Campus climate and intersectional inequities in eating disorders among U.S. college students: A multilevel analysis of individual heterogeneity and discriminatory accuracy.

Abstract

Purpose: To advance understanding of how contextual factors explain eating disorder (ED) inequities among college students, we examined associations between campus climate - i.e., the extent to which a given school is hostile vs. friendly to students of diverse social/cultural backgrounds - and ED prevalence across intersections of gender, sexual, and racialized identity.

Method: Cross-sectional data came from 15,544 students at colleges/universities that participated in the 2018/2019 Healthy Minds Study. We conducted a Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) by grouping participants into 35 intersectional social strata defined by gender, sexual, and racialized identity and fitting multilevel models to obtain stratum-specific prevalence estimates of probable EDs across the range of campus climate ratings (1 = "very hostile" to 5 = "very friendly").

Results: Campus climate was inversely associated with probable EDs; specifically, for every 1-unit increase in ratings (i.e., more friendly climates), odds decreased by 8 %. There were differences in the magnitude of this association across strata, such that multiply marginalized students experienced the largest benefits from attending "very friendly" campuses, and especially those who were cisgender women and/or LGBQ+.

Conclusions: Results reveal a complex social patterning of EDs among college students across campus climate ratings and provide preliminary evidence suggesting that hostile campus climates may function as a driver of intersectional inequities in this population.