Several large national studies are producing a wealth of information about women's health--and showing the importance of behavioral scientists in designing such research, say researchers who discussed the studies at APA's "Enhancing Outcomes in Women's Health" conference, Feb. 21-23, in Washington, D.C.
The research efforts, they explained, involve thousands of women and will paint a far more accurate picture of the risks and predictors of disease in women. "These studies will produce thousands of papers in women's health issues over the next several decades," said Wake Forest University psychologist Sally Shumaker, PhD, who chaired the session. "It's an amazing wealth of knowledge that's going to be pouring into the journals on women's health."
The studies are also providing critical insight into the best ways to recruit large numbers of study participants and to help them maintain the lifestyle changes researchers ask them to make, such as strict diet requirements.
By helping with such behavioral elements, psychologists are an integral part of these research teams, says Shumaker. "There are incredible opportunities for behavioral and social scientists to do research with funding from NIH, and we really need more folks with that kind of background and training and expertise to help us do the kind of complicated studies that are emerging," she added.
Study of Women's Health Across the Nation (SWAN)
SWAN, a seven-site, multiethnic study of women as they transition through menopause, was developed to investigate the chronology of biological and psychosocial characteristics of menopause, describe the impact of this transition on women's subsequent health, examine psychosocial factors related to menopause, and elucidate factors that differentiate symptomatic and asymptomatic women.
"SWAN is the largest, most ambitious and most complete study of menopause to date," said Nancy Avis, PhD, of Wake Forest University School of Medicine. "Because we have such detailed and extensive psychological, behavioral, epidemiologic and physiologic data, we can integrate all of these factors and really look at a biopsychosocial model [of menopause.]"
Begun in 1994 and now in its third phase, SWAN is conducting a prospective, longitudinal study of more than 3,000 women ages 42 to 52 as they approach and experience menopause. Researchers are collecting data on a multitude of factors--cardiovascular health, bone density, blood pressure, glucose, body composition, lipids, ovarian markers, hormone profiles, menstrual calendars and psychosocial and epidemiologic factors--to examine how they relate to women's quality of life, menopause symptoms, depression and sexual functioning. The study, funded largely by the National Institute on Aging, includes large numbers of African-American, Hispanic, Chinese, Japanese and Caucasian women.
The second phase, a community-based cross-sectional survey, has already yielded interesting data, including:
African-American women reported the most positive attitudes toward menopause while Chinese and Japanese women had the least positive attitudes.
Caucasian women reported significantly more psychosomatic symptoms and dysphoric mood symptoms. Dysphoric mood symptoms were more frequent in perimenopasual women than either pre- or postmenopausal women.
Menopausal status was not related to women's quality of life.
During SWAN's first phase, researches conducted 27 focus groups of middle-aged women to make sure the study protocol was relevant for several ethnicities included in the study.
Women's Intervention Nutrition Study (WINS)
WINS is tracking 2,437 women, ages 48 to 78, treated for early-stage breast cancer and randomized into a nutrition intervention or control group. Researchers are investigating whether those in the nutrition intervention--who are consuming significantly less dietary fat and more fruits, vegetables and grains than the control group--are less likely to have a re-occurrence of breast cancer. Women in the intervention group receive counseling to reduce their dietary fat intake to 15 percent of their total calories, while those in the control group only received information on dietary guidelines.
The study will close at the end of next year, with final results that will tease out the relationship between dietary fat and breast cancer by the end of 2004.
Data from the WINS feasibility trial are already pointing out some useful information about how women adhere to strict diet requirements. Researchers have found that continual assessment and intervention may be necessary to help women maintain their diet, said Kathryn Hoy, a nutritionist with the American Health Foundation, which is funding the study.
"Dietary behavior change is a dynamic process," Hoy explained. "Don't just assume that high adherers are home-free, low adherers are a lost cause and middle adherers are the only best bet. All participants may benefit from brief intervention periodically to promote adherence and prevent relapse."
Women's Health Initiative (WHI)
Coordinated out of the National Institutes of Health's Heart, Blood and Lung Institute, WHI is tracking thousands of women in three clinical trials and an observational trial to see whether better nutrition, calcium supplements and hormone-replacement therapy can reduce the occurrence of coronary heart disease, breast and colorectal cancer, and osteoporotic-fractures in postmenopausal women. The initiative is a 15-year, multimillion dollar research project that's taking a three-prong approach:
Randomized controlled clinical trials. In three trials, researchers are investigating whether hormone-replacement therapy reduces coronary heart disease in more than 27,000 women, whether dietary modification can reduce the chances of breast cancer in about 48,800 women, and whether taking a calcium and vitamin D supplements reduces hip fractures in about 40,000 women.
Observational study. Researchers are tracking the health of more than 93,600 women who have been given no intervention over 10 years to identify predictors of disease.
Study of community approaches. WHI is also investigating ways to develop healthful behaviors in community-based settings.
"We don't know a lot about how to ask people [to make] and help people maintain large changes," said Deborah Bowen, PhD, of the Fred Hutchinson Cancer Research Center in Seattle. "So, this is an opportunity for social scientists to both understand the process of maintenance, but also get involved in producing the maintenance effects" needed to test the WHI's hypotheses.
While the last participant visits for WHI won't occur for another three years, and final data won't be available for a year or so after that, WHI researchers have already published dozens of articles on the data gathered thus far. More information is available at www.nhlbi.nih.gov/whi.