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We examined the prediction of affective well-being to work performance in the United States Army. We found that high positive affect (PA), low negative affect (NA), and high optimism predicted awards for performance and heroism in a sample of 908,096 U.S. Army soldiers (mean age 29.60 years old, SD = 9.16 years; with over ¼ of a million ethnic minorities and over 150,000 women). Baseline high PA, low NA, and high optimism predicted awards over a four-year follow up window, in which 114,443 soldiers (12.60%) received an award. Each well-being variable predicted future awards for both women and men, for enlisted soldiers as well as officers, for several ethnicities, for varying levels of education, and controlling for a number of other potential explanatory variables. The effects of high positive and low negative affect were additive, with each predicting significantly beyond the other. Comparing the soldiers highest vs. lowest in well-being predicted an almost fourfold greater award recognition in the high group. Awards were predicted by both high and low arousal positive emotions, as well as low sadness and low anger. The relations between PA, NA, and optimism with award attainment were curvilinear, with the greatest difference in award attainment occurring between low and moderate levels of affective well-being, with little effect between moderate and high well-being.

17 USC 105 interim-entered record; under review. The article of record as published may be found at http://dx.doi.org/10.1177/08902070211012931 How soldiers adapt to and change in response to the deployment experience has received a great deal of attention. What predicts which soldiers are resilient and which soldiers decline in character strengths across the deployment transition? We examined this question in two analyses drawing from the same data source of soldiers deploying for the first time (Analysis 1: N ¼ 179,026; Analysis 2: N ¼ 85,285; Mage¼ 24.6–24.7 years old, SD ¼ 4.87; 66.5–66.9% White). Specifically, we examined how individual (e.g. sociodemographic, military) and deployment (e.g. stressful experiences) characteristics predict character development across the deployment cycle. Character strengths were assessed once before and up to three times after soldiers’ return from deployment. Reproducing previous work, we found evidence for two classes of change—a resilient class (“stable high”) and a recovery class (“persistent low”). The strongest predictor of high, resilient character strength levels was better self-rated health at baseline. The findings are discussed in the context of the mechanisms that drive character development, evidence for post-traumatic growth, and practical implications for the U.S. Army Office of the Deputy Under Secretary of the Army Army Analytics Group Research Facilitation Laboratory Robert Wood Johnson Foundation

OBJECTIVE Despite a narrative of post-traumatic growth and resilience, research reliably demonstrating positive character development following adversity has proved elusive. In the current study, we examined changes in character strengths in Army soldiers deploying for the first time. METHOD The sample was comprised of 212,386 Army soldiers (Mage = 26.5 years old, SD = 7.13; 70.8% White) who were deploying for the first time. Character strengths were assessed once before and up to three times following soldiers' return from deployment. RESULTS We found evidence for two classes of change-a resilient class ("stable high") and a declining class ("persistent low"). Most soldiers were resilient-they had high levels of character strengths prior to deployment and changed very little across the deployment cycle. Approximately 40% of soldiers started with lower character and experienced initial declines post-deployment, from which they experienced no more than small gains over time. CONCLUSIONS Character strengths were highly stable across the deployment transition but some soldiers experienced initial declines from which they never fully rebounded. The findings are discussed in the context of the mechanisms that drive character development.

Aims Optimism is associated with reduced cardiovascular disease risk; however, few prospective studies have considered optimism in relation to hypertension risk specifically. We investigated whether optimism was associated with a lower risk of developing hypertension in U.S. service members, who are more likely to develop high blood pressure early in life. We also evaluated race/ethnicity, sex and age as potential effect modifiers of these associations. Methods Participants were 103 486 hypertension-free U.S. Army active-duty soldiers (mean age 28.96 years, 61.76% White, 20.04% Black, 11.01% Hispanic, 4.09% Asian, and 3.10% others). We assessed optimism, sociodemographic characteristics, health conditions, health behaviours and depression status at baseline (2009–2010) via self-report and administrative records, and ascertained incident hypertension over follow-up (2010–2014) from electronic health records and health assessments. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and adjusted models for a broad range of relevant covariates. Results Over a mean follow-up of 3.51 years, 15 052 incident hypertension cases occurred. The highest v. lowest optimism levels were associated with a 22% reduced risk of developing hypertension, after adjusting for all covariates including baseline blood pressure (HR = 0.78; 95% CI = 0.74–0.83). The difference in hypertension risk between the highest v. lowest optimism was also maintained when we excluded soldiers with hypertension in the first two years of follow-up and, separately, when we excluded soldiers with prehypertension at baseline. A dose–response relationship was evident with higher optimism associated with a lower relative risk (p < 0.001). Higher optimism was consistently associated with a lower risk of developing hypertension across sex, age and most race/ethnicity categories. Conclusions In a diverse cohort of initially healthy male and female service members particularly vulnerable to developing hypertension, higher optimism levels were associated with reduced hypertension risk independently of sociodemographic and health factors, a particularly notable finding given the young and healthy population. Results suggest optimism is a health asset and a potential target for public health interventions.

We used the Army Person-Event Data Environment to explore risk and protective factors for diagnosed posttraumatic stress disorder (PTSD). We examined the entire eligible cohort of 79,438 active duty soldiers who deployed to Iraq or Afghanistan between 2009 and 2013, an unusually large and complete cohort. Soldiers highest on catastrophic thinking were 29% more likely to develop PTSD than soldiers with average catastrophic thinking, whereas soldiers lowest on catastrophic thinking were 25% less likely to develop PTSD, adjusting for demographic characteristics; psychological (including baseline depression), behavioral, and physical health; and military characteristics. Soldiers who faced four or more combat stressors were 120% more likely to develop PTSD than soldiers who experienced two combat stressors. Additionally, soldiers higher in catastrophic thinking and experiencing higher combat intensity were 274% more likely to develop PTSD than those low on both. The Army might consider interventions to reduce catastrophic thinking prior to combat to lower PTSD casualties.

Optimistic people have reduced risk for cardiovascular disease and cardiovascular-related mortality compared with their less optimistic peers. One explanation for this is that optimistic people may be more likely to engage in healthy behavior like exercising frequently, eating fruits and vegetables, and avoiding cigarette smoking. However, researchers have not formally determined the extent or direction of optimism’s association with health behaviors. Moreover, it is unclear whether optimism temporally precedes health behaviors or whether the relationship is because of shared common causes. We conducted random effects meta-analyses examining optimism’s association with 3 health behaviors relevant for the prevention of cardiovascular disease. PubMed and PsycINFO databases were searched for studies published through November 2017 reporting on optimism’s relationship with physical activity, diet, and cigarette smoking. We identified 34 effect sizes for physical activity (n=90 845), 15 effect sizes for diet (n=47 931), and 15 effect sizes for cigarette smoking (n=15 052). Findings suggested that more optimistic individuals tended to engage in healthier behaviors compared with less optimistic individuals, but effect sizes were modest ( r activity =0.07, P r diet =0.12, P r smoking =0.07, P =0.001). Most evidence was cross-sectional (≥53% of effect sizes) and did not consider sociodemographic characteristics (

This study prospectively examined psychological strengths targeted in U.S. Army training programs as predictors of psychiatric diagnosis in active duty soldiers. At baseline, the cohort (140,584 soldiers) was without psychiatric disorder. Soldiers were then followed for 2 yr and classified as healthy, or acquiring a psychiatric diagnosis (adjustment disorder, anxiety disorder, depression, or post-traumatic stress disorder), or being prescribed psychotropic medication without a psychiatric diagnosis. Soldiers who remained healthy reported significantly higher strengths scores at baseline, compared with soldiers who were diagnosed with a psychiatric disorder. In addition, soldiers in the worst strengths decile were twice as likely to develop a psychiatric disorder, compared with soldiers in the top 50% on baseline strengths. Strengths afforded the greatest protection against depression. Offering tailored resilience training programs could help the Army steel vulnerable soldiers against the challenges of life, military training, and combat.

Background Cardiovascular conditions are common in US Army and civilian populations. The recently developed concept of ideal cardiovascular health provides a new approach to evaluating population cardiovascular status. Methods and Results We defined a cohort of 263 430 active duty Army personnel, aged 17 to 64 years, who completed a 2012 physical examination and a corresponding subset of the noninstitutionalized, civilian US population, who participated in the National Health and Nutrition Examination Survey ( NHANES ) 2011 to 2012 cycle. We compared 4 cardiovascular health metrics (current smoking, body mass index, blood pressure, and diabetic status) between Army and civilian groups overall, and separately by sex, race/ethnicity, and age. The Army population was younger, was less often women or Hispanic, and had less post–high school education than the NHANES population. Smoking rates were ≈20% in the Army and NHANES groups, but NHANES groups and NHANES women, but nearly half of Army women, demonstrated ideal body mass index. Ideal blood pressure was strikingly less prevalent in the Army than NHANES participants (30% versus 55%). Diabetes mellitus was rare in both groups. Conclusions Ideal cardiovascular health was less prevalent in the Army than NHANES group, despite exclusion of the least healthy recruits. Prevalence of ideal body mass index and blood pressure was low in both the Army and NHANES groups, even at early adult ages. This finding reveals the need for policy changes to promote, preserve, and improve ideal cardiovascular health in both the Army and the US population as a whole.

The U.S. Army developed the Global Assessment Tool (GAT) to monitor psychosocial fitness and well-being among soldiers and provide a means to objectively gauge the success of newly implemented resilience training programs. Despite its widespread use (taken over 5.2 million times) and stated utility for program evaluation, there is relatively little published evidence regarding the GAT’s reliability and validity. We used exploratory structural equation modeling (ESEM) with 4 random samples of soldiers (n = 10,000 each) to examine the factorial validity and reliability of the GAT. An 11-factor solution (Self-Management, Positive Affect, Meaning, Work Engagement, Organizational Trust, Loneliness, Negative Cognitions, Hostility, Negative Emotions, Depressive Symptoms, and Emotion-Focused Coping), with 4 additional factors assessing character strengths (Intellect, Warmth, Civic Strengths, and Temperance), fit well and replicated in a second random sample. A higher order, 2-factor model using composites scores ...

Job performance in the US Army is a complex construct, in part because of the stressors that soldiers face, both day-to-day and during deployment. This chapter critically reviews job performance, and the connections between performance and stress and health, discussing how findings may also be relevant within the specific context of the Army. We review established conceptualizations and metrics of job performance within the Army as well as the civilian sector. Then, we discuss the existing research on the associations between performance and stress, physical health, health behaviors, and mental health. Considering these findings, we discuss lessons learned for Army performance metrics, recommending that stress- and health-related issues be incorporated into unit and leader performance metrics, with two critical caveats: (1) data are aggregated at a company level and (2) non-reactive measures are used. Finally, we discuss how existing data repositories can facilitate future research and note potential constraints of using secondary data.

Accumulating evidence suggests that positive psychological well-being (e.g., optimism, life satisfaction) is associated with a reduced risk of cardiovascular disease. One possible explanation for this association is that individuals with greater positive psychological well-being tend to engage in health behaviors that are relevant to the prevention of cardiovascular disease (e.g., exercising, eating a healthy diet, avoiding smoking). If positive psychological well-being actually precedes and induces healthy behaviors such that it is a true causal factor, then well-being may be a useful target for intervention. In this article, we briefly review evidence linking well-being with health behaviors. We also describe possible strategies to enhance well-being (e.g., expressing gratitude, mindfulness meditation) and evaluate how effective such strategies may be for fostering behavior change.

Key Points Question Are higher levels of predeployment optimism among US Army soldiers associated with fewer reports of new pain after deployment? Findings Among 20 734 US Army soldiers in this longitudinal cohort study, optimism was associated with 11% lower odds of reporting new postdeployment pain, even while adjusting for demographic, military, and combat factors, including traumatic experiences and combat injury. In addition, 37.3% of soldiers reported pain in at least 1 new area of the body after deployment. Meaning The findings suggest that soldiers with low levels of predeployment optimism may be at greater risk of developing new postdeployment pain and may benefit from scalable interventions designed to increase optimism., This longitudinal cohort study examines the association between predeployment factors and the onset of new pain after deployment in US Army soldiers., Importance Pain after deployment is a major health care concern. While risk factors have been previously studied, few studies have explored protective factors. Objective To examine the prospective association between predeployment optimism and the onset of new pain after deployment in US Army soldiers. Design, Setting, and Participants This prospective longitudinal cohort study examined US Army soldiers (active duty, Reserve, and National Guard) who deployed to Afghanistan or Iraq between February 12, 2010, and August 29, 2014, and completed the necessary psychological and health assessments before and after deployment. Analyses were performed in the Person-Event Data Environment between July 2016 and November 2018. This study relied exclusively on existing, secondary Army data. Of the 413 763 Army soldiers who met the specified deployment criteria, 385 925 soldiers were missing 1 or more of the required assessment forms. Of the remaining 27 838 soldiers who were examined for eligibility, 7104 soldiers were excluded because of preexisting back pain, joint pain, or frequent headaches. These exclusions resulted in a final analytic sample of 20 734 eligible soldiers. Main Outcomes and Measures This study examined new reports of pain after deployment, including new back pain, joint pain, and frequent headaches. Results Among 20 734 US Army soldiers (87.8% male; mean [SD] age, 29.06 [8.42] years), 37.3% reported pain in at least 1 new area of the body after deployment: 25.3% reported new back pain, 23.1% reported new joint pain, and 12.1% reported new frequent headaches. As a continuous measure, each 1-U increase in optimism was associated with 11% lower odds of reporting any new pain after deployment, even while adjusting for demographic, military, and combat factors (odds ratio, 0.89; 95% CI, 0.86-0.93). Tertile analyses revealed that compared with soldiers with high optimism (lowest odds of new pain) soldiers with low optimism had 35% greater odds of reporting new pain in any of the 3 sites evaluated (odds ratio, 1.35; 95% CI, 1.21-1.50). In addition, a larger increase in risk of new pain was observed when comparing the moderate-optimism and low-optimism groups rather than the high-optimism and moderate-optimism groups. Conclusions and Relevance Higher levels of optimism were associated with lower odds of reporting new pain after deployment, over and above other common determinants of pain, including demographic and military characteristics and combat experiences. Soldiers with low levels of optimism before deployment could benefit from programs geared toward enhancing optimism.

Background Homeless youth are at higher risk for sexually transmitted infections and unwanted pregnancy than non-homeless youth. However, little is known about how they evaluate risk within the context of their sexual relationships. It is important to understand homeless youths' condom use decisions in light of their sexual relationships because condom use decisions are influenced by relationship dynamics in addition to individual attitudes and event circumstances. It is also important to understand how relationship level factors, sexual event circumstances, and individual characteristics compare and intersect. Methods To explore these issues, we conducted semi-structured interviews with 37 homeless youth in Los Angeles County in 2011 concerning their recent sexual relationships and analyzed the data using systematic methods of team-based qualitative data analysis. Results We identified themes of risk-related evaluations and decisions at the relationship/partner, event, and individual level. We also identified three different risk profiles that emerged from analyzing how different levels of risk intersected across individual respondents. The three profiles included 1) Risk Takers, who consistently engage in risk and have low concern about consequences of risk behavior, 2) Risk Avoiders, who consistently show high concern about protection and consistently avoid risk, and 3) Risk Reactors, those who are inconsistent in their concerns about risk and protection and mainly take risks in reaction to relationship and event circumstances. Conclusions Interventions targeting homeless youth should reflect multiple levels of risk behavior and evaluation in order to address the diversity of risk profiles. Relationship/partner-, event-, and individual-level factors are all important but have different levels of importance for different homeless youth. Interventions should be tailored to address the most important factor contributing to homeless youth reproductive needs. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1419-9) contains supplementary material, which is available to authorized users.

The gene encoding sortilin receptor 1 (SORL1) has been associated with Alzheimer's disease risk. We examined 15 SORL1 variants and single nucleotide polymorphism (SNP) set risk scores in relation to longitudinal verbal, spatial, memory, and perceptual speed performance, testing for age trends and sex-specific effects. Altogether, 1609 individuals from 3 population-based Swedish twin studies were assessed up to 5 times across 16 years. Controlling for apolipoprotein E genotype (APOE), multiple simple and sex-moderated associations were observed for spatial, episodic memory, and verbal trajectories (p = 1.25E-03 to p = 4.83E-02). Five variants (rs11600875, rs753780, rs7105365, rs11820794, rs2070045) were associated across domains. Notably, in those homozygous for the rs2070045 risk allele, men demonstrated initially favorable performance but accelerating declines, and women showed overall lower performance. SNP set risk scores predicted spatial (Card Rotations, p = 5.92E-03) and episodic memory trajectories (Thurstone Picture Memory, p = 3.34E-02), where higher risk scores benefited men's versus women's performance up to age 75 but with accelerating declines. SORL1 is associated with cognitive aging, and might contribute differentially to change in men and women.