Elsevier

Women's Health Issues

Volume 25, Issue 1, January–February 2015, Pages 35-41
Women's Health Issues

Original article
Gender Differences in the Impact of Warfare Exposure on Self-Rated Health

https://doi.org/10.1016/j.whi.2014.09.003Get rights and content

Abstract

Background

This study examined gender differences in the impact of warfare exposure on self-reported physical health.

Methods

Data are from the 2010 National Survey of Veterans, a nationally representative survey of veterans from multiple eras of service. Regression analyses assessed gender differences in the association between warfare exposure (deployment to a war zone, exposure to casualties) and health status and functional impairment, adjusting for sociodemographics.

Findings

Women reported better health status but greater functional impairment than men. Among men, those who experienced casualties only or both casualties and deployment to a war zone had worse health compared with those who experienced neither stressor or deployment to a war zone only. Among women, those who experienced casualties only or both stressors reported worse health than those who experienced war zone only, who did not differ from the unexposed. No association was found between warfare exposure and functional impairment in women; in men, however, those who experienced exposure to casualties or both stressors had greater odds of functional impairment compared with those who experienced war zone only or neither stressor.

Conclusions

Exposure to casualties may be more predictive of health than deployment to a war zone, especially for men. We did not find a stronger association between warfare exposure and health for women than men. Given that the expansion of women's military roles has allowed them to serve in direct combat, their degree and scope of warfare exposure is likely to increase in the future.

Section snippets

Sample

The 2010 National Survey of Veterans is the sixth in a series of surveys commissioned by the VA to assess needs for veteran programs and services, as well as beneficiaries' awareness of these services (Westat, 2010). The 2010 National Survey of Veterans was mandated by Congress as part of the Veterans Benefits Improvement Act (2004). Veterans were recruited using an address-based sampling approach, which matched U.S. Postal Service residential addresses with VA health care and beneficiary data

Measures

The key independent variable was a veteran's level of warfare exposure. This was assessed by two dichotomous items: 1) “Did you ever serve in a combat or war zone? [NOTE: Persons serving in a combat or war zone usually receive combat zone tax exclusion, imminent danger pay, or hostile fire pay.]” and 2) “During your military service, were you ever exposed to dead, dying, or wounded people?” The two variables were multiplied to yield an overall warfare exposure term with four categories: Neither

Results

Male and female veterans differed across most study variables (Table 1). Women were younger [t (7711) = 17.3, p < .001], better educated [t (7702) = −7.54, p < .001], and more likely to be of minority status [χ2(1) = 84.7, p < .001] compared with men. Median income did not differ between men and women [t (7270) = 1.0, p = .32]. Regarding warfare exposure, men and women endorsed significantly different categories of exposure [χ2(3) = 59.0, p < .001]. The majority of veterans experienced neither

Discussion

Overall, we found that warfare exposure was associated with worse health status in both men and women, and greater functional impairment in men. Findings suggest the relative importance of exposure to casualties compared with deployment to a war zone when predicting self-reported health status and functional impairment, especially for men. Deployment to a war zone only did not have a significant impact on health. Contrary to our hypothesis, we did not find stronger associations between warfare

Joyce M. Wang is affiliated with the Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System and the Department of Epidemiology, Boston University School of Public Health.

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  • Cited by (0)

    Joyce M. Wang is affiliated with the Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System and the Department of Epidemiology, Boston University School of Public Health.

    Lewina O. Lee, PhD, is affiliated with the National Center for PTSD, VA Boston Healthcare System, the Department of Epidemiology, Boston University School of Public Health, and the Department of Psychiatry, Boston University School of Medicine.

    Avron Spiro III, PhD, is affiliated with the Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, and with the Department of Epidemiology, Boston University School of Public Health, the Department of Psychiatry, Boston University School of Medicine, and the Department of Health Policy and Health Services Research, Boston University Goldman School of Dental Medicine.

    This research was supported by a VA Clinical Science Research and Development Service Senior Research Career Scientist Award and National Institutes of Health grant R24-AG039343. The views expressed in this paper are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs.

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