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Abstract: Background: Little is known regarding long-term performance decrements associated with mild Traumatic Brain Injury (mTBI). The goal of this study was to determine if individuals with an mTBI may be at increased risk for subsequent mishaps. Methods: Cox proportional hazards modeling was utilized to calculate hazard ratios for 518,958 active duty U.S. Air Force service members (Airmen) while controlling for varying lengths of follow-up and potentially confounding variables. Two non-mTBI comparison groups were used; the second being a subset of the original, both without head injuries two years prior to study entrance. Results: Hazard ratios indicate that the causes of increased risk associated with mTBI do not resolve quickly. Additionally, outpatient mTBI injuries do not differ from other outpatient bodily injuries in terms of subsequent injury risk. Conclusions: These findings suggest that increased risk for subsequent mishaps are likely due to differences shared among individuals with any type of injury, including risk-taking behaviors, occupations, and differential participation in sports activities. Therefore, individuals who sustain an mTBI or injury have a long-term risk of additional mishaps. Practical applications: Differences shared among those who seek medical care for injuries may include risk-taking behaviors (Cherpitel, 1999; Turner & McClure, 2004; Turner, McClure, & Pirozzo, 2004), occupations, and differential participation in sports activities, among others. Individuals with an mTBI should be educated that they are at risk for subsequent injury. Historical data supported no lingering effects of mTBI, but more recent data suggest longer lasting effects. This study further adds that one of the longer term sequelae of mTBI may be an increased risk for subsequent mishap. [Copyright &y& Elsevier]

Purpose: The characteristics of U.S. military personnel who use dietary supplements have not been well described. This study aimed to determine whether deployment experience and physical activity were associated with the use of bodybuilding, energy, or weight-loss supplement among U.S. military personnel. Methods: Self-reported data from active-duty, Reserve, and National Guard participants of the Millennium Cohort Study collected from 2007–2008 (n = 106,698) on supplement use, physical activity, and other behavioral data were linked with deployment and demographic data. We used multivariable logistic regression sex-stratified models to compare the adjusted odds of each type of supplement use among those with deployment experience in support of operations in Iraq or Afghanistan and those engaged in aerobic or strength-training activities. Results: Overall, 46.7% of participants reported using at least one type of supplement, and 22.0% reported using multiple supplements. Male deployers were more likely to use bodybuilding supplements, whereas female deployers were more likely to use weight-loss supplements. Physically active and younger subjects reported all types of supplement use. Men and women reporting 5 or less hours of sleep per night were more likely to use energy supplements. Conclusions: The high prevalence of supplement use and important characteristics found to be associated with their use, including deployment, physical activity, and suboptimal sleep, suggest focus areas for future research and adverse event monitoring. [Copyright &y& Elsevier]

Purpose: To describe medical symptom and condition reporting in relation to complementary and alternative medicine (CAM) use among members of the US military. Methods: CAM was defined as health treatments not widely taught at US medical schools or typically available at US hospitals. By using data from the Millennium Cohort Study, we included participants who completed a survey from 2004 to 2006 (n =86,131) as part of this cross-sectional analysis in which we sought to identify demographic characteristics and types of health-related symptoms and conditions associated with CAM use. Chi-square tests were used to compare health assessed by self-reported symptoms and conditions among those not reporting CAM use with those reporting practitioner-assisted or self-administered CAM. Results: Of 86,131 participants, 30% reported using at least one practitioner-assisted CAM therapy, 27% reported using at least one self-administered CAM therapy, whereas 59% did not report using any CAM therapy. Both women and men who used CAM reported a greater proportion of specific health conditions and health-related symptoms compared with those not reporting CAM use (p <0.05). Conclusions: These findings illustrate that a relatively young adult occupational cohort of military personnel using CAM therapies also report multiple comorbidities which may indicate chronic illness management and poorer overall health. [Copyright &y& Elsevier]

Abstract: This study explores adverse events severe enough to warrant hospitalization that may have been associated with receiving the smallpox vaccine in conjunction with military service. Cox proportional hazards modeling was used to identify the risk of hospitalization among US active-duty military personnel during a 1-year period following receipt of the smallpox vaccine. The reference group consisted of active-duty military personnel who also received the smallpox vaccine after the conclusion of their health care observation period, allowing for comparison to a temporally and demographically similar population. The risk of hospitalization was slightly elevated among the postvaccine group for any-cause hospitalization and for hospitalization in several broad diagnostic categories. Hospitalizations for asthma, autoimmune diseases, and myopericarditis, were more likely in the postvaccine group. The increased risk of hospitalization for varied outcomes does not necessarily imply a cause–effect relationship, but it does offer areas for more focused study, using longitudinal data to explore the long-term impact of smallpox vaccination on the health of young adults. [Copyright &y& Elsevier]

Abstract: Objectives: The 12-month prevalence of common mental illnesses in the United States is estimated to be 26%, accounting for an increasing fraction of all disability in the general population. The U.S. military is a unique group involved in response and defense during times of conflicts and disasters. The mental health of service members affects organizational productivity and effectiveness and is of great importance to the health of U.S. military members and public health in general. Study Design and Setting: In the present report, the authors describe the baseline prevalence of mental disorders in a large U.S. military cohort, the Millennium Cohort, established for a 22-year longitudinal study of the health effects of military service. Using crude and weighted prevalence and multivariable logistic regression, the mental health morbidity of the Millennium Cohort is reported for various demographics. Results: These analyses suggest that although the cohort compares favorably to other populations, there are military subpopulations, including women, younger, less educated, single, white, short-term service, enlisted, and Army members, who are at greater odds for some mental disorders. Conclusion: With ongoing U.S. involvement in combat operations around the world, these baseline data are essential to assessing long-term mental health morbidity in U.S. military service members. [Copyright &y& Elsevier]

Abstract: Objective: In response to health concerns of military members about deployment and other service-related exposures, the Department of Defense (DoD) initiated the largest prospective study ever undertaken in the U.S. military. Study Design and Setting: The Millennium Cohort uses a phased enrollment strategy to eventually include more than 100,000 U.S. service members who will be followed up through the year 2022, even after leaving military service. Subjects will be linked to DoD and Veterans Affairs databases and surveyed every 3 years to obtain objective and self-reported data on exposures and health outcomes. Results: The first enrollment phase was completed in July 2003 and resulted in 77,047 consenting participants, well representative of both active-duty and Reserve/Guard forces. This report documents the baseline characteristics of these Cohort members, describes traditional, postal, and Web-based enrollment methods; and describes the unique challenges of enrolling, retaining, and following such a large Cohort. Conclusion: The Millennium Cohort was successfully launched and is becoming especially relevant, given current deployment and exposure concerns. The Cohort is representative of the U.S. military and promises to provide new insight into the long-term effects of military occupations on health for years to come. [Copyright &y& Elsevier]

Background: Injuries, one of the leading public health problems in an otherwise healthy military population, affect operational readiness, increase healthcare costs, and result in disabilities and fatalities. This paper describes a systematic, data-driven, injury prevention–decision making process to rank potential injury prevention targets. Methods: Medical surveillance and safety report data on injuries for 2004 were reviewed. Nonfatal injury diagnoses (ICD-9-CM codes) obtained from the Defense Medical Surveillance System were ranked according to incident visit frequency and estimated limited duty days. Data on the top five injury types resulting in the greatest estimated limited duty days were matched with hospitalization and Service Safety Centers'' accident investigation data to identify leading causes. Experts scored and ranked the causes using predetermined criteria that considered the importance of the problem, preventability, feasibility, timeliness of intervention establishment/results, and ability to evaluate. Department of Defense (DoD) and Service-specific injury prevention priorities were identified. Results: Unintentional injuries lead all other medical conditions for number of medical encounters, individuals affected, and hospital bed days. The top ten injuries resulted in an estimated 25 million days of limited duty. Injury-related musculoskeletal conditions were a leading contributor to days of limited duty. Sports and physical training were the leading cause, followed by falls. Conclusions: A systematic approach to injury prevention–decision making supports the DoD''s goal of ensuring a healthy, fit force. The methodology described here advances this capability. Immediate follow-up efforts should employ both medical and safety data sets to identify and monitor injury prevention priorities. [Copyright &y& Elsevier]