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Study Design. A prospective cohort study. Objective. Activities performed during military operations vary in complexity and physical demand. The risk for mental illness following military combat deployment has been well documented. However, information regarding the possible contribution of back pain to decreased mental and functional health is scarce. To our knowledge, this is the first study to prospectively assess deployment and self-reported recent back pain in a population-based U.S. military cohort. Summary of Background Data. The study consisted of Millennium Cohort participants who were followed for the development of back pain for an average of 3.9 years. Methods. Descriptive statistics and longitudinal analyses were used to assess the temporal relationship of deployment with self-reported recent back pain at follow-up (N = 53,933). Results. Recent back pain was self-reported by 8379 (15.5%) participants at follow-up. After adjusting for covariates, deployers with combat experiences had higher odds [odds ratio (OR) = 1.38, 95% confidence interval (95% CI): 1.28–1.50] of recent back pain than noncombat deployers. There was no association between recent back pain and nondeployers compared with noncombat deployers. Service support/supply handlers were at an increased odds of reporting recent back pain (OR = 1.11, 95% CI: 1.02–1.21) than functional support/administration occupations. Occupations associated with a physically demanding work environment had a higher risk of back pain. Conclusion. Deployers with combat experiences were more likely to report back pain postdeployment. This well-defined group of military personnel may potentially benefit from integrated prevention efforts. Level of Evidence: 3

OBJECTIVES:: Combat exposure is known to increase the risk for mental disorders; however, less is known about the temporal relationship between mental disorders and alcohol misuse or smoking. To better understand these interrelationships, this study investigated mental disorders in association with hazardous drinking and cigarette smoking. METHODS:: Using data from a large population-based military cohort, standardized instruments were used to screen for posttraumatic stress disorder, depression, panic, and other anxiety syndromes. Self-reported use of cigarettes and hazardous drinking was also assessed. Subjects were classified as having "new-onset," "persistent," or "resolved" mental disorders and health risk behaviors on the basis of screening results from baseline to follow-up (n = 50,028). Multivariable logistic regression models were used to investigate temporal patterns between the development of mental disorders and the uptake of smoking or hazardous drinking. RESULTS:: The strongest associations of new-onset mental disorders were among those who newly reported smoking or hazardous drinking (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.28-2.59 and OR, 2.49; 95% CI, 2.15-2.89, respectively), even after adjustment for combat deployment experience. In addition, persistent smokers and hazardous drinkers had elevated odds for developing a mental disorder at follow-up. CONCLUSIONS:: This study demonstrates a positive association between the onset of mental disorders with the uptake of smoking and hazardous drinking and the likelihood that multiple temporal sequence patterns exist to explain the relationship between mental disorders and hazardous drinking and smoking. Clinical approaches to mitigate deployment-related mental disorders should include alcohol and tobacco-related assessments and interventions. Language: en

To investigate respiratory illnesses and potential open-air burn pit exposure among Millennium Cohort participants who deployed to Iraq or Afghanistan.Using multivariable logistic regression, newly reported chronic bronchitis or emphysema, newly reported asthma, and self-reported respiratory symptoms and possible burn pit exposure within 2, 3, or 5 miles were examined among Army and Air Force deployers surveyed in 2004 to 2006 and 2007 to 2008 (n = 22,844).Burn pit exposure within 3 or 5 miles was not associated with respiratory outcomes after statistical adjustment. Increased symptom reporting was observed among Air Force deployers located within 2 miles of Joint Base Balad; however, this finding was marginally significant with no evidence of trend.In general, these findings do not support an elevated risk for respiratory outcomes among personnel deployed within proximity of documented burn pits in Iraq.

Background Recently, there has been concern that service members deploying in support of the current operations in Iraq and Afghanistan may have higher odds of developing chronic diseases, such as lupus or rheumatoid arthritis, as a result of environmental and occupational exposures that have been associated with these diseases in the general US population. One such exposure garnering much attention from media and veterans groups suggest smoke from open-air burning of trash and other waste in theater is contributing to widespread illness. Methods Of the 63,590 participants who completed both the 2004?2006 and 2007?2008 questionnaires, exclusions included those who affirmatively reported disease to all provider-diagnosed medical conditions, reported ever having lupus or rheumatoid arthritis prior to or on the 2004?2006 survey assessment, did not complete the outcome responses, were in the Navy or Marine Corps, never deployed between 2003 and 2007?2008 survey assessments, experienced a first deployment or exposure to a documented burn pit after newly reporting either outcome, or were missing any covariates of interest. Results 3201 and 3145 participants from the respective lupus and rheumatoid arthritis study populations identified with at least one deployment to an area within a 3-mile radius of a documented open-air burn pit. After adjustment, proximity to a documented 3-mile burn pit was not significantly associated with rheumatoid arthritis or lupus in general. Conclusions Results indicate deployers exposed to documented burn pits in the combined three-camp analysis were not at an elevated risk of lupus or rheumatoid arthritis.

Current deployments to Iraq and Afghanistan have generated concern regarding the association between combat deployment and mental health disorders. Those deploying on an individual assignment (IA) may be at increased risk for mental health challenges. The objective of this research is to describe new-onset of self-reported posttraumatic stress disorder (PTSD), depression, anxiety, and alcohol disorders in the Millennium Cohort and assess the relationship between IA deployment and mental health morbidity. Millennium Cohort Study members deployed for the first time in support of the wars in Iraq and Afghanistan between baseline and follow-up were included in these analyses (n = 12 952). Women deployed on an IA with reported combat exposures were at greatest risk of any mental health outcome (odds ratio [OR] 4.04; 95% confidence interval [CI], 1.90-8.62), PTSD (OR 8.24; 95% CI, 2.88-23.61), or alcohol abuse (OR 3.20; 95% CI, 1.11-9.25) postdeployment compared with regular deployed women without combat exposures. This investigation contributes insight into which additional services those deployed on an IA may benefit from to prevent mental health challenges. Military women deployed on IA, in particular, may benefit from additional time and efforts to increase social support and unit cohesion before deployment.

High-stress situations, such as combat deployments, are a potential risk factor for hypertension. Although stress is postulated to increase blood pressure, the underlying role of stress on hypertension is not well established. We sought to determine the relations between combat deployment–induced stress and hypertension. The Millennium Cohort baseline questionnaire (2001–2003) was completed by 77 047 US active-duty and Reserve/National Guard members. Follow-up was completed by 55 021 responders ≈3 years later (2004–2006). Multivariable logistic regression was used to estimate the 3-year risk of newly reported hypertension, adjusting for general and mental health, demographics, and occupational and behavioral characteristics. After applying exclusion criteria, our analyses included 36 061 service members. Subanalyses of deployers included 8829 participants. Newly reported hypertension was identified in 6.9% of the cohort between baseline and follow-up, many of whom had deployed on military operations in support of the conflicts in Iraq and Afghanistan. After adjusting, deployers who experienced no combat exposures were less likely to report hypertension than nondeployers (odds ratio: 0.77; 95% CI: 0.67 to 0.89). Among deployers, those reporting multiple combat exposures were 1.33 times more likely to report hypertension compared with noncombat deployers (95% CI: 1.07 to 1.65). Although military deployers, in general, had a lower incidence of hypertension than nondeployers, deployment with multiple stressful combat exposures appeared to be a unique risk factor for newly reported hypertension.

There is much concern over the potential for short- and long-term adverse mental health effects caused by the terrorist attacks on September 11, 2001. This analysis used data from the Millennium Cohort Study to identify subgroups of US military members who enrolled in the cohort and reported their mental health status before the traumatic events of September 11 and soon after September 11. While adjusting for confounding, multivariable logistic regression, analysis of variance, and multivariate ordinal, or polychotomous logistic regression were used to compare 18 self-reported mental health measures in US military members who enrolled in the cohort before September 11, 2001 with those military personnel who enrolled after September 11, 2001. In contrast to studies of other populations, military respondents reported fewer mental health problems in the months immediately after September 11, 2001.