Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, United States of America; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, Massachusetts, 01655, United States of America.
Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, Massachusetts, 01655, United States of America.
Eat Behav. 2019 Aug;34:101299. doi: 10.1016/j.eatbeh.2019.05.002. Epub 2019 May 9.
Gender and racial/ethnic disparities in disordered eating among youth exist, although whether having multiple marginalized identities disproportionately increases risk is unclear. Therefore, we aimed to quantify the risk of disordered eating associated with intersecting gender and racial/ethnic identities of U.S. adolescents.
We analyzed data from 11,514 U.S. high school students identifying as White, Black/African American, or Hispanic/Latino who participated in the 2013 National Youth Risk Behavior Surveillance System. Age-adjusted relative risks (RR) of purging, fasting, diet pill use, and any disordered eating were estimated using log-binomial models. Relative excess risk due to interaction (RERI) was estimated to evaluate the degree to which the combined effect of marginalized gender and racial/ethnic identity was larger than the sum of their individual effects.
Disordered eating was prevalent (girls: 20.4% Black/African American, 29.2% Hispanic/Latina, 21.4% White; boys: 13.4% Black/African American, 12.4% Hispanic/Latino; 8.1% Whites). Girls of all racial/ethnic identities and racial/ethnic minority boys had elevated risks of purging, fasting, and any disordered eating compared to White boys (RR range = 1.57-7.43); Hispanic/Latina and White girls also had elevated risk of diet pill use (RR range = 1.98-3.20). Among Hispanic/Latina girls, positive interaction between gender and race/ethnicity produced excess risk of any disordered eating and purging (RERI: any = 0.42 (95% confidence interval (CI) = -0.02, 0.87); purging = 1.74 (95% CI = 0.06, 3.42).
Findings illustrate the advantages of adopting an intersectional approach to disordered eating research. Future research should investigate the mechanisms of these disparities.
青少年在饮食失调方面存在性别和种族/民族差异，但具有多种边缘化身份是否会不成比例地增加风险尚不清楚。因此，我们旨在量化与美国青少年性别和种族/民族身份交叉相关的饮食失调风险。
我们分析了 2013 年全国青年风险行为监测系统中 11514 名自认为是白人、黑/非裔美国人或西班牙裔/拉丁裔的美国高中生的数据。使用对数二项式模型估计了暴食、禁食、减肥药使用和任何饮食失调的年龄调整相对风险 (RR)。相对超额交互作用风险 (RERI) 用于评估边缘化性别和种族/民族身份的综合影响大于其各自影响之和的程度。
饮食失调很普遍（女孩：20.4%的黑/非裔美国人，29.2%的西班牙裔/拉丁裔，21.4%的白人；男孩：13.4%的黑/非裔美国人，12.4%的西班牙裔/拉丁裔；8.1%的白人）。与白人男孩相比，所有种族/民族身份的女孩和少数族裔男孩的暴食、禁食和任何饮食失调风险都升高（RR 范围为 1.57-7.43）；西班牙裔/拉丁裔和白人女孩也有更高的减肥药使用风险（RR 范围为 1.98-3.20）。在西班牙裔/拉丁裔女孩中，性别和种族/民族之间的积极相互作用导致任何饮食失调和暴食的风险增加（RERI：任何饮食失调=0.42（95%置信区间（CI）= -0.02，0.87）；暴食=1.74（95%CI=0.06，3.42）。
研究结果说明了采用交叉方法研究饮食失调的优势。未来的研究应该调查这些差异的机制。
