Prior Military Service Research Articles

Low psychological resilience and physical fitness predict attrition from US Marine Corps Officer Candidate School training

ABSTRACT The objective is to examine the predictors of attrition in male and female candidates undergoing a 10-week early career military training program. 1006 candidates (79.5% male, 24.7 ± 3.2 years) consented to participating in a larger study examining predictors of injury during US Marine Corps Officer Candidates School (OCS). Participants completed a blood draw, demographic and psychological characteristics questionnaires, and two fitness tests. Participants were then grouped based on successful completion of OCS or not. Associations between potential predictors and attrition were analyzed using simple logistic regression analyses, followed by a backward stepwise elimination method. Area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to determine the accuracy of the attrition prediction model. 260 candidates (25.8%) attritted over the 10-week training, with the highest number of discharges during week 5. Musculoskeletal injury (MSKI) was the most common cause of attrition (30%), followed by non-MSKI medical (21.5%), and volitional withdrawals (19.6%). Sex, body mass index (BMI), resilience, initial physical fitness test score, combat fitness test (CFT) score, and prior military service were all significantly associated with attrition from OCS (all p < .05). The final prediction model of attrition included CFT score (p = .027) and resilience (p = .018). Multiple demographic, psychological, and fitness characteristics are associated with attrition from an early career military training course (OCS) and may be utilized as part of early screening procedures to identify and provide guidance for individuals at risk for not completing OCS.

Military Intervention in Civil Wars: Individual-Level Explanation of Leaders’ Decisions

Why are some national leaders more likely to intervene in a civil war than others? In this paper, I suggest that prior military service and combat experience can influence leaders’ risk perception by altering what they expect the result of their (in)action to be, as well as making militaristic means more mentally accessible, creating a militaristic heuristic for judgments. Analyzing national leaders from 1875 to 2004, I find that 1) leaders who have a military service background are about 3.86 percent more likely to engage in third-party intervention compared to those without; 2) leaders who were deployed in combat are around 4.53 percent more likely to intervene than those who either do not have any military experience at all or have military service experience but were never deployed; and 3) leaders’ military service experience without deployment in combat shows almost no impact especially when the standard error was taken into consideration. By examining how individual leaders’ experiences impact third-party intervention, this study aims to contribute to the agent-structure debate in IR and the debate on political decision-makers and their personal backgrounds.

Association of prior military service with olfactory function among older adults.

Olfactory dysfunction (OD) is a condition primarily affecting older adults. Several factors have been implicated in OD, such as age, socioeconomic status, and neurodegenerative disease; however, the effect of military service still requires additional investigation. Here, we aim to determine if there is an association between prior military service and OD among older adults. This cross-sectional study included 2268 adults from Round 1 of the National Social Life, Health, and Aging Project. OD was defined as 0-3 odors correctly identified on the 5-item Sniffin' Sticks test. Bivariate analysis was conducted to calculate crude odds ratios (cOR) for the association of prior military service with OD and identify covariates for regression. Associations between prior military service and OD were assessed using logistic regression, and adjusted odds ratios (aOR) were calculated controlling for age, gender, race/ethnicity, education, stroke history, dementia, diabetes, and mental health. All analyses were weighted using survey weights to account for sampling design. OD was present in 489 adults (21.6%). Among those with OD, the average age was 71.0 ± 7.9 years, whereas the average age in those without OD was 67.0 ± 7.2 years. Among adults with OD, 34.4% reported prior military service, compared to 27.7% of adults without OD (cOR = 1.37; 95% CI: 1.05-1.79). However, after adjusting for covariates, prior military service was not associated with OD (aOR: 1.09; 95% CI: 0.79-1.50). Older age (aOR: 1.07; 95% CI: 1.05-1.09) and worse mental health (aOR: 1.68; 95% CI: 1.14-2.49) were associated with OD. Prior military service was not associated with OD among older adults after controlling for covariates. More nuanced research is needed to examine correlations between OD and specific elements of military service such as duration, toxin exposure, and head trauma.Level of Evidence: Level 4.

Palliative care in the older adult Veteran.

The United States military Veteran population is aging, thus leading to a group of Veterans who have functional disabilities, sensory impairments, and geriatric syndromes such as frailty and dementia. As they age, Veterans are also at risk of being diagnosed with a variety of serious illnesses, such as neurologic conditions and cancers, some of which are a consequence of prior military service or toxic exposures. In addition to frailty and multicomplexity, Veterans have higher rates of mental health disorders than civilians. All of these factors lead to a population of older Veterans who can benefit from palliative care involvement. Major tenets of palliative care focus on enhancing quality of life and provision of goal-concordant care, which are also aims of the services provided by the Veterans Health Administration (VHA) to all enrolled Veterans. Palliative care involvement in the holistic care of Veterans can deliver expert pain and symptom management, promote Veteran-centric plans of care, and provide crucial support of complex medical decision making often required for those Veterans with serious illness. In this review article, we discuss the unique palliative care needs of Veterans as they age, while also sharing information about relevant resources and services provided by the VHA.

Exploring how military culture shapes veterans' perception of aortic aneurysm repair: A qualitative study.

Veterans represent a distinct cultural group whose perceptions of illness and treatment are influenced by military culture. The study explores how prior military service shapes Veterans' assumptions and behaviors in the setting of aneurysm repair surgery. We conducted content and thematic analysis of a case series of 10 transcripts from telephone interviews with older (76.7 ± 4.3 years) African American and White male Veterans now residing in the Southern U.S. who underwent open or endovascular aneurysm surgery at Veterans Affairs Medical Centers or university affiliates between 2004 and2019. Throughout the continuum of care, Veterans described deferring to authority and not questioning provider's decisions ["I just can't make a judgment on that, because I'm not a doctor"]. Veterans valued commitment and articulated pride in keeping logistically challenging surveillance appointments [I always took them very seriously. . . If I'm scheduled for something by the doctor, I always make it."]. The routine structure of VA care aligned with Veterans military experiences, facilitating compliance with doctor's orders. However, procedural deviations in VA care were disconcerting for patients ["They haven't reached out to me in at least three years, since my surgery; I was being seen once a year and then all of a sudden, they just quit."]. While Veterans praised VA care, they exhibited sensitivity to signs of untoward treatment from clinical and support staff "…my surgeon, he never talked to me before, nor after, no anytime…I thought that maybe that wasn't right". Military culture embodies rank, order, and respect, and remains a source of strength and stability for Veterans in their medical care late in life. Cultural competency about how military service has shaped Veterans' expectations can enhance providers' awareness of patients' military mindsets and inform surgeons' efforts to engage Veterans in shared decision making.

Transgender older adults' prior military service: Mental health differences by gender identification.

Despite a proportionally higher likelihood of serving, the role of prior military service in the mental health of transgender individuals is understudied. Research on the impact of military service on mental health tends to be proximal. We examined the distal relationship between prior military service, identity stigma, and mental health among transgender older adults, drawing comparisons between transgender men and women. We conducted a series of weighted multivariate linear models to predict the relationships between prior military service, identity stigma, perceived stress, and depression among 183 transgender women and men aged 51-87 (M = 60.11, SD = 0.668) using 2014 data from the National Health, Aging, and Sexuality/Gender Study. Prior military service was negatively associated with depression and perceived stress; identity stigma was positively associated with both. Prior military service and lower depression and perceived stress were significant for transgender men, but not women. Identity stigma was significant with depression and perceived stress among transgender women, but not transgender men. Our preliminary findings suggest that prior military service may serve as a protective factor for mental health among transgender men, but not transgender women. We need to better understand how military experience interacts with other characteristics, such as differing gender identities influences the mental health of transgender service members. Further research is needed to inform underlying mechanisms whereby military service differentially impacts mental health by gender identity so all active-duty personnel can share in the many benefits that accrue from military service, including protective effects on mental health in later life. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The protective effects of prior military service on burnout in criminal justice professions: A multiagency comparison.

The protective effects of prior military service on burnout in criminal justice professions: A multiagency comparison.

From combat boots to running shoes: The role of military service in shaping masculine identity in Israeli long-distance running groups

This study examines the social construction of masculinity within the Israeli society, focusing on the associations between masculine identity, prior military service, and current involvement in long-distance running. A 2-year ethnographic research design was utilized, involving two running groups, which incorporated participant observation, semi-structured interviews, and running websites. The findings shed light on the significance of military service experience and the utilization of military discourse as strategies employed by runners to navigate the challenges of long-distance running and to reinforce their masculine identity. Through an analysis of the runners’ military discourse and behavior, it becomes evident that the integration of women into traditionally masculine domains of intense physical activity poses a threat to masculine dominance, eliciting various responses from men, such as intensified sports training and the use of sexist and aggressive language. These coping mechanisms contribute to the perpetuation of male dominance within the long-distance running sphere while simultaneously providing male runners with a pseudo-corrective experience associated with their personal history of non-combat military involvement.

Does prior military and/or law enforcement experience influence officer retention? A case study of the Charleston Police Department

Abstract Police agencies across the country have relied on applicants with prior military and/or law enforcement experience to fill vacancies within their ranks for many years. Despite the strong push to recruit officers with these types of backgrounds, few scholars have tested whether prior military and/or law enforcement experience affects officer tenure within policing. In this study, we use hiring and employment data from the Charleston (SC) Police Department (CPD) to assess whether these highly sought after characteristics influence officer retention. Our analysis revealed that officers with prior military service were significantly more likely to leave the agency, and tended to do so about 20 months sooner, than officers who did not serve in the military. Prior law enforcement experience was unrelated to officer separation but had a significant impact on the length of time officers remained with the agency. These findings suggest that police agencies must reevaluate current approaches to recruitment and retention. However, more research is needed to determine why certain officers are more likely to resign and how agencies can better address the underlying needs of high-risk officers.

Chronic Kidney Disease and Military Service in US Adults, 1999-2018.

Although the management of chronic kidney disease (CKD) has changed considerably in US adults, it is uncertain whether the burden, risk factors, and temporal trends of CKD are similar regarding prior military service. This observational study used National Health and Nutrition Examination Survey data to quantify the association between CKD and military service in a generalizable sample of US adults between 1999 and 2018. The respective frequencies (standard error [SE]) of CKD and military service were 15.2% (0.3) and 11.5% (0.3). The proportion (SE) with CKD was significantly higher among those with prior MS vs the overall population (22.7% [0.7] vs 15.2% [0.3]; P < .001). Within the military service population, the proportion (SE) with CKD differed by era: 1999 to 2002, 18.9% (1.1); 2003 to 2006, 24.9% (1.5); 2007 to 2010, 22.3% (1.5); 2011 to 2014, 24.3% (1.7); and 2015 to 2018, 24.0% (1.8) (P = .02). Following adjustment for age, sex, and race and ethnicity, prior military service was associated (P < .05) with a higher likelihood of CKD (adjusted odds ratio, 1.17; 95% CI 1.06-1.28). Adjusted associations of CKD differed in groups with and without military service for the 40 to 64 years age group, ≥ 65 years age group, female sex, and family poverty (P < .05 vs variable-specific reference category). Military service is associated with a higher likelihood of CKD in US adults. Risk factors for CKD differed among many subgroups both with and without military service history. Future research is needed to better determine whether military service constitutes a unique risk factor for CKD.

Investigating the effects of age and prior military service on fluid and crystallized cognitive functions using virtual morris water maze (vMWM) and NIH Toolbox tasks

Much of current knowledge of aging involves war veterans and research about age-related cognitive changes in veterans involves generalized or single function tests or health or neurological disorders. The current study examined military service within the context of comparisons of young and old humans involving generally healthy individuals to address normal age-associated cognitive changes. Adult participants included 11 young females (8 non-veterans; 3 veterans; 21–31 years), 5 young males (non-veterans, 21-24 years), 9 older females (non-veterans, 62–80 years), and 21 older males (11 non-veterans; 10 veterans; 60–86 years). They were tested in virtual Morris water maze (vMWM) tasks, which were designed to test spatial learning, cognitive flexibility and working memory, similar to rodent studies, and were validated by correlations with specific NIH Toolbox (NIH-TB) Cognitive Battery or Wechsler Memory Scale (WMS) Logical Memory I and II tests. Significant age-related deficits were seen on multiple vMWM tasks and NIH-TB fluid cognition tasks. Among older males, vMWM tasks appeared to be more sensitive, based on finding statistical differences, to prior military service than NIH Toolbox tasks. Compared with male non-veterans of comparable age and younger, older male veterans exhibited significant deficits in spatial learning, cognitive flexibility, and working memory on vMWM tasks. Our findings support continued development and characterization of vMWM tasks that are comparable between rodents and humans for translating aging interventions between species, and provide impetus for larger investigations examining the extent to which prior military service can serve as a “hidden” variable in normal biological declines of cognitive functions.

Chronic disease multimorbidity and substance use among African American men: veteran-non-veteran differences

ABSTRACT Objectives The purpose of the study was to explore the extent to which prior military service may moderate the relationship between chronic disease multimorbidity and substance use among African American men in the United States. Design Data for this cross-sectional study was downloaded from the 2016 –2019 United States (US) National Survey on Drug Use and Health. We estimated three survey-weighted multivariable logistic regression models, where use of each of the following substances served as the dependent variables: illicit drugs, opioids, and tobacco. Differences in these outcomes were examined along two primary independent variables: veteran status and multimorbidity (and an interaction term for these variables). We also controlled for the following covariates: age, education, income, rurality, criminal behavior, and religiosity. Results From the 37,203,237 (weighted N) African American men in the sample, approximately 17% reported prior military service. Veterans with ≥ 2 chronic diseases had higher rates of illicit drug use (aOR = 1.37, 95% CI = 1.01, 1.87; 32% vs. 28%) than non-veterans with ≥ 2 chronic diseases. Non-veterans with one chronic disease had higher rates of tobacco use (aOR = 0.80, 95% CI = 0.69, 0.93; 29% vs. 26%) and opioid misuse (aOR = 0.49, 95% CI = 0.36, 0.67; 29% vs. 18%) than veterans with one chronic disease. Discussion Chronic disease multi-morbidity appears to be a context in which African American veterans may be at greater risk for certain undesirable health behaviors than African American non-veterans and at lower risk for others. This may be due to exposure to trauma, difficulty accessing care, socio-environmental factors, and co-occurring mental health conditions. These complex interactions may contribute to higher rates of SUDs among African American veterans compared to African American non-veterans.

Exploratory and confirmatory factor analysis of the new region-generic version of Fremantle Body Awareness-General Questionnaire.

As the field of pain evaluation grows, newer and more targeted tools are being published for patient-centric evaluation of specific aspects of the pain experience. The Fremantle Back Awareness Questionnaire (FreBAQ) is intended to capture alterations in bodily awareness or perception. To date only region-specific (back, neck, shoulder, knee) versions have been published. The purpose of our study was to report on the properties of a new region-generic version of the FreBAQ, the FreBAQ-general. Structural validity, internal consistency, and convergent validity against external criteria were evaluated in a sample of Canadian military veterans with chronic pain, with results compared against those published for the region-specific FreBAQ versions. Eligible participants were those that had prior military service, were at least 18 years of age and self-identified as having chronic pain. We used a split-sample approach to Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) on independent random samples. Factor structure, internal consistency, and associations with external criteria were used to compare against prior versions. 328 respondents (74% of consented) completed at least 7 of the 9 FreBAQ-general questions. EFA and CFA on two independent samples offered support for both 6- and 7-item versions. Comparisons against the external criteria (pain severity, interference, catastrophizing) indicated no statistical superiority of one over the other, so in the interest of parsimony the 6-item FreBAQ-general was endorsed. The Fremantle Body Awareness Questionnaire (FreBAQ-general) showed psychometric properties very much in alignment with those previously reported for the region-specific versions, and sound factorial validity accomplished with fewer items (6 vs. 9). We believe this version can be implemented in practice for those seeking a shorter scale without the need to have multiple region-specific versions on hand, though suggest that those seeking direct comparability with previously published work will still wish to use the original versions.

Her Cold War: Women in the U.S. Military 1945–1980 by Tanya L. Roth

<i>Her Cold War: Women in the U.S. Military 1945–1980</i> by Tanya L. Roth

See G.I. Jane Run: The Rise of Female Military Veteran Candidates for Congress

Veteran women are better represented in Congress than non-veteran women, but the reasons for this are unclear. Veteran women may be better represented because they run at higher rates and in more winnable races or because their military service leaves them uniquely qualified to overcome gender and partisan stereotypes. Voters often perceive women as lacking leadership ability and ill-suited to handling national security. However, female veterans have experience that may help them overcome gendered beliefs about their abilities. Using election data from the 2012–2020 U.S. congressional elections, we test whether veteran women gain greater voter support compared to non-veteran candidates and whether veteran women running as Democrats outperform male veteran Democrats. We find only limited evidence that military service wins more votes for candidates of either gender. Among Democrats, prior military service levels the playing field between male and female candidates, but veteran women only outperform veteran men in 2018.

The Forgotten Heroes of the Balkan Wars: Greek-Americans and Philhellenes, 1912–1913 by Peter S. Giakoumis

Reviewed by: The Forgotten Heroes of the Balkan Wars: Greek-Americans and Philhellenes, 1912–1913 by Peter S. Giakoumis Fevronia K. Soumakis (bio) Peter S. Giakoumis, The Forgotten Heroes of the Balkan Wars: Greek-Americans and Philhellenes, 1912–1913. Rochester, NY: Starry Night Publishing, 2020. Pp. iii + 686. 18 illustrations. Paper $24.00. Peter S. Giakoumis’s The Forgotten Heroes of the Balkan Wars: Greek-Americans andPhilhellenes, 1912–1913 is a welcome addition to the growing body of scholarship on the history of Greek America. Giakoumis sheds light on the little-known contributions of Greek American soldiers who returned to Greece to [End Page 469] fight in the Balkan Wars between 1912 and 1913. At the conclusion of those wars, the Greek kingdom nearly doubled in size and population through the incorporation of Thessaloniki, Macedonia, Epirus, Crete, and the eastern Aegean islands. In his 1964 history The Greeks in the United States, Theodore Saloutos describes the events leading up to the mobilization of approximately 45,000 men who returned to Greece to fight (Saloutos 1964, 96–117). Giakoumis expands upon Saloutos’s work by situating Greek American volunteers and philhellene supporters within the broader political and military context of the Balkan Wars. Giakoumis did not set out to write a monograph. Rather, his purpose was to uncover the voices and experiences of Greek American soldiers during the war. In doing so, he relies on extensive documentation: his book is a compilation of reprinted newspaper articles, photographs, reports, eyewitness accounts, memoirs, and quotations from secondary sources. The author brings to life the “forgotten heroes” of Greek immigrant life as well as the unfolding social and political events in Greece and the United States. The history of the soldiers’ involvement in the Balkan Wars is told overwhelmingly through primary source documents and historical timelines. The book is divided into eight chapters with eight appendices that comprise nearly one-quarter of the book. The first chapter presents newspaper excerpts that detail world events leading up to the Balkan Wars. In the second chapter, the author explores Greek communal life in the United States between 1900 and 1913. Spyros Matsoukas, “the inspired apostle and patriotic missionary” figures prominently in the Greek-language newspapers: Matsoukas arrived in the United States from Greece in 1909 and embarked on an ambitious fund-raising tour that raised thousands of dollars toward the “regeneration and rehabilitation” of Greece, including the purchase of a battleship (35). In the same year, the first Greek American military clubs were established in major cities in anticipation of an impending war with Ottoman Turkey. These military units were made up of Greek military veterans as well as those without prior military training. They received ample coverage in the American press, as for instance on 9 October 1910, when the St. Louis Dispatch ran the headline “Greeks Arming and Drilling in St. Louis, Strange New Colony Ready to Attack Turkey—Subscribe for a Battleship—Greeks all over Southwest Co-Operate” (40). In addition to showcasing the activities of military units as reported by Greek-language and other American newspapers, Giakoumis rightly focuses on the important work of the Panhellenic Union in mobilizing Greek American volunteers during the Balkan Wars. The Union was established in New York in 1907 as a mutual benefit society and a centralized vehicle for uniting [End Page 470] and harnessing the financial capacities of Greek immigrants. The remainder of chapter 2 captures Greek immigrant life in many parts of the United States through the lens of the American press, focusing in particular on Greek Americans’ initial settlement, establishment of businesses and churches, and other important activities. Giakoumis asserts that, as war loomed on the horizon, there were three notable components that defined the Greek American response: “1. They raised over $400,000 USD. 2. Greek-American soldiers set out to fight in the war, even though a fair number of them did not have prior military service. 3. Most of them returned to the U.S. after the war” (103). On 17 September 1912 the Greek government issued mobilization instructions ordering Greek veterans, reservists, and men of military age to return to Greece to fight. Many Greeks in the United States...

Mental Health of Incarcerated Veterans and Civilians: Latent Class Analysis of the 2016 Survey of Prison Inmates

Using data from the 2016 Survey of Prison Inmates, this study used latent class analysis to examine patterns of mental health comorbidity within a large, nationally-representative sample of incarcerated adults ( N = 24,848), including 7.6% with prior military service. Classes were compared on Veteran status, military service-related variables, and treatment-related variables. Results suggest four latent mental health patterns—“Low Psychopathology” (70% of the total sample), “Internalizing + Thought Disorder” (8%), “Internalizing” (14%), and “High Psychopathology” (8%). The High Psychopathology class had the highest rates of prior psychiatric/psychological treatment. Incarcerated Veterans were more likely to be in the Internalizing class, and rates of combat exposure, military service-related injury, and less-than-honorable military discharge were highest in Internalizing and High Psychopathology classes. Results attest to the importance of person-centered mental health care within correctional settings and suggest a “treatment track” or “step-based” approach may best address the needs of individuals in these settings.

Secondary Traumatic Stress in Emergency Services Systems Project: Quantifying the Effect of Personal Trauma Profiles on Lifetime Prevalence of Suicidality in Emergency Medical Services Personnel

ObjectiveWithin the last 20 years, there has been a 500% increase in public safety suicides, the exact cause of which is unknown. MethodsThis was a cross-sectional survey of emergency medical services (EMS) personnel. Nine EMS agencies were selected to participate based on geography and population. The survey assessed sociodemographic, occupational, and military factors. Childhood adversity and traumatic experiences were evaluated using the Adverse Childhood Experiences Questionnaire and the Life Events Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, respectively. Using factors significant in univariate analyses, a logistic regression was conducted to determine predictors of suicidality while controlling for potential confounders. ResultsA total of 681 EMS providers participated; 56.1% were male, 12.6% were minorities, and 72.8% were paramedics. Nearly a quarter (24.4%) had considered suicide. Approximately twice as many had received counseling for a stress-related event, and 1.5 times as many identified as currently in counseling. Indigenous populations were 4.76 times more likely to have suicidality (odds ratio [OR] = 4.76; 95% confidence interval [CI], 1.22-18.62). Suicidality was 97% more likely in EMS professionals with prior military service (OR = 1.97; 95% CI, 1.08-3.57) and 2.22 times more likely in sexual minorities (OR = 2.22; 95% CI, 1.16-4.25). Emotional abuse (OR = 1.86; 95% CI, 1.08-3.21) and burnout (OR = 2.88; 95% CI, 1.78-4.66) were also predictive. ConclusionsSuicidality is an indisputable concern for the EMS profession and represents a multifaceted issue that must be addressed.

Resilience Measured as an Outcome Variable in a Sample of Emergency Medical Service (EMS) Professionals

The construct of resilience is usually entered into statistical models as an independent variable even though scholars assert it should be conceptualised similarly to other post-trauma mental health outcomes (Kalisch et al., 2017). To the best of our knowledge, there are no other published papers using a dependent variable from a standardised resilience assessment and individual trauma exposure item-level responses as predictor variables. 93 Emergency Medical Service (EMS) professionals completed the Life Events Checklist (LEC) and the Brief Resilience Scale (BRS). Each response to all LEC questions was entered into a backwards stepwise regression predicting resilience. The backwards stepwise regression was significant F(7, 85) = 9.14, p &lt; .001 and accounted for 38.3% of the variability in resilience. Gender and LEC items 3, 10, 12, and 13 negatively predicted resilience, whereas prior military service and LEC item 14 (sudden violent death) increased resilience. Even 20 months into the COVID-19 pandemic, EMS professionals continued to serve their communities. Surprisingly, sudden violent death significantly increased resilience (β = .43, p &lt; .001). We concur with scholarship on EMS professionals (before and during the pandemic) that resilience should be thought of as applied when needed (Carbajal et al., 2021; Ponder et al., 2022).

Medical Cannabis and Utilization of Nonhospice Palliative Care Services: Complements and Alternatives at End of Life.

Background and ObjectivesThere is a need to know more about cannabis use among terminally diagnosed older adults, specifically whether it operates as a complement or alternative to palliative care. The objective is to explore differences among the terminal illness population within the Illinois Medical Cannabis Program (IMCP) by their use of palliative care.Research Design and MethodsThe study uses primary, cross-sectional survey data from 708 terminally diagnosed patients, residing in Illinois, and enrolled in the IMCP. We compared the sample on palliative care utilization through logistic regression models, examined associations between palliative care and self-reported outcome improvements using ordinary least squares regressions, and explored differences in average pain levels using independent t-tests.Results115 of 708 terminally diagnosed IMCP participants were receiving palliative care. We find increased odds of palliative care utilization for cancer (odds ratio [OR] [SE] = 2.15 [0.53], p < .01), low psychological well-being (OR [SE] = 1.97 [0.58], p < .05), medical complexity (OR [SE] = 2.05 [0.70], p < .05), and prior military service (OR [SE] = 2.01 [0.68], p < .05). Palliative care utilization is positively associated with improvement ratings for pain (7.52 [3.41], p < .05) and ability to manage health outcomes (8.29 [3.61], p < .01). Concurrent use of cannabis and opioids is associated with higher pain levels at initiation of cannabis dosing (p < .05).Discussion and ImplicationsOur results suggest that cannabis is largely an alternative to palliative care for terminal patients. For those in palliative care, it is a therapeutic complement used at higher levels of pain.