As the population ages, there is a need to better understand the types of assistance people need and where they receive it, whether in their own homes, in nursing homes, or, increasingly, in community-based residential care settings (e.g., assisted living facilities) that offer access to long-term services and supports. We estimated the United States older adult population, their places of residence, and their demographic, health, and functional characteristics using multiple data sources: the Medicare Current Beneficiary Survey 2008 and 2013 Cost and Use Files; Health and Retirement Survey 2008 and 2014; National Health and Aging Trends Study 2011 and 2015; and the National Study of Long Term Care Providers 2010, 2012, and 2014. The number of people living in community-based residential care has increased over time, but estimates vary by survey. However, with a few key exceptions, the demographic characteristics of residents are similar across years and datasets. In all data sources, and at all points in time, people living in community-based residential care settings reported more impairments than did those living in traditional settings. People living in community-based residential settings were similar, in many ways, to those living in nursing homes. In all settings, the proportion of people with dementia increased over time. These patterns were consistent across data sets. The share of older adults living in community-based residential care settings is increasing, along with their health and functional needs. Whether these setting have the staffing or expertise to meet these care needs is an important policy consideration.

Residential care facilities, known by a variety of names such as assisted living or group homes, offer assistance to people who find it difficult to live alone but who do not need or wish to enter a nursing home. There is substantial variation in the amount that residents are charged each month. Data from the 2010 National Survey of Residential Care Facilities were used to identify factors that affect the total monthly charges to residents. These findings can inform an individual's search for an appropriate, affordable option.

Many military personnel returning from deployment have significant mental health issues, which may impact family functioning. This descriptive study examines 1,702 child maltreatment incidents involving previously deployed soldiers to identify characteristics associated with intimate partner violence committed on the same day as the child maltreatment incident. Such events were more likely to be committed by male parents, to consist of emotional abuse, and to involve offender alcohol use. Soldier concerns regarding interpersonal conflict predicted co-occurring intimate partner violence, but depression and post-traumatic stress disorder (PTSD) did not. Better understanding of co-occurrence may suggest opportunities for prevention and early intervention services.

Military settings present a unique context that can affect the continuity of care for substance abuse and other issues. We examined the impact of military work-related factors (increased work tempo, deployment, and permanent change of station) on treatment disruption for substance abuse and family violence among Army soldiers from the perspective of substance abuse treatment providers and clinical social workers. Among the 264 respondents, nearly 90% of providers reported that work-related factors resulted in disruption or termination of soldiers' treatment. Given the potential implications of treatment disruption on treatment effectiveness, steps for ensuring treatment continuity for soldiers should be considered.

Deployment represents a significant potential strain on military families. The impact of postdeployment stresses may be increased if family coping resources are diminished by returning service members’ physical injuries, mental health issues, or substance abuse. This article examines the health and mental health correlates of self-reported concerns regarding interpersonal conflict among married soldiers following return from deployment and the likelihood that soldiers acknowledging such concerns are referred to counseling services. Among 20,166 married Army soldiers completing Post-Deployment Health Reassessments, 18% reported having experienced serious interpersonal conflict with their spouse, family members, close friends, or coworkers. Results indicate that interpersonal conflict was more common among those who reported health problems, depression, post-traumatic stress disorder, and alcohol abuse. Among soldiers reporting interpersonal conflict and not already receiving services, 11% were referred to service. Findings support the need to communicate with soldiers and their spouses about the availability of services following return from deployment and to continue efforts to reduce stigma associated with seeking treatment.

Attention to child maltreatment in the military has risen in recent years in response to greater focus on family well-being and evolving response to domestic violence. This research brief describes aspects of military life that may protect against risks for child maltreatment or increase such risks. Based on this evidence, we suggest a research agenda to inform prevention and intervention efforts.

Few studies have compared persons in treatment to those not in treatment with regard to perceived stigma. We surveyed soldiers to examine differences in stigma perceptions among those in treatment for substance abuse and/or mental health problems (n = 470) and those not in treatment (n = 966). Analyses revealed that soldiers in treatment perceived greater stigma regarding mental health treatment compared with soldiers not in treatment. These findings support the notion that personnel most in need of treatment perceive greater stigma associated with these services and as a result may be less likely to pursue them. We discuss the implications of our findings for theory, research, and practice.

Attention to child maltreatment within military families has grown in recent decades in response to the increasing numbers of children in military families, the broader evolution of child maltreatment policy and services, and the development of military policy on issues such as domestic violence. This chapter summarizes current understanding of child maltreatment in the military. Several characteristics of military populations and military life are likely protective with respect to child maltreatment. However, three aspects of military life may increase risks for child maltreatment: elevated rates of domestic violence among military families, increased prevalence of alcohol among service members, and deployment of service member parents.

Data on 7,424 soldier spouse abuse offenders were analyzed to determine the prevalence of substance use during abusive incidents, and to examine differences between substance-using and non-substance-using offenders. Results showed that 25% of all offenders used substances during abusive incidents, with males and non-Hispanic Whites being more likely to have used substances. Substance-using offenders were more likely to perpetrate physical spouse abuse and more severe spouse abuse. These findings underscore the importance of educating military personnel (including commanders) about links between substance use and domestic violence, and of coordinating preventive and therapeutic substance abuse and violence-related interventions.

Skin cancer studies depend on questionnaires to estimate exposure to ultraviolet light and subsequent risk but are limited by recall bias. We investigate the feasibility of developing a short checklist of categories comprising outdoor activities that can improve sun exposure questionnaires for use in epidemiologic studies. We recruited 124 working and retired U.S. radiologic technologists (52% women). Each subject was instructed to complete a daily activity diary, listing main indoor and outdoor activities between 9:00 A.M. and 5:00 P.M. during a 7 day period. A total of 4697 entries were associated with 1408 h (21.1%) of the total 6944 h spent outdoors. We were able to classify the activities into seven main activity categories: driving, yard work, home-maintenance, walking or performing errands, water activities, other recreational or sports activities and leisure activities or relaxing outside. These activities accounted for more than 94% of time spent outdoors both for working and retired men and women. Our data document the feasibility and guidance for developing a short checklist of outdoor activities for use in epidemiologic questionnaires for estimating sunlight exposures of working and retired indoor workers.

Army data from 2000 to 2004 were used to compare two groups of married, male, Army soldier, first-time family violence offenders: 760 dual offenders (whose initial incident included both child maltreatment and spouse abuse) and 2,209 single offenders (whose initial incident included only child maltreatment). The majority (81%) of dual offenders perpetrated physical spouse abuse; however, dual offenders were less likely than single offenders to perpetrate physical child abuse (16% vs. 42%) or sexual child abuse (1% vs. 11%), but they were more likely to perpetrate emotional child abuse (45% vs. 12%). These findings may be, at least in part, explained in light of the Army Family Advocacy Program policy, which considers spouse offenders as also being emotional child abuse offenders since children may be traumatized by exposure to spouse abuse.

Although substance abuse has consistently been linked to child maltreatment, no study to date has described the extent of substance abuse among child maltreatment offenders within the military. Analysis of U. S. Army data on all substantiated incidents of parental child maltreatment committed between 2000 and 2004 by active duty soldiers found that 13% of offenders were noted to have been abusing alcohol or illicit drugs at the time of their child maltreatment incident. The odds of substance abuse were increased for offenders who committed child neglect or emotional abuse, but were reduced for child physical abuse. The odds of offender substance abuse nearly tripled in child maltreatment incidents that also involved co-occurring spouse abuse. Findings include a lack of association between offender substance abuse and child maltreatment recurrence, possibly because of the increased likelihood of removal of offenders from the home when either substance abuse or spouse abuse were documented.

This study analyzed data collected by the U.S. Army’s Family Advocacy Program, the group primarily responsible for family violence prevention, identification, evaluation, treatment, and follow-up on Army installations. Patterns of spouse abuse and child abuse perpetrated within a five year period (2000–2004) were examined in a sample of 10,864 Army Soldiers who were substantiated for family violence offenses. Three groups of family violence offenders were compared: (1) those who perpetrated spouse offenses only; (2) those who perpetrated child offenses only; and (3) those who perpetrated both spouse and child offenses. Results showed that the majority of substantiated family violence offenders were spouse offenders who had not committed child abuse (61%), followed by child offenders who had not committed spouse abuse (27%), and finally those who committed both spouse and child offenses (12%). The three groups of family violence offenders differed in terms of the types of abuse they perpetrated (neglect of children, emotional abuse, physical abuse, and sexual abuse), their experiences of being a spouse abuse victim, and sociodemographic characteristics. Twelve percent of all spouse abusers committed multiple spouse abuse incidents, and 10% of all child abusers committed multiple child abuse incidents.

CONTEXT Parental stress is believed to play a critical role in child maltreatment, and deployment is often stressful for military families. OBJECTIVE To examine the association between combat-related deployment and rates of child maltreatment in families of enlisted soldiers in the US Army who had 1 or more substantiated reports of child maltreatment. DESIGN AND SETTING Descriptive case series of substantiated incidents of parental child maltreatment in 1771 families of enlisted US Army soldiers who experienced at least 1 combat deployment between September 2001 and December 2004. MAIN OUTCOME MEASURES Conditional Poisson regression models were used to estimate rate ratios (RRs) that compare rates of substantiated child maltreatment incidents during periods of deployment and nondeployment. RESULTS A total of 1858 parents in 1771 different families maltreated their children. In these families, the overall rate of child maltreatment was higher during the times when the soldier-parents were deployed compared with the times when they were not deployed (942 incidents and 713 626 days at risk during deployments vs 2392 incidents and 2.6 million days at risk during nondeployment; RR, 1.42 [95% confidence interval {CI}, 1.31-1.54]). During deployment, the rates of moderate or severe maltreatment also were elevated (638 incidents and 447 647 days at risk during deployments vs 1421 incidents and 1.6 million days at risk during nondeployment; RR, 1.61 [95% CI, 1.45-1.77]). The rates of child neglect were nearly twice as great during deployment (761 incidents and 470 657 days at risk during deployments vs 1407 incidents and 1.6 million days at risk during nondeployment; RR, 1.95 [95% CI, 1.77-2.14]); however, the rate of physical abuse was less during deployments (97 incidents and 80 033 days at risk during deployments vs 451 incidents and 318 326 days at risk during nondeployment; RR, 0.76 [95% CI, 0.58-0.93]). Among female civilian spouses, the rate of maltreatment during deployment was more than 3 times greater (783 incidents and 382 480 days at risk during deployments vs 832 incidents and 1.2 million days at risk during nondeployment; RR, 3.33 [95% CI, 2.98-3.67]), the rate of child neglect was almost 4 times greater (666 incidents and 303 555 days at risk during deployments vs 605 incidents and 967 362 days at risk during nondeployment; RR, 3.88 [95% CI, 3.43-4.34]), and the rate of physical abuse was nearly twice as great (73 incidents and 18 316 days at risk during deployments vs 141 incidents and 61 105 days at risk during nondeployment; RR, 1.91 [95% CI, 1.33-2.49]). CONCLUSIONS Among families of enlisted soldiers in the US Army with substantiated reports of child maltreatment, rates of maltreatment are greater when the soldiers are on combat-related deployments. Enhanced support services may be needed for military families during periods of increased stress.

In this study we investigate reasons why teachers adapt substance use prevention curricula in the nation's middle schools. We hypothesize that these reasons will be most salient in schools with racially and ethnically diverse student populations, for whom teachers may believe it appropriate to tailor their curricula. The study sample comprised a nationally representative sample of lead substance use prevention teachers in the nation's middle schools. Respondents answered questions concerning eight student problems or needs that constituted reasons why they might adapt their prevention lessons. Controlling for a variety of school and teacher characteristics, we found that teachers in high minority schools were more likely to adapt curricula in response to three of the eight characteristics presented: youth violence, limited English proficiency, and various racial/ethnic or cultural groups. We suggest that curriculum developers make a systematic effort to understand how teachers are adapting their curricula in high minority schools and incorporate these modifications, if found effective, into their curricula.

Teachers' fidelity of implementation of substance use prevention curricula is widely considered desirable and is linked empirically to effectiveness. The authors examine factors pertinent to teachers' fidelity to curricula guides, using data from a nationally representative sample of 1,905 lead substance use prevention teachers in the nation's public and private schools. Findings suggest that about one-fifth of teachers of substance use prevention curricula did not use a curriculum guide at all, whereas only 15% reported they followed one very closely. Positively associated with adherence were teachers' discretion in their coverage of prevention lessons, beliefs concerning the effectiveness of the most recent training they received and the curricula they taught, and level of support they received from their principals for substance use prevention. The authors conclude that some degree of curriculum adaptation is inevitable and suggest how adherence to curricula guides may be improved through teacher training.