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Introduction: Injury epidemiology research with military populations typically utilizes data obtained through medical chart review (MCR) or injury self-reports (ISRs). MCR data will not capture musculoskeletal injury (MSKI) data for which medical care was not sought, which is common during military recruit training. Injury self-report is affected by issues with recall, especially for MSKIs perceived as less severe. U.S. Marine Corps (USMC) recruits participate in an intense 13-week recruit training program during which they are susceptible to MSKIs. The purpose of the current analysis was to utilize a novel statistical method, the capture-recapture (CRC) technique, to account for the undercounting inherent in MSKI data sources and estimate the ascertainment-corrected cumulative incidence of MSKIs during USMC recruit training., Materials and Methods: Data for the current study were derived from a larger study, the USMC Gender-Integrated Recruit Training Study, which was initiated to provide data-driven recommendations to increase gender integration in USMC recruit training. The estimated cumulative incidence of MSKIs during 13-weeks of USMC recruit training was calculated from the 2 sources of MSKI data (MCR, ISR) and using CRC analysis. Medical charts were reviewed to extract data about MSKIs that occurred during recruit training. Self-reported MSKI data for the same period were obtained from recruits at the end of recruit training. MSKIs were classified according to their anatomical location and type. The Chapman modification of the Lincoln-Peterson estimator was utilized to conduct the CRC analysis., Results: Medical chart review and ISR MSKI data were available for 464 USMC recruits (age: 19.1 ± 1.9 years; gender: men 70.0%). The observed 13-week cumulative incidence of MSKI in the sample was 21.8% in the MCR and 28.4% in the ISR, while the CRC incidence was much higher (62.0%). The MCR and ISR ascertainment were 35.1% and 45.9%, respectively, while the overall ascertainment or completeness of MSKI data when 2 sources were used was moderate (65.0%). When stratified by MSKI anatomical location, the overall ascertainment varied by anatomical location of the MSKI. It was highest for lower extremity MSKIs (64.8%), but lower for upper extremity (38.9%) and spine (33.3%) MSKIs. The overall ascertainment also varied by MSKI type; it was highest for sprain (55.1%), followed by strain (54.8%), and the pain/spasm/ache (43.3%)., Conclusions: This was the first study to utilize the CRC technique to access the ascertainment-corrected incidence of MSKIs among USMC recruits. There was significant undercounting in both sources of the data analyzed, and the extent of undercounting varied by both MSKI anatomical location and type. When 2 sources of data were utilized simultaneously, the percent of CRC-estimated MSKIs observed from 2 sources of data was more complete. There is a need for further application of the CRC technique to MSKI data in military populations to provide a more complete assessment of MSKIs. Identification of modifiable factors that influence completeness of MSKI data obtained during military recruit training is also warranted., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Introduction: This article describes alternate models and policy recommendations created by an interdisciplinary team of researchers to increase gender integration at U.S. Marine Corps (USMC) recruit training. The USMC requested a study to analyze current approaches to gender integration at recruit training and provide alternate models that maximize integration, while continuing to train marines to established standards. USMC remains the only service that segregates recruits by gender at the lowest unit level (e.g., platoon) in recruit training and maintains gender-segregated drill instructor teams (i.e., same-gender teams train platoons of same-gender recruits)., Materials and Methods: A mixed-method, interdisciplinary approach was used to capture multiple perspectives and informed recommendations and alternate models for gender integration. The team studied select USMC, army, navy, air force, and coast guard recruit training locations, between June and November 2021. At each site, the team collected qualitative, quantitative, and administrative data as well as physical performance metrics and human performance outcomes. Study participants included recruits, drill instructors, training cadre, service leaders, and subject matter experts on gender integration in military services. Each alternate model was designed to maximize the feasibility of implementation within current USMC training conditions., Results: The research team developed three alternate models and several policy recommendations. Alternate model 1 proposed a methodology for mixed-gender drill instructor teams within the Integrated Company model, USMC's current integrated training model. Alternate model 2 proposed an Integrated Company Plus model which increases the number and types of gender-integrated training events at or below the platoon level within the Integrated Company model. Alternate model 3 outlined an integrated platoon model where recruits fall out into integrated training platoons after their morning routine, with two options of varying integration based on USMC priorities for integration. The team also proposed a set of policy recommendations independent of the three alternate models to support current and future gender integration efforts at the Marine Corps Recruit Depots., Conclusions: Gender-integrated military training has been shown to positively alter perceptions and evaluations of women in military settings over detrimental aspects developed by gender-segregated training. The study team recommended USMC train recruits in the Integrated Company model with mixed-gender drill instructor teams (alternate model 1) and integrate more training events following the priority tiers outlined in the Integrated Company plus model (alternate model 2). The combined execution of these two alternate models would provide USMC recruits increased exposure to direct, sustained training from opposite-gender drill instructors and deliver intentional training opportunities for male and female recruits to work together and interact in meaningful ways. The integrated platoon model (alternate model 3) would offer USMC recruits the most direct exposure to training and working with members of the opposite gender, but it requires substantial changes to current logistics, accountability, and training procedures., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Recruit training is the initial entry for enlisted personnel in the military. The Services execute gender-integrated recruit training differently. The U.S. Marine Corps (USMC) maintains same-gender platoons led by same-gender drill instructors in integrated companies; further integration occurs at select training events. The other Services train recruits in gender-integrated units with mixed-gender drill instructor teams. We examine recruits' experiences and perceptions of gender integration at recruit training, their desired level of integration, and preferences for increasing gender integration, comparing by Service and gender., Materials and Methods: Recruit perspectives and experiences were captured in a 19-question survey (n = 632) and 90-min focus groups (n = 260) near graduation from recruit training. Data were collected from June to November 2021. Because of the Coronavirus disease (COVID-19) pandemic restrictions, the Navy and Air Force were not conducting gender-integrated recruit training during data collection. Outcome variables were compared cross-Service by gender and within Service by gender using chi-squared tests or Fisher's exact tests, as appropriate; focus group data were analyzed using initial and secondary coding schemes. Three USMC training models, varied by level of integration, were also analyzed (Male-Only, Series Track, and Integrated Company)., Results: Significant gender differences across and within Service emerged in recruits' experience being trained by an opposite-gender instructor. Male recruits had significant differences by Service (P < .001), and USMC female recruits reported being trained by male instructors more than their male peers by female instructors (Series Track P = .002; Integrated Company P < .001). In the focus groups, recruits described common differences with how men and women embodied being a drill instructor. Significant gender differences across (both male and female P < .001) and within Service were reported for closeness of training with opposite-gender peers (Air Force P = .028; U.S. Marine Corps (USMC) Integrated Company P = .010; Army P = .048), an expected finding given varied integration during data collection. Male and female recruits had significant differences by Service in their preference for integration at the lowest unit level (both male and female P < .001), with those who experienced integrated training showing higher levels of endorsement. In the focus groups, recruits articulated benefits and challenges of gender-integrated recruit training. Significant gender differences across Service emerged in preferences for more integration in specific training activities. Within Service, female USMC Integrated Company recruits wanted more integration in tactical/field, physical fitness, and classroom training than their male peers (P < .001 for all). In the focus groups, USMC recruits of both genders desired more integrated training events, particularly those involving combat and tactical skill development., Conclusions: This study provided an opportunity to examine recruit perspectives on gender-integrated training. Services valuing opposite-gender instructor exposure in recruit training must ensure that male recruits are being taught and led by female instructors given disproportionate demographics. Recruits who experienced integrated training were more supportive of integration, indicating that this experience may increase their support for gender-integrated training units and environments. Today's recruits understand that they are entering gender-integrated working environments, and our results indicate that they expect recruit training to mirror that reality., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Drill instructors (DIs) are responsible for executing their Services' recruit training programs and for training recruits. DIs assume a variety of roles, including teaching and developing practical skills and knowledge, mentoring, modeling appropriate behavior and attitudes, motivating recruits for success during and after recruit training, applying and instilling discipline, and ensuring the safety and welfare of recruits. This article examines two major research questions at the intersection of gender, gender-integrated training, and the DI role: (1) What differences exist in how DIs experience their role by gender? and (2) how does gender-integrated recruit training affect DIs' approach to training?, Materials and Methods: This article draws from 87 semistructured interviews conducted with Service leaders, training cadre, and DIs in service of a broader Marine Corps interdisciplinary study on gender integration at recruit training. Interviews were conducted virtually and in-person with Marine Corps, Army, Navy, Air Force, and Coast Guard personnel from June to November 2021. Each interview was coded with initial and secondary codes developed through a flexible coding approach. Data were analyzed across and within relevant categories such as gender and Service to identify themes and patterns., Results: Although the DI role was universally described as demanding and difficult, unique challenges for women consistently emerged from the data. The top reported challenges faced by female DIs were personnel shortages, work and family conflict, culture-driven sexism in the training environment from male peers and recruits, and pressure to excel above and beyond their male peers. In recruit training, DIs are responsible for executing gender-integrated practices. Service leaders, training cadre, and DIs described how gender integration practices affect their approach to the role and implementation of training, including addressing and dismantling sexism, shutting down recruit romantic relationships, training all recruits in an equal manner, knowing gender-specific grooming standards, increasing communication among DIs, and working with mixed-gender DI teams., Conclusions: Female DIs face additional challenges in and outside the role compared with their male peers, and some of these challenges are preventable. Staffing and personnel issues plague the female DI population and are a persistent and pervasive challenge to gender integration efforts. Women are a necessary and highly desirable population to fill the DI role, particularly as Services aim to expose recruits to leaders of both genders during their critical first training experience. DIs play an important role in ensuring the successful completion of recruit training, ultimately helping to build the future leaders of the military. The success of gender integration efforts depends on DIs' intentional approach to the process. Future research can build on this work by expanding the scope to other military training environments (beyond recruit training) and examining how DIs' own sociodemographic positions (e.g., gender, race, ethnicity, and sexual orientation) inform their perspective on and approach to equity in the training environment., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: This article uses recent survey data from a study on gender integration at recruit training across the U.S. Armed Forces to examine service, gender, and training differences in recruit's gender attitudes, beliefs, and cohesion metrics. In addition to providing a descriptive understanding of our recruit sample, this article examines factors germane to gender integration at recruit training such as gender attitudes, sexist beliefs, and unit cohesion., Materials and Methods: This article uses data from a survey of U.S. Marine Corps (USMC), U.S. Army, U.S. Air Force, U.S. Navy, and U.S. Coast Guard recruits as part of a USMC-commissioned study to develop alternate models and recommendations for increasing gender integration in USMC recruit training. At all sites but the USMC, recruits completed the survey 1 to 2 weeks before graduation. At the Marine Corps Recruit Depots, recruits participated in the survey at the beginning (week 2) and end (week 11) of their 13-week training cycle. A 19-question survey captured sociodemographic information, perspectives and experiences during recruit training, and gender attitudes and beliefs. Analyses were conducted on the sample with complete data on the measures reported, including those USMC recruits observed at both week 2 and week 11 (n = 629). Descriptive statistics (percentage) were calculated for all categorical outcome variables. Outcome variables (cohesion, gender, and sexism attitudes) were compared between groups using chi-squared tests or Fisher's exact tests, as appropriate., Results: Recruits differed significantly across services in perceptions of unit cohesion on 3 of the 4 indicators: Platoon members are cooperative, know they can depend on each other, and really respect each other (P < .05). These differences appear to be driven by female recruit difference across service. They reported significant differences in gender role attitudes across the services, with USMC recruits being most likely to endorse traditional gender roles compared to other service recruits. Male USMC recruits were significantly more likely than their female peers to agree that men should achieve outside the home and women should take care of the home and family (21.3% versus 6.3%, P < .05). The only statistical differences in attitudes about equality of treatment and opportunity among recruits were between male and female USMC recruits. All items capturing sexist attitudes elicited statistically significant differences between male USMC recruits and male recruits in other services (P < .05). There were significant differences in all sexism measures between male and female USMC recruits (P < .05). There is a significant decline in some sexist attitudes between weeks 2 and 11 of training among male USMC recruits (P < .05). Nearly one-half to three-fourths of male USMC recruits hold sexist attitudes, even near the end of recruit training., Conclusions: The disparate gender and sexism attitudes of male USMC recruits compared with their peers in other services, and their fellow female USMC recruits suggest efforts to increase gender integration at entry-level training are needed, but also may be challenging since male USMC recruits report the highest levels of sexist attitudes among all recruits., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Introduction: Recruit training is designed to transform civilians into physically fit military service members, who embody their service's core values and possess military discipline and skills. At the time this research began, the U.S. Marine Corps (USMC) remained the only service that segregated recruits by gender at the lowest unit level (e.g., platoon) and employed gender-segregated drill instructor teams. USMC's Marine Corps Recruit Depots (MCRD) must comply with a 2020 Congressional Mandate to not segregate training by gender in Parris Island by 2025 and San Diego by 2028. In turn, USMC requested an independent scientific study to analyze current approaches to gender integration at recruit training to propose alternate models and other policy recommendations that increase gender integration while maintaining current USMC standards. The Marine Corps is currently evaluating alternate models and recommendations to optimize entry-level training. This article outlines considerations for choosing the optimal research study design, research methods, and types of data collected in a study intended to provide policy recommendations on gender-integrated recruit training for the USMC., Materials and Methods: Research data were collected during visits to the MCRDs and selected recruit training locations for the Army, Air Force, Navy, and Coast Guard. Data collection on USMC recruits from three cohorts involved social science assessments (focus groups and surveys) and human performance testing (countermovement jumps and isometric mid-thigh pulls, sleep and activity wearables, and cortisol data) at multiple points in the training cycle. Data on recruits from the sister services were limited to social science assessments. Approximately 600 recruits between the two MCRDs and 160 recruits from the sister services participated in the study during a 7-month timeframe in 2021. The research team conducted extensive ethnographic observations of recruit training at all selected research sites and interviewed training cadre, drill instructors, and service leadership responsible for recruit training (∼90 interviews). Additionally, the research team interviewed 20 experts on gender integration or recruit training who possessed alternate viewpoints from the current USMC practice., Results: The mixed methods study was designed to assess the current gender integration practices at recruit training across the services to generate alternative models of gender integration for USMC. The research team developed a set of multidisciplinary objectives and research questions serving as the foundation of the research study design and data collection process. The study was designed to collect qualitative, quantitative, and administrative data informed by social science and human performance disciplines. To ensure that all aspects and implications relevant to gender integration were considered, select data were collected across services and with stakeholders at all levels., Conclusions: This multidisciplinary research approach provided a comprehensive picture of the current USMC recruit training models. The research team captured multiple perspectives and data points for analysis through an expansive view on gender integration across all services, by interacting with participants at all levels of the institutions in varied ways. The information and data gathered enabled the research team to establish objective, data-driven alternate models, and recommendations for enhancing gender integration at recruit training for the USMC., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Everyone who serves in the military (and survives the experience) will eventually become a Veteran, and most will face the challenge of finding a civilian job. This paper investigates how contemporary Veterans experience the transition period between military exit and entrance into civilian life and how their own actions before separation shape their post-transition outcomes. We follow 35 servicemembers through the transition process, interviewing them before and several months after they left the military. These interviews reveal the importance of three factors - the conditions triggering their exit, the strength of their military identity, and their own planning (or lack thereof) for the transition to civilian life - in enhancing or detracting from achievement of a stated post-military goals and objective success in moving into work or school. The strength and depth of an individual's institutional identity shapes how and when servicemembers plan for military exit and how they adjust to unanticipated military exits. Early planning reflects anticipatory socialization for new civilian roles and is associated with better post-military outcomes. But early planning is often hindered by a strong military identity or facilitated by a weak military identity. These findings have important implications for the military and advocates who serve them with the recent military policy changes to transition assistance and the retirement pension system that encourage early planning for post-military life., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 Society for Military Psychology, Division 19 of the American Psychological Association.)