Janet M. Wilmoth

Military Service and Men's Health Trajectories in Later Life

OBJECTIVES This study examines differences in the relationship between veteran status and mens trajectories of health conditions, activities of daily living limitations, and self-rated health. METHODS We use data on 12,631 men drawn from the 1992-2006 waves of the Health and Retirement Study to estimate growth curve models that examine differences in health trajectories between nonveterans and veterans, veterans with and without wartime service, and war service veterans who served during World War II, Korea, Vietnam, and multiple wars. RESULTS The results indicate that veterans have better health at the mean age of 66.2 years, but experience greater age-related changes in health than nonveterans. Similarly, men who served during wartime have better health at the mean age, but more age-related changes in health than men who did not serve during wartime. Among war veterans, Vietnam veterans are in poorer health at the mean age, but they experience less substantial age-related health changes than men who served during previous wars. DISCUSSION Although veterans experience better health relative to nonveterans around retirement age, they have poorer health than nonveterans among the oldest old. These findings inform our understanding of the veteran-nonveteran health-mortality paradox found in previous research and suggest a health crossover among veterans and nonveterans in later life.

Military Service and (Dis)Continuity in the Life Course Evidence on Disadvantage and Mortality From the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest-Old

This study uses a life-course framework and data from the Health and Retirement Study and the Study of Assets and Health Dynamics Among the Oldest-Old to examine three hypotheses related to (dis)continuity in the effects of early-life disadvantage (African American race and low paternal education) and military service on later-life mortality. Specifically, the authors consider whether military service (and age at enlistment) mediates or moderates the effects of early-life disadvantage on later-life mortality and whether mid- to late-life marital status, socioeconomic status, health status, and health behaviors mediate the effects of military service on mortality. The authors find very little evidence to support the notion that any mortality benefits accrue to men as a consequence of military service overall or enlistment at any particular age. Most of the evidence is consistent with life-course disruption and continuity of disadvantage interpretations.

Demographic Trends That Will Shape U.S. Policy in the Twenty-First Century

This article first reviews recent facts about the size, distribution, and general characteristics of the older adult population. Next, the importance of considering variation in the aging experience is discussed. Then the implications of trends related to American families and womens labor force participation are explored. Finally, the challenges of addressing these trends given projected fiscal pressures are considered. The authors emphasize the diversity that exists among the older adult population and argue that mounting disparities could increase the salience of public programs for certain segments of the older adult population. In addition, even under the best-case scenarios of improving health, lower disability, and declining mortality, the projected increase in the older adult population is likely to place heavy demands on federal, state, and local programs for older adults. Overall, this review of issues related to recent demographic trends provides a foundation for the subsequent articles in this edited volume.

Health trajectories among older movers

Objective: To examine health trajectories among older migrants by reason for move. Method: Data from the 1992 to 2006 Health and Retirement Study (HRS) are used to model trajectories of self-rated health and activity of daily living (ADL) limitations that occurred prior seven types of moves. Results: There are substantial differences across the reason-for-move groups in initial levels of self-rated health. Declines in self-rated health among nursing home movers are more than two times steeper than the other reason-for-move groups. Employment, comfort, economic security, life crisis, and affiliation movers have low initial levels of ADL limitations and slow increases in ADL limitations. Health and nursing home movers have higher initial ADL limitations and increases in ADL limitations that are three and seven times higher respectively than the other groups. Discussion: The results are consistent with the predictions of Litwak and Longino’s (1987) typology of later-life migration and the extant literature on later-life migration. Implications for communities are considered.

Aging Veterans: Needs and Provisions

Current knowledge about aging is primarily based on cohorts that were born during the early part of the twentieth century. A substantial percentage of men in these cohorts, and subsequent cohorts who are currently middle aged, served in the military during war, peace, Cold War, or some combination thereof. Consequently, veterans are a sizeable demographic group in the United States. In 2000, over 26 million Americans were veterans, representing approximately 12.7% of those aged 18 years or older (U.S. Census Bureau 2003). Military service is particularly prevalent among older cohorts who served in World War II (WWII) and the Korean War (Hogan 1981); almost 9.2 million men age 65 years and older were veterans in 2000, which represents 64% of men in this age group (Interagency Forum on Aging-Related Statistics 2008). In addition, participation in the military has increased substantially among women; in 2000, nearly 1.6 million American women were veterans (U.S. Census Bureau 2003).

Work-related disability, veteran status, and poverty: Implications for family well-being

The authors examine the interrelationships between work-related disability, veteran, and poverty statuses using data from the 1992–2004 panels of the Survey of Income and Program Participation. They find that households with nondisabled veterans present have a lower likelihood of poverty, but that advantage is severely eroded when the veteran or another family member has a work-limiting disability. Nevertheless, all veteran households have substantially lower odds of poverty than disabled nonveteran households, which have the highest poverty rate (32.53%). Veteran and disability statuses interact at the household level in ways that contribute to substantial variability in household-level poverty, which has implications for all household members.

Moving for care: findings from the US HIV cost and services utilization Study

This paper examines sociodemographic and HIV-related factors associated with moving post-HIV diagnosis for non-care- and care-related reasons (versus never moving post-HIV diagnosis). Distinctions are made between those who move for informal care only, formal care only, or informal and formal care. Data come from the nationally representative US HIV Cost and Services Utilization Study (N=2,864). Overall, 31.8% moved at least once post-HIV diagnosis and 16.3% moved most recently for care. Among those who moved for care, 32.6% moved for informal care only, 26.8% for formal care only, and 40.6% moved for both. Post-HIV diagnosis moves for reasons unrelated to care were less likely among African Americans and older persons, and more likely among those with longer durations positive. Moves for care were less likely among African Americans, older persons, and persons with higher educational attainments, while they were more likely among those with an AIDS diagnosis and longer durations HIV-positive. Among those who moved for care, women and persons with higher incomes were less likely to move for formal or mixed care than informal care only. Given that moving for care may reflect disparities in access to care and unmet needs, additional analyses with more detailed data are warranted.

Veteran Status, Extramarital Sex, and Divorce Findings From the 1992 National Health and Social Life Survey

Despite perceptions that infidelity is common among military and veteran populations, there is relatively little evidence documenting the prevalence of extramarital sex among persons with a history of military service or its consequences for marital stability. Using data from the 1992 National Health and Social Life Survey, we estimate multivariate logistic regression models to examine the associations between veteran status, extramarital sex, and divorce among ever-married persons aged 18 to 60 years. We also conduct supplemental analyses of gender differences. We find that 32.17% of veterans report extramarital sexual relationships, which is twice the rate among nonveterans in this sample. Controlling for sociodemographic and early-life factors, veterans are significantly more likely than nonveterans to report extramarital sex and to have ever divorced, whereas extramarital sex has a strong, independent association with divorce. We conclude that veteran status is strongly associated with extramarital sex and divorce, at least among men; extramarital sex and divorce might also be elevated among female veterans, but research that uses larger, representative samples of female veterans is needed to confirm those associations. The higher rates of infidelity among veterans may be related to selection factors; military experiences, such as deployment; or postmilitary factors. The current research provides a foundation for further research that aims to explicate the mechanisms underlying this association.

Veteran Status and Material Hardship: The Moderating Influence of Work-Limiting Disability

Veterans are a sizable and policy-relevant demographic group in the United States, yet little is known about their economic well-being. Although having a work-limiting disability is known to be associated with material hardship, no known study compares material hardship between veteran households and nonveteran households or investigates whether work-limiting disability moderates the association between veteran status and material hardship. This study uses data from the Survey of Income and Program Participation to examine how household work-limiting disability status moderates the relationship between veteran status and the likelihood of material hardship. Results suggest the following: nondisabled-veteran households report lower or equivalent levels of material hardship than do households with no veteran or disabled member; regardless of whether a veteran is present, households that include a disabled person have higher levels of every type of hardship than other households do; and disabled-veteran households experience statistically significantly more hardship than nondisabled-veteran households do.

Economic Well-Being among Older-Adult Households: Variation by Veteran and Disability Status

This analysis uses data from the Survey of Income and Program Participation (SIPP) to examine whether veteran and disability statuses are jointly associated with poverty and material hardship among households that include an older adult. Compared to households that do not include a person with a disability or veteran, disabled nonveteran households are more likely to be in poverty and to experience home hardship, medical hardship, and bill-paying hardship. Disabled veteran households are not significantly different in terms of poverty, but exhibit the highest odds of home hardship, medical hardship, bill-paying hardship, and food insufficiency. The implications for social work practice are discussed.