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Publications (367)
Background
Physician delivered weight management counseling (WMC) occurs infrequently and physicians report lack of training and poor self-efficacy. The purpose of this study was to develop and test the Video-based Communication Assessment (VCA) for weight management counseling (WMC) training in medical residents.
Methods
This study was a mixed me...
Background:
Chronic inflammation is implicated in cancer prognosis and can be modulated by diet. We examined associations between post-diagnosis dietary inflammatory potential and mortality outcomes among post-menopausal women diagnosed with cancer in the Women's Health Initiative (WHI).
Methods:
Energy-adjusted dietary inflammatory index scores...
Background
Physician delivered weight management counseling (WMC) occurs infrequently and physicians report lack of training and poor self-efficacy. The purpose of this study was to develop and test the Video-based Communication Assessment (VCA) for weight management counseling (WMC) training in medical residents.
Methods
This study was a mixed me...
Physicians’ abilities to address obesity in routine care may be affected by their own health behaviors, skills in and attitudes toward weight management counseling (WMC). Gender differences have been noted amongst these factors as well. We examined gender differences in personal health behaviors and predictors of perceived WMC skills and attitudes...
Physicians can play a vital role in counseling patients on overweight and obesity. This secondary analysis examined whether experiences in patient care specific to weight management before starting medical school were associated with students’ intentions and confidence to provide weight management counseling (WMC) to patients who have overweight or...
BACKGROUND
Given the rising rates of obesity there is a pressing need for medical schools to better prepare students for intervening with patients who have overweight or obesity and for prevention efforts.
OBJECTIVE
To assess the effect of a multi-modal weight management curriculum on counseling skills for health behavior change.
DESIGN
A pair-ma...
Introduction
Clinical guidelines support physician intervention consistent with the Ask, Advise, Assess, Assist, Arrange framework for adults who have obesity. However, weight management counseling curricula vary across medical schools. It is unknown how frequently students receive experiences in weight management counseling, such as instruction, o...
Purpose
Dietary factors may influence colorectal cancer (CRC) survival through effects on inflammation. We examined the association between post-CRC diagnosis inflammatory potential of diet and all-cause and cancer-specific mortality in the Women’s Health Initiative.
Methods
The study included 463 postmenopausal women who developed CRC during foll...
Importance
Physical activity is inversely associated with hip fracture risk in older women. However, the association of physical activity with fracture at other sites and the role of sedentary behavior remain unclear.
Objective
To assess the associations of physical activity and sedentary behavior with fracture incidence among postmenopausal women...
In this article, we present the development and validation of the Perceived Subtle Gender Bias Index. Given the inherent difficulty in identifying and measuring the perceptions of subtle gender biases, this index provides researchers and interventionists with a tool that does not require participants to identify/label an event as a gender bias inci...
Objectives:
The United States Preventive Services Task Force (USPSTF) 2018 guideline for the management of adults with obesity continues to support screening and offering or referring patients with obesity to intensive multi-component behavioral intervention. Training the primary care work force is important for implementation of guidelines. It is...
Introduction:
Primary care providers, using brief counseling, can help patients increase motivation to initiate or maintain weight loss, improve diet, and increase physical activity. However, no prior studies have examined the degree to which primary care preceptors, who are responsible for mentoring medical students during their core clerkships,...
Laboratory studies indicate that melatonin has beneficial vascular effects. However, epidemiologic studies on the relationship between endogenous levels of melatonin and hypertension in humans are limited. We examined the association of quartile levels of 6-sulfatoxymelatonin (aMT6s) in first morning urines with prevalent and incident hypertension...
Obesity is a prevalent disease that is often a source of stigmatization. Weight bias has been documented in healthcare settings and associated with less physician time spent with patients, less patient-centered communication, and more patient delay or withdrawal from care. Weight bias is widespread in society and the healthcare field, including amo...
Background:
Inflammation is important in chronic disease and can be modulated by dietary exposures. Our aim was to examine whether the inflammatory potential of diet after cancer diagnosis, assessed using the dietary inflammatory index (DII®), is associated with all-cause and cause-specific mortality among women diagnosed with invasive breast canc...
Physicians have an important role addressing the obesity epidemic. Lack of adequate teaching to provide weight management counseling (WMC) is cited as a reason for limited treatment. National guidelines have not been translated into an evidence-supported, competency-based curriculum in medical schools. Weight Management Counseling in Medical School...
Background:
A thorough understanding of gender differences in physical activity is critical to effective promotion of active living in older adults.
Objectives:
To examine gender and age differences in levels, types and locations of physical activity.
Design:
Cross-sectional observation.
Setting:
Car-dependent urban and rural neighborhoods i...
INTRODUCTION: Older adults may have more physical limitations and no longer routinely travel outside their neighborhoods to work. Their daily living, health, and well-being may depend on neighborhood resources close to their homes. Therefore, access to resources critical for healthy aging may influence health in various aspects. In this study we in...
We examined the associations between changes in dietary inflammatory potential and risk of colorectal cancer (CRC) in 87,042 postmenopausal women recruited from 1993-1998 into the Women's Health Initiative. Food frequency questionnaire data were used to compute patterns of change in dietary inflammatory index (DII) scores and cumulative average DII...
Background
Proper levels of physical activity (PA) are important to healthy aging. Little is known about racial differences in influences of neighborhood perceptions (NP) on PA and use of neighborhood resources among community-dwelling older women.
Materials and methods
In 2014 and 2015, 49 white and 44 black women of age 65 and older living in Wa...
Racial and ethnic disparities exist in cancer screening and management among Hispanics. Although cancer poses a burden among Hispanic women compared to non-Hispanic white women (nHw), screening rates for breast, colorectal and cervical cancer in Hispanic women lag behind nHw. The Hispanic population is heterogeneous and comprises individuals with d...
Objectives: Older female smokers are highly vulnerable, yet little is known about their attitudes, beliefs, and behaviors regarding smoking cessation. Methods: Southeast region Women’s Health Initiative participants identified as smokers on at least one prior assessment were surveyed in 2012 regarding current tobacco use. Results: Most of these cur...
Falling significantly affects quality of life, morbidity, and mortality among older adults. We sought to evaluate the prospective association between sedentary time, physical activity, and falling among post-menopausal women aged 50–79 y recruited to the Women’s Health Initiative Observational Study between 1993 and 1998 from 40 clinical centers ac...
Objectives: To examine the agreement in nutrient intake and alternate healthy eating indices (AHEI) between a self-administered Food Frequency Questionnaire (FFQ) and 24-hour recall (24HR) measurements of diet by race, among urban older women.
Design: Cross-sectional observational study
Setting: Urban neighborhoods in Washington, DC, USA.
Participa...
To compare impact of incident diabetes on atherosclerotic cardiovascular disease (ASCVD) risk among postmenopausal women according to statin use. Prospective data from 120,499 postmenopausal women without prevalent diabetes or cardiovascular disease at baseline from the Women’s Health Initiative were used. Incident diabetes was self-reported annual...
We utilized the dietary inflammatory index (DII) to investigate associations between patterns of change in, and history of the inflammatory potential of diet and risk of breast cancer in the Women’s Health Initiative (WHI). We included 70,998 postmenopausal women aged 50–79 years recruited from 1993 to 1998 into the WHI Observational Study and Diet...
Background/objectives:
The dietary inflammatory index (DII) measured at one time point is associated with risk of several chronic diseases, but disease risk may change with longitudinal changes in DII scores. Data are lacking regarding changes in DII scores over time; therefore, we assessed changes in the DII in the Women's Health Initiative (WHI)...
Objective
To examine whether weight history and weight transitions over adult lifespan contribute to physical impairment among postmenopausal women.
Design
BMI categories were calculated among postmenopausal women who reported their weight and height at age 18 years. Multiple-variable logistic regression was used to determine the association betwe...
Background:
Diet modulates inflammation and inflammatory markers have been associated with cancer outcomes. In the Women's Health Initiative, we investigated associations between a dietary inflammatory index (DII) and invasive breast cancer incidence and death.
Methods:
The DII was calculated from a baseline food frequency questionnaire in 122 7...
Individuals with excess weight have increased morbidity and mortality compared to those of normal weight, and there are differences in disease risk between overweight and obese men and women. However, limited information on how physicians counsel these groups and on patients’ experiences with weight management counseling (WMC) is available. The goa...
Background.
A better understanding of medically centered outcomes, such as physical function, for older women with multiple chronic conditions is a national public health priority.
Methods.
The prevalence of multimorbidity (defined as having 2 chronic conditions from a list of 12) and comorbidity with coronary disease (CHD) were calculated for 33,...
Background.
As the proportion of the population aged 80 and over accelerates, so does the value of understanding the processes of aging well. The purposes of this article are to: (a) review contemporary theoretical and conceptual perspectives on aging well, (b) describe indicators of aging well that reflect key concepts and perspectives as assessed...
Background.
Independent predictors of preserved cognitive functioning and factors associated with maintaining high preserved cognitive function in women ≥80 years remain elusive.
Methods.
Two thousand two hundred twenty-eight women with a mean age of 85 years who participated in the Women’s Health Initiative Memory Study were classified as cogniti...
Background: Inflammation regulates key biologic processes in chronic disease and can be modulated by diet. Our objective was to use the dietary inflammatory index (DII), a novel tool to characterize the inflammatory potential of diet, to examine how post-cancer diagnosis dietary quality is associated with overall survival in the Women's Health Init...
Early in medical education, physicians must develop competencies needed for tobacco dependence treatment.
OBJECTIVE: To assess the effect of a multi-modal tobacco dependence treatment curriculum on medical students' counseling skills.
DESIGN: A group-randomized controlled trial (2010-2014) included ten U.S. medical schools that were randomized to r...
Objective
We examined the association between the dietary inflammatory index (DII) and risk of invasive breast cancer (BC) incidence and mortality in postmenopausal women.
Methods
The DII was calculated from a baseline food frequency questionnaire administered to 117,510 women at risk of BC in the Women's Health Initiative (WHI) Observational Stud...
Many dietary factors have either proinflammatory or anti-inflammatory properties. We previously developed a dietary inflammatory index (DII) to assess the inflammatory potential of diet. In this study, we conducted a construct validation of the DII based on data from a food frequency questionnaire and three inflammatory biomarkers in a subsample of...
Objectives To determine whether statin treatment is associated with increased risk of haemorrhagic stroke (HS) in older women. A secondary objective was to evaluate HS risk in users of combined statin and antiplatelet treatment.
Design Observational study: secondary data analysis from the Women's Health Initiative (WHI) clinical trials.
Setting Wom...
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,...
Mortality among current smokers is 2 to 3 times as high as that among persons who never smoked. Most of this excess mortality is believed to be explained by 21 common diseases that have been formally established as caused by cigarette smoking and are included in official estimates of smoking-attributable mortality in the United States. However, if...
Objective:
Physicians play a critical role in addressing tobacco dependence, yet report limited training. Tobacco dependence treatment curricula for medical students could improve performance in this area. This study identified student and medical school tobacco treatment curricula characteristics associated with intentions and use of the 5As for...
PURPOSE: Inflammation is a process central to carcinogenesis and in particular to colorectal cancer (CRC). Previously, we developed a dietary inflammatory index (DII) from extensive literature review to assess the inflammatory potential of diet. In the current study, we utilized this novel index in the Women's Health Initiative to prospectively eva...
Construct: This article describes the development and implementation of an assessment intended to provide objective scores that would be valid indications of medical students' abilities to counsel patients about tobacco dependence.
Assessing medical students' advanced communication skills, particularly in the context of providing tobacco-dependence...
INTRODUCTION:
Obesity is a major risk factor for physical disability in older adults. The contribution of early onset of obesity and weight history to physical impairment later in life remains inconclusive.
METHODS:
Postmenopausal women (n=76,016, 63.5 ± 7.3 years) recalled weight and height at ages 18, 35, 50 years and reported it at their b...
Background:
Case-control studies have reported an increased risk of ovarian cancer among talc users; however, the only cohort study to date found no association except for an increase in serous invasive ovarian cancers. The purpose of this analysis was to assess perineal powder use and risk of ovarian cancer prospectively in the Women's Health Ini...
Background: Osteoporosis is the most common bone disease in the United States, and it is particularly common among women with multiple sclerosis (MS). However, despite this association, the temporal relationship between these two conditions has not been previously studied. Data from the Women’s Health Initiative provides a unique opportunity to exa...
The role of diet in modifying chronic disease risk through its potential effect on inflammation is of great interest. We assessed changes over time in the inflammatory potential of specific dietary factors in the Observational Study cohort of the Women’s Health Initiative using the dietary inflammatory index (DII).The DII was calculated based on da...
Background: Statin therapy is recommended for treatment of hypercholesterolemia and prevention of cardiovascular events. Concerns have been raised about a potentially higher risk of hemorrhagic stroke in statin users; however, there is limited information in women and in older populations. We evaluated whether statin treatment was associated with i...
Background:
Results from prospective studies on the association between urinary levels of melatonin and risk of postmenopausal breast cancer have been mixed. Several although not all studies have found lower urinary levels of melatonin in women who developed breast cancer compared with cancer-free women.
Methods:
We examined the association betw...
The Women's Health Initiative (WHI) was a placebo-controlled randomized study that investigated the benefits and risks of 2 menopausal hormone regimens in healthy normal postmenopausal women. The present report provides a comprehensive, integrated overview of findings from the intervention and extended postintervention phases of 2 WHI trials: one u...
Physician-delivered tobacco treatment using the 5As is clinically recommended, yet its use has been limited. Lack of adequate training and confidence to provide tobacco treatment are cited as leading reasons for limited 5A use. Tobacco dependence treatment training while in medical school is recommended, but is minimally provided. The MSQuit trial...
Healthy lifestyle behaviors are recommended to reduce cancer risk and overall mortality. Adherence to cancer-preventive health behaviors and subsequent cancer risk has not been evaluated in a diverse sample of postmenopausal women. We examined the association between the American Cancer Society (ACS) Nutrition and Physical Activity Cancer Preventio...
Background: Training in tobacco dependence counseling during medical school influences tobacco treatment-related attitudes. First year medical students may vary in their prior tobacco dependence counseling experiences, which may influence their tobacco treatment-related attitudes and opinions. Our objectives were to 1) assess prior clinical experie...
Stresses the importance of a multifaceted approach to addressing tobacco use.
Citation: Pbert, L., Jolicoeur, D., Hayes, R.B., & Ockene, J.K. (2013) "Addressing Tobacco Use and Dependence" in: K.A. Riekert, J.K. Ockene, L. Pbert (eds.). Handbook of Health Behavior Change. 4th ed. Springer Pub. Co., p. 179-209. ISBN-13: 9780826199355
A partial previ...
Provides a comprehensive overview of behavior change as it relates to public health.
Chapter learning objectives: Define translational research and understand its importance to improve population health; compare and contrast translational research phases in biomedical research with behavioral and social sciences research; identify strategies to improve translational research in health behavior change interventions.
An AHA Science Advisory recommending that physicians intervene more assertively to get patients to adopt healthier lifestyles, directly targeting smoking, obesity, poor diet, and physical inactivity.
Importance:
Menopausal hormone therapy continues in clinical use but questions remain regarding its risks and benefits for chronic disease prevention.
Objective:
To report a comprehensive, integrated overview of findings from the 2 Women's Health Initiative (WHI) hormone therapy trials with extended postintervention follow-up.
Design, setting,...
Using data from the Women's Health Initiative (1993-2009; n = 158,833 participants, of whom 84.1% were white, 9.2% were black, 4.1% were Hispanic, and 2.6% were Asian), we compared all-cause, cardiovascular, and cancer mortality rates in white, black, Hispanic, and Asian postmenopausal women with and without diabetes. Cox proportional hazard models...
Moderate intensity physical activity is recommended for individuals with diabetes to control glucose and prevent diabetes-related complications. The extent to which a diabetes diagnosis motivates patients to increase physical activity is unclear. This study used data from the Women's Health Initiative Observational Study (baseline data collected fr...
Recent studies reported that smoking cessation leads to higher short-term risk of type 2 diabetes than continuing to smoke. However, the duration of increased diabetes risk following smoking cessation needs further investigation. We followed 135,906 postmenopausal women aged 50-79 years enrolled in the Women's Health Initiative between September 1,...
Objectives:
We investigated whether depressive symptoms and antidepressant use are associated with biomarkers for glucose dysregulation and inflammation, body mass index (BMI), and waist circumference.
Methods:
Postmenopausal women were recruited into the Women's Health Initiative from 1993 to 1998, and data were collected at regular intervals t...
Objective:
To examine the association of dietary quality and risk of incident diabetes overall and by race/ethnicity among postmenopausal women enrolled in the Women's Health Initiative (WHI).
Research methods and procedures:
The WHI recruited 161,808 postmenopausal women between 1993 and 1998, and followed them until 2005. Incident diabetes was...
Objective: Testing a novel instrument for assessing the perceptions of the food environment, and personal and family factors influencing food purchasing behaviors in community-living older women.
Methods: Women 65 years and older residing in Worcester County were enrolled into the study and returned a 26-item food purchasing survey. The survey inqu...
Background:
Long and short sleep duration are associated with increased risk for coronary heart disease (CHD) and cardiovascular disease (CVD); however, evidence is inconsistent. We sought to identify whether self-reported sleep duration and insomnia, based on a validated questionnaire, are associated with increased incident CHD and CVD among post...
Spirituality has been associated with better cardiac autonomic balance, but its association with cardiovascular risk is not well studied. We examined whether more frequent private spiritual activity was associated with reduced cardiovascular risk in postmenopausal women enrolled in the Women's Health Initiative Observational Study.
Frequency of pri...
Background
Laxatives are among the most widely used over-the-counter medications in the United States but studies examining their potential hazardous side effects are sparse. Associations between laxative use and risk for fractures and change in bone mineral density [BMD] have not previously been investigated.
Methods
This prospective analysis inc...
We previously developed a dietary inflammatory index (DII) from extensive literature review to assess the inflammatory potential of diet. The purpose of this study was to validate the novel DII based on responses to a food frequency questionnaire (FFQ), using data from three 24‐hour dietary recalls (24HR), as well as inflammation biomarkers in the...
Objective:
The relatively modest benefit of vasomotor symptom relief in clinical trials of isoflavones may reflect once-daily dosing and low percentages of participants who are able to metabolize daidzein into equol, a potentially more biologically active isoflavone. This pilot study examined whether symptom reduction was greater with more frequen...
To determine how the number of geriatric syndromes is associated with incident disability in community-based populations of older adults.
Longitudinal analysis from the Women's Health Initiative Observational Study (WHI-OS).
Community.
Twenty-nine thousand five hundred forty-four women aged 65 and older enrolled in the WHI-OS and free of disability...
This study identifies factors associated with walking among postmenopausal women and tests whether neighborhood walkability moderates the influence of intrapersonal factors on walking. We used data from the Women's Health Initiative Seattle Center and linear regression models to estimate associations and interactions. Being white and healthy, havin...
Post-menopausal hormone therapy with estrogen plus progestin is consistently reported to be associated with an increased risk of invasive breast cancer. However, findings on an association between hormone use and ductal carcinoma in situ of the breast (DCIS), a possible precursor lesion of invasive breast cancer, are sparse and inconsistent. Women'...
Habitual snoring may be associated with cardiovascular disease (CVD); however, limited evidence exists among women. We investigated whether frequent snoring is a predictor of coronary heart disease (CHD) and stroke among 42,244 postmenopausal women participating in the Women's Health Initiative Observational Study. Participants provided self-report...
Objective
Attention control (AC) conditions are used to balance nonspecific attention in randomized trials of behavioral interventions. Very little guidance about which behavioral interventions and outcomes merit AC is available in the literature. The primary aim of the present study is to demonstrate a scenario in which use of AC in a behavioral r...
Background
The Multiple Risk Factor Intervention Trial evaluated a multifactor intervention on coronary heart disease (CHD) in 12 866 men. A priori defined endpoints (CHD death, CHD death or nonfatal myocardial infarction, cardiovascular disease [CVD] death, and all-cause death) did not differ significantly between the special intervention (SI) and...
Introduction:
Women who smoke, particularly older women, have been relatively neglected in smoking research. There is a lack of knowledge concerning the relation of level of smoking to quality of life and mortality among middle-aged and older women smokers.
Methods:
This study examined the relation of smoking status to physical health-related qu...
Implications
Practice: Strong science-based leadership, advocacy, and research are essential for advancing national and global efforts to reduce tobacco use, which remains the world’s single largest cause of preventable disease, premature death, and avoidable healthcare costs.
Policy: SBM and SRNT support the design and implementation of planned,...
OBJECTIVE
To examine determinants of racial/ethnic differences in diabetes incidence among postmenopausal women participating in the Women’s Health Initiative.
RESEARCH DESIGN AND METHODS
Data on race/ethnicity, baseline diabetes prevalence, and incident diabetes were obtained from 158,833 women recruited from 1993–1998 and followed through August...
1501
Background: In the WHI clinical trial, E+P increased both breast cancer incidence and breast cancer mortality (JAMA 2010;304:1684). In contrast, breast cancers associated with E+P use in most observational studies have a more favorable prognosis. To address differences, a cohort of WHI Observational Study participants with characteristics simi...
To examine the associations between depressive symptoms, antidepressant use, and duration of use with incident frailty 3 years later in nonfrail women aged 65 and older.
Secondary analysis of the Women's Health Initiative Observational Study (WHI-OS), a prospective cohort study.
WHI-OS was conducted in 40 U.S. clinical centers.
Women aged 65 to 79,...
While observational studies have suggested that vitamin D deficiency increases risk of depression, few clinical trials have
tested whether vitamin D supplementation affects the occurrence of depression symptoms. The authors evaluated the impact of
daily supplementation with 400 IU of vitamin D3 combined with 1,000 mg of elemental calcium on measure...
We used data from the Women's Health Initiative, a large prospective study with detailed information on smoking status, weight changes, and potential confounders, to assess the relationship between smoking cessation, weight gain, and subsequent diabetes risk. We examined diabetes risk by smoking status, including new quitters who smoked at baseline...
By contrast with many observational studies, women in the Women's Health Initiative (WHI) trial who were randomly allocated to receive oestrogen alone had a lower incidence of invasive breast cancer than did those who received placebo. We aimed to assess the influence of oestrogen use on longer term breast cancer incidence and mortality in extended...
Recent legislation and delivery system reform efforts are greatly expanding the use of electronic health records. For these efforts to reach their full potential, they must actively involve patients and include patient-reported information about such topics as health behavior, preferences, and psychosocial functioning. We offer a plan for including...
Antidepressants are commonly prescribed medications in the elderly, but their relationship with incident mild cognitive impairment (MCI) and probable dementia is unknown.
The study cohort included 6,998 cognitively healthy, postmenopausal women, aged 65-79 years, who were enrolled in a hormone therapy clinical trial and had baseline depressive symp...
This study investigates whether the incidence of new-onset diabetes mellitus (DM) is associated with statin use among postmenopausal women participating in the Women's Health Initiative (WHI).
The WHI recruited 161,808 postmenopausal women aged 50 to 79 years at 40 clinical centers across the United States from 1993 to 1998 with ongoing follow-up....
Measures of religiosity are linked to health outcomes, possibly indicating mediating effects of associated psychological and social factors. We examined cross-sectional data from 92,539 postmenopausal participants of the Women's Health Initiative Observational Study who responded to questions on religious service attendance, psychological character...
The aim of this study was to determine the patterns and predictors of sexual activity in the Hormone Therapy (HT) Trials of the Women's Health Initiative (WHI).
Sexual activity questions were administered to 27,347 women ages 50 to 79 years at baseline and at year 1 and to a random 8.6% subsample at years 3 and 6. The associations with demographic...
The purpose of this study was to examine the role of 2 types of social influence—general social support and living with a smoker—on smoking behavior among middle-aged and older women in the Women's Health Initiative (WHI) Observational Study. Participants were postmenopausal women who reported smoking at some time in their lives (N = 37,027), who w...
Although mortality rates from cardiovascular disease (CVD) declined by 26% from 1995 to 2005,1 it remains the leading cause of death for US adults. The American Heart Association (AHA) set a 2020 impact goal to “improve the cardiovascular health of all Americans by 20% while reducing deaths from CVD and stroke by 20%.”2 To this end, the AHA recomme...
