Study
Abstract
BACKGROUND: Over the past 5 years, diagnoses for opiate abuse or dependency and post-traumatic stress disorder (PTSD) have increased across all U.S. military services. Moreover, in the United States, opiate prescription dependence and abuse has now surpassed all other illicit drugs of abuse with the exception of marijuana. Some research indicates that PTSD is predictive of substance dependence and abuse, while other research suggests that substance dependence and abuse may lead to events that trigger PTSD. This dichotomy has not been extensively explored within a military population.
METHODS: Using conditional multiple logistic regression analysis, a matched case-control study with 18,606 active-component U.S. military service members was conducted to examine the relationship between opiate dependence or abuse and PTSD.
RESULTS: Among the 18,606 service members included in the analysis, 21% were cases and 79% were controls. Thirteen percent of service members with substance dependence or abuse diagnosis had a prior PTSD diagnosis compared to 1% of controls. After, adjusting for sociodemographic and military characteristics, the odds of having a prior diagnosis of PTSD was 28 (95% CI: 21.24-37.78) times greater for service members with opiate abuse/dependency compared to controls.
CONCLUSION: These findings suggest active duty military personnel diagnosed with PTSD should be closely monitored to reduce the likelihood of future morbidity because of opiate dependence or abuse.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Armed Forces Health Surveillance Center
- Congressionally Mandated: No
- Funding Source: Army
- Release Date/Publication: August 01, 2014
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Citation: Dabbs C, Watkins EY, Fink DS, Eick-Cost A, Millikan AM. Opiate-related dependence/abuse and PTSD exposure among the active-component U.S. military, 2001 to 2008. Mil Med. 2014 Aug;179(8):885-90.
Study
Abstract
This study examined the prospective course of neurobehavioral symptom reporting and health-related quality of life within the first 3 years following moderate-to-severe traumatic brain injury (TBI). Participants were 52 U.S. service members who were evaluated following a moderate-to-severe TBI sustained in the combat theater during Operations Iraqi and Enduring Freedom (90.4%), or from other noncombat-related incidents. Participants completed the Neurobehavioral Symptom Inventory and Post-Traumatic Stress Disorder-Checklist within 3 months postinjury, and at least one follow-up telephone interview at 12 (n = 27), 24 (n = 31), or 36 months (n = 22) postinjury. Approximately half of the sample (41.9%-63.0%) reported "persistent" symptoms from baseline to follow-up. A substantial minority also "improved" (22.2%-31.8%) or "developed" new symptoms (3.7%-16.1%). Ongoing physical and mental health problems were also reported. The number of service members receiving mental health treatment significantly reduced between 12 and 36 months postinjury (48.1%-18.2%), while complaints of bodily pain significantly increased (40.7%-68.2%). Despite ongoing symptom reporting, few reported suicidal/homicidal ideation (6.5%-9.1%), and a substantial majority reported good/excellent health status (74.1%-90.9%) and satisfaction with their life (81.5%-90.9%). Continued support and care for all service members who sustain a combat-related moderate-to-severe TBI is recommended, regardless of the presence or absence of symptom reporting within the first few months postinjury.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense and Veterans Brain Injury Center
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: August 01, 2014
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Citation: Brickell TA, Lange RT, French LM. Three-year outcome following moderate-to-severe TBI in U.S. military service members: a descriptive cross-sectional study. Mil Med. 2014 Aug;179(8):839-48.
Study
Abstract
The death of a military service member in war provokes feelings of distress and pride in mortuary workers who process the remains. To further understand their reactions, the authors interviewed 34 military and civilian personnel to learn more about their work stresses and rewards. They review stresses of anticipation, exposure, and experience in handling the dead and explore the personal, supervisory, and leadership strategies to reduce negative effects and promote personal growth. These results can be applied to many other situations requiring planning, implementing, and supervising mortuary operations involving mass death.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: August 01, 2014
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Citation: Flynn BW, McCarroll JE, Biggs QM. Stress and Resilience in Military Mortuary Workers: Care of the Dead From Battlefield to Home. Death Stud. 2014 Aug 20:1-7.
Study
Abstract
This study examined health-related quality of life within the first 5 years following concurrent mild traumatic brain injury (MTBI) and polytrauma. Participants were 167 U.S. service members who had sustained a MTBI who had completed a brief neurobehavioral evaluation within 3 months postinjury and at least one telephone follow-up interview at 6 (n = 46), 12 (n = 89), 24 (n = 54), 36 (n = 42), 48 (n = 30) or 60 months (n = 25) postinjury. Within the first 5 years postinjury, service members reported ongoing headaches (67.4% to 92.0%), bodily pain (66.7% to 88.9%), medication use (71.7% to 92.0%), mental health treatment (28.3% to 60.0%), and the need for help with daily activities (18.5% to 40.0%). Problematic alcohol consumption was common within the first 24 months postinjury (23.9% to 29.2%). Many service members were working for pay (36.0% to 70.8%) though many reported a decline in work quality (16.0% to 30.4%). Despite ongoing symptom reporting, many service members reported that their medications were effective (43.3% to 80.0%), good/excellent health status (68.0% to 80.0%), and life satisfaction (79.6% to 90.5%). A minority reported suicidal or homicidal ideation (5.6% to 14.8%). Recovery from MTBI in a military setting is complex and multifaceted. Continued support and care for all service members who sustain a combat-related MTBI with polytrauma is recommended, regardless of the presence or absence of symptom reporting within the first few months postinjury.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense and Veterans Brain Injury Center
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: August 01, 2014
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Citation: Brickell TA, Lange RT, French LM. Health-related quality of life within the first 5 years following military-related concurrent mild traumatic brain injury and polytrauma. Mil Med. 2014 Aug;179(8):827-38.
Study
Abstract
Epidemiologic studies have previously reported an association between high fat intake and colon cancer risk. However, findings have generally been inconclusive. This study aimed to investigate the association between fat as a percentage of energy intake and colon cancer risk. Study subjects included 215 cases and 215 matched controls identified by the Defense Medical Surveillance System. Percentage energy from fat (Pfat) was estimated using a short dietary screener developed by the National Cancer Institute for two time periods: the year before the first blood draw and the year before colon cancer diagnosis. Conditional logistic regression analysis was used to assess the relationship between colon cancer risk and Pfat. Odds ratios and 95% confidence intervals (CIs) were calculated. Compared with the lowest quartile of Pfat, the adjusted odds of having colon cancer were 2.00 (95% CI 0.96-4.18), 2.83 (95% CI 1.41-5.66), and 3.37 (95% CI 1.58-7.17), respectively, for the second, third, and highest quartiles in the year before cancer diagnosis. Similar results were observed for Pfat at an earlier time point. Our findings suggest a positive association between Pfat and colon cancer in the US military population.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: July 01, 2014
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Citation: Shao S, Kao TC, Eckhaus J, Bourgeois J, Perera K, Zhu K. The association of percentage energy from fat and colon cancer risk among members of the US military. Eur J Cancer Prev. 2014 Jul 29.
Study
Abstract
In early 2014, the Department of Defense Sexual Assault Prevention and Response Office asked the RAND National Defense Research Institute to conduct an independent assessment of sexual assault, sexual harassment, and gender discrimination in the military — an assessment last conducted in 2012 by the department itself with its Workplace and Gender Relations Survey of Active Duty Personnel. This volume documents the methodology used in the resulting RAND Military Workplace Study, which invited close to 560,000 service members to participate in a survey fielded in August and September of 2014. It describes the survey methods, how the new questionnaire was designed, and how sampling, recruitment, and analytic weighting were pursued. It also includes the entire survey instrument.
- Publication Status: Published
- Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
- Sponsoring Office: National Development and Research Institutes, Inc.
- Congressionally Mandated: No
- Funding Source: Federally Funded Research and Development Center
- Release Date/Publication: July 01, 2014
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Citation: Rand Corporation, National Defense Research Institute
Study
Abstract
BACKGROUND: The US military has been continuously engaged in combat operations since 2001. Assessing trends in respiratory health diagnoses during this time of prolonged military conflict can provide insight into associated changes in the burden of pulmonary conditions in the US military population.
PURPOSE: To estimate and evaluate trends in rates of chronic obstructive
pulmonary diseases in the active duty US military population from 2001 through
2013.
METHODS: A retrospective analysis of ambulatory medical encounter diagnosis data corresponding to a study base of over 18 million personnel-years was performed to estimate average rates and evaluate temporal trends in rates of chronic obstructive lung conditions. Differences in rates and the time trends of those rates were evaluated by branch of military service, military occupation, and
military rank.
RESULTS: During the 13-year period, we observed 482,670 encounters for chronic
obstructive pulmonary disease and allied conditions (ICD-9 490-496) among active
duty military personnel. Over half (57%) of the medical encounters in this
category were for a diagnosis of bronchitis, not specified as acute or chronic.
There was a statistically significant 17.2% average increase in the annual rates
of this nonspecific bronchitis diagnosis from 2001-2009 (95% CI: 13.5% to 21.1%),
followed by a 23.6% annual decline in the rates from 2009 through 2013 (95% CI:
8.6% to 36.2%). Statistically significant declines were observed in the rates of
chronic bronchitis over time (annual percentage decline: 3.1%; 95% CI: 0.5% to
6.6%) and asthma (annual percentage decline: 5.9%; 95% CI: 2.5% to 9.2%). A 1.6%
annual increase in the rate of emphysema and a 0.1% increase in the rate of
chronic airways obstruction (not elsewhere classified) over the study period were
not statistically significant (P>.05). The magnitude of the estimated rates of
these chronic obstructive lung conditions, and, to a lesser extent, the temporal
trends in these rates, were sensitive to the requirement that there be
persistence of the diagnosis evidenced in the medical record in order qualify as
an incident case.
- Publication Status: Published
- Sponsoring Organization: Army
- Sponsoring Office: US Army Public Health Command
- Congressionally Mandated: No
- Funding Source: Army
- Release Date/Publication: July 01, 2014
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Citation: Abraham JH, Clark LL, Sharkey JM, Baird CP. Trends in rates of chronic obstructive respiratory conditions among US military personnel, 2001-2013. US Army Med Dep J. 2014 Jul-Sep:33-43.
Study
Abstract
OBJECTIVE: To determine if overweight or obesity is associated with mental health disorder (MHD) symptoms among military personnel Methods: Secondary analysis using the 2005 Department of Defense Health Related Behaviors Survey (N = 15,195). Standard Body Mass Index (BMI) categories were used to classify participants' body composition.
RESULTS: For women, obesity was associated with symptoms of serious psychological distress (SPD), post-traumatic stress disorder, and depression. For men, obesity and overweight was associated with symptoms of generalized anxiety disorder and SPD, respectively. Self-reported high personal stress was the strongest predictor of MHD symptoms and suicide attempts.
CONCLUSION: Self-reported stress was a stronger predictor of MHD symptoms than BMI. There is potential value in screening personnel for personal stress as a MHD risk factor.
- Publication Status: Published
- Sponsoring Organization: Army
- Sponsoring Office:
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: July 01, 2014
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Citation: Smith TJ, White A, Hadden L, Young AJ, Marriott BP. Associations between mental health disorders and body mass index among military personnel. Am J Health Behav. 2014 Jul;38(4):529-40.
Study
Abstract
The Department of Defense (DOD), Defense Health Agency submits this report in accordance with the National Defense Authorization Act for Fiscal Year 2013 (HR 4310), section 737, that calls on The Secretary of Defense to conduct a study on the incidence of breast cancer among members of the Armed Forces.
The findings from this study indicate that breast cancer incidence among active service members is a rare event. The female breast cancer incidence rate among this population has not changed significantly across the study period, 2000 through 2010, and the age-adjusted incidence rate is significantly lower over that time period when compared with national incidence rates reported by the National Cancer Institute (NCI). Approximately 72% of all breast cancer patients are first diagnosed at stages 0, I or II, which suggests that the Department’s outreach efforts to promote awareness and use of screening services have been effective for detecting tumors early. Upon detection, the service member has access to robust treatment options that reflect evidenced-based clinical practices and cutting-edge technologies offered in nationally-accredited cancer programs within the Military Health System. Since TRICARE has a process to assimilate emerging cancers technologies, medications, and practice into the benefit, the need for changes to law or policy are not apparent for the DOD to sustain a high level of commitment to quality cancer care.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Defense Health Agency (formerly TRICARE Management Activity)
- Congressionally Mandated: Yes
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: June 01, 2014
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Citation: Williams TV, AFHSC, JPC, NMCPHC, WRNMMC, Brandeis University, Axiom Resource Management, Inc.
Study
Abstract
According to the Centers for Disease Control and Prevention, so far in 2014, reported cases of pertussis in the U.S. have increased 24% over the previous year; by June 16, a total of 9,964 cases of pertussis had been reported by 50 states and the District of Columbia. On June 13, the California Department of Public Health announced that the state was experiencing a pertussis (“whooping cough”)
epidemic. As of June 10, a total of 3,458 cases had been reported in the state; this number of pertussis cases exceeds the number of cases reported in the entire year in 2013. Th e MSMR has previously reported on spatiotemporal clusters of pertussis in the military that were associated with outbreaks in neighboring non-military communities; this association was clearly demonstrated during a previous 2010 outbreak in California. Between January 2012 and June 2014, the greatest number of pertussis cases (both confi rmed and probable) diagnosed in military
benefi ciaries occurred in California, Texas, Washington, Virginia, and Florida (Figure); 90 cases have been diagnosed in California since January 2014, which is more than was reported in all of 2012 (n=68) or 2013 (n=89).
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Armed Forces Health Surveillance Center
- Congressionally Mandated: No
- Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
- Release Date/Publication: June 01, 2014
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Citation: Armed Forces Health Surveillance Center (AFHSC). Surveillance snapshot: states with the most pertussis diagnoses among service members and other beneficiaries of the Military Health System, January 2012-June 2014. MSMR. 2014 Jun;21(6):18.
Study
Abstract
Military mild traumatic brain injury (mTBI) differs from civilian injury in important ways. Although mTBI sustained in both military and civilian settings are likely to be underreported, the combat theater presents additional obstacles to reporting and accessing care. The impact of blast forces on the nervous system may differ from nonblast mechanisms, mTBI although studies comparing the neurologic and cognitive sequelae in mTBI survivors have not provided such evidence. However, emotional distress appears to figure prominently in symptoms following military mTBI. This review evaluates the extant literature with an eye towards future research directions.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: June 01, 2014
-
Citation: Chapman JC, Diaz-Arrastia R. Military traumatic brain injury: a review. Alzheimers Dement. 2014 Jun;10(3 Suppl):S97-104.
Study
Abstract
BACKGROUND: Limited data exist examining the use of fecal diversion in combatants from modern armed conflicts. Characterization of factors leading to colostomy creation is an initial step toward optimizing and individualizing combat casualty care.
METHODS: A retrospective review of the US Department of Defense Trauma Registry database was performed for all US and coalition troops with colorectal injuries sustained during combat operations in Iraq and Afghanistan over 8 years. Colostomy rate, anatomic injury location, mechanism of injury, demographic data, and initial physiologic parameters were examined. Univariate and multivariate analyses were conducted.
RESULTS: We identified 867 coalition military personnel with colorectal injuries. The overall colostomy rate was 37%. Rectal injuries had the highest diversion rate (56%), followed by left-sided (41%) and right-sided (20%) locations (P < .0001). Those with gunshot wounds (GSW) underwent diversion more often than blast injuries (43% vs 31% respectively, P < .0008). Injury Severity Score ≥16 (41% vs 30%; P = .0018) and damage control surgery (DCS; 48.2% vs 31.4%; P < .0001) were associated with higher diversion rates. On multivariate analysis, significant predictors for colostomy creation were injury location: Rectal versus left colon (odds ratio [OR], 2.2), rectal versus right colon (OR, 7.5), left versus right colon (OR, 3.4), GSW (OR, 2.0), ISS ≥ 16 (OR, 1.7), and DCS (OR, 1.6).
CONCLUSION:
In this exploratory study of 320 combat-related colostomies, distal colon and rectal injuries continue to be diverted at higher rates independent of other comorbidities. Additional outcomes-directed research is needed to determine whether such operative management is beneficial in all patients
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Army
- Release Date/Publication: June 01, 2014
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Citation: Watson JD, Aden JK, Engel JE, Rasmussen TE, Glasgow SC. Risk factors for colostomy in military colorectal trauma: a review of 867 patients. Surgery. 2014 Jun;155(6):1052-61.
Study
Abstract
BACKGROUND: Sexually transmitted infections (STIs) are prevalent in the U.S. military. However, there are limited data on risk-factor differences between sexes.
METHODS: We used data from the 2008 Department of Defense Survey of Health Related Behaviors among active duty military personnel to identify risk factors for self-reported STIs within the past 12 months and multiple sexual partners among sexually active unmarried service members.
RESULTS: There were 10,250 active duty personnel, mostly white (59.3%) aged 21 to 25 years (42.6%). The prevalence of any reported STI in the past 12 months was 4.2% for men and 6.9% for women. One-fourth of men and 9.3% of women reported 5 or more sexual partners in the past 12 months. Binge drinking, illicit substance use, and unwanted sexual contact were associated with increased report of sexual partners among both sexes. Family/personal-life stress and psychological distress influenced number of partnerships more strongly for women than for men (Adjusted Odds Ratio [AOR]=1.58, 95% Confidence Interval [CI]=1.18-2.12 and AOR=1.41, 95% CI=1.14-1.76, respectively). After adjusting for potential confounders, we found that the report of multiple sexual partners was significantly associated with the report of an STI among men (AOR, 5.87 [95% CI, 3.70-9.31], for ≥5 partners; AOR, 2.35 [95% CI, 1.59-3.49], for 2-4 partners) and women (AOR, 4.78 [95% CI, 2.12-10.80], for ≥5 partners; AOR, 2.35 [95% CI, 1.30-4.25], for 2-4 partners).
CONCLUSIONS: Factors associated with the report of increasing sexual partnerships and report of an STI differed by sex. Sex-specific intervention strategies may be most effective in mitigating the factors that influence risky sexual behaviors among military personnel.
- Publication Status: Published
- Sponsoring Organization: Undetermined
- Sponsoring Office:
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: June 01, 2014
-
Citation: Stahlman S, Javanbakht M, Cochran S, Hamilton AB, Shoptaw S, Gorbach PM. Self-reported sexually transmitted infections and sexual risk behaviors in the U.S. Military: how sex influences risk. Sex Transm Dis. 2014 Jun;41(6):359-64
Study
Abstract
Malaria chemoprophylaxis is used as a preventive measure in military personnel deployed to malaria-endemic countries. However, limited information is available on compliance with chemoprophylaxis among trauma patients during hospitalization and after discharge. Therefore, we assessed antimalarial primary chemoprophylaxis and presumptive antirelapse therapy (primaquine) compliance among wounded United States military personnel after medical evacuation from Afghanistan (June 2009-August 2011) to Landstuhl Regional Medical Center in Landstuhl, Germany, and then to three U.S. military hospitals. Among admissions at Landstuhl Regional Medical Center, 74% of 2,540 patients were prescribed primary chemoprophylaxis and < 1% were prescribed primaquine. After transfer of 1,331 patients to U.S. hospitals, 93% received primary chemoprophylaxis and 33% received primaquine. Of 751 trauma patients with available post-admission data, 42% received primary chemoprophylaxis for four weeks, 33% received primaquine for 14 days, and 17% received both. These antimalarial chemoprophylaxis prescription rates suggest that improved protocols to continue malaria chemoprophylaxis in accordance with force protection guidelines are needed.
- Publication Status: Published
- Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
- Sponsoring Office: Walter Reed National Military Medical Center/Uniformed Services University of Health Sciences
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: June 01, 2014
-
Citation: Rini EA, et.al., . Compliance with antimalarial chemoprophylaxis recommendations for wounded United States military personnel admitted to a military treatment facility. Am J Trop Med Hyg. 2014 Jun;90(6):1113-6.
Study
Abstract
BACKGROUND: Understanding physical activity (PA) after discharge from the military can inform theory on the role of habit and reinforcement in behavior maintenance and has implications for this population's future health.
METHODS: Using data from 28,866 Millennium Cohort Study participants (n=3782 of whom were discharged during the years between assessments), we: 1) investigated changes in meeting federal PA Guidelines for moderate-to-vigorous activity (MVPA) following military discharge, and 2) determined predictors of meeting these Guidelines after discharge.
RESULTS: MVPA declined more in those who were discharged than those who were not (-17.8 percentage points vs. -2.7 percentage points), with greater declines in former active-duty personnel, those who had deployed with combat exposures, had 14-25 years of service, and had been discharged more recently (>2 years prior). In those who were discharged, being normal or overweight (vs. obese), and a nonsmoker or former smoker (vs. current smoker) were positively associated with meeting MVPA Guidelines at follow-up, while meeting MVPA Guidelines at baseline and depression were inversely associated.
CONCLUSIONS: Reductions in MVPA were substantial and unexpected. Increased understanding of transitional periods that may benefit from interventions to mitigate declines in PA will help prevent excess weight gain and physical inactivity-associated health consequences.
- Publication Status: Published
- Sponsoring Organization: Undetermined
- Sponsoring Office:
- Congressionally Mandated: No
- Funding Source: Undetermined
- Release Date/Publication: May 01, 2014
-
Citation: Littman A, Jacobson IG, Boyko EJ, Smith TC. Changes in Meeting Vigorous Physical Activity Guidelines After Discharge From the Military. J Phys Act Health. 2014 May 9.
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