E Michael Foster1. 1. Gillings School of Global Public Health, University North Carolina, Chapel Hill, NC 27599, USA. emfoster@unc.edu
Abstract
BACKGROUND: The wars in Iraq and Afghanistan have made unprecedented demands on the nation's citizen soldiers, the National Guard and Reserve. A major concern involves the repeated deployment of these forces overseas. OBJECTIVES: Using data from the Department of Defense Survey of Health Related Behaviors among the Guard and Reserve Force, we examined the effects of deployment on 6 health outcomes. SUBJECTS: The Department of Defense Survey of Health Related Behaviors among the Guard and Reserve Force is a sample (n = 17,754) of all Reserve component personnel (including full time and/or activated Guard and Reservists) serving in all pay grades throughout the world. RESEARCH DESIGN: We relied on inverse probability of treatment weights to adjust for observed confounders and used sensitivity analyses to examine the sensitivity of our findings to potential unobserved confounding. RESULTS: Observed confounders explain much of the apparent effect of deployment. For men, the adjusted relationships could very well reflect further confounding involving unobserved factors. However, for women, effects of deployment on marijuana use, symptoms of post-traumatic stress disorder, and suicidal ideation are robust to adjustments for multiple testing and possible unobserved confounding. CONCLUSIONS: These effects are large in practical terms and troubling but suggest that media reports of the harm caused by deployment may be overstated. Such exaggerations run the risk of stigmatizing those who serve.
BACKGROUND: The wars in Iraq and Afghanistan have made unprecedented demands on the nation's citizen soldiers, the National Guard and Reserve. A major concern involves the repeated deployment of these forces overseas. OBJECTIVES: Using data from the Department of Defense Survey of Health Related Behaviors among the Guard and Reserve Force, we examined the effects of deployment on 6 health outcomes. SUBJECTS: The Department of Defense Survey of Health Related Behaviors among the Guard and Reserve Force is a sample (n = 17,754) of all Reserve component personnel (including full time and/or activated Guard and Reservists) serving in all pay grades throughout the world. RESEARCH DESIGN: We relied on inverse probability of treatment weights to adjust for observed confounders and used sensitivity analyses to examine the sensitivity of our findings to potential unobserved confounding. RESULTS: Observed confounders explain much of the apparent effect of deployment. For men, the adjusted relationships could very well reflect further confounding involving unobserved factors. However, for women, effects of deployment on marijuana use, symptoms of post-traumatic stress disorder, and suicidal ideation are robust to adjustments for multiple testing and possible unobserved confounding. CONCLUSIONS: These effects are large in practical terms and troubling but suggest that media reports of the harm caused by deployment may be overstated. Such exaggerations run the risk of stigmatizing those who serve.