Chew and spit (CHSP) in a large adolescent sample: prevalence, impact on health-related quality of life, and relation to other disordered eating features

ABSTRACT

A recent general population study of Chew and Spit (CHSP) behavior in adults found a 0.4% prevalence, predominantly in females. The current study explores this further by examining the same phenomenon in secondary-school aged adolescents. This study also explores the relationship between CHSP and other demographic and eating disorder (ED) features in 5111 adolescents (11-to-19 years of age) from 13 schools in New South Wales, Australia. Participants completed measures of ED symptoms and behaviors and change to impairment with two components: psychological distress (K-10) and health related quality of life (HRQoL; PedsQL). CHSP was found to have a 12.2% (95% CI 0.114, 0.132]) point-prevalence rate. Participants who indicated engaging in CHSP reported significantly higher levels of psychological distress (K-10) and lower HRQoL scores (PedsQL) compared to those that did not report CHSP. There was a dose-response relationship between CHSP frequency, psychological distress and HRQoL physical scores but not for HRQoL emotional and HRQoL social scores. Participants who reported regular CHSP were more likely to be female, younger, and to engage in compensatory behaviors such as purging. The high frequency of CHSP behavior in adolescents with disordered eating could suggest that CHSP should be considered in routine ED screening practices. Future studies may examine how to treat CHSP or investigate more focused treatment approaches, in order to target the behavior of CHSP more directly.

Acknowledgments

Author’s contributions: PA conducted the initial literature search, quality assessment, data analysis, and draft of manuscript. DM conceived the study, methodology, and conducted data collection. NS conducted a secondary literature search, quality assessment and editing of manuscript. ST and PH provided significant input and guidance, assisted in drafting and editing the manuscript while HM did statistical modelling and editing of manuscript. All authors have read and approved the final manuscript before submission

Declaration of Interest Statement

Competing interests: ST and PH receive royalties from Hogrefe, and Huber and McGraw-Hill publishers for contributions on eating disorders. ST has received travel grants, consulting fees and grant funding from Shire Pharmaceuticals. ST has chaired the Australian Advisory Board on Binge Eating Disorder and provided commissioned requests PH received royalties from Oxford University Press and receives sessional fees and lecture fees from the Australian Medical Council, Therapeutic Guidelines publication, and New South Wales Institute of Psychiatry. PH is an author of a paper cited in this Editorial. PH is a member of the World Health Organization Working Group on Feeding and Eating Disorders for the Revision of ICD-10 Mental and Behavioral Disorders and this paper represents personal views of the author. PH has received an honorarium from Shire Pharmaceuticals for a commissioned report.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.