Faculty Bibliography

Women with a history of sexual violence may face obstacles to obtaining preventive health services. Group education models have been used in other settings to improve knowledge and uptake of care. Focus groups were conducted to solicit the concerns and input of the subject population. Interdisciplinary group education sessions (GESs) were designed specifically to address concerns voiced in focus groups. GESs were conducted, addressing mammograms, pelvic examinations, and menopause, and emphasized preventive health education, as well as shared decision-making. GESs were audio recorded and qualitative feedback was collected immediately after each GES. Surveys were administered before and after each GES to evaluate attitude and knowledge change. A total of 18 women attended the focus groups, and 27 women attended at least one GES, with 12 women attending both. GESs were well received, and participants cited the education, group support, and healing dynamic as benefits of participation. Content knowledge improved after all three GESs. Attitude change showed a trend toward improvement, but the sample size was not large enough to detect statistical significance. Group education is an acceptable and feasible model among survivors of sexual violence. GESs improved knowledge among this small group of participants. GESs could be made available in a wide range of topics, as requested by our participants. Larger studies are warranted to examine long-term knowledge and attitude change after GESs.

INTRODUCTION: The impact of sexual violence (SV) on mental health, self-care, and interpersonal relationships is profound and poses special challenges to health care delivery. Reproductive health care merits special attention because the care required may be linked to reminders of past abuse. We explored facilitators and barriers affecting the use of reproductive health services among women veterans with a history of SV. METHOD: Between June and September 2015, we conducted 2 focus groups and 3 general education sessions with 27 female veterans with a history of SV at 1 medical center. We analyzed transcripts according to applied thematic analysis and used Nvivo software for data management and retrieval. RESULTS: Three main themes emerged from the focus groups and education sessions. PARTICIPANTS: (a) expressed a desire for greater agency in relation to the control they have over their bodies and medical care; (b) described how posttraumatic stress symptoms are retriggered during medical care; and (c) expressed needs for additional education, peer and provider support within the medical system. DISCUSSION: For women with a history of SV, multiple individual and systemic barriers complicate how they utilize reproductive health services. Group education sessions were an effective mode of support, information and connection to other women within the Veterans Health Administration. (PsycINFO Database Record

BACKGROUND: Food insecurity (FI) occurs when individuals or households have limited or uncertain access to adequate food. People with FI may find it particularly difficult to eat a balanced diet and manage weight. Individuals who report FI are 1.4 times more likely to have obesity. U.S. Veterans have a greater prevalence of FI compared with the general population (24% vs. 19%). As part of a pilot randomized controlled trial to test the impact of an obesity intervention for Veterans, we explored the prevalence of FI in our sample and assessed the impact of FI on weight outcomes. METHODS: Veterans with a Body Mass Index of greater than or equal to 30 or between 25 and 29.99 with at least one comorbidity were recruited by phone for a pilot study. Participants randomized to the intervention received a technology-assisted health coaching session and follow-up coaching calls; control participants received a VA "healthy living messages" pamphlet. At baseline and 3 months, participants had weight measurements and completed surveys. To measure FI, we used a 6-item Household Food Security Scale (FI = 2 or more affirmative responses). We assessed the impact of FI on variables independent of arm assignment in participants who returned for a 3-month measurement visit (Wilcoxon rank sum tests and Fisher's Exact Test). We also analyzed the role of FI as a moderator between arm and study variables using ANOVA. RESULTS: Out of 31 Veterans who enrolled in the study (Mean age = 53.48, 63% male, mean BMI = 31.72), 10 demonstrated FI at baseline and 25 participants completed 3 month measurements. Independent of the intervention, those with FI (n = 10) lost .01 kg of weight and those without FI (n = 15) lost 1.69 kg at 3-months but the difference was not significant (p = 0.2). Similarly, 0/10 Veterans with FI achieved 2.5% weight loss, compared to 4/15 of those without FI (p = 0.12). Those with FI in the control group gained weight when compared to those without FI (1.04 kg, SD = 1.41 vs. -1.75, SD = 3.96) and those with FI in the intervention lost the same amount of weight as those without FI (-1.59 kg, SD = 0.83, vs. -1.59, SD = 2.27; p = 0.24 for the interaction (not significant)). CONCLUSIONS: FI in Veterans enrolled in a weight management study is high. Participants with FI in the control arm may have gained weight when compared to non-FI participants, while intervention arm participants with FI lost similar amounts of weight to those without FI. This suggests that the intervention may reduce the negative impact of FI. While this pilot study was not powered to show a significant difference, we have amended health coaching protocols to better address FI in our intervention (e.g. screening for FI and linking participants with Supplemental Nutrition Assistance Program (SNAP) benefits and similar resources) hoping to maximize its effectiveness

BACKGROUND: Obesity is under-treated and primary care teams find it difficult to provide effective lifestyle-based weight management counseling. Further, only 10% of eligible patients attendMOVE!, theVAweight management and health promotion program. We developed an intervention called Goals for Eating and Moving (GEM) to improve counseling within primary care (PC) and increase attendance in intensive weight management programs such as MOVE!. METHODS: Veterans with a Body Mass Index of greater than or equal to 30 or between 25 and 29.99 with at least one comorbidity were recruited by phone and randomized toGEMor "Enhanced Usual Care" (EUC). GEMutilizes the Patient Aligned Care Teams (PACTs) within the VA to deliver 5As counseling (Assess, Advise, Agree, Assist and Arrange) to promote modest weight loss and behavior change. Participants use a goal-setting tool to generate tailored materials, which facilitates in-person and phone counseling with health coaches. Coaches support PACTcounseling during regular PC visits and encourage participants to join VA weight management services. Veterans in GEM received the intervention and Veterans in EUC met with a coach to receive the VA "healthy living messages" pamphlet. At baseline and 3 months, participants had weight measurements and completed surveys. We used the Paffenbarger Physical Activity Questionnaire and a 17-item screener to derive fruit and vegetable intake, energy from fat, and dietary fiber. Vegetable intake (leafy greens/salad) and sugar-sweetened beverage were measured as individual items. We performed per-protocol analyses (Wilcoxon Rank sums test and Spearman Correlation) to assess the relationship between GEM and different variables. RESULTS: Thirty-one Veterans (mean age = 53.48, 63% male, mean BMI = 31.72) enrolled and 25 returned at 3-months (1 dropped out and 5 were lost-tofollow up). Those in GEM lost significantly more weight at 3-months (-1.59 kg, SD = 1.76) than those in EUC (-0.63 kg, SD = 3.42, p = 0.03). There were no statistically significant differences in diet and physical activity. For Veterans that received GEM, higher number of phone coaching sessions was correlated with weight loss (Spearman Correlation -0.58, p = 0.09). CONCLUSIONS: This early analysis indicates that GEM promotes small but significant (p = 0.03) weight loss at 3-months and identified the need for high patient retention and engagement, since the number of health coaching calls may correlate with weight loss. Based on this we have refined protocols for phone coaching to ensure that scheduling and reminder calls are patientcentered. This pilot study informed the development of a multi-site cluster- RCT of GEM to begin in June 2017 (NIH # 1R01 DK111928-01)

OBJECTIVE: This study compared health care access, utilization, and functional indicators among adults with and without serious psychological distress (SPD) in the years surrounding implementation of the Patient Portable and Affordable Care Act (ACA). METHODS: Adults ages 18 to 64 from the 2006-2014 National Health Interview Survey (N=207, 853) were examined on 11 access, utilization, and functional indicators: health insurance coverage (health coverage), insufficient money for medications, delay in health care (delay in care), insufficient money for health care, visiting a doctor ten or more times in the past 12 months, change in place of health care, change in place of health care due to insurance, limitations in ability to work, limitations in activities of daily living (ADLs), insufficient money for mental health care, and having seen a mental health care provider. RESULTS: Multivariate models that were adjusted for health coverage and sociodemographic characteristics indicated that compared with adults without SPD, adults with SPD had greater odds of lacking money for medications (AOR=10.0) and health care (AOR=3.1), experiencing delays in care (AOR=2.7), visiting a doctor ten or more times in the past 12 months (AOR=3.2), changing usual place of health care (AOR=1.5), changing usual place of health care because of insurance (AOR=1.5), and experiencing limitations in ADLs (AOR=3.6) and ability to work (AOR=1.8). The proportions of adults with SPD who lacked health coverage and money to buy prescriptions increased during the study period. Although this trend reversed in 2014, the proportion with SPD experiencing barriers remained above 2006 levels. CONCLUSIONS: Health care patterns among adults with SPD require greater attention.