Relationships Among Veteran Status, Gender, and Key Health Indicators in a National Young Adult Sample
Abstract
Objective
Although many risk behaviors peak during young adulthood, little is known about health risk factors and access to care. This study assessed health indicators and health care access in a national sample of young adult veterans and civilians.
Methods
Data were from the 2010 Behavioral Risk Factor Surveillance System, a national telephone survey. Of 27,471 participants, ages 19–30 years, 2.2% were veterans (74.6% were male) and 97.7% were civilians (37.6% were male). Gender-stratified comparisons assessed health indicators and health care access by veteran status. Multivariate logistic regression was used to examine health indicators and health care access as a function of gender and veteran status.
Results
In the overall sample, women were more likely than men to have insurance, to have a regular physician, and to have had a routine checkup and yet were more likely to report financial barriers to care. Women also were more likely than men to report general medical and mental distress and higher lifetime anxiety and depressive disorders, whereas men were more likely to be overweight or obese and to report tobacco use and high-risk drinking. Adjusted analyses revealed a higher likelihood of general medical distress and higher rates of lifetime anxiety disorders among veterans compared with civilians, although there were no differences between veterans and civilians regarding health care utilization and hazardous drinking.
Conclusions
Findings extend the literature on health care status and modifiable risk factors for young adults by identifying differences between men and women and between veterans and civilians. Interventions may need to be tailored on the bases of gender and veteran status because of several differences in mental health and general health needs.
Young adulthood is associated with the initiation and escalation of health risk behaviors that are among the leading causes of preventable morbidity and premature death in the United States. Rates of excessive alcohol use, sexually transmitted infections (STIs), and motor vehicle accidents peak during this life stage (1–3). Approximately 40% of young adults self-report binge drinking (4), which contributes to over one-third of premature deaths in this age group (5). Over half of the 19 million STIs diagnosed annually afflict 15- to 24-year-olds (6). Tobacco use accounts for 443,000 deaths annually (6), and 90% of smokers initiate tobacco use before age 21.
Although these risk behaviors are modifiable through preventive care interventions (7–9), approximately 30% of U.S. young adults (18–29 years of age) lack health insurance (3,10). Young adults are least likely to have a regular medical provider or facility, and their annual rate of emergency department utilization (8%) is second only to those over age 75 (2). An integral part of Healthy People 2010 and 2020, a set of national health objectives, involves enhancing young adults’ access to preventive care to reduce substance use–related injuries and STIs (6). Thus knowledge about health disparities and access to services among subgroups of young adults is needed to inform targeted prevention and outreach efforts.
Young adults who have served in the military have unique health care needs compared with the general young adult population (11–13). Veterans have disproportionately high rates of posttraumatic stress disorder (PTSD), depression, and substance abuse (14–17). Although younger age and male gender are associated with greater health risk behaviors and lower health care utilization among veterans (18,19) and civilians (2,20), comparatively less attention has focused on risk behaviors and health care access and utilization among young veterans, particularly female veterans, compared with civilians.
Population-based study findings are not consistent with regard to the impact of veteran status and gender on health indicators among young adults. Evidence suggests higher rates of heavy drinking among veterans compared with civilians of similar age and gender (21,22), although a recent nationally representative study of men observed comparable rates between young adult veterans and civilians (23). Nationally representative data indicate that smoking rates among male and female veterans (27% and 23%, respectively) are higher compared with their civilian counterparts (23% and 18%, respectively) (11). Studies of veterans seeking health care at U.S. Department of Veterans Affairs (VA) facilities suggest that veterans are more likely than civilians in similar age samples to be overweight (16,24). Although studies (25–27) show high rates of risk behaviors (such as drinking and driving and risky sexual behavior) among soldiers after a military deployment, no research has documented population-based estimates of risk behaviors in association with gender and veteran status.
Limitations of previous research include samples comprising only men (22,23) or only women (28,29), thereby not allowing gender comparisons. Studies of veterans have typically included those engaged in the VA health care system (18,24), so findings may not generalize to veterans who are patients in non-VA care (30). Given the growing numbers of veterans separating from military service, a more comprehensive understanding of health risks and access to care is needed to inform targeted health interventions for young adult men and women to prevent future chronic disease. This study evaluated a nationally representative sample of U.S. young adult veterans and civilians on general health, risk behaviors, access to care, and health care utilization. We hypothesized that male and female veterans would have poorer health and greater health risk behaviors despite greater access to and utilization of services than civilian counterparts. Further, we hypothesized that among both veterans and civilians, women would have greater health care utilization and lower rates of health risk behaviors compared with men.
Methods
Study design, data source, and study population
This retrospective, cross-sectional study used data obtained from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System (BRFSS), a national telephone survey conducted annually to monitor health conditions of U.S. adults. BRFSS data are publicly available (31), and the survey uses state-level sampling plans and weighting to obtain a representative sample from households with telephones. Each respondent is assigned a final sampling weight based on probability of selection and a poststratification factor to ensure that the distribution of the weighted sample agrees with population estimates from the U.S. Census Bureau. We analyzed 2010 BRFSS data from all states that included items on health care access, health status, alcohol consumption, and tobacco use. In addition, respondents from 13 states completed items on depression and anxiety. A total of 451,075 adults completed the 2010 survey.
Respondents were asked whether they had “ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit.” Among 28,183 men and women surveyed between the ages of 19 and 30, 42 were missing data on military status. Because of the 12-month time frame for measures of health care access and utilization, we excluded respondents who reported “current active duty” (N=315), “active duty within the past 12 months but not currently” (N=169), and “service in the National Guard or Reserves” (N=186). The final sample was 27,471 respondents categorized into two groups: veteran (631 endorsed “active duty in the past but not during the last 12 months”) and civilian (26,840 endorsed “never served in the military”). Study approval was obtained from the VA Puget Sound Institutional Review Board.
Measures
Demographic characteristics.
The BRFSS collects self-reported age, race and ethnicity, marital status, education, employment status, and income. To create a variable reflecting where respondents lived, we grouped states into Census Bureau Regions (Northeast, Midwest, South, and West) by their Federal Information Processing Standard codes, and we grouped participants living in Guam, Puerto Rico, and the Virgin Islands into an “Islands” region.
Health care access and utilization.
Respondents were asked whether they had any kind of health care coverage (such as health insurance or Medicare) and whether there was a time in the past 12 months when they needed to see a physician but could not because of cost. Respondents reported whether they had a personal physician or health care provider and how much time had elapsed since they visited a physician for a routine checkup (within the past year or more than one year). Eligibility and enrollment in VA care were not assessed in the 2010 BRFSS.
General medical health and mental distress.
Poor general medical health and mental distress were assessed with two items: number of days of poor general medical health in the past 30 days and number of days of mental distress in the past 30 days. Consistent with a recent BRFSS study validating the use of a six-day cutoff point (32), poor general medical health and mental distress were dichotomized (six or more days versus fewer than six days).
Respondents were asked whether a health care provider ever told them they had a depressive disorder (such as major depression) or an anxiety disorder (such as generalized anxiety disorder or PTSD). Overweight and obesity status were derived by calculating body mass index (BMI) based on self-reported height and weight: normal weight (BMI <25 kg/m2) and overweight or obese (BMI ≥25 kg/m2) (33). Respondents indicated whether they exercised regularly in the past month, defined as physical activity or exercise outside of regular job duties.
Health risk behaviors.
Respondents reported whether they had engaged in the following behaviors: smoking and other tobacco use (currently smoking or using tobacco at least some days in past month), binge drinking (four or more drinks for women and five or more drinks for men at least once during the past month), heavy drinking (one or more drinks for women and two or more drinks for men per day in the past month), drinking and driving in the past month, HIV/AIDS risk behaviors (injection drug use or unprotected sex in the past year), and lack of seat belt use (not always using a seat belt when driving or riding in a car).
Data analysis
Analyses were performed in Stata/IC version 11.2 (34) and accounted for survey design and weighted sampling probabilities. Respondents with missing data on income were included in a separate income category (35). Descriptive statistics, stratified by gender, were used to compare veterans and civilians on demographic characteristics and health indicators; t tests compared means, and chi square tests compared proportions. Multivariable logistic regression was used to generate odds ratios and 95% confidence intervals for health indicators to identify main effects and the interaction of gender and veteran status, with adjustment for sociodemographic characteristics.
Results
Sample characteristics
We identified 631 veterans (74.6% were male, N=471) and 26,840 civilians (37.6% were male, N=10,080) ages 19 to 30. Weighted proportions of sociodemographic characteristics are presented by gender for veterans and civilians in Table 1. Compared with civilian counterparts, veterans were older, more likely to be married or partnered, and more likely to have graduated from high school or to have a GED but were less likely to have completed college.
| Men | Women | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Veterans | Civilians | Veterans | Civilians | |||||||
| (N=471) | (N=10,080) | (N=160) | (N=16,760) | |||||||
| Variable | N | % | N | % | p | N | % | N | % | p |
| Age (M±SD) | 27.1±2.5 | 25.0±3.7 | <.001 | 27.3±2.6 | 25.8±3.4 | <.001 | ||||
| Race and ethnicity | ns | <.001 | ||||||||
| White, non-Hispanic | 325 | 61.2 | 6,527 | 56.3 | 99 | 59.8 | 10,277 | 57.1 | ||
| Black, non-Hispanic | 39 | 14.3 | 927 | 10.5 | 30 | 18.5 | 2,156 | 11.8 | ||
| Asian | 29 | 6.6 | 787 | 8.5 | 4 | .8 | 1,057 | 6.7 | ||
| Hispanic | 21 | 2.3 | 281 | 2.3 | 7 | 1.7 | 463 | 2.4 | ||
| Multiracial | 49 | 15.6 | 1,449 | 22.4 | 19 | 19.2 | 2,674 | 22.0 | ||
| Married or partnered | 217 | 47.2 | 3,059 | 24.6 | <.001 | 88 | 60.0 | 7,113 | 37.0 | <.001 |
| Currently employed | 335 | 65.4 | 6,789 | 63.2 | ns | 70 | 35.7 | 9,312 | 52.9 | <.001 |
| Education | <.001 | <.001 | ||||||||
| <High school diploma or GED | 12 | 1.4 | 1,107 | 11.6 | 1 | .3 | 1,659 | 10.1 | ||
| High school diploma or GED | 177 | 35.8 | 3,480 | 34.2 | 32 | 28.8 | 4,582 | 26.2 | ||
| 1–3 years of college | 195 | 44.1 | 3,039 | 31.1 | 81 | 48.5 | 5,449 | 34.7 | ||
| ≥4 years of college | 84 | 18.7 | 2,430 | 23.0 | 46 | 22.4 | 5,033 | 29.1 | ||
| Incomeb | <.001 | <.001 | ||||||||
| <$15,000 | 41 | 11.1 | 1,058 | 11.1 | 19 | 8.6 | 2,371 | 14.8 | ||
| $15,000 to <$25,000 | 85 | 17.3 | 1,756 | 17.3 | 32 | 26.5 | 3,116 | 17.4 | ||
| $25,000 to <$35,000 | 72 | 16.4 | 1,058 | 9.5 | 19 | 10.6 | 1,873 | 10.4 | ||
| $35,000 to <$50,000 | 80 | 17.2 | 1,235 | 10.6 | 29 | 19.7 | 2,142 | 11.4 | ||
| ≥$50,000 | 143 | 28.2 | 3,219 | 32.9 | 52 | 30.5 | 4,763 | 29.7 | ||
| Region | ns | ns | ||||||||
| Northeast | 80 | 19.4 | 1,740 | 16.0 | 20 | 12.2 | 2,931 | 15.9 | ||
| Midwest | 83 | 16.6 | 2,103 | 22.0 | 30 | 30.0 | 3,204 | 21.7 | ||
| South | 163 | 40.8 | 3,189 | 33.2 | 68 | 39.3 | 6,022 | 33.5 | ||
| West | 137 | 22.0 | 2,802 | 26.8 | 41 | 18.5 | 4,273 | 27.0 | ||
| Islands | 8 | 1.2 | 246 | 2.0 | 1 | .1 | 330 | 1.8 | ||
a
Source: 2010 Behavioral Risk Factor Surveillance System. Means were compared by t tests, and proportions were compared by chi square tests.
b
Data were missing for 15.7% of respondents.
Health care access and utilization
Weighted proportions for health care access and utilization according to veteran status are presented in Table 2. Among men, veterans were more likely than civilians to have health insurance, although no significant differences were found in health care utilization. Female veterans and civilians did not differ on rates of health insurance coverage or health care utilization. Veteran status was not associated with differences in financial barriers to receiving health care for either men or women.
| Men | Women | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Veterans | Civilians | Veterans | Civilians | |||||||
| (N=471) | (N=10,080) | (N=160) | (N=16,760) | |||||||
| Variable | % | SE | % | SE | p | % | SE | % | SE | p |
| Health care access and utilization | ||||||||||
| Health insurance coverage | 73.3 | .032 | 66.3 | .008 | <.05 | 80.7 | .042 | 74.4 | .006 | ns |
| Regular health care provider | 52.4 | .039 | 54.9 | .008 | ns | 76.3 | .047 | 72.1 | .006 | ns |
| Routine checkup, prior year | 50.9 | .039 | 46.8 | .008 | ns | 61.8 | .058 | 62.0 | .006 | ns |
| Financial barrier to care | 21.3 | .028 | 20.0 | .007 | ns | 20.8 | .047 | 24.5 | .006 | ns |
| General medical and mental health status | ||||||||||
| Frequent poor general health | 19.3 | .031 | 9.5 | .005 | <.001 | 21.0 | .047 | 12.2 | .004 | <.05 |
| Frequent mental distress | 24.6 | .038 | 17.2 | .007 | <.05 | 22.6 | .047 | 21.8 | .006 | ns |
| Depressive disorder | 30.6 | .076 | 11.2 | .012 | <.001 | 33.9 | .115 | 20.4 | .012 | ns |
| Anxiety disorder | 25.7 | .072 | 9.9 | .011 | <.01 | 52.2 | .269 | 18.1 | .011 | <.001 |
| Overweight or obese | 71.4 | .033 | 56.2 | .007 | <.05 | 62.2 | .055 | 47.7 | .007 | <.01 |
| Regular exercise | 85.7 | .023 | 81.8 | .006 | ns | 75.9 | .047 | 77.8 | .005 | ns |
| Health risk behavior | ||||||||||
| Binge drinking | 37.3 | .041 | 32.1 | .008 | ns | 22.9 | .057 | 18.2 | .005 | ns |
| Heavy drinking | 8.4 | .020 | 7.5 | .005 | ns | 4.3 | .021 | 4.9 | .003 | ns |
| Drinking and driving | 5.3 | .015 | 4.2 | .003 | ns | 3.1 | .019 | 1.8 | .002 | ns |
| Current smoker | 36.1 | .039 | 26.8 | .007 | <.01 | 26.6 | .047 | 18.2 | .005 | <.05 |
| Tobacco use (excluding smoking) | 12.3 | .021 | 7.5 | .004 | <.001 | 2.4 | .014 | 1.1 | .001 | ns |
| Injection drug use or unprotected sex | 6.7 | .018 | 6.6 | .004 | ns | 8.9 | .030 | 6.8 | .004 | ns |
| Seat belt use | 78.9 | .033 | 75.8 | .007 | ns | 85.8 | .045 | 85.8 | .004 | ns |
a
Source: 2010 Behavioral Risk Factor Surveillance System. Weighted proportions were compared by chi square tests.
General medical and mental health
Compared with their civilian counterparts, veterans were more likely to report poor general medical health in the past month and were more likely to be overweight or obese (Table 2). Male veterans had higher rates of lifetime depression and anxiety disorders than civilian men. Among women, veterans had significantly higher rates of anxiety disorders than civilians and had higher absolute rates of depression (33.9% versus 20.4%), but the difference for the latter was not statistically significant.
Health risk behaviors
Male and female veterans had higher rates of current smoking compared with civilians (Table 2). No differences between men and women were found in rates of the other health risk behaviors for veterans and their civilian counterparts.
Adjusted analyses of health outcomes
Table 3 presents findings from multivariate logistic regression models testing the main effects and interaction of veteran status and gender with adjustment for sociodemographic covariates.
| Men | Veterans | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| (referent: women) | (referent: civilians) | Gender × veteran status | |||||||
| Variable | AOR | 95% CI | p | AOR | 95% CI | p | AOR | 95% CI | p |
| Health care access and utilization | |||||||||
| Health insurance coverage | .68 | .61–.76 | <.001 | 1.38 | .83–2.28 | ns | .95 | .52–1.73 | ns |
| Regular health care provider | .45 | .41–.50 | <.001 | 1.15 | .68–1.94 | ns | .74 | .40–1.36 | ns |
| Routine checkup, prior year | .54 | .49–.59 | <.001 | .99 | .60–1.63 | ns | .48 | .68–2.24 | ns |
| Financial barrier to care | .75 | .67–.84 | <.001 | .74 | .43–1.28 | ns | 1.32 | .69–2.51 | ns |
| General medical and mental health status | |||||||||
| Frequent poor general health | .75 | .65–.86 | <.001 | 1.93 | 1.08–3.45 | <.05 | 1.18 | .58–2.39 | ns |
| Frequent mental distress | .70 | .63–.79 | <.001 | 1.10 | .64–1.91 | ns | 1.54 | .77–3.08 | ns |
| Depressive disorder | .45 | .34–.60 | <.001 | 2.13 | .72–6.31 | ns | 1.63 | .40–6.62 | ns |
| Anxiety disorder | .47 | .35–.63 | <.001 | 5.60 | 1.70–18.3 | <.001 | .56 | .13–2.50 | ns |
| Overweight or obese | 1.52 | 1.39–1.66 | <.001 | 1.33 | .81–2.16 | ns | 1.07 | .59–1.92 | ns |
| Regular exercise | 1.31 | 1.18–1.46 | <.001 | .92 | .55–1.55 | ns | 1.62 | .83–3.14 | ns |
| Health risk behavior | |||||||||
| Binge drinking | 2.07 | 1.86–2.30 | <.001 | 1.43 | .77–2.67 | ns | .96 | .45–2.03 | ns |
| Heavy drinking | 1.41 | 1.17–1.70 | <.001 | .94 | .35–2.52 | ns | 1.28 | .41–3.97 | ns |
| Drinking and driving | 2.16 | 1.67–2.79 | <.001 | 1.93 | .54–6.96 | ns | .65 | .16–2.68 | ns |
| Current smoker | 1.54 | 1.39–1.71 | <.001 | 1.62 | .98–2.68 | ns | .89 | .47–1.67 | ns |
| Tobacco use (excluding smoking) | 7.46 | 5.63–9.88 | <.001 | 2.30 | .69–7.66 | ns | .71 | .20–2.51 | ns |
| Injection drug use or unprotected sex | .89 | .75–1.05 | ns | 1.44 | .68–3.05 | ns | .83 | .32–2.15 | ns |
| Seat belt use | .55 | .49–.61 | <.001 | .97 | .49–1.95 | ns | 1.13 | .51–2.52 | ns |
a
Source: 2010 Behavioral Risk Factor Surveillance System. AOR, adjusted odds ratio. Multivariate logistic regression models were adjusted for race-ethnicity, education, income, marital status, and region.
Health care access and utilization.
There were main effects for gender predicting health care access and utilization. Women were more likely than men to have insurance and to have had a routine checkup and a regular provider in the past year. Women were more likely than men to report not being able to see a provider due to cost. There were no main effects for veteran status or interactions between veteran status and gender.
General medical and mental health.
Main effects for gender indicated that women were more likely than men to report frequent poor general health, frequent mental distress, and lifetime depression or anxiety disorder. Although men were more likely than women to report having exercised in the past month, men were more likely to be overweight or obese. Main effects for veteran status indicated that veterans had poorer general health and were more likely than civilians to have a lifetime anxiety disorder. There were no two-way interactions between veteran status and gender.
Health risk behaviors.
Compared with women, men were more likely to report binge-drinking, heavy drinking, drinking and driving, smoking, and tobacco use, and less likely to always to wear a seat belt. There were no main effects for veteran status or interactions between veteran status and gender.
Discussion
This study sought to provide population-based estimates of health risk behaviors and health care access and utilization in a representative sample of adult veterans and civilians ages 19–30. Given the lack of preventive care guidelines for young adults (8), identification of health disparities within this group informs the provision of care. Notable gender differences were identified across measures of health care access, utilization, and health status among the overall sample of young adults. Targeted outreach efforts may need to account for barriers to health care access and utilization that may differ for young adult men and women. Although women had higher rates of insurance coverage and health care utilization than men in our sample, women reported greater financial barriers to receiving care. Young adult women may be unable to access needed care due to competing school, work, and family demands (36). With regard to young adult men, lower rates of health care utilization in conjunction with greater risk-taking behaviors compared with women may reflect men’s negative attitudes and stigma toward help seeking or perceived invulnerability to health consequences (37).
After analyses adjusted for sociodemographic factors, veterans had poorer general health and higher rates of lifetime anxiety disorders compared with civilians. Exposure to trauma and military-related stress heightens the risk of experiencing comorbid psychiatric and general medical symptoms, particularly in the context of PTSD (38,39). Moreover, approximately one-third of veterans had a diagnosed depressive disorder. With research suggesting that rates of severe psychiatric distress and suicide peak during young adulthood, these findings support extending mental health assessment and early intervention efforts beyond the VA health system to other health care settings that serve veterans (37). Contrary to expectations, being a veteran (versus a civilian) was not associated with higher rates of hazardous alcohol use and drinking and driving. Although prior work suggests higher rates of heavy drinking among military service members compared with civilians (40), our findings highlight the importance of accounting for age, in addition to gender, when evaluating the association between veteran status and alcohol use (23). Veterans in our sample were older and more likely than civilian counterparts to be married or partnered, which may serve as protective factors for hazardous drinking (41,42). It is also possible that heavy drinking among military personnel represents a temporary escalation that upon transition to veteran status returns to levels more similar to the general young adult population.
Most health care studies of veterans have used health care utilization information captured from VA databases, thereby selecting treatment-seeking patients who may have poorer health compared with nonusers of VA health care services (43). Our finding that young adult veterans had poorer general health compared with their civilian peers suggests that veteran health disparities extend beyond those seeking VA services. Although these data did not include a measure of VA and non-VA health care utilization, our results underscore the need for clinicians to be cognizant of the mental and general medical problems affecting young adult veterans within and outside of the VA health care system. Despite these disparities in health status, rates of health care access and utilization did not differ between young adult veterans and civilians in adjusted analyses. In light of the availability of VA care at no cost to most veterans for five years after separating from military service in Afghanistan or Iraq, we expected veterans to report greater health care utilization compared with civilians. Thus the VA may need to further address patient- and system-level barriers to utilization of VA services for young adult veterans.
A number of challenges impede the delivery of evidence-based preventive care (8). A recent study using a national sample of U.S. young adults found that an estimated 70% of visits to primary care providers did not include preventive care counseling; of particular concern were low rates of screening for mental problems, substance use, STIs, frequency of exercise, and obesity (2). The use of clinical decision-making support tools for screening high-risk behaviors within primary care settings may assist providers faced with competing time demands (44,45) and allow for more targeted prevention approaches for young adult men, who appear to be particularly at risk for engaging in such behaviors regardless of veteran status. For example, Web-based behavioral health screening tools that recommend brief interventions depending on the results of screening may be particularly useful for young adults in busy primary care settings (46,47) and have been associated with patients’ self-reported knowledge gains and improved health outcomes (in regard to obesity and smoking, for example) (48). Other innovative technologies to support self-management of substance use and mental health problems among veterans include the VA Web site “My HealtheVet” in addition to smartphone applications such as PTSD Coach from the U.S. Department of Defense and the National Center for Telehealth and Technology (49).
Our study had several limitations. The cross-sectional nature of the BRFSS precludes evaluation of temporal relationships between health risk behaviors and health care utilization in relationship to veteran status. Longitudinal studies are necessary to evaluate health conditions before and after deployment and before and after other related developmental milestones, such as leaving home for the first time. In addition, the number of female veterans in the sample was relatively low, potentially limiting power to detect statistically significant differences between female veterans and civilians that may be clinically important, highlighting the need for prospective studies that include larger numbers of female veterans. Only a select number of states included BRFSS items assessing psychiatric issues, so those results should be interpreted with caution. The BRFSS also relies on single-item, self-reported measures, thus preventing a more thorough assessment of general medical and mental health conditions. Finally, rates of health care access and utilization reported in this study may underestimate current rates among U.S. young adults, because 2010 BRFSS data were collected before the recent implementation of the Affordable Care Act that now enables young adults to remain on their parents’ health insurance plan until age 26. As a result, greater numbers of young adults have coverage, and additional provisions of this law will likely increase utilization, including expanded coverage of screening services for young adults and greater funding for programs targeting health promotion and preventive care for young adults.
Conclusions
Strengths of this research include use of a U.S. population–based data set, assessment of multiple health indicators, and inclusion of both young adult veterans and civilians. Findings suggesting differences across veteran status and gender on chronic health risk factors—namely general medical and mental health problems, tobacco use, and being overweight or obese—may inform providers’ and policy makers’ efforts to improve young adults’ engagement in care, particularly those engaging in health risk behaviors. Results highlight the need for innovative outreach programs tailored to the needs of young adult veterans and civilians.
Acknowledgments and disclosures
This work was supported by grant TP 61-025 from the VA Puget Sound Health Services Research and Development Postdoctoral Fellowship Program. This article is the result of work supported by resources from the VA Puget Sound Health Care System. The views expressed in this article are those of the authors and do not necessarily reflect the views of the Department of Veterans Affairs.
The authors report no competing interests.
References
1.
Callahan ST, Cooper WO: Changes in ambulatory health care use during the transition to young adulthood. Journal of Adolescent Health 46:407–413, 2010
2.
Fortuna RJ, Robbins BW, Halterman JS: Ambulatory care among young adults in the United States. Annals of Internal Medicine 151:379–385, 2009
3.
Park MJ, Mulye TP, Adams SH, et al.: The health status of young adults in the United States. Journal of Adolescent Health 39:305–317, 2006
4.
Helping Patients Who Drink Too Much: A Clinician’s Guide (Updated 2005 Edition). NIH pub no 07-3769. Washington, DC, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 2007
5.
Kulig JW: Tobacco, alcohol, and other drugs: the role of the pediatrician in prevention, identification, and management of substance abuse. Pediatrics 115:816–821, 2005
6.
Healthy People 2010 Final Review. Atlanta, Ga, Centers for Disease Control and Prevention. Available at www.cdc.gov/nchs/data/hpdata2010/hp2010_final_review.pdf. Accessed April 7, 2012
7.
Marshall EG: Do young adults have unmet healthcare needs? Journal of Adolescent Health 49:490–497, 2011
8.
Ozer EM, Urquhart JT, Brindis CD, et al.: Young adult preventive health care guidelines: there but can’t be found. Archives of Pediatrics and Adolescent Medicine 166:240–247, 2012
9.
Ryan BL, Stewart M, Campbell MK, et al: Understanding adolescent and young adult use of family physician services: a cross-sectional analysis of the Canadian Community Health Survey. BMC Family Practice 12:118, 2011
10.
Park MJ, Brindis CD, Chang F, et al.: A midcourse review of the Healthy People 2010: 21 critical health objectives for adolescents and young adults. Journal of Adolescent Health 42:329–334, 2008
11.
Brown DW: Smoking prevalence among US veterans. Journal of General Internal Medicine 25:147–149, 2010
12.
Vogt D, Vaughn R, Glickman ME, et al.: Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of US OEF/OIF veterans. Journal of Abnormal Psychology 120:797–806, 2011
13.
Widome R, Kehle SM, Carlson KF, et al. Post-traumatic stress disorder and health risk behaviors among Afghanistan and Iraq War veterans attending college. American Journal of Health Behavior 35:387–392, 2011
14.
Eisen SV, Schultz MR, Vogt D, et al.: Mental and physical health status and alcohol and drug use following return from deployment to Iraq or Afghanistan. American Journal of Public Health 102(suppl 1):S66–S73, 2012
15.
Haskell SG, Gordon KS, Mattocks K, et al.: Gender differences in rates of depression, PTSD, pain, obesity, and military sexual trauma among Connecticut war veterans of Iraq and Afghanistan. Journal of Women’s Health 19:267–271, 2010
16.
Nelson KM: The burden of obesity among a national probability sample of veterans. Journal of General Internal Medicine 21:915–919, 2006
17.
Seal KH, Cohen G, Waldrop A, et al.: Substance use disorders in Iraq and Afghanistan veterans in VA healthcare, 2001–2010: implications for screening, diagnosis and treatment. Drug and Alcohol Dependence 116:93–101, 2011
18.
Fasoli DR, Glickman ME, Eisen SV: Predisposing characteristics, enabling resources and need as predictors of utilization and clinical outcomes for veterans receiving mental health services. Medical Care 48:288–295, 2010
19.
Hoge CW, Castro CA, Messer SC, et al.: Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351:13–22, 2004
20.
Mojtabai R, Olfson M, Mechanic D: Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Archives of General Psychiatry 59:77–84, 2002
21.
Summary of Findings From the 2000 National Household Survey on Drug Abuse. SMA 01-3549. Rockville, Md, Substance Abuse and Mental Health Services Administration, 2001
22.
Hoerster KD, Lehavot K, Simpson T, et al.: Health and health behavior differences: US military, veteran, and civilian men. American Journal of Preventive Medicine 43:483–489, 2012
23.
Bohnert ASB, Ilgen MA, Bossarte RM, et al.: Veteran status and alcohol use in men in the United States. Military Medicine 177:198–203, 2012
24.
Barber J, Bayer L, Pietrzak RH, et al.: Assessment of rates of overweight and obesity and symptoms of posttraumatic stress disorder and depression in a sample of Operation Enduring Freedom/Operation Iraqi Freedom veterans. Military Medicine 176:151–155, 2011
25.
Jacobson IG, Ryan MAK, Hooper TI, et al.: Alcohol use and alcohol-related problems before and after military combat deployment. JAMA 300:663–675, 2008
26.
Kelley AM, Athy JR, Cho TH, et al.: Risk propensity and health risk behaviors in US army soldiers with and without psychological disturbances across the deployment cycle. Journal of Psychiatric Research 46:582–589, 2012
27.
Thomsen CJ, Stander VA, McWhorter SK, et al.: Effects of combat deployment on risky and self-destructive behavior among active duty military personnel. Journal of Psychiatric Research 45:1321–1331, 2011
28.
Dichter ME, Cerulli C, Bossarte RM: Intimate partner violence victimization among women veterans and associated heart health risks. Women’s Health Issues 21(suppl):S190–S194, 2011
29.
Lehavot K, Hoerster KD, Nelson KM, et al.: Health indicators for military, veteran, and civilian women. American Journal of Preventive Medicine 42:473–480, 2012
30.
Ross JS, Keyhani S, Keenan PS, et al.: Use of recommended ambulatory care services: is the Veterans Affairs quality gap narrowing? Archives of Internal Medicine 168:950–958, 2008
31.
Behavioral Risk Factor Surveillance System (BRFSS) Survey Data. Atlanta, Ga, Centers for Disease Control and Prevention. Available at www.cdc.gov/brfss/technical_infodata/surveydata.htm. Accessed March 6, 2012
32.
Bossarte RM, He H, Claassen CA, et al.: Development and validation of a 6-day standard for the identification of frequent mental distress. Social Psychiatry and Psychiatric Epidemiology 46:403–411, 2011
33.
Assessing Your Weight and Health Risk: Body Mass Index. Bethesda, Md, National Heart Lung and Blood Institute. Available at www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/risk.htm. Accessed April 7, 2012
34.
Stata Statistical Software: Release 11. College Station, Tex, Stata Corp, 2009
35.
Buchmueller T, Carpenter CS: Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. American Journal of Public Health 100:489–495, 2010
36.
Maguen S, Ren L, Bosch JO, et al.: Gender differences in mental health diagnoses among Iraq and Afghanistan veterans enrolled in Veterans Affairs health care. American Journal of Public Health 100:2450–2456, 2010
37.
Eisenberg D, Downs MF, Golberstein E, et al.: Stigma and help seeking for mental health among college students. Medical Care Research and Review 66:522–541, 2009
38.
Cohen BE, Marmar C, Ren L, et al.: Association of cardiovascular risk factors with mental health diagnoses in Iraq and Afghanistan war veterans using VA health care. JAMA 302:489–492, 2009
39.
Schnurr PP, Spiro A, Paris AH: Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans. Health Psychology 19:91–97, 2000
40.
Bray RM, Hourani LL: Substance use trends among active duty military personnel: findings from the United States Department of Defense Health Related Behavior Surveys, 1980–2005. Addiction 102:1092–1101, 2007
41.
Leonard KE, Eiden RD: Marital and family processes in the context of alcohol use and alcohol disorders; in Annual Review of Clinical Psychology. Palo Alto, Calif, Annual Reviews, 2007
42.
Muthén BO, Muthén LK: The development of heavy drinking and alcohol-related problems from ages 18 to 37 in a US national sample. Journal of Studies on Alcohol 61:290–300, 2000
43.
Agha Z, Lofgren RP, VanRuiswyk JV, et al.: Are patients at Veterans Affairs medical centers sicker? A comparative analysis of health status and medical resource use. Archives of Internal Medicine 160:3252–3257, 2000
44.
Buckelew SM, Adams SH, Irwin CE, et al.: Increasing clinician self-efficacy for screening and counseling adolescents for risky health behaviors: results of an intervention. Journal of Adolescent Health 43:198–200, 2008
45.
Ozer EM, Adams SH, Lustig JL, et al.: Increasing the screening and counseling of adolescents for risky health behaviors: a primary care intervention. Pediatrics 115:960–968, 2005
46.
Amstadter AB, Broman-Fulks J, Zinzow H, et al.: Internet-based interventions for traumatic stress-related mental health problems: a review and suggestion for future research. Clinical Psychology Review 29:410–420, 2009
47.
Cucciare MA, Darrow M, Weingardt KR: Characterizing binge drinking among US military veterans receiving a brief alcohol intervention. Addictive Behaviors 36:362–367, 2011
48.
Nguyen B, Kornman KP, Baur LA: A review of electronic interventions for prevention and treatment of overweight and obesity in young people. Obesity Reviews 12:e298–e314, 2011
49.
Seal KH, McCaslin SE, McCamish N, et al: Can motivational interviewing engage mental health treatment engagement in Iraq and Afghanistan veterans? Presented at the annual meeting of the Society of General Internal Medicine, Minneapolis, Minn, April 28–May 1, 2010
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Cover: Sir Charles, Alias Willie Harris, by Barkley Leonnard Hendricks, 1972. Oil on canvas. William C. Whitney Foundation, 1973.19.1. National Gallery of Art, Washington, D.C.
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Published in print: June 2013
Published online: 15 October 2014
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