LeardMann et al. BMC Public Health 2010, 10:437 http://www.biomedcentral.com/1471-2458/10/437 in this study, actual combat exposures could not be assessed in this study. These Marines may have been exposed to varying levels of combat or trauma, however, it is likely that the combat exposure experienced by this homogeneous sample of active duty, male Marines in this study was similar since they all deployed for the first time shortly after finishing recruit training [10]. Responders who had a previous PTSD diagnosis recorded in their military medical records or billed to the military were excluded, though it was not possible to account for PTSD diagnoses that may have occurred before responders joined the Marine Corps. Adverse childhood experiences were self-reported on a survey that was administered at the beginning of recruit train- ing. Like all self-reported data, it is difficult to know the extent of recall bias and reporting bias, especially with a sensitive topic such as ACE. With the low prevalence of PTSD and the sample size of this study, there was insuf- ficient power to detect small differences in the risk of being diagnosed with PTSD across exposure categories. We were able to identify significant differences in risk for more common exposures, such as physical neglect. Since this study was conducted among male Marines, the results may not be generalizable across all service branches or to female personnel. Despite these limitations, this study had a number of strengths. Prospective design eliminated biases related to same-time assessment of exposures and outcomes. Med- ical records, an objective outcome measure, were used to assess PTSD in contrast to self-reported symptoms. The electronic medical records are very complete for active-duty service members since medical visits at Department of Defense facilities and those billed to the military are included in these records. Both hospitaliza- tion and outpatient data were used to assess PTSD diag- noses, allowing for the full spectrum of health effects to be examined. The all-male population provided unique perspective on ACE, which is not always well described among men. Proportional hazard modeling allowed for hazard risk estimation while adjusting for many covari- ates and varied length of follow-up. Conclusions In summary, this study describes an at-risk population whose adverse childhood experiences appear to increase vulnerability to receiving a postdeployment PTSD diag- nosis. Young, male Marine recruits who self-reported multiple types of ACE were at significantly increased risk for a postdeployment PTSD diagnosis. More specifi- cally, those who reported childhood physical neglect were at greatest risk of being diagnosed with postde- ployment PTSD. These findings suggest that reporting of ACE increases the risk of subsequent diagnosis of postdeployment PTSD among Marines. It is plausible Page 7 of 8 that such a population could be targeted for PTSD pre- vention programs, early intervention after exposure to stress, or even protection from stressful exposures, when possible. Acknowledgements We thank Scott L. Seggerman and Gregory Boyd from the Management Information Division, Defense Manpower Data Center, Seaside, California. We also are very grateful for the help of other team members, including Christian Hansen; Chrislee Leyco; Robert Reed, MS; Tyler Smith, MS, PhD; Christina Spooner, MPH; Steven Speigle; Annie Wang; James Whitmer; and Sylvia Young, MD, MPH, from the Department of Defense Center for Deployment Health Research, Naval Health Research Center, San Diego, California. We appreciate the support of the Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland. This work represents report 09-05, supported by the Department of Defense, under work unit no. 60002. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government. The funding organization had no role in the design and conduct of the study; collection, analysis, or preparation of data; or preparation, review, or approval of the manuscript. Authors’ contributions CL and BS performed the statistical analysis. All authors helped conceive the study, participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. Received: 20 August 2009 Accepted: 26 July 2010 Published: 26 July 2010 References 1. Yehuda R, McFarlane AC: Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis. Am J Psychiatry 1995, 152(12):1705-1713. 2. 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