title: Gender and the use of Veterans Health Administration homeless services programs among Iraq/Afghanistan veterans.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, New Haven, CT 06520-8080, USA. oni.blackstock@yale.edu
authors.forename: Oni J
authors.initials: OJ
authors.lastname: Blackstock
authors.forename: Sally G
authors.initials: SG
authors.lastname: Haskell
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Brandt
authors.forename: Rani A
authors.initials: RA
authors.lastname: Desai
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D016016:Proportional Hazards Models; D012306:Risk; D012737:Sex Factors; D012947:Social Work / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*; D055815:Young Adult