U.S. Military and The Community Guide

“Air Force Global Strike Command’s most valuable resource is and will always be our Airmen. The health of our Airmen is vitally important to our mission of strategic deterrence and global strike. [The Community Preventive Services Task Force] provides data-driven recommendations our commanders can utilize to improve the health and performance of their units.”

Paul W. Tibbets IV
Brigadier General, U.S. Air Force
Deputy Commander, Air Force Global Strike Command

Community Preventive Services Task Force (CPSTF) findings help the United States Armed Forces achieve key health objectives:

• Readiness — healthy, active duty and reserve personnel who can move into action
• Recruitment — healthy, eligible candidates to serve
• Health and resilience — increased quality and years of healthy life for personnel, retirees, and their families
• Cost — reduced healthcare costs

The United States Armed Forces account for 3.5 million people including active duty personnel, reserve members, and civilian personnel, not including military dependents or retirees (Department of Defense, 2015). Their reach extends around the world, both on and off military bases.

Annual Reports to Congress

The CPSTF has released two annual reports to Congress that highlight ways CPSTF recommendations can be used to support the readiness and resilience of United States Armed Forces:

• 2018-2019 Annual Report to Congress: Supporting Community Health and National Security [PDF – 521 kB]
  • This report shows how branches of the military have used CPSTF recommendations to reduce tobacco use among service members. It also identifies important evidence gaps that researchers, evaluators, and funders may choose to address, as well as priority areas for future CPSTF work.
• 2017 Annual Report to Congress: Providing the Science to Support Military Readiness and Resilience
  • This report highlights ways the U.S. Armed Forces used CPSTF recommendations to improve the health of service members and their families and increase the population of young people who are eligible for service. It also identifies important evidence gaps that researchers, evaluators, and funders may choose to address, as well as priority areas for future CPSTF work. Particular emphasis is placed on the challenges of obesity, tobacco use, and excessive alcohol use.

How have the U.S. Armed Forces used CPSTF recommendations?

Obesity, tobacco use, and alcohol abuse pose significant threats to military readiness and resilience. Decision makers across the U.S. Armed Forces use CPSTF recommendations to ensure our active duty and reserve personnel are “ready to fight tonight.”

The Facts

• Obesity among active duty service members has risen 61% between 2002 and 2011 (CDC, 2017)
• Service members are 47% more likely to experience a musculoskeletal injury if they are overweight or obese (Cowan, et al., 2011).
• By the year 2030, 64% of potential recruits will not qualify for service because of their weight (Healthy Base Initiative, 2015)
• Tobacco use has been implicated in higher dropout rates during and after basic training, poorer visual acuity, and a higher rate of absenteeism in active-duty military personnel in addition to a multitude of health problems (IOM, 2009).
• In 2015, there were nearly 59,000 instances when service members were unable to deploy because of alcohol misuse. This cost the DoD approximately $35 million in lost productivity (non-medical costs; Cost of Tobacco Use & Exposure, 2016).
• Numerous reports document higher prevalence of heavy drinking and alcohol abuse in the military than the general population, with serious consequences such as missing a week or more of duty, productivity losses, and driving while impaired (Ames et al., 2004; Bray et al., 2014)

Department of Defense

When Pentagon decision-makers need to know how to prevent diseases and injury that reduce military readiness and drive up health care costs, Department of Defense (DoD) policy directs them to The Community Guide.

• In 2013, the Healthy Base Initiative was launched in 14 military installations (e.g., bases, camps, stations) across all branches of the military. This two-year pilot included 27 evidence-based interventions, many based on CPSTF recommendations, to encourage healthier food choices, increased physical activity, and tobacco-free living by active duty personnel and their families. The initiative has strengthened policies and business practices to improve nutrition and reduce tobacco use.
• The DoD found that 38% of military smokers started smoking after enlisting, and estimated that tobacco use among the military population costs the department more than $1.6 billion per year in health costs and lost productivity. In response, the department issued a comprehensive tobacco policy that led to the following actions based on CPSTF recommendations:
  • Tobacco use was restricted to outdoor areas
  • The prices of tobacco products on base were increased to match the prevailing prices in the surrounding community
  • Education on harmful effects of tobacco use was provided
  • Tobacco cessation programs were more available
  • Smoke-free multi-unit housing and tobacco-free zones were established around areas likely to have children

Air Force

• The Air Force Medical Service has implemented numerous programs built on CPSTF recommendations.
  • The Healthy Airman Report drives interventions for improving eating behaviors, sleep health, physical activity, and tobacco-free living.
  • Healthy Military Children and Lifestyle Balance target childhood obesity and diabetes prevention, respectively.
  • The Commanders Wellness Program is aimed at improving healthy behaviors to enhance Airmen’s performance and mission readiness.
  • The Military Nutrition Environment Assessment Tool is used annually to assess and improve eating establishments and the nutrition environment of each base.
  • The Smart Fueling Initiative is a multi-component approach to improve recruitment, readiness, resiliency, and retention by refining the food environment and delivering smart eating opportunities.

Army

• The Army Medicine’s Health and Wellness is transforming into a System for Health, including behavior and environmental change initiatives supported by CPSTF recommendations.
• Healthy Army Communities is a demonstration project that applies CPSTF recommendations on tobacco, physical activity, and healthy eating to transform selected installations into healthy living communities.
• At one Army installation, the Senior Mission Commander established a policy based on a CPSTF recommendation to reduce the number of hours of alcohol sales on-post to align with the surrounding communities. Alcohol-impaired driving and serious incident reports decreased among junior enlisted soldiers.

Navy

• The Navy and Marine Corps Public Health Center (NMCPHC) uses CPSTF recommendations to drive policy changes, design programs, and improve interventions to address a wide array of health issues affecting enlisted personnel.
• NMCPHC added provider feedback to their annual health risk appraisals (HRA) for sailors and marines based on a CPSTF recommendation for HRA plus health education.
• The Navy and Marines Corps have seen reductions in tobacco use since they instituted smoke-free policies and removed the on-post discount for tobacco products, both based on CPSTF recommendations.

Who are the military Liaisons to the CSPTF?

The following serve as Liaisons to the Community Preventive Services Task Force.

• U.S. Air Force
• U.S. Army Public Health Command
• U.S. Navy Medicine
• Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, National Center for Health Promotion and Disease Prevention

References

Cowan DN, Bedno SA, Urban N, Yi B, Niebuhr DW. Musculoskeletal injuries among overweight army trainees: incidence and health care utilization. Occupational Medicine 2011;61(4):247-52.

Cost of Tobacco Use & Exposure, Overweight and Obesity, and High Alcohol Consumption within the TRICARE Prime and Standard Population. Technical Report, March 2016.

Healthy Base Initiative Executive Report, 2015