Black-White (B/W) multiracial women represent one of the fastest-growing demographics in the United States and are at increased risk of mental health concerns due to their historical connection to racism in combination with other multiracial stressors. However, despite the growing multiracial population and the known increased health risks among this group, there remains little understanding of how sociocultural and contextual factors are related to their experiences of eating, exercise, and embodiment. Therefore, the study investigated the relationships among mindful eating (ME), intuitive exercise (IExS), racial identity invalidation (RII), and positive embodiment, as well as examined the indirect effects of multiracial identity invalidation on mindfulness-based approaches to eating and exercise via positive embodiment experiences in a sample of N = 306 cisgender, B/W multiracial women (MAge = 33.8; Range = 18-61). Participants completed an online survey through Prolific assessing demographics, RII, ME behaviors, IExS, and experiences of embodiment. Pearson's correlations demonstrated positive relationships between positive embodiment and both ME and IExS. Inverse associations were observed between positive embodiment and RII. No significant associations emerged between RII and ME or IExS. The indirect effects of RII on both ME and IExS via positive embodiment were significant (p < .01). Findings contribute to the scant literature centering multiracial women's health, recognizing discriminatory stressors and experiences of positive embodiment as important correlates of health practices. Results call for multi-systemic, culturally-tailored interventions to effectively bolster engagement in mindfulness-based wellness-promoting practices among B/W multiracial women in support of strengthening their embodied well-being.

BACKGROUND:Recently, emerging population-based evidence has revealed that yoga practitioners are particularly vulnerable to engaging in disordered eating behaviors, inclusive of orthorexia symptoms (OS). Although orthorexia tends to be characterized by a hypervigilance over consuming so-called healthy or clean foods based on quality attributes, its associations with variables related to broader diet culture (eg, internalized weight bias [IWB] and body- and fitness-related shame, guilt, and hubristic pride) remain underexamined. In addition, previous research has yet to explore the psychological correlates of OS specifically among yoga professionals, who are uniquely positioned to influence their students' and clients' orientations toward eating and embodied well-being. OBJECTIVE:This secondary analysis from the Yoga Teacher and Therapist Lifestyle and Well-Being Study (2019-2020) aimed to investigate the relationships among diet culture-related experiences, specifically IWB and body- and fitness-related self-conscious emotions, role modeling positive body image, and OS among female yoga professionals, as well as to evaluate the indirect effects of IWB via role modeling positive body image and other diet culture-related experiences on OS. DESIGN:A secondary, cross-sectional correlational analysis was performed to address the research questions. PARTICIPANTS:The study included 406 female yoga professionals living in the United States and Canada (37% racial/ethnic minority and 13% sexual minority). MAIN OUTCOME MEASURES:These included IWB, body- and fitness-related self-conscious emotions, role modeling positive body image, and OS. STATISTICAL ANALYSES PERFORMED:These included Pearson correlations and regression models. RESULTS:Nearly 40% of participants consumed an exclusively vegetarian or vegan diet; 25% identified as engaging in "clean eating." Positive associations were observed between IWB and OS, shame, and guilt. Inverse associations were observed between IWB and role modeling positive body image and authentic pride. OS were positively linked to all body and fitness-related self-conscious emotion variables and to role modeling positive body image. The indirect effect of IWB on OS via shame was significant (β = .16, 95% CI .07 to .26). The indirect effect via role modeling positive body image was nonsignificant (β = -.01, 95% CI -.02 to .00). CONCLUSIONS:Findings contribute to the growing scholarship recognizing orthorexia's links with harmful diet culture among yoga professionals, potentially reflecting regulating internal body- and fitness-related shame stemming from IWB and perceptions of modeling positive body image for students and clients who may be at risk. Results call for increased collaborative outreach efforts to identify appropriate interventions to effectively target these public health concerns within the broader yoga community.

Body image has a key impact on adolescent mental health. Yet there are few evidence-based interventions for older adolescents (aged 14 + years). This study evaluated the effectiveness of Be Real's BodyKind, a strengths-focused, gender-inclusive programme, culturally adapted for older adolescents in Ireland, which combines empirically-supported principles of cognitive dissonance, self-compassion, compassion for others, and social activism to support positive body image. Twenty-three second-level schools in Ireland participated in a pragmatic cluster randomised controlled trial. Overall, 1099 students (612 girls, 460 boys, 27 gender minority students) in Transition (4th) Year aged 15-16 years (M=15.4, SD=.5) were randomly assigned to receive the 4-session intervention delivered by teachers (n = 630) or waitlist control (n = 469). Outcomes were assessed at baseline, post-intervention and 2-month follow-up. Significant improvements in the main outcome of body appreciation (p = .03, d=.17) were observed at post-intervention. Girls demonstrated higher levels of body appreciation at post-intervention, and self-compassion at follow-up, but not boys. No significant changes in body satisfaction, psychological wellbeing, body ideal internalisation, compassion for others or social activism were observed. Findings indicate that girls may experience brief gains in body appreciation, but refining the programme and optimising implementation may be warranted to enhance programme impact, particularly in boys.

Hedonic hunger, pleasure-driven motivation to consume highly palatable foods independent of physical hunger, was conceptualized as a stable trait, yet may differ with biopsychosocial changes during pregnancy and postpartum. This study examined measurement equivalence and convergent validity of the Power of Food Scale (PFS), a measure of hedonic hunger, throughout pregnancy (each trimester) and postpartum (6 and 12 months) in N = 458 mothers in North Carolina, United States (Pregnancy Eating Attributes Study; 67.3% White, 15.1% Black) and in comparison to young adult women ( N = 1333 from the NEXT Generation Health Study; 60.8% White, 15.8% Black). Confirmatory factor analysis supported longitudinal equivalence in pregnant/postpartum individuals and partial equivalence with young adult women. Associations of PFS with emotional eating, external eating, and delay of gratification supported convergent validity. PFS functions as expected during pregnancy and postpartum. Item-level comparisons to primarily non-pregnant populations should be avoided. Cognitive interviews may clarify item interpretations during pregnancy and postpartum.

OBJECTIVE:Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans.METHOD:Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model.RESULTS:After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist-Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters.CONCLUSIONS:Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary.

Body image is an established public health concern and there is a pressing need for evidence-informed universal programmes for older adolescents. To ensure high standard, quality programmes, there have been calls to adapt existing programmes to different contexts in ways that ensure materials are relevant, but still aligned with their theoretical foundations. This study outlines the cultural adaptation of the BodyKind programme in Ireland, which was initially developed in the USA, to address an unmet need to provide an inclusive, strengths-focused, school-based body image intervention for older adolescents. After receiving BodyKind, codesign workshops were conducted with 12 adolescents aged 15-16 years, who provided feedback and designed content (examples/ scenarios) to increase the programme's relevance for adolescents. Feedback on cultural appropriateness of programme materials were obtained via interviews with six female post-primary teachers and one mental health clinician. Qualitative data were analysed using thematic analysis. BodyKind was perceived as highly acceptable by stakeholders who offered suggestions for programme refinement. Themes included 1.) Programme acceptability, 2.) Implementation considerations, 3.) Programme refinement. This study used multi-stakeholder feedback to engage in cultural adaptation of BodyKind prior to further evaluation, thereby informing efforts to implement sustainable and scalable programmes in schools.

Birth doulas were classified as nonessential personnel during COVID-19 and generally excluded from providing physical, in-hospital birth support. This amplified their emotional and informational support to clients, offering a unique opportunity to examine psychological mechanisms underlying birth doulas’ impact on perinatal outcomes. We conducted a methodologically rigorous qualitative case study leveraging a social action theory framework and interviewed 15 demographically diverse birth doulas. Doulas played an important role in supporting their clients’ psychological change processes (e.g., problem solving, outcome expectancies, self-efficacy, goal structures, cognitive schemas). This study contributes to our understanding of psychosocial interventions that may drive the positive effects of doula care on health outcomes, both within and beyond the pandemic context.

Initial evidence suggests that body appreciation prospectively predicts intuitive eating. However, the limited number of longitudinal studies focused solely on girls and women, with a lack of evaluation among men. Furthermore, the underlying mechanisms explaining this relationship remain poorly understood. The present study examined whether body appreciation prospectively predicted intuitive eating facets among women and men in Germany. We also tested whether adaptive affect regulation skills (i.e., body image flexibility) mediated these relationships. We analyzed data from 1436 women and 704 men across three time points: Baseline (T1), 6month (T2), and 12-month (T3) follow-up, using latent variable path models to assess direct and indirect effects. Among women, T1 body appreciation directly predicted T3 body-food choice congruence. Additionally, body appreciation indirectly predicted unconditional permission to eat, eating for physical rather than emotional reasons, and reliance on hunger and satiety cues at T3 via its effect on T2 body image flexibility. Among men, T1 body appreciation indirectly predicted T3 eating for physical rather than emotional reasons via T2 body image flexibility. Our findings suggest that body image flexibility plays a pivotal role in explaining why individuals who appreciate their bodies are more likely to eat intuitively.

Pregnancy embodiment describes the way a pregnant individual inhabits their body, including disconnection and connection, likely influencing both distress and well-being. Emerging work indicates that acceptance of pregnancy-related bodily change may support well-being, particularly when co-occurring with self-care behaviors. Yet, specific associations of pregnant embodiment and intentional, individualized self-care practices (mindful self-care; MSC) with well-being and distress remain unexamined. The present study tested independent and interactive associations between MSC and positive embodiment (body agency), and negative embodiment (body estrangement), respectively, with maternal distress and wellbeing in a sample of US pregnant women (N = 179; Mage = 31.3 years, aged 21-43; 85.6 % White, 4.9 % Hispanic/Latinx). Challenge and threat/harm appraisals of the COVID-19 pandemic were included in the model to represent responses to the unique sociohistorical context. Measurement-corrected path analytic models explained a substantial proportion of variation in well-being and a smaller proportion in prenatal distress. Among those with higher MSC, the association between body estrangement and prenatal distress was weaker. Results support mindful self-care as protective for pregnancy distress in the setting of body disconnection. Future individualized health promotion might consider how high-stress contexts influence application of self-care practices and impact distress and well-being during pregnancy. (c) 2023 Elsevier Ltd. All rights reserved.

The COVID-19 pandemic provided a context associated with negative consequences for body image and eating behavior. However, little is known about what factors helped to mitigate these consequences and build a positive body image. Previous research pointed to the significance of body image flexibility and perceived body acceptance by others in predicting body appreciation. However, as most of the studies have been cross-sectional, causal relationships are poorly understood. This longitudinal study tested the reciprocal association between body appreciation, body image flexibility, and perceived body acceptance by others during the COVID-19 pandemic in Germany. We analyzed data from a large community sample consisting of 1436 women and 704 men who were invited to complete the study measures (BAS-2, BI-AAQ-5, BAOS-2) at three time points, each approximately six months apart. Latent cross-lagged panel analyses revealed that greater T1 body appreciation predicted an increase in T2 body image flexibility among both genders, while for women, we additionally observed reciprocal effects between T2 and T3. Among both genders, we further found that greater body appreciation predicted increased perceived body acceptance by others over both measurement intervals (but not vice versa). Our findings are discussed in light of pandemical constraints during the studies' assessments.

We conducted one-on-one interviews with 25 Canadian cisgender women who self-identified as having (a) a condition or characteristic causing their body to deviate from societal norms and (b) overcome a negative body image to develop a positive body image. Using coding reliability thematic analyses, we identified 12 themes (italicised) involving processes and experiences associated with shifts in body image. Women had moments that sparked and confirmed the importance of building positive body image (Enough is Enough). They experienced accepting Social Connections and Community and Accessed Critical Knowledge conducive to body positivity. They engaged in Joyful Movement, Adaptive Appearance Investment, and Joyful and Intuitive Eating. They identified how Changing Societal Norms, Becoming Older and Wiser, COVID-19 Pandemic, having Illnesses and Medical Conditions, Pregnancy and Motherhood, and Spirituality, Religion, and Nature affected their body image, values, and valued action. As women engaged in these processes and experiences, shifts occurred in their perceptions of their embodied selves in the world, represented by four "Bigger Lessons:" I Am More Than My Looks, I Am More Than My Body, I am More Than My Self, and I am Inherently Worthy of Love, Respect, and Joy. These findings can inform body image programmes and clinical interventions.

Body dissatisfaction is prevalent among adolescents and a primary risk factor for eating disorders, yet there are few body image interventions for older adolescents that support development of positive body image. Therefore, we assessed the feasibility, acceptability and preliminary effectiveness of BodyKind, a four-lesson, mixed gender, teacher-led, school-based curriculum for older adolescents, that combines principles of self-compassion, compassion for others, cognitive dissonance, and social activism to address contemporary adolescent body image concerns (i.e., appearance bias, comparisons on social media) and strengthen positive body image development. The sample contained 147 adolescents, predominantly racial/ethnic minorities (>95%), 54.8% male, 41.5% female and 4.1% gender-minority students aged 15-18 years (M=16.24, SD=.96) from a lowincome, inner-city high school in the Midwestern US. Two teachers received training and delivered the curriculum to students. This single arm, mixed methods trial assessed student and teacher acceptability, teacher fidelity and student intervention outcomes. Despite reasonable teacher fidelity, recruitment/attendance rates, post-intervention data loss (35% attrition) limited evaluations of program effectiveness and study feasibility. Important learnings regarding study feasibility will inform optimisation for future school-based trials. Findings demonstrate high acceptability of BodyKind among teachers and adolescents in a lower socioeconomic school setting, and further randomized controlled effectiveness trials are required.

The modern millennial- and Gen Z-targeted Barbiecore feminist movement has emerged in tandem with Barbie®'s reinvention to inspire inclusion and active play. Stimulated by these media trends, the present study using a pre-post experimental design evaluated whether exposure to images depicting contemporary passively-posed Barbie Fashionista® (BF) dolls versus images of actively-posed Barbie Made to Move® (M2M) "fitspiration" dolls versus images of Lego Friends® (LF) scenes would differentially affect aspects of state body image and affect in a sample of 106 racially-diverse young adult college women (MAge = 19.2, SD = 1.39). ANCOVA models assessed the effects of condition on post state measures while controlling for baseline state measures. Results indicated that participants exposed to the BF images reported significantly lower body appreciation relative to those who viewed the LF play sets. A similar trend emerged for participants shown the newer M2M doll images. Additionally, viewing images of the actively-posed M2M dolls was associated with marginally higher appearance comparison scores versus the LF control. These initial findings have implications for considering the relevance of expanded digital strategies for marketing more realistically appearing and functioning Barbie® dolls in affecting the body image experiences and potential purchasing choices of young adult female consumers.

BACKGROUND:Poor body image is prevalent among adolescents and associated with several negative outcomes for their physical and psychological health. There is a pressing need to address this growing public health concern, yet there are few evidence-informed universal programmes for older adolescents that address contemporary body image concerns (i.e., social media). BodyKind is a four lesson, school-based, teacher led, universal body image programme that incorporates empirically supported principles of cognitive dissonance, self-compassion, compassion for others and social activism, to support positive body image development. Building on previous pilot trials in the USA, this paper outlines the protocol for a cluster randomised control trial (cRCT) and implementation evaluation of the BodyKind programme which was culturally adapted for the Irish cultural context.METHODS:We aim to recruit 600 students aged 15-17 years in Transition Year (4th year) across 26 second-level schools in Ireland. Using minimisation, schools will be randomly assigned to receive BodyKind (intervention condition, n=300) or classes as usual (waitlist control, n=300). Teachers in intervention groups will receive training and deliver the programme to students over four weeks, at a rate of one lesson per week. Primary outcomes of body appreciation, body dissatisfaction and psychological wellbeing and secondary outcomes of self-compassion, compassion for others, body ideal internalisation, social justice motives and appearance-based social media use will be assessed at pre-, post- and 2 month follow up. Mediation and moderation analyses will be conducted to identify how and for whom the intervention works best. An implementation evaluation will assess the quality of programme implementation across schools and how this may influence intervention outcomes. Waitlist control schools will receive the programme after the 2-month follow up.CONCLUSION:This study will be the first to implement a cRCT and an implementation evaluation to assess the impact of this multicomponent school-based body image programme designed to support healthy body image development. If shown to be effective, BodyKind will have the potential to improve adolescent body image and wellbeing and inform efforts to implement sustainable and scalable programmes in schools.TRIAL REGISTRATION:The trial was retrospectively registered on 10/10/2023 on ClinicalTrials.gov NCT06076993 .

The predominant approach of existing eating disorder prevention programs targets risk factors for development; furthermore, burgeoning evidence suggests that promotion of protective factors against eating disorders (e.g., positive body image) is also a worthy avenue for prevention efforts. The present study considered existing literature gaps in the design of an 8-week guided self-help intervention meant to address the risk for disordered eating through the improvement of positive body image and enhancement of current adaptive functioning. The intervention incorporated elements of weight-inclusive health promotion (e.g., Health at Every Size; HAES) alongside positive psychology and third-wave behavioral interventions [e.g., self-compassion, mindful eating, Acceptance and Commitment Therapy (ACT)] to promote engagement in mindful-self-care. This mixed-methods study evaluated the feasibility and acceptability of the text-messaging based intervention in a diverse sample of cisgender college women (N = 30; 30% Black; 30% bisexual) at risk for disordered eating. Results indicated a high level of engagement and satisfaction with the intervention. Proof of concept was preliminarily supported by the observed significant changes in variables of interest (i.e., body appreciation, positive embodiment, mindful self-care, intuitive eating, self-compassion, disordered eating, and body image dissatisfaction) across the intervention. Overall, results of this study suggest that the use of a guided self-help program based in technology which seeks to reduce risk factors for disordered eating while also supporting adaptive functioning may be indicated for emerging adult women. This article will discuss how the present study provides the groundwork for continued development of innovative and remotely accessible interventions which promote positive body image.

The present pilot randomized controlled trial (RCT) evaluated the feasibility, acceptability, and preliminary efficacy of a 4-week online yoga and body gratitude journaling intervention for strengthening positive embodiment among racially-diverse higher weight college women. Seventy-five participants were initially randomized to either the yoga condition ( n = 36) or to a wait-list control ( n = 39). Participants completed measures of positive and negative body image, weight bias internalization, self-compassion, drive for leanness, and physical activity acceptance at both baseline and post. Preliminary results among the 42 analyzed completers (mean age = 20.9, SD = 2.4; 30% Black or African American) revealed acceptable feasibility given the low-intensity nature of the intervention reflected in a 36% attrition rate. Self-reported adherence was strong for the yoga component with 81% of participants indicating that they practiced with the videos ≥3–4 times per week as suggested. Although 71% reported completing the body gratitude journal ≥1–2 times per week, daily adherence was minimal. Acceptability was also high among participants randomized to the yoga condition as indicated by 86% expressing at least moderate levels of satisfaction with the overall program. Qualitative feedback from participants further supported the acceptability of the program and pointed to important areas in further refining the protocol in the future. Preliminary efficacy was supported by significant reductions in internal body shame and gains in body appreciation, functional body appreciation, functional body satisfaction, functional body awareness, and behavioral commitment to physical activity engagement among the yoga vs. wait-list control participants. These promising findings once replicated in larger, higher-powered trials may have important implications for extending the reach and accessibility of mind-body wellness practices like yoga to benefit racially-/ethnically-diverse college women of higher weight. This research is further responsive to the growing need for efficacious remotely-delivered, and scalable behavioral health interventions in the ongoing era of the COVID-19 pandemic. However, additional research is warranted to explore ways of enhancing engagement of participants with lower levels of positive embodiment and to further incentivize the journaling component of the intervention.

Birth doulas were deemed "non-essential" personnel during the COVID-19 pandemic and were generally excluded from attending hospital births in person. This study documents the impacts of pandemic-related contextual factors on birth doula care in the San Francisco Bay Area, examines how doulas adapted their services, and explores implications for policy and practice. We employed a contextually bound qualitative case study methodology driven by social action theory and conducted interviews with 15 birth doulas. The pandemic disrupted physical settings, the social environment, communication modalities, contractual arrangements, and organizational level factors. The historical context also amplified awareness of institutionalized racism in birth settings and highlighted birth doulas' advocacy role. Striking deficits exist in birth doulas' integration into US healthcare systems; this made their services uniquely vulnerable to the pandemic circumstances. Birth doulas' value ought to be more formally recognized within health policy, health insurance, and hospital systems as complementary care to that provided by medical providers to improve access to high-quality perinatal care.