Research Questions

  1. Within the domains considered, how do service members compare with the general U.S. population, and how do various subgroups within the active component population compare with each other on issues of health, health-related behaviors, and well-being?
  2. What are the policy implications of the 2018 HRBS findings?
  3. How might future iterations of the HRBS be improved?

The Health Related Behaviors Survey (HRBS) is the U.S. Department of Defense's (DoD's) flagship survey for understanding the health, health behaviors, and well-being of service members. Originally implemented to assess substance use — illicit drugs, alcohol, and tobacco — the survey now includes a number of content areas that can potentially affect force readiness, or the ability to meet the demands of military life, including mental and physical health, sexual behavior, and postdeployment problems. In 2016, the Defense Health Agency asked the RAND Corporation to update survey content, administer a revised version of the survey, and analyze data from the resulting 2018 HRBS of active component personnel, including those in the U.S. Air Force, Army, Marine Corps, Navy, and Coast Guard. This report details the methodology, sample demographics, and results from that survey in the domains of health promotion and disease prevention, substance use, mental and emotional health, physical health and functional limitations, and sexual behavior and health. Two special sections focus on sexual orientation and health and deployment experiences and health. Differences across subgroups are examined, including service branch, pay grade, gender, race/ethnicity, and age group. The results presented are intended to supplement data already collected by DoD and to inform policy initiatives to help improve the readiness, health, and well-being of the force.

Key Findings

  • An annual check-up is required for all service members. However, nearly 30 percent of respondents had not had this medical appointment in the previous year.
  • About one-third of service members met Healthy People 2020 guidelines for adequate sleep, and roughly 28 percent reported lack of energy because of poor sleep over the past week.
  • More than one-third of service members reported binge drinking in the past 30 days, and nearly ten percent were categorized as heavy drinkers.
  • An estimated 37.8 percent of service members used tobacco in some form. This rate is higher than estimated rates of tobacco use in the general population (19.3 percent).
  • Nearly one in ten service members met criteria for current serious psychological distress. Roughly 10 percent met the criteria for probable posttraumatic stress disorder.
  • Approximately one in four service members reported using any mental health services in the past year.
  • Risky sexual behaviors were not uncommon. Almost one-fifth of service members reported having more than one sex partner in the past year, and more than one-third did not use condoms with new sex partners. Rates of past-year sexually transmitted infections had increased significantly since the 2015 HRBS.
  • Just over 6 percent of all active component service members identified as lesbian, gay, or bisexual (LGB). Significantly more women (17.6 percent) than men (4.1 percent) identified as LGB.
  • More than one-third (36.2 percent) of all service members had experienced at least one of the six types of combat traumas measured by the survey.

Recommendations

  • Educate service members on the importance of sleep.
  • Improve access to and emphasize annual medical appointments.
  • Better understand the culture and climate surrounding alcohol use and then take steps to shift the culture away from excessive use.
  • Reduce tobacco use in all forms.
  • Continue efforts to help mitigate challenges associated with scheduling and attending appointments for mental health treatment.
  • Ensure that condoms are easily available through TRICARE and are available to service members, regardless of location, at no or reduced cost.
  • Consider implementing regular testing for sexually transmitted infections.
  • Include LGB-specific considerations in broadly targeted health promotion efforts.
  • In future iterations of the HRBS, consider the use of survey incentives, shorten the survey and focus survey content, and explore the use of a service member panel for tracking risky behaviors over time.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methodology

  • Chapter Three

    Demographics

  • Chapter Four

    Health Promotion and Disease Prevention

  • Chapter Five

    Substance Use

  • Chapter Six

    Mental and Emotional Health

  • Chapter Seven

    Physical Health and Functional Limitations

  • Chapter Eight

    Sexual Behavior and Health

  • Chapter Nine

    Sexual Orientation and Health

  • Chapter Ten

    Deployment Experiences and Health

  • Chapter Eleven

    Summary and Policy Implications

  • Appendix A

    2018 DoD Health Related Behaviors Survey

  • Appendix B

    Invitation Letter and Letters of Support

  • Appendix C

    Description of Measures Used in the 2018 DoD Health Related Behaviors Survey

  • Appendix D

    Key Outcomes by Race/Ethnicity and Age Group

  • Appendix E

    Missing Data and Imputation Method Detail

This research was sponsored by the Defense Health Agency and conducted within the Forces and Resources Policy Center of the International Security and Defense Policy Center (NSRD).

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