Active Duty Air Force Research Articles

Factors influencing health behaviors among active duty Air Force personnel

BackgroundIndividual health behaviors affect whether U.S. Air Force (USAF) service members are fit and ready to deploy. PurposeThe purpose of this study was to understand health behaviors of USAF members to guide future interventions to reduce cardiovascular risks. MethodsA qualitative descriptive study was conducted with a purposive sample of 24 active duty USAF participants. Conventional content analysis was used to derive data-driven themes that were compared with the Health Promotion Model (HPM). DiscussionParticipants defined health in a multifactorial way that covered physical, emotional, and spiritual dimensions. The three themes that contributed to participants' health behaviors addressed: “who I am,” “what works for me,” and the USAF culture. There was a poor fit between findings as expressed by these participants and the HPM. ConclusionAlthough these findings were derived from a sample of USAF participants, the findings have implications for members of other military services. The findings also have relevance for nurses and other providers within the civilian work environments who can promote health and wellness by integrating a client's personal history into a plan for developing and sustaining a healthy lifestyle.

Case series of 23 deaths from Hymenoptera stings among United States Air Force populations

Medical conditions arising from hymenopteran sting allergy or mass envenomation are a serious health concern, particularly in austere environments. Both practicing allergists and entomological pest control personnel should consider the relevance of stinging insects when responding to problems with Hymenoptera. Recent occupational reviews of civilian deaths from insect bites and stings prompted our review of the US Air Force Mortality Registry to determine the relevance of insect stings and bites as a cause of death in the US Air Force. After reviewing over 40 years of death records we identified 23 death records, among US Air Force Active duty, guard, or retirees that arose directly from hymenopteran stings.

The Willingness of Military Members to Seek Help: The Role of Social Involvement and Social Responsibility.

Anchored in the social organization theory of action and change, we use data from a large sample of active-duty Air Force members to examine the direct and indirect influence of social involvement and social responsibility on willingness to seek help in times of need via trust in formal systems and informal supports. Group comparisons are conducted between junior male, junior female, senior male, and senior female service members. The key mediational path in the model for all groups is the connection between social involvement and willingness to seek help via trust in formal systems. These results can inform both unit- and community-level interventions intended to increase the likelihood that active-duty AF members will seek help in times of need.

Gastrointestinal Disease in Pilots, 2001-2013.

The frequency and distribution of gastrointestinal (GI) disease in the population of active duty Air Force pilots is poorly understood, even though GI illness can temporarily or permanently lead to disqualification from flying duties. Better understanding of GI disease within this population could yield considerable operational risk and human performance insight and provide data to use in assessing the effectiveness of current medical standards related to flight training and flying duties. A dataset reflecting inpatient and outpatient healthcare visits from 2001 through 2013 was developed and reviewed. Gastrointestinal illness was grouped into 18 subcategories of disease, and the frequency and distribution of visits for these categories were tallied. The total burden of GI illness over the target dates was compared between pilots, nonpilot aircrew/special operational duty personnel, and nonaircrew/nonspecial duty personnel. Esophageal disease and dyspeptic conditions were the two most frequently encountered diagnoses among all three population groups, comprising almost 50% of the gastrointestinal diagnoses in age and gender-matched samples of all three populations. The overall burden of disease over the total timeframe of the study was not statistically different in the three populations, with a median of four encounters per person for GI disease. Of interest, the total burden of disease increased over the course of the study period in all populations, driven in large measure by increases in esophageal disease and dyspeptic conditions. The general distribution and overall burden of GI disease in populations of Air Force pilots, nonpilot aircrew/special operational duty personnel, and nonaircrew/nonspecial duty personnel were similar. The increase in esophageal and dyspeptic conditions over time warrants further attention.

Mental Health Monitoring During Basic Military Training: Psychometric Properties of the Outcome Questionnaire-30.2

This study examined the psychometric properties of the Outcome Questionnaire-30.2 (OQ-30.2; designed to measure patient progress throughout mental health treatment) in a sample of United States Air Force active duty basic military trainees who were evaluated for mental health concerns during the course of basic training. Findings indicate that the OQ-30.2 was internally consistent and Total scores decreased with more contact with mental health professionals. Previously reported 1- and 3-factor structures were not replicated; rather, results suggested the use of a broad 27-item general psychological distress subscale and a separate subscale of 3 critical items assessing substance use concerns. Present findings support the utility of the OQ-30.2 as a tool for repeated monitoring of patient progress in military mental health settings. Recommendations for future directions in the development of alternate calculations of the clinical cut score and reliable change index are discussed.

Psychological flexibility as a dimension of resilience for posttraumatic stress, depression, and risk for suicidal ideation among Air Force personnel

Rates of psychological disorders and suicide have increased dramatically among military personnel since the onset of combat operations in Iraq and Afghanistan. To date, few studies have identified psychological factors that insulate service members from emotional distress and suicide risk following combat. The current study investigates the protective effects of psychological flexibility on emotional distress and suicidal ideation in 168 active duty Air Force convoy operators. Self-report data were collected before deployment and at 1, 3, 6, and 12 months postdeployment. Robust generalized estimating equations with repeated measurements indicated that, over time, service members with greater psychological flexibility reported less severe posttraumatic stress (B=−.039, SE=.011, p=.001) and depression (B=−.053, SE=.009, p<.001) than subjects with less psychological flexibility. Greater psychological flexibility was also associated with decreased suicide risk (B=−.035, SE=.010, p<.001), significantly moderating the effects of depression on suicidal ideation over time (B=.115, SE=.044, p=.008). Results suggest that psychological flexibility guards against emotional distress among service members and buffers the effects of depression on suicide risk.

Efficacy of a Tobacco Quitline in Active Duty Military and TRICARE Beneficiaries: A Randomized Trial.

A higher proportion of military personnel than civilians smoke cigarettes. Few randomized trials of tobacco use interventions have been conducted in the U.S. military. We evaluated the efficacy of a tobacco quitline (QL) in 1298 active duty military personnel, their dependents, reservists, and retirees who smoke cigarettes. Participants were randomized to either a proactive (counselor-initiated) or reactive (participant-initiated) QL intervention for 8 weeks. The proactive condition included up to an 8-week supply of free nicotine replacement therapy, and the reactive condition included a 2-week supply. The primary outcome was 12-month smoking abstinence. The enrolled population was predominantly affiliated with the Air Force and Army. At the end of treatment, proactive treatment was associated with a greater odds of both prolonged (44.22% vs. 24.96%; odds ratio [OR] = 2.4, P < 0.0001) and 7-day point prevalence (49.92% vs. 28.20%; OR = 2.5, P < 0.0001) smoking abstinence, a difference that was maintained for prolonged smoking abstinence at 12 months (22.03% vs. 13.41%; OR = 1.8, P < 0.0001). Our findings provide evidence that a proactive QL with nicotine replacement therapy is highly efficacious among Air Force and Army active duty and TRICARE beneficiaries and would provide an effective telephonic treatment option for this population of smokers.

Belonging protects against postdeployment depression in military personnel.

Depression among U.S. military personnel has received relatively little empirical attention compared to posttraumatic stress disorder, despite evidence that depression is associated with poor psychosocial outcomes and increased suicide risk. Even less is known about factors that protect against depression in military populations. A sample of 168 active duty Air Force convoy operators completed self-report measures of depression, posttraumatic stress, and sense of "belonging" before deploying to Iraq, and again at 1, 3, 6, and 12 months following their return. Linear growth modeling was used to test the associations of the variables over time. Mean depression scores remained low and stable across the deployment and 12-month follow-up period. Increased depression severity was significantly associated with low belonging (P < .001) and with posttraumatic stress symptoms (P < .001) at every time point. Relatively small, predominantly male sample utilizing self-report methods. A sense of belongingness may protect service members from depression at all stages of the deployment cycle, from predeployment preparations through deployment and postdeployment adjustment.

Individual differences in biophysiological toughness: sustaining working memory during physical exhaustion.

Recent evidence suggests that increased dehydroepiandrosterone sulfate (DHEAS), in combination with decreased cortisol levels have been correlated with enhanced performance outcomes in stressful military environments. This study was implemented to replicate these findings in a group of active duty Air Force members to provide information on the usefulness of these biomarkers indices in the training and operational environment. Seventeen active duty males participated in the 4 sessions of this study. Sessions 1 and 2 were training days for the cognitive testing. Session 3 was a baseline measure of physical fitness, utilizing the VO2 Maximal Treadmill test. Session 4 was centered around a modified-Astrand treadmill protocol designed to induce physical exhaustion. Blood draws for biomarker analysis, cognitive testing (NovaScan), psychomotor vigilance, and physiological measures were collected before, during, and following the treadmill protocol. Results showed that prolonged increases in cortisol negatively correlate with working memory performance. DHEAS release from baseline to poststress was negatively related to the changes in cortisol for 20 minutes following stress. These results indicate that the ratio of DHEAS to cortisol buffers, the effect of cortisol increases that are related to poor working memory performance because of physical exhaustion.

Maintenance and flight scheduling of low observable aircraft

AbstractIn this article, we focus on relatively new maintenance and operational scheduling challenges that are faced by the United States Air Force concerning low‐observable (LO) or stealth aircraft. The LO capabilities of an aircraft degrade stochastically as it flies, making it difficult to make maintenance scheduling decisions. Maintainers can address these damages, but must decide, which aircraft should be put into maintenance, and for how long. Using data obtained from an active duty Air Force F‐22 wing and interviews with Air Force maintainers and program specialists, we model this problem as a generalization of the well‐known restless multiarmed bandit superprocess. Specifically, we use an extension of the traditional model to allow for actions that require varying lengths of time, and generate two separate index policies from a single model; one for maintenance actions and one for the flying action. These index policies allow maintenance schedulers to intuitively, quickly, and effectively rank a fleet of aircraft based on each aircraft's LO status and decide, which aircraft should enter into LO maintenance and for how long, and which aircraft should be used to satisfy daily sortie requirements. Finally, we present extensive data‐driven, detailed simulation results, where we compare the performance of the index policies against policies currently used by the Air Force, as well as some other possible more naive heuristics. The results indicate that the index policies significantly outperform existing policies in terms of fully mission capable (FMC) rates. In particular, the experiments highlight the importance of coordinated maintenance and flying decisions. © 2015 Wiley Periodicals, Inc. 62:60–80, 2015

Metabolic syndrome in the Military Health System based on electronic health data, 2009-2012.

Metabolic syndrome prevalence in the United States rose from 27% to 34.2% between 1999-2000 and 1999-2006. However, prevalence has not been determined in the Military Health System. This retrospective descriptive study included enrolled Military Health System adults during fiscal years 2009-2012. We explored three populations (nonactive duty, active duty, and Air Force active duty) and their metabolic syndrome components (body mass index or waist circumference, blood glucose test, triglyceride, high density lipoprotein, and blood pressure). The active duty sample (who had all five components measured) was representative of its population, but the nonactive duty sample was not. Therefore, we reported component-wise prevalence for both nonactive and active duty populations, but only reported prevalence of metabolic syndrome for active duty. A decreasing trend, greater in men, was seen. Crude prevalence in 2012 was higher among men and highest among males and females aged 45-64. Only Air Force active duty data contained waist circumference measurements, enabling comparison to the United States. This subgroup prevalence was significantly lower than the United States prevalence in 2010 for both genders in every age group. Although decreasing metabolic syndrome prevalence is promising, prevalence is still high and future research should explore policies to help lower the prevalence.

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.

Standard of care of erectile dysfunction in U.S. Air Force aircrew and active duty not on flying status.

In 2011, over 3,000 active duty U.S. Air Force (USAF) members were prescribed a phosphodiesterase inhibitor (PDEI). PDEIs are first-line therapy for treating erectile dysfunction and can have significant side effects that could impact aircrew performance. In total, 200 eligible subject records were randomly sampled from the active duty USAF population of those males filling a prescription for a PDEI in June 2011; 100 of those records were from aviators. The electronic records were reviewed and scored to determine if USAF aeromedical standards for prescribing PDEIs were followed, with a minimum score of 0 for no standards met and a maximum of 3 for all standards met. The average score for both groups was 1, with no significant difference between the group scores. A proper aeromedical disposition was documented in 67% of the aviator records. Although there was no significant difference in standard of care for aviators and nonaviators, the overall documented standard of care was poor. Lack of documentation was the primary reason for the low scores and the low percentage of properly rendered aeromedical dispositions. Proper medical record documentation is important for evaluating quality of care and ensuring compliance with regulations in an Air Force aviator population.

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.

Agency is Associated with Decreased Emotional Distress and Suicidal Ideation in Military Personnel

Suicides in the U.S. military continue to rise at a rapid rate. Identification of protective factors that reduce risk for suicidal thoughts and behaviors among military personnel are therefore needed. Agency—the sense that one is competent, effective, and in control of one's life—has shown to reduce the effects of hopelessness and emotional distress on suicidal thoughts and attempts in non-military populations. The current study explores the association of agency with suicidal ideation in a sample (n = 273) of active duty Air Force Security Forces personnel. Results of generalized regression modeling suggest that agency is directly associated with decreased emotional distress and severity of suicidal ideation, but does not moderate the effect of emotional distress on suicidal ideation.

Identifying unique and shared risk factors for physical intimate partner violence and clinically-significant physical intimate partner violence.

Intimate partner violence (IPV) is a significant public health concern. To date, risk factor research has not differentiated physical violence that leads to injury and/or fear (i.e., clinically significant IPV; CS-IPV) from general physical IPV. Isolating risk relations is necessary to best inform prevention and treatment efforts. The current study used an ecological framework and evaluated relations of likely risk factors within individual, family, workplace, and community levels with both CS-IPV and general IPV to determine whether they were related to one type of IPV, both, or neither for both men and women. Probable risk and promotive factors from multiple ecological levels of influence were selected from the literature and assessed, along with CS-IPV and general IPV, via an anonymous, web-based survey. The sample comprised US Air Force (AF) active duty members and civilian spouses (total N = 36,861 men; 24,331 women) from 82 sites worldwide. Relationship satisfaction, age, and alcohol problems were identified as unique risk factors (in the context of the 23 other risk factors examined) across IPV and CS-IPV for men and women. Other unique risk factors were identified that differed in prediction of IPV and CS-IPV. The results suggest a variety of both established and novel potential foci for indirectly targeting partner aggression and clinically-significant IPV by improving people's risk profiles at the individual, family, workplace, and community levels. Aggr. Behav. 41:227-241, 2015. © 2014 Wiley Periodicals, Inc.

Improving the detection and prediction of suicidal behavior among military personnel by measuring suicidal beliefs: An evaluation of the Suicide Cognitions Scale

BackgroundNewer approaches for understanding suicidal behavior suggest the assessment of suicide-specific beliefs and cognitions may improve the detection and prediction of suicidal thoughts and behaviors. The Suicide Cognitions Scale (SCS) was developed to measure suicide-specific beliefs, but it has not been tested in a military setting. MethodsData were analyzed from two separate studies conducted at three military mental health clinics (one U.S. Army, two U.S. Air Force). Participants included 175 active duty Army personnel with acute suicidal ideation and/or a recent suicide attempt referred for a treatment study (Sample 1) and 151 active duty Air Force personnel receiving routine outpatient mental health care (Sample 2). In both samples, participants completed self-report measures and clinician-administered interviews. Follow-up suicide attempts were assessed via clinician-administered interview for Sample 1. Statistical analyses included confirmatory factor analysis, between-group comparisons by history of suicidality, and generalized regression modeling. ResultsTwo latent factors were confirmed for the SCS: Unloveability and Unbearability. Each demonstrated good internal consistency, convergent validity, and divergent validity. Both scales significantly predicted current suicidal ideation (βs >0.316, ps <0.002) and significantly differentiated suicide attempts from nonsuicidal self-injury and control groups (F(6, 286)=9.801, p<0.001). Both scales significantly predicted future suicide attempts (AORs>1.07, ps <0.050) better than other risk factors. LimitationsSelf-report methodology, small sample sizes, predominantly male samples. ConclusionsThe SCS is a reliable and valid measure that predicts suicidal ideation and suicide attempts among military personnel better than other well-established risk factors.

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.

Risk Factors for Disability Retirement Among Active Duty Air Force Personnel

To determine risk factors for disability retirement in Air Force personnel, as well as the conditions contributing to disability retirement. A matched case-control study was conducted. Air Force personnel with accession records who were disability retired between 2002 and 2011 were included as cases. Controls were matched by accession year from the population of accessions not evaluated for disability at a ratio of 2:1. Conditional logistic regression was used to determine the odds of disability retirement. Women and those aged 25 or older were significantly more likely to be disability retired. Deployment was also associated with disability retirement but was significantly protective. Among women, the odds of disability retirement did not vary when stratified by deployment history. Preexisting medical conditions were not associated with disability retirement. Psychiatric conditions were the most common condition type among those who were disability retired in the Air Force. Additional studies are needed to assess risk factors for psychiatric disability, the most common disability retired condition, as well as to describe the role of occupation and combat exposure in disability retirement from the Air Force.

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.