Problematic Use of Internet Associates with Poor Quality of Life via Psychological Distress in Invididuals with ADHD.

Background: Problematic use of internet (PUI) may have negative impacts on psychological distress and quality of life (QoL). This situation might be more profound in people with attention-deficit/hyperactivity disorder (ADHD) due to poorer behavioral control and regulatory capacity. However, there is little evidence regarding mediated effects in the associations between PUI, psychological distress, and QoL in people with ADHD. Aims: To investigate mediating effects of psychological distress in the associations of problematic smartphone use (PSPU), problematic use of social media (PUSM), and problematic gaming (PG) with QoL in individuals with ADHD. Methods and Procedures: PUI behaviors of participants with ADHD (n = 99) were assessed using the Smartphone Application-Based Addiction Scale, Bergen Social Media Addiction Scale, and Internet Gaming Disorder-Short Form. Psychological distress was assessed using the Depression, Anxiety, Stress Scale and QoL using the Kid-KINDL. Outcomes and Results: Psychological distress mediated the associations between PUI and different domains of QoL, except for self-esteem QoL. There were also positively direct effects between PG and physical QoL, PUSM and friends' QoL, and PSPU and physical QoL. Conclusions and Implications: PUI may associate with poor QoL in people with ADHD via psychological distress. Programs on reducing PUI for people with ADHD are needed.

Differential item functioning for the Tendency of Avoiding Physical Activity and Sport Scale across two subculture samples: Taiwanese and mainland Chinese university students.

Aims: The aims of the study were to examine the differential item functioning (DIF) of the Tendency of Avoiding Physical Activity and Sport Scale (TAPAS) among three subgroups (gender, weight status, and region) and to test the construct and concurrent validities of the scale. Methods: Using an online survey, university students (608 Taiwanese and 2319 mainland Chinese) completed the TAPAS. Rasch analysis examined if all the 10 TAPAS items fitted the same construct and displayed no substantial DIF across three subgroups: gender (male vs. female), weight status (overweight vs. non-overweight), and region (Taiwan vs. China). Concurrent validity was examined using the scores on the Weight Self-Stigma Questionnaire (WSSQ) and Weight Bias Internalization Scale (WBIS). Results: All TAPAS items, except for Item 10 ("Prefer to participate in physical activity in a more private setting"), fitted the same construct. None of the TAPAS items displayed DIF in any of the subgroups except for Item 10 across participants from Taiwan and China (DIF contrast = -1.41). Conclusion: The TAPAS can appropriately assess the tendency to avoid physical activity and sport among both Taiwanese and mainland Chinese university students. However, Item 10 may need to be further examined.

The tendency to avoid physical activity and sport scale (TAPAS): Rasch analysis with differential item functioning testing among a Chinese sample.

BACKGROUND: The benefits of physical activity are well-known to prevent multiple long-term health conditions. Physical appearance and weight-related stigma may influence individuals' decision to engage in physical activity and sport. Therefore, the present study examined the psychometric properties of a newly developed instrument, the Tendency to Avoid Physical Activity and Sport Scale (TAPAS), using modern test theory. METHODS: A total of 2319 university students were recruited from mainland China and they completed the TAPAS. Rasch analysis was used to examine the TAPAS' rating scaling functioning, test unidimensionality, item hierarchy, ceiling and floor effects, and differential item functioning (DIF). Moreover, the concurrent validity of the TAPAS was examined using the Weight Self-Stigma Questionnaire (WSSQ), Weight Bias Internalization Scale (WBIS), and body mass index (BMI). RESULTS: Unidimensionality was confirmed except for one item. Items corresponding to attitude toward physical activity were more easily adopted compared to items corresponding to actual behavioral aspects. No ceiling and floor effects were found. No DIF existed in the TAPAS items. The TAPAS was strongly correlated with both the WSSQ and WBIS, but not BMI. CONCLUSION: The study showed that overall, the TAPAS has robust psychometric properties. However, future research needs to address the misfit item and explore the feasibility of applying the TAPAS to other populations including wider ethnic groups, age ranges, and life stages.

Exploring mediational roles for self-stigma in associations between types of problematic use of internet and psychological distress in youth with ADHD.

BACKGROUND: Several studies have linked the problematic use of the Internet (PUI) to psychological distress. Youth with attention deficit hyperactivity disorder (ADHD) are considered a particular disadvantaged population with a high risk of developing PUI, psychological distress, and self-stigma. Nonetheless, the interrelationships of PUI, self-stigma, and psychological distress in adolescents with ADHD are not well understood. AIMS: This study investigated whether self-stigma mediates relationships between different forms of PUI, such as problematic gaming (PG), problematic social media use (PSMU), problematic smartphone use (PSPU), and psychological distress (i.e., depression, anxiety, and stress), in children with ADHD. METHODS AND PROCEDURES: We recruited 100 youth with ADHD (mean age=10.80 [SD=3.07] years; 84 boys) from psychiatric outpatient clinics in Taiwan. All participants were assessed for PUI (via Internet Gaming Disorder-Short Form for PG, Bergan Social Medica Addiction Scale for PSMU, and Smartphone Application-Based Addiction Scale for PSPU), self-stigma (via Self-Stigma Short-Scale), and psychological distress (via Depression, Anxiety, Stress Scale). OUTCOMES AND RESULTS: The results of path and bootstrapping analyses indicated that self-stigma mediated the associations between PSMU and PSPU, but not PG, and depression, anxiety, and stress. CONCLUSIONS AND IMPLICATIONS: This study expands the extant literature by revealing that self-stigma mediates the association between specific forms of PUI and psychological distress in adolescents with ADHD. Interventions aimed at reducing self-stigma and PUI, particularly PSMU and PSPU, may help decrease psychological distress among adolescents with ADHD.

Weight Stigma and Avoidance of Physical Activity and Sport: Development of a Scale and Establishment of Correlates.

Participation in sport and physical activity (PA) is declining, and the psychosocial factors underpinning avoidance of these activities are not understood. This study developed and tested a new measure assessing the tendency to avoid PA and sport because of weight stigma and appearance-related concerns. University students (n = 581, mean age = 19.8 years) completed an online survey at two time points. Demographic details and measures of weight stigmatization, appearance evaluations, and enjoyment and participation in PA or sport were taken. In addition, we developed and tested a new measure of the tendency to avoid physical activity and sport (TAPAS). Psychometric testing of the scale was conducted, and correlates of TAPAS were examined. The ten-item TAPAS provided a single factor solution, and the final scale score was predictive of lower levels of enjoyment of, and participation in, physical activity and sport (p < 0.001). The scale also displayed good internal and test-retest reliability. This study provides a new measure for assessing people's tendency to avoid PA and sport because of weight stigma or appearance-related concerns. The results suggest that initiatives seeking to increase participation in PA and sport may need to address weight stigma and associated appearance related concerns.

Effects of Weight-Related Self-Stigma and Smartphone Addiction on Female University Students' Physical Activity Levels.

Physical inactivity is a common health problem in female college students, and factors such as weight self-stigma and smartphone addiction may negatively impact physical activity in this population. The aim of the current study was to investigate the associations between these variables and identify the moderating effects of smartphone addiction between weight stigma and physical activity. Using a cross-sectional study, information on the level of physical activity in the past week, weight-related self-stigma, and smartphone addiction, as well as demographics, were collected via an online survey from 391 female college students in Taiwan. Participants in two groups of moderate to high and low physical activity were compared using a zero-order bivariate correlation in terms of independent variables. A moderated mediation model using Model 14 in the Hayes' PROCESS macro with 1000 bootstrapping resamples was applied to assess moderation effects. There were significant differences in terms of weight status, smartphone addiction, and weight stigma between active and inactive groups (p < 0.001). All independent variables except for age were positively correlated (0.14 < r < 0.45). Multivariate regression models indicated that weight status was associated with weight stigma (odds ratio [OR] = 9.13, p < 0.001; 95% CI = 6.90, 11.35). Weight status (OR = 0.47, p = 0.03; 95% CI = 0.23, 0.93), weight stigma (OR = 0.96, p = 0.03; 95% CI = 0.922, 0.997), and smartphone addiction (OR = 0.11, p = 0.003; 95% CI = 0.03, 0.47) were associated with physical activity. The moderating role of smartphone addiction on the association between weight stigma and physical activity was also identified (OR = 1.05, p = 0.049; 95% CI = 1.0001, 1.1004). The moderating effect of smartphone addiction on the association between weight stigma and physical activity suggests that designing interventions to address the negative impacts of both weight stigma and smartphone addiction may help to improve physical activity in female college students.

The mediation effect of perceived weight stigma in association between weight status and eating disturbances among university students: is there any gender difference?

BACKGROUND: The study aimed to examine the association between perceived weight stigma (PWS), weight status, and eating disturbances. We hypothesized that PWS would partially mediate the association between weight status and eating disturbances among university students. METHODS: The study involved 705 undergraduate students (379 females and 326 males) recruited from Hong Kong and Taiwan Universities (399 Hong Kong; 306 Taiwan participants). Our sample was from one Hong Kong university (located in Kowloon) and five Taiwan universities (three located in Southern Taiwan, one located in Central Taiwan, and one located in North Taiwan). Participants' mean age was 20.27 years (SD = 1.79). All participants completed a demographic information sheet, the Three-Factor Eating Questionnaire-18 (TFEQ-R18), and the PWS questionnaire. PROCESS macro models were used to analyze potential mediations. RESULTS: We found a significantly higher PWS scores in a high weight group for females and males. There was a significant difference between weight status and eating disturbances. Moreover, PWS partially mediated the association between weight status and eating disturbances for both genders. CONCLUSIONS: PWS is associated with weight status and eating disturbances, making it an important target for health improvement among young adults. Further studies are needed to corroborate such associations in participants from other societies and cultures.

Perceived weight stigma, weight status (e.g., low weight, average weight, and high weight) and eating disturbances have been found to have associations between each other. However, such research is needed among Asians, and the present study examined a mediation mechanism among the three factors (i.e., perceived weight stigma, weight status, and eating disturbances). Using data from 705 university students across two regions (Hong Kong and Taiwan), the present study revealed that weight status might be associated with perceived weight stigma, and perceived weight stigma might be associated with eating disturbances. Such findings were consistent across male and female university students. The present study's findings underscore the importance of perceived weight stigma. Reducing perceived weight stigma may be an important strategy in developing health eating behaviors among university students.

Relationships among Physical Activity, Health-Related Quality of Life, and Weight Stigma in Children in Hong Kong.

Objectives: Our objective in this study was to establish the relationships among active and inactive physical activity, HRQoL, and weight stigma in children. Additionally, we investigated weight stigma as a mediator of the relationship between physical activity and HRQoL.Methods: This cross-sectional study was conducted in Hong Kong (June 2017-July 2018). Participants were 437 children in elementary school (2 primary schools and 2 non-governmental organizations) and their parents (dyads). Participants completed questionnaires containing items assessing demographic characteristics, physical activity level, and several HRQoL measures.Results: We found a statistically significant difference between a higher physically activity group (exercise > 2 hours/week) in all measures of HRQoL. Weight stigma had a significant mediating effect on the relationship between physical activity and child-rated HRQoL (Coefficient = -0.37; SE=0.05; t = 8.21; p < .001), parent-rated HRQoL (Coefficient = -0.16; SE = 0.04; t = 4.21; p < .001), and child-rated weight-related QoL (Coefficient = -0.56; SE = 0.04; t = 14.92; p < .001). Conclusions: Physical activity was associated with better HRQoL and lower weight stigma. Weight stigma appears to affect how physical activity is related to better HRQoL, but the association is somewhat weak.

Problematic Use of Internet-Related Activities and Perceived Weight Stigma in Schoolchildren: A Longitudinal Study Across Different Epidemic Periods of COVID-19 in China.

Background: Social distancing and school suspension due to the coronavirus pandemic (COVID-19) may have a negative impact on children's behavior and well-being. Problematic smartphone use (PSU), problematic social media use (PSMU) and perceived weight stigma (PWS) are particularly important issues for children, yet we have a poor understanding of how these may have been affected by lockdowns and physical isolation resulting from COVID-19. This research aimed to understand how these psychosocial and behavioral variables may be associated with psychological distress, and how these associations may have changed during the COVID-19 pandemic. Methods: A total of 489 children completed a three-wave longitudinal study from January 2020 to June 2020. The first wave was conducted before the COVID-19 outbreak. The second wave was conducted during the outbreak. The third wave was conducted during post-COVID-19 lockdown. Questionnaires measured psychological distress, PSU, PSMU, and PWS. Results: PSU, PSMU, PWS and psychological distress were all significantly associated with each other. PSU was significantly higher during outbreak. PWS was significantly higher before outbreak. We found an increased association between PSMU and PWS across three waves in all three models. The association between PSU and depression/anxiety decreased across three waves; however, association between PSMU and depression/anxiety increased across three waves. Conclusions: COVID-19 initiated school suspension and associated lockdowns appear to have exacerbated PSU and depression among children. However, PWS was reduced during this period. Children should use smartphones and social media safely and cautiously, and be aware of the potential exposure to weight stigmatization.

Psychosocial Variables Related to Weight-Related Self-Stigma in Physical Activity among Young Adults across Weight Status.

A healthy lifestyle with sufficient physical activity (PA) can contribute to weight management. Yet, many people do not maintain a healthy lifestyle. To explain PA, we propose a model that incorporates the Theory of Planned Behavior (TPB) with weight-related self-stigma. We recruited 325 young adults to complete questionnaires regarding their physical activities, weight-related self-stigma, and TPB factors. We used structural equation modeling to examine the model fit and the path invariance across weight groups. The model showed excellent model fit, but path invariance was not supported. Weight-related self-stigma significantly explained the perceived behavioral control, behavioral intention, and engagement of PA. People without overweight and people with overweight have different considerations for PA. Weight-related self-stigma is important for PA as well. To promote a healthy lifestyle, healthcare providers should provide different suggestions or interventions that suit their patients' weight-related concerns.

Psychometric properties and measurement invariance of the Weight Self-Stigma Questionnaire and Weight Bias Internalization Scale in children and adolescents.

Given the negative consequences of weight bias, including internalized weight stigma, on health outcomes, two instruments-the Weight Self-Stigma Questionnaire (WSSQ) and Weight Bias Internalization Scale (WBIS)-have been developed. However, their psychometric properties are yet to be tested for Asian pediatric populations. METHOD: Participants aged 8 to 12 years (N = 287; 153 boys) completed the WSSQ and the WBIS, and they were classified into either a group with overweight or a group without overweight based on self-reported weight and height. RESULTS: Both WSSQ and WBIS had their factor structures supported by confirmatory factor analyses (CFAs). The measurement invariance of two-factor structure was further supported for WSSQ across gender and weight status. The measurement invariance of single-factor structure was supported for WBIS across gender but not across weight status. CONCLUSIONS: WSSQ and WBIS were both valid to assess the internalization of weight bias. However, the two instruments demonstrated different properties and should be applied in different situations.

ANTECEDENTES/OBJETIVO: Dadas las consecuencias negativas del sesgo de peso, incluyendo el estigma de peso internalizado, sobre los resultados de salud, se han desarrollado dos instrumentos -el Weight Self-Stigma Questionnaire (WSSQ) y la Weight Bias Internalization Scale (WBIS)-. Método:Los participantes de 8 a 12 años de edad (N = 287; 153 varones) completaron el WSSQ y la WBIS, y fueron clasificados en un grupo con sobrepeso o un grupo sin sobrepeso basado en el peso y la altura autoinformados. Resultados:Tanto en el WSSQ como en la WBIS se confirmaron sus estructuras factoriales mediante análisis factoriales confirmatorios (CFAs). La invarianza de la medida de la estructura de dos factores fue más apoyada para el WSSQ a través del género y del estado del peso. La invarianza de la medida de la estructura unifactorial fue apoyada para la WBIS a través de género, pero no a través de estado del peso. Conclusiones:WSSQ y WBIS son instrumentos válidos para evaluar la internalización del sesgo de peso. Sin embargo, los dos instrumentos demostraron diferentes propiedades y deben aplicarse en diferentes situaciones.

Validating Sizing Them Up: A parent-proxy weight-related quality-of-life measure, with community-based children.

Background/Objective: A weight-related Quality of Life (QoL) questionnaire elicits parents' perceptions to understand the impacts of weight on children's QoL. Sizing Them Up, a parent-proxy of a weight-related instrument, is a proper measure for the purpose, but its psychometric properties have not been validated on a non-clinical child population. This study aimed to thoroughly examine the psychometric properties of the Sizing Them Up on a non-clinical child population. Methods: Children from Taiwan (M age  = 11; SD = 1.02; N = 236) filled out a weight-related QoL instrument (Sizing Me Up) while their parents completed Sizing Them Up and two generic QoL instruments. Confirmatory factor analysis (CFA), concurrent validity, and known-group validity were conducted. Results: CFA supported the factor structure of Sizing Them Up. The concurrent validity of the Sizing Them Up total score was satisfactory: r = .46 to .53 with other QoL instruments. Known-group validity was supported as obese children had significantly lower Sizing Them Up total score than did normal-weight and underweight children. Conclusions: We extended the use of Sizing Them Up from clinically obese children to a community-based sample of underweight as well as overweight children. Healthcare providers may use Sizing Them Up to measure the weight-related QoL for children.

Antecedentes/objetivo: Un cuestionario que relaciona peso y calidad de vida (CV) estimula la percepción de los padres para comprender los impactos del peso sobre la CV de los niños. Sizing Them Up es un instrumento para padres, relacionado con el peso, pero sus propiedades psicométricas no se han validado en población infantil no clínica. Este estudio examina minuciosamente dichas propiedades en una población infantil no clínica. Método: Niños de Taiwán (M edad = 11,00; DT = 1,02; N = 236) completaron el Sizing Me Up, mientras sus padres completaron este mismo instrumento y otros dos genéricos de CV. Se realizó análisis factorial confirmatorio (CFA), y se examinó la validez concurrente y validez de grupo conocido. Resultados: El CFA apoya la estructura factorial del Sizing Them Up. La validez concurrente fue satisfactoria. La validez de grupo conocido fue apoyada, ya que los niños obesos obtuvieron una puntuación en Sizing Them Up significativamente menor que los niños de peso normal o bajo peso. Conclusiones: Los proveedores de atención médica pueden utilizar Sizing Them Up para medir la CV relacionada con el peso de los niños.

Poor Health and Experiences of Being Bullied in Adolescents: Self-Perceived Overweight and Frustration with Appearance Matter.

OBJECTIVE: To examine the associations between body image (actual and self-perceived weight status; feelings about appearance) and health outcomes (overall health, life satisfaction, and mental health) and between body image and experiences of being bullied. METHODS: Participants included 8,303 children from 7th to 10th grade in the Health Behavior of School-Aged Children (HBSC) 2009-2010 data set, a large-scale sample in the United States. Several multiple linear regressions (with health outcomes as dependent variables) and multivariate logistic regressions (with being bullied or not as dependent variable) were conducted to investigate the associations between each dependent variable and the following independent variables: relationship with parents, frustration with appearance, and actual and self-perceived weight status. RESULTS: Self-perceived underweight, self-perceived overweight (OW), and frustration with appearance were positively associated with being bullied. Frustration with appearance was a risk factor, while good relationship with parents was a protective factor, especially for psychological health outcomes. Self-perceived OW had a stronger association with the experience of being bullied than actual OW. The relationship between actual OW and being bullied might be attenuated when self-perceived OW is simultaneously considered. CONCLUSIONS: Body image may be an important factor in the association between weight status and the experience of being bullied.

Using the Theory of Planned Behavior incorporated with perceived barriers to explore sexual counseling services delivered by healthcare professionals in individuals suffering from epilepsy.

People with epilepsy (PWE) are highly likely to suffer from sexual dysfunction, and dealing with this issue is a challenge for healthcare providers. Unfortunately, there is no theory-driven study that has investigated the counseling practice of healthcare providers for sexual problems in PWE. Therefore, we decided to apply the well-established Theory of Planned Behavior (TPB) to examine factors associated with healthcare providers' sexual counseling in PWE. Apart from TPB, perceived barriers toward providing counseling could be a possible factor that needs to be investigated as well. Therefore, two models explaining sexual counseling practice were proposed. Model 1 included only TPB and Model 2 included TPB incorporated with perceived barriers. Five hundred fifty-nine Iranian healthcare professionals responsible for PWE were recruited across several neurology clinics and asked to complete TPB-specific questionnaires. The same healthcare professionals were asked to complete an additional questionnaire on their attitudes toward sexual counseling 18months later. Structural equation modeling suggested Model 2 to be more useful in explaining sexual counseling practice compared with Model 1. Moreover, attitude and perceived behavioral control showed stronger associations with behavioral intention, whereas subjective norm showed weaker associations. The associations were similar across different healthcare professionals (i.e., medical doctors vs. nurses). In conclusion, TPB incorporated with perceived barriers might be a useful theory for different types of healthcare providers to improve and enhance sexual counseling practice.