Junior Enlisted Research Articles

Variation in Time-to-Gender-Affirming Hormone Therapy in the US Active Duty Service Members.

Beginning in July 2016, transgender service members in the US military were allowed to receive gender-affirming medical care, if so desired. This study aimed to evaluate variation in time-to-hormone therapy initiation in active duty Service members after the receipt of a diagnosis indicative of gender dysphoria in the Military Health System. This retrospective cohort study included data from those enrolled in TRICARE Prime between July 2016 and December 2021 and extracted from the Military Health System Data Repository. A population-based sample of US Service members who had an encounter with a relevant International Classification of Diseases 9/10 diagnosis code. Time-to-gender-affirming hormone initiation after diagnosis receipt. A total of 2439 Service members were included (Mage 24y; 62% white, 16% Black; 12% Latine; 65% Junior Enlisted; 37% Army, 29% Navy, 25% Air Force, 7% Marine Corps; 46% first recorded administrative assigned gender marker female). Overall, 41% and 52% initiated gender-affirming hormone therapy within 1 and 3 years of diagnosis, respectively. In the generalized additive model, time-to-gender-affirming hormone initiation was longer for Service members with a first administrative assigned gender marker of male relative to female (P<0.001), and Asian and Pacific Islander (P=0.02) and Black (P=0.047) relative to white Service members. In time-varying interactions, junior enlisted members had longer time-to-initiation, relative to senior enlisted members and junior officers, until about 2-years postinitial diagnosis. The significant variation and documented inequities indicate that institutional data-driven policy modifications are needed to ensure timely access for those desiring care.

Racial Disparities in Highly Effective Contraceptive Use Among U.S. Active Duty Servicewomen, Fiscal Years 2016-2019.

Background: Previous studies have found that unintended pregnancy rates are higher among racial minorities and active duty servicewomen (ADSW), correlating with lower rates of effective contraceptive use. The Military Health System (MHS) provides universal health care benefit coverage for all ADSW, including access to all highly effective contraceptive (HEC) methods. This study investigated the association between race and HEC use among ADSW. Materials and Methods: We conducted a cross-sectional study using fiscal year 2016-2019 data from the MHS Data Repository for all ADSW ages 18-45 years. Statistical analyses included descriptive statistics and logistic regression models, adjusted and unadjusted, determining the odds of HEC use, overall and by method. Results: Of the 729,722 ADSW included in the study, 59.7% used at least one HEC during the study period. The highest proportions of users were aged 20-24 years, White, single, Junior Enlisted, and serving in the Army. Lower odds of HEC use were demonstrated in Black (odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.92-0.95), American Indian/Alaska Native (OR = 0.85, 95% CI = 0.82-0.89), Asian/Pacific Islander (OR = 0.81, 95% CI = 0.80-0.83), and Other (OR = 0.97, 95% CI = 0.94-0.99) ADSW compared with White ADSW. Conclusions: Universal coverage of this optional preventive service did not guarantee its use. The MHS can serve as a model for monitoring racial disparities in HEC use.

The Impact ofthe COVID-19 Pandemic onthe Military Health System's Care ofMilitary Sexual Assault.

Sexual assault remains a high priority challenge for leaders in the U.S. military. The COVID-19 pandemic further complicated the issue by disrupting work and lifestyles, potentially affecting reporting and care-seeking by victims. To date, there are no studies addressing the impact of changes in access to health services and reporting of sexual assault by active duty service members to inform medical and public health interventions in a post-COVID-19 era and during future public health emergencies. Using the Military Health System Data Repository (MDR), we identified a retrospective open cohort of active duty servicemembers receiving care in the Military Health System (MHS) from fiscal years 2018 to 2021. Through the use of ICD-10 diagnostic codes, all corresponding sexual assault care was identified for the cohort before (October 1, 2017-February 28, 2020; pre-pandemic period) and after (March 1, 2020-September 30, 2021; pandemic period) the institution of COVID-19 pandemic protective measures. Pre-pandemic and pandemic period rates of sexual assault associated encounters per 10,000 total health encounters were calculated by geographic location and compared using Wilcoxon's sign rank test. Multivariate log binomial regression models were performed to estimate associated risk of sexual assault among active duty servicemembers and compared across both periods. The study identified 47,067,073 encounters for servicemembers in the pre-pandemic period, of which 7,813 (0.016%) were associated with sexual assault. During the pandemic period, 4,377 (0.015%) of 28,926,480 encounters were associated with sexual assault, indicating a 44% reduction in total encounters and a 9% reduction in the proportion of encounters associated with sexual assault. Eighteen installations within the MHS had statistically significant increases in rates of encounters. Most sexual assault encounters occurred in the 20-24 year age, Female, White, Junior Enlisted, Army, and Unmarried categories. During both time-frames, younger age and being female were associated with an increased risk of sexual assault encounters. Race, service branch, and marital status were also associated with the risk of encounters. Contrary to reports indicating a modest increase in the number of sexual assaults reported within the DoD, we found a reduction in the frequency of healthcare encounters associated with sexual assault during the pandemic which may be related to reduced access to care. Men comprised approximately 22% of sexual assault encounters delivered through the MHS although the racial distribution of encounters approximates the estimates of the DoD-published demographic statistics. This study illustrates that COVID-19 measures appear to have reduced access to care for sexual assault within the MHS but did not demonstrably alter the demographics of servicemembers seeking care. These findings suggest that the MHS may require contingency plans for future disruptions to care and public health emergencies.

Opioid Prescription Clusters Associated With Early or Unplanned Military Separation.

Early/unplanned military separation in Active Component U.S. service members can result in reduced readiness during periods of high-tempo combat and increased demand for health care services within the Military Health System and Veterans Administration. Although current assessment tools leverage prescription data to determine deployment-limiting medication receipt and the need for interventions or waivers, there is a lack of understanding regarding opioid prescription patterns and subsequent early/unplanned military separation after return from deployment. As such, understanding these relationships could support future tool development and strategic resourcing. Therefore, the goal of the present study was to identify unique 12-month opioid prescription patterns and evaluate their relationship with early/unplanned military separation in Active Component service members who returned from deployment. This retrospective, IRB-approved cohort study included data from 137,654 Active Component Army service members who returned from deployment between 2007 and 2013, received a post-deployment (index) opioid prescription, and had at least 1 year of Active Component service post-opioid initiation. A k-means clustering analysis identified clusters using opioid prescription frequency, median dose, median days supply, and prescription breaks (≥30 days) over the 12-month post-initiation (monitoring) period. A generalized additive model examined whether cluster membership and additional covariates were associated with early/unplanned separation. In addition to the single opioid prescription (38%), the cluster analysis identified five clusters: brief/moderate dose (25%), recurrent breaks (16%), brief/high dose (11%), long/few prescriptions (8%), and high prescription frequency (2%). In the generalized additive model, the probability of early/unplanned military separation was higher for the high prescription frequency cluster (74%), followed by recurrent breaks (45%), long/few prescriptions (37%), brief/moderate dose (30%), and brief/high dose (29%) clusters, relative to the single prescription (21%) cluster. The probability of early/unplanned separation was significantly higher for service members with documented substance use disorders, mental health conditions, or traumatic brain injuries during the monitoring periods. Service members assigned male were more likely to have an early/unplanned separation relative to service members assigned female. Latinx service members and service members whose race was listed as Other were less likely to experience early/unplanned separation relative to white service members. Relative to Junior Officers, Junior Enlisted and Senior Enlisted service members were more likely to experience early/unplanned separation, but Senior Officers were less likely. Further evaluation to support the integration of longitudinal opioid prescription patterns into existing tools (e.g., a screening tool for deployment-limiting prescriptions) may enable more timely intervention and support service delivery to mitigate the probability and impact of early/unplanned separation.

Sources ofInformation Utilized by Active Duty Service Members forNutritional Supplement Safety andEfficacy.

The increasing prevalence of nutritional supplement use in the United States, combined with the risk of adverse effects from these largely unregulated products, poses a significant challenge to health care professionals. The purpose of our study is to evaluate the use of nutritional supplements in an active duty military population, particularly those supplements with increased adverse effect profiles, and the sources of information that service members use to make decisions regarding the safety and efficacy of supplements. The investigators distributed a voluntary, anonymous, self-report survey to a battalion of active duty service members to collect demographic data and information pertaining to the use of, adverse effects from, and sources of information utilized regarding the safety and efficacy of nutritional supplements. Statistical analysis utilized Fisher's exact test for categorical variables and Kruskal-Wallis test for numeric variables via SAS 9.4 (SAS Institute Inc., Cary, NC, USA). The Henry Ford Health System Institutional Review Board evaluated and approved the study. The battalion commander approved the study protocol before the distribution of the survey. Over 50% of respondents reported using high-risk nutritional supplements. Males were more likely to use high-risk supplements than females (54.3% vs. 28.1%; P = .0017). Non-Commissioned Officers were more likely to use high-risk supplements than Junior Enlisted soldiers (67.2% vs. 40.2%, P = .0037). Only 27% of respondents who used high-risk supplements utilized medical professionals as their source of knowledge regarding the safety and efficacy of supplements. Females were more likely than males to seek supplement information from medical professionals (28.1% vs. 10.6%; P = .0202). Company-Grade Officers were more likely to seek supplement information from medical professionals than Junior Enlisted soldiers (40.9% vs. 8.3%; P = .0018). There was no statistically significant difference found for the rate of high-risk supplement use and obtaining information from a medical professional (P = .6982). About 3% of respondents reported adverse or unintended effects of supplement use. The results of our study suggest that a minority of service members seek advice from medical professionals regarding nutritional supplements, women are more likely to do so than men, men may be more likely to use high-risk supplements than women, and Non-Commissioned Officers use high-risk supplements more often than Junior Enlisted. Limitations of this study include the voluntary self-report survey design, relatively small sample size, and single location. A larger, multicenter study would aid to alleviate these limitations in future studies. Numerous studies investigating nutritional supplement use and associated risks are present in the literature; however, the data comparing supplement use with sources of information regarding safety and efficacy are lacking.

Analysis of Telehealth Equity Within the Military Health System During the COVID-19 Pandemic.

Background: Telehealth care expanded during the COVID-19 pandemic, although previous studies show racial, gender, and socioeconomic inequalities in its usage. Racial disparities are known to be mitigated in the Military Health System (MHS), whose 9.6 million beneficiaries are universally insured and nationally representative. This study investigated whether known disparities in telehealth usage were mitigated in the MHS. Methods: This study performed a retrospective cross-sectional study of TRICARE telehealth claims data from January 2020 to December 2021. Beneficiaries aged 0 to 64 years were identified with Common Procedural Terminology code modifiers 95, GT, and GQ, which indicated procedures that were delivered through either synchronous or asynchronous telecommunication services. Visits were defined as one encounter per patient per day. Analyses included descriptive statistics of patient demographics, number of telehealth visits, and differences between military-provided and private sector care (PSC). Military rank was used as a proxy for socioeconomic status (SES), generally combining income, education, and occupation type. Results: A total of 917,922 beneficiaries received telehealth visits during the study period: 25% in direct care, 80% in PSC, and 4% in both care settings. The majority of visits were received by females (57%) and associated with a Senior Enlisted rank (66%). The visits by racial category were proportional to the percentage of each category in the population. The lowest number of visits was for those older than 60 years, potentially receiving Medicare instead, and those associated with Junior Enlisted rank, a potential disparity that may also reflect access to leave or smaller family size. Conclusions and Relevance: Within the MHS, telehealth visits were equitable by race, in line with previous findings, but not by gender, SES, or age. Findings by gender are reflected in the greater U.S. population. Further research is needed to assess and address potential disparities associated with Junior Enlisted rank as proxy for low SES.

Time-dependent suicide rates among Army soldiers returning from an Afghanistan/Iraq deployment, by military rank and component

BackgroundTo date, knowledge is limited regarding time-dependent suicide risk in the years following return from deployment and whether such rates vary by military rank (i.e., enlisted, officer) or component (i.e., active duty, National Guard, reserve). To address these gaps in knowledge, the objectives of this study were to determine and compare postdeployment suicide rates and trends (percent change over time), and hazard rates for Army soldiers, by rank and component (measured at the end of the deployment).MethodsLongitudinal cohort study of 860,930 Army soldiers returning from Afghanistan/Iraq deployment in fiscal years 2008–2014 from the Substance Use and Psychological Injury Combat study. Death by suicide was observed from the end of the first deployment in the study period through 2018 (i.e., the most recently available mortality data) for up to 11 years of follow-up. Analyses were conducted in 2021–2022.ResultsAdjusting for age, lowest-ranking Junior Enlisted (E1–E4) soldiers had a suicide rate 1.58 times higher than Senior Enlisted (E5–E9)/Warrant Officers (95% CI [1.24, 2.01]) and 2.41 times higher than Officers (95% CI [1.78, 3.29]). Suicide rates among lower-ranking enlisted soldiers remained elevated for 11 years postdeployment. Overall and annual postdeployment suicide rates did not differ significantly across components. Comparisons across rank and component for females were generally consistent with the full cohort results.ConclusionsLower-ranking enlisted soldiers had the highest rate of suicide, underscoring the importance of understanding rank as it relates to social determinants of health. For over a decade following Afghanistan/Iraq deployment, lower-enlisted rank during deployment was associated with an elevated rate of suicide; thereby suggesting that postdeployment prevention interventions targeting lower-ranking military members are warranted.

Women's Health Care in the Deployed Setting 2013-2020: A Health Services Research Approach.

With the management and oversight of MTFs moving under the authority of the Defense Health Agency, coupled with a careful examination of the composition of uniformed medical personnel, it is imperative to ensure that active duty servicewomen who are in deployed settings receive timely, appropriate, and quality health care. This study sought to examine the amount and types of gynecological and obstetric care provided in the deployed setting and to examine that data by the socioeconomic and demographic characteristics of the women receiving that care. Using the Military Health System's Theater Medical Data Store, we identified women aged 15 to 54 years old who received care at a theater-based MTF between 2013 and 2020. Within our study population, we subsequently identified obstetric and gynecologic (OBGYN) health services during the study period, and ran descriptive statistics on patient demographics (age group, race, rank, and U.S. military branch of service) and OBGYN health services. Patient age was assessed at the time of data extraction and race was categorized as Black, White, Other, and Unknown. The military branch of service was categorized as Army, Navy/Marines, Air Force, and Other. Rank was used as a proxy for socioeconomic status and categorized as Junior Enlisted, Senior Enlisted, Junior Officer, Senior Officer, Warrant Officer, and Other. Multivariable logistic regressions were also conducted and used to assess the odds of OBGYN health service utilization, with all patient demographics included as predictor variables. A total of 490,482 women were identified and received OBGYN health services at theater-based MTFs between 2013 and 2020. The majority of our population consisted of women aged 25 to 34 years (56.98%), associated with a Junior Enlisted rank (39.27%) and with the Navy/Marines (37.27%). Race was severely underreported, with 51.58% associated with an unknown race; however, 20.88% of our population were White women, 16.81% were Black women, and 10.72% of women identified their race as Other. The top five diagnoses for women seen in the deployed environment were for a contraceptive prescription (12.13%), followed by sexually transmitted infection (STI) screening (8.14%), breast disorder (7.89%), GYN exam (6.86%), and menstrual abnormalities (6.35%). Compared to White women, Black women had higher odds of seeking the contraceptive prescription (3.03 OR, 2.91-3.17 95% CI), obtaining STI screening (5.34 OR, 5.16-5.54 95% CI), being seen for a breast disorder (4.88 OR, 4.71-5.06 95% CI), GYN exam (3.21 OR, 3.10-3.32 95% CI), and menstrual abnormalities (3.71 OR, 3.58-3.85 95% CI). Almost consistently, senior officers were more likely to receive OBGYN services during deployment. Policymakers and health-care providers need to identify interventions to close this care gap, particularly in preventive OBGYN services (contraception, GYN exams, STI screenings). Fully implementing the Comprehensive Contraceptive Counseling and Access to the Full Range of Methods of Contraception policy and developing one standard Defense Health Affairs policy on pre-deployment evaluation standards and deployment follow-up care for women's health care may also assist in closing care gaps.

Prevalence of Polytrauma Clinical Triad Among Active Duty Service Members

The polytrauma clinical triad (PCT), encompassing traumatic brain injury, PTSD, and chronic pain, has been identified as a significant concern in the Military Health System (MHS). Conditions in this triad mutually reinforce one another and can pose a significant challenge to treatment for patients and providers. Polytrauma clinical triad has previously been studied in deployed veterans but remains understudied in the active duty military population. Therefore, this novel study seeks to determine the prevalence of PCT among active duty service members and to identify the subpopulations most at risk for PCT. This cross-section study used the MHS Data Repository in order to retrospectively review all administrative claim data for active duty service members within the Army, Navy, Air Force, and Marine Corps from fiscal years 2010 to 2015. Specific ICD-9 codes were extracted that correlated with traumatic brain injury, PTSD, and chronic pain to determine the risk of PCT. We used logistic regression to compare individuals presenting with the PCT conditions to those service members without any of the PCT diagnoses codes. The study identified 2,441,698 active duty service members eligible for inclusion. The prevalence of all three conditions of PCT was 5.99 per 1,000 patients. Patients with PCT were most likely to be 20-29 years old (52.15%), male (89.83%), White (59.07%), married (64.18%), Junior Enlisted (55.27%), and serving in the Army (74.71%). This study is the first to identify the risk of PCT in the active duty military population. Awareness of the risk and subsequent prompt identification of the triad will enable treatment through an integrated, team approach, which should alleviate potential patient suffering and improve the efficiency of care and readiness of service members.

Longitudinal Effect of United States Military Policy on Contraception Use and Childbirth Among Junior Enlisted [10OP

INTRODUCTION: Contraceptive use and unintentional pregnancy rates among junior enlisted vary between United States service-branches, despite equal access to no-cost contraception. Therefore, branch-specific policy may influence contraceptive use. METHODS: Secondary analysis of insurance records from 92,072 servicewomen, who attended basic training between 2013 and 2017, assessing the longitudinal effect of changes in branch-specific contraceptive policy on rates of: longer-acting (depot-medroxyprogesterone, implant, and intrauterine) contraception use at six months on active duty; and childbirth during the first 24-months of active duty. Multivariable Logistic (contraception use) and Cox (time to childbirth) Regression models were used to compare outcomes before and after the intervention, between the service making the intervention and the other three branches, and the interaction between these variables. IRB approved. RESULTS: Group contraceptive education emphasizing implantable and intrauterine methods followed by individual contraceptive consultation with a provider for all female, Navy basic trainees increased longer-acting method use (11.8% to 24.3%, Interaction Term OR: 2.14 (95% CI: 1.92-2.39), P<.001) and decreased childbirth rates (7.5% to 6.3%, HR: 0.86 (0.76-0.88), P=.015). Restricting time away from training for implant or intrauterine method insertion during Marine Corps basic training and providing education emphasizing use of depot-medroxyprogesterone for menstrual control decreased overall longer-acting method use (16.2% to 10.0%, OR: 0.43 (0.38-0.49), P<.001) and increased childbirth rates (8.0% to 9.7%, HR: 1.24 (1.02-1.51), P=.027). Allowing contraceptive implant placement during basic training increased use of longer-acting contraception among Air Force recruits 4.4% to 6.9%, OR: 1.31 (1.14-1.51), P<.001). CONCLUSION: Branch-specific changes in military contraceptive policy significantly impact contraceptive use and childbirth rates among junior enlisted.

Non-modifiable Risk Factors Associated with Sternoclavicular Joint Dislocations in the U.S. Military.

Sternoclavicular joint (SCJ) dislocations, although uncommon, are observed in patients with ligamentous laxity as well as those who experience traumatic injuries. The incidence and epidemiology of this costly and debilitating injury to our relatively young and active military population have not previously been reported. The purpose of this study is to consider and quantify the non-modifiable risk factors associated with this injury. Using Defense Medical Epidemiological Database, first-time occurrences, from 2006 to 2015 for the ICD-9-CM code 839.61 (closed dislocation of the SCJ), were obtained and further categorized by gender, race, age, rank, and branch of service. Race was classified based on self-reporting of patients into White, Black, or other categories. Age was divided into the categories of less than 20 yr, 20-24 yr, 25-29 yr, 30-34 yr, 35-39 yr, and greater than 40 yr. Rank was categorized as junior enlisted (E-1 to E-4), senior enlisted (E-5 to E-9), junior officer (O-1 to O-3), and senior officer (O-4 to O-10). Branch of service includes Army, Navy, Air Force, and Marines. Multivariate data analysis was performed to obtain rate per 1,000 person-years as well as adjusted rate (adjusted for age group, gender, race, rank, and service) to isolate risk factors. Between 2006 and 2015, 427 cases of closed SCJ dislocations occurred among an at-risk population of 13,772,342 person-years for an unadjusted incidence rate (IR) of 0.031 per 1,000 person-years. The annual unadjusted IR ranged from 0.017 in 2006 to 0.059 in 2014 with the greatest increase occurring between 2006 and 2007 representing 61% increase in the rate of injuries. Males were almost twice as likely to sustain these injuries compared with females (adjusted rate ratio 1.73; 95% confidence interval [CI] 1.23, 2.43). Age was not found to be a risk factor for the development of these injuries with IRs for each age group overlapping with 95% CI for all other age groups. Similarly, the other category for race was also not found to be a statistically significant risk factor. Junior Officers (adjusted rate 0.017; 95% CI 0.011, 0.025) were found least likely to suffer from these injuries with Junior Enlisted (0.034; 95% CI 0.030, 0.040) and Senior Enlisted (0.032; 95% CI 0.028, 0.037) most at risk. Being in the Navy (0.019; 95% CI 0.015, 0.025) was found to be most protective compared with Air Force (0.032; 95% CI 0.026, 0.039), Army (0.036; 95% CI 0.031, 0.041), and Marines (0.036; 95% CI 0.028, 0.045). Annual unadjusted IR of SCJ dislocations readily increased from 2006 to 2014. Statistically significant risk factors, for suffering a closed SCJ dislocation, identified by our study, were male sex, enlisted rank, and branch of service other than Navy. Age and race were not found to have a statistically significant risk. These results can shed light on non-modifiable risk factors for dislocations of the SCJ and can be used in other studies to aid in reducing injury burden on the U.S. Military.

Socioeconomic class and universal healthcare: Analysis of stroke cost and outcomes in US military healthcare

ObjectiveDo socioeconomic disparities exist in the US military healthcare system with ischemic stroke admissions? MethodsCivilian healthcare in the United States is paid for by a variety of payers. Significant disparities exist in this system based upon socioeconomic status (SES). In contrast, the military healthcare system (MHS) is a universal healthcare system. Military rank is a SES surrogate. Data was collected from the MHS database for years 2010 through 2015. All admissions to military health care facilities with a primary diagnosis of ischemic stroke were reviewed. Military rank was compared for primary outcomes of: Disposition (In-hospital mortality and discharge destination setting) and IV tPA administration and for secondary outcomes of: Total cost of hospitalization and Length of hospital stay (LoS). All adjusted for relevant demographics and co-morbidities. ResultsMilitary rank was identified with 1895 (52.3%) of the 3623 admissions. The ranks identified were: Junior Enlisted 100 (2.7%), Senior Enlisted/Warrant Officers 1390 (38.4%), Junior Officers 59 (1.6%) and Senior Officers 346 (9.6%). Statistically significant results included: Lower SES group/ranks were more likely to have poor discharge destination setting while the highest SES group/ranks and had lower rates of in-hospital mortality, shorter lengths of stay and higher hospitalization costs after controlling for relevant variables. ConclusionHigher military ranks (Higher SES) had shorter hospitalization stays, higher costs and less in-hospital mortality in the military's universal healthcare system. This suggests aggregate characteristics of SES plays a large role in the outcomes among SES groups.

Abstract TMP79: Does Race or Socioeconomic Class Matter in Socialized Medicine? A Retrospective Analysis of Stroke cost and outcomes in US Military Health Care System

Introduction: The racial disparity of stroke outcomes is well documented in the US Civilian Healthcare system. In contrast, the Military Healthcare system is a single payer system (Every member has the same health benefits). Does this affect outcomes? Hypothesis: We hypothesize there will be no difference in Healthcare outcomes within the Military Healthcare system when the effects of race and rank (socioeconomic surrogate) are considered. Methods: Data was collected from the Defense Health Agency Military Mart (M2) database from fiscal year 2010 to 2016 (All admissions to military care facilities). The M2 database stores data including rank and race. Adult patients with a primary diagnosis of stroke at discharge (International Classification of Diseases, 9th Revision codes 434.91, 434.11 or 10 th Revision code I63.9) were reviewed. Race and Rank were compared for Duration of hospitalization, total Cost of the hospitalization and Outcome (disposition status) using Multivariate Analysis. Results: A total of 3,910 patients discharged from Military hospitals were identified. The racial composition of this sample was: White 50.1%, Black 17.3%, Asian 7.2%, Other 2.9%, and Unknown/Not Reported 22.5%. There was no correlation between race and Duration of hospitalization, total Cost of the hospitalization or Outcome. Military Rank was identified with 2,134 (54.6%) of the 3,910 patients in the study. The Rank identified study population was: Senior Enlisted 71.4%, Senior Officers 18.2%, Junior Enlisted 4.9%, Junior Officers 2.9% and Warrant Officers 2.5%. There was no correlation between Rank and Duration of hospitalization or total Cost of the hospitalization. There was a statistically significant trend to better Outcome for higher rank then lower (p&lt;0.05). Conclusions: Racial disparities evident in the Civilian Healthcare system do not appear to transfer to the Military Healthcare system. Rank (as a socioeconomic surrogate) did have a trend toward better Outcomes with higher rank.

Combat-related gunshot wounds in the United States military: 2000–2009 (cohort study)

IntroductionThe armed forces of the United States are engaged in the longest conflict in their history. No prior works have described the incidence or epidemiology of gunshot wounds in the U.S. military. MethodsAll combat-related gunshot wounds sustained by uniformed servicemembers in the years 2000–2009 were identified using the Defense Medical Epidemiology Database. Demographic information for all individuals identified as having sustained gunshot injuries was obtained and like data was captured for the entire military population serving in the same time-period. Raw unadjusted incidence rates were calculated for gunshot wounds within the entire demographic, as well as for the subcategories of sex, military rank, branch of service, and age. Adjusted incidence rate ratios were also calculated via multivariate Poisson regression analysis, using subcategories with the lowest unadjusted incidence rates as referents. ResultsWe identified 4693 gunshot wounds within a population of 13,813,333 person-years for an overall incidence of 0.34 per 1000 person-years. Marine Corps service demonstrated the highest unadjusted incidence rate at 0.68 per 1000 person-years. Male sex, Junior Enlisted rank, Army and Marine Corps service, and ages 20-29 demonstrated significant adjusted incidence rate ratios and maintained unadjusted incidence rates above the population mean. ConclusionsMale sex, Junior Enlisted rank, Army and Marine Corps service, and ages 20–29 were identified as significant independent risk factors for war-related gunshot injuries. This investigation is the first to report on the incidence and epidemiology of gunshot wounds and includes the largest cohort of individuals to sustain such injuries in the literature.

Factors Which Influence Tobacco Use among Junior Enlisted Personnel in the United States Army and Air Force: A Formative Research Study

Despite the implementation of a host of tobacco control initiatives, tobacco use among active duty members of the U.S. Military remains high. It has been suggested that a positive culture of tobacco, which drives consumption, exists in the military. However, little is know about factors that impact tobacco use among military personnel. This study provides the first formative data on the culture of tobacco in the U.S. Military. A total of 15 focus groups on six military installations were conducted (n = 189). These military installations were located throughout the continental United States and were of average size for each service. Participants suggested that the primary method the military uses to discourage use is tobacco bans. Unfortunately, they also believed that the military accommodates tobacco use so that smoking remains convenient despite the bans on tobacco use. Smoking was believed to be encouraged through liberal smoking breaks, social interaction within designated smoking areas, and cheap and convenient tobacco products sold on military installations. Additionally, smoking was seen as an effective method to combat the stress and boredom of military life and to avoid weight gain. Suggestions for addressing the culture of tobacco are suggested.

Stress in Junior Enlisted Air Force Women With and Without Children

The objective was to determine if there are differences between young enlisted military women with and without preschool children on role strain, stress, health, and military career aspiration and to identify the best predictors of these variables. The study used a cross-sectional descriptive design of 50 junior Air Force women with preschool children and 50 women without children. There were no differences between women with and without children in role strain, stress, health, and military career aspiration. In all women, higher stress was moderately predictive of higher role strain (39.9% of variance explained) but a poor predictor of career aspiration (3.8% of variance explained). Lower mental health scores were predicted by high stress symptoms (27.9% of variance explained), low military career aspiration (4.1% of variance explained), high role strain (4.0% of variance explained), and being non-White (3.9% of variance explained). Aspiration for a military career was predicted by high perceived availability of military resources (16.8% of variance explained), low family of origin socioeconomic status (4.5% of variance explained), and better mental health status (3.3% of variance explained). Contrary to theoretical expectations, in this sample, motherhood was not a significant variable. Increased role strain, stress, and decreased health as well as decreased military career aspiration were evident in both groups and may have more to do with individual coping skills and other unmeasured resources. More research is needed to determine what nursing interventions are needed to best support both groups of women.

Exploring Factors that Influence the Food Behaviors of Junior Enlisted Army Family Members

ABSTRACT With the stress of an ongoing war and soldiers being deployed, the needs of US military families have likely increased. Young military families, generally E-4s (Specialists) and below, may suffer even more stress due to lack of experience and life skills. Many families have seen financial difficulties arise as a result of the soldier being deployed. The nutrition and health status of these families may be at risk because of some of the dietary behaviors associated with limited financial resource audiences. Thus, the purpose of this study was to explore factors that influenced the food behaviors of junior enlisted (E-4s and below) Army families.

The Health Readiness of Junior Enlisted Military Women: The Social Determinants of Health Model and Research Questions

Currently, women comprise 17% of the 1.4 million U.S. active military and 20% of the 1.2 million reserve force. Well over three-quarters of these women are enlisted (82%). Enlisted women are young, between the ages of 17 and 29, and one-half are ethnic minorities. Enlisted women are a growing minority within the predominantly male hierarchical military organization. The most junior of these women, in addition to being vastly outnumbered by men, fall along with junior enlisted men at the bottom of the military organizational structure. This unique position may have health consequences. The purpose of this article is to propose research questions within the context of the Marmot and Wilkinson's social determinants of health model. Proposed research questions are provided to address the current gaps in the science related to the contextual health readiness issues of junior enlisted military women.

Prevalence and Correlates of Interpersonal Violence Victimization in a Junior Enlisted Navy Cohort

This study assesses the prevalence and correlates of interpersonal violence victimization in a cohort of 493 male and 220 female junior Navy personnel who participated in a cross-sectional follow-up study on health-related behaviors. Survey data were obtained during 2000 about past-year prevalence of physical violence and sexual victimization. Chi-square tests of independence and multivariable logistic regression analyses were employed to estimate prevalence rates and to assess correlates of interpersonal violence. No gender differences were found for rates of violence victimization (16.4%) or sexual victimization (4.5%). Significant correlates of interpersonal violence victimization among males were depression and tobacco use; among females, significant correlates were depression and frequent heavy drinking. Findings suggest that large numbers of young enlisted adults serving in the military may be victims of interpersonal violence.

Prevalence and Correlates of Interpersonal Violence Victimization in a Junior Enlisted Navy Cohort

Prevalence and Correlates of Interpersonal Violence Victimization in a Junior Enlisted Navy Cohort