Eating Expectancies among Trauma-Exposed Latinx College Students: The Role of Mindful Attention

Abstract

Objective:

Emergent research suggests that trauma-exposed Latinx college students are a particularly at-risk group for eating-related problems. For this reason, there is a need to further understand the cognitive processes that may underpin maladaptive eating among this vulnerable segment of the population.

Participants:

Participants included 304 trauma exposed Latinx college students (84.5% females; M_age = 22.8 years, SD = 5.79).

Methods:

The current study examined the role of mindful attention in relation to several distinct expectancies related to eating.

Results:

Results indicated that lower reported levels of mindful attention were associated with greater levels of expectancies of eating to help manage negative affect, expectancies that eating will alleviate boredom, and expectancies that eating will lead to feeling out of control.

Conclusions:

These findings suggest that it may be beneficial to assess for mindful attention among Latinx college students with a history of trauma exposure presenting with problematic eating behaviors.

The Latinx population in the United States (U.S.) has experienced a rapid growth in the past two decades, making this group the largest ethnic minority population in the country.¹ Further, Latinx college enrollment has tripled in the last two decades, and continues to rise.^1,2 Unfortunately, the Latinx population, especially youth and college-age persons, showcase higher rates of trauma exposure, posttraumatic stress symptoms, and conditional risk of posttraumatic stress disorder (PTSD) when compared to other racial/ethnic groups.³ Further, estimates suggest 31% of newcomer (persons who migrated to the U.S. within the last 3 years) Latinx youth and young adults report exposure to trauma and clinically significant posttraumatic stress symptoms, which is substantially higher compared to the rates of 21% in low-income youth^4,5 and 5% in the general youth population.⁶ Several factors have been explored for such elevated rates of trauma exposure and posttraumatic stress, including acculturation,⁷ poverty and financial strain,⁸ among others (e.g., exposure to severe political violence).⁹

Some emergent research suggests that trauma-exposed Latinx college students are a particularly at-risk group for health problems, including high blood pressure, elevated cholesterol, and diabetes, among other conditions.^10–12 This work sits in the larger context of research among non-Latinx Whites that has found posttraumatic stress is frequently comorbid with health problems.^13–16 Of various health problems, eating-related problems are among the most common among Latinx persons.^17–20 For instance, when compared to non-Latinx White youth, Latinx youth evince higher abdominal adiposity²¹ and are more likely to develop glucose dysregulation, a potential risk factor for obesity.²² Additionally, among Latinx young adults, studies have documented high rates of eating disorder symptoms (e.g., binge eating) compared to non-Latinx Whites and other ethnic/racial minority groups.^23–26 Moreover, Latinx persons showcase elevated rates of binge eating disorder,¹⁹ which has been found to be associated with greater body adiposity, waist circumference, and psychological distress among a racially and ethnically diverse sample (i.e., 29.1% of the sample were Latinx individuals).²⁷ Several cultural explanations may exist for such elevated rates of maladaptive eating behaviors among Latinx individuals. For example, Latinx individuals experience significant health disparities as it relates to psychological distress,³ and therefore, may resort to maladaptive eating behaviors as a way of managing such distress.²⁸

In order to better understand maladaptive eating behaviors among trauma exposed Latinx, there is clinical utility in understanding the cognitive processes that may underpin such behaviors. Eating expectancies have been shown to be a key cognitive process involved in maladaptive eating.²⁹ Eating expectancies represent the cognitive-based learned relations between behaviors and their consequences.³⁰ There are several distinct eating expectancies that vary within and between persons.³¹ These expectancies include eating to help manage negative affect, eating to alleviate boredom, and eating leading to a loss of control.³¹ Eating expectancies showcase significant relations with numerous aspects of eating behavior (e.g. emotional eating, binge eating),^32–34 and therefore, represent a clinically significant cognitive-based factor in models of health behavior change.^35–37

There has thus far been no work expressly focused on eating expectancies among the Latinx population, especially those with history of trauma exposure. Indirect work by Harrington and colleagues³⁸ found that the function of eating (i.e., latent variable consisting of expectancies of eating to help manage negative affect, expectancies of eating to alleviate boredom, and eating in response to trauma) was related to binge eating pathology among a diverse sample of college students. However, only 3.9% of this sample included Latinx individuals. Other work suggests that among young adults, expectancies for eating to help manage negative affect, expectancies of eating to alleviate boredom, and expectancies of eating to lead to feeling out of control are related to bulimic symptoms.³¹ Similarly, this sample was comprised of majority non-Latinx participants (less than 5%), highlighting the need to examine these relations among a more diverse sample.

To facilitate understanding of the nature of eating expectancies, there is a need to explicate the individual difference factors that may be related to, or protect against, maladaptive eating expectancies among trauma exposed Latinx college students. One such construct of potential relevance is mindfulness.^39–41 Although there are numerous types of mindfulness evident in the clinical and scientific literatures, one promising approach has been specifically focused on mindful attention. According to Brown and Ryan,⁴² mindful attention reflects “attention to, and awareness of, what is occurring in the present moment” (p. 824). This construct differs theoretically and empirically from other self-regulatory and self-awareness constructs, such as openness to experience, knowledge of self, and emotional intelligence.⁴² Extant work has found that lower levels of mindful attention are associated with maladaptive eating behaviors (e.g., overeating) among non-clinical college students.³⁹ To our knowledge, no work has focused on the role of mindful attention and eating behavior among Latinx young adults. However, other non-eating specific studies focused on Latinx populations have found that lower levels of mindful attention are related to a number of clinically relevant adverse psychiatric processes, including greater anxiety/depressive symptoms,^43–45 more severe PTSD symptoms,⁴⁶ and number of anxiety and depressive disorders.^44,45

It is possible that mindful attention may be an important individual difference factor for better understanding eating expectancies among trauma exposed Latinx college students. Past work suggests that mindfulness-based processes promote enhanced emotion regulation in stressful situations,^47,48 and trauma-exposed Latinx college students who can notice uncomfortable experiences nonjudgmentally and without automatically reacting to them might be less likely to eat to modulate subjective distress. Conversely, trauma-exposed Latinx college students with lower levels of mindful attention capacity may be unable to adaptively attend to their patterns of thoughts, emotions, and behaviors related to their experienced psychological distress.⁴⁰ Thus, these individuals may resort to ‘mindless’ coping strategies to attenuate such discomfort. For example, they may resort to eating as a means to attenuate their distress (e.g., anxiety, boredom).^49,50 In doing so, they may experience a loss of control while eating in response to their distress.⁵¹ As a result of a continued pattern of maladaptive behavioral regulation,⁴² such Latinx individuals may be at heightened risk for the development of expectancies related to the function and control of eating, including expectancies of eating to help manage their negative affect, alleviate boredom, and to lead to a loss of control once they start eating.

The present study sought to explore the association between mindful attention and expectancies of eating to manage negative affect, expectancies of eating to alleviate boredom, and expectancies of eating to lead to a loss of control among trauma exposed Latinx college students. We hypothesized that lower levels of mindful attention would be associated with greater expectancies that eating would manage negative affect, alleviate boredom, and lead to a loss of control. Additionally, we hypothesized that these relationships would be observed over and above variance accounted for by sex,⁵² body mass index (BMI),⁵³ and posttraumatic stress symptom severity.^54,55

Materials and Methods

Participants

Participants were 304 Latinx students enrolled in a large, southwestern university. The sample consisted of males and females (84.5% females) ages 18 to 53, with a mean age of 22.8 (SD = 5.79) who had reported at least one incident of trauma exposure assessed utilizing the International Neuropsychiatric Interview (MINI), version 7.0.2⁵⁶ for DSM-5 (American Psychiatric). ⁵⁷ Participants endorsed a mean of 2.1 (SD = 1.52) traumatic life events. The following traumatic events were identified by participants as most distressing: natural disaster (33.2%), sexual assault by someone you know (12.6%), serious accident (7.8%), sexual assault by a stranger (7.7%), non-sexual assault by a stranger (6.3%), life-threatening illness (5.3%), sexual contact under 18 with someone 5 years older or more (3.9%), non-sexual assault by someone you know (2.8%), military combat or war zone (1.6%), imprisonment (1.0%), torture (0.3%), and other (16.4%).¹

Measures

Demographic Questionnaire.

The Demographics Questionnaire was utilized to obtain information regarding participant’s age, sex (assigned at birth), and race/ethnicity.

Body Mass Index (BMI).

BMI for each individual was calculated based on subjective measures of weight and height ([weight (pounds)]/[height (inches)2 × 703]).⁵⁸

Posttraumatic Diagnostic Scale (PDS).⁵⁹

DSM-IV-TR PTSD Criterion A⁶⁰ trauma exposure and symptom severity were measured with the 49-item self-report PDS. In Part 1, participants are first asked if they have ever experienced or witnessed any of 13 traumatic events (e.g., serious accident, fire, or explosion). In Part 2, participants are asked to describe the most distressing of the traumatic events identified in Part 1. An index of posttraumatic stress symptom severity is presented in Part 3 in which respondents are asked to rate the degree of symptoms associated with the most distressing traumatic event experienced. Extant literature shows the PDS to be a reliable and valid measure of posttraumatic stress symptom severity,⁶¹ including work among Latinx samples.^46,62 Responses from Part 2 were presented in the current study to describe the most distressing traumatic event the participant endorsed ever witnessing or experiencing. The posttraumatic stress symptom severity was utilized as a study covariate (Cronbach’s α = .97).

Mindful Attention Awareness Scale (MAAS).⁴²

The MAAS is a 15-item measure of respondents’ levels of awareness of present events and experiences (e.g., “I find myself doing things without paying attention”). Items are rated on a 6-point Likert-type scale ranging from 1 (almost always) to 6 (almost never). Lower scores indicate lower levels of mindful attention. The MAAS has shown good psychometric properties and good test-retest reliability,⁴² and has been employed successfully among Latinx samples.⁴⁴ The MAAS demonstrated excellent internal consistency (Cronbach’s α = .95) in the present study.

Eating Expectancy Inventory (EE1).³¹

The EEI was used as a measure of eating expectancies. The EEI is a 34-item self-report measure containing 5 subscales: eating helps manage negative affect (18 items); eating is pleasurable and useful as a reward (6 items); eating leads to feeling out of control (4 items); eating enhances cognitive competence (2 items); and eating alleviates boredom (4 items). Respondents rate items on a 7-point Likert-type scale, reporting the degree to which they 1 (completely disagree) to 7 (completely agree) with each item. The EEI is a valid and reliable measure of eating expectancies.³¹ In the present study, eating helps to manage negative affect (Cronbach’s α = .95), eating alleviates boredom (Cronbach’s α = .65), and eating leads to feeling out of control (Cronbach’s α = .68) were used as criterion variables.

Procedure

Participants were recruited from a large southwestern university via flyers and postings on the university extra credit webpage. Participants were compensated by receiving course credit for participating in the study. All participants provided informed consent before participating in the study. Inclusionary criteria included being between the ages of 18 and 64, a part or full time undergraduate or post-baccalaureate enrollment at the university where the study took place, exposure to at least one lifetime traumatic event measured with the MINI version 7.0.2⁵⁶ for DSM-5,⁵⁷ and proficiency in English (to ensure comprehension of study questions). As this sample was selected from a larger study with a primary interest in adult populations, older adults (i.e., individuals ≥ 65) were not includes as part of the study sample. This study received institutional review board approval.

Data analysis

Sample descriptive statistics and zero-order correlations among study variables were examined. To evaluate the incremental predictive value of mindful attention, three separate two-step hierarchical regressions were conducted for each of the criterion variables; (1) expectancies of eating to help manage negative affect, (2) expectancies of eating to alleviate boredom, and (3) expectancies of eating to lead to feeling out of control. Step 1 included covariates of sex (0 = male, 1 = female), BMI, and posttraumatic stress symptom severity; in Step 2, mindful attention was added. We used the F statistic to evaluate model fit. Change in R² was utilized to show the increase in variance that was accounted for by adding mindful attention to Step 2. We also used the squared semi-partial correlations (sr²) as an indicator of effect size.

Results

Missing Data and Descriptive Statistics

Data were first checked for quality assurance by removing cases that evidenced careless responding (n = 6). Thus, we had a sample of 304 Latinx participants who completed the survey. Out of the 304 respondents, data were missing for BMI for 16 participants. We utilized Little’s Missing Completely at Random (MCAR) test to evaluate whether the data were missing at random. The test was non-significant, suggesting that the data were missing at random. Subsequently, missing data were imputed using the expectation-maximization algorithm in SPSS 25.0. Analyses were conducted with the imputed dataset and the non-imputed raw dataset. Results from the dataset with imputed missing data were identical in terms of significant and non-significant findings compared to results from the raw, non-imputed, dataset. Thus, results from the expectation-maximization dataset are reported. Means and zero-order correlations are presented in Table 1. Mindful attention was negatively correlated with expectancies of eating to help manage negative affect (r = −.28), expectancies of eating to alleviate boredom (r = −.16), and expectancies of eating to lead to feeling out of control (r = −.30).

Table 1.

Descriptive Statistics and Bivariate Correlations between Study Variables (N = 304)

Variable	Observed Range	Mean/n (SD/%)	1	2	3	4	5	6	7
1. Sexa		257 (84.5%)	-
2. BMIa	16.14 – 58.57	26.29 (6.23)	−.08	-
3. Posttraumatic Stress Symptom Severitya	0 – 51	10.63 (11.79)	.07	.06	-
4. Mindful Attentionb	15 – 90	57.50 (18.54)	−.05	−.01	−.32***	-
5. Eating Expectancies-Negative Affectc	18 – 125	53.89 (24.30)	.04	.12	.30***	−.28***	-
6. Eating Expectancies-Boredomc	4 – 28	16.11 (5.21)	.08	.12*	.08	−.16**	.46***	-
7. Eating Expectancies-Controlc	4 – 28	11.77 (5.37)	.01	.12*	.29***	−.30***	.55***	.20**	-

Note.

^***p < .001

^**p < .01

^*p < .05.

^aCovariate

^bPredictor

^cCriterion; Sex: % listed as females (Coded: 0 = male and 1 = female); BMI = Body Mass Index; Posttraumatic Stress Symptom Severity = Posttraumatic Diagnostic Scale-Total Severity Score⁵⁹; Mindful Attention = Mindful Attention and Awareness Scale⁴²; Eating Expectancies-Negative Affect = Eating Expectancy Inventory-Eating Helps Manage Negative Affect subscale³¹; Eating Expectancies-Boredom = Eating Expectancy Inventory-Eating Alleviates Boredom subscale³¹; Eating Expectancies-Control = Eating Expectancy Inventory-Eating Leads to Feeling out of Control subscale.31

Regression Analyses

In the model with expectancies of eating to help manage negative affect, step 1 with covariates only was statistically significant (R² = .10, p < .001). Examining the individual predictors indicated that posttraumatic stress symptom severity was a significant predictor of expectancies of eating to help manage negative affect (b = 0.61, SE = 0.11, p < .001, sr² = .09). In step 2, mindful attention was a significant predictor (b = −0.27, SE = 0.07, p < .001, sr² = .04; see Table 2).

Table 2.

Hierarchical Regression Results

		Eating Expectancies: Negative Affect
Model		b	SE	β	t	p	CI (l)	CI (u)	sr 2
1	Sex	1.71	3.70	0.03	0.46	.644	−5.56	8.98	.00
	BMI	0.35	0.22	0.09	1.65	.100	−0.07	0.78	.01
	Posttraumatic Stress Symptom Severity	0.61	0.11	0.30	5.41	< .001	0.39	0.84	.09
2	Sex	1.35	3.63	0.02	0.37	.710	−5.79	8.49	.00
	BMI	0.37	0.21	0.09	1.73	.085	−0.05	0.78	.01
	Posttraumatic Stress Symptom Severity	0.48	0.12	0.23	4.08	< .001	0.25	0.71	.05
	Mindful Attention	−0.27	0.07	−0.20	−3.57	< .001	−0.41	−0.12	.04
		Eating Expectancies: Boredom
Model		b	SE	β	t	p	CI (l)	CI (u)	sr 2
1	Sex	1.25	0.82	0.09	1.52	.130	−0.37	2.87	.01
	BMI	0.12	0.05	0.13	2.21	.028	0.01	0.20	.02
	Posttraumatic Stress Symptom Severity	0.03	0.03	0.06	1.11	.269	−0.02	0.08	.00
2	Sex	1.19	0.82	0.08	1.46	.145	−0.41	2.80	.01
	BMI	0.11	0.05	0.13	2.26	.024	0.01	0.20	.02
	Posttraumatic Stress Symptom Severity	0.01	0.03	0.02	0.25	.806	−0.05	0.06	.00
	Mindful Attention	−0.04	0.02	−0.15	−2.54	.012	−0.08	−0.01	.02
		Eating Expectancies: Control
Model		b	SE	β	t	p	CI (l)	CI (u)	sr 2
1	Sex	−0.03	0.82	−0.01	−0.04	.971	−1.64	1.58	.00
	BMI	0.08	0.05	0.10	1.77	.077	−0.01	0.18	.01
	Posttraumatic Stress Symptom Severity	0.13	0.03	0.29	5.22	<.001	0.08	0.18	.08
2	Sex	−0.12	0.80	−0.01	−0.15	.881	−1.69	1.45	.00
	BMI	0.09	0.05	0.10	1.87	.062	−0.01	0.18	.01
	Posttraumatic Stress Symptom Severity	0.10	0.03	0.21	3.78	<.001	0.05	0.15	.04
	Mindful Attention	−0.07	0.02	−0.23	−4.02	<.001	−0.01	−0.03	.05

N for analyses is 304 cases. Sex coded: 0 = male and 1 = female; BMI = Body Mass Index; Posttraumatic Stress Symptom Severity = Posttraumatic Diagnostic Scale-Total Severity Score⁵⁹; Mindful Attention = Mindful Attention and Awareness Scale⁴²; Eating Expectancies-Negative Affect = Eating Expectancy Inventory-Eating Helps Manage Negative Affect subscale³¹; Eating Expectancies-Boredom = Eating Expectancy Inventory-Eating Alleviates Boredom subscale³¹; Eating Expectancies-Control = Eating Expectancy Inventory-Eating Leads to Feeling out of Control subscale.³¹

In terms of expectancies of eating to alleviate boredom, step 1 of the model was statistically significant (R² = .03, p = .039); BMI was a significant predictor (b = 0.12, SE = 0.05, p = .028, sr² = .02). In step 2, mindful attention was a significant predictor of expectancies of eating to alleviate boredom (b = −0.04, SE = 0.02, p = .012, sr² = .02; see Table 2).

When examining expectancies of eating leading to a loss of control, step 1 was statistically significant (R² = .09, p < .001). Posttraumatic stress symptom severity was a significant individual predictor of expectancies of eating leading to a loss of control (b = 0.13, SE = 0.03, p < .001, sr² = .08). Mindful attention was added to the model in step 2 and it was a significant predictor (b = −0.07, SE = 0.02, p < .001, sr² = .05; see Table 2).

Discussion

The current study aimed to examine the association between mindful attention and eating expectancies among trauma exposed Latinx college students. Findings from this investigation demonstrated that lower levels of mindful of attention were associated with higher levels of expectancies of eating to manage negative affect, alleviate boredom, and loss of control. These findings were found after accounting for the theoretically- and clinically-relevant covariates of sex,⁵² BMI,⁵³ and posttraumatic stress symptom severity.^54,55 Such results are in line with past research on non-Latinx populations,³⁹ and extends this work to a sample of a trauma-exposed Latinx college students.

Despite the statistically significant incremental nature of the observed effects, the magnitude of the effect sizes for each of the three models were small. Thus, while mindful attention was related to each of the studied eating expectancies, the overall explanatory value were relatively modest for the studied criterion variables. These small effects for mindful attention may be expected in this sample given that these persons were not formally trained in mindful attention skill development. Clinically, it may be beneficial to assess for mindful attention within current screening protocols for Latinx college students with a history of trauma exposure presenting with problematic eating behaviors. Such an approach may allow for more appropriate treatment planning and referrals. In order to further test the validity and potential clinical implications of mindful attention on eating behaviors, future research is needed that permits training (versus no training) in mindful attention and examining the impact of such training on trauma exposed Latinx college students in terms of eating behavior and expectancies about eating. Indeed, extant work among non-Latinx populations has shown that improvements in mindful attention can reduce poor eating habits (e.g., overeating).^{39,40,65–67} Moreover, non-eating related interventions that incorporated mindful attention tactics among Latinx populations have shown promising results in improving clinical outcomes.^68,69 For example, one study reported that a mindfulness-based intervention was effective at increasing mindful attention and reducing levels of stress among Latinx youth.⁷⁰

Although not a primary focus of the investigation, it is noteworthy that posttraumatic stress symptom severity was a significant individual predictor of expectancies of eating to help manage negative affect and eating leading to a loss of control. Moreover, the size of the observed effects for posttraumatic stress symptom severity (before accounting for mindful attention) were moderate at 8–9% of variance. These results extend past work by demonstrating that the severity of posttraumatic stress among trauma exposed Latinx college students is significantly related to some maladaptive eating expectancies. The current study is in line with empirical studies that have highlighted childhood maltreatment and traumatic events as risk factors for maladaptive eating behaviors⁷¹ and obesity.^72–74 Future research is needed to build integrative models for trauma exposed Latinx college students and other segments of the developmental spectrum to better understand the role of trauma in terms of eating beliefs and behavior.

The present investigation has several limitations worth mentioning. First, the data were cross-sectional, limiting our ability to examine temporal sequencing or determine causal relations. Future research may benefit from examining the proposed relations between study variables through longitudinal modeling to clarify the direction of the observed effects. Additionally, the sample was comprised of majority female college students seeking extra credit for their participation. The use of college students who are predominately female may limit the generalizability of our results. Future prospective studies my benefit from including a greater proportion of Latinx males to ensure generalizability of results. Similarly, only Latinx individuals with English proficiency were included in the sample, which may limit the generalizability of our findings to more acculturated Latinx individuals. Future studies may benefit from extending the present investigation to a sample of Spanish-monolingual Latinx individuals. Moreover, key variables were assessed via self-report measures; thus, the observed relations may be partially accounted for by shared method variance. Future work would benefit from examining such variables with a multi-method assessment approach. Next, the definitions of trauma and posttraumatic stress symptoms used in the current study were based on DSM-IV criteria utilizing the validated PDS.⁶¹ Future studies should extend this work according to DSM-5 criteria utilizing the newly validated Posttraumatic Stress Disorder Symptom Scale Inventory for DSM-5 (PSSI-5).⁷⁵

Despite the study limitations, to our knowledge, this is the first study to examine whether mindful attention is related to eating expectancies among trauma exposed Latinx college students. As past work has shown that mindfulness skills development is related to improved eating and other clinical outcomes,⁷⁰ the current findings suggest that there may be merit to continuing to explore mindful attention as a psychological construct that could serve an important explanatory role for high-risk Latinx subpopulations. Future work may benefit from expanding on the proposed models to include measures of maladaptive eating (e.g., binge eating, emotional eating) and mental health symptoms (e.g., anxiety, depression). Moreover, future work may benefit from examining other facets of mindfulness (i.e., observing, describing, nonreacting, non-judging; Baer et al., 2006) with eating expectancies among this subset of the population.

Data availability statement:

The data that support the findings of this study are available from the corresponding author, MJZ, upon reasonable request.