Marital Status & Risk Behaviors Among U.S. Soldiers

Mirroring the civilian literature, military research has shown that married individuals tend to engage in fewer health risk behaviors, such as substance misuse, compared to individuals who were not married. These findings are consistent with the extensive civilian research literature documenting the physical and mental health advantage of being married, especially for men. However, few military studies have examined the relationship between marital status and other risk behaviors such as reckless driving. Using cross-sectional data collected from U.S. soldiers (n=2,588) six months after Iraq and Afghanistan deployments, six self-reported risk behaviors are assessed: driving under the influence of alcohol, using alcohol to sleep or calm down, riding with an alcohol-impaired driver, non-seat belt use while driving, reckless driving, and risky sexual behavior. The prevalence of these behaviors is reported for three marital status groups: currently married, never married, and previously married (separated/widowed/divorced). The associations between marital status and the risk behaviors are also examined with logistic regression analyses adjusting for combat exposure, mental health problems, alcohol misuse, gender, education, rank, number of children supported financially, and service type. In these analyses, never married and previously married soldiers are compared to married soldiers. Findings show that for all six risk behaviors, prevalence rates were highest in either the never married or the previously married group. For one of the outcomes (driving with an alcohol-impaired driver), the prevalence rate was identical in both the never and previously married groups. The logistic regression analyses revealed that for three of the six risk behaviors (driving after having several drinks, riding with an impaired driver, and risky sexual behavior) both the never married and previously married soldiers were more likely than the married soldiers to engage in the behaviors. However, for two of the risk behaviors (using alcohol to sleep or calm down, and reckless driving) neither of the non-married groups of soldiers was more likely than the married soldiers were to exhibit the behavior. Lastly, only never married soldiers had a greater likelihood of driving without a seatbelt compared to married soldiers. The findings indicate that marital status is an important variable for understanding risk behavior among military populations; not all soldiers are at equal risk for engaging in harmful behaviors. Programs aimed at reducing risk behaviors should consider these findings in their design. Report Documentation Page Form Approved OMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE APR 2011 2. REPORT TYPE N/A 3. DATES COVERED 4. TITLE AND SUBTITLE Marital Status & Risk Behaviors Among U.S. Soldiers 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Center for Military Psychiatry and Neuroscience Walter Reed Army Institute of Research 503 Robert Grant Ave. Silver Spring, MD 20190 USA 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) 11. SPONSOR/MONITOR’S REPORT NUMBER(S) 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release, distribution unlimited 13. SUPPLEMENTARY NOTES See also ADA578905. Mental Health and Well-Being across the Military Spectrum (Bien-être et santé mentale dans le milieu militaire). RTO-MP-HFM-205 14. ABSTRACT Mirroring the civilian literature, military research has shown that married individuals tend to engage in fewer health risk behaviors, such as substance misuse, compared to individuals who were not married. These findings are consistent with the extensive civilian research literature documenting the physical and mental health advantage of being married, especially for men. However, few military studies have examined the relationship between marital status and other risk behaviors such as reckless driving. Using cross-sectional data collected from U.S. soldiers (n=2,588) six months after Iraq and Afghanistan deployments, six self-reported risk behaviors are assessed: driving under the influence of alcohol, using alcohol to sleep or calm down, riding with an alcohol-impaired driver, non-seat belt use while driving, reckless driving, and risky sexual behavior. The prevalence of these behaviors is reported for three marital status groups: currently married, never married, and previously married (separated/widowed/divorced). The associations between marital status and the risk behaviors are also examined with logistic regression analyses adjusting for combat exposure, mental health problems, alcohol misuse, gender, education, rank, number of children supported financially, and service type. In these analyses, never married and previously married soldiers are compared to married soldiers. Findings show that for all six risk behaviors, prevalence rates were highest in either the never married or the previously married group. For one of the outcomes (driving with an alcohol-impaired driver), the prevalence rate was identical in both the never and previously married groups. The logistic regression analyses revealed that for three of the six risk behaviors (driving after having several drinks, riding with an impaired driver, and risky sexual behavior) both the never married and previously married soldiers were more likely than the married soldiers to engage in the behaviors. However, for two of the risk behaviors (using alcohol to sleep or calm down, and reckless driving) neither of the non-married groups of soldiers was more likely than the married soldiers were to exhibit the behavior. Lastly, only never married soldiers had a greater likelihood of driving without a seatbelt compared to married soldiers. The findings indicate that marital status is an important variable for understanding risk behavior among military populations; not all soldiers are at equal risk for engaging in harmful behaviors. Programs aimed at reducing risk behaviors should consider these findings in their design. 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT SAR 18. NUMBER OF PAGES 15 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Marital Status & Risk Behaviors Among U.S. Soldiers RTO-MP-HFM-205 28 3 1.0 INTRODUCTION Studies of United States (U.S.) civilians have typically shown that married individuals have better physical and psychological health compared to individuals in other marital status groups. This is particularly so when married individuals are compared to widowed, divorced, or separated individuals (Liu & Umberson, 2008), which may reflect the strains of marital dissolution (Williams & Umberson, 2004). The health advantage of the married has been attributed to a variety of reasons including the economic benefits, health regulation, and the social support provided by marriage (social causation hypothesis) (Bierman, Fazio, & Milkie, 2006; Musick, Bumpass, & 2010; Stutzer & Frey, 2006; Wade & Pevalin, 2004; Waldron, Hughes, & Brooks, 1996). Another explanation is that people who get married are healthier than those who do not (social selection hypothesis) (Stutzer & Frey, 2006; Wade & Pevalin, 2004). Married individuals also appear less likely to engage in risk behaviors such as substance misuse (Kessler, Berglund, Demler, Jin, & Merikangas, 2005; Simon, 2002); similar findings have been documented among military service members (Riviere & Merrill, 2011). This health advantage has been much less studied in U.S. military populations. Further, it is unclear from both the civilian and military literatures whether the marriage health advantage extends to lower risk behavior prevalence, apart from lower substance misuse, among married individuals. The limited information known about marital status and risk behaviors (apart from substance misuse) among military personnel comes from one study in the United Kingdom (U.K.) of regular (active component) service members and one U.S. study of treatment-seeking veterans. The first study showed that separated, divorced, and widowed (but not single) service members were more likely than married/cohabiting service members to be risky drivers (not wearing a seatbelt and/or speeding; Fear et al., 2008). The latter study (Kuhn, Drescher, Ruzek, & Rosen, 2010), which seemed to have used a binary marital status variable (married vs. unmarried), had contrary findings to the U.K. study. These authors found that married veterans were more likely to drive aggressively; although they were not statistically more or less likely to drive after substance use or to use seatbelts infrequently. No military study was found that examined the independent association of marital status with risk behaviors after adjusting for combat exposure, alcohol misuse, mental health problems, and demographic variables among service members. This study will explore such relationships among U.S. soldiers who had deployed to Iraq or Afghanistan.