Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-18T19:51:43.527Z Has data issue: false hasContentIssue false
  • English
  • Français

Body Dissatisfaction, Weight-Related Behaviours, and Health Behaviours: A Comparison Between Australian and Malaysian in Female Emerging Adults

Published online by Cambridge University Press:  01 July 2021

Pravina Santhira Shagar Open the ORCID record for Pravina Santhira Shagar [Opens in a new window] ,
Caroline L. Donovan ,
Jennifer Boddy ,
Caley Tapp ,
Patricia Lee  and
Neil Harris
Pravina Santhira Shagar*
Affiliation:
School of Medicine, Griffith University, Gold Coast Campus, Southport, Queensland4222, Australia
Caroline L. Donovan
Affiliation:
School of Applied Psychology, Griffith University, Mount Gravatt Campus, Southport, Queensland4122, Australia
Jennifer Boddy
Affiliation:
School of Human Services and Social Work, Griffith University, Gold Coast Campus, Southport, Queensland4222, Australia
Caley Tapp
Affiliation:
School of Applied Psychology, Griffith University, Mount Gravatt Campus, Southport, Queensland4122, Australia
Patricia Lee
Affiliation:
School of Medicine, Griffith University, Gold Coast Campus, Southport, Queensland4222, Australia
Neil Harris
Affiliation:
School of Medicine, Griffith University, Gold Coast Campus, Southport, Queensland4222, Australia
*
*Corresponding author: Pravina Santhira Shagar, School of Medicine, Griffith University, Gold Coast Campus, Queensland4222, Australia. Email: [email protected]
Get access

Abstract

The presence of body dissatisfaction (BD) in non-Western countries is an important area of empirical enquiry. The results reflect collectivistic and individualistic cultures of Malaysians and Australians, respectively, whereby social approval, social acceptance, and cultural values are of high importance to Malaysians compared with the more liberal attitudes of Australians with respect to health behaviours. This study sought to compare: (1) Australian and Malaysian women on BD, thin ideal internalisation, sociocultural influences, problematic weight-related behaviours, and health behaviours; and (2) the degree to which BD is associated with health behaviours (smoking, alcohol consumption, drug use, and sexual behaviours) across the two cultures. Participants were 428 Australian females and 402 Malaysian females aged 18–25 years old. Australians had higher BD, thin ideal internalisation, family and media influences, restrained eating, and poorer health behaviours, while Malaysians had higher peer influence. There was no difference for bulimic behaviours across the two countries. BD was found to have an association with use of drugs, smoking, and sexual behaviours among Malaysian women, but not for Australian participants. The permeation of Western standards of the thin ideal due to increased industrialisation, Westernisation, and modernisation has brought about bulimic behaviours in Malaysian women, similar to that of Australian women.

Keywords

body dissatisfactioncross-cultural comparisonlifestyle behaviourscollectivistic culturesthin ideal internalisation
Type
Standard Paper
Information
Behaviour Change , Volume 38 , Issue 3 , September 2021 , pp. 148 - 163
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Australian Association for Cognitive and Behaviour Therapy

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ahrold, TK and Meston, CM (2010). Ethnic differences in sexual attitudes of US college students: Gender, acculturation, and religiosity factors. Archives of Sexual Behavior, 39, 190–202.CrossRefGoogle Scholar
Baillie, LE and Copeland, AL (2013). Disordered eating and body image in Chinese and Caucasian students in the United States. Eating Behaviors, 14, 314–319.CrossRefGoogle ScholarPubMed
Becker, AE, Franko, DL, Speck, A and Herzog, DB (2003). Ethnicity and differential access to care for eating disorder symptoms. International Journal of Eating Disorders, 33, 205–212. doi:10.1002/eat.10129.CrossRefGoogle ScholarPubMed
Bell, HS, Donovan, CL and Ramme, R (2016). Is athletic really ideal? An examination of the mediating role of body dissatisfaction in predicting disordered eating and compulsive exercise. Eating Behaviors, 21, 24–29.CrossRefGoogle ScholarPubMed
Benowitz-Fredericks, CABA, Garcia, KBA, Massey, ME, Vasagar, BMDMPH and Borzekowski, DLGE (2012). Body image, eating disorders, and the relationship to adolescent media use. Pediatric Clinics of North America, 59, 693–704. doi:10.1016/j.pcl.2012.03.017.CrossRefGoogle ScholarPubMed
Bisaga, K, Whitaker, A, Davies, M, Chuang, S, Feldman, J and Walsh, BT (2005). Eating disorder and depressive symptoms in urban high school girls from different ethnic backgrounds. Journal of Developmental and Behavioral Pediatrics, 26, 257–266. doi:10.1097/00004703-200508000-00001.CrossRefGoogle ScholarPubMed
Blodgett Salafia, EH, Jones, ME, Haugen, EC, & Schaefer, MK (2015). Perceptions of the causes of eating disorders: A comparison of individuals with and without eating disorders. Journal of Eating Disorders, 3(1), 32. doi:10.1186/s40337-015-0069-8.CrossRefGoogle ScholarPubMed
Blostein, F, Assari, S and Caldwell, CH (2017). Gender and ethnic differences in the association between body image dissatisfaction and binge eating disorder among blacks. Journal of Racial and Ethnic Health Disparities, 4, 529–538. doi:10.1007/s40615-016-0255-7.CrossRefGoogle ScholarPubMed
Bornioli, A, Lewis-Smith, H, Smith, A, Slater, A and Bray, I (2019). Adolescent body dissatisfaction and disordered eating: Predictors of later risky health behaviours. Social Science and Medicine, 238, 1–8.CrossRefGoogle ScholarPubMed
Brokhoff, M, Mussap, AJ, Mellor, D, Skouteris, H, Ricciardelli, LA, McCabe, MP and Fuller-Tyszkiewicz, M (2012). Cultural influences on body dissatisfaction, body change behaviours, and disordered eating of Japanese adolescents: Body image in Japanese adolescents. Asian Journal of Social Psychology, 15, 238–248. doi:10.1111/j.1467-839X.2012.01379.x.CrossRefGoogle Scholar
Bui, TV, Blizzard, CL, Luong, KN, Truong, NLV, Tran, BQ, Otahal, P, Srikanth, V, Nelson, MR, Au, TB, Ha, ST, Phung, HN, Tran, MH, Callisaya, M and Gall, S (2016) Alcohol Consumption in Vietnam, and the Use of 'Standard Drinksï' to Measure Alcohol Intake. Alcohol and Alcoholism 51(2), 186–195.Google ScholarPubMed
Cash, TF and Szymanski, ML (1995). The development and validation of the body-image ideals questionnaire. Journal of Personality Assessment, 64, 466–477.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention (2019). Retrieved from: https://www.cdc.gov/healthyyouth/data/yrbs/index.htm.Google Scholar
Chang, F-C, Lee, C-M, Chen, P-H, Chiu, C-H, Pan, Y-C and Huang, T-F (2013). Association of thin-ideal media exposure, body dissatisfaction and disordered eating behaviors among adolescents in Taiwan. Eating Behaviors, 14, 382–385. doi:10.1016/j.eatbeh.2013.05.002.CrossRefGoogle ScholarPubMed
Chen, PPD and Jacobson, KCPD (2012). Developmental trajectories of substance use from early adolescence to young adulthood: Gender and racial/ethnic differences. Journal of Adolescent Health, 50, 154–163. doi:10.1016/j.jadohealth.2011.05.013.CrossRefGoogle ScholarPubMed
Chen, L-J, Fox, KR, Haase, AM and Ku, P-W (2010). Correlates of body dissatisfaction among Taiwanese adolescents. Asia Pacific Journal of Clinical Nutrition, 19, 172–179.Google ScholarPubMed
Clark, MM, Hurt, RD, Croghan, IT, Patten, CA, Novotny, P, Sloan, JA, … Rowland, KM (2006). The prevalence of weight concerns in a smoking abstinence clinical trial. Addictive Behaviors, 31, 1144–1152.CrossRefGoogle Scholar
Cooley, E and Toray, T (2001). Body image and personality predictors of eating disorder symptoms during the college years. International Journal of Eating Disorders, 30, 28–36.CrossRefGoogle ScholarPubMed
Cotton, S, Larkin, E, Hoopes, A, Cromer, BA and Rosenthal, SL (2005). The impact of adolescent spirituality on depressive symptoms and health risk behaviors. Journal of Adolescent Health, 36, 529.CrossRefGoogle ScholarPubMed
CSO and UNICEF (2012). Afghanistan Multiple Indicator Cluster Survey 2010–2011. Final report. Kabul: Central Statistic Organisation and UNICEF. Retrieved from: http://cso.gov.af/Content/files/AMICS-Jun24-2012-FINAL.pdf (accessed 2 March 2018).Google Scholar
Eckersley, RM (2005). ‘Cultural fraud’: The role of culture in drug abuse. Drug and Alcohol Review, 24, 157–163.CrossRefGoogle ScholarPubMed
Eckersley, R (2009). Population measures of subjective wellbeing: How useful are they? Social Indicators Research, 94, 1–12.CrossRefGoogle Scholar
Forbes, GB and Frederick, DA (2008). The UCLA body project II: Breast and body dissatisfaction among African, Asian, European, and Hispanic American college women. Sex Roles, 58, 449–457.CrossRefGoogle Scholar
Franko, DL, Becker, AE, Thomas, JJ and Herzog, DB (2007). Cross-ethnic differences in eating disorder symptoms and related distress. International Journal of Eating Disorders, 40, 156–164. doi:10.1002/eat.20341.CrossRefGoogle ScholarPubMed
Garner, DM, Olmsted, MP, Bohr, Y and Garfinkel, PE (1982). The eating attitudes test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871–878. doi:10.1017/S0033291700049163.CrossRefGoogle ScholarPubMed
Gattario, KH, Frisén, A and Anderson-Fye, E (2014). Body image and child well- being. In Ben-Arieh, A, Casas, F, Frønes, I and Korbin, JE (Eds.), Handbook of child well-being: Theories, methods and policies in global perspective (pp. 2409–2436). Dordrecht: Springer Netherlands.CrossRefGoogle Scholar
George, JBE and Franko, DL (2009). Cultural issues in eating pathology and body image among children and adolescents. Journal of Pediatric Psychology, 35, 231–242.CrossRefGoogle ScholarPubMed
Gillen, MM, Lefkowitz, ES and Shearer, CL (2006). Does body image play a role in risky sexual behavior and attitudes? Journal of Youth and Adolescence, 35, 230–242.CrossRefGoogle Scholar
Grogan, S (2007). Body image: Understanding body dissatisfaction in men, women, and children (2nd ed.). New York, NY: Routledge.CrossRefGoogle Scholar
Hirschman, C (2016). Gender, the status of women, and family structure in Malaysia. Malaysian Journal of Economic Studies, 53, 33–50.Google Scholar
Holzhauer, CG, Zenner, A and Wulfert, E (2016). Poor body image and alcohol use in women. Psychology of Addictive Behaviors, 30, 122.CrossRefGoogle ScholarPubMed
Homan, K (2010). Athletic-ideal and thin-ideal internalisation as prospective predictors of body dissatisfaction, dieting, and compulsive exercise. Body Image, 7, 240–245.CrossRefGoogle Scholar
Hosking, W, Borland, R, Yong, H-H, Fong, G, Zanna, M, Laux, F, … Omar, M (2009). The effects of smoking norms and attitudes on quitting intentions in Malaysia, Thailand and four Western nations: A cross-cultural comparison. Psychology & Health, 24, 95–107. doi:10.1080/08870440802385854.CrossRefGoogle ScholarPubMed
Howe, LJ, Trela-Larsen, L, Taylor, M, Heron, J, Munafò, MR and Taylor, AE (2017). Body mass index, body dissatisfaction and adolescent smoking initiation. Drug and Alcohol Dependence, 178, 143–149.CrossRefGoogle ScholarPubMed
Izydorczyk, B and Sitnik-Warchulska, K (2018). Sociocultural appearance standards and risk factors for eating disorders in adolescents and women of various ages. Frontiers in Psychology, 9, 429.CrossRefGoogle ScholarPubMed
Jackson, T, Jiang, C and Chen, H (2016). Associations between Chinese/Asian versus Western mass media influences and body image disturbances of young Chinese women. Body Image, 17, 175–183. doi:10.1016/j.bodyim.2016.03.007.CrossRefGoogle ScholarPubMed
Javier, SJ and Belgrave, FZ (2015). An examination of influences on body dissatisfaction among Asian American college females: Do family, media, or peers play a role? Journal of American College Health, 63, 579–583.CrossRefGoogle ScholarPubMed
Jones, DC, Vigfusdottir, TH and Lee, Y (2004). Body image and the appearance culture among adolescent girls and boys: An examination of friend conversations, peer criticism, appearance magazines, and the internalisation of appearance ideals. Journal of Adolescent Research, 19, 323–339.CrossRefGoogle Scholar
Jung, J and Forbes, GB (2007). Body dissatisfaction and disordered eating among college women in China, South Korea, and the United States: Contrasting predictions from sociocultural and feminist theories. Psychology of Women Quarterly, 31, 381–393. doi:10.1111/j.1471-6402.2007.00387.x.CrossRefGoogle Scholar
Jung, J, Forbes, GB and Lee, Y-J (2009). Body dissatisfaction and disordered eating among early adolescents from Korea and the us. Sex Roles, 61, 42–54. doi:10.1007/s11199-009-9609-5.CrossRefGoogle Scholar
Khor, GL, Zalilah, M, Phan, Y, Ang, M, Maznah, B and Norimah, A (2009). Perceptions of body image among Malaysian male and female adolescents. Singapore Medical Journal, 50, 303.Google ScholarPubMed
Khumsaen, N and Gary, FA (2009). Determinants of actual condom use among adolescents in Thailand. Journal of the Association of Nurses in AIDS Care, 20, 218–229.CrossRefGoogle ScholarPubMed
Koupil, I, Tooth, L, Heshmati, A and Mishra, G (2016) Social patterning of overeating, binge eating, compensatory behaviours and symptoms of bulimia nervosa in young adult women: results from the Australian Longitudinal Study on Women’s Health. Public Health Nutrition 19(17), 3158–3168.CrossRefGoogle ScholarPubMed
Lai, C-M, Mak, K-K, Pang, JS, Fong, SSM, Ho, RCM and Guldan, GS (2013). The associations of sociocultural attitudes towards appearance with body dissatisfaction and eating behaviors in Hong Kong adolescents. Eating Behaviors, 14, 320–324. doi:10.1016/j.eatbeh.2013.05.004.CrossRefGoogle ScholarPubMed
Lee, S and Lee, AM (2000). Disordered eating in three communities of China: A comparative study of female high school students in Hong Kong, shenzhen, and rural hunan. International Journal of Eating Disorders, 27, 317–327.3.0.CO;2-2>CrossRefGoogle Scholar
Lee, SK, Sulaiman-Hill, CM and Thompson, SC (2014). Alcohol experiences and concerns of newly arrived migrant women. Sage Open, 4, 2158244014530727.CrossRefGoogle Scholar
Levine, MD, Perkins, KA and Marcus, MD (2001). The characteristics of women smokers concerned about post cessation weight gain. Addictive Behaviors, 26, 749–756.CrossRefGoogle Scholar
Littleton, H, Breitkopf, CR and Berenson, A (2005). Body image and risky sexual behaviors: An investigation in a tri-ethnic sample. Body Image, 2, 193–198.CrossRefGoogle Scholar
Lucea, MB, Hindin, MJ, Gultiano, S, Kub, J and Rose, L (2013). The context of condom use among young adults in the Philippines: Implications for HIV prevention. Health Care for Women International, 34, 227–248.CrossRefGoogle ScholarPubMed
McCabe, MP and Ricciardelli, LA (2003). Sociocultural influences on body image and body changes among adolescent boys and girls. The Journal of Social Psychology, 143, 5–26.CrossRefGoogle ScholarPubMed
Mellor, D, Waterhouse, M, Mamat, NHb, Xu, X, Cochrane, J, McCabe, M and Ricciardelli, L (2013). Which body features are associated with female adolescents’ body dissatisfaction? A cross-cultural study in Australia, China and Malaysia. Body Image, 10, 54–61. doi:10.1016/j.bodyim.2012.10.002.CrossRefGoogle ScholarPubMed
Meule, A (2016). Cultural reflections on restrained eating. Frontiers in Psychology, 7, 205.CrossRefGoogle ScholarPubMed
Mond, JM, Chen, A and Kumar, R (2010). Eating-disordered behavior in Australian and Singaporean women: A comparative study. International Journal of Eating Disorders, 43, 717–723.CrossRefGoogle ScholarPubMed
Mond, J, Mitchison, D, Latner, J, Hay, P, Owen, C and Rodgers, B (2013). Quality of life impairment associated with body dissatisfaction in a general population sample of women. BMC Public Health, 13, 920.CrossRefGoogle Scholar
Moore, L, Beksinska, M, Rumphs, A, Festin, M and Gollub, EL (2015). Knowledge, attitudes, practices and behaviors associated with female condoms in developing countries: A scoping review. Open Access Journal of Contraception, 6, 125.CrossRefGoogle ScholarPubMed
Nelson, MC, Lust, K, Story, M and Ehlinger, E (2009). Alcohol use, eating patterns, and weight behaviors in a university population. American Journal of Health Behavior, 33, 227–237.CrossRefGoogle Scholar
Neumark-Sztainer, D, Paxton, SJ, Hannan, PJ, Haines, J and Story, M (2006). Does body satisfaction matter? Five-year longitudinal associations between body satisfaction and health behaviors in adolescent females and males. Journal of Adolescent Health, 39, 244–251.CrossRefGoogle ScholarPubMed
Ng, CJ and Kamal, S (2006). Bridging the gap between adolescent sexuality and HIV risk: The urban Malaysian perspective. Singapore Medical Journal, 47, 482.Google ScholarPubMed
Noh, J-W, Kwon, YD, Yang, Y, Cheon, J and Kim, J (2018). Relationship between body image and weight status in east Asian countries: Comparison between South Korea and Taiwan. BMC Public Health, 18, 814.CrossRefGoogle ScholarPubMed
Paxton, SJ, Neumark-Sztainer, D, Hannan, PJ and Eisenberg, ME (2006). Body dissatisfaction prospectively predicts depressive mood and low self-esteem in adolescent girls and boys. Journal of Clinical Child and Adolescent Psychology, 35, 539–549.CrossRefGoogle ScholarPubMed
Perloff, RM (2014). Social media effects on young women's body image concerns: Theoretical perspectives and an agenda for research. Sex Roles, 71, 363–377.CrossRefGoogle Scholar
Pike, KM and Dunne, PE (2015). The rise of eating disorders in Asia: A review. Journal of Eating Disorders, 3, 33.CrossRefGoogle ScholarPubMed
Ramme, RA, Donovan, CL and Bell, HS (2016). A test of athletic internalisation as a mediator in the relationship between sociocultural influences and body dissatisfaction in women. Body Image, 16, 126–132.CrossRefGoogle ScholarPubMed
Rasman, NSB, Rahid Kay, NAK, Ahmed, SU and Ahmed, MK (2018). Prevalence of eating disorders among medical students in Ipoh, Perak, Malaysia. Indian Journal of Natural Science, 8, 13024–13031.Google Scholar
Razali, MM and Kliewer, W (2015). Risk and protective factors for recreational and hard drug use among Malaysian adolescents and young adults. Addictive Behaviors, 50, 149–156. doi:10.1016/j.addbeh.2015.06.022.CrossRefGoogle ScholarPubMed
Ricciardelli, LA and McCabe, MP (2002). Psychometric evaluation of the body change inventory: An assessment instrument for adolescent boys and girls. Eating Behaviors, 3, 45–59. doi:10.1016/S1471-0153(01)00044-7.CrossRefGoogle ScholarPubMed
Schaefer, LM, Burke, NL, Thompson, JK, Dedrick, RF, Heinberg, LJ, Calogero, RM, … Swami, V (2015). Development and validation of the sociocultural attitudes towards appearance questionnaire-4 (SATAQ-4). Psychological Assessment, 27, 54–67. doi:10.1037/a0037917.CrossRefGoogle Scholar
Sepúlveda, AR and Calado, M (2012) Westernization: The role of mass media on body image and eating disorders. Relevant Topics in Eating Disorders, 47–61.Google Scholar
Shaw, H, Ramirez, L, Trost, A, Randall, P and Stice, E (2004). Body image and eating disturbances across ethnic groups: More similarities than differences. Psychology of Addictive Behaviors, 18, 12–18. doi:10.1037/0893-164X.18.1.12.CrossRefGoogle ScholarPubMed
Smith, AM, Rissel, CE, Richters, J, Grulich, AE and de Visser, RO (2003). Sex in Australia: The rationale and methods of the Australian study of health and relationships. Australian and New Zealand Journal of Public Health, 27, 106–117.CrossRefGoogle ScholarPubMed
Soh, NL, Touyz, SW and Surgenor, LJ (2006). Eating and body image disturbances across cultures: A review. European Eating Disorders Review, 14, 54–65. doi:10.1002/erv.678.CrossRefGoogle Scholar
Stice, E (2002). Risk and maintenance factors for eating pathology: A meta-analytic review. Psychological Bulletin, 128, 825–848. doi:10.1037/0033- 2909.128.5.825.CrossRefGoogle ScholarPubMed
Stice, E and Shaw, HE (1994). Adverse-effects of the media portrayed thin-ideal on women and linkages to bulimic symptomatology. Journal of Social and Clinical Psychology, 13, 288–308. doi:10.1521/jscp.1994.13.3.288.CrossRefGoogle Scholar
Tangmunkongvorakul, A, Musumari, PM, Srithanaviboonchai, K, Manoyos, V, Techasrivichien, T, Suguimoto, SP, … Chariyalertsak, S (2017). “When I first saw a condom, I was frightened”: A qualitative study of sexual behavior, love and life of young cross-border migrants in urban chiang Mai, Thailand. PLoS One, 12, e0183255.CrossRefGoogle Scholar
Teerawichitchainan, B. (2007). Romance and sexual initiation among unmarried young people in Vietnam: A multi-method approach [Conference presentation abstract]. Annual Meeting of Population Association of America, New York City, United States.Google Scholar
Thompson, JK and American Psychological Association (1999). Exacting beauty: Theory, assessment, and treatment of body image disturbance (1st ed.). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
Tsai, G, Curbow, B and Heinberg, L (2003). Sociocultural and developmental influences on body dissatisfaction and disordered eating attitudes and behaviours of Asian women. The Journal of Nervous and Mental Disease, 191, 309–318. doi:10.1097/01.NMD.0000066153.64331.10.CrossRefGoogle ScholarPubMed
Tuschl, RJ (1990). From dietary restraint to binge eating: Some theoretical considerations. Appetite, 14, 105–109.CrossRefGoogle ScholarPubMed
UNFPA, UNESCO & WHO (2015). Sexual and reproductive health of young people in Asia and the pacific: A review of issues, policies and programmes. Bangkok: UNFPA.Google Scholar
van Strien, T, Frijters, JER, Bergers, GPA and Defares, PB (1986). The Dutch eating behavior questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. International Journal of Eating Disorders, 5, 295–315. doi:10.1002/1098-108X(198602)5:2<295:AID-EAT2260050209 > 3.0.CO;2-T.3.0.CO;2-T>CrossRefGoogle Scholar
Warren, CS, Lindsay, AR, White, EK, Claudat, K and Velasquez, SC (2013). Weight-related concerns related to drug use for women in substance abuse treatment: Prevalence and relationships with eating pathology. Journal of Substance Abuse Treatment, 44, 494–501.CrossRefGoogle ScholarPubMed
Webb, HJ and Zimmer-Gembeck, MJ (2016). A longitudinal study of appearance-based rejection sensitivity and the peer appearance culture. Journal of Applied Developmental Psychology, 43, 91–100. doi:10.1016/j.appdev.2016.01.004.CrossRefGoogle Scholar
WHO (2014). Global status report on alcohol and health 2014. Geneva: World Health Organization.Google Scholar
Yamamiya, Y, Cash, TF and Thompson, JK (2006). Sexual experiences among college women: The differential effects of general versus contextual body images on sexuality. Sex Roles, 55, 421–427.CrossRefGoogle Scholar
Zhang, L, Qian, H and Fu, H (2018). To be thin but not healthy-the body-image dilemma may affect health among female university students in China. PLoS One, 13, e0205282.CrossRefGoogle ScholarPubMed