Assessing the Health Readiness of Active Component Soldiers

Assessing the Health Readiness of Active Component Soldiers: Results from Army Respondents to the HRBS

DoD Health Related Behaviors Survey for active component service members

Weight and Sleep Issues

• 63.2% were overweight or obese, according to body mass index
• 29.5% met age-appropriate sleep quantity requirements
• 29.4% were moderately or severely bothered by sleep-related lack of energy
• 9.7% took sleep medications to help them sleep at least three times weekly

Substance Use

Alcohol, Tobacco, Illicit Drugs, and Prescription Drugs

• 30.5% had engaged in binge drinking in the past 30 days (five or more drinks for men or four or more for women on one occasion)
• 8.5% were heavy drinkers (binge drinking at least one or two days a week in the past 30 days)
• 26.8% viewed military culture as supportive of drinking
• 36.2% reported any current tobacco or nicotine use
• 18.0% were current cigarette smokers
• 14.7% were current smokeless tobacco users
• 13.9% were current e-cigarette users
• 1.1% reported illicit drug use (mostly marijuana or synthetic cannabis) in the past 12 months
• 1.8% reported prescription drug misuse in the past 12 months (use without a prescription or use in greater amounts, more frequently, or for longer than prescribed)

Mental and Emotional Health

• 9.7% met criteria for serious psychological distress in the past 30 days
• 17.0% met criteria for serious psychological distress in the past 12 months
• 11.7% met criteria for probable posttraumatic stress disorder (PTSD) in the past 30 days
• 8.5% had thought about attempting suicide in the past 12 months
• 1.4% reported a suicide attempt in the past 12 months
• 7.6% needed mental health services in the past 12 months but did not receive them
• 28.7% reported mental health service use in the past 12 months
• 33.0% said that seeking military mental health treatment damages one's military career

Physical Health and Functional Limitations

• 47.0% reported one or more chronic medical conditions (e.g., high blood pressure) in the past 12 months
• 33.6% reported that pain (including headaches) had bothered them a lot over the past 30 days
• 7.3% screened positive for mild traumatic brain injury

Sexual Behavior and Health

• 17.8% had more than one sexual partner in the past 12 months
• 33.9% had sex with a new partner without using a condom in the past 12 months
• 3.0% reported contracting a sexually transmitted infection in the past 12 months
• 20.4% were at high risk for human immunodeficiency virus (HIV)
• 19.3% of those not expecting or trying to conceive a child did not use birth control during their most recent vaginal sex in the past 12 months
• 2.7% reported having or causing an unintended pregnancy in the past 12 months

Sexual Orientation, Identity, and Health

5.7% identified as lesbian, gay, or bisexual (LGB)

Significantly greater percentages of LGB personnel than non-LGB personnel reported serious psychological distress and probable PTSD, suicidal thoughts and attempts, binge and heavy drinking, e-cigarette and smokeless tobacco use, illicit drug use, and unwanted sexual contact.* These results are not specific to the Army.

* Unwanted sexual contact in the HRBS is a broader construct than sexual assault, and these survey responses do not represent official reports of sexual assault.

Deployment Experiences and Health

57.9% reported at least one prior combat or noncombat deployment

Among those who had ever deployed:

• 84.9% reported at least one lifetime combat deployment
• 57.5% reported past exposure to combat trauma (e.g., knowing someone wounded in combat)
• 44.7% reported a deployment in the past 12 months

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

• The HRBS allows leadership to better understand the health-related readiness of the force.
• The HRBS is used to facilitate benchmarking in combination with Healthy People benchmarks (designed for the general U.S. population).
• Results are weighted to represent the 2018 active component.

Comparison with the U.S. General Population

The 2018 HRBS shows that active component soldiers met Healthy People 2020 goals for weight and had low rates of illicit drug use. Nevertheless, there are several areas of concern.

Most soldiers did not get appropriate amounts of sleep, and many reported a sleep-related lack of energy. Levels of binge drinking were above Healthy People 2020 goals, as were levels of use of tobacco and nicotine products. Soldiers reported more serious psychological distress and PTSD than members of the adult general population did. Suicidal ideation and suicide attempts were also more common among soldiers than they are among members of the adult general population.

Development of military-appropriate population benchmarks, especially by service branch, could facilitate goal-setting, command visibility, and incremental improvements in health-related readiness.

Limitations

A low overall response rate (6.0 percent for the Army and 9.6 percent across all services) suggests that the results should be interpreted with caution and in conjunction with other existing data. Use of targeted incentives, modules administered to subsets of respondents, or a service member panel survey could help improve response rates and representation. The above comparisons with the general adult population do not control for demographic differences between the two populations.

Adapted from 2018 Department of Defense Health Related Behaviors Survey (HRBS): Results for the Active Component, by Sarah O. Meadows, Charles C. Engel, Rebecca L. Collins, Robin L. 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 Simmons, Santa Monica, Calif.: RAND Corporation, RR-4222-OSD, 2021. 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/RR4222.

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