Publications

The following manuscripts have been published or are currently in press. Listings are in chronological order, unless otherwise noted.

Research Publication 2
Title Publication Date/Location
Occupation and Risk of Traumatic Brain Injury in the Millennium Cohort Study Military Medicine 2022 Feb 27;usac035

Jannace KC, Pompeii L, Gimeno Ruiz de Porras D, Perkison WB, Yamal JM, Trone DW, Rull RP

Using 2014-16 survey data from active duty 33,646 Millennium Cohort Study participants, we assessed the association between their primary military occupational categories (MOC) and self-reported traumatic brain injury (TBI) sustained during military service. Adjusting for military and demographic characteristics and pre-service TBI, all MOCs except for health care MOCs were statistically significantly more likely to experience service-related TBI compared with “Administration & Executive” MOCs, while those in “Infantry/Tactical Operations” had the highest odds of service-related TBI. Enlisted (28%) personnel were more likely than officers (24%) to experience a service-related TBI. Results highlight the importance of targeting specific occupational categories for TBI risk reduction and a quantification of risk among enlisted MOCs suggests a need for further research into the causes of TBI.

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Factors associated with human papillomavirus vaccine initiation and compliance among U.S. military service members Military Medicine 2022 Jan 25:usab562

Matsuno RK, Seay J, Porter B, Tannenbaum K, Warner S, Wells N

The goal of this study was to assess factors associated with human papillomavirus (HPV) vaccine initiation and compliance in a cohort of active duty US military service members (SM). We included active-duty participants aged 18-26 years from the Millennium Cohort Study, a longitudinal cohort study of over 200,000 military SMs. The eligible study population included 22,387 female SMs and 31,705 male SMs. Vaccination was assessed over the period 2006-2017. Among female SMs, 37.8% initiated the vaccine and 40.2% of initiators completed the series within a year. Among male SMs, 3.9% initiated the vaccine and 22.1% of initiators completed the series within a year. Differences were observed by sociodemographic factors, deployment status, branch of service, occupation, and smoking status, but not by selected mental health conditions. These results indicated that HPV vaccination uptake may be subpar across all military service branches. Certain subgroups of SMs could be targeted to increase overall HPV vaccine coverage in the US military population.

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Military service experiences and reasons for service separation among lesbian, gay, and bisexual individuals in a large military cohort BMC Public Health 2022 Jan 6;22(1):39

Carey FR, Jacobson IG, Lehavot K, LeardMann CA, Kolaja CA, Stander VA, Rull RP

The goal of this study was to examine differences in military and service separation experiences by sexual orientation among a large representative sample of United States service members and veterans. Survey data from the 2016 Millennium Cohort Study follow-up questionnaire were used to assess sexual orientation (lesbian, gay, and bisexual [LGB] versus heterosexual) and military experiences and service separation experiences. Of the 99,599 participants, 3.4% identified as LGB. Those service members were more likely than their heterosexual peers to report feeling unimpressed by the quality of unit leadership, unsupported by the military, and negative about the military overall. LGB veterans were more likely than heterosexual peers of the same sex to separate from service for a variety of reasons (e.g., administrative, dissatisfaction with promotions/pay, disability/medical reasons, dissatisfaction with leadership and incompatibility with the military). Less positive military- and separation-specific experiences disproportionately affected LGB service members in this study. Promoting inclusion and increasing support for LGB service members may improve satisfaction with military service and retention.

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Problematic Anger and Economic Difficulties: Findings from the Millennium Cohort Study Journal of Affective Disorders 2022 Jan 15;297:679-68

Adler AB, LeardMann CA, Yun S, Jacobson IG, Forbes D; Millennium Cohort Study Team

Of 95,895 participants, 17.4% screened positive for problematic anger. Problematic anger was significantly associated with involuntary job loss and financial problems, adjusting for demographics, military characteristics, disabling injury, and behavioral health factors. Among veterans, problematic anger was associated with unemployment and homelessness after adjustment for covariates. These findings suggest it may be useful for military leaders, veteran organizations, and policy makers to support the adjustment and financial health of military personnel and veterans by proactively addressing problematic anger.

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Prevalence and predictors of insomnia and sleep medication use in a large tri-service U.S. military sample Sleep Health 2021 Dec;7(6):675-682

Markwald RR, Carey FR, Kolaja CA, Jacobson IG, Cooper AD, Chinoy ED

Several deployment-related characteristics were significantly associated with the development of insomnia and/or newly-reported sleep medication use, and more than half of the sample with insomnia reported using sleep medication, indicating a high rate of medicating for insomnia. These findings may indicate an underlying systematic issue related to the inability to obtain adequate sleep in military personnel

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Cigarette smoking patterns among U.S. military service members before and after separation from the military PLoS One 2021 Oct 4;16(10):e0257539

Nieh C, Mancuso JD, Powell TM, Welsh MM, Gackstetter GD, Hooper TI.

Millennium Cohort Study data were used to examine smoking behavior at enrollment into the study and through their first follow-up survey, approximately 3 years later. Time remaining in service from baseline until separation or the first follow-up survey was the main exposure of interest. The baseline prevalence of smoking in the Cohort was higher among those who eventually separated (20.1%) than among those who remained on active service (17.4%), but the overall prevalence of current smokers significantly declined over the observation period. Factors significantly associated with greater likelihood of smoking at follow- up were baseline smoking, non-White Hispanic individuals, being non-married, enlisted rank, underweight or healthy BMI, active duty component, any alcohol consumption, experiencing two or more stressful life events, and screening positive for either PTSD or depression. Including smoking prevention and/or cessation programs in pre-separation counseling sessions and developing smoking screening and cessation programs targeting high-risk subgroups may reduce smoking among Service members and veterans.

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Longitudinal associations of military-related factors on self-reported sleep among U.S. service members Sleep 2021 Dec 10;44(12):zsab168

Cooper AD, Kolaja CA, Markwald RR, Jacobson IG, Chinoy ED

This study examined military factors in relation to the development and reoccurrence of short sleep duration (≤5 hours or 6 hours) and insomnia symptoms (i.e., trouble falling asleep or staying asleep in the past month)over a 3-15 year follow-up period. Military factors consistently associated with an increased risk for development and/or reoccurrence of short sleep duration and insomnia symptoms included active duty service, Army or Marine Corps service, combat deployment, and longer than average deployment lengths. Officers and noncombat deployers had decreased risk for either poor sleep characteristic. Length of service and separation from the military were complex factors; each lowered risk for ≤5 hours sleep but increased risk for insomnia symptoms. Findings suggest that efforts to improve sleep prioritization and implement interventions targeting at-risk military populations, behaviors, and other significant factors are warranted.

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Combat Experience, New-Onset Mental Health Conditions, and Posttraumatic Growth in U.S. Service Members Psychiatry Fall 2021;84(3):276-290

Jacobson IG, Adler AB, Roenfeldt KA, Porter,B., LeardMann CA, Rull RP, Hoge CW

Research on posttraumatic growth (PTG) after traumatic experiences has raised questions on measurement, validity, and clinical utility. We longitudinally examined PTG among Millennium Cohort Study deployers (n=8,732), who screened negative for PTSD and depression at time 1, using a measure that improved upon previous psychometric issues. A strong inverse correlation was found between PTG scores at time 2 and new onset mental health problems (PTSD, depression), where lower growth scores correlated with worse mental health (i.e. higher PTSD or depression screening scores). Only 5% of participants who screened positive for a mental health problem at time 2 experienced positive growth. Results suggest that measurement of PTG is not independent from mental health problems following combat experiences and thus challenge the clinical utility of the PTG construct.

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Association of deployment with maintenance of healthy weight among active duty service members in the Millennium Cohort Study Obesity Science and Practice 2021; 1- 7. doi:10.1002/osp4.556

Carey FR, Jacobson IG, Roenfeldt KA, Rull RP

Understanding changes in weight in relation to deployment readiness can inform Department of Defense fitness policies. This study examined longitudinal associations between deployment and service branch-specific changes in body mass index (BMI) among active duty participants without obesity (BMI< 30kg/m2) at baseline (n=22,995). Service members, particularly Army and Marine Corps personnel, with longer deployments were less likely to maintain a healthy weight (BMI < 30) than those with shorter deployment lengths. Conversely, each additional deployment increased the likelihood of maintaining a healthy weight post-deployment for personnel in the Army, Marine Corps, and within the pooled population. These results indicate that multiple deployments may support healthy weight maintenance and longer deployments may adversely impact weight maintenance. Fitness policies designed to optimize service member readiness should consider modifiable behaviors related to weight gain among those who are deployed for long periods of time.

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Sexual Health Difficulties Among Service Women: The Influence of Posttraumatic Stress Disorder Journal of Affective Disorders 2021 Sep 1;292:678-686

Kolaja CA, Schuyler AC, Armenta RF, Orman JA, Stander VA, LeardMann CA

Sexual health of service women was found to be negatively impacted by recent combat deployment and sexual assault. Post-traumatic stress disorder(PTSD) mediated the associations of recent combat deployment and sexual assault with sexual health difficulties. Some military factors (i.e., service branch, component, paygrade) were associated with sexual health difficulties among service women. Findings indicate that effective treatment of PTSD may mitigate sexual health issues.

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