title: Alcohol misuse, alcohol-related risky behaviors, and childhood adversity among soldiers who returned from Iraq or Afghanistan.
abstract: BACKGROUND
  Soldiers face a great number of traumatic combat exposures while deployed, which research has shown to contribute to the development of alcohol misuse. In addition to this known risk factor, we hypothesize that adverse childhood experiences (ACEs) also contribute to the likelihood that soldiers will engage in these behaviors, even after adjusting for deployment-related factors (mental health problems and combat exposure).
  
  
  METHODS
  Soldiers were surveyed anonymously approximately 3 months upon return from Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF) from 2003 to 2006. Six brigade combat teams were included in the analyses (n=7849). Participants were asked about ACEs, mental health symptoms, alcohol misuse, risky behaviors related to alcohol misuse, and combat exposure.
  
  
  RESULTS
  Of the 7849 soldiers in the sample, 31.5% screened positive for alcohol misuse and of those almost half also screened positive for risky behaviors related to alcohol misuse (43.3%). Having an alcoholic in the household and experiencing sexual abuse were significantly associated with screening positive for alcohol misuse and alcohol misuse with risky behaviors. Experiencing sexual abuse was a strongly associated ACE item, with an almost 2-fold increase in risk of both outcomes even after adjusting for mental health problems and combat exposure.
  
  
  CONCLUSIONS
  Findings suggest that ACEs are a substantial risk factor for alcohol misuse with and without risky behaviors among soldiers returning from deployments and should be considered when directing prevention efforts.
authors.affiliation: Center for Military Psychiatry and Neuroscience, 503 Robert Grant Ave., Silver Spring, MD 20910, United States. Electronic address: kristina.clarke@amedd.army.mil.
authors.forename: Kristina
authors.initials: K
authors.lastname: Clarke-Walper
authors.forename: Lyndon A
authors.initials: LA
authors.lastname: Riviere
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Wilk
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D016009:Chi-Square Distribution; D002648:Child; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D002650:Child Abuse, Sexual / Q000523:psychology / Q000706:statistics & numerical data; D016241:Child of Impaired Parents; D003430:Cross-Sectional Studies; D004522:Educational Status; D006801:Humans; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008889:Military Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012309:Risk-Taking; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Adverse childhood experiences; Alcohol misuse; Combat exposure; Mental health; Military