U.S. active-duty service women's urogenital health and operational readiness through the lens of the IBM-WASH model: A systematic integrative review.

AIM: Identify literature regarding urogenital health and hygiene practices/behaviors of U.S. active-duty service women (ADSW) with attention to environmental conditions; access to water, sanitation, and hygiene (WASH) resources in austere environments. Synthesize relationships among the 3-dimensions and 5-levels of the Integrated Behavioral Model for Water, Sanitation, and Hygiene (IBM-WASH). BACKGROUND: ADSW face sex-specific urogenital health challenges due to decreased access to WASH resources in austere environments, leading to increased risk for urogenital infection-related outcomes (urinary tract infections, vulvovaginal candidiasis, and bacterial vaginosis). During military conflicts in Afghanistan and Iraq, urogenital infections in ADSW were reported as one of the top five medical encounters, and one of the top seven reasons for medical evacuation. METHODS: A systematic review was performed in MEDLINE, CINAHL, Embase, and ClinicalTrials.gov databases, between January 2007-November 2021, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses as a reporting guideline. Eligible literature was evaluated utilizing the Johns Hopkins Research Evidence Appraisal Tool. WASH interactions were mapped using the IBM-WASH interactive matrix. RESULTS: Evidence gaps include shifting focus from "deployment" to environmental austerity; lack of training/education; shifting male-centric culture; and innovative technologies for safety/security. CONCLUSIONS: The IBM-WASH framework allowed for quantification and interpretation of complex interactions occurring in real world austere environments. Some could be overcome individually, but in aggregate they lead to progressive urogenital conditions and potential mission failure. Prevention, diagnosis, and treatment can mitigate disease sequelae. Preventive knowledge and access to innovative technologies designed for ease and private use are critical to preserve operational readiness.

Continuing the legacy of a military women's health research interest group.

The Military Women's Health Research Interest Group (MWHRIG) was established in 2010. The purpose of the MWHRIG is to support military clinicians and leaders in determining research priorities, and making evidence-based practice and policy decisions relevant to sex- and gender-appropriate healthcare. This article highlights the history of the MWHRIG, and current activities inclusive of research, mentorship, and collaboration. Future activities for the MWHRIG will focus on continued use of a theoretical framework for military women's health research, inclusivity of gender sexual diversity (GSD), and metrics for future success.

Determinants of Human Papillomavirus Vaccination Among U.S. Navy Personnel.

BACKGROUND: Human papillomavirus (HPV) is the most common sexually transmitted infection, with at least half of sexually active people contracting the virus-a leading etiology for genital warts and anal, cervical, laryngeal, penile, vaginal, and vulvar cancers. Research suggests HPV is higher among U.S. military personnel than in U.S. civilian populations and can result in significant morbidity or complications and limit U.S. military's duties or deployable status. OBJECTIVES: The aim of the study was to identify determinants of HPV vaccination among U.S. Navy personnel. METHODS: Participants (N = 233) recruited from both active duty and activated reservists, attached to Commander, Naval Surface Force, U.S. Pacific Fleet (COMNAVSURFPAC), located in Japan and the United States, completed an anonymous online survey between June and October 2015. Bivariate analysis was used to examine relationships between sociodemographic, psychological factors, and HPV vaccination. Logistic regression was utilized to identify factors that increase odds for HPV vaccination. RESULTS: HPV vaccination was associated with gender; having deployed in the past 3 years; having heard of HPV, HPV testing, and HPV vaccine; HPV self-rating knowledge; where one heard about the vaccine; belief the chain of command recommends the vaccine; and HPV general knowledge, testing knowledge, and vaccine knowledge (p < .05). The regression model was statistically significant, χ(19) = 97.216, p < .001; four variables contributed to the model. DISCUSSION: Determinants of HPV vaccination were female gender; hearing about HPV vaccine from a healthcare provider, media, or Internet; belief the chain of command recommends the HPV vaccine; and greater HPV vaccine knowledge. Results augment healthcare professionals' and policy makers' existing evidence-based knowledge of the determinants of HPV vaccination to help develop effective HPV immunization policies and programs.

HPV-Related Cancers: A Growing Threat to U.S. Military Health and Readiness.

The incidence of human papillomavirus (HPV) related cancers is growing in the United States. Active duty service members (ADSM) have higher rates of HPV infection than civilians and are therefore at greater risk of developing HPV-related cancers. The purpose of this commentary is to examine the burden of HPV-related cancers in ADSM. The current HPV vaccination and cervical cancer screening uptake rates of U.S. ADSM are presented, including a literature review of military-focused studies on HPV vaccination and cervical cancer screenings. We provide directions for future research, interventions, and policy recommendations to improve HPV-related cancer prevention among ADSM.

A Grounded Theory Approach to Navigating Infertility Care During U.S. Military Service.

INTRODUCTION: In this study, we aimed to understand how active duty service members and their partners navigate the infertility care process within the Military Health System (MHS) while managing a military career. MATERIALS AND METHODS: We obtained Institutional Review Board approval to employ a qualitative design using grounded theory methods. We recruited participants using purposive sampling, followed by theoretical sampling. We derived data from demographic questionnaires and semi-structured interviews. Consistent with grounded theory methods, we began analysis with line-by-line coding and moved to focused coding. We employed constant comparative analysis throughout the process to name, categorize, and conceptualize data and relationships. RESULTS: The participants included 28 patients, five partners, nine health care providers, and two military leaders. The infertility care process began with active duty service members and their partners recognizing the desire to have a child and discovering infertility, followed by deciding to seek infertility care. The experience was temporally bound within the context of the military environment. We identified the following themes, which described facilitators and barriers to accessing care: Duty station location, career stage, military versus the civilian cost of services, command climate, and policy. These facilitators and barriers varied widely across the Department of Defense (DoD), which resulted in fragmented and inconsistent care cycles, contributed to emotional and physical stress, and created tension between career progression and family formation. CONCLUSIONS: Understanding how military couples perceive and manage demands of infertility care may enhance access to care, decrease patient costs, improve outcomes, result in better support for military couples who experience infertility, and ultimately improve the health and military readiness of our armed forces. The results support the need for action by providers, policy makers, and military leaders to develop effective infertility treatment programs and policies in the DoD.

Vaccination for Human Papillomavirus: Immunization Practices in the U.S. Military

Human papillomavirus (HPV) is the most common sexually transmitted infection and is a leading etiology for cancer. The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of males and females aged 11-26 years. Studies suggest that U.S. military service members have higher HPV incidence rates and lower vaccination rates compared to the national average. Although the U.S. military enforces many recommended vaccines, the HPV vaccine fails to make the list.