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Sexually transmitted infections on the rise in military

Some sexually transmitted infections are on the rise in the military. To increase awareness, members of Team McConnell attend a briefing on STIs at McConnell Air Force Base, Kansas. (U.S. Air Force photo by Airman 1st Class Alexi Myrick) Some sexually transmitted infections are on the rise in the military. To increase awareness, members of Team McConnell attend a briefing on STIs at McConnell Air Force Base, Kansas. (U.S. Air Force photo by Airman 1st Class Alexi Myrick)

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The rates of certain types of sexually transmitted infections, or STIs, are rising dramatically for both male and female service members, according to a recent report. These STIs include chlamydia, gonorrhea, and syphilis. Data from the Centers for Disease Control and Prevention confirm similar surges for these three types of infections in the civilian population. The current high rates in the military pose challenges for more than 1.3 million DoD personnel, 84 percent of whom are men.

“We have a large number of males in the service, and the population we see normally is the 18 to 25 year olds. STI is most common in that age group,” said Norma Jean Suarez, a nurse practitioner in preventive medicine at Brook Army Medical Center in San Antonio. She added that the men she sees often don’t know how prevalent STIs are.

STI myths (MHS graphic)
STI myths (MHS graphic)

“STIs place a significant economic strain on the U.S. and military health care systems,” said Maj. Dianne Frankel, an Air Force internal medicine physician and USU preventive medicine resident. In 2012, STIs in the Navy alone accounted for health care costs of $5.4 million.

“From a military standpoint, STIs can have a significant impact on individual readiness, which in turn impacts unit readiness, which then leads to a decrease in force health protection,” said Frankel. She added that there can be serious health consequences for untreated STIs, including, down the road, cancer in the case of genital human papillomavirus, or HPV.

But why are STIs on the rise, and why now? “There appears to be an increase in high-risk behaviors among service members; that is, having sex without a condom or having more than one sexual partner,” said Frankel, referring to the 2015 DoD Health-Related Behaviors Survey, known as HRBS. This report documented that one-fifth of respondents reported having more than one sexual partner in the past year, while one-third reported having sex with a new partner in the past year without use of a condom. These numbers have doubled since the last reported survey in 2011, said Frankel.

Suarez added another factor she’s been seeing: Dating apps can promote random, anonymous encounters, and when infections result, that anonymity can make partners difficult to track down. Having anonymous sex is one of the CDC’s list of behaviors that can increase risk of contracting an STI or HIV. Others include having vaginal, oral, or anal sex without a condom; having multiple sexual partners; or having sex while under the influence of drugs or alcohol, which can lower inhibitions and result in greater sexual risk-taking.

In general, STIs spread readily if precautions aren’t taken, according to Col. Amy Costello, chief of preventive medicine at the Air Force Medical Support Agency. “Chlamydia and gonorrhea are quite common; they can be transmitted vaginally, anally, or through oral-sexual contact,” she said. “Pretty much any time you have mucous membrane contact with an infected person, you have a chance of getting it.” She added that syphilis is usually spread through open sores that can be non-painful, meaning an infected person might not know the infection is present.

Not all STIs are on the rise, according to the HRBS. Rates for genital herpes simplex decreased slightly between 2010 and 2018, and HPV dropped by almost 52 percent. She credited the widespread adoption of the HPV vaccine for the dramatic decline in the rate of infection.

HIV is another STI of concern. “A lot of service members don’t understand that HIV exists on the active-duty military side,” said Suarez. “Here in San Antonio alone, we manage 30+ HIV-positive active-duty soldiers.” But rates of HIV are much lower in the military than in the U.S. population, Frankel said, adding that numbers for HIV from 2012 – 2017 “have been relatively stable.”

Costello said that chlamydia, gonorrhea, and syphilis are bacterial infections that are treated with antibiotics. HPV, herpes, and HIV are viruses and more difficult to treat. She said the most reliable way to avoid getting an STI is to stay away from oral, vaginal, and anal sex unless in a long-term, mutually monogamous relationship with a partner known to be uninfected. But, she added, “That’s not a realistic plan for many of our younger service members who aren’t yet married or in long-term monogamous relationships.” Therefore, condom use is critical, she concluded, and any symptoms should lead to testing.

Efforts are ongoing to combat the rise of STIs through education. “STIs are preventable,” said Frankel. “It’s important for everyone to know how to protect themselves and their partners.”

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Insomnia and motor vehicle accident-related injuries, Active Component, U.S. Armed Forces, 2007 – 2016

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Insomnia is the most common sleep disorder in adults and its incidence in the U.S. Armed Forces is increasing. A potential consequence of inadequate sleep is increased risk of motor vehicle accidents (MVAs). MVAs are the leading cause of peacetime deaths and a major cause of non-fatal injuries in the U.S. military members. To examine the relationship between insomnia and motor vehicle accident-related injuries (MVAs) in the U.S. military, this retrospective cohort study compared 2007 – 2016 incidence rates of MVA-related injuries between service members with diagnosed insomnia and service members without a diagnosis of insomnia. After adjustment for multiple covariates, during 2007 – 2016, active component service members with insomnia had more than double the rate of MVA-related injuries, compared to service members without insomnia. Findings:  •	Line graph shows the annual rates of motor vehicle accident-related injuries, active component service members with and without diagnoses of insomnia, U.S. Armed Forces, 2007 – 2016  •	Annual rates of MVA-related injuries were highest in the insomnia cohort in 2007 and 2008, and lowest in 2016 •	There were 5,587 cases of MVA-related injuries in the two cohorts during the surveillance period. •	Pie chart displays the following data: 1,738 (31.1%) in the unexposed cohort and 3,849 (68.9%) in the insomnia cohort The highest overall crude rates of MVA-related injuries were seen in service members who were: •	Less than 25 years old •	Junior enlisted rank/grade •	Armor/transport occupation •	 •	With a history of mental health diagnosis •	With a history of alcohol-related disorders Access the full report in the December 2017 (Vol. 24, No. 12). Go to www.Health.mil/MSMR Image displays a motor vehicle accident.

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Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

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This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

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Update: Cold Weather Injuries, Active and reserve components, U.S. Armed Forces, July 2012 – June 2017

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1/18/2018
The total number of cold weather injuries among active component service members in 2016 – 2017 cold season was the lowest since 1999. 2016 – 2017 versus the previous four cold seasons  •	A total of 387 members of the active (n=328) and reserve (n=59) components had at least one medical encounter with a primary diagnosis of cold weather injury. •	Rates tended to be higher among service members who were in the youngest age groups, female, non-Hispanic black, or in the Army. •	Cold weather injuries associated with overseas deployments have fallen precipitously in the past three cold seasons due to changes in military operations in Iraq and Afghanistan. There were just 10 cases in the 2016 – 2017 season.  •	Frostbite was the most common type of cold weather injury. Bar chart displays numbers of service members who had a cold injury (one per person per year), by service and cold season, active and reserve components, U.S. Armed Forces, July 2012 – June 2017. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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Five cold seasons: July 2012-June 2017, Active reserve component service members who were diagnosed with a cold weather injury

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1/18/2018
Did you know during the 5-year surveillance period, the 2,717 service members who were affected by any cold weather injury included 2,307 from the active component and 410 from the reserve component. Overall, Army members comprised the majority (61.6%) of all cold injuries affecting active and reserve component service members. Of all affected reserve component members, 71.7% (n=294) were members of the Army. Cold weather injuries During Basic Training Of all active component service members who were diagnosed with a cold weather injury (n= 2,307), 230 (10.0% of the total) were affected during basic training. Additionally, during the surveillance period, 60 service members who were diagnosed with cold weather injuries during basic training (2.6% of the total) were hospitalized, and most (93.3%) of the hospitalized cases were members of either the Army (n=32) or Marine Corps (n=24). Cold weather injuries during basic training pie chart: The Army (n=122) and Marine Corps (n=99) comprised 96.1% of all basic trainees who were diagnosed with a cold weather injury. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness Image of service member tracking in the snow is the infographic background graphic.

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Cold weather injuries by military location, U.S. Armed Forces, July 2012 – June 2017

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1/18/2018
From July 2016 through June 2017, a total of 24 military locations had at least 30 incident cold weather injuries (one per person, per year) among active and reserve component service members.  The locations with the highest 5-year counts of incident injuries were: •	Fort Wainwright, AK (175) •	Bavaria (Grafenwoehr/Vilseck), Germany (110) •	Marine Corps Recruit Depot Parris Island/ Beaufort, SC (102) •	Fort Benning, GA (99) •	Fort Carson, CO (88) •	Marine Corps Base Quantico, VA (86) •	Fort Bragg, NC (78) Map displays the information above. 2016 – 2017 cold season During the 2016 – 2017 cold season, the numbers of incident cases of cold weather injuries were higher than the counts for the previous 2015-2016 cold season at seven of the 24 locations. The most noteworthy increase was found at the Army’s Fort Wainwright, where there were 48 total cases diagnosed in 2016 – 2017 , compared to just 16 during the 2015 – 2016 cold season. Bar chart shows annual number of cold weather injuries (cold season 2016 – 2017) and median number of cold weather injuries (cold seasons 2012 – 2016) at military locations with at least 30 cold weather injuries during the surveillance period, active component, U.S. Armed Forces, July 2012 – June 2017. Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR Image in background includes  service members out in the snow.

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Incidence rates of cold weather injuries: Non-Hispanic black service members, five cold weather seasons, July 2012 – June 2017

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2016 – 2017 Cold Season, Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces

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Cold weather injuries during deployments, July 2012 – June 2017

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1/18/2018
During the 5-year surveillance period, 105 cold weather injuries were diagnosed and treated in service members deployed outside the U.S. of these, 39 (37%) were immersion injuries; 33 (31%) were frostbite; 16 (15%) were hypothermia; and 17 (16%) were “unspecified” cold weather injuries. Pie chart for cold weather injuries during deployments displays depicting the information above. Number of cold weather injuries bar chart: Of all 105 cold weather injuries during the surveillance period, 68% occurred during the first two cold seasons. Bar chart shows the number of cold weather injuries by year: •	2012-2013 cold season had 35 cold weather injuries •	2013-2014 cold season had 100 cold weather injuries •	2014 -2015 cold season had 13 cold weather injuries •	2015-2016 cold season had 11 cold weather injuries •	2016 – 2017 had 10 cold weather injuries Access the full report in the October 2017 MSMR (Vol. 24, No. 10). Go to: www.Health.mil/MSMR  #ColdReadiness

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Percentages of each Service’s cold weather injuries, 2016 – 2017 cold season

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Gestational diabetes among pregnant service members, active component, U.S. Armed Forces 2012 – 2016

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Gestational diabetes is an abnormal increase in blood sugar levels that can adversely affect the health of both a pregnant woman and her baby. During 2012 – 2016, 4,017 (6.3%) of active component female service members who had live births were affected by gestational diabetes. Women aged 25-34 and 35-49 years had consistently higher annual prevalences of gestational diabetes than younger females. The percentage of pregnant service members affected by gestational diabetes was more than twice as high for obese women as for non-obese women (12.4% vs. 5.5%). The percentage of live births affected by gestational diabetes increased with increasing age and was highest among Asians/Pacific Islanders. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

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Complications and Care Related to Pregnancy, Labor and Delivery among Active Component Service Women U.S. Armed Forces, 2012 – 2016

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Maternal complications and delivery outcomes are important components of the overall health and well-being of reproductive-age service women. This analysis provides an update on pregnancy complications and characterizes the counts, rates, and trends of several specific pregnancy complications. FINDINGS •	55,601 U.S. service women whose pregnancies resulted in 63,879 live births had 657,060 medical encounters •	For all age groups, percentages of live births affected by preterm labor decreased, but during 2012 – 2016, the percentages of pregnant service members diagnosed with obesity increased. •	The percentage of pregnant service members affected by gestational diabetes was more than twice as high for obese women, compared with non-obese women (12.4% vs. 5.5%). Bar graph shows the number of medical encounters with a primary (first-listed) diagnosis of any pregnancy-related complication or indication for care decreased each year between 2012 and 2016. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR  Background image: New born being provided medical attention by nurse. Secondary image: babies of diverse background on a blanket.

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Contraception among active component service women, U.S. Armed Forces, 2012 – 2016

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1/5/2018
Because the majority of women serving in the Armed Forces are of childbearing age, and women’s military career opportunities have expanded into combat roles, contraceptive health care is an increasingly important public health issue. The lack of available, population-based descriptive information on contraceptive use among U.S. service women has generated questions and concerns about ready access to these medical products. This infographic summarizes the annual prevalence of permanent sterilization, as well as use of long – and short-acting reversible contraceptives (LARCs and SARCs, respectively), contraceptive counseling services, and use of emergency contraception from 2012 through 2016, among active component service women. FINDINGS •	2012 through 2016, Sterilization decreased from 4.2% to 3.6% LARC use increased from 17.2% to 21.7%; SARC use decreased from 38.5% to 30.4%. •	Emergency contraception use increased from 0.4% to 1.9%. •	Among deployed women, the average annual prevalence of permanent sterilization was 4.2%. •	For deployed women, LARC use was 17.9% SARC use was 28.0%. •	Emergency contraception use among deployed women was 0.4%. •	262,907 (76.2%) women of childbearing potential (WOCBP) used either a LARC or a SARC at some time during the surveillance period. •	The vast majority of service women have utilized at least one form of contraception, and women are selecting LARCs in greater numbers with each passing year. The bar graph displays information on the annual prevalence of contraceptive utilization, by type, service women of child-bearing potential, active component, U.S. Armed Forces, 2012– 2016. Graphic displayed: contraception option. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

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Pregnancies and live births among female service members

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12/21/2017
Women have been able to serve officially in the U.S. military since 1901. Both the number of women serving in the active component and their occupational roles have steadily increased and expanded. Currently, almost one in seven active component service members are female and more than 95% of military occupational specialties are open to women. This infographic summarizes data on the demographic and military characteristics of women including women of childbearing potential (WOCBP) in the active component of the U.S. Armed Forces during 2012 – 2016. Data on pregnancy-related care and birth rates are also presented. FINDINGS •	In 2016, WOCBP comprised the vast majority of active component service women. •	202,849 women served in the active component of the Army, Navy, Air Force, or Marine Corps. 197,947 (97.6%) were WOCBP. Pie chart displays depicting this information. •	In 2016, 13.1% of all WOCBP had at least one pregnancy-related event. Pie chat displays depicting this information. Female stick figures display to show visual of the largest proportions of WOCBP. Breakdown of WOCBP by service: •	Army (32.9%) •	Air Force (30.0%) •	Navy (29.7%) •	Marine Corps (7.5%) Pie chart displays to visually depict breakdown of WOCBP by service. The largest proportions of WOCBP were: •	In a communications / intelligence occupation (32.3%) •	Junior enlisted rank (46.5%) •	Non-Hispanic white (43.4%) •	20 – 24 years old (34.3%) Live births: •	There were 63,879 live births during the surveillance period. •	Overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). This rate of live births decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. Line graph displays this information. Rates of live births were highest among: •	Women who were 30 – 34 years old •	Enlisted or junior officer rank •	Army •	In healthcare / intelligence occupations •	Married Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to: www.Health.mil/MSMR

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Live births among female service members, active component, U.S. Armed Forces, 2012 – 2016

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12/21/2017
Did you know…?  •	From 2012 – 2016, there were 63,879 live births to women of childbearing potential in the active component. The overall live birth rate was 64.9 live births per 1,000 person-years (p-yrs). The live birth rate decreased steadily from 69.8 per 1,000 p-yrs in 2012 to 59.7 per 1,000 p-yrs in 2016. The decrease was primarily driven by declining rates among women in their 20s. Overall, live birth rates were highest among women who were: •	30-34 years old •	Army members •	In healthcare occupations •	Married Of the total 63,879 live birth deliveries: •	24.7% were cesarean •	75.3% were vaginal Pie chart depicting this information displays. United States map displays showing the highest numbers of deliveries during the surveillance period reported by military hospitals at: •	Naval Medical Center Portsmouth, VA (7.4%) •	Naval Medical Center San Diego, CA (6.1%) •	The Carl R. Darnall Army Medical Center, TX (4.1%) •	Womack Army Medical Center, NC (3.8%) •	Tripler Army Medical Center, HI (3.7%) Live birth rates were broadly similar among the race/ethnicity groups, although the overall rate was slightly higher among American Indians/ Alaska Natives. Access the full report in the November 2017 MSMR (Vol. 24, No.11). Go to: www.Health.mil/MSMR

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Pregnancies among female service members, Active component, U.S. Armed Forces, 2012 – 2016

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12/21/2017
With the increasing numbers of service women and the expansion of roles available to women within the military, understanding the epidemiology of pregnancy is important for both the health of U.S. service women and the readiness of the U.S. fighting force, two closely related issues. Between 2012 – 2016, 344,536 unique women of childbearing potential (WOCBP) served at least 1 day in the military, and of those, 132,466 spend at least 1 day as a recruit trainee. Of the 224,718 WOCBP who served at any time in 2016, 13.1% had at least one pregnancy-related event during that year. A “pregnancy-related event,” refers to a health care encounter (visit) for which the record contains a diagnosis code for either pregnancy or a positive pregnancy test. In 2016, the highest prevalence of pregnancy-related events was among service women 30-34 years of age (16.8%) and among senior enlisted women (13.7%). Pie chart displays depicting the information. The annual prevalence of pregnancy-related events decreased slightly, from 14.2% in 2012 to 13.1% in 2016. Line plot graph displays this information. FINDINGS •	Prevalence of pregnancy-related events was approximately evenly distributed among the race/ethnicity categories and military occupation groups. •	A slightly higher percentage of WOCBP in the Army (14.5%) had pregnancy-related events compared to WOCBP in the other services. •	A higher percentage of women who were married (21.4%) had a pregnancy-related event, compared with those in the single (5.7%) or “other” (8.8) categories. •	Only 0.2% of women who served during a recruit training period in any given year had a pregnancy-related event. Access the full report in the November 2017 MSMR (Vol. 24, No. 11). Go to www.Health.mil/MSMR.  Graphic on infographic shows a pregnant service member.

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