MMC- Women's Health

Women’s Health

LEADERSHIP

CORE investigators represent a wide range of expertise in women’s health. Dr. Nananda Col conducts research on risk assessment and shared decision making focusing on women’s health issues including menopause, osteoporosis and breast cancer. She has been an expert panelist on medication use in women for the Agency for Healthcare Research and Quality (AHRQ) and the Department of Health and Human Services (DHHS), and is a member of the Breast Cancer Technology Assessment Working Group at the American Society of Clinical Oncologists (ASCO). She has been a career mentor for investigators in women’s health and was director of a women’s health career development program. Dr. Heather Miller has extensive experience addressing women’s health issues at the National Institutes of Health, where she served as Senior Advisor on Women’s Health. She has served as a member of various advisory groups on family planning, women’s health and the environment and menopause at the Department of Health and Human Services (DHHS), the Center for Disease Control (CDC) and the National Institutes of Health (NIH). She has led multiple large-scale studies on sexually transmitted disease and high risk sexual behavior. Dr. Susan Miesfeldt, a clinical oncologist and the Director of the Cancer Risk and Prevention Program at Maine Medical Center, specializes in screening and detection of breast, cervical and colon cancer among high risk populations. She serves on multiple tasks forces for the State of Maine and is involved with the National Institutes of Health Cancer Genetics Studies Consortium and the American Society of Clinical Oncology.

Smoking Cessation among Young Women

PROJECTS (Current)

Young women who smoke face serious health risks, yet rarely seek help. Brief Behavioral Interventions by physicians in smoking are effective but underused in this population. Computer-generated health behavior interventions can be effective, especially when tailored, but there are many barriers to integrating screening and behavioral interventions into primary care practices. Audience segmentation, currently used to market cigarettes and alcohol to young adults, is a method that may allow us to develop more effective, targeted messages to patients and providers for prevention counseling.

This project seeks to increase the successful application of brief interventions by combining them with social marketing theory to enhance patient appeal and effectiveness. It utilizes the advantages of web-based technologies to maximize dissemination and minimize costs. We have developed a practical, innovative web-based intervention tool called DEBBI designed to be used by young female smokers and their clinicians. Based on women’s responses to questions on the web site, DEBBI delivers a brief message tailored to the smoker. We now seek to integrate this technology into different clinical practice settings as part of the Randomized Controlled Trial (RCT) phase. This study is funded by the Agency for Healthcare Research and Quality (AHRQ).

SELECTED PUBLICATIONS (since 2000)

Haskins A, Mukhopadhyay S, Pekow P, Markenson G, Bertone-Johnson E, Carbone E, Fortner RT, Chasan-Taber L.. Smoking and risk of preterm birth among predominantly Puerto Rican women. Ann Epidemiol 2008; 18: 440-446.
Ewan Whyte C, Keller SN, Slater MD, Pbert L, Chang E, Druker S, Kuhl LN, Col NF. Tailoring web-based interventions to young female smokers using audience segmentation. Journal of General Internal Medicine. In press (abstract).
Kuhl L, Keller SN, Slater MD, Pbert L, Chang E, Druker S, Ewan Whyte C, Col NF. A novel approach to tailoring physician-delivered smoking cessation messages to young women. Journal of General Internal Medicine. In press (abstract).
Rose JS, Chassin JL, Presson CC, Sherman SJ, Stein MD, Col NF. A latent class typology of young women smokers. Addiction 2007; 102:1310-1319.
Hanauer D, Dibble E, Fortin J, Col NF. Internet usage among community college students: Implications in designing health care interventions. J Am College Health 2004; 52(5):197-202.

Menopause

PROJECTS (Current and Completed within the past 3 years)

We developed an online decision support tool called Women’s Interactive System for Decisions on Menopause (WISDOM©). Using WISDOM©, patients complete an online, interactive tutorial and questionnaire about their menopausal symptoms, medical history, general health status, blood pressure, cholesterol, and bone density readings and treatment preferences. The WISDOM© system generates risk reports reflecting their individualized risk assessments for cardiovascular disease, breast cancer, and osteoporotic hip fracture. It also generates a personalized interactive matrix that allows an exploration of choices for menopausal therapy (prescription, OTC, herbal, and dietary/vitamins), along with any contraindications to treatments. WISDOM© also generates a summary report for her clinician and pharmacist. This unique website was tested in a large randomized controlled clinical trial and found to have a strong positive impact on both patients and providers, improving knowledge, patient satisfaction, and patient-provider communication.

Building on the success of the clinical trial, CORE is currently adding to WISDOM© with a study called Incorporating Temporary Health States into Decision Support (PATHS). This study seeks to address the issues of duration and severity of symptoms during menopause and how these may effect decision making regarding treatment for menopausal symptoms. Providing women with information about the duration and severity of their symptoms may help them make more informed decisions regarding the risks and benefits of various treatment options. Additionally, PATHS incorporates values clarification exercises into the decision-making process. This project is funded by the Agency for Healthcare Research and Quality (AHRQ).

SELECTED PUBLICATIONS (since 2000)

Col NF, Chlebowski RC. Managing the risk of breast cancer in postmenopausal women. Menopause 2008; In press.
Politi M, Schleinitz M, Col NF. Revisiting the duration of vasomotor symptoms of menopause: a meta-analysis. J Gen Int Med 2008; In press.
Matloff ET, Shannon KM, Moyer A, Col NF. Should menopausal women at increased risk for breast cancer use tamoxifen, raloxifene, or hormone therapy? A framework for personalized risk assessment and counseling. J Cancer Edu 2007; 22:10-14.
Col NF. Using internet technologies to improve and simplify counseling about menopause. Maturitas 2007; 57:95-99.
Col NF, Ngo L, Fortin JM, Goldberg RJ, Stiggelbout AM. Can computerized decision support help patients make complex treatment decisions? A randomized controlled trial of an individualized menopause decision aid. Med Decis Making 2007; 27: 585-598
Hohenhaus MH, McGarry KA, Col NF. Hormone therapy for the prevention of bone loss in menopausal women with osteopenia: is it a viable option? Drugs 2007; 67(16):2311-21.
Chlebowski RC, Garnet L. Anderson GL, Geller M, Col NF. Coronary heart disease and stroke with aromatase inhibitor, tamoxifen and menopausal hormone therapy use. Clin Breast Cancer 2006; 6:S58.
Matloff ET, Moyer A, Shannon KM, Niendorf, KB, Col NF. Healthy women with a family history of breast cancer: impact of a tailored genetic counseling intervention on risk perception, knowledge, and menopausal therapy decision-making. J Women’s Health 2006; 15(7):843-56.
Col NF. The impact of risk status, preexisting morbidity, and polypharmacy on treatment decisions concerning menopausal symptoms. Am J Med 2005; 118 (12):1411.
Col NF, Kim JA, Chlebowski RT. Menopausal hormone therapy after breast cancer: A meta-analysis and critical appraisal of the evidence. Breast Cancer Research 2005; 7:R535-40.
Chlebowski RC, Col NF. Menopausal hormone therapy after breast cancer. Lancet 2004; 363:410-411.
Sherman S, Miller HG, Nerurkar L, Schiff I. Research opportunities for reducing the burden of menopause-related symptoms. American Journal of Medicine 2005, 118 (Suppl. 2): 166-171.
Col NF, Weber G, Stiggelbout AM, Chou J, D’Agostino R, Corso P. Short-term menopausal hormone therapy for symptom relief: An updated decision model. Arch Intern Med 2004; 164:1634-1640.
Miller HG, Li RM. Measuring hot flashes. Mayo Clinic Proceedings 2004, 79:668-670.
Chlebowski RC, Kim JA, Col NF. Estrogen deficiency symptom management in breast cancer survivors in the changing context of menopausal hormone therapy. Seminars in Oncology 2003; 30:776-88.
Col NF, Pauker SG. Discrepancy between observational studies and randomized trials of menopausal hormone therapy: Did expectations shape experience? Ann Intern Med 2003; 139:923-929.
Bond B, Hirota L, Fortin J, Col NF. Women like me: Reflections on health and hormones from women treated for breast cancer. J Psychosoc Onc 2002; 20:39-56.
Col NF, Hirota LK, Orr RK, Erban JK, Wong JB, Lau J. Hormone replacement therapy after breast cancer: A systematic review and quantitative assessment of risk. J Clin Oncol 2001; 19(8):2357-2363.

Osteoporosis

PROJECTS (Current)

The goal of this project is to develop a web-based decision aid to help postmenopausal women choose among the various treatment options for osteoporosis. Currently there are multiple options for the treatment of osteoporosis, and clinical guidelines do not suggest one best treatment. CORE is designing a website that helps women to find the treatment that is best for them. It includes the latest evidence on all drugs that affect osteoporosis, and helps them understand the benefits and risks of treatment and incorporate their preferences into the decision. This project is funded by the Agency for Healthcare Research and Quality (AHRQ).

SELECTED PUBLICATIONS (since 2000):

Kuhl LN, Ettinger B, Rosen CJ, Col NF. Non-skeletal effects of osteoporosis: does the evidence support the conclusions? Annals of Internal Medicine Online Mar 11 2008.
Col NF, Bowlby LA, McGarry K. The role of menopausal hormone therapy in preventing osteoporotic fractures: A critical review of the clinical evidence. Minerva Medica 2005; 96(5):331-42.
Braithwaite RS, Col NF, Wong JB. Estimating hip fracture morbidity, mortality and costs. J Am Geriatr Soc 2003; 51:364-70.

CANCER

CORE investigators are involved in many areas of cancer research related to women’s health, including research on breast, ovarian and colon cancer. Please visit our cancer research page for more information on research in this area.