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Current excessive drinking among Vietnam veterans: a comparison with other veterans and non-veterans.

Analysis of recent data collected in a 1977 U.S. national epidemiologic study of substance abuse revealed that Vietnam veterans (N=87) had substantially higher levels of alcohol consumption and binge drinking, than comparable groups of Vietnam "era" veterans with no Vietnam service (N=107), other veterans (N=483), and nonveterans (N=2,600). Vietnam veterans and Vietnam era veterans also had a somewhat higher level of drug abuse than expected for individuals from similar social backgrounds. Multiple Classification Analysis (MCA) was the technique used to adjust for demographic differences between these four groups. The results of these analyses reinforced previous research findings and substantiated the President's Commission on Mental Health, which speculated that alcohol abuse may become a special health problem among this population. Since evidence for "post-traumatic" or delayed stress among Vietnam veterans has been culminating, and some research has indicated a link between stress and increased alcohol consumption, it was suggested that the drinking pattern found among this Vietnam veteran sample may be a symptom of post-traumatic stress.

Adult↗

Stress symptomatology among Vietnam veterans. Analysis of the Veterans Administration Survey of Veterans. II.

In 1979, the US Veterans Administration conducted a health survey of 11,230 veterans. The present analysis of these data focuses on the association between Vietnam service and combat experience with eight post-traumatic stress disorder symptoms among the 1,787 Vietnam era veterans who entered military service between 1965 and 1975. The advantages of this study are that it includes a large random sample selected from the total US population, had a high interview response rate (93%), and collected data prior to the recent public controversy surrounding the issue of the health effects of possible exposure of Vietnam veterans to Agent Orange. After adjustment for the potential confounding effects of military service and demographic factors, the level of combat exposure was significantly associated with all eight symptoms of post-traumatic stress disorder in a dose response pattern. For seven of the eight symptoms, a twofold increase in the factor-adjusted prevalence odds ratio was observed when non-Vietnam service veterans were compared with Vietnam veterans who experienced the most intense combat experience. Being younger, less well educated, or nonwhite at the time of military service are factors which independently further increased the probability of stress symptoms.

Adult↗

Are veterans seeking Veterans Affairs' primary care as healthy as those seeking Department of Defense primary care? A look at Gulf War veterans' symptoms and functional status.

OBJECTIVE: This study compared Gulf War veterans seeking VA primary care with Gulf War veterans seeking treatment from a Department of Defense primary care clinic on measures of physical symptoms, psychiatric complaints, and functional status. Additionally, the association between employment status and health was examined. METHODS: Analysis was based on the responses of consecutive patients attending the Gulf War Primary Care clinics at either the VA Puget Sound Health Care System in Seattle, WA (N= 223), or the Walter Reed Army Medical Center in Washington, DC (N= 153), between March 1998 and September 1999. RESULTS: After controlling for demographic variables, Gulf War veterans who sought VA care reported significantly more anxiety and PTSD symptoms than active duty military personnel. The groups did not differ on somatic complaints or summary scores from the SF-36. Employment status was significantly, independently, and consistently associated with greater psychiatric symptoms, physical symptoms, and decreased functional status. CONCLUSIONS: Our findings reveal important differences in health status between veterans seeking primary care at a VA and a Department of Defense facility, differences that are in part related to employment status. Both groups report symptoms of psychiatric distress and decreased functional status, though VA patients are more impaired. Research findings based on clinical samples of veterans at VA sites may not generalize to Gulf War veterans still on active duty (and vice versa).

Adult↗

The focus on women veterans who use Veterans Administration health care: the Veterans Administration Women's Health Project.

Women have served in every war and conflict in our history, but the effects of military duty on women are largely unknown. This article discusses the history of women in the military and presents findings from the Veterans Administration Women's Health Project. This study was designed to describe the health-related quality of life of women veterans who receive Veterans Administration ambulatory care. We assessed health status using the Short Form 36, an easily administered 36-item health survey that has been widely used and that has been shown to be reliable and valid. We compared Short Form 36 scores between veteran and nonveteran women. The results indicate that veteran women score lower on every scale compared with nonveteran women.

Adult↗

Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study.

BACKGROUND: The Department of Veterans Affairs Health Care System (VA) is the largest integrated single payer system in the United States. To date, there has been no systematic measurement of health status in the VA. The Veterans Health Study has developed methods to assess patient-based health status in ambulatory populations. OBJECTIVES: To describe the health status of veterans and examine the relationships between their health-related quality of life, age, comorbidity, and socioeconomic and service-connected disability status. METHODS: Participants in the Veterans Health Study, a 2-year longitudinal study, were recruited from a representative sample of patients receiving ambulatory care at 4 VA facilities in the New England region. The Veterans Health Study patients received questionnaires of health status, including the Medical Outcomes Study Short Form 36-Item Health Survey; and a health examination, clinical assessments, and medical history taking. Sixteen hundred sixty-seven patients for whom we conducted baseline assessments are described. RESULTS: The VA outpatients had poor health status scores across all measures of the Medical Outcomes Study Short Form 36-Item Health Survey compared with scores in non-VA populations (at least 50% of 1 SD worse). Striking differences also were found with the sample stratified by age group (20-49 years, 50-64 years, and 65-90 years). For 7 of the 8 scales (role limitations due to physical problems, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health), scores were considerably lower among the younger patients; for the eighth scale (physical function), scores of the young veterans (aged 20-49 years) were almost comparable with the levels in the old veterans (>65 years). The mental health scores of young veterans were substantially worse than all other age groups (P<.001) and scores of screening measures for depression were significantly higher in the youngest age group (51%) compared with the oldest age groups (33% and 16%) (P<.001). CONCLUSIONS: The VA outpatients have substantially worse health status than non-VA populations. Mental health differences between the young and old veterans who use the VA health care system are sharply contrasting; the young veterans are sicker, suggesting substantially higher resource needs. Mental health differences may explain much of the worse health-related quality of life in young veterans. As health care systems continue to undergo a radical transformation, the Department of Veterans Affairs should focus on the provision of mental health services for its younger veteran.

Adult↗

The health and functional status of US veterans aged 65+: implications for VA health programs serving an elderly, diverse veteran population.

As the US population is aging, so too is the US veteran population. Chief among the challenges facing the Department of Veterans Affairs (VA) is developing health programs and services that mesh with the needs of an aging veteran population and therefore improve the health status of elderly veterans. Meeting this challenge requires an understanding of the health needs of the older veteran population, including health disparities that exist across racial ethnic populations. This study examines the self-rated health and functioning of a national sample of veterans aged 65+ participating in the National Survey of Veterans. The results show that over one half of elderly veterans report difficulty in functioning and rate their health status as fair or poor. Additionally, elderly African American and Hispanic veterans report worse health than non-Hispanic white veterans across the majority of health indicators. Given the health profile of older veterans found in this study, it would seem necessary that programs serving older veterans be adept at the ongoing medical management of chronic disease and the provision of long-term care services.

Activities of Daily Living↗

Access of women veterans to Veterans Affairs hospitals.

Women veterans represent a rapidly growing segment of the veteran population. This study examines how the utilization of VA hospitals by women veterans has changed since 1980. Information on the use of VA hospitals was obtained from the discharge database for all VA hospitals. The demographics of the veteran population was compiled from the Veteran Population Files, which contain annual estimates of the number of veterans by age and sex. The VA hospital discharge rate for women increased nearly 29 percent during the 1980's while the VA user rate increased nearly 18.6 percent for women. The increase in the average number of VA stays per user was smaller for women than for men (8.4 percent versus 11 percent). Substantial increases in the utilization of VA hospitals by women veterans occurred during the 1980's. In most cases these increases were larger for women veterans than for men veterans. However, women veterans still use VA hospitals at about one-half the rate for men. Regardless, the VA system will continue to be an important source of health care for women.

Adult↗

Mortality among Vietnam veterans compared with non-veterans and the Australian population.

A retrospective cohort study of mortality was conducted to assess whether the military service of young Australian men in Vietnam has influenced their overall death rates, or those from specific causes. The study was of all national servicemen who were conscripted during the conflict and served in the Army for at least 12 months. Of these, 19 205 served in Vietnam (veterans) while 25 677 served only in Australia (non-veterans). These men were traced from the end of their national service (between 1966 and 1973) until the beginning of 1982. For most causes of death, the observed number of deaths of veterans and of non-veterans was less than expected from Australian population death rates, and for no cause was there a statistically significant excess of deaths compared with that of the Australian population. Similarly, when veterans were compared with non-veterans, there was no statistically significant difference in deaths for all causes combined, for diseases of the circulatory system, for deaths in motor vehicle accidents, for suicide and for all external causes after adjustment for the different subsequent death rates of men who had served in different Army corps. All seven deaths from diseases of the digestive system were of veterans. There was no excess of deaths among veterans from cancer or from atypical causes of death in this group of young men. Three-quarters of deaths of both veterans and non-veterans were from external causes, often involving motor vehicle accidents.

Adult↗

Pregnancy outcomes among U.S. Gulf War veterans: a population-based survey of 30,000 veterans.

PURPOSE: We evaluated an association between veterans' Gulf War service and reported adverse pregnancy outcomes. METHODS: We conducted a health survey in which selected reproductive outcomes of a population-based sample of 15,000 Gulf War veterans representing four military branches and three unit components (active, reserve, and National Guard) were compared to those of 15,000 non-Gulf veteran controls. RESULTS: Male Gulf veterans, compared with their non-Gulf veteran controls, reported a significantly higher rate of miscarriage (odds ratio [OR] = 1.62; 95% confidence interval [CI] = 1.32-1.99). Female Gulf veterans also reported more miscarriages than their respective controls, although their excess was not statistically significant (OR= 1.35; CI = 0.97-1.89). Both men and women deployed to the Gulf theater reported significant excesses of birth defects among their liveborn infants. These excess rates also extended to the subset of "moderate to severe" birth defects [males: OR= 1.78 (CI = 1.19-2.66); females: OR = 2.80 (CI = 1.26-6.25)]. No statistically significant differences by deployment status were found among men or women for stillbirths, pre-term deliveries or infant mortality. CONCLUSION: The risk of veterans reporting birth defects among their children was significantly associated with veteran's military service in the Gulf War. This observation needs to be confirmed by a review of medical records to rule out possible reporting bias.

Abortion, Spontaneous↗

The health status of Gulf War veterans: lessons learned from the Department of Veterans Affairs Health Registry.

OBJECTIVE: To describe the demographic characteristics and postwar health status of U.S. Gulf War veterans who participated in the Department of Veterans Affairs health examination registry program. DESIGN: Case records of 52,835 veterans who participated in a standardized health examination program were reviewed. SETTING: Participants volunteered for physical examinations at a Department of Veterans Affairs medical treatment facility from August 1992 to September 1996. SUBJECTS: U.S. Gulf War veterans deployed to southwest Asia between August 1990 and 1996. MAIN OUTCOME MEASURE: Demographic, military, symptom, and International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic categories. RESULTS: A wide variety of symptoms and diagnoses were reported without apparent internal variation by military characteristics (branch and service component). The frequency of symptoms (fatigue, skin rash, headache, muscle and joint pain, and memory loss) reported increased over time, whereas the proportion of individuals with physician-diagnosed illnesses remained fairly constant. No single category of disease increased or decreased substantially over time. CONCLUSIONS: Veterans have experienced a wide variety of health problems since their Gulf War service. These problems, in aggregate, are different from what has been seen in other armed conflicts. The Department of Veterans Affairs registry is a very large case series and has failed to identify a single, unique syndrome or new illness after Gulf War service. An epidemiologic study would better define the prevalence of specific symptoms and medical conditions among Gulf War veterans and to what extent any of the conditions identified are associated with Gulf War military service. The knowledge provided by such studies would be important to development of preventive measures and future deployment medical surveillance planning.

Adult↗

Female veterans' use of Department of Veterans Affairs health care services.

OBJECTIVES: As access of women to mental health services has become increasingly important, empirical research has begun to examine the determinants of mental health care utilization across gender. This article examines the effect of being an extreme minority on utilization of Department of Veterans Affairs (VA) health services by female veterans. METHODS: Data were collected on a representative national sample of veterans in 1992 as part of the National Survey of Veterans. These data included information on sociodemographic variables, military service variables, physical health and disability, and health services utilization. The authors examined whether women who used health services in 1992, and who were eligible for VA care, differed from men on the likelihood of using any VA health services and on the likelihood of use of VA outpatient and inpatient health services. In addition, we compared VA health care utilization among subgroups of veterans with physical and mental disorders, and compared self-reported reasons for choice of health care provider, across gender. RESULTS: Results indicated that female veterans were less likely than male veterans to use VA health services. This difference was explained by lower utilization by women of VA outpatient services, since inpatient admission rates were the same across gender. The lower outpatient utilization was specific to women with self-reported mental disorders. Women with physical conditions did not differ from men with similar conditions in their VA outpatient utilization. Finally, men and women did not differ on their reasons for choosing VA or non-VA care. CONCLUSIONS: The authors conclude that extreme gender minority status appears to affect outpatient utilization rates at the VA among women with mental disorders, perhaps because of the more personal or sensitive nature of the services involved. Further research is needed to understand why certain women may be underutilizing VA outpatient services and on the consequences of minority gender status for health service utilization, more generally.

Adult↗

Veterans Administration and ambulatory care: the "low-priority" veteran.

We describe several consequences of an effort to reduce patient volume in a general medical clinic (GMC) by releasing "low-priority" veterans. With a before-after descriptive study, we determined what sources of medical care these veterans used and assessed changes in their medical status using hypertension as a tracer condition. Private providers were used exclusively by 35% of veterans, 33% continued to use VA medical services, 11% used a combination of VA and private care, and 16% used other miscellaneous sources of care. While most veterans (74%) paid cash for their care, 35% also used Medicare or Medicaid supplementally. In veterans with hypertension, the diastolic blood pressure distributions were ostensibly unchanged after release. These results suggest that a reduction in services provided to "low-priority" veterans is feasible without deleteriously affecting their medical status. With regard to blood pressure control, those veterans who obtained private sources of care did as well as those who remained in the GMC.

Adult↗

Enrollment--provision of hospital and outpatient care to veterans. Department of Veterans Affairs. Final rule.

This document amends VA's medical regulations. The Veterans' Health Care Eligibility Reform Act of 1996 mandates that VA implement a national enrollment system to manage the delivery of healthcare services. Accordingly, the medical regulations are amended to establish provisions consistent with this mandate. Starting October 1, 1998, most veterans were required to be enrolled in the VA healthcare system as a condition of receiving VA hospital and outpatient care. Veterans will be allowed to apply to be enrolled at any time. They will be eligible to be enrolled based on funding availability and their priority status. In accordance with statutory provisions, the final rule also states that some categories of veterans are eligible for VA hospital and outpatient care even if not enrolled. This document further establishes a "medical benefits package" setting forth, with certain exceptions, the hospital and outpatient care that will be provided to enrolled veterans and certain other veterans. Moreover, this document announces that VA will enroll all 7 priority categories of veterans for the period October 1, 1999 through September 30, 2000, unless it is necessary to change this determination by a subsequent rulemaking document.

Ambulatory Care↗

Mortality and morbidity of members of the British Nuclear Tests Veterans Association and the New Zealand Nuclear Tests Veterans Association and their families.

More than 20,000 British servicemen--many of them on their National Service, few of them volunteering for the tests, and most in their early twenties, some still boy soldiers in their teens--were required to 'participate' in the United Kingdom nuclear tests in Australia and Christmas Island in the 1950s and 1960s. 528 members of the New Zealand Navy were also present for one series of tests. There was also a Fijian Army contingent, which has been variously numbered between 100 and 500 men. An estimated 16,000 Australian servicemen and civilians were also involved in the tests at Maralinga and other sites. The men performed a wide range of duties, from highly technical preparations for the detonations to catering and clerical jobs. But whatever their role, they were all required to witness the detonations as part of their 'indoctrination' for the possibility of nuclear war. Most of them were required to line up on the beach, with their backs to the detonations and their hands over their eyes for the first minute or so. They were then allowed to turn around and look at the awesome sight as the mushroom cloud plumed thousands of feet into the air. Very few wore more than shorts and sandals during their time at the tests; only those who were thought to be at risk from radiation injury were issued with protective clothing and radiation dose badges. The UK government was sure that the troops, most of whom were standing within 20 km of the detonations and some of whom were present for 25 nuclear bomb blasts in as many weeks on Christmas Island, were not irradiated. The Ministry of Defence still routinely issues a document to nuclear veterans who feel that their illnesses were caused by the radiation they encountered when they were young men which states: The background [radiation] dose received by civilians and members of HM Forces serving at or off Christmas Island in the years 1956 to 1964 was only about 35% of that which they would have received on average had they remained, for that period of their lives, in the United Kingdom--that is, some 100 microsieverts per calendar month less at Christmas Island than in the United Kingdom. This sanguine view of the health burden borne by nuclear veterans and their families is not borne out by the data reported in this study of the health outcomes of the 2,500 men (2,200 UK, 238 New Zealand and 62 Fijian) on whom data are available to the present researcher. Thirty per cent of the men in this sample have already died, mostly in their fifties. Two-thirds of them died from cancers that are pensionable in the United States as presumptively radiogenic among nuclear veterans. About one in seven of the men in the sample of 1,014 who responded to the questionnaire circulated in late 1997 did not father any children after they returned from the weapons tests. Among the nearly 5,000 children and grandchildren of this group of more than a thousand veterans, there are 26 cases of spina bifida alone--more than five times the usual rate for live births in the UK. Nearly half the health problems among the offspring of the nuclear weapons tests veterans reported in this study consist of the same dermatological, musculoskeletal and gastrointestinal conditions from which many of the men have also suffered. Among the 2,261 children of 1,041 veterans, more than 200 skeletal abnormalities were reported, including more than 30 cases of short stature and 18 spinal problems, mostly curvature and scoliosis. More than 100 skin conditions were reported, mostly eczema and dermatitis, in many cases described as congenital. Over 50 of the children are already suffering from arthritis and similar conditions, although they are only now entering their thirties. Hip deformities were reported for 19 children and kneecap deformities for 14. More than 100 of the veterans' children reported reproductive difficulties; 24 women reported problems with their ovaries. This pattern of morbidity was repeated in the grandchildren, tho

Adolescent↗

Utilization, attitudes, and experiences of Vietnam Era veterans with Veterans Administration health facilities: the American Legion experience.

A random sample of American Legion members in six states who had served in the Armed Forces during the Vietnam Era was conducted through a mailed questionnaire, in order to determine patterns of usage of Veterans Administration health facilities, as well as attitudes toward the VA and experiences at these facilities. Of the 6810 male respondents, 42.0% had served in Southeast Asia. These subjects were categorized according to their level of combat in South Vietnam. Thirty-six percent of those who had served in Southeast Asia had used VA health facilities, compared to only 18% of men who served elsewhere. Among Southeast Asia veterans, combat level was an important predictor of extent of usage of VA facilities for problems of both physical and mental health. Combat level was also associated with lack of basic and major medical insurance. While men with lower incomes tended to make greater use of VA mental health facilities, nearly one-fourth of mental health users had family incomes above $30,000. Despite their greater usage of the VA, men with higher combat levels expressed lower feelings of security about this agency, and rated its staff less helpful and of lower quality than did men who experienced lower levels of combat. On the other hand, higher combat veterans thought themselves better informed about VA services. Men who had gone to the VA for mental health assistance reported a disturbingly low frequency of having been asked basic questions that relate to possible diagnosis of post-traumatic stress disorder (PTSD), questions related to combat, which may be one of its etiologic factors, or other questions relating to their military history. Because combat level in Vietnam veterans is a major determinant of both attitudes toward and utilization of VA health facilities, the VA as well as other health agencies which deal with Vietnam veterans should be especially sensitive to this factor, and should take it into consideration when evaluating veterans' physical and mental health.

Attitude↗

Characteristics of veterans using Veterans Affairs community-based outpatient clinics.

In the late 1990s, the Department of Veterans Affairs (VA) initiated a system of community-based outpatient clinics to enhance access to care. The purpose of this study was to explore factors that may be related to veterans' desire to transfer care from VA-based to community clinics. Among 1,452 veterans who were currently receiving VA clinic care and were eligible for care in two community-based clinics in rural Minnesota, 85 percent responded to a survey. Fifty-four percent of respondents requested community-based outpatient clinic care. Multivariate analysis revealed that veterans less satisfied with VA care were more likely to request a transfer to a community clinic, whereas Veterans SF-36 scale scores were not strongly associated with request for community-based outpatient clinic care. Veterans who had more VA clinic visits were less likely to request community-based outpatient clinic care. The likelihood of requesting also varied across the VA facilities and by VA eligibility level.

Aged↗

Innovation in veterans' health care and assistance: the Department of Veterans Affairs 10 years after the Gulf War.

The Department of Veterans Affairs (VA) has responded to significant challenges in treating and compensating Persian Gulf War veterans by adapting existing programs and developing new ones. The VA established a Gulf War health examination registry and expanded existing "Vet Centers" to provide assistance to Gulf War veterans. Health care eligibility income limitations were eliminated. Outreach efforts included a national newsletter, veterans' organization briefings, and other products. The VA is developing targeted training programs and continuing medical education for health care providers. Numerous major research initiatives have begun. Innovations include the establishment of environmental hazards research centers, clinical demonstration projects, and centers for the study of war-related illness. These efforts required increased coordination among federal agencies and collaboration with other countries. In a precedent-setting development, Congress gave the VA authority to compensate certain veterans with undiagnosed illnesses. Veterans from future conflicts and peacekeeping missions can expect improved services from the VA as a result of these initiatives.

Humans↗