2 - (SYM 118) a Qualitative Examination of Disordered Eating Among Adolescents in Rural Appalachia

Eating disorders (EDs) are serious psychiatric illnesses that disproportionately impact rural youth. Nearly 25% of high school girls in rural Appalachia screen as high-risk for an ED, compared to a nationwide rate of 15%. However, it is unknown why rural youth experience EDs at such high rates. Additionally, despite elevated prevalence, ED treatment options in rural communities are scarce. To address gaps in the understanding of EDs among rural youth, we are currently conducting a study designed to (1) understand rural adolescents’ perceptions of how the sociocultural and built environment in their communities has influenced the development and perpetuation of their ED symptoms, and (2) compare experiences of rural and urban adolescents to identify factors unique to rural adolescents that can be targeted in prevention programs. Data collection is ongoing; we aim to recruit 72 adolescents (n = 36 from rural Appalachia, n = 36 from urban/suburban Virginia, ages 11-17, anticipated 50% girls, 50% middle school) with current ED symptoms. Adolescents who hold identities from underrepresented or historically marginalized groups are especially encouraged to participate. Participants will be assessed individually using the American Psychiatric Association Cultural Formulation Interview (CFI), which uses open-ended questions to examine adolescents’ understanding of their ED symptoms within the context of their cultural identities and environment. We also will probe for experiences of the following ED risk factors, given high prevalence rates among rural youth: (1) current/past food insecurity, (2) experiences of stigma (e.g., weight, race, gender, sexuality), and (3) substance misuse. The potential influence of intersecting identities will be considered. Data will be analyzed using reflexive thematic analysis. The research team (n = 4) will first independently review interview transcripts to generate preliminary codes that represent content across responses in each of the two participant groups (rural/urban). Preliminary codes will be grouped into overarching themes. The team will then meet to review overarching themes, address discrepancies, and finalize study themes. Analyses will be completed in advance of the ABCT 2023 meeting. Findings will inform efforts to culturally adapt an ED prevention program that addresses the specific needs of rural youth. Experiences using the CFI and qualitative methods to examine rural adolescents’ understanding of their ED will be discussed, and recommendations for future research will be provided.