Associations Between Problematic Internet Use and Mental Health Outcomes of Students: A Meta-analytic Review.

The increasing prevalence of problematic internet use has heightened concerns about its adverse impact on internet users' mental health. Despite reviews investigating the associations between problematic internet use and mental health outcomes, there is a lack of understanding of various aspects of students' mental health. This study aimed to bridge this gap by providing a more comprehensive overall picture of this issue through a quantitative synthesis based on three-level random-effects meta-analytic models. In total, 223 studies with a cumulative total of 498,167 participants and 512 effect sizes were included in this synthesis. The results showed that problematic internet use was moderately and positively associated with depressive symptoms, anxiety, loneliness, and other mental health outcomes, and negatively related to subjective well-being. Moderator analyses revealed that several study features (i.e., school grade, region, measure of problematic internet use, publication year, and gender) could explain the variations in the findings across individual studies. These research results provide solid evidence for the link between problematic internet use and different mental health outcomes and have implications for future research and interventions on students' problematic internet use. Supplementary Information: The online version contains supplementary material available at 10.1007/s40894-022-00201-9.

Validation of the Chinese Version of the Body Image Acceptance and Action Questionnaire and the Mediating Role of Body Image Flexibility in the Relationship Between Body Dissatisfaction and Psychological Distress.

The psychometric properties of the Chinese version of the Body Image Acceptance and Action Questionnaire (C-BI-AAQ) and its short form (C-BI-AAQ-5) were examined with a sample of Chinese undergraduates (n =1,068, 52.6% female). The factor structure, measurement reliability, measurement invariance across gender, and latent gender mean difference of the two scales were explored. Confirmatory factor analysis was used to examine the factor structure of the C-BI-AAQ and the C-BI-AAQ-5. The original one-factor structure was replicated for both the C-BI-AAQ and the C-BI-AAQ-5. Both the C-BI-AAQ and C-BI-AAQ-5 showed good internal consistency, test-retest reliability, and convergent and discriminant validity (e.g., relationship patterns in the expected directions with theoretically similar psychological flexibility, and with theoretically dissimilar body dissatisfaction, and psychological distress). The C-BI-AAQ-5 was shown to be equivalent to the C-BI-AAQ. Furthermore, strict measurement invariance across gender was confirmed for both the C-BI-AAQ and C-BI-AAQ-5, and latent mean difference tests showed that men had higher levels of body image flexibility than women. Thus, both the C-BI-AAQ and C-BI-AAQ-5 appear to be psychometrically sound instruments for use in the Chinese young adult population. In addition, body image flexibility measured by both the C-BI-AAQ and the C-BI-AAQ-5 fully mediated the relationship between body dissatisfaction and psychological distress.

Validation of the 12-item Short Form of the Eating Disorder Examination Questionnaire in the Chinese context: confirmatory factor analysis and Rasch analysis.

PURPOSE: As a 12-item Short Form of the Eating Disorder Examination Questionnaire (EDE-QS), the EDE-QS was developed based on Rasch modeling to address certain weaknesses of the EDE-Q, and it has been demonstrated to be a psychometrically sound measure. Thus, the current study aimed to obtain a Chinese version of the EDE-QS and validate its psychometric properties in the Chinese context. METHODS: According to standard procedures, the Chinese version of the EDE-QS (C-EDE-QS) was obtained. A total of 1068 Chinese college students finished the survey. The psychometric properties of the C-EDE-QS were examined under the frameworks of both classic test theory and Rasch modeling. RESULTS: The one-factor structure of the C-EDE-QS was confirmed in confirmatory factor analysis; the C-EDE-QS showed good reliability with a Cronbach's α of 0.89; and the total scores of the C-EDE-QS were significantly correlated with eating disturbances and psychological distress in expected magnitudes and directions. Rasch analysis supported the unidimensional construct of the C-EDE-QS and the four-point rating scale structure. However, results revealed differential item functioning (DIF) across gender groups. CONCLUSIONS: The findings suggest that the C-EDE-QS could be a useful tool to assess key attitudes and behavioral features of eating disorder psychopathologies in the Chinese context. LEVEL OF EVIDENCE: V, descriptive (cross-sectional) study.

Revisiting the relationship between body dissatisfaction and eating disorder symptoms in Chinese adolescents: the mediating roles of regulatory emotional self-efficacy and depression symptoms.

PURPOSE: Even though many studies have investigated the relationship between body dissatisfaction and eating disorder symptoms, the relationship is still far from being clear, especially about what factors that could potentially mediate such relationship. This study aimed to examine the direct pathway in the relationship between body dissatisfaction and eating disorder symptoms, and possible mediation pathways between the two via regulatory emotional self-efficacy and depression symptoms. METHODS: A sample of 654 adolescents from central China completed questionnaires for a set of study variables. Modeling analysis was conducted that examined the direct pathway between body dissatisfaction and eating disorder symptoms, and the mediating roles of regulatory emotional self-efficacy and depression symptoms between these two constructs. Multi-group modeling analysis was conducted to assess model invariance across gender and age groups. RESULTS: The results showed that, in addition to the direct pathway between body dissatisfaction and eating disturbances, regulatory emotional self-efficacy and depression symptoms partially mediated the relationship between these two constructs. Results of multi-group invariance analysis showed that the mediation model was consistent across gender and age groups. DISCUSSION: These results indicated that management of regulatory emotional self-efficacy and appropriate intervention for depression could potentially buffer against the negative impact of body dissatisfaction on eating disorder symptoms. Finally, some potential clinical implications are discussed, and possible preventions for eating disorder symptoms are suggested. LEVEL OF EVIDENCE: V, Cross-sectional descriptive study.

Assessing Appetitive Traits Among Chinese Young Adults Using the Adult Eating Behavior Questionnaire: Factor Structure, Gender Invariance and Latent Mean Differences, and Associations With BMI.

The current study examined the factor structure, measurement reliability, measurement invariance across genders, and latent gender mean differences, of a new Chinese translation of the Adult Eating Behavior Questionnaire (C-AEBQ) in a Chinese young adult sample (n = 1,068, 52.57% women). The associations between the appetitive traits assessed by the AEBQ and body mass index were also explored. The previously established eight-factor model of the AEBQ was supported in the present sample. The C-AEBQ had strong measurement invariance between genders. Cronbach's alpha estimates of the eight subscales of the C-AEBQ ranged from 0.76 to 0.97, and the test-retest reliability coefficients of the subscales ranged from 0.50 to 0.77. The C-AEBQ had adequate convergent and divergent validity, as supported by the theoretically expected correlations between C-AEBQ and the Three-Factor Eating Questionnaire. Furthermore, Satiety Responsiveness, Slowness in Eating, and Food Fussiness were inversely associated with body mass index. Overall, the C-AEBQ appears to be a psychometrically sound instrument as a comprehensive measure for appetitive traits for Chinese young adults.

Obesity as a "self-regulated epidemic": coverage of obesity in Chinese newspapers.

OBJECTIVE: The aim of this study was to investigate how obesity was covered in Chinese newspapers from 1999 to 2018, demonstrating the trends and the characteristics of obesity-related news. METHODS: Content analysis was conducted to analyze a total of 358 news articles spanning two decades (1999-2018). We explored how Chinese newspapers portrayed obesity in terms of the evidence/sources cited in articles, its impacts, drivers/causes, and solutions; and how such portrayals have evolved over time. We further compared the articles across different types of newspapers (government-sponsored vs. commercial), two subpopulations (children vs. adults), and periods of time (1999-2008 vs. 2009-2018). RESULTS: Results showed that medical experts' interviews and statistics were the two most cited types of evidence in the articles. When discussing causes and solutions of obesity, factors pertaining to personal lifestyles were mentioned most frequently. Compared to psychological and social impacts, physical health risk was stressed more often. Compared with commercial newspapers, government-funded newspapers mentioned societal drivers of obesity and suggested reforming schools more frequently. Such differences were also found between coverage of child obesity and adult obesity. Our research, furthermore, revealed significant differences of media coverage of obesity across the two decades. CONCLUSIONS: Our findings indicate that obesity was generally depicted as a "self-regulated epidemic" in Chinese newspapers. Although the revealed causes and consequences of obesity are evidently related to individual factors, more attention should be directed to the roles that the government, media, and the society can play in preventing obesity and mitigating related social/economic burden. LEVEL OF EVIDENCE: Level V, cross-sectional descriptive study.

The Relationship Between Attitude Toward Science and Academic Achievement in Science: A Three-Level Meta-Analysis.

Science education is attracting increasing attention and many researchers focus on the issue about the attitude-achievement relationship in science, but there is still no consistent conclusion. By using a three-level meta-analytic approach, the aim of the current study was to investigate the relationship between attitude toward science and academic achievement in learning science among primary and secondary school students, and to explore if some study characteristics could have contributed to the inconsistent findings with regard to this relationship as observed in the research literature. A total of 37 studies with 132 effect sizes involving a total of 1,042,537 participants were identified. The meta-analytic results revealed that there was an overall positive and moderate relationship between attitude toward science and learning achievement in science (r = 0.248, p < 0.001). The results further found that this association was moderated by the type of attitude and larger effect sizes were shown in self-efficacy than in interest, societal relevance of attitude toward science, and mixed attitude. Moreover, the effect sizes of studies with unstandardized measure to assess science achievement were larger than those with standardized measure. Possible explanations for these findings and its implications for future research directions were also discussed in this review.

Chinese Version of the Nine Item ARFID Screen: Psychometric Properties and Cross-Cultural Measurement Invariance.

Objective: The current study aimed to provide initial psychometric evidence for a Chinese version of the Nine-Item ARFID Screen (C-NIAS), which measures the symptoms of avoidant/restrictive food intake disorder (ARFID), including picky eating, poor appetite/limited interest in eating, and fear of aversive consequences from eating. Method: The NIAS was translated into Chinese according to standard procedures. A total of 1,069 college students from mainland China responded to the C-NIAS. The factor structure was confirmed using confirmatory factor analysis. Convergent and divergent validity were assessed using regression analyses. Finally, measurement invariance was tested, and latent mean differences were compared, between Chinese and American college samples. Results: The measure's original three-factor structure was confirmed. Strong measurement invariance between college samples of the United States and China was supported, and Chinese students had significantly higher latent mean scores on all three factors. The subscales showed the expected patterns of correlations with other validity constructs. Conclusions: The C-NIAS shows good psychometric characteristics and holds promise to facilitate much-needed research on subclinical symptoms of this understudied eating disorder in Chinese-speaking adult populations. Moreover, Chinese college students demonstrate greater potential ARFID symptomatology than American counterparts. More attention to ARFID should be called for in China.

Body dissatisfaction and sexual orientations: A quantitative synthesis of 30 years research findings.

Previous research studies on the relationship between body dissatisfaction and sexual orientation in men and women showed inconsistent results. To better understand this body of research, we conducted a quantitative synthesis based on a three-level random-effects meta-analytic model. In total, we analyzed 229 effect sizes from 75 primary studies published between 1986 and 2019. Results showed that sexual minority men had a higher level of body dissatisfaction than heterosexual men (57 studies, 128 effect sizes), with a small to medium effect size (d = 0.34; 95% CI: 0.28, 0.39). Other comparisons-bisexual men vs. gay men (6 studies, 9 effect sizes), sexual minority women vs. heterosexual women (36 studies, 85 effect sizes), and bisexual women vs. lesbian women (6 studies, 7 effect sizes)-showed smaller and statistically insignificant differences. Moderator analyses revealed that the inconsistency in previous studies comparing sexual minority men and heterosexual men could be partially explained by specific study features, including publication year, survey method, participants' age, participants' BMI, and measures used to assess body dissatisfaction. The inconsistent findings in comparing sexual minority women and heterosexual women could be partially explained by the different survey methods used in previous studies. Explanations and implications are discussed.

Patterns of negative emotional eating among Chinese young adults: A latent class analysis.

There is ample evidence suggesting that negative emotional eating is closely related to disordered eating behaviors. However, most previous studies on the topic focused only on emotional over-eating, but neglected emotional under-eating. Moreover, previous studies also mainly used variable-oriented methods by reducing negative emotional eating to a single dimension, which limits our understanding of individual differences in negative emotional eating. In this study, we used a person-oriented approach, latent class analysis (LCA), to examine the negative emotional eating patterns and to characterize these patterns in a sample of 1,068 Chinese young adults (52.6% females, aged 17-24 years). Negative emotional eating was measured by the Emotional Over-Eating and Emotional Under-Eating subscales of the Adult Eating Behavior Questionnaire. Four patterns, namely, "non-emotional eating" (38.9%), "emotional over- and under-eating" (15.4%), "emotional over-eating" (14.7%), and "emotional under-eating" (31.0%), were identified. Sex and BMI were found to be statistically significant predictors for negative emotional eating patterns. The identified four patterns showed significant differences in eating disorder symptoms and psychological distress. Particularly, participants in emotional over- and under-eating exhibited the highest level of eating disorder symptoms and psychological distress. Overall, this study identified four distinct negative emotional eating patterns, among which, the emotional over- and under-eating was the most problematic. Future studies regarding negative emotional eating and its impact on mental health may benefit from focusing not only on individuals with emotional over-eating, but also on those showing a mixed pattern of negative emotional eating.

The association between body appreciation and body mass index among males and females: A meta-analysis.

To date, a number of studies have reported an association between body appreciation and body mass index (BMI), but the findings are not consistent. Using a meta-analytic approach, the current study aimed to clarify this association as well as to explore what factors might have contributed to the inconsistency across previous studies. By searching and screening potential studies published up to June 2019 in four databases, we identified 26 articles that reported an association between body appreciation and BMI among males, and 59 articles among females. Under a random-effects model, among males the overall estimate of the association between body appreciation and BMI was negative and small, with the pooled r = -.20 (95 % CI: -.25, -.14) and an adjusted (for publication bias) pooled r = -.11 (95 % CI: -.16, -.06). Among females, the overall estimate of the association was negative and small (but close to moderate), with r = -.27 (95 % CI: -.30, -.24). A mixed-effects model identified several moderators that contributed to the inconsistency across previous studies. These results indicate that the overall negative association between body appreciation and BMI is weak among males, and slightly larger among females. Potential explanations, implications, and future research directions are discussed.

Investigating the Multidimensionality of the Work-Related Flow Inventory (WOLF): A Bifactor Exploratory Structural Equation Modeling Framework.

This study investigated the factor structure of the Work-Related Flow Inventory (WOLF) through the application of the bifactor exploratory structural equation modeling (B-ESEM) framework. Using a sample of 577 Chinese teachers, we contrasted a series of competing models, including CFA, ESEM, bifactor CFA, and B-ESEM models. The results suggested that the B-ESEM structure with three S-factors (absorption, work enjoyment, and intrinsic work motivation) and one G-factor (global flow) was the best representation of the WOLF ratings. The results also supported the composite reliability and the strict invariance of this measurement structure between male and female groups. Relative to males, female teachers showed a higher level of global work-related flow experience. Finally, the nomological validity of WOLF ratings was supported by the statistical relationships of the WOLF factors with job satisfaction and autonomy.

Meta-analysis of gender differences in body appreciation.

There are a number of studies that have conducted comparisons of body appreciation between males and females. However, findings are largely inconsistent, making it unclear whether there are actual gender differences in body appreciation. With a meta-analytic approach, the current study quantitatively reviewed and synthesized previous findings, published up to May 2019, on gender differences in body appreciation. After searching and screening potential studies in four databases (i.e., PubMed, PsycINFO, Web of Science, and ProQuest Dissertations & Theses Global), we identified 40 relevant articles published from 2008 to 2019. A random-effects model reveals an overall estimate of gender difference in body appreciation of d = 0.27 (95 % CI: 0.21, 0.33; p <  .001); that is, males generally have a higher level of body appreciation than females, with a small effect size. Survey method, type of sample (cohorts), and age were identified as significant moderators that have contributed to the variability in previous findings. Future research and interventions in body appreciation may consider gender differences in their designs.

Classifying and characterizing Chinese young adults reporting picky eating: A latent profile analysis.

OBJECTIVE: Picky eating (PE) is common across the lifespan and related to psychosocial impairment and limited dietary variety. However, research about PE in non-Western countries is limited. Because eating behaviors may differ by culture, operationalizing PE in non-Western countries (e.g., China) is needed. The present study aimed to replicate two previous studies identifying PE profiles in Western countries by using latent profile analysis (LPA) to classify and characterize adults reporting picky eating in a Chinese sample. METHOD: A sample of 1,068 Chinese young adults completed a battery of questionnaires including the adult eating behavior questionnaire (AEBQ). LPA was utilized to identify eating profiles. The three-step approach was used to examine predictors of latent memberships and profile differences on various self-reported measures. RESULTS: The best fit was a four-profile solution, with two picky eating profiles emerging: picky eating and severe picky eating. Compared to those in the other two profiles, participants in the picky eating profile (19.4%) and severe picky eating profile (3.3%) had significantly higher scores on self-reported eating disorder symptoms and psychological distress, and lower scores on self-reported food-related life satisfaction. Relative to the picky eating profile, participants in the severe picky eating profile reported significantly greater self-reported eating disorder symptoms, psychological distress, and food-related dissatisfaction. DISCUSSION: Characterizing PE profiles is an important step toward understanding eating behaviors among Chinese young adults. Identifying various eating profiles has implications for future research related to PE, including the development of diagnostic tools and interventions to address PE in a Chinese context.

Chinese media coverage of eating disorders: Disorder representations and patient profiles.

OBJECTIVE: Eating disorders (EDs) are becoming more prevalent in China; however, no studies have been conducted to explore how Chinese media represented EDs, and how media representation of ED impacted public understanding of EDs. The aim of this study was to analyze articles about EDs in Chinese newspapers, and to identify any potential inaccuracies about EDs as represented in the media. METHOD: Content analysis was employed to analyze a total number of 292 news articles over the span of two decades (1998-2019). Intercoder reliability was satisfactory for all the coded categories. The analysis was conducted on two different dimensions: for individual news article and for individual patient profile. RESULTS: The bulk of news reporting on EDs was about anorexia nervosa and bulimia nervosa. A majority of individual patient profiles focused on young women. Anorexia nervosa was mentioned and discussed more frequently than bulimia nervosa. Chinese newspapers generally presented correct information concerning anorexia nervosa and bulimia nervosa, but conveyed shallow information about the etiology and treatment. There were also misconceptions of EDs as reported in Chinese media. DISCUSSION: EDs have not received sufficient attention in Chinese media, as shown by the media coverage on EDs over the last two decades. Considering the increasing prevalence of EDs in China with its large population base, effective communication strategies are needed to call public attention to this health issue, and to galvanize the medical community and the society to devote more resources to improve the prevention and treatment of EDs in China.

A Comparison of Fixed-Effects and Random-Effects Models for Multivariate Meta-Analysis Using an SEM Approach.

This study compared fixed-effects (FE) and random-effects (RE) models in meta-analysis for synthesizing multivariate effect sizes under the framework of structural equation modeling. Monte Carlo simulations were conducted to examine the performance characteristics of the two models under different data conditions. The results indicated that, for the homogeneous case, there was little difference between the FE model and the RE model applications. But the FE model had better performance in standard error estimation when number of studies is not large and the sample size of primary studies is small. Furthermore, under the heterogeneous case, FE model exhibited biased estimates of population parameters and extreme levels of inflated Type I error in testing the effect size estimates. However, RE model maintained unbiased estimates of the population parameters, and controlled Type I error well under various data conditions investigated. These findings provided empirical evidence that it is likely that RE model application in a meta-analysis would be preferred when the number of primary studies and the sample sizes in the primary studies are reasonably large, and FE model could be favored for situations with smaller numbers of studies and uniformly small sample sizes of primary studies.

Mapping and Predicting Patterns of Chinese Adolescents' Food Preferences.

This study aimed to examine the patterns of, as well as the predictors for, Chinese adolescents' food preferences. Using the national data of the China Health and Nutrition Survey (CHNS), we analyzed the data of 697 adolescents in the age range of 12 to 17 years. Latent class analysis revealed four types of food preferences: varied diet (37.09%, n = 254), avoiding vegetables (19.69%, n = 131), low appetite (7.56%, n = 50), and healthy diet (35.66%, n = 222). Major predictors for food preferences included demographic variables (e.g., gender, urban versus rural residence), nutrition knowledge, preference for activities, and social attitudes. Results did not show any significant differences in BMI z-scores among the four latent classes. However, there were significant differences in the number of sleeping hours among the classes.

Translating, modifying, and validating the Adult Picky Eating Questionnaire for use in China.

OBJECTIVE: The aim of this study was to translate, modify, and validate the Adult Picky Eating Questionnaire (APEQ) for use in China. METHODS: Based on standard procedures, the APEQ was translated into Chinese. Four items were added in the final Chinese version of the APEQ (C-APEQ). For testing the psychometric properties of the C-APEQ, a total of 1069 participants (17-24 years; 52.57% women) were recruited from two universities in mainland China. RESULTS: Exploratory factor analysis and confirmatory factor analysis supported the previous four-factor structure of the APEQ. Findings also showed that the C-APEQ had adequate internal consistency (α = 0.874) and test-retest reliability (ICC = 0.778). The C-APEQ demonstrated strong measurement invariance across gender. Furthermore, the C-APEQ composite score presented positive and significant correlations with eating disturbance, psychological distress, and psychological inflexibility. It also showed a negative and significant correlation with food-related life satisfaction. CONCLUSION: Findings suggested that the Chinese version of the APEQ demonstrated sound psychometric properties. Thus, the C-APEQ can be a useful tool in future studies to accurately assess picky eating among adult population and explore the relationships between picky eating and other physical and psychological outcomes in a Chinese context.

Psychometric properties of the Chinese version of the Düsseldorf Orthorexia Scale: prevalence and demographic correlates of orthorexia nervosa among Chinese university students.

PURPOSE: As there is no measure available in Chinese for assessing orthorexia nervosa (ON), and as the Düsseldorf Orthorexia Scale (DOS) has demonstrated to be a valid measure for such a purpose, the current study aimed to obtain a Chinese version of the DOS (C-DOS), to evaluate psychometric properties of the C-DOS in a sample of Chinese university students, and to explore the prevalence of ON among the participants. METHODS: According to standard procedures, the C-DOS was obtained and administered to 1075 mainland Chinese university students (52.7% female) recruited from two provinces in mainland China. To examine the factor structure of the C-DOS, the total sample was split into two halves, one for exploratory factor analysis, and the other for confirmatory factor analysis. The ordinal alpha and test-retest reliability were examined. Convergent and divergent validity was assessed by conducting Pearson correlation analyses between the C-DOS and other theoretically related/unrelated measures. Prevalence of ON was estimated based on the total score of the C-DOS with the cutoff value of 30. RESULTS: A three-factor structure was revealed for the C-DOS. The C-DOS showed good internal consistency with an ordinal alpha of 0.80, and it also had good test-retest reliability of 0.77. The total scores of the C-DOS had strong and statistically significant positive correlations with eating inflexibility, while the total scores had weak correlations with other eating disturbances. Strong measurement invariance across gender groups was also supported. The prevalence of ON was 7.8% with males showing higher rates of ON than females (10.6% vs. 5.3%). CONCLUSIONS: The Chinese version of the DOS (C-DOS) was psychometrically adequate for the sample of Chinese students. Given the high prevalence of ON found in the current study, more attention to ON, as well as further research and potential interventions, are warranted in China. LEVEL OF EVIDENCE: Descriptive (cross-sectional) study, Level V.

Is there a relationship between body mass index and academic achievement? A meta-analysis.

OBJECTIVE: To date, although there have been several systematic reviews about the relationship between overweight/obesity and academic performance, none of the reviews were conducted quantitatively, thus the extent overweight/obesity is related to academic performance still remains unclear. Thus, the aim of this study was to quantitatively review the scientific evidence on the association between body mass index (BMI) and academic performance. STUDY DESIGN: A systematic review of articles examining such relationship was undertaken using four databases, namely, PubMed, Web of Science, EBSCOhost and ProQuest Dissertations & Theses Global. The search period covered the research literature up to July 2017. METHODS: Data from 60 selected studies (involving 164,049 participants) were extracted and analysed following procedures for meta-analysis. RESULTS: Sixty studies met all inclusion criteria and were included. Using a random-effects meta-analysis model, a weak negative correlation between BMI and academic achievement (r = -.111; 95% confidence interval [CI]: -.155 to -.067; P < .01) was revealed. After conducting a series of moderator analyses, such a relationship was found to be significantly moderated by regions and students' study grades. CONCLUSIONS: BMI is weakly and negatively associated with academic achievement. For a better understanding of such a relationship, future studies are needed to explore whether there is a causal relationship and also explore whether there are other factors that potentially moderate such a relationship.