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Studies

Welcome to the Military Health System Studies Inventory Tool (MSIT). Military Health System (MHS) data are used by Department of Defense, Veterans Administration, and academic health professionals and scientists to implement health care studies. These studies reflect the MHS interest to rigorously assess and improve our beneficiaries’ access to the high quality health care services they need. Additionally, these studies are frequently used to develop or improve MHS policy and often adopt useful, relevant comparisons to the national health care experience.

The MSIT allows easy review of recent studies that are either conducted or sponsored by the MHS, or accomplished using datasets developed or maintained by the Defense Health Agency for administrative, operational, or research purposes. The studies within this website represent important contributions of the MHS to the national health care dialogue and reflect our capacity to tackle the challenging issues needed to support evidence-informed health policy. Thank you for your interest in them.

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The Experience, Expression, and Control of Anger Following Traumatic Brain Injury in a Military Sample.

Study

Abstract

OBJECTIVE: To investigate the impact of traumatic brain injury (TBI) on the experience and expression of anger in a military sample. PARTICIPANTS: A total of 661 military personnel with a history of TBI and 1204 military personnel with no history of TBI. DESIGN: Cross-sectional, between-group design, using multivariate analysis of variance. MAIN MEASURE: State-Trait Anger Expression Inventory-2 (STAXI-2). RESULTS: Participants with a history of TBI had higher scores on the STAXI-2 than controls and were 2 to 3 times more likely than the participants in the control group to have at least 1 clinically significant elevation on the STAXI-2. Results suggested that greater time since injury (ie, months between TBI and assessment) was associated with lower scores on the STAXI-2 State Anger scale. CONCLUSION: Although the results do not take into account confounding psychiatric conditions and cannot address causality, they suggest that a history of TBI increases the risk of problems with the experience, expression, and control of anger. This bolsters the need for proper assessment of anger when evaluating TBI in a military cohort.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense and Veterans Brain Injury Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: February 01, 2014
  • Citation: Bailie JM, Cole WR, Ivins B, Boyd C, Lewis S, Neff J, Schwab K. The Experience, Expression, and Control of Anger Following Traumatic Brain Injury in a Military Sample. J Head Trauma Rehabil. 2014 Feb 28.

Outcomes after bankart repair in a military population: predictors for surgical revision and long-term disability.

Study

Abstract

PURPOSE: To quantify the rate of surgical failure after anterior shoulder stabilization procedures, as well as to identify demographic and surgical risk factors associated with poor outcomes. METHODS: All Army patients undergoing arthroscopic or open Bankart repair for shoulder instability were isolated from the Military Health System Management Analysis and Reporting Tool between 2003 and 2010. Demographic variables (age, gender) and surgical variables (treatment facility volume, admission status, surgical technique) were extracted. Rates of surgical failure, defined as subsequent revision surgery or medical discharge with persistent shoulder complaints, were recorded from the electronic medical record and US Army Physical Disability Agency database. Risk factor analysis was performed with univariate t tests, χ(2) tests, and a multivariable logistic regression model with failure as the outcome. RESULTS: A total of 3,854 patients underwent Bankart repair during the study period, with most procedures having been performed arthroscopically (n = 3,230, 84%) and on an outpatient basis (n = 3,255, 84%). Patients were predominately men (n = 3,531, 92%), and the mean age was 28.0 years (SD, 7.5 years). A total of 193 patients (5.0%) underwent revision stabilization whereas 339 patients (8.8%) were medically discharged with complaints of shoulder instability, for a total combined failure rate of 13.8% (n = 532). Univariate analyses showed no significant effect for gender; however, younger age, higher facility volume, open repair, and inpatient status were significant factors associated with subsequent surgical failure. Multivariable analyses confirmed that young age (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.91 to 0.96; P < .001), open repair (OR, 0.52; 95% CI, 0.36 to 0.75; P = .001), and inpatient status (OR, 0.58; 95% CI, 0.40 to 0.84; P = .004) were independently associated with failure by revision surgery. CONCLUSIONS: Young age remains a significant risk factor for surgical failure after Bankart repair. Patients who underwent arthroscopic Bankart repair had a significantly lower surgical failure rate (4.5%) than patients who underwent open anterior stabilization (7.7%). Despite advances in surgical technique, 1 in 20 military service members required revision surgery after failed primary stabilization in this study.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: February 01, 2014
  • Citation: Waterman BR, Burns TC, McCriskin B, Kilcoyne K, Cameron KL, Owens BD. Outcomes after bankart repair in a military population: predictors for surgical revision and long-term disability. Arthroscopy. 2014 Feb;30(2):172-7.

Mental health outcomes in US and UK military personnel returning from Iraq.

Study

Abstract

BACKGROUND: Research of military personnel who deployed to the conflicts in Iraq or Afghanistan has suggested that there are differences in mental health outcomes between UK and US military personnel. AIMS: To compare the prevalence of post-traumatic stress disorder (PTSD), hazardous alcohol consumption, aggressive behaviour and multiple physical symptoms in US and UK military personnel deployed to Iraq. METHOD: Data were from one US (n = 1560) and one UK (n = 313) study of post-deployment military health of army personnel who had deployed to Iraq during 2007-2008. Analyses were stratified by high- and low-combat exposure. RESULTS: Significant differences in combat exposure and sociodemographics were observed between US and UK personnel; controlling for these variables accounted for the difference in prevalence of PTSD, but not in the total symptom level scores. Levels of hazardous alcohol consumption (low-combat exposure: odds ratio (OR) = 0.13, 95% CI 0.07-0.21; high-combat exposure: OR = 0.23, 95% CI 0.14-0.39) and aggression (low-combat exposure: OR = 0.36, 95% CI 0.19-0.68) were significantly lower in US compared with UK personnel. There was no difference in multiple physical symptoms. CONCLUSIONS: Differences in self-reported combat exposures explain most of the differences in reported prevalence of PTSD. Adjusting for self-reported combat exposures and sociodemographics did not explain differences in hazardous alcohol consumption or aggression.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office: United States Army Medical Research and Materiel Command
  • Congressionally Mandated: No
  • Funding Source: Army
  • Release Date/Publication: March 01, 2014
  • Citation: Sundin J, Herrell RK, Hoge CW, Fear NT, Adler AB, Greenberg N, Riviere LA, Thomas JL, Wessely S, Bliese PD. Mental health outcomes in US and UK military personnel returning from Iraq. Br J Psychiatry. 2014 Mar;204(3):200-7.

Melanoma incidence rates in active duty military personnel compared with a population-based registry in the United States, 2000-2007.

Study

Abstract

OBJECTIVES: This study was conducted to investigate whether incidence rates of malignant cutaneous melanoma in U.S. Department of Defense active duty military personnel differed from rates in the U.S. general population between 2000 and 2007. METHODS: The study population included active duty military personnel and the general population aged 18 to 56 years. Data were obtained from the U.S. Department of Defense medical data systems and from the Surveillance Epidemiology and End Results program. Melanoma risk was estimated by incidence rate ratios (IRRs). RESULTS: Melanoma risk was higher among active duty personnel than the general population (IRR = 1.62, 95% confidence interval = 1.40-1.86). Incidence rates were higher for white military personnel than for white rates in general population (36.89 and 23.05 per 100,000 person-years, respectively). Rates were also increased for military men and women compared with SEER (men, 25.32 and 16.53 per 100,000; women, 30.00 and 17.55 per 100,000). Air Force service personnel had the highest rates and Army had the lowest. CONCLUSION: Melanoma rates were marginally higher among active duty military personnel than the general population between 2000 and 2007.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: March 01, 2014
  • Citation: Lea CS, Efird JT, Toland AE, Lewis DR, Phillips CJ. Melanoma incidence rates in active duty military personnel compared with a population-based registry in the United States, 2000-2007. Mil Med. 2014 Mar;179(3):247-53.

Absolute and relative morbidity burdens attributable to various illnesses and injuries, non-service member beneficiaries of the Military Health System, 2013.

Study

Abstract

Individuals who are eligible for care through the Military Health System (MHS) (“beneficiaries”) include family members of active component service members, family members of National Guard and Reserve service members, and retirees and eligible family members of retirees. In 2013, there were approximately 1.98 million active component family members, 550,000 Guard/Reserve family members, and 5.29 million retirees and their family members eligible for medical care from the MHS. Some beneficiaries of MHS care do not enroll in the healthcare plans provided by the MHS (e.g., if they use insurance through their own employment); also, some of those who are enrolled do not seek care through the MHS. MHS beneficiaries may receive care from resources provided directly by the Uniformed Services (i.e., military medical treatment facilities [MTFs]) or from civilian healthcare resources (i.e., outsourced [purchased] care) that supplement direct military medical care. In 2013, approximately 6.8 million individuals utilized inpatient or outpatient services provided by the MHS. In the population of MHS care recipients in 2013, there were more females (58%) than males (42%) and more infants, children, and adolescents (<20 years: n=1.9 million; 28.9%) and more seniors (65 years or older: n=1.8 million; 26.1%) than younger (20–44 years: n=1.4 million; 20.1%) or older (45–64 years: n=1.7 million; 24.9%) adults. Since 1998, the MSMR has published annual summaries of the numbers and rates of hospitalizations and outpatient medical encounters to assess the healthcare “burdens” of 16 categories of illnesses and injuries among active component military members. This year, for the first time and using similar methodology, this report quantifies the illnesses and injuries among non-service members who received care in the MHS in 2013. Healthcare burden estimates are stratified by direct versus outsourced care and across four age groups of healthcare recipients.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: April 01, 2014
  • Citation: AFHSC. Absolute and relative morbidity burdens attributable to various illnesses and injuries, non-service member beneficiaries of the Military Health System, 2013. MSMR. 2014 Apr;21(4):23-30; discussion 30.

Legionellosis in Military Health System beneficiaries, 1998-2013.

Study

Abstract

Legionellosis is an infection caused by exposure to mist or vapor contaminated with Legionella bacteria. During the 16-year surveillance period, 73 cases of legionellosis were identified in active component service members; 37 were identified among the reserve component; and 1,044 were identified among all other beneficiaries of the Military Health System (MHS). Of the total 1,154 cases of legionellosis, 11 percent (n=126) were confirmed cases (i.e., reportable medical events); 52 percent (n=599) were probable cases (i.e., hospitalizations); and 37 percent (n=429) were suspected cases (i.e., ambulatory visits). Most of the cases (59%) were identified in individuals aged 60 years and older. The annual number of cases increased during the surveillance period and demonstrated a seasonal trend with more cases occurring in the summer and early fall. Recent trends in the incidence of legionellosis among MHS beneficiaries and civilian populations in the United States highlight the importance of correctly identifying the etiologic agents of bacterial pneumonia and submitting reports of cases of legionellosis through the appropriate reporting system.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: March 01, 2014
  • Citation: AFHSC. Legionellosis in Military Health System beneficiaries, 1998-2013. MSMR. 2014 Mar;21(3):6-9.

Military healthcare providers reporting of adverse events following immunizations to the vaccine adverse event reporting system.

Study

Abstract

OBJECTIVES: We studied military health care provider (HCP) practices regarding reporting of adverse events following immunization (AEFI). METHODS: A convenience sample of HCP was surveyed to assess familiarity with Vaccine Adverse Event Reporting System (VAERS), AEFI they were likely to report, methods used and preferred for reporting, and perceived barriers to reporting. We analyzed factors associated with HCP reporting AEFI to VAERS. RESULTS: A total of 547 surveys were distributed with 487 completed and returned for an 89% response rate. The percentage of HCP aware of VAERS (54%) varied by occupation. 47% of respondents identified knowledge of at least one AEFI with only 34% of these indicating that they had ever reported to VAERS. More serious events were more likely to be reported. Factors associated with HCP reporting AEFIs in bivariate analysis included HCP familiarity with filing a paper VAERS report, HCP familiarity with filing an electronic VAERS report, HCP familiarity with VAERS, and time spent on immunization tasks. In a multivariable analysis, only HCP familiarity with filing a paper VAERS report was statistically significant (Odds ratio = 115.3; p < 0.001). CONCLUSIONS: Specific educational interventions targeted to military HCP likely to see AEFIs but not currently filing VAERS reports may improve vaccine safety reporting practices.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Walter Reed National Military Medical Center
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: April 01, 2014
  • Citation: Li R, McNeil MM, Pickering S, Pemberton MR, Duran LL, Collins LC, Nelson MR, Engler RJ. Military healthcare providers reporting of adverse events following immunizations to the vaccine adverse event reporting system. Mil Med. 2014 Apr;179(4):435-41

Variation in rates of autoimmune thyroid disease by race/ethnicity in US military personnel.

Study

Abstract

The relationship between Graves disease and race/ethnicity is undefined. Based on thyroid antibody prevalence, the rates of Hashimoto thyroiditis may be highest in whites and lowest in blacks. Using a large and comprehensive data set of medical diagnoses for all US active duty service personnel, we calculated age-standardized incidence rates for Graves disease and Hashimoto thyroiditis by race/ethnicity. Compared with whites, the IRR for Graves disease was significantly elevated in black women (IRR, 1.92; 95% CI, 1.56-2.37) and men (IRR, 2.53; 95% CI, 2.01-3.18) and Asian/Pacific Islander women (IRR, 1.78; 95% CI, 1.20-2.66) and men (IRR, 3.36; 95% CI, 2.57-4.40) (Figure). In contrast, Hashimoto thyroiditis incidence was highest in whites and lowest in black women (IRR, 0.33; 95% CI, 0.21-0.51) and men (IRR, 0.22; 95% CI, 0.11-0.47) and Asian/Pacific Islander women (IRR, 0.31; 95% CI, 0.17-0.56) and men (IRR, 0.23; 95% CI, 0.07-0.72). The differences in incidence by race/ethnicity may be due to different environmental exposures, genetics, or a combination of both. Our results are not easily attributable to the strongest known environmental risk factor, cigarette smoking.

  • Publication Status: Published
  • Sponsoring Organization: Undetermined
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Government, academic, or industry source other than Federal Government
  • Release Date/Publication: April 01, 2014
  • Citation: McLeod DS, Caturegli P, Cooper DS, Matos PG, Hutfless S. Variation in rates of autoimmune thyroid disease by race/ethnicity in US military personnel. JAMA. 2014 Apr 16;311(15):1563-5.

Lower obesity rate during residence at high altitude among a military population with frequent migration: a quasi experimental model for investigating spatial causation.

Study

Abstract

We sought to evaluate whether residence at high altitude is associated with the development of obesity among those at increased risk of becoming obese. Obesity, a leading global health priority, is often refractory to care. A potentially novel intervention is hypoxia, which has demonstrated positive long-term metabolic effects in rats. Whether or not high altitude residence confers benefit in humans, however, remains unknown. Using a quasi-experimental, retrospective study design, we observed all outpatient medical encounters for overweight active component enlisted service members in the U.S. Army or Air Force from January 2006 to December 2012 who were stationed in the United States. We compared high altitude (>1.96 kilometers above sea level) duty assignment with low altitude (<0.98 kilometers). The outcome of interest was obesity related ICD-9 codes (278.00-01, V85.3x-V85.54) by Cox regression. We found service members had a lower hazard ratio (HR) of incident obesity diagnosis if stationed at high altitude as compared to low altitude (HR 0.59, 95% confidence interval [CI] 0.54-0.65; p<0.001). Using geographic distribution of obesity prevalence among civilians throughout the U.S. as a covariate (as measured by the Centers for Disease Control and Prevention and the REGARDS study) also predicted obesity onset among service members. In conclusion, high altitude residence predicts lower rates of new obesity diagnoses among overweight service members in the U.S. Army and Air Force. Future studies should assign exposure using randomization, clarify the mechanism(s) of this relationship, and assess the net balance of harms and benefits of high altitude on obesity prevention.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences/Armed Forces Health Surveillance Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: April 01, 2014
  • Citation: Voss JD, Allison DB, Webber BJ, Otto JL, Clark LL. Lower obesity rate during residence at high altitude among a military population with frequent migration: a quasi experimental model for investigating spatial causation. PLoS One. 2014 Apr 16;9(4):e93493

Energy drinks: review of performance benefits, health concerns, and use by military personnel.

Study

Abstract

Energy drinks (EDs) are highly caffeinated beverages usually containing herbal ingredients promoted and consumed for purported improvements in attention and athletic performance. The popularity of EDs among adolescents and young adults has steadily increased for more than a decade. Reports suggest U.S. military populations consume EDs with greater frequency as compared to age-matched civilian populations. This article reviews the literature and outlines the current body of evidence evaluating the human performance benefits and potential harms associated with ED use.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: April 01, 2014
  • Citation: Johnson LA, Foster D, McDowell JC. Energy drinks: review of performance benefits, health concerns, and use by military personnel. Mil Med. 2014 Apr;179(4):375-80.

Occupational driving as a risk factor for low back pain in active-duty military service members.

Study

Abstract

BACKGROUND CONTEXT: Although occupational driving has been associated with low back pain, little has been reported on the incidence rates for this disorder. PURPOSE: To determine the incidence rate and demographic risk factors of low back pain in an ethnically diverse and physically active population of US military vehicle operators. STUDY DESIGN/SETTING: Retrospective database analysis. PATIENT SAMPLE: All active-duty military service members between 1998 and 2006. OUTCOME MEASURES: Low back pain requiring visit to a health-care provider. METHODS: A query was performed using the US Defense Medical Epidemiology Database for the International Classification of Diseases, Ninth Revision, Clinical Modification code for low back pain (724.20). Multivariate Poisson regression analysis was used to estimate the rate of low back pain among military vehicle operators and control subjects per 1,000 person-years, while controlling for sex, race, rank, service, age, and marital status. RESULTS: A total of 8,447,167 person-years of data were investigated. The overall unadjusted low back pain incidence rate for military members whose occupation is vehicle operator was 54.2 per 1,000 person-years. Compared with service members with other occupations, motor vehicle operators had a significantly increased adjusted incidence rate ratio (IRR) for low back pain of 1.15 (95% confidence interval [CI] 1.13-1.17). Female motor vehicle operators, compared with males, had a significantly increased adjusted IRR for low back pain of 1.45 (95% CI 1.39-1.52). With senior enlisted as the referent category, the junior enlisted rank group of motor vehicle operators had a significantly increased adjusted IRR for low back pain: 1.60 (95% CI 1.52-1.70). Compared with Marine service members, those motor vehicle operators in both the Army, 2.74 (95% CI 2.60-2.89), and the Air Force, 1.98 (95% CI 1.84-2.14), had a significantly increased adjusted IRR for low back pain. The adjusted IRRs for the less than 20-year and more than 40-year age groups, compared with the 30- to 39-year age group, were 1.24 (1.15-1.36) and 1.23 (1.10-1.38), respectively. CONCLUSIONS: Motor vehicle operators have a small but statistically significantly increased rate of low back pain compared with matched control population.

  • Publication Status: Published
  • Sponsoring Organization: Army
  • Sponsoring Office:
  • Congressionally Mandated: No
  • Funding Source: Undetermined
  • Release Date/Publication: April 01, 2014
  • Citation: Knox JB, Orchowski JR, Scher DL, Owens BD, Burks R, Belmont PJ Jr. Occupational driving as a risk factor for low back pain in active-duty military service members. Spine J. 2014 Apr;14(4):592-7.

Dwell time and psychological screening outcomes among military service members with multiple combat deployments.

Study

Abstract

Recent studies have found that longer dwell times, or the period of time between deployments, may be protective against combat-related psychological outcomes. The purpose of this study was to examine the association between dwell time and psychological morbidity, while accounting for combat exposure. U.S. Marines with two combat deployments between 2005 and 2008 were identified from electronic deployment records. Those who screened positive for post-traumatic stress disorder and depression, and who were referred for mental health services were identified from the Post-Deployment Health Assessment. For the final study sample of 3,512 Marines, dwell time was calculated as time between deployments, and was analyzed as a ratio over length of first deployment. After adjustment for all covariates, there was an interaction (p = 0.01) between dwell time and combat exposure on mental health referral outcome. For personnel with maximum reported combat exposure, longer dwell times were associated with a 49% to 92% reduced odds of mental health referral. Longer dwell times may be protective against combat-related psychological outcomes. Because multiple deployments are likely to be the norm in future military operations, regulating dwell time, particularly for those with greater risk of combat exposure, should continue to be explored.

  • Publication Status: Published
  • Sponsoring Organization: Navy
  • Sponsoring Office: Naval Health Research Center
  • Congressionally Mandated: No
  • Funding Source: Navy
  • Release Date/Publication: April 01, 2014
  • Citation: MacGregor AJ, Heltemes KJ, Clouser MC, Han PP, Galarneau MR. Dwell time and psychological screening outcomes among military service members with multiple combat deployments. Mil Med. 2014 Apr;179(4):381-7.

Diagnostic and psychosocial differences in psychiatrically hospitalized military service members with single versus multiple suicide attempts.

Study

Abstract

INTRODUCTION: Individuals with multiple versus single suicide attempts present a more severe clinical picture and may be at greater risk for suicide. Yet group differences within military samples have been vastly understudied. PURPOSE: The objective is to determine demographic, diagnostic, and psychosocial differences, based on suicide attempt status, among military inpatients admitted for suicide-related events. METHOD: A retrospective chart review design was used with a total of 423 randomly selected medical records of psychiatric admissions to a military hospital from 2001 to 2006. RESULTS: Chi-square analyses indicated that individuals with multiple versus single suicide attempts were significantly more likely to have documented childhood sexual abuse (p =.025); problem substance use (p=.001); mood disorder diagnosis (p=.005); substance disorder diagnosis (p =.050); personality disorder not otherwise specified diagnosis (p =.018); and Axis II traits or diagnosis (p=.038) when compared to those with a single attempt history. Logistic regression analyses showed that males with multiple suicide attempts were more likely to have problem substance use (p=.005) and a mood disorder diagnosis (p =.002), while females with a multiple attempt history were more likely to have a history of childhood sexual (p =.027). DISCUSSION: Clinically meaningful differences among military inpatients with single versus multiple suicide attempts exist. Targeted Department of Defense suicide prevention and intervention efforts that address the unique needs of these two specific at-risk subgroups are additionally needed.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: April 01, 2014
  • Citation: Kochanski-Ruscio KM, et.al., Diagnostic and psychosocial differences in psychiatrically hospitalized military service members with single versus multiple suicide attempts. Compr Psychiatry. 2014 Apr;55(3):450-6.

Energy drink and energy shot use in the military.

Study

Abstract

Use of energy drinks and energy shots among military personnel is controversial. High amounts of caffeine (the primary active ingredient in these products) may impact performance of military duties. The impact of caffeine overconsumption and potential subsequent side effects that might be experienced by service members with unique roles and responsibilities is a concern. Reported here are the prevalence of use, reasons for use, and side effects associated with consumption of energy drinks and energy shots among several populations of active duty personnel in the US military. A snowball survey was sent to over 10,000 active duty personnel. A total of 586 (∼6% response rate) individuals completed a 30-item electronic survey. Over half of respondents (53%) reported consuming an energy drink at least once in the past 30 days. One in five (19%) reported energy shot consumption in the prior 30 days. One in five (19%) also reported consuming an energy drink in combination with an alcoholic beverage. Age and gender were significantly associated with energy drink consumption. Young male respondents (18-29 years) reported the highest use of both energy drinks and energy shots. Among those reporting energy drink and energy shot use, the most common reasons for consumption were to improve mental alertness (61%) and to improve mental (29%) and physical (20%) endurance. Nearly two-thirds (65%) of users self-reported at least one side effect. The most commonly reported side effects included increased pulse rate/palpitations, restlessness, and difficulty sleeping. Use of energy products among military personnel is common and has the potential to impact warrior health and military readiness.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Uniformed Services University of Health Sciences
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2014
  • Citation: Stephens MB, Attipoe S, Jones D, Ledford CJ, Deuster PA. Energy drink and energy shot use in the military. Nutr Rev. 2014 Oct;72 Suppl 1:72-7.

Influence of the severity and location of bodily injuries on post-concussive and combat stress symptom reporting after military-related concurrent mild traumatic brain injuries and polytrauma.

Study

Abstract

Traumatic brain injuries (TBI) sustained in combat frequently co-occur with significant bodily injuries. Intuitively, more extensive bodily injuries might be associated with increased symptom reporting. In 2012, however, French et al. demonstrated an inverse relation between bodily injury severity and symptom reporting. This study expands on that work by examining the influence of location and severity of bodily injuries on symptom reporting after mild TBI. Participants were 579 US military service members who sustained an uncomplicated mild TBI with concurrent bodily injuries and who were evaluated at two military medical centers. Bodily injury severity was quantified using a modified Injury Severity Score (ISSmod). Participants completed the Neurobehavioral Symptom Inventory (NSI) and the Posttraumatic Stress Disorder Checklist (PCL-C), on average, 2.5 months post-injury. There was a significant negative association between ISSmod scores and NSI (r=-0.267, p<0.001) and PCL-C (r=-0.273, p<0.001) total scores. Using linear regression to examine the relation between symptom reporting and injury severity across the six ISS body regions, three body regions were significant predictors of the NSI total score (face; p<0.001; abdomen; p=0.003; extremities; p<0.001) and accounted for 9.3% of the variance (p<0.001). For the PCL-C, two body regions were significant predictors of the PCL-C total score (face; p<0.001; extremities; p<0.001) and accounted for 10.5% of the variance. There was an inverse relation between bodily injury severity and symptom reporting in this sample. Hypothesized explanations include underreporting of symptoms, increased peer support, disruption of fear conditioning because of acute morphine use, or delayed expression of symptoms.

  • Publication Status: Published
  • Sponsoring Organization: Defense Health Agency (formerly TRICARE Management Activity)
  • Sponsoring Office: Defense and Veterans Brain Injury Center
  • Congressionally Mandated: No
  • Funding Source: Defense Health Agency (formerly TRICARE Management Activity)
  • Release Date/Publication: October 01, 2014
  • Citation: French LM, et.al . Influence of the severity and location of bodily injuries on post-concussive and combat stress symptom reporting after military-related concurrent mild traumatic brain injuries and polytrauma. J Neurotrauma. 2014 Oct 1;31(19):1607-16.
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