In an online-only, open access special issue of the American Journal of Public Health, researchers investigate issues of health equity, quality and disparities within the Veterans Affairs health care system.
"As one of the largest integrated health care systems, we are reminded of access and quality in our mission statement daily - 'to care for him who shall have borne the battle and or his widow, and his orphan.' Yet, we have realized that some veterans, especially those having characteristics linked to social discrimination and exclusion, continue to experience disparities in access and equitable care," wrote Robert Jesse, MD, PhD, former acting under secretary for health of the Veterans Health Administration.
"Any lapse in care quality, access or equity is antithetical to our duty to those who have served to protect our freedoms; it is simply not who we are as an organization."
Accompanying the 11 research papers are a collection of editorials and briefs taking on topics including, gender disparities, race and genomics, social determinants of health equity and transgender veteran care.
Papers from this issue will be freely available online Aug. 6, 2014 at 12 p.m. EDT.
Highlights from the special issue of the American Journal of Public Health include:
1.Veterans show increase in making homes smoke-free, yet still lag behind civilians
2.Racial disparities observed among cancer patients receiving care in VA health care system
3.Suicidal ideation and mental distress correlated with individuals in midlife with military history
Veterans show increase in making homes smoke-free, yet still lag behind civilians
New research from the American Journal of Public Health finds that veterans, though showing an increase between 2001 and 2011, still lag behind non-veterans in voluntarily adopting smoke-free rules in their home. Over this period of time, the disparity between veteran and non-veteran smoke-free rule adoption has also widened.
Using data from the 2001-2002 and 2010-2011 Tobacco Use Supplement to the Current Population Survey, researchers analyzed patterns of veterans adopting smoke-free home rules between 2001 and 2011. Smoke-free home rules, denoted as rules voluntarily made by the inhabitants of a household or landlord, were defined as a respondent indicating that "no one is allowed to smoke anywhere inside [their] home" within this study.
Results from the study indicated that veterans have shown an increase in adopting smoke-free home rules between 2001 and 2011, from 64 percent of veterans to 79.7 percent. This increase, however, does not match the smoke-free home patterns of non-veterans who have shown an increase from 67.6 percent with smoke-free homes in 2001 to 84.4 percent in 2011. In addition, prevalence of smoking among veterans was found to be higher and smoking veterans were found to smoke more heavily than non-veterans who smoke.
"Because of high rates of smoking and sub-optimal rates of smoke-free home rules, we recommend that all Department of Veteran Affairs patients be screened for smoke-free home rule status and counseled to establish complete smoke-free home rules, especially those from smoker households," the study suggests.
Racial disparities observed among cancer patients receiving care in VA health care system
New research from the American Journal of Public Health finds the presence of racial disparities in cancer care and outcomes among black and white veterans receiving cancer care for within the Veterans Affairs health care system.
Researchers reviewed data from the VA Central Cancer Registry from 2001 to 2004 along with VA administrative data from 2000 to 2005. They also used 2000 Census data and information from the National Death Index through 2005. The VA cancer patients spanned 118 VA medical centers in which the study assessed 20 cancer-related process and outcome measures to investigate potential racial disparities between white and black veteran cancer patients.
Results showed that for 13 of the 20 quality measures, black and white patients received similar care. However, for seven of the 20 measures, racial disparities existed in which blacks received lower quality of care. Measures affected by racial disparities included blacks with lower rates of early-stage colon cancer diagnosis, three-year survival for colon and rectal cancer, curative surgery for early stage lung cancer and stage I, II and III rectal cancer, among other measures.
"Past research indicates that racial/ethnic disparities in care and outcomes exist for many conditions, but that these disparities are attenuated in the Veterans Affairs health care system," the authors explain.
"Future efforts should focus on understanding the sources of these within-hospital disparities. However, differential patterns in the adoption of new technologies and use of medications across VA hospitals are potential sources of cancer disparities that deserve further exploration," they conclude.
Individuals in midlife with military history may be at greater risk for suicidal ideation and mental distress
Military service history is associated with suicidal ideation and mental distress among individuals aged 40 to 64, according to new research from the American Journal of Public Health.
Researchers reviewed data from the Centers for Disease Control and Prevention's 2010 Behavioral Risk Factor Surveillance System including data from five states that inquired about past-year suicidal ideation in 2010 accounting for a sample size of 26,685 people. The study sought to examine the prevalence of suicidal ideation and mental distress among adults with a history of military service.
Results from the study indicated that mental distress and past year suicidal ideation were correlated with military service history among individuals aged 40-64 years old.
"Reasons for an increased prevalence of past-year suicidal ideation among individuals with military experience in midlife (ages 40-64) are unclear. It may possibly be a phenomenon linked with a cohort effect, a service era effect or both," the study suggests.
Find a full list of papers to be published online on Aug. 6, 2014, at 12 p.m. below:
•Advancing the Elimination of Health Disparities in Veterans through Quality, Access, and Equity
•Institutional Journey in Pursuit of Health Equity: Veterans Health Administration's Office of Health Equity
•The Struggle for Health Equity: The Sustained Effort by the VA Healthcare System
•Editorial - Social Determinants of health Equity
•Partnership, Research, and Leadership to Advance Health Equity and Eliminate Health Disparities
•Race and genomics in the Veterans Health Administration
•Health Equity Research in the Veterans Health Administration -- We've Come Far But Aren't There Yet
•Excellence and Equality in Health Care
•Improving Trends in Gender Disparities in the Department of Veterans Affairs: 2008-2013
•Access to Care for Transgender Veterans in VHA: 2006-2013
•Suicidality among veterans: Implications of sexual minority status
•Asian American and Pacific Islander military veterans in the United States: Health service use and perceived barriers to mental health services
•Understanding How to Enhance the Provision of Culturally Competent Services for American Indian and Alaska Native Veterans to Address Health Care Disparities
•Impact of Race/Ethnicity and Sex on Hepatitis C Virus Screening and Prevalence among US Veterans in Department of Veterans Affairs Care
•Racial Disparities in Cancer Care in the Veterans Affairs Healthcare System and the Role of Site of Care
•Battling Tobacco Use at Home: An Analysis of Smoke-free Home Rules among U.S. Veterans from 2001 to 2011
•Smoking cessation among African American and White smokers in the Veterans Affairs Healthcare System
•Retaining homeless veterans in outpatient care: A pilot study of mobile phone text message appointment reminders
•Suicidal ideation and mental distress among adults with military service history:Results from 5 U.S. states, 2010
•Prevalence of Suicidality among Hispanic and African-American Veterans Following Surgery
•Can we address population health and health inequalities without addressing fundamental causes? An in-silico experiment
•Feasibility and Effectiveness of a Community-based Smoking Cessation Intervention in a Racially Diverse, Urban Smoker Cohort
American Public Health Association