Active Duty Air Force Members Research Articles

Virologic suppression among HIV-infected US Air Force members in a highly-structured programme with free access to care.

SummaryThe United States Air Force HIV programme has several features that may enhance antiretroviral therapy outcomes, including free access to healthcare and mandatory clinical visits every six months at a single centre. We evaluated viral load suppression (<50 copies/ml) after 12 months of initial antiretroviral therapy, with extension to 18 and 24 months. Active duty Air Force members were categorised by year of antiretroviral therapy initiation: 2000-2005 (n = 95, 36.1%) and 2006-2011 (n = 168, 63.9%). The median months from HIV diagnosis to initial antiretroviral therapy were shorter in the 2000-2005 group (2.4, IQR 1.2-5.9) compared with the 2006-2011 group (12.6, IQR 2.6-29.0; p < 0.001). Viral load suppression was greater in the 2006-2011 group compared with the 2000-2005 group at 12 months (93.2% versus 78.6%, p = 0.002) and 18 months (91.8% versus 80.3%, p = 0.03), and trended higher at 24 months (90.8% versus 82.5%; p = 0.15). Factors associated with viral load suppression at 12 months in multivariate models included antiretroviral therapy initiation during 2006-2011 (OR 5.22, 95% CI 1.50-18.18) and CD4 count at antiretroviral therapy initiation (OR 2.29, 95% CI 1.19-14.43 per 100 cells/µl increase). Structured programmes that minimise traditional barriers to care combined with the use of contemporary antiretroviral therapy regimens can achieve clinic-wide viral load suppression in >90% of patients.

An ecological model of intimate partner violence perpetration at different levels of severity.

Intimate partner violence (IPV) is a significant public health concern. This study proposed and tested an ecological model of both general and clinically significant (i.e., injurious or fear-evoking) IPV perpetration (IPVPerp). Risk and promotive factors from multiple ecological levels of influence (i.e., individual, family, workplace, community) were hypothesized to be important in the prediction of IPVPerp. Although clinically significant IPVPerp and general IPVPerp were hypothesized to relate, specific risks for clinically significant IPVPerp were hypothesized. U.S. Air Force active duty members and civilian spouses (N = 34,861 men; 24,331 women) from 82 sites worldwide completed the 2006 Community Assessment, an anonymous online survey assessing IPVPerp along with a variety of potential risk and promotive factors. Final structural equation models for men and women, cross-validated in holdout samples, clearly supported the relevance of an ecological approach to IPVPerp. Factors from all 4 levels were associated with both general IPVPerp and clinically significant IPVPerp, with relatively distal community and workplace factors operating via more proximal individual and family level variables (e.g., relationship satisfaction). The results suggest a variety of both established and novel potential targets for indirectly targeting general and clinically significant IPVPerp by improving risk profiles at the individual, family, workplace, and community levels.

Network Supports and Resiliency among U.S. Military Spouses with Children with Special Health Care Needs

Understanding how military families who have children with special health care needs (CSHCN) successfully cope in the context of exceptional demands of the military lifestyle can inform scholarship, policy, and practice to the benefit of families. Using data from 775 female civilian parents (mothers serving as Key Spouses) married to active duty Air Force members, this study examined differences on dimensions of network support and spouse resiliency between mothers who do and do not have CSHCN, as well as the relative contribution of formal and informal network support to variation in self-reports of resiliency among mothers with CSHCN. Mothers with CSHCN experience significantly less formal and informal network support than their counterparts. Despite this, they reported equivalent overall resiliency, with lower perceived resiliency on only one of four resiliency outcomes. More formal and informal network support was generally associated with higher resilience. Implications for policy, practice, and research are discussed.

Acceleration of image analyst training with transcranial direct current stimulation.

Humans today are routinely and increasingly presented with vast quantities of data that challenge their capacity for efficient processing. To restore the balance between man and machine, it is worthwhile to explore new methods for enhancing or accelerating this capacity. This study was designed to investigate the efficacy of transcranial DC stimulation (tDCS) to reduce training time and increase proficiency in spatial recognition using a simulated synthetic aperture radar (SAR) task. Twenty-seven Air Force active duty members volunteered to participate in the study. Each participant was assigned to 1 of 3 stimulation groups and received two, 90-min training sessions on a target search and identification task using SAR imagery followed by a test. The tDCS anode was applied to site F10 according to the 10-20 electroencephalographic electrode convention while the cathode was placed on the contralateral bicep. Group 1 received anodal tDCS at 2 mA for 30 min in the first training session and sham tDCS in the second session. Group 2 received the stimulation conditions in the opposite order. Group 3 did not receive stimulation at all. Results showed that participants receiving training plus tDCS attained visual search accuracies ~25% higher than those provided with sham stimulation or no stimulation. However, a corresponding performance improvement was not found in the first training session for the change detection portion of the task. This indicates that experience with the imagery is important in the tDCS-elicited performance improvements in change detection.

The U.S. Air Force Diabetes and Obesity Research Working Group: A Model for Building Military-Specific Clinical Research Infrastructure

The diabetes and obesity epidemic is sweeping through our nation. The Centers for Disease Control and Prevention estimates that 26 million Americans now have diabetes and 79 million have prediabetes. If current trends continue through 2050, one in three Americans will have diabetes, predominantly attributable to the rise in obesity. When a patient is diagnosed with diabetes, that individual’s lifetime medical costs more than double. The military is not immune from these national trends. The Tobacco, Obesity, and Alcohol (TOBESAHOL) study estimated that obesity/overweight-related illnesses account for $1.1 billion and diabetes accounts for $300 million among TRICARE Prime beneficiaries. Beyond the heavy cost implications, these conditions also have direct impact on military readiness. Although policy changes in recent years have allowed members with diabetes to continue serving on active duty, their ability to participate in operational missions is typically limited. Military population health figures indicate that approximately 1,000 active duty Air Force members have diabetes, and 3,000 have prediabetes. These numbers are the result of an underlying, unhealthy lifestyle among Airmen. The 2010 Air Force Healthy Airman Report (accessible only by military personnel) states that only 54% of Airmen have a healthy weight. Less than 5% of Airmen consume 5 servings of fruits and vegetables daily, far below the nine U.S. Food and Drug Administrationrecommended daily servings. Accordingly, there is a sharp rise in the prevalence of diabetes after retirement when these habits continue without the enforcement of military fitness standards. There are an estimated 49,000 Air Force Medical Service (AFMS) adult beneficiaries with diabetes and well over 100,000 with prediabetes. It is clear that unhealthy lifestyle practices during the active duty years lead to obesity, which ultimately contribute to the increasing rates of diabetes and prediabetes in later years. Given the magnitude of the problem and the reality of limited resources, research is necessary to determine the best methodologies to prevent diabetes and to manage the disease cost effectively. Unfortunately, there has traditionally been limited infrastructure in place to facilitate this research. Military medical researchers are challenged by multiple duties to include deployments, assignment changes, clinical duties, and teaching responsibilities. The current mode of staffing specialty medical departments is based primarily upon clinical productivity and wartime support, rather than research requirements. Therefore, the ability of an active duty clinician to effectively conduct research is limited. In view of these limitations, it is necessary to have a mechanism to organize research priorities, define appropriate research projects, and efficiently utilize available research resources. In recognition of the need for expandedAFMS diabetes and obesity research, the Air Force Surgeon General’s research division (AFMSA/SG9) hosted an initial meeting in 2009 with potential investigators from six Air Force medical centers (Andrews, Keesler, Lackland, Nellis, Travis, and WrightPatterson Air Force Bases). There was great interest among the investigators, and the need for dedicated research staff to assist in building a viable program was identified. In response, AFMSA/SG9 awarded a contract that provided diabetes research coordinators at each of themedical centers for 3 years. In February 2010, the group of investigators and coordinators met to generate the Air Force Diabetes Research Development Document (RDD). The purpose of this document was to establish research priorities relevant to theAir Forcemission, against which future projects would be organized. The priorities included (1) primary prevention of diabetes, (2) technologies to *Endocrinology Flight, 59 Medical Operations Squadron, Lackland AFB, TX. †Medical Education, 99 Medical Group, Nellis AFB, NV. ‡Clinical Investigations Facility, Travis AFB, CA. The views expressed in the article are those of the authors, and do not reflect the official policy or position of the U.S. Air Force, Department of Defense, or the U.S. Government. doi: 10.7205/MILMED-D-12-00401

Fitness correlates of obligatory versus health motives for exercise: An examination of men in the military

ObjectivesTo examine quantity of exercise and motives for exercise as predictors of men in the military’s health and fitness level. DesignParticipants completed a survey to address research questions of interest. MethodsOne-hundred and fourteen men who were active duty Air Force members, with a mean age of 31.43 years (SD = 7.43) and an average military time in service of 10.66 years (SD = 7.75), completed a modified version of the Reasons for Exercise Inventory, a survey assessing their quantity of exercise, and reported their most recent score on their Air Force Fitness Test. ResultsCorrelational analyses indicated a relation between quantity of exercise and men’s score on the Air Force Fitness Test and a relation between intrinsic motives for exercise and quantity of exercise. Intrinsic motivation was found to moderate the relation between quantity of exercise and men’s health and fitness score. ConclusionsMen in the military who exercise because of their military obligation are less likely to score high on the Air Force Fitness Test than are men who are motivated to exercise for health benefits.

Hazardous drinking and military community functioning: Identifying mediating risk factors.

Hazardous drinking is a serious societal concern in military populations. Efforts to reduce hazardous drinking among military personnel have been limited in effectiveness. There is a need for a deeper understanding of how community-based prevention models apply to hazardous drinking in the military. Community-wide prevention efforts may be most effective in targeting community functioning (e.g., support from formal agencies, community cohesion) that impacts hazardous drinking via other proximal risk factors. The goal of the current study is to inform community-wide prevention efforts by testing a model of community functioning and mediating risk factors of hazardous drinking among active duty U.S. Air Force personnel. A large, representative survey sample of U.S. Air Force active duty members (N = 52,780) was collected at 82 bases worldwide. Hazardous drinking was assessed with the widely used Alcohol Use Disorders Identification Test (Saunders, Aasland, Babor, de la Fuente, & Grant, 1993). A variety of individual, family, and community measures were also assessed. Structural equation modeling was used to test a hypothesized model of community functioning, mediating risk factors and hazardous drinking. Depressive symptoms, perceived financial stress, and satisfaction with the U.S. Air Force were identified as significant mediators of the link between community functioning and hazardous drinking for men and women. Relationship satisfaction was also identified as a mediator for men. These results provide a framework for further community prevention research and suggest that prevention efforts geared at increasing aspects of community functioning (e.g., the U.S. Air Force Community Capacity model) may indirectly lead to reductions in hazardous drinking through other proximal risk factors.

Relationship of Military Deployment Recency, Frequency, Duration, and Combat Exposure to Alcohol Use in the Air Force

With today's new military deployment environment, characterized by more frequent and longer deployments, significant attention has focused on the effects of deployment on problem behaviors, including alcohol use. The current study examined the relationship between aspects of deployment and alcohol use. The data for the current study were collected as part of the Air Force Community Assessment survey, an anonymous Web-based survey of Air Force members. The survey was administered to a stratified random sample of 56,137 active duty Air Force members across 80 bases worldwide; 78% were male and 22% were female. The Alcohol Use Disorders Identification Test measured the rate of alcohol problems. Deployment histories were collected using a series of questions that asked respondents about various aspects and characteristics of their recent deployments. Logistic regression was used to examine the impact of various aspects of deployment on problem drinking. After controlling for demographic variables related to the likelihood of problem drinking, both a higher frequency of deployment and a greater total cumulative length of time deployed since September 11, 2001, were associated with a higher likelihood of problem drinking. For each increase in deployment frequency category the odds that an Air Force member was a problem drinker increased by 14%, and for each additional year spent deployed the odds increased by 23%. These findings indicate a significant relationship between deployment and problem drinking. However, most members who deployed multiple times remained resilient. This points to the need for future research on protective factors that foster resiliency.

Recent Suicidal Ideation and Suicide Attempts in a Large–Scale Survey of the U.S. Air Force: Prevalences and Demographic Risk Factors

One-year prevalences of self-reported noteworthy suicidal ideation and nonfatal suicide attempts were assessed in a large sample of U.S. Air Force active duty members (N = 52,780). Participants completed the 2006 Community Assessment, which was conducted online. Over 3% of male and 5.5% of female participants reported having experienced noteworthy suicidal ideation during the previous year, and 8.7% of those with ideation reported a recent suicide attempt. Demographic factors predicting significantly increased risk for suicidal ideation included female gender, low rank, and non-Christian religious affiliation; unmarried men were also at increased risk. Groups that were at increased risk for nonfatal suicide attempts included low-ranking men and Hispanic women. Implications for prevention efforts are discussed.

Reducing drinking among junior enlisted Air Force members in five communities: early findings of the EUDL program's influence on self-reported drinking behaviors.

In the fall of 2006, the Office of Juvenile Justice and Delinquency Prevention awarded discretionary grants to five communities in four states as part of the Enforcing Underage Drinking Laws initiative. These 3-year grants were designed to support implementation of a set of interventions using an environmental strategies approach to reduce drinking and associated alcohol-related misconducts among active-duty Air Force members ages 18-25, with a specific focus on the underage population. The current article presents findings from Year 1 of the evaluation. Data on alcohol use were obtained from a large-scale, anonymous survey that fielded in the spring of 2006 (i.e., pretest) and the spring of 2008 (i.e., posttest) from a stratified random sample of Air Force members at five demonstration and five comparison communities. The percentage of junior enlisted personnel at risk for an alcohol problem dropped 6.6% in the Air Force overall during the last 2 years but dropped as much as 13.6% and 9.8% in two Arizona demonstration communities that implemented the intervention. The first-year results suggest that the Enforcing Underage Drinking Laws intervention may have been one factor that helped to reduce the percentage of junior enlisted Air Force members at risk for an alcohol problem in the demonstration communities.

Postdeployment, Self-Reporting of Mental Health Problems, and Barriers to Care

PURPOSE. This study explored the relationship between self-reported mental health symptoms and help-seeking behaviors of active-duty Air Force members. DESIGN AND METHODS. Mixed-methods approach reviewed 200 postdeployment surveys from active-duty members assigned to Eglin Air Force Base, Florida, USA. Chi-square analysis examined significance between self-reporting mental health problems and accessing treatment. FINDINGS. As the rate of self-reported mental health symptoms increased, active-duty members were less inclined to seek help. There were inconsistencies among gender for self-reporting and accessing services. PRACTICE IMPLICATIONS. Air Force psychiatric nurses need to be at the forefront of outreach services when treating combat-stressed troops.

Spouses' Ability to Cope with Deployment and Adjust to Air Force Family Demands

Using data from 34,381 Air Force active-duty members, the current study examines active-duty members' perceptions of their spouse's or significant other's ability to cope with deployment of unknown length and adjust to demands of being an Air Force family. Active-duty members' perception of their spouse's ability to cope with deployment significantly varied by rank and time married, with 35 percent of junior enlisted and 30 percent of members married less than three years indicating their spouse would have a serious or very serious problem coping with deployment of unknown length. Protective factors—unit relationship quality, leadership effectiveness, and tangible social support from community members—were positively and significantly related to members' reports of spousal ability to adjust to Air Force family demands. The variance explained by these protective factors was highest for active-duty members who had been away from home for deployment or temporary duty for more than six months in the past twelve months.

A Low-Intensity Intervention to Prevent Annual Weight Gain in Active Duty Air Force Members

Elevated body weight among active duty Air Force (ADAF) members is a substantial and growing problem, and typically results from gaining small amounts of weight each year over many years. We designed a strategy to prevent annual weight gain in ADAF members using self-directed behavior change booklets followed by weekly e-mails about diet and physical activity for a year. The intervention was universally offered to ADAF members meeting selection criteria at five U.S. Air Force bases (n = 3,502); members at 60 other U.S. Air Force bases served as controls (n = 65,089). The intervention was completely effective at preventing weight gain in a subgroup of men (those above the lowest three ranks, with baseline weight above maximum allowable) and in women, while controls continued to gain weight. Since the intervention did not require personalized contact, this approach has promise for large-scale population-based efforts aimed at preventing weight gain in working adults.

Understanding Air Force members' intentions to participate in pro-environmental behaviors: an application of the theory of planned behavior.

At a single installation, a cross section of 307 active duty Air Force members completed questionnaires to assess whether the theory of planned behavior was useful in explaining the service members' intentions to participate in three environmentally protective behaviors-recycling, carpooling, and energy conservation. While the individual tenets of the theory of planned behavior, i.e., attitude toward the behavior, subjective norms, and perceived control, accounted for differing amounts of variance in intentions, the results indicated that the intentions of these Air Force members to recycle, conserve energy, and carpool were moderately explained by the tenets of the theory of planned behavior collectively when the results of a multiple regression were analyzed.

Predictors of low physical fitness in a cohort of active-duty U.S. Air Force members

Background: Each branch of the U.S. armed forces has standards for physical fitness as well as programs for ensuring compliance with these standards. In the U.S. Air Force (USAF), physical fitness is assessed using submaximal cycle ergometry to estimate maximal oxygen uptake (VO 2max). The purpose of this study was to identify the independent effects of demographic and behavioral factors on risk of failure to meet USAF fitness standards (hereafter called low fitness). Methods: A retrospective cohort study (N=38,837) was conducted using self-reported health risk assessment data and cycle ergometry data from active-duty Air Force (ADAF) members. Poisson regression techniques were used to estimate the associations between the factors studied and low fitness. Results: The factors studied had different effects depending on whether members passed or failed fitness testing in the previous year. All predictors had weaker effects among those with previous failure. Among those with a previous pass, demographic groups at increased risk were toward the upper end of the ADAF age distribution, senior enlisted men, and blacks. Overweight/obesity was the behavioral factor with the largest effect among men, with aerobic exercise frequency ranked second; among women, the order of these two factors was reversed. Cigarette smoking only had an adverse effect among men. For a hypothetical ADAF man who was sedentary, obese, and smoked, the results suggested that aggressive behavioral risk factor modification would produce a 77% relative decrease in risk of low fitness. Conclusions: Among ADAF members, both demographic and behavioral factors play important roles in physical fitness. Behavioral risk factors are prevalent and potentially modifiable. These data suggest that, depending on a member’s risk factor profile, behavioral risk factor modification may produce impressive reductions in risk of low fitness among ADAF personnel.

Validity of Bioelectrical Impedance Analysis to Measure Body Fat in Air Force Members

This study determined if the bioelectrical impedance analysis (BIA) method was a more valid assessment of body fat in Air Force members than the current Air Force circumference (AF) method. Both methods were compared with hydrostatic weighing, which is the presumed standard for identifying body fat. Subjects included 50 male and 50 female active duty Air Force members between the ages of 19 and 47 years. The AF method had higher correlation coefficients and lower standard error of estimates for both male and female subjects (r = 0.91 [3.00%] and r = 0.79 [3.28%], respectively) than the BIA method (r = 0.84 [3.25%] and r = 0.75 [4.30%], respectively). The false-positive rates for individuals having excess body fat were greater for the AF method (14.7 and 29.3% for males and females, respectively) than the BIA method (7.3 and 8.8% for males and females, respectively). The data suggest that caution should be used when the current AF method or the BIA method is used to make individual Air Force career decisions.

Impact of a Dining Hall Based Nutrition Education Program On Healthier Food Choices

Recognizing an area to impact a large number of our active duty population, the Air Force developed and implemented the “Check-It-Out” nutrition education program. This program is an environmental support program which focuses on changing the food choices of active duty Air Force members through modifications in base dining facility menu selections. Literature reveals that dining hall based nutrition programs can be one of the most popular worksite interventions. Realizing that most employees eat at least one meal a day at work, “Check-It-Out” is designed to educate customers on healthier food choices, and to affect the foods selected. This program was launched Air Force wide in 1992 at base dining halls, clubs, and medical treatment facility dining halls. The marketing campaign consisted of a media blitz including a recognizable logo on posters, flyers, table tents, steam table signs, and menu markers that were prominently located in participating dining halls and clubs. A publicity letter was distributed to all Health Promotion Managers and dietitians throughout the Air Force, and newspaper articles were available for printing in all base papers. A training video and implementation guidelines were prepared for facilities. Point of sale information includes nutrient analysis of the menu item to include calorie, fat, cholesterol, and sodium content of foods on the menu. At least one item per menu category must meet specified criteria in order to be labeled with the “Check-It-Out” symbol. Results have been tracked through the use of two metrics, which are the “Check-It-Out” Implementation Checklist, and the count of healthy entrees as a percentage of total entrees sold. Results show that 70% of dining facilites are rated “excellent” on the implementation checklist, and the proportion of healthier choices selected has increased by 12% over the 1994-1996 reporting period.

Use of the Food Guide Pyramid and US Dietary Guidelines to Improve Dietary Intake and Reduce Cardiovascular Risk in Active-Duty Air Force Members

Objective To determine whether adoption of dietary patterns consistent with the US Dietary Guidelines for Americans and the Food Guide Pyramid, combined with exercise training, result in significant reductions in cardiovascular risk compared with a regimen of exercise therapy alone. Design A randomized trial to compare the effects of exercise alone (n=17) with the effects of exercise and dietary intervention (n=15). Setting McClellan Air Force Base medical clinic (Sacramento, Calif). Subjects Thirty-two members of the Air Force (20 men and 12 women) were recruited at the time they entered a 90-day fitness improvement program. Mean age was 32 years. Intervention All subjects participated in a 90-day fitness program. Half of the group received individualized dietary counseling using the Food Guide Pyramid as a primary educational tool. Main outcome measures Changes in body mass index, plasma lipids and lipoprotein levels, aerobic capacity, and dietary intake were selected to evaluate the effectiveness of the intervention. Statistical analyses performed Outcome measures were evaluated by analysis of variance. A paired t test was performed to compare changes in food-group servings and food-group fat intake from baseline values for the exercise-plus-diet group. Results Percentage of energy from fat decreased from 39% to 23% for the exercise-plus-diet group, and servings from each of the food groups changed to reflect current guidelines. This group also had significant reductions in body mass index, total cholesterol level, and low-density lipoprotein level: 2% ( P=.0001), 9% ( P=.003), and 13% ( P=.005), respectively. No change was observed for the exercise-only group. Additionally, a significant improvement in maximum oxygen consumption ( P=.01) of 38% (vs 14% for the control group) was achieved. Conclusions Dietary modification in accordance with the Food Guide Pyramid and the US Dietary Guidelines results in significant reductions in known cardiovascular risk factors and improves the response to exercise training. J Am Diet Assoc. 1995; 95:1268-1273.

Use of the food guide pyramid to improve dietary intake and reduce cardiovascular risk in active duty air force members

Abstract : The goal of this study was to determine if adherence to the Food Guide Pyramid guidelines, when combined with exercise, results in significant reductions in cardiovascular risk and enhancement in aerobic capacity (VO2 max) when compared to a regimen of exercise therapy alone. Twenty men and twelve women, mean age=32, with similar baseline V02max, total cholesterol (TC), low density lipoprotein (LDL), body mass index (BMI), and dietary fat intakes were randomized into two groups. All subjects participated in a 90-day fitness improvement program. One-half of the subjects (treatment group), received weekly, individualized dietary counseling using the Food Guide Pyramid as an educational tool. All participants completed a food frequency questionnaire at baseline and post-treatment.

Analysis of disease progression from clinical observations of US Air Force active duty members infected with the human immunodeficiency virus: distribution of AIDS survival time from interval-censored observations

A non-parametric estimator of the AIDS survival time (after developing AIDS) is computed for the AIDS data set from the US Air Force (USAF). Survival times are unobservable. They are censored by the screening mechanism. The Armstrong Laboratory's Epidemiologic Research Division maintains data on over 954 active duty US Air Force (USAF) individuals who tested positive for human immunodeficiency virus (HIV) antibodies. Many have been clinically evaluated seven times since 1986. The HIV-positive individual is classified in seven stages of the disease complex as time progresses. Exact times of transition from one stage to the next are unknown. It is known that transition occurred between two consecutive evaluations. The aim of this study is to analyse distributions of the times that individuals spend in each stage of the HIV disease complex. We will discuss methods used to obtain non-parametric estimators of the distribution of times that individuals spend in stage 6. Finally, it is hoped to model the median time spent in each stage of the disease. This, along with incidence and separation data, will allow the prediction of the impact of HIV disease on USAF individuals and medical care systems.