Timothy E. Powers

Assessment of recruit motivation and strength study: preaccession physical fitness assessment predicts early attrition.

BACKGROUND The Assessment of Recruit Motivation and Strength (ARMS) study was designed to pilot-test the use of a physical fitness screening tool for Army applicants before basic training. METHODS The ARMS test consists of two components, namely, a 5-minute step test and push-ups. Attrition among 7,612 recruits who underwent preaccession ARMS testing and began service between May 2004 and December 2005 was studied. RESULTS ARMS test performance was found to be significantly related to risk of attrition within 180 days; the hazard ratios for failing relative to passing the ARMS test were 2.27 (95% confidence interval, 1.70-3.04) among female subjects and 1.36 (95% confidence interval, 1.13-1.64) among male subjects. The attributable risk of attrition associated with failing the ARMS test was approximately 40% among female subjects and approximately 30% among male subjects. DISCUSSION The ARMS study is the first prospective study conducted in the U.S. Army to assess physical fitness before accession. Physical fitness and motivation to serve were shown to correlate with attrition during initial entry training.

Preaccession Fitness and Body Composition as Predictors of Attrition in U.S. Army Recruits

The Assessment of Recruit Motivation and Strength (ARMS) project evaluated whether active duty Army enlistees who exceeded weight and body-fat standards but were able to pass the ARMS physical fitness test were at elevated risk of early attrition relative to the traditional recruit population. Attrition among 1146 overweight and overbody-fat (OBF) recruits who passed ARMS was compared to 10,514 fully qualified (FQ) recruits who began service in February 2005 through September 2006. The ARMS test includes a 5-minute step test and a 1-minute pushup test. There were no significant differences in attrition between OBF and FQ at 180 days: adjusted hazard ratios were 1.17 (95% CI: 0.83, 1.65) among females and 1.23 (95% CI: 0.95, 1.58) among males. This study indicates that physically fit recruits who exceeded weight/body-fat standards were equally capable of serving at least 180 days compared to those who met standards.

Prior Knee Injury and Risk of Future Hospitalization and Discharge from Military Service

BACKGROUND Athletic capability is paramount for survival in military basic training and successful service. Orthopedic conditions are common reasons for hospitalization and premature discharge of military recruits. Medical fitness for military service is determined through a medical examination. Individuals medically disqualified may receive a waiver to enter the service on a case-by-case basis. This study was carried out to determine how individuals with a medical waiver for knee problems compared to recruits without a history of knee injury regarding hospitalization and military discharge. METHODS Two hundred eighty-one enlisted recruits with a history of a waiver for a knee condition were considered high risk. The comparison group was 843 recruits without prior knee pathology. Comparisons were made using frequency and chi-square analyses, relative risk estimates, and survival analyses. RESULTS Individuals in the high-risk group were 1.4 (CI 1.0, 2.1) times more likely to be hospitalized for any diagnoses and 8.0 (CI 2. 1, 29.9) times more likely to be hospitalized for a knee condition than those in the comparison group. Individuals with a knee waiver were 2.1 (CI 1.3, 3.5) times more likely to be prematurely discharged, and 14.0 (CI 4.6, 39.6) times more likely to be discharged for a knee-related condition than those in the comparison group. CONCLUSION Unfavorable outcomes were more likely in recruits disqualified initially and granted a waiver than in recruits without a history of knee injury. Military service requires intense physical activity; therefore, further research should be conducted to limit knee-related morbidity, especially in those with a prior history of knee injury.

Accession standards for attention-deficit/hyperactivity disorder: a survival analysis of military recruits, 1995-2000.

A retrospective cohort study was conducted to evaluate the Department of Defense practice of allowing some individuals with a history of attention-deficit/hyperactivity disorder (ADHD) to enter military service (waiving for ADHD). Enlisted recruits who entered active duty with a waiver for academic problems related to ADHD were compared with control subjects who did not reveal health problems before entry, in terms of retention, promotion, and mental health-related outcomes. A total of 539 recruits with a history of ADHD were retained at the same rate as 1,617 control subjects, with no differences in promotion rates, comorbid diagnoses, or mental health-related discharges. On the basis of these findings, the Department of Defense medical accession standards have been changed to allow applicants who reveal a history of ADHD but did not require medication to finish high school or to hold a job for at least 1 year the opportunity to enter active duty without going through the current waiver process.

Retention of Mild Asthmatics in the Navy (REMAIN): A Low-Risk Approach to Giving Mild Asthmatics an Opportunity for Military Service

OBJECTIVE Rising U.S. asthma prevalence will be reflected in military applicants. We studied retaining mild asthmatics on active duty. METHODS A cohort study at Great Lakes Naval Training Center from 2000 to 2002 compared recruits diagnosed during basic training with mild asthma to matched comparison recruits on outpatient visits, hospitalizations, and discharge through August 2003. RESULTS A total of 136 asthmatic and 404 control subjects were enrolled. Overall attrition was greater among the asthma cohort (p < 0.01), largely during training. Asthmatics used more health care than controls during training (0.1 vs. 0.004 per person-month). No asthma-related hospitalizations or deaths occurred during the study. CONCLUSIONS Although attrition during recruit training was higher in mild asthmatics, nearly 40% of recruits were retained on active duty without significant risk of hospitalization or excessive outpatient treatment after recruit training. These findings argue for consideration of a trial on active duty for recruits with mild asthma.

A Review of Initial Entry Training Discharges at Fort Leonard Wood, MO, for Accuracy of Discharge Classification Type: Fiscal Year 2003

OBJECTIVE This study examines the extent to which discharges from Initial Entry Training can be adequately characterized by the current policy of a single descriptive category. METHODS Service records of each trainee discharged from Fort Leonard Wood in 2003 were examined. Discharged trainees counseling and outpatient clinic visit records were reviewed for evidence of multiple reasons for discharge. RESULTS Evidence of medical involvement was found by record review in 13% of administrative discharges. Among discharges classified as being for medical or physical conditions that did not exist before service, 17% had clear evidence of preexisting chronic conditions. CONCLUSION The policy of allowing only one categorization code to describe reasons for an Initial Entry Training discharge frequently resulted in incomplete characterization of factors leading to discharge. Pre-existing medical and mental health conditions were found in a much greater percentage of discharges than indicated by a simple review of discharge codes.

Attrition of U.S. Military Enlistees with Waivers for Hearing Deficiency, 1995–2004

BACKGROUND Hearing deficiency is the condition for which accession medical waivers are most commonly granted. The retention of individuals entering service with a waiver for hearing deficiency has not been previously studied. METHODS Military retention among new enlistees with a medical waiver for hearing deficiency was compared with that among a matched comparison group of fully qualified enlistees. Comparisons according to branch of service over the first 3 years of service were performed with the Kaplan-Meier product-limit method and proportional-hazards model. RESULTS Army subjects had significantly lower retention rates than did their fully qualified counterparts. In the adjusted model, Army and Navy enlistees with a waiver for hearing deficiency had a significantly lower likelihood of retention than did their matched counterparts. DISCUSSION The increased likelihood of medical attrition in enlistees with a waiver for hearing loss provides no evidence to make the hearing accession standard more lenient and validates a selective hearing loss waiver policy.

Attrition of Military Enlistees with a Medical Waiver for Myopia, 1999–2001

BACKGROUND Military service requires physical fitness, including vision within set standards. Premature attrition inflicts a considerable manpower and fiscal burden upon the military. METHODS We conducted a retrospective cohort survival analysis of newly enlisted military personnel who entered active duty with a medical waiver for myopia between January 1, 1999, and December 31, 2001. Premature attrition rates, both medical and overall, were compared with those for a matched, fully qualified, comparison group. RESULTS New enlistees with a waiver for myopia had the same probability of remaining on active duty through the first 2 years of service as did fully qualified peers. Enlistees with a waiver for myopia also had a low probability of an early medical discharge for myopia. CONCLUSION The results of this study tend to validate the current branch-specific myopia waiver processes. They also provide evidence that current myopia accession criteria may be too restrictive and in need of policy review.