Mothers in the Military: Effect of Maternity Leave Policy on Take-Up.

This study exploits changes in paid maternity leave offered by one of the United States' largest employers, the Department of Defense, to estimate the effect of such policies on mothers' leave-taking. Since 2015, the U.S. Marine Corps has shifted its maternity leave policy from 6 to 18 to 12 weeks. Leave expansions increased leave duration, whereas contractions decreased leave taken by active-duty service members. However, the policy changes crowded out other forms of leave: with an increase in maternity leave available, mothers increased use of maternity leave and stopped supplementing with additional annual leave. Although all mothers used the full 6 weeks of leave in the early period, it is the less advantaged mothers-those in the enlisted ranks, first-time mothers, and single mothers-who disproportionately used more of the additional leave than officers, experienced mothers, and married mothers. Pregnant officers, experienced mothers, and single women used less leave than nonpregnant women in the months leading up to birth, but expecting additional post-birth leave did not change average pre-birth leave-taking. Our results highlight the importance of optimally sizing family leave policies and provide evidence that the true cost of such programs may be lower than the raw count of weeks provided by additional maternity leave allowances.

Violence and Vigilance: The Acute Effects of Community Violent Crime on Sleep and Cortisol.

The data combine objectively measured sleep and thrice-daily salivary cortisol collected from a 4-day diary study in a large Midwestern city with location data on all violent crimes recorded during the same time period for N = 82 children (Mage  = 14.90, range = 11.27-18.11). The primary empirical strategy uses a within-person design to measure the change in sleep and cortisol from the person's typical pattern on the night/day immediately following a local violent crime. On the night following a violent crime, children have later bedtimes. Children also have disrupted cortisol patterns the following morning. Supplementary analyses using varying distances of the crime to the child's home address confirm more proximate crimes correspond to later bedtimes.

Mental Health Treatment Rates During Pregnancy and Post Partum in US Military Service Members.

Importance: Although new parents' mental health is known to decline, less is known about changes in therapy attendance, especially among military service members. Objective: To investigate changes in therapy attendance among new parents and by parental leave length. Design, Setting, and Participants: This cohort study of US Army and Navy service members from January 1, 2013, to December 31, 2019, compared parents' monthly therapy attendance with matched nonparents' across childbirth and compared mothers' weekly therapy attendance before vs after returning to work. Eligible monthly sample members included service members with first births from January 1, 2014, to December 31, 2017, and 12 months of data before to 24 months after birth and nonparents with 36 months of data. Eligible weekly sample members included mothers with first births from January 1, 2013, to June 30, 2019, and data from 12 months before to 6 months after birth and nonparents with 18 months of data. Data analysis was performed from July 1, 2023, to January 15, 2024. Exposure: Those exposed to parenthood had no prior children, acquired a dependent younger than 1 year, and, for mothers, had an inpatient birth. Unexposed matches did not add a dependent younger than 1 year. Main Outcomes and Measures: Monthly counts of mental health therapy sessions and any therapy sessions (weekly). Results: The monthly sample included 15 554 193 person-month observations, representing 321 200 parents and matches, including 10 193 mothers (3.2%; mean [SD] age, 25.0 [4.9] years), 50 865 nonmother matches (15.8%; mean [SD] age, 25.0 [5.0] years), 43 365 fathers (13.5%; mean [SD] age, 26.4 [4.8] years), and 216 777 nonfather matches (67.5%; mean [SD] age, 26.4 [4.8] years). The weekly sample included 17 464 mothers. Mothers went to 0.0712 fewer sessions at 1 month post partum (95% CI, -0.0846 to -0.0579) compared with 10 months before birth. Fathers went to 0.0154 fewer sessions in the month of birth (95% CI, -0.0194 to -0.0114) compared with 10 months before. Parents with preexisting treatment needs had larger decreases in treatment. Weekly therapy attendance increased by 0.555 percentage points (95% CI, 0.257-0.852) when mothers returned to work from 6 weeks of leave and 0.953 percentage points (95% CI, 0.610-1.297) after 12 weeks of leave. Conclusions and Relevance: In this cohort study of new parents, therapy attendance decreased around childbirth, especially among parents with prior mental health needs and mothers with longer maternity leaves. These findings suggest that more accessible treatment, including home visits or telehealth appointments, is needed.

Standing Tall: Do Height-Based Accountability Incentives Predict Artificial Increases in Measured Height Among Sailors in the U.S. Military?

INTRODUCTION: The objective of this study was to investigate the changes in men's and women's measured height in response to weight gain above standards for the U.S. Navy and to quantify associated distortions in body mass index (BMI). We expected that some servicemembers would manipulate their measured height to comply with service standards. MATERIALS AND METHODS: The study was a retrospective observational study. The data were housed in the Person-Event Data Environment, an individual-level administrative registry from the United States Department of Defense. All participants were active-duty U.S. Navy sailors aged 21-50 during the years 2010-2019. The main outcomes were height and weight as recorded during twice-yearly physical fitness assessments and BMI calculated as: height in pounds × 703/(height in inches)2. We assessed whether weight gain above standards was associated with an increase in height at the subsequent height-weight assessment. RESULTS: Among the 489,020 sailors, individuals were nearly 1.5 times as likely to measure taller when they gained weight that put them above military height-weight standards as compared to those who continued to remain within standards. Men were more often out of standards and therefore their measured height increased during subsequent assessments more often than women. Increases in height depressed measures of BMI slightly. CONCLUSIONS: Among U.S. sailors, taller height was correlated with surpassing height-based weight limits, where taller individuals were allowed to weigh more and still meet professional weight standards. Results underscore that current height-weight accountability standards may distort behavior, leading servicemembers to manipulate measurements rather than improve job-relevant fitness. Instead, greater reliance on fitness-based measures of health, such as fitness tests, may hold promise for upholding servicemember readiness. Our results highlight that when stakes are attached to a measure, individuals may work to raise their performance using strategies that are misaligned with the policy intent.

Propensity of US Military Personnel to Seek Mental Health Care When Community Psychiatric Capacity Changes.

Importance: Understanding how the active duty military population's mental health care use is associated with local military and civilian psychiatrist capacity is critical in designing the optimal allocation of mental health resources from both sectors to improve the mental health of military personnel. Objective: To evaluate whether the probability of mental health care visits by military personnel changes when psychiatrist capacity changes in their communities, when capacity is measured separately for military treatment facilities and civilian sectors. Design, Setting, and Participants: This cohort study of active duty US military service members between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census. Data were collected and analyzed from June 2022 to July 2023. Main Outcomes and Measures: The main outcome was the probability of making at least 1 mental health care visit in a given quarter at military treatment facilities and in civilian settings. Linear probability models with 2-dimensional fixed effects at individual and community levels were implemented to estimate changes in individual outcomes when community psychiatrist capacity changed. Results: This study includes 1 958 421 US service members (83% men; mean [SD] age at baseline, 28.4 [8.0] years). Thirteen percent of service members did not have military treatment facility psychiatrists available within a 30-minute driving time, and 66% lived in communities with a psychiatrist shortage (<1 psychiatrist per 20 000 relevant population), while 9% lived in communities with high (>3 psychiatrists per 20 000 relevant population) military treatment facility psychiatrist capacity. Five percent of service members lived in communities with no civilian psychiatrists within a 30-minute driving time, while 66% lived in communities with high civilian psychiatrist capacity. The mean quarterly mental health care visit rates to military treatment facilities and civilian settings were 7% and 2%, respectively. The probability of a mental health care visit to a military treatment facility increased by 0.95 percentage points (95% CI, 0.79-1.10 percentage points; equivalent to 14%) when the individual experienced a change in military treatment facility capacity from no psychiatrist to high capacity. The probability of a mental health care visit to a civilian setting increased by 0.57 percentage points (95% CI, 0.38-0.76 percentage points; equivalent to 32%) when civilian capacity changed from no psychiatrist to high capacity. The magnitude of responses to military treatment facility capacity changes remained similar in communities that already had high civilian capacity. Conclusions and Relevance: This cohort study of the US military population suggests that active duty military personnel rely largely on military treatment facilities for their mental health care and that there are meaningful responses to military treatment facility psychiatrist capacity changes even in communities with high civilian psychiatric capacity. Realigning military treatment facility psychiatrists across communities with shortages and high-capacity military treatment facilities, as well as addressing nongeographical barriers in the civilian sector, remain critical to achieve the optimal balance between military and civilian care provision.

Physiological and Cognitive Performance in F-22 Pilots During Day and Night Flying.

BACKGROUND: Many workers routinely transition between day and night shiftsincluding pilots, where night flights are commonly considered more stressful. The physiological toll from this transition is not fully understood, though fatigue is a factor in many aviation accidents. This research investigated the changes in physiological markers of stress and cognitive performance as F-22 pilots transitioned from day flying to night flying.METHODS: There were 17 fully-qualified F-22 pilots who took part in a 2-wk data collection using salivary swabs, wrist-worn activity monitors, the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) inventory, and a go/no-go (GNG) test.RESULTS: No differences were found in comparing day and night flying on the GNG reaction time/accuracy, NASA-TLX scores, or sleep quantity. Cortisol levels were significantly higher than civilian levels in all experimental conditions and control days. Participants had higher than predicted cortisol levels postflight in the day-flying condition and lower than predicted cortisol levels postflight in the night-flying condition, relative to levels from control day patterns. We also found smaller changes in cortisol (pre- to postflight) in the day-flying condition for those with more F-22 experience. Finally, we found a negative correlation between Perceived Stress Scale scores and age of pilots (r 0.72).DISCUSSION: We hypothesized that the night-flying environment would be more stressful, but our results disputed this claim. Our results suggest day flying elicits more of a stress response; however, a larger sample size is required to verify results. Preliminary findings of potential stress adaptation may suggest stress adaptation in the F-22 community needs further investigation.Combs EK, Dahlman AS, Shattuck NL, Heissel JA, Whitaker LR. Physiological and cognitive performance in F-22 pilots during day and night flying. Aerosp Med Hum Perform. 2021; 92(5):303311.

Adolescents' technology and face-to-face time use predict objective sleep outcomes.

OBJECTIVES: The present study examined both within- and between-person associations between adolescents' time use (technology-based activities and face-to-face interactions with friends and family) and sleep behaviors. We also assessed whether age moderated associations between adolescents' time use with friends and family and sleep. DESIGN: Adolescents wore an actigraph monitor and completed brief evening surveys daily for 3 consecutive days. PARTICIPANTS: Adolescents (N=71; mean age=14.50 years old, SD=1.84; 43.7% female) were recruited from 3 public high schools in the Midwest. MEASURES: We assessed 8 technology-based activities (eg, texting, working on a computer), as well as time spent engaged in face-to-face interactions with friends and family, via questions on adolescents' evening surveys. Actigraph monitors assessed 3 sleep behaviors: sleep latency, sleep hours, and sleep efficiency. RESULTS: Hierarchical linear models indicated that texting and working on the computer were associated with shorter sleep, whereas time spent talking on the phone predicted longer sleep. Time spent with friends predicted shorter sleep latencies, while family time predicted longer sleep latencies. Age moderated the association between time spent with friends and sleep efficiency, as well as between family time and sleep efficiency. Specifically, longer time spent interacting with friends was associated with higher sleep efficiency but only among younger adolescents. Furthermore, longer family time was associated with higher sleep efficiency but only for older adolescents. CONCLUSION: Findings are discussed in terms of the importance of regulating adolescents' technology use and improving opportunities for face-to-face interactions with friends, particularly for younger adolescents.

Psychological and biological responses to race-based social stress as pathways to disparities in educational outcomes.

We present the race-based disparities in stress and sleep in context model (RDSSC), which argues that racial/ethnic disparities in educational achievement and attainment are partially explained by the effects of race-based stressors, such as stereotype threat and perceived discrimination, on psychological and biological responses to stress, which, in turn, impact cognitive functioning and academic performance. Whereas the roles of psychological coping responses, such as devaluation and disidentification, have been theorized in previous work, the present model integrates the roles of biological stress responses, such as changes in stress hormones and sleep hours and quality, to this rich literature. We situate our model of the impact of race-based stress in the broader contexts of other stressors [e.g., stressors associated with socioeconomic status (SES)], developmental histories of stress, and individual and group differences in access to resources, opportunity and employment structures. Considering both psychological and biological responses to race-based stressors, in social contexts, will yield a more comprehensive understanding of the emergence of academic disparities between Whites and racial/ethnic minorities. (PsycINFO Database Record

Developmental histories of perceived racial discrimination and diurnal cortisol profiles in adulthood: A 20-year prospective study.

Perceived racial discrimination (PRD) has been associated with altered diurnal cortisol rhythms in past cross-sectional research. We investigate whether developmental histories of PRD, assessed prospectively, are associated with adult diurnal cortisol profiles. One-hundred and twelve (N=50 Black, N=62 White) adults from the Maryland Adolescent Development in Context Study provided saliva samples in adulthood (at approximately age 32 years) at waking, 30min after waking, and at bedtime for 7 days. Diurnal cortisol measures were calculated, including waking cortisol levels, diurnal cortisol slopes, the cortisol awakening response (CAR), and average daily cortisol (AUC). These cortisol outcomes were predicted from measures of PRD obtained over a 20-year period beginning when individuals were in 7th grade (approximately age 12). Greater average PRD measured across the 20-year period predicted flatter adult diurnal cortisol slopes for both Black and White adults, and a lower CAR. Greater average PRD also predicted lower waking cortisol for Black, but not White adults. PRD experiences in adolescence accounted for many of these effects. When adolescent and young adult PRD are entered together predicting cortisol outcomes, PRD experiences in adolescence (but not young adulthood) significantly predicted flatter diurnal cortisol slopes for both Black and White adults. Adolescent, but not young adult PRD, also significantly predicted lower waking and lower average cortisol for Black adults. Young adult PRD was, however, a stronger predictor of the CAR, predicting a marginally lower CAR for Whites, and a significantly larger CAR for Blacks. Effects were robust to controlling for covariates including health behaviors, depression, income and parent education levels. PRD experiences interacted with parent education and income to predict aspects of the diurnal cortisol rhythm. Although these results suggest PRD influences on cortisol for both Blacks and Whites, the key findings suggest that the effects are more pervasive for Blacks, affecting multiple aspects of the cortisol diurnal rhythm. In addition, adolescence is a more sensitive developmental period than adulthood for the impacts of PRD on adult stress biology.