Relationship between patterns of alcohol use and negative alcohol-related outcomes among U.S. Air Force recruits

The negative impact of alcohol use on workplace performance is of significant concern to the U.S. military, given the costs associated with recruiting, hiring, and training personnel. However, little is known about the extent of potential alcohol use problems of recruits. We examined the history of alcohol-related problems among recruits entering the Air Force (N=37858). Although the average age of recruits was <21 years, 78% reported consuming alcohol and 49% reported binging before basic military training. Recruits who drank reported having negative alcohol-related outcomes (NAROs). In fact, >95% reported that they or someone else had been injured as a result of their drinking and that a relative, friend, doctor, or other health care worker has been concerned about their drinking. The remaining NAROs were reported by approximately one-quarter of those who drank. However, recruits who reported binge drinking were substantially more likely to report more NAROs, such as morning drinking, inability to stop drinking, having others be concerned about their drinking, having blackouts, fighting, having injured or been injured, feeling guilty about their drinking, and wanting to reduce the amount they drink. Results suggest that alcohol-related problems are common among recruits before basic military training and screening for future problems may be beneficial.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

The epidemiology of tuberculosis in the U.S. Air Force, 1987

In preparation for a major revision of the Air Force tuberculosis (TB) prevention and control program, we reviewed tuberculosis cases treated at Air Force hospitals and the U.S. Air Force tuberculin skin testing program for 1987. The highest rates of active TB cases and infection were observed in the Pacific overseas region. Active tuberculosis cases occurred most frequently in white male retirees and in Asian dependent females. Nineteen cases (9% of total TB cases) occurred in children under the age of 5. Only 46-60% of individuals with a positive Purified Protein Derivative-Tuberculin were placed on isoniazid (INH) chemoprophylaxis. Flying status personnel were less likely to have either active disease or TB infection than non-flying active duty members. Based upon these findings, Air Force tuberculosis prevention and control program efforts should de-emphasize screening of low risk active duty populations and stress timely reporting and case finding, compliance with therapy, and initiation of INH chemoprophylaxis in accordance with existing guidelines. Young children who are contacts of active TB cases should receive special emphasis.     

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.     

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.     

Deaths attributed to suicide among enlisted U.S. Armed Forces recruits, 1980-2004

OBJECTIVE: The purpose of this study was to describe the epidemiology of suicides among U.S. Air Force, Army, Marine Corps, and Navy recruits from 1980 through 2004. METHODS: Recruit suicides were identified through the Department of Defense Recruit Mortality Registry. We calculated crude, category-specific, and age-adjusted mortality rates as deaths per 100,000 recruit-years. RESULTS: There were 46 onsite suicides by gunshot (39%), hanging (35%), fall/jump (22%), and drug overdose (4%). An additional 20 recruits committed suicide from 1980 through 2004 after leaving the military training site. Methods included gunshot (70%), hanging (20%), fall/jump (5%), and poisoning (5%). Therefore, the overall recruit suicide rate was 6.9 (95% confidence interval = 5.4-8.8) deaths per 100,000 recruit-years. Only three (5%) suicides occurred among females resulting in a 3.5 times higher risk for males compared to females (95% confidence interval = 1.1-11.2). CONCLUSIONS: Suicide rates among military recruits were lower than those of comparably aged U.S. civilians. However, the occurrence of any suicide during basic military training emphasizes the importance of routine evaluation of the effectiveness of each military service's suicide prevention program as it applies to this population.     

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.     

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.