Ethnicity, socioeconomic status, and eating disorder symptomatology in Canada: implications for mental health care

Purpose – There is a gap in the understanding of relationships between socioeconomic status (SES), urban-rural differences, ethnicity and eating disorder symptomatology. This gap has implications for access to treatment and the effectiveness of treatment. The paper aims to discuss these issues. Design/methodology/approach – Data are presented from a major Canadian survey, analyzing the impact of body mass index (BMI), urban-non-urban residency, income, and ethnicity on eating disorder symptomatology. Findings – One of the strongest findings is that high income non-White women expressed less eating disorder symptomatology than lower income non-White women. Research limitations/implications – Future research needs to consider how factors such as urban residency, exposure to Western “thinness” ideals, and income differentials impact non-White women. Practical implications – Effective treatment of ethnic minority women requires an appreciation of complicated effects of “culture clash,” income and BMI on eating disorder symptomatology. Originality/value – This study makes a unique contribution to the literature by examining relationships between SES (income) and eating disorder symptomatology in White and non-White Canadian women. The review of the scientific literature on ethnic differences in eating disorder symptomatology revealed a disparity gap in treatment. This disparity may be a by-product of bias and lack of understanding of gender or ethnic/cultural differences by practitioners.

Overcoming weight bias: promoting physical activity and psychosocial health

Purpose – The purpose of this paper is to evaluate Feel WonderFull Fitness (FWF), a program adhering to the Health At Every SizeTM (HAES) paradigm, on larger women's physical activity and psychosocial health. FWF was tailored to overcome barriers based on weight bias. Design/methodology/approach – The study compared “overweight” and “obese” women in FWF to those not currently enrolled in formal exercise programs. Controls were divided into low physical activity (LPA) and moderate physical activity (MPA) conditions based on pretest exercise level. Outcome measures were collected at pretest and three months later at posttest. Findings – FWF participants had the greatest gains in physical activity and demonstrated significantly greater improvements in depression than the LPA group. FWF and the MPA group showed more improved scores on perceived body attractiveness than the LPA group. Scores on an eating disorders measure improved for all groups, but somewhat more so for the FWF group. Improvements occurred in the absence of weight loss or decreases in body mass index and body fat percentage. Research limitation – The study was based on a small, homogenous sample using a quasi-experimental design. Practical implications – The study illustrates HAES strategies that practitioners might incorporate into various health and fitness settings. Social implications – The study highlights weight bias as a social justice issue and as a barrier to physical activity participation for larger women. Originality/value – The study adds to a growing body of literature evaluating HAES approaches, with HAES representing a novel alternative to weight-loss interventions for improving psychosocial health among larger women. It also contributes to the literature on weight bias that has been understudied relative to bias based on other areas of difference.

Body image and body work among older women: a review

Purpose – The purpose of this paper is to review the literature on body image and aging among older women. Using existing qualitative research, this paper explores how aging affects body image and how women respond to body image issues as they age. Design/methodology/approach – Multiple databases were used to locate original and review articles on the topics of body image and aging, with a target population of women ages 60 years and older. The findings of the literature search were compiled, summarized and sorted to create themes. Findings – Women struggle with body image issues throughout their lives. Women tend to perceive age-related changes in appearance negatively, as a threat to their identity and social value. This is due, in part, to the sociocultural environment, which pressures women to “fight” aging and maintain an ideal (young and thin) image at all costs. Some women do come to terms with their aging body and report increased self-acceptance with age. However, others turn to various forms of body work (e.g. dieting, hair dye, makeup) in order to maintain their value in an appearance-based society. Practical implications – Poor body image can affect older women's emotional, psychological and physical health and overall well-being. Health care professionals, community workers and policy makers need to be made aware of these issues so that they can respond appropriately. Originality/value – There has been limited research exploring body image among older women. This paper identifies gaps in the literature and suggests avenues for future research in this area.

Improving health and wellbeing in women's secure services: physical activity, appearance, self-care and body image

Purpose – Lifestyle change to improve physical health is a significant challenge in secure psychiatric hospitals for women. In addition to factors that contribute to an obesogenic environments body image, self-care, self-esteem, and motivational problems compound efforts to increase physical activity and to lose weight. The paper aims to discuss these issues. Design/methodology/approach – Two elements of a comprehensive programme to improve physical health and mental wellbeing are discussed. The first describes the development of a unique role of self-care and body image therapists and an evaluation of the effects of treatment. The second describes initiatives to assess the environmental and therapeutic milieu contingencies that impact on physical activity and to increase engagement in exercise through motivational strategies. Findings – Research within the current settings has resulted in a validation of the role of the self-care and body image therapist. Other evaluations have described the environmental contingencies that impact on physical activity along with strategies to increase exercise participation. Originality/value – While much has to be learnt about how to translate awareness of the value of a healthy lifestyle for women into positive behaviour change the programme described represents part of a comprehensive and long term attempt to evaluate and improve the physical wellbeing of women in secure care.

Promoting mental health of immigrant seniors in community

Purpose – The purpose of this paper is to explore if and how community organizations providing services to late-in-life Punjabi immigrants in British Columbia, Canada, offer services with the potential to promote their mental health or well-being. The authors also wanted to know how Punjabi seniors perceived available services and if they supported their mental well-being. Design/methodology/approach – To guide the research, the authors used the VicHealth Framework, which identifies three overarching social and economic determinants of mental health: social inclusion (SI), freedom from violence and discrimination, and access to economic resources and participation. This mixed methods study combines descriptive survey and qualitative focus group data with input from Punjabi seniors and community service providers. Findings – All three mental health determinants were identified as important by service providers and seniors, with SI as the most important. Family dynamics (shaped by migration and sponsorship status) influence all three determinants and can promote or diminish mental well-being. Research limitations/implications – The pilot study is limited in sample size and scope and further inquiry with different groups of immigrant older adults is warranted. Practical implications – Service providers assert that more outreach and sustainable funding are needed to reach the majority of potential beneficiaries unable to participate in community programmes. Information on mental well-being of seniors should be targeted at both seniors and their families. Originality/value – The VicHealth Framework provided a unique lens through which to explore the contributions of community organizations to mental health promotion for immigrant older adults.

Pacific peoples, mental health service engagement and suicide prevention in Aotearoa New Zealand

Purpose – The purpose of this paper is to discuss the engagement of Pacific peoples in mental health services in Aotearoa New Zealand and Pacific strategies for suicide prevention. Design/methodology/approach – This qualitative study involved 22 interviews with Samoans who had made a suicide attempt and/or had suicide ideation, were engaged in a mental health service. Findings – Narratives of mental health services and suicide prevention focused on issues of cultural competency, the importance of family involvement, dichotomous views of western and traditional beliefs around mental illness and the unsuccessful engagement of Pacific youth. Originality/value – This research argues that cultural considerations for Pacific communities are of paramount importance if mental health service engagement and developments towards Pacific suicide prevention strategies are to be effective.

Mortality, ethnicity, and education in an occupational cohort

Purpose – The purpose of this paper is to investigate the relationship between occupational degree requirement and mortality between ethnic groups in a cohort of urban workers. Design/methodology/approach – The study included 118,606 health-insured full-time workers from the New York City Health and Hospitals Corporation (HHC). Mortality rates (MR) and mortality rate ratios (MRR) were calculated for major ethnic categories. Estimates were adjusted for age, sex, and occupational degree requirement. Findings – Prior to adjustment for degree requirement, mortality rates (MRs) by ethnic groups in the Health and Hospitals Corporation were in line with national estimates: highest for blacks, followed by whites, Hispanics, and Asian/Pacific Islander (APIs). After adjustment, the MR for blacks became comparable to whites (mortality rate ratio (MRR)=1.02). The low-Hispanic MR did not change; the Hispanic advantage persisted (MRR=0.66), as did the API advantage (MRR=0.50). Research limitations/implications – Higher education may not substantially change the MR for Hispanics, and it may only account for a portion of the survival advantage among APIs. The findings also suggest that without reducing the disparity in higher education attainment between blacks and whites, equality in other socioeconomic factors may not abolish the disparity in mortality between these groups. Originality/value – This study bypassed common limitations of ethnic mortality studies, with intrinsic parity for certain socio-economic status factors (full-time employment and health care access) across cohort members and consistent ethnic classification across time-points. This includes a cohort of API workers with complete self-identification of ethnicity, which has not been accomplished by previous investigations.

Psychological health and discrimination experience among graduate students: findings from the Stress Coping Obstruction Prevention & Education (SCOPE) Study

Purpose – African-Americans historically report greater exposure to discrimination and also experience unfavorable outcomes associated with physical health, poverty concentration, residential segregation, and poorer education. The effects of discrimination are particularly harmful on mental health as discriminatory experiences contribute significantly to diminished mental health status and psychological distress. African-Americans pursuing graduate education may experience additional stressors, increasing the risk for poorer mental health. The purpose of this paper is to examine the association of psychological health and discrimination experiences among black and white graduate students at a southeastern university. Design/methodology/approach – Participants were 505 graduate students at a predominantly white southeastern institution. Researchers collected data via self-administered online and paper questionnaires during the spring 2010 semester. Graduate students were asked questions pertaining to individual demographics, discrimination, and psychosocial concerns. Findings – Approximately 15 percent of the graduate students reported psychological distress. Additionally, black graduate students reported significantly higher levels of day-to-day and lifetime discrimination when compared to white graduate students. In addition to the proportions of psychological distress differing by race, African-American graduate students reported better psychological well-being when exposed to both day-to-day and lifetime discrimination than whites with similar exposure. Practical implications – Resilience factors and coping strategies should be examined further among African-American graduate students for greater understanding. Moreover, it is important to develop applications to improve mental health outcomes for all graduate students. Originality/value – This is one of the few studies to focus on the mental health and discrimination experiences among a graduate student population. The sample is drawn from the southeastern USA where there are long vestiges of discrimination and a sizable sampling of African-Americans who live in the USA.