BACKGROUND/RATIONALE:
Substance use disorders (SUD)-drug use illnesses consistent with abuse or dependence of a range of substances-are common and costly mental health conditions among Veterans. Research has demonstrated that women differ from men in their patterns of SUD and in their use of services and determinants of treatment and outcomes. Although the emphasis of SUD care in the VA has been on the men who make up 96% of Veterans in SUD treatment, women Veterans represent a particularly vulnerable group with distinct needs and barriers to treatment. Women Veterans have higher rates of other psychiatric conditions, including PTSD, military sexual trauma (MST), bipolar/psychotic disorder, and mood disorders than do their male counterparts, and the occurrence of concomitant PTSD or MST requires assessing and accommodating women's needs in a private and safe SUD treatment environment. Despite VA requirements for "gender aware care", most VA providers outside of women's health clinics have little or no experience delivering services to women Veterans. Women Veterans may have difficulty in the predominantly-male VA treatment environment.

OBJECTIVE(S):
The goal of the proposed CDA project is to develop the foundational evidence needed to improve women Veterans' access to optimal, gender-sensitive SUD care. To accomplish this goal, I will examine patient, provider, and organizational factors that foster or hinder the delivery of appropriate and effective care for women Veterans using mixed methods.

METHODS:
The proposed CDA research plan will comprise 3 separate projects. The first, a secondary analysis of linked organizational- and patient-level data, will describe the patterns and determinants of women's SUD treatment involvement (initiation, engagement, and pharmacotherapy) and patient outcomes across VA facilities. The second will include the development and administration of the first survey of the organizational structure of women Veterans' VA SUD care. The survey data will be linked to patient-level data to determine the impact of women's SUD treatment structure on women veterans' treatment involvement and patient outcomes. The third project will be an in-depth qualitative study to learn from women VA SUD patients their experiences with VA SUD care and their perceptions of treatment barriers, preferences, and needs. The proposed CDA career plan builds on my strong epidemiology and biostatistics training while ensuring education, training and mentorship in the use of VA data sources, health services research design, the theory of substance use disorder, gender issues in mental health, qualitative research, organizational survey design, a nd implementation science.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Providing patient-centered, gender-sensitive care for women Veterans with SUD is a VA goal, but there are fundamental information gaps on where and how women access SUD care in the VA. Moreover, little work has been done to determine the features of care that can best address women Veterans' specific needs and treatment barriers. This project is addressing these knowledge gaps to support quality improvement efforts aimed at providing women Veterans with optimal, gender-sensitive SUD care.

PUBLICATIONS:

Journal Articles

1. Schweizer CA, Hoggatt KJ, Washington DL, Bean-Mayberry B, Yano EM, Mitchell MN, Alessi CA, Martin JL. Use of alcohol as a sleep aid, unhealthy drinking behaviors, and sleeping pill use among women veterans. Sleep health. 2019 Oct 1; 5(5):495-500.
2. Breland JY, Wong MS, Frayne SM, Hoggatt KJ, Steers WN, Saechao F, Washington DL. Obesity and Health Care Experiences among Women and Men Veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2019 Jun 25; 29 Suppl 1:S32-S38.
3. Hoggatt KJ, Frayne SM, Saechao FS, Yano EM, Washington DL. Substance Use Disorder-Related Disparities in Patient Experiences of Primary Care. Health equity. 2019 May 2; 3(1):193-197.
4. Wong MS, Hoggatt KJ, Steers WN, Frayne SM, Huynh AK, Yano EM, Saechao FS, Ziaeian B, Washington DL. Racial/Ethnic Disparities in Mortality Across the Veterans Health Administration. Health equity. 2019 Apr 8; 3(1):99-108.
5. Snow SC, Fonarow GC, Ladapo JA, Washington DL, Hoggatt KJ, Ziaeian B. National Rate of Tobacco and Substance Use Disorders Among Hospitalized Heart Failure Patients. The American journal of medicine. 2019 Apr 1; 132(4):478-488.e4.
6. Hepner KA, Paddock SM, Watkins KE, Hoggatt KJ, Rubenstein LV, Bogart A, Iyiewuare PO, Rosenbluth SC, Pincus HA. Rates and Impact of Adherence to Recommended Care for Unhealthy Alcohol Use. Journal of general internal medicine. 2019 Feb 1; 34(2):256-263.
7. Giannitrapani KF, Huynh AK, Schweizer CA, Hamilton AB, Hoggatt KJ. Patient-centered substance use disorder treatment for women Veterans. Journal of Military, Veteran, and Family Health. 2018 Sep 10; 4(1):DOI: 10.3138/jmvfh.2017-0006.
8. Hoggatt KJ, Hepner KA. Assessing Brief Intervention for Unhealthy Alcohol Use: A Comparison of Electronic Health Record Documentation and Patient Self-Report. Journal of studies on alcohol and drugs. 2018 Sep 1; 79(5):697-701.
9. Hoggatt KJ, Simpson T, Schweizer CA, Drexler K, Yano EM. Identifying women veterans with unhealthy alcohol use using gender-tailored screening. The American journal on addictions. 2018 Mar 1; 27(2):97-100.
10. Hepner KA, Hoggatt KJ, Bogart A, Paddock S. Does Documented Brief Intervention Predict Decreases in Alcohol Use in Primary Care?. Substance use & misuse. 2018 Aug 24; 53(10):1633-1637.
11. Evans EA, Upchurch DM, Simpson T, Hamilton AB, Hoggatt KJ. Differences by Veteran/civilian status and gender in associations between childhood adversity and alcohol and drug use disorders. Social psychiatry and psychiatric epidemiology. 2018 Apr 1; 53(4):421-435.
12. Timko C, Hoggatt KJ, Wu FM, Tjemsland A, Cucciare M, Rubin A, Simpson TL. Substance Use Disorder Treatment Services for Women in the Veterans Health Administration. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2017 Nov 1; 27(6):639-645.
13. Hoggatt KJ, Lehavot K, Krenek M, Schweizer CA, Simpson T. Prevalence of substance misuse among US veterans in the general population. The American journal on addictions. 2017 Jun 1; 26(4):357-365.
14. Washington DL, Steers WN, Huynh AK, Frayne SM, Uchendu US, Riopelle D, Yano EM, Saechao FS, Hoggatt KJ. Racial And Ethnic Disparities Persist At Veterans Health Administration Patient-Centered Medical Homes. Health affairs (Project Hope). 2017 Jun 1; 36(6):1086-1094.
15. Breland JY, Phibbs CS, Hoggatt KJ, Washington DL, Lee J, Haskell S, Uchendu US, Saechao FS, Zephyrin LC, Frayne SM. The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans. Journal of general internal medicine. 2017 Apr 1; 32(Suppl 1):11-17.
16. Lewis ET, Jamison AL, Ghaus S, Durazo EM, Frayne SM, Hoggatt KJ, Bean-Mayberry B, Timko C, Cucciare MA. Receptivity to alcohol-related care among U.S. women Veterans with alcohol misuse. Journal of addictive diseases. 2016 Oct 1; 35(4):226-237.
17. Harris AH, Chen C, Rubinsky AD, Hoggatt KJ, Neuman M, Vanneman ME. Are Improvements in Measured Performance Driven by Better Treatment or "Denominator Management"? Journal of general internal medicine. 2016 Apr 1; 31 Suppl 1:21-7.
18. Cucciare MA, Lewis ET, Hoggatt KJ, Bean-Mayberry B, Timko C, Durazo EM, Jamison AL, Frayne SM. Factors Affecting Women's Disclosure of Alcohol Misuse in Primary Care: A Qualitative Study with U.S. Military Veterans. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2016 Mar 1; 26(2):232-9.
19. Simpson TL, Rillamas-Sun E, Lehavot K, Timko C, Rubin A, Cucciare MA, Williams EC, Padula CB, Hunt JR, Hoggatt KJ. Alcohol Consumption Levels and All-Cause Mortality Among Women Veterans and Non-Veterans Enrolled in the Women's Health Initiative. The Gerontologist. 2016 Feb 1; 56 Suppl 1:S138-49.
20. Harris AH, Rubinsky AD, Hoggatt KJ. Possible Alternatives to Diagnosis-Based Denominators for Addiction Treatment Quality Measures. Journal of substance abuse treatment. 2015 Nov 1; 58:62-6.
21. Friedman SA, Frayne SM, Berg E, Hamilton AB, Washington DL, Saechao F, Maisel NC, Lin JY, Hoggatt KJ, Phibbs CS. Travel time and attrition from VHA care among women veterans: how far is too far? Medical care. 2015 Apr 1; 53(4 Suppl 1):S15-22.
22. Katon JG, Hoggatt KJ, Balasubramanian V, Saechao FS, Frayne SM, Mattocks KM, Feibus KB, Galvan IV, Hickman R, Hayes PM, Haskell SG, Yano EM, Phibbs CS, Zephyrin LC. Reproductive health diagnoses of women veterans using department of Veterans Affairs health care. Medical care. 2015 Apr 1; 53(4 Suppl 1):S63-7.
23. Hoggatt KJ, Prescott MR, Goldmann E, Tamburrino M, Calabrese JR, Liberzon I, Galea S. The prevalence and correlates of risky driving behavior among National Guard soldiers. Traffic Injury Prevention. 2014 Sep 26; 16(1):17-23.
24. Robinson WR, Cheng MM, Hoggatt KJ, Stürmer T, Siega-Riz AM. Childbearing is not associated with young women's long-term obesity risk. Obesity (Silver Spring). 2014 Apr 1; 22(4):1126-32.
25. Cucciare MA, Simpson T, Hoggatt KJ, Gifford E, Timko C. Substance use among women veterans: epidemiology to evidence-based treatment. Journal of addictive diseases. 2013 Jan 1; 32(2):119-39.
26. Hoggatt KJ, Flores M, Solorio R, Wilhelm M, Ritz B. The "Latina epidemiologic paradox" revisited: the role of birthplace and acculturation in predicting infant low birth weight for Latinas in Los Angeles, CA. Journal of immigrant and minority health / Center for Minority Public Health. 2012 Oct 1; 14(5):875-84.

Journal Other

1. Hill J, Hoggatt KJ. The Tenability of Counterhypotheses: A comment on Bross' discussion of statistical criticism. Observational studies. 2018 Jan 1; 4(2018):34-41.
2. Hoggatt KJ, Greenland S. Commentary: extending organizational schema for causal effects. Epidemiology (Cambridge, Mass.). 2014 Jan 1; 25(1):98-102.
3. Bhavnani D, Hoggatt KJ, Goldstick JE, Cevallos W, Trueba G, Eisenberg JN. Bhavnani et Al. respond to "assessing mechanistic interaction". American journal of epidemiology. 2012 Sep 1; 176(5):400-1.

Reports

1. Yano E, Uchendu U, Washington DL, Frayne S, Haskell S, Saechao F, Farmer M, Haynes P, Saliba D, Hoggatt K, Izquierdo A, Cozad A, Capra G, Maher N, Cohen A, Glover D. National Veteran Health Equity Report -- FY2013. Washington, D.C.: US Department of Veterans Affairs; 2016 Oct 1. 199 p.

VA Cyberseminars

1. Russell L, Wong M, Zulman DM, Hoggatt KJ, Steers WN, Frayne SM, Huynh AK, Yano EM, Saechao FS, Ziaeian B, Washington DL. Social Risks for Adverse Health Outcomes Among Veterans. Focus on Health Equity and Action [Cyberseminar]. VA HSR&D. 2019 Jul 10.
2. Uchendu US, Hoggatt KJ, Frayne S. Advancing Health Equity Through Partnered Evaluation and Action. Focus on Health Equity and Action [Cyberseminar]. HSR&D. 2017 Nov 16.
3. Hoggatt K, Hepner K. Improving the Measurement of Alcohol-related Care: Results from the RAND-VA AQUAL Study. HSR&D Career development Awardee Series [Cyberseminar]. HSR&D. 2016 Dec 13.

Conference Presentations

1. Frayne SM, Phibbs CS, Berg E, Friedman SA, Yano EM, Washington DL, Saechao FS, Finlay AK, Hoggatt K, Hamilton AB. One foot in the door and one foot out: Attrition among women community care users who have recently joined the VA. VA National Meeting: Examining the New Landscape of Care in the Community for Veterans. Paper presented at: VA HSR&D Field-Based Examining the New Landscape of Care in the Community for Veterans Meeting; 2016 Aug 8; Arlington, VA.

DRA: Mental, Cognitive and Behavioral Disorders, Substance Use Disorders
DRE: Prognosis
Keywords: none
MeSH Terms: none