The Influence of State-Level Contextual Factors on State/Federal System Vocational Rehabilitation Employment Outcomes for Persons With Traumatic Brain Injury

The purpose of this exploratory study was to develop a preliminary understanding of the influence of state-level contextual factors predictive of employment outcomes for State/Federal Vocational Rehabilitation System (State VR) participants with traumatic brain injury (TBI). Participants were 5,213 individuals with TBI with Individualized Plans for Employment closed during Federal Fiscal Year 2016. A four-step hierarchical logistic regression model (5.6% explained variance) containing five demographic, three state-level economic, six state TBI service climate, and nine State VR service variable expenditures correctly classified 57.0% of cases as attaining or not attaining an employment outcome at closure. Significant predictors associated with an employment closure were (a) education, veteran status, and presence of a secondary area of disability impairment; (b) state-level per-capita income; (c) State VR specialized acquired brain injury (ABI)/TBI service and state TBI Implementation Partnership grant funding; and (d) State VR service expenditures on diagnosis and treatment, occupational or vocational training, on-the-job training, job readiness training, transportation, maintenance support, and benefits counseling. The practice, policy, and research implications of these findings are presented.

Latent Class Patterns of Adverse Childhood Experiences and Their Relationship to Veteran Status and Sex in the National Epidemiologic Survey of Alcohol and Related Conditions Wave III

ABSTRACT Introduction Adverse childhood experiences (ACEs) are associated with poor psychosocial and health outcomes in adulthood. Veterans and females experience ACEs disproportionately. A greater understanding of this disparity may be achieved by examining the relationship between distinct ACE patterns and these demographic characteristics. Therefore, this study examined distinct ACE patterns and their association with Veteran status, sex, and other demographics in a nationally representative sample of U.S. adults to inform interventions tailored to ACE patterns experienced by specific groups. Materials and Methods Latent class analysis (LCA) was conducted with data from the National Epidemiologic Survey of Alcohol and Related Conditions-III, a nationally representative structured diagnostic interview conducted from 2012-2013. The target population was the noninstitutionalized adult population living in the USA. The analytic sample was 36,190 (mean age 46.5 years; 48.1% male). Of these participants, 3,111 were Veterans. Data were analyzed between September 2020 and January 2021. Results Latent class analysis revealed a four-class solution: (1) “Low adversity” (75.3%); (2) “Primarily household dysfunction” (9.0%); (3) “Primarily maltreatment” (10.7%); and (4) “Multiple adversity types” (5.1%). Compared to “Low adversity,” members in the other classes were more likely to be Veterans (odds ratio (OR)C2vC1 = 1.33, ORC3vC1 = 1.55, ORC4vC1 = 1.98) and female (ORC2vC1 = 1.58, ORC3vC1 = 1.22, ORC4vC1 = 1.65). While lower education and income were also related to higher adversity class membership, Veteran status and sex were the strongest predictors, even when controlling for education and income. Conclusions Distinct and meaningful patterns of ACEs identified in this study highlight the need for routine ACE screenings in Veterans and females. As in the current study, operationalizing and clustering ACEs can inform screening measures and trauma-informed interventions in line with personalized medicine. Future work can test if classes are differentially associated with health outcomes.

The Veteran Reintegrated in You’re the Worst and One Day at a Time

As the “War on Terror” continues, the national myth of veteran-as-hero has given way to a narrative shorthand of veteran-as-villain. Films and television shows depicting the reintegration of veterans tend to focus on the struggle and alienation from the homefront that veterans feel upon their return. In contrast, comedy television portrayals such as One Day at a Time and You’re the Worst, both of which slowly but successfully reintegrate their central veteran characters, do so narratively by shifting their characters’ veteran status from their defining feature to one aspect of their past. Ultimately, I argue that the process of reintegration is one paralleled in the rehumanization that these comedy television portrayals permit, ultimately offering hope that reintegration, while not easy, is possible.

The Association Between Veteran Status and Obesity Differs Across Race/Ethnicity

Purpose This study aims to evaluate the interaction between veteran status and race/ethnicity on obesity status. Design Cross-sectional survey Setting The 2013–2017 National Health Interview Survey Sample A total of 151,765 adults (8.62% veterans and 91.38 nonveterans) with 69.30% identifying as White, 13.05% identifying as Hispanic, 12.57% identifying as Black, and 5.08% identifying as Asian Measures Obesity status (measured using self-reported body mass index), race/ethnicity, survey year, age, marital status, educational attainment, federal poverty level, health insurance, type of insurance, self-reported health status, and whether participant had a usual care source. Analysis Weighted logistic regression analysis Results In a fully adjusted model, there was no evidence that veterans overall had higher odds of obesity compared to nonveterans (adjusted odd ratio (aOR): 1.05, 95% CI: .99, 1.11). White veterans had lower odds of obesity compared to White nonveterans (OR: .93, 95% CI: .87, .98). Hispanic veterans had higher odds of obesity compared to Hispanic nonveterans (aOR: 1.53, 95% CI: 1.23, 1.90). There was no evidence of an association between veteran status and obesity status for Black and Asian adults. Conclusions Effectual prevention strategies are needed to decrease obesity risks among active and retired Hispanic veterans.

Montani Semper Liberi: Age And Depression Among Veterans In Appalachia

Depression is higher in rural areas and military veterans (Kimron et al., 2019; Bedard-Gilligan et al., 2018). West Virginia, the only state contained entirely within Appalachia, has a higher percentage of military service among its citizenry than other states. Thus, the purpose of the current study was to examine the association between veteran status and depression among adults in WV. Using 2018 WV data from the CDC’s Behavioral Risk Factor Surveillance System, we examined depression as a function of veteran status and age, among 612 younger adults, 1813 middle-aged adults, and 2445 older adults (N = 4,870; 12.4% veterans). Our ANOVA revealed a significant overall effect, F(5, 4864) = 14.64, p < .001, a main effect for veteran status (18.8% of veterans and 26% of non-veterans reported depression), and an age effect emerged, with more younger (28.6%) and middle-aged adults (30.5%) reporting depression than did older adults (20.3%). No significant interaction between age and veteran status emerged, F(2, 4864) = 1.75, p = .175. Of note, 25% of the sample reported having depression. Given that place-based mental health disparities exist, this finding is not unexpected. But fewer older adults and fewer veterans reported depression. At least three possibilities warrant further investigation. Future studies should examine whether these age and veteran status differences in depression reflect differences in resilience, differences in reporting, and/or differences in selective survival.

Are Anatomical Gift Donors Demographically Representative of the American Aging Patient Population?

Body donation for medical education is voluntary and open to all; however, it is undetermined if the donors studied at UMass Medical School (UMMS) are demographically representative of the national patient population. If not, medical students are missing the opportunity of experiencing normal variation within the population, which may promote bias in their clinical years. This cross-sectional study compared data from the UMMS Anatomical Gift Program (AGP) with the Health and Retirement Study (HRS) population data. This study examined sex, race, ethnicity, veteran status, and sexual orientation. 5 years (n=540) of AGP data and 3 waves (n=5,037) of HRS data were examined. The results demonstrate that sex differences between the AGP and HRS populations (55% for females vs. 45% for males; p=.10) are NOT significant. A significant racial difference between populations is noted (p=.000), with 98.3% of the AGP vs. 72.7% of the HRS identifying as white. Veterans are overrepresented in the AGP (22.6% AGP vs. 9.6% HRS; p=.000). 12.3% of HRS participants report Hispanic ethnicity compared to 0% in the AGP. In 2016, HRS included sexual orientation, with 92.7% of respondents identifying as heterosexual, 2.6% gay or lesbian, 1.0% bisexual and 1.3% other. No data were collected by the AGP pertaining to sexual orientation and neither database ask about gender identity. Aging populations are not represented in the anatomy labs at UMMS and likely nationally. Efforts are needed to improve this and enhance the education of the medical professionals, while expanding the end-of-life options for all community members.

Binge Drinking and Heavy Drinking Among Older Military Veterans: Applying the Theory of Intersectionality

The post-service impact of military experiences include post-traumatic stress disorder, depression, substance misuse and several other adverse outcomes that persist well into older adulthood. As such, older military veterans are at risk of developing alcohol dependency and those with existing stressors from other identities are at the highest risk of engaging in binge drinking or heavy drinking. This study used the theory of intersectionality to examine alcohol misuse by veteran status and age, veteran status and race and veteran status and sex. Data were derived from the 2016, 2017 and 2018 Brief Risk Factor Surveillance System (BRFSS) from the Centers for Disease Control and Prevention (CDC). The BRFSS is an annual survey conducted over the phone in all 50 states and territories. Survey-weighted logistic regression models were used to examine alcohol misuse among adults aged 65+ by veteran status and the intersection between age, race, and sex. Results showed no interaction between veteran status and age, and no interaction between veteran status and sex. However, there was a significant interaction between veteran status and race, in that Black/Other race veterans were more likely to engage in both binge drinking and heavy drinking compared to White veterans, White nonveterans and nonveterans of the same race. Interventions geared towards this population should therefore engage culturally sensitive approaches that consider the historical and systemic factors that contribute to these disparities in rates of alcohol misuse among older military veterans.

Progress Toward Increasing Women’s and Minorities’ Access to Top State Government Jobs?

This study examines the impact of qualifications and hiring advantages on women’s and minorities’ access to state government jobs, both in managerial and high-salary positions and overall. It also looks at how race and gender differences in representation have changed since 1990 and how they compare with the private sector. All groups, except Latino and Asian men, are more likely than White men to work for state governments, and all groups are more likely to do so than comparable White men. White men remain more likely to be managers and to earn top-decile salaries than comparable White women and people of color. Differences in education, experience, veteran status, and citizenship contribute, in different ways, to each group’s underrepresentation at top levels, but sizable unexplained gaps remain. The good news is that access to top jobs is better in state governments than in the private sector and has improved since 1990.

G.I. Jane Goes to College? Female Educational Attainment, Earnings, and the Servicemen’s Readjustment Act of 1944

The 1944 Servicemen’s Readjustment Act (the “G.I. Bill”) provided returning WWII veterans with educational benefits sufficient to cover tuition, fees, and living expenses at almost any U.S. university or college. While several studies examine subsequent educational attainment and earnings for male veterans, little is known about how the G.I. Bill affected the 330,000 American females who served in WWII. Using data from the 1980 5 percent Census Public-use Microdata Sample, I find that female WWII veteran status is associated with a 19 percentage point increase in the proportion who report any college attendance, a 7.8 percentage point increase in college completion, and earnings that are 19.8 percent greater relative to comparable females who are not veterans. Because service was entirely voluntary for females, I use service eligibility requirements, enlistment records, 1940 Census data, and the G.I. Bill’s retroactive nature to establish a causal relationship among veteran status, educational attainment via the G.I. Bill, and increased earnings. To help separate the effect of the G.I. Bill from the effect of military service itself, and because benefits increased with longer service, I instrument for female veterans’ educational attainment using age at the time of the G.I. Bill’s announcement. My instrumental variables estimates imply that female veterans’ earnings increase by $1,350 (11.6 percent) per year of G.I. Bill-induced education, explaining 73 percent of the overall difference between veteran and non-veteran females’ earnings in 1980.