Michael R. Pemberton

Substance Use and Mental Health Trends Among U.S. Military Active Duty Personnel: Key Findings From the 2008 DoD Health Behavior Survey

OBJECTIVE Examine substance use and mental health issues among U.S. military personnel. METHODS Data were from the 2008 (and before) population-based Department of Defense Health Related Behavior Surveys. The sample size for the 2008 survey was 28,546 (70.6% response rate). RESULTS Analyses examined substance use, stress, depression, post-traumatic stress disorder (PTSD), suicidal ideation and attempts, deployment, and job satisfaction. Trends show reductions in tobacco use and illicit drug use, but increases in prescription drug misuse, heavy alcohol use, stress, PTSD, and suicidal attempts. Deployment exacerbated some of these behavior changes. Despite the demanding lifestyle, job satisfaction was high. CONCLUSIONS The military has shown progress in decreasing cigarette smoking and illicit drug use. Additional emphasis should be placed on understanding increases in prescription drug misuse, heavy alcohol use, PTSD, and suicide attempts, and on planning additional effective interventions and prevention programs. Challenges remain in understanding and addressing military mental health needs.

PEER AND ROLE MODEL INFLUENCES FOR CIGARETTE SMOKING IN A YOUNG ADULT MILITARY POPULATION

Previous research has shown that 8% to 10% of nonsmokers initiated smoking during their first year of military service despite a period of forced abstinence during boot camp. To our knowledge, no studies have looked at the influence of peers and role models on the initiation of smoking among U.S. Air Force personnel who recently completed boot camp. This cross-sectional study examined the role of perceived peer norms, roommate influence, role model influence, perceived norms of all active duty personnel, and depressive symptoms in the initiation and reinitiation of smoking among 2,962 Air Force technical training students. Previous nonsmokers were more likely to initiate smoking if they perceived that the majority of their classmates smoked (OR = 1.67, 95% CI[1.05-2.67]) and if they reported that their military training leader or classroom instructor used tobacco products (OR = 1.69, 95% CI[1.12-2.56]). Additionally, previous nonsmokers were more likely to initiate smoking if their roommate smoked (OR = 1.67, 95% CI[1.09-2.56]). Similar results were seen with previous smokers who perceived that the majority of their classmates smoked (OR = 1.63, 95% CI[1.03-2.58]) and if they reported that their military training leader or classroom instructor used tobacco products (OR = 1.95, 95% CI[1.29-2.94]). Our study suggests that military role models who use tobacco, peer smoking behavior, and perceived smoking norms increase the likelihood of smoking initiation among newly enlisted military personnel who have recently undergone a period of forced abstinence.

Binge drinking and the risk of suicidal thoughts, plans, and attempts

BACKGROUND Major depression is one of the strongest known risk factors for suicide. However, of the estimated 8.5 million adults with serious thoughts of suicide in the past year, only half had a major depressive episode (MDE). Identifying risk factors for suicide in the absence of depression may provide additional targets for prevention and intervention. This study uses nationally representative data to evaluate the association of binge drinking with suicidal thoughts, plans, and attempts in adults with and without MDE. METHODS Combined 2008-2012 National Survey on Drug Use and Health data were analyzed. Sex-stratified prevalence estimates of past year suicide indicators were generated by past month binge drinking and past year MDE status. Logistic regression was used to evaluate the association of binge drinking with suicide indicators by sex with and without MDE. RESULTS Unadjusted prevalence estimates for suicide indicators in males and females were higher among binge drinkers than among nonbinge drinkers, regardless of MDE status. Regression analyses indicated that binge drinking was associated with suicidal thoughts (adjusted odds ratio [aOR]=1.51, 95% confidence interval [CI]=1.28-1.79), plans (aOR=1.75, CI=1.23-2.48), and attempts (aOR=2.57, CI=1.74-3.79) in females without MDE and with suicidal thoughts in males without MDE (aOR=1.25, CI=1.04-1.49). Among males and females with MDE, binge drinking was not associated with any of the suicide indicators (p>.05). CONCLUSIONS Binge drinking in females without MDE may be an indicator for identifying at risk individuals for targeting suicide prevention activities.

Who is unlikely to report adverse events after vaccinations to the Vaccine Adverse Event Reporting System (VAERS)

BACKGROUND Healthcare provider (HCP) reporting to the Vaccine Adverse Event Reporting System (VAERS) is important to assuring the safety of U.S. licensed vaccines. HCP awareness of and practices regarding reporting of adverse events following immunization (AEFI) is understudied. METHODS A large, nationally representative sample of U.S. office-based HCP across three occupational groups (physicians, mid-level providers [physician assistants, advanced practice nurses] and nurses) and three primary care practice areas (pediatrics, family medicine, internal medicine) were surveyed utilizing standardized methodology. We assessed HCP familiarity with VAERS, the situations under which they were likely to report an AEFI, and the methods they used and preferred for reporting. We used logistic regression to determine factors associated with HCP not reporting AEFI to VAERS. RESULTS Our survey response rate was 54.9%. The percentage of HCP aware of VAERS (71%) varied by occupation and primary care practice area. About 37% of HCP had identified at least one AEFI with only 17% of these indicating that they had ever reported to VAERS. More serious events were more likely to be reported. Factors associated with HCP not reporting AEFI included: HCP not familiar versus very familiar with filing a paper VAERS report (OR=12.84; p<0.0001), primary care practice area of internal medicine versus pediatrics (OR=4.22; p=0.0005), and HCP not familiar versus very familiar with when it was required to file a VAERS report (OR=5.52; p=0.0013). CONCLUSIONS Specific educational interventions targeted to HCP likely to see AEFI but not currently reporting may improve vaccine safety reporting practices.

Measurement invariance of alcohol use motivations in junior military personnel at risk for depression or anxiety.

Measurement invariance is typically assumed when assessing drinking-related constructs across distinct groups of respondents. However, measurement properties of motivations related to mood maintenance and stress relief may differ in those experiencing symptoms of depression or anxiety. Invariance of social and coping drinking motives were explored with a sample of 4133 junior enlisted Air Force and Navy personnel. Measurement did not differ in those with depression symptoms. In contrast, those with anxiety symptoms differed in measurement of both motives. The impact of non-equivalence was demonstrated with a mediation model in which anxiety and depression predicted drinking motives, which in turn predicted heavy drinking. Incorporation of the partial invariance of the social motives factor attenuated the estimate of the mediated effect of social drinking motives by almost half compared to the estimate with invariance assumed. These results suggest that lack of measurement invariance could seriously bias or alter conclusions from tests of theoretical models and highlight the need for researchers to carefully consider the measurement properties of their constructs prior to model estimation.

Military Healthcare Providers Reporting of Adverse Events Following Immunizations to the Vaccine Adverse Event Reporting System

OBJECTIVES We studied military health care provider (HCP) practices regarding reporting of adverse events following immunization (AEFI). METHODS A convenience sample of HCP was surveyed to assess familiarity with Vaccine Adverse Event Reporting System (VAERS), AEFI they were likely to report, methods used and preferred for reporting, and perceived barriers to reporting. We analyzed factors associated with HCP reporting AEFI to VAERS. RESULTS A total of 547 surveys were distributed with 487 completed and returned for an 89% response rate. The percentage of HCP aware of VAERS (54%) varied by occupation. 47% of respondents identified knowledge of at least one AEFI with only 34% of these indicating that they had ever reported to VAERS. More serious events were more likely to be reported. Factors associated with HCP reporting AEFIs in bivariate analysis included HCP familiarity with filing a paper VAERS report, HCP familiarity with filing an electronic VAERS report, HCP familiarity with VAERS, and time spent on immunization tasks. In a multivariable analysis, only HCP familiarity with filing a paper VAERS report was statistically significant (Odds ratio = 115.3; p < 0.001). CONCLUSIONS Specific educational interventions targeted to military HCP likely to see AEFIs but not currently filing VAERS reports may improve vaccine safety reporting practices.