Proposed explanations for excess injury among veterans of the Persian Gulf War and a call for greater attention from policymakers and researchers

Risky Driving Behaviors for Older Adults: Differences by Veteran's Status

Veterans are at an increased risk of being injured or killed in motor vehicle crashes, potentially due to their proclivity to engage in risky driving behaviors. However, most research in this area has focused on driving behaviors of veterans who have recently returned home after deployment. No research has focused on risky driving behaviors of older veterans (aged 65 or older) and if risky driving behaviors extend beyond the time period immediately following return from deployment. The purpose of this research is to determine if differences exist in risky driving behaviors of veterans and non-veterans aged 65 or older. This study used data from the 2011 National Health and Aging Trend Study (NHATS), a nationally representative, longitudinal survey of community-dwelling, Medicare beneficiaries aged 65 or older. Binary logistic regression analyses were conducted in 2017 to determine if veteran's status was predictive of specific risky driving behaviors. Veteran's status was found to be predictive of specific driving behaviors for adults aged 65 and older, with non-veterans significantly more likely than veterans to: not currently drive; avoid driving at night; avoid driving alone; avoid driving on busy roads or highways; and avoid driving in bad weather. The results of this study highlight the need to further understand the effects of veteran's status on risky driving behaviors among older adults, specifically, whether veteran's status compounds driving-related risks associated with aging-related physical and mental changes.

Military Generation and Its Relationship to Mortality in Women Veterans in the Women's Health Initiative

PURPOSE OF THE STUDY

Women's military roles, exposures, and associated health outcomes have changed over time. However, mortality risk-within military generations or compared with non-Veteran women-has not been assessed. Using data from the Women's Health Initiative (WHI), we examined all-cause and cause-specific mortality by Veteran status and military generation among older women.

DESIGN AND METHODS

WHI participants (3,719 Veterans; 141,802 non-Veterans), followed for a mean of 15.2 years, were categorized into pre-Vietnam or Vietnam/after generations based on their birth cohort. We used cox proportional hazards models to examine the association between Veteran status and mortality by generation.

RESULTS

After adjusting for sociodemographic characteristics and WHI study arm, all-cause mortality hazard rate ratios (HRs) for Veterans relative to non-Veterans were 1.16 (95% CI: 1.09-1.23) for pre-Vietnam and 1.16 (95% CI: 0.99-1.36) for Vietnam/after generations. With additional adjustment for health behaviors and risk factors, this excess mortality rate persisted for pre-Vietnam but attenuated for Vietnam/after generations. After further adjustment for medical morbidities, across both generations, Veterans and non-Veterans had similar all-cause mortality rates. Relative to non-Veterans, adjusting for sociodemographics and WHI study arm, pre-Vietnam generation Veterans had higher cancer, cardiovascular, and trauma-related morality rates; Vietnam/after generation Veterans had the highest trauma-related mortality rates (HR = 2.93, 1.64-5.23).

IMPLICATIONS

Veterans' higher all-cause mortality rates were limited to the pre-Vietnam generation, consistent with diminution of the healthy soldier effect over the life course. Mechanisms underlying Vietnam/after generation Veteran trauma-related mortality should be elucidated. Efforts to modify salient health risk behaviors specific to each military generation are needed.

Preliminary findings of a novel measure of driving behaviors in Veterans with comorbid TBI and PTSD

Veterans of the military operations in Iraq and Afghanistan are at an elevated risk of driving-related accidents and fatalities compared with civilians. Combat exposure, military driving training, risk-seeking, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD) are all factors associated with driving-related risk. However, few empirical studies have observed driving patterns in this population, and the influence of these contributing factors remains unclear. This study utilized a novel self-report measure to assess driving behaviors, subjective driving-related anxiety, and the emotional experiences of military Veterans who have returned to civilian driving. This questionnaire was completed by 23 combat Veterans diagnosed with comorbid TBI and PTSD and 10 nondisabled combat Veterans. Drivers with TBI and PTSD reported more frequent high-risk driving behaviors and higher levels of anxiety while driving in certain situations than nondisabled combat Veterans. These preliminary findings highlight the importance of studying on-the-road situations and cues that produce anxiety in Veterans, particularly those with TBI and PTSD. A greater understanding of driving-related anxiety is needed to inform targeted and effective interventions for unsafe driving in Veterans.

The prevalence and correlates of risky driving behavior among National Guard soldiers

OBJECTIVE

Previous studies have reported that risky driving is associated with deployment and combat exposure in military populations, but there is limited research on risky driving among soldiers in the National Guard and Reserves, a group increasingly deployed to active international conflicts. The goal of this analysis was to assess the prevalence of risky driving and its demographic, mental health, and deployment-related correlates among members of the Ohio Army National Guard (OHARNG).

METHODS

The study group comprised 2,616 eligible OHARNG soldiers enlisted as of June 2008, or who enlisted between June 2008 and February 2009. The main outcome of interest was the prevalence of risky driving behavior assessed using six questions: "How often do you use seat belts when you drive or ride in a car?"; "In the past 30 days, how many times have you driven when you've had perhaps too much to drink?"; "In the past year, have you ever become impatient with a slow driver in the fast lane and passed them on the right?"; "In the past year have you crossed an intersection knowing that the traffic lights have already changed from yellow to red?"; "In the past year have you disregarded speed limits late at night or early in the morning?"; and "In the past year have you underestimated the speed of an oncoming vehicle when attempting to pass a vehicle in your own lane?" We fit multiple logistic regression models and derived the adjusted prevalence of risky driving behavior for soldiers with mental health conditions, deployment experience, exposure to combat or trauma, and psychosocial stressors or supports.

RESULTS

The prevalence of risky driving was higher in soldiers with a history of mental health conditions, deployment to a conflict area, deployment-related traumatic events, and combat or post-combat stressors. In contrast, the prevalence of risky driving was lower for soldiers who reported high levels of psychosocial support.

CONCLUSIONS

Efforts to mitigate risky driving in military populations may be more effective if they incorporate both targeted messages to remediate dangerous learned driving behaviors and psychosocial interventions to build resilience and address underlying stressors and mental health symptoms.

Deployment experiences and motor vehicle crashes among U.S. service members

BACKGROUND

Motor vehicle crashes (MVCs) continue to account for a third of service member fatalities each year. Sociodemographic factors associated with MVCs among service members have been evaluated, but whether deployment-specific experiences during the recent operations are associated with a higher risk of MVCs is unclear.

PURPOSE

Evaluate if military members with specific deployment experiences are at an increased risk of MVCs, while taking into account several potential confounders.

METHODS

Millennium Cohort Study participants who enrolled during 2001-2006 and were on active-duty service were evaluated. The Military Health System Data Repository (MDR) was used to investigate MVC-related injuries occurring 6 months postdeployment in relation to service-related factors, while adjusting for demographic, behavioral, and mental and physical health factors. Analysis conducted in 2012 used Cox proportional hazards modeling.

RESULTS

There were 13,620 deployed personnel included in this study. After adjusting for covariates, deployers with combat experiences (hazard ratio [HR]=1.86, 95% CI=1.33, 2.62) and those with more than one deployment (two deployments, HR=1.93, 95% CI=1.32, 2.83; three or more deployments, HR=2.83, 95% CI=1.71, 4.67) had an increased risk for an MVC within 6 months postdeployment. Enlisted rank and non-Hispanic black race/ethnicity were also associated with increased risk for MVCs.

CONCLUSION

Experiencing combat during deployment and multiple deployments are both strong predictors for MVCs within 6 months of returning home among U.S. military members. These data provide critical information for targeting prevention strategies to decrease MVCs among personnel postdeployment.

Risk propensity and health risk behaviors in U.S. army soldiers with and without psychological disturbances across the deployment cycle

Anecdotal and preliminary evidence suggests that Soldiers returning from a combat deployment engage in an increased number of health risk behaviors. Three potential factors driving this change were examined in this study; posttraumatic stress disorder (PTSD), concussion and traumatic brain injury (TBI), and perceived invincibility. We studied members of a combat arms brigade one month prior to a deployment to Iraq and approximately one month after their return (N = 319). Participants anonymously completed surveys characterizing attitudes about risk, risk propensity, invincibility, engagement in health risk behaviors, and personality. Using standardized screening instruments, participants were categorized with respect to PTSD and probable TBI. Results suggest that Soldiers engage in more alcohol use and reckless driving behaviors post-deployment. These changes were exaggerated in those who screened positive for PTSD. Perception of one's invincibility and survival skills increased post-deployment thus suggesting that participants felt less susceptible to adverse consequences and more adept at surviving dangerous situations. This study provides documentation of the pattern of health behavior in Soldiers engaged in the deployment cycle. Our findings suggest increases in the number of risks Soldiers' engage in post-deployment are not limited to those with PTSD symptomtotology. This study has implications for not only adjustment to life post-deployment at the individual level but also operational readiness.

Health impact of US military service in a large population-based military cohort: findings of the Millennium Cohort Study, 2001-2008

BACKGROUND

Combat-intense, lengthy, and multiple deployments in Iraq and Afghanistan have characterized the new millennium. The US military's all-volunteer force has never been better trained and technologically equipped to engage enemy combatants in multiple theaters of operations. Nonetheless, concerns over potential lasting effects of deployment on long-term health continue to mount and are yet to be elucidated. This report outlines how findings from the first 7 years of the Millennium Cohort Study have helped to address health concerns related to military service including deployments.

METHODS

The Millennium Cohort Study was designed in the late 1990s to address veteran and public concerns for the first time using prospectively collected health and behavioral data.

RESULTS

Over 150,000 active-duty, reserve, and National Guard personnel from all service branches have enrolled, and more than 70% of the first 2 enrollment panels submitted at least 1 follow-up survey. Approximately half of the Cohort has deployed in support of operations in Iraq and Afghanistan.

CONCLUSION

The Millennium Cohort Study is providing prospective data that will guide public health policymakers for years to come by exploring associations between military exposures and important health outcomes. Strategic studies aim to identify, reduce, and prevent adverse health outcomes that may be associated with military service, including those related to deployment.

War-related stress exposure and mortality: a meta-analysis

BACKGROUND

Domestic and international wars continue to be pervasive in the 21st century. This study summarizes the effects of war-related stress on all-cause mortality using meta-analyses and meta-regressions.

METHODS

A keyword search was performed, supplemented by extensive iterative hand-searches for observational studies of war-related stress and mortality. Two hundred and twenty mortality risk estimates from 30 studies were extracted, providing data on more than 9 million persons.

RESULTS

The mean hazard ratio (HR) was 1.05 [95% confidence interval (CI) 0.98-1.13] among HRs adjusted for age and additional covariates. The mean effect for men was 1.14 (CI 1.00-1.31), and for women it was 0.92 (CI 0.66-1.28). No differences were found for various follow-up durations or for various types of war stress. Neither civilians nor military personnel had an elevated mortality risk. Those exposed to a combat zone during the Vietnam War had a slightly higher chance of death (HR 1.11; 95% CI 1.00-1.23).

CONCLUSIONS

The results show that, over all, exposure to war-stress did not increase the risk of death when studies were well controlled. Effects were small when found. This lack of substantial effect may be the result of selection processes, developed resiliency and/or institutional support.

Aggressive and unsafe driving in male veterans receiving residential treatment for PTSD

Aggressive and unsafe driving was examined in 474 male veterans receiving Veterans Affairs residential treatment for posttraumatic stress disorder (PTSD). Specifically, the authors evaluated if PTSD was associated with aggressive and unsafe driving and if Iraq and Afghanistan War veterans were at higher risk than other war veterans. Approximately two thirds of the sample reported lifetime aggressive driving and one third reported current aggressive driving. Posttraumatic stress disorder severity was associated with aggressive driving, but not other forms of unsafe driving. Iraq and Afghanistan veterans endorsed higher rates of and more frequent aggressive driving than did other veterans. After accounting for PTSD severity, age, income, and marital status being an Iraq and Afghanistan War veteran predicted aggressive driving frequency and infrequent seatbelt use.

The use of electronic pharmacy data to investigate prescribed medications and fatal motor vehicle crashes in a military population, 2002-2006

The authors examined the association between prescribed medications and fatal motor vehicle crashes (MVCs) in an active duty military population between 2002 and 2006. Using a case-control design, MVC deaths were ascertained using a military mortality registry, and an integrated health system database provided information on health system eligibility, pharmacy transactions, and medical encounters. Cases and controls were matched on comparable observation time outside periods of deployment. Among selected categories, only one, antidepressant medications, was an independent predictor of fatal MVC (odds ratio, 3.19; 95% confidence interval, 1.01-10.07). Male gender, Black race, enlisted rank, service branch (Navy and Marine Corps), and selected co-morbidities were also independent predictors. Unexpectedly, the odds of younger age quartiles (< 27 years) and history of deployment were reduced for MVC cases. Although results need to be considered in the context of data limitations, the association between prescribed antidepressants and fatal MVC may reflect unmeasured co-morbidities, such as combined effects of prescribed and over-the-counter medications and/or alcohol or other substance abuse. Younger individuals, representing new military accessions in training or returning from deployment with serious injuries, may have fewer opportunities to operate vehicles, or targeted efforts to reduce MVC following deployment may be showing a positive effect.

A systematic review of post-deployment injury-related mortality among military personnel deployed to conflict zones

BACKGROUND

This paper reports on a systematic review of the literature on the post-conflict injury-related mortality of service members who deployed to conflict zones.

METHODS

Literature databases, reference lists of articles, agencies, investigators, and other sources were examined to find studies comparing injury-related mortality of military veterans who had served in conflict zones with that of contemporary veterans who had not served in conflict zones. Injury-related mortality was defined as a cause of death indicated by International Classification of Diseases E-codes E800 to E999 (external causes) or subgroupings within this range of codes.

RESULTS

Twenty studies met the review criteria; all involved veterans serving during either the Vietnam or Persian Gulf conflict. Meta-analysis indicated that, compared with non-conflict-zone veterans, injury-related mortality was elevated for veterans serving in Vietnam (summary mortality rate ratio (SMRR) = 1.26, 95% confidence interval (95%CI) = 1.08-1.46) during 9 to 18 years of follow-up. Similarly, injury-related mortality was elevated for veterans serving in the Persian Gulf War (SMRR = 1.26, 95%CI = 1.16-1.37) during 3 to 8 years of follow-up. Much of the excess mortality among conflict-zone veterans was associated with motor vehicle events. The excess mortality decreased over time. Hypotheses to account for the excess mortality in conflict-zone veterans included post-traumatic stress, coping behaviors such as substance abuse, ill-defined diseases and symptoms, lower survivability in injury events due to conflict-zone comorbidities, altered perceptions of risk, and/or selection processes leading to the deployment of individuals who were risk-takers.

CONCLUSION

Further research on the etiology of the excess mortality in conflict-zone veterans is warranted to develop appropriate interventions.

Risky driving among regular armed forces personnel from the United Kingdom

BACKGROUND

Road traffic accidents are the leading cause of death for service personnel from the United Kingdom (UK). Little is known about the pattern of risky driving by these service personnel.

METHODS

Cross-sectional data (collected postdeployment, between June 2004 and March 2006) were analyzed from a large, randomly selected cohort of military personnel from the UK. These analyses were limited to regular-service personnel who were drivers (n=8,127; 7,443 men and 684 women). "Risky driving" (not wearing a seatbelt, speeding, or both) was examined. Analyses were then repeated but restricted to those with experience of deployment to Iraq (n=4,611). All analyses were undertaken during 2007.

RESULTS

Nineteen percent of armed forces personnel from the UK were defined as risky drivers. Risky driving was associated with being of young age; being male; being in the Army; childhood adversity; being deployed to Iraq; having a combat role; and being separated, divorced, or widowed. Restricting analyses to those deployed to Iraq revealed that risky driving was associated with increasing exposure to traumatic events and low in-theater morale.

CONCLUSIONS

There are clear sociodemographic associations of risk-taking behaviors in the military population, and the study's results imply that risky driving is more common in drivers who had deployed.

Alcohol use and alcohol-related problems before and after military combat deployment

CONTEXT

High rates of alcohol misuse after deployment have been reported among personnel returning from past conflicts, yet investigations of alcohol misuse after return from the current wars in Iraq and Afghanistan are lacking.

OBJECTIVES

To determine whether deployment with combat exposures was associated with new-onset or continued alcohol consumption, binge drinking, and alcohol-related problems.

DESIGN, SETTING, AND PARTICIPANTS

Data were from Millennium Cohort Study participants who completed both a baseline (July 2001 to June 2003; n=77,047) and follow-up (June 2004 to February 2006; n=55,021) questionnaire (follow-up response rate = 71.4%). After we applied exclusion criteria, our analyses included 48,481 participants (active duty, n = 26,613; Reserve or National Guard, n = 21,868). Of these, 5510 deployed with combat exposures, 5661 deployed without combat exposures, and 37 310 did not deploy.

MAIN OUTCOME MEASURES

New-onset and continued heavy weekly drinking, binge drinking, and alcohol-related problems at follow-up.

RESULTS

Baseline prevalence of heavy weekly drinking, binge drinking, and alcohol-related problems among Reserve or National Guard personnel who deployed with combat exposures was 9.0%, 53.6%, and 15.2%, respectively; follow-up prevalence was 12.5%, 53.0%, and 11.9%, respectively; and new-onset rates were 8.8%, 25.6%, and 7.1%, respectively. Among active-duty personnel, new-onset rates were 6.0%, 26.6%, and 4.8%, respectively. Reserve and National Guard personnel who deployed and reported combat exposures were significantly more likely to experience new-onset heavy weekly drinking (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.36-1.96), binge drinking (OR, 1.46; 95% CI, 1.24-1.71), and alcohol-related problems (OR, 1.63; 95% CI, 1.33-2.01) compared with nondeployed personnel. The youngest members of the cohort were at highest risk for all alcohol-related outcomes.

CONCLUSION

Reserve and National Guard personnel and younger service members who deploy with reported combat exposures are at increased risk of new-onset heavy weekly drinking, binge drinking, and alcohol-related problems.

Wartime stressors and mental health symptoms as predictors of late-life mortality in World War II survivors

BACKGROUND

Pathways through which wartime stress leads to excess mortality have not been examined so far. The current study examines wartime stress in relation to late-life mortality among 1448 World War II survivors, and potential mediating effects of mental health symptoms that were assessed in 1992.

METHODS

In 1992, a community survey was held. In 2002, vital status was checked.

RESULTS

The highest hazard rates of mortality were found among military veterans and war survivors who had been seriously wounded. Posttraumatic stress disorder, suicidal thoughts, and, particularly, depression were associated with a higher hazard rate. Depression, anxiety, and somatic complaints appeared to act as mediators between the wartime stressor 'permanent disability or illness' and survival time.

LIMITATIONS

The results may not be generalizable to all World War II survivors since the sample was restricted to those who survived until 1992. In addition, there was a considerable level of non-response, and the study used self-report data on wartime exposure and psychological symptoms.

CONCLUSIONS

Exposure to wartime stress as well as mental health symptoms in the long-term aftermath of war and violence are significant predictors of late-life mortality. Wounded survivors and those with a permanent disability or illness are particularly vulnerable.

Health services use among Gulf War veterans and Gulf War era nondeployed veterans: a large population-based survey

We sought to analyze the self-reported hospitalization, emergency department visits, and outpatient visits of Persian Gulf War (deployed; n=1896) and Persian Gulf War-era (nondeployed; n=1799) military personnel 5 years postconflict to determine whether these groups had different rates of health care use. Compared with personnel who had not been deployed, personnel who had been deployed were more likely to have visited an emergency department (25% vs 21%; odds ratio [OR]=1.24; 95% confidence interval [CI] = 1.06, 1.51]). Among these groups, the National Guard and Reserve personnel were more likely to have been hospitalized than were the regular military personnel (OR= 1.65; 95% CI=1.21, 2.26).

External-cause mortality after psychologic trauma: the effects of stress exposure and predisposition

Research suggests that exposure to psychologic trauma is associated with mortality from external causes, including homicide, suicide, drug overdoses, and unintended injury. However, the etiology of this association is unclear. We examined the survival time and cause of death among a national sample of 15288 US Army veterans by posttraumatic stress disorder (PTSD) status 30 years after military service. In these analyses, we included demographic (age, race, marital status, service entry age, and birthplace), predisposing (army volunteer status, discharge status, history of drug abuse, early-age alcohol use, and intelligence), and combat exposure variables. After adjusting for demographic and predisposing factors, all-cause mortality was associated with PTSD for all veterans combined (hazards ratio [HR] = 2.1, P < .001), as well as for era veterans without Vietnam service (HR = 2.0, P = .001) and theater veterans with Vietnam service (HR = 2.1, P < .001). For theater veterans, PTSD remained significant for all-cause mortality, even after controlling for demographic, predisposition, and combat exposure measures (HR = 2.1, P < .001). For external mortality, the adjusted results indicated that PTSD was associated with death for all veterans combined (HR = 2.3, P < .001) and for theater veterans separately (HR = 2.2, P = .002). For era veterans, the adjusted external mortality results also approached statistical significance (HR = 2.2, P = .068). Among theater veterans, PTSD remained significant for external mortality, even after controlling for all variables and combat exposure (HR = 2.2, P = .002). Combat exposure was not associated with external mortality once all variables were controlled. In addition, theater veterans who volunteered for Vietnam and those with dishonorable discharges were at increased risk for external-cause mortality.

Understanding the effect of deployment on the risk of fatal motor vehicle crashes: a nested case-control study of fatalities in Gulf War era veterans, 1991-1995

Motor vehicle crashes (MVCs) are an important cause of morbidity and premature loss of life among military personnel during peacetime and particularly following combat. A nested case-control study of fatal MVC occurring between 1991 and 1995 was conducted in a cohort of Gulf War era veterans. Cases were validated MVC deaths in the Fatality Analysis Reporting System. Controls were selected using risk set sampling by gender and year of case ascertainment in a 10:1 ratio. Preliminary results, consistent with previous reports of increased fatal MVC risk among returning combat veterans, showed a crude odds ratio of 1.45 (95% confidence interval 1.27-1.65). Multivariable logistic regression modeling was used to identify important independent predictors, as well as to quantify the influence of deployment on a risk profile for fatal MVC. Because of significant interaction between deployment and inpatient diagnosis of substance abuse, the final model was stratified by deployment status. Results suggest that demographic, military, and behavioral characteristics of deployed healthy warriors are similar to the risk profile for fatal MVC. In addition to young, single, high school-educated, enlisted male personnel, those who served during times of ground combat, particularly in infantry, gun crews, or seamanship occupations, should be targeted for preventive interventions.

Healthcare utilization and mortality among veterans of the Gulf War

The authors conducted an extensive search for published works concerning healthcare utilization and mortality among Gulf War veterans of the Coalition forces who served during the 1990-1991 Gulf War. Reports concerning the health experience of US, UK, Canadian, Saudi and Australian veterans were reviewed. This report summarizes 15 years of observations and research in four categories: Gulf War veteran healthcare registry studies, hospitalization studies, outpatient studies and mortality studies. A total of 149728 (19.8%) of 756373 US, UK, Canadian and Australian Gulf War veterans received health registry evaluations revealing a vast number of symptoms and clinical conditions but no suggestion that a new unique illness was associated with service during the Gulf War. Additionally, no Gulf War exposure was uniquely implicated as a cause for post-war morbidity. Numerous large, controlled studies of US Gulf War veterans' hospitalizations, often involving more than a million veterans, have been conducted. They revealed an increased post-war risk for mental health diagnoses, multi-symptom conditions and musculoskeletal disorders. Again, these data failed to demonstrate that Gulf War veterans suffered from a unique Gulf War-related illness. The sparsely available ambulatory care reports documented that respiratory and gastrointestinal complaints were quite common during deployment. Using perhaps the most reliable data, controlled mortality studies have revealed that Gulf War veterans were at increased risk of injuries, especially those due to vehicular accidents. In general, healthcare utilization data are now exhausted. These findings have now been incorporated into preventive measures in support of current military forces. With a few diagnostic exceptions such as amyotrophic lateral sclerosis, mental disorders and cancer, it now seems time to cease examining Gulf War veteran morbidity and to direct future research efforts to preventing illness among current and future military personnel.

Fatal motor vehicle crashes among veterans of the 1991 Gulf War and exposure to munitions demolitions at Khamisiyah: a nested case-control study

BACKGROUND

A proposed explanation for the observed higher risk of fatal motor vehicle crashes (MVC) among 1991 Gulf War-deployed veterans is neurocognitive deficits resulting from nerve agent exposure at Khamisiyah, Iraq. Our objective was to assess any association between postwar fatal MVC and possible nerve agent exposure based on 2000 modeled plume data.

METHODS

Cases were defined as MVC deaths with a record in the Department of Transportation Fatality Analysis Reporting System through 1995. Cases (n = 282) and controls (n = 3,131) were derived from a larger nested case-control study of Gulf War-era veterans and limited to Army, male, deployed personnel. Exposure and cumulative dose by case-control status were analyzed using multivariate techniques.

RESULTS

Exposure status was not associated with fatal MVC (OR 0.96, 95% CI 0.72-1.26), nor were tertiles of cumulative dose.

CONCLUSIONS

Findings do not support an association between possible exposures at Khamisiyah and postwar fatal MVC among Gulf War veterans.

Motor vehicle fatalities among Gulf War era veterans: characteristics, mechanisms, and circumstances

OBJECTIVES

Our objective was to describe fatal motor vehicle crashes (MVC) among veterans of the 1991 Gulf War era and to compare the distribution of crash and individual characteristics between those deployed to the Gulf War (GWV) and those not deployed (NDV).

METHODS

We compared individual characteristics, crash mechanisms, and crash circumstances between 765 GWV and 553 NDV who died from MVC within the first five years of the war, between May 1991 and December 1995.

RESULTS

Overall, GWV and NDV who died from a MVC were more likely to be enlisted males (97%), 21-30 years old (72%), have a high school education or less (91%), drive a passenger car (52%), and not use restraints (60%). The overall annual rate of motor vehicle fatalities for GWV (23.6 per 100,000; 95% confidence interval: 21.9-25.3) was significantly greater than the rate for NDV (15.9, 95% CI: 14.6-17.3). GWV with the highest motor vehicle fatality rates include males (24.8, 95% CI: 23.0-26.6), 17-20 year olds (105.0, 95% CI: 78.2-138.1), and those not married (27.3, 95% CI: 25.1-30.1). Adjusting for differences in age distribution across GWV and NDV did not account for the difference in rates. Characteristics of MVC fatalities that were over-represented among GWV include serving as regular active duty (p = 0.001), having a high school education or less (p = 0.01), being involved in a single-vehicle crash (p = 0.008), and dying within the first hour following the crash (p = 0.004). Also, we identified a greater proportion of alcohol-related crashes among GWV during the late night and early morning hours.

CONCLUSIONS

The highest rates of motor vehicle fatality among young, single males in the military mirror the experience of the general population. Further research is necessary to determine modifiable risk factors that can be targeted for specific interventions and whether the elevated late night alcohol-related crash rate among GWV is an effect of deployment or an inherent population bias among those selected for operational deployments.

Long-term mortality amongst Gulf War Veterans: is there a relationship with experiences during deployment and subsequent morbidity?

BACKGROUND

Gulf War Veterans have previously been shown to have, in the short-term, an excess risk of death from 'external' (i.e. non-disease) causes of death. This study aims to determine whether there remains an excess of non-disease-related deaths in Gulf Veterans, 13 years after deployment, and, for the first time, to determine whether there is a relationship between experiences reported in the Gulf, post-war symptoms, and subsequent mortality experience.

METHODS

We conducted a cohort study with follow-up from April 1, 1991 (the end of the Gulf War) to June 30, 2004. Participants were 53 462 Gulf War Veterans and a cohort of military personnel, matched for age-group, sex, rank, service and level of fitness, who were not deployed to the Gulf. The outcome measure used was mortality as recorded on the NHS central register.

RESULTS

There is no difference, 13 years after the end of the Gulf War, in the overall mortality experience of Gulf War Veterans. The excess in non-disease-related deaths previously reported is confined to the initial 7 years of follow-up [mortality rate ratio (MRR) 1.31, 95% confidence interval (CI) 1.06-1.63] rather than the more recent period (MRR 1.05, 95% CI 0.83-1.33). Overall experiences reported during Gulf deployment did not influence subsequent risk of dying, but there was non-significant increased risk of dying from a disease-related death (MRR 1.99, 95% CI 0.98-4.04) associated with reported exposure to depleted uranium and of a non-disease-related death associated with reporting handling of pesticides (MRR 2.05, 95% CI 0.91-4.61). Reporting of morbidity in the health surveys conducted was not related to future risk of death.

CONCLUSION

The higher rates of non-disease-related deaths in Gulf War Veterans is not evident in the period of follow-up since 1997. Neither the excess morbidity reported in health surveys nor the experiences during deployment significantly influenced future mortality. The two non-significant associations found (reported depleted uranium exposure and disease death, reporting handling pesticides and non-disease deaths) need to be considered in the context of the number of possible associations examined and potential biases-although they are biologically plausible.

Biofield detection: role of bioenergy awareness training and individual differences in absorption

OBJECTIVE

To measure health care providers' capacity to detect biofields before and after bioenergy awareness training in relation to individual differences in the personality trait of absorption.

METHODS

Twenty-seven (27) physicians, psychologists, and nurses participated in a 5-day intensive bioenergy healing training course with Rev. Rosalyn Bruyere. The course was part of the Associate Fellows Program in the Program in Integrative Medicine at the University of Arizona. Blindfolded participants received a 24-trial hand biofield detection test (HBDT) pretraining and post-training. The experimenter placed his or her dominant hand a few inches above the participant's left or right hand for 30-second trials. After each trial, the participant guessed which hand was being tested. Blocks contained two right- and two left-hand trials in different orders. Participants filled out Tellegen's Absorption Scale, a measure of the capacity to focus attention in tasks.

RESULTS

Percent HBDT accuracy for the entire sample was 50.8% (standard deviation [SD] = 12.24) at pretraining (50% is chance); accuracy increased to 55.5% (SD = 12.38) at post-training (t = p = 2.08, p < 0.05). Pretraining absorption (mean = 23.9; SD = 5.52) was significantly correlated with degree of detection accuracy increase (r = 0.42, n = 22, p < 0.05). High absorption (mean = 28.2 n = 11) participants increased to 58.3% compared to 52.7% for low absorption (mean = 19.2 n = 11) participants.

CONCLUSION

The findings support claims of energy healers that (1) training can improve bioenergy awareness, and (2) there are substantial individual differences in response to training.

After more than 10 years of Gulf War veteran medical evaluations, what have we learned?

Since the 1991 Gulf War, more than 10 years and 1 billion dollars of health evaluations and research have been invested in understanding illnesses among Gulf War veterans. We examined the extensive published healthcare utilization data in an effort to summarize what has been learned. Using multiple search techniques, data as of June 2003 from four different national Gulf War health registries and numerous hospitalization and ambulatory care reports were reviewed. Thus far, published reports have not revealed a unique Gulf War syndrome nor identified specific exposures that might explain postwar morbidity. Instead, they have demonstrated that Gulf War veterans have had an increase in multi-symptom condition, injury, and mental health diagnoses. While these diagnoses are similar to those experienced by other comparable military populations, their explanation is not fully understood. New strategies to identify risk factors for, and to reduce, such postdeployment conditions are summarized.

Behavioral, demographic, and prior morbidity risk factors for accidental death among men: a case-control study of soldiers

BACKGROUND

In the United States, the leading cause of death for young men is unintentional injury. The experience of the U.S. Army, because it comprises mostly young men, provides insights into factors associated with risk of accidental death. Between 1990 and 1998, accidents accounted for more than half of all deaths of men on active duty in the U.S. Army.

METHODS

All men on active duty in the U.S. Army who died in an accident between 1990 and 1998 were included in the study. For each accidental death case, four randomly selected controls were also included, matched on gender and contemporaneous military service.

RESULTS

In multivariate analyses, accidental death victims were more likely to be unmarried, limited to a high school education, in combat-specific occupations, veterans of a recent deployment, and previously hospitalized for an "injury/poisoning," "mental disorder," or "sign/symptom/ill-defined condition." Of behaviors reported on routine health risk assessments, the strongest predictor of a subsequent fatal accident was motorcycle use while the most excess deaths were attributable to consuming more than five alcoholic drinks per week.

CONCLUSIONS

There are characteristics, experiences, and behaviors that predict accidental death risk. The findings may inform safety and health promotion programs aimed at young adults.