Social Appearance Anxiety Scale: a psychometric investigation and evaluation of the influence of individual characteristics on social appearance anxiety in Brazilian adults who practice physical exercise.

Introduction: Evaluating signs of anxiety related to body appearance is becoming increasingly important in contemporary society and, in this sense, the Social Appearance Anxiety Scale (SAAS) seems an interesting alternative of measurement. Objectives: To evaluate the psychometric properties of the Portuguese version of the SAAS when applied to Brazilian adults who practice physical exercise and verify the influence of individual characteristics on participants' social appearance anxiety. Methods: This was a cross-sectional study conducted online. The participants completed the SAAS and a demographic questionnaire. The psychometric properties of the SAAS one-factor model were evaluated using confirmatory factor analysis. A structural model was built for men and women to verify the influence of individual characteristics of the participants on social appearance anxiety. Results: 1,495 individuals participated in the study (70.8% women; mean age = 29.5, SD = 8.9 years). The data obtained with the SAAS presented good indicators of validity and reliability for both genders (CFI > 0.97, TLI > 0.97, SRMR = 0.04, α > 0.97, ω > 0.85). For both men and women, greater levels of social appearance anxiety were observed among younger participants, who had a higher body mass index, self-reported an eating disorder, and perceived a change in their body after the onset of the COVID-19 pandemic. For women specifically, higher income and having started physical exercise more recently were associated with greater levels of social appearance anxiety. Conclusion: The findings supported the validity and reliability of the data obtained with the SAAS and revealed that when investigating social appearance anxiety in future research and clinical protocols, specific individual characteristics should be considered.

Effect of a Nutritional Behavioral Intervention on Intuitive Eating in Overweight Women With Chronic Kidney Disease.

OBJECTIVES: This study aimed to evaluate the impact of a nutritional behavioral intervention on intuitive eating (IE) scores of overweight non-dialysis-dependent women with chronic kidney disease and to investigate the relationship of IE scores with demographic, nutritional, and quality of life parameters in this group. DESIGN AND METHODS: This is a prospective noncontrolled clinical trial of a behavioral multisession group intervention for dietary management. Each group comprised five to eight participants in 14 weekly or biweekly sessions lasting about 90 minutes each. The IE principles were discussed during the meetings. The IE scale 2, translated and adapted to the study population, with a four-factor model was applied to assess IE attitudes. The 36-Item Short-Form Health Survey questionnaire was applied to assess health-related quality of life. RESULTS: Of the 33 patients who began participation in the study, 23 patients (median [interquartile range]: age = 62.0 years [58.0-68.0]; 52.2% with diabetes; body mass index = 32.6 kg/m2 [30.2-39.3]; estimated glomerular filtration rate = 28.0 mL/min/1.73 m2 [22.0-31.0]) completed the intervention. Except for the IE subscale Body-Food Choice Congruence, the IE total score and all its subscales (Unconditional Permission to Eat, Eating for Physical Rather than Emotional Reasons, Reliance on Hunger and Satiety Cues, and Body-Food Choice Congruence) improved after the intervention. In a cross-sectional analysis, more intuitive eaters were older and had better scores for health-related quality of life. CONCLUSIONS: The nutritional behavioral intervention embracing IE principles was effective to improve IE attitudes for this group of chronic kidney disease patients. These results are promising and may contribute to a paradigm change in the strategies to enhance motivation and adherence to dietary recommendations in this population.

Brazilian Adults' Attitudes and Practices Regarding the Mandatory COVID-19 Vaccination and Their Hesitancy towards Childhood Vaccination.

BACKGROUND: This study investigated the attitudes and practices of Brazilian adults regarding the mandatory COVID-19 vaccination and their hesitancy towards the vaccination of children. METHODS: Between March and May 2022, Brazilian adults answered an online questionnaire distributed through social media. The SAGE-WG questionnaire was adapted to measure hesitancy to the vaccination of children. RESULTS: Of the 1007 participants, 67.4% believed that adult COVID-19 vaccination should be mandatory. Just over half of the participants (51.5%) believed that parents and/or guardians should decide if their children should be vaccinated against COVID-19 or not and 9.1% were unsure. Individuals who were younger, non-religious and had higher awareness of COVID-19 risks and critics of the federal government's performance in combating the pandemic were more likely to agree with mandatory adult vaccination. However, less agreement among parents and/or guardians concerning children's vaccination was observed, with lower scores for hesitancy to the vaccination of children. CONCLUSION: In Brazil, there is still far from a consensus on mandatory COVID-19 vaccination for adults and a significant proportion of the population believes that parents and/or guardians should be free to decide on their children's vaccination. These views are associated with age, religion, knowledge of COVID-19 risks and political inclination.

Investigating method effects associated with the wording direction of items of the Social Physique Anxiety Scale.

PURPOSE: The use of psychometric instruments to measure latent concepts is common. The development of these instruments usually involves mechanisms to reduce response bias, such as the inclusion of reversed items. The aim of this study was to investigate method effects related to the wording direction of the Social Physique Anxiety Scale (SPAS) items, a one-dimensional instrument that assesses individual's level of anxiety when others observe their body. METHODS: In total, 152 Brazilian adults (65.8% female) answered 2 formats of the SPAS: the original with 12 items (7 regular and 5 reversed); and a new format with all items written in the same direction (i.e., regular). Both formats were filled out at different times and alternately. Differential item functioning analysis (DIF) and confirmatory factor analysis were conducted. RESULTS: The original SPAS did not fit the data, but after allowing covariances between all reversed items, the fit improved. The wording effect was supported by the DIF, indicating a better fit to the data for the new format with all items worded in the same direction. CONCLUSION: The wording of the SPAS items had effect on the psychometric properties of instrument. When the wording of the reversed items was modified, the factor model fitted the data. Future studies should take these findings into account and evaluate the SPAS with all items worded in the same direction in different contexts. LEVEL OF EVIDENCE: Descriptive (cross-sectional) study, Level V.

Cross-cultural adaptation and psychometric assessment of the Portuguese language version of the Eating and Appraisal due to Emotions and Stress (EADES) Questionnaire in Brazilian adults.

PURPOSES: To develop a Brazilian Portuguese version of the Eating and Appraisal due to Emotions and Stress (EADES) Questionnaire and estimate the psychometric properties of the EADES factorial model for young Brazilian adults and also to assess the association between EADES factors and age, body mass index (BMI), and economic level. METHODS: The cross-cultural adaptation was performed using a standardized protocol. The psychometric properties were assessed separately for each sex. A structural model for each sex was developed to investigate the influence of age, economic level, and BMI on the EADES factors. RESULTS: A total of 1240 participants completed the study [65.8% female, mean age 23.91 (SD = 5.03) years]. The EADES original factorial model did not present good psychometric properties. Then, a factorial model proposed for a Mexican sample was tested and a different model was fitted for each sex. The results showed that younger women have lower self-efficacy and self-confidence and poorer assessment of resources and coping skills. Women with a higher economic level have lower self-efficacy. Higher BMI was associated with lower self-efficacy and self-confidence in both sexes. Younger men have lower self-efficacy and poorer assessment of resources and coping skills. CONCLUSIONS: The Brazilian Portuguese version of the EADES provided valid and reliable data after refinement, and a different model was fitted for each sex. Sex, age, BMI, and economic level were significantly associated with the EADES factors. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Brazilian Portuguese versions and cross-cultural adaptation of two instruments to assess knowledge, attitude, and practice regarding the COVID-19 pandemic in the Brazilian population.

INTRODUCTION: Studies based on knowledge, attitude, and practice (KAP) theory are conducted to identify ways to improve strategies aimed at preventing and combatting certain conditions or diseases, to understand the way how behavioral changes are assimilated by the populations, and to reorient interventions. In view of the coronavirus disease 2019 (COVID-19) pandemic, studies based on KAP theory have been useful to better understand certain behaviors, such as adherence to prevention measures and control of the spread of the virus. OBJECTIVE: To describe the process of cross-cultural adaptation of two complementary instruments for assessing KAP regarding the COVID-19 pandemic in the Brazilian population. METHODS: Two independent translators proposed a first Brazilian Portuguese version of the scales. The cultural adaptation and pre-test of the Brazilian Portuguese versions occurred at different stages, using a panel of specialists and a subsample of the target population, respectively. RESULTS: The pre-test of the adapted instruments involved 30 Brazilian adults (mean age = 41.8 years; standard deviation = 4.24) and was carried out to assess instrument understanding and applicability. The participants informed they did not have difficulties to self-complete the instruments and reported a high level of clarity and understanding. CONCLUSION: Both instruments can bring an opportunity to study behavioral constructs about COVID-19 in the Brazilian population, aiming to articulate strategies that enable the fulfillment of effective preventive measures.

Examination of the factorial model of a scale developed to assess body satisfaction in the Brazilian context: a study with people 18 to 40 years old.

PURPOSE: Confirmatory factor analysis was employed to investigate an instrument developed to assess body satisfaction of Brazilian women and men and to identify participants' body satisfaction level. METHODS: Brazilian young adults completed the Body Satisfaction Situational Scale and a sociodemographic questionnaire. A total of 1481 individuals (female = 1035; male = 446) aged between 18 and 40 years old participated in the study. Factorial, convergent and discriminant validity and reliability were evaluated. An invariance test was performed across sexes using multi-group analysis. The prevalence of body satisfaction among participants was calculated using the final models of the instrument. RESULTS: The complete model of the scale (23 items and four factors) was invariant across sexes, but it did not fit the samples even after refinement. Therefore, a theoretical investigation of the scale content was performed based on literature. Thus, a reduced model composed of two factors and ten items was found for each sex. These models showed good validity and reliability to independent samples. About prevalence, most of the women were not at all satisfied with body fat and most of the men were slightly satisfied with body musculature. Further, women and men were moderately satisfied with their face, hair, and skin. CONCLUSION: A reduced model of the instrument for women and another for men showed adequate indices of construct validity and reliability to samples. The most participants were not very satisfied with their bodies. The results can be useful to develop protocols aiming to promote body satisfaction. LEVEL OF EVIDENCE: Level V, descriptive cross-sectional study.

Psychometric characteristics of the Three-Factor Eating Questionnaire-18 and eating behavior in undergraduate students.

PURPOSE: To assess the psychometric characteristics of the Three-Factor Eating Questionnaire-18 (TFEQ-18) and to estimate the prevalence of cognitive restraint (CRes), uncontrolled eating (UE), and emotional eating (EE) among Brazilian undergraduate students. METHODS: A total of 775 students completed TFEQ-18 (62.1% females; total mean age = 20.9 years [SD = 2.8]; females mean age: 20.8 years [SD = 2.8]; males mean age: 21.2 years [SD = 2.7]). Total sample was randomly separated in test/validation samples. An assessment of psychometric characteristics was conducted to each subsample with confirmatory factor analysis considering the indices: chi-square per degree of freedom ratio (χ2/df), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), and Root Mean Square Error of Approximation (RMSEA). The mean score of each TFEQ-18 factor was estimated. The prevalence of CRes, UE, and EE was calculated with 95% confidence intervals (95%CI) and compared by sex and weight status. RESULTS: The psychometric characteristics of the TFEQ-18 were adequate in both samples (test/validation: χ2/df = 3.58/2.86; CFI = 0.938/0.958; TLI = 0.928/0.951; RMSEA = 0.081/0.069). The prevalence of students with moderate to exacerbated scores of CRes, UE, and EE was 34.4% (95%CI 31.1-37.7%), 35.6% (95%CI 32.2-39.0%), and 43.1% (95%CI 39.6-46.6%), respectively. There were no statistically significant differences in prevalence according to sex or weight status. CONCLUSIONS: The TFEQ-18 presented adequate psychometric characteristics and indicated a high prevalence of CRes, UE, and EE among the students. This research emphasizes the importance of investigating aspects of eating behavior to best direct clinical and educational strategies for reducing the risk of adopting unhealthy eating behaviors among undergraduate students. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

A psychometric investigation of Brazilian Portuguese versions of the Caregiver Eating Messages Scale and Intuitive Eating Scale-2.

The Caregiver Eating Messages Scale (CEMS) was developed to assess perceived restrictive or critical caregiver messages in relation to food intake and pressure to eat, whereas the Intuitive Eating Scale-2 (IES-2) measures one's tendency to follow internal cues of hunger and satiety when making eating-related decisions. Both scales are useful in the arsenal of eating behaviour scholars. Here, we developed Brazilian Portuguese translations of both scales and assessed their psychometric properties in Brazilian adults. A total of 288 participants (men = 52.8%) completed the CEMS, IES-2, Body Appreciation Scale (BAS), and a demographic questionnaire. The results of confirmatory factor analysis indicated that the factor structure of both scales had adequate fit following the elimination of items and addition of covariances. Evidence of adequate factorial, convergent and discriminant validity, as well as reliability was identified. Furthermore, correlations of CEMS and IES-2 with BAS scores and body mass index were obtained. Both instruments' models were found to be invariant across sex, with men having significantly higher scores on three subscales of the IES-2 only. These results provide evidence for the psychometric properties of the CEMS and IES-2 in Brazilian Portuguese-speaking adults.Level of Evidence: V, cross-sectional descriptive study.

Body Image Quality of Life Inventory: cross-national study in college students from four different countries.

PURPOSE: This study was aimed to examine the psychometric proprieties of the Body Image Quality of Life Inventory (BIQLI) among Brazilian, Portuguese, Mozambican, and Italian college students. METHODS: A total of 1630 subjects (Brazilians = 446; Portuguese = 480, Mozambicans = 360, and Italians = 344) completed the Portuguese (Brazilian, Portuguese, and Mozambican students) and the Italian versions (Italian students) of the BIQLI for measuring the effects of body image on one's quality of life. Psychometric testing included confirmatory factor analysis (CFA), discriminant and convergent validity, internal consistency, and composite reliability. The cross-national invariance of the BIQLI was assessed by multi-group analysis using ΔCFI. Moreover, the global score of the BIQLI for all countries was calculated by an algorithm and compared using the Welch's ANOVA and the Games-Howell post-test (α = 5%). RESULTS: CFA showed an inadequate fit of unifactorial model of the BIQLI. Therefore, an alternative model comprising nine first-order factors and one second-order factor was proposed and evaluated. This new model showed adequate fit in all samples, despite some limitations that were found with respect to its convergent and discriminant validity. The alternative BIQLI model was invariant among countries. Global scores for the influence of body image on quality of life were significantly different across countries, with the Italians presenting the lowest scores. CONCLUSIONS: The BIQLI factorial model found in this study represents a reliable and valid alternative to its original structure for the assessment of the effect of body image on college students' perceived quality of life. This model must be further tested in other populations. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

The Body Shape Questionnaire Is Not Invariant Across Sex: Evidence From Portuguese-Speaking University Students.

The Body Shape Questionnaire (BSQ) is a widely used measure of body shape concerns that was originally designed for use with women but has more recently been used with boys and men. The latter use may be problematic, given that no previous study has demonstrated sex invariance for BSQ scores. To determine the extent to which BSQ scores are sex invariant, we asked Portuguese-speaking women ( n = 1,613) and men ( n = 871) to complete the full BSQ (34 items). Confirmatory factor analysis indicated that a hypothesized 32-item model of BSQ scores and shorter versions had acceptable fit indices in women and men, separately. However, multigroup confirmatory factor analysis showed that these BSQ model scores had configural but not metric, scalar, or strict sex invariance. Differential item analysis indicated significant item-functioning differences on 19 of the 32 retained BSQ items. Thus, BSQ scores are not sex invariant, making problematic the results of previous studies that have compared latent BSQ scores across sex.

Male body dissatisfaction scale (MBDS): proposal for a reduced model.

AIMS: To evaluate the psychometric properties of the male body dissatisfaction scale (MBDS) in Brazilian and Portuguese university students; to present a reduced model of the scale; to compare two methods of computing global scores for participants' body dissatisfaction; and to estimate the prevalence of participants' body dissatisfaction. METHODS: A total of 932 male students participated in this study. A confirmatory factor analysis (CFA) was used to assess the scale's psychometric properties. Multi-group analysis was used to test transnational invariance and invariance in independent samples. The body dissatisfaction score was calculated using two methods (mean and matrix of weights in the CFA), which were compared. Finally, individuals were classified according to level of body dissatisfaction, using the best method. RESULTS: The MBDS model did not show adequate fit for the sample and was, therefore, refined. Thirteen items were excluded and two factors were combined. A reduced model of 12 items and 2 factors was proposed and shown to have adequate psychometric properties. There was a significant difference (p < 0.001) between the methods for calculating the score for body dissatisfaction, since the mean overestimated the scores. Among student participants, the prevalence of body dissatisfaction with musculature and general appearance was 11.2 and 5.3%, respectively. CONCLUSIONS: The reduced bi-factorial model of the MBDS showed adequate validity, reliability, and transnational invariance and invariance in independent samples for Brazilian and Portuguese students. The new proposal for calculating the global score was able to more accurately show their body dissatisfaction. No level of evidence Basic Science.

Validation of the Weight Concerns Scale Applied to Brazilian University Students.

The aim of this study was to evaluate the validity and reliability of the Portuguese version of the Weight Concerns Scale (WCS) when applied to Brazilian university students. The scale was completed by 1084 university students from Brazilian public education institutions. A confirmatory factor analysis was conducted. The stability of the model in independent samples was assessed through multigroup analysis, and the invariance was estimated. Convergent, concurrent, divergent, and criterion validities as well as internal consistency were estimated. Results indicated that the one-factor model presented an adequate fit to the sample and values of convergent validity. The concurrent validity with the Body Shape Questionnaire and divergent validity with the Maslach Burnout Inventory for Students were adequate. Internal consistency was adequate, and the factorial structure was invariant in independent subsamples. The results present a simple and short instrument capable of precisely and accurately assessing concerns with weight among Brazilian university students.

Confirmatory factor analysis of different versions of the Body Shape Questionnaire applied to Brazilian university students.

This study aimed at evaluating the validity, reliability, and factorial invariance of the complete (34-item) and shortened (8-item and 16-item) versions of the Body Shape Questionnaire (BSQ) when applied to Brazilian university students. A total of 739 female students with a mean age of 20.44 (standard deviation=2.45) years participated. Confirmatory factor analysis was conducted to verify the degree to which the one-factor structure satisfies the proposal for the BSQ's expected structure. Two items of the 34-item version were excluded because they had factor weights (λ)<40. All models had adequate convergent validity (average variance extracted=.43-.58; composite reliability=.85-.97) and internal consistency (α=.85-.97). The 8-item B version was considered the best shortened BSQ version (Akaike information criterion=84.07, Bayes information criterion=157.75, Browne-Cudeck criterion=84.46), with strong invariance for independent samples (Δχ(2)λ(7)=5.06, Δχ(2)Cov(8)=5.11, Δχ(2)Res(16)=19.30).