Short-Term Efficacy of <Emphasis Type="Italic">Click City</Emphasis>®<Emphasis Type="Italic">: Tobacco</Emphasis>: Changing Etiological Mechanisms Related to the Onset of Tobacco Use

This paper described the short-term results from an ongoing randomized controlled efficacy study of Click City®: Tobacco, a tobacco prevention program designed for 5th graders, with a booster in sixth grade. Click City®: Tobacco is an innovative school-based prevention program delivered via an intranet, a series of linked computers with a single server. The components of the program target theoretically based and empirically supported etiological mechanisms predictive of future willingness and intentions to use tobacco and initiation of tobacco use. Each component was designed to change one or more etiological mechanisms and was empirically evaluated in the laboratory prior to inclusion in the program. Short-term results from 47 elementary schools (24 schools who used Click City®: Tobacco, and 23 who continued with their usual curriculum) showed change in intentions and willingness to use tobacco from baseline to 1-week following the completion of the 5th grade sessions. The results demonstrate the short-term efficacy of this program and suggest that experimentally evaluating components prior to including them in the program contributed to the efficacy of the program. The program was most efficacious for students who were most at risk.     

Toxic Element Concentrations in the Bottlenose (<Emphasis Type="Italic">Tursiops truncatus</Emphasis>), Striped (<Emphasis Type="Italic">Stenella coeruleoalba</Emphasis>) and Risso’s (<Emphasis Type="Italic">Grampus griseus</Emphasis>) Dolphins Stranded in Eastern Adriatic Sea

Concentrations of cadmium (Cd), arsenic (As), mercury (Hg) and lead (Pb) were measured in muscle, liver and kidney of three cetacean species, the bottlenose (Tursiops truncatus), striped (Stenella coeruleoalba) and Risso’s (Grampus griseus) dolphins from the Croatian waters of the Adriatic Sea. In all three dolphin species Cd levels decreased in tissues in the order: kidney > liver > muscle, while As and Pb decreased in the order: liver > kidney > muscle for striped and Risso’s dolphins, but with the order reversed for liver and kidney in the bottlenose dolphin for Pb. Levels of Hg consistently followed the order: liver > muscle > kidney, with mean concentrations in the liver being 11–34 times higher than in the other tissues. The highest mean concentrations of trace elements were measured in Risso’s dolphins at 14.9 μg/g wet weight, for Cd in the kidney, and concentrations in the liver of 2.41, 1,115 and 0.63 μg/g for As, Hg and Pb, respectively. Statistically significant differences between the three dolphin species were determined for Cd, Hg and Pb in liver tissues, for As in muscle and for Cd in kidney. Significant correlations of metals between tissues were determined in all three species. The results presented give an indication of the environmental condition with regard to the content of toxic metals along the eastern coast of the Adriatic Sea.     

Effects of Hypoxia and Sedimentary Naphthalene on the Activity of <Emphasis Type="Italic">N</Emphasis>-acetyl-<Emphasis Type="Italic">β</Emphasis>-Glucosaminidase in the Epidermis of the Brown Shrimp, <Emphasis Type="Italic">Penaeus aztecus</Emphasis>

The brown shrimp, Penaeus aztecus, is subject to dual stresses of environmental hypoxia and contamination of polycyclic aromatic hydrocarbons (PAHs) in the northern Gulf of Mexico. The effects of hypoxia and sedimentary naphthalene, administered alone and in combination, on epidermal activity of N-acetyl-β-glucosaminidase (NAG), a biomarker for molt-interfering effects in P. aztecus, were investigated. It was found that hypoxia and sedimentary naphthalene, when given simultaneously, significantly inhibited epidermal NAG activity, suggesting that these two environmental stressors together can have adverse effects on molting of the brown shrimp. The results of this study also show that sedimentary naphthalene potentiates hypoxia effects on epidermal NAG activity.     

Assessment of a 2,4,6-Trinitrotoluene–Contaminated Site Using <Emphasis Type="Italic">Aporrectodea rosea</Emphasis> and <Emphasis Type="Italic">Eisenia andrei</Emphasis> in Mesocosms

Polynitro-organic compounds such as 2,4,6-trinitrotoluene (TNT) can be released into the environment from production and processing facilities and military firing ranges as well as through field use and disposal practices. Based on laboratory toxicity data, TNT has lethal (at 260 mg TNT/kg dry soil) and sublethal effects (at 59 mg TNT/kg dry soil) to the earthworm. However, field studies are needed to relate exposure of organisms to explosives in mixed-contaminated soil under field conditions and to define effects-based ecotoxicologic benchmarks for TNT-contaminated soil. In the present study, the lethal and sublethal effects of a 10-day in situ exposure at a TNT-contaminated field site using mesh-bag mesocosms were assessed. In addition to the survival end point, the biomarkers of earthworm exposure and effect—including tissue residues, lysosomal neutral red retention time (NRRT), and total immune activity (TIA)–were measured. Concentrations of TNT in soil mesocosms ranged from 25 to 17,063 mg/kg. Experiments indicated a trend toward decreasing survival of caged Aporrectodea rosea and Eisenia andrei as the concentration of TNT and total nitroaromatic compounds increased. E. andrei tolerated higher concentrations of TNT (up to 4050 mg/kg dry soil) in mesocosms than did indigenous earthworms, who survived only at 1146 mg TNT/kg. Earthworms E. andrei and A. rose survived in 67% and 75% of TNT-contaminated mesocosms, respectively, compared with references groups. NRRT was significantly decreased in surviving earthworms from the contaminated areas compared with those from the reference site. TIA was not affected by field exposure to TNT. Earthworm tissue concentrations of TNT metabolites 2-amino-4,6-dinitrotoluene and 4-amino-2,6-dinitrotoluene were not correlated with TNT soil concentrations. In addition, higher tissue concentrations of TNT metabolites were observed at concentrations ranging from 116 to 130 mg TNT/kg soil. The results showed that earthworm exposure in TNT-contaminated soil produced both lethal and sublethal effects in the field. The results of study indicated that mesocosm experiments would be useful to assess the toxicity of a site and to characterize the overall effects of contaminants. However, mesocosm experiments present special considerations (e.g., abiotic factors, exposure period) when used at heterogenous sites, and data must be interpreted with caution.     

Mechanism-Based Quantitative Structure–Activity Relationships on Toxicity of Selected Herbicides to <Emphasis Type="Italic">Chlorella vulgaris</Emphasis> and <Emphasis Type="Italic">Raphidocelis subcapitata</Emphasis>

Four quantitative structure-activity relationships were developed for toxicity of selected photosynthesis (PHS) inhibitors and acetolactate synthase (ALS) inhibitors to Chlorella Vulgaris and Raphidocelis subcapitata using a mechanism-based approach. These models have good fitness and predictive ability. The potential of electron transfer, intermolecular interactions with weak electron-transfer, and intermolecular dispersive interactions between PHS inhibitors and the active site of action are key factors influencing the toxicity of these PHS inhibitors. Intermolecular weak electron-transfer interactions and intermolecular dispersive interactions mainly determine the toxicity of these ALS inhibitors. Sulfonyl is an important functional group governing the toxicity of ALS inhibitors investigated.     

Influence of common variants in <Emphasis Type="Italic">FTO</Emphasis> and near <Emphasis Type="Italic">INSIG2</Emphasis> and <Emphasis Type="Italic">MC4R</Emphasis> on growth curves for adiposity in African– and European–American youth

Recent genome-wide association (GWA) studies identified several common variants for obesity: rs9939609 in FTO, rs7566605 near INSIG2 and both rs17782313 and rs17700633 near the MC4R gene. This study aimed to assess the influence of these polymorphisms on development of adiposity in European– (EA) and African–American (AA) youth in two ongoing longitudinal studies including 986 and 606 participants with age ranges of 10–25.8 and 4.0–23.9 years, respectively. Individual growth curve modeling was conducted separately in the two studies. We tested the effect of the SNPs on levels and increase with age (i.e., slope) of weight, body mass index (BMI), waist circumference and skinfolds from childhood to adulthood, and potential moderation by ethnicity or gender. Beta coefficients computed in the two studies were pooled using meta-analysis. Rs9939609 was associated with logtransformed levels of BMI (β = 0.021, P = 0.01), weight (β = 0.019, P = 0.04) and waist circumference (β = 0.012, P = 0.04). Rs17782313 was associated with triceps (β = 0.05, P = 0.02). Significant interactions of rs17700633 with gender were observed on subscapular-, suprailiac- and sum of skinfolds, with significant associations limited to males (P < 0.05). No significant interactions with ethnicity were found. Only one effect on the slope was observed, rs17700633 showed a significant interaction with age on triceps (β = 0.004, P = 0.04). In two longitudinal studies of EA and AA youth, we replicated the effect of FTO and common variants near MC4R on general and central adiposity. These variants did not affect the increase with age of adiposity from childhood to adulthood with one exception. Common variants for obesity identified in GWA studies have detectable but modest effects on growth curves for adiposity in EA and AA youth.     

A1330V polymorphism of the <Emphasis Type="Italic">low</Emphasis>-<Emphasis Type="Italic">density lipoprotein receptor</Emphasis>-<Emphasis Type="Italic">related protein 5</Emphasis> gene and bone mineral density in Japanese male workers

Objectives  

Both genetic and lifestyle factors have been shown to influence bone mineral density (BMD). We investigated the correlations between BMD and low-density lipoprotein receptor-related protein 5 (LRP5) A1330V (rs3736228) polymorphism, exercise, smoking, and alcohol intake in Japanese male workers.     

When to Intervene: Elementary School,Middle School or Both? Effects of <Emphasis Type="Italic">keepin’ It REAL</Emphasis> on Substance Use Trajectories of Mexican Heritage Youth

This article presents the findings of a study exploring two questions: What age is most efficacious to expose Mexican heritage youth to drug abuse prevention interventions, and what dosage of the prevention intervention is needed? These issues are relevant to Mexican heritage youth—many from immigrant families—in particular ways due to the acculturation process and other contextual factors. The study utilized growth curve modeling to investigate the trajectory of recent substance use (alcohol, cigarettes, marijuana, inhalants) among Mexican heritage students (N?=?1,670) participating in the keepin’ it REAL drug prevention program at different developmental periods: the elementary school (5th grade), middle school (7th grade), or both. The findings provide no evidence that intervening only in elementary school was effective in altering substance use trajectories from 5th to 8th grade, either for licit nor illicit substances. Implementing keepin’ it REAL in middle school alone altered the trajectories of use of all four substances for Mexican heritage youth. A double dose of prevention, in elementary and middle school proved to be equally as effective as intervening in 7th grade only, and only for marijuana and inhalants. The decrease in use of marijuana and inhalants among students in the 7th-grade-only or the 5th- and 7th-grade interventions occurred just after students received the curriculum intervention in 7th grade. These results are interpreted from an ecodevelopmental and culturally specific perspective and recommendations for prevention and future research are discussed.     

Test–retest reliability of <Emphasis Type="Italic">HeartQoL</Emphasis> and its comparability to the <Emphasis Type="Italic">MacNew</Emphasis> heart disease health-related quality of life questionnaire

Objectives

Heart Quality of Life (HeartQoL) is a new “hybrid” developed from the MacNew and two condition-specific questionnaires measuring health-related quality of life (HRQoL) in patients with ischemic heart disease (IHD). This study investigates test–retest reliability of HeartQoL (English version) according to international criteria (e.g., COSMIN, GRRAS). Findings on HeartQoL are compared to the published data on MacNew in view that both serve as the core IHD-specific HRQoL instrument.

Methods

Out of 105 patients with IHD, 76 completed self-administration of HeartQoL at the clinic followed by at home within a 2-week interval. In retest, patients responded using non-interview methods (phone messaging, email, fax, and post). Phone interviewing was reserved for non-respondents to reminder.

Results

Reliability of HeartQoL was good (intraclass correlation coefficients = 0.78–0.82), was supported in the Bland–Altman plot, and was comparable to five studies on MacNew of similar retest interval (MacNew-English = 0.70–0.75; translated MacNew = 0.72–0.91). Applicability of its standard error of measurement (0.20–0.25) and smallest detectable change (0.55–0.70) will depend on availability of normative data in future.

Conclusion

The reliability of HeartQoL is comparable to its parent instrument, the MacNew. The HeartQoL is a potentially reliable core IHD-specific HRQoL instrument in measuring group change.

     

<Emphasis Type="Italic">In vitro</Emphasis> starch digestibility and <Emphasis Type="Italic">in vivo</Emphasis> glucose response of gluten–free foods and their gluten counterparts

BACKGROUND: Recently there has been increasing interest in the production of gluten-free (GF) foods and studies on minor cereals and pseudocereals without celiac activity in order to fulfill the specific needs of people affected by celiac disease. GF bread, pasta, biscuits are usually manufactured using different combinations of thickenings and particular food processing procedures that could affect starch digestibility. Carbohydrates, mainly starch from cereals, play an important part in a balanced diet, and dietary guidelines suggest a diet with low glycemic index foods, that is to say rich in slowly digested carbohydrates. AIM: The present study was aimed at evaluating: 1) the importance of some GF food characteristics in relation to their effects on in vitro starch accessibility to digestion, in comparison with traditional gluten products; 2) the in vivo metabolic responses to GF foods. METHODS: Firstly, starch digestibility of several products was evaluated in vitro. Then, an in vivo study was performed on a group of healthy volunteers. Postprandial glucose and insulin responses were evaluated after administration of three GF foods and traditional bread. Triglycerides and free fatty acids (FFA) were also evaluated. Attempts were also made to explore differences in metabolic responses to GF foods in healthy subjects with respect to celiac subjects. RESULTS: The area under the curve (AUC) of digested starch of GF bread was slightly higher than that of the traditional counterpart. No significant difference was observed in AUCs of digested starch between GF pasta and the traditional pasta. The AUCs of digested starch of quinoa and the two samples of pasta were not statistically different. Significant differences were observed between GF bread and bread-like products. Statistic differences in glucose responses to GF pasta were observed between healthy and celiac subjects. In healthy subjects, the AUCs of glucose response after GF bread were higher than those after bread with gluten. No significant differences were observed between the AUCs of insulin responses to all products tested. Glycemic index (GI) for GF pasta was similar to GI for GF bread while GI for quinoa was slightly lower than that of GF pasta and bread. Two-way ANOVA revealed that quinoa induced lower FFA levels with respect to GF pasta. In addition, triglyceride concentrations were significantly reduced for quinoa with respect to GF bread and bread. CONCLUSIONS: Our results indicate that the different formulations and the food processing procedures used in the manufacturing of GF products may affect the rate of starch digestion both in vitro and in vivo. It may be worthwhile improving the formulation of these products. Furthermore, quinoa seems to represent a potential alternative to traditional foods, even if further and larger studies are required to demonstrate its hypoglycemic effects.     

Binational Cultural Adaptation of the keepin’ it REAL Substance Use Prevention Program for Adolescents in Mexico

Prevention Science - Sharp increases in substance use rates among youth and the lack of evidence-based prevention interventions in Mexico are a major concern. A team of investigators from Mexico...     

Elevated Concentrations of Ethinylestradiol, 17β-Estradiol,and Medroxyprogesterone have Little Effect on Reproduction and Survival of <Emphasis Type="Italic">Ceriodaphnia </Emphasis><Emphasis Type="Italic">dubia</Emphasis>

Wastewater effluent contains synthetic and natural hormones, often in complex mixtures, that may be associated with reproductive abnormalities in fish and other aquatic biota. We exposed the sentinel invertebrate Ceriodaphnia dubia to the natural estrogen 17beta-estradiol (E(2)), a synthetic estrogen, ethinylestradiol (EE(2)), and a synthetic progestin, medroxyprogesterone in a 7-day test. These compounds had no significant effect on reproduction or survival even at 10(6) times the concentrations at which reproductive effects have been documented in several fish species. C. dubia is routinely used for screening the toxicity of wastewater effluent. However, in the standard chronic 7-day exposure the endpoints of survival and reproduction were insensitive to several synthetic and natural vertebrate hormones. The C. dubia 7-day chronic toxicity test is probably not a useful monitoring tool for vertebrate hormones and their pharmaceutical analogs unless other sensitive endpoints such as maturation rates, molt frequency, and offspring sex ratios are incorporated in a practical manner.     

Accumulation and Distribution of Trivalent Chromium and Effects on Hybrid Willow (<Emphasis Type="Italic">Salix matsudana</Emphasis> Koidz × <Emphasis Type="Italic">alba</Emphasis> L.) Metabolism

The metabolic response of plants to exogenous supply and bioaccumulation of trivalent chromium (Cr³⁺ ) was investigated. Pre-rooted young hybrid willows (Salix matsudana Koidz × alba L.) were exposed to hydroponic solution spiked with CrCl₃ at 24.0°C ± 1°C for 192 hours. Various physiologic parameters of the plants were monitored to determine toxicity from Cr exposure. The transpiration rate of willows exposed to 2.5 mg Cr/L was 49% higher than that of the untreated control plants, but it was decreased by 17% when exposed to 30.0 mg Cr/L. Significant decrease (≥20%) of soluble protein in young leaves of willows was detected in the treatment group with ≥7.5 mg Cr/L. The measured chlorophyll contents in leaves of treated plants varied with the dose of Cr, but a linear correlation could not be established. The contents of chlorophyll in leaves of willows exposed to ≥7.5 mg Cr/L were higher than that of the untreated plants but lower at 30.0 mg Cr/L. Superoxide dismutase activity (SOD) in leaves between the treated and untreated willows did not show any significant difference, but activities of both catalase (CAT) and peroxidase (POD) in leaf cells of all treated plants were higher than those in the untreated willows. The correlation between the concentration of Cr and CAT activity in leaf cells was the highest of all toxicity assays (R ² = 0.9096), indicating that CAT activity was most sensitive to the change in Cr³⁺ doses compared with the other selected parameters. Results from the Cr uptake study showed that significant removal of Cr from hydroponic solution was observed in the presence of hybrid willows without showing detectable phytotoxicity, even at high does of Cr. More than 90% of the applied Cr³⁺ was removed from the aqueous solution by willows at concentrations up to 7.5 mg Cr/L. Approximately 70% of the initial Cr was recovered in the plant materials. At the low-Cr³⁺ treatment (2.5 mg Cr/L), Cr accumulation by willow materials was the greatest (92%) in roots and the lowest (0.2%) in leaves, whereas the greatest (66%) was in stems and the lowest (0.1%) in leaves of willows exposed to 30.0 mg Cr/L. The correlation between applied Cr³⁺ (mg Cr/L) and Cr (μg Cr/g fresh weight [fw]) accumulated in plant materials was significant. The bioaccumulation kinetics of Cr by hybrid willows can be described by a typical saturation curve. Results also indicated that translocation of Cr from roots to shoots was possible. It is to conclude that hybrid willows have great potential as bioremediation technology in the removal of chromium (Cr³⁺) from contaminated effluents and sediments.     

Occupational allergy to <Emphasis Type="Italic">Limonium sinuatum</Emphasis> — a case report

Decorative flowers are known to be a cause of occupational allergy in the floral industry. The allergic manifestations induced by flowers include asthma, rhinoconjunctivitis and urticaria. We present a case of a 55-year-old woman, who has been working for the last 30 years as a gardener with various kinds of flowers, e.g., Limonium sinuatum (LS), chrysanthemum, sweet William (Dianthus barbatus) and Lilium. During the last 10 years she has developed nasal and eyes symptoms, dry cough, dyspnoea, chest tightness and wheezing. Clinical examination, routine laboratory testing, chest radiography, skin prick tests (SPT) involving common allergens, native plants pollens and leaves by the prick-prick technique, rest spirometry, methacholine challenge test and specific inhalation challenge test (SICT) were conducted. SPT results to common allergens were positive for grass pollens. SPT with native plants pollens and leaves showed a positive reaction only for LS. SICT induced an isolated early asthmatic reaction and significant increase in the number of eosinophils in the nasal lavage fluid. Additionally, significant increase in non-specific bronchial hyperreactivity was observed after SICT. To our knowledge, the presently described report is the first one of Limonium sinuatum induced occupational asthma and rhinitis in a Polish gardener.     

Acute Exposure to 17α-Ethinylestradiol Alters Aggressive Behavior of Mosquitofish (<Emphasis Type="Italic">Gambusia affinis</Emphasis>) Toward Japanese Medaka (<Emphasis Type="Italic">Oryzias latipes</Emphasis>)

Behavior of the mosquitofish (Gambusia affinis) toward the Japanese medaka (Oryzias latipes) was tested under exposure to environmental 17α-ethinylestradiol (EE2), a synthetic derivative of natural estrogen, estradiol. The mosquitofish were exposed to EE2 at different concentrations—0, 0.5, 5.0, and 50.0 ng/L—for 2 days, before their behavioral changes toward the medaka were observed. Results indicate that female mosquitofish became more aggressive at the high level of EE2 (50 ng/L), in terms of how persistently they attempted to approach the medaka. The males showed increased aggressive behavior toward the medaka, by significantly increasing the number and persistence of approach attempts at the low (0.5 and 5 ng/L) levels of EE2. At the highest EE2 concentration (50 ng/L), however, the number of attempts decreased, while the persistence increased in the males showing the same pattern as in the females. All behavioral changes were reversed once EE2 was removed from the environment.     

Improving the Language Skills of Pre-kindergarten Students: Preliminary Impacts of the <Emphasis Type="Italic">Let’s Know!</Emphasis> Experimental Curriculum

Background

Improving children’s oral language skills is an important focus of educational research and practice; however, relatively few interventions have demonstrated impacts on these skills. This work makes a unique contribution to our understanding of the effects of language-focused interventions in pre-kindergarten settings by examining impacts on both lower- and higher-level language skills as well as overall language comprehension.

Objective

The goal is to assess the impacts of business-as-usual pre-kindergarten with implementation of two versions of an experimental curriculum supplement, Let’s Know!, designed to enhance three component language skills (vocabulary, comprehension monitoring, and text-structure knowledge) and overall language comprehension in pre-kindergarteners.

Methods

Eleven pre-kindergarten teachers and 49 low socioeconomic-status students participated. Teachers were randomly assigned to either business-as-usual, Let’s Know! Broad, or Let’s Know! Deep, unless they participated in a previous pilot study, in which case they were randomly assigned to either Let’s Know! Broad or Deep. The Broad version included five different lesson types, whereas the Deep version included three lesson types with additional practice. Children’s gains were assessed proximally with measures of vocabulary, comprehension monitoring, and text-structure knowledge and distally with a measure of language comprehension.

Results

Children in both experimental versions significantly improved their vocabulary skills relative to children who received business-as-usual instruction. For comprehension monitoring, children who received the Deep and Broad versions improved their scores relative to BAU children for Units 1 and 3, respectively. Improvement in language comprehension was only found for children who received Let’s Know! Deep compared with business-as-usual.

Conclusion

This study provides initial evidence that the Let’s Know! curricula may serve to foster young children’s vocabulary, comprehension monitoring, and language comprehension skills.

     

Genetic and diet effects on <Emphasis Type="Italic">Ppar-α</Emphasis> and <Emphasis Type="Italic">Ppar-γ</Emphasis> signaling pathways in the Berlin Fat Mouse Inbred line with genetic predisposition for obesity

Background  

The Berlin Fat Mouse Inbred (BFMI) line is a new mouse model for obesity, which was long-term selected for high fatness. Peroxisome proliferator-activated receptors (PPARs) are involved in the control of energy homeostasis, nutrient metabolism and cell proliferation. Here, we studied the expression patterns of the different Ppar genes and the genes in the PPAR pathway in the BFMI line in comparison to physiological changes.     

Effects of Elevated Ozone on Photosynthetic CO<Subscript>2</Subscript> Exchange and Chlorophyll <Emphasis Type="Italic">a</Emphasis> Fluorescence in Leaves of <Emphasis Type="Italic">Quercus mongolica</Emphasis> Grown in Urban Area

The aim of this study was to determine the responses of photosynthesis in leaves of Quercus mongolica to elevated O₃ exposure in an urban area. The results showed that the photosynthesis parameters were all decreased by the elevated O₃ during the whole season. Especially, light-saturated net photosynthetic rate (A) was reduced about 72% after 45 days exposure, and over the whole growing season, the differences were significant (p < 0.05) compared with control. The reduction is related to both stomatal and non-stomatal factors, including a decrease (about 9%) in the maximum quantum yield of PSII photochemistry (F _v/F _m) detected after 90 days O₃ exposure.     

“<Emphasis Type="Italic">We are out of balance here</Emphasis>”: a Hmong Cultural Model of Diabetes

A Hmong cultural model of type 2 diabetes has not been described. We analyzed 20 group discussions during 21 group visits over 1 year with 39 Hmong adults with type 2 diabetes in order to describe a model that underlines their discussions. These Hmong adults attribute their diabetes to their refugee experience. They do not fit with the food, activity, weather, or community in the United States. Consuming sugar, salt, fat, and chemicals and then not sweating them out of the body, combined with emotional losses of being refugees, the participants feel they are out of balance. And being out of balance, they develop diabetes. The participants interpret biomedical information, community experiences, and personal sensations of diabetes in terms of a traditional health model of balance and in the context of refugee loss of place. Throughout their discussions, the shared suffering of their personal experiences of diabetes was evident. This cultural model may help providers implement diabetes treatment and prevention programs.