Shawna Follis

All Publications

• Abdominal visceral and subcutaneous adipose tissue associations with postmenopausal breast cancer incidence. JNCI cancer spectrum Bea, J. W., Ochs-Balcom, H. M., Valencia, C. I., Chen, Z., Blew, R. M., Lind, K. E., Caan, B. J., Roe, D. J., Rohan, T. E., Reeves, K. W., Manson, J. E., Ballinger, T., Reding, K. W., Follis, S., Ziller, S. G., Odegaard, A. O. 2025

  Abstract

  Obesity, classified by body mass index (BMI), is associated with higher postmenopausal breast cancer (BCa) risk. Yet, the associations between abdominal visceral (VAT) and subcutaneous adipose tissue (SAT) with BCa are unclear.We assessed BCa associations with abdominal VAT and SAT in a prospective cohort of postmenopausal women without a history of cancer and with 27 years follow-up (N = 9950), during which all new cancers were adjudicated. Dual-energy X-ray absorptiometry scans assessed adiposity at baseline, year 3, and year 6. Competing risks multivariable sub-hazard ratios (SHR), with adjustments for sociodemographic, behavioral, reproductive, and anthropometric characteristics, were estimated for baseline and time-dependent associations between VAT, SAT, and incident BCa.Participants averaged 63.3 ± 7.4 years of age and a BMI of 28.20 ± 5.72 kg/m2 at baseline. The models included 738 incident BCa cases (N = 593 invasive; N = 145 in situ). Baseline VAT and SAT area were associated with significantly increased BCa risk, by 36% and 19% respectively. Increasing VAT/SAT ratio was associated with an 8% increase in incident BCa. Time-dependent models produced similar results. VAT and VAT/SAT associated BCa risk was highest for African American/Black women, though not significantly different from other groups. Quartiles (Q) of VAT/SAT were also explored; the SHR for Q4 compared to Q1 was 1.49 (95% CI: 1.18, 1.87).Higher abdominal VAT and SAT are associated with an increased risk of postmenopausal BCa, and VAT/SAT may provide a distinctive risk estimate. Potential racial and ethnic differences require replication in a larger sample.(NCT00000611).

  View details for DOI 10.1093/jncics/pkaf007

  View details for PubMedID 39847539

• Pathways From Socioeconomic Factors to Major Cardiovascular Events Among Postmenopausal Veteran and Nonveteran Women: Findings From the Women's Health Initiative. Journal of the American Heart Association Beydoun, H. A., Beydoun, M. A., Kinney, R. L., Liu, S., Yu, R., Allison, M., Wallace, R. B., Xiao, Q., Liu, L., Gradidge, P., Jung, S. Y., Tindle, H. A., Follis, S., Brunner, R., Tsai, J. 2024; 13 (24): e037253

  Abstract

  Cardiovascular disease (CVD) remains a leading cause of death for women in the United States, with veterans being at potentially higher risk than their nonveteran counterparts due to accelerated aging and distinct biopsychosocial mechanisms. We examined pathways between selected indicators of socioeconomic status (SES) such as education, occupation, household income, and neighborhood SES and major CVD events through lifestyle and health characteristics among veteran and nonveteran postmenopausal women.A total of 121 286 study-eligible WHI (Women's Health Initiative) participants (3091 veterans and 118 195 nonveterans) were prospectively followed for an average of 17 years, during which 16 108 major CVD events were documented. Using generalized structural equations modeling coupled with survival analysis techniques, we estimated the effects of SES on major CVD events through smoking, body mass index, comorbidities, cardiometabolic risk factors, and self-rated health, controlling for WHI component, region, age, race, ethnicity, marital status, and health care provider access. Among veterans, SES characteristics were indirectly related to major CVD events through body mass index, comorbidities, cardiometabolic risk factors, and self-rated health. Among nonveterans, lower education (β= 0.2, P<0.0001), household income (β=+0.4, P<0.0001), and neighborhood SES (β=+0.2, P<0.0001) were positively related to major CVD events, and these relationships were partly mediated by body mass index, comorbidities, cardiometabolic risk factors, and self-rated health. Smoking played a mediating role only among nonveterans.Nonveteran postmenopausal women exhibit more complex pathways between SES and major CVD events than their veteran counterparts, informing the design, conduct, and evaluation of preventive strategies targeting CVD by veteran status.

  View details for DOI 10.1161/JAHA.124.037253

  View details for PubMedID 39673348

• Fractures by race and ethnicity in a diverse sample of postmenopausal women: a current evaluation among Hispanic and Asian origin groups. Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research Wright, N. C., Follis, S., Larson, J. C., Crandall, C. J., Stefanick, M. L., Ing, S. W., Cauley, J. A. 2024

  Abstract

  Using 1998-2022 Women's Health Initiative (WHI) data, our study provides contemporary fracture data by race and ethnicity, specifically focusing on Hispanic and Asian women. Fractures of interest included any clinical, hip, and major osteoporotic fractures (MOFs). We utilized the updated race and ethnicity information collected in 2003, which included seven Asian and five Hispanic origin groups. We computed crude and age-standardized fracture incidence rates per 10 000 woman-years across race and ethnic categories and by Asian and Hispanic origin. We used Cox proportional hazards model, adjusting for age and WHI clinical trial arm, to evaluate the risk of fracture (1) by race compared to White women, (2) Asian origin compared to White women, (3) Hispanic compared to non-Hispanic women, and (4) Asian and Hispanic origins compared the most prevalent origin group. Over a median (interquartile range) follow-up of 19.4 (9.2-24.2) years, 44.2% of the 160 824 women experienced any clinical fracture, including 36 278 MOFs and 8962 hip fractures. Compared to White women, Black, Pacific Islander, Asian, and multiracial women had significantly lower risk of any clinical and MOFs, while only Black and Asian women had significantly lower hip fracture risk. Within Asian women, Filipina women had 24% lower risk of any clinical fracture compared to Japanese women. Hispanic women had significantly lower risk of any clinical, hip, and MOF fractures compared to non-Hispanic women, with no differences in fracture risk observed within Hispanic origin groups. In this diverse sample of postmenopausal women, we confirmed racial and ethnic differences in fracture rates and risk, with novel findings among within Asian and Hispanic subgroups. These data can aid in future longitudinal studies evaluate contributors to racial and ethnic differences in fractures.

  View details for DOI 10.1093/jbmr/zjae117

  View details for PubMedID 39142704

• Risk factors for long COVID syndrome in postmenopausal women with previously reported diagnosis of COVID-19. Annals of epidemiology Neuhouser, M. L., Butt, H. I., Hu, C., Shadyab, A. H., Garcia, L., Follis, S., Mouton, C., Harris, H. R., Wactawski-Wende, J., Gower, E. W., Vitolins, M., Von Ah, D., Nassir, R., Karanth, S., Ng, T., Paskett, E., Manson, J. E., Chen, Z. 2024; 98: 36-43

  Abstract

  Long COVID-19 syndrome occurs in 10-20 % of people after a confirmed/probable SARS-COV-2 infection; new symptoms begin within three months of COVID-19 diagnosis and last > 8 weeks. Little is known about risk factors for long COVID, particularly in older people who are at greater risk of COVID complications.Data are from Women's Health Initiative (WHI) postmenopausal women who completed COVID surveys that included questions on whether they had ever been diagnosed with COVID and length and nature of symptoms. Long COVID was classified using standard consensus criteria. Using WHI demographic and health data collected at study enrollment (1993-98) through the present day, machine learning identified the top 20 risk factors for long COVID. These variables were tested in logistic regression models.Of n = 37,280 survey respondents, 1237 (mean age = 83 years) reported a positive COVID-19 test and 425 (30 %) reported long COVID. Symptoms included an array of neurological, cardio-pulmonary, musculoskeletal, and general fatigue, and malaise symptoms. Long COVID risk factors included weight loss, physical and mobility limitations, and specific heath conditions (e.g., history of heart valve procedure, rheumatoid arthritis).Knowledge of risk factors for long COVID may be the first step in understanding the etiology of this complex disease.

  View details for DOI 10.1016/j.annepidem.2024.08.003

  View details for PubMedID 39142425

• Revolutionizing Postdoctoral Training Using the Social Ecological Model: Insights and Experiences from the Propel Scholars GEN BIOTECHNOLOGY Hayes, C. A., Headley, C. A., Nava, A. R., Vizcarra, E. A., Garcia, K. C., Mullen, M. S., Morales, J., Venida, A. C., Follis, S. 2024

  View details for DOI 10.1089/genbio.2024.0014

  View details for Web of Science ID 001283346900001

• Effects of moderate/vigorous activity on 3-year body composition changes in postmenopausal women: a target trial emulation. American journal of epidemiology Li, J., Bea, J. W., LaMonte, M., Jiang, L., Reding, K., Garcia, L., Manson, J. A., Follis, S., Odegaard, A. O. 2024

  Abstract

  Background and Objective Postmenopausal women tend to experience significant changes in body composition, particularly abdominal adipose tissue (AAT) deposition patterns, which are hypothesized to be critical factors influencing future cardiometabolic disease risk. Physical activity has a demonstrable effect on body composition and overall health. However, there is little evidence for how different intensities and durations of physical activity over a sustained period of time influence AAT patterns and other measures of body composition in postmenopausal women. We emulated a target trial of physical activity interventions, including the 2018 Physical Activity Guidelines for Americans recommendations, on 3-year changes in AAT and body composition. Methods We analyzed observational data from 4,451 postmenopausal women aged 50-79 years in the Women's Health Initiative (WHI) to emulate a three-year target trial of adhering to increasing minutes of moderate (at least 15, 30, 75, 150, 300 minutes/week) and vigorous (at least 15, 30, 75, 150 minutes/week) physical activity aligned with the physical activity guidelines. All participants had repeated whole body Dual X-Ray Absorptiometry (DXA) scans with derived abdominal visceral (VAT) and subcutaneous adipose tissue (SAT). The measured differences in average levels of VAT, SAT, and other body composition measures determined at end of follow-up were estimated with the parametric-g formula. Results Over 3 years, interventions of increasing minutes of moderate activity would result in dose-dependent reductions in abdominal VAT, SAT, and overall body fat, and increases in lean soft tissue, with the greatest estimated benefit at the 2018 physical activity guideline recommendation of 150 mins/wk or more. Compared to no intervention, if all participants had adhered to at least 150 mins/wk of moderate physical activity, they would have 16.8 cm2 lower VAT (95% CI -23.1, -10.4), 26.8 cm2 lower SAT (95% CI -36.3, -17.3), 1.3% lower total body fat% (95% CI -1.8, -0.7), 1.2 % higher total lean soft tissue% (95% CI 0.7, 1.8), and 2.6 kg lower total bodyweight (95% CI -3.6, -1.5). We saw similar patterns in our vigorous-intensity activity interventions - if all participants adhered to at least 150 mins/wk, they would have experienced 6.7 cm2 lower VAT (95% CI -17.7, 4.3), 13.3 cm2 lower SAT (95% CI -28.8, 2.1), 1.0 % lower total body fat percent (95% CI -2.0, 0.0 ), % higher total lean soft tissue percent (95% CI) and a 0.9 kg lower total bodyweight (95% CI -2.7, 0.8). Conclusion This hypothetical emulated intervention indicated that postmenopausal women who adhere to physical activity guideline recommendations would experience beneficial changes in abdominal VAT, SAT, and overall body composition over 3 years. The study results underscore the imperative to explore further how physical activity may serve as a potential determinant of body composition.

  View details for DOI 10.1093/aje/kwae190

  View details for PubMedID 38992341

• The association between reproductive history and abdominal adipose tissue among postmenopausal women: results from the Women's Health Initiative. Human reproduction (Oxford, England) Banack, H. R., Cook, C. E., Grandi, S. M., Scime, N. V., Andary, R., Follis, S., Allison, M., Manson, J. E., Jung, S. Y., Wild, R. A., Farland, L. V., Shadyab, A. H., Bea, J. W., Odegaard, A. O. 2024

  Abstract

  What is the association between reproductive health history (e.g. age at menarche, menopause, reproductive lifespan) with abdominal adiposity in postmenopausal women?Higher visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) tissue levels were observed among women with earlier menarche, earlier menopause, and greater parity.Postmenopausal women are predisposed to accumulation of VAT and SAT. Reproductive health variables are known predictors of overall obesity status in women, defined by BMI.This study is a secondary analysis of data collected from the baseline visit of the Women's Health Initiative (WHI). The WHI is a large prospective study of postmenopausal women, including both a randomized trial and observational study. There were 10 184 women included in this analysis.Data were collected from a reproductive health history questionnaire, dual-energy x-ray absorptiometry scans, and anthropometric measures at WHI baseline. Reproductive history was measured via self-report, and included age at menarche, variables related to pregnancy, and age at menopause. Reproductive lifespan was calculated as age at menopause minus age at menarche. Statistical analyses included descriptive analyses and multivariable linear regression models to examine the association between reproductive history with VAT, SAT, total body fat, and BMI.Women who reported early menarche (<10 years) or early menopause (<40 years) had the highest levels of VAT. Adjusted multivariable linear regression results demonstrate women who experienced menarche >15 years had 23 cm2 less VAT (95% CI: -31.4, -14.4) and 47 cm2 less SAT (95% CI: -61.8, -33.4) than women who experienced menarche at age 10 years or earlier. A similar pattern was observed for age at menopause: compared to women who experienced menopause <40 years, menopause at 50-55 years was associated with 19.3 cm2 (95% CI: -25.4, -13.3) less VAT and 27.4 cm2 (-29.6, 10.3) less SAT. High parity (>3 pregnancies) was also associated with VAT and SAT. For example, adjusted beta coefficients for VAT were 8.36 (4.33, 12.4) and 17.9 (12.6, 23.2) comparing three to four pregnancies with the referent, one to two pregnancies.The WHI reproductive health history questionnaire may be subject to poor recall owing to a long look-back window. Residual confounding may be present given lack of data on early life characteristics, such as maternal and pre-menarche characteristics.This study contributes to our understanding of reproductive lifespan, including menarche and menopause, as an important predictor of late-life adiposity in women. Reproductive health has also been recognized as a sentinel marker for chronic disease in late life. Given established links between adiposity and cardiometabolic outcomes, this research has implications for future research, clinical practice, and public health policy that makes use of reproductive health history as an opportunity for chronic disease prevention.HRB and AOO are supported by the National Institute of Health National Institute of Aging (R01AG055018-04). JWB reports royalties from 'ACSM'S Body Composition Assessment Book' and consulting fees from the WHI. The remaining authors have no competing interests to declare.N/A.

  View details for DOI 10.1093/humrep/deae118

  View details for PubMedID 38890130

• Engagement With Remote Delivery Channels in a Physical Activity Intervention for Senior Women in the US. American journal of health promotion : AJHP Mendoza-Vasconez, A. S., King, A. C., Chandler, G., Mackey, S., Follis, S., Stefanick, M. L. 2024: 8901171241229537

  Abstract

  Identify the effects of engagement with different intervention delivery channels on physical activity (PA), and the participant subgroups engaging with the different channels, among Women's Health Initiative Strong and Healthy (WHISH) PA trial participants.Secondary analysis of data from WHISH, a pragmatic trial that used passive randomized consent.United States (remote intervention in all 50 states).18,080 U.S. women, aged 68-99 years, assigned to the WHISH PA intervention arm.6 dichotomous variables operationalized engagement: Engagement with Targeted Inserts, Email (opened), Email (clicked links), Website (logging in), Website (tracking), Interactive Voice Response (IVR). PA was measured using the CHAMPS PA questionnaire.Linear regressions evaluated effects of engagement on PA. Conditional Inference Trees identified subgroups of participants engaging with different channels based on demographic and psychosocial variables.Engagement with each channel, except IVR, was associated with significantly more hours/week of PA (square root coefficients .29 - .13, P values <.001). Consistently across channels, features that identified subgroups of participants with higher engagement included younger age, and higher levels of PA and physical function. Subgroups with the highest engagement differed from those with the lowest in most participant characteristics.For equitable population-level impact via large-scale remotely-delivered PA programs, it may be necessary to identify strategies to engage and target harder to reach subgroups more precisely.The WHISH trial is registered at ClinicalTrials.gov (No. NCT02425345).

  View details for DOI 10.1177/08901171241229537

  View details for PubMedID 38344760

• Allostatic load and risk of invasive breast cancer among postmenopausal women in the U.S. Preventive medicine Wang, F., Skiba, M. B., Follis, S., Liu, N., Bidulescu, A., Mitra, A. K., Mouton, C. P., Qi, L., Luo, J. 2023: 107817

  Abstract

  OBJECTIVE: Allostatic load can reflect the body's response to chronic stress. However, little is known about the association between allostatic load and risk of breast cancer in postmenopausal women. This study used a large prospective cohort in the United States to examine the relationship between allostatic load and invasive breast cancer risk, and to evaluate the relationship by racial and ethnic identity and breast cancer subtypes.METHODS: Among 161,808 postmenopausal participants in Women's Health Initiative, eligible were a subsample of 27,393 postmenopausal women aged 50-79 years old, who enrolled from 1993 to 1998, had serum test biomarkers, and were followed for breast cancer incidence through February 2022. Allostatic load at enrollment was computed based on eight biomarkers from lab serum tests and a questionnaire about participants' prescription drug use. The associations between allostatic scores and risk of breast cancer (overall and by subtypes) were assessed using Cox proportional hazards models. The race and ethnic differences were examined.RESULTS: Over a median follow-up time of 17.24 years, 1722 invasive breast cancer cases were identified. High allostatic load was associated with an increased risk of breast cancer (HR = 1.36, 95%CI: 1.20, 1.54 for third tertile vs first tertile, Ptrend < 0.0001). Similar trends were found in White women and non-Hispanic women. Higher allostatic load was associated with hormone receptor-positive and HER2/Neu-negative breast cancer (HR = 1.54, 95%CI: 1.30, 1.80 for third tertile vs first tertile, Ptrend < 0.0001).CONCLUSION: In this study, we found that higher allostatic load was significantly associated with an increased risk of breast cancer in postmenopausal women.

  View details for DOI 10.1016/j.ypmed.2023.107817

  View details for PubMedID 38097139

• RACIAL AND ETHNIC DISPARITIES IN NEIGHBORHOOD SOCIOECONOMIC CHARACTERISTICS ASSOCIATIONS WITH VISCERAL FAT Follis, S., Shropshire, J. OXFORD UNIV PRESS. 2023: 299

  View details for Web of Science ID 001178258401337

• Evaluating Fractures by Race and Ethnicity in a Diverse Sample of Postmenopausal Women - Results from the Women's Health Initiative Wright, N., Ing, S., Larson, J., Crandall, C., Follis, S., Stefanick, M., Cauley, J. A. OXFORD UNIV PRESS. 2023: 63

  View details for Web of Science ID 001266167000190

• Quantifying structural racism in cohort studies to advance prospective evidence. SSM - population health Follis, S., Breathett, K., Garcia, L., Jimenez, M., Cené, C. W., Whitsel, E., Hedlin, H., Paskett, E. D., Zhang, S., Thomson, C. A., Stefanick, M. L. 2023; 22: 101417

  Abstract

  Calls-to-action in health research have described a need to improve research on race, ethnicity, and structural racism. Well-established cohort studies typically lack access to novel structural and social determinants of health (SSDOH) or precise race and ethnicity categorization, contributing to a loss of rigor to conduct informative analyses and a gap in prospective evidence on the role of structural racism in health outcomes. We propose and implement methods that prospective cohort studies can use to begin to rectify this, using the Women's Health Initiative (WHI) cohort as a case study. To do so, we evaluated the quality, precision, and representativeness of race, ethnicity, and SSDOH data compared with the target US population and operationalized methods to quantify structural determinants in cohort studies. Harmonizing racial and ethnic categorization to the current standards set by the Office of Management and Budget improved measurement precision, aligned with published recommendations, disaggregated groups, decreased missing data, and decreased participants reporting "some other race". Disaggregation revealed sub-group disparities in SSDOH, including a greater proportion of Black-Latina (35.2%) and AIAN-Latina (33.3%) WHI participants with income below the US median compared with White-Latina (42.5%) participants. We found similarities in the racial and ethnic patterning of SSDOH disparities between WHI and US women but less disparity overall in WHI. Despite higher individual-level advantage in WHI, racial disparities in neighborhood resources were similar to the US, reflecting structural racism. Median neighborhood income was comparable between Black WHI ($39,000) and US ($34,700) women. WHI SSDOH-associated outcomes may be generalizable on the basis of comparing across race and ethnicity but may quantitatively (but not qualitatively) underestimate US effect sizes. This paper takes steps towards data justice by implementing methods to make visible hidden health disparity groups and operationalizing structural-level determinants in prospective cohort studies, a first step to establishing causality in health disparities research.

  View details for DOI 10.1016/j.ssmph.2023.101417

  View details for PubMedID 37207111

  View details for PubMedCentralID PMC10189286

• Resiliency among Women's Health Initiative women aged 80 and older by race, ethnicity, and neighborhood socioeconomic status. The journals of gerontology. Series B, Psychological sciences and social sciences Krok-Schoen, J. L., Naughton, M. J., Felix, A. S., Cene, C. W., Springfield, S., Yu, M., McLaughlin, E. M., Shadyab, A. H., Nolan, T. S., Kroenke, C. H., Garcia, L., Follis, S., Jackson, R. D. 2023

  Abstract

  OBJECTIVES: A comprehensive examination of resilience by race, ethnicity, and neighborhood socioeconomic status (NSES) among women aged ≥80 is needed, given the aging of the US population, increasing longevity, and growing racial and ethnic diversity.METHODS: Participants were women aged ≥80 enrolled in the Women's Health Initiative (WHI). Resilience was assessed with a modified version of the Brief Resilience Scale. Descriptive statistics and multiple linear regression examined the association of demographic, health, and psychosocial variables with resilience by race, ethnicity, and NSES.RESULTS: Participants (n=29,367, median age=84.3) were White (91.4%), Black (3.7%), Hispanic (1.9%), and Asian (1.7%) women. There were no significant differences by race and ethnicity on mean resiliency scores (p=0.06). Significant differences by NSES were observed regarding mean resiliency scores between those with low NSES (3.94±0.83, out of 5) and high NSES (4.00±0.81). Older age, higher education, higher self-rated health, lower stress, and living alone were significant positive correlates of resilience in the sample. Social support was correlated with resilience among White, Black, and Asian women, but not for Hispanic women. Depression was a significant correlate of lower resilience, except among Asian women. Living alone, smoking, and spirituality were significantly associated with higher resilience among women with moderate NSES.DISCUSSION: Multiple factors were associated with resilience among women aged ≥80 in the WHI. Despite some differing correlates of resilience by race, ethnicity, and NSES, there were many similarities. These results may aid in the design of resilience interventions for the growing, increasingly diverse population of older women.

  View details for DOI 10.1093/geronb/gbad048

  View details for PubMedID 36933001

• Social Support, social ties, and cognitive function of women with breast cancer: findings from the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) Study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Yang, Y., McLaughlin, E. M., Naughton, M. J., Lustberg, M. B., Nolan, T. S., Kroenke, C. H., Weitlauf, J. C., Saquib, N., Shadyab, A. H., Follis, S., Pan, K., Paskett, E. D. 2022; 31 (1): 48

  Abstract

  PURPOSE: This study examined associations between self-reported cognitive functioning and social support as well as social ties among women with breast cancer.METHODS: The study included 3351 women from the Women's Health Initiative Life and Longevity After Cancer cohort who were diagnosed with breast cancer stages I-III. Social support was assessed using a modified Medical Outcomes Study (MOS) Social Support Survey, and marital status was obtained from the baseline questionnaire. We also assessed social ties (e.g., number of friends, relatives, living children) and cognitive function (Functional Assessment of Cancer Therapy-Cognitive Function [FACT-COG]) on the year-1-follow up questionnaire. Multivariable quantile regression was used to estimate the changes in median cognitive scores. Kruskal-Wallis tests were used to assess the association of cognitive function with social ties.RESULTS: The majority of participants were non-Hispanic White (93.3%), presently married (49%), with at least a 4-year college degree (53.2%), and had been diagnosed with localized breast cancer (79%). A 10-point higher social support score correlated to a 0.32 higher (better) median cognitive score (p<0.001). Women who were presently married tended to have better cognition than women who were divorced/separated or widowed (p=0.01). Significant associations were also present for having close relatives (p<0.001) or friends (p<0.001), with cognitive scores being higher in those with at least one close relative or friend compared to none.CONCLUSION: Women reporting higher social support and greater numbers of friends or relatives have higher cognitive functioning. Compared to divorced or separated women, married women were likely to have higher cognitive functioning. These findings suggest that social support assessments have the potential to help identify women at higher risk of cognitive decline.

  View details for DOI 10.1007/s00520-022-07505-5

  View details for PubMedID 36525119

• Correction: Taking action to advance the study of race and ethnicity: the Women's Health Initiative (WHI). Women's midlife health Garcia, L., Follis, S., Thomson, C. A., Breathett, K., Cene, C. W., Jimenez, M., Kooperberg, C., Masaki, K., Paskett, E. D., Pettinger, M., Aragaki, A., Dilworth-Anderson, P., Stefanick, M. L. 2022; 8 (1): 13

  View details for DOI 10.1186/s40695-022-00083-w

  View details for PubMedID 36434684

• REEXAMINING RACE AND ETHNICITY FROM A STRUCTURAL RACISM AND SOCIAL DETERMINANTS OF HEALTH LENS IN COHORT STUDIES Follis, S. OXFORD UNIV PRESS. 2022: 810

  View details for Web of Science ID 000913044004094

• Contributions of the Women's Health Initiative to Cardiovascular Research: JACC State-of-the-Art Review. Journal of the American College of Cardiology LaMonte, M. J., Manson, J. E., Anderson, G. L., Baker, L. D., Bea, J. W., Eaton, C. B., Follis, S., Hayden, K. M., Kooperberg, C., LaCroix, A. Z., Limacher, M. C., Neuhouser, M. L., Odegaard, A., Perez, M. V., Prentice, R. L., Reiner, A. P., Stefanick, M. L., Van Horn, L., Wells, G. L., Whitsel, E. A., Rossouw, J. E. 2022; 80 (3): 256-275

  Abstract

  The WHI (Women's Health Initiative) enrolled 161,808 racially and ethnically diverse postmenopausal women, ages 50-79 years, from 1993 to 1998 at 40 clinical centers across the United States. In its clinical trial component, WHI evaluated 3 randomized interventions (menopausal hormone therapy; diet modification; and calcium/vitamin D supplementation) for the primary prevention of major chronic diseases, including cardiovascular disease, in older women. In the WHI observational study, numerous clinical, behavioral, and social factors have been evaluated as predictors of incident chronic disease and mortality. Although the original interventions have been completed, the WHI data and biomarker resources continue to be leveraged and expanded through ancillary studies to yield novel insights regarding cardiovascular disease prevention and healthy aging in women.

  View details for DOI 10.1016/j.jacc.2022.05.016

  View details for PubMedID 35835498

• Taking action to advance the study of race and ethnicity: the Women's Health Initiative (WHI). Women's midlife health Garcia, L., Follis, S., Thomson, C. A., Breathett, K., Cene, C. W., Jimenez, M., Kooperberg, C., Masaki, K., Paskett, E. D., Pettinger, M., Aragaki, A., Dilworth-Anderson, P., Stefanick, M. L. 1800; 8 (1): 1

  Abstract

  "Race" and "ethnicity" are socially constructed terms, not based on biology - in contrast to biologic ancestry and genetic admixture - and are flexible, contested, and unstable concepts, often driven by power. Although individuals may self-identify with a given race and ethnic group, as multidimensional beings exposed to differential life influencing factors that contribute to disease risk, additional social determinants of health (SDOH) should be explored to understand the relationship of race or ethnicity to health. Potential health effects of structural racism, defined as "the structures, policies, practices, and norms resulting in differential access to goods, services, and opportunities of society by "race," have been largely ignored in medical research. The Women's Health Initiative (WHI) was expected to enroll a racially and ethnically diverse cohort of older women at 40U.S. clinical centers between 1993 and 1998; yet, key information on the racial and ethnic make-up of the WHI cohort of 161,808 women was limited until a 2020-2021 Task Force was charged by the WHI Steering Committee to better characterize the WHI cohort and develop recommendations for WHI investigators who want to include "race" and/or "ethnicity" in papers and presentations. As the lessons learned are of relevance to most cohorts, the essence of the WHI Race and Ethnicity Language and Data Interpretation Guide is presented in this paper. Recommendations from the WHI Race and Ethnicity Language and Data Interpretation Guide include: Studies should be designed to include all populations and researchers should actively, purposefully and with cultural-relevance, commit to recruiting a diverse sample; Researchers should collect robust data on race, ethnicity and SDOH variables that may intersect with participant identities, such as immigration status, country of origin, acculturation, current residence and neighborhood, religion; Authors should use appropriate terminology, based on a participant's self-identified "race" and "ethnicity", and provide clear rationale, including a conceptual framework, for including race and ethnicity in the analytic plan; Researchers should employ appropriate analytical methods, including mixed-methods, to study the relationship of these sociocultural variables to health; Authors should address how representative study participants are of the population to which results might apply, such as by age, race and ethnicity.

  View details for DOI 10.1186/s40695-021-00071-6

  View details for PubMedID 34983682

• MRI based validation of abdominal adipose tissue measurements from DXA in postmenopausal women. Journal of clinical densitometry : the official journal of the International Society for Clinical Densitometry Bea, J. W., Chen, Z., Blew, R. M., Nicholas, J. S., Follis, S., Bland, V. L., Cheng, T. D., Ochs-Balcom, H. M., Wactawski-Wende, J., Banack, H. R., Neuhouser, M. L., Laddu, D., Stefanick, M. L., Cauley, J. A., Caan, B., LeBoff, M. S., Chlebowski, R. T., Odegaard, A. O. 2021

  Abstract

  INTRODUCTION: Visceral adipose tissue (VAT) is a hypothesized driver of chronic disease. Dual-energy X-ray absorptiometry (DXA) potentially offers a lower cost and more available alternative compared to gold-standard magnetic resonance imaging (MRI) for quantification of abdominal fat sub-compartments, VAT and subcutaneous adipose tissue (SAT). We sought to validate VAT and SAT area (cm2) from historical DXA scans against MRI.METHODOLOGY: Participants (n = 69) from the Women's Health Initiative (WHI) completed a 3 T MRI scan and a whole body DXA scan (Hologic QDR2000 or QDR4500; 2004-2005). A subset of 43 participants were scanned on both DXA devices. DXA-derived VAT and SAT at the 4th lumbar vertebrae (5 cm wide) were analyzed using APEX software (v4.0, Hologic, Inc., Marlborough, MA). MRI VAT and SAT areas for the corresponding DXA region of interest were quantified using sliceOmatic software (v5.0, Tomovision, Magog, Canada). Pearson correlations between MRI and DXA-derived VAT and SAT were computed, and a Bland-Altman analysis was performed.RESULTS: Participants were primarily non-Hispanic white (86%) with a mean age of 70.51 ± 5.79 years and a mean BMI of 27.33 ± 5.40 kg/m2. Correlations between MRI and DXA measured VAT and SAT were 0.90 and 0.92, respectively (p ≤ 0.001). Bland-Altman plots showed that DXA-VAT slightly overestimated VAT on the QDR4500 (-3.31 cm2); this bias was greater in the smaller subset measured on the older DXA model (QDR2000; -30.71 cm2). The overestimation of DXA-SAT was large (-85.16 to -118.66 cm2), but differences were relatively uniform for the QDR4500.CONCLUSIONS: New software applied to historic Hologic DXA scans provide estimates of VAT and SAT that are well-correlated with criterion MRI among postmenopausal women.

  View details for DOI 10.1016/j.jocd.2021.07.010

  View details for PubMedID 34404568

• The intersectional role of social stress in fracture risk: results from the Women's Health Initiative. Journal of epidemiology and community health Follis, S., Klimentidis, Y. C., Bea, J., Hu, C., Garcia, D., Wactawski-Wende, J., Kohler, L., Shadyab, A. H., Flores, M., Tindle, H. A., Chen, Z. 2021

  Abstract

  BACKGROUND: The biological consequences of stress from the social environment pattern health outcomes. This study investigated whether social stress is prospectively associated with fracture incidence among racially and ethnically diverse, postmenopausal women.METHODS: Data from 160 709 postmenopausal women in the Women's Health Initiative was analysed using Cox proportional hazards regression models to examine prospective associations of social stress with time to total and hip fracture incidence. Self-reported questionnaires measuring social strain, social functioning and social support were used to assess social stress.RESULTS: Age and race/ethnicity modified associations between social stress and total and hip fractures. HRs for the associations between higher social support (indicating lower social stress) and total fractures among those age 50-59 years were 0.92 (95% CI: 0.90 to 0.94); HR=0.94 (95% CI: 0.93 to 0.95) for those age 60-69 years and HR=0.96 (95% CI: 0.95 to 0.98) for those age 70-79 years. Higher social strain was associated with greater hip fracture incidence among Native American women (HR=1.84, 95% CI: 1.10 to 3.10), Asian women (HR=1.37, 95% CI: 1.01 to 1.86) and white women (HR=1.04, 95% CI: 1.01 to 1.08).CONCLUSION: Identifying population patterns of fracture incidence as biological expressions of social environments reveals how race/ethnic specific social environmental factors influence disparities in fractures.

  View details for DOI 10.1136/jech-2020-216354

  View details for PubMedID 34039659

• Comparison of Wearable Sensor to Traditional Methods in Functional Outcome Measures: A Systematic Review. Journal of orthopaedic research : official publication of the Orthopaedic Research Society Follis, S., Chen, Z., Mishra, S., Howe, C. L., Toosizadeh, N., Dohm, M. 2020

  Abstract

  Traditional methods of collecting functional outcome measures are widely used for lower extremity arthroplasty outcome assessment. Wearable sensors are emerging as viable tools for functional outcome measures in monitoring of post-arthroplasty recovery. The objective of this review was to compare the efficacy of wearable sensors with traditional methods for monitoring post-arthroplasty functional recovery. Articles were searched for inclusion in this review that used both traditional and wearable sensor functional outcome measures to assess lower-extremity function before and after lower extremity arthroplasty. Two independent screeners reviewed all articles, and resolved differences through consensus and consultation with the senior author. Studies that met inclusion criteria were evaluated for methodologic quality using performed risk of bias assessments. Results from several traditional and wearable sensor functional outcome measures from baseline through follow-up were normalized across studies. Fourteen articles met inclusion criteria. Six studies used statistical methods to directly compare functional outcome measures, and eight studies used qualitative description of comparisons. This review found evidence that wearable sensors detected nuanced functional outcome information on the specific biomechanics and timing of recovery, which were unaccounted for using traditional methods.Wearable sensors have shown promising utility in providing additional recovery information from lower extremity arthroplasty compared with traditional functional outcome measures, but future research is needed to assess the clinical significance of this additional information. Wearable sensor technology is an emerging clinical tool providing advanced and determinative data with the potential for advancing assessment of lower extremity arthroplasty outcomes. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1002/jor.24950

  View details for PubMedID 33300119

• Psychosocial stress and bone loss among postmenopausal women: results from the Women's Health Initiative JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH Follis, S. L., Bea, J., Klimentidis, Y., Hu, C., Crandall, C. J., Garcia, D. O., Shadyab, A. H., Nassir, R., Chen, Z. 2019; 73 (9): 888–92

  Abstract

  Bone loss is a major public health concern with large proportions of older women experiencing osteoporotic fractures. Previous research has established a relationship between psychosocial stressors and fractures. However, few studies have investigated bone loss as an intermediary in this relationship. This study investigates whether social stress is associated with bone loss during a 6-year period in postmenopausal women.Data from 11 020 postmenopausal women from the USA was used to examine self-reported psychosocial stress in relation to change in bone mineral density (BMD) measured at the femoral neck, lumbar spine and total hip. Linear regression models were used to examine associations between social measures of psychosocial stress (social strain, social functioning and social support) and per cent change in BMD over 6 years.High social stress was associated with decreased BMD over 6 years. After adjustment for confounders, each point higher in social strain was associated with 0.082% greater loss of femoral neck BMD, 0.108% greater loss of total hip BMD and 0.069% greater loss of lumbar spine BMD (p<0.05). Low social functioning and low social support were associated with greater decreases in femoral neck BMD, and low social functioning was associated with greater decreases in total hip BMD.The findings provide evidence for an association between high social stress and greater bone loss over 6 years of follow-up. In agreement with the prior literature, the findings for social strain and social functioning suggest that poor quality of social relationships may be associated with bone loss in postmenopausal women.

  View details for DOI 10.1136/jech-2019-212516

  View details for Web of Science ID 000490193000016

  View details for PubMedID 31289118

• Reply to Effects of Hormone Replacement Therapy on Sarcopenia: Is It Real? JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Follis, S., Bea, J. W., Cauley, J. A., Shadyab, A. H., Cook, A., Chen, Z. 2019; 67 (6): 1298–99

  View details for DOI 10.1111/jgs.15805

  View details for Web of Science ID 000471133600034

  View details for PubMedID 30697691

• Association Between Sarcopenic Obesity and Falls in a Multiethnic Cohort of Postmenopausal Women JOURNAL OF THE AMERICAN GERIATRICS SOCIETY Follis, S., Cook, A., Bea, J. W., Going, S. B., Laddu, D., Cauley, J. A., Shadyab, A. H., Stefanick, M. L., Chen, Z. 2018; 66 (12): 2314–20

  View details for DOI 10.1111/jgs.15613

  View details for Web of Science ID 000454532800014

• Association Between Sarcopenic Obesity and Falls in a Multiethnic Cohort of Postmenopausal Women. Journal of the American Geriatrics Society Follis, S., Cook, A., Bea, J. W., Going, S. B., Laddu, D., Cauley, J. A., Shadyab, A. H., Stefanick, M. L., Chen, Z. 2018

  Abstract

  OBJECTIVES: To investigate associations between sarcopenia, obesity, and sarcopenic obesity and incidence of falls in a racially and ethnically diverse cohort of healthy postmenopausal women.DESIGN: Prospective cohort study.SETTING: Three Women's Health Initiative (WHI) clinical centers (Tucson-Phoenix, AZ; Pittsburgh, PA; Birmingham, AL).PARTICIPANTS: Postmenopausal women aged 50 to 79 enrolled in the WHI who underwent bone and body composition scans using dual-energy x-ray absorptiometry at baseline (N = 11,020).MEASUREMENTS: Sarcopenia was defined as the lowest 20th percentile of appendicular lean mass, correcting for height and body fat. Obesity was defined as a body fat percentage greater than 42%. Sarcopenic obesity was defined as co-occurrence of sarcopenia and obesity. The fall outcome was defined as falling 2 or more times in any year during 7 years of follow-up. The risk of falls associated with sarcopenic obesity were analyzed using log binomial regression models stratified according to age and race/ethnicity.RESULTS: Sarcopenic obesity was associated with greater risk of falls in women aged 50 to 64 (relative risk (RR) = 1.35, 95% confidence interval (CI)=1.17-1.56) and 65 to 79 (RR = 1.21, 95% CI=1.05-1.39). Sarcopenic obesity related fall risk was higher in Hispanic women (RR = 2.40, 95% CI=1.56-3.67) than non-Hispanic white women (RR = 1.24, 95% CI=1.11-1.39).CONCLUSION: In a multiethnic cohort of postmenopausal women, sarcopenic obesity-related fall risk was high in women younger than 65 and those age 65 and older. Sarcopenic obesity posed the highest risk for falls in Hispanic women. The findings support identification of causal factors and health disparities in sarcopenic obesity to customize fall prevention strategies and ameliorate this significant public health burden.

  View details for PubMedID 30375641