Changes in the Seroprevalence of Tick-Borne Rickettsia and Ehrlichia Among Soldiers-Fort Liberty, North Carolina, 1991-2019.

We obtained samples from the Department of Defense Serum Repository from soldiers who were stationed at Fort Liberty, North Carolina, between 1991 and 2019 to assess temporal trends in tick-borne rickettsiosis and ehrlichiosis. Serological evidence of infection was common, with nearly 1 in 5 (18.9%) demonstrating antibodies. We observed significant decreases in Rickettsia seroprevalence (adjusted odds ratio [aOR], 0.42 [95% CI, .27-.65], P = .0001) while over the same period Ehrlichia seroprevalence, albeit less common, nearly doubled (aOR, 3.61 [95% CI, 1.10-13.99], P = .048). The increase in Ehrlichia seroprevalence likely reflects increased transmission resulting from the expanding geographic range of the lone star tick.

Rates of Lapidus Procedures in the US Military Before and After the Advent of and Advocacy for Tri-Plane Lapidus Corrective Surgery.

Tri-plane corrective Lapidus surgery has been described as advantageous with respect to its anatomic basis and outcomes. Because the procedure has been broadly publicized, changes in overall Lapidus procedure rates due to increased numbers of patients opting for the tri-plane approach could have occurred. Data supporting this possibility appears lacking. We employed official personnel and health records of the total active-duty US military to conduct a retrospective cohort study of Lapidus surgery rates before and after the advent of the tri-plane corrective Lapidus procedure. Least-squares and locally-weighted scatterplot smoother regression functions were used to confirm time trends. Sociodemographic and occupational traits of Lapidus patients were compared using 2-sided t tests and chi square tests. Lapidus surgery rates among hallux valgus patients decreased during 2014 to 2016 and increased during 2017 to 2021. While multiple factors might explain these trends, they coincide with the advent of and advocacy for tri-plane Lapidus surgery. The results support the possibility that its rise influenced overall Lapidus rates in this population. As these findings represent limited evidence of such an influence, further research is required to confirm a causal link. If such a link is found, and if the ongoing research suggests that superior outcomes are associated with tri-plane Lapidus surgery, substantial implications could exist for this population. Benefits might include enhanced medical readiness due to the importance of lower extremity function during military duties. Additional research is needed to confirm the impact of the procedure and to determine whether Lapidus surgery rate patterns in civilian populations mirror these findings.

Feasibility of Mild Traumatic Brain Injury Assessment Based on Cardiovascular Response to Postural Change.

OBJECTIVE: To determine the feasibility of short-term cardiovascular responses to postural change as a screening tool for mild traumatic brain injury (mTBI), using heart rate metrics that can be measured with a wearable electrocardiogram sensor. SETTING: Military TBI clinic. DESIGN: Data collected from active-duty service members who had sustained a medically diagnosed mTBI within the prior 72 hours and from age- and sex-matched controls. Cardiac data collected while participants performed a sequence of postural changes. MAIN MEASURES: Model classification compared with clinical mTBI diagnosis. RESULTS: Cardiac biomarkers of mTBI were identified and logistic regression classifiers for mTBI were developed from different subsets of biomarkers. The best model achieved 90% sensitivity and 69% specificity using data from 2 different postural changes. CONCLUSION: Noninvasive measurement of cardiovascular response to postural change is a promising approach for field-deployable post-mTBI screening.

Gender differences in the associations of body mass index, physical fitness and tobacco use with lower extremity musculoskeletal injuries among new US Army soldiers.

BACKGROUND: Musculoskeletal (MSK) injuries are a leading cause of morbidity among US Army soldiers, especially among women and the newly enlisted. While extremes of body mass index (BMI), low physical fitness and tobacco use have been identified as risk factors, no prior studies have determined the combined effects of these risk factors or tested for gender differences in the associations. METHODS: We conducted a retrospective cohort study utilising the Stanford Military Data Repository to study all enlisted soldier accessions to the US Army between January 2011 and January 2014, with follow-up through December 2014 (n=238 772). We used discrete-time logistic regression to test for associations between demographic, socioeconomic and health behaviour-related predictors and incident lower extremity injuries. We included interaction terms to test for gender differences. RESULTS: Among men, there were greater adjusted odds of injury among underweight (OR 1.27), overweight (OR 1.14) and obese soldiers (OR 1.54) (all p<0.001) relative to normal-weight soldiers. No statistically significant differences in the odds of injury on the basis of BMI were observed for female soldiers. Physical fitness was a significantly stronger predictor of injury for female as compared with male soldiers, while the association between tobacco use and injury was stronger for men (OR 1.47) than for women (OR 1.30) (p<0.001 for both). CONCLUSION: This is the largest known study to simultaneously assess important, modifiable musculoskeletal injury risk factors and to test for gender differences in these associations. These findings provide critical gender-related nuances for clinicians and leaders seeking to reduce the risk of these problems.

Interacting effects of selected trace and toxic metals on thyroid function.

Interacting effects of blood levels of manganese (Mn), selenium, cadmium (Cd), lead (Pb), and mercury, and serum levels of iron (Fe), zinc (Zn), and copper (Cu) on thyroid function in general US population were evaluated. Data from the National Health and Nutrition Examination Survey for 2011-2012 were used for this evaluation. The variables used to evaluate thyroid function were as follows: thyroid-stimulating hormone, free and total triiodothyronine (FT3, TT3), free and total thyroxine (FT4, TT4), and thyroglobulin (Tg). Levels of FT4 were positively associated with the levels of copper and negatively associated with the levels of Fe for males only. Elevated levels of Mn and Fe were associated with increased levels of FT3 for both males and females. TT4 had a positive association with the levels of Cu and a negative association with the levels of Fe for both males and females.

Human epididymis protein 4: Analysis of national health and nutrition examination survey data.

BACKGROUND: Human epididymis protein 4 (HE4) is a tumor marker overexpressed in ovarian cancer and is commonly utilized to aid with diagnosis of an adnexal mass. HE4 levels vary based on pregnancy, age, menopausal status, and tobacco use. OBJECTIVE(S): The objective of this study was to evaluate population-based data to examine factors that affect HE4 among adult women in the United States and stratify levels of HE4 by demographic and gynecologic factors. STUDY DESIGN: A retrospective analysis was conducted using data from 2,480 women aged 20 + who participated in the National Health and Nutrition Examination Survey (2001-2002). From these cross-sectional data, serum HE4 and cotinine, a marker of tobacco exposure, were combined with demographic and interview data. Estimated glomerular filtration rates (eGFR) were based on serum creatinine, age, sex, and race. Other variables of interest included menopausal status, pregnancy, and various gynecologic factors. Summary HE4 data are provided as geometric means with associated 95 % confidence intervals. RESULTS: HE4 levels were independently associated with age, renal function, and nicotine use, all p < 0.001. Pre-menopausal women with a history of endometriosis were found to have elevated HE4 levels compared to those without, p < 0.01; however, we found no such difference among post-menopausal women. Adjusting for age, no differences in HE4 were found based on race/ethnicity, p = 0.29. HE4 levels showed statistically significant associations with income level; however, these were small and clinically irrelevant. CONCLUSION: This study provides evaluation of HE4 levels among a data set representative of 98.5 million non-institutionalized women in the United States and gives insight into extraneous factors that may influence these levels.

Exposome Signatures of Gastrointestinal Disorders Among Active Duty Service Members.

INTRODUCTION: We evaluated the risk factors associated with gastrointestinal disorders (GD) among the soldiers of the Army and Marine Aviation community (AMAC) using an exposomic approach. Specifically, we aimed to determine the medical and operational factors associated with reported GD in the Military Health System. METHODS: Longitudinal data were obtained from the Medical Assessment and Readiness System (MARS) housed at Womack Army Medical Center, Fort Liberty, NC, for a retrospective cohort study that included 79,249 active duty United States AMAC active duty service members (ADSMs) from October 2015 to December 2019. Multivariable mixed-effects logistic regression was used to assess the relationship between the incidence occurrence of GD and variables including rank, service time, deployment, Armed Forces Qualification Test score, education, tobacco use, alcohol use, age, gender, race, ethnicity, body mass index (BMI), and marital status. RESULTS: The incidence of GD included 22,813 person-years of observations with a rate of 2.2 per 100 person-years and a period prevalence of 3.2%. GD was independently associated with rank, service time, and deployment (all P < 0.05). CONCLUSION: The high-risk categories associated with GD in the AMAC included age, BMI, race (not ethnicity), marital status, and service time. Our data also show that deployment time, not geographical location, was associated with a higher risk of GD. Together, these analyses suggest that White ADSMs older than 33 years of age who have experienced marriage, longer service time, and deployments appear to have a higher risk of GDs. Our assessment shows the utility of using an exposomic approach to create a member-specific, big data-informed personalized clinical algorithm of health outcomes.

Randomized, controlled clinical trial of acoustic stimulation to reduce postconcussive symptoms.

OBJECTIVE: Effective interventions are needed to address postconcussive symptoms. We report the results of randomized, sham-controlled trial of Cereset Research™ Standard Operating Procedures (CR-SOP), a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology previously shown to improve insomnia. METHODS: Military service members, veterans, or their spouses with persistent symptoms (Neurobehavioral Symptom Inventory [NSI] Score ≥23) after mTBI 3 months to 10 years ago, were randomized to receive 10 sessions of engineered tones linked to brainwaves (LB, intervention), or random engineered tones not linked to brainwaves (NL, sham control). The primary outcome was change in NSI, with secondary outcomes of heart rate variability and self-report measures of sleep, mood, and anxiety. RESULTS: Participants (n = 106, 22% female, mean age 37.1, 2.8 deployments, 3.8 TBIs) were randomized 1:1 to LB or NL, with no significant differences between groups at baseline. Among all study participants, the NSI declined from baseline 41.0 to 27.2 after (P < 0.0001), with gains largely sustained at 3 months (31.2) and 6 months (28.4). However, there were no significant differences between the LB (NSI declined from 39.9 at baseline to 28.2 post-intervention, 31.5 at 3 months, and 29.4 at 6 months) and NL (NSI declined from 41.5 at baseline to 26.2, 29.9, and 27.3, respectively. Similar patterns were observed for the PCL5 and PHQ-9 and there was no difference in HRV between groups. INTERPRETATION: Ten hours of acoustic stimulation while resting in a zero-gravity chair improves postconcussive symptoms. However, linking tones to brain electrical activity did not reduce symptoms more than random tones. REGISTRATION: ClinicalTrials.gov - NCT03649958.

Fasciotomy and Occupational Separation among US Service Members with Lower Extremity Chronic Exertional Compartment Syndrome.

PURPOSE: Lower extremity chronic exertional compartment syndrome (LE-CECS) can limit rigorous physical activity, particularly in the US military, and fasciotomy is a potential treatment. Associations between LE-CECS, fasciotomy, and occupational outcomes appear understudied. We studied active-duty US service members to identify whether LE-CECS diagnoses and fasciotomy for LE-CECS predict military service separation. METHODS: We conducted a retrospective cohort study of 1,103,417 individuals who entered service during 2011 to 2017. Distributions of separation statuses and independent variables were tabulated, and sex-specific multivariable regression models were computed for separation outcomes. RESULTS: LE-CECS was associated with a 474% medical service separation risk in men (95% confidence interval (CI) for adjusted risk ratio: 5.21 to 6.33) and a 282% increase in women (CI: 2.99 to 4.88). Among 1947 patients with LE-CECS, men saw a 57% nonmedical separation risk increase (CI: 1.27 to 1.93) and women had a 119% increase (CI: 1.10 to 4.35) when anterior and/or lateral compartment procedures occurred. Men with LE-CECS and any posterior procedures saw a 47% nonmedical separation risk increase (CI: 1.17 to 1.86). Men with anterior and/or lateral procedures and any posterior procedures experienced 36% (CI: 1.09 to 1.71) and 78% (CI: 1.40 to 2.26) medical separation risk increases, respectively. No statistically significant risk increases for the outcomes were otherwise seen for women. CONCLUSIONS: LE-CECS was associated with increased military service discharge risks. Among the affected patients, positive effects on career longevity were not seen in association with fasciotomy. However, fasciotomy could simply serve as a marker of the most refractory cases that are least likely to continue service. More study is needed to clarify causal pathways and identify patients who may derive career benefits from surgical treatment.

Novel noninvasive anthropometric measure in preterm and full-term infants: normative values for waist circumference:length ratio at birth.

BACKGROUND: Waist circumference:length ratio (WLR) and ponderal index (PI) appear to be useful markers of visceral and total adiposity, respectively. However, there are no normative birth data across the full range of gestational ages. METHODS: In this retrospective cohort study of 500 preterm and 1,426 full-term infants, born in 1998 and 2008 at three military hospitals, the percentile growth curves for WLR and PI were calculated. There were no sex differences, and results were combined to obtain values from 26 to 42 wk gestation. RESULTS: Between 26 and 42 wk gestation, median birth WLR increased from 0.55 to 0.62, and median PI increased from 21.1 to 25.6. The adjusted mean WLR at birth among infants born <34 wk increased from 0.55 in 1998 to 0.58 in 2008 (P = 0.048), suggesting that early-preterm infants born in 2008 had greater abdominal adiposity than those born in 1998. CONCLUSION: We report normative birth data for WLR and PI in preterm and full-term infants by gestational age and sex. WLR and PI may be useful as clinical markers of visceral and overall adiposity. In conjunction with other anthropometric measures, WLR and PI may be useful to monitor postnatal nutrition and growth and assess risk for later obesity and cardiometabolic disorders.

Prediction of Metabolic Syndrome in U.S. Adults Using Homeostasis Model Assessment-Insulin Resistance.

Background: The prevalence of obesity among U.S. adults has risen steadily over recent decades. Consequently, interest in identification of those at greatest metabolic risk necessitates the periodic assessment of underlying population characteristics. Thus, the aim of this study is to assess the efficacy of using insulin resistance (IR) as a predictor of metabolic syndrome (MetS). Methods: We performed a serial, cross-sectional analysis of nationally representative data from the National Health and Nutrition Examination Survey (NHANES). Data included nonpregnant adults who participated in NHANES between 2011 and 2018. IR was estimated using the homeostasis model assessment (HOMA). Optimal HOMA-IR cut points for MetS were identified using receiver operating characteristic curve analysis. Results: Data from 8897 participants representing 222 million individuals were analyzed. The estimated prevalence of MetS was 31.7% (n = 2958; 95% confidence interval 30.1-33.3). The optimal HOMA-IR to discriminate between individuals with and without MetS in the general population was 2.83 (sensitivity = 73.8%; specificity = 73.8%; area under the curve = 0.82). Conclusion: The HOMA-IR is a sensitive and specific method of screening for individuals with MetS. Prospective evaluation of this approach's efficacy in identifying those at risk for progression to MetS is warranted.

Exposomic Signatures of Cervical Pain.

INTRODUCTION: We evaluated risk factors associated with cervical pain (CP) among officers and enlisted members of the U.S. Army and Marine Aviation community using an exposomic approach. Specifically, we aimed to determine the factors associated with reported CP. MATERIALS AND METHODS: This is a retrospective cohort study that utilized the Medical Assessment and Readiness System housed at Womack Army Medical Center to evaluate the longitudinal data taken from medical and workforce resources. This study included 77,864 active duty AMAC members during October 2015-December 2019. Multivariable mixed-effects logistic regression was used to assess the relationship between the independent variables of rank, service time, deployment, Armed Forces Qualification Test score, tobacco use, alcohol use, age, gender, race, ethnicity, body mass index, marital status, and education level and the dependent variable, incidence occurrence of CP. RESULTS: The total analysis included 77,864 individuals with 218,180 person-years of observations. The incidence rate of CP was 18.8 per 100 person-years, with a 12% period prevalence. Cervical pain was independently associated with rank, service time, Armed Forces Qualification Test score, and alcohol use (all P < .05). CONCLUSIONS: Our longitudinal exposomic signatures-based approach aims to complement the outcomes of data science and analytics from Medical Assessment and Readiness System with validations of objective biochemical indicator species observed in Army and Marine Aviation community members suffering from CP. This initial approach using parallel track complementarity has the potential of substantiating the underlying mechanisms foundational to design prospective personalized algorithms that can be used as a predictive model. Finally, a specific evaluation of occupational risk factors may provide insight into factors not readily ascertained from the civilian literature.

Exposomic Signatures of Tinnitus and/or Hearing Loss.

INTRODUCTION: We evaluated the risk factors associated with tinnitus and/or hearing loss (THL) among active duty (AD) members of the U.S. Army and Marine Aviation Community (AMAC) using an exposomic approach. Specifically, we aimed to determine the factors associated with the reported THL in the Military Health System. METHODS: Longitudinal data were obtained from the Medical Assessment and Readiness System housed at Womack Army Medical Center, Fort Bragg, NC, for a retrospective cohort study that included 78,546 AD AMAC members from October 2015 to December 2019. Multivariable mixed-effects logistic regression was used to assess the relationship between THL and numerous variables to include rank, service time, deployment, tobacco use, alcohol use, age, gender, race, ethnicity, and body mass index. RESULTS: Our analysis included a total of 220,044 person-years of observations. The THL incidence rate was 6.7 per 100 person-years, with an 8.1% period prevalence. THL was associated with age, gender, body mass index, race, deployment, service time, marital status, and tobacco use (all P < .05). Service time greater than 16 years had the greatest odds ratio of THL (4.46, 95% CI: 3.58-5.55, P < .001). CONCLUSIONS: Our assessment shows the utility of using an exposomic approach to create member-specific personalized clinical algorithms for health outcomes. We examined individuals with THL diagnoses and identified a combination of risk factors from biomedical, lifestyle, environmental, and stochastic sources. Taken together, the risk factors identified across the four exposomic domains could help understand the etiology of THL. Our exposomic methodology could be the foundation for generating predictive models. Finally, a specific evaluation of occupational risk factors may provide insight into aspects not readily available from civilian literature. In upcoming years, as the Medical Assessment and Readiness System matures, we will expand our analyses to include prospective, untargeted metabolites and biomarker data.

Prevalence of high body mass index among children and adolescents at a US military treatment facility, 2008-2009.

We assessed the prevalence of high body mass index (BMI) in a large cohort of military children. We compared BMI data from electronic medical records of military children aged 2 to 18 years with BMI data from the National Health and Nutrition Examination Survey (NHANES). The 23,778 military children studied were significantly less likely than the NHANES children to be overweight (27.1% vs 31.8%) or obese (11.9% vs 16.9%). Even though military parents are required to maintain fitness and weight standards, the absolute difference between military and civilian children was small.

Attention deficit hyperactivity disorder medications and bone mineral density of adults in the United States.

Introduction: Several medications used to treat attention deficit hyperactivity disorder (ADHD) have been associated with diminished bone mineral density (BMD) in children. The objective of this study was to determine if evidence exists for a similar association among adults. Materials and methods: A retrospective cross-sectional analysis was conducted using data collected by the National Health Nutrition Examination Survey 2013-2018. Data from 7961 individuals aged 18 to 50, 79 of whom were taking medications to treat ADHD. Dual-energy X-ray absorptiometry scans provided measure of body composition. Linear regression models were used to examine associations between ADHD medication use and body composition. Results: Stimulant ADHD medication usage was found to be associated with decreased BMD in both the skull (-6.6%; 95% CI 5.9-7.2) (P < 0.05) and thoracic spine (-6.0%; 95% CI 5.1-7.0) (P < 0.05). No difference in BMD was seen in any other skeletal region based on stimulant ADHD medication use (P > 0.05). We found no evidence to suggest that duration of use affected the observed decreases in BMD, P > 0.05. Conclusion: This study using a nationally representative sample assessed whether stimulant medication use in adults with ADHD was associated with decreased BMD. The overall results are inconclusive. Further study is needed to better evaluate if ADHD and/or stimulant medication use is independently associated with bone health.

Prevalence of Hepatic Steatosis and Fibrosis in the United States.

Introduction: Nonalcoholic fatty liver disease (NAFLD) is the most common liver disease in the world. We evaluated vibration-controlled transient elastography (VCTE) data to determine the prevalence of two principle manifestations of NAFLD, hepatic steatosis and hepatic fibrosis. Methods: Data were sourced from the 2017 to 2018 National Health and Nutrition Examination Survey, which provides a representative cross-section of the noninstitutionalized U.S. population. Participants 18 years of age and older were examined using sera and VCTE. Sociodemographic and medical history information were gathered through self-report. Logistic regression models assessed relationships between steatosis, fibrosis, and variables of interest. Prevalence estimates are reported as weighted percentages with 95% Wald confidence intervals (CIs). Results: A total of 4083 participants representing 187 million U.S. adults were included in our analysis. We estimate the prevalence of steatosis (controlled attenuation parameter ≥302 dB/m, ≥S1) at 27.3% (95% CI: 25.3-29.4) and significant fibrosis (liver stiffness ≥8.2 kPa, ≥F2) at 7.7% (95% CI: 6.1-9.6). Both were independently associated with age, gender, body mass index (BMI), and diabetes (all P < 0.05). The greatest predictor of both steatosis and fibrosis was BMI. Steatosis was present in 3.6%, 18.7%, and 49.4% of those in the normal or underweight, overweight, or obese categories, respectively. Significant fibrosis was present in 2.1%, 3.2%, and 14.7% of those in the normal or underweight, overweight, or obese categories, respectively. Conclusions: Clinically significant steatosis and/or fibrosis are highly prevalent among the U.S. adult population. The greatest predictor of both steatosis and fibrosis is obesity.

Normative formaldehyde-hemoglobin adduct levels among the US Population: Analysis of the 2013-2016 National Health and Nutrition Examination Survey.

INTRODUCTION: Formaldehyde (FA) is currently classified as a known carcinogen. In addition to being a ubiquitous compound with many common exogenous exposure sources, it is also part of multiple metabolic pathways and present in every living cell. The objectives of this study were to determine normative levels of FA as measured by FA-Hemoglobin (Hb) adducts in the United States (US) and to determine if FA-Hb levels differ based on a variety of demographic factors. METHODS: Data collected between 2013 and 2016 by the National Health and Nutrition Examination Survey were assessed from 4521 participants representing approximately 244 million individuals living in the US. General linear models were used to examine associations between FA-Hb adducts and sample characteristics. FA-Hb levels were summarized using geometric mean concentrations (GMC) and associated 95% confidence intervals (CI). RESULTS: The overall GMC was 131.10 nmol/g Hb (95% CI 129.39-132.83). Analyses revealed no evidence to support associations between FA-Hb levels and age, gender, income, or nicotine use. Among adults, non-Hispanic Black race was associated with lower FA-Hb levels compared to all other race/ethnicity groups, P < 0.01. CONCLUSION: The study provides the first normative values for FA in adults and children. These data could be a tool to assess the body's response to acute and chronic exposure.

Augmented Reality Forward Damage Control Procedures for Nonsurgeons: A Feasibility Demonstration.

INTRODUCTION: This article presents an emerging capability to project damage control procedures far forward for situations where evacuation to a formal surgical team is delayed. Specifically, we demonstrate the plausibility of using a wearable augmented reality (AR) telestration device to guide a nonsurgeon through a damage control procedure. METHODS: A stand-alone, low-profile, commercial-off-the-shelf wearable AR display was utilized by a remotely located surgeon to synchronously guide a nonsurgeon through proximal control of the distal external iliac artery on a surgical manikin. The manikin wound pattern was selected to simulate a rapidly exsanguinating junctional hemorrhage not controllable by nonsurgical means. RESULTS: This capability demonstration displayed successful use of AR technology, telecommunication, and procedural training and guidance in a single test pilot. The assisted physician assistant was able to rapidly control the simulated external iliac artery injury on this model. The telestration system used was commercially available for use with available civilian cell phone, wireless and satellite networks, without the need for dedicated high-speed networks. CONCLUSIONS: A nonsurgeon, using a wearable commercial on-visual-axis telestration system, successfully performed a damage control procedure, demonstrating the plausibility of this approach.

US Army Soldiers With Type 1 Diabetes Mellitus.

US Army soldiers diagnosed with type 1 diabetes were previously considered unfit for duty. For highly motivated soldiers, current advanced technologies allow the possibility of not only retention on active duty, but military deployment. We present our experience at Fort Bragg, North Carolina, taking care of soldiers newly diagnosed with type 1 diabetes mellitus. Through intensive diabetes education, extensive military and physical training, optimization of diabetes technology, and remote real-time monitoring, soldiers are able to continue to serve their country in the most specialized roles.

Prevalence of Genital Human Papillomavirus Infection and Human Papillomavirus Vaccination Rates Among US Adult Men: National Health and Nutrition Examination Survey (NHANES) 2013-2014.

IMPORTANCE: Human papillomavirus (HPV) is a common sexually transmitted infection that is a major cause of noncervical anogenital and oropharyngeal cancers. Prophylactic HPV vaccine is available for primary prevention. However, the population prevalence data for male genital HPV infection is not well known, while the HPV vaccination coverage is low in the United States. OBJECTIVES: To estimate the prevalence of genital HPV infection and the HPV vaccination rate in the United States among adult men and to examine potential risk factors for HPV infection. DESIGN, SETTING, AND PARTICIPANTS: The National Health and Nutrition Examination Survey (NHANES) samples a representative cross-section of the US population. Men aged 18 to 59 years were examined in mobile examination centers during the NHANES 2013-2014. DNA was extracted from self-collected penile swab specimens, and HPV genotyping was performed by polymerase chain reaction amplification. Demographic and vaccination information was gathered via self-report during home-based standardized interviews. Binary multivariable logistic regression was used to estimate the odds of HPV infection. MAIN OUTCOMES AND MEASURES: The prevalence of genital HPV infection and the HPV vaccination coverage rate among adult men. RESULTS: During the NHANES 2013-2014, a total of 1868 men aged 18 to 59 years were examined. The overall genital HPV infection prevalence was 45.2% (95% CI, 41.3%-49.3%). The infection prevalence with at least 1 high-risk HPV subtype defined by DNA testing was 25.1% (95% CI, 23.0%-27.3%). In vaccine-eligible men, the prevalence of infection with at least 1 HPV strain targeted by the HPV 4-valent vaccine and HPV 9-valent vaccine was 7.1% (95% CI, 5.1%-9.5%) and 15.4% (95% CI, 11.7%-19.6%), respectively. Among vaccine-eligible men, the HPV vaccination coverage was 10.7% (95% CI, 7.8%-14.6%). CONCLUSIONS AND RELEVANCE: Among men aged 18 to 59 years in the United States, the overall prevalence of genital HPV infection was 45.2% (95% CI, 41.3%-49.3%). The overall genital HPV infection prevalence appears to be widespread among all age groups of men, and the HPV vaccination coverage is low.