title: Injury during U.S. Army basic combat training: a systematic review of risk factor studies.
abstract: BACKGROUND
  Approximately one quarter of men and half of women in U.S. Army basic combat training experience an injury. Preventing basic combat training-related injuries would reduce associated human and economic costs and discharges from the Army. Identification of risk factors for such injuries is a crucial step toward their prevention. Although some research has begun to address this need, prior studies of risk factors for training-related injury have not been reviewed systematically. This study systematically reviews the literature on risk factors for injury during U.S. Army basic combat training.
  
  
  METHODS
  Original studies of risk factors for injury during U.S. Army basic combat training published since 1990 in peer-reviewed journals were identified using PubMed and manual searches of reference lists. This search was last performed in May 2013. Nineteen studies met the inclusion criteria.
  
  
  RESULTS
  Methodologic quality and potential for bias were assessed. The findings of 11 studies deemed to be of high or medium quality were synthesized to determine the level of evidence supporting the association between each risk factor studied and risk of injury during basic combat training. Quality assessment and evidence synthesis were performed from June to September 2013.
  
  
  CONCLUSIONS
  There is strong or moderate evidence supporting association of older age, history of smoking, and self-rated low physical activity level prior to basic combat training with increased risk of training-related injury among male trainees. There is limited, mixed, or insufficient evidence to identify risk factors for injury among female trainees.
authors.affiliation: Department of Public Health, University of Massachusetts-Amherst, Massachusetts. Electronic address: bulzacchelli@schoolph.umass.edu.
authors.forename: Maria T
authors.initials: MT
authors.lastname: Bulzacchelli
authors.affiliation: ENVIRON International Corporation, Amherst, Massachusetts.
authors.forename: Sandra I
authors.initials: SI
authors.lastname: Sulsky
authors.affiliation: Department of Public Health, University of Massachusetts-Amherst, Massachusetts.
authors.forename: Rosa
authors.initials: R
authors.lastname: Rodriguez-Monguio
authors.affiliation: ENVIRON International Corporation, Amherst, Massachusetts.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Karlsson
authors.affiliation: U.S. Army Research Institute of Environmental Medicine, Natick, Massachusetts.
authors.forename: Maj Owen T
authors.initials: MO
authors.lastname: Hill
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000193:education / Q000706:statistics & numerical data; D060051:Occupational Injuries / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D010806:Physical Education and Training / Q000379:methods*; D010809:Physical Fitness; D012307:Risk Factors; D014481:United States