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Feature Article

Promoting the health of young Veterans

Every Veteran returning from Iraq and Afghanistan can receive cost free medical care from the Department of Veterans Affairs for any condition related to their service in the theater of war for five years after the date of the discharge or release. In addition, combat Veterans may be eligible for additional VA services, including dental benefits, family support, and help in going back to school and finding a job.

Because most returning Veterans are young adults, the five-year window of opportunity for free care VA offers provides a unique opportunity to address the chronic behavioral risk factors most young adults face, including Veterans. (Veterans with service-related disabilities or other related issues are eligible to receive free VA care for life.)

These factors are enumerated in a new essay titled "Preventing Chronic Illness in Young Veterans by Promoting Healthful Behaviors" in the journal Preventing Chronic Disease, published by the Centers for Disease Control.i The essay's lead author is Rachel Widome, PhD, MHS, of the Center for Chronic Disease Outcomes Research at the Minneapolis VA Medical Center.

According to Widome: "Adoption of healthful lifestyles has the benefits of improved health, reduced disease, and an enhanced quality of life for years to come. As young Iraq and Afghanistan war Veterans return, many will interact with organizations that have a stake in their well-being, which represents an opportunity to emphasize ways to prevent chronic illness in this population."

The paper cites three modifiable behaviors—tobacco use, physical inactivity, and poor diet—that caused one-third of all deaths in the United States in the year 2000. Tobacco use is cited as a particular issue for returning Veterans.

According to the paper, nearly one-third of active duty military personnel reported smoking in the past month in 2008, and 14 percent were reported to be current smokers. (In the general population, the essay states, just fewer than 20 percent of adult Americans are reported to be current smokers and three percent use smokeless tobacco.) ii In addition, it appears Veterans who deploy to combat zones are 50 percent more likely to smoke than their fellow service members who do not deploy.

Weight-related behavior patterns are another concern. The essay cites previous VA data indicating that Iraq and Afghanistan combat Veterans are more likely to be overweight but less likely to be obese compared with others of the same age. The authors also cite a large military cohort study in which nearly half of the participants experienced extreme weight gain (defined as more than 10 percent of their body weight) at a time when many members of the cohort were deployed to Iraq and Afghanistan.

They also cite a study that found that compared with their non-Veteran peers, young adult Veterans may be more affected by stress, depression, substance and alcohol abuse, and sleep loss. All of these issues are linked to weight-related behaviors and obesity.

The paper urges a number of interventions in the lives of young Veterans to help them "set a beneficial health behavior trajectory." The authors suggest that researchers gather additional data, gaining information by using social networking websites, surveying on line, and formulating questions that are relevant to young adults. They also recommend "innovative interventions and�policies" to steer young Veterans toward healthful behaviors, such as improving the nutritional quality of food served at National Guard Weekends, offering fitness classes at VA clinics, and ensuring that all combat Veterans have access to free tobacco cessation aids.

Finally, because not all Veterans enroll in VA health care, Widome and colleagues suggest that VA partner with the Department of Defense (DoD), colleges and universities, and other organizations that may be responsible for the health of young Veterans. These "natural partnerships" among organizations devoted to promoting Veteran health could help reduce health risk behaviors.

VA already has a number of programs targeted at behavioral issues related to those described in the study. VA's National Center for Health Promotion and Disease Prevention (NCP) operates the MOVE program, a national weight management program for Veterans to help Veterans lose weight, keep weight off, and improve their health. All VA facilities have either MOVE or an alternative weight management program.

To help Veterans quit smiling and tobacco use, VA offers screening for tobacco use during primary care visits; individual counseling; prescriptions for nicotine replacement therapy, such as nicotine patches and gum; and participation in evidence-based smoking cessation programs—and VA has a partnership with DoD enabling Veterans to receive access to DoD's tobacco cessation website, which includes online tools, personalized quit plan, and live chat services.

VA also offers specialty inpatient and outpatient mental health services at its medical centers and community-based outpatient clinics. In addition, readjustment counseling services are available to Veterans and their families at Vet Centers throughout the Nation. All VA mental health care supports recovery, striving to enable a person with mental health problems to live a meaningful life in their community and achieve their full potential.

For information on VA's MOVE program, visit www.move.va.gov. For information on VA's smoking cessation program, go to www.publichealth.va.gov/smoking. And for a brochure on the mental health services VA provides to enrolled Veterans, visit www.mentalhealth.va.gov.


i R Widome, AJ Littman, MN Laska, SS Fu, "Preventing Chronic Illness in Young Veterans by Promoting Healthful Behaviors," Prev Chronic Dis 2012;9:110132.DOI: http://www.cdc.gov/pcd/issues/2012/11_0132.htm ii Centers for Disease Control and Prevention (CDC). Vital signs: current cigarette smoking among adults aged ?18 years --- United States, 2005--2010. MMWR Morb Mortal Wkly Rep 2011;60:1207-12., cited in Widome et al, Idem.

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