Publications

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

Title Publication Date/Location
Smokeless tobacco use related to military deployment, cigarettes, and mental health symptoms in a large, prospective cohort study among US service members Addiction 2012 May;107(5):983-994

Hermes ED, Wells TS, Smith B, Boyko EJ, Gackstetter GD, Miller SC, Smith TC, for the Millennium Cohort Study Team

Chronic use of smokeless tobacco has been linked to poor military training performance, early discharge, and a host of medical problems from cancer to heart disease. Smokeless tobacco initiation occurred in 1.9% and persistent use in 8.9% of Millennium Cohort participants. The study showed that deployment, combat exposure, smoking, and symptoms of posttraumatic stress disorder increased the risk for smokeless tobacco initiation, while deployment and combat exposure increased the risk for persistent use.

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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 In press

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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Chronic multisymptom illness: A comparison of Iraq and Afghanistan deployers with 1991 Gulf War Veterans American Journal of Epidemiology 2014;180(12):1176-1187

Smith TC, Powell TM, Jacobson IG, Smith B, Hooper TI, Boyko EJ, Gackstetter GD

These data highlight a difference in CMI reporting when comparing deployed to non-deployed military members. While symptom reporting in this contemporary Cohort occurred less frequently than in the historical 1991 GW cohort, increased CMI reporting was noted among deployed compared to non-deployed contemporary Cohort members.

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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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When epidemiology meets the Internet: Web-based surveys in the Millennium Cohort Study American Journal of Epidemiology 2007 Nov;166(11):1345-54

Smith B, Smith TC, Gray GC, Ryan MAK, for the Millennium Cohort Study Team

Optimal use of the Internet - with minimal response bias, maximum cost-savings, and improved data - is highlighted.

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Disordered eating and weight changes after deployment: longitudinal assessment of a large US military cohort American Journal of Epidemiology 2009 Feb;169(4):415-27

Jacobson IG, Smith TC, Smith B, Keel PK, Amoroso PJ, Wells TS, Bathalon GP, Boyko EJ, Ryan MAK for the Millennium Cohort Study Team

Deployed women who reported combat exposures represent a subgroup at higher risk for developing eating problems and weight loss postdeployment compared with deployed women who did not report combat exposures.

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Newly reported respiratory symptoms and conditions among military personnel deployed to Iraq and Afghanistan: a prospective population-based study American Journal of Epidemiology 2009 Dec;170(11):1433-42

Smith B, Wong CA, Smith TC, Boyko EJ, Gackstetter GD, Ryan MAK, for the Millennium Cohort Study Team

Elevated risk for self-reported respiratory symptoms was found among Army and Marine Corps personnel deployed in support of operations in Iraq and Afghanistan. No increased risk for self-reported asthma, bronchitis, or emphysema was found.

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Prospective evaluation of mental health and deployment experience among women in the US military American Journal of Epidemiology 2012;176(2):135-45

Seelig AD, Jacobson IG, Smith B, Hooper TI, Gackstetter GG, Ryan MAK, Wells TS, MacDermid Wadsworth S, Smith TC, for the Millennium Cohort Study Team

Women with reported combat exposures were more likely to have mental health symptoms than women who deployed without combat associated exposures and women who never deployed.

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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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Deployment-related depression screening results, 2001-2008: comparing clinical vs. research surveys American Journal of Preventative Medicine 2014 Nov;47(5):531-540

Welsh MM, PhD, Federinko SP, Burnett DG, Gackstetter GD, Boyko EJ, Seelig AD, Wells TS, and Hooper TI

This study compared depression symptoms reported on military-linked surveys, post-deployment health assessments, with responses from confidential surveys of the Millennium Cohort Study and then evaluated whether any factors were associated with discrepant responses. Moderate agreement was observed between paired survey responses. A higher proportion of active duty members, unmarried participants, and new accessions into military service endorsed depression symptoms on the confidential survey but not the military-linked survey. This study identifies potential subgroups to target for improving follow-up care for optimal mental health.

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