The Effects of Adverse Childhood Experiences and Warfare Exposure on Military Sexual Trauma Among Veterans.

Military sexual trauma (MST) is a pervasive problem; this study examined the relationship of the precursory traumas of adverse childhood experiences (ACEs) and warfare exposure with MST. Post-9/11 veterans were surveyed at 3 months and at 24 to 30 months post-military separation. Female veterans who experienced at least 1 ACE but no warfare exposure were significantly more likely to receive unwanted sexual attention. Veterans (males and females) experiencing three or more ACEs but no warfare exposure were significantly more likely to receive unwanted sexual attention and contact. Experiencing only warfare exposure was not related to unwanted sexual attention or contact for females; however, a significant interaction was found between combined warfare exposure, ACEs, and MST for males and females. Veterans who reported warfare exposure and one to two or three or more ACEs were more likely to report unwanted sexual attention and/or contact. Exploration of individual ACEs revealed a significant relationship between childhood sexual abuse and unwanted sexual contact. For females, witnessing domestic violence predicted unwanted sexual contact. There was also a significant interaction between childhood sexual abuse and warfare exposure. Females who experienced both childhood sexual abuse and warfare exposure were significantly more likely to receive unwanted sexual attention and unwanted sexual contact. Albeit a small sample, males who experienced both were also significantly more likely to receive unwanted sexual attention. The findings reveal that precursory traumatic experiences in childhood and the interaction of ACEs and warfare exposure during military service can increase the likelihood of unwanted sexual attention and contact. This research further substantiates the need for screening efforts. It also demonstrates the importance of practitioners engaging in trauma-informed care principles and practices to address the residual effects of previous experiences during sexual trauma or mental health treatment efforts.

The Moral Injury Symptoms Scale-Military Version-Short Form: Further Scale Validation in a U.S. Veteran Sample.

This study assessed the Moral Injury Symptoms Scale - Military Version - Short Form's (MISS-M-SF) factor structure and construct validity. Participants included 3650 combat-deployed U.S. veterans who answered all 10 MISS-M-SF items from the sixth wave of The Veterans Metric Initiative (TVMI). EFA results suggested a two-factor solution, based on item wording, fit best. CFA results indicated a bifactor model (one general factor and two method factors, based on item wording) fit best. Further investigation revealed that a one-factor model could be used despite the data's multidimensionality. Item-level analyses revealed four items represented the general factor exceptionally well, potentially simplifying assessment in research and clinical applications. Construct validity was also demonstrated through moderate to high correlations with conceptually related measures.

The subjective underemployment experience of post-9/11 veterans after transition to civilian work.

BACKGROUND: Underemployment is a challenge for the civilian workforce and a particular risk for veterans as they transition from military service to civilian employment. Workers' economic and demographic characteristics factor into underemployment risk. Veterans may be at greater risk due to specific economic and demographic factors, transitional factors (e.g., geographic relocation), and characteristics of their military service (e.g., military skill alignment with civilian jobs). OBJECTIVES: Describe underemployment experiences in employed post-9/11 veterans three years after their military transition to the civilian workforce. METHODS: The current study uses self-reported underemployment experience data from a longitudinal study of transitioning veterans. This study compares average perceptions of veteran underemployment experiences by specific groups (e.g., by race, gender, and paygrade) using analysis of variance and logistic regression. RESULTS: Veterans reported underemployment in their current jobs based on a perceived mismatch between the skills, education, and/or leadership experience they gained during military service. CONCLUSIONS: Veterans who were enlisted rank, identified as non-White, completed a bachelor's degree, and indicated PTSD symptoms reported higher pervasive underemployment. Intervention implications for the results, such as employer and veteran employment supports, are discussed.

Foodborne Outbreak Rates Associated with Restaurant Inspection Grading and Posting at the Point of Service: Evaluation Using National Foodborne Outbreak Surveillance Data.

ABSTRACT: A previously conducted national survey of restaurant inspection programs associated the practice of disclosing inspection results to consumers at the restaurant point of service (POS) with fewer foodborne outbreaks. We used data from the national Foodborne Disease Outbreak Surveillance System (FDOSS) to assess the reproducibility of the survey results. Programs that participated in the survey accounted for approximately 23% of the single-state foodborne illness outbreaks in restaurant settings reported to FDOSS during 2016 to 2018. Agencies that disclosed inspection results at the POS reported fewer outbreaks (mean = 0.29 outbreaks per 1,000 establishments) than those that disclosed results online (0.7) or not at all (1.0). Having any grading method for inspections was associated with fewer reported outbreaks than having no grading method. Agencies that used letter grades had the lowest numbers of outbreaks per 1,000 establishments. There was a positive association (correlation coefficient, R2 = 0.29) between the mean number of foodborne illness complaints per 1,000 establishments, per the survey, and the mean number of restaurant outbreaks reported to FDOSS (R2 = 0.29). This association was stronger for bacterial toxin-mediated outbreaks (R2 = 0.35) than for norovirus (R2 = 0.10) or Salmonella (R2 = 0.01) outbreaks. Our cross-sectional study findings are consistent with previous observations that linked the practice of posting graded inspection results at the POS with reduced occurrence of foodborne illnesses and outbreaks associated with restaurants. Support for foodborne illness surveillance programs and food regulatory activities at local health agencies is foundational for food safety systems coordinated at state and federal levels.

The influence of employment program components upon job attainment during a time of identity and career transition.

This study assessed the effectiveness of employment programs components, which resulted in the identification of content and process components that increase employability. Employment program use was studied among 1172 United States of America military veterans to determine which content (i.e., interviewing skills) and process (i.e., working with a mentor/coach) components influence job attainment during a time of career and identity transition. Components were distilled utilizing a common components analysis approach (Morgan et al., 2018). Associations with finding employment up to 15 months after the military-to-civilian transition were explored. Veterans who engaged with employment programs were primarily accessing the following components: career planning, resume writing, and interviewing skills. However, only a few content components were significantly related to obtaining employment: interviewing (with mentor/coach), resume writing (online tools), translating military to civilian work (with mentor/coach), entrepreneurship (with mentor/coach), and virtual career fairs. Furthermore, not all processes or modes of instruction for content components were associated with success in the job market. Having a mentor/coach was one of the most effective delivery strategies. For example, veterans using programs delivered by a mentor/coach that translated military skills to civilian work were more likely to find a job at 6-9-months (84%) and 12-15-months (91%) post military separation. In addition, risks that predicted lower use of employment program components by veterans were identified such as junior enlisted rank, combat exposure, combat arms occupation, and physical health problems. With these findings, program developers, implementers, and funders can channel efforts towards the utilization of employment programs with effective components.

L'influence des composantes du programme d'emploi sur l'obtention d'un travail au cours d' une période de transition identitaire et professionnelle L'utilisation des programmes d'emploi a été étudiée parmi 1172 vétérans de l'armée américaine afin de déterminer quelles composantes du contenu et du processus influencent l'obtention d'un emploi. Une approche d'analyse des composantes communes (common component analysis, CCA) a été utilisée. Les associations avec l'obtention d'un emploi jusqu'à 15 mois après la transition de l'armée à la société civile ont identifié des composantes significativement liées à l'obtention d'un emploi: l'entretien (avec un mentor/coach), la rédaction d'un CV (outils en ligne), la transposition du travail militaire au travail civil (avec un mentor/coach), l'esprit entrepreneurial (avec un mentor/coach) et les salons de l'emploi virtuels. Le recours à un mentor/coach était l'une des stratégies de prestation les plus efficaces. Les risques prédisant une utilisation moindre des composantes du programme ont été identifiés: grade d'enrôlé junior, exposition au combat, occupation dans les armes de combat et problèmes de santé physique.

La influencia de los componentes del programa de empleo en la consecución del trabajo durante una época de transición de identidad y carrera Se estudió el uso del programa de empleo entre 1,172 veteranos militares de los Estados Unidos para determinar qué contenido y componentes del proceso influyen en la consecución del empleo. Se utilizó un enfoque de análisis de componentes comunes. Las asociaciones con la búsqueda de empleo hasta 15 meses después de la transición de militar a civil identificaron componentes relacionados significativamente con la obtención de empleo: entrevistas (con mentor / entrenador), redacción de currículos (herramientas en línea), traducción de trabajo militar a civil (con mentor / entrenador), emprendimiento (con mentor / coach) y ferias de carreras virtuales. Tener un mentor / entrenador fue una de las estrategias de ejecución más efectivas. Se identificaron los riesgos que predecían un menor uso de los componentes del programa: rango de alistados juveniles, exposición al combate, ocupación de armas de combate y problemas de salud física.

The interaction of exposure to adverse childhood and combat experiences on the current mental health of new post-9/11 veterans.

Military veterans have greater exposure to adverse childhood experiences (ACEs) than civilians and many also encounter warfare exposures, which can increase the likelihood of mental health problems. The purpose of this study was to test an interaction between childhood traumas and warfare exposures on the mental health of a sample of nearly 10,000 new post-9/11 veterans. Results revealed that male veterans exposed to one or two ACEs, but no warfare, were more likely to experience anxiety, depression, suicidal thinking, and angry outbursts than the reference group (i.e., no ACEs and no warfare exposure). Female veterans exposed to one or two ACEs, but no warfare, were only more likely to experience suicidal thinking. Male and female veterans exposed to three or more ACEs and no warfare were more likely to experience probable posttraumatic stress disorder (PTSD), anxiety, depression, suicidality, and angry outbursts. Among those veterans who experienced corollaries of combat only (e.g., seeing someone killed or seriously wounded), male, but not female veterans were more likely to have probable PTSD, anxiety, and depression. Veterans exposed to warfare (i.e., combat and the corollaries of combat), irrespective of ACEs exposure, were the most likely to report mental health symptoms. Implications for community-based mental health services are discussed.

Moral Injury and Social Well-Being: A Growth Curve Analysis.

Moral injury (MI) may occur in the context of committing transgressions (i.e., self-directed MI reactions), witnessing transgressions, or being the victims of others' transgressions (i.e., other-directed MI reactions) that violate an individual's moral principles. Veterans with MI may experience impaired social well-being (SWB). Studies on MI and veterans' SWB have focused almost exclusively on social support and used cross-sectional data. The present study used growth curve analyses to examine the associations between self- and other-directed MI reactions and veterans' levels of social support, social functioning, social activities, and social satisfaction over the first 18 to 21 months of their transition to civilian life (N = 9,566). The results demonstrated declines in all SWB outcomes, with self- and other-directed MI reactions having differential effects. Higher versus lower levels of other-directed MI reactions were related to lower baseline scores on all SWB outcomes, ßs = -.06 to -.20, and steeper declines over time in social functioning, ß = -.09, and social satisfaction, ß = -.10. Higher versus lower levels of self-directed MI reactions were related to lower baseline levels of social functioning, ß = -.07, but higher baseline levels of social activity, ß = .04. Higher versus lower levels of self-directed MI reactions were related to a steeper decline in social activity over time, ß = -.10. These findings present a more nuanced picture than that depicted by current MI theoretical frameworks and support further research to uncover moderators of the associations between self- and other-directed MI reactions and SWB outcomes.

The impact of adverse childhood experiences (ACEs) and combat exposure on mental health conditions among new post-9/11 veterans.

OBJECTIVE: Adverse childhood experiences (ACEs) are early life experiences of abuse and neglect, and observed violence, among others. For military veterans, both ACEs and combat exposure are associated with mental health problems. METHOD: This study examines the relationship between ACEs and combat exposure on the current mental health in a large sample of recent post-9/11 U.S. veterans. RESULTS: Fifty-nine percent of female and 39% of male veterans reported exposure to 1 ACE, whereas 44% of female and 25% of male veterans were exposed to multiple ACEs. Female veterans were more likely to experience 4 or more ACEs. ACEs were more consistently associated with mental health problems for male veterans than their female peers. For female veterans, exposure to 1 or 2 ACEs did not increase the odds of having any mental health condition, whereas for males, this level of exposure was associated with probable PTSD and anxiety. Combat patrol events were associated with an increase in the likelihood of having a probable mental health problem, with 2 exceptions-combat patrol events were not associated with depression in male veterans and not associated with alcohol misuse in female veterans. Combat was not associated with alcohol misuse. Experiencing a corollary of combat (e.g., accidents, moral injury) was inconsistently associated with the odds of having a probable mental health problem. CONCLUSIONS: This study confirms prior studies demonstrating a relationship between ACEs and combat on subsequent mental health problems. Importantly, 2 different types of combat exposure had differential effects on mental health problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Reducing barriers to post-9/11 veterans' use of programs and services as they transition to civilian life.

BACKGROUND: Numerous programs exist to support veterans in their transitions to civilian life. Programs are offered by a host of governmental and non-governmental stakeholders. Veterans report encountering many barriers to program participation. This study identified barrier reduction strategies offered by programs that new post-9/11 veterans reported using, determined which strategies veterans use and value, and examined veteran characteristics that impact their odds of using programs that offer barrier reduction strategies. METHOD: This study reflects findings from the first wave of data collection of The Veterans Metrics Initiative (TVMI), a longitudinal study examining the military-to-civilian reintegration of new post-9/11 veterans. The websites of programs used by respondents were coded for barrier reduction components. Veterans also indicated which barrier reduction components they found most helpful in meeting their reintegration goals. RESULTS: Of 9566 veterans who participated in Wave 1 data collection, 84% reported using a program that offered at least one barrier reduction component. Barrier reduction components included tangible supports (e.g., scholarships, cash), increased access to programs, decreased stigma, and encouraged motivation to change. Although only 4% of programs that were used by veterans focused on helping them obtain Veterans Administration benefits, nearly 60% of veterans reported that this component was helpful in reaching their goals. Access assistance to other resources and supports was also reported as a helpful barrier reduction component. For instance, approximately 20% of veterans nominated programs that offered transportation. The study also found evidence of a misalignment between the kinds of barrier reduction components veterans valued and those which programs offered. Veterans from the most junior enlisted ranks, who are at most risk, were less likely than those from other ranks to use barrier reduction components. Study limitations and ideas for future research are discussed. CONCLUSIONS: Despite the evidence that barrier reduction components enhance access to programs and contribute to program sustainability, many programs used by post-9/11 veterans do not offer them. There was also a misalignment between the barrier reduction strategies that veterans value and the strategies offered by programs. Veteran serving organizations should increasingly implement barrier reduction strategies valued by veterans.

Use of Health Services Among Post-9/11 Veterans With Mental Health Conditions Within 90 Days of Separation From the Military.

OBJECTIVE: The Veterans Metrics Initiative is a longitudinal survey study examining the military-to-civilian transition of a cohort of new post-9/11 veterans. This study identified the programs and services used by new post-9/11 veterans who screened positive for mental health problems (N=3,295) and factors that predicted use. METHODS: The population of veterans who separated from active duty service in the 90 days prior to August-November 2016 (N=48,965) was identified and invited to participate in the study. This study reports results from the first wave of data collected. RESULTS: Complete data were provided by 9,566 veterans. Of these, 34% (N=3,295) screened positive for one or more probable mental health problems. A substantial majority of these veterans also reported having a general medical problem. Results revealed that veterans from junior enlisted ranks were significantly less likely than those from higher ranks to use programs and services. Use of programs and services by male and female veterans was similar. Several racial-ethnic differences also emerged. There was some evidence that veterans may underrecognize their own mental health problems. Veterans who were exposed to combat, had a medical discharge, or reported an ongoing general medical condition were all significantly more likely to report using U.S. Department of Veterans Affairs (VA) health care services. CONCLUSIONS: These findings suggest that veterans, particularly those from the junior enlisted ranks-who are most at risk for poor transitions-should be encouraged to use programs and services provided by both the VA and non-VA health care alternatives.

Examining the Factor Structure of the Moral Injury Events Scale in a Veteran Sample.

INTRODUCTION: Interest in moral injury has burgeoned over the last decade as an increasing number of professionals recognize that current conceptualizations of trauma are not sufficient to explain some of the challenges that military service members face. The Moral Injury Events Scale (MIES) was the first instrument developed to measure exposure to military events that could produce moral injury (Nash et al., 2013). Two previously published validation studies that focused on service members still in uniform reveal some discrepancies regarding the scale's factor structure. Bryan and colleagues (2016) documented a three-factor solution (i.e., transgressions-others, transgressions-self, and betrayal), while Nash and colleagues (2013) noted a two-factor solution (i.e., perceived transgressions and perceived betrayals). MATERIALS AND METHODS: With an interest in further scale validation, the present study utilized survey data from a group of veterans recently separated from service, to test the fitness of the two- or three-factor model and to examine the invariance of the scale across gender and branch. The investigators followed the policies governing the protection of human subjects as prescribed by ICF Institutional Review Board. RESULTS: Findings revealed a two-factor structure that differed from previous factor solutions (transgressions-self and transgressions-others) and was invariant across gender and branch. High intercorrelations among the MIES items that addressed exposure and reaction to events suggested that these experiences tend to co-occur. Removal of the event items did not significantly impact model fit. CONCLUSIONS: The factor structure identified in the present study aligns with current theoretical conceptualizations of moral injury. The inability to distinguish between event and reaction items and the lack of impact on the factor structure when event items were removed from the model suggest the MIES is more accurately described as a measure of moral pain as compared to a measure of potentially morally injurious experiences (PMIEs). Given that all events associated with moral injury have impinged upon welfare, justice, rights, and fairness considerations, one could argue that little would be gained by focusing attention on the development of a measure of PMIEs. Given the lack of convergence in factor structure across samples, future directions may profit from a focus on further clarifying the temporal stability of the MIES factor structure.

Parents' and Children's Categorization of Candy are Similar: A Card Sort Protocol.

American children frequently consume candy and, in excess, this may contribute to poor diets with attendant effects on obesity risk. Despite the ubiquity of candy in children's diets, parental concern about children's candy intake, and the diversity of confectionery products available, very little is known about how children and their parents conceptualize candy. Card sorting tasks offer a novel and visual technique to explore and compare an individuals' perceptions of foods and are useful where literacy is limited (e.g. young children). This study aimed to understand and compare how young school-aged children and parents categorize various candy products using a photo card sorting task. In individual laboratory sessions, children (n = 42, 5 to 8 years old) and parents (n = 35) categorized 51 types of candy based on their similarity. A cluster analysis showed that parents created more categories of candies than children (11 versus 8). For example, parents distinguished between candied fruit and candied nuts, whereas children tended to collapse these categories. However, 7 clusters were virtually identical between parents and children (93% similarity). The findings from this study can inform the measurement of candy intake and the development of education materials targeted towards parent feeding around candy.

A novel approach for evaluating programs designed to serve military veterans: Using an adapted common components analysis.

Evaluators are challenged to keep pace with the vast array of Veteran support programs operating in the United States, resulting in a situation in which many programs lack any evidence of impact. Due to this lack of evidence, there is no efficient way to suggest which programs are most effective in helping Veterans in need of support. One potential solution to this dilemma is to reconceptualize program evaluation, by moving away from evaluating programs individually to evaluating what is common across programs. The Common Components Analysis (CCA) is one such technique that aggregates findings from programs that have undergone rigorous evaluation at the level of program components (e.g., content, process, barrier reduction). Given that many Veteran programs lack outcome evidence from rigorous studies, an adaptation to CCA is needed. This report examines cross-sectional data from a pilot study using an adapted CCA across five domains of well-being (i.e., employment, education, legal/financial/housing, mental/physical health, and social/personal relationships). The purpose of this preliminary study is to determine the feasibility of eliciting program nominations and program components from Veterans via an online survey. When coupled with a longitudinal research design, this adaptation to CCA will allow for stronger causal claims about the expected impact of different program components within and across a variety of domains.