The 2020 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, see Methodology.
As in previous editions, 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, see Methodology.
The 2020 Health of Those Who Have Served Report is based on 29 measures. 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.
Data and Analysis
This report utilizes eight years of data, 2011- 2018, drawn from BRFSS, NSDUH, and NHIS. Data were weighted and age-adjusted into two-year periods as follows:
- Baseline reporting period, 2011-2012: provides a baseline by which to compare trends across editions, and over time.
- Prior reporting period, 2015-2016: these rates were presented as the “current” rate in the 2018 Edition, and now represent the most recent interim period in the trends analysis.
- Current, 2017-2018: provides the most current rates and an opportunity to measure change since the prior and baseline reporting period.
Unless otherwise noted, this report mainly features data from 2017-2018, and tracks progress since the baseline reporting period, 2011-2012.
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 additional information, see Methodology.