OBJECTIVE The present study aimed to describe the experience of, and factors associated with, disordered eating in a population-based sample of emerging adults during the COVID-19 outbreak. METHOD Participants in the EAT 2010-2018 (Eating and Activity over Time) study were invited to complete the C-EAT (COVID-19 EAT) survey in April-May 2020. There were 720 respondents to the survey (age: 24.7 ± 2.0 years). Psychological distress, stress, stress management, financial difficulties, and food insecurity during the COVID-19 pandemic were examined as cross-sectional correlates of disordered eating in 2020. Open-ended questions assessed the perceived impact of the pandemic on eating behaviors. RESULTS Low stress management was significantly associated with a higher count of extreme unhealthy weight control behaviors (UWCBs). Food insecurity, higher depressive symptoms, and financial difficulties were significantly associated with a higher count of less extreme UWCBs. Higher stress and depressive symptoms were significantly associated with greater odds of binge eating. Six themes pertaining to disordered eating during the pandemic emerged: (a) mindless eating and snacking; (b) increased food consumption; (c) generalized decrease in appetite or dietary intake; (d) eating to cope; (e) pandemic-related reductions in dietary intake; and (f) re-emergence or marked increase in eating disorder symptoms. DISCUSSION Psychological distress, stress management, financial difficulties, and abrupt schedule changes may have contributed to disordered eating during the COVID-19 pandemic. Interventions that target stress management, depressive symptoms, and financial strain and provide tools to develop a routine may be particularly effective for emerging adults at risk of developing disordered eating during public health crises.

Objectives: To understand pediatric and family medicine residents' and practitioners' perceived ability to work with lesbian, gay, bisexual, and queer (LGBQ) youth, assessment of their prior educational experiences, and recommendations for medical training to better prepare physicians to provide quality care to this population. Methods: We conducted semi-structured individual interviews with 24 pediatric/family medicine residents (n=20) and practicing physicians (n=4) in the U.S. Recorded interviews were professionally transcribed. Data were analyzed using Grounded Theory and qualitative content analysis approaches. Results: Most physicians did not feel adequately prepared to provide quality care to LGBQ youth, and many who felt knowledgeable obtained their knowledge from on-the-job experiences of caring for LGBQ patients. Findings regarding physicians' recommendations for implementing a formal training program revealed three themes: (I) medical school training (implemented earlier in medical school within a structured program as part of the normal curriculum), (II) training content (LGBQ-specific health needs, self-awareness of implicit biases, interviewing techniques, and resources), and (III) training strategies (panels of LGBQ patients , role-playing/standardized patients, and online modules). Conclusions: Understanding physicians' assessment of abilities and recommendations for training improvements based on their experiences is important for advancing the quality of healthcare for LGBQ youth. Guidance came mostly from residents who recently completed medical school. Thus, their perspectives are especially useful to improve medical education and, ultimately, the care provided to LGBQ youth. Findings suggest a multi-pronged approach that offers several training modalities encompassing individual, intrapersonal, and institutional/systemic/community levels can improve medical school curricula on caring for LGBQ youth.

Background Collection of demographic information about sexual orientation (SO) and gender identity (GI) is crucial to address inequitable health outcomes for lesbian, gay, bisexual, transgender and queer/questioning (LGTBQ) youth.1,2 To begin to understand the needs of LGBTQ patients, this study describes SO and health behaviors at a pediatric emergency department (ED). Methods We administered a survey to 12-18 year olds presenting to the ED between December, 2018 and June, 2019. The survey contained questions adapted from the Minnesota Student Survey about SO, mental and sexual health, substance use, and violence.2 We …

Background Lesbian, gay, bisexual, transgender and queer/questioning (LGTBQ) youth have poorer health outcomes than straight or cisgender youth.1,2 Understanding a child’s gender identity (GI) is an opportunity to intervene in this disparity. As one approach, we sought to describe GI and health behaviors among adolescents in an emergency care setting. Methods A survey was conducted in 12-18 year olds presenting at two urban emergency departments in Minnesota between December, 2018 and June, 2019. The survey was adapted from the Minnesota Student Survey2, including questions on GI, mental and …

Purpose:This study aimed to identify the associations between social isolation, social contextual factors, and behavioral and psychological health during emerging adulthood.Methods:Participants (n ...

Purpose: Body dissatisfaction and disordered eating are linked to adverse health consequences. Research describing socioeconomic patterns in the prevalence of these problems is important for informing the design of health services and efforts to improve health equity. Methods: Population-based cohort study (EAT 2010–2018: Eating and Activity over Time) of socioeconomically and ethnically/racially diverse U.S. young people who completed surveys as adolescents in 2009–2010 (mean age = 14.5 years) and as emerging adults in 2018 (mean age = 22.0 years). Participants were recruited from 20 schools in Minneapolis-St. Paul, Minnesota. Household socioeconomic status was determined using adolescent report of parental education, employment, and public assistance benefits. Analyses were conducted using data from 1531 participants and regression models that accounted for repeated measures within individuals. Results: Among females, high body dissatisfaction and unhealthy weight control behaviors (e.g., skipping meals) were more prevalent and regular use of lifestyle weight management behaviors (e.g., exercise) was less prevalent in the low SES group as compared to the middle and/or upper SES groups (p ≤ .010). Among males, thinness-oriented dieting, unhealthy weight control behaviors, and extreme weight control behaviors (e.g., taking diet pills) were all more prevalent in the low SES group as compared to the middle and/or upper SES groups (p ≤ .010). Few differences were observed across SES groups in models that adjusted for ethnic/racial identity and body mass index. Conclusions: There is a need for greater attention to the reach and relevance of efforts to prevent disordered eating and improve body satisfaction to ensure efforts benefit young people across SES groups.

This study describes transgender and gender diverse (TGD) youth perceptions of parental messages regarding sexuality and sexual/romantic relationships and how those messages impact feelings and dec...

School bullying receives considerable attention in research and in prevention and intervention activities, but microaggressions (a related form of aggressive behaviors) are largely ignored. This exploratory and descriptive qualitative study reports on diverse students’ experiences with microaggressions related to racism, homophobia, transphobia, and anti-fat bias, and school responses to such incidents. As part of a larger study on bullying, we conducted four focus groups (n = 25 youth) and 13 dyadic interviews (n = 26 youth and parents). Questions about experiences of bullying gave rise to descriptions of numerous incidents that were classified as microaggressions in inductive thematic analysis. Four themes emerged: (1) Many types of microaggressions communicate marginalization, stereotypes, and lack of acceptance; (2) Experiences of microaggressions negatively affect mental health and school engagement; (3) Many youth stay silent in the face of microaggressions, but some stand up to aggressors; and (4) School and teacher responses to microaggressions are perceived mostly as nonexistent or ineffective. Schools should consider microaggressions a subset of bullying behaviors and address them in prevention activities, as well as provide resources and activities to engender a school climate that is respectful and supportive of diverse students.

The original Adverse Childhood Experiences (ACE) study demonstrated strong, graded relationships between child maltreatment and household dysfunction and adult health status. The present study re-examined these relationships in a sample of young adult, college students to better characterize the developmental timing of health problems related to ACE exposure and differences by biological sex. A cross-sectional general health questionnaire that included items on ACE was administered to young adults (ages 18–29) at universities in California (n = 3880), Minnesota (n = 7708), and Texas (n = 451) between 2017 and 2018. Seven ACE were assessed: psychological, physical, or sexual abuse; violence between parents; or living with household members who were substance misusers, mentally ill, or ever imprisoned. Binary health indicators were regressed on number of ACE as 0 (referent), 1, 2, 3, and 4 or more using logistic regression controlling for age, biological sex, race/ethnicity, and site. Approximately 51.7% of the sample reported at least one ACE with a significantly higher rate among Texas participants (p < 0.001). We observed graded relationships between levels of ACE exposure and physical, mental, and behavioral health indicators including cigarette use, e-cigarette use, drinking and driving, obesity, lifetime depression, suicide ideation and attempt, non-suicidal self-injury, and lack of restful sleep. ACE-exposed females reported worse mental health status than ACE-exposed males while males reported more substance use than females. Most outcomes did not vary significantly by sex. The strong, graded relationships observed between ACE exposure and health status among young adults reinforce the need for trauma-informed intervention programs on college campuses.

This study explored weight-based victimization by family members, accepting lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) attitudes, and family connectedness, and how these experiences are associated with health, self-esteem, and depressive symptoms among LGBTQ adolescents. Data came from the LGBTQ National Teen Survey (N = 9261, mean age = 15.6 years). The 3 key variables were significantly associated with poorer self-rated health, self-esteem, and depressive symptoms. For example, weight-based victimization was associated with approximately 2 more points on the depressive symptoms scale (β = 1.81, P < .001), adjusting for covariates. Findings highlight the negative impact of weight-based victimization among LGBTQ youth, even in the context of other types of family support.

BACKGROUND Weight stigma is common for people with obesity and harmful to health. Links between obesity and complications from COVID-19 have been identified, but it is unknown whether weight stigma poses adverse health implications during this pandemic. PURPOSE We examined longitudinal associations between prepandemic experiences of weight stigma and eating behaviors, psychological distress, and physical activity during the COVID-19 pandemic in a diverse sample of emerging adults. METHODS Participants (N = 584, 64% female, mean age = 24.6 ± 2.0 years, mean body mass index [BMI] = 28.2) in the COVID-19 Eating and Activity over Time (C-EAT) study were cohort members of the population-based longitudinal study EAT 2010-2018. Weight stigma reported by participants in 2018 was examined as a predictor of binge eating, eating to cope, physical activity, depressive symptoms, and stress during COVID-19. Data were collected via online surveys during the U.S. outbreak of COVID-19 in 2020. RESULTS Prepandemic experiences of weight stigma predicted higher levels of depressive symptoms (β = 0.15, p < .001), stress (β = 0.15, p = .001), eating as a coping strategy (β = 0.16, p < .001), and an increased likelihood of binge eating (odds ratio = 2.88, p < .001) among young adults during the COVID-19 pandemic but were unrelated to physical activity. Although associations remained after accounting for demographic characteristics and BMI, the magnitude of longitudinal associations was attenuated after adjusting for prior levels of the outcome variables. CONCLUSIONS Young adults who have experienced weight stigma may have increased vulnerability to distress and maladaptive eating during this pandemic. Public health messaging could be improved to support people of diverse body sizes and reduce the harmful consequences of weight stigma.

Lesbian, gay, bisexual, queer, and questioning (LGBQ) adolescents experience large disparities in an array of health problems and bullying experiences. Supportive LGBTQ community and school climates may protect LGBQ youth from general and bias-based bullying victimization. We combined data from LGBQ respondents on the 2013 Minnesota Student Survey (N = 2404) with information on the presence of a GSA (N = 79 schools; 2014 School Health Profiles), and new data collection on a range of LGBTQ-supportive community indicators within a 15-min drive time around the school. Hierarchical logistic regressions assessed the role of community supportiveness, GSA presence, and prevalence of LGBQ peers on general and bias-based bullying victimization, adjusted for sociodemographic covariates. Results indicated that for birth-assigned females, attending a school with a GSA was related to lower odds of sexual orientation–based bullying and attending school in an area with more LGBTQ-supportive community resources predicted lower odds of sexual orientation- and weight/appearance-based bullying. Having more LGBQ peers was related to lower levels of race- and weight/appearance-based bullying for all LGBQ youth. These findings provide support for the assumption that more LGBTQ-supportive communities and schools protect against bias-based bullying, particularly for girls, but they are not related to general bullying. Expanding and strengthening supportive resources for LGBTQ youth in schools and communities and identifying protective factors for GBQ boys are recommended.

Transgender and gender-diverse (TGD) youth experience significant health and well-being disparities compared to their cisgender peers. However, disparities experienced at a population level might b...