Veterans Of Military Service Research Articles

VA Outreach Is an Essential Area for Improving Veterans' Health Care Accessibility.

The Veterans Health Administration (VHA) is tasked with providing access to health care to veterans of military service. However, many eligible veterans have either not yet enrolled or underutilized VHA services. Further study of barriers to access before veterans enroll in VHA care is necessary to understand how to address this issue. The ChooseVA (née MyVA Access) initiative aims to achieve this mission to improve veterans' health care access. Although veteran outreach was not specifically addressed by the initiative, it is a critical component of improving veterans' access to health care. Findings from this multisite evaluation of ChooseVA implementation describe sites' efforts to improve VHA outreach and veterans' experiences with access. This quality improvement evaluation employed a multi-method qualitative methodology, including 127 semi-structured interviews and 81 focus groups with VHA providers and staff ("VHA staff") completed during 21 VHA medical center facility site visits between July and November 2017 and 48 telephone interviews with veterans completed between May and October 2018. Interviews and focus groups were transcribed and analyzed using deductive and inductive analysis to capture challenges and strategies to improve VHA health care access (VHA staff data), experiences with access to care (veteran data), barriers and facilitators to care (staff and veteran data), contextual factors, and emerging categories and themes. We developed focused themes describing perceived challenges, descriptions of VHA staff efforts to improve veteran outreach, and veterans' experiences with accessing VHA health care. VHA staff and veteran respondents reported a lack of veteran awareness of eligibility for VHA services. Veterans reported limited understanding of the range of services offered. This awareness gap served as a barrier to veterans' ability to successfully access VHA health care services. Veterans described this awareness gap as contributing to delayed VHA enrollment and delayed or underutilized health care benefits and services. Staff focused on community outreach and engaging veterans for VHA enrollment as part of their efforts to implement the ChooseVA access initiative. Staff and veteran respondents agreed that outreach efforts were helpful for engaging veterans and facilitating access. Although efforts across VHA programs informed veterans about VHA services, our results suggest that both VHA staff and veterans agreed that missed opportunities exist. Gaps include veterans' lack of awareness or understanding of VHA benefits for which they qualify for. This can result in delayed access to care which may negatively impact veterans, including those separating from the military and vulnerable populations such as veterans who experience pregnancy or homelessness.

ЗАКОРДОННИЙ ДОСВІД ПЕНСІЙНОГО ЗАБЕЗПЕЧЕННЯ ВІЙСЬКОВОСЛУЖБОВЦІВ

The article summarizes the foreign experience of pension provision for military personnel. It is determined that it is advisable to analyze the foreign experience of pension provision for military personnel on the example of leading NATO member countries (Great Britain, Germany, and the United States). This expediency is due to the fact that Ukraine is planning to join NATO, respectively, the directions of reforming the domestic pension system for military personnel in Ukraine should be based on borrowing the experience of these countries. It is established that in these States, military personnel, veterans of military service, military pensioners are officially granted numerous socially significant benefits and privileges that allow them not to experience special material and household, financial difficulties, both during the period of military service and after its end. In turn, this attracts volunteers to military service and contributes to the preservation of highly qualified specialists in the National Armed Forces. It is proved that decent pension provision is one of the factors of attractiveness of military service, which affects both the attitude of a serviceman to the performance of his official duties and the recruitment of personnel. It should be emphasized that military service differs from other types of labor activity by an increased risk of death of a serviceman, causing harm to his health, so the presence of problems in the field of pension provision for military personnel most acutely affects the implementation of social policy of any state. Studying and borrowing the best practices of pension provision for military personnel of foreign countries is the basis for the formation of an effective system of pension provision for military personnel, which is the key not only to meeting the basic socio-economic needs of military personnel and their family members, but also to ensuring high combat readiness of troops, and, accordingly, to ensure the defense and security of the country as a whole.

IRONMAN: A Novel International Registry of Men With Advanced Prostate Cancer.

To describe a newly established international registry recruiting diverse patients with advanced prostate cancer across academic and community practices to address unmet needs in this population. Initiated in 2017, IRONMAN (International Registry for Men with Advanced Prostate Cancer) is a prospective cohort of patients with advanced prostate cancer. The study will enroll 5,000 patients with metastatic hormone-sensitive prostate cancer (mHSPC) or castration-resistant prostate cancer (CRPC), recruited from Australia, the Bahamas, Barbados, Brazil, Canada, Ireland, Jamaica, Kenya, Nigeria, Norway, South Africa, Spain, Sweden, Switzerland, the United Kingdom, and the United States. The study is collecting datatypes to study variation in care and treatment of advanced prostate cancer across countries and across academic, community-based, and government practices with a focus on clinical outcomes, patient-reported outcomes, epidemiologic data, biologic subtypes, and clinician questionnaires. Through July 2022, 2,682 eligible patients were enrolled in 11 of 12 active countries. Sixty-six percent of patients have mHSPC, and 34% have CRPC. On the basis of self-report, 11% of patients are Black and 9% are Hispanic. Five Veterans Affairs Medical Centers are enrolling patients. Globally, 23% of patients report being veterans of military service. To our knowledge, this is the first international cohort of people newly diagnosed with advanced prostate cancer designed to describe variations in patient management, experiences, and outcomes. IRONMAN aims to identify optimal treatment sequences to improve survival, understand patient-reported outcomes, and explore novel biomarkers to understand treatment resistance mechanisms. Insights from IRONMAN will inform and guide future clinical management of people with mHSPC and CRPC. This cohort study will provide real-world evidence to facilitate a better understanding of the survivorship of people with advanced prostate cancer.

Race and retention in permanent supportive housing: a secondary analysis of housing outcomes

ABSTRACT Despite the overrepresentation of People of Color among people experiencing homelessness and ongoing housing discrimination against racial and ethnic minorities, research has paid scant attention to the intersections of race and homelessness, including assessments of race-related outcomes of permanent supportive housing (PSH), a mainstay homeless assistance program in the U.S. The purpose of this study, therefore, framed by the Public Health Critical Race praxis, was to use secondary Homeless Management Information System (HMIS) data obtained from a Continuum of Care in North Texas to explore the intersections of race and PSH outcomes. Given the high representation of veterans of military service among the sample, and the parallel VA service system generally accessible to veterans, separate analyses examined housing loss among veterans and non-veterans. Findings show that, while race does predict housing loss for all participants or any race or veteran-based subgroup, race was associated with demographic identifiers, such as gender, disabling condition, domestic violence victimization, income, and access to benefits, but these factors were also largely insignificant predictors in regression models. The only demographic identifier predicting housing loss was the number of times an individual was homeless in the last three years, predicting housing loss for all service recipients, White service recipients, and non-veteran service recipients. The results of the study are discussed, including important between-group variations that inform recommendations for administrative policy and practice.

Fostering Infantry Veterans’ Civilian Cultural Adaptation for Employment

AbstractMilitary service members belong to a unique culture identified, in part, by their clothing, language, job requirements, and relationships. Their experiences within the military set them apart in ways that are unlikely to be understood by most in the civilian employment community. When transitioning into civilian employment, veterans navigate numerous challenges including engaging in networking and questions about future work and career options, each relating to service member's need to culturally adapt from military to civilian. Veterans transitioning into civilian work must navigate their feelings, beliefs, and assumptions about what it means to no longer be identified as a member of the military culture. The purpose of this chapter is to explore the cultural adaptation challenges of infantry veterans of military service moving into civilian employment. This chapter will provide recommendations to adult educators regarding supportive strategies to assist veterans in adapting their cultural identity from military to civilian.

Brief Report: Opioid-Involved Overdose Mortality in United States Veterans.

The purpose of this study is to assess trends in opioid-involved overdose mortality among US Veterans. Age-adjusted drug overdose mortality rates, overall and by opioid subtype, were assessed from National Death Index data for US Veterans; statistical significance of trends was assessed for 2010 to 2015 and 2015 to 2016. Veteran age-adjusted overdose mortality rates increased 23.7% from 2010 to 2015 (19.7-24.4 of 100 000) and a further 20.4% through 2016 (29.3 of 100 000). Opioid involvement increased from 51.3% in 2010 to 62.1% in 2016, as opioid overdose rates increased from 10.9 to 19.5 of 100 000. Overdose mortality varied substantially by opioid subtype and demographics. This report provides the first-ever description of trends and characteristics of overdose mortality and opioid-involved deaths among US Veterans of military service for the period 2010 to 2016. With the exception of female Veterans and Veterans in Western States, it has been found that trends in Veteran overdose mortality paralleled rising rates of drug overdose observed in the United States more broadly. Published 2020. This article is a U.S. Government work and is in the public domain in the USA. (Am J Addict 2020;00:00-00).

МЕДИЧНЕ ТА САНАТОРНО-КУРОРТНЕ ЗАБЕЗПЕЧЕННЯ ВІЙСЬКОВОСЛУЖБОВЦІВ ЗБРОЙНИХ СИЛ УКРАЇНИ, ЗВІЛЬНЕНИХ ІЗ ВІЙСЬКОВОЇ СЛУЖБИ ТА ЧЛЕНІВ ЇХНІХ СІМЕЙ (1991–2011)

The level and conditions of medical and health resort support for retired servicemen of the Armed Forces of Ukraine and their families members from 1991 to 2011 are analyzed in the article on the basis of archival sources and publications. Insufficient budget financing of the medical and sanatorium and resort establishments of the Ministry of Defense of Ukraine negatively affected the treatment’s quality of the dismissed or retired servicemen and their families members. In order to improve this problem in military hospitals introduced paid services for the civilian population, and the proceeds went to the needs of the military medical industry. Statistical analysis showed that annually stationary treatment in polyclinics and hospitals of the Ministry of Defense of Ukraine was held by more than 30 thousand veterans of military service and disabled people of war. In the system of medical servicing of servicemen, one of the key roles is given to sanatorium and resort support. It is noted that the reduction in military sanatorium in the early 2000 s negatively affected the provision of sanatorium treatment for pensioners of the Ministry of Defense of Ukraine. The distribution of sanatorium and resort vouches between different categories of dismissed servicemen was studied. The procedure for providing and the list of privileges granted to veterans of military service, deficiencies and problematic issues that aroused at that time regarding the medical and sanatorium and resort support of servicemen of the Armed Forces of Ukraine dismissed from military service and their families were determined. Keywords: servicemen, medical support, sanatorium and resort support, hospital, polyclinic, the Armed Forces of Ukraine, the Ministry of Defense of Ukraine.

An individually-tailored smoking cessation intervention for rural Veterans: a pilot randomized trial.

BackgroundTobacco use remains prevalent among Veterans of military service and those residing in rural areas. Smokers frequently experience tobacco-related issues including risky alcohol use, post-cessation weight gain, and depressive symptoms that may adversely impact their likelihood of quitting and maintaining abstinence. Telephone-based interventions that simultaneously address these issues may help to increase treatment access and improve outcomes.MethodsThis study was a two-group randomized controlled pilot trial. Participants were randomly assigned to an individually-tailored telephone tobacco intervention combining counseling for tobacco use and related issues including depressive symptoms, risky alcohol use, and weight concerns or to treatment provided through their state tobacco quitline. Selection of pharmacotherapy was based on medical history and a shared decision interview in both groups. Participants included 63 rural Veteran smokers (mean age = 56.8 years; 87 % male; mean number of cigarettes/day = 24.7). The primary outcome was self-reported 7-day point prevalence abstinence at 12 weeks and 6 months.ResultsTwelve-week quit rates based on an intention-to-treat analysis did not differ significantly by group (Tailored = 39 %; Quitline Referral = 25 %; odds ratio [OR]; 95 % confidence interval [CI] = 1.90; 0.56, 5.57). Six-month quit rates for the Tailored and Quitline Referral conditions were 29 and 28 %, respectively (OR; 95 % CI = 1.05; 0.35, 3.12). Satisfaction with the Tailored tobacco intervention was high.ConclusionsTelephone-based treatment that concomitantly addresses other health-related factors that may adversely affect quitting appears to be a promising strategy. Larger studies are needed to determine whether this approach improves cessation outcomes.Trial registrationClinicalTrials.gov identifier number NCT01592695 registered 11 April 2012.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3493-z) contains supplementary material, which is available to authorized users.

Associations between the Department of Veterans Affairs' Suicide Prevention Campaign and Calls to Related Crisis Lines

The Transit Authority Suicide Prevention (TASP) campaign was launched by the Department of Veterans Affairs (VA) in a limited number of U.S. cities to promote the use of crisis lines among veterans of military service. We obtained the daily number of calls to the VCL and National Suicide Prevention Lifeline (NSPL) for six implementation cities (where the campaign was active) and four control cities (where there was no TASP campaign messaging) for a 14-month period. To identify changes in call volume associated with campaign implementation, VCL and NSPL daily call counts for three time periods of equal length (pre-campaign, during campaign, and post-campaign) were modeled using a Poisson log-linear regression with inference based on the generalized estimating equations. Statistically significant increases in calls to both the VCL and the NSPL were reported during the TASP campaign in implementation cities, but were not reported in control cities during or following the campaign. Secondary outcome measures were also reported for the VCL and included the percentage of callers who are veterans, and calls resulting in a rescue during the study period. Results from this study reveal some promise for suicide prevention messaging to promote the use of telephone crisis services and contribute to an emerging area of research examining the effects of campaigns on help seeking.

Developing a benefits counseling website for Veterans using Motivational Interviewing techniques

Understanding Veterans’ narrated experience as they navigate a web-based intervention is important because it can inform the content, layout and format of these therapies. Using the “Think Aloud” method, twenty-five Veterans of military service expressed thoughts and reactions while navigating through a web-based Motivational Interviewing intervention. The intervention encouraged Veterans applying for Compensation for military-related psychiatric conditions to engage in work related activities. They then completed quantitative ratings of the site. Overall, the site was rated highly, and ratings were in the neutral range as to whether internet delivery of the material was preferable to in-person counseling. Comments revealed the complexity of adapting Motivational Interviewing for a web-based intervention. The intervention provided reflections and non-judgmental statements to Veterans accustomed to more directive statements, and receiving reflections from a computer-therapist evoked mixed responses. Veterans answered questions with intuitive formats quickly, and usually did not read directions concerning how to answer questions. Veterans felt frustrated by the lack of support throughout the Compensation process. They advocated for further development of this web-based intervention as a support for people awaiting their claim determination.

Evaluating Evidence of Risk for Suicide Among Veterans

There is evidence of increased rates of suicide among veterans when compared to those without history of military service. However, empirical studies of the associations between military service and risk for suicide have reported confl icting results. Results from studies of mortality among Vietnam veterans have suggested that rates of suicide may be elevated following service in a combat area. 1 However, not all studies have reported statistically signifi cant increases in suicide mortality among veterans from the Vietnam War. 2‐4 Assessments of postservice mortality among veterans of the Persian Gulf War similarly failed to identify a statistically signifi cant increase in risk for suicide. 5,6 A more recent study of suicide risk among more than 490,000 veterans of Iraq and Afghanistan did report a statistically signifi cant increase in suicide risk among veterans who had been on active duty (standardized mortality ratio 1.33) and among those who had been diagnosed with a mental disorder and had received services from the Veterans Health Administration (VHA) (standardized mortality ratio 1.77). 7 Analyses of existing survey data, when linked with information on the participant’s manner of death, can be used to identify risk for suicide when veteran status is included in the original data fi le. A recent analysis of more than 300,000 male participants in the National Health Interview Survey series (1986‐ 1997) reported a twofold increase in risk for suicide among veterans when compared to those without self-reported history of military service. 8 Somewhat paradoxically, another prospective study of mortality among more than 500,000 male participants in a large cancer survey using similar methodology failed to identify an increased risk for suicide among veterans. 9 Contradictory fi ndings exist in prior work partially because, while national-level mortality data provide an important surveillance tool for understanding changes in overall and groupspecifi c U.S. rates of suicide, veteran-specifi c data are limited. The National Center for Health Statistics (Centers for Disease Control and Prevention) does not currently upload veteran identifi ers as part of their routine death reporting protocol from states that collect this information. Rates of suicide for the entire U.S. veteran population are therefore not routinely attainable. The consequence of current gaps in data availability has been a general reliance on convenience data (such as state-level mortality records) or other existing data sources (including a veteran identifi er) that are linked with information from the National Death Index. In either case, veteran status is often obtained through self- or proxy-report and the sampling procedures employed by existing studies are unlikely to ensure representation of high-risk subpopulations. Questions surrounding the reliability or validity of much existing data remain largely unanswered. Despite challenges associated with ascertainment of veteran status and the relative lack of data for the identifi cation of clinical and behavioral characteristics associated with increased risk for suicide, our understanding of suicide risk among some veteran groups is improving. By linking administrative data obtained from the VHA with national level cause of death data obtained from the National Death Index, researchers from the VA-funded Serious Mental Illness Treatment Research and Evaluation Center (SMITREC) were able to identify 1,613 suicides among veterans who had received inpatient or outpatient VHA services during the 2000 and 2001 fi scal years. 10 When compared to suicide rates for the general U.S. population, the authors identifi ed a statistically signifi cant increase in the relative risk for suicide for both male (standardized mortality ratio 1.66) and female (standardized mortality ratio 1.87) veterans. 10 Comparisons of rates of suicide for veterans and similarly aged groups from the U.S. general population are useful, yet may lack suffi cient information to identify potential differences in clinical or behavioral characteristics among veterans and nonveterans or between veterans who do and do not receive VHA services, effectively limiting our ability to identify those characteristics associated with increased risk. The introduction and limited expansion of the National Violent Death Reporting System (NVDRS) has provided data that can be used to compare the prevalence and characteristics of suicide among veterans and nonveterans in a small number of states. In 2006, there were 1,594 veteran suicides identifi ed in the 16 states participating in NVDRS and 5,966 suicides among those who were not identifi ed as veterans of military service (approximately 21% of all suicides in these areas). However, results from comparisons of NVDRS data should be interpreted with caution. To date, NVDRS has only been implemented in a limited number of states and the

Health Effects of Combat: A Life-Course Perspective

Armed combat (also termed war or armed conflict) has profound direct and indirect impacts on the long-term physical and mental health of both military personnel and noncombatant civilians. Although most research has focused on immediate and short-term health consequences of war, an increasing number of studies have focused on the long-term health consequences for both veterans of military service and noncombatant civilians. However, these long-term studies focus almost entirely on posttraumatic stress disorder and other mental health problems; relatively few long-term studies have focused on physical injuries due to war and the impact of those injuries on relationships, work, and other aspects of life. This article reviews illustrative examples of the existing literature on these long-term health consequences of war, focusing not only on military veterans of several different armed conflicts but also on noncombatant civilian populations, including spouses and children of military veterans as well as refugees and internally displaced persons. Public health professionals can help address these problems.

Attitudes of women toward homosexual behavior as a function of veteran status.

Analysis of data from the General Social Surveys: 1972–1992 indicated no difference between 49 women who were veterans of military service and 5402 women who were not veterans in approval of homosexual behavior.

Social welfare for veterans of military service: An introductory synthesis

Abstract The symposium is intended to fill a gap in the literature on comparative social welfare. Very little has been published on how societies deal with the problems experienced by veterans of military service and their dependants, and the survivors of deceased military service personnel and veterans. The term ‘veterans of military service’ refers both to both military personnel who have combat experience and those who have not.