Teaching adolescents about changing bodies: Randomized controlled trial of an Internet puberty education and body dissatisfaction prevention program
Introduction
The middle school years represent a unique phase when adolescents are faced with many transitions, including emerging self-reflection, drive for autonomy, puberty, and changes in both social networks and social expectations (Patton & Viner, 2007). Longitudinal research supports the contention that the transition to middle school comes with changes in several domains of self-concept, including a precipitous drop in self-perceived physical attractiveness and concomitant body image concerns among girls, and decreased self-perceived competence in social acceptance for both boys and girls (Cole et al., 2001).
The emerging evidence indicates that body dissatisfaction predicts harmful weight change practices, eating disorders, depression, and substance abuse (Cash and Deagle, 1997, Marcotte et al., 2002). Further, early pubertal status influences body dissatisfaction and increases vulnerability to eating disorders and depression (Biro et al., 2006, Davison and McCabe, 2006), with a particular gender disadvantage for early maturing girls (Hayward & Sanborn, 2002).
As recently reviewed by Levine and Smolak (2009), prevention programs have been developed to address body dissatisfaction and disordered eating in children and adolescents (Richardson et al., 2009, Stice et al., 2007). Taylor and Jones (2007) provide a compelling argument for the use of Internet-based prevention programs but currently they are few in number (Paxton & Franko, 2010). One well-researched example is Student Bodies, an Internet-based program developed to decrease weight and shape concerns (Taylor et al., 2006). Abascal, Brown, Winzelberg, Dev, and Taylor (2004) evaluated Student Bodies with 13–16-year-old girls as part of the physical education curriculum and reported that all groups improved on measures of eating disordered attitudes and behaviors. Heinicke, Paxton, McLean, and Wertheim (2007) evaluated an Internet-based intervention with seventy-three adolescent girls and found clinically significant improvements in body dissatisfaction, disordered eating, and depression at post-intervention and follow-up.
With the increasing use of technology by children and in school settings, Internet-based programs offer distinct advantages over leader-led programs, including greater capacity for dissemination, less training time, and the ability to target information to relevant factors such as gender. Thus, this randomized controlled study tested the efficacy of an Internet-based universal prevention program, Trouble on the Tightrope: In Search of Skateboard Sam (“Skateboard Sam”), designed to educate about puberty, body image, and self-esteem in a school-based sample. The primary hypotheses were that exposure to Skateboard Sam, relative to the control condition, would improve participants’ (1) puberty knowledge; (2) body image; and (3) self-esteem.
Section snippets
Design
This randomized controlled trial was conducted at five middle schools in the northeastern US between January and June 2006 and was approved by the Inflexxion, Inc. institutional review board.
Participants
Depending on the school district's policy, the study took place within the school day in health classes (n = 4), or after school (n = 1). Teachers placed information sheets and a consent form into students’ folders to take home. Of the 256 students given the materials, 190 (74.2%) students returned signed
Results
The sample consisted of 82 boys (43%) and 108 girls (57%). The mean age of the sample 11.7 years (SD = .06) and 81% were Caucasian. T-tests conducted to assess for baseline differences between the intervention and control group indicated no differences. Similarly, no differences were found between participants who completed the study during school (n = 163) and those who completed the study in an after school setting (n = 27). Complete data were available for 178 out of 190 enrolled participants
Discussion
Although the primary hypotheses were not supported, pubertal status was found to moderate the effects on weight-related body esteem and several domains of self-esteem. It may be that the focus on pubertal education was particularly relevant for students in the midst of body changes. Given that more girls than boys were in puberty, it is likely the moderator effects were accounted for by the girls in the sample. This is consistent with the moderating effects of gender on self-esteem. Girls in
Acknowledgments
The study was funded through the National Institutes of Health Small Business Innovative Research Program, Grant # 2R44DK061269-02; National Institute of Diabetes & Digestive & Kidney Diseases; Christine Densmore, NIDDK Project Officer; Tara Cousineau, PhD, Principal Investigator. We would like to thank the participants and teachers at the schools and to acknowledge the following people: Leslie Caulfield, Writer/Producer, 360 Kid Inc., Watertown, MA; Inflexxion Interactive Design Department:
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This work was conducted when T. Cousineau was a research scientist at Inflexxion, Inc.