DQ Veterans

Veteran Status and Material Hardship: The Moderating Influence of Work-Limiting Disability

Colleen M. Heflin University of Missouri

Janet M. Wilmoth Syracuse University

Andrew S. London Syracuse University

Veterans are a sizable and policy-relevant demographic group in the United States, yet little is known about their economic well-being. Although having a work-limiting disability is known to be associated with material hardship, no known study compares material hardship between veteran households and nonveteran households or investigates whether work-limiting disability moderates the association between veteran status and material hardship. This study uses data from the Survey of Income and Program Participation to examine how householdwork-limitingdisabilitystatusmoderatestherelationshipbetween veteran status and the likelihood of material hardship. Results suggest the following: nondisabled-veteran households report lower or equivalent levels of material hardship than do households with no veteran or disabled member; regardless of whether a veteran is present, households that include a disabled person have higher levels of every type of hardship than other households do; and disabled-veteran households experience statistically significantly more hardship than nondisabled-veteran households do.

Little is known about the economic well-being of veteran households despite the fact that they constitute a sizable and policy-relevant demographic group in the United States (USCensusBureau2009;Burland and Lundquist, forthcoming). This is surprising because emerging research documents that veteran status is associated with increases in rates

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of functional limitation and disability over the life course (Dobkin and Shabani 2009; MacLean 2010; Wilmoth, London, and Parker 2010, 2011). So too, having a work-limiting disability is positively associated with poverty and material hardship (Mayer and Jencks 1989; Fujiura, Yamaki, and Czechowicz 1998; She and Livermore 2007; Rose, Parish, and Yoo 2009). In fact, Bonnie O’Day and Marcie Goldstein’s (2005) analysis identifies the effect of poverty among people with disabilities as an overarching theme in key informant interviews with disability advocacy and research leaders; however, none of those key informants specifically mentions that addressing the needs of disabled veterans is a top priority. Few studies of disability and economic hardship measure participants’ veteran status. One recent study documents a large and negative association between disabled-veteran status and income, such that income is estimated to be statistically significantly lower for disabled veterans thanforpersonswithoutdisabilitiesandfornonveteranswithdisabilities (Fulton et al. 2009).

Another recent study demonstrates that house hold level veteran and work-limiting disability statuses are jointly associated with household poverty status (London, Heflin, and Wilmoth 2011). Poverty and various material hardships are conceptually distinct and only modestly correlated (Mayer and Jencks 1989, 1993; Mayer 1995; Beverly 2001; Boushey et al. 2001; Bradshaw and Finch 2003; Heflin, Sandberg, and Rafail 2009). Researchers increasingly focus on the experience of material hardship net of household income (Iceland and Bauman 2004; She and Livermore 2007; Heflin and Iceland 2009), but the authors are aware of no study that focuses on experiences of material hardship among veteran and comparable nonveteran households. Nor does any known study consider whether the presence of a household member with a work-limiting disability moderates the risk for material hardship in veteran households. This is a surprising omission in the literature given that veterans are eligible for an array of federal cash and noncash benefits, many of which are tied to service-related disability (Wilmoth and London 2011). Thus, households that include veterans may have lower levels of material hardship than comparable nonveteran households do, regardless of whether any household member has a work-limiting disability. This article uses pooled data from five waves of the Survey of Income and Program Participation (SIPP; 1992, 1993, 1996, 2001, and 2004 panels) to examine variation in the likelihood of household-level materialhardshipbyveterananddisabilitystatuses.Specifically,itexamines the extent to which having a household member with a work-limiting disability moderates the relationship between having an adult household member who is a veteran and the experience of each of four types of material hardship: home hardship, medical hardship, bill-paying hardship, and food insufficiency. The analysis takes into account household

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income-to-needs ratios and various household-level demographic characteristics.

Relevant Literature

The Well-Being of Veterans in the United States

In 2009, over 21.9 million Americans were veterans. They represent approximately 9.5 percent of those ages 18 years or older (US Census Bureau 2009). Experience with military service is particularly prevalent amongcohortsofmenages65andolder.In2000,therewere9.4million male veterans (65 percent) in that age group, many of whom served in World War II and the KoreanWar(FederalInteragencyForumonAgingRelatedStatistics2010).Althoughratesofexperiencewithmilitaryservice have declined in cohorts that came of age during the Vietnam War and the All-Volunteer Force (AVF) era, which began in 1974, a substantial portion of the working-age population served in the military: as of 2010, veterans accounted for 4 percent of the population ages 25–44 and for 11 percent of the population ages 45–64 (Wilmoth and London 2011). The effect of military service on subsequent human capital development and socioeconomic attainment receives sustained attention in the literature (MacLean and Elder 2007; Bennett and McDonald, forthcoming; Kleykamp, forthcoming). By paying close attention to different historical and policy periods, these studies provide insight into the possible complexity of the relationship between military service and material well-being. Considerable evidence suggests that large numbers of World War II veterans took advantage of the generous GI Bill benefits to enhance their education beyond what they would have attained without military service (Bound and Turner 2002; Turner and Bound 2003; Mettler 2005).

Yet, research that considers the effect of military service and the use of benefits on educational outcomes in other historical periods finds that veterans from the Cold War (MacLean 2005), the Vietnam War era (Teachman 2004, 2005; Teachman and Call 1996), and the AVF era (Teachman 2007) have lower educational attainments than nonveterans do. These findings might be due to increases in the educational attainment of the nonveteran population, changes in the availability of GI Bill benefits, and declines in the value of such benefits during the latter half of the twentieth century. Other research focuses on occupational and income components of socioeconomic attainment and again provides mixed evidence that depends upon individual and historical specificities. Studies suggest that, compared with nonveterans from the same period, veterans from World War II did not experience higher earnings or substantial occupational gains; there is one exception: officers converted their service into postwar occupational advancement (Angrist and Krueger 1994; Dechter and

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Elder 2004). Studies focusing mostly on Vietnam War–era veterans suggest that military service in a war zone and combat exposure are adversely associated with labor market experiences and negatively associated with earnings (Angrist 1990). In part, findings on the earnings of Vietnam War–era veterans may be attributable to post-traumatic stress disorder and other psychiatric disorders, as Vietnam veterans who meet the diagnostic criteria for those conditions are less likely to be working and, if working, have lower wages than comparable Vietnam veterans who do not meet those criteria (Savoca and Rosenheck 2000).

There is also evidence that military service substantially decreases accumulated net worth among veterans relative to that among nonveterans, although the magnitude of this effect varies with length of service (Fitzgerald 2006). In contrast, some studies suggest that military service has positive effects on socioeconomic outcomes (SampsonandLaub1996). Earnings among African American and other, nonwhite World War II veterans (Teachman and Tedrow 2004) and also among AVF-era veterans are higher than those among their nonveteran counterparts (Angrist 1998). This provides evidence that military service can produce a positive turning point in the earnings trajectories of initially disadvantaged men (see also Elder 1986; Xie 1992). In addition, men from disadvantaged backgrounds who served during the AVF era are found to earn more than their civilian counterparts, but the difference in earnings dissipates after the service members are discharged (Teachman and Tedrow 2007). Although research pays a substantial amount of attention to whether, how, and for whom military service affects human capital development and socioeconomic attainment, no known study specifically compares material hardship outcomes among veterans and nonveterans.

Perhaps this is due in part to the assumption that current and former military personnel are unlikely to experience material hardships because they are eligible for and use benefits provided by the US Department of Veterans Affairs. Through the direct distribution of cash and noncash resources, such benefits can enhance human capital development. These benefits also directly subsidize housing, health care, and income. Yet, evidence from the 1 percent sample of the 2000 US Census suggests that a substantial percentage of veterans (8.4 percent) live in poverty, even though they are less likely than nonveterans to do so (London and Wilmoth 2008). In an analysis based on SIPP data, the authors (London et al. 2011) find that households with nondisabled veterans are less like to be in poverty than are households whose members include no veterans or disabled people; however, this advantage diminishes if the veteran is disabled or shares the household with an adult family member who has a work-limiting disability. This suggests that veteran status interacts with disability status in ways that could also affect material hardship. Also, a substantial additional percentage of the veteran population likely lives near poverty, and this puts them at risk for

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Material hardship. Veterans ‘experiences of material hardship may differ from those of nonveterans because nonveterans lack access to veterans benefits and services (Goodman and Stapleton 2007; US Department of Veterans Affairs 2009a, 2009b; Wilmoth and London 2011).1

Disability Status as a Moderator of Veteran Status Although selection into military service may alter the risk of material hardship, a potential treatment effect of military service (or direct effect of program participation) is that veterans are more likely to be disabled than nonveterans are (Dobkin and Shabani 2009; MacLean 2010; Wilmoth et al. 2010, 2011). Military personnel are initially selected for their good health and functioning (National Research Council 2006), but military service carries a risk of injury and exposure to circumstances, such as combat, training-related accidents, interpersonal violence, substance abuse, and stress-related mental health problems, that increase the likelihood of having a functional limitation or disability (Elder and Clipp 1988, 1989; Clipp and Elder 1996; Bedard and Descheˆnes 2006; Dobkin and Shabani 2009; MacLean 2010). Exposure to these servicerelated risks may therefore distinguish veteran households from nonveteran households. They also may distinguish households that include veterans with disabilities from those that include nondisabled veterans. Under some circumstances, military service can disrupt the life course by interfering with established marital, parenting, and occupational trajectories (Teachman, Call, and Wechsler 1993; Elder, Shanahan, and Clipp 1994; Tseng et al. 2006). Although trajectories vary by gender, race, ethnicity, social class origins, active-duty status, rank, combat exposure, and historical period, some evidence suggests that veterans have higher rates of divorce than nonveterans do (Burland and Lundquist, forthcoming; London, Allen, and Wilmoth, forth coming)

.To the extent that military service causes interference and instability in marriage and life-course trajectories, it might impede veterans’ access to social and economic resources or contribute to lifestyles that ultimately increase their risk of functional limitation or disability. Previous research suggests that poor health and the presence of a work-limiting disability respectively increase the risk of material hardship (Mayer and Jencks 1989; Bauman 1998; Corcoran, Heflin, and Siefert 1999; Heflin, Corcoran, and Siefert 2007; She and Livermore 2007; Parish, Rose, and Andrews 2009). In the study closest to the current one, Peiyun She and Gina Livermore (2007) use data from the 1996

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panel of the SIPP to demonstrate that individuals with some type of disability compose a large share of the population reporting material hardship (49–62 percent depending on the hardship domain). The risk of material hardship among households that include a disabled person is likely due in part to that person’s limited employment, but the care work performed by nondisabled household members can impede their labor force participation and suppress household income (Cancian and Oliker 2000; London, Scott, and Hunter 2002; Pavalko and Henderson 2006). Few studies focus on care work in veteran households, although care for veterans with disabilities can require long-term commitment due to the debilitating nature of some combat-related injuries (Resnik and Allen 2007). A recent study finds that the majority of wounded veterans’ caregivers experience relatively long spells of intense care work; this group provides care for about 10 hours per week for an average of 19 months, and 43 percent report that they expect to continue providing long-term care (Christensen et al. 2009). Such care work demands contribute to losses in time spent on paid employment and, thus, could increase the risk of material hardship. This article extends the previous literature on the economic wellbeing of policy-relevant groups by documenting how levels of material hardship vary by veteran and disability statuses. It then examines the extent to which disability status moderates the relationship between veteran status and each of four specific material hardships. Previous research identifies links between military service and disability as well as between disability and hardship. By considering these links, the current study seeks to address an important gap in the literature.

Method

Sample and Procedures

To examine the relationships among veteran status, disability status, and each of four distinct types of material hardship, this research uses data from the 1992–2004 panels of the SIPP, a nationally representative household survey conducted in the United States by the US Census Bureau. Each interview in the panel consists of a core interview and a topical module interview. The core interview poses standard questions on demographics, labor force participation, and income. The topical module interview includes questions on topics that change from one interview wave to the next. Interview waves are conducted every 4 months. Data on material hardship come from the Adult Well-Being Topical Module, which was fielded in one wave of each panel from 1992 to 2004: the third wave of the 1992 SIPP panel (collected October 1992 throughJanuary1993);then in the wave of the1993 SIPP panel(collected October 1995 through January 1996); the eighth wave of the 1996 SIPP

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panel (collected August through November 1998); the eighth wave of the 2001 SIPP panel (collected June through September 2003); and the eighth wave of the 2004 SIPP panel (collected June through September 2005). If survey weights are used, results from analyses of SIPP data are representative of the civilian (nonveteran and veteran), noninstitutionalized population of the United States. Imputed data are used as provided by the US Census Bureau. The maximum analytic sample includes 58,686 individuals across all waves; as the notes to table 1 indicate, some models are estimated on slightly smaller samples because of missing values on the hardship questions. Although veteran and disability statuses are measured at the individual level, material hardship is a household-level indicator. Individual-level analysis is likely to understate the associations among veteran status, work-limiting disability status, and the measured material hardships, because many nonveteran and able-bodied individuals share households with veterans and the disabled. Thus, all analyses are conducted at the household level.

Measures

This study incorporates established principles for the measurement of material hardship (Beverly 2001; Ouellette et al. 2004) into models that are based upon four domains of material need: home hardship, medical hardship, bill-paying hardship, and food insufficiency. It utilizes a number of dichotomous indicators from the SIPP instrument designed for this purpose. The measure of home hardship indicates whether, in the 12 months prior to the survey, a member of the respondent’s household reportedly had a problem with the following: pests; a leaky roof or ceiling; broken windows; plumbing issues; or cracks in the walls, floor, or ceiling. Medical hardship indicates that a member of the respondent’s household reportedly was not able to see a doctor or a dentist when he or she needed to do so in the 12 months prior to the survey. Bill-paying hardship measures respondents’ reports of whether, in the 12 months prior to the survey, the household experienced any of three events: the household was behind on a utility, rent, or mortgage payment; the telephone was disconnected; or other essential expenses were not met. The food insufficiency measure is based on the following question: “Which of the following statements best describes the food eaten in your household in the last 12 months: enough to eat, sometimes not enough to eat, or often not enough to eat?” The responses “sometimes” and “often not enough to eat” are coded as food insufficient. The measure of veteran status is based on whether a member of a household self-reports that he or she ever served on active duty (yes p 1). Work-limiting disability (hereafter disability) is defined as the presence of a member of the household with physical, mental, or other

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condition that limits the kind or amount or work that can be performed (yes p 1). The SIPP poses this question to persons ages 16 or older. Household-level interaction terms are created to capture different possible combinations of disability and veteran statuses: disabled veteran present; nondisabled veteran present; disabled nonveteran present; and nondisabled veteran with disabled nonveteran present. These four household types are compared with all households in which no household member is either disabled or a veteran.2 The measure of disability likely underestimates the presence of disability among household members who are over age 65. These individuals are more likely than the general working-age population to be out of the labor force and therefore more likely to report functional limitations and disabilities other than a work-limiting disability. Thus, the analytic sample for the main models excludes households that include adults ages 65 years and older (households with adults in that age range make up 25 percent of all households in the total sample). Supplementaryanalysesestimateidenticalmodelsonthetotalsampleofhouseholds, and the results are consistent with those from the models estimated on the analytic sample that only includes households without adultsages65orolder.Supplementaryanalysesalsosuggestthat,among households with a working-aged member and at least one working-aged veteran, 25 percent include a veteran who served in or after May 1974 (the start of the AVF era), 39 percent include a veteran who served between August 1964 and April 1974 (the Vietnam War era), 17 percent served before August 1964 (most likely during the Cold War or the Korean War), and 14 percent served across multiple time periods.3 The study includes controls for a variety of household-level demographic characteristics that are known to be associated with material hardship.Theseincludethefollowing:theratiooftheannualhousehold income to the federal needs standard for a household of that size (the income-to-needs ratio); the racial and ethnic composition of the household (black only, Hispanic only, Asian only, and other and mixed races or ethnicities; white-only households comprise the reference group); the highest level of education achieved by a household member (high school diploma, some college, college degree; the comparison group haslessthanahighschooldiploma);themaritalstatusofthehouseholder (never married or previously married, which includes divorced, widowed, or separated respondents; married respondents comprise the reference group); whether the household includes children younger than age 18

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(yes p 1); and whether the household is located in an urban area (yes p 1).

Data Analysis

After describing the sample and the prevalence of each of the four material hardships overall, this study presents the proportion of households reporting each hardship. The typology is employed to distinguish households with respect to the work-limiting-disability and veteran statuses of all adult household members. Then, logistic regression models are employed to assess statistical significance using Stata statistical software (version 10.1). By including dichotomous variables for each year, the study effectively adjusts for the changes in material hardships over the 14-year period.4 All analyses employ sample weights. Predicted probabilities for the main variables of interest are calculated in models that hold all other observed characteristics at their mean values. In addition, supplementary analyses test for statistically significant differences in the point estimates for each household type, which is defined by the veteran and disability statuses of adult household members. Statistically significant differences are reported in the tables and text.

Results

Table 1 shows descriptive statistics for all of the variables included in the analysis. The first row specifies the prevalence of each form of material hardship in the analytic sample. Among the four domains of material hardship, bill-paying hardship is reportedly the most common (19.39 percent). About 12 percent of households are reported to experience medical hardship; home hardships and food insufficiency are relatively rare experiences, with respondents in approximately3percent of all households’ report experiencing these. The first column of table 1 presents the sample characteristics. In the left-most column, the first five household disability- and veteran-status categories represent the key independent variable in this analysis. The largest share of households, over two-thirds, includes neither a veteran nor a disabled household member; 13.67 percent of households reportedly include a nondisabled veteran, and 13.27 percent of households include a disabled nonveteran. Less than 3 percent of all households include a disabled veteran, and only 1.21 percent are classified as nondisabled-veteran households with a disabled-nonveteran member.

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Almost three-quarters of the households include whites only; 12.03 percent include blacks only, 8.58 percent include Hispanics only, 2.40 percent include Asians only, and 5.14 percent include persons of other and mixed races and ethnicities. The distribution of highest educational attainment in the household ranges from 7.65 percent (less than high school education) to 34.14 percent (a college degree or higher). One fourth of households include a member who graduated from high school, and 33.2 percent include one who has some college. About 40 percent of householders report that they are married (40.44 percent), though sizable percentages report that they are previously married (38.21 percent) and never married (21.35 percent). About 42 percent of households reportedly include at least one minor child. The mean income-to-needs ratio is 3.86, and supplementary analysis (not shown) suggests that almost 14 percent of sampled households live at or below the poverty threshold. About 82 percent of households live in urban areas. Table 1 also shows the percentage of household types reporting each of the four domains of material hardship. Several patterns emerge regarding variation in material hardship across the veteran- and disability status categories. First, reports of all forms of material hardship are lowest among nondisabled-veteran households: 1.26 percent report home hardship, 6.86 percent report medical hardship, 10.46 percent report bill-paying hardship, and 1.19 percent report food insufficiency. Rates of arterial hardship are relatively low among households in which no member is a veteran or disabled, although they are somewhat higher than rates among nondisabled-veteran households. Rates of each type of material hardship are reportedly highest among disabled-nonveteran households: 6.13 percent for home hardship, 22.54 percent for medical hardship, 34.98 percent for bill-paying hardship, and 9.01 percent for food insufficiency. Disabled-veteran households have relatively high levels of each type of material hardship; they rank second-highest by a substantial margin in each hardship domain: 5.51 percent for home hardship, 19.93 percent for medical hardship, 24.89 percent for billpaying hardship, and 4.87 percent for food insufficiency. In all four domains, nondisabled-veteran households that include a disabled nonveteran do substantially better than households with a disabled veteran. A second observation from the top panel of table 1 is that bill-paying hardship and medical hardship are consistently the first- and second most frequently reported hardship domains across all household types. However, veteran and nonveteran households differ in their likelihood of reporting home hardship and food insufficiency: nonveteran households (regardless of whether they include a person with a disability) report higher levels of food insufficiency than home hardship, but veteran households (regardless of whether they include a person with a

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disability) are more likely to report home hardship than food insufficiency. Table 1 also shows that demographic and compositional differences across households are related to the prevalence of material hardship. In general, each type of material hardship is reportedly more common among black and Hispanic households than among white, Asian, and other mixed-race households. Among households whose members’ highest level of education is less than a high school diploma, the percentage reporting each hardship is greater than the percentage reportingitamonghouseholdswithahighschooldiplomaormore.Nevermarried householders respectively report more of each hardship than their married counterparts do, and the same is true of previously married householders. So too, each of the percentages is higher for urban than for nonurban households, and they are higher for households that include members under age 18 than for those whose members are all over that age. In addition, the average income-to-needs ratio in each hardship category is lower than the average ratio for the analytic sample as a whole. The average ratio is particularly low among the subsample reporting food insufficiency. Table 2 presents results from multivariate logistic regression models that examine each domain of material hardship in relation to each household-level configuration of veteran and disability statuses among adult household members. The models control for other known correlates of household-level hardship. In the first column, estimates suggest that nondisabled-veteran households are not statistically significantly different from households in the comparison group (i.e., those that do not include a veteran or a disabled person). However, households that include a person with a disability, regardless of the disabled individual’s veteran status, are estimated to face an elevated risk of home hardship. Disabled-veteran households are 2.73 times more likely to report experiencing home hardship than are households with no veteran or disabled person. Compared to the same reference group, disabled-nonveteran households are 2.27 times more likely to report home hardship. Finally, nondisabled-veteran households with a disabled nonveteran are 1.91 times more likely to report home hardship than are households with no disabled person and no veteran. Results from supplementary analyses (see table 2, note a) suggest that disabled-veteran households are statistically significantly more likely than nondisabled veteran households to report experiencing home hardship. It is useful to keep in mind that the overall prevalence of experiencing a home hardship is rather low (2.65 percent across the full analytic sample) but disabled-veteran households face the highest probability of reporting this material hardship (4.38 percent) and a substantively higher probability than nondisabled households do (1.38 percent). Although

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veteran status appears to be protective in relation to home hardship, the protection only accrues to households that do not include an adult with a work-limiting disability. The pattern of results is similar in the second model, which predicts medical hardship. The sign on the coefficient for nondisabled-veteran households is once again negative, but this difference is statistically significant. The results suggest that nondisabled-veteran households have 10 percent lower odds of reporting medical hardship than households in the comparison group. Households that include a disabled adult are estimated to face an increased likelihood of reporting a medical hardship, regardless of veteran status; disabled-veteran households are estimated to be 2.17 times more likely than the comparison group households to report medical hardship; the odds are 1.88 higher for nondisabled-veteran households with a disabled nonveteran. Supplementary analyses suggest once again that disabled-veteran households experience statistically significantly more medical hardship than nondisabled-veteran households do. In addition, the difference in the coefficients for disabled-veteran and disabled-nonveteran households is marginally statistically significant (p p .089). In substantive terms, the predictedprobabilityofexperiencingamedicalhardshipis7.9percent for nondisabled-veteran households but double that (16.8 percent) for disabled-veteran households. Although disabled veterans have access to an array of veteran health benefits that are not available to nonveterans or to veterans with no disability, there is no evidence that the risk of medical hardship is lower in disabled-veteran households than in disabled-nonveteran households; the predicted probability that disabled nonveteran households experience a medical hardship is 14.15 percent. Results in the third model show the estimated odds of experiencing bill-paying hardship, and the patterns are very similar to those for the experienceofhomeandmedicalhardships.Nondisabled-veteranhouseholds enjoy a statistically significantly lower likelihood of experiencing bill-paying hardship than that faced by households in the comparison group, though the substantive effect is only moderate (the predicted probabilities are 12.14 percent for nondisabled-veteran households and 13.22 percent for the comparison group households). In contrast, the odds of experiencing a bill-paying hardship are similarly elevated among all of the households that include a disabled person, regardless of veteran status. Compared to households in which no member is a veteran or disabled, disabled-veteran households are estimated to be 1.96 times more likely to experience a bill-paying hardship; nondisabled-veteran households with a disabled nonveteran are 2.08 times more likely, and disabled-nonveteran households are 2.04 times more likely. The predicted probabilities are 22.43 percent for disabled-veteran households, 23.43 percent for nondisabled-veteran households, and 21.74 percent for disabled-nonveteran households. Results from supplementary anal

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suggest that disabled-veteran households experience statistically significantly more bill-paying hardship than nondisabled-veteran households do. In the case of bill-paying hardship, as with other forms of material hardship, the advantage that accrues to veteran households appears to decline and, in fact, becomes a disadvantage, if the veteran is disabled. The final model estimates the likelihood of experiencing food insufficiency. Among nondisabled-veteran households and households in which a nondisabled veteran lives with a disabled nonveteran, the estimated odds of experiencing food insufficiency are not statistically significantly different from the odds that this hardship is experienced by households in which no member is a disabled person or veteran. The odds of experiencing food insufficiency are 2.12 times higher among disabled-veteranhouseholdsand2.39timeshigheramongdisabled-nonveteran households. Note that the overall prevalence of reported food insufficiency is low, but the substantive difference in the odds of experiencing food insufficiency is meaningful. The predicted probability for a disabled-veteran household is 2.39 percent, but that for a nondisabled nonveteran household is 1.1 percent. Consistent with the findings for other forms of material hardship, results from supplementary analysissuggestthatdisabled-veteranhouseholdsarestatisticallysignificantly more likely than nondisabled-veteran households to experience food insufficiency.

The other covariates in each of the four models yield estimates that are consistent with previous research in all regards. Black-only and Hispanic-only households are more likely than white-only households to experience home hardship, bill-paying hardship, and food insufficiency but are slightly less likely than their white-only counterparts to experience medical hardship. Households that include at least one person who has a college education are less likely to experience each measured hardship than are households in which all members have less than a high school education. Households with never-married and previously married householders are estimated to have greater likelihood of hardship than households with married householders. Households with children under age 18 are estimated to be at greater likelihood than all adult households. The household-level income-to-needs ratio is estimatedtobenegativelyassociatedwiththelikelihoodofexperiencing each type of hardship, such that the odds of experiencing each decline as the ratio rises. Living in an urban area is estimated to be positively associated with the experience of bill-paying hardship and food insufficiency. Reports of home and medical hardships, respectively, are estimated to decline across the survey periods, but there are no clear patterns of sustained change in the experience of bill-paying hardship or food insufficiency across the survey years.

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Discussion

This study contributes to the literatures on veteran well-being and material hardship. Using nationally representative data from the1992–2004panels of the SIPP, it examines how adult work-limiting disability status moderates the relationships between veteran status and each of four material hardships: home hardship, medical hardship, bill-paying hardship, and food insufficiency. The results suggest that veteran and disability statuses jointly influence material hardships net of the household’s income-to-needs ratio, household demographics, and compositional characteristics. Although nondisabled-veteran households experience levels of hardship that are similar to(home hardship and food insufficiency)or statistically significantly lower than (medical and bill-paying hardships) those experienced by households with no disabled person or veteran, the levels of material hardship are statistically significantly higher for all other household types that include a disabled person than for households in the reference group (with the exception of food insufficiency among households that include a nondisabled veteran and a disabled nonveteran).

The odds ratios for all contrasts are in the range of 1.88 to 2.73, and some of the highest increases in the estimated odds of hardship are in households that include a veteran. Moreover, disabled-veteran households are estimated to experience statistically significantly more of each type of hardship than nondisabled-veteran households do. To the authors’ knowledge, this is the first study to document material hardships among households with different configurations of veteran and disability statuses. Several limitations should be noted. First, the results in this study should be interpreted as descriptive and do not provide direct evidence that military service has a treatment effect on material hardship. It is possible that veteran households differ from other households on unobserved factors, and those factors could influence their probability of reporting a hardship. Second, this study measures disability as a physical, mental, or other condition that limits the kind or amount of work an individual can perform. Such a measure does not capture the full range of specific functional limitations and disabled statuses that could influence a household’s chances of experiencing material hardship. Of particular note is the exclusion from the analysis those households that contain members who are ages 65 and older. The authors exclude these households because the measure of work-limiting disability underestimates disability among older adults. However, children with disabilities may be present in the households, and their presence may also affect household well-being. As a consequence, the estimates provide a downward-biased account of the effect of disability on the risk of material hardship at the household level. Also, because of sample size and data limitations, this study is not able to distinguish among veterans by the

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historical time periods of their service or by their military service experiences (e.g., branch of service, rank, military occupational specialty, exposure to combat). The moderating influence of veteran status on the relationship between disability and material hardship is likely to vary with the characteristics of the veteran. Finally, because this study is largely descriptive, it does not explore how participation in different disability or veteran programs affects well-being. This is an important topic for future research. Future research should focus attention on whether the provision of benefits and services mitigates material hardships in veterans’ households. Provisions from the US Department of Veterans Affairs directly aim to address service-related needs. These provisions try to mitigate some of the disruption that military service can cause. They compensate and care for persons harmed in the course of their service, as well as their dependents. They generally reward those who have taken risks and made various personal sacrifices in service to their country. These benefits and services represent two approaches in the effort to address the needs of veterans. Some benefits work in tandem with social insurance programs, such as Social Security and Medicare (Goodman and Stapleton 2007). Others are designed to accommodate the unique needs of specific subgroups of veterans (e.g., veterans with service connected post-traumatic stress disorder, illnesses, and disabilities; veterans from specific wars; and other veterans with unique service-related experiences). Provisions for veterans have expanded over time, but the basic types of benefits have remained the same since World War II (US Department of Veterans Affairs 2009a). To qualify, the service member must have performed full-time, active-duty service and must not be separated from service through dishonorable discharge. Eligibility for some benefits is contingent on service during wartime. Members of Reserve and National Guard components qualify for benefits under certain conditions. Special provisions are made for other historically relevant groups (US Department of Veterans Affairs 2009b). Veterans with service-connected disabilities are given priority in access to benefits and receive premiums in resource allocations. This priority depends on an individual’s disability rating, which is determined by the US Department of Veterans Affairs and can range from 0 to 100 percent (Wilmoth and London 2011). Thus, access to veterans benefits varies considerably across the population of individuals who served in the military. This study’s results suggest that it is important to recognize this underlying heterogeneity in the veteran population, and particularly the heterogeneity in access to veterans benefits, time period served, and other military-related experiences. Although nondisabled-veteran households may fare better in terms of experiences of material hardship than comparable households, disabled-veteran households face a dis

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tinct disadvantage relative to households with nondisabled nonveterans. Specific veteran programs were created to address the special challenges faced by disabled-veteran households. As such, they may not meet the needs of households with nondisabled veterans. For example, these programs may fail nondisabled veterans who require assistance to address basic needs for adequate housing, medical care, and food, or to pay bills. Further research is needed to investigate whether nonparticipation is a key issue in current veterans programs and whether, as recent analyses suggest, the veterans program participants experience a hole in the social safety net (Fulton et al. 2009; Perl 2010).

Note

Colleen M. Heflin is an associate professor at the Truman School of Public Affairs at the University of Missouri. Her interdisciplinary research program focuses on understanding the survival strategies employed by low-income households to make ends meet, the implications of using these strategies for individual and household well-being, and how public policies influence well-being. A central focus of her work has been on understanding the causes and consequences of material hardship. Janet M. Wilmoth has a PhD in sociology and demography, with a minor in gerontology, from the Pennsylvania State University. She is a professor of sociology, director of the Aging Studies Institute, and senior fellow in the Institute for Veterans and Military Families at Syracuse University. Her research examines older adult migration and living arrangements, health status, and financial security. She and Andrew London are collaborating on several projects about military service and various life course outcomes. Andrew S. London is professor and chair of sociology, senior research associate in the Center for Policy Research, senior fellow in the Institute for Veterans and Military Families, and codirector of the Lesbian, Gay, Bisexual, and Transgender Studies Program at Syracuse University. His research focuses on the health, care, and well-being of stigmatized and vulnerable populations, including persons living with HIV, welfare-reliant and working poor women and children, the previously incarcerated, and veterans. This research was supported by a Survey of Program Participation (SIPP) Analytic Research Small Grant from the National Poverty Center, Gerald R. Ford School of Public Policy, University of Michigan (Co-PIs: Colleen M. Heflin, Andrew S. London, and Janet M. Wilmoth). Additional support was provided by a grant from the National Institute on Aging: “Military Service and Health Outcomes in Later Life” (1 R01 AG028480-01; PI: Janet M. Wilmoth).

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