Abstract
Background:
Ensuring enhanced delivery of care to women Veterans is a top Veterans Affairs (VA) priority; however, women are historically underrepresented in research that informs evidence-based health care. A primary barrier to women's participation is the inability to engage with research in person due to a number of documented challenges. The VA Million Veteran Program (MVP) is committed to increasing access for women Veterans to participate in research, thereby better understanding conditions specific to this population and how disease manifests differently in women compared to men. The goal of this work is to describe the results of the MVP Women's Campaign, an effort designed to increase outreach to and awareness of remote enrollment options for women Veterans.
Materials and Methods:
The MVP Women's Campaign launched two phases between March 2021 and April 2022: the Multimedia Phase leveraged a variety of strategic multichannel communication tactics and the Email Phase focused on direct email communication to women Veterans. The effect of the Multimedia Phase was determined using t-tests and chi-square tests, as well as logistic regression models to compare demographic subgroups. The Email Phase was evaluated using comparisons of the enrollment rate across demographic groups through a multivariate adjusted logistic regression model.
Results:
Overall, 4694 women Veterans enrolled during the MVP Women's Campaign (54% during the Multimedia Phase and 46% during the Email Phase). For the Multimedia Phase, the percentage of older women online enrollees increased, along with women from the southwest and western regions of the United States. Differences for women Veteran online enrollment across different ethnicity and race groups were not observed. During the Email Phase, the enrollment rate increased with age. Compared to White women Veterans, Blacks, Asians, and Native Americans were significantly less likely to enroll while Veterans with multiple races were more likely to enroll.
Conclusion:
The MVP Women's Campaign is the first large-scale outreach effort focusing on recruitment of women Veterans into MVP. The combination of print and digital outreach tactics and direct email recruitment resulted in over a fivefold increase in women Veteran enrollees during a 7-month period. Attention to messaging and communication channels, combined with a better understanding of effective recruitment methods for certain Veteran populations, allows MVP the opportunity to advance health and health care not only for women Veterans, but beyond. Lessons learned will be applied to increase other populations in MVP such as Blacks, Hispanics, Asians, Native Americans, younger Veterans, and Veterans with certain health conditions.
Keywords: Veterans, Million Veteran Program, women, recruitment
Introduction
Women Veterans make up the fastest growing segment of Veterans Health Administration (VHA) users. From 2005 to 2015, women Veterans accessing VHA care nearly tripled.1 As such, ensuring delivery of comprehensive, evidence-based women's care is a key VHA priority, given that its health care system predominantly delivers services to men, who comprise over 90% of the Veteran population. Research focusing on enhanced treatment for women Veterans has also increased in recent years2; an important step in helping to overcome the historical lack of women represented in research overall. This imbalance limits understanding gender-based differences in Veterans and their impact on health, especially as women Veterans vary both from a demographic and clinical care perspective.
Women Veterans are younger, more racially and ethnically diverse, and are 20% more likely to utilize mental health services compared to men.3 Access to care for women Veterans, particularly for mental health services, is also faced with challenges, ranging from lack of family care and travel issues to reports of harassment experienced in waiting rooms.4,5 Offering remote methods for women to receive care (e.g., through telehealth or virtual options) has garnered support in an effort to remove barriers reported by women Veterans.2 Likewise, remote participation opportunities should also be offered to engage more women Veterans in research.
The Department of Veterans Affairs (VA) Million Veteran Program (MVP), launched in 2011, is one of the world's largest and most comprehensive cohorts of genetic, health record, lifestyle, and military experience information with a focus on understanding how these factors impact the health and wellness of Veterans.6,7 As of October 2022, over 912,000 Veterans are enrolled in MVP, with participant demographics closely matching VHA users. To date, ∼90,000 women Veterans enrolled in MVP, representing close to 10% of the overall cohort. One of MVP's priorities is to over-index women in the cohort, thereby increasing statistical power needed for meaningful genetic research on conditions important to this population.
In 2019, MVP launched an online platform enabling at-home enrollment, including informed consent, survey completion, and blood specimen collection arrangements. While ∼97% of MVP enrollments continue to occur at VA facilities, the online option for enrollment has increased access for many Veterans, including underrepresented populations in research. As of November 2021, Veterans who enroll online can have blood collection devices mailed directly to them, allowing for full remote enrollment.
MVP offers a unique opportunity to better understand conditions, particularly genetic conditions, in areas specific to women Veterans, such as breast cancer and mental health, which affect more women than men in the Veteran community. Previous work has described gender differences in the demographic and health characteristics of MVP, with small-scale pilot work on focused recruitment of women Veterans.8
In 2021, MVP launched a recruitment campaign to increase enrollment of women Veterans focusing on the ability to enroll online, to support expanding research into women Veterans' health. The goal of this work is to describe the results of the MVP Women's Campaign overall and stratified by demographic characteristics.
Materials and Methods
The VA Central Institutional Review Board is responsible for oversight and approval of MVP (no. 10-02). The MVP Women's Campaign comprised two phases which took place between March 2021 and April 2022. The Multimedia Phase focused on leveraging a variety of multichannel communication strategies such as social and traditional media, mass email, blogs, videos, podcasts, newsletters, print outreach materials, and presentations to partners and stakeholders. The Email Phase focused on direct email communication to women Veterans. Key messages for all campaign materials focused on highlighting the importance and potential impacts of increasing the representation and inclusion of women Veterans in health research, including how participation in MVP may help advance breakthroughs in women Veteran's health care.
Multimedia phase
The Multimedia Phase ran from March 2021 to August 2021 and involved ∼90 activities ranging from a national VA press release; an outreach toolkit with materials such as posters, social media posts, digital billboards distributed to all 171 VA medical centers and women Veteran-focused Veteran Service Organizations (VSOs); podcast episodes; a Facebook Live event; local feature stories; public service announcements; a VA News episode; and an email campaign distributed by the VA Veteran Experience Office.
To evaluate the effect of the Multimedia Phase on enrollment of women Veterans online, the crude difference of MVP enrollment online was compared before and after the Multimedia Phase across different demographic groups using t-tests for continuous variables and chi-square tests for categorical characteristics. A multivariate adjusted comparison with mutual adjustment of age, ethnicity, race, geographic area, and service era was conducted using logistic regression models comparing each demographic subgroup with the reference group.
Email Phase
The Email Phase ran from March 24, 2022, to April 30, 2022, and entailed testing and full rollout phases. Four different email templates were tested with ∼4600 women Veterans in each group. The most successful template, determined by largest percent of enrollments, was used to contact an additional 478,979 women Veterans. Women were contacted using the same email two times, about 1 week apart.
To determine the impact of the Email Phase, the enrollment rate of the 478,979 women Veterans contacted by email was calculated. Comparisons of the enrollment rate across different demographic groups were conducted using a multivariate adjusted logistic regression model mutually adjusted for age, ethnicity, race, geographic area, and service era. Likelihood of enrollment comparing different groups was calculated using odds ratios (ORs) and 95% confidence intervals (CIs). Missing data were not included in the analyses of enrollment rate but were included in the multivariate adjusted logistic regression model as a separate group.
Data for both phases include information from participant self-report (through the MVP Baseline Survey) supplemented with information obtained from the VA Corporate Data Warehouse (CDW).9 All analyses were completed using SAS 9.4 (Cary, North Carolina).
Results
Overall, 4594 women Veterans enrolled during the MVP Women's Campaign time frame. Of these enrollments, 54% occurred during the Multimedia Phase and 46% occurred during the Email Phase.
Multimedia Phase
During the 6 months of the Multimedia Phase, a total of 2496 women Veteran enrolled online. The percentage of women enrollees increased from 9.2% to 25.4% of all new enrollees. Table 1 presents the demographic characteristics of women Veterans who enrolled online before (n=1068) and after the Multimedia Phase (n=2496). Among women Veterans who enrolled online, the percentage of older women enrollees increased, primarily in the 60–69 years age bracket (22.7–35.3%). Women from the southwest (14.5–17.4%, p=0.03) and west increased (17.4–23.0%, p=0.001) while women from the northeast decreased (12.3–8.4%, p=0.01).
Table 1.
Demographic Characteristics of Women Veteran Online Enrollees Before and After the Multimedia Phase
| Characteristicsa | Total women enrolled online n=3568 | Before Multimedia Phase (August 2019–February 2021) n=1072 | After Multimedia Phase (March 2021–August 2021) n=2496 | Crude pb | Multi-pc |
|---|---|---|---|---|---|
| Duration, months | 18 | 6 | |||
| Enrollment rate, n per month | 60 | 416 | |||
| Age at MVP enrollment, mean±SD | 52.5±11.4 | 51.2±11.7 | 53.0±11.3 | <0.001 | <0.001 |
| Age category, n (%) | <0.001 | ||||
| 18–39 years | 597 (16.8) | 203 (18.9) | 394 (15.9) | Ref | |
| 40–49 years | 807 (22.7) | 272 (25.4) | 535 (21.5) | 0.42 | |
| 50–59 years | 874 (24.6) | 298 (27.8) | 576 (23.2) | 0.30 | |
| 60–69 years | 1120 (31.5) | 243 (22.7) | 877 (35.3) | <0.0001 | |
| 70+ years | 160 (4.5) | 56 (5.2) | 104 (4.2) | 0.01 | |
| Hispanic, n (%) | 252 (7.6) | 73 (7.2) | 179 (7.7) | 0.60 | 0.96 |
| Race, n (%) | 0.91 | ||||
| White | 2810 (82.4) | 850 (81.5) | 1960 (82.8) | Ref | |
| Black | 400 (11.7) | 133 (12.8) | 267 (11.3) | 0.37 | |
| Asian | 36 (1.1) | 12 (1.2) | 24 (1.0) | 0.70 | |
| Native American/Alaskan | 34 (1.0) | 9 (0.9) | 25 (1.1) | 0.70 | |
| Native Hawaiian or other Pacific Islander | 17 (0.5) | 5 (0.5) | 12 (0.5) | 0.83 | |
| Other | 27 (0.8) | 9 (0.9) | 18 (0.8) | 0.72 | |
| Multiple races | 87 (2.6) | 25 (2.4) | 62 (2.6) | 0.61 | |
| Geographic area, n (%) | <0.0001 | ||||
| Southeast | 1098 (33.8) | 371 (35.4) | 727 (33.0) | Ref | |
| Northeast | 313 (9.6) | 129 (12.3) | 184 (8.4) | 0.01 | |
| Midwest | 607 (18.7) | 209 (19.9) | 398 (18.1) | 0.91 | |
| Southwest | 534 (16.4) | 152 (14.5) | 382 (17.4) | 0.03 | |
| West | 688 (21.2) | 182 (17.4) | 506 (23.0) | 0.001 | |
| Territories | 10 (0.3) | 6 (0.6) | 4 (0.2) | 0.18 | |
| Service era, n (%) | 0.03 | ||||
| Sep 2001 or later | 240 (7.7) | 82 (8.4) | 158 (7.4) | 0.004 | |
| August 1990–August 2001 (including Gulf War) | 1211 (38.9) | 377 (38.5) | 834 (39.1) | Ref | |
| May 1975–July 1990 | 515 (16.6) | 154 (15.7) | 361 (16.9) | 0.05 | |
| August 1964–April 1975 (Vietnam Era) | 181 (5.8) | 71 (7.2) | 110 (5.2) | <0.0001 | |
| December 1941–July 1964 | 11 (0.4) | 7 (0.7) | 4 (0.2) | 0.005 | |
| Multiple service eras | 954 (30.7) | 289 (29.5) | 665 (31.2) | 0.68 |
List of missing observations: age: 10, ethnicity: 229, race: 157, region: 318; service era: 456.
Comparison between enrolled before and after Multimedia Phase by t-test for continuous variable and chi-square test for categorical characteristics.
Mutually adjusted for age, ethnicity, race, geographic area and service era applying logistic regression model.
MVP, Million Veteran Program; SD, standard deviation.
The percentage of women from the Vietnam era decreased (7.2–5.2%, p<0.0001) as well as those who served earlier than July 1964 (0.7–0.2%, p=0.005), while women who served during May 1975–July 1990 marginally increased (15.7–16.9%, p=0.05). Significant differences for women Veteran online enrollment across different ethnicity and race groups were not observed.
Email Phase
Of the 478,979 women Veterans contacted as part of the Email Phase, 2098 enrolled between March 2022 and April 2022, representing a 0.44% enrollment rate. Most enrollments occurred online compared to in person (75.3% vs. 24.7%). Table 2 displays the demographic characteristics of women Veterans contacted during the Email Phase. The enrollment rate increased with age increment, especially among the 60–69 years age bracket, who were eight times more likely to enroll into MVP (OR=8.45, 95% CI: 7.31–9.77, p<0.0001) compared to women Veterans aged 18–39 years. Compared to White women Veterans, Blacks, Asians, and Native Americans were significantly less likely to enroll, while Veterans with multiple races were more likely to enroll (all p's<0.0001).
Table 2.
Demographic Characteristics of Women Veterans Contacted During the Email Phase
| Characteristicsa | Veterans with Email deliveredb | Not enrolledc | Enrolledc | OR (95% CI)d | p d |
|---|---|---|---|---|---|
| n | 478,979 | 476,881 | 2098 | ||
| % | 99.56 | 0.44 | |||
| Age at enrollment, mean±SD | 48.1±13.1 | 48.1±13.1 | 55.5±10.7 | <0.0001 | |
| Age category, n (%) | |||||
| 18–39 years | 150,176 (31.5) | 149,917 (99.8) | 259 (0.2) | 1.0 | Ref |
| 40–49 years | 110,825 (23.3) | 110,551 (99.7) | 274 (0.3) | 1.46 (1.23–1.73) | <0.0001 |
| 50–59 years | 101,488 (21.3) | 101,178 (99.7) | 310 (0.3) | 2.23 (1.88–2.64) | <0.0001 |
| 60–69 years | 91,467 (19.2) | 90,272 (98.7) | 1195 (1.3) | 8.45 (7.31–9.77) | <0.0001 |
| 70+ years | 22,555 (4.7) | 22,500 (99.8) | 55 (0.2) | 2.62 (1.92–3.57) | <0.0001 |
| Hispanic, n (%) | |||||
| No | 391,461 (90.5) | 389,658 (99.5) | 1803 (0.5) | 1.0 | Ref |
| Yes | 41,317 (9.6) | 41,143 (99.6) | 174 (0.4) | 0.96 (0.81–1.14) | 0.65 |
| Race, n (%) | |||||
| White | 258,737 (61.2) | 257,272 (99.4) | 1465 (0.6) | 1.0 | Ref |
| Black | 137,736 (32.6) | 137,364 (99.7) | 372 (0.3) | 0.50 (0.44–0.56) | <0.0001 |
| Asian | 8838 (2.1) | 8810 (99.7) | 28 (0.3) | 0.59 (0.41–0.86) | 0.007 |
| Native American/Alaskan | 5192 (1.2) | 5176 (99.7) | 16 (0.3) | 0.57 (0.35–0.94) | 0.03 |
| Native Hawaiian or other Pacific Islander | 5544 (1.3) | 5525 (99.7) | 19 (0.3) | 0.76 (0.48–1.21) | 0.25 |
| Other | 427 (0.1) | 405 (94.9) | 22 (5.2) | 1.37 (0.87–2.16) | 0.17 |
| Multiple races | 6180 (1.5) | 6090 (98.5) | 90 (1.5) | 1.39 (1.11–1.73) | 0.004 |
| Geographic area, n (%) | |||||
| Southeast | 138,226 (41.1) | 137,522 (99.5) | 704 (0.5) | 1.0 | Ref |
| Northeast | 27,801 (8.3) | 27,654 (99.5) | 147 (0.5) | 0.88 (0.73–1.05) | 0.15 |
| Midwest | 51,789 (15.4) | 51,497 (99.4) | 292 (0.6) | 0.96 (0.83–1.10) | 0.55 |
| Southwest | 59,868 (17.8) | 59,562 (99.5) | 306 (0.5) | 0.95 (0.83–1.09) | 0.46 |
| West | 56,900 (16.9) | 56,558 (99.4) | 342 (0.6) | 1.03 (0.90–1.18) | 0.67 |
| Territories | 1654 (0.5) | 1649 (99.7) | 5 (0.3) | 0.49 (0.20–1.19) | 0.12 |
| Service era, n (%) | |||||
| September 2001 or later | 3201 (1.0) | 2960 (92.5) | 241 (7.5) | 6.30 (5.32–7.47) | <0.0001 |
| August 1990–August 2001 (including Gulf War) | 172,721 (51.5) | 172,164 (99.7) | 557 (0.3) | 1.0 | Ref |
| May 1975–July 1990 | 53,946 (16.1) | 53,666 (99.5) | 280 (0.5) | 0.67 (0.57–0.77) | <0.0001 |
| August 1964–April 1975 (Vietnam Era) | 19,185 (5.7) | 19,111 (99.6) | 74 (0.4) | 0.50 (0.38–0.64) | <0.0001 |
| December 1941–July 1964 | 2098 (0.6) | 2094 (99.8) | 4 (0.2) | 0.36 (0.13–0.97) | 0.04 |
| Multiple service eras | 84,346 (25.1) | 83,708 (99.2) | 638 (0.8) | 2.66 (2.37–2.99) | <0.0001 |
List of missing observations: age: 2468, sex: 2466, ethnicity: 46,201, race: 56,325, region: 142,741; service era: 143,482.
Percentage is the column percentage of categories proportion.
Percentage is raw proportion, for example, “Enrolled” and “Not Enrolled” rates within each category of demographic characteristics.
Mutually adjusted for age, ethnicity, race, geographic area, and service era applying logistic regression model.
CI, confidence interval; OR, odds ratio.
The enrollment rate was significantly higher among women Veterans who served post 2001 (enrollment rate=7.5%, OR=6.30, 95% CI: 5.32–7.47, p<0.0001) and those who served in multiple eras (OR=2.66, 95% CI: 2.37–2.99, p<0.0001), but significantly lower among women Veterans who served in the Vietnam era (OR=0.50, 95% CI: 0.38–0.64, p<0.0001) or between May 1975 and July 1990 (OR=0.67, 95% CI: 0.57–0.77, p<0.0001), compared with women Veterans who served in the Gulf War era. We did not observe significant differences of enrollment rates between Hispanic and non-Hispanics, or cross geographic areas (all p's>0.05).
Discussion
The MVP Women's Campaign represents the first large-scale outreach effort focusing on recruitment of women Veterans into MVP. Through a combination of multimedia outreach and direct email recruitment, MVP was able to significantly increase the number of women Veterans online by over fivefold during a 7-month period.
During the 6 months of the Multimedia Phase, a higher percentage of women Veterans enrolled online who were older (primarily between the ages of 60–69 years) and geographically located in the west. Research from 2017 suggests that Veterans 65 years and older are more likely than their non-Veteran counterparts to go online,10 potentially explaining an increase in online enrollment patterns among older women Veterans aged 60–69 years during the Multimedia Phase. Decreases for online enrollment were observed among women Veterans in the northeast, and those who served before 1975. Differences in online enrollment by women Veterans were not observed for ethnicity or race, similar to research indicating that overall, significant differences across ethnicity and race are not reported for internet usage.11
Findings from the 1 month of the Email Phase demonstrated increases in White women Veterans and those between the ages of 60–69 years. Decreases were observed for Black women Veterans, with no differences for ethnicity or geographic locale. Despite the higher enrollment observed during the Multimedia Phase compared to the Email Phase, it is important to note the difference in timing between the two phases (6 months vs. 1 month, respectively), suggesting that direct recruitment by MVP through email is a more effective digital outreach mechanism.
The availability of online enrollment offers women Veterans the option to participate at home without having to navigate the multiple challenges reported by women Veterans at VA facilities, such as feeling uncomfortable or experiencing harassment.4 With the addition of at-home blood collection capabilities now available for MVP, complete remote enrollment is possible. Given that women Veterans are more likely to endorse use of remote care options,12 combined with efforts to better accommodate women Veterans within VA research,13 MVP women-focused recruitment efforts will continue to highlight the benefits of online enrollment. In addition, this work supports the development of focused campaigns to reach other populations of interest such as minority Veterans through multimedia and email campaigns tailored to those populations. Doing so can enhance the data available to researchers for addressing health disparities in traditionally underrepresented populations.
Limitations of this work include a comprehensive understanding of how many women Veterans were reached through the Multimedia Phase. Efforts are underway to better monitor and measure the impact of digital MVP outreach and public relations efforts on gender diversification to get a better representation of the denominator. In addition, at the time of the Email Phase deployment, features to assess email open and click rates were unavailable (important tools to understand patterns in email user behavior), thereby limiting the understanding of how many women Veterans acted upon receipt of the emails. As these features have since been made available, future efforts will better describe overall and group specific behavior. General recruitment and enrollment rates for online enrollment (not just online recruitment) are difficult to determine, given the lack of available published information.
Conclusions
The MVP Women's Campaign demonstrates the ability to utilize tailored digital outreach and engagement methods to successfully connect with specific audiences, ultimately increasing the rate of that audience enrolling in MVP. Attention to messaging and communication channels, combined with a better understanding of effective recruitment methods for certain Veteran populations, allows MVP the opportunity to advance health and health care not only for women Veterans but also beyond. Lessons learned will be applied to increase other populations in MVP such as Blacks, Hispanics, Asians, Native Americans, younger Veterans, and Veterans with health conditions of interest.
Acknowledgments
The authors thank the members of the MVP Core, those who have contributed to the MVP, and especially the Veteran participants for their generous contributions. The authors also thank Shakeria Cohen, PhD, Martha Wilkes, MFA, and the partners who supported the Women's Campaign including the VA Center for Women Veterans and VA Veterans Experience Office. MVP Program Office: Program Director—Sumitra Muralidhar, PhD, US Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420. Associate Director, Scientific Programs—Jennifer Moser, PhD, US Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420.
They thank the Associate Director, Cohort Management & Public Relations—Jennifer E. Deen, BS, US Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420. MVP Executive Committee: Co-Chair: J. Michael Gaziano, MD, MPH, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Co-Chair: Sumitra Muralidhar, PhD, US Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420. Jean Beckham, PhD, Durham VA Medical Center, 508 Fulton Street, Durham, NC 27705. Kyong-Mi Chang, MD, Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104. Philip S. Tsao, PhD, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304. Shiuh-Wen Luoh, MD, PhD, VA Portland Health Care System, 3710 SW US Veterans Hospital Rd, Portland, OR 97239; US Department of Veterans Affairs, 810 Vermont Avenue NW, Washington, DC 20420.
The authors also thank Juan P. Casas, MD, PhD, Ex-Officio, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. MVP Principal Investigators: J. Michael Gaziano, MD, MPH, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Philip S. Tsao, PhD, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304. MVP Operations: MVP Executive Director—Juan P. Casas, MD, PhD, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Director of Regulatory Affairs—Lori Churby, BS, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304. MVP Cohort Management Director—Stacey B. Whitbourne, PhD, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. MVP Recruitment/Enrollment Director—Jessica V. Brewer, MPH, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Director, VA Central Biorepository, Boston—Mary T. Brophy, MD, MPH, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Executive Director for MVP Biorepositories—Luis E. Selva, PhD, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. MVP Informatics, Boston—Shahpoor (Alex) Shayan, MS, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Director, MVP Data Operations/Analytics, Boston—Kelly Cho, MPH, PhD, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Director, Center for Computational and Data Science (C-DACS) & Genomics Core—Saiju Pyarajan, PhD, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Director, Molecular Data Core—Philip S. Tsao, PhD, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304. Director, Phenomics Data Core—Kelly Cho, MPH, PhD, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Director, VA Informatics and Computing Infrastructure (VINCI)—Scott L. DuVall, PhD, VA Salt Lake City Health Care System, 500 Foothill Drive, Salt Lake City, UT 84148. MVP Coordinating Centers: Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque—Todd Connor, PharmD; Dean P. Argyres, BS, MS, New Mexico VA Health Care System, 1501 San Pedro Drive SE, Albuquerque, NM 87108. Genomics Coordinating Center, Palo Alto—Philip S. Tsao, PhD, VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304. MVP Boston Coordinating Center, Boston—J. Michael Gaziano, MD, MPH, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. MVP Information Center, Canandaigua—Brady Stephens, MS, Canandaigua VA Medical Center, 400 Fort Hill Avenue, Canandaigua, NY 14424.
Current MVP Local Site Investigators: Atlanta VA Medical Center (Peter Wilson, MD), 1670 Clairmont Road, Decatur, GA 30033. Bay Pines VA Healthcare System (Rachel McArdle, PhD), 10,000 Bay Pines Blvd Bay Pines, FL 33744. Birmingham VA Medical Center (Louis Dellitalia, MD), 700 S. 19th Street, Birmingham AL 35233. Central Western Massachusetts Healthcare System (Kristin Mattocks, PhD, MPH), 421 North Main Street, Leeds, MA 01053. Cincinnati VA Medical Center (John Harley, MD, PhD), 3200 Vine Street, Cincinnati, OH 45220. Clement J. Zablocki VA Medical Center (Jeffrey Whittle, MD, MPH), 5000 West National Avenue, Milwaukee, WI 53295. VA Northeast Ohio Healthcare System (Frank Jacono, MD), 10701 East Boulevard, Cleveland, OH 44106. Durham VA Medical Center (Jean Beckham, PhD), 508 Fulton Street, Durham, NC 27705. Edith Nourse Rogers Memorial Veterans Hospital (John Wells, PhD), 200 Springs Road, Bedford, MA 01730.
Edward Hines, Jr. VA Medical Center (Salvador Gutierrez, MD), 5000 South 5th Avenue, Hines, IL 60141. Veterans Health Care System of the Ozarks (Kathrina Alexander, MD), 1100 North College Avenue, Fayetteville, AR 72703. Fargo VA Health Care System (Kimberly Hammer, PhD), 2101N. Elm, Fargo, ND 58102. VA Health Care Upstate New York (James Norton, PhD), 113 Holland Avenue, Albany, NY 12208. New Mexico VA Health Care System (Gerardo Villareal, MD), 1501 San Pedro Drive, S.E. Albuquerque, NM 87108. VA Boston Healthcare System (Scott Kinlay, MBBS, PhD), 150 S. Huntington Avenue, Boston, MA 02130. VA Western New York Healthcare System (Junzhe Xu, MD), 3495 Bailey Avenue, Buffalo, NY 14215-1199. Ralph H. Johnson VA Medical Center (Mark Hamner, MD), 109 Bee Street, Mental Health Research, Charleston, SC 29401.
Columbia VA Health Care System (Roy Mathew, MD), 6439 Garners Ferry Road, Columbia, SC 29209. VA North Texas Health Care System (Sujata Bhushan, MD), 4500 S. Lancaster Road, Dallas, TX 75216. Hampton VA Medical Center (Pran Iruvanti, DO, PhD), 100 Emancipation Drive, Hampton, VA 23667. Richmond VA Medical Center (Michael Godschalk, MD), 1201 Broad Rock Blvd., Richmond, VA 23249. Iowa City VA Health Care System (Zuhair Ballas, MD), 601 Highway 6 West, Iowa City, IA 52246-2208. Eastern Oklahoma VA Health Care System (River Smith, PhD), 1011 Honor Heights Drive, Muskogee, OK 74401. James A. Haley Veterans' Hospital (Stephen Mastorides, MD), 13000 Bruce B. Downs Blvd, Tampa, FL 33612.
James H. Quillen VA Medical Center (Jonathan Moorman, MD, PhD), Corner of Lamont & Veterans Way, Mountain Home, TN 37684. John D. Dingell VA Medical Center (Saib Gappy, MD), 4646 John R Street, Detroit, MI 48201. Louisville VA Medical Center (Jon Klein, MD, PhD), 800 Zorn Avenue, Louisville, KY 40206. Manchester VA Medical Center (Nora Ratcliffe, MD), 718 Smyth Road, Manchester, NH 03104. Miami VA Health Care System (Ana Palacio, MD, MPH), 1201 NW 16th Street, 11 GRC, Miami FL 33125. Michael E. DeBakey VA Medical Center (Olaoluwa Okusaga, MD), 2002 Holcombe Blvd, Houston, TX 77030. Minneapolis VA Health Care System (Maureen Murdoch, MD, MPH), One Veterans Drive, Minneapolis, MN 55417. N. FL/S. GA Veterans Health System (Peruvemba Sriram, MD), 1601 SW Archer Road, Gainesville, FL 32608. Northport VA Medical Center (Shing Shing Yeh, PhD, MD), 79 Middleville Road, Northport, NY 11768.
Overton Brooks VA Medical Center (Neeraj Tandon, MD), 510 East Stoner Ave, Shreveport, LA 71101. Philadelphia VA Medical Center (Darshana Jhala, MD), 3900 Woodland Avenue, Philadelphia, PA 19104. Phoenix VA Health Care System (Samuel Aguayo, MD), 650 E. Indian School Road, Phoenix, AZ 85012. Portland VA Medical Center (David Cohen, MD), 3710 SW U.S. Veterans Hospital Road, Portland, OR 97239.
Providence VA Medical Center (Satish Sharma, MD), 830 Chalkstone Avenue, Providence, RI 02908. Richard Roudebush VA Medical Center (Suthat Liangpunsakul, MD, MPH), 1481 West 10th Street, Indianapolis, IN 46202. Salem VA Medical Center (Kris Ann Oursler, MD), 1970 Roanoke Blvd, Salem, VA 24153. San Francisco VA Health Care System (Mary Whooley, MD), 4150 Clement Street, San Francisco, CA 94121. South Texas Veterans Health Care System (Sunil Ahuja, MD), 7400 Merton Minter Boulevard, San Antonio, TX 78229. Southeast Louisiana Veterans Health Care System (Joseph Constans, PhD), 2400 Canal Street, New Orleans, LA 70119.
Southern Arizona VA Health Care System (Paul Meyer, MD, PhD), 3601 S 6th Avenue, Tucson, AZ 85723. Sioux Falls VA Health Care System (Jennifer Greco, MD), 2501W 22nd Street, Sioux Falls, SD 57105. St. Louis VA Health Care System (Michael Rauchman, MD), 915 North Grand Blvd, St. Louis, MO 63106. Syracuse VA Medical Center (Richard Servatius, PhD), 800 Irving Avenue, Syracuse, NY 13210. VA Eastern Kansas Health Care System (Melinda Gaddy, PhD), 4101 S 4th Street Trafficway, Leavenworth, KS 66048.
VA Greater Los Angeles Health Care System (Agnes Wallbom, MD, MS), 11301 Wilshire Blvd, Los Angeles, CA 90073. VA Long Beach Healthcare System (Timothy Morgan, MD), 5901 East 7th Street Long Beach, CA 90822. VA Maine Healthcare System (Todd Stapley, DO), 1 VA Center, Augusta, ME 04330. VA New York Harbor Healthcare System (Peter Liang, MD, MPH), 423 East 23rd Street, New York, NY 10010. VA Pacific Islands Health Care System (Daryl Fujii, PhD), 459 Patterson Rd, Honolulu, HI 96819. VA Palo Alto Health Care System (Philip Tsao, PhD), 3801 Miranda Avenue, Palo Alto, CA 94304-1290. VA Pittsburgh Health Care System (Patrick Strollo, Jr., MD), University Drive, Pittsburgh, PA 15240. VA Puget Sound Health Care System (Edward Boyko, MD), 1660 S. Columbian Way, Seattle, WA 98108-1597.
VA Salt Lake City Health Care System (Jessica Walsh, MD), 500 Foothill Drive, Salt Lake City, UT 84148. VA San Diego Healthcare System (Samir Gupta, MD, MSCS), 3350 La Jolla Village Drive, San Diego, CA 92161. VA Sierra Nevada Health Care System (Mostaqul Huq, PharmD, PhD), 975 Kirman Avenue, Reno, NV 89502. VA Southern Nevada Healthcare System (Joseph Fayad, MD), 6900 North Pecos Road, North Las Vegas, NV 89086. VA Tennessee Valley Healthcare System (Adriana Hung, MD, MPH), 1310 24th Avenue, South Nashville, TN 37212.
Washington DC VA Medical Center (Jack Lichy, MD, PhD), 50 Irving St, Washington, D. C. 20422. W.G. (Bill) Hefner VA Medical Center (Robin Hurley, MD), 1601 Brenner Ave, Salisbury, NC 28144. White River Junction VA Medical Center (Brooks Robey, MD), 163 Veterans Drive, White River Junction, VT 05009. William S. Middleton Memorial Veterans Hospital (Prakash Balasubramanian, MD), 2500 Overlook Terrace, Madison, WI 53705.
Abbreviations Used
- CDW
Corporate Data Warehouse
- CI
confidence interval
- MVP
Million Veteran Program
- OR
odds ratio
- SD
standard deviation
- VA
Veterans Affairs
- VAMCs
VA medical centers
- VHA
Veterans Health Administration
- VSOs
Veteran-focused Veteran Service Organizations
Contributor Information
on behalf of the VA Million Veteran Program:
Shakeria Cohen, Martha Wilkes, Jennifer Moser, Jean Beckham, Kyong-Mi Chang, Shiuh-Wen Luoh, Juan P. Casas, Lori Churby, Mary T. Brophy, Luis E. Selva, Shahpoor (Alex) Shayan, Kelly Cho, Saiju Pyarajan, Scott L. DuVall, Todd Connor, Dean P. Argyres, Brady Stephens, Peter Wilson, Rachel McArdle, Louis Dellitalia, Kristin Mattocks, John Harley, Jeffrey Whittle, Frank Jacono, John Wells, Salvador Gutierrez, Kathrina Alexander, Kimberly Hammer, James Norton, Gerardo Villareal, Scott Kinlay, Junzhe Xu, Mark Hamner, Roy Mathew, Sujata Bhushan, Pran Iruvanti, Michael Godschalk, Zuhair Ballas, River Smith, Stephen Mastorides, Jonathan Moorman, Saib Gappy, Jon Klein, Nora Ratcliffe, Ana Palacio, Olaoluwa Okusaga, Maureen Murdoch, Peruvemba Sriram, Shing Shing Yeh, Neeraj Tandon, Darshana Jhala, Samuel Aguayo, David Cohen, Satish Sharma, Suthat Liangpunsakul, Kris Ann Oursler, Mary Whooley, Sunil Ahuja, Joseph Constans, Paul Meyer, Jennifer Greco, Michael Rauchman, Richard Servatius, Melinda Gaddy, Agnes Wallbom, Timothy Morgan, Todd Stapley, Peter Liang, Daryl Fujii, Patrick Strollo, Jr., Edward Boyko, Jessica Walsh, Samir Gupta, Mostaqul Huq, Joseph Fayad, Adriana Hung, Jack Lichy, Robin Hurley, Brooks Robey, and Prakash Balasubramanian
Collaborators: on behalf of the VA Million Veteran Program
Authors' Contributions
S.B.W. supported study administration, drafted the original article, oversaw the data analyses, interpreted study results, coordinated the internal review and revisions of the draft, and prepared the final article for submission. Y.L. conducted analyses, formatted the data tables, interpreted the results, and critically reviewed and edited the article. J.V.V.B. supported study administration, interpreted the results, and critically reviewed and edited the article. J.D., C.G., and S.A.M. supported study administration and critically reviewed and edited the article. E.L., J.Y., and X.-M.T.N. conducted analyses and critically reviewed and edited the article. J.M.G. and P.S.T. are the MVP Principal Investigators, designed the study, and critically reviewed and edited the article. S.M. is the MVP Director, designed the study, and critically reviewed and edited the article. All authors approved the final article as submitted and agreed to be accountable for all aspects of the work.
Author Disclosure Statement
No competing financial interests exist.
Funding Information
This research is based on data from the MVP, Office of Research and Development, VHA, and was funded by award no. MVP000. This publication does not represent the views of the Department of VA or the Government of the United States.
Cite this article as: Whitbourne SB, Li Y, Brewer JVV, Deen J, Gutierrez C, Murphy SA, Lord E, Yan J, Nguyen X-MT, Tsao PS, Gaziano JM, Muralidhar S; on behalf of the VA Million Veteran Program (2023) Overview of Efforts to Increase Women Enrollment in the Veterans Affairs Million Veteran Program, Health Equity 7:1, 324–332, DOI: 10.1089/heq.2023.0006.
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