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The
Latest in Nursing Research
 Surviving
Menopause with Soy
When
the Battered Are Men
Examining
Links Between
Violence and Substance Abuse
Raising
Awareness in the Korean Community
Surviving
Menopause with Soy
 Joan
Clark was on hormone replacement therapy (HRT) for 10 years, but after
hearing about the dangers of long-term HRT use, she immediately stopped
taking the drugs. She wasn’t prepared for what came next.
“Women
now are advised to taper off the drugs, but I just stopped cold,” she
explains. That was in August of 2001. “The symptoms of menopause came
back — full force — in just two weeks.”
When
a co-worker told Clark about a Johns Hopkins School of Nursing trial
testing the potential of soy to lower cholesterol levels and alleviate
menopausal symptoms in postmenopausal women, her interest was piqued.
Clark’s main concern was easing her hot flashes and mood swings, but
when enrolled in the trial, she was alerted to a serious health concern.
“My
cholesterol had crept up to 260! I see an internist every year, and
I had no idea it was that high,” says Clark, a Hopkins employee since
1965. Clark qualified for the NIH-funded study — the Beneficial Effects
of Soy Trial (BEST) — led by Jerilyn Allen, ScD, RN, professor and
associate dean for research at the School of Nursing. The study looks
at postmenopausal women with slightly elevated levels of cholesterol.
Though such levels would not necessarily require medication, they might
increase lifetime risk for cardiovascular disease. Researchers aim
to enroll a total of 180 women in the study.
“Cardiovascular
disease remains the leading cause of mortality and disability in postmenopausal
women,” Allen says. “Lack of estrogen from menopause can cause increases
in bad cholesterol and decreases in good cholesterol, which can lead
to narrowing of the arteries and increased risk for heart attack.”
Previous
clinical trials have shown that soy protein containing isoflavones
(a plant hormone that resembles a weak version of human estrogen) can
offset high cholesterol. According to Allen, what sets this study apart
from others is that recruitment targets equal numbers of African American
women and white women.
“There
is very little research [involving] African American postmenopausal
women. Many of these women prefer natural remedies as opposed to medication,” explains
Allen. “This is a group that is eager for alternatives to hormone replacement
therapy.”
As
an initial step, each woman in the study is given a health assessment.
Then BEST provides an hour’s worth of nutrition and diet counseling
so that the participants can make healthier choices. The women then
begin the four month program, taking a daily shake-like drink, which
may or may not contain a soy protein. The women are randomly assigned
to one of the two groups, and the study is double-blind, so neither
participants nor researchers know which women are receiving the soy
supplement and which are taking the placebo. At the beginning, in the
middle, and at the end of the four months, each woman’s cholesterol
levels are measured and each completes a questionnaire about her symptoms
of menopause.
Unlike
Joan Clark, BEST participants Brenda Joyce Johnson and Jean Headen
weren’t too concerned about easing the symptoms of menopause. They
were primarily interested in soy’s positive effects on cholesterol.
Both women learned about the study from a flier posted at their jobs.
Johnson
says she began trying to improve her health last year and decided to
participate in the study because she knew that consuming soy, along
with eating more fruits and vegetables, exercising, and avoiding salt,
was good for her health.
With
a total cholesterol level at 280 mg/DL, Headen’s doctor considered
putting her on medication, but Headen resisted. “The hardest thing
for me to accept about getting older is taking medication,” she says.
So
Headen started watching what she ate and exercising more, and she participated
in the BEST pilot study, in which 17 women were all given a daily soy
supplement. Her cholesterol dropped to 160 and she enrolled in the
larger study.
Participants
in the study are given the opportunity to receive a free three-month
supply of soy supplement once they complete the trial, and program
coordinator Carol Curtis says most women take advantage of this offer.
But
Headen chose not to. “I was able to drink the supplement every morning
while I was in the study, but after a while, it just got boring,” she
says.
Allen
says that boredom with the regime and non-compliance points to an important “next
step.” “A logical extension of the study, if effective, is how to incorporate
soy into everyday foods,” she explains. “This will present a problem
with some women, particularly low-income women, because soy products,
like tofu, may not be readily accessible in low-income areas.”
Most
women are glad to have participated in the trial, says Curtis: “The
women tell me they like being part of a study that may lead to ways
to help our daughters and granddaughters survive menopause without
taking hormones.”
Recruitment
for the study continues and final results will be available next year.
—MT
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When
the Battered Are Men
In
spite of common belief, victims of domestic violence are not always
women. Michael Relf, PhD, RN, ’01, a professor at the Georgetown
University School of Nursing, authored a study on the prevalence of
battering victimization among gay men, published in last December’s
issue of the American Journal of Public Health. His research
found that gay men living in big cities are as likely to be battered
as heterosexual women and that two in five urban gay men were abused
by a partner sometime in the last five years.
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Examining
Links Between Violence and Substance Abuse
Are
domestic violence and substance abuse related? Assistant Professor Benita
Walton-Moss, DNSc, RN, ’78, intends to find out. She is
principal investigator of a study that was recently awarded grant support
from the National Institute on Drug Abuse. The research focuses on
abused women who are also substance abusers. Walton-Moss examines the
relationship between intimate partner violence and the physical and
mental health of women entering substance abuse treatment.
Walton-Moss
will also adapt and implement a cognitive behavioral therapy specifically
for abused women in drug treatment and obtain initial results of the
therapy’s effectiveness in reducing substance use, improving health
outcomes, increasing safety behaviors, and preventing further violence.
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Raising
Awareness in the Korean Community
 Community-based
research is the focus of a project led byinstructor HaeRa Han, PhD,
RN, aimed at raising awareness about breast cancer among Korean
American women. Han received a grant from the Johns Hopkins University
Urban Health Institute for her study called “Building Community for
Better Breast Health for Korean American Women.” It uses a church-based
breast cancer screening program to increase awareness of breast cancer
and promote breast cancer screening behavior.
—KP
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