Incidence and health care burden of uterine fibroids among female service members in the active component of the U.S. Armed Forces, 2011-2022.

Uterine fibroids are the most common benign tumors of the uterus among women of reproductive age, disproportionally affecting non-Hispanic Black women compared to other races and ethnicities. This report is an update of a 2011 MSMR report that examined uterine fibroids among female active component service members in the U.S. Armed Forces from 2001 to 2010. Incident uterine fibroids were identified for this report from inpatient and outpatient medical encounter data from 2011 to 2022. Health care burden was estimated utilizing uterine fibroid-related inpatient and outpatient diagnostic and procedure codes. Crude incidence rates and incidence rate ratios were calculated to compare rate differences between subpopulations. A total of 16,046 new uterine fibroid cases were identified, with an incidence rate of 63.5 cases per 10,000 person-years (95% confidence interval: 62.5-64.5). The highest incidence rates were observed among service women 40 years and older, non-Hispanic Black women, and those who served in the Army. Health care burden analysis showed that, even with increases in medical encounters and individuals affected, the numbers of hospital bed days declined over time. The decline in uterine fibroid-related hospital bed days could be attributed to early diagnoses and minimally-invasive treatments. Continued promotion of uterine fibroid awareness can potentially help further reduce uterine fibroid-related impacts on military readiness.

Cigarette smoking patterns among U.S. military service members before and after separation from the military.

U.S. military Service members have consistently smoked more than the general population and the prevalence of smoking is even higher among U.S. veterans. Our study examined cigarette smoking patterns among Service members before and after military separation to better understand the disproportionate rate of smoking among veterans. Data from the Millennium Cohort Study were used. All study participants were in the military at baseline and some transitioned from the military to civilian life during the observation period. We investigated any impact of military separation on smoking, as well as other potential risk factors for smoking. Overall, we observed higher smoking prevalence among veterans than Service members. Additionally, we found that Service members smoked more while approaching their separation from the military. Longitudinal analysis revealed military separation was not a risk factor for smoking, as we had hypothesized. Baseline smoking was the most influential predictor of current smoking status. Other significant factors included alcohol consumption, life stressors, and mental health conditions, among others. Military separation was not a risk factor for smoking. However, Service members in the process of transitioning out of the military, as well as high alcohol consumers and Service members with mental health conditions, may be at higher risk of smoking. Including smoking prevention/cessation programs in pre-separation counseling sessions and developing smoking screening and cessation programs targeting specific high-risk subgroups may reduce smoking among Service members and veterans.

Sexual Harassment, Sexual Assault, and Physical Activity Among U.S. Military Service Members in the Millennium Cohort Study.

Sexual harassment (SH) and sexual assault (SA) continue to be a focus of prevention efforts in the U.S. military because of the prevalence and potential to affect the health and readiness of service members. Limited research exists on the association of SH and SA with coping behaviors, such as physical activity, within the military. Data including self-reported SA, SH, and physical activity were obtained from the Millennium Cohort Study, a longitudinal cohort study designed to examine the impact of military service on the health and well-being of service members. A hierarchical regression approach was applied to examine the association between SH or SA and subsequent physical activity levels. Hierarchical regression showed that, among those self-reporting recent SA, the odds of medium-high (300-449 min/week) and high physical activity levels (≥450 min/week) were significantly increased. Although the magnitude of these associations was attenuated with an increasing amount of adjustment, the odds of high physical activity levels remained statistically significant in the fully adjusted model (medium-high: odds ratio [OR] = 1.72, 95% confidence interval [CI] = [1.08, 2.73]; high: OR = 1.58, 95% CI = [1.02, 2.44]). We observed statistically significant negative associations between recent SH and medium-high physical activity levels in adjusted models (OR = 0.70, 95% CI = [0.54, 0.91]). The current results demonstrate that SA is generally associated with increased levels of physical activity among military service members. Analyzing the relationship between sexual trauma and physical activity is valuable because of the high prevalence of SH and SA in the military, long-term health implications including physical and emotional well-being, and potential impact on military readiness.

Smoking Among U.S. Service Members Following Transition From Military to Veteran Status.

Smoking rates among U.S. Service members and veterans have been consistently higher than in civilian populations. While much has been published about tobacco use in both military and veteran populations, smoking patterns during transition from military to veteran status remains unclear. We studied military members participating in the Millennium Cohort Study, who separated from their respective Services between baseline and first follow-up survey (N = 5,510). Two generalized estimating equation models were used to examine any association between smoking status and time to military separation (days between baseline survey and separation), as well as smoking during transition and reason for separation. Reason for separation was categorized into three groups: (1) not meeting military standards or judicial-related reasons, (2) drugs-/alcohol-related misconduct, and (3) other types of separation including retirement, pregnancy, and so on. Statistical models accounted for baseline smoking and demographic/military/health behavioral/mental health characteristics. Overall, we observed a decline in smoking prevalence over time (19.5%, 16.7%, 15.2%, and 12.6%, respectively). However, we found a 22% increase in the odds of smoking among those who stayed in the military between 3 months and 1 year, compared to those who stayed 2+ years. Additionally, participants separating for standard/judicial reason(s) showed 69% increased smoking compared to those with other reasons for separation. The time period immediately prior to Service separation and certain types of separation were associated with increased odds of smoking. Thus, smoking cessation interventions should target Service members during this transition period to potentially reduce smoking prevalence after separation.

The Epidemiology of Irritable Bowel Syndrome in the US Military: Findings from the Millennium Cohort Study.

OBJECTIVES: Functional gastrointestinal disorders occur more frequently among deployed veterans, although studies evaluating the relative impact of risk factors, including stress and antecedent infectious gastroenteritis (IGE), are limited. We examined risk factors for new-onset irritable bowel syndrome (IBS) among active duty participants in the military's Millennium Cohort Study. METHODS: Medical encounter data from 2001 to 2009, limited to Cohort members on active duty, were used to identify incident IBS cases (any and highly probable). IGE was identified using medical encounter or self-report. Covariate data were obtained from the Millennium Cohort Study surveys and analyzed using Cox proportional hazards methods. RESULTS: Overall, 41,175 Cohort members met the eligibility criteria for inclusion and 314 new-onset cases of IBS were identified among these. Significant risk factors (adjusted hazard ratio, 95% confidence interval) included antecedent IGE (2.05, 1.53-2.75), female gender (1.96, 1.53-2.52), number of life stressors (1: 1.82, 1.37-2.41; 2: 2.86, 2.01-4.06; 3+: 6.69, 4.59-9.77), and anxiety syndrome (1.74, 1.17-2.58). Limited to highly probable IBS, a stronger association with antecedent IGE was observed, particularly when based on medical encounter records (any IGE: 2.20, 1.10-4.43; medical encounter IGE only: 2.84, 1.33-6.09). Precedent anxiety or depression and IGE interacted with increased IBS risk compared with IGE alone. CONCLUSIONS: These results confirm previous studies on the association between sociodemographic or life stressors and IBS. IGE was significantly associated with IBS risk. Whether deployed or not, US service members often encounter repeated exposure to high levels of stress, which, combined with other environmental factors such as IGE, may result in long-term debilitating functional gastrointestinal disorders.

Evaluation of imputation methods for microbial surface water quality studies.

Longitudinal studies of microbial water quality are subject to missing observations. This study evaluates multiple imputation (MI) against data deletion, mean or median imputation for replacing missing microbial water quality data. The specific context is data collected in Chicago Area Waterway System (2007-2009), where 45% of Escherichia coli and 53% of enterococci densities were missing owing to sample analysis deficiencies. Imputation methods were compared performing a simulation study using complete observations with introduced missing values and subsequently compared with the original data with missing observations. Coefficients for E. coli densities in linear regression models predicting somatic coliphages density show that MI introduces the least bias among other methods while controlling Type I error. Further exploration of utilizing different MI implementations is recommended to address the influence of missing percentage on MI performance and to explore sensitivity to the degree of violation of the missing completely at random assumption.