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Kasper KB, Cockerell M, Escamilla C, Gonzalez R. Multivitamin Compliance Reduces Injuries of Female Recruits at Air Force Basic Training: A Randomized Controlled Cohort Study. Mil Med 2024; 189:93-98. [PMID: 39160796 DOI: 10.1093/milmed/usae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/06/2023] [Accepted: 02/06/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION Department of the Air Force basic military training (BMT) is the 7.5-week initial entry training for all enlisting U.S. Air Force and Space Force recruits. Overuse musculoskeletal injuries (MSKI) during training threaten success in BMT, and trainees with nutritional deficiencies are at higher risk. Several efforts are made at BMT to mitigate these issues to help trainees graduate on time, such as the distribution of multivitamins (MVI) to female recruits. However, trainee compliance with the prescribed MVI has been reported to be low, calling into question the effectiveness of this intervention. This study evaluated the effect of briefing modality offered to these trainees at the time of distribution on educational effectiveness, MVI compliance, and injury rates. MATERIALS AND METHODS This was a randomized controlled cohort study of BMT female trainees. Subjects included all female trainees of a single iteration of BMT concurrently completing training within the same squadron. At the outset of training, cohorts were randomly educated in one of two ways regarding the provided MVI. The control cohort (n = 80) was presented with the standard educational video created by BMT-registered dietitians, while the test cohort (n = 79) was presented the video and then also briefed in-person by a group of subject matter experts. At the end of BMT, the trainees completed a questionnaire regarding their knowledge, confidence, and compliance with the MVI. Additionally, a routinely collected training database was queried and analyzed for differences in injuries and training outcomes using the chi-squared test with significance set to α ≤ 0.05. RESULTS Although both cohorts found their educational presentation useful, the "in-person" cohort reported significantly higher compliance rates and were found to be diagnosed with MSKI and bone stress injuries at significantly lower rates (43% and 66% relative risk reductions, respectively). CONCLUSIONS Education to female BMT trainees regarding the MVI, which included a face-to-face discussion with subject matter experts, resulted in greater compliance and reduced incidence of MSKI and bone stress injury, compared to a video prepared by registered dietitians alone. Such educational approaches should continue to be strived for in this and other military population health measures. This study's implication of MVI efficacy for injury risk reduction in female trainees should be further studied, verified, and improved upon in this and other populations.
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Affiliation(s)
- Korey B Kasper
- 559th Trainee Health Squadron, JBSA-Lackland, TX 78236, USA
| | | | - Clarissa Escamilla
- 37th Training Wing, Human Performance Directorate, JBSA-Lackland, TX 78236, USA
| | - Richard Gonzalez
- 37th Training Wing, Human Performance Directorate, JBSA-Lackland, TX 78236, USA
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Kirkpatrick K, Kleinberger C, Kazman J, Libretto S, Boyd C, Deuster PA. Total Force Kitchen: Exploring Active-Duty Service Member Performance Optimization Through Cooking. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:66-76. [PMID: 37367196 PMCID: PMC10801678 DOI: 10.1089/jicm.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Introduction: Obesity, overweight, and suboptimal eating habits are threats to U.S. active-duty service member (SM) nutritional fitness. Offering programs that improve diet quality and nutritional status is of high interest to military leaders. Methods: Total force kitchen (TFK) was developed as a performance-focused multicomponent program centered around culinary skills with education and skill building in key areas of nutrition, physical activity, and mindfulness. This pilot study's objectives were to determine the feasibility and acceptability of the TFK program, to make recommendations for program modification, and to determine impact on behavior, self-efficacy, and health-related outcomes. Participants were single or geographically single active-duty SMs (n = 17) who attended the 12-week, 60-h innovative culinary education and performance optimization program at a local United Service Organization facility. A mixed-method approach assessed pre- and post-program metrics, including attrition rates and participant satisfaction. Results: The TFK program retention rate was 76.5%. All participants were "somewhat satisfied" or "very satisfied" with the overall TFK program. The highest satisfaction was with the cooking-related components. Improvements in other behavioral (d = 0.39, 95% confidence interval [CI]: -0.17 to 0.95), self-rated health (d = 0.58, 95% CI: -0.02 to 0.16), and anthropometric measures (e.g., body fat percentage: d = -0.01, 95% CI: -0.12 to 0.10) were smaller than improvements in cooking attitudes (d = 0.66, 95% CI: 0.17 to 1.13) and self-efficacy for techniques (d = 1.80, 95% CI: 0.96 to 2.62). Participants reported positive changes in lifestyle related to what they eat and how they prepare their meals. They also highly valued active learning and instructor knowledge and enthusiasm. Discussion: This multidisciplinary evidence-based program offers ample opportunities for SMs to gain knowledge, build skills, and engage in a supportive community to optimize their performance through cooking. A successful pilot has the potential to leverage resources for the TFK program expanding its reach and impact to the larger military population and nonmilitary communities.
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Affiliation(s)
- Katie Kirkpatrick
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Carolyn Kleinberger
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Josh Kazman
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Salvatore Libretto
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Courtney Boyd
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Patricia A Deuster
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD, USA
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Kegel JL, Kazman JB, Clifton DR, Deuster PA, de la Motte SJ. Self-Reported Health Indicators in the US Army: Longitudinal Analysis From a Population Surveillance System, 2014‒2018. Am J Public Health 2021; 111:2064-2074. [PMID: 34499537 PMCID: PMC8630498 DOI: 10.2105/ajph.2021.306456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To describe health-related behaviors or indicators associated with overall health and well-being using the Global Assessment Tool (GAT), a health behavior and psychosocial questionnaire completed annually by US Army personnel. Methods. We analyzed GAT responses from 2014 to 2018, consisting of 367 000 to 449 000 respondents per year. We used generalized estimating equations to predict the presence of each health behavior or indicator, aggregated by year and stratified on various demographics. Results. Key findings included decreases from 2014 to 2018 in risky health behaviors such as hazardous drinking (7.5% decrease) and tobacco use (7.9% decrease), dietary supplement use (5.0% to 10.6% decrease, depending on type), self-reported musculoskeletal injury (5.1% decrease), and pain interference (3.6% decrease). Physical activity, sleep, and nutritional habits largely remained consistent over time. Conclusions. In the Army, tobacco, alcohol, and risky dietary supplement usage appears to be declining, whereas lifestyle health behaviors have been stable. Whether these trends reflect responses to health education is unknown. The GAT provides useful insights into the health of the Army, which can be leveraged when developing health-related educational programs and policies. Public Health Implications. Health behaviors that have changed less over time (e.g., nutrition, sleep) may require novel approaches compared with those that changed more (e.g., dietary supplement use, drinking). (Am J Public Health. 2021;111(11):2064-2074. https://doi.org/10.2105/AJPH.2021.306456).
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Affiliation(s)
- Jessica L Kegel
- All authors are with the Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD. Jessica L. Kegel, Josh B. Kazman, and Daniel R. Clifton are also affiliated with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda. Note. The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the US government
| | - Josh B Kazman
- All authors are with the Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD. Jessica L. Kegel, Josh B. Kazman, and Daniel R. Clifton are also affiliated with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda. Note. The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the US government
| | - Daniel R Clifton
- All authors are with the Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD. Jessica L. Kegel, Josh B. Kazman, and Daniel R. Clifton are also affiliated with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda. Note. The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the US government
| | - Patricia A Deuster
- All authors are with the Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD. Jessica L. Kegel, Josh B. Kazman, and Daniel R. Clifton are also affiliated with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda. Note. The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the US government
| | - Sarah J de la Motte
- All authors are with the Consortium for Health and Military Performance, Department of Military and Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD. Jessica L. Kegel, Josh B. Kazman, and Daniel R. Clifton are also affiliated with the Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda. Note. The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense. The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of the Henry M. Jackson Foundation for the Advancement of Military Medicine Inc. Mention of trade names, commercial products, or organizations does not imply endorsement by the US government
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Breland JY, Patel ML, Wong JJ, Hoggatt KJ. Weight Perceptions and Weight Loss Attempts: Military Service Matters. Mil Med 2020; 185:e397-e402. [PMID: 31822913 DOI: 10.1093/milmed/usz413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION People who do not perceive themselves as overweight or obese are less likely to use weight loss treatments. However, little is known about weight perceptions and their association with weight loss attempts among people who have served in the military. They represent a special population with regard to weight perceptions as military personnel must meet strict weight standards to remain in military service. MATERIALS AND METHODS Using data from the U.S.-based 2013-2014 and 2015-2016 National Health and Nutrition Examination Surveys, we fit logistic regression models to determine whether people with overweight or obesity were: (1) more or less likely to underestimate their weight if they reported military service and (2) less likely to attempt weight loss if they underestimated their weight (stratifying by military status). Estimates were adjusted for sociodemographic factors, including objective weight class, gender, age, race/ethnicity, income ratio, comorbidities, and education. This work received exempt status from the Stanford University institutional review board. RESULTS Among 6,776 participants, those reporting military service had higher odds of underestimating their weight compared to those not reporting military service [OR (odds ratio): 1.44; 95% confidence interval (CI): 1.15, 1.79]. Underestimating weight was associated with lower odds of attempting weight loss among those reporting military service (OR: 0.20; CI: 0.11, 0.36) and those not reporting military service (OR: 0.27; CI: 0.22, 0.34). CONCLUSIONS This study offers the new finding that underestimating weight is more likely among people reporting military service compared to those not reporting military service. Findings are consistent with past work demonstrating that underestimating weight is associated with a lower likelihood of pursuing weight loss. To combat weight misperceptions, clinicians may need to spend additional time discussing weight-related perceptions and beliefs with patients. The present findings suggest such conversations may be especially important for people reporting military service. Future research should be designed to understand the effects of correcting weight misperceptions. This work would advance the science of weight management and offer ways to increase weight loss treatment engagement, prevent chronic conditions, and improve health outcomes, especially among people reporting military service.
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Affiliation(s)
- Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025
| | - Michele L Patel
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025.,Department of Psychology and Neuroscience, Duke University, 417 Chapel Dr., Durham, NC 27708
| | - Jessie J Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, 616 Serra Mall C100, Stanford, CA 94305-6055
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073.,Department of Epidemiology, UCLA Fielding School of Public Health, Box 951772, Los Angeles, CA 90095-1772
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5
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Shams-White MM, Chui K, Deuster PA, McKeown NM, Must A. Comparison of Anthropometric Measures in US Military Personnel in the Classification of Overweight and Obesity. Obesity (Silver Spring) 2020; 28:362-370. [PMID: 31904192 DOI: 10.1002/oby.22675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 09/17/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study aimed to determine (1) the level of agreement between BMI, circumference-based equation (CBE) measures, waist circumference (WC), and bioelectrical impedance analysis (BIA) measures and (2) whether BMI, CBE measures, or WC alone or in combination adequately reflects adiposity in military personnel compared with BIA. METHODS BMI from measured height and weight (using military overweight cutoffs in men [BMI ≥ 27.5 kg/m2 ] and World Health Organization overweight cutoffs [BMI ≥ 25.0 kg/m2 ]), BMI body fat percentage (BF%), WC, CBE BF%, and BIA BF% were collected. Respondents (N = 389, 78% men) were categorized with normal fat versus overweight, obesity, or overfat. Levels of agreement and standard screening performance measures were compared between anthropometric measures and BIA. RESULTS World Health Organization BMI and BIA BF% classified the most men and women with overweight/obesity; WC with BMI (BMI + WC) and WC alone classified the fewest men and women with overweight/obesity. Levels of agreement were all statistically significant and highest for BMI (men: Cohen's κ = 0.711; women: Cohen's κ = 0.814) and lowest for WC and BMI + WC (all Cohen's κ ≤ 0.270). BMI + CBE performed best overall (sensitivity = 50.9%, false discovery rate = 5.4%). CONCLUSIONS Our findings support BMI + CBE as an easy-to-implement combination to assess adiposity in the military.
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Affiliation(s)
- Marissa M Shams-White
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth Chui
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, Massachusetts, USA
| | - Patricia A Deuster
- Department of Military and Emergency Medicine, Consortium for Health and Military Performance, Department of Defense Center of Excellence, Uniformed Services University, Bethesda, Maryland, USA
| | - Nicola M McKeown
- Jean Mayer USDA Human Nutrition Research Center on Aging, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Aviva Must
- Department of Public Health and Community Medicine, School of Medicine, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
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Shams-White MM, Cuccia A, Ona F, Bullock S, Chui K, McKeown N, Must A. Lessons Learned From the Creating Active Communities and Healthy Environments Toolkit Pilot: A Qualitative Study. ENVIRONMENTAL HEALTH INSIGHTS 2019; 13:1178630219862231. [PMID: 31320799 PMCID: PMC6628517 DOI: 10.1177/1178630219862231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 06/10/2023]
Abstract
The US Army Public Health Center developed the Creating Active Communities and Healthy Environments (CACHE) Toolkit to help military installations evaluate the quality of their built environments relative to healthy eating, physical activity, and tobacco-free living. This study sought to improve its implementation process and assess subsequent Action Plan Guides' utility at 5 military installations. Baseline data included a knowledge, attitudes, and beliefs survey (N = 34); post-Toolkit implementation data included focus groups (N = 2) and interviews (N = 10). Although >80% of participants agreed the built environment affects healthy living, only 44%, 53%, and 35% agreed their installations' built environments promoted healthy eating, physical activity, and tobacco-free living, respectively. Emerging themes comprised "Opportunities to Improve Toolkit and Action Plan Guide Functionality," the "Sociopolitical Landscape Affects Toolkit Implementation," and the "Sociopolitical and Physical Landscapes Affect the Toolkit's Value and Utility." This study provides concrete lessons for the CACHE Toolkit and other public health-based military initiatives.
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Affiliation(s)
- Marissa M Shams-White
- Friedman School of Nutrition Science and
Policy, Tufts University, Boston, MA, USA
- Cancer Prevention Fellowship Program,
Division of Cancer Prevention, National Cancer Institute, National Institutes of
Health, Rockville, MD, USA
| | - Alison Cuccia
- NorthTide Group, LLC in support of the
Public Health Assessment Division, Health Promotion and Wellness Directorate, U.S.
Army Public Health Center, Blackhawk Road, Aberdeen Proving Ground, MD, USA
| | - Fernando Ona
- Department of Public Health and
Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Steven Bullock
- Public Health Enterprise Performance
Improvement Division, Product Management Directorate, US Army Public Health Center,
Aberdeen Proving Ground, MD, USA
| | - Kenneth Chui
- Department of Public Health and
Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Nicola McKeown
- Friedman School of Nutrition Science and
Policy, Tufts University, Boston, MA, USA
- Cancer Prevention Fellowship Program,
Division of Cancer Prevention, National Cancer Institute, National Institutes of
Health, Rockville, MD, USA
| | - Aviva Must
- Friedman School of Nutrition Science and
Policy, Tufts University, Boston, MA, USA
- Cancer Prevention Fellowship Program,
Division of Cancer Prevention, National Cancer Institute, National Institutes of
Health, Rockville, MD, USA
- Department of Public Health and
Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
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