Health Related Behavior Study 2018 – Experiences and Health During Deployment

The Health Behavior Survey (HRBS) is a primary survey conducted by the U.S. Department of Defense (DoD) to learn about the health, health-related behaviors, and well-being of service members. The HRBS has been conducted periodically for more than 30 years and covers areas that may affect military readiness or the ability to meet the demands of military life.

The Department of Defense commissioned the RAND Corporation to review and administer the 2018 HRBS to active and reserve military personnel. This summary analyzes the results for the active component.

This summary examines deployment experiences and health outcomes. Some results are also compared to the Healthy People 2020 (HP2020) goals set by the U.S. Department of Health and Human Services for the U.S. population. Because military personnel are very different from the general population (e.g., military personnel are more likely to be young and male than the general population), these comparisons are presented only as benchmarks of interest.

Frequency and Duration of Service

The 2018 HRBS included several questions asking respondents to share their personnel deployment experiences. These included the number of times respondents were deployed, the duration, and the experience of those deployments.

Across all units, 60.4% (confidence interval [CI]: 59.2-61.7) of respondents reported having been deployed at least once before, including combat and non-combat deployments. Respondents from the naval sector were the most likely to report having been deployed at some point.

The majority of personnel who had been deployed more than once, 28.4% (CI: 27.5-29.3), had been deployed at least three times. Coast Guard personnel reported the most who had been deployed at least three times.

Among those who had been deployed, the total duration of deployment varied considerably. At one end of the spectrum, 18.1% (CI: 16.9-19.3) had been on post for six months or less; at the other end, 11.2% (CI: 10.6-11.9) had been on post for more than 48 months.

Overall, 50.1% (CI: 48.8-51.5) of those who had ever been deployed had been deployed for a total period of seven to 24 months. Air Force and Marine Corps personnel were the most likely to report having been deployed for six months or less.

Ground Forces, Navy, and Coast Guard personnel were the most likely to report having been deployed for more than 48 months in their lifetime. Of those who had been deployed, 54.3% (CI: 52.9-55.7) had not been deployed in the past year. Air Force members are the most likely to report not having been deployed in the past year.

Deployment while Combat

Employees' experiences in combat deployment vary. Of all deployed personnel, 72.7% (CI: 71.3-74.0) had participated in at least one combat mission. Coast Guardsmen participated the least in combat missions, while Air Force and Army personnel participated the most in at least three combat missions.

Among all personnel, 36.2% (CI: 34.9-37.5) reported having had a traumatic combat experience, such as working with landmines, having members of their unit or an allied unit seriously wounded or killed, or being wounded in combat at some point during their deployment. Military personnel (57.5%, CI 54.5-60.4) were more likely than other forces to report having experienced combat trauma.

The four most frequent combat traumatic experiences were: feeling good about someone killed in action (22.3%, CI: 21.2-23.3), being seriously injured or killed in action (21.0%, CI: 20.0-22.0), seriously injuring or killing civilians (18.9%, CI: 17.9-19.9), and working with landmines or other unexploded ordnance (10.5%, CI: 9.6-11.3).

Military Service and Drug Use

Those who had been deployed in the past 12 months (recently deployed) differed from those who had not been deployed during this period in terms of alcohol, tobacco, and marijuana use. Specifically:

• 39.8% (CI: 37.5-42.2) of recently deployed individuals reported binge drinking (having had five or more drinks for men or four or more drinks for women on the same occasion in the past 30 days), compared with 31.8% (CI: 30.5-33.2) of recently deployed individuals who were not.
• 12.6% (CI: 10.9-14.4) of recently deployed individuals reported binge drinking (at least once a week in the past 30 days), compared to 8.7% (CI: 7.9-9.6) of non-recently deployed individuals
• 22.4% (CI: 20.2-24.5) of recent recruits reported smoking in the past 30 days, compared to 16.8% (CI: 15.7-18.0) of non-recruits.
• 0.7% (CI: 0.03-1.4) of recent recruits reported using marijuana or synthetic cannabis in the past 30 days, compared with 0.2% (CI: 0.1-0.3) of recent recruits who had not deployed.

Recent refusers and non-refusers did not differ significantly in e-cigarette use, use of substances other than marijuana, and abuse of prescription drugs, stimulants, sedatives, and pain relievers.

Substance Use and Mental and Emotional Health

The HRBS asked respondents about a number of mental health indicators. General mental health status was assessed using the Kessler-6 (K6), a commonly used measure of severe, nonspecific psychological distress.

The K6 is designed to distinguish between anxiety, which indicates a psychiatric disorder that would be identified and treated by a clinician, and anxiety, which is commonly experienced but does not indicate a clinical condition. The HRBS also includes questions that suggest probable post-traumatic stress disorder (PTSD) and questions about sleep quality.

Compared with the K6, recent recruits (68.3%, CI: 66.0-70.6) were less likely than non-recent recruits (71.2%, CI: 66.9-72.6) to report no or low stress in the past 12 months. They were also more likely (14.6%, CI: 12.8-16.4) to report moderate stress in the past 12 months (14.6%, CI: 12.8-16.4) than non-recenters (12.6%, CI: 11.6-13.5).

However, the difference between the two groups was not significant with respect to the degree of severe stress in the last 12 months. There was also no significant difference between the newly deployed and the others with respect to psychological distress, probable PTSD, or sleep quality in the past 30 days.

Physicall Health During Deployment

In the HRBS, respondents were asked whether they had experienced symptoms of bodily pain in the past 30 days, experienced signs of traumatic brain injury in the past 12 months, or symptoms suggestive of post-concussion symptoms in the past 30 days, and were asked to provide a self-assessment of their health status.

No significant differences were found between recent recruits and nonrecruits on any of these questions (for more information on military-wide physical health indicators, see the Physical Health and Functional Limitations for Active Duty Military report).

Findings

The HRBS provides information on how deployment is associated with the physical and mental health status and vulnerability to risk behaviors of active-duty personnel. Understanding this relationship is important because active-duty soldiers are often deployed more than once during their career and because negative health and behavioral consequences of deployment can affect readiness for future deployments.

The majority of HRBS 2018 respondents have experienced at least one deployment since joining the military. Exposure to combat trauma was also common. Alcohol, tobacco, and marijuana use problems were more common among those who had recently deployed. Abuse of other drugs and prescription drugs was much less common, and there were no differences between recently deployed and nondeployed soldiers.

Recently deployed personnel were also less likely to report no psychological distress in the past 12 months and more likely to report moderate distress during this period. However, they were less likely than the others to report severe stress during this period. They also did not differ from the others in terms of past 30-day stress, probable PTSD, sleep quality, physical pain symptoms, postconvulsive symptoms, or health self-esteem.

Methods

RAND conducted the 2018 HRBS survey of active and reserve military personnel in the U.S. Air Force, Army, Navy, Marine Corps, and Coast Guard between October 2018 and March 2019. The 2018 HRBS was a confidential online survey that allowed researchers to address reminders to nonrespondents and reduce survey burden by linking responses to administrative records.

The sampling frame used a stratified random sampling method by unit, grade, and sex. The overall weighted response rate for the survey was 9.6%, resulting in a final analytical sample of 17,166 responses.

Missing data were treated by imputation, a statistical procedure in which available data are used to estimate missing values. To represent the working population, RAND researchers weighted responses so that members of the working population were overrepresented in some sections. Point estimates and 95% CIs are presented in this survey summary.

RAND researchers tested for differences in each outcome at the level of key factors or subgroups-branch of service, rank, gender, race/ethnicity, and age group-using a two-step procedure based on the Rao-Scott chi-square test for overall differences between individual factor levels, and if the overall test was statistically significant, a two-sample t-test for all possible pairwise comparisons between factor levels (e.g., male and female).

Readers interested in these differences should refer to the full HRBS 2018 Active Component final report. This summary is one of eight summaries of the Active Component; this summary and six of the other seven summaries each correspond to a different chapter of the full report, and the eighth summary provides an overview of all findings and policy implications. A similar set of eight summaries covers the reservist findings.

Restrictions

The response rate is considered low for the survey. While a low response rate does not automatically mean that the survey data are biased, it does increase the possibility of bias. As with any self-report survey, social desirability bias is possible, especially for sensitive questions and topics. For some groups, which represent a small percentage of the total military population, survey estimates may be inaccurate and should be interpreted with caution.