The Health Behavior and Behavior Survey (HRBS) is the US Department of Defense's (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, 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 conduct the 2018 HRBS survey for active and reserve military personnel. This report examines the results for the Reserve.
This report examines the results of drug use, specifically alcohol, tobacco, nicotine products, and illicit and prescription drug use. Some results are also compared to the US Department of Health and Human Services' Health Promotion 2020 (HP2020) targets for the US population.
Because military personnel are significantly 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 for comparative purposes only.
Excessive alcohol consumption is one of the leading preventable causes of death in the United States and worldwide, and is associated with a wide range of problems, including substance use disorders, work-related problems, relationship problems, and poor physical and mental health.
The 2018 HRBS measured binge drinking (defined as drinking five or more drinks on one occasion in the past 30 days for men and four or more drinks at least once in the past 30 days for women) and heavy drinking (defined as reporting heavy drinking at least one day per week in the past 30 days). The study found that:
- 29.0% (confidence interval [CI]: 27.9-30.1) of reservists reported binge drinking in the past 30 days (Figure 1). According to the latest US National Survey on Drug Use and Health (NSDUH) population estimate, 26.5% of adults aged 18 years and older reported being under the influence of alcohol in the past 30 days. The HP2020 programme aims to limit alcohol consumption to 24.2% of adults.
- 7.4% (CI 6.8-8.1) of adults reported having used alcohol in the last 30 days. According to the most recent comparable NSDUH estimate, 8.9% of the US adult population were heavy drinkers.
In the 2018 HRBS survey, 4.8 percent (CI: 4.2-5.3) of reservists reported experiencing serious consequences (e.g., arrest, fight) as a result of alcohol use in the past 12 months. In addition, 6.1 percent (CI: 5.5 to 6.7) reported taking a risk behind the wheel in the past 12 months, i.e., driving after drinking too much alcohol or being a passenger of a driver who consumed too much alcohol.
In addition, 5.3% (CI: 4.8-5.9) reported a loss of productivity due to alcohol in the past 12 months.
In the 2018 HRBS, reservists were asked about their perceptions of military culture regarding alcohol, i.e., whether respondents found it difficult to “fit in” with their command if they did not drink, whether they felt drinking was part of being part of the unit, whether everyone was encouraged to drink at social events, or whether they felt leaders tolerated drinking when staff were not on duty.
Overall, 20.2 percent (CI 19.2-21.2) of reservists agreed with at least one statement regarding support for drinking in military culture, although Coast Guard reservists were the least likely to agree.
Tobacco products and nicotine consumption
Tobacco is a preventable cause of disease and death in the U.S. Although smoking has declined over the past decade, smoking is still the cause of six out of seven lung cancer deaths, one out of three cancer deaths, and more than three out of four cases of chronic obstructive pulmonary disease.
Traditional tobacco products are not the only cause for concern; the use of electronic cigarettes has increased rapidly in recent years and there is growing evidence that their use may increase the risk of cardiovascular and lung disease. The results of the 2018 HRBS survey are as follows:
- 13.3% (CI: 12.5-14.2) of reservists reported currently smoking. The HP2020 strategy set a target of 12.0% of US adults smoking; in 2017, 14.1% of US adults reported currently smoking.
- Electronic cigarettes are currently used by 9.9% (CI: 9.1-10.7) of reservists. According to the 2017 Behavioral Risk Factor Surveillance System, 4.6% of US adults currently smoke e-cigarettes. Reasons cited by reservists for using e-cigarettes included that they are healthier than cigarettes (30.8%, CI: 27.1-34.5), that they help people quit smoking (33.1%, CI: 29.5-36.7), and that they can be used in places where smoking is prohibited (24.0%, CI: 20.7-27.3).
- Among reservists, 8.0% (CI: 7.3-8.7) currently smoke a cigar and 3.1% (CI: 2.6-3.5) smoke a pipe or hookah. The HP2020 has set a target of 0.3% cigar smoking, but currently 3.8% of US adults smoke cigars. HP2020 does not set a target for the use of pipes or hookahs, which are currently used by 1.0% of US adults.
- 11.0% (CI 10.1-11.8) of reservists currently use smokeless tobacco. HP2020 has set a target of 0.2-0.1% smokeless tobacco use among adults; in 2017, 2.1% of US adults reported currently using smokeless tobacco.
- 24.6 percent (CI: 23.5-25.7) of reservists reported tobacco or nicotine use.
Of current smokers participating in the 2018
HRBS survey, 45.5 percent (CI: 41.9-49.1) reported trying to quit smoking in the past 12 months.
Marijuana and other Drugs
The 2018 HRBS measured the use of several types of drugs in the past 12 months and past 30 days among those who had booked:
Marijuana or hashish, synthetic cannabis, sedative inhalants, synthetic stimulants, over-the-counter cough or cold medicines, over-the-counter anabolic steroids, and drugs other than marijuana and synthetic cannabis (including cocaine [including crack]), lysergic acid diethylamide [LSD], phencyclidine [PCP], 3,4-methylenedioxymethamphetamine [MDMA, commonly known as ecstasy], methamphetamine, heroin and gamma hydroxybutyrate [GHB]). The results are as follows:
- 2.7% (CI: 2.2-3.2) of reservists reported having used drugs (mainly marijuana) in the past 12 months; 1.4% (CI: 1.1-1.8) reported having used drugs in the past 30 days.
- 2.5% (CI: 2.0-3.0) reported using marijuana or synthetic cannabis in the past 12 months; 1.3% (CI: 1.0-1.7) reported using these substances in the past 30 days.
- 0.7% (CI: 0.4-1.0) reported using drugs other than marijuana and synthetic cannabis in the past 12 months; 0.2% (CI: 0.1-0.3) reported using these drugs in the past 30 days.
- 0.4% (CI: 0.3-0.6) reported using a self-medication drug in the past 12 months to obtain the effects of the drug.
Prescription Drug Use and Abuse
In the 2018 HRBS survey, respondents were asked about three types of prescription medications.
These included stimulants or mindfulness enhancers (e.g., Adderall, amphetamine, Ritalin, prescription drugs), sedatives (e.g., Ambien, Valium, Xanax, Rohyphol, phenobarbital, ketamine), and painkillers (e.g., OxyContin/Oxycodone, Percocet, codeine, methadone, hydrocodone, Vicodin). The results are as follows:
- 12.1 percent (CI: 11.4-12.8) of reservers reported using prescription medications in the past 12 months.
- 2.6% (CI: 2.2-3.0) reported having used a prescription medicine in the last 12 months. In the 2018 NSDUH survey, 6.5% of US adults reported using stimulants in the past 12 months.
- 4.5% (CI 4.1-4.9) reported using a prescription drug in the past 12 months. In the 2018 NSDUH survey, 18.1% of US adults reported using sedatives in the past 12 months.
- 8.3% (CI 7.7-8.9) reported using prescription medicines in the past 12 months. In the 2018 NSDUH survey, 33.1% of US adults reported using prescription medicines in the past 12 months.
In the 2018 HRBS, respondents were asked about their misuse of stimulants, sedatives or prescription drugs. Misuse is the use of a prescription medicine in a way other than prescribed by a doctor.
This can mean use without a personal prescription or use in larger quantities, more often or for longer than prescribed. Across all services, 1.7% (CI 1.3-2.1) of the composite sample reported misusing prescription medicines. Of the three types of prescription drugs surveyed, misuse was highest at 1% (CI 0.7-1.3).
Comparisons with the Active Members
RAND researchers developed regression models to compare HRBS results for active and reserve military personnel, taking into account the demographic characteristics of respondents. Significant differences between reservists and active duty service members included the following:
- Less binge drinking, binge drinking, and alcohol-related consequences and less likely to perceive the military culture as favoring alcohol use.
- Are less likely to use cigarettes, e-cigarettes, smokeless tobacco, pipe or hookah, and tobacco or nicotine products in general.
- They are more likely to have used any illicit drug, including marijuana or synthetic cannabis, in the past 30 days and in the past 12 months.
- Are less likely to use prescription drugs such as stimulants, tranquilizers and painkillers.
Conclusions and policy implications
Reservists were more likely to be heavy drinkers of alcohol than the general population. A small but significant proportion of reservists were also heavy drinkers, reported consequences of drinking or felt that the military culture supported drinking. DOD, the services, and the Coast Guard could promote alcohol prevention and reduction programs among reservists to change cultural beliefs about drinking and promote self-management.
Many reservists reported using some form of tobacco. Given the long-term health effects of smoking, reducing tobacco use in all its forms should be a priority. The Department of Defense, the Services, and the Coast Guard should consider ways to facilitate access to intervention and prevention measures.
In the past 12 months, illegal drug use was more likely among reservists than active duty personnel. Prevention of all drug use, including marijuana and synthetic cannabis use, should be a priority, given the potential immediate and long-term effects of drug use and the legal complications associated with illicit drug use at the federal level.
RAND conducted the 2018 HRBS survey among active duty and reserve military personnel in the U.S. from October 2018 to March 2019. Five members of the reserve component – Air Force, Army, Marine Corps, Navy, and Coast Guard – and two members of the National Guard – Air National Guard and Army National Guard – participated in the reserve component survey.
The 2018 HRBS was a confidential online survey that allowed researchers to target reminders to non-respondents and reduce survey burden by linking responses to administrative data.
A stratified random sampling method was used to select the sample by grade level, grade and gender. The overall weighted response rate to the survey was 9.4%, resulting in a final analytical sample of 16,475 responses for the Reserve.
To deal with missing data, RAND researchers used imputation, a statistical procedure that uses available data to estimate missing values. To represent reservists, they weighted the responses to account for over-selection of service members in certain sections. Point estimates and 95% CIs are presented in this research report.
RAND researchers controlled for differences in each outcome between key factor levels or subgroups – service area, grade, 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. men vs. women).
Readers interested in these differences should consult the full final report of the HRBS 2018 reserve component. This memo is one of eight memos on the Reserve; this memo and six of the other seven memos are from different chapters of the full report, with the eighth memo providing an overview of all findings and policy implications. Eight similar reports deal with the results of the active part.
Limitations & Restrictions
The response rate to the survey is considered low. While a low response rate does not automatically mean that the survey data are biased, it does increase the likelihood of bias. As with any self-report survey, social desirability bias is possible, especially for sensitive questions and topics. For some groups representing a small percentage of the total military population, survey estimates may be inaccurate and should be interpreted with caution.
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David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.