The impact of familial influence and Filipino cultural values in Filipina body image and disordered eating symptoms
Table of Contents Page I. STATEMENT OF THE PROBLEM 1 Purpose of the Study 2 Significance of the Study 3 II. LITERATURE REVIEW 4 Filipino Americans 4 Asian Americans 4 Filipino History 6 Population of Filipino and Filipino Americans in the United States 8 Filipino Culture and Values 10 Spectrum of Disordered Eating 13 Research on Eating Disorders 15 Disordered Eating Symptoms 17 Body Image in Relation to Other Disordered Eating Symptoms 19 Body Image and Disordered Eating Symptoms in Filipino Americans 20 Body Image in Asians and Asian Americans 20 Disordered Eating Symptoms in Asian Americans 24 Body Image in Filipino Women 24 Disordered Eating Symptoms in Filipino Americans 25 Sociocultural Influence on Body Image and Disordered Eating Symptoms 27 Theoretical Framework 27 Family Influence 28 v
Page Summary of the Literature 34 Research Objectives and Questions 36 III. METHODS 37 Research Design 37 Participants 37 Procedure 38 Measures 40 Multidimensional Body-Self Relations Questionnaire - Appearance Scales (MBSRQ-AS) 40 Eating Attitudes Test (EAT-26) 42 Asian American Values Scale - Multidimensional (AAVS-M) 44 Loss of Face Scale (LOF) 45 Parent Involvement Scale (PIS) 45 Demographic Questionnaire 46 Short Answer Questions 46 Data Analysis 46 Hypotheses 47 Hypothesis 1 47 Hypothesis 2 48 Hypothesis 3 49 Hypothesis 4 49 vi
Page IV. RESULTS 51 Sample Population 51 Reliability 57 Multidimensional Body-Self Relations Questionnaire - Appearance Scales (MBSRQ-AS) 57 Eating Attitudes Test (EAT-26) 57 Asian American Values Scale - Multidimensional (AAVS-M) 58 Loss of Face Scale (LOF) 58 Parent Involvement Scale (PIS) 58 Preliminary Analysis 59 Prevalence of Body Image Dissatisfaction and Disordered Eating 60 Relationship Between Body Image Dissatisfaction and Disordered Eating 63 Appearance Evaluation 63 Appearance Orientation 63 Body Area Satisfaction 64 Overweight Preoccupation 64 Family Influence on Body Image 65 Moderating Effects of Loss of Face on the Relationship Between Parent Involvement and Body Image 66 Appearance Evaluation 67 Body Area Satisfaction 67 vii
Page Appearance Orientation and Overweight Preoccupation 68 Moderating Effects of Asian American Values Scale - Multidimensional (AAVS-M) on the Relationship Between Parent Involvement and Body Image Dissatisfaction... 69 Emotional Self-Control and Appearance Evaluation 70 Emotional Self-Control and Appearance Orientation 70 Humility and Appearance Orientation 72 Family Influence on Eating Attitudes and Behaviors 74 Moderating Effect of Loss of Face on the Relationship Between Parent Involvement and Disordered Eating 74 Moderating Effects of Asian American Values Scale - Multidimensional (AAVS-M) on the Relationship Between Parent Involvement and Disordered Eating 75 Collectivism and Bulimia and Food Preoccupation 75 Humility and Bulimia and Food Preoccupation 77 Qualitative Findings from Optional Short-Answer Questions 78 V. DISCUSSION 82 Disordered Eating Attitudes and Behaviors and Body Image 82 Family Influence on Body Image and Disorder Eating Attitudes and behaviors 86 Other Sociocultural Influence on Body Image and Disordered Eating Attitudes and Behaviors 89 Loss of Face 90 Asian American Cultural Values 92 Limitations 97 viii
Page Clinical Implications 98 Conclusion 100 REFERENCES 101 Appendix A: Flyer 109 Appendix B: Permission to Recruit at Church or Group Meetings 111 Appendix C: Permission to Post Flyers 113 Appendix D: Webpage Opening 115 Appendix E: Webpage Ending Raffle Entry Information 119 Appendix F: Phone Message 121 Appendix G: Phone Call Assessment and E-mail Response 123 Appendix H: Mail Survey Packet Directions and Informed Consent 126 Appendix I: Signed Informed Consent (For In-Person Completion of Questionnaire)... 129 Appendix J: Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ-AS) ® 132 Appendix K: Eating Attitudes Test (EAT-26)® 136 Appendix L: Asian American Values Scale-Multidimensional (AAVS-M) 139 Appendix M: Loss of Face Scale (LOF) 143 Appendix N: Parent Involvement Scale (PIS) 146 Appendix O: Demographic Questionnaire 148 Appendix P: Short Answer Questionnaire 153 IX
List of Tables Page Demographic Variables 52 Alpha Coefficients for Measures 59 Correlations Between Demographic Variables and Dependent Variables of the Study 61 Means and Standard Deviations of Measures 62 Linear Regression Results for PIS and MBSRQ Appearance Evaluation 66 Linear Regression Results for PIS and MBSRQ Body Area Satisfaction Scale 66 Stepwise Multiple Regression Results for the Moderating Effect of Loss of Face on Parent Involvement and Appearance Evaluation 68 Stepwise Multiple Regression Results for the Moderating Effect of Loss of Face on Parent Involvement and Body Area Satisfaction Scale 69 Stepwise Multiple Regression Results for the Moderating Effect of Emotional Self-Control on Parent Involvement and Appearance Evaluation 71 Stepwise Multiple Regression Results for the Moderating Effect of Emotional Self-Control on Parent Involvement and Appearance Orientation 71 Stepwise Multiple Regression Results for the Moderating Effect of Humility on Parent Involvement and Appearance Orientation 73 Linear Regression Results for PIS and EAT-26 Bulimia and Food Preoccupation Subscale 74 Stepwise Multiple Regression Results for the Moderating Effect of Collectivism on Parent Involvement and Bulimia and Food Preoccupation 76 Stepwise Multiple Regression Results for the Moderating Effect of Humility on Parent Involvement and EAT-26 Bulimia and Food Preoccupation Subscale.... 77 x
List of Figures Page 1. Appearance Orientation as a function of Emotional Self-Control and Parent Involvement 72 2. Appearance Orientation as a function of Humility and Parent Involvement 73 3. Bulimia and Food Preoccupation as a function of Collectivism and Parent Involvement 76 4. Bulimia and Food Preoccupation as a function of Humility and Parent Involvement 78 xi
1 CHAPTER I Statement of the Problem A surge of interest in eating disorders over the last 2 decades has resulted in a large amount of research concentrating on prevalence rates, risk factors, and symptomatology of eating disorders in Western populations—Caucasian populations in particular. In the last 10 years, research on eating disorders has been extended to non-Western countries such as those on the Asian continent (Lee, Leung, Lee, Yu, & Leung, 1996; Matsuura, Fujimura, Nozawa, Iida, & Hirayama, 1992) as well as to Asian and Asian American populations (Akan & Grilo, 1995; Arriaza & Mann, 2001; Cachelin, Veisel, Barzegarnazari, & Striegel-Moore 2000; Cummins, Simmons, & Zane, 2005; Mintz & Kashubeck, 1999). Studies have shown that there are a number of factors that contribute to the development of eating disorders. These studies indicate that body image dissatisfaction is not only a risk factor for development of an eating disorder but is also considered a symptom of eating disorders. Furthermore, studies indicate that there is a strong relationship between body dissatisfaction and disordered eating symptoms when taking into account moderating variables (Tylka, 2004). Filipinos and Filipino Americans have been lumped into the homogenized category of "Asian Americans." One result of this is that limited research has been conducted examining the body image and eating attitudes and behaviors of Filipino Americans specifically. However, Filipino history, colonization, migration experience, and even cultural values give support to the fact that Filipinos, much like other Asian subgroups, are a culturally distinct Asian American ethnic group. This suggests that
2 further research focusing on how the particular cultural experience of the Filipino American population may impact eating disorders and their symptoms for this population is warranted. A number of studies have indicated that sociocultural influence, such as the influence of an individual's family, impacts an individual's body image and maladaptive eating behaviors and attitudes (Byely, Arichibald, Graber, & Brooks-Gunn, 2000; Dixon, Gill, & Adair, 2003; Laliberte, Boland, & Leichner, 1999; Pike & Rodin, 1991; Twamley & Davis, 1999). These studies have mostly been conducted with Caucasian populations. The ways in which family factors are related to body dissatisfaction and disordered eating may be significantly influenced by cultural variables as family values and dynamics are often culturally determined. Very little research has been conducted on how family influence impacts disordered eating in Asian populations despite the fact that such investigations would provide an opportunity to study these relationships in culturally diverse populations. As a result, it is important to examine such factors in Asian Americans and Filipino Americans in particular. Purpose of the Study One purpose of this study was to minimize the assumption of homogeneity within Asian American women; thus, the current study was limited to Filipino and Filipino American women. Furthermore, this study addressed how specific cultural values in Filipinos may affect the ways in which familial influence impacts their body image and eating attitudes and behaviors. This study focused specifically on body image and body dissatisfaction as opposed to clinically diagnosable eating disorders, in part because prevalence rates of eating disorders in the Filipino American population are unknown due
3 to the lack of research on this particular group. Additionally, this study looked at problematic eating behaviors and attitudes as possible disordered eating symptoms as it is unknown whether the eating attitudes and behaviors of Filipino Americans can be classified as disordered eating symptoms. Furthermore, factors such as familial influence, moderated by cultural values of pakisama or pakikpawa-tao (collectivism), hiya (loss of face) and other Asian cultural values were examined to determine whether such variables could explain the experience of body dissatisfaction and eating behaviors and attitudes that would be considered disordered in Filipino and Filipino American women in the United States. Significance of the Study Although more and more research has been conducted on Asian and Asian American populations, there is still a dearth of literature on specific ethnic subgroups of the Asian American population. This study aimed to contribute to the literature by examining Filipino American women and the influence of family and Filipino cultural values on their body image and eating attitudes and behaviors. Furthermore, the study aimed to generate more interest in the Filipino American community and the need for this particular population to be viewed as separate and not just a homogenized group to be lumped together in a nonspecific category. Last, this study aimed to make Filipino American women aware of how they view their own body image with the hope that it would spark introspection and a healthier view of the Filipina American body.
4 CHAPTER II Literature Review The following sections reviewed the current research and literature, which shaped the basis of this study. A brief overview of the Asian American population in the United States was followed by an exploration of Filipino Americans, their history, migration, and cultural values in order to understand the importance of studying this specific Asian American ethnic subgroup. Next, the ways in which the spectrum of disordered eating has been studied was examined, followed by sections on body image and disordered eating symptoms, and finally, sociocultural influence on body image, and, specifically, an examination of familial influence on body dissatisfaction and disordered eating symptoms. Filipino Americans Asian Americans According to the United States 2000 Census, approximately 11.9 million (4.2%) of the United States population identify as Asian or Asian American (U S. Department of Commerce, 2000). The 2000 Census illustrated the fact that Asian Americans are a heterogeneous group of people with diverse cultures, languages, socioeconomic statuses, and immigration experiences. For example, there are more than 25 ethnic subgroups of Asian ancestry residing in the United States (Kim, Yang, Atkinson, Wolfe, & Hong, 2001; U. S. Department of Commerce, 2000). However, despite these differences, there appears to be a tendency in Western society to group these unique ethnic groups together, thus creating a "homogenized" view of Asian Americans. Although it is true that Asians and Asian Americans, as a whole, share similar cultural values, it should be noted that
each ethnic subgroup of the Asian population has values, beliefs, and behaviors that are unique to its own culture. The uniqueness and differences may stem from that particular group's history, language, social economic status (SES), and experience of the Western culture, as well as their immigration experience. Kim and colleagues (Kim et al., 2001) explored the cultural value similarities and differences among four Asian American ethnic groups (Japanese, Chinese, Filipino, and Korean) using the Asian Values Scale. In their study, Kim et al. (2001) identified six Asian cultural value dimensions: Collectivism, Conformity to Norms, Emotional Self-Control, Family Recognition Through Achievement, Filial Piety, and Humility. Kim and colleagues reported that the four Asian American ethnic groups differed in terms of degree of adherence to these values. The study found that Filipino Americans endorsed a number of these values differently from the other three groups. These included (a) less adherence to emotional self-control than all three other Asian American groups, (b) less adherence to Family Recognition Through Achievement and Filial Piety than Japanese and Korean Americans, (c) less adherence to Conformity to Norms than Chinese and Japanese Americans, and (d) less adherence to Collectivism than Japanese Americans. However, Kim et al.'s (2001) study indicated that Filipino Americans adhered similarly to the value of the Humility Dimension when compared to the other three groups. Kim's study illustrated that there is, in fact, a difference between Asian American subgroups in terms of adherence to similar cultural values and that the homogenized view of Asian Americans is inaccurate and potentially harmful.
6 Kim et al. (2001) found that there was a significant difference between Filipinos and the other Asian ethnic groups. In order to understand the evolution of these differences, one must examine the unique history of Filipinos and Filipino Americans. Filipino History Although the Filipino culture can trace some of its influences to Buddhism and Confucian philosophy, as well as some Malaysian and Indonesian influences (Salvador, Omizo, & Kim, 1997), these Asian and Southeast Asian philosophies have been greatly tempered by the influence of foreign colonial cultures. Filipinos have had a long history of colonization, invasion, and unrest (Root, 1997). In order to provide a background for how Filipino cultural values may influence disordered eating behaviors and attitudes, I will briefly go over the colonization of the Philippines and of Filipinos as well as their early immigration experiences to the United States. The Philippines was colonized by Spain in 1521 (Kim et al., 2001). Spaniards came because they believed the Philippines had something they wanted, such as spices and gold (Bacho, 1997). According to Rimonte (1997), although there is a romanticized sense in Filipino history that Spain colonized the Philippines for the betterment of the Filipino people, the reality is that Filipinos were, in fact, the intended victims, not beneficiaries, of Spanish colonialism. Furthermore, Rimonte (1997) stated that Filipinos were victimized by the assumptions and presumptions of colonial ideology, by the very act of cultural invasion, by coercive cultural transformations, and by the complicit collaboration of leaders and elders who perpetuated the violence of historical distortions. Thus, the previous cultural influences of Buddhism, Confucianism, and other East Asian philosophies on Filipino culture were replaced by new Spanish doctrines. Furthermore,
7 Spain's colonization of the Philippines led to a rise in Catholicism as well as the ascension of the Spaniards and the Spanish Mestizos (biracial, Spanish and Filipino) to the ruling class, which then led to more changes in Filipino culture (Kim et al., 2001). Additionally, although there exists about 75 ethno-linguistic groups speaking over 100 languages in the Philippines (Salvador et al., 1997), Spanish influence is apparent in the main dialect of the Philippinos, Tagalog. There are notably many similarities between Tagalog and Spanish words, such as, sombrero, which means hat in both languages; the Tagolog word sapatos is similar to the Spanish zapatos, which means shoes in both languages. After the Spanish colonization, the Americans then colonized the Philippines in 1898. This caused more changes in Filipino society that resulted in the transmission of American cultural values (Kim et al., 2001). For example, the English language was adopted as the medium of communication in all Filipino educational institutions. Therefore, it can be said that Filipino culture is derived from and developed through an integrated mixture of Malaysian, Chinese, Indonesian, Spanish, and American cultural influences (Salvador et al., 1997), although the Malaysian, Indonesian and Chinese influences were greatly tempered by values acquired from Spain and the United States. Thus the difference between Filipinos' histories in terms of contact with Western culture when contrasted with other Asian cultures may account for their difference in adherence to common Asian cultural values. Finally, during the time of World War II, the Japanese attacked the Philippines 10 hours after their attack on Pearl Harbor (Frank, 2006). The Filipinos and the Americans fought together against Japanese invaders; however, their combined forces still lost the
8 Bataan and Corregidor fronts.1 The Japanese occupation in the Philippines (1941-1945) marked a particularly difficult time for Filipinos, with approximately 1 million casualties and thousands of Filipinas who became "comfort women" for the Japanese soldiers. However, the years of occupation also transmitted some of the Japanese cultural values to the Filipino, which may have resulted in reinstating their own Asian cultural values, such as deference to the one's family and Filipino kapwa-tao. Population of Filipino and Filipino Americans in the United States There have been four noted waves in the history of Filipino immigration to the United States. The first Filipinos to set foot in North America arrived in Morro Bay, California, in 1587 on board the Manila-built galleon ship Nuestra Senora de Esperanza under the command of Spanish Captain Pedro de Unamuno. They were called the "Luzon Indios" or Luzon Indians. In 1763, the first wave of Filipino immigrants came to the United States by crossing the Gulf of Mexico from Acapulco and establishing seven Philippine-style fishing villages in Louisiana. They were called the "mahogany-colored Manila men of Louisiana" and pioneered the dried shrimp industry in America. From 1906 to 1935, more than 125,000 Filipinos were brought to the United States as contract workers and manual laborers for Hawaiian sugar and pineapple fields as well as for California agriculture; these laborers are identified as the second wave of Filipino immigrants. In 1945 to 1965, the third wave of Filipino immigrants came to the United States shortly after the end of World War II. Furthermore, the Filipinos who served under the U.S. Armed Forces in World War II were granted U.S. citizenship under the Tydings-McDuffie Act of 1942. With the passing of the Immigration Act of 1965 began ' Bataan and Corregidor are provinces in the Philippines.
9 the fourth wave of the Filipino immigration to America. As many as 20,000, mostly professionals such as doctors and nurses, immigrated annually, and Filipinos continue to immigrate to the United States to this day (Frank, 2006). In the 1910 census, the number of Filipinos living in the United States was 2,767—90% were male (Lott, 1997). Between 1920 and 1929, 31,092 Filipinos immigrated to the state of California alone. From 1930 to 1960, the Filipino population experienced a slow growth, which included immigration for spouses of World War II servicemen and of Filipino sailors who had been recruited into the United States Navy (Lott, 1997). As seen in the different waves of Filipino immigration to the U.S., Filipinos' numbers in the United States have grown exponentially in the last 4 decades. By 1960, there were 176,310 Filipinos residing in the United States; however, at the time, two thirds of the Filipino population was male. By 1970, Filipinos were the third-largest Asian American group after Chinese and Japanese (U.S. Department of Health, Education and Welfare, 1974). One third of the Filipino population during that time was new births of Filipinos in the United States. By 1990, Filipinos were the second largest Asian group in the United States (U.S. Department of Commerce, 1993). They were also noted as the largest Asian group in California. According to Lott (1997), this continuing growth of Filipino Americans is due to high migration rates as well as high birth rates. The trend seemed to favor Filipino females since, by 1990, Filipino females outnumbered Filipino males (756,946 females to 656,765 males). Furthermore, when comparing Asian American groups, the trend indicates that Filipino Americans may become the largest Asian ethnic group in the United States; in the 2000 U.S. Census, there were 2.4 million
10 people who reported being Filipino, thus making Filipinos the second largest Asian group in the United States currently (U S. Census Bureau, 2000). Filipino Culture and Values Similar to other Asian ethnic groups, Filipinos have a strong sense of collectivism. For the purposes of this dissertation, collectivism will be defined as a term used to describe any doctrine that stresses the importance of the group, rather than the importance of the individual. Collectivism would thus be considered the opposite of individualism. One way in which collectivism and individualism have been conceptualized is in terms of independent self-construal (individualism) and interdependent self-construal (collectivism) (Markus & Kitayama, 1991; Triandis, Leung, Villareal, & Clack, 1985). Those with a strong independent self-construal, or those who are more individualistic in nature, tend to give priority to personal goals over group goals and tend to define themselves independently from the group or groups they belong to. Those with a strong interdependent self-construal, or those who are more collectivistic in nature, are most likely to prioritize collective goals and define themselves in terms of the group or groups they belong to (Sue, Mak & Sue, 1998). When related to family, Yee, Huang, and Lew (1998) stated that Asian individuals tend to make more collective statements than private statements. Furthermore, Triandis (1989) posited that the Asian self depended more on the situation and the values of the group when compared with their Caucasian counterparts. Thus, Asian Americans tend to respond and react to judgments and demands of their social environment and external influences in their environment over their own individual motives and self-assessments (Yee et al., 1998).
11 The closest definition of collectivism in Tagalog would be pakisama: paki means "please" and sama means "go with." Thus, this word means that one unites one's will with the will of the others for the sake of camaraderie whether in a traditional family unit, extended family, or peer group situation (Andres, 1994). Pakisama also means "yielding to the will of the leader of the group and conforming to the group in order to come to a unified decision." Another term that illustrates Filipino collectivism is Pakikapwa or Pakikapwa-tao, which speaks of the Filipino value of solidarity and empathy (tao means "person"). It should also be noted that pakikapwa-tao can also be defined as "being human" or "the essence of what it means for a Filipino to be human."2 A Filipino who shows good pakisama and good pakikapwa-tao is rewarded with social approval, whether with the family or with peer groups (Andres, 1994). Furthermore, like most Asian and Asian American ethnic groups, Filipinos and Filipino Americans value the family highly. The family does not only consist of the "nuclear" family (i.e., the mother, father, and siblings), but it also includes grandparents, godparents, aunts, uncles, cousins, second cousins, and even friends of the family (Salvador et al., 1997). Moreover, in Filipino culture, the needs of the family are more important than individual needs or even that of the community. Thus, the Filipino defines one's self in terms of one's family (i.e., my needs are the needs of the family). Hence, what the family thinks of its members is very important to Filipinos and Filipino Americans. Perhaps the Filipino cultural value of putting the family's needs first (Salvador et al., 1997) over the needs of the group or groups outside of the family that Filipinos belong to may explains why Kim et al. (2001) found such a discrepancy in adherence to collectivism between Filipino Americans and the other Asian groups. 2 Anecdotal information from Jei Africa, Psy.D.
12 Salvador et al. (1997) also addressed other cultural characteristics and values that profoundly affect Filipinos, such as patron-client relationship, personalism, hiya (which is translated into "shame" or "propriety" and can also be interpreted as "humility"), love of self, group solidarity, and gratitude or reciprocity. In order to understand pakikapwa-tao, pakisama, and pakisama-tao, one must understand the meaning of hiya. Hiya is a word that has a range of meanings from "embarrassment" to "social etiquette" and "proper behavior in public." Salvador et al. (1997) described hiya as follows: "A Filipino's behavior is determined by what others will say, think, or do" (p. 204). Furthermore, Salvador posited, that hiya is a form of self-deprecation involving embarrassment, inferiority, and shyness, which all arise from improper behavior. As a result, hiya operates as a powerful sanction in the maintenance of the overall system of social relationships in Filipino culture. In addition, Andres (1994) described hiya as a "Filipino trait with emphasis on fear of losing face" (p. 204). Simply put, hiya is the feeling of embarrassment one experiences or the perception that one's behavior is socially unacceptable for whatever reason (Andres, 1994). It is important to note that, from the Western perspective, cultural values such as hiya may be viewed as somewhat negative whereas the ethnocentric point of view holds these values as imperative for family cohesion and cultural harmony. As aforementioned, there is a tendency in the United States to group together all Asian Americans under one category as though Asian Americans are a homogenous group. Not surprisingly, this is also true for psychological research conducted on Asians and Asian Americans. Okazaki and Sue (1995) submitted that the rationale behind grouping together individuals of the same ethnic background, such as Asian Americans,
13 is based on the assumption that these individuals share some common psychological characteristics associated with culture and that such shared cultural psychological characteristics are related to personality or psychopathology. However, using race and ethnicity is a distal way to look at any population (Cummins et al., 2005; Okazaki & Sue, 1993) and is less telling than using actual cultural values such as the Filipino concept of hiya or familial piety and collectivism, which are more proximal ways to understand the variations among ethnic subgroups. Thus, conducting studies on population groups that are categorized by such distal variables as ethnicity and race poses a problem because "research involving individuals from different ethnic and cultural backgrounds must specify and directly measure the underlying psychological variables associated with that culture that are hypothesized to produce cultural or ethnic group differences" (Okazaki & Sue, 1993, p. 28). Due to their unique cultural experiences, one cannot assume that Filipino Americans will experience body image dissatisfaction the same way as other Asian American subgroups, nor can we assume that Filipino Americans' eating attitudes or behaviors are attributed to the same cultural factors that influence other Asian American subgroups' eating attitudes and behaviors. Thus, not only would further research on body dissatisfaction and disordered eating among culturally diverse groups benefit from investigating psychological variables that are culturally based, it would also be important to examine how such relationships might vary for specific populations, such as Filipino Americans, as they are a unique cultural group. Spectrum of Disordered Eating An eating disorder is defined as a persistent disturbance of eating behavior intended to control weight that significantly impairs physical health or psychosocial