Are They Living Healthy?

How well are service members taking care of themselves — Are they living healthy?

Results from 16,699 respondents across the Air Force, Army, Marine Corps, Navy, and Coast Guard

The health related behaviors survey for active-duty service members

Weight and sleep issues

• 29.9% were moderately or severely bothered by sleep-related lack of energy
• 8.6% took sleep medications daily or almost daily

More than 1/2 ½

• 65.7% were overweight or obese according to body mass index
• 56.3% reported less sleep than needed

Substance Use

Alcohol, Tobacco, Illicit Drugs, and Prescription Drugs

• 30.0% binge drank in the past month (5+ drinks for men or 4+ for women in one sitting)
• 5.4% were heavy drinkers (5+ drinks 5 or more times in the past month)
• 68.2% viewed military culture as supportive of drinking
• 13.9% were current cigarette smokers
• 12.7% were current smokeless tobacco users
• 12.4% reported using e-cigarettes in the past month
• 0.7% reported illicit drug use (mostly marijuana or synthetic cannabis) in the past year
• 4.1% used prescription drugs without a valid prescription (i.e., prescription drug misuse) in the past year
• 0.9% used more of a drug than prescribed (i.e., prescription drug overuse) in the past year

Mental and Emotional Health

• 9.4% met survey criteria for probable depression
• 14.2% met survey criteria for probable generalized anxiety disorder
• 8.5% met survey criteria for probable posttraumatic stress disorder
• 6.3% thought about attempting suicide in the past year
• 1.4% reported a suicide attempt in the past year
• 29.7% reported a self-perceived need for mental health services in the past year
• 17.4% reported that someone else told them they needed mental health treatment in the past year
• 26.2% reported mental health service use in the past year
• 56.8% of that care was provided by a military health system provider
• 50.0% of that care was provided by a mental health specialist
• 35.0% said that seeking military mental health treatment damages one's military career
• 17.9% of the sample met criteria for one of three mental health disorders (probable depression, probable generalized anxiety disorder, and probable posttraumatic stress disorder)

Physical Health and Functional Limitations

• 38.6% reported diagnosis of at least one of nine chronic medical conditions (e.g., high blood pressure) in their lifetime
• 35.7% reported that pain bothered them a lot over the past 30 days
• 42.5% reported a functional impairment in at least one domain — work or school, social life, or family life

Sexual Behavior and Health

• 19.4% had more than one sex partner in the past year
• 36.7% had sex with a new partner without a condom in the past year
• 1.7% reported contracting a sexually transmitted infection in the past year
• 20.9% were at high risk for human immunodeficiency virus (HIV)
• 19.4% of those not expecting or trying to conceive a child had vaginal sex without using birth control in the past year
• 2.4% reported having or causing an unintended pregnancy in the past year

Sexual Orientation, Transgender Identity, and Health

6.1% identified as lesbian, gay, bisexual, or transgender (LGBT)

LGBT personnel were more likely than their peers to report moderate and severe depression, self-injury, suicide ideation and attempts, risky sexual behavior, binge drinking, and current cigarette use.

Deployment Experiences and Health

61.3% reported at least one prior combat or noncombat deployment

Among those who had ever deployed:

• 64.9% reported exposure to combat trauma
• 27.7% reported a deployment-related injury
• 11.9% screened positive for deployment-related mild traumatic brain injury
• 8.6% reported deployment-related postconcussive symptoms
• 67.6% reported substance use, mostly alcohol or cigarettes, during their most-recent deployment

Among those deployed in the past three years:

• 10.4% met survey criteria for probable depression
• 15.0% met survey criteria for probable generalized anxiety disorder
• 9.9% met survey criteria for probable posttraumatic stress disorder
• 37.8% reported chronic pain

The Health Related Behaviors Survey (HRBS) is the U.S. Department of Defense (DoD)'s flagship survey for understanding the health, health-related behaviors, and well-being of active-duty service members.

• It allows leadership to better understand the readiness of the force.
• It is used to facilitate benchmarking in combination with Healthy People benchmarks (designed for the general U.S. population).
• Results are weighted to represent the 2015 active-duty force by service branch, pay grade, and gender.

Comparison to U.S. General Population

The 2015 HRBS shows that active-duty service members generally have better health and health-related behaviors than the U.S. adult population.

Exceptions include binge and hazardous alcohol use, common mental health conditions, and sleep problems.

Nicotine use is comparable to civilian populations; cigarette use is down, but e-cigarette use has significantly increased since the 2011 HRBS.

Obesity compares favorably to civilian populations and has been largely stable over recent HRBSs; percentage overweight is a possible concern, but measurement method may be an issue.

HIV testing among those at high risk may be an opportunity for improvement.

Currently, there are no military-appropriate benchmarks for comparison purposes.

Development of military-appropriate population benchmarks may facilitate goal-setting, command visibility, and incremental improvements in health-related readiness.

Limitations

A low overall response rate (8.6%) suggests that the results should be interpreted with caution and in conjunction with other existing data. New ways to improve survey response rates are needed, including focusing survey content, shifting to a confidential rather than anonymous survey, and addressing information technology issues related to use of a non-DoD email address. The above comparisons to the general adult population do not control for differences in demographic composition.

Adapted from 2015 Department of Defense Health Related Behaviors Survey (HRBS) of Active-Duty Service Members: Final Report, by Sarah O. Meadows, Charles C. Engel, Rebecca L. Collins, Robin Beckman, Matthew Cefalu, Jennifer Hawes-Dawson, Molly Doyle, Amii M. Kress, Lisa Sontag-Padilla, Rajeev Ramchand, and Kayla M. Williams, Santa Monica, Calif.: RAND Corporation, RR-1695-OSD, 2018. The RAND Corporation is a research organization that develops solutions to public policy challenges to help make communities throughout the world safer and more secure, healthier and more prosperous. RAND is nonprofit, nonpartisan, and committed to the public interest. For the complete report detailing these and other findings, visit www.rand.org/t/RR1695.

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