Health risks of diving among U.S. Navy officers

The objectives were to compare hospitalization, medical board, and mortality rates of diving-related disorders and stress-induced diseases between U.S. Navy male diving officers (n = 1977) and a matched sample of nondiving officers (n = 1973). Less experienced diving officers had significantly higher hospitalization rates than more experienced diving officers for total admissions, stress-related disorders (primarily alcoholism), and cardiovascular disease. Diving officers had significantly higher hospitalization rates than controls for nervous system diseases and joint disorders; none of these hospitalized diving officers had a recorded incident of decompression sickness. To ensure the safety and overall excellent health status of diving officers, it is necessary to promote and continue adherence to the procedures developed for safe diving in the U.S. Navy diving community.     

Non-Hodgkin's lymphomas in U.S. Navy personnel

Non-Hodgkin's lymphomas are one of the most commonly occurring cancers in the age groups heavily represented in the U.S. Navy. The Navy has a wide range of potential occupational exposures. This study was initiated to identify any occupational associations of non-Hodgkin's lymphomas that may adversely affect naval readiness. The objective of this study was to compare the incidence of non-Hodgkin's lymphomas in U.S. Navy active duty enlisted personnel during the period 1974-1983 with the general U.S. population, and to assess if risk varied by naval occupation or length of service. The Naval Health Research Center's computer-based disease registry was used to conduct a prospective study of all white U.S. Navy enlisted men during 1974-1983 to test for the existence of any short-term risk possibly due to occupation. Men in 80 occupations, ranging from clerk to journalist to machinist and boiler operator were observed for 3,704,864 person-years; mean length of service was 5.1 yr, but 19% of person-years were contributed by men who had served at least 11 yr. Incident cases of non-Hodgkin's lymphomas were identified and verified using Medical Board findings or review of original medical records. Average annual age-specific and age-adjusted incidence rates were calculated. Examination of pathology records and medical review boards confirmed 68 cases of non-Hodgkin's lymphomas. The annual age-adjusted incidence rate per 100,000 person-years in Navy men was significantly lower than in the U.S. Surveillance, Epidemiology, and End Results (SEER) population, probably due to screening and other selection factors associated with Navy service that result in a healthy worker effect.(ABSTRACT TRUNCATED AT 250 WORDS)     

Health risks among enlisted males in the U.S. Navy: race and ethnicity as correlates of disease incidence

A cross-sectional study of all Black and Caucasian enlisted males in the U.S. Navy between 1974 and 1979 was conducted to determine if there were any significant racial group differences in disease incidence. First hospitalization rates for sixteen ICDA-8 diagnostic categories and selected diagnoses were examined and compared on the basis of race, age, year hospitalized, education and occupation. Results indicated that total disease incidence among Black males has declined in the past decade, with a reduction in total first hospitalizations from 1652 per 10,000 men in 1974 to 1088 per 10,000 men in 1979. Total incidence rates for Caucasian males in the same period declined from 1347 per 10,000 men to 1100 per 10,000 men. However, Blacks were found to be at significant risk for: mental disorders; diseases of the genitourinary system; diseases of the circulatory system; diseases of the digestive system; diseases of the blood and blood-forming organs; symptoms and ill-defined conditions; supplementary classifications; and diseases of the musculoskeletal system. Caucasians had significant higher incidence rates for diseases of the skin and subcutaneous tissue, and accidents, poisonings and violence. Nevertheless, the study results indicated that the populations of Blacks and Caucasians in the Navy are not uniform with respect to disease incidence. There exist numerous subgroups within either racial group, defined on the basis of certain demographic and social characteristics, which are at risk for particular diseases. In addition, the relationship between race and disease is mediated by several factors, including genetic predisposition, socioeconomic status and cultural patterns of belief and behavior. No single factor can account for the excess risk for all diseases among all members of either racial group.     

Prevalence of elevated serum cholesterol in personnel of the U.S. Navy

Fasting blood lipid profiles were collected for 5,487 active duty Navy men and women presenting for routine physical examinations. Mean serum cholesterol for the sample (mean age 33.6 years) was 208.2 milligrams per deciliter (mg per dL). Cholesterol level increased with age, decreased with education, and was higher in men than in women. Using the Navy's own risk cutpoints for total cholesterol (200 mg per dL for ages 18-24, 220 mg per dL for ages 25 and older), 36.9 percent of the sample were found to be at risk. When the percentage of the population at risk was computed using the guidelines suggested by the National Institutes of Health Consensus Conference, rather than the Navy's cutpoints, results were almost identical (36.3 percent at risk); when based on the National Cholesterol Education Program's recommended cutpoints, the percent at risk was considerably higher (55.4 percent). Risk estimates that included LDL- or HDL-cholesterol risk levels (or both) also were higher. A larger percentage of Navy personnel were at risk because of total cholesterol than were persons in an age-adjusted national sample. However, because routine examinations generally are not given until first reenlistment, the Navy sample underrepresented younger service members, and results may overestimate the prevalence of hypercholesterolemia in the Navy at large. The author draws attention to the problem of lack of standardization in cholesterol testing and notes that the Navy does not yet participate in an external quality control program. The difficulty in setting appropriate risk cutpoints, given the complexity of factors that must be considered as well as the general unreliability of cholesterol tests, is also discussed.     

Aseptic bone necrosis among U.S. Navy divers: survey of 934 nonrandomly selected personnel

Nine hundred thirty-four U.S. Navy divers were selected and surveyed radiographically using standard techniques developed for detecting aseptic bone necrosis (ABN). X rays were read by qualified radiologists. A total of 16 positive cases was detected, and another 11 were interpreted as doubtful. ABN was found to be related to age and number of months in diving. After controlling for these factors, ABN could not be related to any of seven indices of diving activity. Divers with ABN did, however, have a history of more treatments for decompression sickness (DCS) than did divers without ABN. Implications of these findings are discussed, and the suggestion is made that ABN and DCS may not be related causally, but may be related to a third common factor. The need for controlled studies is discussed. The conclusion is made that the low prevalence rates of ABN among U.S. Navy divers cannot be related to any specific index of diving activity, and may not be causally related to DCS.     

Health risk factors for the development of decompression sickness among U.S. Navy divers

The relationship between the health status and physical characteristics of 185 U.S. Navy divers and their risk for experiencing decompression sickness was examined utilizing historical cohort design. Data on multiphasic medical examinations performed on these men between 1972-1978 were obtained. Cases of decompression sickness before and after examination were identified. Divers who did experience decompression sickness either before or after examination had significantly higher measures of skinfold thickness and weight when compared to those who remained free of decompression sickness. Those divers in the highest quartile of each of three significant skinfold thicknesses measured had risks for decompression sickness that were generally 9 to 10 times as great as those calculated for the combined lower 3 quartiles and 5 to 6 times as great as the average crude risk calculated for all Navy divers over the past 5 yr. These findings suggest that obesity may be a contributory factor to the occurrence of decompression sickness.     

Trends in overweight and physical activity among U.S. military personnel, 1995-1998

BACKGROUND: The purpose of this study was to deter mine whether changes in physical activity patterns account for the increasing prevalence of obesity, utilizing a large, representative sample of male and female U.S. military personnel. METHODS: Data from the 1995 and 1998 waves of the Department of Defense Survey of Health Related Behaviors among Military Personnel were utilized. Overweight was defined as body mass index > or =25. Respondents were classified as physically active if they reported > or =3 days/week of vigorous activity. Three sequential multivariate logistic regression models were analyzed separately for males and females with overweight regressed on year of study (1995 or 1998), demographic characteristics, and physical activity. RESULTS: Some 50% of military personnel in 1995 and 54% in 1998 were classified as overweight, representing a significant increase in overweight over the 3-year period for both males and females. Overweight military personnel were more likely to be male, older, African American or Hispanic, married, and enlisted personnel. Physical activity levels were high, with around 67% of the sample engaging in regular, vigorous physical activity. Although physical activity levels increased among male personnel between 1995 and 1998, there was not an independent association between physical activity and overweight, and changing physical activity patterns did not account for the increase in over weight from 1995 to 1998. CONCLUSIONS: The U.S. military is experiencing a trend toward increasing overweight that mirrors the pattern among the general population. The results of this study suggest that the rise in overweight among the military is not explained by a decrease in physical activity.     

Noise at sea: Characterization of extended shift noise exposures among U.S. Navy aircraft carrier support personnel

The purpose of this investigation was to characterize 12-hr on-duty, 12-hr off-duty, and 24-hr noise exposures among U.S. Navy aircraft carrier support personnel. Noise dosimetry samples were collected for 47 aircraft carrier support personnel while at sea during airwing carrier qualifications. L_eq measurements during 12-hr on-duty, 12-hr off-duty, and over 24-hr periods were compared to Threshold Limit Values. Four similar exposure groups (SEGs) were created based upon departmental assignment and similarity of work tasks: (1) Administration/Religious Ministries/Legal/Training, (2) Combat Systems/Operations, (3) Medical/Dental, and (4) Supply. Equivalent sound level (Leq) measurements in decibels “A” weighted (dBA) were compared to determine significant differences between each group according to 12-hr on-duty, 12-hr off-duty, and 24-hr periods. Mean 24-hr noise levels ranged from 69–88 dBA with 22% exceeding the 80 dBA Threshold Limit Value. Twelve-hr on-duty noise levels ranged from 71–90 dBA with 17% exceeding the 83 dBA 12-hr on-duty Threshold Limit Value. Twelve-hr off-duty noise exposure ranged from 68–84 dBA with 95% exceeding the 70 dBA American Conference of Governmental Industrial Hygienists threshold classified as effective quiet to allow for temporary threshold shift recovery. Welch Analysis of Variance and Dunnett T3 post hoc tests revealed SEG 2 had significantly higher 24-hr noise exposures than SEG 3 (p?=?0.019) and SEG 4 (p?=?0.045). SEG 2 had significantly higher 12-hr on-duty noise exposure than SEG 3 (p?=?0.030). One Way Analysis of Variance revealed no significant differences between 12-hr off-duty noise exposures according to SEG (p = .096). Some aircraft carrier support personnel had 12-hr on-duty and 24-hr noise exposures exceeding Threshold Limit Values with a large proportion exceeding the 70 dBA effective quiet limit during 12-hr off-duty periods. Results suggest personnel that are typically considered low risk for hazardous noise exposure (<85 dBA) during 8-hr shifts may have a greater risk of noise exposure when considering full 12-hr and 24-hr shifts when working and living in close proximity.     

Estimated savings in U.S. dental expenditures, 1979-89.

The American public saved more than $39 billion (1990 dollars) in dental expenditures from 1979 through 1989 in contrast to the substantial increases in expenditures in other sectors of the U.S. health care system that have pushed the system to the brink of major reform. The dental savings were estimated after controlling for the influence of economic factors, such as changes in prices, insurance, and income, as well as noneconomic factors that could influence the extent of dental disease in the U.S. population. Results of the analysis confirm the importance of both economic and noneconomic factors in the determination of the savings in dental expenditures.     

Disability among U.S. Army personnel vaccinated against anthrax

This study was conducted to examine whether U.S. Army personnel receiving > or =1 dose of anthrax vaccine adsorbed (AVA) between March 1998 and February 2002 were at higher risk of disability than unvaccinated personnel. We studied a historical cohort study of 716,833 active-duty soldiers (154,456 vaccinated) followed for 4.25 years to determine rates of evaluation for disability discharge. Cox proportional hazards models compared estimated risk of evaluation for disability, accounting for occupation and sociodemographics. Adjusted hazard ratio (HR) and 95% confidence interval (CI) was 0.96 (CI = 0.92-0.99). Separate adjusted HRs for men, women, permanent and temporary disability, musculoskeletal and neurologic conditions were similar, ranging from 0.90 to 1.04. Latency assumptions did not affect results. Anthrax vaccination does not increase risk of disability. This finding may be partially the result of factors influencing selection for vaccination or vaccine tolerance.     

Alcohol abuse among U.S. Navy recruits who were maltreated in childhood

AIMS: To examine relationships between childhood maltreatment and alcohol-related problems among U.S. Navy recruits. METHODS: An anonymous sample of 5697 Navy recruits completed a survey regarding their alcohol consumption, alcohol problems (binge drinking, drinking until drunk, alcohol dependence, alcohol-related arrests), and experiences of childhood physical and sexual abuse. RESULTS: Most of the recruits used alcohol, and a substantial proportion reported histories of childhood maltreatment. Recruits who had been victimized as children were more likely to use alcohol. Furthermore, among drinkers, those who had been abused were more likely to exhibit alcohol problems than were non-abused drinkers. CONCLUSION: Substantial numbers of personnel with alcohol-related problems may be using alcohol to self-medicate due to a history of childhood abuse. Attention to the association between alcohol abuse and childhood maltreatment might help improve the efficacy of military alcohol reduction programs.     

Widening health inequalities among U.S. military retirees since 1974

I explore trends in mortality among U.S. military retirees using a new dataset of payroll records that include pay grade. Trends in mortality by pay grade reveal that health inequalities steadily widened between 1974 and 2004. Additive differentials in mortality rates remained stable, but since mortality declined exponentially, by a factor of about one third, proportional differentials in mortality and thus additive differentials in life expectancy have widened. The advantage in life expectancy enjoyed by retired officers grew roughly from 3 to 4 years. The sources of these trends remain unclear and are beyond the ability of the data to inform, but the results bear implications for trends in inequality and for policy.     

Challenges of contraceptive use and pregnancy prevention among women in the U.S. Navy

In this article we present the results of a study to illuminate the explanatory factors related to unplanned pregnancies in the United States Navy, particularly with regard to female contraceptive training and practices, and occupational culture. The data set consists of 52 semistructured interviews with key informants, sailors, and enlisted personnel who were recruited via a quota sample stratified by gender, occupation, and location. The research team carried out semistructured interviews at seven different naval facilities in the mainland United States, the South Pacific, and Europe. Textual analysis of the interview data revealed four domains pertinent to unplanned pregnancies: (a) ineffective training for women regarding contraceptive options, proper dosing, and potentially negative side effects; (b) discrepancies between contraceptive knowledge and their proper use; (c) different foci of contraceptive training for men (sexually transmitted infection prevention) and women (pregnancy prevention); and (d) cultural norms that equate contraceptive use with promiscuity.     

Trends in mortality from coronary heart disease and stroke among U.S. veterans; 1954-1979

A cohort of nearly 300,000 insured veterans (Dorn Cohort), experienced a much greater percent decline in CHD death rate over the period, 1954-1979, than the population of the U.S., while for stroke, the percent decline in death rate was virtually the same as the U.S. For CHD, greater percent declines were noted over the study period for non-smokers compared to cigarette smokers, for professionals compared to non-professionals and for persons with high socioeconomic scores (SES) compared to those with low scores. In each group, younger persons experienced greater percent declines than older persons. For stroke, non-smokers experienced a somewhat greater percent decline in rate than smokers but this did not hold true for all age groups. Unlike CHD, professionals experienced a smaller percent decline in their stroke death rate than non-professionals, as did persons with high SES compared to those with low SES. The contradictory patterns observed for the two diseases with respect to occupation and SES suggest that the risk factors for stroke and coronary heart disease are not exactly the same. Throughout, the findings were much more convincing for CHD than for stroke.     

Difference in composition of personnel among government, voluntary, and investor-owned U.S. community hospitals

The relationship between an organization's staff structure, particularly the relative proportions of its administrators and line staff, and the organization's size, ownership status, financial condition, and scope of services is a subject that has attracted a good deal of attention from organizational theorists. At the present time, the subject is especially important to the hospital industry because of widespread concern about hospital costs and interest in how personnel expenses contribute to these costs.     

Progress toward healthy people 2000 objectives among U.S. military personnel

OBJECTIVE: Examine progress toward Healthy People 2000 objectives among active-duty military personnel and identify subgroups at risk for not meeting objectives. METHODS: Comprehensive Department of Defense surveys were completed in 1995, 1998, and 2002. Target behaviors were analyzed for achievement of objectives and demographic factors for their relationship to unmet objectives. RESULTS: The military met 7 of 15 objectives assessed in 2002. Achieved objectives, such as drug use, exercise, and safety equipment use, were generally behaviors monitored by military requirements. Unmet risk behavior and health maintenance objectives were related to military demographics, civilian trends, and societal norms. Smoking was more likely not met by enlisted (OR = 2.7, CI = 2.0-3.9), male, white, less educated, younger, single, Army, and Navy personnel. Overweight was more likely not met by male (OR = 3.4, CI = 3.0-4.0), African American, Hispanic, more educated, aged 35 or older, married, enlisted, and Navy personnel. Health maintenance goals were more likely not met by enlisted (OR = 1.5, CI: 1.1-2.2), male, nonwhite, less educated, younger, single, Navy, and Marine personnel. CONCLUSIONS: Objectives are more likely met when regulatory mechanisms encourage compliance. Future studies are needed to understand mechanisms accounting for achievement of objectives. Next steps for unmet objectives are to target interventions for high-risk groups.     

Age-specific morbidity and mortality rates among U.S. Navy enlisted divers and controls

The purpose of this study was to compare age-specific hospitalization, disability, and mortality rates for diving-related and stress-induced disorders between U.S. Navy enlisted divers (n = 11,584) and a matched sample of nondiver enlistees (n = 11,517). Divers had significantly higher hospitalization rates than controls for the category of environmentally induced disorders and deflected nasal septum as well as for joint disorders at ages 23-28. Controls had significantly higher hospitalization rates for stress-related disorders (e.g., alcohol and drug abuse and transient situational disturbances) and circulatory diseases (e.g., cardiovascular disease). Higher rates of medical and physical evaluation board actions for stress-related disorders were observed among controls than among divers. For both groups, medical board, physical evaluation board, and mortality rates increased with age as did hospitalizations for musculoskeletal diseases, stress-related disorders, and circulatory diseases. Subsequent research will examine the long-term health effects associated with divers job-related accidents as well as hospitalizations for environmentally induced disorders and musculoskeletal conditions.