Military medicine
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Suicidal thoughts and behaviors (STB) and intimate partner violence (IPV) are both serious and prevalent problems in the Veteran population that often occur in tandem, particularly among women Veterans. Women Veterans, the fastest growing segment of the Veteran population, may have unique overlapping risks that are worth exploring. Although the intersection of IPV and STB is well documented in the civilian population, it has not been thoroughly explored in women Veterans. ⋯ Frequently, the risk factors for IPV and STB are shared and it is important to consider how research, screening and intervention efforts for these serious problems might be integrated. Our exploration of the literature may be used as a basis for future research with women Veterans on the intersection of STB and IPV. Further, Veterans Health Administration clinicians should be aware of these intersecting risk factors to enhance care and improve screening for both issues in women Veteran clients.
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Transgender and gender-diverse (TGD) youth are at greater risk for mental health and medical conditions than their cisgender peers; however, poor health outcomes and identity-based discrimination can be minimized in the context of optimal support. Approximately 1.7 million youth may be eligible for care covered by the Military Health System, which includes mental health and gender-affirming medications. The purpose of the current study is to identify sociodemographic characteristics, the psychosocial and behavioral risk profile, and health care utilization patterns of TGD dependent youth cared for in the U.S. military system to inform provider training and resource allocation. ⋯ This study elucidated the sociodemographic and behavioral risk profile of a sample of TGD youth in the MHS. Military and non-military health care providers across a broad spectrum of specialties should be knowledgeable about the unique psychosocial and medical needs, requisite sensitivity, and available referral options in the care of TGD youth. Assumptions about one's gender identity, sexual orientation, gender expression, or behaviors cannot be made based on birth-assigned sex. Further research is needed to investigate the health and wellbeing of TGD military-affiliated youth over time and to determine quality transgender-related services in support of this vulnerable and underserved population.
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Musculoskeletal (MSK) conditions have a significant impact on the health and operational readiness of military members. The Canadian Forces Health Services (CFHS) provides a spectrum of health services in managing Canadian Armed Forces (CAF) personnel health care needs with on-base and off-base services provided by civilian and uniformed health care professionals, including chiropractors. Although chiropractic services are available in US DoD and VA systems, little is known about the facilitators and barriers to integrating on-base chiropractic services within the CFHS. This study explored key informants' perceptions of facilitators and barriers to the integration of on-base chiropractic services within the CFHS. ⋯ This study illuminated many opportunities and barriers, in complex and diverse domains, related to introducing collaborative chiropractic services in the CFHS. The findings are relevant to increasing understanding and strengthening interprofessional collaborative care within the unique CAF health care delivery system.
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There is a high prevalence of at-risk drinking in the U.S. military. Among HIV-infected individuals, alcohol abuse confers additional risk for adverse health outcomes. In the military, however, the characteristics of HIV-infected individuals who engage in high-risk drinking are not well defined. The purpose of this study was to assess risk factors associated with at-risk drinking in an HIV-positive longitudinal cohort of DoD beneficiaries. ⋯ Consistent with general alcohol consumption patterns in the military, we found a high prevalence of at-risk drinking among individuals with HIV infection, which was associated most closely with young, non-African Americans. Targeting interventions toward this group will be important to reduce at-risk drinking and its potential for HIV-related complications.
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Despite evidence that the unintended pregnancy rate is higher among U.S. servicewomen than the general population and that servicewomen may face barriers to contraceptive use, there is little research about contraceptive access and use experiences of non-deployed active duty servicewomen. This qualitative study aimed to explore the experiences of accessing contraception while in the U.S. military among active duty servicewomen who had an abortion. ⋯ Active duty servicewomen who had an abortion experienced many barriers to accessing contraception while in the military. These findings highlight the need to improve contraceptive counseling and access in the U.S. military. Results support the need to implement mandatory yearly and pre-deployment contraceptive counseling as required by the 2016 National Defense Authorization Act, offer contraceptive counseling in multiple settings, ensure military providers receive training to avoid contraceptive coercion, expand military clinic and pharmacy hours, increase the number of female military health care providers and providers able to administer all forms of contraception, and expand the contraceptive methods included under the Basic Core Formulary. Limitations to this study include that participants were self-selected and were asked to recall experiences up to several years in the past. Future studies should evaluate representative samples to understand the proportion of servicewomen with unmet contraceptive need.