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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards
garding the difficulties of maintaining weight loss, the committee thinks that it is unrealistic for retention standards to be more stringent than accession standards.
Recommendation 5-3: Any BMI standard used for retention should not be more stringent than a standard used for accession.
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. Currently, asthma at any level of severity precludes participation in the military without a waiver.
Available data indicate little difference after basic training between military personnel with and without asthma. A reasonable question is whether or not having asthma should make an individual ineligible for service. As reflected in the current waiver system, it is likely that individuals without symptoms for a prolonged period of time or even those with mild and infrequent symptoms could carry out their service requirements, especially if they received optimal medical therapy and self-management education. However, there are costs associated with ensuring timely access of personnel to needed medical therapies and making self-management education available. Furthermore, existing data are not informative regarding whether the conduct of certain military operations are more conducive to problems for those with asthma than others, for example, whether environmental conditions or specific tasks may trigger exacerbations. Nonetheless, in general, available data do not suggest a different service trajectory after initial training for individuals with asthma compared with those without.
Basic training appears to provide a natural screening process for individuals with asthma, as the greatest attrition occurs during this phase of service. Individuals with asthma leave at a higher rate in basic training. Basic training is a costly facet of military activity and a careful cost-benefit analysis would be needed to determine whether or not the Services should enlist individuals with asthma knowing that a number are sure to drop out during training. It is important to note, however, that much of the research on asthma and attrition in basic training focuses on individuals whose asthma is diagnosed after enlistment. As recruiting decisions can be made only on the basis of information known prior to enlistment, information on the attrition of individuals whose condition is known or