Seattle-Denver Center of Innovation (COIN)

COIN Investigators & Staff

COIN Investigators

Alyson Littman, MPH, PhD

Title: Core Investigator
Research Professor; University of Washington, School of Public Health

Contact: Alyson.Littman@va.gov

Location: Seattle

University of Washington webpage

See Dr. Littman's Dimensions profile that includes: publications, grants, datasets, patents and clinical trials

I am interested understanding how modifiable risk factors impact well-being in those with lower limb amputation and studying approaches involving technology to reduce the risk of amputation and subsequent complications of amputation. An emerging research area relates to gender-affirming treatment preferences and impacts of gender-affirming treatment in transgender and gender diverse Veterans.

I do this work to have an impact on Veterans’ health and well-being, especially those marginalized because of chronic health conditions, disability, and gender and racial identities. Importantly, I follow my curiosity and try to work with good people on topics that matter.

I hope that my work leads to reductions in amputation overall and closes racial and geographic disparities. I also hope my work can help VA become a place where Veterans can obtain high-quality gender-affirming care and that we are able to measure the impacts in a rigorous way.

The following images visualize Dr. Littman's work. The word cloud is drawn from publication titles. The research collaboration map shows research relationships (click the image to enlarge):

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Grants & Funding

Needs, preferences, and perceived barriers and facilitators for gender-affirming surgeries for transgender and other gender diverse Veterans: moving towards a more inclusive VHA

Role: Co-PI with Keren Lehavot
HSR website

Home foot-temperature monitoring through smart mat technology to improve access, equity, and outcomes in high-risk patients with diabetes

Role: PI
Diabetic foot ulcers are common, debilitating, and costly complications of diabetes, disproportionately impacting Black and rural Veterans. Forty percent of individuals have an ulcer recurrence within a year of ulcer healing and 65% within five years.
Monitoring plantar foot temperatures is one of the few interventions that reduce the risk of ulcer recurrence. Despite the evidence, adoption could have been better because the original procedures, using handheld thermometers, were burdensome and time-consuming.
Podimetrics, a private company, has developed a temperature monitoring system involving a “smart” mat that can wirelessly transmit data to a remote monitoring team that works with VA providers to assist with triage and monitoring.
This care model has incredible promise but has yet to be tested in VA. We propose to conduct a randomized trial to evaluate the effectiveness of remote temperature monitoring and costs. Additionally, we will evaluate the implementation process, including barriers and facilitators to use among key stakeholders.
Funder: Veterans Administration
NIH website

Understanding prosthetic needs and outcomes in women Veterans with amputation

The proportion of US Veterans who are women is currently at its highest point in history, and the trend will continue. Nonetheless, the literature regarding prosthetic and functional outcomes in women Veterans with lower extremity amputation (LEA) is nearly non-existent.
Research in other healthcare systems indicates gender differences in prosthetic outcomes and functional mobility, with women being less likely to be prescribed a prosthesis, less likely to use it, and more likely to be dissatisfied than men.
This mixed-methods study will use VA administrative data, qualitative interviews, and a patient survey to characterize women Veterans’ outcomes after an LEA. Additionally, the study compares them to male Veterans, resulting in the largest study on women Veterans with LEA. Data from this rigorous evaluation will inform clinical care by identifying intervention targets to improve prosthetic and functional outcomes for women Veterans.
Funder: Veterans Administration
NIH website: NIH website
Publications of note:
Validity of Methods to Identify Individuals With Lower Extremity Amputation Using Department of Veterans Affairs Electronic Medical Records
Voices of Women Veterans with Lower Limb Prostheses: a Qualitative Study
Race/Ethnicity and Sexual Orientation Disparities in Mental Health, Sexism, and Social Support among Women Veterans

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Recent Publications

2024

Wolfe HL, Jeon A, Goulet JL, Simpson TL, Eleazer JR, Jasuja GK, Blosnich JR, Kauth MR, Shipherd JC, Littman AJ. Non-affirmation minority stress, internalized transphobia, and subjective cognitive decline among transgender and gender diverse veterans aged 45 years and older. Aging Ment Health. 2024 Apr 3:1-7. doi: 10.1080/13607863.2024.2335565. Epub ahead of print.
PMID: 38567655
Learn more about this publication at Dimensions

Littman AJ, Timmons AK, Jones KT, Shirley S, Robbins J, Moy E. Assessing equity in the uptake of remote foot temperature monitoring in a large integrated US healthcare system. PLoS One. 2024 Apr 1;19(4):e0301260. doi: 10.1371/journal.pone.0301260.
PMID: 38557772
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Paing PY, Littman AJ, Reese JA, Sitlani CM, Umans JG, Cole SA, Zhang Y, Ali T, Fretts AM. Association of Achievement of the American Heart Association's Life's Essential 8 Goals With Incident Cardiovascular Diseases in the SHFS. J Am Heart Assoc. 2024 Mar 8:e032918. doi: 10.1161/JAHA.123.032918. Epub ahead of print.
PMID: 38456410
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2023

Jewell M, Jampel SM, Casagrande MG, Ásbjörnsdóttir K, Littman AJ. Self-reported condom use among Washington State residents prior to and during the COVID-19 pandemic: a cross-sectional analysis of BRFSS data. BMJ Open. 2023 Dec 20;13(12):e075877. doi: 10.1136/bmjopen-2023-075877. PMCID: PMC10748982.
PMID: 38128941
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Boyer TL, Wolfe HL, Littman AJ, Shipherd JC, Kauth MR, Blosnich JR. Patient Experiences and Provider Perspectives on Accessing Gender-Affirming Surgical Services in the Veterans Health Administration. J Gen Intern Med. 2023 Sep 5. doi: 10.1007/s11606-023-08389-9. Epub ahead of print.
PMID: 37670068
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Kuo PB, Lehavot K, Thomas RM, Dashtestani K, Peterson AC, Korpak AM, Turner AP, Williams RM, Czerniecki JM, Norvell DC, Littman AJ. Gender differences in prosthesis related outcomes among Veterans: Results of a national survey of U.S. Veterans. PM R. 2023 Jun 21. doi: 10.1002/pmrj.13028. Epub ahead of print.
PMID: 37343123
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Littman AJ, Timmons AK, Korpak A, Chan KCG, Jones KT, Shirley S, Nordrum K, Robbins J, Masadeh S, Moy E. Evaluation of the Effectiveness of Remote Foot Temperature Monitoring for Prevention of Amputation in a Large Integrated Health Care System. Diabetes Care. 2023 Jun 15:dc221492. doi: 10.2337/dc22-1492. Epub ahead of print.
PMID: 37319007
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Cox SN, Fajans MA, Frivold CJ, Littman AJ, Balkus JE. Differences in influenza vaccination by gender identity and state-level gender equity policies: Behavioral risk factor surveillance system, 2015-2019. Prev Med. 2023 Mar 30:107485. doi: 10.1016/j.ypmed.2023.107485. Epub ahead of print.
PMID: 37003590
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Littman AJ, Peterson AC, Korpak A, Czerniecki JM, Turner A, Norvell DC, Williams RM, Lehavot K. Differences in prosthetic prescription between men and women Veterans following transtibial or transfemoral lower extremity amputation: a longitudinal cohort study (2005-2018). Arch Phys Med Rehabil. 2023 Mar 9:S0003-9993(23)00146-6. doi: 10.1016/j.apmr.2023.02.011. Epub ahead of print.
PMID: 36906098
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Mansi ET, Banks S, Littman AJ, Weiss NS. Association between sociodemographic factors and cholesterol-lowering medication use in U.S. adults post-myocardial infarction. PLoS One. 2023 Feb 9;18(2):e0281607. doi: 10.1371/journal.pone.0281607. PMCID: PMC9910652.
PMID: 36758062
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2022

Stern KE, Hicks S, Gavin AR, Littman AJ, Wander PL. Cross-sectional Associations of Multiracial Identity with Self-Reported Asthma and Poor Health Among American Indian and Alaska Native Adults. J Racial Ethn Health Disparities. 2022 Oct 7. doi: 10.1007/s40615-022-01423-2. Epub ahead of print.
PMID: 36205849
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Neff Warner LR, Littman AJ, O'Leary M, Sarche M, Nelson LA, Gray JS, Fretts AM. Diet Quality and Depression in a Cohort of American Indians: The Strong Heart Family Study. Am Indian Alsk Native Ment Health Res. 2022;29(3):90-121. doi: 10.5820/aian.2903.2022.90.
PMID: 36178749
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Lehavot K, Young JP, Thomas RM, Williams RM, Turner AP, Norvell DC, Czerniecki JM, Korpak A, Littman AJ. Voices of Women Veterans with Lower Limb Prostheses: a Qualitative Study. J Gen Intern Med. 2022 Sep 1. doi: 10.1007/s11606-022-07572-8. Epub ahead of print.
PMID: 36050521
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Hill CM, Tseng AS, Holzhauer K, Littman AJ, Jones-Smith JC. Association between health care access and food insecurity among lower-income older adults with multiple chronic conditions in Washington State, United States. Public Health Nutr. 2022 May 23:1-26. doi: 10.1017/S1368980022001240. Epub ahead of print.
PMID: 35603699
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Czerniecki JM, Littman AJ, Landry G, Norvell DC. Risks and Risk Factors for Contralateral Amputation in Patients who have Undergone Amputation for Chronic Limb Threatening Ischemia. Eur J Vasc Endovasc Surg. 2022 Apr 14:S1078-5884(22)00218-0. doi: 10.1016/j.ejvs.2022.03.038. Epub ahead of print.
PMID: 35430387
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Beckman KL, Williams EC, Hebert P, Hawkins EJ, Littman AJ, Lehavot K. The impact of military sexual trauma and gender on receipt of evidence-based medication treatment among veterans with opioid use disorder. J Subst Abuse Treat. 2022 Mar 18:108775. doi: 10.1016/j.jsat.2022.108775. Epub ahead of print.
PMID: 35317959
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Meadows M, Peterson A, Boyko EJ, Littman AJ. Validity of Methods to Identify Individuals With Lower Extremity Amputation Using Department of Veterans Affairs Electronic Medical Records. Arch Rehabil Res Clin Transl. 2022 Jan 24;4(1):100182. doi: 10.1016/j.arrct.2022.100182. PMID: 35282148; PMCID: PMC8904866.
PMID: 35148871
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Neff Warner LR, Ruderman SA, Zinsli KA, Jones-Smith JC, Littman AJ. Menu Labeling Utilization and Socioeconomic Status in West Virginia and Mississippi. J Nutr Educ Behav. 2022 Feb;54(2):172-180. doi: 10.1016/j.jneb.2021.11.005.
PMID: 35148871.
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2021

Kim JJ, Littman AJ, Sorkin JD, Roghmann MC. Association Between Foot Surgery Type and Subsequent Healing in Veterans With Moderate-to-Severe Diabetic Foot Infections. Open Forum Infect Dis. 2021 Dec 24;9(2):ofab650. doi: 10.1093/ofid/ofab650. PMCID: PMC8802798.
PMID: 35111873.

Beckman KL, Williams EC, Hebert PL, Frost MC, Rubinsky AD, Hawkins EJ, Littman AJ, Lehavot K. Associations Among Military Sexual Trauma, Opioid Use Disorder, and Gender. Am J Prev Med. 2021 Nov 3:S0749-3797(21)00505-5. doi: 10.1016/j.amepre.2021.08.020. Epub ahead of print.
PMID: 34742619.

Littman AJ, Bratman GN, Lehavot K, Engel CC, Fortney JC, Peterson A, Jones A, Klassen C, Brandon J, Frumkin H. Nature versus urban hiking for Veterans with post-traumatic stress disorder: a pilot randomised trial conducted in the Pacific Northwest USA. BMJ Open. 2021 Sep 23;11(9):e051885. doi: 10.1136/bmjopen-2021-051885.
PMID: 34556516

Littman AJ, Young J, Moldestad M, Tseng CL, Czerniecki JR, Landry GJ, Robbins J, Boyko EJ, Dillon MP. How patients interpret early signs of foot problems and reasons for delays in care: Findings from interviews with patients who have undergone toe amputations. PLoS One. 2021 Mar 10;16(3):e0248310. doi: 10.1371/journal.pone.0248310.
PMID: 33690723

Littman AJ, Timmons AK, Moore KP, Tseng CL, Landry G, Robbins JM, Korpak A, Boyko EJ. Comparison of Diagnostic Accuracy for Lower-Extremity Amputation Codes During the ICD-9 and ICD-10 Eras in a High-Risk Population of Patients With Diabetes. Diabetes Care. 2021 Jan 12:dc202452. doi: 10.2337/dc20-2452. Epub ahead of print.
PMID: 33436400

2020

Horn DL, Butler EK, Stahl JL, Rowhani-Rahbar A, Littman AJ. A multi-state evaluation of the association between mental health and firearm storage practices. Prev Med. 2020 Dec 29:106389. doi: 10.1016/j.ypmed.2020.106389. Epub ahead of print.
PMID: 33385422

Grenard DL, Valencia EJ, Brown JA, Winer RL, Littman AJ. Impact of Caregiving During Emerging Adulthood on Frequent Mental Distress, Smoking, and Drinking Behaviors: United States, 2015-2017. Am J Public Health. 2020 Dec;110(12):1853-1860. doi: 10.2105/AJPH.2020.305894. Epub 2020 Oct 15. PMC7661987.
PMID: 33058707

Loroña NC, Allen SB, Lam EW, Rowley S, Littman AJ, Enquobahrie DA. Risks of preterm birth and growth restriction in second births after a first-born male infant. Ann Epidemiol. 2020 Dec;52:71-76.e1. doi: 10.1016/j.annepidem.2020.07.019. Epub 2020 Aug 6.
PMID: 32771458

Jacobson IG, Williams EC, Seelig AD, Littman AJ, Maynard CC, Bricker JB, Rull RP, Boyko EJ; Millennium Cohort Study Team. Longitudinal Investigation of Military-specific Factors Associated With Continued Unhealthy Alcohol Use Among a Large US Military Cohort. J Addict Med. 2020 Jul/Aug;14(4):e53-e63. doi: 10.1097/ADM.0000000000000596. PMC7280069.
PMID: 31821191

Liew JW, Cannon CA, Ji Y, Littman AJ, Hawes SE. Association of Arthritis and Antihypertensive Medication Use Among Individuals With Hypertension: A Cross-Sectional Analysis of the 2017 Behavioral Risk Factor Surveillance System. J Clin Rheumatol. 2020 Jun 12:10.1097/RHU.0000000000001426. doi: 10.1097/RHU.0000000000001426. Epub ahead of print. PMC7736264.
PMID: 32541614

Badon SE, Littman AJ, Chan KCG, Williams MA, Kirkegaard H, Nohr EA, Enquobahrie DA. Leisure Time Physical Activity, Sedentary Time in Pregnancy, and Infant Weight at Approximately 12 Months. Womens Health Rep (New Rochelle). 2020 May 12;1(1):123-131. doi: 10.1089/whr.2020.0068. PMC7325488.
PMID: 32617532

Giovanni SP, Keller TL, Bryant AD, Weiss NS, Littman AJ. Electronic Cigarette Use and Chronic Respiratory Symptoms among U.S. Adults. Am J Respir Crit Care Med. 2020 May 1;201(9):1157-1160. doi: 10.1164/rccm.201907-1460LE. PMC7193846.
PMID: 31922902

Littman AJ, Tseng CL, Timmons A, Moore K, Landry G, Czerniecki JM, Robbins J, Boyko EJ. Risk of Ipsilateral Reamputation Following an Incident Toe Amputation Among U.S. Military Veterans With Diabetes, 2005-2016. Diabetes Care. 2020 May;43(5):1033-1040. doi: 10.2337/dc19-2337. Epub 2020 Mar 11.
PMID: 32161048

Littman AJ, Knott CJ, Boyko EJ, Hawes SE. Associations Between Racial and Ethnic Groups and Foot Self-Inspection in People With Diabetes. Diabetes Care. 2020 May;43(5):956-963. doi: 10.2337/dc19-1486. Epub 2020 Mar 4.
PMID: 32132006

2019

Bookwalter DB, Porter B, Jacobson IG, Kong SY, Littman AJ, Rull RP, Boyko EJ. Healthy behaviors and incidence of overweight and obesity in military veterans. Ann Epidemiol. 2019 Nov;39:26-32.e1. doi: 10.1016/j.annepidem.2019.09.001. Epub 2019 Sep 11.
PMID: 31588009

Bond JC, Mancenido AL, Patil DM, Rowley SS, Goldberg J, Littman AJ. Residence change during the first trimester of pregnancy and adverse birth outcomes. J Epidemiol Community Health. 2019 Oct;73(10):913-919. doi: 10.1136/jech-2018-211937. Epub 2019 Jul 30.
PMID: 31362943

Czerniecki JM, Thompson ML, Littman AJ, Boyko EJ, Landry GJ, Henderson WG, Turner AP, Maynard C, Moore KP, Norvell DC. Predicting reamputation risk in patients undergoing lower extremity amputation due to the complications of peripheral artery disease and/or diabetes. Br J Surg. 2019 Jul;106(8):1026-1034. doi: 10.1002/bjs.11160. Epub 2019 May 28.
PMID: 31134619

Norvell DC, Thompson ML, Boyko EJ, Landry G, Littman AJ, Henderson WG, Turner AP, Maynard C, Moore KP, Czerniecki JM. Mortality prediction following non-traumatic amputation of the lower extremity. Br J Surg. 2019 Jun;106(7):879-888. doi: 10.1002/bjs.11124. Epub 2019 Mar 13. PMC7504291
PMID: 30865292

Beresford SA, Bowen DJ, Littman AJ, Albano DL, Chan KG, Langer SL, Barrington WE, Patrick DL. Relationship of Socioeconomic Status Indicators to Obesity in Hispanic and Non-Hispanic White Middle-Aged Women: A Population Study. Int J Womens Health Wellness. 2019;5(1):090. doi: 10.23937/2474-1353/1510090. Epub 2019 Feb 28. PMC6469717
PMID: 31008438

Adams SV, Mader MJ, Bollinger MJ, Wong ES, Hudson TJ, Littman AJ. Utilization of Interactive Clinical Video Telemedicine by Rural and Urban Veterans in the Veterans Health Administration Health Care System. J Rural Health. 2019 Jun;35(3):308-318. doi: 10.1111/jrh.12343. Epub 2019 Jan 1.
PMID: 30600557

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Media (Webinars, Podcast, Other)

Focus on Health Equity and Action:
Reducing Disparities in Diabetic Foot Ulcers with Research, Clinical Care, and Technology

by Alyson Littman, PhD, MD ; Jeffrey Robbins, DPM ; Suzanne Shirley, LCSW
Seminar date: 7/8/2020

Description: Disparities exist around which Veterans with diabetes develop diabetic foot ulcers and subsequent amputations. The July 2020 Focus on Health Equity and Action Cyberseminar addresses these foot ulcer and amputation disparities and the efforts VA is engaged in to reduce these diabetes complications through remote and in clinic monitoring. The intended audience: Researchers, clinicians, care coordinators, policy makers, educators, data analysts, Veteran stakeholders and representatives of vulnerable Veteran groups who are interested in understanding and/or promoting equitable health among all Veterans.

Watch: https://www.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=3836

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