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High-intensity functional training (HIFT) is a promising fitness paradigm that gained popularity among military populations. Rather than biasing workouts toward maximizing fitness domains such as aerobic endurance, HIFT workouts are designed to promote general physical preparedness. HIFT programs have proliferated as a result of concerns about the relevance of traditional physical training (PT), which historically focused on aerobic condition via running. Other concerns about traditional PT include: (1) the relevance of service fitness tests given current combat demands, (2) the perception that military PT is geared toward passing service fitness tests, and (3) that training for combat requires more than just aerobic endurance. Despite its' popularity in the military, concerns have been raised about HIFT's injury potential, leading to some approaches being labeled as "extreme conditioning programs" by several military and civilian experts. Given HIFT programs' popularity in the military and concerns about injury, a review of data on HIFT injury potential is needed to inform military policy. The purpose of this review is to: (1) provide an overview of scientific methods used to appropriately compare injury rates among fitness activities and (2) evaluate scientific data regarding HIFT injury risk compared to traditional military PT and other accepted fitness activities.

© Association of Military Surgeons of the U.S. All rights reserved. Tobacco use prevalence is unacceptably high in the U.S. military, and the Department of Defense and service branches have implemented tobacco control policies and cessation programs. To explore aspects of programs regarded as exemplary by their services, we visited four installations, nominated by their service’s health promotion leaders, and conducted interviews, observations, and focus groups. Installations included Naval Hospital Guam, Tripler Army Medical Center, MacDill Air Force Base, and the Naval Hospital at Marine Corps Air Ground Combat Center Twentynine Palms. The tobacco control managers (TCMs) at the programs studied were all civilian employees, highly motivated and enthusiastic, and had remained in their positions for approximately a decade. Other commonalities included support from command, a “culture” of health, and location in warm climates. Programs varied in their involvement in establishing designated tobacco use areas, and length and requirement of attending cessation classes; however, no evaluation of cessation programs is currently underway. TCMs should be more engaged in policy discussions for the larger installations they serve. A strong policy framework and command support for TCMs will be necessary to achieve the goal of a tobacco-free military.

Military installation newspapers are a primary means used by military commanders to communicate information about topics important to military personnel including leadership, training issues, installation events, safety concerns, and vital health issues. We conducted a content analysis of military commanders' messages about health issues that were published in online military installation newspapers/newsfeeds. We identified a total of 75 publicly accessible installation newspapers/newsfeeds with commanders' messages (n = 39 Air Force, n = 19 Army, n = 7 Navy, n = 1 Marine, and n = 9 Joint Bases). Commander messages published from January 2012 to December 2012 were collected, screened, and coded. Coder inter-rater reliability was 98.9%. Among the 2,479 coded commanders' messages, 132 (5.3%) addressed a health topic as the primary focus. There were no significant differences between service branches in the percentage of health-oriented messages (χ(2) = 5.019, p = 0.285). The most commonly addressed health topics were exercise/fitness (23.5%), other mental health concerns (19.7%), alcohol/driving under the influence (13.6%), and suicide (12.1%). Tobacco use was directly addressed as a primary health aim in only two commanders' messages (1.5%). Health topics, and particularly tobacco-related content, are rarely written about by military commanders. The absence of tobacco-related health messages from line leadership contributes to the perception that tobacco control is a low priority.

The purpose of this study was to conduct a content analysis of Veterans and Military Service Organizations (VMSOs) magazines to determine what health-related topics VMSOs target and how they inform their constituencies about health issues. Health-related topics in 288 VMSOs' magazines from 21 VMSOs published in 2011 and 2012 were coded by trained raters using a standardized manual. The top three most addressed health topics were Health Services (Health care, Insurance), Disability and Disability benefits, and post-traumatic stress disorder. Topics least frequently covered were Tobacco and Smoking cessation, Illegal drugs, Alcohol, Gulf War Syndrome, and Weight and Body composition. VMSOs are concerned about the health and well-being of their members given the considerable amount of content devoted to certain health topics such as health insurance concerns, disability, and post-traumatic stress disorder. However, other health concerns that affect a considerable number of both current military personnel and veterans and cost both the Department of Veterans Affairs and the Department of Defense millions annually, such as drug and alcohol problems, and tobacco use and smoking cessation, are infrequently covered. The results of this study improve our understanding of the health-related information that reaches the military and veteran populations through this important media outlet.

Tobacco use is the leading cause of preventable death in the United States (US) and has been demonstrated to significantly harm the combat readiness of military personnel. Unfortunately, recent research demonstrated that cigarettes are sold at substantial discounts in military retail outlets. In fact, the military is the only retailer which consistently loses money on tobacco. Cheap tobacco prices have been identified by enlisted personnel and Department of Defense health policy experts as promoting a culture of tobacco use in the US Military. This paper provides an analysis of why current military tobacco pricing policy has failed to eliminate cheap tobacco prices as an incentive for use. A rationale for increasing tobacco prices also is presented along with recommendations for improved military tobacco control policy.

Appropriate and effective physical fitness training is imperative for soldier survival and mission success. The purpose of this study was to determine the effects of Mission Essential Fitness (MEF) circuit-style training program compared to standard Army Physical Readiness Training (APRT) on fitness, physiological, and body composition changes. Active duty Army personnel were randomly assigned to two groups (MEF = 34 or APRT = 33) for 8 weeks of training (15 sessions each). The MEF program included functional movements focused on strength, power, speed, and agility. Fifteen exercises were performed continuously for 60 to 90 seconds for 45 minutes. Baseline and post-test measures included the Army physical fitness test, physiological indicators, body composition, and additional fitness indicators. One-way analysis of covariance models indicated that MEF participants significantly increased their push-ups (p = 0.033), bench press (p = 0.001), and flexibility (p = 0.003) and significantly decreased their 2-mile run (p = 0.003) and step test heart rate (p = 0.004) compared to participants doing APRT. Both groups maintained body composition (p0.05) and reported no injuries. The MEF training program safely improved muscular strength and endurance, cardiovascular endurance, and flexibility, supporting functional fitness circuit-style exercise training for military personnel.

Despite progress in policy changes, tobacco use rates are still high in the military. Little is known about the views of those who create and implement tobacco control policies within the Department of Defense. These individuals determine what policy initiatives will be developed, prioritized, and implemented. We conducted key informant interviews with 16 service-level policy leaders (PLs) and 36 installation-level tobacco control managers (TCMs). PLs and TCMs believed that line leadership view tobacco control as a low priority that has minimal impact on successful mission completion. They also identified cultural factors that perpetuate tobacco use, such as low cost and easy accessibility to tobacco, smoke breaks, and uneven or unknown enforcement of current tobacco policies.

Smoking during deployments is a growing problem, particularly among junior-enlisted personnel, who have the highest smoking rates in the military. Few studies have examined reasons for smoking initiation among never smokers, relapse among former smokers, or increased smoking frequency among current smokers. We conducted 24 focus groups at four Air Force and two Army installations (N = 189) to examine the extent of smoking during deployment and to elucidate factors thought to contribute to new initiation, relapse, and increased smoking in a sample of junior-enlisted personnel and their supervisors. Important reasons for smoking included: (1) managing stress, boredom, anxiety, and sleep deprivation; (2) lack of alternate activities and privileges; (3) the perception that dangers in the field trumps the health impact of smoking; and (4) the role of the military environment in encouraging smoking. In addition, the phenomenon of new initiation and relapse to smoking in the field was discussed.

The purpose of this study was to evaluate obesity classifications from body fat percentage (BF%), body mass index (BMI), and waist circumference (WC).A total of 451 overweight/obese active duty military personnel completed all three assessments.Most were obese (men, 81%; women, 98%) using National Institutes of Health (NIH) BF% standards (men,25%; women,30%). Using the higher World Health Organization (WHO) BF35% standard, 86% of women were obese. BMI (55.5% and 51.4%) and WC (21.4% and 31.9%) obesity rates were substantially lower for men and women, respectively (p0.05). BMI/WC were accurate discriminators for BF% obesity (theta for all comparisons0.75, p0.001). Optimal cutoff points were lower than NIH/WHO standards; WC = 100 cm and BMI = 29 maximized sensitivity and specificity for men, and WC = 79 cm and BMI = 25.5 (NIH) or WC = 83 cm and BMI = 26 (WHO) maximized sensitivity and specificity for women.Both WC and BMI measures had high rates of false negatives compared to BF%. However, at a population level, WC/BMI are useful obesity measures, demonstrating fair-to-high discriminatory power.

Both tobacco and overweight present serious threats to public health. Although the military has targeted both health issues, only weight status is included in tests of fitness. This study contrasted the relative utility of body weight and smoking as markers for fitness for duty.Using data from the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel (N = 12,149; 24.7% female), troops were categorized according to weight (underweight, healthy weight, overweight, or obese) and smoking status (never smoker, former smoker, or current smoker).Logistic models were developed to examine the usefulness of smoking status and weight status as predictors of items assessing four domains of military fitness for duty, namely, physical health, mental health, substance abuse, and legal problems. Smoking status was a consistent and strong predictor of items within all four fitness domains. In contrast, weight status was not a consistent predictor of fitness.The military should consider adding smoking status to assessments of military fitness. Also, given that underweight and not overweight status predicted negative outcomes among military members, the services should consider revising their weight status fitness standards.

This study examined the weight standards used by the U.S. Air Force and tested whether Air Force personnel who exceed the maximum allowable weight standard are more likely to engage in health risk behaviors compared with individuals who do not exceed current Air Force weight standards. Participants were 32,144 individuals who completed basic military training from August 1995 to August 1996. Compared with body mass levels known to predict increased health risks, the Air Force maximum allowable weight standards were found to be more stringent for women than for men. Furthermore, exceeding the maximum allowable weight standard of the weight management programs did not consistently indicate that an individual engaged in a less healthy lifestyle than other airmen. Perhaps other risk factors, such as cigarette smoking, may be more closely linked to negative health consequences than body weight.

Although submaximal cycle ergometry testing (CET) can provide a good estimate of an individual's physical fitness, anticipatory heart rate increases accompanying pre-test anxiety can negatively affect the outcome of a submaximal CET. The present study evaluated the efficacy of a low-cost, technician-administered anxiety reduction intervention in the natural setting to reduce false-positives by removing heart rate feedback, and offering cognitive distraction and controlled breathing techniques. There were consistent findings for removing heart rate (HR) feedback and offering relaxation and distraction techniques on increasing the passing rate and decreasing HR at minute 1. Furthermore, when evaluated by gender, this minimal intervention also had an effect on increasing VO 2max estimates, decreasing average HR, and increasing the passing rate for the female subjects. Interestingly, there were no effects found for any of the treatment conditions for the male subjects. The intervention's implications and future research directions are discussed.

Previous investigations of the health behaviors of active duty military members and their dependent spouses generally have found a higher rate of smoking and greater alcohol use in this group compared to their civilian counterparts. Horwever, it is not knorvn whether military retirees and their dependents also report higher smoking and alcohol use compared to the general senior population. Therefore, this study examined cigarette and alcohol use in a group of military retirees (n = 1,359) and dependents (n = 983). Contrary to studies surveying active duty members and their spouses, the present study found that smoking rates and alcohol use among military retirees and de pendents were similar to those reported in surveys of the gen eral senior population. In addition, the fact that the majority of retirees (68%) classified themselves as ex-smokers suggests that these individuals may adopt more healthy lifestyles over time. Factors associated with smoking and alcohol use are also presented, along with suggestions for future research