LeardMann et al. BMC Public Health 2010, 10:437 http://www.biomedcentral.com/1471-2458/10/437 Table 1 Characteristics of Recruit Assessment Program male responders deployed between September 1, 2001 and June 30, 2004 Characteristic Study Postdeployment Sample PTSDa N = 8391 N = 226 (%) (%) Age, y 17-18 19-20 20+ Education High school or less More than high school AFQT score < 42 (below 25th percentile) 42-54 (25-49th percentile) 55-70 (50-74th percentile) > 70 (above 74th percentile) Parents’ education High school or less Some college College graduate Unknown Race/ethnicity White non-Hispanic Hispanic Black non-Hispanic Other Marital status at time of deployment Not married Married Number of close friends 0-1 2 or more Alcohol drinking behavior at service entry Nondrinker Non-problematic drinker Potential problematic drinker Smoking status at service entry Never Past smoker Current < 2 pack years Current ≥ 2 pack years Cumulative length of deploymentsb < 3 months 3-6 months 6-9 months > 9 months Number of deployments 1 2-3 54.0 32.0 14.1 82.4 17.6 22.9 25.3 25.5 26.4 36.0 29.7 27.8 6.6 63.8 23.6 4.5 8.1 84.3 15.8 12.1 87.9 32.7 34.8 32.6 67.8 3.3 19.2 9.7 11.9 51.6 32.2 4.4 95.0 5.1 54.9 32.3 12.8 83.6 16.4 36.3 23.5 24.3 15.9 36.3 31.9 25.7 6.2 68.1 19.9 4.0 8.0 77.9 22.1 16.8 83.2 30.5 38.9 30.5 61.1 3.5 24.3 11.1 12.8 53.1 27.9 6.2 88.5 11.5 Page 4 of 8 95.6 4.4 98.2 1.8 74.8 25.2 59.7 40.3 Table 1 Characteristics of Recruit Assessment Program male responders deployed between September 1, 2001 and June 30, 2004 (Continued) Diagnosed with mental health disorder prior to deployment No Yes Self-reported visiting mental health professional in last 5 years No Yes Self-reported poor mental healthc None or a little of the time Some, most, or all the time Non-ACE past traumatic eventd No Yes 98.1 1.9 98.8 1.2 78.0 22.0 59.7 40.3 Abbreviations: ACE = adverse childhood experiences; AFQT = Armed Forces Qualification Test; PTSD = posttraumatic stress disorder. As a result of rounding, percentages may not sum to 100%. aDiagnosed with PTSD after returning from first deployment in support of the operations in Iraq and Afghanistan and within 2 years of last deployment. Responders with a PTSD diagnosis prior to first deployment are excluded from this model. bCumulative number of days deployed until first diagnosis, 2 years after last deployment, or June 30, 2005, whichever came first. cAverage of Likert scale responses to 4 survey questions asking about feeling downhearted and blue, nervous, down in the dumps, and not calm or peaceful, during the past year. dSelf-reported having a severe accident, seeing someone badly injured or killed, being attacked or assaulted, threatened with a weapon, or being raped. After adjusting for covariates, those who reported ACE in 2 or more categories were at significant risk for being diagnosed with postdeployment PTSD (HR = 1.57; 95% CI = 1.09, 2.26) and mental health disorders not specific to PTSD (HR = 1.41; 95% CI = 1.10, 1.80) com- pared with those who reported no ACE (Table 4). Discussion Adverse childhood experiences, including neglect and abuse, have been associated with an increase in various diseases and negative health outcomes in adulthood, including depression, PTSD, alcohol-related problems, and even chronic fatigue syndrome in adulthood [13,15-17, 20,21,26-29]. Previous studies have shown a graded rela- tionship between the total number of ACE and negative health behaviors, including early onset of drinking alcohol and suicide attempts [17,20,21,30]. An association between ACE and alcohol problems has been demonstrated among the same population of young, male Marines examined in the current study [31]. Adverse childhood experiences, including sexual abuse, emotional abuse, physical abuse, and emotional and physical neglect, have been associated with combat-related PTSD in retrospective and cross-sec- tional studies [13-15,32,33].