Jeffrey O. Williams

A Comparison of Injuries, Limited-Duty Days, and Injury Risk Factors in Infantry, Artillery, Construction Engineers, and Special Forces Soldiers

OBJECTIVES We compared injuries/risk factors in infantry soldiers (I), construction engineers (CE), combat artillery (CA), and Special Forces (SF) during their operational and fitness activities. METHODS Anthropometrics, ethnicity, and fitness data were collected before review of medical records. RESULTS Injury rates for I, CE, and CA were 4.0, 7.2, and 5.5 injuries/100 soldier-months, respectively; over 70% of them resulted from overuse. SF soldiers had an injury rate of 3.5 injuries/100 soldier-months, 50% of them reported as traumatic. Average limited-duty days (LDDs) were threefold higher in SF. Smoking, BMI > or =25, and APFT run time for 3.2 km >14 minutes were risk factors in I. Caucasian ethnicity, height <170.2 cm, weight > or =90 kg, and BMI > or =25 were risk factors in CE and CA. Age >27 years old was a risk factor in SF. CONCLUSIONS Greater emphasis should be placed on risk factor identification and testing strategies to reduce injuries among SF and other troops.

Demographic, Physical, and Mental Health Factors Associated with Deployment of U.S. Army Soldiers to the Persian Gulf

A total of 675,626 active duty Army soldiers who were known to be at risk for deployment to the Persian Gulf were followed from 1980 through the Persian Gulf War. Hospitalization histories for the entire cohort and Health Risk Appraisal surveys for a subset of 374 soldiers were used to evaluate prewar distress, health, and behaviors. Deployers were less likely to have had any prewar hospitalizations or hospitalization for a condition commonly reported among Gulf War veterans or to report experiences of depression/suicidal ideation. Deployers reported greater satisfaction with life and relationships but displayed greater tendencies toward risk taking, such as drunk driving, speeding, and failure to wear safety belts. Deployed veterans were more likely to receive hazardous duty pay and to be hospitalized for an injury than nondeployed Gulf War-era veterans. If distress is a predictor of postwar morbidity, it is likely attributable to experiences occurring during or after the war and not related to prewar exposures or health status. Postwar excess injury risk may be explained in part by a propensity for greater risk taking, which was evident before and persisted throughout the war.

The Reliability and Validity of the Self-Reported Drinking Measures in the Army’s Health Risk Appraisal Survey

BACKGROUND The reliability and validity of self-reported drinking behaviors from the Army Health Risk Appraisal (HRA) survey are unknown. METHODS We compared demographics and health experiences of those who completed the HRA with those who did not (1991-1998). We also evaluated the reliability and validity of eight HRA alcohol-related items, including the CAGE, weekly drinking quantity, and drinking and driving measures. We used Cohens kappa and Pearsons r to assess reliability and convergent validity. To assess criterion (predictive) validity, we used proportional hazards and logistical regression models predicting alcohol-related hospitalizations and alcohol-related separations from the Army, respectively. RESULTS A total of 404,966 soldiers completed an HRA. No particular demographic group seems to be over- or underrepresented. Although few respondents skipped alcohol items, those who did tended to be older and of minority race. The alcohol items demonstrate a reasonable degree of reliability, with Cronbachs alpha = 0.69 and test-retest reliability associations in the 0.75-0.80 range for most items over 2- to 30-day interims between surveys. The alcohol measures showed good criterion-related validity: those consuming more than 21 drinks per week were at 6 times the risk for subsequent alcohol-related hospitalization versus those who abstained from drinking (hazard ratio, 6.36; 95% confidence interval=5.79, 6.99). Those who said their friends worried about their drinking were almost 5 times more likely to be discharged due to alcoholism (risk ratio, 4.9; 95% confidence interval=4.00, 6.04) and 6 times more likely to experience an alcohol-related hospitalization (hazard ratio, 6.24; 95% confidence interval=5.74, 6.77). CONCLUSIONS The Armys HRA alcohol items seem to elicit reliable and valid responses. Because HRAs contain identifiers, alcohol use can be linked with subsequent health and occupational outcomes, making the HRA a useful epidemiological research tool. Associations between perceived peer opinions of drinking and subsequent problems deserve further exploration.