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Health Disparities and Occupational Health in Military Service Members and Veterans

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 November 2020) | Viewed by 21406

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Special Issue Editors

Dr. Jud Janak

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Guest Editor

Bexar Data Limited Company, San Antonio, TX 78210, USA
Interests: life-course epidemiology; military and veterans’ health; combat casualty care; injury epidemiology; preventable death; biostatistics
Special Issues, Collections and Topics in MDPI journals

Dr. Jeffrey T. Howard

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Assistant Guest Editor

Department of Kinesiology, Health and Nutrition, University of Texas at San Antonio, San Antonio, TX 78249, USA
Interests: traumatic injury and chronic disease; epidemiology; military/veterans’ health; biodemography and aging; health disparities; mortality; environmental disaster and climate change health impacts; medical/physiologicalmonitoring; statistical method
Special Issues, Collections and Topics in MDPI journals

Dr. Alexis Raúl Santos

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Assistant Guest Editor

102 Health and Human Development, University Park, PA 16802, USA
Interests: health and well being; stress; mortality; vulnerable populations

Dr. Ian J. Stewart

E-Mail Website
Assistant Guest Editor

1. David Grant USAF Medical Center, Travis Air Force Base, California, CA 94533， USA
2. Uniformed Services University of Health Sciences, Bethesda, Maryland, MD 20814, USA
Interests: veterans and military health; acute kidney injury; burn care; trauma

Dr. Avron Spiro

E-Mail Website
Assistant Guest Editor

1. Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston MA 02130, USA
2. Departments of Epidemiology and Psychiatry, Boston University Schools of Public Health and Medicine, Boston, MA 02118, USA
Interests: aging/gerontology; veteran/military health and well-being; cognitive aging; personality; longitudinal methodology

Special Issue Information

Dear Colleagues,

Military service is an occupation that confers both health-promoting and health-compromising factors over the life-course. Understanding the temporal association of these factors over the life-course is important to understanding the public health impact of military service and to guide future public health prevention strategies to reduce the risk of adverse health outcomes. This includes understanding any important racial/ethnic and sex health disparities in this diverse population.

This Special Issue seeks research papers on various aspects of Military Service Members’ and Veterans’ Health. We encourage submissions related to military occupational risks both during and after service, health systems, and health economics. We welcome original research papers using different study designs as well as systematic reviews and meta-analysis.

Dr. Jud Janak
Dr. Jeffrey T. Howard
Dr. Alexis Raúl Santos
Dr. Ian J. Stewart
Dr. Avron Spiro
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

veterans’ health
military health
health disparities
occupational health

Published Papers (7 papers)

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Research

15 pages, 334 KiB

Open AccessArticle

Racial and Ethnic Disparities in U.S. Veteran Health Characteristics

by Rachel E. Ward, Xuan-Mai T. Nguyen, Yanping Li, Emily M. Lord, Vanessa Lecky, Rebecca J. Song, Juan P. Casas, Kelly Cho, John Michael Gaziano, Kelly M. Harrington, Stacey B. Whitbourne and on behalf of the VA Million Veteran Program

Int. J. Environ. Res. Public Health 2021, 18(5), 2411; https://doi.org/10.3390/ijerph18052411 - 2 Mar 2021

Cited by 14 | Viewed by 3417

Abstract

Racial/ethnic health disparities persist among veterans despite comparable access and quality of care. We describe racial/ethnic differences in self-reported health characteristics among 437,413 men and women (mean age (SD) = 64.5 (12.6), 91% men, 79% White) within the Million Veteran Program. The Cochran–Mantel–Haenszel test and linear mixed models were used to compare age-standardized frequencies and means across race/ethnicity groups, stratified by gender. Black, Hispanic, and Other race men and women reported worse self-rated health, greater VA healthcare utilization, and more combat exposure than Whites. Compared to White men, Black and Other men reported more circulatory, musculoskeletal, mental health, and infectious disease conditions while Hispanic men reported fewer circulatory and more mental health, infectious disease, kidney, and neurological conditions. Compared to White women, Black women reported more circulatory and infectious disease conditions and Other women reported more infectious disease conditions. Smoking rates were higher among Black men, but lower for other minority groups compared to Whites. Minority groups were less likely to drink alcohol and had lower physical fitness than Whites. By identifying differences in burden of various health conditions and risk factors across different racial/ethnic groups, our findings can inform future studies and ultimately interventions addressing disparities. Full article

(This article belongs to the Special Issue Health Disparities and Occupational Health in Military Service Members and Veterans)

13 pages, 823 KiB

Open AccessArticle

Telomere Shortening and Accelerated Aging in US Military Veterans

by Jeffrey T. Howard, Jud C. Janak, Alexis R. Santos-Lozada, Sarah McEvilla, Stephanie D. Ansley, Lauren E. Walker, Avron Spiro and Ian J. Stewart

Int. J. Environ. Res. Public Health 2021, 18(4), 1743; https://doi.org/10.3390/ijerph18041743 - 11 Feb 2021

Cited by 7 | Viewed by 2784

Abstract

A growing body of literature on military personnel and veterans’ health suggests that prior military service may be associated with exposures that increase the risk of cardiovascular disease (CVD), which may differ by race/ethnicity. This study examined the hypothesis that differential telomere shortening, a measure of cellular aging, by race/ethnicity may explain prior findings of differential CVD risk in racial/ethnic groups with military service. Data from the first two continuous waves of the National Health and Nutrition Examination Survey (NHANES), administered from 1999–2002 were analyzed. Mean telomere length in base pairs was analyzed with multivariable adjusted linear regression with complex sample design, stratified by sex. The unadjusted mean telomere length was 225.8 base shorter for individuals with prior military service. The mean telomere length for men was 47.2 (95% CI: −92.9, −1.5; p < 0.05) base pairs shorter for men with military service after adjustment for demographic, socioeconomic, and behavioral variables, but did not differ significantly in women with and without prior military service. The interaction between military service and race/ethnicity was not significant for men or women. The results suggest that military service may contribute to accelerated aging as a result of health damaging exposures, such as combat, injury, and environmental contaminants, though other unmeasured confounders could also potentially explain the results. Full article

(This article belongs to the Special Issue Health Disparities and Occupational Health in Military Service Members and Veterans)

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15 pages, 683 KiB

Open AccessArticle

Mental Health and Psychosocial Functioning in Recently Separated U.S. Women Veterans: Trajectories and Bi-Directional Relationships

by Karen A. Lawrence, Dawne Vogt, Adam J. Dugan, Shawn Nigam, Emily Slade and Brian N. Smith

Int. J. Environ. Res. Public Health 2021, 18(3), 935; https://doi.org/10.3390/ijerph18030935 - 22 Jan 2021

Cited by 7 | Viewed by 3287

Abstract

Prior research on the relationship between veterans’ mental health and psychosocial functioning has primarily relied on male samples. Here, we investigated prospective longitudinal relationships between mental health and psychosocial functioning in 554 female Iraq and Afghanistan War veterans who were surveyed three times between two- and seven-years following separation from service. Mixed effects modeling revealed that increasing depression and posttraumatic stress disorder (PTSD) severity predicted declines in work functioning. Increasing PTSD severity predicted declining parental functioning and worsening depression predicted a decline in relationship functioning. In turn, decreased work and intimate relationship functioning predicted increased PTSD and depression symptom severity suggesting bi-directional effects between mental health and psychosocial functioning. An examination of the effect of deployment stressors on psychosocial functioning revealed that deployment sexual harassment was the strongest predictor of decreased psychosocial functioning across all domains. Evidence for the reciprocal nature of relationships between mental health and psychosocial functioning underscore the need for treatment targeted at PTSD and depression, as well as work and relationship functioning to improve outcomes for women veterans. Full article

(This article belongs to the Special Issue Health Disparities and Occupational Health in Military Service Members and Veterans)

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15 pages, 800 KiB

Open AccessFeature PaperArticle

Dietary Intake and Elevated C-Reactive Protein Levels in US Military Veterans

by Stephanie D. Ansley and Jeffrey T. Howard

Int. J. Environ. Res. Public Health 2021, 18(2), 403; https://doi.org/10.3390/ijerph18020403 - 6 Jan 2021

Cited by 3 | Viewed by 2856

Abstract

Elevated inflammatory markers, such as high sensitivity C-reactive protein (hs-CRP), have been associated with the pathogenesis of cardiovascular disease (CVD)-related diseases. However, limited studies have evaluated the potential association between dietary consumption and hs-CRP levels in a large, nationally representative sample, and fewer have investigated their role in ethnic and racial minority military populations. The goal of this study is to explore the relationship between dietary intake, health behaviors, and hs-CRP in individuals with prior military status and whether these associations differ by race/ethnicity. A complex, multistage, probability sample design was used from the National Health and Nutrition Examination (NHANES) 2015–2018 waves. Our results indicate that previously deployed military service members had a higher prevalence of clinically elevated hs-CRP levels than civilians. Differences in hs-CRP among deployed veterans and civilians remained even after multivariable adjustment. Individuals classified as overweight and obese demonstrated clinically elevated hs-CRP levels compared with those with a normal body mass index (BMI). Dietary factors did not attenuate the association between changes in hs-CRP levels and veteran status. These findings suggest the need for further investigation into how military-specific stressors contribute to unfavorable health outcomes for the military population. Full article

(This article belongs to the Special Issue Health Disparities and Occupational Health in Military Service Members and Veterans)

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14 pages, 331 KiB

Open AccessArticle

Long-Term Outcomes of Service Women Injured on Combat Deployment

by Jessica R. Watrous, Cameron T. McCabe, Amber L. Dougherty, Abigail M. Yablonsky, Gretchen Jones, Judith Harbertson and Michael R. Galarneau

Int. J. Environ. Res. Public Health 2021, 18(1), 39; https://doi.org/10.3390/ijerph18010039 - 23 Dec 2020

Cited by 4 | Viewed by 1731

Abstract

Sex- and gender-based health disparities are well established and may be of particular concern for service women. Given that injured service members are at high risk of adverse mental and behavioral health outcomes, it is important to address any such disparities in this group, especially in regard to patient-reported outcomes, as much of the existing research has focused on objective medical records. The current study addressed physical and mental health-related quality of life, mental health symptoms, and health behaviors (i.e., alcohol use, sleep, and physical activity) among a sample of service women injured on deployment. Results indicate that about half of injured service women screened positive for a mental health condition, and also evidenced risky health behaviors including problematic drinking, poor sleep, and physical inactivity. Many of the mental and behavioral health variables demonstrated statistically significant associations with each other, supporting the relationships between psychological health and behaviors. Results provide additional evidence for the importance of access to integrated and effective mental healthcare treatment for injured service women and the need for screening in healthcare settings that address the multiple factors (e.g., mental health symptoms, alcohol use, poor sleep) that may lead to poor outcomes. Full article

(This article belongs to the Special Issue Health Disparities and Occupational Health in Military Service Members and Veterans)

16 pages, 322 KiB

Open AccessArticle

Examining the Association between Trauma Exposure and Work-Related Outcomes in Women Veterans

by Megan E. Sienkiewicz, Aneline Amalathas, Katherine M. Iverson, Brian N. Smith and Karen S. Mitchell

Int. J. Environ. Res. Public Health 2020, 17(12), 4585; https://doi.org/10.3390/ijerph17124585 - 25 Jun 2020

Cited by 10 | Viewed by 3825

Abstract

Women veterans have high rates of trauma exposure, including military sexual trauma (MST), which are associated with numerous health and psychosocial consequences. However, associations between trauma history and work-related outcomes are less well-characterized. We examined whether military-related and non-military trauma types were associated with work-related outcomes and whether posttraumatic stress disorder (PTSD) and depression symptoms mediated these associations. A total of 369 women veterans completed up to two mailed surveys, 12 months apart, assessing trauma exposure, depression and PTSD symptoms, occupational functioning, and employment status (unemployed, out of the workforce, employed). Participants reported high rates of trauma exposure. Nearly half (47.5%) were out of the workforce. Military-related trauma, military sexual assault, and adult sexual assault were associated with worse occupational functioning. Only PTSD symptoms mediated associations between trauma types and occupational functioning. No trauma types were significantly directly associated with employment status; however, PTSD and depression symptoms mediated associations between trauma types and being out of the workforce. Findings can inform screening for military trauma exposures, mental health, and work-related needs among women veterans. Full article

(This article belongs to the Special Issue Health Disparities and Occupational Health in Military Service Members and Veterans)

15 pages, 338 KiB

Open AccessArticle

Predicting Health-Related Quality of Life in Trauma-Exposed Male Veterans in Late Midlife: A 20 Year Longitudinal Study

by Samantha M. Stevens, Daniel E. Gustavson, Bin Fang, Xin Tu, Mark Logue, Michael J. Lyons, Chandra A. Reynolds, William S. Kremen and Carol E. Franz

Int. J. Environ. Res. Public Health 2020, 17(12), 4554; https://doi.org/10.3390/ijerph17124554 - 24 Jun 2020

Cited by 4 | Viewed by 2307

Abstract

Trauma-exposed adults with high levels of posttraumatic stress symptoms (PTSS) report poorer health-related quality of life (HRQOL), but less is known about the persistence of this relationship over time. Participants from the Vietnam Era Twin Study of Aging reported on PTSS, health, and sociodemographic characteristics at average age 38; 775 participants reported having been exposed to trauma. Later, at average ages 56 and 62, mental and physical HRQOL were assessed with the Short-Form 36. Premorbid risk for anxiety/neuroticism was evaluated with a polygenic risk score derived from a large genome-wide association study meta-analysis. In multivariate mixed models, having higher levels of PTSS, poorer self-rated health, lower income, and less education at age 38 were associated with worse physical and mental HRQOL two decades later. Chronic health problems at age 38 predicted midlife physical but not mental HRQOL. Although genetic risk for neuroticism was correlated with HRQOL and PTSS, it was no longer significant in multivariate models. Health-related quality of life (HRQOL) predicts morbidity and mortality independently of objective health measures; early interventions may help to mitigate the ongoing impact of trauma on quality of life. Full article

(This article belongs to the Special Issue Health Disparities and Occupational Health in Military Service Members and Veterans)

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