Valentine M. Villa

Veteran identity and race/ethnicity: Influences on VA outpatient care utilization

Background. “Veteran identity” is defined as veterans’ self-concept that derives from his/her military experience within a sociohistorical context. Veteran identity may vary by race/ethnicity because the sociohistorical context of the military experience varies by race. Objectives. To explore veteran identity and how it varies by race/ethnicity, and to identify aspects of veteran identity that significantly influence preferences for, and use of, VA outpatient care. Research Design. Focus groups were conducted at community sites to explore concepts related to veteran identity, race/ethnicity, military experience, and health services use. The focus groups informed the development of a telephone survey, which was administered to veterans of four racial/ethnic groups in Southern California and Southern Nevada. Subjects. One hundred seventy-eight veterans participated in the focus groups, and 3,227 veterans completed the telephone survey. Measures. Dependent variables include: (1) preference for VA health services, (2) VA-only outpatient use, (3) Any VA outpatient use, and (4) number of outpatient visits within the previous 12 months. Independent variables include veteran identity, sociodemographic, and health-related characteristics. Results. All veteran identity variables were significantly associated with race/ethnicity. Race/ethnicity, eg, being black or Hispanic, in addition to veteran identity factors, significantly influenced preferences for VA outpatient care. Veteran identity factors, however, had less influence on VA outpatient service utilization than socioeconomic factors. Conclusions. Minority veterans who highly identify with their veteran status may prefer the VA to other systems of care. Factors associated with veteran identity may be useful for incorporation into interventions to improve access to VA care.

Hispanic Baby Boomers: Health Inequities Likely to Persist in Old Age

PURPOSE As the Baby-Boom generation enters the ranks of the elderly adults over the next 4 decades, the United States will witness an unprecedented growth in racial/ethnic diversity among the older adult population. Hispanics will comprise 20% of the next generation of older adults, representing the largest minority population aged 65 years and older, with those of Mexican-origin comprising the majority of Hispanics. Little is known about the health status of this population. DATA/METHODS: Data are for Baby Boomers born between 1946 and 1964 (ages 43-61) in the 2007 California Health Interview Survey. Logistic regression estimates the odds of diabetes, hypertension, obesity, fair/poor self-rated health (SRH), and functional difficulties among U.S.-born non-Hispanic Whites (NHW), U.S.-born Mexicans, naturalized Mexican immigrants, and noncitizen Mexican immigrants. RESULTS The Mexican-origin populations are disadvantaged relative to NHW for all socioeconomic status (SES) and several health outcomes. The Mexican origin disadvantage in health attenuates when controlling for SES and demographics, but the disadvantage remains for diabetes, obesity, and fair/poor SRH. IMPLICATIONS Baby Boomers of Mexican origin do not share the advantages of health, income, and educational attainment enjoyed by U.S.-born NHW. As this cohort moves into old age, the cumulative disadvantage of existing disparities are likely to result in continued or worse health disparities. Reductions in federal entitlement programs for the elderly adults that delay eligibility, scale back programs and services, or increase costs to consumers may exacerbate those inequities.

Racial/ethnic variations in veterans' ambulatory care use.

OBJECTIVES We assessed racial/ethnic variations in patterns of ambulatory care use among Department of Veterans Affairs (VA) health care-eligible veterans to determine if racial/ethnic differences in health care use persist in equal-access systems. METHODS We surveyed 3227 male veterans about their health and ambulatory care use. RESULTS Thirty-eight percent of respondents had not had a health care visit in the previous 12 months. Black (odds ratio [OR] = 0.5), Hispanic (OR = 0.4), and Asian/Pacific Islander veterans (OR=0.4) were less likely than White veterans to report any ambulatory care use. Alternately, Whites (OR=2.2) were more likely than other groups to report ambulatory care use. Being White was a greater predictor of health care use than was having fair or poor health (OR=1.4) or functional limitations (OR=1.5). In non-VA settings, racial/ethnic minorities were less likely to have a usual provider of health care. There was no VA racial/ethnic variation in this parameter. CONCLUSIONS Racial/ethnic disparities in health and health care use are present among VA health care-eligible veterans. Although the VA plays an important role in health care delivery to ethnic minority veterans, barriers to VA ambulatory care use and additional facilitators for reducing unmet need still need to be investigated.

The Health and Functional Status of US Veterans Aged 65+: Implications for VA Health Programs Serving an Elderly, Diverse Veteran Population:

As the US population is aging, so too is the US veteran population. Chief among the challenges facing the Department of Veterans Affairs (VA) is developing health programs and services that mesh with the needs of an aging veteran population and therefore improve the health status of elderly veterans. Meeting this challenge requires an understanding of the health needs of the older veteran population, including health disparities that exist across racial ethnic populations. This study examines the selfrated health and functioning of a national sample of veterans aged 65+ participating in the National Survey of Veterans. The results show that over one half of elderly veterans report difficulty in functioning and rate their health status as fair or poor. Additionally, elderly African American and Hispanic veterans report worse health than non-Hispanic white veterans across the majority of health indicators. Given the health profile of older veterans found in this study, it would seem necessary that programs serving older veterans be adept at the ongoing medical management of chronic disease and the provision of long-term care services.

Exploring Veteran Identity and Health Services Use among Native American Veterans

ABSTRACT The objectives of this study were to describe the military experiences of Native American veterans and to explore how factors related to veteran identity influence their use of health services. Study participants completed a demographic and health questionnaire, followed by participation in a focus group session. The findings revealed that, despite their negative experiences during military service, most participants had a positive veteran identity. Almost 46% of participants reported having a service-related illness or injury. Almost one-third (28.2%) used the Indian Health Service (IHS) exclusively for their health care, followed by those who used both IHS and Veterans Affairs (VA) services (23.5%), followed by VA-only users (21.2%). We conclude that Native American veterans highly identify with their military service but may turn to IHS for their medical care. The data support the current VA policy of strengthening coordination with the IHS to ensure that the medical needs of Native American v...

Exploring the Diversity of Women Veterans' Identity to Improve the Delivery of Veterans' Health Services:

This qualitative study explored the domains of gender, ethnicity, and military association in a population of women veterans as these domains related to the womens access to and use of health care services and assessed barriers to the use of health services and suggestions for improving them. The study found that a significant proportion of the participants had experienced some form of gender discrimination in the military, through segregation or sexual harassment, and that their perceptions of the Veterans Administration health care system were framed by their military, ethnic/racial, and gender experiences.

Health Practices of Korean Elderly People: National Health Promotion Priorities and Minority Community Needs

The official health promotion goals for the year 2000 in the United States include an emphasis on behavioral and contextual changes to increase the healthy lifespan of Americans. The goals also encompass reducing disparities in health status among different groups, and many of the specific goals address issues pertinent to older people. Limited data on the health status and health behaviors of older Asians and Pacific Islanders contributed to the absence of any goals for this group of elderly people. This article uses 1993 to 1994 data on 213 Korean and 201 non-Hispanic white people age 65 and over who lived in Los Angeles County to compare, by ethnicity and gender, health behaviors that may influence the health of older people. The older Koreans practiced a somewhat higher number of healthy behaviors overall, but smoking cessation for older Korean men and increased exercise for older Korean women were specific areas needing attention. Limited English-speaking ability and educational levels of the older Koreans make it imperative that health promotion activities for older Koreans use community-based organizations that can reach the older Koreans in an effective manner.

Evaluating a Multicomponent Caregiver Intervention

ABSTRACT There is compelling evidence that caring for an elderly individual with functional limitations is physically and psychologically stressful. The purpose of this study is to test a multimodal caregiver intervention of ethnically and racially diverse caregivers. We sought to examine if caregivers (n = 199) of older adults with physical and/or cognitive problems experienced improved depression and caregiver outcomes after participating in a community-based Caregiver Support/Training Program (CS/TP). Using a single group pretest–post-test design, caregiver depression decreased significantly. Specifically, caregivers were more likely to report higher positive affect at post-test. Although caregivers reported decreased caregiver burden, the difference was not statistically significant. One-way ANOVAs were also conducted to look at group differences. The findings of this study will help practitioners understand the importance of developing more targeted interventions that take specific ethnic and cultural characteristics of caregivers into consideration.