- Email: [email protected]
Acculturation and eating disorders in Asian and Caucasian Australian university students
Eating Behaviors 7 (2006) 214 – 219
Acculturation and eating disorders in Asian and Caucasian Australian university students Piangchai S. Jennings a,*, David Forbes b, Brett McDermott a,b,c, Gary Hulse a a
School of Psychiatry and Clinical Neurosciences at UDP Level 4, Princess Margaret Hospital for Children, The University of Western Australia, GPO Box D184, Perth, Western Australia 6840, Australia b School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia c Child and Youth Mental Health Service, Mater Children Hospital and University of Queenland, Australia Received 11 July 2004; received in revised form 11 August 2005; accepted 18 August 2005
Abstract This study aimed to compare the attitudes and psychopathology of eating disorders of Asian and Caucasian university students using a survey method. The study also investigated the relationship between acculturation, attitudes and psychopathology of eating disorders in sub-groups of Asian girls. There were 130 Asian and 110 Caucasian adolescent girls, aged 18–24 who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2) and an Acculturation Index. The Asian group did not have higher mean EAT score than the Caucasian group, but had higher mean score in some sub-scales of the EDI-2. Eating disordered attitudes and psychopathology was not significantly different in the low compared to the high accultured Asian girls. This study suggests that Asian and Caucasian university students in Western Australia are equally susceptible to eating disorders, and that the level of acculturation does not modify the susceptibility of Asian students for eating disorders. D 2005 Elsevier Ltd. All rights reserved. Keywords: Acculturation; Adolescent; Asians; Australians; Eating disorders
1. Introduction Eating disorders were previously labelled as a culture-bound syndrome specific to western women, but are now reported across the world, including Asia (Gordon, 2001). This may be due to western influence, in which the desire for thinness is spread through the mass media (Mukai, Kambara, & Sasaki, 1998). Some British studies suggested that Asian adolescents who live in Western societies had significantly higher scores in the test of attitudes to eating than Caucasians (Dolan, Lacey, & Evans, 1990; Mujtaba & Furnham, 2001). Furthermore, some studies of Asian groups in Western societies found that less accultured (to Western culture) Asians had higher eating attitudes scores than highly accultured Asians (Lake, Staiger, & Glowinski, 2000; Mumford, Whitehouse, & Platts, 1991; Pate, Pumariega, Hester, & Garner, 1992). The focus on eating disorders in Asian groups in Australia has been very limited. Asian university students in Western Australia similar to their counterparts in USA or Britain may have unhealthier eating attitudes and * Corresponding author. Tel.: +61 8 9382 2163; fax: +61 8 9340 8121. E-mail address: [email protected] (P.S. Jennings). 1471-0153/$ - see front matter D 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.eatbeh.2005.08.006
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
215
psychopathology compared to Caucasian Australians. A recent nation wide study on 14 779 young women aged 18 to 23 in Australia (Ball & Kenardy, 2002) reported that risk factors for eating disorders were present across many ethnic groups. They also observed a strong acculturation effect where the longer the time that new migrants spent in Australia, the more their weight-related values and behaviors came closer to those of Australian-born women. The present study, therefore, aims to examine the attitudes to eating and psychopathology in these two non-clinical samples and to test the relationship between acculturation and eating disorders. Two hypotheses have been developed from the results of the studies above. The first hypothesis is that Asians have unhealthier attitudes and psychopathology towards eating than Caucasians. The second hypothesis is that less accultured Asians have unhealthier attitudes and psychopathology towards eating than high accultured Asians. 2. Methods This study is a cross-sectional survey study. The participants were 130 Asian and 110 Caucasian, female students, aged 18–24 years from The University of Western Australia in the Perth metropolitan area, Western Australia. Approval of the University Ethics Committee was obtained. The study was advertised in large classes that had a high proportion of Asian students. Only Asian and Caucasian students of the age group were asked to participate. Desks were placed in central areas to collect the questionnaires that were returned in each student’s own time. The Eating Attitudes Test (EAT-26) (Garner & Garfinkel, 1997) measures attitudes and symptoms of eating disorders. EAT-26 is a 26-item instrument that generates a total score and three sub-scales scores: Dieting, Bulimia and Food Preoccupation, and Oral Control. A cut off score of z 20 on the total score indicates an individual is susceptible to developing an eating disorder. The Eating Disorders Inventory-2 (EDI-2) (Garner, 1991) is a self-rating inventory, with 91 items and 11 subscales designed for the assessment of psychopathological and behavioural dimensions relevant to anorexia nervosa and bulimia nervosa. Other information collected includes the individual’s age, height, current body weight, and desired body weight. The suggested cut off score for screening purposes is z 14 in the sub-scale bDrive for ThinnessQ. The Eating Disorders Inventory-Symptom Checklist (EDI-SC) is a self-report that details eating disorder symptoms (Garner, 1991), which serve as a semi-structured interview and aid the diagnosis of eating disorders in the susceptible cases using the DSM-IV criteria (American Psychiatric Association, 1994). The Acculturation Index (Ward, 1998; Ward & Rena-Deuba, 1999) was used with the Asian group, which resulted in two independent scores, termed bTypical Asian IndexQ (TA) and bTypical Caucasian Australian IndexQ (TCA). The Asian students were categorised according to their degree of Asian acculturation (Typical Asian Index, TA) or Caucasian acculturation (Typical Caucasian Australian Index, TCA). For TCA scales, a subject with a score of mean (83.79) plus one standard deviation (20.53) or greater was categorised as high (western) accultured, while subjects with a score of mean minus one standard deviation or less were categorised as low accultured. For TA scales, a subject with a score of mean (99.49) plus one standard deviation (20.59) or greater was categorised as low (western) accultured, while subjects with a score of mean minus one standard deviation or less were categorised as high accultured. Measures of eating disorders attitudes and psychopathology were compared between these groups. The data were analysed using SPSS, the t-Test, Chi-Squares, Bivariate correlations and Reliability testing. A probability level of 0.05 was used as acceptance in all statistical tests of significance. 3. Results Of the total 300 questionnaire sets, 240 sets were completed. The participation rates were 130 / 150 (83%) in Asian students and 110 / 150 (71%) in Caucasian students. The demographic and physical data of the participants are shown in Table 1. Participants in Asian and Caucasian groups were similar in term of sex, age, religions and fathers’ occupation. There were differences in mean height, weight, body mass index (BMI = weight / height2) and years in Australia. The counts for categories of years in Australia, less than three years, four to five years, greater than five years, were (51, 13, 66) for Asians and were (3, 0, 107) for Caucasians. The Asian subjects were mostly born overseas (110 / 130, 85%), while most of the Caucasians were born in Australia (87 / 110, 79%). Of the Asian group, 42 / 130 (32%) were Chinese, and 26 / 130 (20%) Malaysian. The rest were other ethnicities such as Asian, Indonesian, Vietnamese, Indian, and Taiwanese.
216
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
Table 1 Mean scores (M), Standard Deviation (SD) of weight, height and BMI for Asian and Caucasian Australian University girls Variables
Age Weight (kg) Desired weight (kg) Height (m) BMI (kg/m2)
Asian, n = 130
Caucasian, n = 110
M
SD
M
SD
19.33 54.28** 51.67** 1.62** 20.66**
1.54 7.70 5.71 0.07 2.48
19.24 62.34 57.65 1.69 21.76
1.33 6.77 10.15 0.07 3.31
Note. **Asian b Caucasian, p = 0.00 (2-tailed).
There were no significant differences of mean total EAT-26 and its sub-scales scores between the Asian and the Caucasian group. However, the Asian group had significantly higher mean scores than the Caucasian group in the Ineffectiveness, Interpersonal Distrust, Maturity Fears and Social Insecurity sub-scales of the EDI-2 (Table 2). Within the Asian group, there were no significant differences in mean scores on the EAT and the EDI scales between the high TA group and the low TA group. Similarly, there were no significant differences in mean scores on the EAT and the EDI scales for the high TCA group and the lower TCA group. There were no significant differences in susceptibility and symptoms between the low accultured Asians and the high accultured Asians (Chi Square test). Fifteen of the 130 (11.3%) Asian students (2 EAT-26 positive only; 6 EDI-2 only; 7 both), and eleven of the 110 (10%) Caucasian girls (4 EAT-26 positive only; 2 EDI-2 only; 5 both) were identified as susceptible to an eating disorder. There were no significant differences in susceptibility between the Asian and Caucasian groups. Using the EDI-SC, none of the susceptible cases had symptoms consistent with the diagnostic criteria for anorexia nervosa of the DSM-IV (American Psychiatric Association, 1994). Four Asians and two Caucasians fitted criteria for bulimia nervosa and two Asians and five Caucasians fitted criteria for the Eating Disorders Not Otherwise Specified. In the non-susceptible groups, twelve Asians and twenty-three Caucasians (near susceptible cases) were identified from the EDI-SC, with a history of binging, purging and inappropriate weight control behaviours. However, there was a significant difference between the groups for those who had symptoms (eighteen Asians and thirty Caucasians) and those that did not (v = 6.71, df = 1, p b 0.01). Cronbach’s alphas for the EAT-26 were 0.87 and 0.89 and EDI-2 were 0.93 and 0.95 in Asian and Caucasian groups, respectively. Cronbach’s alphas for the Typical Asian Index (TA) and the Typical Caucasian Australian Index (TCA) were 0.93 and 0.92, respectively. These instruments had excellent internal consistency. Table 2 Mean scores (M), Standard Deviation (SD) and probability values ( p) of EAT-26, EDI-2 and its sub-scales for Asian and Caucasian Australian University students Variable
Total EAT Dieting Bulimia (EAT-26) Oral control Total EDI Drive for thinness Bulimia (EDI-2) Body dissatisfaction Ineffectiveness Perfectionism Interpersonal distrust Interoceptive awareness Maturity fears Asceticism Impulse regulation Social insecurity Note. *Asian N Caucasian, p = 0.05 (2-tailed).
Asian
Caucasian
M
SD
M
SD
7.38 4.86 1.02 1.49 49.33 3.91 1.64 10.16 3.51* 6.35 3.45* 3.81 5.05* 3.35 3.53 4.61*
8.57 6.12 2.36 2.10 28.35 5.13 2.71 7.68 4.05 4.44 3.04 4.53 3.99 2.47 4.16 3.57
7.77 5.06 1.44 1.27 42.50 3.76 1.74 11.50 2.38 5.05 2.12 3.35 2.94 3.25 2.88 3.39
9.32 6.73 2.73 1.85 30.52 5.20 3.05 8.09 3.39 4.22 2.68 4.95 3.69 2.70 4.26 2.96
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
217
The Convergent Validity (Williamson, Anderson, Jackman, & Jackson, 1995), that is the agreement between subscale Drive for Thinness of EDI-2 and sub-scale Dieting of EAT-26 were high, r = 0.85 in both groups. A moderate positive relationship existed between Total EAT–Total EDI scores, r = 0.64 and 0.74 in the Asian group and the Caucasian group, respectively. 4. Discussion The major findings are that the Asian groups score in eating disorders psychopathology as measured by the EDI-2 is significantly higher than that of the Caucasian group. The less accultured Asian group had a similar score of attitudes to eating as measured by the EAT-26 and of eating psychopathology as that of the more accultured Asian group. The first hypothesis, which stated that the attitudes to eating and psychopathology in the Asian group would be higher than in the Caucasian group, was partially accepted. The psychopathological traits of the Asian group was significantly unhealthier than that of the Caucasian group in Ineffectiveness, Interpersonal Distrust, Maturity Fears, and Social Insecurity sub-scales, but not others. The possible explanation is that the Asian group and the Caucasian group have similar levels of attitudes and psychopathology, since these higher scores may reflect ego development traits rather than eating disorders psychopathology (Garner, 1991). An earlier study using a small number of Asian and Caucasian high school students in Perth, Western Australia showed a similar result (Jennings, Forbes, McDermott, Juniper, & Hulse, 2005). The differences could be interpreted as due to cultural differences to the Caucasian group. These may reflect the family background of Asian female students, who have a tendency to have overprotective parents, receive less encouragement towards independent values, have more restrictive expression of emotions, are more emotionally dependent on their parents, and experience more conflict with their parents due to cultural change than the Caucasian students (Mujtaba & Furnham, 2001; Nishizono-Maher, 1998; Rosenthal, Ranieri, & Klimidis, 1996). Stress from higher Asian parental expectations in education (Feng, 1994; Schwartz, 2003) compared to Caucasian parental expectations may lead to higher scores on the four sub-scales. The last explanation concerns the validity of the EDI-2 in cultures outside where it was developed, without clinical validation in the new culture. There are limited studies that use the EDI-2 to compare Asian and Caucasian University students. The result of Asian and Caucasian scores of the EDI-2 in the present study is consistent with the study of Lee, Lee, Leung, and Yu (1997) and Jennings et al. (2005) but not consistent with Haudek, Rorty, and Henker (1999) who used only three sub-scales, Drive for Thinness, Bulimia and Body Dissatisfaction. The higher number of EDI-SC positives in the Caucasian group may be explained by the freer parental control even though nearly half of the Asian students were without their parents. These Caucasian girls may feel freer to experiment with behaviour that is classified as a symptom of eating disorders. It is also possible that use of dieting, vomiting or other purging behaviours has different connotations in different settings. These results are similar to the finding of Ball and Kenardy (2002) in a large Australian wide sample, where 47% of young females used dieting in the year previous to the time of the survey. In both Asian and Caucasian groups, these reported symptoms could also be interpreted as testing behaviours that most girls are able to control. Some may go too far and develop serious eating disorders. A study of dieting by Patton et al. (1997) on a large sample of Australian adolescents where 45% of girls were classified as intermediate or extreme dieters, supports this notion. The second hypothesis, that the low accultured Asian group would have unhealthier eating disorders attitudes and psychopathology than the high accultured Asian group, has been rejected. The result in this Asian group is in contrast to the finding from some studies which found that less accultured Asian girls had higher eating disorders attitudes scores than high accultured Asian girls (Furnham & Adam-Saib, 2001; Jennings et al., 2005; Lake et al., 2000; McCourt & Waller, 1996; Mujtaba & Furnham, 2001; Mumford et al., 1991). The result of the eating disorders psychopathology in this Asian group is similar to the finding of Gowen, Hayward, Killen, Robinson, and Taylor (1999) but not consistent with the study of Davis and Katzman (1999) which found that high accultured Asian girls had higher eating disorders attitudes scores than the less accultured Asian girls. This contrasts with the result of the study of Jennings et al. (2005), which found that less accultured Asian girls in high school had higher eating disorders psychopathological scores than high accultured Asian girls. It might be that the less accultured group in the present study was already adjusted to the culture they are immersed in. Another reason is that the older Asian students may have passed the critical period of their development in which they were vulnerable to eating disorders.
218
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
The reliability of the instruments is high and acceptable. This finding is consistent with the studies of Mumford et al. (1991) and Joiner and Heatherton (1998). Since the internal reliability of the instruments is acceptable, we believe that the EAT-26 and the EDI-2 might be useful as a first step in screening susceptible cases of eating disorders in female youths in these Asian and Caucasian communities. Some factors should be taken into consideration in the interpretation of this study. Potential limitations include reliance on volunteers and self-report measures. This may have a sampling bias, since the eating disorders attitudes and psychopathology of the Asians and Caucasians who decline to volunteer are still unknown. The measures used in the EAT-26 and EDI-2 were developed for eating disorders in Western societies and may have cultural bias. Despite these limitations, our finding is consistent with some studies of Asians in other Western societies and some studies of Asians in their societies. EDI-SC also serves as a semi-structured interview, which is aimed at a clearer assessment with the diagnostic criteria, though clinical verification is still required. Acknowledgement We are grateful to Drs. Anh-Van Pham, Dominique Blache and Sato Juniper, for their advice. References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). Washington, DC7 American Psychiatric Association. Ball, K., & Kenardy, J. (2002). Body weight, body image, and eating behaviours: Relationships with ethnicity and acculturation in a community sample of young Australian women. Eating Behaviors, 3, 205 – 216. Davis, C., & Katzman, M. A. (1999). Perfection as acculturation: Psychological correlates of eating problems in Chinese male and female students living in the United States. International Journal of Eating Disorders, 25, 65 – 70. Dolan, B. M., Lacey, J. H., & Evans, C. (1990). Eating behaviour and attitudes to weight and shape in British women from three ethnic groups. British Journal of Psychiatry, 157, 523 – 528. Feng, J. (1994). Asian-American children: What teachers should know. Retrieved 10 October, 2003, from http://gateway2.ovid.com/ovidweb.cgi Furnham, A., & Adam-Saib, S. (2001). Abnormal eating attitudes and behaviours and perceived paretal control: A study of white British and British-Asian school girls. Social Psychiatry and Psychiatric Epidemiology, 36, 462 – 470. Garner, D. M. (1991). Eating disorders inventory-2. Odessa, FL7 Psychological Assessment Resources. Garner, D. M., & Garfinkel, P. E. (1997). Psychoeducation principles of treatment. In D. M. Garner, & P. E. Garfinkel (Eds.), Handbook of treatment for eating disorders (2nd ed.). New York7 The Guilford Press. Gordon, R. A. (2001). Eating disorders East and West: A culture-bound syndrome unbound. In M. Nasser, M. A. Kazman, & R. A. Gordon (Eds.), Eating disorders and cultures in transition (pp. 1 – 16). New York7 Brunner-Routledge. Gowen, L. K., Hayward, C., Killen, J. D., Robinson, T. N., & Taylor, C. B. (1999). Acculturation and eating disorder symptoms in adolescent girls. Journal of Research on Adolescence, 9, 67 – 83. Haudek, C., Rorty, M., & Henker, B. (1999). The role of ethnicity and parental bonding in the eating and weight concerns of Asian-American and Caucasian college women. International Journal of Eating Disorders, 25, 425 – 433. Jennings, P., Forbes, D., McDermott, B. M., Juniper, S., & Hulse, G. (2005). Acculturation and eating disorders in Asian and Caucasian Australian adolescent girls. Psychiatry and Clinical Neurosciences, 59, 56 – 61. Joiner Jr., T. E., & Heatherton, T. F. (1998). First-and second-order factor structure of five subscales of the eating disorders inventory. International Journal of Eating Disorders, 23, 189 – 198. Lake, A. J., Staiger, P. K., & Glowinski, H. (2000). Effect of Western culture on women’s attitudes to eating and perceptions of body shape. International Journal of Eating Disorders, 27, 83 – 89. Lee, S., Lee, A. M., Leung, T., & Yu, H. (1997). Psychometric properties of the Eating Disorders Inventory (EDI-1) in a non-clinical Chinese population in Hong Kong. International Journal of Eating Disorders, 21, 187 – 194. McCourt, J., & Waller, G. (1996). The influence of sociocultural factors on the eating psychopathology of Asian women in British society. European Eating Disorders Review, 4, 73 – 83. Mujtaba, T., & Furnham, A. (2001). A cross-cultural study of parental conflict and eating disorders in a non-clinical sample. International Journal of Social Psychiatry, 47, 24 – 35. Mukai, T., Kambara, A., & Sasaki, Y. (1998). Body dissatisfaction, need for social approval, and eating disturbances among Japanese and American college women. Sex Roles, 39, 751 – 763. Mumford, D. B., Whitehouse, A. M., & Platts, M. (1991). Sociocultural correlates of eating disorders among Asian schoolgirls in Bradford. British Journal of Psychiatry, 158, 222 – 228. Nishizono-Maher, A. (1998). Eating disorders in Japan: Finding the right context. Psychiatry and Clinical Neurosciences, 52, 320 – 323. Pate, J. E., Pumariega, A. J., Hester, C., & Garner, D. M (1992). Cross-cultural patterns in eating disorders: A review. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 802 – 809. Patton, G. C., Carlin, J. B., Shao, Q., Hibbert, M. E., Rosier, M., & Selzer, R., et al. (1997). Adolescent dieting: Healthy weight control or borderline eating disorder?. Journal of Child Psychology and Psychiatry and Allied Disciplines, 38, 299 – 306.
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
219
Rosenthal, D., Ranieri, N., & Klimidis, S. (1996). Vietnamese adolescents in Australia: Relationships between perceptions of self and parental values, intergenerational conflict, and gender dissatisfaction. International Journal of Psychology, 31, 81 – 91. Schwartz, W. (2003). A guide to communicating with Asian American families. Retrieved 19 December, 2003, from http://www.bway.org/ education/cultasian.html Ward, C. (1998). Models and measurements of acculturation. Paper presented at the the XIV Congress of the International Association for Crosscultural Psychology, Bellingham, Washington. Ward, C., & Rena-Deuba, A. (1999). Acculturation and adaptation revisited. Journal of Cross-Cultural Psychology, 30, 422 – 442. Williamson, D. A., Anderson, D. A., Jackman, L. P., & Jackson, S. R. (1995). Assessment of eating disordered thoughts, feelings, and behaviors. In D. B. Allison (Ed.), Handbook of assessment methods for eating behaviors and weight-related problems. Thousand Oaks, USA7 Sage Publications, Inc.
Acculturation and eating disorders in Asian and Caucasian Australian university students Piangchai S. Jennings a,*, David Forbes b, Brett McDermott a,b,c, Gary Hulse a a
School of Psychiatry and Clinical Neurosciences at UDP Level 4, Princess Margaret Hospital for Children, The University of Western Australia, GPO Box D184, Perth, Western Australia 6840, Australia b School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia c Child and Youth Mental Health Service, Mater Children Hospital and University of Queenland, Australia Received 11 July 2004; received in revised form 11 August 2005; accepted 18 August 2005
Abstract This study aimed to compare the attitudes and psychopathology of eating disorders of Asian and Caucasian university students using a survey method. The study also investigated the relationship between acculturation, attitudes and psychopathology of eating disorders in sub-groups of Asian girls. There were 130 Asian and 110 Caucasian adolescent girls, aged 18–24 who were screened using the Eating Attitudes Test (EAT-26), the Eating Disorders Inventory (EDI-2) and an Acculturation Index. The Asian group did not have higher mean EAT score than the Caucasian group, but had higher mean score in some sub-scales of the EDI-2. Eating disordered attitudes and psychopathology was not significantly different in the low compared to the high accultured Asian girls. This study suggests that Asian and Caucasian university students in Western Australia are equally susceptible to eating disorders, and that the level of acculturation does not modify the susceptibility of Asian students for eating disorders. D 2005 Elsevier Ltd. All rights reserved. Keywords: Acculturation; Adolescent; Asians; Australians; Eating disorders
1. Introduction Eating disorders were previously labelled as a culture-bound syndrome specific to western women, but are now reported across the world, including Asia (Gordon, 2001). This may be due to western influence, in which the desire for thinness is spread through the mass media (Mukai, Kambara, & Sasaki, 1998). Some British studies suggested that Asian adolescents who live in Western societies had significantly higher scores in the test of attitudes to eating than Caucasians (Dolan, Lacey, & Evans, 1990; Mujtaba & Furnham, 2001). Furthermore, some studies of Asian groups in Western societies found that less accultured (to Western culture) Asians had higher eating attitudes scores than highly accultured Asians (Lake, Staiger, & Glowinski, 2000; Mumford, Whitehouse, & Platts, 1991; Pate, Pumariega, Hester, & Garner, 1992). The focus on eating disorders in Asian groups in Australia has been very limited. Asian university students in Western Australia similar to their counterparts in USA or Britain may have unhealthier eating attitudes and * Corresponding author. Tel.: +61 8 9382 2163; fax: +61 8 9340 8121. E-mail address: [email protected] (P.S. Jennings). 1471-0153/$ - see front matter D 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.eatbeh.2005.08.006
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
215
psychopathology compared to Caucasian Australians. A recent nation wide study on 14 779 young women aged 18 to 23 in Australia (Ball & Kenardy, 2002) reported that risk factors for eating disorders were present across many ethnic groups. They also observed a strong acculturation effect where the longer the time that new migrants spent in Australia, the more their weight-related values and behaviors came closer to those of Australian-born women. The present study, therefore, aims to examine the attitudes to eating and psychopathology in these two non-clinical samples and to test the relationship between acculturation and eating disorders. Two hypotheses have been developed from the results of the studies above. The first hypothesis is that Asians have unhealthier attitudes and psychopathology towards eating than Caucasians. The second hypothesis is that less accultured Asians have unhealthier attitudes and psychopathology towards eating than high accultured Asians. 2. Methods This study is a cross-sectional survey study. The participants were 130 Asian and 110 Caucasian, female students, aged 18–24 years from The University of Western Australia in the Perth metropolitan area, Western Australia. Approval of the University Ethics Committee was obtained. The study was advertised in large classes that had a high proportion of Asian students. Only Asian and Caucasian students of the age group were asked to participate. Desks were placed in central areas to collect the questionnaires that were returned in each student’s own time. The Eating Attitudes Test (EAT-26) (Garner & Garfinkel, 1997) measures attitudes and symptoms of eating disorders. EAT-26 is a 26-item instrument that generates a total score and three sub-scales scores: Dieting, Bulimia and Food Preoccupation, and Oral Control. A cut off score of z 20 on the total score indicates an individual is susceptible to developing an eating disorder. The Eating Disorders Inventory-2 (EDI-2) (Garner, 1991) is a self-rating inventory, with 91 items and 11 subscales designed for the assessment of psychopathological and behavioural dimensions relevant to anorexia nervosa and bulimia nervosa. Other information collected includes the individual’s age, height, current body weight, and desired body weight. The suggested cut off score for screening purposes is z 14 in the sub-scale bDrive for ThinnessQ. The Eating Disorders Inventory-Symptom Checklist (EDI-SC) is a self-report that details eating disorder symptoms (Garner, 1991), which serve as a semi-structured interview and aid the diagnosis of eating disorders in the susceptible cases using the DSM-IV criteria (American Psychiatric Association, 1994). The Acculturation Index (Ward, 1998; Ward & Rena-Deuba, 1999) was used with the Asian group, which resulted in two independent scores, termed bTypical Asian IndexQ (TA) and bTypical Caucasian Australian IndexQ (TCA). The Asian students were categorised according to their degree of Asian acculturation (Typical Asian Index, TA) or Caucasian acculturation (Typical Caucasian Australian Index, TCA). For TCA scales, a subject with a score of mean (83.79) plus one standard deviation (20.53) or greater was categorised as high (western) accultured, while subjects with a score of mean minus one standard deviation or less were categorised as low accultured. For TA scales, a subject with a score of mean (99.49) plus one standard deviation (20.59) or greater was categorised as low (western) accultured, while subjects with a score of mean minus one standard deviation or less were categorised as high accultured. Measures of eating disorders attitudes and psychopathology were compared between these groups. The data were analysed using SPSS, the t-Test, Chi-Squares, Bivariate correlations and Reliability testing. A probability level of 0.05 was used as acceptance in all statistical tests of significance. 3. Results Of the total 300 questionnaire sets, 240 sets were completed. The participation rates were 130 / 150 (83%) in Asian students and 110 / 150 (71%) in Caucasian students. The demographic and physical data of the participants are shown in Table 1. Participants in Asian and Caucasian groups were similar in term of sex, age, religions and fathers’ occupation. There were differences in mean height, weight, body mass index (BMI = weight / height2) and years in Australia. The counts for categories of years in Australia, less than three years, four to five years, greater than five years, were (51, 13, 66) for Asians and were (3, 0, 107) for Caucasians. The Asian subjects were mostly born overseas (110 / 130, 85%), while most of the Caucasians were born in Australia (87 / 110, 79%). Of the Asian group, 42 / 130 (32%) were Chinese, and 26 / 130 (20%) Malaysian. The rest were other ethnicities such as Asian, Indonesian, Vietnamese, Indian, and Taiwanese.
216
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
Table 1 Mean scores (M), Standard Deviation (SD) of weight, height and BMI for Asian and Caucasian Australian University girls Variables
Age Weight (kg) Desired weight (kg) Height (m) BMI (kg/m2)
Asian, n = 130
Caucasian, n = 110
M
SD
M
SD
19.33 54.28** 51.67** 1.62** 20.66**
1.54 7.70 5.71 0.07 2.48
19.24 62.34 57.65 1.69 21.76
1.33 6.77 10.15 0.07 3.31
Note. **Asian b Caucasian, p = 0.00 (2-tailed).
There were no significant differences of mean total EAT-26 and its sub-scales scores between the Asian and the Caucasian group. However, the Asian group had significantly higher mean scores than the Caucasian group in the Ineffectiveness, Interpersonal Distrust, Maturity Fears and Social Insecurity sub-scales of the EDI-2 (Table 2). Within the Asian group, there were no significant differences in mean scores on the EAT and the EDI scales between the high TA group and the low TA group. Similarly, there were no significant differences in mean scores on the EAT and the EDI scales for the high TCA group and the lower TCA group. There were no significant differences in susceptibility and symptoms between the low accultured Asians and the high accultured Asians (Chi Square test). Fifteen of the 130 (11.3%) Asian students (2 EAT-26 positive only; 6 EDI-2 only; 7 both), and eleven of the 110 (10%) Caucasian girls (4 EAT-26 positive only; 2 EDI-2 only; 5 both) were identified as susceptible to an eating disorder. There were no significant differences in susceptibility between the Asian and Caucasian groups. Using the EDI-SC, none of the susceptible cases had symptoms consistent with the diagnostic criteria for anorexia nervosa of the DSM-IV (American Psychiatric Association, 1994). Four Asians and two Caucasians fitted criteria for bulimia nervosa and two Asians and five Caucasians fitted criteria for the Eating Disorders Not Otherwise Specified. In the non-susceptible groups, twelve Asians and twenty-three Caucasians (near susceptible cases) were identified from the EDI-SC, with a history of binging, purging and inappropriate weight control behaviours. However, there was a significant difference between the groups for those who had symptoms (eighteen Asians and thirty Caucasians) and those that did not (v = 6.71, df = 1, p b 0.01). Cronbach’s alphas for the EAT-26 were 0.87 and 0.89 and EDI-2 were 0.93 and 0.95 in Asian and Caucasian groups, respectively. Cronbach’s alphas for the Typical Asian Index (TA) and the Typical Caucasian Australian Index (TCA) were 0.93 and 0.92, respectively. These instruments had excellent internal consistency. Table 2 Mean scores (M), Standard Deviation (SD) and probability values ( p) of EAT-26, EDI-2 and its sub-scales for Asian and Caucasian Australian University students Variable
Total EAT Dieting Bulimia (EAT-26) Oral control Total EDI Drive for thinness Bulimia (EDI-2) Body dissatisfaction Ineffectiveness Perfectionism Interpersonal distrust Interoceptive awareness Maturity fears Asceticism Impulse regulation Social insecurity Note. *Asian N Caucasian, p = 0.05 (2-tailed).
Asian
Caucasian
M
SD
M
SD
7.38 4.86 1.02 1.49 49.33 3.91 1.64 10.16 3.51* 6.35 3.45* 3.81 5.05* 3.35 3.53 4.61*
8.57 6.12 2.36 2.10 28.35 5.13 2.71 7.68 4.05 4.44 3.04 4.53 3.99 2.47 4.16 3.57
7.77 5.06 1.44 1.27 42.50 3.76 1.74 11.50 2.38 5.05 2.12 3.35 2.94 3.25 2.88 3.39
9.32 6.73 2.73 1.85 30.52 5.20 3.05 8.09 3.39 4.22 2.68 4.95 3.69 2.70 4.26 2.96
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
217
The Convergent Validity (Williamson, Anderson, Jackman, & Jackson, 1995), that is the agreement between subscale Drive for Thinness of EDI-2 and sub-scale Dieting of EAT-26 were high, r = 0.85 in both groups. A moderate positive relationship existed between Total EAT–Total EDI scores, r = 0.64 and 0.74 in the Asian group and the Caucasian group, respectively. 4. Discussion The major findings are that the Asian groups score in eating disorders psychopathology as measured by the EDI-2 is significantly higher than that of the Caucasian group. The less accultured Asian group had a similar score of attitudes to eating as measured by the EAT-26 and of eating psychopathology as that of the more accultured Asian group. The first hypothesis, which stated that the attitudes to eating and psychopathology in the Asian group would be higher than in the Caucasian group, was partially accepted. The psychopathological traits of the Asian group was significantly unhealthier than that of the Caucasian group in Ineffectiveness, Interpersonal Distrust, Maturity Fears, and Social Insecurity sub-scales, but not others. The possible explanation is that the Asian group and the Caucasian group have similar levels of attitudes and psychopathology, since these higher scores may reflect ego development traits rather than eating disorders psychopathology (Garner, 1991). An earlier study using a small number of Asian and Caucasian high school students in Perth, Western Australia showed a similar result (Jennings, Forbes, McDermott, Juniper, & Hulse, 2005). The differences could be interpreted as due to cultural differences to the Caucasian group. These may reflect the family background of Asian female students, who have a tendency to have overprotective parents, receive less encouragement towards independent values, have more restrictive expression of emotions, are more emotionally dependent on their parents, and experience more conflict with their parents due to cultural change than the Caucasian students (Mujtaba & Furnham, 2001; Nishizono-Maher, 1998; Rosenthal, Ranieri, & Klimidis, 1996). Stress from higher Asian parental expectations in education (Feng, 1994; Schwartz, 2003) compared to Caucasian parental expectations may lead to higher scores on the four sub-scales. The last explanation concerns the validity of the EDI-2 in cultures outside where it was developed, without clinical validation in the new culture. There are limited studies that use the EDI-2 to compare Asian and Caucasian University students. The result of Asian and Caucasian scores of the EDI-2 in the present study is consistent with the study of Lee, Lee, Leung, and Yu (1997) and Jennings et al. (2005) but not consistent with Haudek, Rorty, and Henker (1999) who used only three sub-scales, Drive for Thinness, Bulimia and Body Dissatisfaction. The higher number of EDI-SC positives in the Caucasian group may be explained by the freer parental control even though nearly half of the Asian students were without their parents. These Caucasian girls may feel freer to experiment with behaviour that is classified as a symptom of eating disorders. It is also possible that use of dieting, vomiting or other purging behaviours has different connotations in different settings. These results are similar to the finding of Ball and Kenardy (2002) in a large Australian wide sample, where 47% of young females used dieting in the year previous to the time of the survey. In both Asian and Caucasian groups, these reported symptoms could also be interpreted as testing behaviours that most girls are able to control. Some may go too far and develop serious eating disorders. A study of dieting by Patton et al. (1997) on a large sample of Australian adolescents where 45% of girls were classified as intermediate or extreme dieters, supports this notion. The second hypothesis, that the low accultured Asian group would have unhealthier eating disorders attitudes and psychopathology than the high accultured Asian group, has been rejected. The result in this Asian group is in contrast to the finding from some studies which found that less accultured Asian girls had higher eating disorders attitudes scores than high accultured Asian girls (Furnham & Adam-Saib, 2001; Jennings et al., 2005; Lake et al., 2000; McCourt & Waller, 1996; Mujtaba & Furnham, 2001; Mumford et al., 1991). The result of the eating disorders psychopathology in this Asian group is similar to the finding of Gowen, Hayward, Killen, Robinson, and Taylor (1999) but not consistent with the study of Davis and Katzman (1999) which found that high accultured Asian girls had higher eating disorders attitudes scores than the less accultured Asian girls. This contrasts with the result of the study of Jennings et al. (2005), which found that less accultured Asian girls in high school had higher eating disorders psychopathological scores than high accultured Asian girls. It might be that the less accultured group in the present study was already adjusted to the culture they are immersed in. Another reason is that the older Asian students may have passed the critical period of their development in which they were vulnerable to eating disorders.
218
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
The reliability of the instruments is high and acceptable. This finding is consistent with the studies of Mumford et al. (1991) and Joiner and Heatherton (1998). Since the internal reliability of the instruments is acceptable, we believe that the EAT-26 and the EDI-2 might be useful as a first step in screening susceptible cases of eating disorders in female youths in these Asian and Caucasian communities. Some factors should be taken into consideration in the interpretation of this study. Potential limitations include reliance on volunteers and self-report measures. This may have a sampling bias, since the eating disorders attitudes and psychopathology of the Asians and Caucasians who decline to volunteer are still unknown. The measures used in the EAT-26 and EDI-2 were developed for eating disorders in Western societies and may have cultural bias. Despite these limitations, our finding is consistent with some studies of Asians in other Western societies and some studies of Asians in their societies. EDI-SC also serves as a semi-structured interview, which is aimed at a clearer assessment with the diagnostic criteria, though clinical verification is still required. Acknowledgement We are grateful to Drs. Anh-Van Pham, Dominique Blache and Sato Juniper, for their advice. References American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders: DSM-IV (4th ed.). Washington, DC7 American Psychiatric Association. Ball, K., & Kenardy, J. (2002). Body weight, body image, and eating behaviours: Relationships with ethnicity and acculturation in a community sample of young Australian women. Eating Behaviors, 3, 205 – 216. Davis, C., & Katzman, M. A. (1999). Perfection as acculturation: Psychological correlates of eating problems in Chinese male and female students living in the United States. International Journal of Eating Disorders, 25, 65 – 70. Dolan, B. M., Lacey, J. H., & Evans, C. (1990). Eating behaviour and attitudes to weight and shape in British women from three ethnic groups. British Journal of Psychiatry, 157, 523 – 528. Feng, J. (1994). Asian-American children: What teachers should know. Retrieved 10 October, 2003, from http://gateway2.ovid.com/ovidweb.cgi Furnham, A., & Adam-Saib, S. (2001). Abnormal eating attitudes and behaviours and perceived paretal control: A study of white British and British-Asian school girls. Social Psychiatry and Psychiatric Epidemiology, 36, 462 – 470. Garner, D. M. (1991). Eating disorders inventory-2. Odessa, FL7 Psychological Assessment Resources. Garner, D. M., & Garfinkel, P. E. (1997). Psychoeducation principles of treatment. In D. M. Garner, & P. E. Garfinkel (Eds.), Handbook of treatment for eating disorders (2nd ed.). New York7 The Guilford Press. Gordon, R. A. (2001). Eating disorders East and West: A culture-bound syndrome unbound. In M. Nasser, M. A. Kazman, & R. A. Gordon (Eds.), Eating disorders and cultures in transition (pp. 1 – 16). New York7 Brunner-Routledge. Gowen, L. K., Hayward, C., Killen, J. D., Robinson, T. N., & Taylor, C. B. (1999). Acculturation and eating disorder symptoms in adolescent girls. Journal of Research on Adolescence, 9, 67 – 83. Haudek, C., Rorty, M., & Henker, B. (1999). The role of ethnicity and parental bonding in the eating and weight concerns of Asian-American and Caucasian college women. International Journal of Eating Disorders, 25, 425 – 433. Jennings, P., Forbes, D., McDermott, B. M., Juniper, S., & Hulse, G. (2005). Acculturation and eating disorders in Asian and Caucasian Australian adolescent girls. Psychiatry and Clinical Neurosciences, 59, 56 – 61. Joiner Jr., T. E., & Heatherton, T. F. (1998). First-and second-order factor structure of five subscales of the eating disorders inventory. International Journal of Eating Disorders, 23, 189 – 198. Lake, A. J., Staiger, P. K., & Glowinski, H. (2000). Effect of Western culture on women’s attitudes to eating and perceptions of body shape. International Journal of Eating Disorders, 27, 83 – 89. Lee, S., Lee, A. M., Leung, T., & Yu, H. (1997). Psychometric properties of the Eating Disorders Inventory (EDI-1) in a non-clinical Chinese population in Hong Kong. International Journal of Eating Disorders, 21, 187 – 194. McCourt, J., & Waller, G. (1996). The influence of sociocultural factors on the eating psychopathology of Asian women in British society. European Eating Disorders Review, 4, 73 – 83. Mujtaba, T., & Furnham, A. (2001). A cross-cultural study of parental conflict and eating disorders in a non-clinical sample. International Journal of Social Psychiatry, 47, 24 – 35. Mukai, T., Kambara, A., & Sasaki, Y. (1998). Body dissatisfaction, need for social approval, and eating disturbances among Japanese and American college women. Sex Roles, 39, 751 – 763. Mumford, D. B., Whitehouse, A. M., & Platts, M. (1991). Sociocultural correlates of eating disorders among Asian schoolgirls in Bradford. British Journal of Psychiatry, 158, 222 – 228. Nishizono-Maher, A. (1998). Eating disorders in Japan: Finding the right context. Psychiatry and Clinical Neurosciences, 52, 320 – 323. Pate, J. E., Pumariega, A. J., Hester, C., & Garner, D. M (1992). Cross-cultural patterns in eating disorders: A review. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 802 – 809. Patton, G. C., Carlin, J. B., Shao, Q., Hibbert, M. E., Rosier, M., & Selzer, R., et al. (1997). Adolescent dieting: Healthy weight control or borderline eating disorder?. Journal of Child Psychology and Psychiatry and Allied Disciplines, 38, 299 – 306.
P.S. Jennings et al. / Eating Behaviors 7 (2006) 214–219
219
Rosenthal, D., Ranieri, N., & Klimidis, S. (1996). Vietnamese adolescents in Australia: Relationships between perceptions of self and parental values, intergenerational conflict, and gender dissatisfaction. International Journal of Psychology, 31, 81 – 91. Schwartz, W. (2003). A guide to communicating with Asian American families. Retrieved 19 December, 2003, from http://www.bway.org/ education/cultasian.html Ward, C. (1998). Models and measurements of acculturation. Paper presented at the the XIV Congress of the International Association for Crosscultural Psychology, Bellingham, Washington. Ward, C., & Rena-Deuba, A. (1999). Acculturation and adaptation revisited. Journal of Cross-Cultural Psychology, 30, 422 – 442. Williamson, D. A., Anderson, D. A., Jackman, L. P., & Jackson, S. R. (1995). Assessment of eating disordered thoughts, feelings, and behaviors. In D. B. Allison (Ed.), Handbook of assessment methods for eating behaviors and weight-related problems. Thousand Oaks, USA7 Sage Publications, Inc.