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Eating disorders: explanatory variables in Caucasian and Hispanic college women.

The authors explored Hispanic and Caucasian college women's (N = 264) behavioral and attitudinal symptoms of eating disorders after controlling for body mass index and internalization of the thinness ideal, as well as the roles of ethnicity and ethnic identity in symptomatology. Correlational analysis, multivariate analysis of variance, and regression analysis suggested more similarities than differences between Hispanic and Caucasian college women in terms of eating disorders.

Keywords: eating disorders, racial/ethnic differences, ethnic identity

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Examinations of eating disorders among women from the Caucasian majority ethnic group are ample; however, there is limited research with women from ethnic minority groups. For many years, researchers have assumed that eating disturbances occurred primarily in female Caucasian populations and did not include members of racial/ethnic minority groups in research studies (Cachelin, Veisel, Barzegarnazari, & Striegel-Moore, 2000). Eating disorders were coined the "White female phenomenon" (Mastria, 2002, p. 59), and racial minority group membership was considered a protective factor against the development of these disorders. However, perhaps underdiagnosis has occurred because of these beliefs.

Researchers who have compared prevalence of eating disorder symptoms among African American and Caucasian college women have consistently reported higher symptomatology among Caucasian participants (Abrams, Allen, & Gray, 1993; Petersons, Rojhani, Steinhaus, & Larkin, 2000). However, in studies that included Hispanic participants, researchers tended to report that there were more similarities than differences in terms of symptomatology between Hispanic and Caucasian college women (Franko, Becker, Thomas, & Herzog, 2007).

Not only the ethnic group that individuals belong to, but also how much they identify with their ethnic group, should be considered--that is, one's value of and attachment to ethnicity as part of one's sense of self (Phinney, 1992). Some researchers have proposed that compared to mainstream Caucasian American culture, ideals of beauty in African American and Hispanic cultures are more accepting of larger figures (Warren, Gleaves, Cepeda-Benito, Fernandez, & Rodriguez-Ruiz, 2005). It is possible that African American and Hispanic women who identify highly with their ethnic group are likely to adhere to these cultural ideals and not feel as pressured as Caucasian women to conform to Western societal ideals of thinness. In contrast, African Americans and Hispanics who do not identify highly with their ethnicity may be more likely to endorse Western values regarding beauty ideals and to exhibit eating disorder symptoms similar to their Caucasian counterparts (Petersons et al., 2000). In other words, high levels of ethnic identity may serve as a protective factor in relation to eating disorder symptoms.

In the United States, approximately 1% to 3% of women are diagnosed with an eating disorder (Tylka & Mezydlo-Subich, 2004). However, the number of young adult women who report engaging in unhealthy eating practices yet do not meet criteria for eating disorder diagnoses is considerably higher (Mintz & Betz, 1988). As members of the country's most ethnically diverse university, we had the opportunity to study whether college women from Hispanic and Caucasian ethnic groups differ in behavioral and attitudinal symptoms of eating disorders. The college population is highly relevant in this matter: According to Mintz and Betz (1988), 61% of college women indicated that they either occasionally or regularly used extreme measures to control their weight, such as fasting, appetite suppressants, diuretics, or purging after eating. Because, in previous research, body mass index (BMI) has emerged as a predictor of concerns with weight and eating, BMI was included in our analysis.

Assessment of Eating Disorder Symptoms

Eating disorder symptoms among normative populations such as college students are typically assessed with self-report measures that include items related to both behavioral and attitudinal symptoms. Behavioral symptoms refer to actions taken to change one's weight or shape, such as abstaining from eating, exercising excessively, binging, purging, and using laxatives or diuretics. Attitudinal symptoms typically involve thoughts or beliefs in reference to body weight or shape, such as fear of gaining weight, preoccupation with being overweight/underweight, and disturbance in the way in which one's body weight or shape is experienced.

Women's weight or BMI, a number calculated from a person's weight and height that is often used as an indicator of body fat, has emerged as an important predictor of eating disorder symptoms. Research with Caucasian and ethnic minority women has shown that weight and BMI are positively associated with eating disorder symptoms, primarily attitudinal symptoms (Abrams, Allen, & Gray, 1993; Arriaza & Mann, 2001). Arriaza and Mann (2001) found that women with higher BMIs reported higher levels of attitudinal symptoms including body dissatisfaction and weight concerns than their peers with lower levels of body fat; however, BMI was not associated with these women's self-reported eating behaviors. Furthermore, Arriaza and Mann's findings indicated that differences in body dissatisfaction and weight concerns among Caucasian and Hispanic women disappear if BMI is controlled for. Because Hispanic and African American women tend to report higher levels of weight or BMI than do Caucasian women (Warren et al., 2005), researchers have argued that it is important to control for BMI when comparing the prevalence of eating disorder symptoms among women from diverse ethnic groups (Arriaza & Mann, 2001; Avina, 2008).

Prevalence of Eating Disorder Symptoms Among Diverse Groups

In examining the literature that compares ethnic minority and Caucasian women with the use of composite measures of eating disorder symptoms, two important factors come to light. One is the role of the BMI in examining differences between women's symptomatology rates. In studies in which researchers controlled for BMI, mixed findings regarding the relative prevalence of eating disorder symptoms among ethnic minority women compared with Caucasian women were reported. Researchers who did not control for BMI consistently found differences between the ethnicities, indicating less symptomatology among African American participants compared with Caucasians (Bulimia Test-Revised [BULIT-R; Smidi & Thelen, 1984] and Eating Disorder Inventory [EDI; Garner, 2004]). There is a discrepancy in the findings based on the ethnic composition of the samples. Researchers who included Hispanic women in their studies, and controlled for BMI, reported similar levels of symptomatology between Hispanic and Caucasian women, regardless of whether participants were college students or women from the community (Rich & Thomas, 2008). In contrast, the majority of researchers who included African American women in their studies indicated that African American women reported less symptomatology than Caucasian women, regardless of whether BMI was used as a control in the comparison (Petersons et al., 2000; Wilfley et al., 1995).

Few researchers have assessed behavioral and attitudinal eating disorder symptoms separately. Researchers who have examined behavioral and attitudinal symptoms of eating disorder separately have found more similarities across ethnic groups in attitudinal compared with behavioral symptoms, particularly among Hispanic and White women (Abrams et al., 1993; Arriaza & Mann, 2001; Shamaley-Kornatz, Smith, & Tomaka, 2007). African American women report lower levels of symptoms than Caucasian women (Abrams et al., 1993), regardless of the use of BMI and/or weight as controls.

Internalization of Ideals for Thinness

Endorsement of thinness as a beauty ideal is a well-established predictor of eating disorder symptoms. Ideals for thinness refer both to an individual's awareness of sociocultural pressures to fit a thin prototype and to the internalization of the thinness beauty standard (Cusumano & Thompson, 1997). It is believed that social pressures to conform to the thin body shape ideal have contributed to the increased incidence of eating disorder symptomatology among young women (Warren et al., 2005).

Research findings have consistently shown that, as the awareness and internalization of ideals for thinness increase, so do eating disorder symptoms, as measured by composite scales such as the Eating Attitudes Test (Griffiths et al., 2000; Stice, Schupak-Neuberg, Shaw, & Stein, 1994) or the EDI (Avina, 2008; Cusumano & Thompson, 1997). More specifically, internalization consistently accounted for more of the variance associated with measures of eating disorder symptoms than awareness, suggesting that it is the acceptance of these ideals and not just the exposure to them that is associated with eating disorder symptomatology (Griffiths et al., 2000). Ethnic minority representation in the aforementioned studies is sparse. However, the few existing studies reveal that among Hispanic college women, internalization of the thin ideal is positively associated to eating disorder symptoms (Avina, 2008; Cusumano & Thompson, 1997; Warren et al., 2005).

To our knowledge, no study has examined the relation of the internalization of beauty ideals to behavioral and attitudinal symptoms separately. However, it seems reasonable to speculate that the internalization of ideals for thinness would be positively associated with both behavioral and attitudinal symptoms and may be an underlying cause for eating disorder symptoms. Although internalization appears as a more attitudinal than behavioral mechanism, one could expect that the effects of internalizing thinness as a beauty ideal may manifest themselves in eating disorder behavioral symptoms.

Acculturation

Internalization of ideals for thinness is part of conforming to societal pressures to fit the thin, Caucasian American prototype. For ethnic minorities, internalization may be one part of the acculturation process. Acculturation refers to the process of psychological change that occurs when immigrants are exposed to the cultural values, languages, and norms of their new environment (Berry, 2004). Compared to mainstream Caucasian American culture, traditional Hispanic beauty standards are more tolerant of larger figures (Cachelin et al., 2000). It is possible that as some Hispanic women in the United States acculturate, they adopt and internalize mainstream values regarding weight, body image, and appearance. Those who are highly acculturated to the Caucasian American culture may be more at risk for eating disorder symptoms due to internalizing the dominant view of beauty.

More important than women's belonging to an ethnic group is perhaps how much they identify with their ethnicity and whether that identification is associated with the internalization of thinness as a beauty ideal. Whereas ethnicity designates membership in a racial, national, or cultural group, ethnic identity involves a selective psychological process that allows individuals to choose aspects of their ethnic group with which they will affiliate. Ethnic identity may be a particularly salient aspect of identity for ethnic minority group members. Members of the ethnic majority score significantly lower on measures of ethnic identity than do members of ethnic minority groups (Greig, 2003; Petersons et al., 2000).

An achieved ethnic identity has been associated with positive mental health and is believed to be protective against adverse mental health outcomes with or without serious risk factors (Greig, 2003). Among members of ethnic minority groups, ethnic identity has emerged as a protective factor in relation to self-esteem, coping, and optimism (Greig, 2003). Ethnic identity may also serve as a protective factor in relation to eating disorder symptoms. We found only one study that explored the relation between ethnic identity and prevalence of eating disorders among college-age women (Petersons et al., 2000). In this study, which included only Caucasian and African American women, Petersons et al., (2000) indicated that a high level of ethnic identity is negatively correlated with eating disorder symptomatology among African American women. For the Caucasian participants, in contrast, high levels of ethnic identity were associated with high levels of eating disorders.

Cachelin, Phinney, Schug, and Striegel-Moore (2006) examined the role of ethnic identity in eating disorders, using the Eating Disorder Examination (Petersons et al., 2007), among women in the Hispanic community who either met or did not meet diagnostic criteria for a current eating disorder. Consistent with Abrams et al.'s (1993) findings, Cachelin et al.'s findings revealed that identification with the Anglo American culture significantly predicted eating disorders.

The findings reviewed here suggest that identification with the majority ethnic group (acculturation) is positively associated with the endorsement of eating disorder symptoms among both Caucasian and ethnic minority women. In contrast, among ethnic minority women, identification with their own ethnic group may be negatively associated with endorsing eating disorder symptoms. A speculative assertion is that Caucasian women who identify with Black or Hispanic cultural identity (e.g., Caucasian blues or mariachi musicians or Caucasians raised in minority-dominated subcultures) may also be more protected against eating disorders than other Caucasian women.

We explored ethnicity, ethnic identity, behavioral symptoms of eating disorders, and attitudinal symptoms of eating disorders, as well as the associations of these variables with each other, to confirm or challenge earlier research findings. The following research questions were examined: (a) Does ethnic identity contribute to behavioral and attitudinal symptomatology, respectively, when controlling for BMI and the internalization of thinness as a beauty ideal? (b) Does ethnicity moderate the relation of ethnic identity to behavioral and attitudinal symptoms, respectively?

Method

Participants

Participants included 264 female students (45% Hispanic, n = 119; 55% Caucasian, n = 145) at a large urban university in the Southwest United States. We collected the data with the approval of the University of Houston's Committee for the Protection of Human Subjects. Participants ranged in age from 18 to 52 years, with the mean age being approximately 23 years (SD = 5.91). The majority of the Hispanic participants identified themselves as second generation (n = 72, 62.2%, SD = 1.27), followed by first generation (n = 25, 21.0%, SD = 1.13). The remaining 22 participants identified as third generation and beyond. BMI scores ranged from 16.64 to 51.49, with the average BMI being 24.3 (SD = 5.39) for Hispanics and 23.78 (SD = 5.97) for Caucasians. Acculturation levels ranged from 2.08 to 5.00, with the average acculturation score being 3.43 (SD = 0.65) for Hispanics and 4.47 (SD =.41) for Caucasians. A high score indicates higher level of acculturation to Anglo culture.

Procedure

Participants were recruited from undergraduate and graduate classes at the University of Houston through the Sona Systems (www.sona-systems.com/ default.aspx) research management system, which allows students to complete online surveys for course extra credit. The protocol consisted of a short demographic questionnaire and three measures described in the following text. Participants filled out informed consent materials and the research measures simultaneously.

Measures

We included demographic questions asking about a participant's age, ethnicity, parents' ethnicity, generational status, and estimated height and weight to calculate body mass. In addition, participants completed the following measures.

Eating disorder symptoms. The Eating Disorder Examination Questionnaire (EDEQ; (Fairburn & Beglin, 1994), a self-report version of a structured clinical interview (the Eating Disorder Examination), assesses both behavioral and attitudinal eating disorder symptoms that have been present for the previous 28 days. The EDEQ assesses behavioral and attitudinal symptoms and is composed of four subscales: Restraint, Eating Concern, Shape Concern, and Weight Concern. The Restraint subscale was used to measure eating disorder behavioral symptoms, and the Eating Concern, Shape Concern, and Weight Concern subscales were combined into a composite scale to measure attitudinal symptoms. The measure includes questions such as, "On how many of the past 28 days have you been deliberately trying to limit the amount of food you eat to influence your weight or shape?" Cronbach's alpha or internal reliability for scores of the scale in the present study was .94.

Ethnic identity. The Multigroup Ethnic Identity Measure (MEIM; Phinney, 1992) was developed to assess the participant's sense of belonging to her ethnic group, her attitudes toward the group, her endorsement of ethnic behaviors, and her understanding of the meaning of her ethnicity (Petersons et al., 2007). The MEIM is a 12-item self-report instrument, with scale totals reflecting levels of ethnic identity. It includes items such as, "I have a clear sense of my ethnic background and what it means for me." It has been used widely and has consistently shown good reliability, typically with alphas above .80 across a wide range of ethnic groups and ages (Phinney, 1999). Cronbach's alpha for scores of the scale in the present study was .87.

Ideals for thinness. The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ; Heinberg, Thompson, & Stormer, 1995) was developed to assess women's recognition and acceptance of societally sanctioned standards of appearance. It is a 14-item self-report measure composed of two subscales: Awareness of Societal Pressures and Internalization. High scores on the Awareness subscale indicate familiarity with the thinness ideal, whereas the Internalization subscale taps adoption of that ideal. The measure includes items such as, "I believe that clothes look better on thin models." The two subscales have strong internal consistency and construct validity based on results from factor analyses (Smolak, Levine, & Thompson, 2001). In a study with Hispanic college-age women, good reliability was reported, with alphas ranging between .81 and .86 (Warren et al., 2005). In the present study, only the Internalization subscale was used as a variable. Cronbach's alpha for scores of the subscale in the present study was .86.

Acculturation. The Short Acculturation Scale for Hispanics (SASH; Marin, Sabogal, VanOss Marin, Otero-Sabogal, & Perez-Stable, 1987) was developed to measure the process of changes in behavior and values by a Hispanic individual due to exposure to mainstream cultural patterns of the United States. It is a 12-item self-report scale, with a higher mean score indicating a higher level of acculturation to Anglo culture and a low score representing lower levels of acculturation to Anglo culture. The measure uses items such as, "What language(s) do you usually speak at home?" An average of 2.99 should be used to differentiate the less acculturated respondents (average score between 1.00 and 2.99) and the more acculturated (average score above 2.99). The scale has been used with Hispanic and Caucasian non-Hispanic participants and is comparable to other standardized acculturation scales in terms of reliability and validity (Marin et al., 1987). In the present study, we included acculturation as an exploratory analysis to provide additional information about our sample.

Results

Preliminary Analyses

In preliminary analyses, we examined means and standard deviations of the predictor and criterion variables for Hispanic and Caucasian participants (see Table 1), and Pearson product-moment correlations were computed for all variables included in the study (see Table 2).

Correlations

Bivariate correlations shown in Table 2 indicate that, as expected, BMI was positively related to eating disorder attitudes for women from both ethnic groups; however, the correlation of BMI to eating disorder behaviors was statistically significant (and positive) only for Hispanic women. Also, as expected, the relation of internalization and eating disorders attitudes and behaviors was positive and statistically significant for both groups of women. Ethnic identity was associated in the expected direction to acculturation, internalization of beauty ideals, and eating disorder attitudes and behavioral symptoms only for Hispanic women. As expected, the more that Hispanic participants identified with their ethnic group, the lower their levels of acculturation, their internalization of thinness as a beauty ideal, and their report of eating disorder behaviors and attitudes. The relation of acculturation to internalization and to attitudinal and behavioral eating disorder symptoms was not statistically significant for Hispanic or Caucasian women.

We conducted independent-samples t tests to compare mean acculturation scores and mean BMI scores for Hispanics and Caucasians. For BMI, the difference between the means was not statistically significant. For acculturation, the difference between the means is statistically significant, t(192) = -13.18, p = .001 (two-tailed).

Multivariate Analysis of Covariance (MANCOVA)

We conducted a MANCOVA with BMI as a covariate to compare ethnic groups on behavioral and attitudinal symptomatology. Results indicated a statistically significant multivariate effect for the covariate (BMI), Wilks's lambda = .88, F(2,259) = 0.88, p = .001, [[eta].sup.2] = .12. Differences in attitudinal and behavioral symptoms by ethnic group were not statistically significant. Univariate follow-up tests showed that the relation of the covariate (BMI) to eating disorder symptoms was positive and statistically significant for both behavioral symptoms, F(1, 259) = 10.04, p < .001, [[eta].sup.2] = .04; and attitudinal symptoms F(1, 259) = 33.99, p < .001, [[eta].sup.2] = .12.

Regression Analyses

We conducted two hierarchical linear regression analyses. The variables ethnicity, BMI, and internalization were entered as a block in the first step to control for their effects. (Acculturation was not entered as a control variable because it was not associated with eating disorder symptoms for either of the two groups of women.) We entered ethnic identity in the second step. In the third step, we entered the interaction term of ethnicity and ethnic identity to examine whether a moderation effect was present.

Behavioral symptoms. Results displayed in Table 3 showed that the combination of ethnicity, BMI, and internalization, entered in Step 1, explained 16% of the variance in behavioral eating disorder symptoms. Inspection of the beta coefficients showed that BMI and internalization of ideals contributed unique variance. The addition of ethnic identity in Step 2 did not contribute a statistically significant amount of variance in behavioral eating disorder symptoms. Inspection of the beta coefficients showed that BMI and internalization once again contributed unique variance. The change in [DELTA][R.sup.2] in Step 3, where the interaction term of ethnicity and ethnic identity was entered, was not statistically significant, indicating that ethnic identity did not affect the two groups differentially there.

Attitudinal symptoms. Results of the second hierarchical regression analyses showed that the combination of ethnicity, BMI, and internalization, entered in Step 1, explained 40% of the variance in attitudinal eating disorder symptoms. Inspection of the beta coefficients showed that BMI and internalization of ideals contributed unique variance. The addition of ethnic identity in Step 2 once again did not contribute a statistically significant amount of variance in behavioral eating disorder symptoms. Inspection of the beta coefficients showed that BMI and internalization once again contributed unique variance. The increment in [R.sup.2] in Step 3, where the interaction term of ethnicity and ethnic identity was entered, was not statistically significant, indicating that there is no moderator effect. Results from this regression are shown in Table 3.

Discussion

In this study, we examined whether Hispanic and Caucasian college women differed in behavioral and attitudinal symptoms of eating disorders as well as potential explanatory variables. Differences in acculturation level between the two groups are understandable, with the minority group less acculturated on average and with more variability among themselves than the majority group. Results showed that, when we controlled for BMI, Hispanic and Caucasian participants reported similar levels of behavioral and attitudinal eating disorder symptoms. These results are consistent with earlier findings that reported more similarities than differences in terms of composite measures of eating disorder symptomatology between Hispanic and Caucasian college women (Franko et al., 2007). However, the results are inconsistent with the findings of Arriaza and Mann (2001) and others who measured attitudes and behaviors separately while controlling for either weight (Abrams et al., 1993) or BMI (Arriaza & Mann, 2001; Gluck & Geliebter, 2002). These researchers found that, compared with Hispanic women, Caucasian women reported higher levels of eating disorder behavioral symptoms (and similar levels of attitudinal symptoms).

In line with Arriaza and Mann's (2001) findings, our results showed similar attitudinal eating disorder symptoms for both Hispanic and Caucasian participants after we controlled for BMI. Furthermore, there may be more likenesses between die two ethnic groups than was previously believed. The similarities in the behavioral findings between both groups could reflect an upward trend in symptomatology for Hispanics since earlier research studies. The present study used the same eating disorder behavioral symptoms scale used in the Arriaza and Mann study. In the present study, the behavioral symptoms' mean score for Hispanic participants was higher (M = 1.77) and closer to the mean for Caucasian women (M = 1.82) than the behavioral symptoms' mean scores reported in Arriaza and Mann's study (Hispanics, M = 1.34; Caucasians, M = 1.93). Past literature has posited that those who are highly acculturated to the Caucasian American culture may be more likely to internalize the dominant view of beauty and, therefore, be at higher risk for presenting eating disorder symptoms than their less acculturated counterparts. However, the lack of a statistically significant correlation between internalization and acculturation among either ethnic group in the present study does not provide support for this speculation. Hispanic participants in the study were highly acculturated and also reported very similar BMI scores to the Caucasian group, which may explain the lack of differences in both behavioral and attitudinal symptoms of eating disorders.

Behavioral and attitudinal symptoms were positively highly correlated with each other for both groups. Our findings also reiterate the strong relations between eating disorder symptoms and BMI in Hispanics; however, in the Caucasian group, BMI was correlated to attitudinal symptoms only. One may wonder why behavioral symptoms are not linked to BMI for this group. This variation cannot be explained through our data and analysis, and further research is needed to explain the differences in the findings.

Also consistent with previous studies is the finding that internalization of the thinness ideal has a positive relation with eating disorder symptoms for Hispanic and Caucasian college women (Avina, 2008; Cusumano & Thompson, 1997; Griffiths et al., 2000; Stice et al., 1994; Warren et al., 2005). Regardless of whether studies examined Caucasian and/or Hispanic women and measured behavioral and attitudinal symptoms together or each type of symptom separately, results indicate that the acceptance of the thin Western ideal is highly related to symptomatology for all women.

As speculated, among Hispanic participants, results of bivariate correlations showed that ethnic identity was negatively correlated to internalization and behavioral and attitudinal symptoms of eating disorder symptoms. These findings concur with the notion that a high ethnic identity for minorities is a protective factor against eating disorder symptoms (Abrams et al., 1993). However, after BMI and internalization were controlled for, ethnic identity failed to add predictive power. In other words, whatever explanatory force ethnic identity carried was redundant with BMI and internalization.

However, the regression analyses showed that the linear combination of BMI and internalization predicts more variance in relation to attitudinal ([R.sup.2] =. 40) than behavioral ([R.sup.2] = .16) symptoms. We are left to wonder why this is so. Perhaps this is because attitudinal symptoms are highly prevalent among all women, regardless of ethnicity or ethnic identity. Also, internalization could be classified as an attitudinal construct in itself, since it involves psychologically accepting and mentally implementing the desire to achieve the thin ideal. It could be that behavioral manifestations of an eating disorder are less socially acceptable, more difficult to maintain, and more often denied in self-reports than attitudes are.

A limitation of this study is the method of measurement. Self-report measures may not elicit completely accurate information, especially for height, weight, personal habits and attitudes, and value-laden information that participants may not be willing to divulge precisely. Online data collection may exacerbate the imprecision of the data. Furthermore, future research should consider whether students are athletes or in sororities, given the high prevalence of disordered eating in these college groups (Alexander, 1998).

Our study extends other research showing that eating disorder symptoms, both behavioral and attitudinal, are equally occurring for Caucasian and Hispanic women. BMI and internalization of ideals of thinness are consistently correlated to eating disorder symptoms and should be key components of eating disorder research.

Implications for College Counselors

This study's findings suggest that counselors should consider eating disorder symptoms among women from all ethnic groups, not just women from the majority ethnic group as popularly believed (Cachelin et at, 2000). Thus, proper concern and intervention should be applied to all female college students.

As Drum and Lawler (1988) proposed, counselors should respond differently to psychological problems according to level of severity: preventive, intermediate, and psychotherapeutic. Carney and Scott (2012) applied a similar philosophy to eating problems in particular. They identified "a continuum of severity, beginning with body image concerns, continuing to disordered eating, and concluding with eating disorders" (2012, p. 291). As our research indicates, intervention plans apply equally to the Hispanic college population as to others.

At the earliest level, Carney and Scott (2012) suggested that school-based programs can reach students who are at risk but not yet eating disordered. Counseling centers can institute outreach programs that promote healthy body image, self-esteem, and media literacy. To reach Hispanic women, such programs and workshops could be offered to Latina organizations and sororities that include mostly Latina women.

At the level of disordered eating, more direct interventions are necessary for women of all ethnic backgrounds. Clients may be invited to join short-term small groups focused on eating management, which give them psychoeducation and cognitive-behavioral strategies without labeling them as pathological. Disseminating invitations in Spanish and English may provide extra encouragement to Hispanic women. Women who compete as gymnasts, dancers, distance runners, or cheerleaders need to be targeted for such invitations, because these activities emphasize a lean physique and may accidentally support disordered eating.

If possible, women with problematic eating can be assessed with a standardized measure such as the Eating Disorder Examination and ideally also assessed by a physician for health problems. These evaluations will result in some formal diagnoses of eating disorders, at which point intensive treatment by experts is indicated. The counselor needs to "express serious concern for the student's health, and insist on enlisting help" (Carney & Scott, 2012, p. 294). If intensive treatment interrupts school attendance, the counseling center should have methods in place to help clients keep up and later reenter the regular school routine.

Received 04/06/12

Revised 01/30/13

Accepted 02/06/13

DOI: 10.1002/jocc.12029

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Vanessa Avina, Student Psychological and Testing Services, St. Mary's University; Susan X Day, Department of Psychological Health and Learning Sciences, University of Houston. Vanessa Avina is now at Counseling Services, The University of Texas at San Antonio. Correspondence concerning this article should be addressed to Vanessa Avina, Counseling Services, The University of Texas at San Antonio, One UTSA Circle, RWC 1.810, San Antonio, TX 78249 (e-mail: vanessa.avina@gmail.com).
TABLE 1
Means and Standard Deviations of Predictor and Criterion Variables

                                Hispanic             Caucasian

Measure                     n     M       SD     n     M       SD

Eating disorder attitudes   118    2.20   1.34   144    2.00   1.34
Eating disorder behaviors   118    1.77   1.48   144    1.82   1.53
Body mass index             119   24.30   5.39   145   23.78   5.97
Ethnic identity             119    3.73   0.73   145    3.35   0.64
Internalization             118   20.36   7.53   141   21.28   7.75
Acculturation               114    3.43   0.65   140    4.47   0.41

Note. The possible scores for eating disorder attitudes and behaviors
ranged from 0 to 6, respectively; Body mass index scores ranged from
16.64 to 51.49; ethnic identity scores ranged from 1 to 5;
internalization scores ranged from 8 to 40; acculturation scores
ranged from 1 to 5. In all cases, higher scores indicate a higher
level of the variable.

TABLE 2
Correlation Matrix

Variable                          1         2          3

1. Eating disorder attitudes     --        .65 **     .35 **
2. Eating disorder behaviors    .66 **      --        .13
3. Body mass index              .33 **     .28 **      --
4. Ethnic identity             -.23 **    -.18 *     -.01
5. Internalization              .54 **     .34 **    -.08
6. Acculturation                .06        .05        .15

Variable                          4          5         6

1. Eating disorder attitudes     .06        .49 **     .06
2. Eating disorder behaviors     .04        .33 **     .14
3. Body mass index               .04       -.05        .06
4. Ethnic identity                --        .06       -.17
5. Internalization              -.23 *        --       .03
6. Acculturation                -.36 **     .08         --

Note. N = 264. Correlation for Hispanic participants are below the
diagonal; correlations for Caucasian participants are above the
diagonal.

* p < .05. ** p < .01.

TABLE 3
Summary of Hierarchical Regression Analyses

Variable                           B     SE B     [beta]

Variables Predicting Behavioral Eating Disorder Symptoms

Step 1
  Ethnicity                       .03    .17      .01
  Body Mass Index                 .06    .02      .22 ***
  Internalization                 .07    .01      .35 ***
Step 2
  Ethnicity                       .03    .17      .01
  Body mass index                 .06    .02      .22 ***
  Internalization                 .07    .01      .35 ***
  Ethnic identity                -.10    .12     -.05
Step 3
  Ethnicity                       .03    .17      .01
  Body mass index                 .06    .02      .22 ***
  Internalization                 .07    .01      .35 ***
  Ethnic identity                -.10    .13     -.05
  Ethnicity x Ethnic Identity     .01    .05      .01

Variables Predicting Attitudinal Eating Disorder Symptoms

Step 1
  Ethnicity                      -.18    .13     -.07
  Body Mass Index                 .09    .01      .37 ***
  Internalization                 .09    .01      .54 ***
Step 2
  Ethnicity                      -.10    .10     -.08
  Body Mass Index                 .09    .01      .37 ***
  Internalization                 .09    .01      .53 ***
  Ethnic Identity                -.10    .10     -.05
Step 3
  Ethnicity                      -.93    .70     -.35
  Body Mass Index                 .09    .01      .37 ***
  Internalization                 .09    .01      .53 ***
  Ethnic Identity                -.40    .31     -.21
  Ethnicity x Ethnic Identity     .20    .19      .28

                                              [DELTA]
Variable                         [R.sup.2]   [R.sup.2]

Variables Predicting Behavioral Eating Disorder Symptoms

Step 1                           .16 ***     .16 ***
  Ethnicity
  Body Mass Index
  Internalization
Step 2                           .16 ***     0
  Ethnicity
  Body mass index
  Internalization
  Ethnic identity
Step 3                           .16 ***     0
  Ethnicity
  Body mass index
  Internalization
  Ethnic identity
  Ethnicity x Ethnic Identity

Variables Predicting Attitudinal Eating Disorder Symptoms

Step 1                           .40 ***     .40 ***
  Ethnicity
  Body Mass Index
  Internalization
Step 2                           .40 ***     0
  Ethnicity
  Body Mass Index
  Internalization
  Ethnic Identity
Step 3                           .40 ***     0
  Ethnicity
  Body Mass Index
  Internalization
  Ethnic Identity
  Ethnicity x Ethnic Identity

Note. N = 259 (259 of 264 respondents provided all necessary data for
analysis).

*** p < .001.
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Title Annotation:Research
Author:Avina, Vanessa; Day, Susan X.
Publication:Journal of College Counseling
Article Type:Report
Geographic Code:1USA
Date:Apr 1, 2016
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