Psychometric properties and validation of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) with a sample of Japanese adolescent girls
Introduction
Research in the areas of body image and disordered eating in Japan is relatively sparse, perhaps due in part to a traditional belief that eating disorders represent a Western phenomenon. However, available data suggest a six-fold increase in the rates of eating disorders in Japan from the 1970s to the 1990s (Pike, Yamamiya, & Konishi, 2011). Indeed, recent work indicates that body image and eating disturbances among Japanese females appear to be reaching levels comparable to those observed in the United States and other Western countries (Nakai, 2010, Nakai et al., 2003). Currently, 11.2% of high-school girls in Japan report clinical levels of eating pathology (Nishizawa et al., 2003), which is similar to the estimates (15%) in the United States (Austin et al., 2008).
Sociocultural etiological models, which emphasize the influence of cultural and interpersonal factors, may provide a useful framework for understanding the apparent increases in harmful eating and weight-related practices in Japan. The Tripartite Influence Model (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999) suggests that appearance-related pressures from three primary sociocultural factors—namely, peers, family, and the media—interactively affect the development of body image disturbances, which leads to pathological eating. In addition, the model proposes that the effects of the three sociocultural factors are mediated via two additional mechanisms: (1) appearance-ideal internalization (i.e., an individual accepts societal ideals of appearance as his/her own ideal) and (2) appearance comparison (i.e., an individual compares his/her appearance to that of someone else).
The model has received strong support using structural equation modeling among Western samples of American men and women (Keery et al., 2004, Shroff and Thompson, 2006, van den Berg et al., 2002), and preliminary support in Japanese women (Yamamiya, Shroff, & Thompson, 2008). Moreover, the individual pathways suggested by the model have been supported through multiple investigations utilizing a variety of samples and methodologies. As body dissatisfaction, engagement in weight change strategies, and disordered eating frequently emerge in adolescence, the impact of sociocultural influences postulated in the model during this critical stage of development may be of particular etiological importance (Hiraiwa, 2008, Levine and Smolak, 2004).
Adolescent girls are significantly affected by mass media that glorifies thin and attractive females. Young girls are often exposed to media messages and images that promote a thin appearance ideal via magazines, television, movies, and the internet (Cusumano and Thompson, 1997, Harper et al., 2008, Thompson and Smolak, 2001). Exposure to thin media images and perceived media pressure to attain a thin physique has been found to predict body concerns and eating disorder symptomatology among adolescent girls (Harrison, 2000, Paxton et al., 1999). In Japan, appearance ideals for girls center on “kawaii (cuteness),” which is associated with thinness and frailty—a physique that is deeply rooted in Japanese culture (Pike & Borovoy, 2004). In addition, “hattou-shin beauty,” which is characterized by a small head and a slender body with long legs, has gained prominence in Japan following the second World War and increased appearances of skinny fashion models or digitally modified female images with unusually long legs in the Japanese media (Kowner, 2004, Mukai et al., 1998, Swami et al., 2006). Moreover, today's Japanese media frequently features articles on weight-loss techniques, exercise, and plastic surgery to attain an idealized thin body (Pike et al., 2011), suggesting increasing media pressures for thinness in Japan. Indeed, recent analyses indicate that appearance-related media influences in Japan may now be comparable to those observed in the United States (Madanat, Lindsay, Hawks, & Ding, 2011). The perception of appearance-related media influence is significantly associated with thin-ideal internalization, which is, in turn, related to body dissatisfaction and restricted eating among young Japanese females (Yamamiya et al., 2008).
Peers also exert strong influence on eating behavior and body image during adolescence. Adolescent girls engage in frequent conversations about body weight/shape, physical attractiveness, and fears about becoming fat with peers (Levine & Smolak, 2004), which have been shown to be associated with body dissatisfaction and low body-esteem among high-school girls in Japan (Yamazaki, Takamori, & Omori, 2003). In addition, girls often receive critical, harsh, or teasing comments regarding their body and weight from peers (Tantleff-Dunn & Gokee, 2004), which predicts body image disturbance and restricted eating (Rieves & Cash, 1996). In one study, Japanese college females reported being criticized or teased about their appearance by peers during childhood and adolescence, which was found to be related to their current body dissatisfaction (Yamamiya et al., 2008). Interestingly, levels of body/weight concern, drive for thinness, use of extreme weight-loss behaviors, and restricted eating show strong similarities within friendship cliques (Paxton et al., 1999), suggesting the transmission and acceptance of potentially harmful appearance- and eating-related norms among peers (Krcmar, Giles, & Helme, 2008). As Japanese culture is highly collectivistic, Japanese adolescents may be even more influenced by perceived norms and peer pressures than their American counterparts (Omori, Yamawaki, & McKyer, 2015).
Finally, families influence girls’ body image and eating behaviors through a number of means, including appearance-related feedback and commentary (McCabe, Ricciardelli, & Ridge, 2003), teasing and criticism (Cash, 1995, Keery et al., 2005, Levine and Smolak, 2004), modeling of weight- and appearance-related attitudes and behaviors (Keery et al., 2006, Vincent and McCabe, 2000), and direct pressures to diet or lose weight (Wertheim et al., 2002, Wertheim et al., 1999). Yamazaki and Omori (2016) found that Japanese girls’ desire to be thin was significantly associated with their mothers’ thin-ideal internalization. This was especially true when girls reported that their mothers engaged in weight-loss behavior and endorsed positive attitudes toward a thin physique not only for themselves, but also for the girls. Furthermore, Japanese college females who report being criticized or teased about their appearance by family members during childhood and adolescence also report high levels of thin-ideal internalization, appearance comparison, body dissatisfaction, and restricted eating (Yamamiya et al., 2008).
Overall, research clearly suggests that sociocultural and interpersonal influences have a significant impact on Japanese girls’ body image and eating behaviors. However, it is apparent that further work is needed to examine the interrelationships among sociocultural influences, body image, and restricted eating among adolescent girls in Japan. Moreover, the translation and validation of commonly used measures that assess the three influences would allow researchers to explore sociocultural risk factors for eating and body image disturbances within Japanese samples.
The Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) was originally developed to assess sociocultural factors related to the development of body image disturbance and disordered eating (Heinberg, Thompson, & Stormer, 1995). The scale has undergone numerous revisions over the years (e.g., Cusumano and Thompson, 1997, Thompson et al., 1999) in an effort to adapt the scale to the current understanding of sociocultural influences. The SATAQ-3 (Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004) focused exclusively on media effects and assessed the extent to which respondents: (1) obtain information about weight-loss and beauty from the media; (2) feel pressure from the media to lose weight; (3) think that thin and beautiful media images are ideal; and (4) think that athletes in the media represent a physical ideal. The scale has been validated in multiple cross-cultural samples, including the United States (Thompson et al., 2004), France (Rousseau, Valls, & Chabrol, 2010), Brazil (Amarel, Conti, Ferreira, & Meireles, 2015), Spain (Llorente, Warren, de Eulate, & Gleaves, 2013), and Japan (Yamamiya et al., 2008, Yamamiya and Shimai, 2012).
Although the validity and utility of the SATAQ-3 have been supported cross-culturally, its limitations have also been suggested (Schaefer et al., 2014). Firstly, the scale solely assesses the effects of the popular media, while past studies have indicated comparable adverse effects on body image and eating behavior from family and peers. Secondly, the items do not explicitly assess thin or muscular ideal internalization. In response to these limitations, Schaefer et al. (2014) have revised the scale to create the SATAQ-4. The SATAQ-4 has a five-factor structure with the following subscales: (1) Internalization: Thin/Low Body Fat subscale, which assesses to what extent a respondent endorses a thin body with low body fat as an ideal; (2) Internalization: Muscular/Athletic subscale, which assesses to what extent a respondent endorses an athletic body with muscles as an ideal; (3) Pressures: Family subscale, which assesses to what extent a respondent feels pressure from family to obtain a certain appearance; (4) Pressures: Peers subscale, which assesses to what extent a respondent feels pressure from peers to obtain a certain appearance; and (5) Pressures: Media subscale, which assesses to what extent a respondent feels pressure from the media to obtain a certain appearance.
The SATAQ-4 has already been validated cross-culturally by using samples from the United States, Italy, England, and Australia (Schaefer et al., 2014). However, the psychometric properties of the measure have not yet been examined in Japanese samples. Therefore, the present study was conducted to: (1) examine the factor structure of the SATAQ-4 and (2) establish internal consistency and concurrent validity of the SATAQ-4 in Japanese adolescent females.
Section snippets
Study 1: Scale Development and Identification of Scale Structure
The purpose of Study 1 was to translate SATAQ-4 into Japanese for use with Japanese respondents and to examine its factor structure in a Japanese adolescent female sample using exploratory factor analysis (EFA).
Exploratory Factor Analysis
Based on Barlett's test of sphericity (χ2 = 8709.93, df = 231, p < .001) and the Kaiser–Meyer–Olkin value (.89), the SATAQ-4 items were deemed appropriate for factor analysis. As expected based on previous validation samples, the eigenvalues, scree plot, and parallel analysis suggested a five-factor solution in the current Japanese adolescent female sample (observed eigenvalues in descending order: 7.97, 3.22, 2.30, 1.51, 1.45; parallel analysis eigenvalues in descending order: 1.37, 1.30, 1.26,
Study 2: Confirmation of Factor Structure and Examination of Reliability and Convergent Validity of the SATAQ-4
The purpose of Study 2 was to further evaluate the five-factor structure of the SATAQ-4 using confirmatory factor analysis (CFA) and to evaluate the reliability and convergent validity of the scale in an independent sample of Japanese adolescent females.
Confirmatory Factor Analysis
The CFA examining the five-factor structure with all 22 original items indicated good model fit (CFI = .95, RMSEA = .07, SRMR = .05). Consistent with results from the EFA, modification indices from the CFA suggested significant model strain associated with Items 1 and 9. A second CFA deleting these two items indicated slightly improved fit (CFI = .96, RMSEA = .07, SRMR = .04). Associated modification indices did not indicate additional areas for model improvement.
Internal Consistency and Intercorrelations between Subscales
Internal consistency and intercorrelations
Discussion
It was once thought that eating disorders were specific to Western cultures, but now most mental health professionals acknowledge and accept that these disorders are prevalent in various cultures, countries, socioeconomic classes, and races (Becker, 2004, Becker et al., 2009, Soh et al., 2006). The best available data in Japan suggest that the prevalence of eating disorders has steadily increased in the last thirty years (MHLW, 2011, Pike et al., 2011) with estimates of eating disorders among
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