Publications

Scholarly Journals--Published

• Leibow, M. S., Lee, J. W., & Morton, K. R. (2020). Exercise, Flourishing, and the Positivity Ratio in Seventh-Day Adventists: A Prospective Study. American Journal of Health Promotion. https://doi.org/10.1177/0890117120930392 Purpose: Flourishing and mental health in the prediction of health behaviors such as exercise has been understudied. Positive emotions may promote, and negative emotions hinder protective health behaviors; however, the direction of these associations is unclear. The objective here was to investigate possible associations prospectively. Design: Longitudinal cohort study. Setting: National Sample: The Biopsychosocial Religion and Health Study of Seventh-day Adventists provided longitudinal data from 2006 to 2007 and 2010 to 2011 (n=5789). Measures: Flourishing was based on 6 measures of social functioning (positive social exchanges, negative social exchanges, religious emotional support given, received, and anticipated, and negative interactions) and 4 measures of psychological functioning (mastery, self-esteem, spiritual meaning, and perceived stress). The positivity ratio was the ratio of positive to negative emotions assessed with the Positive and Negative Affect Schedule. Analysis: Linear multiple regression and mediation. Results: Flourishing worked indirectly through the positivity ratio to predict a later increase in exercise over the course of 3 to 5 years. Tests of mediation suggest that the association of flourishing with later exercise was indirect through an increased ratio of positive to negative affect. Initial exercise frequency was also associated with later improved flourishing and positivity ratio scores over the same period. Conclusion: The association of mental health and exercise is likely bidirectional. Exercise improves mental health, and those that have better psychosocial functioning have better mood and are more likely to increase exercise behaviors over time. Exercise is likely integral to mental health in mid to late life. (06/2020) (link)
• Tan, A., Morton, K. R., Lee, J. W., Hartman, R., & Lee, G. (2020). Adverse childhood experiences and depressive symptoms: Protective effects of dietary flavonoids. Journal of Psychosomatic Research, 131. https://doi.org/10.1016/j.jpsychores.2020.109957 Objectives: Adverse childhood experiences (ACEs) are associated with increased in?ammation, stress, and depression. Diet patterns rich in ?avonoids may bu?er the e?ects of ACEs on depression through neuroprotective mechanisms. No studies have examined the protective e?ects of dietary ?avonoids on depressive symptoms after ACEs. We examine the relationships among ACEs, perceived stress, depressive symptoms, and ?avonoid intake in older adults.Methods: In this longitudinal cohort study, ?avonoid intake was provided by 6404 Seventh-day Adventist adults in North America who, as part of the Adventist Health Study-2, completed a validated food frequency questionnaire in 2002–6. ACEs, perceived stress, and depressive symptoms were assessed in the Biopsychosocial Religion and Health Study in 2006–7 and 2010–11. Bootstrapping models predicting depression were tested after controls.Results: ACEs were associated with adult depressive symptoms and perceived stress mediated this relationship. A moderated mediation model indicates that ?avonoid intake bu?ers the association between perceived stress and depressive symptoms after ACEs. Flavonoid consumption was negatively associated with depressive symptoms (β = −0.034, p = .03). As ACEs increased by one standard deviation, depressive symptoms increased through the interaction of perceived stress and ?avonoids when ?avonoids were consumed a standard deviation below the mean (e?ect = 0.040 SD, BC 95% CI [0.030, 0.052]). Depressive symptoms were lower for those that consumed ?avonoids a standard deviation above the mean (e?ect =. 035 SD, BC 95% CI [0.025, 0.046]).Conclusion: A varied diet rich in ?avonoids may reduce depressive symptoms associated with perceived stress following ACEs exposure. (02/2020) (link)
• Dos Santos, H., Raphael, J. C., Reis, W. P., Gaio, J., Berk, L. S., Bellinger, D., & Lee, J. W. (2019). The Association between Affect and Biomarkers of Stress and Inflammation in Healthy Seventh-day Adventists. Advances in Mind-Body Medicine, 33(3), 12-20. Objectives • To evaluate the association between positive and negative affective states with stress biomarkers, biomarkers of inflammation and blood pressure in a population of healthy Seventh-day Adventists.Design • In a cross-sectional study, biomarkers were regressed on positive and negative affect and control variables among reportedly healthy 133 females and 100 males (35% Black and 65% White) who provided blood and urine samples following completion of a questionnaire and measurement of anthropometrics and vital signs.Setting/Location • Data were extracted from the Biological Manifestations of Religion Study, an NIA-funded study conducted in members of the entity who lived within driving distance of two clinic sites.Outcome Measures • The stress biomarkers, epinephrine, and norepinephrine, were measured in 12-hour overnight urine samples analyzed by high-performance liquid chromatography. Urinary cortisol was evaluated by enzyme-linked immunosorbent assay (ELISA) and normalized for urinary output (reported in µg/g creatinine). Serum DHEA-S (reported in µg/ml) was measured by ELISA. Inflammatory markers included CRP (ng/ml), IL-6, IL-10, and TNF-α, all analyzed in serum by ELISA, and the data expressed in pg/ml.Results • Multiple linear regression analyses showed after controlling for age, gender, ethnicity, body mass index (BMI), education, socioeconomic status, exercise, and use of blood pressure medication, that negative affect was associated with higher levels of epinephrine (β = .143; P = .030). Positive affect was not associated with the biomarkers.Conclusions • While negative affect was associated with a biomarker of sympathetic stimulation, positive affect was not protective against such stimulation. (07/2019)
• Teteh, D. K., Lee, J. W., Montgomery, S. B., & Wilson, C. M. (2019). Working Together with God: Religious Coping, Perceived Discrimination, and Hypertension. Journal of Religion and Health. doi:10.1007/s10943-019-00822-w This study examined the relationships of perceived discrimination and religious coping with hypertension in a sample of Black and White Seventh-day Adventists. Data come from a community-based sample of 6128 White American, 2253 African American and 927 Caribbean American adults (67% women; mean age = 62.9 years). Results indicate lifetime unfair treatment was significantly associated with hypertension regardless of race/ethnicity. Positive religious coping was associated with lower odds of hypertension and did not interact with unfair treatment. Both positive and negative religious coping were indirectly associated with increased hypertension risk through an increase in perceived discrimination.Keywords Discrimination · Religious coping · Hypertension · Allostatic load (04/2019)
• Morton, K. R., Tanzini, L., & Lee, J. W. (2019). Adult Life Satisfaction and the Role of Forgiveness After Childhood Sexual Abuse: Evidence from a Seventh-day Adventist Cohort. Journal for the Scientific Study of Religion, 58(1), 138-152. doi:10.1111/jssr.12575 Negative physical and mental health outcomes are well documented for those who experience child sexual abuse. We explore the role of three types of dispositional forgiveness (of self, of others, and by God) as effect modifiers of the child sexual abuse and life satisfaction relationship. In 2010–2011, a sample of 5,506 Seventh-day Adventists reported levels of forgiveness, life satisfaction, and whether or not they had experienced sexual abuse in each of the two age periods (younger than 8 years and 8–18 years). Reported experience of childhood sexual abuse lowered life satisfaction regardless of when the child sexual abuse occurred. Forgiveness of self and of others were associated with higher life satisfaction regardless of sexual abuse exposure. Feeling forgiven by God was associated with increased life satisfaction indirectly through forgiveness of self and others. However, for those abused later in childhood, the association of abuse with reduced life satisfaction was weaker for those who felt forgiven by God. These findings suggest forgiveness by God operates primarily through forgiveness of self (and others) but can also buffer the effects of childhood sexual abuse on later life satisfaction when the abuse occurs in childhood/adolescence. (01/2019)
• Banta, J., Lee, J., Hodgkin, G., Yi, Z., Fanica, A., & Sabate, J. (2018). The Global Influence of the Seventh-Day Adventist Church on Diet. Religions, 9(9), 251. doi:https://doi.org/10.3390/rel9090251 The emphasis on health ministry within the Seventh-day Adventist (SDA) movement led to the development of sanitariums in mid-nineteenth century America. These facilities, the most notable being in Battle Creek, Michigan, initiated the development of vegetarian foods, such as breakfast cereals and analogue meats. The SDA Church still operates a handful of food production facilities around the world. The ?rst Battle Creek Sanitarium dietitian was co-founder of the American Dietetics Association which ultimately advocated a vegetarian diet. The SDA Church established hundreds of hospitals, colleges, and secondary schools and tens of thousands of churches around the world, all promoting a vegetarian diet. As part of the ‘health message,’ diet continues to be an important aspect of the church’s evangelistic efforts. In addition to promoting a vegetarian diet and abstinence from alcohol, the SDA church has also invested resources in demonstrating the health bene?ts of these practices through research. Much of that research has been conducted at Loma Linda University in southern California, where there have been three prospective cohort studies conducted over 50 years. The present study, Adventist Health Study-2, enrolled 96,194 Adventists throughout North America in 2003–2004 with funding from the National Institutes of Health. Adventist Health Studies have demonstrated that a vegetarian diet is associated with longer life and better health. (08/2018)
• Schulz, K. A., Modeste, N., Lee, J. W., Roberts, R., Saunders, G. H., & Witsell, D. L. (2017). Burden of Hearing Loss on Communication Partners and Its Influence on Pursuit of Hearing Evaluation. Ear and Hearing, 38(5), e285-e291. doi:10.1097/AUD.0000000000000421 OBJECTIVE: Describe how the burden on the communication partner (CP) from the patient's hearing loss, as perceived by both the patient and their CP, influences a patient's pursuit of hearing evaluation. DESIGN: Cross-sectional design. Demographics, perception of patient's hearing loss, and associated burden on the CP were collected from both patient and CP via online questionnaires. Patients and their CPs from Duke University Medical Center Otolaryngology Clinic, 55 to 75 years of age, being seen for any reason, who indicated a CP has expressed concern about their hearing. Final sample was 245 matched pairs. RESULTS: Based on completed questionnaires, on average, patients perceived their own hearing loss as more burdensome to the CP than the CP did. However, CPs of patients who believed themselves to have no hearing handicap scored the patient's hearing loss 54.3% higher than the patient. The patient's perspective about the amount of burden their hearing loss placed on the CP predicted patients seeking a hearing evaluation. CONCLUSIONS: Recognition of early stage hearing loss and associated burden on CPs may be delayed in patients; CPs may help elucidate unrecognized concerns. Educational approaches that raise awareness of burden of hearing loss on CPs along with hearing loss indications could be a feasible, multidimensional strategy to promote help seeking behaviors. (09/2017)
• Alanazi, N. H., Lee, J. W., Dos Santos, H., Job, J. S., & Bahjri, K. (2017). The use of planned behavior theory in predicting cigarette smoking among Waterpipe smokers. Tobacco Induced Diseases, 15, 29. doi:10.1186/s12971-017-0133-z BACKGROUND: Waterpipe and cigarette smoking have been found to be associated with each other as cigarette smokers were more likely to be waterpipe users than non-cigarette smokers. Also, waterpipe smokers were likely to be former daily cigarette users. The aim of this study is to examine the likelihood of waterpipe use leading to cigarette use among current waterpipe users using theory of planned behavior. METHODS: Four hundred six current waterpipe smokers who initially had started tobacco use with the waterpipe were recruited from 15 waterpipe lounges in 2015. From a total of 70 waterpipe lounges in Riyadh, the 15 waterpipe lounges were selected randomly and participants were also selected randomly inside each waterpipe lounge based on the table or section number. The survey was developed using the Qualtrics Online Survey Software and participants completed a survey using iPad tablets. RESULTS: Cigarette smoking and intention to smoke cigarettes were predicted by attitude and perceived behavioral control. There was no direct effect of subjective norm on the cigarette use behavior, yet subjective norm had a statistically significant indirect effect on intentions through attitude and perceived behavioral control. CONCLUSIONS: The findings of this study could be useful in prevention/intervention programs aimed at reducing tobacco smoking behaviors among waterpipe users. Intervention programs might be directed at the attitude and perceived behavioral control by targeting underlying behavioral and control beliefs. The theory of planned behavior provided solid explanations of intention to use cigarettes among waterpipe smokers. (07/2017)
• Teteh, D. K., Lee, J. W., Montgomery, S. B., & Wilson, C. M. (2017). Validity of Self-Reported High Blood Pressure among Black and White Seventh-Day Adventists. International Journal of Health Sciences and Research (IJHSR), 7(7), 212-220. Background: Self-reported diagnosis of high blood pressure is frequently used to study representative samples of a population.Objective: Using a cross-sectional design, we examined the relationship between self-reported high blood pressure and clinical evidence for the disease, such as use of antihypertensive medications. Methods: A community-based sample of older Seventh-day Adventist adults aged 50 years and older (n = 457) was recruited from a prospective cohort study. Confirmed high blood pressure was defined as using an antihypertensive medication, having a systolic blood pressure ≥ 140 mmHg, or a diastolic blood pressure ≥ 90 mmHg.Results: There were 236 (52.0%) out of 457 participants with self-reported high blood pressure. Blacks (n = 118, 64.8%) reported higher rates of high blood pressure compared to Whites (n = 118, 42.9%). Based on the diagnostic criteria 13.6% (n = 62) were undiagnosed with high blood pressure. Blacks (49.7%) were more likely to report a true positive diagnosis and Whites (50.2%) were more likely to report a true negative diagnosis of high blood pressure. Sensitivity was 72% and specificity 80%. Sensitivity was significantly higher for Blacks (80%) than for Whites (62%). Agreement between self-report and diagnostic criteria for high blood pressure was substantial (kappa 0.68) across all participants.Conclusions: Our findings add to the evidence that self-report is usually a valid method for assessing high blood pressure, at least for studies with large sample sizes. The greater sensitivity rate for Blacks than Whites suggests that self-report of high blood pressure is more accurate for Blacks. (07/2017)
• Fider, C. R., Lee, J. W., Gleason, P. C., & Jones, P. (2017). Influence of Religion on Later Burden and Health of New Black and White Caregivers. Journal of Applied Gerontology. doi:10.1177/0733464817703017 OBJECTIVE: We assessed the relationship between positive aspects of religiosity and reduced stress in caregivers, and negative aspects of religiosity and increased caregiver burden. METHOD: Using data from the Biopsychosocial Religion and Health Study, we performed multiple linear regression analysis on 584 caregivers. RESULTS: Mental health, but not physical health, was predicted by caregiver burden. Caregivers who viewed God as loving and not controlling and felt a sense of community with their church family had less burden. Caregivers who engaged in negative religious coping had a greater decline in mental health than those who saw God as loving and not controlling and who gave emotional support to others. DISCUSSION: Some aspects of religion appear to play an important role in alleviating the mental stresses of being a caregiver. (04/2017)
• Morton, K. R., Lee, J. W., & Martin, L. R. (2017). Pathways From Religion to Health: Mediation by Psychosocial and Lifestyle Mechanisms. Psychology of Religion and Spirituality, 9(1), 106-117. doi:10.1037/rel0000091 Religiosity, often measured as attendance at religious services, is linked to better physical health and longevity though the mechanisms linking the two are debated. Potential explanations include a healthier lifestyle, increased social support from congregational members, and/or more positive emotions. Thus far, these mechanisms have not been tested simultaneously in a single model though they likely operate synergistically. We test this model predicting all-cause mortality in Seventh-day Adventists (SDAs), a denomination that explicitly promotes a healthy lifestyle. This allows the more explicit health behaviors linked to the religious doctrine (e.g., healthy diet) to be compared with other mechanisms not specific to religious doctrine (e.g., social support and positive emotions). Finally, this study examines both church activity (including worship attendance and church responsibilities) and religious engagement (coping, importance, and intrinsic beliefs). Religious engagement is more inner-process focused (vs. activity-based) and less likely to be confounded with age and its associated functional status limitations, although it should be noted that age is controlled in the present study. The findings suggest that religious engagement and church activity operate through the mediators of health behavior, emotion, and social support to decrease mortality risk. All links between religious engagement and mortality are positive but indirect through positive religious support, emotionality, and lifestyle mediators. However, church activity has a direct positive effect on mortality as well as indirect effects through religious support, emotionality, and lifestyle mediators (diet and exercise). The models were invariant by gender and for both Blacks and Whites. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (01/2017)
• Wigginton, M., Lee, J., Marshak, H. H., & Freier, K. (2016). Modifying the Theory of Planned Behavior to Predict Children’s Exercise Behaviors. The International Journal of Health, Wellness, and Society, 6(2), 57-71. modified Theory of Planned Behavior (TPB) (Ajzen 1991) was applied to predict children’s exercise behaviors and determine if the constructs attitude, subjective norm, and perceived behavioral control (PBC) directly predict children’s exercise behaviors better than intention. We also examined whether body mass index, socioeconomic status, age, gender, past exercise behaviors, and planning improved prediction of children’s exercise behaviors. Children (N=345) ages eight to fourteen years participated in the study. Attitude, subjective norm, and PBC were found to significantly predict 25.4% of the variance in children’s exercise (p < .001). Intention was not a significant predictor, contributing less than 1% to the prediction of children’s exercise behaviors. The modified model was found to have a significantly better fit (Z (345) = 3.11, p = .002), in that it predicted 9.7% more variance in children’s physical activity than the original TPB model. (06/2016)
• Holland, K. J., Lee, J. W., Marshak, H. H., & Martin, L. R. (2016). Spiritual Intimacy, Marital Intimacy, and Physical/Psychological Well-Being: Spiritual Meaning as a Mediator. Psychology of Religion and Spirituality, 8(3), 218-227. doi:10.1037/rel0000062 Intimacy is an essential part of marital relationships, spiritual relationships, and is also a factor in well-being, but there is little research simultaneously examining the links among spiritual intimacy, marital intimacy, and well-being. Structural equation modeling was used to examine associations among the latent variables—spiritual intimacy, marital intimacy, spiritual meaning, and well-being—in a cross-sectional study of 5,720 married adults aged 29 to 100 years (M = 58.88, SD = 12.76, 59% female). All participants were from the Adventist Health Study-2, Biopsychosocial Religion and Health Study. In the original structural model, all direct associations between the 3 latent variables of spiritual intimacy, marital intimacy, and well-being were significantly positive indicating that there was a significant relationship among spiritual intimacy, marital intimacy, and well-being. When spiritual meaning was added as a mediating variable, the direct connections of spiritual intimacy to marital intimacy and to well-being became weakly negative. However, the indirect associations of spiritual intimacy with marital intimacy and with well-being were then strongly positive through spiritual meaning. This indicates that the relationship among spiritual intimacy, marital intimacy, and well-being was primarily a result of the meaning that spiritual intimacy brought to one’s marriage and well-being, and that without spiritual meaning greater spirituality could negatively influence one’s marriage and well-being. These findings suggest the central place of spiritual meaning in understanding the relationship of spiritual intimacy to marital intimacy and to well-being. (PsycINFO Database Record (c) 2016 APA, all rights reserved). (journal abstract) (03/2016)
• Schulz, K. A., Modeste, N., Lee, J., Roberts, R., Saunders, G. H., & Witsell, D. L. (2016). Factors influencing pursuit of hearing evaluation: Enhancing the health belief model with perceived burden from hearing loss on communication partners. International Journal of Audiology, 55(sup3), S69-S78. doi:10.3109/14992027.2015.1136437 OBJECTIVE: There is limited application of health behavior-based theoretical models in hearing healthcare, yet other fields utilizing these models have shown their value in affecting behavior change. The health belief model (HBM) has demonstrated appropriateness for hearing research. This study assessed factors that influence an individual with suspected hearing loss to pursue clinical evaluation, with a focus on perceived burden of hearing loss on communication partners, using the HBM as a framework. DESIGN: Cross-sectional design collecting demographics along with three validated hearing-loss related questionnaires. STUDY SAMPLE: Patients from Duke University Medical Center Otolaryngology Clinic aged 55-75 years who indicated a communication partner had expressed concern about their hearing. A final sample of 413 completed questionnaire sets was achieved. RESULTS: The HBM model construct 'cues to action' was a significant (p <0.001) predictor of pursuing hearing evaluation. Perceived burden of hearing loss on communication partners was a significant (p <0.001) predictor of pursuing hearing evaluation and improves the model fit when added to the HBM: 72.0% correct prediction when burden is added versus 66.6% when not (p <0.0001). CONCLUSIONS: Hearing healthcare initiatives that incorporate these factors may improve hearing help-seeking behavior. More research using sound theoretical models in hearing healthcare is warranted. (02/2016)
• Reinert, K. G., Campbell, J. C., Bandeen-Roche, K., Lee, J. W., & Szanton, S. (2015). The Role of Religious Involvement in the Relationship Between Early Trauma and Health Outcomes Among Adult Survivors. Journal of Child & Adolescent Trauma, 9, 231-241. doi:10.1007/s40653-015-0067-7 The purpose of this study was to determine the role of religious involvement and related indicators - religious coping, intrinsic religiosity, forgiveness and gratitude - in reducing the negative impact of early traumatic stress on the mental and physical health of adult survivors. Multiple linear regressions were used to analyze self-reported data of 10,283 Seventh-day Adventist men and women across North America. The study also included an original analysis on a subsample (n = 496) of the larger group, examining diabetes risk factors in conjunction with Adverse Childhood Events (ACE) data. Higher early trauma scores were associated with decreased mental health (B = −1.93 p < .0001) and physical health (B = −1.53, p < .0001). The negative effect of early trauma on mental health was reduced by intrinsic religiosity (B = .52, p = .011), positive religious coping (B = .61, p = .025), forgiveness (B = .32 p = .025), and gratitude (B = .87 p = .001). Adult survivors of early trauma experienced worse mental and physical health; however, forgiveness, gratitude, positive religious coping, and intrinsic religiosity were protective against poor mental health. The findings support a holistic perspective in the care of childhood trauma survivors. (11/2015) (link)
• Reinert, K. G., Campbell, J. C., Bandeen-Roche, K., Lee, J. W., & Szanton, S. (2015, in press). The Role of Religious Involvement in the Relationship Between Early Trauma and Health Outcomes Among Adult Survivors. the Journal of Child and Adolescent Trauma, 8(4). Purpose: The purpose of this study was to determine the role of religious involvement and related indicators - religious coping, intrinsic religiosity, forgiveness and gratitude - in reducing the negative impact of early traumatic stress on the mental and physical health of adult survivors. Design and Methods: Multiple linear regressions were used to analyze self-reported data of 10,283 Seventh-day Adventist men and women across North America. The study also included an original analysis on a subsample (n=496) of the larger group, examining diabetes risk factors in conjunction with Adverse Childhood Events (ACE) data. Results: Higher early trauma scores were associated with decreased mental health (B= -1.93 p<.0001) and physical health (B= -1.53, p<.0001). The negative effect of early trauma on mental health was reduced by intrinsic religiosity (B=.52, p=.011), positive religious coping (B=.61, p=.025), forgiveness (B=.32 p=.025) and gratitude (B=.87 p=.001). Conclusion:  Adult survivors of early trauma experienced worse mental and physical health; however, forgiveness, gratitude, positive religious coping, and intrinsic religiosity were protective against poor mental health. The findings support a holistic perspective in the care of childhood trauma survivors. (10/2015)
• Charlemagne-Badal, S. J., & Lee, J. W. (2015). Religious Social Support and Hypertension Among Older North American Seventh-Day Adventists. Journal of Religion & Health, 55, 709-728. doi:10.1007/s10943-015-0104-8 Seventh-day Adventists have been noted for their unique lifestyle, religious practices and longevity. However, we know little about how religion is directly related to health in this group. Specifically, we know nothing about how religious social support is related to hypertension. Using data from the Biopsychosocial Religion and Health Study, we carried out a cross-sectional study of 9581 and a prospective study of 5720 North American Seventh-day Adventists examining new 534 cases of hypertension occurring up to 4 years later. We used binary logistic regression analyses to examine study hypotheses. Of the religious social support variables, in both the cross-sectional and prospective study only anticipated support significantly predicted hypertension, but the relationship was mediated by BMI. There were no significant race or gender differences. The favorable relationships between anticipated support and hypertension appear to be mediated by BMI and are an indication of how this dimension of religion combined with lifestyle promotes good health, specifically, reduced risk of hypertension. (09/2015)
• Charlemagne-Badal, S. J., & Lee, J. W. (2015). Intrinsic Religiosity and Hypertension Among Older North American Seventh-Day Adventists. Journal of Religion & Health. doi:10.1007/s10943-015-0102-x A unique lifestyle based on religious beliefs has been associated with longevity among North American Seventh-day Adventists (SDAs); however, little is known about how religion is directly associated with hypertension in this group. Identifying and understanding the relationship between hypertension and its predictors is important because hypertension is responsible for half of all cardiovascular-related deaths and one in every seven deaths in the USA. The relationship between intrinsic religiosity and hypertension is examined. Cross-sectional data from the Biopsychosocial Religion and Health Study (N = 9581) were used. The relationship between intrinsic religiosity and hypertension when controlling for demographics, lifestyle variables, and church attendance was examined using binary logistic regression. While lifestyle factors such as vegetarian diet and regular exercise were important predictors of reduced rates of hypertension, even after controlling for these, intrinsic religiosity was just as strongly related to lower hypertension rates as the lifestyle factors. This study is the first to examine the relationship between intrinsic religiosity and hypertension among North American SDAs and demonstrates that in addition to the positive effects of lifestyle choices on health noted in the group, religion may offer direct salutary effects on hypertension. This finding is particularly important because it suggests that religiosity and not just lifestyle is related to lower risk of hypertension, a leading cause of death in the USA. (09/2015)
• Reinert, K. G., Campbell, J. C., Bandeen-Roche, K., Sharps, P., & Lee, J. (2015). Gender and race variations in the intersection of religious involvement, early trauma, and adult health. Journal of Nursing Scholarship, 47(4), 318-327. doi:10.1111/jnu.12144 PURPOSE: This study aimed to determine gender and race variations in regards to the influence of religious involvement (RI) as a moderator of the effects of early traumatic stress (ETS) on health-related quality of life among adult survivors of child abuse. DESIGN: A cross-sectional predictive design was used to study Seventh-day Adventist adults in North America (N = 10,283). METHODS: A secondary analysis of data collected via questionnaires was done using multiple regression. RESULTS: Data revealed that women had a significantly higher prevalence of any or all ETS subtypes, except for physical abuse prevalence, which was the same for both genders. Blacks reported a significantly higher prevalence of at least one ETS subtype than did Whites, except for neglect, where Whites had a higher prevalence. Exposure to at least one ETS subtype was associated with worse negative effect on mental health (B = -2.08, p < .0001 vs. B = -1.54, p < .0001) and physical health (B = -2.01, p < .0001 vs. B = -1.11, p < .0001) for women compared to men. Among those exposed to all ETS subtypes (n = 447), Whites had significant worse physical health, with White women having almost two times the negative effect on physical health (B = -4.50, p < .0001) than White men (B = -2.87, p < .05). As for RI moderation, based on tests of three-way interactions of race-RI-ETS, there were no associated differences. However, tests of three-way interactions of gender-RI-ETS showed a significant buffering effect. Among those with high levels of negative religious coping (RC), women exposed to ETS had significantly worse physical health (B = -1.28) than men. CONCLUSIONS: Results give evidence of gender and racial differences on the magnitude of the ETS-health effect, as well as gender differences in ETS-health buffering by RC. CLINICAL RELEVANCE: Findings suggest gender and racial differences must be considered when devising holistic nursing interventions for improving health outcomes of early trauma survivors. (07/2015)
• Tareg, A. R., Modeste, N. N., Lee, J. W., & Santos, H. D. (2015). Health Beliefs About Tobacco With Betel Nut Use Among Adults in Yap, Micronesia. International Quarterly of Community Health Education, 35(3), 245-257. doi: 10.1177/0272684X15581344 Tobacco use is high among Pacific Islanders in general and little tobacco research has been done in Yap, Micronesia. This study aimed to explore perceptions of tobacco use coupled with chewing of betel (areca) nut among adults in Yap using self-administered questionnaires based on the health belief model. A Likert scale (ranging from strongly disagree to strongly agree or very unlikely to very likely) was used to measure susceptibility, severity, benefits, barriers, cues to action, and self-efficacy among individuals aged 18 and older. Older adults felt quitting tobacco or betel nut use would be significantly more difficult because of social reasons and withdrawal problems. Most participants felt susceptible to tobacco-related diseases. These findings possibly indicate a receptive attitude toward any future tobacco use prevention and intervention program. Older Yapese population would need to be especially targeted. Health promotion programs should target smoking behaviors and risk reduction. (07/2015)
• McKinney, O., Modest, N. N., Lee, J. W., & Gleason, P. C. (2015). Predicting Malawian women’s intention to adhere to antiretroviral therapy. Journal of Public Health Research, 4(2), 82-89. doi: http://dx.doi.org/10.4081/jphr.2015.533 Background. With the increase in scaling up of antiretroviral therapy (ART), knowledge of the need for adherence to ART is pivotal for successful treatment outcomes.Design and Methods. A cross-sectional study was carried out between October and December 2013. We administered theory of planned behaviour (TPB) and adherence questionnaires to 358 women aged 18-49 years, from a rural and urban ART-clinics in southern Malawi. Hierarchical linear regression models were used to predict intentions to adhere to ART. Results. Regression models showed that attitude (β=0.47), subjective norm (β=0.31), and perceived behavioral control (β=0.12) explain 55% of the variance in intentions to adhere to ART. The relationship between both food insecurity and perceived side effects with intentions to adhere to ART is mediated by attitude, subjective norm, and perceived behavioural control. Household (r=0.20) and individual (r=0.21) food insecurity were positively and significantly correlated with perceived behavioural control. Household food insecurity had a negative correlation with perceived side effects (r=-0.11). Perceived side effects were positively correlated with attitude (r=0.25). There was no statistically significant relationship between intentions to adhere to ART in the future and one month self-report of past month adherence. These interactions suggest that attitude predicted adherence only when food insecurity is high or perception of side effects is strong.Conclusions. This study shows that modification might be needed when using TPB constructs in resource constraint environments (07/2015)
• Holt, M. E., Lee, J. W., Morton, K. R., & Tonstad, S. (2015). Trans fatty acid intake and emotion regulation. Journal of Health Psychology, 20(6), 785-793. doi: 10.1177/1359105315580215 We examined whether there is a relationship between trans fatty acid intakes and emotion regulation, mediated by positive or negative affect. Archival data on 1699 men and 3293 women were used to measure trans fatty acid intake at baseline, positive, and negative affects and emotion regulation at follow-up. Higher trans fatty acid intake related to subsequent difficulties with emotional awareness (p = 0.045), clarity (p = 0.012), and regulation strategies (p = 0.009). Affect mediated these relationships. Lower trans fatty acid intake associated with increased positive and decreased negative affects which, in turn, associated with improved emotion regulation. Trans fatty acid intakes may be associated with subsequent ability to regulate emotions. (06/2015)
• Hemmy Asamsama, O., Lee, J. W., Morton, K. R., & Tonstad, S. (2015). Bidirectional longitudinal study of type 2 diabetes and depression symptoms in Black and White church going adults. Journal of Diabetes & Metabolic Disorders, 14, 25. doi: 10.1186/s40200-015-0150-5 BACKGROUND: There is a need to longitudinally examine depression and DM2 relationship in a population that values positive health behaviors. The aim of this study was to prospectively investigate the bidirectional relationship between depression and DM2. METHODS: A cohort sample of 4,746 Black (28.4%) and White (71.6%) Seventh-day Adventist adults who participated in the Biopsychosocial Religion and Health Study (BRHS) completed a short form of the Center for Epidemiologic Studies Depression Scale (CES-D) 11 along with self-report of lifetime physician diagnosis of type 2 diabetes (DM2) and treatment of DM2 and/or depression in the last 12 months in 2006-7 and 2010-11. Hierarchical logistic regression analyses were completed to predict risk for future disease while controlling for demographic and health related variables. RESULTS: While there were no direct effects of depression on later DM2, there was an indirect effect mediated by BMI (effect = 0.13; 95% CIs [0.08, 0.20]) even after controlling for demographic variables as covariates using Hayes' PROCESS macro mediation analysis. Similarly, there was also only an indirect effect of DM2 on later depression mediated by BMI (effect = 0.13; 95% CIs [0.05, 0.22]) after controlling for demographic variables. CONCLUSIONS: The results highlight BMI as a risk factor for both DM2 and depression. The negative consequences of having higher BMI in conjunction at baseline with another disease can increase the risk for other chronic disease even in a span of 2.04 - 5.74 years, the length of study interval. (05/2015)
• McKinney, O., Modeste, N. N., Lee, J. W., Gleason, P. C., & Maynard-Tucker, G. (2014). Determinants of Antiretroviral Therapy Adherence among Women in Southern Malawi: Healthcare Providers’ Perspectives. AIDS Research and Treatment, 2014, 1-9. doi: 10.1155/2014/489370 Background. The purpose of this study was to explore healthcare providers’ perspectives on antiretroviral (ART) adherence in two ART clinics in southern Malawi. Nonadherence to ART is a significant hindrance to the success of HIV/AIDS treatment. Methods. A one-on-one semistructured interview was conducted with eight healthcare providers in two ART clinics in rural and urban southern Malawi. The interviews were focused on factors facilitating or hindering ART adherence and strategies to improve adherence. Interviews were audio-recorded, transcribed, and content-analyzed with the use of the constant comparison approach. Results. Of the eight participants, 63% were between the ages of 20 and 30 years and 37% were HIV counselors. Factors facilitating adherence include patients’ belief and knowledge, HIV/AIDS education, and a supportive network. Barriers to adherence include discrimination, nondisclosure of HIV status, food insecurity, medication side effects, religion, misinformation, and staff and drug shortages. Strategies to improve adherence were identified by participants to include nutritional/food supplementation for malnourished or undernourished patients and patient counseling. Conclusions. There is a need for collaborative efforts between healthcare providers, patients, and faith-based organizations to identify and address hindrances and facilitators to patients’ adherence. Further research is needed to develop strategies addressing religion, staff, and drug shortages. (12/2014) (link)
• Asamsama, O. H., Lee, J. W., Morton, K. R., & Tonstad, S. (2014). Validity of Type 2 Diabetes Self-Reports Among Black And White Church Going Adults. International Journal of Health Sciences and Research (IJHSR), 4(12), 286-293. Background: There is a paucity of research evaluating the accuracy of type 2 diabetes (DM2) self-reports compared to laboratory measures for Blacks and Whites.Objectives: The authors cross-sectionally compared DM2 self-reports to hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), and a diabetes medication inventory order to evaluate the accuracy of self-reports to laboratory measures. Methods: Data was collected as part of a community-based prospective cohort study of Black and White Seventh-day Adventist adults. Confirmed DM2 was defined as HbA1c³ 6.5% or FPG³ 126 mg/dL or use of hypoglycemic medications. Results: There were 50 (12.7%) out of 394 participants with self-reported DM2. Blacks (19.6%, n = 31) reported significantly higher rates of DM2 compared to Whites (8.1%, n = 19). Detection of undiagnosed DM2 within the total sample population ranged from 2.3% to 6.7% with higher rates of undiagnosed DM2 for Blacks (2.4% to 11.0%) compared to Whites (2.3% to 4.1%). The sensitivity of self-reported DM2 ranged from 65.2% to 80.5% and the specificity ranged from 95.2% to 97.9%, depending on the diagnostic criteria. Conclusions: Our findings add to the evidence that self-report is a relatively valid method for assessing DM2 with no observed ethnic differences. (12/2014)
• Serrano, S., Lee, J. W., Dehom, S., & Tonstad, S. (2014). Association of TV Watching With Sleep Problems in a Church-Going Population. Family & Community Health: The Journal of Health Promotion & Maintenance, 37(4), 279-287. doi: 10.1097/FCH.0000000000000038 Sensory stimuli/inactivity may affect sleep. Sleep problems are associated with multiple health problems. We assessed TV habits in the Adventist Health Study-2 at baseline and sleep problems in the Biopsychosocial Religion and Health Study 1 to 4 years later. After exclusions, 3914 subjects split equally into TV watchers less than 2 hours per day or 2 or more hours per day. Watching TV 2 or more hours per day predicted problems falling asleep, middle of the night awakening, and waking early with inability to sleep again in multiple logistic regression. Excess TV watching disturbed sleep induction and quality, though the relationship may be bidirectional. TV habits should be considered in individuals with sleep problems. (09/2014)
• Holt, M. E., Lee, J. W., Morton, K. R., & Tonstad, S. (2014). Mediterranean diet and emotion regulation. Mediterranean Journal of Nutrition and Metabolism. doi: DOI:10.3233/MNM-140016 BACKGROUND: Mediterranean dietary patterns have been associated with cardiovascular and psychological health, including positive affect. Emotion regulation has not been linked to this pattern.OBJECTIVE: The present study prospectively examined the relationship betweenMediterranean diet and later emotion regulation and whether positive or negative affect mediated any such relationship.METHODS: Data was derived from the Adventist Health Study-2 (2002-6), and Biopsychosocial  Religion and Health Substudy (2006-7; 2010-11). We assessed adherence to Mediterranean diet using the Trichopoulou score at baseline, and responses to Positive and Negative Affect Schedule (2006-7) and Difficulties in Emotion Regulation Scale (2010-11) in 1,699 men and 3,293 women. Statistical analyses were performed using multiple linear regression and Hayes PROCESS SPSS macros.RESULTS: Mediterranean dietary adherence scores were inversely related to difficulty with clarity of emotional responses 17 (B=−0.013, p = 0.006, 95% CI [−0.23, −0.004]) but unrelated to difficulty with awareness of emotional responses or lack of access to strategies for regulating emotions. Positive and negative affect fully mediated the diet and clarity relationship by respectively decreasing and increasing difficulty with clarity (effect scores −0.007 [95% CI −0.009, −0.005] and −0.005 [95%20 CI −0.001, −0.003]).CONCLUSIONS:Mediterranean diet adherence showed associationwith emotional clarity via increasing positive and decreasing negative affect. (08/2014)
• Superville, D. J., Pargament, K. I., & Lee, J. W. (2014). Sabbath Keeping and Its Relationships to Health and Well-Being: A Mediational Analysis. The International Journal for the Psychology of Religion, 24(3), 241-256. doi: 10.1080/10508619.2013.837655 Prior research showing positive relationships between indicators of religiousness and health has generally defined and measured religion broadly. In addition, researchers have not given much attention to the pathways through which the relationship between religion and health is maintained. The result is a lack of specificity which fails to address questions about how and why religion is associated with health. The present study sought to address these limitations and clarify the ties between religion and health through a finer grained analysis of one specific aspect of religiousness -- Sabbath-keeping -- and four possible mediators -- religious coping, religious support, diet, and exercise -- through which it might affect health. We examined data from a sample of Seventh-day Adventists in North America (N= 5411) and bootstrapping analysis reveal that the association between Sabbath-keeping and physical and mental health was partially mediated by all four mediators. Implications and limitations of the findings are discussed.Prior research showing positive relationships between indicators of religiousness and health has generally defined and measured religion broadly. In addition, researchers have not given much attention to the pathways through which the relationship between religion and health is maintained. The result is a lack of specificity which fails to address questions about how and why religion is associated with health. The present study sought to address these limitations and clarify the ties between religion and health through a finer grained analysis of one specific aspect of religiousness -- Sabbath-keeping -- and four possible mediators -- religious coping, religious support, diet, and exercise -- through which it might affect health. We examined data from a sample of Seventh-day Adventists in North America (N= 5411) and bootstrapping analysis reveal that the association between Sabbath-keeping and physical and mental health was partially mediated by all four mediators. Implications and limitations of the findings are discussed. (06/2014)
• Roberts, L. R., & Lee, J. W. (2014). Autonomy and Social Norms in a 3 Factor Grief Model Predicting Perinatal Grief in India. Health Care for Women International, 35(3), 285-299. doi: 10.1080/07399332.2013.801483 Perinatal grief following stillbirth is a significant social and mental health burden. We examined associations among the following latent variables: Autonomy, Social norms, Self-Despair, Strained Coping, and Acute Grief among poor, rural women of India after stillbirth. A structural equation model was built and tested using quantitative data from 347 women of reproductive age in Chhattisgarh. Maternal acceptance of traditional social norms worsens self-despair and strained coping and increases the autonomy granted to her. Greater autonomy increases acute grief. Greater despair and acute grief increase strained coping. Social and cultural factors were found to predict perinatal grief in India. (03/2014)
• Charlemagne-Badal, S. J., Lee, J. W., Butler, T. L., & Fraser, G. E. (2014). Conceptual domains included in wellbeing and life satisfaction instruments: A review. Applied Research in Quality of Life, 1-24. doi: 10.1007/s11482-014-9306-6 Wellbeing and life satisfaction instruments are increasingly used in health outcome research, and by health professionals. Despite their usefulness, the absence of an agreed on conceptual definition of wellbeing, and corresponding inconsistencies in operationalization, makes it difficult for researchers to operationalize the concept, and for health professionals to determine which instruments are most suitable for use. Therefore the aim of the study was to identify and define conceptual domains included in wellbeing, and life satisfaction instruments and delineate their operationalization. Using the Health and Psychosocial Instruments database (HaPI), a search for wellbeing and life satisfaction instruments was conducted for all available years using the key words of wellbeing, wellness, life satisfaction, and personal satisfaction. Measurement instruments were critically reviewed using five coding guides. Next, three raters content-analyzed the 680 items in the instruments and identified 15 conceptual domains. Finally, five other raters separately coded items into the 15 domains with a .83 coefficient of agreement. Twenty-six of the 250 instruments met inclusion criteria. The documents revealed moderate or high reliability and validity for the instruments. Items from the emotional health, physical health, social health, and non-leisure activities domains were most commonly included in the instruments. These domains were included in 73, 69, 65, and 65 % of all instruments respectively. No instrument included items from all 15 domains; the largest number included was 12 in two instruments. Despite the need for a comprehensive wellbeing instrument for research, and clinical applications, most wellbeing and life satisfaction instruments include only a few domains. (02/2014)
• Osei, D. K., Lee, J. W., Modest, N. N., & Pothier, P. K. T. (2013). Effects of an Online Support Group For Prostate Cancer Survivors: A Randomized Trial. Urologic Nursing, 33(3), 123-133. doi: 10.7257/1053-816X.2013.33.3.123 This longitudinal study evaluated the effect a prostate cancer-specific online support group had for self-assessed quality of life. Participants (N = 40) were randomly assigned to an online support group or the control group. Data consisted of four previously validated quality-of-life measurements. Analysis determined that over time, quality of life improved for those in the online group and decreased for those in the control group, but returned to baseline at eight weeks. Providing support using online methods is effective; the length of time this intervention should be provided to patients will require further research. (09/2013)
• Leon, N., Modeste, N., & Lee, J. (2012-2013). Predicting Mexican youths' intention to engage in risky behaviors: Applying moral norms to the theory of planned behavior.  International Quarterly of Community Health Education, 33(4), 349-362. doi: 10.2190/IQ.33.4.c This study explored if moral norms as applied to the theory of planned behavior (TPB) account for additional variance in predicting intention to consume alcohol, smoke cigarettes, and engage in sexual activity among youth at a high school in Mexico. Additionally, it investigated if moral norms provide a moderating influence on the constructs of the theory: attitude, subjective norm, and perceived behavioral control for prediction of risky behavior intention. Multiple regression analyses identified predictive power of constructs; interactions of moral norms with the theory constructs were studied. Moral norms only significantly predicted sexual activity. Significant interactions were found between moral norms and the theory constructs for the three behaviors. Interventions aimed at preventing risky conduct among youth would benefit from strategies targeting beliefs in the moral order, especially because of its interaction with the other theoretical mechanisms. (09/2013)
• Jadalla, A., & Lee, J. (2013). Validation of Arabic and English Versions of the ARSMA-II Acculturation Rating Scale. Journal of Immigrant and Minority Health. doi: 10.1007/s10903-013-9889-2 To translate and adapt the Acculturation Rating Scale of Mexican–Americans II (ARSMA-II) for Arab Americans. A multistage translation process followed by a pilot and a large study. The translated and adapted versions, Acculturation Rating Scale for Arabic Americans-II Arabic and English (ARSAA-IIA, ARSAA-IIE), were validated in a sample of 297 Arab Americans. Factor analyses with principal axis factoring extractions and direct oblimin rotations were used to identify the underlying structure of ARSAA-II. Factor analysis confirmed the underlying structure of ARSAA-II and produced two interpretable factors labeled as ‘Attraction to American Culture’ (AAmC) and ‘Attraction to Arabic Culture’ (AArC). The Cronbach’s alphas of AAmC and AArC were .89 and .85 respectively. Findings support ARSAA-II A & E to assess acculturation among Arab Americans. The emergent factors of ARSAA-II support the theoretical structure of the original ARSMA-II tool and show high internal consistency. (08/2013)
• Ford, Patricia A., Jaceldo-Siegl, Karen, Lee, Jerry W., Youngberg, Wes, & Tonstad, Serena. (2013). Intake of Mediterranean foods associated with positive affect and low negative affect. Journal of Psychosomatic Research, 74(2), 142-148. doi: 10.1016/j.jpsychores.2012.11.002 Objective To examine associations between consumption of foods typical of Mediterranean versus Western diets with positive and negative affect. Nutrients influence mental states yet few studies have examined whether foods protective or deleterious for cardiovascular disease affect mood. Methods Participants were 9255 Adventist church attendees in North America who completed a validated food frequency questionnaire in 2002–6. Scores for affect were obtained from the Positive and Negative Affect Schedule questionnaire in 2006–7. Multiple linear regression models controlled for age, gender, ethnicity, BMI, education, sleep, sleep squared (to account for high or low amounts), exercise, total caloric intake, alcohol and time between the questionnaires. Results Intake of vegetables (β = 0.124 [95% CI 0.101, 0.147]), fruit (β = 0.066 [95% CI 0.046, 0.085]), olive oil (β = 0.070 [95% CI 0.029, 0.111]), nuts (β = 0.054 [95% CI 0.026, 0.082]), and legumes (β = 0.055 [95% CI 0.032, 0.077]) were associated with positive affect while sweets/desserts (β = − 0.066 [95% CI − 0.086, − 0.046]), soda (β = − 0.025 [95% CI − 0.037, − 0.013]) and fast food frequency (β = − 0.046 [95% CI − 0.062, − 0.030]) were inversely associated with positive affect. Intake of sweets/desserts (β = 0.058 [95% CI 0.037, 0.078]) and fast food frequency (β = 0.052 [95% CI 0.036, 0.068]) were associated with negative affect while intake of vegetables (β = − 0.076 [95% CI − 0.099, − 0.052]), fruit (β = − 0.033 [95% CI − 0.053, − 0.014]) and nuts (β = − 0.088 [95% CI − 0.116, − 0.060]) were inversely associated with negative affect. Gender interacted with red meat intake (P &lt; .001) and fast food frequency (P &lt; .001) such that these foods were associated with negative affect in females only. Conclusions Foods typical of Mediterranean diets were associated with positive affect as well as lower negative affect while Western foods were associated with low positive affect in general and negative affect in women. (02/2013)
• Morton, K. R., Lee, J. W., Haviland, M. G., & Fraser, G. E. (2012). Religious Engagement in a Risky Family Model Predicting Health in Older Black and White Seventh-Day Adventists. Psychology of Religion and Spirituality, 4(4), 298-311. doi: 10.1037/a0027553 In a structural equation model, associations among latent variables—Child Poverty, Risky Family exposure, Religious Engagement, Negative Social Interactions, Negative Emotionality, and Perceived Physical Health—were evaluated in 6,753 Black and White adults aged 35–106 years (M = 60.5, SD = 13.0). All participants were members of the Seventh-day Adventist church surveyed in the Biopsychosocial Religion and Health Study. Child Poverty was positively associated with both Risky Family exposure (conflict, neglect, abuse) and Religious Engagement (intrinsic religiosity, religious coping, religiousness). Risky Family was negatively associated with Religious Engagement and positively associated with both Negative Social Interactions (intrusive, failed to help, insensitive, rejecting) and Negative Emotionality (depression, negative affect, neuroticism). Religious Engagement was negatively associated with Negative Emotionality and Negative Social Interactions. Negative Social Interactions was positively associated with Negative Emotionality, which had a direct, negative effect on Perceived Physical Health. All constructs had indirect effects on Perceived Physical Health through Negative Emotionality. The effects of a risky family environment appear to be enduring, negatively affecting one's adult religious life, emotionality, social interactions, and perceived health. Religious engagement, however, may counteract the damaging effects of early life stress. (10/2012)
• Roberts, L. R., Anderson, B. A., Lee, J. W., & Montgomery, S. B. (2012). Grief and Women: Stillbirth in the Social Context of India. International Journal of Childbirth, 2(3), 187-198. doi: 10.1891/2156-5287.2.3.187 INTRODUCTION: Few in Western society would argue the potentially devastating impact of stillbirth related grief; but in many developing countries where stillbirth remains the highest in the world, perinatal grief is barely recognized as an issue. The purpose of this study was to explore how poor, rural central Indian women perceive and cope with stillbirths. METHODS: Seventeen key informant interviews and two focus groups (N = 33) with local health care providers, family members, and women who experienced stillbirth were conducted over a 1-month period in 2011 and then systematically coded for emerging themes using grounded theory methods to explore how women experienced stillbirth. RESULTS: Although usually never talked about and not recognized as an issue, perinatal grief emerged as a significant shared experience by all. The perceptions of stillbirth-related grief emerged in three major themes and bear evidence of gender and power issues and indicate that local social norms negatively factor heavily into their perinatal grief experiences. DISCUSSION: The findings in this richly textured study add to the limited literature regarding rural, central Indian women's experiences with stillbirth and factors influencing their resulting perinatal grief. In light of the void of recognition of this phenomenon in Indian society, a better understanding of the context in which poor Indian women experience perinatal grief will be a first step toward developing much needed culturally rooted interventions to positively impact the women's abilities to better cope with stillbirth in the context of their realities. (09/2012) (link)
• Roberts, L., Montgomery, S., Lee, J., & Anderson, B. (2012). Social and Cultural Factors Associated with Perinatal Grief in Chhattisgarh, India. Journal of Community Health, 37(3), 572-582. doi: 10.1007/s10900-011-9485-0 Stillbirth is a globally significant public health problem with many medical causes. There are also indirect causal pathways including social and cultural factors which are particularly salient in India’s traditional society. The purpose of this study was to explore women’s perceptions of stillbirth and to determine how issues of gender and power, social support, coping efforts, and religious beliefs influence perinatal grief outcomes among poor women in rural Chhattisgarh, India. Structured interviews were done face-to-face in 21 randomly selected villages among women of reproductive age ( N = 355) who had experienced stillbirth ( n = 178) and compared to those who had not (n = 177), in the Christian Hospital, Mungeli catchment area. Perinatal grief was significantly higher among women with a history of stillbirth. Greater perinatal grief was associated with lack of support, maternal agreement with social norms, and younger maternal age. These predictors must be understood in light of an additional finding—distorted sex ratios, which reflect gender discrimination in the context of Indian society. The findings of this study will allow the development of a culturally appropriate health education program which should be designed to increase social support and address social norms, thereby reducing psychological distress to prevent complicated perinatal grief. Perinatal grief is a significant social burden which impacts the health women. (03/2012)
• Jadalla, A., & Lee, J. W. (2012). The Relationship Between Acculturation and General Health of Arab Americans. Journal of Transcultural Nursing, 23(2), 159-165. doi: 10.1177/1043659611434058  PURPOSE: To determine the relationship between acculturation and health status among Arab Americans in southern California. DESIGN: A cross-sectional survey with 297 adult Arab Americans used (a) a demographic and health survey, SF-36 Version-1, to assess physical and mental health and (b) the Acculturation Rating Scale for Arab Americans-II to assess acculturation. FINDINGS: Participants reported significantly better physical health and worse mental health compared to the published norm for the 1998 U.S. population. Better physical health was associated with demographic factors and bicultural identification; better mental health was associated with attraction to American culture. Attraction to American culture predicted alcohol use, whereas attraction to Arabic culture predicted cigarette smoking. Conclusion: Different patterns of association existed between acculturation and physical and mental health among Arab Americans. IMPLICATIONS: Findings suggest that acculturation is an important factor to consider in the well-being of Arab Americans, especially in their mental health. (08/2011)
•  Paalani, M., Lee, J. W., Haddad, E., & Tonstad, S. (2011). Determinants of inflammatory markers in a bi-ethnic population. [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov''t]. Ethnicity & Disease, 21(2), 142-149.     Background: Inflammation is a common pathophysiological pathway for a number of chronic diseases, and is strongly influenced by sociodemographic factors and lifestyle. Less is known about factors that may influence the inflammatory response in individuals of distinct ethnic backgrounds. Therefore, this study examined the relationship between ethnicity and blood levels of inflammatory markers in a sample of non-smoking church-goers.  Methods: In a cross-sectional investigation, 508 men and women (.35 years old, 62% White, 38% Black) participated in the Biopsychosocial Religion and Health substudy of the Adventist Health Study 2. The contribution of socioeconomic status (education level and difficulty meeting expenses for basic needs) and health covariates (exercise, vegetarian or other type of diet, body mass index, and presence of inflammatory conditions) toward serum levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-a) was assessed with linear regression models. Levels of interleukin-10 (IL-10), an anti-inflammatory marker, were also assessed.  Results: Blacks showed higher levels of CRP and IL-6 than Whites. Controlling for sociodemographic and health variables attenuated the ethnic difference in CRP while IL-6 levels remained higher in Blacks than in Whites (b5.118; 95% confidence interval5.014- .206; P5.025). Ethnic differences in IL-10 and TNF-a were not found. Vegetarian diet was associated with lower CRP levels while exercise frequency was associated with higher IL-10 levels.  Conclusion: Higher susceptibility of Blacks to inflammatory diseases may reflect higher IL-6, which could be important in assessing health disparities among Blacks and Whites. Vegetarian diet and exercise may counteract effects of disparities. (Ethn Dis. 2011;21(2):142-149)  (07/2011) (link)
• Tanyi, R. A., Berk, L. S., Lee, J. W., Boyd, K., & Arechiga, A. (2011). The Effects of a Psychoneuroimmunology (PNI) Based Lifestyle Intervention in Modifying the Progression of Depression in Clinically Depressed Adults. The International Journal of Psychiatry in Medicine, 42(2), 151-166. doi: 10.2190/PM.42.2.d  Objective: Uncontrolled stress can lead to poorly controlled upsurges of cortisol and deregulation of the hypothalamus pituitary-adrenal axis (HPA), thereby leading to major depression.  Psychoneuroimmunology (PNI) is the area of medicine dealing with the bidirectional pathways connecting the influences of brain, neuroendocrine and immune system.  Individual PNI-based lifestyle interventions such as humor and guided imagery have been shown to modulate the stress response.  However, researchers have not examined the composite effect of a PNI-based lifestyle intervention among clinically depressed adults.   Method: This randomized interventional study examined the composite effect(s) of a PNI-based lifestyle intervention: progressive muscle relaxation, spiritual guided imagery, and humor as an adjunct therapy to modifying the progression of depression.  Forty-one participants recruited from doctors’ offices in San Bernardino and Riverside counties in Southern California, USA, were randomized into two groups: treatment (N=20) and control (N= 21).  For a period of three weeks, participants in the treatment group listened to a 12-minute progressive muscle relaxation and spiritual guided imagery CD daily and watched 10 minutes of humorous DVDs.   Participants in both groups were also receiving cognitive behavioral therapy and pharmacotherapy. Results: Depression, spirituality, humor, and stress were assessed at baseline and week 3.  Depression significantly decreased from severe to mild from baseline to week 3 in the treatment group.  Spirituality significantly increased in the treatment group but remained unchanged in the controls. Conclusions: These findings offer depressed patients alternative approaches to preventing complications and managing their illness in the context of whole-person lifestyle optimization and integration of mind-body-spirit. (06/2011)
•  Jones, P. S., Lee, J. W., & Zhang, X. E. (2011). Clarifying and measuring filial concepts across five cultural groups. Research in Nursing & Health, 34(4), 310-326. doi: 10.1002/nur.20444    Literature on responsibility of adult children for aging parents reflects lack of conceptual clarity. We examined filial concepts across five cultural groups: African-, Asian-, Euro-, Latino-, and Native Americans. Data were randomly divided for scale development (n = 285) and cross-validation (n = 284). Exploratory factor analysis on 59 items identified three filial concepts: Responsibility, Respect, and Care. Confirmatory factor analysis on a 12-item final scale showed data fit the three-factor model better than a single factor solution despite substantial correlations between the factors (.82, .82 for Care with Responsibility and Respect, and .74 for Responsibility with Respect). The scale can be used in cross-cultural research to test hypotheses that predict associations among filial values, filial caregiving, and caregiver health outcomes. © 2011 Wiley Periodicals, Inc. Res Nurs Health 34:310–326, 2011 (05/2011) (link)
•  Jones, P. S., Winslow, B.W., Lee, J.W., Burns, B. & Zhang, X. E. (2011). Development of a Caregiver Empowerment Model To Promote Positive Outcomes. Journal of Family Nursing, 17, 11-28. DOI: 10.1177/1074840710394854  Family members caring for aging parents experience both negative and positive  outcomes  from  providing  care.  Theoretical  explanations  for  negative outcomes have been developed. There is need for models that explain and predict positive outcomes. This article describes the evolution of the Caregiver Empowerment Model (CEM) to explain and predict positive outcomes of family caregiving. Although empirical findings support positive outcomes of family caregiving, less attention has been given to theoretical rationale for positive effects. The CEM predicts that, in the presence of filial values and certain background variables, caregiving demands are appraised as challenges instead of stressors. Appraising caregiving demands as a challenge, finding meaning, and using certain types of coping strategies are posited to be associated with growth and well-being. The CEM extends our understanding of the complexity of the caregiving experience, and can serve as a framework to guide in developing and testing theory-based interventions to promote positive outcomes. (02/2011) (link)
•  Webb, A. P., Ellison, C. G., McFarland, M. J., Lee, J. W., Morton, K., & Walters, J. (2010). Divorce, religious coping, and depressive symptoms in a conservative protestant religious group. Family Relations, 59(5), 544-557. doi: 10.1111/j.1741-3729.2010.00622.x A long tradition of research demonstrates that divorce is a risk factor for depressive symptoms. Although a growing literature examines links between religious factors and marital quality and stability, researchers have neglected the role of religion in successful or problematic coping following divorce. Building on Pargament''''s seminal work on religious coping, we outline relevant theory concerning several specific religious coping styles. Hypotheses are then tested using data from a large sample of members of the Seventh-day Adventist denomination. Results indicate that several types of religious coping bear a direct inverse association with depressive symptoms and also buffer the deleterious effects of divorce on this outcome. Several promising future directions and suggestions for practitioners are identified. (12/2010) (link)
• Lin, Shih-Fan, Lee, J. W., Modeste, N. N., & Johnson, E. G. (2010). Attitudes and beliefs predicting Taiwanese older adults'''' intentions to attend strength and balance training programs.  Journal of Applied Gerontology. doi:10.1177/0733464810385815   While strength and balance training (SBT) programs are effective in preventing falls, older adults rarely participate. A cross-sectional study design was used to explore factors that influence their decisions to attend SBT programs. Questionnaires were collected that measured theory of planned behavior constructs from 221 community-dwelling Taiwanese older women between the age of 55 and 94. Results suggest that (a) benefits of SBT programs such as increasing independence in daily life, (b) participation approval and involvement from the older adults’ family members, and (c) SBT programs conducted in familiar places strengthened potential participants’ positive attitude, subjective norm, and perceived behavioral control, respectively. Health care professionals should consider incorporating these factors in the recruitment materials or the actual design of SBT programs to enhance older adults’ decision to attend and increase the recruitment rate of such programs. (10/2010) (link)
• Bramson, L., Lee, J. W., Moore, E., Montgomery, S., Neish, C., Bahjri, K., et al. (2010). Effect of Early Skin-to-Skin Mother-Infant Contact During the First 3 Hours Following Birth on Exclusive Breastfeeding During the Maternity Hospital Stay. Journal of Human Lactation, 26(2), 120-137. doi: 10.1177/0890334409355779 This was a nurse-driven, hospital-based, prospective cohort study of data collected in 19 hospitals in San Bernardino and Riverside counties by California Perinatal Services Network on all mothers (n = 21 842) who delivered a singleton infant (37-40 weeks gestation) between July 2005 through June 2006. Multivariate ordinal logistic regression showed that maternal infant-feeding method intention (measured prior to birth), sociodemographic characteristics, intrapartum variables, and early skin-to-skin mother—infant contact during the first 3 hours following birth (controlling for delivery hospital) were correlated with exclusive breastfeeding during the maternity hospitalization. Compared with mothers with no early skin-to-skin contact, exclusive breastfeeding was higher in mothers who experienced skin-to-skin contact for 1 to 15 minutes (odds ratio [OR] 1.376; 95% confidence interval [CI], 1.189-1.593), 16 to 30 minutes (OR 1.665; 95% CI, 1.468-1.888), 31 to 59 minutes (OR 2.357; 95% CI, 2.061-2.695), and more than 1 hour (OR 3.145; 95% CI, 2.905-3.405). The results demonstrate a dose—response relationship between early skin-to-skin contact and breastfeeding exclusivity. (05/2010) (link)
• Aja, G., Modeste, N., Lee, J., Montgomery, S., & Belliard, J. (2010). Perceived Church-Based Needs and Assets for HIV/AIDS Prevention in an Urban Nigerian Community.  Journal of Religion & Health, 49, 50-61. doi: 10.1007/s10943-008-9234-6 Abstract: Health intervention programs have the potential to use church-based assets to address a wide range of health issues. This study examined the assets Nigerian church members believed their churches needed, including the assets they thought they had to engage in HIV/AIDS prevention activities. Eight hundred and thirty members from 83 churches completed a questionnaire designed from forum focus group data. Respondents were males and females aged 18 years old and above, with primary, secondary, university, or vocational education, and were more likely to be married than single (never married), separated, divorced, widowed or remarried. The data revealed that church members needed access to health promotion assets, including the expertise of members who are health professionals to engage in HIV/AIDS prevention activities. We recommend an intensive HIV/AIDS prevention reorientation-training workshop for church leaders to ensure a sustainable plan to address HIV/AIDS prevention needs. (03/2010) (link)
• Lee, J. W., Morton, K. R., Walters, J., Bellinger, D. L., Butler, T. L., Wilson, C., et al. (2009). Cohort Profile: The biopsychosocial religion and health study (BRHS). International Journal of Epidemiology, 38, 1470-1478. doi: 10.1093/ije/dyn244 (12/2009) (link)
• Herrera, A.P., Lee, J.W., Nanyonjo, R.B., Laufman, L.E., Torres-Vigil, Isabel (2009). Religious coping and caregiver well-being in Mexican-American families.  Aging and Mental Health, 13, 84-91. Objective: We sought to explore the association of religious and spiritual coping with multiple measures of well-being in Latinos caring for older relatives with long-term or permanent disability, either with or without dementia. Methods: Using a multi-dimensional survey instrument, we conducted in-home interviews with 66 predominantly Mexican-American Catholic family caregivers near the U.S.-Mexico border. We assessed caregivers’ intrinsic, organizational, and non-organizational religiosity with the Duke Religiosity Index, as well as Pargament’s brief positive and negative spiritual coping scale to determine the association of religiosity with caregivers’ mental and physical health, depressive symptomatology, and perceived burden. Results: In a regression analysis, after controlling for other sociocultural factors, instrumental support, and characteristics of the caregiving arrangement, we found that intrinsic and organizational religiosity were associated with lower burden, while non-organizational religiosity was associated with poorer mental health. Negative religious coping predicted greater depression. Conclusion: Further investigation is warranted regarding how knowledge of the positive and negative associations of religiosity on caregiving may assist healthcare providers in supporting Latino caregivers. (01/2009)
• Aja, G. N., Modeste, N. N., Lee, J. W., Montgomery, S. B., & Belliard, J. C. (2008). Perceived importance of church-based needs and assets to HIV/AIDS prevention and control in an urban Nigerian city.  International Quarterly of Community Health Education, 29, 199-209 This study explored the extent to which church members thought the assets they might have to engage in HIV/AIDS prevention and control activities were important. Eight hundred and thirty members from 83 Christian churches in Aba, Nigeria completed a multi-item survey questionnaire designed to obtain information on the importance they attached to church-based assets relevant to HIV/AIDS prevention and control. The rating of importance of assets was on a scale of 1 to 5. Rating on the importance of assets was highest in the spiritual asset category (mean=4.20), followed by health education (4.02), capacity building (4.01), social (3.62), and financial assets (3.54). Among the denominational assets, free HIV/AIDS drug donation was rated higher (4.10) than other assets in the subcategories. This study demonstrates the usefulness of ascertaining members'' perspectives on the importance of church-based assets and provides a basis for recommendation to health education administrators. (12/2008)
• Vang, A., Singh, P. N., Lee, J. W., Haddad, E. H., & Brinegar, C. H. (2008). Meats, Processed Meats, Obesity, Weight Gain and Occurrence of Diabetes among Adults: Findings from Adventist Health Studies. Annals of Nutrition and Metabolism, 52(2), 96-104. Aim: To examine the relation between meat intake and diabetes occurrence in adults. Methods: In a prospective cohort study we examined the relation between diet and incident diabetes recorded among 8,401 cohort members (ages 45-88 years) of the Adventist Mortality Study and Adventist Health Study (California, USA) who were non-diabetic at baseline. During the 17-year follow-up, we identified 543 incident diabetes cases. Results: (1) Subjects who were weekly consumers of all meats were 29% (OR = 1.29; 95% CI 1.08, 1.55) more likely (relative to zero meat intake) to develop diabetes. (2) Subjects who consumed any processed meats (salted fish and frankfurters) were 38% (OR = 1.38; 95% CI 1.05-1.82) more likely to develop diabetes. (3) Long-term adherence (over a 17-year interval) to a diet that included at least weekly meat intake was associated with a 74% increase (OR = 1.74; 95% CI 1.36-2.22) in odds of diabetes relative to long-term adherence to a vegetarian diet (zero meat intake). Further analyses indicated that some of this risk may be attributable to obesity and/or weight gain - both of which were strong risk factors in this cohort. It is noteworthy that even after control for weight and weight change, weekly meat intake remained an important risk factor (OR = 1.38; 95% CI 1.06-1.08) for diabetes. Conclusions: Our findings raise the possibility that meat intake, particularly processed meats, is a dietary risk factor for diabetes. (05/2008)
• Herrera, A. P., Lee, J., Palos, G., & Torres-Vigil, I. (2008). Cultural Influences in the Patterns of Long-Term Care Use Among Mexican American Family Caregivers. Journal of Applied Gerontology, 27(2), 141-165. This study sought to explore cultural attitudes toward caregiving and long-term care and their influence on patterns of long-term care use among Mexican American family caregivers of relatives aged 50 and older. Using a cross-sectional design, the researchers used mixed methods and conducted interviews with 66 Mexican American family caregivers in San Diego, California. They applied the Andersen behavioral model of health service utilization to examine familism, gender roles, acculturation, religiosity, and knowledge and perceptions of longterm care as factors in usage. Caregivers with greater long-term care use displayed lower levels of familism, were knowledgeable about services, had a care recipient with health insurance, shared caregiving responsibilities, and were less acculturated. Medicaid coverage for low-income care recipients was associated with higher long-term care use. Although familism may deter service use, caregivers empowered with resources and knowledge or Medicaid coverage are inclined to use long-term care services. (04/2008)
• Wu, K., Lindsted, K. D., Tsai, S.-Y., & Lee, J. W. (2008). Chinese NEO-PI-R in Taiwanese adolescents. [Article]. Personality & Individual Differences, 44(3), 654-665. Since there has been no research using the revised NEO personality inventory (NEO-PI-R) with Taiwanese adolescents, the main objectives of this study were to examine the replicability of the five-factor model and establish a baseline profile of personality traits in this population. A total of 3396 11th graders from the city of Kaohsiung, Taiwan completed the Chinese NEO-PI-R. Using principal component analysis with varimax rotation, the dimensions of personality in this Taiwanese adolescent sample clearly replicate the five-factor structure shown in adults and support the generalizability of the five-factor model in Chinese adolescents. Women had higher neuroticism, extraversion, and agreeableness scores than males. The gender differences reported in our study correspond to results from other cultures which suggest that the Chinese NEO-PI-R retains the psychometric properties of other language versions. (02/2008)
• Anjejo, D., Modeste, N. N., Lee, J. W., & Wilson, C. M. (2007). Factors associated with sexual intercourse among African-born adolescents in Southern California. Californian Journal of Health Promotion, 5(4), 97-112 Based on the theory of planned behavior the research aims were to: (a) ascertain how attitude, subjective norm, and perceived control predict intentions to engage in sexual intercourse among Black, African-born adolescents in Southern California; and (b) determine how behavioral beliefs, normative beliefs, and control beliefs predict attitude, subjective norm and perceived control. A questionnaire was developed based on focus group findings. One hundred and thirty-five adolescents aged 15 to 19 years completed the questionnaire. The strongest predictor of intention was attitude, then subjective norm. Enjoying sex, “wanting to be a parent” and to “keep sexual partners” predicted attitude. Educative, informative, cultural and faith based programs, if initiated may help African adolescents in Southern California. (12/2007)
• Neergaard, J. A., Lee, J.W., Anderson, B. and Gengler, S.W. (2007). Women experiencing intimate partner violence: Effects of confiding in religious leaders.  Pastoral Psychology, 55(6), 773-787. The incidence of child abuse and neglect is epidemic. Many abused children have sustained lifelong injuries. Often they become perpetrators of abuse, continuing the cycle into future generations. Studies have indicated that mothers who are likely to abuse their children can be identified by a predictive method during the prenatal and postpartum periods. Pilot studies have indicated that mothers who are identified by the method and who receive early intervention, consisting of home visits by registered nurses, show a significantly lower rate of verified cases of child abuse. The author proposes a strategy for early intervention to prevent child abuse and neglect and to help infants and children attain their appropriate developmental milestones. The strategy calls for training and employing women from the Foster Grandparent Program. Foster grandmothers would be a valuable resource for high-risk mothers, providing role models for parenting skills in the home setting. Participating foster grandmothers would be trained and supervised in an interdisciplinary team setting. Evaluation of the program would compare the target population of infants and children whose mothers received the proposed intervention with a similar high-risk group that received only traditional interventions. (07/2007)
• Binggeli, A. L., Montgomery, S., Lee, J. W., & Modeste, N.. "Intentions for Having Sex: What Matters.." Californian Journal of Health Promotion 4.3 (2006): 68-79. The intentions of 614 adolescents to have sex were examined in conjunction with their participation in risky behaviors (hard drugs, violence and suicide, alcohol and marijuana use) and protective factors (community connected and against teen sex, educational aspirations, emotional support from family, friends and girlfriend/boyfriend or sexual partner). Key findings from bivariate and linear regression analyses revealed that alcohol and marijuana use were correlated with intention to have sex among adolescents, as was emotional support from a boyfriend/girlfriend or sexual partner. This study offers insights regarding intentions to have sex among adolescents, pointing particularly to the issue of emotional support in a dating relationship as a motivation for having sex. Findings from this study can be used to develop health education and promotion programs focusing on delaying sexual intercourse. (08/2006) (link)
• Stein, J. A, Lee, J.W., Jones, P.S. . "Assessing cross-cultural differences through use of multiple group invariance analyses.." Journal of Personality Assessment 87.3 (2006): 249-258. The use of structural equation modeling in cross-cultural personality research has become a popular method for testing measurement invariance. In this report, we present an example of testing measurement invariance using the Sense of Coherence Scale of Antonovsky (1993) in 3 ethnic groups: Chinese, Japanese, and Whites. In a series of increasingly restrictive constraints on the measurement models of the 3 groups, we demonstrate how to assess differences among the groups. We also provide an example of construct validation. (08/2006)
• Flores, Janet E., Susanne Montgomery, Jerry W. Lee. "Organization and staffing barriers to parent involvement in teen pregnancy prevention programs: challenges for community partnerships." Journal of Adolescent Health 37.3 (2005): S108-S114. Purpose To evaluate parent involvement in a Southern California teen pregnancy prevention community partnership project. Researchers expected to find parent and family-related participation barriers similar to those described in the family support literature, which they could address with program modifications. Methods Three phases of qualitative evaluation occurred: key informant interviews and focus groups with youth and parents; focus groups with service providers; and key informant interviews with service providers, their supervisor, and the collaborative coordinator. Theory-based, open-ended question guides directed the interviews and focus groups, and transcriptions were coded and themed using grounded theory methods. Results Parents and youth sought ways to improve connections and communication with each other, and parents welcomed parenting education from the project. Unexpectedly, the major obstacles to parent participation identified in this project were largely organizational, and included the assignment of parent involvement tasks to agencies lacking capacities to work effectively with parents, inadequate administrative support for staff, and the absence of an effective system for communicating concerns and resolving conflicts among collaborative partners. Conclusions Youth serving agencies may not be the best partners to implement effective parent involvement or family support interventions. Collaborative leadership must identify appropriate partners, engender their cooperation, and support their staff to further the overall goals of the collaborative. (09/2005)
• Kassem, Nada, Lee, Jerry W., Modeste, Naomi N., Johnston, Patricia K. . "Understanding Reduced-Fat Milk Consumption among Female Adolescents Using the Theory of Planned Behavior. ." Journal of Pediatrics and Neonatology. 2.2 (2005): PD 1-PD 10. Background: Calcium is an essential dietary nutrient and a major constituent of bone mineral. Adolescents need to be in positive calcium balance to meet skeletal demands. However, studies have shown that their calcium intake is well below the Recommended Dietary Allowance (RDA), and even farther below the latest Dietary Reference Intake recommendations (DRI). Conclusions: This study?s fi ndings suggest points of intervention in increasing reduced-fat milk consumption among female adolescents. Material/Methods: This study identifi ed factors that infl uence reduced-fat milk consumption among 710 female students, aged 13?18 years, attending North Los Angeles County public high schools. Participants completed a group-administered Theory of Planned Behavior based questionnaire. Results: The majority of the participants, 89.6%, reported that they currently drink some kind of milk. Of those who reported that they drink milk, 64.3% reported that they currently drink reduced-fat milk or skim milk. Attitude, subjective norm and perceived behavioral control were each significant predictors of intention to drink reduced-fat milk and together explained 66% of its variance. The strongest predictor was attitude, followed by perceived behavioral control and subjective norm. Taste and possible health benefi ts were the primary predictors of attitude; parents? opinions predicted subjective norm; and availability of reduced-fat milk at home, school and in vending machines predicted perceived control. (06/2005) (link)
• Wu, K., Lindsted, K. D., & Lee, J. W. . "Blood type and the five factors of personality in Asia.." Personality and Individual Differences 38.4 (2005): 797-808. Research investigating the association of blood type with personality has yielded mixed results. Two recent studies (Cramer & Imaike, 2002; Rogers & Glendon, 2003) used inventories based on the widely accepted five-factor model and found no significant relationship between blood type and personality. Our study is the third published article to examine this relationship using the five-factor model. We analyzed 2681 Taiwanese high school students who completed the Chinese version of NEO-PI-R (Costa & McCrae, 1992a) and reported their blood type. An ABO blood group test was performed on a sub-sample of 176 students in the pilot study to assess the accuracy of blood type recall. Multiple linear regression analysis showed no significant relationship between blood type and personality except for Type AB females who scored lower on the Conscientiousness domain. MANOVA results showed that the combined dependent variables were not significantly affected by blood type or its interaction. We concluded that the potential effect seen in Type AB females on Conscientiousness might be a chance finding because of the small sample size (78). Academic achievement was positively related to Openness and negatively related to Extraversion. However, BMI was inversely related to Extraversion in females. (01/2005) (link)
• Kassem, Nada, Lee, Jerry W. . "Understanding reduced-fat milk consumption among male adolescents using the theory of planned behavior. ." American Journal of Health Education 36.1 (2005): 16-25. This study identifies factors that influences reduced fat milk consumption among 560 male students, ages 13-18 years, attending North Los Angeles County public high schools. Participants completed a group-administered Theory of Planned Behavior-based questionnaire. The majority of the participants, 94.8%, reported that they currently drank some kind of milk. Of those who reported that they drank milk, 68.2% reported that they currently drank reduced fat milk or skim milk. Attitude, subjective norm and perceived behavioral control were each significant predictors of intention to drink reduced fat milk and together explained 62% of its variance. The strongest predictor was attitude, followed by perceived behavioral control and subjective norm. Taste and possible health benefits were the primary predictors of attitude; parents, siblings and doctors' opinions predicted subjective norm; and availability of reduced fat milk at home and school predicted perceived control. These findings may guide health professionals in planning programs intended to increase reduced fat milk consumption among male adolescents. (01/2005)
• Kassem, N. O., & Lee, J. W. . "Understanding soft drink consumption among male adolescents using the theory of planned behavior.." Journal of Behavioral Medicine 27.3 (2004): 273-296. This study identified factors that influence regular soda consumption among 564 male students, aged 13?18 years, attending North Los Angeles County public high schools. Participants completed a group-administered Theory of Planned Behavior based questionnaire. Almost all of the participants, 96.5%, reported that they currently drink soda, 60.2% reported drinking two glasses of soda or more per day during the past year. Students reported drinking regular soda more than diet soda and reported drinking phosphoric acid containing soda (cola) more than nonphosphoric acid containing soda (noncola). Attitude, subjective norm, and perceived behavioral control were significant predictors of intention to drink regular soda and together explained 61% of its variance. Our results suggest that parents, teachers/coaches, and health professionals should encourage the perception that there are other healthier drinks that quench thirst better than soft drinks and taste good, and that soda should not be excessively available at home. (01/2004)
• Modeste, N., Lee, J., Lim, V. J., & Anjejo, D. . "Factors associated with intention to quit smoking among African American pregnant women. ." Californian Journal of Health Promotion 2.1 (2004): 98-106. The purposes of this study were: 1) to determine beliefs salient to African American women quitting smoking while pregnant; 2) to determine how these beliefs relate to African American Women?s intent to quit smoking while pregnant. The study had two-phases. First, qualitative data was collected in focus groups among 49 pregnant women, recruited from the Black Infant Health Program in San Bernardino County. Second, guided by the findings from the focus group, and based on the theory of planned behavior, a questionnaire was developed, pre-tested, and used as the instrument for collecting quantitative data. One hundred and fifty-six women ages 18-52 years completed the questionnaire. Of these, 97% percent were current smokers and 21% had tried quitting in the past. Perceived control was the strongest predictor of intention, followed by attitude. Findings from this study will be used to plan a smoking cessation intervention for African American Pregnant women. (01/2004) (link)
• Kassem, N. O., Lee, J. W., Modeste, N. N., & Johnston, P. K.. "Understanding soft drink consumption among female adolescents using the theory of planned behavior." Health Education Research 278.291 (2003): 18-3. This study identified factors that influence regular soda consumption among 707 female students, aged 13-18 years, attending North Los Angeles County public high schools. Participants completed a group-administered Theory of Planned Behavior-based questionnaire. Almost all of the participants, 96.3%, reported that they currently drink soda; 50.1% reported drinking 2 glasses of soda or more per day during the past year. Students reported drinking regular soda more than diet soda and reported drinking phosphoric acid-containing soda more than non-phosphoric acid-containing soda. Attitude, subjective norm and perceived behavioral control had statistically significant positive associations with intention, and were each significant predictors of intention to drink regular soda and together explained 64% of its variance. The strongest predictor was attitude, followed by perceived behavioral control and subjective norm. Our results suggest that efforts to reduce soda consumption among female adolescents should include parents and friends. It is also important that soda should not be excessively available at home or widely accessible to teenagers at schools. Healthy eating messages for adolescents need to be developed and incorporated into existing and future campaigns to reinforce the perception that there are other healthier drinks that quench thirst and that taste good as well. (01/2003)
• Salabarría-Peña, Y., Lee, J. W., Montgomery, S. B., Hopp, H. W., & Muralles, A. A.. "Determinants of female and male condom use among immigrant women of Central American descent. ." AIDS & Behavior 7.2 (2003): 163-174. This study was designed to determine factors that influence female and male condom use among Central American women, applying the theory of planned behavior. A cross-sectional design was employed and a sample of 175 Central American women, 18-50 years old, was recruited from a community-based clinic in Los Angeles County. Participants in this study were interviewed face-to-face. Attitude, subjective norm, and perceived behavioral control explained 41% and 45% of the variation in the intention to use male and female condoms, respectively. Respondents' friends and mothers influenced their subjective norms. Beliefs regarding sexual sensation and sexually transmitted infection/pregnancy prevention affected respondents' attitudes toward condoms. Trust issues were also a major factor affecting attitudes toward female condoms. Condom use and sex negotiation skills predicted control over condoms. Results of this study can be used to design HIV/AIDS prevention programs that help women feel control over condom use and their sexual behavior. (01/2003)
• Chan, J., Knutsen, S. F., Blix, G. G., & Lee, J. W., Fraser, Gary E. . "Water, other fluids, and fatal coronary heart disease: The Adventist Health Study. ." American Journal of Epidemiology 155.833 (2002): 827-833. Whole blood viscosity, plasma viscosity, hematocrit, and fibrinogen are considered independent risk factors for coronary heart disease and can be elevated by dehydration. The associations between fatal coronary heart disease and intake of water and fluids other than water were examined among the 8,280 male and 12,017 female participants aged 38-100 years who were without heart disease, stroke, or diabetes at baseline in 1976 in the Adventist Health Study, a prospective cohort study. A total of 246 fatal coronary heart disease events occurred during the 6-year follow-up. High daily intakes of water (five or more glasses) compared with low (two or fewer glasses) were associated with a relative risk in men of 0.46 (95% confidence interval (CI): 0.28, 0.75; p trend = 0.001) and, in women, of 0.59 (95% CI: 0.36, 0.97). A high versus low intake of fluids other than water was associated with a relative risk of 2.47 (95% CI: 1.04, 5.88) in women and of 1.46 (95% CI: 0.7, 3.03) in men. All associations remained virtually unchanged in multivariate analysis adjusting for age, smoking, hypertension, body mass index, education, and (in women only) hormone replacement therapy. Fluid intake as a putative coronary heart disease risk factor may deserve further consideration in other populations or using other study designs. (01/2002)
• Gálvez, C. A., Modeste, N., Lee, J. W., Betancourt, H., & Wilkins, R. L. . "Peruvian mothers' knowledge and recognition of pneumonia in children under 5 years of age ." Pan American Journal of Public Health 11.2 (2002): 99-108. Objective. To assess Peruvian mothers' knowledge and recognition of pneumonia in children under 5 years of age, the mothers' attitude toward seeking medical help if they had a child with signs of pneumonia, and their perception of a Government of Peru pneumonia campaign. Methods. In this cross-sectional study, 501 mothers were selected randomly from 20 lowincome communities of the metropolitan area of Lima, Peru, and were interviewed between June and August 2000. Using SPSS software, descriptive statistics were applied to summarize the demographic data and the data regarding the mothers' knowledge of pneumonia and recognition of signs of the disease. Cross-tabulations and chi-squares were done to assess relationships between variables and to make comparisons. Results. About 84% of the mothers said that they knew what pneumonia is. Most believed that pneumonia is dangerous. A majority (58.7%) indicated that pneumonia is caused by lack of parental care. Only 28.9% believed that a virus causes the disease. More than 80% correctly picked rapid breathing and/or chest retraction from a list of possible signs and symptoms of pneumonia, and 94.6% said they were ready to take their child to the closest health center if they thought their child had pneumonia. Although 57.1 % said they had heard about the Government of Peru pneumonia campaign, 69.3%a of these mothers said they could not recall the motto of the campaign. Mothers who reported having heard of the campaign through TV were more likely than other mothers to correctly recognize the two major signs of pneumonia presented in the campaign. Conclusions. Although the percentage of mothers believing they can recognize pneumonia through rapid breathing and chest retraction seems to have increased in recent years, there is still a sizable percentage of mothers who remain uninformed about pneumonia and its possible fatal consequences. Efforts need to continue to educate Peruvian mothers about the causes, recognition of the signs, and treatment of pneumonia. The results suggest that the Government of Peru pneumonia campaign should use television much more, as well as the health centers, where most of the mothers receive medical attention and health information. (01/2002)
• Lee, J. W., Jones, P. S., Mineyama, Y., & Zhang, X. E. . "Cultural differences in responses to a Likert scale. ." Research in Nursing & Health 25.4 (2002): 295-306. Cultural differences in responses to a Likert scale were examined. Self-identified Chinese, Japanese, and Americans (N=136, 323, and 160, respectively; aged 18 yrs old and older) recruited at ethnic or general supermarkets in Southern California completed a 13-question Sense of Coherence scale with a choice of either 4, 5, or 7 responses in either Chinese, Japanese, or English. The Japanese respondents more frequently reported difficulty with the scale, the Chinese more frequently skipped questions, and both these groups selected the midpoint more frequently on items that involved admitting to a positive emotion than did the Americans, who were more likely to indicate a positive emotion. Construct validity of the scale tended to be better for the Chinese and the Americans when there were 4 response choices and for the Japanese when there were 7. Although culture affected response patterns, the association of sense of coherence and health was positive in all 3 cultural groups. (01/2002)
• Backman, D. R., Haddad, E. H., Lee, J. W., Johnston, P. K., & Hodgkin, G. E. . "Psychosocial predictors of healthful dietary behavior in adolescents.." Journal of Nutrition Education & Behavior 34.4 (2002): 184-192. To identify predictors of healthful dietary practices in adolescents using the Theory of Planned Behavior and determine how gender and ethnicity influence the relationship among the theoretical constructs. Design: Initial and 1-month follow-up questionnaires, designed to measure the constructs of the Theory of Planned Behavior and select demographic items, were administered to the participants in the spring of 1997 to gather data for this descriptive research. Settings/Participants: A sample of 780 adolescents, aged 14 to 19 years, was recruited from randomly selected science classes at 4 public high schools in San Bernardino, California. Seven hundred and fifty participants (96%) completed the initial questionnaire and 672 (86%) completed the follow-up questionnaire. Analysis: A 5-step hierarchical multiple regression procedure, general linear model analysis, and Tukey's honestly significant difference post hoc test were used to analyze the data. Results: Intention to eat a healthful diet was a predictor of healthful dietary behavior. Intention was influenced most by attitude and then by perceived behavioral control and subjective norm. Those with positive attitudes toward healthful eating believed that they would like the taste of healthful foods, feel good about themselves, tolerate giving up foods that they like to eat, and lose weight or maintain a healthful weight. Mother, siblings, and friends were identified as important predictors of subjective norm. Knowledge about how to eat a healthful diet, availability of healthful foods, motivation, and access to enough money were salient facilitating factors related to perceived behavioral control. Interesting contrasts among gender and ethnic groups also were noted. (01/2002)
• Gengler, S. W., & Lee, J. W. . "Ministers' understanding of battered women: Differences among catholic male priests, protestant female ministers and protestant male ministers.." Journal of Religion and Abuse 3.3 (2001): 41-52. Domestic violence does not stop at the threshold of the churches' doors. Domestic violence not only endangers victims' physical and mental health, but also their spiritual health. In this study Protestant and Catholic ministers' beliefs and attitudes on the issue of wife abuse and the possible effects of their beliefs and attitudes on interventions with battered women were examined. Results showed that the degree of ministers' adherence to fundamentalist religious beliefs and the gender of the minister may affect the breadth of their definition of wife abuse, their attitudes toward gender roles, whether or not the minister asks women about wife abuse, and the degree to which a wife or husband is judged responsible in the abuse. (01/2001)
• Jones, P. S., Jaceldo, K. B., Lee, J. W., Zhang, X. E., & Meleis, A. I. . "Role integration and perceived health in Asian American women caregivers.." Research in Nursing & Health 24.2 (2001): 133-144. Examined role involvement, role integration, and perceived health in Asian-American caregivers. Ss comprised 50 females (mean age 47.8 yrs) residing in the US and of Chinese or Filipino descent who were simultaneously occupying the roles of wife, mother, employee, and caregiver. Ss completed interviews concerning demographic characteristics, acculturation, perceived health, and role occupancy and involvement. Results show that the role of wife and multiple role integration are positively associated with overall health, current health, and psychological well-being. Total stress is significantly and negatively associated with overall and current health. Total role satisfaction is positively associated with psychological well-being. Chinese Ss have higher wife role integration, and Filipino Ss have higher wife and employee role stress. Satisfaction is generally high for all Ss. Findings suggest that role integration is a predictor of perceived health for Asian-American females. (01/2001)
• Jones, P. S., Lee, J. W., Phillips, L. R., Zhang, X. E., & Jaceldo, K. B. . "An adaptation of Brislin's translation model for cross-cultural research.." Nursing Research 50.5 (2001): 300-304. Critiques R. W. Brislin's classic model (1970, 1986) for translation and validation of instruments for cross-cultural research. Adaptations and extensions of that model are recommended. The translation process is described and lessons learned are outlined and discussed. An example is the selection of instruments for a study by L. I. Pearlin (1994) that examined filial caregiving by Chinese and Filipino American women. Steps toward a more efficient and valid approach to the preparation of instruments are suggested. (01/2001)
• Madrid, G. A., MacMurray, J., Lee, J. W., Anderson, B. A., & Comings, D. E. . "Stress as a mediating factor in the association between the DRD2 TaqI polymorphism and alcoholism.." Alcohol 23.2 (2001): 117-122. Results of earlier studies have shown that rating of prior stress exposure in preadolescent boys influenced the association between DRD2 genotypes and alcoholism risk factors, suggesting that variability in stress exposure, either in patient or control samples, could readily account for at least part of the confusion in DRD2 study outcomes. In order to test the hypothesis that the DRD2 A1 allele is only associated with alcoholism in subjects with elevated stress exposure, we examined the gene-stress interactional model in a sample of males of Mayan descent in the Olancho district of Honduras. Ascertainment was based on an epidemiologic, observational cross-sectional design, and the study was approved by the Institutional Review Board. A total of 309 adult males (age range 18-87 years) were interviewed by a physician or a public health nurse, blood samples were obtained for genetic studies, and participants were administered the short version of the Michigan Alcoholism Screening Test (S-MAST) and the Hispanic Stress Inventory (HSI). Three explanatory models were evaluated. The first model tested the effect of the demographic variables alone as predictors of MAST scores, the second tested the effects of stress and DRD2 genotypes separately, and the third tested the effect of the interaction between stress and the DRD2 genotypes. Neither model 1 nor model 2 yielded significant results; neither MAST scores nor HSI scores were found to be associated with DRD2 genotypes. However, Model 3 was confirmed reflecting a significant (P (01/2001)
• Coleman-Wallace, D., Lee, J. W., Montgomery, S., Blix, G., & Wang, D. T. . "Evaluation of school based adolescent tobacco cessation programs. ." Prevention Researcher 8. (2000): 14-16. (01/2000)
• Gálvez, C., Modeste, N., Lee, J., Betancourt, H., & Wilkins, R. . "Predictors of intention to seek medical help by Peruvian mothers for children who have signs of pneumonia. ." International Quarterly of Community Health Education 20.4 (2000): 347-368. The Theory of Planned Behavior was used to assess predictors of Peruvian mothers seeking medical help when they believed their child had signs of pneumonia. Open-ended interviews to identify beliefs were followed by a questionnaire administered to 500 mothers from low-income settlements in Lima in June and July 2000. Subjective norm (what important referents want) was the best predictor of intention, followed by mothers' feelings about how easy it would be to take the child to the clinic. Attitude toward taking the child to a clinic was not a significant predictor of intention. This study indicates a stronger role for subjective norm than attitudes and perceived control in similar studies done with this model in other settings. It, of course, only predicts intention to act and not behavior, important here given socialeconomic barriers, e.g., cost, to access to care among this study group. (01/2000)
• Coleman-Wallace, D., Lee, J. W., Montgomery, S., Blix, G., & Wang, D. T.. "Evaluation of developmentally appropriate programs for adolescent tobacco cessation.." Journal of School Health 69.8 (1999): 314-319. Despite introduction of numerous smoking prevention programs in schools, tobacco use has not declined among adolescents. Schools face the dilemma of what to do with students who smoke and are not ready to quit. This study evaluated two programs based on the stages of change model. The educational program, the Tobacco Education Group (TEG), was designed for adolescents not yet thinking about quitting. The cessation program, the Tobacco Awareness Program (TAP), was intended for adolescents who want to quit. Evaluation was completed on 351 students at six public high schools. Compared to a control group of adolescent smokers not assigned to programs, both intervention groups significantly decreased tobacco use. Self-reported use was validated biochemically. Self-efficacy for quitting increased in both programs. Posttest use was predicted by posttest self-efficacy, peer support, and parental support, after controlling for initial use and initial self-efficacy. (01/1999)
• Koffman, D. M., Lee, J. W., Hopp, J. W., & Emont, S. L. . "The impact of including incentives and competition in a workplace smoking cessation program on quit rates." American Journal of Health Promotion 13.2 (1998): 105-111. Examined the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition. A quasi-experimental design was employed to compare the effectiveness of 3 different aerospace industry worksites (n = 11,743). The multicomponent program included a self-help package, telephone counseling, and other elements. The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 mo of the program. The traditional program offered a standard smoking cessation program. Questionnaires and carbon monoxide tests of tobacco use or abstinence were used over a 12-mo period. Results show that the incentive-competition program had an abstinence rate of 41% at 6 mo, which was significantly better than the multicomponent program or the traditional program. At 12 mo, the quit rates for the incentive and multicomponent programs were statistically indistinguishable (37 vs 30%), but remained higher than the traditional program (11%). (01/1998)
• Lee, J. W., Rice, G. T., & Gillespie, V. B. . "Family worship patterns and their correlations with adolescent behavior and beliefs.." Journal for the Scientific Study of Religion 36.3 (1997): 372-381. We examine behaviors involved in family worship, how these behaviors cluster together into specific patterns of family worship, and how these patterns of family worship relate to the behaviors and beliefs of adolescents attending Seventh-day Adventist schools. Seven patterns of family worship were detected by cluster analysis of questionnaires completed by 7,658 Seventh-day Adventist youth, grades 6 through 12. Worship patterns that actively involved youth in reading, praying, and sharing their religious experience were rated as more meaningful and interesting and were associated with higher levels of Active Faith (a factor score). Youth in families with worship patterns that did not actively involve the youth were even lower on Active Faith than youth whose families had no worship. However, No Worship youth were highest on Materialism/Legalism and Alcohol/Drug Use. With one exception, worship patterns with high youth involvement were associated with lower Alcohol/Drug Use and lower Materialism/Legalism. Youth in the Shared Worship group, in which every family member participated in every phase of worship every day, were high on Active Faith but also relatively high on Materialism/Legalism, and Alcohol/Drug use suggesting a pattern of compulsive behavior. (01/1997)
• Swanson, J. A., Lee, J. W., Hopp, J. W., & Berk, L. S. . "The impact of caffeine use on tobacco cessation and withdrawal.." Addictive Behaviors 22.1 (1997): 55-68. To test whether caffeine abstinence influences smoking cessation, 162 caffeine-using smokers were enlisted from American Lung Association smoking cessation programs. Volunteers were randomly assigned by clinic to caffeine-use and caffeine-abstinence conditions and measured for 3 wks postsmoking cessation, at 6 mo, and at 1 yr. Results showed a significant linear increase in caffeine sputum levels across 3 wks post-cessation for those who quit smoking and continued using caffeine. Three wks after cessation, concentrations reached 203% of baseline for the caffeine user. Typical nicotine withdrawal symptoms occurred during the 1st 16 days of cessation. The caffeine abstainers, but not continued users of caffeine, reported increased fatigue during the 1st 3 days of cessation. Among complete caffeine abstainers, compared with caffeine users, there was a significant increase in fatigue, a decrease in stimulation and a marginal increase in caffeine craving immediately following tobacco cessation. There were no differences between the groups on other withdrawal symptoms or in cessation success at 16 days, 6 mo, or 12 mo. (01/1997)
• Calderon, L. L., Johnston, P. K., Lee, J. W., & Haddad, E. H. . "Risk factors for obesity in Mexican American girls: Dietary factors, anthropometric factors, and physical activity.." Journal of the American Dietetic Association 96.11 (1996): 1177-1179. (01/1996)
• Warber, J. P., Haddad, E. H., Hodgkin, G. E., & Lee, J. W. . "Foodservice specialists exhibit lack of knowledge in identifying whole-grain products. ." Journal of the American Dietetic Association 96.8 (1996): 796-798. (01/1996)
• Warber, J. P., Haddad, E. H., Hodgkin, G. E., & Lee, J. W. . "Dietary fiber content of a six-day weighed military ration.." Military Medicine 160.9 (1995): 438-442. No studies have accurately reported on the total dietary fiber content of current military dining facility meals. The military nutrition data base is incomplete for total, insoluble, and soluble dietary fiber content. The Military Recommended Dietary Allowances has no recommendation for dietary fiber. The American Dietetic Association advises all Americans to consume 25 to 35 g/day. This study estimated total dietary fiber intake from a calculated analysis of a 6-day weighed military ration. The calculated fiber values for the sample military diet provided 6.8 g of total dietary fiber per 1,000 kcal. Substituting whole-grain cereal products for all the refined cereal products increased the fiber to 9.5 g/1,000 kcal. Calculated results were validated by chemical analysis. Total dietary fiber was 4.1 g/1,000 kcal for the sample military diet and 5.6 g/1,000 kcal for the whole-grain test diet. Fiber content of the sample military diet was well below recommended levels but similar to that found in other studies on the typical American diet. (01/1995)
• Swanson, J. A., Lee, J. W., & Hopp, J. W. . "Caffeine and nicotine: A review of their joint use and possible interactive effects in tobacco withdrawal. ." Addictive Behaviors 19.3 (1994): 229-256. Reviews the current scientific literature from 1972 through March 1993 on caffeine and nicotine as it relates to nonhealth effects in smoking cessation. 15 studies on the joint use of caffeine and nicotine were analyzed. 17 studies on the physiological and behavioral rationales for this joint use were examined. 86 studies compared the withdrawal symptoms of the 2 drugs and compared caffeine toxicity symptoms with nicotine withdrawal symptoms. The strong significant relationship of coffee consumption and smoking was apparent from these studies. (01/1994)
• Matson, D. M., Lee, J. W., & Hopp, J. W. . "The impact of incentives and competitions on participation and quit rates in worksite smoking cessation programs.." American Journal of Health Promotion 7.4 (1993): 270-280. Examines whether incentives and competitions improve participation and long-term smoking cessation rates in worksite programs. The article focuses on the 15 evaluations of smoking cessation programs that had a quasi-experimental or experimental design and were published between 1966 and 1992. Only 8 studies had an appropriate comparison group that allowed separation of the effects of incentives and competitions from other program elements; only 1 study separated the effects of competition from incentives with competition. Three studies showed that incentives positively influenced participation rates, and 5 enhanced smoking reduction. However, no study showed that incentives and/or competition enhanced smoking cessation past 6 mo. (01/1993)
• Blix, A. G., Lee, J. W. . "Occupational stress among university administrators." Research in Higher Education 32.3 (1991): 289-302. A questionnaire completed by 575 college deans, associate deans, and chairpersons found that misfit between the administrator's motivational style and job demands were related to perceived work stress and the perception of poor coping ability. The perception of poor coping ability was correlated with stress-related illnesses, and misfit was correlated with consideration to change jobs. (01/1991)
• Cramer, S. R., Nieman, D. C., & Lee, J. W. . "The effects of moderate exercise training on psychological well-being and mood state in women." Journal of Psychosomatic Research 35.4 (1991): 437-449. Examined the relationship between moderate exercise training (5 45-min sessions/wk of brisk walking) for 15 wks, psychological well-being, and mood state in 35 sedentary, mildly obese women (aged 25-45 yrs). 18 Ss exercised; 17 Ss were controls. Measures included a general well-being schedule (GWB), the State-Trait Anxiety Inventory (STAI), and Profile of Mood States. Moderate exercise was associated with improved GWB scores. GWB total scores and subscale "energy level" scores were significantly correlated with improvement in submaximal cardiorespiratory fitness. Exercise training also had a significant effect on STAI scores, with a significant decrease seen in Ss who exercised at 6 wks, but not 15 wks. (01/1991)
• Lee, R., Nieman, D., Raval, R., Blankenship, J., & Lee, J. . "The effects of acute moderate exercise on serum lipids and lipoproteins in mildly obese women. International Journal of Sports Medicine,." International Journal of Sports Medicine 12.6 (1991): 537-542. The extent and duration of serum lipid and lipoprotein changes were examined in 12 mildly obese women who walked 45 minutes at 60% VO2max in a laboratory setting. A two-factor, 2 x 6 design with repeated measures on both factors was utilized. The first factor was condition (exercise and rest) and the second factor was time (six times of measurement over a 24-hour period) with treatment counterbalanced. The patterns of change in total high-density lipoprotein-cholesterol (HDL-C) [F(5,55) = 5.75, p less than 0.001] and HDL3-C [F(5,55) = 2.62, p = 0.034], but not HDL2-C [F(5,55) = 1.15, p = 0.346], were significantly different between conditions. Relative to baseline and the rest condition, total HDL-C tended to rise due to a significant 11.6% increase in HDL3-C immediately post-exercise, with values returning to baseline 1.5 hours post-exercise. The interaction statistic for triglycerides was significant with trends for a decrease in triglycerides at 1.5 and 23 hours post-exercise relative to baseline and the rest condition. No significant differences were seen between the exercise and rest conditions for total cholesterol, low-density lipoprotein cholesterol, glucose, or plasma volume. These data indicate that an exercise intensity achievable by brisk walking (7.4 kph) is sufficient to evoke significant but short-term changes in serum HDL3-C concentrations in women. (01/1991)
• Luna, P., Lee, J.W., Nieman, D., Hopp, J.. "Predicting sum of skinfolds in children using a multiple regression equation.." Wellness Perspectives 7.4 (1991): 3-23. A multiple regression equation composed of variables that could be easily collected in a school setting was developed to assist school personnel in predicting the sum of the triceps and subscapular skinfolds. The data used for the development of this equation were deriVed from 8,723 subjects ages, 10 through 18, who participated in the first National Children and Youth Fitness Study (NCYFS I). A random half of the subjects was used to develop the equation, and the remainder was used to cross-validate it. Several equations were developed to predict the sum of the triceps and subscapular skinfolds. Using the selected equation, health and physical educators can predict the sum of triceps and subscapular skinfolds and thereby identify overfat children. Subsequently, they can direct these children into weight management programs. (01/1991)
• Nehlsen-Cannarella SL, Nieman DC, Balk-Lamberton AJ, Markoff PA, Chritton DB, Gusewitch G, Lee JW.. "The effects of moderate exercise training on immune response. ." Medical Science in Sports and Exercise 23.1 (1991): 64-70. The relationship between moderate exercise training (ET) (five 45-min sessions per week, brisk walking at 60 heart rate reserve for 15 wk) and changes in immune system variables and function was investigated in a group of 36 sedentary, mildly obese women. The study was conducted using a two (exercise (EX) and nonexercise (NEX) groups) by three (baseline, 6 wk, and 15 wk testing sessions) factorial design, with data analyzed using repeated measures ANOVA. The pattern of change over time between groups for number of peripheral blood lymphocytes (total), T cells (CD5), B cells (CD20), and serum IgG, IgA, and IgM levels was significantly different. This was not the case for spontaneous blastogenesis or number of T helper/inducer cells (CD4) or T cytotoxic/suppressor cells (CD8). Within-EX-group changes were characterized by significant decreases in percentage and number of total lymphocytes, and in T cell number after 6 wk, and significant increases in each of the serum immunoglobulins after both 6 and 15 wk of training. B cell number increased significantly in NEX subjects relative to baseline values at both 6 and 15 wk, with no significant changes experienced in EX subjects. In summary, these data suggest that moderate ET is not associated with an improvement in lymphocyte function but is associated with a 20% increase in serum immunoglobulins and several small changes in circulating numbers of immune system variables, highlighted by significant decreases in circulating numbers of lymphocytes, particularly the T cell subpopulation. These changes were especially apparent after 6 wk of training, with some attenuation by 15 wk. (01/1991)
• Nieman DC, Nehlsen-Cannarella SL, Donohue KM, Chritton DB, Haddock BL, Stout RW, Lee JW.. "The effects of acute moderate exercise on leukocyte and lymphocyte subpopulations." Medical Science in Sports and Exercise 23.5 (1991): 578-585. The extent and duration of changes in circulating leukocyte and lymphocyte subpopulations, cortisol, and catecholamines were examined in 12 women who walked 45 min at 60% VO2max in a laboratory setting. A two-factor, 2 x 6 design with repeated measures on both factors was utilized. The first factor was condition (exercise and rest), and the second factor was time (six points of measurement over a 24-h period), with treatment order counterbalanced. The 45-min walk, in comparison with rest in a seated position, was associated with a significant but moderate leukocytosis and lymphocytosis immediately following the walk. The leukocytosis was still evident after 3 h of recovery and was primarily due to a neutrophilia. The change in lymphocyte count, relative to baseline levels and the control condition, lasted less than 1.5 h, with an increase in the natural killer (CD16 and/or CD56) and cytotoxic T cell component (CD3 and CD16 and/or CD56) (NKCT) representing approximately two-thirds of the lymphocytosis and T cells (CD5) the other third. A significant decrease in the CD4:CD8 ratio was seen, with cytotoxic/suppressor (CD8) cells increasing and helper/inducer (CD4) cells demonstrating little change in comparison with baseline. This seems to have been due to a subpopulation of CD8 (low density antigen) cells, probably natural killer cells. The 45-min walk had no effect on plasma cortisol and epinephrine levels relative to the rest condition but was associated with a moderate increase in norepinephrine (01/1991)
• Berk, L. S., Nieman, D. C., Youngberg, W. S., Arabatzis, K., Simpson-Westerberg, M., Lee, J. W., et al.. "The effect of long endurance running on natural killer cells in marathoners." Medical Science in Sports and Exercise 22.2 (1990): 207-212. Ten experienced marathoners were exercised 3 h in the laboratory. Blood samples were collected at 0 h baseline, 1 h exercise, and 5 min, 1.5 h, 6 h, and 21 h recovery and were analyzed for total number of lymphocytes expressing membrane antigens found on natural killer (NK) cells. NK activity was also measured. Four of the seven subpopulations of lymphocytes studied, Leu-11+19+, Leu-11+19-, Leu-11+7-, and Leu-19+11-, showed significant within-subject effects over time, using repeated measures ANOVA. Simple contrasts with baseline values showed that, at 1.5 h and 21 h recovery, total number of lymphocytes bearing three different combinations of NK markers, Leu-11+19+, Leu-11+19-, and Leu-11+7-, were significantly decreased when compared with baseline values. At 1.5 h recovery, NK activity was significantly decreased below baseline levels for four of the six effector NK cell/target K562 myelogenous leukemia cell (E:T) ratios tested. At 6 h recovery, NK activity was still decreased significantly with the 12.5:1 and 3:1 E:T ratios. By 21 h recovery, NK activity did not differ significantly from baseline levels. Cortisol levels at 5 min post-exercise were negatively correlated with NK activity at 1.5 h recovery (r = -0.62, P = 0.05, 50:1 E:T ratio; r = -0.66, P = 0.04, 25:1 E:T ratio). Further research is needed to elucidate the effect these changes have on host immunosurveillance and immunoresponsiveness in vivo. (01/1990)
• Cramer, S. R., Nieman, D. C., & Lee, J. W.. "The effects of moderate exercise training on personality traits in women.." Annals of Sports Medicine 5. (1990): 128-132. (01/1990)
• Lee, J. W., & Nieman, D. C. . "A nomogram for calculation of aerobic capacity from cycle ergometry.." Annals of Sports Medicine 5. (1990): 163-165. A nomogram is a graphic method for solving an equation. Nomograms enable practitioners to provide results quickly and easily for their subjects. They require no calculation. The practitioner draws lines connecting points on scales representing known values and reads off the final value from the point where the drawn line intersects with a scale representing the final value. Nomograms were developed to predict VO2max in cycle ergometry. These nomograpms are based on multiple regression equations developed by Storer, Davis, and Caiozzo. They should give practitioners a quick way to provide their clients with information about the results of cycle ergometry. (01/1990)
• Nieman, D. C., Johanssen, L. M., Lee, J. W., & Arabatzis, K. . "Infectious episodes in runners before and after the Los Angeles marathon." Journal of Sports Medicine and Physical Fitness 30.3 (1990): 316-328. An epidemiologic study of Los Angeles Marathon (LAM) applicants was conducted to investigate the relationship between self-reported infectious episodes (IE), training data, and LAM participation. Eight days before the LAM, 4926 of 12,200 applicants were randomly selected, and sent a pilot-tested four page questionnaire, which was received 7 days after the LAM. The 2311 respondents were found to be 2.0 yr older and 7.6 min faster than other LAM finishers (p less than.01). Univariate and multivariate analyses (logistic regression) were conducted to test the relationship between IE and km/wk of running (6 total categories). The final model tested controlled for age, marital status, reported sickness in other members of the runner's home, perceived feelings of stress in response to personal training regimens, and the suppressive effect of sickness on regular training. In runners training greater than or equal to 97 vs less than 32 km/wk, the odds ratio (OR) for IE during the 2 month period prior to the LAM was 2.0 (95% confidence interval (CI) 1.2-3.4). A test for trend showed an increase in OR with increase in km/wk category (p =.04) which was largely explained by the increased odds of reported sickness in the greater than or equal to 97 km/wk category. Of the 1828 LAM participants without IE before the LAM, 236 (12.9%) reported IE during the week following the LAM vs 3 of 134 (2.2%) similarly experienced runners who did not participate, OR = 5.9 (95% CI 1.9-18.8). These data suggest that runners may experience increased odds for IE during heavy training or following a marathon race. (01/1990)
• Nehlsen-Cannarella SL, Nieman DC, Balk-Lamberton AJ, Markoff PA, Chritton DB, Gusewitch G, Lee JW.. "The effects of moderate exercise training on natural killer cells and acute upper respiratory tract infections." International Journal of Sports Medicine 11.6 (1990): 467-473. A randomly controlled 15-wk exercise training (ET) study (five 45-min sessions/wk, brisk walking at 60% heart rate reserve) with a group of 36 mildly obese, sedentary women was conducted to investigate the relationship between improvement in cardiorespiratory fitness, changes in natural killer (NK) cell number and activity, and acute upper respiratory tract infection (URI) symptomatology. The study was conducted using a 2 (exercise and nonexercise groups) x 3 (baseline, 6-, and 15-wk testing sessions) factorial design, with data analyzed using repeated measures ANOVA. No significant change in NK cell number occurred as a result of ET as measured by the CD16 and Leu-19 monoclonal antibodies. ET did have a significant effect on NK cell activity (E:T 50:1) especially during the initial 6-wk period [F(2.68) = 12.34, p less than 0.001]. Using data from daily logs kept by each subject, the exercise group was found to have significantly fewer URI symptom days/incident than the nonexercise group (3.6 +/- 0.7 vs 7.0 +/- 1.4 days, respectively, p = 0.049). Improvement in cardiorespiratory fitness was correlated significantly with a reduction in URI symptom days/incident (r = 0.37, p = 0.025) and a change in NK cell activity from baseline to six but not 15 wks (r = 0.35, p = 0.036). In summary, moderate ET is associated with elevated NK cell activity after six but not 15 weeks, and reduced URI symptomatology in comparison to a randomized, sedentary control group. (01/1990)
• Nieman, D. C., Onasch, L. M., & Lee, J. W.. "The effects of moderate exercise training on nutrient intake in mildly obese women." Journal of the American Dietetic Association 90.11 (1990): 1557-1562. The relationship between moderate exercise training (five 45-minute sessions per week, brisk walking at 62 +/- 2% VO2 max for 15 weeks) and changes in nutrient intake was investigated in a group of 36 sedentary, mildly obese women. The study was conducted using a 2 x 3 factorial design (two groups of subjects: exercise and nonexercise groups; three periods: baseline, 6-week, and 15-week testing sessions). Data were analyzed using repeated measures ANOVA. The pattern of change in caloric intake over time tended to be different between groups (F[2, 68] = 2.50, p =.089); the exercise group experienced a significant decrease in caloric intake by 15 weeks. Significant group x time interactions were found for intakes of carbohydrate, dietary fiber, thiamin, niacin, vitamin B-6, and folate. Intake tended to decrease in the exercise group and to increase in the nonexercise group. Change in intake of each of these nutrients was significantly correlated with change in bread and cereal consumption. The pattern of change in bread and cereal intake over time was significantly different between groups (Pillais Trace = 0.266, F[2, 33] = 5.99, p =.006); the exercise group had significant decreases in intake at 6 and 15 weeks vs baseline values. These data suggest that mildly obese women reduce energy intake subsequent to initiating an exercise program; concomitantly there is a decrease in the quality of nutrient intake from their diets compared with those of sedentary controls. (01/1990)
• Bezjak, J. E., & Lee, J. W. . "Relationship of self-efficacy and locus of control constructs in predicting college students' physical fitness behaviors. ." Perceptual & Motor Skills 71.2 (1990): 499-508. Examined whether elements of J. B. Rotter's (1954, 1966) social learning theory and A. Bandura's (see PA, Vols 58:5733 and 68:5814) self-efficacy theory would jointly predict the physical fitness (PF) behaviors of approximately 511 undergraduates. A PF opinion questionnaire was developed to measure locus of control beliefs, self-efficacy, value placed on PF, expectancy of reinforcement, and value of reinforcement specific to PF behaviors. Specific locus of control measures combined with general values held toward PF were not effective in predicting participation in PF activities. Only self-efficacy and value of specific reinforcement for fitness appeared to predict participation in health-related PF activities. (01/1990)
• Hopp, J. W., Lee, J. W., & Hills, R. . "Development and validation of a pulmonary rehabilitation knowledge test." Journal of Cardiopulmonary Rehabilitation 8. (1989): 15-33. To facilitate evaluation of the education component of pulmonary rehabilitation programs, we have developed and validated a knowledge test covering the content areas identified as common to programs nationwide. Procedures were divided into five stages: item construction, item testing, test validation, program evaluation and cross testing of the final form. Results from 27 programs demonstrated an improvement from pre- and post-test scores and from post-test and the three -month followup. The final form of the test has high internal consistency (Cronbach's alpha = .86). Development of further education evaluative instruments specific to pulmonary rehabilitation programs is recommended. (01/1989)
• Nieman DC, Berk LS, Simpson-Westerberg M, Arabatzis K, Youngberg S, Tan SA, Lee JW, Eby WC.. "Effects of long-endurance running on immune system parameters and lymphocyte function in experienced marathoners." International Journal of Sports Medicine 10.5 (1989): 317-323. The extent and duration of changes in leukocyte subsets, lymphocyte subpopulations, spontaneous blastogenesis, cortisol, and catecholamines were measured in ten experienced marathoners, who ran 3 h to exhaustion in a laboratory setting. Blood samples were taken at baseline, 1 h of exercise, and 5 min, 1.5 h, 6 h, and 21 h of recovery. The 3-h endurance run was associated with significant leukocytosis, granulocytosis, neutrophilia, monocytosis, and eosinopenia during recovery. All of these parameters except for eosinophils returned to normal by 21 h of recovery. Total lymphocyte count increased 31% at 1 h of exercise, then decreased 19% at 1.5 h of recovery when compared with baseline values. T cell count showed no significant changes, but B cell lymphocytosis was measured at 5 min and 6 h of recovery. T helper/T suppressor ratio (H/S) was significantly elevated 39% at both 1.5 h and 21 h of recovery due to the decrease in number of T suppressor cells. Spontaneous blastogenesis was significantly increased 52% by 1 h of exercise and remained elevated throughout recovery. The increase in cortisol from baseline to 1.5 h of recovery correlated positively with the increase in both total leukocyte count (r = 0.78, P = 0.008) and granulocyte count (r = 0.81, P = 0.005). Our results suggest that exhaustive endurance exercise in marathon runners is associated with many significant perturbations in immune system parameters, most of which return to normal levels at 21 h of recovery. (01/1989)
• Nieman, D. C., Johanssen, L. M., & Lee, J. W.. "Infectious episodes in runners before and after a roadrace." Journal of Sports Medicine and Physical Fitness 29.3 (1989): 289-296. Various researchers have implied that regular and moderate exercise training may improve the ability of the immune system to protect the host from infection. In contrast, acute, maximal, and exhaustive exercise may have negative effects of the immune system. This study compared the incidence of infectious episodes in 273 runners during a two month training period prior to a 5 K, 10 K, or half-marathon race. In addition, the effect of the race experience on infectious episodes was studied. Twenty-five percent of the runners training more than 15 miles per week reported at least one infectious episode as compared with 34.3% of runners training less than 15 miles per week (p = 0.09). Only 6.8% of the runners preparing for the half-marathon race reported becoming sick with the flu versus 17.9% of the 5 K and 10 K runners (p = 0.067). During the week following the roadrace, runners did not report an increase in infectious episodes as compared to the week prior to the race. These trends suggest that runners with a more serious commitment to regular exercise may experience less infectious episodes than recreational runners because of both direct and indirect affects on immunosurveillance. In addition, the stressful race experience does not appear to increase risk of acquiring an acute respiratory infection. (01/1989)
• Nieman DC, Sherman KM, Arabatzis K, Underwood BC, Barbosa JC, Johnson M, Shultz TD, Lee J.. "Hematological, anthropometric, and metabolic comparisons between vegetarian and nonvegetarian elderly women. ." International Journal of Sports Medicine 10.4 (1989): 243-251. The purpose of this study was to investigate hematological, anthropometric, and metabolic differences in elderly women who were similar in most respects except for choice of diet. Nineteen vegetarian (V) and 12 non-vegetarian (NV) elderly women (mean ages 72.3 +/- 1.4 and 69.5 +/- 1.0 years, respectively) were recruited based on several selection criteria including race, religion, education, Quetelet Index, absence of major chronic disease and use of medications, physical activity, and geographic area. Average years of adherence by V and NV groups to dietary regimens were 46.3 +/- 3.3 and 69.6 +/- 1.0, respectively; Hematological comparisons revealed that the V elderly women had significantly lower glucose (4.60 +/- 0.09 vs 5.13 +/- 0.11 mmol/L), low-density lipoprotein cholesterol (3.14 +/- 0.19 vs 4.09 +/- 0.27 mmol/L) and total cholesterol levels (5.41 +/- 0.20 vs 6.48 +/- 0.29 mmol/L) than the NV elderly women (P less than 0.01) for each. The V elderly women tended to have less body fat and midupper arm muscle area than the NV. No differences between groups were found in a variety of metabolic and electrocardiographic parameters during graded maximal treadmill testing except for lower heart rates in the V women. VO2max was not significantly different between the V and NV elderly women (23.8 +/- 1.5 vs 21.9 +/- 0.8 ml.kg-1.min-1, respectively). In summary, when healthy elderly V women are compared with closely matched NV peers, the vegetarian diet is associated with several benefits, primarily lower blood glucose and lipid levels, but not greater functional capacity. (01/1989)
• Nieman, D. C., Tan, S. A., Lee, J. W., & Berk, L. S. . "Complement and immunoglobulin levels in athletes and sedentary controls." International Journal of Sports Medicine 10.2 (1989): 124-128. Eleven marathon runners (42.7 +/- 2.1 yrs, 54.2 +/- 1.8 ml.kg-1.min-1) and nine sedentary controls (44.2 +/- 1.2 yrs, 33.3 +/- 1.1 ml.kg-1.min-1) were studied during 30 min of rest, a graded maximal treadmill test using the Balke protocol, and 45 min of recovery to determine the effects of training and acute exercise on complement and immunoglobulin levels. Three baseline and five recovery blood samples were obtained in addition to repeated 5-min samples during exercise. Data for the exercise period were analyzed using a multiple regression approach to repeated measures ANOVA to allow comparison between groups on a percent VO2max basis. Groups did not differ during any of the three phases for IgG, IgA, or IgM. Resting levels of complement C3 (0.89 +/- 0.05 vs 1.27 +/- 0.10 g/L, P less than 0.001) and C4 (0.19 +/- 0.02 vs 0.29 +/- 0.03 g/L, P less than 0.001) were significantly lower in athletes than in controls. Exercise complement C3 [F(1,18) = 14.1, P = 0.001] and C4 [F(1,18) = 7.6, P = 0.013], and recovery complement [F(1,18) = 19.4, P less than 0.001] and C4 [F(1,18) = 13.5, P = 0.002] were also lower in the athletes than in sedentary controls. Acute increases during exercise were not associated with changes in catecholamines or cortisol. These data suggest that blood concentrations of C3 and C4, but not IgG, IgA, or IgM, are decreased during rest, graded maximal exercise, and recovery in marathon runners in comparison with sedentary controls. (01/1989)
• Berk, L. S., Tan, S. A., Fry, W. F., Napier, B. J., Lee, J. W., Hubbard, R. W., et al. . "Neuroendocrine and stress hormone changes during mirthful laughter. ." Am J Med Sci 298.6 (1989): 390-396. Positive emotional activities have been suggested as modifiers of neuroendocrine hormones involved in the classical stress response. To detect changes in these components during a mirthful laughter experience, the authors studied 10 healthy male subjects. Five experimental subjects viewed a 60 minute humor video and five control subjects did not. Serial blood samples were measured for corticotropin (ACTH), cortisol, beta-endorphin, 3,4-dihydrophenylacetic acid (dopac)--the major serum neuronal catabolite of dopamine, epinephrine, norepinephrine, growth hormone, and prolactin. Repeated measures analysis of variance showed that cortisol and dopac in the experimental group decreased more rapidly from baseline than the control group (p = 0.011, p = 0.025, respectively). Epinephrine levels in the experimental group were significantly lower than the control at all time points (p = 0.017). Growth hormone levels in the experimental group significantly increased during baseline (p = 0.027) and then decreased with laughter intervention (p less than 0.0005), whereas, the controls did not change over time (p = 0.787). ACTH, beta-endorphin, prolactin, and norepinephrine levels did not significantly increase. The mirthful laughter experience appears to reduce serum levels of cortisol, dopac, epinephrine, and growth hormone. These biochemical changes have implications for the reversal of the neuroendocrine and classical stress hormone response. (01/1989)
• Berk, L. S., Tan, S. A., Nehlsen-Cannarella, S., Napier, B. J., Lewis, J. E., Lee, J. W., et al. . "Humor associated laughter decreases cortisol and increases spontaneous lymphocyte blastogenesis.." Clinical Research 36.3 (1988): A435-A435. (01/1988)
• Rausch, J. C., Zimmerman, G., J., H., & Lee, J.. "Smoking behavior of student nurses enrolled in diploma associate degree and undergraduate nursing programs. ." Journal of Advanced Nursing 12. (1987): 111-119. Because the literature shows that (1) cigarette smoking is a major causative factor in the occurrence of chronic illness, (2) lung cancer is becoming more common in women than breast cancer, (3) nurses smoke more than any other group of health care providers and (4) studies have not examined differences of smoking among the associate degree, undergraduate and diploma levels of nursing, this study was designed to examine selected health behaviours and their relationship to cigarette use among Alabama senior student nurses, and to determine smoking prevalence by level of educational preparation. A sample of senior associate degree, undergraduate and diploma student nurses in Alabama responded to an 87-item questionnaire which was personally administered by the investigator in a classroom setting. Twenty-two of the 87 items were used to compile the demographics, prevalences and health behaviours reported here. The remaining items were used to develop a sequence of information required to test Ajzen and Fishbein's Theory of Reasoned Action and are beyond the scope of this article. Though there was no significant difference of smoking prevalence among educational levels, there was a trend for increased smoking from undergraduate to diploma level with prevalences of: total sample, 26.2%; diploma, 30%; associate degree, 26%; and undergraduate, 24%. Health behaviours which were significantly different between smoking and non-smoking student nurses were breakfast frequency and coffee consumption. Having a regular exercise routine was not significant. Males smoked significantly more than females. More older nurses (over 40 years) smoked than younger nurses. The findings reported here are useful to the development of health education strategies designed to reduce and preventing smoking among nurses. (01/1987)
• Lee, J. W.. "Attitudes and behavior." Ministry 54.June (1981): 24-25. There has been considerable controversy over the relationship between faith and works. Since Luther, the Protestant position has been that we are not saved by our works but by our faith. However, modern social psychological research has shown that our attitudes (presumably including faith) can be influenced by what we choose to do. Scripture suggests this is also true. (01/1981)
• Lee, J.W.. "Summary of a study concerning church membership loss." Journal of Adventist Behavioral Scientists 5. (1981): 922-. A survey of individuals who had left the Seventh-day Adventist Church showed that most left because of disputes with other people or because they felt rejected or ignored by other church members. Theology played little role in most persons' choices to leave the church. (01/1981)
• Lee, J. W.. "God and the development of morality." Journal of Adventist Behavioral Scientists 2. (1978): 815-820. One thorn in the side of many Christians is the apparent difference in God's behavior toward the men of Old and New Testament times. Research by Kohlberg (1969) and Turiel (1969) suggests that moral reasoning develops through a series of confrontations with higher stage reasoning and that individuals whose moral reasoning is at a low stage cannot understand the reasoning of individuals who are at a higher stage. It is suggested that this fact may account for the apparent change in God's behavior. The premises underlying such an explanation are examined. (01/1978)

Abstract

• Ford, P. A., Jaceldo-Siegl, K., Lee, J. W., & Tonstad, S. (2016). Trans fatty acid intake is related to emotional affect in the Adventist Health Study-2. Nutrition Research, 36(6), 509-517. doi:10.1016/j.nutres.2016.01.005 Trans fatty acids in Western diets increase health risks, and have been associated with the risk of depression. We hypothesized that intakes of trans fatty acids (primarily from margarines and baked goods) were inversely associated with positive affect and positively associated with negative affect in a longitudinal study. Church attendees residing in North America completed a food frequency questionnaire in 2002-6 as part of the Adventist Health Study-2. A subset in which we excluded participants with established cardiovascular disease (n=8,771) completed the Positive and Negative Affect Schedule (PANAS) in 2006-7. The associations between dietary intakes of fatty acids to positive and negative affect were tested with linear regression analysis controlling for age, gender, ethnicity, education, body mass index, exercise, sleep, sleep squared, Mediterranean diet, total energy intake and alcohol. Intakes of trans fatty acids were inversely associated with positive affect (β=-0.06, B=-0.27 [95% CI -0.37, -0.17], p<.001) and positively associated with negative affect (β=0.05, B=0.21 [95% CI 0.11, 0.31], p<.001). In comparison, we found no association between n-3 polyunsatured fatty acids (PUFA) intakes with affect. The n-6:n-3 PUFA ratio was inversely associated with positive affect (β=-0.03, B=-0.34 [95% CI -0.58, -0.10], p=0.006). The findings suggest that lower dietary trans fatty acids have beneficial effects on emotional affect while the n-6: n-3 ratio is detrimental to positive affect. (06/2016)
• (PEER REVIEWED) Knutsen, S. F., Chan, J., Blix, G. G., & Lee, J. W. . "Does low fluid intake increase the risk of stroke?." European Heart Journal 19. (2001): 325-. (01/2001)

Non-Scholarly Journals

• Lee, Jerry W."Religion and health: interschool collaboration explores their connection.." Sphere 29 05 2007: (05/2007) (link)
• Lee, J. W."Curiosity and investigation grows." Scope 01 07 1991: 47 - 49 (07/1991)
• Lee, J. W."Building a mouse." Creative Computing 01 07 1980: 102 - 111 Abstract from the editor: The theory of learning has been central to experimental psychology since Pavlov’s dogged experiments over 50 years ago. Some theorists like (Hall and more recently, Skinner) think learning theory covers all behavior, and that such areas of psychology as perception, personality and human motivation can eventually be predicted and controlled within its framework. To the learning theorist, every organism is always in a “learning” situation; but starkly simplified learning experience, like running mice through mazes, are seen as the clearest way to experiment in this field. Learning takes place when reward (or “reinforcement”) occurs; under reinforcement, the organism becomes more likely to emit a certain “behavior.” Punishment, or negative reinforcement, doesn’t work as well. Enough said. Here’s a simplified mouse you can train all you like. But be aware that while you are training it, it is training you.  (07/1980) (link)

Books and Chapters

• Lee, J. W., Stacey, G. E., & Fraser, G. E.. Social support, religiosity, other psychological factors, and health. In G. E. Fraser (Ed.), Diet, life expectancy, and chronic disease: Studies of seventh-day adventists and other vegetarians : New York: Oxford University Press., 2003. 149 - 176 (01/2003)
• Rausch, J. C., Lee, J. W., & White, R. . Cigarette use among alabama student nurses: An application of the theory of reasoned action, In J. Humphrey (Ed.), Advances in health education (Vol. 1). New York: AMS Press, 1988. (01/1988)