Based on a survey of health-related behaviors conducted for the Department of Defense by RTI International since 1980, this book examines trends in substance abuse, health behavior, and mental health among active duty military personnel over the past 20 years
From the stresses of repeated deployments to the difficulties of re-entry into civilian life, we are just beginning to understand how protracted conflicts, such as those in Iraq and Afghanistan, are affecting service members. Issues such as risky health behaviors and chemical dependence raise productivity concerns as they do with all organizations, but they also have a profound impact on the safety and readiness of troops--and by extension, the military as a whole--in life-or-death situations.
Understanding Military Workforce Productivity cuts through the myths and misconceptions about the health and resilience of today's active-duty armed forces.
This first-of-its-kind volume presents up-to-date findings across service branches in core health areas including illness and injury, alcohol and drug abuse, tobacco use, obesity, and mental health. The short- and long-term implications discussed relate to the quality of the lives of service members and their families, the quality and preparedness of the military as a workforce, and prevention and intervention efforts. The book:
- Presents data from ten large-scale health behavior surveys sponsored by the Department of Defense.
- Offers background context for understanding health and behavioral health and productivity among service members.
- Introduces a health and behavioral health model of productivity loss in the armed forces.
- Compares key indicators of substance abuse, health, and mental health in military and civilian populations.
- Reviews approaches for improving military productivity.
- Identifies areas for further study.
Understanding Military Workforce Productivity offers a rare close-up of health issues in the services, making it an invaluable source of information for practitioners and researchers in mental health, substance abuse, health behaviors, and military behavioral health.
| 1 Health and Behavioral Health in the Military |
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1 | (20) |
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1.1 Overview and Background |
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2 | (2) |
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1.3 The Active Duty Military Force Across the World |
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4 | (2) |
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1.4 Influences on Military Productivity and Readiness |
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6 | (5) |
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6 | (1) |
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1.4.2 Health Status and Health Behaviors |
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7 | (1) |
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1.4.3 Mental Health Problems |
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8 | (1) |
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1.4.4 Deployment and Combat Experience |
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9 | (1) |
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1.4.5 Stress During Separations |
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9 | (1) |
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10 | (1) |
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1.4.7 Problems in Reintegration |
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10 | (1) |
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1.4.8 Job Satisfaction and Retention |
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1.5 Programmatic Responses to Military Productivity and Readiness |
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1.6 Overview of This Book |
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1.6.1 Conceptual Framework |
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1.6.2 The Health-Related Behavior Surveys |
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1.6.3 Overview of
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16 | (5) |
| 2 Methodology |
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21 | (30) |
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21 | (1) |
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2.3 Survey Instrumentation and Data Collection Procedures |
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2.3.1 Survey Questionnaires |
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24 | (1) |
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2.4 Sample Size and Survey Performance Rates |
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2.4.2 Eligibility/Accessibility Rates |
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27 | (1) |
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2.5 Survey Participants and Military Population Characteristics |
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28 | (4) |
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2.6 Background Characteristics |
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2.6.1 Sociodemographic Characteristics |
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2.6.2 Psychosocial Characteristics |
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32 | (2) |
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2.6.3 Military Conditions |
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34 | (1) |
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2.7 Substance Abuse, Health, and Mental Health |
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35 | (7) |
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35 | (3) |
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2.7.2 Health-Related Behaviors and Conditions |
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38 | (2) |
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40 | (2) |
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2.8 Activity Limitations and Productivity Loss |
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2.8.1 Physical Health-Limited Activity |
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42 | (1) |
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2.8.2 Mental Health-Limited Activity |
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43 | (1) |
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2.10 Strengths and Limitations of the Data |
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44 | (2) |
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46 | (5) |
| 3 Substance Abuse |
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51 | (30) |
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3.1 Overview and Background |
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51 | (3) |
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3.2 Trends in Substance Use and Related Consequences in the Military |
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54 | (5) |
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3.3 Military and Civilian Comparisons |
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59 | (3) |
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3.4 Correlates and Predictors of Substance Use and Abuse |
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62 | (13) |
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64 | (1) |
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64 | (5) |
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69 | (5) |
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3.4.4 Alcohol-Related Serious Consequences |
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74 | (1) |
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3.4.6 Nicotine Dependence |
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74 | (1) |
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3.5 Summary and Discussion |
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75 | (3) |
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75 | (2) |
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3.5.2 Consequences of Substance Use |
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77 | (1) |
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78 | (1) |
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78 | (3) |
| 4 Health Behaviors and Health Status |
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81 | (28) |
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4.1 Overview and Background |
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81 | (9) |
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81 | (4) |
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4.1.2 DoD Health Directives |
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85 | (1) |
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4.1.3 Healthy People Objectives |
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86 | (2) |
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4.1.4 Achievement of Selected Healthy People 2010 Objectives in 2008 |
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88 | (2) |
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4.2 Trends in Overweight, Illness, and Injury |
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90 | (3) |
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4.3 Correlates and Predictors of Healthy Behaviors for 2008 |
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93 | (6) |
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4.3.1 Overweight and Obesity |
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93 | (5) |
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98 | (1) |
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98 | (1) |
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4.4 Summary and Discussion |
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99 | (4) |
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4.4.1 Healthy People Objectives |
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99 | (1) |
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99 | (2) |
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101 | (1) |
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102 | (1) |
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103 | (1) |
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104 | (5) |
| 5 Stress and Mental Health |
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109 | (36) |
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5.1 Overview and Background |
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109 | (3) |
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5.2 Trends in Stress and Mental Health Among Military Personnel |
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112 | (6) |
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5.2.1 Trends in Work and Family Stress |
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112 | (1) |
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5.2.2 Specific Life Events to Which Stress Is Attributed |
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113 | (1) |
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114 | (2) |
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5.2.4 Trends in Depression, Suicidal Thoughts When Stressed, and Receipt of Counseling |
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116 | (2) |
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5.2.5 Trends in Generalized Anxiety Disorder and Posttraumatic Stress Disorder |
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118 | (1) |
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5.3 Correlates and Predictors of Mental Health Problems |
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118 | (15) |
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5.3.1 Work and Family Stress |
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119 | (1) |
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119 | (5) |
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5.3.3 Generalized Anxiety Disorder |
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124 | (1) |
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125 | (5) |
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130 | (1) |
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5.3.6 Mental Health Counseling |
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131 | (2) |
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5.4 Summary and Discussion |
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133 | (5) |
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5.4.1 Levels and Sources of Stress |
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133 | (1) |
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134 | (1) |
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5.4.3 Mental Health Indicators |
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135 | (2) |
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5.4.4 Mental Health Services Utilization |
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137 | (1) |
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138 | (1) |
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138 | (7) |
| 6 Productivity Loss Associated with Substance Use, Physical Health, and Mental Health |
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145 | (20) |
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6.1 Overview and Background |
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145 | (4) |
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6.1.1 Defining Productivity and Understanding the Impact of Productivity Loss |
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146 | (1) |
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6.1.2 Substance Use and Productivity Loss |
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147 | (1) |
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6.1.3 Physical Health and Productivity Loss |
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148 | (1) |
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6.1.4 Mental Health and Productivity Loss |
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148 | (1) |
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6.2 Trends in Productivity Loss |
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149 | (6) |
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6.2.1 Trends in Overall Productivity Loss |
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150 | (1) |
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6.2.2 Trends in Productivity Loss by Substance Use |
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151 | (1) |
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6.2.3 Trends in Productivity Loss by Physical Health |
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152 | (2) |
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6.2.4 Trends in Productivity Loss by Mental Health |
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154 | (1) |
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6.3 A Health and Behavioral Health Model of Productivity Loss |
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155 | (3) |
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6.3.1 Model Constructs and Latent Factors |
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155 | (1) |
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6.3.2 Estimating Productivity Loss |
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156 | (2) |
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6.4 Summary and Discussion |
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158 | (4) |
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158 | (2) |
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6.4.2 Productivity Loss Model |
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160 | (2) |
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162 | (1) |
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163 | (2) |
| 7 Summary and Implications of Findings |
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165 | (20) |
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7.1 Overview and Background |
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165 | (2) |
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7.2 Key Findings and Implications |
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167 | (9) |
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167 | (2) |
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7.2.2 Health and Health Behaviors |
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169 | (2) |
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7.2.3 Stress and Mental Health Problems |
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171 | (1) |
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7.2.4 Effects of Military and Psychosocial Factors |
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172 | (1) |
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7.2.5 Productivity Loss Associated with Substance Use, Physical Health, and Mental Health |
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173 | (2) |
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175 | (1) |
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7.3 Programmatic Approaches to Improve Military Productivity |
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176 | (3) |
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7.4 Further Investigations |
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179 | (1) |
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180 | (1) |
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181 | (4) |
| Index |
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185 | |
Robert M. Bray, PhD, a fellow of the American Psychological Association, is a Senior Research Psychologist and Senior Director of the Substance Abuse Epidemiology and Military Behavioral Health Program at RTI International. His research interests focus on the epidemiology of substance use and other health behaviors in military and civilian populations, with an emphasis on understanding the prevalence, causes, correlates, and consequences of these behaviors. He has directed nine comprehensive worldwide Department of Defense Surveys of Health Related Behaviors Among Active Duty Military Personnel, which have furnished the most widely cited data on substance use and health behaviors in the active duty military and which serve as the basis for the findings in this book. He has directed and/or supported other studies of the military population assessing health-related behaviors among the Reserve component, risk and protective factors for initiation of tobacco and alcohol use, mental fitness and resilience among Army basic combat trainees, and a Web-based intervention to reduce heavy alcohol use among active duty servicemembers. He is currently leading the RTI component of a large multi-institutional clinical trial to optimize usual primary care for soldiers with post-traumatic stress disorder and depression. Dr. Bray is principal editor of the book Drug Use in Metropolitan America, which integrates findings from a large-scale study of drug use among diverse populations in the Washington, DC, metropolitan area. He has published and presented widely in the area of substance use- and health-related behaviors. Dr. Bray received his PhD in Social Psychology from the University of Illinois.
Laurel L. Hourani, PhD, MPH, joined RTI in 2001 as a research epidemiologist after heading the Health Sciences Division of the Naval Health Research Center in San Diego. She has conducted health and psychological research in the United States and abroad formore than 20 years and has extensive experience with military populations. Dr. Houranis expertise and main research interests are in the areas of mental health and substance abuse. She has been the principal investigator on several military-sponsored studies of suicide and mental disorders among U.S. Navy and Marine Corps personnel and was instrumental in the development and annual analysis of the Department of the Navy Suicide Incident Report, which later became the basis for the current Department of Defense Suicide Event Report. She was associate project director for the 2002, 2005, and 2008 Department of Defense Surveys of Health Related Behaviors Among Active Duty Military Personnel and pioneered the Surveys of Health Related Behavior for the Reserve Component, both of which have served as models for military behavioral health research. She is currently leading a project on post-traumatic stress disorder that includes the development and testing of pre-deployment stress inoculation training programs in the Marine Corps and Army to prepare warriors psychologically to better deal with combat and operational stress. Dr. Hourani received her PhD in Psychiatric Epidemiology from the University of Pittsburgh and is a Fellow of the American Psychological Association.
Jason Williams, PhD, is a Research Psychologist at RTI International with extensive experience in applying advanced statistical methods to the estimation and modeling of behavioral and mental health outcomes in military personnel. Dr. Williams has led the analyses for many large- and small-scale survey and program evaluation projects, including the Department of Defense Surveys of Health Related Behaviors Among Active Duty Military Personnel and the companion surveys for the Reserve Component. Dr. Williams substantive research interests include program evaluation and substance use and violence prevention in at-risk populations such as youth and military personnel. In addition to leading analysis tasks for multiple studies, he conducts methodological development and applications studies, primarily in the area of mediation, including a National Institutes of Healthfunded study examining methods of comparing mediated effects across groups. He has authored or coauthored multiple peer-reviewed articles on measurement of military-relevant mental health constructs such as PTSD as well as papers applying complex longitudinal and mediation models to military program evaluations and models of substance use. Dr. Williams received his PhD in Social Psychology from Arizona State University.
Marian E. Lane, PhD, is a Research Psychologist at RTI International. She has more than 12 years of experience in industrial-organizational psychology, including more than a decade of studies of active duty and Reserve component personnel with an emphasis on substance abuse, mental health, and workforce productivity. At RTI, she has led numerous military research studies, including the Navy and Marine Corps Reservists Needs Assessment and the DoD/VA Integrated Mental Health Strategy (IMHS) Strategic Action #23: Chaplains Roles studies. She has been a lead analyst for the Department of Defense Surveys of Health Related Behaviors Among Active Duty and Reserve Component Military Personnel. Her areas of expertise include survey research, multivariate statistics, focus group and key informant interviews, and organizational assessment, and she has had responsibility for study design, implementation, and evaluation of program effects. She has authored and coauthored articles on military mental health and substance abuse for peer-reviewed journals, presentations for national and international conferences, and briefings for senior military and civilian leaders. Dr. Lane received her PhD in Experimental Psychology from the University of Memphis.
Mary Ellen Marsden, PhD, has more than 35 years of experience in the study of substance use epidemiology, treatment effectiveness, treatment organization, and policy issues. In her 20 years as a Senior Research Sociologist at RTI International, she was an analyst on eight Department of Defense Surveys of Health Related Behaviors Among Active Duty Military Personnel, reporting director for the National Survey on Drug Use and Health, and associate director of the National Analytic Center for the National Household Survey on Drug Abuse. She is coauthor of Drug Abuse Treatment: A National Study of Effectiveness, co-editor of Drug Use in Metropolitan America, and author of numerous articles on substance use among youth and military personnel, substance abuse treatment, and the substance abuse treatment system. Dr. Marsden received her PhD in Sociology from the University of Chicago.
Jason Williams, PhD, is a Research Psychologist at RTI International with extensive experience in applying advanced statistical methods to the estimation and modeling of behavioral andmental health outcomes in military personnel. Dr. Williams has led the analyses for many large- and small-scale survey and program evaluation projects, including the Department of Defense Surveys of Health Related Behaviors Among Active Duty Military Personnel and the companion surveys for the Reserve Component. Dr. Williams substantive research interests include program evaluation and substance use and violence prevention in at-risk populations such as youth and military personnel. In addition to leading analysis tasks for multiple studies, he conducts methodological development and applications studies, primarily in the area of mediation, including a National Institutes of Healthfunded study examining methods of comparing mediated effects across groups. He has authored or coauthored multiple peer-reviewed articles on measurement of military-relevant mental health constructs such as PTSD as well as papers applying complex longitudinal and mediation models to military program evaluations and models of substance use. Dr. Williams received his PhD in Social Psychology from Arizona State University.
Marian E. Lane, PhD, is a Research Psychologist at RTI International. She has more than 12 years of experience in industrial-organizational psychology, including more than a decade of studies of active duty and Reserve component personnel with an emphasis on substance abuse, mental health, and workforce productivity. At RTI, she has led numerous military research studies, including the Navy and Marine Corps Reservists Needs Assessment and the DoD/VA Integrated Mental Health Strategy (IMHS) Strategic Action #23: Chaplains Roles studies. She has been a lead analyst for the Department of Defense Surveys of Health Related Behaviors Among Active Duty and Reserve Component Military Personnel. Her areas of expertise include survey research, multivariate statistics, focus group and key informant interviews, and organizational assessment, and she has had responsibility for study design, implementation, and evaluation of program effects. She has authored and coauthored articles on military mental health and substance abuse for peer-reviewed journals, presentations for national and international conferences, and briefings for senior military and civilian leaders. Dr. Lane received her PhD in Experimental Psychology from the University of Memphis.
Mary Ellen Marsden, PhD, has more than 35 years of experience in the study of substance use epidemiology, treatment effectiveness, treatment organization, and policy issues. In her 20 years as a Senior Research Sociologist at RTI International, she was an analyst on eight Department of Defense Surveys of Health Related Behaviors Among Active Duty Military Personnel, reporting director for the National Survey on Drug Use and Health, and associate director of the National Analytic Center for the National Household Survey on Drug Abuse. She is coauthor of Drug Abuse Treatment: A National Study of Effectiveness, co-editor of Drug Use in Metropolitan America, and author of numerous articles on substance use among youth and military personnel, substance abuse treatment, and the substance abuse treatment system. Dr. Marsden received her PhD in Sociology from the University of Chicago.
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