Adaptation and validation of the Body Image Life Disengagement Questionnaire (BILD-Q) for use in english among adolescents in urban India.

Body image concerns are a global issue among adolescents, including in India. These concerns can prevent adolescents from engaging in everyday life activities, impeding social and academic development. However, at present, there are no psychometrically valid measures to assess such impact in the Indian context. This study culturally adapted and validated the Body Image Life Disengagement Questionnaire (BILD-Q) for use in English among adolescents in urban India. A total of 1427 adolescents completed an adapted version of the BILD-Q along with additional measures pertaining to body image. Exploratory factor analysis identified one dimension of body image life disengagement, which provided the best fit. The 9-item one-factor model was further supported by confirmatory factor analysis. The scale demonstrated good internal consistency and test re-test reliability. Further analysis demonstrated that the scale can be used to compare scores between boys and girls without measurement bias. This study presents a culturally adapted version of the BILD-Q, which can be used as a valid and reliable measure to assess the impact of body image concerns on life disengagement among English-speaking adolescents in urban India.

Adaptation and Validation of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) for Use in English among Adolescents in Urban India.

Eating pathology is increasingly common among Indian adolescents. However, brief validated measures of disordered eating in Indian contexts are scarce. This study adapted and validated a culturally appropriate English language version of the Child Eating Disorder Examination Questionnaire (ChEDE-Q) among 385 adolescents (mean age = 13.42 years; 47.3% girls) in urban India. Confirmatory factor analysis indicated that a two-factor eight-item solution had an acceptable fit to the data across gender: an 'Eating Concerns and Restraint' subscale and a 'Weight and Shape Concerns' subscale. Further, the questionnaire can be utilised as both a unidimensional and multidimensional tool. This allows for the computation of a total score on the primary factor of 'Child Eating Pathology', as well as the two subscales. Internal consistency of the 'Weight and Shape Concerns' subscale (α = 0.825) and 'Eating Concerns and Restraint' subscale (α = 0.649) was satisfactory. Concurrent validity was established through medium significant correlations with measures of body image and broader mental health. The results support the use of the ChEDE-Q for assessing disordered eating among urban Indian adolescents, thus providing the research community and practitioners with a measure to investigate the nature and scale of disordered eating among adolescents in India.

Evaluating a body image school-based intervention in India: A randomized controlled trial.

Body dissatisfaction is highly prevalent among adolescents in low- and middle- income countries, including in India. However, evidence-based interventions are lacking. This study evaluated the efficacy of a school-based mixed-gender body image intervention among adolescents in India. A randomized controlled trial was conducted among 568 (43 % girls) Year 7 students (aged 11-14; 94 % aged 12-13) in six schools in Delhi. Each school was randomly allocated to receive five 45-minute intervention sessions delivered by trained psychologists or a wait-list control condition. The primary outcome of body image and related secondary outcomes were assessed at pre-intervention, post-intervention, and 3-month follow-up. Intention-to-treat linear mixed models analyses showed improvements in body image relative to the control group at post-intervention and 3-month follow-up. Significant improvements were identified at post-intervention for internalization, life disengagement, disordered eating, self-esteem, and negative affect, with effects maintained in nearly all outcomes (girls only - internalization, boys only - life disengagement) at 3-month follow-up. This study presents the first mixed-gender school-based body image intervention in India, which was efficacious in improving urban adolescents' body image, disordered eating, and related outcomes.

Addressing mealtime behaviours of children with autism spectrum disorders in schools: a qualitative study with educators in Mumbai, India.

This study was conducted to explore the experiences of educators with mealtime behaviours of children with a diagnosis of Autism Spectrum Disorders (ASD) in schools, and to explore the strategies undertaken in schools to improve nutrition among these children. In-depth interviews were conducted with 13 educators of various special schools across Mumbai. They described their experiences with 3-11 year-old children with a diagnosis of ASD. Four themes emerged from this study: reasons for disruptive mealtime behaviours, using mealtimes as opportunities for indirect learning, strategies used to avoid disruptive mealtime behaviours, and school policies regarding food and nutrition. The presence of sensory stressors, changes in break-time schedules, and inability to communicate hunger were identified as main reasons for disruptive mealtime behaviours in the classroom. Strategies to tackle these behaviours were discussed. Most educators reported that their school followed a strict 'no junk-food' policy. The perspective of educators is important to understand the mealtime behaviours of children with ASD in school settings. The initiatives taken at the school-level are valuable as they provide a different approach and diverse strategies that may work to improve the food intake and nutrition of children with ASD.

Acceptability and preliminary efficacy of a school-based body image intervention in urban India: A pilot randomised controlled trial.

This pilot study evaluated the acceptability and preliminary efficacy of a culturally adapted school-based body image intervention, Dove Confident Me, for use in urban India. Two private schools in New Delhi were randomly assigned at the school level to receive either the five-session intervention facilitated by trained psychologists or lessons-as-usual (control). Participants were Year 7 students (N = 166; Mage = 11.9 years). Students, facilitators, and observing teachers, provided acceptability feedback. Fidelity was assessed. Body image and related measures were completed by students in a classroom setting at pre-intervention, post-intervention, and two-month follow-up. Most students enjoyed (73.7 %) and understood (84.2 %) the intervention. Facilitators (90 %) and observing teachers (70 %) reported that the learning objectives were achieved. Adherence and facilitator competence were rated as very good. Body esteem improved significantly among intervention students at post-intervention and follow-up (Cohen's ds = .45-.46), relative to control students. Positive affect also improved at post-intervention (d = .58). No significant effects on internalisation, life engagement, eating pathology, self-esteem, or negative affect emerged. This study provides evidence for the acceptability and preliminary efficacy of Dove Confident Me in urban India. Intervention refinements to increase acceptability and efficacy are recommended.

Cultural adaptation and validation of the Body Esteem Scale for Adults and Adolescents for use in English among adolescents in urban India.

Body image research is growing in India; however, there are no psychometrically valid measures to assess body image concerns among an Indian population. In this study, the Body Esteem Scale for Adults and Adolescents (BESAA) underwent adaptation and validation among urban Indian adolescents in English. Cultural adaptations were made in consultation with body image experts and acceptability interviews with adolescents in India. 1462 adolescents living in Northern India completed the adapted BESAA and measures to assess construct validity. For girls, a 15-item three-factor model provided the best fit to our data, using exploratory factor analysis, with 'Appearance-Negative', 'Appearance-Positive', and 'Weight' subscales. For boys, a 7-item two-factor model provided best fit, with 'Appearance-Negative' and 'Appearance-Positive' subscales. Models were confirmed via confirmatory factor analysis. The scales demonstrated good internal consistency and satisfactory test-retest reliability. Construct, convergent validity was supported for girls and boys through significant correlations with figure rating scales and disordered eating. Further analyses using common items across the female and male scales, produced a psychometrically sound scale that can be used comparatively across genders. This study presents a culturally adapted, shortened BESAA as a valid and reliable measure to assess body image concerns in English among urban Indian adolescents.

Adaptation and validation of the Internalisation-General subscale of the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ-3) in English among urban Indian adolescents.

Few studies have validated body image related measures in Asian countries, including in India, thus stunting research progress. To provide a robust method of assessing internalisation of cultural appearance ideals, the purpose of this study was to validate a culturally appropriate English version of the Internalisation-General subscale from the Sociocultural Attitudes Towards Attitudes Questionnaire-3 among a school sample of 1,432 urban Indian adolescents (Mage = 12.9 years; 44 % girls). Exploratory factor analyses revealed a one-factor solution for both girls and boys. Analyses indicated a six-item scale for girls and a four-item scale for boys; both of which were verified by confirmatory factor analysis. Cronbach's alpha was high for both female (.88) and male scales (.87), and convergent validity was confirmed via significant correlations with measures of body esteem and disordered eating. Using the items which were common in both the male and female versions of the scale, confirmatory factor analysis supported a psychometrically sound model that was gender invariant, and thus can be used to assess and compare both genders. Overall, results support the reliability and validity of the Internalisation-General subscale among English-speaking urban Indian adolescents.

Adaptation and validation of the Eating Disorder Examination-Questionnaire in English among urban Indian adolescents.

OBJECTIVE: Eating pathology is a salient issue in India, with clinical features reported among adults and adolescents. However, there are currently no validated measures of disordered eating in the Indian context. The present study therefore aimed to validate a culturally appropriate English language version of the Eating Disorder Examination Questionnaire (EDE-Q), a widely used measure, among adolescents in India. METHOD: We adapted and examined the factor structure, reliability, and construct validity of the EDE-Q among an urban sample of 1,413 Indian adolescents (mean age = 13 years; 45% girls). RESULTS: In contrast to the original four-factor model, exploratory factor analysis identified a two-factor solution for girls and boys, which was verified by confirmatory factor analysis; a "Preoccupation and Control" subscale and a "Weight and Shape Concerns" subscale. The total scale comprised 15 items for girls and 18 items for boys. Test-retest reliability and internal consistency were satisfactory for the girls' and boys' scales (Cronbach's α = .91 for both) and their comprising subscales (αs ≥ .80). Concurrent validity was established through medium-high significant correlations with measures of body image and internalization of appearance ideals. Combining items common to both versions of the scale led to a psychometrically acceptable model which was largely invariant across both genders, thus facilitating gendered comparison. DISCUSSION: Findings indicate the reliability and validity of the EDE-Q among English-speaking urban Indian adolescents. This will facilitate further research examining the prevalence and nature of eating pathology among adolescents in India.

An exploration of the psychometric properties of the SATAQ-4 among adolescent boys in Japan.

Research among Western adult and adolescent males suggests that sociocultural influences are implicated in the drive for muscularity and weight-change behaviors. However, few studies have examined these relationships among adolescent boys from non-Western backgrounds. The current study sought to assess the psychometric properties of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4), a 22-item, 5-factor measure of sociocultural influence on appearance ideals, among Japanese (n = 984) adolescent boys. Relationships between appearance-related pressures, appearance ideal internalization, appearance-related teasing, drive for muscularity, and weight-change behaviors were also assessed. Exploratory and confirmatory factor analyses identified a four factor solution (Internalization: Thin/Low Body Fat, Internalization: Muscular/Athletic, Pressures: Media, and Pressures: Family/Peers) with 16 items in this sample. Correlational analyses supported the construct validity of the SATAQ-4. Thin internalization was associated with strategies to lose weight, while muscular internalization was associated with drive for muscularity and strategies to gain weight. Further, peer and parental appearance teasing was associated with perceived appearance pressures from family and peers, as well as weight change strategies. Overall, results suggested modification of the SATAQ-4 when used with Japanese samples, but supported its use to assess sociocultural influences. Additionally, the results highlight that sociocultural influences and muscularity concerns among Japanese adolescent boys are associated in similar ways with weight change strategies as has been established for adolescent males in Western countries.

The relationship between sensory integration challenges and the dietary intake and nutritional status of children with Autism Spectrum Disorders in Mumbai, India.

Objective: This study was conducted to assess the dietary intake, food refusal, and nutritional status of younger and older children with Autism Spectrum Disorders (ASD) in Mumbai, India, and to understand the relationships between these variables and mealtime behaviors and sensory integration. Methods: This was an observational cross-sectional study. Convenience and snowball sampling was used. Data were collected from 146 mother-children pairs, where children belonged to two age groups (3-6 years and 7-11 years). Caregivers completed scales on mealtime behaviors, sensory integration, and the dietary intake of their children. Nutritional status of the children was assessed by measuring their height and weight. Based on BMI 'z' scores, children were classified as 'Underweight', 'Mild Underweight', 'Normal BMI', 'Overweight', or 'Obese'. Results: There was no significant difference in mealtime behavior and sensory integration scores between the two age groups. There was a significant inverse relationship between the mealtime behavior and sensory integration scores. There was no relationship between these two variables and the dietary intake of children. However, there was a significant relationship between these two variables and the number of food groups refused by children with ASD. Only 39.7% children had a normal BMI. There was a significant positive relationship between dietary intake and nutritional status of children. Conclusion: Difficulties in sensory integration may contribute to mealtime behavioral problems and inadequate dietary intake in these children. At the same time, higher dietary intake (which may be poor in diversity) may be related with a higher likelihood of being overweight.

Skin Color, Cultural Capital, and Beauty Products: An Investigation of the Use of Skin Fairness Products in Mumbai, India.

The use of skin fairness products that frequently contain toxic ingredients is associated with significant adverse health side effects. Due to the high prevalence of use in Asian and African countries, skin fairness product use is recognized as a growing public health concern. The multi-million-dollar skin fairness product industry has also been criticized for perpetuating racism and social inequalities by reinforcing beliefs about the benefits of skin fairness for cultural capital. No quantitative studies have assessed people's beliefs about fairness and reasons for using or not using these products in India, one of the largest global markets for skin fairness products. The current study explored skin fairness product use among 1,992 women and men aged 16-60 years in the city of Mumbai, India using a self-report questionnaire. A total of 37.6% of the sample reported currently using skin fairness products, with women being two times more likely to use these products. Among current users, 17% reported past experiences of adverse side effects, and "Media/TV/Adverts" were the most common prompts for using fairness products, followed by "Friends" and "Family." Men were significantly more likely than women to endorse beliefs about fairness being more attractive and were more likely to perceive family and peers as viewing fairness as beneficial for cultural capital. There were no differences between women and men currently using products in their desire to look as fair as media celebrities. Among non-users, women were significantly more likely than men to report concerns about product efficacy and side effects as reasons for non-use, while men were significantly more likely to report socioeconomic reasons for non-use. Implications of these findings are discussed in light of growing public health concerns about the use of fairness products, and potential for advocacy and public health interventions to address the use of skin fairness products.

Mass media exposure to tobacco messages among secondary school children in Mumbai.

The objectives of this study were to explore differences in exposure to media messages (pro- and antitobacco messages, marketing and promotions) between students consuming tobacco, areca nut, nonconsumers, and those intending to quit and to examine differences between municipal and private school students. The Global Youth Tobacco Survey was completed by secondary school students (N = 534) from municipal and private schools in Mumbai. Overall, the number of students who reported ever use of tobacco was quite low (5.1%). There was no significant difference in exposure to media messages between users of tobacco, areca nut, and nonusers. There were significantly higher numbers of ever users of tobacco in private compared to municipal schools. There was a significant association between exposure to marketing and promotions and intention to quit, but not with the other exposure variables. Media exposure may be related to intention to quit but not to quitting behavior.

The tripartite influence model of body image and eating disturbance: a replication with a Japanese sample.

OBJECTIVE: To examine the tripartite influence model of body image and eating disturbance as a viable sociocultural explanation for the development of eating and body image problems with young Japanese females. METHOD: A sample of 289 Japanese female undergraduates completed a variety of measures designed to index family, peer, and media influences, as well as levels of body dissatisfaction, eating disturbances, and self-esteem. RESULTS: The data were evaluated with structural equation modeling to test the tripartite model. Fit indices indicated a moderate fit to the overall tripartite model, replicating previous findings. CONCLUSION: This study suggests that the sociocultural variables found to influence body image and eating disturbances in Japan are similar to those observed with US samples. The implications for prevention and intervention programs are discussed.

Relations among multiple peer influences, body dissatisfaction, eating disturbance, and self-esteem: a comparison of average weight, at risk of overweight, and overweight adolescent girls.

OBJECTIVE: The goal of this study was to evaluate peer-related influences on appearance, body dissatisfaction, eating disturbance, and self-esteem in average weight, at risk of overweight, and overweight adolescent girls. METHODS: Three hundred twenty-five adolescent girls from high schools in Florida were assessed. Ninety met criteria for being at risk of overweight or overweight. Logistic and multiple regression analyses were used to evaluate group differences on all variables and to assess the amount of variance accounted for by peer-influence variables in the prediction of body dissatisfaction, eating disturbance, and self-esteem. RESULTS: Overweight and at risk of overweight girls scored higher than average weight girls on body dissatisfaction, dieting, and a peer measure that assessed negative comments and attributions about appearance. They also scored lower than average weight girls on self-report measures that assessed conversations about appearance and anti-dieting advice. How influential friends were in determining one's body image was a unique predictor of body dissatisfaction but only for the overweight and at risk of overweight group. CONCLUSIONS: Possible implications for clinical intervention programs are discussed along with directions for future research.

Peer influences, body-image dissatisfaction, eating dysfunction and self-esteem in adolescent girls.

A sample of 344 adolescent girls completed a variety of measures designed to index the associations among peer influences, body-image dissatisfaction, eating dysfunction and self-esteem. Results indicated that participants were significantly similar to their nominated friends on self-esteem, but not body image or eating disturbance. Peer measures were significantly associated with body dissatisfaction, eating problems and self-esteem. Peer suppression of feelings, internalization of the thin-ideal and appearance comparison were significant mediators in path analyses testing the direct and indirect role of peer influences on outcome variables. Implications for intervention and prevention programs are discussed.

Features associated with excessive exercise in women with eating disorders.

OBJECTIVE: Excessive exercise and motor restlessness are observed in a substantial number of patients with eating disorders. This trait has been studied extensively among animal models of activity anorexia nervosa (AN) and may hold particular interest as an endophenotype for AN. We explored features associated with excessive exercise across subtypes of eating disorders. METHOD: Participants were female probands and affected female relatives from the multi-site international Price Foundation Genetic Studies with diagnoses of AN, bulimia nervosa (BN), and both AN and BN or eating disorder not otherwise specified (ED-NOS) (N=1,857). Excessive exercise was defined based on responses to the Structured Interview for Anorexic and Bulimic Disorders (SIAB). RESULTS: Among the eating disorder diagnostic groups, excessive exercise was most common among the purging subtype of AN. Individuals who reported excessive exercise also reported lower minimum BMI, younger age at interview, higher scores on anxiety, perfectionism, and eating disorder symptom measures, more obsessions and compulsions, and greater persistence. CONCLUSION: Excessive exercise may be associated particularly with the purging subtype of AN as well as with a constellation of anxious/obsessional temperament and personality characteristics among women with eating disorders.

The tripartite influence model of body image and eating disturbance: A replication with adolescent girls.

The tripartite influence model of body image and eating disturbance is a recent theoretical approach that includes a test of direct (peer, parental, and media factors) and mediational links (internalization of societal appearance standards, appearance comparison processes) as factors potentially leading to body dissatisfaction and eating disturbance. The theory was evaluated in the current study in a sample of 391 adolescent females. A structural equation model that evaluated the tripartite model replicated previous findings reported by Keery, van den Berg and Thompson (2004) [Keery, H., van den Berg, & Thompson, J. K. (2004). A test of the tripartite influence model of body image and eating disturbance in adolescent girls. Body Image: An International Journal of Research, 1, 237-251.]. Additionally, a second model extended these findings, suggesting that peer and media influences are more important than parental influences. The results are discussed in light of the need for prevention programs to incorporate formative influences and mediational processes in the construction of intervention strategies.

Body image and eating disturbance in India: media and interpersonal influences.

OBJECTIVE: The current study was designed to examine the relationships among the variables of body mass index (BMI), interpersonal teasing, media internalization, body dissatisfaction, and drive for thinness in samples of young adult and middle school females from India. METHOD: Ninety-six adolescent and 93 adult females from Bombay, India, completed measures of body dissatisfaction, restriction, teasing history, and internalization of media images. Correlational and path analytic procedures were used to examine the data. RESULTS: Path analyses indicated that teasing and internalization mediated the effect of BMI on body dissatisfaction and in certain cases influenced drive for thinness. DISCUSSION: These findings replicate and extend previous work with U.S., Australian, and Swedish samples, suggesting that there are similar potential risk factors, cross-culturally, that may explain the development of eating and shape-related problems.