Families serve too: military spouse well-being after separation from active-duty service.

BACKGROUND AND OBJECTIVES: Transitioning from military to civilian life can be challenging for families, but most research focuses only on the service member. We applied a life course model to assess spouse well-being following this important transition. DESIGN: Prospective, longitudinal survey of service members and their spouses. METHODS: We captured three spouse well-being domains: psychological health, physical health, and family relationships. We identified differences between families who separated from service and those still affiliated (N = 4,087) and assessed baseline factors associated with spouse well-being after the family separated from service (N = 1,199). RESULTS: Spouses of service members who had separated from the military (versus those who had not) reported poorer mental health and family relationship quality at baseline and follow-up. After controlling for baseline differences, spouses whose families transitioned experienced a greater increase in PTSD symptoms and a steeper decline in quality of marriage. Spouses of active-duty service members reported greater increases in work-family conflict. Among families who had transitioned, the most consistent predictor of positive outcomes was baseline well-being. Protective factors included having more psychological and social resources and less financial stress. CONCLUSIONS: Several protective and risk factors identified in the study may inform programming for families transitioning from active duty.

Addressing Posttraumatic Stress Disorder in Primary Care: Primary Care Physicians' Knowledge, Confidence and Screening Practices Related to PTSD Among Military Populations.

BACKGROUND: Posttraumatic stress disorder (PTSD) is an undertreated psychological condition prevalent among service members and veterans. Members of the military community often raise mental health concerns in primary care settings. However, many primary care physicians (PCPs) lack training in PTSD within the military community and may be underprepared to discuss PTSD or trauma with patients. OBJECTIVES: We assessed PCPs' knowledge of evidence-based PTSD screening and treatment practices, confidence in their abilities to provide clinical care around PTSD, and frequency of asking new patients about their military history. We also examined PCP characteristics related to these measures. RESEARCH DESIGN: We surveyed a national sample of 7426 PCPs to assess their PTSD knowledge, confidence, and military history screening practices. Data were analyzed using weighted multivariable regressions. RESULTS: Forty-three percent of PCPs reported they very often or always screened for military history and, on average, PCPs answered 41% of the PTSD knowledge items correctly. PCPs who rated their PTSD knowledge higher were more confident and more frequently screened for military history, but did not have higher knowledge scores compared with PCPs with lower self-assessed knowledge. Several PCP characteristics, such as sex, years of practice, and practice setting, predicted PTSD measures. CONCLUSIONS: PCPs have gaps in their knowledge and screening practices related to PTSD. The absence of a meaningful correlation of knowledge scores with PCP self-assessed knowledge or confidence suggests PCPs may not accurately rate their own knowledge. Targeted, evidence-based training on effective practices may promote PTSD clinical knowledge.

Examining the influence of the Enforcing Underage Drinking Laws (EUDL) program on alcohol-related outcomes in five communities surrounding Air Force bases.

In 2006, the Office of Juvenile Justice and Delinquency Prevention (OJJDP) awarded discretionary grants to five communities as part of the Enforcing Underage Drinking Laws (EUDL) initiative to implement an environmental strategy approach to reduce drinking and associated misconducts among Air Force members. The evaluation design was a within-site, pre-test/post-test intervention comparison of baseline data to out-year data. Four of the five communities had significant decreases in one or more of the outcomes of interest from pre-test to post-test. Two communities (Great Falls, MT and Tucson, AZ) had a significant decline in the compliance check failure rate of local establishments that sell alcohol. One community (Great Falls, MT) had a significant decline in arrests for possession of alcohol by a minor. Four communities (Great Falls, MT; Tucson, AZ; Phoenix, AZ; Honolulu, HI) had a significant decline in DUI/DWI arrests. These findings build on results reported in an earlier article which provided evidence to suggest that the EUDL program had an influence on self-reported drinking behaviors in three of the five communities. These two articles, in combination, provide evidence to suggest for the first time that community-level programs using an environmental strategy approach can be successful in targeting military members.

Relationship of military deployment recency, frequency, duration, and combat exposure to alcohol use in the Air Force.

OBJECTIVE: With today's new military deployment environment, characterized by more frequent and longer deployments, significant attention has focused on the effects of deployment on problem behaviors, including alcohol use. The current study examined the relationship between aspects of deployment and alcohol use. METHOD: The data for the current study were collected as part of the Air Force Community Assessment survey, an anonymous Web-based survey of Air Force members. The survey was administered to a stratified random sample of 56,137 active duty Air Force members across 80 bases worldwide; 78% were male and 22% were female. The Alcohol Use Disorders Identification Test measured the rate of alcohol problems. Deployment histories were collected using a series of questions that asked respondents about various aspects and characteristics of their recent deployments. RESULTS: Logistic regression was used to examine the impact of various aspects of deployment on problem drinking. After controlling for demographic variables related to the likelihood of problem drinking, both a higher frequency of deployment and a greater total cumulative length of time deployed since September 11, 2001, were associated with a higher likelihood of problem drinking. For each increase in deployment frequency category the odds that an Air Force member was a problem drinker increased by 14%, and for each additional year spent deployed the odds increased by 23%. CONCLUSIONS: These findings indicate a significant relationship between deployment and problem drinking. However, most members who deployed multiple times remained resilient. This points to the need for future research on protective factors that foster resiliency.

Reducing drinking among junior enlisted Air Force members in five communities: early findings of the EUDL program's influence on self-reported drinking behaviors.

OBJECTIVE: In the fall of 2006, the Office of Juvenile Justice and Delinquency Prevention awarded discretionary grants to five communities in four states as part of the Enforcing Underage Drinking Laws initiative. These 3-year grants were designed to support implementation of a set of interventions using an environmental strategies approach to reduce drinking and associated alcohol-related misconducts among active-duty Air Force members ages 18-25, with a specific focus on the underage population. The current article presents findings from Year 1 of the evaluation. METHOD: Data on alcohol use were obtained from a large-scale, anonymous survey that fielded in the spring of 2006 (i.e., pretest) and the spring of 2008 (i.e., posttest) from a stratified random sample of Air Force members at five demonstration and five comparison communities. RESULTS: The percentage of junior enlisted personnel at risk for an alcohol problem dropped 6.6% in the Air Force overall during the last 2 years but dropped as much as 13.6% and 9.8% in two Arizona demonstration communities that implemented the intervention. CONCLUSIONS: The first-year results suggest that the Enforcing Underage Drinking Laws intervention may have been one factor that helped to reduce the percentage of junior enlisted Air Force members at risk for an alcohol problem in the demonstration communities.

Parental aspirations for their children's educational attainment: relations to ethnicity, parental education, children's academic performance, and parental perceptions of school climate.

This study examined parental aspirations for their children's educational attainment in relation to ethnicity (African American, Asian, Caucasian, Hispanic), parental education, children's academic performance, and parental perceptions of the quality and climate of their children's school with a sample of 13,577 middle and high school parents. All parents had relatively high educational aspirations for their children, and within each ethnic subgroup, parental education and children's academic performance were significantly and positively related to parental aspirations. However, moderating effects were found such that Caucasian parents with lower levels of education had significantly lower educational aspirations for their children than did parents of other ethnicities with similar low levels of education. Although the strength of the relationship between parental perceptions of school-related factors and parental aspirations for their children's educational attainment was not strong, it was most predictive of non-Caucasian parental aspirations for their children.

Estimating person--environment transactions on intention to change drug-using behaviors.

The community attachment model of addiction is an ecologically based social process model that suggests social context referents (peers, family, neighbors, etc.) will influence attachment to addiction or recovery communities, via cognitive, affective, and behavioral commitments. This study examined the influence of social context referents on intention to change drug using behavior, and examined moderating effects of three contextual indicators (labor market attachment, educational attainment, and family poverty status) on these relationships. The study sample consisted of 302 adults in inpatient and outpatient substance abuse treatment facilities, who completed a set of instruments that included the Ecological Assessment of Substance Abuse Experiences (EASE), a new instrument designed to measure the influence of social context referents on addiction and recovery attachment processes. Results showed that all three contextual indicators moderated relationships among social context referenced attitudes, drug use concern, and intention to change drug using behaviors. Findings suggest that practitioners should attend to both microlevel orientations to social context and macrolevel contextual dimensions (e.g., labor force attachment), as both may influence behavioral change opportunities.

Examining the relative importance of social context referents in predicting intention to change substance abuse behavior using the EASE.

There is growing consensus across literatures that more than individual motivation and "will to change" influence whether a client will be able to make and sustain recovery-related changes to prevent drug relapse post-treatment. New areas of inquiry in the substance abuse field have proposed conceptual models that promote an integration of both individual and social context factors, which offer the opportunity for important developments in clinical practice. This study examined the influence of social context referents on clients' intention to change substance abusing behaviors. The Ecological Assessment of Substance abuse Experiences (EASE), an instrument that measures the influence of social context referents on addiction and recovery behaviors, was administered to 302 inpatient and outpatient adults in treatment for substance abuse. Results showed that the number of people in his/her social network favorable towards recovery (Beta=.222); the extent to which one personally identifies with being in recovery (Beta=.339); the perceived importance of people in the client's social network encouraging recovery-related behaviors (Beta=.369); weak beliefs that drugs will lead to positive outcomes (Beta=-.220); and strong beliefs that recovery will lead to positive outcomes (Beta=.307) were all associated with intention to change substance abusing behavior.

Ecological Assessment of Substance-abuse Experiences (EASE): findings from a new instrument development pilot study.

A newly developed instrument that assesses a client's orientation to addiction or recovery communities using social context referents was pilot tested with a sample of 103 adults seeking treatment for substance abuse at outpatient and residential treatment facilities on the East Coast. Preliminary findings show promising subscale reliabilities, and suggest that drug- and recovery-related social identities are related to drug-use severity and drug-use concern; and drug-related attitudinal congruence between the treatment-seeker and family and treatment-seeker and other significant persons are related to intention to make behavioral changes in reducing substance abuse.