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Original Investigation |

Disparities in Adverse Childhood Experiences Among Individuals With a History of Military Service

John R. Blosnich, PhD, MPH1,2; Melissa E. Dichter, PhD, MSW3,4; Catherine Cerulli, PhD, JD1,5; Sonja V. Batten, PhD6,7; Robert M. Bossarte, PhD1,8
[+] Author Affiliations
1Department of Psychiatry, University of Rochester, Rochester, New York
2Center for Health Equity Research and Promotion, Department of Veterans Affairs, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
3Center for Health Equity Research and Promotion, Department of Veterans Affairs, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
4School of Social Policy and Practice, University of Pennsylvania, Philadelphia
5Susan B. Anthony Center for Women’s Leadership, University of Rochester, Rochester, New York
6Department of Veterans Affairs Central Office, Mental Health Services, Washington, DC
7Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
8Department of Veterans Affairs, Veterans Integrated Service Network 2, Center of Excellence for Suicide Prevention, Canandaigua, New York
JAMA Psychiatry. 2014;71(9):1041-1048. doi:10.1001/jamapsychiatry.2014.724.
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Importance  Adverse childhood experiences (ACEs) are associated with several adulthood health problems, such as self-directed violence. For some individuals, enlistment in the military may be an instrumental act to escape adverse household environments; however, to our knowledge prevalence of ACEs among persons with a history of military service has not been documented in the United States using population-based data.

Objective  To compare the prevalence of ACEs among individuals with and without a history of military service.

Design, Setting, and Participants  Data are from the 2010 Behavioral Risk Factor Surveillance System. Computer-assisted telephone interviews were conducted with population-based samples of noninstitutionalized US adults from January 1 through December 31, 2010. Analyses were limited to respondents who received the ACE module (n = 60 598). Participants were categorized by history of military service and whether a respondent was 18 years of age in 1973.

Main Outcomes and Measures  History of military service was defined by active duty service, veteran status, or training for the Reserves or National Guard. The ACE inventory assessed 11 negative experiences before the age of 18 years. Weighted χ2 tests and multiple logistic regression analyses were used to examine differences in ACEs by history of military service, era of service, and sex.

Results  Those with military experience had greater odds of any difference in prevalence of ACEs. In the all-volunteer era, men with military service had a higher prevalence of ACEs in all 11 categories than men without military service. Notably, in the all-volunteer era, men with military service had twice the odds of reporting forced sex before the age of 18 years (odds ratio, 2.19; 95% CI, 1.34-3.57) compared with men without military service. In the draft era, the only difference among men was household drug use, in which men with a history of military service had a significantly lower prevalence than men without a history of military service (2.1% vs 3.3%; P = .003). Fewer differences were observed among women in the all-volunteer and draft eras.

Conclusions and Relevance  Differences in ACEs by era and sex lend preliminary support that enlistment may serve as an escape from adversity for some individuals, at least among men. Further research is needed to understand how best to support service members and veterans who may have experienced ACEs.

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