Skip to main content
NCBI home page
NIHPA Author Manuscripts logoLink to NIHPA Author Manuscripts
. Author manuscript; available in PMC: 2016 May 1.
Published in final edited form as: Mil Med. 2015 May;180(5):539–546. doi: 10.7205/MILMED-D-14-00210

Health in the news: An analysis of magazines coverage of health issues in Veterans and Military Service Organizations

Nattinee Jitnarin 1, Walker SC Poston 1, Christopher K Haddock 1, Sara Jahnke 1
PMCID: PMC4428679  NIHMSID: NIHMS677424  PMID: 25939108

Introduction

Since October 2011, approximately two million military personnel have served in Afghanistan and Iraq either as part of Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF) and more than half of those personnel have been deployed at least twice.1,2 These military conflicts are considered the longest sustained United States (US) military operation since the Vietnam War. It has been estimated that between 712,800 and 840,000 OEF and OIF veterans back in the US are eligible to apply for Department of Veterans Affairs (VA) disability benefits. These veterans, along with veterans from previous eras, constitute an estimated 22.7 million military veterans in the US.3

Given the rising numbers of veterans, Veterans and Military Service Organizations' (VMSOs) often take the responsibility for assisting service members in their transition to veteran status. VMSOs provide assistance and representation to active duty military members, veterans, and their families on both health and economic issues including separation and retirement, disability, education and training, employment, medical treatment and health benefits. There are currently 47 chartered (formally recognized by the VA Secretary for processing veteran claims) and 96 non-chartered VMSOs in the US that represent the interests of veterans and military members, particularly with respect to assisting with VA claims (http://www.va.gov/vso/VSO-Directory_2012-2013.pdf).

Although there are differences in VMSOs' perspectives, missions, and audiences, they share a primary aim to represent and provide resources and information to their members. One of several channels VMSOs use to communicate information is through the magazines and newsletters they provide to their members. Many VMSOs have their own magazines and newsletters (henceforth referred as magazines), which are distributed digitally or in hard copy. VMSOs' magazines are an influential source of information and are used to update and inform military personnel and veterans about important health, legislative, and other relevant issues. From a public health perspective, the news stories or articles in these magazines can play an important role in influencing and promoting perceptions of health issues in the targeted audiences.4,5 However, little is known about what topics VMSOs choose to educate their members or whether they attempt to promote health and well-being of their members through these outlets.

Given the important role of news media on promoting awareness and education of health-related issues, we conducted a content analysis of health-related information in magazines published and distributed by active VMSOs in hard copy and digital formats.6,7 Previous studies have used content analysis of military media to better understand how health information is transmitted to active duty military personnel and found that content analyses provided critical data for understanding important health issues, especially tobacco use.8-10 The purpose of the present study was to conduct a content analysis of VMSOs' magazines in order to determine which health-related topics VMSOs target and how they inform veterans about health issues. The study was designed to result in an improved understanding of the health-related information that reaches the military and veteran population through this important media outlet.

Methods

A content analysis of VMSOs magazines was conducted to identify health-related information presented to members of VMSOs.

Selection of VMSOs

An initial list of VMSOs was developed for consideration by reviewing the VA's published list of chartered and non-chartered organizations, as well as VSMOs found during an internet search or referenced in the materials of the other organizations. Because the aim of the project was to collect information about VSMOs with broad missions, organizations were excluded if they targeted a specific ethnic or religious group, were limited to a specific medical disorder or injury (e.g., blind), were not national organizations, were determined to be primarily a social organization, did not appear to be currently active at the time of data collection, did not publish magazines or newsletters either online or in hard copy, or did not have an active website. A total of 21 active VMSOs with 23 magazines published either in print or online were included in the final sample (see Table 1).

Table 1.

Characteristics of Veteran and Military Service Organizations' magazines.

Organizations Target Audience Names of Magazine/Newsletter Frequency No. of issues coded First issue examined Last issue examined
Air Force Sergeants Association Military/Active duty SERGEANTs Bimonthly 11 January-February 2011 November- December 2012
American Gold Star Mothers, Inc Military/Active duty The Gold Star Mothers Bimonthly 12 January-February 2011 November- December 2012
American Legion Military/Active duty and Veterans The American Legion Magazine Monthly 24 January 2011 December 2012
The American Legion Dispatch Monthly 23 January 2011 December 2012
American Military Society Military/Active duty and Veterans American Military Society Advocate Bimonthly 12 January-February 2011 November- December 2012
American Veterans Military/Active duty and Veterans American Veterans Magazine Quarterly 7 Spring 2011 Winter 2012
Association of Military Surgeons (AMSUS) Military/Active duty AMSUS Newsletter Quarterly 6 Winter 2011 Summer 2012
Disabled American Veterans Veterans DAV Magazine Bimonthly 12 January-February 2011 November- December 2012
DAV Voluntary Service Bulletin Bimonthly 10 February 2011 December 2012
Fleet Reserve Association Military/Active duty and Veterans FRA Today Monthly 24 January 2011 December 2012
Help Hospitalized Veterans Veterans The HHV Bugle Call Quarterly 5 Spring 2011 Christmas 2012
Korean War Veterans Association, Inc Veterans The Graybeards Magazine Bimonthly 12 January-February 2011 November- December 2012
Marine Corps League Military/Active duty and Veterans SEMPER FI Quarterly 5 January-February 2011 November- December 2011
National Coalition for Homeless Veterans Veterans NCHV e-Newsletter Monthly 23 January 2011 December 2012
Non Commissioned Officers Association Military/Active duty and Veterans NCOA Journal Quarterly 8 January 2011 August 2012
TREA: The Enlisted Association Military/Active duty and Veterans The Voice of the Enlisted Monthly 24 January 2011 December 2012
Rolling Thunder, Inc Veterans Rolling Thunder® Times Monthly 15 March 2011 December 2012
U.S. Department of Veteran Affairs Veterans VAnguard Bimonthly 11 January-February 2011 November- December 2012
Veterans of Foreign Wars of the United States Veterans VFW Monthly 20 January 2011 November- December 2012
Veterans of Modern Warfare, Inc Military/Active duty and Veterans The Modern Warrior Quarterly 3 February 2011 November 2011
Vietnam Veterans of America Veterans The VVA Veteran Bimonthly 12 January-February 2011 November- December 2012
Women’s Veterans of America Military/Active duty and Veterans Women Veterans of American National Newsletter Mont 1 January 2011 January 2011
Wounded Warrior Project Veterans After Action Report Magazine Quarterly 8 January 2011 October 2012
Open in a new tab

Magazines Coding Process

The goals developed for magazine coding were to understand: 1) how VMSOs provide information to their membership; and 2) what health related topics VMSOs address. Coding protocols were developed through an iterative and recursive process that was developed based on previously published content analyses that have been described in detail previously.8-11 We reviewed and modified previous coding manuals used in our health media studies8-11 based on an initial review of the selected VMSOs by our research team. The goal of the coding manual development was to capture all relevant health information contained in the VMSOs magazines. Health topics were identified by the research team, reviewed by military and veteran consultants, and then pilot-tested with a sample of magazines, which led to revisions and finalization of the coding form. The final 15 health topics were selected based on their frequency of occurrence in the sample of magazines, their relevance to military and veterans' health concerns, and previous studies conducting content analyses of health topics among military- and veteran-related print media, policies, and websites.8-11 Health topics identified included substance use issues (alcohol, illegal drugs, tobacco, and smoking cessation), mental health (suicide, posttraumatic stress disorder [PTSD]), war and deployment-related health issues (disability and disability benefit, traumatic brain injury [TBI], Gulf War syndrome [GWS], and Agent Orange), fitness and weight (physical activity, weight and body composition), and health system issues (health care, insurance, VA benefits and services, pharmaceutical formulary provisions).

The coding strategy focused on whether targeted health issues were present or not on the covers of magazines, in the leadership messages (when available), and in the content of the magazine. Magazine covers were defined as the first or the front page of magazines; however, if there was only a masthead on the front page with articles, the health issue was coded as being in the content. A leadership messages was defined as column or note from the magazine/newsletter Editor or a message from the VMSO leadership (i.e., Commanders Call, President Corner, etc.). Magazine content was defined as the remainder of the magazine/newsletter including legislative sections, articles, but excluding lists or short announcements (i.e., award, promotions, conferences, and listings of deceased members), table of contents, editorial board list, caption of photos, and jokes, comics, or humor. Dividing the content coding into these three categories, provided us the ability to capture and compare health information from VMSOs, their actions and priorities on health, and the frequency and types of health promotion messages portrayed. The cover of magazines was coded separately as they generally feature the most critical content used to entice readers. Leadership messages also were coded separately from the general content as they reflect the organization's mission, vision and values, and address current high-profile events or news.

Full coding of the 23 VMSOs magazines/newsletter was conducted from January 2011 through December 2012. Of the 23 magazines selected for coding, three magazines (the Modern Warrior, SEMPER FI, and Women Veterans of American National Newsletters) were coded only for one year (January 2011-December 2011) because their organizations discontinued publishing the newsletters or no longer made them publically available. Each magazine was coded by two independent raters trained and experienced in content analysis and their results were then checked for consistency. When coding differences were identified, health items were reassessed using a consensus process among three additional independent investigators who read and coded the items. If consensus was not obtained, all three investigators were asked to present their decision, and finally make a judgment about the rating. However, given the objective nature of most health topics assessed, rater consistency was easily obtained. Detailed coding definitions and decision rules were included with the coding manual to assist with proper coding procedures and to minimize inter-rater differences.

Analysis Strategy

SPSS (Version 21) was used to conduct all descriptive analyses. The frequency that each health topic was mentioned on the cover, leadership message, and other contents by each VMSO magazine was computed and the proportion of the total health messages that each topic represented across all VMSO magazines for the covers, leadership messages, and other content was calculated.

Results

VMSOs Magazines Characteristics

Of the 21 veterans and military service organizations included in the study, nine served veterans only, three focused on active duty military members, and nine targeted both active duty military and veterans. Nineteen VMSOs published one magazine/newsletter each for their audience while the American Legion and the Disabled American Veterans published two magazines each (see Table 1). Among 23 magazines, 19 were digital and were accessed online via the VMSOs website while four were published only in hard copy and required a membership to receive the magazine/newsletter (SERGEANTS Magazine, American Legion Magazine, SEMPER FI, and the AMSUS newsletter).

Frequency of Health-Related Content in VMSO Magazines

Overall, a total of 288 issues of the 23 magazines from 21 VMSO organizations were collected and coded over two years (n = 150 in 2011; n = 138 in 2012). Among the magazines, 207 had covers and 222 contained leadership messages.

Health Topics on Magazine Covers

Of the 207 covers, 49 (24%) addressed health issues. Within these 49 covers, the top three most addressed health topics were health services-related topics (e.g., Health care, Insurance, VA; 12.1%), Disability and Disability benefits (6.8%), and Agent Orange (3.4%). Smoking Cessation, Illegal Drugs, GWS, Physical Activity, Weight and Body Composition, and General Health issues were never addressed.

Health Topics in Leadership Messages

Among 222 leadership messages, 30% (n=86) mentioned or addressed health issues. Health services-related topics was mentioned most frequently (30%), followed by Disability and Disability Benefit (14.0%) and PTSD (5.3%). Topics such as Smoking Cessation, Illegal Drugs, Physical Activity, Weight and Body Composition, Alcohol, General Health, and Tobacco-related issues, though important to military and veteran's health by the public health community, were never addressed.

Health Topics in Other Contents

Nearly 80% of magazines' other contents mentioned or addressed health issues and all 15 coded health topics were covered in the other contents. Health services-related topics, Disability and Disability Benefit, and PTSD were the top three most mentioned topics while Tobacco-related content and Smoking Cessation, Illegal Drugs, Alcohol, GWS, and Weight and Body Composition were all mentioned with the least frequency (i.e., each represented less than 10% of all health topics). Table 2 provides the frequency counts and ranking (% of total) for the 15 health issues coded within the magazines.

Table 2.

Health topics mentioned or addressed on the covers, leadership messages, and contents of magazines (No [%]).

Health topics Covers Leadership messages Contents
Health services (Health care, Insurance, VA) 25 (12.1) 62 (30.0) 215 (74.7)
Disability and Disability Benefit 14 (6.8) 29 (14.0) 165 (57.3)
PTSD 6 (2.9) 11 (5.3) 117 (40.6)
Agent Orange 7 (3.4) 7 (3.4) 68 (23.6)
Suicide 3 (1.4) 3 (1.4) 50 (17.4)
TBI 2 (1.0) 9 (4.3) 68 (23.6)
Tobacco-related topics 2 (1.0) 0 17 (5.9)
Pharmaceutical Formulary 1 (0.5) 10 (4.8) 67 (23.3)
Gulf War Syndrome 0 1 (0.5) 19 (6.6)
General Health 0 0 95 (33.0)
Physical Activity 0 0 30 (10.4)
Weight and Body Composition 0 0 27 (9.4)
Alcohol 0 0 15 (5.2)
Illegal Drugs 0 0 15 (5.2)
Smoking cessation 0 0 13 (4.5)
Open in a new tab

Top Health Issues in VMSO Magazines

Health services-related topics

The most commonly addressed health topic were those related to health care, health insurance, TRICARE or delivery of health services through the VA health system. For example, 30% of coded leadership messages and nearly 75% of magazines' other content addressed this topic. Health care, Insurance, and VA-related contents typically focused on how VMSOs handled or delivered health care service, how members' health claims were processed, or how TRICARE's new policy or fees affected their members. Examples include:

“TRICARE Prime Enrollment Fees”

(Cover; NCOA Journal, Nov/Dec, 2011).

“VA Moving Toward Paperless Claims”

(Cover; DAV, Mar/Apr 2012).

“…On January 5 at Walter Reed Army Medical Center an Army colonel stood up to offer unsolicited praise for the DAV during a seminar on how to navigate medical boards and the VA claims process…”

(Leadership message; Disabled American Veteran Magazine, March/April 2011).

“…One such issue is health care, more specifically TRICARE and TRICARE for Life. AFSA strongly believes our country should keep faith with its veterans and hold down costs to ensure access to reasonable priced health care…”

(Leadership message; AFSA Magazine, May/June 2012).

“…Armed with the knowledge you gain from the site, you can address your benefits and compensation concerns with WWP counselors and be better informed when working with the VA…”

(Contents page 16; After Action Report Magazine, April 2011).

“…Effective Oct 1, military retirees enrolling in the TRICARE Prime health plan began paying slightly higher annual fees…”

(Contents page 1; AMS, January/February 2012).

The challenges that VAs currently are experiencing, such as health disparities among veterans or VA budget cuts also were highlighted frequently.

“A VA Challenge – Health Disparities among Veterans”

(Cover; The VVA Veteran, March/April 2011).

“…The discussions about cutting the defense budget, and especially about cutting your medical benefits, and perhaps your COLA, should make all of us very concerned…”

(Leadership message; The Voice of the Enlisted, October 2011).

Disability and Disability Benefits

VMSO magazines also devoted a considerable amount of space to information about Disability and Disability Benefits. Generally, Disability-related content focused on war-related disability, amputations or wounds, as well new medical treatments for wounded service members. Examples include:

“Treating and Bringing the wounded home”

(Cover; VFW, February 2011).

“Modern Miracle – Veterans benefit from advances in regenerative medicine”

(Cover; The American Legion, February 2012).

“…Once they come to accept the reality of being wounded this way, then [they] have to deal with all the surgeries to try to fix them up to look more normal…”

(Contents page 25; VFW, February 2011)

Challenges related to the filing of VA claims also were consistently highlighted.

“…Military retirees and the disabled particularly would be affected because they start drawing inflation-adjusted pay at relatively young ages…”

(Leadership message, AMS, November/December 2011)

“…Every dollar donated goes to buy products and services that improve the lives of wounded veterans and military personnel…”

(Leadership message, American Legion Dispatch, November 2012).

“…This 3.6% cost of living adjustment, or COLA, affects veterans receiving compensation for service-connected disabilities…”

(Contents page 1; NCHV, November 2011).

“…VA is facing an unprecedented surge in compensation and pension disability claim filings by 2015…”

(Contents page 29; VAnguard January/February 2012).

PTSD

When PTSD was mentioned, contents generally included details on prevalence, treatment, effects or health concerns related to PTSD.

“The Paradox of PTSD”

(Cover; The VVA Veteran, September/October 2011).

“…these funds be used to address the issues of military retiree health care, research and treatment for PTSD and TBI…”

(Leadership message; FRA Today, September 2012).

“…The numbers of those with Post Traumatic Stress, Traumatic Brain Injury, as well as Chronic Depression are staggering to hear…”

(Leadership message; The Gold Star Mothers, July/August 2012).

“…The president's budget includes $6 billion to enhance VA's ability to provide the best possible specialized care for post traumatic stress, traumatic brain injury and other mental health needs…”

(Contents page 6; The American Legion Dispatch, December 2011).

“…Parsons began to experience symptoms of what would eventually be diagnosed as post traumatic stress disorder (PTSD)…”

(Contents page 44; AmVet Magazine, Winter 2012).

Infrequently Mentioned Health Topics in VMSO Magazines

Smoking Cessation or any Tobacco-related content, Illegal Drugs, and Alcohol were the least three mentioned health issues among the 288 magazines (see Table 2). Smoking Cessation, Alcohol, and Illegal Drugs issues were never addressed on magazine covers or in leadership messages and were mentioned or addressed infrequently in the magazines content. In addition, General Health, Physical Activity, and Weight and Body Composition were never mentioned either in magazine covers or leadership messages, and rarely addressed in the content. GWS also was not mentioned in the covers and was addressed only once in leadership message.

Discussion

This study examined the content of a large and diverse group of VMSO magazines, which provides important data on how VMSOs convey health information to their membership. We assessed the frequency with which 15 health topics were mentioned in 288 issues from 23 different VMSO magazines over two years. The most common health issues addressed in VMSOs' magazines were Health-related topics such as Insurance or VA, Disability and Disability benefits, and PTSD. These results are similar to an earlier study on health topics presented on VMSO websites,11 which found that health system issues (e.g., Health Insurance/TRICARE/VA), PTSD, Disability, Amputation, Wounds were the most addressed topics on VMSO websites. The heavy focus on these topics is not surprising given a core mission of many VMSOs' is assisting their members with disability benefits and claims, keeping their members informed regarding health care, health benefits, disability pension issues, and service-connected disability compensation. Given the high number of veterans with battle-injury amputations, wounds, and PTSD since the beginning of OEF, OIF, and Operation New Dawn (OND),12 it also is reasonable that VMSOs' magazines focus on these health topics.

This study also found that war-related health conditions such as PTSD, TBI, Agent Orange, and Suicide, were frequently mentioned in VMSOs' magazines. These health issues impact a large number of both current military personnel and veterans. For instance, mental health conditions have been found to be highly prevalent among those who served in the recent military conflicts (e.g., OEF and OIF).13-15 Seal et al.,16 estimated that 25% of OEF/OIF veterans who enrolled in the VA health care system were diagnosed with one or more mental health disorders, with PTSD being the most common, followed by depression. It has been predicted that the number of military veterans seeking treatment for mental issues such as PTSD will continue to increase.17 Therefore, it is not surprising that VMSOs provide a considerable attention to these war-related illnesses and conditions as a service to their audience. Interestingly, approximately one-third of veterans from the 1991 Gulf War (175,000-250,000 veterans)2 have been reported to suffer from GWS, but this topic received very little attention when compared with other war-related health problems addressed in VMSOs' magazines.

Tobacco-related topics, including Smoking Cessation, were rarely mentioned in VMSO magazines, which is consistent with previous content analyses in both military and veterans groups. Haddock et al.,8 found that only 6% of coded military installation newspapers over a one year period contained any tobacco-related information. In addition, a previous analysis of health issues covered in the Military Time magazines, a highly influential source of information for military service members, indicates that tobacco-related topics received among the least amount of coverage among all health topics covered.9. Poston and colleagues11 also recently reported that tobacco-related issues were very rarely mentioned in the content of VMSO websites. Given the negative toll tobacco use has on the health of veterans and military personnel (e.g., tobacco-related costs to the military and the VA were over $560 million and $5 billion per year, respectively),18-20 the fact that it is not more frequently addressed by VMSOs is a missed opportunity to communicate critically important health information to our nation's veterans and military personnel. VMSOs could play an important role in combating the culture of tobacco which is prevalent in the armed services8,21-23 and VMSOs should be encouraged to join the military and VA in changing the culture of tobacco among our nation's military personnel and veterans.

VMSOs' magazines also rarely addressed drug and alcohol abuse, despite the unacceptably high rates found among veterans and military members. Current research24 indicated that 8.8% of active military personnel were heavy drinkers, while 39.6% had alcohol binge episode in the past 30 days. In addition, 27.5% of active duty personnel reported any lifetime illicit drug use.24 Alcohol and drug misuse also frequently occurs among veterans. It has been reported that 7.5% classified as heavy drinkers, 22.8% as binge drinkers, and 6% reporting use of illicit drugs in the past year.25 Given the relationship between PTSD and alcohol and drug use,26,27 healthcare utilization and costs for treating individuals with drug and alcohol problems,28 productivity and society impacts (i.e., productivity losses, accident and crime related burdens),29 VMSOs' magazines have an important opportunity to provide critical information regarding alcohol and drug use among its members, as well as raise concerns and awareness that alcohol and drug use often co-occur with PTSD and depression.

Physical activity and body weight were rarely mentioned by VMSOs' magazines. However, despite the physical fitness requirements for service members, 51.2% and 13% of active duty personnel were classified as overweight (Body Mass Index [BMI]=25.0-29.9 kg/m2), and obese (BMI≥30.0 kg/m2), respectively.24 In addition, veterans have a high prevalence of being overweight and obese and they were more likely to be inactive compared to nonveterans.30,31 Importantly, there has been a considerable amount of research and public health concerns into the relationship between these lifestyle behaviors and health.32-34 However, these health issues received little attention by VMSOs magazines when compared to other health topics.

The lack of healthy lifestyle intervention programs provided for this population who are experiencing both physical and mental health problems is crucial for VA's healthcare programs and VMSOs. Thus, providing effective interventions and recommendations addressing lifestyle behaviors in VMSOs' magazines that can be used by both military personnel and veterans is ideal. For example, encouraging more walking was found to be feasible in post-deployment veterans35 or promoting healthy lifestyle behaviors via internet or text messages have proven to be effective.36,37 Thus, improvements in these lifestyle behavioral health of active duty personnel and veterans would directly impact them physically and mentally, and it would increase their job readiness and preparedness.

Our study had several strengths, including the analysis of magazines and newsletters from organizations that serve both military members and veterans, a reliable and well-published coding scheme developed from previous research,8-11,38,39 health information coding by multiple independent raters to ensure coding consistency, and a large sample of nearly 300 VMSO magazine issues over two years for most of the included VMSO magazines. However, our study was limited in that we were unable to obtain two full years of magazine issues from a few of the VSMOs. In addition, the content categories used in this study may not capture all health concerns that are perceived as important by the readers of VMSOs' magazines. However, we used a highly researched method of coding health content.8-11,38,39

Future research should include other VMSOs' communication channels or their social media in order to capture adequate health-related issues provided for their members, specifically tobacco-, alcohol, and drug-related topics. Currently the VA has established more than 150 Facebook accounts and 75 twitter accounts for their offices and medical centers (http://www.va.gov/opa/socialmedia.asp). In addition, the VA already reaches 3 million viewers on their YouTube channels (http://www.youtube.com/user/DeptVetAffairs/videos). Similarly, VMSOs also have their social media outlets for updating news and communicating with their member as well as providing their members a social media handbook for properly following military instruction and protecting operations security (http://www.defense.gov/socialmedia/).

Acknowledgments

Funding Source: This research was supported by National Institute on Drug Abuse R01CA157014, Enhancing Civilian Support for Military Tobacco Control, Christopher K. Haddock and Ruth Malone, principal investigators. Note: The views expressed in this article are those of the authors and do not reflect the official policy or position of the US military, the Department of Defense, the US government, or the VA.

Guarantor: Dr Jitnarin

References

  • 1.Tanielian TL, Jaycox Lisa H. Invisible wounds of war: Psychological and Cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: RAND Corporation; 2008. [Google Scholar]
  • 2.National Research Council. Gulf War and Health: Treatment for Chronic Multisymptom Illness. Washington, DC: The National Academic Press; 2013. [PubMed] [Google Scholar]
  • 3.Department of Veterans Affairs. Washington, DC: Veterans Health Administration; 2012. [accessed April 1, 2014]. 2011 Survey of Veteran Enrollees' Health and Reliance upon VA with Selected Comparisons to the 1999–2010 Surveys. Retrieved from: http://www.va.gov/healthpolicyplanning/soe2011/soe2011_report.pdf. [Google Scholar]
  • 4.Durrant R, Wakefield M, McLeod K, Clegg-Smith K, Chapman S. Tobacco in the news: an analysis of newspaper coverage of tobacco issues in Australia, 2001. Tob Control. 2003;12:S75–81. doi: 10.1136/tc.12.suppl_2.ii75. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Abroms LC, Maibach EW. The effectiveness of mass communication to change public behavior. Annu Rev Public Health. 2008;29:219–34. doi: 10.1146/annurev.publhealth.29.020907.090824. [DOI] [PubMed] [Google Scholar]
  • 6.Brodie M, Hamel EC, Altman DE, Blendon RJ, Benson JM. Health news and the American public, 1996-2002. J Health Polit Policy Law. 2003;28:927–50. doi: 10.1215/03616878-28-5-927. [DOI] [PubMed] [Google Scholar]
  • 7.Clegg SK, Wakefield M, Edsall E. The good news about smoking: how do U.S. newspapers cover tobacco issues? J Public Health Policy. 2006;27:166–81. doi: 10.1057/palgrave.jphp.3200079. [DOI] [PubMed] [Google Scholar]
  • 8.Haddock CK, Parker C, Taylor JE, Poston WSC, Lando H, Talcott GW. An analysis of messages in military installation newspapers. Am J Public Health. 2005;95:1458–63. doi: 10.2105/AJPH.2004.048454. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Haddock CK, Hoffman K, Taylor JE, Schwab L, Poston WSC, Lando HA. An analysis of messages about tobacco in the Military Times magazines. Nicotine Tob Res. 2008;10:1191–7. doi: 10.1080/14622200802163126. [DOI] [PubMed] [Google Scholar]
  • 10.Hoffman KM, Poston WSC, Jitnarin N, et al. A conten analysis of tobacco control policy in the US department of Defense. J Public Health Policy. 2011;32:334–9. doi: 10.1057/jphp.2011.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Poston WSC, Haddock CK, Jahnke SA, Jitnarin N. What do veteran service organizations' websites say about tobacco control? Am J Health Promot. 2013;28:88–96. doi: 10.4278/ajhp.120905-QUAL-426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Fischer H. Congressional Research Service; 2013. [accessed April 1, 2014.]. U.S. Military casualty statistics: Operation New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom. Retrieved from: www.fas.org/crs/natsec/RS22452.pdf. [Google Scholar]
  • 13.United States Army Medical Command. Washington DC: Department of the Army, Office of the Surgeon General; 2008. [accessed April 1, 2014]. Mental Health Advisory Team (MHAT) V Operation Iraqi Freedom 06-08. Retrieved from: http://armymedicine.mil/Documents/Redacted1-MHATV-OIF-4-FEB-2008Report.pdf. [Google Scholar]
  • 14.United States Army Medical Command. Washington DC: Department of the Army, Office of the Surgeon General; 2013. [accessed April 1, 2014]. Mental Health Advisory Team 9 (MHAT 9) Operation Enduring Freedom (OEF) 2013, Afghanistan. Retrieved from: http://armymedicine.mil/Documents/MHAT_9_OEF_Report.pdf. [Google Scholar]
  • 15.Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351:13–22. doi: 10.1056/NEJMoa040603. [DOI] [PubMed] [Google Scholar]
  • 16.Seal KH, Bertenthal D, Miner CR, Sen S, Marmar C. Bringing the war back home. Mental health disorders among 103 788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs Facilities. Arch Intern Med. 2007;167:476–82. doi: 10.1001/archinte.167.5.476. [DOI] [PubMed] [Google Scholar]
  • 17.Stiglitz J, Bilmes L. The three trillion dollar war: The true cost of the Iraq conflict. New York, NY: W. W. Norton & Company; 2008. [Google Scholar]
  • 18.Dall TM, Zhang Y, Chen YJ, et al. Cost associated with being overweight and with obesity, high alcohol consumption, and tobacco use within the military health system's TRICARE prime- enrolled population. Am J Health Promot. 2007;22:120–39. doi: 10.4278/0890-1171-22.2.120. [DOI] [PubMed] [Google Scholar]
  • 19.Poston WSC, Taylor JE, Hoffman KM, et al. Smoking and deployment: Perspectives of junior-enlisted US Air Force and US Army personnel and their supervisors. Mil Med. 2008;173:441–7. doi: 10.7205/milmed.173.5.441. [DOI] [PubMed] [Google Scholar]
  • 20.Institute of Medicine. Combating Tobacco Use in Military and Veteran Populations. Washington, DC: The National Academies Press; 2009. [PubMed] [Google Scholar]
  • 21.Bray RM, Pemberton MR, Hourani LL, et al. Research Triangle Park, NC: RTI International; 2009. [accessed April 3, 2014]. 2008 Department of Defense Survey of Health Related Behaviors among Active Duty Military Personnel. Retrieved from http://www.tricare.mil/tma/2008healthbehaviors.pdf. [Google Scholar]
  • 22.Nelson JP, Pederson LL. Military tobacco use: A synthesis of the literature on prevalence, factors related to use and cessation interventions. Nicotine Tob Res. 2008;10:775–90. doi: 10.1080/14622200802027123. [DOI] [PubMed] [Google Scholar]
  • 23.Poston WSC, Suminski RR, Hoffman KM, et al. Military line leadership and tobacco control: Perspectives of military policy leader and tobacco control managers. Mil Med. 2010;175:811–6. doi: 10.7205/milmed-d-10-00092. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Barlas FM, Higgins WB, Pflieger JC, Diecker K. Fairfax VA: Department of Defense; 2013. [accessed April 3, 2014]. 2011 Health related behaviors survey of active duty military personnel. Retrieved from: http://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-508947957a0f/final-2011-hrb-active-duty-survey-report.pdf. [Google Scholar]
  • 25.Office of Applied Studies. Rockville, MD: Substance Abuse and Mental Health Service Administration; 2005. [accessed April 3, 2014]. Alcohol use and alcohol-related risk behaviors among veterans. Retrieved from: http://www.samhsa.gov/data/2k5/vetsAlc/vetsAlc.pdf. [Google Scholar]
  • 26.Chilcoat HD, Menard C. Epidemiological investigations: Comorbidity of posttraumatic stress disorder and substance use disorder. In: Ouimette P, Brown Pj, editors. Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders. Washington, DC: American Psychological Association; 2003. pp. 9–28. [Google Scholar]
  • 27.McFall M, Cook J. PTSD and health risk behavior. [accessed April 3, 2014];PTSD Research Quarterly. 2006 17:1–7. Retrieved from: http://www.ptsd.va.gov/professional/newsletters/research-quarterly/V17N4.pdf. [Google Scholar]
  • 28.Yu W, Ravelo A, Wagner TH, et al. Prevalence and costs of chronic conditions in the VA health care system. Med Care Res Rev. 2003;60:S146–67. doi: 10.1177/1077558703257000. [DOI] [PubMed] [Google Scholar]
  • 29.U.S. Department of Health and Human Services. Washington, DC: U.S. Department of Health and Human Service; 2000. [accessed April 3, 2014]. 10th Special report to the US Congress on Alcohol and Health; pp. 364–71. Retrieved from: http://pubs.niaaa.nih.gov/publications/10Report/10thSpecialReport.pdf. [Google Scholar]
  • 30.Littman AJ, Forsberg CW, Koepsell TD. Physical activity in a national sample of veterans. Med Sci Sports Exerc. 2009;41:1006–13. doi: 10.1249/MSS.0b013e3181943826. [DOI] [PubMed] [Google Scholar]
  • 31.Almond N, Kahwati L, Kinsinger L, Porterfield D. Prevalence of overweight and obesity among U.S. military veterans. Mil Med. 2008;173:544–9. doi: 10.7205/milmed.173.6.544. [DOI] [PubMed] [Google Scholar]
  • 32.Looney SM, Raynor HA. Behavioral lifestyle intervention in the treatment of obesity. Health Services Insights. 2013;6:15–31. doi: 10.4137/HSI.S10474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Perreira KM, Sloan FA. Excess alcohol consumption and health outcomes: a 6-year follow-up of men over age 50 from the health and retirement study. Addiction. 2002;97:301–10. doi: 10.1046/j.1360-0443.2002.00067.x. [DOI] [PubMed] [Google Scholar]
  • 34.Ford ES, Zhao G, Tsai J, Li C. Low-risk lifestyle behaviors and all-cause mortality: findings from the National Health and Nutrition Examination Survey III Mortality Study. Am J Public Health. 2011;101:1922–9. doi: 10.2105/AJPH.2011.300167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Buis LR, Kotagal LV, Porcari CE, et al. Physical activity in postdeployment Operation Iraqi Freedom/Operation Enduring Freedom veterans using Department of Veterans Affairs services. J Rehabil Res Dev. 2011;48:901–12. doi: 10.1682/jrrd.2010.08.0144. [DOI] [PubMed] [Google Scholar]
  • 36.Spittaels H, De Bourdeaudhuij I, Vandelanotte C. Evaluation of a website-delivered computer-tailored intervention for increasing physical activity in the general population. Prev Med. 2007;44:209–17. doi: 10.1016/j.ypmed.2006.11.010. [DOI] [PubMed] [Google Scholar]
  • 37.Dallery J, Raiff BR, Grabinski MJ. Internet-based contingency management to promote smoking cessation: a randomized controlled study. J Appl Behav Anal. 2013;46:750–64. doi: 10.1002/jaba.89. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38.Krippendorff KH. Content analysis: an introduction to its methodology. Beverly Hills, CA: Sage Publications; 1980. [Google Scholar]
  • 39.Weber RP. Basic content analysis (Quantitative applications in the Social Science) 2nd. Newbury Park, CA: Sage Publications; 1990. [Google Scholar]

RESOURCES