scholarly journals Risk Factors for Veteran Food Insecurity: Findings from a National US Department of Veterans Affairs Food Insecurity Screener

2021 ◽  
pp. 1-26
Author(s):  
Alicia J. Cohen ◽  
David M. Dosa ◽  
James L. Rudolph ◽  
Christopher W. Halladay ◽  
Michele Heisler ◽  
...  
Keyword(s):  
Food Insecurity ◽  
Low Income ◽  
Sexual Trauma ◽  
Social Needs ◽  
Housing Instability ◽  
Military Sexual Trauma ◽  
Veterans Health ◽  
Health Administration ◽  
Post Traumatic Stress ◽  
Cross Sectional

Abstract Objective: Food insecurity is associated with numerous adverse health outcomes. The US Veterans Health Administration (VHA) began universal food insecurity screening in 2017. This study examined prevalence and correlates of food insecurity among Veterans screened. Design: Retrospective cross-sectional study using VHA administrative data. Multivariable logistic regression models were estimated to identify sociodemographic and medical characteristics associated with a positive food insecurity screen. Setting: All US VA medical centers (n=161). Participants: All Veterans screened for food insecurity since screening initiation (July 2017-December 2018). Results: Of 3,304,702 Veterans screened for food insecurity, 44,298 were positive on their initial screen (1.3% of men; 2.0% of women). Food insecurity was associated with identifying as non-Hispanic Black or Hispanic. Veterans who were non-married/partnered, low-income Veterans without VA disability-related compensation, and those with housing instability had higher odds of food insecurity, as did Veterans with a BMI<18.5, diabetes, depression, and post-traumatic stress disorder. Prior military sexual trauma was associated with food insecurity among both men and women. Women screening positive, however, were eight times more likely than men to have experienced military sexual trauma (48.9% vs 5.9%). Conclusions: Food insecurity was associated with medical and trauma-related comorbidities as well as unmet social needs including housing instability. Additionally, Veterans of color and women were at higher risk for food insecurity. Findings can inform development of tailored interventions to address food insecurity such as more frequent screening among high-risk populations, onsite support applying for federal food assistance programs, and formal partnerships with community-based resources.

Comparing PTSD treatment retention among survivors of military sexual trauma utilizing clinical video technology and in-person approaches

2019 ◽  
Vol 26 (7-8) ◽  
pp. 443-451 ◽  
Author(s):  
Lisa M Valentine ◽  
Shannon D Donofry ◽  
Rachel B Broman ◽  
Erin R Smith ◽  
Sheila AM Rauch ◽  
...  
Keyword(s):  
Cognitive Processing ◽  
Sexual Trauma ◽  
Prolonged Exposure ◽  
Cognitive Processing Therapy ◽  
Military Sexual Trauma ◽  
Health Administration ◽  
Video Technology ◽  
Post Traumatic Stress ◽  
Ptsd Treatment ◽  
Delivery Format

Introduction Interventions such as Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) have demonstrated efficacy for the treatment of post-traumatic stress disorder (PTSD) following military sexual trauma (MST). However, MST survivors report a number of logistical and social barriers that impede treatment engagement. In an effort to address these barriers, the Veterans Health Administration offers remote delivery of services using clinical video technology (CVT). Evidence suggests PE and CPT can be delivered effectively via CVT. However, it is unclear whether rates of veteran retention in PTSD treatment for MST delivered remotely is comparable to in-person delivery in standard care. Methods Data were drawn from veterans ( N = 171, 18.1% CVT-enrolled) with PTSD following MST who were engaged in either PE or CPT delivered either via CVT or in person. Veterans chose their preferred treatment modality and delivery format in collaboration with providers. Data were analysed to evaluate full completion (FP) of the protocol and completion of a minimally adequate care (MAC) number of sessions. Results FP treatment completion rates did not differ significantly by treatment delivery format. When evaluating receipt of MAC care, CVT utilizers were significantly less likely to complete. Kaplan–Meier analyses of both survival periods detected significant differences in attrition speed, with the CVT group having higher per-session attrition earlier in treatment. Discussion Disengagement from CVT-delivered treatment generally coincided with early imaginal exposures and writing of trauma narratives. CVT providers may have to take special care to develop rapport and problem-solve anticipated barriers to completion to retain survivors in effective trauma-focused interventions.

scholarly journals The Veterans Health Administration and Military Sexual Trauma

2007 ◽  
Vol 97 (12) ◽  
pp. 2160-2166 ◽  
Author(s):  
Rachel Kimerling ◽  
Kristian Gima ◽  
Mark W. Smith ◽  
Amy Street ◽  
Susan Frayne
Keyword(s):  
Sexual Trauma ◽  
Veterans Health Administration ◽  
Military Sexual Trauma ◽  
Veterans Health ◽  
Health Administration

scholarly journals 1353. Gonorrhea and Chlamydia Testing and Case Rates Among Women Veterans in the Veterans Health Administration

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S763-S764
Author(s):  
Shimrit Keddem ◽  
Marissa Maier ◽  
Carolyn Gardella ◽  
Joleen Borgerding ◽  
Elliott Lowy ◽  
...  
Keyword(s):  
Sexual Trauma ◽  
Women Veterans ◽  
Veterans Health Administration ◽  
Military Sexual Trauma ◽  
Veterans Health ◽  
Health Administration ◽  
Infection Rates ◽  
Factors Associated ◽  
Chlamydia Testing ◽  
Case Rate

Abstract Background United States (US) rates of sexually transmitted infection (STI) in women, especially gonorrhea and chlamydia, have increased over the past decade. Women Veterans have many risk factors associated with STIs, including high rates of childhood sexual assault, military sexual trauma and intimate partner violence. Despite the availability of effective diagnostic tests and evidence-based guidelines for annual screening among sexually active women under age 25, screening rates for gonorrhea and chlamydia remain low in the US and among Veterans. Methods We performed a retrospective cohort study of all women Veterans in Veterans Health Administration (VHA) care between January 1, 2018 and December 31, 2019 to examine patient characteristics and health system factors associated with gonorrhea and chlamydia testing and case rates among women Veterans in the VHA in 2019. Results Among women under age 25, 21.3% were tested for gonorrhea or chlamydia in 2019. After adjusting for demographic and other health factors, predictors of testing in women under age 25 included Black race (aOR: 2.11 CI: 1.89, 2.36), rural residence (aOR: 0.84, CI: 0.74, 0.95), and cervical cancer screening (aOR: 5.05 CI: 4.59, 5.56). Women under age 25 had the highest infection rates, with an incidence of chlamydia and gonorrhea of 1,950 and 267 cases/100,000, respectively. Incidence of gonorrhea and chlamydia was higher for women with a history of military sexual trauma (MST) (Chlamydia case rate: 265, Gonorrhea case rate: 97/100,000) and those with mental health diagnoses (Chlamydia case rate: 263, Gonorrhea case rate: 72/100,000.) Over a third of chlamydia cases (35.2%) and gonorrhea cases (35.5%) occurred in women who resided in the South Atlantic census division. Chlamydia cases per 100,000 women Veterans seen in VHA (2019) Gonorrhea cases per 100,000 women Veterans seen in VHA (2019) Conclusion Gonorrhea and chlamydia testing remains underutilized among women in the VHA and infection rates are high among younger women. Patient-centered, system-level interventions are urgently needed to address low testing rates. Disclosures All Authors: No reported disclosures

Abstract 48: Military Sexual Trauma Is Associated With Incident Hypertension In A 16-year Cohort Study Of 1.2 Million Young And Middle-aged Men And Women

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Allison E Gaffey ◽  
Lindsey Rosman ◽  
Sally G Haskell ◽  
Cynthia A Brandt ◽  
Jason J Sico ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Sexual Trauma ◽  
Lifestyle Factors ◽  
Sensitivity Analyses ◽  
Military Sexual Trauma ◽  
Veterans Health ◽  
Health Administration ◽  
Middle Aged ◽  
Incident Hypertension ◽  
Increased Risk

Introduction: Exposure to traumatic events and the sequelae [e.g., posttraumatic stress disorder (PTSD) and poor health] are linked to incident cardiovascular disease (CVD) in military and community samples. Veterans, especially women, are 3-times as likely to experience sexual harassment and assault [military sexual trauma (MST)] compared to civilian populations. It is unknown if exposure to MST is independently associated with risk of incident hypertension. Methods: We conducted a retrospective analysis to assess the effect of MST on the risk of incident hypertension, defined as a medical record diagnosis, meeting clinical threshold based on blood pressure in vital sign records, or use of antihypertensive medication, in a cohort of 1,177,944 young and middle-aged veterans (mean age= 30.2 [SD:9.2], 12% women) using nationwide data from the Veterans Health Administration from 2001 to 2017. Time-varying multivariate Cox models were computed to estimate hypertension risk by MST status while sequentially adjusting for demographics, lifestyle factors, CVD comorbidities, and psychiatric disorders. Sensitivity analyses controlled for healthcare utilization based on the number of primary care visits over two years after military discharge. Results: During 16 years of follow-up (mean=9.6 years [SD:4.0]), 33,881 veterans screened positive for MST (65% women) and 307,332 patients were diagnosed with hypertension. The overall incidence rate of hypertension was 305.1 events per 1,000-person years. MST was associated with a 30% greater risk of hypertension in unadjusted models (hazard ratio [HR], 1.30 [95% CI, 1.28-1.33]) and remained significantly associated with hypertension in models that adjusted for demographics, lifestyle factors, CVD comorbidities, PTSD, anxiety, and depression (adjusted HR, 1.10 [95% CI, 1.08-1.12]. In sensitivity analyses, the effect of MST remained significant when controlling for healthcare utilization (HR, 1.11, [95% CI, 1.09-1.13]). Conclusions: In this large prospective cohort of young adults, MST was associated with an increased risk of hypertension after controlling for established risk factors. Further research is needed to determine if early identification of MST improves cardiovascular risk management.

The influence of gender on suicidal ideation following military sexual trauma among Veterans in the Veterans Health Administration

2016 ◽  
Vol 244 ◽  
pp. 257-265 ◽  
Author(s):  
Lindsey L. Monteith ◽  
Nazanin H. Bahraini ◽  
Bridget B. Matarazzo ◽  
Holly R. Gerber ◽  
Kelly A. Soberay ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Sexual Trauma ◽  
Veterans Health Administration ◽  
Military Sexual Trauma ◽  
Veterans Health ◽  
Health Administration

scholarly journals Patient Characteristics Associated With the Receipt of Hormone Therapy Among Transgender Patients in the Veterans Health Administration

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A794-A794
Author(s):  
Denise H Wong ◽  
Varsha G Vimalananda ◽  
Joel I Reisman ◽  
Sowmya R Rao ◽  
Jillian C Shipherd ◽  
...  
Keyword(s):  
Gender Identity ◽  
Hormone Therapy ◽  
Sexual Trauma ◽  
Patient Characteristics ◽  
Veterans Health Administration ◽  
Sex Characteristics ◽  
Military Sexual Trauma ◽  
Veterans Health ◽  
Health Administration ◽  
Social Stressors

Abstract Background: Many transgender patients experience gender dysphoria as a result of an incongruence between their gender identity and sex assigned at birth. Gender-affirming hormone therapy improves the quality of life for transgender patients seeking to increase alignment of their secondary sex characteristics and gender identity. However, little is known about the patient factors that are associated with receipt of this therapy which is critical to identifying areas for improvement in care for transgender patients. Objective: To evaluate patient characteristics associated with transgender patients’ receipt of hormone therapy from the Veterans Health Administration (VHA). Methods: Inpatient and outpatient data were reviewed for transgender patients, identified through ICD-9/ICD-10 diagnosis codes for gender identity disorder (GID), receiving VHA health care from January 2006 to December 2018. We evaluated receipt of hormone therapy (testosterone or estrogen +/- spironolactone) from the VHA, socio-demographics, comorbidities, social stressors, military sexual trauma, and documented suicide attempts. Adjusted Odds Ratios (aOR) and 95% Confidence Intervals (CI) were obtained from a multivariable logistic regression model used to ascertain the relationship between patient characteristics and hormone therapy. Results: Of 9,406 patients with documented GID, 5,487 (58.3%) received hormone therapy from the VHA. Compared to patients not receiving hormone therapy, a higher proportion of patients receiving hormone therapy were younger (21-29 years: 18.1% vs. 11.6%; 30-39 years: 20.0% vs. 14.6%; 40-49 years: 16.2% vs. 13.6%), had documentation of a positive military sexual trauma screening (22.2% vs. 16.2%; p&lt;0.0001), and a suicide attempt (11.4% vs. 9.9%; p=0.0067). There were significant associations between receipt of hormone therapy and: 1) younger age (aOR: 1.33; 95% CI: 1.29-1.36; p&lt;0.0001); 2) Black non-Hispanic patients (aOR: 0.58; 95% CI: 050-0.68; p&lt;0.0001); 3) increasing number of comorbidities (aOR: 0.86; 95% CI: 0.84-0.88; p&lt;0.0001); and 4) increasing number of social stressors (aOR: 0.86; 95% CI: 0.83-0.90; p&lt;0.0001). Conclusions: Age, race/ethnicity, comorbidities, and social stressors among other factors are associated with receipt of hormone therapy among transgender patients in the VHA. Subsequent efforts should focus on understanding clinician- and site-level determinants to facilitate the design of effective quality improvement measures that optimize gender affirming hormone therapy through VHA for transgender patients.

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