White Veterans Research Articles

Time-Dependent Risk Differences in Kidney Failure and Death Between Black and White Veterans Following Incident CKD

Time-Dependent Risk Differences in Kidney Failure and Death Between Black and White Veterans Following Incident CKD

Variation in Clinical Treatment and Outcomes by Race Among US Veterans Hospitalized With COVID-19

Patients from racially and ethnically minoritized populations, such as Black and Hispanic patients, may be less likely to receive evidence-based COVID-19 treatments than White patients, contributing to adverse clinical outcomes. To determine whether clinical treatments and outcomes among patients hospitalized with COVID-19 were associated with race. This retrospective cohort study was conducted in 130 Department of Veterans Affairs Medical Centers (VAMCs) between March 1, 2020, and February 28, 2022, with a 60-day follow-up period until May 1, 2022. Participants included veterans hospitalized with COVID-19. Data were analyzed from May 6 to June 2, 2022. Self-reported race. Clinical care processes (eg, intensive care unit [ICU] admission; organ support measures, including invasive and noninvasive mechanical ventilation; prone position therapy, and COVID-19-specific medical treatments) were quantified. Clinical outcomes of interest included in-hospital mortality, 60-day mortality, and 30-day readmissions. Outcomes were assessed with multivariable random effects logistic regression models to estimate the association of race with outcomes not attributable to known mediators, such as socioeconomic status and age, while adjusting for potential confounding between outcomes and mediators. A total of 43 222 veterans (12 135 Black veterans [28.1%]; 31 087 White veterans [71.9%]; 40 717 [94.2%] men) with a median (IQR) age of 71 (62-77) years who were hospitalized with SARS-CoV-2 infection were included. Controlling for site of treatment, Black patients were equally likely to be admitted to the ICU (4806 Black patients [39.6%] vs 13 427 White patients [43.2%]; within-center adjusted odds ratio [aOR], 0.95; 95% CI, 0.88-1.02; P = .17). Two-thirds of patients treated with supplemental oxygen or noninvasive or invasive mechanical ventilation also received systemic steroids, but Black veterans were less likely to receive steroids (within-center aOR, 0.88; 95% CI, 0.80-0.96; P = .004; between-center aOR, 0.67; 95% CI, 0.48-0.96; P = .03). Similarly, Black patients were less likely to receive remdesivir (within-center aOR, 0.89; 95% CI, 0.83-0.95; P < .001; between-center aOR, 0.68; 95% CI, 0.47-0.99; P = .02) or treatment with immunomodulatory drugs (within-center aOR, 0.77; 95% CI, 0.67-0.87; P < .001). After adjusting for patient demographic characteristics, chronic health conditions, severity of acute illness, and receipt of COVID-19-specific treatments, there was no association of Black race with hospital mortality (within-center aOR, 0.98; 95% CI, 0.86-1.10; P = .71) or 30-day readmission (within-center aOR, 0.95; 95% CI, 0.88-1.04; P = .28). These findings suggest that Black veterans hospitalized with COVID-19 were less likely to be treated with evidence-based COVID-19 treatments, including systemic steroids, remdesivir, and immunomodulatory drugs.

Telemedicine Utilization Among Patients With Multiple Sclerosis in the US Veterans Health Administration, 2010-2020.

Telemedicine may help to bridge the specialty care access gap for patients with MS (PwMS) restricted by distance or disability. The objective of this study is to assess the frequency and longitudinal patterns of telemedicine utilization among PwMS and controls. We conducted a population-based nested case-control study within the Veterans Health Administration (VHA) from January 1, 2010, to December 31, 2020. MS cases and controls were individually matched on sex, age, and Veterans Affair (VA) service region (Veterans Integrated Service Network). MS case and control participants sample sizes by year included 2010: 19,387/86,379; 2016: 19,752/88,535; and 2020: 16,451/78,315. Telemedicine encounter codes were used to identify telemedicine utilization among MS cases and controls in the VHA for 2010, 2016, and 2020. Telemedicine encounters were categorized according to mode (video, phone, and supplementary remote) and type of care provided. Patients in the VHA have had increasing utilization of telemedicine over the past decade. Among PwMS, mean telemedicine encounters increased steadily from 2010 to 2020 (5.6-10.5 encounters/patient, respectively). Across all years, MS cases were significantly more likely than controls to use telemedicine. The odds ratios (ORs) (95% confidence interval [CI]) of any telemedicine utilization comparing MS cases with controls in 2010, 2016, and 2020, respectively, were 1.5 (CI: 1.3-1.5), 1.9 (CI: 1.8-2.0), and 1.7 (CI: 1.6-1.8). Compared with non-Hispanic White veterans, non-Hispanic Black veterans were more likely to use telemedicine (adjusted OR = 1.5; [CI: 1.40-1.60]). The most common and least common modes of telemedicine among cases and controls were telephone and supplementary remote, respectively. Comparing 2010 with 2020, the largest increases in telemedicine utilization exhibited among MS cases were among primary care, specialty care, specialty neurology care, and other types of health care. States with the highest increases in telemedicine utilization were AL, CA, CO, FL, GA, KS, IL, NY, and SC. PwMS tended to live in counties with more adverse social determinants of health compared with controls. PwMS were significantly more likely to use telemedicine than their matched controls. There were significant increases in telemedicine utilization between 2010 and 2020. The VHA has a robust telemedicine system of care that has grown to supplement in person care more so than other US health care systems. Future work is needed to assess the determinants of telemedicine utilization.

Editors' Selections from Relevant Scientific Publications

Editors' Selections from Relevant Scientific Publications

Advance Care Planning and Goals-of-Care Decisions Among Veterans With Malignancy.

There is a limited knowledge base about factors affecting advance directives and code status decisions among veterans with malignancy. In addition, few studies have focused on the benefit of palliative care (PC) in goals-of-care discussions among veterans with cancer. This study examined advance care planning and goals-of-care decisions among veterans with malignancy. Demographic and clinical data were obtained using retrospective chart analysis. Patient characteristics were analyzed using univariate descriptive statistics. To compare patients with and without a do-not-resuscitate (DNR) decision, chi-square test was performed. More than half of the patients in the study were referred to PC within one year of their cancer diagnosis. Most had documented metastatic disease at the time of their PC referral. Veterans with prostate cancer were more likely to elect full code status. In this study, White veterans were more likely to choose a DNR order than African American veterans.

Reliability and Factor Structure of the Saint Louis University Mental Status (SLUMS) Examination

ABSTRACT Objectives Compared to its alternatives (e.g., Mini-Mental State Examination [MMSE] and Montreal Cognitive Assessment [MoCA]), little is known about the psychometric properties and factor structure of the Saint Louis University Mental Status (SLUMS) Examination. The purpose of the current study is to describe the internal consistency, factor structure, and temporal stability of the SLUMS, a widely used cognitive screening measure. Methods We examined the SLUMS of 108 mostly White male Veterans seen for home-based primary care services, 101 of whom had complete data and 28 who completed retesting approximately one year later. Results At time one, Veterans averaged 76.44 (SD = 9.88) years of age and 13.07 (SD = 2.26) years of formal education. Results indicated that the SLUMS had acceptable internal consistency (α = .709) and temporal stability (ρ =.723), with strongest evidence for a one-factor structure. Conclusions The SLUMS appears to have adequate reliability and clear one-factor structure in this sample. Additional research with diverse samples is needed to characterize the psychometrics of the SLUMS more comprehensively. Clinical Implications The SLUMS appears to be an efficient method for approximating global cognitive functioning among medically complex older adults.

Sexually Transmitted Infection Testing in the National Veterans Health Administration Patient Cohort During the Coronavirus Disease 2019 Pandemic.

ObjectivesWe performed a retrospective study of chlamydia, gonorrhea, syphilis, and HIV testing in the Veterans Health Administration (VHA) during 2019-2021.MethodsWe determined the annual number of chlamydia, gonorrhea, syphilis, and HIV tests from 2019-2021 using electronic health record data. We calculated rates by age, birth sex, race, census region, rurality, HIV status, and use of PrEP.ResultsThe VHA system experienced a 24% drop in chlamydia/gonorrhea testing, a 25% drop in syphilis testing, and a 29% drop in HIV testing in 2020 versus 2019. By the conclusion of 2021, testing rates had recovered to 90% of baseline for chlamydia/gonorrhea, 91% for syphilis, and 88% for HIV.Declines and subsequent improvements in STI testing occurred unequally across age, sex, race, and geographic groups. Testing for all four STIs in 2021 remained below baseline in rural Veterans. Excluding those <25, women experienced a steeper decline and slower recovery in chlamydia/gonorrhea testing relative to men, but quicker recovery in HIV testing. Asian Americans and Hawaiian/Pacific Islanders had a steeper decline and a slower recovery in testing for chlamydia/gonorrhea. Black and White Veterans had slower recovery in HIV testing compared with other race groups. People living with HIV experienced a smaller drop in testing for syphilis compared with people without HIV, followed by a near-total recovery of testing by 2021.ConclusionAfter dramatic reductions from 2019-2020, STI testing rates returned to near-baseline in 2021. Testing recovery lagged in rural, women, Asian American, Hawaiian/Pacific Islander, and Black Veterans.

The Effect of Race on Outcomes in Veterans With Hepatocellular Carcinoma at a Single Center.

Black patients have a higher incidence and mortality associated with hepatocellular carcinoma (HCC) compared with that of White patients in many retrospective analyses. This study sought to determine whether veterans treated for HCC at the Memphis Veterans Affairs Medical Center (VAMC) in Tennessee showed similar disparities in terms of stage at diagnosis, type of therapy received, and overall survival (OS). A retrospective review evaluated 132 White and 95 Black patients treated for HCC between 2009 and 2021. We evaluated the impact on OS of age, sex, comorbidities, tumor stage, α-fetoprotein level, method of diagnosis, first-line treatment, systemic treatment, and surgical options offered. Kaplan-Meier analysis was used to investigate differences in OS and cumulative hazard ratio for death. Cox regression multivariate analysis evaluated discrepancies among investigated variables. The study found no significant difference in OS between Black and White veterans with HCC. Significant differences were found in who received surgical treatment and systemic therapy. More White veterans received any form of treatment compared with Black veterans (P < .001), and White veterans were more likely to undergo surgical resection and transplant (P = .052). There was no significant difference between age or stage at diagnosis, receipt of systemic therapy, alcohol, tobacco or drug use, HIV coinfection, or cirrhosis. Black veterans with HCC at the Memphis VAMC were less likely to receive any form of treatment, surgical resection, or transplant compared with White veterans, but this did not have a statistically significant effect on OS.

Impact of COVID-19 on the incidence of localized and metastatic prostate cancer among White and Black Veterans.

The COVID‐19 pandemic disrupted prostate‐specific antigen (PSA) screening and prostate biopsy procedures. We sought to determine whether delayed screening and diagnostic workup of prostate cancer (PCa) was associated with increased subsequent rates of incident PCa and advanced PCa and whether the rates differed by race. We analyzed data from the Veterans Health Administration to assess the changes in the rates of PSA screening, prostate biopsy procedure, incident PCa, PCa with high‐grade Gleason score, and incident metastatic prostate cancer (mPCa) before and after January 2020. While the late pandemic mPCa rate among White Veterans was comparable to the pre‐pandemic rate (5.4 pre‐pandemic vs 5.2 late‐pandemic, p = 0.67), we observed a significant increase in incident mPCa cases among Black Veterans in the late pandemic period (8.1 pre‐pandemic vs 11.3 late‐pandemic, p < 0.001). Further investigation is warranted to fully understand the impact of the COVID‐19 pandemic on the diagnosis of advanced prostate cancer.

Obesity in Latinx and White U.S. military veterans: prevalence, physical health, and functioning

ObjectiveWhile Latinx Americans in the general population are more likely to have obesity than non-Hispanic Whites, limited research has examined ethnic differences in obesity and its correlates among military veterans. To address this gap, we examined the prevalence, physical health and functional correlates of obesity in a population-based sample of Latinx and White U.S. military veterans. MethodsData were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of veterans. Bivariate and multivariate analyses were conducted to evaluate the relation between obesity, and health and functioning measures in Latinx and White veterans. ResultsThe prevalence of obesity was significantly higher among Latinx veterans (weighted 43.6% vs. 35.5%; odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.10–1.81). While obesity was associated with a greater number of medical conditions, reduced functioning, higher somatic symptoms, and insomnia severity in both Latinx and White veterans, these differences were more pronounced in Latinx relative to White veterans, with higher rates of arthritis, liver disease, diabetes, high blood pressure and cholesterol, heart attack, stroke, migraine, and physical disability, and greater physical, mental, and psychosocial dysfunction. ConclusionObesity is more prevalent in Latinx than in White U.S. veterans, and the associated elevated health and functional impairments are more pronounced in Latinx veterans. Characterization of co-occurring physical and functioning problems among Latinx and White veterans with obesity may help inform ethnically-sensitive obesity prevention and treatment efforts in this population.

Predictors of discharge from the VA Caregiver Support Program.

The Department of Veterans Affairs (VA) Program of Comprehensive Assistance for Family Caregivers (PCAFC) is a clinical program providing training, a monthly stipend, and other services to caregivers of qualifying post-9/11 veterans with service-related injuries. Veteran-caregiver discharge from the program occurs when veteran recovery is achieved, participation is no longer in the veteran's best interest, or caregiving ceases. Public scrutiny about potentially inappropriate discharges resulted in a nationwide freeze on all discharges. PCAFC expanded to pre-9/11 veterans in October 2020; thus, lessons learned can continue to inform the expanded program. We pursued 3 objectives: (1) describe the discharge rate, reasons for discharge, and veteran and caregiver characteristics by discharge status; (2) identify factors associated with discharge from PCAFC nationally; and (3) characterize network variation in discharge predictors. Retrospective observational study using VA administrative data from fiscal year (FY) 2011 to FY 2017. Using multivariable Cox proportional hazards regression, we examined factors associated with PCAFC discharge among veterans and caregivers enrolled in PCAFC during FY 2011 to FY 2016. A total of 40.5% of all participants were discharged. Nonspouse caregivers and those applying in later years had the highest rates of discharge; spouse caregivers and those applying in earlier years had the lowest rates of discharge. In 4 of 18 networks, caregivers of Black veterans faced higher rates of discharge compared with caregivers of White veterans, and in 1 network, they faced lower rates of discharge. Substantial variability in rates of discharge was also observed across Veterans Integrated Service Networks. Training on clinically appropriate discharge criteria could improve practice and increase equity.

COVID-19 vaccine adoption and hesitancy among older Veterans

BackgroundOlder adults are particularly at risk for severe illness or death from COVID-19. Accordingly, the Veterans Health Administration (VA) has prioritized this population group in its COVID-19 vaccination strategy. This study examines the receptivity of Veterans enrolled in the VA’s Geriatric Patient Aligned Care Team (GeriPACT) to receiving the COVID-19 vaccine. GeriPACT is an outpatient primary care program that utilizes multi-disciplinary teams to provide health services to older Veterans.MethodsWe conducted semistructured interviews with 42 GeriPACT-enrolled Veterans from five states. Participants were asked to identify barriers to vaccine acceptance. We gathered data from January-March 2021 and analyzed them using qualitative methods.ResultsBoth White and African American GeriPACT Veterans had minimal vaccine hesitancy towards the COVID-19 vaccine. On-line registration and ineligibility of a spouse/caregiver for vaccination were primary barriers to early vaccination.ConclusionsAs the first wave of early adopters of the COVID-19 vaccination effort nears completion, targeted strategies are needed to understand and respond to vaccine hesitancy to lower the risk of subsequent waves of infections. The 2021 SAVE LIVES Act, begins to address identified vaccination barriers by permitting vaccination of Veteran spouses and caregivers, but consideration must be given to creating alternatives to on-line registration and allowing spouses and caregivers to register for appointments together.

Preliminary findings from reevaluating the MMPI Response Bias Scale items in veterans undergoing neuropsychological evaluation

The Response Bias Scale (RBS) was developed to predict non-credible cognitive presentations among disability claimants without head injury. Developers used empirical keying, which is independent of apparent content, to select items from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) item pool that distinguished between individuals passing or failing performance validity tests (PVTs). No study has examined which of these items would have psychometric value when used in clinical neuropsychological evaluations. This study reexamined items comprising RBS with reference to manifest item content, internal consistency, PVTs, and a symptom validity test (SVT) in a sample of 173 predominately White male veterans (MAGE = 50.70, MEDU = 13.73) in a VA outpatient neuropsychology clinic. Participants completed the MMPI-2 Restructured Form (MMPI-2-RF), PVTs, and an SVT. The 28-item RBS appears to contain three types of items: those that manifestly address cognitive functioning, those that are supported but do not appear to address cognitive functioning, and nine items that were unrelated to cognition and not statistically supported. The 19 empirically supported items, or RBS-19, predicted PVT and SVT failures marginally better than the RBS. Both the RBS and RBS-19 had stronger relationships with SVTs relative to PVTs. Although the removal of the nine problematic items improved the diagnostic accuracy of the scale, it still did not reach the level that is generally considered to be clinically optimal. The RBS-19 offers a measure with improved internal consistency and predictive validity compared to the RBS and warrants additional research.

Complementary/integrative healthcare utilization in US Gulf-War era veterans: Descriptive analyses based on deployment history, combat exposure, and Gulf War Illness

Complementary and integrative health (CIH) approaches have gained empirical support and are increasingly being utilized among veterans to treat a myriad of conditions. A cluster of medically unexplained chronic symptoms including fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems, often referred to as Gulf War Illness (GWI) prominently affect US Gulf War era (GWE) veterans, yet little is known about CIH use within this population. Using data collected as part of a larger study (n = 1153), we examined the influence of demographic characteristics, military experiences, and symptom severity on CIH utilization, and utilization differences between GWE veterans with and without GWI. Over half of the sample (58.5%) used at least one CIH modality in the past six months. Women veterans, white veterans, and veterans with higher levels of education were more likely to use CIH. GWE veterans with a GWI diagnosis and higher GWI symptom severity were more likely to use at least one CIH treatment in the past six months. Over three quarters (82.7%) of veterans who endorsed using CIH to treat GWI symptoms reported that it was helpful for their symptoms. Almost three quarters (71.5%) of veterans indicated that they would use at least one CIH approach if it was available at VA. Results provide a deeper understanding of the likelihood and characteristics of veterans utilizing CIH to treat health and GWI symptoms and may inform expansion of CIH modalities for GWE veterans, particularly those with GWI.

Military sexual trauma in context: Ethnoracial differences in ecological resources among treatment-seeking veterans.

Veterans who have experienced military sexual trauma (MST) are at increased risk for a host of negative outcomes, including posttraumatic stress disorder, depressive disorders, and substance use disorders. Previous studies have shown racial differences in MST exposure, namely that Black veterans experience MST more frequently than White veterans. One way to help clinicians and researchers understand the impact of these ethnoracial differences in MST exposure is through an applied theory of ecological resources, which has demonstrated ecological factors (e.g., aspects of identity, beliefs, and environmental stressors) contribute to veteran well-being in the aftermath of MST. The present study aimed to examine ethnoracial differences in ecological resources (i.e., available social support, spiritual coping, past-year interpersonal violence, financial sufficiency, and stable living environment). Participants (N = 505) were U.S. veterans who sought care at a Veterans Healthcare Administration clinic in the midwestern United States for mental health issues related to MST. Results demonstrated Black veterans were more likely than White veterans to report being financially insecure, U = 18,091.50, z = -2.04, p = .042, r = .10. Black veterans were also more likely to report spiritual beliefs that assisted with coping, Cramer's V = .19, but less likely to report having a social support system, Cramer's V = .16. These findings highlight the importance of assessing and addressing disparities illuminated by ethnoracial differences in ecological resources and barriers in veterans seeking care for MST.

Race Differences in Veteran's Affairs Emergency Department Utilization.

African Americans (AAs) experience disparities in chronic pain care. This study aimed to identify the rates of emergency department (ED) utilization for visits associated with chronic pain diagnoses among AAs compared to Whites and to determine variables that accounted for any differences. This retrospective observational study used national Veterans Affairs (Veteran's Health Administration) administrative data to identify Veterans with chronic pain diagnoses in 2018. Race/ethnicity was self-reported and assessed to examine if differences exist in ED utilization. Differences between AAs and Whites were examined using negative binomial regression models, controlling for ethnicity. Multivariable models (including demographics, pain characteristics, psychiatric comorbidities, medical comorbidities, pain-related health care utilization, and medication utilization) were examined to determine factors that contributed to these disparities. Among the 2,261,030 patients, 22% (n = 492,138) were AA. The incidence rate ratio of ED utilization for AAs, relative to Whites, was 1.58 (95% CI: 1.56-1.59). The only independent variable that produced a clinically meaningful reduction in the race effect on ED use was rurality, which was associated with reduced ED use. Post hoc model including all variables reduced the race effect to 1.37 (95% CI: 1.36-1.38). AA Veterans had a 58% greater risk of ED utilization for visits associated with chronic pain diagnoses relative to White Veterans, which remained meaningfully elevated after adjustment for observable confounders (37%). This observation may reflect disparities in outpatient chronic pain care for AAs. Future research could focus on enhancing therapeutic alliance in primary care to improve chronic pain treatment for AAs.

0076 Differences in Pain Catastrophizing and Insomnia Among Racially Diverse Veterans with Chronic Pain

Abstract Introduction Racially diverse Veterans may be particularly susceptible to insomnia in the context of chronic pain. Pain catastrophizing (PC) involves a negative response to pain including rumination, magnification, and helplessness, and is positively associated with deleterious pain outcomes, including insomnia severity. As little work has examined racial differences among Veterans, this poster will explore differences in insomnia severity and PC between Black/African American, Hispanic/Latino, and White Veterans. Methods 271 Veterans with moderate to severe chronic pain seeking treatment to address insomnia completed PC (Pain Catastrophizing Scale; PCS) and insomnia (Insomnia Severity Index; ISI) measures. The sample consisted of 100 Black/African American, 48 Hispanic/Latino, and 123 White Veterans. A one-way analysis of covariance (ANCOVA) investigated whether ISI varied significantly across racial groups. Similarly, ANCOVAs were conducted to test whether PC differed by race. Numerical pain rating was included as a covariate in the models. Results There was a significant difference in insomnia severity [F(2 , 263) = 4.03; p = .02; partial n2 = .03] by race. Post-hoc analyses demonstrated a significant difference in insomnia severity between Black/African Americans and White Veterans (p = .02). There was also a statistically significant difference in PC based on race, (F(2 , 262) = 7.03, p = .001; partial n2 = .05). Post-hoc analyses indicated a significant difference in PC between Black/African Americans and White Veterans (p = .01), as well as White and Hispanic/Latino Veterans (p &amp;lt; .01).In addition, there were significant differences in all three PCS subscales by race. Black/African Americans and White Veterans significantly differed on rumination (p &amp;lt; .01), and magnification (p &amp;lt; .001). White and Hispanic Veterans significantly differed on rumination (p = .02), magnification (p = .001) and helplessness (p &amp;lt; .05). Conclusion This is the first study to explore insomnia and PC differences by race in Veterans. Black/African American and Hispanic Veterans demonstrated higher insomnia severity and PC than White Veterans. No significant differences emerged between Black/African American and Hispanic Veterans. Interventions that reduce PC may be particularly important for improving sleep for racial minority Veterans. Future studies should explore the relationship between sleep and PC for racial minority Veterans. Support (If Any)

Self-reported health behaviors and risk perceptions following the COVID-19 vaccination rollout in the USA: an online survey study

ObjectivesConcerns have been raised that mass vaccination campaigns might lead to reduced engagement with other recommended health behaviors. We assessed self-reported behaviors and risk perceptions following the COVID-19 vaccine rollout in the USA. Study designBetween December 2, 2020, and March 23, 2021, we conducted three online survey studies with US adult respondents. MethodsRespondents self-reported their COVID-19 vaccination status, their frequency of engaging in risk-increasing behaviors and wearing a mask when in public places, and their COVID-19 risk perceptions (i.e., perceived likelihood of getting COVID-19 and of being hospitalized if they got COVID-19). ResultsOur analytical sample included 832 respondents who had completed the first and final surveys and had received either 0 or 2 doses of a COVID-19 vaccine. Most respondents were non-Hispanic White (75%), male (77%), and US Veterans (64%), with the median age between 55 and 74 years. Overall, respondents reported frequently wearing masks when in public and rarely engaging in risk-increasing behaviors. Regardless of vaccination status, respondents reported more frequently engaging in risk-increasing behaviors and lower risk perceptions in March 2021 than in December 2020. Mask wearing did not change over the study period, with vaccinated respondents consistently reporting more frequent mask wearing than unvaccinated respondents. ConclusionsTaken together, our findings indicate that the COVID-19 vaccine rollout in the USA did not result in the rapid abandonment of protective behaviors or dramatic uptake of risk-increasing behaviors. Additional studies are needed to monitor how mass vaccination might impact public behaviors and risk perceptions as coverage widens.

We Have Buried Our Tomahawks Very Deep in the Ground and in the Sky: Rock River Ho-Chunk Peacekeeping in the 1832 “Black Hawk War”

Abstract In Spring 1832, a Ho-Chunk delegation attempted to resolve a refugee crisis that threatened to bring war with the Americans into their lands. The return migration of a removed multiethnic band made up primarily of Sauk and Fox families into northern Illinois precipitated a conflict known as the Black Hawk War. When direct diplomacy failed, Rock River Ho-Chunks attempted to spare the lives of their refugee kin while also protecting their cornfields from American invaders. The federal government used the crisis to force a land cession and removal treaty. Nineteenth-century American observers, and historians ever since, have generally overlooked the imaginative peacekeeping strategies deployed by the Ho-Chunk people, schemes designed to prevent troops from finding the refugees and from destroying raised field agriculture. They almost succeeded. Emphasizing Native voices and actions in the historical record and questioning accounts published by the White conflict veterans on which historians traditionally rely allows a new history of this tragic crisis that privileges Native autonomy, ingenuity, and survivance.

My Commander in Chief is Black! The Mental Health Significance of Barack Obama’s 2008 Presidential Election for Military Veterans

This study investigated the mental health significance of Barack Obama’s 2008 presidential election for military veterans. Many believed his election signaled a progressive shift in race relations and crucial challenge to White supremacy. Furthermore, many argued his election generated hope, especially among Blacks. We therefore hypothesized Black and Hispanic veterans would experience improved mental health after installment of the nation’s first Black commander in chief. We also hypothesized White veterans would experience no change in their mental health. With nationally representative survey data from the Behavioral Risk Factor Surveillance System (BRFSS), we tested these hypotheses by predicting poor mental health days self-identified Black, Hispanic, and White veterans experienced preelection and postelection in fall 2008. Net of established social determinants of health, we estimated Black and Hispanic veterans, respectively, experienced approximately 2.01 and 2.17 fewer poor mental health days postelection, whereas White veterans experienced no significant postelection change. Sensitivity analyses seemed to corroborate these findings.