Drive time to care and retention in HIV care: Rural-urban differences among Medicaid enrollees in the United States South.

PURPOSE: Less than 50% of people with HIV (PWH) in the United States are retained in care, a key step along the HIV care continuum. We examined the impact of geographic access to care on retention in care for urban and rural PWH. METHODS: We used Medicaid claims and clinician data (Medicaid Analytic eXtract and MAX Provider Characteristics, 2009-2012) for 13 Southern states plus the District of Columbia. We calculated drive time from the enrollees' ZIP Code Tabulation Area to their usual source of care. We used generalized estimating equations to examine the association between drive time to care >30 min (versus ≤30 min) and retention in care, overall and stratified by rurality. In sensitivity analysis, we examined the definition of retention in care, states included in the analysis, and enrollee- and care-related characteristics. FINDINGS: The sample included 49,596 PWH. Overall, the association between drive time >30 min and retention was significant, but small (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00, 1.01) and was not significant in urban areas; however, the significance and direction of the association differed in sensitivity analysis. In rural areas, driving >30 min to care was associated with 7% higher odds of retention in care (aOR 1.07, 95% CI 1.05, 1.08) and this association remained significant and positive in nearly all sensitivity analyses. CONCLUSIONS: For PWH in rural areas, greater drive time is consistently associated with greater retention in care. Disentangling the mechanisms of this relationship is a future research priority.

Direct and vicarious exposure to healthcare discrimination and erasure among transgender and gender independent individuals: Testing the indirect effect of mistrust in healthcare on utilization behaviors.

RATIONALE: Direct exposure to gender identity-related discrimination and erasure among the transgender and gender independent (TGI) population are associated with healthcare underutilization, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, exposure to such harm vicariously (i.e., through observation or report) is underexplored. OBJECTIVE: The present study examined the relationships among direct and vicarious gender identity-related healthcare discrimination and erasure exposure and past-year healthcare utilization. METHOD: Gender identity-based mistrust in healthcare was also assessed, as a mechanism through which direct and vicarious gender identity-related healthcare discrimination and erasure predict healthcare utilization behaviors among a sample (N = 385) of TGI adults in the U.S., aged 18 to 71 recruited online. RESULTS: Results indicated direct lifetime and vicarious healthcare discrimination and erasure exposure significantly predicted past-year healthcare underutilization when participants anticipated encountering gender identity-related healthcare discrimination. Mediational analyses indicated that higher levels of exposure to direct lifetime and vicarious healthcare discrimination and erasure were related to higher levels of mistrust in healthcare, through which past-year underutilization was significantly related. CONCLUSIONS: These findings are vital to informing healthcare practice and policy initiatives aimed at ensuring the barriers that deleteriously influence the accessibility of healthcare among TGI individuals are ameliorated.

Brief Report: Physician Reimbursement and Retention in HIV Care: Racial Disparities in the US South.

BACKGROUND: Retention in HIV care remains a national challenge. Addressing structural barriers to care may improve retention. We examined the association between physician reimbursement and retention in HIV care, including racial differences. METHODS: We integrated person-level administrative claims (Medicaid Analytic eXtract, 2008-2012), state Medicaid-to-Medicare physician fee ratios (Urban Institute, 2008, 2012), and county characteristics for 15 Southern states plus District of Columbia. The fee ratio is a standardized measure of physician reimbursement capturing Medicaid relative to Medicare physician reimbursement across states. Generalized estimating equations assessed the association between the fee ratio and retention (≥2 care markers ≥90 days apart in a calendar year). Stratified analyses assessed racial differences. We varied definitions of retention, subsamples, and definitions of the fee ratio, including the fee ratio at parity. RESULTS: The sample included 55,237 adult Medicaid enrollees with HIV (179,002 enrollee years). Enrollees were retained in HIV care for 76.6% of their enrollment years, with retention lower among non-Hispanic Black (76.1%) versus non-Hispanic White enrollees (81.3%, P < 0.001). A 10-percentage point increase in physician reimbursement was associated with 4% increased odds of retention (adjusted odds ratio 1.04, 95% confidence interval: 1.01 to 1.07). In stratified analyses, the positive, significant association occurred among non-Hispanic Black (1.08, 1.05-1.12) but not non-Hispanic White enrollees (0.87, 0.74-1.02). Findings were robust across sensitivity analyses. When the fee ratio reached parity, predicted retention increased significantly overall and for non-Hispanic Black enrollees. CONCLUSION: Higher physician reimbursement may improve retention in HIV care, particularly among non-Hispanic Black individuals, and could be a mechanism to promote health equity.

Far from a monolith: a typology of externalizing behavior among African American youth.

PURPOSE: Previous studies have examined externalizing behaviors among African American youth using variable-centered approaches that study aggression and delinquency separately. However, aggression and delinquency often operate together in shaping adolescent behavior. For this reason, person-centered approaches are essential for identifying subgroups of African American youth using multiple indicators of aggression and delinquency to model the behavioral heterogeneity within this population. We examined the relationship between interpersonal, school, and parenting factors and externalizing behaviors among African American youth. METHOD: Drawing from the National Survey on Drug Use and Health 2015-2018, we conducted latent class analysis based on 5 externalizing behavior indicator variables (i.e., serious fight, attack to harm, stealing, drug selling, handgun carrying) using a sample of 7,236 African American adolescents, aged 12-17. RESULTS: We identified a three class solution: Class #1-No Involvement (74.4%), characterized by very low levels of involvement in all of the externalizing behaviors examined; Class #2-Serious fight (23.3%), which is characterized by near-universal involvement in a serious fight, far lower levels of attack to harm, and negligible levels of stealing, drug selling, and handgun caring; and Class #3-Multidimensional externalizing (2.3%), characterized by very high levels of involvement in all of the externalizing variables examined. CONCLUSION: Most African American youth are not involved in externalizing behaviors. It is vital to support both the large majority of African-American youth who are abstaining from externalizing behaviors and to develop/implement programs to address the contextual and interpersonal needs of youth at elevated risk for consequences related to externalizing.

The effect of affective versus cognitive persuasive messages on African American women's attitudes toward condom use.

OBJECTIVE: Health decision making models propose that affective associations at both the implicit and explicit level and cognitive beliefs influence health behaviours. The current studies investigated whether affective or cognitive persuasive messages would lead to more positive implicit and explicit condom use attitudes and higher intentions among African American college women. DESIGN: Participants (Study 1 N = 109; Study 2 N = 112) explicit attitudes were assess prior to watching a short video that contained either affective (e.g., safe sex is pleasurable) or cognitive messages (e.g., latex condoms are effective in preventing HIV) in favour of condom use. MAIN OUTCOME MEASURES: Following the video, participants completed the Affect Misattribution Procedure (AMP), a measure of implicit attitudes, explicit measures of condom use attitudes that assessed attitudes at the overall and component level, intentions to use condoms, and interest in receiving free sample of condoms. RESULTS: Participants in the affective message condition reported more positive condom use attitudes on both the implicit and explicit measure, higher intentions to use condoms, and more interest in receiving free condoms than those in the cognitive message condition. CONCLUSION: These results suggest that affective messages may be more effective in changing condom use attitudes, which can be used in interventions to promote protective condom use behaviours.

Human Immunodeficiency Virus-Experienced Clinician Workforce Capacity: Urban-Rural Disparities in the Southern United States.

BACKGROUND: Human immunodeficiency virus (HIV)-experienced clinicians are critical for positive outcomes along the HIV care continuum. However, access to HIV-experienced clinicians may be limited, particularly in nonmetropolitan areas, where HIV is increasing. We examined HIV clinician workforce capacity, focusing on HIV experience and urban-rural differences, in the Southern United States. METHODS: We used Medicaid claims and clinician characteristics (Medicaid Analytic eXtract [MAX] and MAX Provider Characteristics, 2009-2011), county-level rurality (National Center for Health Statistics, 2013), and diagnosed HIV cases (AIDSVu, 2014) to assess HIV clinician capacity in 14 states. We assumed that clinicians accepting Medicaid approximated the region's HIV workforce, since three-quarters of clinicians accept Medicaid insurance. HIV-experienced clinicians were defined as those providing care to ≥ 10 Medicaid enrollees over 3 years. We assessed HIV workforce capacity with county-level clinician-to-population ratios, using Wilcoxon-Mann-Whitney tests to compare urban-rural differences. RESULTS: We identified 5012 clinicians providing routine HIV management, of whom 28% were HIV-experienced. HIV-experienced clinicians were more likely to specialize in infectious diseases (48% vs 6%, P < .001) and practice in urban areas (96% vs 83%, P < .001) compared to non-HIV-experienced clinicians. The median clinician-to-population ratio for all HIV clinicians was 13.3 (interquartile range, 38.0), with no significant urban-rural differences. When considering HIV experience, 81% of counties had no HIV-experienced clinicians, and rural counties generally had fewer HIV-experienced clinicians per 1000 diagnosed HIV cases (P < .001). CONCLUSIONS: Significant urban-rural disparities exist in HIV-experienced workforce capacity for communities in the Southern United States. Policies to improve equity in access to HIV-experienced clinical care for both urban and rural communities are urgently needed.

"You put yourself at risk to keep the relationship:" African American women's perspectives on womanhood, relationships, sex and HIV.

Recent trends indicate that HIV and STI infection rates are rising among adults over the age of 50, and African American women have the highest rates of HIV infection across racial and ethnic groups of women in the USA. Limited research has examined factors that contribute to HIV risk among older African American women. The current study used Collins' Black Feminist Thought to examine and understand attitudes and perceptions around HIV and sexual risk behaviours among African American women aged 50 years and older. Participants were recruited from two faith-based organisations in the mid-Atlantic region of the USA. Overarching themes and subthemes included those of expectations among African American women (carry yourself as you were raised, and carry a big burden), risk factors (not at risk, sexual networks and loneliness) and protective factors (maintaining high standards and education). Findings from this study have implications for the development of future HIV prevention programmes involving older African American women, who have largely been overlooked by past and ongoing HIV prevention trials and safer sex promotion efforts.

HIV Testing Behaviors among Black Rural Women: The Moderating Role of Conspiracy Beliefs and Partner Status Disclosure.

Objective: This study investigated whether HIV testing attitudes, HIV conspiracy beliefs, and reported sexual partner disclosure of HIV/STI status related to one-month self-report HIV testing outcomes following a brief intervention among Black women aged 18-25 years residing in rural Mississippi. Participants: Black women (N=119; M age=19.90, SD=1.81) recruited in rural Mississippi completed an online assessment before a brief HIV prevention intervention and a one month follow-up assessment during January to November 2016. Main Outcome Measures: Self-reported HIV testing 30-days following the intervention, partner HIV/STI status disclosure, beliefs in HIV conspiracy theory, and HIV testing attitudes in pre- and post-intervention assessments. Bivariate and multivariate analyses tested associations with HIV testing behaviors following the intervention. Results: Moderated moderation was used to examine whether HIV conspiracy beliefs and partner disclosure status both moderated the relationship between pre-intervention attitudes toward HIV testing and HIV testing at 1-month follow-up. It was found that both HIV conspiracy beliefs and partner disclosure moderated the relationship between attitudes and HIV testing at one-month follow-up. When partner disclosure was low, women with more negative attitudes toward testing and higher conspiracy beliefs were less likely to get tested than those with negative attitudes and lower conspiracy beliefs; conspiracy beliefs did not relate to testing outcomes when testing attitudes were positive. Conclusion: Findings suggest that interventions may benefit from accounting for conspiracy beliefs and the dyadic status disclosure when encouraging young rural women to test for HIV.

"I'm not White, I have to be pretty and skinny": A qualitative exploration of body image and eating disorders among Asian American women.

The purpose of the current study was to examine the relationships between body image, eating disorders, and treatment-seeking motivations among Asian American women in emerging adulthood (ages 18-24). Twenty-six Asian American women participated in qualitative focus groups of 4 to 6 individuals each from December 2015 to February 2016. Constructivist grounded theory was used to analyze focus group data. The resulting theoretical model, the "Asian American Body Image Evolutionary Model," maintains that a central phenomenon of perceptions and interpretation of messages about body image and eating, is rooted in three influencing factors: (1) Societal influence of mainstream White culture and Asian culture; (2) interpersonal influences of immediate family and close others; and (3) individual influence. An individual's perceptions and subsequent interpretation of messages may lead to disordered eating and decisions around treatment-seeking. The model developed can be utilized by practitioners or clinicians to help obtain a better understanding of the societal, interpersonal, and intrapersonal forces that may shape conceptualizations about body image and eating behaviors among Asian American women. In addition, findings from this study can be incorporated into prevention programs and interventions that focus on mental health among this population.

Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban-rural differences.

Achieving US state and municipal benchmarks to end the HIV epidemic and promote health equity requires access to comprehensive HIV care. However, this care may not be geographically accessible for all people living with HIV (PLHIV). We estimated county-level drive time and suboptimal geographic accessibility to HIV care across the contiguous US, assessing regional and urban-rural differences. We integrated publicly available data from four federal databases to identify and geocode sites providing comprehensive HIV care in 2015, defined as the co-located provision of core HIV medical care and support services. Leveraging street network, US Census and HIV surveillance data (2014), we used geographic analysis to estimate the fastest one-way drive time between the population-weighted county centroid and the nearest site providing HIV care for counties reporting at least five diagnosed HIV cases. We summarized HIV care sites, county-level drive time, population-weighted drive time and suboptimal geographic accessibility to HIV care, by US region and county rurality (2013). Geographic accessibility to HIV care was suboptimal if drive time was >30 min, a common threshold for primary care accessibility in the general US population. Tests of statistical significance were not performed, since the analysis is population-based. We identified 671 HIV care sites across the US, with 95% in urban counties. Nationwide, the median county-level drive time to HIV care is 69 min (interquartile range (IQR) 66 min). The median county-level drive time to HIV care for rural counties (90 min, IQR 61) is over twice that of urban counties (40 min, IQR 48), with the greatest urban-rural differences in the West. Nationally, population-weighted drive time, an approximation of individual-level drive time, is over five times longer in rural counties than in urban counties. Geographic access to HIV care is suboptimal for over 170,000 people diagnosed with HIV (19%), with over half of these individuals from the South and disproportionately the rural South. Nationally, approximately 80,000 (9%) drive over an hour to receive HIV care. Suboptimal geographic accessibility to HIV care is an important structural barrier in the US, particularly for rural residents living with HIV in the South and West. Targeted policies and interventions to address this challenge should become a priority.

Trends in binge drinking and alcohol abstention among adolescents in the US, 2002-2016.

BACKGROUND: Binge drinking accounts for several adverse health, social, legal, and academic outcomes among adolescents. Understanding trends and correlates of binge drinking and alcohol abstention has important implications for policy and programs and was the aim of this study. The current study examined trends in adolescent binge drinking and alcohol abstention by age, gender, and race/ethnicity over a 15-year period. METHODS: Respondents between the ages of 12 and 17 years who participated in the National Survey on Drug Use and Health (NSDUH) between 2002 and 2016 were included in the sample of 258,309. Measures included binge drinking, alcohol abstention, and co-morbid factors (e.g., marijuana, other illicit drugs), and demographic factors. RESULTS: Logistic regression analyses were conducted to examine the significance of trend changes by sub-groups while controlling for co-morbid and demographic factors. Findings indicated that binge drinking decreased substantially among adolescents in the US over the last 15 years. This decrease was shown among all age, gender, and racial/ethnic groups. In 2002, Year 1 of the study, 26% of 17-year-olds reported past-month binge drinking; in 2016, past-month binge drinking dropped to 12%. Findings also indicated comparable increases in the proportion of youth reporting abstention from alcohol consumption across all subgroups. Black youth reported substantially lower levels of binge alcohol use and higher levels of abstention, although the gap between Black, Hispanic and White youth narrowed substantially between 2002 and 2016. CONCLUSION: Study findings are consistent with those of other research showing declines in problem alcohol- use behavior among youth.

Circumstances Beyond Their Control: Black Women's Perceptions of Black Manhood.

Insufficient empirical attention has been paid to Black women's perceptions of Black male gender roles and associated masculinity. Although constructions of Black masculinity have been speculated about in popular media and literature, no known published studies have specifically investigated Black women's perceptions of Black men or offered a conceptualization of Black masculinity informed by their voices. Because women's perceptions of and beliefs about men affect partnership decisions, quality of relationships, childrearing decisions, health behaviors, and other aspects of personal and psychosocial well-being, the purpose of the present exploratory qualitative study was to fill the noted gap in the literature while highlighting context related to these beliefs. Participants in eight focus groups were 44 Black women, ranging in age from 18 to 91, from the Mid-Atlantic region of the United States. Transcribed focus group data were coded via a qualitative data analysis software program. Thematic analysis of data revealed three main themes: (a) Strong Armed and Strong Minded, (b2) Challenges with Familial and Personal Connections, and (c) Circumstances Beyond Their Control: Impact of the Black Experience. Implications for research and practice related to Black marriage, family, and parenting relationships are discussed.

Structural barriers to comprehensive, coordinated HIV care: geographic accessibility in the US South.

Structural barriers to HIV care are particularly challenging in the US South, which has higher HIV diagnosis rates, poverty, uninsurance, HIV stigma, and rurality, and fewer comprehensive public health programs versus other US regions. Focusing on one structural barrier, we examined geographic accessibility to comprehensive, coordinated HIV care (HIVCCC) in the US South. We integrated publicly available data to study travel time to HIVCCC in 16 Southern states and District of Columbia. We geocoded HIVCCC service locations and estimated drive time between the population-weighted county centroid and closest HIVCCC facility. We evaluated drive time in aggregate, and by county-level HIV prevalence quintile, urbanicity, and race/ethnicity. Optimal drive time was ≤30 min, a common primary care accessibility threshold. We identified 228 service locations providing HIVCCC across 1422 Southern counties, with median drive time to care of 70 min (IQR 64 min). For 368 counties in the top HIV prevalence quintile, median drive time is 50 min (IQR 61 min), exceeding 60 min in over one-third of these counties. Among counties in the top HIV prevalence quintile, drive time to care is six-folder higher for rural versus super-urban counties. Counties in the top HIV prevalence quintiles for non-Hispanic Blacks and for Hispanics have >50% longer drive time to care versus for non-Hispanic Whites. Including another potential care source-publicly-funded health centers serving low-income populations-could double the number of high-HIV burden counties with drive time ≤30 min, representing nearly 35,000 additional people living with HIV with accessible HIVCCC. Geographic accessibility to HIVCCC is inadequate in the US South, even in high HIV burden areas, and geographic and racial/ethnic disparities exist. Structural factors, such as geographic accessibility to care, may drive disparities in health outcomes. Further research on programmatic policies, and evidence-based alternative HIV care delivery models improving access to care, is critical.

Condom Use Efficacy and Sexual Communication Skills Among African American College Women.

Despite condom use being the most protective measure against the transmission of human immunodeficiency virus (HIV), little is known about the intermediary relationships between condom negotiation, assertive sexual communication, and condom use efficacy. The purpose of the current study was to examine the relationships between these constructs within the context of an HIV prevention intervention. We examined two samples of African American college women participating in two HIV prevention interventions, one of which was based on social learning theory ( N = 214). Data collected at intervention posttest and 3-month follow-up were analyzed. Findings revealed that condom use efficacy at posttest fully mediated the relationship between intervention effect and assertive sexual communication at 3-month follow-up. In addition, condom use efficacy at posttest fully mediated the relationship between intervention effect and condom negotiation at 3-month follow-up. Implications of the importance of experiential learning, in combination with behavior observance, on the maintenance of condom protective behaviors are discussed. Findings have the potential to inform clinic and community-based HIV prevention interventions conducted among African American women.

Change in Risk Perceptions and Marijuana and Cigarette Use Among African American Young Adult Females in an HIV Prevention Intervention.

Cigarette smoking and marijuana use have been tied to increased risky sexual behaviors, which may exacerbate risk of HIV transmission and other STIs (sexually transmitted infections). Research suggests that change in general perceptions of risk is associated with change in non-domain-targeted behaviors. The goal of the current study was to determine whether change in general risk perceptions among African American college females enrolled in a culturally-tailored HIV prevention intervention would be associated with decreased cigarette and marijuana use over time. Data were collected from 108 women enrolled in the SISTA Project intervention at a large university at baseline, post-test, and 3-month follow-up. Results from moderation analyses indicated that change in risk perceptions moderated the relationship between past 30-day cigarette use at baseline and past 30-day cigarette use at both post-test and at 3-month follow-up. Change in risk-perceptions also moderated the relationship between past 30-day marijuana use at baseline and past 30-day marijuana use at 3-month follow-up. Implications of the study indicate that heightening risk perceptions in any one area may impact behavior via specific and general increases in self-efficacy and motivation to reduce health risks more generally.

"Jimmy Cap Before You Tap": Developing Condom Use Messages for African American Women.

This study examined which characteristics of persuasive communications are most effective in changing African American women's condom use attitudes. Focus groups were convened with 40 African American women (Mage = 25.54, SD = 4.67) to assess their opinions on current effective strategies used to promote condom use among their peers. Participants discussed effective characteristics of messaging campaigns (i.e., source, message type, channel) and how these could be used in future prevention messages. Findings revealed that making messages that are fun, catchy, and informative, delivered frequently through social media, TV, or radio by a peer or celebrity would be perceived as most effective in changing young African American women's attitudes. Other themes that emerged were that condom use is more strongly associated with pregnancy prevention than HIV prevention and that sexual partners were perceived to have negative condom use attitudes. Recommendations centered on increasing exposure of HIV prevention messages by placing messages on the Internet and including a funny phrase or jingle in the message so that it is easy to remember and could potentially serve as a conversation starter for discussing safe sex with partners.

Ethnic Comparisons in HIV Testing Attitudes, HIV Testing, and Predictors of HIV Testing Among Black and White College Students.

OBJECTIVES: This study's primary aim was to examine ethnic differences in predictors of HIV testing among Black and White college students. We also examined ethnic differences in sexual risk behaviors and attitudes toward the importance of HIV testing. PARTICIPANTS/METHOD: An analytic sample of 126 Black and 617 White undergraduatestudents aged 18-24 were analyzed for a subset of responses on the American College Health Association-National College Health Assessment II (ACHA-NCHA II) (2012) pertaining to HIV testing, attitudes about the importance of HIV testing, and sexual risk behaviors. Predictors of HIV testing behavior were analyzed using logistic regression. t tests and chi-square tests were performed to access differences in HIV test history, testing attitudes, and sexual risk behaviors. RESULTS: Black students had more positive attitudes toward testing and were more likely to have been tested for HIV compared to White students. A greater number of sexual partners and more positive HIV testing attitudes were significant predictors of HIV testing among White students, whereas relationship status predicted testing among Black students. Older age and history of ever having sex were significant predictors of HIV testing for both groups. There were no significant differences between groups in number of sexual partners or self-reports in history of sexual experience (oral, vaginal, or anal). CONCLUSIONS: Factors that influence HIV testing may differ across racial/ethnic groups. Findings support the need to consider racial/ethnic differences in predictors of HIV testing during the development and tailoring of HIV testing prevention initiatives targeting college students.

Reducing disparities and achieving equity in African American women's health.

The colloquial phrase "Black Don't Crack" refers to perceptions of African American women retaining youthful features over time and seemingly defying the aging process. This conjecture appears to only be skin deep, as across almost every health indicator, African American women fare worse than women in other racial/ethnic groups. African American women experience excess morbidity in obesity, diabetes, and adverse birth outcomes, and are more likely than women of other ethnic groups to die from breast and cervical cancer, cardiovascular disease, and HIV/AIDS. This article provides an overview of social, biological, psychological, and cultural factors that contribute to African American women's health. Attention is directed to cultural factors that are both protective and risky for African American women's health. There is a need to garner a better understanding of the complex nature of health disparities experienced by African American women in order to move the field forward in making progress toward achieving health equity for this population. This article addresses this need and offers recommendations for translating science in this area into meaningful population level impact. (PsycINFO Database Record

Development and Validation of a Preliminary Measure of African American Women's Gender Role Beliefs.

Gender role beliefs of African American women differ from those of women in other ethnic/racial groups and a culturally valid measure of their gender role beliefs is needed. Three studies were conducted to develop a preliminary measure. In Study 1, focus groups were conducted with a community and college sample of 44 African American women. Transcripts reviewed resulted in an initial pool of 40 items. These items were reviewed by an expert panel and 18 items were retained. In Study 2, an exploratory factor analysis was computed with data from 94 African American female college students. The 18 items were included along with measures to assess convergent and discriminant validity. Nine items were retained. These nine items comprised two subscales labeled Agency and Caretaking. The scales demonstrated good internal consistency and convergent and discriminant validity. In Study 3, a confirmatory factor analysis was computed with a different sample of 184 African American female college students. The confirmatory factor analysis showed acceptable fit for the two-factor structure of Agency and Caretaking.

Racial comparisons in perceptions of maternal and peer attitudes, body dissatisfaction, and eating disorders among African American and White women.

Although once thought primarily to affect White women, body dissatisfaction and disordered eating exist among all racial groups. In the current study, the authors determined whether the relationship between participants' perceived maternal/peer attitudes toward appearance and the outcomes of body dissatisfaction and eating pathology varied by race. Self-reported data, including measures of body dissatisfaction, disordered eating behaviors, body mass index (BMI), and perceptions of maternal/peer attitudes, were collected from December 2012 to May 2013 at a large Mid-Atlantic university. BMI (ß = 0.20, p = .01), perceptions of peers' attitudes toward appearance (ß = 0.23, p = .02), and White race (ß = 0.33, p < .001) were independently associated with body dissatisfaction. Additionally, race interacted with perceptions of peers' attitudes toward appearance such that at high perceptions, African American women reported high levels of body dissatisfaction (ß = -0.20, p = .04), but this was not true for White women. Higher perceived peer concern about weight and shape (ß = 0.32, p < .001), increased BMI (ß = 0.30, p < .001), and White race (ß = 0.21, p = .002), also were associated with disordered eating. The results of this study have implications for prevention programs that address disordered eating for racially diverse groups of women.