Research Questions

  1. Within the domains considered, how do reserve component service members compare with the general U.S. population, and how do various subgroups within the reserve 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 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 impact 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 reserve component personnel, including those in the Air Force Reserve, Air National Guard, Army Reserve, Army National Guard, Marine Corps Reserve, Navy Reserve, and Coast Guard Reserve. 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 here are intended to supplement data already collected by DoD and 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 reserve component respondents had not had this medical appointment in the previous year.
  • Less than half (45.4 percent) of reserve component service members met Healthy People 2020 guidelines for adequate sleep, and nearly 20 percent reported lack of energy because of poor sleep over the past week.
  • Nearly one-third of reserve component service members (29.0 percent) reported binge drinking in the past 30 days, and 7.4 percent were categorized as heavy drinkers.
  • An estimated 30.5 percent of reserve component service members used tobacco in some form. This rate is higher than estimated rates of tobacco use in the general population (19.3 percent).
  • Approximately 7 percent of reserve component service members met criteria for current serious psychological distress. Roughly 9 percent met the criteria for probable posttraumatic stress disorder.
  • Approximately one in five reserve component service members reported using any mental health services in the past year.
  • Risky sexual behavior among reserve component service members was not uncommon: 15.9 percent reported having more than one sex partner in the past year, and 33.2 percent did not use condoms with new sex partners.
  • Just over 6 percent of all reserve component service members identified as lesbian, gay, or bisexual (LGB). Significantly more women (15.4 percent) than men (3.8 percent) identified as LGB.
  • Roughly 40 percent of all reserve component service members had experienced at least one of the six types of combat traumas measured by the survey.

Recommendations

  • Educate reserve component 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.
  • Conduct additional research to identify, improve, and evaluate the sources, quality, and outcomes of nonspecialty mental health services utilized by reserve component service members.
  • Ensure that condoms are easily available through TRICARE and are available to reserve component 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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