Publications
The following manuscripts have been published or are currently in press. Listings are in chronological order, unless otherwise noted.
| Title | Publication | Date/Location |
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| Brief Report: Menstrual Suppression Among U.S. Female Service Members in the Millennium Cohort Study | Medical Surveillance Monthly Report | 2022 Sept 29(9), 19-22 |
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Zhu Y, Kolaja CA, Stamas N, Matsuno RK, Rull RP; Millennium Cohort Study Team This study examined the prevalence of self-reported menstrual suppression among U.S. female active duty personnel (N=22,920) at two time points (2008, 2013) by demographic and military characteristics. Menstrual suppression increased significantly overall from 2008 (2.5%) to 2013 (3.8%) and among younger age groups (aged 18-34), non-Hispanic White individuals, Army, Navy, or Air Force personnel. The highest prevalence of menstrual suppression was reported in 2013 among those who deployed in the past year (4.7%) or worked in health care (5.1%) or combat specialties (4.7%). Increased health education is needed to support the health care needs and readiness of female service members. |
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| The relative impact of injury and deployment on mental and physical quality of life among military service members | PLoS One | 2022 Sep 29 | doi: 10.1371/journal.pone.0274973 |
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Kolaja CA, Castañeda SF, Woodruff SI, Rull RP, Armenta RF Deployment and injury status was associated with poorer mental and physical quality of life (QOL) with clinically significant decreases in physical QOL observed for those who deployed and were injured, either in battle or nonbattle settings, compared with uninjured deployers. |
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| Health Disparities Among Lesbian, Gay, and Bisexual Service Members and Veterans | American Journal of Preventive Medicine | 2022 Oct | doi: 10.1016/j.amepre.2022.04.034 |
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Carey FR, LeardMann CA, Lehavot K, Jacobson IG, Kolaja CA, Stander VA, Rull RP, Millennium Cohort Study Team This study examined whether differences in mental, physical, and behavioral health exist by sexual orientation among active duty and Reserve/National Guard service members and veterans (N=96,930). Lesbian, gay, and bisexual (LGB) individuals (3.6% of the sample) were more likely to screen positive for post-traumatic stress disorder, depression, anxiety, binge eating, problematic anger, multiple somatic symptoms, and insomnia than heterosexual individuals. LGB women reported more adverse health outcomes (overweight and obesity, smoking, problem/risky drinking) than heterosexual women. Gay and bisexual men reported some adverse health outcomes (e.g., smoking and problem drinking) but better physical health (e.g., less overweight/obesity) than heterosexual men. These results suggest that LGB service members experience health disparities, despite many having equal eligibility for health care, highlighting the need for improved equity initiatives that promote cultural responsiveness, acceptance, and approaches to support the healthcare needs of LGB military members. |
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| The Effect of Combat Exposure on Financial Problems | International Review of Economics and Finance | 2022 May | doi: 10.1016/j.iref.2022.02.042 |
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Ackerman A, Porter, B This paper examined whether combat exposure led to new-onset financial problems and financial stress among 64,508 veterans using 2001-2016 data from the Millennium Cohort Study. The average predicted probability of developing a new major financial problem (such as bankruptcy) and greater financial stress increased 0.44% (21% relative to the mean probability) following a single combat exposure and increased 0.90% (43% relative to the mean probability) following multiple combat exposures. The likelihood of financial decline resulting from combat exposure were greater for veterans with poorer pre-deployment mental or physical health, veterans in enlisted ranks, and younger veterans between the ages of 26 and 36. These results translate to a crude cost estimate of lost productivity of at least $41 million and up to 3,629 bankruptcies for the 2.7 million veterans (1.34 per 1,000) deployed from 2001 through 2016. |
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| The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans | Annals of Epidemiology | 2022 Mar;67:61-72 |
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Belding JN, Castañeda SF, Jacobson IG, LeardMann CA, Porter B, Powell TM, Kolaja CA, Seelig AD, Matsuno RK, Carey FR, Rivera AC, Trone DW, Sheppard B, Walstrom J, Boyko EJ, Rull RP, For The Millennium Cohort Study Team In commemoration of the 20th anniversary of the Millennium Cohort Study, this paper provides a summary of the study design, key findings, and future directions. Published findings are summarized and categorized into 3 core areas (psychological health, physical health, and health-related behaviors) and several crosscutting areas culminating in more than 120 publications to date. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts. |
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| Combat exposure and behavioral health in U.S. Army Special Forces | PLoS One | 2022 Jun 28 | doi: 10.1371/journal.pone.0270515 |
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Rivera AC, LeardMann CA, Rull RP, Cooper A, Warner S, Faix D, Deagle E, Neff R, Caserta R, Adler AB, Millennium Cohort Study Team In this cross-sectional study using Millennium Cohort Study data, various types of combat, such as combat severity, fighting, threat to oneself, and killing noncombatants, were consistently associated with mental health disorders, trouble sleeping, and problem drinking among all three Army occupational specialization investigated (General Purpose Forces infantrymen, Ranger Qualified infantrymen, and Special Forces personnel). However, with few exceptions, Special Forces personnel and Ranger Qualified infantrymen had lower prevalence of these adverse outcomes. Findings suggest that even elite personnel may be negatively impacted by experiencing combat, thus trainings and interventions focused on moral conflict reasoning and resolution may help to mitigate some of these adverse behavioral outcomes. |
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| Association of Problematic Anger With Long-term Adjustment Following the Military-to-Civilian Transition | JAMA Network Open | 2022 Jul 1 | doi: 10.1001/jamanetworkopen.2022.23236 |
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Adler AB, LeardMann CA, Villalobos J, Jacobson IG, Forbes D, for the Millennium Cohort Study Team In the Millennium Cohort Study's third paper documenting the risks associated with problematic anger, 15.9% of active duty service members reported problematic anger two years before military separation. This prevalence essentially doubled to 31.2% two years following separation. Problematic anger around the time of military separation was associated with PTSD, depression, low relationship quality, difficulties coping with parental demands, low social support, and economic difficulties approximately 5 years later, after adjustment for demographics and baseline health. Findings suggest that training in emotion regulation may improve the military-to-civilian transition. |
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| Military service experiences and reasons for service separation among lesbian, gay, and bisexual individuals in a large military cohort | BMC Public Health | 2022 Jan 6;22(1):39 |
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Carey FR, Jacobson IG, Lehavot K, LeardMann CA, Kolaja CA, Stander VA, Rull RP The goal of this study was to examine differences in military and service separation experiences by sexual orientation among a large representative sample of United States service members and veterans. Survey data from the 2016 Millennium Cohort Study follow-up questionnaire were used to assess sexual orientation (lesbian, gay, and bisexual [LGB] versus heterosexual) and military experiences and service separation experiences. Of the 99,599 participants, 3.4% identified as LGB. Those service members were more likely than their heterosexual peers to report feeling unimpressed by the quality of unit leadership, unsupported by the military, and negative about the military overall. LGB veterans were more likely than heterosexual peers of the same sex to separate from service for a variety of reasons (e.g., administrative, dissatisfaction with promotions/pay, disability/medical reasons, dissatisfaction with leadership and incompatibility with the military). Less positive military- and separation-specific experiences disproportionately affected LGB service members in this study. Promoting inclusion and increasing support for LGB service members may improve satisfaction with military service and retention. |
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| Factors associated with human papillomavirus vaccine initiation and compliance among U.S. military service members | Military Medicine | 2022 Jan 25:usab562 |
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Matsuno RK, Seay J, Porter B, Tannenbaum K, Warner S, Wells N The goal of this study was to assess factors associated with human papillomavirus (HPV) vaccine initiation and compliance in a cohort of active duty US military service members (SM). We included active-duty participants aged 18-26 years from the Millennium Cohort Study, a longitudinal cohort study of over 200,000 military SMs. The eligible study population included 22,387 female SMs and 31,705 male SMs. Vaccination was assessed over the period 2006-2017. Among female SMs, 37.8% initiated the vaccine and 40.2% of initiators completed the series within a year. Among male SMs, 3.9% initiated the vaccine and 22.1% of initiators completed the series within a year. Differences were observed by sociodemographic factors, deployment status, branch of service, occupation, and smoking status, but not by selected mental health conditions. These results indicated that HPV vaccination uptake may be subpar across all military service branches. Certain subgroups of SMs could be targeted to increase overall HPV vaccine coverage in the US military population. |
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| Problematic Anger and Economic Difficulties: Findings from the Millennium Cohort Study | Journal of Affective Disorders | 2022 Jan 15;297:679-68 |
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Adler AB, LeardMann CA, Yun S, Jacobson IG, Forbes D; Millennium Cohort Study Team Of 95,895 participants, 17.4% screened positive for problematic anger. Problematic anger was significantly associated with involuntary job loss and financial problems, adjusting for demographics, military characteristics, disabling injury, and behavioral health factors. Among veterans, problematic anger was associated with unemployment and homelessness after adjustment for covariates. These findings suggest it may be useful for military leaders, veteran organizations, and policy makers to support the adjustment and financial health of military personnel and veterans by proactively addressing problematic anger. |
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