Active Duty Air Force Members Research Articles

Comment on "Self-Perception of Risk for HIV Acquisition and Calculated Risk for HIV Acquisition Among Active Duty Air Force Members With Newly Diagnosed HIV Infection".

Comment on "Self-Perception of Risk for HIV Acquisition and Calculated Risk for HIV Acquisition Among Active Duty Air Force Members With Newly Diagnosed HIV Infection".

Self-Perception of Risk for HIV Acquisition and Calculated Risk for HIV Acquisition Among Active Duty Air Force Members With Newly Diagnosed HIV Infection.

There have been nearly 1,600 new diagnoses of Human Immunodeficiency Virus (HIV) across the US Armed Forces between 2017 and 2022. While treatment has improved overall survival, self-perception of acquiring HIV may not align with actual risk of acquiring HIV, thus slowing diagnosis and treatment. We aim to evaluate self-perceived risk (SPR) versus calculated risk (CR) of HIV infection in US Air Force (USAF) members with incident HIV diagnosis. All USAF members with new HIV diagnosis evaluated at a specialty care military medical center between January 2015 and March 2020 with case report forms were included (n = 142). SPR was compared to CR using the Denver HIV Risk Score (DHRS). The study was approved by the Army Public Health Center's Public Health Review Board (#14-311) and the Walter Reed Army Institute of Research Human Subjects Protection Branch (#1861E). Patients were predominantly male (98%), with a median age of 26 (IQR 22-30) years, and the majority (85%) reported same-sex partners. Most patients reported a low SPR (n = 78; 55%). A higher proportion of low SPR patients were married or partnered than high SPR patients (29% versus 14%; P = 0.04). Both groups had median DHRS scores in the highest risk category with similar results by reason for HIV screening. The majority of USAF members with incident HIV infection reported a low SPR despite risk factors and CRs identical to high SPR patients. In order to inform HIV prevention strategies in the military, further efforts are needed to educate the military population and providers about HIV risk perception.

"Always on parade": Pregnancy experience of active-duty air force members.

Findings are reported from a qualitative study that sought to understand the maternity experience of active-duty women in the context of improved and expanded pregnancy accommodations. Semistructured interviews were conducted with 30 active-duty women serving in the United States Air Force (15 enlisted and 15 commissioned members). Women described experiencing negative pregnancy-related stereotypes and stigma in the workplace. Connotations unique to military culture were unavoidable changes to uniform and physical body shape, cultural expectations of fitness, and uniformity of dress/appearance. Use of necessary pregnancy accommodations led to increased exposure to stereotypes and stigma, such as being perceived as less disciplined, lazy, weak, or receiving unfair advantages/fewer duties at work. Women relied on "covering behaviors" to separate themselves from negative stereotypes. Extreme covering behaviors put pregnant women's health and well-being at risk. Finally, women navigated a shift in priorities from an indoctrinated "service before self" perspective to a prioritization of personal health and well-being during pregnancy. Leadership skills were strengthened through this change in perspective, which were perceived as positively influencing unit morale, cohesion, productivity, and retention. Study findings suggest the military will experience limited success in fully integrating and retaining active-duty women due to an organizational climate that lags behind the recent, progressive improvements in pregnancy policies and accommodations. Organizational culture related to pregnancy within the military must be targeted for change to reduce negative stigma and pregnancy-related bias. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Theory of Planned Behavior and Active Duty Air Force Members' Mental Health Help-Seeking.

Although military members often encounter significant atypical stressors while serving, many service members are still reluctant to seek mental health (MH) treatment. Help-seeking behavior for MH needs is a rising concern for active duty Air Force personnel. Conditions such as post-traumatic stress disorder, depression, anxiety, and substance abuse are just a few issues that military members deal with, but things like stigma, attitudes toward MH, and behavioral control might keep these individuals from seeking services. This study utilizes the theory of planned behavior (TPB) to identify better and understand barriers to the help-seeking behavior of active duty Air Force members. The 2017 Air Force Community Feedback Tool was used for this study. This confidential survey was completed by a large sample of the military population (N = 10,705). The survey was used to examine relationships between the TPB-related variables and respondents with mood problems identifying a need for professional counseling, seeking MH services, and reporting that the services met their needs. Multiple linear and binary logistic regression models were utilized to analyze findings from this sample. This study highlights how attitudes, subjective norms, and perceived behavioral control impact help-seeking behavior for these individuals. Findings include the MH providers' good reputations, wait times for services, ease of access to care, and negative experiences with supervisor permission, all of which showed a statistically significant impact on help-seeking behavior. Dependent variables included "I need professional counseling," "I contacted a MH care provider in the past year to try to meet this need," and "How much the MH care provider helped you meet your needs." Each of these variables had statistically significant relationships with the connecting variables of the TPB. Findings from this study reveal how attitudes, subjective norms, and perceived behavioral control play an essential role in an active duty Air Force member's decision to seek help for MH concerns. This study suggests that active duty military members are less concerned about the belief that seeking MH care could harm their reputations and more aware of the potential negative reputations of MH clinics. Finally, actionable steps are outlined to better support help-seeking behavior, which might be recommended to better train and encourage military leaders to address the MH needs of themselves and the members of their units.

Predictors of Crosscutting Patterns of Psychological Health and Family Maltreatment.

Psychological problems and family maltreatment are significant public health problems. Although research focuses almost exclusively on either individual psychological problems or family maltreatment, there is substantial co-occurrence of these problems. Similarly, intervention services are often "siloed": individuals with mental health needs are referred for mental health services, individuals with family conflict are referred for family-based treatment, etc. These treatment "silos" may miss the larger picture of the co-occurrence of risk, promotion, and the problems themselves. In a previous paper, we used latent class analysis to identify subgroups of individuals with crosscutting patterns (i.e., classes) of psychological and family maltreatment problems. In this study, we explored the predictors of these latent classes. Participants consisted of two large population samples of U.S. Air Force active duty members (ns = 27,895 and 30,841) who were married or cohabiting and had one or more children living in their household. Participants completed an anonymous community assessment survey, which included questionnaire items tapping personal, family, and community problems and well-being. Assessments were conducted in 2008 and 2011. All study procedures were approved by the authors' Institutional Review Board. We used exploratory factor analysis and latent class analysis to (1) identify higher-order factors of risk and promotive variables and (2) examine them as predictors of our previously identified latent classes. Findings indicated that individuals who reported better physical well-being as well as personal and family coping, relationship satisfaction, and support were more likely to be in the lowest-risk subgroup. Notably, individuals in the subgroup most at risk for serious violence and suicide, evidencing disinhibitory psychopathology, endorsed lower risk and higher promotive factors than those individuals in other high-risk subgroups who fell along the internalizing/externalizing continuum. These findings reinforce the need for integrated prevention and treatment of psychological and family maltreatment problems. Not only do these problems often co-occur, but their risk and promotive factors also tend to be intertwined. The unique (i.e., not on the continuum of the other five classes) problem profile of participants evidencing disinhibitory psychopathology is matched by a unique risk/promotive factor profile, and they will thus likely require a unique intervention approach.

Associations between Family Maltreatment Perpetration and Latent Profiles of Personal and Family Strengths among Active-Duty Air Force Members

Associations between Family Maltreatment Perpetration and Latent Profiles of Personal and Family Strengths among Active-Duty Air Force Members

54. Self-Perception of Risk for HIV Acquisition and Calculated Risk for HIV Acquisition Among Active Duty Air Force Members with Newly Diagnosed HIV Infection

BackgroundPersons may underestimate their risk of HIV infection despite presence of risk factors. Accurate appraisal of HIV risk may assist both patients and providers in preventing HIV acquisition. We evaluated self-perceived risk (SPR) versus calculated risk (CR) of HIV infection in active duty US Air Force (USAF) members with incident HIV infection.MethodsUSAF members with new HIV diagnosis evaluated at a specialty care military medical center between January 2015-March 2020 with available case report forms were included (n=142). Chart reviews were performed and demographic, social, and clinical characteristics were collected from initial Infectious Disease specialty encounters and case report forms. SPR was characterized as Low or High and compared to CR derived by the Denver HIV Risk Score (DHRS) by points based on patient demographic and risk exposure characteristics.ResultsOverall, patients were predominantly male (98%), with a median age of 26 years (IQR 22-30), and the majority (85%) reported same-sex partners (Table 1). Patients more commonly characterized themselves as Low SPR (n=78; 55%) than High SPR (n=64; 45%). Demographic characteristics were similar except a higher proportion of Low SPR patients (29%) were married or partnered compared to High SPR patients (14%; p=0.04). There was no difference in self-reported condom use (≥50% of the time) between Low (63%) and High (72%) SPR patients (p=0.28) and documented history of sexually transmitted infections was similarly high in both groups ( >70%; p=0.85). Previous HIV pre-exposure prophylaxis (PrEP) use was uncommon in both Low SPR (8%) and High SPR (6%) groups. For the evaluation of CR by DHRS (Table 2), both Low and High SPR groups had median scores in the very high risk category (≥50 points) with similar results by test component. ConclusionUSAF members with incident HIV infection more commonly identified with low SPR despite similar risk behaviors and CRs as high SPR patients. The development of patient education programs and promotion of HIV prevention services including PrEP are needed to reduce incident HIV cases in the USAF. Validated HIV risk calculators like the DHRS may also assist medical providers in identifying candidates for HIV prevention services.Disclosures All Authors: No reported disclosures

Associations between Family Maltreatment Perpetration and Latent Profiles of Personal and Family Strengths among Active-Duty Air Force Members

Although individual and family strengths have been found to impact family maltreatment risk, optimal approaches to their assessment are lacking. To substantiate the utility of holistically assessing multiple strengths among active-duty Air Force members (i.e., Airmen) who might be at risk of perpetrating family maltreatment, the current study aimed to identify latent patterns of personal and family strengths among Airmen and assess associations with family maltreatment perpetration. A representative a sample of 30,187 Airmen from the 2011 Air Force Community Assessment Survey was used to identify patterns across latent-factor scores representing unit leader support, informal support, family functioning, individual fitness, and personal resilience. Latent profile analysis was conducted to extract an optimal number of response patterns and estimate associations with family maltreatment perpetration. A five-profile solution was optimal, representing patterns marked by low (10%), below average (26%), mixed (16%), above average (36%), and high (12%) levels of personal and family strengths. Predicted probabilities of family maltreatment among families not identifying as stepfamilies were 39%, 21%, 14%, 10%, and 8% across low, below average, mixed, above average, and high patterns, respectively. Among stepfamilies (20% of sample), predicted probabilities were 49%, 29%, 21%, 15%, and 12%, respectively. Findings encourage a holistic assessment of personal and family strengths among Airmen. The Personal and Family Strengths Inventory, which was developed to gauge these strengths, can position practitioners well to engage Airmen in conversations around strengths and growth opportunities for the purposes of service planning aimed at preventing family maltreatment.

1542. Provider Uptake of Extragenital Screening for Gonorrhea and Chlamydia in Active Duty Air Force Members with Incident HIV Diagnosis

BackgroundThe prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is much higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. National guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), however uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection.MethodsAll USAF members newly diagnosed with HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016-2018 (n=98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C.ResultsPatients were predominantly male (97.9%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis (Table 1). A previous history of STIs was reported in 53 (54.1%) patients and the majority of males self-identified as MSM (66.3%) or bisexual (22.5%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62.2%) patients (Table 2). EG-STI screening was conducted in 3 (3.1%) patients overall and in (3.4%) MSM/bisexuals. A total of 31 (31.6%) patients had missed STIs; the majority due to EG-STIs of the rectum (71%) and pharynx (21.9%). All EG-STIs would have been missed by urethral GC/CT screening alone.Table 1 Table 2 ConclusionEG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored. Continued education and training of PCPs may be necessary to improve uptake of EG-STI screening.Disclosures All Authors: No reported disclosures

Risk for suicide attempts among United States Air Force active duty members with suicide ideation: An ecological perspective.

Differentiating suicide attempters from suicide ideators has been named a critical suicidology frontier (Klonsky & May, 2013). Per Bronfenbrenner's (1977, 1994) ecological systems theory, risk/protective factors from four ecological levels (individual, family, workplace, and community) were used to predict last year suicide attempt status among active duty service members expressing suicide ideation. Active duty U.S. Air Force members (N = 52,780, 79.3% male, 79.2% non-Hispanic White, M age = 31.8 years) anonymously completed an online community assessment administered biennially at 82 bases worldwide. Last year suicide ideation and attempts were concurrently measured, as were an array of co-occurring risk and protective factors. Among the 1,927 (approximately 4%) service members self-reporting suicidal ideation, 152 also reported a last year suicide attempt (7.9% of the ideators, 8.7% of men vs. 6.1% of women). However, in multivariate models, military member sex was not a significant moderator. In bivariate models, numerous individual, family/spouse/parent, and community factors were associated with suicide attempt status. In the final multivariate model for the whole sample, risk for a last year attempt was associated with years in the military, social support, and alcohol use problems, but not depression. Among active duty military in relationships, attempt status risk was associated with years in the military, social support, and intimate partner violence victimization. However, the effect sizes for these models were small. Beyond a focus on depression, addressing alcohol misuse, facilitating resilient and nonviolent couple/family relationships, and increasing social support may enhance suicide attempt prevention efforts among military members. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Patterns of psychological health problems and family maltreatment among United States Air Force members.

We sought to identify subgroups of individuals based on patterns of psychological health problems (PH; e.g., depressive symptoms, hazardous drinking) and family maltreatment (FM; e.g., child and partner abuse). We analyzed data from very large surveys of United States Air Force active duty members with romantic partners and children. Latent class analyses indicated six replicable patterns of PH problems and FM. Five of these classes, representing ∼98% of survey participants, were arrayed ordinally, with increasing risk of multiple PH problems and FM. A sixth group defied this ordinal pattern, with pronounced rates of FM and externalizing PH problems, but without correspondingly high rates/levels of internalizing PH problems. Ramifications of these results for intervention are discussed.

Informing efforts to prevent family maltreatment among airmen: A focus on personal resilience

ABSTRACTFamily maltreatment is a serious public health concern within civilian and military populations. The U.S. Air Force Family Advocacy Program (FAP) delivers services to active-duty Air Force members and their families that aim to promote personal resilience and prevent maltreatment perpetration among those most at risk. Informed by family resilience and ecological perspectives, the purpose of this study is to empirically test a theory of change or conceptual model that could serve as an evidence-informed foundation for the selection of prevention interventions used by military and FAP service providers. A representative sample of 30,541 active-duty Air Force members from the 2011 Air Force Community Assessment Survey was analyzed, comprising participants who had at least one child and who were in a committed relationship. Structural equation modeling was employed to test the hypothesized model. Neighborhood safety was analyzed as a moderating influence. With a focus on personal resilience as an asset-based outcome, results indicated that personal resilience among airmen was positively associated with features of individual fitness, informal support, adaptive family processes, and unit leader support. Results also indicated that neighborhood safety significantly moderated associations in the empirical model.

Family Violence, Suicidality, and Substance Abuse in Active Duty Military Families: An Ecological Perspective

ABSTRACTEffective community-based prevention requires an understanding of risk and protective factors in the population of interest. This article consolidates myriad risk and protective factor studies on family violence, alcohol abuse, and suicidality investigating various ecological levels (individual, family, workplace, and community) in random population samples of U.S. Air Force active-duty members. The reviewed program of research attempted to address gaps in the literature through two major improvements: (a) the use of a large, biennial epidemiological sample across the U.S. Air Force and (b) the application of a social ecological framework (Bronfenbrenner & Morris, 1998). Multivariate models (both within and across ecological levels) delineated which variables make unique contributions to each specified outcome. Variables contributing unique variance (a) within the family ecological level and (b) across all ecological levels are reported. This integrative review of this research program on behavioral health problems can help direct current and future prevention practices in the military and, given these studies' unusual examination of multiple ecological levels simultaneously, may inform and promote replication in civilian populations.

Precision Military Medicine: Conducting a multi-site clinical utility study of genomic and lifestyle risk factors in the United States Air Force

Following several years enrolling disease-specific and otherwise healthy cohorts into the Coriell Personalized Medicine Collaborative, a prospective study aimed at evaluating the clinical utility of personal genomic information for common complex disease and pharmacogenomics, the Coriell Personalized Medicine Collaborative expanded to create a military cohort, specifically, the United States Air Force. Initial recruitment focused on Air Force Medical Service personnel and later expanded to include all Active Duty Air Force members and beneficiaries. Now in its 6th year, the study has produced a wide variety of insights, including optimal study design for military-sponsored genomic research, and discussion on genetic information sharing between and amongst Air Force study participants, civilian and military researchers, and the United States Department of Defense. Over the longer term, analyses will further contribute to the development of policies and processes relevant to clinical decision support and data sharing within the US military, and on-going work with the Air Force Medical Service sub-cohort will generate critical insights into how best to deploy useful genomic information in clinical care. Here we discuss challenges faced and critical success factors for military-civilian collaborations around genomic research.

Prevention of family maltreatment in the U.S. Air Force: A systematic review of research on active-duty military personnel

ABSTRACTSystematic review procedures are used to empirically evaluate the “implicit” logic model that guides the Air Force Family Advocacy Program’s secondary prevention efforts of family maltreatment among active-duty Air Force members. Searches of seven electronic databases and manual searches of 10 journals yielded 586 peer-reviewed articles published in 2000 or later. This review synthesizes the findings of 23 quantitative studies meeting inclusion criteria, including the prediction of some form of family maltreatment among U.S. active-duty military members. Based on review results, we identify critical success variables that function as family protective factors to decrease the likelihood of family maltreatment. These modifiable variables include formal supports, such as ecosystem supports from installation and unit leaders; informal supports, such as the social support of fellow service members and their families; and safe, stable, and nurturing family processes. The results generally align with the implicit logic model but suggest the model should be extended to include intrapersonal vulnerabilities and assets as well as contextual risks and assets. In addition to informing secondary prevention efforts in the Air Force, this novel use of systematic review procedures offers a strategy for evaluating logic models in other areas of prevention research, practice, or policy.

The Impact of Environment and Occupation on the Health and Safety of Active Duty Air Force Members: Database Development and De-Identification.

Preparing data for medical research can be challenging, detail oriented, and time consuming. Transcription errors, missing or nonsensical data, and records not applicable to the study population may hamper progress and, if unaddressed, can lead to erroneous conclusions. In addition, study data may be housed in multiple disparate databases and complex formats. Merging methods may be incomplete to obtain temporally synchronized data elements. We created a comprehensive database to explore the general hypothesis that environmental and occupational factors influence health outcomes and risk-taking behavior among active duty Air Force personnel. Several databases containing demographics, medical records, health survey responses, and safety incident reports were cleaned, validated, and linked to form a comprehensive, relational database. The final step involved removing and transforming personally identifiable information to form a Health Insurance Portability and Accountability Act compliant limited database. Initial data consisted of over 62.8 million records containing 221 variables. When completed, approximately 23.9 million clean and valid records with 214 variables remained. With a clean, robust database, future analysis aims to identify high-risk career fields for targeted interventions or uncover potential protective factors in low-risk career fields.

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.

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.

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.