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.     

Smoking and body weight as markers of fitness for duty among U.S. military personnel

BACKGROUND: Both tobacco and overweight present serious threats to public health. Although the military has targeted both health issues, only weight status is included in tests of fitness. This study contrasted the relative utility of body weight and smoking as markers for fitness for duty. METHODS: Using data from the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel (N = 12,149; 24.7% female), troops were categorized according to weight (underweight, healthy weight, overweight, or obese) and smoking status (never smoker, former smoker, or current smoker). RESULTS: Logistic models were developed to examine the usefulness of smoking status and weight status as predictors of items assessing four domains of military fitness for duty, namely, physical health, mental health, substance abuse, and legal problems. Smoking status was a consistent and strong predictor of items within all four fitness domains. In contrast, weight status was not a consistent predictor of fitness. CONCLUSION: The military should consider adding smoking status to assessments of military fitness. Also, given that underweight and not overweight status predicted negative outcomes among military members, the services should consider revising their weight status fitness standards.     

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.     

Meibomian gland status comparison between active duty personnel and U.S. veterans

PURPOSE: To evaluate the lid and meibomian gland status of active duty forces (ADF) and U.S. veterans (USV) to compare the prevalence of lid dysfunction and disease in each population. METHODS: One examiner observed 113 consecutive patients in both groups during a 2-week period at two federal service optometry clinics. All eyes were graded with regard to negative findings (or normal), meibomian gland dysfunction (MGD), and/or meibomitis from an established criterion. RESULTS: 90.3% of ADF had normal lid findings, 5.3% of ADF had MGD (all contact lens patients), and 4.4% of ADF had meibomitis; 28.9% of USV had normal findings, and 71.1% of USV had MGD or meibomitis (no patients wore contact lenses). CONCLUSION: Our findings reveal that a definite difference exists between ADF personnel and USV in eyelid physiology and pathophysiology. This difference should be noted by the clinician who evaluates such patients. This will affect the differential diagnosis of ocular symptomatology in the contact lens and non-contact lens patient.     

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.     

Estimated cost of dental treatment for active duty and recruit U.S. military personnel

This paper estimates the cost of restoring U.S. military personnel to optimal oral health. The data come from a 30-site oral health survey of Army, Navy, Marine Corps, and Air Force personnel conducted from February 1994 to January 1995. A systematic random sample of 2,711 recruits was drawn. From a prestratified, random sample of 15,924 active duty personnel, 13,050 (82% response rate) participated in the survey. Applying their best clinical judgment, one dentist per site charted comprehensive dental treatment needs on each service member. Radiographs were used. After the samples were weighted to reflect the 1994 population of recruits (202,144) and active duty personnel (1,699,662), treatment costs were calculated applying median fees reported by U.S. general dentists in 1995. Results show total estimated costs of $1.9 billion for active duty personnel and $203 million for recruits. Periodontal disease accounts for the greatest proportion (47%) of active duty treatment costs, and oral surgery accounts for the greatest proportion (32%) of recruit treatment costs. The cost of restoring U.S. service members to optimal oral health is substantial.     

A 41-year-old active duty U.S. Air Force enlisted man with a 3-week history of fevers,arthralgias, and myalgias

A 41-year-old active duty male was transferred to Walter Reed Army Medical Center in Washington, DC, for further evaluation of fever, rash, myalgias, arthralgias, and respiratory failure. An extensive evaluation with input from numerous subspecialties of medicine was performed. The patient was eventually diagnosed with adult Still's disease, which is a diagnosis of exclusion. This case illustrates the importance of having a broad differential diagnosis when evaluating a patient with fever of unknown origin, with emphasis on the approach to young, active duty military personnel.     

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.     

Costs of using motivational interviewing for problem drinking in the U.S. Air Force

Despite the popularity of motivational interviewing (MI) to address heavy drinking, limited evidence exists on the costs of using MI to address heavy drinking. This study examines the costs of using MI to address heavy drinking at four U.S. Air Force (USAF) bases. Clients were referred to and assessed at a base program to address their drinking as a result of an incident; those who were not alcohol dependent were invited to participate in the study. Participants consented and were randomly assigned to one of three intervention arms: individual MI (IMI), group MI (GMI), and Substance Abuse Awareness Seminar (SAAS). Three cost perspectives were taken: USAF, client, and the two combined. Data were collected from bases and public sources. The start-up cost per base ranged from $1340 to $2400 per provider staff member. Average implementation costs across bases were highest for the SAAS intervention ($148 per client).     

A low-intensity intervention to prevent annual weight gain in active duty Air Force members

Elevated body weight among active duty Air Force (ADAF) members is a substantial and growing problem, and typically results from gaining small amounts of weight each year over many years. We designed a strategy to prevent annual weight gain in ADAF members using self-directed behavior change booklets followed by weekly e-mails about diet and physical activity for a year. The intervention was universally offered to ADAF members meeting selection criteria at five U.S. Air Force bases (n = 3,502); members at 60 other U.S. Air Force bases served as controls (n = 65,089). The intervention was completely effective at preventing weight gain in a subgroup of men (those above the lowest three ranks, with baseline weight above maximum allowable) and in women, while controls continued to gain weight. Since the intervention did not require personalized contact, this approach has promise for large-scale population-based efforts aimed at preventing weight gain in working adults.     

The incidence of known diabetics among U.S. Army active duty dental patients

Diabetes affects an estimated 16 million Americans. The purpose of this study was to determine the incidence of known diabetes among active duty soldiers by reviewing medications dispensed for diabetes at a large military installation. This study was conducted from July 31, 1997, through August 1, 1998. Fifty-eight (0.18%) members of the total active duty male population of 32,593 had been dispensed diabetes medications, whereas 43 (0.48%) members of the total female active duty population of 8,898 had been dispensed medications for diabetes. Gestational diabetes was the cause for 88.37% of the total active duty females dispensed diabetic medication at Fort Hood, Texas. The female-to-male ratio for diabetes was 2.7:1. Diabetics made up 0.27% of the total population.     

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.     

Descriptive epidemiology and natural history of idiopathic venous thromboembolism in U.S. active duty enlisted personnel, 1998-2007

The estimated incidence of idiopathic venous thromboembolism (IVTE) cases in the United States ranges from 24,000 to 282,000/year. This analysis explores the incidence and prevalence of IVTE in the military and if cases experience increased attrition. The Defense Medical Surveillance System was searched for incident IVTE cases from 1998 through 2007. Enlisted cases were each matched to 3 controls. Kaplan-Meier survival analysis and Cox proportional hazard modeling were performed. We matched 463 cases to 1,389 controls. Outpatient IVTE rates have increased markedly from 1998 through 2007. Cases of all-cause attrition risk (0.56 [95% CI = 0.44, 0.72]) and rates were significantly less than controls (p < 0.0001), and cases of medical attrition risk (1.64 [95% CI = 1.13, 2.37]) and rates were significantly higher (p < 0.01). Increasing rates with lower attrition suggests increasing case prevalence. Health care providers must maintain a high index of suspicion for venous thromboembolism to minimize adverse sequelae affecting health, unit readiness, and medical costs.     

Incidence of anterior cruciate ligament injury among active duty U.S. military servicemen and servicewomen

Although some studies have reported an increased incidence of anterior cruciate ligament (ACL) injuries in women athletes, little is known about the gender differences in injury patterns in the U.S. military. Using the Defense Medical Epidemiology Database, a search was performed for International Classification of Diseases, 9th Revision (ICD-9) codes 717.83 (old disruption of ACL) and 844.2 (sprain, strain cruciate ligament of the knee) among all servicemen and servicewomen between 1997 and 2003. Multivariate Poisson regression analysis was used to estimate the rate of ACL injuries per 1000 person-years, controlling for age and race, for each ICD-9 code. We computed rate ratios and 95% confidence intervals (CIs) by using male as the reference category. The injury rates for code 717.83 were 3.09 cases per 1,000 person-years for men and 2.29 cases per 1000 person-years for women, controlling for age and race (relative risk, 0.74; 95% CI, 0.71-0.76). The injury rates for ICD-9 code 844.2 were 3.79 cases per 1000 person-years for men and 2.95 cases per 1,000 person-years for women, controlling for age and race (relative risk, 0.78; 95% CI, 0.76-0.80). There was not an observed increase in the incidence of ACL injuries among female soldiers in the U.S. military between 1997 and 2003.     

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.