Cultural strengths as moderators of the relationship between acculturation to the mainstream U.S. Society and eating- and body-related concerns among Mexican American women

Cultural Strengths as Moderators of the Relationship BetweenAcculturation to the Mainstream U.S. Society and Eating- andBody-Related Concerns Among Mexican American Women

Sonya K. Bettendorf and Ann R. FischerSouthern Illinois University Carbondale

This study explored whether 3 culturally relevant variables (i.e., ethnic identity, familism, and encul-turation) operated as sources of strength for 209 Mexican American women by buffering the relationshipbetween their acculturation to the mainstream U.S. society and eating- and body-related concerns. In aneffort to capture the underlying dimensions of women’s eating- and body-related concerns, the authorsused principal components analysis to identify 3 components: control concerns, restricted eating, andbody dissatisfaction. As hypothesized, results from a series of hierarchical regressions suggestedfamilism significantly buffered the links between acculturation to the mainstream U.S. society and all 3eating- and body-related variables. However, enculturation did not moderate the associations, and ethnicidentity moderated only the link between acculturation and restricted eating.

Keywords: eating disorders, acculturation, familism, ethnic identity, Mexican American women

In Susan Bordo’s examination of the experiences of Women ofColor related to eating disorders, a health organization represen-tative responded to an initial inquiry with “That’s a White girls’thing,” (Bordo, 2003). Empirical evidence, however, illustrates thepresence of eating and body concerns among Women of Color—inparticular, Mexican American women (e.g., Chamorro & Flores-Ortiz, 2000). For example, research has often shown similar levelsof eating disorder behaviors and body dissatisfaction in Latina andWhite women (e.g., Shaw, Ramirez, Trost, Randall, & Stice,2004), with some research showing higher levels of eating disorderbehaviors and body dissatisfaction for Latina than for Whitewomen (e.g., Fitzgibbon et al., 1998). Taken together, these find-ings underscore the importance of exploring these concerns amongMexican American women. In addition, although Mexican Amer-ican women demonstrate similar levels of eating- and body-relatedconcerns as White women, limited research has examined howvariables interact to predict or protect against eating- and body-related concerns.

Several studies have identified a link between acculturation andeating disorder concerns among Mexican American women suchthat higher levels of acculturation to mainstream U.S. society hasbeen associated with increased levels of eating disordered behav-iors (e.g., Cachelin, Phinney, Schug, & Striegel-Moore, 2006).Considered a multidimensional construct (Chun, Organista, &Marin, 2003), acculturation is defined as changes in cultural

attitudes, values, and behaviors that result from sustained contactbetween two or more distinct cultures (Berry, 1980). Some evi-dence indicates that Latina culture is more appreciative of largerbody types than is mainstream U.S. culture (Chamorro & Flores-Ortiz, 2000). It may be the case that acculturation to mainstreamU.S. society is accompanied by changes in conceptualization of theideal body. If this change is such that the ideal body becomesunrealistically thin, Mexican American women may become morevulnerable to eating- and body-related concerns.

Identifying moderators in the link between acculturation tomainstream U.S. society and eating- and body-related concernswill help illuminate conditions under which women may be resil-ient to thin ideals. To this end, research should integrate cultureinto existing theoretical approaches to eating disorders. Specifi-cally, research should explore culturally related factors and theirimpact on eating- and body-related concerns to gain a deeper andmore meaningful understanding of the unique experiences ofWomen of Color, including Mexican American women. Researchshould also generate new theories, given that Mexican Americanwomen may not be well represented in literature addressing othergroups’ experiences.

Exploring Features of the Sociocultural Model

The sociocultural model of eating disorders (Stice, 1994) is awidely endorsed account for the development of eating disordersamong women; it describes three factors that promote eatingdisorders, including the centrality of appearance in the femalegender role, the importance of appearance for women’s societalsuccess, and the thin ideal body image espoused for women.Research has most recently integrated one of these three factorsinto studies surrounding eating disorders, such that the thin idealbody image espoused for women and the role that the media playsin transmitting this ideal have been examined. Research charac-terizing this integration has posited that awareness of the thin ideal

Sonya K. Bettendorf and Ann R. Fischer, Department of Psychology,Southern Illinois University Carbondale.

This research is based in part on Sonya K. Bettendorf’s master’s thesis,supervised by Ann R. Fischer. Thanks to Yu-Wei Wang and Joan McDer-mott for invaluable input and feedback on an earlier version of this article.

Correspondence concerning this article should be addressed to Sonya K.Bettendorf, Department of Psychology (LSII), Southern Illinois University,Carbondale, IL 62901-6502. E-mail: [email protected]

Journal of Counseling Psychology © 2009 American Psychological Association2009, Vol. 56, No. 3, 430–440 0022-0167/09/$12.00 DOI: 10.1037/a0016382

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fosters an internalization of this ideal, leading to body dissatisfac-tion, which in turn places individuals at risk for developing eatingdisorders (Stice, 2002). Although this model is a broadly supportedaccount for the development of eating disorders in White women(e.g., Stice, 2001; Stice & Agras, 1999; Stice, Mazotti, Weibel, &Agras, 2000; Stice, Presnell, & Spangler, 2002), it must not beuncritically generalized to other cultural groups. It may, however,lay a foundation for further exploration surrounding MexicanAmerican women’s experiences. Therefore, examining compo-nents of the model that are theoretically and empirically relevant toMexican American women as well as modifying the model toauthentically capture experiences of this group may provide apreliminary framework for eating- and body-related research withMexican American women.

For example, acculturation to mainstream U.S. society may be amore important variable in predicting eating concerns than isawareness of the thin ideal proposed in Stice’s (1994) model.Ethnic minority women who have been exposed to Western soci-eties’ emphasis on thinness may be more prone to exhibiting eatingdisorders than are those who have not (Dolan, 1991). Thus, Mex-ican American women may be susceptible to the kinds of eatingand body concerns represented in research with White Americansamples insofar as they are connected to U.S. society. Further,retaining internalization of the thin ideal in the model may beproblematic given that little empirical evidence exists concerningthe reliability and validity performance of scores on existingmeasures of internalization in Mexican American women. In ad-dition, given that items on current internalization measures do notspecify which cultural values participants may be internalizing(i.e., Mexican or U.S.), items may be ambiguous and consequentlyrender the findings questionable. Therefore, internalization willnot be examined in this study.

Adding Strength-Based Culturally Related Variables

Our goal in this project was to work from a strength-basedframework to examine factors that may protect against eating- andbody-related concerns. We identified as possibilities from theliterature three culturally related factors that may foster resiliencein Mexican American women: ethnic identity, familism, and en-culturation.

First, ethnic identity refers to one’s sense of connectedness andbelonging to an ethnic group, coupled with attitudes and feelingsconcerning one’s ethnicity (Phinney, 2003). Previous research hasindicated that ethnic identity played a protective role in the rela-tionship between racial discrimination and psychological distressamong 2,047 Asians living in the United States (Yip, Gee, &Takeuchi, 2008) and between negative peer norms and schoolengagement among a sample of Adolescents of Color (includingLatino, African American, Asian American, Native American, andmultiracial participants; Shin, Daly, & Vera, 2007). Ethnic identitymay support Mexican American women’s resilience, in that thefocus is more on oneself as a member of a cultural group than onone’s personal identity with a particular appearance (Cachelin etal., 2006). Theorists have proposed that cultural factors—such asaccepting attitudes toward larger bodies, broader definitions ofbeauty, and more multifaceted senses of self-esteem, whichwomen with stronger ethnic identities may endorse to a greaterextent—are protective (Gray, Ford, & Kelly, 1987). In contrast to

mainstream U.S. culture, Mexican culture traditionally valuesmore voluptuous and curvy body types (Chamorro & Flores-Ortiz,2000). Mexican American women may endorse this cultural valueto a greater extent when they have a stronger ethnic identity.Mexican American women, therefore, may be somewhat protectedagainst eating- and body-related concerns due to their affiliationwith a culture of origin that does not idealize a thin body.

Further, identification with a culture that places less value onindividual appearance as a determinant of self-worth may under-mine pressures of thinness. The value of collectivism (Shkodriani& Gibbons, 1995), for example, may provide ways for MexicanAmerican women who are strongly identified with their culturalheritage to minimize concerns about their individual bodily ap-pearance. In other words, Mexican American women with strongerethnic identities may be more focused on the interests of theircultural group than on their individual bodily attributes, therebyprotecting themselves against eating- and body-related concerns.

The second culturally related variable, familism, may also increaseresilience. Familism is a deeply ingrained sense of the individualbeing inextricably rooted in the family (Bacallo & Smokowski, 2007).Strong feelings of connectedness, loyalty, solidarity, and attachment(Cuellar, Arnold, & Gonzalez, 1995) are among the core elements offamilism, described as a central feature of Mexican American culture(Casas & Pytluk, 1995). Research among White women has demon-strated that the family often plays a critical role in the development ofeating disorders. Specifically, in samples of White women, those withbehaviors related to anorexia nervosa have been depicted as emergingfrom overprotective family environments (French et al., 1997),whereas noncohesive or disconnected family environments have beenassociated with bulimia nervosa (Vandereycken, 1995) and greaterfrequency of dieting (French et al., 1997). Further, in White adoles-cent women, a low level of family connectedness has been associatedwith frequency of dieting (French et al., 1997). These findings high-light the importance of exploring family variables in studies of eatingdisorders. Thus, in keeping with the construct of familism and itsemphasis on connectedness, it may be the case that the family playsa positive role in protecting Mexican American women from thedevelopment of eating- and body-related concerns (Austin & Smith,2008).

Moreover, several studies have explored healthy family envi-ronments and components of familism. For example, Valdez,Mikow, and Cepeda (2006) examined healthy family environ-ments—the ability of the immediate family to cope with difficul-ties, stress, and conflicts—and risk behaviors in a cross-sectionalstudy of 150 Mexican American adolescent women. Findingsrevealed that healthy family environments were protective againstrisk behaviors, providing evidence for the role of the family inprotecting women against the negative outcomes associated withacculturation to mainstream U.S. society (i.e., eating- and body-related concerns), which may be considered a stressful experience.

Although research has not examined familism in MexicanAmerican women as it relates to eating- and body-related concernsspecifically, studies have examined its association with mentalhealth concerns in general. For example, higher familism has beenassociated with lower substance use (Gil, Wagner, & Vega, 2000),lower rates of child abuse (Coohey, 2001), lower interpersonalviolence (Sommers, Fagan, & Baskin, 1993), and higher rates ofseeking health-care services (Suarez, 1994). These findings areconsistent with researchers’ recommendations to study adaptive

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aspects of culture (Garcia Coll, Akerman, & Cicchetti, 2000) aswell as calls to move beyond designs of simple main effects tostudies that illuminate the conditions under which cultural values,such as familism, operate as sources of strength (Cauce &Domenech-Rodriguez, 2002).

As a third potentially protective culturally related variable,enculturation involves maintaining cultural ties to one’s ethnicgroup (Knight et al., 2008). It is possible that enculturation couldprotect Mexican American women against eating- and body-related concerns, even if these individuals also identify with themainstream U.S. culture. Thus, in an effort to simultaneouslyexamine acculturation and enculturation, we find that biculturalismbecomes a relevant point of interest. Biculturalism involves inter-nalizing, navigating, and identifying with more than one culture(Padilla, 1994), such that both enculturation and acculturationlevels are high. In other words, bicultural individuals preserve thetraditions and values of their culture of origin while simulta-neously maintaining integration with the mainstream society(Phinney, 2003). Bicultural identity has been hypothesized tobuffer the negative effects of acculturative stress (Romero et al.,2007) and has been related to greater well-being (Nguyen &Benet-Martinez, 2007), general life functioning (e.g., Berry, 1997),and psychological adjustment (e.g., Ward & Kennedy, 1993).These findings underscore the importance of employing bidimen-sional approaches to studying acculturation, which allows forindependent examination of connection to both culture of originand majority culture (Benet-Martinez et al., 2002).

In sum, the current study reflects an effort to integrate astrength-based cultural perspective into a leading theoretical modelof eating disorders. Culturally related variables were incorporatedinto aspects of Stice’s (1994) model, which was derived primarilyfrom White women but which may provide a provisional frame-work for initial explorations of Mexican American women’s ex-periences. We substituted acculturation to mainstream U.S. societyfor awareness of thin ideals, eliminated internalization of thinideals, and included culturally related moderators. Other vari-ables—such as pressures of thinness, body mass index, and neg-ative affect—are included within Stice’s model; however, thesevariables were not central to the goals of our study.

In an effort to authentically represent the voices and illuminatethe experiences of Mexican American women, the current studyseeks to ground hypotheses within a Mexican American culturalcontext. Given the interrelated content of items across existingmeasures of eating- and body-related concerns (Kashubeck-West,Mintz, & Saunders, 2001), it seems appropriate to examine ratherthan assume the current sample’s pattern of responding. In otherwords, it will be important to explore Mexican American women’spatterns of responding to items related to eating- and body-relatedconcerns, rather than imposing a Eurocentric perspective onto thisgroup of women. In addition, given that current measures ofeating- and body-related concerns were developed and validatedwith samples of White women, the underlying dimensions may notrepresent Mexican American women’s experiences well. In keep-ing with these goals and concerns, we conducted a principalcomponents analysis of items contained in a set of measuresintended to assess eating- and body-related constructs. As detailedbelow, we created weighted factor scores, in order to conserve thedimensions underlying Mexican American women’s pattern ofresponding, rather than imposing additional structure.

The overarching hypothesis was that cultural variables would mod-erate the links between acculturation to mainstream U.S. society andeating- and body-related concerns. We predicted that familism, ethnicidentity, and enculturation (i.e., Mexican cultural orientation) wouldmoderate the relations, such that at high levels of each moderator, thelink would be weaker than at low levels. In other words, although weused cross-sectional data, we expected results consistent with concep-tualizations of Mexican culture as a buffer.

Method

Participants and Procedures

Participants were recruited online from university cultural organi-zations and Latino studies programs across the United States. Ane-mail message describing the purpose of the study, requesting par-ticipation, and including a URL link to the survey was sent tocoordinators of student organizations and Latino studies faculty. Ofthe 209 Mexican American women participating (mean age � 28.84years, SD � 10.33), 63% were students, 13% nonstudents, 5% pro-fessors, and 19% other. The majority identified as heterosexual(92%), and the rest identified as gay or lesbian (3%), bisexual (3%),or other (2%). About 98% reported being extremely or very confidentin their ability to read English, and 2% were moderately confident.Nearly 50% responded on the basis of an e-mail to university culturalorganizations, while 33% responded from a listserv e-mail and 17%from some other source (e.g., a forwarded e-mail). About half (48.8%)identified as second generation, 20.6% as third, 18.7% as first, and12.0% as “one and a half” generation (i.e., moved to the United Statesafter living a few years in Mexico).

Measures

Acculturation and enculturation. The Acculturation RatingScale for Mexican Americans–II (ARSMA-II; Cuellar et al., 1995)contains 30 items assessing cultural domains unique to acculturation,including language use and preference as well as ethnic identity,behaviors, and interactions. As a multidimensional scale, it containsboth a Mexican Orientation Subscale (MOS; enculturation) and anAnglo Orientation Subscale (AOS; acculturation). Items were ratedon a 5-point scale ranging from 1 (not at all) to 5 (extremely often ormost always). Mean scores ranged from 2.69 to 4.62 on the MOS and1.82 to 4.82 on the AOS, with higher scores indicating greaterorientation to Mexican and Anglo culture, respectively.

Cronbach’s alpha of .89 has been reported for the AOS in a sampleof 188 Mexican Americans (Cachelin et al., 2006). Good split-halfreliability for AOS (� � .77) and MOS (� � .84) scores has beendemonstrated (Cuellar et al., 1995). One-week test–retest reliabilitycoefficients were reported as .94 for AOS and .96 for MOS among asample of 31 Mexican Americans (Cuellar et al., 1995). Alphas in thecurrent study were .69 for the AOS and .85 for the MOS. TheARSMA-II scores have shown concurrent validity of r � .89 betweenacculturation scores from the ARSMA and ARSMA-II among 171Mexican Americans (Cuellar et al., 1995). In addition, the positivecorrelation (r � .47) between the AOS subscale of the ARSMA-IIand the U.S. Orientation Subscale of the Acculturation, Habits, andInterests Multicultural Scale for Adolescents (Unger et al., 2002) in asample of 317 Mexican American adolescents provides support forconvergent validity. Finally, ARSMA-II scores showed expected dif-

432 BETTENDORF AND FISCHER

ferences in acculturation scores across five generations of 379 Mex-ican Americans (Cuellar et al., 1995).

Ethnic identity. The Multigroup Ethnic Identity Measure–Revised (Phinney, 1992) is a 12-item scale that measures three centralaspects of ethnic identity, including (a) positive ethnic attitudes and asense of belonging, (b) ethnic identity achievement, and (c) ethnicbehaviors and practices. Response options range from 1 (stronglyagree) to 4 (strongly disagree). Mean scores ranged from 1.33 to 4.00,higher scores indicating stronger ethnic identity. A Cronbach’s alphaof .86 was reported for a sample of 188 Mexican American women(Cachelin et al., 2006) and .80 in a sample of 755 Mexican Americans(Roberts et al., 1999); current alpha � .86. Regarding constructvalidity among a sample of 755 Mexican Americans, scale scoresshowed positive correlations with measures of psychological well-being, including coping (r � .20), mastery (r � .12), self-esteem (r �.14), and optimism (r � .10). In addition, scale scores correlatednegatively with loneliness (r � –.09) and depression (r � –.09)among a sample of 755 Mexican Americans, 755 African Americans,and 1,237 European Americans (Phinney, 2003).

Familism. The three familism subscales of the overall Mexi-can American Cultural Values Scale for Adolescents and Adults(Knight et al., 2008) were also used. The six-item Support subscalerefers to the extent to which one’s family provides a sense ofsecurity, cohesiveness, and connectedness. The five-item Obliga-tion subscale addresses the degree to which one helps, cares for,and makes sacrifices for immediate and extended family. Thefive-item Referent subscale refers to the extent to which one seeksadvice from family members when making important decisions,considers how decisions will impact the family, and represents thefamily in a positive manner. The subscales contain a total of 16items, which were used to create an overall familism scale score.Items were rated on a scale ranging from 1 (not at all) to 5(completely). Mean scores ranged from 2.06 to 5.00, with higherscores indicating greater familism. Cronbach’s alphas of .86 and.84 have been reported for Mexican American adolescents (Ger-man, Gonzales, & Dumka, 2009; Updegraff, McHale, Whiteman,Thayer, & Delgado, 2005); current alpha � .88. Regarding con-struct validity evidence, Knight et al. (2008) reported that each ofthe three familism subscales correlated positively with MexicanAmerican ethnic pride for adolescents (rs � .49–.68) and fathers(rs � .26–.31), though only the Referent subscale did so formothers (r � .22). The three familism subscales correlated posi-tively with Mexican orientation (ARSMA-II scores) for adoles-cents (rs � .22–.29), mothers (rs � .30–.45), and fathers (rs �.17–.43) in one of Knight et al.’s samples, though the links wereless consistent for adolescents and mothers in the second sample.

Eating- and body-related concerns. Three measures were usedto assess eating- and body-related concerns. First, participantsresponded to the Body Dissatisfaction subscale of the EatingDisorder Inventory (EDI-BD; Garner, Olmsted, & Polivy, 1983),which includes nine items addressing satisfaction with parts of thebody. Items were rated on a 6-point scale ranging from 1 (never)to 6 (always). As recommended by Garner et al. (1983), extremescores earned a score of 3; the immediately adjacent response 2,the next response 1, and the 3 choices opposite the most extremeresponse 0. Prior to obtaining the mean, 1 was added to all itemsto avoid having zeros in the distribution of scores while maintain-ing the internal structure of the measure. Higher scores reflectgreater dissatisfaction. Cronbach’s alpha of .91 was reported for

120 Mexican American women (Joiner & Kashubeck, 1996);current alpha � .88. Regarding construct validity, EDI-BD scoresdifferentiated between women with anorexia nervosa or bulimianervosa and comparison groups (Garner et al., 1983). Further,there was good agreement between eating disorder patients’ self-report profiles of body dissatisfaction and the clinical judgments ofexperienced clinicians (Garner et al., 1983).

Second, participants responded to the Eating Attitudes Test-26(EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982), previouslybelieved to be a measure of attitudes and behaviors associated withanorexia nervosa. However, more recent research has indicated thatthe EAT-26 also measures bulimic behavior and other concerns(Kashubeck-West, Mintz, & Saunders, 2001). The 26 items are scoredon a 6-point scale ranging from always to never. Scores were obtainedby procedures outlined by Garner et al. (1982). The most extremeresponse (always or never, depending on the keyed direction) earneda score of 3, while the next two extreme responses earned a score of2 and 1, respectively, and the last three responses earned a score of 0.After adding 1 to each item, mean scores ranged from 1.04 to 3.19,with higher scores indicating greater concerns. Cronbach’s alpha wasreported as .90 for an anorexic group and .83 for a control group(Garner et al., 1982). A Cronbach’s alpha of .85 was reported for asample of Mexican American adolescent women (Joiner & Kashu-beck, 1996). Current alpha � .89. Results of discriminant functionanalysis revealed that the EAT-26 correctly classified 83.6% of theparticipants included in the clinically identified anorexia and controlgroups in a study by Garner et al. (1982), providing support forconstruct validity of EAT-26 scores.

Third, we used the Bulimia Test–Revised (BULIT-R; Thelen,Farmer, Wonderlich, & Smith, 1991), intended as a self-reportmeasure of bulimia as defined by the Diagnostic and StatisticalManual of Mental Disorders (3rd ed., rev.; DSM–III–R; AmericanPsychiatric Association, 1987). For the 28 multiple-choice items, a5 indicates extreme behaviors and a 1 indicates no behaviors.Mean scores ranged from 1.03 to 4.00, with higher scores indicat-ing greater bulimia nervosa behaviors. Joiner and Kashubeck(1996) reported Cronbach’s alpha of .92 among Mexican Ameri-can adolescent women; current alpha � .95. BULIT-R scores haveshown test–retest reliability of .95 over a 2-month period among asample of 1,793 college women (Thelen et al., 1991). Goodpredictive ability was revealed in retest scores’ significant corre-lations with group membership (with or without bulimia) amongthe sample of 1,793 college women on the basis of rater judgment(Thelen et al., 1991). Concurrent validity for BULIT-R scores isaddressed by a correlation of .93 between BULIT-R scores andscores on the Binge Scale Questionnaire from 89 control womenand 20 women reporting bulimia concerns (Hawkins & Clement,1980), while scores on the BULIT-R correlated .99 with theoriginal BULIT among a sample of 39 college-aged women(Brelsford, Hummel, & Barrios, 1992).

Results

Data Screening

There were no univariate outliers and one multivariate outlier(Mahalanobis distance � 34.04; Tabachnick & Fidell, 2007),which was dropped, resulting in a final N of 209. The mean agewas 28.84 years (SD � 10.33; range � 18–63). To eliminate


significant skew of distributions, we applied a reflected log 10transformation for ethnic identity, along with a reflected squareroot for familism. No mean differences emerged (all ps � .05) forsecond- versus first-generation women or for students versus non-students on the variables of interest.

Data Reduction: Eating- and Body-Related Variables

To tap the underlying dimensions of Mexican American wom-en’s eating- and body-related concerns, we conducted a principalcomponents analysis of items comprising the body dissatisfaction,anorexia, and bulimia measures. Given the interrelated contentacross these scales, it seemed appropriate to examine rather thanassume this sample’s pattern of responding. Initial extraction re-vealed 12 components with eigenvalues over 1, but examination ofthe scree plot suggested exploring both two- and three-componentstructures. After oblimin rotation, the third component was clearlyinterpretable and accounted for a nontrivial amount of total vari-ance (5.5%). Therefore, the three-component structure, accountingfor 49.4% of total variance, is presented below. Although the screetest involves researcher judgment, Tabachnick and Fidell (2007)noted that it is more reliable when there are high loadings on eachfactor, which was true of the current data. Complete results areavailable from Sonya K. Bettendorf.

The first component (accounting for 36.7% of total variance)demonstrated high loadings on items from both the BULIT-R andthe EAT-26. The highest loading items seemed to reflect behaviorsand attitudes related to concerns about losing control and the needto regain control of one’s eating and body shape/size (e.g., engag-ing in intense exercise, dieting, vomiting; being obsessed withone’s body size and shape) and therefore was labeled controlconcerns (CC). The second component, which accounted for 7.2%of total variance, also contained a mix of high-loading items fromboth the BULIT-R and the EAT-26. It was labeled restrictedeating (RE), as it involved restricting the kind and amount of foodconsumed (e.g., self-discipline about eating, eating diet foods,

avoiding sugar). Finally, high-loading items on the third compo-nent all reflected dissatisfaction with the size and shape of one’sbody (e.g., not liking the size or shape of one’s hips, thighs, orother parts of one’s body), with most items originating from theEDI-BD. Accounting for 5.5% of total variance, this componentwas labeled body dissatisfaction (BD).

Rather than creating simple scores by averaging responses onhigh-loading items, we used factor scores in subsequent analyses. Asoutlined by Tabachnick and Fidell (2007), regression-like coeffi-cients, which are referred to as factor score coefficients, are computedfor weighting variable scores, which are then used to produce factorscores. In essence, factor scores are weighted and summed combina-tions of scores on the components. To estimate participants’ scores onall three eating- and body-related factors, we standardized partici-pants’ scores on the variables, weighted the standardized scores, andadded the results. We chose to implement this method given that itconserves the dimensions underlying Mexican American women’spattern of responding, rather than presuming a structure derivedprimarily from European American samples.

Descriptive Statistics and Bivariate Correlations

Table 1 shows bivariate correlations for both transformed anduntransformed scores. All subsequent reporting of results has beenadjusted to account for transformations. Using a conservativealpha of .01, greater RE was associated with lower levels of ethnicidentity and familism. Greater BD was related to lower encultura-tion (i.e., Mexican orientation) and familism.

Hypothesis Testing: Moderation by CulturallyRelated Variables

A series of nine hierarchical regressions was conducted, each ofwhich included three potential moderators and three criterionvariables. Age was controlled, given the prevalence of eating- andbody-related concerns among college-aged women and the high

Table 1Intercorrelations Among and Descriptive Statistics for All Variables

Variable 1 2 3 4 5 6 7 8

1. Acculturation (Anglo culturalorientation) — �.05 .02

2. Enculturation (Mexicancultural orientation) �.23� — .28�� .22��

3. Ethnic identity �.12� .34�� — .28�� .10 �.07 �.03 .16�

4. Familism .01 .26�� .30�� — .05 �.20�� .15� �.095. Factor 1: Control concerns �.02 .01 .10 .02 —6. Factor 2: Restricted eating .05 �.15� �.19�� .25�� .25�� —7. Factor 3: Body dissatisfaction .13� �.23�� .11 �.18�� .25�� .25�� —8. Age .06 �.11 .16� �.10 �.14� .00 .12� —M 3.69 3.49 3.48 3.81 0.00 0.00 0.00 28.89SD 0.39 0.64 0.48 0.59 1.00 1.00 1.00 10.33Possible range 1.00 to 5.00 1.00 to 5.00 1.00 to 4.00 1.00 to 5.00Actual range 2.69 to 4.62 1.82 to 4.82 1.33 to 4.00 2.06 to 5.00 �1.30 to 3.36 �1.28 to 5.24 �2.96 to 2.05 18 to 63� .69 .85 .86 .88

Note. N � 209. Descriptive statistics are for untransformed distributions. Higher scores indicate higher levels of the named construct. Figures below thediagonal represent results with untransformed scores. Figures above the diagonal represent Pearson’s rs with transformed scores for ethnic identity andfamilism, which have been reversed for interpretation, given that both scales’ transformations involved reflecting scores.� p � .05. �� p � .01.


percentage (63%) of college-aged women in the current sample.Predictors were centered, and the interaction terms were createdfrom the products of centered variables. Age was entered in Step1, the predictor and proposed moderator in Step 2, and the inter-action term in Step 3 for each of the nine regressions. Moderationof links of eating- and body-related concerns with acculturation tomainstream U.S. society would be demonstrated by significant Fvalues for the increments in R2 at Step 3, reflecting predictivevalue of the interactions of acculturation to mainstream U.S.society with the three culturally related variables, above and be-yond variance accounted for by main effects and the covariate(age). Given the typically small sizes of moderator effects (Cham-poux & Peters, 1987), Type II error was of greater concern thanusual in multiple regression. Therefore, we did not adjust the alphadownward for the multiple hypothesis tests (McClelland & Judd,1993).

As shown in Table 2, familism significantly moderated the linkbetween acculturation to mainstream U.S. society and the firsteating- and body-related component, CC, as hypothesized. Neitherethnic identity nor enculturation moderated the relationship be-tween acculturation to mainstream U.S. society and CC. To probethe familism interaction, we calculated simple regression lines for1 SD above and 1 SD below the mean for familism (Aiken & West,1991). As illustrated by Figure 1A, at lower levels of familism, thedirection of the slope was positive, such that the trend was forhigher acculturation to mainstream U.S. society to predict higherCC, t(207) � 4.18. As predicted, at high levels of familism, theslope changed such that higher levels of acculturation to main-stream U.S. society were unrelated to CC, t(207) � �1.11.

Next, we tested moderation by the same three culturally relatedvariables of the association between acculturation to mainstreamU.S. society and the second eating- and body-related component,RE. A similar pattern to that shown when predicting CC emerged,such that familism significantly moderated the relationship be-tween acculturation to mainstream U.S. society and RE. As shownin Figure 1B, when familism was low, higher acculturation tomainstream U.S. society significantly predicted greater RE,t(207) � 2.47, p � .05. This link was not only attenuated, aspredicted, but reversed at high levels of familism, such that higheracculturation to mainstream U.S. society was significantly relatedto less RE, t(207) � �3.21, p � .01. Ethnic identity also acted asa moderator. Figure 2 shows that at lower levels of ethnic identity,the direction of the slope was positive, such that higher accultur-ation to mainstream U.S. society significantly predicted higher RE,t(207) � 4.08, p � .001. In addition to the relationship attenuating,as predicted, the relationship reversed directions, such that athigher levels of ethnic identity, higher levels of acculturation tomainstream U.S. society significantly predicted lower levels ofRE, t(207) � �3.97, p � .001.

Finally, the moderating effect of the three culturally relatedvariables on the association between acculturation to mainstreamU.S. society and the third eating- and body-related component,BD, was tested. Familism significantly moderated the link betweenacculturation to mainstream U.S. society and BD, consistent withhypotheses, though neither enculturation nor ethnic identity did so.Tests of simple slopes (see Figure 1C) indicated that when fa-milism was high, higher acculturation to mainstream U.S. societywas significantly associated with lower BD, t(207) � – 3.71, p �.001. At lower levels of familism, the direction of the slope was

reversed, although the slope at �1 SD for familism was notsignificantly different from 0, t(207) � 1.25, p � .21.

Despite the nonsignificant Acculturation � Enculturation inter-actions in the regressions above, we conducted an additional test ofbiculturalism as a predictor of eating- and body-related concernsby classifying participants’ acculturation statuses according torecommendations by Cuellar et al. (1995). This resulted in 12participants classified as traditional (high enculturation, low ac-culturation), 55 as low bicultural (low to moderate enculturation,low to moderate acculturation), 41 as high bicultural (high encul-turation, high acculturation), and 5 as assimilated (low encultura-tion, high acculturation). Only the low and high bicultural groupshad sufficient numbers for group comparisons. Independent sam-ples t tests revealed that these two groups did not differ on anyof the three variables related to eating- and body concerns (allps � .05).

A noteworthy finding is the strength of the interactions. Inparticular, the Acculturation � Familism interaction accounted for4.8% of the variance in BD and 7.6% of the variance in RE, bothabove and beyond the influences of the main effects and covariate.McClelland and Judd (1993) noted that “moderator effects arenotoriously difficult to detect” (p. 377) in nonexperimental re-search and often are regarded as important when accounting foronly 1%–3% of the variance in the criterion above and beyondmain effects.1

Discussion

The current study explored culturally related variables as poten-tial moderators of the relationship between acculturation to main-stream U.S. society (i.e., Anglo orientation) and eating- and body-related variables among Mexican American women, a group thathas been grossly underrepresented in the eating- and body-relatedconcerns literature. Although there is great within-group hetero-geneity, our focus on this self-identification improves on use of theextremely broad Latina category.

One major set of findings indicated that familism moderated thelinks of acculturation to mainstream U.S. society with RE, CC, andBD. In addition, ethnic identity moderated the relationship be-tween acculturation to mainstream U.S. society and RE but not CCor BD. No moderating effects were found for enculturation. Asecond major finding was that the principal components analysisrevealed patterns consistent with those in the eating disorderliterature. For example, control and restriction have been consis-tently addressed as behaviors linked with eating disorders (Dolan,1991; French et al., 1997). Although the empirical base for manyeating disorder instruments is limited regarding Mexican Ameri-can women, a strength of the current study is that the eating- andbody-concern factor scores reflected dimensions emerging from

1 In addition to conducting hierarchical regression analyses with trans-formed variables, we conducted analyses with untransformed variables.Results with the untransformed variables were equivalent to those with thetransformed variables, with three exceptions: Using untransformed vari-ables, we found that the interaction effect of acculturation by familism onCC was not significant ( p � .05), the interaction effect of acculturation byethnic identity on CC was not significant ( p � .05), and the interactioneffect of acculturation by ethnic identity on BD was significant ( p � .05).


Table 2Hierarchical Multiple Regressions Testing the Moderating Effects of Culturally Relevant Variables on Links Between Acculturation toMainstream U.S. Society and Eating- and Body-Related Concerns

Variable Final � t(204)Cumulative

R2 �R2 �F dfOverall

F(4, 204)

Control concernsFamilism 2.268

Step 1: Age �.013 �1.996� .018 .018 3.880� 1, 207Step 2

Acculturation �.028 �0.401Familism �.043 �0.623 .020 .001 0.137 2, 205

Step 3: Acculturation � Familism .027 2.207� .043 .023 4.873� 1, 204Enculturation 0.982

Step 1: Age �.013 �1.887 .018 .018 3.880� 1, 207Step 2

Acculturation �.017 �0.233Enculturation �.001 �0.159 .019 .000 0.045 2, 205

Step 3: Acculturation � Enculturation �.001 �0.110 .019 .000 0.012 1, 204Ethnic identity 2.184

Step 1: Age �.014 �2.074� .018 .018 3.880� 1, 207Step 2

Acculturation �.023 �0.326Ethnic identity �.139 �1.967 .033 .015 1.565 2, 205

Step 3: Acculturation � Ethnic Identity .018 1.296 .041 .008 1.681 1, 204

Restricted eating concernsFamilism 6.731��

Step 1: Age �.004 �0.558 .000 .000 0.004 1, 207Step 2

Acculturation .028 0.423Familism .181 2.725�� .041 .041 4.386� 2, 205

Step 3: Acculturation � Familism .049 4.177�� .117 .076 17.445�� 1, 204Enculturation 1.664

Step 1: Age .000 �0.059 .000 .000 0.004 1, 207Step 2

Acculturation .024 0.332Enculturation �.014 �1.693 .025 .025 2.634 2, 205

Step 3: Acculturation � Enculturation �.008 �1.172 .032 .007 1.374 1, 204Ethnic identity 1.335

Step 1: Age .002 0.266 .000 .000 0.004 1, 207Step 2

Acculturation .018 0.256Ethnic identity .045 0.624 .000 .007 0.710 2, 205

Step 3: Acculturation � Ethnic Identity .027 1.974� .006 .019 3.897� 1, 204

Body dissatisfaction concernsFamilism 5.511��

Step 1: Age �.009 �1.385 .015 .015 3.153 1, 207Step 2

Acculturation �.103 �1.542Familism �.129 �1.927 .049 .034 3.674� 2, 205

Step 3: Acculturation � Familism �.039 �3.309�� .098 .048 10.947�� 1, 204Enculturation 4.326��

Step 1: Age �.011 �1.680 .015 .015 3.153 1, 207Step 2

Acculturation �.086 �1.216Enculturation .020 2.386� .070 .055 6.014� 2, 205

Step 3: Acculturation � Enculturation .010 1.379 .078 .009 1.902 1, 204Ethnic identity 2.005

Step 1: Age �.013 �1.867 .015 .015 3.153 1, 207Step 2

Acculturation �.100 �1.434Ethnic identity �.023 �0.329 .030 .015 1.616 2, 205

Step 3: Acculturation � Ethnic Identity �.017 �1.265 .038 .008 1.600 1, 204

� p � .05. �� p � .01.


Restricted Eating

0.45

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Figure 1. Simple slopes of significant Acculturation to Mainstream U.S. Society � Familism interactionspredicting three eating- and body-related variables.


the experiences of our sample (i.e., patterns of responding wereexplored rather than assumed).

Consistent with hypotheses, stronger acculturation to main-stream U.S. society was linked with higher levels of all three of theeating- and body-related concerns but only among women whoheld lower values on familism. At high levels of familism, thisrelationship was attenuated or reversed. The moderator effect sizeswere substantial and larger than is common in cross-sectionalresearch (McClelland & Judd, 1993). The hint that strong familyvalues play a central role in positive experiences corresponds withresearch that shows links between dimensions of familism andfavorable mental health outcomes (Austin & Smith, 2008; Castillo,Conoley, & Brossart, 2004; Coohey, 2001; Gil et al., 2000). Inaddition, it is possible that exposure to U.S. values of thinness isa form of acculturative stress from conflicting cultural norms(Berry, 1980), such as ideals related to attractiveness. Given that itwas only in the context of low familism that higher levels ofacculturation to mainstream U.S. society predicted increasedeating- and body-related concerns, it appears that the family playsa role in buffering the negative effects of living in a society thatendorses the thin ideal, a possible source of acculturative stress.This scenario would be consistent with Bacallo and Smokowski’s(2007) finding that families coped with postimmigration changesby maintaining high levels of familism and cultural traditions.

Further, ethnic identity moderated the relationship between ac-culturation to mainstream U.S. society and RE. However, contraryto hypotheses, ethnic identity did not moderate the relationshipsbetween acculturation to mainstream U.S. society and either BD orCC. This pattern of findings provides mixed evidence for ourspeculation that ethnic identity may be protective in that groupmembership is emphasized more than one’s physical appearanceor body type (Cachelin et al., 2006). However, directly measuringrather than inferring the extent to which body appearance is acentral component of one’s personal and group identity would beuseful.

As with ethnic identity, enculturation (i.e., Mexican culturalorientation) did not moderate the relationship between accultura-tion to mainstream U.S. society and eating- and body-relatedconcerns. This finding may have emerged given the possibility thatwomen can endorse ARSMA-II (Cuellar et al., 1995) items thatindicate connectedness to both Mexican and Anglo orientationgenerally while simultaneously subscribing to any combination ofMexican and Anglo beauty-specific ideals. In addition, simply

living in a society in which messages and images of thinness areprofoundly pervasive may be sufficient to produce body concerns,regardless of Mexican cultural orientation.

Limitations, Future Research, and Implicationsfor Counseling

Although the factor scores generated conserve the dimensionsunderlying Mexican American women’s response patterns, theitems used were developed with predominantly European Ameri-can samples. Thus, results should be interpreted with caution.Development of measures of experiences relevant to Mexicanculture will contribute to research. In addition, the cross-sectionaldata does not allow for causal inferences. The high representationof college students and professionals, as well as members ofcultural organizations or Latino/Latin American studies, may limitgeneralizability of findings as well. Moreover, no specific validitychecks for random responding were included. Regarding the onlinedata collection, no conclusive evidence has indicated substantialdifferences in responses between handwritten and online surveys(Ilieva, Baron, & Healey, 2002). However, anecdotal evidencesuggests that technical problems such as lacking access to onlinetechnology as well as not responding truthfully or posing as adifferent person may contribute to random responding and otherresponse sets (Lefever, Dal, & Matthiasdottir, 2007). Finally, thealpha for the acculturation measure used in the current study is lessthan desirable, although significant effects were still obtained.

Findings underscore the importance of increasing psychologists’knowledge about cultural issues in conceptualizing, treating, andpreventing eating- and body-related concerns. On the basis of ourfamilism results, for example, psychologists can work within afamily context and support interdependence or connectednessamong the client’s family of origin, which may protect against theharmful effects of living in a society that values thinness. At thesame time, it is important to be aware that some clients may notembrace this as a goal, particularly if the family has been a sourceof substantial pain. Further, Vasquez (1994) cautioned therapistsagainst using a Western frame of reference to conceptualize familyprocesses (e.g., individuation) with Latina clients.

Findings also suggest the potential usefulness of working fromfeminist and other social justice–oriented frameworks. A corner-stone of feminist therapy, for example, is attention to context,which provides an opportunity to conceptualize Mexican Ameri-

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Figure 2. Simple slopes of significant Acculturation to Mainstream U.S. Society � Ethnic Identity interactionpredicting restricted eating.


can women’s experiences from a social constructivist perspective.For example, Vasquez (1994) suggests that developing a criticalconsciousness regarding effects of institutional racism and sexismis an important aspect of therapeutic work with Latina women.Warren and Constantine (2007) also offer many suggestions forintegrating a social justice perspective into education, prevention,intervention, and advocacy efforts. In addition, collaborating withclients to understand eating- and body-related concerns in thecontext of their sociopolitical environments may provide opportu-nities for empowerment. Indeed, the cultivation of empowermentstands as a central value of counseling psychology.

References

Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing andinterpreting interactions. Thousand Oaks, CA: Sage.

American Psychiatric Association. (1987). Diagnostic and statistical man-ual of mental disorders (3rd ed., rev.). Washington, DC: Author.

Austin, J. L., & Smith, J. E. (2008). Thin ideal internalization in Mexicangirls: A test of the sociocultural model of eating disorders. InternationalJournal of Eating Disorders, 41, 448–457.

Bacallo, M., & Smokowski, P. (2007). Acculturation, internalizing mentalhealth symptoms, and self-esteem: Cultural experiences of Latino ado-lescents in North Carolina. Child Psychiatry and Human Development,37, 273–292.

Benet-Martınez, V., Leu, J., Lee, F., & Morris, M. (2002). Negotiatingbiculturalism: Cultural frame-switching in biculturals with ‘opposi-tional’ vs. ‘compatible’ cultural identities. Journal of Cross-CulturalPsychology, 33, 492–516.

Berry, J. W. (1980). Acculturation as varieties of adaptation. In A. M.Padilla (Ed.), Acculturation: Theory, models and some new findings (pp.9–25). Boulder, CO: Westview.

Berry, J. W. (1997). Immigration, acculturation, and adaptation. AppliedPsychology: An International Review, 46, 5–34.

Bordo, S. (2003). Unbearable weight: Feminism, Western culture, and thebody. Berkeley: University of California Press.

Brelsford, T. N., Hummel, R. M., & Barrios, B. A. (1992). The BulimiaTest–Revised: A psychometric investigation. Psychological Assessment,4, 399–401.

Cachelin, F., Phinney, J., Schug, R., & Striegel-Moore, R. H. (2006).Acculturation and eating disorders in a Mexican American communitysample. Psychology of Women Quarterly, 30, 340–347.

Casas, J. M., & Pytluk, S. D. (1995). Hispanic identity development:Implications for research and practice. In J. G. Ponterotto, J. M. Casas,L. A. Suzuki, & C. M. Alexander (Eds.), Handbook of multiculturalcounseling (pp. 155–180). Thousand Oaks, CA: Sage.

Castillo, L. G., Conoley, C. W., & Brossart, D. F. (2004). Acculturation,White marginalization, and family support as predictors of perceiveddistress in Mexican American female college students. Journal of Coun-seling Psychology, 51, 151–157.

Cauce, A. M., & Domenech-Rodriguez, M. (2002). Latino families: Mythsand realities. In J. M. Contreras, K. A. Kerns, & A. M. Neal-Barnett(Eds.), Latino children and families in the United States (pp. 3–25).Westport, CT: Praeger.

Chamorro, R., & Flores-Ortiz, Y. (2000). Acculturation and disorderedeating patterns among Mexican American women. International Journalof Eating Disorders, 28, 125–129.

Champoux, J. E., & Peters, W. S. (1987). Form, effect size and power inmoderated regression analysis. Journal of Occupational Psychology, 60,243–255.

Chun, K. M., Organista, P. B., & Marin, G. (2003). Acculturation. Wash-ington, DC: American Psychological Association.

Coohey, C. (2001). The relationship between familism and child maltreat-

ment in Latino and Anglo families. Child Maltreatment: Journal ofAmerican Professional Sociology, 6, 130–142.

Cuellar, I., Arnold, B., & Gonzalez, G. (1995). Cognitive referents ofacculturation: Assessment of cultural constructs in Latinos. Journal ofCommunity Psychology, 23, 339–356.

Dolan, B. (1991). Cross-cultural aspects of anorexia nervosa and bulimia:A review. International Journal of Eating Disorders, 10, 67–78.

Fitzgibbon, M. L., Spring, B., Avellone, M. E., Blackman, L. R., Pingitore,R., & Stolley, M. R. (1998). Correlates of binge eating in Hispanic,Black, and White women. International Journal of Eating Disorders, 24,43–52.

French, S. A., Story, M., Neumark-Sztainer, D., Downes, B., Resnick, M.,& Blum, R. (1997). Ethnic differences in psychosocial and healthbehavior correlates of dieting, purging, and binge eating in a population-based sample of adolescent females. International Journal of EatingDisorders, 22, 315–322.

Garcia Coll, C., Akerman, A., & Cicchetti, D. (2000). Cultural influenceson developmental processes and outcomes: Implications for the study ofdevelopment and psychopathology. Development and Psychopathology,12, 333–356.

Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. (1982). TheEating Attitudes Test: Psychometric features and clinical correlates.Psychological Medicine, 12, 871–878.

Garner, D. M., Olmsted, M. P., & Polivy, J. (1983). Development andvalidation of a multidimensional eating disorder inventory for anorexianervosa and bulimia. International Journal of Eating Disorders, 2,15–34.

German, M., Gonzales, N. A., & Dumka, L. E. (2009). Familism values asa protective factor for Mexican-origin adolescents exposed to deviantpeers. Journal of Early Adolescence, 29, 16–42.

Gil, A. G., Wagner, E. F., & Vega, W. A. (2000). Acculturation, familismand alcohol use among Latino adolescent males: Longitudinal relations.Journal of Community Psychology, 28, 443–458.

Gray, J., Ford, K., & Kelly, L. (1987). The prevalence of bulimia in a Blackcollege population. International Journal of Eating Disorders, 6, 733–740.

Hawkins, R. C., & Clement, P. F. (1980). Development and constructvalidation of a self-report measure of binge eating tendencies. AddictiveBehaviors, 5, 219–226.

Ilieva, J., Baron, S., & Healey, H. M. (2002). Online surveys in marketingresearch: Pros and cons. International Journal of Market Research, 44,3, 362–380.

Joiner, G. W., & Kashubeck, S. (1996). Acculturation, body image, self-esteem, and eating disorder symptomatology in adolescent MexicanAmerican women. Psychology of Women Quarterly, 20, 419–435.

Kashubeck-West, S., Mintz, L. B., & Saunders, K. (2001). Assessment ofeating disorders in women. Counseling Psychologist, 29, 662–694.

Knight, G., Gonzales, A., Saenz, D., German, M., Deardorff, J., Roosa, M.,& Updegraff, K. (2008). The Mexican American Cultural Values Scalefor Adolescents and Adults. Unpublished manuscript.

Lefever, S., Dal, M., & Matthiasdottir, A. (2007). Online data collection inacademic research: Advantages and disadvantages. British Journal ofEducational Technology, 38, 574–582.

McClelland, G. H., & Judd, C. M. (1993). Statistical difficulties of detect-ing interactions and moderator effects. Psychological Bulletin, 114,376–390.

Nguyen, A. M., & Benet-Martinez, V. (2007). Biculturalism unpacked:Components, measurement, individual differences, and outcomes. Socialand Personality Psychology, 1, 101–114.

Padilla, A. M. (1994). Bicultural development: A theoretical and empiricalexamination. In R. G. Malgady & O. Rodriguez (Eds.), Theoretical andconceptual issues in Hispanic mental health (pp. 20–51). Melbourne,FL: Robert E. Krieger.

Phinney, J. S. (1992). The Multigroup Ethnic Identity Measure: A new


scale for use with diverse groups. Journal of Adolescent Research, 7,156–176.

Phinney, J. S. (2003). Ethnic identity and acculturation. In K. M. Chun &P. B. Organista (Eds.), Acculturation: Advances in theory, measurement,and applied research (pp. 63–81). Washington, DC: American Psycho-logical Association.

Roberts, R., Phinney, J. S., Masses, L., Chen, Y., Roberts, C., & Romero,A. (1999). The structure of ethnic identity in young adolescents fromdiverse ethnocultural groups. Journal of Early Adolescence, 19, 301–322.

Romero, A. J., Martinez, D., & Carvajal, S. C. (2007). Bicultural stress andadolescent risk behaviors in a community sample of Latinos and non-Latino European Americans. Ethnicity & Health, 12, 443–463.

Shaw, H., Ramirez, L., Trost, A., Randall, P., & Stice, E. (2004). Bodyimage and eating disturbances across ethnic groups: More similaritiesthan differences. Psychology of Addictive Behavior, 18, 12–18.

Shin, R., Daly, B., & Vera, E. (2007). The relationships of peer norms,ethnic identity, and peer support to school engagement in urban youth.Professional School Counseling, 10, 379–388.

Shkodriani, G. M., & Gibbons, J. L. (1995). Individualism and collectivismamong university students in Mexico and the United States. Journal ofSocial Psychology, 135, 765–772.

Sommers, I., Fagan, J., & Baskin, D. (1993). Sociocultural influences onthe explanation of delinquency for Puerto Rican youths. Hispanic Jour-nal of Behavioral Sciences, 15, 36–62.

Stice, E. (1994). A review of the evidence for a sociocultural model ofbulimia nervosa and an exploration of the mechanisms of action. Clin-ical Psychology Review, 14, 633–661.

Stice, E. (2001). A prospective test of the dual pathway model of bulimicpathology: Mediating effects of dieting and negative affect. Journal ofAbnormal Psychology, 110, 124–135.

Stice, E. (2002). Risk and maintenance factors for eating pathology: Ameta-analytic review. Psychological Bulletin, 128, 825–848.

Stice, E., & Agras, W. S. (1999). Risk factors for the emergence ofchildhood eating disturbances: A five-year prospective study. Interna-tional Journal of Eating Disorders, 25, 375–387.

Stice, E., Mazotti, L., Weibel, D., & Agras, W. S. (2000). Dissonanceprevention program decreases thin-ideal internalization, body dissatis-faction, dieting, negative affect, and bulimic symptoms: A preliminaryexperiment. International Journal of Eating Disorders, 27, 206–217.

Stice, E., Presnell, K., & Spangler, D. (2002). Risk factors for binge eatingonset in adolescent girls: A 2-year prospective investigation. HealthPsychology, 21, 131–138.

Suarez, L. (1994). Pap smear and mammogram screening in Mexican-American women: The effects of acculturation. American Journal ofPublic Health, 742–746.

Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (5thed.). Boston: Allyn & Bacon.

Thelen, J. F., Farmer, J., Wonderlich, S., & Smith, M. (1991). A revisionof the Bulimia Test: The BULIT-R. Psychological Assessment, 3, 119–124.

Unger, J. B., Gallaher, P., Shakib, S., Ritt-Olson, A., Palmer, P. H., &Anderson Johnson, C. (2002). A new measure of acculturation foradolescents in a multicultural society. Journal of Early Adolescence, 22,225–251.

Updegraff, K. A., McHale, S. M., Whiteman, S. D., Thayer, S. M., &Delgado, M. Y. (2005). Adolescent sibling relationships in MexicanAmerican families: Exploring the role of familism. Journal of FamilyPsychology, 19, 512–522.

Valdez, A., Mikow, J. & Cepeda, A. (2006). The role of stress, familycoping, ethnic identity and mother-daughter relationships on substanceuse among gang affiliated Hispanic females. Journal of Social WorkAddictions, 6, 31–54.

Vandereycken, W. (1995). The families of patients with an eating disorder.In K. D. Brownell & C. G. Fairburn (Eds.), Eating disorders andobesity: A comprehensive handbook (pp. 219–223). New York: GuilfordPress.

Vasquez, M. J. T. (1994). Latinas. In L. Comas-Dıaz & B. Greene (Eds.),Women of color: Integrating ethnic and gender identities in psychother-apy (pp. 114–138). New York: Guilford Press.

Ward, C., & Kennedy, A. (1993). Where’s the “culture” in cross-culturaltransition? Comparative studies of sojourner adjustment. Journal ofCross-Cultural Psychology, 24, 221–249.

Warren, A. K., & Constantine, M. G. (2007). Social justice issues. In M. G.Constantine (Ed.), Clinical practice with people of color: A guide tobecoming culturally competent (pp. 231–242). New York: TeachersCollege Press.

Yip, T., Gee, G. C., & Takeuchi, D. T. (2008). Racial discrimination andpsychological distress: The impact of ethnic identity and age amongimmigrant and United States-born Asian adults. Developmental Psychol-ogy, 44, 787–800.

Received May 5, 2008Revision received April 19, 2009

Accepted April 26, 2009 �


Documents

Cultural strengths as moderators of the relationship between acculturation to the mainstream U.S. Society and eating- and body-related concerns among Mexican American women