Risky Dieting Amongst Adolescent Girls: Associations With ...388594/UQ388594_OA.pdf · Risky...
Transcript of Risky Dieting Amongst Adolescent Girls: Associations With ...388594/UQ388594_OA.pdf · Risky...
�������� ����� ��
Risky Dieting Amongst Adolescent Girls: Associations With Family Rela-tionship Problems And Depressed Mood
Gemma L.M. Hinchliff (Hons), Adrian B. Kelly, Gary C.K. Chan, George C.Patton, Joanne Williams
PII: S1471-0153(16)30081-2DOI: doi: 10.1016/j.eatbeh.2016.06.001Reference: EATBEH 1066
To appear in: Eating Behaviors
Received date: 17 March 2016Accepted date: 1 June 2016
Please cite this article as: Hinchliff (Hons), G.L.M., Kelly, A.B., Chan, G.C.K., Pat-ton, G.C. & Williams, J., Risky Dieting Amongst Adolescent Girls: Associations WithFamily Relationship Problems And Depressed Mood, Eating Behaviors (2016), doi:10.1016/j.eatbeh.2016.06.001
This is a PDF file of an unedited manuscript that has been accepted for publication.As a service to our customers we are providing this early version of the manuscript.The manuscript will undergo copyediting, typesetting, and review of the resulting proofbefore it is published in its final form. Please note that during the production processerrors may be discovered which could affect the content, and all legal disclaimers thatapply to the journal pertain.
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 1
BRIEF RESEARCH REPORT
RISKY DIETING AMONGST ADOLESCENT GIRLS: ASSOCIATIONS WITH
FAMILY RELATIONSHIP PROBLEMS AND DEPRESSED MOOD
Gemma L. M. Hinchliff (Hons) 1,2, Adrian B. Kelly PhD 1, Gary C. K. Chan PhD 1,
George C. Patton PhD 4,5, and Joanne Williams PhD 3
1. Centre for Youth Substance Abuse Research, The University of
Queensland, Brisbane, Australia
2. School of Psychology, The University of Queensland
3. Deakin University, Melbourne, Australia
4. Murdoch Children’s Research Institute, Melbourne, Australia
5. Department of Paediatrics, The University of Melbourne, Melbourne,
Australia
WORD COUNT (ABSTRACT): [134]
WORD COUNT (MANUSCRIPT): [1493]
RUNNING HEAD: [RISKY DIETING AMONG ADOLESCENT GIRLS]
CORRESPONDING AUTHOR: Adrian B. Kelly PhD, Centre for Youth Substance
Abuse Research, The University of Queensland, Brisbane, QLD 4072. Email:
[email protected]. Phone: +61 7 33655143. Fax: +61 7 33655488
ACKNOWLEDGEMENTS: This research was funded by an NHMRC Project
Grant to J. Williams, J. Toumbourou, R. Homel, and G. Patton. Data analysis and
preparation of this manuscript was supported by ARC DP130102015 to A. B. Kelly
(first investigator). The first author completed this research in fulfilment of an
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 2
honours dissertation under the supervision of the second author. Study sponsors were
not directly involved in the production of this manuscript or decision to submit the
manuscript for publication. We thank Professor John Toumbourou for his assistance
and guidance with respect to this manuscript.
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 3
Abstract
Objective: This study examined the association of risky dieting amongst
adolescent girls with depressed mood, family conflict, and parent-child emotional
closeness. Method: Grade 6 and 8 females (aged 11-14 years, N = 4,031) were
recruited from 231 schools in 30 communities, across three Australian States
(Queensland, Victoria, and Western Australia). Key measures were based on the
Adolescent Dieting Scale, Short Mood and Feelings Questionnaire, and widely used
short measures of family relationship quality. Controls included age, early pubertal
onset, and socioeconomic status. Results: Risky dieting was significantly related to
family conflict and depressed mood, depressed mood mediated the association of
family conflict and risky dieting, and these associations remained significant with
controls in the model. Conclusion: Family conflict and adolescent depressed mood
are associated with risky dieting. Implications: Prevention programs may benefit
from a broadening of behavioural targets to include depressed mood and family
problems.
Key Words: adolescent, female, dieting, family, conflict, depressed mood
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 4
Preoccupations with weight and weight control are prevalent amongst
adolescent girls (1), and dieting may carry heightened health risks regardless of
overweightness (2). When dieting pre-occupations become excessive, there are
increased risks of psychological distress, nutritional deficiencies, and subsequent
eating disorders (3). In Australia, available data indicate that amongst 12-17 year
olds, approximately 39% of girls compared to 13% of boys are classified as
intermediate or extreme dieters (4).
In this study we examined the association of depressed mood and family
relationship problems with dieting in a large population of early adolescent girls (11-
14 years of age). While some research indicates simple associations between dieting
and depressed mood, family problems, and early pubertal onset, research is needed on
the extent to which these factors predict dieting independent of each other. This is
important because contextual factors are likely to be interrelated, and the
identification of significant independent contextual factors should inform prevention
policies and programs. The first hypotheses was that depressed mood and family
relationship quality would be associated with dieting. Drawing on research showing
that depressed mood mediates linkages between family distress and other adolescent
health risk behaviours (5), the second hypothesis was that depressed mood would
mediate any family relationship – dieting association.
METHOD Sample
The sample consisted of 4058 girls in Grade 6 (modal age 11 years) and
Grade 8 (modal age 13) from 231 schools located in 31 Australian communities
(Victoria/Queensland/Western Australia).
Survey Procedure
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 5
Data was collected via a two-stage sampling strategy (community and
school). The community sampling frame consisted of Statistical Local Areas (6).
Within each community, primary (N = 164) and secondary schools (N = 82) were
randomly selected. Of schools invited to participate, 83% (n = 443) responded,
and of these, 52% agreed to participate. Adolescents only participated if signed
parent consent was obtained (67% response rate). The survey was approved by
the University of Melbourne Human Research Ethics Committee. Further details
of the survey methods are described elsewhere (7). Of the analysis sample, 684
girls had missing data on one or more variables, of which 8, 115, and 27
participants had missing data on depressed mood, family conflict, and dieting
respectively. Missing data were multiply imputed with chained equations using
STATA 13 (5 datasets). Twenty-seven girls were excluded because responses
were unreliable (e.g., reported Menarche under 6 years of age).
Measures
Participants completed a modified version of the Communities That Care
(CtC) Youth Survey (8). Dieting was assessed using the 8-item Adolescent Dieting
Scale (ADS) (4). The ADS assesses calorie counting, reducing food quantities at
meals, and skipping meals (e.g., “Do you try to eat less than a certain number of
calories as a means of controlling weight?”; 4-point Likert scales from 0
“Seldom/never” to 3 “almost always”; α=0.87).
Depressed mood was measured using the 13-item Short Mood and Feelings
Questionnaire (SMFQ) (9) (α = .91). Family conflict was assessed using three items
(e.g., “People in my family often insult and yell at each other”) (4-point Likert scale 1
‘YES!’ to 4 ‘NO!’; α=.80) (10). Parent-child emotional closeness was measured using
three items for each parent (e.g., “Do you feel close to your mother/father?”) (11) (4-
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 6
point scale, α=.82-83). Pubertal timing was assessed with the items “Have you begun
to menstruate (had your first period)” (yes/no) (12), and “How old were you when
you started to menstruate (had your first period)?” (13). Participants who responded
„yes‟ to the first question were coded as having early pubertal onset if they reported
an age of menarche of 11 years or younger. Socioeconomic status (SES) was
determined using standard Australian census measures based on income and type of
occupation.
Analysis
Analyses were performed using STATA13. In Model 1, dieting was regressed
on family conflict, allowing for the estimation of the total effect of family conflict on
dieting. In Model 2, depressed mood was regressed on family conflict, to estimate the
statistical effect of family conflict on depressed mood. In Model 3, dieting was
regressed on family conflict and depressed mood. This allowed the estimation of the
direct and indirect effects of family conflict on dieting (via depressed mood). Control
variables were adjusted in each model. The product of the coefficient of family
conflict in Model 2 and the coefficient of depressed mood in Model 3 was calculated,
and its 95% confidence interval was computed using 5000 bootstrap replicates. A
95% confident interval that does not include zero indicates significant mediation.
RESULTS
For Model 1 there was a significant total effect of family conflict on dieting
after adjusting for controls (Table 1). There were significant yet small associations
between dieting and age (p<.001), early pubertal onset (p<.001), and socioeconomic
advantage (p<.001). The association of dieting and mother/father emotional closeness
was nonsignificant. For Model 2 there was a significant effect of family conflict on
depressed mood (p<.001). Depressed mood was also positively associated with early
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 7
pubertal onset (p<.001), and negatively associated with high socioeconomic
advantage (p<.05) and emotional closeness to either parent (p<.001). For Model 3
there was a significant direct effect of family conflict on dieting (p<.001). The effect
of depressed mood was also significant (p < .001). The product of the relevant
coefficient was 0.05 (95% CIs = 0.04,0.06), indicating a significant indirect effect of
family conflict on dieting through depressed mood. Comparison of family conflict
coefficients across Models 1-3 indicated that 44% of the total effect was mediated by
depressed mood.
[TABLE 1 HERE]
DISCUSSION
The key findings of this study were that dieting behaviour was negatively
associated with family conflict, positively associated with depressed mood, and that
depressed mood mediated family conflict and dieting behaviour. Dieting behaviour
was also associated with socioeconomic disadvantage and early pubertal onset.
Emotional closeness to parents showed weak and consistent associations with
depressed mood. While this study is based on a large sample and controls for several
potential confounds, it is cross-sectional nature so it cannot address etiological
pathways. The results are consistent with earlier research that family conflict leads to
depressed mood, particularly in girls, and this may contribute to weight gain and
weight control behaviours, including excessive dieting. The present study points to
the need for further research on the longitudinal role of family distress and depressed
mood in driving excessive dieting. If family conflict and depressed mood are drivers
of early and excessive dieting, parents may benefit from education on effective
conflict management, and school-based programs might increase their focus on
depressed mood. The study is limited by its reliance on adolescent self-report and the
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 8
positive parental consent mechanism may have biased the sample towards those with
fewer problems (14).
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 9
References
1. Lawrence CM, Thelen MH. Body image, dieting, and self-concept: Their
relation in African-American and Caucasian children. Journal of Clinical Child
Psychology. 1995;24(1):41-8.
2. Crow S, Eisenberg ME, Story M, Neumark-Sztainer D. Psychosocial and
behavioral correlates of dieting among overweight and non-overweight adolescents.
Journal of Adolescent Health. 2006;38(5):569-74.
3. Patton GC, Selzer R, Coffey C, Carlin JB, Wolfe R. Onset of adolescent
eating disorders: population based cohort study over 3 years. BMJ (Clinical research
ed). 1999;318(7186):765-8.
4. Patton GC, Carlin JB, Shao Q, Hibbert ME, Rosier M, Selzer R, et al.
Adolescent dieting: healthy weight control or borderline eating disorder? Journal of
child psychology and psychiatry, and allied disciplines. 1997;38(3):299-306.
5. Chan GCK, Kelly AB, Toumbourou JW. Accounting for the association of
family conflict and very young adolescent female alcohol use: The role of depressed
mood. Journal of Studies on Alcohol and Drugs. 2013;74(3):396-505.
6. ABS. Socio-economic indices for areas. Canberra: Australian Bureau of
Statistics; 2009.
7. Hemphill S, Toumbourou JW, Smith R, Kendall GE, Rowland B, Freiberg K,
et al. Are rates of school suspension higher in socially disadvantaged
neighbourhoods? An Australian study. Health Promotion Journal of Australia.
2010;21:12-8.
8. Arthur MW, Hawkins JD, Pollard JA, Catalano RF, Baglioni AJ, Jr.
Measuring risk and protective factors for substance use, delinquency, and other
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING AMONG ADOLESCENT GIRLS 10
adolescent problem behaviors. The Communities That Care Youth Survey. Eval Rev.
2002;26(6):575-601.
9. Angold A, Costello EJ, Messer SC, Pickles A. Development of a short
questionnaire for use in epidemiological studies of depression in children and
adolescents. International Journal of Methods in Psychiatric Research. 1995;5:237-49.
10. Salom C, Kelly AB, Alati R, Williams G, Williams JW. School and family
factors influence the development of depressive symptoms and alcohol use in young
adolescents. Drug and Alcohol Review. 2015.
11. Kelly AB, O'Flaherty M, Toumbourou JW, Connor JP, Hemphill SA,
Catalano RF. Gender differences in the impact of families on alcohol use: A lagged
longitudinal study of early adolescents. Addiction. 2011;106(8):1427-36.
12. Petersen A, Crockett L, Richards M, Boxer A. A self-report measure of
pubertal status: Reliability, validity, and initial norms. Journal of Youth and
Adolescence. 1988;17(2):117-33.
13. Tanner JM. Growth at adolescence; with a general consideration of the effects
of hereditary and environmental factors upon growth and maturation from birth to
maturity. Oxford: Blackwell Scientific Publications; 1962.
14. Kelly AB, Halford WK. Responses to ethical challenges in conducting
research with Australian adolescents. Australian Journal of Psychology.
2007;59(1):24-33.
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
RISKY DIETING 11
Table 1. Regression models of dieting and depressed mood (N = 3704 females, 11-13 years old).
Model 1
Dieting
Model 2
Depressed mood
Model 3
Dieting
b 95% CI b 95% CI b 95% CI
Age -0.06*** (-0.08, -0.04) -0.02 (-0.03, 0) -0.05*** (-0.08, -0.03)
Early puberty 0.11*** (0.05, 0.16) 0.08*** (0.04, 0.12) 0.09** (0.03, 0.14)
Socio-economic status (Ref: 1st Quartile - Least advantaged)
2nd quartile -0.09*** (-0.14, -0.04) 0.02 (-0.02, 0.05) -0.09*** (-0.14, -0.05)
3rd quartile -0.07** (-0.12, -0.02) 0.00 (-0.04, 0.04) -0.07** (-0.11, -0.02)
4th
quartile - Most advantaged -0.10*** (-0.14, -0.05) -0.05** (-0.09, -0.01) -0.08*** (-0.13, -0.04)
Emotional closeness with mother 0.00 (-0.03, 0.04) -0.09*** (-0.12, -0.07) 0.03 (0, 0.06)
Emotional closeness with father 0.00 (-0.03, 0.03) -0.07*** (-0.09, -0.05) 0.02 (-0.01, 0.05)
Family conflict 0.12*** (0.09, 0.14) 0.18*** (0.17, 0.2) 0.07*** (0.05, 0.09)
Depressed mood 0.26*** (0.22, 0.3)
R
2 = 0.05 R
2 = 0.20 R
2 = 0.09
Notes. * p < .05; ** p < .01; *** p < .001. Bold text indicates findings relating to the key research question. Model 1 tests
whether family conflict predicts dieting without depressed mood in the model. Model 3 includes depressed mood in the model,
and shows a significant drop in the effect for family conflict. Model 2 tests the association of family conflict with depressed mood.
Early Puberty was based on items relating to whether Menarche had occurred and the age at which Menarche occurred (see
Measures).
ACC
EPTE
D M
ANU
SCR
IPT
ACCEPTED MANUSCRIPT
AUTHOR DISCLOSURE STATEMENTS
Statement 1: Role of Funding Sources
This research was funded by an NHMRC Project Grant to J. Williams, J.
Toumbourou, R. Homel, and G. Patton. Data analysis and preparation of this
manuscript was supported by ARC DP130102015 to A. B. Kelly (first investigator).
Study sponsors were not directly involved in the production of this manuscript or
decision to submit the manuscript for publication.
Statement 2: Contributors
Hinchliff completed this project as part of her honours dissertation under the
supervision of the second author. Chan assisted in the data analysis. Hinchliff and
Kelly wrote the first draft of the manuscript. Patton provided conceptual input on the
study and reviewed the final manuscript. All authors contributed to and have
approved the final manuscript.
Statement 3: Conflict of Interest
All authors declare that they have no conflicts of interest.
Statement 4: Acknowledgements (optional)
The authors thank Professor John Toumbourou for his assistance and guidance with
respect to this manuscript.