Susan Kelly-Weeder

Validity and utility of the current definition of binge eating.

OBJECTIVE Binge eating, a cardinal symptom of bulimia nervosa (BN) and binge eating disorder (BED), continues to pose challenges in terms of its definition and thus construct validity and clinical utility. This article reviews the available empirical data that support or refute the current DSM-IV-TR defined characteristics of a binge episode. METHOD A systematic literature review was conducted using Medline/PubMed electronic database on DSM-IV-TR defined binge characteristics and associated attributes. RESULTS Data support the current DSM guidelines indicating that binge episodes typically occur in less than 2 h. Size of binge episodes has variability across BN and BED diagnostic groups. Loss of control (LOC) continues to be a core feature of binge eating. Negative affect is the most widely reported antecedent. Strikingly, little is known about binge episodes among individuals with anorexia nervosa-binge/purge subtype. DISCUSSION Available empirical evidence supports the current DSM duration and LOC attributes of a binge episode in BN and BED. However, a more controversial issues is the extent to which size is important in the definition of a binge episode (e.g., subjective vs. objective episodes) across diagnostic categories and the extent to which binge size informs prognosis, treatment, and clinical outcomes. Further study of binge eating attributes in AN is needed.

Binge drinking and disordered eating in college students

Purpose: To explore the co‐occurrence of binge drinking and disordered eating behaviors in college‐aged students. Data sources: Data were collected from 211 college‐aged students (mean age 20.7 years) at a private university in the northeastern United States using a web‐based survey. Gender‐specific binge drinking rates (five drinks per occasion for men and four drinks per occasion for women) were ascertained. Disordered eating behaviors included measures of binge eating as well as unhealthy weight loss behaviors (skipping meals, fasting, diet pills, laxatives, and self‐induced vomiting). Conclusions: Binge drinking rates were high (63% of female, 83% of male students). Binge eating was reported by 48% of students and was correlated with healthy and unhealthy weight loss behaviors. Female students were more likely to endorse the use of skipping meals, fasting, use of diet pills, laxatives, and self‐induced vomiting. Implications for practice: Binge drinking and disordered eating behaviors are practiced by both male and female students and are common occurrences on college campuses. Nurse practitioners need to be aware of these behaviors, their co‐occurrence, and the need to assess and intervene with students who are at risk for the negative health outcomes associated with the use of these behaviors.

The Impact of Lifestyle Risk Factors on Female Infertility

ABSTRACT Background: Over 2 million couples in the United States are infertile. The literature reflects a number of potential lifestyle risks that have been associated with the development of this condition; however, few studies have investigated these risks concurrently. With knowledge of the importance of behavioral threats to fertility, womens health care providers will be in a better position to screen and assist women to modify their fertility risks. Objectives: The objectives of this study were (1) to identify lifestyle factors associated with infertility in women by comparing a sample of infertile women with a group of fertile women and (2) to offer recommendations to womens health providers, on counseling women at risk for infertility. Methods: A re-examination of the 1995 National Survey of Family Growth (NSFG) allowed for the investigation of lifestyle factors associated with infertility in women. Using a conceptual model of health behavior to guide the selection of variables, together with multiple logistic regression techniques, an explanatory model of infertility was estimated on a sample of 824 women between the ages of 16 and 45 years. Results: Factors directly related to infertility included increasing age, a history of an ectopic pregnancy, current smoking, obesity, and self reported health status. Protective effects were associated with a history of condom use and having had a Pap smear in the last year. Conclusions and Implications: Routine well-women visits offer an excellent opportunity to begin to address the impact of selected risk factors for infertility. Clinicians can utilize these visits to target appropriate interventions for initiating, repeating, and reinforcing messages on fertility risk.

Multiple health behavior clusters among female college students

OBJECTIVE To examine prevalence of multiple unhealthful behaviors and detect clusters of unhealthful behaviors among college women. METHODS Women ages 18-22 enrolled full-time at an urban university located in the Northeastern United States were invited to complete an online survey, which assessed maintenance behaviors: fruits/vegetables, physical activity, cervical screening and at-risk behaviors: frequent drinking, smoking, and non-use of protective measures during sexual intercourse. Of 4774 invited, complete data is available for 1463 participants (1463/4774=30.6%). RESULTS Nearly 65% had two or more unhealthful behaviors. Three distinct clusters were defined: cluster one included women who were lower in health maintenance and higher in at-risk behaviors; cluster two included women who were lower in health maintenance and lower in at-risk behaviors; and cluster three included women who were higher in health maintenance and intermediate in at-risk behaviors. CONCLUSION These clustering patterns suggest health programs directed at college students address multiple behaviors simultaneously. PRACTICE IMPLICATIONS Programs targeting multiple behaviors should consider activities for those seen within and outside of the context of health services.

Binge drinking in college-aged women: framing a gender-specific prevention strategy.

PurposeTo provide an overview of binge drinking in college-aged women and to suggest strategies for nurse practitioners (NPs) to assist women in preventing the negative consequences associated with this behavior. Data sourcesOriginal research articles and comprehensive review articles identified through Medline, CINAHL, and OVID databases. ConclusionsResearchers have shown that the rates of binge drinking in college-aged women are increasing, which places these women at increased risk for the long-term complications associated with alcohol use. Implications for practiceNPs must be aware of this phenomenon and carefully screen women for high-risk alcohol use. Prevention strategies are reviewed and include the use of brief motivational interviews delivered during individual client encounters as well as through Web-based programs.

Modifiable risk factors for impaired fertility in women: What nurse practitioners need to know

Purpose: To provide an overview of impaired fertility in childbearing‐aged women, to review the current research on modifiable lifestyle risk factors implicated in its development, and to suggest strategies for nurse practitioners (NPs) to assist women in behavioral changes that will allow them to protect their fertility. Data sources: Original research articles and comprehensive review articles identified through Medline, CINAHL, and OVID databases. Conclusions: Research has shown that advancing age, a history of a sexually transmitted infection and/or pelvic inflammatory disease, extremes of body weight, and tobacco and caffeine use are potentially modifiable risk factors in the development of impaired fertility. Implications for practice: NPs must be aware of the link between these behaviors and the development of impaired fertility in order to assist women in preserving their fertility. Individual counseling, education, and community‐wide education strategies are discussed.

Binge eating and weight loss behaviors of overweight and obese college students.

Purpose: To investigate binge eating (BE) and weight‐related behaviors in overweight and obese college students. Data sources: This was a secondary analysis of data from 487 overweight and obese college‐age students from a private university in the northeastern United States. Conclusions: BE was reported by 34.9% of students. Only 6.2% of participants reported the use of compensatory behaviors (i.e., self‐induced vomiting, laxative, or diuretic use) to prevent weight gain. BE was associated with smoking and exercising to lose weight. Gender differences emerged from the data as women were more likely to report being obese, the use of compensatory behaviors, and to perceive themselves as moderately or extremely overweight. Implications for practice: BE is a significant problem on college campuses and is associated with the development of obesity and eating disorders. Nurse practitioners (NPs) are in an excellent position to effect change in this population through their frequent contact with young adults in community and school‐based venues. NPs are well‐prepared to identify at‐risk college students and provide them with individualized care, education, and support.

Gender differences in binge eating and behavioral correlates among college students

PURPOSE: The purpose of this study was to investigate gender differences in binge eating and associated behavioral correlates in college students. METHODS: A webbased survey was conducted with 2073 students (mean age 19.8 yr; range 18–23 yr). Multiple logistic regression was used to calculate odds ratios and 95% confidence intervals for the factors associated with binge eating. RESULTS: Twenty-nine percent of students reported recent bingeing. Factors associated with binge eating included being female, having a higher body mass index, current tobacco use, and exercising to lose weight. Women were more likely to binge eat (73.8%; χ2 =32.3; p≦0.001), report loss of control (45%; χ2=16.3; p≦0.001), self induced vomiting (20.7%; χ2=15.9; p≦0.001), and laxative use (6.7%; χ2=8.93; p≦0.001). CONCLUSIONS: Results generated from this study suggest that gender-disparate behaviors are potential targets for future tailored interventions.

Gender differences in risky sexual behavior among urban adolescents exposed to violence

Purpose: The purpose of this study was to use an ecological lens to explore gender differences in risky sexual behavior among urban adolescents exposed to violence. Data Sources: This was a secondary analysis of data from a larger behavioral intervention trial that targeted drinking behaviors among adolescents. Data from a total of 2,560 male and female urban adolescents between the ages of 14 and 21 were analyzed for personal, interpersonal, and community exposure to violence and risky sexual behavior. Conclusions: Violence has an impact on sexual risk. For females, carrying a weapon (p= 0.020) and feeling safe in intimate relationships (p= 0.029) were individual correlates of risky sexual behavior, while for males, race/ethnicity (p= 0.019) and being in a physical fight (p= 0.001) were significant correlates of risky sexual behavior. Implications for Practice: Risky sexual behavior among adolescents may lead to negative reproductive health outcomes. Nurse practitioners are in an excellent position to affect change in this population through their frequent contact with adolescents in a variety of community and school-based venues. Nurse practitioners are also well-prepared to identify at-risk adolescents and provide them with individualized care, education, and support.Purpose: The purpose of this study was to use an ecological lens to explore gender differences in risky sexual behavior among urban adolescents exposed to violence. Data Sources: This was a secondary analysis of data from a larger behavioral intervention trial that targeted drinking behaviors among adolescents. Data from a total of 2,560 male and female urban adolescents between the ages of 14 and 21 were analyzed for personal, interpersonal, and community exposure to violence and risky sexual behavior. Conclusions: Violence has an impact on sexual risk. For females, carrying a weapon (p= 0.020) and feeling safe in intimate relationships (p= 0.029) were individual correlates of risky sexual behavior, while for males, race/ethnicity (p= 0.019) and being in a physical fight (p= 0.001) were significant correlates of risky sexual behavior. Implications for Practice: Risky sexual behavior among adolescents may lead to negative reproductive health outcomes. Nurse practitioners are in an excellent position to affect change in this population through their frequent contact with adolescents in a variety of community and school‐based venues. Nurse practitioners are also well‐prepared to identify at‐risk adolescents and provide them with individualized care, education, and support.

Binge eating among racial minority groups in the United States: an integrative review.

BACKGROUND: Binge eating (BE) is a disordered eating behavior that has been linked to the development of eating disorders and obesity, with the latter being a condition with higher prevalence rates among some racial minority groups. Although researchers have begun to examine characteristics of BE among racial minority groups, it is unclear how these differ from White populations. OBJECTIVE: This article provides an integrative review of published literature within the past decade reporting on the characteristics of BE in minority compared with White racial groups. METHOD: Health care computerized databases were searched using key terms. RESULTS: Eighteen research studies met the inclusion criteria. More than half of the studies reviewed reported racial differences in some aspect of BE; however, heterogeneity in the definition and measurement of BE limits the ability to compare findings across studies. CONCLUSIONS: BE is reported across racial groups. To determine whether meaningful differences in BE exist by race, further studies using the same conceptual and operational definitions of BE are needed.