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CDA 13-263 – HSR&D Study

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CDA 13-263
Peer Support for Cardiovascular Risk Reduction in Female Veterans
Karen Goldstein MD MSPH
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: July 2015 - June 2020

BACKGROUND/RATIONALE:
Cardiovascular disease is the leading cause of death among women in the United States. Due to elevated rates of cardiovascular disease (CVD) risk factors and inadequate awareness of CVD risk, the growing female veteran population is at significant risk for developing CVD related morbidity and mortality. Compared with non-veteran women, high rates of mental health disease and low levels of social support create unique challenges for traditional models of health behavior interventions for veteran women. Growing evidence supports the use of peer support to deliver health related content for chronic disease management, including in the male Veteran population.

OBJECTIVE(S):
Aim 1: To estimate the prevalence of co-morbid diagnoses, health behaviors and health care preferences among women Veterans at risk for CVD, among those with a diagnosis of CVD, and those not at risk.
Aim 2a: To assess which aspects of social support and modalities for providing peer support would be most effective in improving CVD risk reduction behaviors among female Veterans and to explore potential barriers and facilitators of reciprocal peer support implementation among female Veterans within the context of PACT.
Aim 2b: To develop a reciprocal peer support (RPS) intervention in female Veterans to reduce CVD risk. This will be structured to address areas of greatest impact for CVD risk identified in Aim 1 and shaped to take into consideration Veteran and PACT preferences from Aim 2.
Aim 3: To test the feasibility of a RPS intervention in targeting CVD risk reduction in female Veterans.
Aim 4: To determine the effectiveness of a reciprocal peer support intervention targeting CVD risk reduction in female Veterans at two VA locations, Durham VAMC and Newington, CT VAMC.
Aim5: To assess women Veteran's experiences of participation in a CVD risk reduction intervention

METHODS:
This proposed project has multiple components: 1) A descriptive analysis of existing National Survey of Women Veterans (NSWV) data will identify women with a CVD diagnosis, those at risk for CVD, and those not at risk and then examine relevant types of CVD risk behaviors (smoking, alcohol use, physical activity), common co-morbidities (e.g., depression and PTSD symptoms), and health care preferences in these groups;2) A qualitative assessment of female veterans who receive care at the Durham VAMC about perceived barriers and facilitators to CVD risk reduction and discussion of ways to utilize peer support; 3) The development and pilot testing of the feasibility of a reciprocal peer support intervention for CVD risk reduction; 4) A two-site effectiveness study whose primary goal will be to evaluate effectiveness of the peer support intervention previously piloted; 5) A qualitative analysis of semi-structured interviews with participants of a clinical-pharmacist delivered, telephone-based CVD risk reduction study to obtain patient-level experiences.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Findings from Aim 1 show that greater than 50% of women Veterans have risk factors for CVD. This is relevant to both VA-based providers and those outside the VA as the majority of women Veterans receive care in the community. Additionally, our findings suggest that women who prefer gender-specific care settings and those with current PTSD symptoms have greater odds of being at risk for CVD. Findings from Aim 2 show that women Veterans desire sharing of a common behavior change goal, being compatible with respect to level of engagement, and need to establish trust with a peer partner. Women also reports that peer support would be helpful for accountability needed to engage with behavior change.

PUBLICATIONS:

Journal Articles

  1. Searfoss GH, Paisley BM, Goldstein KM, Baker TK, Willy JA. The Integrated Stress Response Regulates Cell Health of Cardiac Progenitors. Toxicological sciences : an official journal of the Society of Toxicology. 2019 Jan 1; 167(1):202-210.
  2. Mattocks KM, Baldor R, Bean-Mayberry B, Cucciare M, Gerber MR, Goldstein KM, Hammer KD, Hill EE, Kroll-Desrosiers A, Prochazka AV, Sadler AG, Bastian L. Factors Impacting Perceived Access to Early Prenatal Care among Pregnant Veterans Enrolled in the Department of Veterans Affairs. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2019 Jan 1; 29(1):56-63.
  3. Khalil L, McNeil RB, Sims KJ, Felder KA, Hauser ER, Goldstein KM, Voils CI, Klimas NG, Brophy MT, Thomas CM, Whitley RL, Dursa EK, Helmer DA, Provenzale DT. The Gulf War Era Cohort and Biorepository: A Longitudinal Research Resource of Veterans of the 1990-1991 Gulf War Era. American journal of epidemiology. 2018 Nov 1; 187(11):2279-2291.
  4. Goldstein KM, Zullig LL, Dedert EA, Alishahi Tabriz A, Brearly TW, Raitz G, Sata SS, Whited JD, Bosworth HB, Gordon AM, Nagi A, Williams JW, Gierisch JM. Telehealth Interventions Designed for Women: an Evidence Map. Journal of general internal medicine. 2018 Dec 1; 33(12):2191-2200.
  5. Zullig LL, Egbuonu-Davis L, Trasy A, Oshotse C, Goldstein KM, Bosworth HB. Countering clinical inertia in lipid management: Expert workshop summary. American heart journal. 2018 Dec 1; 206:24-29.
  6. Zullig LL, Goldstein KM, Sims KJ, Williams CD, Chang M, Provenzale D, Kelley MJ. Cancer Among Women Treated in the Veterans Affairs Healthcare System. Journal of women's health (2002). 2019 Feb 1; 28(2):268-275.
  7. Goldstein KM, Zullig LL, Oddone EZ, Andrews SM, Grewe ME, Danus S, Heisler M, Bastian LA, Voils CI. Understanding women veterans' preferences for peer support interventions to promote heart healthy behaviors: A qualitative study. Preventive medicine reports. 2018 Jun 1; 10:353-358.
  8. Zullig LL, Goldstein KM, Bosworth HB, Andrews SM, Danus S, Jackson GL, Provenzale D, Weinberger M, Kelley MJ, Voils CI. Chronic disease management perspectives of colorectal cancer survivors using the Veterans Affairs healthcare system: a qualitative analysis. BMC health services research. 2018 Mar 9; 18(1):171.
  9. Bosworth HB, Olsen MK, McCant F, Stechuchak KM, Danus S, Crowley MJ, Goldstein KM, Zullig LL, Oddone EZ. Telemedicine cardiovascular risk reduction in veterans: The CITIES trial. American heart journal. 2018 May 1; 199:122-129.
  10. Befus D, Coeytaux RR, Goldstein KM, McDuffie JR, Shepherd-Banigan M, Goode AP, Kosinski A, Van Noord MG, Adam SS, Masilamani V, Nagi A, Williams JW. Management of Menopause Symptoms with Acupuncture: An Umbrella Systematic Review and Meta-Analysis. Journal of alternative and complementary medicine (New York, N.Y.). 2018 Apr 1; 24(4):314-323.
  11. Gonsoulin ME, Durazo-Arvizu RA, Goldstein KM, Cao G, Zhang Q, Ramanathan D, Hynes DM. A Health Profile of Senior-Aged Women Veterans: A Latent Class Analysis of Condition Clusters. Innovation in aging. 2017 Nov 20; 1(2):19.
  12. Zullig LL, Goldstein KM, Bosworth HB. Changes in the Delivery of Veterans Affairs Cancer Care: Ensuring Delivery of Coordinated, Quality Cancer Care in a Time of Uncertainty. Journal of oncology practice. 2017 Nov 1; 13(11):709-711.
  13. Goldstein KM, Oddone EZ, Bastian LA, Olsen MK, Batch BC, Washington DL. Characteristics and Health Care Preferences Associated with Cardiovascular Disease Risk among Women Veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2017 Nov 1; 27(6):700-706.
  14. Naylor JC, Ryan Wagner H, Brancu M, Shepherd-Banigan M, Elbogen E, Kelley M, Fecteau T, Goldstein K, Kimbrel NA, Marx CE, VA Mid-Atlantic MIRECC Work Group, VA Mid-Atlantic MIRECC Women Veterans Work Group, Strauss JL. Self-Reported Pain in Male and Female Iraq/Afghanistan-Era Veterans: Associations with Psychiatric Symptoms and Functioning. Pain medicine (Malden, Mass.). 2017 Sep 1; 18(9):1658-1667.
  15. Shepherd-Banigan M, Goldstein KM, Coeytaux RR, McDuffie JR, Goode AP, Kosinski AS, Van Noord MG, Befus D, Adam S, Masilamani V, Nagi A, Williams JW. Improving vasomotor symptoms; psychological symptoms; and health-related quality of life in peri- or post-menopausal women through yoga: An umbrella systematic review and meta-analysis. Complementary therapies in medicine. 2017 Oct 1; 34:156-164.
  16. Batch BC, Goldstein K, Yancy WS, Sanders LL, Danus S, Grambow SC, Bosworth HB. Outcome by Gender in the Veterans Health Administration Motivating Overweight/Obese Veterans Everywhere Weight Management Program. Journal of women's health (2002). 2018 Jan 1; 27(1):32-39.
  17. Goldstein KM, Vogt D, Hamilton A, Frayne SM, Gierisch J, Blakeney J, Sadler A, Bean-Mayberry BM, Carney D, DiLeone B, Fox AB, Klap R, Yee E, Romodan Y, Strehlow H, Yosef J, Yano EM. Practice-based research networks add value to evidence-based quality improvement. Healthcare (Amsterdam, Netherlands). 2018 Jun 1; 6(2):128-134.
  18. Shepherd-Banigan M, Kelley ML, Katon JG, Curry JF, Goldstein KM, Brancu M, Wagner HR, Fecteau TE, VA Mid-Atlantic MIRECC Women Veterans Workgroup, VA Mid-Atlantic MIRECC Workgroup, Van Houtven CH. Paternal history of mental illness associated with posttraumatic stress disorder among veterans. Psychiatry Research. 2017 Oct 1; 256:461-468.
  19. Goldstein KM, Shepherd-Banigan M, Coeytaux RR, McDuffie JR, Adam S, Befus D, Goode AP, Kosinski AS, Masilamani V, Williams JW. Use of mindfulness, meditation and relaxation to treat vasomotor symptoms. Climacteric : The Journal of The International Menopause Society. 2017 Apr 1; 20(2):178-182.
  20. Goldstein KM, Stechuchak KM, Zullig LL, Oddone EZ, Olsen MK, McCant FA, Bastian LA, Batch BC, Bosworth HB. Impact of Gender on Satisfaction and Confidence in Cholesterol Control Among Veterans at Risk for Cardiovascular Disease. Journal of women's health (2002). 2017 Jul 1; 26(7):806-814.
  21. Goldstein KM, Callegari LS. Should a history of assisted reproductive technology be another consideration when assessing cardiovascular risk? Journal of clinical hypertension (Greenwich, Conn.). 2017 Feb 1; 19(2):170-172.
  22. Goldstein KM, Zullig LL, Bastian LA, Bosworth HB. Statin Adherence: Does Gender Matter? Current Atherosclerosis Reports. 2016 Nov 1; 18(11):63.
  23. Duan-Porter W, Goldstein KM, McDuffie JR, Hughes JM, Clowse ME, Klap RS, Masilamani V, Allen LaPointe NM, Nagi A, Gierisch JM, Williams JW. Reporting of Sex Effects by Systematic Reviews on Interventions for Depression, Diabetes, and Chronic Pain. Annals of internal medicine. 2016 Aug 2; 165(3):184-93.
  24. Rosenbaum DL, Kimerling R, Pomernacki A, Goldstein KM, Yano EM, Sadler AG, Carney D, Bastian LA, Bean-Mayberry BA, Frayne SM. Binge Eating among Women Veterans in Primary Care: Comorbidities and Treatment Priorities. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2016 Jul 1; 26(4):420-8.
  25. Goldstein KM, McDuffie JR, Shepherd-Banigan M, Befus D, Coeytaux RR, Van Noord MG, Goode AP, Masilamani V, Adam S, Nagi A, Williams JW. Erratum to: Nonpharmacologic, nonherbal management of menopause-associated vasomotor symptoms: an umbrella systematic review (protocol). Systematic reviews. 2016 Apr 25; 5(1):69.
  26. Goldstein KM, McDuffie JR, Shepherd-Banigan M, Befus D, Coeytaux RR, Van Noord MG, Goode AP, Masilamani V, Adam S, Nagi A, Williams JW. Nonpharmacologic, nonherbal management of menopause-associated vasomotor symptoms: an umbrella systematic review (protocol). Systematic reviews. 2016 Apr 7; 5(1):56.
  27. Katon JG, Gray KE, Gerber MR, Harrington LB, Woods NF, Weitlauf JC, Bean-Mayberry B, Goldstein KM, Hunt JR, Katon WJ, Haskell SG, McCutcheon SJ, Gass ML, Gibson CJ, Zephyrin LC. Vasomotor Symptoms and Quality of Life Among Veteran and Non-Veteran Postmenopausal Women. The Gerontologist. 2016 Feb 1; 56 Suppl 1:S40-53.
  28. Washington DL, Bird CE, LaMonte MJ, Goldstein KM, Rillamas-Sun E, Stefanick ML, Woods NF, Bastian LA, Gass M, Weitlauf JC. Military Generation and Its Relationship to Mortality in Women Veterans in the Women's Health Initiative. The Gerontologist. 2016 Feb 1; 56 Suppl 1:S126-37.
  29. Fox AB, Hamilton AB, Frayne SM, Wiltsey-Stirman S, Bean-Mayberry B, Carney D, Di Leone BA, Gierisch JM, Goldstein KM, Romodan Y, Sadler AG, Yano EM, Yee EF, Vogt D. Effectiveness of an Evidence-Based Quality Improvement Approach to Cultural Competence Training: The Veterans Affairs' "Caring for Women Veterans" Program. The Journal of Continuing Education in The Health Professions. 2016 Jan 1; 36(2):96-103.
  30. Goldstein KM, Zullig LL, Bosworth HB, Oddone EZ. Consideration of Out-of-Office Blood Pressure Monitoring in Hypertension Management. Journal of clinical hypertension (Greenwich, Conn.). 2016 May 1; 18(5):381-2.
  31. Katon J, Gray K, Gerber M, Harrington L, Woods N, Weitlauf J, Bean-Mayberry B, Goldstein K, Hunt J, Katon W, Haskell S, McCutchen S, Gibson CJ, Zephyrin L. Vasomotor Symptoms and Quality of Life Among Veteran and Non-Veteran Postmenopausal Women. The Gerontologist. 2015 Sep 23; 1-15.
  32. Pomernacki A, Carney DV, Kimerling R, Nazarian D, Blakeney J, Martin BD, Strehlow H, Yosef J, Goldstein KM, Sadler AG, Bean-Mayberry BA, Bastian LA, Bucossi MM, McLean C, Sonnicksen S, Klap R, Yano EM, Frayne SM. Lessons from Initiating the First Veterans Health Administration (VA) Women's Health Practice-based Research Network (WH-PBRN) Study. Journal of the American Board of Family Medicine : JABFM. 2015 Sep 1; 28(5):649-57.
  33. Zullig LL, Stechuchak KM, Goldstein KM, Olsen MK, McCant FM, Danus S, Crowley MJ, Oddone EZ, Bosworth HB. Patient-reported medication adherence barriers among patients with cardiovascular risk factors. Journal of managed care & specialty pharmacy. 2015 Jun 1; 21(6):479-85.
  34. Kimerling R, Bastian LA, Bean-Mayberry BA, Bucossi MM, Carney DV, Goldstein KM, Phibbs CS, Pomernacki A, Sadler AG, Yano EM, Frayne SM. Patient-centered mental health care for female veterans. Psychiatric services (Washington, D.C.). 2015 Feb 1; 66(2):155-62.
Reports

  1. Goldstein KM, Gierisch JM, Zullig LL, Alishahi A, Brearly T, Dedert EA, Raitz G, Sata SS, Whited JD, Bosworth HB, McDuffie J, Williams JW. Telehealth Services Designed for Women: An Evidence Map. VA ESP #09-010. Department of Veterans Affairs; 2017 Nov 1. 86 p.
  2. Goldstein KM, Coeytaux RR, Williams JW, Shepherd-Banigan M, Goode AP, McDuffie JR, Befus D, Adam S, Masilamani V, Van Noord M, Nagi A, Wing L. Nonpharmacologic Treatments for Menopause-Associated Vasomotor Symptoms. Washington (DC): Department of Veterans Affairs (US); 2016 Jul 1. 98 p. Report No.: VA ESP Project #09-009.
  3. Duan-Porter W, Goldstein K, McDuffie J, Clowse M, Hughes JM, Klap R, Masilamani V, Allen LaPointe NM, Williams JW. Mapping the Evidence: Sex Effects in High-Impact Conditions for Women Veterans - Depression, Diabetes, and Chronic Pain. Washington (DC): Department of Veterans Affairs (US); 2015 Sep 1. 93 p.
HSR&D or QUERI Publications

  1. Duan-Porter W, Williams JW, McDuffie J, Goldstein K, Hughes J, Clowse M, Klap R, Masilamani V, AllenLaPointe NM. Mapping the Evidence: Sex Effects in High-Impact Conditions for Women Veterans - Depression, Diabetes, and Chronic Pain. 2015 Sep 24;(10/2015).
Center Products

  1. Goldstein K. PBRN experiences with recruiting women Veterans: Lessons Learned. 2016 Feb 17.
VA Cyberseminars

  1. Christy A, Coeytaux R, Goldstein K, Katon J, Shepherd-Banigan M, Williams JW. Nonpharmacologic Treatments for Menopause-associated Vasomotor Symptoms. Spotlight on Evidence-based Synthesis Program; Spotlight on Women's Health [Cyberseminar]. Health Services Research and Development. 2016 Dec 19.
  2. Duan-Porter W, Goldstein K, Williams JW. Mapping the evidence: Sex & Gender Differences in Treatments for Depression, Diabetes & Chronic Pain. Spotlight on Evidence-based Synthesis Program & Women's Health [Cyberseminar]. VA Office of R&D and HSR&D. 2015 Dec 9.
Conference Presentations

  1. Goldstein K, Vogt D, Hamilton A, Frayne S, Gierisch JM, Blakeney J, Sadler A, Bean-Mayberry BM, Carney D, DiLeone B, Fox-Galalis A, Klap R, Yee E, Romodan Y, Strehlow H, Yosef J, Yano EM. Practice-Based Research Networks Add Value to Evidence-Based Quality Improvement. Presented at: North American Primary Care Research Group Annual Meeting; 2016 Jul 11; Bethesda, MD.
  2. Goldstein K. Comparative Effectiveness Research in Veterans with PTSD (CERV-PTSD). Paper presented at: VA Durham Cooperative Studies Program Epidemiology Center Research Day; 2016 Jun 20; Durham, NC.
  3. Duan-Porter W, Goldstein K, McDuffie J, Hughes J, Clowse ME, Klap RS, Masilamani V, LaPointe NA, Nagi A, Gierisch JM, Williams JW. Mapping the Evidence: Intervention Sex Effects for Depression, Diabetes, and Chronic Pain. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 15; Hollywood, FL.
  4. Goldstein K, Oddone EZ, Bastian LA, Mor SS, Washington DL. Characteristics and health care preferences of women veterans at risk for cardiovascular disease. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 13; Hollywood, FL.
  5. Goldstein K, McNeil R, Khalil L, Felder KG, Thomas C, Whitley LR, Grewe ME, Hauser E, Gray K, Sims KJ, Huang G, Provenzale D. Health Conditions of a 1990-1991 Gulf War Era Veteran Cohort - The Gulf War ERA Cohort and Biorepository. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 12; Hollywood, FL.
  6. Miller RK, Michener J, Yang P, Goldstein KM, Groce-Martin J, True G, Johnson J. Impact of Community Based Service Learning Experience in Geriatrics for Internal Medicine Residents. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2016 May 11; Hollywood, FL.
  7. Goldstein K. What's new? Update on recent women's health literature. Paper presented at: VA VISN 6 Designated Women's Health Provider Retreat; 2016 May 4; Durham, NC.
  8. Goldstein K. STIs and Vaginitis. Paper presented at: VA National Women's Mental Health Mini-Residency Seminar; 2016 May 1; Orlando, FL.
  9. Goldstein K, Manwell LB, Polak B, Nocera L, Sanders A, Royal L, Conway T, Golden S, Veet L. Training Together: An Inter-professional Continuing Education Program to Improve Primary Care for Women Veterans. Poster session presented at: AMSUS Society of Federal Healthcare Professionals Federal Interdisciplinary Skin Integrity Group Annual Meeting; 2015 Dec 1; San Antonio, TX.
  10. Goldstein K, Stechuchak KM, Zullig LL, Oddone EZ, Olsen MK, McCant FA, Batch B, Bosworth HB. Gender differences in satisfaction and confidence in lipid control among high risk individuals. Paper presented at: Society for Women's Health Research Annual Conference; 2015 Oct 7; Winston Salem, NC.
  11. Williams JW, Duan-Porter W, Goldstein K, LaPointe NA, Hughes JM, Klap RS, McDuffie JR, Clowse ME, Gierisch JM. Evidence Mapping - Do Systematic Reviews Report the Inclusion of Women and Sex as a Moderator of Intervention Effects? Paper presented at: Cochrane Collaboration International Annual Colloquium; 2015 Oct 3; Vienna, Austria.
  12. Goldstein K, Stechuchak KM, Zullig LL, Oddone EZ, Olsen MK, McCant FA, Batch B, Bosworth HB. Gender differences in satisfaction and confidence in lipid control among high risk Veterans. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  13. Goldstein KM, Vogt D, Frayne S, Gierisch JM, Blakeney J, Sadler A, Bean-Mayberry B, Carney D, DiLeone B, Yano E. Do Practice Based Research Networks add value to VA implementation research? Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  14. Williams JW, Duan-Porter W, Hughes JM, Goldstein K, Klap RS, McDuffie J, Gierisch JM, Clowse M, Allen N. Evidence Mapping - Do Systematic Reviews Report the Inclusion of Women and Sex as a Moderator of Intervention Effects? Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
  15. Goldstein K, Frayne S, Gierisch JM, Blakeney J, Yano E, Sadler A, Bean-Mayberry B, Carney D, DiLeone B, Fox-Galais A, Klap R, Hamilton A, Yee E, Vogt D. Evidence-based Quality Improvement in a VA Women's Health Practice Based Research Network. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2015 Apr 23; Toronto, Canada.
  16. Zullig LL, Stechuchak KM, Goldstein K, Olsen MK, McCant FA, Danus SM, Crowley M, Oddone EZ, Bosworth HB. Patient-Reported Medication Adherence Barriers among Veterans Affairs Patients with Cardiovascular Risk Factors. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2015 Apr 23; Toronto, Canada.


DRA: Aging, Older Veterans' Health and Care, Cardiovascular Disease
DRE: Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: none
MeSH Terms: none