Examination of eating disorder psychopathology across sexual and gender identities among a Canadian sample.

OBJECTIVE: Eating disorders (EDs) disproportionately affect sexual and gender minorities, with majority of research conducted among samples in the United States. The purpose of this study was to examine ED psychopathology among adolescents and young adults in Canada with diverse gender and sexual identities. METHOD: Data were collected from 2,714 Canadians, aged 16-30 years old, via an online survey at the end of 2021 during the COVID-19 pandemic. Participants responded to sociodemographic questions (including history of EDs) and reported on eating attitudes and behaviors. Descriptive statistics and multiple modified Poisson and linear regressions were conducted. RESULTS: Over half the sample was heterosexual, 35% were sexual minority cisgender men and women, and 6.5% were transgender and gender non-conforming (TGNC) people. The sample overall reported elevated ED psychopathology based on their eating attitudes and behaviors. TGNC participants reported the most severe ED psychopathology. Generally, sexual minority cisgender women and cisgender men had elevated ED psychopathology compared to their heterosexual counterparts. Regression analyses revealed all gender and sexual minorities reported greater ED psychopathology compared to heterosexual cisgender men. DISCUSSION: The Canadian sample reported elevated ED psychopathology compared to previous studies among various populations. Additional investigations are now needed to observe how ED psychopathology continues to change after the onset of the pandemic. Further research is needed among cisgender men, TGNC people, and sexual minorities to understand the unique stressors they face that lead to high ED psychopathology, and develop appropriate prevention and treatment tools. PUBLIC SIGNIFICANCE: EDs affect people of all gender and sexual identities. People who identify as a gender and/or sexual minority often experience problematic eating attitudes and behaviors, particularly transgender and gender non-conforming people of all sexual identities. More research attention is needed among these populations, especially due to a paucity of research among Canadians, to develop effective diagnostic tools, prevention efforts, and treatment programs specific to gender and sexual identities.

Use of Legal Appearance- and Performance-Enhancing Drugs and Substances: Findings from the Canadian Study of Adolescent Health Behaviors.

BACKGROUND: Use of appearance- and performance-enhancing drugs and substances (APEDS) is common among adolescent and young adults. Many APEDS are legally sold "over-the-counter," however research has documented contamination of legal APEDS and many adverse effects of use. Despite this, little research has been conducted on legal APEDS use in Canada, particularly regarding the prevalence and sociodemographic predictors of use, which was the aim of this study. METHODS: Data from the Canadian Study of Adolescent Health Behaviors (N = 2,731) were analyzed. Prevalence and frequency of use of 10 common APEDS in the past 12 months were estimated overall and across genders. Multiple modified Poisson regression analyses were conducted to determine the sociodemographic predictors of APEDS use. RESULTS: Overall, use of caffeine was most common among the sample (71.3%), along with protein bars (63.4%), and whey protein powders or protein shakes (63.1%). Boys and men reported greater prevalence of use of eight of the 10 APEDS, with the exception of diuretics or water pills and probiotics, compared to girls and women and transgender/gender non-confirming participants. Over three quarters (82.5%) of boys and men reported use of whey protein powders or protein shakes and 50.3% reported use of creatine monohydrate. Use of APEDS varied based on several key sociodemographic identifiers. CONCLUSIONS: This study is the first to document legal APEDS use among a sample of Canadian adolescents and young adults, providing important implications for health care and policymaking professionals. Further research is needed to gain greater insight into APEDS use among Canadian young people.

Contemporary screen use and symptoms of muscle dysmorphia among a national sample of Canadian adolescents and young adults.

PURPOSE: Screen time has been previously linked to body dissatisfaction and eating disorder behaviors. However, less is known about whether use of common forms of screen technology is associated with symptoms of muscle dysmorphia (MD), which was the aim of this study. METHODS: Data from the Canadian Study of Adolescent Health Behaviors (N = 2538) were analyzed. Associations between hours of use of six contemporary forms of recreational screen time, as well as total screen time, and symptoms of MD were determined using multiple linear regression models, stratified by gender, and adjusting for potential confounders. RESULTS: Among both men and women, greater total screen time and texting were associated with greater symptoms of MD; however, differences emerged across the screen time modalities by gender. Among women, video chatting was most strongly associated with symptoms of MD, while social media use was most strongly associated with symptoms of MD among men. CONCLUSION: Findings add to the growing literature documenting the potentially harmful correlates of screen time by including MD symptomatology. Findings have important implications for health care, public health, and policymaking professionals. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

A systematic review of treatment approaches for compulsive exercise among individuals with eating disorders.

Individuals with eating disorders often experience compulsive exercise which, if left untreated, can lead to longer treatment and worsened symptoms. Compulsive exercise must be addressed within eating disorder treatment to help individuals establish a healthy relationship with exercise. However, there are currently no standardized guidelines for treating compulsive exercise or a consensus on which forms of treatment are most effective. Therefore, the purpose of this review was to examine interventions that address compulsive exercise and their impact on treating compulsive exercise among individuals with eating disorders. A systematic review of the literature was conducted. Eleven studies testing treatments for compulsive exercise were included in this review. Participants were diagnosed with anorexia nervosa, bulimia nervosa, or EDNOS, and a small portion had BED. Improvements in compulsive exercise and eating psychopathology were observed across all studies. The interventions focused on exercise psychoeducation and often incorporated exercise sessions. The findings highlight the positive impact of treating compulsive exercise, suggesting it should be a standard component of eating disorder treatment. Future studies should examine differences in treatment approaches and outcomes specific to each eating disorder, and specific to males. More consistency across studies in the conceptualization and measurement of compulsive exercises is also needed.

"Compulsive exercise is a socially acceptable prison cell": Exploring experiences with compulsive exercise across social media.

OBJECTIVE: Investigations into online eating disorder (ED) communities have allowed for a rich exploration of lived experiences focused on a number of aspects, such as recovery and support groups. There is a lack of understanding around compulsive exercise (CE), which is often a characterizing condition of EDs. Exploring the lived experiences of CE as discussed online could provide helpful insight towards a better understanding of CE. Therefore, the purpose of this study was to explore experiences around CE and EDs shared on social media sites. METHOD: Social media posts related to CE and EDs from Reddit, Twitter, Instagram, and forums were collected for 12 months. A thematic analysis of 881 posts was used to identify common themes among individuals' lived experiences with CE. RESULTS: Five themes (and three subthemes) were identified across the social media posts: (1) seeking control, but ultimately CE takes hold, (2) burning off binges, but at what expense?, (3) recovery is a battle, but worth it, (4) is my exercise healthy?, and (5) frustration with comments about CE. DISCUSSION: The lived experiences of CE among individuals with EDs have provided support for current definitions of CE and shared novel insight into the recovery experience. Individuals online also highlighted the need for improvement in treatment around CE specifically, and greater awareness around CE for the general public and healthcare providers.

"This is just how I cope": An inductive thematic analysis of eating disorder recovery content created and shared on TikTok using #EDrecovery.

OBJECTIVE: To explore eating disorder (ED) recovery-related content created and shared on the social media platform TikTok. METHOD: A systematic review and inductive thematic analysis of 150 TikTok posts catalogued under hashtag (#) EDrecovery. Two coders independently analyzed the posts and a critical peer facilitated discussions about the resulting codes and themes. RESULTS: Creators on TikTok used #EDrecovery to share their personal experiences with recovery through the use and cooption of popular (or viral) video formats, succinct storytelling, and the production of educational content. Five themes were interpreted across the data: (a) ED awareness, (b) inpatient story time: "ED unit tings", (c) eating in recovery, (d) transformations: "how about a weight gain glow up?", and (e) trendy gallows humor: "let's confuse people who have a good relationship with food". DISCUSSION: TikTok as a user-friendly, creative media may provide the artistic and social tools for some creators to add their distinct voice to the ED recovery narrative and foster some semblance of community. Although all of the analyzed content was catalogued under #EDrecovery, some of the posts reified the increasingly blurred boundary that exists between ED recovery and pro-ED content on TikTok.

An Experimental Test of the Efficacy of Gain- and Loss-Framed Messages for Doping Prevention in Adolescent Athletes.

Background: Doping is a prevalent issue, not only among Olympians and professional athletes; young athletes and those at the sub-elite level have reported doping as well. Doping programs have been developed to target adolescent athletes and prevent doping initiation. The efficacy of primary doping prevention initiatives may be enhanced with health communication strategies, such as message framing. To date, there have been very few studies examining message framing among adolescents and none in the context of doping prevention. Objectives: The purpose of this study was to compare the efficacy of gain-framed and loss-framed messages on key psychological antecedents of doping among adolescent athletes. Methods: In a randomized controlled trial, 133 athletes aged 12 to 16 years old (Mage=13.73; 53% boys) from a variety of sports viewed either a gain- or loss-framed video. Intentions, attitudes, self-efficacy, and perceived norms were all assessed immediately before and after the videos. Results: Mixed between-within subjects ANOVAs revealed no differential influence for either message frame on changes in any of the outcomes. Attitudes, self-efficacy, and perceived norms all increased significantly over time for participants in both conditions. Conclusions/Importance: Overall, the findings suggest that a brief messaging intervention may have a beneficial influence on psychosocial constructs related to doping. There is no strong evidence to support definitive recommendations regarding optimal message framing for doping prevention among adolescent athletes.

An exploration and comparison of #BodyPositivity and #BodyNeutrality content on TikTok.

TikTok, one of the most popular visual social media platforms, has been criticized for perpetuating and glorifying eating disorders. In response, content focused on body positivity (loving your body) is growing on TikTok. However, body positivity content on other social platforms promotes positive body image but also perpetuates unrealistic beauty ideals. Body neutrality (deemphasizing the focus on the body's appearance) is an alternative concept that could portray less harmful content, but has yet to be explored. Therefore, the purpose of this study was to explore and compare the content under #BodyPositivity and #BodyNeutrality on TikTok. One hundred and fifty TikToks under each hashtag were downloaded. A thematic analysis of the TikToks was conducted. Three themes were generated that captured content across both hashtags, with only minor differences in content between the two: (1) Resisting societal ideologies (with subtheme: Normalizing insecurities), (2) (Re)producing disordered content (with subtheme: Toxic (body) positivity promotes the need for neutrality), and (3) Social critique. Within the themes, there was the promotion of body positivity through self-love and body acceptance, but also content that continued to emphasize standard beauty ideals and the thin-ideal. Certain TikToks provided educational content that explained the roots of the #BodyPositivity movement and what #BodyNeutrality means as a potentially more realistic approach to body acceptance. Findings suggest that #BodyNeutrality may provide a safer space for individuals online, and future research should assess the impact of such TikToks on those viewing them to assess body and eating attitudes and behaviours.

Associations between violent victimization and symptoms of muscle dysmorphia: Findings from the Canadian Study of Adolescent Health Behaviors.

This study aimed to determine the associations between violent victimization and symptoms of muscle dysmorphia (MD) among a sample of Canadian adolescents and young adults. Data from 2538 adolescents and young adults (16-30 years) from the Canadian Study of Adolescent Health Behaviors were analyzed. Violent victimization assessed included experiences of rape, sexual assault, emotional abuse, and physical abuse occurring in the past 12 months. A violent victimization sum score was also created. Symptoms of MD were assessed using the Muscle Dysmorphic Disorder Inventory (MDDI). Linear regression analyses were conducted, stratified by gender, to determine the associations between violent victimization and MDDI total score and subscale scores. Among women and men, experiencing sexual assault, physical abuse, and emotional abuse in the past 12 months were significantly associated with a higher MDDI total score. Additionally, as the number of forms of violent victimization experienced increased, the likelihood of a higher MDDI total score also increased, with the strongest association among women and men who reported experiencing three or more victimizations. Findings expand the limited prior research suggesting associations between violent victimization and MD by assessing these associations via multiple forms of victimization and amongst a sample of Canadian adolescents and young adults.

Anabolic-Androgenic Steroid Use: Patterns of Use among a National Sample of Canadian Adolescents and Young Adults.

Background: Androgenic-anabolic steroid (AAS) use is relatively common among international recreational and community samples and is associated with several deleterious side effects and health consequences that have not been studied recently among a large Canadian sample. Therefore, the purpose of this study was to assess and describe characteristics of AAS users compared to non-AAS users among a national sample of Canadian adolescents and young adults. Methods: Data from 2,774 adolescents and young adults from the Canadian Study of Adolescent Health Behaviors were analyzed. Participants were recruited via social media advertisements and completed the survey online. Survey items measured sociodemographics, AAS use, AAS side effects, motives for AAS use, AAS administration, body satisfaction, other illicit substance use, mental health, and violence involvement. Results: Among the overall sample, 1.6% of participants reported lifetime AAS use, with the majority of users being White, heterosexual males. Most users strived to gain weight, with main motives for AAS use including increased muscularity and strength, and improved appearance. Most AAS users were satisfied with their body compared to non-users. Approximately one in five users had AAS dependence and experienced multiple adverse side effects. Few differences between users and non-users in self-reported mental health were found. Conclusion: Findings indicate that AAS use among a community sample of Canadian adolescents and young adults is an important health issue, particularly given the relatively high occurrence of AAS dependence and adverse side effects reported by users. Findings support the need for education and intervention efforts from healthcare professionals. Further investigations among Canadian AAS users may provide more insight regarding the unique supports these individuals require.

Prevalence and correlates of dry scooping: Results from the Canadian Study of Adolescent Health Behaviors.

Dry scooping is a novel dietary practice characterized by consuming pre-workout powders without mixing with a liquid as directed. Despite purported benefits of this practice, such as increased energy due to the high concentration of caffeine, there are potential harms of engagement. To date, no known empirical research has investigated dry scooping in epidemiological research. Therefore, the aim of this study was to characterize the prevalence and correlates of dry scooping among a sample of Canadian adolescents and young adults. Data from the Canadian Study of Adolescent Health Behaviors (N = 2731) were analyzed. Prevalence of any dry scooping in the past 12 months among the overall sample, and by gender, was estimated. Modified Poisson regression analysis was used to determine the adjusted associations between sociodemographic and descriptive characteristics and dry scooping. Overall, 16.9 % of the sample reported dry scooping in the past 12 months, which was significantly more common among men (21.8 %) compared to women (14.2 %) and transgender/gender non-confirming participants (8.0 %). Participants who reported weight training, greater time spent on social media, and clinically significant symptoms of muscle dysmorphia were more likely to report dry scooping, while sexual minorities, relative to heterosexual participants, and those with higher education were less likely to report dry scooping. This study is the first known epidemiological study of dry scooping, underscoring the common nature of this contemporary dietary behavior. Findings emphasize the need for future research and prevention and intervention efforts to protect the health and well-being of young people.

Associations between gender identity, eating disorder psychopathology, and food insecurity among Canadian adolescents and young adults during the COVID-19 pandemic.

There is a clear association between food insecurity and eating disorder (ED) psychopathology, mainly among samples in the United States and prior to the COVID-19 pandemic. However, Canadians experience food insecurity as well, which may have been heightened by the pandemic and its associated restrictions. The associations between food insecurity and ED psychopathology among Canadians remains underexamined. Therefore, the purpose of this study was to explore associations between food insecurity and ED psychopathology by gender identity among a national sample Canadian adolescents and young adults. Data were collected from 2714 participants aged 16 to 30 years old from across Canada. Participants reported sociodemographic characteristics, ED psychopathology, and food insecurity experienced during the COVID-19 pandemic through an online survey. Descriptive statistics, chi-square tests, ANOVAs, and regression analyses were conducted. Overall, 8.9% of the sample experienced food insecurity, with the highest prevalence among transgender and gender nonconforming individuals. Generally, those with no food insecurity reported the lowest ED psychopathology compared to higher ED psychopathology among those with food insecurity. Several unique differences were observed between cisgender men and cisgender women, while there were no significant associations between food insecurity and ED psychopathology found among transgender and gender nonconforming individuals. Further research is needed to investigate how the relationship between food insecurity and ED psychopathology differs based on gender, and to continue to explore food insecurity experienced beyond the COVID-19 pandemic as food insecurity possesses a considerable health threat to all.

Muscle dysmorphia symptomatology among a national sample of Canadian adolescents and young adults.

The aim of this study was to describe muscle dysmorphia (MD) symptomatology among a large, diverse, and national sample of adolescents and young adults in Canada. Data from the Canadian Study of Adolescent Health Behaviors (N = 2256) were analyzed. MD symptomatology was assessed using the Muscle Dysmorphic Disorder Inventory (MDDI). Men (mean [M] = 33.9, standard deviation [SD] = 8.6) reported significantly greater overall MD symptomatology compared to women (M = 30.1, SD = 7.3) and transgender/gender non-conforming (TGNC; M = 31.5, SD = 7.6) participants. Similarly, the prevalence of clinical MD risk was also highest among men (25.7 %). In regression analyses, participants who identified as South Asian (B 1.97, 95 % confidence interval [CI] 0.41, 3.52) or Middle Eastern (B 2.92, 95 % CI 0.50,5.35), compared to White participants, or identified as gay or lesbian (B 2.65, 95 % CI 1.19, 4.10), compared to heterosexual participants, had greater MD symptomatology. Findings are the first to describe the MD symptomatology among Canadian adolescents and young adults. Health care and public health professionals should be aware of the overall high occurrence of MD symptomatology in this sample, and future research is needed to continue to describe MD among Canadian young people.

Associations between social media use, fitness- and weight-related online content, and use of legal appearance- and performance-enhancing drugs and substances.

Prior research has documented the connection between social media use and engaging with fitspiration with body dissatisfaction, disordered eating behaviors, and various health risk behaviors (e.g., substance use). However, gaps remain in the knowledge base on whether social media use and engaging with fitness- and weight-related online content are associated with the use of legal appearance- and performance-enhancing drugs and substances (APEDS; e.g., whey protein), which was the aim of this study. Data from participants ages 16-30 years in Canadian Study of Adolescent Health Behaviors (N = 2731) were analyzed. Multiple modified Poisson regression analyses were conducted to determine the associations between hours per day of social media use and any engagement with fitness- and weight-related online content in the past 30 days and use of 10 different legal APEDS in the past 30 days. Greater time on social media was significantly associated with use of energy drinks and pre-workout drinks or powders in the past 30 days. Engaging with fitness- and weight-related online content was significantly associated with the use of caffeine, creatine monohydrate, pre-workout drinks or powders, probiotics, protein bars, and whey protein powders or shakes in the past 30 days. These findings expand prior research on the correlates of social media use and engagement with fitness- and weight-related online content among young people and have important implications for healthcare and public health professionals, as well as technology companies.

Intermittent fasting: Describing engagement and associations with eating disorder behaviors and psychopathology among Canadian adolescents and young adults.

Intermittent fasting has grown in popularity over the past several years. However, intermittent fasting has also been shown to relate to eating disorder behaviors and psychopathology, yet little research has explored this relationship in epidemiological samples. Therefore, the aims of this study were to determine prevalence and characteristics of engagement in intermittent fasting, and associations with eating disorder behaviors and psychopathology. Data from the Canadian Study of Adolescent Health Behaviors, a national study of Canadian adolescents and young adults (N = 2762) were analyzed. Multiple modified Poisson regression analyses were conducted to determine the association between intermittent fasting (past 12 months and 30 days) and eating disorder behaviors and psychopathology (measured using the Eating Disorder Examination Questionnaire). Overall, 47.7 % of women, 38.4 % of men, and 52.0 % of transgender/gender non-conforming (TGNC) participants reported engaging in intermittent fasting in the past 12 months. Intermittent fasting in the past 12 months and 30 days was significantly associated with eating disorder psychopathology among women, men, and TGNC participants. Varying patterns of association between intermittent fasting and eating disorder behaviors were found across genders, with the most consistent relationships between intermittent fasting and ED behaviors in women. Findings underscore the common nature of intermittent fasting among a large, community sample of adolescents and young adults across Canada, as well as associated eating disorder behaviors and psychopathology. Continued research is needed to further understand the effects of intermittent fasting, as clinical and public health efforts are needed to protect the health of adolescent and young adults.

Feasibility, Acceptability, and Clinical Significance of a Dyadic, Web-Based, Psychosocial and Physical Activity Self-Management Program (TEMPO) Tailored to the Needs of Men with Prostate Cancer and Their Caregivers: A Multi-Center Randomized Pilot Trial.

BACKGROUND: Prostate cancer is the most common cancer diagnosis among men. Family caregivers (often female spouses) play a key role in ensuring patients' needs are met, frequently assuming their role with no formal training, which can contribute to a high burden. The purpose of this study was to pilot TEMPO-the first dyadic, Tailored, wEb-based, psychosocial and physical activity self-Management PrOgram for men with prostate cancer and their caregivers. METHODS: 49 men with prostate cancer and their caregivers were randomized to TEMPO or usual care. Baseline and follow-up questionnaires were completed to assess feasibility, acceptability, and clinical significance. A priori benchmarks for these outcomes were set. Thirteen exit interviews were conducted to further explore acceptability. RESULTS: Feasibility benchmarks were met with the exception for recruitment with on average 6.1 dyads recruited/month (benchmark: 8 dyads/month). Benchmarks of acceptability focused on attrition (<25%) and system usability, which were met. Using the strict criteria for adherence of 100% of the module viewed and participants spending at least 15 min on the module, 45% of participants were adherent. The clinical significance on anxiety and quality of life was supported for caregivers, and mostly supported for the men with prostate cancer. CONCLUSION: This pilot trial was successful, with minor modifications needed prior to a large trial.

Behaviour change techniques in physical activity interventions for men with prostate cancer: A systematic review.

Physical activity interventions can improve prostate cancer survivors' health. Determining the behaviour change techniques used in physical activity interventions can help elucidate the mechanisms by which an intervention successfully changes behaviour. The purpose of this systematic review was to identify and evaluate behaviour change techniques in physical activity interventions for prostate cancer survivors. A total of 7 databases were searched and 15 studies were retained. The studies included a mean 6.87 behaviour change techniques (range = 3-10), and similar behaviour change techniques were implemented in all studies. Consideration of how behaviour change techniques are implemented may help identify how behaviour change techniques enhance physical activity interventions for prostate cancer survivors.

Prostate Cancer Survivors' and Caregivers' Experiences Using Behavior Change Techniques during a Web-Based Self-Management and Physical Activity Program: A Qualitative Study.

Both men with prostate cancer and their caregivers report experiencing a number of challenges and health consequences, and require programs to help support the cancer patient-caregiver dyad. A tailored, web-based, psychosocial and physical activity self-management program (TEMPO), which implements behavior change techniques to help facilitate behavior change for the dyads was created and its acceptability was tested in a qualitative study. The purpose of this secondary analysis was to explore the dyads' experiences using behavior change techniques to change behavior and address current needs and challenges while enrolled in TEMPO. Multiple semi-structured interviews were conducted with 19 prostate cancer-caregiver dyads over the course of the program, resulting in 46 transcripts that were analyzed using an inductive thematic analysis. Results revealed four main themes: (1) learning new behavior change techniques, (2) engaging with behavior change techniques learned in the past, (3) resisting full engagement with behavior change techniques, and (4) experiencing positive outcomes from using behavior change techniques. The dyads' discussions of encountering behavior change techniques provided unique insight into the process of learning and implementing behavior change techniques through a web-based self-management program, and the positive outcomes that resulted from behavior changes.

Cheater, cheater, pumpkin eater: the Dark Triad, attitudes towards doping, and cheating behaviour among athletes.

We examined the relationships between the Dark Triad personality traits (Machiavellianism, narcissism, and psychopathy), attitudes towards doping, and cheating behaviour among athletes. One-hundred and sixty-four athletes completed a completed a matrix solving task within a specific time limit. Participants were told they would receive a financial reward for the total number matrices they could solve, but only 13 of the 20 matrices were solvable. This provided the incentive and opportunity for the athletes to cheat. Following this, athletes completed two questionnaires, which assessed the Dark Triad and their attitudes towards doping. All three Dark Triad personality traits correlated positively with attitudes towards doping and cheating behaviour. Regression analyses revealed that psychopathy and narcissism positively predicted attitudes towards doping, and narcissism emerged as a positive predictor of cheating behaviour. Attitudes towards doping correlated positively with cheating behaviour. The Dark Triad appears to be important in relation to both attitudes towards doping and cheating behaviour among athletes. In addition, our findings illustrate that favourable attitudes towards doping are linked with actual cheating among athletes. National Anti-Doping Organizations, sports federations, and coaches could assess athletes' Dark Triad scores and attitudes towards doping in order to identify who may be more likely to cheat.