Kristin E. Heron

Objective: Changes in affect may precede or follow intuitive eating (IE) behaviors; however, few studies have examined these associations temporally. Affect‐IE processes may also differ between sexual minority women (SMW) and heterosexual women (HW). The current study examined associations between positive and negative affect before and after IE, and whether they differed by sexual orientation. Method: Participants were 296 cisgender women (146 SMW, 150 HW) who binge eat aged 18–30 who completed 14 days of EMA measures. Data were analyzed using multilevel lagged models with sexual orientation as a moderator. Results: Higher positive affect was associated with greater subsequent enjoyment of foods but not other IE behaviors. Lower negative affect was associated with greater subsequent enjoyment and permission to eat. Regarding prior IE and current positive affect, enjoyment of foods and trusting one's body were associated with higher positive affect across participants, while permission to eat demonstrated significant linear and cubic associations. Only HW demonstrated an association between prior performance‐based eating and positive affect. For negative affect, higher prior eating to support performance, trusting one's body, and enjoyment of food were associated with lower negative affect among all participants, whereas the prior permission to eat‐negative affect association was significant for only SMW. Discussion: Affect is temporally linked with some IE behaviors, more often following than preceding them, with subsequent higher positive and lower negative affect potentially reinforcing IE over time. SMW and HW showed largely similar patterns with a few differences, warranting continued investigation into the underlying mechanisms.

The denial, concealment, or omission of disordered eating behaviors has received limited attention in the eating disorder literature, partly due to the lack of reliable and valid measures. This study re-examined the factor structure of the Denial of Disordered Eating Behaviors Scale (DDEBS-12) and tested measurement invariance across gender identity, racial identity, and levels of disordered eating in a non-clinical undergraduate sample (N = 3285). Confirmatory factor analyses did not support the original unidimensional structure. Instead, a seven-item model assessing denial of dietary restriction demonstrated the best fit and was renamed the DDEBS-restriction. The revised scale showed good internal consistency and demonstrated expected associations with measures of concealment, disclosure, and dietary restriction, supporting convergent and criterion validity. Measurement invariance analyses supported configural and metric invariance across men and women, Black and White participants, and individuals with non-clinical versus elevated levels of disordered eating; scalar invariance was not supported across disordered eating severity groups. These findings suggest that the DDEBS-restriction demonstrates promising psychometric properties within an undergraduate sample, though additional research is needed to establish its generalizability across broader and more diverse populations.

Cisgender sexual minority women (SMW, e.g., lesbian, queer) are at greater risk for poor mental and physical health compared to heterosexual women and face challenges when accessing health care. Previous research has largely focused on general sexual and gender minority barriers to health care, but more research is needed on the experiences of specific subgroups, including cisgender SMW. The current study qualitatively explored barriers and facilitators for cisgender SMW seeking health care. Twenty cisgender SMW aged 18–40 recruited using Meta advertisements and past participant lists completed 45 min semi-structured interviews and a brief survey. Thematic analysis conducted by two coders revealed a barrier theme with six subthemes, and a facilitator theme with seven subthemes. The barrier subthemes included discrimination, dominant culture centric, unsupportive socio-political environment, lack of patient-centered care, avoidance/concealment of sexual identity, and socio-economic challenges. The facilitator subthemes included supportive socio-political environment, advance identification of LGBTQ-affirming HCPs, patient-centered care, HCP identity similar to patient, social support, re-engagement with care after bad experiences, and socio-economic advantages. This study provides insight into the lived experiences of cisgender SMW that can help improve knowledge about health care disparities and inform health care interventions for this population.

Sexual minority youth (e.g., lesbian, queer, bisexual) encounter higher rates of abuse compared to their heterosexual peers. Similarly, Black youth are disproportionately affected by adverse experiences, including abuse. Seeking help after experiencing abuse has been shown to improve both mental and physical health outcomes. There is a lack of research on how the intersection of these identities affects help-seeking behaviors when experiencing different types of abuse. To address this gap, our study analyzed national data from 716 Black cisgender sexual minority women (SMW) aged 18 to 21 ( M _age = 19.5) who participated in the Healthy Minds Study and examined the likelihood of seeking formal and informal support based on past year emotional, physical, and sexual abuse experiences. Formal help-seeking was assessed by whether participants received counseling or therapy, and informal help-seeking was defined as seeking support from a non-professional source (e.g., family member, friend, and significant other). We found participants who reported abuse experiences, including physical abuse, sexual abuse, emotional abuse, or combined abuse experiences, were significantly more likely to seek informal support, with odds ratios of 2.20, 1.66, 2.77, and 2.38, respectively. However, there was no difference in formal help-seeking compared to participants without abuse experiences. Specific sources of informal support sought were explored descriptively by participants with and without abuse experiences, showing that participants who experienced abuse primarily sought informal support from friends, family members, significant others, and roommates. This trend was consistent among participants who did not report any abuse experiences. Overall, findings suggest that there were no significant differences in the likelihood of seeking formal support regardless of participants’ abuse history. However, those who experienced abuse were significantly more likely to seek informal support compared to those who did not. Findings suggest Black adolescent SMW who have endured abuse may face barriers accessing formal support networks; therefore, targeted interventions are needed.

Background: Affective state-disordered eating associations are often studied to evaluate emotion regulation models of eating disorders. Disordered eating is common among sexual minority women, yet little is known about affect-disordered eating associations among this group. Purpose: Ecological momentary assessment (EMA) was used to assess affect preceding and following disordered eating among sexual minority and heterosexual young women (ages 18-30) who binge eat. Method: Five daily EMA surveys assessed affective states and disordered eating for 2 weeks among 146 sexual minority and 151 heterosexual cisgender women. Concurrent and time-lagged multilevel models were tested with sexual orientation as a moderator. Results: Higher negative affect was associated with a greater likelihood of emotional eating in the next several hours. Higher positive affect was associated with a lower likelihood of subsequent emotional eating for both heterosexual and sexual minority women, and both higher and lower positive affect than average was associated with a lower likelihood of loss of control eating and dietary restraint for heterosexual women only. Negative affect was higher following emotional eating, and skipping meals for both groups, and higher following loss of control eating for heterosexual women only. Positive affect was higher for both groups following times when they did not report emotional eating. Conclusions: Sexual minority and heterosexual women generally showed similar affect-disordered eating patterns, but several critical differences were noted. In particular, among young sexual minority women, higher positive affect was not associated with lower likelihood of loss of control eating and dietary restraint, whereas it was for heterosexual women. Future research considering how unique sociocultural pressures (eg, heterosexist discrimination, community norms) impact sexual minority women could improve understanding of disordered eating for this at-risk and understudied group.

Young cisgender sexual minority women (e.g. lesbian, queer) in the U.S. are at risk for disordered eating behaviors (DEB). Minority stress theory proposes sexual minority stressors (SMS; e.g. discrimination) related to marginalized statuses are culturally specific stressors that may explain engagement in these behaviors. However, little is known about daily SMS-DEB associations. We conducted a 14-day daily diary study of 321 U.S.-based sexual minority cisgender women ages 19-35 who were in a relationship with a woman. SMS were assessed using an 8-item daily measure of distal SMS (e.g. heard anti-LGBT talk, verbal harassment), and DEB with single items capturing dietary restraint, overeating, loss of control eating, and emotional eating. Multi-level models revealed on days when women experienced SMS, they were more likely to report dietary restraint and emotional eating, but not overeating or loss of control eating. Women who generally reported more frequent SMS were more likely to report all four DEB. There were no significant couple-level SMS-DEB associations. These findings expand our understanding of how SMS is associated with DEB in the daily lives of cisgender sexual minority women. Future studies are needed to explore the temporal sequencing of the associations. Findings may also help to inform the design of culturally tailored interventions aimed at reducing DEB among sexual minority women.

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science–based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for a unique and comprehensive exploration of current drivers of digital health inequities. This paper aims to present a compilation of strategies that can potentially have an actionable impact on digital health equity. Multilevel factors drive unequal access, so strategies require action from tool developers, individual delivery agents, organizations, and systems to effect change. Strategies were shaped with a behavioral medicine focus as the field has a unique role in improving digital health access; arguably, all digital tools require the user (individual, provider, and health system) to change behavior by engaging with the technology to generate impact. This paper presents a model that emphasizes using multilevel strategies across design, delivery, dissemination, and sustainment stages to advance digital health access and foster health equity.

The goal of the present study was to examine naturalistic associations between body satisfaction and physical activity (PA) among women in midlife. Women 40–60 years of age with cardiovascular risk factors (e.g., hypertension; N = 75; M_age = 51.63) responded to five surveys per day for 10 days while accelerometer-derived PA measurements were collected continuously. PA parameters included cognitive determinants (PA motivation and intentions) and accelerometer-measured PA behavior (sedentary behavior, light-intensity PA, and moderate to vigorous PA). Multilevel models indicated that associations between body satisfaction and everyday PA differed across PA determinants, time frames (concurrent and prospective), and levels (momentary, daily, and person). For example, positive bidirectional associations were identified between women’s daily body satisfaction and PA motivation, whereas greater momentary light-intensity PA (but not moderate to vigorous PA) was unidirectionally associated with greater body satisfaction at a subsequent prompt. These findings provide insight into how associations between body satisfaction and PA unfold in the daily lives of women in midlife and highlight the complexities of these associations.

Background: Ecological momentary assessment (EMA) is used to capture daily lived experiences, states, and environments. Although EMA is commonly used in behavioral health research, there remains a dearth of literature on how researchers account for design considerations of EMA techniques when designing studies. The goal of this formative mixed methods study was to elicit feedback on EMA study procedures and materials from the target populations for a larger study about binge eating among sexual minority and heterosexual young women, in which data are collected entirely remotely. Methods: Sexual minority (n=12) and heterosexual (n=9) women ages 18–30 who binge ate took part in a pilot EMA study and exit interview and survey. As part of the consent and orientation process, participants reviewed video and written materials describing the study purpose and procedures. Using a smartphone app, for seven consecutive days they completed a survey each morning, 5 random surveys per day, and self-initiated a survey each time they binge ate. Participants then provided feedback on the study via a 1-hour virtual interview and online survey. Interviews were transcribed and reviewed by two coders to identify themes on the acceptability and feasibility of the EMA procedures with a focus on: (I) the training and study description materials; (II) general smartphone app and survey preferences; and (III) specific EMA survey question content and wording. Results: The qualitative and quantitative data converged to suggest participants were able to easily download and use the app to complete surveys and report on binge eating events. Participants provided feedback that was incorporated into revisions on general study procedures, the training video content, and EMA question content for binge eating, identity-related stressors, and appearance-related pressures. No systematic themes in the quantitative or qualitative data emerged to suggest questions were perceived differently by sexual minority and heterosexual young women. Conclusions: These findings provide evidence for the feasibility of conducting a remote EMA study to assess young women’s experiences around binge eating. This formative study provides an example of how a mixed methods approach can be used to refine EMA study methods and questions to improve study design.