Bidirectional Associations between Probable Eating Disorders and Mental Health Conditions Among Military Service Members and Veterans.

Although prior research has examined the prevalence of eating disorders (EDs) such as binge eating disorder (BED) and bulimia nervosa (BN) among military personnel, less is known regarding temporal associations between EDs and other mental health conditions. Using longitudinal data from 179,694 service members and veterans from the Millennium Cohort Study, temporal associations between EDs (BN, BED) and mental health conditions (posttraumatic stress disorder, anxiety, depression, and problem drinking) were investigated using a cross-lagged panel model approach. Results indicated consistent bidirectional associations between most mental health conditions and EDs; however, the magnitude of these cross-lagged associations varied across BN and BED. Cross-lagged effects of mental health conditions on subsequent BED were significantly stronger than BED to mental health condition cross-lagged effects. In contrast, cross-lagged effects of BN on subsequent mental health conditions were stronger than mental health conditions to BN. Preventive screening for those at risk for BN may have a stronger impact on mitigating downstream mental health conditions, while interventions among those with mental health conditions may play a greater role in eliminating maladaptive coping strategies including binge eating. Study findings underscore the importance of early detection of mental health conditions and EDs to maximize readiness among service members.

Prevalence and Risk Factors for the Development of Bulimia Nervosa and Binge Eating Disorder in a Large U.S. Military Cohort.

While bulimia nervosa (BN) and binge eating disorder (BED) are prevalent in military populations, an understanding of risk and protective factors is limited by a lack of longitudinal population-based epidemiological research. This study examined the prevalence of BN and BED among active duty service members and identified military and psychosocial factors associated with their development. Millennium Cohort Study participants were followed for up to 15 years and prevalence was ascertained using survey and electronic medical record data. Longitudinal multivariable logistic regression models evaluated risk factors associated with the development of bulimia nervosa (n=96,245) or binge eating disorder (n=113,733). Weighted prevalence estimates from survey data (range, 0.80%-4.80%) were higher than those from medical records (0.04%-0.14%). Military factors significantly associated with increased risk for BN and BED included active duty component (vs Reserve/Guard); serving in the Army, Marines, or Navy/Coast Guard (vs Air Force); and combat deployment (vs deployment without combat). Associated psychosocial factors included lack of social support, experiencing at least one life stressor, and screening positive for posttraumatic stress disorder or problem drinking. Findings highlight the critical need for disordered eating screening and prevention efforts that bolster coping skills, which can ultimately improve service member functioning and readiness.

Racial, Ethnic, and Sex Differences in Eating Disorder Onset Among U.S. Military Service Members.

Bulimia nervosa (BN) and binge eating disorder (BED) are the most prevalent eating disorders (EDs) among military personnel. Although sex differences are noted in ED prevalence in military and civilian samples, mixed findings have emerged when evaluating racial and ethnic differences. The present study examined independent associations and interactions between sex, race, ethnicity, and probable BED and BN onset. The sample included 91,413 and 96,245 service members from the Millennium Cohort Study for BED and BN analyses, respectively. Up to four datapoints (from 2001-2013) were used to conduct longitudinal complementary log-log regression analyses, as participants were followed until the outcome occurred or until study completion. BN was more likely among women than men, and no sex difference emerged for BED onset. BN was more likely among Hispanic/Latinx, Multiracial, Black, and Asian/Pacific Islander (API) while BED was less likely among Black and API versus non-Hispanic/Latinx White (NHW) service members. Interactions revealed greater likelihood of BN in Hispanic/Latinx service members was driven by men. Additional efforts are needed amongst racially and ethnically diverse groups in preventing and detecting EDs in military personnel. Future intersectionality research could elucidate systemic inequities and other contributing factors to ED onset to inform prevention and treatment efforts.

Racial, Ethnic, and Sex Disparities in Mental Health Among US Service Members and Veterans: Findings From the Millennium Cohort Study.

Although disparities in mental health occur within racially, ethnically, and sex-diverse civilian populations, it is unclear whether these disparities persist within US military populations. Using cross-sectional data from the Millennium Cohort Study (2014-2016; n = 103,184; 70.3% male; 75.7% non-Hispanic White), a series of logistic regression analyses were conducted to examine whether racial, ethnic, and/or sex disparities were found in mental health outcomes (posttraumatic stress disorder (PTSD), depression, anxiety, and problematic anger), hierarchically adjusting for sociodemographic, military, health-related, and social support factors. Compared with non-Hispanic White individuals, those who identified as American Indian/Alaska Native, non-Hispanic Black, Hispanic/Latino, or multiracial showed greater risk of PTSD, depression, anxiety, and problematic anger in unadjusted models. Racial and ethnic disparities in mental health were partially explained by health-related and social support factors. Women showed greater risk of depression and anxiety and lower risk of PTSD than men. Evidence of intersectionality emerged for problematic anger among Hispanic/Latino and Asian or Pacific Islander women. Overall, racial, ethnic, and sex disparities in mental health persisted among service members and veterans. Future research and interventions are recommended to reduce these disparities and improve the health and well-being of diverse service members and veterans.

Sleep health among US Navy afloat versus ashore personnel in the Millennium Cohort Study.

Despite emerging public concern regarding the sleep health of military personnel over the past two decades, there remains a dearth of research examining sleep health among naval personnel assigned to sea duty. This study examined sleep metrics (e.g. fatigue, short sleep duration) and mental (e.g. posttraumatic stress disorder, depression) and physical health (e.g. type 2 diabetes, bodily pain) outcomes among naval personnel with recent sea duty (i.e. afloat) compared with naval personnel with recent shore duty (i.e. ashore). Prevalence ratios and mean differences for all outcomes were estimated and adjusted for demographic and military variables, and subsequently stratified by obesity. Sleep metrics were similar between afloat and ashore sailors except for short sleep duration, while sailors with recent shore duty had poorer physical health compared with those with recent sea duty. Stratified analyses suggested naval personnel with obesity had a higher proportion of nearly all adverse sleep-related health outcomes than those without obesity. Among participants without obesity, afloat personnel were more likely to report very short sleep (≤ 5 hours) and fewer hours of average nightly sleep, but were less likely to report physical health outcomes compared with ashore personnel. These findings suggest potential differences in sleep metrics and sleep-related health outcomes between afloat and ashore naval personnel. Additional research examining sleep outcomes using more objective measures is required to further investigate these findings, which may inform strategies to foster consolidated sleep despite environmental and occupational challenges in order to maintain high-performing naval personnel.

Social network characteristics moderate associations between cortical thickness and cognitive functioning in older adults.

INTRODUCTION: Prior research suggests that the strength of association between Alzheimer's disease (AD) pathology and lower cognitive performance is influenced by modifiable psychosocial factors, such as social network size. However, little is known about distinct social relationship types. METHODS: The current cross-sectional study used data from the Washington Heights-Inwood Columbia Aging Project to examine whether social network characteristics (i.e., total size, spouse/partner, number of children, other relatives, friends) moderate associations between cortical thickness in regions implicated in AD and cognitive performance. RESULTS: Lower cortical thickness was associated with worse global cognition among individuals with smaller friend networks, but not among individuals with larger friend networks. This pattern of results was most prominent for language and speed/executive functioning. DISCUSSION: Longitudinal and intervention studies are needed to determine whether these cross-sectional findings reflect a protective effect of later-life friendships for maintaining cognitive performance in the context of poorer brain health.

Positive Psychosocial Factors and Cognitive Decline in Ethnically Diverse Older Adults.

OBJECTIVES: Previous cross-sectional studies have documented associations between positive psychosocial factors, such as self-efficacy and emotional support, and late-life cognition. Further, the magnitudes of concurrent associations may differ across racial and ethnic groups that differ in Alzheimer's disease risk. The goals of this longitudinal study were to characterize prospective associations between positive psychosocial factors and cognitive decline and explicitly test for differential impact across race and ethnicity. METHODS: 578 older adults (42% non-Hispanic Black, 31% non-Hispanic White, and 28% Hispanic) in the Washington Heights-Inwood Columbia Aging Project completed cognitive and psychosocial measures from the NIH Toolbox and standard neuropsychological tests over 2.4 years. Latent difference scores were used to model associations between positive psychosocial factors and cognitive decline controlling for baseline cognition, sociodemographics, depressive symptoms, physical health, and other positive psychosocial factors. Multiple-group modeling was used to test interactions between the positive psychosocial factors and race/ethnicity. RESULTS: Higher NIH Toolbox Friendship scores predicted less episodic memory decline. One standard deviation increase in friendship corresponded to 6 fewer years of memory aging. This association did not significantly differ across racial/ethnic groups. CONCLUSIONS: This longitudinal study provides support for the potential importance of friendships for subsequent episodic memory trajectories among older adults from three ethnic groups. Further study into culturally informed interventions is needed to investigate whether and how friend networks may be targeted to promote cognitive health in late life.

Mediators and Moderators of the Association Between Perceived Stress and Episodic Memory in Diverse Older Adults.

OBJECTIVE: Stress is a risk factor for numerous negative health outcomes, including cognitive impairment in late-life. The negative association between stress and cognition may be mediated by depressive symptoms, which separate studies have identified as both a consequence of perceived stress and a risk factor for cognitive decline. Pathways linking perceived stress, depressive symptoms, and cognition may be moderated by sociodemographics and psychosocial resources. The goal of this cross-sectional study was to identify modifying factors and enhance understanding of the mechanisms underlying the stress-cognition association in a racially and ethnically diverse sample of older adults. METHOD: A linear regression estimated the association between perceived stress and episodic memory in 578 older adults (Mage = 74.58) in the Washington Heights-Inwood Columbia Aging Project. Subsequent models tested whether depressive symptoms mediated the stress-memory relationship and whether sociodemographics (gender, race, and ethnicity) or perceived control moderated these pathways. RESULTS: Independent of sociodemographics and chronic diseases, greater perceived stress was associated with worse episodic memory. This relationship was mediated by more depressive symptoms. Higher perceived control buffered the association between stress and depressive symptoms. There was no significant moderation by gender, race, or ethnicity. CONCLUSION: Depressive symptoms may play a role in the negative association between perceived stress and cognition among older adults; however, longitudinal analyses and studies using experimental designs are needed. Perceived control is a modifiable psychological resource that may offset the negative impact of stress.

Longitudinal Associations Between Contact Frequency with Friends and with Family, Activity Engagement, and Cognitive Functioning.

OBJECTIVES: Social engagement may be an important protective resource for cognitive aging. Some evidence suggests that time spent with friends may be more beneficial for cognition than time spent with family. Because maintaining friendships has been demonstrated to require more active maintenance and engagement in shared activities, activity engagement may be one underlying pathway that explains the distinct associations between contact frequency with friends versus family and cognition. METHODS: Using two waves of data from the national survey of Midlife in the United States (n = 3707, Mage = 55.80, 51% female at baseline), we examined longitudinal associations between contact frequency with friends and family, activity engagement (cognitive and physical activities), and cognition (episodic memory and executive functioning) to determine whether activity engagement mediates the relationship between contact frequency and cognition. RESULTS: The longitudinal mediation model revealed that more frequent contact with friends, but not family, was associated with greater concurrent engagement in physical and cognitive activities, which were both associated with better episodic memory and executive functioning. CONCLUSION: These findings suggest that time spent with friends may promote both cognitively and physically stimulating activities that could help to preserve not only these social relationships but also cognitive functioning.

Psychological predictors of memory decline in a racially and ethnically diverse longitudinal sample of older adults in the United States.

OBJECTIVES: In the United States, racial and ethnic disparities in memory dysfunction and Alzheimer disease are evident even after accounting for many risk factors. Psychological factors, such as psychological well-being, perceived control, depressive symptoms, and negative affect, may influence memory dysfunction, and associations may differ by race and ethnicity. This study examined whether psychological factors are differentially associated with episodic memory trajectories across racial and ethnic groups in the United States. METHODS/DESIGN: The National Health and Aging Trends Study (NHATS), is a US-representative, longitudinal study of Medicare-eligible adults 65+ years old. Analyses of 5 years of data, included a total of 9411 participants without dementia at baseline. Adjusting for relevant covariates, a linear mixed model estimated the associations between psychological predictors and a composite of immediate and delayed trials from a word list memory test. RESULTS: More depressive symptoms (B = -0.02), lower psychological well-being (B = 0.03), and lower perceived control (B = 0.05) were independently associated with lower initial memory. Depressive symptoms were associated with faster rate of memory decline (B = -0.01). Black (B = -0.34) and Hispanic (B = -0.28) participants evidenced lower initial memory level than whites, but only Hispanic (B = -0.04) participants evidenced faster memory decline than whites. There were no significant interactions between the psychological variables and race and ethnicity. CONCLUSIONS: Results extend previous studies showing racial and ethnic disparities in episodic memory trajectories, and the longitudinal effects of depressive symptoms on episodic memory in US samples. Epidemiological studies of cognitive aging should incorporate more psychological factors clarify cognitive decline and disparities.

The longitudinal association between social network composition and episodic memory in older adulthood: the importance of contact frequency with friends.

Objectives: The composition of one's social network has been associated with cognition such that a greater proportion of family is associated with worse cognition compared to a greater proportion of friends. It is not clear whether this association between network composition and cognitive aging is driven by potential negative effects of family interactions or positive effects of friend interactions.Methods: Using the Health and Retirement Study (T1: 2006/2008, T2: 2010/2012, T3: 2012/2014), a longitudinal mediation model was conducted to test the effects of composition on episodic memory and latent change in memory through contact frequency with friends and family.Results: Analyses revealed indirect effects of composition on both T2 memory and latent change in memory through contact frequency with friends. A greater proportion of family in one's network was associated with lower contact frequency with friends and in turn lower memory. Composition was also associated with higher contact frequency with family; however, contact frequency with family was not associated with memory.Conclusions: These findings suggest that spending time with family may not affect episodic memory in older adulthood, but spending time with friends may be beneficial. Potential mechanisms and implications regarding the importance of friendships in later life are discussed.

Managing expectations: How stress, social support, and aging attitudes affect awareness of age-related changes.

The degree to which social support (SS) moderates the effects of stress on self-perceptions of aging may depend on individual differences in general aging attitudes. We examined how stress, different types of SS, and general expectations regarding aging (ERA) affect awareness of age-related changes (AARCs). The sample included 137 adults (21-76 years; 56.2% women) who took an online survey on Amazon's Mechanical Turk. Regression analyses showed differential moderation of stress effects due to ERA and the SS measure (perceived and received) and function (emotional and instrumental). Received emotional SS was only associated with AARC losses, whereas perceived support-both emotional and instrumental-was associated with AARC gains and losses. Findings may help guide future work aimed at promoting health and well-being in adulthood.

Inflammatory mechanisms underlying the effects of everyday discrimination on age-related memory decline.

BACKGROUND/OBJECTIVES: Previous research suggests that everyday discrimination is associated with worse episodic memory and partially mediates Black-White disparities in memory aging. The biological mechanisms underlying the link between everyday discrimination and memory are unclear but may involve inflammatory processes. This study aimed to determine whether systemic inflammation, indexed by blood levels of C-reactive protein (CRP), mediates associations between everyday discrimination and episodic memory over 6 years. DESIGN: A longitudinal mediation model quantified associations between baseline everyday discrimination, 4-year change in CRP, and 6-year change in episodic memory. SETTING: The Health and Retirement Study (HRS). PARTICIPANTS: 12,624 HRS participants aged 51 and older. MEASUREMENTS: Everyday Discrimination Scale, high-sensitivity CRP assays of dried blood spots, composite scores of immediate and delayed recall of a word list. RESULTS: Black participants reported greater everyday discrimination. Greater discrimination was associated with lower baseline memory and faster memory decline. Higher CRP at baseline partially mediated the negative association between discrimination and baseline memory, but CRP change did not mediate the association between discrimination and memory decline. CONCLUSION: This U.S.-representative longitudinal study provides evidence for deleterious effects of discrimination on subsequent episodic memory. The fact that elevated CRP only partially explained the concurrent association between discrimination and memory highlights the need for more comprehensive investigations of biological mechanisms underlying the link between social stress and age-related memory decline in order to better characterize potential intervention targets to reduce racial inequalities in memory aging.

Resource or Hindrance? The benefits and costs of social support for functional difficulties and its implications for depressive symptoms.

OBJECTIVES: The impact of social support on the relationship between stress and well-being remains somewhat inconclusive, with work suggesting either null, buffering, or amplification effects. The current study investigated the conditions in which perceived social support is likely to act as a buffer or amplifier by considering individual differences in self-perceptions of aging. METHODS: Using data from two subsamples of the Wisconsin Longitudinal Study (graduates: 70-74 years, siblings: 40-92 years), we examined how perceived social support (emotional versus instrumental) and self-perceptions of aging (SPA) moderated the effect of functional limitations on depressive symptoms (DS). RESULTS: Although emotional support positively predicted DS, its effects did not depend on SPA. Instrumental support was associated with both increases and decreases in well-being that were dependent upon SPA. Functional limitations predicted more DS at both low and high levels of instrumental support when SPA were negative. However, when SPA were positive, low levels of social support were found to decrease depressive symptoms, and high levels were found to increase depressive symptoms. CONCLUSIONS: The impact of social social may enhance or deteriorate well-being, depending on how it interacts with self-evaluative beliefs. Findings offer insights as to the boundary conditions associated with the (positive) effects of social support and SPA, and highlight the need for continued research on the mechanisms associated these effects.

The Differential Impact of Social Participation and Social Support on Psychological Well-Being: Evidence From the Wisconsin Longitudinal Study.

Being socially engaged is theorized to diminish age-related declines in emotional functioning. However, unique facets of social engagement may differentially impact functioning in older adulthood. In particular, social participation (SP) might be more beneficial than social support (SS) in buffering declines. The goal of this study was to examine whether interindividual differences in SP and SS influenced intraindividual change in Psychological Well-Being (PWB). The impact of SS and SP on change in PWB was investigated in two samples from the Wisconsin Longitudinal Study spanning 19 years (1992-2011): graduate respondents and their siblings. Using latent growth curve models, small declines in PWB were found. Individuals high in SP demonstrated a less steep decline in PWB across the three time points than individuals low in SP. SS, however, did not buffer declines in PWB. Developmental implications of the age-related trajectory of PWB and the relationship with social engagement are discussed.

All-cause mortality among United States military personnel: Findings from the Millennium Cohort Study, 2001-2021.

PURPOSE: The goal of this study was to estimate all-cause mortality among Operations Enduring Freedom, Iraqi Freedom, and New Dawn era service members and veterans and to identify protective and risk factors for mortality. METHODS: Using 20 years of longitudinal data from the Millennium Cohort Study (2001-2021), sequential Cox proportional hazard models were conducted to examine demographic, military, and health-related characteristics associated with all-cause mortality among service members and veterans. RESULTS: Among 201,619 participants, 3806 (1.9 %) were deceased by the end of the observation period, with an age- and sex-adjusted incidence of 37.6 deaths per 100,000 person-years. Deployed service members had lower all-cause mortality risk than those who did not deploy. Personnel who experienced combat had higher mortality risk compared with those who did not in unadjusted models; this association was nonsignificant after accounting for health-related factors. Enlisted and Army personnel both had a higher mortality risk, while women and Hispanic individuals had a lower risk. Stressful life events, lower physical health related quality of life, problem drinking, and smoking were also associated with greater mortality risk. CONCLUSION: These profiles may be useful for developing preventive education and intervention efforts in military and veteran populations to reduce premature mortality.

Prospective comparison of risk factors for firearm suicide and non-firearm suicide in a large population-based cohort of current and former US service members: findings from the Millennium Cohort Study.

Background: Suicide is a leading cause of death among service members and veterans. Among suicide methods, firearms are the most lethal and commonly used method among military populations. Limited research has compared risk factors for the various suicide methods. This study evaluated and compared risk factors for firearm versus non-firearm suicides using data from the Millennium Cohort Study, a large longitudinal military cohort. Methods: Using a competing risk approach, we identified factors associated with each suicide method. Risk factors included demographics, mental health diagnoses, mental health symptoms, military-specific characteristics, health behaviors, and psychosocial factors. Cause of death was assessed from July 1, 2001, through December 31, 2018. Findings: Among 201,565 eligible participants with a mean [SD] age of 29.0 [58.1] years, there were 139,789 (69.3%) male, 61,776 (30.7%) female, 15,927 (7.9%) Hispanic, 24,667 (12.3%) non-Hispanic Black, 14,138 (7.0%) Asian, Pacific Islander, American Indian or Multiracial, and 146,736 (72.8%) non-Hispanic White participants. During the study period, 330 died by firearm suicide and 168 died by non-firearm suicide. Overall, effect estimates for risk factors were similar across both methods of suicide. After adjustment, men (HR: 3.69, 95% CI: 2.59, 5.24) and those who screened positive for depression (HR: 1.97, 95% CI: 1.36, 2.87) had an elevated risk for firearm suicide. In contrast, those who self-reported a history of bipolar diagnosis (HR: 3.40, 95% CI: 1.76, 6.55) had significantly increased risk for non-firearm suicide. Interpretation: Findings suggest that prevention and intervention strategies overall may not need to be differentiated by specific demographic, military, or health factors. Targeted interventions that consider sex and mental health screens might have relative utility in preventing firearm related suicide risk compared with non-firearm suicide. Funding: Military Operational Medicine Research Program, Defense Health Program, and Department of Veterans Affairs.

Factors associated with mental healthcare utilization among United States military personnel with posttraumatic stress disorder or depression symptoms.

INTRODUCTION: Although posttraumatic stress disorder (PTSD) and depression are prominent mental health conditions affecting United States service members, only a subset of individuals with these conditions utilize mental healthcare services. Identifying factors associated with mental healthcare utilization may elucidate military subgroups with unmet mental healthcare needs. METHODS: Cross-sectional survey data from the 2019-2021 Millennium Cohort Study assessment were used to examine correlates of unmet mental healthcare needs among military personnel who screened positive for PTSD or depression symptoms (n=18,420) using modified Poisson regression models. Data analyses for this study were conducted between 2023 and 2024. RESULTS: Approximately 32-43% of service members reported receiving any mental healthcare in the past 12 months. Hispanic and Asian or Pacific Islander personnel, and those with certain service characteristics (higher pay grade, recent deployment, experienced discrimination) had a lower likelihood of mental healthcare utilization. Female sex, greater symptom severity, experiencing bullying, and other psychosocial factors were associated with greater likelihood of mental healthcare utilization. CONCLUSIONS: One-third of service members with PTSD or depression symptoms reported any mental healthcare use, highlighting the need to identify factors that may impede or delay treatment. Racial and ethnic disparities in treatment utilization persist as do differences in utilization by military characteristics. Further research and initiatives are necessary to identify potential service-specific or cultural barriers and provide equitable quality and access to needed mental health services within the Military Health System.

Contribution of post-trauma insomnia to depression and posttraumatic stress disorder in women service members: findings from the Millennium Cohort Study.

STUDY OBJECTIVES: We examined whether women service members and veterans who reported recent combat and/or sexual trauma experiences had a greater risk of insomnia compared with women who did not report these recent experiences, and whether insomnia would be associated with a greater risk of mental health outcomes. METHODS: We analyzed two waves of survey data (2011-2013, Time 1 [T1] and 2014-2016, Time 2 [T2]) from 26 443 current and former women service members from the Millennium Cohort Study. We assessed recent traumas in the past 3 years, and probable insomnia at T1 and probable post-traumatic stress disorder (PTSD) and depression at T2. A longitudinal mediation model was used to quantify separate indirect effects of recent traumas on mental health outcomes through probable insomnia. RESULTS: Women who had experienced recent sexual assault (odds ratio [OR] = 1.68; 95% CI = 1.24-2.10), sexual harassment (OR = 1.22; 95% CI = 1.05-1.41), and combat (OR = 1.34; 95% CI = 1.20-1.49) at T1 had a greater risk of probable insomnia at T1 compared with women who had not recently experienced these events. Probable insomnia at T1, in turn, was associated with probable depression (OR = 2.66; 95% CI = 2.31-3.06) and PTSD (OR = 2.57; 95% CI = 2.27-2.90) at T2. Recent combat experience did not moderate the associations of recent sexual trauma with insomnia or mental health outcomes. CONCLUSIONS: Insomnia contributes to the risk of subsequent mental health conditions following trauma. The diagnosis and treatment of post-trauma insomnia should be prioritized to mitigate the development of posttraumatic mental health conditions.

Risk and Protective Factors for Cancer Mortality among United States Service Members and Veterans (2001-2018).

BACKGROUND: Prior research linking military factors with cancer-specific mortality has shown inconsistent findings, with few studies examining these associations among U.S. service members and veterans who served in Operation Iraqi Freedom/Operation Enduring Freedom conflicts. METHODS: Cancer mortality between 2001 and 2018 was ascertained from the Department of Defense Medical Mortality Registry and National Death Index for 194,689 Millennium Cohort Study participants. Cause-specific Cox proportional hazard models were used to examine links between military characteristics and cancer mortality [overall, early (<45 years), and lung]. RESULTS: Compared with individuals who deployed with no combat experiences, non-deployers had a greater risk of overall [HR = 1.34; 95% confidence interval (CI) = 1.01-1.77] and early cancer mortality (HR = 1.80; 95% CI = 1.06-3.04). Enlisted individuals had a greater risk of lung cancer mortality compared with officers (HR = 2.65; 95% CI = 1.27-5.53). No associations by service component, branch, or military occupation and cancer mortality were observed. Higher education was associated with reduced overall, early and lung cancer mortality risk and smoking and life stressors were associated with elevated overall and lung cancer mortality risk. CONCLUSIONS: These findings are consistent with the healthy deployer effect in which military personnel who were deployed tend to be healthier than those who did not deploy. Further, these findings highlight the importance of considering socioeconomic factors, such as military rank, that may have long-term implications for health. IMPACT: These findings highlight military occupational factors that may predict long-term health outcomes. Additional work is necessary to investigate more nuanced environmental and occupational military exposures and cancer mortality.