Predictors of reintegration adjustment among female U.S. Army spouses: A preliminary exploration

LAY SUMMARY

Little is known about how military families navigate the challenges they experience during reintegration, the period after a deployment separation when a service member returns home and families must readjust to their presence. This study considers how family risk factors such as the mental health of both partners and protective factors such as social support and participation in military-sponsored training influence family adjustment during reintegration. Military spouses who reported having more social support were likely to report that their families adjusted more quickly during reintegration. However, spouses who expressed concern about a partner’s mental health were less likely to feel prepared for reintegration and, in turn, were more likely to report that their families adjusted more slowly. The results of this study suggest that supporting military spouses in feeling more prepared for reintegration may be an important means to shorten the adjustment period after a deployment.

Intimate Partner Violence Perpetration Among Military Spouses

Military spouses are an understudied population with respect to intimate partner violence (IPV) perpetration. Due to the unique demands of service members' jobs, military couples are documented to experience particular individual, couple, and family-level risk factors that may lead to IPV perpetration. Using the frustration-aggression hypothesis and considering the possibility of mutual violence, we examined (a) the direct effects of stressful events, marital discord, and work-family conflict on IPV perpetration among military spouses and (b) the indirect effect of anger arousal between stressful events, marital discord, and work-family conflict on IPV perpetration. This study is a secondary analysis of data drawn from a survey of army spouses conducted by the Walter Reed Army Institute of Research in 2012. The sample consists of 314 female spouses of active-duty members (white 75%, enlisted 80%). After controlling for covariates (including spouse race, rank, household size, age, living distance from military installation), the direct effects of marital discord and anger on IPV perpetration were statistically significant. Also, the direct effects of marital discord and work-family conflict on anger were significant. The path model demonstrated that the indirect effects of marital discord and work-family conflict on IPV perpetration via anger were significant. Finally, most physical and verbal violence was reported to occur in the form of mutual violence with their partners. Study findings suggest that the pathway of risk factors impacting IPV might differ depending on the sources of stress. The Family Advocacy Program, military social work practitioners, and other behavioral health providers should consider domains of risk and provide support to military spouses that is specifically tailored to these risk factors. Furthermore, considering the mediating role of anger arousal in the relationship between marital discord, work-family conflict and IPV, programs to address anger might be helpful to reduce IPV among military spouse perpetrators.

Association between cumulative risk and protective factors with mental distress among female military spouses

OBJECTIVE

Guided by a resilience framework, this study examines the accumulation of risk and protective factors, as well as the potential buffering effects of protective factors on mental distress among female military spouses.

BACKGROUND

Most research with this population has focused on individual risk factors affecting military spouses. Less frequently have the effects of cumulative risk, risk factors not specifically associated with military service, or protective factors been examined, though there is evidence for their importance.

METHOD

This study used secondary survey data from 334 female Army spouses collected in 2012 as part of the Land Combat Study 2. Cumulative risk and protective factor scores as well as scores within risk (intrapersonal, family, and military-specific) and protective (individual and environmental) factor domains were calculated. Four structural equation models were run to examine main and interaction effects on mental distress, a latent variable representing depression, anxiety, and trauma symptoms.

RESULTS

In cumulative risk and protective factor models, cumulative risk was directly, positively associated with mental distress. This relationship was moderated by cumulative protection. In domain-specific models, only family risk was directly associated with mental distress. This relationship was moderated by environmental protective factors.

CONCLUSION

Findings indicate mental distress among military spouses is associated with exposure to cumulative risk and attenuated by the presence of certain domains of protective factors. Family risk factors including marital distress and work-family conflict may be particularly pernicious stressors, but informal and structural supports may be important targets for prevention and intervention efforts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sleep leadership in the army: A group randomized trial

OBJECTIVES

Examine impact of training military leaders in sleep health on leaders and unit members.

DESIGN

Following a baseline survey, two-person platoon leadership teams were randomly assigned by company to a training or waitlist control condition. After training, leadership teams completed a post-training survey. Six weeks later, leaders and unit members completed a final survey.

SETTING

Classroom-style areas on a US military base.

PARTICIPANTS

US soldiers (76 leaders and 448 unit members) from 39 platoons across 14 companies in a brigade combat team.

INTERVENTION

One-hour training in sleep leadership.

MEASUREMENTS

Leaders were surveyed about sleep knowledge, sleep attitudes, sleep training, sleep quantity, sleep quality and sleep problems. Unit members were surveyed about sleep leadership behaviors, sleep hours, sleep quality and sleep problems.

RESULTS

Leaders rated the training highly and most knowledge and some attitudes about sleep improved from the baseline to post-training survey. Fewer leaders in the training condition reported sleep problems at follow-up than those in the waitlist control condition; there were no differences in sleep hours or sleep quality. More unit members with leaders in the training condition reported that their leaders engaged in sleep leadership behaviors at least sometimes and reported sleeping at least 7 hours/24 hours period than did unit members in the waitlist control condition; sleep quality and sleep problems did not differ by condition.

CONCLUSIONS

Results suggest a simple training intervention targeting leaders may be able to shift sleep health and the cultural perspective on sleep across an organization.

Leader provided purpose: Military leadership behavior and its association with suicidal ideation

Suicide in U.S. Army Soldiers is of major concern as it is estimated that over 100 Soldiers die by suicide each year. Examining risk and protective factors is essential to develop both an understanding of Soldier suicide as well as inform systemic interventions to reduce suicide. One potential systemic approach is to embed preventive mechanisms within the structure of the military rather than the typical administration of primary intervention through mandatory training. To examine potential mechanisms of leader-based interventions, several leadership behaviors were assessed in a cross-sectional sample of n = 1,096 active duty Soldiers. Soldiers completed self-report measures of interpersonal predictors of suicide, suicidal ideation (SI), leadership behaviors, and unit cohesion. Logistic regression was used to identify leadership behaviors related to SI. Only the leader behavior attempting to foster a sense of purpose predicted SI. Leader provided purpose (LPP) was then entered into indirect effect analyses to evaluate the mechanisms of this relationship. Analyses revealed that LPP predicted SI through unit cohesion, thwarted belongingness, and perceived burdensomeness. Results demonstrate that specific aspects of military leadership such as fostering Soldier purpose may enhance resilience and reduce risk for SI.

p53 peptide prevents LITAF-induced TNF-alpha-mediated mouse lung lesions and endotoxic shock

Abnormal and prolonged inflammatory reaction is seen in a wide variety of disorders, and high level of Tumor Necrosis Factor alpha (TNF-α) has been linked to these disorders. Therefore, modulation of TNF-α expression is important in the regulation of inflammatory disorders. In our previous study, we have shown that a transcription factor LPS-induced TNF factor (LITAF) significantly induces TNF-α production. Furthermore, we found that p53 and its synthetic peptide 162-motif specifically downregulate LITAF/TNF-α gene expression in human cells in vitro. Thus, in the present study, the role of p53 in regulating TNF-α-mediated inflammation was investigated. Our data showed that a synthetic peptide, named 162-motif, corresponding to this region functions independently from p53 to cause a significant suppression of TNF-α gene expression in mouse primary macrophages. The 162-motif, when delivered into cells and organs, reduces serum TNF-α level in mice and prevents TNF-α-induced lung lesions and endotoxic shock. Our findings highlight the regulation of LITAF/TNF-α by p53 and its short peptide 162-motif. These in vitro and in vivo observations serve to pave the way for pharmacotherapeutic approaches in the treatment of inflammatory diseases.

Women on welfare: a study of the Florida WAGES population

Using the ASI, a multi-dimensional survey instrument, data were collected on women in Florida's welfare program (WAGES). The women manifested serious problems in terms of physical and mental health, employment skills and childcare needs. Length of time on welfare was strongly associated with the severity of recipients' problems. Women with 2 + years on welfare were significantly more likely to have problems. However, substance use was lower than anticipated which may be because substance abusers are dropping out of welfare. This possibility raises concerns that, rather than going into the workfore, women may be returning to the streets. If so, instead of reducing the welfare costs, we are shifting those costs to local health, social service and criminal justice systems.

Treatment services received by supplemental security income drug and alcoholic clients

This study examined self reported problems and treatment services received by 237 recipients of Supplemental Security Income (SSI) benefits for "drug abusers and alcoholics" who had been assigned and entered into substance abuse treatment. All were administered the Treatment Services Review (TSR), a brief interview in which patients describe treatment services they have received during the past month and substance-related problems they are currently experiencing. In addition to describing serious alcohol and drug problems, SSI recipients reported a need for treatment for medical and psychiatric problems. The TSR data revealed that these clients primarily received drug and alcohol services and more limited medical, psychiatric, and employment services during treatment. There was relatively little indication of the provision of legal or family/social treatment services. The data are consistent with other findings that indicate that treatment for substance dependence provides only limited services other than those for alcohol and drug abuse.

Cigarettes, alcohol, marijuana, other risk behaviors, and American youth

Increases in adolescent marijuana and other drug use have created widespread concern. One theory argues that increased use of cigarettes and alcohol among younger adolescents leads to greater use of marijuana which, in turn, leads to subsequent use of other drugs (e.g. cocaine, heroin, hallucinogens). Detractors of this theory claim that use of these substances is a symptom of a larger set of destructive behaviors (e.g. violence, suicide, promiscuous sex), and marijuana has no independent effect on the use of other more serious drugs. The authors examined whether, for high school seniors, early use of cigarettes, alcohol and marijuana has an independent effect on more serious drug use even when other behaviors are considered. Using the 1995 Youth Risk Behavior Survey (n = 2871) and logistic analysis, after accounting for selected other behaviors, seniors using cigarettes before age 13 were 3.3 (95% C.I. 2.3,4.6) times likelier to have used marijuana than ones who never smoked; for alcohol, the odds ratio was 4.5 (2.6,7.7). Seniors using marijuana before the age of 14 were 7.4 times (4.0,13.6) likelier to have used other drugs. Though no causal effect is demonstrated, cigarette and alcohol use was associated with the likelihood of marijuana use; marijuana use was associated with the likelihood of other drug use, even after selected other risk and protective behaviors were considered.

Polybrominated biphenyl induction of cytochrome P450 mixed function oxidase activity in primary rat and human hepatocytes

Polybrominated biphenyl (PBB) is an industrial chemical and environmental contaminant with known incidence of significant human exposure. PBB has been studied in laboratory animals and found to have significant toxicological effects as well as being a potent inducer of hepatic cytochrome P450 mixed function oxidase (MFO) activity. As part of our program to compare the response of laboratory animals and humans to industrial and environmental toxicants, we studied the effect of a major component of commercial PBB mixtures, 2,2',4,4',5,5'-hexabromobiphenyl (HBB), on MFO induction in primary cultures of human and rat hepatocytes. MFO induction was evaluated by measuring the deethylation of 7-ethoxycoumarin by intact hepatocytes. Rat hepatocytes were found to be highly susceptible to HBB induction of 7-ethoxycoumarin O-deethylase (ECOD) activity, with significant induction observed at the lowest concentration tested of 10(-8) M. Human hepatocytes were found to have a higher threshold for HBB induction of ECOD activity than rat hepatocytes. The lowest concentration of HBB required for ECOD induction observed for human hepatocytes was 10- to 1000-fold higher (10(-7), 10(-6), 10(-5) M for the four human samples) than that found in rat hepatocytes. Future mechanistic investigation of this observed difference in sensitivity towards PBB between rat and human hepatocytes may aid the extrapolation of human health risk from toxicological data obtained from laboratory animals.

Estimating the costs of substance abuse to the Medicaid hospital care program

OBJECTIVES

The purpose of this study was to develop a model, using the epidemiologic tool of attributable risk, for estimating the cost of substance abuse to Medicaid.

METHODS

Based on prior substance-use and morbidity research, population attributable risks for substance abuse-related diseases were calculated. (These risks measure the proportion of total disease cases attributable to smoking, drinking, and drug use.) The risks for each disease were applied to Medicaid hospital discharges and days on the 1991 National Hospital Discharge Survey that had these diseases as primary diagnoses. The cost of these substance abuse-related days were added to Medicaid hospital costs for direct treatment of substance abuse.

RESULTS

More than 60 medical conditions involving 1100 diagnoses were identified, at least in part, as attributable to substance abuse. Factoring these substance abuse-related conditions into hospital costs, 1 out of 5 Medicaid hospital days, or 4 million days, were spent on substance abuse-related care in 1991. In 1994, this would account for almost $8 billion in Medicaid expenditures.

CONCLUSIONS

The use of tobacco, alcohol, and drugs contributes significantly to hospital costs. To address rising costs, substance abuse treatment and prevention should be an integral part of any health care reform effort.

State initiatives for the medically uninsured

Recently, Medicaid has changed in terms of both perception and reality. After a period of decline in entitlement, that trend has been reversed through both Federal mandates and an increasing role for Medicaid in dealing with the uninsured. As States and the Federal Government seek structural solutions, further eligibility expansions may be necessary, such as public subsidies of private insurance of using Medicaid as a reinsurance mechanism. Currently, there is considerable State activity in identifying such solutions. These activities have given us some ideas about what is necessary to expand coverage to more of the population. Continued demonstrations and better definitions of the respective roles of the private and public sectors are needed.

Role of glutathione in the toxicity of the sesquiterpene lactones hymenoxon and helenalin

Hymenoxon and helenalin are toxic sesquiterpene lactones present in the toxic range plants Hymenoxys odorata and Helenium microcephalum. Helenalin (25 mg/kg) or hymenoxon (30 mg/kg) administered to immature male ICR mice caused a rapid decrease in hepatic glutathione levels and were lethally toxic to greater than 60% of the animals within 6 d. L-2-Oxothiazolidine 4-carboxylate (OTC), a compound that elevates cellular glutathione levels, administered to mice 6 or 12 h before either helenalin or hymenoxon protected against hepatic glutathione depletion and the lethal toxicity of these toxins. OTC administered at the same time as the sesquiterpene lactones was not protective, suggesting that the critical events against which glutathione is protective occur within the first 6 h. In primary rat hepatocyte cultures, hymenoxon and helenalin (4-16 microM) caused a rapid lethal injury as determined by the release of lactate dehydrogenase. Cotreatment of cultures with N-acetylcysteine at high concentrations (4 mM) afforded significant protection against lethal injury by both toxins. In contrast, BCNU, which inhibits glutathione reductase, or diethylmaleate, which depletes hepatocellular glutathione, potentiated the hepatotoxicity of helenalin and hymenoxon in monolayer rat hepatocytes. These studies suggest that the in vivo and in vitro toxicity of hymenoxon and helenalin is strongly dependent on hepatic glutathione levels, which hymenoxon and helenalin rapidly deplete at very low concentrations.

Regulation of estrogen biosynthesis in human adipose stromal cells. Effects of dibutyryl cyclic AMP, epidermal growth factor, and phorbol esters on the synthesis of aromatase cytochrome P-450

Using human adipose stromal cells in monolayer culture as a model system for study of the regulation of aromatase activity, as well as polyclonal antibodies raised in this laboratory against aromatase cytochrome P-450 (cytochrome P-450AROM), it was found that the rate of synthesis of cytochrome P-450AROM was stimulated by dibutyryl cyclic AMP. This stimulation was attenuated by epidermal growth factor and was potentiated by phorbol esters. These changes in cytochrome P-450AROM synthesis were associated with comparable changes in the levels of translatable cytochrome P-450AROM mRNA, as well as with changes in the activity of aromatase of these cells. By contrast, there was little change in the synthesis of the reductase component of the aromatase enzyme complex in response to these factors. The increase in mRNA was blocked by cycloheximide, indicative of a requirement for protein synthesis in mediating this inductive response. It is concluded that aromatase activity is regulated primarily by changes in the level of mRNA encoding cytochrome P-450AROM, and that such changes are likely a reflection of changes in the rate of transcription of the gene encoding this enzyme. Increases in the levels of cytochrome P-450AROM mRNA are apparently mediated by a regulatory protein(s), similar to that found for other steroidogenic forms of cytochrome P-450.

The in vitro metabolism of benzo[a]pyrene by polychlorinated and polybrominated biphenyl induced rat hepatic microsomal monooxygenases

The metabolism of benzo[a]pyrene by halogenated biphenyl-induced rat hepatic microsomal monooxygenases was determined using a high pressure liquid chromatographic assay system. Incubation of benzo[a]pyrene with microsomes from rats pretreated with phenobarbitone or phenobarbitone-type inducers (2,2',4,4',5,5'-hexachlorobiphenyl, 2,2',4,4',6,6'-hexachlorobiphenyl, 2,2',5,5'-tetrachlorobiphenyl, 2,2',4,4',5,5'-hexabromobiphenyl, and 2,2',5,5'-tetrabromobiphenyl) resulted in increased overall metabolism of the hydrocarbon (less than fourfold) into phenolic, quinone, and diol metabolites, with the most striking increase observed in the formation of 4,5-dihydro-4,5-dihydroxybenzo[a]pyrene. In contrast, the metabolism of benzo[a]pyrene by microsomes from rats induced with 3-methylcholanthrene or 3,3',4,4'-tetrachlorobiphenyl resulted in a greater than 10-fold increase in overall benzo[a]pyrene metabolism, with the largest increases observed in the formation of the trans-7,8- and -9,10-dihydrodiol metabolites of benzo[a]pyrene. However, in comparison to control and phenobarbitone-induced microsomes, the oxidative conversion of benzo[a]pyrene by microsomes induced with 3-methylcholanthrene and 3,3',4,4'-tetrachlorobiphenyl into the 6,12-quinone was substantially inhibited. Previous reports have shown that the commercial halogenated biphenyl mixtures, fireMaster BP-6, and Aroclor 1254 are mixed-type inducers and that microsomes from rats pretreated with these mixtures markedly enhance the overall metabolism of benzo[a]pyrene. Not surprisingly, the metabolism of benzo[a]pyrene by microsomes from rats pretreated with the mixed-type inducers, 2,3,3',4,4'-penta-,2,3,3',4,4',5-hexa-, and 2',3,3',4,4',5-hexa- chlorobiphenyl was also increased and the metabolic profile was similar to that observed with fireMaster BP-6 and Aroclor 1254 induced microsomes.

Health care institutions: survival in a changing environment

The health care system in the United States has been altered by recent economic and political events, including a major recession and a retrenchment in federal nonentitlement spending programs. The economic recovery and the continuing high federal deficits prompt new questions about both the future expansion and the distribution of health spending. Long-term economic forecasts and public opinion polls suggest that health will consume a growing share of the national resources. Nevertheless, the level of health spending will not grow as rapidly as in the past, and the distribution of that spending may also change. Because of these changes, the growth in health spending will not guarantee the survival of existing institutions. New competitive forces and revised reimbursement mechanisms will lead to a redistribution of the health dollar, and this redistribution will create both risk and opportunity for America's important health care institutions and their health professionals.

DRG-based case mix and public hospitals

The 12 acute care public hospitals in New York City (HHC hospitals) are compared with a matched group of nonpublic hospitals (non-HHC hospitals). The following questions are considered: using DRGs to define case mix, how does the case mix of HHC and non-HHC hospitals differ; to what extent do differences in case mix account for differences in average length of stay (ALOS); can factors other than case mix be identified that may explain differences in ALOS? Although about one half of the 20 most prevalent DRGs are similar in both types of institutions, there are clear case mix differences. The higher percentage of abortion, psychiatric, and chemical dependence discharges and the lower prevalence of surgery in HHC hospitals contribute to this difference. The case load is more concentrated in fewer DRGs in HHC hospitals. HHC hospitals treat more patients in DRGs with a shorter ALOS, but, on the average, patients in the same DRG stay more than 1 day longer in HHC facilities. To some extent, this longer LOS can be explained by differences in payor type, primary diagnosis within a DRG, and, most important, in the percentage of outlier patients.

The effect of dietary and sulfur compounds in alleviating 3-methylindole-induced pulmonary toxicity in goats

The present experiment was designed to determine the effect of tissue concentrations of glutathione (GSH) and GSH-S-transferase activity on 3-methylindole (3MI)-induced pulmonary toxicity in vivo. Forty goats were given high protein, normal protein, high cysteine, high sulfate or diethyl maleate (DEM) to vary tissue concentrations of GSH before i.v. infusion of 3MI. The severity of lung lesion was scored. Tissue GSH concentration, GSH-S-transferase activity and cytochrome P-450 content were measured. Compared to goats fed normal protein diet, high cysteine or high sulfate increased the tissue GSH levels and reduced the severity of the lung lesion induced by 3MI. Pretreatment with DEM, by which the tissue GSH was depleted, increased the severity of 3MI-induced lung lesion. Tissue GSH-S-transferase activity was not changed. These results indicate that the tissue concentration of conjugating agents play an important role in 3MI-induced lung disease.

Effects of species, MFO inducers and conjugation agents on the in vitro covalent binding of 14C-3-methylindole metabolite in liver and lung tissues

The degree of tissue covalent binding of 14C-3-methylindole metabolite in goat and rat pretreated with phenobarbital or 3-methylcholanthrene was compared. The effect of conjugating agents, i.e. glutathione (GSH), cysteine and sulfate, in reducing the degree of tissue covalent binding was measured. The degree of tissue covalent binding was significantly higher in the lung than the liver of goats. In rats, covalent binding was higher in the liver than the lung. Glutathione and cysteine were effective in decreasing the degree of in vitro covalent binding in both liver and lung tissues of goat and rat.

The effect of dietary protein quantity on the activity of UDP-glucuronyltransferase and its physiological significance in drug metabolism

Low dietary protein has been shown to induce the activity of rat hepatic UDP-glucuronyltransferase (UDPGTase) as measured in vitro. The assay of UDPGTase in vitro is hampered by the need to solubilize the microsomal membrane, without destroying the physiological significance of the measurements. The present work was to determine the effect of dietary protein on the activity of UDPGTase and on the activity of UDP-glucose dehydrogenase. Chloral hydrate induced sleeping time was used as a bioassay for UDPGTase, confirming the physiological significance of the in vitro analysis. Sixty male rats were maintained on three different protein levels (7.5, 15, and 45%) for 16 days. Fifteen rats from each group were sacrificed and hepatic UDPGTase, cytochrome P-450, UDP-glucose dehydrogenase, and alcohol dehydrogenase were assayed. Five rats from each group were dosed with 7.5% chloral hydrate (4.8 mL/kg body weight) to measure sleeping time. Rats on 7.5% dietary protein had significantly higher UDPGTase activity than rats fed either 15 or 45% protein diets. These differences in enzyme activity in vitro correlated with the differences in chloral hydrate sleeping time. Dietary protein was not found to affect the activity of UDP-glucose dehydrogenase as measured in vitro.

The impact of u.s. Energy policy on international health: alternate paths into the future

Historical, sociological, and epidemiological research shows that international health and mortality levels are determined primarily not by health sector policies but, instead, by national and international policies that shape the broader sociopolitical and economic systems within which health sectors are embedded. Such policies have traditionally been considered to lie outside the domain of the health sector and, therefore, not of concern to health educators. One such national policy with the potential to powerfully influence international health and mortality levels is the looming choice between alternate American energy paths: the capital-intensive, large-scale, and centralized "hard" path of non-renewable energy resources; and the labor-intensive, small-scale, and decentralized "soft" path of renewable energy sources. Substantial effort has been directed to projecting the physical environmental impacts in the United States for both paths. But the social environmental impacts of each path and their implications for international health have been ignored. This article reviews links between alternate U.S. energy paths and alternate international health futures, and their implications for health educators around the world.

Radiation therapy technologist survey: state of Michigan

A survey of institutions in Michigan utilizing megavoltage equipment demonstrated a shortage of certified radiation therapy technologists. The low number of such personnel who can be trained in the available approved programs in the state is barely sufficient to maintain the present level. Projections show a continued shortage and a need for more approved radiation therapy technology training programs.

Localization of radioactive lead in ocular and skin melanoma

The ability of radioactive lead to localize melanomas was studied. The Greene melanoma in the Syrian Golden hamster served as a model for both skin and ocular melanoma. The affinity of heavy metals for neoplasms has been studied but previous reports have been inconsistent as to tumor specificity. For this investigation the radioactive lead (203-Pb,) was studied as the chemical complex 203-Pb-Tris. Significant tumor:nontumor ratios were found in ocular melanoma and the concentration in the lens was minimal. The ratio of per cent uptake per gram of tumor: per cent uptake per gram in control tissue with skin melanoma was 9.4 at 24 hours and for the eye melanoma the ratio was 26.3 at 24 hours. The affinity of 203-Pb-Tris for melanomas appears to be as promising as other compounds presently being evaluated for ocular scintigraphy, namely, labeled quinoline analogs. Therefore, further preclinical evaluation is warranted.