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Citation |
Fink DS, Keyes KM, Calabrese JR, Liberzon I, Tamburrino MB, Cohen GH, Sampson L, Galea S. Am. J. Epidemiol. 2017; 186(4): 411-419. |
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Affiliation |
Dean, School of Public Health, Boston University, Boston, Massachusetts. |
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Copyright |
(Copyright © 2017, Oxford University Press) |
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DOI |
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PMID |
28482012 |
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Abstract |
Studies have shown that combat area deployment is associated with increases in alcohol use; however, studying the influence of deployment on alcohol use faces two complications. First, the military considers a confluence of factors before determining whether to deploy a service member, creating a nonignorable exposure and unbalanced comparison groups that inevitably complicate inference about the role of deployment itself. Second, regression analysis assumes that a single effect estimate can approximate the population's change in post-deployment alcohol use, which ignores that previous studies have documented that respondents tend to exhibit heterogeneous post-deployment drinking behaviors. Therefore, we used propensity score matching to balance baseline covariates for the two comparison groups (deployed and non-deployed), followed by a variable-oriented difference-in-differences approach to account for the confounding and person-oriented approach using a latent growth mixture model to account for the heterogeneous response to deployment in a prospective cohort study of the Army National Guard (2009-2014). We observed a non-significant increase in estimated monthly drinks in the first year post-deployment that regressed to pre-deployment drinking levels 2 years after deployment. We found a four-class model that fit these data best, suggesting that common regression analyses likely conceal substantial interindividual heterogeneity in post-deployment alcohol use behaviors. Language: en |
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Keywords |
alcohol drinking; cohort analysis; military personnel; propensity score |