Sleep health among US Navy afloat versus ashore personnel in the Millennium Cohort Study.

Despite emerging public concern regarding the sleep health of military personnel over the past two decades, there remains a dearth of research examining sleep health among naval personnel assigned to sea duty. This study examined sleep metrics (e.g. fatigue, short sleep duration) and mental (e.g. posttraumatic stress disorder, depression) and physical health (e.g. type 2 diabetes, bodily pain) outcomes among naval personnel with recent sea duty (i.e. afloat) compared with naval personnel with recent shore duty (i.e. ashore). Prevalence ratios and mean differences for all outcomes were estimated and adjusted for demographic and military variables, and subsequently stratified by obesity. Sleep metrics were similar between afloat and ashore sailors except for short sleep duration, while sailors with recent shore duty had poorer physical health compared with those with recent sea duty. Stratified analyses suggested naval personnel with obesity had a higher proportion of nearly all adverse sleep-related health outcomes than those without obesity. Among participants without obesity, afloat personnel were more likely to report very short sleep (≤ 5 hours) and fewer hours of average nightly sleep, but were less likely to report physical health outcomes compared with ashore personnel. These findings suggest potential differences in sleep metrics and sleep-related health outcomes between afloat and ashore naval personnel. Additional research examining sleep outcomes using more objective measures is required to further investigate these findings, which may inform strategies to foster consolidated sleep despite environmental and occupational challenges in order to maintain high-performing naval personnel.

Steps toward developing a comprehensive fatigue monitoring and mitigation solution: perspectives from a cohort of United States Naval Surface Force officers.

Study Objectives: This study analyzed fatigue and its management in US Naval Surface Force warships, focusing on understanding current practices and barriers, and examining the influence of organizational and individual factors on managing chronic fatigue. Furthermore, this study explored the impact of organizational and individual factors on fatigue management. Methods: As part of a larger study, 154 naval officers (mean ±â€…standard deviation; 31.5 ±â€…7.0 years; 8.8 ±â€…6.8 years of service; 125 male, and 29 female) completed a fatigue survey. The survey addressed (1) self-reported fatigue, (2) fatigue observed in others, (3) fatigue monitoring strategies, (4) fatigue mitigation strategies, and (5) barriers to fatigue mitigation. Logistic and ordinal regressions were performed to examine the effect of individual (i.e. sleep quality and years in military service) and organizational (i.e. ship-class) factors on fatigue outcomes. Results: Fatigue was frequently experienced and observed by 23% and 54% of officers, respectively. Of note, officers often monitored fatigue reactively (i.e. 65% observed others nodding off and 55% observed behavioral impairments). Still, officers did not frequently implement fatigue mitigation strategies, citing few operationally feasible mitigation strategies (62.3%), being too busy (61.7%), and not having clear thresholds for action (48.7%). Fatigue management varies across organizational factors, which must be considered when further developing fatigue management strategies. Conclusions: Fatigue remains a critical concern aboard surface force ships and it may be better addressed through development of objective sleep and fatigue monitoring tools that could inform leadership decision-making.

Advancing a U.S. navy shipboard infrastructure for sleep monitoring with wearable technology.

Development of fatigue management solutions is critical to U.S. Navy populations. This study explored the operational feasibility and acceptability of commercial wearable devices (Oura Ring and ReadiBand) in a warship environment with 845 Sailors across five ship cohorts during at-sea operations ranging from 10 to 31 days. Participants were required to wear both devices and check-in daily with research staff. Both devices functioned as designed in the environment and reliably collected sleep-wake data. Over 10,000 person-days at-sea, overall prevalence of Oura and ReadiBand use was 69% and 71%, respectively. Individual use rates were 71 ± 38% of days underway for Oura and 59 ± 34% for ReadiBand. Analysis of individual factors showed increasing device use and less device interference with age, and more men than women found the devices comfortable. This study provides initial support that commercial wearables can contribute to infrastructures for operational fatigue management in naval environments.

Organizational caring as a predictor of good mental health in an operational naval environment.

Military service members encounter numerous stressors that adversely affect their mental health. These pervasive stressors emphasize the need to continually surveil, identify, and mitigate negative factors before they can produce cascading consequences for the individual. The present study utilized a large sample (N = 13,666) to identify several factors that might lead individuals to have poor mental health days in an austere naval operating environment. One quarter of respondents (N = 3,484; 25.49%) indicated that they had 0 poor mental health days in the preceding month, whereas one in eight (N = 1,868; 13.57%) indicated experiencing poor mental health every day in the preceding month. This bimodal distribution allowed for binary logistic regression to determine the relative influence of various factors in identifying individuals who reported significant mental health concerns versus those who did not. Split-half analyses also permitted replication of the data through randomized sampling and dividing data by ship class. Gender emerged as the most prominent predictor of mental health quality with females reporting poorer mental health. Meanwhile, organizational caring (a service member's belief that higher organizational levels cared about them) emerged as a protective factor. Perceptions of caring among the organizational hierarchy depended upon organizational tier; that is, a connection to the larger organization functioned as an even more robust predictor than perceptions that their local and more salient organizational structure (e.g., direct supervisor) cared about them. Taken together, this evidence helps identify factors related to mental health issues that may negatively impact military personnel on active duty. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Selecting senior leaders in the public sector: Challenges and best practices.

Although the careful assessment and selection of leaders are important for an organization to succeed, selecting senior leaders can prove paramount given their potential to impact the entire organization. While private sector businesses expend substantial resources to recruit and retain senior leaders, the public sector struggles to do so, which in turn impacts the attitudes and retention of employees throughout the enterprise. For example, a recent survey of federal employees in the United States found that most respondents did not believe their senior leaders generated high levels of motivation and commitment in the workforce. Enhancing the senior leader selection process thus represents a prime opportunity to enhance organizational success in the public sector. The current discussion reviews four core topics for senior leader selection: (a) determine organizational needs, (b) agree upon competencies for a senior leader, (c) leverage employees from all organizational tiers via a selection committee, and (d) examine ethical issues in selecting senior leaders. Each topic contains an overview of the relative challenge while drawing a contrast between senior and junior leadership positions, as well as comparisons between the public and private sectors. These challenges are presented alongside best practices that should produce a more effective selection process. Taken together, this combined evidence should enable organizational success by ensuring that the highest quality candidates are selected into senior leadership positions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological endurance: how grit, resilience, and related factors contribute to sustained effort despite adversity.

Many concepts describe how individuals sustain effort despite challenging circumstances. For example, scholars and practitioners may incorporate discussions of grit, hardiness, self-control, and resilience into their ideas of performance under adversity. Although there are nuanced points underlying each construct capable of generating empirically sound propositions, the shared attributes make them difficult to differentiate. As a result, substantial confusion arises when debating how these related factors concomitantly contribute to success, especially when practitioners attempt to communicate these ideas in applied settings. The model proposed here-psychological endurance-is a unified theory to explore how multiple concepts contribute to sustained goal-directed behaviors and individual success. Central to this model is the metaphor of a psychological battery, which potentiates and sustains optimal performance despite adversity. Grit and hardiness are associated with the maximum charge of the psychological battery, or how long an individual could sustain effort. Self-control modulates energy management that augments effort required to sustain endurance, whereas resilience represents the ability to recharge. These factors are constrained by both psychological and physiological stressors in the environment that drain the psychology battery. Taken together, these ideas form a novel framework to discuss related psychological concepts, and ideally, optimize intervention to enhance psychological endurance.

Prevalence and correlates of destructive behaviors in the US Naval Surface Forces from 2010-2020.

PURPOSE: To estimate the prevalence of domestic violence, sexual assault, and suicide for United States Navy (USN) personnel between 2010 and 2020 and identify potential associated factors. METHODS: Official report data were used to calculate prevalence rates and odds ratios, accounting for sample and general USN population demographic data to assess differences in over- or underrepresentation of destructive behaviors. RESULTS: Domestic violence and sexual assault offenders tended to be younger lower-ranked males. For sexual assaults, offenders were three times more likely to be senior to the victim, which was not the case for domestic violence. Females were overrepresented in terms of suicidal ideation and attempts relative to the USN population, while males accounted for more actual suicides. The relative rates of suicidal ideation and attempts for females exceeded those for males (i.e., comparing the sample rate against the USN male and female populations), but the sample proportion for completed suicides (compared to the USN population) were greater for males than for females. Those in the junior enlisted (E1-E3) paygrades exhibited greater odds of suicide attempts versus suicidal ideations relative to those in the Petty Officers (E4-E6) paygrades, although E4-E6s completed more suicides. CONCLUSION: The descriptive profile of destructive behaviors in a representative sample of USN personnel provides an overview of the possible factors associated with destructive behaviors and includes an exploration of the relational dynamics and nature of the incidents. The results suggest that sexual assault and domestic violence are characterized by unique relational dynamics and that these destructive behaviors should not necessarily be classified together as male-oriented aggressions (i.e., mainly perpetrated by males against female victims). Those in the E1-E3 and E4-E6 paygrades displayed different patterns in suicidal ideation, attempts, and actual suicides. The results highlight individual characteristics to help inform the development of targeted policies, practices, and interventions for military and other hierarchical organizations (e.g., police).

Sleep deficiency, operational fatigue and the interplay of compromising factors: Analysis to aid in fatigue management.

The United States Navy is a high-reliability organization that must maintain optimum performance under challenging conditions. One key challenge for sailors is obtaining sufficient sleep, which can lead to fatigue and other outcomes that compromise operational readiness. Identifying sleep issues and their causes is critical for military leaders to care for their personnel, and to make informed, risk-based operational decisions. Though previous studies in shipboard environments have implicated factors responsible for insufficient sleep (e.g. poor sleep environment and work demands), there has been less research into characterizing the complex interplay among such factors in relation to sleep and work-related fatigue outcomes. This study seeks to address this gap. Data were drawn from the Afloat Safety Climate Assessment Survey of 7617 sailors from 73 ships. The survey included demographic characteristics and measures of crew endurance (e.g. sleep, occupational impairment due to fatigue). Descriptive analyses characterized the presence and severity of sleep issues across subpopulations and operational settings (e.g. the type of ship); structural equation modelling techniques characterized and quantified the statistical associations among factors. The results indicate that sleep deficits are widespread, holding across subpopulations and operational settings. Though sleep deficits varied across subpopulations, no group obtained an average of more than 7 hr of sleep per night. Fatigue-induced occupational functional impairment was directly related to sleep deficiency, and sleep environment and job-related factors were contributors to sleep deficiency. Moreover, job-related factors emerged as potentially more consequential. Lastly, factors may exist aboard a ship that could help promote better sleep.

Development and testing of a tool to measure the organizational safety climate aboard US Navy ships.

INTRODUCTION: Safety climate is a critical human factor that can increase safety-related behaviors and reduce accidents. This research reports on a three-phase program of development and validation of a safety climate survey tool initiated by U.S. Naval Surface Forces after numerous accidents and near misses. METHOD: The initial survey was administered to 4,042 sailors aboard 30 warships, and factor analysis supported a three-factor measure of a safety climate composed of operational compliance, positive work environment, and organizational resources. The predictive validity of the newly developed safety climate measure was tested against the number of accidents reported in the 12 months after the safety climate survey. RESULTS: This analysis revealed that a positive work environment and operational compliance were linked to fewer accidents; surprisingly, organizational resources were linked to more accidents. Implications for future research on safety climate and occupational safety are discussed.

Self-reported sleep and sleep deficiency: Results from a large initiative of sailors attached to U.S. Navy warships.

Chronic insufficient sleep is known to lead to a broad range of negative consequences (e.g. poor health and cognitive performance). While insufficient sleep and associated fatigue are present in many diverse populations, it is of special concern in high-risk military environments, where a mishap can result in catastrophic outcomes. Although many studies have been conducted to characterise sleep in general military populations, relatively few have been conducted using a large representative sample of sailors assigned to United States Naval warships. The present cross-sectional study characterises self-reported sleep parameters in sailors (N = 11,738) and explores the role of possible contributors to insufficient sleep. The results indicate that sailors, across a variety of different subgroups, do not obtain the amount of sleep that they report requiring for feeling well-rested. Of the many potential factors thwarting sleep, workload and an uncomfortable mattress are the most promising candidates to target for improvement.

The stress bias in mental health reporting: Death anxiety biases mental health self-assessments amongst deployed soldiers.

This study examined whether posing questions that create a stress state in respondents biases subsequent reporting of mental health (MH) symptomology. For instance, questions related to trauma exposure may activate thoughts about death (facing it, surviving it, being afraid of it), and these death anxieties can influence assessments of one's health and thus bias self-reports of MH measured in the same questionnaire context. A controlled randomized experiment was conducted as part of a longitudinal study of U.S. Army soldiers who deployed to Afghanistan between April 2013 and January 2014. Anonymous surveys administered middeployment (n = 464) included self-report MH screening instruments for posttraumatic stress disorder, depression, and generalized anxiety disorder. Combat exposures (CEs) were primed by randomly presenting the CE questions before or after MH instruments. The order of the measures significantly influenced reports of MH symptoms, and this stress bias is explained by differences in death anxiety. Moderated mediation analyses revealed that the well-documented relationship between the intensity of CEs and each MH screener severity score was significant when the CEs were primed but not vice versa (index of moderated mediation: for PTSD, 95% CI [.0000, .0216]; for depression, 95% CI [.0000, .0216]; and for generalized anxiety disorder, 95% CI [.0005, .0170]), and that death anxiety mediated these relationships. Health care providers and psychological researchers who use standardized, nonrandomized, clinical screening instruments should be aware of this stress bias: Asking respondents to report a potentially traumatic exposure can bias the self-reporting of MH symptomatology. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

To what extent is psychological resilience protective or ameliorative: Exploring the effects of deployment on the mental health of combat medics.

Exposure to a major traumatic stressor increases the odds of negative mental health and maladaptive behavioral outcomes not only for victims but also for 1st responders and health care professionals who are exposed to the aftermath. This study investigates the extent to which psychological resilience acts as either a Protective (i.e., vaccine-like) or an Ameliorative (i.e., antibiotic-like) factor to reduce the deleterious mental health outcomes associated with exposure to a major stressor. To do so, this pilot study focused on the understudied population of military combat medics, who are exposed to both stressors associated with direct combat and with providing intense battlefield trauma care. Military combat medics who were identified as having deployed to Iraq or Afghanistan shortly after baseline measurements of posttraumatic stress disorder, depression, and aggressive behavioral tendencies and returned from deployment prior to the follow-up assessment (protective model) were compared to those who returned from deployment in Iraq or Afghanistan shortly before the baseline measurements and were not deployed again prior to the follow-up assessments (ameliorative model). Data were collected on combat experiences to equate the stressor for these 2 samples, and a propensity score matching technique was used to ensure that the 2 samples were similar. The findings provide support for both the protective and the ameliorative models of psychological resilience. Results are discussed in terms of the potential benefits of resilience in mental health programs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Genetic association of FKBP5 with PTSD in US service members deployed to Iraq and Afghanistan.

Post-traumatic stress disorder (PTSD) is a debilitating mental disorder with a prevalence of more than 7% in the US population and 12% in the military. An interaction of childhood trauma with FKBP5 (a glucocorticoid-regulated immunophilin) has been reported to be associated with PTSD in the general population. However, there are few reports on the association of FKBP5 with PTSD, particularly in important high-risk population such as the military. Here, we examined the association between four single-nucleotide polymorphisms (SNPs; rs3800373, rs9296158, rs1360780, rs9470080) covering the FKBP5 gene and probable PTSD in US service members deployed to Iraq and Afghanistan, a high-risk military population (n = 3890) (Hines et al., 2014). We found that probable PTSD subjects were significantly more likely to carry the A-allele of rs3800373, G-allele of rs9296158, C-allele of rs1360780, and C-allele of rs9470080. Furthermore, the four SNPs were in one block of strong pairwise linkage disequilibrium (r = 0.91-0.96). Within the block there were two major haplotypes of CATT and AGCC (rs3800373-rs9296158-rs1360780-rs9470080) that account for 99% of haplotype diversity. The distribution of the AGCC haplotype was significantly higher in probable PTSD subjects compared to non-PTSD (p<.05). The diplotype-based analysis indicated that the AGCC carriers tended to be probable PTSD. In this study, we demonstrated the association between FKBP5 and probable PTSD in US service members deployed to Iraq and Afghanistan, indicating that FKBP5 might be a risk factor for PTSD.

The evolution of mental health outcomes across a combat deployment cycle: A longitudinal study of the Guam Army National Guard

In the United States, National Guard soldiers have been called upon at unprecedented rates since 2001 to supplement active duty military forces. Frequent military deployments generate many occupational and environmental stressors for these citizen-soldiers, from serving in a dangerous zone to being away from family and home for long periods of time. Whereas there is a substantial amount of research focused on deployment-related health outcomes in relation to active duty (i.e., full-time) military populations, reserve forces are less understood. This study focuses on a United States Army National Guard combat unit deployed to Afghanistan. This prospective longitudinal study was conducted over the course an operational deployment cycle (i.e., before, during, and after) to document the evolution of salient mental health outcomes (i.e., post-traumatic stress, depression, general anxiety, and aggression). The findings show that both combat (e.g., killing others) and non-combat (e.g., boredom) stressors negatively affect mental health outcomes, and the severity of these outcomes increases over the course of a deployment cycle. Of special note, the study reveals key gender differences in the evolution of post-traumatic stress (PTS), depression, and anxiety across a deployment cycle: females report increased PTS, depression, and anxiety 6 months post-deployment, whereas the levels reported by males stabilize at their mid-deployment levels. The findings offer insights for medical providers and policymakers in developing more targeted health promotion campaigns and interventions, especially at the post-deployment phase.

Body Composition and Physical Fitness Tests Among US Army Soldiers: A Comparison of the Active and Reserve Components.

OBJECTIVES: US Army reserve soldiers and active-duty soldiers differ in their daily work demands and supporting resources, yet research on reservists' health and fitness is lacking. The objectives of this study were to (1) determine whether physical test failure rates and health behaviors differed between active-duty soldiers and reserve soldiers and (2) establish which demographic and health behavioral factors were associated with failing physical tests. METHODS: We analyzed a sample of 239 329 US Army active-duty and reserve soldiers surveyed from September 2013 through March 2015 using the Global Assessment Tool. We extracted data on soldier demographic characteristics and health behaviors, as well as Body Composition Test (BCT) and Army Physical Fitness Test (APFT) results. We compared the 2 groups using the active-to-reserve adjusted odds ratio (aOR) for each variable. We used logistic regression models to determine which variables were associated with failing these tests. RESULTS: The odds of failing the BCT (aOR = 0.76; 95% confidence interval [CI], 0.73-0.78) or the APFT (aOR = 0.31; 95% CI, 0.30-0.32) were lower among active-duty soldiers than among reservists, and the odds of doing high levels of high-intensity interval training (aOR = 1.47; 95% CI, 1.42-1.51), resistance training (aOR = 1.45; 95% CI, 1.42-1.48), and vigorous physical activity (aOR = 2.92; 95% CI, 2.86-2.98) were higher among active-duty soldiers than among reservists. The odds of using tobacco (aOR = 1.37; 95% CI, 1.35-1.40), binge drinking alcohol (aOR = 1.11; 95% CI, 1.09-1.13), having insomnia (aOR = 1.46; 95% CI, 1.43-1.48) or mild depression (aOR = 1.50; 95% CI, 1.48-1.53), and sustaining a physical activity-related injury (aOR = 2.52; 95% CI, 2.47-2.57) were higher among active-duty soldiers than among reservists. CONCLUSIONS: Policy makers and military leaders could use this information to implement health screenings and tailor health-promotion, intervention, and treatment programs.

Association between leukocyte telomere length and hostility in US army service members.

Hostility is a common form of emotionally charged anger which can lead to maladaptive and unhealthy behaviors. Significant association between shortened telomeres and greater levels of hostility has been observed in civilian populations, but has not yet been comprehensively studied in military populations. Our study investigates the relationship between hostility, post-traumatic stress disorder (PTSD), and leukocyte telomere length (LTL) in a sample of United States Army Special Operations personnel (n = 474) who deployed to Iraq and/or Afghanistan as part of combat operations. Hostility was measured with five items from the Brief Symptom Inventory (BSI). PTSD was determined using the PTSD Checklist (PCL) total score. The LTL was assessed using quantitative polymerase chain reaction methods and regression analyses were conducted to determine the association of hostility and telomere length. PTSD subjects reported higher hostility scores compared with those without PTSD. Among the participants with PTSD, those with medium or high level of hostility had shorter LTL than those with low level hostility (P < 0.01). Stepwise regression indicated that hostility level and age, but not gender and PTSD, were negatively correlated with LTL. Univariate regression showed that total hostility score was negatively associated with LTL (CI= -0.06 to -0.002, Beta= -0.095, p < 0.039) as well as a significant correlation between LTL and hostility impulses (HI) (CI= -0.108 to -0.009, Beta= -0.106, p < 0.021) and hostility controlling (HC) (CI= -0.071 to -0.002, Beta= -0.095, p < 0.004). Multiple regression analyses revealed that, while HC has no significant association with LTL, HI was still negatively correlated with LTL (p = 0.021). Our data indicates that LTL is associated with HI levels. Prevention and treatment efforts designed to reduce hostility may help mitigate risk for LTL shortening, a process of cellular aging, and thus slow accelerated aged-related health outcomes.

Association of suicidal ideation with trajectories of deployment-related PTSD symptoms.

This study examined the association between suicidal ideation and posttraumatic stress disorder (PTSD) symptom trajectories in a nationally representative sample of United States Reserve Component soldiers. PTSD symptoms related to a traumatic event during the most recent deployment were assessed in four annual waves in 2010-2013 among 682 Reserve Component soldiers. Latent Growth Mixture Modeling (LGMM) was used to examine the longitudinal trajectories of PTSD symptoms. The association between the PTSD trajectories and suicidal ideation at waves 2 to 4 was examined in logistic regression analyses. Four trajectories were identified: resilience (73.0%), recovery (11.7%), late onset (11.6%) and chronic (3.6%). Pairwise comparisons demonstrated significant differences between trajectories in risk of suicidal ideation. Among the chronic trajectory group, 50.9% reported suicidal ideation (25.8% late onset group; 11.3% recovery group; 4.0% resilience group). After controlling for baseline characteristics, the late onset and chronic trajectory groups were more likely to have suicidal ideation than the resilience and recovery trajectories, respectively. Findings suggest the late onset and chronic trajectories of PTSD symptoms are associated with higher risk of suicidal ideation. They support the importance of follow-up assessment of suicide risk even among individuals with low PTSD symptoms at homecoming.

It's not just showing up: How social identification with a veterans service organization relates to benefit-finding and social isolation among veterans.

Social identity theory suggests that the degree to which people identity with an organizational group can have multiple beneficial outcomes. This research focuses on how membership in and engagement with a Veterans Service Organization (VSO) relate to veterans' social isolation and perceptions that military service was beneficial to society, ultimately leading to improved veterans' health. Data from an online survey of 444 military veterans show that physical attendance and the degree to which veterans identify identification with the VSO play different roles in improving veterans' lives. Not only is VSO attendance linked to reduced social isolation but social isolation is further reduced when members both attend and feel strong social identification with the VSO. The degree to which veterans identify with the VSO is also directly linked to greater perceptions of benefit-finding from military service, even for those who do not physically partake in the VSO's activities. Lesser isolation and greater benefit-finding are related to lower levels of posttraumatic stress symptomology. The results suggest that VSOs may be integrated into new approaches to assist veterans' transition from military into civilian life. (PsycINFO Database Record

Sensation seeking moderates television's cultivation of alcohol and tobacco beliefs: Evidence from a national study of French adolescents.

BACKGROUND: Television (TV) is a key socialization agent, especially amongst youth. According to cultivation theory, youth heavily exposed to TV content, where positive images of smoking and drinking abound, should hold more positive beliefs concerning drinking and smoking outcomes. This research investigates the role of the sensation-seeking personality trait in moderating this TV cultivation effect. METHODS: A French national research company contacted its panel members with children aged 13-17. Parents completed a short survey and were asked for consent for their child to participate in a study. The children were then contacted, informed, and asked for assent. Assenters completed a survey that included measures of TV exposure, personality traits, drinking and smoking behaviors, and beliefs about the outcomes associated with drinking and smoking (expectancies). Parental drinking, smoking, and strictness were included as controls. RESULTS: Survey data from 1040 adolescents (54.2% males) and their parents reveal that the relationship between cumulative TV exposure and drinking and smoking behavior, mediated through expectancies, is strongest amongst high sensation seeking adolescents. The moderated mediation analysis shows that sensation seeking trait moderates the relationship between TV exposure and the beliefs adolescents hold about the consequences of alcohol and tobacco use, which themselves are related to greater likelihood to engage in substance use. CONCLUSION: Key personality traits and TV exposure levels must be accounted for to identify youth at risk of using substances at a time when many lifelong maladaptive behaviors and beliefs form.