A Qualitative Examination of Health Barriers and Facilitators Among African American Mothers in a Subsidized Housing Community.

Although African American families are at particular risk for obesity and its associated health comorbidities, few interventions have directly targeted low-income members of this group living in subsidized public housing. Using a consensual qualitative research approach, we conducted 11 interviews with African American mothers living in two public housing communities to enhance understanding of their perceived barriers and facilitators to health. Five primary domains emerged, including barriers (access, financial, personal, and neighborhood concerns), resources (personal and community), current behaviors (diet, physical activity, and program participation), definition of health (mental well-being, physical well-being, and health behaviors), and needs/interests in programming (health behavior-specific programs, non-health-related programs, child-focused programming, and qualities of programs and their leaders). Results demonstrate the complex interaction among social, environmental, and personal factors on health behaviors for this priority population, and highlight the need for community members' involvement in the development of community-based obesity prevention programming.

Examining social physique anxiety and disordered eating in college women. The roles of social comparison and body surveillance.

Social physique anxiety has been found to be associated with disordered eating. However, what is not yet known is what behaviors college women may engage in that strengthen this relation. In the current study, we examined two possible moderating factors, social comparison and body surveillance. We examined whether these moderators might also generalize to trait anxiety, as well. Participants were 265 women attending a Southeastern university. Social comparison (both general and appearance-related) and body surveillance were tested as moderators of the relation between social physique anxiety and disordered eating. Results indicated that general social comparison, appearance-related social comparison, and body surveillance significantly moderated this relation. Individuals who were high in social physique anxiety and who reported high levels of general or appearance-related social comparison or body surveillance reported much higher levels of disordered eating than those with high social physique anxiety and low levels of these behaviors. Results indicated that only the trait anxiety×body surveillance interaction was significant in identifying elevated disordered eating. Results provide information regarding who may experience high levels of disordered eating in association with social physique anxiety, which has clinical implications including the conceptualization of social comparison and body surveillance as safety behaviors.

Development and preliminary effectiveness of an innovative treatment for binge eating in racially diverse adolescent girls.

INTRODUCTION: Binge and loss of control (LOC) eating are significant concerns among many adolescents and are associated with poor physical, social, and psychological functioning. Black girls appear to be particularly vulnerable to binge and LOC eating. Yet, empirically validated, culturally sensitive treatments for these disordered eating behaviors are not well established. This investigation examined satisfaction, feasibility, and preliminary outcomes of a binge eating intervention for ethnically diverse adolescent girls. METHODS: Participants were 45 girls (age 13-17years; 44.4% white, 42.2% black) randomized into a dialectical behavior therapy (DBT)-based intervention (Linking Individuals Being Emotionally Real, LIBER8) or a weight management group (2BFit). Following each meeting, participants completed satisfaction measures, and therapists assessed intervention feasibility. Participants also completed assessments of eating behavior and related psychological constructs at baseline, immediately following the intervention, and at 3-month follow-up. RESULTS: Descriptive statistics indicated that LIBER8 was feasible, and participants were highly satisfied with this intervention. Significant reductions in eating disorder cognitions, dietary restraint, and eating in response to negative affect were observed for participants in both groups, with no differences between LIBER8 and 2BFit. DISCUSSION: The acceptability and feasibility of LIBER8 and associated reductions in emotional eating show promise in ameliorating binge eating and provide insight into multiple options for treating this challenging eating concern.

Negative affective experiences in relation to stages of eating disorder recovery.

The purpose of this study was to examine a collection of negative affect symptoms in relation to stages of eating disorder recovery. Depressive symptoms, anxiety symptoms, loneliness, and perceived stress are known to be present in individuals with eating disorders; however, less is known about the presence of such constructs throughout the recovery process. Does this negative affect fog continue to linger in individuals who have recovered from an eating disorder? Female participants seen at some point for an eating disorder at a primary care clinic were categorized into one of three groups using a stringent definition of eating disorder recovery based on physical, behavioral, and psychological criteria: active eating disorder (n=53), partially recovered (n=15; psychological criteria not met), and fully recovered (n=20; all recovery criteria met). Additionally, data were obtained from 67 female controls who had no history of an eating disorder. Self-report data indicated that controls and women fully recovered from an eating disorder scored significantly lower than partially recovered and active eating disorder groups in perceived stress, depression, and anxiety. Controls and the fully recovered group were statistically indistinguishable from each other in these domains, as were the partially recovered and active eating disorder groups, suggesting an interesting divide depending on whether psychological criteria (e.g., normative levels of weight/shape concern) were met. In contrast, controls and fully recovered and partially recovered groups all reported feeling significantly less lonely relative to those with an active eating disorder suggesting that improved perceptions of interpersonal functioning and social support may act as a stepping stone toward more comprehensive eating disorder recovery. Future research may want to longitudinally determine if an increase in actual or perceived social support facilitates the movement toward full recovery and whether this, in turn, has salutatory effects on depression, anxiety, and perceived stress.

What if high expectations feel good? Perceived parental expectations, their meanings, and bulimic symptoms in Black and White college women.

This study aimed to test an interactive model of perceived parental expectations and the meaning of those expectations in relation to bulimic symptoms in Black (n=97) and White (n=179) college women. Black young women reported higher parental expectations and attached more positive meanings to high parental expectations, in comparison to their White peers. There was an interactive effect for Black young women such that, in the context of perceived high parental expectations, interpreting high parental expectations as negative was associated with higher levels of bulimic symptoms whereas interpreting high expectations as positive was associated with lower levels of bulimic symptoms. However, no interactive effect emerged for White young women. The role of differences in cultural contexts is discussed.

Development and validation of the Body, Eating, and Exercise Comparison Orientation Measure (BEECOM) among college women.

We constructed and validated a measure of comparison dimensions associated with eating pathology, namely, the body, eating, and exercise comparison orientation measure (BEECOM). Participants were 441 undergraduate women. In Study 1, items were generated and refined via exploratory factor analysis, yielding three interpretable factors (i.e., body, eating, and exercise comparison orientation). Confirmatory factor analysis was then used to confirm the three-factor structure of the BEECOM and to investigate the potential presence of a higher-order factor. Given that the lower-order factors loaded strongly onto a higher-order factor, it is appropriate to use a total BEECOM score, in addition to subscale scores. Further, the BEECOM's scores yielded evidence of internal consistency and construct validity in this sample. Study 2 demonstrated two-week test-retest reliability of the BEECOM among college women. Overall, the BEECOM demonstrated good psychometric properties and may be useful for more comprehensively assessing eating disorder-related social comparison behavior.

Evaluating the roles of anxiety and dimensions of perfectionism in dieting and binge eating using weekly diary methodology.

This study examined the relations between weekly reports of anxiety, dimensions of trait perfectionism, and dieting and binge eating over the course of 11 weeks. Participants were 406 college women who completed a battery of questionnaires at Time 1 that assessed trait-like characteristics (e.g., self-oriented and socially prescribed perfectionism). For 11 weeks following that, participants filled out a short questionnaire packet that assessed their weekly anxiety, dieting, and binge eating. Using multilevel modeling, results indicated that on average, both within- and between-person levels of anxiety predicted increased binge eating, while only between-person levels of anxiety predicted increased dieting. Higher levels of self-oriented perfectionism also predicted increased dieting and binge eating, while higher levels of socially prescribed perfectionism predicted increased binge eating only (not increased dieting). The relation between weekly anxiety and disordered eating was not moderated by either dimension of perfectionism. Results provide support for the notion that dieting is generally affected by trait-like characteristics, while binge eating is generally affected by both trait- and state-like characteristics; these findings have significant clinical implications.

The inter-relationships between vegetarianism and eating disorders among females.

When individuals with a suspected or diagnosed eating disorder adopt a vegetarian diet, health care professionals might worry that this choice could function as a socially acceptable way to legitimize food avoidance. Yet only limited research has examined vegetarianism in relation to eating disorders. Our study objectives were to compare individuals with and without an eating disorder history and individuals at different stages of eating disorder recovery on past and current vegetarianism and motivations for and age at becoming vegetarian. Participants were females seen at some point for an eating disorder (n=93) and controls who never had an eating disorder (n=67). Recruitment and data collection for this cross-sectional study occurred in 2007-2008. χ(2) analyses and analyses of variance and covariance were used to examine the research questions. Compared with controls, individuals with an eating disorder history were considerably more likely to ever have been vegetarian (52% vs 12%; P<0.001), to be currently vegetarian (24% vs 6%; P<0.01), and to be primarily motivated by weight-related reasons (42% vs 0%; P<0.05). The three recovery status groups (fully recovered, partially recovered, and active eating disorder) did not differ significantly in percentiles endorsing a history of vegetarianism or weight-related reasons as primary, but they differed significantly in current vegetarianism (33% of active cases, 13% of partially recovered, 5% of fully recovered; P<0.05). Most perceived that their vegetarianism was related to their eating disorder (68%) and emerged after its onset. Results shed light on the vegetarianism-eating disorders relation and suggest intervention considerations for clinicians (eg, investigating motives for vegetarianism).

Explaining the relation between thin ideal internalization and body dissatisfaction among college women: the roles of social comparison and body surveillance.

Sociocultural models of disordered eating lack comprehensive explanations as to how thin ideal internalization leads to body dissatisfaction. This study examined two social psychological theories as explanations of this relation, namely social comparison and objectification theories, in a sample of 265 women attending a Southeastern university. Social comparison (both general and appearance-related) and body surveillance (the indicator of objectification) were tested as mediators of the relation between thin ideal internalization and body dissatisfaction using bootstrapping analyses. Results indicated that body surveillance was a significant specific mediator of this relation; however, neither operationalization of social comparison emerged as such. Results serve to elaborate upon the sociocultural model of disordered eating by providing a more comprehensive understanding of the processes by which thin ideal internalization manifests itself in body dissatisfaction. The current findings also highlight the importance of targeting body surveillance in clinical settings.

Perceptions of parental attitudes toward body and eating: associations with body image among Black and White college women.

This study examined Black and White young women's perceptions of parental body- and eating-related attitudes and behaviors from growing up and the relations of these parental factors with their current body image. Female undergraduates (97 Black women, 179 White women) completed questionnaires of perceptions of parental attitudes/behaviors related to body image and eating and of their current body image, operationalized as weight/shape concern. Results indicated that perceived parental communication was more strongly related to body image than perceived parental modeling in both ethnic groups, and that there were some differences in how frequently Black and White women reported encountering specific maternal messages about the body or eating. Perceived parental modeling and communication constructs were related to body image in similar ways for both ethnic groups after controlling for BMI. Future research directions are discussed.

Defining recovery from an eating disorder: Conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity.

Conceptually, eating disorder recovery should include physical, behavioral, and psychological components, but such a comprehensive approach has not been consistently employed. Guided by theory and recent recovery research, we identified a "fully recovered" group (n = 20) based on physical (body mass index), behavioral (absence of eating disorder behaviors), and psychological (Eating Disorder Examination-Questionnaire) indices, and compared them with groups of partially recovered (n = 15), active eating disorder (n = 53), and healthy controls (n = 67). The fully recovered group was indistinguishable from controls on all eating disorder-related measures used, while the partially recovered group was less disordered than the active eating disorder group on some measures, but not on body image. Regarding psychosocial functioning, both the fully and partially recovered groups had psychosocial functioning similar to the controls, but there was a pattern of more of the partially recovered group reporting eating disorder aspects interfering with functioning. Regarding other psychopathology, the fully recovered group was no more likely than the controls to experience current Axis I pathology, but they did have elevated rates of current anxiety disorder. Results suggest that a stringent definition of recovery from an eating disorder is meaningful. Clinical implications and future directions regarding defining eating disorder recovery are discussed.

Neocortical neuronal arrangement in Miller Dieker syndrome.

Miller Dieker syndrome (MDS, type I lissencephaly) is a neuronal migration disorder, which is caused by deletions along the short arm of chromosome 17 (17p13.3). Recent studies would suggest that the cortical lamination in MDS is inverted, based on morphological criteria. The present neuropathological study examines the cerebral cortex from a 33-week old fetus with MDS using both neuronal and laminar-specific markers. These expression studies demonstrate a relatively preserved cortex and cortical lamination, overlying a layer of immature neurons in MDS brain. The findings are consistent with both a migratory and proliferative defect, giving rise to lissencephaly. Moreover, characterization of such rare human malformations of cortical development by immunohistochemical techniques will provide a greater understanding of the underlying mechanisms.

Impaired proliferation and migration in human Miller-Dieker neural precursors.

OBJECTIVE: Miller-Dieker syndrome (MDS) is a malformation of cortical development that results in lissencephaly (meaning smooth brain). This disorder is caused by heterozygous deletions on chromosome 17p13.3, including the lissencephaly 1 (LIS1) gene. Various mouse models have been used as an experimental paradigm in understanding human lissencephaly, but clear limitations exist in these studies, particularly because mice are naturally lissencephalic. Thus, the objective of this article was to establish human neural precursor cell lines from postmortem MDS tissue and to characterize the pathological cellular processes that contribute to the human lissencephalic phenotype. METHODS: Human neural precursors were isolated and expanded from the frontal cortices of a 33-week postmortem fetus with MDS and an age-matched control subject. Relative rates of proliferation and cell death were assessed in vitro, whereas the migration of precursors was examined after transplantation in vivo. RESULTS: Precursors showed haploinsufficiency of the LIS1 gene and a reduction in LIS1 protein. Precursors could also differentiate into both neurons and glia. MDS precursors demonstrated impairments in neuronal migration, diminished rates of cell proliferation, and increased cell death. INTERPRETATION: These results suggest that, in addition to migration, disruption in cell proliferation could play a more important role in the development of lissencephaly than previously suspected.

Mutation in filamin A causes periventricular heterotopia, developmental regression, and West syndrome in males.

PURPOSE: Familial periventricular heterotopia (PH) represents a disorder of neuronal migration resulting in multiple gray-matter nodules along the lateral ventricular walls. Prior studies have shown that mutations in the filamin A (FLNA) gene can cause PH through an X-linked dominant pattern. Heterozygotic female patients usually remain asymptomatic until the second or third decade of life, when they may have predominantly focal seizures, whereas hemizygotic male fetuses typically die in utero. Recent studies have also reported mutations in FLNA in male patients with PH who are cognitively normal. We describe PH in three male siblings with PH due to FLNA, severe developmental regression, and West syndrome. METHODS: The study includes the three affected brothers and their parents. Video-EEG recordings and magnetic resonance image (MRI) scanning were performed on all individuals. Mutations for FLNA were detected by using polymerase chain reaction (PCR) on genomic DNA followed by single-stranded conformational polymorphism (SSCP) analysis or sequencing. RESULTS: Two of the siblings are monozygotic twins, and all had West syndrome with hypsarrhythmia on EEG. MRI of the brain revealed periventricular nodules of cerebral gray-matter intensity, typical for PH. Mutational analyses demonstrated a cytosine-to-thymidine missense mutation (c. C1286T), resulting in a threonine-to-methionine amino acid substitution in exon 9 of the FLNA gene. CONCLUSIONS: The association between PH and West syndrome, to our knowledge, has not been previously reported. Males with PH have been known to harbor FLNA mutations, although uniformly, they either show early lethality or survive and have a normal intellect. The current studies show that FLNA mutations can cause periventricular heterotopia, developmental regression, and West syndrome in male patients, suggesting that this type of FLNA mutation may contribute to severe neurologic deficits.