Funded by the VA HSR&D (Project# SDR 10-012)

Spotlight on Women Cyberseminar Series
Findings from the 

National Survey of Women VeteNational Survey of Women Vete

Donna L Washington MD MPH Donna

L. Washington, MD, MPH

Professor of Medicine

VA Greater Los Angeles HSR&D Center of Excel

UCLA S h l f M di i UCLA

S

c

hool o

f

M

edi

cine

VA HSR&D C

yber Semina

r

January 12, 2011

VA HSR&D C t f VA HSR&D

Center 

for 

the Study of Healthcare Provider Behavior
Research Team: Research Team:

Bevanne Bean-Mayberry, MD, MHSElizabeth M Yano PhD MSPH Elizabeth M. Yano, PhD, MSPHMichael N. Mitchell, PhD Mark CanningDeborah Riop, , elle, MPH Su Sun, MPHMingming Wang, MPH Julia Yosef, MFunding: VA Office of Public Health and EnvironmeH d W V t H lth St t Hazards, Women Veterans Health Strateg

Healthcare Group & VA HSR&D SDR-08-
Background: Women Vetera

Background: Women Vetera

 Growin

gg y se

gment of militar

y and 

veteran population

► 15% of active duty military 15% of active duty military► 20% of new military recruits

 U.S. women veterans number m

than 1.8 million

 Unique healthcare needs comp

with male veterans with male veterans
Bk d ac ground

 Only prior national survey of wom

Only prior national survey of wom

veterans conducted 25 years ago 

1985 Survey of Female Veterans 1985 Survey of Female Veterans

 Women’s military roles, experien

and needs have changed drama

 Current data needed for evidenc

Current data needed for evidencbased strategic planning for progand services for women veterans and services for women veterans
National Survey of Women Vetera

Objectives

 Identify in a national sample the c

Identify in a national sample, the c

status, demographics, VA experien

and health care needs of women vand health care needs of women v

 Determine how health care needs 

barriers to VA health care use diffeperiod of military service

 Assess women veterans’ health ca

preferences in order to address VA barriers and health care needs
Methods

 National p po ulation-based teleph

survey of women veterans fielded 2008-09

 Inclusion: Service in regular arme

forces; National Guard or Reservforces; National Guard or Reserv

who served tour of duty

 Exclusions: Current active duty, 

VA employee, institutionalized 
NSWV Sampling Frame NSWV Sampling Frame

U.S. Women Veterans

n

=925,946 w

NED

n 925,946 w

veterans iden

51% of U.S. 

DEERS NED 51% of U.S. 

DEERS: Defense Eli

g y p 

ibilit

y Re

portin

NED: VHA NationEnrollment Databa

*CP/Vetsnet

* CP/VETSNET: VB

Pen Mini File plus 

Source: Washington DL, et.al. Journal of RehabilitaResearch & Development. 2010; 47(8):763-71
NSWV Sample NSWV Sample

 Stratified random sample

► S ifi i ili i i d Stratification on military service perio

d

(pre-Vietnam, OEF/OIF, all other periods) VA use (VA user, VA nonuser)

 Oversampled VA users, pre-Vietnam E

OEF/OIF militar

y cohorts

 All VISNs represented 3 611 ti i t (86% f li ibl ) 3,611 parti

cipan

ts (86% o

f eli

gibl

e

)

 Analyses weighted to represent U.S. w

veteran population
Measures

 Demographic characteristics Demographic characteristics Health status and personal hea

behaviors

 VA and non-VA health care use Knowledge and perceptions of 

health care

 Determinants of and barriers to 

VA health care use VA health care use
Demographics: Age distributio

U.S. Women Veterans n=1,802,0

from population projection models

400 000500,000

22%

27%

300,000400,000

17%

14%

100 000200,000

6% 5% 

0

100,000

< 25 25 34 35 44 45 54 55 64 65 74 75 84 

3%

< 25 25

-34 35

-44 45

-54 55

-64 65

-74 75

-84 

Age group in years
Age distribution of U.S. Women 

V t b i d f ilit V

e

terans 

by perio

d o

f military ser

(% distribution)

Age group in yea

18-44 45-64 65-84 

S i id i t Service perio

ds prior 

to 

Vietnam Era 0.0 2.1 59.6 Vietnam and 15 5 76 9 7 2 

Post-Vietnam Eras 15.5 76.9

7.2

Gulf War Pre-9/30/2001 69.1 30.0 0.9 Gulf War Post-9/30/2001 86.6 13.4 0.1 

*derived from VetPop2007
D hi Eth i it & R Demographics: Eth

nicity 

&

R

100% Hispanic

%

80% non-His

non-His

40%60

% non-His

0%

20%

pre-Vietnam Vietnam to 

present, 

no OEF/OIF

OEF/OIF
Health care use in prior 12 mo

Health care use in prior 12 mo

100%

VA Non-VA only None 

7% 10% 8% 1

80%

100%

78% 77%

57%

7

40%60%

20% 35%

15% 13% 1

0%

Pre-Vietnam Vietnam to 

present

OEF/OIF Ov

*

, 

no OEF/OIF *p<0.05 vs. other military cohorts
Health Status and Prevalenc

Health Status and Prevalenc

Chronic conditions*

60%50%40%30%20%10%0%

Health 

fair or

poo

r

>

3

diagnosed

medical

Depression Anxiety

disorder

p

conditions

*all p< .05 

(+) screening tes
100%

80%

60%

40%

20%

0%

Types of Health Care Servic

Used in Prior 12 Months*

Health Care Health Care % of Women Veterans us

Service 

% of Women Veterans us

Health Care Service Ty

Primary care 85% Most common categ 

o

all military cohorts

Women's health 62% Lower for Pre-Vietna

Specialty care 55% Higher for Pre-VietnaMental health 13% OEF/OIF highest; 

Pre-Vietnam era lowe

Hospitalization 17% Higher for Pre-Vietna

*Not mutually exclusive
VA Prenatal Care VA Prenatal Care

 Aware VA offers prenatal care: Aware VA offers prenatal care:

67% of OEF/OIF

51% of other military cohorts

 Among current or former VA us

who have been pregnant:

9% used prenatal care through (via on-site, contract, or fee bas
Post-partum attrition from VA partum attrition from VA

Timeframe for return to VA health care among those using VA at time of preg(n=546)

Returned 

57% within

( )

30%

1 year

57%

Did not

go back

30%

Returned 

go back

14%

after 1 year
Barriers to using VA health ca

Barriers to using VA health ca

among Women Veterans wh

considered but did not use considered, but did not use, 

31% Did t thi k th li ibl Did no

t thi

n

k they were eli

gibl

e

21% Did not know how to apply for be

Did not know how to apply for be

20% Closest VA is too far from their ho

*Not mutually exclusive
Kno ledge of VA ser ices Kno

wledge of VA services

 39% have none or almost none 

39% have none or almost none 

needed information about VA

 Misperceptions in all cohorts ab

who is eligible for VA health car

 OEF/OIF more knowledgeable 

than other cohorts about availathan other cohorts about availa

women’s health and readjustme

counseling services counseling services
Knowledge of VA services Knowledge of VA services

Pre-Vietnam Vietnam to present, 

no OEF/OIF

OEF/OIF

aware of contraception 

availabilit

y

no OEF/OIF

aware of readjustment

aware of mammography 

availability

y

misperception: only 

service

-connected eligible

aware of readjustment

counseling availability

amount of benefits 

information: little to none

service connected eligible

0% 20% 40% 60% 80% 
Perceptions of VA health care Perceptions of VA health care

*

VA users VA nonusers

VA providers are skilled in 

treating women

VA providers are sensitive to VA providers are sensitive to

concerns of women patients

You may see a female 

provider if you wish provider if you wish

You can see the same 

provider on most visits

0% 20% 40% 60% 80% 

VA quality of care rated high

* ll 05 *

all p< .05 0% 20% 40% 60% 80% 
Influences on perceptions* Influences on perceptions*

VA users VA nonusers

Personal ex

perience

Media, other veterans, friends

0% 20% 40% 60% 80% 

*p<.05
Conclusions and Implication

Conclusions and Implication

 Po

p gp gg ulation demo

gra

phics hi

ghli

ghts 

need for VA services that are gendage, and culturally appropriate

►Reproductive health; long-term care

 Hi

gh rates of cardiovascular and 

other chronic disease risk factors, particularly among VA users

►Address prevention to delay onset of 

complex chronic conditions

►Monitor risk reduction efforts by gend
I li ti A t C Implications: 

Access 

to 

Car

 Targeted care coordination Targeted care coordination

►General medical care, women’s h

and lh lh d mental healt

h

►Prenatal and postpartum services

 Geographic planning models to 

identify Women Veteran populaidentify Women Veteran popula

and develop appropriate servic

delivery arrangements delivery arrangements
Implications: Outreach

 O t h d d ti t i O

u

treac

h an

d e

ducation 

to imp

knowledge for all Women Veter

of VA benefits, eligibility, & ser

 Dissemination of accurate Dissemination of accurate

information to public and militar

about high quality of VA health about high quality of VA health 
Discussant: 

Laura Herrera, MD, MPHDeputy Chief, VA Office of Public Health and VA Office of Public Health and

Environmental Hazards
Questions ? Questions ?

For more information:Women Veterans Health Care Women Veterans Health Care, OPHEHhttp://vaww.publichealth.va.gov/womenshealth/VA R&D Women’s Healthhttp g pg ://www.research.va.gov/programs/womens 

_ 

default.cfm

National Survey of Women Veterans National National Survey of Women Veterans VeteransDonna L. Washington, MD, MPHVA Greater Los Angeles HealthcareDonna.Washington@va.gov, 310-478-3711 x4