Plot details in extremist activity based on prior military experience

Understanding the radicalization process is an important step to preventing violent extremism. Although many individuals may be susceptible to radicalization, there is particular concern about radicalization among people with prior military experience. These individuals may have skillsets that could be valuable to extremist organizations and are sometimes the target of active recruitment efforts. However, there is little empirical information to aid in understanding how the process differs between individuals who are radicalized while on active-duty status with their national military versus veteran personnel who are inactive at the time of their radicalization. The current study thus utilized the Profiles of Individual Radicalization in the United States (PIRUS; N > 3,000) dataset to explore the influence of prior military experience on the radicalization process, including a comparison of active-duty versus veteran personnel. Veterans were more likely to engage in violent plots to produce casualties than either civilians or active-duty military, and veterans were also radicalized more often in response to actions of their domestic government. However, active-duty personnel were likely to be radicalized over a shorter period and did not hold a deep commitment to radicalized beliefs. These findings help provide insight into radicalization differences due to prior military experience.

Complementary and Alternative Medicine (CAM) covers a heterogeneous spectrum of ancient to new-age approaches that purport to prevent or treat disease. By definition, CAM practices are not part of conventional western-style medicine because there is a perception of insufficient proof that they are safe and effective or because they are not taught in conventional medical and nursing schools. Complementary interventions are typically used together with conventional western-style treatments, whereas alternative interventions are used instead of conventional approaches. When combined with conventional practices they are often labeled Integrative Medicine (IM). Many people in the United States (US) use CAM and IM modalities1–7 and its use is increasing.2 In 1990, a national survey estimated that 33.8% of US adults used CAM modalities in the previous year,7 which increased to 42.1% in 19973 and 62% in the 2002 National Health Interview Survey (NHIS).1 These surveys included spiritual healing and "folk" medicine (remedies common, ethnically derived remedies used at home), in the CAM modality definition. Recently published results of the 2007 NHIS used a different CAM modality taxonomy and excluded these practices.2,8,9 When prayer specifically for health reasons was excluded, the 2002 and 2007 NHIS found 36% and 38.3%, respectively, of US adults reported using some form of CAM modality in the last 12 months.1,2 These national surveys only include civilian, noninstitutionalized individuals; they do not include our 1.8 million active duty military personnel and families. In the last 10 years, there has been an increase in interest and use of CAM modalities and IM in the military.9 This important segment of the US population receives health care from both military and civilian practitioners; and is subject to similar health risks as civilians plus additional physical, emotional, and cognitive stress of deployment with associated family separations for both the active duty member and families, and the consequences of combat.10,11 It would not be unexpected for military personnel to seek to improve their health through complementary practitioners, potentially at a greater extent due to health and performance expectations,10 and for the same reasons reported by civilians.1,2,11,12 This interest in CAM has been accelerated by the surge of chronic pain, chronic stress, and chronic symptoms associated with trauma and injuries from over a decade of wars in Iraq and Afghanistan.13 However, until recently there were little data to determine which CAM modalities are being used, how often, by whom, and for what purposes. Recently, these informational gaps are being filled in and the current picture is summarized below. USE OF CAM IN THE MILITARY The use of CAM in the military is higher than in the civilian population. Samueli Institute and Research Triangle International conducted the largest and most comprehensive survey of CAM use in over 16,000 active duty service members in all branches stationed both in the United States and overseas.14 Data were drawn from the 2005 Department of Defense (DoD) Survey of Health Related Behaviors among Active Duty Military Personnel, which draws on a worldwide, random sample of over 40,000 service members from all branches, sexes, races, and ranks.15 It asked about overall CAM use and 19 specific CAM therapies using a methodology that closely matched the NHIS used by the National Center for Complementary and Alternative Medicine.16 This military survey showed that approximately 45% of active duty military personnel reported using at least 1 CAM type in the previous 12 months. CAM use when not counting self-prayer was approximately 36%. The 8 most frequently reported CAM approaches included 4 mind body therapies (prayer for your own health: 24.4%; relaxation techniques: 10.8%; art/music therapy: 7.7%; exercise/movement therapy: 6.8%), 2 biologically based therapies (herbal medicine: 8.9%; high-dose megavitamins: 8.4%), and 2 manipulative and body-based methods (massage therapy: 14.1%; chiropractic: 5.2%). Eleven CAM types were used by <5.0% of respondents and 6 types were used by <1% of personnel. When both surveys were adjusted for the 2000 census bureau demographics, CAM use by military personnel was significantly higher than that of the general population (44.5% vs. 36.0% and 38.3% in the 2 NHIS surveys, respectively, P<0.001). Significantly more military personnel reported use of energy healing, guided imagery therapy, massage therapy, hypnosis, and relaxation techniques than civilians in both NHIS surveys (P<0.001) with more reported use of "folk" remedies, high-dose megavitamins, and spiritual healing by others than the 2002 NHIS survey (P<0.001) and more frequent use of biofeedback than the 2002 NHIS and 2007 NHIS surveys (P<0.001 and P<0.01, respectively). There were no statistical differences in reported use of acupuncture and homeopathy. Overall, the prevalence of CAM use in this study was consistent with smaller military surveys where 49.6% CAM use was reported by military veterans in the Southwestern United States,17 and with 37.2% use of 12 CAM modalities (excluding prayer) in US Navy and Marine Corps personnel.18 The vast majority of CAM health care occurs outside the military health system, some of it provided by TRICARE, the military's health insurance program. However, as in the civilian population, most CAM is paid for out of pocket by military personnel as TRICARE covers very few CAM modalities. Massage therapy, used by 14% or an estimated 137,000 personnel, is not a covered benefit, whereas biofeedback (for certain conditions) is covered. Chiropractic is the only CAM modality that is currently included in a systematic manner in the military health system; however, access to chiropractic practitioners is limited. In 2005, 54% of active duty personnel resided in areas served by chiropractic clinics, and the remaining 46% were not served by clinics because of living overseas (14%), in remote areas (5%), or in US installations without chiropractic clinics (28%).19 Herbal medicines and high-dose vitamins also are not covered by military health care. However, many military installations include a General Nutrition Center store on the premises where these products readily are available. Three CAM modalities (yoga, massage, and imagery), which are commonly used for stress management were used by military populations at an estimated 2.5–7 times the rate of civilians. The fact that military members and their families are seeking and personally paying for these therapies outside both direct military care system and the TRICARE System may reflect access problems in Military Treatment Facilities (MTF), a preference for CAM/IM over traditional modalities (ie, not turning away from traditional medicine but rather turning toward and preferring CAM/IM), growing concern about the results of traditional pharmacologically based treatments, and an increasing interest in and need for appropriate access to CAM modalities within the military health system to decrease symptoms and improve function for military members suffering from the "wounds of war." Unmonitored and uninformed use of CAM modalities in the military may have negative consequences on health and military performance. A number of large randomized, placebo controlled trials of herbal treatments20–22 and acupuncture7,23,24 have been negative, making the substitution of these CAM modalities for proven therapies risky. In addition, some CAM therapies, particularly herbal supplements, have been associated with potential harm through toxicity and herb/pharmaceutical interactions.25,26 Herbal medicines and nutrients in doses well above the Dietary Reference Intakes27 are 2 of the CAM modalities most commonly used by military personnel. With 45% of the over 1million active duty personnel reportedly using CAM modalities, and a steady increase globally, it is important to understand why military personnel are using CAM, the role these therapies should play in their health care, and for military health care providers to recognize, monitor, and integrate CAM modalities into their health care practices. OFFERINGS OF CAM IN MTF Two recent surveys have assessed the use of CAM across DoD medical facilities and evaluated their reported effects and attitudes by health care leaders in military MTFs. The first is in a report entitled "Integrative medicine in the military health system report to congress" by the DoD Undersecretary of Personnel and Readiness (P&R).28 In this survey, 29% (120) of 421 MTFs reported offering a total of 275 CAM programs including 213,515 CAM patient visits in calendar year 2012 for active duty members. The most visits were for chiropractic care (73%) and acupuncture therapy (11%). The report states that, of those doing evaluation of CAM they have found: (1) patients reporting a reduction in anxiety levels and improved sleep with meditation; (2) breath-based practices reportedly helped patients to remain sober and reduced overall stress levels; (3) patients using massage therapy noted 75% improvement of symptoms, including pain; and, (4) overall positive outcomes were reported by 50%–90% of patients using massage therapy. The Report also states that patients practicing yoga had declines in psychological symptoms and improvement in overall health. Over 30 research projects have been funded by DoD and have reported improvements in symptoms and sleep, reduction in anxiety and psychological symptoms across a number of CAM practices being used. The Report concluded that: "There is wide-spread use of CAM therapies across the [Military Health System] MHS. Providers and patients were interested in using CAM therapies even though many are not evidence-based. Some providers have added CAM therapies as an adjunct to conventional therapies for a holistic approach to patient management." The second survey, completed by Samueli Institute did a more in-depth survey of CAM availability across a more limited sample of both MTFs and morale, welfare, and recreation (MWRs) centers. The study examined the CAM services offered during the year 2013 in 47 DoD MTFs, and MWRs locations across all military service branches.29 Information was collected on the prevalence of CAM modalities provided; the attitudes and beliefs towards CAM among the leadership in the different facilities; the obstacles and barriers to access in military facilities; the funding sources for CAM offered at military facilities; and, whether CAM is part of the strategic plan for the future of health care delivery. In addition, information was collected on the provision of CAM treatments for highly prevalent conditions in military personnel (pain, combat-related stress, and rehabilitation), how beneficial medical leaders thought CAM was, and how practitioners were accredited to practice CAM modalities. The results of this survey showed that 30 (70%) of the 47 facilities surveyed provided some type of CAM service with most being provided for active duty service members (70%), followed by family members (43%) and retirees (36%). Less than 9% of the participants reported providing CAM services to federal employees, contractors, or members in the community. Overall, acupuncture and chiropractic were among the top 3 most prevalent practices followed by yoga and massage. For pain management the primary CAM modalities were acupuncture (36.2%), chiropractic or osteopathic medicine (27.7%), and breathing exercises (25.5%). For stress and stress-related conditions, the top modalities were acupuncture (25.5%), breathing exercises (21.3%), and biofeedback (17%). For wellness and fitness, offerings included weight management, diet-based therapies, and movement practices. In this Samueli Institute survey, 57% of medical leaders felt that CAM practices were either beneficial (40%) or highly beneficial (17%) with 40% being neutral on the benefit and 3.3% feeling CAM practices were not beneficial. Despite this generally favorable response, over 75% had no provision or guidelines for CAM use in their strategic plans. Still, 46% funded CAM services out of their general budget, with 12% receiving money from the Office of the Army Surgeon General, 8% receiving congressional money, and 4% private money for CAM. Only 10% reported any research or evaluation of CAM going on in their facility. This survey also examined the challenges to improving access to these practices. Although the majority of leadership responses (57%) rated CAM modalities as highly favorable or favorable, the identified obstacles and barriers for access to CAM in military facilities included (in order of frequency): (1) inadequate space to provide services; (2) patients do not know to ask for CAM; (3) CAM costs too much; (4) CAM is too time consuming; and (5) CAM does not contribute to workload coverage. The prevalence of CAM practices provided by MTFs and MWR across DoD shows 75% availability within MTFs, and 33% within MWR facilities and programs. There were no appreciable differences in availability of CAM across military branches. MINDING THE GAP: ALIGNING PATIENTS, PRACTICE, AND POLICY In the report to Congress by DoD P&R, it was recommended to evaluate CAM programs for safety and effectiveness, as well as cost-effectiveness and consider widespread implementation in the military health system if cost-effective. The criteria for how to do this are specified. Part 199 of Title 32, CFR, governs TRICARE benefits and restricts services to those medically necessary drugs, devices, treatments, or procedures for which safety and efficacy have been proven to be comparable or superior to established therapies. Established criteria state that unproven drugs, devices, treatments, or procedures may not be covered: (1) unless reliable evidence shows that any medical treatment or procedure has undergone well-controlled clinical studies that show maximum tolerated dose, toxicity, safety, or efficacy compared with standard treatment or diagnosis; (2) if the available reliable evidence is considered inadequate by experts who recommend further studies or clinical trials are needed. The criteria for making a determination of proven safe and effective to nationally accepted medical standards are evidence that comes from: (1) well-controlled studies of clinically meaningful endpoints published in referred medical literature; (2) published formal technology assessments; (3) published reports of national professional medical associations; and (4) published reports of national expert opinion organizations. However, these guidelines and criteria and not being applied appropriately to CAM modalities. Biofeedback is the only CAM practice currently covered under TRICARE guidelines, and TRICARE only covers biofeedback therapy for nerve injury, not stress management. The 2 most widely used CAM modalities (chiropractic and acupuncture) are excluded in Title 32 CFR section 199.4 (g) even though neither has been evaluated using TRICARE guidelines. In other words, none of the CAM modalities (with the possible exception of biofeedback) have been evaluated by the DoD or TRICARE using their own guidelines for determining which practices should be covered. Despite this, TRICARE declines to pay for acupuncture but will pay for biofeedback. Chiropractic (which also has not been evaluated by TRICARE guidelines) is provided to DoD beneficiates through MTFs but not through TRICARE. Chiropractic is currently being implemented across DoD even though research on the effectiveness of chiropractic in the DoD is only recently underway because of a Congressional mandate and special appropriation.30 Acupuncture is both widely accepted and used in the DoD and currently the Defense and Veteran's Pain Task Force is training medical practitioners in "Battlefield Acupuncture" (BA). BA is a specific auricular acupuncture protocol developed by Col (Ret) Richard Niemtzow, an Air Force physician, seeking to add a simple nonpharmacological pain management technique that could be used by a broad array of first responders and primary care providers to help reduce pain, reduce medication load, and improve function.31 Acupuncture has been shown to be superior to conventional therapy for several chronic conditions prevalent in the military, and has also been shown not to be due only to placebo effects.32 Samueli Institute has performed a comprehensive systematic review of acupuncture for the Trauma Spectrum Response, an important collection of comorbidities often experienced by service members after deployment.33 Recently, a comprehensive review of self-care CAM modalities for pain has been published in a special issue of Pain Medicine in which reasonable evidence for use of yoga, tai chi, and music were found for the treatment of pain.34 These areas are ripe for evaluation by the military and TRICARE Systems for possible inclusion into the array of services provided. CONCLUSIONS Over a decade of war has left hundreds of thousands of our service members and their families suffering from a range of psychological and physical injuries, many leading to or exacerbating chronic pain. They and their health care providers have surged ahead in seeking out drug-free and self-care healing practices to help them recover and return to wholeness in peacetime. The availability of efficacious CAM modalities adds needed access to a cadre of promising services and practices that promote healing and improved function with less medication and fewer unwanted side effects. However, DoD policy and priorities have not kept up with this surge, leaving the majority of active duty service members, veterans, and their families to fend for themselves, to pay for or go without the beneficial effects of CAM and IM practices. As stated in the DoD P&R report to Congress, "At this time, there are insufficient internal evaluations and reported results to determine whether the CAM programs being provided in the MTFs meet these [TRICARE] criteria." It is time for the DoD to step up their efforts to complete these evaluations and ensure that "sufficient evaluation" occurs in a more timely manner. Our long-suffering heroes deserve nothing less!

Posttraumatic stress disorder (PTSD) affects approximately 8% of the general population. The prevalence of PTSD is twice as high in active duty service members and military veterans. Few studies have investigated the incidence rates of PTSD in active duty military personnel. The present study evaluated the incidence of PTSD diagnoses and the differences between demographic factors for service members between 2001 and 2017. Data on 182,400 active duty service members between 2001 and 2017 were drawn from the Defense Medical Epidemiological Database and examined by sex, age, service branch, military pay grade, marital status, and race. From 2001 to 2017, the incidence rates of PTSD in the active force (per 1,000 service members) steadily climbed, with a low of 1.24 in 2002 to a high of 12.94 in 2016. Service members most often diagnosed with PTSD were in the U.S. Army, with the enlisted pay grades of E-5-E-9, White, married, male, and between 20 and 24 years old. Statistically significant differences, ps < .001, were found between observed and expected counts across all examined demographic variables. The present study is the first to our knowledge to provide a comprehensive examination of PTSD incidence rates in an active duty military population.

Soldier resilience is of paramount importance to the U.S. Military. Mindfulness and Resilience are positively correlated to one another in research focused on civilian populations. Since mindfulness can be learned, if the correlations remain consistent over time, then perhaps resilience can be increased by learning to be mindful. However, no published research has investigated the relationship between mindfulness and resilience among military active duty and veteran populations who have not undergone mindfulness training. Thirty active duty and veteran service members volunteered and completed the Mindful Attention Awareness Scale (MAAS) and the Resilience Scale, while 29 fully completed the Five Facet Mindfulness Questionnaire (FFMQ). Results reveal significant correlations between resilience scores and three of the FFMQ scale (Describe, Conscious Action, and Non-Reactive, p &lt; .05), but not with the overall FFMQ, the other two facets (Observe and Non-Discrimination of the FFMQ), and not with the MAAS (p &gt; .05). These results provide initial information on the relationship between mindfulness and resilience among active duty military and veterans, revealing that only some aspects of mindfulness appear related to, and predictive of, resilience. Should the relationships be consistent over time, then instruction in mindfulness may ultimately impact resilience, however additional research is necessary.

A review of the literature suggests that law enforcement agencies adopted a paramilitary model of management based on little empirical evidence supporting the suitability of this model. Moreover, relatively little is known about the effects of prior military service experience on the work events experienced by police officers. This paper will examine the effects of prior military service experience on exposure to organizational and field work events, and perceptions of stress among these events. The results show that more military experience did not significantly predict fewer organizational work events and lower perceptions of stress, or more field work events and greater perceptions of stress. More years of police experience and section assignment predicted fewer field work events, although perceptions of stress were not significantly lower. These results are discussed, as they compare with salient demographic variables found to influence work stress in police officers.

Insomnia is highly prevalent among military personnel, with many gaps in knowledge. The purpose of this study was to quantify the medical, psychiatric, and utilization burden of insomnia among active-duty military personnel. We hypothesized that insomnia is associated with worsened health and economic outcomes. This was a retrospective case-control study. Data were derived from the Military Data Repository (2016-2021). Active-duty service members (ADSMs) younger than 65 years, with 12 months of continuous enrollment before and after first insomnia diagnosis and no evidence of previous insomnia or insomnia treatment, were matched 1:1 on demographic, clinical, and military characteristics to ADSMs without insomnia. Insomnia and psychiatric and medical comorbidities were defined using International Classification of Diseases, 10th Revision diagnostic codes. The impact of newly diagnosed insomnia on psychiatric and medical outcomes within 12 months was examined using time-to-event models. The impact of newly diagnosed insomnia on 12-month health care resource utilization (HCRU) was examined using generalized linear models. A total of 40,978 ADSMs met insomnia criteria and were matched to 40,978 ADSMs without insomnia. Participants were 78.6% male and 61.8% identified as White, with most younger than 44 years (90.3%). Insomnia was associated with increased risk of almost every studied physical and psychological health outcomes; relative to those without insomnia, ADSMs with insomnia demonstrated a 6-fold increased risk of post-traumatic stress disorder (hazard ratio [HR] 6.51, 95% CI 5.95-7.12, p < 0.001), as well as elevated risk of traumatic brain injury (HR 5.32, 95% CI 4.53-6.24, p < 0.001). ADSMs with insomnia demonstrated greater all-cause HCRU across all points of service (all p's < 0.001). Among active-duty personnel, new-onset insomnia was associated with substantially increased risk of adverse medical and psychiatric burden, as well as increased utilization, over 12 months. Key limitations include our observational study design.

Health and Utilization Burden of OSA Among US Active-Duty Military Personnel

Free AccessVeteransAlpha Delta Sleep in Younger Veterans and Active Duty Military Personnel: An Unrecognized Epidemic? John D. Roehrs, MD, FAASM John D. Roehrs, MD, FAASM Address correspondence to: John D. Roehrs, MD, FAASM, VAMC, Sleep Medicine Service, Tucson, AZ(520) 792-1450 x 5842 E-mail Address: [email protected] VAMC, Tucson, AZ Search for more papers by this author Published Online:March 15, 2015https://doi.org/10.5664/jcsm.4546Cited by:1SectionsPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutINTRODUCTIONRecently, we have observed an apparent increased incidence of alpha wave intrusion into N2 and N3 sleep in military and ex-military personnel. Conversations with military physicians in Honolulu, San Antonio, and the sleep center at Walter Reed also suggested that they are seeing an increased number of active duty personnel with this phenomenon.The significance of this finding is not clear and has not been systematically studied. From a 30,000 foot perspective, the US has never before done sleep medicine evaluations on returning active duty personnel and veterans recently discharged from the military. One reason is the compensation which the service member or veteran receives if a diagnosis of sleep apnea is made. None the less, many of the OIF/OEF veterans have sleep problems including complaints of non-restorative sleep along with the other sleep problems including difficulty of initiating and maintaining sleep (DIMS) as well as disorders of excessive somnolence (DOES). These complaints engender sleep medicine consultations many with attended polysomnograms. This apparent increased frequency in returning soldiers and veterans has not been previously reported.Alpha delta sleep was first reported by Hauri et al. in 1973.1 It is most often reported in chronic pain situations. Treatment usually involves treatment of the underlying condition. Patients with fibromyalgia have shown an increased incidence of alpha intrusion.4 A recent report of patients with depression who had PSGs showed a two-fold increase in alpha intrusion.2 A Medline search with keywords of alpha delta sleep in veterans and active duty military returned no articles. However, we have reported one case which has been fairly characteristic.3The patients seem to have in common current or prior military service, usually with one or more deployments to war zones. Many have a sleep disordered breathing diagnosis, especially in veterans (weight gain). Treatment of the OSA with CPAP generally does not reduce the observed alpha intrusion.Several questions are raised by this finding: What is the reason for this increased finding compared to a civilian population group where it is seen very infrequently?Why is it seen in current returned veterans but not apparently in the older Vietnam era veterans?Is there a clinical significance (non-restorative sleep) of sleep deprivation which is associated with depression, self-harm, etc.?Are there medications which could improve the nonrestorative sleep symptoms?What is the natural history of the alpha intrusion—does it spontaneously remit with time and/ or treatment of underlying disorders (depression)?Is this observation merely an epiphenomenon, or is it like hypertension which took many years to elucidate the medical consequences of uncontrolled elevated blood pressure? Is it like OSA, where it was thought to represent a noisy inconvenience, but with study has been shown to be associated with many medical complications? Many of the wounds suffered by our service personnel are not visible, and one wonders if this observation is an EEG manifestation of non-visible wounds. A systematic long term study of those patients with this phenomenon could be helpful in further defining care needed by those patients.Clearly a multicenter registry with a structured long-term follow-up would be needed to begin to answer these questions.DISCLOSURE STATEMENTThe author has indicated no financial conflicts of interest.CITATIONRoehrs JD. Alpha Delta Sleep in Younger Veterans and Active Duty Military Personnel: An Unrecognized Epidemic? J Clin Sleep Med 2015;11(3):277.REFERENCES1 Hauri P, Hawkins DAlpha-delta sleep. Electroencephalogr Clin Neurophysiol; 1973;34:233-7, 4129610. CrossrefGoogle Scholar2 Jaimchariyatam N, Rodriguez CPrevalence and correlates of alpha delta sleep in major depressive disorders. Innov Clinical Neurosci; 2011;8:35-49. Google Scholar3 Nahapetian R, Roehrs JDAlpha intrusion on overnight polysomnogram. Southwest J Pulm Crit Care; 2014;8:3. CrossrefGoogle Scholar4 Moldofsky H, Harris HW, Archambault WT, Kwong T, Lederman SJ Rheumatol; 2011;38:2653-63, 21885490. CrossrefGoogle Scholar Previous article Next article FiguresReferencesRelatedDetailsCited by Daytime Central Thalamic Deep Brain Stimulation Modulates Sleep Dynamics in the Severely Injured Brain: Mechanistic Insights and a Novel Framework for Alpha-Delta Sleep GenerationGottshall J, Adams Z, Forgacs P and Schiff N Frontiers in Neurology, 10.3389/fneur.2019.00020, Vol. 10, Volume 11 • Issue 03 • March 15, 2015ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationDecember 1, 2014Accepted for publicationDecember 1, 2014Published onlineMarch 15, 2015 Information© 2015 American Academy of Sleep MedicinePDF download

A comparison of factors that impact retention of nursing students with and without military experience: A mixed method study

Introduction Non-Department of Defense (DoD)-curated health surveillance data on military personnel is limited and that which is generated by sources other than the DoD is rarely analyzed for the purposes of disseminating intelligence about health trends in this population. The purpose of this study was to determine spatiotemporal variations in the prevalence of certain conditions (i.e., hearing loss, vision impairment, and executive dysfunction) among active duty and National Guard/Reserve (NGR) military personnel. Materials and Methods We obtained person-level data from the 2015–2019 United States Census Bureau’s American Community Survey on active duty military personnel (N = 44,503) and NGRs (N = 146,488). We estimated survey-weighted logistic regression models to determine spatiotemporal differences in hearing loss, vision impairment, and executive dysfunction. Results Results showed that when aggregated across time and stratified by military service status, hearing loss was most prevalent (1.71%, 95% CI = 1.55, 1.89), followed by executive dysfunction (1.48%, 95% CI = 1.34, 1.64) and vision impairment (0.65%, 95% CI = 0.55, 0.77), among active duty service members. Among the NGR sample, hearing loss was most prevalent (9.99%, 95% CI = 9.80, 10.18), followed by executive dysfunction (5.35%, 95% CI = 5.20, 5.50) and vision impairment (3.43%, 95% CI = 3.31, 3.55). Overall, disability rates were higher among individuals in the NGR than among those on active duty. Results showed that risk for the aforementioned disabilities varied between 2015 and 2019 and was dependent on the rural location of the respondent’s residence. Specifically, limiting condition prevalence increased from 2015 to 2019 for all types—except for hearing loss among NGRs—among active duty members and NGRs living in rural areas. Conclusions Proper surveillance, education, treatment/rehabilitation, and prevention are essential components of mitigating these impairments to help assure the health, wellness, and combat readiness of our military personnel. Recommendations for future military health surveillance activities and health care services are provided.

: Research in the national population has revealed a link between limited health literacy and disparities in health care utilization and resulting health status. Limited health literacy has also been found at higher rates among individuals who are non-whites, have lower education levels and/or income, and may differ by gender. In the military health system (MHS),gender, race, educational level and income should not impact the availability of health services as all active-duty personnel have universal access to health care. Yet disparities continue to exist in utilization of preventive services and achievement of goals related to improved health status and health outcomes. Limited health literacy may be contributing to these disparities in active duty military personnel with universal access to health care, services, and information. To date, there are no published research studies assessing health literacy in the active-duty military population. Before studies can be conducted to explore the relationship between limited health literacy and health status/outcomes in active duty personnel, research is needed to determine health literacy rates in active duty personnel and the comparability of these rates to rates in the national population. Objective. The purpose of this study was to determine health literacy rates in active duty military personnel receiving health care and services within a culture of universal access, and to compare the health literacy rates of the national population to those of the active duty military.

The purpose of this paper is to present research findings on the effects of mindfulness meditation training on four weekly self-report measures among three groups: those receiving training delivered in-person (M-IP) or in a virtual world (M-VW), and a waitlist control group (WLC). Participants (n = 191) were US military active duty service members and veterans. The M-IP and M-VW groups reported their stress, energy, pain, and sleepiness before/after each mindfulness training class, while the control group answered the same questions once a week for the 8-week duration of training. The M-IP and M-VW groups showed greater reductions in stress over the 8 weeks than the control group (1.70, 0.80, and 0.30 points, respectively; p = .028). Meaningful improvements (> 20%) pre- to post-training were seen for stress, pain, and sleepiness in the M-IP group, for pain only in the VW group, and for none in the WLC group. Those experiencing high levels of stress or pain before training experienced reductions in their stress or pain post mindfulness training, while those with lower initial levels did not (p < .001). Within class improvements were seen for both intervention groups; however, improvements were greater for those attending M-IP for energy, pain, and sleepiness (p < .034). In-person mindfulness training yielded statistically and meaningfully superior results; however, both IP and VW delivery methods were effective in reducing stress among healthy US military active duty and veteran participants. Mindfulness was particularly helpful for those experiencing initially high levels of stress or pain.

Introduction: This study examines the relationship between traumatic experiences and firearm availability, a known suicide risk factor, for both male and female active duty servicemembers and military retirees in the United States. Availability of firearms was predicted to differ by gender, with male servicemembers having elevated rates of firearm availability compared to female servicemembers. It was also expected that experiences of trauma would be associated with higher availability of firearms in both male and female servicemembers and military retirees. Methods: Survey respondents included 1,869 active-duty and military retiree participants recruited from six different primary care clinics located within various military treatment facilities. Analyses compared associations among trauma exposure, firearm availability, and gender. Results: Both male and female servicemembers and retirees reported elevated rates of firearm availability, with men reporting the highest rates of available firearms. There was a significant interaction between gender and firearm availability on trauma type; men with available firearms reported elevated levels of directly experienced trauma. When controlling for covariates, men with available firearms reported highest levels of “happened to me” trauma exposure for fire and explosion and sudden violent death. Discussion: Men who positively endorse firearm availability have the highest rates of directly experienced traumatic events among active duty military personnel and retirees. Firearm availability, trauma exposure, and perceptions of safety for both genders are discussed.

There is a large body of research that has comparatively explored the relationship that military experience has with the attitudes and behaviors of employees who work in military organizations. However, very few studies have extended this line of research in civilian organizations. This study seeks to add to this body of research by exploring whether there are meaningful attitude and behavioral differences between veterans and non-veterans who work in a government civilian organization. Using a sample of 500 federal employees in the United States, the findings of this study revealed that prior military experience had no meaningful relationship to the work satisfaction, performance, person-organization fit, public service motivation, work stress, nor turnover intentions of public employees. The most important predictors of the work attitudes of employees were their age, education level, full-time status, and years of work experience. The implications this study has for the field of public management are discussed.

This study was conducted to investigate whether incidence rates of malignant cutaneous melanoma in U.S. Department of Defense active duty military personnel differed from rates in the U.S. general population between 2000 and 2007. The study population included active duty military personnel and the general population aged 18 to 56 years. Data were obtained from the U.S. Department of Defense medical data systems and from the Surveillance Epidemiology and End Results program. Melanoma risk was estimated by incidence rate ratios (IRRs). Melanoma risk was higher among active duty personnel than the general population (IRR = 1.62, 95% confidence interval = 1.40-1.86). Incidence rates were higher for white military personnel than for white rates in general population (36.89 and 23.05 per 100,000 person-years, respectively). Rates were also increased for military men and women compared with SEER (men, 25.32 and 16.53 per 100,000; women, 30.00 and 17.55 per 100,000). Air Force service personnel had the highest rates and Army had the lowest. Melanoma rates were marginally higher among active duty military personnel than the general population between 2000 and 2007.