Jerry W. Lee

An Adaptation of Brislin’s Translation Model for Cross-cultural Research

BackgroundThe number of nurse scientists pursuing cross-cultural research using quantitative designs is increasing. Preparation of instruments that are conceptually and functionally appropriate in the language of the participants is a complex process that needs examination. ObjectivesBrislin’s classic model for translation and validation of instruments for cross-cultural research is critiqued. Adaptations and extensions of that model are recommended. MethodsBrislin’s model guided tool preparation in a cross-cultural investigation. The process is described and lessons learned are outlined and discussed. ConclusionsSteps toward a more efficient and valid approach to the preparation of instruments are suggested.

Neuroendocrine and Stress Hormone Changes During Mirthful Laughter

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.

Caffeine and nicotine: A review of their joint use and possible interactive effects in tobacco withdrawal

There is a strong, significant relationship between coffee consumption and smoking. In six epidemiological studies reviewed and analyzed here, 86.4% of smokers consumed coffee versus 77.2% of nonsmokers. Exsmokers use more coffee than nonsmokers but somewhat less than smokers. Seventeen experimental studies suggest that the pharmacologic effect of caffeine in coffee may be partially but not totally responsible for the relationship. Conditioning, a reciprocal interaction (caffeine intake increases anxiety/arousal--nicotine decreases it), or joint effect of a third variable (e.g., stress, alcohol) may account for the relationship. In abstinent smokers, blood caffeine levels increase and remain elevated for as long as 6 months. These higher caffeine plasma levels may be sufficient to produce caffeine toxicity syndrome. A review of 86 studies of nicotine withdrawal, caffeine withdrawal, and caffeine toxicity suggests that the symptoms are similar enough to be confused, and that reported nicotine withdrawal symptoms may be a mixture of nicotine withdrawal and caffeine toxicity.

Psychosocial Predictors of Healthful Dietary Behavior in Adolescents

OBJECTIVE 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 Tukeys 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. CONCLUSIONS AND IMPLICATIONS The findings indicate that multiple attitudinal, normative, and control factors influence healthful dietary behavior in adolescents. The synergistic use of these factors in the development and implementation of nutrition education interventions may assist in the promotion of healthful eating among teens from culturally diverse communities.

Meats, Processed Meats, Obesity, Weight Gain and Occurrence of Diabetes among Adults: Findings from Adventist Health Studies

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.

The effects of moderate exercise training on immune response.

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.

Effect of Early Skin-to-Skin Mother—Infant Contact During the First 3 Hours Following Birth on Exclusive Breastfeeding During the Maternity Hospital Stay:

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.

Stress as a mediating factor in the association between the DRD2 TaqI polymorphism and alcoholism.

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<.05) interaction between DRD2 genotype and stress score as a predictor of MAST score. Additionally, this difference was found to be largely accounted by the HSI occupational/economic stress score, which had a highly significant (P=.003) interaction with DRD2 genotype as a predictor of MAST score. This stress score was the only one of four that showed levels of stress as high as HSI scores in a US population. The MAST scores of A2A2 genotype participants were found to be nearly identical in low stress and high stress participants, whereas the MAST scores of A1A2 participants increased modestly with stress (P=.01) and that of A1A1 participants increased markedly with stress (P=.001). These findings support the hypothesis that DRD2 genotype-phenotype associations depend on the magnitude of stress exposure, and they lend support to the view that variability in DRD2 study outcomes may in part be explained by this gene-environment interaction.

Understanding soft drink consumption among male adolescents using the theory of planned Behavior

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.

The effects of acute moderate exercise on leukocyte and lymphocyte subpopulations

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.(ABSTRACT TRUNCATED AT 250 WORDS)