Brief Writing Programs for Sexual Minority Young Adults in Alabama

Study Overview
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Brief Summary
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Sexual minority (SM; e.g., gay, lesbian, bisexual, pansexual, queer) young adults are at elevated risk for eating disorders (EDs). Researchers have used minority stress theory to understand how increased risk is due, in part, to stigma and discrimination from being part of a marginalized group. Despite this glaring inequity, limited programs exist to prevent EDs in SM populations. Critically, many SM young people live in rural regions with high anti-LGBTQ+ stigma and limited access to SM-specific resources. The proposed project will address this gap by adapting and evaluating two brief online interventions to reduce ED risk. N = 120 SM young adults in rural regions of Alabama with high LGBTQ+ stigma and low SM-specific resources will be randomized into one three brief online writing interventions: 1) expressive writing (n = 40), 2) self-affirmation (n = 40), or 3) control (n = 40). Participants will complete assessments pre-intervention, post-intervention, and 1-month post-intervention. Aim 1 will assess intervention feasibility and acceptability. Aim 2 will compare the brief online writing interventions to control in improving body image and ED symptoms. Finally, an exploratory aim will examine posited intervention mechanisms and whether the level of SM stigma and discrimination participants experience pre-intervention impacts intervention efficacy. This research will help support and benefit underserved SM young adults by filling a critical need for brief, scalable interventions that can be delivered online to help reduce ED risk. Data from this project will serve as pilot data for a subsequent R-series grant application from NIH.

Official Title
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Brief Writing Programs for Sexual Minority Young Adults in Alabama

Conditions
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Expressive Writing, Self-Affirmation, Control

Intervention / Treatment
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* Behavioral: Expressive Writing
* Behavioral: Self-Affirmation
* Behavioral: Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ages 18-30 identify as SM (gay, lesbian, bisexual, pansexual, or queer) endorse body dissatisfaction currently living in one of the following AL counties: Lee, Dallas, Lowndes, Autauga, Coosa, Elmore, Tallapoosa, Macon, or Russell have internet access (either via computer/tablet, mobile phone, or community center[e.g., library]) Exclusion Criteria: meet criteria for an ED, based on self-report screener non-English speaking Lack of internet access Not living in one of the following AL counties: Lee, Dallas, Lowndes, Autauga, Coosa, Elmore, Tallapoosa, Macon, or Russell Younger than 18, older than 30

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 30 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Expressive Writing<br>Participants will be asked to write about the biggest body image or eating-related stressor they have experienced as a member of the LGBTQ+ community. A general list of the types of stressors and contexts commonly described will be provided to participants, given that meta-analytic research supports that providing examples enhances the efficacy of expressive writing. | Behavioral: Expressive Writing<br>* Participants will be asked to write about the biggest body image or eating-related stressor they have experienced as a member of the LGBTQ+ community.<br>|
| Experimental: Self-Affirmation<br>Participants will respond to one new vignette per day describing a SM young adult experiencing severe body image stress in Alabama. Participants will be asked to write to this person and provide advice based on their own experience as a SM young adult. Vignettes will be identical across participants; however, they will be matched to participants' sexual identity, gender identity, and race/ethnicity. | Behavioral: Self-Affirmation<br>* Participants will receive one new vignette per day describing a SM young adult experiencing severe body image stress in Alabama. Participants will be asked to write to this person and provide advice based on their own experience as a SM young adult. Vignettes will be identical across participants; however, they will be matched to participants' sexual identity, gender identity, and race/ethnicity.<br>|
| Placebo Comparator: Control<br>Consistent with prior research participants will write about their routine daily activities since waking up for 20 minutes each day, sans emotional content. | Behavioral: Control<br>* Consistent with prior research participants will write about their routine daily activities since waking up for 20 minutes each day, sans emotional content.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body Image | Body Image States Scale (BISS); 7-item self-report measure about satisfaction with overall appearance. Scores range from 1-9, with higher scores reflecting more positive body image | changes from baseline through 1-month follow-up | 
| Eating Disorder Symptoms | Eating Pathology Symptom Inventory (EPSI); 45-item measure that assesses 8 domains of eating disorder pathology, scores range from 0-32, with higher scores indicating greater pathology | changes from baseline through 1-month follow-up | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Internalization of Appearance Ideals and Pressures | Sociocultural Attitudes Towards Appearance Scale-4 (SATAQ-4); 22-item measure of internalization of appearance ideals and pressures. Scores range from 4-25, with higher scores indicating greater appearance internalization | changes from baseline through 1-month follow-up | 
| Negative Affect | Depression, Anxiety, and Stress Scale (DASS-21); 21 item measure used to assess depression, anxiety, and nonspecific physiological arousal which load onto a higher order factor of psychological distress/negative affect. Scores range from 0-63, with higher scores indicating greater negative affect | changes from baseline through 1-month follow-up | 
| Interpersonal Emotion Regulation | Difficulties in Interpersonal Regulation of Emotion (DIRE); 24-item measures of maladaptive interpersonal emotional regulation. Scores range from 3-30 and higher scores indicate greater pathology. | changes from baseline through 1-month follow-up | 
| Health-related quality of life | World Health Organization Quality of Life- (WHO-BREF); 26-item self-report measure for physical and psychological social relationships and environmental health. Scores range from 4-20; higher scores indicate a better quality of life. | changes from baseline through 1-month follow-up | 
| Social Self-Esteem | Social Self-Esteem Scale (SSES); Measures confidence and self-esteem in social situations across 9 items. Scores range from 9-54, with higher scores indicating grater social self-esteem. | changes from baseline through 1-month follow-up | 
| Self-Stigma of Seeking Help | Self-Stigma of Seeking Help (SSOSH); Stigma surrounding seeking help for psychological concerns. Scores range from 10-50, with higher scores indicating greater stigma. | changes from baseline through 1-month follow-up | 
| Substance Use | Alcohol, Smoking, and Substance Involvement Screening (ASSIST); Examines alcohol and substance use patterns. Scores range from 0-39 and higher scores reflect greater substance use problems. | changes from baseline through 1-month follow-up | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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LGBTQIA+, Body Image, Alabama, Eating Disorders