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Military service poses unique threats to sleep and circadian health, and the shipboard environment presents further challenges. Disrupted sleep and circadian rhythms are linked to myriad health and safety issues that compromise readiness, including negative psychological health outcomes. Thus, one advantage of mitigating sleep problems includes the possibility of also enhancing mental health.We evaluated the efficacy of the Circadian, Light, and Sleep Skills program for shipboard military personnel for improving sleep, and examined the impact of sleep on mental health in participating sailors. Questionnaires were administered to US sailors (N = 150) assigned to three ships (one control, two intervention) before the program (T1), immediately afterward (T2), and 2-4 months later, after a period at sea (T3). Outcomes included motivation to improve sleep; sleep and circadian knowledge; frequency of sleep-promoting behaviors; sleep quality (Pittsburgh Sleep Quality Index); and mental health symptoms. Satisfaction with specific program elements and perceived relevance were also examined.Sleep and circadian knowledge, frequency of sleep-promoting behaviors, and sleep quality improved from T1 to T3 in the intervention versus control group. Sleep quality also mediated the effects of the underway (at sea) period on mental health. The intervention was well received, with high satisfaction and perceived relevance ratings.A brief 30-min intervention before an underway period improved sleep, circadian, and psychological health outcomes in shipboard sailors, even months later. Broader dissemination of this program may provide significant positive impact with minimal investment of resources.

Service members are at risk for sleep and psychological conditions affecting their readiness. Chronotype (“morningness” or “eveningness”) is strongly associated with sleep, health and performance. The objective of this study was to examine associations between validated measures of chronotype and sleep quality, daytime functioning, alertness, and symptoms of depression, anxiety, and post-traumatic stress disorder (PTSD) in US service members (n = 298). Although predominantly young males (who skew toward eveningness in civilian populations), these Sailors skewed toward morningness (35.6% morning, 51.3% intermediate). Eveningness was associated with symptoms of depression and post-traumatic stress disorder (PTSD) (P P P P P

The purpose of this study was to test the relationship between self-efficacy, readiness to change, and Alcohol Use Disorders Identification Test (AUDIT) risk levels in a sample of active duty drinkers who were seeking care in a military emergency department. Civilian health educators screened participants for alcohol use with the AUDIT and collected sociodemographic, service, and drinking-related cognitions data from active duty patients admitted to an emergency department. A total of 787 active duty military personnel participated in the study. Almost half (48%) drank at least once a week and 32% reported consuming five or more alcoholic drinks during a typical drinking episode. One in five participants reported heavy episodic drinking weekly to almost daily. Results of a multinomial logistic regression model showed that active duty service members with a self-reported diagnosis of posttraumatic stress disorder since joining the military were more likely to be an at-risk or high/severe risk drink...

Objective Rates of heavy alcohol use among active-duty military personnel in the United States are high and negatively affect individuals within the service branches. This study tested the effectiveness of a military-focused screening, brief intervention, and referral to treatment (SBIRT) intervention for reducing risky alcohol use among active-duty patients. Method We used a randomized, parallel, two-group design to test the effectiveness of the SBIRT intervention in a convenience sample of service members recruited from the emergency department of a military hospital. A total of 791 participants were randomized to the SBIRT or usual care conditions, and 472 participants (59.7%) completed a 6-month follow-up. Fifteen percent of the sample was female. Self-reported Alcohol Use Disorders Identification Test (AUDIT), controlled drinking self-efficacy (CDSE), and readiness to change drinking behaviors were assessed at baseline and follow-up. Results Among higher risk participants (i.e., AUDIT ≥8), results of a complete case analysis showed a significant reduction in scores on the AUDIT-C (consumption questions from the AUDIT) and a significant increase in CDSE. Null findings were observed for intent-to-treat analyses testing the effectiveness of the SBIRT intervention; significant decreases in AUDIT and AUDIT-C scores and significant increases in CDSE were observed over time, irrespective of condition assignment for both complete case and intent-to-treat analyses. Conclusions Results of a complete case analysis provided some support for the effectiveness of the SBIRT intervention for higher risk participants. The results of the more conservative intent-to-treat analyses did not support any of the study hypotheses. Future SBIRT effectiveness trials should also test electronic SBIRT intervention approaches.

Background As part of their day-to-day operational mission, shipboard sailors experience unique stressors that can affect their health and readiness. The San Diego Fleet and Family Support Center (FFSC) conducts in-person classes to teach stress management principles to sailors. The FFSC stress management course covers the causes and consequences of stress, reviews the Navy Operational Stress Control model, and provides information on basic stress management skills. This course has not been rigorously evaluated to determine its impact on the sailors’ ability to manage stress. The purpose of this study was to evaluate the short-term impact of the FFSC stress management class on the (1) sailors’ stress management knowledge, (2) sailors’ intention to share knowledge from the class with others, and (3) sailors’ satisfaction with the class. Method Shipboard sailors (n = 95) who attended a stress management course completed pretest and posttest assessments that measured workplace stress, current stress management behaviors, stress management knowledge, intention to share course information, and participant satisfaction with the course. Most ratings were made on a 5-point scale, where higher scores indicated more positive outcomes. Results In the aggregate, participants gave high marks for the class (M = 3.81, SD = 0.66), gave positive ratings for the class instructors (M = 3.84, SD = 0.67), and were satisfied with the class (M = 4.05, SD = 0.63). Sailors also reported that the class was relevant to their work (M = 3.64, SD = 0.81). Overall, 80% of class participants intended to share information learned in the class with family members and military friends, potentially extending the reach and impact of the FFSC class. Finally, sailors did not show increased stress management knowledge as a result of taking the FFSC stress management class (P = .31). Conclusion This study was the first evaluation of the short-term impact of the FFSC stress management course on the stress management knowledge of shipboard crews. Study limitations prevented the study team from assessing the long-term impact of the stress management course on future stress levels and stress abatement behaviors. Recommendations are made to enhance future evaluations of FFSC classes for service members.

Introduction Sleep disturbance is prevalent among service members; however, little is known about factors that compromise sleep in unique operational environments, such as naval ships. Given the importance of sleep to health and performance, it is critical to identify both causes and potential solutions to this serious issue. The objective of this qualitative study was to elucidate the barriers to sleep and the strategies service members use to improve their sleep and combat fatigue while living and working aboard ships (i.e., underway). Methods and Materials Interviews were conducted with 22 active duty service members assigned to sea duty. The semi-structured interview guide assessed the experiences of service members sleeping in shipboard environments. Interview transcripts were analyzed using applied thematic content analysis by two independent coders. Results Participants were largely male (77.8%) and enlisted (88.9%). The most common barrier to obtaining sufficient sleep was stress, followed by rotating schedules, and environmental factors (e.g., noise and light). Additionally, many participants reported prioritizing other activities over sleep when off duty. Many participants did not report using any specific strategies to improve their sleep while underway. Among those who did, most described mitigating environmental barriers (e.g., noise-cancelling headphones or sleep masks). However, some participants also acknowledged these strategies are not always feasible, either attributable to cost or because sailors must be able to respond to alarms or commands. Notably, few sailors reported using stress mitigation or relaxation strategies to help sleep. Ingesting caffeine was the only strategy sailors reported using to alert themselves while fatigued. Conclusions Service members reported many unique barriers to sleep in the shipboard environment, yet many did not report the use of strategies to mitigate them. Further, few used alerting techniques when fatigued. This at-risk population could benefit from targeted educational interventions on sleep-promoting behaviors, prioritization of sleep, and fatigue mitigation.

Service members face unique barriers to sufficient and high quality sleep. In the present study, a circadian, light, and sleep skills program for shipboard military personnel (CLASS-SM) was designed to encourage and inform strategies that support optimal sleep and circadian health in the context of those barriers. Phase 1 included program development and refinement via an iterative formative evaluation, including structured interviews with service members and feedback from veterans and experts, resulting in further tailoring to the population. In Phase 2, the highly tailored program was administered to shipboard personnel (n = 55), and acceptability indicators were measured. Sleep- and circadian-related knowledge (pre- and post-program) and the perceived relevance of, and satisfaction with, program content (post-program) were assessed. Before the intervention, most individuals were unaware that 7–9 h of sleep is recommended (72%) and had little understanding of the physiological effects of light; however, knowledge scores increased significantly post-program, from 51% to 88% correct (p < 0.0001). Reception was positive, with high reported satisfaction and relevance. Most individuals reported that they learned something new (89%), planned to use one or more learned strategies (100%), and intended to share learned information with others (85%); the physiological effects of light and circadian rhythms were the content areas most frequently reported as new and useful. The results demonstrate the need for, and feasibility of, the delivery of this program in operational environments.

The transient nature of military life coupled with environmental and psychosocial stressors increase the risk for alcohol misuse and abuse among active duty (AD) military service members and recent epidemiological studies demonstrate high rates of heavy drinking among AD personnel. Over the past decade, Department of Defense health care systems have observed increases in the utilization of substance use services among military personnel demobilizing from Operation Enduring Freedom and Operation Iraqi Freedom. Given the high rates of heavy drinking and increased use of substance use services in this population of AD personnel, the purpose of this study was to investigate how to best translate and implement an effective alcohol abuse prevention intervention tool (screening, brief intervention, and referral to treatment [SBIRT]) used in civilian populations to a military emergency department (ED) setting.We conducted focus groups with ED staff as well as short interviews with AD personnel at a Naval Medical Center in the southwestern United States to determine the suitability of SBIRT with military populations as well as how to best translate SBIRT to a military hospital setting.Participants expressed support for utilizing civilian health educators to conduct the SBIRT intervention; however, many were concerned with issues of confidentiality and were skeptical of whether AD would speak truthfully about alcohol consumption.Results of this formative research study clearly indicate the implementation and translation of SBIRT into a military medical setting require attention to issues related to confidentiality, the veracity of alcohol reporting, as well as use of civilians over AD military personnel to deliver the SBIRT intervention. Furthermore, most participants expressed support for the SBIRT model and felt it could be implemented, with caveats, into a military health care setting such as an ED.

Introduction Sleep disturbance is prevalent among service members; however, little is known about factors that impede sleep in unique operational environments, such as aboard naval ships. Given the importance of sleep to health and performance, identifying both causes and potential solutions to sleep disturbance is critical. The objective of this qualitative study was to elucidate barriers to sleep and the strategies U.S. Navy sailors use to improve their sleep and combat fatigue while underway. Methods Interviews were conducted with 22 active duty service members assigned to sea duty. The semi-structured interview guide assessed the experiences of service members sleeping in shipboard environments, including the strategies used to improve sleep and combat fatigue. Interview transcripts were analyzed using applied thematic content analysis by two independent coders. Results Most participants were male (91.8%) and enlisted (95.5%). The most commonly reported barrier to sleep was stress (e.g., job-related stress), followed by rotating schedules, and environmental factors (e.g., noise, light). Many reported prioritizing other activities over sleep when off duty. Though only a few reported specific strategies to improve sleep while underway, strategies that were described primarily included mitigation of environmental barriers (e.g., noise-canceling headphones or sleep masks). However, some participants acknowledged these strategies are not always feasible (e.g., cost, reduced responsiveness to alarms or commands). Notably, few sailors reported using stress mitigation or relaxation strategies to help sleep. Caffeine intake was the only reported strategy for alerting when fatigued. Conclusion Sailors reported many barriers to sleep that are unique to the shipboard environment, yet most did not report using any mitigation strategies. Further, few used alerting techniques (other than caffeine) when fatigued. This at-risk population could benefit from targeted educational interventions covering sleep-promoting behaviors, prioritization of sleep, and fatigue mitigation. Support This work was supported by the Military Operational Medicine Research Program, Early Assessment and Intervention Working Group, under work unit no. N1702.

Although there is significant need for mental health care among service members, stigma surrounding these services, along with myths associated with behavioral health treatment, discourages care seeking. This study evaluated the effect of a video designed to demystify mental health treatment on barriers to seeking care among military personnel.Participants were 294 active duty U.S. Marine Corps personnel who were randomly assigned to the intervention video only, the intervention video with discussion, or an attentional control video. Participants completed questionnaires that assessed social stigma regarding mental health treatment and willingness to seek help at pretest, posttest, and 6-week follow-up; personal desire for mental health care was assessed at pretest and 6-week follow-up.Participants who viewed the intervention video in either condition showed significant and similar decreases in social stigma and increases in willingness to seek help at posttest (p.001), whereas participants in the control group showed no change at posttest in either variable. Although social stigma did not differ by intervention group at the 6-week follow-up, participants in either intervention were 2.56 times more likely than participants in the control group to report a personal desire for mental health care at the 6-week follow-up (p=.05). There were no significant differences between the two interventions on the main outcomes.A video in which mental health care providers explain the treatment process may be effective as an initial stand-alone social stigma reduction intervention. Additional efforts are likely needed to sustain effects and to realize increases in help-seeking behavior.

Introduction Sleep disturbance is pervasive among active duty military service members (ADSM) and has serious adverse effects on performance and health. Interventions designed to improve sleep in operational settings are critical to maintain the health and readiness of this at-risk population. The objective of this study is to evaluate a novel sleep education program developed for ADSM. Methods Participants were U.S. Sailors (N=150; 82.7% male, 35.3% Results At baseline, scores were comparable for the PSQI (Control: 8.58±0.35 vs. Intervention: 8.58±0.38), sleep behaviors (12.26±0.35 vs. 11.32±0.38; Range: 0–17), sleep-related knowledge (0.48±0.21 vs. 0.50±0.24; Range: 0–1), and sleep motivation (4.12±0.35 vs. 4.07±0.34; Range: 0–5). A significant group x time interaction indicating benefits for the intervention group were observed on PSQI (F (1,139) = 7.99, p=0.005), knowledge (F (1,139) = 36.54, p.05). Main effects of group were observed (p Conclusion Study results indicate that participation in a brief, educational program prior to deploying may improve ADSM’s sleep quality. Future research is needed to explore mechanisms of intervention effect, and to determine best practices for disseminating such programs force-wide. Support (if any) This work was supported by Defense Health Program 6.7 under work unit no. N1634. The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.

Background Alcohol misuse has been an ongoing issue for the US Armed Services, with the Marine Corps maintaining the highest levels of problematic drinking. Broad environmental, social, and policy factors play an important role in alcohol misuse but are rarely studied as objective measures. Methods This case study used a pattern-matching approach to examine the associations between objective on- and off-base community environmental risk and protective factors and 4 objective alcohol-related outcomes at 3 large Marine Corps installations. The study utilized existing aggregated data from Marine Corps electronic data sources and information from internet searches of installation and community services and characteristics. Installation-level alcohol misuse outcomes included the rates of personnel receiving non-medical alcohol services, combined inpatient and outpatient alcohol-related primary diagnoses, alcohol-related domestic violence, and driving under the influence arrests. Installation-level environmental correlates included dollars spent on alcohol sales, density of alcohol outlets, extent of alternative activities, and installation and off-base sociodemographic factors. Results In general, younger age, enlisted pay grade, and being stationed overseas were related with higher rates of alcohol-related problems among Marines. Greater on-base alcohol sales (both in bars and stores), as well as a greater density of restaurants and bars that serve alcohol, were associated with alcohol misuse outcomes. Several community factors were also associated with alcohol misuse. The hypothesized protective effects of alternative activities were inconsistent. Conclusions Findings suggest that environmentally-oriented strategies, particularly restricting on-base sales of alcohol, may help to reduce alcohol-related harm in the Marine Corps.

This study assessed the impact of a definition change on the prevalence estimates and the odds of heavy drinking among a large sample of male and female Marine Corps personnel using data from the 2008 and 2011 Department of Defense Health Related Behaviors surveys. It appears that, based on the new gender-specific definition, female Marines' risk for heavy drinking is comparable to that of males. This finding highlights the need to address gender-specific risks in alcohol prevention efforts in the U.S. Marine Corps. These results provide valuable baseline estimates by which to compare future heavy-drinking rates in military personnel.

Introduction Alcohol misuse, in particular binge drinking, is a serious concern among military personnel because it is strongly associated with adverse consequences and has a deleterious effect on readiness. Although most alcohol misuse studies have focused on individual risk factors, studies are increasingly examining environmental influences and strategies for reducing alcohol risks. The purpose of this study is to address gaps in what is known about how service members' perceptions of environmental factors are related to binge drinking in the U.S. Marine Corps. Materials and methods The relationship between Marines' self-reports of environmental factors and alcohol binge drinking was assessed in this correlational study using data from three large Marine Corps installations drawn from the Department of Defense 2011 Health Related Behaviors Survey of Active Duty Military Personnel (N = 2,933). We proposed several directional hypotheses based on existing civilian and military studies of alcohol use and misuse, as well as health behavior theory. Results Agreement with the statements that alcoholic beverages cost too much, that drinking might negatively affect one's military career, and that one's immediate supervisor and installation discourage alcohol use were independently associated with decreased odds of binge drinking (i.e., protective factors). Perceptions that alcoholic beverages are difficult to get was particularly protective; the odds of having binged were lower for participants who endorsed this belief than for those who did not. Perceptions that drinking is part of being in one's unit was a risk factor for binge drinking (odds ratio = 1.29). Conclusion Even after accounting for strong sociodemographic correlates, binge drinking was independently associated with a number of environmentally oriented perceptions. Beliefs that alcohol is affordable and easy to access were the strongest environmental correlates of increased risk of binge drinking. Addressing the threat alcohol misuse poses to both Marines and mission readiness will likely require multiple strategies, including both policy and environmental changes.

Background Enhancing resilience and reducing stress are critical to increasing the readiness and performance of military personnel in operational settings. Stress and resilience programs can improve service members’ ability to manage their stress during both normal and extreme operational conditions, and have the potential to enhance safety at sea. Implementing an efficient and effective application-based training program in a military setting has unique challenges, including minimizing intrusion on the command’s training time and technological considerations (eg, Wi-Fi and Bluetooth technology restrictions). Objective An enhanced version of a training program called the Stress Resilience Training System (SRTS) was implemented into the operating environment of a naval vessel. The system contains an in-person workshop, regular mentoring in resilience-building techniques, and an iPad-based app used for biofeedback of heart rate variability coherence and training support. This work describes the lessons learned from the implementation process of the app component of the program, based on responses from active duty service members. Methods Crew members aboard a Navy vessel (N=92) volunteered to participate in the evaluation of the 10-week program. All ship personnel were provided with an initial 2.5-hour workshop, mentorship, and iPads containing the SRTS app to use for the duration of the 10-week program. Participants rated different components of the training, and their app usage during the course of the study was recorded. Results Participants somewhat agreed that the app was appropriate for military service members (mean 2.51, SD 1.14; response options 0=strongly disagree to 4=strongly agree for all ratings) and were somewhat likely to recommend the app to fellow service members (mean 2.53, SD 1.03). Ratings of the workshop’s relevance to military readiness (mean 2.68, SD 0.95) and of the instructors’ credibility (mean 3.22, SD 0.92) were higher than ratings of the app. Additionally, usage of the app was low and highly variable (mean 42.26, SD 60.53; range 0 to 312.54 minutes). Anecdotal evidence provided by crewmembers suggested that using the app on an iPad was cumbersome and that the Wi-Fi was often inaccessible, making the iPad a less valuable tool overall. Conclusions This implementation of the app component of SRTS raised questions regarding the suitability of the technological format for this operational setting. User ratings and participant comments suggested that the technology was not the most successful component of the program. The implementation in the iPad format was not conducive to the operational setting and the inconvenience of this format may have deterred participants from using it in settings where a personal or more compact device may have been more appropriate. Recommendations going forward include making the app component available for use on smartphones operating on both iOS and Android platforms to make it user friendly, accessible, and more engaging, which, in turn, is expected to increase usage and uptake of the program’s techniques. Furthermore, incorporating more engaging content, gamification, and tracking and reporting user progress into the overall app may enhance motivation to use more components of the app and increase usage, ultimately enhancing its impact on resilience.

The purpose of this paper is to report on the development of a mental health stigma reduction toolkit and training, and the acceptability and level of stigma awareness following the stigma-reduction training for military personnel. The overall aims of the training were to provide discussion tools highlighting the experiences of Marines seeking help for stress concerns, improve communication between leaders and their Marines around the issue of help seeking, and familiarize Marines with behavioral health treatment. Senior enlisted leaders and officers (N = 52) from a Marine Corps battalion participated in a pretest, 2-h stigma-reduction training and immediate posttest. Acceptability of the training was measured by querying participants about the usefulness and helpfulness of the training among other factors, and stigma awareness was measured with 10 items about mental health stigma. The stigma-reduction training and materials were well accepted by participants. In addition, there was a significant improvement in four of ten stigma-reduction awareness concepts measured before and immediately after the training, which included an increase in agreement that mental health treatments are usually effective in reducing stress reactions [t(51) = −3.35, p = 0.002], and an increase in disagreement that seeking counseling after a deployment will jeopardize future deployments [t(51) = −3.05, p = 0.004]. Level of agreement with several statements including those regarding perceptions of invincibility, and malingering, among others, did not change significantly after the training. The stigma-reduction training containing educational and contact strategies was highly acceptable to the leaders and may have promise for initially dispelling myths associated with seeking help for stress concerns among military service members; however, results indicate that there is clearly more work to be done in combatting stigma.

The present study evaluated two relapse-prevention interventions intended to help women smokers maintain the “quit status” mandated during Navy basic training. Women with any smoking experience before entering the Navy (N = 2,781) were assigned to either a control group or to one of two intervention groups (access to a telephone help line or receive a series of monthly mailings) after graduating from basic training. Smoking/quit rates at 3, 6, and 12 months after graduation were assessed with mailed surveys. Response rates to the surveys ranged from 39% to 52%. There were no phone or mail intervention effects: cessation rates for the three conditions at the 12-month follow-up were 43% for control, 45% for the mail intervention, and 41% for the phone intervention. Results suggest the need for more aggressive relapse-prevention efforts, although quit rates were higher than expected “spontaneous” quit rates, indicating an impact of the totally smoke-free recruit training environment.

This study examines long-term health and physical readiness trends in the U.S. Navy. We mailed lifestyle questionnaires to all participants in baseline studies between 1983 and 1989 who were still on active duty in 1994. Commands provided body composition and physical readiness test scores for the participants. Two longitudinal cohorts were created: an 8-year sample (N = 640) with matched data from 1986, 1989, and 1994; and an 11-year sample (N = 1,576), with data from 1983 and 1994. Analyses of both cohorts revealed significant improvements in cardiovascular fitness, muscle strength, exercise, lean body mass, dietary habits, and sleep, as well as significant decreases in tobacco and alcohol use and job stress. However, hypertension rates, percentage of body fat, and body mass index increased over time. Women's scores were significantly better than men's on a number of factors. Overall, these findings suggest that the Navy's health promotion efforts have had a significant positive effect on the fitness and health behaviors of career Navy men and women.

This study surveyed 2,287 U.S. Navy health care providers (HCPs) regarding patient-care practices and attitudes related to tobacco use. Almost 80% of HCPs reported that they usually asked new patients about tobacco use. Of 11 recommended practices, two-thirds to three-quarters of HCPs engaged in only 4 behaviors with most or all of their tobacco-using patients: advise patients to stop, advise pregnant users of health risks to the fetus, inform patients of benefits of quitting, and explain dangers of using tobacco. Other recommended cessation strategies were not performed regularly (e.g., assist patients in setting quit date, develop cessation plan, provide self-help materials, make referrals to cessation programs, prescribe nicotine gum, or arrange follow-up visits). It is recommended that concerted efforts he made to train all military HCPs (e.g., physicians, dentists, nurse practitioners, and physician assistants) to use the National Cancer Institute's "Four A's" approach for patient tobacco cessation, and that strong organizational support to implement these procedures be provided.

Objective: The objective of this study was to examine mental health screening practices and attitudes from both counselor and client perspectives in the U.S. Marine Corps substance abuse program. Method: This study examined mental health screening practices and attitudes of 23 substance abuse counselors and 442 clients from six Marine Corps substance abuse counseling centers. Results: After receiving training on screening and enhanced counseling practices, 76% of counselors reported that they almost always screened their clients for post-traumatic stress symptoms. Seventy-three percent of clients agreed that substance abuse counselors should ask about their clients' stress concerns. Conclusion: Overall, implementing screening for common mental disorders was feasible in this setting. Counselors may need further support to increase collaboration with mental health professionals and adapt treatment plans to address co-occurring mental health conditions.

The purpose of this research was to determine if viewing a videotape could be an effective method to promote healthful knowledge and behaviors among Navy personnel. The objectives of this study were to (a) evaluate six U.S. Navy health promotion videotapes in terms of changes in knowledge, self-efficacy, behavioral intentions, and self-reported behavior, and (b) determine the effects of a pre- and post-viewing discussion. A repeated-measures, split-plot factorial design with experimental and control groups was employed to evaluate the six videotapes. A pre- and post-test questionnaire was used to assess changes in knowledge, self-efficacy, behavioral intent, and self-reported behavior in 299 active duty personnel. It was found that the back injury prevention videotape produced a significant increase in knowledge by group over time. However, the other five videotapes did not produce significant increases in knowledge, self-efficacy, behavioral intentions, or self-reported behavior. These findings ...

The Naval Health Research Center was tasked by Headquarters Marine Corps with assessing the process by which the Marine Corps Substance Abuse Counseling Centers (SACCs) address clients with stress concerns and behavioral health conditions stemming from deployment, such as post-traumatic stress disorder (PTSD) and combat operational stress. The following report details findings from the scientific literature and SACC site assessments, and provides specific recommendations. It documents the current treatment approach with regard to substance abuse clients with co-occurring mental health concerns at selected Marine Corps SACCs; and it reviews and recommends best practices for screening, referrals, treatment, patient education, and case management. The overall purpose is to provide recommendations that will lead to optimal treatment of SACC clients suffering from PTSD and other military-related behavioral health conditions.

This study identified risk factors for lifetime marijuana use among 435 sixth- through twelfth-grade participants in a youth development program. Multivariate regression analysis results revealed that modifiable risk factors, including smoking cigarettes and friends' substance use, were strongly associated with increased risk for lifetime marijuana use.

The objective of this study was to evaluate the effect of an alcohol misuse prevention program on drinking behavior and alcohol-related problems among United States Marine Corps personnel. A total of 567 men from two Marine Corps infantry battalions participated in the evaluation in which members of one battalion received an alcohol misuse prevention program, while members of the second battalion served as controls. The program consisted of targeted, small-group training sessions, with corporals and sergeants training their subordinates. Subjects completed questionnaires on alcohol use behavior at baseline and at 3- and 6-months postintervention. Alcohol-related legal incidents, alcohol abuse counseling referrals, and other outcomes were measured in aggregate. This study found that there was a greater decrease in the percentage of some self-reported alcohol-related problems, including serious consequences resulting from alcohol and specifically in the inability to remember things that happened while drinking, not being able to stop drinking, and getting drunk from alcohol among the intervention group compared with the control group. There was a small decrease in the number of drinks per day at the 3-month follow-up and in the rate of counseling referrals among the intervention group. No differences were observed in the Alcohol Use Disorders Identification Test score, drinking days per month, or in the other outcomes. The results suggest that the alcohol reduction training program did not have a significant overall effect on drinking behavior, however, the program may have prompted a short-term decrease in drinking and affected some alcohol-related problems.

The purpose of this study is to develop an enhanced alcohol misuse secondary prevention training program for Marine Corps aviation personnel and to evaluate its effectiveness in reducing drinking levels and alcohol-related negative consequences. The evaluation will be conducted with Marine Corps personnel in aviation squadrons using a repeated-measures study with a control group. Alcohol-related problems will be monitored during a 6-month baseline period and then an anonymous survey of alcohol use will be administered prior to the intervention. The training program will be given to the intervention squadrons followed by an anonymous post-intervention survey, and two follow-up surveys for all participants. Alcohol-related problems will continue to be monitored during the 6-month follow-up period. During the first year, contacts within the 3rd Marine Aircraft Wing were made and support was granted by the Commanding General. Available squadrons were identified for participation in the evaluation and the first two months of pre- intervention, alcohol-related incident data were collected. Modifications to the educational program content have begun and the development of a computerized self- assessment and feedback tool was integrated into the program. Focus groups were conducted with aviation personnel at several Marine Corps Air Stations to identify aviation-specific factors that may affect drinking behavior.

The present study was designed to describe the prevalence of dietary supplement use, including androstenedione, ephedrine, and creatine, in a population of active-duty US Marines. Method: Participants completed a self-report questionnaire that was designed to assess behavioral and health factors in Marines stationed at Camp Pendleton, CA. Results: Fifty-four percent of the 1482 participants had used dietary supplements in the preceding year. Of the individuals who consumed supplements, 684 (87%) provided detailed Information regarding the type of supplement they used. Among supplement users, 443 (65%) consumed multiple supplements and 145 (21%) consumed at least 4 supplements. The most commonly used type of dietary supplement was muscle mass/strength aids (53%) followed by energy boosters (28%) and vitamins/minerals (27%). Of the specific supplements investigated, 350 (51%) of the supplement users consumed a supplement that contained ephedrine, 260 (38%) consumed creatine, and 75 (11%) individuals consumed androstenedione in the previous year. Conclusions: The level of dietary supplement use in this population requires further investigation due to the reported adverse effects of some of these products. Future studies are needed to determine the prevalence of use as well as the determinants of use In a variety of populations.

Heavy drinking and associated problems are relatively common in young men, including those in a military setting. This article explores characteristics of alcohol intake and associated difficulties and their relationship to a self-report of the usual intensity of response to alcohol in a sample of U.S. Marines. Two questionnaires related to demography and alcohol use histories, along with a simple, 12-item self-report measure of the usual number of drinks to experience an effect (the Self-Rating of the Effects of Alcohol, SRE) were administered to 1320 U.S. Marines. The sample had an average age of 22 years, 78% were Caucasian, and 92% were enlisted personnel. The relationships and correlations among drinking characteristics and problems and the usual number of drinks for an effect were determined. These subjects drank an average of 6 days per month, consuming an average of almost six drinks per drinking day, and reported more than three times per month in which they consumed six or more drinks per occasion. Consistent with studies of other populations, the SRE measures of intensity of response to alcohol showed a positive correlation with both drinking practices and problems, with the latter remaining significant even after controlling for recent drinking practices. The prodigious level of alcohol intake and associated problems, along with the SRE scores, indicate that the Marine Corps personnel are at especially high risk for alcohol-related life problems. These data also support the potential usefulness of the SRE both in identifying individuals likely to have more severe alcohol profiles and in educating individuals regarding their levels of risk for alcohol abuse and dependence.

Background. Although the U.S. Navy mandated Total Quality Leadership (TQL) as a management strategy throughout its medical department in the early 1990s, it was unknown to what extent it was being used for health promotion activities and, if so, how effectively. Methods. A brief mail survey of 204 Navy commands supplemented by 97 telephone interviews to TQL-for-health-promotion-using commands and nonusing controls provided worksite information on TQL implementation. Responses from a Navywide health and fitness survey provided perceptions and health behavior attitudes from the individuals at commands. Results. A total of 32% of commands surveyed had used TQL specifically for improving health- and fitness-related processes and outcomes between 1991 and 1995. Participants at commands that had used TQL for health- and fitness-related processes reported a higher importance of good health (P < 0.05) and were more certain that they would reach and or maintain their ideal weight (P < 0.05) than participants at non-TQL commands. However, there were no significant differences in perceptions of command support for health and fitness between TQL and non-TQL commands. Conclusions. Several factors and organizational arrangements that were pertinent to the development and practice of TQL in the Navy were identified. The use of TQL specifically for health promotion was not consistently related to health-related perceptions or health behavior attitudes.

To assess he impact of a no-smoking policy over time aboard the U.S. Atlantic Fleet carrier, USS THEODORE ROOSEVELT, baseline levels of tobacco use, exposure to environmental tobacco smoke (ETS), and crew attitudes regarding smoking policy needed to be established prior to implementation of the no-smoking policy. A total of 2,221 surveys were completed by the crew aboard the USS THEODORE ROOSEVELT before the ship went nonsmoking. Thirty-six percent of participants classified themselves as current cigarette smokers, 42% as never smokers, and 22% as former smokers. Nonsmokers rated their general exposure to ETS between 'low' to 'moderate' and nonsmokers estimated that they were exposed to ETS an average of 10 minutes per day. Fifty-seven percent of participants were in favor of AIRLANT's restricted smoking policy and most participants rated the smoking policy as 'somewhat unfair' to 'generally fair.' Differences in responses to ETS exposure and attitude items by smoking status and enlisted/ officer status were seen. General support for the no-smoking policy or disagreement with the policy because it violates an individual's right to smoke were common themes in the written comments. Follow-up research has been planned to assess the long-term impact of the no-smoking policy on changes in attitudes regarding policy, tobacco-use rates, and ETS exposure. Environmental tobacco smoke, Tobacco use policy, Attitudes, Shipboard medicine.

A representative sample of 406 U.S. Navy commands, including all medical treatment facilities, was surveyed in 1990 about their activities and programs to prevent the use of tobacco and promote smoking cessation during the preceding year. The vast majority of Navy commands (86 percent) provided some type of tobacco cessation educational materials or programs. However, the most common activities typically were rated as only "somewhat useful" in helping to curb tobacco use. Almost one-half of all commands offered psychological or behavioral cessation programs. Survey respondents estimated that approximately one-third of those persons who attended such a program stopped their tobacco use and nearly one-half reduced their tobacco use as a result of the program. Over-the-counter smoking cessation aids were not widely available at Navy exchange stores, individual commands, or medical treatment facilities. Furthermore, only 61 percent of all commands reported that they had a written policy or instruction regarding tobacco use. Only about one-third of medical treatment facilities had a routine system for identifying tobacco users by glancing at their medical records. However, it was estimated that 80 percent of medical treatment facility physicians routinely asked their patients about their tobacco use. The authors discuss the need for a more active Navy approach in prevention and cessation efforts and a routine system for identifying tobacco users from their medical records. In addition, inequities in cessation efforts were found among command subgroups.