Risk Factors Associated With Suicide Completions Among US Enlisted Marines.

US enlisted Marines have experienced a substantial increase in suicide rates. We sought to identify risk factors for suicide completions among male Marines who entered basic training in San Diego, California, between June 2001 and October 2010. Suicides that occurred during active-duty military service were counted from June 1, 2001, through June 30, 2012. A total of 108,930 male Marines (66,286 deployers and 42,644 never deployed) were followed for 467,857 person-years of active-duty service time. Of the 790 deaths, 123 (15.6%) were suicides. In the final multivariate hazard model, preservice characteristics of not being a high-school graduate (hazard ratio (HR) = 2.17, 95% confidence interval (CI): 1.28, 3.68) and being a smoker at the time of enlistment (HR = 1.91, 95% CI: 1.32, 2.76) were significantly associated with a higher risk for suicide completion. Diagnosed with traumatic brain injury (HR = 4.09, 95% CI: 2.08, 8.05), diagnosed with depression (HR = 2.36, 95% CI: 1.22, 4.58), and received relationship counseling (HR = 3.71, 95% CI: 1.44, 9.54) during military service were significant risks for suicide death. Deployment alone was not significantly associated with a risk for suicide death (HR = 0.53, 95% CI: 0.26, 1.05).

Health care utilization among complementary and alternative medicine users in a large military cohort.

BACKGROUND: Complementary and Alternative Medicine use and how it impacts health care utilization in the United States Military is not well documented. Using data from the Millennium Cohort Study we describe the characteristics of CAM users in a large military population and document their health care needs over a 12-month period. The aim of this study was to determine if CAM users are requiring more physician-based medical services than users of conventional medicine. METHODS: Inpatient and outpatient medical services were documented over a 12-month period for 44,287 participants from the Millennium Cohort Study. Equal access to medical services was available to anyone needing medical care during this study period. The number and types of medical visits were compared between CAM and non-CAM users. Chi square test and multivariable logistic regression was applied for the analysis. RESULTS: Of the 44,287 participants, 39% reported using at least one CAM therapy, and 61% reported not using any CAM therapies. Those individuals reporting CAM use accounted for 45.1% of outpatient care and 44.8% of inpatient care. Individuals reporting one or more health conditions were 15% more likely to report CAM use than non-CAM users and 19% more likely to report CAM use if reporting one or more health symptoms compared to non-CAM users. The unadjusted odds ratio for hospitalizations in CAM users compared to non-CAM users was 1.29 (95% CI: 1.16-1.43). The mean number of days receiving outpatient care for CAM users was 7.0 days and 5.9 days for non-CAM users (p < 0.001). CONCLUSIONS: Our study found those who report CAM use were requiring more physician-based medical services than users of conventional medicine. This appears to be primarily the result of an increase in the number of health conditions and symptoms reported by CAM users.

Demographic and Psychosocial Predictors of Early Attrition for Drug Use in U.S. Marines.

OBJECTIVE: The objective of this study was to determine demographic and psychosocial predictors of early attrition for drug use in a cohort of U.S. Marines and the resulting lost person-days. METHOD: The study included data from 35,193 male Marines who completed a life history questionnaire during their first week of basic training. Associations between demographic and psychosocial variables with subsequent discharge for drug use were analyzed using logistic regression. RESULTS: The strongest predictors of early attrition because of drug use were being a smoker, African American race, moving around often as a child, not having a high school diploma, joining the military to leave problems behind, and having a prior arrest record. The results also indicate that approximately 3.1 million person-days were lost in this cohort because of early discharge for drug abuse. CONCLUSIONS: Despite effective policies that prohibit drug use, these findings suggest that a significant loss in manpower and training costs still occurs because of early attrition for drug use. Postenlistment interventions for those recruits at higher risk for drug abuse may help to reduce this attrition.

Smoking cessation and improvement in physical performance among young men.

Tobacco use among young adults is a major public health challenge. Near-term benefits of cessation may motivate active young people to quit or avoid smoking. Military basic training includes mandatory tobacco cessation, as well as uniform physical conditioning regimes, creating an opportunity to evaluate changes in physical performance metrics in direct relation to smoking cessation. These analyses included data from all men who completed Marine Corps recruit training in San Diego, California, between 2002 and 2006. Recruits reported tobacco use and other health metrics on a pretraining survey. Initial and final aerobic run-times were recorded over the 3-month training period. Multivariable linear regression analyses assessed changes in run-speed relative to pre-enlistment smoking history. Among 52,419 young men included in analyses, 13,248 (25.3%) reported smoking before enlistment. Average run-speeds improved among all groups of recruits; however, improvement was greater among prior smokers compared to recruits with no history of smoking (average increase of 0.31 vs. 0.21 miles per hour) and statistically significant in multivariate analyses. Smoking cessation in this cohort of young men resulted in improved physical aerobic performance, independent of other behavioral health characteristics. These data may be useful in promoting and motivating smoking cessation among young, active adults.

Trends in new U.S. Marine Corps accessions during the recent conflicts in Iraq and Afghanistan.

The objective of this study was to analyze trends in preservice characteristics among Marine Corps recruits during the recent operations in Iraq and Afghanistan. Recruits completed a confidential survey during their first week of training at the Marine Corps Recruit Depot in San Diego, California. Demographics, behaviors, and health information were analyzed for trends from 2001 to 2010 using the Cochran-Armitage trend test and F statistic. Data from 131,961 male recruits with a mean age of 19.8 years were analyzed. Overall, entry characteristics remained stable exhibiting only modest changes over the study period. Favorable trends included recent (2009-2010) improvements in body mass index and physical activity levels. Unfavorable trends included increases in smokeless tobacco and caffeine use, and angry outbursts. Although many recruit characteristics remained similar over the past decade, both favorable and unfavorable trends in sociobehavioral characteristics were noted. The ongoing assessment of preservice characteristics is important for detecting emerging trends over time. Findings may guide leadership's understanding of changes to help develop early-service trainings promoting a healthier force and potentially reducing future adverse outcomes.

Preinjury psychiatric status, injury severity, and postdeployment posttraumatic stress disorder.

CONTEXT: Physical injury has been associated with the development of posttraumatic stress disorder (PTSD). Previous studies have retrospectively examined the relationship of preinjury psychiatric status and postinjury PTSD with conflicting results, but no prospective studies regarding this subject have been conducted, to our knowledge. OBJECTIVE: To prospectively assess the relationship of predeployment psychiatric status and injury severity with postdeployment PTSD. DESIGN: Prospective, longitudinal study. SETTING: United States military personnel deployed in support of the conflicts in Iraq and Afghanistan. PARTICIPANTS: United States service member participants in the Millennium Cohort Study who completed a baseline questionnaire (from July 1, 2001, through June 30, 2003) and at least 1 follow-up questionnaire (from June 1, 2004, through February 14, 2006, and from May 15, 2007, through December 31, 2008) and who were deployed in the intervening period. Self-reported health information was used to prospectively examine the relationship between baseline psychiatric status and follow-up PTSD in injured and uninjured deployed individuals. MAIN OUTCOME MEASURES: A positive screening result using the PTSD Checklist-Civilian Version. RESULTS: Of 22 630 eligible participants, 1840 (8.1%) screened positive for PTSD at follow-up, and 183 (0.8%) sustained a deployment-related physical injury that was documented in the Joint Theater Trauma Registry or the Navy-Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database. The odds of screening positive for PTSD symptoms were 2.52 (95% confidence interval, 2.01-3.16) times greater in those with 1 or more defined baseline mental health disorder and 16.1% (odds ratio, 1.16; 95% confidence interval, 1.01-1.34) greater for every 3-unit increase in the Injury Severity Score. Irrespective of injury severity, self-reported preinjury psychiatric status was significantly associated with PTSD at follow-up. CONCLUSIONS: Baseline psychiatric status and deployment-related physical injuries were associated with screening positive for postdeployment PTSD. More vulnerable members of the deployed population might be identified and benefit from interventions targeted to prevent or to ensure early identification and treatment of postdeployment PTSD.

Self-reported health symptoms and conditions among complementary and alternative medicine users in a large military cohort.

PURPOSE: To describe medical symptom and condition reporting in relation to complementary and alternative medicine (CAM) use among members of the US military. METHODS: CAM was defined as health treatments not widely taught at US medical schools or typically available at US hospitals. By using data from the Millennium Cohort Study, we included participants who completed a survey from 2004 to 2006 (n=86,131) as part of this cross-sectional analysis in which we sought to identify demographic characteristics and types of health-related symptoms and conditions associated with CAM use. Chi-square tests were used to compare health assessed by self-reported symptoms and conditions among those not reporting CAM use with those reporting practitioner-assisted or self-administered CAM. RESULTS: Of 86,131 participants, 30% reported using at least one practitioner-assisted CAM therapy, 27% reported using at least one self-administered CAM therapy, whereas 59% did not report using any CAM therapy. Both women and men who used CAM reported a greater proportion of specific health conditions and health-related symptoms compared with those not reporting CAM use (p<0.05). CONCLUSIONS: These findings illustrate that a relatively young adult occupational cohort of military personnel using CAM therapies also report multiple comorbidities which may indicate chronic illness management and poorer overall health.