DoD Patient Satisfaction Surveys by wuyunqing

VIEWS: 38 PAGES: 68

									   Preliminary Findings from the 2006 DoD
     Survey of Health Related Behaviors
    among the Guard and Reserve Force



           A Component of the
DoD Lifestyle Assessment Program (DLAP)
                      Presented by
              Laurel Hourani, Ph.D., M.P.H.
     RTI International • Research Triangle Park, NC
                          for the
     Assistant Secretary of Defense (Health Affairs)
           & TRICARE Management Activity
                  September, 2007
             DoD Lifestyles Assessment
                  Program (DLAP)
   BACKGROUND
     – Initiated in 2005 by USD (P&R); directed by ASD (HA)
     – DLAP builds on Active Duty (AD) health behavior surveys
       conducted since 1980; 2005 AD final report most current fielding
       and is basis for comparison
     – In 2006, broadened assessment scope to Reserve Component
       (RC) and Unit-level influences (2006 study data analysis in
       progress)
     – Includes surveys, special studies, and evaluations
   PURPOSE
     – Assess lifestyle factors affecting health and readiness
     – Identify/track health-related trends and high-risk groups
     – Target groups and/or lifestyle factors for intervention
     – Help identify future directions for additional studies, DoD programs
       and policies

                                                                         2
                     2006 DoD Survey of
                   the Reserve Component
   BACKGROUND
     – Largest anonymous population-based health behavior survey of Reserve
       Component personnel
     – First survey of its kind conducted on the Reserve Components (RC)
     – ASD(HA) and ASD(CN) - proponents
   METHODOLOGY
     – Reserve Centers and Armories randomly chosen from 16 randomly selected
       clusters
     – All RCs represented: Army Reserve, Army National Guard, Navy Reserve,
       Marine Corps Reserve, Air Force Reserve, and Air National Guard
     – Anonymous on-site administration (80%). Mail questionnaires sent to non-
       clustered, remote installations (20%).
     – 18,342 usable questionnaires overall (including full-time and/or activated
       Guard/Reservists)
     – Overall response rate of 55.3% (completed questionnaires/number expected to
       be drilling on data collection weekend)
     – Stratified by each RC; due to large number of small facilities and unknown
       composition of personnel attending on a given drill weekend, additional
       stratification not possible.
                                                                                 3
                      Topic Areas
              169 Questions; 9 Standard Scales
   Substance Use: Alcohol, Tobacco, Illicit drug use
   Selected Healthy People 2010 Objectives
   Mental well being
   Weight management
   Exercise/fitness/nutrition
   Deployment related issues
   Safety - Helmet/safety belt use
   Health Status
     – Preventive/sexual/oral health
     – Productivity
     – Negative life events/behavioral problems/risk-taking behaviors
   Spirituality/religiosity
   Job satisfaction
   Sociodemographics
                                                                        4
               Selected Results* Presented

   Demographics
   Substance Use
      – Alcohol Use
      – Tobacco Use
      – Illicit Drug Use
   Weight Management
   Indicators of Mental Well Being, relating to the following:
      – Stress
      – Depression, Anxiety, PTSD, Suicide Ideation
   Deployment and Job Satisfaction

*A note about Analyses:
   To facilitate significance testing between Reserve components, most estimates presented have been adjusted to
    control for socio-demographic differences (gender, age group, enlisted/officer status, marital status, education,
    and race/ethnicity) across the groups. These estimates vary only slightly from unadjusted rates which show the
    actual magnitude of the problem which have been included as backup slides. For this presentation, Reserve
    component excludes full-time and/or activated guard/reservists.
   Since most estimates are prevalence rates and limited statistical comparisons made, Bonferroni or other
    adjustments not made for this presentation.



                                                                                                                        5
          A word about survey data….

   In interpreting and understanding the findings, three points
    should be considered:
     – (a) The data and results are self-reported findings that may
        differ from information in official records or more objective
        data sources;
     – (b) some questionnaire items comprise screeners
        suggestive of possible substance abuse or mental health
        problems; results from these screeners may suggest the
        need for further evaluation but do not represent a formal
        clinical diagnosis; and
     – (c) in reporting the findings, the term “significant” is often
        used. This term refers to statistical significance resulting
        from statistical tests of differences that were conducted.
        Differences between two or more estimates were mentioned
        if they were significant at the 95% confidence level unless
        otherwise stated.



                                                                        6
Demographics
                 Reserve Component Characteristics-
                         Current Job Status
   100                                                                                                     Army National Guard

                                                                                                           Army Reserve

                                                                                                           Navy Reserve
             80             *
                                                                                                           Air National Guard

                                                                                                           Air Force Reserve
Percentage (%)




                                                                                                           Marine Corps Reserve

             60                                                                                            Total Reserve
                                                                                                           Component


                                                                                                       *
             40

                                                               *                                                           *
             20
                                                                                      *

                 0
                     Full-time civilian job    Part-time civilian job     Self-employed    In school            Multiple jobs

                        *Significant   difference between highest and lowest percentages
                                                                                                                                  8
       Reserve Component (RC) Characteristics:
       Past Active Duty and Years Served in RC*


                           100                                  Army
100
                                                                National
 90                         90                                  Guard
                            80                                  Army
 80
                                                                Reserve
 70                         70
                            60                                  Navy
 60
                                                                Reserve
                            50
 50
                            40                                  Air National
 40                                                             Guard
                            30
 30
                            20                                  Air Force
 20                                                             Reserve
                            10
 10
                              0                                 Total RC
  0                                 Served Served Served
       Served on AD
                                      Less      2 - 9 10+ Yrs
                                     than 2      Yrs
                                       Yrs
*Significant differences between highest and lowest estimates
                                                                               9
                      Reserve Component Characteristics-
                   Number of days spent performing duty in
                  National Guard or Reserves, past 12 months*

   100
                                                                                                 Army National Guard

                                                                                                 Army Reserve

                                                                                                 Navy Reserve
                 80                                                                              Air National Guard

                                                                                                 Air Force Reserve
Percentage (%)




                                                                                                 Total Reserve
                 60                                                                              Component


                            *

                 40                                                                                        *


                 20


                 0
                       Less than 28 days               At least 28 days, less than 60        60 or more days
                             *Significant differences between highest and lowest estimates
                             Marine Corps estimates are not shown due to low precision.
                                                                                                                       10
            Demographics, Total Reserve Component
                 and Active Duty Comparison
Sociodemographic characteristic           Reserve Component (%)              Active Duty (%)
Gender
 Male                                     82.5                               85.2

 Female                                   17.5                               14.8

Race/Ethnicity
 White, non-Hispanic                      69.0                               64.4

 African American, non-Hispanic           14.4                               17.6

Education
 High School or less                      25.8a                              33.9

 Some College                             47.9a                              44.1

Age
 34 or younger                            60.3a                              76.9
 Over 34                                  39.7a                              23.1

Marital Status
 Not married, unknown                     52.0a                              46.3

 Married                                  48.0a                              53.7

Pay grade
 E1-E3                                    19.6                               24.0

 E4-E6                                    56.9a                              49.6

 E7-E9                                    9.9                                9.7
 W1-W5                                    1.0                                1.0

 O1-O3                                    5.6a                               9.4

 O4-O10                                   7.0                                6.3


aEstimate   is significantly different from AD personnel at the 95% confidence level
                                                                                               11
Substance Use
                             Heavy1 Alcohol Use, Adjusted for
                              Socio-demographic Differences

100
                                                                                                                        Active Duty

         80                                                                                                             Reserve

                                                                                                                        National Guard

         60
Percentage (%)




                                                                                                                        Guard and
                                                                                                                        Reserves

         40
                          23.0
                                 16.5 a
                                       19.7                                     19.6     20.6                                17.8           c
                                                      16.9                                                                               15.7
         20                                                   11.5b                                         11.9 13.5 12.6



                 0
                                 Army                        Navy                 Marine Corps                  Air Force      Total DoD
1Heavy               Alcohol Use is defined as 5 or more drinks per occasion at least once a week in past 30 days.
aEstimate              is significantly different from Army Active Duty at the 95% confidence level.
bEstimate              is significantly different from Navy Active Duty at the 95% confidence level.
cEstimate              is significantly different from Total DoD Active Duty at the 95% confidence level.
                                                                                                                                                13
                                   Binge Drinking*
                                by Service and Gender

                           Adjusted Rates                                                             Unadjusted Rates
                100                                                                      100
                 90                                                                       90                Active Duty
                 80                                                                       80
                                                                                                            Reserve
                 70                                                                       70                Component




                                                                            Percentage
   Percentage




                 60                                                                       60
                                                                                               48.0
                 50      44.1                                                             50            42.7
                                                  39.6
                 40                                                                       40
                                                                                                                                       29.5
                 30                                                                       30                              24.5
                 20                                                                       20
                 10                                                                       10
                  0                                                                        0
                      Active Duty           Reserve                                                Male                      Female
                                           Component
*Binge drinking defined as consumption of 5 or more drinks (four for females) on the same occasion at least once in the past 30 days
                                                                                                                                              14
                         Any1 Cigarette Smoking, Adjusted for
                           Socio-demographic Differences
   100
                                                                                                                         Active Duty

                 80                                                                                                      Reserve

                                                                                                                         National Guard
Percentage (%)




                 60                                                                                                      Guard and
                                                                                                                         Reserves

                             38.2
                 40
                                        a
                                                     31.5                     30.7                                          31.3
                                    26.1 26.1   a                                           c             d        d                          e
                                                                                     23.9            24.9 23.6                         22.8
                                                                b
                                                         18.7                                                     18.1
                 20


                  0
                                    Army                    Navy              Marine Corps                Air Force          Total DoD

                      1Any Cigarette Smoking is defined as any cigarette use in past 30 days.
                      aEstimate is significantly different from Army Active Duty at the 95% confidence level.
                      bEstimate is significantly different from Navy Active Duty at the 95% confidence level.
                      cEstimate is significantly different from Marine Corps Active Duty at the 95% confidence level.
                      dEstimate is significantly different from Air Force National Guard at the 95% confidence level.
                      eEstimate is significantly different from Total DoD Active Duty at the 95% confidence level.



                                                                                                                                                  15
                        Illicit Drug Use1, Adjusted for
                       Socio-demographic Differences

    100
                                                                                                                                         Active Duty

                 80                                                                                                                      Reserve

                                                                                                                                         National Guard
Percentage (%)




                 60                                                                                                                      Guard and
                                                                                                                                         Reserves

                 40


                 20
                        6.9 6.2 8.9                                                 5.7     4.7
                                                        4.8 4.1                                                       a     a
                                                                                                                 3.0 3.4                       5.1              4.9
                                                                                                                                2.0
                  0
                                  Army                         Navy                  Marine Corps                    Air Force                    Total DoD
                      1Illicit   drug use is defined as any drug use for non-medical purposes without a prescription or physician’s approval in past 30 days.
                      aEstimate      is significantly different from Air Force National Guard at the 95% confidence level.


                                                                                                                                                                      16
                   Summary of Significant Findings:
                      Adjusted Estimates for
                          Substance Use
– Heavy Alcohol Use
   • Army Reserve rates of heavy alcohol use (16.5%) were significantly lower than Army Active Duty rates
     (23.0%).
   • Navy Reserve rates (11.5%) were significantly lower than Navy Active Duty rates (16.9%).
   • Among the total DoD, Active Duty rates (17.8%) were significantly higher than total Guard and Reserve
     rates (15.7%).

– Cigarette Use
   • Army National Guard (26.1%) and Army Reserve (26.1%) rates were significantly lower than
      Army Active Duty rates (38.2%).
   • Navy Reserve rates (18.7%) were significantly lower than Navy Active Duty rates (31.5%)
   • Marine Corps Reserve rates (23.9%) were significantly lower than Marine Corps Reserve Active Duty rates
     (30.7%).
   • Air Force National Guard rates (18.1%) were significantly lower than Air Force Reserve rates (23.6%) and
     Air Force Active Duty rates (24.9%).
   • Among the total DoD, Guard and Reserve rates (22.8%) were significantly lower than Active Duty rates
     (31.3%).

– Illicit Drug Use
    • Army National Guard rates (8.9%) were highest of all Reserve components (though not all differences
      reached statistical significance).
    • Air Force Active Duty (3.0%) and Air Force Reserve rates (3.4%) were significantly higher than Air Force
      National Guard rates (2.0%).


                                                                                                             17
Mental Well Being
                     Perceived High Stress1, Adjusted for
                       Socio-demographic Differences
  100
                                                                                                                          Active Duty

                                                                                                                          Reserve
             80
                                                                                                                          National Guard
Percentage (%)




             60                                                                                                           Guard and
                                                                                                                          Reserves
                     46.3                                              44.2
                               a        a                                      42.0                                        40.7             c
                            38.7 38.7        37.4 37.0                                                b   36.9
                                                                                                                 b
                                                                                                                                     37.3
             40                                                                                34.9
                                                                                                                 30.7


             20


                 0
                            Army                    Navy                Marine Corps                 Air Force                Total DoD
                      1RC  personnel who reported a great deal of military or civilian job or family stress in the past 12 months.
                      aEstimate is significantly different from Army Active Duty at the 95% confidence level.
                      bEstimate is significantly different from Air Force National Guard at the 95% confidence level.
                      cEstimate is significantly different from Total DoD Active Duty at the 95% confidence level.
                                                                                                                                                19
              Sources of Self-Reported Stress,
                Past Year, Total RC and AD
                                      Reserve Component
                                                                               Active Duty (2005)
                                            (2006)
Stressor                            Men (%)         Women (%)             Men (%)        Women (%)

Being away from family                10.0*             13.5                   16.6          16.9

Problems with money                    9.7*             13.9                    8.0           7.5

Problems at my civilian job            9.6*             14.1                   N/A           N/A

Deployment                             7.6               6.7                   13.9*         10.1
Conflicts between military and
                                       6.5               7.3                   N/A           N/A
civilian job demands
Divorce or breakup                     5.2*              8.1                   5.2*           9.0

Death in the family                    3.8*              7.5                   5.2*           6.7
Conflicts between military and
                                       6.0               7.3                    9.0          10.0
family responsibilities

                  *Difference between men and women significant at .05 level                        20
                               Need for Further Depression
                                 Evaluation1, Adjusted for
                              Socio-demographic Differences
          100
                                                                                                              Active Duty

                                                                                                              Reserve
                     80
                                                                                                              National Guard
        Percentage (%)




                     60                                                                                       Guard and
                                                                                                              Reserves


                     40
                             27.7
                                      a     a                      24.2                                             22.5
                                                21.7                             c                                                      d
                                19.6 20.9                                 18.4            16.3
                     20                                                                                                          17.0
                                                       14.0 b                                    14.3 15.0



                         0
                                    Army               Navy        Marine Corps                Air Force              Total DoD
1Military
        personnel exhibited symptoms in the past 7 days that would indicate a need for a depression evaluation per screening criteria on Burnam scale.
aEstimate is significantly different from Army Active Duty at the 95% confidence level.
bEstimate is significantly different from Navy Active Duty at the 95% confidence level.
cEstimate is significantly different from Marine Corps Active Duty at the 95% confidence level.
dEstimate is significantly different from Total DoD Active Duty at the 95% confidence level.
                                                                                                                                                     21
                         Need for Further PTSD
                        Evaluation1, Adjusted for
                     Socio-demographic Differences
  100
                                                                                                              Active Duty

                                                                                                              Reserve
             80
                                                                                                              National Guard
Percentage (%)




             60                                                                                               Guard and
                                                                                                              Reserves


             40


             20
                     9.1 8.5 9.8                      a
                                            6.0 4.2                 6.4 6.7                4.1                       6.4          6.2
                                                                                                  3.7 4.1
                 0
                         Army                    Navy               Marine Corps                 Air Force             Total DoD
                      1Military
                              personnel who were considered in need for further Posttraumatic Stress Disorder evaluation in the past 30
                      days defined as 50+ on PCL-C.
                      aEstimate is significantly different from Navy Active Duty at the 95% confidence level.



                                                                                                                                          22
                     Suicide Ideation1, Adjusted for
                     Sociodemographic Differences

  100
                                                                                                               Active Duty

                                                                                                               Reserve
             80
                                                                                                               National Guard
Percentage (%)




             60                                                                                                Guard and
                                                                                                               Reserves


             40


             20
                     5.5 5.5      6.5         5.2    4.7               5.1 4.7                  3.8 4.1 3.2         4.9      4.8


                 0
                         Army                       Navy               Marine Corps               Air Force         Total DoD
                     1Military   personnel who reported seriously considering suicide in the past 12 months.


                                                                                                                                   23
                   Summary of Significant Findings:
                      Adjusted estimates for
                        Mental Well Being
– Perceived Stress at Work and in Family Life
   • Army National Guard (38.7%) and Army Reserve (38.7%) had significantly lower prevalence rates than
     Army Active duty (46.3%).
   • Air Force National Guard (30.7%) had a significantly lower prevalence than Air Force Active Duty (34.9%)
     and Air Force Reserve (36.9%).
   • Among the total DoD, Active Duty had significantly higher rates (40.7%) than Guard and Reserves (37.3%).
   • Unlike active duty personnel, problems at their civilian jobs and problems with money are among the top 3
     sources of stress for both men and women RC members

– Need for Further Depression Evaluation
   • Army National Guard (20.9%) and Army Reserve (19.6%) had significantly lower prevalence rates than
     Army Active duty (27.7%).
   • Navy Reserve (14.0%) had a significantly lower prevalence than Navy Active Duty (21.7%).
   • Marine Corps Reserve (18.4%) had a significantly lower prevalence than Marine Corps Active Duty
     (24.2%).
   • Total DoD Active Duty had significantly higher rates (22.5%) than Guard and Reserves (17.0%).

– Need for further PTSD Evaluation
   • Navy Reserve (4.2%) had a significantly lower prevalence than Navy Active Duty (6.0%).
   • Army National Guard had the highest of all Reserve components (9.8%) though not all comparisons
     reached statistical significance.

– Suicide Ideation
   • There were no statistically significant differences within components though Air Force rates were
     significantly lower than Army and Navy rates.
                                                                                                           24
Weight Management, Physical
Fitness, and Supplement Use
                   Elevated BMI by Reserve Component (2006) and
                             Active Duty Branch (2005)
                       (Based on 1998 NHLBI BMI Guidelines*)
             100
                                                                                                                               BMI 30+
                                                                                                                               BMI 25.0-29.9
              80
                                60.7        60.6                   65.0        63.1                    60.8                                         61.0
                   61.3                                                                    60.6                              57.7         60.3
Percentage




                                                       59.6
              60           a            a                      b
                                                                                      cd
                                            10.3        11.9       18.2        15.7        12.7        13.8                    7.9                   12.5
                    17.9         16.4                                                                                                     13.6

              40

                           a            a   50.3        47.7       46.8        47.4        47.9        47.0                   49.8        46.7       48.5
                    43.4         44.3
              20
                                                                                                                   +

               0
                      Arm            Arm         A      N          Na v        Air         Air         Air        Mar           Mar       Tota          Tota
                          y    Na t       y Re rmy Ac a vy Re          y Ac         Nat
                                                                                        iona
                                                                                               For
                                                                                                   ce R
                                                                                                           For
                                                                                                              ce A ine Cor ine Cor             l Re           l Ac
                                   iona        serv  tiv e      s erv      t iv e                                                                    s erv        ti
                                        l Gu       e       Dut       e            D ut      l Gu
                                                                                                 ard
                                                                                                       es e
                                                                                                           rve
                                                                                                                  ct iv
                                                                                                                        e Du
                                                                                                                                ps R
                                                                                                                                    es e
                                                                                                                                           ps A
                                                                                                                                                ct iv     e Co v e D ut
                                             ard              y                       y                                                 rve           e Du       mpo       y
                                                                                                                             ty                                      nen
                                                                                                                                                           ty            t

                       *National Heart, Lung and Blood Institute (NHLBI) defined BMI>25 as a screener for overweight
                       status. BMI based on self reports of height and weight; does not differentiate between muscle
                       and fat. Numbers in bars may not sum to totals due to rounding.
                       aEstimate is significantly different from the Army Active Duty at the 95% confidence level.
                       bEstimate is significantly different from the Navy Active Duty at the 95% confidence level.
                       cEstimate is significantly different from the Air Force Active Duty at the 95% confidence level.
                       dEstimate is significantly different from the Air Force Reserve at the 95% confidence level.

                       +Low precision.
                                                                                                                                                                          26
                     Moderate or Vigorous Physical Activity at Least 20
                             Min/day on 3 or More Days/week

  100                                                                                                             Active Duty
                                                                                                                  Reserve
                                                                                                                  National Guard
                                                                                                                  Guard and Reserves
                     80.0                                        80.3                                                   e
             80                                                                           76.3                    76.6
                                        70.0                                 c
                              a                     b                 65.8
                        60.1 59.2   a        61.6                                                    d        d                60.3
                                                                                               57.5 57.5
             60
Percentage (%)




             40


             20


                 0
                            Army               Navy              Marine Corps                 Air Force              Total DoD
   aEstimate is significantly different from the Army Active Duty at the 95% confidence level.
   bEstimate is significantly different from the Navy Active Duty at the 95% confidence level.
   cEstimate is significantly different from the Marine Corps Active Duty at the 95% confidence level.
   dEstimate is significantly different from the Air Force Active Duty at the 95% confidence level.
   eEstimate is significantly different from the Total DoD, Guard and Reserves at the 95% confidence level.
                                                                                                                                       27
                           Selected Dietary Supplement
                              Use, Men (Unadjusted)
             100
                            Men, Reserve Component
                            Men, Active Duty
              80
                            Total Reserve Component
                            Total Active Duty
Percentage




              60                                                                                    a
                                                                                                        b
                                                                                             46.2           47.845.0
                                                                                                    43.0
              40
                   21.9 23.020.2 20.5        a     b   a
                                                                  b                                                           a
                                                                                                                                           a
              20                              16.8 15.6 18.0                                                           16.2         b
                                                                                                                                   16.0 b
                                         14.0                                                                                 11.8
                                                                      10.1 9.4 9.7 8.4                                                11.7

               0
                     Body Building               Weight Loss            Performance           Multivitamins &                     Herbal
                                                                         Enhancing               Minerals


                          aEstimate   is significantly different from the Total DoD, Active Duty at the 95% confidence level.
                          bEstimate   is significantly different from the Total DoD, Guard and Reserves at the 95% confidence level.




                                                                                                                                               28
                               Selected Dietary Supplement
                                Use, Women (Unadjusted)
             100
                              Women, Reserve Component
                              Women, Active Duty
              80
                              Total Reserve Component
                              Total Active Duty
Percentage




              60                                                                                      55.156.2
                                                                                                                 47.8 45.0

              40
                                                    25.0
                                20.2 20.5 23.0
                                                                       b
                                                                a                                                                   a             a
              20          a                                15.6 18.0                                                         15.4         b16.0
                                                                                                                                                      b
                   12.6         b
                                                                              a
                                                                                            9.7 8.4                                 11.0          11.7
                          6.2                                              8.2
                                                                                        b
                                                                                  2.4
               0
                     Body Building                  Weight Loss             Performance                Multivitamins &                  Herbal
                                                                             Enhancing                    Minerals


                              aEstimate   is significantly different from the Total DoD, Active Duty at the 95% confidence level.
                              bEstimate   is significantly different from the Total DoD, Guard and Reserves at the 95% confidence level.




                                                                                                                                                          29
             Summary of Significant Findings:
        Weight Management, Physical fitness, and
                       Supplement Use
– Overweight and Obese
 • No significant difference between Active duty (60.5%) and
   RC (62.7%)
 • Air National Guard (68.5%) had significantly higher rates
   than Army Reserve and Army National Guard
– Moderate or Vigorous Physical Activity
 • More active duty military personnel engage in moderate or
   vigorous physical activity (76.5%) than Reserve Component
   (59.3%)
 • Marine Corps Reserve and Navy Reserve had the highest
   rates of moderate or vigorous physical activity
– Selected Dietary Supplement Use
 • Approximately 22% of men in the RC report taking body-
   building supplements and 23% of women report taking
   weight loss supplements
                                                          30
Deployment and Substance
    Use/Mental Health
                             Heavy1 Alcohol Use by Deployment
                                    Status, Adjusted for
                               Sociodemographic Differences
  100

                                                                                                                          Deployed 1+
             80                                                                                                           times in past 36
                                                                                                                          months
Percentage (%)




                                                                                                                          Not deployed in
             60                                                                                                           past 36 months



             40

                                          20.1a                16.5                                        17.9a
             20                                                                                                                13.9



                 0
                                               Active Duty                                             Reserve Component
                 1Heavy   Alcohol Use is defined as 5 or more drinks per occasion at least once a week in past 30 days.
                 aEstimate   is significantly different from Not Deployed within Service at the 95% confidence level

                                                                                                                                             32
                           Past Year Cigarette Smoking by
                           Deployment Status, Adjusted for
                            Sociodemographic Differences
  100
                                                                                                            Deployed 1+
                                                                                                            times in past 36
             80                                                                                             months

                                                                                                            Not deployed in
Percentage (%)




                                                                                                            past 36 months
             60
                                     44.5ab               39.6b

             40
                                                                                                       32.1                28.9


             20


                 0
                                         Active Duty                                              Reserve Component

                     aEstimate   is significantly different from not deployed within Service at the 95% confidence level
                     bEstimate   is significantly different from Reserve Component at the 95% confidence level


                                                                                                                                  33
                                        Past Year Illicit Drug Use*, by
                                       Deployment Status, Adjusted for
                                          Sociodemographic Differences

  100
                                                                                                                    Deployed 1+
                                                                                                                    times in past 36
                 80                                                                                                 months

                                                                                                                    Not deployed in
Percentage (%)




                 60                                                                                                 past 36 months



                 40


                 20                       12.4a                                                           12.6a
                                                            10.3b                                                            8.3


                  0
                                              Active duty                                              Reserve Component

                  *Illicit drug use is defined as any drug use for non-medical purposes without a prescription or physician’s approval in past 36 months.
                  aEstimate is significantly different from not deployed within Service at the 95% confidence level
                  bEstimate is significantly different from Reserve Component at the 95% confidence level
                                                                                                                                                            34
                           Met Screening Criteria for PTSD1, by
                            Deployment Status, Adjusted for

  100
                                 Sociodemographic Differences
                                                                                                                 Deployed 1+
                                                                                                                 times inpast 36
             80                                                                                                  months

                                                                                                                 Not deployed in
Percentage (%)




                                                                                                                 past 36 months
             60


             40


             20
                                   7.6a                                                        8.4a
                                                    6.1                                                          5.9

                 0
                                     Active Duty                                            Reserve Component

                     1Military
                             personnel who were considered in need for further Posttraumatic Stress Disorder evaluation in the past 30
                     days.
                     aEstimate is significantly different from not deployed at the 95% confidence level



                                                                                                                                         35
                     Suicide Ideation1,by Deployment
                           Status, Adjusted for
                      Sociodemographic Differences
  100
                                                                                                           Deployed 1+
                                                                                                           times in past 36
                                                                                                           months
             80
                                                                                                           Not deployed in
Percentage (%)




                                                                                                           past 36 months
             60


             40


             20
                                                                                                  ab
                                 5.4                                                        7.1
                                                4.5                                                        3.8
                 0
                                   Active Duty                                          Reserve Component
                     1Military
                             personnel who reported seriously considering suicide in the past 12 months.
                     aEstimate is significantly different from not deployed at the 95% confidence level
                     bEstimate is significantly different from Active Duty at the 95% confidence level




                                                                                                                              36
                         High Stress in Family1, by Theater of
                               Operation, Adjusted for
                                   Sociodemographic Differences

  100
                                                                                                                OIF/OEF

             80
                                                                                                                Other
Percentage (%)




             60                                                                                                 None



             40

                                 19.8                                                         21.5a
                                               18.6         18.5                                        19.2   17.0
             20


                 0
                                         Active Duty                                             Reserve Component
                     1Military   personnel who reported high family stress in the past 12 months.
                     aEstimate    is significantly different from none at the 95% confidence level


                                                                                                                          37
                               Met screening criteria for PTSD1,
                             by Theater of Operation, Adjusted for
                                        Sociodemographic Differences
  100
                                                                                                                               OIF/OEF

             80
                                                                                                                               Other
Percentage (%)




             60                                                                                                                None



             40


             20
                                                                                                 10.1ab         8.2a
                                      7.5          6.1            6.7
                                                                                                                              4.2b

                 0
                                             Active Duty                                            Reserve Component

                     aEstimate   is significantly different from none within service at the 95% confidence level
                     bEstimate   is significantly different between Active duty and reserve component at the 95% confidence level



                                                                                                                                         38
                                        Suicide Ideation1, by Theater
                                         of Operation, Adjusted for
  100
                                       Socio-demographic Differences
                                                                                                                     OIF/OEF

             80
                                                                                                                     Other
Percentage (%)




             60                                                                                                      None



             40


             20                                                                                                 ab
                                                                                                         ab   9.8
                                    5.3           5.2           4.5                                6.4
                                                                                                                     3.1
                 0
                                            Active Duty                                             Reserve Component
                     1Military
                             personnel who reported seriously considering suicide in the past 12 months.
                     aEstimate is significantly different from other and none at the 95% confidence level
                     bEstimate is significantly different from Active Duty at the 95% confidence level




                                                                                                                               39
                                      Comparisons of Job Satisfaction*,
                                         RC (2006) and AD (2005)

  100
                       Active Duty      Reserve           National Guard          Guard and Reserves
                                                                                                                   86.2
                                                                                                              80
             80             74.2 75                75.2
                                                                                                       72.6
                                                                                                                                  77.4

                                                                           70.7
                                            68.3                                                                          67.8

                     59.7
             60
Percentage (%)




             40


             20


                 0
                            Army                   Navy                    Marine Corps                  Air Force         Total DoD
   *Job satisfaction defined as those who reported that they were satisfied or very satisfied with their work assignment.
   Estimates for Reserves and Guard are significantly different from the Active Duty at the 95% confidence level.
                                                                                                                                         40
        Summary of Significant Findings for
         Deployment and Job Satisfaction
   Substance use was associated with deployment. After adjustment,
    heavy alcohol use was higher for AD and RC deployed personnel
    compared with their nondeployed colleagues. AD and RC personnel
    who were deployed also reported significantly higher past-year illicit
    drug use than those not deployed.
   Deployed AD personnel showed higher rates than nondeployed
    personnel for past-year cigarette smoking, heavy smoking and nicotine
    dependence, whereas deployed and nondeployed RC personnel
    showed no significant differences.
   Theater of operation was also associated with substance use. The
    general pattern was that AD or RC personnel deployed either to
    OIF/OEF or to another theater tended to have higher rates of use in one
    or both theaters relative to those not deployed to a theater. This was
    true for illicit drug use and cigarette smoking. For heavy alcohol use, the
    pattern held for AD personnel, but RC personnel did not differ by
    theater.
   Deployment was related to perceived stress and mental health.
    Whereas there was no difference in reported stress in family life by
    theater for AD personnel, RC personnel deployed to OIF/OEF had
    higher rates of reported family stress than those not deployed.

                                                                                  41
              Summary of Significant Findings for
             Deployment and Job Satisfaction (cont.)
   The association of deployment status and meeting screening criteria for PTSD
    symptoms was similar for AD and RC personnel. Those who were deployed
    showed significantly higher rates of meeting the criteria than those who were
    not deployed.
   There were notable differences in deployment status between AD and RC
    personnel in reports of suicidal ideation and suicide attempts. AD personnel
    showed no significant differences associated with deployment, whereas RC
    personnel who were deployed were significantly more likely to report these
    behaviors than those not deployed.
   Theater of operation was also associated with mental health. The general
    pattern was that whereas theater of operation was not associated with many
    of the mental health measures for AD personnel, it was associated for RC
    personnel. RC personnel who served in OIF/OEF showed significantly higher
    rates of PTSD symptoms than any AD personnel and higher rates than those
    serving in no theater. Likewise, for suicidal ideation and suicide attempts, AD
    personnel showed no significant differences due to theater, but RC personnel
    did. This was also true for need for further depression evaluation, met
    screening criteria for anxiety symptoms, and poor mental health limiting
    normal activities.
   RC Personnel were more likely to report that they are satisfied or very
    satisfied with their work assignment in the Guard or Reserve than AD
    personnel (77.4% vs. 67.8%).
                                                                                      42
                         Looking Ahead

   Though cross-sectional data, significance of above findings suggest
    need for further study
   Suggested areas of further investigation
     – Conduct evaluation of stress management and suicide prevention
       programs, especially among deploying RC personnel.
     – Identify additional risk and protective factors with multivariate
       analyses that examine impact of deployment, civilian work stress,
       problems with money, coping behaviors, etc. on mental well being.
     – Need additional analyses to profile high risk members with civilian
       job stress and problems with money to assess need for policy
       changes.
     – Examine effect of other deployment variables such as length of
       deployment, number of deployments, amount of trauma/combat
       exposure, etc.
     – Examine comorbidity across substance use and mental wellbeing
       indicators.


                                                                             43
                  Contact Information

   Dr. Laurel Hourani, RTI International
     – (757) 689-3227
     – hourani@rti.org
   Lynn Pahland, OASD, Health Affairs
     – (703) 681-1703
     – Lynn.Pahland@ha.osd.mil
   COL Kathleen Woody, OASD, Reserve Affairs
     – (703) 693-2296
     – Kathleen.Woody@osd.mil
   LTC Lorraine Babeu, OASD, Tricare Management Activity
     – (703) 681-3636
     – Lorraine.Babeu@tma.osd.mil
   DLAP Website
     – http://dlap.rti.org



                                                            44
Backup Slides




                45
                       Definitions
                  Levels of Alcohol Use

   Abstainer:          Drinks once a year or less
   Infrequent/Light:   Per typical drinking occasion:
                        1–4 drinks 1–3 times per month
   Moderate:           Per typical drinking occasion:
                        1 drink at least once a week, or
                        2–4 drinks 2–3 times per month
                        or 5+ drinks once a month or less
   Moderate/Heavy:     Per typical drinking occasion:
                        2–4 drinks at least once a week
                        or 5+ drinks 2–3 times per month
   Heavy:              5+ drinks at least once a week

   Binge:              5+ drinks at least once in the past 30 days


                                                                      46
                                    Definitions
                                 Illicit Drug Use
   During the past 30 days, on about how many days did you use each of the following drugs for
    nonmedical purposes/without a prescription or physician’s approval? (never in past 30 days,
    1-3 days, 4-10 days, 11 or more days)
   O the average, how often in the past 12 months, have you taken each of the following drugs
    for nonmedical purposes/without a prescription or physician’s approval? (never in past year,
    1-2 days, 3-5 days, 6-11 days, 12-24 days, 25-51 days, 52 days or more)


     –   Marijuana/hashish
     –   Hallucinogens (e.g., LSD, PCP, ecstasy)
     –   Cocaine (including crack)
     –   Amphetamines, Methamphetamines or Other Stimulants (e.g., speed, crystal meth, “uppers)
     –   Tranquilizers or other depressants (e.g., Xanax, Valium, “rufies”
     –   Barbiturates or other sedatives/hypnotics (e.g., downers, quaaludes, GHB, prescription
         sleeping pills)
     –   Heroin or other Opiates (e.g., morphine, opium)
     –   Analgesics or other narcotics (e.g., prescription pain relievers)
     –   Inhalants (e.g., aerosol sprays, gasoline, poppers, “whippets)
     –   Anabolic Steroids (e.g., Testosterone)
     –   Sexual Enhancers (e.g., Viagra)
   Definition of any illicit drug use:
     – Use of any of the above drugs (excluding steroids and sexual enhancers) one or more times in
          the past 30 days or the past 12 months



                                                                                                      47
      Standardized Mental Health Measures

   Need for further Depression evaluation: Based on 3-
    item version A Burnam depression scale (Rost, Burnam,
    and Smith ; 1993)
   Generalized Anxiety Disorder symptoms screen:
    Adapted from the Patient Health Questionnaire (PRIME-
    MD) (Spitzer, Kroenke, & Williams, 1999)
   Serious Psychological Distress: Kessler 6-item scale
    (K-6) (Kessler, 2002) for serious psychological distress
   PTSD screen: PTSD Checklist – Civilian version used to
    capture symptoms that may be the result of either
    military or non-military traumatic exposures (PCL-C)
    (Weathers, et al, 1994)
                                                               48
                 Theater of Operations
                  classified as “other”

   Operations Desert Shield or Desert Storm (e.g., the Persian
    Gulf)
   Operation Just Cause (e.g., Panama)
   Operation Restore Hope (e.g., Somalia)
   Operation Uphold Democracy (e.g., Haiti)
   Operations Joint Endeavor or Joint Guard (e.g., Bosnia)
   Operation Safe Haven (e.g., Cuba)
   Tsunami Relief (e.g., South Asia)
   Hurricane Relief (e.g., Louisiana, Texas, Mississippi)
   Other Combat and/or peace-keeping mission
   Homeland Security (airport security and/or security for active
    duty installations)
   Other remote
                                                                     49
                       Heavy1 Alcohol Use in Past 30 Days by
                        Sociodemographic Characteristics

  100
                                                                                                                          Men
                                                                                                                          Women
             80                                                                                                           24 or younger
                                                                                                                          25-34
                                                                                                                          35-44
Percentage (%)




             60                                                                                                           45 or older
                                                                                                                          Not married
                                                                                                                          Married

             40
                                                                               27.5
                                                                                                                                             22.8
                          18                                                          17.2
             20                 10.5
                                                                                         8.7                                                        10.3
                                                                                               5.6

                 0
                                       Gender                                         Age                                 Marital Status

   1Heavy            Alcohol Use is defined as 5 or more drinks per occasion at least once a week in past 30 days. Differences by gender, age group and marital
   Status significant at 95% confidence level.                                                                                                                    50
                           Driving After Too Much to Drink*,
                                   by Drinking Level
                 100



                  80                                                                                                 AD              RC
Percentage (%)




                  60



                  40



                  20



                   0
                          Infrequent/light                   Moderate                   Moderate/Heavy                         Heavy

                       *Unadjusted percentage of personnel in each drinking-level group who reported driving a car or other vehicle after too much to
                        drink one or more times in past 12 months.

                                                                                                                                                        51
                           Any1 Cigarette Smoking in Past 30 Days
                            by Sociodemographic Characteristics

  100
                                                                                                                   Men
                                                                                                                   Women
                                                                                                                   E1-E3
             80                                                                                                    E4-E6
                                                                                                                   E7-E9
                                                                                                                   W1-W5, O1-O3
Percentage (%)




                                                                                                                   O4-O10
             60                                                                                                    Not married
                                                                                                                   Married


             40
                                                                       28.3                                                                      27.4
                     24                                                        26.7
                           22.2
                                                                                   18.6                                                             19.9
             20
                                                                                        10.9
                                                                                           6.8

                 0
                                   Gender                                     Pay Grade                                  Marital Status
                          1Any  Cigarette Smoking is defined as any cigarette use in past 30 days. Differences by pay grade and marital status
                          significant at the 95% confidence level.




                                                                                                                                                           52
                          Illicit Drug Use in Past 30 Days1 by
                          Sociodemographic Characteristics

  100
                                                                                                                 Men
                                                                                                                 Women
                 80                                                                                              24 or Younger
                                                                                                                 25-34
                                                                                                                 35-44
Percentage (%)




                                                                                                                 45 or Older
                 60                                                                                              Not married
                                                                                                                 Married

                 40


                 20
                             9.1                                         9.8                                                        9
                      6.1                                                      6.1 4.3 4.9                                              4.2

                  0
                                   Gender                                       Age                               Marital Status
                           drug use is defined as any drug use for non-medical purposes without a prescription or physician’s
                      1Illicit

                      approval in past 30 days. Differences by gender and marital status significant at the 95% confidence level.


                                                                                                                                              53
                     Perceived High Military Work Stress1
                            in Past 12 Months by
                      Sociodemographic Characteristics
  100
                                                                                                                        Men
                                                                                                                        Women
                                                                                                                        24 or Younger
             80                                                                                                         25-34
                                                                                                                        35-44
                                                                                                                        45+
Percentage (%)




             60                                                                                                         Not married
                                                                                                                        Married


             40

                                                                            12.9       17
             20      12.4
                         15.5                                        12.8                                                         12.7 13.2
                                                                                10.8


                 0
                                 Gender                                       Age                                Marital Status

                     1RC  personnel who reported a great deal of military job stress in the past 12 months. Difference by gender significant
                     at 95% confidence level.


                                                                                                                                               54
                         Perceived High Family Stress1
                              in Past 12 Months by
                        Sociodemographic Characteristics
  100
                                                                                                                       Men
                                                                                                                       Women
                                                                                                                       24 or Younger
             80                                                                                                        25-34
                                                                                                                       35-44
                                                                                                                       45+
Percentage (%)




             60                                                                                                        Not married
                                                                                                                       Married


             40
                           28.4
                                                                           20.1
                                                                    21.9                                                         21.5
                     17.2                                                         18.1                                                  16.8
             20                                                                15.6



                 0
                                  Gender                                     Age                                Marital Status

                     1RC  personnel who reported a great deal of family/personal life stress in the past 12 months. Difference by gender
                     significant at 95% confidence level.


                                                                                                                                               55
                          Need for Further Depression
                          Evaluation1 in Past 7 Days by
                        Sociodemographic Characteristics
  100
                                                                                                                    Men
                                                                                                                    Women
                                                                                                                    24 or younger
             80                                                                                                     25-34
                                                                                                                    35-44
Percentage (%)




                                                                                                                    45+
             60                                                                                                     Not Married
                                                                                                                    Married


             40
                            27

                                                                    19.818.2 21.2                                             20.7
             20      17.1                                                   17                                                   16.8




                 0
                                  Gender                                    Age                              Marital Status


                      1Military
                             personnel exhibited symptoms in the past 7 days that would indicate a need for a depression evaluation per
                      Burnam screen. Differences by gender and marital status significant at 95% confidence level.
                                                                                                                                          56
                          Need for Further PTSD
                       Evaluation1 in Past 30 Days by
                     Sociodemographic Characteristics
  100
                                                                                                                        Men
                                                                                                                        Women
             80                                                                                                         24 or younger
                                                                                                                        25-34
                                                                                                                        35 or older
Percentage (%)




                                                                                                                        Not married
             60
                                                                                                                        Married


             40


             20
                      7.3 9.1                                             8.3 8 6.9                                               8.2 7.1


                 0
                                   Gender                                     Age                               Marital Status
                       1Military   personnel who were considered in need for further Posttraumatic Stress Disorder
                       evaluation in the past 30 days per PCL-C cutoff of 50. Difference by gender significant at 95% significant level.


                                                                                                                                            57
                     Suicide Ideation1 in Past 12 Months,
                      Unadjusted for Sociodemographic
                                 Differences
  100
                                                                                                                 Active Duty

                                                                                                                 Reserve
             80
                                                                                                                 National Guard
Percentage (%)




             60                                                                                                  Guard and
                                                                                                                 Reserves


             40


             20
                     5.6 5.6 6.9                5.3 3.7                 5.9 5.9
                                                                                               3.5                4.9        5.5
                                                                                                      3.4 2.9
                 0
                          Army                       Navy               Marine Corps                 Air Force     Total DoD
                      1Military   personnel who reported seriously considering suicide in the past 12 months.




                                                                                                                                   58
                      Heavy1 Alcohol Use by Deployment Status,
                     Unadjusted for Sociodemographic Differences

  100
                                                                                                                      Deployed 1+
             80                                                                                                       times in past 36
                                                                                                                      months
Percentage (%)




                                                                                                                      Not deployed in
             60                                                                                                       past 36 months



             40

                                       20.0                  16.3                                         17.9
             20                                                                                                                14.2



                 0
                                            Active Duty                                                Reserve Component
                      1Heavy   Alcohol Use is defined as 5 or more drinks per occasion at least once a week in past 30 days.




                                                                                                                                         59
                      Past Year Cigarette Smoking by
                     Deployment Status, Unadjusted for
                      Sociodemographic Differences
  100
                                                       Deployed 1+
                                                       times in past 36
             80                                        months

                                                       Not deployed in
Percentage (%)




                                                       past 36 months
             60
                        44.7
                                        38.9

             40
                                                32.7            29.0


             20


                 0
                          Active Duty          Reserve Component




                                                                          60
                      Past year Illicit Drug Use, by Deployment Status,
                       Unadjusted for Sociodemographic Differences


  100
                                                                Deployed 1+
                                                                times in past 36
                 80                                             months

                                                                Not deployed in
Percentage (%)




                 60                                             past 36 months



                 40


                 20                                      13.5
                            11.4        9.9                           9.3


                  0
                              Active duty              Reserve Component




                                                                                   61
                           High Stress in Family1, by Theater of
                                Operation, Unadjusted for
                                     Sociodemographic Differences

  100
                                                                                                               OIF/OEF

             80
                                                                                                               Other
Percentage (%)




             60                                                                                                None



             40

                                 19.4                       19.8                              20.9
                                               16.6                                                    17.7   18.5
             20


                 0
                                         Active Duty                                            Reserve Component

                     1Military   personnel who reported high family stress in the past 12 months.



                                                                                                                         62
                     Met screening criteria for PTSD1, by
                     Deployment Status, Unadjusted for
                       Sociodemographic Differences
  100
                                                                                                                  Deployed 1+
                                                                                                                  times in past 36
             80                                                                                                   months

                                                                                                                  Not deployed in
Percentage (%)




                                                                                                                  past 36 months
             60


             40


             20
                                   7.2                                                           9.0
                                                     5.8                                                           6.6

                 0
                                     Active Duty                                             Reserve Component
                     1Militarypersonnel who met screening criteria for need for further Posttraumatic Stress Disorder evaluation in the
                     past 30 days.


                                                                                                                                          63
                      Met screening criteria for PTSD1, by
                      Theater of Operation, Unadjusted for
                        Sociodemographic Differences
  100
                                                                                                                          OIF/OEF

             80
                                                                                                                          Other
Percentage (%)




             60                                                                                                           None



             40


             20
                                                                                              10.7
                                 7.0                         7.3                                            7.0
                                               4.4                                                                        5.0

                 0
                                         Active Duty                                           Reserve Component
                     1Military   personnel who were considered in need for further Posttraumatic Stress Disorder evaluation in the past 30
                     days.


                                                                                                                                             64
                         Suicide Ideation1,by Deployment
                              Status, Unadjusted for
                          Sociodemographic Differences
  100
                                                                                                               Deployed 1+
                                                                                                               times in past 36
                                                                                                               months
             80
                                                                                                               Not deployed in
Percentage (%)




                                                                                                               past 36 months
             60


             40


             20
                                       5.1                                                          6.9
                                                        4.6                                                    4.1

                 0
                                         Active Duty                                           Reserve Component
                     1Military   personnel who reported seriously considering suicide in the past 12 months.




                                                                                                                                  65
                            Suicide Ideation1,by Theater of
                              Operation, Unadjusted for
                            Sociodemographic Differences
  100
                                                                                                                 OIF/OEF

             80
                                                                                                                 Other
Percentage (%)




             60                                                                                                  None



             40


             20
                                                                                              5.9          7.7
                                 4.9          3.7          5.4                                                   3.9
                 0
                                       Active Duty                                            Reserve Component
                     1Military   personnel who reported seriously considering suicide in the past 12 months.




                                                                                                                           66
          Perceived Need for and Receipt of
      Mental Health Counseling in Past 12 Months,
      Adjusted for Sociodemographic Differences

100                                                       100
 90                                                         90
80                                                          80
70                                                          70
60                                                          60
50                                                          50
40                                                          40
30                                                          30
                *
20       17.6          14.5            15.8                 20        14.6
                                                                              *
                                                                                      11.9        13
10                                                          10
 0                                                            0
      Active Duty    Reserve       Total Force                    Active Duty      Reserve    Total Force
                    Component                                                     Component

        Perceived Need for Mental Health                                 Receipt of Mental Health
          Counseling in past 12 Months                                 Counseling in past 12 Months

                    *Estimate is significantly different from the Reserve Component
                                                                                                            67
                      Illicit drug Use by Stress and
                           Mental Health Indices*


100
                                                                          Never Used Drugs
 80
                                                                          Used in Lifetime but Not
                                                                          Past 12 Months
 60                                                                       Used in Past 12 Months

 40                      33.1                        33.8
                  21.5                          20
             16                          15.9                                     15.7                        17
 20
                                                                      6.6 6.5                      3.8 4.7
  0
          Stress in Family,            Need for Further             PTSD Symptoms,               Suicidal Ideation,
          Past 12 Months               Depression Eval,               Past 30 Days                  Past Year
                                          Past Week
      *Percentage of personnel by drug use category who reported the stress and mental health problems;
      all Past 12 month Users significantly different from Never and Lifetime Users at 95% confidence level

                                                                                                                      68

								
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