School-based eating disorder prevention: A pilot effectiveness trial of teacher-delivered Media Smart

Author version made available in accordance with Publisher copyright policy.AIM: This pilot study tested teacher-delivered Media Smart, a school-based eating disorder prevention program that has achieved significant benefits when delivered by health professionals. METHOD: Two Grade 7 classes (N = 51; M age = 12.43 years) participated, with one randomly allocated to Media Smart (n = 27; 67% girls) and the other to a control condition of usual lessons (n = 24; 37% girls). Program feasibility was assessed by teacher self-report, whereas student self-report of shape and weight concern (primary outcome variable) and seven additional risk factors were measured at baseline, post-program and 6-month follow up. RESULTS: Teacher ratings of program feasibility revealed that 25 of the 29 (86.2%) program activities were taught with 96% of activities rated as either highly (19 activities) or moderately (5 activities) valuable for students. Mixed model analyses were conducted using a 2 (group: Media Smart, control) × 2 (time: post-program, 6-month follow up) × 2 (gender: girls, boys) design, with baseline scores as a covariate. A not-significant trend for group favouring Media Smart was observed for shape and weight concern (Cohen's d effect size [d] = 0.32), whereas significant effects were found for feelings of ineffectiveness (d = 0.52) and weight-related peer teasing (d = 0.68). CONCLUSIONS: The program was feasible for teacher delivery and showed some promising results, supporting a more substantial randomized-controlled effectiveness trial

An investigation of temperament endophenotype candidates for early emergence of the core cognitive component of eating disorders

This study was designed to investigate potential temperament endophenotypes for clinically significant importance of shape and weight. Seven temperament risk factors for eating disorders and the Eating Disorder Examination were assessed in 699 female twins aged 12–15 years. Each variable was evaluated against the following endophenotype criteria : associated with illness in the general population ; found in non-affected family members at a higher rate than in the general population ; and, heritable. All seven variables were significantly associated with clinically significant importance of shape and weight, while thin-ideal internalization, ineffectiveness, body dissatisfaction and sensitivity to punishment were found at significantly elevated levels in non-affected twins, when controlling for sister’s temperament score. These four variables had genetic correlations with importance of shape and weight, ranging from 0.48 to 0.95. Future research should evaluate the stability of the identified endophenotypes and their utility for predicting significant growth in importance of shape and weight, and also whether different endophenotypes emerge when the importance of weight and shape reaches its peak in adolescents, around 15 to 16 years of age

Depression as a moderator of benefit from Media Smart: a school-based eating disorder prevention program

© 2013. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Objective: To investigate if baseline depression moderated response to Media Smart, an 8-lesson school-based program previously found to achieve a long-term risk reduction effect in young adolescents. Method: 540 Grade 8 students (M age = 13.62 years, SD = .37) from 4 schools participated with 11 classes receiving the Media Smart program (126 girls; 107 boys) and 13 comparison classes receiving their normal lessons (147 girls; 160 boys). Shape and weight concern, media internalization, body dissatisfaction, dieting, ineffectiveness, and perceived pressure were the outcome variables. Results: Moderation was indicated by significant interaction effects for group (Media Smart; Control) X moderator (high depression; low depression) X time (post-program; 6-month follow-up; 2.5-year follow-up), with baseline entered as a covariate. Such effects were found for shape and weight concern, media internalization, body dissatisfaction, ineffectiveness and perceived pressure. Post-hoc testing found high depression Media Smart participants scored significantly lower than their control counterparts at post-program on shape and weight concern, media internalization and dieting, whereas low depression Media Smart participants scored significantly lower on shape and weight concern at 2.5-year follow-up. Discussion: Media Smart achieved a reduction in eating disorder risk factors for high-depression participants and a reduced rate of growth in risk factor scores for low-depression participants

Examination of the Sociocultural Attitudes Towards Appearance Questionnaire-3 in a mixed-gender young-adolescent sample

Author version made available in accordance with publisher copyright policy.Thin-ideal (or media) internalization is an important eating disorder risk factor that has become a central target of many prevention programs. However, evidence for its valid assessment in young, mixed-gender, adolescent samples is limited, and the current study is the first published to explore the psychometric properties of the 30-item Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3: Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004) in a non-adult community sample. Two samples of Grade 8 students (M age = 13.68 years, SD = .39), totalling 680 girls (N =332) and boys (N =348) completed the SATAQ-3 and other measures, whereas a smaller sample (N = 123) of Grade 10 females (M age = 15.01 years, SD = .41) served as a comparison group for supplementary analyses. Principal component analyses (PCA) with data from Sample One (N=201) revealed four factors with eigenvalues >1.0, similar to the original authors structure but where some cross-loading occurred between the Pressures and Internalization – General scales. Confirmatory factor analyses (CFA) were conducted with data from Sample Two (N=479) on the factor solution found in the PCA. The model did not fit well, leading to further revisions based on removal of cross-loading items and CFA modification indices, resulting in a 19-item, 4 factor solution with acceptable fit. Examinations of validity and reliability were generally acceptable. The overall findings suggest an abbreviated version of the SATAQ-3 might be more appropriate than the original version with young-adolescent, mixed gender audiences. Further examinations of the psychometric properties of the SATAQ-3 with this demographic are indicated

Online prevention of disordered eating in at-risk young-adult women: A two-country pragmatic randomized controlled trial

This article has been published in a revised form in Psychological Medicine. This version is free to view and download for private research and study only. Not for re-distribution, re-sale or use in derivative works. © Cambridge University Press 2017. This author accepted manuscript is made available following 6 month embargo from date of publication (Dec 2017) in accordance with the publisher’s copyright policyDisordered eating (DE) is a widespread, serious problem. Efficacious prevention programs that can be delivered at-scale are needed. A pragmatic randomized controlled trial of two online programs was conducted. Participants were young-adult women from Australia and New Zealand seeking to improve their body image. Media Smart-Targeted (MS-T) and Student Bodies (SB) were both 9-module interventions released weekly, whilst control participants received positive body image information. Primary [Eating Disorder Examination–Questionnaire (EDE-Q) Global], secondary (DE risk factors) and tertiary (DE) outcome measures were completed at baseline, post-program, 6- and 12-month follow-up. Baseline was completed by 608 women (M age = 20.71 years); 33 were excluded leaving 575 randomized to: MS-T (N = 191); SB (N = 190) or control (N = 194). Only 66% of those randomized to MS-T or SB accessed the intervention and were included in analyses with controls; 78% of this sample completed measures subsequent to baseline. Primary intent-to-treat (ITT) analyses revealed no differences between groups, while measure completer analyses found MS-T had significantly lower EDE-Q Global than controls at 12-month follow-up. Secondary ITT analyses found MS-T participants reported significantly higher quality of life–mental relative to both SB and controls (6-month follow-up), while MS-T and controls had lower clinical impairment relative to SB (post-program). Amongst measure completers, MS-T scored significantly lower than controls and SB on 5 variables. Of those with baseline DE, MS-T participants were significantly less likely than controls to have DE at 12-month follow-up. Given both programs were not therapist-moderated, MS-T has potential to achieve reductions in DE risk at low implementation costs

A longitudinal investigation of the impact of disordered eating on young women's quality of life

"This article may not exactly replicate the authoritative document published in the APA journal. It is not the copy of record." Author manuscript made available here in accordance with Publisher copyright policy.OBJECTIVE: The extent to which subclinical levels of disordered eating affect quality of life (QOL) was assessed. METHOD: Four waves of self-report data from Survey 2 (S2) to 5 (S5) of a national longitudinal survey of young Australian women (N = 9,688) were used to assess the impact of any level of disordered eating at S2 on QOL over the following 9 years, and to evaluate any moderating effects of social support and of depression. RESULTS: At baseline, 23% of the women exhibited some level of disordered eating, and they scored significantly lower on both the physical and the mental component scores of the SF-36 at every survey; differences in mental health were still clinically meaningful at S5. Social support and depressive symptoms each acted as a moderator of the mental component scores. Women with both disordered eating and low social support, or disordered eating and depression, had the worst initial scores; although they improved the most over time, they still had the lowest scores at S5. Higher social support at baseline resulted in women with disordered eating being largely indistinguishable from women without disordered eating who had low social support. Lower levels of depression resulted in women with disordered eating having a significantly better QOL than women with high levels of depression, regardless of eating status. CONCLUSIONS: This is the first study to examine the long-term impact of subclinical levels of disordered eating on QOL, and it suggests that even apparently minor levels of symptomatology are associated with significant and far-reaching deficits in well-being

Impact of guidance on intervention adherence in computerised interventions for mental health problems: A meta-analysis.

Web-based interventions are increasingly used for the prevention, treatment and aftercare of mental disorders. A crucial factor to the efficacy of such online programmes is adherence to the intervention content and procedure. It has been frequently suggested that adherence in web-based interventions is low and little is known about which factors influence adherence. To increase intervention uptake and completion, studies increasingly include interventions with some form of guidance. Guided interventions have been shown to have higher efficacy, however, evidence for the impact on adherence is limited and mixed. This meta-analysis explored the impact of human guidance on intervention completion in web-based mental health interventions. A total of 22 studies were included with interventions primarily targeting symptoms of depression and anxiety disorders. Results showed that guidance significantly increases the average amount of intervention completion [g = 0.29, 95% confidence interval (CI) 0.18-0.40] and the proportion of intervention completers [log odds ratio (OR) = 0.50, 95% CI 0.34-0.66] with small effects. On average, full completion rates were 12% higher in guided intervention groups. This meta-analysis demonstrated that guidance in web-based mental health interventions does increase adherence, but more research is required to better understand the specific mechanisms between guidance, adherence and outcomes.</p

Life Smart: A Pilot Study of a School-Based Program to Reduce the Risk of Both Eating Disorders and Obesity in Young Adolescent Girls and Boys.

Author version made available following 36 month embargo from date of publication (22 May 2013) in accordance with publisher copyright policy.Objective: To develop and pilot Life Smart, an 8-lesson program aimed at reducing risk factors for both eating disorders and obesity. Methods: Grade 7 girls and boys (N=115) from one independent school were randomly allocated to the Life Smart (2 classes; N = 51) or control (3 usual classes; N=64) conditions. Risk factors were measured at baseline and post-program (5-weeks later). Results: Life Smart was rated as moderately enjoyable and valuable by participants. ANCOVAs with baseline as a covariate revealed a significant main effect for group favouring Life Smart for shape and weight concern (Effect Size [ES] = .54), with post-hoc testing finding girls particularly benefited on this variable (ES = .78). Conclusions: Feedback was generally favourable, with some suggestions for even more interactive content. The program showed more promise with girls. Informed by these findings, the program underwent revisions and is now being evaluated in a randomized controlled trial