Veteran Status Research Articles

Military Service and Physical Capital: Framing Musculoskeletal Disorders Among American Military Veterans Using Pierre Bourdieu’s Theory of Cultural Capital

There are 22 million veterans in the U.S. Armed Forces. Past research on the musculoskeletal health of military veterans has explored the prevalence of musculoskeletal disorders (MSDs) but largely avoids situating findings within a theoretical framework. This article uses Pierre Bourdieu’s theory of cultural capital to contextualize veteran’s greater rates of MSDs compared to nonmilitary civilians. Cultural capital consists of objectified, institutional, and embodied capital that can be transubstantiated to capital in other areas. Embodied or physical capital is central to military service, and military veteran status is beneficial in accessing social and institutional capital. Using the 2012–2014 National Health Interview Survey, we show veterans are more likely to report activity-limiting MSDs, and at younger ages, compared to nonveterans. Physical capital is central to, and impaired by, status as a veteran.

Differences by Veteran/civilian status and gender in associations between childhood adversity and alcohol and drug use disorders.

To examine differences by US military Veteran status and gender in associations between childhood adversity and DSM-5 lifetime alcohol and drug use disorders (AUD/DUD). We analyzed nationally representative data from 3119 Veterans (n = 379 women; n = 2740 men) and 33,182 civilians (n = 20,066 women; n = 13,116 men) as provided by the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III). We used weighted multinomial logistic regression, tested interaction terms, and calculated predicted probabilities by Veteran status and gender, controlling for covariates. To test which specific moderation contrasts were statistically significant, we conducted pairwise comparisons. Among civilians, women had lower AUD and DUD prevalence than men; however, with more childhood adversity, this gender gap narrowed for AUD and widened for DUD. Among Veterans, in contrast, similar proportions of women and men had AUD and DUD; with more childhood adversity, AUD-predicted probability among men surpassed that of women. Childhood adversity elevated AUD probability among civilian women to levels exhibited by Veteran women. Among men, Veterans with more childhood adversity were more likely than civilians to have AUD, and less likely to have DUD. Childhood adversity alters the gender gap in AUD and DUD risk, and in ways that are different for Veterans compared with civilians. Department of Defense, Veterans Affairs, and community health centers can prevent and ameliorate the harmful effects of childhood adversity by adapting existing behavioral health efforts to be trauma informed, Veteran sensitive, and gender tailored.

Rooted in the Community: Assessing the Reintegration Effects of Agriculture on Rural Veterans

ObjectiveTo assess the effect of a veteran-oriented community agricultural initiative on transitioning rural veterans. DesignConvergent mixed-method program evaluation. SettingVeteran-oriented farm-to-market community agricultural initiative. ParticipantsVeterans (N=43) who were members of the community agricultural initiative. Main Outcome MeasuresHealth, well-being, and reintegration were assessed by self-reported data from interviews, a demographic survey, a validated health quality of life measure (Veterans RAND-12 [VR-12]), a validated reintegration measure (Military to Civilian Questionnaire), and a general satisfaction survey. ResultsVeteran participants were primarily white (88.4%, n=38) and men (74.4%, n=32), and most had a service-connected disability rating (58.2%, n=25). Qualitative and quantitative data revealed that the veterans participating in this community agricultural initiative experienced health and reintegration benefits. Results on the Military to Civilian Questionnaire, VR-12, and satisfaction survey suggest that participating in this community agricultural initiative contributed to improved mental, physical, and emotional health and vocational skills, community connectedness, and interpersonal communication. Qualitative interviews supported quantitative findings and revealed that participating in the community agricultural initiative provided veterans with a sense of satisfaction, a sense of belonging, and helped decrease the stigma surrounding their veteran status. ConclusionsVeterans who participate in this community agricultural initiative reported general improvements in physical and mental health, including improvements in sleep, nutrition, and exercise, and decreases in anxiety, pain, depression, and medication and substance use, all known factors which effect veteran reintegration.

Thought, language, and communication deficits and association with everyday functional outcomes among community-dwelling middle-aged and older adults with schizophrenia

Older adults with schizophrenia experience poorer community integration and social functioning compared to same-age peers with no mental health disorders; these individuals are at elevated risk for functional decline and early institutionalization in long-term care facilities. Deficits in thought, language, and communication (TLC; that is, thought disorder and alogia) are core features of schizophrenia and may worsen with age; however, little research focuses on the functional sequelae of these impairments among older adults with schizophrenia. The present study aimed to examine the relationships among age, TLC deficits, and functional outcomes in a sample of community-dwelling middle-aged and older adults with schizophrenia (N = 245; ages 40–85). Participants completed assessments of symptoms, neurocognition, TLC deficits, and functional outcomes. Two different categories of TLC deficits were examined: verbal underproductivity (i.e., alogia) and disconnected speech. Regression analyses, controlling for gender, age, Veteran status, smoking status, cognitive impairment, and symptom severity, found that disconnected speech predicted occupational functioning, while verbal underproductivity predicted capacity to communicate skillfully in semi-structured social situations, as well as community functioning across interpersonal, occupational, and everyday living domains. Exploratory mediation analyses found significant indirect effects of age, through TLC deficits, on certain functional outcomes. Targeted training to improve TLC deficits, especially verbal underproductivity, among older adults with schizophrenia could have downstream effects on community functioning, improving outcomes for a vulnerable group.

Staff Perceptions of Key Factors Guiding Nursing Home Search and Selection Within the Veterans Health Administration.

Veterans enter nursing homes (NHs) for short-term postacute, rehabilitation, respite, or end-of-life care. They also enter NHs on a long-term basis due to frailty, disability, functional deficits, and cognitive impairment. Little is known about how a particular NH is chosen once the decision to enter a NH has been made. This study identified VA staff perceptions of the key factors influencing the search and selection of NHs within the Veterans Health Administration (VHA). Data derived from 35 semistructured interviews with discharge planning and contracting staff from 12 Veterans Affairs Medical Centers (VAMCs). VA staff placed a premium on Veteran and family preferences in the NH selection process, though VA staff knowledge and familiarity with placement options established the general parameters within which NH placement decisions were made. Geographic proximity to Veterans' homes and families was a major factor in NH choice. Other key considerations included Veterans' specialty care needs (psychiatric, postacute, ventilator) and Veteran/facility demographics (age, race/ethnicity, Veteran status). VA staff tried to remain neutral in NH selection, thus instructing families to visit facilities and review publicly available quality data. VA staff report that amenities (private rooms, activities, smoking) and aesthetics (cleanliness, smell, layout, décor) often outweighed objective quality indicators in Veteran and family decision making. Findings suggest that VAMCs facilitate Veteran and family decision making around NH selection. They also suggest that VAMCs endeavor to identify and recruit a broader array of higher quality NHs to better match the specific needs of Veterans and families to the choice set available.

Chronic obstructive pulmonary disease in Scottish military veterans

IntroductionSmoking is a major risk factor for chronic obstructive pulmonary disease (COPD). Serving military personnel have previously been shown to be more likely to smoke, and to smoke more heavily,...

Predictors of retention and attrition in a study of an advanced upper limb prosthesis: implications for adoption of the DEKA Arm

Purpose: The purpose was to identify factors associated with completion of the VA home study of the DEKA Arm.Design and methodological procedures used: Differences between groups were examined using chi-square and t-tests. A multivariable logistic regression model predicting completion was generated and odds ratios (OR) for significant variables calculated. Post-hoc analysis was performed to plot the receiver operating characteristics (ROC) curve.Results: Participants who completed were more likely to be prosthesis users at study onset (p = .03), and less likely to have a history of musculoskeletal problems (p = .047). There were no statistically significant differences between groups who completed and those who did not in gender, race, veteran status, age, body mass index (BMI), weight, height, musculoskeletal pain at baseline, satisfaction with current prosthesis, type of prosthesis, or months of prosthesis use. Two variables, prosthesis use and history of musculoskeletal problems were significant at p < .10. The area under the curve (AUC) accuracy index was 0.78.Conclusions: We considered completion of the home use study a reasonable proxy for participant willingness to adopt the device; and believe that findings can be extrapolated to guide DEKA Arm prescription recommendations. Participants most likely to complete the study were already using a personal prosthesis, and without pre-existing musculoskeletal problems.Implications for rehabilitationData from the VA Study of the DEKA Arm were analysed to determine which factors were associated with likely successful adoption of the DEKA Arm.Participants most likely to complete the study were those who already using a personal prosthesis, and those without pre-existing chronic or re-occurring musculoskeletal problems.This information may be useful when attempting to identify and target the most appropriate candidates for DEKA Arm prescription.

Sexual Behaviors and Sexually Transmitted Infections Among Male Veterans and Nonveterans.

Little is known about the sexual health of male veterans. This study used nationally representative data from the 2011 to 2013 National Survey of Family Growth to compare sexual behaviors and history of sexually transmitted infections (STIs) between male veterans and nonveterans. The sample included 3,860 men aged 18 to 44 years who reported ever having sex with a man or woman. The key independent variable was veteran status. Sexual behavior outcomes included ≥6 lifetime female partners, ≥10 lifetime partners of either sex, ≥2 past-year partners of either sex, having past-year partners of both sexes, and condom nonuse at last vaginal sex. STI outcomes included past-year history of chlamydia, gonorrhea, or receiving any STI treatment; lifetime history of herpes, genital warts, or syphilis; and an aggregate measure capturing any reported STI history. Logistic regression models were used to evaluate associations between veteran status and each outcome. In models adjusting for age, race/ethnicity, education, income, and marital status, veterans had significantly greater odds than nonveterans of having ≥6 lifetime female partners (OR = 1.5, 95% CI [1.02, 2.31]). In models adjusting for age and marital status, veterans had significantly greater odds of having partners of both sexes in the past year (OR = 4.8, 95% CI [1.2, 19.8]), and gonorrhea in the past year (OR = 3.2, 95% CI [1.2, 8.5]). Male veterans were thus significantly more likely than nonveterans to have STI risk factors. Health care providers should be aware that male veterans may be at higher risk for STIs and assess veterans’ sexual risk behaviors.

A Cautionary Tale About Control Variables in IV Estimation

AbstractMany instrumental variable (IV) regressions include control variables to justify (conditional) independence of the instrument and the potential outcomes. The plausibility of conditional IV independence crucially depends on the timing when the control variables are determined. This paper works through different IV models and discusses the (conditions for the) satisfaction of conditional IV independence depending on whether the control variables are measured prior to or after instrument assignment. To illustrate the identification issues, we consider the Vietnam War draft risk as instrument either for veteran status or education to evaluate the effects of these variables on labour market and health outcomes. Our empirical analysis based on the ‘Young Men in High School and Beyond’ survey suggests that commonly used conditional IV strategies to estimate the impact of draft induced military service or education may be severely biased due to the use of improper controls.

Behavioral Indicators on a Mobile Sensing Platform Predict Clinically Validated Psychiatric Symptoms of Mood and Anxiety Disorders.

BackgroundThere is a critical need for real-time tracking of behavioral indicators of mental disorders. Mobile sensing platforms that objectively and noninvasively collect, store, and analyze behavioral indicators have not yet been clinically validated or scalable.ObjectiveThe aim of our study was to report on models of clinical symptoms for post-traumatic stress disorder (PTSD) and depression derived from a scalable mobile sensing platform.MethodsA total of 73 participants (67% [49/73] male, 48% [35/73] non-Hispanic white, 33% [24/73] veteran status) who reported at least one symptom of PTSD or depression completed a 12-week field trial. Behavioral indicators were collected through the noninvasive mobile sensing platform on participants’ mobile phones. Clinical symptoms were measured through validated clinical interviews with a licensed clinical social worker. A combination hypothesis and data-driven approach was used to derive key features for modeling symptoms, including the sum of outgoing calls, count of unique numbers texted, absolute distance traveled, dynamic variation of the voice, speaking rate, and voice quality. Participants also reported ease of use and data sharing concerns.ResultsBehavioral indicators predicted clinically assessed symptoms of depression and PTSD (cross-validated area under the curve [AUC] for depressed mood=.74, fatigue=.56, interest in activities=.75, and social connectedness=.83). Participants reported comfort sharing individual data with physicians (Mean 3.08, SD 1.22), mental health providers (Mean 3.25, SD 1.39), and medical researchers (Mean 3.03, SD 1.36).ConclusionsBehavioral indicators passively collected through a mobile sensing platform predicted symptoms of depression and PTSD. The use of mobile sensing platforms can provide clinically validated behavioral indicators in real time; however, further validation of these models and this platform in large clinical samples is needed.

Accounting for Diversity in Suicide Research: Sampling and Sample Reporting Practices in the United States

Research on suicidal thoughts and behaviors (STB) has identified many risk factors, but whether these findings generalize to diverse populations remains unclear. We review longitudinal studies on STB risk factors over the past 50years in the United States and evaluate the methodological practices of sampling and reporting sample characteristics. We found that articles frequently reported participant age and sex, less frequently reported participant race and ethnicity, and rarely reported participant veteran status or lesbian, gay, bisexual, and transgender status. Sample reporting practices modestly and inconsistently improved over time. Finally, articles predominantly featured White, non-Hispanic, young adult samples.

Self-Reported Lifetime Depression and Current Mental Distress Among Veterans Across Service Eras.

Limited research exists comparing the prevalence of lifetime depression and current mental distress between veterans and nonveterans by military service era. We compared the prevalence of self-reported lifetime depression and current mental distress between veterans and nonveterans of the World War II, Korea, Vietnam, and Gulf War eras. Data from the 2012 Behavior Risk Factor Surveillance System were analyzed for 243,561 survey participants aged 18 years and older. Separate multivariable logistic regression models were computed for each service era to estimate the association between veteran status and lifetime depression and current mental distress. Lifetime depression was lower among veterans vs. nonveterans who served in the military during World War II era (adjusted odds ratio [aOR] = 0.54; 95% confidence interval [CI] = 0.43-0.66) and the Korean War era (aOR = 0.50; 95% CI = 0.42-0.59) but higher among veterans vs. nonveterans of the Vietnam War era (aOR = 1.39; 95% CI = 1.43-1.73). Similarly, current mental distress was lower among veterans vs. nonveterans of the World War II era (aOR = 0.56; 95% CI = 0.44-0.71) and the Korean War era (aOR = 0.47; 95% CI = 0.37-0.60) but higher among veterans vs. nonveterans of the Vietnam War era (aOR = 1.14; 95% CI = 1.02-1.28). Both lifetime depression rates and current mental distress differed among veterans compared to nonveterans within each service era. Understanding the burden of depressive disorder among veterans of all eras may facilitate efficient and effective treatment and allocation of mental health care resources.

Returning to civilian life: Family reintegration challenges and resilience of women veterans of the Iraq and Afghanistan wars

ABSTRACTThe cohort of women who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) was the largest group of women in history to serve in the military and be deployed to combat zones. This large cohort is now moving into veteran status as the numbers of deployed service members decreases. Upon separation from the military, many of these women step back into family roles and responsibilities. To date, there has been sparse research on how military service, particularly in Iraq and Afghanistan, has affected the family relationships, family functioning, and parenting of women veterans. In an effort to better understand the experiences of women veterans as they return to their families and civilian life, five focus groups were conducted with 29 veterans. Analysis of focus group transcripts revealed seven common challenges, ranging from adjustments to the civilian pace of life and developmental changes in children’s behavior to managing anger and difficult emotional interactions with family members. Women demonstrated strength and resilience in dealing with family challenges by employing four common strategies, such as making meaning of their military service, accessing veteran social support, and drawing on military-acquired skills. Implications of the findings for social work practice are discussed.

Post-traumatic stress disorder symptom burden and gender each affect generalization in a reward- and punishment-learning task.

Post-traumatic stress disorder (PTSD) can develop following exposure to a traumatic event. Re-experiencing, which includes intrusive memories or flashbacks of the trauma, is a core symptom cluster of PTSD. From an associative learning perspective, this cluster may be attributed to cues associated with the trauma, which have come to elicit symptoms in a variety of situations encountered in daily life due to a tendency to overgeneralize. Consistent with this, prior studies have indicated that both individuals with clinically diagnosed with PTSD, and those with self-reported symptoms who may not meet full diagnostic criteria, show changes in generalization. Building on prior research, the current study examined whether PTSD symptom burden, but also gender, veteran status, and combat experience–all associated with PTSD vulnerability–modulate learning and generalization in a computer-based task. Participants were presented with stimulus compounds consisting of a foreground and background that could be predictive of reward, punishment or no outcome. Learning was followed by a generalization test where these components were recombined to form novel configurations. An interaction between PTSD symptom burden and gender was found where females with more severe PTSD symptoms showed no evidence of sensitivity to the background. This result is consistent with increased generalization, and may indicate a decrease in the ability to process cue configurations leading to re-experiencing in a variety of situations. Further work is indicated to help elucidate the cognitive processes driving gender differences that may confer vulnerability to PTSD.

Veterans Living with HIV: A High-Risk Group for Cigarette Smoking.

The Veterans Health Administration is the largest U.S. medical provider for persons living with HIV (PLHIV). Although HIV and veteran status are known risk factors for smoking, there are no population estimates of smoking prevalence among veteran PLHIV. Using data from a national random sample (National Survey on Drug Use and Health; 2005-2014), smoking prevalence was estimated by self-reported veteran and HIV status (N=376,620). Results indicated 42% of veteran PLHIV smoked daily, compared to 18% of veterans without HIV and 30% of non-veteran PLHIV. Findings suggest that veteran PLHIV have high risk for smoking and consequent poor health.

Evaluating Recidivism and Job Quality Outcomes for Participants in the Hoosier Initiative for Reentry Employment (HIRE) Program

ABSTRACTThe Hoosier Initiative for Reentry Employment (HIRE) program provides employment assistance to Indiana residents with felony offenses. We examine whether HIRE participants (n = 328), who obtained jobs after release from prison in 2014, had lower recidivism rates than the comparison group of all offenders released from Indiana prisons in 2014 (n = 17,901). Our results show that HIRE participants, despite having more serious criminal histories, have lower hazards of reincarceration (both new offenses and technical violations) than the comparison group. Contrary to hypotheses, HIRE offenders who had better paying and more prestigious jobs did not have significantly lower hazards of reincarceration. Finally, several factors predict quality of job placement (wage, prestige of field) including: age, veteran status, gender, race/ethnicity, and previous sex offense.

Examination of Veteran Fathers' Parenting and Their Adolescent Children's Substance Use in the United States

ABSTRACTBackground: Adolescent children of U.S. military veterans may be at increased risk for engaging in substance use; however, this has yet to be examined using nationally representative data. Parental involvement and communication are potential protective factors to target with prevention efforts, but veterans' parenting has not been studied in general, nonclinical populations. Objectives: This study presents data on parenting characteristics among fathers who are veterans of the U.S. military and the substance use behaviors of their adolescent children. Methods: Data were analyzed from approximately 2,200 veteran fathers, 13,100 nonveteran fathers, and their children aged 12 to 17 who participated in the National Survey on Drug Use and Health from 2004 to 2013. Parenting characteristics and adolescent substance use were compared by fathers' veteran status. Results: Compared with nonveteran fathers, veteran fathers were less likely to have talked with their children about the dangers of substance use, were more likely to believe that their children used substances, and were just as likely to be parentally involved. Higher percentages of adolescent children of veterans than those of nonveterans engaged in tobacco use and nonmedical use of psychotherapeutic drugs. Parental involvement and father-child communication about the dangers of substance use did not explain differences in substance use among adolescents with veteran versus nonveteran fathers. Conclusions/Importance: Adolescent children of veterans appear to be a group in particular need of substance use prevention services. Parental involvement and father-child communication may be appropriate protective factors to address in prevention efforts.

Auditory Brainstem Response Altered in Humans With Noise Exposure Despite Normal Outer Hair Cell Function.

Recent animal studies demonstrated that cochlear synaptopathy, a partial loss of inner hair cell-auditory nerve fiber synapses, can occur in response to noise exposure without any permanent auditory threshold shift. In animal models, this synaptopathy is associated with a reduction in the amplitude of wave I of the auditory brainstem response (ABR). The goal of this study was to determine whether higher lifetime noise exposure histories in young people with clinically normal pure-tone thresholds are associated with lower ABR wave I amplitudes. Twenty-nine young military Veterans and 35 non Veterans (19 to 35 years of age) with normal pure-tone thresholds were assigned to 1 of 4 groups based on their self-reported lifetime noise exposure history and Veteran status. Suprathreshold ABR measurements in response to alternating polarity tone bursts were obtained at 1, 3, 4, and 6 kHz with gold foil tiptrode electrodes placed in the ear canal. Wave I amplitude was calculated from the difference in voltage at the positive peak and the voltage at the following negative trough. Distortion product otoacoustic emission input/output functions were collected in each participant at the same four frequencies to assess outer hair cell function. After controlling for individual differences in sex and distortion product otoacoustic emission amplitude, the groups containing participants with higher reported histories of noise exposure had smaller ABR wave I amplitudes at suprathreshold levels across all four frequencies compared with the groups with less history of noise exposure. Suprathreshold ABR wave I amplitudes were reduced in Veterans reporting high levels of military noise exposure and in non Veterans reporting any history of firearm use as compared with Veterans and non Veterans with lower levels of reported noise exposure history. The reduction in ABR wave I amplitude in the groups with higher levels of noise exposure cannot be accounted for by sex or variability in outer hair cell function. This change is similar to the decreased ABR wave I amplitudes observed in animal models of noise-induced cochlear synaptopathy. However, without post mortem examination of the temporal bone, no direct conclusions can be drawn concerning the presence of synaptopathy in the study groups with higher noise exposure histories.

Aiming High

This study investigates how veteran status influences earnings for working-age American women. Recent increases in women’s participation in the U.S. military mean that the proportion of female veterans is rising and is forecast to increase over the next 30 years. Yet we still know relatively little about the relationship between women’s military experience and later labor-market outcomes. Drawing on American Community Survey data from 2008 to 2010 and employing a new set of occupational categories better suited to veterans, we investigate how occupation and race/ethnicity influence the effect of veteran status on women’s earnings. Findings corroborate previous support for the “bridging hypothesis” in two ways. First, veterans are overrepresented in higher paying occupations and underrepresented in the lowest paying ones, partially accounting for their higher earnings. Second, military experience particularly enhances the earnings of disadvantaged race/ethnic minority women.

Activity-Limiting Musculoskeletal Conditions in US Veterans Compared to Non-Veterans: Results from the 2013 National Health Interview Survey.

Past military service is associated with health outcomes, both positive and negative. In this study we use the 2013 National Health Interview Survey to examine the constellation of conditions referred to as musculoskeletal disorders (MSDs) for Veterans and non-veterans with health conditions that limit their daily activities. Multivariate logistic regression analysis reveal that Veterans are more likely to report MSDs like neck and back problems, fracture bone and joint problems as an activity limiting problem compared to non-veterans. The relationship between age and reports of activity limiting MSDs is moderated by Veteran status. Veterans in this sample report more activity limiting MSDs at younger ages compared to non-veterans and fewer MSDs at older ages. This research contributes to our understanding of potentially limiting health conditions at earlier ages for Veterans.