Stanford Response to RFQ Solicitation for WHI Participant Supplemental Questionnaire 2018 Proposal for the Administration of the 6-page i.e. 3 ...
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Stanford Response to RFQ Solicitation for WHI Participant Supplemental Questionnaire 2018
Proposal for the Administration of the 6-page (i.e. 3 page, 2-sided) Brief Stanford WELL for Life Survey
(attached, mocked up in WHI format) NOTE: We are able to cover the costs
From: Marcia Stefanick, PhD (Stanford PI, Western Regional Center PI), Professor of Medcine (SPRC)
stefanick@stanford.edu
Catherine Heaney, Ph.D., Associate Professor of Psychology and Medicine (SPRC), Stanford University
Sandra Winter, Ph.D., Senior Research Scholar, Stanford Prevention Research Center, Stanford
Biosketches are attached for each.
Women in WHI have expressed the desire to have the WHI study address important, positive aspects of their
lives. The WHI RFQ responds to this desire and focuses on questions of resilience, aging well, and well-
being. We are proposing that the newly developed Brief Stanford WELL for LIfe Scale be administered.
Scientific Rationale
The study of well-being is growing in popularity and importance across various disciplines: the biomedical
sciences, the health promotion and wellness field, psychology, and other social science arenas. These
literatures present a broad array of approaches to conceptualizing and measuring well-being, with most
approaches stemming from an expert-driven process based on the research traditions, priorities, theories and
methodologies of a given field. Typically, early measures tended to emphasize the absence or presence of
detractors from well-being (e.g. role limitations, episodes of pain, lack of energy, stress, depression). Later
measures have incorporated questions about the extent to which contributors to well-being (e.g., resilience,
social support, positive emotions) are being experienced.
Stanford SPRC researchers wanted to identify a comprehensive conceptualization of well-being, constructed
from the experiences and perspectives of a diverse set of people. We conducted an innovative measurement
development process using narrative inquiry. Fundamental to narrative inquiry is the notion that people
understand and give meaning to their lives through stories. These stories are “especially translucent windows
into cultural and social meanings,” and therefore narrative inquiry is very well-suited to creating an
understanding of well-being that is valid across cultures and for people who have had very different life
experiences. Through the telling of stories and the application of a rigorous qualitative coding process of
elements of those stories, we developed a multi-faceted conceptualization of well-being that is grounded in the
life experiences of the participants in our study. The process employed identified the key domains of well-
being, i.e. what matters to people when they think about being well.
Among the many questions that can be asked when these data are available in WHI are:
¡ Who experiences high levels of well-being? [Analyses can be conducted to compare/contrast across sub-
groups of the WHI population, e.g. by age, SES, race/ethnicity, education, medical history, etc.
¡ How does the experience of chronic disease influence women’s perceptions of well-being?
¡ How can well-being be used to motivate chronic disease prevention?
¡ What are potential biomarkers of well-being?
Measurement Development Process
The process for developing a comprehensive measure of well-being is detailed in the attached Methods. It
was initiated with a literature search relevant to the study of wellbeing, spanning a number of disciplines.
Following this, 103 face-to-face semi-structured qualitative interviews (see Interview document) of a diverse
purposeful sample of women (including many aged 60 and over) and men were conducted. Rigorous analysis
of the verbatim interview transcripts identified ten domains of well-being. These are displayed in the figure
below, with the % of coded data elements that mentioned each domain shown on each petal.
3%
4%
4%
5%
25%
8%
10%
17%
12%
12%
From this qualitative formative process, we developed and pilot tested a comprehensive 67-item scale that
includes all 10 domains of well-being. For WHI, we engaged in further data reduction and developed a
parsimonious 20 item scale that still includes all 10 domains and is highly correlated with the longer scale
(r=.93) indicating that items chosen for the short scale are good indicators of their respective domains. The 20-
item scale is also strongly correlated with a 1 item global well-being question (#21 in the proposed WELL
Survey) (r=.74). We created a table that shows how WELL questions relate to WHI questions, and when these
were asked, noting that 13 have no WHI counterpart, see: WELL vs WHI Qs (included with this submission)
The 1-item global well-being question could potentially be asked as a stand-alone question; in the event
that the WHI is not willing to administer the full 20-item Brief Stanford WELL for Life Scale. As noted above,
we are able to cover the cost of administering the full survey and hope the committee will give this serious
consideration.
Important Supporting Documents (Attachments)
§ Brief Stanford WELL for LIfe Scale (Mock Up in WHI format)
§ Sources of Brief Stanford WELL for Life Questions
§ WELL vs WHI Qs
§ Methods for WELL for Life Long and 20 item Scale
§ Interview WELL Global Assessment
If the committee has any questions, please do not hesitate to contact us.
The Stanford WELL for Life Scale
The Stanford Prevention Research Center
This booklet has questions about things in your life that may affect your well-
being. Please answer each question as honestly as you can. No one will see your
answers except for the scientists and staff at WHI. Your answers will be kept secret
and will never be put with your name in a report. Please answer using your first
thoughts about each question. Do not go back later to ‘figure out’ answers. Your
answers will help us to understand the well-being of women like you.
Instructions:
Use Pencil
Darken the circle completely next to the answer you choose
Erase cleanly any marks you wish to change
Do not make any stray marks on this form
Read the questions carefully as some of them ask you to think about the last two
weeks, and others ask you to think about the last month.
1During the last two weeks:
1. How often did you feel 2. How often did you feel 3. How often did you feel
you lacked companionship? that other people upset energized by the opportunity
you? to help or take care of others?
Very often Very often Very often
Fairly often Fairly often Fairly often
Sometimes Sometimes Sometimes
Almost never Almost never Almost never
Never Never Never
The questions in this section ask about what you eat and drink. While answering
these questions, please think about what you have been eating and drinking during
the last month.
4. How often did you eat sugar-sweetened baked goods or candy, such as cookies,
donuts, pastry, and candy bars? Please mark one response from only one box.
Refer to question 4.1 only 4.1 How many times a month?
Less than once a week
Never
Refer to question
Every week but not every day 4.2 only 1 time in past month
Everyday Refer to question 4.3 2-3 times in past month
only
4.3 How many times a day?
4.2 How many times a week?
1 time a day
1-2 times a week
2-3 times a day
3-4 times a week
4-5 times a day
5-6 times a week
2
6 or more times a day5. How often did you eat vegetables? Please mark one response from only one
box.
Refer to question 5.1 only
5.1 How many times a month?
Less than once a week Never
Refer to question 1 time in past month
Every week but not every day 5.2 only
Refer to question 5.3
2-3 times in past month
Everyday only
5.3 How many times a day?
5.2 How many times a week?
1 time a day
1-2 times a week
2-3 times a day
3-4 times a week
4-5 times a day
5-6 times a week
6 or more times a day
6. Think about your physical activity. During the past month, which statement
best describes the kinds of physical activity you usually did? Do not include the
time you spent working at a job. Please read all six statements before selecting one.
I did not do much physical activity. I mostly did things like watching
television, reading, playing cards, or playing computer games. Only
occasionally, no more than once or twice a month, did I do anything more
active such as going for a walk or playing tennis.
Once or twice a week, I did light activities such as getting outdoors on the
weekends for an easy walk or stroll. Or once or twice a week, I did chores
around the house such as sweeping floors or vacuuming.
About three times a week, I did moderate activities such as brisk walking,
swimming, or riding a bike for about 15-20 minutes each time. Or about once
a week, I did moderately difficult chores such as raking or mowing the lawn
for about 45-60 minutes. Or about once a week, I played sports such as
softball, basketball, or soccer for about 45-60 minutes.
Almost daily, that is five or more times a week, I did moderate activities such
as brisk walking, swimming or riding a bike for 30 minutes or more each
time. Or about once a week, I did moderately difficult chores or played sports 3
for 2 hours or more.About three times a week, I did vigorous activities such as running or riding
hard on a bike for 30 minutes or more each time.
Almost daily, that is, five or more times a week, I did vigorous activities such
as running or riding hard on a bike for 30 minutes or more each time.
7. During the past two weeks, how 8. Altogether, have you smoked at least
would you rate your sleep quality 100 or more cigarettes in your entire
overall? lifetime?
Yes 9. How often do you
Very good currently smoke?
No Every day
Fairly good
Refused
Some days
Fairly bad Don’t Know
Not at all
knowNo
Very bad
10. During the past 30 days, did you ever have 4 or more drinks containing any kind
of alcohol within a two-hour period? [That would be the equivalent of at least four 12-
ounce cans or bottles of beer, four 5-ounce glasses of wine, four drinks each containing
one shot of liquor or spirits]
Yes
No
During the last two weeks:
11. How often have you felt that you 12. How confident are you that you
were not able to give enough energy to can deal with whatever comes your
the important things in life? way?
Very often Extremely Confident
Very Confident
Fairly often
Moderately Confident
Sometimes
Almost never Slightly Confident
Never Not at all Confident
4During the last two weeks:
13. How often did you feel 14. How often did you feel
joyful? worried?
Very often Very often
Fairly often Fairly often
Sometimes Sometimes
Almost never Almost never
Never Never
15. How often did you feel 16. How would you
satisfied with yourself? describe your current
Very often level of physical fitness?
Excellent
Fairly often
Very good
Sometimes
Good
Almost never
Fair
Never
Poor
Very poor
517. How often does your 18. During the last year, how
daily life include experiences often have you had enough
that give your life meaning? money to meet your needs?
you Very
describe your current
often All of the time
Fairly often Most of the time
Sometimes More than half of the time
Almost never Less than half of the time
Never Some of the time
None of the time
19. How important are spiritual or 20. How often do you engage with
religious beliefs in your day to day life? opportunities to challenge yourself and
Very important grow as a person?
in your day to day life?
Very often
Fairly important
Fairly often
Somewhat important
Sometimes
Not too important
Almost never
Not at all important
Never
21. Please think about your current level of well-being. When you think about well-being,
think about your physical health, your emotional health, any challenges you are experiencing,
the people in your life, and the opportunities or resources you have available to you. How
would you describe your current level of wellbeing?
Excellent
Very good
Good
Fair
Poor
6
Very poor
Thank you for completing our survey!Sources for Brief Stanford WELL for Life Scale
Domain: Social Connectedness
Definition: Positive or negative relationships with others and how they influence well-
being/wellness. Includes people who are family, friends, intimates and broader social network.
Functions of social relationships include social support, social influence, social pressure, social
undermining and social comparisons. Also includes how the characteristics and decisions of
others impact one’s own well-being or wellness (e.g., substance abuse of a loved one).
Sources of Items:
Russell, D, Peplau, L. A., & Cutrona, C. E. (1980). The Revised UCLA Loneliness Scale:
Concurrent and Discriminant Validity Evidence. Journal of Personality and
Social Psychology, 39:472–80. [R-UCLA Loneliness Scale]
WELL Measures Workgroup, 2016 [WELL]
Items:
The following items share the same stem:
The next questions are about how you feel about different aspects of your life. Again, think about
the last two weeks as you answer these questions. During the last two weeks, how often did you
feel…
1. [Adapted from R-UCLA Loneliness Scale] …that you lacked companionship? 5, Very
often | 4, Fairly often | 3, Sometimes | 2, Almost never | 1, Never
[Original question from R-UCLA Loneliness Scale] Item 2. I lack companionship.
Never; Rarely; Sometimes; Often
The remaining items share the same stem:
During the last two weeks, how often did you feel…
1. [WELL] …that other people upset you? 5, Very often | 4, Fairly often | 3, Sometimes | 2,
Almost never | 1, Never
2. [WELL] …energized by the opportunity to help or take care of others? 5, Very often | 4,
Fairly often | 3, Sometimes | 2, Almost never | 1, NeverDomain: Diet
Definition: Consumption behavior of food and beverages.
Sources of Items:
Centers for Disease Control and Prevention. (2013). Behavioral Risk Factor Surveillance
System Survey Questionnaire [pdf]. Atlanta, Georgia: U.S. Department of Health
and Human Services, Centers for Disease Control and Prevention,
[http://www.cdc.gov/brfss/questionnaires/pdf-ques/2013-brfss_english.pdf].
[BRFSS 2013]
The Board of Trustees of the Leland Stanford Junior University (2010). The Stanford
Health & Lifestyle Assessment [word doc]. Revised Jan 15, 2015. Provided by
BeWell staff. [SHALA]
Items:
The questions in this section ask about what you eat and drink. While answering these questions,
please think about what you have been eating and drinking during the last month.
1. [Adapted from SHALA] How often did you eat sugar-sweetened baked goods or candy,
such as cookies, donuts, pastry, and candy bars?
1, Less than once a week (if selected, branch into 1, Never | 2, 1 time in past month | 3, 2-
3 times in past month); 2, Every week but not every day (if selected, branch into 1, 1-2
times a week | 2, 3-4 times a week | 3, 5-6 times a week); 3, Every day (if selected,
branch into 1, 1 time a day | 2, 2-3 times a day | 3, 4-5 times a day | 4, 6 or more times a
day)
[Original question from SHALA] Item 28. On average, how many servings of
foods and/or drinks of lower nutritional value do you consume each day?
(Examples of these foods/drinks include sweetened beverages/sodas, alcohol,
baked goods, candy, French fries/chips). None or less than 1; 1 serving; 2
servings; 3 servings; 4 servings; 5 servings; 6 or more servings. A serving of
beverages is equal to: 1 cup or 2/3can of soda 1.5 oz hard liquor 5 oz wine 12
oz beer A serving of baked goods is equal to: 1/8 slice of 8” round cake 2 2”
cookies 1 medium donut 5” length or diameter pastry A serving of other foods
in this category is equal to: 3 pieces of hard candy 2 fun-size pieces of candy
bars 15 (1 oz) chips 10 saltine crackers 20 small pretzels Small order of
French fries.
2. [Adapted from BRFSS 2013] How often did you eat vegetables?
1, Less than once a week (if selected, branch into 1, Never | 2, 1 time in past month | 3, 2-
3 times in past month); 2, Every week but not every day (if selected, branch into 1, 1-2
times a week | 2, 3-4 times a week | 3, 5-6 times a week); 3, Every day (if selected,branch into 1, 1 time a day | 2, 2-3 times a day | 3, 4-5 times a day | 4, 6 or more times a
day)
[Original question from BRFSS 2013] Item 11.4. During the past month, how
many times per day, week, or month did you eat dark green vegetables for
example broccoli or dark leafy greens including romaine, chard, collard greens or
spinach? _ _Per day; _ _Per week; _ _ Per month; Never; Don’t know / Not sure;
RefusedDomain: Physical Activity
Definition: Physical activity behavior.
Sources of Items:
Kiernan, M., Schoffman, D. E., Lee, K., Brown, S. D., Fair, J. M., Perri, M. G., &
Haskell, W. L. (2013). The Stanford Leisure-Time Activity Categorical Item (L-
Cat): a single categorical item sensitive to physical activity changes in
overweight/obese women. International Journal of Obesity, 37(12), 1597–1602.
http://doi.org/10.1038/ijo.2013.36 [LCAT 2.2]
Items:
1. [LCAT 2.2] Think about your physical activity. During the past month, which statement
best describes the kinds of physical activity you usually did? Do not include the time you
spent working at a job. Please read all six statements before selecting one.
|1, I did not do much physical activity. I mostly did things like watching television,
reading, playing cards, or playing computer games. Only occasionally, no more than once
or twice a month, did I do anything more active such as going for a walk or playing
tennis.
|2, Once or twice a week, I did light activities such as getting outdoors on the weekends
for an easy walk or stroll. Or once or twice a week, I did chores around the house such as
sweeping floors or vacuuming.
|3, About three times a week, I did moderate activities such as brisk walking, swimming,
or riding a bike for about 15-20 minutes each time. Or about once a week, I did
moderately difficult chores such as raking or mowing the lawn for about 45-60 minutes.
Or about once a week, I played sports such as softball, basketball, or soccer for about 45-
60 minutes.
|4, Almost daily, that is five or more times a week, I did moderate activities such as brisk
walking, swimming, or riding a bike for 30 minutes or more each time. Or about once a
week, I did moderately difficult chores or played sports for 2 hours or more.
|5, About three times a week, I did vigorous activities such as running or riding hard on a
bike for 30 minutes or more each time.
|6, Almost daily, that is, five or more times a week, I did vigorous activities such as
running or riding hard on a bike for 30 minutes or more each time.
[Original question from LCAT 2.2] Think about your physical activity. During
the past month, which statement best describes the kinds of physical activity you
usually did? Do not include the time you spent working at a job. Please read allsix statements before selecting one. |1, I did not do much physical activity. I mostly did things like watching television, reading, playing cards, or playing computer games. Only occasionally, no more than once or twice a month, did I do anything more active such as going for a walk or playing tennis. |2, Once or twice a week, I did light activities such as getting outdoors on the weekends for an easy walk or stroll. Or once or twice a week, I did chores around the house such as sweeping floors or vacuuming. |3, About three times a week, I did moderate activities such as brisk walking, swimming, or riding a bike for about 15-20 minutes each time. Or about once a week, I did moderately difficult chores such as raking or mowing the lawn for about 45-60 minutes. Or about once a week, I played sports such as softball, basketball, or soccer for about 45-60 minutes. |4, Almost daily, that is five or more times a week, I did moderate activities such as brisk walking, swimming, or riding a bike for 30 minutes or more each time. Or about once a week, I did moderately difficult chores or played sports for 2 hours or more. |5, About three times a week, I did vigorous activities such as running or riding hard on a bike for 30 minutes or more each time. |6, Almost daily, that is, five or more times a week, I did vigorous activities such as running or riding hard on a bike for 30 minutes or more each time.
Domain: Sleep
Definition: Sleep behavior
Sources of Items:
Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The
Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and
research. Psychiatry Research, 28(2), 193–213. [PSQI]
Items:
1. [Adapted from PSQI] During the past two weeks, how would you rate your sleep quality
overall? 4, Very good | 3, Fairly good | 2, Fairly bad | 1, Very bad
[Original question from PSQI] Item 6. During the past month, how would you
rate your sleep quality overall? Very good; Fairly good; Fairly bad; Very badDomain: Smoking
Definition: Smoking behaviors, including use of cigarettes, electronic cigarettes, Vape Pens and
E-hookahs.
Sources of Items:
California Health Interview Survey. (2011) CHIS 2009 Adult Questionnaire. UCLA
Center for Health Policy Research. Los Angeles, CA, Retrieved from
http://healthpolicy.ucla.edu/chis/design/Documents/CHIS2009
adultquestionnaire.pdf. [CHIS 2009]
California Health Interview Survey. (2015) CHIS 2013-2014 Adult Questionnaire. UCLA
Center for Health Policy Research. Los Angeles, CA. Retrieved from
http://healthpolicy.ucla.edu/chis/design/Documents/chis2013adultq
uestionnaire.pdf. [CHIS 2013-2014]
WELL Measures Workgroup, 2016 [WELL]
Items:
1. [CHIS 2013-2014] Altogether, have you smoked at least 100 or more cigarettes in your
entire lifetime? 1, Yes | 0, No
[Original question from CHIS 2013-2014] Item QA13_C14. Altogether, have you
smoked at least 100 or more cigarettes in your entire lifetime? Yes; No; Refused;
Don’t Know
1a. If answered 1: [Adapted from CHIS 2013-2014] How often do you currently
smoke? 3, Every day | 2, Some days | 1, Not at all
[Original question from CHIS 2013-2014] Item Q13_C15. Do you now
smoke cigarettes every day, some days, or not at all? Every day; Some
days; Not at all; Refused; Don’t know
1a.1. If answered 2 or 3: [Adapted from CHIS 2009] For how long have
you smoked? YEARS; MONTHS
[Original question from CHIS 2009] Item QA09_C30. About how
long {have you smoked/did you smoke} cigarettes regularly?
Number of years; Number of months; Refused; Don’t know
1a.2. If answered 2 or 3: [CHIS 2013-2014] On average, how many
cigarettes do you now smoke a day? 1-80 or more[Original question from CHIS 2013-2014] Item QA13_C16. On
average, how many cigarettes do you now smoke a day?
1b. If answered 1, or 1 to item 1a: [Adapted from CHIS 2009] For how long did
you smoke? YEARS; MONTHS
[Original question from CHIS 2009] Item QA09_C30. About how long
{have you smoked/did you smoke} cigarettes regularly? Number of years;
Number of months; Refused; Don’t know.Domain: Alcohol Use
Definition: Alcohol use behavior.
Sources of Items:
Task Force on Recommended Alcohol Questions (2003). Recommended Alcohol
Questions. Retrieved from the National Institute on Alcohol Abuse and
Alcoholism, National Institutes of Health website:
http://www.niaaa.nih.gov/research/guidelines-and-resources/recommended-
alcohol-questions [NIAAA]
Items:
1. If answered 4 (female), 2 (transfemale), or 1 (fluid/queer) on Item 13 on Participant
Information page: [NIAAA] During the past 30 days, did you ever have 4 or more drinks
containing any kind of alcohol within a two-hour period? [That would be the equivalent
of at least four 12-ounce cans or bottles of beer, four 5-ounce glasses of wine, four drinks
each containing one shot of liquor or spirits] 1, Yes | 0, No
[Original question from NIAAA] From 3-Question Set, Question 3. During the
last 12 months, how often did you have 5 or more (males) or 4 or more (females)
drinks containing any kind of alcohol in within a two-hour period? [That would
be the equivalent of at least 5 (4) 12-ounce cans or bottles of beer, 5 (4) five
ounce glasses of wine, 5 (4) drinks each containing one shot of liquor or spirits -
to be provided by interviewer if asked.] Choose only one: Every day; 5 to 6 days a
week; 3 to 4 days a week; two days a week; one day a week; 2 to 3 days a month;
one day a month; 3 to 11 days in the past year; 1 or 2 days in the past yearDomain: Stress and Resilience
Definition: Resilience is described as the ability to/experience of adapting to change or tendency
to bounce back after illness or hardship, ability to effectively manage stress, ability to balance
tasks. Stress is described as a feeling of overload, being overwhelmed, out of control, using the
term “stress," inability to balance or manage tasks.
Sources of Items:
Cohen, S., Kamarck, T., Mermelstein, R. (1983). A global measure of perceived
stress. Journal of Health and Social Behavior, 24, 385-396. Retrieved from
http://www.psy.cmu.edu/~scohen/globalmeas83.pdf. [Perceived Stress Test
(PSS)]
Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The
Connor-Davidson Resilience scale (CD-RISC). Depression and Anxiety, 18(2),
76–82. http://doi.org/10.1002/da.10113 [CD-RISC]
Items:
1. [Adapted from PSS] During the last two weeks, how often have you felt that you were
not able to give enough time to the important things in your life? 5, Very often | 4, Fairly
often | 3, Sometimes | 2, Almost never | 1, Never
[Original question from PSS] Item 2. In the last month, how often have you felt
that you were unable to control the important things in your life? Never | Almost
never | Sometimes | Fairly often | Very often
2. [Adapted from CD-RISC] How confident are you that you can deal with whatever comes
your way? 5, Extremely confident | 4, Very confident | 3, Moderately confident | 2,
Slightly confident | 1, Not at all confident
[Original question from CD-RISC] Item V4. I can deal with whatever comes my
way. Rated from "not true at all" to "true nearly all the time".Domain: Experience of Emotions
Definition: Addresses different emotional states, including high arousal pleasant states
(excitement, joy, exhilaration, enthusiasm), neutral pleasant states (happy, content, satisfied),
low-arousal pleasant states (calm, secure, peaceful), high arousal unpleasant states (angry, afraid,
anxious, frustrated, hurt), neutral unpleasant states (sad, uncomfortable), and low arousal
unpleasant states (depressed, bored).
Sources of Items:
WELL Measures Workgroup, 2016 [WELL]
Items:
1. [WELL] During the last two weeks, how often did you feel joyful? 5, Very often | 4,
Fairly often | 3, Sometimes | 2, Almost never | 1, Never
2. WELL] During the last two weeks, how often did you feel worried? 5, Very often | 4,
Fairly often | 3, Sometimes | 2, Almost never | 1, NeverDomain: Physical Health
Definition: Physical symptoms including pain, physical fitness, energy level, ability to resist or
fight off illness, and self-assessment of physical health.
Sources of Items:
Podlog, L., & Dionigi, R. A. (2009). Psychological need fulfillment among workers in an
exercise intervention: a qualitative investigation. Research Quarterly for Exercise
and Sport, 80(4), 774–787. http://doi.org/10.1080/02701367.2009.10599619
Items:
1. [Adapted from Podlog & Dionigi] For the following question, please select the answer
that best describes your own experiences and feelings. How would you describe your
current level of physical fitness? 6, Excellent | 5, Very good | 4, Good | 3, Fair | 2, Poor |
1, Very poor
[Original question from Podlog &Dionigi] Item 2. How would you describe your
current level of physical fitness and health? Open ended response.Domain: Purpose and Meaning
Definition: May include anticipating/looking forward to the future, planning, sense of
accomplishment, doing something valuable, reason for being on this earth, engagement, mention
of motivation. Autonomy, lack of feeling constrained, sense of agency. Negative aspects of
purpose/meaning can include feelings of failure, lack of accomplishment, a loss of purpose.
Sources of Items:
WELL Measures Workgroup, 2016 [WELL]
Items:
1. [WELL] How often does your daily life include experiences that give your life meaning?
5, Very often | 4, Fairly often | 3, Sometimes | 2, Almost never | 1, NeverDomain: Sense of Self
Definition: Describes an understanding or questioning of one’s own nature, capacity, or worth.
Ability, confidence, knowledge, self-worth, self-satisfaction, and understanding of self.
Sources of Items:
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton
University Press. [Rosenburg Self-Esteem Scale (RSES)]
Items:
During the last two weeks, how often did you feel …
1. [Adapted from RSES] …satisfied with yourself? 5, Very often | 4, Fairly often | 3,
Sometimes | 2, Almost never | 1, Never
[Original question from RSES] Item 1. On the whole, I am satisfied with
myself. Strongly Agree | Agree | Disagree | Strongly DisagreeDomain: Financial Security/Satisfaction
Definition: Addresses financial security, money, income, wealth, self-sufficiency, financial
benefits, monetary resources, or other material resources.
Sources of Items:
O’Connell, K. A., & Skevington, S. M. (2010). An International Quality of Life
Instrument to Assess Wellbeing in Adults Who are HIV-Positive: A Short Form
of the WHOQOL-HIV (31 items). AIDS and Behavior, 16(2), 452–460.
http://doi.org/10.1007/s10461-010-9863-0 [WHOQOL-HIV BREF]
Items:
1. [Adapted from WHOQOL-HIV BREF] During the last year, how often have you had
enough money to meet your needs? 6, All of the time | 5, Most of the time | 4, More than
half of the time | 3, Less than half of the time | 2, Some of the time | 1, None of the time
[Original question from WHOQOL-HIV BREF] Item 16 (F18.1). The following
questions ask about how completely you experience or were able to do certain
things in the last two weeks. Have you enough money to meet your needs? Not at
all | a little | moderately | mostly | completely. Asked to think about the last 2
weeks.Domain: Spirituality and Religion
Definition: Anything having to do with connecting to the sacred or immaterial world (faith or
religion) such as relationship with God, spiritual communities, religious activities or impact of
spirituality on sense of self or life outlook. Practice of faith, outlook on life/resilience, sense of
self, life course/evolution of beliefs, connection with others, personal relationship with God
Sources of Items:
Pew Research Center.(2014) 2014 Religious Landscape Study (RLS-II)
[pdf].Washington, D.C.
http://www.pewforum.org/files/2015/11/201.11.03_RLS_II_topline.pdf, accessed
July 29, 2016. [Pew RLS-II]
Items:
1. [Adapted from Pew RLS-II] How important are spiritual or religious beliefs in your day
to day life? 5, Very important | 4, Fairly important | 3, Somewhat important | 2, Not too
important | 1, Not at all important
[Original question from Pew RLS-II] Item QF2. How important is religion in your
life? Very important; somewhat important; not too important; not at all importantDomain: Exploration and Creativity
Definition: Someone being creative, being engaged in artistic activities, creative thinking, self-
expression. Also includes new personal experiences such as travel or learning. Can include new
hobbies as well as new life experiences and transformations, as well as change in perspective.
Source of Items:
Kashdan, T. B., Gallagher, M. W., Silvia, P. J., Winterstein, B. P., Breen, W. E., Terhar,
D., & Steger, M. F. (2009). The Curiosity and Exploration Inventory-II.
Development, factor structure, and psychometrics. Journal of Research in
Personality, 43, 987-998 [CEI-II]
Items:
1. [Adapted from CEI-II] How often do you engage with opportunities to challenge yourself
and grow as a person? 5, Very often | 4, Fairly often | 3, Sometimes | 2, Almost never | 1,
Never
[Original question from CEI-II] Item 9. I frequently seek out opportunities to
challenge myself and grow as a person. Rate accordingly, 1) very slightly or not at
all; 2) a little; 3) moderately; 4) quite a bit; 5) extremelyTable 1. Overlap of questions from Brief WELL for Life Scale and WHI (n=7)
WELL Question WHI Questionnaire Number WHI Question WHI Last
Time Asked
During the last two weeks, 157- Supplemental 4.1-4.3 The next questions ask about 2014-2015
how often did you feel that Questionnaire 2014-2015 companionship. (4.1) How often do you feel
you lacked companionship? that you lack companionship?
How often did you eat sugar- 155- Lifestyle Questionnaire 4. How would you describe…your appetite?
sweetened baked goods or
candy, such as cookies, donuts,
pastry, and candy bars?
How often did you eat 155- Lifestyle Questionnaire 4. How would you describe…your appetite?
vegetables?
Think about your physical 155- Lifestyle Questionnaire 10-19. The following are questions about a
activity. During the past typical (or usual) day's activities. Does your
month, which statement best health now limit you in these activities and, if
describes the kinds of physical so, how much? Vigorous activities, such as
activity you usually did? Do not running, lifting heavy objects, or strenuous
include the time you spent sports; Moderate activites, such as moving a
working at a job. Please read table, vacuuming, bowling, or golfing; Lifting or
all six statements before carrying groceries; Climbing several flights of
selecting one. stairs; Climbing one flight of stairs; Bending,
kneeling, stooping; Walking more than a mile;Walking several blocks; Walking one block;
Bathing or dressing yourself
During the past 30 days, did 155- Lifestyle Questionnaire 9. In the past 3 months, how often have you had
you ever have 4 or more drinks drinks containing alcohol?
containing any kind of alcohol
within a two-hour period?
During the last two weeks, 157- Supplemental 7. Rate how intensely you felt each emotion 2014-2015
how often did you feel joyful? Questionnaire 2014-2015 during the past 24 hours by marking a circle on
each line (Not at all - Extremely). Amusement,
Awe, Gratitude, Hope, Interest, Joy, Love, Pride,
Serenity
How would you describe your 155- Lifestyle Questionnaire 10-19. The following are questions about a
current level of physical typical (or usual) day's activities. Does your
fitness? health now limit you in these activities and, if
so, how much? Vigorous activities, such as
running, lifting heavy objects, or strenuous
sports; Moderate activites, such as moving a
table, vacuuming, bowling, or golfing; Lifting or
carrying groceries; Climbing several flights of
stairs; Climbing one flight of stairs; Bending,
kneeling, stooping; Walking more than a mile;
Walking several blocks; Walking one block;
Bathing or dressing yourselfTable 2. Questions from Brief WELL for Life Scale not found in WHI (n=13)
WELL Question
During the last two weeks, how often did you feel that other people upset you?
During the last two weeks, how often did you feel energized by the opportunity to help or take care of others?
During the past two weeks, how would you rate your sleep quality overall?
Altogether, have you smoked at least 100 or more cigarettes in your lifetime?
During the last two weeks, how often have you felt that you were not able to give enough energy to the important
things in your life?
How confident are you that you can deal with whatever comes your way?
During the last two weeks, how often did you feel worried?
How often does your daily life include experiences that give your life meaning?
During the last two weeks, how often did you feel satisfied with yourself?
During the last two weeks, how often have you had enough money to meet your needs?
How important are spiritual or religious beliefs in your day to day life?
How often do you engage with opportunities to challenge yourself and grow as a person?
Please think about your current level of wellbeing. When you think about wellbeing, think about your physical
health, your emotional health, any challenges you are experiencing, the peole in your life, and the opportunities or
resources you have available to you.WELL for Life Scale: Survey Development
Methods
Figure 1 provides an overview of the process used to gather and analyze data in
order to develop an inclusive comprehensive measure of well-being that stems
from the perspectives and experiences of a diverse sample of people. Each of the
major steps in the process are more fully described below.
Literature review
The literature relevant to the study of well-being and wellness was reviewed.
This literature spanned a number of different disciplines such as the biomedical
sciences, the health promotion and wellness field, psychology, and other social science
arenas. In addition, current initiatives that utilize survey data to assess well-being (e.g.,
the Gallup/Healthways Survey [1] and the City of Santa Monica Well-Being Project [2])
were explored. As mentioned above, the literature demonstrates (1) a broad array of
approaches to conceptualizing and operationalizing well-being and (2) a dearth of
grounded phenomenological approaches to exploring well-being. Our review also
enabled us to identify the extant questionnaire measures relevant to the concept of well-
being. We selected some of these measures to administer to study participants after
they had completed the semi-structured qualitative interviews.
Semi-structured interviews
Description of IW protocol. Face-to-face interviews were conducted with the
participants in quiet, mutually convenient locations. During the interview, participants
were asked to consider their adult lives from the age of 18 onward, and to think about a
time when they were experiencing (1) a particularly high level of well-being and (2) a
particularly low level of well-being. Participants were asked to describe each of these
times, and if needed, were prompted to describe more fully how they were feeling
during those times and what they were experiencing. The interviewer did not define the
word “well-being”, and if a participant asked for clarification, the interviewer would
respond that the purpose of the study was to learn about the participant’s views and
perspectives. The interviews were audio-recorded and lasted from 30 to 90 minutes.
Description of Sample: A purposeful sample of 102 participants was selected so
as to maximize variation in age, gender and ethnicity. Participants needed to be at least
18 years of age and to have enough fluency in English to be able to conduct the
interview in that language. The sample ranged in age from 18 to 86, consisted of 45
males and 57 females, and included 20 Vietnamese Americans, 18 Chinese
Americans, 18 Latinos, 17 European Americans, 17 Filipino Americans, and 10
Japanese Americans. The ethnic groups represent the groups that are well-
represented in the local population. Participants were recruited from a variety of
sources, including from the staff and students of the local university, community
agencies, email distribution lists, and general word of mouth.
Inductive coding
Each interview was professionally transcribed, and then checked and cleaned by
the interviewer. A research team of 8 people inductively coded the interviews using theFigure 1. Process used to develop measure of well-being
Review of Literatures and Expert Consultation
Conduct semi-structures interviews with Develop and administer survey of
diverse sample (n=102) previously validated items (n=102)
Inductive coding to identify domains of
well-being Assess items for face validity, relevance,
and reliability
Identification of survey items to measure the domains of
well-being identified in interviews
Cognitive interviewing and resultant revisions
Administered pilot survey online (n=250)
Further assessment of question wording, item response
variability, and internal consistency
Cognitive interviewing and resultant revisions
Final set of items for measuring well-being domains
Launched online survey (n=1000)qualitative analysis software NVIVO 10 (QSR International, 2015). A small subset of
the interviews was carefully read to seed the coding scheme used. Codes (and their
definitions) were added, modified and refined through ongoing discussions of the
research staff. Research team members also routinely wrote analytic memos in order
to document and reflect on the coding process and to begin to identify emergent themes
in the data (Saldana, 2013). Second pass codes identified important content within
each of the domains of well-being identified through previous coding (Miles and
Huberman). This multi-phased inductive coding process continuously refined the
definitions of the 10 prominent domains of well-being that emerged from the data.
Identifying survey items
The content of the survey items was ascertained through the coding processes
described above. The previously validated questionnaire items that we had piloted
were examined to assess the extent to which they matched the themes that arose from
the interviews. Items that were a good match in terms of relevance, were then
assessed for adequate variability and face validity. New items were developed to
measure themes for which we could not locate appropriate extant items.
Cognitive interviewing
Once a set of questionnaire items were identified to assess the domains of well-
being identified through the qualitative interviews, cognitive interviews were conducted
in order to strengthen the quality of the items. A combination of both the “think-aloud”
approach and the “probing” approach (Beatty and Willis, 2007) was used. The
interviewer explicitly encouraged participants to verbalize their thought processes as
they answered each of the survey items. During the interview, the interviewer was
primarily passive but would reiterate the invitation to “tell me what you are thinking” if
there was an extended pause or the participant seemed to be struggling.
The cognitive interviews were audio-recorded and systematically reviewed to
identify which questions needed improvement and how best to modify them. Problems
with items tended to stem from the use of unfamiliar or vague vocabulary, overly
complex sentence structures, and validity problems stemming from respondents
interpreting the question in ways different from how the research team intended or
different from each other.
Pilot test of the survey questions
The survey items were then entered into RedCap, a secure web application for
building and managing online surveys (ref). An invitation to help us with the
development of our well-being survey, along with a link to the survey, was sent to
various email distribution lists available to the research team. We received 251 surveys
from a sample of individuals that was predominantly white (75%), female (77%), and
older (median age of 60). Many of these participants also provided open-ended
feedback on the survey items. Based on this feedback, assessment of item variability
and inter-item consistency, and further cognitive interviewing, another round of revisions
to the survey items was performed.10 Domains were recognized
Ten domains were most commonly discussed by interviewees as contributing to
or detraction from well-being, as presented in Figure 2. The document entitled “Sources
of WELL for Life questions” provides references and information that pertains to each
question within each domain for the 20-item scale.
Figure 2. The ten domains most commonly discussed as contributing to or detracting from
wellbeing, with each petal sized in accordance to the percent of total mentions coded within the
domain.
Development of short scale (20 item) wellbeing index
SPRC WELL investigators, in agreement with the WELL External Advisory Board,
recognized the need to develop a shorter instrument which would still include all 10 domains.Therefore, a 20 item scale was developed in which each domain is equally weighted, with the
exception of the lifestyle domain. [Each of the three lifestyle subdomains (diet, physical activity,
and sleep) are given weight equal to a domain.]
Coding
Items that were not coded on a Likert scale were converted to an ordinal variable.
• Each diet question contains two Likert scales – we combined these into a single ordinal
variable with 10 levels ordered from least frequent to most frequent
• Smoking was classified as current, former, never smoker
• Drinking was defined as binge drinking or not (using gender-specific cutoffs)
Identifying items for inclusion in the short wellbeing index
• We examined the variability of items (looking for approximations of normal distributions and
that responses were spread across levels)
• We examined the Spearman correlations of items with the overall well-being item.
• We examined the Spearman correlations of items with other items in the domain
• For domains with more than 3 items, we conducted exploratory factor analysis (principal
components with varimax rotation) in order to identify factors represented within the domain.
• Items that showed acceptable variability and correlation with the overall well-being item AND
had strong factor loadings were chosen.
• The number of items selected per domain equaled the number of eigenvalues that were
greater than 1.
• Analyses were performed in R version 3.1.3. Factor analysis used the “psych” package in R.
Items included in the short wellbeing index
The document entitled “WELL for Life Survey in WHI Format Mock Up” presents the 20 items
chosen, with Q#21 as a global well-being question. The document entitled: “Sources of WELL
for Life Questions” provides the details regarding each domain and each item.
Scoring the short wellbeing index
• Items where poor wellbeing scores higher are reverse coded.
• Each item is first scaled so that it is out of 5 to give each item equal weight. For
example, an item with six possible responses would be multiplied by 5/6.
• Items from a domain with more than one item included are scaled so that the domain
has equal weight with the other domains. For example, each item from the social
connectedness domain is multiplied by 1/3 because there are 3 items included from
that domain. (Lifestyle behavior subdomains are separate domains.)
• The items are then summed together.
• Participants with more than 3 items (20%) missing are not scored. Participants with
3 or fewer items missing have scores approximated by summing the available items
and scaled by (number of items in the short index)/(number of items answered).Performance of Stanford WELL for Life Scale (20 item) The 20 item Stanford WELL for Life Scale has a potential range of scores from 0 – 100. In our current data (n=751), the scores range from 27.9 – 67.3 with a distribution that approximates normal (see below). The 20 item scale is highly correlated with the longer (r=.93) indicating that items chosen for the short scale are good indicators of their respective domains. The 20 item scale is also strongly correlated with our 1 item global well-being question (r=.74) and moderately correlated with the 1 item self-reported health question (r=.52). This indicates that the Stanford WELL for Life scale shares variance with respondents’ perceptions of their health but also includes some unique components. References: Beatty, P.C. & Willis, G.B. (2007). Research Synthesis: The Practice of Cognitive Interviewing. Public Opinion Quarterly, 71, 287– 311 Gallup, Inc. "How Does the Gallup-Sharecare Well-Being Index Work?" Gallup.com. Miles, Matthew B., A. Michael Huberman, and Johnny Saldaña. Qualitative data analysis: a methods sourcebook. Thousand Oaks: Sage Publications, 2014. Print. QSR International, Inc. "NVivo Products" qsrinternational.com. Saldana. (2013). "The coding manual for qualitative researchers." Reference & Research Book News. N.p., Warner, Karen, and Margaret Kern. (2013). A City of Wellbeing The What, Why & How of Measuring Community Wellbeing," 1-29.
Global assessment of wellness protocol
I am involved with a project that has the goal of enhancing our understanding of what people
are thinking about when they consider their own sense of well-being and wellness. Thanks for
being willing to answer some questions to help us out.
First I would like to ask you about well-being.
So to start, I’d like to ask you to consider your adult life--- maybe from the age of 18 onward---
and to think back to a time in your adult life when you were experiencing a particularly high
level of well-being. [GIVE YOUR RESPONDENT A CHANCE TO HONE IN ON A PARTICULAR TIME]
Please tell me about the time that you are thinking about.
Prompts IF NEEDED:
What were you feeling back then?
What was going on in your life?
When was this?
Next, I’d like for you to think back to a time in your adult life when you were experiencing a
particularly low level of well-being. [AGAIN, PAUSE SO THAT YOUR RESPONDENT CAN CHOOSE
A TIME]
Please tell me about the time that you are thinking about.
Prompts IF NEEDED:
What were you feeling back then?
What was going on in your life?
When was this?
Thanks for sharing these thoughts with me.
Now that you have described times in the past, I would like for you to think about your current
level of well-being. Please use this ladder (on next page) to indicate your current level of well-
being. For the top and bottom rungs of this ladder, you should think not only about your own
experiences. Instead, the top of the ladder represents the highest possible level of well-being
that any person can experience. The bottom of the ladder represents the lowest possible level
of well-being that any person can experience. Where would you put your level of well-being at
this time?AFTER RESPONDENT MARKS A PLACE ON THE LADDER:
Why did you choose this rung of the ladder?
Now, let’s talk about wellness.
If I ask you to consider your adult life and to think back to a time when you were experiencing a
particularly high level of wellness, would you think about the same time in your life that you
described before or a different time?
If same--- What was going on at that time that leads you to say it was a time of particularly high
wellness?
If different--- tell me about the time that you are thinking about.
Prompts IF NEEDED:
When was this?
What were you feeling back then?
What was going on in your life?
Thank you. Now, I’d like for you to think back to a time in your adult life when you were
experiencing a particularly low level of wellness. [AGAIN, PAUSE SO THAT YOUR RESPONDENT
CAN CHOOSE A TIME]
Are you thinking about the same time in your life that you described before or a different time?If same--- What was going on at that time that leads you to say it was a time of particularly low
wellness?
If different--- tell me about the time that you are thinking about.
Prompts IF NEEDED:
What were you feeling back then?
What was going on in your life?
When was this?
Thanks for sharing these thoughts with me.
Let’s return to the ladder. This time, please use this ladder to indicate your current level of
wellness. Again, for the top and bottom rungs of this ladder, you should think not only about
your own experiences. Instead, the top of the ladder represents the highest possible level of
wellness that any person can experience. The bottom of the ladder represents the lowest
possible level of wellness that any person can experience. Where would you put your level of
wellness at this time?
Thanks for allowing me to try these questions out with you. Is there anything else that you
would like to tell me about your experiences with well-being or wellness?BIOGRAPHICAL SKETCH
Provide the following information for the Senior/key personnel and other significant contributors.
Follow this format for each person. DO NOT EXCEED FIVE PAGES.
NAME: Stefanick, Marcia L.
eRA COMMONS USER NAME (credential, e.g., agency login): STEFANICK.MARCIA
POSITION TITLE: Professor of Medicine (Research) and Professor of Obstetrics & Gynecology (Research)
EDUCATION/TRAINING (Begin with baccalaureate or other initial professional education, such as nursing,
include postdoctoral training and residency training if applicable. Add/delete rows as necessary.)
DEGREE Completion
FIELD OF STUDY
INSTITUTION AND LOCATION (if Date
applicable) MM/YYYY
University of Pennsylvania, Philadelphia, PA B.A. 05/1974 Biology
Stanford University, Stanford, CA Ph.D. 06/1982 Physiology
Stanford Center for Research in Disease Postdoctoral 09/1983-86 Cardiovascular Disease
Prevention, Stanford University, Stanford, CA Fellow Prevention (NHLBI)
A. Personal Statement
I am a Professor of Medicine at the Stanford Prevention Research Center (SPRC) and Professor of Obstetrics
& Gynecology, with key leadership roles in the Stanford University School of Medicine (SOM) including being
the Director of the Stanford Women and Sex Differences in Medicine (WSDM) Center. I am PI of the Western
Regional Center of the Women’s Health Initiative (WHI) Extension Study (2010-2020) and PI of a large U01
WHI Strong & Healthy (WHISH) physical activity (PA) trial, which randomly assigned ~50,000 WHI participants
to PA (with “opt out” consent) or “usual activity” comparison for 5 years in a pragmatic trial, for which the
primary outcome is major CV events and quality of life (independence, well-being) is one of the key secondary
outcomes. [I was PI of the Stanford WHI Clinical Center from 1994-2010, Chair of the WHI Steering and
Executive Committees (by PI election) from 1998-2011, and Stanford’s PI of many WHI ancillary studies, e.g.
WHI Memory Study (WHIMS), Study of Cognitive Aging (WHISCA), WHI Brain MRI, WHIMS-Younger Cohort
(WHIMSY), WHI Coronary Artery Calcification Study, and Objective Physical Activity for Cardiovascular Health
(OPACH).] I am also Stanford’s PI of the multi-center NIA/NIAMS Study of Osteoporotic Fractures in Men
(MrOS), which is continuing to follow an initial cohort of ~6000 men aged 65 years and older in 2001 (including
clinic assessments). I’m a key faculty of the SPRC Community Health and Prevention Research (CHPR)
Masters program and also direct many undergraduate Human Biology courses focusing on health promotion
over the lifecourse and sex and gender themes and co-chair the Sex & Gender Working Groups in Stanford’s
Population Health Sciences Center and in the Stanford Cancer Institute’s Population Science Program, which
I co-lead, focusing on lifestyle and other intervention research for cancer prevention and survivorship.
1. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD,
Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J. (2002) Risks and benefits of estrogen
plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative
randomized controlled trial. JAMA;288(3):321-33. PMID: 12117397
2. Stefanick ML, Anderson GL, Margolis KL, Hendrix SL, Rodabough RJ, Paskett ED, Lane DS, Hubbell FA,
Assaf AR, Sarto GE, Schenken RS, Yasmeen S, Lessin L, Chlebowski RT, for the WHI Investigators
(2006), Effects of conjugated equine estrogens on breast cancer and mammography screening in
postmenopausal women with hysterectomy. JAMA 295(14):1647-57. PMID:16609086
3. Manson JE, Chlebowski RT, Stefanick ML, Aragaki AK, Rossouw JE, Prentice RL, Anderson G, Howard
BV, Thomson CA, LaCroix AZ, Wactawski-Wende Jean, Jackson RD, Limacher M, Margolis KL,
Wassertheil-Smoller S, Beresford SA, Cauley JA, Eaton CB, Gass M, Hsia J, Johnson KC, Kooperberg
C, Kuller LH, Lewis CE, Liu S, Martin LW, Ockene JK, O’Sullivan MJ, Powell LH, Simon MS, Van Horn L,
Vitolins MZ, Wallace RB (2013). Menopausal hormone therapy and health outcomes during the
intervention and extended post-stopping phases of the Women’s Health Initiative randomized trials
JAMA. Oct 2;310(13):1353-68. - PubMed PMID: 24084921 PMCID: PMC3963523
4. Wang A, Qin F, Hedlin H, Desai M, Chlebowski R, Gomez S, Eaton CB, Johnson KC, Qi L, Wactawski-
Wende J, Womack C, Wakelee HA, Stefanick ML. (2016) Physical activity and sedentary behavior in
relation to lung cancer incidence and mortality in older women: the Women’s Health Initiative. Int J
Cancer 139: 2178-2192 PMID:27439221B. Positions of Honor and Employment
Employment
1970-1974 Undergraduate work, Univ. of Penn.: German translator; Veterinary Research Assistant
1974-1975 Research Assistant, Oregon Regional Primate Research Center, Beaverton, OR
1975-1976 Research Assistant, Dept. of Physiology, Stanford University, Stanford, CA
1986-1987 Research Associate, Stanford Center for Research in Disease Prevention (SCRDP)
1988-1997 Senior Research Scientist, SCRDP, Dept. of Medicine, Stanford Univ., Stanford, CA
1997-2003 Associate Professor of Medicine, Stanford University, Stanford, CA
2003-present Professor of Medicine (Stanford Prevention Research Center), Stanford Univ,
2003-present Professor of Obstetrics and Gynecology, Stanford University
Other Experience and Professional Memberships and Honors
1976-1981 PHS-NRS Award - Training Grant in Systems Biology (GMO7181-02 thru-06)
1983-1986 Stanford Cardiovascular Disease Prevention Training Grant (T32 HL07034-09-12)
1987 (2001) Fellow of the (A.H.A. and) Council on Arteriosclerosis; Thrombosis, and Vascular Biology
1998-2011 Chair, Women’s Health Initiative (Steering &) Executive Committee(s) [elected by WHI PIs]
2009-2010 Iris F. Litt Faculty Fellowship, Clayman Institute of Gender Research
2012-present Director, Stanford Women and Sex Differences in Medicine (WSDM) Center
C. Contribution to Science
1. My early work consisted of a series of 1-2 year RCTs of overweight or high (CV) risk adults to determine
independent and interactive effects of physical activity, diet, and weight loss on high and low density
lipoprotein (HDL, LDL) cholesterol, with the findings that changes in diet composition (caloric restriction
versus dietary fat reduction) strongly influenced weight loss effects of diet, particularly in women, and
aerobic exercise, which generally increases HDL-C or prevents diet-induced reduction.
a. Wood P, Stefanick ML, Dreon D, Frey-Hewitt B, et al. (1988) Changes in plasma lipids and lipoproteins
in overweight men during weight loss through dieting as compared with exercise. N Engl J Med;319
(18):1173-9. PMID: 3173455
b. Wood PD, Stefanick ML, Williams PT, Haskell WL. (1991). The effects on plasma lipoproteins of a
prudent weight-reducing diet, with or without exercise, in overweight men and women. N Engl J
Med;325(7):461-6. PubMedID: 1852180
c. Terry RB, Stefanick ML, Haskell WL, Wood PD. (1991) Contributions of regional adipose tissue depots
to plasma lipoprotein concentrations in overweight men and women: possible protective effects of thigh
fat. Metabolism 40(7):733-40. PubMedID: 1870428
d. King AC, Haskell WL, Young DR, Oka RK, Stefanick ML (1995). Long-term effects of varying intensities
and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged
50 to 65 years. Circulation 91(10):2596-604. PMID: 7743622
e. Stefanick ML, Mackey S, Sheehan M, Ellsworth N, Haskell WL, Wood PD (1998). Effects of diet and
exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL
cholesterol. N Engl J Med;339(1):12-20. PMID: 9647874
2. A second line of research has focused on effects of menopausal hormone therapy (MHT) on coronary heart
disease, CHD, cognitive function CHD, and bone health in light of substantial observational study evidence
of lower CHD, dementia, and osteoporosis in MHT users versus non-users, leading to increased MHT
prescriptions older women. In contrast, WHI demonstrated no benefit to CHD (and early harm with
combined estrogen and progestin therapy) and adverse effects on dementia, but did show benefit to bone.
a. Shumaker SA, Legault C, Kuller L, Rapp SR, Thal L, Lane DS, Fillit H, Stefanick ML, Hendrix SL, Lewis
CE, et al. (2004). Conjugated equine estrogens and incidence of probable dementia and mild cognitive
impairment in postmenopausal women: Women's Health Initiative Memory Study. JAMA;291(24):2947-
58. PMID: 15213206
b. Rossouw JE, Prentice RL, Manson JE, Wu L, Barad D, Barnabei VM, Ko M, LaCroix AZ, Margolis KL,
Stefanick ML. (2007) Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age
and Years Since Menopause. JAMA 297(13):1465-77. PMID: 17405972
c. Robbins J, Aragaki AK, Kooperberg C, Watts N, Wactawski-Wende J, Jackson RD, LeBoff MS, Lewis
CE, Chen Z, Stefanick ML, Cauley J. (2007) Factors Associated With 5-Year Risk of Hip Fracture in
Postmenopausal Women. JAMA 298(20):2389-98.You can also read
