Validity of a Subjective Financial Situation Measure to Assess Socioeconomic Status in US Young Adults.

PURPOSE: Young adulthood is an important period for preventing the establishment of negative health behaviors that can influence trajectories to chronic disease and early death. Given the evolving nature of educational attainment and income variation during this developmental period, identifying indicators of socioeconomic status (SES) remains a challenge. This study examines measures of subjective and objective indicators of SES to predict health risk for young adults. METHODS: This study uses data from the Truth Initiative Young Adult Cohort Study from respondents aged 18 to 34 years who completed 3 consecutive surveys between June 2011 and August 2012 (n = 2182). Analyses were conducted to compare a measure of subjective financial situation (SFS) to commonly used SES measures for adults and adolescents. Age-stratified, multivariable logistic regression was used to model the relationship between 5 SES indicators (SFS, household income, respondent education, parental education, and subjective childhood financial situation) and dichotomized versions of 3 health status measures (body mass index, self-reported health status, and quality of life), controlling for gender, race/ethnicity, and region. RESULTS: Findings indicate that SFS is associated with other commonly used SES measures. Prospective associations with health outcomes revealed that SFS is a stronger predictor of health outcomes among young adults aged 18 to 24 years as compared with other SES measures. CONCLUSION: This study provides evidence that subjective financial situation may be more robust than traditional SES indicators in predicting health outcomes among young adults, particularly for 18- to 24-year-olds, and should be considered a viable candidate measure for assessing SES among this age group.

Impact of Exposure to Electronic Cigarette Advertising on Susceptibility and Trial of Electronic Cigarettes and Cigarettes in US Young Adults: A Randomized Controlled Trial.

INTRODUCTION: This study assessed the impact of brief exposure to four electronic cigarette (e-cigarette) print advertisements (ads) on perceptions, intention, and subsequent use of e-cigarettes and cigarettes in US young adults. METHODS: A randomized controlled trial was conducted in a national sample of young adults from an online panel survey in 2013. Participants were randomized to ad exposure or control. Curiosity, intentions, and perceptions regarding e-cigarettes were assessed post-exposure and e-cigarette and cigarette use at 6-month follow-up. Analyses were conducted in 2014. RESULTS: Approximately 6% of young adults who had never used an e-cigarette at baseline tried an e-cigarette at 6-month follow-up, half of whom were current cigarette smokers at baseline. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette (18.3% exposed vs. 11.3% unexposed, AOR = 1.63, 95% CI = 1.18, 2.26) among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up (3.6% exposed vs. 1.2% unexposed, AOR = 2.85; 95% CI = 1.07, 7.61) among never users of cigarettes and e-cigarettes. Exploratory analyses did not find an association between ad exposure and cigarette trial or past 30-day use among never users, nor cigarette use among smokers over time. Curiosity mediated the relationship between ad exposure and e-cigarette trial among e-cigarette never users. CONCLUSIONS: Exposure to e-cigarette ads may enhance curiosity and limited trial of e-cigarettes in never users. Future studies are needed to examine the net effect of curiosity and trial of e-cigarettes on longer-term patterns of tobacco use. IMPLICATIONS: This randomized trial provides the first evidence of the effect of e-cigarette advertising on a behavioral outcome in young adults. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up in a small number of never e-cigarette users and greater likelihood of e-cigarette trial at follow-up among never users of cigarettes and e-cigarettes.

Patterns of Longitudinal Transitions in Menthol Use Among US Young Adult Smokers.

INTRODUCTION: Menthol is the only characterizing flavor in cigarettes that was not banned as part of the 2009 Family Smoking Prevention and Tobacco Control Act. This longitudinal study explores the role of menthol in smoking initiation and progression. Purpose (a) to examine young adult patterns of menthol cigarette use including switching between menthol and non-menthol and (b) to describe associations between these patterns of menthol use and cessation related intentions and behaviors. Additional data on the role of menthol in cigarettes on smoking uptake and maintenance is needed to inform proposed policy making at the local, state, and national levels. METHODS: Using 3 time points from a longitudinal national sample of young adults aged 18-34 years (N = 267 smokers), patterns of menthol use over 1 year were defined among smokers as: (a) remained menthol smoker; (b) remained non-menthol smoker; (c) switched from menthol to non-menthol; and (d) switched from non-menthol to menthol. Associations were assessed between current menthol cigarette use and cessation intentions and behaviors. RESULTS: Significant predictors of current menthol cigarette use at 1 year included initiation with menthol (OR = 8.26), Black race (OR = 23.60), and higher scores on the Allen menthol taste subscale (OR = 1.53). Menthol smokers were more likely to report intention to quit but no differences existed between menthol and non-menthol users in ever making a quit attempt. CONCLUSIONS: Most young adults stay with the product that they start smoking with. Menthol smokers were interested in quitting, but less interested in next 30-day action than non-menthol smokers.

Skin and soft tissue infections, active component, U.S. Armed Forces, January 2016-September 2020.

During 1 January 2016-30 September 2020, there were 210,914 incident cases of skin and soft tissue infections (SSTIs) among active component U.S. military members, corresponding to a crude overall incidence rate of 352.8 per 10,000 person-years (p-yrs). An additional 4,250 cases occurred in theaters of operations (251.0 per 10,000 p-yrs). Of the total incident SSTI diagnoses, 64.5% were classified as cellulitis/abscess, 30.0% were "other SSTIs" (e.g., folliculitis, impetigo), 5.3% were carbuncles/furuncles, and 0.2% were erysipelas. Crude annual incidence rates declined by 21.9% over the surveillance period. In general, higher rates of SSTIs were associated with younger age, recruit/trainee status, and junior enlisted rank. A total of 174,893 service members were treated for SSTIs, which accounted for 307,160 medical encounters and 14,819 hospital bed days. SSTIs in the military are associated with significant operational and health care burden. Strategies for the prevention, early diagnosis, and definitive treatment of SSTIs are warranted, particularly in initial military training and operational settings associated with increased risk of infection.

Acute and chronic pancreatitis, active component, U.S. Armed Forces, 2004-2018.

Pancreatitis is an inflammatory disease of the pancreas resulting from the premature activation of digestive enzymes within the pancreas. Pancreatitis occurs in both acute and chronic forms. During 2004-2018, a total of 6,471 U.S. active component service members received incident diagnoses of acute pancreatitis (AP), for a crude overall incidence rate of 31.8 per 100,000 person- years (p-yrs). Compared to their respective counterparts, overall rates of AP diagnoses were highest among females, those in older age groups, non-Hispanic blacks, Army members, and those working in healthcare occupations. Crude annual rates of AP diagnoses increased by 25.5% over the 15-year period; this trend was driven largely by a rise in outpatient rates. Of the total incident cases of AP, 9.0% received a subsequent incident diagnosis of chronic pancreatitis (CP) during the surveillance period. Between 2004 and 2018, the crude overall incidence rate of CP was 4.4 per 100,000 p-yrs. Patterns of overall rates of CP by demographic and military characteristics were generally similar to those for AP. Crude annual rates of CP fluctuated between 3.7 per 100,000 p-yrs and 5.7 per 100,000 p-yrs during the surveillance period, with no pronounced overall trend over time. To inform preventive and therapeutic strategies, continued research is needed to understand the factors that increase risk of progression from AP to CP and the importance of the interaction between genetic and environmental factors in this transition.

Carbon monoxide poisoning, active and reserve component service members and non-service member beneficiaries of the Military Health System, U.S. Armed Forces, July 2009-June 2019.

Morbidity and mortality from carbon monoxide (CO) poisoning are important public health problems, but their full impact is difficult to estimate. The current analysis used the 2018 Council of State and Territorial Epidemiologist criteria and International Classification of Diseases (ICD) codebased data to classify CO poisoning cases by intent, source of exposure, and degree of certainty that poisoning was CO related. During July 2009-June 2019, there were 1,288 CO poisoning cases classified as confirmed/probable among active component service members, 366 among reserve component members, and 4,754 among non-service member beneficiaries. Service members working in repair/engineering occupations accounted for the greatest proportion of confirmed CO poisoning cases among active component members and the second greatest proportion among reserve component members. Compared to suspected cases, confirmed/probable cases were more often associated with intentional self-harm and undetermined causes of injury, whereas suspected cases were more often coded as unintentional. Confirmed/probable active component and non-service member beneficiary cases were more likely than their respective suspected case counterparts to receive care in inpatient settings. The need for improvements in ICD coding to reduce the percentage of CO poisoning cases coded with unknown injury intent and/or unknown CO poisoning source is discussed.

Update: Incidence of acute gastrointestinal infections and diarrhea, active component, U.S. Armed Forces, 2010-2019.

Laboratory, reportable medical event, and medical encounter data were analyzed to identify cases of acute gastrointestinal (GI) infections caused by Campylobacter, nontyphoidal Salmonella, Shigella, Escherichia coli (E. coli), or norovirus, as well as cases of unspecified gastroenteritis/diarrhea among U.S. active component service members during 2010-2019. Unspecified gastroenteritis/ diarrhea diagnoses accounted for 98.8% of identified incident cases (4,135.1 cases per 100,000 person-years [p-yrs]). Campylobacter was the most frequently identified specific etiology (17.6 cases per 100,000 p-yrs), followed by nontyphoidal Salmonella (12.7 cases per 100,000 p-yrs), norovirus (10.8 cases per 100,000 p-yrs), E. coli (7.5 cases per 100,000 p-yrs), and Shigella (3.2 cases per 100,000 p-yrs). Crude annual rates of norovirus, E. coli, Campylobacter, and Salmonella infections and unspecified gastroenteritits/diarrhea increased between 2010 and 2019 while rates of Shigella infections were relatively stable. Among deployed service members during the 10-year period, only 150 cases of the 5 specific causes of gastroenteritis were identified but a total of 20,377 cases of unspecified gastroenteritis/diarrhea were diagnosed (3,062.9 per 100,000 deployed p-yrs).

Diabetes mellitus and gestational diabetes, active and reserve component service members and dependents, 2008-2018.

During 2008-2018, a total of 12,582 active component service members received incident diagnoses of any diabetes mellitus (DM), for a crude overall incidence rate of 84.8 per 100,000 person-years. More than four-fifths of incident cases were type 2 DM. The overall rates of this form of DM among Asian/Pacific Islander and non-Hispanic black active and reserve component service members were 1.5 or more times the rates among their respective counterparts in other race/ethnicity groups. Crude annual rates of type 2 DM diagnoses among active and reserve component members peaked in 2010 and then decreased to their lowest points in 2018. From 2010 through 2018, decreases in rates of incident type 2 DM diagnoses were observed among active and reserve component members in all subgroups examined (sex, age, race/ethnicity, service), with the greatest slopes of decline seen among service members aged 40 years or older, Asian/Pacific Islanders, and Army members. During 2008-2018, total counts of incident diagnoses of type 2 DM among Military Health System (MHS) dependents decreased by 66.0%, from 29,625 to 10,066. The overall crude prevalence of gestational DM ranged from 7.3% among active component service women to 8.4% among female MHS dependents. Comparisons to data from U.S. civilian populations are made when appropriate.

Measles, mumps, rubella, and varicella among service members and other beneficiaries of the Military Health System, 1 January 2016-30 June 2019.

Measles, mumps, rubella, and varicella (MMR/V) are highly communicable infectious diseases whose causative agents are spread through contact with contaminated surfaces or airborne droplets. Individuals at highest risk for MMR/V infections include infants; unvaccinated or inadequately vaccinated persons; individuals living in communities with low vaccination rates or in crowded, unsanitary conditions; and persons with compromised immune systems. Between 1 January 2016 and 30 June 2019, there were 5 confirmed measles cases and 64 confirmed mumps cases among all Military Health System (MHS) beneficiaries. During this period, no cases of measles were reported among U.S. service members. There were 29 confirmed mumps cases among service members during the surveillance period; 2 cases occurred in 2016, 17 in 2017, 5 in 2018, and 5 in the first 6 months of 2019. There were 6 confirmed rubella cases among all MHS beneficiaries. Among service members, there were 39 confirmed cases of varicella during the surveillance period; 9 cases occurred in 2016, 11 in 2017, 11 in 2018, and 8 in the first 6 months of 2019. Recent trends in MMR/V in both military and civilian populations in the U.S. highlight the importance of primary and booster vaccinations.

Vasectomy and vasectomy reversals, active component, U.S. Armed Forces, 2000-2017.

During 2000-2017, a total of 170,878 active component service members underwent a first-occurring vasectomy, for a crude overall incidence rate of 8.6 cases per 1,000 person-years (p-yrs). The most common operative procedure performed was conventional vasectomy (99.2%), with less than 1% of vasectomies categorized as minimally invasive vasectomy. Among the men who underwent incident vasectomy, 2.2% had another vasectomy performed during the surveillance period. Compared to their respective counterparts, the overall rates of vasectomy were highest among service men aged 30-39 years, non-Hispanic whites, married men, and those in pilot/air crew occupations. Male Air Force members had the highest overall incidence of vasectomy and men in the Marine Corps, the lowest. Crude annual vasectomy rates among service men increased slightly between 2000 and 2017. The largest increases in rates over the 18-year period occurred among service men aged 35-49 years and among men working as pilots/air crew. Among those who underwent vasectomy, 1.8% also had at least 1 vasectomy reversal during the surveillance period. The likelihood of vasectomy reversal decreased with advancing age. Non-Hispanic black and Hispanic service men were more likely than those of other race/ethnicity groups to undergo vasectomy reversals.

Infectious mononucleosis, active component, U.S. Armed Forces, 2002-2018.

Infectious mononucleosis (IM) is an acute infectious illness characterized by swollen lymph nodes, fever, pharyngitis, fatigue, and head and body aches. This report describes the incidence rates, trends, and demographic correlates of IM among active component service members during 2002-2018. During the surveillance period, there were 23,780 incident cases of IM, resulting in an overall incidence rate of 104.2 cases per 100,000 person-years (p-yrs). The incidence of IM diagnoses was highest among the youngest age groups and decreased with increasing age. The rate of incident IM diagnoses was markedly higher among non-Hispanic white service members (123.4 per 100,000 p-yrs) compared to those in other race/ethnicity groups. The incidence of IM diagnoses among recruits (364.9 per 100,000 p-yrs) was 3.4 times that among other enlisted personnel (106.0 per 100,000 p-yrs) and 5.6 times that among officers (64.7 per 100,000 p-yrs). The incidence of IM diagnoses remained relatively stable during the surveillance period, at about 100 per 100,000 p-yrs. IM is not considered to be a serious illness; however, it can seriously impact availability for duty during the acute phase.

Update: Gallbladder disease and cholecystectomies, active component, U.S. Armed Forces, 2014-2018.

The term gallbladder disease refers to a variety of conditions of the gallbladder and the biliary tract. The more common of these conditions are cholelithiasis (gallstones) and cholecystitis (inflammation of the gallbladder), and these conditions often are treated with cholecystectomy (gallbladder removal). During the 2014-2018 surveillance period, 8,008 active component service members were identified as incident cases of gallbladder disease. The crude overall incidence rate of gallbladder disease was 1.2 per 1,000 person-years; the crude annual rate decreased very slightly during the period. A total of 6,470 active component service members underwent incident cholecystectomies. Almost all (97.4%) were performed laparoscopically, and the majority were performed in outpatient settings (65.2%). The number of hospital bed days per open cholecystectomy far exceeded those per laparoscopic cholecystectomy. However, the number of hospital bed days per open cholecystectomy markedly decreased throughout the period. Gallbladder disease and cholecystectomies were more common among service members who were female, American Indian/Alaska Native or Hispanic, older, in the Air Force, and in healthcare occupations. Clinicians should continue to advocate for lifestyle changes, such as maintaining a healthy weight and a diet low in fat and cholesterol, that could prevent gallbladder disease. Similarly, continued Department of Defense-wide initiatives to promote healthy lifestyles could also help prevent gallbladder disease and maintain the health of the force.

Animal bites and rabies post-exposure prophylaxis, active and reserve components, U.S. Armed Forces, 2011-2018.

During 2011-2018, there were 22,729 diagnoses of animal bites among active and reserve component members of the U.S. Armed Forces. Of these, 899 (4.0%) were documented during medical encounters associated with deployments to overseas theaters of operations. Army, Navy, Air Force, and Marine Corps members were affected by 55.6%, 23.5%, 14.2%, and 6.7% of all animal bites diagnosed in theater, respectively. More than four-fifths of total animal bite cases (82.4%) and bites diagnosed in theater (88.4%) affected enlisted members. The crude overall incidence rate of animal bite diagnoses was 175.7 per 100,000 person-years (p-yrs) among active component service members between 2011 and 2018. Overall rates were highest among active component service members who worked in law enforcement (462.5 per 100,000 p-yrs) or veterinary occupations (437.8 per 100,000 p-yrs). Among active component service members, the crude annual rate of animal bite diagnoses in 2018 was more than twice that in 2001 (194.1 per 100,000 p-yrs and 85.1 per 100,000 p-yrs, respectively). Dog bites accounted for approximately three-quarters (74.8%) of total animal bites during the surveillance period. Only a small proportion of animal bites were associated with documentation of exposure to or post-exposure prophylaxis for rabies. Animal bite avoidance and rabies education should be reinforced before service members travel or deploy to areas where rabies is highly enzootic.

Non-alcoholic fatty liver disease (NAFLD), active component, U.S. Armed Forces, 2000-2017.

During 2000-2017, a total of 19,069 active component service members received incident diagnoses of non-alcoholic fatty liver disease (NAFLD), for a crude overall incidence rate of 77.7 cases per 100,000 person-years. The overall rate of incident NAFLD diagnoses among males was more than 1.5 times the rate among females. Overall incidence rates of NAFLD diagnoses increased with advancing age and were highest among service members aged 50 years or older. Asian/Pacific Islander and Hispanic service members had the highest overall incidence of NAFLD diagnoses compared to those in other race/ethnicity groups. The lowest overall incidence by race/ethnicity was observed among non-Hispanic black service members. Crude annual incidence rates of NAFLD diagnoses increased 12-fold between 2000 and 2017. During this period, annual rates of incident NAFLD diagnoses increased in both sexes and in all age groups. Increases in annual rates were seen over time in all race/ethnicity groups and in all services. More than two-thirds of incident NAFLD cases had one or more diagnosed metabolic comorbidities, with dyslipidemia affecting the greatest percentage of cases, followed by obesity/overweight and hypertension. The percentage of NAFLD cases with 2 or more metabolic comorbidities increased 36.0% during the 18-year surveillance period from 22.2% in 2001 to 30.2% in 2017. Selected recommendations from the American Association for the Study of Liver Diseases 2018 practice guidance document for the diagnosis and management of NAFLD are discussed.

Absolute and relative morbidity burdens attributable to ocular and vision-related conditions, active component, U.S. Armed Forces, 2018.

The current report used an ocular and vision disease classification system and several healthcare burden measures to quantify the impacts of various ocular and vision-related illnesses and injuries among active component service members of the U.S. Armed Forces during 2018. More service members received care for refractive error and related disorders than any other ocular and vision-related major category; this category accounted for slightly more than one-half (51.1%) of all ocular and vision-related medical encounters. Conjunctival disorders accounted for the next highest percentage of total medical encounters (13.3%) followed by corneal disorders (7.5%). The 3 specific ocular and vision-related conditions that accounted for the most medical encounters (i.e., myopia, astigmatism, and acute conjunctivitis) accounted for almost one-half (47.7%) of all ocular and vision-related medical encounters overall. In general, the conditions that accounted for the most medical encounters were predominantly refractive error and related disorders and conjunctival disorders. More active component service members received medical care for myopia than for any other specific condition. Optic nerve conditions and visual discomfort/disturbances accounted for more than onequarter (30.1%) of all ocular and vision-related hospital bed days.

Herpes zoster, active component, U.S. Armed Forces, 2000-2016.

During 2000-2016, a total of 52,895 active component service members received incident diagnoses of herpes zoster (HZ), for an overall unadjusted incidence rate of 2.5 cases per 1,000 person-years (p-yrs). Compared to their respective counterparts, overall incidence rates of HZ were highest among females, those aged 50 years or older, and Air Force members. Overall rates generally increased with increasing age and were highest among non-Hispanic whites and Asian/Pacific Islanders and lowest among non-Hispanic blacks. Unadjusted annual incidence rates of HZ increased steadily from 2000 to a peak in 2014. From 2000 through 2016, annual rates of HZ increased in each service and increases in annual rates were seen in all race/ethnicity groups. Individuals who were identified as immunocompromised constituted 2.1% of the total incident HZ cases. During 2000-2016, the cumulative numbers of incident cases of HZ were highest during June, July, and August. The increase in HZ incidence observed in this and many other studies is a public health concern that requires a better understanding of key risk factors. Additional research focused on these factors could make trends more interpretable, suggest new approaches for prevention and treatment of HZ, and allow for better targeting of existing strategies.

Update: Accidental drownings and near drownings, active component, U.S. Armed Forces, 2013-2017.

Service members are at risk for unintentional drownings or near drownings during training, occupational activities, and off-duty recreation. During 2013-2017, there were 359 incident accidental drowning episodes (includes drownings and near drownings) for a crude rate of 5.7 cases per 100,000 person-years. Compared with their respective counterparts, the overall incidence rates of drowning episodes were highest among males, those aged 29 years or younger, those who were unmarried, and enlisted service members. Across the services, crude overall rates were highest among Marine Corps and Navy members and lowest among Air Force members. Overall rates of drowning episodes were highest among those working in motor transport and lowest among those in repair/engineering or communications/intelligence occupations. The overall rate of drowning episodes among service members with any history of alcohol-related disorder was nearly twice that of those without any history of alcohol-related disorder. Between 2015 and 2017, annual rates of drowning episodes decreased in each service, with the greatest decline observed among Navy and Marine Corps members. The results of this report may be useful to increase awareness regarding the ongoing risks and effects of drowning episodes among U.S. service members.

Update: Lightning strike injuries, active component, U.S. Armed Forces, 2008-2017.

During 2008-2017, a total of 241 service members had incident lightning-related medical encounters with ICD-9 or ICD-10 codes that documented specific lightning-associated injuries or illnesses. The crude overall incidence rate of lightning strike injury during the surveillance period was 1.9 cases per 100,000 person-years. Compared to their respective counterparts, overall rates of lightning strike injury were higher among males, those aged 20-29 years, non-Hispanic whites, Army members, enlisted service members, those in combat-specific occupations, and those stationed in the Southern region of the U.S. During the surveillance period, there was a peak in incidence of lightning strike injury during 2015, as well as two smaller peaks in 2011 and 2013. "Disturbance of skin sensation," headache, limb pain, and burns were the four most frequent diagnoses during medical encounters for incident lightning strike injuries. The largest numbers of incident lightning strike injuries occurred in June, July, August, and September. Service members who routinely train and work outdoors should be vigilant about the dangers of lightning, especially in field settings during summer months.

Adrenal gland disorders, active component, U.S. Armed Forces, 2002-2017.

During 2002-2017, the most common incident adrenal gland disorder among male and female service members was adrenal insufficiency and the least common was adrenomedullary hyperfunction. Adrenal insufficiency was diagnosed among 267 females (crude overall incidence rate: 8.2 cases per 100,000 person-years [p-yrs]) and 729 males (3.9 per 100,000 p-yrs). In both sexes, overall rates of other disorders of adrenal gland and Cushing's syndrome were lower than for adrenal insufficiency but higher than for hyperaldosteronism, adrenogenital disorders, and adrenomedullary hyperfunction. Crude overall rates of adrenal gland disorders among females tended to be higher than those of males, with female:male rate ratios ranging from 2.1 for adrenal insufficiency to 5.5 for adrenogenital disorders and Cushing's syndrome. The highest overall rates of adrenal insufficiency for males and females were among non-Hispanic white service members. Among females, rates of Cushing's syndrome and other disorders of adrenal gland were higher among non-Hispanic white service members compared with those in other race/ethnicity groups. In both sexes, the annual rates of adrenal insufficiency and other disorders of adrenal gland increased slightly during the 16-year period.

Incidence and prevalence of the metabolic syndrome using ICD-9 and ICD-10 diagnostic codes, active component, U.S. Armed Forces, 2002-2017.

This report uses ICD-9 and ICD-10 codes (277.7 and E88.81, respectively) for the metabolic syndrome (MetS) to summarize trends in the incidence and prevalence of this condition among active component members of the U.S. Armed Forces between 2002 and 2017. During this period, the crude overall incidence rate of MetS was 7.5 cases per 100,000 person-years (p-yrs). Compared to their respective counterparts, overall incidence rates were highest among Asian/Pacific Islanders, Air Force members, and warrant officers and were lowest among those of other/unknown race/ethnicity, Marine Corps members, and junior enlisted personnel and officers. During 2002-2017, the annual incidence rates of MetS peaked in 2009 at 11.6 cases per 100,000 p-yrs and decreased to 5.9 cases per 100,000 p-yrs in 2017. Annual prevalence rates of MetS increased steadily during the first 11 years of the surveillance period reaching a high of 38.9 per 100,000 active component service members in 2012, after which rates declined slightly to 31.6 per 100,000 active component service members in 2017. Validation of ICD-9/ICD-10 diagnostic codes for MetS using the National Cholesterol Education Program Adult Treatment Panel III criteria is needed to establish the level of agreement between the two methods for identifying this condition.