Advanced Individual Training Research Articles

Effect of a Basic Training Nicotine-Free Policy on Soldiers in the United States Army

Rates of tobacco use among US active duty service members and veterans are higher than those for the civilian population,1,2 costing the Department of Defense $1.6 billion annually in related health and productivity effects and the Department of Veterans Affairs (VA) $2.7 billion.3,4 Among service members, the highest prevalence of nicotine use occurs in those 17 to 24 years of age, which is the age range during which most join the military.1 Initial US Army training is separated into two phases, the 10-week US Army Basic Combat Training (BCT) followed by the time-variable Advanced Individual Training (AIT).

Implementation and Evaluation of a Military-Civilian Partnership to Train Mental Health Specialists.

Mental health specialists (MHS, or 68X) play a central role in meeting the growing demand for combat stress care among Service Members. Partnering with civilian institutions may enhance the MHS training experience beyond Advanced Individual Training (AIT). We describe a novel military-civilian collaboration to train U.S. Army Reserve MHS's in the psychiatric emergency service (PES) of a public, safety-net hospital. Details of implementation are described. The training rotation was evaluated after 1 year through a comprehensive chart abstraction of patients seen as well as surveys of MHS's and civilian partners. The roles of MHS and physician officers in this rotation are described. Over 9 days in the PES, the MHS team evaluated 26 patients. MHS's described a high-quality training environment (83% rated very good or excellent) in which they frequently saw high-risk patients relevant to military practice. Experience with a certain patient presentation was correlated with comfort assessing and managing that presentation (p < 0.01). Many civilian staff (40%) felt the PES operated better with the presence of the Army team and 50% of civilians agreed their impression of the U.S. Army Reserve improved as a result of the partnership. Hundred percent of specialists and 80% of civilians reported very good to excellent rapport between military and civilian staff. Two civilian respondents (11%) expressed concern that the military team's presence impeded patient care. This is the first military-civilian training collaboration for behavioral health specialists, who have already completed AIT. This program provided well-received and mission-relevant training for MHS's without notable adverse effects on patient care or team functioning in a civilian environment. Our findings are based on a small sample size, and no other such programs exist against which to compare these results. We propose that such educational partnerships, which have long been effective for other clinical specialists, may benefit the military, civilian communities, and the country.

Surveyed Reasons for Not Seeking Medical Care Regarding Musculoskeletal Injury Symptoms in US Army Trainees.

Musculoskeletal injuries (MSKIs) pose a significant threat to military readiness and are difficult to monitor due to Soldiers' reluctance to seek medical treatment. There is high risk of developing MSKIs while going through initial entry training (IET), many of which go unreported. The purposes of this study were to identify the contributing factors that influence US Army trainees to not seek medical care for self-reported symptoms of musculoskeletal injury (SMSKI) and establish how those factors may differ by sex, training school, and installation site. Data were collected from 739 trainees (607 males, 132 females) completing IET at either Fort Benning, GA, Fort Sill, OK or Fort Leonard-Wood, MO, USA. Male trainees were in combat arms jobs while female trainees were from both combat arms and other physically demanding jobs. All surveys were completed within 5 weeks of graduation from Advanced Individual Training and One Station Unit Training. Trainees answered a series of questions about SMSKIs sustained during IET that lasted seven or more days. Using a Likert-type scale (1-strongly disagree through 5-strongly agree), trainees rated the influence that each of the following seven statements contributed to their decision not to seek medical care: "graduating on time," "avoiding negative perceptions associated with injuries," "avoiding profile," "inconvenience in seeing a provider," "self-managing the injury based on past experience," "severity of the injury," and "prior negative experiences seeking medical care in the military." Pearson's Chi-square test was used to assess significant relationships among SMSKI reporting across sex, training school and training installation. Overall, SMSKI incidence was 36.1% and 58.3% among IET male and female trainees, respectively (40% overall). Nearly two-thirds (64%) of all trainees injured during IET had a SMSKI that they did not report to leadership or a medical provider. Across sex, female trainees were more likely to report SMSKIs than male trainees (p < 0.01), but there was no difference in SMSKI reporting rates by sex (p = 0.48). There was a difference in SMSKI rates by training school (p < 0.01), where infantry had higher SMSKI rates than field artillery (p < 0.01). There were no differences across training schools in how often trainees sought medical care (p = 0.58). The most common reasons selected for not reporting SMSKIs (i.e., not seeking medical care) included "I wanted to graduate on time" and "I wanted to avoid a profile." "I had prior negative experiences seeking medical care in the military" was consistently rated as the least important reason. Female trainees were more likely to not report SMSKIs in order "to avoid a profile" than male trainees (p < 0.05). Over 64% of trainees' did not seek medical care for their SMSKI during IET. As early detection, better reporting and timely treatment may result in reductions in SMSKI severity, reduced IET attrition, and lower medical expenses, trainees should be encouraged to report SMSKIs for proper early stage treatment. These study findings could be used to assist military leadership to create a positive environment for reporting and seeking care for SMSKIs.

Personality Traits and Family Styles of Combat Medics in Training.

This descriptive study examines the relationship between four family types and five personality traits. The four family types are balanced, moderately balanced, midrange, and extreme. The five personality traits are extraversion, openness to experiences, agreeableness, emotional stability, and conscientiousness. Data were collected through anonymous questionnaires distributed to combat-naïve Soldiers at the beginning of their advanced individual training. This study utilized the Family Adaptability and Cohesion Evaluation Scale1 and the Ten-Item Personality Inventory2 as measures. Overall the analyses found that participants classified as a balanced family type scored significantly higher on the personality traits of extraversion, agreeableness, and openness to experience than those classified in the family types of extreme, midrange, and moderately balanced. It appears that family types are associated with personality traits. This study opens doors to future research including looking at how family and personality types relate to each other in military units and personnel.

Prevalence of Body Dysmorphic Disorder and Muscle Dysmorphia Among Entry-Level Military Personnel.

To determine the prevalence of body dysmorphic disorder (BDD) and muscle dysmorphia (MD) in enlisted U.S. military personnel; and secondarily, to determine supplement use and relationship with BDD and MD. A survey of advanced individual training of tri-service personnel at Fort Sam Houston, Texas, was performed combining the dysmorphia concern questionnaire, the MD symptom questionnaire, a supplement questionnaire, and demographic factors. Of the 1,320 service members approached, 1,150 (87.1%) completed the survey. The majority of participants were male, 62.8% (n = 722) and Army soldiers 59.0% (n = 679). The prevalence rate of BDD was 13.0% in males and 21.7% in females. The prevalence of MD was 12.7% in males and 4.2% in females. There was a strong correlation between having BDD and using supplements to get thinner (odds ratio 5.1; 95% confidence interval 3.4-7.8; p < 0.001) and MD to get more muscular (odds ratio 5.4; 95% confidence interval 3.5-8.3; p < 0.001). Our study shows a higher than expected prevalence rate of BDD and MD in service members. This indicates a need for increased awareness of dysmorphias in mental health providers, primary care providers, and commanders and justifies further military specific BDD and MD research.

General Self-Reported Health as it Relates to Self-Esteem, Situational Self-Efficacy and Coping among Soldiers

As an indicator of broad-spectrum health, Behavioral Risk Factor Surveillance scales frequently use a single question on general self-reported health (GSRH). However, little information exists on whether a single question of GSRH is related to indices of a person’s mental health. The purpose of this paper is to examine the relationship between GSRH and indices of self-esteem, self-efficacy and coping. During their first two weeks of Advanced Individual Training (AIT), 579 US Army Health Care Specialist Trainees completed demographic and self-report data, including GSRH, the Revised Ways of Coping Checklist (RWCCL), the Situational Self-Efficacy Scale (SSE), and the Rosenberg Self-Esteem Scale (SES). Spearman Rho correlation coefficients were used to analyze the data with Stata statistical software (StataCorp, 2005). GSRH was positively correlated with SSE, the SES, and problem focused and social support seeking methods of coping, (p &lt; .05). GSRH was negatively correlated with blaming self, wishful thinking, and avoidance methods of coping (p &lt; .05). Results indicate that, among active duty service members attending medical AIT, a single question on general selfreported health appears to be a good representation of a persons’ perception of his or her self-esteem, selfefficacy and coping skills.

The relationship between symptoms of attention deficit and hyperactivity disorder and oppositional defiant disorder with soldier performance during training

During interviews with Health Care Specialist military cadre, instructors voiced concern that symptoms associated with attention deficit and hyperactivity disorder (SoADHD) and oppositional defiant disorder (SoODD) were interfering with soldiers' ability to complete training. The purpose of this research was to examine the relationship between SoADHD and SoODD with soldiers' grade point average (GPA), Army Physical Fitness Test (APFT) scores, and musculoskeletal injuries during Health Care Specialist (HCS) Advanced Individual Training (AIT). Participants included 122 soldiers attending HCS training. Participants completed a demographic survey and Barkley and Murphy's ADHD and ODD self-report symptom surveys. Their ADHD and ODD self-report scores were correlated with course performance metrics at the conclusion of their 16 weeks of training. Pearson Correlation Coefficients revealed a significant negative relationship between ratings on the Oppositional Defiant Disorder scale with soldiers' GPA (p < 0.05), however the relationship was weak - accounting for 4% of the variance. No significant findings were noted between SoADHD and GPA, nor were significant relationships found between SoADHD or SoODD with APFT scores or musculoskeletal injuries. Symptoms associated with ADHD and ODD had little impact on the academic and physical performance of soldiers attending HCS training. Implications and future research are explored, in this article.

The Relationship of Self-Reported Health to other Indices of Physical Health and Performance among Soldiers

A single question on self-reported health (SRH) is often used as part of Behavioral Risk Factor Surveillance to describe populations and as an indicator of general health. However, little information exists on whether a single question of SRH is related to other indices of a person’s health and fitness. The objective of this paper is to examine the relationship between SRH and other health-related self-disclosures, as well as physical performance. Demographic, self-report, and physical fitness data were collected from 579 US Army Health Care Specialist Trainees during their first two weeks of Advanced Individual Training. Physical fitness data was collected again after approximately 8 weeks and 16 weeks. Spearman Rho correlation coefficients were used to analyze the data. SRH was positively correlated with self reports of past and current physical activity and physical abilities, and with the physical fitness portion of the Banderet Life Experiences Questionnaire (p < .05). SRH was positively correlated w...

Discrepancies in Clinical Definitions of Stress Fractures: Implications for the United States Army

ABSTRACT In the United States Army initial entry training (IET) environment, stress fractures are common musculoskeletal injuries. Due to the repetitive physical demands placed on soldiers, stress fractures are particularly common in individuals matriculating through basic combat training (BCT) and advanced individual training (AIT). Within the Army medical department, the clinical definitions of stress fractures vary widely among providers who are directly responsible for diagnosing these injuries. The use of diversified definitions of stress fractures in patient evaluations, treatment, communication measures, and injury data collection negatively affect patient dispositions and soldier training outcomes. This report identifies discrepancies in clinical definitions of stress fractures and the implications for the Army regarding the lack of a standardized definition for stress fractures.

Sleep across Military Environments

This focus of this discussion panel is on the effect of sleep on human performance in different military environments or contexts. Panelists will discuss a wide range of topics including how to address fatigue among Air Force pilots, the impact of sleep on performance in Army Advanced Individual Training, the effects of adjusting Army and Navy recruits' sleep schedules during training, the existing gaps in addressing sleep needs on naval vessels, the impact of sleep loss and other stressors on dismounted warfighter performance, and the effects of chronic inadequate sleep on cognitive readiness. It is important to understand both the differences in the effects of sleep in these environments, as well as the commonalities that can be applied to multiple environments and operators. Our panelists include some of the foremost sleep experts of today, as well as others who examine sleep in their human performance research. Participation in this panel will include discussing their latest research, offering practical applications, and engaging the audience in discussions of cross-disciplinary applications, including areas for collaboration across military and civilian services and environments. Finally, panelists and audience members will and share ideas about directions for future sleep-related research.

Tobacco Use Prevalence and Factors Associated with Tobacco Use in New U.S. Army Personnel

ABSTRACT This study examined the prevalence of tobacco use and factors associated with pre-military service cigarette and smokeless tobacco use. From January 2000 to December 2006, military students arriving for Advanced Individual Training at the U.S. Army Ordnance School completed a questionnaire that asked about their use of tobacco products. The prevalence of smokeless tobacco use from 2000 to 2006 for women generally decreased, as did the number of cigarettes smoked per day by men. For men and women, factors associated with cigarette use included younger age, Caucasian race, and use of smokeless tobacco. Factors associated with smokeless tobacco use among men included younger age, Caucasian race, and cigarette use. For women, cigarette use was the only factor associated with smokeless tobacco use. The identified factors in this study could be used to establish strategies in the future to reduce tobacco use in the military.

Risk factors associated with self-reported training-related injury before arrival at the US army ordnance school

This study examined risk factors for self-reported injury incurred before arrival at Ordnance School for advanced individual training (AIT). During AIT in-processing, soldiers (n=27,289 men and 3856 women) completed a questionnaire that collected demographic and lifestyle information, and asked if the soldier currently had an injury that would affect their AIT performance. Potential risk factors for self-reported injury were explored using logistic regression. For men, self-reported injury was associated with older age [odds ratio (OR) >or=30 years/17-19 years=1.9], race (OR Black/Caucasian=1.2), basic combat training (BCT) site (OR Fort Benning/Fort Jackson=1.7; OR Fort Leonard Wood/Fort Jackson=1.6, OR Fort Knox/Fort Jackson=1.3), smoking on 20 or more days in the 30 days prior to BCT (OR smoker/non-smoker=1.2) and current illness (OR ill/not ill=6.2). For women, increased self-reported injury was associated with older age (OR>or=30 years/17-19 years=2.0), BCT site (OR Fort Leonard Wood/Fort Jackson=1.5) and current illness (OR ill/not ill=5.8). Certain demographic characteristics and lifestyle behaviours may be identified as injury risk factors on arrival at Ordnance AIT.

Risk Factors For Time-loss Injuries In The United States Army Ordnance School Advanced Individual Training

Risk Factors For Time-loss Injuries In The United States Army Ordnance School Advanced Individual Training

Fear of failure: Implications for military health care specialist student training

During scholastic or physical performance testing, individuals who fear failure tend to focus on their fears instead of the task and often perform poorly. This study examined the relationship between fear-of-failure (FoF) and performance among 200~students (male=140, female =60) attending Health Care Specialist Advanced Individual Training (AIT) at Ft. Sam Houston. Performance measures included grade point average, pass/fail status, Army Physical Fitness Test scores, and number of musculoskeletal injuries. Pearson Product Moment Correlations revealed that Soldiers who scored higher on a FoF scale also had higher final grades (r=0.16, p=0.02, r<formula>;{2}</formula>=0.026). No significant correlations were found between FoF and other performance measures. While the variation in GPA accounted for by FoF was small (2.6%), this finding demonstrates a positive relationship that differs from previous studies. This finding may be explained by the concepts of failure avoidance and success orientation (self confidence and motivation), as well as the unique military setting. Suggestions for designing military educational interventions during AIT and throughout one's military career are offered.

Self-reported health status of students in-processing into military medical advanced individual training

It is important to be aware of the health and injury status of students in military training settings in order to adequately plan for their progression through required physical training and provision of health care to meet their needs. This paper describes the self-reported health status of students arriving in two medical training Battalions at Ft. Sam Houston. The results revealed that 43% of arriving soldiers had musculoskeletal symptoms and 35% had symptoms that interfered with their ability to accomplish the normal daily activities required as students. The most common sites of symptoms were knee (17 and 18%), foot/toe (16 and 13%), ankle (9 and 10%), and lower leg (9 and 12%) for the 232nd and 187th Medical Battalions respectively. Risk factors for those with musculoskeletal injury (MSI) symptoms that interfere with their abilities to do their jobs include gender, past history of injury, and self-reported stress and fitness levels. Other risk factors for medical specialties other than combat medic include being older (over 24 yrs of age), active duty status, being overweight, and use of smokeless tobacco. This information can help identify soldiers considered at risk of incurring a MSI during AIT. With this knowledge, physical training can be designed to help soldiers achieve fitness without additional injury and health care facilities can be designed to provide appropriate staffing of the health care professionals needed for evaluation and treatment.

Risk Factors Associated with Self-Reported Training-Related Injury at the U.S. Army Ordnance School

Soldiers who have completed Basic Combat Training (BCT) continue to Advanced Individual Training (AIT) where they learn their military occupational specialty. Previous studies have focused on injuries experienced during AIT. PURPOSE: This study examined risk factors for self-reported injury incurred before arrival for Ordnance School AIT training. METHODS: Upon arrival for AIT, Soldiers (n=27,289 men and 3,856 women) completed a questionnaire that asked if they had a training-related injury that would interfere with their AIT training. The questionnaire also collected demographic and lifestyle characteristics. Backward stepping logistic regression was performed to examine associations between injury and other factors on the questionnaire. Multivariate odds ratios (OR) and 95% confidence intervals (95%CI) were calculated. RESULTS: The prevalence of training injuries on arrival for AIT was 7.6% for men and 17.4 % for women. For men, analysis showed that higher risk of injury was independently associated with older age (OR (≥ 30years/17-19 years)=1.9, 95%CI=1.5-2.3), race (OR (Black/Caucasian)=1.2, 95%CI=1.1-1.4), BCT site (OR (Fort Benning/Fort Jackson)=1.7, 95%CI=1.4-2.1; OR (Fort Leonard Wood/Fort Jackson)=1.5, 95%CI=1.2-2.0), smoking within the last 30 days before BCT (OR(smoking/not smoking)=1.2, 95%CI=1.1-1.3), and a current self-reported illness (OR (ill/not ill)=6.4, 95%CI=5.2-7.9). For women, increased risk of injury was independently associated with older age (OR (≥ 30years/17-19 years)=2.2, 95%CI=1.5-3.2), basic training site (OR (Fort Leonard Wood/Fort Jackson)=1.5, 95%CI=1.1-2.0), and a current self-reported illness (OR(ill/not ill)=5.5, 95%CI=3.6-8.2). Factors not independently associated with injury included rank and smokeless tobacco use. CONCLUSION: Men were at higher injury risk if they were older, Black (relative to Caucasians), smoked within 30 days of attending BCT, attended BCT at Fort Leonard Wood or Fort Benning, or reported a current illness. Women were at higher injury risk if they were older, attended BCT at Fort Leonard Wood, or reported a current illness.

Significance of Cultural Beliefs in Presentation of Psychiatric Illness: A Case Report of Selective Mutism in a Man from Nepal

A 22-year-old active duty E1 Nepalese male who recently emigrated from Nepal suddenly exhibited strange behaviors and mutism during Advanced Individual Training. After receiving care from a hospital near his unit, he was transferred to Walter Reed Army Medical Center Inpatient Psychiatry for further evaluation and treatment. Although he was admitted with a diagnosis of psychosis not otherwise specified (NOS), after consideration of cultural factors and by ruling out concurrent thought disorder, a diagnosis of selective mutism was made. To our knowledge this is the first reported case of selective mutism in a soldier. This case serves as a reminder of the need for cultural awareness during psychological evaluation, diagnosis, and treatment of patients.

Revisiting an Old Question with a New Technology: Gender Differences on a Neuro-Cognitive Temporal Tracking Task

Gender differences exist, but the strength and importance of those differences is debatable. This study examined differences in performance among men (n = 64) and women (n = 56) on 14 neuro-cognitive temporal tasks. No adult norms exist for these tasks. Therefore, the goals were to 1) record and compare scores achieved by men and women, and 2) investigate differences in terms of performance (grade point average and physical fitness score) during Army Health Care Specialist Advanced Individual Training (AIT). Descriptive statistics and t-tests identified and compared scores by gender, while IM scores and performance relationships were explored with Pearson product-moment correlations and regression analysis. Men's temporal responses were closer to the reference beat than women's on 14.3% of tasks (p &lt; 0.05). There were no significant relationships between temporal responses and physical fitness performance scores and only two correlations between temporal responses and grade point average (right hand tapping, Task Average and Super Right On (percent within ±15ms of the target beat) ( r = 0.189, p = 0.04; and r = 0.20, p = 0.03). While this research upheld findings of differences between men and women in temporal abilities, the differences did not impact functional performance during AIT.

Rationale, design, and protocol for the prevention of low back pain in the military (POLM) trial (NCT00373009)

BackgroundThere are few effective strategies reported for the primary prevention of low back pain (LBP). Core stabilization exercises targeting the deep abdominal and trunk musculature and psychosocial education programs addressing patient beliefs and coping styles represent the current best evidence for secondary prevention of low back pain. However, these programs have not been widely tested to determine if they are effective at preventing the primary onset and/or severity of LBP. The purpose of this cluster randomized clinical trial is to determine if a combined core stabilization exercise and education program is effective in preventing the onset and/or severity of LBP. The effect of the combined program will be compared to three other standard programs.Methods/DesignConsecutive Soldiers participating in advanced individual training (AIT) will be screened for eligibility requirements and consented to study participation, as appropriate. Companies of Soldiers will be randomly assigned to receive the following standard prevention programs; a core stabilization exercise program (CSEP) alone, a CSEP with a psychosocial education (PSEP), a traditional exercise (TEP), or a TEP with a PSEP. Proximal outcome measures will be assessed at the conclusion of AIT (a 12 week training period) and include imaging of deep lumbar musculature using real-time ultrasound imaging and beliefs about LBP by self-report questionnaire. We are hypothesizing that Soldiers receiving the CSEP will have improved thickness of selected deep lumbar musculature (transversus abdominus, multifidi, and erector spinae muscles). We are also hypothesizing that Soldiers receiving the PSEP will have improved beliefs about the management of LBP. After AIT, Soldiers will be followed monthly to measure the distal outcomes of LBP occurrence and severity. This information will be collected during the subsequent 2 years following completion of AIT using a web-based data entry system. Soldiers will receive a monthly email that queries whether any LBP was experienced in the previous calendar month. Soldiers reporting LBP will enter episode-specific data related to pain intensity, pain-related disability, fear-avoidance beliefs, and pain catastrophizing. We are hypothesizing that Soldiers receiving the CSEP and PSEP will report the longest duration to first episode of LBP, the lowest frequency of LBP, and the lowest severity of LBP episodes. Statistical comparisons will be made between each of the randomly assigned prevention programs to test our hypotheses related to determining which of the 4 programs is most effective.DiscussionWe have presented the design and protocol for the POLM trial. Completion of this trial will provide important information on how to effectively train Soldiers for the prevention of LBP.Trial registrationNCT00373009

Depression in Entry-Level Military Personnel

The goal was to determine the prevalence of, and risk factors for, depression in an entry-level U.S. Army population. A cross-sectional survey of U.S. Army soldiers in advanced individual training was performed by using an anonymous self-report survey including demographic data, history (including abuse and psychiatric treatment), and the Patient Health Questionnaire-9. Soldiers in advanced individual training (n = 1,184) were approached, and 1,090 (91.2%; 955 male soldiers and 135 female soldiers) voluntarily chose to participate. Eleven percent reported a psychiatric history, 26% reported a history of abuse, and 15.9% endorsed moderate or more severe current depressive symptoms (male, 15.0%; female, 22.2%). A history of psychiatric treatment (odds ratio, 2.08; 95% confidence interval, 1.21-3.59; p = 0.009) and a history of verbal abuse (odds ratio, 4.11; 95% confidence interval, 2.45-6.90; p = 0.000) placed soldiers at higher risk for depression. Our study shows a higher than expected rate of depression in entry-level training soldiers and identifies some risk factors for depression. This indicates an important need for further study, effective screening, preventive counseling, and early intervention.