Female Service Members Research Articles

Impact Of Operational Stress On Motor Evoked Potentials In Military Personnel

Sleep restriction is a prevalent operational stressor that may degrade neurophysiological performance in military personnel. Transcranial magnetic stimulation (TMS) is an established non-invasive brain stimulation technique capable of assessing corticospinal excitability that is not extensively investigated in military populations. PURPOSE: To examine the influence of operational stress (i.e., sleep restriction) on corticospinal excitability in military personnel. METHODS: Thirty-one male and seven female service members (25.1±4.9yr) performed two series of stimulus response curves (SRCs) at 15% maximum voluntary muscle contraction for five consecutive days (D0-D4) using single-pulse TMS and a figure-of-eight coil. A familiarization day served as D0 with baseline testing on D1. Participants were allowed eight hours to sleep on D0, D1 and D4. On D2 and D3, participants had their sleep restricted for two 2-hour segments. For the SRC, stimulator outputs were randomly administered from 5-100% in 5% increments. Motor evoked potentials of the first dorsal interosseous muscle were quantified as the peak-to-peak electromyography amplitude of the 50ms post TMS stimulus. Corticospinal excitability was assessed by fitting MEP responses to a Boltzmann sigmoidal curve (BSC) via nonlinear regression and determining BSCMAX and BSCV50 (i.e., stimulator output at the mid-point between BSCMIN and BSCMAX). Repeated-measures one-way ANOVAs with Tukey post-hoc tests were used to compare BSC properties over time. RESULTS: ANOVAs revealed a main effect of time for both BSCMAX and BSCV50 (F(3.31, 122.40)=2.71, p=.04 and F(2.96, 109.50)=3.26, p=.02, respectively). No significant pairwise comparisons were detected for BSCV50. BSCMAX revealed to be significantly greater on D3 compared to D0 (5.21 vs 4.56 mV, p=.02) and D1 (5.21 vs 4.44 mV, p=.02) but similar to D2 and D4 (p>.05). CONCLUSION: Our findings suggest corticospinal excitability is a sensitive biomarker for subtle alterations during simulated operational stress. Furthermore, BSCMAX remained elevated on D4, suggesting one day is inadequate recovery time after operational stress. Supported by the Department of Defense W81XWH-16-PHTBIRP-CR3A.

Sex Differences In The Clinical Sequelae Of Exertional Heat Stroke In Military Servicemembers

Exertional heat stroke (EHS) represents a significant source of morbidity and mortality for the military and other occupational and athletic populations. EHS patients tend to present with elevated biomarkers of acute liver and kidney injury, rhabdomyolysis, and altered hematological parameters. However, little is know about how men and women may respond differently to EHS, in terms of clinical severity and/or biochemical responses. PURPOSE: The aim of this study was to characterize clinical and biochemical differences between male and female servicemembers immediately following an EHS episode. METHODS: We performed a retrospective analysis of EHS patient records in all US military personnel (41% between 20-24 years old) from 2008-2014 using the Military Health Systems Data Repository. We compared diagnoses of organ failure during the course of treatment and clinical laboratory markers of end organ damage. Sex differences in clinical outcomes are presented with odds ratios, and biomarker differences are presented as the median difference with 95% confidence intervals in brackets. RESULTS: A total of 2,529 EHS cases were recorded with 9.8% [8.7, 11.2] occuring in women. Per patient treatment cost was lower in women by $1110 [620, 1647]. Men were 2.35 [1.6, 3.58] times more likely to experience renal failure (p = < .001). Blood urea nitrogen, (difference = -121.05 mg/dL [41.9, 182.28]), myoglobin (difference = 3 ng/mL [2, 4]), aspartate transaminase (difference = 7 units/L [1, 14]), and alanine transaminase (difference = 13 units/L [8.5, 15.92]) were elevated in men (all p < .01). Platelet count was also lower in men compared to women (difference = -22.14*103 per uL [-39.25, -2.99], p = 0.03). CONCLUSION: Female servicemembers appear to have a slightly less severe response to EHS compared to their male counterparts. In particular, renal failure was more common, and numerous markers of end-organ damage (hepatic, renal, and cardiovascular) were more likely to be elevated immediately following EHS in men. Supported by USAMRDC; author views not official US Army or DoD policy.

From "Hooah" to "Om": Mindfulness Practices for a Military Population

Mindfulness practices, in general, have a growing body of evidence of effectiveness for improving both physical health and mental health. Further, these practices are showing promise when implemented with military populations for mental health issues such as PTSD. Challenges arise for practitioners in understanding the military's cultural differences and the functional aspects of mindfulness that may be specifically useful to military members. We outline strategies for referring military members to quality services and instruction, as well as best practices for connecting with military clients. Recommendations are made for further research with female service members and using single case design.

Alcohol misuse and separation from military service: A dyadic perspective

ObjectiveAlcohol misuse is a prevalent problem among military service members and their spouses. Service member alcohol misuse may contribute to poor job performance, legal infractions, and failure to meet physical standards. Spousal alcohol misuse may indicate problems with military life. However, limited information is available about how alcohol misuse in military families affects occupational outcomes, specifically military attrition. MethodThe current study examined 7,965 opposite sex married couples from the Millennium Cohort Family Study with one military and one civilian/veteran partner. Both partners reported on three measures of alcohol misuse (binge drinking, alcohol problems, and heavy weekly drinking). The associations between each partner’s measures of alcohol misuse and subsequent military separation were evaluated using logistic regression. Sex, concordance of alcohol misuse, mental health, and service branch were explored as moderators. ResultsIn fully adjusted models, service member alcohol problems were directly related to military separation. Additionally, service member heavy weekly drinking was strongly associated with military separation among female service members but not male service members. Service member and spouse binge drinking interacted such that when only one partner reported binge drinking military separation was less likely, but both partners’ binge drinking conveyed a marginally increased risk of military separation. ConclusionsPrevalence of alcohol misuse was high among military families. Service member alcohol misuse was more strongly related to military separation than spouse alcohol misuse. Additionally, heavy weekly drinking among female service members may be an indicator of a significant issue that merits interventions aimed at retaining these service members.

Trauma-informed exercise for women survivors of sexual violence.

Compared to their male counterparts, women experience alarmingly high rates of sexual violence (SV). Nearly 20% of women in the USA have been victims of SV, and prevalence of sexual assault among female service members is reported to be even higher, up to 50%. SV results in negative health outcomes like posttraumatic stress disorder, depression, obesity, poor body image, and pain-related disability. Exercise has been shown to positively impact both mental and physical health outcomes in populations experiencing posttraumatic symptoms, yet women survivors of SV are often excluded from exercise trials in trauma-affected populations. The purpose of this paper is to comment on the importance of incorporating women-specific trauma-informed principles in the content and delivery of exercise interventions in trauma-affected populations, particularly as it relates to SV. Researchers discuss the implications of female-specific and trauma-informed exercise considerations for SV survivors. This commentary highlights the need for trauma-informed implementation efforts and outcome measurements in exercise interventions involving women affected by SV. Researchers call for (a) increased qualitative work on trauma-specific implementation efforts across exercise intervention domains and (b) increased assessment of trauma-specific outcomes in exercise trials.

Clinical Use of the Automated Neuropsychological Assessment Metrics TBI-Mil Expanded Battery in Evaluating Concussion Recovery: A Retrospective Study

This retrospective study evaluated the use of the Automated Neuropsychological Assessment Metrics (ANAM4) Expanded battery in a clinical setting to determine if the resolution of physiological symptoms, in the absence of neurocognitive assessment, was sufficient data in the return-to-duty (RTD) determination. In this study, 508 U.S. Naval Academy midshipmen were diagnosed with concussion and prescribed a standard treatment protocol. As directed by the protocol, they were evaluated and tracked by medical providers until determined to have normal balance and to be asymptomatic at rest and with exertion. Upon the resolution of these physiological symptoms, the midshipmen were referred for neurocognitive (ANAM4) testing. When results indicated a return to neurocognitive baseline, a RTD determination was made. The analysis of data in this study indicated that RTD determinations based solely on the resolution of physiological symptoms would have resulted in 25.1% of the sample being returned to duty before neurocognitive recovery. Additional analysis of the ANAM4 reliable change index (RCI) data for each of the concussed patients revealed a pattern of scores that correlated with an expected length of recovery. Individuals with at least one RCI greater than or equal to -1.64 returned to neurocognitive baseline in 8.92 days, whereas individuals with 2 or more RCIs greater than or equal to -1.25 (but less than -1.64) returned to baseline in 5.78 days, and those with a difference in measured reaction times that were greater or equal to -1.25 returned to baseline in 3.20 days. Furthermore, findings indicated that female service members required additional time for the resolution of physical symptoms as compared to their male counterparts. The mean number of days from injury to being deemed symptoms free in males was approximately 14, as compared to females who were deemed symptom free in 21 days. This difference is statistically significant. Findings of this investigation revealed three specific outcomes. First, a computerized neurocognitive assessment instrument should be used as an adjunct measure in evaluating the resolution of physiological symptoms following a concussive injury. Second, results revealed that based on the RCIs of postinjury ANAM4 assessments, it is possible to estimate the remaining recovery time needed for a return to neurocognitive baseline. Third, results of this analysis revealed that gender appears to be a factor in time between concussive injury and resolution of symptoms.

Incidence Rates of Gynecologic Cancers in the U.S. Active Duty Military Population.

Despite an increasing number of female service members, incidence rates of gynecologic cancers (other than cervical cancer) have not been previously documented in the U.S. active duty military population. This study sought to determine the incidence rates of all gynecologic, including peritoneal, malignancies in the U.S. Active Duty population compared to the general US population as reported in the Surveillance, Epidemiology, and End Results Program database. Gynecologic cancers diagnosed in U.S. Active Duty women aged 20-59 between 2004 and 2013 were retrospectively ascertained. Cancer cases were identified in both the Automated Central Tumor Registry and the Military Health System Data Repository. All cases in Automated Central Tumor Registry plus cases recorded in Military Health System Data Repository, but not duplicative of Automated Central Tumor Registry cases, were included. Age-specific and age-adjusted incidence rates were calculated in military and Surveillance, Epidemiology, and End Results cases. In U.S. Active Duty women, 327 incident cases of gynecologic cancer were identified. There were 110 cases of cervical cancer, 40 cases of endometrial cancer, 152 cases of ovarian cancer, and 25 other gynecologic malignancies. Of the 327 cases, 154 were ascertained from the Automated Central Tumor Registry database and the remainder from Military Health System Data Repository claims data. The age-adjusted rate of all gynecologic cancers for U.S. Active Duty women was 49.17 per 105 (95%CI 37.58, 65.12), while the age-adjusted rate for Surveillance, Epidemiology, and End Results -18 was 42.09 per 105 (95%CI 41.83, 42.35). The kappa coefficient assessing the overlap between the data sources was -0.1937. Though insufficient in numbers for statistical analysis, the observed proportion of ovarian to cervical cancer cases in active duty women < 45years of age was substantially greater than in the general population. U.S. Active Duty women exhibited a similar age-adjusted rate of gynecologic cancer as the general US population. There was suboptimal overlap between the Automated Central Tumor Registry and Military Health System Data Repository databases, indicating the necessity of using both databases in order to obtain reliable data in the active duty population. This study is the current best estimate of a baseline rate of gynecologic cancer in U.S. active duty military women. This rate might change over time as women's roles and exposures in recent and future military conflicts evolve.

0242 Efficient Perception-Action Coupling Relates to More Slow Wave Sleep in Military Personnel

Abstract Introduction The ability to adapt actions to perceptions of environmental constraints, perception-action coupling, may be compromised by military operational stress (caloric restriction, sleep disruption, physical exertion). Differences in sleep may influence susceptibility to these stressors. We investigated perception-action coupling during simulated military operational stress and the influence of sleep on perception-action coupling. Methods During a 5-day simulated military operational stress protocol, thirty-six (6 female) service members (25.8 ± 4.7 years) completed three trials of a perception-action coupling task (PACT) in the evening after a night of baseline sleep (BASE), two nights of sleep restriction (T1) and a night of recovery sleep (T2). Participants had 8-hr for baseline and recovery sleep (2300-0700) and 4-hr disturbed sleep on sleep restriction nights (0100-0300 and 0500-0700). Polysomnography was used to determine time spent in different sleep stages: stage 2 (N2), slow wave (SWS) and rapid-eye movement (REM). The tablet-based PACT requires participants make quick, accurate perceptual judgments and responses about the ability of virtual balls to fit through virtual apertures. Linear mixed models were used to assess interaction and main effects of study day and prior sleep on PACT response time (RT) and accuracy (ACC). Results No significant sleep x time interactions or significant main effect of time were found for RT or ACC. A significant main effect of SWS was found for RT (F1,88.307 = 4.331, p = .04). Higher SWS was related to lower (faster) RT. No significant main effects of other sleep stages were found. Conclusion Perception-action coupling was maintained during simulated military operational stress. Participants with more SWS across the study responded faster during the PACT but N2 and REM sleep did not relate to perception-action coupling performance, suggesting a specific effect of SWS on perception-action coupling abilities and behaviors. Support Department of Defense Award #W81XWH-17-2-0070 (PI: Nindl)

Focusing on SELF (Safety, Empowerment, Living Life Differently, and Forging a New You): Evaluating a New Approach toward Sexual Trauma Treatment for Military Service Members

Sexual assault is a pervasive problem in the United States military. The U.S. Department of Defense established the Sexual Assault Prevention and Response Office as the centralized helm of all sexual assault efforts. Their focus however, is on prevention, surveillance, and the reporting of sexual assault. Safety, Empowerment, Living Life Differently and Forging a New You (SELF) was designed at a large military treatment facility as a supplemental treatment option for female active-duty service members who require additional clinical services in an outpatient setting. SELF’s goal is to facilitate change and instill hope in trauma survivors by providing psychoeducation and utilizing evidenced-based interventions that focus on the developmental, psychological, and social impact of trauma. A total of 19 female active-duty soldiers completed all eight sessions. Pre- and post-test data were available for 23 participants. Numerical variables were reported in medians and interquartile ranges. All categorical variables were reported in counts and frequencies. Paired pre- and post- Post-Traumatic Stress Disorder Checklist (PCL-5) differences were analyzed using the Wilcoxon Signed Rank and differences in initial PCL-5 score between attendance adherence groups were determined using the Kruskal Wallis test. Results show a mean decrease of 10 from baseline (p = .001). SELF may provide a supplement to current treatment modalities for survivors of sexual trauma.

Optimism and risk of incident hypertension: a target for primordial prevention.

Optimism is associated with reduced cardiovascular disease risk; however, few prospective studies have considered optimism in relation to hypertension risk specifically. We investigated whether optimism was associated with a lower risk of developing hypertension in U.S. service members, who are more likely to develop high blood pressure early in life. We also evaluated race/ethnicity, sex and age as potential effect modifiers of these associations. Participants were 103 486 hypertension-free U.S. Army active-duty soldiers (mean age 28.96 years, 61.76% White, 20.04% Black, 11.01% Hispanic, 4.09% Asian, and 3.10% others). We assessed optimism, sociodemographic characteristics, health conditions, health behaviours and depression status at baseline (2009-2010) via self-report and administrative records, and ascertained incident hypertension over follow-up (2010-2014) from electronic health records and health assessments. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and adjusted models for a broad range of relevant covariates. Over a mean follow-up of 3.51 years, 15 052 incident hypertension cases occurred. The highest v. lowest optimism levels were associated with a 22% reduced risk of developing hypertension, after adjusting for all covariates including baseline blood pressure (HR = 0.78; 95% CI = 0.74-0.83). The difference in hypertension risk between the highest v. lowest optimism was also maintained when we excluded soldiers with hypertension in the first two years of follow-up and, separately, when we excluded soldiers with prehypertension at baseline. A dose-response relationship was evident with higher optimism associated with a lower relative risk (p < 0.001). Higher optimism was consistently associated with a lower risk of developing hypertension across sex, age and most race/ethnicity categories. In a diverse cohort of initially healthy male and female service members particularly vulnerable to developing hypertension, higher optimism levels were associated with reduced hypertension risk independently of sociodemographic and health factors, a particularly notable finding given the young and healthy population. Results suggest optimism is a health asset and a potential target for public health interventions.

The Efficacy of Cognitive Processing Therapy for PTSD Related to Military Sexual Trauma in Veterans: A Review

ABSTRACTWomen currently comprise 12% of the total number of service personnel who have served in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. Presently, 15% of active duty personnel, 17% of National Guard personnel, and 20% of new recruits are female. The number of female veterans utilizing the Veterans Health Administration has more than doubled, from 159,000 to 337,000 from 2000–2011 and is expected to double again within the next decade. Similar overall numbers of female and male service members report experiencing military sexual trauma (MST). Prevalence rates vary by study where 20 to 68% of female service members and 1% to 6% of male service members have experienced MST. Many of these service members subsequently develop mental health issues and are diagnosed with conditions related to MST.Purpose: The purpose of this review was to summarize outcome studies examining Cognitive Processing Therapy (CPT) for the treatment of Post-traumatic Stress Disorder (PTSD) related to Military Sexual Trauma.Methods: The informational databases that were utilized for the current review were ERIC (EBSCO), ERIC (ProQuest), Google Scholar, and PsycINFO. The dates for literature inclusion was from 2010 to March of 2019. The literature search was initiated in March and was terminated in April of 2019.Results: The results indicated that CPT is an effective intervention for the reduction of MST related PTSD symptoms, including negative cognitions, compared to Present-Centered Therapy (PCT). Additionally, at 6-month post-treatment follow-up symptom reduction was stable. Results were mixed for CPT associated with quality of life and exposure to child Sexual abuse (CSA). Veterans who self-identified as African-American and Caucasian female veterans experienced significant reductions in PTSD symptomology with no differences between groups.Discussion: All studies included in the review resulted in significant reductions in PTSD but four of five also suffered from treatment fidelity in the CPT treatment condition. Researchers chose to exclude participant data from the therapists who did not adhere to CPT protocol resulting in a reduction of statistical power in these studies. The final study included in the review administered multiple treatment modalities concurrently.

Gender Differences in Outcomes after Traumatic Brain Injury among Service Members and Veterans.

This scoping study describes the range of outcomes in traumatic brain injury (TBI) studies of military service members and veterans addressing gender differences. A secondary purpose is to identify differences in outcomes between male and female participants in such studies. We searched PubMed, CiNAHL, and PsycInfo databases for relevant articles. Two reviewers independently screened results. Of 822 unique titles and abstracts screened for eligibility, 55 full articles were reviewed, with 29 studies meeting full inclusion criteria. Twenty of the 29 included studies used retrospective designs and all but two used data collected from Veterans Affairs or Department of Defense health care settings. TBI was diagnosed by self-report, screening, and evaluation procedures, and medical record documentation. Ten different outcome categories were identified among the included studies. In general, female service members and veterans have not been well represented in TBI outcomes research. Evidence suggests that female veterans with mild TBI (mTBI) report more neurobehavioral symptoms and use more outpatient services than male veterans. Studies also indicate that female veterans with TBI are more frequently diagnosed with depression. Additional research is essential to support precision treatment recommendations for female veterans with TBI, as women represent a growing proportion of the patients served by the Veterans Health Administration. LEVEL OF EVIDENCE: IV.

Contraception and Unintended Pregnancy in the Military Healthcare System

The number of women serving in the Armed Forces is growing and readiness has been decreed as the number 1 priority for the total Army. Provision of contraception and unintended pregnancy rates higher than the general population are two key factors in readiness of female soldiers. An in-depth review of women's healthcare in the military identified these two areas of women's health as greatly understudied. Long-acting reversible contraception provides effective and cost-efficient method for contraception and a proven way to decrease unintended pregnancy. Increased research and focus into these two areas of women's health is crucial to providing the best care for our female service members.

Conceptualizing comorbid PTSD and depression among treatment-seeking, active duty military service members

BackgroundAmong active duty service members and veterans with PTSD, depression is the most commonly diagnosed comorbid psychiatric condition. More research is warranted to investigate the relationship between PTSD and depression to improve treatment approaches. Byllesby et al. (2017) used confirmatory factor analyses in a sample of trauma-exposed combat veterans with PTSD and found that only the general distress factor, and not any specific symptom cluster of PTSD, predicted depression. This study seeks to replicate Byllesby et al. (2017) in a sample of treatment-seeking active duty soldiers. MethodsConfirmatory factor analyses, bifactor modeling, and structural equation modeling (SEM) were used with data gathered at pretreatment and posttreatment as part of a large randomized clinical trial. ResultsConfirmatory factor analyses and bifactor modeling demonstrated that PTSD symptom clusters, Negative Alterations in Cognition and Mood (NACM) and Alterations in Arousal and Reactivity (AAR), as well as the general distress factor significantly predicted depression at pretreatment and posttreatment. LimitationsThe current study was predominantly male, limiting the generalizability to female service members with PTSD. Also, self-report measures were used, which may introduce response-bias. ConclusionsThe current study did not replicate Byllesby et al. (2017). Results demonstrated that the relationship between PTSD and depression among active duty service members can be explained by both transdiagnostic factors and disorder-specific symptoms.

Ebola Response: A study of the Psychosocial Factors of Preparedness Among Commissioned Corps Officers of the United States Public Health Service.

The purpose of the cross-sectional study was to explore the relationships between occupational and general-self efficacy, and perceived preparedness among Commissioned Corps officers in the United States Public Health Service (Commissioned Corps). Commissioned Corps officers fight to protect the United States from diseases and care for the survivors of natural disasters and terrorist attacks. Commissioned Corps officers play a vital role in the fight to protect the United States from diseases and care for the survivors of natural disasters and terrorist attacks. The Commissioned Corps provided healthcare services in Liberia during the 2014 Ebola crisis that underscored the challenges of emerging diseases in a globalized community. It is imperative that these health professionals maintain a high level of self-efficacy and feel confident in their overall preparedness training as they respond to public health emergencies. This study used assessment instruments derived from Albert Bandura's concept of self-efficacy to analyze the occupational and general self-efficacy, and perceived preparedness levels of health services officers in the Commissioned Corps. 82 Commissioned Corps officers completed the assessment survey. To date, no study has examined the relationship between these constructs in this population. There was a statistically significant relationship between feeling confident in one's Commissioned Corps training and perceived preparedness (rs = 0.55, p < 0.001). This study reflects the training perceptions and self-beliefs of Commissioned Corps officers, fills an important gap in the empirical research in this population, and advances previous investigations, which suffered from an underrepresentation of female service members.

Analysis of Injuries and Prehospital Interventions Sustained by Females in the Iraq and Afghanistan Combat Zones

Background: Women served in both combat and non-combat units in the recent conflicts in Iraq and Afghanistan. Moreover, the recent conflicts lacked traditional separation of civilians from combatants carrying additional risk for injury to local civilians. There is a relative paucity of data specific to this topic. We compare injury patterns and interventions performed in the prehospital, combat setting among females versus males. Methods: This is a secondary analysis of previously published data from the Department of Defense Trauma Registry. We included all subjects that had at least one prehospital intervention documented. We compared variables between females and males. Results: From January 2007 to August 2016, our inclusion criteria captured 19,485 males and 533 females. Female casualties were older (median age 29 vs. 25), less likely to have sustained injuries from explosives (48.0% vs. 56.8%), and more severely injured as measured by median composite injury scores (10 vs. 9). Most subjects were in Afghanistan for both females and males (52.9% vs. 73.9%). Among United States (US) service members, findings were similar to the overall study population, except female service members had lower median composite injury scores than males (5 vs. 9). In unadjusted analyses, females were less likely to survive to hospital discharge (OR 0.68, 95% CI 0.48–0.97). There was no difference in survival (OR 0.73, 95% CI 0.50–1.07), when controlling for confounders. In both unadjusted and adjusted analyses specific to US forces, we were unable to detect any differences in survival or for select analgesic administration. In both unadjusted and adjusted analyses specific to host nation civilians, we were unable to detect any differences in survival; however, even when controlling for confounders females were less likely to receive ketamine and IV morphine (OR 0.31, 95% CI 0.15–0.63; 0.69, 95% CI 0.49–0.98, respectively). Conclusions: Females accounted for a small proportion of total casualties within our dataset. After controlling for confounders, survival was comparable between males and females, but host nation females were less likely to receive ketamine and intravenous morphine. Future studies should seek to elucidate the reasons for these subtle differences between males and females in prehospital combat casualty care.

This We’ll Defend: Expanding UCMJ Article 2 Subject Matter Jurisdiction as a Response to Nonconsensual Distribution of Illicit Photographs

In March 2017, it was revealed that current and former armed service members shared thousands of nude photos of their female counterparts over social media. Although some of these photos were taken with the women’s consent, almost none of them were distributed with the women’s consent. Victims have little legal recourse. Military law is silent on the matter of non-consensual distribution. Federal civilian law speaks only to interstate stalking, domestic violence, and harassment, while only thirty-four states have revenge porn laws that sufficiently criminalize nonconsensual distribution of illicit photographs. Further complicating matters, the perpetrator’s military status as active duty, reservist, or National Guardsman at the time of the crime determines which remaining punitive remedies are available to the victim, if any. Under the current legal framework, two recent developments in U.S. military policy risk opening female service members to additional exposure. First, in 2015, the Department of Defense opened all combat roles to women. Second, and concurrently, the Department began downscaling the military to a smaller, more flexible force increasingly supplemented by its reserve and National Guard (non-active-duty) forces. In light of these developments, the current state of the law poses an unacceptable risk that the growing number of female service members will be subjected to the dual horrors of seeing lewd photos of themselves plastered across the internet, and of seeing the perpetrator walk freely. This Note argues for expanding Article 2 subject matter jurisdiction of the Uniform Code of Military Justice to include all currently contracted members of the U.S. military—active duty, reservist, and guard—in order to bring peace of mind to those female service members willing to fight for peace abroad.

Gendered: A Qualitative Interpretive Meta-Synthesis of Female Service Members at War

This qualitative interpretive meta synthesis provides an understanding of the perspectives associated with the lived experience of women during deployment. A total of 11 studies using data collected from 198 female military personnel were included in this analysis. Qualitative analysis yielded 2 overarching themes: gender expectations and lack of support. The first theme, gender expectations, included two subthemes: female roles and responsibilities at home, and gender discrimination and harassment within the military. The second theme, lack of support, generated 2 subcategories related to support during deployment and postdeployment. Findings suggest a deployment experience is inextricably colored by characteristics such as gender, ethnicity, parental status, and other factors. Perception of threat for female service members often includes the threat of military sexual trauma, which is magnified by a lack of social support both during and after deployment.

The Gynecologic Health Consequences of Chlamydia trachomatis Infection in Military Servicewomen.

Chlamydia trachomatis is the most common sexually transmitted bacterial infection in the United States. Within the U.S. military, the age- and race-adjusted chlamydia infection rates among female service members are consistently higher than civilian rates, with a 20% annual acquisition rate among young active-duty women. The sequelae of chlamydia disproportionately impact women in terms of severity and cost. Untreated chlamydia progresses to pelvic inflammatory disease in 40% of cases, and is a leading cause of fallopian tube damage and pelvic adhesive disease resulting in ectopic pregnancy, tubal infertility, and acute and chronic pelvic pain. Tubal infertility is among the leading indications for in vitro fertilization (IVF) nationally and rates among couples undergoing IVF at military treatment centers are double the national average. Collectively, chlamydia infection represents a significant resource burden to the military health care system and, in view of the serious gynecologic health sequelae, a significant threat to the readiness of servicewomen. In this review, we discuss the gynecologic impact of chlamydia infection within the military, the critical gaps for research funding, and opportunities for intervention.

Alcohol use affects sleep duration among military couples

ABSTRACTAlcohol misuse and sleep disorders are highly comorbid, prevalent among service members and their romantic partners, and affected by relationship interdependence. As most military health research focuses on either service members or their spouses, the current study examined dyadic effects of alcohol use on sleep cycle duration in dating and married military couples (N = 149 dyads), using data from the National Longitudinal Study of Adolescent Health. Person-level results from a series of multilevel path models showed partial support for our focal hypothesis implicating high alcohol use in shortened average sleep duration for the service members and their romantic partners. Specifically, partners of service members who drank more regularly had shorter average sleep durations, as did female service members who drank more alcohol per drinking occasion. At the couple-level, a partner effect indicated that service members’ lower depressive symptoms were associated with their partner’s shorter average sleep durations. In addition, when service members reported relatively high alcohol-related problems, their partner tended to have a shorter average sleep duration. In contrast, when service members’ partners reported relatively high alcohol-related problems, they had a longer average sleep duration. This suggests the consequences of problematic alcohol use for service members’ partners depended on each dyad member’s drinking patterns. Taken together, these findings underscore the importance of viewing military couples as a dyadic unit in research studies and clinical interventions.