Health Related Behavior Study 2018 – A Comparison of Active and Reservists

The Health Behavior and Behavior Survey (HRBS) is the US Department of Defense’s (DoD) primary survey of the health, health behaviors and well-being of military personnel. The HRBS, which has been conducted regularly for more than 30 years, covers areas that may affect military readiness or the ability to meet the demands of military life.

The Department of Defense commissioned the RAND Corporation to review and conduct the 2018 HRBS survey for active and reserve military personnel. This report compares active duty and reservist outcomes in five areas: health promotion and disease prevention, substance use, mental health and mental health, physical health and functioning, and sexual health and behavior.

Because direct comparisons between these two components are not recommended, RAND researchers used a regression model to compare the two components. It is important to note that this method cannot explain all of the differences between the two subsamples, although several important military and demographic characteristics were included in the model (e.g. branch of service, military rank, age, marital status).

This report does not focus on actual numbers, but identifies areas where the situation of reservists is better, worse or comparable to that of active members. The reserve forces complement the activities of the active forces. Its members must therefore always be ready for active service. This requirement raises an important question for decision-makers: how ready are reservists for active service?

What behaviors and health conditions can undermine readiness? And how do these behaviors and outcomes compare with those of active forces? This memo summarizes the answers to these questions. The HRBS compares the outcomes of active and reserve forces in several domains, using a statistical procedure to control for demographic differences between the two components.

Disease Prevention and Health Support

Reservists were significantly more likely than military personnel to report being obese and significantly less likely than military personnel to meet HP2020 targets for moderate and vigorous physical activity. At the same time, reservists were more likely to meet HP2020 targets for strength training. They were also more likely to meet HP2020 targets for sleep quantity and report better sleep quality than their active peers.

They were less likely to use medication to help them sleep. Consumption of energy drinks to maintain wakefulness was significantly lower among reservists than among members of the active component, while consumption of caffeinated drinks and prescription and over-the-counter medicines to maintain wakefulness was essentially the same in both components.

Substance and Drug Use

Reservists reported high levels of alcohol use and lower levels of negative consequences associated with alcohol use than members of the active component. They also reported that the military culture did not favour alcohol consumption. They were also less likely to use tobacco products such as traditional cigarettes, electronic cigarettes and smokeless tobacco.

Although they were less likely to use prescription drugs (i.e. stimulants, tranquilizers and painkillers) than active duty soldiers, reservists were more likely to report using illegal drugs such as marijuana. There were no differences in prescription drug abuse between the two components.

Emotional and Mental health

The prevalence of many mental health problems was lower among reservists than among military personnel. These include severe psychological distress in the past 30 days and past year, post-traumatic stress disorder in the past 30 days, aggressive and angry behavior in the past 30 days, and suicidal thoughts, suicide plans and suicide attempts in the past year.

Reservists were also less likely than conscripts to report having been physically abused in the past year and since joining the military. Reservists were significantly less likely than active service members to report using mental health services, but it is not known whether this difference is positive or negative. However, significantly fewer reservists reported an unmet need for mental health care.

Disabilities and General Physical Health

Reservists were significantly less likely than members of the active component to report a number of chronic health problems diagnosed by a doctor, such as high blood pressure, back pain and bone, joint and muscle injuries (including arthritis).

Reservists are also less likely to report pain, severe physical symptoms and health-related absenteeism or absences (i.e. loss of productivity). Reservists were more likely to report ‘very good’ or ‘excellent’ health and less likely to report ‘poor’ health than active members.

Sexual Behavior and Sexual Health

Reservists were significantly less likely than active members to engage in a range of risky sexual behaviors. These included having two or more partners in the past year, not using a condom with a new partner in the past year and not using a condom during a recent vaginal intercourse. Perhaps for this reason, they were also less likely to report having had an STI in the past year.

However, reservists were significantly less likely than active service men to use highly effective contraception at last intercourse and moderately or highly effective contraception (among women aged 20-44). Reservists were less likely to be at high risk of HIV than active duty members, but those at high risk were significantly less likely to have been tested in the past year.

The number of unintended pregnancies, pre-deployment contraceptive counselling and availability of selected contraceptive methods before or during deployment did not differ significantly between the reserve and active components.

Methodology

RAND conducted the 2018 HRBS survey among US active and reserve military personnel between October 2018 and March 2019. The active component survey included members of the Air Force, Army, Navy, Marine Corps, and Coast Guard.

Members of five reserve forces – the Air Force, Army, Navy, Marine Corps and Coast Guard – and two national guard forces – the Air National Guard and the Army National Guard – participated in the reserve component survey. The 2018 HRBS was a confidential online survey that allowed researchers to target reminders to non-respondents and reduce survey burden by linking responses to administrative data.

The sample was selected using a random sampling method stratified by grade level, grade and gender. The overall weighted response rate was 9.6%, resulting in an analytical sample of 17 166 responses. The total weighted response rate for the reserve component survey was 9.4% and the analytical sample consisted of 16,475 responses.

To deal with missing data, RAND researchers used imputation, a statistical procedure that uses available data to estimate missing values. To represent the population in each component, RAND researchers weighted the responses to avoid over-selecting service members in certain components.

In addition to this file, one set of eight files contains summaries of results for the active component and another set of eight files contains summaries of results for the reserve component. In both sets, one memo contains an overview of all the results and policy implications, while the remaining seven memos correspond to different chapters of the full report for each component.

Limitations & Restrictions

Response rates for the active and reserve surveys are low in sample surveys. While low response rates do not automatically mean that survey data are biased, they do increase the possibility of bias. As with any self-reporting, socially desirable bias is possible, especially for sensitive questions and topics.