U.S. Service Members in Generally Good Health, but Risky Behaviors Persist

For Release

April 28, 2021

U.S. military service members are mostly healthy but the level of risky behaviors such as binge drinking, tobacco use, and unprotected sex is cause for concern, according to new RAND Corporation research.

The findings draw from the 2018 Health Related Behaviors Study (HRBS), the flagship Department of Defense survey for understanding the health and well-being of military service members. It assesses areas that could potentially affect force readiness across all branches.

From a physical health perspective, just over half of active component service members reported very good or excellent health, with low rates of high blood pressure, high cholesterol, and diabetes, RAND researchers found. Nonetheless, about 40% reported at least one physician-diagnosed chronic condition—mostly back pain and bone, joint, or muscle injuries, including arthritis.

More worrisome than general physical health statistics were the numbers for substance abuse and sexual behavior. More than a third of service members reported binge drinking in the past 30 days, and nearly 10% were categorized as heavy drinkers, the survey found. The rate of binge drinking rose by 14% from 2015 to 2018, while heavy drinking increased by 32%. An estimated 4 in 10 service members used tobacco or nicotine. More than a third reported having unprotected sex with a new partner, and 5.5% of active component women reported unintended pregnancy in the past year. The rate of sexually transmitted infections (STI) significantly increased between the 2015 and 2018 surveys, which mirrored trends in the civilian population.

“The numbers for 2018 do indicate some problem areas that the military should continue to track,” said Sarah Meadows, lead author of the report and a senior sociologist at nonprofit, nonpartisan RAND. “It is discouraging that rates of heavy alcohol use, binge drinking, and STIs in the military have gone up since 2015. Even more troubling are things like tobacco use and e-cigarettes that are trending down in the general population, yet on the rise in the military.”

The HRBS also followed the mental health of service members, and outcomes over time were mixed. Roughly 10% met the criteria for probable post-traumatic stress disorder, and nearly 10% showed signs of serious psychological distress in the past 30 days. About half reported angry or aggressive behavior in the past 30 days, and another 8.3% reported having suicidal thoughts in the past year. Both of these statistics increased from 2015 to 2018. Finally, while researchers saw an encouraging one-quarter of service members seek some form of needed mental health service in the past year, more than a third reported that seeking mental health treatment would be damaging to one's military career.

The HRBS also looked at sexual orientation and its impact on the health of service members. Slightly more than 6% of all active component service members identified as lesbian or gay, with the number significantly higher for women at 17.6% than men at 4.1%.

LGB service members reported slightly higher levels of binge drinking, heavy drinking, and e-cigarette use than their non-LGB counterparts, and the data also showed they were more likely to engage in risky sex behaviors. For example, 41.8% of LGB members reported having more than one sex partner in the past year versus 17.8% of non-LGB members. This group also reported more mental and emotional health issues, as well as more instances of unwanted sexual contact from another service member.

To combat these issues, the authors make a number of recommendations to the DoD including: emphasizing annual medical appointments, addressing a culture change around excessive alcohol use, reducing tobacco use, offering free or reduced cost condoms, implementing regular testing for STIs, including LGB-specific health promotion efforts, and continuing efforts to improve mental health treatments.

Other authors of the report, 2018 Department of Defense Health Related Behaviors Survey (HRBS): Results for the Active Component, are Charles Engel, Rebecca Collins, Robin Beckman, Joshua Breslau, Erika Litvin Bloom, Michael Stephen Dunbar, Mary Lou Gilbert, David Grant, Jennifer Hawes-Dawson, Stephanie Brooks Holliday, Sarah MacCarthy, Eric R. Pedersen, Michael W. Robbins, Adam J. Rose, Jamie Ryan, Terry L. Schell, and Molly M. Simmons.

A separate report, 2018 Department of Defense Health Related Behaviors Survey (HRBS): Results for the Reserve Component, examines the health behaviors of the reserve component and provides a comparison to the active component.

Both reports were sponsored by the Defense Health Agency and conducted within the Forces and Resources Policy Center of the RAND National Security Research Division.

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