Characteristics Associated with Persistent Versus Transient Food Insecurity Among US Veterans Screened in the Veterans Health Administration
Abstract: Awareness of negative health impacts associated with food insecurity among US veterans is growing. Yet, little research has examined characteristics associated with persistent vs transient food insecurity. Our aim was to investigate characteristics associated with persistent vs transient food insecurity among US veterans. The study used a retrospective, observational design to examine data from Veterans Health Administration electronic medical records. The sample consisted of veterans (n = 64,789) who screened positive for food insecurity in Veterans Health Administration primary care during fiscal years 2018-2020 and were rescreened within 3 to 5 months. Food insecurity was operationalized using the Veterans Health Administration food insecurity screening question. Transient food insecurity was a positive screen followed by a consecutive negative screen within 3 to 15 months. Persistent food insecurity was a positive screen followed by a consecutive positive screen within 3 to 15 months. A multivariable logistic regression model was used to assess characteristics (eg, demographic characteristics, disability rating, homelessness, and physical and mental health conditions) associated with persistent vs transient food insecurity. Veterans with increased odds of persistent vs transient food insecurity included men (adjusted odds ratio [AOR] 1.08; 95% CI 1.01 to 1.15) and those from Hispanic (AOR 1.27; 95% CI 1.18 to 1.37) or Native American (AOR 1.30; 95% CI 1.11 to 1.53) racial and ethnic groups. Psychosis (AOR 1.16; 95% CI 1.06 to 1.26); substance use disorder, excluding tobacco and alcohol (AOR 1.11; 95% CI 1.03 to 1.20); and homelessness (AOR 1.32; 95% CI 1.26 to 1.39) were associated with increased odds of persistent vs transient food insecurity. Veterans who were married (AOR 0.87; 95% CI 0.83 to 0.92) or had a service-connected disability rating of 70% to 99% (AOR 0.85; 95% CI 0.79 to 0.90) or 100% (AOR 0.77; 95% CI 0.71 to 0.83) had lower odds of persistent vs transient food insecurity. Veterans at risk for persistent vs transient food insecurity may struggle with underlying issues like psychosis, substance use, and homelessness in addition to racial and ethnic inequities and gender differences. More research is needed to understand the characteristics and mechanisms that increase risk for persistent vs transient food insecurity among veterans.
Abstract: U.S. Air Force remotely piloted aircraft (USAF RPA) personnel face diverse stressors negatively affecting psychological health and military readiness. Prior research in diverse populations supports predictable impact of the COVID-19 pandemic on occupational stressors, burnout, and more distal outcomes. Extending earlier studies linking broad variables (e.g., COVID-19 threat → work stress → burnout), the current study tests and refines an expanded mediation model based on multiple distinct pandemic concerns, occupational stressors, and burnout facets as antecedents of psychological distress mid-pandemic in RPA personnel (N = 496). Differential representation of demands, resources, and rewards evident across distinct occupational stressors in light of job demands/resources theory guided specification of mediated pathways. SEM analysis yielded moderate fit. Following removal of non-significant paths and addition of two interpretable direct paths, fit was improved, yielding seven dominant pandemic concern → occupational stressor → burnout → psychological distress pathways. In support of domain specification, five 'hub' variables (pandemic-driven change, personal stressors, workload, leader communication, and exhaustion) emerged as key intervention targets in mitigating distress in the USAF RPA community and similar populations during future pandemic-related crises.