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Norovirus is the leading cause of acute gastroenteritis (AGE) worldwide. Norovirus outbreaks at military facilities can cause loss of training and working days and increased healthcare utilization, affecting force readiness. During 2013-2023, we enrolled 2,304 US military recruits from 4 basic training facilities to investigate AGE outbreaks among this population. Among enrollees, we detected norovirus in 433 (18.8%) AGE cases, and norovirus caused 49 AGE outbreaks during our longitudinal study. On average, each norovirus case-patient missed 1.2 training days due to illness, and 6.2% required infusion care. Whole-genome sequencing of selected samples from each outbreak produced full-length genomes (6,989-7,787 bp) for 39 samples. Norovirus GII.4 Sydney was the most (12/39, 30.8%) identified genotype over the study period. Phylogenetic and comparative genomic analyses revealed that several outbreak strains were responsible for causing >1 outbreak, even across different training sites. Our findings can inform infection control practices at military installations and overall norovirus vaccine development.

Introduction: In the aftermath of anthrax bioterrorism, the US military began its smallpox immunization program in 2002. Dryvax was superseded in 2008 by ACAM2000, a second-generation smallpox vaccine, after clinical trials demonstrated favorable outcomes. However, these trials focused on significant adverse effects and provided less specific classifications and descriptions of cutaneous eruptions. The purpose of this systematic review was to investigate the clinicopathological characteristics of skin lesions that emerged in US military personnel following the reinstatement of new smallpox immunizations., Methods: PubMed, ScienceDirect, and Google Scholar were searched. The search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using appropriate keywords., Results: Of the 467 studies initially identified, 5 (1%) were analyzed, with a sample size of 15. There were 10 men and 4 women. The mean age of presentation was 24.3 years. The interval between inoculation and eruption was 15 days. The length of the eruption until clearance was 36.26 days. Grossly, most skin lesions were described as having papules (n = 9). Histological examination revealed vesicles with spongiotic dermatitis and eosinophils (n = 5) and a dermal hypersensitivity reaction with lymphocytic vasculitis (capillaritis) (n = 2). Definitive diagnoses included acral and vesiculopustular dermatosis (n = 7), generalized vaccinia (GV) (n = 1), and progressive vaccinia (n = 1). Concurrent or near-concurrent vaccination was administered (n = 12)., Conclusion: Although rare, clinically significant skin lesions can occur after ACAM2000 administration. A feared complication of progressive vaccinia has been reported; however, to determine its causal relationship, further clinical trials are required to provide universal guidelines., Competing Interests: The authors report no funding or conflicts of interests., (Copyright © 2024 Baylor University Medical Center.)

Background: Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations., Objective: We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force., Methods: We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ≥21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library., Results: In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age., Conclusions: This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force., (©Chase A Aycock, Indika Mallawaarachchi, Xin-Qun Wang, Daniel G Cassidy, Jordan M Ellis, Robert C Klesges, G Wayne Talcott, Kara Wiseman. Originally published in JMIR Formative Research (https://formative.jmir.org), 19.03.2024.)

Despite the substantial transition assistance available for honorably separating servicemembers, 75% of US veterans report difficulties with the transition to civilian life. For the 16% of veterans who separate with less-than-honorable discharges, these difficulties are compounded by the lack of structural support from the US military. Social stigma, limited transition programming, and loss of benefits create a perfect storm of barriers for these discharged servicemembers. These barriers compound with post-service mental and physical health challenges to contribute to cycles of misconduct that can result in criminal incarceration. Further, because most of these veterans lack health benefits from the Department of Veterans Affairs due to their discharge status, this population is substantially understudied from a public health perspective. However, actionable policy paths forward and federal policy change offer opportunity to soften the landing for these veterans and meet their legitimate needs for care., Competing Interests: Conflicts of interest Please see ICMJE form(s) for author conflicts of interest. These have been provided as supplementary materials., (© The Author(s) 2024. Published by Oxford University Press on behalf of Project HOPE - The People-To-People Health Foundation, Inc.)

Service Members, particularly members of the Reserve Component, seek medical and mental health care in their civilian communities. To the extent that providers communicate respect and value for military culture, they can better engage and enhance outcomes., Competing Interests: Acknowledgments: The authors have no conflicts of interest to disclose. The views expressed are those of the authors and do not necessarily reflect the opinions of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Uniformed Services University of the Health Sciences, the Department of Defense, the Department of Health and Human Services, or the US Government. The identification of specific products, scientific instrumentation, or organizations is considered an integral part of the scientific endeavor and does not constitute endorse­ment or implied endorsement on the part of the authors, DoD, DHHS, or any component agency., (Copyright ©2023 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Objectives: There are currently no reliable estimates of the prevalence of gastrointestinal disease in the US Military Veterans. Hence, the study aims to determine its prevalence in military Veterans in the United States., Methods: This study utilized a retrospective, correlational design using a patient record database from the Department of Veteran's Affairs. The participants in the study were Veterans diagnosed with gastrointestinal disease. Specific gastrointestinal diseases include more than 500,000 ambulatory care visits annually in the United States, which included peptic ulcer disease, gastroesophageal reflux disease, diverticular disease, ulcerative colitis, Crohn's disease, irritable bowel syndrome, and functional dyspepsia, as well as the symptoms of constipation and nausea/vomiting. This study revealed the exact prevalence of gastrointestinal disease diagnosed in Veterans served in outpatient settings by the Veterans Health Administration and broke down this prevalence over time and by the Veteran period of service., Results: Findings revealed that gastrointestinal disease prevalence among Veterans varied according to their period of service., Conclusions: Findings may help improve screening for Veterans with this increased risk factor. However, further research should be performed to verify the prevalence of gastrointestinal disease in Veterans as compared to the general American population., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2021.)

Electronic Nicotine Delivery Systems (ENDS) are an increasingly popular form of a nicotine delivery device, particularly among young adults and adolescents. The health consequences of long-term ENDS use are not known. Two populations that warrant special consideration are members of the United States Military (service members) and US Veterans. In this narrative review of literature before December 2019, research on ENDS use in these two populations is described in relation to four themes relevant to ENDS use: Prevalence of ENDS use; perceptions of ENDS; correlates of ENDS use; and use of ENDS for smoking cessation. This narrative review summarized research findings in each of these four areas and identified areas for future research., Competing Interests: The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense., (© 2021 Society for Military Psychology, Division 19 of the American Psychological Association.)

Sexual violence is a serious problem within armed services. This article explores intra-service rape in branches of the U.S. military from the 1990s to the present. The article begins by establishing the parameters of the crisis of sexual abuse within the U.S. armed services. Second, it explores systematic failures to recognize forms of suffering. Victim-survivors in the military are vulnerable to military-specific obstacles to reporting their abuse and being believed. Attention is paid to differences by gender and sexual orientation. Third, it analyses the medicalization of suffering in the modern military and its effects. What meanings are assigned to 'military sexual trauma' (MST) and how has that label affected victim-survivors of rape or sexual assault? The article concludes by arguing that the concept of 'trauma' as it is applied to victims of sexual abuse does a formidable amount of political and ideological work., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included ( n  = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25-2.35] and 6.12 [3.47-10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23-2.72] and 2.65 [1.70-4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH.

Introduction: The Department of Defense encourages service members ≤26 years of age to receive the human papillomavirus (HPV) vaccine. Although this vaccine is not recommended in pregnancy, inadvertent vaccination may occur. The objective of this study was to assess whether active duty US military women who received the quadrivalent HPV vaccine (4vHPV) during pregnancy were at increased risk for adverse maternal or infant outcomes., Methods: The study population included active duty US military women aged 17-28 years with at least one pregnancy between 2007 and 2014, and the infants resulting from those pregnancies. Pregnancies, live births, and outcomes were identified using medical codes in administrative medical records. Exposure to 4vHPV during pregnancy was ascertained from personnel immunization records. Multivariable regression models were used to calculate risk estimates and 95% confidence intervals for the maternal outcomes of spontaneous abortion, preeclampsia/eclampsia and preterm labor, and the infant outcomes of preterm birth, birth defects, growth problems in infancy or in utero, and infant sex., Results: Overall, 90,600 pregnancies and 75,670 singleton infants were identified. Approximately 2% of pregnancies and infants were exposed to 4vHPV during pregnancy. After adjustments, no positive associations were detected between inadvertent exposure to 4vHPV during pregnancy and any adverse pregnancy or infant outcomes., Discussion: Our findings add to an established body of literature demonstrating the safety of 4vHPV when inadvertently administered during pregnancy. Although 4vHPV is no longer administered in the US, its use continues overseas; therefore, safety studies remain important. Furthermore, such studies can provide reassurance to women inadvertently exposed to nonavalent HPV vaccine (9vHPV) in pregnancy, which protects against four of the same antigens as 4vHPV, since safety of 9vHPV has not yet been established in pregnant women., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Influenza rates for the US Army and West Point cadets showed that seasonal influenza was not necessarily an annual event, and there was little influenzal illness in the decade before 1918 except for 1911 and 1916. Annual records from 1862-1918 also indicated a similar paucity of influenzal illness before 1890.

Introduction: Traumatic brain injury (TBI) is a significant health issue that affects U.S. military service members (SM) at home and in combat deployments. We estimated the TBI incidence rate in the deployed and non-deployed setting between 2010 and 2014 and identified subgroups with elevated rates for prevention efforts., Methods: Retrospective population-based study of all active duty U.S. military SM that sustained a first active duty TBI diagnosis between January 2010 and December 2014 collected and analyzed in 2017. Using Armed Forces Health Surveillance Branch data we calculated the Mantel-Haenszel (MH) standardized TBI incidence rate in the deployed and non-deployed setting, adjusting for service and demographic factors., Results: From 2010 to 2014, the MH standardized incidence rate for deployed SMs was 3,265 TBIs per 100 thousand p-yrs (95% CI: 3,222-3,307) and 1,705.2 (95% CI: 1,694.0-1,716.5) for non-deployed SMs. The youngest deployed male Army soldiers, those ages 17-24, especially White and Hispanic soldiers, had the highest TBI incidence rate (IR) of 5,748.7 (95% CI: 5,585.8-5,916.4) and 5,010.3 (95% CI: 4,647.5-5,401.4), respectively. The IR for all branches was 1,972.6 (95% CI: 1,959.5-1,985.7) and 724.0 (95% CI: 714.9-733.0) for Reserve/Guard Service members., Conclusions: Across all years, Marines and Army Soldiers experience the highest rates of injury with deployed SMs having elevated IRs of TBI. The TBI IR among deployed SMs was 91% higher than among those in the non-deployed setting, due to continued exposures to combat. Deployed Reserve/Guard component SMs seem to have an above average rate, a finding with implications for training and prevention., (© Association of Military Surgeons of the United States 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Research has revealed a significant association between several peritraumatic emotional responses and posttraumatic stress disorder (PTSD). Preliminary research has also linked peritraumatic emotional responses with a diagnosis of major depressive disorder (MDD). The majority of this research has been cross-sectional, thereby making it difficult to determine the extent to which the various peritraumatic emotional responses may increase risk for, or serve as a premorbid marker of, PTSD and MDD. This study examined the longitudinal role of peritraumatic emotional responses on the subsequent development of PTSD and MDD in a sample of US military veterans. Whereas a number of peritraumatic emotional responses were concurrently associated with PTSD, only peritraumatic numbness maintained the association with this diagnosis longitudinally. For MDD, peritraumatic numbness was the only emotional response related to the diagnosis both concurrently and longitudinally. Study findings are a preliminary proof of concept that peritraumatic numbness may serve as a premorbid marker for the development of PTSD and MDD following a traumatic event. Implications of these findings for the diagnosis, assessment, and treatment of both PTSD and MDD are discussed.

How will the robot age transform warfare? What geopolitical futures are being imagined by the US military? This article constructs a robotic futurology to examine these crucial questions. Its central concern is how robots - driven by leaps in artificial intelligence and swarming - are rewiring the spaces and logics of US empire, warfare, and geopolitics. The article begins by building a more-than-human geopolitics to de-center the role of humans in conflict and foreground a worldly understanding of robots. The article then analyzes the idea of US empire, before speculating upon how and why robots are materializing new forms of proxy war. A three-part examination of the shifting spaces of US empire then follows: (1) Swarm Wars explores the implications of miniaturized drone swarming; (2) Roboworld investigates how robots are changing US military basing strategy and producing new topological spaces of violence; and (3) The Autogenic Battle-Site reveals how autonomous robots will produce emergent, technologically event-ful sites of security and violence - revolutionizing the battlespace. The conclusion reflects on the rise of a robotic US empire and its consequences for democracy.

Background: In conducting population-based surveys, it is important to thoroughly examine and adjust for potential non-response bias to improve the representativeness of the sample prior to conducting analyses of the data and reporting findings. This paper examines factors contributing to second stage survey non-response during the baseline data collection for the Millennium Cohort Family Study, a large longitudinal study of US service members and their spouses from all branches of the military., Methods: Multivariate logistic regression analysis was used to develop a comprehensive response propensity model., Results: Results showed the majority of service member sociodemographic, military, and administrative variables were significantly associated with non-response, along with various health behaviours, mental health indices, and financial and social issues. However, effects were quite small for many factors, with a few demographic and survey administrative variables accounting for the most substantial variance., Conclusions: The Millennium Cohort Family Study was impacted by a number of non-response factors that commonly affect survey research. In particular, recruitment of young, male, and minority populations, as well as junior ranking personnel, was challenging. Despite this, our results suggest the success of representative population sampling can be effectively augmented through targeted oversampling and recruitment, as well as a comprehensive survey weighting strategy.

In the face of an unprecedented epidemic of Ebola Virus Disease, in September 2014, the US military began sending thousands of personnel to Liberia and supporting areas in Senegal in its largest deployment to the African continent in over two decades. In this review, media reports, published photographs and official statements are evaluated and summarized to identify and describe key time points in the US military response. Specific events include the initial establishment of the Monrovia Medical Unit and the buildup of forces for the expanded mission, which involved enhancement of laboratory testing capacity, construction of Ebola Treatment Units, and training of health care workers. The review concludes with a discussion and critical evaluation of the timeliness of this US military response in the context of the original expectations of the humanitarian community and government officials.

Background: We hypothesize that there is a higher incidence of vasectomy within the military at a younger age based on this equal access health care system., Materials and Methods: A review of the CHAMPS military database was conducted for men receiving vasectomies from 2000 to 2009. Age at vasectomy, number of children, race, religion, and marital status were recorded and incidence was computed., Results: Total of 82,945 vasectomies was performed. The overall incidence to have a vasectomy was approximately 7.10 per 1000 men. The highest rate of occurrence was 14.4 per 1000 men in men 30-34 years old. Whites had a higher rate than blacks at 10.03 per 1000 men compared to 6.27 per 1000 men. Protestants had the highest rate at 8.44 per 1000 men, and Jewish people had the lowest at 1.86 per 1000 men. Married men had a rate of 12.3 per 1000 men, whereas single men were 1.03 per 1000 men., Conclusions: The incidence to have a vasectomy in the military was 7.10 per 1000 men, with an age adjusted rate at 8.66 per 1000 men. This information may assist primary care providers in discussing vasectomies as a permanent form of contraception.