Women's Health Issues Addresses Sex and Gender Differences in Veterans' Health

WASHINGTON, D.C. (June 25, 2019) — A new supplement to the peer-reviewed journal Women’s Health Issues, sponsored by the Cooperative Studies Program of the Veterans Health Administration (VA) Office of Research and Development, examines sex and gender differences in U.S. veterans’ health conditions and responses to treatments. Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, based in the Milken Institute School of Public Health at the George Washington University.
 
Women veterans make up a growing share of the population receiving VA care (7.5 percent) and are enrolling in cohort studies and clinical trials in greater numbers, but too few trials report results by sex or gender. This supplement adds to the growing literature on veterans’ health and contributes to broader efforts to improve reporting of results by sex/gender as well as informing ongoing work to improve care for women veterans.
 
“Our research program is a major driver of VA’s ability to provide patient-centered, evidence-based care for women veterans,” said Rachel B. Ramoni, DMD, ScD, chief research and development officer at the VA. “This collection of articles highlights some of the innovative, impactful work we are doing in this area.”
 
Articles in the supplement include commentaries providing historical context and recommendations for research attentive to sex/gender differences, examinations of how existing VA research addresses these differences, analyses of health and health behaviors among men and women enrolled in cohort studies of Gulf War Era veterans, and studies on sex/gender differences in specific areas of health, from trauma and suicide to smoking and obesity.
 
Ideas about Harassment Differ by Gender
Women veterans seeking care at VA facilities have reported a high prevalence of harassment from men who use those facilities. To examine veterans' perceptions and experiences of harassment on VA grounds, Karen Dyer of VA Greater Los Angeles Healthcare System and colleagues conducted single-gender discussion groups with men and women veterans. They found that women veterans readily identified comments and behaviors they considered harassing or offensive, such as catcalls, whistles, uncomfortable stares, and being gawked at or touched, whereas men were not in agreement about whether behaviors such as stares, whistles, telling women to smile, or complimenting women's appearances constituted harassment. Both women and men recommended that VA staff do more to address and prevent harassment. However, men suggested that women should set boundaries with their harassers, whereas women stated that they should not be responsible for "training" men about acceptable behavior.
 
Risk of Self Harm Higher in Veterans with Both PTSD and Substance Use Disorder
Silvia Ronzitti, of VA Connecticut Healthcare System and Yale School of Medicine, and colleagues analyzed data on 352,476 Iraq/Afghanistan veterans diagnosed with post-traumatic stress disorder (PTSD) to examine the relationship between substance use disorder (SUD) and the likelihood of dying by suicide and engaging in non-fatal self-directed violence in men and women. For both genders, they found that having a SUD increased the risk of engaging in self-directed violence in veterans with PTSD, while having a SUD increased the risk of dying by suicide only in men with PTSD.
 
Relationship between Pain Intensity and Interference Similar for Women and Men
Jennifer C. Naylor, of Durham VA Medical Center and Duke University Medical Center, and colleagues examined the experience of pain among Iraq/Afghanistan-era veterans. More than 80 percent of the sample reported chronic pain (lasting for three or more months), and women with chronic pain reported a greater degree of interference from pain on several aspects of life: activity, enjoyment, mood, relations with other people, sleep, walking, and work. This greater degree of pain interference, the authors found, was associated with women's reports of greater pain intensity. After they controlled statistically for pain intensity, gender differences in pain interference disappeared, suggesting that the relationship between pain intensity and interference with life is similar for women and men.
 
Men and Women with Obesity Report Self-Management Support
People with obesity often receive less preventive care and experience stigma and discrimination, so Jessica Y. Breland of VA Palo Alto Health Care System and colleagues examined care experiences and primary care provider ratings of patients in different body mass index categories (no obesity and obesity classes 1-3). Their analysis of data from the 2014 VA Survey of Health Care Experiences of Patients found that men, but not women, with class 2 obesity gave lower overall ratings to their providers, suggesting a need to investigate possible obesity-related stigma. For both women and men, those with obesity were more likely than those without it to report having conversations with providers about health goals and barriers. This, the authors write, "suggests that VA patients with obesity are receiving support to facilitate the considerable behavior change required to manage obesity and its related conditions."
 
Veterans More Likely to Report Military Sexual Trauma to Researchers than to Providers
The VA screens all patients for military sexual trauma (MST) – sexual assault or repeated, threatening sexual harassment that occurred while a veteran was serving on active duty or in training – but some veterans who have experienced MST don't report it to their providers. Michelle J. Bovin, of the National Center for PTSD at the VA Boston Health Care System and Boston University School of Medicine, and colleagues compared reports of MST from the same group of veterans using three different modalities: the VA screen administered at a medical appointment, a study interview, and a study questionnaire. They found that both men and women were more likely to report MST on both of the study measures than they were when a VA provider asked about it in a clinical setting, and the difference was greatest for men. "Providing a clear rationale for screening and increasing privacy around screening results, particularly for male veterans, may help to facilitate MST disclosure," the authors conclude.
 
The supplement “Examining Sex/Gender Differences in Veterans Affairs Research” was published online June 25.