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.

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.

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.

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.

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 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.

The effect of low parental warmth and low monitoring on disordered eating in mid-adolescence: Findings from the Australian Temperament Project.

OBJECTIVE: To investigate the interactions between low parental warmth and monitoring at age 13-14 years and disordered eating attitudes and behaviours at age 15-16 years. METHOD: Data on 1300 (667 females) adolescents and their parents were drawn from The Australian Temperament Project (ATP), a 30 year (15 wave) population based longitudinal study of social-emotional development. Parent participants completed surveys on parenting practices in late childhood, and adolescent participants reported disordered eating using the drive for thinness and bulimia subscales of the Eating Disorder Inventory (EDI) and an additional body dissatisfaction scale. Interaction was examined on the additive scale by estimating super-additive risk; i.e., risk in excess of the sum of individual risks. RESULTS: For boys, neither parental warmth or monitoring, nor their interaction, was related to disordered eating. For girls, low parental warmth (alone) was associated with bulimic behaviours. In contrast, exposure to both low monitoring and warmth was associated with ∼3½-fold, ∼4-fold and ∼5-fold increases in the odds of reporting body dissatisfaction, drive for thinness and bulimia, respectively. For body dissatisfaction and drive for thinness, risk associated with joint exposure exceeded the sum of individual risks, suggesting an additive interaction between parenting styles. CONCLUSION: Further investment in family-level interventions that focus on promoting parental monitoring behaviour and a warm parent-child relationship remain important strategies for preventing a range of disordered eating behaviours in adolescents.

Does Media Literacy Mitigate Risk for Reduced Body Satisfaction Following Exposure to Thin-Ideal Media?

Exposure to thin-ideal media can contribute to increased body dissatisfaction in adolescent girls. Understanding the factors that may prevent or exacerbate the negative effects of media exposure on body dissatisfaction is important to facilitate prevention of these problems. This study evaluated the effects of exposure to thin-ideal media images on body image in three instructional set experimental conditions: appearance comparison, peer norms, and control. An important aim was to examine baseline levels of media literacy as a protective factor and trait thin-ideal internalization and trait upward appearance comparison as risk factors. Early adolescent girls (N = 246) completed baseline measures and 1 week later viewed thin-ideal media images, before and after which they rated their state body satisfaction. Participants in the appearance comparison instruction but not peer norms instruction condition had significantly reduced body satisfaction. Media literacy, particularly high levels of critical thinking, mitigated the negative effects of trait thin-ideal internalization and trait upward appearance comparison on body satisfaction outcomes. These findings provide evidence for the role of media literacy as a protective factor against the negative effects on body satisfaction of exposure to thin-ideal media images, and also provide evidence to support the development and implementation of media literacy-based body image interventions.

"Stop eating lollies and do lots of sports": a prospective qualitative study of the development of children's awareness of dietary restraint and exercise to lose weight.

BACKGROUND: Beliefs surrounding the usefulness of dietary restriction and physical activity as means of body shape and size modification is already present in children as young as 5-years-old, and these beliefs may increase the risk of unhealthy weight control behaviours later in life. To date, however, little is known regarding the development of these beliefs in younger children. The aim of the present study was, therefore, to explore young (aged 3- to 5-years old) children's conceptualisations of dietary restriction and physical activity as means to change body size using a prospective approach. METHODS: A sample of 259 children (116 boys, 143 girls) participated in interviews at 3-, 4- and 5-years-old. Participants were shown silhouette figures of a child of their gender and age. Their responses to questions regarding how the figure could return to a previous thinner shape were qualitatively coded using thematic analysis. RESULTS: Children's responses revealed that while, for a subsample, modifications of food, eating, and exercise patterns were the most salient ideas, a number of other mechanisms of body change were also suggested. Responses also evidenced adoption or awareness of stigmatising attitudes towards overweight individuals (over 15% by age 5). The proportion of children demonstrating an awareness of dietary restriction and physical exercise as methods for body size change increased significantly at each time point. While only 4.2% demonstrated dieting awareness at 3-years-old, this proportion had risen to almost 28% by 5-years-old (p < .001). Similarly, the proportion of children aware of exercise as a body change strategy rose from 2.3 to 16.3% (p < .001), with 22% of 5-year-olds mentioning general physical activity as a strategy. No gender differences were found. CONCLUSIONS: Awareness of dietary restriction and physical exercise as strategies for weight loss and body change emerges as young as 3-years-old, and significantly increases from 3- to 5-years-old. Interventions aiming to promote healthy means of weight control and obesity prevention should consider that certain attitudes may already be present in very young children.

Photoshopping the selfie: Self photo editing and photo investment are associated with body dissatisfaction in adolescent girls.

OBJECTIVE: Social media engagement by adolescent girls is high. Despite its appeal, there are potential negative consequences for body dissatisfaction and disordered eating from social media use. This study aimed to examine, in a cross-sectional design, the relationship between social media use in general, and social media activities related to taking "selfies" and sharing specifically, with overvaluation of shape and weight, body dissatisfaction, and dietary restraint. METHOD: Participants were 101 grade seven girls (M(age) = 13.1, SD = 0.3), who completed self-report questionnaires of social media use and body-related and eating concerns measures. RESULTS: Results showed that girls who regularly shared self-images on social media, relative to those who did not, reported significantly higher overvaluation of shape and weight, body dissatisfaction, dietary restraint, and internalization of the thin ideal. In addition, among girls who shared photos of themselves on social media, higher engagement in manipulation of and investment in these photos, but not higher media exposure, were associated with greater body-related and eating concerns, including after accounting for media use and internalization of the thin ideal. DISCUSSION: Although cross-sectional, these findings suggest the importance of social media activities for body-related and eating concerns as well as potential avenues for targeted social-media-based intervention.

Dietary restraint of 5-year-old girls: Associations with internalization of the thin ideal and maternal, media, and peer influences.

OBJECTIVE: Understanding socio-cultural factors associated with the development of dieting tendencies is important for preventing future disordered eating. We explored individual and socio-cultural factors associated with weight-focussed dietary restraint tendencies (described as dietary restraint) in 5-year-old girls. METHOD: Participants were 111 5-year-old girls and 109 of their mothers. Girls were interviewed about their dietary restraint, body image, appearance ideals, positive weight bias (attributing positive characteristics to thinner figures), and peer conversations. Mothers completed self-report questionnaires assessing dietary restraint and appearance ideals, as well as measures reporting on their daughter's media exposure and peer appearance interest. RESULTS: Thirty-four percent of girls reported at least a moderate level of dietary restraint. While most girls were satisfied with their body size, half showed some internalization of the thin ideal. Girls' dietary restraint was correlated with weight bias favoring thinner bodies, and greater internalization of the thin ideal, media exposure, and appearance conversations with peers. Media exposure and appearance conversations were the strongest predictors of dietary restraint. DISCUSSION: These cross-sectional findings suggest that the socio-cultural environment of young girls may be important in the very early development of unhealthy dieting tendencies. Longitudinal research is necessary to identify whether these are prospective risk factors.

Maternal negative affect is associated with emotional feeding practices and emotional eating in young children.

BACKGROUND: Although mothers of young children frequently experience negative affect, little is known about the association between these symptoms and their children's eating behaviors. We aimed to test a model in which maternal negative affect would be related to maternal emotional eating which in turn would be associated with child emotional eating through maternal feeding practices (emotional and instrumental feeding) in a cross-sectional sample of mothers and their children. METHODS: A sample of 306 mothers (mean age = 35.0 years, SD = 0.46) of 2-year-old children completed a survey assessing symptoms of depression, anxiety and stress, maternal emotional eating, maternal feeding practices, and child emotional eating. RESULTS: Maternal symptoms of depression, anxiety, and stress were correlated with maternal emotional eating (p < .001), and child emotional eating (p < .05). The initial model proposed was not a good fit to the data. Modification indices indicated that the model would be improved if a direct pathway was added between maternal and child emotional eating. As this model was theoretically plausible these changes were made. The resulting model proved a good fit to the data, χ2 = 17.36, p = .098, and explained 29% of the variance in child emotional eating. CONCLUSIONS: High levels of negative affect and associated emotional eating in mothers may contribute to the use of instrumental and emotional feeding practices. Our findings suggested that maternal negative affect has an indirect effect on children's emotional eating, primarily through mothers' own emotional eating and feeding her child to regulate the child's emotions.

Maternal feeding practices predict weight gain and obesogenic eating behaviors in young children: a prospective study.

BACKGROUND: Maternal feeding practices have been proposed to play an important role in early child weight gain and obesogenic eating behaviors. However, to date longitudinal investigations in young children exploring these relationships have been lacking. The aim of the present study was to explore prospective relationships between maternal feeding practices, child weight gain and obesogenic eating behaviors in 2-year-old children. The competing hypothesis that child eating behaviors predict changes in maternal feeding practices was also examined. METHODS: A sample of 323 mother (mean age = 35 years, ± 0.37) and child dyads (mean age = 2.03 years, ± 0.37 at recruitment) were participants. Mothers completed a questionnaire assessing parental feeding practices and child eating behaviors at baseline and again one year later. Child BMI (predominantly objectively measured) was obtained at both time points. RESULTS: Increases in child BMI z-scores over the follow-up period were predicted by maternal instrumental feeding practices. Furthermore, restriction, emotional feeding, encouragement to eat, weight-based restriction and fat restriction were associated prospectively with the development of obesogenic eating behaviors in children including emotional eating, tendency to overeat and food approach behaviors (such as enjoyment of food and good appetite). Maternal monitoring, however, predicted decreases in food approach eating behaviors. Partial support was also observed for child eating behaviors predicting maternal feeding practices. CONCLUSIONS: Maternal feeding practices play an important role in the development of weight gain and obesogenic eating behaviors in young children and are potential targets for effective prevention interventions aiming to decrease child obesity.

Do maternal body dissatisfaction and dietary restraint predict weight gain in young pre-school children? A 1-year follow-up study.

BACKGROUND: The relationships between maternal body image and eating concerns and increases in body mass index (BMI) in early childhood are poorly understood. Our aim was to test a model in which mothers' BMI, body dissatisfaction, dietary restraint and concerns about their child's weight were related to restrictive feeding practices and child BMIz change. METHODS: Mothers of 2-year-old children (n=202, aged between 1.5 and 2.5years) reported concerns regarding their own and their child's weight, their dietary restraint, and restrictive feeding practices. Height and weight were measured for children and reported by mothers at baseline and 1-year later. RESULTS: Thirty five percent of mothers and 29% of children were in overweight or obese categories at baseline. Using path analysis, after adding an additional pathway to the proposed model the final model provided a good fit to the data (χ(2) (8)=5.593, p=.693, CFI=1.000, RMSEA=.000), with maternal dietary restraint directly predicting change in child BMIz over the year. Concern about child's weight and, to a lesser extent, maternal dietary restraint mediated the relationship between maternal body dissatisfaction and the use of restrictive feeding practices. However, the pathway from restrictive feeding practices to change in child BMIz was not significant. CONCLUSIONS: Mothers' BMI and body dissatisfaction may contribute indirectly to weight change in their young children. Interventions targeting maternal body dissatisfaction and informing about effective feeding strategies may help prevent increases in child BMIz.

#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.

Men's emotional responses to their partner's pregnancy and their views on support and information received.

The main aim of this study was to extend previous research of men's experiences of pregnancy; 48 Australian men and their pregnant partners took part. Most men reported feeling positive about the pregnancy, emotionally well supported and well informed. Men reported receiving more valuable information from their partner than from doctors/obstetricians, family or the internet and were accurate observers of women's depression levels.

#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.

Factors associated with body dissatisfaction and disordered eating in women in midlife.

OBJECTIVE: In this study, we examined developmentally appropriate factors that may be associated with body dissatisfaction and disordered eating in women in midlife. METHOD: Participants were a community sample of 200 women aged 35-65. Outcome measures were the weight concern, shape concern, eating concern, and restraint subscales of the Eating Disorder Examination-Questionnaire (EDE-Q). Independent variables were importance of appearance, importance of function, cognitive reappraisal (of aging changes to appearance), and body-related self-care. RESULTS: Importance of appearance, self-care, and body mass index (BMI) accounted for variance in regression modeling for all EDE-Q variables. In addition, cognitive reappraisal was related to shape concern and restraint, and importance of function and age were also associated with restraint. Participants identified as probable eating disorder cases had significantly higher BMI, importance of appearance and function, and significantly lower cognitive reappraisal and self-care scores than participants identified as noncases. DISCUSSION: This study provides support for the role of developmentally relevant factors in body dissatisfaction and disordered eating in midlife women.