Quality of Life Research 11: 157–171, 2002.

157
Ó 2002 Kluwer Academic Publishers. Printed in the Netherlands.

Psychometric evaluation of the impact of weight on quality

of life-lite questionnaire (IWQOL-Lite) in a community sample

Ronette L. Kolotkin1 & Ross D. Crosby2,3

1
Obesity and Quality of Life Consulting, Durham, NC (E-mail: rkolotkin@yahoo.com); 2Neuropsychiatric
Research Institute; 3University of North Dakota School of Medicine and Health Sciences, Fargo, ND

Accepted in revised form 13 December 2001

Abstract

The short form of impact of weight on quality of life (IWQOL)-Lite is a 31-item, self-report, obesity-specific
measure of health-related quality of life (HRQOL) that consists of a total score and scores on each of five
scales – physical function, self-esteem, sexual life, public distress, and work – and that exhibits strong
psychometric properties. This study was undertaken in order to assess test–retest reliability and discrimi-
nant validity in a heterogeneous sample of individuals not in treatment. Individuals were recruited from the
community to complete questionnaires that included the IWQOL-Lite, SF-36, Rosenberg self-esteem
(RSE) scale, Marlowe–Crowne social desirability scale, global ratings of quality of life, and sexual func-
tioning and public distress ratings. Persons currently enrolled in weight loss programs or with a body mass
index (BMI) of less than 18.5 were dropped from the analyses, leaving 341 females and 153 males for
analysis, with an average BMI of 27.4. For test–retest reliability, 112 participants completed the IWQOL-
Lite again. ANOVA revealed significant main effects for BMI for all IWQOL-Lite scales and total score.
Females showed greater impairment than males on all scales except public distress. Internal consistency
ranged from 0.816 to 0.944 for IWQOL-Lite scales and was 0.958 for total score. Test–retest reliability
ranged from 0.814 to 0.877 for scales and was 0.937 for total score. Internal consistency and test–retest
results for overweight/obese subjects were similar to those obtained for the total sample. There was strong
evidence for convergent and discriminant validity of the IWQOL-Lite in overweight/obese subjects. As in
previous studies conducted on treatment-seeking obese persons, the IWQOL-Lite appears to be a reliable
and valid measure of obesity-specific quality of life in overweight/obese persons not seeking treatment.

Key words: Health-related quality of life (HRQOL), IWQOL-Lite, Psychometric, Quality of life

Abbreviations: BMI – body mass index; HRQOL – health-related quality of life; IWQOL – impact of
weight on quality of life

Introduction HRQOL in obese persons participating in clinical

The use of health-related-quality of life (HRQOL)
measures to assess clinical outcomes is rapidly
growing [1, 2]. Clinical researchers, with increasing
frequency, are choosing measures of HRQOL as
primary and secondary outcomes in clinical trials
[3]. As new, anti-obesity drugs are developing,
there is an increasing need for the measurement of
trials for treatment of obesity. While generic
measures of HRQOL can provide important in-
formation about improvements in general health,
it is often recommended that they be accompanied
by disease-specific instruments for the condition
under study [2, 3]. Disease-specific HRQOL in-
struments focus on the domains most relevant to a
particular disease such as obesity, as well as on the
158
characteristics and complaints of persons who
have the disease. In addition, disease-specific in-
struments are usually more sensitive to changes
that occur in treatment than generic instruments
[4].
The impact of weight on quality of life (IW-
QOL) questionnaire was the first instrument spe-
cifically developed to assess quality of life in
obesity [5]. At the time of this instrument’s devel-
opment, quality of life and the impact of obesity
was rarely assessed in obesity research or practice,
with the exception of some surgical interventions
reporting quality of life improvements following
dramatic weight reduction [6]. The original IW-
QOL is a self-report instrument (with five response
categories, from ‘never true’ to ‘always true’)
consisting of 74-item items that ask about the ef-
fects of obesity on quality of life in eight areas
(health, social/interpersonal, work, mobility, self-
esteem, sexual life, activities of daily living, and
comfort with food). The IWQOL was developed
by clinicians specializing in the treatment of obe-
sity who catalogued patients’ concerns about the
impact of their obesity, developed items based on
these concerns, and verified with patients that the
items were comprehensive and accurate. The items
of the IWQOL begin with the phrase ‘Because of
my weight’ in order to assess obesity-specific
quality of life. The goals in developing the IWQOL
were as follows: (1) to develop an instrument that
would reliably and validly measure the extent to
which weight affects quality of life, (2) to be able to
determine the aspects of quality of life that are
most affected by weight, and (3) to measure im-
provements in quality of life that are associated
with weight loss or other treatment interventions
[5]. Construct validity, test–retest reliability, and
internal consistency reliability were determined to
be good for this instrument [5, 7]. Furthermore,
scores changed significantly in the expected direc-
tion after treatment in an intensive weight loss
program [5].
A 31-item, short form of the IWQOL (IWQOL-
Lite) was developed recently [8] in order to mini-
mize response burden to subjects. Correlations
between parallel scores on the original and short
form of the IWQOL are extremely high, ranging
from 0.948 (sexual life) to 0.974 (total score). The
IWQOL-Lite appears to have strong psychometric
properties [8]. Internal consistency reliabilities of
the IWQOL-Lite ranged from 0.90 to 0.94 for the
five scales and equaled 0.96 for the total score.
Correlations between the IWQOL-Lite and col-
lateral measures supported the validity of the
IWQOL-Lite. In addition, baseline IWQOL-Lite
scale scores and total score increased as a function
of BMI. Changes at 1-year follow-up on the IW-
QOL-Lite total score were also related strongly to
changes in BMI at the 1-year follow-up, and
confirmatory factor analysis provided strong sup-
port for the adequacy of the scale structure (five
scales – physical function, self-esteem, sexual life,
public distress, and work – and a total score).
Furthermore, all five scales and total score showed
statistically significant correlations with percent-
age of weight loss at 1-year follow-up. For three
scales (physical function, self-esteem, sexual life)
and total score, the relationship between weight
loss and clinically meaningful change was linear
and significant, with physical function and self-
esteem most strongly affected by weight loss [9].
Baseline scores on the IWQOL-Lite were found to
differ for obese individuals seeking treatment and
obese individuals not seeking treatment (with
treatment-seekers being more impaired) and for
obese persons seeking treatments of varying in-
tensities (with poorer quality of life associated with
more intensive treatments) [10].
In spite of the encouraging psychometric results
obtained thus far on the IWQOL-Lite, several
limitations exist. Analyses of the IWQOL-Lite to
date have been based on participants’ responses to
the original 74-item IWQOL, rather than to the 31-
item format. Additionally, there are no test–retest
data on the IWQOL-Lite. Furthermore, nearly all
research subjects studied thus far have been obese
people in treatment (e.g., only 223 out of 1987 re-
search subjects were from a community sample)
and Caucasian (77% of the subjects in the devel-
opment and cross-validation samples were Cauca-
sian) [8]). Finally, there are no data available on the
discriminant validity of the IWQOL-Lite.
Because the Lite version of the IWQOL is new,
further research is needed to provide support for
the psychometric properties of this instrument.
This study was undertaken to obtain further psy-
chometric data on the IWQOL-Lite in a sample of
‘normal’ adults.

Methods
Participants
Participants were individuals, age 18 and over,
recruited from the community through religious
organizations, local businesses, health clubs, and
schools. There were 532 participants recruited for
this study. Data for 18 subjects were dropped due
to current involvement in a weight loss program.
In addition, data for four subjects were dropped
due to failure to provide height or weight infor-
mation, and 16 subjects for reporting BMI’s less
than 18.5 (i.e., below a normal weight; [11]). The
final sample for analysis consisted of 494 partici-
pants: 341 (69.0%) females and 153 (30.0%)
males. The average age of females was 37.6 (SD:
13.4; range: 18–90) and for males was 38.6 (SD:
13.1; range: 18–74). A total of 297 individuals
(60.1%) were Caucasian, 174 (35.2%) were Afri-
can American, 10 (2.0%) were Hispanic, two
(0.4%) were Asian, two (0.4%) were Native
American, three (0.6%) reported their ethnicity as
‘other’, and six (1.2%) failed to respond.
The first 112 participants, 80 (71.4%) females
and 32 (28.6%) males provided test–retest data.
The average age for females was 38.7 (SD: 12.5;
range: 18–76) and for males was 40.1 (SD: 13.5;
range: 20–72). Ethnic composition of test–retest
participants included 71 (63.4%) Caucasian, 36
(32.1%) African American, two (1.8%) Hispanic,
one (0.9%) Native American, and two (1.8%) who
failed to provide ethnicity.
Procedures
Participants were given a packet of questionnaires
to complete (described below) along with a con-
sent form. They were also asked to report their
height, weight, age, ethnicity, and whether they
were currently enrolled in a weight loss program.
BMI’s of subjects were computed from their self-
reported heights and weights. Participants received
$10 for their participation in this study. A subset
of participants completed one of the question-
naires (IWQOL-Lite) a second time. Test–retest
intervals averaged 14.0 days (SD: 0.7) and ranged
from 10 to 16 days. These participants received an
additional $10. This study received approval by
the medical center’s institutional review board and
159
conformed to ethical standards for research in-
volving human participants.
Measures
Impact of weight on quality of life questionnaire,
short-form (IWQOL-Lite)
The IWQOL-Lite was administered [8]. The IW-
QOL-Lite is a 31-item self-report measure that
assesses obesity-specific quality of life in obese
individuals. The measure consists of scores on five
scales – physical function (11 items), self-esteem
(seven items), sexual life (four items), public dis-
tress (five items), and work (four items) – and a
total score (sum of scale scores). Participants are
asked to rate items with respect to the past week
on this questionnaire (from ‘never true’ to ‘always
true’). Higher scores indicate poorer quality of life
on the IWQOL-Lite.
SF-36
The SF-36 is the most widely used generic
HRQOL measure. It assesses physical functioning,
role limitations due to physical health problems,
bodily pain, general health, vitality, social func-
tioning, role limitations due to emotional prob-
lems, and mental health. In addition, there are two
summary scores: a physical summary score and a
mental summary score [12]. For most of the SF-36
items, subjects rate themselves over the past
4 weeks.
Rosenberg self-esteem scale
This scale is a widely used 10-item scale that
measures personal self-esteem in terms of liking
and/or approving of oneself [13]. There is no time
reference in the instructions for completing the
Rosenberg self-esteem (RSE) scale.
Sexual functioning ratings
Since most measures of sexual functioning are
quite detailed and often intended to assess sexual
dysfunctions, we felt that participants in this study
might find such measures intrusive. Instead, we
asked participants to respond to four obesity-
specific items taken from the sexual life scale of the
obesity quality of life instrument [14]. The items,
rated on a five-point scale, were as follows:
(1) How satisfied have you been with your sex life?
(2) How much of a problem for you was enjoying
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sex? (3) How concerned were you that your weight
would cause your partner discomfort during sex?
(4) How concerned were you that your weight
made you physically unattractive during sex?
Subjects were asked to rate themselves with respect
to the past week. The items were scored by sum-
ming the responses.
Public distress ratings
In order to provide evidence for construct validity
of the IWQOL-Lite public distress scale, we
needed to assess the social stigma of obesity and
the impact of obesity on everyday functioning due
to size. We used four items from the OBQOL [14]
pertaining to discrimination, judgment, and criti-
cism by others: (1) How much have you been
bothered by people judging you for what you ate?
(2) How much have you been bothered by people
making fun of you? (3) How much have you been
bothered by criticism about your size or shape? (4)
How much of the time did you feel you had to
perform better than others because of your size?
We added an additional item: ‘When out in public,
I have difficulty fitting into my environment
physically because of my size.’ These five items
were rated on a five-point scale from ‘not at all
bothered’ to ‘extremely bothered,’ or from ‘all of
the time’ to ‘none of the time.’ Subjects were asked
to rate themselves with respect to the past week.
The items were scored by summing the responses.
Marlowe–Crowne social desirability scale form C
(M–C form C)
The Marlowe–Crowne social desirability scale [15]
is the most widely used measure of social desir-
ability. The Marlowe–Crowne assesses the ten-
dency for individuals to think or act in ways that
conform to societal norms. The Marlowe–Crowne
social desirability scale and the form C short form
of this scale [16] are comprised of items that de-
scribe highly desirable, culturally approved be-
haviors, but have a low probability of occurrence.
For example, items such as, ‘No matter who I’m
talking to, I’m always a good listener’ or ‘I have
never deliberately said something that hurt some-
one’s feelings’ make up the Marlowe–Crowne. The
original Marlowe–Crowne scale has been criticized
by researchers as demonstrating weak discriminant
ability [17]. The Marlowe–Crowne form C short
form (consisting of 13 items derived from the
original Marlowe–Crowne social desirability scale)
has been studied more extensively than other
Marlowe–Crowne short forms and appears to be
superior to all others [18].
A measure of social desirability was included in
this study in order to provide evidence for discri-
minant validity of the IWQOL-Lite. There is no
time frame specified in the instructions for com-
pletion of the Marlowe–Crowne.
Global ratings
Subjects were asked to make global ratings (using
a seven-point response scale, ranging from ‘not
limited at all’ to ‘severely limited’) in each of the
five content areas of the IWQOL-Lite, as well as a
global rating of overall quality of life. There was
no time frame specified in the instructions for
completion of the global ratings.
Hypotheses
We expected to find an association between total
score on the IWQOL-Lite and other measures of
overall health – global rating of overall quality of
life, and SF-36 general health, physical summary,
and mental summary. The IWQOL-Lite physical
function scale was predicted to be associated with
global ratings of physical function and with the
following SF-36 scales which measure physical
aspects of health: physical functioning, general
health, physical role, bodily pain, and physical
summary. The IWQOL-Lite self-esteem scale was
predicted to be associated with measures related to
self-esteem: global ratings of self-esteem, the RSE
scale, and SF-36 role emotional, mental health,
and mental summary scales. The IWQOL-Lite
sexual life scale was expected to be associated with
global ratings of sexual functioning and sexual
functioning ratings. The IWQOL-Lite public dis-
tress scale was expected to be associated with
global ratings of public distress and public distress
ratings. The IWQOL-Lite work scale was expected
to be associated with global ratings of work and
with SF-36 scales related to ability to perform
daily responsibilities due to physical condition:
physical role, vitality, general health, and physical
summary. In addition, we predicted that the IW-
QOL-Lite scales would not be strongly correlated
with scores on the Marlowe–Crowne social desir-
ability scale. While we were aware that overweight

and obese people are under some social pressure to
conform to society’s standards regarding weight
and appearance (and therefore, this may influence
their scores on the social desirability scale), we
expected to find no more degree of relationship
between social desirability and IWQOL than be-
tween social desirability and SF-36 due to the ro-
bustness of the IWQOL, IWQOL-Lite and SF-36
in previous research.
Data analysis
Internal consistency reliability coefficients were
computed using Cronbach’s a. Test–retest reli-
ability coefficients for the IWQOL-Lite were
computed using intraclass correlations. Reliability
coefficients were computed first for all subjects and
then for overweight/obese subjects (BMI’s of 25
and over). A 2 (Gender) by 5 (BMI group)
ANOVA was used to examine differences in IW-
QOL-Lite scores as a function of gender and BMI.
Post-hoc tests for comparisons between BMI
groups were performed using Tukey’s honestly
significant difference procedure [19] based on an a
coefficient of 0.05. Construct validity was assessed
by calculating Pearson correlations between IW-
QOL-Lite scores and collateral measures for sub-
jects with BMI’s of 25 and over.
Results
Body mass index
The average BMI for participants was 27.4 (SD:
7.1; range: 18.6–73.0). BMI did not differ signifi-
cantly by gender (mean BMI for females ¼ 27.1;
SD: 7.3; mean BMI for males ¼ 28.0, SD: 6.7; t:
1.40; df: 492; p ¼ 0:163). Two hundred twenty
participants (44.5%) had a BMI less than 25, 146
(29.6%) had a BMI between 25 and 29.9, 65
(13.2%) had a BMI between 30 and 34.9, 38
(7.7%) had a BMI between 35 and 39.9, and 25
(5.1%) had a BMI of 40 or greater. The prevalence
of overweight (BMI between 25.0 and 29.9) and
obesity (BMI greater than or equal to 30.0) in this
sample is similar to that reported by the National
Center for Chronic Disease Prevention and Health
Promotion: 35% of US adults were reported as
overweight (vs. about 30% of our sample) and
161
27% of US adults were reported as obese (vs. 26%
of our sample) [20].
For the subset of participants who completed
the IWQOL-Lite a second time, the average BMI
was 27.9 (SD: 8.3; range: 18.9–69.6). Forty-six
(41.1%) participants had a BMI less than 25, 34
(30.4%) had a BMI between 25 and 29.9, 15
(13.4%) had a BMI between 30 and 34.9, 9 (8.0%)
had a BMI between 35 and 39.9, and 8 (7.1%) had
a BMI of 40 or greater. The prevalence of over-
weight and obesity in this subset was similar to
that of the total sample.
IWQOL-Lite scores
Table 1 presents IWQOL-Lite scale scores and
total score separately by gender and BMI classifi-
cation. Scores for this community sample are
consistently lower (better quality of life) than those
reported for treatment samples across comparable
gender and BMI classes [8]. ANOVA revealed
significant main effects for BMI on all five IW
QOL-Lite scales (physical function: F ¼ 74:6,
df ¼ 4484, p < 0:001; self-esteem: F ¼ 16:9, df ¼
4484, p < 0:001; sexual life: F ¼ 6:2, df ¼ 4476,
p < 0:001; public distress: F ¼ 51:5, df ¼ 4484,
p < 0:001; work: F ¼ 41:4, df ¼ 4467, p < 0:001)
and total score (F ¼ 56:8, df ¼ 4484, p < 0:001),
with higher BMI associated with increasing im-
pairment. Results of post-hoc tests for differences
between BMI groups revealed that, with the ex-
ception of the sexual life scale, the 40þ BMI group
showed significantly more impairment than all
other BMI groups on all IWQOL-Lite scores.
In addition, the 35–39.9 group was significantly
more impaired than lower BMI groups on all scales
except self-esteem. Finally, the 25–29.9 group did
not differ from the normal weight group (<25) on
any scales or total score. Main effects for gender
were obtained for physical function (F ¼ 22:6,
df ¼ 1484, p < 0:001), self-esteem (F ¼ 16:5,
df ¼ 1484, p < 0:001), sexual life (F ¼ 14:6,
df ¼ 1476, p < 0:001), work (F ¼ 8:1, df ¼ 1467,
p ¼ 0:004), and total score (F ¼ 23:7, df ¼ 1484,
p < 0:001), with females showing greater impair-
ment than males. Finally, a significant BMI-by-
gender interaction was obtained for physical
function (F ¼ 4:0, df ¼ 4484, p ¼ 0:003), where the
largest difference between females and males was in
the 35–39.9 category. Figure 1 presents graphs of
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Table 1. IWQOL-Lite scores by BMI and gender

IWQOL scale BMI

<25 25–29.9 30–34.9 35–39.9 40þ

Physical function
Females 12.6 ± 2.4 14.9 ± 5.6 17.8 ± 5.3 25.3 ± 10.0 33.5 ± 11.3
(172) (77) (48) (27) (17)
Males 12.5 ± 2.7 13.0 ± 2.6 16.2 ± 5.8 17.9 ± 9.0 28.1 ± 14.8
(48) (69) (17) (11) (8)
Total 12.6 ± 2.4a 14.0 ± 4.5a 17.4 ± 5.4b 23.2 ± 10.2c 31.8 ± 12.5d
(220) (146) (65) (38) (25)
Self-esteem
Females 10.3 ± 5.0 11.9 ± 6.2 13.3 ± 6.4 15.5 ± 7.4 18.2 ± 7.3
(172) (77) (48) (27) (17)
Males 7.6 ± 1.6 9.4 ± 4.1 9.2 ± 3.4 9.9 ± 3.8 18.6 ± 10.4
(48) (69) (17) (11) (8)
Total 9.7 ± 4.6a 10.7 ± 5.4a 12.2 ± 6.0ab 13.9 ± 7.0b 18.3 ± 8.2c
(220) (146) (65) (38) (25)
Sexual life
Females 4.6 ± 2.1 4.9 ± 2.4 5.3 ± 2.5 6.4 ± 3.4 7.5 ± 3.6
(169) (75) (46) (27) (17)
Males 4.1 ± 0.6 4.3 ± 1.3 4.3 ± 1.0 5.4 ± 3.4 5.1 ± 1.3
(48) (69) (16) (11) (8)
Total 4.5 ± 1.9a 4.6 ± 2.0a 5.1 ± 2.2a 6.1 ± 3.4b 6.7 ± 3.2b
(217) (144) (62) (38) (25)
Public distress
Females 5.3 ± 1.5 5.2 ± 0.5 5.9 ± 1.5 7.6 ± 3.6 10.9 ± 5.8
(172) (77) (48) (27) (17)
Males 5.2 ± 0.9 5.2 ± 0.7 5.0 ± 0.0 6.0 ± 2.4 11.8 ± 7.1
(48) (69) (17) (11) (8)
Total 5.3 ± 1.4a 5.2 ± 0.6a 5.7 ± 1.4a 7.1 ± 3.4b 11.2 ± 6.1c
(220) (146) (65) (38) (25)
Work
Females 4.2 ± 1.1 4.5 ± 1.2 4.8 ± 1.5 6.2 ± 2.8 8.3 ± 3.4
(165) (75) (48) (24) (17)
Males 4.0 ± 0.2 4.1 ± 0.4 4.3 ± 1.0 4.4 ± 1.3 8.3 ± 5.2
(45) (68) (17) (10) (8)
Total 4.2 ± 0.9a 4.3 ± 1.0a 4.7 ± 1.4a 5.7 ± 2.6b 8.3 ± 4.0c
(210) (143) (65) (34) (25)
IWQOL-Lite total
Females 37.1 ± 9.0 41.4 ± 12.8 47.2 ± 14.2 61.2 ± 21.5 78.3 ± 24.9
(172) (77) (48) (27) (17)
Males 33.6 ± 5.3 36.1 ± 7.4 39.2 ± 8.0 44.0 ± 15.8 71.9 ± 36.0
(48) (69) (17) (11) (8)
Total 36.3 ± 8.4a 38.9 ± 10.9a 45.1 ± 13.3b 56.2 ± 21.3c 76.2 ± 28.3d
(220) (146) (65) (38) (25)

Cell entries represent mean ± SD (n). Means with common subscripts are not significantly different based on Tukey’s hsd (p O 0:05).

IWQOL-Lite scores by gender and BMI group.
These graphs clearly depict the impact of increasing
BMI upon diminished quality of life, particularly in
the higher BMI groups. The correlation be-
tween BMI and IWQOL-Lite scores were: physi-
cal function ¼ 0.681, self-esteem ¼ 0.370, sexual
life ¼ 0.281, public distress ¼ 0.518, work ¼ 0.522,
and total score ¼ 0.615. All correlations were sig-
nificant at p < 0:001.
IWQOL-Lite reliability
Table 2 presents reliability information for the
IWQOL-Lite scales and total score for all subjects

Figure 1. IWQOL-Lite scores by gender and BMI.
and for overweight/obese subjects only. Males and
females obtained similar results for internal con-
sistency and test–retest reliability (data not
shown). For the total sample, internal consistency
a coefficients ranged from 0.816 (work) to 0.944
163
(self-esteem) for IWQOL-Lite scales and was 0.958
for the total score, while test–retest intraclass
correlation coefficients ranged from 0.814 (public
distress) to 0.877 (physical function) for IWQOL-
Lite scales and was 0.937 for the total score. For
164

Table 2. Internal consistency and test–retest reliability for the the overweight/obese sub-sample, internal consis-
IWQOL-Lite tency coefficients ranged from 0.816 (work) to
IWQOL Internal consistencya Test–retestb 0.946 (self-esteem) for IWQOL-Lite scales and was
scale 0.962 for the total score, while test–retest intraclass
All subjects BMIP25.0 All subjects BMIP25.0 correlation coefficients ranged from 0.840 (work)
N = 494 N = 274 N = 112 N = 66 to 0.912 (sexual life) for IWQOL-Lite scales and
Physical 0.935 0.940 0.877 0.898 was 0.954 for total score. These data suggest that
function the reliability of the IWQOL-Lite scales and total
Self-esteem 0.944 0.946 0.870 0.901 score is excellent for both the total sample and the
Sexual life 0.921 0.903 0.849 0.912 overweight/obese participants.
Public 0.916 0.916 0.814 0.884
distress
Work 0.816 0.816 0.857 0.840 Collateral measures
Total 0.958 0.962 0.937 0.954
a
SF-36
a Coefficients.
b Table 3 presents SF-36 scores separately by gender
Intraclass correlation coefficients.
and BMI classification, as well as US population

Table 3. SF-36 scores by BMI and gender

SF-36 scale BMI

<25 25–29.9 30–34.9 35–39.9 40þ US Norms

Physical functioning
Females 93.3 ± 12.3 84.9 ± 23.5 82.8 ± 20.2 73.0 ± 22.2 62.7 ± 25.3 81.5 ± 24.6
(172) (77) (47) (27) (17) (1412)
Males 93.5 ± 13.5 91.7 ± 18.4 84.4 ± 24.9 83.2 ± 17.4 74.4 ± 28.3 87.2 ± 21.3
(48) (69) (17) (11) (8) (1055)
Total 93.4 ± 12.5a 88.1 ± 21.4ab 83.2 ± 21.4bc 75.9 ± 21.2c 66.4 ± 26.3d 84.2 ± 23.3
(220) (146) (64) (38) (25) (2474)
Role physical
Females 89.8 ± 25.5 87.2 ± 26.6 87.2 ± 26.5 78.7 ± 34.4 47.1 ± 40.4 77.8 ± 36.2
(172) (76) (47) (27) (17) (1412)
Males 95.8 ± 16.6 91.5 ± 21.9 86.8 ± 26.7 84.1 ± 32.2 78.1 ± 36.4 86.6 ± 30.9
(48) (68) (17) (11) (8) (1055)
Total 91.1 ± 23.9a 89.2 ± 24.5a 87.1 ± 26.4a 80.3 ± 33.5a 57.0 ± 41.2b 81.0 ± 34.0
(220) (144) (64) (38) (25) (2474)
Bodily pain
Females 77.2 ± 19.2 72.2 ± 23.8 67.5 ± 22.7 61.9 ± 25.3 51.8 ± 25.3 73.6 ± 24.3
(172) (77) (48) (27) (17) (1412)
Males 83.6 ± 15.2 78.0 ± 16.5 67.7 ± 28.2 72.7 ± 27.2 57.5 ± 25.5 76.9 ± 23.0
(47) (69) (17) (11) (8) (1055)
Total 78.6 ± 18.6a 74.9 ± 20.8ab 67.5 ± 24.1b 65.0 ± 26.0b 53.6 ± 25.0c 75.2 ± 23.7
(219) (146) (65) (38) (25) (2474)
General health
Females 74.9 ± 16.1 71.1 ± 18.8 66.3 ± 15.3 56.5 ± 21.2 52.4 ± 23.1 70.6 ± 21.5
(172) (77) (48) (27) (17) (1412)
Males 81.6 ± 16.8 77.2 ± 17.1 72.7 ± 15.6 72.3 ± 14.9 51.3 ± 29.5 73.5 ± 20.0
(47) (69) (17) (11) (8) (1055)
Total 76.3 ± 16.5a 74.0 ± 18.2a 67.9 ± 15.5ab 61.1 ± 20.7b 52.0 ± 24.7c 72.0 ± 20.3
(219) (146) (65) (38) (25) (2474)
Vitality
Females 60.3 ± 19.0 59.3 ± 19.9 58.8 ± 19.0 53.3 ± 23.6 45.0 ± 21.4 58.4 ± 21.5
(171) (77) (48) (27) (17) (1412)
Males 65.9 ± 18.9 67.5 ± 18.4 63.5 ± 18.6 68.2 ± 16.8 49.4 ± 30.1 63.6 ± 20.0
(47) (69) (17) (11) (8) (1055)
 165

Table 3. (Continued)

SF-36 scale BMI

<25 25–29.9 30–34.9 35–39.9 40þ US Norms

Total 61.5 ± 19.1a 63.2 ± 19.6a 60.0 ± 18.9a 57.6 ± 22.7a 46.4 ± 24.0b 60.9 ± 21.0
(218) (146) (65) (38) (25) (2474)
Social functioning
Females 86.2 ± 18.4 85.2 ± 19.5 84.0 ± 18.7 73.3 ± 28.3 70.7 ± 26.2 81.5 ± 23.7
(172) (77) (48) (27) (17) (1412)
Males 87.9 ± 20.9 90.9 ± 15.9 83.2 ± 19.2 79.7 ± 24.4 82.9 ± 29.1 85.2 ± 21.3
(47) (69) (17) (11) (8) (1055)
Total 86.6 ± 18.9a 87.9 ± 18.1a 83.8 ± 18.7ab 75.1 ± 27.0b 74.6 ± 27.1b 83.3 ± 22.7
(219) (146) (65) (38) (25) (2474)
Role emotional
Females 78.1 ± 36.0 82.5 ± 32.0 83.7 ± 28.6 85.2 ± 25.1 60.7 ± 41.3 79.5 ± 34.4
(172) (76) (47) (27) (17) (1412)
Males 84.0 ± 33.7 87.9 ± 28.6 86.3 ± 29.0 78.8 ± 40.2 83.3 ± 31.0 83.3 ± 31.3
(48) (69) (17) (11) (8) (1055)
Total 79.4 ± 35.5a 85.1 ± 30.4a 84.4 ± 28.5a 83.3 ± 29.8a 67.9 ± 39.2a 81.3 ± 33.0
(220) (145) (64) (38) (25) (2474)
Mental health
Females 74.8 ± 16.0 76.1 ± 15.4 76.7 ± 15.8 76.7 ± 14.3 70.1 ± 16.1 73.3 ± 18.7
(171) (77) (48) (27) (17) (1412)
Males 76.9 ± 18.9 80.5 ± 13.2 79.1 ± 11.8 84.0 ± 15.8 72.0 ± 24.8 76.4 ± 17.2
(47) (69) (17) (11) (8) (1055)
Total 75.2 ± 16.7a 78.2 ± 14.5a 77.3 ± 14.8a 78.8 ± 14.9a 70.7 ± 18.8a 74.7 ± 18.1
(218) (146) (65) (38) (25) (2474)
Physical summary
Females 53.3 ± 6.5 50.0 ± 8.8 48.0 ± 6.9 43.3 ± 11.5 38.3 ± 12.5 50 ± 10
(171) (76) (47) (27) (17) (1412)
Males 55.1 ± 5.5 52.3 ± 6.3 48.8 ± 10.6 48.8 ± 7.8 42.9 ± 12.6 50 ± 10
(47) (68) (17) (11) (8) (1055)
Total 53.7 ± 6.3a 51.1 ± 7.8ab 48.3 ± 8.0bc 44.9 ± 10.8 c
39.8 ± 12.4 d
50 ± 10
(218) (144) (64) (38) (25) (2474)
Mental summary
Females 48.5 ± 10.2 50.5 ± 9.3 51.3 ± 9.2 50.8 ± 9.1 47.2 ± 9.3 50 ± 10
(171) (76) (47) (27) (17) (1412)
Males 50.1 ± 11.4 52.7 ± 9.0 52.2 ± 7.9 52.6 ± 10.8 50.1 ± 12.9 50 ± 10
(47) (68) (17) (11) (8) (1055)
Total 48.8 ± 10.5a 51.5 ± 9.2a 51.5 ± 8.8a 51.4 ± 9.5a 48.2 ± 10.4a 50 ± 10
(218) (144) (64) (38) (25) (2474)

Cell entries represent mean ± SD (n). US population norms obtained from Ware, et al. [12]; Means with common subscripts are not
significantly different based on Tukey’s hsd (p O 0:05).

norms for comparison [12]. With increasing BMI,
SF-36 scores tended to decrease as would be ex-
pected [21]. At the lower BMI’s, SF-36 scores were
comparable to or better than the US population
norms, whereas at the higher BMI’s SF-36 scores
fell below the norms.
Correlations between SF-36 scores and IWQOL-
Lite scores for subjects with BMI’s of 25 and higher
(i.e., overweight and obese subjects only) are
presented in Table 4. The pattern of correlations is
generally consistent with the predictions above.
As predicted, the IWQOL-Lite total score corre-
lated most strongly with general health (0.579)
and the physical summary score (0.539) from the
SF-36. However, the correlation between the
IWQOL-Lite total score and the mental summary
score from the SF-36 was lower (0.332) than an-
ticipated. Consistent with predictions, the physical
function score from the IWQOL-Lite correlated
greater than 0.50 (absolute value) with the physical
summary score (0.674), physical functioning
(0.553), general health (0.582), bodily pain
166

Table 4. IWQOL-Lite correlations with collateral measures

SF-36 IWQOL-Lite scores

Physical function Self-esteem Sexual life Public distress Work Total score

Physical functioning 0.553a 0.206a 0.250a 0.294a 0.396a 0.448a

Role physical 0.531a 0.254a 0.315a 0.299a 0.448a 0.468a
Bodily pain 0.522a 0.257a 0.314a 0.220a 0.370a 0.444a
General health 0.582a 0.440a 0.398a 0.390a 0.466a 0.579a
Vitality 0.444a 0.488a 0.348a 0.304a 0.426a 0.510a
Social functioning 0.456a 0.345a 0.431a 0.205a 0.397a 0.461a
Role emotional 0.165b 0.365a 0.254a 0.134c 0.165b 0.274a
Mental health 0.283a 0.448a 0.358a 0.186b 0.284a 0.391a
Physical summary 0.674a 0.234a 0.313a 0.351a 0.493a 0.539a
Mental summary 0.180b 0.459a 0.345a 0.141c 0.222a 0.332a
Rosenberg self-esteem 0.325a 0.567a 0.465a 0.333a 0.391a 0.500a
Sexual functioning 0.433a 0.549a 0.639a 0.306a 0.455a 0.559a
Public distress 0.476a 0.496a 0.341a 0.549a 0.475a 0.570a
Marlowe–Crowne 0.053 0.290a 0.172b 0.168a 0.157c 0.188b
Global ratings
Physical function 0.610a 0.551a 0.474a 0.497a 0.568a 0.666a
Self-esteem 0.372a 0.631a 0.431a 0.387a 0.433a 0.550a
Sexual function 0.354a 0.510a 0.575a 0.242a 0.387a 0.490a
Public distress 0.417a 0.558a 0.390a 0.420a 0.409a 0.542a
Work 0.378a 0.407a 0.363a 0.337a 0.404a 0.457a
Overall quality of life 0.437a 0.516a 0.468a 0.426a 0.474a 0.555a

Shaded areas represent correlations hypothesized to provide evidence of convergent validity; Data in this table are based on subjects
with BMI’s of 25 and higher.
a
p 6 0.001.
b
p 6 0.01.
c
p 6 0.05.

(0.522) and role physical (0.531) scores from
the SF-36. Also consistent with predictions, the
IWQOL-Lite self-esteem score correlated 0.459
with the mental summary score and 0.448 with
mental health scores of the SF-36, but somewhat
less than expected for the role emotional score
(0.365). The correlation of 0.488 between the
IWQOL-Lite self-esteem scale and the Vitality
scale of the SF-36 was unexpected. Also not ex-
pected was the correlation between the IWQOL-
Lite self-esteem score and the general health score
from the SF-36 (0.440). Finally, as predicted, the
IWQOL-Lite work score correlated 0.448 with
the role physical, 0.466 with general health score,
0.426 with vitality, and 0.493 with the physical
summary score from the SF-36.
RSE scale
The mean RSE score for the current sample was
0.99, with a SD of 1.3 and a range from 0–6.
Normative data from a group of high school stu-
dents tested by Rosenberg produced a mean of
1.89, SD of 1.44, and a score indicating high self-
esteem (0 or 1) in 44.8% of students, medium self-
esteem (2) in 25.1%, and low self-esteem (3–6) in
30% of students [22]. The mean of the present
sample is in the high to medium self-esteem range
and is somewhat higher than that reported for the
high school students. As predicted, the RSE cor-
related most strongly for overweight/obese sub-
jects with the IWQOL-Lite self-esteem scale
(0.567), but also correlated 0.500 with the IW-
QOL-Lite total score (see Table 4).
Sexual functioning ratings
The mean sexual functioning score was 6.5 (pos-
sible scores ¼ 4–20, with higher scores indicating
more impairment) with a SD of 2.7 and a range of
4–17. The a coefficient for the four sexual func-
tioning items was 0.721, indicating reasonable in-
ternal consistency, particularly considering the
small number of items. As predicted, sexual func-
tioning ratings correlated most strongly for over-
weight/obese subjects with the IWQOL-Lite sexual

life (0.639), but also correlated 0.549 with self-es-
teem (see Table 4).
Public distress ratings
The mean public distress score was 7.3 (possible
scores ¼ 5–25, with higher scores indicating more
impairment) with a SD of 3.1 and a range of 5–25.
The a coefficient for the five public distress items
was 0.766. As predicted, public distress ratings
correlated most strongly for overweight/obese
subjects with IWQOL-Lite public distress (0.549)
(see Table 4).
Marlowe–Crowne
The mean score for the Marlowe–Crowne was 7.5,
with a SD of 3.2 and a range of 0–13. This mean
score of 7.5 was higher than that obtained by
previous researchers in university samples [16, 23].
With one exception, correlations between the
Marlowe–Crowne and the IWQOL-Lite scales for
overweight/obese subjects were below 0.19 (al-
beit significant for most), indicating little associa-
tion between social desirability and IWQOL-Lite
scales. For the self-esteem scale, the correlation
with the Marlowe–Crowne was 0.290 (Table 4).
This suggests that participants with higher social
desirability scores tended to report fewer problems
with self-esteem. The relationship between the
IWQOL-Lite self-esteem scale and the Marlowe–
Crowne accounts for only 8.4% shared variance
(i.e., r2 ¼ 0:2902 ¼ 0:084). Correlations between
the Marlowe–Crowne and other collateral mea-
sures were as follows (significant at p O 0:01):
RSE ¼ 0.217, sexual functioning ratings ¼
0.310, public distress ratings ¼ 0.213, and
global ratings ranging from 0.169 (physical
function) to 0.266 (self-esteem). Correlations
between the Marlowe–Crowne and the SF-36
scales were significant (p O 0:01) for Vitality
(0.239), role emotional (0.167), mental health
(0.168) and mental summary (0.218).
Global ratings
Correlations between global ratings of quality of
life and corresponding IWQOL-Lite scale scores
for overweight/obese subjects were significant
(p < 0:001) and ranged from 0.404 (work) to 0.631
(self-esteem) (Table 4). The correlation between
IWQOL-Lite total score and global ratings of
quality of life ranged from 0.457 (global rating on
167
work) to 0.666 (global rating on physical function)
and was 0.555 for the global rating of overall
quality of life.
On the physical function, self-esteem, and sexual
life scales of the IWQOL-Lite, the highest corre-
lations with global ratings were obtained on the
global ratings that corresponded to these dimen-
sions. However, the IWQOL-Lite public distress
scale correlated more highly with a global rating of
physical function than with a global rating of
public distress. Similarly, the IWQOL-Lite work
scale correlated more highly with global ratings of
physical function, self-esteem, and overall quality
of life than with a global rating of work. In addi-
tion, the IWQOL-Lite total score correlated more
highly with a global rating of physical function
than with a global rating of overall quality of life.
Discussion
This paper describes the psychometric evaluation
of the IWQOL-Lite, a recently developed, brief
measure of HRQOL in obesity [8]. The IWQOL-
Lite was derived from the longer IWQOL [5],
which was shown to be psychometrically sound [7].
Previous research on both the IWQOL and the
IWQOL-Lite has been conducted almost exclu-
sively on Caucasian patients in treatment for
obesity. The current study was undertaken to
provide data on test–retest reliability, convergent
validity, and discriminant validity for the Lite
version in a more heterogeneous sample of non-
treatment-seeking adults.
Internal consistency reliability and test–retest
reliability for the IWQOL-Lite were shown to be
excellent for both the total sample and overweight/
obese participants only. This study also provides
support for the convergent validity of the IWQOL-
Lite. In general, predictions concerning associa-
tions between the IWQOL-Lite instrument and
collateral measures were well supported.
In addition, these data also provide support for
the discriminant validity of the IWQOL-Lite.
We predicted that the IWQOL-Lite scales would
not be strongly correlated with scores on the
Marlowe–Crowne social desirability scale due to
our belief that the IWQOL-Lite is measuring
strictly the impact of weight on quality of life.
While we were aware that overweight and obese
168
people are under some social pressure to conform
to society’s standards regarding weight and ap-
pearance (and therefore, this may influence their
scores on the social desirability scale), we expected
to find no more degree of relationship between
social desirability and IWQOL than between social
desirability and SF-36 due to the robustness of the
IWQOL, IWQOL-Lite and SF-36 in previous re-
search. In the present study, the IWQOL-Lite
showed relatively low relationships with the Mar-
lowe–Crowne social desirability Scale. Only the
correlation between social desirability and IW-
QOL-Lite self-esteem was above 0.20. Social de-
sirability scores correlated to a similar extent with
other measures of quality of life. For example,
correlations between SF-36 scales and the Mar-
lowe–Crowne social desirability scale (between
0.167 and 0.239 for four of the 10 scales) and
correlations between RSE and the Marlowe–
Crowne social desirability scale (0.217) were
comparable to those observed between the IW-
QOL-Lite and the Marlowe–Crowne. To further
demonstrate discriminant validity, we expected
non-shaded correlations between scales of the
IWQOL-Lite and collateral measures in Table 4 to
be lower than the shaded ones (where shaded
correlations represent those we hypothesized to be
strong a priori). In most cases, we did indeed find
lower correlations in the non-shaded cells of the
table. For example, the RSE scale had the highest
correlation with the self-esteem scale of the IW-
QOL-Lite and lower correlations with other scales
of the IWQOL-Lite. Similarly, sexual functioning
and public distress ratings correlated most
strongly with their respective IWQOL-Lite scales
and to a lesser degree with the other IWQOL-Lite
scales. On the global ratings of quality of life, the
highest correlations for IWQOL-Lite scales oc-
curred for their corresponding scales for three of
the five scales (physical function, self-esteem, and
sexual life), providing evidence of discriminant
validity for those three scales. When examining
correlations between the SF-36 scales and the
IWQOL-Lite scales, we found that most non-
shaded correlations were lower than the shaded
ones. Taken together, this pattern of results gen-
erally supported the discriminant validity of the
IWQOL-Lite.
In the present study, as in previous research on
the IWQOL-Lite in a primarily clinical population
[8], high to moderate correlations were found be-
tween BMI and IWQOL-Lite scores. In addition,
analyses of variance revealed significant main ef-
fects for BMI for all five scales of the IWQOL-Lite
and total score (p < 0:001), with higher BMI as-
sociated with increasing impairment. This finding
of poorer HRQOL in individuals with higher
BMI’s is consistent with previous reports of pop-
ulation studies [24–30] and treatment studies [21,
31]. As would be expected with an obesity-specific
instrument, the IWQOL-Lite differentiated be-
tween BMI groups better than the SF-36. For ex-
ample, individuals in the 40þ BMI group were
significantly more impaired than those in the 35–
39.9 group on five out of six IWQOL-Lite scores
but only six of 10 SF-36 scales. Similarly, indi-
viduals in the 35–39.9 BMI group were more im-
paired than those in the 30–34.9 group on five out
of six IWQOL-Lite scores but did not differ on any
SF-36 scales.
When exploring gender differences on the IW-
QOL-Lite, we found that women experienced the
effects of their weight more profoundly than did
men on five out of six IWQOL-Lite scales (all ex-
cept public distress). This finding is consistent with
what is generally known about gender differences
and body image [32]. In previous research on the
IWQOL-Lite, women experienced more impaired
HRQOL than men, but only on sexual life, self-
esteem, and total score [8]. It is unclear whether this
different pattern of results reflects true differences
between community and treatment-seeking sam-
ples, or is merely the result of a much larger sample
size in the earlier study. In any case, it is important
to assess men and women separately when evalu-
ating the impact of weight on quality of life. Two
other obesity-specific quality of life instruments
showed more impaired quality of life for women vs.
men – obesity-related well-being scale (ORWELL
97) [33] and obesity-related psychosocial problems
(OP) [34]. Similarly, overweight/obese women had
lower SF-36 scores than overweight/obese men in a
survey of patients with chronic medical and psy-
chiatric conditions [35]. In addition, overweight/
obesity in a general population sample was asso-
ciated with major depression and suicidal behav-
iors for women but not for men [36].
Comparison of the IWQOL-Lite scores for the
present community sample with those reported for
a sample consisting primarily of participants in

weight reduction programs [8] suggests that the
community sample scores are consistently lower
(i.e., less impaired) across comparable BMI and
gender classifications. This is consistent with pre-
vious findings of more impaired HRQOL at
baseline for treatment-seeking overweight indi-
viduals than for individuals of comparable BMI
who are not seeking treatment [31]. Since the
IWQOL-Lite is intended as a tool for assessing
changes in a clinical population, one might ask
whether the results of the present study are gen-
eralizable to those of a clinical sample. Since the
results of the present study, using a community
sample, are very similar to those obtained using a
primarily clinical sample [8], we believe that the
IWQOL-Lite is applicable to any sample of over-
weight or obese persons. While most users of this
instrument would be studying a clinical sample, it
is conceivable that some researchers would be
studying a non-clinical sample of overweight per-
sons (e.g., an epidemiologist studying the impact
of weight in a particular geographic location or
socioeconomic group; or researchers comparing
the impact of weight on quality of life for persons
in treatment versus persons not in treatment).
As in the previous study of the IWQOL-Lite
with a clinical sample [8], this study found no
statistically significant differences between the
overweight group (BMI between 25 and 29.9) and
the normal weight group (BMI less than 25).
However, the IWQOL-Lite mean scores were
slightly higher (indicating poorer quality of life) in
the overweight group. Also consistent with previ-
ous studies, the current study demonstrates that
IWQOL-Lite scores (particularly physical function
and total score) increase exponentially with in-
creasing BMI. This suggests that the IWQOL-Lite
may be most useful in the upper ranges of the
scale, i.e. in those circumstances in which quality
of life is most impaired. Researchers who are in-
terested in assessing changes in HRQOL associ-
ated with weight loss treatment for persons with a
BMI between 25 and 29.9 will require a large
sample size in order to demonstrate statistically
significant improvements.
A limitation of this study is that BMI groupings
are based on self-reported weights and heights.
Previous research has found that self-reported
weights may be inaccurate [37], and heavier indi-
viduals misreport their weight to a greater extent
169
than lighter persons [38, 39]. Furthermore, height
tends to be overestimated along with the tendency
to underestimate weight [40]. As a result, actual
BMI values may be underestimated in the current
study. However, the prevalence of overweight and
obesity in this sample is similar to that reported by
the National Center for Chronic Disease Preven-
tion and Health Promotion, and the correlations of
BMI with IWQOL-Lite scores in the current study
are comparable to those reported in previous re-
search [20]. This suggests that the self-report bias
has not dramatically affected the obtained BMI
values and the overall relationship between BMI
and quality of life scores. Of interest, a study ex-
amining social desirability scores in young men and
women (mean age 28.3) of non-overweight status
(mean BMI between 22.4 and 24.3) found that
women highest in the tendency to score in socially
desirable ways were most likely to underreport
their weight [41]. Since our sample had a higher
mean Marlowe–Crowne score than that obtained
in university samples by other researchers, it is
possible that our subjects, particularly women, had
a tendency to underreport their weight.
Another limitation of this study is that some
correlations between IWQOL-Lite scales and col-
lateral measures were unexpectedly high. For ex-
ample, the public distress scale of the IWQOL-Lite
correlated more highly with the global rating of
physical function than with the global rating of
public distress and the work scale of the IWQOL-
Lite correlated more highly with the global rating
of physical function than with the global rating of
work. A possible explanation we have for this
finding is that the time reference in the IWQOL-
Lite instructions was for the past week, whereas
there was no time reference in the instructions for
the global ratings. In addition, we also found
higher than expected correlations between IW-
QOL-Lite self-esteem scores and SF-36 general
health and vitality and between the RSE scale and
IWQOL-Lite total score. Regarding the relation-
ship between IWQOL-Lite self-esteem and SF-36
scores, in retrospect this relationship should not be
unexpected. Correlations between medical out-
comes study (MOS) measures of psychological
distress and SF-36 general health are approxi-
mately 0.40, and between psychological distress
and SF-36 vitality range from 0.51 to 0.56 [12].
Since the IWQOL-Lite self-esteem score is in some
170
ways a measure of psychological distress, these
correlations with the SF-36 make sense. Regarding
the relationship between IWQOL-Lite total score
and RSE, it is possible that self-esteem serves a
protective function to minimize the impact of
weight on quality of life in general.
The current study was undertaken because of
the absence of data on test–retest reliability and
convergent/discriminant validity for this newly
developed Lite version of the IWQOL. Further-
more, previous research on the IWQOL-Lite was
based on participants’ responses to the original set
of 74 IWQOL items, rather than to the 31-item
format. Overall, psychometric properties of the
IWQOL-Lite appear to be quite strong. This study
demonstrates that the IWQOL-Lite is a valid and
reliable obesity-specific questionnaire that can be
included in a clinical trial to measure the HRQOL
impact of new treatments for obesity. Data are
currently being collected on the IWQOL-Lite in
several placebo-controlled randomized clinical
trials (both pharmacological and behavioral) and
in clinical treatment programs. Future research is
being planned that will develop norms for sub-
groups, establish clinically meaningful change
scores, and determine the psychometric properties
of this instrument in other languages and cultures.
Acknowledgements
Financial support for this project was provided by
Glaxo Smith Kline. We would like to thank
Kenneth Crews, Kathleen Meter, Carol Beebee,
Che Che Casto, and Marya Mc Neish for their
assistance with data collection.
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Address for correspondence: Ronette L. Kolotkin, Ph.D., 1004
Norwood Avenue, Durham, NC 27707, USA
Phone: +1-919-493-9995; Fax: +1-919-493-9925
E-mail: rkolotkin@yahoo.com