RESUMO
Background: Over the past two decades, increasing numbers of women have served in the military, with women now comprising 17.3% of active-duty personnel and 21.4% of National Guard and reserves. During military service, women often incur painful musculoskeletal (MSK) injuries related to carrying heavy loads and wearing ill-fitting gear. While women may receive initial care for these injuries under the auspices of the Department of Defense (DoD), these injuries often linger and further treatment in required as women transition to Department of Veterans Affairs (VA) care. However, little is known about this transition process, and whether women are given adequate information and support regarding how to access VA care after their military service has ended. Research Design: To better understand these issues, we interviewed 65 women veterans with military service-related MSK injuries about their transition from DoD to VA care. Results: Six major themes emerged from the interviews. Those themes were: (1) Military injuries are often related to ill-fitting gear or carrying heavy loads; (2) Stigma/discrimination related to military injuries; (3) Limited assistance with transition between DoD and VA to manage ongoing injuries and pain; (4) Women have a difficult time managing perceptions and expectations of their weight after military service; (5) Childcare is a substantial burden for veterans in self-care; and (6) veterans desire peer-support services to help them stay healthy. Conclusions: Based on these findings, DoD and VA should continue to work together to develop programs to educate and support women as they transition from military to VA care. Furthermore, VA should consider developing peer support programs for women Veterans who may require additional support to maintain health, especially among Veteran mothers who have complex family responsibilities that may limit their ability to focus on their own health.
RESUMO
BACKGROUND: People with serious mental illness are disproportionately affected by smoking and face barriers to accessing smoking cessation treatments in mental health treatment settings. Text-based interventions are cost-effective and represent a widely accessible approach to providing smoking cessation support. OBJECTIVE: We aimed to identify key factors for adapting text-based cessation interventions for people with serious mental illness who smoke. METHODS: We recruited 24 adults from mental health programs who had a serious mental illness and currently smoked cigarettes or had quit smoking within the past 5 years. We then conducted virtual qualitative interviews between November 2020 and August 2021. Data were analyzed using the rapid thematic analytic approach. RESULTS: We identified the following 3 major themes: (1) interplay between smoking and having a serious mental illness, (2) social contextual factors of smoking in adults with serious mental illness, and (3) smoking and quitting behaviors similar to the general population. Participants reported barriers and facilitators to quitting across the 3 themes. Within the "interplay between smoking and having a serious mental illness" theme, barriers included smoking to manage stress and mental health symptoms, and facilitators to quitting included the awareness of the harm of smoking on mental health and patient-provider discussions on smoking and mental health. In the "social contextual factors of smoking in adults with serious mental illness" theme, barriers included high social acceptability of smoking among peers. Positive support and the combined social stigma of smoking and having a mental health condition outside of peer groups motivated individuals to quit. Some participants indicated that low exposure to other smokers during the COVID-19 pandemic helped them to engage in cessation efforts. In the "smoking and quitting behaviors similar to the general population" theme, barriers included smoking after eating, having coffee, drinking alcohol, and experiencing negative social support, and facilitators included health concerns, improvement in the general quality of life, and use of evidence-based tobacco treatments when available. CONCLUSIONS: People with serious mental illness often smoke to cope with intense emotional states, manage mental health symptoms, or maintain social bonds. Text message content emphasizing equally effective and less harmful ways for stress reduction and mental health symptom management may improve quit rates in individuals with serious mental illness.
