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1 NAVAL HEALTH RESEARCH CENTER ALCOHOL USE, ALCOHOL-RELATED PROBLEMS, AND PERCELVED STRESS AND COPLNG AMONG U, S MARLNE CORPS PERSONNEL B. McClenny R. D. Cmstck ^^mm m Reprt N Apprved fr public release; distributin unlimited. NAVAL HEALTH RESEARCH CENTER P.O. BOX SAN DIEGO, CA BUREAU OF MEDICINE AND SURGERY (MED-02) 2300 E ST. NW WASHINGTON, DC

2 Alchl Use, Alchl-Related Prblems, and Perceived Stress and Cping amng U.S. Marine Crps Persnnel Bnita McCIenny, Ph.D. LT MSC USN R. Dawn Cm stck, M.S. Divisin f Operatinal Readiness Naval Health Research Center P. O. Bx San Dieg, CA k Reprt N , supprted by (give name f funding surce.) under research wrk unit HQ U. S. Marine Crps Reimbursable The views expressed in this article are thse f the authrs and des nt reflect the fficial plicy r psitin f the Department f the Navy, Department f Defense, r the U.S. Gvernment. Apprved fr public release; distributin unlimited.

3 Cntents Chapter Page 1. Intrductin and Backgrund Purpse and Objectives Trends in Alchl Use and Alchl-Related Prblems Drinking Levels and Alchl-Related Prblems Drinking Levels and Other Health-Related Behavirs Perceived Stress and Quality f Life Organizatin f the Reprt Methdlgy Data Surces, Perfrmance Rates, and Respndent Characteristics Survey Questinnaire Key Definitins and Measures Demgraphic Characteristics Alchl Use, Alchl-Related Prblems, and Other Health 18 Behavir Measures 2.4 Analytical Apprach Suppressin f Estimates Marine Crps Trends in Alchl Use and Alchl-Related 21 Prblems 3.1 Average Daily Ounces f Alchl ' Alchl Drinking Levels Alchl-Related Prblems Summary Drinking Levels and Alchl-Related Prblems Prblems Attributed t Alchl Use Serius Cnsequences Prductivity Lss Prblems Symptms f Dependence " Prblems Nt Attributed t Alchl Use General Life Prblems Criminal Justice Prblems/Fights Health Prblems/Injuries 40

4 4.2.4 Jb-Related Prblems Prductivity Lss Demgraphic Crrelates f Prblems Crrelates f Prblems Attributed t Alchl Use Crrelates f Prblems Nt Attributed t Alchl Use Odds f Experiencing Prblems Odds f Experiencing Prblems Attributed t Alchl Use Odds f Experiencing Prblems Nt Attributed t Alchl 50 Use 4.5 Summary Drinking Levels and Other Health-Risk Behavirs Drinking and Driving Drinking and the Use f Seat Belts Drinking and Sexual Behavir Health Risk Behavirs and the Odds f Heavy Alchl Use Summary Perceived Stress and Quahty f Life Appraisal f Stress Demgraphic Crrelates f Stress Occupatinal Crrelates f Stress Surces f Stress Cping With Stress Impact f Stress n Jb Perfrmance Interference f Stress With Military Occupatin Perceived Stress and Prductivity Lss Summary 71 References 74 List f Appendices Appendix Page A Calculatin f Alchl Measures 77 B Technical Discussin f Standardizatin Apprach 82 and Multivariate Analyses C 1998 DD Survey Questinnaire 85

5 List f Tables Table Page 2.1 Marine Crps Survey Respnse Data and Perfrmance Rates Scidemgraphic Characteristics f 1998 Marine Crps Respndents 16 and f Ttal Eligible Respndent Ppulatin 3.1 Marine Crps and Ttal DD Trends in Average Daily Ounces f 23 Ethanl Cnsumed, Past 30 Days, Unadjusted and Adjusted fr Scidemgraphic Differences, Marine Crps and Ttal DD Trends in Alchl Drinking Levels, Marine Crps and Ttal DD Trends in Heavy Alchl Use, Past Days, Unadjusted and Adjusted fr Scidemgraphic Differences, Marine Crps and Ttal DD Alchl-Related Prblems, Alchl-Related Prblems in Past 12 Mnths fr Marine Crps, by 31 Drinking Level 4.2 Occurrence f Specific Serius Cnsequences in Past 12 Mnths, 32 by Drinking Level 4.3 Occurrence f Specific Types f Alchl-Related Prductivity Lss in 34 Past 12 Mnths, by Drinking Level 4.4 Occurrence f Specific Symptms f Alchl Dependence in Past Mnths, by Drinking Level 4.5 Unattributed Prblem Areas, by Drinking Level Occurrence f Specific Prblems Assciated With General Life Prblems, 38 by Drinking Level /- 4.7 Occurrence f Specific Prblems Assciated With Criminal Justice ^ 39 Prblems/Fights, by Drinking Level 4.8 Occurrence f Specific Prblems Assciated With Health 40 Prblems/Injuries, by Drinking Level 4.9 Occurrence f Specific Prblems Assciated With Jb-Related Prblems, 41 by Drinking Level 4.10 Occurrence f General Prductivity Lss, by Drinking Level Alchl-Related Prblems, by Selected Demgraphic Characteristics Life Prblem Areas, by Selected Demgraphic Characteristics Adjusted Odds Ratis f Alchl-Related Prblems fr Enlisted 49 Persnnel 4.14 Adjusted Odds Ratis f Unattributed Prblems fr Enlisted Persnnel Frequency f Drinking and Driving, by Drinking Level Frequency f Seat Belt Use, by Drinking Level Degree f Risk fr Sexually Transmitted Disease Amng Sexually 55 Active Persnnel, by Drinking Level 5.4 Adjusted Odds Ratis f Heavy Alchl Use, With an Emphasis n Other 58 Health-Risk Behavirs

6 6.1 Levels f Perceived Stress at Wrk and in Family Life, Past 12 Mnths, 59 by Gender 6.2 High Perceived Stress at Wrk r in Family Life, by Selected 61 Scidemgraphic Characteristics 6.3 Levels f Perceived Stress at Wrk in the Past 12 Mnths, by Occupatin Specific Surces f Stress, Past 12 Mnths, by Gender Behavirs fr Cping With Stress, by Gender Interference With Military Jb Perfrmance Due t Stress at Wrk, by 66 Selected Demgraphic Characteristics 6.7 Interference v^'ith Military Jb Perfrmance Due t Stress in Family, by 67 Selected Demgraphic Characteristics 6.8 Inability t Perfrm Military Jb Due t Stress at Wrk, by Occupatin Inability t Perfrm Military Jb Due t Stress in Family, by Occupatin Perceived Stress and Prductivity Lss, Past 12 Mnths 72 List f Figures Figure Page 3.1 Marine Crps Trends in Average Daily Ounces f Ethanl 22 Cnsumed, Past 30 Days, Unadjusted and Adjusted fr Scidemgraphic Differences, Marine Crps Trends in Heavy Alchl Use, Past 30 Days, 27 Unadjusted and Adjusted fr Scidemgraphic Differences, MarineCrpsTrendsin Alchl-Related Prblems,

7 Executive Summary This reprt presents findings frm analyses f U.S. Marine Crps data taken frm the Department f Defense (DD) series f Wrldwide Surveys f Substance Use and Health Behavirs Amng Military Persnnel with emphasis n the 1998 survey. Seven surveys f the active-duty persnnel, frm 1980 thrugh 1998, prvide cntinuity f infrmatin n substance use by military persnnel. The sampling designs and data cllectin methds have been similar thrughut the survey series. Methds are clarified in the discussin f methds used fr the 1998 survey. Analyses examine trends in alchl use and alchl-related prblems, the relatinship f drinking levels t alchlrelated prblems and ther health risk behavirs. In additin, issues f perceived stress and quality f life amng active-duty Marine Crps men and wmen were examined. The eligible survey ppulatin fr the Marine Crps cnsisted f all active-duty persnnel except recruits, service academy students, persns absent withut leave (AWOL), and persns wh had a permanent change f statin (PCS) at the time f data cllectin. Fr the 1998 survey, a sample f 3,622 Marine Crps persnnel cmpleted annymus, self-administered questinnaires. Participants were selected t represent men and wmen in all pay grades serving n active-duty thrughut the wrld. Recruits, academy students, r AWOL persnnel were excluded because they either were nt n active-duty lng enugh t typify the Marine Crps r were nt accessible. Thse with a PCS status were excluded because f the practical difficulties f btaining data frm them quickly enugh t be f use t the study. Results f the 1998 analyses f the Marine Crps data are specified belw: Trends in Alchl Use and Alchl-Related Prblems; Overall, rates f alchl use amng Marine Crps persnnel declined between 1980 and This was evident by the decrease in average unces f alchl cnsumed and in the increase in the percentage f abstainers. Ounces f alchl cnsumed decreased frm 1.75 unces t 1.00 unces. The percentages f abstainers increased frm 10.4% in 1980 t 19.7% in Serius cnsequences and prductivity lss due t alchl use declined significantly between 1980 and 1998, while rates f dependence symptms remained relatively cnstant. Over the perid, serius cnsequences declined frm 26.2% t 12.3%, prductivity lss drpped frm 34.1% t 19.2%, and dependence symptms decreased slightly frm 11.8% t 8.2%. Despite these declines, rates fr all three measures were substantially and cnsistently higher fr Marine Crps persnnel than fr DD persnnel verall. Thus, whereas verall alchl use declined frm 1980 t 1998, heavy use remained relatively cnstant. Prblems due t alchl use als declined ver the perid, but in 1998 sme categries f prblems still remained at relatively high levels. Many f these prblems have clear implicatins fr the health and readiness f the Marine Crps and the DD. Drinking Levels and Alchl-Related Prblems, 1998 Heavy drinkers were cnsistently mre likely than ther alchl users in the Marine Crps t experience prblems attributed t their use f alchl. Abut ne third f heavy drinkers

8 experienced alchl-related serius cnsequences (30%), neariy half (45.9%) experienced sme frm f alchl-related prductivity lss, and apprximately ne third (30%) had symptms suggestive f dependence. Heavy drinkers als demnstrated substantially higher rates f prblems cmprising the individual alchl-related prblems summary measures. Fr example, 23.7% f heavy drinkers had been in physical fights in the past 12 mnths because f drinking, cmpared with less than 10% f ther alchl users in the Marine Crps; abut 14% f heavy drinkers reprted being drunk while n the jb at least nce in the past 12 mnths and abut 15% had been called in t wrk feeling drunk. Less than 5% f ther drinkers in the Marine Crps had these prblems. Apprximately tw thirds f heavy alchl users (62.6%) had ne r mre alchl-related blackuts in the past 12 mnths, whereas less than 13% f infrequent/light r mderate drinkers had blackuts. Fr prblems unattributed t alchl use, heavy alchl users had higher rates than ther Marines f criminal justice prblems/fights. Specifically, tw thirds f the heavy drinkers (34.8%) had ne r mre ccasins f fighting r criminal justice prblems, cmpared with abut 8% t 15% fr abstainers and ther drinkers. Fr enlisted persnnel, heavy alchl use cntinued t be a risk factr fr the ccurrence f alchlrelated serius cnsequences, prductivity lss, and the dependence symptms. Therefre, heavy drinkers were much mre likely than ther drinkers in the Marine Crps t experience alchlrelated prblems. Drinking Levels and Other Health Risk Behavirs, 1998 Heavy drinking was assciated with higher frequencies f drinking and driving, nt using seat belts, and an increased number f sexual partners. Apprximately 37% f Marine Crps persnnel categrized as heavy drinkers reprted drinking and driving at least nce a mnth, 19.2% f heavy drinkers reprted using seat belts nly smetimes r less, and 23.3% f heavy drinkers reprted having at least 5 sexual partners in the past 12 mnths. Males, single persnnel, and persnnel in lwer pay grades, were mre likely t be categrized as heavy drinkers. Heavy drinking had a strng impact n the ccurrence f risky behavir. The findings suggest the need fr increased attentin t awareness prgrams that emphasize and demnstrate the cnsequences f heavy drinking. Plicies shuld be emplyed that emphasize alchl tlerance. Further, eclgical mdels shuld be implemented that fster supprt thrughut the Crps. Perceived Stress and Quality f Life Overall, Marines wh were yunger, less educated, and in lwer pay grades were mre likely t reprt high levels f stress. Apprximately 4 in 10 Marine Crps persnnel reprted experiencing a great deal r a fairly large amunt f stress at wrk in the past 12 mnths (prir t the study). Wmen (43.8%) were smewhat mre likely than men (38.9%) t experience stress at wrk. White persnnel reprted higher levels f stress than African American and Hispanic Marine Crps persnnel. In terms f stress, the surces f stress indicated by the majrity f persnnel were:

9 Being away frm family-19.2% Financial prblems-15.3% " Increases in wrklad-15.2% Men (12.8%) were mre likely than wmen (4.1%) t indicate that deplyment was a significant surce f stress. Wmen (23.8%) were mre likely than men (13.5%) t indicate that changes in the family was a significant surce f stress. Prductive cping strategies were the rhst widely used methd fr dealing with stress. Apprximately 84% f Marine Crps persnnel endrsed the cping strategy, "Think f a plan t slve prblem." This was fllwed by, 'Talk t friend/family" (67.9%) and "Exercise r play sprts" (65.5%). The mst cmmnly used unprductive cping strategies were "Get smething t eat" (39.3%), "Light up a cigarette" (27.7%), and "Smke marijuana/use illegal drugs" (1.5%). Overall, wmen were mre likely t use scial supprt netwrks and eating fd t alleviate stress. Men were mre likely t use alchl t alleviate stress than wmen. Apprximately 44.1% f all Marine Crps persnnel indicated sme level f stress-related interference with their ability t perfrm their military jbs. Overall, persnnel wh had nt graduated frm cllege, were white, Hispanic, r ther race/ethnicity, were age 25 r yunger, and were in pay grades E6 and belw experienced higher levels f military jb perfrmance interference due t stress. Fr thse persnnel wh experienced high levels f stress during the past 12 mnths (prir t the study), the mst frequent wrk-related ramificatins due t perceived stress were: Summary Left wrk early-36.1% Wrked belw nrmal perfrmance level-41.3% Late fr wrk by 30 minutes r mre-27.8% Given the cntinued high rates f heavy alchl cnsumptin amng subgrups f Marine Crps persnnel, it is mre urgent than ever t allcate resurces fr effective preventin and interventin prgrams. Furthermre, persns wh drink heavily are at a markedly increased risk f suffering frm adverse cnsequences. The current data and past research have indicated that heavy cnsumptin f alchl is assciated with adverse cnsequences, such as increased absenteeism, perfrmance decrements, and criminal justice prblems. Preventin strategies shuld enhance plicies and prcedures that further enhance the educatin and prmtin f healthy lifestyles as well as attempt t identify eclgical and persnal factrs that are assciated with varying degrees f alchl use.

10 1. Intrductin and Backgrund This reprt cnsists, f findings specific t the U.S. Marine Crps frm data cllected in the 1998 Department f Defense Survey f Health-related Behavirs Amng Military Persnnel. Research Triangle Institute (RTI) cnducted seven f these surveys f the active-duty frce in the perid frm 1980 t Thus a cntinuity f infrmatin n health-related behavirs amng military persnnel during that time perid has been analyzed. The primary fcus f this reprt is n the resultant effects f alchl use by active-duty persnnel. This chapter presents the purpse and bjectives f the study and utlines the rganizatin f the reprt. 1.1 Purpse and Objectives RTI presented the final reprt n the 1998 DD Survey f Health-related Behavirs Amng Military Persnnel t the Assistant Secretary f Defense (Health Affairs) (Bray et al., 1999). That reprt des nt cntain service-level data r data n specific selected issues in detail but rather reprts verall DD infrmatin as well as verviews arrayed by military service. This reprt delivers Marine Crps-specific analyses f data presented in the general reprt as well as in-depth analyses f issues f specific interest t the Marine Crps. The specific bjectives f this reprt were t examine - trends in alchl use and alchl-related prblems - drinking level stratificatin and alchl-related prblems - drinking level stratificatin and ther health-related behavirs - perceived stress and quality f life The determinants fr the classificatin f drinking level are described in detail in Chapter 2 and Appendix A. In this reprt, drinking level refers t five categries f alchl use: abstainer, infrequent/light drinker, mderate drinker, mderate/heavy drinker, and heavy drinker. The research questins that were examined in each bjective area are discussed in the fllwing sectins Trends in Alchl Use and Alchl-Related Prblems Several questins cncerning trends in Marine data frm 1980 t 1998 were addressed. - What are the trends in the prevalence f alchl use (bth average daily unces f ethanl and drinking levels), with special emphasis n heavy drinkers? - What are the effects f changes in the demgraphic cmpsitin f the Marine Crps n trends in alchl use? - What are the trends in prblems attributed t alchl use?

11 The answers t such questins can illustrate changes in key behavirs f interest and can be used when decisins cncerning changes in plicies and prgrams need t be made Drinking Levels and Alchl-Related Prblems Several questins cncerning drinking levels and alchl-related prblems fr active-duty Marines were addressed. - What are the relatinships between drinking levels and summary measures f alchlrelated serius cnsequences, prductivity lss, and dependence symptms? - What are the relatinships between drinking levels and individual indicatrs f alchlrelated prblems? - What are the relatinships between drinking levels and ther prblems nt specifically attributed t alchl use, such as general life prblems, criminal justice prblems, fights, health prblems, injuries, and jb-related prblems? - What are the relatinships between the demgraphic characteristics f persnnel and alchl-related prblems? - What are the dds f experiencing alchl-related prblems fr varius drinking levels after cntrlling fr the effects f demgraphic characteristics? In the past, alchl use has been an integral part f the military culture in general and the Marine Crps culture in particular. The answers t these questins are imprtant because the relatinship between excessive drinking and serius negative utcmes is well dcumented Drinking Levels and Other Health-Related Behavirs Tw questins cncerning the relatinship f drinking levels with ther health-related behavirs were addressed. - What are the relatinships amng drinking levels and drinking and driving, nnuse f seat belts, high-risk sexual behavir, and ther health-related behavirs? - What is the assciatin between varius health-related behavirs and the dds f heavy drinking? It is well knwn that excessive drinking can lead t drinking and driving and nnuse f seat belts, which can result in serius injury r death due t crashes. Additinally, excessive drinking assciated with sexual activity can increase the risk f cntracting sexually transmitted diseases. Thus, the abve questins can prvide an estimate f the tll excess alchl use takes n the health and readiness f the Marine Crps Perceived Stress and Quahty f Life Several questins cncerning perceived stress amng Marine Crps persnnel and quality f life were addressed. - What levels f stress d Marines attribute t their wrk versus their family relatinships? 10

12 - Which subgrups f Marines experience the highest levels f stress at wrk? - Which subgrups f Marines experience the highest levels f stress in their family life? - What are the specific surces f stress? - Hw d men and wmen differ in their perceptins f stressr events? - What methds d men and wmen use t cpe with high levels f stress? - T what extent and in which subgrups des stress interfere with the ability f persnnel t perfrm their military jbs? These questins examine the wide range f stressrs that Marine Crps men and wmen are subject t as a part f their military duties, such as physical r mental challenges, demands due t shrtage f persnnel, cmbat-assciated trauma, and cnflicts between military and family respnsibilities. In additin, these questins acknwledge that Marines are als likely t experience similar stressrs t civilians, such as thse assciated with the cnflict between family and wrk respnsibilities and changing ecnmic cnditins. 1.2 Organizatin f the Reprt The purpse f these analyses was t examine alchl use, the negative effects f excessive alchl use, and perceived stress and quality f life amng Marine Crps persnnel. The reprt is rganized arund these main themes. Chapter 2 describes the techniques used in this analysis. In additin, it describes the target ppulatin, the data cllectin prcedures, the survey respnse rate, the study ppulatin characteristics, and key definitins and measures. Chapter 3 describes the trends in alchl use and alchl-related prblems amng Marine Crps persnnel and the ttal DD ppulatin identified by the seven surveys f health-related behavirs amng military persnnel cnducted by RTI frm 1980 thrugh Chapter 4 describes the findings cncerning drinking levels and negative effects f excessive drinking as well as ther prblems nt attributed t alchl use. The demgraphic crrelates t these prblems and the dds f experiencing them are reprted. Chapter 5 describes the findings cncerning alchl use and ther health-risk behavirs. The demgraphic crrelates t these prblems and the dds f experiencing them are reprted. life. Chapter 6 describes the findings cncerning perceived stress and its relatinship t quality f Appendix A describes the methdlgies emplyed in the calculatin f alchl measures used in this reprt. Appendix B describes the techniques used in standardizatin and multivariate analyses. 11

13 Appendix C cntains the survey instalment used by RTI in the 1998 Department f Defense Survey f Health-related Behavirs Amng Military Persnnel t cllect the data used in this analysis and presented in this reprt. 12

14 2. Methdlgy This chapter describes the techniques used during the analysis f the Marine Crps data frm the 1998 Department f Defense Survey f Health-Related Behavirs Amng Military Persnnel perfrmed by RTI. Included are discussins f the target ppulatin, survey respnse rates, study ppulatin demgraphics, key definitins and measures, and analytic techniques. 2.1 Data Surces, Perfrmance Rates, and Respndent Characteristics The data presented in this reprt are primarily frm the Marine Crps respndent subset f the 1998 Department f Defense Survey f Health-related Behavirs Amng Military Persnnel. As reprted by RTI, the methdlgy fr the Marine Crps prtin f the survey cnsisted f selecting a randm sample f Marine Crps persnnel and asking them t cmplete annymus questinnaires cncerning health-related behavirs. Mst surveys were cmpleted in grup sessins cnducted by civilian data cllectin teams at Marine Crps bases. Eligible persnnel wh culd nt attend grup sessins cmpleted surveys by mail. The reference ppulatin fr the 1998 survey cnsisted f all active-duty DD persnnel. Recruits, service academy students, and persns absent withut fficial leave (AWOL), were excluded frm the study ppulatin because they had nt been in the service lng enugh r because they were inaccessible. Persnnel wh had a permanent change f statin (PCS) at the time f data cllectin were excluded frm the study ppulatin due t difficulties in administering surveys t them during the study perid. The remaining persnnel cmprised the target ppulatin. Subjects frm the target ppulatin were selected fr inclusin in the study ppulatin in tw stages. The first stage f sampling invlved the selectin f 12 Marine Crps installatins frm within the cntinental United States (CONUS) and 2 frm utside the cntinental United States (OCONUS) t represent active-duty Marine Crps persnnel. The secnd stage f sampling invlved the selectin f Marine Crps persnnel frm the identified 14 installatins stratified by 12 crss-classificatins f gender by pay grade. The data cllected frm survey respndents were weighted t represent the eligible active-duty Marine Crps persnnel ppulatin (the target ppulatin). T assess the quality f the survey methdlgy, RTI cmputed fur different perfrmance rates: Phase 1 eligibility rate. Phase 1 availability rate. Phase 1 cmpletin rate, and the respnse rate amng eligibles. Table 2.1 shws these rates as well as the crrespnding respnse data that were used t cmpute them. 13

15 Table 2.1 Marine Crps Survey Respnse Data and Perfrmance Rates Item Marine Crns Respnse Data 1. Persn selected fr survey (ttal sample) 9, Phase 1 (grup sessin) 6,933 " 3. Remte (mail-ut) 2, Number f eligible persns identified 7, Phase 1 (grup sessin)'' 5, Remte (mail-ut)*' 1, Eligibles available during Phase 1 3, Ttal questinnaires frm Phase 1 2, Usable questinnaires frm Phase 1 2, Eligible persns fr Phase 2 (fllw-up t Phase 1) (Item 5 - Item 8) 3, Ttal questinnaires frm Phase Usable questinnaires frm Phase Ttal questinnaires frm remtes Usable questinnaires frm remtes Ttal questinnaires frm all surces 3, Usable questinnaires frm all surces 3,622 Perfrmance Rates (%) 17. Phase 1 eligibility rate = (Item 5/Item 2) Phase 1 availability rate = (Item 7/Item 5) Phase 1 cmpletin rate = (Item 8/Item 7) Phase 1 respnse rate amng eligibles = (Item 9/Item5) Phase 2 respnse rate amng eligibles = (Item 12/Item 10) Remte respnse rate amng eligibles = (Item 14/Item 6) Phase 1 & Phase 2 respnse rate amng eligibles (Item 9 + Item 12 / Item 5) Overall respnse rate amng eligibles = (Item 16/Item 4) 50.4 Nte: Respnse data are frequencies; perfrmance rates are percentages. * "Excludes 1,403 Marines frm the sample wh had a permanent change f statin (PCS) r wh were separated, unknwn, AWOL, r deceased. ''Excludes 422 Marines wh were estimated t be PCS, separated, unknwn. AWOL, r deceased at the same rate as thse fr Phase 1 data cllectin. The annymity f the study participants did nt permit tracking f specific eligibility cnditins. Surce: DD Survey f Health-related Behavirs Amng Military Persnnel Reference: Bray, et. al., 1998 Department f Defense Survey f Health-related Behavirs Amng Military Persnnel, March

16 As defined by RTI, the Phase 1 ehgibihty rate is the percentage f individuals selected fr the grup sessins wh were still eligible several weeks later during data cllectin. Sme selected individuals were ineligible because they left the Marine Crps, were AWOL, deceased, PCS, r unknwn. The eligibility rate fr the Marine Crps was 79.8%. The Phase 1 availability rate is the percentage f identified eligible persnnel wh were available t attend a Phase 1 grup sessin. Sme eligible persnnel selected fr the grup sessins were nt available t attend due t varius reasns including temprary duty (TDY) assignments, deplyment, leave, and illness. The Phase 1 availability rate was 72.1%. The Phase 1 cmpletin rate is the percentage f identified eligible persnnel wh attended a Phase 1 sessin and cmpleted a questinnaire. The Phase 1 cmpletin rate was 62.9%. The respnse rates amng eligibles are the rates at which usable questinnaires were btained frm eligible persnnel fr the individual and cmbined cmpnents f data cllectin. Fr these respnse rate calculatins, RTI excluded ineligible individuals frm the ppulatin (i.e., thse wh were separated, deceased, AWOL, PCS, r unknwn). These rates fr the individual data cllectin cmpnents (Phase 1, Phase 2, and remte) indicate that Phase 1 grup sessins had the highest respnse rate (45.1%), fllwed by remte mail-ut (39%) and by Phase 2 mail-ut (15.9 %). The verall respnse rate amng eligibles (50.4%) cmbines data frm all three data cllectin activities. Table 2.2 shws the scidemgraphic distributin f the survey respndents cmpared with the eligible respndent ppulatin. As can be seen, all subgrups had at least 195 respndents, and mst grups had several hundred r mre. Eligible persnnel were mre likely t be male (94.5%), t be Caucasian (62.8%), t have a high schl diplma r less (52.8%), t be age 25 r yunger (60%), t nt be married (50.1%), and t be in pay grades El t E6 (79.9%). 15

17 Table 2.2 Scidemgraphic Characteristics f 1998 Marine Crps Respndents and f Ttal Eligible Respndent Ppulatin Scidemgraphic Number f Percentage f Eligible Characteristic Respndents Respndent Ppulatin Gender Male 3, (0.8) Female (0.8) Race/Ethnicity Caucasian, nn-hispanic 2, (2.0) African American, nn-hispanic (1.2) Hispanic (1.9) Other (0.4) Educatin High schl r less 1, (3.0) Sme cllege 1, (1.9) Cllege degree r beynd (2.0) Age (y) 20 r yunger (2.0) , (2.9) (2.2) 35 r lder (1.9) Family status^ Nt married 1, (2.1) Married 2, (2.1) Married, spuse nt present (0.5) Married, spuse present 1, (2.3) Pay grade E1-E (3.8) E4-E6 1, (2.5) E7-E (0.9) W1-W (0.1) (1.3) (1.1) Ttal persnnel 3, (NA) Nte: The number f respndents abve is based n the number f respndents wh cmpleted a usable questinnaire. Table values in right clumn are percentages (with standard errrs in parentheses). 'Estimates f family status in 1998 are nt strictly cmparable t thse frm ther survey years. In 1998, persnnel wh reprted that they were living as married were classified in the "nt married" grup. In prir years, the marital status questin did nt distinguish between persnnel wh were married and thse wh were living as married. NA = nt applicable. - Surce: DD Survey f Health-related Behavirs Amng Military Persnnel, Reference: Bray, et. al, 1998 Department f Defense Survey f Health-related Behavirs Amng Military Persnnel, March 1999.' 16

18 2.2 Survey Questinnaire The survey instrument used by RTI measured selected aspects f substance use as well as ther health behavirs. (See Appendix C fr the survey instrument.) Mre specifically, the questinnaire cllected data n the fllwing: - quantity and frequency f alchl use - adverse effects cntributed t alchl use - alchl dependence symptms - general life prblems - use f tbacc prducts - reasns fr smking cigarettes - frequency f illicit drug use - exercise, eating, and sleeping behavirs - illnesses and medical care received - use f seat belts and bicycle helmets - perceived stress at wrk r in family life - status f physical and mental health - health risks assciated with high bld pressure r high chlesterl - access t and satisfactin with medical care knwledge and beliefs abut transmissin f human immundeficiency virus (HIV) - sexual practices and sexually transmitted diseases - general scidemgraphic characteristics and military experience In additin, the questinnaire cllected data n gender-specific health issues (testicular care fr males and gyneclgical care, pregnancy, prenatal care, and alchl and cigarette use during pregnancy fr females). The final reprt n the 1998 Department f Defense Survey f Health- Related Behavirs Amng Military Persnnel presented t DD by RTI (Bray et al., 1999) fcuses n all f the abve-listed measures. The emphasis f this reprt is n alchl use, alchl-related prblems, ther health-risk behavirs, and perceived stress and quality f life amng Marine Crps persnnel. 2.3 Key Definitins and Measures Demgraphic Cliaracteristics RTI defined the demgraphic characteristics cntained in this reprt as fllws: Gender - Gender was defined as male r female. Race/Ethnicity - Fllwing the current U.S. Bureau f the Census classificatin, persnnel were divided int fur racial/ethnic grups, which were mstly self-explanatry: Caucasian, nn- Hispanic; African-American, nn-hispanic; Hispanic (including anyne f Hispanic rigin - whether racially black r African-American, white r ther); and ther (including all ther persns nt classified elsewhere, such as Native Americans r Asians). Age - Age was defined as the respndent's current age at the time f the survey. 17

19 Family Status - Family status was defined in terms f marital status and spuse presence at the member's duty statin. Categries include "nt married" (including persnnel wh were living as married, single, widwed, divrced, r separated), "married spuse nt present" (including thse wh were legally married and whse spuse was nt living at the member's present duty lcatin), and "married, spuse present" (including thse legally married and living in the same husehld). These categries represent a change frm previus surveys where "married" persnnel included thse wh were living as married. Thus, estimates relating t family status in 1998 are nt strictly cmparable t thse presented in prir survey years. Pay Grade Grups - Military pay grades fr enlisted persnnel were gruped as El t E3, E4 t E6, and E7 t E9. Pay grades fr fficers and warrant fficers were gruped as 01 t 03, 0'4 t O10,andWltW5. Regin - Regin refers t the lcatin f the installatin where persnnel were statined at the time f the survey and includes CONUS and OCONUS installatins Alchl Use, Alchl-Related Prblems, and Other Health Behavir Measures The questinnaire measured alchl use in terms f the quantity f alchl cnsumed and the frequency f drinking. RTI calculated tw summary measures f alchl use, the average number f unces f abslute alchl (ethanl) cnsumed per day and drinking level. The ethanl index was cmputed fllwing the methds used in the DD surveys (see Bray et al., 1999) and the Rand study f alchl use amng Air Frce persnnel. The ethanl index is a functin f (a) the amunt f ethanl cntained in the unces f beer, wine, and liqur cnsumed n a typical drinking day during the past 30 days; (b) the frequency f use f each beverage; and (c) the amunt f ethanl cnsumed n atypical ("heavy") drinking days during the past 12 mnths. The index represents average daily unces f ethanl cnsumed during a 12-mnth perid. Althugh the index is expressed in terms f 12-mnth use, mst f the data cme frm reprts f 30-day typical use. (See discussin in Appendix A fr details abut the prcedures fr creating this index.) The drinking level classificatin scheme RTI used was adapted frm Mulfrd and Miller (1960) and fllwed the methd used in the previus DD surveys (Bray et al., 1999). RTI cmputed drinking levels using the "quantity per typical drinking ccasin" and the "frequency f drinking" fr the type f beverage (beer, wine, r hard liqur) with the largest amunt f abslute alchl per day used t fit individuals int 1 f the 10 categries resulting frm all cmbinatins f quantity and frequency f cnsumptin. RTI then cllapsed the resulting quantity/frequency categries int five drinking-level grups: abstainers, infrequent/light drinkers, mderate drinkers, mderate/heavy drinkers, and heavy drinkers. The categry f mst cncern, heavy drinkers, was defined as drinking 5 r mre drinks per typical drinking ccasin at least nce a week in the 30 days, prir t the survey. This criterin is cnsistent with the definitin used in ther natinal surveys f civilians, including the Natinal Husehld Survey n Drug Abuse and Mnitring the Future. (See discussin in Appendix A fr details abut the prcedures fr creating the drinking level classificatin scheme.) 18

20 RTI cmputed three summary measures fr prblems assciated with alchl use in the past 12 mnths: serius cnsequences, prductivity lss, and symptms f dependence. Serius cnsequences refers t the ccurrence f Unifrm Cde f Military Justice (UCMJ) punishment, lss f 1 week r mre frm duty because f a drinking-related illness, alchl-related injury, spuse left, arrests fr driving while impaired (DWI) r ther incidents, incarceratin, fights, nt getting prmted, and/r needing detxificatin n ne r mre ccasin in the past 12 mnths. Alchl-related prductivity lss refers t being late fr wrk r leaving early, nt cming t wrk at all, being drunk at wrk, and/r perfrming belw a nrmal level f prductivity because f alchl use r its aftereffects n ne r mre ccasin in the past 12 mnths. Dependence symptms refers t the ccurrence f withdrawal symptms (e.g., the "shakes"), inability t recall things that happened while drinking, inability t stp drinking befre becming drunk, and/r mrning drinking n ne r mre ccasin in the past 12 mnths. (The measure f these dependence symptms was based n the Rand Air Frce study definitin by Plich & Orvis in 1979 that was used in the previus DD surveys rather than the strict definitin f dependence used in the Diagnstic and Statistical Manual f Mental Disrders, American Psychlgical Assciatin, 1994.) RTI als asked a series f questins abut prblems that individuals experienced in the past 12 mnths that were nt directly attributed t alchl. These included issues dealing with health, wrk, legal, and family-related prblems. T examine the underlying dimensins f these items RTI cnducted a principal cmpnents analysis with varimax rtatin f resulting matrices. The results defined items related t fur types f prblem areas: an indicatr f general life prblems, criminal justice prblems/fights, health prblems/injuries, and jb-related prblems. These variables were categrized dichtmusly as a 1 if an individual had ne r mre ccurrences f any f the prblems cmprising the factr in the past 12 mnths. (See discussin in Appendix A fr details abut the prcedures fr creating these variables.) RTI als gathered data abut a variety f ther health-risk behavirs and mental health issues. These included indicatrs f the use f seat belts, the use f bicycle helmets, the use f cndms by sexually active unmarried persnnel, levels f stress at wrk and in family life, surces f stress, and behavirs fr cping with stress. 2.4 Analytical Apprach The purpse f these analyses was t examine alchl use, the negative effects f excessive alchl use, and perceived stress and quality f life amng Marine Crps persnnel. Trends in alchl use, current prevalence f alchl use and related prblems, ther health behavirs and ther prblems, and perceived stress and quality f life were analyzed. Three basic techniques were used: - descriptive univariate and bivariate analyses f the prevalence f alchl use, prblems due t alchl use, prblems nt attributed t alchl use, and ther health-risk behavirs - cmparisns f trends in alchl use frm 1980 thrugh 1998 (bth direct and standardized t cntrl fr changes in demgraphic cmpsitin) - multivariate lgistic regressin analyses 19

21 Mst analyses were descriptive. Data frm these analyses are presented in the reprt as percentages with standard errrs. Trend data were used t cmpare changes in alchl use ver time. The DD surveys are crss-sectinal nt lngitudinal (data fr different years cme frm different individual.ppulatins due t the high turnver amng military persnnel), thus cautin must be used when cmparing these trends ver time. Trend data are presented in tw frms, unadjusted and adjusted. Unadjusted (direct) estimates are the bserved rates, while the adjusted (standardized) estimates are the expected rates if the military ppulatin in each survey year had the same demgraphic distributin (the same age, educatinal status, and marital status). Lgistic regressin analyses were used t mdel utcme measures (f experiencing alchl-related negative effects as well as ther prblems) as a functin f expsure measures (f demgraphic variables, drinking levels, and military ccupatin). In lgistic regressin, the natural lg f the dds (i.e., In p/l-p) is mdeled as a linear functin f the independent variables. Thus, the parameters f a lgistic regressin mdel are transfrmed t reflect relative changes in the dds due t changes in the independent variables. 2.5 Suppressin f Estimates In past reprts RTI mitted estimates that were cnsidered t be unreliable by using a suppressin f estimates rule develped in-huse. While estimates f means and prprtins that are either based n small sample sizes r have large sampling errrs may nt be reprted with cnfidence, these estimates may still prvide valuable infrmatin. Thus, this reprt has nt mitted any data. It cntains all estimates f means and prprtins alng with their standard errrs. This allws all data t be evaluated and allws an assessment f certain assciatins and trends that wuld nt have been pssible if suppressin f estimate rules had been applied. Readers shuld use cautin when evaluating estimates based n small sample sizes r having large sampling errrs. In general, all sample sizes <30 individuals shuld be critically evaluated. Readers interested in applying the RTI suppressin f estimate rules may refer t Bray et al., 1999 Department f Defense Survey f Health-related Behavirs Amng Military Persnnel, March 1999, Appendix C, sectin 4, pages C-5 and C-6. 20

22 3. Marine Crps Trends in Alchl Use and Alchl-Related Prblems This chapter examines the general trends in alchl use and Selected alchl-related prblems amng Marine Crps persnnel frm 1980 thrugh The data presented here came frm the seven DD Wrldwide Surveys f Substance Use and Health-Related Behavirs Amng Military Persnnel (Bray et al., 1983,1986,1988,1992,1995,1998). The tables in this chapter present specific Marine Crps estimates as well as the ttal DD estimates fr cmparisn purpses. The ttal DD and specific Marine Crps estimates alng with ther Service-specific data were previusly reprted in the 1998 DD Wrldwide Survey final reprt (Bray et al., 1999). Tw estimates f alchl use are analyzed: the average daily unces f alchl (ethanl) and heavy alchl use in the past 30 days. Fr bth measures unadjusted and adjusted estimates are reprted. Unadjusted estimates represent the bserved rates reprted in the surveys and illustrate the verall pattern f alchl use by Marine Crps persnnel. Adjusted rates are cnstructed rates that have been mdified t take int accunt changes in the scidemgraphic cmpsitin f the Marine Crps ver time. Fr example, Marines in 1998 were mre likely t be lder, t be fficers, t be married, and t have mre educatin than in previus survey years. Adjusted rates therefre reflect whether changes in the pattern f alchl use by Marine Crps persnnel may be due t shifts in the demgraphics f the Crps. 3.1 Average Daily Ounces f Alchl Table 3.1 displays the trends in the average daily unces f ethanl cnsumed in the past 30 days fr Marine Crps persnnel versus ttal DD persnnel ver the seven survey perids as bth unadjusted and adjusted estimates. T examine whether the bserved decrease in alchl cnsumptin may have partially reflected changes in the scidemgraphic cmpsitin f the persnnel ver time, unadjusted estimates were cmpared with the adjusted estimates. The adjusted estimates were btained by standardizing the demgraphic distributins f the ppulatins frm the 1982 thrugh the 1998 surveys t the 1980 ppulatin distributins by age, educatin, and marital status. (It shuld be nted that the adjusted estimates are cnstructed estimates rather than bserved estimates.) Table 3.1 shws that the unadjusted average daily unces f ethanl cnsumed per day decreased substantially frm 1.75 unces per day in 1980 t 1.08 unces per day in 1998 fr Marine Crps persnnel. This represents a significant 38.3% decrease ver the 18-year perid. After adjustment, the estimate fr 1998 Marine Crps persnnel increased frm 1.08 t 1.27 average daily unces f ethanl cnsumed. Readers shuld keep in mind that adjusted estimates are cnstructed estimates rather than bserved estimates intended t take int accunt the changes in the scidemgraphic cmpsitin f the Marine Crps ver time. Differences between bth the unadjusted and adjusted estimates f average daily unces f ethanl cnsumed per day in 1998 cmpared with 1980 were statistically significantly. The general decreasing trend in cnsumptin frm 1980 t 1998 is present in bth the unadjusted and adjusted estimates indicating that the verall decrease in average alchl cnsumptin amng Marine Crps persnnel was nt primarily due t scidemgraphic changes. 21

23 Ttal DD estimates f average daily unces f ethanl cnsumed per day are als presented in Table 3.1. The general decreasing trend in cnsumptin frm 1980 t 1998 nted amng Marine Crps persnnel is present and statistically significant in bth the uiiadjusted and adjusted estimates fr the Ttal DD as well. The Ttal DD estimates are cnsistently lwer than Marine Crps estimates fr each survey year in bth the unadjusted and adjusted frms. Figure 3.1 depicts the trends ver time in bth unadjusted and adjusted estimates f alchl cnsumptin fr the Marine Crps. Figure 3.1 Marine Crps Trends in Average Daily Ounces f Ethanl Cnsumed, Past 30 Days, Unadjusted and Adjusted fr Scidemgraphic Differences, 1980 thrugh Unadjusted ^t^adjusted Nte: Adjusted estimates have been standardized t the 1980 Marine Crps distributin by age, educatin, and marital status. Surce: Wrldwide Surveys f Health-Related Behavirs Amng Military Persnnel, 1980 thrugh

24 G 03 ON I 00 r- <N d ON NO r-~ \ d d, l-h TJ O c ^ 3 s S I 1=1 u c^ 9- -w O S w 3 J= c J5 " 9 ^ x: bo 3 ON x: i i e u 5 M u e P a a 9J ON 3 H U '.a u cs gj u B 43 O 12 i O c«- u Ml C8 '5 > U xn Vi 9\ \ \ 2 GO 00 ON V5 QO 0\ 0\ 00 ON 0) > a Q Ml e c d OS r- VO NO d d -H * tn CM 2- S' ON O Tl- NO ON cs d d ^ ^ V -* ON 0\ in m (Dxi ID < r~- \ 00 ON d d d ON ^H r- ON d d en m d d CS»n \ d -^ NO NO d d CS en U-) en d d -H 00 rt m I-- r- d d it's CO 4-> "^ Sil > S - 3 ^ ^ T= ^ t^ M -^ M -^ M T3 s p (/I c ^ H ^ 1 < 0). bo S?g 2 ti b S m «00 <u c 3 O T3 0) 2 > ca B^s S 8. «. s.a s fc c.2 8 S T3 "S *^ S x) [L '*-' 1-' O cs IH > U c«s c's ^ I :^ s«c 3-3? en?^ -3 -;,- g S ^ «" 3 O w S c (U OH O.3 c 00:3 -^.3 c«=3 -" 3 "O <u g XJ 8 > ^ s (U x; H t 3 '3 3 O 4) O 3 3 O I 3 00 O u II c s O 8 I u > ~ (D OJ 't^i S Cu (0 I 3 O. 4-) 3' > ^ 3 Xi J^ 3 O s M in «;a ON ^ 00 x: S8 ^ M a, ^ 2 f ^ 8.H > g S) s «> «3 Q ca ^ ^ t! 00 S Ci-ON w ^ S3 "3 " 00 3 O ON =^ -^ ON >-,T3 -^ 3 ^ «i "^ c3 00 XI 00 4-> 03 '~H 3 ts-^ _ X> U -D M S 00 3^3 O = O CO M M tl I O M O U W U u 3 c CO U PH ^ b<; J 2 ^ 2 2w U 3 3 O CO IH 4) T3 B 3 ffi ^ (D 3 O 6 < O > x: u pq xt (U 3 U CO E ex HC Os r" ON CO ^ t «3 >. ^«Q 8 8 E u 00 0< CN

25 3.2 Alchl Drinking Levels Table 3.2 displays the trends in the prprtin f persnnel classified t each drinking level ver time. The majrity (80.3%) f Marine Crps persnnel in 1998 used alchl at sme level in the past 30 days. This is cnsistent with all previus study years. While the prprtin f persnnel wh abstained frm alchl r wh were infrequent/light users cntinued t increase frm 11.0% in 1980 t 37.5% in 1998, this was nt accmpanied by a decrease in heavy drinking. The prprtin f heavy drinkers, 28.6 % in 1980 versus 22.4% in 1998, remained high. While the prgress in reducing verall use f alchl in the Marine Crps is encuraging, the lack f a reductin in heavy drinking is f cncern since heavy drinkers experience mre negative utcmes related t their drinking than individuals in ther drinking categries. The ttal DD data presented in Table 3.2 are cmpared with the Marine Crps data. As in previus years, the majrity (75.7%) f ttal DD persnnel in 1998 used alchl at sme level in the past 30 days. The prprtin f persnnel wh abstained frm alchl r wh were infrequent/light users increased frm 25.6% in 1980 t 44% in 1998, while the prprtin f heavy drinkers decreased frm 20.8% in 1980 t 15% in In each survey perid, the Marine Crps reprted ntably higher prprtins f heavy drinkers than the ttal DD ppulatin. Table 3.3 displays the trends in unadjusted and adjusted rates f Marine Crps persnnel classified as heavy drinkers ver time. In general, the adjusted rates were slightly higher than the unadjusted rates fr bth the Marine Crps persnnel and the Ttal DD. This difference did nt affect the significance f the difference between the 1980 data and the 1998 data fr the Marine Crps. The difference did affect the significance f the difference in the Ttal DD data, with the difference in the unadjusted rate being statistically significant while the adjusted rate was nt significant. Adjusting the Marine Crps rates did affect the significance f the difference between the 1995 and 1998 data, with the difference in the unadjusted data nt being significant while the decrease in the adjusted data was statistically significant. While there was a decrease in the unadjusted percentage f Marine Crps persnnel classified as heavy drinkers frm 1995 (27.8%) t 1998 (23.0%) and frm 1980 (28.6%) t 1998 (23.0%), the magnitude f the decreases was nt significant. The lack f significant differences in the unadjusted trends in heavy alchl use ver time suggests that Marine Crps prgrams aimed at reducing heavy drinking have had little effect. In cmparisn, the decrease in the unadjusted percentage f Ttal DD persnnel classified as heavy drinkers frm 1980 (20.8%) t 1998 (15.4%) was statistically significant. Fr bth unadjusted and adjusted data, the percentages f persnnel classified as heavy drinkers were ntably higher amng Marine Crps persnnel cmpared with Ttal DD persnnel at each time pint. 24

26 00 ON ON 0\ ON CS p p O O "-H T-4 c4 r~; q en t--; --t 0\ t~^ r^ CN c4. ( ^H»-< CS (SI v ) in >n -rf 00 O O OO O, en t~-; ri q p Tt ON 0(3 (si in (SI --H -H (S -H ON I ON OS 1 1 O 00 ON > 61 G 9i ON 0\ ON ON QO QO ON r-. vq rh p Tt c> --H ^ cs OS CS rt VO 00 v Tf r-^ cs i> -H -H ( (SI (S r-; (S rt 00 (Sj O ' ' "-^ ^^ " ' ^H (SI (S m ON 4 (N (SI ON" rt ^ f^ ON" O C. 1 ) ^ ' en O ON O (S ON 00 in 2; 00 (N m csi in v in NO 00 <5 d> d d d> v-^ ^*-x v^^ %_ s^ -H NO ON (S -H -H 00 ' <^' r-^ (N ^ -H (SI ^ 00 m in NO f~~ d d TI- 00 in cs O 00 ON NO in (N -H -M (S < ^ in m r^ ON d d d d d (N in in 00 p r~^ t~^ ON 00 r-' -H rm -H (SI,-H c J3 M C ^ s ^< 2 g O -JT S > 2m ll O JS u I/) H i G a D U c H in 00 ON 00 ON O 00 ON en > x u /^ ^ f^ I f-^ (SI. ( w t ( w CO \ H > ( Tt O en ON. 1 (N 00 en r- Os cj, ^ IT) (Sj ON 00 \0 en en Tf r-^ O -^ -H ^H (SI en p in (sj Tt in -H O ^ -H (si rt; p vq en NO -H t-^ (si 00 -H I < en CN 22 ^ >. a j= > u bo rt u s 1 h C (U (D S u }«!;< g.s ^ Q 1 ^ t: b2 b2 «NO r- NO OO ^H S S ci- ^ NO NO in ON en NO 00 ' (S -H -H -H (SJ (SI in in NO 0C3 VO O VO --^ < r^ r-' ON Tt < -H -H (S) (Sl in TT r- NO ^ in ^ (Sj Tt 00 en" (si ^ (si d ^ -H (SI en (SI 60 > h c (U S U ti ti C -^ cd c^ ^ <]:;.Q O > a < ^Sffi ih x: y P^ ;!=; ei, >-?5 c ^ta 1 (D T3 J C/5 s < 2^ t n w b 5 jr «^Q 0) O 1) W -M S ^ S U c<3 fe ^ ^ PH ^Q ca cd 00 -a tc ON <4-l O ^r M 13 X (D!-> > u a S >; S CO- g u Q ffl.. s c Q 8 w i O ft u b (D 3 «<u '/^ 00 Pi <si

27 a a a u in I H Q H e C8 U a c s QO ON *n CM O N 00 ^ 00 p O) en v CM (N >n Os CSl -H ^ v «n 1 ( 00 fo fs m 00 OS CO CO I I 1 ( ^ vb d c^ en c~<i cs Ti- d cs en r~- (^ en en Tt in C3S CM cs en as d \0 VO d -^ en en m W-) (N 00 a VO VO ON 1-H (M CM JS D A W! b a bj )- T3 Q O Ux> V fll i-^ +-» - S ^.3 PN 00 ON d d ^ ^ ^-^ "^ f iri ON ON 00 d d Tf >n r-" d 00 cs d ^ in -H in ON OS -H r-' d < CJN ^ ^ -^ d ^^' P 00 en -rf O ON -J d ^ vq Ti-' en CO cs d d CM CM c c -^ OQ u >. >% B I M. CO - 9 c g Q ex 5 c ^ '^ S -^ c 2 'C <D <U CO.t; c -c 3 > O CO <ii s p " J3.5 m <u 0) 8 Z CO CO 3..4-) 13 "?; =«(D a g 6 ^ C - c in ^ 5 2 u «^ «S)3 8 ^ -2 >.'fi ^ ca S ON '1 ( J^ CO S Ti -" S 8 =«s ^ f^on t S-^ 00 S \ C«f ON "^ c3 CO "ts ^ S 2 +-> C CO c dj _ (U g g ^ U ^ X) u X) CO C CO O -^ O CO CO CO a w -a ca 5 fa III O CO O U W U ON ON ON x: 13 c CO u OH c3 C g 0\ O > (fl JS 00 pq T3 (1) (L> C3 u <L> O "T <u.^ S '^ M fa O 'Zl S "y rj CO ^ 'B IQ ffl ^ <u S t & '^ 00 U C?\ ffion CO cc <D +-" > <U 3 >. Q ffl.. Q 8 is.w 3 ^-H u CO Pi

28 Figure 3.2 depicts the trends ver time in bth unadjusted and adjusted estimates f the percentage f Marine Crps persnnel classified as heavy alchl users. Figure 3.2 Marine Crps Trends in Heavy Alchl Use, Past 30 Days, Unadjusted and Adjusted fr Scidemgraphic Differences, 1980 thrugh Unadjusted -*-Adjusted Nte: Adjusted estimates have been standardized t the 1980 Marine Crps distributin by age, educatin, and marital status. Surce: Wridwide Surveys f Health-Related Behavirs Amng Military Persnnel, Alchl-Related Prblems Negative cnsequences n the wrk perfrmance, health, and scial relatinships f military persnnel assciated with alchl use are a cncern fr military cmmanders and plicymakers. As seen in Table 3.4, bth the Marine Crps and Ttal DD experienced reductins in each type f alchl-related prblem frm 1980 thrugh The Marine Crps reprted a higher percentage f persnnel experiencing each type f alchl-related prblem at each time pint cmpared with the Ttal DD (with the exceptin f dependence symptrhs in 1985). While the rates f alchlrelated prblems have decreased ver time the percentage f Marine Crps persnnel reprting experiencing serius cnsequences (12.3%), prductivity lss (19.2%), r dependence symptms (8.2%) are still cause fr cncern. 27

29 cs 00 ON en (N '-' r4 ; ^ < I. I 00 t:^v->-. ^ d ^ O "^O ^-'VO ^-' ^ en f^ VO I Tt &. 0) x; a ON 1 1 x: i 00 ON ON O 00 ON O PH TS I CO < CO H s CQ Vi O U I t CM O u at IT) ON ON ON ON ON 00 ON 00 ON 00 ON 2 & O CO VO ON t~- 00 VO -^ CN) ON I ON r- ci d d vq c<l Tt v-i ^ Tt q ^^ en en '"^ ^ ' -^ ' _i "^ r-; <N -H en Ov r-; -H in m NO -^ r4 r- P CN OO r- VO cn ON r~-' O I en H CN VO rj C~^ ^ -H CM vd Tf CM en g 3 CT (U CO 1= CO PH B a, (Zl u c c u Q Q H 00 IT) d ^ - ' m ^ ' NO VO t-; r- -H in "I -; -*. ^ VO <^. r- -^ in.^ cs.^ ^ ^ "n w '^ w p ^ -? ON CS VO 0\ ^H ^ d -; I^. --' ^ r- ^ '^^ d t-^ t~^ ^ cvi r- v r- VO Tt m en 0\»-H CN) ^^ < ( T ( VO ^^ en r- v_^ r- VO CN 00 c 00 2 ex s 00 CO 6 cr O >>-. (L) >-, > -t-» n > S n O T3 3 3 C O T3 1 s a, 00 CL, Q U a. CO B I H a -a I O x: CO O CO <L> x; 4-) i g 1 CO (U M» a 4-1 c u CO CO 13 (U CO 00 &, x u CO u q W CO O O > u c cfi C m \ ^ -S > <^ flj fci u S 1= a!=! io cs Ov 2 3 -tt " c ^.& 3 CO " >. I.a U t «& CO OJ CO ^3 00 S O^ «! ON -a ^ s 3 =^ (U <u Xi X) CO CO f= O O s CO CO c CO C 00 -^ 0\ CO ON VH I ( O *-> d OS CQ ^ T3 ^' (D c CO r W 2 4J c B < > x; PQ B CO u CO C c t c3 I <u <u ON ffi ON 1-H q-h r CO rfl >^ (1) >-> ^ flj 3 >, CO 2 Q «Q (U u i p s ;1H l-h (1) 3 C+in n <^ 00 Pi 00 CM

30 Figure 3.3 depicts the trends ver time in alchl-related prblems amng Marine Crps persnnel. Figure 3.3 Marine Crps Trends in Alchl-Related Prblems, *- Serius Cnsequences - Prductivity Lss -*- Dependence Symptms Surce: Wrldwide Surveys f Health Related Behavirs Amng Military Persnnel, 1980 thrugh Summary Rates f alchl use amng Marine Crps persnnel declined frm 1980 thrugh 1988 and the percentage f abstainers and infrequent/light users cntinued t increase. Hwever, the percentage f heavy drinkers remained high fr Marines cmpared with the ttal DD ppulatin. Heavy drinking increases the risk fr prblem develpment and has a direct impact n peratinal readiness. This finding is a cncern t health prfessinals and thers interested in the preventin f alchl-related prblems. 29

31 4. Drinking Levels and Alchl-Related Prblems Heavy drinking and its cnsequences cntinue t be a prblem amng Marine Crps persnnel. Chapter 3 indicated that mre than 1 in 5 Marine Crps persnnel in 1998 were classified as heavy alchl users. Additinally, the reprt frm the 1998 Department f Defense Survey f Health-Related Behavirs Amng Military Persnnel (Bray et al., 1999) shwed that the rate f heavy alchl use was highest in the Marine Crps cmpared with the ther services. Analysis f data fr the military as a whle has shwn that heavy alchl users are mre likely than ther persnnel t experience prblems assciated with their alchl use (Bray et al., 1995). This chapter presents detailed analysis f the relatinships between drinking levels and drinking-related prblems, as well as prblems nt necessarily attributed t alchl use amng the 1998 Marine Crps sample. Prblems directly attributed t alchl use included health prblems, scial prblems, legal prblems, prductivity lss, and dependence symptms due t alchl use. Prblems nt necessarily attributed t alchl use but fr which there may be an assciatin included general life prblems, criminal justice prblems/fights, health prblems/injuries, and jbrelated prblems. Demgraphic crrelates f the abve-mentined prblems are presented as are multivariate analyses predicting the likelihd f persnnel experiencing these prblems. 4.1 Prblems Attributed t Alchl Use Infrmatin n serius cnsequences, prductivity lss, and symptms f alchl dependence attributed t the use f alchl by Marine Crps persnnel is presented in Table 4.1. (Each f these prblem categries will be defined and analyzed in detail in subsequent subsectins.) Highlights frm Table 4.1 include the fllwing: - The prevalence f all three types f negative effects f alchl use was greatest amng heavy alchl users. - Fr serius cnsequences and measures f alchl dependence, there was little difference in the rates amng infrequent/light, mderate, and mderate/heavy drinkers. - Alchl-related prductivity lss was the mst cmmn f the three alchl-related prblems. Table 4.1 displayes the strng relatinship between heavy alchl use and the 3 brad alchl-related prblem categries. The fllwing subsectins analyze in greater detail the specific types f prblems within these categries in an attempt t understand hw heavy alchl use might be affecting the health and perfrmance f Marine Crps persnnel. 30

32 Table 4.1 Alchl-Related Prblems in Past 12 Mnths fr Marine Crps, by Drinking Level Drinking Level Alchl-Related Prblem Any Any Serius Cnseauences Prductivity Lss Dependence Infrequent/light 6.8(1.5) 8.0(0.9) 2.4(0.6) Mderate 7.7(1.0) 12.5(1.3) 1.2 (0.6) Mderate/heavy 12.6(1.8) 22.1(2.0) 3.6 (0.9) Heavy 30.0 (2.0) 45.9 (1.9) 30.0(2.1) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel, Serius Cnsequences Table 4.2 shws the prevalence f specific types f alchl-related serius cnsequences reprtedby Marine Crps persnnelin The fur mst cmmnly ccurring serius cnsequences assciated with alchl reprted by Marine Crps persnnel were fights, truble with the plice, truble n the jb, and difficulty handling prblems. Highlights frm Table 4.2 include the fllwing: % f heavy drinkers had been in physical fights while drinking at least nce in the past 12 mnths. This is mre than three times the frequency f the ccurrence f fights amng mderate/heavy drinkers (7.8%) and 10 times the frequency f the ccurrence f fights amng abstainers r infrequent/light r mderate drinkers (2.3%) % f heavy drinkers had truble with plice attributed t drinking in the past 12 mnths cmpared with 3.3% f mderate/heavy drinkers and 1.7% f abstainers r infrequent/light r mderate drinkers % f heavy drinkers reprted having had truble n the jb because f drinking in the past 12 mnths cmpared with 3.1% f mderate/heavy drinkers and 1.0% f abstainers r infrequent/light r mderate drinkers. - Similarly, heavy drinkers were much mre likely than mderate/heavy drinkers r abstainers r infrequent/light r mderate drinkers t reprt difficulty handling prblems 31

33 because f drinking in the past 12 mnths and t have lwer scres n perfrmance ratings due t alchl use in the past 12 mnths. Table 4.2 Occurrence f Specific Serius Cnsequences in Past 12 Mnths, by, Drinking Level Abstainer, Infrequent/ Mderate/ Cnsequences Light, r Mderate heavv Heavy Ttal Did nt get prmted 1.0 (0.2) 1.2 (0.4) 3.4 (0.7) 1.6 (0.3) because f drinking Lwer scre n perfrmance 0.8 (0.3) 2.6 (0.6) 5.5 (0.8) 2.2 (0.3) rating because f drinking Kept frm duty fr a 0.2(0.1) 0.2 (0.2) 0.5 (0.3) 0.3 (0.1) week r mre due t drinking-related illness UCMJ punishment because 1.6 (0.2) 2.0 (0.6) 4.5 (0.8) 2.3 (0.4) f drinking DWI arrest 1.4(0.3) 3.2 (0.7) 3.1 (0.7) 2.2 (0.4) Other drinking-related arrest 0.4 (0.2) 0.7 (0.4) 2.3 (0.6) 0.9 (0.3) Drinking-related incarceratin 0.5 (0.2) 1.5 (0.5) 2.2 (0.4) 1.1 (0.2) Drinking-related injury 1.0 (0.2) 0.8 (0.3) 3.6 (0.8) 1.5 (0.3) Drinking caused injury t 0.5 (0.2) 0.7 (0.4) 2.4 (0.5) 1.0(0.2) thers r prperty damage Fights while drinldng 2.3 (0.4) 7.8 (1.8) 23.7 (1.8) 8.3 (1.0) Spuse threatened t leave 0.4 (0.2) 1.2 (0.4) 2.7 (0.5) 1.1 (0.2) because f drinking Had t be detxified 0.5 (0.2) 1.2(0.4) 1.8(0.8) 0.9 (0.2) Truble n the jb because 1.0 (0.2) 3.1 (0.7) 9.3(1.0) 3.4 (0.4) f drinking Truble with plice because 1.7 (0.3) 3.3 (0.7) 9.2(1.2) 3.7(0.6) f drinking Difficulty handling prblems 0.7 (0.2) 2.7 (0.5) 8.4(1.3) 2.9 (0.3) because f drinking Emergency medical help 0.6 (0.3) 0.5 (0.2) 1.5 (0.4) 0.8 (0.3) because f drinking Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-Related Behavirs Amng Military Persnnel, Prductivity Lss Table 4.3 presents infrmatin n specific types f prductivity lss due t alchl use reprted by Marine Crps persnnel by drinking levels. Persnnel classified as heavy drinkers were mre likely than ther persnnel t reprt the ccurrence f specific types f alchl-related prductivity lss and much mre likely t reprt multiple ccurrences f such prblems. 32

34 Highlights frm Table 4.3 include the fllwing: % f heavy drinkers reprted wrking belw nrmal perfrmance levels at least ne time in the past 12 mnths due t alchl use cmpared with 18.2% f mderate/heavy drinkers and 5.7% f abstainers r infrequent/light r mderate drinkers. 16.1% f the heavy drinkers reprted 4 r mre ccurrences f this prblem in the past 12 mnths % f heavy drinkers reprted arriving late fr wrk r leaving wrk early due t alchl use at least nce in the past 12 mnths cmpared with 9.0% f mderate/heavy drinkers and 2.7% f abstainers r infrequent/light r mderate drinkers. 6.4% f the heavy drinkers reprted 4 r mre ccurrences f this prblem in the past 12 mnths. 15.6% f heavy drinkers reprted being called in t wrk while feeling drunk, and 14.3% reprted being drunk at wrk at least nce in the past 12 mnths. 5.3% reprted being drunk at wrk 4 r mre times in the past 12 mnths. 33

35 Table 4.3 Occurrence f Specific Types f Alchl-related Prductivity Lss in Past 12 Mnths, by Drinking Level Abstainer, Infrequent, Mderate/ Cnsequences Li^ht, r Mderate Heavv Heavv Ttal Hurt in n-the-jb accident because f drinking Any ccurrence 0.2(0.1) 0.4 (0.2) 0.9 (0.5) 0.4(0.1) Late fr wrk r left wrk early because f drinking Any ccurrence 2.7 (0.3) 9.0(1.2) 23.3 (1.9) 8.7 (0.5) 1 time 1.7 (0.3) 5.2 (0.9) 7.4(1.1) 3.8 (0.4) 2-3 times 0.7 (0.2) 3.0 (0.6) 9.5(1.2) 3.2 (0.2) 4 r mre times 0.3(0.1) 0.8 (0.3) 6.4 (0.9) 1.8 (0.3) Did nt cme t wrk because f drinking Any ccurrence 0.7 (0.3) 1.1 (0.5) 3.8 (0.6) 1.5 (0.2) 1 time 0.7 (0.3) 0.3 (0.3) 1.8(0.7) 0.9 (0.2) 2-3 times 0.0(0.0) 0.6(0.3) 1.2(0.4) 0.4(0.1) 4 r mre times 0.0 (0.0) 0.2 (0.2) 0.8 (0.4) 0.2 (0.1) Wrked belw nrmal perfrmance level because f drinking Any ccurrence 5.7 (0.5) 18.2(1.7) 37.7 (2.1) 15.7(1.1) 1 time 3.7 (0.4) 6.1 (1.0) 6.7(1.1) 4.9 (0.5) 2-3 times 1.2(0.2) 8.7 (1.3) 14.9(1.3) 6.0 (0.5) 4 r mre times 0.8 (0.2) ) 16.1 (1.6) 4.8 (0.7) Drunk while wrking Any ccurrence 1.3 (0.3) 4.3 (0.9) 14.3 (1.5) 4.9 (0.8) 1 time 0.5(0.2) 3.2 (0.7) 3.8 (0.6) 1.9(0.3) 2-3 times. 0.5 (0.2) 0.6 (0.3) 5.3 (0.9) 1.6(0.3) 4 r mre times 0.3 (0.1) 0.5 (0.4) 5.3(1.1) 1.5 (0.4) Called in t wrk while feeling drunk Any ccurrence 1.0 (0.3) 2.9 (0.8) 15.6(2.1) 4.7 (0.9) 1 time 0.3(0.1) 2.8 (0.9) 7.0 (0.9) 2.4 (0.4) 2-3 times 0.5 (0.1) 0.0 (0.0) 5.0(1.1) 1.4(0.3) 4 r mre times 0.2(0.1) 0.2 (0.2) 3.6 (0.9) 0.9 (0.2) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavir Amng Military Persnnel,

36 4.1.3 Symptms f Dependence Table 4.4 presents infrmatin n specific symptms f alchl dependence. Heavy drinkers again reprted these incidents mre frequently than ther persnnel. Hwever, specific symptms f alchl dependence were reprted much mre frequently than serius cnsequences f alchl use r alchl-related prductivity lss by all persnnel. Highlights f Table 4.4 include the fllwing: % f heavy drinkers reprted any ccurrence f blackuts (being unable t remember things that happened when they were drinking) cmpared with 28.9% f mderate/heavy drinkers and 12.2% f abstainers r infrequent/light r mderate drinkers. 12.8% f heavy drinkers reprted experiencing blackuts at least weekly in the past 12 mnths % f heavy drinkers reprted any ccurrence f impaired cntrl (being unable t stp drinking befre feeling drunk) cmpared with 16.2% f mderate/heavy drinkers and 5.8% f abstainers r infrequent/light r mderate drinkers. 15.5% f heavy drinkers reprted experiencing impaired cntrl at least weekly. - Mre than 20% f heavy drinkers reprted any ccurrence f mrning drinking (25.3%), hands shaking a lt after drinking (28.5%), r general "shakes" because f drinking (22.2%). 35

37 Table 4.4 Occurrence f Specific Symptms f Alchl Dependence in Past 12 Mnths, by Drinking Level Drinking Level Abstainer, Infrequent/ Mderate/ Symptms Lisht, r Mderate Heavv Heavv Ttal Hands shk a lt after drinking Any ccurrence 2.1(0.4) 9.6 (0.9) 28.5(0.8) 9.7 (0.7) Less than mnthly 1.8 (0.3) 7.4 (1.0) 14.8(1.5) 6.0 (0.3) 1-3 days a mnth 0.2 (0.2) 1.3(0.3) 5.6 (1.0) 1.7(0.3) Weekly r mre 0.1(0.1) 0.9 (0.4) 8.0(1.4) 2.1 (0.5) Blackuts Any ccurrence 12.2(1.0) 28.9(1.9) 62.6 (1.3) 27.3 (1.6) Less than mnthly 10.5 (1.0) 24.2(1.5) 33.0 (L9) 18.7 (1.0) 1-3 days a mnth 1.2(0.3) 3.6 (0.6) 16.8(1.4) 5.3 (0.7) Weekly r mre 0.5 (0.2) 1.1 (0.5) 12.8 (1.7) 3.4 (0.6) Impaired cntrl Any ccurrence 5.8 (0.5) 16.2(1.2) 41.6 (3.2) 16.2(1.0) Less than mnthly 4.2 (0.4) 11.6(1.3) 14.3 (1.4) 8.1 (0.3) 1-3 days a mnth 1.0(0.2) 3.4 (0.6) U.7(1.3) 4.0 (0.4) Weekly r mre 0.6 (0.2) 1.3(0.6) 15.5(1.6) 4.1 (0.6) Mrning drinking Any ccurrence 1.6 (0.3) 7.7 (0.7) 25.3 (1.7) 8.3 (0.7) Less than mnthly 1.3 (0.3) 6.8 (0.7) 12.7(1.6) 5.1 (0.3) 1-3 days a mnth 0.3 (0.1). 0.9 (0.4) 7.2(1.3) 2.0 (0.4) Weekly r mre 0.1 (0.1) 0.0 (0.0) 5.3 (0.9) 1.2(0.3) "Shakes" because f drinking Any ccurrence 1.9(0.4) 6.2 (0.8) 22.2 (0.9) 7.4 (0.8) Less than mnthly 1.7 (0.4) 4.7 (0.7) 11.6(1.3) 4.6(0.5) 1-3 days a mnth 0.1 (0.1) 0.9 (0.4) 4.5 (0.6) 1.3(0.3) Weekly r mre 0.1 (0.1) 0.6 (0.4) 6.1 (1.2) 1.6 (0.4) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel,

38 The infrmatin presented in Tables 4.1 thrugh 4.4 clearly shws that heavy drinkers experience much higher rates f alchl-related prblems than ther Marine Crps persnnel. 4.2 Prblems Nt Attributed t AlchlUse Infrmatin n general life prblems, criminal justice prblems/fights, health prblems/injuries, and jb-related prblems nt necessarily attributable t alchl use is presented in Table 4.5. (Each f these prblem areas will be defined and analyzed in detail in subsequent subsectins.) Highlights f Table 4.5 include the fllwing: - While general life prblems (mre than 60% f each drinking level), health prblems/injuries (ver 40% f each drinking level), and jb-related prblems (ver 40% f each drinking level) were cmmn amng all persnnel, heavy drinkers still reprted higher rates than ther persnnel % f heavy drinkers als reprted experiencing criminal justice prblems/fights in the past 12 mnths. Table 4.5 Unattributed Prblem Areas, by Drinking Level General Life Criminal Justice Health Prblems/ Jb-Related Drinking Level Prblems^ Prblems/Fights'' Injuries'^ Prblems'^ Abstainer 66.4(3.3) 13.7(1.5) 42.4(2.6) 40.0(2.1) Infrequent/light 77.0(2.3) 16.0(2.2) 46.8(2.8) 47.1(3.3) Mderate 73.8(2.4) 19.0(1.7) 43.9(2.0) 44.3(2.2) Mderate/heavy 77.3(1.8) 17.3(1.0) 44.6(1.9) 44.2(2.5) Heavy 83.4(2.2) 29.0(2.0) 47.5(1.7) 55.8(1.9) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel, " One r mre f the fllwing the past 12 mnths: heated arguments with family r friends, truble n the jb (unspecified), health prblems, drve unsafely, neglected family respnsibilities, serius mney prblems, difficulty handling prblems, lud argument in public. *" One r mre f the fllwing in the past 12 mnths: UCMJ punishment; arrest fr a driving vilatin, arrest fr a nndriving vilatin, time in jail, hit significant ther, physical fights (nnfamily), truble with the plice (civilian r military). "^ One r mre f the fllwing in the past 12 mnths: hurt in accident, caused an accident resulting in anther's injury r prperty damage, invlved in a mtr vehicle accident, health prblems, needed emergency medical help. ** One r mre f the fllwing in the past 12 mnths: kept frm duty fr a week r mre due t illness, did nt get prmted when expected, lwer scre n perfrmance rating. 37

39 4.2.1 General Life Prblems Infrmatin n the specific prblems cmprising the general life prblem variable in Table 4.5 is presented by drinking level in Table 4.6. Highlights f Table 4.6 include the fllwing: % f all Marine Crps persnnel reprted having heated arguments with family r friends, with 60.4% f heavy drinkers, 53.5% f mderate/heavy drinkers, 51.4% f infrequent/light r mderate drinkers, and 45.0% f abstainers reprting such incidents. - A higher percentage f heavy drinkers cmpared with ther drinking levels reprted experiencing truble n the jb (43.2% cmpared with 27% t 29.6%) r having lud arguments in public (30.3% cmpared with 11.9% t 15.8%). - There was little difference between drinking levels in the percentage f persnnel reprting health prblems r neglect f family respnsibilities. Table 4.6 Occurrence f Speciflc Prblems Assciated With General Life Prblems, by Drinking Level Drinking Level Prblem Abstainer Infrequent/ Light r Mderate Mderate/ Heavy Heavy Ttal Heated arguments with family r friends Truble n the jb (unspecified) 45.0(1.8) 51.4(2.0) 53.5 (1.9) 60.4 (1.7) 52.6 (0.9) 29.4(1.8) 29.6 (1.5) 27.0(1.8) 43.2(1.6) 32.0(1.2) Health prblems 28.4 (2.3) 30.0 (1.5) 32.0(1.6) 32.2(1.1) 30.6 (0.6) Drve unsafely 16.6(1.2) 24.3 (1.1) 30.5 (1.4) 39.8 (2.3) 27.7(1.1) Neglected family respnsibilities 9.2(1.0) 8.5 (0.8) 9.1(1.5) 12.8(1.5) 9.7 (0.5) Serius mney prblems 23.6 (1.5) 26.8 (1.4) 28.3 (2.3) 37.8 (1.4) 29.0 (1.3) Difficulty handling prblems 18.0(1.2) 21.1 (1.4) 20.8(1.4) 30.3 (2.1) 22.5 (0.9) Lud arguments in public 11.9(1.6) 14.3(1.1) 15.8(1.3) 30.3 (1.6) 17.8(1.1) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel,

40 The data in Table 4.6 demnstrate that the specific prblems cmprising the measure f general life prblems presented in Table 4.5 are assciated with the use f alchlt different degrees. While sme prblems appear highly assciated with drinking level thers appear less s. Hwever, heavy drinkers cnsistently reprted experiencing the highest percentage f each prblem Criminal Justice Prblems/Fights Infrmatin n the specific criminal justice and fighting prblems cmprising the criminal justice prblems/fights variable frm Table 4.5 is presented by drinking level in Table 4.7. Highlights f Table 4.7 include the fllwing: 17% f Marine Crps persnnel reprted being invlved in a least ne physical fight with smene utside their family, with 34.8% f heavy drinkers reprting such incidents cmpared with 14.3% f mderate/heavy drinkers, 12.1% f infrequent/light r mderate drinkers, and 8.4% f abstainers. - A higher percentage f heavy drinkers cmpared with ther drinking levels reprted receiving UCMJ punishment (13.2% cmpared with 6% t 7.1%) r having experienced truble with either the military r civilian plice (16.9% cmpared with 4.0% t 7.8%). - While a similar percentage f heavy drinkers and mderate drinkers reprted drivingrelated arrests as cmpared with infrequent/light r mderate drinkers and abstainers (5.0 and 5.1% cmpared with 2.9% and 2.1%), heavy drinkers reprted a higher percentage f nn-driving-related arrests cmpared with ther drinking levels (5.0% cmpared with 1.5% t 2.3%) as well as having spent time in jail (4.8% cmpared with 1.6% t 2.4%). Table 4.7 Occurrence f Specific Prblems Assciated With Criminal Justice Prblems/Fights, by Drinking Level Drinking Level Infrequent/ Light r Mderate/ Prblem Abstainer Mderate Heavy Heavy Ttal UCMJ punishment 6.0 (0.9) 7.1(1.2) 6.0 (1.4) 13.2 (1.3) 8.0 (0.9) Arrest, driving-related 2.1 (0.5) 2.9 (0.4) 5.1 (0.8) 5.0(0.9) 3.7 (0.5) Arrest, nt driving-related 1.5 (0.4) 2.3(0.5) 1.9(0.4) 5.0 (0.7) 2.7 (0.4) Time in jail 1.6(0.5) 2.4 (0.5) 2.3 (0.7) 4.8 (0.7) 2.8 (0.3) Hit significant ther 2.6 (0.6) 2.0(0.3) 2.0 (0.8) 3.9 (0.7) 2.5 (0.2) Physical fights, nnfamily 8.4 (1.7) 12.1(1.5) 14.3 (1.7) 34.8 (3.0) 17.0(1.8) Truble with the plice 4.0(1.0) 7.8(1.1) 7.0 (0.7) 16.9 (2.0) 8.9(1.0) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel,

41 The data in Table 4.7 demnstrate that the specific prblems cmprising the measure f criminal justice prblems/fights presented in Table 4.5 are assciated with the use f alchl. This assciatin is cnsistent amng heavy drinkers fr each specific prblem with sme prblems being strngly assciated with heavy drinking. This explains the strng dse-respnse relatinship bserved between the general criminal justice prblems/fights and drinking level displayed in Table Health Prblems/Injuries Infrmatin n the specific health prblems/injuries cmprising the health prblems/injuries variable frm Table 4.5 is presented by drinking level in Table 4.8. Highlights f Table 4.8 include the fllwing: - A higher percentage f heavy drinkers reprted having been hurt in an accident cmpared with the ther drinking levels (20.4% cmpared with 13.4% t 16%). - In general, there did nt appear t be an assciatin between the ther prblems and drinking level. Althugh nt apparently assciated with alchl use, a large percentage (30.6%) f Marine Crps persnnel reprted experiencing health prblems in the past 12 mnths. Table 4.8 Occurrence f Specific Prblems Assciated With Health Prblems/Injuries, by Drinking Level Drinking Level Infrequent/ Light r Mderate/ Prblem Abstainer Mderate Heavy Heavy Ttal Hurt in an accident Caused an accident Invlved in mtr vehicle accident Health prblems Needed emergency medical help 13.4(1.6) 14.6(1.3) 16.0(1.1) 20.4(1.2) 16.0(0.5) 2.6(0.7) 3.6(0.6) 4.0(0.6) 4.6(0.6) 3.7(0.4) 10.9(1.0) 12.1(0.9) 11.1(1.3) 11.6(1.1) 11.5(0.5) 28.4(2.3) 30.0(1.5) 32.0(1.6) 32.2(1.1) 30.6(0.6) 10.3(1.0) 11.5(1.0) 13.7(1.2) 13.4(1.2) 12.2(0.4) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel,

42 The data in Table 4.8 indicate that in general alchl use des nt appear t be assciated with selfreprting f health prblems/injuries Jb-Related Prblems Infrmatin n the specific jb-related prblems cmprising the jb-related prblems variable frm Table 4.5 is presented by drinking level in Table 4.9. Highlights f Table 4.9 include the fllwing: - Heavy drinkers were mre likely t reprt having received a lwer than expected scre n a perfrmance rating in the past 12 mnths than ther drinking levels (36.3% cmpared with 23.1% t 27%). ' Table 4.9 Occurrence f Speciflc Prblems Assciated With Jb-Related Prblems, by Drinking Level Drinking Level Infrequent/ Light r Mderate/ Prblem Abstainer Mderate Heavy Heavy Ttal Kept frm duty fr 1 week r mre due t illness 12.7(0.9) 11.6(1.3) 12.6(2.0) 14.4(1.1) 12.7(4.8) Nt prmted when 20.8(1.5) 28.9(1.9) 21.4(2.2) 28.1(2.7) 23.7(1.6) expected Lwer scre n 23.1(2.9) 27.0(1.7) 26.2(1.9) 36.3(1.3) 28.2(1.5) perfrmance rating [ Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel, The data in Table 4.9 indicate that in general alchl use des nt appear t be assciated with selfreprting f jb-related prblems Prductivity Lss Prblems The infrmatin presented in Table 4.10 cncerning prductivity lss is similar t that presented in Table 4.3, except that the prblems in Table 4.10 did nt necessarily have t be attributable t alchl use. Highlights f Table 4.10 include the fllwing: 41

43 A higher percentage f heavy drinkers reprted any ccurrence f wrking belw nrmal perfrmance level in the past 12 mnths cmpared with ther drinking levels (41.7% cmpared with 26.7% t 32.6%) and 4 r mre ccurrences f wrking belw nrmal perfrmance level (22.8% cmpared with 14.0% t 15.8%). Table 4.10 Occurrence f General Prductivity Lss, by Drinking Level Drinking Level Infrequent/ Light r Mderate/ Prblem Abstainer Mderate Heavy Heavy Ttal Late fr wrk by 30 minutes r mre Any ccurrence 22.1 (1.9) 22.4 (1.3) 24.5 (1.4) 28.5 (1.9) 24.2(1.0) 1 time 9.1 (1.2) 10.2 (0.9) 10.3 (1.0) 11.3(1.0) 10.3 (0.5) 2-3 times 9.1 (1.2) 8.3 (0.7) 8.7(1.1) 10.4(1.3) 9.0 (0.7) 4 r mre times 3.9 (0.8) 3.8 (0.5) 5.5 (0.9) 6.8 (0.7) 4.9 (0.3) Left wrk early Any ccurrence 34.6(1.9) 33.7 (1.6) 35.0(1.6) 34.5 (1.8) 34.4 (1.2) 1 time 7.3 (1.6) 8.3 (0.8) 7.1(1.1) 6.6(0.9) 7.4 (0.7) 2-3 times 13.7(1.1) 10.2 (0.9) 14.0 (0.9) 9.4(1.2) 11.6(0.6) 4 r mre times 13.6(1.8) 15.2(1.4) 14.0 (0.9) 18.6(1.1) 15.3 (0.9) Hurt in n-the-jb accident Any ccurrence 10.3 (1.9) 11.0(1.1) 11.7(1.5) 15.0 (1.4) 11.9(1.0) 1 time 5.8(1.1) 6.4 (0.8) 5.4 (0.7) 7.0(1.0) 6.2 (0.5) 2-3 times 2.6 (0.5) 2.9 (0.5) 4.2 (0.8) 5.6 (0.8) 3.8 (0.4) 4 r mre times 1.8 (0.6) 1.7(0.4) 2.1 (0.5) 2.4 (0.5) 2.0 (0.3) Wrked belw nrmal perfrmance level Any ccurrence 26.7 (2.3) 30.2(1.7) 32.6(1.6) 41.7 (2.3) 32.6(1.1) 1 time 5.7 (0.8) 5.5 (1.0) 6.8 (0.8) 6.6(0.7) 6.1 (0.5) 2-3 times 7.0 (1.2) 10.6 (0.7) 10.0(1.2) 12.3 (1.2) 10.0 (0.6) 4 r mre times 14.0(1.7) 14.1(1.1) 15.8 (1.4) 22.8 (1.6) 16.4 (0.8) Did nt cme t wrk because f illness r injury Any ccurrence 18.2(1.7) 17.9(1.3) 19.2(2.2) 17.0(1.6) 18.0(1.1) 1 tiine 7.6 (0.9) 7.5 (0.8) 7.2(1.1) 6.6(0.9) 7.2 (0.5) 2-3 times 5.8 (0.7) 5.9(0.8) 6.6 (1.4) 5.3 (0.8) 5.9 (0.6) 4 r mre times 4.8 (0.8) 4.5 (0.6) 5.4 (0.7) 5.1(1.0) 4.9 (0.4) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel,

44 The data in Table 4.10 indicate that in general alchl use des nt appear t be assciated with self-reprting f general prductivity lss nt specifically attributed t drinking. " 4.3 Demgraphic Crrelates f Prblems The previus sectins f this chapter presented relatinships between drinking levels and specific prblems in several general prblem areas either directly attributable t alchl use r nt necessarily related t alchl use. This sectin will present infrmatin abut the demgraphic subgrups f Marine Crps persnnel that were mre r less likely t be assciated with sme f these prblems Crrelates f Prblems Attributed t Alchl Use Infrmatin n the percentage f varius demgraphic subgrups f Marine Crps persnnel wh reprted experiencing alchl-related prblems is presented in Table Highlights f Table 4.11 include the fllwing: - A higher percentage f males than females reprted experiencing each f the three specific alchl-related prblems. - A lwer percentage f Black, nn-hispanics reprted experiencing any serius cnsequences than ther racial grups (6.1% cmpared with 13.1% t 16.9%). - A lwer percentage f individuals with at least a cllege degree reprted experiencing each f the three specific alchl-related prblems. - A higher percentage f individuals in the 20 r yunger and age grups cmpared with the and 35 r lder age grups reprted experiencing any serius. cnsequences (16.5 and 18.2% cmpared with 5.6% and 2.6%), any prductivity lss (21.0 and 27.1% cmpared with 12.7% and 7.3%), r symptms f dependence (11.9 and 12.8% cmpared with 2.3% and 1.0%). - Fr each f the three alchl-related prblems, the nn-married subgrup had the highest percentage f individuals reprting experiencing the prblem, while the married, spuse present subgrup had the lwest percentage. - Within the enlisted ranks and the fficer ranks the percentage f individuals wh reprted experiencing each f the three alchl-related prblems decreased as rank increased. This did nt necessarily hld true between the enlisted and fficer ranks, since junir fficers tended t have higher percentages reprting prblems than senir enlisted. - There was little difference in the percentage f individuals reprting prblems frm CONUS-cmpared with OCONUS-based Marine Crps persnnel. 43

45 Table 4.11 Alchl-Related Prblems, by Selected Demgraphic Characteristics Alchl-Related Prblem Any Any Serius Prductivity Characteristics Cnseauences Lss Dependence Gender Male 12.7(1.3) 19.6(1.3) 8.5 (1.2) Female 5.1(1.4) 12.2(1.3) 2.8 (0.9) Race/Ethnicity White, nn-hispanic 13.1 (1.2) 21.4(1.4) 9.4 (1.4) Black, nn-hispanic 6.1 (1.3) 12.4 (1.6) 4.7 (0.8) Hispanic 13.6 (1.5) 18.5 (1.7) 6.9 (1.2) Other 16.9 (4.8) 16.1 (3.8) 8.7 (2.9) Educatin High schl r less 14.2(1.7) 21.6(1.3) 11.0(1.6) Sme cllege 13.1 (0.8) 19.0(1.5) 6.8 (0.6) Cllege graduate r higher 2.2 (0.5) 10.2(1.4) 0.6(0.4) Age (years) 20 r yunger 16.5 (1.6) 21.0 (2.6) 11.9(2.2) (1.4) 27.1 (1.2) 12.8 (1.0) (0.9) 12.7 (1.4) 2.3 (0.6) 35 r lder 2.6 (0.7) 7.3(0.9) 1.0 (0.3) Family status Nt married 18.5(1.3) 26.0(1.3) 13.0(1.6) Married, spuse nt present 9.0 (3.9) 18.9 (3.2) 6.5 (2.4) Married, spuse present 5.8 (0.9) 11.5(1.0) 3.0 (0.5) Pay grade E1-E (1.2) 25.3 (1.4) 14.4(1.3) E4-E6 10.2(1.2) 19.3 (1.6) 6.7(1.1) E7-E9 2.8 (0.7) 7.5 (1.2) 1.2(0.4) W1-W5 1.6(1.4) 4.2(1.3) 0.5(0.5) (0.7) 13.4 (2.3) 1.4 (0.7) (0.5) 5.1 (1.0) 0 (0.0) Regin CONUS 11.7(1.4) 18.6(1.2) 7.5 (1.4) OCONUS 14.8 (2.5) 21.7 (3.8) 11.3(2.1) Ttal } Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel,

46 4.3.2 Crrelates f Prblems Nt Attributed t Alchl Use Infrmatin n the percentage f varius demgraphic subgrups f Marine Crps persnnel wh reprted experiencing prblems nt necessarily related t alchl is presented in Table Highlights f Table 4.12 include the fllwing: - A higher percentage f female Marine Crps persnnel cmpared with males reprted general life prblems (85.2% cmpared with 75.3%), health prblems/injuries (61.8% cmpared with 44.1 %), and jb-related prblems (53.2% cmpared with 46.1 %). - While there was little difference in mst f the life prblem areas by race, a higher percentage f Black, nn-hispanics and Hispanics reprted experiencing criminal justice prblems/fights cmpared with White, nn-hispanics, and Others (25.0% and 21.8% cmpared with 17.4% and 16.9%). - A lwer percentage f persnnel with at least a cllege degree reprted experiencing each f the life prblem areas. - While persnnel lder than 25 years f age reprted a lwer percentage f general life prblems, criminal justice prblems/fights, and jb-related prblems than thse 25 years f age r yunger, this was nt the case fr health prblems/injuries. - The married, spuse present subgrup reprted a lwer percentage f criminal justice prblems/fights cmpared with the ther family status subgrups (13.2% cmpared with 24.2% and 23.2%). - A higher percentage f enlisted persnnel cmpared with fficers reprted experiencing general life prblems (67.4% t 80.0% cmpared with 59.2% t 61.9%), criminal justice prblems/fights (8.3% t 30.6% cmpared with 4.3% t 6.1 %), health prblems/injuries (44.8% t 49.5% cmpared with 28.3% t 39.1 %), and jb-related prblems (29.0% t 58.4% cmpared with 17.3% t 25%). - There was little difference in the percentage f individuals reprting prblems frm CONUS- cmpared with OCONUS-based Marine Crps persnnel. 45

47 Table 4.12 Life Prblem Areas, by Selected Demgraphic Characteristics Prblem Areas Health General Life Criminal Justice Prblems/ Jb-related Characteristics Prblems' Prblems/Fights'' Iniuries*^ Prblems^ Gender Male 75.3(1.1) 19.5(1.3) 44.1 (0.8) 46.1 (1.9) Female 85.2(1.9) 16.0(1.9) 61.8(2.0) 53.2 (3.3) Race/Ethnicity White, nn-hispanic 76.3 (1.2) 17.4(1.3) 46.1 (1.2) 44.5 (1.6) Black, nn-hispanic 76.9 (2.0) 25.0 (2.4) 45.3 (2.9) 48.7 (2.7) Hispanic 74.8 (1.9) 21.8(2.2) 40.4(1.3) 51.0(1.7) Other 71.6(3.1) 16.9 (2.8) 46.5 (4.0) 50.1 (6.0) Educatin High schl r less 77.9(1.4) 23.8(1.4) 45.8 (1.6) 52.1 (2.0) Sme cllege 78.0(1.5) 17.2 (0.9) 48.2(1.4) 45.9(1.8) Cllege graduate r higher 61.5 (2.0) 6.0(1.2) 33.6(1.3) 24.7 (1.3) Age 20 r yunger 76.9(1.9) 28.6(2.1) 44.9(2.0) 53.2(2.1) (1.2) 23.5 (1.4) 47.7(1.1) 55.6(2.1) (1.4) 11.8(1.2) 42.1 (1.7) 33.6 (2.0) 35 r lder 65.3(1.9) 8.1 (0.9) 43.1 (1.7) 34.5(1.9) Family status Nt married 77.7 (1.0) 24.2(1.2) 46.7 (1.2) 51.1 (2.0) Married, spuse nt present 72.0 (3.8) 23.2 (4.7) 39.0 (3.7) 46.2 (6.5) Married, spuse present 74.3 (1.6) 13.2(1.1) 44.1 (1.2) 41.3(1.4) Pay Grade E1-E3 80.0(1.7) 30.6(1.6) 49.5 (1.6) 58.4 (2.0) E4-E6 78.3(1.3) 16.3 (1.4) 44.8 (0.7) 47.2(1.9) E7-E (2.5) 8.3 (1.4) 45.7 (2.4) 29.0 (3.0) W1-W5 61.9(5.6) 6.1(1.3) 39.1 (4.8) 25.0 (3.8) (3.0) 4.3 (1.2) 28.3(2.1) 17.3(1.6) (4.4) 4.7 (1.9) 35.6(3.1) 23.3 (2.0) Regin CONUS 75.7(1.3) 19.5 (1.4) 45.7 (0.8) 45.3(1.8) OCONUS 76.3 (0.5) 18.5 (3.4) 42.6(1.4) 51.5(4.5) Ttal 75.9(1.0) 19.3 (1.3) 45.1 (0.8) 46.5(1.8) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel, " One r mre f the fllwing the past 12 mnths: heated arguments with family r friends, truble n the jb (unspecified), health prblems, drve unsafely, neglected family respnsibilities, serius mney prblems, difficulty handling prblems, lud argument in public. '' One r mre f the fllwing in the past 12 mnths: UCMJ punishment, arrest fr a driving vilatin, arrest fr a nndriving vilatin, time in jail, hit significant ther, physical fights (nn-family), truble with the plice (civilian r military). ^ One r mre f the fllwing in the past 12 mnths: hurt in accident, caused an accident resulting in ther's injury r prperty damage, invlved in a mtr vehicle accident, health prblems, needed emergency medical help. One r mre f the fllwing in the past 12 mnths: kept frm duty fr a week r mre due t illness, did nt get prmted when expected, lwer scre n perfrmance rating. 46

48 Tables 4.11 and 4.12 shw that the demgraphic crrelates f prblems attributed t alchl use differ frm thse f life prblems nt necessarily attributed t alchl use. While a higher percentage f males reprted experiencing each f the alchl-related prblems, a higher percentage f females reprted experiencing each f the life prblems nt necessarily assciated with alchl use except criminal justice prblems/fights. While a lwer percentage f Blacks, nn-hispanics reprted experiencing any f the alchl-related prblems than each f the ther racial/ethnic subgrups, this racial/ethnic subgrup had the highest percentage f persnnel reprting experiencing criminal justice prblems/fights. A lwer percentage f persnnel with at least a cllege educatin cmpared with ther educatin subgrups reprted experiencing all prblems, alchl-related r nt. Similarly, a higher percentage f yunger persnnel reprted experiencing bth alchl-related and nt necessarily alchl-related prblems. While the married, spuse present subgrup reprted a lwer percentage f alchl-related prblems, there was little difference between the family status subgrups in respect t life prblems nt necessarily assciated with alchl use. While a higher percentage f junir fficers cmpared with senir fficers reprted experiencing alchl-related prblems, the reverse was true f each f the specific life prblem areas nt necessarily assciated with alchl use. There did nt appear t be differences between CONUS- and OCONUS-based persnnel in the percentages reprting either alchlrelated prblems r life prblem areas nt necessarily related t alchl use. 4.4 Odds f Experiencing Prblems As the previus sectin shwed, different demgraphic attributes f Marine Crps persnnel appear t be assciated with alchl-related prblems and life prblems nt necessarily assciated with alchl. Hwever, demgraphic characteristics such as age, pay grade, and family status are ften interrelated in Marine Crps persnnel, and alchl use patterns vary amng demgraphic subgrups. T cntrl fr these interrelatins multivariate lgistic regressin analyses were cnducted t identify the independent effects f alchl use and demgraphic characteristics n different indicatrs f alchl-related prblems and prblems nt necessarily attributed t alchl use. Results f these analyses were expressed as dds ratis with the null value (value indicating n assciatin) being 1.00, a value >1.00 indicating a psitive assciatin, and a value <1.00 indicating a negative (prtective) assciatin. 95% cnfidence intervals are reprted t allw an assessment f the statistical significance f the reprted measures f assciatin (a cnfidence interval that cntains the null value f 1.00 indicates a lack f significance). Since Tables 4.11 and 4.12 indicate a higher percentage f enlisted persnnel reprted experiencing prblems (and t remain cnsistent with previus reprts f Department f Defense Surveys f Health-related Behavirs Amng Military Persnnel) lgistic regressin analyses are presented fr nly enlisted Marine Crps persnnel Odds f Experiencing Prblems Attributed t Alchl Use The results f the lgistic regressin analysis f alchl-related prblems are shwn in Table 4.13 as dds ratis with accmpanying cnfidence intervals. Abstainers were excluded frm the analysis f prblems attributed t alchl use. Statistically significant highlights f Table 4.13 include the fllwing: 47

49 Marine Crps persnnel with a high schl educatin r less r sme cllege were significantly mre likely t reprt experiencing symptms f alchl dependence than persnnel with at least a cllege degree. This was a very strng assciatin. Marine Crps persnnel in the 21- t 25-year-ld age range were 3.59 times as likely t reprt experiencing symptms f alchl dependence than persnnel wh were ages 35 years r lder. Single persnnel were 1.54 times as likely t reprt experiencing serius cnsequences and 1.39 times as likely t reprt experiencing prductivity lss due t alchl use as married persnnel whse spuse was living with them at their duty statin at the time f the survey. Persnnel in the E1-E3 pay grade grup were 2.81 times as likely t reprt experiencing serius cnsequences as the result f alchl use as persnnel in the E7-E9 pay grade grup. Persnnel in the military jb categries electrnic repair were 1.45 times as likely, craftsman were 2.08 times as likely, and technical/nn-health care were 0.65 times as likely as functinal supprt persnnel t reprt experiencing alchl-related prductivity lss. Drinking level was highly assciated with each f the alchl-related prblems and appeared t exhibit a dse-respnse relatinship. Mderate/heavy drinkers were 1.98 times as likely and heavy drinkers were 3.72 times as likely t reprt experiencing serius cnsequences as a result f alchl use as infrequent/light drinkers. Mderate drinkers were 1.62 times as likely, mderate/heavy drinkers were 2.97 times as likely, and heavy drinkers were 7.76 times as likely t reprt experiencing alchl-related prductivity lss as infrequent/light drinkers. Heavy drinkers were times as likely t reprt experiencing alchl-related dependence symptms as infrequent/light drinkers. The infrmatin frm the lgistic regressin analyses limited t enlisted persnnel presented in Table 4.13 demnstrates that alchl use was an independent risk factr fr alchl-related prblems after cntrlling fr the effects f ther variables. There appeared t be a dse-respnse relatinship, with heavier drinking levels being mre likely t reprt prblems than infrequent/light drinkers. This assciatin was fairly cnsistent in each f the specific alchl-related prblems. Additinally, the demgraphic variables educatin, age, family status, and pay grade were assciated t sme degree with specific alchl-related prblems after the cntributins f alchl use. All ther variables in the mdel were taken int accunt and therefre may be useful fr targeting effrts t reduce heavy drinking and alchl-related prblems amng Marine Crps persnnel. 48

50 Table 4.13 Adiusted Odds Ratis f Alchl-Related Prblems fr Enlisted Persnnel Alchl-Related Prblem Serius Prductivity. Characteristics Cnsequences Lss Dependence Gender Male 1.70(0.83,3.49) 0.96(0.71,1.28) 1.38 (0.60, 3.16) Female 1.00 (-) 1.00 (-) 1.00 (-) Race/Ethnicity White, nn-hispanic 1.00 (-) 1.00 (-) 1.00 (-) Black, nn-hispanic 0.67(0.41,1.09) 0.90 (0.65, 1.24) 1.05(0.52,2.12) Hispanic 1.05 (0.71, 1.55) 0.91 (0.78, 1.06) 0.76(0.52,1.11) Other 1.22(0.71,2.09) 0.69(0.39,1.22) 0.89 (0.42, 1.90) Educatin High schl r less 1.30 (0.48, 3.57) 1.09(0.46,2.60) 56.23(35.41,89.30) ' Sme cllege 1.70(0.57,5.07) 1.18(0.52,2.68) (25.90, 76.96) Cllege graduate r higher 1.00 (-) 1.00 (-) 1.00 (-) Age (years) 20 r yunger 1.60(0.51,4.97) 1.18(0.56,2.47) 3.06 (0.74, 12.62) (0.67, 5.93) 1.55(0.82,2.92) 3.59(1.00,12.83) (0.43,3.60) 1.10(0.65,1.86) 1.74(0.49,6.14) 35 r lder 1.00 (-) 1.00 (-) 1.00 (-) Family status Nt married 1.54(1.09,2.18) 1.39(1.12,1.73) 1.32(0.90,1.94) Married, spuse nt present 0.81(0.29,2.27) 1.16(0.68,1.98) 1.05 (0.35, 3.12) Married, spuse present 1.00 (-) 1.00 (-) 1.00 (-) Pay grade E1-E (1.12,7.07) 1.68 (0.82, 3.45) 1.56(0.52,4.71) E4-E6 1.52(0.71,3.26) 1.48(0.77,2.86) 0.96 (0.34, 2.74) E7-E (-) 1.00 (-) 1.00 (-) Regin CONUS 0.97 (0.74,1.27) 1.14(0.83,1.55) 0.97 (0.73,1.29) OCONUS 1.00 (-) 1.00 (-) 1.00 (-) Occupatin Direct cmbat 1.16(0.69,1.96) 0.92(0.71,1.18) 1.01(0.52,1.96) Electrnic equipment repair 0.90(0.50,1.62) 1.45(1.01,2.11) 1.15 (0.35, 3.72) Cmmunicatins/intelligence 0.91 (0.49, 1.72) 1.08(0.69,1.68) 1.05(0.53,2.08) Technical/nn-health Care 0.92(0.61,1.39) 0.65 (0.44, 0.96) 0.52(0.15,1.76) Functinal supprt 1.00 (-) 1.00 (-) 1.00 (-) Electrical/mechanical repair 0.83 (0.50, 1.37) 1.09(0.85,1.39) 0.94(0.55,1.61) Craftsman 1.92(0.99,3.73) 2.08(1.02,4.24) 1.85(0,70,4.87) Service and supply 1.02(0.57,1.83) 1.21 (0.84, 1.76) 0.80(0.41,1.54) Nn-ccupatinal 1.13(0.50,2.56) 0.99(0.52,1.87) 0.46(0.10,2.00) Drinking level Infrequent/light 1.00 (-) 1.00 (-) 1.00 (-) Mderate 1.18(0.63,2.22) 1.62(1.06,2.48) 0.48(0.18,1.28) Mderate/heavy 1.98(1.22,3.23) 2.97 (2.00, 4.42) 1.27(0.65,2.49) Heavy 3.72(2.10,6.60) 7.76(5.33,11.29) (6.49, 18.54) Nte: Table entries are dds ratis adjusted fr effects f gender, race/ethnicity, educatin, age. family status, pay grade. regin, ccupatin, and drinking level. Reference grups have an dds rati f Abstainers were excluded frm these analyses. Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel,

51 4.4.2 Odds f Experiencing Prblems Nt Attributed t Alclil Use The results f the lgistic regressin analysis f prblems nt necessarily assciated with alchl use are shwn in Table 4.14 as dds ratis with accmpanying cnfidence intervals. Abstainers were included in the analysis and were used as the reference grup fr the drinking level variable. Statistically significant highlights f Table 4.14 include the fllwing: - Males were 0.44 times as likely t reprt experiencing general life prblems as females, 0.50 times as likely t reprt health prblems/injuries, and 0.64 times as likely t reprt jb-related prblems. - Black, nn-hispanics were 2.07 times as likely t reprt criminal justice prblems/fights as White, nn-hispanics while Hispanics were 0.75 times as likely t reprt health prblems/injuries as White, nn-hispanics. - Persnnel in the age range were 1.83 times as likely t reprt experiencing general life prblems as thse ages 35 years r lder. Persnnel in the 20 r yunger and age ranges were 0.55 and 0.45 times as likely t reprt jb-related prblems as thse ages 35 years r lder. Single individuals were 0.72 times as likely t reprt experiencing general life prblems as married persnnel whse spuse was present at their duty statin at the time f the survey. - Persnnel in the E1-E3 pay grade grup were 3.87 times as likely and thse in the E4-E6 grup were 1.97 times as likely t reprt criminal justice prblems/fights as persnnel in the E7-E9 pay grade grup. Persnnel in the E1-E3 pay grade grup were 4.75 times as likely and thse in the E4-E6 grup were 3.15 times as likely t reprt jb-related prblems as persnnel in the E7-E9 pay grade grup. - Persnnel statined in the cntinental United States were 1.16 times as likely t reprt health-related prblems/injuries as thse utside the cntinental United States. - Persnnel in the military jb categry electrnic repair were 1.74 times as likely as thse in the functinal supprt categry t reprt experiencing general life prblems. Persnnel in the cmmunicatins/intelligence categry were 1.15 times as likely, thse in the technical/nn-health care categry were 1.33 times as likely, and thse in the electrical/mechanical repair categry were 1.26 times as likely t reprt health prblems/injuries as persnnel in the functinal supprt categry. It shuld be nted, hwever, that the assciatins between ccupatin categry and health prblems/injuries require careful cnsideratin since their cnfidence intervals were very clse t cntaining 1.00, which wuld have signified a lack f significance. 50

52 - While alchl use was assciated with prblems nt necessarily attributed t alchl use, a dse-respnse relatinship did nt appear t be present. Infrequent/light drinkers were 2.07 times as likely, mderate drinkers were 1.70 times as likely, Mderate/heavy drinkers were 2.08 times as likely, and heavy drinkers were 2.66 times as likely t reprt experiencing general life prblems as abstainers. Mderate drinkers were 1,76 times as likely, mderate/heavy drinkers were 1.55 times as likely, and heavy drinkers were 2.40 times as likely t reprt criminal justice prblems/fights as abstainers. Mderate drinkers were 1.25 times as likely, mderate/heavy drinkers were 1.25 times as likely, and heavy drinkers were 1.59 times as likely t reprt jb-related prblems as abstainers. The infrmatin frm the lgistic regressin analyses limited t enlisted persnnel presented in Table 4.14 demnstrates that after cntrlling fr the effects f ther variables, alchl use was an independent risk factr fr prblems nt necessarily related t alchl use (except health prblems/injuries). Lwer pay grade was assciated with criminal justice prblems/fights and jbrelated prblems, even after cntrlling fr the effects f age, educatin, and family status. Male gender appeared t be a prtective factr fr general life prblems, health prblems/injuries, and jb-related prblems. 4.5 Summary Alchl use and abuse have cnsistently been assciated with a range f prblem behavirs and negative cnsequences. Previus research has brught attentin t the extent f heavy alchl cnsumptin and the prevalence f alchl-related prblems. In fact, previus research has indicated that despite ften significant decreases in alchl cnsumptin and alchl-related prblems amng DD persnnel. Marine Crps persnnel cntinue t evidence significantly mre prblems due t heavy alchl use. The present data indicate that amng Marine Crps persnnel, heavy drinkers were cnsistently and substantially mre likely than ther drinkers t experience alchl-related cnsequences. Fr example, f the heavy drinkers, apprximately ne third experienced alchl-related serius cnsequences (30.0 %), neariy half (45.9%) experienced sme frm f alchl-related prductivity lss, and apprximately ne third (30%) had symptms f dependence. In additin, heavy drinkers had substantially higher rates f prblems cmprmising the individual alchl-related prblems summary measures. Marine Crps patterns f heavy alchl cnsumptin and negative cnsequences were assciated with being male, between the ages f 20-25, and having a high schl educatin r less. These findings indicate that heavy alchl use is still prblematic fr the Marine Crps and mre effrt shuld be targeted at alchl preventin prgrams. Alchl use and its related cnsequences have an adverse effect n military perfrmance and readiness. Furthermre, these data have implicatins fr plicies and prcedures used by decisin-makers in their attempt t prevent and cntrl the impact f alchl abuse. 51

53 Table 4.14 Adjusted Odds Ratis f Unattributed Prblems fr Enlisted Persnnel Prblem Area General Life Criminal Justice Health Prblems/ Jb-Related Characteristics Prblems' Prblems/Fiehts' Injuries' Prblems? Gender Male 0.44 (0.30, 0.65) 1.08(0.81,1.43) 0.50 (0.37, 0.67) 0.64 (0.52, 0.80) Female 1.00 (-) 1.00 (-) 1.00 (-) 1.00 (-) Race/Ethnicity White, nn-hispanic 1.00 (-) 1.00 (-) 1.00 (-) 1.00 (-) Black, nn-hispanic 1.18(0.95,1.47) 2.07(1.49,2.88) 0.98(0.79,1.22) 1.23(0.91,1.65) Hispanic 0.79(0.63,1.00) 1.05(0.79,1.40) 0.75 (0.65, 0.85) 1.10(0.96,1.26) Other 0.82(0.59,1.15) 0.93 (0.70, 1.23) 0.95 (0.64, 1.40) 1.12(0.69,1.84) Educatin High schl r less 1.06(0.63,1.80) 1.56 (0.83, 2.95) 1.11 (0.64, 1.90) 1.30(0.90,1.86) Sme cllege 1.17(0.70,1.97) 1.30(0.68,2.50) 1.17(0.76, 1.80) 1.19(0.83,1.69) Cllege graduate r higher 1.00 (-) 1.00 (-) 1.00 (-) 1.00 (-) Age (years) 20 r yunger 1.37(0.75,2.52) 1.22(0.65,2.28) 0.67(0.36,1.23) 0.55 (0.38,0.80) (1.04,3.19) 1.16(0.70,1.90) 0.88(0.52,1.48) 0.76(0.52,1.10) (0.65,1.98) 0.91 (0.55, 1.51) 0.87(0.55, 1.39) 0.45 (0.32,0.62) 35 r lder 1.00 (-) 1.00 (-) 1.00 (-) 1.00 (-) Family status. Nt married 0.72 (0.56,0.93) 1.07(0.87,1.31) 0.95(0.77,1.17) 0.88(0.76,1.01) Married, spuse nt present 0.69 (0.38,1.27) 1.43(0.90,2.27) 0.70(0.46, 1.08) 0.93(0.52,1.66) Married, spuse present 1.00 (-) 1.00 (-) 1.00 (-) 1.00 (-) Pay grade E1-E3 1.39(0.75,2.55) 3.87(2.13,7.02) 1.51(0.97,2.35) 4.75(3.17,7.12) E4-E6 1.22(0.70,2.11) 1.97(1.13,3.46) 1.04(0.70, 1.56) 3.15(2.34,4.24) E7-E (-) 1.00 (-) 1.00 (-) 1.00 (-) Regin CONUS 1.08(0.78,1.48) 1.43(0.94,2.18) 1.16(1.01, 1.33) 0.83 (0.60, 1.16) OCONUS 1.00 (-) 1.00 (-) 1.00 (-) 1.00 (-) Occupatin Direct cmbat 0.99(0.76, 1.27) 1.11(0.78,1.56) 1.04(0.82, 1.33) 1.17(0.97, 1.42) Electrnic equipment repair 1.74(1.37,2.21) 0.71 (0.42, 1.21) 1.30(0.93,1.83) 1.15(0.86,1.52) Cmmunicatins/intelligence 1.02(0:73, 1.43) 0.94(0.67,1.33) 1.15(1.01,1.29) 1.07(0.88,1.29) Technical,/nn-health care 0.85(0.56,1.29) 0.94(0.54,1.65) 1.33(1.00,1.77) 1.21 (0.95,1.55) Functinal supprt 1.00 (-) 1.00 (-) 1.00 (-) 1.00 (-) Electrical/mechanical repair 0.97(0.74,1.26) 0.91 (0.67, 1.25) 1.26(1.00, 1.59) 1.09 (0.84, 1.40) Craftsman. 1.10(0.49,2.49) 1.33(0.87,2.05) 0.92(0.64,1.31) 1.00(0.67,1.49) Service and supply 1.15(0.81,1.65) 1.25(0.88,1.76) 0.84(0.70,1.01) 1.45(0.91,2.33) Nn-ccupatinal 0.98(0.57,1.68) 0.81 (0.41,1.60) 0.90(0.58, 1.41) 1.04(0.63, 1.73) Drinking level Abstainer 1.00 (-) 1.00 (-) 1.00 (-) 1.00 (-) Infrequent/light 2.07(1.32,3.24) 1.42(0.89,2.26) 1.38(0.93,2.64) 1.33(0.98,1.97) Mderate 1.70(1.07,2.68) 1.76(1.26,2.45) 1.18(0.92,1.51) 1.25(1.08,1.44) Mderate/heavy 2.08(1.28,3.38) 1.55(1.16,2.06) 1.22(0.90,1.65) 1.25(1.00,1.57) Heavy 2.66(1.97,3.59) 2.40(1.73,3.34) 1.26(0.97,1.64) 1.59(1.27,2.00) Nte: Table entries are dds ratis adjusted fr effects f gender, race/ethnicity, educatin, age, family status, pay grade, regin, ccupatin, and drinking level. Reference grups have an dds rati f Abstainers were excluded frm these analyses. Surce: DD Surveys f Health-related Behavirs Amng Military Persnnel, " One r mre f the fllwing the past 12 mnths: heated arguments with family r friends, truble n the jb (unspecified), health prblems, drve unsafely, neglected family respnsibilities, serius mney prblems, difficulty handling prblems, lud argument in public. '' One r mre f the fllwing in the past 12 mnths: UCMJ punishment, arrest fr a driving vilatin, arrest fr a nndriving vilatin, time in jail, hit significant ther, physical fights (nn-family), truble with the plice (civilian r military). '^ One r mre f the fllwing in the past 12 mnths: hurt in an accident, caused an accident resulting in ther's injury r prperty damage, invlved in a mtr vehicle accident, health prblems, needed emergency medical help. '' One r mre f the fllwing in the past 12 mnths: kept fi-m duty fr a week r mre due t illness, did nt get prmted when expected, lwer scre n perfrmance rating. 52

54 5. Drinking Levels and Other Health-Risk Behavirs Alchl use can impair an individual's judgment and can lead t an increase in risky behavir. Specifically, Marine Crps persnnel wh drink heavily may be mre likely t drive under the influence f alchl, t nt wear seat belts, r t have unsafe sex. This chapter will examine the relatinship amng drinking levels and these health-risk behavirs as well as the assciatin between selected demgraphic and risk variables and the dds f heavy drinking in an effrt t identify subgrups f Marine Crps persnnel wh are mre likely t engage in high-risk behavirs. 5.1 Drinking and Driving Infrmatin n the frequency f drinking and driving by Marine Crps persnnel is presented in Table 5.1. Highlights f Table 5.1 include the fllwing: 16.3% f Marine Crps persnnel categrized as heavy drinkers reprted drinking and driving at least nce a week % f Marine Crps persnnel categrized as heavy drinkers and 25.9% categrized as mderate/heavy drinkers reprted drinking and driving at least nce a mnth % f Marine Crps persnnel reprted perating a mtr vehicle within 2 hurs f drinking any alchlic beverage n at least ne ccasin in the past 12 mnths. - Drinking and driving appeared t be assciated with increased alchl use, with 41.1% f infrequent/light r mderate drinkers, 68.3% f the mderate/heavy drinkers, and 70.2% f the heavy drinkers reprting drinking and driving at least nce in the past 12 mnths. Table 5.1 Frequency f Drinking and Driving, by Drinking Level Drinking Level Infrequent/ Light r Mderate/ Frequency* Mderate Heavy Heavy Ttal" 5 t 7 days per week 0.3 (0.2) 0.5 (0.3) 1.9 (0.6) 0.7(0.2) 1 t 4 days per week 0.8 (0.2) 5.3 (0.7) 14.4 (0.8) 5.1 (0.3) 1 t 3 days per mnth 6.2(0.7) 20.1(1.9) 20.8 (1.7) 12.3 (0. At least nce in the past 12 mnths 33.9(2.4) 42.3(2.0) 33.0(1.5) 32.1(0.9) Never 58.9(2.6) 31.7(1.4) 29.8 (1.2) 49.8(1.5) Nte: Entries are expressed as percentages (with standard errrs in parentheses). "Drinking and driving" was defined as perating a mtr vehicle within 2 hurs f drinking any alchlic beverages. Surce: DD Surveys f Health-related Behavir Amng Military Persnnel, " Of all peple wh drive a mtr vehicle. " Ttal excludes abstainers. 53

55 Table 5.1 displayed the strng relatinship between increasing levels f alchl use and drinking and driving. In additin t the increased frequency at which heavy drinkers reprted drinking and driving, heavy drinkers, by definitin, cnsume mre alchl and therefre may ften be driving after cnsuming large amunts f alchl. This, cmbined with the high percentage f Marine Crps persnnel reprting drinking and driving, suggests the need t address this issue by targeting persnnel fr interventins aimed at reducing the frequency f drinking and driving. 5.2 Drinking and the Use f Seat Belts Infrmatin n the frequency f the use f seat belts by Marine Crps persnnel is presented in Table 5.2. Highlights f Table 5.2 include the fllwing: - Only 87.3% f Marine Crps persnnel reprted always r nearly always using seat belts. - Nt using seat belts appeared t be assciated with increasing alchl use, with 6.4% f abstainers, 7.9% f infrequent/light r mderate drinkers, 13.5% f mderate/heavy, and 19.2% f heavy drinkers reprting using seat belts nly smetimes r less. Table 5.2 Frequency f Seat Belt Use, by Drinking Level Drinking Level Infrequent/ Light r Mderate/ Frequency" Abstainer Mderate Heavy Heavy Ttal Always r nearly always Smetimes Seldm Never 92.0(1.2) 91.0(1.0) 85.4(1.1) 79.2(1.3) 87.3(0.7) 3.1 (0.7) 5.3 (0.8) 9.3 (1.0) 11.7(1.2) 7.2 (0.5) 1.7 (0.5) 1.9 (0.6) 3.5 (0.8) 4.9(1.3) 2.9 (0.4) 1.6 (0.4) 0.7 (0.3) 0.7 (0.4) 2.6 (0.6) 1.3 (0.3) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavir Amng Military Persnnel, ^ Of peple "wh drive r ride in a car. Table 5.2 displayed the strng relatinship between increasing levels f alchl use and failure t use seat belts. Taken tgether. Tables 5.1 and 5.2 indicate that heavy drinkers are nt nly 54

56 mre likely t drink and drive but that they are als mre likely t cmpund their risk by nt using seat belts when they drive. 5.3 Drinking and Sexual Behavir Infrmatin n the frequency f unsafe sexual behavir by Marine Crps persnnel is presented in Table 5.3. Highlights f Table 5.3 include the fllwing: - Only 25.2% f Marine Crps persnnel reprted using a cndm at their last sexual encunter. - A higher percentage f persnnel categrized as heavy drinkers (32.1%) reprted using a cndm at their last sexual encunter than persnnel in the ther drinking levels (13.3% t 24.9%). - An increased number f sexual partners appeared t be assciated with increased alchl use, with 5.8% f abstainers, 7.7% f infrequent/light r mderate drinkers, 11.1% f mderate/heavy drinkers, and 23.3% f heavy drinkers reprting at least 5 sexual partners in the past 12 mnths. Table 5.3 Degree f Risk fr Sexually Transmitted Disease Amng Sexually Active Persnnel, by Drinking Level Drinking Level Infrequent/ Light r Mderate/ Sexual Behavir* Abstainer Mderate Heavy Heavy Ttal Used a cndm at last sexual encunter Yes 21.1 (1.7) 13.3 (1.4) 24.9 (1.4) 32.1 (1.4) 25.2 (0.6) N 69.8(1.8) 71.5(1.5) 72.3 (1.3) 62.8 (2.1) 69.4(1.0) Number f sexual encunters in past 12 mnths 20 r mre peple 0.9 (0.4) 0.8 (0.3) 0.8 (0.2) 3.2 (0.4) 1.3 (0.1) peple 0.7 (0.5) 1.0(0.3) 2.0 (0.6) 5.8(0.7) 2.2 (0.3) 5-9 peple 4.2 (0.9) 5.9 (0.7) 8.3 (1.0) 14.3 (2.0) 8.0 (0.8) 2-4 peple 15.7(1.5) 19.8(1.3) 24.8 (1.2) 33.4(1.8) 23.2 (0.8) 1 persn 63.9 (1.9) 62.8 (1.2) 58.8 (2.1) 35.6 (2.6) 56.0(1.6) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavir Amng Military Persnnel, " Of peple wh had sex in the past 12 mnths. 55

57 Table 5.3 displays the relatinship between alchl use and risky sexual behavir. Overall reprted cndm use by Marine Crps persnnel is lw (25.2%) and the reprted frequency f sexual encunters is high (44% reprting mre than 1 partner in the past 12 mnths). While a higher percentage f heavy drinkers reprted cndm use at their last sexual encunter, this must be weighed against the much higher percentage f heavy drinkers reprting multiple sexual encunters. As increased alchl use impairs judgment, heavy drinkers with a high number f sexual partners are at increased risk fr sexually transmitted diseases. In additin, the higher percentages f abstainers, infrequent/light r mderate drinkers, r mderate drinkers cmpared with heavy drinkers reprting 1 sexual partner in the past 12 mnths are mre likely t include mngamus married individuals wh d nt use cndms. These individuals wuld cntribute t the percentage f individuals reprting lack f cndm use at last sexual encunter althugh they wuld actually be at a much lwer risk fr sexually transmitted diseases. 5.4 Health-Risk Behavirs and the Odds f Heavy Alchl Use Infrmatin n the assciatin between health-risk behavirs and the dds f heavy alchl use is presented in Table 5.4. As seen in previus sectins, there may be crrelatins between varius risk behavirs r between specific demgraphic variables and risk behavirs. T cntrl fr these interrelatins, multivariate lgistic regressin analyses were cnducted t identify the independent effects f risk behavirs and demgraphic characteristics n alchl use. Results f these analyses were expressed as dds ratis with the null value (value indicating n assciatin) being 1.00, a value >1.00 indicating a psitive assciatin, and a value <1.00 indicating a negative (prtective) assciatin. 95% cnfidence intervals are reprted t allw an assessment f the statistical significance f the reprted measures f assciatin (a cnfidence interval that cntains the null value f 1.00 indicates a lack f significance). Statistically significant highlights f Table 5.4 include the fllwing: ^ - Male Marine Crps persnnel were 3.41 times as likely t be categrized as heavy drinkers as female persnnel. - Blacks were 0.32 times as likely and Hispanics were 0.61 times as likely t be categrized as heavy drinkers as Whites. - Single persnnel were 1.87 times as likely t be categrized as heavy drinkers as married persnnel whse spuses were present at their present duty statin at the time f the survey. - Persnnel in lwer pay grades were mre likely t be categrized as heavy drinkers than persnnel in higher pay grades. Persnnel in the E1-E3 pay grade grup were times as likely, thse in the E4-E6 grup were 7.59 times as likely, thse in the E7-E9 grup were 3.57 times as likely, and thse in the grup were 3.91 times as likely t be categrized as heavy drinkers as thse in the grup. - Drinking and driving was strngly assciated with heavy drinking. Persnnel wh reprted drinking and driving 5 t 7 days per week were 5.53 times as likely, thse wh 56

58 reprted drinking and driving 1 t 4 days per week were 9.63 times as likely, thse wh reprted drinking and driving 1 t 3 days per mnth were 3.67 times as likely, and thse wh reprted drinking and driving at least nce in the past 12 mnths Were 1.61 times as likely t be categrized as heavy drinkers as thse wh reprted never drinking and driving. - The number f sexual encunters in the past 12 mnths reprted by Marine Crps persnnel was highly assciated with heavy drinking. Individuals wh reprted having 20 r mre encunters were 4.37 times as likely, thse wh reprted having encunters were 4.13 times as likely, thse wh reprted having 5-9 encunters were 1.74 times as likely, and thse wh reprted having 2-4 encunters were 1.44 times as likely t be categrized as heavy drinkers than thse wh reprted having nly 1 sexual. partner in the past 12 mnths. Table 5.4 shws that there were several strng and significant predictrs f heavy drinking. Several demgraphic variables were assciated with heavy drinking. Males were mre likely t drink heavily than females, Whites were mre likely t drink heavily than ther racial grups, single persnnel were mre likely t drink heavily than married persnnel whse spuses were present at their present duty statin, and lwer pay grades were mre likely t drink heavily than senir fficers. Tw f the fur risky health behavirs were als assciated with heavy drinking. Persnnel wh reprted drinking and driving were mre likely t drink heavily than thse wh did nt, and persnnel wh reprted multiple sexual encunters in the past 12 mnths were mre likely t drink heavily than thse wh reprted having nly 1 sexual partner. These assciatins were significant after cntrlling fr all ther variables in the mdel that demnstrates independent assciatins. These data suggest the need fr interventins targeted at heavy drinkers t address the assciatin between risky sexual behavirs and alchl use. 5.5 Summary The data indicated a clear assciatin between drinking levels and risky behavir. Cnsiderable literature has indicated that imprtant differences can exist between the lifestyles f individuals in relatin t drinking levels. These differences can express themselves thrugh a range f behaviral indicatrs including health-risk behavirs, such as driving under the influence, nt wearing seat belts, and/r having unsafe sex. Therefre, the reductin f excessive alchl cnsumptin shuld be an imprtant target f the Marine Crps. Risky health behaviral practices are likely t affect peratinal readiness f Marine Crps persnnel. 57

59 Table 5.4 Adjusted Odds Ratis f Heavy Alchl Use, With an Emphasis n Other Health-Risk Behavirs Gender Male Female Race/Ethnicity White Black Hispanic Other Educatin High schl r less Sme cllege Cllege graduate r higher Family status Nt married Married, spuse nt present Married, spuse present Pay grade E1-E3 E4-E6 E7-E9 W1-W Regin CONUS OCONUS Seat belt use Seldm r never Smetimes Always r nearly always Operated a mtr vehicle within 2 hurs f drinking an alchlic beverage 5 t 7 days per week 1 t 4 days per week 1 t 3 days per mnth At least nce in the past 12 mnths Never Used a cndm at last sexual encunter N Yes Number f sexual encunters in the past 12 mnths 20 r mre peple peple 5-9 peple 2-4 peple 1 persn Nte: Table entries are dds ratis adjusted fr regin, and indicatrs f seat belt use, drinking frm these analyses. Heavy Drinking % Cnfidence Interval (1.81,6.41) (--). (0.18,0.55) (0.46,0.81) (0.24,1.01) (0.69,4.35) (0.49,2.80) (--) (1.41,2.47) (0.75,2.10) (--) (3.88, 30.70) (2.12,27.09) (1.15,11.07) (0.34,6.75) (1.72, 8.91) (--) (0.47,1.11) (--) (0.50,2.12) (0.61,1.34) (--) (1.88, 16.27) (6.17,15.04) (2.72,4.93) (1.13,2.27) (--) (0.73, 1.34) (--) (1.92,9.92) (1.93, 8.83) (1.10,2.77) (1.09,1.91) Irzl the effects f gender, race/ethnicity, educatin, family status, pay grade, and driving, and high-risk sexual behavirs. Abstainers were excluded Surse: DD Survey f Health-related Behavirs Amng Military Persnnel,

60 6. Perceived Stress and Quality f Life Marine Crps persnnel are likely t experience the same types f stress as"civilians frm similar surces, including family and wrk respnsibilities. Additinally, specific challenges assciated with being in the military may be surces f stress. This chapter examines the impact f perceived stress frm the family r wrk envirnment n Marine Crps persnnel. Specifically, this chapter will present infrmatin n the appraisal f stress, the demgraphic crrelates f stress, particular surces f stress, ways f cping with stress, and interference f stress with military jb perfrmance. 6.1 Appraisal f Stress Infrmatin n the level f stress experienced at wrk and in family life r persnal life by Marine Crps persnnel is presented in Table 6.1. Highlights f Table 6.1 include the fllwing: - A great deal r a fairly large amunt f stress at wrk was reprted by 39.1 % f Marine Crps persnnel. This was reprted by a slightly higher percentage f female persnnel (43.8%) than male persnnel (38.9%). - A smaller percentage f Marine Crps persnnel (23.3%) reprted experiencing a great deal r a fairly large amunt f stress in family life r persnnel relatinships. Again, a higher percentage f female persnnel (31.8%) reprted experiencing this stress than male persnnel (22.8%). Table 6.1 Levels f Perceived Stress at Wrk and in Family Life, Past 12 Mnths, by Gender Gender Type f Stress/ Level Men Wmen Ttal Stress at wrk Great deal 16.2 (0.9) 18.3 (1.9) 16.3 (0.8) Fairly large amunt 22.7 (0.9) 25.5 (2.6) 22.8 (0.8) Sme 30.7 (0.9) 30.3 (2.0) 30.7(0.9) A little 18.7(1.0) 17.1 (1.8) 18.6 (0.9) Nne 10.8 (0.7) 8.1 (1.3) 10.6 (0.6) Stress in family Great deal 10.2 (0.3) 16.3 (2.2) 10.5 (0.3) Fairly large amunt 12.6 (0.7) 15.5 (2.3) 12.8 (0.6) Sme 27.6 (0.5) 25.4 (2.3) 27.5 (0.6) A little 27.1 (0.9) 27.5 (1.8) 27.1 (0.8) Nne 21.4 (1.0) 14.8 (3.2) 21.0(1.0) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavir Amng Military Persnnel,

61 6.2 Demgraphic Crrelates f Stress Infrmatin n the percentage f varius demgraphic subgrups f male and female Marine Crps persnnel wh reprted experiencing a great deal r a fairly large amunt f stress either at wrk r in their family life r persnal relatinships is presented in Table 6.2. Highlights f Table 6.2 include the fllwing: - In each subgrup f each scidemgraphic variable (except the E4-E6 and pay grade grups), a higher percentage f female Marine Crps persnnel reprted experiencing a great deal r a fairly large amunt f stress either at wrk r in their family life r persnal relatinships than male persnnel. - The White, nn-hispanic (51.5%) race/ethnicity categry had the highest percentage f persnnel wh reprted experiencing a great deal r a fairly large amunt f stress while the Black, nn-hispanic (40.9%) categry had the lwest percentage f persnnel reprting stress. This was true fr bth male and female persnnel. - Amng bth genders, a lwer percentage f persnnel with a cllege degree r higher reprted experiencing stress than persnnel in the ther educatin categries. - Amng bth genders, a lwer percentage f persnnel in the 35 r lder age categry reprted experiencing stress than persnnel in the ther age categries. Amng males, the categry with the highest percentage f persnnel reprting experiencing stress was the 21 t 25-year-ld age grup (54.1% cmpared with 38.3% t 51.7%) while amng females it was the 20 r yunger age grup (65.7% cmpared with 47.3% t 56.0%). - A higher percentage f single persnnel reprted experiencing stress than married persnnel. - The percentage f persnnel in the E1-E3 pay grade grup (55.3%) reprting experiencing stress was higher than the percentage reprting experiencing stress in any ther categry (35.5% t 46.8%). Fr males, the pay grade grups with the highest percentages f persnnel reprting stress were E4-E6 (64.4%), fllwed by E1-E3 (54.7%), while fr females it was E1-E3 (65.3%), fllwed by (60.1%). - Duty statin (CONUS vs. OCONUS) did nt appear t be assciated with the percentage f persnnel reprting experiencing stress. 60

62 Table 6.2 High Perceived Stress at Wrk r in Family Dife, by Selected Scidem6' raphic Characteristics \_ GenderjJ' ' ^x - " 1^1 : Characteristic Men ^Vnien' TMl :, Race/Ethnicity White, nn-hispanic 50.9 (1.4) 63.7 (3.5) 51.5(1.3) Black, nn-hispanic ) 46.8 (6.2) 40.9 (2.8) Hispanic 44.5(1.8) 48.5 (6.1) 44.8 (1.7) Other 47.8 (3.5) 50.7 (7.6) 48.0 (3.3) >- f ' Educatin High schl r less 48.6(1.1) 56.0 (4.4) 49.0 (0.9) Sme cllege 48.9(1.8) 58.1 (3.1) 49.6(1.7) Cllege graduate r higher 44.0(1.6) 51.1 (4.8) 44.4(1.5) Age (years) 20 r yunger 51.7(1.9) 65.7 (7.4) 52.6(1.8) (1.4) 56.0 (3.8) 54.2 (1.4) (2.4) 52.5 (4.7) 42.6 (2.3) 35 r lder 38.3 (2.0) 47.3 (5.0) 38.7 (2.0) Marital status Nt married 51.4(1.2) 61.7 (3.5) 52.1(1.1) Married 45.0(1.9) 48.4(3.8) 45.1(1.8) Pay grade E1-E (1.3) 65.3 (5.8) 55.3 (1.2) E4-E6 64.4(1.7) 53.4 (3.9) 46.8(1.5) E7-E (2.5) 44.5 (6.5) 37.7 (2.5) W1-W (6.6) 50.5(14.6) 35.5 (6.5) (2.5) 39.0(13.6) 44.5(2.3) (3.2) 60.1 (11.0) 44.5 (3.0) Regin CONUS 48.3(1.3) 56.7 (2.4) 48.8(1.1) OCONUS 47.6(1.1) 53.6(1.6) 47.8 (0.6) Ttal 48.1(1.1) 56.3 (2.8) 48.6(0.9) Nte: Entries are expressed as percentages f persnnel wh reprted "a great deal" r a "fairly large amunt" f stress at wrk r in the family in the past 12 mnths. (Standard errrs are in parentheses.) Surce: DD Survey f Health-related Behavirs Amng Military Persnnel,

63 6.3 Occupatinal Crrelates f Stress Infrmatin n the levels f perceived stress experienced at wrk by Marine Crps persnnel is presented in Table 6.3 by self-reprted military ccupatin. Highlights f Table 6.3 include the fllwing: - Overall, the percentages f persnnel reprting experiencing a great deal r a fairly large amunt f stress at wrk were similar between enlisted persnnel (lw f 27.7% in craftsman, high f 46.9% in technical nn-health care, median 39.2%) and fficers (lw f 24.4% in intelligence, high f 46.9% in general/executive, and median 32.8%). - The percentages f persnnel reprting experiencing sme/a little stress at wrk were als similar between enlisted persnnel (46.3% t 63.3%) and fficers (41.9% t 68.2%). Table 6.3 Levels f Perceived Stress at Wrk in the Past 12 Mnths, by Occupatin Stress Level Great Deal/ Grup/Occupatin Fairly Large Amunt Sme/A Little Nne Enlisted Direct cmbat Electrnic equipment repair Cmmunicatins/intelligence Technical/nn-health care Functinal supprt Electrical/mechanical repair Craftsman Service and supply Nn-ccupatinal Ttal enlisted 40.6 (1.7) 43.4(5.1) 33.5 (3.6) 46.9(3.1) 37.6 (1.9) 39.4 (2.9) 27.7 (3.4) 37.7 (3.6) 39.6 (4.2) 39.0 (1.1) 48.3 (0.9) ) 56.6 (3.1) 43.0 (3.3) 49.6 (2.7) 46.3 (3.3) 63.3 (4.5) 50.3 (3.3) 50.5 (4.3) 49.6 (1.0) 10.2(1.4) 7.2 (1.9) 8.9(1.5) 9.5(2.1) 12.3 (1.6) 13.3(1.3) 9.0 (4.3) 11.3(1.0) 9.0 (3.2) 10.6 (0.7) Officer General/executive 46.9 (9.3) 41.9(10.9) 11.1(4.5) Tactical peratins 41.4(3.6) 52.3 (3.0) 6.3 (1.4) Intelligence 24.4 (9.3) 72.0 (7.8) 3.6 (3.3) Engineering/maintenance 38.3 (4.9) 52.6 (4.4) 9.1 (3.2) Scientist/nn-health care 30.9 (7.8) 55.5(11.5) 13.6 (7.0) Administratin 30.6 (5.0) 59.4 (5.4) 10.0 (3.6) Supply/prcurement 32.8 (4.4) 55.3 (7.2) 11.7(4.9) Nn-ccupatinal 28.4 (4.9) 68.2 (6.3) 3.5 (2.0) Ttal fficer 36.8(1.8) 55.0 (1.5) 8.1 ri.5) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavir Amng Military Persnnel, Table 6.3 demnstrates that perceptins f stress at wrk are similar amng enlisted persnnel and fficers. Overall, apprximately 25% t 50%) f all Marine Crps persnnel reprted experiencing a great deal/fairly large amunt f stress at wrk in the past 12 mnths. 62

64 6.4 Surces f Stress Infrmatin n the specific surces f stress experienced by male and female Marine Crps persnnel is presented in Table 6.4. Highlights f Table 6.4 include the fllwing: - The specific surces f stress that the highest percentage f Marine Crps persnnel reprted experiencing were being away frm family (19.2%), financial prblems (15.3%), and increases in wrk lad (15.2%). - The specific surce f stress that the highest percentage f male Marine Crps persnnel reprted experiencing was being away frm family (19.3%). - The specific surce f stress that the highest percentage f female Marine Crps persnnel reprted experiencing was changes in the family (23.8%). - While the percentages f male and female persnnel wh reprted experiencing different surces f stress were cmparable verall, there were sme exceptins. A higher percentage f male persnnel (12.8%) reprted deplyment as a specific surce f stress cmpared with female persnnel (4.1%). A higher percentage f female persnnel cmpared with male persnnel reprted wrk relatinships (17.4% cmpared with 11.8%), changes in family (23.8% cmpared with 13.5%), and persnal health prblems (12.7% cmpared with 3.9%) as specific surces f stress. Table 6.4 Specific Surces f Stress, Past 12 Mnths, by Gender Gender Stressr Men Wmen Ttal Deplyment 12.8(1.9) 4.1 (0.8) 12.3 (1.9) Having a PCS" 8.1 (0.3) 9.6(1.3) 8.2 (0.3) Wrk relatinships 11.8(1.0) 17.4 (2.4) 12.1 (0.9) Prblems with supervisr 12.0 (0.9) 13.0(2.1) 12.0 (0.9) Cncern abut perfrmance 8.8 (0.7) 8.6(1.5) 8.8 (0.6) rating Increases in wrk lad 15.2 (0.7) 16.7 (1.9) 15.2 (0.6) Being away frm family 19.3(1.1) 18.0(2.1) 19.2(1.0) Changes in family 13.5 (0.6) 23.8(1.7) 14.1 (0.6) Cnflicts between military 12.6 (0.7) 16.7(1.6) 12.9 (0.7) and family respnsibilities Financial prblems 15.3 (0.9) 16.4 (2.2) 15.3 (0.9) Husing prblems 6.3 (0.4) 8.5(1.2) 6.4 (0.4) Persnal health prblems 3.9(0.5) 12.7 (1.9) 4.4 (0.4) Family health prblems 8.1 (0.6) 10.5 (1.2) 8.3(0.5) Nte: Entries are expressed as percentages f persnnel wh reprted "a great deal" r a "fairly large amunt" f stress in the past 12 mnths. (Standard errrs are in parentheses.) Surce: DD Surveys f Health-related Behavir Amng Military Persnnel, " PCS = Permanent change f statin 63

65 6.5 Cping With Stress Infrmatin n the specific behavirs used by male and female Marine Crps persnnel fr cping with stress is presented in Table 6.5. Highlights f Table 6.5 include the fllwing: - The specific cping behavirs that the highest percentage f Marine Crps persnnel reprted using t deal with stress were think f a plan t slve the prblem (83.9%), talk t a friend r family member (67.9%), and exercise r play sprts (65.5%). These were the mst cmmnly reprted fr bth male and female persnnel. - Abut 5% f bth male (4.8%) and female (5.7%) persnnel reprted cnsidering hurting r killing themselves as an ptin fr dealing with stress. - While the percentages f male and female persnnel reprting using the specific cping behavirs fr stress were cmparable verall, there were sme differences. A higher percentage f male persnnel cmpared with female persnnel reprted having a drink (28.0% cmpared with 16.7%) r smking marijuana r using illegal drugs (1.5% cmpared with 0.2%) as strategies fr cping with stress. A higher percentage f female persnnel cmpared with male persnnel reprted talking t a friend r family member (82.6% cmpared with 67.0%) r getting smething t eat (44.8% cmpared with 39.0%) as strategies fr cping with stress. Table 6.5 Behavirs fr Cping With Stress, by Gender Gender Cping Behavir Men Wmen Ttal Talk t friend/family 67.0 (0.7) 82.6(1.7) 67.9 (0.8) Light up a cigarette 27.7(1.7) 27.3 (2.9) 27.7 (1.7) Have a drink 28.0(1.7) 16.7 (1.4) 27.4(1.7) Exercise r play sprts 65.6(2.1) 62.4 (2.9) 65.5 (2.0) Get smething t eat 39.0(1.0) 44.8 (3.4) 39.3 (1.0) Smke marijuana/use illegal drugs 1.5(0.3) 0.2 (0.3) 1.4(0.3) Think f plan t slve prblem 83.8 (0.8) 86.1 (1.3) 83.9 (0.8) Cnsider hurting r killing yurself 4.8 (0.7) 5.7(1.5) 4.9 (0.6) Nte: Entries are expressed as percentages f persnnel wh "frequently" r "smetimes" engage in a behavir when they feel pressured, stressed, depressed, r anxius. (Standard errrs are in parentheses.) Surce: DD Surveys f Health-related Behavir Amng Military Persnnel,

66 6.6 Impact f Stress n Jb Perfrmance Stress may interfere with the ability f Marine Crps persnnel t perfrm their military jb. Infrmatin n the extent t which stress at wrk interfered with military jb perfrmance is presented in Table 6.6, by selected demgraphic variables. Infrmatin n the extent t which stress in the family r persnal life interfered with military jb perfrmance is presented in Table 6.7, by selected demgraphic variables. Highlights f Table 6.6 include the fllwing: - Overall, 44.1% f Marine Crps persnnel reprted that stress at wrk interfered with their ability t perfrm their military duties at least sme/a little. - Overall 6.0% f Marine Crps persnnel reprted that stress at wrk interfered with their ability t perfrm their military duties a lt. - A higher percentage f females cmpared with males reprted that stress at wrk interfered with their military jb perfrmance a lt (7.5% cmpared with 5.9%) r sme/a little (44.6% cmpared with 37.7%). - A higher percentage f Marine Crps persnnel wh reprted their race as Other cmpared with remaining racial categries reprted stress at wrk interfered with their military jb perfrmance a lt (7.1% cmpared with 5.9% t 6.1%), while a lwer percentage f persnnel wh reprted their race as Black, nn-hispanic reprted stress interfered sme/a little (35.2% cmpared with 38.3% t 39.9%). - A lwer percentage f persnnel with a cllege degree r higher cmpared with the ther educatin categries reprted stress at wrk interfered with their military jb perfrmance a lt (2.6% cmpared with 5.9% t 7.0%) r sme/a little (30.0% cmpared with 39.2% t 39.3%). - A lwer percentage f persnnel in the and 35 r lder age grups cmpared with the 21 t 25 and 20 r yunger age grups reprted stress at wrk interifered with their military jb perfrmance a lt (3.1% t 3.2% cmpared with 6.7% t 8.6%) r sme/a little (28.6% t 32.3% cmpared with 40.9% t 47.0%). - A lwer percentage f married persnnel cmpared with single persnnel reprted that stress at wrk interfered with their military jb perfrmance a lt (4.6% cmpared with 7.5%) r sme/a little (34.5% cmpared with 41.7%). - A higher percentage f enlisted persnnel cmpared with fficers reprted that stress at wrk interfered with their military jb perfrmance (3.9% t 9.7% cmpared with 1.3% t 1.4%), while a higher percentage f persnnel in the E4-E6 and E1-E3 pay grups cmpared with the ther pay grups reprted stress interfered sme/a little (37.1% t 45.2% cmpared with 26.4% t 29.5%). 65

67 Table 6.6 Interference With Military Jb Perfrmance Due t Stress at Wrk, by Selected Demgraphic Characteristics Interference with Jb Nt At All/ Characteristic A Lt Sme/A Little N Stress Gender Male 5.9(0.7) 37.7(1.0) 54.9(1.3) Female 7.5 (1.8) 44.6(1.8) 46.9 (2.3) Race/Ethnicity White, nn-hispanic 5.9 (0.7) 38.3(1.2) 54.5 (1.3) Black, nn-hispanic 6.0(1.2) 35.2 (2.3) 56.2(2.1) Hispanic 6.1 (1.5) 39.2 (2.5) 53.3 (2.8) Other 7.1(1.7) 39.9 (2.5) 52.0 (3.5) Educatin High schl r less 7.0(1.0) 39.3(1.4) 51.9(1.3) Sme cllege 5.9 (0.6) 39.2(1.4) 53.9(1.4) Cllege graduate r higher 2.6 (0.6) 30.0(1.8) 66.4(2.1) Age 20 r yunger 6.7(0.9) 47.0(1.9) 44.6(1.7) (1.1) 40.9(1.2) 49.0(1.2) (0.5) 32.3(1.8) 63.2(1.5) 35 r lder 3.2 (0.7) 28.6(1.7) 67.0(1.7) Family status Nt married' 7.5 (0.8) 41.7(1.5) 49.2(1.4) Married 4.6 (0.7) 34.5 (1.2) 59.7(1.4) Pay grade E1-E3 9.7 (0.9) 45.2(1.4) 43.2(1.3) E4-E6 4.8 (0.7) 37.1(1.3) 57.0(1.1) E7-E9 3.9 (0.9) 27.5 (2.3) 66.4 (2.7) W1-W5 1.4 (0.7) 28.5 (3.4) 70.1 (3.3) (0.3) 29.5 (2.6) 68.0 (2.6) (0.8) 26.4(2.1) 72.1(1.9) Regin CONUS 6.0 (0.7) 38.3 (0.9) 54.3(1.4) OCONUS 6.3 (1.4) 37.1 (2.9) 54.8(1.8) Ttal 6.0 (0.6) 38.1 (1.0) 54.4(1.2) Nte: Entries are expressed as percentages (with standard errrs are in parentheses). Surce: DD Survey f Health-related Behavirs Amng Military Persnnel, Overall, Table 6.6 shws that stress at wrk affected the military jb perfrmance f yung, single, junir grade persnnel with less educatin mre than ther Marine Crps persnnel. A higher percentage f female persnnel than male persnnel als reprted interference with military jb perfrmance due t stress at wrk. Highlights f Table 6.7 include the fllwing: - Overall, 30.9% f Marine Crps persnnel reprted that stress in family r persnal life interfered with their ability t perfrm their military duties at least sme/a little. - Only 3.1% f Marine Crps persnnel reprted that stress in family r persnal life interfered with their ability t perfrm their military duties a lt. 66

68 A lwer percentage f persnnel with a cllege degree r higher cmpared with the ther educatin categries reprted stress in family r persnal life interfered with their military jb perfrmance a lt (1.5% cmpared with 2.4% t 3.9%) r sme/a little (23.0% cmpared with 28.2% t 29.0%). A lwer percentage f persnnel in the 26 t 34 and 35 r lder age grups cmpared with the 21 t 25 and 20 r yunger age grups reprted stress in family r persnal life interfered with their military jb perfrmance a lt (2.2% cmpared with 2.9% t 4.1%) r sme/a little (21.9% t 24.4% cmpared with 29.9% t 31.1%). A higher percentage f persnnel in the E1-E3 and E4-E6 pay grades cmpared with the ther pay grade categries reprted stress in family r persnal life interfered with their military jb perfrmance a lt (3.0% t 4.2% cmpared with 1.0% t 1.7%) r sme/a little (27.5% t 31.6% cmpared with 20.4% t 23.1%). Table 6.7 Interference With Military Jb Perfrmance Due t Stress in the Family, by Selected Demgraphic Characteristics Interference With Jb Nt At All/ Characteristic A Lt Sme/A Little N Stress Gender Male 3.1(0.3) 27.6(0.6) 68.0 (0.6) Female 37(0.7) 30.8(1.7) 64.3 (1.6) Race/Ethnicity White, nn-hispanic 2.9 (0.3) 27.0 (0.8) 68.8 (0.8) Black, nn-hispanic 3.8 (0.7) 27.5 (2.6) 67.4 (2.4) Hispanic 3.0 (0.8 ) 31.5(1.6) 63.8 (2.0) Other 3.8 (1.4) 26.8 (3.2) 68.4 (3.7) Educatin High schl r less 3.9 (0.3) 28.2 (1.0) 66.1(1.1) Sme cllege 2.4 (0.4) 29.0(1.0) 67.5 (0.9) Cllege graduate r higher 1.5(0.6) 23.0(1.6) 75.3(1.4) Age 20 r yunger 2.9 (0.4) 29.9 (3.6) 65.3 (3.5) (0.6) 31.1(1.9) 63.3(1.5) (0.6) 24.4(1.7) 72.5 (1.8) 35 r lder 2.2 (0.7) 21.9(1.8) 74.9(1.8) Family status Nt married 3.4(0.4) 26.8 (1.5) 68.1(1.5) Married 2.8 (0.3) 28.8(1.4) 67.4(1.4) Pay Grade E1-E3 4.2 (0.5) 31.6(1.5) 62.0(1.5) E4-E6 3.0(0.3) 27.5 (0.8) 68.6 (0.7) E7-E9 1.7(0.5) 22.4 (2.3) 74.4(2.3) W1-W5 1.3 (0.9) 20.8 (3.3) 76.9 (3.2) (0.3) 20.4 (2.7) 78.5 (2.7) (0.6) 23.1 (1.7) 75.2(1.9) Regin CONUS 3.1(0.3) 27.8 (0.6) 67.8(0.7) OCONUS 3.2 (0.2) 27.9(1.4) 67.4(1.3) Ttal 3.1 (0.2) 27.8 (0.6) 67.8 (0.6) Nte: Entries are expressed as percentages (with standard errrs are in parentheses). Surce: DD Survey f Health-related Behavirs Amng Military Persnnel,

69 While Table 6.7 shwed fewer differences between demgraphic variable categries than Table 6.6, verall stress in family r persnal life affected the military jb perfrmance f yung, junir grade persnnel with less educatin mre than ther Marine Crps persnnel. A cmparisn f Table 6.6 with Table 6.7 indicates that stress at wrk has mre f a negative impact n military jb perfrmance than stress in family r persnal life fr Marine Crps persnnel Interference f Stress With Military Occupatin Infrmatin n the extent t which stress at wrk interfered with military jb perfrmance is presented in Table 6.8 by ccupatin. Infrmatin n the extent t which stress in the family r persnal life interfered with military jb perfrmance is presented in Table 6.9 by ccupatin. Highlights f Table 6.8 include the fllwing: - In General, a lwer percentage f enlisted persnnel (43.3% t 62.7%) reprted that stress at wrk des nt affect their ability t perfrm their military jb cmpared with fficers (excluding intelligence, 53.3% t 83.5%). - By far the highest percentage f Marine Crps persnnel reprting that stress at wrk interfered with their ability t perfrm their military jb were fficers with the selfreprted grup/ccupatin intelligence with 23.2% reprting a lt f interference and 72.7% reprting sme/a little interference. - Amng enlisted persnnel, 2.5% t 9.4% reprted that stress at wrk interfered a lt with their ability t perfrm their military jb, while 34.9% t 50.0% reprted that it interfered sme/a little. - After excluding the intelligence grup/ccupatin, 0.0% t 3.5% f fficers reprted that stress at wrk interfered a lt with their ability t perfrm their military jb, while 16.5% t 43.2% reprted that it interfered sme/a little. - The highest percentage f enlisted persnnel reprting at least sme/a little interference with their ability t perfrm their military jb frm stress at wrk was frm the electrnic equipment repair grup/ccupatin (56.7%), while the lwest percentage reprted was frm the craftsman grup/ccupatin (37.3%). - The highest percentage f fficers reprting at least sme/a little interference with their ability t perfrm their military jb frm stress at wrk was frm the intelligence grup/ccupatin (95.9%), while the lwest percentage reprted was frm the general/executive grup/ccupatin (16.5%). 68

70 Table 6.8 Inability t Perfrm Military Jb Due t Stress at Wrk, by Occupatin Interference With Jb Grup/Occupatin A Lt Sme/A Little Nt at All/N Stress Enlisted Direct cmbat 6.6 (0.7) 34.9 (2.9) 56.8(2.6) Electrnic equipment repair 6.6(1.7) 50.0 (3.8) 43.3 (4.6) Cmmunicatins/intelligence 5.7(1.5) 40.2(1.9) 52.8 (2.3) Technical/nn-health care 4.3 (1.0) 40.8 (3.1) 54.2(3.6) Functinal supprt 6.1 (1.2) 40.2(1.9) 52.6 (2.4) Electrical/mechanical repair 7.4(2.2) 38.2 (2.2) 52.4 (3.0) Craftsman 2.5 (2.8) 34.8 (6.3) 62.7 (6.8) Service and supply 9.4(3.1) 39.1 (2.7) 51.3(4.3) Nn-ccupatinal 6.0 (2.5) 43.2 (5.0) 48.6 (4.5) Ttal enlisted 6.5 (0.7) 39.2 (1.2) 53.1(1.3) Officer General/executive 0.0 (0.0) 16.5 (6.7) 83.5 (6.7) Tactical peratins 3.0(1.6) 30.1 (3.3) 66.9 (3.6) Intelligence 23.2(7.0) 72.7 (8.0) 4.1(4.1) Engineering/maintenance 0.0 (0.0) 23.4(2.7) 76.6(2.7) Scientist/nn-health care 0.0 (0.0) 38.6 (7.9) 61.4 (7.9) Administratin 0.4 (0.4) 26.1 (4.0) 72.4 (3.9) Supply/prcurement 0.0(0.0) ) 70.2(4.7) Nn-ccupatinal 3.5 (2.0) 43.2 (8.4) 53.3 (7.3) Ttal fficer 1.5(0.6) 28.2(1.8) 69.6 (1.9) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavir Amng Military Persnnel, Table 6.8 indicates that stress at wrk interferes with enlisted persnnel's ability t perfrm their military jb mre ften than with fficers' ability t perfrm their military jb. Highlights f Table 6.9 include the fllwing: - In general, a lwer percentage f enlisted persnnel (63.9% t 71.1 %) reprted that stress in family r persnal life des nt affect their ability t perfrm their military jb cmpared with fficers (70.2% t 82.1%). - Amng enlisted persnnel, 1.1% t 4.3% reprted that stress in family r persnal life interfered a lt with their ability t perfrm their military jb, while 25.5% t 31.6% reprted that it interfered sme/a little. - Amng fficers, 0.0% t 1.9% reprted that stress in family r persnal life interfered a lt with their ability t perfrm their military jb, while 17.7% t 28.7% reprted that it interfered sme/a little. 69

71 - The highest percentage f enlisted persnnel reprting at least sme/a little interference with their ability t perfrm their military jb frm stress at wrk was frm the technical/nn-health care grup/ccupatin (36.1%), while the lwest percentage reprted was frm the direct cmbat grup/ccupatin (28.9%). - The highest percentage f fficers reprting at least sme/a little interference with their ability t perfrm their military jb frm stress at wrk was frm the administratin grup/ccupatin (29.8%), while the lwest percentage reprted was frm the supply/prcurement grup/ccupatin (17.9%). Table 6.9 Inability t Perfrm Military Jb Due t Stress in Family, by Occupatin Interference With Jb GruD/Occupatin A Lt Sme/A Little Nt at All/N Stress Enlisted Direct cmbat 2.7 (0.7) 25.5(2.1) 71.1 (2.0) Electrnic equipment repair 1.1 (0.8) 31.3(3.1) 66.9 (2.8) Cmmunicatins/intelligence 3.0 (0.9) 27.7 (2.9) 67.8 (3.3) Technical/nn-health care 3.6(1.0) 30.5 (2.8) 63.9 (3.2) Functinal supprt 4.2 (1.0) 28.6( ) Electrical/mechanical repair 3.8 (1.3) 28.7 (2.9) 64.7 (2.7) Craftsman 2.4(1.8) 31.6(5.8) 66.1 (4.8) Service and supply 4.3 (1.8) 29.5(3.7) 66.0 (3.0) Nn-ccupatinal 2.8 (1.7) 30.2 (5.8) 67.0(6.1) Ttal enlisted 3.3 (0.2) 28.2 (0.7) 67.5 (0.7) Officer General/executive 0.9 (0.9) 27.1 (8.5) 72.0 (8.0) Tactical peratins 1.2 (0.4) 23.6 (3.2) 74.6 (2.9) Intelligence 0.0 (0.0) 26.8 (7.0) 73.2(7.0) Engineering/maintenance 1.9(1.0) 19.3 (3.9) 78.1 (4.1) Scientist/nn-health care 0.0 (0.0) 20.0 (6.9) 79.8(6.9) Administratin 1.1 (1.2) 28.7 (5.5) 70.2(5.1) Supply/prcurement 0.0 (0.0) 17.7 (3.9) 82.1 (3.8) Nn-ccupatinal 0.0 (0.0) 23.0 (7.8) 77.0 (7.8) Ttal fficer 0.9 (0.3) 23.0(1.1) 75.7(1.1) Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavir Amng Military Persnnel, Table 6.9 indicates that stress in family r persnal life interferes with enlisted persnnel's ability t perfrm their military jb mre ften than with fficers' ability t perfrm their military jb. A cmparisn f Table 6.8 with Table 6.9 indicates that in general stress at wrk has mre f a negative impact n military jb perfrmance than stress in family r persnal life acrss Marine Crps persnnel military ccupatins. 70

72 6.6.2 Perceived Stress and Prductivity Lss Infrmatin n the relatinship between stress at wrk and/r in the family and specific prductivity lss prblems is presented in Table Highlights f Table 6.10 include the fllwing: - Apprximately 25% f all Marine Crps persnnel reprted experiencing several f the specific prductivity lss prblems. 24.2% reprted being late fr wrk by 30 minutes r mre at least nce in the past 12 mnths. 34.3% reprted they left wrk early at least nce in the past 12 mnths. 32.6% reprted they wrked belw nrmal perfrmance level at least nce in the past 12 mnths. - A higher percentage f persnnel wh reprted experiencing a high level f stress in the past 12 mnths reprted each f the prductivity lss prblems than thse persnnel wh reprted mderate r lw level stress in the past 12 mnths. The mst striking difference was between the percentage f persnnel with high-level stress (41.3%) and the percentage f thse with mderate r lw-level stress (24.7%) reprting wrking belw'nrmal perfrmance level at least nce in the past 12 mnths. - While the percentage f Marine Crps persnnel reprting 1 ccurrence versus 2 r 3 ccurrences versus 4 r mre ccurrences f being late fr wrk by 30 minutes r mre, being hurt in an n-the-jb accident, r failing t cme int wrk because f an illness r injury decreased, the percentage increased fr thse reprting leaving wrk early r wrking belw nrmal perfrmance levels. - The percentage f persnnel reprting high stress, leaving wrk early (7.6% 1 time, 10.2% 2 r 3 times, and 18.2% 4 r mre times in the past 12 mnths), and wrking belw nrmal perfrmance level (7.4% 1 time, 11.9% 2 r 3 times, and 22.0% 4 r mre times in the past 12 mnths) increased as the number f ccurrences increased. 6.7 Summary The data indicated that Marine Crps persnnel experience stress that is assciated with family life and wrk in the military. Stress had its greatest effect n yung (21 t 25-year-ld age grup), single, junir grade (E1-E3 pay grade grup) Marine Crps persnnel with less than a cllege educatin. White, nn-hispanic persnnel reprted the highest percentage f stress; while Black, nn-hispanic persnnel reprted the lwest percentages f stress. A higher percentage f female (43.8%) than male (38.9%) reprted experiencing a great deal r a fairly large amunt f stress verall as well as stress in family life and persnnel relatinships. The leading surce f stress fr wmen was changes in the family, while deplyment was the leading surce f stress fr men. The majrity f respndents endrsed prductive cping strategies, such as thinking f a plan t slve the prblem, talking t a friend r family member, and exercising t cpe with stress. Results als indicated that mre males reprted having a drink in respnse t stress. In cntrast, mre females reprted talking t friends r family members in respnse t stress. 71

73 Table 6.10 Perceived Stress and Prductivity Lss, Past 12 Mnths Number f Occurrences, Past 12 Mnths 2r3 4 r Mre Grup/Prblem Any ITime Times Times All Marines Late fr wrk by 30 minutes 24.2 (LO) 10.3 (0.5) 9.0 (0.7) 4.9 (0.3) r mre Left wrk early 34.3 (L2) 7.4 (0.7) 11.6(0.6) 15.3 (0.9) Hurt in an n-the-jb accident 11.9 a 0) 6.2 (0.5) 3.8 (0.4) 2.0 (0.3) Wrked belw nrmal 32.6(1.1) 6.1 (0.5) 10.1 (0.6) 16.4 (0.8) perfrmance level Did nt cme int wrk 18.0(1.1) 7.2(0.5) 5.9 (0.6) 4.9 (0.4) because f illness r injury High level f stress/past 12 mnths^ Late fr wrk by 30 minutes 27.8(1.1) 11.6(0.8) 9.8(0.8) 6.3(0.5) r mre Left wrk early 36.1 (1.6) 7.6 (0.8) 10.2 (0.9) 18.2(1.3) Hurt in an n-the-jb accident 14.9(1.3) 7.0 (0.6) 5.1 (0.7) 2.8 (0.5) Wrked belw nrmal 41.3 (1.4) 7.4 (0.6) 11.9(0.7) 22.0 (1.2) perfrmance level Did nt cme int wrk 20.4(1.5) 7.7(0.8) 6.5(0.8) 6.2(0.7) because f illness r injury Mderate r lw level f stress past 12 mnths*' Late fr wrk by 30 minutes 21.1(1.2) 9.0(0.8) 8.5(0.9) 3.5(0.6) r mre Left wrk early Hurt in an n-the-jb accident Wrked belw nrmal perfrmance level 32.9(1.1) 9.2 (0.9) 24.7(1.3) 7.4 (0.7) 5.5 (0.7) 4.9 (0.6) 13.0 (0.8) 2.5 (0.4) 8.6 (0.9) 12.5 (0.7) 1.2 (0.3) 11.3(0.7) Did nt cme int wrk 15.9 (1.2) 6.8 (0.4) 5.4 (0.6) 3.7 (0.5) because f illness r injury Nte: Entries are expressed as percentages (with standard errrs in parentheses). Surce: DD Surveys f Health-related Behavir Amng Military Persnnel, ^ Defined as a "great deal" r a "fairly large amunt" f stress either at wrk r in the family in the past 12 mnths. Defined as "sme," "a little," r n stress bth at wrk and in the family in the past 12 mnths. 72

74 Table 6.10 indicates that there is a relatinship between high levels f stress and prductivity lss prblems in Marine Crps persnnel. Excessive stress can diminish the health and quality f life fr persnnel. Furthermre, lack f apprpriate cping strategies can exacerbate the effects f stress. The data suggest that a substantial number f Marine Crps persnnel reprted experiencing stress in the wrk setting and in their persnal lives. Attentin shuld be given t the specific surces f stress and ways t alleviate it. Further, different stress management strategies may need t be investigated fr males and females. 73

75 REFERENCES An, A. & Watts, D. (1998). New SAS Prcedures fr Analysis f Sample Survey Data. Prceedings f the Twenty-third Annual SAS Users Grup Cnference. SAS Institute Inc., Gary NC. Bennett, M., McGrady, B., Jhnsn, V., & Pandina, R. (1999). Prblem Drinking frm Yung Adulthd t Adulthd: Patterns, Predictrs and Outcmes. J Stud Alchl, 60(5), Bennett, M. E., McGrady, B. S., McGrady, & Jhnsn, V. (1998). Prblem Drinking frm Yung Adulthd t Adulthd: Patterns, Predictrs and Outcmes. Jurnal f Studies n Alchl, 60, Bradizza, G. M., Reifman, A., & Barnes, G. M. (1999). Scial and Gping Reasns fr Drinking: Predicting Alchl Misuse in Adlescents. Research Institute n Addictin, 60, Bray, R. M., Fairbank, J. A., & Marsden, M. E. (1999). Stress and Substance Use Amng Military Wmen and Men. A.M. J. Drug Alchl Abuse, 25(2), Bray, R.M., Krutil, L.A., & Marsden, M.E. (1995). Trends in Alchl, Illicit Drug, and Gigarette use Amng U.S. Military Persnnel: Armed Frces & Sciety, 21, Bray, R.M., Krutil, L.A., Runds-Bryant, J.R., & Walker, J.A. (1997). Alchl Use, Alchl-Related Prblems, and Perceived Stress and Cping Amng U.S. Marine Crps Persnnel. Research Triangle Park, NG: Research Triangle Institute. Bray, R.M., Sanchez, R.P., Omstein, M.L., Lentine, D., Vincus, A.A., Baird, T.U., Walker, J.A., Wheeless, S.G., Guess, L.L., Krutil, L.A.,&Iannacchine,V.G. (1999) Department f Defense Survey f Health-related Behavirs Amng Military Persnnel (DD Cntract DAMD ). Research Triangle Park, NG: Research Triangle Institute. Gatanzar, S. J., & Greenwd, G. (1994). Expectancies fr Negative Md Regulatin, Gping, and Dysphria Amng Cllege Students. Cunseling Psychlgy, 41(1), Clements, R. (1999). Prevalence f Alchl-Use Disrders and Alchl-Related Prblems in a Cllege Student Sample. Jurnal American Cllege Health, 48(3), Curry, S., Suthwick, L., & Steele, G. (1987). Restrained Drinking: Risk Factr fr Prblems with Alchl? Addict Behav, 12(1), 13-n. Dawsn, D., & Archer, L. (1993). Relative Frequency f Heavy Drinking and the Risk f Alchl Dependence. Addictin, 88(11), S. De Wit, D., Adlaf, E., Offrd, D., & Ogbme, A. (2000). Age at First Alchl Use: a Risk Factr fr the Develpment f Alchl Disrders. Am J Psych, 157(5), Epstein, J., Btvin, G., Diaz, T., & Schinke, S. (1995). The Rle f Scial Factrs and Individual Characteristics in Prmting Alchl Use Amng Inner-City Minrity Yuths. J study Alchl, 56(1), Fillmre, K., Glding, J., Lein, E., Mtyshi, M., Ager, C, & Ferrer, H. (1994). Relatinships f Measures f Alchl Cnsumptin with Alchl-Related Prblems in Multiple Studies: a Research 74

76 Synthesis frm the Cllabrative Alchl-Related Lngitudinal Prject. Addictin, 89(9), Fisher, C, Hffman, K., Austin-Lane, J., & Ka, T. (2000). The Relatinship Between Heavy Alchl Use and Wrk Prductivity Lss in Active-duty Military Persnnel: a Secndary Analysis f the 1995 Department f Defense Wrlwide Survey. MJZ Me<i, 765(5), Greenfield, T., & Rgers, J. (1999). Wh Drinks Mst f the Alchl in the US? The Plicy Implicatins. J Study Alchl, 60(1), 1S-S9. Hawkins, J., Graham, J., Maguin, E., Abtt, R., Hill, K., & Catalan, R. (1997). Explring the Effects f Age f Alchl Use Initiatin and PsychScisl Risk Factrs n Subsequent Alchl Misuse. J Stud Alchl, 58(3), 2S Jhnsn, P., & Glassman, M. (1999). The Mderating Effects f Gender and Ethinicity n the Relatinship Between Effect Expectancies and Alchl Prblems. J stud Alchl, 60(1), Jhnsn, V., & Pandina, R. J. (2000). Alchl Prblems amng a Cmmunity Sample: Lngitudinal Influences f Stress, Cping, and Gender. Substance Use & Misuse, 35(5), Kaltn, G. (1968). Standardizatin: A Technique t Cntrl fr Extraneus Variables. Applied Statistics, 23, King, M., & Tucker, J. (2000). Behavir Change Patterns and Strategies Distinguishing Mderatin Drinking and Abstinence During the Natural Reslutin f Alchl Prblems Withut Treatment. Psychl Addict Behav, 14(1), 4S-55. Knijn, H.S. (1973). Statistical Thery f Sample Survey Design and Analysis. Lndn: Nrth-Hlland. Kunz, J. L., & Graham, K. (1998). Drinking Patterns, Psychscial Characteristics and Alchl Cnsequences. Addictin, 93(1), Lennx, R., Steele, P., Zarkin, G., & Bray, J. (1998). The Differential Effects f Alchl Cnsumtin and Dependence n Adverse Alchl-Related Cnsequences: Implicatins fr the Wrkfrce. Drug and Alchl Depend, 50(?>), Little, R.J.A. (1982). Direct Standardizatin as a Tl fr Teaching Linear Mdels fr Unbalanced Data. American statistician, 56(1), Madians, M., Gefu-Madianu, D., & Stefanis, C. (1995). Patterns f Alchl Cnsumptin and Related Prblems in the General Ppulatin f Greece. Addictn, 90(1), Fisher, C.A. (2000). The Relatinship Between Heavy Alchl Use and Wrk Prductivity Lss in Activeduty Military Persnnel; A Secndary Analysis f the 1995 Department f Defense Wrldwide Survey. Military Medicine, 165, Marczynski,-K., Welte, J., Marshall, J., & Ferby, E. (1999). Prevalence and Determinants f Alchl-Related Prblems. Am J Drug Alchl-related prblems, 25(4), McCreary, D., & Sadava, S. (2000). Stress, Alchl Use and Alchl-Related Prblems: the Influence f Negative and Psitive Affect in Tw Chrts f Yung Adults. J Stud Alchl, 61(3),

77 Mulfrd, H.A. & Miller, D.A. (1960). Drinking in Iwa: 2. THe extent f drinking and selected scicultural categries. Quarterly Jurnal f Studies n Alchl, 21, Muthen, B. O., & Muthen, L. K. (2000). The Develpment f Heavy Drinking and Alchl-Related Prblems frm Ages 18 t 37 in a U.S. Natinal Sample. J. Stud Alchl, 61, Piklainen, K. (2000). Risk Factrs fr Alchl Dependence: A Case-Cntrl Study. Alchl and alchlism, 55(2), Pwer, C, Rdgers, B., & Hpe, S. (1999). Heavy Alchl Cnsumptin and Marital Status: Disentangling the Relatinship in a Natinal Study f Yung Adults. Addictin, 94{\Q)), Pritchard, M., & Martin, M. (1996). Factrs Assciated with Alchl Use in Yung Adulthd. Subst Use and Misuses, 31(6), Pulkkinen. (1994). A Prspective Study f the Precursrs t Prblem Drinking in Yung Adulthd. J Stud Alchl, 55(5), Rachal, J.V., Guess, L.L., Hubbard, R.L., Maist, S.A., Cavanaugh, E.R., Waddell, R., & Benrud, C.H. (1980). Adlescent drinking behavir: Vl. 1.The extent and nature f adlescent alchl and drug use: The 1974 and 1978 Natinal Sample Studies (NTIS N. PB ). Research Triangle Park, NC: Research Triangle Institute. Rachal, J.V., Hubbard, R.L., Willims, J.R. & Tuchfeld, B. (1976). Drinking levels and prblem drinking amngjunir and senir high students. Jurnal f Studies n Alchl, 37, Rehm, J., & Gmel, G. (1999). Patterns f Alchl Cnsumptin and Scial Cnsequences. Results frm an 8-Year-Fllw-Up Study in Switzerland. Addictin, 94(6), Schuckit, M. A., Daeppen, J. B., Tipp, J. E., Hesselbrck, M., & Buchlz, K. K. (1998). The Clinical Curse f Alchl-Related Prblems in Alchl Dependent and Nnalchl Dependent Drinking Wmen and Men. J stud Alchl, 59(5), Shah, B.V., Bamwell, B.G., & Bieler, G.S. (1996). SUDAAN User's Manual: Release 7.0. Research Triangle Park, NC: Research Triangle Institute. Van Oers, J. A., Bngers, I. M., van de Gr, L. A., & Garretsen, H. F. (1999). Alchl Cnsumptin, Alchl-Related Prblems, Prblem Drinking, and Sciecnmic Status. Alchl and Alchlism, 34{l), Werch, C. E., Grman, D. R., & Marty, P. J. (1987c). Relatinship Between Alchl Cnsumptin and Alchl Prblems in Yung Adults. J. Drug Educatin, 17(3),

78 APPENDIX A CALCULATION OF ALCOHOL MEASURES This reprt fllwed the precedent f previus reprts frm the Department f Defense Surveys f Health-Related Behavirs Amng Military Persnnel in using the cnstructin f measures f alchl use that were created by the Research Triangle Institute (RTI). This appendix describes the RTFs calculatin f the drinking level classificatin measure, the average daily unces f ethanl index, and the unattributed prblem measures. A.l Drinking Level Classiflcatin Measure The drinking level classificatin scheme was adapted by RTI frm Mulfrd and Miller (1960; see als Rachal et al., 1980; Rachal, Hubbard, Williams, & Tuchfeld, 1976) and used previusly in the 1982,1985,1988,1992, and 1995 DD surveys (Bray et al, 1983,1986,1988, 1992,1995). The classificatin scheme used (a) the "quantity per typical drinking ccasin," and (b) the "frequency f drinking" fr the type f beverage (beer, wine, r liqur), with the largest amunt f abslute alchl cnsumed per day t fit individuals int 1 f the 10 categries resulting frm all cmbinatins f quantity and frequency f cnsumptin. (Althugh infrmatin n the cnsumptin f beer in 40-unce cntainers was available in the 1998 survey, fr cnsistency with previus Marine Crps specific reprts the calculatins t identify the beverage with the largest amunt f abslute alchl cnsumed per day in the past 30 days in this reprt were based n reprted cnsumptin f beer nly in 8-, 12-, 16-, and 32-unce cntainers. This cnsistency in the algrithm fr calculating the drinking level index allws cmparisn f data acrss the reprts.) The 10 categries describe whether individuals abstained, drank nce a mnth, 3 t 4 times a mnth, r at least nce a week and whether small, medium, r large amunts f alchl were drunk during a typical drinking ccasin. The secnd step in frming the classificatin scheme was t cmbine the 10 quantity/frequency categries int 5 drinking levels: abstainers, infrequent/light drinkers, mderate drinkers, mderate/heavy drinkers, and heavy drinkers. The resulting 5 drinking levels and their definitins are: Abstainer: Drinks nce a year r less. Infrequent/Light Drinker: Drinks 1-4 drinks per typical drinking ccasin 1-3 times per mnth. Mderate Drinker: Drinks 1 drink per typical drinking ccasin at least nce a week, r 2-4 drinks per typical drinking ccasin 2-3 times per mnth, r 5 r mre drinks per typical drinking ccasin nce a mnth r less. Mderate/Heavy Drinker: Drinks 2-4 drinks per typical drinking ccasin at least nce a week r 5 r mre drinks per typical drinking ccasin 2-3 times per mnth. Heavy Drinker: Drinks 5 r mre drinks per typical drinking ccasin at least nce a week. 78

79 A.2 Average Daily Ounces f Ethanl Index The average daily ethanl cnsumptin index used in this study was develped by RTI. This average daily ethanl cnsumptin index cmbines measures f bth the typical drinking pattern f an individual ver the past 30 days and any episdes f heavier cnsumptin during the past year. Fr all survey respndents, a daily Vlume was cmputed separately fr beer, wine, and hard liqur, using parallel prcedures. The first step in these calculatins was t determine the frequency with which respndents cnsumed each beverage during the past 30 days (Questins 15, 18, and 21). We cmputed each frequency in terms f the daily prbability f cnsuming the given beverage. The respnse alternatives and crrespnding frequency cdes are listed belw. Frequency Cdes fr Typical Drinking Days Respnse Alternative days (abut every day) days (5-6 days a week, average) days (3-4 days a week, average) 4-10 days (1-2 days a week, average) 2-3 days in the past 30 days Once in the past 30 days Frequencv Cde (F) Methd f Calculatin / / / / / /30 Didn't drink any beer/wine/liqur in the past 30 days /30 "Frequency f cnsumptin f given beverage during past 30 days. Surce: 1998 DD Survey f Health-related Behavirs Amng Military Persnnel (Q15,18, and 21). The secnd step in cmputing the daily vlume resulting frm typical drinking days was t determine the typical quantity (Qn) f each beverage that respndents cnsumed during the past 30 days, n days when they cnsumed the given beverage (Questins 17, 20, and 23). Fr quantities up thrugh 8 beers, glasses f wine, r drinks f liqur, the cde used was the exact number that the respndent indicated n Questins 17, 20, and 23. Fr larger quantities f each beverage fr which the answer was a range, the value used was the midpint f the'range (e.g., 9 t 11 beers were cded as 10). The cdes used fr the highest quantity were 22 beers, 15 glasses f wine, and 22 drinks f liqur. The size f a glass f wine (standard wine glass) was specified as 4 unces. Tw additinal questinnaire items were emplyed t accunt fr variatins in the size f beer cntainers (Questin 16) and strength f drinks cntaining liqur (Questin 22). Respndents indicated the size can r bttle f beer they usually drank (Questin 16), with alternatives f 8-, 12-, 16-, 32-, r 40-unce cntainers, and the number f unces f liqur in their average drink (Questin 22), with alternatives f 1,1.5, 2, 3,4, 79

80 and 5 r mre (cded as 5) unces. (Althugh infrmatin n the cnsumptin f beer in 40-unce cntainers was available in the 1998 survey, fr cnsistency with previus Marine Crps-specific reprts, the algrithm fr calculating the ethanl index in this reprt was based n teprted cnsumptin f beer nly in 8-, 12-, 16-, and 32-unce cntainers. This cnsistency in the algrithm fr calculating the drinking level index allws cmparisn f data acrss the reprts.) Using the measures described in the preceding paragraph, typical quantities fr beer and liqur were determined by multiplying (a) the number f cans r drinks typically cnsumed by (b) the number f unces f the given beverage they cntained. Because the standard 4-unce size was used fr wineglasses, the typical quantity fr wine was simply fur times the number f glasses cnsumed n a typical day when the respndent drank wine. Once the typical quantity fr each beverage had been determined, it was multiplied by the cde fr the frequency f drinking that beverage. The resulting prduct cnstituted a measure f the average number f unces f the given beverage cnsumed daily as a result f the individual's typical drinking behavir. The final step in measuring typical vlume was t transfrm the number f unces f beer, wine, and liqur cnsumed daily t unces f ethanl fr each beverage. The transfrmatins were made by weighting unces f beer by 0.04, wine by 0.12, and liqur by These weights were determined by using the standard alchl cntent (by vlume) f the three beverages. There was ne exceptin t this weighting prcedure. Because individuals cnsuming large quantities f wine n a regular basis may typically drink a "frtified" wine with a higher alchl cntent than regular "table" wine, a questin was included t measure the type f wine usually cnsumed by the respndent during the past 30 days (i.e., regular r frtified; see Questin 19). If the respndent indicated frtified wine, the weight used fr ethanl cntent was 0.18 (rather than 0.12). The prcedures described abve measure daily ethanl vlume resulting frm the individual's typical drinking days. Many peple wh drink als experience "atypical" days during which they cnsume larger quantities f alchl than what they usually cnsume. T the extent that the amunts cnsumed n thse days are clse t the individual's typical vlume, r that the number f atypical days is very small, the impact f such days n daily vlume indices is minimal. As the quantity f alchl cnsumed r the number f atypical days becmes larger, hwever, these episdes f heavier drinking can have a cnsiderable impact f the individual's mean daily vlume. Mrever, estimates f mean daily vlume in the ttal ppulatin will be incmplete if the episdic heavier cnsumptin f such individuals is ignred. In light f the imprtance f accunting fr the vlume f alchl cnsumed n atypical days, the frequency f cnsuming 8 r mre cans f beer, glasses f wine, r drinks f liqur in the past year was measured (Questins 28, 29, and 30). Because the intentin was t measure episdic behavir, the frequency questins pertained t the past year (rather than t the past 30 days, the time perid used t measure typical cnsumptin). The quantity f ethanl cnsumed n such atypical drinking days was cded as 5 unces (i.e., 10 cans, glasses, r drinks, each cntaining 0.5 unces f ethanl). The respnse alternatives and crrespnding frequency cdes fr these questins are listed belw. The sum f these three frequency cdes (beer, wine, and liqur) cnstitutes the measure f the "frequency f heavy drinking" (i.e., days f atypical high cnsumptin). 80

81 Frequency Cdes fr Atypical High-Cnsumptin Drinking Days Respnse Alternative^ Frequency Cde (D) Methd f Calculatin Abut every day 5-6 days a week 3-4 days a week 1-2 days a week 2-3 days a mnth Abut nce a mnth 7-11 days in the past 12 mnths 3-6 days in the past 12 mnths Once r twice in the past 12 mnths X x X x X Never in the past 12 mnths 0 0 * Frequency f atypical high cnsumptin fr given beverage during past year. Surce: 1998 DD Survey f Health-related Behavirs Amng Military Persnnel (Questins 28-30). The vlumes resulting frm typical and atypical cnsumptin days were cmbined in a straightfrward manner. Fr each beverage, the number f days during the past year n which the beverage was cnsumed was estimated by multiplying the likelihd f cnsuming it n a given day (F) by 365. This number was then partitined int the number f days n which atypical high cnsumptin ccurred, (D), accrding t the frequency cdes given abve and the number f typical days, 365 x F, minus the number f atypical days. If the respndent typically cnsumed 8 r mre drinks f the given beverage (i.e., had a Qn > 5), the number f atypical days fr that beverage was 0. If the number f atypical days was greater than r equal t the number f typical days, the term (365 X F - D) was set t 0. Each number f days was then multiplied by the unces f ethanl cnsumed n such days (i.e., 5 fr atypical days and the typical quantity Qn fr typical days). We summed these prducts and then divided by 365. The resulting cmpsite estimates refer t daily vlume fr the given beverage. The frmula may be written as AQnF = (5D + Qn (365xF-D))/365 Where AQnF = average daily vlume f ethanl cnsumed in the frm f the given beverage, D = number f atypical high cnsumptin days fr the given beverage (0 if Qn is >5 fr the given beverage), 81

82 Qn = vlume f ethanl cnsumed n typical drinking days fr the given beverage, and F = prbability f cnsuming the given beverage n a given day. The cmpsite vlume measures fr the three beverages were then summed t equal the ttal average daily vlume measure. In s ding, the fllwing cnstraints were applied: (a) the cmpsite and ttal vlume measures were nt cmputed fr individuals fr whm typical beverage-specific vlumes culd nt be calculated, and (b) the maximum value permitted fr the cmpsite and ttal vlume measures was 30 unces f ethanl per day. 82

83 APPENDIX B TECHNICAL DISCUSSION OF STANDARDIZATION APPROACH AND MULTIVARIATE ANALYSIS This appendix describes the apprach t standardizatin and multivariate lgistic regressin analysis used in this reprt. In general, the analyses used t prduce this reprt remain cnsistent with thse used by Research Triangle Institute in previus reprts f Department f Defense Surveys f Health-Related Behavirs Amng Military Persnnel. B.l Standardizatin Apprach Many analyses in this reprt assess the difference between tw r mre grups with respect t a ppulatin characteristic. This reprt cmpared alchl use between Marine Crps persnnel in 1998 and Marine Crps persnnel in prir survey years. When estimating such diflferences, hwever, it is ften necessary r infrmative t take int accunt ther cnfunding factrs that are nt f interest themselves but that culd clud the effect being studied. Fr example, heavy alchl use may vary by demgraphic characteristics, such as age, rape, gender, marital status, and educatin, and cnsequently wuld result in differences in the distributins acrss the survey years. Standardizatin is a technique cmmnly used t cntrl fr imprtant differences (such as demgraphic characteristics) between grups that are related t the utcme in questin (Kaltn, 1968; Knijn, 1973). The standardized estimate (r adjusted mean) can be interpreted as the estimate that wuld have been btained if the ppulatin had the distributin f the standardizing variables, all ther things being equal (Little, 1982). Direct standardizatin was the methd used fr the standardized cmparisns presented in this reprt (Kaltn, 1968). With direct standardizatin, cells defined by the cmplete crssclassificatin f the standardizing variables are frmed. Then the cell means are weighted by the prprtins in the standardizing ppulatin. Direct standardizatin requires separate cell estimates fr the cmplete crss-classificatin f all f the cnfunding and study variables. Althugh this requirement can limit the number f cnfunding variables that can be cntrlled (i.e., due t small sample sizes in each cell f the crss-classificatin), the relatively large sample sizes permitted use f this apprach. The SUDAAN (SUrvey DAta ANalysis) sftware develped at RTI was used t cmpute the direct standardizatins in this reprt (Shah, Bamwell, & Bieler, 1996). In particular, SUDAAN's Descript prcedure was used t prvide sample design-based estimates f the standard errrs f the standardized and unstandardized estimates. T tests were calculated t assess the statistical significance f the differences between cmparisn grups (e.g., 1980 vs estimates). The Marine Crps data frm the 1998 DD survey (and similarly frm the 1995,1992, 1988,1985, and 1982 surveys) were standardized t the 1980 Marine Crps ppulatin distributin f service, age, educatin, and marital status. In this case, the 1980 ppulatin was cnsidered the "cntrl" ppulatin r baseline fr adjusting the age, educatin, and marital status characteristics 83

84 f the ther ppulatins. Prir examinatin f demgraphic changes in the military indicated that age, educatin, and marital status were the characteristics that exhibited the greatest change since 1980 (Bray, et al., 1995). Fr each measure (prprtin f heavy drinkers and unces f ethanl), the estimate f use in 1998 was calculated fr each f the standardizing cells frmed by the crss-tabulatin f service, age, educatin, and marital status. These estimates were then weighted by the estimated prprtin f the 1980 Marine Crps ppulatin that fell int each cell. Hence, the 1998 data were standardized t the jint ppulatin distributin in 1980 f standardizing variables, and the standardized estimate was an estimate f what heavy alchl use and average unces f ethanl might be in 1998 if the 1998 Marine Crps ppulatin had the age, educatin, and marital status demgraphics f the 1980 Marine Crps ppulatin. B.2 Multivariate Lgistic Regressin Analysis Fr this reprt, multivariate lgistic regressin analyses were cnducted t examine the independent relatinships between demgraphic characteristics, ccupatin, drinking level, and negative effects. Lgistic regressin was used t mdel binary dependent measures (e.g., prductivity lss vs. n prductivity lss). Multiple lgistic regressin expresses the natural lgarithm f the individual's dds (i.e., ln[p/l-p]) f exhibiting the utcme behavir as a linear functin f the independent variables. There are several reasns fr using lgistic regressin instead f rdinary least squares regressin fr binary variables: - it assumes a mre reasnable nnlinear relatinship between the independent variables and the prbability f the utcme; - it des nt permit negative predicted prbabilities; and - it makes the prper assumptin that the errr has a binmial rather than a nrmal distributin (Nte, hwever, that the methds used by the SUDD AN linear regressin prcedure d nt depend n hmscedasticity.) In its natural frm, the parameters f a lgistic regressin mdel indicate the change in the lg dds due t a ne-unit change in the independent variable. When the independent variable is a 0,1 indicatr variable (e.g., nn-heavy drinker = 0, heavy drinker = 1), the regressin parameter indicates the difference in the lg dds between the categry cded 1 and the categry cded 0 fr that independent variable. An estimated parameter that is nt significantly different frm 0 indicates that the assciated independent variable is nt assciated with the prbability f the utcme ccurring; a significant negative estimated regressin parameter indicates a negative relatinship with the utcme prbability; and a significant psitive estimated regressin indicates a psitive relatinship with the utcme prbability. It is easier t interpret the parameters f a lgistic regressin mdel if the riginal parameters are expnentiated (i.e., exp(b)) because the expnentiated parameters indicate the relative change in the dds fr each unit increase in the assciated independent variable. Fr a 0,1 indicatr variable, the transfrmed parameter indicates the rati f the dds f the utcme ccurring fr the categry cded 1 t the dds f the utcme ccurring fr the categry cded 0. 84

85 As discussed abve, separate lgistic regressin mdels were fitted fr alchl-related prblems assciated with heavy alchl use in the past 30 days (i.e., bth attributed measures and unattributed measures), and heavy alchl use. Fr each f the mdels, the utcme variable was mdeled as a functin f the fllwing demgraphic variables: gender, race/ethnicity, educatin, age, family status (i.e., marital status and presence/absence f spuse if married), pay grade, and regin (i.e., statined within the cntinental United States [CONUS] r utside the cntinental United States [OCONUS]. Mdels in Chapter 4 that examined the dds f experiencing alchlrelated negative effects included ccupatin and drinking level as independent variables. Hwever, mdels fr prblems attributed t alchl use excluded abstainers frm the drinking level classificatin, whereas mdels that examined unattributed prblems included abstainers as part f the drinking levels variable. Mdels in Chapter 5 that examined the dds f heavy alchl use accrding t ther health-risk behavirs included demgraphic measures nted abve, alng with indicatrs f the use f seat belts, drinking and driving, and risky sexual behavir. The SUDAAN regressin prcedure LOGIST was used fr estimating the parameters, preparing the variance-cvariance matrix, and perfrming statistical tests abut the parameters. The results f the lgistic regressin analyses were expressed as dds ratis, with the dds rati f the cmparisn r reference grup expressed as Odds ratis greater than 1.00 indicate a greater likelihd f the cmparisn grup exhibiting the utcme f interest (e.g., alchl-related negative effects, heavy alchl use) relative t the reference grup. Odds ratis less than 1.00 indicate a lwer likelihd f the cmparisn grup exhibiting the utcme f interest. The 95% cnfidence intervals are als shwn fr the dds ratis based n these lgistic regressin analyses. If the dds f a persn being a heavy alchl user in a cmparisn grup (e.g., Marines statined in CONUS) were significantly different frm the dds f a persn in the reference grup having this utcme, then the dds rati f the cmparisn grup t the reference grup (e.g., CONUS vs. OCONUS) was significantly different frm An dds rati that is significantly different frm 1.00 is indicated by a 95% cnfidence interval that des nt include 1.00 in the interval. Cnfidence intervals fr all tables appear with the estimates in each table. 85

86 Appendix C 1998 DD Survey Questinnaire 86

87 j HEALTH AFFAIRS INTRODUCTION 1998 DEPARTMENT OF DEFENSE SURVEY OF HEALTH RELATED BEHAVIORS AMONG MILITARY PERSONNEL iasamas^h^si^ss!^ RCS # DD-HA(AR)1786 Wh are we? We are frm Research Triangle institute, a nt-fr-prfit researcii cmpany under cntract t the Assistant Secretary f Defense-Health Affairs. Hw were yu selected? Yu were randmly selected t participate in this imprtant research sun/ey. Must yu participate? Yur participatin in this survey is vluntary. We encurage yu t answer all f the questins hnestly, but yu are nt required t answer any questin t w^ich yu bject. What are the questins abut? Mainly abut alchl, tbacc, and.drug use. Additinal questins ask abut health attitudes and behavir, such as questins n stress, exercise, high bld pressure, and sexual behavir. We als.ask sme questins abut gambling. Wh will see yur answers? Only civilian researchers. N military persnnel will see yur answers. Yur answers will be cmbined with thse frm tiier military persnnel t prepare a statistical reprt. This questinnaire will be annymus if yu DO NOT WRITE YOUR NAME OR SOCIAL SECURITY NUMBER ANYWHERE ON THIS BOOKLET. INSTRUCTIONS FOR COMPLETING THE QUESTIONNAIRE '~~ Mst questins prvide a set f answers. Read ail the printed answers befre marlcing yur chice. If nne f the printed answers exactly applies t yu, maric the circle fr the ne answer that best fits yur situatin. Use nly the pencil yu were given. Malce heavy blacic marie that fill the circle fr yur answer. If yu are asked t give numbers fr yur answer, please cmplete the grid as shwn belw. FXAMPIF! During the p^sf 30 days, hw many full 24-hur days were yu deplyed at sea CORRECT MARK INCORRECT MARKS r in the field? # 4& Erase plean)y any answer yu wish t change. D nt make stray marks f any kind anywhere in this bklet. Fr many questins, yu shuld mark nly SQS circle First, write yur answer in the bxes. Use bth bxes. Write ONE number in fifir.h hnr... _ 1 Always write the last number in the riaht-hand bx. Fill in anv unused 1 OAYS 0 5 ^i-^ [-» - 0r4 fr yur answer in the clumn belw the questin, as bxes with zers. a shwn here: Fr example, an answer f "5 days' ' t EXAMPLE: Hw wuld yu describe yur health? wuld be written as "05.' HB»- 'i^ O Excellent Gd Then, darken the matching circle O Fair belw each bx. B OPr ' Smetimes yu will be asked t "Darlwn ne circle n each line." Fr these questins, recrd an answer fr each part f the questin, as shwn here: EXAMPLE: Hw ften d yu d each f the fllwing? (Daricen ne cirde n each line) Often Smetimes Never CDl Swim Bwl O Play tennis O O O O O NOW PLEASE TURN THE PAGE AND BEGIN WITH QUESTION 1. 1

88 1> What Service are yu in? O Army O Navy O Marine Ck)rps O Air Frce If yu are ynqified r living as married, the term i! a, spuse," as used In this questinnaire, refers t yur wife r husband r t the persn with whm yu live as married. 2. What Is yur pay grade? ENLISTED OE-1 OE-6 OE-2 OE-7 OE-3 OE-8 OE-4 OE-9 OE-5 OFFiCER O Trainee O W1-W5 O 0-1 r 0-1E 0 0-2rO-2E O0-3r0-3E 3. What is yur highest level f educatin nw? O0-4 I I O0-6 I O I O Did nt graduate frm high schl O GED r ABE certificate O High schl certificate O Trade r technical schl graduate O Sme cllege but nt a 4-year degree O 4-year cllege degree (BA, BS, r equivalent) O Graduate r prfessinal study but n graduate degree O Graduate r prfessinal degree 4. Hw ld were yu n yur last birthday? ^Q^ Is yur spuse nw living with yu at yur present duty lcatin? OYes ON O I have n spuse 8. D yu have any children living with yu at yur present duty lcatin? O Yes O N O I have n children 9. Are yu f SpanishAHispanic rigin r descent? O N (nt Spanish/Hispanic) O Yes, Mexican/Mexican-American/Chican O Yes, Cuban O Yes, Puert l^ican O Yes, Central r Suth American O Yes, ther Spanish/Hispanic First, enter yur age in the - bxes. Use bth bxes. Write \ ONE number in each bx /7, darken the matching circle belwssst bx. 0 c: I 10. Which f these categries ^ssf describes yu? O American Indian/Eskim/Aleut O Black/African-American O Asian/Chinese/Japanese/Krean/ Filipin/Pacific Islander O White/Caucasian O Other (Please specify belw) 5. Are yu male r female?, O Male O Female 6. What is yur marital status? O Married O Living as married O Separated and nt living as married O Divrced and nt living as married O Widwed and nt living as manied O Single, never married and nt living as married 11. Are yu currently serving n a ship that is deplyed? OYes ON 12. in what type f husing d yu currently live? (If yur dependents are with yu mark type f family husing.) O Husing that yu rent r lease frm a civilian r that yu persnally wn O On bard ship O Military barracks/drmitry r bachelr quarters O On-base military family husing O Off-base military family husing

89 13. Here are sme statements abut things that happen t peple. Hw many times in the past 12 mnths did each f the fllwing happen t yu? NUIVIBER OF TIMES IN PAST 12 MONTHS (Darken ne circle n each line) 3 '' Desn't Mre 2 1 Never Apply J had an iliness that kept me frm: duty fr a week r Jnger O... O... O O O 1 didn't get prmted when 1 thught I shuld have been O... O... O O O 1 gt a twer scre tfjan I expected n my fifficiency reprt r.. ^ perfrmance rating.,.>..., O... O... O.:... C G i received UCMJ punishment (Curt IWartial, Article 15, Captain's Mast, Office Hurs), O... O... O O O 1 was arrested fr a driving vilatin..,. J.;.-.. i..,..;...! G... O... O O O I was arrested fr an incident nt related t driving..., O... O -.. O O... O I sp^t time in jail, "Stckade, r brig,.,...;,..,,..:.:..,;\\,...>'... O...O..- O... O... O. I was hurt in an accident (any kind)? -. O Q.. O O... O l;caus!ed;anaccidentyhets ciarrfegeid.vv.:.'^v;;'i'i;;.:.';v:^^^^ O.., O'.:.','Q >;-e.-'gi:;'.-.r-.-'-0." I hit my spuse rthe persn I date O... O... 0 O... O!-brtmy-<^ild?ren)f<3iF'a. C O :.:.>..v!?%..;i..,;.::..:.: I gt int a fight where I hit smene ther than a member f my family... O... O... O... O...;. O Myvi«ferihusbaiSd*reatened*J'ieave^^,.;;.;::I:iCi';.:,i,...>..:,.'... O... O'-..;. D'...C-,..i-'.p\:.'v.;::;;:i.:0'''''- My wife rhusband left me O... O... O O O 14. The statements belw are abut sme ther things that happen t peple. Hw many times In the past 12 IQnths did each f the fllwing happen t yu? NUMBER OF TIMES IN PAST 12IVIONTHS (Darken ne circle n each line).^ '' ^ ^. Desn't Mre 2 1 Never Apply -'f hi^ ih8iat«l;argum6riteiwith.' i'had truble n the jb,...,,...,.,...,..,...:...- O,... Q ,.., 0...,-,:.Q '. laikklnyiityediin^ v;;\-:;:;.;;;;^-:;;;>:^>;;j-h.-^:-:-''':';u; ^jl^ibtbhks^df^wttui^wf^ I had health prblems...,...'...._..,...'v^,:..::,.^,..;^^,..-.;. ' Q...,,,^.^ ^,.,,.,.. Q...,,...O.,:,.,...,;,..:..P^.^,,^ I neglected my family respnsibilities.._.,;... O.._ ,..0..:-,;.. O..;l.^liad:isefipu^:m<^^ i}:j^;i^. ".^.'^ b;.'.i.i;x;:^;^iis^iiii:>'';;.; ;;.v'q^'''v'^i^ J^Q^I^-^-;;?'--^''^^ I had trubie vrtth the plice (civilian r miiitary)...,.., Q... O... Q... Q...,;,.;,..O j ;fiu»kl handefr?^ i had t have emergency medical help (fr any reasn).^,... O Q....^...C?...,-,.:.,;., Q,,. '. ^1gMilnt»;iai!ti3d i3iei«9ct;gks«p«^^ py rilqui^t we=i^^ 'Pl ase1ali»?yiur#s^ iareswer ch<^ctoi>e««iserj^uar^ fr the timeyii dranlt tte if^

90 15. During the past 30 days, n hw many days did yu drink beer? C days (abut every day) O days (5-6 days a week, average) O days (3-4 days a week, average) O 4-10 days {1-2 days a week, average). O 2-3 days in the past 30 days O Once in the past 30 days O Didn't drink any beer in the past 30 days 16. During the past 30 days, what size cans r bttles f beer did yu usuaiiy drinic? (Beer is mst cnnmnly sld and served in 12-unce cans, mugs, bttles, r glasses in the U.S.) O 8-unce can, bttle, r glass O Standard 12-unce can, bttle, r mug O 16-unce (lall by") can, bttle, r mug {Vz liter) O Liter r quart (32-z.) bttle r mug O 40-unce bttle (a lrty") O Sme ther size O Didn't drink any beer iri the past 30 days 17. Thinic abut the days when yu drank beer in Vie past 30 days. Hw much beer did yu Msually drink n a typical day when yu drank beer? O 18 r mre beers O beers O beers beers O 8 beers O 7 beers O 6 beers O 5 beers O 4 beers O 3 beers O 2 beers O 1 beer O Didn't drink any beer in the past 30 days 18. During the past 30 days, n hw many days did yu drink wine?. O days (alxsut every day) O days (5-6 days a week, average) C days (3-4 days a week,- average) O 4-10 days (1-2 days a week, average) O 2-3 days in tlie past 30 days O Once in tlie past 30 days. O Didnt drink any wine in the past 30 days 19. During the past 30 days, did yu usually driiik a regular wine r a frtified wine? O Regular wine (als called lable" r "dinner" wine) O Frtified wine {like Thunderiaird, Night Train, sherry, prt, vemnuth, brandy, Dutwnnet, champagne, etc.) O Wine cler (such as Bartles & Jaymes, etc.) O Didn't drink any wine in the past 30 days 20. Think abut the days when yu drank wine In the past 30 days. Hw much wine did yu usalty drink n a typical day when yu drank wine? (The standard wineglass hlds abyt 4 unces f wine. The standard wine bttle hlds 750 ml.) O 12 r mre wineglasses (2 bttles r mre) ^ O 9-11 wineglasses O 8 wineglasses O 7 wineglasses O 6 wineglasses (abut 1 bttle) O 5 wineglasses O 4 wineglasses. O 3 wineglasses (abut Vz bttle) O 2 wineglasses O 1 wineglass O Didn't drink any wine in the past 30 days 21. During the past 30 days, n hw many days did yu drink liqur? O days (abut every day) O days (5-6 days a week, average) O days (3-4 days a week, average) O 4-10 days (1-2 days a week, average) O 2-3 days in the past 30 days O Once in the past 30 dayg O Didn't drink any liqur in the past 30 days 22. During the past 30 days, abut hw many unces f liqur did yu usually have in yur average drink? (The average bar drink, mixed r straight, cntains a "jigger" r 1% unces f liqur.) O 5 r mre unces O 4 unces O 3 unces (a "duble") O 2 unces O 1>4 unces (a "jigger") O 1 unce (a "shf) O Didn't drink any liqur in the past 30 days 23. Think abut the days when yu drank liqur In the past 30 days. Hw much liqur did yu Msually drink n a typical day when yu drank iiaur? O 18 r mre drinks O drinks O drinks O 9-11 drinks O 8 drinks O 7 drinks O 6 drinks O 5 drinks O 4 drinks O 3 drinks O 2 drinks O 1 drink O Didn't drink any liqur in the past 30 days

91 24. During the past 3D davs. n hw many days did yu have 5 r mre drinks f beer, wine, r liqur n the same ccasin? (By "drink," we mean a bttle r can f beer, a wine cler r a glass f wine, a slit f liqur, r a mixed drink r ccktail. By "ccasin," we mean at Xhe same time r witiiin a cuple f hurs f each ther.) O days {abut every day) O days (5-6 days a week, average) O days (3-4 days a week, average) days (1-2 days a week, average) O 2-3 days in the past 30 days O Once in the past 30 days O I drank during the past 30 days, but I never had 5 r mre drinks n the same ccasin O I didn't drink in the past 30 days 25. Think abut the days yu wrked during the past 30 days. Hw ften did yu have a drink 2 hurs r less befre ging t wrk? O Every wrk day O IWsl wrk days O Wsut half f my wrk days O Several wrk days O One r tw wrk days O Never in the past 30 days O Dn't drink 26. On thse days when yu wrked during the past 30 Staiffi. hw ften did yu have a drink during yur lunch break? (Answer fr the main meal that ccurred during yur usual duty hurs.) O Every wrk day O Mst wrk days O Abut half f riiy wri< days O Several wrk days O One r tw wrk days O Never in the past 30 days O Dn't drink 27. During the past 30 days, hw ften did yu have a drink while yu were wrking (n-the-jfa) r during a wrk break? O Every wric day O Mst wrk days O Abut half f my wrk days O Several wri< days C One r tw wri< days O Never in the past 30 days O Dn't drink The next three questins ask abut yur use f beer, wine, and liqur during the past 12 mnths that is, since this time last year,, 28. During the past 12 mnths, hw ften did vu drink p r mre cans, bttles, r glasses f beer (3 quarts r mre) in a single dav? O Abut every day O 5-6 days a week O 3-4 days a week O 1-2 days a week O 2-3 days a mnth O Abut nce a mnth O 7-11 days in the past 12 mnths O 3-6 days in the past 12 mnths O Once r twice in the past 12 mnths O Never in the past 12 mnths O Dn't drink beer 29. During the past 12 mnths, hw ften did yu drink 8 r mre glasses f wine (mre than a 750 mi bttle) in a single day? " O Abut every day O 5-6 days a week O 3-4 days a week O 1-2 days a week O 2-3 days a mnth O Abut nce a mnth O 7-11 days in the past 12 mnths O 3-6 days in the past 12 mnths O Once r twice in the past 12 mnths O Never in the past 12 mnths O Dn't drink wine 30. During the past 12 mnths, hw ften did yu drink 8 r mre drinks f liqur (a haif*pint r mre) \f\ a single day? O Abut every day O 5-6 days a week O 3-4 days a week O 1-2day$awe6k O 2-3 days a mnth O Abut nce a mnth O 7-11 days in the past 12 mnths O 3-6 days in the past 12 mnths O Once r twice in the past 12 mnths O Never in the past 12 mnths O Dn't drink liqur

92 31. The fllwing list includes sme f the reasns peple give fr drinking beer, wine, r liqur. Please tell us hw imprtant each reasn is t yu, fr yur drinking. Very Fairly Slightly Nt at All Dn't (Darken ne circle n each line) Imprtant Imprtant imprtant Intiprtant Drink T be friendly r scial., O C r^, O V, O C T frget my wrries O O O O O trelax... O 0., O O T help cheer me up when I am in a bad md O O O O O T help me when I am depressed r nervus C O O ;.. O O T help me when I am bred and have nthing t d O O O O O T Increase my self-cnfidence O O O O, C Tgetdmnkr-high". O O O O O NwWmkiabut yur 4tse f beer, wine, r liqurverthe;past12rhhths-tiiatis: since titis time last year. Thei tenn i'^w^k i^ were:nriqiiiick>fespnse:(doininutes r less) call 32. The fllwing statements describe sme things cnnected with drinking that affect peple n their wrk days. Please indicate n hw many wrkdays in the past 12 mnths these things ever happened t yu. NUMBER OF WORK DAYS IN PAST 12 MONTHS 40 r Dn't (Darken ne circle n each line) Mre Nne Drink :; A«iK^hurt:in.ian;n^heT^db;fifficident ' ^:y'' :\.': ^^../:.l I:'!.l ;bec«us;etdf;mydririking...;.,;. O...O'... O-..-. O. r-;o>..^-o...v:-o'^..,vt-0.', v:; ' I was late fr wrk r left wrk early because f drinking, a hangver, r an iliness caused by drinking O... O.., O... O... O... O.... O... O... O... C. 1 did! n6tick>rtie;t6 wrk atiah pbr^»iaii;iixiaie#caus O..:.. O -..VQ' 0-:.\:.O- :0-v.:.r;?Qv. Q'v. ^..v^iir-;:; ^ ;..v ;fc:ucx...i.-'o- I wri<ed belw my nmnal level f perfrmance because f drinking, a hangver, r an illness caused by drinking O... O... O... O... O.., O... O., O... O.. : I was drunk bi" "lilgh'fwhbe wridng ; ibecsaiis^^dmm^^^... C.-. Q:.:: O-...O;iir-^k^Lr^^^;:.:^O. :V-O-i^ I was called in during ff-duty hurs and reprted t wrk feeling drunk r "high" frm alchl O... O... O... O... O... O... O... O... O... O 33. Fr each statement belw, please indicate hw ften yu have had this experience during the past 12 mnths Less ^ut Days Days Days Days Often Every a a a a Than Dn't (Darken ne circle n each line) Day Week Week Week Mnth Mcmthiy Never Drink..'=Myhancis^k::a'ltafter:dririlan^^^^... O. I awakened unable t remember sme f the things I had dne v»^ile drinking the day befre O. iciildrt«tch3drjnktng'befrebecbmingdrunk.,...,., O : I was sick because f drinking (nausea, vmiting, severe headaches, etc.) O. Itkadrinkthefirstthlnjgwbenlgtupfrtheday.,, Q. I had the "shakes" because f drinking,... O. 1 gt drunk r very high frm drinking '^:.....:..., O / Oi,.:.:,.....'0-- ;:::;.':.../ O...G.... O.. ' V r\ r\...p... O....-.D......O b c o ,..d; v.o...

93 34. Here are sme statements abut thfngs that happen t peple while r after drinking r because f using alchl. Hw many times In «ie past 12 mnths did each f the fllwing happen t yu? NUMBER OF TIMES IN PAST 12 MONTHS,«..,... I 3r Dn't, (Darken ne circle n each line) ^^^^^ 2 1 Never Drink I didn't get prmted because f my drinking C*... O... O... O O 1 gt a lwer scre n my efficiency reprt r perfrmance rating because f drinking, O... O... O..'... O O I had an illness cnnected with my drinwng'tiiat kept me frm duty fr a weekrlnger,..,» ; O... O....G....O O I received UCMJ punishment (Curt Martial, Article 15, Captain's Mast, Office Hurs) tiecause f my drinking O... O... O... O O I wasarrested-frdriyirigunder:ttie influence f atefibl.; O... O... O. <.,^ O..., O I was arrested fr a drinking incident nt related t driving O... O... O... - Q... O 1 spent time in jaii/stckadeiribtigibetea^ O... O... O ;..v..,^:1 ::;:r.,>,>,.:0.'. I was hurt in any kind f accident because f drinking O... O... O... O... O My d!*>kingcaused:ahacddentwh.f ^^ ^:'.: \!::; ;: -!pix)perty'was-darnaged :>,.,;. J':^y.i.hx^-:.:^-$^:t^)^J^.;,.X, ^r C)... ^ O :.Q,^-.;l ^u:f2>--^y~iyw-0 ' I gt int a fight Where I tilt smene ther than a member f my family when I was drinking... O... O... O O..:..,. O MyiWiferinisband:threat nedldleavemeibeca^ >,: D..:;, O...-.Q,..>... O >','-.. Q My wife r husband left me because f my drinking O... O... O O O I igegrapliici*^ Ci I 'wh n^ri1iht e k)rfc^ H".' '.;!. '' :;(.:'/.. v-! :]. ' ':Q'i'^ "^'--/i^.'i^''''^'^'-j^? ' "':> 'j.35. Please indicate hw much yu agree r disagree with each f the fllwing statements. D<>n't Strngly Strngly Knw/N (Darken ne circle n each line) Agree Agree Disagree Disagree Opinin /prinkingwilljnterferewtfiifnybeal^... O :. :~-^^-^;^.-0 '.ii!::u-^'is^0i]m-^-^l^^-^s^h^^^^ ifs hard t fit in at this iristallatln if yu dn't drink... Q... O...:.. O.,-,Q....,:,^.r.^.O ;;CSsciplihaiy«u:Jj6ri!wiil?tife^ :--r:---- -;::;:^ ^' ;.^^;X/ ^ ^i f^^^^^.;'identifiedas:hawhgv»ilnnj^ ^,.../O.-'.;... O'-.:...v,;^-;':0--.,::.:.:;.jJ;jii.i.:J!SS^^ ^ Driving while intxicated n-base at this installatin is a sure way t get arrested,...,.,... O... O,..., p...,.. '. vtq--t'--..:--,i.p, wii?ifethj installati6h^:vire'shiia. '' '^ ^^Ph-^^^P^':'^:'^:^}^!' Use f aichil is aigainst my ijasic values r beliefs O... O... O O i:^^sibi^r^ih8lpitradranwng:pr(^^ ''':-. :-;'{':\]-Pi:\ypp% ; imititaiyareer''j.-r. :''..^^:.:'::^:^.JPI.\.^Z..'...^^]^'l-':j.'...;..-^ O...r'- O;i:....*: :; ;v0l:.i;^;vl.,'.,!-..'.'i.r.jui-:0''' ' there-are sme times at wrk wh Bjil culd use a drink., O O... O... O... O ti^slasmfitier^tiikik:,.^^^ O,,,..;:-,, 0:^::...Z Q.<::.:-C.:.^'-^0- i;.;>-^,.--."0 '', ' Drinking is part f being in the military... O... O.,... O,... O... O *^ispiwisebrthe,.p^sbhi=d^^ : --.'.'.-:i : k )f^^:p'i:^ r :\':: ]:.\:.. '.. ^ '^ /. itiiwiiiid-dfea^i?^. :Q;.:...v:i ^.. ^^S;^.^.;;;.;;:^':^';^^.!:^^^^^^^^ Drinking is just abut the nly recreatin available at this Installatin :,...,,.,...,...,,.. O,. O.:... Q... O...p %xjrihkings(otetlmes:interfa'es w^^...,..'... O.... D. i...,; Q-..;;.: :.:..Q.-..,... O At parties r scial functins at this Installatin, everyne is encuraged t drink O O... O O O