Examining the Association Between Social Determinants of Health and Food Insecurity Among U.S. Military Veterans

Abstract Food insecurity remains a recognized major public health crisis in the U.S. It affects all segments of the population, but specifically U.S. military veterans who between 2012 and 2018 had a higher prevalence of food insecurity in contrast to the general population (27% - 48.5% and 11.1% - 14.5% respectively). Despite strides being made in various levels of society to mitigate the American experience with food insecurity, research addressing U.S. military veterans concerning this topic is inadequate. The aim of this explanatory sequential mixed methods study was conducted in two well-defined phases by: (1) analyzing three waves of secondary data from the National Health and Nutrition Examination Survey (NHANES) 2011 – 2016 to examine the prevalence of food insecurity among U.S. military veterans, and (2) utilizing an interpretive qualitative interview component to uncover the meaning U.S. military veterans gave to their lived experience with social determinants of health and food insecurity. The selected theoretical approach was an adapted version of the National Institute on Minority Health and Health Disparities Framework (NIMHD Framework). Data for the first phase of the study was acquired from three waves (2011-2016) of secondary data from NHANES. Utilizing an interpretive qualitative approach for the second phase of the study, data from Central Pennsylvania U.S. military veterans who completed semi-structured open-ended interviews were inductively analyzed. Results from the quantitative arm revealed that the prevalence of food insecurity among U.S. military veterans between 2011 and 2016 was 19.4%. Significant independent health status correlates of food insecurity among U.S. military veterans included general health rated as good compared to excellent/very good, prevalent liver problem, and major depression. Although gender had a moderating effect on the relationship between food insecurity and prevalent liver problem, the estimated odds ratio for the gender-stratified fully adjusted model for females was not reliable due to the small sample size for females. The qualitative findings revealed study participants highlighted financial strain as the main driver of food insecurity. Notwithstanding that finding, access to healthcare, having a social support network, and monthly access to community food safety net programs were among the factors that mitigated their experience with food insecurity. U.S. military veterans also offered suggestions to decrease the experience of food insecurity. This study has shown that U.S. military veterans not only experience higher rates of food insecurity compared to the general population but the main driver of food insecurity was their lived experience with financial strain and other determinants such as service-connected disabilities, health status, military culture and pride, and limitations affecting ability to work that warrant further attention. Insights gained from this study may inform the development of multi-sectoral intervention strategies aimed at identifying and addressing associated determinants of health among food insecure U.S. military veterans.

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Work Title Examining the Association Between Social Determinants of Health and Food Insecurity Among U.S. Military Veterans
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Penn State
Creators
  1. Suzanne Akuley
Keyword
  1. Chronic disease
  2. Post-traumatic stress disorder
  3. Qualitative methods
  4. Veterans’ health
  5. Social determinants of health
License In Copyright (Rights Reserved)
Work Type Research Paper
Acknowledgments
  1. Committee Members, Dr. F. Sarpong, PSU Public Health Sciences staff, LTC (ret) John Wheatley, U.S. Department of Veterans Affairs, Veteran Readiness and Employment Program, Central Pennsylvania Food Bank -- MilitaryShare, Veterans Employment Representative, and Director, York County Veterans Affairs, Mr. Saunders & Mrs. Waters -- Pennsylvania Department of Health.
Publication Date March 22, 2022
DOI doi:10.26207/xds7-x186
Deposited March 22, 2022

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  • Updated Acknowledgments Show Changes
    Acknowledgments
    • Committee Members, Dr. F. Sarpong, PSU Public Health Sciences staff, LTC (ret) John Wheatley, U.S. Department of Veterans Affairs, Veteran Readiness and Employment Program, Central Pennsylvania Food Bank -- MilitaryShare, Veterans Employment Representative, and Director, York County Veterans Affairs, Mr. Saunders & Mrs. Waters -- Pennsylvania Department of Health.
  • Added Creator Suzanne Akuley
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    Work Title
    • Examining the Association Between Social Determinants of Health and Food Insecurity Among U.S. Military Veterans.
    • Examining the Association Between Social Determinants of Health and Food Insecurity Among U.S. Military Veterans
    Keyword
    • Chronic disease, Post-traumatic stress disorder, Qualitative methods, Veterans’ health, Social determinants of health
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