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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| Occupation and Risk of Traumatic Brain Injury in the Millennium Cohort Study | Military Medicine | 2022 Feb 27;usac035 |
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Jannace KC, Pompeii L, Gimeno Ruiz de Porras D, Perkison WB, Yamal JM, Trone DW, Rull RP Using 2014-16 survey data from active duty 33,646 Millennium Cohort Study participants, we assessed the association between their primary military occupational categories (MOC) and self-reported traumatic brain injury (TBI) sustained during military service. Adjusting for military and demographic characteristics and pre-service TBI, all MOCs except for health care MOCs were statistically significantly more likely to experience service-related TBI compared with Administration & Executive MOCs, while those in Infantry/Tactical Operations had the highest odds of service-related TBI. Enlisted (28%) personnel were more likely than officers (24%) to experience a service-related TBI. Results highlight the importance of targeting specific occupational categories for TBI risk reduction and a quantification of risk among enlisted MOCs suggests a need for further research into the causes of TBI. |
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| The bi-directional relationship between post-traumatic stress disorder and obstructive sleep apnea and/or insomnia in a large U.S. military cohort | Sleep Health | 2022 December | doi: 10.1016/j.sleh.2022.07.005 |
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Chinoy ED, Carey FR, Kolaja CA, Jacobson IG, Cooper AD, Markwald RR Study findings indicate a bi-directional relationship between the development of sleep disorders and PTSD. Military-related factors associated with new onset PTSD or sleep disorders, such as combat deployment, recent military separation, and rank, should be considered in prevention efforts for sleep disorders and PTSD. |
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| Association of deployment with maintenance of healthy weight among active duty service members in the Millennium Cohort Study | Obesity Science and Practice | 2022 Apr;8(2):247-253 |
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Carey FR, Jacobson IG, Roenfeldt KA, Rull RP Understanding changes in weight in relation to deployment readiness can inform Department of Defense fitness policies. This study examined longitudinal associations between deployment and service branch-specific changes in body mass index (BMI) among active duty participants without obesity (BMI< 30kg/m2) at baseline (n=22,995). Service members, particularly Army and Marine Corps personnel, with longer deployments were less likely to maintain a healthy weight (BMI < 30) than those with shorter deployment lengths. Conversely, each additional deployment increased the likelihood of maintaining a healthy weight post-deployment for personnel in the Army, Marine Corps, and within the pooled population. These results indicate that multiple deployments may support healthy weight maintenance and longer deployments may adversely impact weight maintenance. Fitness policies designed to optimize service member readiness should consider modifiable behaviors related to weight gain among those who are deployed for long periods of time. |
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| A temporal analysis of mental health symptoms relative to separation from the military | Depression and Anxiety | 2022 Apr;39(4):334- 343 |
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Porter B, Carey FR, Roenfeldt KA, Rull RP, Castro CA This paper examined mental health symptoms among 23,887 active duty Millennium Cohort Study participants who completed a survey within one year of their separation from the military. While significant, timing prior to or after separation did not have a practical impact on mental health among all study participants, accounting for less than 0.2% of variance in mental health symptoms. However, among participants with Other Than Honorable or General discharges, timing to separation accounted for 5.1% and 3.6% of the variance in posttraumatic stress disorder and depression symptoms, respectively; mental health symptoms increased among these participants around the time of separation and remained elevated in the period following separation. Increased outreach at the time of separation and post-separation is needed for service members with bad paper discharges. |
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| Cervical cancer screening compliance among active duty service members in the US military | Preventive Medicine Reports | 2022 Apr; 26: 101746 |
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Seay J, Matsuno RK, Porter B, Tannenbaum K, Warner S, Wells N Previous research suggests active duty service members (ADSM) experience higher rates of human papilloma virus infection and cervical dysplasia, which puts them at greater risk for cervical cancer. The current study examined crude rates and correlates of cervical cancer screening compliance in 2003, 2015 among screening-eligible ADSM in the Millennium Cohort Study (MCS). Most participants were 21- 29 years old (79.4%), non-Hispanic White (60.6%), and enlisted (82.2%). Crude rates of cervical cancer screening compliance increased from 2003 (61.2%) to 2010 (83.1%), and then declined in 2015 (59.8%). Older ADSM and those who had a history of deployment had lower odds of screening compliance. ADSM in the Air Force and those in healthcare occupations had higher odds of screening compliance. Study findings suggest that cervical cancer screening compliance is declining among ADSM. Interventions to improve screening should target groups with lower screening compliance. |
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| The Role of Posttraumatic Stress Symptoms and Negative Affect in Predicting Substantiated Intimate Partner Violence Incidents Among Military Personnel | Military Behavioral Health | 2021;9(4):442–462 |
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Stander, VA, Woodall KA, Richardson SM, Thomsen CJ, Milner JS, McCarroll JE, Riggs DS, Cozza SJ, for the Millennium Cohort Study Team Increasing rates of posttraumatic stress disorder (PTSD) in military populations may indicate heightened risk for aggression, including aggression among domestic partners. Using longitudinal data from the Millennium Cohort Study, we evaluated the association of PTSD symptom clusters and comorbid conditions as predictors of incidents of met criteria incidents of domestic abuse (physical and psychological) from DoD Family Advocacy Program (FAP) Central Registry data. Among 54,667 active-duty personnel who responded to the 2011 survey, FAP records documented 501 participants (1%) with incidents of emotional or physical met criteria incidents of aggression in the data collection period. Results showed that certain aspects of PTSD and behavioral health problems predicted incidents. In particular, general PTSD symptoms (e.g., anger/irritability, sleep disruption) and comorbid alcohol dependence were stronger predictors than trauma-specific PTSD symptomology (e.g., reexperiencing, hypervigilance). These results indicate that clinicians should consider the interpersonal consequences of PTSD and related behavioral problems. |
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| Association of Combat Experiences With Suicide Attempts Among Active-Duty US Service Members | JAMA Network Open | 2021;4(2):e2036065 |
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LeardMann CA, Matsuno R, Boyko EJ, Powell TM, Reger MA, Hoge CW, for the Millennium Cohort Study Team Among 57,841 active-duty service members who had deployed, high combat severity and certain specific combat experiences were associated with suicide attempts. However, these associations were mostly accounted for by mental disorders, especially PTSD. Findings suggest that service members who experience high levels of combat or are exposed to certain types of combat experiences, involving unexpected events or those that challenge moral or ethical norms, may have an increased risk of a suicide attempt, either directly or indirectly through mental disorders. |
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| Comparison of Posttraumatic Stress Disorder Checklist Instruments from Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition vs Fifth Edition in a Large Cohort of US Military Service Members and Veterans | JAMA Network Open | 2021; 4(4): e218072 |
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LeardMann, CA, McMaster HS, Warner S, Esquivel AP, Porter B, Powell TM, Tu XM, Lee WW, Rull RP, Hoge CW, for the Millennium Cohort Study Team To assist in the longitudinal assessment of PTSD spanning the transition between the DSM-IV and DSM-V, we compared the PTSD Checklist-Civilian version (PCL-C) with the PCL for DSM-5 (PCL-5) in a sample of 1,921 servicemembers. There was substantial to excellent agreement when comparing individual items, frequency of probable PTSD, and sum scores; and nearly identical associations with comorbid conditions. Our results provide support that PTSD can be successfully assessed and compared over time with either PCL instrument in veteran and military populations. |
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| Sexual Health Difficulties Among Service Women: The Influence of Posttraumatic Stress Disorder | Journal of Affective Disorders | 2021 Sep 1;292:678-686 |
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Kolaja CA, Schuyler AC, Armenta RF, Orman JA, Stander VA, LeardMann CA Sexual health of service women was found to be negatively impacted by recent combat deployment and sexual assault. Post-traumatic stress disorder (PTSD) mediated the associations of recent combat deployment and sexual assault with sexual health difficulties. Some military factors (i.e., service branch, component, paygrade) were associated with sexual health difficulties among service women. Findings indicate that effective treatment of PTSD may mitigate sexual health issues. |
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| Cigarette smoking patterns among U.S. military service members before and after separation from the military | PLoS One | 2021 Oct 4;16(10):e0257539 |
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Nieh C, Mancuso JD, Powell TM, Welsh MM, Gackstetter GD, Hooper TI. Millennium Cohort Study data were used to examine smoking behavior at enrollment into the study and through their first follow-up survey, approximately 3 years later. Time remaining in service from baseline until separation or the first follow-up survey was the main exposure of interest. The baseline prevalence of smoking in the Cohort was higher among those who eventually separated (20.1%) than among those who remained on active service (17.4%), but the overall prevalence of current smokers significantly declined over the observation period. Factors significantly associated with greater likelihood of smoking at follow-up were baseline smoking, non-White Hispanic individuals, being non-married, enlisted rank, underweight or healthy BMI, active duty component, any alcohol consumption, experiencing two or more stressful life events, and screening positive for either PTSD or depression. Including smoking prevention and/or cessation programs in pre-separation counseling sessions and developing smoking screening and cessation programs targeting high-risk subgroups may reduce smoking among Service members and veterans. |
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