Eating Behaviors 21 (2016) 16

Contents lists available at ScienceDirect

Eating Behaviors

Weight perceptions, disordered eating behaviors, and emotional

self-efcacy among high school adolescents
Keith J. Zullig a,, Molly R. Matthews-Ewald b, Robert F. Valois c
a
b
c

Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, Morgantown, WV 26506-9190, United States
Texas Obesity Research Center, University of Houston, Houston, TX 77004, United States
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, United States

a r t i c l e

i n f o

Article history:
Received 23 April 2015
Received in revised form 27 August 2015
Accepted 11 November 2015
Available online 17 November 2015
Keywords:
Adolescents
Eating disorders
Self-efcacy
Emotional aspects
Gender differences

a b s t r a c t
Although emotional disorders and disordered eating behaviors are known to be related, the relationship between
emotional self-efcacy (ESE) and disordered eating is unknown. This study examined the relationship between
ESE and disordered eating in a statewide sample of public high school adolescents (n = 2566). The Centers for
Disease Control Youth Risk Behavior Survey and an adolescent ESE scale were utilized. Logistic regression adjusted for key covariates explored the relationship between low ESE and disordered eating among selected race and
gender groups. Self-perceived weight as underweight or overweight; and dieting, vomiting or taking laxatives,
taking diet pills, and fasting to lose weight were each associated (p b .05) with lower levels of ESE for certain
race/gender groups. Findings provide increased justication for tailoring disordered eating interventions and
treatments to accommodate the highest risk groups. Measures of ESE should be considered for adolescent mental
health assessments in eldwork, research, and evaluation efforts.
2015 Elsevier Ltd. All rights reserved.

1. Introduction
Adolescence is characterized by heightened stress (Spear, 2000) and
a struggle for independence (Blakemore, 2008; Spear, 2000), which may
cause some adolescents difculty in emotional and behavioral regulation (Compas, Connor-Smith, Saltzman, et al., 2001). As a consequence,
maladaptive behaviors, including disordered eating, may result as inappropriate coping mechanisms (Ball & Lee, 2000; Martyn-Nemeth,
Penckofer, Gulanick, et al., 2009), and specically as a means to regulate
emotions (Ackard, Croll, & Kearney-Cooke, 2002; Lavender & Anderson,
2010).
Disordered eating, sometimes referred to as extreme weight control
practices (Gonsalves, Hawk, & Goodenow, 2014), is posited to occur at
higher rates than clinically diagnosed eating disorders (Croll, NeumarkSztainer, Story, et al., 2002), and can include behaviors such as laxative
use, vomiting, fasting or skipping meals, and diet pills with the explicit
purpose of controlling or losing weight (Croll et al., 2002; Gonsalves
et al., 2014; Matthews, Zullig, Ward, et al., 2012). Among high school adolescents, disordered eating is estimated to occur at rates anywhere from
7.3% to 31% for males and between 15.8% and 57% among females (Croll
et al., 2002; Gonsalves et al., 2014), and is thought to be the intermediary
step between dieting and the development of clinically diagnosed eating
disorders (Forman-Hoffman, 2004).

Corresponding author.
E-mail address: kzullig@hsc.wvu.edu (K.J. Zullig).

http://dx.doi.org/10.1016/j.eatbeh.2015.11.007
1471-0153/ 2015 Elsevier Ltd. All rights reserved.

Whereas disordered eating has been positively associated to feelings

of loss of control (Atkins, Sharp, & Watt, 2002), self-efcacy has been
negatively associated with perceived loss of control (Sherer, Maddux,
Mercandante, et al., 1982). Dened as an individual's perceived
condence in performing a behavior that leads to a desired outcome
(Bandura, 1997), self-efcacy has been shown to be predictive of the
engagement in a variety of positive behaviors (Bandura, 1997). For example, high school students with positive emotional well-being are less
likely to engage in disordered eating behaviors (Croll et al., 2002).
Although the concept of self-efcacy is not new (Bandura, 1977), a
specic aspect of self-efcacy, emotional self-efcacy (ESE) (Hessler &
Katz, 2010; Muris, 2001), has emerged in explaining why some individuals are better able to cope with aversive life events. ESE is dened as
the ability to avoid negative emotions or the ability to reestablish ones
usual emotional state (Hessler & Katz, 2010; Muris, 2001). ESE is hypothesized to be a precursor of emotion regulation, or the capacity to
engage in appropriate behaviors in response to specic environmental
situations (Suveg & Zeman, 2004). Common applications of ESE include
a person's belief in their abilities to avoid negative emotional states and
to restore normal emotional states (e.g., self-talk to regain a positive attitude, calming yourself once scared or anxious). As such, research suggests that adolescents with increased ESE are less likely to engage in
risky sexual behavior (Valois, Zullig, Kammermann, et al., 2013), suicide
ideation (Valois, Zullig, & Hunter, 2013), and substance use (Zullig,
Teoli, & Valois, 2015), and are more likely to engage in physical activity
(Valois, Umstattd, Zullig, et al., 2008). In addition, each of these studies
found signicant differences by race and gender.

K.J. Zullig et al. / Eating Behaviors 21 (2016) 16

The current study examined the relationship between disordered

eating and ESE in a large sample of high school adolescents from a
southern state in the United States (US). If disordered eating is signicantly associated with low levels of ESE, these results would extend
the current literature on both adolescent ESE and adolescent disordered
eating. Consistent with previous adolescent ESE research (Valois, Zullig,
Kammermann, et al., 2013; Valois, Zullig, & Hunter, 2013; Valois et al.,
2008; Zullig et al., 2015), the current study examines potential associations by four race/gender groups: Black females, Black males, White females, and White males. Past research has indicated that unique
patterns of race/gender differences consistently arise in regard to adolescent disordered eating (Chao, Pisetsky, Dierker, et al., 2008; Croll
et al., 2002; Neumark-Sztainer, Croll, Story, et al., 2002). However,
there has not been a consistent pattern for racial groups (Ricciardelli,
McCabe, Williams, et al., 2007). By exploring potential race and gender
differences, this study could offer additional justication for the tailoring of disordered eating intervention and treatment programs to accommodate the highest risk groups. The current study hypothesized
that associations would exist and vary among the selected race/gender
groups, however given the exploratory nature of the study, no additional hypotheses were generated.
2. Materials and methods
2.1. Participants
Study data were derived from the 3836 participants, with usable
data from 3376 students. However, only 2566 valid observations were
available for analysis owing to: (a) nonresponse by participants to variables of interest (n = 79, 2.4%), (b) out-of-range responses or responses that could not be read (n = 470, 13.9%), and (c) the exclusion
of participants that self-reported their race as Other [than Black or
White] (n = 261, 7.73%). The nal sample contained 1037 (40.4%) females and 1529 (59.6%) males of which 579 (22.6%) were Black females,
809 (31.5%) were Black males, 458 (17.8%) were White females, and
720 (28.1%) were White males. Participants were in grades 912 with
ages ranging from 12 to 18 years. There were 833 (32.5%) 9th grade
students, 741 (28.9%) 10th grade students, 518 (20.2%) 11th grade
students, and 474 (18.5%) 12th grade students. Approximately
34% (n = 876) of the sample reported being eligible for free or
reduced-priced school lunch, 52.5% (n = 1348) reported not being eligible, while 13.3% (n = 342) reported being unsure of their eligibility.
2.2. Procedure
The Center for Disease Control and Prevention's (CDC) Youth Risk
Behavior Survey (YRBS) from a southern state was utilized. The YRBS
used a sampling methodology specic to obtaining a representative
sample of all students (grades 9 through 12) enrolled in the public
high schools in one southern US state. These data were chosen for this
study because they were the only YRBS data to contain questions on
emotional self-efcacy. Special education students were not included
in this sample. Brener et al. (Brener, Kann, McManus, et al., 2002)
established adequate test-retest reliability for the YRBS. For this study,
215 schools were stratied by enrollment size into three categories:
small schools had enrollments of 74 to 874 students; medium
schools had enrollments of 875 to 1278 students; and large schools
had enrollments greater than 1278 students. Of the 68 eligible schools,
39 participated (57%). Among the participating schools, the student response rate was 89% for an overall response rate of 51% (.57 .89).
These data were treated as a simple random sample since the overall response rate did not meet CDC's criteria for weighted data (60%). Passive
parental consent was used with b 1% of eligible students opting out via
parental refusal. This study was approved by the referent university's
Institutional Review Board.

2.3. Measures
2.3.1. Emotional self-efcacy
The ESE scale included in the YRBS was originally validated with adolescents in Belgium by Muris (2001) and served as this study's dependent variable. Valois and Zullig (2013) recently demonstrated the
validity and the reliability of the scale with adolescents in the US. Consistent with Valois and Zullig (2013) the ESE scale used in this investigation consisted of seven items: How well do you succeed at cheering
yourself up when an unpleasant event has happened; How well do
you succeed in becoming calm again when you are very scared; How
well can you prevent becoming nervous; How well can you control
your feelings; How well can you give yourself a pep-talk when you
feel low; How well do you succeed in suppressing unpleasant
thoughts; and How well do you succeed in not worrying about things
that might happen? Items were scored on a 5-point Likert-type scale
with the following response options: (a) not at all, (b) a little bit,
(c) pretty well, (d) well, (e) very well. Internal consistency estimates
for the scale in this investigation were acceptable at .85.
2.3.2. Weight perceptions and body mass index (BMI)
Selected YRBS items used to measure weight perceptions served as
the independent variables. These included: How do you describe
your weight? (very underweight, slightly underweight, about the
right weight, slightly overweight, very overweight), Which of the
following are you trying to do about your weight? (lose weight, gain
weight, stay the same weight, I am not trying to do anything about
my weight). Since weight perceptions among high school students
may not always be accurate (Martin, Frisco, & May, 2009), BMI
was also calculated from two questions: How tall are you with your
shoes on? and How much do you weight without your shoes on?
using metric measures (i.e., meters and kilograms) where weight is divided by height squared. Using standard weight status categories
(World Health Organization, 2015), participants were categorized as
underweight (BMI 18.5 kg/m2), normal weight (BMI = 18.6
24.9 kg/m2), overweight (BMI = 25.029.9 kg/m2), or obese
(BMI 30.0 kg/m2).
2.3.3. Disordered eating
A series of questions on disordered eating behaviors with yes/no response options are standard on the YRBS. Those questions were During
the past 30 days, did you eat less food, fewer calories, or foods low in fat
to lose weight or keep from gaining weight?, During the past 30 days,
did you exercise to lose weight or keep from gaining weight?, During
the past 30 days, did you vomit or take laxatives to lose weight or to
keep from gaining weight?, During the past 30 days, did you take
any diet pills, powders, or liquids, without a doctor's advice to lose
weight or to keep from gaining weight?, and During the past
30 days, did you go without eating for 24 h or more (also called fasting)
to lose weight or keep from gaining weight?
2.4. Statistical analysis
Analyses were conducted using SAS. 9.4. All ESE scale items were
pooled to form a pseudo-continuous variable ranging in score from
7 (1 7) to 35 (5 7), expressed as a mean emotional self-efcacy
(MESE) score with lower scores indicative of being less emotionally
self-efcacious. Consistent with prior research using the ESE scale
(Valois, Zullig, Kammermann, et al., 2013; Valois, Zullig, & Hunter,
2013; Valois et al., 2008; Valois & Zullig, 2013; Zullig et al., 2015), a numeric collapse of the pooled dependent variable was performed owing
to adolescents reporting their ESE as pretty well was measured with
one scale response option, whereas the other two categories were
each composed of three response options. As a result, MESE scores of
15 or less were categorized as having lower ESE, scores between 16
and 21 were deemed as having mid-range ESE, while scores of 22 or

K.J. Zullig et al. / Eating Behaviors 21 (2016) 16

greater were designated as having higher ESE. To account for the three
levels of the outcome variable (lower, mid-range, and higher ESE), logistic regression analyses were conducted with those reporting high ESE
serving as the referent group where the mid-range group was rst compared to the referent group, followed by a comparison of the low ESE
group to the referent group. Logistic regression was chosen because:
1) the ESE scale items are ordinal variables; and, 2) because of the
large sample, we wanted to be conservative in our estimates (more toward a null hypothesis of no association).
For weight perceptions, participants who were coded as being about
the right weight (referent group) were compared to participants who
reported being slightly/very overweight and slightly/very underweight.
For current weight goals, participants who reported that they were not
trying to lose weight or stay the same weight (referent) were compared
to those who reported trying to lose weight or trying to gain weight. The
30 day prevalence independent variables (e.g., dieted, exercised,
vomited, diet pill use, or fasted to lose weight) were coded as having
participated in the behavior or not, with the referent group designated
as those who did not report any disordered eating behavior. The use
of dummy variables to represent the four race/gender groups would
have assumed that the coefcient of all risk (disordered eating) and
confounding variables were constant across all groups. Because that assumption was false, the four race/gender groups were analyzed separately. All analyses controlled for BMI, socioeconomic status (SES)
(i.e., eligibility for free/reduced price school lunch), depression (reported as feeling so sad or hopeless almost every day for 2+ weeks in a row
that you stopped doing some usual activities), and the use of tobacco
and alcohol during the past 30 days because adolescents who engage
in disordered eating have also been shown to be at elevated risk for depression, cigarette smoking, and alcohol use (Croll et al., 2002; Measelle,
Stice, & Hogansen, 2006; Pisetsky, May Chao, Dierker, et al., 2008;
Santos, Richards, & Bleckley, 2007). Adjusted odds ratios (OR) and 95%
condence intervals (CI) were calculated to determine which disordered eating behaviors were associated with reduced ESE for each
race/gender group. Level of signicance was determined a priori at
.05. Descriptive data for the disordered eating and ESE variables
are presented in Table 1.
3. Results
3.1. Relationship between weight perceptions, BMI, disordered eating,
and midrange ESE
Owing to the lack of association between the self-perceptions of
weight and disordered eating variables and midrange ESE, these variables are neither tabled nor discussed.
3.2. Relationship between weight perceptions, BMI, disordered eating,
and lower ESE
3.2.1. Black Females
A signicant relationship was established between lower ESE and
fasting to lose weight (past 30 days) for Black females (Table 2). Black
females who reported fasting to lose weight increased the odds of
reporting lower ESE by 1.59 times in comparison to Black females who
reported higher ESE and not fasting to lose weight (p b .05).
3.2.2. Black males
Signicant relationships were established between lower ESE and
self-perceived weight as slightly/very overweight and for three of the
disordered eating behaviors (past 30 days) for Black males (Table 2).
Black males who reported their weight perception as slightly/very overweight increased the odds of reporting lower ESE by 1.53 times in comparison to Black males who reported higher ESE and their weight as
about right (p b .05). In addition, Black males who reported vomiting
or taking laxatives, diet pills, or fasting to lose weight increased the

Table 1
Prevalence of emotional self-efcacy, weight perceptions, BMI, and disordered eating, by
race and gender (N = 2566).
Variables

Black
females
N = 579
N(%)

Black
males
N = 809
N(%)

White
females
N = 458
N(%)

White
males
N = 720
N(%)

Emotional self-efcacy
Low
Medium
High

131 (22.6)
265 (45.8)
183 (31.6)

215 (26.6)
371 (45.9)
223 (27.5)

104 (22.7)
152 (33.2)
202 (44.1)

100 (13.9)
239 (33.2)
381 (52.9)

BMI
Underweight
Normal weight
Overweight
Obese

73 (12.6)
273 (47.2)
164 (28.3)
69 (11.9)

140 (17.3)
512 (63.3)
128 (15.8)
29 (3.6)

42 (9.2)
244 (53.3)
110 (24.0)
62 (13.5)

81 (11.2)
427 (59.3)
154 (21.4)
58 (8.1)

Weight perceptions
About the right weight
Overweight
Underweight

323 (55.8)
86 (14.9)
170 (29.3)

435 (53.8)
102 (12.6)
272 (33.6)

278 (60.6)
105 (23.0)
75 (16.4)

412 (57.2)
152 (21.2)
156 (21.6)

Current weight goal

Stay the same weight
Trying to lose weight
Trying to gain weight

191 (33.0)
265 (45.8)
123 (21.2)

266 (32.9)
513 (63.4)
30 (3.7)

155 (33.9)
169 (36.8)
134 (29.3)

295 (41.0)
202 (28.1)
223 (30.9)

Dieted to lose weight (past 30 days)

Yes
183 (31.7)
No
396 (68.3)

335 (41.4)
474 (58.6)

114 (24.8)
344 (75.2)

203 (28.2)
517 (71.8)

Exercised to lose weight (past 30 days)

Yes
285 (49.2)
No
294 (50.8)

626 (74.4)
183 (25.6)

234 (51.1)
224 (48.9)

361 (50.1)
359 (49.9)

Vomited or taken laxatives to lose weight (past 30 days)

Yes
27 (4.6)
57 (7.0)
No
552 (95.4)
752 (93.0)

32 (7.0)
426 (93.0)

35 (4.8)
685 (95.2)

Taken diet pills to lose weight (past 30 days)

Yes
37 (6.4)
84 (10.4)
No
542 (93.6)
725 (89.6)

34 (7.4)
424 (92.6)

64 (8.9)
656 (91.1)

odds of reporting lower ESE by approximately 1.9, 1.8, and 1.6 times, respectively, in comparison to Black males who reported higher ESE and
not vomiting or taking laxatives, diet pills, or fasting to lose weight
(p b .05).
3.2.3. White females
Signicant relationships were established between lower ESE and
self-perceived weight as slightly/very overweight, trying to lose weight,
and for four of the disordered eating behaviors (past 30 days) for White
females (Table 2). White females who reported dieting to lose weight,
vomiting or taking laxatives, diet pills, or fasting to lose weight increased the odds of reporting lower ESE by approximately 2.5, 7.2,
10.9, and 3.6 times, respectively, in comparison to White females who
reported higher ESE and not dieting to lose weight, vomiting or taking
laxatives, diet pills, or fasting to lose weight (p b .01).
3.2.4. White males
Signicant relationships were established between lower ESE and
self-perceived weight as slightly/very underweight and for two of the
disordered eating behaviors (past 30 days) for White males (Table 2).
White males who reported their weight perception as slightly/very underweight increased the odds of reporting lower ESE by 2.37 times in
comparison to White males who reported higher ESE and their weight
as about right (p b .01). In addition, White males who reported vomiting
or taking laxatives or fasting to lose weight increased the odds of
reporting lower ESE by approximately 1.9 and 2.8 times, respectively,
in comparison to White males who reported higher ESE and not
vomiting or taking laxatives or fasting to lose weight (p b .05).

K.J. Zullig et al. / Eating Behaviors 21 (2016) 16

Table 2
Association between low emotional self-efcacy, weight perceptions, and disordered eating, by race and gender.a
Eating behavior variable

Black females (BF) OR(CI)

Black males (BM) OR(CI)

White females (WF) OR(CI)

White males (WM) OR(CI)

Self-perceived weight as slightly/very underweight

1.74
(0.903.38)
1.02
(0.561.84)
0.79
(0.461.34)
1.37
(0.772.46)
0.82
(0.491.39)
0.80
(0.501.30)
1.00
(0.303.34)
0.77
(0.272.20)
1.59
(1.032.89)

1.18
(0.701.98)
1.53
(1.022.30)
1.34
(0.901.98)
1.65
(0.664.10)
1.00
(0.701.44)
0.94
(0.631.41)
1.94
(1.043.64)
1.81

1.78
(0.843.75)
1.94
(0.824.65)
1.77
(0.923.44)
1.62
(0.863.07)
2.47
(1.264.85)
1.22
(0.662.25)
7.20
(2.7418.90)
10.87

(1.063.09)
1.61
(1.062.45)

(3.8830.46)
3.59
(1.677.72)

2.37
(1.274.40)
1.14
(0.552.38)
0.88
(0.481.61)
0.73
(0.421.29)
1.17
(0.672.04)
0.91
(0.541.52)
1.95
(1.043.64)
0.89
(0.372.14)
2.79
(1.325.90)

Self-perceived weight as slightly/very overweight

Trying to lose weight
Trying to gain weight
Dieted to lose weight (past 30 days)
Exercised to lose weight (past 30 days)
Vomited or taken laxatives to lose weight (past 30 days)
Taken diet pills to lose weight (past 30 days)
Fasted to lose weight (past 30 days)

The referent group for emotional self-efcacy (ESE) are those students reporting high ESE and the referent group for disordered eating are those students who have not reported any disordered eating.
p b .05.
p b .01.
p b .001.
a
All analyses are adjusted for BMI, socio-economic status, depression, and past 30 day use of alcohol and tobacco.

4. Discussion
Previous research indicates that ESE is associated with several maladaptive adolescent health behaviors (Valois, Zullig, Kammermann,
et al., 2013; Valois, Zullig, & Hunter, 2013; Zullig et al., 2015). Furthermore, research has largely examined dieting self-efcacy or weight/
shape self-efcacy in relation to disordered eating behaviors (Cain,
Bardone-Cone, Abramson, et al., 2008; Linde, Jeffery, Levy, et al., 2004)
rather than exploring the relationship between ESE and disordered eating. This is surprising given the known positive association between
emotional disorders (i.e., depression, anxiety) and disordered eating behaviors (Brytek-Matera, 2008; Loth, van den Berg, Eisenberg, et al.,
2008). For example, Santos et al. (Santos et al., 2007) found that disordered eating occurred in 12% of a sample of 241 high school students,
and depression and disordered eating co-occurred in between 10%
and 12% of the sample. This study controlled for depression (among
other covariates) and examined the relationship between disordered
eating and ESE among high school students. It was hypothesized that associations between disordered eating and ESE would exist and vary
among selected race/gender groups. Generally, study results conrmed
the hypothesized associations.
The most notable patterns of association appeared for fasting to lose
weight, vomiting or laxative use to lose weight, and taking diet pills to
lose weight and low ESE. The relationship between disordered eating
and low ESE may be supported by some of the disordered eating and
self-efcacy literature. For example, research by Kinsaul, Curtin,
Bazzini, et al. (2014) indicates that increased general self-efcacy predicts both positive body image and lower disordered eating among
young women (mean age = 18.76 1.13 years).
Associations also varied by race and gender. Although fasting to lose
weight was associated with low ESE among all race/gender groups, in
both White females and Black males, diet pill use was associated with
low ESE. Conversely, weight perceptions of being slightly or very overweight or slightly or very underweight were associated with low ESE
only among Black and White males. Results also indicate that White females who reported dieting, vomiting or using laxatives, taking diet
pills, and fasting to lose weight were more likely to report low ESE.
The nding that White females appeared to engage in more types of
disordered eating behaviors is substantiated by previous research
(Neumark-Sztainer & Hannan, 2000).

Interestingly, both Black and White males fasting to lose weight

were more likely to report low ESE. Additionally, Black males taking
diet pills to lose weight and White males vomiting or using laxatives
to lose weight were more likely to report low ESE. A review article examining ethnicity and disordered eating behaviors and body image
among males suggests that differences between Black and White
males are largely mixed (Ricciardelli et al., 2007). Although differences
noted in these studies may be attributed to sampling design and other
population parameters, there is little dispute that disordered eating
also occurs in males, and more research is needed to clarify the role
that gender plays in disordered eating behaviors.
It is possible that the differential relation between disordered eating
and ESE by race/gender is a result of cultural norms. For instance, some
studies indicate that Black females are less at risk for disordered eating
(DeBate, Topping, & Sargent, 2001; Roberts, Cash, Feingold, et al., 2006)
and view a larger body size as more desirable (Croll et al., 2002) compared to White females. This pattern may be similar for males, such
that Black males prefer a larger body size compared to White males
(Welch, Gross, Bronner, et al., 2004; Yates, Edman, & Aruguete, 2004).
However, other research indicates that Black females and males may
be as much at risk for disordered eating behaviors as White females
and males (Adams, Sargent, Thompson, et al., 2000; Rhea & Thatcher,
2013; Shaw, Ramirez, Trost, et al., 2004), suggesting disordered eating
may have less to do with race or ethnicity and more to do with the degree of inuence that the dominant thin ideal has on individuals.
Most females cannot attain the thin ideal presented by Western culture, yet this standard is what many females use to determine their
body size (Brener, Eaton, Lowry, et al., 2004). The Sociocultural Theory
(Stice, 2002) suggests that the internalization of an unrealistic body
ideal may lead to body dissatisfaction, whereby individuals engage in
disordered eating to alter their appearance (Stice, 1994; Stice, Shaw, &
Nemeroff, 1998; Stice & Shaw, 2002). Conversely, it is possible that
those with high ESE are less inuenced by the social pressure to attain
an unrealistic body type. For example, those with high ESE have more
condence in the ability to manage their emotions (Hessler & Katz,
2010; Muris, 2001); therefore, when confronted with the unrealistic
body type, they may possess more appropriate coping skills. Future research should examine whether the Sociocultural Theory can assist in
explaining the relationship between ESE and disordered eating, particularly race/gender differences.

K.J. Zullig et al. / Eating Behaviors 21 (2016) 16

Abrams et al. (Abrams, Allen, & Gray, 1993) found that Black females
were more likely to engage in disordered eating when they subscribed
to the dominant culture. Similarly, Root (1990) noted that a greater
identication with one's ethnic identity may be protective when the
identication supports a healthy body type. This assertion was recently supported by Rogers Wood and Petrie (2010) who found that Black
females with a stronger ethnic identity were less likely to engage in
disordered eating behaviors, and that those who subscribe to societal
pressures to be thin are more likely to engage in disordered eating. It
is possible that the ability to withstand the societal pressures to be
thin may be due, at least in part, to increased ESE.
4.1. Limitations
Study limitations are noted here. First, the current study utilized a
cross-sectional design. Thus, no causal inferences between ESE and disordered eating may be made. In the future, it would be imperative to determine the causal associations between the variables of interest from
this study. Second, because all participants were located in one southern
US state, results may not be generalizable to other states, or the United
States. Third, because some observed condence intervals were wide,
and because some of the levels of the disordered eating variables were
infrequently reported, the results should be interpreted cautiously. Finally, although this study included a diverse sample of youth, it did
not include youth of other ethnicities (only Blacks and Whites were
included in the analyses). Future research should examine the relationship between ESE and disordered eating among a more diverse sample.
Given rates of disordered eating among adolescents and accompanying adverse outcomes (Croll et al., 2002; Gonsalves et al., 2014), understanding its correlates to inform future research, prevention
interventions, and health care related services is important. For example, although disordered eating research has addressed the potential inuence of general self-efcacy, the condence to manage emotions may
be a stronger predictor of disordered eating. Further, among those with
disordered eating symptoms in its more severe form, the desire to maintain a slim appearance is intended to decrease unpleasant emotions or
feelings and improve mood. This desire then reinforces unhealthy
behaviors to reduce or lose weight, which is subsequently positively
reinforced through an elevated mood. Additionally, engagement in disordered eating behaviors can lead to clinically diagnosable eating disorders (Neumark-Sztainer, Wall, Guo, et al., 2006), which can have even
more severe psychological and physical consequences both in the
short- (e.g., anxiety, impulse control, substance use, mood disorders, depression) (Blinder, Cumella, & Sanathara, 2006; Hudson, Hiripi, Pope,
et al., 2007) and long-term (e.g., anxiety disorders, suicidal thoughts,
depressive symptoms, chronic fatigue and pain, cardiovascular symptoms, activity limitations due to poor health) (Johnson, Cohen, Kasen,
et al., 2002). Although somewhat speculative, the results from this
study suggest that ESE may play an important role in decreasing the
likelihood that individuals will engage in disordered eating behaviors
by perhaps intervening in this emotional cycle. Therefore, our ndings
add to the adolescent health literature by demonstrating the association
between the correlates of disordered eating and emotional self-efcacy.
Results from this study have implications for disordered eating
prevention and risk reduction interventions. In regard to interventions,
adolescent health experts suggest necessary skills for navigating
the challenges of the immediate social environment (Halberstadt,
Denham, & Dunsmore, 2001; Saarni, 1999; Buckley, Storino, & Saarni,
2003; Saarni, Campos, Camras, et al., 1998). A basic set of adolescent
emotional self-efcacy skills could include: developing an awareness
of one's emotional state; skills for discerning emotions in others; skills
in using the language and vernacular of emotion and expression in a culturally competent manner; developing the capacity for empathy and
sympathy involving the emotions of others; skills in recognizing that
inner emotional state does not need to translate to outer emotional expression; and developing a capacity for managing stress (Buckley et al.,

2003; Halberstadt et al., 2001; Saarni, 1999; Saarni et al., 1998). These
skills are adaptive and assist the adolescent to: reach goals; cope with
life challenges; manage emotional arousal for effective problem solving;
discern what others feel and to respond sympathetically as the situation
is presented; and recognize how emotion communication and selfpresentation affect relationships, including individual relationship
with food (Buckley et al., 2003). More importantly, in regard to effective
learning for improved emotional self-efcacy for disordered eating risk
reduction, is skill development to the degree where an adolescent can
begin to trust their ability to reach their goals when faced with
emotion-laden interactions with others. In turn, increasing selfefcacy, in particular emotional self-efcacy, appears to be an important
component for interventions designed to prevent adolescent engagement in risky emotion driven behaviors (DiClemente, Crittenden,
Rose, et al., 2008; Hennessy, Romer, Valois, et al., 2013; Hessler & Katz,
2010) often associated with the risk factors for adolescent disordered
eating (Balis & Postolache, 2008; van den Bree & Pickworth, 2005;
Borowsky, Ireland, & Resnick, 2001).
5. Conclusions
Study ndings suggest signicant associations between adolescent
disordered eating and ESE, with signicant variations by race and gender. It should be noted that the complexity of adolescent disordered eating presents multiple personal and professional challenges and cannot
be left to any single entity. A multifaceted, collaborative, and coordinated response at the micro and macro levels of primary and secondary
prevention is imperative.
Role of funding sources
This research was funded by Cooperative Agreement #U63/CCU 802750-04, U.S.
Centers for Disease Control and Prevention, National Center for Disease Prevention &
Health Promotion, Division of Adolescent & School Health, Atlanta, Georgia, and Cooperative Agreements with the Department of Education, in South Carolina. The U.S. Centers for
Disease Control & Prevention, National Center for Disease Prevention & Health Promotion,
Division of Adolescent & School Health, Atlanta, Georgia, nor the Department of Education,
in South Carolina had no role in the study design, collection, analysis or interpretation of
the data, writing the manuscript, or the decision to submit the paper for publication.
Contributors
Dr. Zullig conceptualized the manuscript, performed the analyses, wrote the results
section, and contributed to the introduction and discussion sections. Dr. MatthewsEwald wrote the rst draft of the introduction and discussion sections. Dr. Valois contributed to the discussion section. All authors contributed to and have approved the nal
manuscript.
Conict of interest
All authors declare that they have no conicts of interest.

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