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INTRODUCTION: Sleep deprivation is rampant within the military population, and insufficient sleep can lead to physical and mental health problems impacting soldier's readiness and deployability. Past research has shown the importance of leadership's role in subordinates' sleep health. Understanding the values, beliefs, and quality of military leader sleep is essential to the development of effective interventions to optimize occupational performance and overall sleep health. Therefore, the purpose of this study was to examine the military leaders' values, beliefs, and sleep quality and the impact on occupational performance. The authors aimed to (1) identify military leaders' sleep quality and beliefs; (2) explore the relationship between military leaders' sleep quality, beliefs and attitudes about sleep, and impact on occupational performance; and (3) examine the value leaders place on sleep for themselves and subordinates in relation to occupational performance. MATERIALS AND METHODS: This observational, mixed-methods study design recruited a convenience sample of 109 Army active duty medical service members currently serving in a leadership role. Participants completed an electronic survey to include general demographic information and three self-report measures: the Pittsburgh Quality of Sleep Index, the Dysfunctional Beliefs about Sleep, and the Functional Outcomes of Sleep Questionnaire. Eleven participants completed the semi-structured qualitative interview focusing on sleep values and the impacts on performance. Univariate and multivariate regressions were performed for statistical analysis of the quantitative survey data, whereas thematic analysis was used to analyze the qualitative interview data. This study was approved by the U.S. Army Medical Center of Excellence Institutional Review Board. RESULTS: Multivariate regression analysis demonstrated small-to-medium effect sizes (R2 = 0.355-0.559) for relationships between sleep quality, sleep beliefs, functional performance, and demographic variables. More specifically, military grade, position, use of alcohol, time in service, and gender were all found to contribute significantly to scores on the Pittsburgh Sleep Quality Index, the Dysfunctional Beliefs About Sleep Scale-16, and the Functional Outcomes of Sleep Questionnaire-10 (P < .05). Qualitative data resulted in three primary themes: (1) Poor sleep degrades performance, (2) sleep is a top priority, and (3) leaders have a responsibility for subordinates' sleep health. CONCLUSIONS: This sample of military leaders was found to perceive themselves as poor-quality sleepers despite demonstrating more functional attitudes and beliefs about sleep and reporting normal-to-mild impairments in daily functioning as a result of daytime sleepiness. Furthermore, findings suggest that leaders' sleep quality and beliefs stand to be further improved, whereas their sleep values need to be consistently demonstrated to subordinates. With a clearer understanding of military leaders' values, beliefs, and sleep quality, future research could focus on implementing and developing holistically based and individualized sleep interventions intended to optimize performance and sleep health.
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The purpose of this study is to identify the socioeconomic and demographic characteristics of women cared for by Certified Nurse-Midwives (CNMs) versus physicians in the Military Health System (MHS) and compare birth outcomes between provider types. The MHS is one of America's largest and most complex health care systems. Using the Military Health System Data Repository, this retrospective study examined TRICARE beneficiaries who gave birth during 2012-2014. Analysis included frequency of patients by perinatal services, descriptive statistics, and logistic regression analysis by provider type. To account for differences in patient and pregnancy risk, odds ratios were calculated for both high-risk and general risk population. There were 136,848 births from 2012 to 2014, and 30.8% were delivered by CNMs. Low-risk women whose births were attended by CNMs had lower odds of a cesarean birth, induction/augmentation of labor, complications of birth, postpartum hemorrhage, endometritis, and preterm birth and higher odds of a vaginal birth, vaginal birth after cesarean, and breastfeeding than women whose births were attended by physicians. These results have implications for the composition of the women's health workforce. In the MHS, where CNMs work to the fullest scope of their authority, CNMs attended almost 4 times more births than our national average. An example to other U.S. systems and high-income countries, this study adds to the growing body of evidence demonstrating that when CNMs practice to the fullest extent of their education, they provide quality health outcomes to more women.