Index

A

Accessions Medical Standards Analysis and Research Activity, 14, 16, 23, 50, 63–64, 85, 98

ADHD. See Attention deficit hyperactivity disorder

Adjustment disorder

among military personnel, 141

as disqualifying condition, 142

medications for, 138

Age factors

asthma patterns, 127, 131

injury and attrition risk, 98–99

mental health history cutoff standards, 143, 147, 149–150, 188–189

Agoraphobia, 142

Air Force

asthma waivers, 128–131

attrition patterns, 80

body weight and composition standards, 117, 118

delayed entry program, 31

mental disorder patterns, 141, 145

occupational specialty placement, 40

recruiting goals, 11–12, 21

substance use policies, 153

tobacco use in, 163, 167, 168, 174

waiver authority, 29

Air Force Strength Aptitude Test, 31, 32

Alcohol consumption

enlistment standards, 4, 152–153, 159, 191

enlistment waivers, 153, 159

patterns and trends, 4–5, 153–156, 192

See also Substance use

Anorexia nervosa, 143

Anterior cruciate ligament, 78

Antidepressant medications, 137–139

Antisocial personality disorder, 140, 188

Anxiety disorders

among military personnel, 140, 141

enlistment disqualifications, 142, 144

epidemiology, 136, 137

pharmacotherapy, 138

recommendations for assessment, 9, 150, 190, 195

recommendations for enlistment standards, 147, 149–150, 189

Appearance and bearing of individual soldiers, 186

Aptitudes and abilities, 10, 11, 12

assessment in recruiting process, 37–39, 49

cost-performance trade-off analysis, 53

evaluation methodology, 48

Armed Forces Qualification Test, 37–38, 39

Armed Services Vocational Aptitude Battery, 37–38

Arm injuries/conditions, 79



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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards Index A Accessions Medical Standards Analysis and Research Activity, 14, 16, 23, 50, 63–64, 85, 98 ADHD. See Attention deficit hyperactivity disorder Adjustment disorder among military personnel, 141 as disqualifying condition, 142 medications for, 138 Age factors asthma patterns, 127, 131 injury and attrition risk, 98–99 mental health history cutoff standards, 143, 147, 149–150, 188–189 Agoraphobia, 142 Air Force asthma waivers, 128–131 attrition patterns, 80 body weight and composition standards, 117, 118 delayed entry program, 31 mental disorder patterns, 141, 145 occupational specialty placement, 40 recruiting goals, 11–12, 21 substance use policies, 153 tobacco use in, 163, 167, 168, 174 waiver authority, 29 Air Force Strength Aptitude Test, 31, 32 Alcohol consumption enlistment standards, 4, 152–153, 159, 191 enlistment waivers, 153, 159 patterns and trends, 4–5, 153–156, 192 See also Substance use Anorexia nervosa, 143 Anterior cruciate ligament, 78 Antidepressant medications, 137–139 Antisocial personality disorder, 140, 188 Anxiety disorders among military personnel, 140, 141 enlistment disqualifications, 142, 144 epidemiology, 136, 137 pharmacotherapy, 138 recommendations for assessment, 9, 150, 190, 195 recommendations for enlistment standards, 147, 149–150, 189 Appearance and bearing of individual soldiers, 186 Aptitudes and abilities, 10, 11, 12 assessment in recruiting process, 37–39, 49 cost-performance trade-off analysis, 53 evaluation methodology, 48 Armed Forces Qualification Test, 37–38, 39 Armed Services Vocational Aptitude Battery, 37–38 Arm injuries/conditions, 79

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards ARMS. See Assessment of Recruit Motivation and Strength Army attrition patterns, 80, 85–86 body weight and composition standards, 117, 118 delayed entry program, 31 mental disorder patterns, 141, 145 occupational specialty placement, 40 physical fitness of inductees, 66 Physical Fitness Test, 70, 71 recruiting goal attainment, 11–12, 21 substance use policies, 153 tobacco use in, 163, 169–170, 174 waiver authority, 29 Army Accessions Command, 64 Army Longitudinal Study, 16 Assessment of Recruit Motivation and Strength (ARMS), 31, 50 Asthma, 2 attrition patterns, 8, 131–132, 133–134, 187 cost of care, 8, 132, 187 as dichotomous assessment criteria, 48 as disqualifying condition, 3, 128, 131–132, 134, 187 epidemiological patterns and trends, 3, 127, 133, 187 medical management, 132–133 medical outcomes, 128, 133, 187 in military population, 128–132, 133–134 recommendations for enlistment standards, 10, 134, 188, 196 research needs, 134, 187–188 risk factors, 131 waiver requests, 128–131 Attention deficit hyperactivity disorder (ADHD), 143 enlistment disqualifications, 144 enlistment standards, 142, 145, 188 pharmacotherapy, 138, 139, 140 prescreening, 150, 190 prevalence, 4, 136, 140 substance use risk and, 4, 136 Attitudes toward enlistment, 10, 12 Attrition asthma-related, 131–132, 133–134, 187 body composition risk factors, 119–121, 185–186 cost-performance trade-off analysis, 57–58 costs, 49, 54 discharge for conditions existing prior to service, 145 educational attainment and, 38–39, 49, 51–52, 54 as enlistment outcome measure, 6–8, 49, 50, 51–52 mental disorder as basis for, 140–141, 142, 144, 145, 188, 195–196 musculoskeletal injury as cause of, 80, 181 patterns and trends, 7, 79, 80, 86, 108, 186 research methodology, 6–7, 15–16, 17 research needs, 9, 107, 108, 195–196 risk factors, 16, 80–82, 85–89, 119–121, 185–186 risk reduction strategies, 8–9, 99–106, 195 substance use outcomes, 159–161, 192–193 tobacco use and, 8, 168–172, 193–194, 196 of tobacco use standards, 172–174 waivers of disqualification and, 7–8, 17, 159, 160–161, 192–193 B Back pain, 109 Basic training body composition changes in, 123–125 delayed entry program, 19 functional capacity assessment for risk reduction in, 100 gender-specific training programs, 105–106, 184 group exercises, 103 injury and attrition in, 7–8, 14, 79–80 injury and attrition risk reduction strategies, 100–106 injury risk factors, 80–85, 181 physical fitness assessment during, 2, 19, 32, 66 physical training in, 66–67, 181 purpose, 66, 102–103, 181 recommendations for redesigning, 9, 106, 195 tailored to fitness levels of recruits, 9, 14, 101, 102–105, 107, 195 Bipolar disorder, 142, 150, 190

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards Blood pressure testing, 39 Blood testing, 39 Body fat. See Body weight and composition Body mass index asthma risk, 131 current military population, 111–117 current standards, 3, 185 injury and attrition rates and, 7–8, 17, 186 population profile, 110, 111 recommendations for fitness assessment, 9, 126–127, 186, 187, 195 retention standards, 187 See also Body weight and composition Body weight and composition, 3 body fat measurement, 113, 117–119 changes in basic training, 123–125 cost-performance trade-off analysis of standards for, 56–59 current military population, 113–119 current population profile, 3, 110–111 current standards, 3, 185 data sources, 17 in definition of physical fitness, 68 demographic differences, 110, 111–113 disqualification for service based on, 3, 15, 109, 185 height and weight tables, 117 MEPS screening, 26, 28–29, 178 military job performance and, 52, 122–123 rationale for enlistment standards, 119, 122–123, 185–186 recommendations for fitness assessment, 9, 126–127, 186, 195 recruiting station assessment, 25, 177 retention standards, 117, 127, 185, 186–187 risk of injury and attrition, 80, 81–82, 96, 119–121, 185–186 waivers of disqualification, 7–8, 17 See also Body mass index; Obese and overweight persons Bone injuries, 79. See also Musculoskeletal injury/disease; Orthopedic screening Bone remodeling, 94 Bulimia, 143 Bureau of Medicine and Surgery, 29 C Cardiorespiratory fitness attrition risk and, 87–88 body composition and, 119 current military profile, 73–74 current population profile, 73, 74–77 data sources, 17 disqualifications for service, 15, 109 as predictive of military service performance, 7 risk of injury and, 80–81, 82, 86 See also Endurance, cardiorespiratory Chief medical officer, MEPS, 26 Chronic pain disorder, 143 Cigarette use associated behavioral problems, 8, 170–172, 194 cost-performance trade-off analysis of standards for, 172–174 educational attainment and, 174–176 enlistment standards, 5, 152, 163 historical military policy, 162 implications for enlistment screening, 174–176 injury and attrition risk, 8, 99, 167–172, 193–194, 196 in military population, 162–163, 165–167, 193, 194 patterns and trends, 5, 163–167 research needs, 9, 176, 194, 196 Combat experience, mental health outcomes, 141 Combat readiness components of, 18 as physical fitness standard, 6, 14 Conduct disorder, 138, 142 Contract, enlistment, 41 Costs asthma care, 8, 132 attrition, 49, 54 benefits of injury reduction programs, 103–105 cost-performance trade-off analysis, 53–59. See also Trade-off model for assessing standards military entrance processing, 29 military training, 168 educational attainment of recruits and, 39, 49, 54 musculoskeletal injuries, 79, 181

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards physical and medical outcome measures, 50 recruiting, 55–56 smoking-related, 162, 168–170 Credit check, 40 Cumulative impact injury, 92–94 D Data collection connectivity and compatibility of databases, 60–61 for evaluating predictive validity of enlistment standards, 6–7, 9, 14, 50 individual medical and mental health data, 9, 30, 59–60, 178 on injury and attrition, 15–16, 17 management databases, 62 medical prescreening, 4, 9, 25, 36, 41–46 mental health, 143–144, 151, 191 privacy protections, 59, 60 recommendations for, 9, 36, 61, 151, 178, 191, 195–196 research needs, 9 sources, 14, 16–17, 62–65 surveillance databases, 62–63 Defense Manpower Data Center, 17, 61, 64 Defense Medical Surveillance System, 62 Delayed entry program, 19, 31, 41, 101 Demands of military service attrition and injury risk, 16 body weight and composition effects, 122–123 combat readiness, 6, 14, 18, 178–179 cross-service requirements, 36–37, 179, 195 functional capacity assessment for, 99–100 mental and emotional stress in, 3–4, 135–136, 188 musculoskeletal injury risk factors, 89 PULHES system of physical examination for, 30–31 research needs, 9, 13, 37, 179 substance use effects, 159–161 See also Cardiovascular fitness; Military occupational specialties Demographics applicants for service, 18 injury and attrition risk, 81, 96–99 physical and medical condition trends, 13, 71–73, 74–77 population of interest, 1–2, 13–14 recruitment goals, 22 See also Age factors; Gender differences; Race/ethnicity Depression among military personnel, 140, 141, 188 clinical course, 149, 189 as disqualifying condition, 142, 145–147, 189 epidemiology, 136, 137 pharmacotherapy, 137–139, 189 recommendations for assessment, 9, 150, 190 recommendations for enlistment standards, 147, 149–150, 189 treatment, 145 Developmental disorders, 138 Diabetes, 117 Dial-A-Medic Program, 25 Dichotomous assessment criteria, 6, 48 Directive 1304.26 (DoD), 152 Disqualifying conditions, 14 asthma, 3, 128, 131–132, 134, 187 body weight and composition, 3, 15, 109, 185 current distribution, 109 current standards, 19, 21 data sources, 17 dichotomous assessment criteria, 48 medical, 2, 15, 17, 19, 24–25, 78–79, 109 military entrance processing, 26 psychiatric disorders, 4, 15, 19, 109, 142–143, 144–147, 149–150, 188, 189 recruitment station processing, 26 retention standards, 71, 117, 127, 185, 186–187 standards based on, 48–49 standards evaluation methodology, 52 substance use, 5, 15, 78, 109, 153 trade-off analysis of tobacco use standards, 172–174 Disruptive behavior disorders, 136 Dissociative disorders, 143 Drug use. See Marijuana use; Substance use E Eating disorders, 143, 188

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards Economic factors influencing enlistment, 1, 11 applicant’s financial problems, 40 unemployment rate, 12 Educational attainment attrition and, 38–39, 49, 51–52, 54 cost-performance trade-off analysis, 53–56 Department of Defense classification, 38 enlistment outcome linkage, 39, 49, 51–52 evaluation methodology, 48 recruitment goals, 39 smoking patterns and, 174–176 Encopresis, 143 Endurance, cardiorespiratory, 2 in definition of physical fitness, 68 demographic differences, 2, 35, 74, 77 measurement, 69 trends, 2 See also Cardiorespiratory fitness Endurance, muscular, 2 Army Physical Fitness Test, 71 in definition of physical fitness, 68 functional capacity assessment, 99–100 measurement, 69 Enlistment standards. See Standards, enlistment Enuresis, 143, 188 Existing prior to service discharges, 145 F Fatigue, in definition of physical fitness, 67 Financial problems, applicant’s, 40 Firefighters, 35, 100 FITNESSGRAM, 69 Form 2807-2 (DoD), 24, 26, 36, 41–46, 178, 190 Functional capacity assessment, 99–100 G Gender differences ADHD prevalence, 136 applicants for service, 18 asthma patterns, 127, 134 asthma risk, 3, 131 body composition changes in basic training, 123–125 body weight and composition, 110, 111, 112–113 cardiorespiratory fitness, 2, 35, 74, 77 current military population, 18 gender-specific physical training programs, 105–106, 184 injury and attrition patterns, 7, 14, 79–80, 105–106, 181, 183 injury and attrition risk, 82, 87, 96–98, 108 musculoskeletal injury during training, 79–80, 105–106, 183 overweight and obese youth, 3 physical fitness testing and, 35–36 psychological disorder patterns, 136, 137, 141 recommendations for research, 108, 184, 195 recruitment goals, 22 substance use patterns, 5, 156–159 tobacco use patterns and trends, 165–166 Goals, recruitment, 1, 11–12, 2 demographic diversity, 22 educational attainment of recruits, 39 See also Shortfalls, recruiting Group training, 103 H Health Examination Survey Cycle II, 77 Health Insurance Portability and Accountability Act (1996), 60 Health-related physical fitness, 68 HIV testing, 26 Hypochondriasis, 143 I Initial contact in recruiting process, 37 Injuries body weight and composition risk factors, 119–121, 185 cigarette smoking and risk of, 167–168 disqualifications for service based on, 109 functional capacity assessment for risk reduction, 99 gender differences, 7, 82, 105–106, 108, 195

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards musculoskeletal. See Musculoskeletal injury/disease preship conditioning and, 107 research methodology, 15–16, 17 research needs, 9, 107, 108, 195 risk factors, 16, 80–85 strategies for reducing, 8–9, 195 in training, 7, 79–85, 106 See also Cardiovascular fitness; Musculoskeletal injury/disease Instruction 1308.3 (DoD), 33 Instruction 6130.4 (DoD), 19, 23–24, 131 International comparisons, physical fitness, 74–77 J Job performance evaluation challenges, 6–7, 16 outcome selection and linkage, 49–53 See also Attrition; Injuries; Trade-off model for assessing standards K Knee problems, 78, 97, 98 L Learning disorders, 142, 188 Legal challenges to preemployment, 35–36 Load-tolerance relationship, 89–90 M Marijuana use attrition outcomes of enlistment waivers for, 159–161, 192–193 cost-performance trade-off analysis of standards, 9, 161–162, 193, 196 as dichotomous assessment criteria, 48 disqualification for service due to, 5, 15, 78, 109, 153 enlistment standards, 4, 153, 162, 192 patterns and trends, 5, 155, 156, 192 Marine Corps attrition patterns, 80 body weight and composition standards, 117, 118 delayed entry program, 31 mental disorder patterns, 141, 145 occupational specialty placement, 40 physical fitness testing, 36 recruiting goal attainment, 12 substance use policies, 153 tobacco use in, 163 waiver authority, 29 Maximal oxygen consumption. See VO2max Medical condition(s) assessment methodology, 48 cost-performance trade-off analysis of standards for, 56–59 data collection in recruitment process, 9, 25, 30, 177 data sources, 59–60 disqualifying conditions and waivers, 2, 14, 15, 17, 24–25, 48–49, 78–79, 178, 188 enlistment outcome evaluations, 50, 52 enlistment standards, 23–24, 47 military entrance processing, 26–31, 177–178 Physical Profile Serial System, 30–31 prescreen, 24–25, 41–46, 177, 178 recommendations for data collection, 9, 178, 195 recruiting station assessment, 24–26, 177 See also Asthma; Body weight and composition; Mental health; Obese and overweight persons; Physical fitness Medical professionals, in MEPS, 26 Mental health attrition and injury risk, 16, 140–141, 142, 144, 188 combat experience and, 141 common disorders, 4. See also specific disorder comorbid disorders, 136 discouragement of potential recruits by recruitment process, 4 disqualifications for service, 15, 109, 145–147, 149–150, 188, 189 enlistment standards, 142–143, 188–189 epidemiology, 4, 136–137, 140, 188 existing prior to service discharges, 145 impairment prevalence, 136 MEPS assessment, 143, 150–151, 190 in military population, 140–142, 143–144, 188

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards prescreening, 4, 9, 148–149, 189 psychotropic medicine use, 4, 137–139, 140 recommendations for assessment, 9, 148–149, 150–151, 190, 195 recommendations for data collection and management, 9, 151, 191, 195 recommendations for enlistment standards, 147, 149–150, 189 stresses of military service, 3–4, 135–136, 188 tobacco use and, 171–172 treatment delivery and utilization, 139–140, 140, 145 waivers of disqualification, 7, 141, 144, 145 See also specific diagnosis MEPS. See Military entrance processing station Military Entrance Processing Command (MEPCOM). See U.S. Military Entrance Processing Command Military entrance processing station (MEPS) costs, 29 detection of musculoskeletal injuries in, 77–78 examinations performed, 29 medical and physical assessments, 19, 26–31, 39, 177–178, 195 medical disqualifications and waivers, 17, 78–79 medical personnel in, 26 mental health assessment, 9, 143, 150–151, 190, 195 substance use disqualifications during, 5 transportation to, 25–26 Military occupational specialties applicant’s selection and placement, 40 different enlistment standards for, 5–6, 14 physical fitness requirements, 32, 36, 178–179 MIRS. See U.S. Military Entrance Processing Command Integrated Resource System Mission requirements as recruitment factor, 1, 11 See also Demands of military service Mood disorders, 142, 144, 145–147, 149–150 See also Depression; specific diagnosis Moral character standards, 39–40, 152–153, 191 Mortality asthma, 128 obesity as risk factor, 110 Muscular strength, 2 Air Force Strength Aptitude Test, 31, 32 in definition of physical fitness, 68 load-tolerance relationship, 89–90 measurement, 69 See also Endurance, muscular Musculoskeletal injury/disease, 7 acute, 92 attrition related to, 80, 181 cigarette smoking and, 167–168 costs, 181 cumulative trauma, 92–94 disqualifications for service, 15, 78–79 functional capacity assessment, 99–100 gender differences, 96–98, 182, 183 incidence in training, 79–80 multifactorial causation, 89, 106 prevalence in applicant population, 77–79 racial/ethnic patterns, 98–99 risk factors, 89–99, 181, 182–183 risk reduction strategies, 99–106, 182 See also Muscular strength; Orthopedic screening N National Guard, 2, 14 National Health and Nutrition Examination Survey, 71–73, 77 Naval Recruiting Command, 29 Navy asthma waivers, 132 attrition patterns, 80 body weight and composition standards, 117, 118 delayed entry program, 31 mental disorder patterns, 141, 145 occupational specialty placement, 40 recruiting goal attainment, 11–12 substance use policies, 153 tobacco use in, 163, 167, 169–170, 172–174, 193 waiver authority, 29

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards Neurological screening, 26 Neurotic disorders, 144–145 O Obese and overweight persons current prevalence, 3, 110–111, 185 definition, 3, 110, 185 disqualification for service, 78 effectiveness of weight control programs, 123–126, 186–187 enlistment outcome evaluations, 50 health outcomes, 110, 185 opportunity for MEPS reevaluation, 28–29 population trends, 111, 185 See also Body mass index; Body weight and composition Obsessive-compulsive disorder, 142 Occupational area counseling, 40 Orthopedic screening, 109 disqualification for service, 78, 79 enlistment outcome measures, 50 MEPS, 26 Oxygen consumption. See VO2max P Panic disorder, 142 Paranoid disorder, 142 Paraphilias, 143 Patella, 78 Peacekeeping missions, 135–136, 188 Penalties for failure to maintain physical fitness, 71 Personality disorders, 138, 140, 143, 145, 188 Pharmacotherapy, psychiatric, 4, 137–139, 140 Phobias, 142 Physical fitness assessment during recruitment process, 100–101, 183 attrition risk factors, 80–82, 85–89 basic training outcomes, 66–67 basic training tailored to fitness levels of recruits, 9, 101, 102–105, 106, 184 civilian employment testing, 33–36 cost-performance trade-off analysis of standards for, 56–59, 180–181 cross-Service requirements, 36–37, 179, 195 data sources, 17, 59–60 definition and components, 2, 33, 67–68, 70 demographic patterns, 13, 71–73, 74–77 disqualifying conditions, 48–49 enlistment outcome indicators, 50 enlistment standards, 2, 6, 9, 18–19, 31–33, 70–71, 85, 88, 100, 178–179 failure to maintain, 71 gender-specific training programs, 105–106, 184 goals of basic training, 66–67, 102–103 health-related components, 68 injury and attrition risk reduction strategies, 99–106, 182 legal challenges to employment testing, 35–36 measurement approaches, 13, 48, 68–69 MEPS testing, 31, 39 as predictive of job performance, 7, 13, 17, 35, 36 PULHES assessment system, 30–31 recommendations for assessment and measurement, 9, 36–37, 106–107, 195 recommendations for assessment prior to basic training, 183 recommendations for measurement, 9 requirements of different military occupational specialties, 5–6, 13, 14, 32, 36, 178–179 research needs, 9, 36, 107, 179, 183–184 risk of injury in training and, 80–85, 96, 182 of soldiers entering service, 66 test components of military Services, 33, 70 testing in basic training, 2, 19, 32, 66 training programs prior to basic training, 19, 31, 101–102, 107 See also Body weight and composition; Cardiorespiratory fitness; Endurance, cardiorespiratory; Endurance, muscular; Medical condition(s); Muscular strength Physical Work Capacity-170 test, 69 Policy options, 8–9, 13, 194–196 Posttraumatic stress disorder, 141, 142 Prescreening medical, 24–25, 41–46, 177, 178

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards mental health, 4, 9, 148–149, 190 recommendations for, 9, 36, 178, 190 President’s Council on Physical Fitness, 74 Primary Care Evaluation of Mental Disorders, 148 Privacy Act (1974), 60 Privacy and confidentiality, health data, 59, 60 Private sector employment, 12 physical fitness testing, 33–36 Psychosexual disorders, 143 Psychosocial context as injury risk factor, 89, 95–96, 181, 182–183 stresses of military service, 3–4, 135–136 See also Mental health Psychotic disorders, 138, 142, 150, 190 PULHES assessment system, 30–31 R Race/ethnicity, 14 applicants for service, 18 asthma patterns, 3, 127, 128, 131–132, 134, 187 asthma waivers, 128 body weight and composition profiles, 111–113, 185 cardiorespiratory fitness, 74 considerations in design of enlistment standards, 18 current military population, 17–18 injury and attrition patterns, 86, 98–99 physical fitness patterns, 73 population trends, 18 prevalence of overweight youth, 3 psychological diagnosis patterns, 136, 137 recruitment goals, 22 substance use patterns, 5, 156–159, 192 tobacco use patterns and trends, 5, 165–166 Recruiting stations data collection and management, 9, 25, 26 initial contacts, 37 medical and physical screening, 24–26, 177, 178 psychiatric disqualifications at, 4 Regression analysis, 51 Regulation 40-1 (USMEPCOM), 26, 29 Repetitive motion injuries, 92–94 Reserve Officers’ Training Corps, 2, 14 Reserve units, 2, 14 Retention standards, 71, 117, 127, 185, 186–187 Risk-taking behavior, 171 Rotator cuff conditions, 79 Running body composition and, 119, 120 injury reduction strategies, 103–105 S Schizophrenia, 140, 142, 150, 188, 190 Sensitivity of tests, 50–51 Shortfalls, recruiting causes of, 12 enlistment standards and, 11, 12 recent history, 11–12, 21 Shoulder problems, 78–79 Sleepwalking, 143, 188 Smokeless tobacco, 163 Social phobia, 142 Somatoform disorders, 143, 145 Specificity of tests, 50, 51 Spine, 95 Standards, enlistment asthma, 10, 134, 188, 196 based on disqualifying conditions, 48 body mass index, 3, 111–119 combat readiness, 6, 14 current predictive validity, 6–8, 13 design procedures, 47, 48, 53 for different military occupational specialties, 5–6, 14, 179 issues of concern, 1–2, 11, 12–13 medical, 23–31, 47 mental health, 142–143, 145–147, 149–150, 188–189 methodology for evaluating. See Standards evaluation methodology moral character, 39–40, 152–153, 191 physical fitness, 2, 6, 18–19, 31–33, 47, 70–71, 85, 88, 100, 179 policy options, 8–9, 13, 194–196 racial/ethnic considerations, 18 strategies for increasing pool of eligible youth, 9, 195 substance use, 4, 152–153, 161–162, 191–192 tobacco use, 5, 152, 163

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards uniformity among military services, 13 See also Body weight and composition; Disqualifying conditions Standards, retention, 71, 117, 127, 185, 186–187 Standards evaluation methodology, 6–7, 16–17, 47 databases for, 59–61 dichotomous assessment criteria, 48 outcome selection and linkage, 49–53, 179–181 recommendations for improving, 36, 61, 179–181 trade-off model, 6–7, 19, 48–49, 53–59 validity testing, 6–7, 9, 14, 50–53 Stimulant medications, 137, 138 Strength. See Muscular strength Substance use attention deficit hyperactivity disorder as risk factor for, 4, 136 cost-performance trade-off analysis, 161–162 degrees of severity, 153 demographic patterns, 156–159, 192 drug trafficking, 153 enlistment disqualifications, 144, 152–153 enlistment standards, 4, 144, 152–153, 161–162, 191–192 military performance and, 159, 192 patterns and trends, 5, 136, 153–159, 192 screening in military entrance processing, 26 waivers of disqualification for, 153 See also Alcohol consumption; Cigarette use; Marijuana use Suicidal behavior/ideation, 142 prevalence among youth, 137 Synovial fluid, 93 T Tendon injury, 92–94 Tobacco. See Cigarette use Total Army Injury and Health Outcome Database, 63 Trade-off model for assessing standards, 19 applications, 6, 53–59 asthma standards, 134, 188 conceptual basis, 48–49 medical and physical fitness standards, 6–7 research needs, 61, 180–181, 196 substance use standards, 161–162, 193, 196 tobacco use, 172–174 Training. See Basic training Training of MEPS personnel, 26 U Unemployment rate, 12 Urinalysis, 39 U.S. Air Education and Training Command, 29 U.S. Air Force Research Laboratory, 16 U.S. Army Accession Command, 16 U.S. Army Center for Health Promotion and Preventive Medicine, 14, 16, 17, 80–81 U.S. Army Recruiting Command, 29 U.S. Army Research Institute of Environmental Medicine, 14, 16 U.S. Military Entrance Processing Command (USMEPCOM), 14, 16, 17, 60 Integrated Resource System (MIRS), 30, 60, 64 U.S. Navy Service Training Command, 16 V Validity testing, 6–7, 9, 14, 50–53 Vision and hearing tests, 26, 39 VO2max, 69, 73, 74, 77, 119. See also Cardiorespiratory fitness W Waiver of disqualification, 14, 19 for asthma, 10, 128–131, 132, 133–134 authorities for, 29 body weight and composition, 7–8, 17 for cigarette smoking, 8 data sources, 17, 30 for medical conditions, 15, 178 military entrance processing, 26, 30, 39 for musculoskeletal conditions, 78 for persons with criminal history, 40

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards for psychiatric conditions, 4, 7, 141, 144, 145 subsequent attrition and, 7–8, 17, 159, 160–161 for substance use, 153, 159–161 Weight. See Body mass index; Body weight and composition; Obese and overweight persons Weight loss programs, 125–126 Wolff’s law, 94–95 Women. See Gender differences

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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards