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
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
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
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
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
ARMS. See Assessment of Recruit Motivation and Strength
Army
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
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
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
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
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
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
recommendations for redesigning, 9, 106, 195
tailored to fitness levels of recruits, 9, 14, 101, 102–105, 107, 195
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
injury and attrition rates and, 7–8, 17, 186
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
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
Contract, enlistment, 41
Costs
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
physical and medical outcome measures, 50
recruiting, 55–56
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
recommendations for, 9, 36, 61, 151, 178, 191, 195–196
research needs, 9
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
as disqualifying condition, 142, 145–147, 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
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
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
Existing prior to service discharges, 145
F
Fatigue, in definition of physical fitness, 67
Financial problems, applicant’s, 40
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
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
musculoskeletal. See Musculoskeletal injury/disease
preship conditioning and, 107
research methodology, 15–16, 17
research needs, 9, 107, 108, 195
strategies for reducing, 8–9, 195
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
outcome selection and linkage, 49–53
See also Attrition;
Injuries;
Trade-off model for assessing standards
K
L
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
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
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
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 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
Neurological screening, 26
Neurotic disorders, 144–145
O
Obese and overweight persons
current prevalence, 3, 110–111, 185
disqualification for service, 78
effectiveness of weight control programs, 123–126, 186–187
enlistment outcome evaluations, 50
opportunity for MEPS reevaluation, 28–29
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
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
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
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
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
Shoulder problems, 78–79
Smokeless tobacco, 163
Social phobia, 142
Somatoform disorders, 143, 145
Spine, 95
Standards, enlistment
based on disqualifying conditions, 48
current predictive validity, 6–8, 13
for different military occupational specialties, 5–6, 14, 179
issues of concern, 1–2, 11, 12–13
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
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
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
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
for medical conditions, 15, 178
military entrance processing, 26, 30, 39
for musculoskeletal conditions, 78
for persons with criminal history, 40