Toni M. Torres-McGehee

Sports Nutrition Knowledge Among Collegiate Athletes, Coaches, Athletic Trainers, and Strength and Conditioning Specialists

CONTEXT Coaches, athletic trainers (ATs), strength and conditioning specialists (SCSs), and registered dietitians are common nutrition resources for athletes, but coaches, ATs, and SCSs might offer only limited nutrition information. Little research exists about sports nutrition knowledge and current available resources for nutrition information for athletes, coaches, ATs, and SCSs. OBJECTIVE To identify resources of nutrition information that athletes, coaches, ATs, and SCSs use; to examine nutrition knowledge among athletes, coaches, ATs, and SCSs; and to determine confidence levels in the correctness of nutrition knowledge questions within all groups. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Division I, II, and III institutions across the United States. PATIENTS AND OTHER PARTICIPANTS The 579 participants consisted of athletes (n = 185), coaches (n = 131), ATs (n = 192), and SCSs (n = 71). MAIN OUTCOME MEASURE(S) Participants answered questions about nutrition resources and domains regarding basic nutrition, supplements and performance, weight management, and hydration. Adequate sports nutrition knowledge was defined as an overall score of 75% in all domains (highest achievable score was 100%). RESULTS Participants averaged 68.5% in all domains. The ATs (77.8%) and SCSs (81.6%) had the highest average scores. Adequate knowledge was found in 35.9% of coaches, 71.4% of ATs, 83.1% of SCSs, and only 9% of athletes. The most used nutrition resources for coaches, ATs, and SCSs were registered dietitians. CONCLUSIONS Overall, we demonstrated that ATs and SCSs have adequate sports nutrition knowledge, whereas most coaches and athletes have inadequate knowledge. Athletes have frequent contact with ATs and SCSs; therefore, proper nutrition education among these staff members is critical. We suggest that proper nutrition programming should be provided for athletes, coaches, ATs, and SCSs. However, a separate nutrition program should be integrated for ATs and SCSs. This integrative approach is beneficial for the continuity of care, as both categories of professionals might be developing and integrating preventive or rehabilitative programs for athletes.

Body Image, Anthropometric Measures, and Eating-Disorder Prevalence in Auxiliary Unit Members

CONTEXT Medical professionals have recognized eating disorders and related problems in competitive athletes. Auxiliary members (color guard, dance, majorettes) experience the same appearance-related pressures observed in sports commonly associated with eating disorders. OBJECTIVE To estimate eating-disorder prevalence based on associated eating-disorder characteristics and behaviors in female auxiliary members and to compare perceived and ideal body images and anthropometric measurements between at-risk and not-at-risk participants for eating-disorder characteristics and behaviors. DESIGN Cross-sectional design. SETTING Three universities in the southeastern United States. PATIENTS OR OTHER PARTICIPANTS Participants (n = 101, mean age = 19.2 +/- 1.2 years) represented 3 auxiliary units, including color guard (n = 35), dance line (n = 47), and majorettes (n = 19). MAIN OUTCOME MEASURE(S) Participants self-reported menstrual history, height, and weight. Anthropometric measurements included height, weight, body fat percentage, and waist and hip circumferences. We screened for eating-disorder risk behavior with the Eating Attitudes Test (EAT)-26 and for body dissatisfaction with the Figural Stimuli Survey. RESULTS Based on the EAT-26, we estimated eating-disorder prevalence among members to measure 29.7% (95% confidence interval = 20.8%, 38.6%). The EAT-26 results revealed that 21% of participants used purgatives and 14% vomited to control weight or shape. The at-risk group had higher scores on the EAT-26 total (P <or= .01) and on the dieting (P <or= .01), oral control (P = .02), and bulimia (P = .01) subscales. Hip circumference (P = .01), self-reported weight (P = .03), measured weight (P = .04), difference between measured and preferred weights (P = .02), and calculated target weight (P = .02) were different between the at-risk and not-at-risk groups. CONCLUSIONS Collegiate auxiliary unit members may have an unacceptable prevalence of eating disorders. Our results validate concerns that auxiliary members may exhibit an unacceptable eating-disorder risk, highlighting the need to examine and address unhealthy weight-management behaviors independent of eating-disorder status.

Prevalence of Eating Disorder Risk and Body Image Distortion Among National Collegiate Athletic Association Division I Varsity Equestrian Athletes

CONTEXT Participation in appearance-based sports, particularly at the collegiate level, may place additional pressures on female athletes to be thin, which may increase the likelihood of their resorting to drastic weight control measures, such as disordered eating behaviors. OBJECTIVES (1) To estimate the prevalence and sources of eating disorder risk classification by academic status (freshman, sophomore, junior, or senior) and riding discipline (English and Western), (2) to examine riding style and academic status variations in body mass index (BMI) and silhouette type, and (3) to examine these variations across eating disorder risk classification type (eg, body image disturbances). DESIGN Cross-sectional study. SETTING Seven universities throughout the United States. PATIENTS OR OTHER PARTICIPANTS A total of 138 participants volunteered (mean age = 19.88 ± 1.29 years). They represented 2 equestrian disciplines English riding (n = 91) and Western riding (n = 47). MAIN OUTCOME MEASURE(S) Participants self-reported menstrual cycle history, height, and weight. We screened for eating disorder risk behaviors with the Eating Attitudes Test and for body disturbance with sex-specific BMI silhouettes. RESULTS Based on the Eating Attitudes Test, estimated eating disorder prevalence was 42.0% in the total sample, 38.5% among English riders, and 48.9% among Western riders. No BMI or silhouette differences were found across academic status or discipline in disordered eating risk. Overall, participants perceived their body images as significantly larger than their actual physical sizes (self-reported BMI) and wanted to be significantly smaller in both normal clothing and competitive uniforms. CONCLUSIONS Disordered eating risk prevalence among equestrian athletes was similar to that reported in other aesthetic sports and lower than that in nonaesthetic sports. Athletic trainers working with these athletes should be sensitive to these risks and refer athletes as needed to clinicians knowledgeable about disordered eating. Professionals working with this population should avoid making negative comments about physical size and appearance.

Eating Disorder Risk and the Role of Clothing in Collegiate Cheerleaders' Body Images

CONTEXT With increased media coverage and competitive opportunities, cheerleaders may be facing an increase in eating disorder (ED) prevalence linked to clothing-related body image (BI). OBJECTIVE To examine ED risk prevalence, pathogenic weight control behaviors, and variation in clothing-specific BI across position and academic status among collegiate cheerleaders. DESIGN Cross-sectional study. SETTING National Collegiate Athletic Association Division I and II institutions. PATIENTS OR OTHER PARTICIPANTS Female collegiate cheerleaders (n = 136, age = 20.4 ± 1.3 years, height = 160.2 ± 8.1 cm, weight = 57.2 ± 8.3 kg). MAIN OUTCOME MEASURE(S) Participants self-reported height, weight, and desired weight and completed the Eating Attitudes Test. Body image perceptions in 3 clothing types (daily clothing, midriff uniform, full uniform) were assessed using sexbased silhouettes (body mass index = 18.3 kg/m(2) for silhouette 1, 23.1 kg/m(2) for silhouette 4). RESULTS The ED risk for cheerleaders was estimated at 33.1%. However, when body mass index was controlled using backward stepwise logistic regression, flyers had greater odds (odds ratio = 4.4, 95% confidence interval = 1.5, 13.2, P = .008) of being at risk compared with bases, but no difference was noted between the base and back-spot positions (odds ratio = 1.9, 95% confidence interval= 0.5, 6.6, P = .333). A main effect of BI perceptions was seen (P < .001), with a significant interaction by clothing type (F(2,133) = 22.5, P < .001, η(2) = 0.14). Cheerleaders desired to be smaller than their perceived BIs for each clothing type, with the largest difference for midriff uniform (2.6 ± 0.8 versus 3.7 ± 0.9), followed by full uniform (2.7 ± 0.8 versus 3.5 ± 0.9) and daily clothing (2.8 ± 0.8 versus 3.5 ± 0.9). CONCLUSIONS Cheerleaders, especially flyers, appear to be at risk for EDs, with greatest BI dissatisfaction when wearing their most revealing uniforms (ie, midriffs). Universities, colleges, and the national governing bodies of these squads need to focus on preventing eating disorders and BI dissatisfaction and promoting self-esteem.

Give or take a few? Comparing measured and self-reported height and weight as correlates of social physique anxiety.

Statistically controlling for physical size is common practice, especially in self-perception studies uncovering the etiology of maladaptive behaviors, such as eating disorders. For example, social physique anxiety (SPA)—apprehension about social evaluations while presenting oneself in front of others (Leary, 1992)—is a prominent correlate of eating disorder indicators (Hausenblas & Mack, 1999; Monsma & Malina, 2004), body image (Ackard, Croll, & Kearny-Cook, 2002; Markey & Markey, 2005), and self-esteem (Caldwell, Brownell, & Wilfley 1997; Forbes, Doroszewicz, Card, & Adams-Curtis, 2004). Physical size may potentially mask relationships among the psychological variables between SPA relationships and such constructs. Psychological analyses frequently control for height, weight, or body mass index (BMI) by examining partial correlations or using physical variables as covariates in mean comparison tests with SPA as well as other psychological disorder symptoms. Among female participants in aesthetic sports, Monsma, Pfeiffer, and Malina (2008) found that physical size characteristics, such as weight, percentage of body fat, and BMI, were the strongest correlates of SPA. Other studies of adolescent and young adult women supported the association of BMI and SPA, with correlations of .14 (Haase & Prapavessis, 1998) and .11 (Russell & Cox, 2003), respectively. Self-reported BMI accounted for 21% of the variance in predicting body satisfaction in 7,200 young adult female dieters (Caldwell et al., 1997), 7.8% of the variance in SPA in 373 college women (Sabiston, Crocker, & Munroe-Chandler, 2005), and measured BMI explained 5% of the variance in eating disorder symptoms among 114 adolescent and young adult figure skaters (Monsma & Malina, 2004). Physical size is particularly important to consider among adolescents because of the variability associated with growth and maturation. In general, participants with higher BMI tend to report higher scores in SPA, decreased body satisfaction, and increased eating disorder symptoms. Given that social desirability to have a lean figure is prevalent in American society, individuals with symptoms of eating disorders, low to moderate increases in SPA, and body dissatisfaction may be more likely to misreport their height and weight (Klesges et al., 2004). Both biological and contextual factors are possible reasons for overor underreporting height and weight among adolescents. Plausible biological explanations include the timing and tempo of growth (Fortenberry, 1992) and time since menarche in girls (Abraham, Luscombe, Boyd, & Oleson, 2004), while contextual factors include those such as the amount of time spent exercising (Abraham et al., 2004) and pressures associated with sports context. Aesthetic activities such as ballet, gymnastics, cheerleading, and figure skating frequently hold weighins, involve high-energy expenditure, and, in some cases, recommendations to diet or lose weight. Aligned with timing and tempo variations of biological events, such as breast development and menarche (Brooks-Gunn, 1988), the ages of ≤ 12.9, 13.0–15.9, 16.0–18.9, ≥ 19 years should be considered because of the associated gains in weight and height. The average age at menarche is 12.8 ± 1.0 years in the North American population and slightly later (13.5–16.8 years) among aesthetic activity participants (Malina, Bouchard, & BarOr, 2004). Peak height followed by peak weight velocities typically occur approximately one year prior to menarche. Give or Take a Few? Comparing Measured and SelfReported Height and Weight as Correlates of Social Physique Anxiety

Developmental and Contextual Risks of Social Physique Anxiety among Female Athletes.

Abstract In the present study, we examined developmental and contextual factors that may increase the odds of reporting higher social physique anxiety (SPA) among 404 adolescent athletes 11 to 16 years old. Findings showed older, later maturing athletes past peak height velocity and with greater body mass index (BMI) reported higher SPA. Individual aesthetic sport athletes were older at menarche, had lower BMI, and reported higher SPA. The odds of reporting higher SPA were 4.5 times higher (odds ratio = 4.61) for individual aesthetic sport athletes than for nonaesthetic sport athletes. Team aesthetic sport contexts were not implicated in SPA risk. Results are discussed in terms of self-selection away from individual aesthetic sports and the relevance of physical size and puberty in the SPA construct.

Attitude and Knowledge Changes in Collegiate Dancers following a Short-Term, Team-Centered Prevention Program on Eating Disorders

Eating knowledge, nutritional knowledge, and psychological changes among female collegiate dancers were examined before and after a 4-wk. team-centered program on sport nutrition, exercise, and disordered eating consequences. Collegiate female dancers from two NCAA Division I institutions participated in a control (n = 19; M age = 19.1 yr., SD = 1.0) or intervention (n = 21; M age = 19.2 yr., SD = 1.2) group. Measures were administered to both groups before and after intervention to assess eating disorders, depression, and nutritional and disordered eating knowledge. There was a statistically significant increase in scores on nutritional and overall eating disorder knowledge in the intervention group compared to the control group. Mean scores on depression, drive for thinness, body dissatisfaction, and maturity fears decreased in the intervention group.

Tackling community-acquired methicillin-resistant Staphylococcus aureus in collegiate football players following implementation of an anti-MRSA programme

Competitive football players’ safety has become an important concern at the high school, collegiate and professional level and warrants attention.1–4 From 2003 to 2008, five players at our institution developed clinically significant community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) skin infections requiring hospitalisation and intravenous antibiotics. In 2008, the University of South Carolina team instituted anti-MRSA precautions based on recommendations made by the Centers for Disease Prevention and Control (CDC) (box 1). In an attempt to understand if guidelines recommended by the CDC resulted in low MRSA colonisation rates, we randomly selected players on a Division I collegiate football programme to evaluate colonisation for MRSA obtained from nares, helmets and shoulder pads. Inclusion criteria were age 18 or older and current team member. Exclusion criteria were presence of skin infection, receiving antibiotics or hospitalisation in the prior month. The study received IRB approval and informed consent was obtained from study participants. A research assistant or team physician obtained specimens from the nares, helmet and shoulder pads with a cotton-tipped swab from …

Agreement of Urine Specific Gravity Measurements Between Manual and Digital Refractometers

CONTEXT Urine specific gravity (Usg), measured by a handheld manual refractometer (MAN), has been recognized as a valid and practical means of assessing hydration status. Newer, digital refractometers are faster and more user friendly but have not been validated against the traditional MAN. OBJECTIVE To compare the reliability and validity of 2 digital refractometer models and a MAN. DESIGN Descriptive laboratory study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS Sample of convenience was recruited from the local university and surrounding community (n = 82). INTERVENTION(S) Participants provided multiple urine samples (n = 124) over a 5-month period under various hydration conditions. MAIN OUTCOME MEASURE(S) Urine specific gravity was compared among a MAN, a digital refractometer requiring the prism to be dipped (DIP) into a urine sample, and a digital refractometer that requires urine to be pipetted (PIP) onto its prism for analysis. RESULTS The MAN measurements were strongly correlated with the DIP (r = 0.99, P < .001) and PIP (r = 0.97, P < .001) measurements. Bland-Altman analyses revealed slight mean underestimation (95% upper and lower levels of agreement) between MAN and DIP (-0.0012 [0.0028] and PIP -0.0011 [0.0035], respectively) and trends toward increased underestimation at higher Usg. Measurement error ≥ .005 was greater for PIP (4/124, 3.2%) than for DIP (2/124, 1.6%). CONCLUSIONS Negligible differences were exhibited between PIP and DIP, with both displaying acceptable reliability and validity compared with the MAN. However, the Bland-Altman analysis suggests underestimation bias for the DIP and PIP as Usg increases, with the potential for rare but substantial underestimation when using PIP that should be recognized by clinicians, particularly when used as a screening measure in weight-class sports.

The Cognitive and Motivational Functions of Imagery Among Athletic Trainers

Knowledge of imagery is a required competency for athletic trainers (ATs) but research has yet to consider imagery use by ATs despite its relevant application for learning, planning, and controlling emotions in high stakes situations like rehabilitation, competency exams or novel injury situations. Aligned with the Applied Model of Mental Imagery, this study examined the cognitive and motivational functions of imagery used by 59 certified ATs and 34 AT students (N = 93, 19-48 years of age). Participants completed the Sport Imagery Questionnaire modified for the population. Image function and direction were also considered. Imagery training was only reported by 23% of the participants but 50% reported encouraging their athletes to use imagery and 86% believed the skill enhances their duties. Internal consistencies of the five image content subscales ranged from .83 to .68 and inter-scale correlations ranged from .72 to .76. ATs reported using MG-Mastery most frequently followed by CS-Skills CG-Strategies MG-Arousal and MS-Goals. Independent t-tests indicated MG-Goals was used more by students than certified ATs, t(91)=2.04, p<.05, and by non-practicing ATs than those who practiced, t(91)=-4.01, p<.001. Participants from curriculum programs reported more use of MG-Arousal than those from internship programs, t(91)=2.23, p=.05 and there was no gender variation across subscales. A trend of significant, negative correlations between education and the three motivation functions of imagery indicated the more educated ATs used imagery less for controlling emotions, mastering skills and setting goals. However, overall, the most frequently cited reason for using individual images was for confidence, followed by anxiety, goals, and skills and strategies. The majority of images were perceived to help job performance while one CG-Strategies and 4/5 MG-Arousal items were perceived as harmful to performance. Enhancing AT curricula with systematic training in psychological skills would enhance AT performance and disseminate information to clients.