Research Brief

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. Fielded periodically for more than 30 years, the HRBS includes content areas that might affect military readiness or the ability to meet the demands of military life. The Defense Health Agency asked the RAND Corporation to revise and field the 2018 HRBS among members of both the active component and the reserve component.

This brief compares results for the active component and the reserve component in five domains: health promotion and disease prevention, substance use, mental and emotional health, physical health and functioning, and sexual behavior and health. Because making direct comparisons between the two components is not advised, RAND researchers employed a regression model that allowed them to compare the two components. It is important to note that this method cannot account for all differences in surveys between the two components, though a number of important military and demographic characteristics (e.g., service branch, pay grade, age, marital status) were included in the model. Rather than focusing on actual numbers, this brief identifies areas where the reserve component does better or worse or is comparable to the active component.

The reserve component supplements the efforts of the active component. As such, its members must be ready at all times for active duty. This requirement raises an important issue for policymakers: How ready are reserve component members to perform active duty? What health behaviors and outcomes could have negative impacts on readiness? And how do those behaviors and outcomes compare with those of the active component force?

This brief summarizes some answers to these questions. Using the HRBS, it compares results for the active component and the reserve component across several domains using a statistical procedure to control for demographic difference between the two components.

Table 1 summarizes comparisons of the active component and the reserve component. Darker teal indicates areas where the reserve component did better than the active component, darker tan indicates areas where the reserve component did worse, and lighter tan indicates that there was no difference. Note that "better" could mean significantly higher or lower prevalence rates, depending on the outcome.[1] Finally, a few cells are shaded in lighter teal. These are outcomes for which the prevalence rate in the reserve component was significantly smaller than in the active component, but it is unclear whether this is "better." Such outcomes are primarily related to use of mental health services (e.g., total number of mental health care visits).

The remainder of this brief summarizes differences in each of the five domains.

Table 1. Significant Differences Between the Active and Reserve Components for Select Outcomes

Health Promotion and Disease Prevention Substance Use Mental and Emotional Health Physical Health and Functioning Sexual Behavior and Health
dark tan Obesity (HP2020 goal) dark teal Binge drinking dark teal Past-month and past-year serious psychological distress dark teal Physician-diagnosed chronic conditions: high blood pressure; back pain; bone, joint, or muscle injury (including arthritis) dark teal 2+ sex partners in past year
light tan Normal weight (HP2020 goal) dark teal Heavy drinking dark teal Probable posttraumatic stress disorder (PTSD) light tan Physician-diagnosed chronic conditions: diabetes, high cholesterol, asthma, angina or coronary heart disease, heart attack dark teal New-partner sex without condom use past year
dark tan Medium activity level (HP2020 goal) dark teal Any alcohol consequences dark teal Any angry or aggressive behavior in past 30 days dark teal No medical condition diagnosed in past year dark teal Condom use during most-recent vaginal sex
dark tan High activity level (HP2020 goal) light tan Risky drinking and driving behavior dark teal Unwanted sexual contact in past 12 months and since joining the military dark teal Physical conditions: stomach or bowel problems, back pain, arm/leg/joint pain, headaches, chest pain or shortness of breath, tired or low energy dark teal Sexually transmitted infection (STI) in past year
dark teal Strength training 3+ days per week light tan Any productivity loss due to drinking dark teal Physically assaulted in past 12 months and since joining the military light tan Physical conditions: dizziness light tan No contraceptive use at most-recent sex
dark teal Less than one hour of screen time per day dark teal Military culture supportive of drinking light tan Past-year gambling problem dark teal Any bodily pain (including headache) dark tan Used highly effective contraceptive at most-recent sex
light tan Routine annual physical exam dark teal Current cigarette smoker dark teal Past-year suicidal thoughts, suicide plans, and suicide attempts dark teal Any bodily pain (excluding headache) dark tan Used moderately or most effective birth control method at last sex (women 20–44 years old)
dark teal Hours of sleep (HP2020 goal) dark teal Current e-cigarette use dark teal Perceived unmet need for mental health services dark teal High physical symptom severity dark tan Human immunodeficiency virus (HIV) test in past year
dark teal Very good and fairly good self-rated sleep quality dark teal Current smokeless tobacco user light teal Past-year mental health care service utilization dark teal Excellent and very good self-rated health dark teal High risk for HIV
dark teal Moderate to severe lack of energy due to poor sleep dark tan Any past-12-month and past-30-day drug use (including marijuana) light teal Total mental health visits in past year dark teal Absenteeism dark tan High risk for HIV tested in past year
dark teal Frequent use of medication to sleep (3+ times per week) light tan Any past-12-month and past-30-day drug use (excluding marijuana) light teal Use of medication for mental health problem in past year dark teal Presenteeism light tan Unintended pregnancy in past year
light tan Frequent use of other caffeinated beverages (e.g., tea, coffee), over-the counter medications, and prescription medications to stay awake (3+ times per week) dark teal Any prescription drug use (including stimulants, sedatives, and pain relievers) light teal Perceived career-related stigma associated with mental health care service utilization light tan Contraceptive counseling prior to deployment
light tan Any prescription drug misuse (including stimulants, sedatives, and pain relievers) light tan Able to get preferred birth control before and while deployed

Health Promotion and Disease Prevention

Significantly more reserve component service members reported obese body weight and significantly fewer met HP2020 goals for medium and high activity levels as compared with active component members.[2] At the same time, reservists were more likely to meet HP2020 goals for strength training. They were also more likely to meet HP2020 goals for quantity of sleep and to report higher-quality sleep than their active component peers. They were less likely to use medications to help them sleep. Use of energy drinks to stay awake was significantly lower among reservists than among active component members, while use of caffeinated beverages, prescription medications, and over-the-counter medications to stay awake was essentially the same for both components.

Substance Use

Reserve component service members reported significantly less binge and heavy drinking and fewer negative consequences associated with drinking than their active component peers. They were also less likely to view the military culture as supportive of drinking. Further, fewer used tobacco products, including traditional cigarettes, e-cigarettes, and smokeless tobacco. Although they were less likely to use prescription drugs (i.e., stimulants, sedatives, and pain relievers) than active component members were, reservists were more likely to report using illicit drugs, especially marijuana. There was no difference between the two components in misuse of prescription drugs.

Mental and Emotional Health

The prevalence of many mental health problems was lower among reserve component service members than among active component members. This included past-30-day and past-year serious psychological distress, past-30-day PTSD, and past-30-day angry and aggressive behavior, as well as having suicidal thoughts, making suicide plans, and attempting suicide in the past year. Reservists were also less likely than active component members to report having been physically assaulted, both in the past year and since joining the military. Significantly fewer reserve component members than active component members reported using mental health care services, but it is not clear whether this was a positive or negative difference. That said, significantly fewer reservists indicated an unmet need for mental health care treatment.

Physical Health and Functional Limitations

Significantly fewer reserve component members than active component members reported several common chronic physical health conditions diagnosed by a physician, including high blood pressure, back pain, and bone, joint, and muscle injuries (including arthritis). Reservists were also less likely to report experiencing pain, severe physical symptoms, and health-related absenteeism from work or presenteeism (i.e., experiencing reduced productivity at work). Reservists were more likely than active component members to report having "very good" or "excellent" health and less likely to report having "poor" health.

Sexual Behavior and Health

Significantly fewer reserve component members than active component members engaged in a number of risky sexual behaviors. These included having two or more partners in the past year, not using a condom with a new partner in the past year, and not using a condom at most-recent vaginal sex. Perhaps as a result, they were also less likely to report having an STI in the past year. Reservists, however, were significantly less likely than active component members to use highly effective contraception at last sex and to use moderately or most effective methods of birth control (among women between the ages of 20 and 44). Reservists were less likely than active component members to be considered at high risk for HIV, but, among those at high risk, they were significantly less likely to have been tested in the past year. Rates of unintended pregnancy, receipt of predeployment contraceptive counseling, and ability to get one's preferred method of birth control before or during deployment did not differ significantly between the reserve component and the active component.

Notes

  • [1] For example, significantly more reserve component members than active component members reported meeting Healthy People 2020 (HP2020) goals for sleep, and so the corresponding cell in the table is shaded green. At the same time, significantly fewer reserve component members than active component members reported a lack of energy due to poor sleep, and so the corresponding cell in the table is also shaded green.
  • [2] HP2020 objectives are established by the U.S. Department of Health and Human Services for the general U.S. population. For further information, see www.healthypeople.gov.

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