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Military Health System Studies Inventory Tool

Welcome to the Military Health System Studies Inventory Tool (MSIT). Military Health System (MHS) data are used by Department of Defense, Veterans Administration, and academic health professionals and scientists to implement health care studies. These studies reflect the MHS interest to rigorously assess and improve our beneficiaries’ access to the high quality health care services they need. Additionally, these studies are frequently used to develop or improve MHS policy and often adopt useful, relevant comparisons to the national health care experience.

The MSIT allows easy review of recent studies that are either conducted or sponsored by the MHS, or accomplished using datasets developed or maintained by the Defense Health Agency for administrative, operational, or research purposes. The studies within this website represent important contributions of the MHS to the national health care dialogue and reflect our capacity to tackle the challenging issues needed to support evidence-informed health policy. Thank you for your interest in them.

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Willingness to receive a hypothetical avian influenza vaccine among US military personnel in mid-deployment.

Study

Abstract

Though no avian influenza vaccine currently exists, development efforts have increased. Given recent reports of suboptimal vaccination rates among US military personnel, we sought to assess factors associated with a willingness to receive a hypothetical avian influenza vaccine. A self-administered questionnaire was completed by US military personnel during mid-deployment to Iraq, Afghanistan, and surrounding regions. Respondents were predominately male (86.2%), Army (72.1%), and enlisted (86.3%) with a mean age of 29.6 y. The majority (77.1%) agreed to receive an avian influenza vaccine if available. Exploratory factor analysis (EFA) identified two factors, vaccine importance and disease risk, that best described the individual perceptions and both were associated with an increased willingness to receive the hypothetical vaccine (OR: 8.2 and 1.6, respectively). Importantly, after controlling for these factors differences in the willingness to receive this hypothetical vaccine were observed across gender and branch of service. These results indicated that targeted education on vaccine safety and efficacy as well as disease risk may modify vaccination patterns in this 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: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: December 01, 2013
  • Citation: Porter CK, Fitamaurice G, Tribble DR, Armstrong AW, Mostafa M, Riddle MS. Willingness to receive a hypothetical avian influenza vaccine among US military personnel in mid-deployment. Hum Vaccin Immunother. 2013 Dec;9(12):2613-7.

Combining surveillance systems: effective merging of U.S. Veteran and military health data.

Study

Abstract

BACKGROUND: The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) had more than 18 million healthcare beneficiaries in 2011. Both Departments conduct individual surveillance for disease events and health threats. METHODS: We performed joint and separate analyses of VA and DoD outpatient visit data from October 2006 through September 2010 to demonstrate geographic and demographic coverage, timeliness of influenza epidemic awareness, and impact on spatial cluster detection achieved from a joint VA and DoD biosurveillance platform. RESULTS: Although VA coverage is greater, DoD visit volume is comparable or greater. Detection of outbreaks was better in DoD data for 58% and 75% of geographic areas surveyed for seasonal and pandemic influenza, respectively, and better in VA data for 34% and 15%. The VA system tended to alert earlier with a typical H3N2 seasonal influenza affecting older patients, and the DoD performed better during the H1N1 pandemic which affected younger patients more than normal influenza seasons. Retrospective analysis of known outbreaks demonstrated clustering evidence found in separate DoD and VA runs, which persisted with combined data sets. CONCLUSION: The analyses demonstrate two complementary surveillance systems with evident benefits for the national health picture. Relative timeliness of reporting could be improved in 92% of geographic areas with access to both systems, and more information provided in areas where only one type of facility exists. Combining DoD and VA data enhances geographic cluster detection capability without loss of sensitivity to events isolated in either population and has a manageable effect on customary alert rates.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: December 01, 2013
  • Citation: Pavlin JA, Burkom HS, Elbert Y, Lucero-Obusan C, Winston CA, Cox KL, Oda G, Lombardo JS, Holodniy M. Combining surveillance systems: effective merging of U.S. Veteran and military health data. PLoS One. 2013 Dec 26;8(12):e84077.

A case-control study of incident rheumatological conditions following acute gastroenteritis during military deployment.

Study

Abstract

OBJECTIVES: The aim of this study was to assess the risk of incident rheumatological diagnoses (RD) associated with self-reported diarrhoea and vomiting during a first-time deployment to Iraq or Afghanistan. Such an association would provide evidence that RD in this population may include individuals with reactive arthritis (ReA) from deployment-related infectious gastroenteritis. DESIGN: This case-control epidemiological study used univariate and multivariate logistic regression to compare the odds of self-reported diarrhoea/vomiting among deployed US military personnel with incident RD to the odds of diarrhoea/vomiting among a control population. SETTING: We analysed health records of personnel deployed to Iraq or Afghanistan, including responses on a postdeployment health assessment and medical follow-up postdeployment. PARTICIPANTS: Anonymous data were obtained from 891 US military personnel with at least 6 months of medical follow-up following a first-time deployment to Iraq or Afghanistan in 2008-2009. Cases were defined using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes; controls had an unrelated medical encounter and were representative of the study population. MAIN OUTCOME MEASURES: The primary measure was an association between incident RD and self-reported diarrhoea/vomiting during deployment. A secondary measure was the overall incidence of RD in this population. RESULTS: We identified 98 cases of new onset RD, with a total incidence of 161/100 000 persons. Of those, two participants had been diagnosed with Reiter's disease (i) (3.3/100 000 persons) and the remainder with non-specific arthritis/arthralgia (157.5/100 000 persons). The OR for acute diarrhoea was 2.67 (p=0.03) after adjusting for important covariates. CONCLUSIONS: Incident rheumatological conditions, even those classified as 'non-specific,' are significantly associated with prior severe diarrhoea in previously deployed military personnel, potentially indicating ReA and need for preventive measures to reduce diarrhoeagenic bacterial exposures in military personnel and other travellers to the developing regions.

  • Publication Status: Published
  • Sponsoring Organization: Navy
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: December 01, 2013
  • Citation: Deyoung KH, Riddle MS, May L, Porter CK. A case-control study of incident rheumatological conditions following acute gastroenteritis during military deployment. BMJ Open. 2013 Dec 5;3(12):e003801.

Risk factors associated with suicide in current and former US military personnel.

Study

Abstract

IMPORTANCE: Beginning in 2005, the incidence of suicide deaths in the US military began to sharply increase. Unique stressors, such as combat deployments, have been assumed to underlie the increasing incidence. Previous military suicide studies, however, have relied on case series and cross-sectional investigations and have not linked data during service with postservice periods. OBJECTIVE: To prospectively identify and quantify risk factors associated with suicide in current and former US military personnel including demographic, military, mental health, behavioral, and deployment characteristics. DESIGN, SETTING, AND PARTICIPANTS: Prospective longitudinal study with accrual and assessment of participants in 2001, 2004, and 2007. Questionnaire data were linked with the National Death Index and the Department of Defense Medical Mortality Registry through December 31, 2008. Participants were current and former US military personnel from all service branches, including active and Reserve/National Guard, who were included in the Millennium Cohort Study (N = 151,560). MAIN OUTCOMES AND MEASURES: Death by suicide captured by the National Death Index and the Department of Defense Medical Mortality Registry. RESULTS: Through the end of 2008, findings were 83 suicides in 707,493 person-years of follow-up (11.73/100,000 person-years [95% CI, 9.21-14.26]). In Cox models adjusted for age and sex, factors significantly associated with increased risk of suicide included male sex, depression, manic-depressive disorder, heavy or binge drinking, and alcohol-related problems. None of the deployment-related factors (combat experience, cumulative days deployed, or number of deployments) were associated with increased suicide risk in any of the models. In multivariable Cox models, individuals with increased risk for suicide were men (hazard ratio [HR], 2.14; 95% CI, 1.17-3.92; P = .01; attributable risk [AR], 3.5 cases/10,000 persons), and those with depression (HR, 1.96; 95% CI, 1.05-3.64; P = .03; AR, 6.9/10,000 persons), manic-depressive disorder (HR, 4.35; 95% CI, 1.56-12.09; P = .005; AR, 35.6/10,000 persons), or alcohol-related problems (HR, 2.56; 95% CI, 1.56-4.18; P <.001; AR, 7.7/10,000 persons). A nested, matched case-control analysis using 20:1 control participants per case confirmed these findings. CONCLUSIONS AND RELEVANCE: In this sample of current and former military personnel observed July 1, 2001-December 31, 2008, suicide risk was independently associated with male sex and mental disorders but not with military-specific variables. These findings may inform approaches to mitigating suicide risk in this population.

  • Publication Status: Published
  • Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: August 01, 2013
  • Citation: LeardMann CA, Powell TM, Smith TC, Bell MR, Smith B, Boyko EJ, Hooper TI, Gackstetter GD, Ghamsary M, Hoge CW. Risk factors associated with suicide in current and former US military personnel. JAMA. 2013 Aug 7;310(5):496-506

Sleep characteristics, mental health, and diabetes risk: a prospective study of U.S. military service members in the Millennium Cohort Study.

Study

Abstract

OBJECTIVE: Research has suggested that a higher risk of type 2 diabetes associated with sleep characteristics exists. However, studies have not thoroughly assessed the potential confounding effects of mental health conditions associated with alterations in sleep. RESEARCH DESIGN AND METHODS: We prospectively assessed the association between sleep characteristics and self-reported incident diabetes among Millennium Cohort Study participants prospectively followed over a 6-year time period. Surveys are administered approximately every 3 years and collect self-reported data on demographics, height, weight, lifestyle, features of military service, sleep, clinician-diagnosed diabetes, and mental health conditions assessed by the PRIME-MD Patient Health Questionnaire and the PTSD Checklist-Civilian Version. Statistical methods for longitudinal data were used for data analysis. RESULTS: We studied 47,093 participants (mean 34.9 years of age; mean BMI 26.0 kg/m2; 25.6% female). During 6 years of follow-up, 871 incident diabetes cases occurred (annual incidence 3.6/1,000 person-years). In univariate analyses, incident diabetes was significantly more likely among participants with self-reported trouble sleeping, sleep duration<6 h, and sleep apnea. Participants reporting incident diabetes were also significantly older, of nonwhite race, of higher BMI, less likely to have been deployed, and more likely to have reported baseline symptoms of panic, anxiety, posttraumatic stress disorder, and depression. After adjusting for covariates, trouble sleeping (odds ratio 1.21 [95% CI 1.03-1.42]) and sleep apnea (1.78 [1.39-2.28]) were significantly and independently related to incident diabetes. CONCLUSIONS: Trouble sleeping and sleep apnea predict diabetes risk independent of mental health conditions and other diabetes risk factors.

  • Publication Status: Published
  • Sponsoring Organization: DoD agency, office, or organization other than the Army, Navy, Air Force, or Defense Health Agency
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: October 01, 2013
  • Citation: Boyko EJ, Seelig AD, Jacobson IG, Hooper TI, Smith B, Smith TC, et. al. Sleep characteristics, mental health, and diabetes risk: a prospective study of U.S. military service members in the Millennium Cohort Study. Diabetes Care. 2013 Oct;36(10):3154-61.

The challenge of sleep management in military operations.

Study

Abstract

It has long been known that short-term (days) insufficient sleep causes decrements in mental effectiveness that put individuals at increased risk of committing errors and causing accidents. More recently, it has been discovered that chronic poor sleep (over years) is associated with a variety of negative health outcomes (metabolic syndrome, obesity, degraded behavioral health). Implementing an effective sleep health program is, therefore, in the best interests of active duty personnel and their families both in the short- and long-term. Like managing physical activity or nutrition, effectively managing sleep health comes with its unique set of challenges arising from the fact that individuals who routinely do not obtain sufficient sleep are generally desensitized to feeling sleepy and are poor at judging their own performance capabilities--and individuals cannot be compelled to sleep. For these reasons, an optimally effective sleep health program requires 3 components: (1) a rigorous, evidence-based sleep education component to impart actionable knowledge about optimal sleep amounts, healthy sleep behaviors, the known benefits of sleep, the short- and long-term consequences of insufficient sleep, and to dispel myths about sleep; (2) a nonintrusive device that objectively and accurately measures sleep to empower the individual to track his/her own sleep/wake habits; and (3) a meaningful, actionable metric reflecting sleep/wake impact on daily effectiveness so that the individual sees the consequences of his/her sleep behavior and, therefore, can make informed sleep health choices.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2013
  • Citation: Wesensten NJ, Balkin TJ. The challenge of sleep management in military operations. US Army Med Dep J. 2013 Oct-Dec:109-18.

Sleep as a component of the performance triad: the importance of sleep in a military population.

Study

Abstract

OBJECTIVE: Sleep habits among military populations are problematic. Poor sleep hygiene occurs in parallel with the global increase in obesity and metabolic syndrome and contributes to a decrease in performance. The extent of sleep issues needs to be quantified to provide feedback for optimizing warfighter performance and readiness. This study assessed various health behaviors and habits of US Army Soldiers and their relationship with poor sleep quality by introducing a set of new questions into the Comprehensive Soldier and Family Fitness (CSF2) Global Assessment Tool (GAT). METHODS: Subjects included 14,148 US Army Active, Reserve, and National Guard members (83.4% male) who completed the GAT, a self-report questionnaire that measures 4 fitness dimensions: social, family, emotional, and spiritual. Approximately 60 new questions, including ones on sleep quality, within the fifth CSF2 dimension (physical) were also answered. A sleep score was calculated from 2 questions validated in the Pittsburgh Insomnia Rating Scale (0 to 6). RESULTS: Poor sleepers (5-6) were significantly (P<.001) more likely than good sleepers (0-1) to consider themselves in fair or poor health, be overweight or obese, and score in the lowest quartile of the emotional, social, family, and spiritual fitness dimensions. Additionally, poor sleepers were significantly (P<.001) less likely to have a healthy body mass index and waist circumference, eat breakfast 6 or more times a week, meet aerobic exercise and resistance training recommendations, and pass their Army Physical Fitness Test in the top quartile. CONCLUSION: This study examined sleep quality in a group of military personnel and indicated significant associations between quality of sleep and physical performance, nutritional habits, measures of obesity, lifestyle behaviors and measures of psychosocial status. Targeted educational interventions and resources are needed to improve sleep patterns based on behaviors that can be most easily modified.

  • 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: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2013
  • Citation: Lentino CV, Purvis DL, Murphy KJ, Deuster PA. Sleep as a component of the performance triad: the importance of sleep in a military population. US Army Med Dep J. 2013 Oct-Dec:98-108

Infant abusive head trauma in a military cohort.

Study

Abstract

OBJECTIVE: Evaluate the rate of, and risk factors for, abusive head trauma (AHT) among infants born to military families and compare with civilian population rates. METHODS: Electronic International Classification of Diseases data from the US Department of Defense (DoD) Birth and Infant Health Registry were used to identify infants born to military families from 1998 through 2005 (N = 676 827) who met the study definition for AHT. DoD Family Advocacy Program data were used to identify infants with substantiated reports of abuse. Rates within the military were compared with civilian population rates by applying an alternate AHT case definition used in a civilian study. RESULTS: Applying the study definition, the estimated rate of substantiated military AHT was 34.0 cases in the first year of life per 100 000 live births. Using the alternate case definition, the estimated AHT rate was 25.6 cases per 100 000 live births. Infant risk factors for AHT included male sex, premature birth, and a diagnosed major birth defect. Parental risk factors included young maternal age (<21 years), lower sponsor rank or pay grade, and current maternal military service. CONCLUSIONS: This is the first large database study of AHT with the ability to link investigative results to cases. Overall rates of AHT were consistent with civilian populations when using the same case definition codes. Infants most at risk, warranting special attention from military family support programs, include infants with parents in lower military pay grades, infants with military mothers, and infants born premature or with birth defects.

  • Publication Status: Published
  • Sponsoring Organization: Navy
  • Sponsoring Office: Naval Health Research Center
  • Congressionally Mandated: No
  • Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)
  • Release Date/Publication: October 01, 2013
  • Citation: Gumbs GR, Keenan HT, Sevick CJ, Conlin AM, Lloyd DW, Runyan DK, Ryan MA, Smith TC. Infant abusive head trauma in a military cohort. Pediatrics. 2013 Oct;132(4):668-76.

Tdap coverage in a military beneficiary population: room for improvement.

Study

Abstract

Pertussis has had a resurgence in recent years. Women of child-bearing age and adults with infant contact are important reservoirs of infection because of waning immunity. Recent infant deaths and outbreaks led to new tetanus, diphtheria, and acellular pertussis (Tdap) vaccine recommendations, but vaccination rates remain low. A performance improvement project was started at Walter Reed Army Medical Center to target women of child-bearing age. Women treated in Gynecology had their electronic medical record screened for Tdap during their vital signs assessment. Those eligible for vaccination were directed to the Immunization Clinic. The intervention was considered successful if the patient received the vaccine within 30 days of the visit. Data were compiled on vaccination rates 1 month before and 1 and 3 months after the start of the performance improvement project. Only 13.9% of all patients had a documented Tdap at any time. During the first month following the intervention, vaccination rates within 30 days of the appointment increased from 0.38% to 6.5% (p < 0.005). The effect waned at 3 months following intervention, with only 1.1% of patients vaccinated within 30 days of the appointment. Overall vaccination rates remain low, and future studies should focus on barriers to vaccination to prevent morbidity and mortality.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2013
  • Citation: Lam ST, George S, Dunlow S, Nelson M, Hartzell JD. Tdap coverage in a military beneficiary population: room for improvement. Mil Med. 2013 Oct;178(10):1133-6.

Nutrition as a component of the performance triad: how healthy eating behaviors contribute to soldier performance and military readiness.

Study

Abstract

OBJECTIVE: Nutrition is a critical element of Soldier health and performance. Food choices, meal timing, and dietary intake behaviors contribute to nutritional fitness. The objectives of this study were to describe Soldier dietary behaviors and quantify the association between healthy eating behaviors and demographic, lifestyle, and psychosocial factors. METHODS: The Comprehensive Soldier and Family Fitness Global Assessment Tool (GAT) assesses emotional, social, family, and spiritual fitness. In 2012, 57 pilot questions were added to the GAT to create a physical dimension that included nutrition assessments. Participants included 13,858 Active Duty, Reserve, and National Guard Soldiers: 83% male; 85% enlisted; a mean age of 28±9 years. A Healthy Eating Score (HES-5) was calculated from 5 questions assessing frequency of fruit, vegetable, whole grain, dairy, and fish intake (Cronbach α=0.81). Associations between HES-5 and other dietary habits, physical activity patterns, and GAT psychosocial dimension scores were examined. RESULTS: Soldiers who ate breakfast regularly (6 times/week or more), drank 7 servings or more of water/day, and met weekly exercise recommendations were more likely to be in the highest HES-5 quartile than those who did not. Those who passed their Army Physical Fitness Test (APFT) in the top quartile were also more likely to report high HES-5 scores than those who failed (P<.001). Soldiers with healthy anthropometric measures and the highest emotional, social, family, and spiritual fitness scores were also more likely to be in the top HES-5 quartile than those with unhealthy measures and with the lowest fitness scores (P<.001). CONCLUSION: The HES-5 may be a useful index for characterizing dietary intake behaviors. Healthy dietary intake behaviors are associated with all dimensions of health, physical fitness, and psychosocial status.

  • 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: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2013
  • Citation: Purvis DL, Lentino CV, Jackson TK, Murphy KJ, Deuster PA. Nutrition as a component of the performance triad: how healthy eating behaviors contribute to soldier performance and military readiness. US Army Med Dep J. 2013 Oct-Dec:66-78.

Predicting non-familial major physical violent crime perpetration in the US Army from administrative data.

Study

Abstract

BACKGROUND: Although interventions exist to reduce violent crime, optimal implementation requires accurate targeting. We report the results of an attempt to develop an actuarial model using machine learning methods to predict future violent crimes among US Army soldiers. METHOD: A consolidated administrative database for all 975 057 soldiers in the US Army in 2004-2009 was created in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Of these soldiers, 5771 committed a first founded major physical violent crime (murder-manslaughter, kidnapping, aggravated arson, aggravated assault, robbery) over that time period. Temporally prior administrative records measuring socio-demographic, Army career, criminal justice, medical/pharmacy, and contextual variables were used to build an actuarial model for these crimes separately among men and women using machine learning methods (cross-validated stepwise regression, random forests, penalized regressions). The model was then validated in an independent 2011-2013 sample. RESULTS: Key predictors were indicators of disadvantaged social/socioeconomic status, early career stage, prior crime, and mental disorder treatment. Area under the receiver-operating characteristic curve was 0.80-0.82 in 2004-2009 and 0.77 in the 2011-2013 validation sample. Of all administratively recorded crimes, 36.2-33.1% (male-female) were committed by the 5% of soldiers having the highest predicted risk in 2004-2009 and an even higher proportion (50.5%) in the 2011-2013 validation sample. CONCLUSIONS: Although these results suggest that the models could be used to target soldiers at high risk of violent crime perpetration for preventive interventions, final implementation decisions would require further validation and weighing of predicted effectiveness against intervention costs and competing risks.

  • 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: January 01, 2016
  • Citation: Rosellini AJ, Monahan J, Street AE, Heeringa SG, Hill ED, Petukhova M. et.al., Predicting non-familial major physical violent crime perpetration in the US Army from administrative data. Psychol Med. 2016 Jan;46(2):303-16.

Development and Initial Validation of Military Deployment-Related TBI Quality-of-Life Item Banks.

Study

Abstract

OBJECTIVE: To investigate unique factors that affect health-related quality of life (QOL) in individuals with military deployment-related traumatic brain injury (MDR-TBI) and to develop appropriate assessment tools, consistent with the TBI-QOL/PROMIS/Neuro-QOL systems. PARTICIPANTS: Three focus groups from each of the 4 Veterans Administration (VA) Polytrauma Rehabilitation Centers, consisting of 20 veterans with mild to severe MDR-TBI, and 36 VA providers were involved in early stage of new item banks development. The item banks were field tested in a sample (N = 485) of veterans enrolled in VA and diagnosed with an MDR-TBI. DESIGN: Focus groups and survey. OUTCOME MEASURES: Developed item banks and short forms for Guilt, Posttraumatic Stress Disorder/Trauma, and Military-Related Loss. RESULTS: Three new item banks representing unique domains of MDR-TBI health outcomes were created: 15 new Posttraumatic Stress Disorder items plus 16 SCI-QOL legacy Trauma items, 37 new Military-Related Loss items plus 18 TBI-QOL legacy Grief/Loss items, and 33 new Guilt items. Exploratory and confirmatory factor analyses plus bifactor analysis of the items supported sufficient unidimensionality of the new item pools. Convergent and discriminant analyses results, as well as known group comparisons, provided initial support for the validity and clinical utility of the new item response theory-calibrated item banks and their short forms. CONCLUSION: This work provides a unique opportunity to identify issues specific to individuals with MDR-TBI and ensure that they are captured in QOL assessment, thus extending the existing TBI-QOL measurement system.

  • 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: Undetermined
  • Release Date/Publication: January 01, 2016
  • Citation: Toyinbo PA, Vanderploeg RD, Donnell AJ, Mutolo SA, Cook KF, Kisala PA, Tulsky DS. Development and Initial Validation of Military Deployment-Related TBI Quality-of-Life Item Banks. J Head Trauma Rehabil. 2016 Jan-Feb;31(1):52-61.

Alcohol Use Among Active Duty Women: Analysis AUDIT Scores From the 2011 Health-Related Behavior Survey of Active Duty Military Personnel.

Study

Abstract

BACKGROUND: Numerous studies document higher substance use among military men after deployment; similar studies focused on military women are limited. OBJECTIVES: This study examines alcohol use of active duty women and deployment factors, social/environmental/attitudinal factors, and psychological/intrapersonal factors. METHODS: Secondary data analysis of the 2011 Survey of Health-Related Behavior of active duty military personnel was conducted using bivariate statistics and multiple regression analyses with Alcohol Use Disorders Identification Test scores as the dependent variable. RESULTS: Nearly 94% had low risk for alcohol use disorders. Length of combat experience and extent of combat exposure were unrelated to Alcohol Use Disorders Identification Test scores; noncombat deployment was unrelated after controlling for marital status, age of first drink, pay grade, and branch of service. Significant motivators (p < 0.001) for drinking were "like/enjoy drinking," "drink to cheer up," "drink to forget problems," and significant deterrents were "cost of alcohol" and "fear of upsetting family/friends if used alcohol." Anger propensity, risk propensity, lifetime prevalence of suicidal ideation, and depressed mood were significant predictors in the regression model after controlling for covariates. CONCLUSION: Findings suggest that some active duty women use alcohol to cope with adverse emotional states, whereas others use alcohol consistent with propensity for high-risk behaviors.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense Health Agency (formerly TRICARE Management Activity)
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: January 01, 2016
  • Citation: Jeffery DD, Mattiko M. Alcohol Use Among Active Duty Women: Analysis AUDIT Scores From the 2011 Health-Related Behavior Survey of Active Duty Military Personnel. Mil Med. 2016 Jan;181(1 Suppl):99-108.

Reproductive Health of Active Duty Women in Medically Austere Environments

Study

Abstract

One in seven of the approximately 2.2 million Department of Defense active duty military personnel are women. Among active duty servicewomen, about 40% are under 26 years old, and almost half are young, lower ranking enlisted personnel. This article will include a review of the literature on military women's health topics such including contraception access, pregnancy, and pregnancy outcomes after environmental exposures. In these early adult years, contraception use may not be consistent, leading to higher rates of unintended pregnancy that is similar to their civilian counterparts, but it may affect troop readiness. Women who become pregnant after deployment must be evacuated from theater. Complications in pregnancy that require immediate intervention, such as ectopic pregnancy, may be more difficult to diagnose and manage if far away from comprehensive medical services. Environmental exposures may affect the pregnancy outcome, or may produce delayed responses for future childbearing. Women face other gynecologic choices including menstrual suppression while deployed. Many of these issues have not been fully studied, sample sizes are small or methodological flaws exist in the analysis limiting conclusions that can be drawn. Further research with greater rigor, larger sample sizes, and careful design are needed to address many of these questions.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense Health Agency (formerly TRICARE Management Activity)
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: January 01, 2016
  • Citation: Krulewitch CJ. Reproductive Health of Active Duty Women in Medically Austere Environments. Mil Med. 2016 Jan;181(1 Suppl):63-9.

Operational Physical Performance and Fitness in Military Women: Physiological, Musculoskeletal Injury, and Optimized Physical Training Considerations for Successfully Integrating Women Into Combat-Centric Military Occupations.

Study

Abstract

This article summarizes presentations from a 2014 United States Department of Defense (DoD) Health Affairs Women in Combat symposium addressing physiological, musculoskeletal injury, and optimized physical training considerations from the operational physical performance section. The symposium was held to provide a state-of-the-science meeting on the U.S. DoD's rescinding of the ground combat exclusion policy opening up combat-centric occupations to women. Physiological, metabolic, body composition, bone density, cardiorespiratory fitness, and thermoregulation differences between men and women were briefly reviewed. Injury epidemiological data are presented within military training and operational environments demonstrating women to be at a higher risk for musculoskeletal injuries than men. Physical training considerations for improved muscle strength and power, occupational task performance, load carriage were also reviewed. Particular focus of this article was given to translating physiological and epidemiological findings from the literature on these topics toward actionable guidance and policy recommendations for military leaders responsible for military physical training doctrine: (1) inclusion of resistance training with special emphasis on strength and power development (i.e., activation of high-threshold motor units and recruitment of type II high-force muscle fibers), upper-body strength development, and heavy load carriage, (2) moving away from "field expediency" as the major criteria for determining military physical training policy and training implementation, (3) improvement of load carriage ability with emphasis placed on specific load carriage task performance, combined with both resistance and endurance training, and (4) providing greater equipment resources, coaching assets, and increased training time dedicated to physical readiness training.

  • 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: January 01, 2016
  • Citation: Nindl BC, Jones BH, Van Arsdale SJ, Kelly K, Kraemer WJ. Operational Physical Performance and Fitness in Military Women. Mil Med. 2016 Jan;181(1 Suppl):50-62.
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