Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Sarah Lowe

Abstract

Objective: To validate The Stress and Weight Stigma Scale (STRAWS), a measure developed to assess prolonged activation and anticipatory stress related to experiences of weight stigma among individuals with overweight and obesity. Methods: Based on an existing instrument for prolonged activation and anticipatory race-related stress, the 17-item STRAWS was developed to capture perseverative cognition, secondary appraisal, and anticipatory stress in response to a specific experience of weight stigma. Participants with a range of body mass indices (BMI; kg/m2) and who believed they had experienced weight stigma were recruited using Amazon’s Mechanical Turk (n = 301). We used confirmatory factor analysis to determine the fit of the factor structure of the STRAWS based on the 4-factor structure of the source instrument (Utsey et al., 2012). We also compared the invariance of the factor structure between participants with BMI ≥ 25 (n = 208) and those with BMI < 25 (n = 93) prior to examining construct validity of the STRAWS. Results: Analyses supported a four-factor oblique model for our current sample of US adults, though model fit was more adequate among the group with BMI ≥ 25 (χ2 (113) = 204.75, p < 0.001, RMSEA = 0.062, CFI = 0.948, TLI = 0.938, SRMR = 0.0074) compared to the group with BMI < 25 (χ2 (113) = 177.48, p < 0.001, RMSEA = 0.078, CFI = 0.940, TLI = 0.927, SRMR = 0.078) . Measurement invariance analysis comparing the 4-factor oblique model fit between BMI groups revealed metric invariance, suggesting that each of the 17 items comprising the STRAWS contributes to the latent structure to a similar extent across BMI groups. The current study also provided evidence for construct validity of the STRAWS in that its total and factor scores correlated in the expected direction with scores on measures of related constructs. Conclusion: Our findings provide support for the validity and reliability of The Stress and Weight Stigma Scale, an instrument that assesses prolonged activation and anticipatory stress related to experiences of weight stigma among individuals with overweight and obesity. The STRAWS offers a method for understanding the long-term stress response to experiences of weight stigma. Public health experts and healthcare providers may wish to utilize the STRAWS to design appropriate, effective interventions that target the connection between weight stigma stress and subsequent poor health outcomes.

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This is an Open Access Thesis.

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