US Marine Corps Research Articles

Pre-enlistment hearing loss and hearing loss disability among US soldiers and marines

Hearing loss is a common condition among US adults, with some evidence of increasing prevalence in young adults. Noise-induced hearing loss attributable to employment is a significant source of preventable morbidity world-wide. The US military population is largely comprised of young adult males serving in a wide variety of occupations, many in high noise-level conditions, at least episodically. To identify accession and service-related risk factors for hearing-related disability, matched case-control study of US military personnel was conducted. Individuals evaluated for hearing loss disability in the US Army and Marine Corps were frequency matched to controls without history of disability evaluation on service and enlistment year. Conditional logistic regression was used to examine the association between accession and service-related factors and hearing-related disability evaluations between October 2002 and September 2010. Individuals with medically disqualifying audiograms or hearing loss diagnoses at application for military service were 8 and 4 times more likely, respectively, to have a disability evaluation related to hearing loss, after controlling for relevant accession, demographic, and service-related factors. Conservative hearing loss thresholds on pre-enlistment audiograms, stricter hearing loss medical waiver policies or qualified baseline audiograms pre-enlistment are needed in the U.S military. Industrial corporations or labor unions may also benefit from identifying individuals with moderate hearing loss at the time of employment to ensure use of personal protective equipment and engineer controls of noise.

Do Sleep Problems Mediate the Relationship between Traumatic Brain Injury and Development of Mental Health Symptoms after Deployment?

Military members screening positive for blast-related traumatic brain injury (TBI) may subsequently screen positive for posttraumatic stress disorder (PTSD) or depression. The role of sleep as a mediating factor in the development of mental health symptoms was explored. Prospective study with symptoms evaluated at two time points. Postdeployment service in Iraq, Afghanistan, or Kuwait during 2008 and 2009. There were 29,640 US Navy and Marine Corps men (29,019 who did not screen positive for PTSD at baseline, 27,702 who did not screen positive for depression at baseline, and 27,320 who did not screen positive at baseline for either condition). After controlling for sleep problems, the adjusted odds of receiving a positive PTSD screening at follow-up decreased from 1.61 (95% confidence interval [CI] 1.21-2.14) to 1.32 (95% CI 0.99-1.77) for a subject screening positive for TBI relative to a subject screening negative, suggesting that sleep problems mediated 26% of TBI's effect on development of PTSD. Likewise, after controlling for sleep problems, the adjusted odds of receiving a positive depression screening decreased from 1.41 (95% CI 1.11-1.80) to 1.15 (95% CI 0.90-1.47), suggesting that sleep problems mediated 41% of TBI's effect on development of depression. Results were similar for those with either PTSD or depression (37% mediated). These results suggest that sleep problems mediate the effect of a positive TBI screening on the development of mental health disorders, and sleep problems may be an early indicator of risk for PTSD or depression.

Prevalence and factors associated with asymptomatic gonococcal and chlamydial infection among US Navy and Marine Corps men infected with the HIV: a cohort study

ObjectivesNeisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) can facilitate transmission of HIV. Men who have sex with men (MSM) may harbour infections at genital and extragenital sites. Data regarding extragenital...

Purple in a Black and White World: Self-Determination Theory and Transgender Military Service

We offer a theoretical framework to advance our understanding of the psychology of transgender service members—the most understudied and mysterious class of US military personnel. Using grounded theory methods with interview data collected from clandestinely-serving active-duty, guard and reserve military members from the US Army, Navy, Air Force and Marine Corps who self-identified as transgender or transsexual, we reveal a latent structure of Self Determination Theory (Deci & Ryan, 1985; Deci & Ryan, 2000; Ryan & Deci, 2000). The variance in our data heavily centers around the concepts of autonomy, competence and relatedness, illustrating how post-DADT military personnel policy, which excludes open transgender service, impacts the mental well-being of transgender service members.

Adaptive Perceptual Training in a Virtual Environment

The United States military’s strategic position is evolving, and as a result, the Services are emphasizing the importance of sociocultural pattern recognition, sensemaking in ambiguous urban contexts, and understanding of patterns of life. In fact, military personnel at increasingly lower echelons are expected to possess these nuanced psychosocial perception and decision-making skills. To facilitate training of these complex competencies, the authors are developing a Virtual Observation Platform, an immersive virtual environment designed to adaptively train US Marine Corps personnel in sustained observation, sociocultural pattern recognition, anomaly detection, and other perceptual–cognitive skills. This paper briefly describes the purpose of the system and then covers its adaptive instructional tailoring in detail. The Platform’s adaptive features include information quality/quantity manipulation and instructional scaffolding in the form of communications from a virtual squad (i.e., peers) that are intrinsic to the narrative of the scenario.

Evaluating the effectiveness of the US Navy and Marine Corps Tobacco Policy: an assessment of secondhand smoke exposure in US Navy submariners

ObjectiveTo evaluate the effectiveness of the US Navy and Marine Corps tobacco policy in protecting submariners from secondhand smoke (SHS) by determining if non-tobacco users experienced a significant increase in...

Did the Panamanian Defense Forces conduct infiltration operations at the Arraijan Tank Farm in 1988?

This article reviews the circumstances surrounding a relatively obscure and almost forgotten US Marine Corps and Army security enhancement operation undertaken in Panama that commenced in early April of 1988. Marines were sent to Panama to protect oil and ammunition storage facilities from potential saboteurs. By April 1989 they had reported sighting armed, uniformed intruders on at least 43 occasions and receiving gunfire or discharging their own weapons during 16 incidents. Yet despite the repeated barrages of small arms fire over the course of a year, they failed to recover enemy ammunition, bodies or body parts and their own equipment and positions displayed no signs of suffering from hostile fire. This article analyzes the events from the point of view of a veteran of the operation and highlights the role that psychological operations may have played in generating the situation.

The Power of Gendered Stereotypes in the US Marine Corps

Gendered stereotypes in the US military context often result in the creation of barriers for women. Constant confrontation with these barriers may negatively impact a servicewoman’s career. The author argues that gendered stereotypes in the US Marine Corps (USMC) have the potential to undermine a female Marine’s performance, and sometimes the performance of others around her. Through the application of ethnographic content analysis to thirty-five in-depth interviews (seventeen female and eighteen male Marines), this article investigates the possible consequences of gendered stereotypes in the USMC. Four themes regarding the origination, socialization, and reinforcement of gender-role stereotypes in the USMC emerge through the interview process. Findings suggest gender-role stereotypes influence (1) the perceived abilities of female Marines, (2) the initial socialization of Marines, (3) camaraderie and opportunities for female Marine mentorship, and (4) a culture of double standards. The aforementioned themes are compared to findings in the literature and implications for camaraderie, shared sense of mission, and leadership are discussed.

Effect of Dwell Time on the Mental Health of US Military Personnel With Multiple Combat Tours

We investigated the association of the length of time spent at home between deployments, or dwell time, with posttraumatic stress disorder (PTSD) and other mental health disorders. We included US Marine Corps personnel identified from military deployment records who deployed to Operation Iraqi Freedom once (n = 49,328) or twice (n = 16,376). New-onset mental health diagnoses from military medical databases were included. We calculated the ratio of dwell-to-deployment time (DDR) as the length of time between deployments divided by the length of the first deployment. Marines with 2 deployments had higher rates of PTSD than did those with 1 deployment (2.1% versus 1.2%; P < .001). A DDR representing longer dwell times at home relative to first deployment length was associated with reduced odds of PTSD (odds ratio [OR] = 0.47; 95% confidence interval [CI] = 0.32, 0.70), PTSD with other mental health disorder (OR = 0.56; 95% CI = 0.33, 0.94), and other mental health disorders (OR = 0.62; 95% CI = 0.51, 0.75). Longer dwell times may reduce postdeployment risk of PTSD and other mental health disorders. Future research should focus on the role of dwell time in adverse health outcomes.

Predictors of short-term work-related disability among active duty US Navy personnel: a cohort study in patients with acute and subacute low back pain

Musculoskeletal disorders of the spine in the US military account for the single largest proportion of the absence of sickness causes leading to early termination. We explored if selected psychological and physical factors were associated with poor outcome after episodes of low back pain (LBP). To identify clinical, demographic, and psychological factors predictive of work duty status after a complaint of LBP. A prospective clinical cohort of US Navy personnel treated for LBP. Eligible cases were active duty US Navy or Marine Corps personnel presenting to an emergency clinic or primary care clinic with a complaint of LBP, where the index episode of LBP was no more than 12 weeks duration before enrollment. The subject's work status (full duty, light duty, sick in quarters [SIQ], limited duty, or medically released to full duty) was abstracted from the subject's electronic medical record at approximately 4 weeks and then again 12 weeks after study enrollment. Work status in this study population is assigned by a Navy health-care provider at the time of a clinical visit and based on the health-care provider's determination of medical fitness for duty. This study collapsed work status into two groups, "full duty" (consisting of "full duty" and "medically released to full duty") and "not at full duty" (consisting of "light duty," "SIQ," and "limited duty"). Volunteers completed a baseline questionnaire consisting of recommended well-validated measures, including attitudes and beliefs about LBP and work (Fear-Avoidance Beliefs Questionnaire [FABQ] and the Tampa Scale of Kinesiophobia), distress (the Pain Catastrophizing Scale), clinical depression (The Center for Epidemiologic Studies Depression scale), a numeric pain intensity scale, self-perceived disability (Oswestry Disability Index), and general health status (12-Item Short Form Health Survey). Navy health-care providers conducted a back pain-specific medical evaluation. Associations are expressed as multivariate-adjusted prevalence ratios (PRs) estimated using Poisson regression. Two hundred fifty-three participants were enrolled. Work status outcome was collected for 239 participants. Predictors of "not at full duty" at 4 weeks after enrollment included having back pain for 4 weeks or less before study enrollment (PR, 2.69; 95% CI, 1.21-5.97) and increased FABQ Work subscale score (PR, 1.05; 95% CI, 1.01-1.08). The sole predictor of work status at 12 weeks after enrollment was increased FABQ Physical Activity (FABQ Physical) subscale score (PR=1.14; 95% CI, 1.00-1.30). The findings that fear-avoidance beliefs were predictive of subsequent work status among active duty service personnel in this study population (after adjusting for clinical, demographic, and psychological covariates) suggest the clinical utility of addressing these factors during treatment of back pain episodes in the military. These findings reflect the important role that psychological factors may play in the return to work process in an active duty military population.

Ocular Myiasis During an Amphibious Military Exercise in Djibouti

In November 2010, a healthy 27-year-old active duty US marine presented to the Battalion Landing Team 3/8 Battalion Aid Station located, at the time, on a beach in the East African nation of Djibouti. His chief complaint was of a foreign body sensation in the right eye, reporting that a bug had flown into the eye 8 hours prior. He denied further symptoms. Physical exam revealed multiple 1 to 2 mm larvae moving vigorously on the conjunctiva of the affected eye, confirming the diagnosis of ocular myiasis. The patient's eye and its maggots were anesthetized with 0.5% tetracaine ophthalmic drops, and a total of 15 maggots were collected manually using cotton-tipped applicators. Antibacterial prophylaxis was given with topical moxifloxacin drops and erythromycin ointment. Slit lamp and fluorescein exams were normal after the procedure. Treatment was stopped after 3 days and the patient had no complications. In March 2011, the entomology team at Camp Leatherneck, Afghanistan, examined the specimens and determined they were most likely the lively, hook-mouthed maggots of the viviparous sheep nasal bot, a fly endemic to most of the Middle East and northern Africa. The presentation was similar to several others described in the literature, though no baseline incidence or other cases have been reported from Djibouti. The environment for the field exercise was a secluded beachfront inhabited sparsely by migrant goat herders with an estimated livestock-to-human ratio of 20:1. The rapid insertion of a 300-man reinforced US Marine Corps rifle company likely changed the behavior of the herds and tenders, but also drastically altered the balance of hosts available to the average gravid bot. The result was a counterintuitive but foreseeable urban microcosm formed in an otherwise desolate rural area. In such a situation, clinicians may reasonably expect the risk for human infestation by zoonotic parasites to well exceed the local baseline risk. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government.

Assisting children and families with military‐related disruptions: The United States Marine Corps school liaison program

AbstractMilitary families face a number of unique challenges, including frequent relocations and school transitions, as well as extended separations from loved ones. The military, schools, and communities have been working together to build the capacity of children, youth, and families to successfully cope with the stressors they encounter. Most branches of the military have instituted liaison programs within schools and communities to help military school‐aged children make more seamless transitions from one school to another due to relocations. This study assessed the thoughts and perceptions of U.S. Marine Corps (USMC) school liaison professionals (SLs) regarding their work with a broad array of stakeholders, both on‐ and off‐base. Generally, SLs expressed positive sentiments regarding the USMC liaison program. They also reported that they were working hard at developing stronger connections to various constituencies in position to assist military families. Unfortunately, there was some indication that SLs may be at risk for burnout. Given the needs of military children, youth, and families, SLs appear to be filling an important function that could enhance military–school–community partnerships. © 2011 Wiley Periodicals, Inc.

The Best‐Laid Schemes: Postcolonialism, Military Social Science, and the Making of US Counterinsurgency Doctrine, 1947–2009

The Best‐Laid Schemes: Postcolonialism, Military Social Science, and the Making of US Counterinsurgency Doctrine, 1947–2009

Combat Versus Civilian Open Tibia Fractures: The Effect of Blast Mechanism on Limb Salvage

This study compares open tibia fractures in US Navy and US Marine Corps casualties from the current conflicts with those from a civilian Level I trauma center to analyze the effect of blast mechanism on limb-salvage rates. Data from the 28,646 records in the University of California San Diego Trauma Registry from 1985 to 2006 was compared with 2,282 records from the US Navy and US Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database for the period of March 2004 to August 2007. Injuries were categorized by Gustilo-Anderson (G-A) open fracture classification. Independent variables included age, gender, mechanism of injury including blast mechanisms, shock, blood loss, prehospital time, procedures, Injury Severity Score, length of stay, and Mangled Extremity Severity Score (MESS). Dependent variables included early or late amputation and mortality. The civilian group had 850 open tibia fractures with 45 amputations; the military group had 21 amputation patients (3 bilateral) in 115 open tibia fractures. Military group patients were more severely injured, more likely have hypotension, and had a higher amputation rate for G-A IIIB and IIIC fractures then civilian group patients. Blast mechanism was seen in the majority of military group patients and was rare in the civilian group. MESS scores had poor sensitivity (0.46, 95% confidence interval: 0.29-0.64) in predicting the need for amputation in the civilian group; in the military group sensitivity was better (0.67, 95% confidence interval: 0.43-0.85), but successful limb salvage was still possible in most cases with an MESS score of ≥7 when attempted. Despite current therapy, limb salvage for G-A IIIB and IIIC grades are significantly worse for open tibia fractures as a result of blast injury when compared with typical civilian mechanisms. MESS scores do not adequately predict likelihood of limb salvage in combat or civilian open tibia fractures.

The dangerous myths and dubious promise of COIN

Counterinsurgency (COIN) has again emerged as a topic of both contemporary and historical interest in the age of what has been called a global counterinsurgency. However, little attention is being paid to the historical lineage of a COIN doctrine that is being rediscovered and promoted by an enthusiastic group of military intellectuals and commanders as the basis for US Army and Marine Corps doctrine. This article argues that historical claims for COIN success, based on courting popular gratitude by improving economic conditions, are at best anchored in selective historical memory, when not fantasy fabrications. The first argument of this article is that COIN does not constitute a distinct form of warfare, but merely a sub-set of minor tactics. Second, ‘hearts and minds’, so-called population-centric warfare, has seldom been a recipe for lasting stability. Rather, historically counterinsurgency succeeded when it has shattered and divided societies by severely disrupting civilian life. In fact, COIN is a nineteenth century legacy of empire whose uniqueness and impact was mythologized in its own day, and that is unlikely to prove a formula for strategic success in the twenty-first century.

Symptomatic medial epicondyle nonunion: treatment by open reduction and fixation with a tension band construct

Nonunion of the medial epicondyle can cause symptoms of pain and instability in certain high-demand individuals. Problems with open reduction and internal fixation (ORIF) have led some to recommend excision of the nonunited fragment, followed by soft tissue repair. This study tests the hypothesis that patients with symptomatic nonunion of the medial epicondyle can be successfully treated with ORIF using a tension band construct. Five male patients were identified who underwent ORIF of a chronic, nonunited medial epicondyle fracture. Patients were a mean age of 15.8 years at presentation. The time since the original injury averaged 24 months. At an average follow-up of 31 months, all patients reported satisfaction with their surgery. All nonunions healed, and the average postoperative extension improved significantly compared with preoperative values (P < .05). Disabilities of Arm, Shoulder and Hand scores were low (mean, 0.8) and Mayo Elbow Performance scores were high (mean, 100) at follow-up. No patient complained of prominent hardware or ulnar nerve irritation. All patients were able to return to high levels of physical activity, including one who qualified for the US Marine Corps. Nonunion of the medial epicondyle can be symptomatic in certain high loading individuals. Surgical repair of the united fragment is difficult due to anatomical and biomechanical factors. We believe that ORIF of chronic medial epicondyle nonunions using a tension band construct is a viable option in the symptomatic, high-demand patient.

Combat Radiology: A Unique Opportunity for Patient-Centered Radiology

The physician-patient relationship has stood as the cornerstone of medicine since its practice began. As modern radiologists, it is often challenging to maintain a conspicuous presence on our patients' health care teams. Frequently playing a significant but peripheral role in patient care, we remain relatively insulated from our patients. Recent initiatives aimed at patient-centered radiology have emerged within the literature and from our own professional societies to help spur radiologists to engage our patients more. As the country faces sweeping health care reform in the years ahead, it is imperative that we continue to reach out to our patients. We must make them aware of the crucial role radiologists play in their care and ensure our participation in meaningful physician-patient relationships. ErratumJournal of the American College of RadiologyVol. 8Issue 1PreviewIn the December issue of JACR (2010;7:915–917), the opinion piece “Combat Radiology: A Unique Opportunity for Patient-Centered Radiology,” the author is incorrectly identified as a member of the US Marine Corps Physicians. Jeremiah Long is a Major in the US Army MEDICAL Corps. Full-Text PDF

Executive Summary and Command Brief

We conclude this special issue with the Executive Summary and Command Brief from the McCain Conference, ‘New Warriors/New Weapons: The Ethical Ramifications of Emerging Military Technologies’, as formulated by the conference convener, the Stockdale Center for Ethical Leadership at the US Naval Academy, and as prepared for the: Chief of Naval Operations and the Commandant, US Marine Corps (Ed).

The Frequency of Replacement of Dental Restorations May Vary Based on a Number of Variables, Including Type of Material, Size of the Restoration, and Caries Risk of the Patient

The authors analyzed the dental records of 2780 Navy (cohort 1 = 1078 entered the Navy in 1997) and US Marine Corps recruits (cohort 2 =1053 entered the USMC in 1999-2000; cohort 3 = 649 entered the USMC in 2002-2005). The records were reviewed at 16 US Navy dental treatment facilities at the following time periods: cohort 1, 2001; cohort 2, 2002-2003; and cohort 3, 2005-2006. The mean age of the subjects was 20 years, and 85% were men. Only posterior teeth (not third molars) with amalgam or resin-based composite (including glass ionomer restorations) were evaluated. Teeth that had been restored with more than one material and restorations that did not involve the occlusal surface were excluded. The minimum follow-up time was 2 years with at least 2 periodic exams following the initial exam. The primary factor of interest was the type of restorative material (amalgam versus resin-based composite). Secondary factors included tooth number, number of restored surfaces (single or multiple), and caries risk of the patient. Caries risk status was defined using the Navy Dental Corps Oral Disease Risk Management protocol. The primary outcome measure of interest was the determination of the relative risk of replacement of an initially intact restoration during the subject's first years of military service. Restorations were classified as clinically acceptable or requiring replacement either as a result of new primary caries, secondary caries, defective restorations, or endodontic therapy. At the initial exam, 964 (15.2%) of the amalgam restorations and 199 (17.4%) of the resin-based composites required replacement and were excluded from further analysis. Of the remaining restorations, an additional 14.2% of the amalgam and 16.7% of the composite restorations required replacement during the observation period. The mean follow-up time was 3.0 years (cohort 1, 3.4 years; cohort 2, 3.1 years; cohort 3, 2.3 years). Replacement rates for resin-based composite restorations compared with amalgam were significantly higher owing to all causes (adjusted hazard ratio [HR], 1.28; P < .05) and for replacement owing to restoration failure (adjusted HR, 1.64; P < .01). Multiple surface restorations demonstrated higher rates of replacement than single surface restorations from all causes (adjusted HR, 1.39; P < .01) and for replacement of existing restorations (adjusted HR, 1.82; P < .01). High-caries-risk subjects experienced more than twice the risk of retreatment than did low-caries-risk subjects when considering all replacements (adjusted HR, 2.04; P < .01) and 50% higher risk of replacement of previously restored surfaces (adjusted HR, 1.48; P<.01) Approximately 30% of all posterior restorations required replacement either at the initial or subsequent exams during the observation period. The number of resin-based composite restorations requiring replacement was significantly higher than amalgam restorations. The authors concluded that because of the extra cost, time, and potential for increased frequency of replacement, posterior composite restorations should be limited to restorations of appropriate size and placed under meticulous restorative technique with strict adherence to manufacturer's instructions.

Counterinsurgency Concepts: What We Learned in Iraq

We have learned a great deal about counterinsurgency operations in recent years. And in this article, I will highlight some of the most important lessons we have distilled from our experiences in Iraq, in particular. In late 2006, violence in Iraq was spiraling out of control. The overall situation was grim. In the midst of this horrific violence, the US Army and US Marine Corps published a field manual on counterinsurgency operations, incorporating lessons learned in Iraq and Afghanistan, as well as in the conduct of past counterinsurgency campaigns. The drafting of the manual represented a focus on a field largely ignored by the US military in the decades after the Vietnam War, with the exception of periodic discussion of so-called ‘low-intensity conflict’ during our activities in Central America in the mid-1980s. As we carried out the so-called ‘surge’ to quell the violence in Iraq in 2007 and 2008, we implemented many of the counterinsurgency concepts in the new manual, achieving significant progress and validating a number of the key concepts along the way. Indeed, we now find ourselves – and the Iraqi people – in a much better place than two years ago, with progress on all fronts – security, economic and political. Although that progress remains fragile, and although innumerable challenges remain, the gains achieved in Iraq have been considerable.