Cigarette use among two cohorts of U.S. Air Force recruits, compared with secular trends

This study provides a comparison of cigarette smoking among two cohorts of U.S. Air Force recruits. The first cohort, Air Force 1, entered the military between August 1995 and August 1996. The second cohort, Air Force 2, entered between October 1999 and September 2000. Cigarette use significantly increased among both men (7.0-percentage point increase) and women (7.3-percentage point increase) between the two cohorts. This difference remained statistically significant in models adjusted for demographic differences between the two groups of recruits. Direct standardization methods were then used to compare rates in both Air Force surveys with rates of current smoking reported for a national sample from the Behavioral Risk Factor Surveillance System surveys from the same years. Although the average number of cigarettes smoked and years of smoking decreased between the two cohorts, troops from Air Force 2 reported being less motivated to quit. This study suggests that efforts to reduce smoking among junior enlisted troops in the Air Force should be bolstered.     

Noise-induced hearing loss among U.S. Air Force cryptolinguists

BACKGROUND: Occupational noise-induced hearing loss remains epidemic in the U.S. Air Force (USAF) and aircrew members continue to be affected. This study examines noise-induced hearing loss (NIHL) observed among USAF cryptolinguists that is attributable to radio noise and attempts to determine whether the current USAF Hearing Conservation Program (HCP) adequately identifies NIHL. METHODS: Audiograms from 120 ground-based cryptolinguists were examined. Comparisons were made between 1998 audiograms and either the reference audiogram or the enlistment audiogram. To determine HCP effectiveness, results were compared with the USAF standard of 3% or fewer permanent threshold shifts (PTS) per year. RESULTS: Some 13.3% of the cryptolinguists experienced standard threshold shifts (STS) between their enlistment audiogram and their initial occupational (reference) audiogram; 9.2% experienced STS in 1998 as compared with their initial enlistment audiogram but only 6 of the 11 (54%) were detectable using the reference audiogram as the baseline. The frequency pattern of changes in hearing thresholds was characteristic for NIHL. CONCLUSIONS: The NIHL that occurs among cryptolinguists prior to performance of the reference audiogram, and the hearing threshold shifts that occur between the enlistment audiogram and the reference audiogram, may obscure future hearing loss in the population. The incidence of PTS appeared to exceed 3% when the enlistment audiogram was used. While this result was not significantly different from 3%, sample size limitations and data accuracy concerns warrant that this population be closely watched in the future.     

Trauma symptomatology among female U.S. Navy recruits

A sample of female U.S. Navy recruits (N = 1,051) was surveyed for histories of childhood abuse and current trauma symptomatology. Victims of only childhood sexual abuse (CSA) and victims of both CSA and childhood physical abuse (CPA) had significantly higher scores on all 10 Trauma Symptom Inventory (TSI) clinical scales than did participants who did not report a history of childhood abuse. Victims of only CPA had significantly higher scores on all TSI clinical scales, except the Sexual Concerns scale, than participants who did not report a childhood history of CPA or CSA. Additionally, more victims of childhood abuse positively endorsed TSI items related to suicidal behavior and ideation than did nonvictims. Overall, the women who experienced CPA and/or CSA reported substantially higher levels of trauma symptomatology.     

Death among U.S. Air Force basic trainees, 1956 to 1996

BACKGROUND: Basic military training in the U.S. Air Force exposes recruits to multiple environmental and psychological stressors. Deaths often prompt examination of the training process. METHODS: This retrospective case study evaluates recruit deaths at Lackland Air Force Base between 1956 and 1996 in terms of demographic, clinical, and environmental variables. RESULTS: Eighty-five deaths occurred, with 81% being natural, 13% suicide, 4% accidental, and 2% not classified. Ninety-four percent of recruits who died were male, and 60% were 17 to 19 years of age. The average death rate was 2.8/100,000 recruits. Seven recruits were sickle cell trait (SCT)-positive. The relative risk for nontraumatic deaths between expected SCT-positive and non-SCT-positive populations was 23.53 (confidence interval, 19.55-30.01). Thirty-five percent (30 recruits) died from cardiac causes, resulting in a death rate of 1.0/100,000 trainees. Thirty-three percent (28 recruits) died primarily from infections. Six deaths were due to heat stroke, 11 to suicide, and 3 to accidents. CONCLUSION: As a result of improvements in immunizations, changes in hydration and exercise policies, limited access to vehicles, close supervision, the "buddy system," and the institution of the Navy-Air Force Medical Evaluation Test, only a few deaths occurred in any given year.     

Unplanned pregnancy among active duty servicewomen, U.S. Air Force, 2001

Unplanned pregnancy is a major public health problem in the United States. Although the U.S. Air Force has the highest proportion of active duty women of any of the U.S. military services, there are no published data on the occurrence of unplanned pregnancy among active duty Air Force (ADAF) women. Civilian female interviewers conducted telephone interviews with a random sample of 2,348 ADAF women during early 2002, using questions that were closely based on the 1995 National Survey of Family Growth. During 2001, approximately 12% of ADAF women had one or more pregnancies. By National Survey of Family Growth criteria, approximately 54% of these pregnancies were unplanned. Thus, approximately 7% of ADAF women had one or more unplanned pregnancies during 2001. Roughly one-half of unplanned pregnancies represented contraceptive nonuse and the other half represented contraceptive failure or misuse. Unplanned pregnancy is a serious and frequently occurring problem among ADAF women, with many opportunities for prevention.     

U.S. Air Force pilot selection and training methods

BACKGROUND: U.S. Air Force (USAF) pilot selection and training procedures have changed substantially in the last several years. Pilot selection procedures were augmented with the introduction of computer-based testing to assess pilot aptitude. Training procedures have changed in an effort to modernize the training fleet and provide better, more specialized training earlier in the training process. RESULTS: Despite several studies showing the utility of USAF pilot aptitude tests for predicting training performance, results of a recent policy capturing study suggest that this information is often ignored by pilot candidate selection boards. The two largest sources of USAF pilot trainees relied heavily on measures of officership when making selection decisions. Cumulative research findings suggest that USAF pilot selection decisions could be improved by making better use of currently available personnel attribute data. Further improvements could be expected from the addition of a structured selection interview and measures of personality.     

U.S. Air Force Mobile Ophthalmic Surgery Team

OBJECTIVE: The objective of this study was to report the evolution of the U.S. Air Force Mobile Ophthalmic Surgical Team (MOST). METHODS: U.S. Air Force ophthalmologists at Wilford Hall Medical Center in San Antonio, Texas, designed a small, portable, rapid-response eye surgical team. Field testing with humanitarian deployments refined the deployment package and provided operational training. RESULTS: MOST successfully deployed to Central and South America, the Caribbean, and Africa 42 times since 1991, with 50,287 patients examined/treated and 4,812 surgeries performed. Realistic readiness training was provided for 80% of U.S. Air Force ophthalmologists and Army, Navy, and Reserve colleagues. Subsequent modifications to the MOST improved its capability while reducing the size and weight of the team, equipment, and supplies by 50%. CONCLUSIONS: Using MOST humanitarian missions as a refining model, U.S. Air Force deployable ophthalmic assets are modular, lightweight, and multifunctional, which allows commanders to custom-build an appropriate response to each unique contingency, disaster, or humanitarian need with mission-ready ophthalmologists.     

Combat stress disorders and the U.S. Air Force

Air Force fliers and base personnel have unique spheres of vulnerability to combat stress disorders. A number of factors unique to the Air Force heighten combat stress vulnerability: (1) The passive nature of combat duties, (2) relatively small amounts of combat skills training, (3) absence of service-wide training in arms use, (4) lack of experience with mass casualty situations, (5) family proximity to potential operational areas, and (6) base and personnel immobility. The impact of combat stress disorders for both fliers and nonfliers in the Air Force can be minimized. Prevention, diagnosis, and treatment are discussed.     

Generalizability of U.S. Air Force studies: 1990 and 2000 demographic distribution comparison of U.S. active duty Air Force personnel and the U.S. general population

A cross population comparison of U.S. Air Force active duty personnel data and U.S. general population estimates from 1990 and 2000 was conducted to compare "nonmodifiable" modifiers (sex, age, and race/ethnicity distributions). Two focus areas for the study were a determination of generalizability for Air Force studies using these modifiers and a discussion of limitations on comparisons between the populations. The populations were stratified by sex and then by age and race separately. Overall, the Air Force has a younger population, a higher percentage of men, and a similar rank order for race/ethnicity distributions (except for Hispanic men in 2000). When race was stratified by sex, the Air Force has a higher percentage of black women, which increased from 1990 to 2000. This baseline research should benefit future genetic epidemiologic research in determining susceptibility or disease predisposition in a large population sample that is similar to the U.S. general population.     

Frontotemporal dementia affecting a U.S. Air Force officer

We present the case of a 51-year-old former U.S. Air Force officer who developed marked behavioral and personality changes over a 9-year period, ultimately leading to his discharge from the Air Force at a rank below that which he achieved during service. Clinical diagnostic features, neuropsychological testing and neuroimaging together confirmed a diagnosis of frontotemporal dementia. This form of presenile dementia is discussed with reference to his case.     

Aircraft coordination training in the U.S. Air Force Air Training Command

Coordinated action among the various members of a multi-crew aircraft is essential for safe flight. Aircrew coordination problems typically fall into one of three broad categories: 1) improper task prioritization, 2) ineffective communication, or 3) lack of coordinated action. The airlines and the Military Airlift Command have very successful crew coordination training programs. The Air Training Command (ATC) will soon transition to a specialized pilot training program where pilots destined for large multi-place aircraft will be trained differently from those who will fly fighter aircraft. Under this new training program, ATC will help establish a crew mind-set early in the new multiplace pilot's career by providing initial crew coordination training.     

Costs of excess body weight among active duty personnel,U.S. Air Force, 1997

Although the increasing public health impact of excess body weight in the U.S. general population has received national attention, the impact of excess body weight among active duty military personnel is unknown. A study was conducted to determine the direct (increased medical care) and indirect (lost workdays) costs of excess body weight among active duty Air Force (ADAF) personnel in 1997. Based on measured height and weight values, in 1997, 20.4% of ADAF men and 20.5% of ADAF women had body weights that exceeded their official maximum allowable weight for height. Total excess body weight-attributable costs were estimated at $22.8 million per year, with annual direct and indirect costs estimated at $19.3 million (approximately 6% of total annual expenditures for ADAF medical care) and $3.5 million, respectively. Attributable lost workdays were estimated at 28,351 per year. Annual excess body weight-attributable costs among ADAF personnel are high, both in dollars and lost duty days.     

Smoking and deployment: perspectives of junior-enlisted U.S. Air Force and U.S. Army personnel and their supervisors

Smoking during deployments is a growing problem, particularly among junior-enlisted personnel, who have the highest smoking rates in the military. Few studies have examined reasons for smoking initiation among never smokers, relapse among former smokers, or increased smoking frequency among current smokers. We conducted 24 focus groups at four Air Force and two Army installations (N = 189) to examine the extent of smoking during deployment and to elucidate factors thought to contribute to new initiation, relapse, and increased smoking in a sample of junior-enlisted personnel and their supervisors. Important reasons for smoking included: (1) managing stress, boredom, anxiety, and sleep deprivation; (2) lack of alternate activities and privileges; (3) the perception that dangers in the field trumps the health impact of smoking; and (4) the role of the military environment in encouraging smoking. In addition, the phenomenon of new initiation and relapse to smoking in the field was discussed.     

Recent developments in U.S. Air Force pilot candidate selection and classification.

Recent U.S. Air Force policy decisions regarding Specialized Undergraduate Pilot Training (SUPT) have eliminated the need to classify pilot candidates into training specialties prior to entering primary jet training. Under the new system, specialized training assignments will occur at the completion of primary jet training and will be based on flying and academic performance, student preferences, and aircraft availability. Another significant change to the SUPT program was the development of a refined pilot candidate selection model that reduced potential threats to test compromise and gaming strategies.     

Psychiatric profiles in the U.S. Air Force: a clinical interpretation of Air Force Instruction 48-123

The foundations of our current system for profiling military psychiatric patients were laid during World War II, well before the development of the first version of the Diagnostic and Statistical Manual of Mental Disorders. The general principles and terminology remain in use today through Air Force Instruction 48-123, Medical Examination and Standards. The terminology used is clearly outdated, making it difficult to use and risking misuse, deploying the wrong person or denying deployment to an appropriate person. Our objective is to review the current standards for making psychiatric profiles in the U.S. Air Force and propose a practical interpretation of the current Air Force Instruction. Considerable research remains to be done to improve our profile system, especially in light of the development of effective treatments for many psychiatric illnesses. Although prognostic data are available for some illnesses, little research has been done on military populations and essentially none of it considers the rigors of military deployment. Diagnosis, prognosis, duty environments, and demands of duties all must be considered in making profile decisions. Reductionistic approaches more simple than this will serve neither the commander nor the airman.     

Comparison of two sources of U.S. Air Force injury mortality data

Is the military's casualty (mortality) reporting system a reliable surrogate for International Classification of Diseases-coded death certificate information? To answer this question, the investigators compare official casualty data to the Air Force Mortality Registry for injury-related deaths occurring in 1991-1997. The investigators first derived International Classification of Diseases, Ninth Revision and Supplementary Classification of External Causes of Injury and Poisoning (E) codes for each death from casualty data and then compared the precision of those codes with the registry's E codes derived and medically coded from death certificates and autopsy reports. Sixty-five percent of registry E codes were "precise" vs. 35% from casualty data. The registry listed nonspecific E codes for 1% (12 deaths) vs. 6% (81 deaths) for casualty data. Unlike casualty data, the registry included expectant deaths that occurred within 120 days after medical retirement. The study concludes that casualty information compares poorly with that of the registry. Air Force Mortality Registry data should be used instead of casualty data for epidemiological research.     

Prevalence, trends, and correlates of alcohol use, nonmedical drug use, and tobacco use among U.S. military personnel

This paper presents data on substance use by military personnel from a series of worldwide surveys conducted in 1985, 1982, and 1980 with primary emphasis on the 1985 survey. Estimates are based on responses from participants serving on active duty in the Army, Navy, Marine Corps, and Air Force. Results for 1985 indicate pervasive use of alcohol, substantial use of tobacco, and low nonmedical use of drugs among military personnel. Average daily consumption of alcohol declined significantly from 1.4 ounces in 1982 to 1.2 ounces in 1985, but the patterns of use remained relatively constant. Nonmedical drug use during the past 30 days declined significantly, from 27.0% in 1980, to 19.0% in 1982, to 8.9% in 1985. Cigarette smoking declined significantly from 51.4% in 1982 to 46.2% in 1985. Current alcohol and drug use is concentrated among younger, less educated, unmarried, and junior and mid-career enlisted personnel. Cigarette pack years are higher among males, whites, those with less than a high school education, and senior enlisted personnel. Results show progress in reducing drug use and smoking in the military, but little change in patterns of alcohol use. New initiatives and approaches by the military to further reduce substance abuse are discussed.     

Objective psychological testing of U.S. Air Force officers in pilot training

Clinical psychologists are increasingly assisting flight surgeons in the assessment of students in pilot training. However, some psychological tests reported in the literature are ill-suited to efficient clinical evaluation of aviators. Recent advances in clinical psychometrics offer improvements in reliability, personality theory, and norms. We administered the Multidimensional Aptitude Battery, the Personality Research Form, and the Millon Clinical Multiaxial Inventory to 350 Air Force officers undergoing Undergraduate Pilot Training. We present normative data for use by practitioners assessing similar populations.