The Psychological Costs of War: Military Combat and Mental Health

While descriptive evidence suggests that deployment in the Global War on Terrorism is associated with adverse mental health, the causal effect of combat is not well established. Using data drawn from the National Longitudinal Study of Adolescent Health, we exploit exogenous variation in deployment assignment and find that soldiers deployed to combat zones where they engage in frequent enemy firefight or witness allied or civilian deaths are at substantially increased risk for suicidal ideation, psychological counseling, and post-traumatic stress disorder (PTSD). Our estimates imply lower-bound health care costs of $1.5 to$2.7 billion for combat-induced PTSD.military service, post-traumatic stress disorder, depression

The Effectiveness of the Army Medical Command Tobacco Cessation Regulation on Self-Reported Tobacco Quit Rates of Soldiers

On the 4th of March, 2013, LTG Patricia D. Horoho, then the Surgeon General and Commanding General of the United States Army Medical Command (MEDCOM) published the Army Medicine 2020 Campaign Plan. The plan incorporates three different methods to take action within MEDCOM. These are to: “Increase Capacity, Enhance Diplomacy and Improve Stamina” (Army Medicine 2020 Campaign Plan; “Extension”). Within the “Improve Stamina” component of the plan, Campaign Objective 3-3 is to “Increase Healthy Behavior.” Specifically detailed within this section is to promote tobacco-free living under sub-objective 3-3.1. This sub-objective seeks to establish a change in culture throughout the United States Army: decreasing use and subsequently reducing the tobacco-related morbidity and mortality in Soldiers, retirees and their families. One specific method mentioned in the 2020 Campaign Plan is to establish more tobacco-free areas both in Army Medical Treatment Facilities (MTF) as well as locations on Army installations. Going one step further, the MEDCOM issued an Operations Order (Medical Command Tobacco Free Living Operations Order 15-48, 8 May 15), which took effect on 1 April, 2016, which not only mandated tobacco-free MTFs, but also states that all MEDCOM Soldiers are not authorized to use tobacco products (including e-cigarettes) while on duty or in uniform. Although many businesses including hospitals throughout the United States have enacted tobacco-free workplaces and campuses, never before has this requirement extended beyond the range of the campus itself. It can be readily assumed that the scope of a regulation of this nature will have far-reaching effects on improving the health of staff through enforcing a change in culture in much of its workforce. This research will determine what effects the new policy has on MEDCOM Soldiers over a short term in an effort to ascertain the future potential for this policy and others to be based upon it. Need for the Study: The United States Centers for Disease Control and Prevention (CDC) estimates that 21.3% of adults in the United States use tobacco products either every day or some days (Hu et al 2016). Of these, the greatest users were in the 18-24 year old male category. Tobacco use has been found to be the cause of approximately 480,000 American deaths per year, with health costs approaching $170 billion and$156 billion in lost productivity (“Tobacco Use,” 2016). Although tobacco use has gone down in the United States over the last fifty years, it is still attributed to 5%-14% of all U.S. healthcare dollars spent per year (Xu, Bishop, Kennedy, Simpson, & Pechaecek, 2015). Furthermore, Xu et al explains that based on the 2006-2010 Medical Expenditure Panel Survey (MEPS), approximately 32.8% of spending from federal health insurance programs (including the Veterans Affairs, Indian Health, and military treatment facilities) was directed toward cigarette smoking related illness. The United States CDC found that smoking in the military is higher than that of the general population on the whole. In 2008, approximately 31% of all Active Duty military were smokers (Bray et al, 2010). In 2011, 24% of Active military smoked compared with 19% of civilians, and from the period of 2007-2010 male veterans were 5% more likely than nonveterans to be smokers (“Current Cigarette Smoking Among U.S. Adults Aged 18 Years and Older,” 2016). According to GlobalSecurity.org (2016), there were approximately 1,301,300 total members of the Active United States military in 2016. This would mean that as many as 312,312 personnel could be smoking in the active duty. The financial and lost work hours of this are significant. In September, 2015, the Veterans Affairs projected a total Veteran population of 21,681,000 (“Department of Veterans Affairs Statistics at a Glance,” 2016). The five percent difference as mentioned above equates to over a million Veterans who are more likely to smoke than their civilian counterparts, which by extension increases the cost to care for these Veterans. The size of the Veteran population continues to grow as new military retirees enter the system, and modern medicine increases the lifespan of those currently enrolled in the system. Lastly, although an older study, Robert Klesges et al (2000) presented statistics on the effects of smoking on military training. The researchers specifically looked at the relationship between smoking and early discharges from the United States Air Force. It was found that of 29,044 personnel entering the Air Force between August, 1995 and August, 1996, smokers were found to be 1.8 times more likely to be prematurely discharged than non-smokers. This equated to 629 Airmen being discharged for problems related to smoking, costing the Air Force in excess of $18 million in excess cost. Their findings over all services were over$133 million, which approached 1% of the total military training budget. The effects of tobacco use in the United States military plays a significant impact on multiple levels. The impact on health from tobacco use has potential effects from the individual Soldiers and their families’ health, through the unit level and on to the readiness of the entire Army. The direct effects of smoking and tobacco on the individual, and smoking-related illness resulting in lost work time has been well documented by numerous studies. In addition, the effects of second-hand smoke on the general population and on the families of smokers has also been noted. Because of the extremely physical nature of many of the career fields in the Army, any loss of physical capacity equates to a decrease in job performance and a degradation in capability to accomplish assigned missions. This results in a direct impact from tobacco. Lastly, due to the nature of military health insurance, which covers 100% of a Soldier’s and family’s care, there is the direct financial impact on caring for the sequelae of tobacco use, with the additional impact of sick time taken by the Soldier, keeping them from being able to support the unit and their mission. Problem Statement: Although the evidence is apparent for the inherent health risks from tobacco use, quit rates in tobacco users are historically low, with a high degree of recidivism back to tobacco use. The Active Duty Army, in having authority to dictate policies to affect their employees (Soldiers) has the potential to influence tobacco use through policies making it “illegal” to use tobacco during the duty day. The purpose of this study is to assess whether the MEDCOM policy against tobacco use results in greater tobacco quit rates among MEDCOM Soldiers, in comparison to the same sample of Soldiers prior to the implementation of the new MEDCOM tobacco use policy. Specific Aim 1: What are the current statistics of tobacco use in the United States Army at this time, in comparison to the American population-at-large? Specific Aim 2: Is there a difference in tobacco quit rates in MEDCOM Soldiers after implementation of the 2016 Tobacco Cessation Policy? Population The population to be considered by this study includes all Active Duty Soldiers stationed on a large Army installation between October 2015 and October 2016, which includes sample data from before and after policy implementation. Hypotheses: The primary goal of the MEDCOM tobacco policy is to reduce the number of Soldiers using tobacco. Thus, the aim of this study will be to examine the use rates and quit rates before and after the implementation of the new tobacco policy. Through accessing data from routine appointments, the following hypotheses will be studied: Hypothesis 1: There is no difference in tobacco use following implementation of the new MEDCOM tobacco policy, in comparison to prior to the policy implementation. Hypothesis 2: There is no difference in tobacco use between MEDCOM Soldiers and non-MEDCOM Soldiers following the implementation of the new tobacco policy

An Assessment of the feasibility of conducting future epidemiological studies at USMC Base Camp Lejeune

From the 1950s through the mid-1980s, persons residing or working at the U.S. Marine Corps Base Camp Lejeune, North Carolina, were potentially exposed to drinking water contaminated with volatile organic compounds (VOCs). The heavily contaminated wells were shut down in February 1985. In 2005, a panel of independent scientists convened by ATSDR recommended that the agency\u2022 identify cohorts of individuals with potential exposure, including adults who lived on base; adults who resided off base, but worked on base; children who lived on base; and those who may have been exposed while in utero; and\u2022 conduct a feasibility assessment to address the issues involved in planning future studies at the base.In response, ATSDR has prepared this assessment of the feasibility of conducting future epidemiological studies at the base. ATSDR visited the Naval Health Research Center (NHRC), the Defense Manpower Data Center (DMDC), and the DOD Education Activity storage facility at Fort Benning, Georgia, to determine whether available databases could identify adults and children who lived at the base, or civilians who worked at the base, during the period when drinking water was contaminated with VOCs. ATSDR also convened a panel of epidemiologists with experience in military and occupational cohort studies to provide recommendations on future studies.feasibility_assessment_Lejeune.pdf20081063

Examining the Correlation Between Childhood Trauma and Suicidal Ideation among Air Force Airmen

For decades, the United States military has been concerned about high suicide rates. Due to the increasing suicide rate within the armed forces, the need to better understand suicide-associated factors such as childhood trauma exposure is imperative. It is important to identify the research gaps that exist for promoting understanding of suicide and suicidal behavior and to enhance identification of those at risk for suicide. While there have been many published studies on the topic, conspicuously absent are studies that have included U.S. Air Force personnel. This research will examine the correlation between childhood trauma and suicidal ideation among Air Force airmen. The questions addressed in this review are (a) Is there a relationship between types of adverse childhood experiences and suicidal ideation among Air Force airmen? and (2) Is there a relationship between military assignments and suicidal ideation among Air Force airmen? The literature reviewed highlights the association between childhood trauma exposures and the risk of suicidal behaviors and the procedures proposed for the study provide directions for identifying those associations among Air Force airmen

A Greedy Institution with Great Job Benefits: Family Structure and Gender Variation in Commitment to Military Employment

Scholars describe both the military and the family as “greedy institutions,” or institutions that require expansive time and energy commitments, and alter participants’ master status (Segal 1986; Coser 1974). However, the military’s employment benefits may counteract its greedy elements. I use data from the 2008 Survey of Active Duty Members to examine commitment to military employment in wartime, accounting for greedy elements of military service (such as geographic mobility, risk of bodily harm, and separations), job benefits, family structure, and gender. The results show that women in dual-service marriages, unmarried men, and those who experienced separations reported lower career commitment and affective organizational commitment. In contrast, the use of military job benefits was positively associated with commitment. Counterintuitively, parenthood, geographic mobility, and being stationed in Afghanistan were also positively associated with commitment. These findings complicate the military’s label as a greedy institution, and contribute to the literature on work-family conflict and gendered organizations

Comparison of Health Promotion Behaviors and Performance on the Navy Physical Readiness Test among Active Duty Shipboard Personnel with and without Anterior Knee Pain

Health promotion is the number one health priority of the nation, yet, health promoting behaviors (HPB) are rarely part of the management plan for persons with anterior knee pain (AKP). In an active duty military population, AKP can interfere with performance on the required, semi-annual physical readiness test (PRT). The purpose of this descriptive, comparative study was to compare the relationships among HPB, AKP and performance on the PRT between two groups of active duty Navy shipboard personnel (those with AKP and those without AKP). Pender\u27s (1996) Health Promotion Model (HPM) served as the theoretical framework. Subjects completed demographic and personal fitness questionnaires, the Health Promoting Lifestyle Profile (HPLP II) (S. Walker, 1996), and the Exercise Benefits and Barriers Scales (EBBS) (K. Sechrist,1987). Performance on the PRT and body mass index (BMI) for all subjects were examined. Data were obtained from 192 active duty Navy personnel stationed aboard four southern California based ships. Analysis included descriptive and inferential statistics. Results indicated that, when compared to the AKP group, subjects without AKP: (a)were significantly different in performance of the PRT, (b)were significantly more likely to perform health promoting behaviors, (c)were significantly more likely to perceive the benefits of exercise, (d)had a significantly higher perceived health score, and (e)were more likely to be nonwhite, have less formal education, married and lower in rank. Age, gender, time with diagnosis of AKP, and BMI were predictors of PRT outcome scores. Time and access to exercise equipment were considered very important factors to shipboard personnel. No significant relationship between AKP and performance on the PRT was identified

Postpartum Fatigue in the Active Duty Military Woman

Up to 16,000 military women annually experience the birth of a child. Barring complications, regulations require a return to work 42 days postpartum, making them susceptible to the effects of postpartum fatigue. The purpose of this descriptive, longitudinal study of 109 military women was to describe fatigue levels across the first 6–8 weeks postpartum; to describe the relationship among selected psychological, physiological, and situational variables of fatigue; and to examine the relationship between predictor variables, fatigue levels, and performance after childbirth. The majority of the sample were married or partnered enlisted women in the U.S. Navy with a mean age of 25 (±5) years. Descriptive statistics, repeated measures ANOVA, correlation, and regression were used to analyze the data. Women were found to be moderately fatigued across time and there was no change in fatigue levels from 2 to 6–8 weeks postpartum. Study variables of type of delivery, lactogenesis, depression, anxiety, maternal sleep, and infant temperament correlated with fatigue during hospitalization and at 2 weeks postpartum. Depression, anxiety, maternal sleep, and performance correlated with fatigue at 6–8 weeks postpartum. Regression analyses indicated that maternal anxiety during hospitalization and at 2 weeks postpartum explained 6% and 20% of the variance in fatigue at 6–8 weeks postpartum. Over half of the women had not regained full functional status when they returned to work and 40% still displayed symptoms of postpartum depression and anxiety. Future research is needed to examine issues surrounding depression and anxiety of military women, including exploration of its causes in both the prenatal and postpartum periods. Designing interventions to reduce fatigue symptoms among military postpartum women may result in improved parenting, decreased healthcare costs, workplace accidents, increased job satisfaction, breastfeeding rates, and physical readiness. Reducing fatigue in this population has the potential benefit of a significant cost-savings to the United States government as well as an improved quality of life for military families

Strategies For Increasing Female Navy Officer Retention: Deploying Mothers’ Perspectives

The complexity of the global environment, driven by rapid and profound change, requires a globally dominant fighting force. To adequately protect and defend the security of the United States, the Department of Defense must maintain warfighting superiority through innovation and diversity of thought (SECNAV, 2016; Scoppio, 2012). More than five years have passed since the 2011 Military Leadership Diversity Commission reported to President Obama and members of Congress that “top military leaders are representative neither of the population they serve nor of the forces they lead” (p. xvi). Females are underrepresented among senior military leadership. Increasing the number of female service members adds new competencies and improves the effectiveness of military operations (Egnell, 2013, 2016). Though women constitute more than half of the U.S. population, women represent only 17.3% of the U.S. military officer corps and a mere 6.7% of the upper most leadership flag ranks of admiral and general (DMDC, 2016a, 2016b; Howden & Meyer, 2011). Research reveals the moral and business case for gender diversity and the advantages of female leadership traits. Barriers to retention include actual and anticipated maternal separation anxiety linked to children and the general stresses linked to separation from children, family, and household. The purpose of this study is to identify and describe effective strategies for Navy officer mothers to embrace a long-term deployment thus enabling the choice to remain in the armed forces and thereby increasing female officer retention. Human capital theory (Becker, 1962, 1993), diversity management theory (Thomas,1991), and social role theory (Eagly, 1987) form the theoretical framework explaining the importance of investing in people, effectively managing diversity and inclusion, and exploring gender roles and associated stresses respectively. This study utilized interpretative phenomenological analysis to reveal mothers’ experience of leaving a child due to a military deployment. Appreciative inquiry formed the basis of assembling positive perspectives and strategies. Analysis identified themes and strategies to be shared with Navy leadership in an effort to improve female officer retention. Findings revealed role issues for deploying military mothers, the importance of the child’s age in creating deployment success, and the criticality of support networks