ing approach has not been used to evaluate standards in the medical and physical domains, in part due to the inaccessibility or unavailability of the required medical data and the difficulty of linking personnel and medical files for research purposes. The committee provides a description of this approach and illustration of its use.

Current Research

Military research organizations have conducted several studies on the relationship between physical and medical factors and injury and attrition for fitness, BMI, asthma, and preservice tobacco use. The committee found one useful study showing that recruits receiving mental health waivers were more likely to leave the military early compared with recruits who were qualified on all physical, medical, and mental health standards. Major contributors to the research base include the Accession Medical Standards Analysis and Research Activity, the U.S. Army Center for Health Promotion and Injury Prevention, the U.S. Army Institute for Environmental Research, the U.S. Army Research Institute for the Behavioral and Social Sciences, and the Human Resources Research Organization.

Fitness

As noted earlier, there are no enlistment standards for physical fitness; however, data are available on the relationship between different levels of physical fitness, as measured in basic training, and injury and attrition. Musculoskeletal injuries resulting from basic and advanced individual training pose the single most significant medical impediment to military readiness. Military research and the committee’s own analyses show that both male and female recruits who have low levels of cardiorespiratory fitness are more likely to be injured or leave basic training and military service early (or both) than those with high levels of cardiorespiratory fitness. Women with low fitness are twice as likely as men with low fitness to be injured and to leave military service. This finding may be due in part to the biomechanical differences between men and women and the interaction of these differences with basic training regimens.

Body Composition

Unlike the findings for fitness, the results for BMI show that there are essentially no relationships between BMI and injury and attrition for men and only a slight relationship between BMI and attrition for women. That is, recruits who exceed the current height and weight standard and body fat standard and have received a waiver to enter military service are not



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