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Gender and the Use of Veterans Health Administration Homeless Services Programs Among Iraq/Afghanistan Veterans

Blackstock, Oni J., MD*,†,‡; Haskell, Sally G., MD*,‡; Brandt, Cynthia A., MD, MPH‡,§; Desai, Rani A., PhD, MPH†,∥,¶

doi: 10.1097/MLR.0b013e318245a738
Brief Reports

Background: Female Veterans comprise 12% of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans, the largest proportion of women to serve of any prior cohort. We sought to determine the sex-specific risk of using a Veterans Health Administration (VHA) homeless program among OEF/OIF Veterans and to identify factors associated with increased risk of program use for women compared with men.

Methods: We included OEF/OIF Veterans with at least 1 VHA clinical visit between October 1, 2001, and September 30, 2009. The study’s outcome was the time to first use of a VHA homeless program. Cox proportional-hazards regression was used to estimate the relative risk of using a homeless program by sex, adjusting for relevant sociodemographic and clinical variables. Exploratory analyses examined interactions between sex and all covariates.

Results: Of 445,319 Veterans, 7431 (1.7%) used a VHA homeless program, of which 961 were females (1.8%), and 6470 were males (1.7%) during a median follow-up period of 3.20 years. Women were as likely as men to use a homeless program (adjusted hazard ratio, 1.02; 95% confidence interval, 0.95–1.09); median time to first use was similar for female and male Veterans (1.88 vs. 1.88 y, respectively, P=0.53). In exploratory analyses, we found increased risk of program use for women compared with men for the following subgroups: ages 26–35 years, 100% service-connected disability rating, posttraumatic stress disorder diagnosis, and northeast location.

Conclusions: Overall, there was no substantial difference in the sex-specific risk of using a VHA homeless program. In light of this finding, VHA homeless programs must be prepared to recognize and address the unique needs of female OEF/OIF Veterans.

*Department of Internal Medicine

Robert Wood Johnson Foundation Clinical Scholars Program

Department of Medicine/VA Connecticut Healthcare System

§Yale Center for Medical Informatics

VISN 1 MIRECC/VA Connecticut Healthcare System

Department of Psychiatry, Yale School of Medicine, New Haven, CT

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Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States government.

Funders: VA HSR&D grant DHI 07-065-1, Robert Wood Johnson Foundation Clinical Scholars Program, and Department of Veterans Affairs/VA Connecticut Healthcare System.

Role of the Funding Sources: The funding sources had no role in any of the following: design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

The authors declare no conflict of interest.

Reprints: Oni J. Blackstock, MD, Robert Wood Johnson Foundation Clinical Scholars, Yale School of Medicine, 333 Cedar Street, SHM IE-61, New Haven, CT 06520-8088. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.