Association of military life experiences and health indicators among military spouses

Promoting healthy behaviors and outcomes has long been a priority for the United States military, and since 1986, the Department of Defense (DoD) has emphasized its Health Promotion and Disease Prevention directive, which provides health guidance and encourages healthy living goals among military personnel and their beneficiaries [1]. Health behaviors that put individuals at risk of physical and social consequences are alarmingly prevalent among service members, particularly those involving substance use [2‐4]. One DoD study found that 39.6% of all active duty current drinkers reported binge drinking in the past month; and 24.5% of active duty service members reported cigarette use in the past month; additionally, 51.2% of active duty personnel were classified as overweight, despite the military’s high physical health standards [3]. Poor health behaviors negatively affect not only the individual, but also their families and broader society, causing an increase in missed days from work and health care costs [5]. The health and well-being of military spouses also directly contribute to a robust military force by enabling the spouse to better support the active duty member’s career [6] and have significant health care cost implications. A study of TRICARE beneficiaries (dependents of active duty personnel, military retirees, and dependents of military retirees) found that each year DoD spends approximately $2.1 billion for medical care associated with obesity, alcohol use, and tobacco use [2].

There is less data available regarding the health of military spouses compared to service members; however, some studies shed light on potential health issues. A 2012 presentation found that one in five Army active duty spouses are overweight, one third are obese [7] and studies suggest that service member deployment is not a predictor of spouses’ overweight or obesity [8, 9]. Approximately 8.2% of military spouses married to service members with 2–5 years of experience reported alcohol misuse [10] and unhealthy alcohol use among military spouses was associated with feeling bothered by communication about the service member’s deployment experiences as well as the spouse feeling stressed by a combat-related deployment or duty assignment [11].

In an effort to combat health disparities and to improve health outcomes for all Americans, the U.S. Department of Health and Human Services launched a health promotion program and evaluation measure called the Healthy People initiative [12]. The Healthy People 2010 initiative (HP2010) analyzed 28 different focus areas containing 467 measurable objectives of physical health from 2000 to 2010, and these objectives were updated for Healthy People 2020 (HP2020) [13]. Although research on the U.S. population shows that particular population groups are disproportionally affected by poor health outcomes and have less access to preventive care (e.g., individuals living below the poverty line, individuals in rural populations, and racial/ethnic/sexual minorities) [14‐18], there has been very little research investigating the relative achievement of Healthy People objectives among military populations, and particularly military spouses. In a 2006 study, self-reported service members’ health behaviors met or exceeded 7 of the 19 HP2010 objectives assessed, including those related to obesity and exercise [19]. Kress and colleagues assessed HP2010 objectives among military retirees and their spouses and found that fewer retirees and beneficiaries met obesity, exercise, substance use, and healthy eating objectives than national target percentages [20]. Being male, having less than a college degree, and less-than-excellent self-reported health status were associated with a lower likelihood of meeting the objectives [20, 21].

Despite DoD’s commitment to the health and well-being of all members of the military community, military spouses may be at greater risk for poor health behaviors than their military partners or civilian counterparts. Military spouses do not have the same incentives and structure to help them maintain their health, yet they are exposed to many stressors unique to military life, such as relocation and deployment, that may challenge healthy living [22, 23]. Additionally, access to military health promotion programs and support systems that have been shown to reduce poor health behaviors [24‐26] is uneven, particularly for certain subgroups, such as male and minority spouses and spouses of those serving in National Guard and Reserve components.

In order to understand the overall health and well-being of military spouses, the current study aimed to investigate various health behaviors and indices, including weight, exercise, sleep, and substance use, using data from the Millennium Cohort Family Study (henceforth referred to as the Family Study), which is a probability-based cohort [27‐29]. We have used the HP2020 goals framework to assess health indicators among military spouses and assess associations between these health indicators, operationalized as attainment of HP2020 goals in several domains, and sociodemographic characteristics, military experiences, and psychosocial factors.

Overall, the majority of military spouses and service members met most of the HP2020 goals analyzed in the study. However, less than half of military spouses met the healthy weight/BMI goal or the strength training goal. Spouses were more likely to achieve healthy weight, sleep, and alcohol and tobacco use goals than were service members, whereas more service members met the aerobic exercise and strength training goals likely due to physical health demands of military service. In addition to comparing military spouses with their partners, it is important to contextualize these results by comparing military spouses with the U.S. adult population. To do so, we compared rates from the current study with the 10-year HP2020 national targets, which represent the aims that the government sets at a population level, acknowledging that these comparisons must be interpreted cautiously due to demographic differences between the target population of the Family Study and the U.S. adult population [30]. A higher proportion of military spouses (44.2%) met the HP2020 healthy weight/BMI goal compared with the national target of 33.9%. Relatedly, fewer military spouses were obese (23.7%) compared with the national obesity target of 30.5%. Sixty-eight percent of military spouses met the HP2020 physical activity objective and 42.6% met the strength training objective, higher than the national targets (47.9 and 24.1%, respectively). The proportion of military spouses meeting the sleep objective (61.3%) was lower than the national target of 70.8%. A comparable proportion of military spouses did not meet goal related to risky drinking, compared with the national target (24.3% vs 25.4%). More military spouses reported currently smoking than the national target (20.6% vs 12.0%). Overall, compared with the HP2020 targets for the entire U.S. adult population, a higher proportion of military spouses met the objectives for healthy weight, obesity, and physical activity than the national targets, while fewer met these targets for sleep and smoking. It is unclear to what extent these differences may be explained by the younger age and other demographic differences between this study’s target population and the adult population as a whole. The Centers for Disease Control and Prevention (CDC) does not provide demographic breakdowns for its population targets.

Multivariable results suggest that social support and perceived support from the military are associated with military spouses’ health behaviors. Specifically, spouses who reported being bothered by not having someone to turn to when they were having a problem were less likely to achieve a healthy weight or sufficient sleep and were more likely to engage in risky alcohol use and to smoke cigarettes. Similarly, when spouses perceived greater efforts by the military to support their families, they were more likely to meet the healthy sleep goal. Research suggests that spouses identify multiple ways their military lifestyle makes it difficult to maintain strong social connections, including frequent moves, living far from family and friends, and lack of time [31]. Together, these results suggest providing resources to assist spouses in developing social networks and support, and addressing identified barriers to connectedness, may have broader implications on the overall health and well-being of spouses. Several spouse demographics were associated with health indicators and were controlled for in the multivariable models, including gender, age, ethnicity and education. Additionally, spouses of officers, compared to enlisted personnel, were more likely to meet the weight, aerobic exercise, and tobacco goals and spouses of Air Force members were more likely to meet the sleep and substance use goals compared to Army spouses.

Based on our results, it is clear that service member and spouse health behaviors are associated and likely influence one another bidirectionally. These findings suggest that enhanced support and program for either or both partners may assist the couple and improve family readiness. Although there are many existing social support and military health promotion programs available, most target service members rather than military spouses, and there is a lack of unified family resource programs [32]. Existing family programs include Military OneSource, which disseminates information on all military family health resources; Operation Live Well, an initiative to improve health and wellness for the entire defense community, and its Healthy Base Initiative targeting service members, DoD civilians, and their families. The U.S. Army Public Health Center Performance Triad includes a specific resource page for spouses with educational materials and social media resources that aim to improve sleep, physical activity, and nutrition and operate the Army Wellness Centers that are available to military spouses. Building upon these existing military health promotion and social support programs to be more accessible and targeted to military spouses could have direct implications for increasing positive health behaviors synergistically among service members and their spouses.

Military experiences associated with injury, PCS moves, and family stress were not significantly associated with the health behavior outcomes in this study. Interestingly, having more stressful experiences related to deployment was associated with a greater likelihood of having a healthy BMI. This finding is inconsistent with previous research. For example, Fish and colleagues (2014) found that deployment has no relationship with healthy weight, but that male Army spouses were more likely to be obese or overweight than female spouses [8]. Padden and colleagues (2011) found that deployment was associated with poorer dietary behaviors [33].In the current study, deployment-related stress was associated with only a single health outcome, healthy weight/BMI, and that relationship was fairly weak, suggesting that deployment-related stress and PCS moves may not have a strong or consistent influence across health behaviors. As Family Study follow-up data for this longitudinal effort become available, it will be possible to further investigate these relationships prospectively. Future studies might assess if other military-related stress influences health indicators over time and if there are directional effects in terms of behavioral influence between the spouses in meeting the goals, and if they are stronger from the service member to the spouse or vice versa. Such studies could inform the most effective points of prevention and intervention for military families. Future longitudinal research could also assess more comprehensive bio-psycho-social models predicting health outcomes for military spouses to distinguish the strongest influencing factors, including behavioral health predictors such as Posttraumatic Stress Disorder which has been linked to health outcomes in various studies [34‐36].

Using the HP2020 objectives as a framework for identifying key health behaviors and benchmarks, this study identified factors, including military-specific experiences that may contribute to physical health behaviors and outcomes among military spouses. The findings provide important insights that could help inform health promotion programs for military families, improve force readiness and retention, and enhance the well-being of military families. The study also offers a unique contribution to the HP2020 efforts by revealing the proportion of military spouses, a large and important segment of the population, who meet several key health objectives.

The spouses in this study face similar challenges in maintaining a healthy lifestyle as individuals in the broader civilian population, but they must also navigate additional stressors related to their role as part of a military dyad. These stressors may include having a spouse who is deployed, not having a strong social support system, and not feeling supported by the military. It is important that these spouses are provided with the support services and programs to help them maintain and improve their health behaviors and improve the overall health and well-being of U.S. military personnel.