BRFSS

The Behavioral Risk Factor Survelliance System abstracts of articles using the Veterans questions.

1: Diabetes mellitus in individuals with spinal cord injury or disorder.

2: The burden of obesity among a national probability sample of veterans.

3: Disease prevalence and use of preventive services: comparison of female veterans in general and those with spinal cord injuries and disorders.

4: Mental distress among younger veterans before, during, and after the invasion of
Iraq.

5: Physical and mental health and access to care among nonmetropolitan Veterans Health Administration patients younger than 65 years .

6: The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System.

7: Diabetes in nonveterans, veterans, and veterans receiving Department of Veterans Affairs health care.

8: Behavioral risk factors and use of preventive services among veterans in Washington State.

1: J Spinal Cord Med. 2006;29(4):387-95.

Diabetes mellitus in individuals with spinal cord injury or disorder.

Lavela SL, Weaver FM, Goldstein B, Chen K, Miskevics S, Rajan S, Gater DR Jr.

Spinal Cord Injury Quality Enhancement Research Initiative, Midwest Center for
Health Services and Policy Research, Department of Veterans Affairs, Edward Hines
Jr. VA Hospital, Hines, Illinois 60141, USA. Sherri.LaVela@va.gov

BACKGROUND/OBJECTIVE: To examine diabetes prevalence, care, complications, and
characteristics of veterans with a spinal cord injury or disorder (SCI/D).
METHODS: A national survey of veterans with an SCI/D was conducted using
Behavioral Risk Factor Surveillance System (BRFSS) survey questions. Data were
compared with national Centers for Disease Control and Prevention BRFSS data for
veteran and nonveteran general populations. RESULTS: Overall prevalence of
diabetes in individuals with an SCI/D was 20% (3 times higher than in the general
population). Veterans with an SCI/D and veterans, in general, had a higher
prevalence of diabetes across all age groups; however, those with an SCI/D who
were 45 to 59 years of age had a higher prevalence than other veterans. One
fourth of the persons with an SCI/D and diabetes reported that diabetes affected
their eyes or that they had retinopathy (25%), and 41% had foot sores that took
more than 4 weeks to heal. More veterans, both with (63%) and without an SCI/D
(60%), took a class on how to manage their diabetes than the general population
(50%). Veterans with an SCI/D and diabetes were more likely to report other
chronic conditions and poorer quality of life than those without diabetes.
CONCLUSIONS: Diabetes prevalence is greater among veterans with an SCI/D compared
with the civilian population, but is similar to that of other veterans, although
it may occur at a younger age in those with an SCI/D. Veterans with an SCI/D and
diabetes reported more comorbidities, more slow-healing foot sores, and poorer
quality of life than those without diabetes. Efforts to prevent diabetes and to
provide early intervention in persons with SCI/D are needed.

Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.

PMID: 17044389 [PubMed - indexed for MEDLINE]

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2: J Gen Intern Med. 2006 Sep;21(9):915-9.

The burden of obesity among a national probability sample of veterans.

Nelson KM.

Primary and Specialty Medical Care Service, VA Puget Sound Health Care System,
Seattle, WA, USA.
Karin.Nelson@va.gov

BACKGROUND: Few national data exist about the prevalence of obesity and the
resulting health burden among veterans. METHODS: We analyzed data from the 2003
Behavioral Risk Factor Surveillance System (n = 242,362) to compare rates of
obesity among veterans who do and do not utilize the VA, compared with
nonveterans. We used bivariate analyses to describe the association of obesity
with lifestyle factors, disability, and comorbid disease, and multivariate
analysis to assess the independent association of obesity with VA care. RESULTS:
Veterans who use the VA for health care have the highest rates of obesity
compared with veterans who do not use the VA and nonveterans (27.7% vs 23.9% vs
22.8%, P < .001). Only 27.8% of veterans who receive health care at the VA are of
normal weight (vs 42.6% of the general population, P < .001), 44.5% are
overweight, 19.9% have class I obesity, 6% have class II obesity, and 1.8% are
morbidly obese (an estimated 82,950 individuals). Obese veterans who utilize the
VA for services have higher rates of hypertension (65.8%) and diabetes (31.3%),
are less likely to follow diet and exercise guidelines, and more likely to report
poor health and disability than their normal-weight counterparts. CONCLUSIONS:
Veterans who receive care at the VA have higher rates of overweight and obesity
than the general population. At present, less than half of VA medical centers
have weight management programs. As the largest integrated U.S. health system,
the VA has a unique opportunity to respond to the epidemic of obesity.

Publication Types:
Comparative Study
Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16918734 [PubMed - indexed for MEDLINE]

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3: J Womens Health (Larchmt). 2006 Apr;15(3):301-11.

Disease prevalence and use of preventive services: comparison of female veterans
in general and those with spinal cord injuries and disorders.

Lavela SL, Weaver FM, Smith B, Chen K.

Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Midwest
Center for Health Services and Policy Research (MCHSPR), Hines, IL 60141, USA.
sherri.lavela@va.gov

BACKGROUND: Disease prevalence and use of preventive services may differ between
women veterans in general and those with spinal cord injuries and disorders
(SCI&D). Prevention is particularly important in SCI&D, and disparities may exist
in receipt of this care, particularly when special equipment and body adjustments
are needed, among women with SCI&D. METHODS: To compare disease prevalence and
preventive service use among female veterans in general and those with SCI&D, we
conducted a cross-sectional survey among female veterans in general (n = 478) and
those with SCI&D (n = 115). Behavioral Risk Factor Surveillance System (BRFSS)
survey questions were administered to veterans with SCI&D and compared with 2003
CDC BRFSS data. RESULTS: Female veterans with SCI&D were similar in age and race
but were better educated and less likely to be employed than female veterans in
general. Coronary heart disease (CHD) prevalence was higher in those with SCI&D
(17% vs. 8%, p < 0.0001). Health status was lower in SCI&D (27%) than in general
female veterans (41%), p = 0.002. Fewer women with SCI&D, than female veterans in
general reported having received recommended dental care (56% vs. 69%, p =
0.004), colon screening in prior 5 years (59% vs. 72%, p = 0.023) or prior 10
years (67% vs. 92%, p< 0.0001), mammogram (84% vs. 91%, p = 0.019), and Pap smear (88% vs. 98%, p < 0.0001). There were no differences in receipt of respiratory
vaccinations or cholesterol screening. CONCLUSIONS: Receipt of services that
require the use of equipment, body adjustments, and potential discomfort due to
disability was lower in women with SCI&D. Veterans Affairs (VA) is doing well in
most areas, but there are gaps in receipt of some preventive services. Efforts to
increase preventive care in women with SCI&D should address equipment and access
barriers and patient and provider education.

Publication Types:
Comparative Study
Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16620189 [PubMed - indexed for MEDLINE]

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4: Psychiatr Serv. 2006 Feb;57(2):244-8.

Mental distress among younger veterans before, during, and after the invasion of
Iraq.

West AN, Weeks WB.

Department of Veterans Affairs (VA) Outcomes Group Research Enhancement Awards
Program (REAP), VA National Center, White River Junction, Vermont 05009, USA.
alan.west@med.va.gov

OBJECTIVE: The purpose of this study was to determine whether patients receiving
care from the Department of Veterans Affairs (VA) reported more mental distress
as the war in Iraq began or reintensified compared with other respondents to
national health surveys. METHODS: Data from the 2000 and 2003 Behavioral Risk
Factor Surveillance System (BRFSS) health surveys were analyzed. Unlike in other
years, these particular surveys asked respondents whether they were military
veterans. As in other years' surveys, these surveys also asked whether
respondents used VA medical care. Male respondents were stratified by age and
separated into three groups: VA patients, other veterans, and nonveterans. The
proportions of respondents who reported five or more recent days of poor mental
or physical health were analyzed with chi square tests. RESULTS: Although the
number of recent days of poor mental health among nonveterans, other veterans,
and older VA patients were stable from 2000 to 2003, younger VA patients in 2003
reported substantially more days of poor mental health in two intervals: during
the Iraq war buildup and invasion, and later, when resistance on the ground
reintensified. Comparable changes in physical health complaints were not
observed. CONCLUSIONS: In times of war, the VA may anticipate more mental health
problems among its current patients, particularly younger veterans.

Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.

PMID: 16452703 [PubMed - indexed for MEDLINE]

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5: J Rural Health. 2006 Winter;22(1):9-16.

Physical and mental health and access to care among nonmetropolitan Veterans
Health Administration patients younger than 65 years.

West A, Weeks WB.

Veterans' Rural Health Initiative, VA Medical Center, White River Junction, VT
05009, USA. alan.west@med.va.gov

CONTEXT: The 4.5 million military veterans treated by the Veterans Health
Administration (VA) are believed to experience poorer physical and mental health
than nonveterans. Furthermore, nonmetropolitan residents have less access to
medical services, whether or not they are veterans in VA care. A direct
comparison of metropolitan and nonmetropolitan veterans and nonveterans on a
national health survey has not been reported, so it is not known whether
nonmetropolitan VA patients experience similar medical need or access as other
nonmetropolitan residents. PURPOSE: We sought to compare the perceptions of
health status and access to care among metropolitan and nonmetropolitan veterans
in VA care, other veterans, and nonveterans in a large national sample surveyed
under the same conditions. METHODS: Male respondents to the 2000 Behavioral Risk
Factor Surveillance System health survey were divided into veterans or
nonveterans, VA users or nonusers, metropolitan or nonmetropolitan residents, and
1 of 3 age groups (18-44, 45-64, and 65(+)). Responses to questions about current
health status, health coverage, and access to care were submitted to chi-square
analyses or analyses of variance, using SUDAAN software to compute survey error
variance. FINDINGS: Nonmetropolitan VA patients younger than 65 years
consistently reported the worst physical and mental health status and reduced
access to care. CONCLUSIONS: VA can anticipate increasing demand for mental and
physical health care among rural veterans younger than 65 years.

PMID: 16441331 [PubMed - indexed for MEDLINE]

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6: Health Serv Res. 2005 Apr;40(2):361-72.

The association between health insurance coverage and diabetes care; data from
the 2000 Behavioral Risk Factor Surveillance System.

Nelson KM, Chapko MK, Reiber G, Boyko EJ.

Primary and Specialty Medical Care Service, VA Puget Sound Health Care System,
1660 South Columbian Way, S-111-GIMC, Seattle, WA 98107, USA.

OBJECTIVE: To describe the association between type of health insurance coverage
and the quality of care provided to individuals with diabetes in the United
States. DATA SOURCE: The 2000 Behavioral Risk Factor Surveillance System. STUDY
DESIGN: Our study cohort included individuals who reported a diagnosis of
diabetes (n=11,647). We performed bivariate and multivariate logistic regression
analyses by age greater or less than 65 years to examine the association of
health insurance coverage with diabetes-specific quality of care measures,
controlling for the effects of race/ethnicity, annual income, gender, education,
and insulin use. PRINCIPAL FINDINGS: Most individuals with diabetes are covered
by private insurance (39 percent) or Medicare (44 percent). Among persons under
the age of 65 years, 11 percent were uninsured. The uninsured were more likely to
be African American or Hispanic and report low incomes. The uninsured were less
likely to report annual dilated eye exams, foot examinations, or hemoglobin A1c
(HbA1c) tests and less likely to perform daily blood glucose monitoring than
those with private health insurance. We found few differences in quality
indicators between Medicare, Medicaid, or the Department of Veterans Affairs (VA)
as compared with private insurance coverage. Persons who received care through
the VA were more likely to report taking a diabetes education class and HbA1c
testing than those covered by private insurance. CONCLUSIONS: Uninsured adults
with diabetes are predominantly minority and low income and receive fewer
preventive services than individuals with health insurance. Among the insured,
different types of health insurance coverage appear to provide similar levels of
care, except for higher rates of diabetes education and HbA1c testing at the VA.

Publication Types:
Comparative Study

PMID: 15762896 [PubMed - indexed for MEDLINE]

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7: Diabetes Care. 2004 May;27 Suppl 2:B3-9.

Diabetes in nonveterans, veterans, and veterans receiving Department of Veterans
Affairs health care.

Reiber GE, Koepsell TD, Maynard C, Haas LB, Boyko EJ.

Seattle Epidemiologic Research and Information Center, Veterans Affairs Puget
Sound Health Care System, Seattle, Washington, USA. greiber@u.washington.edu

OBJECTIVE: To compare behavioral risk factors and health and disease
characteristics among three groups of adults with diabetes: nonveterans, veterans
not receiving Department of Veterans Affairs (VA) health care, and veterans using
VA services. RESEARCH DESIGN AND METHODS: Two data sources were used to describe
the veteran population. First, the 2000 Behavioral Risk Factor Surveillance
System (BRFSS) characterized the U.S. adult population by preventive health
practices and risk behaviors linked to chronic and preventable diseases. New to
the 2000 survey were questions on veteran status, which were administered in all
states. Second, VA administrative and veterans benefits data were analyzed to
describe comorbidity, education services, and veterans benefits. RESULTS: The
estimated prevalence of diabetes in male veterans receiving VA care was 16%. Male
veterans with diabetes using VA care were more likely to be nonwhite, not
employed, have lower income, lower health status, and more activity limitations
than male veterans not using these services. Computerized records indicate VA
users with diabetes also had high concurrent comorbidity. Frequency of VA
diabetes and preventive care services, as measured by selected quality
indicators, was equivalent to or higher than the levels reported by veterans not
receiving VA care and nonveterans. In addition to health care, nearly one-fourth
of veterans with diabetes also received monthly awards for compensation and
pension. CONCLUSIONS: Males receiving VA care with self-reported diabetes
indicated receiving preventive care services at equivalent or higher levels than
their counterparts receiving care outside the VA and nonveterans.

PMID: 15113776 [PubMed - indexed for MEDLINE]

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8: Prev Med. 2002 Dec;35(6):557-62.

Behavioral risk factors and use of preventive services among veterans in
Washington State.

Koepsell T, Reiber G, Simmons KW.

Seattle Epidemiologic Research and Information Center, U.S. Department of
Veterans Affairs, VAPSHCS, Box 152E, 1660 S. Columbian Way, Seattle, WA
98108-1597, USA. koepsell@u.washington.edu

BACKGROUND: Little is known about the special preventive health needs of U.S.
veterans and the 3.6 million users of VA health care. METHODS: The Washington
State version of the 1999 Behavioral Risk Factor Survey included three new
questions about veteran status and use of VA health care. Data on this
population-based sample of 3,608 adults were used to compare sociodemographic,
health, and behavioral characteristics between veterans and nonveterans and
between VA users and nonusers. RESULTS: Veterans were nearly 13 years older than
nonveterans. VA users were socioeconomically worse off and had poorer health
status than nonusers. Current smoking among males was more common among veterans
than among nonveterans (24% vs 18%). This difference persisted after controlling
for age, race, education, and income and held across all age groups. Use of
several screening tests varied little in relation to veteran or VA user status.
CONCLUSIONS: The BRFSS has become a rich source of data on veteran health.
Veterans and VA users have distinct sociodemographic profiles that must be
considered when comparing health-related characteristics. Cigarette smoking is
especially prevalent among veterans--an excess unexplained by sociodemographic
differences.

Publication Types:
Research Support, U.S. Gov't, Non-P.H.S.

PMID: 12460523 [PubMed - indexed for MEDLINE]

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