| | Negative perceptions about self-control and identification with gender-role stereotypes related to binge eating, problem drinking, and to co-morbidity among adolescentsAccepted 27 June 2002. Abstract PurposeTo examine the role of both positive and negative styles of self-control, and gender-role stereotypes in binge eating and problem drinking MethodParticipants were 428 adolescent boys and 555 girls from predominantly Anglo-Australian backgrounds who attended regional state schools in New South Wales, Australia. Students completed standardized questionnaires that assessed problem drinking, binge eating, self-control styles, and identification with gender-role stereotypes. ANOVA and post hoc Tukey tests were conducted to examine differences among adolescents who reported problems in binge eating, drinking, and both domains. ResultsAdolescents who reported eating and drinking problems also reported a high negative and a low positive sense of self-control coupled with self-identification with the traits that typically describe negative dimensions of gender-role stereotypes. Regardless of gender, problem drinking was mainly related to traits of negative masculinity (bossy, noisy aggressive, etc.) whereas binge eating was mainly related to negative femininity (shy, needs approval from others, etc.). Participants who reported eating and drinking symptoms recorded low scores on positive control, high scores on negative control, and also high scores on the negative dimensions of masculinity and femininity. SummaryA negative and passive style of self-control coupled with an identification with negative dimensions of gender summarizes the type of self-regulation that is implicated in both binge eating and problem drinking, and co-morbid symptoms. There is a need for interventions working toward a more balanced gender self-concept and a positive sense of self-control.
Adolescents tend to experiment with a range of mood-altering appetitive behaviors, but the two most frequently observed syndromes that indicate risk to both current and future health and well-being during this period involve the use/abuse of alcohol and the occurrence of symptoms of binge eating 1, 2, 3, 4. The prevalence of binge eating in adolescents from the United States and other Western countries is high, with estimates ranging from 7% to 32% for adolescent boys and from 17% to 32% for adolescent girls 1, 5.
The prevalence of binge drinking and other symptoms of problem drinking is also high among adolescents. Prevalence of binge drinking in the United States and other Western countries ranges from 26% to 63% for adolescent boys and from 20% to 61.6% for adolescent girls 6, 7. Patterns of binge eating and/or drinking denote impaired self-control, and there are increasing reports of the co-occurrence of such symptoms amongst nonclinical samples of adolescent boys and girls 8, 9. Comparable data have also been reported in Australian samples 10, 11.
The capacity for self-regulation has been described as one of the most felicitous and adaptive aspects of the human psyche [12], but the empirical study of self-control can involve a multi-dimensional range of potential variables. Haidt and Rodin [13] have recently differentiated among three major interrelated but empirically separable perspectives ranging from the motivational (appetitive/behavioral) to the cognitive (beliefs related to control) to the systemic (interpersonal and associated social factors). Petraitis et al. [14] describe a similar categorization of potential influences on adolescent substance abuse that they call the intrapersonal, the attitudinal, and the social dimensions.
In this study the focus is on the individual’s subjective experience concerning self-control. Self-perceptions about self-control are known to play an important role in the development and maintenance of psychological health and well-being [15]. Self-cognitions have the potential to form a bridge of self-awareness that can connect the personal appetitive/behavioral experience with the intrapersonal variables that provide the context for social learning. A better understanding of the adolescent’s self-perceptions with regard to self-control will aid in the development of innovative, practical, and preventative educational/counseling programs that are required to better empower individuals to resist the environmental and interpersonal pressures that encourage poor impulse control.
This study brings together two promising but previously separate areas of research on self-control as a context for understanding the dynamics of the risky use of alcohol and the occurrence of symptoms of binge eating. The first involves the individual’s sense of possessing a positive, as compared with a negative, sense of managing self-control 16, 17. Negative Control assesses whether a person feels he/she is losing control in areas where he/she once had it, lacks control of his/her environment, feels too passive and helpless and is controlled too much by other individuals [16]. Positive Control assesses a person’s ability to attain control in the future if he/she wishes, the ability to use two positive modes of attaining control (positive assertiveness, positive yielding), the ability to set meaningful goals and skills to carry out the goals, and the ability to adjust his/her level of self-control [16].
The second focus of this study is the degree of personal adherence to gender-role stereotypes. Examined were both positive and negative stereotypic aspects of masculinity and femininity 18, 19. These measures provide an assessment of the adolescent’s perceptions of social identity within what is often a highly gendered milieu, and it relates to self-esteem and social confidence 20, 21. Several studies have found a significant relationship between personality traits related to gender-role stereotypes and disordered eating amongst adults 22, 23 and adolescents 24, 25. There is also increasing literature associating adherence to gender-role stereotypes with problem drinking for both adults 26, 27 and adolescents 28, 29.
The present study seeks to map the similarities and the differences in perceptions about self-control and identification with gender-role stereotypes in relationship to both problem drinking and binge eating among adolescent boys and girls. Eating and drinking symptoms have to date always been studied separately amongst adolescents in relationship to gender-role stereotypes, but in this current study both behaviors will be examined within the same sample so as to also allow identification of any evidence of their co-occurrence.
Methods  Participants The participants were 555 girls and 438 boys between ages 14 and 16 years (mean age = 15.21 years, SD = 0.46 years). The participants were recruited from grade 9 and 10 classes from three regional state schools in New South Wales, Australia. The schools were attended by students who come from diverse socioeconomic backgrounds. The majority of respondents (95%) were from Anglo-Australian backgrounds, whilst the remaining sample included approximately 2% from non-English-speaking European backgrounds, 2% from Asian backgrounds, and 1% who were Indigenous Australians. Measures A summary of the materials used is given in Table 1. | | |  | Measure | Authors [Reference] | Number of Items | Examples | Range of Possible Scores | |
|---|
| AUDIT | Babor et al. [30] | 10 | How often do you have six or more drinks on one occasion? | 0 to 32 | |
| | | | Have you or someone else been injured as a result of your drinking? | | |
| Bulimia | Garner [32] | 7 | I have gone on eating binges where I felt that I could not stop. | 7 to 42 | |
| | | | I eat moderately in front of others and stuff myself when they’re gone. | | |
| Negative control | Shapiro [35] | 5 | I am too passive and helpless. | 5 to 35 | |
| | | | Others have too much control over me. | | |
| Positive control | Shapiro [35] | 11 | I am able to act assertively and decisively to try to change or alter what I want to do. | 11 to 77 | |
| | | | I am able to calmly accept that which I am not able to change or alter. | | |
| Positive femininity | Antill et al. [18] | 10 | Loves children | 10 to 70 | |
| | | | Patient | | |
| Positive masculinity | Antill et al. [18] | 10 | Confident | 10 to 70 | |
| | | | Strong | | |
| Negative femininity | Antill et al. [18] | 10 | Dependent | 10 to 70 | |
| | | | Needs approval | | |
| Negative masculinity | Antill et al. [18] | 10 | Bossy | 10 to 70 | |
| | | | Aggressive | | | | | |
Problem drinking Problem drinking was assessed using the Alcohol Use Disorder Identification Test (AUDIT) [30]. The AUDIT is a 10-item scale that assesses the number of standard drinks consumed on a typical occasion, frequency of binge drinking, symptoms of alcohol dependence, and alcohol-related problems. Eight items were scored on a five-point scale (0 to 4) and two items were scored on a three-point scale (0 to 2), with higher scores indicating greater problems. Extensive reliability and validity data for the AUDIT are available [31]. Binge-eating symptoms Binge eating symptoms were assessed using the Bulimia scale from the Eating Disorders Inventory-2 [32]. This is a 7-item scale that assesses thoughts and behaviors primarily associated with binge eating. To increase the instrument’s sensitivity with community samples, items were scored using a six-point scale (1 to 6) [33]. Higher scores indicate higher levels of problem eating. Reliability and validity data for the scale that include data from nonclinical populations and from both males and females are available [34]. Self-control scale Shapiro’s Negative and Positive Sense of Control Scales [35] were used to assess self-control strategies. The items were scored on a seven-point scale (1 to 7) with higher scores on Negative Control indicating a more passive and negative yielding style of control. Higher scores on Positive Control are indicative of both an assertive and more positive yielding style of control. Shapiro [35] has provided extensive reliability and validity data for these two scales. Gender-role stereotypes The Australian Sex-Role Scale [18] was used to assess four dimensions of gender-role traits. These included both positive and negative stereotypic aspects of masculinity and femininity. The scale has been closely modeled on the Extended Personality Attributes Questionnaire [19]. It contains 10 items previously rated as more typical and desirable for men (e.g., “confident”); 10 items which have been rated as more typical and desirable for women (e.g., “loves children”); 10 items rated as more typical but undesirable for men (e.g., “bossy”); and 10 items rated as more typical but undesirable for women (e.g., “needs approval”). All items in the four subscales, labeled Positive Masculinity, Positive Femininity, Negative Masculinity, and Negative Femininity were scored on a seven-point scale (1 to 7). Higher scores indicated higher ratings on each of the four types of gender traits. Reliability and validity data for the scales have been reported 19, 22, 36. Procedures The study was approved by the Charles Sturt University Ethics Committee. Letters outlining the nature of the study were sent out to parents and all students in grade 9 and 10 classes from three regional state schools. Both parental and student consent were obtained before respondents completed the questionnaire. Ninety-eight percent of the respondents who were approached to take part in the study agreed to do so. The test materials were administered using an anonymous survey method by a trained research assistant. The questionnaires were completed by the students during one class period (40 minutes). Data analysis Z-scores greater then 1 on the Bulimia scale were used to define participants high on binge eating. AUDIT scores greater than 8 were used to define problem drinkers 30, 31. Participants who had high scores on both the Bulimia scale and the AUDIT were defined as “co-morbid.” ANOVAs were conducted to examine group differences among the groups: “High Bulimia,” “High AUDIT,” “Co-morbid,” and “Low Bulimia, Low AUDIT,” on each of the self-control and gender scales for boys and girls separately. Significant univariate F-tests, summarized in Table 2, were examined further using Tukey post hoc tests (p < .05) to establish specific differences among the four groups, for the boys and girls separately. Additional ANOVAs were conducted to examine whether they were any gender by group differences. These results are summarized in Table 3. | | | | Measures | Univariate F(3, 434) | High on AUDIT only | High on Bulimia only | High on AUDIT and Bulimia | Low on Both AUDIT and Bulimia | |
|---|
| Boys | | | | | | |
| n | | 113 | 35 | 25 | 265 | |
| Negative control | 16.64, p < .001 | | | | | |
| Mean | | 13.43a | 15.31a | 15.08a | 11.28b | |
| SD | | 5.03 | 4.23 | 4.66 | 3.94 | |
| Positive control | 9.89, p < .001 | | | | | |
| Mean | | 56.47a | 56.13 | 51.87a | 60.97b | |
| SD | | 11.05 | 9.41 | 11.00 | 10.43 | |
| Positive femininity | 5.43, p < .01 | | | | | |
| Mean | | 48.66a | 51.55 | 48.06a | 51.86b | |
| SD | | 7.64 | 8.01 | 7.14 | 8.11 | |
| Positive masculinity | 4.09, p < .01 | | | | | |
| Mean | | 47.71a | 43.46b | 49.93a | 47.74a | |
| SD | | 7.57 | 9.04 | 7.15 | 7.71 | |
| Negative femininity | 10.72, p < .001 | | | | | |
| Mean | | 34.99a | 44.03b | 36.45b | 37.13b | |
| SD | | 8.61 | 6.84 | 7.30 | 8.36 | |
| Negative masculinity | 12.36, p < .001 | | | | | |
| Mean | | 43.67a | 40.31x | 48.75y | 39.22b,x | |
| SD | | 9.14 | 10.20 | 10.68 | 8.99 | |
| Girls | univariate F (3, 551) | | | | | |
| n | | 103 | 67 | 47 | 338 | |
| Negative control | 11.90, p < .001 | | | | | |
| Mean | | 12.48a | 15.21b | 14.95 | 12.04a | |
| SD | | 4.37 | 5.47 | 5.33 | 4.67 | |
| Positive control | 19.07, p < .001 | | | | | |
| Mean | | 56.85a,x | 53.00a | 51.62a,y | 60.96b | |
| SD | | 9.46 | 11.13 | 11.11 | 10.96 | |
| Positive femininity | 4.34, p < .01 | | | | | |
| Mean | | 51.90 | 51.41 | 49.65a | 53.37b | |
| SD | | 6.86 | 7.42 | 7.94 | 7.80 | |
| Positive masculinity | 8.67, p < .001 | | | | | |
| Mean | | 47.68a | 41.68b | 45.95a | 46.00a | |
| SD | | 6.98 | 8.29 | 8.45 | 7.57 | |
| Negative femininity | 15.62, p < .001 | | | | | |
| Mean | | 36.30a | 44.79b | 37.25a | 37.15a | |
| SD | | 8.07 | 8.24 | 8.40 | 8.93 | |
| Negative masculinity | 21.80, p < .001 | | | | | |
| Mean | | 42.71a | 39.27a | 45.74y | 36.88b,x | |
| SD | | 9.31 | 8.87 | 10.73 | 8.34 | | | | |
| | | | | Boys High on AUDIT Only vs. Girls High on AUDIT Only | Boys High on Bulimia Only vs. Girls High on Bulimia Only | Boys High on AUDIT and Bulimia vs. Girls High on AUDIT and Bulimia | Boys Low on Both AUDIT and Bulimia vs. Girls Low on Both AUDIT and Bulimia | |
|---|
| Univariate F(1, 214) | Univariate F(1, 100) | Univariate F(1,70) | Univariate F(1, 601) | |
|---|
| Negative control | 2.17, p = .14 | 0.01, p = .93 | 0.01, p = .92 | 4.54, p < .05 | |
| Boys mean (SD) | 13.43 (5.03) | 15.31 (4.23) | 15.08 (4.66) | 11.28 (3.94) | |
| Girls mean (SD) | 12.48 (4.37) | 15.21 (5.47) | 14.95 (5.33) | 12.04 (4.67) | |
| Positive control | 0.07, p = .79 | 2.02, p = .16 | 0.01, p = .93 | 0.00, p = .99 | |
| Boys mean (SD) | 56.47 (11.05) | 56.13 (9.41) | 51.87 (11.00) | 60.97 (10.43) | |
| Girls mean (SD) | 56.85 (9.46) | 53.00 (11.13) | 51.62 (11.11) | 60.96 (10.96) | |
| Positive femininity | 10.69, p < .01 | 0.01, p = .93 | 0.70, p = .40 | 5.39, p < .05 | |
| Boys mean (SD) | 48.66 (7.64) | 51.55 (8.01) | 48.06 (7.14) | 51.86 (8.11) | |
| Girls mean (SD) | 51.90 (6.86) | 51.41 (7.42) | 49.65 (7.94) | 53.37 (7.80) | |
| Positive masculinity | 0.01, p = .97 | 1.00, p = .32 | 4.01, p < .05 | 7.72, p < .01 | |
| Boys mean (SD) | 47.71 (7.57) | 43.46 (9.04) | 49.93 (7.15) | 47.74 (7.71) | |
| Girls mean (SD) | 47.68 (6.98) | 41.98 (8.24) | 45.95 (8.45) | 46.00 (7.57) | |
| Negative femininity | 1.32, p = .25 | 0.22, p = .64 | 0.12, p = .73 | 0.01, p = .98 | |
| Boys mean (SD) | 34.99 (8.61) | 44.03 (6.84) | 36.45 (7.30) | 37.13 (8.36) | |
| Girls mean (SD) | 36.30 (8.07) | 44.79 (8.24) | 37.25 (8.40) | 37.15 (8.93) | |
| Negative masculinity | 0.58, p = .45 | 0.29, p = .59 | 1.28, p = .26 | 10.92, p < .001 | |
| Boys mean (SD) | 43.67 (9.14) | 40.31 (10.20) | 48.75 (10.68) | 39.22 (8.99) | |
| Girls mean (SD) | 42.71 (9.31) | 39.27 (8.87) | 45.74 (10.73) | 36.88 (8.34) | | | | |
Results Prevalence of problem drinking, binge eating, and co-morbid symptoms Alcohol-related symptoms were most prevalent in the current study in that 18.6% of the girls and 25.8% of the boys scored above the cut-off point on the AUDIT. Twelve percent of the girls and 8.0% of the boys reported a significant degree of binge eating. A further 8.5% of the girls and 5.7% of the boys reported significant co-morbid problems in both drinking and eating. Problem drinking A summary of the findings for boys and girls is given in Table 2. Boys with high AUDIT scores were found to be significantly higher on negative control and on negative masculinity than boys who were low on both appetitive behaviors. The boys with high AUDIT scores were also significantly lower on positive femininity and on positive control than the boys low on both the AUDIT and Binge Eating, and significantly lower than the other three groups on negative femininity. The girls who were high on the AUDIT scored significantly lower on negative control than the girls high on Binge Eating. The girls high on the AUDIT also scored significantly lower on positive control than the girls low on both problem behaviors. The only other variable that differentiated high AUDIT girls from the girls low on both problem drinking and binge eating was their higher scores on negative masculinity. A direct comparison between the high AUDIT boys and high AUDIT girls was also conducted. This analysis, as shown in Table 3, revealed few gender differences. The only difference was that High AUDIT girls had significantly higher scores on positive femininity than the High AUDIT boys. Binge eating A summary of these findings for boys and girls is also given in Table 2. The boys as well as the girls with high binge-eating symptoms scored significantly higher on Negative Control and lower on Positive Control than their counterparts who recorded low scores on both eating and drinking symptoms. Adolescent boys as well as girls with high scores on binge eating scored significantly lower on positive masculinity when compared with the other three groups of boys and girls. In addition, the adolescent girls high on bulimia scored significantly higher on negative femininity than the other three groups of girls. The specific comparisons of the high bulimia boys with the high bulimia girls, as indicated in Table 3, revealed no significant differences on any of the measures. Co-morbidity of problem drinking and binge eating Overall, as shown in Table 2, the adolescent boys who displayed co-morbid symptoms were very similar in terms of their positive and negative sense of control to the boys who were high on only problem drinking or binge eating. However, the co-morbid boys displayed more diverse gender-role stereotypes. They were similar to the boys high on bulimia in terms of their “feminine” self-descriptions but were also similar to the boys high on the AUDIT in their “masculine” self-descriptions. On the other hand, the adolescent girls who displayed co-morbid symptoms reported significantly poorer positive self-control strategies than the girls high on the AUDIT, but they were similar to the girls high on the AUDIT in terms of their gender-role stereotypes. Three of the gender-role measures separated the co-morbid girls from the girls high on bulimia alone. The co-morbid girls in comparison to the girls high on bulimia scored significantly higher on positive and negative masculinity but significantly lower on negative femininity. Finally, as shown in Table 3, both co-morbid boys and girls were similar in their styles of self-control and gender-role stereotypes. The only significant difference was that the co-morbid boys scored significantly higher than the co-morbid girls on positive masculinity. Discussion The severity and early onset of problem drinking and binge eating amongst adolescents continues to be a matter of grave concern because of the immediate and future consequences for current and future health and well-being 1, 2, 3. The sample in the current study was chosen to be representative of Australian adolescents and the estimated problems of binge eating and drinking fall within the ranges reported from the United States and other Western countries 1, 5, 6. Self-control strategies of yielding and assertion, and self-identification with the personality-related traits that describe gender-role stereotypes have both been implicated in the development of eating and drinking problems, and the results obtained reveal significant relationships among these different dimensions. As expected, a greater proportion of girls than boys reported experiencing eating problems and more of the boys than the girls reported experiencing problem drinking. However, similar kinds of relationships between a negative sense of self-control and an identification with the negative dimensions of gender-role stereotypes of masculinity and femininity predominated, regardless of gender, in those adolescents who reported eating, drinking, and both problems. In fact, there were very few differences between the girls’ and boys’ sense of self-control and their gender-role stereotypes when the same problem behaviors were compared directly. A major difference between those adolescents who reported problem drinking and those who reported binge eating was found in the contrast between identification with the traits of negative masculinity (drinking) with those of negative femininity (eating), although both problem drinking and binge eating were related to a negative sense of self-control. High scorers on negative control see themselves as lacking control over their environment. They also feel themselves to be too passive in general and they are inclined to believe that they are being controlled by other people’s behavior [16]. The current results suggest that the reliance on negative strategies of interaction with others and the environment may tend to restrict adolescents who are already portraying symptoms of binge eating and problem drinking. Not only were these particular adolescents scoring high on negative control, but they also were often low scorers on the positive sense of control scale. Negative self-cognitions coupled with occurrence of binging suggest a fundamentally self-limiting means of achieving temporary resolution of issues related to personal identity, self-expression, and self-esteem. 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PII: S1054-139X(02)00454-8 © 2002 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved. | |
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