Justine J. Reel

The Relationship between Body Esteem, Exercise Motivations, Depression, and Social Support Among Female Free Clinic Patients

PURPOSE Obesity is a significant public health problem in womens health. This study examined relationship between body esteem, exercise motivations, depression, and social support among female free clinic patients. Low-income women who are at risk for obesity and other health concerns would benefit from health education efforts. METHODS We compared 299 female and 164 male free clinic patients 18 years or older using assessments for body esteem, motivation to exercise, depression, and social support. RESULTS Although female participants reported lower levels of body esteem and higher levels of depression compared with male participants (p < .01), female participants were more motivated to exercise for weight-related reasons than male participants (p < .05). U.S.-born female participants reported lower exercise motivations compared with non-U.S.-born female participants (p < .01). Social support might be an important factor to increase exercise motivation among female free clinic patients (p < .05); depression lowers levels of body esteem (p < .01). CONCLUSIONS The results of this study suggest that female free clinic patients should receive gender-specific interventions to promote positive body image and physical activity. It is important for health educators to engage a myriad of physical activity motives to increase the likelihood that clients will experience enjoyment and sustained adoption of exercise into their lifestyle. Future practice and research should warrant the implementation of body image and physical activity programs and the potential impact of using exercise to reducing depression among female patients at free clinics.

Stress, Coping Strategies, and Depression--Uninsured Primary Care Patients.

OBJECTIVES People of low socio-economic status (SES) are particularly at risk for developing stress-related conditions. The purpose of this study is to examine depression, stress, and coping strategies among uninsured primary care patients who live below the 150th percentile of the federal poverty level. Specifically, this study compares the experiences of impoverished US-born English speakers, non-US-born English speakers, and Spanish speakers. METHODS Uninsured primary care patients utilizing a free clinic (N = 491) completed a self-administered survey using standardized measures of depression, perceived stress, and coping strategies in the spring of 2015. RESULTS US-born English speakers reported higher levels of depression and perceived stress compared to non-US-born English speakers and Spanish speakers. US-born English speakers are more likely to use negative coping strategies than non-US-born English speakers and Spanish speakers. Perceived stress and negative coping strategies are significant predictors of depression. CONCLUSION US-born English speakers, non-US-born English speakers, and Spanish speakers reported different coping strategies, and therefore, may have different needs for addressing depression. In particular, US-born English speakers need interventions for reducing substance use and negative psychological coping strategies.

Personality and psychological correlates of eating disorder symptoms among male collegiate athletes.

Despite a proliferation of research on disordered eating in female athletes, few studies have included male athletes. The purpose of this study was to determine which of five personality and psychological variables of interest (i.e., perfectionism, self-esteem, optimism, reasons for exercise, and appearance orientation) best predicted eating disorder status (i.e., symptomatic or asymptomatic) in male athletes. Two hundred three male athletes (Mage=20.29, SD=1.64) from three National Collegiate Athletic Association (NCAA) Division I institutions participated. More athletes were asymptomatic (80.8%) than symptomatic (19.2%). None of the variables significantly predicted symptomatic status. These findings contrast the literature on predictors of disordered eating symptomatology among female athletes, and suggest the need for further research to identify other potential predictors of eating disturbance among male athletes.

Strategic Approach to Assess Training Needs Across a Diverse Region

The mission of the Region IV (R-IV) Public Health Training Center (PHTC), headquartered at the Rollins School of Public Health at Emory University in Atlanta, GA, is to develop and implement programming to train and educate public health professionals in U.S. Department of Health and Human Services Region IV. To identify public health workforce development needs, the R-IV PHTC created a systematic process that included the implementation of a variety of strategies, to gain insights from each state within the diverse region. Conducting regular needs assessments is an integral step to ensure trainings are relevant and meet the needs of public health professionals. To this end, the PHTC employed a mixed methods approach to gather information on both competency-based and non–competency-based training needs, as well as training needs within R-IV’s content focus area of infectious disease. In R-IV there is great variability between the structures of the state and local health departments (e.g., some centralized, some decentralized), each of which faces different funding challenges and works with different service delivery models and regulatory authorities. Moreover, states have diverse populations (e.g., races, urban/rural, migrant/refugees, tribal, Appalachian) and face a wide range of public health priority concerns. Health departments were found to be at different stages of readiness to undertake a training needs assessment due to a number of issues, including their stage of pursuing Public Health Accreditation Board accreditation and recent participation in other needs assessment efforts. The R-IV PHTC approach to assessing training needs within this challenging environment is described.

Integrating exercise and mindfulness for an emerging conceptual framework: The intuitive approach to prevention and health promotion (IAPHP)

Body image, which predicts increased risk for eating disorders and obesity, has been intricately linked to one’s relationship with food and exercise (Neumark-Sztainer, 2012). This connection should not be overlooked when generating potential solutions for prevention and health promotion (Austin, 2011). Underscoring the challenging nature of addressing eating disorders and obesity, strong prevention approaches are needed to promote positive body image as well as a healthy relationship with both food and exercise. Marked increases in dysfunctional eating and exercise behaviors over the past several decades have been associated with concomitant rises in obesity, eating disorders, disordered eating and dysfunctional exercise patterns (Irving & Neumark-Sztainer, 2002). Disordered eating behaviors exist along a continuum ranging from overly restrictive (e.g., dietary restraint; anorexia nervosa) to overeating (e.g., emotional eating; binge eating disorder) (Emery, King, Fischer, & Davis, 2013). Disordered eating can result in patterns of oscillation between restrictive and overeating, conditions such as being overweight or obese, and mental health issues (Muazzam & Khalid, 2011). Like disordered eating, dysfunctional exercise patterns represent a spectrum of behaviors from a lack of physical activity (i.e., sedentary) to excessive and compulsive exercise behaviors. Although being inactive or not engaging in enough physical activity can lead to overweight and obesity, exercising too much can be hazardous (Calogero & Pedrotty-Stump, 2010). For male and female clients, overexercise can represent a purging method as well as a common pathway to more severe eating disorders (American Psychiatric Association, 2013). Feeling compelled to exercise to the extreme yields negative consequences such as overuse injuries, fatigue, sleep disturbances, and problems with social relationships (Taranis & Meyer, 2011). Furthermore, these “disordered” exercise behaviors can be de-motivating

Psychosocial predictors of drive for muscularity in male collegiate athletes.

The purpose of this study was to examine the simultaneous relation of general and sport-specific pressures about body weight and shape, negative affect, and body satisfaction to drive for muscularity (DM) in male collegiate athletes. Participants were 183 male athletes who were drawn from three NCAA Division I institutions and represented 17 different sports. As hypothesized, after controlling for BMI and sport type, sport-specific pressures, negative affect, and body satisfaction were significant predictors, and accounted for 15-34% of the variance in muscularity-oriented body image and muscularity behaviors; general pressures however were not significantly related. These findings offer insight into the personal and social antecedents of DM in male athletes, and serve as a starting point for future research on DM in this population.

Building the Plane While Flying It: Lessons Learned in the Development of the North Carolina Local Performance Site for the HRSA Region IV Public Health Training Center

Developing a public health training center has provided a unique opportunity to meet the training needs of the public health workforce across North Carolina. Furthermore, the training center has fostered collaborations with community partners and other universities in the state. This article describes some lessons learned while building a local performance site that may help inform and shape expectations about what it takes to build a public health training center. Recommendations for successfully creating a local performance site within the Regional Public Health Training Center model are included.

The association between tobacco, alcohol, and drug use, stress, and depression among uninsured free clinic patients: U.S.-born English speakers, non-U.S.-born English speakers, and Spanish speakers

ABSTRACT The abuse of substances is a significant public health issue. Perceived stress and depression have been found to be related to the abuse of substances. The purpose of this study is to examine the prevalence of substance use (i.e., alcohol problems, smoking, and drug use) and the association between substance use, perceived stress, and depression among free clinic patients. Patients completed a self-administered survey in 2015 (N = 504). The overall prevalence of substance use among free clinic patients was not high compared to the U.S. general population. U.S.-born English speakers reported a higher prevalence rate of tobacco smoking and drug use than did non-U.S.-born English speakers and Spanish speakers. Alcohol problems and smoking were significantly related to higher levels of perceived stress and depression. Substance use prevention and education should be included in general health education programs. U.S.-born English speakers would need additional attention. Mental health intervention would be essential to prevention and intervention.

Development and validation of the intuitive exercise scale

Up to 80% of individuals with eating disorders engage in dysfunctional exercise, which is characterized by exercising in excessive quantities often past the point of pain as well as compulsive feelings and negative affect when exercise is disrupted (Cook, Hausenblas, Crosby, Cao, & Wonderlich, 2015). Intuitive exercise involves an awareness of the senses while moving and attending to ones bodily cues for when to start and stop exercise, rather than feeling compelled to adhere to a rigid program (Reel, 2015). The purpose of this study was to design a measurement tool to evaluate the construct of intuitive exercise in research, treatment, and prevention settings. The 14-item Intuitive Exercise Scale (IEXS) was developed and validated in the current study with completed surveys from 518 female and male adult participants. Exploratory factor analysis was used to identify four latent constructs, including emotional exercise, exercise rigidity, body trust, and mindful exercise, which were supported via confirmatory factor analysis (CFI=0.96; SRMR=0.06). The IEXS demonstrated configural, metric, and scalar invariance across women and men. Correlations with measures of intuitive eating, exercise dependence, and exercise motivation supported convergent and discriminant validity.

Frequency and Psychosocial Correlates of Eating Disorder Symptomatology in Male Figure Skaters

Using a cross-sectional, mixed-method design, this study examined the frequency and psychosocial correlates of eating disorder (ED) symptomatology among male figure skaters (n = 29; Mage = 18.45 years) and explored their perspectives on skating-related weight pressures. One participant (3.7%) scored within range of a clinical ED. Body mass index, sport-related weight pressures, and sport-related body dissatisfaction explained 30% of variance in ED symptomatology; only weight pressures were significant. Although most endorsed the positive influences of skating, a perceived body–performance link was their most frequent weight pressure. Coping with sport-related weight pressures should be addressed in applied sport psychology and ED prevention.