Understanding Eating Disorders Among Adolescents - Research Proposal Example

Prospectus (for Dissertation) Understanding Eating Disorders among Adolescents and Young Adult females between 15-24 years of age in, Ohio: A Community Based Study Department: Public Health Ph. D Program – Community Health and Education NAME Course Institution Professor Date Purpose: The purpose of the study is to explore social determinants of eating disorders among females in Ohio. Problem Statement Awareness of eating disorders (ED) as a serious mental illnesses and a public health issue lacks among the public and populations with adolescents and young adult women between 19-24 years old as the most affected. According to the American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual (APA, 2013) of Mental Disorders (DSM-5), Eating Disorder illnesses classification is Anorexia-Nervosa (AN), Bulimia-Nervosa (BN) and Binge Eating disorder (BED). Lack of awareness for diseases like ED is the greatest enemy for prevention and treatment of those affected. According to research (Bailey et al. 2014), this complacency is mainly attributed to lack of a holistic understanding and awareness of the disease in question. Relatively, there is a need for studies that focus on understanding the disease from the perspective of those most at risk and mostly affected. Consequently, this will facilitate the development of preventive programs that meet individual and comprehensive needs relative to ED. Decisively, this research bases on the assessment of eating disorders in Warren County (Ohio) to provide descriptive data as a basis for much needed, similar, future research in this area. Additionally, the research aims at studying and investigating level of awareness, associated risk factors and symptomatology of these eating disorders among adolescents and young adults in Ohio’s Warren County area. Eating disorders are complex psychiatric illnesses with high rates of morbidity and mortality (Rikani et al., 2013); and they are not only about food. As such, addressing such a complicated health issue needs a systematic approach. Conversely, researchers agree and highly recommend starting with community based research (Bailey, et al., 2014) in order to inform and guide program planners. This notion forms the basis for this prospectus through the application of past studies, research and comprehensive findings. Initially reviewed literature shows that more evidence based research that is community inspired, has the potential to play a significant role not only in raising awareness of this issues but also in developing effective prevention and treatment interventions. Kostro, Lerman and Attia (2014) argued that while wide research exists on co-existence of eating disorders with other diseases like suicide, self-injury and non-suicidal-self-injury (NSSI), reviewed research focused mainly on one group of eating disorders (Anorexia) leaving other groups (Bulimia and Binge-Eating) under-studied for co-morbidity with suicide and self-injury. Becker et al., ( 2014) added the need for pilot studies before public health interventions are applied to larger populations. Additionally, the Manitoba Department of Health emphasized focusing on factors including environments that puts adolescents most at risk, as one of the best practices in prevention and intervention of eating disorders, and in agreement with previous authors suggests that one of the main hurdles is the need for community/public health based research to inform these efforts. Similarly, the Ohio Department of health highlighted the need and importance of community-based research that would generate baseline data about the prevalence of eating disorders and assess communities ’awareness related to eating disorders and their impact on health. Evidently, such research would inform health officials and stakeholders and guide the development of effective interventions (ODH, 2013a). Unfortunately, adolescents and young adult women are the most exposed to ED (NIMH, 2013); however, studies lack a discovery approach of considering these young women’s experiences, attitudes, beliefs etc. Therefore, this dissertation proposal aims at closing the information gap by conducting a community-based assessment focusing on the population most at risk, adolescents and young adults by assessing their knowledge, attitudes and beliefs among others related to eating disorders. Moreover, it lays a foundation for future research by focusing on the community in order to understand eating disorders from the perspective of those most at risk. Concurrently, it will guide and inform the development of effective interventions at the interpersonal and community levels. The study will also be a conduit to educate the public about eating disorders. Significance According to the APA (2013), multiple people struggle with different eating disorders especially adolescents and young adult women. However, regardless of the growing evidence on characteristics of ED, such as over-evaluation of weight, binge eating and purging, the affected do not get the necessary assistance, even with the numerous health risks (Churruca, 2014). Reflecting on this notion, research should focus on this population’s experiences, fears, attitudes etc. related to body self-perception and eating as a way of empowering victims to seek help and share about their experiences without fear of stigma or alienation from society (Zwickert & Rieger 2013). There is need for such research so that effective prevention program planners are well informed and to give basis for more studies. Behaviors, diagnosis criteria and symptoms of ED show the gravity of the issue, as the characteristic symptoms for ED are an excessive focus on body image and weight. While it is normal for one to think about how one looks and appears occasionally, for people with ED this attention to self-image is constant, extreme and obsessive. However, for each ED, criterion behaviors vary. Evidence shows that, satisfying the need to meet these underweight criteria is what drives the behaviors of sufferers (Golan, 2013) – because then the individual engages in dangerous behaviors to lose weight i.e. starvation or eating minimal amounts of food. Better understanding of the development, reasons and nature of every disorder requires more studies of a qualitative nature in order to explore and discover more about this illness. Regardless of clinical approaches to address the dissimilar issues, new cases of eating disorders continue to rise (Austin, 2012 and NIH, 2013). Concomitantly, this prospectus addresses an area that is under-studied and needs more attention from a public health approach (Austin, 2012) assessment of multiple disorders like Bulimia Nervosa, Anorexia-Nervosa and Binge-Eating from a public health and community perspective. The results of this research will inform, guide and inspire evidence-based interventions to facilitate in addressing eating disorders. Background This section entails reviewed literature discussing issues on eating disorders and a lack of community based/public health involvement in addressing ED 1. Eating Disorders are an illness of great concern among women, especially adolescents and young adults. Hudson (2007) shows that prevalence of eating disorders (AN, BN and BED) among young adults is a significant public health issue that needs attention. Kostro et al., (2013) also show the same by highlighting that the disease complications is due to its co-morbidity with other issues like self-injury, obesity and suicide. With more public health/community based research, there are greater chances of understanding the risk better. Becker et al (2014) noted that not only community based research in this area was needed but also recommend the evaluation of pilot interventions to prevent ED before such efforts are applied to larger population groups. ED are complex and risk factors associated with each ED need to be understood for effective prevention programs. 2. A response by Churruca et al., (2014) shows that by exploring constructions of bulimia nervosa using to understand if BN is only uncontrollable behavior or a real mental illness, in qualitative study. Findings from this study confirm that BN, like other ED illnesses, is a serious public health concern and needs more than one approach or discipline to understand. This creates the need to study ED with emphasis on those affected with vast consideration of their perspectives, experiences etc. 3. Major and global health organizations are in alignment on the need for more community/based research in the fight against eating disorders. The American Psychological Association (APA, 2013) in DSM-5 identified classification of BN, AN and BED as clinically recognized and diagnosable diseases – that still needs more evidence based research to better understand and devise effective, disease specific, intervention programs. Manitoba (2006) for the Canadian Health Organization lists this approach among its list of “Best Practices in Prevention and Intervention of Eating Disorders.” The National Institute of Health (NIH, 2013) recent report on Eating Disorders emphasizes on this approach. 4. Rikani et al (2013) identified a gap between current research and etiology of eating disorders in their article. They review developmental intervention with reference to childhood sexual abuse and social-cultural factors with reference to Western cultural influence. However, the conclusion emphasizes that other factors like body image and dissatisfaction are the main risk for eating disorders in adolescence. 5. Zhao (2011) illustrates the significance of eating disorders as a public health issue in his report by providing statistical updates on hospitalizations for ED from 1999 to 2009, by age, state, race etc. The review shows that eating disorders have the highest mortality rate, especially among teenagers and young adults ages 15 – 24 hence making it a critical and significant public health issue. 6. In “Theory at a Glance” monograph, the National Cancer Association describes models, frameworks and theories relevant and useful for behavioral research and studies. NIH (2013) highly recommends use of socio-ecological model (SEM) to study public health issues, like ED that are concentrated on young adults and adolescents because it takes into account the holistic nature of health and disease prevention. Framework The theoretical framework for this study will be Bronfenbrenners (NIH 2013) socio-ecological model (SEM). By using the ecological systems framework, the study will be able to investigate ED among these young women, using interpersonal and community levels, especially the interpersonal level. Figure 1: The Ecological Framework Image source: With permission from Wilson, B (2001), Return to Ecological Weight Management System. Retrieved 11/2/2014 from http://www.balancedweightmanagement.com/TheSocio-EcologicalModel.htm The purpose of this study is to understand (by assessment) eating disorders in adolescence and young adults; i.e. the study aims at finding out and measuring the risk factors associated with eating disorders in this population, and the behaviors (symptomatology) characteristic of eating disorders. Risk factor assessment will look at attributes that give rise to distorted eating behaviors. There are multiple levels of influence for eating disorders to occur (APA, 2013) in an individual and effective assessment needs to look at factors that bring about this issue in the first place. Therefore, an appropriate theoretical approach needs to take into consideration these levels: from intra-personal factors to interpersonal, community and society that are all connected and interrelated in eating disorders (Manitoba, 2013). According to Yan & Bissel (2004), multiple levels explain an individual’s behaviors for eating disorders. The ecological model of social behavior is appropriate for this study, because it explains relationships of people with their physical and social environments. The ecological model (Figure 1) postulates that behavior affects multiple levels of influence that also affect it; individual behavior shapes the social environment, which also shapes it (NIH, 2013). Development of eating disorders has been associated with sociocultural pressures on women to be thin, distorted attitudes on ones’ body image, low self-esteem, among others. The social Ecological theory helps to explain this interconnectedness both for disease assessment that will in turn inform interventions that bring about positive behavioral change. Connecting inputs to outcomes is the key to addressing a public health issue (NIH, 2013) at any level. Research Questions RQ1.How much does adolescents and young adult females know about eating disorders? Do they have peers suffering with such disorder? How do they perceive people (other girls) with any of these disorders? Do they think they are at risk of developing one of these disorders? RQ2. What individual and interpersonal factors can influence the development of ED adolescents and young adult females? Do they feel stressed by expectations placed on them by others? What is the influence of peer pressure on their behaviors and attitudes related to their weight and appearance? What is the influence of family relationships and views on their eating behavior and attitude related to their weight and appearance? How do they view themselves: their physical appearance, their attractiveness? Do they diet? RQ3. What psychosocial factors have an impact on the development of ED among this group? How do prevalent social norms influence their eating behaviors, and perception of body image in young females 19-24? Nature of the Study Definitely, the needs of a particular research should guide the methodology selection (Patton, 2002). Likewise, qualitative methodology was selected as best suited for this research for several reasons: The goal of this study is to understand young women’s eating disorder behavior and reasons that govern such behavior using the SEM. The primary aim is providing a complete detailed description report of eating disorder illnesses, AN, BN and BED from the perspective of these young women (19-24 years of age) with personal interpretation of their comprehensive responses. Therefore, data gathering is mainly verbal rather than numerical. Significantly, methodology selection is in alignment with other ED studies that have used a similar approach. For example, Churruca et al., (2014) wanted to understand factors leading to development of BN among adults with different experiences of eating disorder. Using qualitative methodology, in an online survey, authors were able to achieve study goals using qualitative methodology. Conversely, this approach will enable study to assess eating disorders awareness, associated risk factors and symptomatology among adolescents and young adult women aged 19-24. Unlike previous studies – this study looks at ED among adolescents and young adult women ages 19-24 in as a single study, in Warren County Ohio. Possible Types and Sources of Information or Data 1. Data Collection: First-person (focus groups, interviews or journals) 8-12 people of less. Can you identify one method at this time? 2. State of Ohio - Health Department 3. Statistical data of Warren County residents – To understand demographics in detail 4. Local experts on adolescent and young adult health (from Ohio Department of Health, Warren county public health officials including County Commissioner); conducting interviews with some of these experts (by phone, face to face or by email) including Warren county Commissioner. REFERENCES American Psychiatry Association (2013) Diagnostic and Statistical Manual of Mental Disorders DSM-5, (5 Ed), American Psychiatry Association, Washington, DC, Retrieved on 28th December 2014 from http://www.psychiatry.org/practice/dsm/dsm5 Austin SB (2012) Public health approach to eating disorders prevention: It is time for public health professionals to take a seat at the table: BMC Public Health 2012, 12:854 http://www.biomedcentral.com/1471-2458/12/854 Bailey, A.P., Parker A, G., Colautti, L.A., Hart, M. L., Liu, P. & Hetrick, S.E (2014). Mapping the evidence for the prevention and treatment of eating disorders in young people Journal of Eating Disorders, Vol.2, no.5 Becker, C, Plasencia, M, Kilpela, L, Briggs, M, Tiffany, S. Stewart S.T (2014). Changing the course of comorbid eating disorders and depression: what is the role of public health interventions in targeting shared risk factors? Journal of Eating Disorders, Vol.2, no.15 Blumenthal, D.S., DiClemente R.J. (2013). Community-Based Participatory Health Research (2ndEd.), New York: Springer Publishing Company. Churruca, K., Pérez, J., and Ussher, J.M. (2014). Uncontrollable behavior or mental illness- Exploring constructions of bulimia using Q methodology: Journal of Eating Disorders, Vol.2, no.22 Golan, M (2013)The journey from opposition to recovery from eating disorders: multidisciplinary model integrating narrative counseling and motivational interviewing in traditional approaches: Journal of Eating Disorders, Vol.19, no.1 Kostro, K., B Lerman J.B., Attia, E. (2014). The status of suicide and self-injury in eating disorders: a narrative review: Journal of Eating Disorders, Vol.2, no.19 Manitoba (2006) Eating disorders: Best practices in Prevention and Intervention: Mental Health and Spiritual Health care Manitoba Health in partnership with The Manitoba Network on Disordered Eating/Eating Disorders. Retrieved on 28th December 2014 from http://www.gov.mb.ca/healthyliving/mh/docs/bppi.pdf National Institute of Mental Health (NIMH) (2013), Eating Disorders: Washington, DC: U.S. Government Printing Office Ohio Department of Health (ODH), (2013a) Adolescent Health – Ohio, Retrieved on September 30, 2014 from http://www.odh.ohio.gov/odhprograms/chss/ad_hlth/adhlth1.aspx Ohio Department of Health (ODH), (2013b) Adolescent Health – Ohio: Youth Risk Behavior Survey, Retrieved on September 30, 2014 from http://www.odh.ohio.gov/en/odhprograms/chss/ad_hlth/youthrsk/youthrsk1.aspx Rikani, A.A., Choudhry., Z., Choudhry, A. M., Ikram, H., Muhammad W Asghar, M.W., Kajal, D., Waheed A., Nusrat, J. & Mobassarah, N. J. ( 2013). A critique of the literature on etiology of eating disorders: Annals of Neurosciences, Vol.4 no.20, Retrieved from http://her.oxfordjournals.org/content/21/6/770.short Zhao, Y & Encinosa, W (2011) Hospitalizations for Eating Disorders from 1999 to 2006 -HCUP Statistical Brief #70 April 2009. Agency for Healthcare Research and Quality at Rockville, MD Retrieved on 28 December 2014, http://www.hcup- us.ahrq.gov/reports/statbriefs/sb70.pdf Zwickert, K & Rieger E (2013) Stigmatizing attitudes towards individuals with anorexia nervosa: an investigation of attribution theory Journal of Eating Disorders, Vol.1, no.2 Read More