Behavioral Risk Factors Among U.S. Air Force Active-Duty Personnel, 1995

Preventive medicine and public health policymakers need data to assess health-promotion efforts, track progress toward meeting national health goals, and focus interventions. To collect such data for U.S. Air Force (USAF) personnel, USAF's Office for Prevention and Health Services Assessment conducted a pilot project to measure the prevalence of behavioral risk factors and preventive health practices. Core questions were used from CDC's Behavioral Risk Factor Surveillance System (BRFSS). Minor changes were made to selected questions from the 1995 survey instrument. This report summarizes the results of the survey, which indicate that USAF personnel met several of the national health objectives. In addition, the report documents that a surveillance system designed to assess health behaviors and practices among the general population can be successfully adapted for a survey of a special population.

A stratified, random sample of all active-duty USAF personnel was selected, but the sampling frame excluded members in training, members in classified duty locations, members pending relocation, and general officers. After stratifying by echelon (major command), sex, and rank (a proxy for socioeconomic status), a random sample of 3930 members was selected. Members were interviewed by telephone during the workday at their worldwide duty locations during July-August 1995. Poststratification weighting (1) was used to adjust for differences in the sex and rank distribution between the sample and the entire USAF population. Data were analyzed by CDC using SESUDAAN (2). Prevalence estimates and 95% confidence intervals (CIs) were calculated for selected risk behaviors and health practices.

National health objectives for 2000 (3) have been set for some of the risk factors and preventive health measures examined. The USAF was considered to have met the objective if the USAF estimate significantly exceeded the objective level in the appropriate direction. Statistical significance was determined by whether the 95% CI around the USAF estimate excluded the objective level. Estimates for alcohol and smoking behaviors were adjusted demographically and compared with USAF results from the 1995 Department of Defense (DoD) Survey of Health Related Behaviors Among Military Personnel (4) and with findings from civilians in the 1994 National Household Survey on Drug Abuse (NHSDA) (5). The DoD survey included USAF members stationed only in the United States (including Alaska and Hawaii) rather than worldwide. Data for civilians in the NHSDA were standardized directly to the age, sex, education, race/ethnicity, and marital status distribution of the entire USAF in 1995.

Interviews were completed for 1931 (49%) persons. Many persons were unavailable for interview because of deployment, base closures, or natural disasters. However, of the persons contacted, few refused to be interviewed (98% response rate). The demographic characteristics of the respondents did not differ meaningfully from those of the sample, except that the respondent population contained a slightly smaller percentage of members located in Europe.

Of the 1931 respondents, 1460 (76%) rated their health as very good or excellent (Table_1). Respondents reported few days during the previous month when their physical or mental health was not good and few days during the previous month when their activity was limited because of health problems (Table_1). Current smoking (ever smoked 100 cigarettes and a smoker at the time of the survey) was reported by 22.4% of respondents. Binge drinking (five or more drinks on at least one occasion during the previous month) was reported by 26.2% of respondents, and chronic drinking (greater than or equal to 60 drinks during the previous month) was reported by 4.1%.

The USAF has met the 2000 health objectives in the following areas: overweight, safety-belt use, child safety-belt use, mammography and clinical breast examination, and Papanicolaou smears (Table_1). The USAF has not met the 2000 health objectives for current smoking and cholesterol testing (Table_1). Data were insufficient to determine whether the objective for child bicycle helmet use had been met.

Reported by: AS Robbins, MD, Information, Studies, and Analysis Div, Office for Prevention and Health Svcs Assessment; JM Miller, DVM Epidemiology Svcs Br, Epidemiologic Research Div, Aerospace Medicine Directorate, United States Air Force, Brooks Air Force Base, Texas. Behavioral Surveillance Br, Div of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report indicated that USAF personnel reported generally good health despite some days of poor mental health and limited activity per month. The prevalence of current smoking (22.4%) was lower than that reported in the 1995 DoD survey (26.0) and the demographically adjusted estimate reported in the 1994 NHSDA (31.3%). Although the difference between the USAF and civilian populations in prevalences of current smoking is statistically significant, the USAF has not met the military-specific goal for 2000. The definition of binge drinking used in this survey was similar to that of heavy drinking (average of five or more drinks at a time at least once per week) reported by 9.4% of USAF respondents to the 1995 DoD survey. The prevalence of binge drinking among respondents to the 1994 NHSDA was 12.0%. As a result, both surveys reported substantially lower estimates than those reported by USAF personnel in the survey described in this report (26%). In general, preventive health practices (e.g., screening tests and the use of safety devices) were common among USAF members.

Many 2000 objectives were not set for military populations. For example, because the USAF has weight standards, the prevalence of overweight in the USAF was significantly below the national objective. In addition, because military security personnel strictly enforce infant and child safety-belt use on all military bases, the prevalence of such use is nearly 100% in the USAF survey.

The BRFSS survey instrument and methodology designed for use among the U.S. civilian population in home telephone interviews was successfully used to interview active-duty military personnel at their duty stations. Because each branch of the U.S. military has a complete listing of all active-duty personnel, probability sampling was also possible for this population.

The worldwide scope of this survey and the high mobility of active-duty personnel, particularly those deployed overseas, made this pilot project particularly challenging. For example, additional time was required to obtain international telephone codes, calling times were extended to reach personnel in overseas locations, and some personnel were difficult to reach because of overseas deployment. In addition, the exclusion of some categories of personnel was made before sampling, but these exclusions probably did not result in substantially biased estimates for several reasons. Inclusion of trainees could have biased the results because certain behaviors required of this group may not represent the usual behavior of members. At any given time, a substantial number of USAF members are pending relocation. Self-selection bias probably did not result from exclusion of these personnel because relocation caused by assignment changes affects all military members. Although the behavior patterns of general officers and members in classified duty locations may differ from those of other USAF personnel, these groups represent only a small proportion of the USAF. Thus, their exclusion probably did not affect the overall estimates.

Behavioral risk factors in the active-duty USAF population should be measured continuously to enable observation of both healthful and deleterious trends. Objective data then become available to help policymakers direct resources and evaluate the effect of health promotion and disease prevention programs among military personnel.

References

1. Aday LA. Designing and conducting health surveys. San Francisco, California: Jossey-Bass, 1989:124-8.

2. Shah BV. SESUDAAN: standard errors program for computing standardized rates from sample survey data. Research Triangle Park, North Carolina: Research Triangle Institute, 1981.

3. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, 1991; DHHS publication no. (PHS)91-50212.

4. Bray RM, Kroutil LA, Wheeless SC, et al. 1995 Department of Defense survey of health related behaviors among military personnel. Research Triangle Park, North Carolina: Research Triangle Institute, 1995.

5. Substance Abuse and Mental Health Administration. National Household Survey on Drug Abuse: population estimates, 1994. Rockville, Maryland: US Department of Health and Human Services, 1995; DHHS publication no. SMA 95-3063.

TABLE 1. Prevalence or mean of United States Air Force Personnel who reported
selected health measures or risk factors -- Behavioral Risk Factor Surveillance System,
1995
=======================================================================================================
Health measure/
 Risk factor                         Prevalence or mean         (95% CI*)         Health objective
------------------------------------------------------------------------------------------------------
General health status very                         75.6       (73.1-78.2)             No objective
 good or excellent
Physical health not good                            1.3       ( 1.1- 1.5)             No objective
 (number of days)+
Mental health not good                              2.3       ( 2.0- 2.6)             No objective
 (number of days)+
Activities limited                                  1.8       ( 1.3- 2.2)             No objective
 (number of days)&
 Current smoking@                                  22.4       (19.7-25.0)                  <=20%** Binge drinking++ 26.2 (23.5-28.9) No objective Chronic drinking&& 4.1 ( 2.9- 5.2) No objective Drinking and driving@@ 2.6 ( 1.5- 3.7) No objective Overweight (body mass 13.4 (11.3-15.4) <="20%" index)*** Lack of safety-belt use+++ 9.8 ( 8.0-11.6) <15% Child safety-belt use&&& 97.4 (95.4-99.4)>=85%
Mammogram and clinical                             93.1       (87.5-98.6)                    >=80%
 breast examination@@@
Ever had a Pap test****                            98.8       (97.6-99.9)                    >=95%
Had Pap test within                                97.8       (96.4-99.3)                    >=85%
 preceding 3 years****
Had cholesterol checked                            71.6       (68.8-74.4)                    >=75%
 within past 5 years
Child bicycle helmet use++++                       55.3       (49.5-61.1)                    >=50%
------------------------------------------------------------------------------------------------------
*    Confidence interval.
+    During the preceding 30 days.
&    Number of days in preceding 30 days when activity was limited because of poor physical
     or mental health.
@    Ever smoked 100 cigarettes and was a smoker at time of survey.
**   Specifically for military personnel.
++   Five or more drinks on at least one occasion during the preceding month.
&&   60 or more drinks during preceding month.
@@   Driving after having too much to drink one or more times during preceding month.
***  >=27.8 for men and >=27.3 for women; from self-reported height and weight.
+++  Does not always wear a safety belt when driving or riding in a car.
&&&  Oldest child aged 5-14 years always or nearly always uses safety belt.
@@@  Ever had a mammogram and a clinical breast examination among women aged >=40 years.
**** Among women with intact uterus.
++++ Oldest child aged 5-14 years always or nearly always uses helmet when riding bicycle.
=======================================================================================================

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