America’s Health Rankings® Health of Women Who Have Served Report was developed with guidance from a panel of experts representing military, veteran, and public health organizations who informed the selection of health measures and other methodological features of the report. For more information on the expert panel, visit the National Advisory Team page.
The primary source of data for this report is the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System (BRFSS), the world’s largest, annual population-based telephone survey system tracking health conditions and risk behaviors in America since 1984. With an annual sample of over 400,000 respondents, BRFSS also has one of the most robust samples of women who have ever served in active duty (over 5,000 annually).
Data from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Survey on Drug Use and Health (NSDUH) and the CDC’s National Health Interview Survey (NHIS) are also included. NSDUH provides national and state data on the use of tobacco, alcohol, illicit drugs, and mental health in the U.S. and includes an annual sample of about 300 women who have served. NHIS is the nation’s largest in-person household health survey conducted since 1957 and includes an annual sample of nearly 600 women who have served.
Definition of Women Who Have Served
Women who have served are defined in this report as “women who have ever served in the U.S. Armed Forces.” While all three data sources utilize this common definition, some differences exist in who is included among those with service. For more information on specific definitions used by BRFSS, NSDUH, and NHIS, see the Description of Measures page.
The selection of the 23 measures that make up America’s Health Rankings® Health of Women Who Have Served Report were driven by three factors:
- Measures must represent overall health conditions, behaviors, and care issues most pertinent to women who have served in the U.S. Armed Forces, including those addressing mental illness and chronic disease.
- Individual measures must have sufficient sample sizes to assure reliable estimates for women who have served and not served overall, for two points in time, and where possible, by age and race/ethnicity.
- Each selected measure must be amenable to change. In other words, each measure can be modified by policy or intervention to achieve measurable improvement.
Data and Analysis
This report utilizes four years of data, 2012-2015, drawn from BRFSS, NSDUH, and NHIS. Data were analyzed using weights and age-adjusted into two- and four-year periods as follows:
- Baseline, 2012-2013: provides a baseline with which to identify changes over time;
- Current, 2014-2015: provides the most current data and an opportunity to measure change since the baseline year; and
- Combined, 2012-2015: provides estimates stratified by age and race/ethnicity. Data were pooled over four years instead of two to produce reliable estimates within the age and race/ethnicity categories.
Women who have served on active duty have a different age distribution than the general U.S. female population. To prevent age from skewing results, data included in this report were age-adjusted to the 2000 U.S. Standard Population. This adjustment produces fairer, more realistic comparisons between women who have and have not served. Age-adjusted prevalence estimates should be understood as relative estimates, not as actual measures of burden. For details on age-adjustment, see the Methodology page.