Findings

Executive Summary Introduction Design Findings ConclusionAppendixDescription of Measures Methodology National Advisory Team The Team Copyright
2017 Health of Women Who Have Served - Full Report 2017 Health of Women Who Have Served - Executive Summary 2017 Health of Women Who Have Served - ChartPack
Overview
This report provides a national baseline and comparative portrait of the health of women who have served on active duty in the U.S. Armed Forces and those who have not. Findings highlight the positive health experiences as well as health challenges affecting women who have served. In particular, key findings from the most recent period, 2014-2015, indicate that as compared to women who have not served, those who have served have: 
Significantly higher overall rates of mental illness including lifetime depression, any mental illness in the past year, and suicidal thoughts in the past year.
Better overall self-reported health status, yet significantly higher rates of chronic disease such as cardiovascular disease, COPD, cancer, and arthritis. 
Significantly higher overall rates of health insurance coverage, access to primary care, and utilization of preventive services such as cancer screenings.
Significantly lower overall rates of physical inactivity and obesity, yet higher rates of insufficient sleep.
Strengths Among Women Who Have Served, 2014-2015
Women who have served report better overall health experiences on seven behavior, policy, clinical care, and health outcome measures than those who have not served. 

Challenges Among Women Who Have Served, 2014-2015
Women who have served face greater challenges across nine behavior and health outcome measures than those who have not served. 

Similarities Between Women Who Have and Have Not Served, 2014-2015
Women who have served report overall rates that are not significantly different from civilian women on seven behavior, community and environment, and health outcome measures.
Beyond overall differences in the health of women who have and have not served, significant differences in health experiences exist by age and race/ethnicity. For example, minority women who have served generally experience positive socioeconomic and clinical care benefits compared to minority women who have not served. At the same time, some minority women face higher rates of unhealthy behaviors such as smoking and excessive drinking than their peers who have not served. And while rates of chronic disease generally rise with age, among women aged 50 years and older, those who have served have significantly higher rates of cancer, cardiovascular disease, and other conditions than those who have not served.
The sections that follow provide a summary of key overall and population-specific findings across behavior, policy, community and environment, clinical care, and health outcome measures. Complete data on all 23 measures can be accessed in the Explore Section of this report.
Behaviors
Unhealthy behaviors can have serious long-term health implications for women, including increased risk for chronic disease, disability, and premature mortality. Certain unhealthy behaviors are also symptoms or coping responses common among women experiencing psychological distress. 
Findings from this study suggest that women who have served report significantly lower rates of physical inactivity and obesity than those who have not served; however they report higher rates of insufficient sleep. Rates of excessive drinking and smoking are similar between those who have and have not served. 
More detailed findings on behavior measures for women who have and have not served show that:
Minority women who have served generally have lower rates of obesity and physical inactivity, yet higher rates of insufficient sleep and smoking than minority women who have not served. 
On measures of insufficient sleep, smoking, and excessive drinking, certain groups of minority women who have served report significantly higher rates than minority women who have not served.
Smoking rates are nearly four times as high for Asian women who have served than those who have not served (16.5% vs. 4.2%).
Excessive drinking rates are about twice as high for Hawaiian/Pacific Islander women who have served than those who have not served (22.2% vs. 11.3%). 
Younger women aged 18 to 34 years who have served have lower rates of obesity and physical inactivity, yet they have higher rates of insufficient sleep as compared to their peers who have not served.
Women aged 50 years and older who have served have significantly higher rates of smoking than women who have not served (15.3% vs. 12.8%).
Women aged 35 years and older who have served have similar rates of obesity as women who have not served. 
How Do Women and Men Who Have Served Compare on Health Behaviors?
The 2016 America’s Health Rankings® Health of Those Who Have Served Report revealed that in 2013-2014, women who have served reported lower overall rates of excessive drinking (12.8% vs 21.7%), smoking (17.5% vs. 22.7%), and obesity (25.1% vs. 29.0%) than men who have served. They reported similar rates of insufficient sleep (42.5% vs. 43.4%). While both men and women who have served were less physically inactive than those who have not served, rates of physical inactivity were higher for women than men (21.9% vs. 19.3%). 

Policy
One policy indicator, health insurance, is measured in this report. Women with health insurance often have greater access to health care, and experience better health outcomes than uninsured women. 
In this study, women who have served report significantly higher rates of health insurance coverage than those who have not served (92.7% vs. 87.6%). Higher coverage rates among women who have served are likely attributable to policies that provide distinctive health insurance options for those who have served in the military. These include TRICARE for those currently serving or retired from military service and VA health benefits for those who served and were not dishonorably discharged. 
For both women who have and have not served, health insurance coverage rates significantly increased between 2012-2013 and 2014-2015. This increase generally coincides with health insurance expansion policies that took effect on January 1, 2014 as part of the Affordable Care Act. 

More detailed findings on health insurance for women who have and have not served show that:
Rates of coverage are significantly higher for many groups of minority women who have served as compared to those who have not. Of note, Hispanic women who have served have higher rates of coverage than Hispanic women who have not served (88.0% vs. 69.8%).
Across all age groups, women who have served have higher rates of health insurance coverage than women who have not served.

How Do Women and Men Who Have Served Compare on Health Insurance?
The 2016 America’s Health Rankings® Health of Those Who Have Served Report revealed that in 2013-2014, women and men who have served reported similar rates of health insurance coverage, 91.4% and 90.3%, respectively. Rates of coverage for both men and women who have served were higher than men and women who have not served. 
Community & Environment
Broader community and environmental factors, such as steady, livable wages and consistent access to nutritious food, play a key role in promoting conditions to enable people to achieve and maintain good health. On measures of employment and food insecurity, women who have served report similar overall rates as women who have not served. 
More detailed findings on employment and food insecurity show that:
Black, Hispanic, and multiracial women who have served report significantly higher rates of employment and lower rates of food insecurity than women in these groups who have not served.
Younger women aged 18 to 25 years (89.5% vs. 81.2%) and aged 26 to 34 years (92.4% vs. 87.3%) who have served report significantly higher rates of employment than those who have not served.
Clinical Care
Having a dedicated health care provider is an important predictor of having a usual source of care when needed, and increases women’s opportunity to obtain crucial preventive screenings. Timely access to a personal or primary care provider is also linked to better health outcomes, and obtaining recommended preventive screenings is known to reduce mortality from chronic conditions such as cancer. 

On all three measures of clinical care, women who have served report higher rates of access to and utilization of primary and preventive services. Women who have served report significantly higher rates of receiving recommended age-appropriate cancer screenings, including colorectal cancer screening, Pap smear, and mammogram, than those who have not served (76.7% vs. 71.7%). They are also more likely to have a dedicated health care provider (84.0% vs. 82.0%) and less likely to have unmet medical need due to cost than those who have not served (10.8% vs. 16.0%). 
Unmet medical need due to cost significantly declined for both women who have and have not served between 2012-2013 and 2014-2015. This change may be due to greater health insurance uptake since the implementation of the Affordable Care Act’s major health insurance policies.  
How Do Women and Men Who Have Served Compare on Clinical Care Measures?
The 2016 America’s Health Rankings® Health of Those Who Have Served Report revealed that in 2013-2014, women who have served reported higher rates of colorectal cancer screening (76.2% vs. 72.2%) and having a dedicated health care provider (82.6% vs. 71.7%) than men who have served. However, rates of unmet medical need due to cost were higher for women than men who have served (12.5% vs. 9.0%). 
Following are more detailed findings on clinical care measures for women who have and have not served:

Minority women and women of all age groups who have served generally report better clinical care access and uptake than those who have not served.
Black (12.9% vs. 21.3%), Hispanic (14.4% vs. 25.8%), and multiracial (16.1% vs. 21.7%) women who have served report significantly lower rates of unmet medical need due to cost than women in these groups who have not served. 
Hispanic (82.8% vs. 70.5%) and Asian (89.4% vs. 81.8%) women who have served report higher rates of having a dedicated health care provider than Hispanic and Asian women who have not served. 
Black (83.4% vs. 76.4%), Hispanic (75.0% vs. 69.7%), Asian (80.0% vs. 65.9%), and Hawaiian/Pacific Islander (77.6% vs. 64.7%) women who have served report significantly higher rates of receiving recommended cancer screenings than women in these groups who have not served.
In contrast to patterns observed among minority women, white women who have served report significantly lower rates of having a dedicated health care provider than their peers who have not served (82.7% vs. 85.3%).
Health Outcomes
Many women experience mental or physical illness that negatively impacts their overall well-being. Chronic health conditions can limit activities of daily living, interfere with one’s ability to function at work, school, or as a family caretaker, and increase the likelihood of premature death. Research has also shown chronic disease and mental illness are frequently risk factors for one another, and symptoms of mental distress can make chronic disease management more challenging.10 
Women who have served report better overall health status, yet experience higher rates of many mental and chronic conditions, than those who have not served. Findings on health outcomes in this section are organized by overall health status, mental health, and chronic conditions.
OVERALL HEALTH STATUS
Women who have served report significantly higher rates of high health status than women who have not served (56.4% vs. 50.8%).
Detailed findings indicate that:
Minority women who have served, particularly blacks (49.1% vs. 40.5%), Hispanics (49.8% vs. 32.3%), Hawaiians/Pacific Islanders (63.3% vs. 45.3%), and American Indians/Alaska Natives (43.7% vs. 37.4%), report significantly higher rates of high health status than those who have not served.
Across all age groups, women who have served are significantly more likely to report high health status than women who have not served. 
MENTAL HEALTH
Four measures of mental health are included in this report. Across three measures, women who have served report significantly higher rates of mental health concerns than those who have not served: having ever been diagnosed with depression (25.1% vs. 21.6%), having any mental illness in the past year (30.8% vs. 21.7%), and having suicidal thoughts in the past year (8.1% vs. 4.2%). 
Following are more detailed findings on mental health measures for women who have and have not served:

Women aged 35 to 49 years who have served have significantly higher rates of any mental illness in the past year (33.2% vs. 23.6%) and diagnosis of depression (27.3% vs. 23.0%) than women in this age group who have not served. 
White women who have served are more likely to have a mental illness than white women who have not served. For example, rates of depression are significantly higher for white women who have served than those who have not served (27.1% vs. 24.5%).
Asian women who have served report nearly twice the rate of depression than Asian women who have not served (16.8% vs. 7.7%), however, others, such as Hawaiian/Pacific Islanders who have served report lower rates of depression than those who have not served (9.6% vs. 15.6%).
How Do Women and Men Who Have Served Compare on Mental Health Measures?
The 2016 America’s Health Rankings® Health of Those Who Have Served Report revealed that in 2013-2014, women who have served reported higher rates of depression (25.5% vs. 14.7%) and frequent mental distress in the past 30 days (14.5% vs. 10.3%) than men who have served.
CHRONIC CONDITIONS
Seven self-reported measures of chronic disease are included in this report. Women who have served report higher overall rates on five of these measures (arthritis, any cancer, cardiovascular disease, COPD, and functional impairment) as compared to women who have not served. Rates of diabetes and pain are similar for women who have and have not served. 
Detailed findings indicate that:
Among women aged 50 years and older, those who have served report significantly higher rates of most chronic conditions than those who have not served: arthritis (51.6% vs. 48.6%), any cancer (23.4% vs. 21.6%), cardiovascular disease (16.1% vs. 13.8%), COPD (14.7% vs. 11.2%), and functional impairment (39.5% vs. 33.4%).
White women who have served report poorer outcomes for many chronic conditions than white women who have not served, such as arthritis (31.7% vs. 27.7%), cardiovascular disease (7.9% vs. 6.4%), COPD (9.0% vs. 7.0%), and functional impairment (28.7% vs. 23.0%).
Some minority women who have served report higher rates of chronic conditions, such as any cancer, than those who have not served: Hispanics (8.8% vs. 5.9%), Hawaiians/Pacific Islanders (13.5% vs. 8.3%), and American Indians/Alaska Natives (14.6% vs. 10.3%). 
Over two in five multiracial women who have served report functional impairment (41.5%), a rate higher than all other racial/ethnic groups who have and have not served.
Asian women who have served report significantly poorer health outcomes on a number of measures than Asian women who have not served. Of note, they have significantly higher rates of functional impairment (24.0% vs. 12.0%), diabetes (14.4% vs. 8.2%), and cardiovascular disease (6.6% vs. 4.2%) than those who have not served.
Across all age groups, women who have served report significantly higher rates of functional impairment than women who have not served. In addition, the highest rate of functional impairment is reported among multiracial women who have served.
Women aged 26 to 34 years who have served report nearly twice the rate of arthritis as women in this age group who have not served (15.3% vs. 8.6%). 
How Do Women and Men Who Have Served Compare on Chronic Conditions?
The 2016 America’s Health Rankings® Health of Those Who Have Served Report found that in 2013-2014, women who have served reported higher rates of chronic conditions than men who have served on measures of: arthritis (29.9% vs. 23.7%), any cancer (12.4% vs. 10.7%), COPD (8.7% vs. 6.3%), and functional impairment (27.8% vs. 24.5%).
[10] National Institute of Mental Health. Chronic Illness and Mental Health, 2015. Available at: https://www.nimh.nih.gov/health/publications/chronic-illness-mental-health/index.shtml.