The Department of Defense today announced results of its 2005 Survey of Health Related Behaviors among Active Duty Military Personnel. The findings show notable decreases in the use of cigarettes and illegal drugs since initiation of the surveys in 1980 and progress towards meeting selected Healthy People 2010 objectives.
The 2005 survey, however, revealed rates of heavy drinking remain elevated especially among our young people, use of smokeless tobacco has increased, and even though most military personnel engage in moderate or vigorous exercise, more service members meet criteria for being overweight.
The 2005 survey indicates the majority of our U.S. Armed Forces, although under heavy work stress during the current wartime environment, use positive coping mechanisms to deal with stress.
According to Dr. William Winkenwerder Jr., assistant secretary of defense for health affairs, “These survey findings provide very useful information for the department to target programs that continue to enhance the physical and mental well being of our troops. I am pleased, and even a little surprised, that despite the stresses of war and ongoing deployments, nearly all indicators of service members’ health and well-being continue to be quite good compared with civilian populations.”
This is the ninth survey in the series of anonymous surveys asking active duty service members about various lifestyle and health-related behaviors. In addition to substance use, the survey also assesses national health status goals from the Department of Health and Human Services’ Healthy People 2010 objectives, nutrition and weight management measures, mental well-being of the force, and deployment issues. More than 16,000 service members, randomly selected to represent men and women in all pay grades of the active force throughout the world, completed the survey.
When comparing the 2005 findings to earlier survey results, there were both tremendous improvements in the past 25 years and some issues of concern. Between 1980 and 1998, the surveys show a continuing decline in the use of illegal drugs and cigarettes and an increase in alcohol abstainers or light drinkers among military personnel.
When first surveyed in 1980, 27.6 percent of the active force acknowledged use of illegal drugs during the month prior to being questioned. In 2002, only 3.4 percent reported using illegal drugs. In 2005, because wording in some drug use questions was modified, estimates cannot be compared to those in prior years. Heavy drinking (five or more drinks per occasion at least once a week) declined from 20.8 percent in 1980 to 15.4 percent in 1998, but rose to 18.1 percent in 2002 but declined slightly in 2005 (18.5 percent); cigarette smoking declined from 51.0 percent in 1980 to 29.9 percent in 1998, increased significantly to 33.8 percent in 2002 and remained at that level in 2005 (32.2 percent). Heavy cigarette smoking (1 or more packs/day), showed a steady decline from 1980 (34.2 percent) to 2002 (13.1 percent) and a further significant decrease from 2002 to 2005 (11.1 percent). In contrast, past month smokeless tobacco use showed a small increase from 2002 (12.2 percent) to 2005 (14.1 percent).
“The 2005 survey is the first time that this series has evaluated behaviors related to mental well being, work stress and family stress associated with deployment to Iraq, Afghanistan and other theaters,” Winkenwerder said. “An important finding is that overall, most military personnel are using positive coping mechanisms in dealing with the stresses of their current wartime environment.”
Rates of current (one month) Post Traumatic Stress Disorder (PTSD) symptoms in the DoD population as measured by a self-report screener were 6.7 percent for total DoD and ranged from 3.7 percent to 9.3 percent for each service. An estimated 8.1 percent met screening criteria for further evaluation for serious psychological distress.
“It is important to remember the results come from self reported data and may differ from information in official records or other data sources,”Winkenwerder noted. “These screening questions do not represent a formal clinical diagnostic evaluation, but suggest some of our personnel should be encouraged to obtain more evaluation.”
Personnel deployed in the past three years (i.e., from 2002 to 2005), compared to those who did not deploy, had higher rates of work and family stress; higher rates of heavy alcohol use, cigarette use, and illicit drug use; and a greater number meeting criteria for depression, anxiety and PTSD symptoms on the screening questions. In contrast, there were no significant differences in self-reported mental health measures among those deployed to OIF/OEF compared to those who did not serve in an operational theater.
Statistically significant relations were observed among heavy alcohol use, stress, and mental health issues. Compared with abstainers, heavy users of alcohol reported more problems with stress at work (41.1 percent vs. 28.4 percent) or in their family (24.7 percent vs. 15.3 percent); were more likely to meet screening criteria for anxiety (17.5 percent vs. 10.1 percent) and depression (31.2 percent vs. 19.1 percent); and reported more limitations in activities as a result of poor mental health (4.8 percent vs. 2.0 percent).
Heavy drinkers were also more likely than those who drank less to meet the criteria for further evaluation for serious mental disorders and reported to have a history of suicidal ideation or physical or sexual abuse.
However, because the survey is cross-sectional data, we are unable to ascertain which behavior (the heavy alcohol use or the mental health problems) came first, but this association points to potential intervention strategies in which reducing one would help reduce the other .(e.g., encouraging more positive coping strategies could both lessen use of alcohol and improve mental health).
DoD continually monitors the general health of our members, their modifiable lifestyle behaviors and the effects of combat and operational-related stressors through the DoD level programs such as: Defense Lifestyle Assessment Program (DLAP), Deployment Health Programs, and Healthy Choices for Life Initiatives. Each service also has comprehensive programs in place to help returning service members and their families deal with their overall physical and mental health, especially with deployment experiences.
“We have continued this survey and initiated many new healthy lifestyle programs because the Military Health System and our defense leaders are committed to programs that improve healthy behaviors and reduce avoidable stress,” Winkenwerder said. “And we will continue to do so in the future.”
In 2005, for example, DoD expanded the scope of the active duty surveys to include the National Guard and Reserves, as well as other special studies, the first of which is examining unit-level influences on alcohol and tobacco use. DoD and Tricare also launched the Healthy Choices for Life initiative, focusing on the key health issues of weight management, tobacco cessation and reducing alcohol abuse, along with measuring their costs. In addition, the secretary of defense has made safety, including safe practices and behaviors to reduce injuries and accidents, a top priority with the establishment of the Defense Safety Oversight Council.
The 2005 survey was conducted independently under contract by RTI International. The final report is available on the World Wide Web at: http://www.ha.osd.mil/special_reports/2005_Health_Behaviors_Survey_1-07.pdf .