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Gnall KE, Sacco SJ, Sinnott SM, Park CL, Mazure CM, Hoff RA. Physical activity, posttraumatic stress, and gender: A longitudinal study of post-9/11 veterans. J Health Psychol 2024:13591053241233380. [PMID: 38400566 DOI: 10.1177/13591053241233380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
Given the importance of physical activity (PA) for both physical and mental health, the present study characterizes post-9/11 veterans' leisure-time PA engagement over time. Further, this study examines the relationship between PA and posttraumatic stress symptoms (PTSS), as well as whether this relation differs by gender and time since military discharge. This study was a secondary analysis of a 12-month longitudinal observational investigation of 410 (39.5% female) post-9/11 veterans. Participants completed self-report questionnaires at baseline and 12 months. Over a third of post-9/11 veterans were not engaging in any weekly leisure-time PA at study baseline and PA engagement significantly decreased in the subsequent year. The longitudinal relationship between PA and PTSS depended on both gender and time since military discharge. These results underscore the importance of considering both gender and time since discharge when tailoring interventions to support leisure-time PA as a key health habit in post-9/11 veterans.
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Affiliation(s)
| | | | | | | | | | - Rani A Hoff
- Yale School of Medicine, USA
- Northeast Program Evaluation Center (NEPEC), USA
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2
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Pebole MM, Singleton CR, Hall KS, Petruzzello SJ, Alston RJ, Whitworth JW, Gobin RL. Impact of Military Affiliation on Exercise Perceptions Among Survivors of Sexual Violence. Mil Med 2023; 188:usac431. [PMID: 36653919 DOI: 10.1093/milmed/usac431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/06/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Military service members disproportionately experience sexual violence (SV) and its related health concerns. Although recent work has shown physical activity to be an effective strategy for improving physical and mental health among trauma-exposed military populations, little of this work has focused specifically on military service members with a history of SV. To address these gaps in knowledge and practice, this study identified the most salient perceived benefits/barriers of exercise among men and women survivors of SV with military affiliations. Additionally, these analyses explore willingness to engage in exercise programs, and preferences for the structure/content of these programs, among men and women survivors of SV with military affiliations. MATERIALS AND METHODS An online, cross-sectional survey of women (n = 355) and men (n = 198) survivors of SV was completed using Amazon Mechanical Turk. Inclusion criteria were men and women, age between 18 and 65 years, self-reported history of SV, and located in the United States. Information on sociodemographics and post-traumatic stress disorder symptoms was collected alongside perceived barriers and benefits to exercise, willingness to engage in exercise programs, and preferences for the structure/content of these programs. Analyses were stratified by sex. Comparisons by history of military involvement (active duty military or veteran; no military involvement/civilian) were reported. RESULTS Both military-involved men (n = 68) and women (n = 139) were more likely to prefer at-home and online exercise options when compared to civilians (Ps < .05; Cramer's Vs 0.19-0.36). Additionally, both men and women with military involvement reported strongly favoring exercising with an instructor over no instructor and preferred that this instructor identifies with their same gender (Ps < .01; Cramer's Vs 0.28-0.36). Women with military involvement also preferred shorter program durations and exercising alone or in a group online or in person, whereas men with military involvement were open to longer program durations, when compared to their civilian counterparts (Ps < .05; Cramer's Vs 0.19-0.37). Women and men with military involvement were more likely than their civilian counterparts to perceive that exercise benefits their psychological outlook and social interactions. They were also more likely than civilians to indicate poor exercise environment, high time expenditure, and family discouragement as perceived barriers to exercise (Ps < .05; Cohen's ds 0.21-0.97). Military-involved women were also more likely than civilian women to endorse the perceived barrier of hard physical exercise (P < .05; Cohen's d = 0.25). CONCLUSIONS This study identified perceived benefits and barriers to exercise, along with willingness to engage in exercise programs, and exercise preferences among men and women survivors of SV with military involvement. Targeting these factors in intervention planning will be important for physical activity promotion and program engagement among veterans to reduce the disproportionate impact of SV and disease burden among U.S. service members and veterans.
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Affiliation(s)
- Michelle M Pebole
- The Translational Research Center for TBI and Stress Disorders (TRACTS), Veterans Affairs Boston Healthcare System, Boston, MA 02130, USA
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61280, USA
| | - Chelsea R Singleton
- Department of Social, Behavioral, and Population Sciences, Tulane School of Public Health & Tropical Medicine, New Orleans, LA 70112, USA
| | - Katherine S Hall
- Department of Medicine, Duke University, Durham, NC 27710, USA
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Healthcare System, Durham, NC 27705, USA
| | - Steven J Petruzzello
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61280, USA
| | - Reginald J Alston
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61280, USA
| | - James W Whitworth
- National Center for PTSD, Behavioral Science Division, Veterans Affairs Boston Healthcare System, 150 S Huntington Ave, Boston, MA 02130, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Robyn L Gobin
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61280, USA
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Wischik DL, Magny-Normilus C, Whittemore R. Risk Factors of Obesity in Veterans of Recent Conflicts: Need for Diabetes Prevention. Curr Diab Rep 2019; 19:70. [PMID: 31368008 PMCID: PMC7530827 DOI: 10.1007/s11892-019-1191-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW To identify factors associated with obesity in veterans of the recent, Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) war conflicts. RECENT FINDINGS Over 44% OEF/OIF/OND veterans are obese (BMI > 30 kg/m2), which exceeds the national obesity prevalence rate of 39% in people younger than 45. Obesity increases morbidity, risk for type 2 diabetes (T2D), and mortality as well as decreases quality of life. A scoping review method was used to identify factors associated with obesity in young veterans. Military exposures, such as multiple deployments and exposure to combat, contribute to challenges in re-integration to civilian life in all veterans. Factors that contribute to increased risk for obesity include changes in eating patterns/eating disorders, changes in physical activity, physical disability, and psychological comorbidity. These conditions can contribute to a rapid weight gain trajectory, changes in metabolism, and obesity. Young veterans face considerable challenges related to obesity risk. Further research is needed to better understand young veterans' experiences and health needs in order to adapt or expand existing programs and improve access, engagement, and metabolic outcomes in this vulnerable population.
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Affiliation(s)
| | | | - Robin Whittemore
- Yale School of Nursing, 400 West Campus Drive, Orange, CT, 06477, USA
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Angel CM, Smith BP, Pinter JM, Young BB, Armstrong NJ, Quinn JP, Brostek DF, Goodrich DE, Hoerster KD, Erwin MS. Team Red, White & Blue: a community-based model for harnessing positive social networks to enhance enrichment outcomes in military veterans reintegrating to civilian life. Transl Behav Med 2018; 8:554-564. [PMID: 30016524 PMCID: PMC6065538 DOI: 10.1093/tbm/iby050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Military service assimilates individuals into a socially cohesive force to address dangerous and traumatic situations that have no counterpart in civilian life. Upon leaving active duty, many veterans experience a “reverse culture shock” when trying to reintegrate into civilian institutions and cultivate supportive social networks. Poor social reintegration is associated with greater morbidity and premature mortality in part due to adoption of risky health behaviors, social isolation, and inadequate engagement in health care services. Although institutions like the Veterans Health Administration (VA) do much to address the complex psychosocial and health care needs of veterans and their families with evidence-based care, only 61% of Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans are enrolled in VA care and there are numerous perceived barriers to care for enrollees. To address this gap, a community-based nonprofit organization, Team Red, White & Blue (RWB), was created to help veterans establish health-enriching social connections with communities through the consistent provision of inclusive and locally tailored physical, social, and service activities. This article provides an overview of the development and refinement of a theory-based framework for veteran health called the Enrichment Equation, comprised of three core constructs: health, people, and purpose. By operationalizing programming activities and roles, we describe how theoretical components were translated into a social networking implementation package that enabled rapid national spread of Team RWB. We conclude with future opportunities to partner with researchers and other organizations to understand program impact, and to identify effective intervention components that could be adapted for similar vulnerable groups.
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Affiliation(s)
- Caroline M Angel
- Team Red, White & Blue, Tampa, FL, USA.,Eagle Research and Innovation Center, Team Red, White & Blue, Tampa, FL, USA.,The Institute for Veterans and Military Families, Syracuse University, Syracuse, NY, USA
| | - Blayne P Smith
- Team Red, White & Blue, Tampa, FL, USA.,Go Ruck, Jacksonville, FL, USA
| | | | - Brandon B Young
- Team Red, White & Blue, Tampa, FL, USA.,Tennyson Center for Children, Denver, CO, USA
| | - Nicholas J Armstrong
- The Institute for Veterans and Military Families, Syracuse University, Syracuse, NY, USA
| | - Joseph P Quinn
- Team Red, White & Blue, Tampa, FL, USA.,Headstrong Project, New York, NY, USA
| | | | - David E Goodrich
- Center for Evaluation and Implementation Resources and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Katherine D Hoerster
- Seattle Division Mental Health Service, VA Puget Sound Healthcare System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Michael S Erwin
- Team Red, White & Blue, Tampa, FL, USA.,The Positivity Project, Pinehurst, NC, USA
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Lee SY, Park CL. Trauma exposure, posttraumatic stress, and preventive health behaviours: a systematic review. Health Psychol Rev 2017; 12:75-109. [PMID: 28854859 DOI: 10.1080/17437199.2017.1373030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Psychological trauma has implications for many aspects of physical health, including preventive health behaviours (PHBs). However, whether trauma exposure additionally contributes to PHBs above and beyond the effects of posttraumatic stress disorder (PTSD) symptoms remains unclear. In this systematic review, 32 studies were analysed to characterise: (1) the relationships between trauma exposure and PHBs, (2) the relationships between PTSD symptoms and PHBs, (3) the unique associations between trauma exposure and PHBs, independent of PTSD symptoms, and (4) the unique associations between PTSD symptoms and PHBs, independent of trauma exposure. Findings were variable across the three examined PHBs (physical activity, diet, medical screening) when only trauma exposure or PTSD symptoms were taken into account. Clearer relationships emerged between trauma exposure and PHBs when PTSD symptoms were taken into account, demonstrating that trauma exposure is related to PHB engagement above and beyond the effects of PTSD symptoms. Additionally, PTSD symptoms shared unique associations with physical activity and screening frequency, which were not explained by trauma exposure. Our review reveals that teasing apart the effects of trauma exposure and PTSD symptoms on PHBs brings greater clarity to the strength and direction of these associations.
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Affiliation(s)
- Sharon Y Lee
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
| | - Crystal L Park
- a Department of Psychological Sciences , University of Connecticut , Storrs , CT , USA
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Fergus TA, Limbers CA, Griggs JO, Kelley LP. Somatic symptom severity among primary care patients who are obese: examining the unique contributions of anxiety sensitivity, discomfort intolerance, and health anxiety. J Behav Med 2017; 41:43-51. [PMID: 28710565 DOI: 10.1007/s10865-017-9873-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/06/2017] [Indexed: 01/04/2023]
Abstract
Prior research indicates the common presentation of somatic symptoms and obesity in primary care settings, as well as links between obesity and somatic symptoms. Anxiety sensitivity, discomfort intolerance, and health anxiety are three variables relevant to somatic symptoms. How those three variables relate to somatic symptom severity among individuals who are obese and the unique variance accounted for by each variable in somatic symptom severity remains unexamined. Among a large sample of primary care patients who are obese (N = 342), anxiety sensitivity, discomfort intolerance, and health anxiety collectively accounted for 35% of variance in somatic symptom severity beyond the effects of sociodemographic variables, body mass index, medical morbidity, and depression severity. Health anxiety accounted for the largest amount of unique variance in somatic symptom severity, potentially supporting the relevance of health anxiety to the presentation of increased somatic symptoms among patients who are obese.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, 76798, USA.
| | - Christine A Limbers
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, 76798, USA
| | - Jackson O Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
| | - Lance P Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
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Hall KS, Gregg J, Bosworth HB, Beckham JC, Hoerster KD, Sloane R, Morey MC. Physical Activity Counseling Promotes Physical and Psychological Resilience in Older Veterans with Posttraumatic Stress Disorder. Ment Health Phys Act 2016; 11:53-59. [PMID: 28458721 PMCID: PMC5404826 DOI: 10.1016/j.mhpa.2016.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Individuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sedentary lifestyle can cause and aggravate the physical health needs of adults with PTSD. The primary aim of this paper was to explore the impact of physical activity (PA) counseling (vs. usual care) on physical and psychological outcomes among individuals with PTSD. A secondary aim was to compare these arm effects between those with and without PTSD. METHODS Older (>60 years) overweight veterans with impaired glucose tolerance were randomly assigned to an intervention or a usual care control arm. Of the 302 participants who underwent randomization, 67 (22%) had PTSD. Participants in the intervention arm received one in-person activity counseling session followed by regular PA telephone counseling over 12 months. Physical and psychological outcomes were assessed at baseline, 3, and 12 months. RESULTS Primary Aim (intervention vs. usual care among those with PTSD): PA increased on average from 80 minutes/week to 161 minutes/week among participants in the intervention arm (p=0.01). Large, clinically meaningful improvements in six-minute walk test and psychological health were observed over the course of the intervention (p<0.01). Secondary Aim (PTSD/No PTSD, intervention/usual care): participants with PTSD responded equally well to the intervention compared to participants without PTSD, though we observed significantly greater improvements in vitality and six-minute walk compared to participants without PTSD (p<0.05). CONCLUSIONS Given the epidemic of comorbid psychological illness and lifestyle-related disease among persons with PTSD, our findings support development and implementation of targeted PA interventions in this high-risk population.
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Affiliation(s)
- Katherine S. Hall
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Claude A. Pepper Center for Aging, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey Gregg
- Mental Health Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Hayden B. Bosworth
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Center for Health Services Research and Development, Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Jean C. Beckham
- VA Research Service/Veterans Integrated Service Network 6 Mental Illness Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Katherine D. Hoerster
- Mental Health Service, VA Puget Sound Healthcare System, Seattle Division, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA , USA
| | - Richard Sloane
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Claude A. Pepper Center for Aging, Duke University Medical Center, Durham, NC, USA
| | - Miriam C. Morey
- Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Claude A. Pepper Center for Aging, Duke University Medical Center, Durham, NC, USA
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Washington DL, Gray K, Hoerster KD, Katon JG, Cochrane BB, LaMonte MJ, Weitlauf JC, Groessl E, Bastian L, Vitolins MZ, Tinker L. Trajectories in Physical Activity and Sedentary Time Among Women Veterans in the Women's Health Initiative. THE GERONTOLOGIST 2016; 56 Suppl 1:S27-39. [PMID: 26768390 PMCID: PMC5881621 DOI: 10.1093/geront/gnv676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/28/2015] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY Trajectories of physical activity (PA) and sedentary time (ST) after military separation are likely important determinants of women's health outcomes later in life, because low PA and high ST are known contributors to premature mortality risk. Our objective was to compare longitudinal trajectories of recreational PA and ST between Veteran and non-Veteran postmenopausal women from the Women's Health Initiative (WHI). DESIGN AND METHODS Women Veteran (n = 3,719) and non-Veteran (n = 141,800) WHI participants were included. Self-reported participation in recreational PA, converted to metabolic equivalent (MET)-hours/week, was prospectively assessed over 8 years. Self-reported ST, defined as hours/day sitting or lying down, was collected at baseline and at Years 3 and 6. Generalized estimating equations were used to compare trajectories of PA and ST between Veterans and non-Veterans, adjusted for demographics and lifestyle behaviors. RESULTS Veterans had higher baseline PA than non-Veterans (13.2 vs 12.5 MET-hours/week, p = .03). PA declined for both groups, with a steeper decline among Veterans (change/visit year -0.19 vs -0.02 MET-hours/week; interaction p < .001). At baseline, Veterans and non-Veterans had similar levels of ST (107.2 vs 105.9 hours/week, p = 0.42). Over time, ST remained stable among Veterans but declined slightly among non-Veterans (change/visit year -0.19 vs -0.49 hours/week; interaction p = .01). IMPLICATIONS The less favorable longitudinal trajectories of PA and ST we observed for women Veterans may contribute to worse health among these individuals later in life. Understanding barriers to enhancing PA and reducing ST in women Veterans could lead to more effective approaches to intervening on these health behaviors.
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Affiliation(s)
- Donna L Washington
- VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, California. Geffen School of Medicine, University of California Los Angeles.
| | - Kristen Gray
- VA Puget Sound Health Care System, Health Services Research and Development, Seattle. Department of Health Services, University of Washington School of Public Health, Seatle
| | - Katherine D Hoerster
- VA Puget Sound Health Care System, Health Services Research and Development, Seattle. Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seatle
| | - Jodie G Katon
- VA Puget Sound Health Care System, Health Services Research and Development, Seattle. Department of Health Services, University of Washington School of Public Health, Seatle. Women's Health Services, VA Office of Patient Care
| | - Barbara B Cochrane
- University of Washington School of Nursing, Seatle. Fred Hutchinson Cancer Research Center
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, State University of New York at Buffalo
| | - Julie C Weitlauf
- VA Palo Alto Health Care System, Sierra Pacific MIRECC and Center for Innovation to Implementation. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine
| | - Erik Groessl
- VA San Diego Health Services Research and Development Unit, California. Department of Family and Preventive Medicine, University of California San Diego
| | | | - Mara Z Vitolins
- Department of Epidemiology and Prevention, Wake Forest University Health Sciences, Winston-Salem
| | - Lesley Tinker
- University of Washington School of Nursing, Seatle. Fred Hutchinson Cancer Research Center
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Individual and contextual correlates of physical activity among a clinical sample of United States Veterans. Soc Sci Med 2015; 142:100-8. [PMID: 26298646 DOI: 10.1016/j.socscimed.2015.07.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 12/11/2022]
Abstract
RATIONALE Veterans, especially those using U.S. Department of Veterans Affairs (VA) healthcare, have poorer health than the general population. In addition, Veterans using VA services are more likely than non-VA users to be physically inactive. Little is known about physical activity correlates among Veterans. To identify targets for health promotion interventions, understanding barriers to and facilitators of physical activity in this population is critical. METHODS This study examined individual-, social-, and perceived neighborhood-level associations of meeting weekly physical activity recommendations (150 min/week of combined leisure and transportation activity) based on the International Physical Activity Questionnaire (IPAQ) among N = 717 patients from VA Puget Sound, Seattle Division using a mailed survey sent 2012-2013 (response rate = 40%). Independent associations were identified with direct estimation of relative risks using generalized linear models (dichotomous outcome), and linear regression (continuous outcome), including variables associated in bivariate tests (p < .05). RESULTS Most participants were male, Caucasian, and unemployed, and had an annual income ≤$40,000. Over two-thirds (69.9%) reported meeting physical activity recommendations. Fewer days of limitations due to physical or mental health (Relative Risk (RR) = 0.99 per day; 95% Confidence Interval (CI) = 0.98, 0.99; p = .01), others doing physical activity with the Veteran (RR = 1.18; 95% CI = 1.04, 1.33; p = .01), receiving ideas from others regarding physical activity (RR = 1.14; 95% CI = 1.01, 1.29; p = .03) and better perceived neighborhood aesthetics (RR = 1.14; 95% CI = 1.06, 1.24; p = .001) were associated with meeting physical activity recommendations. Findings were comparable for total weekly physical activity, but lower depression symptom severity was also associated with increased physical activity. CONCLUSION This study identified individual and contextual correlates of physical activity among VA-using Veterans. Targeting these factors will be important in promoting physical activity in order to address the disproportionate disease burden facing U.S. Veterans. Existing VA interventions targeting physical activity may need to be adapted to account for the influence of contextual factors.
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10
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Hoerster KD, Jakupcak M, Hanson R, McFall M, Reiber G, Hall KS, Nelson KM. PTSD and depression symptoms are associated with binge eating among US Iraq and Afghanistan veterans. Eat Behav 2015; 17:115-8. [PMID: 25687231 DOI: 10.1016/j.eatbeh.2015.01.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/25/2014] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE US Iraq and Afghanistan Veterans with post-traumatic stress disorder (PTSD) and depression are at increased risk for obesity. Understanding the contribution of health behaviors to this relationship will enhance efforts to prevent and reduce obesity. Therefore, we examined the association of PTSD and depression symptoms with binge eating, a risk factor for obesity, among Iraq/Afghanistan Veterans. METHOD Iraq/Afghanistan Veterans were assessed at intake to the VA Puget Sound Healthcare System-Seattle post-deployment clinic (May 2004-January 2007). The Patient Health Questionnaire was used to measure depression and binge eating symptoms, and the PTSD Checklist-Military Version assessed PTSD symptoms. RESULTS The majority of the sample (N=332) was male (91.5%) and Caucasian (72.6%), with an average age of 31.1 (SD=8.5) years; 16.3% met depression screening criteria, 37.8% met PTSD screening criteria, and 8.4% met binge eating screening criteria. In adjusted models, those meeting depression (odds ratio (OR)=7.53; 95% CI=2.69, 21.04; p<.001) and PTSD (OR=3.37; 95% CI=1.34, 8.46; p=.01) screening criteria were more likely to meet binge eating screening criteria. Continuous measures of PTSD and depression symptom severity were also associated with meeting binge eating screening criteria (ps<.05). CONCLUSION PTSD and depression are common conditions among Iraq/Afghanistan Veterans. In the present study, PTSD and depression symptoms were associated with meeting binge eating screening criteria, identifying a possible pathway by which psychiatric conditions lead to disproportionate burden of overweight and obesity in this Veteran cohort. Tailored dietary behavior interventions may be needed for Iraq/Afghanistan Veterans with co-morbid obesity and psychiatric conditions.
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Affiliation(s)
- Katherine D Hoerster
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Rm BB1644, Seattle, WA 98195, United States.
| | - Matthew Jakupcak
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Rm BB1644, Seattle, WA 98195, United States.
| | - Robert Hanson
- VA Puget Sound Healthcare System, Seattle Division, Research and Development Service, 1660 S. Columbian Way, Seattle, WA 98108, United States.
| | - Miles McFall
- VA Puget Sound Healthcare System, Seattle Division, Mental Health Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington, Department of Psychiatry and Behavioral Sciences, 1959 NE Pacific Street, Box 356560, Rm BB1644, Seattle, WA 98195, United States.
| | - Gayle Reiber
- VA Puget Sound Healthcare System, Seattle Division, Research and Development Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington School of Public Health, Departments of Health Services and Epidemiology, 1959 NE Pacific Street, Box 356560, Rm BB1644, Seattle, WA 98195, United States.
| | - Katherine S Hall
- Durham Veterans Affairs Medical Center Geriatric Research, Education, and Clinical Center, 508 Fulton St., Durham, NC 27705, United States; Duke University Medical Center, Department of Medicine, 201 Trent Drive, Box 3003 DUMC, Rm 3502 Busse Building, Durham, NC 27710, United States.
| | - Karin M Nelson
- VA Puget Sound Healthcare System, Seattle Division, Research and Development Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; VA Puget Sound Healthcare System, General Internal Medicine Service, 1660 S. Columbian Way, Seattle, WA 98108, United States; University of Washington Department of Medicine, 1959 N.E. Pacific St. Seattle, WA 98195, United States.
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11
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Yaffe K, Hoang TD, Byers AL, Barnes DE, Friedl KE. Lifestyle and health-related risk factors and risk of cognitive aging among older veterans. Alzheimers Dement 2015; 10:S111-21. [PMID: 24924664 DOI: 10.1016/j.jalz.2014.04.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Lifestyle and health-related factors are critical components of the risk for cognitive aging among veterans. Because dementia has a prolonged prodromal phase, understanding effects across the life course could help focus the timing and duration of prevention targets. This perspective may be especially relevant for veterans and health behaviors. Military service may promote development and maintenance of healthy lifestyle behaviors, but the period directly after active duty has ended could be an important transition stage and opportunity to address some important risk factors. Targeting multiple pathways in one intervention may maximize efficiency and benefits for veterans. A recent review of modifiable risk factors for Alzheimer's disease estimated that a 25% reduction of a combination of seven modifiable risk factors including diabetes, hypertension, obesity, depression, physical inactivity, smoking, and education/cognitive inactivity could prevent up to 3 million cases worldwide and 492,000 cases in the United States. Lifestyle interventions to address cardiovascular health in veterans may serve as useful models with both physical and cognitive activity components, dietary intervention, and vascular risk factor management. Although the evidence is accumulating for lifestyle and health-related risk factors as well as military risk factors, more studies are needed to characterize these factors in veterans and to examine the potential interactions between them.
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Affiliation(s)
- Kristine Yaffe
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA; Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Department of Epidemiology, University of California, San Francisco, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA.
| | - Tina D Hoang
- Northern California Institute for Research and Education, San Francisco, CA, USA
| | - Amy L Byers
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Deborah E Barnes
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Karl E Friedl
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Hall KS, Hoerster KD, Yancy WS. Post-Traumatic Stress Disorder, Physical Activity, and Eating Behaviors. Epidemiol Rev 2015; 37:103-15. [DOI: 10.1093/epirev/mxu011] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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