Publications

The following manuscripts have been published or are currently in press. Listings are in chronological order, unless otherwise noted.

Research Publication 2
Title Publication Date/Location
Epidemiology of Inflammatory Bowel Disease Among Participants of the Millennium Cohort: Incidence, Deployment-Related Risk Factors, and Antecedent Episodes of Infectious Gastroenteritis Alimentary Pharmacology & Therapeutics 2017 Apr;45(8):1115-1127

Porter CK, Welsh M, Riddle MS, Nieh C, BoykoEJ, Gackstetter GD, Hooper TI

This study describes the incidence of and risk factors for two pathotypes of inflammable bowel disease (IBD), Crohn’s Disease (CD) and ulcerative colitis (UC) among Millennium Cohort Study participants using survey responses as well as data from post-deployment health assessments and medical encounters in the Military Health System. We observed that CD risk predictors included current smoking, two life stressors (vs. none), and prior irritable bowel syndrome. For UC, a dose-response relationship between the risk of UC and an increasing number of life stressors was observed. Antecedent infectious gastroenteritis was associated with an almost three-fold increase in risk in UC, but was not associated with CD. Stressful conditions along with infectious gastroenteritis are usual features of any deployment operation and may play a role in the development of IBD. However, observed differences in risk factors for UC and CD warrant further investigation.

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Risk Factors Associated with Miscarriage and Impaired Fecundity Among United States Servicewomen During the Recent Conflicts in Iraq and Afghanistan Women's Health Issues 2017 Feb;27(3):356-365

Ippolito AC, Seelig AD, Powell TM, Conlin AMS, Crum-Cianflone NF, Lemus H, Sevick CS, LeardMann CA

Among Servicewomen aged 18-45 years, 31% reported a miscarriage and 11% reported impaired fecundity (infertility) during a 3-year study period. Findings suggest that deployments in support of the operations in Iraq and Afghanistan do not increase the risk for miscarriage and infertility among U.S. Servicewomen. More research is needed to better understand whether specific combat experiences or environmental exposures encountered during deployments increase the risk for adverse reproductive health outcomes.

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Longitudinal Assessment of Self-Reported Recent Back Pain and Combat Deployment in the Millennium Cohort Study Spine 2016;41:1754–1763

Granado NS, Pietrucha A, Ryan M, Boyko EJ, Hooper TI, Smith B, Smith TC

Among military personnel, back pain is among the most frequent reasons for medical visits and lost duty time, and has been associated with pain-related disability. This study found that 15.5% of participants reported recent back pain at follow-up. Our study confirmed the high burden of this condition in the military, showing that deployers with combat experiences had a 38% higher odds of reporting back pain at follow-up, and 27% higher odds of repeated back pain, compared with deployers without combat experiences. Additionally, exposures associated with a physically demanding work environment were related to a higher risk of back pain. This well-defined group of military personnel would potentially benefit from integrated prevention efforts focused on mitigating and eliminating back pain over time.

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Obesity and Associated Adverse Health Outcomes Among US Military Members: Findings from the Millennium Cohort Study Obesity 2016 Jul;24(7):1582-1589

Rush T, LeardMann CA, Crum-Cianflone NF

This study examined body weight among Service members and Veterans over time (2001-2007), finding a doubling of the prevalence of obesity. Obesity rates were significantly higher among veterans, including among those recently discharged from service. The study found that military personnel, even during service time, experienced weight gain and the development of obesity. Individuals with obesity had higher rates of adverse physical, mental, and functional health, suggesting that weight control should be a DoD and national priority.

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Longitudinal Associations Among PTSD, Disordered Eating, and Weight Gain in Military Men and Women American Journal of Epidemiology 2016 Jul 1;184(1):33-47

Mitchell KS, Porter B, Boyko EJ, Field AE

This study examined longitudinal associations between PTSD, disordered eating, and weight change in Millennium Cohort data from U.S. military Service members who completed the baseline survey and first and second follow-up surveys. The association between PTSD and weight change from time 2 to time 3 was partially mediated by disordered eating symptoms measured at time 2, specifically compensatory behaviors (vomiting, laxative use, fasting, over-exercise). In stratified models, the association between PTSD and weight gain via compensatory behaviors was significant for men and for non-Hispanic white participants only. Results highlight potentially important demographic differences in these associations and emphasize the need for further investigation of eating disorders in military Service members.

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Mental Health and Comorbidities in U.S. Military Members Military Medicine 2016 June;181(6):537-45

Crum-Cianflone NF, Powell TM, LeardMann CA, Russell DR, Boyko EJ

This study examined incidence rates of mental and behavioral disorders using self-reported and electronic medical record data from US Servicemembers who joined the military after September 11th, 2001. Combat deployers had the highest incidence rates of PTSD, panic/anxiety disorder, and any mental disorder. Of those with recent PTSD, 73% concurrently developed at least one other incident mental or behavioral conditions. Most diagnoses were not represented in the medical records. Findings indicate the high burden of these conditions that are greatly underestimated using medical data alone, demonstrating the value of survey data and screening tools among this population.

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Sleep and Health Resilience Metrics in a Large Military Cohort Sleep 2016 May;39(5):1111-1120

Seelig AD, Jacobson IG, Donoho CJ, Trone DW, Crum-Cianflone NF, Balkin TJ

The presence of insomnia symptoms was significantly associated with worse self-rated health, more lost work days, lower odds of deployment, higher odds of leaving military service early, and more health care utilization, after adjustment for demographic, military, behavioral and other health covariates. Findings were similar for those reporting less than 6 hours of sleep per night. Future research should focus on the efficacy of interventions to promote healthy sleep in military populations.

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Sexual Trauma and Adverse Health and Occupational Outcomes Among Men Serving in the US Military Journal of Traumatic Stress 2016 Apr;29(1):132-40

Millegan J, Wang L, LeardMann CA, Miletich D, Street AE

This study examined the association of recent sexual trauma with health and occupational outcomes among US Service men using longitudinal Millennium Cohort data (2004-2013). Findings from this study indicated that recent sexual trauma, sexual harassment or sexual assault, is associated with adverse physical health and mental health among Service men, after adjustment for relevant covariates. Men who reported sexual trauma were more likely to have left military service and experience post-service disability or unemployment. Results demonstrate that, among Service men, sexual trauma is significantly associated with adverse health and functionality extending to post-military life. Findings support the need for developing more effective prevention strategies and services to reduce the burden of sexual trauma of Service men.

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Deployment, Combat, and Risk of Multiple Physical Symptoms in the US Military: A Prospective Cohort Study Annals of Epidemiology 2016 Feb;26(2):122-8

McCutchan PK, Liu X, LeardMann CA, Smith TC, Boyko EJ, Gore KL, Freed MC, Engel CC

This study examined longitudinal trends in multiple physical symptoms and its relationship to deployment among US military service members and veterans. Those who had deployed and experienced combat were significantly more likely to report multiple physical symptoms at each time point compared with those not deployed and those who deployed without combat, after adjustment for demographic, military, and health characteristics. Longitudinal trends indicate that the probability of reporting multiple physical symptoms has increased consistently over time only for those deployed, regardless of combat experience.

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The Epidemiology of Irritable Bowel Syndrome in the US Military: Findings from the Millennium Cohort Study American Journal of Gastroenterology 2016;111:93-104

Riddle MS, Welsh M, Porter CK, Nieh C, Boyko EJ, Gackstetter GD, Hooper TI

This study describes the incidence of irritable bowel syndrome (IBS) and its association with antecedent infectious gastroenteritis among Millennium Cohort Study participants using survey data and post-deployment health assessments and medical encounter data in the military health system. Consistent with other studies, the risk of IBS increased after acute enteric infection. Novel findings included increased risk of incident IBS among those with post-traumatic stress disorder (PTSD) and preceding life stressors, as well as stronger associations between infectious gastroenteritis and IBS among those with antecedent depression or anxiety. These results reinforce the need to prevent acute gastrointestinal infections and their chronic consequences among our Service members. Additional studies on the underlying biopsychosocial mechanisms of IBS may help to explain these findings.

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