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1.  Bidirectional longitudinal study of type 2 diabetes and depression symptoms in black and white church going adults 
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.
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.
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.
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.
PMCID: PMC4404000  PMID: 25897418
Type 2 diabetes; Depression; Bidirectional; Black; Adventist
2.  Religious Engagement in a Risky Family Model Predicting Health in Older Black and White Seventh-day Adventists 
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 (BRHS). 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 at a given level of risky family. 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.
PMCID: PMC3613156  PMID: 23560134
religious engagement; risky family; emotionality; physical health
3.  Intake of Mediterranean foods associated with positive affect and low negative affect 
Journal of psychosomatic research  2012;74(2):142-148.
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.
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.
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<.001) and fast food frequency (P<.001) such that these foods were associated with negative affect in females only.
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.
PMCID: PMC3790574  PMID: 23332529
Affect; Dietary behaviors; Mediterranean; Mental health; Western
4.  Determinants of Inflammatory Markers in a Bi-ethnic Population 
Ethnicity & disease  2011;21(2):142-149.
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.
In a cross-sectional investigation, 508 men and women (>35 years old, 62% White, 38% Black) participated in the Biopsy-chosocial 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-α) was assessed with linear regression models. Levels of interleukin-10 (IL-10), an anti-inflammatory marker, were also assessed.
Blacks showed higher levels of CRP and IL-6 than Whites. Controlling for socio-demographic and health variables attenuated the ethnic difference in CRP while IL-6 levels remained higher in Blacks than in Whites (β=.118; 95% confidence interval=.014–.206; P=.025). Ethnic differences in IL-10 and TNF-α were not found. Vegetarian diet was associated with lower CRP levels while exercise frequency was associated with higher IL-10 levels.
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.
PMCID: PMC3427005  PMID: 21749016
Inflammatory Markers; Ethnicity; Health Behavior; Adventists
5.  Clarifying and Measuring Filial Concepts across Five Cultural Groups 
Research in nursing & health  2011;34(4):310-326.
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 the 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.
PMCID: PMC3155420  PMID: 21618557
culture; filial attitudes; filial values; intergenerational responsibility; reciprocity; caregiver health outcomes

Results 1-6 (6)