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Overview

The 2018 Health of Those Who Have Served Report was developed with guidance from a National Advisory Group 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 group, visit the Health of Those Who Have Served Report Advisory Committee.
As with the 2016 Edition, 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 those who have served, totaling nearly 60,000 each year.
This report also draws on data from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health (NSDUH) and the CDC’s National Health Interview Survey (NHIS). 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 2,500 individuals who have served. NHIS is the nation’s largest in-person household health survey conducted since 1957 and includes an annual sample of nearly 7,000 individuals who have served.

Definition of Those Who Have Served

Those who have served are defined in this report as “those who have ever served in the U.S. Armed Forces.” While all three data sources use 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, visit the Methodology page.

Measures

The 2018 Health of Those Who Have Served Report is based on an expanded set of 31 measures. New to this edition are two socioeconomic measures – employment and food insecurity – as well as a measure of self-reported pain. Also new to this edition are six additional mental health measures which span the behaviors, clinical care, and health outcomes domains. Informed by the latest literature and guidance from the National Advisory Group, the selection of these measures was driven by three criteria:
  • Measures must represent overall health conditions, behaviors, and care issues most pertinent to those 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 those who have served and not served overall, and where possible, by age, gender, race/ethnicity, education, and income.
  • Each selected measure must be amenable to change. In other words, each measure can be modified by policy or intervention to achieve measurable improvement.
For more information, see Description of Measures.

Data and Analysis

This report utilizes six years of data, 2011-2016, drawn from BRFSS, NSDUH, and NHIS. Data were weighted and age-adjusted into three two-year periods as follows:
  • Baseline, 2011-2012: provides a baseline by which to compare trends across editions, and over time.
  • Midpoint, 2013-2014: these rates were presented as the “current” rate in the 2016 Edition, and now represent an interim period in the trends analysis.
  • Current, 2015-2016: provides the most current years’ rates and an opportunity to measure change since the midpoint and baseline years.
Unless otherwise noted, this report mainly features data for the most current period, 2015-2016, and tracks progress since the baseline period, 2011-2012.

Age Adjustment

Those who have served on active duty have a different age distribution from the general U.S. 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 those 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 Methodology.

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