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Alison E. Field, ScD; Carlos A. Camargo, Jr, MD, DrPH; C. Barr Taylor, MD; Catherine S. Berkey, ScD, MA; Graham A. Colditz, MD, DrPH

Arch Pediatr Adolesc Med. 1999;153:1184-1189.

Objective  To assess prospectively the relation of peer and media influences on the risk of development of purging behaviors.

Design  Prospective cohort study.

Setting  One year follow-up of 6982 girls aged 9 to 14 years in 1996 who completed questionnaires in 1996 and 1997 and reported in 1996 that they did not use vomiting or laxatives to control weight.

Main Outcome Measure  Self-report of using vomiting or laxatives at least monthly to control weight.

Results  During 1 year of follow-up, 74 girls began using vomiting or laxatives at least monthly to control weight. Tanner stage of pubic hair development was predictive of beginning to purge (odds ratio [OR]=1.8; 95% confidence interval [CI], 1.3-2.4). Independent of age and Tanner stage of pubic hair development, importance of thinness to peers (OR=2.3; 95% CI, 1.8-3.0) and trying to look like females on television, in movies, or in magazines (OR=1.9; 95% CI, 1.6-2.3) were predictive of beginning to purge at least monthly. Regardless of the covariates included in the logistic regression model, the risk of beginning to purge increased approximately 30% to 40% per 1-category increase in frequency of trying to look like females on television, in movies, or in magazines.

Conclusions  Both peers and popular culture, independent of each other, exert influence on girls' weight control beliefs and behaviors. Therefore, to make eating disorder prevention programs more effective, efforts should be made to persuade the television, movie, and magazine industries to employ more models and actresses whose weight could be described as healthy, not underweight.

From the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (Mss Field and Berkey and Drs Camargo and Colditz); the Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (Dr Camargo); the Department of Psychiatry and Behavioral Science, Stanford Medical School, Stanford, Calif (Dr Taylor); and the Departments of Health Policy and Management (Ms Berkey) and Epidemiology (Dr Colditz), Harvard School of Public Health, Boston.

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