Self-Reported Health Indicators in the US Army: Longitudinal Analysis From a Population Surveillance System, 2014‒2018

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. Published online ahead of print September 9, 2021: e1–e11. https://doi.org/10.2105/AJPH.2021.306456 )

Educational inequalities and self-reported health among men and women aged 18–49 years in Yangon Region, Myanmar: analysis of a population-based, cross-sectional study

“… 82 Regarding soldiers, they can positively report their health due to the impact on their careers, despite the confidential and non-disclosure of data to their chain of command. 83 So, including nuns, monks and soldiers could have introduced selection bias in this study. However, no individuals were excluded due to sickness in the present study.…”

Development and preliminary evaluation of the Comprehensive Health Self-Assessment Questionnaire (CHSAQ) for individuals in the Chinese People Liberation Army

“…Approximately 90% of the GAT items were adapted directly from existing measures or were slightly modified to fit the U.S. Army context. Approximately 80% of the resulting items (44/55) of the CHSAQ were adapted from well-validated and published questionnaires, such as the SF-36, the CMI and the WHOQOL instruments, which are aligned with the GAT [ 19 ]. These tools are well developed for the assessment of health quality and are used for a great number of studies.…”

“…For example, self-report questionnaires, such as the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36 C), which was developed by the Boston Institute of Health in the United States (U.S.), have been adopted by many researchers for their ease of understanding and ability to reflect individuals’ evaluations and expectations of their health status [ 15 – 17 ]. On this basis, some developed countries have developed comprehensive military health assessment questionnaires, such as the Global Assessment Tool (GAT), developed in the U.S [ 18 , 19 ].. This health survey questionnaire for military personnel takes approximately 15 min to complete and includes a total of 105 items and four dimensions, namely, emotional health, family health, social health, and mental health.…”

The combined effects of coping and pain interference on army readiness

“…Our sample was also limited to soldiers who had both completed the GAT and consented for their records to be used. This process availed a large sample that is likely comparable to the general Army population ( 28 ), but it may have introduced some bias (e.g., if MNR risk was associated with the choice to consent).…”

“…Upon completion of the required survey, soldiers can consent to allow their data be used for research purposes. GAT data are available for about 40% of all soldiers, as previously described ( 28 ).…”