Substance Use Disorder Treatment Services for Women in the Veterans Health Administration

PurposeThe present study used national Veterans Health Administration (VHA) facility-level data to examine the extent of women's specialty substance use disorder (SUD) treatment programming in the VHA. In addition, the study compared facilities with women's specialty SUD programming with facilities without to determine whether having this programming was associated with serving other special patient populations, treatment staffing, and breadth of service provision.MethodsThe study used data from the VHA Program Evaluation and Resource Center's Drug and Alcohol Program Survey, conducted in 2015 (100% response rate among VHA specialty SUD treatment programs). Program responses were calculated at the facility level (n = 140 VHA facilities).Main FindingsThe majority of VHA facilities (85%) provided women veterans with SUD-specific individual psychotherapy. However, only 30% of facilities provided SUD-specific groups for women only, and only 14% provided SUD–posttraumatic stress disorder groups for women only in specialty SUD treatment. VHA facilities with greater numbers of specialty SUD treatment staff members, a greater breadth of staff roles, and a broader scope of treatment services, activities, and practices were more likely to provide women-only groups.ConclusionsBecause the number of women veterans in specialty SUD treatment is likely to continue to grow, these data serve as a benchmark against which future administrations of the Drug and Alcohol Program Survey will document the extent to which VHA services are responsive to their needs.     

Emotion Dysregulation Predicts Dropout from Prolonged Exposure Treatment among Women Veterans with Military Sexual Trauma-Related Posttraumatic Stress Disorder

BackgroundMilitary sexual trauma (MST) is notably prevalent among military personnel and can result in mental and physical health problems, including post-traumatic stress disorder (PTSD). Although there are several evidence-based treatments for MST-related PTSD, including prolonged exposure (PE) therapy, it is unclear what factors are associated with premature termination (i.e., dropout) from this treatment. Given the popularity of PE as an evidence-based treatment for PTSD, the examination of variables that influence dropout from PE among women veterans with MST is warranted. Identification of these specific factors may assist clinicians in addressing the unique symptom profiles and potential barriers to treatment access for individual MST survivors.MethodsThe current study presents secondary data analyses from an ongoing randomized clinical trial that compared the effectiveness of PE delivered in person to delivery via telemedicine for women veterans with MST-related PTSD (n = 136).ResultsA total of 50% of participants dropped out from the study (n = 68). Difficulties with emotion regulation at baseline were associated with treatment dropout (odds ratio, 1.03; p < .01), whereas baseline PTSD and demographic factors were not.ConclusionsFindings from the current study indicate that emotion regulation skills deficits contribute to PE dropout and may be an appropriate target to address in future clinical trials for PTSD treatment.     

Psychotherapy Utilization,Preferences, and Retention among Women Veterans with Post-traumatic Stress Disorder

BackgroundPsychotherapy is the gold standard treatment for post-traumatic stress disorder (PTSD), yet psychotherapy use and retention among veterans is low. Little is known about the barriers to care and factors associated with women veterans' PTSD psychotherapy use and retention. Using a nationally representative sample of 986 women Veterans Health Administration primary care users with PTSD and a perceived need for mental health care, we examined 1) the proportion of women who used psychotherapy, 2) retention in psychotherapy among women who used any psychotherapy, and 3) individual factors related to psychotherapy use and retention.MethodsWomen completed a survey on their mental health care experiences. Outpatient mental health care use in the year before the survey was obtained from Veterans Health Administration administrative data.ResultsMost women (79.1%) used psychotherapy, and 41.7% of those women had a minimal therapeutic dose of psychotherapy (≥8 visits). Mental health diagnostic comorbidity and being African American/Black or identifying as neither African American/Black nor White were significantly associated with higher psychotherapy use. Mental health diagnostic comorbidity, exposure to military sexual trauma, and receiving treatment aligned with gender-related and group-related preferences were associated with higher psychotherapy retention. Being a parent was associated with lower retention.ConclusionsAlthough a significant proportion of women veterans with PTSD are using psychotherapy, retention is enhanced when women are able to obtain treatment aligned with their preferences. Thus, efforts to promote patient-centered, shared decisions regarding mental health treatment options could increase the efficacy and efficiency of treatment for PTSD among women.     

Characteristics and Health Care Preferences Associated with Cardiovascular Disease Risk among Women Veterans

BackgroundWomen veterans are at increased risk for cardiovascular disease (CVD), but little is known about comorbidities and healthcare preferences associated with CVD risk in this population.MethodsWe describe the prevalence of CVD-relevant health behaviors, mental health symptoms, and health care use characteristics and preferences among participants of the National Survey of Women Veterans (conducted 2008–2009).FindingsFifty-four percent of respondents were at risk for CVD (defined as a diagnosis of hypertension, diabetes, current tobacco use, or obesity without CVD). In unadjusted analysis, ORs for being at risk for CVD were greater among those interested in gender-specific clinical settings (OR, 2.0; 95% CI, 1.2–3.4) and gender-specific weight loss programs (OR, 1.8; 95% CI, 1.1–2.9). ORs were also greater for women who were physically inactive (OR, 1.9; 95% CI, 1.1–3.3), with current symptoms of depression (OR, 2.5; 95% CI, 1.1–6.1), anxiety (OR, 2.1; 95% CI, 1.2–3.6), and posttraumatic stress disorder (OR, 2.4; 95% CI, 1.2–4.8). Adjusting for age, race/ethnicity, marital status, education level, employment, and source of health care use, the ORs for CVD risk were higher for women with current posttraumatic stress disorder symptoms (2.5; 95% CI, 1.1–5.3) and gender-specific health care preferences (2.0; 95% CI, 1.1–3.4), and gender-specific weight loss programs (1.9; 95% CI, 1.1–3.2).ConclusionsRisk for CVD was common and preferences for gender-specific care and posttraumatic stress disorder were associated with being at risk for CVD. Women's health clinics may be a good location for targeted CVD prevention interventions for women veterans both in and outside the Veterans Health Administration.     

Prenatal Stress Exposure and Post-traumatic Stress Disorder Associated With Risk of Postpartum Alcohol Misuse Among Women Veterans

ObjectivesMaternal alcohol misuse during the postpartum period is associated with negative maternal and infant outcomes. This study examined whether greater stress exposure in the year before the baby's birth and maternal post-traumatic stress disorder (PTSD) were associated with postpartum alcohol misuse among a sample of women veterans. Maternal PTSD was also examined as a moderator of the association between stress exposure and postpartum alcohol misuse.MethodsData were drawn from the Center for Maternal and Infant Outcomes Research in Translation study, a multisite prospective cohort study of pregnant and postpartum women veterans. Interviews were conducted within 12 weeks after birth. At this post-birth interview, women reported whether they experienced stressful events (e.g., loss of job, military deployment, separation/divorce) in the year before birth. PTSD diagnosis and postpartum scores on the Alcohol Use Disorders Identification Test (AUDIT-C) were derived from the Department of Veterans Affairs medical records.ResultsModels testing main and interaction effects showed a statistically significant association of both PTSD (p = .02) and stress exposure (p = .04), as well as significant interaction of PTSD and stress exposure (p = .03) with AUDIT-C scores postpartum, after controlling for marital status, age, and race. Specifically, compared with women without PTSD, those with PTSD had higher overall AUDIT-C scores postpartum, regardless of stress exposure. For women without PTSD, more stress exposure before birth was associated with higher AUDIT-C scores during the postpartum phase.ConclusionsPTSD diagnosis and life stressors before infant birth predicted maternal alcohol misuse during the postpartum period. Identifying such risk factors is an initial step in preventing alcohol misuse, with the goal of enhancing postpartum health for the birthing parent and infant.     

Trauma Exposure and Posttraumatic Stress Disorder among Incarcerated Men

Trauma exposure and trauma-related symptoms are prevalent among incarcerated men, suggesting a need for behavioral health intervention. A random sample of adult males (N = 592) residing in a single high-security prison were screened for trauma exposure and posttraumatic stress disorder (PTSD) symptoms. Trauma was a universal experience among incarcerated men. Rates of current PTSD symptoms and lifetime PTSD were significantly higher (30 to 60 %) than rates found in the general male populations (3 to 6 %). Lifetime rates of trauma and PTSD were associated with psychiatric disorders. This study suggests the need for a gender-sensitive response to trauma among incarcerated men with modification for comorbid mental disorders and type of trauma exposure. Developing gender-sensitive trauma interventions for incarcerated men and testing them is necessary to improve the behavioral health outcomes of incarcerated men who disproportionately return to urban communities.     

汶川地震后成都军区总医院住院高龄老干部创伤后应激障碍调查

目的 调查汶川地震后军队高龄老干部创伤后应激障碍(PTSD)发生情况及特点.方法 采用PTSD诊断工具、症状自评量表(SCL-90),在震后30 d对170名亲历地震的军队住院老干部进行评估.结果 根据DSM-IV诊断标准,震后30 d有20.59%的老干部发生PTSD;PTSD患者年龄与非PTSD组患者年龄相比,明显较大(P<0.05);PTSD组患者的躯体化、焦虑、抑郁因子分均显著高于非PTSD组(P<0.01).结论 地震后30 d,军队老干部PTSD的发生率是20.59%,PTSD组老干部平均年龄比非PTSD组明显更大.因此,有必要主动对受灾老干部进行精神心理干预.     

Posttraumatic Stress Disorder Among Women Receiving Prenatal Care at Three Federally Qualified Health Care Centers

This study assessed the prevalence and interrelationships of posttraumatic stress disorder (PTSD), antecedent trauma, and psychosocial risk factors among pregnant women served at three urban Federally Qualified Health Care Centers. This analysis was part of a validation study of the prenatal risk overview, a structured psychosocial risk screening interview. The study sample included 745 prenatal patients at three clinics who also were administered the major depression, PTSD, alcohol, and drug use modules of the Structured Clinical Interview for DSM-IV (SCID). Most participants were women of color (89.1 %), under the age of 25 years (67.8 %), and unmarried (86.2 %). The rate for a current PTSD diagnosis was 6.6 % and for subthreshold PTSD 4.2 %. More than half (54 %) of participants reported a trauma that met PTSD criteria; 21 % reported being a victim of or witness to violence or abuse, including 78 % of women with PTSD. Compared to those without PTSD, those with PTSD were 4 times more likely to be at risk for housing instability (AOR 4.15; 95 %CI 1.76, 9.80) and depression (AOR3.91; 95 %CI 2.05, 7.47) and 2 times as likely to be at risk for a drug use disorder (AOR 1.96, 95 %CI 1.04, 3.71) and involvement with child protective services (AOR 2.27; 95 % CI 1.06, 4.89). Women age 25 or older were twice as likely to meet PTSD diagnostic criteria as younger women (AOR2.27; 95 %CI 1.21, 4.28). Trauma exposure and pervasive PTSD were common in this population. Systematic psychosocial risk screening may identify the population with PTSD even without questions specific to this disorder.     

Posttraumatic Stress Disorder and Incident Heart Failure Among a Community-Based Sample of US Veterans

Objectives. We investigated the association between posttraumatic stress disorder (PTSD) and incident heart failure in a community-based sample of veterans.Methods. We examined Veterans Affairs Pacific Islands Health Care System outpatient medical records for 8248 veterans between 2005 and 2012. We used multivariable Cox regression to estimate hazard ratios and 95% confidence intervals for the development of heart failure by PTSD status.Results. Over a mean follow-up of 7.2 years, veterans with PTSD were at increased risk for developing heart failure (hazard ratio [HR] = 1.47; 95% confidence interval [CI] = 1.13, 1.92) compared with veterans without PTSD after adjustment for age, gender, diabetes, hyperlipidemia, hypertension, body mass index, combat service, and military service period. Additional predictors for heart failure included age (HR = 1.05; 95% CI = 1.03, 1.07), diabetes (HR = 2.54; 95% CI = 2.02, 3.20), hypertension (HR = 1.87; 95% CI = 1.42, 2.46), overweight (HR = 1.72; 95% CI = 1.25, 2.36), obesity (HR = 3.43; 95% CI = 2.50, 4.70), and combat service (HR = 4.99; 95% CI = 1.29, 19.38).Conclusions. Ours is the first large-scale longitudinal study to report an association between PTSD and incident heart failure in an outpatient sample of US veterans. Prevention and treatment efforts for heart failure and its associated risk factors should be expanded among US veterans with PTSD.Posttraumatic stress disorder (PTSD) is a psychiatric illness that affects approximately 7.7 million Americans aged older than 18 years.1 PTSD typically results after the experience of severe trauma, and veterans are at elevated risk for the disorder. The National Vietnam Veterans Readjustment Study reported the prevalence of PTSD among veterans who served in Vietnam as 15.2% among men and 8.1% among women.2 In fiscal year 2009, nearly 446 045 Veterans Administration (VA) patients had a primary diagnosis of PTSD, a threefold increase since 1999.3 PTSD is of growing clinical concern as evidence continues to link psychiatric illnesses to conditions such as arthritis,4 liver disease,5 digestive disease,6 and cancer.6 When the postwar health status of Vietnam veterans was examined, those with PTSD had higher rates of diseases of the circulatory, nervous, digestive, musculoskeletal, and respiratory systems.7The evidence linking PTSD to coronary heart disease (CHD) is substantial.8–10 Veterans with PTSD are significantly more likely to have abnormal electrocardiograph results, myocardial infarctions, and atrioventricular conduction deficits than are veterans without PTSD.11 In a study of 605 male veterans of World War II and the Korean War, CHD was more common among veterans with PTSD than among those without PTSD.12 Worldwide, adults exposed to the disaster at Chernobyl experienced increased rates of CHD up to 10 years after the event,13 and studies of stressors resulting from the civil war in Lebanon found elevated CHD mortality.14,15Although the exact biological mechanism by which PTSD contributes to CHD remains unclear, several hypotheses have been suggested, including autonomic nervous system dysfunction,16 inflammation,17 hypercoagulability,18 cardiac hyperreactivity,19 altered neurochemistry,20 and co-occurring metabolic syndrome.16 One of the hallmark symptoms of PTSD is hyperarousal,21 and the neurobiological changes brought on from sustained sympathetic nervous system activation affect the release of neurotransmitters and endocrine function.22 These changes have negative effects on the cardiovascular system, including increased blood pressure, heart rate, and cardiac output.22,23Most extant literature to date examining cardiovascular sequelae has shown a positive association between PTSD and coronary artery disease.8–10 Coronary artery disease is well documented as one of the most significant risk factors for future development of heart failure.24 Despite burgeoning evidence for the role of PTSD in the development of coronary artery disease, there are few studies specifically exploring the relationship between PTSD and heart failure. Limited data suggest that PTSD imparts roughly a threefold increase in the odds of developing heart failure in both the general population5 and in a sample of the elderly.25 These investigations, however, have been limited by cross-sectional study design, a small proportion of participants with PTSD, and reliance on self-reported measures for both PTSD and heart failure.5,25 Heart failure is a uniquely large public health issue, as nearly 5 million patients in the United States are affected and there are approximately 500 000 new cases each year.26 Identifying predictors of heart failure can aid in early detection efforts while simultaneously increasing understanding of the mechanism behind development of heart failure.To mitigate the limitations of previous investigations, we undertook a large-scale prospective study to further elucidate the role of prevalent PTSD and development of incident heart failure among veterans, while controlling for service-related and clinical covariates. Many studies investigating heart failure have relied on inpatient records; we leveraged outpatient records to more accurately reflect the community burden of disease.     

Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care

Objectives. We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis.Methods. We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009–2011) of suicide-related events among all VHA users to examine suicide risk.Results. GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population.Conclusions. The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) defines gender identity disorder (GID) as having deeply rooted feelings of persistent discomfort with one’s current biological gender and having the desire to be of the opposite gender to the extent that “the disturbance causes clinically significant distress or impairment in … important areas of functioning.”1^(p260)Although the diagnosis is relatively rare, persons diagnosed with GID constitute a subpopulation of people who experience numerous disparities in physical and mental health as well as health care access.2 Although a precise estimate of GID occurrence among the general population is unknown, one theoretical framework (i.e., flight into hypermasculinity) posits that GID may be overrepresented in the military and among veterans,3 and there is support for this hypothesis in community-based samples of transgender persons in which high prevalence of military service is observed.4 Furthermore, there is evidence of elevated risk for suicidal behavior among transgender populations.5–10 However, prevalence of GID and suicide-related events (e.g., suicide planning, suicide attempt) have yet to be examined among veterans who have received Veterans Health Administration (VHA) services. We have addressed this unmet need.     

Factors Associated With Quitting Smoking During Pregnancy Among Women Veterans

IntroductionLittle is known about the rates of smoking among pregnant veterans. Our objective was to examine rates of smoking during pregnancy and factors associated with quitting smoking during pregnancy.MethodsWe used data from a cohort study of pregnant veterans from 15 Veterans Health Administration facilities nationwide. Veterans who reported smoking during pregnancy were included in this analysis. Poisson regression models were used to estimate the relative risk (RR) of quitting smoking during pregnancy.ResultsOverall, 133 veterans reported smoking during pregnancy. Among this group of women who smoked, the average age was 31.6 years, 20% were Black, and 14% were Hispanic/Latino. More than one-half of women (65%) who reported smoking at the start of pregnancy quit smoking during pregnancy. Multivariable models, adjusted for history of deployment and age, indicated that prenatal care initiation at 12 or fewer weeks compared with more than 13 weeks (relative risk [RR], 2.06; 95% confidence interval [CI], 1.18–3.58), living without household smokers compared with any household smokers (RR, 1.58; 95% CI, 1.14–2.17), and first pregnancy (RR, 1.51; 95% CI, 1.17–1.95) were significant predictors of quitting versus persistent smoking during pregnancy.ConclusionsWomen veterans who quit smoking may be different than those who continue to smoke during pregnancy. Establishing prenatal care early in pregnancy, which likely includes counseling about smoking cessation, seems to be an important factor in quitting. Those for whom it is not a first pregnancy and who live with other smokers may especially benefit from such counseling.     

Stress and the City: Housing Stressors are Associated with Respiratory Health among Low Socioeconomic Status Chicago Children

Asthma disproportionately affects non-whites in urban areas and those of low socioeconomic status, yet asthma's social patterning is not well-explained by known risk factors. We hypothesized that disadvantaged urban populations experience acute and chronic housing stressors which produce psychological stress and impact health through biological and behavioral pathways. We examined eight outcomes: six child respiratory outcomes as well as parent and child general health, using data from 682 low-income, Chicago parents of diagnosed and undiagnosed asthmatic children. We created a continuous exposure, representing material, social and emotional dimensions of housing stressors, weighted by their parent-reported difficulty. We compared the 75th to the 25th quartile of exposure in adjusted binomial and negative binomial regression models. Higher risks and rates of poor health were associated with higher housing stressors for six of eight outcomes. The risk difference (RD) for poor/fair general health was larger for children [RD = 6.28 (95% CI 1.22, 11.35)] than for parents [RD = 3.88 (95% CI −1.87, 9.63)]. The incidence rate difference (IRD) for exercise intolerance was nearly one extra day per 2 weeks for the higher exposure group [IRD = 0.88 (95% CI 0.41, 1.35)]; nearly one-third extra day per 2 weeks for waking at night [IRD = 0.32 (95% CI 0.01, 0.63)]; and nearly one-third extra day per 6 months for unplanned medical visits [IRD = 0.30 (95% CI 0.059, 0.54)]. Results contribute to the conceptualization of urban stress as a “social pollutant” and to the hypothesized role of stress in health disparities. Interventions to improve asthma outcomes must address individuals' reactions to stress while we seek structural solutions to residential stressors and health inequities.     

Use of a Learning Collaborative to Support Implementation of Integrated Care for Smoking Cessation for Veterans With Posttraumatic Stress Disorder

Objectives. We evaluated the feasibility of incorporating integrated care (IC) for smoking cessation into routine treatment for posttraumatic stress disorder (PTSD) at Department of Veterans Affairs (VA) Medical Centers and the utility of the Learning Collaborative (LC) model in facilitating implementation.Methods. We conducted 2 LCs aimed at implementing IC for smoking cessation using multidisciplinary teams comprising 70 staff members from 12 VA PTSD clinics. Using questionnaires, we evaluated providers’ perceptions of the LC methodology and the effectiveness and feasibility of routine IC delivery. We assessed number of providers delivering and patients receiving IC using medical record data.Results. More than 85% of participating VA staff considered the LC to be an effective training and implementation platform. The majority thought IC effectively addressed an important need and could be delivered in routine PTSD care. All LC participants who planned to deliver IC did so (n = 52). Within 12 months of initial training, an additional 46 locally trained providers delivered IC and 395 veterans received IC.Conclusions. The LC model effectively facilitated rapid and broad implementation of IC. Facilitators and barriers to sustained use of IC are unknown and should be identified to understand how best to promote ongoing access to evidence-based treatment for smoking cessation in mental health populations.Despite gains in reducing tobacco use among the general public, nicotine dependence continues to disproportionately affect individuals with mental illness, including those with posttraumatic stress disorder (PTSD), a prevalent mental health disorder1 associated with heavy cigarette consumption and low cessation rates.2 One in 10 current US smokers have had PTSD at some point in their lives.2 Tobacco dependence likely contributes to the high mortality,3 morbidity,4 and health care costs5 of persons with PTSD. Recent epidemiological studies, although unable to elucidate causal pathways unequivocally, strongly suggest that smoking cessation reduces risk for suicidal ideation,6 depression,7,8 and anxiety,9 emphasizing the critical importance for cessation among those with PTSD and other mental health conditions. Thus, effective cessation treatment interventions and delivery systems are needed to reach this population.To address this need within the Veterans Health Administration, McFall et al.10 developed integrated care (IC) for smoking cessation, which incorporates guideline-based cessation treatment into mental health care for veterans with PTSD. IC is delivered by veterans’ PTSD providers, capitalizing on the existing therapeutic relationship between provider and patient. A randomized trial at 10 Department of Veterans Affairs (VA) Medical Centers, VA Cooperative Study No. 519 (CSP 519), found that, compared with referral to specialized smoking cessation clinics, IC improved cessation outcomes among veterans with PTSD without detracting from mental health treatment.10Although providers who participated in CSP 519 held positive views of IC and supported delivering cessation treatment in mental health care,11 most did not continue delivering IC at the study’s conclusion (C. Wallace, PhD, unpublished data, August 2011). Such a finding is unsurprising given that the use of evidence-based treatments in mental health remains sparse and inconsistent outside of academic settings.12,13 The challenge of making best practice usual practice has been identified as a major public health priority.12,14 Information dissemination and training remain 2 of the most widely used strategies for attempting to spread new practices13,15 but are insufficient for ensuring broad and sustained use of evidence-based treatments; longer-term multilevel implementation strategies are necessary to overcome numerous and complex barriers to adoption.15–17Quality collaboratives are one methodology used to support health care system change and improve quality of care.18–21 The Breakthrough Series is a quality collaborative model that brings together multidisciplinary teams from different organizations with recognized experts to work in a structured way to accelerate spread of best practices.22 The National Center for Child Traumatic Stress’s Learning Collaborative (LC) Model, an adaptation of the Breakthrough Series, supports rapid delivery and sustained use of effective treatments in community settings23 by melding best practices in training and consultation with quality improvement methods.In 2010, the VA partnered with the Duke Evidence-Based Practice Implementation Center to conduct an LC to implement IC in 6 Veterans Affairs PTSD clinics, followed by a second LC with 6 additional Veterans Affairs PTSD clinics in 2012. The objective of this project evaluation was to assess the feasibility of delivering IC as part of routine PTSD care and the utility of the LC model in facilitating IC implementation. Specifically, we examined whether (1) VA staff actively participated in the collaborative and considered LC methodology useful in supporting IC implementation; (2) collaborative participation resulted in rapid delivery of IC (i.e., delivery within 3 months of training) and continued use of the intervention after LC completion; and (3) VA providers viewed IC as compatible with current clinical practices and feasible to deliver as part of routine mental health care for veterans with PTSD. Because troops newly returning from deployment have higher rates of smoking than the general population24,25 and high rates of PTSD,26 it is imperative than an evidence-based treatment such as IC be widely implemented to preserve the physical and mental health of our returning service members.     

Factors Associated with Health Information-Seeking in Low-Income Pregnant Women

The purpose of this study was to examine the relationships of health literacy, self-efficacy, and fetal health locus of control to health information-seeking in low-income pregnant women and the contribution from each factor alone or in combination to the variance in health information-seeking. This was a cross-sectional study of 143 English-speaking pregnant women who were recruited from a prenatal clinic and were 18 years of age or older in 2007–2008. Health literacy, self-efficacy, fetal health locus of control, and health information-seeking were measured using the Short Form of the Test of Functional Health Literacy in Adults, the Health Information Competence Scale, the Fetal Health Locus of Control Scale, and the Pregnancy Health Information-Seeking Scale. Health literacy was not significantly correlated with health information-seeking. Self-efficacy (r = .33) and internal fetal health locus of control (r = .27) demonstrated significant correlations with health information-seeking, and together they accounted for 15% of the variance in health information-seeking. After controlling for covariates, self-efficacy (p = .0006) and internal fetal health locus of control (p = .03) remained significantly associated with health information-seeking. In conclusion, pregnant women's characteristics, such as self-efficacy and internal fetal health locus of control belief, are associated with their health information-seeking during pregnancy.     

Prenatal Care for Women Veterans Who Use Department of Veterans Affairs Health Care

ObjectiveThe number of women Veterans of childbearing age enrolling in Department of Veterans Affairs (VA) health care is increasing. Our objective was to describe characteristics of women veterans and resumption of VA care after delivery by use of VA prenatal benefits.Study designWe used data from the National Survey of Women Veterans, a population-based survey. VA-eligible women veterans with at least one live birth who had ever used VA and were younger than 45 years when VA prenatal benefits became available were categorized based on self-reported receipt of VA prenatal benefits. Characteristics of by use of VA prenatal benefits were compared using χ² tests with Rao–Scott adjustment. All analyses used sampling weights.ResultsIn our analytic sample, of those who potentially had the opportunity to use VA prenatal benefits, 25% used these benefits and 75% did not. Compared with women veterans not using VA prenatal benefits, those who did were more likely to be 18 to 24 years old (39.9% vs. 3.7%; p = .03), and more likely to have self-reported diagnosed depression (62.5% vs. 24.5%; p = .02) and current depression or posttraumatic stress disorder (PTSD) symptoms (depression, 46.1% vs. 8% [p = .02]; PTSD, 52.5% vs. 14.8% [p = .02]). Compared with women veterans not using VA prenatal benefits, those who did were more likely to resume VA use after delivery (p < .001).ConclusionPregnant women veterans who use VA prenatal benefits are a high-risk group. Among those who opt not to use these benefits, pregnancy is an important point of attrition from VA health care, raising concerns regarding retention of women veterans within VA and continuity of care.     

Factors Associated with Mental Health Services Use among Disconnected African-American Young Adult Population

Research related to mental health service use among vulnerable young adults is limited. This study used an expanded version of Andersen’s Behavioral Model of Health Services Use to evaluate factors associated with the use of different types of mental health services among a sample of predominantly African-American 16–24 year olds (n = 500) in an employment training program in Baltimore City. Results indicated that participants were more likely to have received mental health services in correctional facilities than in community- or school-based contexts. Use of mental health services in correctional facilities was significantly greater among males, those less than 18 years, and those who experienced more stressful events. Findings illustrate the need to develop seamless mental health services for vulnerable young adults in multiple contexts, including the criminal justice system.