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Gender and the use of Veterans Health Administration homeless services programs among Iraq/Afghanistan Veterans. Oni J. Blackstock, MD Yale RWJF Clinical Scholars Program/VA Connecticut Health Care System Cynthia Brandt, MD MPH, Sally Haskell, MD, Rani Desai, PhD MPH

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slide1

Gender and the use of Veterans Health Administration homeless services programs among Iraq/Afghanistan Veterans

Oni J. Blackstock, MD

Yale RWJF Clinical Scholars Program/VA Connecticut Health Care System

Cynthia Brandt, MD MPH, Sally Haskell, MD, Rani Desai, PhD MPH

Yale School of Medicine/VA Connecticut Health Care System

slide2

The authors have no potential conflicts of interest to disclose

  • Disclaimer: The views expressed in this presentation are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.
slide4

Operation Enduring

Freedom

(OEF)

Operation

Iraqi

Freedom

(OIF)

The OEF/OIF Veteran cohort has the largest proportion of women to serve and to be exposed to combat of any Veteran era cohort.

slide5

Homelessness

Use of homeless services programs

research questions
Research Questions

1. What is the risk of using a VHA homeless program among OEF/OIF Veterans in VHA care?

2. Is there a difference in risk between female and male Veterans?

3. How do the characteristics of female and male Veterans who used a homeless program compare?

methods study population
Methods: Study population

OEF/OIF Veterans

(~1.1 million)

Enrolled in VHA system

10/1/01 to 9/30/09

(~500,000)

  • Nonmissing gender
  • Nonmissing separation date
  • At least 1 VHA clinical visit
  • (445,319)
primary outcome time to first use of a vha homeless program
Primary Outcome:Time to first use of a VHA homeless program

Separation

Date

1st visit

indicating use of

VHA homeless

program

use of vha homeless programs identified using program codes
Use of VHA homeless programs identified using program codes

Health Care for Homeless Veterans

Housing and Urban Development- VA Supported Housing

Compensated Work Therapy/ Transitional Residences

Domiciliary Care for Homeless Veterans

Grant and Per Diem Program

slide11

Socio-demographic variables

Age, race/ethnicity, marital status, education

Rank

(officer vs. enlisted)

Rural vs. urban location, geographic region

slide12

Clinical variables

Service-connected disability rating

Mental health conditions

data analysis
Data Analysis
  • Survival analysis
    • Cox proportional hazards regression
    • Adjusting for socio-demographic & clinical variables
  • Χ2 and Wilcoxon rank-sum tests to compare female and male Veterans who used a VHA homeless program
results
Results

OEF/OIF Veterans

(~1.1 million)

  • Median age, 26 years (IQR, 23 – 37)
  • 12% female
  • 62% White, 18% Black, 12% Hispanic, 6% Other
  • 56% unmarried
  • 80% high school diploma or less
  • 22% Post-traumatic stress disorder
  • 2% - 8% with psychiatric /substance use disorders

Median duration of follow-up

3.21 years

(IQR, 1.74-4.52)

Enrolled in VHA system

(~500,000)

Study population

(445,319)

research questions1
Research Questions

1. What is the risk of using a VHA homeless program among OEF/OIF Veterans in VHA care?

2. Is there a difference in risk between female and male Veterans?

3. How do the characteristics of female and male Veterans who used a homeless program compare?

risk of using a vha homeless program
Risk of using a VHA homeless program

Study population 445,319

Used a VHA

homeless program

7,431 (1.7%)

Median time to first use:

1.88 years

(IQR, 0.81-3.29)

IQR, interquartile range

research questions2
Research Questions

1. What is the risk of using a VHA homeless program among OEF/OIF Veterans in VHA care?

2. Is there a difference in risk between female and male Veterans?

3. How do the characteristics of female and male Veterans who used a homeless program compare?

risk of using a vha homeless program by gender
Risk of using a VHA homeless program by gender

Study population

(445,319)

Female

53,650 (12%)

Male

391,667 (88%)

Used a VHA

homeless program

961 (1.8%)

Used a VHA

homeless program

6,470 (1.7%)

no difference in risk of using a homeless program
No difference in risk of using a homeless program

Male

Female

Hazard ratio for use of a VHA homeless program

*Adjusted for age, race/ethnicity, marital status, education, rank, rural/urban, geographic region

disability rating, mental health diagnoses

research questions3
Research Questions

1. What is the risk of using a VHA homeless program among OEF/OIF Veterans in VHA care?

2. Is there a difference in risk between female and male Veterans?

3. How do the characteristics of female and male Veterans who used a homeless program compare?

limitations
Limitations
  • Includes only OEF/OIF Veterans in VHA care
  • Does not capture Veterans who accessed only non-VHA-directed homeless services programs
  • Lack of data to explore the role of dependents, military sexual trauma, and employment status
what we learned
What we learned
  • About 1.7% of OEF/OIF Veterans in VHA care used a VHA homeless program
  • Overall, female Veterans were as likely as male Veterans to use a VHA homeless program
  • Differences exist between female and male Veterans who used a homeless program
      • Females more likely to have depression, less likely to have substance/alcohol use disorder or PTSD
implications
Implications
  • Determine whether homeless program use shortly after return represents vulnerability for this group of young Veterans
  • Ensure homeless programs are tailored to also meet the needs of female Veterans
  • Expand services in areas that may disproportionately affect female Veterans such as depression and programs for families
stakeholders
Stakeholders

Northampton VA Medical Center

acknowledgements
Acknowledgements
  • Women Veterans Cohort Study
    • Cynthia Brandt, MD MPH
    • Sally Haskell, MD
    • Rani Desai, PhD MPH
    • Melissa Skanderson, MSW
  • Yale RWJF Clinical Scholars Program
  • Department of Veterans Affairs/VA Connecticut Healthcare System
  • OEF/OIF Veterans for their service