FIGURE 5-12 Probability of remaining on active duty among enlistees granted a waiver for asthma versus matched comparison subjects, all Services.

SOURCE: Krauss (2004).

education studies of adults and found that such interventions improve asthma outcomes. Janson and Roberts (2003) observed that mild asthmatics as well as those with more severe disease can benefit from educational interventions. Both group and individualized self-management programs can produce positive results (Wilson et al., 1993). Use of asthma action plans as part of these programs has been shown to be important to positive results (Gibson et al., 2002). Clark et al. (2000) showed that clinicians can be trained to enhance self-management by patients, and this results in fewer symptoms and less health care use with no more physician time expended. No evaluations of interventions for military personnel are available, however.

Issues for the Military

Asthma is ubiquitous in the general population, affecting about 8 percent of the population, with higher prevalence noted among blacks compared with others and women compared with men. An appreciable number of potential military recruits can therefore be expected to have asthma.

Available data indicate that military personnel with asthma waivers, in fact, have lower attrition rates than those without the condition, although studies show that their health care costs are higher. Some evi-



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