A two-generation study of body mass index, energy balance and specific physical activity of college students and their respective parents living in the same household at Los Angeles, California, U.S.A.
Overweight and obesity are increasing rapidly in the United States (Mokdad et al, 1999), leading many Americans to the risk of obesity-related diseases. According to the National Health and Nutrition Examination Survey (NHANES) 1999-2002, 65% of U.S. adults are classified as overweight or obese based on their body mass indexes (BMI) (Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, 2005). Obesity is defined as having an excessively high amount of body fat or adipose tissue in relation to lean body mass (Office of Genomics and Disease Prevention, 2002). Overweight and obesity in adults are associated with increased risk of chronic diseases, including coronary heart disease, dyslipidemia, diabetes mellitus and hypertension (US Department of Health and Human Services Publication, 1988). According to Olshansky et al. (2005), obesity in the U.S. today will lead to a reduction of 4-9 months in life expectancy at birth and the impact of obesity on reduction of life expectancy is larger than the negative impact of all accidental deaths combined.
Coronary heart disease encompasses approximately 35% of all deaths among Asian-Americans and 29% of all death among Hispanic-Americans (National Center for Health Statistics, Division of Vital Statistics, 2005). Asians and Hispanics are two to six times more likely to have Non-insulin-dependent diabetes (NIDDM, or Type II Diabetes) than non-Hispanic white Americans in the United States (Carter, Pugh, & Monterrosa, 1996). Asian Americans and Hispanic Americans comprised a large proportion of the U.S. population (Bureau of Census, U.S. Department of Commerce, 1982 & 1992). In the year 2003, the student population of the California State University at Los Angeles (CSULA) was composed of 22.1% Asian Americans/Pacific Islanders, 52.4% Latinos (Hispanics), 16.2% white Americans and 9.2% African Americans and others (Office of Institutional Research and Public Affairs, CSULA, 2003). The student body of CSULA in general, can reflect the ethnic composition of the population in the Greater Los Angeles Area.
College students are commonly under stress from different sources, such as maintaining a high level of academic achievement, adjusting to a new social environment, dealing with financial problems, etc. (Ross, 1999), which might place them at higher risk of heart disease (O'Connor, Gurbel, & Serebruany, 2000). Between male and female college students, there were differences in dietary atherogenicities, energy balance, and physical activity levels (Tam et al., 1996). Whereas there were a few studies to survey a combined effect of physical activity and dietary kcal patterns in a family setting, we chose CSULA college students and their respective parents living in the same household for the study of their BMI, energy balances (EB) and specific physical activities (SPA).
BMI is commonly used to determine if an individual is overweight or obese, which is a mathematical formula defined as a person's body weight in kilograms divided by the square of his or her height in meters. BMI is highly correlated with body fat and desirable BMI levels vary with ages. Adults (aged 18 years or older) are considered overweight with a BMI of 25.0 to 29.9 and obese with a BMI of 30 or more (Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, 2005). According to the National Institutes of Health, adults with a BMI of 25 or more are considered at risk of various cardiovascular and other diseases as a consequence of overweight or obesity, and the risk increases as the BMI reaches and surpasses 30 (National Institutes of Health, 1998). Because obesity is becoming a serious issue in the United States, public health associations have strongly recommended the general population to maintain a healthy body weight, regardless of age, gender and ethnicity (U.S. Department of Agriculture & U.S. Department of Health and Human Services [USDA & USDHHS], 2005).
EB is a comparison between the sum of food energy intake and total energy expenditure, which includes the energy needs for basal metabolism, specific dynamic action (S.D.A.) of food (or thermic effect of food) and SPA. Basal metabolism is the energy used to maintain life when a body is at complete physical, emotional and digestive rest (Whitney, Cataldo, & Roffes, 2002). It is calculated based on basal metabolic rate (BMR), the rate at which the body spends energy for maintenance activities. S.D.A. of food is an estimation of the energy used to process food, including digestion, absorption, metabolism, transportation and nutrient storage (Whitney et al., 2002). It can be calculated by taking 10% of the energy used for basal metabolism and SPA (Guthrie, 1983). During SPA, such as walking, running, etc., extra energy is needed for voluntary skeletal muscle movement, oxygen and nutrient delivery, and waste disposal (Whitney et al., 2002).
The energy expenditure on a physical activity is dependent on the duration, intensity and frequency of the activity. The longer, the more frequent, and the more intense the activity, the more calories are expended. Usually, the energy expenditure distribution is 60% for basal metabolism, 10% for S.D.A. of food and 30% for SPA (Tam et al., 1996). EB usually can predict changes in body weight. A continuing positive EB can lead to weight gain, while an incessant negative EB can cause weight loss (Groff, Gropper, & Hunt, 1995; Swinburn & Ravussin, 1994).
Performing appropriate physical activity and maintaining proper EB are important for healthy weight management and prevention of obesity-related diseases. Considering human beings are tied together in the form of family, eating and physical activity habits of parents may be adopted by their offspring. Based on Tam et al., 1996, we evaluated SPA categorized as: light (LA) (1.4-3.0Kcal/kg/hr), moderate (MA) (3.1-5.3), severe (SA) (5.4-7.4) and very severe (VSA) (7.5 or over) in these groups.
The purpose of our study was to compare the differences in total energy intake (TEI), total energy expenditure (TEE) [including basal metabolism in one day (BMR), SPA and S.D.A. of food], EB, BMI, and SPA levels in one day between CSULA students and their respective parents living in the same household. The findings from the study would help us better understand diet and other lifestyle factors related to obesity from the perspectives of family habits/impacts. We hoped our study could provide fundamental data for developing intervention programs to combat physical inactivity and obesity at the basic unit of the society--at the family level.
The subjects in our study consisted of 30 undergraduate students (10 males and 20 females) enrolled at the CSULA and their respective parents (30 total: 17 males and 13 females) living in the same household. The reason for selecting participants living in the same household was to minimize environment as an influential variable (Wu-Tso, Yeh, & Tam, 1995). The average age of subjects was 26 for the young college students and 59 for the older parents. This study was reviewed and approved by the Institutional Review Board on Human Subjects Committee at the CSULA.
Dietary and physical Activity Measures
The data was from a 24-hour dietary record along with specific physical activity journal of 30 CSULA students and their respective parents riving in the same household. The students had been trained in the nutrition class on how to accurately complete a one-day dietary record and physical activity journal that included activity type, intensity and the time spent on it. Additionally, instructions were given on how to calculate food energy intake, basal metaboric rate (BMR), specific physical activity (SPA) and specific dynamic action (S.D.A) of food. BMI was calculated by the Quetelet index (Bray, 1992). Total energy intake (TEI), body surface area, BMR, S.D.A. of food, energy expenditure on SPA and total energy expenditure (TEE) were calculated using the formulas from McWilliams (McWilliams, 1984). Based on Tam et al., 1996, SPA was divided into four levels: light (LA) (1.4-3.0Kcal/kg/hr), moderate (MA) (3.1-5.3 Kcal/kg/hr), severe (SA) (5.4-7.4 Kcal/kg/hr), and very severe (VSA) (7.5 Kcal/kg/hr or over). The time spent and calories expended by each subject who participated in one or more levels of SPA, were manually calculated. The differences in TEI, TEE, energy balance, and SPA from the one-day record between the students and their parents were compared.
The results were analyzed using the SPSS (version 10.0) statistical computer program. The college student group was named as "young" while the parent group was categorized as "old". All data were expressed as mean [+ or -] SD by groups. Independent t-test was used to test the difference between the two groups. Statistical differences were considered significant at alpha level of 0.05.
Characteristics of Young and Old Subjects
This study included 30 college students and their 30 respective parents living in the same household. The younger student group was composed of 10 males and 20 females, while the older parent group consisted of 17 males and 13 females. The average age was 26, ranging from 19 to 38 years for the young, and 59, ranging from 46 to 70 years for the old (see Table 1).
Differences of BMI between Young and Old Subjects
The average BMI between the two groups was significantly different (p<0.05). The mean BMI was 24.0 kg/[m.sup.2] for the young (ranging from 18.0 to 34.1 kg/[m.sup.2]) and 27.0 kg/[m.sup.2] for the old (ranging from 19.6 to 42.6 kg/[m.sup.2]) (Table 1). When BMI was broken down to three levels: normal, overweight, and obese, 48% and 21% of the old and 23% and 15% of the young were overweight and obese, respectively (Table 2). The total of overweight and obese was higher among the older parents than that of the young.
A Comparison of BMR, Kcal for All Physical Activity, SDA of Food, TEE, TEI and EB of the Young and Old Groups
Although the young and old groups were significantly different in BMIs, there were no statistical differences between them in their total energy expenditure (young: 2552.6 [+ or -] SD 629.6 vs. old: 2564.3 [+ or -] 570.1kcal/day) and total energy intake (young: 1818.1 [+ or -] 954.7 vs. old: 1837.4 [+ or -] 901.8kcal/day) in the 24-hour record (see Table 3). The energy expended for BMR, SPA and SDA of food by the two groups were very much comparable (Table 3). In addition, both the young and old had negative EB of more than 700Kcal/day based on one day (Table 3), even though many of them were over weight or obese.
A Comparison of Time Spent and Total Calorie Expended for Each SPA Level between the Young and Old Groups
There was no significant difference in 24-hour SPA between the young and old. For light activity, the young spent average 1.7hr and 182.0kcal vs. 2.5hr and 263.lkcal for the old; for moderate activity, the young spent average 0.8hr and 188.6kcal vs. 1.9hr and 221.3kcal for the old; only a few subjects from the two groups performed the severe or very severe activity (Table 4). The participation rates for light, moderate, severe and very severe activity were 83%, 40%, 13% and 10% for the young, and 76%, 23%, 3% and 0% for the old, respectively (Table 4).
A study of young and old Asian Americans by Wu-Tso, Yeh and Tam (1995) showed that compared to their parents, young Asian college students dined out more often and their diet was higher in fat and cholesterol but lower in fiber. Due to a combined effect of insufficient physical activity and unhealthy dietary pattern, college students could put themselves at high risk of having chronic health problems at young age. A follow-up study looking into the two generations' physical activity and dietary kcal intake would reveal if there is a difference in patterns between the parents and the college students.
The objective therefore was to analyze and compare BMIs, energy intakes, energy expenditures, and physical activity patterns between college students and their respective parents living in the same household at Los Angeles. It is one of a few two-generation studies on the topic, and the results of the study should shed lights on the understanding of the relationship of physical activity and dietary kcal intake patterns between two generations. It is important to note, however, this is a biased, nonrandomized study due to convenient sampling, the younger subjects' education level and taking a nutrition course at CSULA. Cautions need to be exercised when generalizing the findings of the study to the population of college students and their parents living in the Greater Los Angeles Area.
Human beings eat periodically to supply energy need from diets for basal metabolism, daily physical activities and S.D.A. of food. When energy expenditure surpasses energy input, the body burns fat or degrades its own lean tissue for fuel. When energy intake exceeds expenditure, the excess will be stored as fat and used whenever needed. When energy in equals energy out, energy is in balance and body weight may be maintained. In this study, both young and old groups had daily calorie intake less than Recommended Dietary Allowances (62.7% and 79.1%, respectively, Table 1). In addition, it showed that there was no significant difference between the two groups in BMR, Kcal for physical activity, SDA of food, TEE, TEI and EB (Table 3).
On average, both young and old groups had negative energy balance of more than 700Kcal/day (Table 3). 90% of the college students and 90% of the parents were in negative energy balance, whereas 10% of each group was in positive energy balance for one day. For those subjects in positive energy balance, ranging from 90.8 to 2143.8 Kcal/day, they would gain weight at a rate of 0.2 to 4.3 pounds per week if they kept on this trend. For the majority of the subjects, who were in negative energy balance ranging from -68 to -2172 Kcal/day, they could loss weight at a rate of 0.1 to 4.3 pounds per week. It is noteworthy that although 90% of the subjects were in one day's negative energy balance, 69% of the old and 38% of the young were overweight or obese in the study (Table 2). This conflicting observation was possibly due to the following two reasons. First, it takes several measurements of negative energy balances to observe weight loss. The participants in the study might just begin having negative energy balance while the overweight/obesity percentages were still high. Follow-up studies with the same participants were needed to test the contention. The second possible reason is associated with the underestimation of portion size when reporting food energy intake or over-reporting the time spent on and the intensity of activities (Tam et al., 1996). Similar findings were reported in some other studies (Drougas, Reed, & Hill, 1992; Kalwarf, Haas, Belko, Roach, & Roe, 1989; Rush & Sexsmith, 1994; Watson & Jennings-White, 1974).
Physical Activity Levels
Although there might be a tendency to over-report physical activity levels, college students and their respective parents in our study spent the majority of the time on sedentary activities, such as sleeping, reading, eating, writing, sitting, etc. These very light activities were not included in any one of the four physical activity levels. Of the 60 subjects, 83% of the students and 76 % of parents participated in light activity (Tables 4); 40% students and 23% parents participated in moderate activity; 13% students and 3% parents participated in severe activity; 10% students and no parents participated in very severe activity. Majority of the college student subjects engaged in light to moderate physical activity, which is consistent with the finding by Tam et al. (1996). It is noteworthy to point out that 10% of the students and 17% of the parents did not participated in any one of the four levels of physical activities.
For inactive individuals, their sedentary lifestyle had been shown to lead to many disease developments (McGinnis, 1992; McGinnis & Foege, 1993). It would also give rise to the risk for depression (Camacho, Roberts, Lazarus, Kaplan, & Cohen, 1991). For those who performed some types of activity from 1.4 to 7.5 Kcal/kg/hr (Tables 4), their positive effort would help with weight control and disease preventions (Tam et al., 1996), and aid in managing mild to moderate depression and anxiety (USDA & USDHHS, 2005). Thirty minutes per day on light activity, such as housecleaning and walking at 2.5 to 3 mph, had been recommended for health exercise program (McGinnis, 1992). 83% of the students and 76% of the parents in the study could meet this goal. In addition, it was found that a total of 30 minutes of moderate activity daily can attain health benefits (Blair, 1995). In the 2005 Dietary Guideline for Americans, the US government has recommended adults to do at least 30 minutes of moderate physical activity on most days of the week to reduce risk of certain chronic diseases, including high blood pressure, stroke, coronary artery disease and colon cancer (USDA & USDHHS, 2005). Our study indicated that only 40% of the students and 23% of the parents had performed 30 minutes or more of moderate physical activity in a day (Table 4).
It is important to note the non-significant difference of physical activity patterns between the two groups. This might suggest that the young generation had probably kept the same activity patterns as that of their parents. Because they lived in the same household, the students might have adopted the same physical activity patterns as their respective parents. This result merits more attention of physical activity experts in the future as it may be necessary to aim changing physical activity patterns on a family basis. It is necessary to note, however, that this was only a correlational study and more studies are needed to further investigate the carryover effects of parental behaviors on the next generation.
Although most people in the two groups had negative energy balance (Table 3), their low frequency of participation in moderate and severe physical activities (Table 4) would lead them to the risk of cardiovascular diseases and other health problems, especially for those who were overweight or obese based on their BMI. According to the National Institutes of Health, National Heart, Lung, and Blood Institute (NIH/NHLBI) guidelines, weight loss is recommended for those people who are obese or overweight (BMI of 25 and above) and have two or more risk factors for obesity-associated diseases, such as physical inactivity, hypertension, hypercholesterolemia. A weight loss as small as 10 percent of current weight may reduce the risk (National Institutes of Health, National Heart, Lung, and Blood Institute, 2004)). Given that more than 50% of the participants in the study were classified as overweight/obese as well as physically inactive, promoting physical activity is urgently needed in the population. Cautions are needed; however, this study was only based on a 24-hour physical activity journal and might not accurately reflect the normal physical activity pattern of the students and their parents.
Many epidemiological studies used BMI as a measure of fatness (Willett, 1990). The average BMI of adults is 26.5 in the United States (Whitney et al., 2002). As BMI of above 25 increases, risks for obesity-associated diseases go up as well (Wu-Tso et al., 1995). A study by LamonFava, Wilson and Schaefer (1996) showed that BMI is associated with most risk factors for coronary heart disease (CHD) and the risk for CHD increases with an increase of BMI. Accordingly, in our study, the average of young college student BMI was 24.0 [+ or -] 4.4 kg/[m.sup.2] (Table 1) and within the normal range; however, the old parents' mean BMI was 27.0 [+ or -] 5.7 kg/[m.sup.2], which was within the category of overweight and put them under the risk of developing obesity-associated diseases. Significant differences in BMI between the two groups were found (p<0.05) (Table 2). This is in agreement of findings found in previous studies that overweight becomes more prevalent as age increases (Daniels, Khoury, & Morrison, 1997; Robertson et al., 1977). In addition, 38% of the young college students in our study were overweight or obese based on their BMI values, which is similar to the finding by Lowry et al. (2000) showing that 35% of US undergraduate college students were overweight or obese.
BMI is likely specific to ethnicity (Deurenberg-Yap & Deurenberg, 2003). It was suggested that the BMI cut-off values for overweight and obesity may be lowered to 23 and 27, respectively, for Asians due to excessive fat accumulation and increased cardiovascular disease risks in Asians. Therefore, the World Health Organization (WHO) cut-off values for overweight and obesity may not be suitable for Asians. If that is the case, a significant proportion of the subjects in our study, who were Asians, could be classified as overweight with the proposed, adjusted lower BMI cut-off values. As a result, the percentage of overweight and obese subjects as shown in Table 2 would increase correspondingly and more subjects would have overweight problems and risks of disease development.
There are strengths and limitations in our study. This is a two-generation family study. Subjects living in the same household were chosen to minimize environment as an influential factor. All students were trained to acquire accurate dietary data and physical activity journals. However, it was a non-randomized and biased study due to convenient sampling and the younger subjects took college level nutrition class. In addition, sample size was relatively small.
It seems that there were similar energy balance and physical activity patterns between the young college students and their parents. They both had high BMI, inadequate moderate physical activity, and lacked severe/very severe physical activity.
This finding is important as it might provide useful information for interventions on the key factors to maintain sound health. Participation in physical activity can play an important role in weight control, health maintenance, and disease prevention. Although most subjects in our study remained negative energy balance for the day, their lacking of severe and very severe activity and the low participation rate of moderate activity were a health concern for high risks of obesity-associated diseases, such as heart disease, diabetes mellitus and hypertension.
Prevalence of obesity has increased strikingly in the United States. Since the obesity epidemic can be attributed to adverse influences in the environment affecting activity level and food intake (Olshansky, et al., 2005), fundamental changes on many levels of our society can help cope with the new epidemic. Community and school programs providing education on fitness and nutrition may change the attitude and the lifestyle of a lot of people, whose diet and physical activity patterns will have a significant impact on their next generation. In this way, obesity may be stopped at the family level in a chain reaction. In addition, public health intervention is urgently needed, which must involve population-based and/or family-based strategies that increase physical activity and reduce sedentary behavior of the people.
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YING LIANG, JUDY LEE AND CHICK F. TAM
School of Kinesiology and Nutritional Science
California State University at Los Angeles
ELIZABETH BRIDGES, Dillard University
New Orleans, LA 70122
XIAOFEN D. KEATING, Department of Curriculum and Instruction
The University of Texas at Austin
Table 1 Gender, Age, Body Weight, Height, Surface Area, Body Mass Index (BMI), Total Energy Intake from One-Day Dietary Record, %RDA for Calorie of the Young and Old Groups Group Young Old Sample size (N) 30 30 gender male 10 17 female 20 13 Age (year) 25.6 [+ or -] 4.4 58.7 [+ or -] 6.1 Weight (kg) 62.2 [+ or -] 13.3 71.0 [+ or -] 13.9 Height (cm) 160.7 [+ or -] 7.5 162.5 [+ or -] 9.6 Surface Area ([m.sup.2]) 1.7 [+ or -] 0.2 1.8 [+ or -] 0.2 Body Mass Index 24.0 [+ or -] 4.43 27.0 [+ or -] 5.7 (a) (BMI)(kg/ [m.sup.2]) (1,a) % RDA for Calorie (2) 62.7 [+ or -] 32.9 79.1 [+ or -] 39.7 Data were expressed as Mean [+ or -] SD. (1) BMI, Body Mass Index 2 = body weight in kg/ [(height in m).sup.2] (2) %RDA was based on 1989 Recommended Dietary Allowances by the National Academy of Sciences. (a) p<0.05, Young vs. Old Table 2 Distribution of Body Mass Index (BMI) at different levels of the Young and Old Groups Levels Young (N=30), % Old (N=30), % Body Mass Index Normal (<25.0) 62 31 (BMI) (1) Overweight 23 48 (25.0-29.9) Obese ([greater than or equal to] 30.0) 15 21 (1) BMI = body weight in kg / [(height in m).sup.2] Table 3 Basal Metabolic Rate (BMR), Kcal for All Physical Activity, Specific Dynamic Action (SDA) of Food, Total Energy Expenditure (TEE), Total Energy Intake(TEI) and Energy Balance (EB) of the Young and Old Groups. Group Young Sample size (N) 30 Basal Metabolic Rate 1466.8 [+ or -] 221.5 (BMR) (Kcal/day) Kcal for All Physical 853.8 [+ or -] 437.4 Activity (1) (Kcal/day) Specific Dynamic Action 232.1 [+ or -] 57.2 (SDA) of Food(Kcal/day) Total Energy Expenditure 2552.6 [+ or -] 629.6 (TEE) (2) (Kcal/day) Total Energy Intake 1818.1 [+ or -] 954.7 (TEI) (Kcal/day) Energy Balance (EB) -734.5 [+ or -] 799.6 (Kcal/day) Group Old Sample size (N) 30 Basal Metabolic Rate 1459.5 [+ or -] 210.4 (BMR) (Kcal/day) Kcal for All Physical 871.7 [+ or -] 411.8 Activity (1) (Kcal/day) Specific Dynamic Action 233.1 [+ or -] 51.8 (SDA) of Food(Kcal/day) Total Energy Expenditure 2564.3 [+ or -] 570.1 (TEE) (2) (Kcal/day) Total Energy Intake 1837.4 [+ or -] 901.8 (TEI) (Kcal/day) Energy Balance (EB) -726.9 [+ or -] 786.2 (Kcal/day) Data were expressed as Mean [+ or -] SD. (1) Kcal for all physical activity refers to all the activity between 0.1 and 7.5 Kcal/kg/hr or over. (2) Total energy expenditure includes energy needs for basal metabolism, kcal for all physical activity and specific dynamic action of food. Table 4 Frequency of Participation for Specific Physical Activity (SPA), Time Spent and Total Calorie Expended for Each SPA Levels between the Young and Old Groups. Frequency of Participation for SPA (%) (1) Young, N=25 (2) 83 Old, N=23 76 p Young, N=12 40 Old, N=7 23 p Young, N=4 13 Old, N=1 3 No Statistical Comparison Young, N=3 10 Old, N=0 0 Time Spent for Total Calorie Expended SPA (hr/day) for SPA (Kcal/day) Light Activity Level (1.4-3.0 Kcal/kg/hr) Young, N=25 (2) 1.7 [+ or -] 1.9 182.0 [+ or -] 176.9 Old, N=23 2.5 [+ or -] 2.3 263.1 [+ or -] 237.7 p 0.171 (NS) 0.190 (N S) Moderate Activity Level (3.1-5.3 Kcal/kg/hr) Young, N=12 0.8 [+ or -] 0.9 188.6 [+ or -] 156.9 Old, N=7 1.9 [+ or -] 2.5 221.3 [+ or -] 302.1 p 0.288 (NS) 0.765 (NS) Severe Activity Level (5.4-7.4 Kcal/kg/hr) Young, N=4 0.8 [+ or -] 0.2 287.4 [+ or -] 69.1 Old, N=1 NA NA No Statistical Comparison Very Severe Activity Level (>=7.5Kcal/kg/hr) Young, N=3 1.5 [+ or -] 1.3 761.9 [+ or -] 764.0 Old, N=0 NA NA No Statistical Comparison Data were expressed as Mean [+ or -] SD. (1) Frequency of Participation (%) for SPA was calculated based on the 60 subjects, 30 young and 30 old, who performed specific activities at levels between 1.4 and 7.5 Kcal/kg/hr or over. (2) N = sample size Legend: Because four levels of SPA as defined may vary throughout the day, it is possible that a subject may have participated in several levels of SPA in one day. Therefore, the counting of SPA exceeded a total a total number of 60. In fact, it was counted as 75 (N=75) in total.
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|Author:||Liang, Ying; Lee, Judy; Tam, Chick F.; Bridges, Elizabeth; Keating, Xiaofen D.|
|Publication:||College Student Journal|
|Date:||Mar 1, 2007|
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