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Yancey JR, Carson CN, McGlade EC, Yurgelun-Todd DA. A Literature Review of Mental Health Symptom Outcomes in U.S. Veterans and Servicemembers Following Combat Exposure and Military Sexual Trauma. TRAUMA, VIOLENCE & ABUSE 2024; 25:1431-1447. [PMID: 37313717 DOI: 10.1177/15248380231178764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Combat exposure (CE) and military sexual trauma (MST) are among the most common types of traumatic experiences faced by veterans and active duty servicemembers and, as such, have both garnered increased research focus over the past decades. However, there has not yet been a critical review of the literature to examine the distinct clinical presentations associated with different trauma types. This is particularly important, as understanding distinct clinical profiles could help researchers and clinicians refine treatment approaches based on trauma type. To address this question, we conducted a search of the available literature in PsycINFO and PubMed prior to October 2022. We identified 43 articles evaluating the distinct and overlapping clinical symptoms of CE and MST. Study findings were conceptually organized by psychiatric condition. In general, there was substantial variability in study methodology including sample size, composition, and operationalizations of CE and MST. Despite this variability, notable patterns emerged across studies. Specifically, MST and CE uniquely predicted posttraumatic stress disorder symptoms, MST was more related to depressive symptoms and suicidality than CE, and CE appeared to be more related to alcohol use and other externalizing behaviors. Gender also played a significant role in the relationship between CE, MST, and clinical variables across studies. This review suggests that individuals with a history of MST and CE likely have distinct clinical presentations and more research into these presentations could better inform assessment and treatment. Important methodological gaps in the literature are also discussed.
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Affiliation(s)
- James R Yancey
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chelsea N Carson
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin C McGlade
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Deborah A Yurgelun-Todd
- Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC), Department of Veterans Affairs, Salt Lake City, UT, USA
- Huntsman Mental Health Institute, University of Utah School of Medicine, Salt Lake City, UT, USA
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Hoggatt KJ, Chawla N, Washington DL, Yano EM. Trends in substance use disorder diagnoses among Veterans, 2009-2019. Am J Addict 2023; 32:393-401. [PMID: 36883297 DOI: 10.1111/ajad.13413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/11/2023] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Substance use disorder (SUD) represents a substantial health burden to US Veterans. We aimed to quantify recent time trends in Veterans' substance-specific disorders using Veterans Health Administration (VA) data. METHODS We identified Veteran VA patients for fiscal years (FY) 2010-2019 (October 1, 2009-September 9, 2019) and extracted patient demographics and diagnoses from electronic health records (~6 million annually). We defined alcohol, cannabis, cocaine, opioid, sedative, and stimulant use disorders with ICD-9 (FY10-FY15) or ICD-10 (FY16-FY19) codes and variables for polysubstance use disorder, drug use disorder (DUD), and SUD. RESULTS Diagnoses for substance-specific disorders (excluding cocaine), polysubstance use disorder, DUD, and SUD increased 2%-13% annually for FY10-FY15. Alcohol, cannabis, and stimulant use disorders increased 4%-18% annually for FY16-FY19, while cocaine, opioid, and sedative use disorders changed by ≤1%. Stimulant and cannabis use disorder diagnoses increased most rapidly, and older Veterans had the largest increases across substances. DISCUSSION AND CONCLUSIONS Rapid increases in cannabis and stimulant use disorder present a treatment challenge and key subgroups (e.g., older adults) may require tailored screening and treatment options. Diagnoses for SUD are increasing among Veterans overall, but there is important heterogeneity by substance and subgroup. Efforts to ensure access to evidence-based treatment for SUD may require greater focus on cannabis and stimulants, particularly for older adults. SCIENTIFIC SIGNIFICANCE These findings represent the first assessment of time trends in substance-specific disorders among Veterans, overall and by age and sex. Notable findings include large increases in diagnoses for cannabis and stimulant use disorder and among older adults.
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Affiliation(s)
- Katherine J Hoggatt
- San Francisco VA Health Care System, Research Division, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
| | - Neetu Chawla
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Research Division, Los Angeles, California, USA
| | - Donna L Washington
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Research Division, Los Angeles, California, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California, USA
| | - Elizabeth M Yano
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, Research Division, Los Angeles, California, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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Bachrach RL, Quinn DA. The role of gender and veteran status in healthcare access among a national sample of U.S. adults with unhealthy alcohol use. Subst Use Misuse 2023; 58:491-499. [PMID: 36722613 DOI: 10.1080/10826084.2023.2170182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: Routine healthcare access is critical to reduce drinking and its effects, yet little is known about Veteran and gender differences in routine healthcare access among unhealthy drinkers. The current study examined differences in routine healthcare access, stratified by Veteran status and gender, among a national sample of adults endorsing unhealthy drinking. Method: Using data from the Centers for Disease Control and Prevention's 2019 Behavioral Risk Factor Surveillance System National Survey, we identified adults who endorsed unhealthy drinking over the past month (N = 58,816; 41.4% female; 2.7% female Veterans). Bivariate and multivariable analyses modeled associations between gender, Veteran status, and their interaction in predicting routine healthcare access. All multivariable models adjusted for sociodemographic characteristics. Results: Veterans with unhealthy alcohol use reported high rates of routine healthcare access (e.g., >86% sought care in the past 2 years) and were less likely to experience a cost barrier to care (aOR = 0.75, 95% CI = 0.62-0.92). Females were more likely than males to report better access to care but also to experience a cost barrier (aOR = 1.2, 95% CI = 1.10-1.37). The interaction between Veteran status and gender was non-significant. Conclusions: Overall, healthcare access was better for Veterans and females with unhealthy alcohol use compared to civilians and males with unhealthy alcohol use. However, given that females were more likely to report a cost barrier, future implementation research aiming to improve equity in care may want to explore reasons for cost barriers and develop strategies to help reduce these barriers in order to eliminate gender disparities in primary care-based alcohol-related care.
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Affiliation(s)
- Rachel L Bachrach
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Mental Illness Research, Education, and Clinical Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deirdre A Quinn
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.,Mental Illness Research, Education, and Clinical Center, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Spinella S, McCune N, McCarthy R, El-Tahch M, George J, Dorritie M, Ford A, Posteraro K, DiNardo D. WVSUD-PACT: a Primary-Care-Based Substance Use Disorder Team for Women Veterans. J Gen Intern Med 2022; 37:837-841. [PMID: 36042085 PMCID: PMC9481786 DOI: 10.1007/s11606-022-07577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 04/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sara Spinella
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA. .,VA Pittsburgh Healthcare System, Pittsburgh, USA.
| | - Nicole McCune
- VA Pittsburgh Healthcare System, Pittsburgh, USA.,Waynesburg University, Waynesburg, USA
| | | | - Maria El-Tahch
- Primary Care Mental Health Integration, VA Pittsburgh Healthcare System, Pittsburgh, USA
| | | | | | - Alyssa Ford
- Primary Care Mental Health Integration, VA Pittsburgh Healthcare System, Pittsburgh, USA
| | | | - Deborah DiNardo
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA.,VA Pittsburgh Healthcare System, Pittsburgh, USA
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Hoggatt KJ, Harris AHS, Washington DL, Williams EC. Prevalence of substance use and substance-related disorders among US Veterans Health Administration patients. Drug Alcohol Depend 2021; 225:108791. [PMID: 34098384 DOI: 10.1016/j.drugalcdep.2021.108791] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Substance use and related disorders are common among US Veterans, but the population burden of has never been directly assessed among Veterans Health Administration (VA) patients. We surveyed VA patients to measure substance use and related disorders in the largest US integrated healthcare system. METHODS We surveyed N = 6000 outpatients from 30 geographically-representative VA healthcare systems. We assessed substance use (lifetime, past 12-month, daily in past 3 months) and past 12-month disorders following DSM-5 criteria and estimated the association with Veteran characteristics (age, gender, race/ethnicity, socioeconomic status, VA utilization). RESULTS Alcohol was the most commonly-reported substance (24% used past 12 months, 11% daily in past 3 months, 10% met criteria for alcohol use disorder), followed by cannabis (42% lifetime use, 12% use in past 12 months, 5% daily use in past 3 months, 3% met criteria for cannabis use disorder). Overall, 5% met criteria for non-alcohol drug use disorder (13% for substance use disorder (SUD)). SUD prevalence was highest for young Veterans and those who were unemployed or otherwise not employed for wages. Past 12-month cannabis use was common, even among older adults (65-74 years: 10%; 75 and older: 2%). CONCLUSIONS Prevalence data are important inputs into decisions around population health monitoring, treatment capacity, and quality measurement strategies. Substance use and SUD are more prevalent than previously reported, and VA may need to screen for non-alcohol drugs to identify patients who need care. More tailored assessment may be needed for cannabis use, high-prevalence subgroups, and older adults.
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Affiliation(s)
- Katherine J Hoggatt
- San Francisco VA Health Care System, 4150 Clement St., San Francisco, CA 94121, USA; University of California, Department of Medicine, 505 Parnassus Ave, San Francisco, CA 94143, USA.
| | - Alexander H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025, USA; Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
| | - Donna L Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., 111G, Los Angeles, CA 90073, USA; Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA, USA.
| | - Emily C Williams
- Center of Innovation for Veteran Centered and Value-Driven Care, VA Puget Sound, 1660 S Columbian Way, S-152 Seattle, WA 98108, USA; Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.
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Milicevic AS, Mitsantisuk K, Tjader A, Vargas DL, Hubert TL, Scott B. Modeling Patient No-Show History and Predicting Future Appointment Behavior at the Veterans Administration's Outpatient Mental Health Clinics: NIRMO-2. Mil Med 2021; 185:e988-e994. [PMID: 32591833 DOI: 10.1093/milmed/usaa095] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION No-shows are detrimental to both patients' health and health care systems. Literature documents no-show rates ranging from 10% in primary care clinics to over 60% in mental health clinics. Our model predicts the probability that a mental health clinic outpatient appointment will not be completed and identifies actionable variables associated with lowering the probability of no-show. MATERIALS AND METHODS We were granted access to de-identified administrative data from the Veterans Administration Corporate Data Warehouse related to appointments at 13 Veterans Administration Medical Centers. Our modeling data set included 1,206,271 unique appointment records scheduled to occur between January 1, 2013 and February 28, 2017. The training set included 846,668 appointment records scheduled between January 1, 2013 and December 31, 2015. The testing set included 359,603 appointment records scheduled between January 1, 2016 and February 28, 2017. The dependent binary variable was whether the appointment was completed or not. Independent variables were categorized into seven clusters: patient's demographics, appointment characteristics, patient's attendance history, alcohol use screening score, medications and medication possession ratios, prior diagnoses, and past utilization of Veterans Health Administration services. We used a forward stepwise selection, based on the likelihood ratio, to choose the variables in the model. The predictive model was built using the SAS HPLOGISTIC procedure. RESULTS The best indicator of whether someone will miss an appointment is their historical attendance behavior. The top three variables associated with higher probabilities of a no-show were: the no-show rate over the previous 2 years before the current appointment, the no-show probability derived from the Markov model, and the age of the appointment. The top three variables that decrease the chance of no-showing were: the appointment was a new consult, the appointment was an overbook, and the patient had multiple appointments on the same day. The average of the areas under the receiver operating characteristic curves was 0.7577 for the training dataset, and 0.7513 for the test set. CONCLUSIONS The National Initiative to Reduce Missed Opportunities-2 confirmed findings that previous patient attendance is one of the key predictors of a future attendance and provides an additional layer of complexity for analyzing the effect of a patient's past behavior on future attendance. The National Initiative to Reduce Missed Opportunities-2 establishes that appointment attendance is related to medication adherence, particularly for medications used for treatment of mood disorders or to block the effects of opioids. However, there is no way to confirm whether a patient is actually taking medications as prescribed. Thus, a low medication possession ratio is an informative, albeit not a perfect, measure. It is our intention to further explore how diagnosis and medications can be better captured and used in predictive modeling of no-shows. Our findings on the effects of different factors on no-show rates can be used to predict individual no-show probabilities, and to identify patients who are high risk for missing appointments. The ability to predict a patient's risk of missing an appointment would allow for both advanced interventions to decrease no-shows and for more efficient scheduling.
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Affiliation(s)
- Aleksandra Sasha Milicevic
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, 2809 Posvar Hall 230 S Bouquet St, Pittsburgh, PA 15213
| | - Kannop Mitsantisuk
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, 2809 Posvar Hall 230 S Bouquet St, Pittsburgh, PA 15213
| | - Andrew Tjader
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, 2809 Posvar Hall 230 S Bouquet St, Pittsburgh, PA 15213
| | - Dominic L Vargas
- Joseph M. Katz Graduate School of Business, University of Pittsburgh, 2809 Posvar Hall 230 S Bouquet St, Pittsburgh, PA 15213
| | - Terrence L Hubert
- Office of Strategic Integration, Veterans Engineering Resource Center, 1010 Delafield Road, 001VERC-A, Bldg. 70, Room BA014, Pittsburgh, PA 15215
| | - Brianna Scott
- VA Pittsburgh Healthcare System, 1010 Delafield Road, 001VERC-A, Bldg. 70, Room BA014, Pittsburgh, PA 15215
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Livingston NA, Simpson T, Lehavot K, Ameral V, Brief DJ, Enggasser J, Litwack S, Helmuth E, Roy M, Rosenbloom D, Keane TM. Differential alcohol treatment response by gender following use of VetChange. Drug Alcohol Depend 2021; 221:108552. [PMID: 33556659 DOI: 10.1016/j.drugalcdep.2021.108552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/30/2020] [Accepted: 01/05/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Proportionally more women use online alcohol interventions but also report less robust treatment outcomes compared to men. Less is known about outcome disparities among veteran women, who are a growing demographic nationally. The current study examined gender differences among returning veteran men and women who used VetChange, a web-based intervention for hazardous drinking and posttraumatic stress symptoms (PTSS). METHOD Using data from a nationwide implementation study of returning combat veterans (n = 222), we performed hierarchical linear modeling to examine gender differences in alcohol and PTSS outcomes over six months following VetChange registration. Additional analyses examined gender differences in proportional changes in hazardous drinking and at each assessment point. RESULTS Returning veterans reported significant decreases in alcohol use and PTSS over time, yet men evidenced significantly greater reduction in average weekly drinks and drinks per drinking day compared to women. Follow up analyses indicated that women were significantly less likely than men to achieve low-risk drinking by one month post-registration. Proportional change in alcohol use yielded marginal and non-significant trends that were, nonetheless, consistent with the overall pattern of gender differences. CONCLUSION These results contribute to emerging literature suggesting that women use online alcohol use interventions at proportionately higher rates than do men, but do not reduce their drinking as much as men. There are a number of potential content changes that could improve outcomes for returning veteran women using online interventions, and data-driven adaptations based on stakeholder input are recommended.
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Affiliation(s)
- Nicholas A Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, USA.
| | - Tracy Simpson
- Center of Excellence in Substance Addiction, Treatment, and Education (CESATE), VA Puget Sound Healthcare System, Seattle, WA, USA; Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Keren Lehavot
- Department of Psychiatry & Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA; Seattle-Denver HSR&D Center of Innovation (COIN), Seattle, WA, USA; Department of Health Services, University of Washington, Seattle, WA, USA
| | - Victoria Ameral
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
| | - Deborah J Brief
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, USA
| | - Justin Enggasser
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, USA
| | - Scott Litwack
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, USA
| | | | - Monica Roy
- U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, USA
| | | | - Terence M Keane
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA; U.S. Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, USA
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Rates and predictors of brief intervention for women veterans returning from recent wars: Examining gaps in service delivery for unhealthy alcohol use. J Subst Abuse Treat 2021; 123:108257. [PMID: 33612192 DOI: 10.1016/j.jsat.2020.108257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 11/01/2020] [Accepted: 12/11/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Approximately one in four women veterans accessing the Department of Veterans Affairs (VA) engage in unhealthy alcohol use. There is substantial evidence for gender-sensitive screening (AUDIT-C = 3) and brief intervention (BI) to reduce risks associated with unhealthy alcohol use in women veterans; however, VA policies and incentives remain gender-neutral (AUDIT-C = 5). Women veterans who screen positive at lower-risk-level alcohol use (AUDIT-C = 3 or 4) may screen out and therefore not receive BI. This study aimed to examine gaps in implementation of BI practice for women veterans through identifying rates of BI at different alcohol risk levels (AUDIT-C = 3-4; =5-7; =8-12), and the role of alcohol risk level and other factors in predicting receipt of BI. METHODS From administrative data (2010-2016), we drew a sample of women veterans returning from recent wars who accessed outpatient and/or inpatient care. Of 869 women veterans, 284 screened positive for unhealthy alcohol use at or above a gender-sensitive cut-point (AUDIT-C ≥ 3). We used chart review methods to abstract variables from the medical record and then employed logistic regression comparing women veterans who received BI at varying alcohol risk levels to those who did not. RESULTS While almost 60% of the alcohol positive-risk sample received BI, among the subset of women veterans who screened positive for lower-risk alcohol use (57%; AUDIT-C = 3 or 4) only 34% received BI. Nurses in primary care programs were less likely to deliver BI than other types of clinicians (e.g., physicians, psychologists, social workers) in mental health programs; further, nurses in women's health programs were less likely to deliver BI than other types of clinicians in mixed-gender programs; Those women veterans with more medical problems were no more likely to receive BI than those with fewer medical problems. CONCLUSIONS Given that women veterans are a rapidly growing veteran population and a VA priority, underuse of BI for women veterans screening positive at a lower-risk level and those with more medical comorbidities requires attention, as do potential gaps in service delivery of BI in primary care and women's health programs. Women veterans health and well-being may be improved by tailoring screening for a younger cohort of women veterans at high-risk for, or with co-occurring disorders and then training providers in best practices for BI implementation.
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Steers MLN, Macia KS, Young CM, Neighbors C, Pedersen ER. Self in the Service: Self-Identification Moderates the Association between Perceived Drinking Norms and Own Drinking among Veterans. Subst Use Misuse 2021; 56:1428-1438. [PMID: 34039252 PMCID: PMC8412459 DOI: 10.1080/10826084.2021.1928216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Drinking is common among young adult veterans. Previous research has established that veterans' drinking is more strongly associated with veteran versus civilian drinking norms. The present research extends these findings by examining the influence of self-identification both with other veterans and with civilians as moderators of the association between perceived norms and drinking. METHODS Veterans aged 18-34 (N = 1015; 88.7% male; M = 28.23, SD = 3.44) were recruited via Facebook to participate. Measures included same-gender veterans/same-gender civilians self-identification, same-gender veterans/same gender-civilians perceived drinking norms, and own drinking. RESULTS Pairwise comparisons revealed both male and female veterans identified more with other veterans than civilians and perceived drinking to be more prevalent among other veterans than civilians. However, males overestimated male veteran drinking norms to a greater degree than male civilian norms whereas the opposite was true for females. Negative binomial analysis examining a three-way interaction between veteran identification, civilian identification, and civilian norms revealed civilian drinking norms were positively associated with drinking, particularly for veterans who strongly identified with both veterans and civilians. Conversely, civilian drinking norms were also found to be negatively associated with drinking, particularly for those who did not identify strongly with civilians but identified strongly with veterans. IMPLICATIONS This study represented a preliminary step for understanding how identity plays a role in terms of veterans' drinking. Given that veterans drank at differing levels of identification, it may be important to consider identities that are most salient when designing interventions targeting individual veterans.
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Affiliation(s)
- Mai-Ly N Steers
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania, USA
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Lipira L, Rao D, Nevin PE, Kemp CG, Cohn SE, Turan JM, Simoni JM, Andrasik MP, French AL, Unger JM, Heagerty P, Williams EC. Patterns of alcohol use and associated characteristics and HIV-related outcomes among a sample of African-American women living with HIV. Drug Alcohol Depend 2020; 206:107753. [PMID: 31785536 PMCID: PMC6980681 DOI: 10.1016/j.drugalcdep.2019.107753] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Alcohol use is common among people living with HIV and negatively impacts care and outcomes. African-American women living with HIV are subject to vulnerabilities that may increase risk for alcohol use and associated HIV-related outcomes. METHODS We used baseline data from a randomized controlled trial of an HIV-related stigma-reduction intervention among African-American women living with HIV in Chicago and Birmingham (2013-2015). Patterns of alcohol use [any use, unhealthy alcohol use (UAU), heavy episodic drinking (HED)] were measured using the AUDIT-C. We assessed demographic, social, and clinical characteristics which may influence alcohol use and HIV-related outcomes which may be influenced by patterns of alcohol use in bivariate and multivariable analyses. RESULTS Among 220 African-American women living with HIV, 54 % reported any alcohol use, 24 % reported UAU, and 27 % reported HED. In bivariate analysis, greater depressive symptoms, lower religiosity, lower social support, marijuana, and crack/cocaine use were associated with patterns of alcohol use (p < 0.05). Marijuana and cocaine/crack use were associated with patterns of alcohol use in adjusted analysis (p < 0.05). In adjusted analysis, any alcohol use and HED were associated with lower likelihood of ART adherence (ARR = 0.72, 95 % CI: 0.53-0.97 and ARR = 0.65, 95 % CI: 0.44-0.96, respectively), and UAU was associated with lack of viral suppression (ARR = 0.78, 95 % CI: 0.63-0.96). CONCLUSIONS Findings suggest any and unhealthy alcohol use is common and associated with poor HIV-related outcomes in this population. Regular alcohol screening and intervention should be offered, potentially targeted to subgroups (e.g., those with other substance use).
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Affiliation(s)
- Lauren Lipira
- Department of Health Services, University of Washington, 1959 NE Pacific St, Magnuson Health Sciences Center, Room H-680, Seattle, WA, 98195-7660, United States; Department of Global Health, University of Washington, Harris Hydraulics Laboratory, Box 357965, Seattle, WA, 98195-7965, United States.
| | - Deepa Rao
- Department of Global Health, University of Washington, Harris Hydraulics Laboratory, Box 357965, Seattle, WA, 98195-7965, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Room BB1644, Seattle, WA, 98195-6560, United States.
| | - Paul E. Nevin
- Department of Global Health University of Washington Harris Hydraulics Laboratory Box 357965 Seattle, Washington, 98195-7965
| | - Christopher G. Kemp
- Department of Global Health University of Washington Harris Hydraulics Laboratory Box 357965 Seattle, Washington, 98195-7965
| | - Susan E. Cohn
- Department of Medicine, Northwestern University Feinberg School of Medicine 645 North Michigan Avenue Suite 926 Chicago, Illinois, 60611
| | - Janet M. Turan
- Department of Health Care Organization and Policy School of Public Health University of Alabama at Birmingham Ryals Public Health Building (RPHB) 1665 University Boulevard Birmingham, Alabama, 35294-0022
| | - Jane M. Simoni
- Department of Psychology University of Washington 119A Guthrie Hall, Box 351525 Seattle, Washington, 98195-1525
| | - Michele P. Andrasik
- Vaccine and Infectious Disease Division Fred Hutch 1100 Fairview Ave N. Mail Stop E5-110 Seattle, Washington, 98109
| | - Audrey L. French
- Stroger Hospital of Cook County Ruth M. Rothstein CORE Center 2020 W. Harrison St Chicago, Illinois, 60612
| | - Joseph M. Unger
- Department of Health Services University of Washington 1959 NE Pacific St Magnuson Health Sciences Center, Room H-680 Seattle, Washington, 98195-7660,Public Health Sciences Division Fred Hutch 1100 Fairview Ave N. Mail Stop M3-C102 Seattle, Washington, 98109
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, Box 357232, Seattle, WA, 98195-7232, United States.
| | - Emily C. Williams
- Department of Health Services University of Washington 1959 NE Pacific St Magnuson Health Sciences Center, Room H-680 Seattle, Washington, 98195-7660,Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care VA Puget Sound Health Care System Health Services Research & Development 1660 S. Columbian Way (S-152) Seattle, Washington, 98108
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Schweizer CA, Hoggatt KJ, Washington DL, Bean-Mayberry B, Yano EM, Mitchell MN, Alessi CA, Martin JL. Use of alcohol as a sleep aid, unhealthy drinking behaviors, and sleeping pill use among women veterans. Sleep Health 2019; 5:495-500. [PMID: 31416799 PMCID: PMC6801087 DOI: 10.1016/j.sleh.2019.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/04/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Sleep complaints, such as insomnia and sleep disturbances caused by posttraumatic stress disorder (PTSD), are more common among women veterans than nonveteran women. Alcohol use among some women may be partially motivated by the desire to improve sleep. This study evaluated rates of alcohol use as a sleep aid among women veterans and explored the relationship between alcohol use to aid sleep and drinking frequency and sleeping pill use. DESIGN AND SETTING National cross-sectional population-based residential mail survey on sleep and other symptoms. PARTICIPANTS Random sample of women veteran VA users who completed a postal survey (N = 1533). INTERVENTIONS None. MEASUREMENTS The survey included demographics, Insomnia Severity Index, Primary Care PTSD screen, and items on alcohol use frequency (days/week), use of prescription or over-the-counter sleep medications, and use of alcohol as a sleep aid (yes/no for each item) over the past month. RESULTS A total of 14.3% of respondents endorsed using alcohol to aid sleep. Logistic regression models showed more severe insomnia (odds ratio [OR] = 1.03; 95% confidence interval [CI]: 1.01-1.06) and PTSD (OR = 2.11; 95% CI: 1.49-2.97) were associated with increased odds of using alcohol to aid sleep. Alcohol use to aid sleep was associated with increased odds of daily drinking (OR = 8.46; 95% CI: 4.00-17.87) and prescription (OR = 1.79; 95% CI: 1.34-2.38) and over-the-counter sleep aid use (OR = 1.54; 95% CI: 1.12-2.11). CONCLUSIONS Insomnia and PTSD may increase risk for using alcohol as a sleep aid, which may increase risk for unhealthy drinking and for mixing alcohol with sleep medications. Findings highlight the need for alcohol use screening in the context of insomnia and for delivery of cognitive-behavioral therapy for insomnia to women veterans with insomnia.
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Affiliation(s)
- C Amanda Schweizer
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System
| | - Katherine J Hoggatt
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Donna L Washington
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System; David Geffen School of Medicine, University of California, Los Angeles; Department of Medicine, VA Greater Los Angeles Healthcare System
| | - Bevanne Bean-Mayberry
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System
| | - Elizabeth M Yano
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Michael N Mitchell
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System
| | - Cathy A Alessi
- David Geffen School of Medicine, University of California, Los Angeles; Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System
| | - Jennifer L Martin
- David Geffen School of Medicine, University of California, Los Angeles; Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System.
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12
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Taylor E, Timko C, Harris AHS, Yu M, Finlay AK. Receipt of pharmacotherapy for alcohol use disorder by justice-involved women in the Veterans Health Administration. Addict Sci Clin Pract 2019; 14:1. [PMID: 30602392 PMCID: PMC6317204 DOI: 10.1186/s13722-018-0129-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/18/2018] [Indexed: 01/30/2023] Open
Abstract
Background Alcohol use disorder (AUD) and unhealthy drinking are prevalent among women involved in the criminal justice system and women military veterans. Pharmacotherapy—including naltrexone, topiramate, acamprosate, and disulfiram—for AUD is one form of effective treatment that is associated with better health and criminal justice outcomes. The current study examined the association of justice involvement with receipt of pharmacotherapy for AUD, as well as other patient factors that may explain variation in receipt of pharmacotherapy for AUD among women veterans who receive care at Veterans Health Administration (VHA) facilities.
Methods Using national VHA clinical records, we examined all women VHA patients who received an AUD diagnosis during an outpatient or inpatient visit in fiscal years (FY) 2014–2017. We compared patient characteristics by justice status, defined as contact with one of the VHA’s justice outreach programs, and used a mixed-effects logistic regression model to test whether justice involvement was independently associated with odds of receiving pharmacotherapy for AUD. Results Of 10,511 women veterans diagnosed with AUD in FY2017, 852 (8%) met our definition of justice-involved. Since FY2014, the percentage of women veterans who received pharmacotherapy for AUD increased (14–21%). Women justice-involved veterans and those who were homeless had higher odds of receiving pharmacotherapy for AUD (OR 1.29, CI 1.15–1.45; OR 1.35, CI 1.25–1.47). Women veterans age 55 or older or who were African-American had lower odds of receiving pharmacotherapy (OR 0.74, CI 0.67–0.82; OR 0.73, CI 0.68–0.79). Conclusions While women involved in the criminal justice system face many barriers to accessing health and social services, women justice-involved veterans had higher odds of receiving pharmacotherapy for AUD at VHA facilities compared to women veterans with no justice involvement. Legal mandates and supportive programming directed towards veterans in the criminal justice system may explain the higher rate of receipt of pharmacotherapy observed among justice-involved women veterans. Women veterans who are homeless may also have more opportunities to access and use pharmacotherapy for AUD compared to their housed counterparts.
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Affiliation(s)
- Emmeline Taylor
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA. .,, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.
| | - Christine Timko
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Alex H S Harris
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA
| | - Mengfei Yu
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA
| | - Andrea K Finlay
- Department of Veterans Affairs Health Care System, Center for Innovation to Implementation, Palo Alto, CA, 94304, USA.,Department of Veterans Affairs, National Center on Homelessness Among Veterans, Menlo Park, CA, 94025, USA
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13
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Giannitrapani KF, Huynh AK, Schweizer CA, Hamilton AB, Hoggatt KJ. Patient-centered substance use disorder treatment for women Veterans. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2018. [DOI: 10.3138/jmvfh.2017-0006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Karleen F. Giannitrapani
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
| | - Alexis K. Huynh
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - C. Amanda Schweizer
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Alison B. Hamilton
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Psychiatry and Biobehavioural Sciences, University of California, Los Angeles, California, USA
| | - Katherine J. Hoggatt
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
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14
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Evans EA, Glover DL, Washington DL, Hamilton AB. Psychosocial Factors that Shape Substance Abuse and Related Mental Health of Women Military Veterans who Use Community-Based Services. Subst Use Misuse 2018; 53:1878-1892. [PMID: 29485302 DOI: 10.1080/10826084.2018.1441309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Women Veterans who use the Veterans Health Administration (VA) have high rates of substance abuse and poorer health than non-Veteran women. Less is known about the psychosocial needs of women Veterans who seek care in non-VA settings. OBJECTIVES We provide a grounded description of factors that impact substance abuse, mental health, and related quality of life of women Veterans who use non-VA community-based health and social services. METHODS Utilizing a mixed methods design, we conducted semi-structured in-person interviews with 22 women Veterans in Los Angeles in 2013-2015. RESULTS The current health of these women Veterans was shaped by substance abuse and several other factors, including: histories of trauma (in childhood, during military service) and discrimination, and associated mental health conditions; post-military socio-economic stressors; shifting social roles and adverse social support; and lost personal identity after military service. Psychosocial factors collectively underscore areas in which delivery of health and social services to women Veterans being treated in non-VA settings could be improved: (1) diffuse, implement, and sustain evidence-based gender-sensitive substance abuse treatment; (2) address traumas contributing to poor health; (3) recognize stress proliferation processes erode women's capacity to access healthcare or cope with stressors in healthy ways; (4) champion women Veterans who embody resilience and thereby can help others to form empowered personal identities of health and wellness. CONCLUSION Findings can inform interventions and services that ameliorate vulnerability to substance abuse and other health risks among women Veterans.
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Affiliation(s)
- Elizabeth A Evans
- a Department of Health Promotion and Policy , School of Public Health and Health Sciences, University of Massachusetts , Amherst , Massachusetts , USA.,b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Dawn L Glover
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Donna L Washington
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c Department of Medicine , Geffen School of Medicine, University of California , Los Angeles , California , USA
| | - Alison B Hamilton
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,d Department of Psychiatry and Biobehavioral Sciences , David Geffen School of Medicine, University of California , Los Angeles , California , USA
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15
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Calhoun PS, Wilson SM, Dedert EA, Cunningham KC, Burroughs TK, Hicks TA, Beckham JC, Kudler HS, Straits-Troster K. The association of alcohol consumption patterns with self-rated physical health and psychiatric distress among Afghanistan- and Iraq-era U.S. veterans. Psychiatry Res 2018; 259:142-147. [PMID: 29045920 PMCID: PMC5742062 DOI: 10.1016/j.psychres.2017.09.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 09/21/2017] [Accepted: 09/24/2017] [Indexed: 01/05/2023]
Abstract
Alcohol misuse is associated with negative mental and physical health outcomes, which presents a public health concern in veterans. However, less is known regarding outcomes among veterans with low to moderate alcohol consumption. This study included veterans with military service in Iraq and/or Afghanistan (N = 1083) who resided in the VA Mid-Atlantic region catchment area (North Carolina, Virginia, and parts of West Virginia). Participants completed a mailed survey that inquired about demographics, past-year alcohol consumption, self-rated physical health, and psychiatric symptoms. Logistic regression was used to evaluate associations between alcohol consumption and posttraumatic stress disorder (PTSD), depression, and self-rated physical health. In both bivariate results and adjusted models, non-drinkers and hazardous drinkers were more likely to endorse clinically significant PTSD and depression symptoms than moderate drinkers. Moderate drinkers were also less likely to report fair/poor health, after adjusting for demographics and psychiatric symptoms. Results overall showed a U-shaped curve, such that moderate alcohol use was associated with lower rates of mental health problems and fair/poor health. While the VA routinely screens for alcohol misuse, current results suggest that non-drinkers are also at risk for poor mental and physical health.
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Affiliation(s)
- Patrick S Calhoun
- Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA; Veterans Affairs Center for Health Services Research in Primary Care, Durham, NC 27705, USA.
| | - Sarah M Wilson
- Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Eric A Dedert
- Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Katherine C Cunningham
- Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Thomas K Burroughs
- Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA; Hunter Holmes McGuire VA Medical Center, Richmond, VA 23249, USA
| | - Terrell A Hicks
- Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA
| | - Jean C Beckham
- Durham Veterans Affairs Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Harold S Kudler
- Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA
| | - Kristy Straits-Troster
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27705, USA; Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC 27705, USA; Phoenix VA Healthcare System, Phoenix, AZ 85012, USA
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16
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Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ. An Evidence Map of the Women Veterans' Health Research Literature (2008-2015). J Gen Intern Med 2017; 32:1359-1376. [PMID: 28913683 PMCID: PMC5698220 DOI: 10.1007/s11606-017-4152-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 06/08/2017] [Accepted: 07/27/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Women comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women's Health Services and the VA Women's Health Research Network requested an updated literature review to facilitate policy and research planning. METHODS The Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans' health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps. RESULTS We identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials. CONCLUSIONS Our evidence map summarizes patterns, progress, and growth in the female Veterans' health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
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Affiliation(s)
- Elisheva R Danan
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA. .,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Erin E Krebs
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Kristine Ensrud
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Eva Koeller
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Roderick MacDonald
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Tina Velasquez
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Nancy Greer
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA
| | - Timothy J Wilt
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, 1 Veterans Drive (152), Minneapolis, MN, 55417, USA.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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17
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Mahmoud KF, Finnell D, Savage CL, Puskar KR, Mitchell AM. A Concept Analysis of Substance Misuse to Inform Contemporary Terminology. Arch Psychiatr Nurs 2017; 31:532-540. [PMID: 29179817 DOI: 10.1016/j.apnu.2017.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/11/2017] [Accepted: 06/04/2017] [Indexed: 11/15/2022]
Abstract
Previous diagnostic categories of substance abuse and dependence have given way to the current view that substance use disorders occur on a continuum with a broad range of severity. This current view is featured in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V). In recognizing the role of stigma in preventing persons from seeking substance use treatment, advocates have called attention that particular terminology can fuel such stigma. To mitigate the negative effects of such stigmatizing language, the International Society of Addiction Journal Editors (ISAJE) recommends against using previously-used and possibly pejorative terminology for substance abuse and dependence, unless a particular scientific justification exists. The purpose of this paper is to: (1) present a concept analysis of the term substance misuse and (2) recommend an alternate term for substance misuse that is neither pejorative nor inadvertently stigmatizing: at-risk substance use.
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Affiliation(s)
- Khadejah F Mahmoud
- University of Pittsburgh School of Nursing, 3500 Victoria Street, 415 Victoria Building, Pittsburgh, PA 15261, USA.
| | - Deborah Finnell
- Johns Hopkins University School of Nursing, Department of Acute and Chronic Care, 525 N. Wolfe Street, Baltimore, MD 21205-1730, USA
| | - Christine L Savage
- Johns Hopkins University School of Nursing, Department of Acute and Chronic Care, 525 N. Wolfe Street, Baltimore, MD 21205-1730, USA
| | - Kathryn R Puskar
- University of Pittsburgh School of Nursing, 3500 Victoria Street, 415 Victoria Building, Pittsburgh, PA 15261, USA
| | - Ann M Mitchell
- University of Pittsburgh School of Nursing, 3500 Victoria Street, 415 Victoria Building, Pittsburgh, PA 15261, USA
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18
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Goldstein KM, Oddone EZ, Bastian LA, Olsen MK, Batch BC, Washington DL. Characteristics and Health Care Preferences Associated with Cardiovascular Disease Risk among Women Veterans. Womens Health Issues 2017; 27:700-706. [PMID: 28890128 DOI: 10.1016/j.whi.2017.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 07/31/2017] [Accepted: 08/01/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women veterans are at increased risk for cardiovascular disease (CVD), but little is known about comorbidities and healthcare preferences associated with CVD risk in this population. METHODS We describe the prevalence of CVD-relevant health behaviors, mental health symptoms, and health care use characteristics and preferences among participants of the National Survey of Women Veterans (conducted 2008-2009). FINDINGS Fifty-four percent of respondents were at risk for CVD (defined as a diagnosis of hypertension, diabetes, current tobacco use, or obesity without CVD). In unadjusted analysis, ORs for being at risk for CVD were greater among those interested in gender-specific clinical settings (OR, 2.0; 95% CI, 1.2-3.4) and gender-specific weight loss programs (OR, 1.8; 95% CI, 1.1-2.9). ORs were also greater for women who were physically inactive (OR, 1.9; 95% CI, 1.1-3.3), with current symptoms of depression (OR, 2.5; 95% CI, 1.1-6.1), anxiety (OR, 2.1; 95% CI, 1.2-3.6), and posttraumatic stress disorder (OR, 2.4; 95% CI, 1.2-4.8). Adjusting for age, race/ethnicity, marital status, education level, employment, and source of health care use, the ORs for CVD risk were higher for women with current posttraumatic stress disorder symptoms (2.5; 95% CI, 1.1-5.3) and gender-specific health care preferences (2.0; 95% CI, 1.1-3.4), and gender-specific weight loss programs (1.9; 95% CI, 1.1-3.2). CONCLUSIONS Risk for CVD was common and preferences for gender-specific care and posttraumatic stress disorder were associated with being at risk for CVD. Women's health clinics may be a good location for targeted CVD prevention interventions for women veterans both in and outside the Veterans Health Administration.
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Affiliation(s)
- Karen M Goldstein
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina.
| | - Eugene Z Oddone
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, North Carolina
| | - Lori A Bastian
- VA Connecticut Healthcare System, West Haven, Connecticut; Department of Medicine, Yale University, New Haven, Connecticut
| | - Maren K Olsen
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Bryan C Batch
- Department of Medicine, Division of Endocrinology, Duke University Medical Center, Durham, North Carolina
| | - Donna L Washington
- VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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19
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Abraham TH, Wright P, White P, Booth BM, Cucciare MA. Feasibility and acceptability of shared decision-making to promote alcohol behavior change among women Veterans: Results from focus groups. J Addict Dis 2017; 36:252-263. [PMID: 28863271 DOI: 10.1080/10550887.2017.1373318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although rates of unhealthy drinking are high among women Veterans with mental health comorbidities, most women Veterans with mental comorbidities who present to primary care with unhealthy drinking do not receive alcohol-related care. Barriers to alcohol-related treatment could be reduced through patient-centered approaches to care, such as shared decision-making. AIMS We assessed the feasibility and acceptability of a telephone-delivered shared decision-making intervention for promoting alcohol behavior change in women Veterans with unhealthy drinking and co-morbid depression and/or probable post-traumatic stress disorder. METHODS We used 3, 2-hour focus group discussions with 19 women Veterans to identify barriers and solicit recommendations for using the intervention with women Veterans who present to primary care with unhealthy drinking and mental health comorbidities. Transcripts from the focus groups were qualitatively analyzed using template analysis. RESULTS Although participants perceived that the intervention was feasible and acceptable for the targeted patient population, they identified the treatment delivery modality, length of telephone sessions, and some of the option grid content as potential barriers. Facilitators included strategies for enhancing the telephone-delivered shared decision-making sessions and diversifying the treatment options contained in the option grids. Focus group feedback resulted in preliminary adaptations to the intervention that are mindful of women Veterans' individual preferences for care and realistic in the everyday context of their busy lives.
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Affiliation(s)
- Traci H Abraham
- a Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,b Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA.,c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Patricia Wright
- d College of Nursing, University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Penny White
- b Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA
| | - Brenda M Booth
- c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
| | - Michael A Cucciare
- a Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,b Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA.,c Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
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20
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Muirhead L, Hall P, Jones-Taylor C, Clifford GD, Felton-Williams T, Williams K. Critical questions: Advancing the health of female Veterans. J Am Assoc Nurse Pract 2017; 29:571-580. [PMID: 28731291 DOI: 10.1002/2327-6924.12490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 06/04/2017] [Indexed: 11/09/2022]
Abstract
PURPOSE Women are the fastest growing Veteran population in the United States and many receive all or part of their health care outside of the Department of Veterans Affairs (VA). The purpose of this article is to review the healthcare issues of women Veterans and discuss implications for care. DATA SOURCES Review of selected literature, VA resources and guidelines, and expert opinion. CONCLUSIONS Few providers are aware of the impact military service has on the health of women and fail to ask the all-important question, "Have you served in the military?" Recognizing women's military service can reveal important information that can answer perplexing clinical questions, aid in designing comprehensive plans of care, and enable women to receive the assistance needed to address complex physical and psychosocial issues to improve the quality of their lives. IMPLICATIONS FOR PRACTICE There are gender disparities related to physical health conditions, mental health issues, environmental exposures, and socioeconomic factors that contribute to female Veterans' vulnerabilities. Many of the health conditions, if recognized in a timely manner, can be ameliorated and shift the health trajectory of this population. Clinicians play a critical role in identifying health risk and helping female Veterans start the sometimes arduous journey toward wellness. Discovering and acknowledging women's military history is critical in ensuring quality care and appropriate decision making.
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Affiliation(s)
- Lisa Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Priscilla Hall
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Cedrella Jones-Taylor
- Primary Care, Atlanta VA Medical Center, Emory University School of Medicine, Decatur, Georgia
| | - Gari D Clifford
- Department of Biomedical Informatics, Georgia Institute of Technology, Emory University, Atlanta, Georgia.,Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, Georgia
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Substance Use Disorder Treatment Services for Women in the Veterans Health Administration. Womens Health Issues 2017; 27:639-645. [PMID: 28602581 DOI: 10.1016/j.whi.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 03/28/2017] [Accepted: 04/07/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE The present study used national Veterans Health Administration (VHA) facility-level data to examine the extent of women's specialty substance use disorder (SUD) treatment programming in the VHA. In addition, the study compared facilities with women's specialty SUD programming with facilities without to determine whether having this programming was associated with serving other special patient populations, treatment staffing, and breadth of service provision. METHODS The study used data from the VHA Program Evaluation and Resource Center's Drug and Alcohol Program Survey, conducted in 2015 (100% response rate among VHA specialty SUD treatment programs). Program responses were calculated at the facility level (n = 140 VHA facilities). MAIN FINDINGS The majority of VHA facilities (85%) provided women veterans with SUD-specific individual psychotherapy. However, only 30% of facilities provided SUD-specific groups for women only, and only 14% provided SUD-posttraumatic stress disorder groups for women only in specialty SUD treatment. VHA facilities with greater numbers of specialty SUD treatment staff members, a greater breadth of staff roles, and a broader scope of treatment services, activities, and practices were more likely to provide women-only groups. CONCLUSIONS Because the number of women veterans in specialty SUD treatment is likely to continue to grow, these data serve as a benchmark against which future administrations of the Drug and Alcohol Program Survey will document the extent to which VHA services are responsive to their needs.
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Hoggatt KJ, Lehavot K, Krenek M, Schweizer CA, Simpson T. Prevalence of substance misuse among US veterans in the general population. Am J Addict 2017; 26:357-365. [PMID: 28370701 DOI: 10.1111/ajad.12534] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/28/2017] [Accepted: 03/04/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Epidemiologic data on substance misuse prevalence among US Veterans are crucial to plan for Veterans' future healthcare needs. We estimated US Veterans' age-specific, overall, and age-adjusted prevalence of substance misuse, assessed whether prevalence differed between Veterans and civilians, and examined temporal trends in prevalence. METHODS Substance-related measures were obtained from the National Surveys on Drug Use and Health, 2002-2012 (N = 24,210 Veterans; 338,556 civilians). RESULTS Among women and men Veterans overall, past-month heavy episodic drinking and daily cigarette smoking were the most prevalent types of substance misuse. For Veteran women and men ages 18-25, the prevalence of past-year illicit drug use was 29% and 38%, which was comparable to the prevalence of past-month daily cigarette smoking, and the prevalence of past-year prescription drug misuse was 14% and 18%. For men ages 18-25, heavy episodic drinking, daily cigarette smoking, alcohol use disorder (AUD), and substance use disorder were more prevalent among Veterans than civilians. For women, the age-specific, overall, and age-adjusted prevalence of daily cigarette smoking was generally greater among Veterans than civilians. There was a decreasing temporal trend in overall AUD prevalence among Veteran men, reflecting a decreasing trend in age-specific prevalence among Veteran men ages 35-49. DISCUSSION AND CONCLUSIONS Young Veterans' high prevalence of substance misuse, and the generally high prevalence of daily smoking among Veterans, underscore the need for evidence-based assessments and treatment options that are accessible and effective for Veterans. SCIENTIFIC SIGNIFICANCE This study provides foundational information on the epidemiology of substance misuse among Veterans. (Am J Addict 2017;26:357-365).
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Affiliation(s)
- Katherine J Hoggatt
- VA Greater Los Angeles Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California
| | - Keren Lehavot
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington.,Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington.,Department of Health Services, University of Washington, Seattle, Washington
| | - Marketa Krenek
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington
| | - Catherine Amanda Schweizer
- VA Greater Los Angeles Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California.,David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Tracy Simpson
- Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, Washington
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23
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Lewis ET, Jamison AL, Ghaus S, Durazo EM, Frayne SM, Hoggatt KJ, Bean-Mayberry B, Timko C, Cucciare MA. Receptivity to alcohol-related care among U.S. women Veterans with alcohol misuse. J Addict Dis 2016; 35:226-237. [PMID: 27049338 DOI: 10.1080/10550887.2016.1171670] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Previous research indicates women Veterans have a potentially large, unmet need for alcohol-related care but are under-represented in treatment settings. The purpose of this study was to identify factors associated with women Veterans' receptivity to a recommendation for alcohol-related care when they present to Veterans Affairs (VA) primary care with alcohol misuse. Semi-structured interviews were conducted from 2012-2013 with 30 women Veterans at two VA facilities who screened positive for alcohol misuse during a primary care visit and discussed their alcohol use with their primary-care provider. Qualitative analyses identified 9 themes women used to describe what affected their receptivity to a recommendation for alcohol-related care (i.e., VA specialty substance use disorder services). The most common themes positively associated with women's receptivity included self-appraisal of their drinking behavior as more severe, the provider's presentation of treatment options, availability of gender-specific services, and worse physical and mental health. The themes identified here may have important implications for the clinical strategies providers can use to present alcohol-related care options to women Veterans to facilitate their use of care. These strategies include educating women about the health effects of alcohol misuse and increasing providers' knowledge about available care options (within the care organization or the community), including the availability of gender-specific services.
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Affiliation(s)
- Eleanor T Lewis
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Andrea L Jamison
- b National Center for Post-Traumatic Stress Disorder (NC-PTSD), VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Sharfun Ghaus
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Eva M Durazo
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA
| | - Susan M Frayne
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA.,c Women's Health Section, VA Palo Alto Health Care System , Palo Alto , California , USA.,d Stanford University School of Medicine, Division of General Medical Disciplines , Stanford , California , USA
| | - Katherine J Hoggatt
- e VA Greater Los Angeles Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy , Sepulveda , California , USA.,f Department of Epidemiology , UCLA Fielding School of Public Health , Los Angeles , California , USA
| | - Bevanne Bean-Mayberry
- g Department of Medicine , David Geffen School of Medicine, University of California Los Angeles , Los Angeles , California , USA
| | - Christine Timko
- a Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park , California , USA.,h Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Stanford , California , USA
| | - Michael A Cucciare
- i Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System , North Little Rock , Arkansas , USA.,j VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System , North Little Rock , Arkansas , USA.,k Department of Psychiatry , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA
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24
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Washington DL, Gray K, Hoerster KD, Katon JG, Cochrane BB, LaMonte MJ, Weitlauf JC, Groessl E, Bastian L, Vitolins MZ, Tinker L. Trajectories in Physical Activity and Sedentary Time Among Women Veterans in the Women's Health Initiative. THE GERONTOLOGIST 2016; 56 Suppl 1:S27-39. [PMID: 26768390 PMCID: PMC5881621 DOI: 10.1093/geront/gnv676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/28/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY Trajectories of physical activity (PA) and sedentary time (ST) after military separation are likely important determinants of women's health outcomes later in life, because low PA and high ST are known contributors to premature mortality risk. Our objective was to compare longitudinal trajectories of recreational PA and ST between Veteran and non-Veteran postmenopausal women from the Women's Health Initiative (WHI). DESIGN AND METHODS Women Veteran (n = 3,719) and non-Veteran (n = 141,800) WHI participants were included. Self-reported participation in recreational PA, converted to metabolic equivalent (MET)-hours/week, was prospectively assessed over 8 years. Self-reported ST, defined as hours/day sitting or lying down, was collected at baseline and at Years 3 and 6. Generalized estimating equations were used to compare trajectories of PA and ST between Veterans and non-Veterans, adjusted for demographics and lifestyle behaviors. RESULTS Veterans had higher baseline PA than non-Veterans (13.2 vs 12.5 MET-hours/week, p = .03). PA declined for both groups, with a steeper decline among Veterans (change/visit year -0.19 vs -0.02 MET-hours/week; interaction p < .001). At baseline, Veterans and non-Veterans had similar levels of ST (107.2 vs 105.9 hours/week, p = 0.42). Over time, ST remained stable among Veterans but declined slightly among non-Veterans (change/visit year -0.19 vs -0.49 hours/week; interaction p = .01). IMPLICATIONS The less favorable longitudinal trajectories of PA and ST we observed for women Veterans may contribute to worse health among these individuals later in life. Understanding barriers to enhancing PA and reducing ST in women Veterans could lead to more effective approaches to intervening on these health behaviors.
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Affiliation(s)
- Donna L Washington
- VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, California. Geffen School of Medicine, University of California Los Angeles.
| | - Kristen Gray
- VA Puget Sound Health Care System, Health Services Research and Development, Seattle. Department of Health Services, University of Washington School of Public Health, Seatle
| | - Katherine D Hoerster
- VA Puget Sound Health Care System, Health Services Research and Development, Seattle. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seatle
| | - Jodie G Katon
- VA Puget Sound Health Care System, Health Services Research and Development, Seattle. Department of Health Services, University of Washington School of Public Health, Seatle. Women's Health Services, VA Office of Patient Care
| | - Barbara B Cochrane
- University of Washington School of Nursing, Seatle. Fred Hutchinson Cancer Research Center
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Innovation to Implementation. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Erik Groessl
- VA San Diego Health Services Research and Development Unit, California. Department of Family and Preventive Medicine, University of California San Diego
| | | | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem
| | - Lesley Tinker
- University of Washington School of Nursing, Seatle. Fred Hutchinson Cancer Research Center
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Washington DL, Bird CE, LaMonte MJ, Goldstein KM, Rillamas-Sun E, Stefanick ML, Woods NF, Bastian LA, Gass M, Weitlauf JC. Military Generation and Its Relationship to Mortality in Women Veterans in the Women's Health Initiative. THE GERONTOLOGIST 2016; 56 Suppl 1:S126-37. [PMID: 26768386 PMCID: PMC5881617 DOI: 10.1093/geront/gnv669] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/05/2015] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF THE STUDY Women's military roles, exposures, and associated health outcomes have changed over time. However, mortality risk-within military generations or compared with non-Veteran women-has not been assessed. Using data from the Women's Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women. DESIGN AND METHODS WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation. RESULTS After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09-1.23) for pre-Vietnam and 1.16 (95% CI: 0.99-1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64-5.23). IMPLICATIONS Veterans' higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed.
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Affiliation(s)
- Donna L Washington
- VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, California. University of California Los Angeles, Geffen School of Medicine.
| | - Chloe E Bird
- RAND Corporation, Pardee Rand Graduate School, Santa Monica, California
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo
| | | | | | - Marcia L Stefanick
- Stanford University School of Medicine, Stanford Center for Health Research on Women & Sex Differences in Medicine, California
| | - Nancy F Woods
- Division of Biobehavioral Nursing & Health Systems, University of Washington School of Nursing, Seattle
| | - Lori A Bastian
- VA Connecticut, and University of Connecticut Health Center, West Haven
| | - Margery Gass
- The North American Menopause Society, Mayfield Heights, Ohio
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Innovation to Implementation, California. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, California
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