c u l t u r a t i v e s t r e s s may help i d e n t i f y which s p e c i f i c components of a c c u l t u r a t i v e s t r e s s ( i . e . , i n t e r p e r s o n a l c o n f l i c t or i n t r a f a m i l i a l c o n f l i c t ) are most important i n the development of e a t i n g pathology. Other promising research d i r e c t i o n s i n c l u d e the t r a n s l a t i o n of the instruments used i n t h i s study i n t o Chinese languages such as Mandarin, Cantonese and Taiwanese. Making these instruments a v a i l a b l e i n other languages may help access a wider range of l e v e l of a c c u l t u r a t i o n and may provide a d d i t i o n a l i n f o r m a t i o n regarding the e a t i n g a t t i t u d e s and behaviours of i n d i v i d u a l s who have l e s s exposure to Western c u l t u r e . S i m i l a r l y , r e p l i c a t i o n of t h i s study w i t h other groups such as an Indo-Canadian or Native Indian p o p u l a t i o n , may help extend the f i n d i n g s of t h i s study and provide greater i n s i g h t as to the r e l a t i o n s h i p between l e v e l of a c c u l t u r a t i o n and e a t i n g a t t i t u d e s and behaviours. 101 F i n a l l y , s ince the r e s u l t s of t h i s study suggest that e a t i n g pathology e f f e c t s female Chinese u n i v e r s i t y students at approximately a s i m i l a r r a t e as female Caucasian u n i v e r s i t y students, i t i s i n c r e a s i n g l y important to do research on t h i s t o p i c w i t h t h i s e t h n i c group. Important s t u d i e s may i n c l u d e q u a l i t a t i v e research which would allow Chinese women s t r u g g l i n g w i t h p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours to share t h e i r s t o r i e s . Q u a l i t a t i v e research addressing the onset and progress of e a t i n g pathology as w e l l as the recovery process i s e s s e n t i a l . Such s t u d i e s would a i d i n the education, prevention and d e t e c t i o n of e a t i n g pathology amongst t h i s p o p u l a t i o n s . In a d d i t i o n , such s t u d i e s may help i d e n t i f y p a r t i c u l a r components of treatment (such as i n d i v i d u a l and f a m i l y therapy s p e c i f i c a l l y addressing and a i d i n g the a c c u l t u r a t i o n process) which may be unique, yet e s s e n t i a l f o r recovery i n t h i s p o p u l a t i o n . I m p l i c a t i o n s f o r C o u n s e l l i n g The present study, the e x i s t i n g knowledge base of research s t u d i e s , and the ones recommended above, are valuable only so f a r as t h e i r p r a c t i c a l usefulness i n the c o u n s e l l i n g process are r e a l i z e d and u t i l i z e d . Therefore, one needs to transform the r e s u l t s of these 102 s t u d i e s i n t o the c o u n s e l l i n g process, i n order to help c l i e n t s deal w i t h the demands of t h e i r l i f e . This r e q u i r e s that the r e s u l t s of t h i s study be recognized and acknowledged by those i n the h e l p i n g p r o f e s s i o n s . F i r s t , the prevalence of e a t i n g pathology i n Chinese females heeds to be acknowledged not only by c o u n s e l l o r s , but other p r o f e s s i o n a l s who may have frequent contact with t h i s p o p u l a t i o n . Thus, i n d i v i d u a l s such as f a m i l y doctors, teachers, school nurses and community leaders need to be made aware that p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours no longer simply occur i n a f f l u e n t white women, as once thought. A d d i t i o n a l l y , these i n d i v i d u a l s need to be aware that e t h n i c m i n o r i t i e s , i n general, are less, l i k e l y to seek out p r o f e s s i o n a l a s s i s t a n c e (Sue, 1977). Cheng, Leong, and G e i s t (1993) found that while Asians experience j u s t as many personal and emotional problems as members of the mainstream c u l t u r e , they are l e s s l i k e l y to seek as s i s t a n c e from p r o f e s s i o n a l s . These researchers a l s o noted that when Asians do seek out p r o f e s s i o n a l help, i t i s o f t e n i n the guise of academic or career problems. Thus, c o u n s e l l o r s and other p r o f e s s i o n a l s need to be aware of these tendencies when seeing Chinese 103 c l i e n t s . Even i f the c l i e n t presented nothing more than academic or career i s s u e s , i t might be wise f o r the p r o f e s s i o n a l to assess p o s s i b l e personal and emotional areas. A d d i t i o n a l l y , i t may be b e n e f i c i a l to r e i n f o r c e to the c l i e n t the appropriateness of addressing personal and emotional i s s u e s , such as ea t i n g pathology, i n the c o u n s e l l i n g s e s s i o n . Doing so may help break down some of the stigma that i s o f t e n attached to personal and emotional problems (Cheng et al. ) . Beyond i d e n t i f i c a t i o n , there may be a need f o r c u l t u r e s p e c i f i c models of c o u n s e l l i n g and treatment f o r Chinese women experiencing e a t i n g pathology. Accordingly, i n t e r p e r s o n a l and i n t r a f a m i l i a l i s s u e s s p e c i f i c to the a c c u l t u r a t i o n process may need to be addressed f o r the recovery process to be s u c c e s s f u l . F i n a l l y , education and prevention campaigns s p e c i f i c a l l y t a r g e t i n g female Chinese students need to be developed and presented to the general p u b l i c throughout the Chinese community. This w i l l not only help educate i n d i v i d u a l s as to the prevalence and i d e n t i f i c a t i o n of e a t i n g pathology, but may a l s o help inform i n d i v i d u a l s s t r u g g l i n g w i t h p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours about l o c a l c o u n s e l l i n g 104 agencies, while r e i n f o r c i n g the appropriateness of u t i l i z i n g such agencies. Conclusions The primary purpose of t h i s research study was to compare the e a t i n g a t t i t u d e s and behaviours of female Chinese and Caucasian u n i v e r s i t y students. A d d i t i o n a l l y , t h i s study attempted to i n v e s t i g a t e whether a r e l a t i o n s h i p e x i s t s between l e v e l of a c c u l t u r a t i o n , a c c u l t u r a t i v e s t r e s s and p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours amongst female Chinese u n i v e r s i t y students. This study found no d i f f e r e n c e s i n e a t i n g a t t i t u d e s and behaviours between the Chinese and Caucasian s u b j e c t s . Both groups scored s i m i l a r l y on the EAT and approximately the same number scored over the c u t - o f f p o i n t f o r e a t i n g pathology on the EAT. Thus, the r e s u l t s of t h i s study revealed that female Chinese u n i v e r s i t y students l i v i n g i n B r i t i s h Columbia, Canada appear to d i s p l a y s i m i l a r e a t i n g a t t i t u d e s and behaviours as t h e i r f e l l o w female Caucasian u n i v e r s i t y students. I t was hypothesized that the e a t i n g a t t i t u d e s and behaviours of the Chinese subjects would be c o r r e l a t e d i n a p o s i t i v e d i r e c t i o n w i t h l e v e l of a c c u l t u r a t i o n , 105 and that t h i s r e l a t i o n s h i p would be the strongest p r e d i c t o r of e a t i n g pathology. The r e s u l t s of t h i s study, however, do not support such p r e d i c t i o n s . C o r r e l a t i o n and r e g r e s s i o n a n a l y s i s found that, i n general, the e a t i n g a t t i t u d e s and behaviours of the Chinese subjects were more s t r o n g l y c o r r e l a t e d w i t h a c c u l t u r a t i v e s t r e s s than l e v e l of a c c u l t u r a t i o n . Examination of the demographic in f o r m a t i o n c o l l e c t e d f o r these subjects suggests that the Chinese students r e c r u i t e d f o r t h i s ' study already had extensive exposure to Western c u l t u r e at the time of the study. Therefore, i t may be p o s s i b l e that they had enough exposure to Western i d e a l s and norms to put them at s i m i l a r r i s k as the Caucasian subjects of developing p a t h o l o g i c a l e a t i n g a t t i t u d e s and behaviours. 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The problem of screening f o r uncommon d i s o r d e r s : A comment on the E a t i n g A t t i t u d e s Test. P s y c h o l o g i c a l Medicine, 12, 431-434. Wiseman, C.L., Gray, J . J . , Mosimann, J.E., & Ahrens, A.H. (1992). C u l t u r a l expectations of thinness i n women: An update. I n t e r n a t i o n a l Journal of E a t i n g Disorders, 11, 85-8 9. Wiseman, C.L., Gunning, F.M., & Gray, J . J . (1993). Increasing pressure to be t h i n : 19 years of d i e t products i n t e l e v i s i o n commercials. E a t i n g Disorders, 1, 52-61. Zheng, Y.M. (1982). The psychotherapy of c h i l d anorexia nervosa: A follow-up study of a case f o r 23 years. Chinese Journal of Neurology and P s y c h i a t r y , 15_, 46-48. Appendix A Demographic Questionnaire 118 DEMOGRAPHIC INFORMATION 1. Age: 2. U n i v e r s i t y year: (degree: Subject: 3. C i t y and Country of b i r t h ? : 4. E t h n i c background: '_ 5. How long have you l i v e d i n North America? 6. Are you an i n t e r n a t i o n a l student: Yes No. 7. I have brothers, and s i t e r s (how many?) I am ( ) the o l d e s t c h i l d the youngest c h i l d the only c h i l d the middle or one of the middle c h i l d r e n other: 9. How many times have you moved i n t h i s country since b i r t h ? (not i n the same c i t y ) times. 10. How many times have you moved between c o u n t r i e s since b i r t h ? times. 11. Parents' background (answer as much as you can). Father Mother Age: Occupation; Education; E t h n i c background: C i t y of b i r t h ; No. of years i n Canada: Languages spoken: Appendix B E a t i n g A t t i t u d e s Test 120 EATING ATTITUDES TEST Instructions: Please c i r c l e the l e t t e r which best applies to each of the numbered statements. Please answer each question c a r e f u l l y . Thank you. A=always; U=usually; 0=often; S=sometimes; R=rarely; N=never A U 0 s R N 1. Am t e r r i f i e d about being overweight. A U 0 s R N 2. Avoid eating when I am hungry. A U 0 s R N 3. Find myself preoccupied with food. A U 0 s R N 4. Have gone on eating binges where I f e e l that I may not be able to stop A U 0 s R N 5. Cut my food into small pieces. A U 0 s R N 6. Aware of the c a l o r i e content of the food that I eat. A U 0 s R N 7. P a r t i c u l a r l y avoid food with high carbohydrates content A U 0 s R N 8. Feel that others would prefer I ate more. A U 0 s R N 9. Vomit a f t e r I have eaten. A U 0 s R N 10. Feel extremely g u i l t y a f t e r eating. A U 0 s R N 11. Am preoccupied with a desire to become thinner. A U 0 s R N 12. Think about burning up c a l o r i e s when I exercise. A U 0 s R N 13. Other people think that I am too t h i n A U 0 s R N 14. Am preoccupied with the thought of having f a t on my body. A u 0 s R N 15. Take longer than others to eat my meals. A u 0 s R N 16. Avoid foods with sugar i n them. A u 0 s R N 17. Eat d i e t foods. A u 0 s R N 18. Feel that food controls my l i f e . A u 0 s R N 19. Display s e l f - c o n t r o l around food. A u 0 s R N 20. Feel that others pressure me to eat. A u 0 s R N 21. Give too much time and thought to food. A u 0 s R N 22. Feel uncomfortable a f t e r eating sweets. A u 0 s R N 23. Engage i n d i e t behavioiurs. A u 0 s R N 24. Like my stomach to be empty. A u 0 s R N 25. Enjoy t r y i n g new foods. A u 0 s R N 26. Have the impulse to d i e t a f t e r meals. Appendix C Suinn-Lew Asia n S e l f - I d e n t i t y A c c u l t u r a t i o n Scale 122 SUINN-LEW ASIAN SELF-IDENTITY ACCULTURATION SCALE INSTRUCTIONS: The question which f o l l o w are f o r the purpose of c o l l e c t i n g i n f o r m a t i o n about your h i s t o r i c a l background as w e l l as more recent behaviduirs which may be r e l a t e d to your c u l t u r a l i d e n t i t y . Choose the one answer which best describes you. What language can you speak? 1. A s i a n only ( i e . , Chinese, Japanese, Korean, Vietnamese, etc.) 2. Mostly Asian, some E n g l i s h 3. A s i a n and E n g l i s h about e q u a l l y w e l l ( b i l i n g u a l ) 4. Mostly E n g l i s h , some Asian 5. Only E n g l i s h What language do you p r e f e r ? 1. Asi a n only ( i e . , Chinese, Japanese, Korean, Vietnamese, etc.) 2. Mostly Asian, some E n g l i s h 3. A s i a n and E n g l i s h about e q u a l l y w e l l ( b i l i n g u a l ) 4. Mostly E n g l i s h , some Asian 5. Only E n g l i s h How do you i d e n t i f y y o u r s e l f ? 1. A s i a n only ( i e . , Chinese, Japanese, Korean, Vietnamese, etc.) 2. Mostly Asian, some E n g l i s h 3. Asi a n and E n g l i s h about e q u a l l y w e l l ( b i l i n g u a l ) 4. Mostly E n g l i s h , some Asian 5. Only E n g l i s h Which i d e n t i f i c a t i o n does (did) your mother use? 1. O r i e n t a l 2. Asi a n 3. Asian-Canadian 4. Chinese-Canadian, Japanese-Canadian, Korean-Canadian, e t c . 5. Canadian Which i d e n t i f i c a t i o n does (did) your f a t h e r use? 1'. O r i e n t a l 2. Asi a n 3. Asian-Canadian 4. Chinese-Canadian,. Japanese-Canadian, Korean-Canadian, e t c . 5. Canadian 123 6. What was the et h n i c o r i g i n of the f r i e n d s and peers you had, as a c h i l d up to age 6? 1. Almost e x c l u s i v e l y Asians, Asian-Canadians, O r i e n t a l s 2. Mostly Asians, Asian-Canadians, O r i e n t a l s 3. About equal A s i a n groups and Anglo groups 4. Mostly Anglos, Blacks, H i s p a n i c s , or other non-Asian e t h n i c groups 5. Almost e x c l u s i v e l y Anglos, Blacks, Hispanics or other non-Asian e t h n i c groups 7. What was the e t h n i c o r i g i n s of the f r i e n d s and peers you had, as a c h i l d from 6 to 18? 1. Almost e x c l u s i v e l y Asians, Asian-Canadians, O r i e n t a l s 2. Mostly Asians, Asian-Canadians, O r i e n t a l s 3. About equal A s i a n groups and Anglo groups 4. Mostly Anglos, Blacks, H i s p a n i c s , or other non-Asian e t h n i c groups 5. Almost e x c l u s i v e l y Anglos, Blacks, Hispanics or other non-Asian e t h n i c groups 8. Whom do you now a s s o c i a t e w i t h i n the community? 1. Almost e x c l u s i v e l y Asians, Asian-Canadians, O r i e n t a l s 2. Mostly Asians, Asian-Canadians, O r i e n t a l s 3. About equal A s i a n groups and Anglo groups 4. Mostly Anglos, Blacks, Hispanics, or other non-Asian e t h n i c groups 5. Almost e x c l u s i v e l y Anglos, Blacks, Hispanics or other non-Asian e t h n i c groups 9. I f you could p i c k , whom would you p r e f e r to a s s o c i a t e w i t h i n the community? 1. Almost e x c l u s i v e l y Asians, Asian-Canadians, O r i e n t a l s 2. Mostly Asians, Asian-Canadians, O r i e n t a l s 3. About equal A s i a n groups and Anglo groups 4. Mostly Anglos, Blacks, H i s p a n i c s , or other non-Asian e t h n i c groups 5. Almost e x c l u s i v e l y Anglos, Blacks, Hispanics or other non-Asian e t h n i c groups 10. What i s you music preference? 1. Only A s i a n mUsic ( i e . , Chinese, Japanese, Korean, Vietnamese, ect.) 2. Mostly A s i a n 3. E q u a l l y A s i a n and E n g l i s h 4. Mostly E n g l i s h 5. Only E n g l i s h 11. What i s you movie preference? 1. Asian-language movies only 2. A s i a n language movies mostly 3. E q u a l l y A s i a n / E n g l i s h 4. English-language movies mostly 5. English-language movies only 124 Where were you born? Canada A s i a Other - where Where was your f a t h e r born? Canada A s i a Other - where Where was your mother born? Canada A s i a Other - where Where was your fa t h e r ' s f a t h e r born? Canada A s i a Other - where Where was your f a t h e r ' s mother born? Canada A s i a Other - where Where was your mother's fa t h e r born? Canada A s i a Other - where Where was your mother's mother born? Canada As i a Other - where On the b a s i s of the above answers, c i r c l e the generation that best a p p l i e s to you: 1. 1st Generation = I was born i n A s i a or other 2. 2nd Generation = I was born i n Canada, e i t h e r parent was born i n A s i a or other . 3. 3rd Generation = I was born i n Canada, both parents were born i n Canada, & a l l grandparents born i n A s i a or other 4. 4th Generation = I was born i n Canada, both parents born i n Canada, and at l e a s t one grandparent born i n A s i a or other & one g grandparent born i n Canada 5. 5th Generation = I was born i n Canada, both parents & a l l grandparents al s o born i n Canada 6. Don't know what generation best f i t s s ince I l a c k some info r m a t i o n 13. Where were your r a i s e d ? 1. In A s i a only 2. Mostly i n Asian, some i n Canada 3. E q u a l l y i n A s i a and Canada 4. Mostly i n Canada 5. In Canada only 14. What contact have your had wit h A s ia? 1. Raised one year or more i n A s i a 2. L i v e d f o r l e s s than one your i n A s i a 3. Occasional v i s i t s to A s i a 4. Occasional communications ( l e t t e r s , phone c a l l s , ect.) to people i n A s i a 5. No exposure or communications wi t h people i n A s i a 125 15. What i s your food preference at home? 1. E x c l u s i v e l y A s i a n food 2. Mostly A s i a n food, some Canadian 3. About e q u a l l y A s i a n and Canadian 4. Mostly Canadian food 5. E x c l u s i v e l y Canadian food 16. What i s your food preference i n restaurants? 1. E x c l u s i v e l y A s i a n food 2. Mostly A s i a n food, some Canadian 3. About e q u a l l y A s i a n and Canadian 4. Mostly Canadian food 5. E x c l u s i v e l y Canadian food 17. Do you 1. read only an A s i a n language 2. read an A s i a n Language b e t t e r than E n g l i s h 3. read both A s i a n and E n g l i s h e q u a l l y w e l l 4. read E n g l i s h b e t t e r than an Asia n language 5. read only E n g l i s h 18. Do you 1. w r i t e only an Asia n language 2. w r i t e an Asia n Language b e t t e r than E n g l i s h 3. w r i t e both A s i a n and E n g l i s h e q u a l l y w e l l 4.. w r i t e E n g l i s h b e t t e r than an Asia n language 5. w r i t e only E n g l i s h i 19. I f you consider y o u r s e l f a member of the As i a n group ( O r i e n t a l , A sian, Asian-Canadian, Chinese-Canadian, e t c . , whatever term you p r e f e r ) , how much p r i d e do you have i n t h i s group? 1. Extremely proud 2. Moderately proud 3. L i t t l e proud 4. No p r i d e but do not f e l l negative toward group 5. No p r i d e but do f e e l negative toward group 20. How would you r a t e y o u r s e l f ? 1. Very A s i a n 2. Mostly A s i a n 3. B i c u l t u r a l 4. Mostly Westernized 5. Very Westernized 21. Do you p a r t i c i p a t e i n A s i a n occasion, h o l i d a y s , t r a d i t i o n , etc.? 1. n e a r l y a l l 2. Most of them 3. Some of them 4. A few of them 5. None at a l l 126 Appendix D SAFE A c c u l t u r a t i v e Stress Questionnaire SAFE ACCULTURATIVE STRESS SCALE 127 I n s t r u c t i o n s : Please c i r c l e the number which best a p p l i e s to each of the numbered statements. Please answer each question c a r e f u l l y . there are no r i g h t answers. Thank you. O=not a p p l i c a b l e ; l=not s t r e s s f u l ; 2=a l i t t l e s t r e s s f u l ; 3=moderately s t r e s s f u l ; 4=quite s t r e s s f u l ; 5=extremely s t r e s s f u l 0 1 2 3 4 5 1. I f e e l uncomfortable when others make jokes about or put down people of my eth n i c background. 0 1 2 3 4 5 2. I have more b a r r i e r s to overcome than most people. 0 1 2 3 4 5 3. I t bothers me that f a m i l y members I am c l o s e to do not understand my new values. 0 1 2 3 4 5 4. Close f a m i l y members & I have c o n f l i c t i n g expectations about my fu t u r e . 0 1 2 3 4 5 5. I t i s hard to express to my f r i e n d s how I r e a l l y f e e l . 0 1 2 3 4 5 6. My f a m i l y does not want me to move away but I would l i k e t o . 0 1 2 3 4 5 7. I t bothers me to th i n k that so many people us drugs. 0 1 2 3 4 5 8. I t bothers me that I cannot be wit h my f fam i l y . 0 1 2 3 4 5 9. In lo o k i n g f o r a good job, I sometimes f e e l t hat my e t h n i c i t y i s a l i m i t a t i o n . 0 1 2 3 4 5 10. I don't have any cl o s e f r i e n d s . 0 1 2 3 4 5 11. Many people have stereotypes about my c u l t u r e or e t h n i c group & t r e a t me as i f they are t r u e . 0 1 2 3 4 5 12. I don't f e e l at home. 0 1 2 3 4 5 13. People t h i n k I am u n s o c i a l when i n f a c t I have t r o u b l e communicating i n E n g l i s h . 0 1 2 3 4 5 14. I of t e n f e e l that people a c t i v e l y t r y to stop me from advancing. 128 0 1 2 3 4 5 15. I t bothers me when people pressure me to a s s i m i l a t e . 0 1 2 3 4 5 16. I o f t e n f e e l ignored by people who are supposed to a s s i s t me. 0 1 2 3 4 5 17. Because I'm d i f f e r e n t I don't get enough c r e d i t f o r the work I do. 0 1 2 3 4 5 18. I t bothers me that I have an accent. 0 1 2 3 4 5 19. Loosening the t i e s w i t h my country i s d i f f i c u l t . 0 1 2 3 4 5 20. T o f t e n t h i n k about my c u l t u r a l background. 0 1 2 3 4 5 21. Because of my e t h n i c background, I f e e l that others o f t e n exclude me from p a r t i c i p a t i n g i n t h e i r a c t i v i t i e s . 0 1 2 3 4 5 22. I t i s d i f f i c u l t f o r me to \"show o f f \" my fa m i l y . 0 % 2 3 4 5 23. People look down upon me i f I p r a c t i c e customs of my c u l t u r e . 0 1 2 3 4 5 24. I have t r o u b l e understanding other when they speak. 129 Appendix E Introductory L e t t e r to Professors 130 Dear: Dr. My name i s C o l l e e n Hyland. I am a MA student i n the Department of Co u n s e l l i n g Psychology working under the s u p e r v i s i o n of Dr. Ishu Ishiyama. I am co n t a c t i n g you because I am desperately seeking subjects to p a r t i c i p a t e i n my study which explores the r o l e of s o c i o c u l t u r a l f a c t o r s i n the occurrence of p a t h o l o g i c a l ' e a t i n g a t t i t u d e s and behaviours. I would g r e a t l y appreciate the opportunity to i n v i t e a l l of your female students to complete Part One of my ques t i o n n a i r e ; t h i s w i l l take about 10 minutes. Part Two i s a p p l i c a b l e to female Chinese students only and w i l l r e q u i r e an a d d i t i o n a l 5-10 minutes to complete; t h i s can be completed w i t h i n c l a s s time or on the students' own time. Your 'assistance i n my endeavour to l o c a t e subjects would be g r e a t l y appreciated, and w i l l be acknowledges i n any ensuing p u b l i c a t i o n s . A l s o , I would be happy to o f f e r p r e s e n t a t i o n of my research to your c l a s s l a t e r t h i s year. I f you are able to help me or have any questions, please contact me or Dr. Ishiyama at 822-5329, or fax the f o l l o w i n g form to 822-2328. Thank you! C o l l e e n Hyland Dr. Ishu Ishiyama C u t t i n g Line Fax TO: Colleen Hyland c/o Dr. I. Ishiyama FROM: Dept. TEL: 2 - FAX: 2 -I am w i l l i n g to allow Colleen Hyland access to my class to do the following: i n v i t e female student to p a r t i c i p a t e on t h e i r own time. complete Part One of the questionnaire complete Part One & Two of the questionnaire Preferred survey date and time: Appendix F P a r t i c i p a n t Information Sheet and Consent Form 132 C o l l e e n Hyland, M.A. Candidate Supervisor: Dr. Ishu ishiyama Research Study: Acculturation and Eating Attitudes i n Female Chinese and Caucasian University Students Dear P a r t i c i p a n t s : I am w r i t i n g to request your help w i t h a research study that I am conducting. As a graduate student, t h i s study c o n s t i t u t e s the f i n a l requirement f o r a Master of A r t s i n C o u n s e l l i n g Psychology at the U n i v e r s i t y of B r i t i s h Columbia. The purpose of my study i s to examine students' e a t i n g a t t i t u d e s and behaviours. Your p a r t i c i p a t i o n i n t h i s study i s e n t i r e l y v o l u n t a r y and you may choose to d i s c o n t i n u e at any p o i n t without penalty. A l l i n f o r m a t i o n i s c o n f i d e n t i a l , only myself and my research supervisor, Fr. I. Ishiyama, w i l l see the q u e s t i o n n a i r e s . Should you choose not to p a r t i c i p a t e i n t h i s study, you ar f r e e to leave. Should you consent to p a r t i c i p a t e , you w i l l be requested to complete a questionnaire package. Completion of the questionnaire w i l l take Caucasian students approximately 5-7 minutes, and Chinese students approximately 10-15 minutes. Upon completion the questionnaire your commitment to the study i s over. I t i s assumed that consent has been given i f t h i s q u e s t i o n n a i r e has been completed and submitted. A copy of the t h e s i s w i l l be made a v a i l a b l e i n the Main L i b r a r y at UBC upon completion. Should you have any questions about the study, please f e e l free to ask me now or contact me at the address l i s t e d above. Thank you i n advance f o r you c o n s i d e r a t i o n . Your cooperation w i l l be i n v a l u a b l e to t h i s research which hoped to add to the body of knowledge concerning e a t i n g a t t i t u d e s and behaviours. S i n c e r e l y , C o l l e e n Hyland Appendix G Follow-up*-Sheet 134 THANK YOU?!f f ? f o r your p a r t i c i p a t i o n i n t h i s survey as i t can not be done without the support of people l i k e you. I f you would l i k e some more in f o r m a t i o n on the goals and outcomes of t h i s survey, please f e e l f r e e to contact C o l l e e n Hyland at the f o l l o w i n g address and I w i l l be pleased to provide you w i t h a l l r e l e v a n t in f o r m a t i o n : C o l l e e n Hyland c/o Department of C o u n s e l l i n g Psychology F a c u l t y of Education The U n i v e r s i t y of B r i t i s h Columbia 2125 Main M a l l Vancouver, BC V6T 1Z4 A d d i t i o n a l l y , examining one's e a t i n g a t t i t u d e s and behaviours can o f t e n r a i s e questions f o r people. Accordingly, I have i n c l u d e d the name and telephone number of a l o c a l resource than can help answer any questions or concerns that you may have. E a t i n g Disorder Resource Centre of BC 631-5313 Please f e e l free to tear t h i s page o f f and keep i t i f you wish. 135 Appendix H I n t e r c o r r e l a t i o n s of the E a t i n g A t t i t u d e s Test (EAT) f o r a l l Subject Combined, Chinese Subjects, and Caucasian Subjects 136 Appendix H I n t e r c o r r e l a t i o n s of the E a t i n g A t t i t u d e s Test (EAT) f o r a l l Subject Combined. Chinese Subjects, and Caucasian Subjects Scale Subjects EAT Diet B u l i m i a OralCon. EAT ( t o t a l ) A l l Chin Cauc Diet Subscale A l l .924** Chin .877** Cauc .971** B u l i m i a Subscale A l l - .756** .668** Chin .716** .573** Cauc .802** .772** Or a l C o n t r o l Subscale A l l .479** .157* .121 Chin .466** .037 .12 6 Cauc .532** .364** .118 Note.: ( A l l ) = a l l subjects combined (N_=231) ; (Chin)= Chinese subjects (n=131); (Cauc)=Caucasian subjects (n=100). *p_ < .05, t w o - t a i l e d . **p_ < .001, t w o - t a i l e d . 137 Appendix I I n t e r c o r r e l a t i o n s of Level of A c c u l t u r a t i o n (SL-ASIA) f o r the Chinese Subjects 138 Appendix I I n t e r c o r r e l a t i o n s of Level of A c c u l t u r a t i o n (SL-ASIA) f o r the Chinese Subjects Scale (Total) (L) (Ft) (A) (G) SL-ASIA (Total) -Language (L).865** - F r i e n d (Fr).538** .482** - A f f i n i t y (A).622** .503** .283* -Generation(G).745** .437** .292* .425** -Food (Fd).609** .551** .289* .302* .362** 11 = 116. *p< ,01, t w o - t a i l e d . **p_< .001, t w o - t a i l e d "@en ; edm:hasType "Thesis/Dissertation"@en ; vivo:dateIssued "1995-11"@en ; edm:isShownAt "10.14288/1.0054135"@en ; dcterms:language "eng"@en ; ns0:degreeDiscipline "Counselling Psychology"@en ; edm:provider "Vancouver : University of British Columbia Library"@en ; dcterms:publisher "University of British Columbia"@en ; dcterms:rights "For non-commercial purposes only, such as research, private study and education. Additional conditions apply, see Terms of Use https://open.library.ubc.ca/terms_of_use."@en ; ns0:scholarLevel "Graduate"@en ; dcterms:title "Acculturation and eating attitudes and behaviours in female Chinese and Caucasian university students: a correlational and comparative study"@en ; dcterms:type "Text"@en ; ns0:identifierURI "http://hdl.handle.net/2429/3837"@en .