Details & Validation Information for Survey Tools

Symptoms of depression were assessed via the 20-item Center for Epidemiologic Studies Depression Scale (CES-DS).Scores can range from 0 – 60; scores ranging from 15 to 21 indicate mild to moderate symptoms of depression and scores > 21 suggest the presence of severe/clinical depression. The CES-DS has been shown to have high internal consistency (α = 0.84 – 0.90) and, as evidenced by a confirmatory factor analysis study (n = 521), has been demonstrated to be an appropriate measurement tool used to measure depressive symptoms in African American women.

Stress levels were measured using two instruments. The first instrument, the Perceived Stress Questionnaire (PSQ),is a 30-item self-administered questionnaire with high internal consistency (α = > 0.90) that assesses the respondent’s appraisal of life events in the previous month. Respondents are asked to reply to all items using a 4-point likert-type scale. Specifically, questions address how often a person has experienced negative emotions or feelings like harassment, overload, irritability, lack of joy, fatigue, worry or tension. The index ranges from 0.0 – 1.0 with higher scores being associated with higher levels of stress. 

The Gender-Related Stress Scale (GRSS) is more race and gender specific. The GRSS was used to measure chronic stress exposure within the past year. The tool consists of 43 questions and is designed to measure the perception of the stressor by the participant using perceived impact ratings. 

The Multiple Caregiving Measurement Instrument (MCMI) developed by Samuel-Hodge et al. (2005) (α = 0.72 – 0.76, by subscale) was used to assess barriers to engaging in healthy behaviors associated with the multiple-caregiver role. The full instrument consists of 10 questions using a 4-point likert-type rating scale ranging from “disagree a little” to “agree a lot”. Results from the full instrument can be reported as two sub-scores. The first score (7 questions, possible score range 6-24) captures the degree to which the respondent identifies with common characteristics of the MCR. The second score (3 questions possible score range 3-24) assesses barriers associated with the MCR. Our questionnaire only included the 3 questions assessing barriers.

An 11-item selection (of 34 total questions) of the Stereotypic Roles for Black Women Scale (SRBWS) developed by Thomas et al. (2004) was used to assess how much respondents relate with stereotypical behaviors associated by the SR. Participants were asked how much they agree or disagree with a series of statements using a 5-item likert scale ranging from “strongly disagree” to “strongly agree”. Examples of statements from the “Superwoman” subscale include “Black women have to be strong to survive” and “If I fall apart, I will be a failure”.

The use of unhealthy eating behaviors as a coping response to stress was measured using the 7-item Giscombe-Woods “Using Food to Cope Scale” (UFTCS). This measure is not designed to assess more severe, pathological eating behaviors such as binge eating, but rather to capture the more commonplace, stress coping responses involving food. Examples of behaviors captured in this scale include: treating yourself to comfort foods to relieve stress; eating in the absence of hunger; and eating prepared foods due to perceived lack of time to cook. The tool assesses the frequency of specific behaviors over the past month using a 5-point likert scale. The scale has been demonstrated to have good internal reliability among adult African American women (α = 0.82) as well as adult African American men and women with pre-diabetes (α = 0.82). 

Symptoms of BED were assessed using the Binge Eating Scale (BES), a 16-item self-administered questionnaire that assesses the severity of BED symptoms. Gormally et al. (1982) found the scale to have high internal consistency (as measured through a chi-squared test for significance, all 16 items > 9.1, p < 0.01). The BES has also shown to have high internal consistency in bariatric surgery patients (α = 0.87) and in obese women (α = 0.89). Scores between 18 and 26 suggest the presence of moderate bingeing behavior and scores greater than 27 may be an indication of severe/clinical binge eating.

Symptoms of NES were assessed using the Night Eating Questionnaire (NEQ) developed by Allison et al. (2008), the NEQ is a 17-item, self-administered likert-type scale with acceptable internal consistency (α = 0.70) among bariatric surgery patients and has been used 61 in studies with African American women. Scores can range between 0 – 52 with scores > 25 being “suggestive of NES” and scores > 30 being s “strong indicator” of the presence of NES.

The Sallis Social Support Surveys for Diet (SS-D) and Exercise (SS-E) Behaviors204 are widely-used 23-item, self-administered questionnaires with acceptable internal consistency (α = 0.80 – 0.87 (friend support for diet, by subscale), α = 0.83 – 0.87 (family support for diet, by subscale), α = 0.84 (friend support for exercise), α = 0.61 – 0.91 (family support for exercise, by subscale). The surveys have been used in several studies with African American women.