Julie C. Weitlauf

All Publications

• Physical function trends and their association with mortality in postmenopausal women. Menopause (New York, N.Y.) Laddu, D. R., Saquib, N., Manson, J. E., Arena, R., Shadyab, A. H., Weitlauf, J. C., Hovey, K. M., Andrews, C., Banack, H., Stefanick, M. L., LaMonte, M. J. 2022

  Abstract

  Research is limited regarding the predictive utility of the RAND-36 questionnaire and physical performance tests in relation to all-cause, cardiovascular disease (CVD), and total-cancer mortality in older women.Data on the RAND-36 questionnaire, gait speed, and chair stand performance were assessed in 5,534 women aged ≥ 65 years at baseline. A subset (n = 298) had physical function assessments additionally at follow-up (years 1, 3, or 6). Multivariable Cox proportional hazards regression models estimated associations (HR) for a 1-standard deviation (SD) difference in baseline RAND-36 scores and performance tests (alone and combined) with mortality outcomes in the overall cohort and in models stratified by enrollment age (<70 and ≥70 y). The relative prognostic value of each physical function exposure was assessed using the Uno concordance statistic.A total of 1,186 deaths from any cause, 402 deaths from CVD, and 382 deaths from total-cancer were identified during a mean follow-up of 12.6 years. Overall, each 1-SD unit higher baseline RAND-36 score was associated with significantly lower all-cause mortality (HR =0.90) and discriminatory capacity (Uno=0.65) that was comparable to each performance exposure (HRs 0.88-0.91; Uno = 0.65). These findings were consistent in women aged <70 and ≥70 years. The associations of RAND-36 and performance measures with CVD mortality and total-cancer mortality were not significant in multivariable models nor in age-stratified models.The RAND-36 questionnaire is a reasonable substitute for tracking physical functioning and estimating its association with all-cause mortality in older adults when clinical performance testing is not feasible.

  View details for DOI 10.1097/GME.0000000000001982

  View details for PubMedID 35324544

• Association of Global Cognitive Function with Psychological Distress and Adherence to Public Health Recommendations during the COVID-19 Pandemic: The Women's Health Initiative. The journals of gerontology. Series A, Biological sciences and medical sciences Shadyab, A. H., Larson, J. C., Rapp, S. R., Shumaker, S. A., Kroenke, C. H., Meliker, J., Saquib, N., Ikramuddin, F., Michael, Y. L., Goveas, J. S., Garcia, L., Wactawski-Wende, J., Luo, J., Hayden, K. M., Chen, J., Weitlauf, J., Baker, L. D. 2022

  Abstract

  BACKGROUND: The association of cognitive function with symptoms of psychological distress during the coronavirus 2019 (COVID-19) pandemic or adherence to COVID-19 protective health behaviors is not well understood.METHODS: We examined 2,890 older women from the Women's Health Initiative cohort. Pre-pandemic (i.e., within 12 months prior to pandemic onset) and peri-pandemic global cognitive function scores were assessed with the modified Telephone Interview for Cognitive Status (TICS-m). Anxiety, stress, and depressive symptom severity during the pandemic were assessed using validated questionnaires. We examined adherence to protective behaviors that included safe hygiene, social distancing, mask wearing, and staying home. Multivariable models were adjusted for age, race, ethnicity, education, region of residence, alcohol intake, and comorbidities.RESULTS: Every five-point lower pre-pandemic TICS-m score was associated with 0.33-point mean higher (95% CI, 0.20,0.45) perceived stress, and 0.20-point mean higher (95% CI, 0.07,0.32) depressive symptom severity during the pandemic. Higher depressive symptom severity, but not anxiety or perceived stress, was associated with a 0.69-point (95% CI, -1.13, -0.25) mean decline in TICS-m from the pre- to peri-pandemic period. Every five-point lower peri-pandemic TICS-m score was associated with 12% lower odds (OR, 0.88; 95% CI, 0.80,0.97) of practicing safe hygiene.CONCLUSIONS: Among older women, we observed that: 1) lower pre-pandemic global cognitive function was associated with higher stress and depressive symptom severity during the pandemic; 2) higher depressive symptom severity during the pandemic was associated with cognitive decline; and 3) lower global cognitive function during the pandemic was associated with lower odds of practicing safe hygiene.

  View details for DOI 10.1093/gerona/glac053

  View details for PubMedID 35235646

• The relationship between sleep and weight change among women diagnosed with breast cancer participating in the Women's Health Initiative. Breast cancer research and treatment Donzella, S. M., Lind, K. E., Skiba, M. B., Farland, L. V., Thomson, C. A., Werts, S. J., Bell, M. L., LeBlanc, E., Weitlauf, J. C., Hery, C. M., Naughton, M. J., Mortimer, J., Crane, T. E. 1800

  Abstract

  PURPOSE: Short and long sleep duration and poor sleep quality are risk factors for weight gain and cancer mortality. The purpose of this study is to investigate the relationship between sleep and weight change among postmenopausal breast cancer survivors.METHODS: Women participating in the Women's Health Initiative who were diagnosed with incident breast cancer between year one and year three were included. Self-reported sleep duration was categorized as≤5h (short), 6h, 7-8h (optimal), and≥9h (long). Self-reported sleep quality was categorized as poor, average, and above average. Post-diagnosis weight change was the difference of weight closest to, but preceding diagnosis, and year 3 weight. We used linear regression to evaluate sleep duration and sleep quality associations with post-diagnosis weight change adjusted for potential confounders.RESULTS: Among 1156 participants, 63% were weight stable after diagnosis; average weight gain post cancer diagnosis was 3.2kg. Six percent of women reported sleeping≤5h, 26% reported 6h, 64% reported 7-8h, and 4% reported≥9h. There were no differences in adjusted estimates of weight change among participants with short duration (0.37kg; 95% CI -0.88, 1.63), or long duration (-0.56kg; 95% CI -2.03, 0.90) compared to optimal duration, nor was there a difference among poor quality (-0.51kg; 95% CI -1.42, 0.41) compared to above average quality.CONCLUSION: Among postmenopausal breast cancer survivors, sleep duration and quality were not associated with weight change after breast cancer diagnosis. Future studies should consider capturing change in adiposity and to expand beyond self-reported sleep.

  View details for DOI 10.1007/s10549-021-06486-z

  View details for PubMedID 35006483

• Evaluation of Social Isolation, Loneliness, and Cardiovascular Disease Among Older Women in the US. JAMA network open Golaszewski, N. M., LaCroix, A. Z., Godino, J. G., Allison, M. A., Manson, J. E., King, J. J., Weitlauf, J. C., Bea, J. W., Garcia, L., Kroenke, C. H., Saquib, N., Cannell, B., Nguyen, S., Bellettiere, J. 1800; 5 (2): e2146461

  Abstract

  Importance: Social isolation and loneliness are increasing public health concerns and have been associated with increased risk of cardiovascular disease (CVD) among older adults.Objective: To examine the associations of social isolation and loneliness with incident CVD in a large cohort of postmenopausal women and whether social support moderated these associations.Design, Setting, and Participants: This prospective cohort study, conducted from March 2011 through March 2019, included community-living US women aged 65 to 99 years from the Women's Health Initiative Extension Study II who had no history of myocardial infarction, stroke, or coronary heart disease.Exposures: Social isolation and loneliness were ascertained using validated questionnaires.Main Outcomes and Measures: The main outcome was major CVD, which was physician adjudicated using medical records and included coronary heart disease, stroke, and death from CVD. Continuous scores of social isolation and loneliness were analyzed. Hazard ratios (HRs) and 95% CIs for CVD were calculated for women with high social isolation and loneliness scores (midpoint of the upper half of the distribution) vs those with low scores (midpoint of the lower half of the distribution) using multivariable Cox proportional hazards regression models adjusting for age, race and ethnicity, educational level, and depression and then adding relevant health behavior and health status variables. Questionnaire-assessed social support was tested as a potential effect modifier.Results: Among 57 825 women (mean [SD] age, 79.0 [6.1] years; 89.1% White), 1599 major CVD events occurred over 186 762 person-years. The HR for the association of high vs low social isolation scores with CVD was 1.18 (95% CI, 1.13-1.23), and the HR for the association of high vs low loneliness scores with CVD was 1.14 (95% CI, 1.10-1.18). The HRs after additional adjustment for health behaviors and health status were 1.08 (95% CI, 1.03-1.12; 8.0% higher risk) for social isolation and 1.05 (95% CI, 1.01-1.09; 5.0% higher risk) for loneliness. Women with both high social isolation and high loneliness scores had a 13.0% to 27.0% higher risk of incident CVD than did women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations (social isolation*social support: r, -0.18; P=.86; loneliness*social support: r, 0.78; P=.48).Conclusions and Relevance: In this cohort study, social isolation and loneliness were independently associated with modestly higher risk of CVD among postmenopausal women in the US, and women with both social isolation and loneliness had greater CVD risk than did those with either exposure alone. The findings suggest that these prevalent psychosocial processes merit increased attention for prevention of CVD in older women, particularly in the era of COVID-19.

  View details for DOI 10.1001/jamanetworkopen.2021.46461

  View details for PubMedID 35107574

• The sunscreen for kindergarteners (SKIN) study trial protocol. Contemporary clinical trials Lee, G. H., Bae, G. H., Barnes, L. A., Pol-Rodriguez, M. M., Ransohoff, K. J., Nord, K. M., Lu, Y., Cannell, B., Weitlauf, J. C. 2021: 106480

  Abstract

  BACKGROUND: Exposure to ultraviolet radiation (UVR) is the major modifiable risk factor for skin cancers. The majority of lifetime UVR exposure occurs before age 20, underscoring an important window for risk reduction. Incorporation of skills-based sunscreen education into school health curricula may foster the development of consistent and effective use of sunscreen among children and youth. We describe the study protocol for a first-of-its-kind study that examined the feasibility of bringing skills-based sunscreen education into kindergarten classrooms.METHODS: Participants were 96 kindergarten students across four classrooms in a single elementary school. A single-blind open-label trial design was used to evaluate the feasibility of incorporating a song-based, video-guided intervention for independent application of sunscreen into the kindergarten curriculum. Students first completed a 10-day no-intervention baseline period, followed by a 10-day intervention period, and then a 10-day randomized follow-up period where students were randomly assigned to continue with the intervention or to revert to the no-intervention condition.OUTCOMES: Feasibility metrics associated with study process, resources, management, scientific outcomes and safety were gathered. The primary outcome was pre-to-post intervention changes in student engagement in the sunscreen task. The secondary outcome was pre-to-post intervention changes in the proportion of exposed skin to which a student applies sunscreen. Teacher and student perceptions of intervention value and utility were also evaluated.DISCUSSION: This is the study protocol for a clinical trial designed to determine the feasibility of implementing a skills-based sunscreen curriculum in kindergarten classrooms. Next steps include evaluation of the intervention for efficacy and effectiveness.CLINICAL TRIAL REGISTRATION: NCT03752736.

  View details for DOI 10.1016/j.cct.2021.106480

  View details for PubMedID 34126263

• Risk of Subsequent Fractures in Postmenopausal Women After Nontraumatic vs Traumatic Fractures. JAMA internal medicine Crandall, C. J., Larson, J. C., LaCroix, A. Z., Robbins, J. A., Wactawski-Wende, J., Johnson, K. C., Sattari, M., Stone, K. L., Weitlauf, J. C., Gure, T. R., Cauley, J. A. 2021

  Abstract

  Importance: The burden of fractures among postmenopausal women is high. Although nontraumatic fractures are strong risk factors for future fracture, current clinical guidelines do not address traumatic fractures.Objective: To determine how future fracture risk varies according to whether an initial fracture is traumatic or nontraumatic.Design, Setting, and Participants: We conducted a prospective observational study using data from the Women's Health Initiative Study (WHI) (enrollment, September 1994-December 1998; data analysis, September 2020 to March 2021), which enrolled postmenopausal women aged 50 to 79 years at baseline at 40 US clinical centers. The WHI Clinical Trials and WHI Bone Density Substudy, conducted at 3 of the clinical centers, asked participants to report the mechanism of incident fractures. Of 75 335 participants, information regarding incident fracture and covariates was available for 66 874 participants (88.8%), who comprised the analytic sample of this study. Mean (SD) follow-up was 8.1 (1.6) years.Interventions: None.Main Outcomes and Measures: Incident clinical fractures were self-reported at least annually and confirmed using medical records. Participants reported the mechanism of incident fracture as traumatic or nontraumatic.Results: Among the 66 874 participants in the analytic sample (mean [SD] age, 63.1 [7.0] years and 65.3 [7.2] years among women without and with clinical fracture, respectively), 7142 participants (10.7%) experienced incident fracture during the study follow-up period. The adjusted hazard ratio (aHR) of subsequent fracture after initial fracture was 1.49 (95% CI, 1.38-1.61). Among women whose initial fracture was traumatic, the association between initial fracture and subsequent fracture was significantly increased (aHR, 1.25; 95% CI, 1.06-1.48). Among women whose initial fracture was nontraumatic, the association between initial fracture and subsequent fracture was also increased (aHR, 1.52; 95% CI, 1.37-1.68). Confidence intervals for associations between initial fracture and subsequent fracture were overlapping for traumatic and nontraumatic initial fracture strata.Conclusions and Relevance: In this cohort study, among postmenopausal women older than 50 years, fracture was associated with a greater risk of subsequent fracture regardless of whether the fracture was traumatic or nontraumatic. These findings suggest that clinical osteoporosis assessment should include high-trauma as well as low-trauma fractures.

  View details for DOI 10.1001/jamainternmed.2021.2617

  View details for PubMedID 34096979

• After the initial fracture in postmenopausal women, where do subsequent fractures occur? EClinicalMedicine Crandall, C. J., Hunt, R. P., LaCroix, A. Z., Robbins, J. A., Wactawski-Wende, J., Johnson, K. C., Sattari, M., Stone, K. L., Weitlauf, J. C., Gure, T. R., Cauley, J. A. 2021; 35: 100826

  Abstract

  Background: The locations of subsequent fractures after initial fracture in postmenopausal women are poorly characterized.Methods: We conducted a prospective analysis of subsequent fractures after initial fracture in Women's Health Initiative (1993-2018) participants who provided follow-up (mean 15.4 years, SD 6.2 years) data (n=157,282 participants; baseline age 50-79; 47,458 participants with incident fracture). Cox proportional hazards models were adjusted for age, race/ethnicity, body mass index, and other covariates.Findings: The risk of each type of subsequent fracture was increased after each type of initial fracture. Incident lower arm/wrist fracture was associated with significantly elevated risks of subsequent fractures at the upper arm/shoulder, upper leg, knee, lower leg/ankle, hip/pelvis, and spine (adjusted hazard ratios [aHRs] ranging 2·63-5·68). The risk of hip fracture was increased after initial lower arm or wrist fracture (aHR 4·80, 95% CI 4·29-5·36), initial upper arm or shoulder fracture (aHR 5·06, 95% CI 4·39-5·82), initial upper leg fracture (aHR 5·11, 95% CI 3·91-6·67), initial knee fracture (aHR 5·03, 95% CI 4·20-6·03), initial lower leg/ankle fracture (aHR 4·10, 95% CI 3·58-4·68), and initial spine fracture (aHR 6·69, 95% CI 5·95-7·53). Associations were significant in all age groups, even women aged 50-59 years. Risks of subsequent fracture were more pronounced among non-Hispanic Black, Hispanic/Latina, and Asian/Pacific Islander than among non-Hispanic White women.Interpretation: Increased risk of subsequent fracture is observed for all fracture types across all ages. Women who experience any of these fractures should be targeted for interventions to prevent subsequent fractures.Funding: National Institutes of Health HHSN268201600018C,HHSN268201600001C, HHSN268201600002C, HHSN268201600003C, and HHSN268201600004C.

  View details for DOI 10.1016/j.eclinm.2021.100826

  View details for PubMedID 34124629

• Associations between changes in loneliness and social connections, and mental health during the COVID-19 Pandemic: The Women's Health Initiative. The journals of gerontology. Series A, Biological sciences and medical sciences Goveas, J. S., Ray, R. M., Woods, N. F., Manson, J. A., Kroenke, C. H., Michael, Y. L., Shadyab, A. H., Meliker, J. R., Chen, J. C., Johnson, L., Mouton, C., Saquib, N., Weitlauf, J., Wactawski-Wende, J., Naughton, M., Shumaker, S., Anderson, G. L. 2021

  Abstract

  Older women have faced significant disruptions in social connections during the coronavirus disease 2019 pandemic. Whether loneliness increased, or whether a change in loneliness from pre- to intra-pandemic period was associated with mental health during the pandemic is unknown.Older women (n=27,479; mean age 83.2 [SD: 5.4] years) completed surveys in mid-2020, including questions about loneliness, living arrangements, changes in social connections, and mental health. Loneliness was also previously assessed in 2014-2016. We examined whether loneliness changed from the pre- to intra-pandemic period and explored factors associated with this change. In multivariable models, we investigated the association of changes in loneliness and social connections with mental health.Loneliness increased from pre- to intra-pandemic levels. Factors associated with worsening loneliness included older age, experiencing stressful life events, bereavement, histories of vascular disease and depression, and social connection disruptions. Factors associated with a decrease in loneliness included identifying as Black, engaging in more frequent physical activity, being optimistic, and having a higher purpose in life. A 3-point increase in loneliness scores was associated with higher perceived stress, higher depressive, and higher anxiety symptoms. Social connection disruptions showed modest or no associations with mental health.Loneliness increased during the pandemic in older women and was associated with higher stress, depressive and anxiety symptoms. Our findings point to opportunities for interventions targeting lifestyle behaviors, well-being, disrupted social connections, and paying closer attention to those with specific medical and mental health histories that may reduce loneliness and improve mental health.

  View details for DOI 10.1093/gerona/glab371

  View details for PubMedID 34915558

• INDICATORS OF ELDER MISTREATMENT: CORRELATES AMONG VETERANS RECEIVING CARE IN THE VETERANS HEALTH ADMINISTRATION Jedele, J., Griffin, C., Weitlauf, J. OXFORD UNIV PRESS. 2021: 877

  View details for Web of Science ID 000842009904243

• Validation of the detection of elder abuse through emergency care technicians (DETECT) screening tool: a study protocol. BMJ open Cannell, B. n., Weitlauf, J. n., Livingston, M. D., Burnett, J. n., Parayil, M. n., Reingle Gonzalez, J. n. 2020; 10 (9): e037170

  Abstract

  Elder mistreatment (EM) is a high prevalence threat to the health and well-being of older adults in the USA. Medics are well-positioned to help with identification of older adults at risk for EM, however, field robust screening tools appropriate for efficient, observation-based screening are lacking. Prior work by this team focused on the development and initial pilot testing of an observation-based EM screening tool named detection of elder abuse through emergency care technicians (DETECT), designed to be implemented by medics during the course of an emergency response (911) call. The objective of the present work is to validate and further refine this tool in preparation for clinical dissemination.Approximately 59 400 community-dwelling older adults who place 911 calls during the 36-month study observation period will be screened by medics responding to the call using the DETECT tool. Next, a random subsample of 2520 of the 59 400 older adults screened will be selected to participate in a follow-up interview approximately 2 weeks following the completion of the screening. Follow-up interviews will consist of a medic-led semistructured interview designed to assess the older adult's likelihood of abuse exposure, physical/mental health status, cognitive functioning, and to systematically evaluate the quality and condition of their physical and social living environment. The data from 25% (n=648) of these follow-up interviews will be presented to a longitudinal, experts and all data panel for a final determination of EM exposure status, representing the closest proxy to a 'gold standard' measure available.This study has been reviewed and approved by the Committee for the Protection of Human Subjects at the University of Texas School of Public Health. The results will be disseminated through formal presentations at local, national and international conferences and through publication in peer-reviewed scientific journals.

  View details for DOI 10.1136/bmjopen-2020-037170

  View details for PubMedID 32912985

• Incident Fractures and Locations of Subsequent Fracturesin Postmenopausal Women: The Women's Health Initiative Observational Study Crandall, C., Hunt, R., Stone, K., Robbins, J., Sattari, M., Johnson, K., Weitlauf, J., Gure, T., LaCroix, A., Cauley, J. WILEY. 2019: 349

  View details for Web of Science ID 000508614701502

• Incident Fractures and Locations of Subsequent Fractures in Postmenopausal Women: The Women's Health Initiative Observational Study Crandall, C., Hunt, R., Stone, K., Robbins, J., Sattari, M., Johnson, K., Weitlauf, J., Gure, T., LaCroix, A., Cauley, J. WILEY. 2019: 349

  View details for Web of Science ID 000508356604195

• Is Interpersonal Abuse Associated with sexual (Dis)satisfaction among Postmenopausal Women? Women's health issues : official publication of the Jacobs Institute of Women's Health Kelley, E. L., Cannell, M. B., Gass, M., Sealy-Jefferson, S., Woods, N. F., Bird, C. E., Stefanick, M. L., Weitlauf, J. C. 2019

  Abstract

  PURPOSE: To investigate associations between past-year verbal and/or physical abuse (VA/PA) and sexual (dis)satisfaction, that is, global or frequency-related (dis)satisfactions with sexual activity, among postmenopausal women in the Women's Health Initiative.PROCEDURES: A cross-sectional analysis of archival data was performed from the subset of 83,329 Women's Health Initiative participants (clinical trial and/or observational study components) who reported sexual activity in the year before baseline. Associations between VA/PA and global frequency (dis)satisfactions were modeled using logistic regression.MAIN FINDINGS: Most participants reported sexual satisfaction (global, 77%; frequency related, 66%). Disappointment with sexual frequency, specifically a desire for more frequent sex, was the most common dissatisfaction expressed. Past-year VA/PA exposure was reported by 9,410 participants (11%). In regression models adjusted for sociodemographic, health and health risk, and menopausal symptom variables, VA/PA was associated with higher rates of global (35% VA/PA exposed vs. 22% non-exposed; adjusted odds ratio, 1.66; 95% confidence interval, 1.53-1.80) and frequency-related dissatisfactions (50% of VA/PA exposed vs. 32% of non-exposed; adjusted odds ratio, 1.73; 95% confidence interval, 1.57-1.90).CONCLUSIONS: Sexual satisfaction was common, but not universally reported by study participants. Sexual dissatisfactions were overrepresented in VA/PA-exposed participants and associated with a desire for more frequent sexual activity. Opportunities for postmenopausal women to receive clinician-led education about safe and healthy ways to increase sexual activity are needed. Further research on this topic, particularly efforts to characterize safety concerns as well as modifiable barriers to satisfying sexual activity among postmenopausal women with recent VA/PA, would ensure that these interventions are evidence based.

  View details for DOI 10.1016/j.whi.2019.05.009

  View details for PubMedID 31277914

• Personality traits and diabetes incidence among postmenopausal women MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY Luo, J., Manson, J. E., Weitlauf, J. C., Shadyab, A. H., Rapp, S. R., Garcia, L., Jonasson, J. M., Tindle, H. A., Nassir, R., Wactawski-Wende, J., Hendryx, M. 2019; 26 (6): 629–36

  View details for DOI 10.1097/GME.0000000000001296

  View details for Web of Science ID 000480751400010

• Personality traits and diabetes incidence among postmenopausal women. Menopause (New York, N.Y.) Luo, J., Manson, J. E., Weitlauf, J. C., Shadyab, A. H., Rapp, S. R., Garcia, L., Jonasson, J. M., Tindle, H. A., Nassir, R., Wactawski-Wende, J., Hendryx, M. 2019

  Abstract

  OBJECTIVE: We examined whether personality traits, including optimism, ambivalence over emotional expressiveness, negative emotional expressiveness, and hostility, were associated with risk of developing type 2 diabetes (hereafter diabetes) among postmenopausal women.METHODS: A total of 139,924 postmenopausal women without diabetes at baseline (between 1993 and 1998) aged 50 to 79 years from the Women's Health Initiative were prospectively followed for a mean of 14 (range 0.1-23) years. Multivariable Cox proportional hazards regression models were used to assess associations between personality traits and diabetes incidence adjusting for common demographic factors, health behaviors, and depressive symptoms. Personality traits were gathered at baseline using questionnaires. Diabetes during follow-up was assessed via self-report of physician-diagnosed treated diabetes.RESULTS: There were 19,240 cases of diabetes during follow-up. Compared with women in the lowest quartile of optimism (least optimistic), women in the highest quartile (most optimistic) had 12% (hazard ratio [HR], 0.88; 95% confidence interval [CI]: 0.84-0.92) lower risk of incident diabetes. Compared with women in the lowest quartile for negative emotional expressiveness or hostility, women in the highest quartile had 9% (HR, 1.09; 95% CI: 1.05-1.14) and 17% (HR, 1.17; 95% CI: 1.12-1.23) higher risk of diabetes, respectively. The association of hostility with risk of diabetes was stronger among nonobese than obese women.CONCLUSIONS: Low optimism and high NEE and hostility were associated with increased risk of incident diabetes among postmenopausal women independent of major health behaviors and depressive symptoms. In addition to efforts to promote healthy behaviors, women's personality traits should be considered to guide clinical or programmatic intervention strategies in diabetes prevention.

  View details for PubMedID 30672885

• Pilot testing the detection of elder abuse through emergency care technicians (DETECT) screening tool: results from the DETECT pilot project. Journal of elder abuse & neglect Cannell, B., Gonzalez, J. M., Livingston, M., Jetelina, K. K., Burnett, J., Weitlauf, J. C. 2019: 1–17

  Abstract

  OBJECTIVE: To pilot test the feasibility of implementing an elder abuse (EA) screening tool (DETECT) designed for medics.METHODS: Testing occurred between September 17th, 2015 and October 26th, 2015. MedStar Mobile Healthcare medics completed the DETECT tool when responding to calls for community-dwelling patients 65 years of age or older.RESULTS: The DETECT tool was used 1,248 times by 97% of medics responding to an eligible 911 call. Medics responded affirmatively to at least one screening item on 209 of the completed screenings (16.8%). Immediately following the introduction of the DETECT tool, there was an increase of 5.4 (226% above baseline) reports per month (p = 0.0056).CONCLUSIONS: The DETECT tool was easily incorporated into medic's field-based practice and resulted in an increase in medic generated reports of EA to APS. Future research designed to evaluate the tool's validity and reliability are warranted.

  View details for PubMedID 30614399

• Characterization and Comparison of Physical and Mental Health Profiles and Department of Veterans Affairs Health Care Utilization Patterns among Operation Iraqi Freedom/Operation Enduring Freedom Women Veterans in Puerto Rico versus the United States. Women's health issues : official publication of the Jacobs Institute of Women's Health Weitlauf, J. C., Ortiz, A. n., Kroll-Desrosiers, A. R., Quiñones Vázquez, M. E., Cannell, B. n., Hernandez, M. N., Brandt, C. n., Mattocks, K. n. 2019

  Abstract

  Research on the physical and mental health profiles and patterns of health care use among women veterans receiving health care from the Department of Veterans Affairs (VA) on the island of Puerto Rico is lacking.This cross-sectional study examines differences in physical and mental health conditions, and patterns of VA health care use, between women veterans of the Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) era who were using VA facilities in Puerto Rico (n = 897) and those using U.S.-based VA facilities (n = 117,216) from 2002 to 2015.Results of fully adjusted logistic regression models revealed that OIF/OEF women in Puerto Rico had heightened risk for global pain-related disorders (i.e., any pain) (adjusted odds ratio [AOR], 1.45; 95% confidence interval [CI], 1.22-1.71), back pain (AOR, 1.83; 95% CI, 1.56-2.14), diabetes (AOR, 1.42; 95% CI, 1.03-1.95), hyperlipidemia (AOR, 3.34; 95% CI, 2.80-3.98), major depression (AOR, 1.78; 95% CI, 1.53-2.06), and bipolar depression (AOR, 1.66; 95% CI, 1.34-2.04). They also evidenced greater risk for a host of reproductive health conditions and had higher average annual use of VA health care than their U.S. counterparts.OIF/OEF women receiving VA health care in Puerto Rico evidenced a greater burden of physical illness, depression, and heightened use of VA health care services relative to their U.S. counterparts. Providers' increased awareness of the physical and mental health care needs of this population is warranted. Research efforts that help to identify efficient and effective strategies to provide culturally tailored and/or personalized health care for this population could also be useful.

  View details for DOI 10.1016/j.whi.2019.10.004

  View details for PubMedID 31796346

• Development of a comprehensive health-risk prediction tool for postmenopausal women. Menopause (New York, N.Y.) Hedlin, H. n., Weitlauf, J. n., Crandall, C. J., Nassir, R. n., Cauley, J. A., Garcia, L. n., Brunner, R. n., Robinson, J. n., Stefanick, M. L., Robbins, J. n. 2019

  Abstract

  The aim of the study was to develop a web-based calculator that predicts the likelihood of experiencing multiple, competing outcomes prospectively over 5, 10, and 15 years.Baseline demographic and medical data from a healthy and racially and ethnically diverse cohort of 161,808 postmenopausal women, aged 50 to 79 at study baseline, who participated in the Women's Health Initiative (WHI), were used to develop and evaluate a risk-prediction calculator designed to predict individual risk for morbidity and mortality outcomes. Women were enrolled from 40 sites arranged in four regions of the United States. The calculator predicts all-cause mortality, adjudicated outcomes of health events (ie, myocardial infarction [MI], stroke, and hip fracture), and disease (lung, breast, and colorectal cancer). A proportional subdistribution hazards regression model was used to develop the calculator in a training dataset using data from three regions. The calculator was evaluated using the C-statistic in a test dataset with data from the fourth region.The predictive validity of our calculator measured by the C-statistic in the test dataset for a first event at 5 and 15 years was as follows: MI 0.77, 0.61, stroke 0.77, 0.72, lung cancer 0.82, 0.79, breast cancer 0.60, 0.59, colorectal cancer 0.67, 0.60, hip fracture 0.79, 0.76, and death 0.74, 0.72.This study represents the first large-scale study to develop a risk prediction calculator that yields health risk prediction for several outcomes simultaneously. Development of this tool is a first step toward enabling women to prioritize interventions that may decrease these risks. : Video Summary:http://links.lww.com/MENO/A463.

  View details for DOI 10.1097/GME.0000000000001411

  View details for PubMedID 31567871

• Social Relationships and Risk of Type 2 Diabetes Among Postmenopausal Women. The journals of gerontology. Series B, Psychological sciences and social sciences Hendryx, M. n., Nicholson, W. n., Manson, J. E., Kroenke, C. H., Lee, J. n., Weitlauf, J. C., Garcia, L. n., Jonasson, J. M., Wactawski-Wende, J. n., Luo, J. n. 2019

  Abstract

  We examined whether social relationship variables (social support, social strain, social network size, and stressful life events) were associated with risk of developing type 2 diabetes among postmenopausal women.139,924 postmenopausal women aged 50-79 years without prevalent diabetes at baseline were followed for a mean of 14 years. 19,240 women developed diabetes. Multivariable Cox proportional hazard models tested associations between social relationship variables and diabetes incidence after consideration of demographics, depressive symptoms, and lifestyle behaviors. We also examined moderating effects of obesity and race/ethnicity, and we tested whether social variable associations were mediated by lifestyle or depressive symptoms.Compared with the lowest quartile, women in the highest social support quartile had lower risk of diabetes after adjusting for demographic factors, health behaviors, and depressive symptoms (hazard ratio [HR] = 0.93, 95% confidence interval [CI] = 0.89-0.97). Social strain (HR = 1.09, 95% CI = 1.04-1.13) and stressful life events (HR = 1.10, 95% CI = 1.05-1.15) were associated with higher diabetes risks. The association between diabetes and social strain was stronger among African American women. Social relationship variables had direct relationships to diabetes, as well as indirect effects partially mediated by lifestyle and depressive symptoms.Social support, social strain, and stressful life events were associated with diabetes risk among postmenopausal women independently of demographic factors and health behaviors. In addition to healthy behaviors such as diet and physical activity, healthy social relationships among older women may be important in the prevention of diabetes.

  View details for DOI 10.1093/geronb/gbz047

  View details for PubMedID 31112615

• Pilot testing the detection of elder abuse through car emergency care technicians (DETECT) screening tool: results from the DETECT pilot project JOURNAL OF ELDER ABUSE & NEGLECT Cannella, B., Gonzalez, J., Livingston, M., Jetelina, K. K., Burnett, J., Weitlauf, J. C. 2019; 31 (2): 129–45

  View details for DOI 10.1080/08946566.2018.1564104

  View details for Web of Science ID 000469924900003

• Trajectories of Relative Performance with 2 Measures of Global Cognitive Function JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Espeland, M. A., Chen, J., Weitlauf, J., Hayden, K. M., Rapp, S. R., Resnick, S. M., Garcia, L., Cannell, B., Baker, L. D., Sachs, B. C., Tindle, H. A., Wallace, R., Casanova, R., Womens Hlth Initiative Memory 2018; 66 (8): 1575–80

  Abstract

  To examine whether trajectories of global cognitive function over time in studies that change assessment protocols may be modeled based on an individual's performance relative to others in the study cohort.Extended follow-up of a cohort originally enrolled in a clinical trial of postmenopausal hormone therapy.The Women's Health Initiative Memory Study switched from an in-person interview with the Modified Mini-Mental State Examination to a telephone-based interview with the modified Telephone Interview for Cognitive Status to assess global cognitive function over long-term follow-up.Women aged 75 to 92 (N=2,561).Annual cognitive assessments from participants, ranked according to age-, race- and ethnicity-adjusted performance levels, were used to identify distinct trajectories. Participants assigned to the resulting trajectories were compared for selected risk factor profiles.Our approach grouped participants into five trajectories according to relative cognitive performance over time. These groups differed significantly according to 3 known risk factors for cognitive decline-education level, apolipoprotein E-ϵ4 genotype, and type 2 diabetes mellitus-and a biomarker based on brain structure that has been linked to cognitive decline and Alzheimer's disease. Participants with consistently low relative levels of cognitive function over time and those whose relative performance over time declined to these levels tended to have poorer risk factor profiles.Longitudinal measures of an individual's relative performance on different assessment protocols for global cognitive function can be used to identify trajectories of change over time that appear to have internal validity with respect to known risk factors.

  View details for PubMedID 29972592

• Therapist Guided Exposure Treatment for Vaginismus: Simulation and Immersive Learning Applications Solone, M., Lynd, K., Williams, K. E., May, M., Nemecek, P., Weitlauf, J. LIPPINCOTT WILLIAMS & WILKINS. 2018: 150S

  View details for DOI 10.1097/01.AOG.0000533092.96380.d9

  View details for Web of Science ID 000442482900522

• Vasomotor symptom characteristics: are they risk factors for incident diabetes? MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY Gray, K. E., Katon, J. G., LeBlanc, E. S., Woods, N. F., Bastian, L. A., Reiber, G. E., Weitlauf, J. C., Nelson, K. M., LaCroix, A. Z. 2018; 25 (5): 520–30

  Abstract

  Vasomotor symptoms (VMS), encompassing hot flashes and night sweats, may be associated with diabetes, but evidence is limited. We sought to estimate these associations.Among 150,007 postmenopausal Women's Health Initiative participants from 1993 to 2014, we prospectively examined associations of incident diabetes with VMS characteristics at enrollment: any VMS, severity (mild/ moderate/severe), type (hot flashes/night sweats), timing (early [premenopausal or perimenopausal]/late [postmenopausal]), and duration. Cox proportional-hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs).Mean duration of follow-up was 13.1 years. VMS prevalence was 33%. Reporting any VMS was associated with 18% increased diabetes risk (95% CI 1.14, 1.22), which increased with severity (mild: HR 1.13, 95% CI 1.08, 1.17; moderate: HR 1.29, 95% CI 1.22, 1.36; severe: HR 1.48, 95% CI 1.34, 1.62) and duration (4% per 5 years, 95% CI 1.03, 1.05), independent of obesity. Diabetes risk was more pronounced for women reporting any night sweats (night sweats only: HR 1.20, 95% CI 1.13, 1.26; night sweats and hot flashes: HR 1.22, 95% CI 1.17, 1.27) than only hot flashes (HR 1.08, 95% CI 1.02, 1.15) and was restricted to late VMS (late: HR 1.12, 95% CI 1.07, 1.18; early and late: HR 1.16, 95% CI 1.11, 1.22; early: HR 0.99, 95% CI 0.95, 1.04).VMS are associated with elevated diabetes risk, particularly for women reporting night sweats and postmenopausal symptoms. The menopause transition may be an optimal window for clinicians to discuss long-term cardiovascular/metabolic risk with patients and leverage the bother of existing symptoms for behavior change to improve VMS and reduce diabetes risk.

  View details for PubMedID 29206771

  View details for PubMedCentralID PMC5898980

• Effect of Depression Before Breast Cancer Diagnosis on Mortality Among Postmenopausal Women CANCER Liang, X., Margolis, K. L., Hendryx, M., Reeves, K., Wassertheil-Smoller, S., Weitlauf, J., Danhauer, S. C., Chlebowski, R. T., Caan, B., Qi, L., Lane, D., Lavasani, S., Luo, J. 2017; 123 (16): 3107–15

  Abstract

  Few previous studies investigating depression before the diagnosis of breast cancer and breast cancer-specific mortality have examined depression measured at more than 1 time point. This study investigated the effect of depression (combining depressive symptoms alone with antidepressant use) measured at 2 time points before the diagnosis of breast cancer on all-cause mortality and breast cancer-specific mortality among older postmenopausal women.A large prospective cohort, the Women's Health Initiative, was used. The study included 3095 women with incident breast cancer who had measures of depressive symptoms and antidepressant use before their diagnosis at the baseline and at year 3. Multivariate Cox proportional hazards regression was used to estimate adjusted hazard ratios (HRs) between depression at the baseline, depression at year 3, and combinations of depression at these time points and all-cause mortality and breast cancer-specific mortality.Depression at year 3 before a breast cancer diagnosis was associated with higher all-cause mortality after adjustments for multiple covariates (HR, 1.35; 95% confidence interval [CI], 1.02-1.78). There was no statistically significant association of baseline depression and all-cause mortality or breast cancer-specific mortality whether or not depression was also present at year 3. In women with late-stage (regional- or distant-stage) breast cancer, newly developed depression at year 3 was significantly associated with both all-cause mortality (HR, 2.00; 95% CI, 1.13-3.56) and breast cancer-specific mortality (HR, 2.42; 95% CI, 1.24-4.70).Women with newly developed depression before the diagnosis of breast cancer had a modestly but significantly increased risk for death from any cause and for death from breast cancer at a late stage. Cancer 2017;123:3107-15. © 2017 American Cancer Society.

  View details for PubMedID 28387934

  View details for PubMedCentralID PMC5544561

• Association of sleep disturbance and sexual function in postmenopausal women MENOPAUSE-THE JOURNAL OF THE NORTH AMERICAN MENOPAUSE SOCIETY Kling, J. M., Manson, J. E., Naughton, M. J., Temkit, M., Sullivan, S. D., Gower, E. W., Hale, L., Weitlauf, J. C., Nowakowski, S., Crandall, C. J. 2017; 24 (6): 604–12

  Abstract

  Sleep disturbance and sexual dysfunction are common in menopause; however, the nature of their association is unclear. The present study aimed to determine whether sleep characteristics were associated with sexual activity and sexual satisfaction.Sexual function in the last year and sleep characteristics (past 4 wk) were assessed by self-report at baseline for 93,668 women age 50 to 79 years enrolled in the Women's Health Initiative (WHI) Observational Study (OS). Insomnia was measured using the validated WHI Insomnia Rating Scale. Sleep-disordered breathing (SDB) risk was assessed using questions adapted from the Berlin Questionnaire. Using multivariate logistic regression, we examined cross-sectional associations between sleep measures and two indicators of sexual function: partnered sexual activity and sexual satisfaction within the last year.Fifty-six percent overall reported being somewhat or very satisfied with their current sexual activity, and 52% reported partnered sexual activity within the last year. Insomnia prevalence was 31%. After multivariable adjustment, higher insomnia scores were associated with lower odds of sexual satisfaction (yes/no) (odds ratio [OR] 0.92, 95% CI, 0.87-0.96). Short sleep duration (<7-8 h) was associated with lower odds of partnered sexual activity (yes/no) (≤5 h, OR 0.88, 95% CI, 0.80-0.96) and less sexual satisfaction (≤5 h, OR 0.88, 95% CI, 0.81-0.95).Shorter sleep durations and higher insomnia scores were associated with decreased sexual function, even after adjustment for potential confounders, suggesting the importance of sufficient, high-quality sleep for sexual function. Longitudinal investigation of sleep and its impact on sexual function postmenopause will clarify this relationship.

  View details for PubMedID 28141665

  View details for PubMedCentralID PMC5443696

• Long-term Effects on Cognitive Trajectories of Postmenopausal Hormone Therapy in Two Age Groups JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES Espeland, M. A., Rapp, S. R., Manson, J. E., Goveas, J. S., Shumaker, S. A., Hayden, K. M., Weitlauf, J. C., Gaussoin, S. A., Baker, L. D., Padula, C. B., Hou, L., Resnick, S. M., WHIMSY WHIMS-ECHO Study Grp 2017; 72 (6): 838–45

  Abstract

  Postmenopausal hormone therapy may have long-term effects on cognitive function depending on women's age.Postintervention follow-up was conducted with annual cognitive assessments of two randomized controlled clinical trial cohorts, beginning an average of 6-7 years after study medications were terminated: 1,376 women who had enrolled in the Women's Health Initiative when aged 50-54 years and 2,880 who had enrolled when aged 65-79 years. Women had been randomly assigned to 0.625mg/d conjugated equine estrogens (CEE) for those with prior hysterectomy (mean 7.1 years), CEE with 2.5mg/d medroxyprogesterone acetate for those without prior hysterectomy (mean 5.4 years), or matching placebos.Hormone therapy, when prescribed to women aged 50-54 years, had no significant long-term posttreatment effects on cognitive function and on changes in cognitive function. When prescribed to older women, it was associated with long-term mean (SE) relative decrements (standard deviation units) in global cognitive function of 0.081 (0.029), working memory of 0.070 (0.025), and executive function of 0.054 (0.023), all p < .05. These decrements were relatively stable over time. Findings did not vary depending on the hormone therapy regimen, prior use, or years from last menstrual period. Mean intervention effects were small; however, the largest were comparable in magnitude to those seen during the trial's active intervention phase.CEE-based hormone therapy delivered near the time of menopause provides neither cognitive benefit nor detriment. If administered in older women, it results in small decrements in several cognitive domains that remain for many years.

  View details for PubMedID 27506836

• Work Characteristics Associated with Physical Functioning in Women. International journal of environmental research and public health Palumbo, A. J., De Roos, A. J., Cannuscio, C., Robinson, L., Mossey, J., Weitlauf, J., Garcia, L., Wallace, R., Michael, Y. 2017; 14 (4)

  Abstract

  Women make up almost half of the labor force with older women becoming a growing segment of the population. Work characteristics influence physical functioning and women are at particular risk for physical limitations. However, little research has explored the effects of work characteristics on women's physical functioning. U.S. women between the ages of 50 and 79 were enrolled in the Women's Health Initiative Observational Study between 1993 and 1998. Women provided job titles and years worked at their three longest-held jobs (n = 79,147). Jobs were linked to characteristics in the Occupational Information Network. Three categories of job characteristics related to substantive complexity, physical demand, and social collaboration emerged. The association between job characteristics and physical limitations in later life, measured using a SF-36 Physical Functioning score <25th percentile, was examined using modified Poisson regression. After controlling for confounding variables, high physical demand was positively associated with physical limitations (RR = 1.09 CI: 1.06-1.12) and substantively complex work was negatively associated (RR = 0.94, CI: 0.91-0.96). Jobs requiring complex problem solving, active learning, and critical thinking were associated with better physical functioning. Employers should explore opportunities to reduce strain from physically demanding jobs and incorporate substantively complex tasks into women's work to improve long-term health.

  View details for DOI 10.3390/ijerph14040424

  View details for PubMedID 28420131

• Institutional Incentives for Mentoring at the US Department of Veterans Affairs and Universities: Associations With Mentors' Perceptions and Time Spent Mentoring ACADEMIC MEDICINE Maisel, N. C., Halvorson, M. A., Finney, J. W., Bi, X., Hayashi, K. P., Blonigen, D. M., Weitlauf, J. C., Timko, C., Cronkite, R. C. 2017; 92 (4): 521-527

  Abstract

  Limited empirical attention to date has focused on best practices in advanced research mentoring in the health services research domain. The authors investigated whether institutional incentives for mentoring (e.g., consideration of mentoring in promotion criteria) were associated with mentors' perceptions of mentoring benefits and costs and with time spent mentoring.The authors conducted an online survey in 2014 of a national sample of mentors of U.S. Department of Veterans Affairs (VA) Health Services Research and Development Service (HSR&D) mentored career development award recipients who received an award during 2000-2012. Regression analyses were used to examine institutional incentives as predictors of perceptions of benefits and costs of mentoring and time spent mentoring.Of the 145 mentors invited, 119 (82%) responded and 110 (76%) provided complete data for the study items. Overall, mentors who reported more institutional incentives also reported greater perceived benefits of mentoring (P = .03); however, more incentives were not significantly associated with perceived costs of mentoring. Mentors who reported more institutional incentives also reported spending a greater percentage of time mentoring (P = .02). University incentives were associated with perceived benefits of mentoring (P = .02), whereas VA incentives were associated with time spent mentoring (P = .003).Institutional policies that promote and support mentorship of junior investigators, specifically by recognizing and rewarding the efforts of mentors, are integral to fostering mentorship programs that contribute to the development of early-career health services researchers into independent investigators.

  View details for DOI 10.1097/ACM.0000000000001507

  View details for Web of Science ID 000398917500042

  View details for PubMedID 28351065

• Prospective data from the Women's Health Initiative on depressive symptoms, stress, and inflammation JOURNAL OF HEALTH PSYCHOLOGY Jones, S. M., Weitlauf, J., Danhauer, S. C., Qi, L., Zaslavsky, O., Wassertheil-Smoller, S., Brenes, G. A., LaCroix, A. Z. 2017; 22 (4): 457-464

  Abstract

  This study examined the longitudinal association of depressive symptoms and stressful life events with inflammation in the Women's Health Initiative. Women aged 50 years and older ( N = 7477) completed questionnaires assessing depressive symptoms and stressful life events at baseline and 15 years later. Serum measures of C-reactive protein were collected at both assessments. In bivariate analyses, C-reactive protein predicted 15-year depressive symptoms and stressful life events ( ps < .03) and baseline depressive symptoms and stressful life events predicted later C-reactive protein ( ps < .03). These longitudinal relationships were not maintained in multivariate adjusted analyses. Combined with previous research, this suggests the relationship between depression, stressful life events and inflammation attenuates with time.

  View details for DOI 10.1177/1359105315603701

  View details for Web of Science ID 000397500600006

• Prospective data from the Women's Health Initiative on depressive symptoms, stress, and inflammation. Journal of health psychology Jones, S. M., Weitlauf, J., Danhauer, S. C., Qi, L., Zaslavsky, O., Wassertheil-Smoller, S., Brenes, G. A., LaCroix, A. Z. 2017; 22 (4): 457-464

  Abstract

  This study examined the longitudinal association of depressive symptoms and stressful life events with inflammation in the Women's Health Initiative. Women aged 50 years and older ( N = 7477) completed questionnaires assessing depressive symptoms and stressful life events at baseline and 15 years later. Serum measures of C-reactive protein were collected at both assessments. In bivariate analyses, C-reactive protein predicted 15-year depressive symptoms and stressful life events ( ps < .03) and baseline depressive symptoms and stressful life events predicted later C-reactive protein ( ps < .03). These longitudinal relationships were not maintained in multivariate adjusted analyses. Combined with previous research, this suggests the relationship between depression, stressful life events and inflammation attenuates with time.

  View details for DOI 10.1177/1359105315603701

  View details for PubMedID 26349616

• Ten-Year Publication Trajectories of Health Services Research Career Development Award Recipients: Collaboration, Awardee Characteristics, and Productivity Correlates EVALUATION & THE HEALTH PROFESSIONS Halvorson, M. A., Finlay, A. K., Cronkite, R. C., Bi, X., Hayashi, K., Maisel, N. C., Amundson, E. O., Weitlauf, J. C., Litt, I. F., Owens, D. K., Timko, C., Cucciare, M. A., Finney, J. W. 2016; 39 (1): 49-64

  Abstract

  This study's purpose was to identify distinct publishing trajectories among 442 participants in three prominent mentored health services research career development programs (Veterans Affairs, National Institutes of Health, and Agency for Healthcare Research & Quality) in the 10 years after award receipt and to examine awardee characteristics associated with different trajectories. Curricula vitae (CVs) of researchers receiving awards between 1991 and 2010 were coded for publications, grants, and awardee characteristics. We found that awardees published at constant or increasing rates despite flat or decreasing rates of first-author publications. Senior-author publications rose concurrently with rates of overall publications. Higher overall publication trajectories were associated with receiving more grants, more citations as measured by the h-index, and more authors per article. Lower trajectory groups were older and had a greater proportion of female awardees. Career development awards supported researchers who generally published successfully, but trajectories varied across individual researchers. Researchers' collaborative efforts produced an increasing number of articles, whereas first author articles were written at a more consistent rate. Career development awards in health services research supported the careers of researchers who published at a high rate; future research should further examine reasons for variation in publishing among early career researchers.

  View details for DOI 10.1177/0163278714542848

  View details for PubMedID 25015081

• Trajectories in Physical Activity and Sedentary Time Among Women Veterans in the Women's Health Initiative GERONTOLOGIST Washington, D. L., Gray, K., Hoerster, K. D., Katon, J. G., Cochrane, B. B., LaMonte, M. J., Weitlauf, J. C., Groessl, E., Bastian, L., Vitolins, M. Z., Tinker, L. 2016; 56: S27–S39

  Abstract

  Trajectories of physical activity (PA) and sedentary time (ST) after military separation are likely important determinants of women's health outcomes later in life, because low PA and high ST are known contributors to premature mortality risk. Our objective was to compare longitudinal trajectories of recreational PA and ST between Veteran and non-Veteran postmenopausal women from the Women's Health Initiative (WHI).Women Veteran (n = 3,719) and non-Veteran (n = 141,800) WHI participants were included. Self-reported participation in recreational PA, converted to metabolic equivalent (MET)-hours/week, was prospectively assessed over 8 years. Self-reported ST, defined as hours/day sitting or lying down, was collected at baseline and at Years 3 and 6. Generalized estimating equations were used to compare trajectories of PA and ST between Veterans and non-Veterans, adjusted for demographics and lifestyle behaviors.Veterans had higher baseline PA than non-Veterans (13.2 vs 12.5 MET-hours/week, p = .03). PA declined for both groups, with a steeper decline among Veterans (change/visit year -0.19 vs -0.02 MET-hours/week; interaction p < .001). At baseline, Veterans and non-Veterans had similar levels of ST (107.2 vs 105.9 hours/week, p = 0.42). Over time, ST remained stable among Veterans but declined slightly among non-Veterans (change/visit year -0.19 vs -0.49 hours/week; interaction p = .01).The less favorable longitudinal trajectories of PA and ST we observed for women Veterans may contribute to worse health among these individuals later in life. Understanding barriers to enhancing PA and reducing ST in women Veterans could lead to more effective approaches to intervening on these health behaviors.

  View details for PubMedID 26768390

  View details for PubMedCentralID PMC5881621

• Longitudinal Cognitive Trajectories of Women Veterans from the Women's Health Initiative Memory Study. Gerontologist Padula, C. B., Weitlauf, J. C., Rosen, A. C., Reiber, G., Cochrane, B. B., Naughton, M. J., Li, W., Rissling, M., Yaffe, K., Hunt, J. R., Stefanick, M. L., Goldstein, M. K., Espeland, M. A. 2016; 56 (1): 115-125

  Abstract

  A comparison of longitudinal global cognitive functioning in women Veteran and non-Veteran participants in the Women's Health Initiative (WHI).We studied 7,330 women aged 65-79 at baseline who participated in the WHI Hormone Therapy Trial and its ancillary Memory Study (WHIMS). Global cognitive functioning (Modified Mini-Mental State Examination [3MSE]) in Veterans (n = 279) and non-Veterans (n = 7,051) was compared at baseline and annually for 8 years using generalized linear modeling methods.Compared with non-Veterans, Veteran women were older, more likely to be Caucasian, unmarried, and had higher rates of educational and occupational attainment. Results of unadjusted baseline analyses suggest 3MSE scores were similar between groups. Longitudinal analyses, adjusted for age, education, ethnicity, and WHI trial assignment revealed differences in the rate of cognitive decline between groups over time, such that scores decreased more in Veterans relative to non-Veterans. This relative difference was more pronounced among Veterans who were older, had higher educational/occupational attainment and greater baseline prevalence of cardiovascular risk factors (e.g., smoking) and cardiovascular disease (e.g., angina, stroke).Veteran status was associated with higher prevalence of protective factors that may have helped initially preserve cognitive functioning. However, findings ultimately revealed more pronounced cognitive decline among Veteran relative to non-Veteran participants, likely suggesting the presence of risks that may impact neuropathology and the effects of which were initially masked by Veterans' greater cognitive reserve.

  View details for DOI 10.1093/geront/gnv663

  View details for PubMedID 26615021

• Military Generation and Its Relationship to Mortality in Women Veterans in the Women's Health Initiative GERONTOLOGIST Washington, D. L., Bird, C. E., LaMonte, M. J., Goldstein, K. M., Rillamas-Sun, E., Stefanick, M. L., Woods, N. F., Bastian, L. A., Gass, M., Weitlauf, J. C. 2016; 56: S126-S137

  Abstract

  Women's military roles, exposures, and associated health outcomes have changed over time. However, mortality risk-within military generations or compared with non-Veteran women-has not been assessed. Using data from the Women's Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women.WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation.After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09-1.23) for pre-Vietnam and 1.16 (95% CI: 0.99-1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64-5.23).Veterans' higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed.

  View details for DOI 10.1093/geront/gnv669

  View details for Web of Science ID 000374221500013

  View details for PubMedID 26768386

• Mortality in Postmenopausal Women by Sexual Orientation and Veteran Status GERONTOLOGIST Lehavot, K., Rillamas-Sun, E., Weitlauf, J., Kimerling, R., Wallace, R. B., Sadler, A. G., Woods, N. F., Shipherd, J. C., Mattocks, K., Cirillo, D. J., Stefanick, M. L., Simpson, T. L. 2016; 56: S150-S162

  Abstract

  To examine differences in all-cause and cause-specific mortality by sexual orientation and Veteran status among older women.Data were from the Women's Health Initiative, with demographic characteristics, psychosocial factors, and health behaviors assessed at baseline (1993-1998) and mortality status from all available data sources through 2014. Women with baseline information on lifetime sexual behavior and Veteran status were included in the analyses (N = 137,639; 1.4% sexual minority, 2.5% Veteran). The four comparison groups included sexual minority Veterans, sexual minority non-Veterans, heterosexual Veterans, and heterosexual non-Veterans. Cox proportional hazard models were used to estimate mortality risk adjusted for demographic, psychosocial, and health variables.Sexual minority women had greater all-cause mortality risk than heterosexual women regardless of Veteran status (hazard ratio [HR] = 1.20, 95% confidence interval [CI]: 1.07-1.36) and women Veterans had greater all-cause mortality risk than non-Veterans regardless of sexual orientation (HR = 1.14, 95% CI: 1.06-1.22), but the interaction between sexual orientation and Veteran status was not significant. Sexual minority women were also at greater risk than heterosexual women for cancer-specific mortality, with effects stronger among Veterans compared to non-Veterans (sexual minority × Veteran HR = 1.70, 95% CI: 1.01-2.85).Postmenopausal sexual minority women in the United States, regardless of Veteran status, may be at higher risk for earlier death compared to heterosexuals. Sexual minority women Veterans may have higher risk of cancer-specific mortality compared to their heterosexual counterparts. Examining social determinants of longevity may be an important step to understanding and reducing these disparities.

  View details for DOI 10.1093/geront/gnv125

  View details for Web of Science ID 000374221500015

  View details for PubMedID 26768389

• Sleep Disturbance, Diabetes, and Cardiovascular Disease in Postmenopausal Veteran Women GERONTOLOGIST Rissling, M. B., Gray, K. E., Ulmer, C. S., Martin, J. L., Zaslavsky, O., Gray, S. L., Hale, L., Zeitzer, J. M., Naughton, M., Woods, N. F., LaCroix, A., Calhoun, P. S., Stefanick, M., Weitlauf, J. C. 2016; 56: S54-S66

  Abstract

  To compare the prevalence and cardiometabolic health impact of sleep disturbance among postmenopausal Veteran and non-Veteran participants in the Women's Health Initiative (WHI).The prevalence of five categories of sleep disturbance--medication/alcohol use for sleep; risk for insomnia; risk for sleep disordered breathing [SDB]; risk for comorbid insomnia and SDB (insomnia + SDB); and aberrant sleep duration [SLD]--was compared in 3,707 Veterans and 141,354 non-Veterans using logistic or multinomial regression. Cox proportional hazards models were used to evaluate the association of sleep disturbance and incident cardiovascular disease (CVD) and Type 2 diabetes in Veterans and non-Veterans.Women Veterans were more likely to have high risk for insomnia + SDB relative to non-Veteran participants. However, prevalence of other forms of sleep disturbance was similar across groups. Baseline sleep disturbance was not differentially associated with cardiometabolic health outcomes in Veteran versus non-Veteran women. Risks for SDB and insomnia + SDB were both linked to heightened risk of CVD and diabetes; SLD was consistently linked with greater risk of CVD and diabetes in non-Veterans but less strongly and consistently in Veterans.Efforts to identify and treat sleep disturbances in postmenopausal women are needed and may positively contribute to the attenuation of cardiometabolic morbidity risk. Increased awareness of women Veterans' vulnerability to postmenopausal insomnia + SDB may be particularly important for health care providers who treat this population.

  View details for DOI 10.1093/geront/gnv668

  View details for Web of Science ID 000374221500007

  View details for PubMedID 26768391

• Vasomotor Symptoms and Quality of Life Among Veteran and Non-Veteran Postmenopausal Women. Gerontologist Katon, J. G., Gray, K. E., Gerber, M. R., Harrington, L. B., Woods, N. F., Weitlauf, J. C., Bean-Mayberry, B., Goldstein, K. M., Hunt, J. R., Katon, W. J., Haskell, S. G., McCutcheon, S. J., Gass, M. L., Gibson, C. J., Zephyrin, L. C. 2016; 56: S40-53

  Abstract

  Vasomotor symptoms (VMS), including hot flashes and night sweats, are common among postmenopausal women and are associated with reduced health related quality of life (HRQOL).To determine whether Veterans are more likely to report VMS than non-Veterans, and whether the association of VMS with HRQOL varies by Veteran status.We used data from the Women's Health Initiative Observational Study, including self-reported baseline VMS presence and severity, and HRQOL at follow-up Year 3 (RAND Short Form 36-Item Health Survey). Employing generalized linear models we estimated whether Veteran status was associated with any VMS. We estimated the association between any VMS and HRQOL using linear regression, stratified by Veteran status. Interaction terms were added separately to determine whether the association varied by baseline depression, obesity, or smoking status.The final analyses included 77,153 postmenopausal women (2,004 Veterans). After adjustment, Veterans were no more likely than non-Veterans to report any VMS at baseline (relative risk [RR] 0.97, 95% confidence interval [CI] 0.90-1.04) or moderate to severe VMS (RR 1.03, 95% CI 0.89-1.18). Any VMS was associated with decreased HRQOL at Year 3, particularly among Veterans (mean difference range: Veterans -2.7 to -4.6, p-values < .001; non-Veterans -2.2 to -2.6, 95% CI -0.13 to -0.09, p values < .001). Baseline depression and obesity, but not smoking, amplified the negative association between VMS and HRQOL.Multicondition care models for postmenopausal Veteran and non-Veteran women are needed that incorporate management strategies for VMS, weight, and depression.

  View details for DOI 10.1093/geront/gnv104

  View details for PubMedID 26220418

• Who Are the Women Veterans in the Women's Health Initiative? GERONTOLOGIST Weitlauf, J. C., Washington, D. L., Stefanick, M. L. 2016; 56: S6–S9

  View details for PubMedID 26768392

• Hysterectomy and Bilateral Salpingo-Oophorectomy: Variations by History of Military Service and Birth Cohort GERONTOLOGIST Callegari, L. S., Gray, K. E., Zephyrin, L. C., Harrington, L. B., Gerber, M. R., Cochrane, B. B., Weitlauf, J. C., Bean-Mayberry, B., Bastian, L. A., Mattocks, K. M., Haskell, S. G., Katon, J. G. 2016; 56: S67–S77

  Abstract

  Little is known about hysterectomy and bilateral salpingo-oophorectomy (BSO), which are associated with both health risks and benefits, among women Veterans.To compare the prevalence of hysterectomy with or without BSO, and early hysterectomy, between postmenopausal Veterans and non-Veterans.We used baseline data from the Women's Health Initiative Clinical Trial and Observational Study. Multinomial logistic regression models examined differences in the prevalence of hysterectomy (neither hysterectomy nor BSO, hysterectomy without BSO, and hysterectomy with BSO) between Veterans and non-Veterans. Generalized linear models were used to determine whether early hysterectomy (before age 40) differed between Veterans and non-Veterans. Analyses were stratified by birth cohort (<65, ≥65 years at enrollment).The unadjusted prevalence of hysterectomy without BSO was similar among Veterans and non-Veterans in both birth cohorts (<65: 22% vs 21%; ≥65: 22% vs 21%). The unadjusted prevalence of hysterectomy with BSO was equivalent among Veterans and non-Veterans in the >65 cohort (21%), but higher among Veterans in the <65 cohort (22% vs 19%). In adjusted analyses, although no differences were observed in the >65 cohort, Veterans in the <65 cohort had higher odds of hysterectomy without BSO (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03, 1.36) and with BSO (OR 1.26, 95% CI 1.10, 1.45), as well as elevated risk of early hysterectomy (relative risk 1.32, 95% CI 1.19, 1.47), compared with non-Veterans.Aging women Veterans may have higher prevalence of hysterectomy and BSO than non-Veterans. This information contributes to understanding the health needs and risks of women Veterans and can inform clinical practice and policy for this population.

  View details for PubMedID 26768393

  View details for PubMedCentralID PMC5881615

• Aging Well Among Women Veterans Compared With Non-Veterans in the Women's Health Initiative GERONTOLOGIST LaCroix, A. Z., Rillamas-Sun, E., Woods, N. F., Weitlauf, J., Zaslavsky, O., Shih, R., LaMonte, M. J., Bird, C., Yano, E. M., LeBoff, M., Washington, D., Reiber, G. 2016; 56: S14–S26

  Abstract

  To examine whether Veteran status influences (a) women's survival to age 80 years without disease and disability and (b) indicators of successful, effective, and optimal aging at ages 80 years and older.The Women's Health Initiative (WHI) enrolled 161,808 postmenopausal women aged 50-79 years from 1993 to 1998. We compared successful aging indicators collected in 2011-2012 via mailed questionnaire among 33,565 women (921 Veterans) who reached the age of 80 years and older, according to Veteran status. A second analysis focused on women with intact mobility at baseline who could have reached age 80 years by December 2013. Multinominal logistic models examined Veteran status in relation to survival to age 80 years without major disease or mobility disability versus having prevalent or incident disease, having mobility disability, or dying prior to age 80 years.Women Veterans aged 80 years and older reported significantly lower perceived health, physical function, life satisfaction, social support, quality of life, and purpose in life scale scores compared with non-Veterans. The largest difference was in physical function scores (53.0 for Veterans vs 59.5 for non-Veterans; p < .001). Women Veterans were significantly more likely to die prior to age 80 years than non-Veteran WHI participants (multivariate adjusted odds ratio = 1.20; 95% confidence interval, 1.04-1.38). In both Veteran and non-Veteran women, healthy survival was associated with not smoking, higher physical activity, healthy body weight, and fewer depressive symptoms.Intervening upon smoking, low physical activity, obesity, and depressive symptoms has potential to improve chances for healthy survival in older women including Veterans.

  View details for PubMedID 26768388

  View details for PubMedCentralID PMC5881616

• Association of Sleep and Sexual Function in Postmenopausal Women Kling, J. M., Manson, J. E., Naughton, M. J., Temkit, M., Sullivan, S. D., Gower, E. W., Hale, L., Weitlauf, J. C., Nowakowski, S., Crandall, C. J. LIPPINCOTT WILLIAMS & WILKINS. 2015: 1368

  View details for Web of Science ID 000369888500049

• The Changing Faces of Mentorship: Application of a Developmental Network Framework in a Health Services Research Career Development Program CTS-CLINICAL AND TRANSLATIONAL SCIENCE Halvorson, M. A., Finney, J. W., Bi, X., Maisel, N. C., Hayashi, K. P., Weitlauf, J. C., Cronkite, R. C. 2015; 8 (6): 824-829

  Abstract

  Historically, mentorship has been conceived of as a dyadic relationship between a senior mentor and an early-career investigator. Models involving multiple mentors have gained favor in recent years, but empirical research on multiple-mentor models has been lacking. The current work aims to fill this gap by describing a long-standing health services research mentoring program at the U.S. Department of Veterans Affairs which has adopted a network-based approach to mentoring. As part of a broader project, we surveyed VA HSR&D Career Development Awardees who received an award between 2000 and 2012. In total, 133 awardees participated (84%). Awardees reported on the structure of mentoring relationships with their two most influential mentors. Awardees were mentored by teams consisting of one to five mentors (M = 2.7 mentors). Most often, one mentor served as primary mentor while one or more mentors played a supporting role. In most cases, an awardee's primary mentor was co-located with the awardee, with fewer secondary mentors co-located. More recently funded CDAs had more mentors and were less likely to be co-located with secondary mentors. The VA HSR&D CDA program incorporates current thinking about Developmental Network models of mentorship into a comprehensive program providing a rich mentorship experience for its awardees.

  View details for DOI 10.1111/cts.12355

  View details for Web of Science ID 000367676600038

  View details for PubMedID 26663417

• Impact of Type 2 Diabetes and Postmenopausal Hormone Therapy on Incidence of Cognitive Impairment in Older Women. Diabetes care Espeland, M. A., Brinton, R. D., Hugenschmidt, C., Manson, J. E., Craft, S., Yaffe, K., Weitlauf, J., Vaughan, L., Johnson, K. C., Padula, C. B., Jackson, R. D., Resnick, S. M. 2015; 38 (12): 2316-2324

  Abstract

  In older women, higher levels of estrogen may exacerbate the increased risk for cognitive impairment conveyed by diabetes. We examined whether the effect of postmenopausal hormone therapy (HT) on cognitive impairment incidence differs depending on type 2 diabetes.The Women's Health Initiative (WHI) randomized clinical trials assigned women to HT (0.625 mg/day conjugated equine estrogens with or without [i.e., unopposed] 2.5 mg/day medroxyprogesterone acetate) or matching placebo for an average of 4.7-5.9 years. A total of 7,233 women, aged 65-80 years, were classified according to type 2 diabetes status and followed for probable dementia and cognitive impairment (mild cognitive impairment or dementia).Through a maximum of 18 years of follow-up, women with diabetes had increased risk of probable dementia (hazard ratio [HR] 1.54 [95% CI 1.16-2.06]) and cognitive impairment (HR 1.83 [1.50-2.23]). The combination of diabetes and random assignment to HT increased their risk of dementia (HR 2.12 [1.47-3.06]) and cognitive impairment (HR 2.20 [1.70-2.87]) compared with women without these conditions, interaction P = 0.09 and P = 0.08. These interactions appeared to be limited to women assigned to unopposed conjugated equine estrogens.These analyses provide additional support to a prior report that higher levels of estrogen may exacerbate risks that type 2 diabetes poses for cognitive function in older women. The role estrogen plays in suppressing non-glucose-based energy sources in the brain may explain this interaction.

  View details for DOI 10.2337/dc15-1385

  View details for PubMedID 26486190

  View details for PubMedCentralID PMC4657616

• Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative JOURNAL OF CANCER SURVIVORSHIP Jones, S. W., LaCroix, A. Z., Li, W., Zaslavsky, O., Wassertheil-Smoller, S., Weitlauf, J., Brenes, G. A., Nassir, R., Ockene, J. K., Caire-Juvera, G., Danhauer, S. C. 2015; 9 (4): 620–29

  Abstract

  Distress and reduced quality of life (QOL) are common among people with cancer. No study has compared these variables after breast cancer diagnosis to pre-cancer diagnosis levels.Data on women with breast cancer 50 years of age or older (n = 6949) were analyzed from the Women's Health Initiative (1993-2013). Health-related QOL (physical function, mental health) was measured using Rand-36. Depressive symptoms were measured with the six-item Center for Epidemiologic Studies Depression scale. Assessments occurred before and after the cancer diagnosis. Hierarchical linear modeling compared pre-cancer QOL and depressive symptoms to levels post-diagnosis and tested whether pre-cancer physical activity, stressful life events, sleep disturbance, and pain predicted post-diagnosis outcomes.Compared with pre-cancer levels, depressive symptoms increased (20.0% increase at 0-6 months, 12.9% increase at 6-12 months), while physical function (-3.882 points at 0-6 months, -3.545 at 6-12 months) and mental health decreased (-2.899 points at 0-6 months, -1.672 at 6-12 months) in the first year after diagnosis (all p < .01). Depressive symptoms returned to pre-cancer levels after 10 years, but QOL remained significantly lower. At more than 10 years post-diagnosis, physical function was 2.379 points lower than pre-cancer levels (p < 0.01) while mental health was 1.922 points lower (p < 0.01). All pre-cancer predictors were associated with all outcomes. Pain predicted uniquely greater decreases in physical function post-diagnosis.Depressive symptoms increased and QOL decreased following breast cancer diagnosis compared with pre-cancer levels, particularly in the first year.QOL may remain lower for years after breast cancer diagnosis, although decreases are small.

  View details for PubMedID 25708515

  View details for PubMedCentralID PMC4547920

• Cross-sectional and longitudinal risk of physical impairment in a cohort of postmenopausal women who experience physical and verbal abuse BMC WOMENS HEALTH Cannell, M., Weitlauf, J. C., Garcia, L., Andresen, E. M., Margolis, K. L., Manini, T. M. 2015; 15: 98

  Abstract

  Exposure to interpersonal violence, namely verbal and physical abuse, is a highly prevalent threat to women's health and well-being. Among older, post-menopausal women, several researchers have characterized a possible bi-directional relationship of abuse exposure and diminished physical functioning. However, studies that prospectively examine the relationship between interpersonal abuse exposure and physical functioning across multiple years of observation are lacking. To address this literature gap, we prospectively evaluate the association between abuse exposure and physical functioning in a large, national cohort of post-menopausal women across 12 years of follow-up observation.Multivariable logistic regression was used to measure the adjusted association between experiencing abuse and physical function score at baseline in 154,902 Women's Health Initiative (WHI) participants. Multilevel modeling, where the trajectories of decline in physical function were modeled as a function of time-varying abuse exposure, was used to evaluate the contribution of abuse to trajectories of physical function scores over time.Abuse was prevalent among WHI participants, with 11 % of our study population reporting baseline exposure. Verbal abuse was the most commonly reported abuse type (10 %), followed by combined physical and verbal abuse (1 %), followed by physical abuse in the absence of verbal abuse (0.2 %). Abuse exposure (all types) was associated with diminished physical functioning, with women exposed to combined physical and verbal abuse presenting baseline physical functioning scores consistent with non-abused women 20 years senior. Results did not reveal a differential rate of decline over time in physical functioning based on abuse exposure.Taken together, our findings suggest a need for increased awareness of the prevalence of abuse exposure among postmenopausal women; they also underscore the importance of clinician's vigilance in their efforts toward the prevention, early detection and effective intervention with abuse exposure, including verbal abuse exposure, in post-menopausal women. Given our findings related to abuse exposure and women's diminished physical functioning at WHI baseline, our work illuminates a need for further study, particularly the investigation of this association in younger, pre-menopausal women so that the temporal ordering if this relationship may be better understood.

  View details for PubMedID 26554450

• Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative WOMENS HEALTH ISSUES Weitlauf, J. C., LaCroix, A. Z., Bird, C. E., Woods, N. F., Washington, D. L., Katon, J. G., LaMonte, M. J., Goldstein, M. K., Bassuk, S. S., Sarto, G. E., Stefanick, M. L. 2015; 25 (6): 649-657

  Abstract

  The health of postmenopausal women veterans is a neglected area of study. A stronger empirical evidence base is needed, and would inform the provision of health care for the nearly 1 million U.S. women veterans currently 50 years of age or older. To this end, the present work compares salient health outcomes and risk of all-cause mortality among veteran and non-veteran participants of the Women's Health Initiative (WHI).This study features prospective analysis of long-term health outcomes and mortality risk (average follow-up, 8 years) among the 3,706 women veterans and 141,009 non-veterans who participated in the WHI Observational Study or Clinical Trials. Outcome measurements included confirmed incident cases of cardiovascular disease (CVD), cancer, diabetes, hip fractures, and all-cause mortality.We identified 17,968 cases of CVD, 19,152 cases of cancer, 18,718 cases of diabetes, 2,817 cases of hip fracture, and 13,747 deaths. In Cox regression models adjusted for age, sociodemographic variables, and health risk factors, veteran status was associated with significantly increased risk of all-cause mortality (hazard ratio [HR], 1.13; 95% CI, 1.03-1.23), but not with risk of CVD (HR, 1.00; 95% CI, 0.90-1.11), cancer (HR, 1.04; 95% CI, 0.95-1.14), hip fracture (HR, 1.16; 95% CI, 0.94-1.43), or diabetes (HR, 1.00; 95% CI, 0.89-1.1).Women veterans' postmenopausal health, particularly risk for all-cause mortality, warrants further consideration. In particular, efforts to identify and address modifiable risk factors associated with all-cause mortality are needed.

  View details for DOI 10.1016/j.whi.2015.08.006

  View details for Web of Science ID 000368247700010

  View details for PubMedCentralID PMC4641800

• Prospective Analysis of Health and Mortality Risk in Veteran and Non-Veteran Participants in the Women's Health Initiative. Women's health issues : official publication of the Jacobs Institute of Women's Health Weitlauf, J. C., LaCroix, A. Z., Bird, C. E., Woods, N. F., Washington, D. L., Katon, J. G., LaMonte, M. J., Goldstein, M. K., Bassuk, S. S., Sarto, G. E., Stefanick, M. L. 2015; 25 (6): 649-57

  Abstract

  The health of postmenopausal women veterans is a neglected area of study. A stronger empirical evidence base is needed, and would inform the provision of health care for the nearly 1 million U.S. women veterans currently 50 years of age or older. To this end, the present work compares salient health outcomes and risk of all-cause mortality among veteran and non-veteran participants of the Women's Health Initiative (WHI).This study features prospective analysis of long-term health outcomes and mortality risk (average follow-up, 8 years) among the 3,706 women veterans and 141,009 non-veterans who participated in the WHI Observational Study or Clinical Trials. Outcome measurements included confirmed incident cases of cardiovascular disease (CVD), cancer, diabetes, hip fractures, and all-cause mortality.We identified 17,968 cases of CVD, 19,152 cases of cancer, 18,718 cases of diabetes, 2,817 cases of hip fracture, and 13,747 deaths. In Cox regression models adjusted for age, sociodemographic variables, and health risk factors, veteran status was associated with significantly increased risk of all-cause mortality (hazard ratio [HR], 1.13; 95% CI, 1.03-1.23), but not with risk of CVD (HR, 1.00; 95% CI, 0.90-1.11), cancer (HR, 1.04; 95% CI, 0.95-1.14), hip fracture (HR, 1.16; 95% CI, 0.94-1.43), or diabetes (HR, 1.00; 95% CI, 0.89-1.1).Women veterans' postmenopausal health, particularly risk for all-cause mortality, warrants further consideration. In particular, efforts to identify and address modifiable risk factors associated with all-cause mortality are needed.

  View details for DOI 10.1016/j.whi.2015.08.006

  View details for PubMedID 26432346

  View details for PubMedCentralID PMC4641800

• Infertility Care Among OEF/OIF/OND Women Veterans in the Department of Veterans Affairs MEDICAL CARE Mattocks, K., Kroll-Desrosiers, A., Zephyrin, L., Katon, J., Weitlauf, J., Bastian, L., Haskell, S., Brandt, C. 2015; 53 (4): S68–S75

  Abstract

  An increasing number of young women Veterans seek reproductive health care through the VA, yet little is known regarding the provision of infertility care for this population. The VA provides a range of infertility services for Veterans including artificial insemination, but does not provide in vitro fertilization. This study will be the first to characterize infertility care among OEF/OIF/OND women Veterans using VA care.We analyzed data from the OEF/OIF/OND roster file from the Defense Manpower Data Center (DMDC)-Contingency Tracking System Deployment file of military discharges from October 1, 2001-December 30, 2010, which includes 68,442 women Veterans between the ages of 18 and 45 who utilized VA health care after separating from military service. We examined the receipt of infertility diagnoses and care using ICD-9 and CPT codes.Less than 2% (n=1323) of OEF/OIF/OND women Veterans received an infertility diagnosis during the study period. Compared with women VA users without infertility diagnosis, those with infertility diagnosis were younger, obese, black, or Hispanic, have a service-connected disability rating, a positive screen for military sexual trauma, and a mental health diagnosis. Overall, 22% of women with an infertility diagnosis received an infertility assessment or treatment. Thirty-nine percent of women Veterans receiving infertility assessment or treatment received this care from non-VA providers.Overall, a small proportion of OEF/OIF/OND women Veterans received infertility diagnoses from the VA during the study period, and an even smaller proportion received infertility treatment. Nearly 40% of those who received infertility treatments received these treatments from non-VA providers, indicating that the VA may need to examine the training and resources needed to provide this care within the VA. Understanding women's use of VA infertility services is an important component of understanding VA's commitment to comprehensive medical care for women Veterans.

  View details for DOI 10.1097/MLR.0000000000000301

  View details for Web of Science ID 000380657800012

  View details for PubMedID 25767979

  View details for PubMedCentralID PMC4410265

• Different Diagnosis, Shared Vulnerabilities: The Value of Cross Disorder Validation of Capacity to Consent JOURNAL OF ALZHEIMERS DISEASE Rosen, A., Weitlauf, J. C. 2015; 46 (1): 11–13

  Abstract

  A screening measure of capacity to consent can provide an efficient method of determining the appropriateness of including individuals from vulnerable patient populations in research, particularly in circumstances in which no caregiver is available to provide surrogate consent. Seaman et al. (2015) cross-validate a measure of capacity to consent to research developed by Jeste et al. (2007). They provide data on controls, caregivers, and patients with mild cognitive impairment and dementia. The study demonstrates the importance of validating measures across disorders with different domains of incapacity, as well as the need for timely and appropriate follow-up with potential participants who yield positive screens. Ultimately clinical measures need to adapt to the dimensional diagnostic approaches put forward in DSM 5. Integrative models of constructs, such as capacity to consent, will make this process more efficient by avoiding the need to test measures in each disorder. Until then, cross-validation studies, such as the work by Seaman et al. (2015) are critical.

  View details for PubMedID 25757647

• A New Perspective on Distress During the Pelvic Examination: The Role of Traumatic Hyperarousal in Women with Histories of Sexual Violence VIOLENCE AND GENDER Khan, C. T., Greene, C. J., Strauss, J. L., Spiegel, D., Weitlauf, J. C. 2014; 1 (3): 117–23

  View details for DOI 10.1089/vio.2014.0016

  View details for Web of Science ID 000217337100007

• Receipt of cervical cancer screening in female veterans: impact of posttraumatic stress disorder and depression. Women's health issues : official publication of the Jacobs Institute of Women's Health Weitlauf, J. C., Jones, S., Xu, X., Finney, J. W., Moos, R. H., Sawaya, G. F., Frayne, S. M. 2013; 23 (3): e153-9

  Abstract

  We evaluated receipt of cervical cancer screening in a national sample of 34,213 women veterans using Veteran Health Administration facilities between 2003 and 2007 and diagnosed with 1) posttraumatic stress disorder (PTSD), or 2) depression, or 3) no psychiatric illness.Our study featured a cross-sectional design in which logistic regression analyses compared receipt of recommended cervical cancer screening for all three diagnostic groups.Cervical cancer screening rates varied minimally by diagnostic group: 77% of women with PTSD versus 75% with depression versus 75% without psychiatric illness were screened during the study observation period (p < .001). However, primary care use was associated with differential odds of screening in women with versus without psychiatric illness (PTSD or depression), even after adjustment for age, income and physical comorbidities (Wald Chi-square (2): 126.59; p < .0001). Specifically, among low users of primary care services, women with PTSD or depression were more likely than those with no psychiatric diagnoses to receive screening. Among high users of primary care services, they were less likely to receive screening.Psychiatric illness (PTSD or depression) had little to no effect on receipt of cervical cancer screening. Our finding that high use of primary care services was not associated with comparable odds of screening in women with versus without psychiatric illness suggests that providers caring for women with PTSD or depression and high use of primary care services should be especially attentive to their preventive healthcare needs.

  View details for DOI 10.1016/j.whi.2013.03.002

  View details for PubMedID 23660429

• Intimate Partner Violence: Perspectives on Universal Screening for Women in VHA Primary Care WOMENS HEALTH ISSUES Sweeney, A. C., Weitlauf, J. C., Manning, E. A., Sze, J. A., Waldrop, A. E., Hasser, C. 2013; 23 (2): E73–E76

  View details for DOI 10.1016/j.whi.2012.12.004

  View details for Web of Science ID 000341105300002

  View details for PubMedID 23415320

• Changes in Depressive Symptoms and Impact on Treatment Course Among Hepatitis C Patients Undergoing Interferon-alpha and Ribavirin Therapy: A Prospective Evaluation AMERICAN JOURNAL OF GASTROENTEROLOGY Chapman, J., Oser, M., Hockemeyer, J., Weitlauf, J., Jones, S., Cheung, R. 2011; 106 (12): 2123–32

  Abstract

  Accounting for severity of depressive symptoms at baseline (pretreatment), this study describes (i) depressive symptom change over the course of antiviral treatment among patients with hepatitis C virus (HCV), and (ii) the relationship of such symptom change to treatment duration and response.Depressive symptoms, measured with the Beck Depression Inventory (BDI), were examined prospectively among 129 HCV patients (95% male) who endorsed minimal (n=91), mild (n=28), or moderate depressive symptoms (n=10) prior to commencement of antiviral therapy. Assessments were obtained at baseline, 2 weeks, 4 weeks, and thereafter at 4-week intervals until treatment was discontinued or completed.The average depression score of the participants prior to commencing treatment was 7.4 (minimal depression). Depressive symptoms increased over the course of treatment, with average scores of 12.6 (mild depression) at the final assessment at the end of treatment. Patients with mild depressive symptoms at baseline demonstrated the greatest increase (M(increase)=12.7) and the greatest change (M(Δ)=5.8) in depressive symptoms from baseline to treatment completion. Patients who were minimally depressed at baseline completed the least amount of treatment (74%). Likewise, minimally depressed patients were less likely than mildly and moderately depressed patients to attain an antiviral treatment response.Depressive symptoms may worsen during antiviral therapy among patients with HCV. Notable changes in patients with subclinical depressive symptoms at baseline may be of significant concern, as the present work suggests that their depressive symptom changes are the most unstable. Thus, findings suggest that the degree of within treatment symptom change may be a more useful predictor (compared with baseline depression status) of ability to tolerate treatment. As the findings of the present study are preliminary, we urge further research and replication before drawing firm conclusions.

  View details for DOI 10.1038/ajg.2011.252

  View details for Web of Science ID 000298251400008

  View details for PubMedID 21826113

• Informed Passion: Addressing the Intersection of Violence Against Women and Contemporary Obstetrical Practice AMERICAN JOURNAL OF BIOETHICS Weitlauf, J. C. 2011; 11 (12): 67–69

  View details for PubMedID 22146041

• Is Military Sexual Trauma Associated with Trading Sex Among Women Veterans Seeking Outpatient Mental Health Care? JOURNAL OF TRAUMA & DISSOCIATION Strauss, J. L., Marx, C. E., Weitlauf, J. C., Stechuchak, K. M., Straits-Troester, K. 2011; 12 (3): 290-304

  Abstract

  A robust association between sexual trauma and trading sex has been documented in civilian samples but has not been examined in veterans. Women veterans experience high rates of sexual victimization across the lifespan, including during military service (military sexual trauma [MST]). Associations between MST and trading sex were examined in 200 women enrolled in a crosssectional study of HIV risks and seroprevalence among women receiving outpatient mental health care at a Veterans Affairs (VA) medical center. Each woman completed an assessment interview composed of validated measures that queried childhood sexual trauma; substance use; and risk behaviors, including trading sex for money, drugs, shelter, food, or other things. History of MST was derived from mandated VA screening results and chart notes. Overall, 19.7% reported a history of trading sex. Those who reported trading sex had a higher rate of MST than those who did not report trading sex (87.2% vs. 62.9%, respectively). A multivariable logistic regression model examined the relationship between trading sex and MST, controlling a priori for substance abuse and childhood sexual trauma (both associated with trading sex in civilian samples) and education, which was associated with trading sex in our sample. In this adjusted model, MST was associated with trading sex: odds ratio = 3.26, p = .025, 95% confidence interval = [1.16, 9.18]. To our knowledge, this is the 1st report of an association between MST and trading sex. Results extend previously observed associations between sexual trauma and trading sex in civilian cohorts and underscore the pernicious influence of sexual victimization across the lifespan.

  View details for DOI 10.1080/15299732.2011.551509

  View details for Web of Science ID 000290053600007

  View details for PubMedID 21534097

• Sexual Violence, Posttraumatic Stress Disorder, and the Pelvic Examination: How Do Beliefs About the Safety, Necessity, and Utility of the Examination Influence Patient Experiences? JOURNAL OF WOMENS HEALTH Weitlauf, J. C., Frayne, S. M., Finney, J. W., Moos, R. H., Jones, S., Hu, K., Spiegel, D. 2010; 19 (7): 1271-1280

  Abstract

  Sexual violence and posttraumatic stress disorder (PTSD) have been linked to increased reports of distress and pain during the pelvic examination. Efforts to more fully characterize these reactions and identify core factors (i.e., beliefs about the examination) that may influence these reactions are warranted.This descriptive, cross-sectional study examines the relationship between sexual violence, PTSD, and women's negative reactions to the pelvic examination. Additional analyses highlight how maladaptive beliefs about the safety, necessity, and utility of the pelvic examination may contribute to these reactions. Materials andA total of 165 eligible women veterans were identified via medical record review and mailed a survey that assessed: (1) background information; (2) history of sexual violence; (3) current symptoms of posttraumatic stress disorder; (4) fear, embarrassment, distress, and pain during the pelvic examination; and (5) core beliefs about the examination. Ninety women (55% response rate) completed the survey.Women with both sexual violence and PTSD reported the highest levels of examination related fear: chi(2) = 18.8, p < .001; embarrassment: chi(2) = 21.2, p < .001; and distress: chi(2) = 18.2, p < .001. Beliefs that the examination was unnecessary or unsafe or not useful were more commonly reported in this group and were associated with higher levels of examination-related fear and embarrassment.Women with sexual violence and PTSD find the pelvic examination distressing, embarrassing, and frightening. Efforts to develop interventions to help reduce distress during the examination are warranted.

  View details for DOI 10.1089/jwh.2009.1673

  View details for Web of Science ID 000279428800007

  View details for PubMedID 20509787

• Distress and Pain During Pelvic Examinations Effect of Sexual Violence 112th Annual Meeting of the Association-of-Military-Surgeons-of-the-United-States Weitlauf, J. C., Finney, J. W., Ruzek, J. I., Lee, T. T., Thrailkill, A., Jones, S., Frayne, S. M. LIPPINCOTT WILLIAMS & WILKINS. 2008: 1343–50

  Abstract

  To estimate the range and severity of distress and pain during pelvic examinations among female veterans with and without histories of sexual violence, and to examine whether posttraumatic stress disorder explains additional variance in examination-related distress and pain above that accounted for by exposure to sexual violence.We employed a cross-sectional cohort design in which 67 selected female veterans completed self-administered questionnaires to assess history of sexual violence and experiences of distress and pain associated with the pelvic examination. A subsample of 49 completed an assessment for posttraumatic stress disorder approximately 2 weeks later.Distress associated with the pelvic examination was highest for women with prior sexual violence and posttraumatic stress disorder (median 5.49), next highest for women with sexual violence only (median 2.44), and lowest for women with neither (median 0), P=.015. Higher ratings of pain were also found among women with sexual violence (median 2.5) compared with those without (median 0), P=.04. However, posttraumatic stress disorder was not linked with increased pain from speculum insertion beyond that accounted for by sexual violence; limited power may have precluded detection of this effect.Distress and pain during pelvic examinations may indicate a history of previous sexual violence, particularly in those with posttraumatic stress disorder. Extra sensitivity to the special needs of this population is warranted and may contribute positively to the quality of patients' experiences.II.

  View details for Web of Science ID 000261316200022

  View details for PubMedID 19037045

• Violence perpetration and childhood abuse among men and women in substance abuse treatment JOURNAL OF SUBSTANCE ABUSE TREATMENT Burnette, M. L., Ilgen, M., Frayne, S. M., Lucas, E., Mayo, J., Weitlauf, J. C. 2008; 35 (2): 217-222

  Abstract

  Despite an association between violence perpetration and substance use, the characteristics associated with violence among patients in treatment for substance use disorders (SUDs) are not well documented. Data were gathered from a national sample of men (n = 4,459) and women (n = 1,774) entering SUD treatment on history of violence perpetration, exposure to childhood physical abuse (CPA) and childhood sexual abuse (CSA), and reasons for entering treatment. Rates of violence perpetration were high (72% of men, 50% of women), and violence was associated with being referred by family members, prior SUD treatment, CPA, and CSA. In multivariate analyses, CPA was a significant correlate of violence perpetration across gender; however, CSA was only significant among women. Findings highlight the need for increased screening and treatment of violence perpetration among patients with SUD and suggest that CSA may be an important correlate of violence perpetration among women.

  View details for DOI 10.1016/j.jsat.2007.10.002

  View details for Web of Science ID 000258799100013

  View details for PubMedID 18248945

• Prevalence and health correlates of prostitution among patients entering treatment for substance use disorders ARCHIVES OF GENERAL PSYCHIATRY Burnette, M. L., Lucas, E., Ilgen, M., Frayne, S. M., Mayo, J., Weitlauf, J. C. 2008; 65 (3): 337-344

  Abstract

  Studies of prostitution have focused largely on individuals involved in the commercial sex trade, with an emphasis on understanding the public health effect of this behavior. However, a broader understanding of how prostitution affects mental and physical health is needed. In particular, the study of prostitution among individuals in substance use treatment would improve efforts to provide comprehensive treatment.To document the prevalence of prostitution among women and men entering substance use treatment, and to test the association between prostitution, physical and mental health, and health care utilization while adjusting for reported history of childhood sexual abuse, a known correlate of prostitution and poor health outcomes.Cross-sectional, secondary data analysis of 1606 women and 3001 men entering substance use treatment in the United States who completed a semistructured intake interview as part of a larger study.Self-reported physical health (respiratory, circulatory, neurological, and internal organ conditions, bloodborne infections) and mental health (depression, anxiety, psychotic symptoms, and suicidal behavior), and use of emergency department, clinic, hospital, or inpatient mental health services within the past year.Many participants reported prostitution in their lifetime (50.8% of women and 18.5% of men) and in the past year (41.4% of women and 11.2% of men). Prostitution was associated with increased risk for bloodborne viral infections, sexually transmitted diseases, and mental health symptoms. Prostitution was associated with use of emergency care in women and use of inpatient mental health services for men.Prostitution was common among a sample of individuals entering substance use treatment in the United States and was associated with higher risk of physical and mental health problems. Increased efforts toward understanding prostitution among patients in substance use treatment are warranted. Screening for prostitution in substance use treatment could allow for more comprehensive care to this population.

  View details for Web of Science ID 000253672200011

  View details for PubMedID 18316680

• Impact of clinician gender on examination anxiety among female veterans with sexual trauma: A pilot study JOURNAL OF WOMENS HEALTH Lee, T. T., Westrup, D. A., Ruzek, J. I., Keller, J., Weitlauf, J. C. 2007; 16 (9): 1291-1299

  Abstract

  The sequelae of sexual trauma, including symptoms or diagnosis of posttraumatic stress disorder (PTSD), may impact women's anxiety and avoidance of preventive healthcare measures such as breast, pelvic, and rectal examinations. As sexual trauma is unfortunately a common occurrence among female patients, particularly veterans, understanding how it influences examination-related distress may improve provision of care to this population. We explored the impact of clinician gender and examination type (breast, pelvic, rectal, and dental) on anticipated examination-related anxiety among women veterans with a history of sexual trauma.We present a cross-sectional pilot study that examines anticipated examination-related distress among 31 female veterans with a history of sexual trauma. Sexual trauma history was verified by chart review. Self-report instruments assessed patient demographics and patients' anticipated anxiety during breast, pelvic, rectal, and dental examinations (stratified by gender of clinician). The PTSD Checklist-Civilian Version (PCL-C) assessed symptom severity.The women reported significantly more anticipated anxiety during breast, pelvic, and rectal examinations, (p < 0.05) when clinician gender was male. Severity of PTSD symptoms was generally unrelated to anticipated examination-related anxiety.Anticipated anxiety was found to be a function of both examination type and clinician gender but not of PTSD symptom severity. These findings emphasize the importance of screening for sexual trauma and the careful consideration of female veterans' unique needs during sensitive medical procedures.

  View details for DOI 10.1089/jwh.2006.0208

  View details for Web of Science ID 000251174900006

  View details for PubMedID 18001185

• Empirically assessing participant perceptions of the research experience in a randomized clinical trial: The Women's Self-Defense Project as a case example JOURNAL OF EMPIRICAL RESEARCH ON HUMAN RESEARCH ETHICS Weitlauf, J. C., Ruzek, J. I., Westrup, D. A., Lee, T., Keller, J. 2007; 2 (2): 11-23

  Abstract

  A growing body of empirical literature has systematically documented the reactions to research participation among participants in traumafocused research. To date, the available data has generally presented an optimistic picture regarding participants' ability to tolerate and even find benefit from their participation. However, this literature has been largely limited to cross-sectional designs. No extant literature has yet examined the perceptions of participants with psychiatric illness who are participating in randomized clinical trials (RCTs) designed to evaluate the efficacy or effectiveness of novel trauma treatments. The authors posit that negative experiences of, or poor reactions to, the research experience in the context of a trauma-focused RCT may elevate the risk of participation. Indeed, negative reactions may threaten to undermine the potential therapeutic gains of participants and promoting early drop out from the trial. Empirically assessing reactions to research participation at the pilot-study phase of a clinical trial can both provide investigators and IRB members alike with empirical evidence of some likely risks of participation. In turn, this information can be used to help shape the design and recruitment methodology of the full-scale trial. Using data from the pilot study of the Women's Self-Defense Project as a case illustration, we provide readers with concrete suggestions for empirically assessing participants' perceptions of risk involved in their participation in behaviorally oriented clinical trials.

  View details for DOI 10.1525/JERHRE.2007.2.2.11

  View details for PubMedID 19385792