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Access to Care and Health Outcomes Among Women Veterans Using Veterans Administration Health Care: Association With Food Insufficiency

  • Kimberly Narain
    Correspondence
    Correspondence to: Kimberly Narain, MD, PhD, MPH, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, 911 Broxton Ave, Los Angeles, CA, 90024. Phone: 213-536-9897.
    Affiliations
    Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California

    VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • Bevanne Bean-Mayberry
    Affiliations
    Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California

    VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • Donna L. Washington
    Affiliations
    Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California

    VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • Ismelda A. Canelo
    Affiliations
    VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • Jill E. Darling
    Affiliations
    VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • Elizabeth M. Yano
    Affiliations
    VA HSR&D Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California

    Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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Published:February 20, 2018DOI:https://doi.org/10.1016/j.whi.2018.01.002

      Abstract

      Background

      Food insecurity has been associated with worse health outcomes in the civilian population. Male veterans of the Gulf Wars have been shown to have a higher prevalence of food insecurity than similarly situated civilians. Women veterans have more risk factors for food insecurity, relative to male veterans, yet little is known about the prevalence of food insecurity in this cohort.

      Methods

      We used the Women Veterans' Health Utilization and Experience Survey for this analysis. Our study population consisted of women veterans who had at least three primary care or women's health visits to 1 of 12 Veteran's Health Administration health care facilities from December 2013 to November 2014. Multiple logistic regression was used to examine the relationship between food insufficiency (an inadequate amount of food intake owing to a lack of money or resources), delayed/missed care, anxiety, depression, and self-reported fair to poor health, controlling for race/ethnicity, marital status, and employment status.

      Results

      The prevalence of food insufficiency among women veterans was 27.6%. Being food insufficient was associated with 16.4, 15.4, 14.9, and 12.1 percentage point increases in the probability of delayed/missed care, screening positive for anxiety, screening positive for depression, and reporting fair to poor health, respectively (p < .05).

      Conclusions

      The prevalence of food insufficiency in this cohort was associated with delayed access to health care and worse health outcomes. Interventions addressing Veterans Administration access and health outcomes will need to examine the potential role of food insufficiency.
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      Biography

      Kimberly Narain, MD, PhD, MPH, is an Assistant Professor in the Division of General Internal Medicine and Health Services Research at the UCLA David Geffen School of Medicine, exploring the implications of health and social policies for health equity.

      Biography

      Bevanne Bean-Mayberry, MD, MHS, is a Clinical Associate Professor of Medicine at the VA Greater Los Angeles Healthcare System and UCLA David Geffen School of Medicine. She is a general internist whose research focuses on gender differences in quality measures and patient satisfaction.

      Biography

      Donna L. Washington, MD, MPH, is Women's Health Focused Research Area Lead, VA HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy; and Professor of Medicine, UCLA. Her research interests include the health care needs of women, and vulnerable/underserved populations.

      Biography

      Ismelda A. Canelo, MPA, is a Health Science Specialist, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy. She has 20 years of experience managing VA primary care and women's health organizational and implementation research.

      Biography

      Jill E. Darling, PhD, MSHS, is a survey research methodologist whose areas of expertise include the design and conduct of large-scale mixed-methods data collection projects, multi-mode surveys, questionnaire development and design, data analysis, and survey research ethics.

      Biography

      Elizabeth M. Yano, PhD, MSPH, is Director, VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, and Professor, Health Policy & Management, UCLA Fielding School of Public Health. Her research focuses on primary care and women's healthcare delivery.