A Systematic Review and Revised Meta-analysis of the Effort-Reward Imbalance Model of Workplace Stress and Hypothalamic-Pituitary-Adrenal Axis Measures of Stress.

OBJECTIVE: Despite considerable research in the past 20 years into associations between the effort-reward imbalance (ERI) model and various health outcomes, the mechanisms responsible for the association remain unclear. Our meta-analysis assessed the associations of ERI and overcommitment (OC) in the workplace with measures from the hypothalamic-pituitary-adrenal (HPA) axis. METHODS: Electronic databases were searched with the phrase "effort * reward * imbalance," which yielded 319 studies leading to 56 full-text studies being screened. Thirty-two studies within 14 articles met the inclusion criteria and were meta-analyzed using mixed- and random-effects models. RESULTS: Greater ERI was associated with increased HPA axis activity (r = 0.05, p = .02, k = 14, n = 2461). The cortisol waking concentrations (r = 0.11, p = .02, k = 6, n = 493) were the only subgroup associated with ERI. Meta-regression revealed that studies that contained more men had stronger ERI to HPA marker associations. When all HPA markers were considered collectively, OC was not associated with greater HPA axis activity (r = 0.01, p = .70, k = 10, n = 1684), with only cortisol (pm) associated with OC (r = -0.24, p = .02, k = 2, n = 95). CONCLUSIONS: ERI and OC were associated with HPA responsivity. Although the cortisol waking concentrations and not the CAR were associated with ERI, this may be due to heterogeneity in the experience of stress between studies. Future studies should consider the concurrent assessment of burnout to better assist the interpretation of ERI with HPA responsivity.

#Bopo: Enhancing body image through body positive social media- evidence to date and research directions.

Body positive content aims to disrupt the monopoly of idealized appearance-focused media and encourage individuals to adopt a positive stance towards their body by increasing diversity and inclusiveness and rejecting harmful appearance ideals. This paper provides an historical context for the body positivity movement, discusses the presence and characteristics of the online body positivity movement, presents evidence of its relationship to body image, and finally offers directions for future research. Findings provide initial support for the potential for body positive social media content to be beneficial for body image, and lower state appearance comparison has received support as a mechanism underpinning these effects. However, efforts to identify individual-level moderators have met with less success, and the research is somewhat confined to comparative effects with idealized social media content, and young women. Additional work to bridge the gaps in the extant data is needed. In particular, expanding the understanding of which types of body positive social media content can be most helpful to both prevent and decrease body image concerns and promote positive body image using a layered lens that considers the interactions of the individual, their context, and the type of body positive social media content will be most fruitful.

Young adult mental health sequelae of eating and body image disturbances in adolescence.

OBJECTIVE: There has been interest in the antecedents and mental health impacts of eating and body image disturbances in adolescence. Less is known about longer-term mental health impacts into young adulthood, as longitudinal studies with data spanning this developmental period are rare. We capitalize on mental health data collected across adolescence and young adulthood from a population-based cohort study that has been following >2000 Australian children and their families from infancy to young adulthood. METHOD: This sample comprised 1,568 participants who completed the Eating Disorder Inventory drive for thinness and bulimic behavior (the severity of binge-purge patterns) subscales, and a modified version of the body dissatisfaction subscale in mid-adolescence (15-16 years), or the Depression Anxiety Stress Scales in young adulthood (19-20, 23-24, and 27-28 years). RESULTS: After adjusting for baseline demographic and prior mental health factors (<13 years of age), all three indices of eating and body image disturbances in adolescence predicted each mental health outcome in young adulthood. Mental health risks associated with adolescent body dissatisfaction and bulimic behavior scores remained stable across young adulthood, with men having more pronounced problems associated with bulimic behavior scores than women. In contrast, mental health risks associated with adolescent drive for thinness scores diminished across this period similarly for men and women. DISCUSSION: Findings suggest that adolescent eating and body image disturbances may have long-term mental health impacts that extend into young adulthood. This underscores the need for early preventative intervention, and longer-term monitoring and support for body image and eating disturbances.

#Take idealized bodies out of the picture: A scoping review of social media content aiming to protect and promote positive body image.

Much evidence has highlighted detrimental effects of social media on body image, and attention has turned towards identifying content that could support and promote positive body image. This study aimed to conduct a scoping review of the emerging evidence focused on social media content that might support positive body image. A total of n = 35 studies (21 experimental) examining social media were identified along with n = 11 studies not specifically focusing on social media but with clear implications. Overall, findings suggest that images that do not portray individuals are most helpful for body image, as well as those portraying appearances diverging from appearance ideals. Our review also identifies types of social media content that have so far not been found to protect body image, and those not sufficiently evaluated. Regarding textual captions and comments, the most promising avenue involves highlighting the contrived and unrealistic nature of social media content. However, empirical data are limited and not robust. Body acceptance-related statements have so far not been found to be helpful for body image, and findings regarding the usefulness of using social marketing strategies (such as hashtags) to identify content that may be more realistic is nascent and conflicted.

Maternal influences on body image and eating concerns among 7- and 8-year-old boys and girls: Cross-sectional and prospective relations.

OBJECTIVE: Little is known regarding maternal influences on the body image and eating concerns of young children. The current study aimed to examine the cross-sectional and longitudinal relationships between maternal comments about their child's weight and shape and eating, and mothers' own body dissatisfaction and disordered eating on one hand, and their children's body esteem and disordered eating behaviors on the other. METHOD: Children, n = 244 of the fifth wave, aged 7 years (58% female), and n = 194 of the sixth wave, aged 8 years (57% female), of the longitudinal Children's Body Image Development Study, in Melbourne, Australia were included. Mothers completed measures of body dissatisfaction, dietary restraint, and comments and concerns regarding their children's weight and eating behaviors. They also reported on their children's disordered eating behaviors. Children's body esteem was assessed through a child interview. RESULTS: Findings revealed cross-sectional and prospective bivariate relationships between maternal comments and disordered eating behaviors among both boys and girls. Similar patterns of relationships emerged between maternal body dissatisfaction and lower child body esteem. CONCLUSION: Findings highlight the importance of conducting prevention within the family environment from a young age, and targeting both direct communication as well as parental body image and eating behaviors.

Effects of thin-ideal instagram images: The roles of appearance comparisons, internalization of the thin ideal and critical media processing.

Recent research has pointed to potential negative effects on young women of using social networking sites. We examined whether exposure to thin-idealised images of users' bodies, typical of those posted on Instagram, would result in changes in state mood and body dissatisfaction. We further examined women's reported thoughts when viewing such images to explore qualitatively their cognitive experiences. Female participants (N = 126) reported on trait body dissatisfaction and body comparison, and state body dissatisfaction and mood, and were randomly assigned to view and describe their thoughts about either images depicting the Western thin-ideal or control images (scenery). The control sample increased mood and decreased body dissatisfaction more than thin-ideal participants following exposure, with only marginal moderating effects of trait appearance comparison and internalization of the thin-ideal. In a sample that viewed the thin-ideal images (n = 91) upward body comparison thoughts and positive thoughts related to the bodies depicted were associated with negative mood changes. Media awareness and literacy thoughts were not protective; however, thoughts unrelated to the thin-ideal bodies were protective. Findings suggest that while young women appeared largely resilient to short-term exposure to Instagram images of thin-idealized peers, a subset of women appeared to be at risk.

A qualitative, prospective study of children's understanding of weight gain.

This study examined 3- to 5-year-old children's understandings of increases in body size via a qualitative prospective approach. A sample of 259 children (55.2% girls) was interviewed at 3, 4, and 5 years old. Participants were shown an average and a larger size figure of a child of their gender and age. Responses to 'Why do you think the boy/girl got bigger here?' were coded using thematic analysis. Diet was cited as a mechanism for increased body size by almost 50% of children referring to this by age 5. Few children mentioned physical activity. Responses suggesting that increases in body size had negative implications increased between ages 3 and 5. Awareness of associations between diet and weight gain emerges as young as 3 years old and increases over time, as do negative attitudes about weight gain. This age may be opportune for interventions targeting sustainable healthy behaviours. Statement of contribution What is already known on this subject? Even very young children present weight bias. Their understanding of the social messages regarding weight and shape increases with age. Older children present a partial understanding of how diet and physical activity are related to body size. What does this study add? Very young children's understandings of increases in body size were investigated. Eating and food-related mechanisms, as well as ageing, were salient. By age 5, over a third of children associated increases in body size with negative implications.

Low body esteem and dietary restraint among 7-year old children: The role of perfectionism, low self-esteem, and belief in the rewards of thinness and muscularity.

Body image concerns and dietary restraint have been shown to emerge among young children (aged 5 to 8 years). However, to date, little is known regarding the way in which individual characteristics and endorsement of sociocultural appearance ideals are associated with these concerns and behaviors in this age group. The aim of the current study was to examine perceived rewards of thinness and muscularity as a mediator of the relationships between personality traits (perfectionism and self-esteem), and body esteem and dietary restraint among 7-year-old children. Participants were 261 children, Mage (SD) = 7.46 (0.32), assessed during interview on a range of scales measuring variables of interest. Findings revealed that, with the addition of direct pathways leading to dietary restraint, the model was a good fit to the data. Furthermore, multi-group analyses revealed no gender differences. These results highlight the role of children's individual personality characteristics as well as the degree to which they uphold thin and muscular appearance ideals in body image and eating concerns in 7 year olds. Additional efforts should be made to engage this age group with prevention resources and to target personality characteristics as well as beliefs in the rewards of appearance ideals.

Dismantling prevention: Comparison of outcomes following media literacy and appearance comparison modules in a randomised controlled trial.

A dismantling study of body dissatisfaction prevention was conducted. Adolescent girls ( N = 260) were randomly allocated to a media literacy (Happy Being Me - Media Literacy) or appearance comparison (Happy Being Me - Appearance Comparison) intervention or healthy eating behaviour control (Happy Being Me - Healthy Eating Behaviour) condition. In the Happy Being Me - Appearance Comparison condition, improvements from baseline to post-programme and follow-up for upward appearance comparison and fear of negative appearance evaluation were observed. In the Happy Being Me - Media Literacy condition, improvements were observed from baseline to post-programme for upward appearance comparison and realism scepticism. Findings were similar in a high-risk subsample and overall are moderately supportive of appearance comparison-based interventions, but less supportive of a stand-alone media literacy intervention.

Trait Mindfulness Helps Explain the Relationships Between Job Stress, Physiological Reactivity, and Self-Perceived Health.

OBJECTIVE: The aim of this study was to assess, for the first time, the associations among work stress as measured by the job-demands resources (JD-R) model, trait mindfulness, and indices of the physiological stress response. METHOD: Dairy farmers (N = 79) completed job stress (using the JD-R model), trait mindfulness, burnout, and self-reported health questionnaires and provided physiological indices of the stress response. RESULTS: Our findings suggest that those reporting higher mindfulness have better physical and mental health, and that being more mindful may buffer the effects of a large cortisol awakening response on poor physical health. CONCLUSION: Although assessments of both psychological and physiological indicators of stress and ill-health will inform the underlying mechanisms of the associations between work stress and disease, assessing the role of trait mindfulness in this relationship may prove useful.

Psychological predictors of body image attitudes and concerns in young children.

We aimed to examine cross-sectional and longitudinal relationships between psychological characteristics, body size, and body image outcomes in 6- to 7-year-old children. Participants were 202 children (91 boys, 111 girls) assessed when 6 and 7 years old. Body image-related variables, body mass index, and psychological characteristics were assessed. Cross-sectionally in the total sample, lower self-esteem was associated with greater body dissatisfaction, internalization of appearance ideals, and rewards of muscularity. Greater perfectionism was associated with greater body dissatisfaction, dietary restraint, drive for muscularity, and rewards of thinness and muscularity. Prospectively, internalization and socially prescribed perfectionism at 6 predicted greater body dissatisfaction at 7; higher perfectionism predicted greater rewards of thinness; higher perfectionism and lower self-esteem predicted greater rewards of muscularity; and lower self-esteem and smaller perceived body size predicted higher internalization. Exploratory gender specific analyses suggest that self-esteem may play a greater role in the development of body image attitudes in girls than boys, while perfectionism appears to increase boys' vulnerability to perceive greater rewards from thinness. Findings support the inclusion of psychological characteristics in etiological models of early body image development, and highlight perfectionism, internalization of appearance ideals, and self-esteem as potential targets for preventative interventions in this age group.

Preferences for being muscular and thin in 6-year-old boys.

Body dissatisfaction emerges at an early age in childhood. However, the unique experiences of young boys regarding muscularity have not been examined. Interview responses were collected from 101 6-year-old boys to examine muscularity- and thinness-oriented body dissatisfaction. Both muscularity- and thinness-oriented body dissatisfaction were evident; boys on average selected ideal figure sizes significantly more muscular and significantly thinner than current figures. In addition, a significantly greater proportion of boys wanted to be more muscular (32.6%) than less muscular (16.8%), and thinner (20.8%) rather than larger-fatter (8.9%). Further, boys perceived significantly greater rewards from muscularity than from thinness. Findings demonstrate that muscularity and thinness-oriented body dissatisfaction is present in a substantial proportion of young boys, although a greater proportion are dissatisfied with muscularity than with thinness, suggesting that examination of body image in young boys needs to focus on muscularity dimensions as well as thinness-fatness dimensions.

The salivary alpha amylase awakening response is related to over-commitment.

We assessed the relationship between physiological and psychological measures of workplace stress as measured by the effort-reward imbalance (ERI) model, with a seldom studied sample of owner-operator dairy farmers. Dairy farmers (N = 74) self-reported ERI, over-commitment (OC), dedication, and health then provided awakening saliva samples that were used to calculate the salivary alpha amylase awakening response (sAA-AR), cortisol awakening response (CAR), and salivary immunoglobulin A (sIgA) level. ERI, OC, and dedication levels were not related with sIgA or the CAR, but more over-committed farmers had a less pronounced sAA-AR. OC was more associated than ERI with the physiological indicators of stress, potentially due to the owner-operator sample used in this investigation. The suitability of sAA as a viable physiological measure of autonomic nervous system activity has been debated, but our findings promote its inclusion in future occupational stress research.

Evaluation of an online self-help version of the REACH forgiveness program: Outcomes and predictors of persistence in a community sample.

OBJECTIVE: We evaluated outcomes of an online, self-directed REACH forgiveness intervention for community-based adults. Because many participants dropped out before program completion, predictors of program persistence were also examined. METHOD: Participants (N = 130 adults, 122 female; mean age 48) completed pretreatment assessment and were randomized to immediate treatment (IT) or delayed treatment (DT). Twenty-three IT and 13 DT participants completed the 7-hour REACH forgiveness modules and postintervention assessment; 32 participants completed 3-month follow-up. RESULTS: The IT group reported greater postintervention improvements in overall forgiveness and emotional forgiveness, as well as reductions in avoidance motivations with large effect sizes and, marginally, state empathy; but revenge motivations, decisional forgiveness, and well-being indicators did not change. Most postintervention improvements were maintained at 3-month follow-up. In this online intervention, persistence was predicted by perspective taking, willingness to forgive the offender, and conscientiousness. Three-month follow-up supported maintenance of gains, particularly in overall and emotional forgiveness, and increases in trait forgiveness compared to pretreatment. CONCLUSION: An online self-directed version of REACH forgiveness applied in a community sample has potential for improving forgiveness-related responses, particularly those involving emotional forgiveness. However, methods to increase program persistence and target suitable recipients need development.

A Systematic Review and Meta-analysis of the Effort-Reward Imbalance Model of Workplace Stress and Hypothalamic-Pituitary-Adrenal Axis Measures of Stress.

OBJECTIVE: The association between effort-reward imbalance (ERI) and various health outcomes has been well documented over the past 20 years, but the mechanisms responsible for this association remain unclear. The present meta-analysis assessed the associations of ERI and overcommitment (OC) in the workplace with hypothalamic-pituitary-adrenal (HPA) axis measures. METHODS: Electronic databases were searched with the phrase "effort*reward*imbalance," which yielded 319 studies leading to 56 full-text studies being screened. Thirty-two studies within 14 articles met inclusion criteria and were meta-analyzed using mixed and random effects models. RESULTS: Greater ERI was associated with increased HPA axis activity (r = .09, p < .001, k = 14, N = 2541). The cortisol awakening response (r = .14, p < .001, k = 9, N = 584) and cortisol waking concentrations (r = .12, p = .01, k = 6, N = 493) were the only HPA measures associated with ERI. OC was also associated with greater HPA axis activity (r = .06, p < .01, k = 10, N = 1918). Cortisol (PM) (r = .13, p = .02, k = 3, N = 295) was the only HPA measure associated with OC. CONCLUSIONS: ERI and OC were similarly related with HPA responsivity. However, because OC moderated the relationship between ERI and HPA axis markers, the importance of OC should not be overlooked. Because OC is likely more malleable than ERI to intervention, this may be a promising avenue for future research.

Associations between the effort-reward imbalance model of workplace stress and indices of cardiovascular health: A systematic review and meta-analysis.

Work stress can increase the risk of cardiovascular disease by 50%, with increasing research focusing on the underlying mechanisms responsible for these associations. Our meta-analysis assessed the associations of the effort-reward imbalance (ERI) workplace stress model with indices of cardiovascular disease. The search term 'effort*reward*imbalance' produced 22 papers (129 associations, N=93,817) meeting inclusion criteria. Greater ERI was most associated with increased hypertension (r=0.26, p<0.001, N=1180), intima media thickness (r=0.23, p<.001, N=828) and fibrinogen (r=0.13, p=0.03, N=4315). Trait over-commitment was most associated with increased hypertension (r=0.24, p=0.02, N=899) and intima media thickness (r=0.19, p=0.02, N=828). Interventions aimed at reducing the impact of ERI and over-commitment on cardiovascular disease should consider concurrently assessing changes in physiological markers of cardiovascular disease.

Media exposure in very young girls: Prospective and cross-sectional relationships with BMIz, self-esteem and body size stereotypes.

Media exposure among young children has been suggested to influence self-concept and the adoption of social stereotypes regarding body weight, as well as being associated with increased weight. The aim of this study was to examine the role of TV/DVD viewing in the development of positive stereotypes toward thinness, self-esteem and body mass index standardized for child age and gender (BMIz) in very young girls. A sample of 143 girls completed interviews at ages 3, 4, and 5 years old. The interviews assessed positive stereotypes about thinness among girls, as well as age 5 dietary restraint. Parents reported on their daughters' self-esteem and TV/DVD viewing. Objective height and weight were obtained for the children. A cross-lagged model exploring TV/DVD viewing as a predictor of lower self-esteem, greater BMIz, and endorsement of positive stereotypes about thinness was tested, including dietary restraint as an outcome at age 5. Findings revealed partial support for the theoretical model, with relationships emerging most strongly between the ages of 4 and 5 years old. Greater TV/DVD viewing was weakly related to greater endorsement of positive stereotypes about thinness between ages 3 and 4. In addition, greater TV/DVD viewing at age 4 predicted BMIz increases at age 5, as well as greater dietary restraint. Our results suggest that the impact of media exposure on body image and weight-related variables may start at a very early age. Findings contribute to the body of literature suggesting that early childhood may be an important developmental period for media exposure. (PsycINFO Database Record

Investigating Direct Links between Depression, Emotional Control, and Physical Punishment with Adolescent Drive for Thinness and Bulimic Behaviors, Including Possible Moderation by the Serotonin Transporter 5-HTTLPR Polymorphism.

Objectives: To examine the relationship between psychological and social factors (depression, emotional control, sexual abuse, and parental physical punishment) and adolescent drive for Thinness and Bulimic behaviors in a large community sample, and to investigate possible genetic moderation. Method: Data were drawn from the Australian Temperament Project (ATP), a population-based cohort study that has followed a representative sample of 2443 participants from infancy to adulthood across 16 waves since 1983. A subsample of 650 participants (50.2% female) of Caucasian descent who provided DNA were genotyped for a serotonin transporter promoter polymorphism (5-HTTLPR). Adolescent disordered eating attitudes and behaviors were assessed using the Bulimia and Drive for Thinness scales of the Eating Disorder Inventory-2 (15-16 years). Depression and emotional control were examined at the same age using the Short Mood and Feelings Questionnaire, and an ATP-devised measure of emotional control. History of sexual abuse and physical punishment were assessed retrospectively (23-24 years) in a subsample of 467 of those providing DNA. Results: EDI-2 scores were associated with depression, emotional control, and retrospectively reported parental physical punishment. Although there was statistically significant moderation of the relationship between parental physical punishment and bulimic behaviors by 5-HTTLPR (p = 0.0048), genotypes in this subsample were not in Hardy-Weinberg Equilibrium. No other G×E interactions were significant. Conclusion: Findings from this study affirm the central importance of psychosocial processes in disordered eating patterns in adolescence. Evidence of moderation by 5-HTTLPR was not conclusive; however, genetic moderation observed in a subsample not in Hardy-Weinberg Equilibrium warrants further investigation.

A pilot evaluation of a social media literacy intervention to reduce risk factors for eating disorders.

OBJECTIVE: This pilot study investigated the effectiveness of a social media literacy intervention for adolescent girls on risk factors for eating disorders. METHOD: A quasi-experimental pre- to post-test design comparing intervention and control conditions was used. Participants were 101 adolescent girls (Mage = 13.13, SD = 0.33) who were allocated to receive three social media literacy intervention lessons (n = 64) or to receive classes as usual (n = 37). Self-report assessments of eating disorder risk factors were completed one week prior to, and one week following the intervention. RESULTS: Significant group by time interaction effects revealed improvements in the intervention condition relative to the control condition for body image (body esteem-weight; d = .19), disordered eating (dietary restraint; d = .26) and media literacy (realism scepticism; d = .32). DISCUSSION: The outcomes of this pilot study suggest that social media literacy is a potentially useful approach for prevention of risk for eating disorders in adolescent girls in the current social media environment of heightened vulnerability. Replication of this research with larger, randomized controlled trials, and longer follow-up is needed.