Changes in healthcare use across the transition from civilian to military life.

Patterns of healthcare use in a sample of young adults entering the US Navy (N=1137) were examined in a longitudinal survey study. Baseline data provided information about healthcare use as a civilian, whereas follow-up data were used to examine changes in patterns of use over time following entry into the Military Health System (MHS). Entrance into the MHS was marked by increased use of preventive care. Although few systematic differences were noted with respect to socioeconomic status or race/ethnicity, women consistently used more healthcare than did men, and women's use increased more over time; however, this increase was largely driven by pregnancy during military service. Findings suggest that individuals with access to universal healthcare are likely to increase their overall use of services. However, these effects were quite small in absolute terms, and they were strongest for preventive care rather than more intensive and expensive services. Published 2013. This article is a US Government work and is in the public domain in the USA.

Evaluation of a sexual assault education/prevention program for female U.S. Navy personnel.

The U.S. Navy Sexual Assault Intervention Training (SAIT) program for women was evaluated in a randomized clinical trial. The SAIT uses multiple presentation modalities (lecture, slides, discussion, film) to provide information related to sexual assault, including risk factors, consequences, prevention, and relevant military regulations. Female personnel who had completed basic training (N = 550) participated in the SAIT or a Comparison condition, and then completed measures of rape knowledge, empathy for rape victims, and acceptance of rape myths (false beliefs about rape justifying sexual violence). Results showed that the SAIT increased factual knowledge about rape. In addition, the SAIT increased empathy with rape victims in some groups of women. However, the program did not reduce women's rape myth acceptance. Given the enormity of the problem of sexual assault and these promising initial findings, additional research on the efficacy of the SAIT is clearly warranted.

Evaluation of a sexual assault education/prevention program for male U.S. Navy personnel.

A randomized clinical trial was conducted to evaluate the effectiveness of the Navy Sexual Assault Intervention Training (SAIT) program for men. A four-group Solomon design was used to control for possible pretest sensitization effects. Male Navy personnel (N = 1,505) were assessed for rape knowledge, rape myth acceptance (two scales), and rape empathy after participating in the SAIT program or viewing an educational video about HIV/AIDS (comparison condition). The SAIT program was found to be effective in increasing rape knowledge, reducing rape myth acceptance, and increasing empathy for rape victims. As expected, men who had exhibited previous coercive sexual behavior, compared with those who had not, reported lower levels of knowledge, higher levels of rape myth acceptance, and less rape empathy. However, the SAIT program was generally effective in changing men's knowledge, beliefs, and feelings on the key measures, regardless of participants' histories of coercive sexual behavior.

Reports of rape reperpetration by newly enlisted male navy personnel.

This study examined the frequency and characteristics of repeated attempted and completed rape (ACR) incidents reported by newly enlisted male navy personnel (N=1146) who participated in a longitudinal study during the transition from civilian to military life. Overall, 13% (n=144) reported engaging in sexual behavior that approximates legal definitions of ACR since the age of 14. Among those men, most (71%) reperpetrated ACR incidents (M = 6.36, SD = 9.55). Demographic variables were unrelated to perpetration history. Regardless of time period, respondents reported perpetrating primarily completed rather than attempted rape, perpetrating multiple ACR incidents rather than a single incident, using substances to incapacitate victims more frequently than force, and knowing their victim rather than targeting a stranger in completed rape incidents.

Premilitary adult sexual assault victimization and perpetration in a Navy recruit sample.

Female (n = 5,226) and male (n = 5,969) U.S. Navy recruits completed a survey assessing their premilitary histories of adult sexual assault (SA), defined as attempted or completed rape since the age of 14. The survey was completed under anonymous or identified conditions. Overall, 39% of women reported premilitary SA victimization and 13% of men admitted premilitary SA perpetration. As predicted, rates were significantly higher in the anonymous than in the identified condition. For the sample of women as a whole, marital status, ethnicity, and family income were associated with SA victimization; for men, only marital status was associated with SA perpetration. Compared to previous college samples, Navy recruits were more likely to have previous SA experience. Given the negative consequences associated with SA victimization and perpetration, the present study reinforces the desirability of developing additional treatment, education, and prevention programs to reduce the occurrence of SA among military recruits.

Posttraumatic stress symptoms in Navy personnel: prevalence rates among recruits in basic training.

Individuals in the military are often required to endure high levels of stress as a result of demanding operational requirements or deployments. Individuals who enter the military with pre-existing mental health problems such as posttraumatic stress disorder (PTSD) are likely to be at heightened risk of adverse reactions to military stressors. The present study documents the prevalence of PTSD symptoms among new Navy recruits and compares the prevalence of PTSD symptomology among recruits to prevalence rates that have been reported for comparable civilian populations. Results suggest that 15 percent of new Navy recruits are experiencing measurable symptoms of posttraumatic stress. Prevalence of these symptoms among Navy recruits is comparable to that among civilian adolescent and young adult populations.

Premilitary sexual assault and attrition in the U.S. Navy.

A prospective study examined whether adult premilitary sexual victimization predicted women's military attrition. In a survey of female Navy recruits (N = 2,431), 56% reported some form of adult unwanted sexual contact before entering the military, with 25% reporting completed rape. Approximately one-third of respondents left the Navy before completing their 4-year term of service. When rape, attempted rape, and lower-level unwanted sexual contact were considered simultaneously, only rape predicted attrition. Women who reported premilitary rape, compared with those who did not, were 1.69 times more likely to leave the military. The pattern of results held across the 4-year period examined and after controlling for demographic predictors.

Premilitary intimate partner violence and attrition from the U.S. Navy.

A prospective study of U.S. Navy recruits (N = 5,498) examined whether premilitary intimate partner violence (IPV) was associated with attrition. Overall, more than one-fourth of recruits reported premilitary physical IPV and more than two-thirds reported premilitary verbal IPV. Women reported more perpetration and receipt of IPV than men, and married or cohabiting respondents reported more IPV than single respondents. Both perpetration and receipt of IPV significantly predicted attrition within 4 years. However, after controlling for other forms of IPV, only receipt of physical IPV significantly predicted attrition. In only one analysis did associations between IPV and attrition vary according to marital status or gender; premilitary receipt of verbal IPV had different effects on women and men.

Perpetration of severe intimate partner violence: premilitary and second year of service rates.

A longitudinal design was used to compare rates of severe intimate partner violence (SIPV) perpetration during the year before enlistment and the second year of service in a sample of 542 female and 421 male Navy personnel. Overall, 11% reported perpetration of SIPV during the year before service. Premilitary SIPV perpetration rates were significantly higher for women (20%) than for men (4%). After 2 years of service, the overall percentage reporting past-year perpetration of SIPV increased slightly (14%, compared with a premilitary rate of 11%). The patterns of changes in rates of SIPV perpetration varied for men and women. Across time, SIPV perpetration increased among men (from 4% to 16%) and decreased among women (from 20% to 12%). Respondents who were female, younger, and minority reported higher rates of premilitary SIPV perpetration. No demographic factors were associated with reports of SIPV perpetration during the second year.

Self-definition as a survivor of childhood sexual abuse among navy recruits.

This study explored how specific childhood sexual experiences (CSEs) might be related to self-identification as a victim of sexual abuse and to gender differences in self-defined victimization. Hierarchical logistic regression was used to estimate the relationship of demographic and CSE characteristics with self-definitions. The characteristics most strongly associated were threats-force, incest, and younger age at the time of the experience. Men were less likely than were women to acknowledge abuse and to report CSE characteristics indicative of abuse. Women were more likely to identify themselves as victims the more CSEs they reported involving sexual penetration. Finally, in an analysis of familial abuse, men were more likely to define themselves as victims if the perpetrator was also male.

Child sexual abuse and number of sexual partners in young women: the role of abuse severity, coping style, and sexual functioning.

The authors proposed and tested a model describing distinct pathways through which childhood sexual abuse (CSA) may lead to relatively low or high numbers of sexual partners in adulthood. Path analyses were conducted on survey responses of young female US Navy recruits who reported CSA (N=547). Use of avoidant strategies to cope with CSA was expected to produce higher levels of sexual problems and fewer heterosexual sex partners, whereas use of self-destructive coping strategies was expected to result in more dysfunctional sexual behavior and more heterosexual sex partners. As predicted, the effect of CSA on number of sex partners was largely mediated by coping strategies and dysfunctional sexual behavior.

Research on child abuse in the U.S. armed forces.

Child maltreatment in the United States has provoked considerable interest in recent years. Child abuse and neglect are prevalent in all parts of American society. Although children of military personnel experience maltreatment, little research has been completed that compares child abuse rates in the military with those for civilian populations. Studies that have assessed child abuse in the armed forces have been based on official reports recorded in military Family Advocacy central registries. Because a standardized method for recording child abuse does not exist, conclusions regarding the prevalence of abuse are often inaccurate. We explore this and other methodological constraints that make estimating child abuse accurately difficult. A review of the literature also reveals that there are many correlates of child abuse unique to the military family. Finally, we discuss both the risk and protective factors within military life that may influence the occurrence of child maltreatment.

Childhood exposure to family violence and attrition in the Navy.

In a prospective study of U.S. Navy recruits (n = 5,491), we examined the relationship between childhood exposure to family violence (child physical abuse, child sexual abuse [CSA], and domestic violence) and attrition. Overall, 55% of recruits experienced one or more forms of childhood family violence and 34% of recruits attrited within 4 years after enlistment. Considered separately, each form of childhood violence was significantly associated with attrition. When considered simultaneously, all three types of childhood violence were associated with attrition in men, but only CSA was associated with attrition in women. Men and women who experienced all three types of childhood violence were 303% and 139%, respectively, more likely to attrite than recruits who reported no childhood violence. In analyses examining the timing of attrition, CSA was associated with early attrition, whereas child physical abuse and domestic violence were unrelated to timing of attrition.

Risk for intimate partner violence and child physical abuse: psychosocial characteristics of multirisk male and female Navy recruits.

This study examined psychosocial characteristics of individuals at risk for perpetrating both intimate partner violence (IPV risk) and child physical abuse (CPA risk). The sample consisted of 775 female and 592 male Navy recruits. The psychosocial variables assessed included symptoms of dysphoria, posttraumatic stress, self-dysfunction, alcohol-related problems, and drug use. IPV risk and CPA risk were positively associated with approximately 9% of the total sample considered multirisk (i.e., positive for both IPV risk and CPA risk). Results of regression analyses revealed that patterns of predictors (demographic and psychosocial variables) for IPV-risk only and CPA-risk only differed with multirisk individuals characterized by the combined predictors of both types of violence risk. Nearly half (47.2%) of the multirisk individuals were characterized by multiple (i.e., two or more) clinical elevations on the psychosocial characteristics assessed.

Do trauma symptoms mediate the relationship between childhood physical abuse and adult child abuse risk?

OBJECTIVE: Although the intergenerational transmission of family violence has been well documented, the mechanisms responsible for this effect have not been fully determined. The present study examined whether trauma symptoms mediate the relationship between a childhood history of child physical abuse (CPA) and adult CPA risk, and whether any such mediation was similar for women and men. METHOD: Female and male US Navy (USN) recruits (N=5,394) and college students (N=716) completed self-report measures of their history of child abuse (i.e., CPA and child sexual abuse [CSA]), exposure to intimate partner violence (IPV), current trauma symptoms, and adult CPA risk. RESULTS: As expected, there was a strong association between a childhood history of CPA and adult CPA risk. This association was significant even after controlling for demographic variables and childhood exposure to other forms of violence (CSA and IPV), and the strength of the relationship did not vary depending on demographics or exposure to other forms of violence. However, the association between a history of CPA and adult risk of CPA was stronger for individuals high in defensive avoidance compared to those low in defensive avoidance. The association between a history of CPA and adult CPA risk was largely, although not entirely, mediated by psychological trauma symptoms. Mediation was observed for both women and men in both the USN and college samples. CONCLUSIONS: Trauma symptoms associated with a history of CPA accounted for a substantial part of the relationship between a history of CPA and adult CPA risk in both women and men. PRACTICE IMPLICATIONS: To the extent that trauma symptoms are a mechanism by which the intergenerational transmission of child abuse occurs, intervening to reduce trauma symptoms in CPA victims has the potential of reducing their risk of continuing the cycle of violence.