Incidence rates of malignant melanoma in relation to years of military service, overall and in selected military occupational groups, active component, U.S. Armed Forces, 2001-2015.

During the 15-year surveillance period, there were 2,233 incident diagnoses of malignant melanoma among members of the active component of the U.S. military (unadjusted incidence rate 1.08 cases per 10,000 person-years [p-yrs]). Unadjusted incidence rates were highest in the fi xed-wing pilot/ crew group (2.45 per 10,000 p-yrs); lowest in the infantry, special operations, combat engineer group (0.77 per 10,000 p-yrs); and intermediate among healthcare providers (1.33 per 10,000 p-yrs) and all others (1.07 per 10,000 p-yrs). During the 15-year period, rates of malignant melanoma diagnoses among U.S. military members overall increased in an exponential fashion in relation to years of active service. However, this relationship varied across occupational groups. Most notably, after several years of service, rates of melanoma diagnoses increased relatively rapidly among pilots and the crews of fixed-wing aircraft (e.g., fighters, bombers, cargo/personnel transporters) and those in occupations inherently conducted outdoors (e.g., infantry, special operations, combat engineers). In contrast, melanoma diagnosis rates increased relatively slowly among healthcare providers and those in "other" military occupations. The findings reiterate the importance of limiting, to the extent possible given mission requirements, exposures of military members to solar ultraviolet and cosmic ionizing radiation.

Insomnia and motor vehicle accident-related injuries, active component, U.S. Armed Forces, 2007-2016.

Insomnia is the most common sleep disorder in adults, and its incidence is increasing in the U.S. Armed Forces. A potential consequence of insomnia (including medications used to treat it) is increased risk of motor vehicle accidents (MVAs), which cause significant morbidity and mortality in service members. To examine the relationship between insomnia and MVA-related injuries in the U.S. Armed Forces, this retrospective cohort study compared incidence rates of MVA-related injuries from 2007 through 2016 between service members with diagnosed insomnia and an unexposed cohort. After adjustment for multiple covariates, service members with insomnia had more than double the rate of MVA-related injuries, compared to service members without insomnia (adjusted incidence rate ratio: 2.08; 95% CI: 1.95-2.22). A subanalysis of service members with insomnia during 2014-2016 found no difference in risk of MVA-related injury based on days' supply of sleep aid medications prescribed in 365 days following insomnia diagnosis. Insomnia is an important potential risk factor for MVAs in the military. Sleep health should be a component of MVA prevention efforts.

Use of complementary health approaches at military treatment facilities, active component, U.S. Armed Forces, 2010-2015.

Survey-based research has demonstrated the increasing use and acceptance of complementary and alternative medicine (CAM) in general and military populations. This report summarizes the use of three CAM procedures (chiropractic/osteopathic manipulation, acupuncture, and biofeedback) among active component service members from 2010 through 2015. Findings document a marked increase in the use of chiropractic/osteopathic manipulation and acupuncture procedures since 2010. The majority of the 240 military installations in this analysis provided chiropractic/osteopathic manipulation; more than three-quarters provided acupuncture; and approximately one-third provided biofeedback procedures. "Other and unspecified disorders of the back" was the most frequent condition for which chiropractic/osteopathic manipulation and acupuncture were used. "Non-allopathic lesions not elsewhere classified" was the second most frequent diagnosis during chiropractic/osteopathic manipulation-related visits. The second and third most frequent diagnoses during acupuncture-related visits were "acute and chronic pain" and "adjustment reaction," respectively. "Adjustment reaction" was the second most frequent diagnosis associated with biofeedback. Continued research is needed to gain a better understanding of why military personnel are using CAM and the role these procedures play in their health care.