All Military Adolescents Are Not the Same: Sexuality and Substance Use among Adolescents in the U.S. Military Healthcare System

Data examining sexuality and substance use among active duty and military-dependent youth is limited; however, these psychosocial factors have military implications. Adolescents and young adults aged 12–23 were recruited from an active-duty trainee clinic (n = 225) and a military pediatric clinic (n = 223). Active duty participants were more likely to be older, male, White, previous tobacco users, and report a history of sexual activity and less contraception use at their most recent intercourse, compared to the dependent group. Over 10% of all participants indicated attraction to members of the same gender or both genders. In logistic regression analysis, non-White participants were less likely to use contraception compared to White participants. Adolescents and young adults seen in military clinics frequently engage in high-risk behavior. Clinicians who care for military youth should assess their patient’s psychosocial history. Further study of this population is warranted to identify factors that may influence risk and resilience.     

Cancer in Guam and Hawaii: A comparison of two U.S. Island populations

BackgroundCancer disparities within and across populations provide insight into the influence of lifestyle, environment, and genetic factors on cancer risk.MethodsGuam cancer incidence and mortality were compared to that of Hawaii using data from their respective population-based, central cancer registries.ResultsIn 2009–2013, overall cancer incidence was substantially lower in Guam than in Hawaii for both sexes while overall cancer mortality was higher for Guam males. Cervical cancer incidence and prostate cancer mortality were higher in Guam. Both incidence and mortality were higher among Guam men for cancers of the lung & bronchus, liver & intrahepatic bile duct, and nasopharynx; Chamorro men were disproportionately affected by these cancers. Filipinos and Whites in Guam had lower overall cancer incidence compared to Filipinos and Whites in Hawaii. Although breast cancer incidence was significantly lower in Guam compared to Hawaii, women in Guam presented at younger ages and with rarer disease histologies such as inflammatory carcinoma were more prevalent. Guam patients were also diagnosed at younger ages for cancers of bladder, pancreas, colon & rectum, liver & intrahepatic bile duct, lung & bronchus, stomach, non-Hodgkin lymphoma, and leukemia.ConclusionSmoking, infectious agents, and betel nut chewing appear to be important contributors to the burden of cancer in Guam. Earlier onset of cancer in Guam suggests earlier age of exposure to key risk factors and/or a more aggressive pathogenesis. Contrasting cancer patterns within Guam and between Guam and Hawaii underscore the potential influence of genes, lifestyle, and environmental factors on cancer development and progression.     

Combining Surveillance Systems: Effective Merging of U.S. Veteran and Military Health Data

Background

The U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) had more than 18 million healthcare beneficiaries in 2011. Both Departments conduct individual surveillance for disease events and health threats.

Methods

We performed joint and separate analyses of VA and DoD outpatient visit data from October 2006 through September 2010 to demonstrate geographic and demographic coverage, timeliness of influenza epidemic awareness, and impact on spatial cluster detection achieved from a joint VA and DoD biosurveillance platform.

Results

Although VA coverage is greater, DoD visit volume is comparable or greater. Detection of outbreaks was better in DoD data for 58% and 75% of geographic areas surveyed for seasonal and pandemic influenza, respectively, and better in VA data for 34% and 15%. The VA system tended to alert earlier with a typical H3N2 seasonal influenza affecting older patients, and the DoD performed better during the H1N1 pandemic which affected younger patients more than normal influenza seasons. Retrospective analysis of known outbreaks demonstrated clustering evidence found in separate DoD and VA runs, which persisted with combined data sets.

Conclusion

The analyses demonstrate two complementary surveillance systems with evident benefits for the national health picture. Relative timeliness of reporting could be improved in 92% of geographic areas with access to both systems, and more information provided in areas where only one type of facility exists. Combining DoD and VA data enhances geographic cluster detection capability without loss of sensitivity to events isolated in either population and has a manageable effect on customary alert rates.     

The "Old West" in the Middle East: U.S. Military Metaphors in Real and Imagined Indian Country

ABSTRACT  In this article, I examine the role of the "Indian Country" heritage metaphor in U.S. military activities in the Middle East from a critical anthropological perspective. Research has revealed the proliferation of such discourse among soldiers, military strategists, reporters, and World Wide Web users to refer to hostile, unsecured, and dangerous territory in Iraq and Afghanistan. The salience of this symbol in 21st-century U.S. armed conflicts attests to its staying power in national narratives of colonialism at home and abroad. Summoning the "Indian wars" of the 19th century in the U.S. West as malleable symbolic parallels to the current war in Iraq serves to offer combat lessons in guerilla warfare while reinscribing epic stories of U.S. military imperialism and renarrating uncritically the struggles and conflicts of Native Americans, past and present, through the lens of contemporary perspectives on terrorism.     

The Distribution of Metals in Soils and Pore Water at Three U.S. Military Training Facilities

Small arms firing ranges at military training facilities can have enormous heavy metal burdens (percent level) in soils. Currently there are few published works that quantify the metal content of soils and waters at military installations or speculate on the potential for migration of these contaminants into groundwater. This article documents metals in soils and waters at nine small arms training ranges at three military installations in the U.S. Soil samples were collected from the surface and shallow subsurface. The results demonstrated that lead, antimony, copper, and zinc were the principal contaminants of interest and mapping a site's lead and copper surface distributions would adequately define the extent of impacted soil. Lower metal concentrations at three of the ranges reflected previous remediation by means of physical separation and mechanical removal of metallic fragments followed by fixation treatment with Maectite^TM. Except for the treated ranges where mixing had occurred, subsurface soil samples indicated limited vertical migration. Several of the ranges were also monitored for trace element migration in the vadose zone by means of suction-cup lysimeters. This pore-water sampling indicated ceramic suction-cup lysimeters are useful for assessing relative concentrations but require care in evaluation because of potential sorption losses. Monitoring of soil water at ranges should include antimony and zinc; the former because, in contrast to the other metals, it is typically soluble in an anionic form, and the latter because of its greater solubility and mobility.     

Cancers of unknown primary: Survival by histologic type,demographic features,and treatment in the U.S. Military Health System

BackgroundCancers of unknown primary (CUP), a group of heterogenous metastatic cancers lacking a known primary site, have poor prognosis. This study compared survival of CUP by histologic type, patient characteristics, and treatment in the U.S. Military Health System (MHS), which provides universal care to its members.MethodsPatients histologically diagnosed with CUP were identified from the U.S. Department of Defense (DoD)’s Automated Central Tumor Registry. Median survival with 95 % confidence intervals was calculated for demographic and treatment variables by histologic type. A multivariable accelerated failure time model estimated time ratios and 95 % confidence intervals.ResultsThe study included 3358 CUP patients. The most prevalent CUP in this study was well- and moderately-differentiated adenocarcinomas. Median survival varied by histologic type with squamous cell carcinoma having the longest at 25.1 months and poorly-differentiated carcinomas having the shortest at 3.0 months. For each histologic type, survival was generally similar by sex and active-duty status although women with well- and moderately-differentiated adenocarcinoma had longer survival than their male counterparts. Younger patients tended to have longer survival than those aged 65 years or older. Generally, there were no racial differences in survival except poorer survival for Black patients than White patients in the group of other histologic types. Patients with chemotherapy and radiation treatment generally had improved survival whereas patients with squamous cell carcinoma who received chemotherapy had shorter survival than those without.ConclusionSurvival generally did not differ between racial groups, which may be related to equal healthcare access despite racial background. Further studies are warranted to better understand how survival in the MHS compares with that in the general U.S. population.     

Social Dimensions of Evolutionary Research: Discovering Native American History in Colonial Southeastern U.S.

Beginning in the late sixteenth century, a series of Spanish missions was built in coastal Georgia and northern Florida. These missions were designed to convert and “civilize” the indigenous peoples of the region and establish a Spanish presence in the southeastern United States. The colony was not a success, and the missions were destroyed by the English by 1706. The native population fared poorly and suffered massive loss of people due to epidemics and colonial period hardships. In this paper, I discuss microevolutionary analyses of archeological skeletal samples representing the native populations from the region. Analyses document changing patterns of variation and intergroup biological integration through time. Formal evolutionary interpretations are offered, but these are reinterpreted with respect to the social and historical context of the time period. Specifically, patterns of variation suggest a nascent Catholic Indian identity was emergent in Spanish Florida when the missions were destroyed. While this may indicate an evolutionary and historical “dead end” for the indigenous peoples of Florida, further interpretation of the data with respect to the later history of the early Seminole people suggests a continuous biological history can be inferred, linking Spanish period (seventeenth century) and Seminole period (eighteenth century) peoples of Florida within a unified historical narrative. This complex, ephemeral history has repercussions for interpreting evolutionary genetic data within a strict cladistic framework. In addition, this research contributes a humanistic component to the evolutionary sciences with respect to cultural patrimony and oral traditions, in this case, of the Seminole peoples.