Sexual minority (SM; e.g., gay, lesbian, bisexual, pansexual, queer) young adults are at elevated risk for eating disorders (EDs). Researchers have used minority stress theory to understand how increased risk is due, in part, to stigma and discrimination from being part of a marginalized group. Despite this glaring inequity, limited programs exist to prevent EDs in SM populations. Critically, many SM young people live in rural regions with high anti-LGBTQ+ stigma and limited access to SM-specific resources. The proposed project will address this gap by adapting and evaluating two brief online interventions to reduce ED risk. N = 120 SM young adults in rural regions of Alabama with high LGBTQ+ stigma and low SM-specific resources will be randomized into one three brief online writing interventions: 1) expressive writing (n = 40), 2) self-affirmation (n = 40), or 3) control (n = 40). Participants will complete assessments pre-intervention, post-intervention, and 1-month post-intervention. Aim 1 will assess intervention feasibility and acceptability. Aim 2 will compare the brief online writing interventions to control in improving body image and ED symptoms. Finally, an exploratory aim will examine posited intervention mechanisms and whether the level of SM stigma and discrimination participants experience pre-intervention impacts intervention efficacy. This research will help support and benefit underserved SM young adults by filling a critical need for brief, scalable interventions that can be delivered online to help reduce ED risk. Data from this project will serve as pilot data for a subsequent R-series grant application from NIH.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Participants will be asked to write about the biggest body image or eating-related stressor they have experienced as a member of the LGBTQ+ community.
Participants will receive one new vignette per day describing a SM young adult experiencing severe body image stress in Alabama. Participants will be asked to write to this person and provide advice based on their own experience as a SM young adult. Vignettes will be identical across participants; however, they will be matched to participants' sexual identity, gender identity, and race/ethnicity.
Consistent with prior research participants will write about their routine daily activities since waking up for 20 minutes each day, sans emotional content.
Body Image
Body Image States Scale (BISS); 7-item self-report measure about satisfaction with overall appearance. Scores range from 1-9, with higher scores reflecting more positive body image
Time frame: changes from baseline through 1-month follow-up
Eating Disorder Symptoms
Eating Pathology Symptom Inventory (EPSI); 45-item measure that assesses 8 domains of eating disorder pathology, scores range from 0-32, with higher scores indicating greater pathology
Time frame: changes from baseline through 1-month follow-up
Internalization of Appearance Ideals and Pressures
Sociocultural Attitudes Towards Appearance Scale-4 (SATAQ-4); 22-item measure of internalization of appearance ideals and pressures. Scores range from 4-25, with higher scores indicating greater appearance internalization
Time frame: changes from baseline through 1-month follow-up
Negative Affect
Depression, Anxiety, and Stress Scale (DASS-21); 21 item measure used to assess depression, anxiety, and nonspecific physiological arousal which load onto a higher order factor of psychological distress/negative affect. Scores range from 0-63, with higher scores indicating greater negative affect
Time frame: changes from baseline through 1-month follow-up
Interpersonal Emotion Regulation
Difficulties in Interpersonal Regulation of Emotion (DIRE); 24-item measures of maladaptive interpersonal emotional regulation. Scores range from 3-30 and higher scores indicate greater pathology.
Time frame: changes from baseline through 1-month follow-up
Health-related quality of life
World Health Organization Quality of Life- (WHO-BREF); 26-item self-report measure for physical and psychological social relationships and environmental health. Scores range from 4-20; higher scores indicate a better quality of life.
Time frame: changes from baseline through 1-month follow-up
Social Self-Esteem
Social Self-Esteem Scale (SSES); Measures confidence and self-esteem in social situations across 9 items. Scores range from 9-54, with higher scores indicating grater social self-esteem.
Time frame: changes from baseline through 1-month follow-up
Self-Stigma of Seeking Help
Self-Stigma of Seeking Help (SSOSH); Stigma surrounding seeking help for psychological concerns. Scores range from 10-50, with higher scores indicating greater stigma.
Time frame: changes from baseline through 1-month follow-up
Substance Use
Alcohol, Smoking, and Substance Involvement Screening (ASSIST); Examines alcohol and substance use patterns. Scores range from 0-39 and higher scores reflect greater substance use problems.
Time frame: changes from baseline through 1-month follow-up
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