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Boots, Birth, and Beyond—Studying the Health of Military Children

At the Naval Health Research Center (NHRC), we use science and research to support the youngest members of our military community. Two projects within our Deployment Health Research Department—the Department of Defense (DoD) Birth and Infant Health Research (BIHR) program and the Millennium Cohort Family Study—focus on the health of service members and their families. Researchers study exposures and experiences, particularly those unique to military service, and whether they have an impact on the physical or mental health of military children. (U.S. Navy graphic by Amanda Wagner/Released)

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Naval Health Research Center

They may not come issued with a seabag, but children are an important part of military families. Healthy, resilient children and families contribute to the readiness of individual service members.

At the Naval Health Research Center (NHRC), we use science and research to support the youngest members of our military community. Two projects within our Deployment Health Research Department—the Department of Defense (DoD) Birth and Infant Health Research (BIHR) program and the Millennium Cohort Family Study—focus on the health of service members and their families. Researchers study exposures and experiences, particularly those unique to military service, and whether they have an impact on the physical or mental health of military children.

Each year, approximately 100,000 infants are born to military families. These children who were born into the military community will continue to be affected by military life for years to come. Understanding the relationship between military service and the health of military children is important to the well-being and readiness of the entire family.

FAST FACTS FOR MILITARY BIRTHS, 2003-2016
• 1.5 million infants born to military families
• 66% born to spouses of active duty service members
• 13% born to active duty women
• 21% born to Reserve/National Guard mothers or other DoD beneficiaries
• 63% born to moms aged 20-29
• 89% born to sponsors who were married
• 66% born to non-Hispanic whites

MILITARY SERVICE AND REPRODUCTIVE HEALTH

The BIHR team monitors health outcomes, such as birth defects and low birth weight, among infants born to military families through their first year of life. However, since exposures that occur just before or during pregnancy can affect the overall health of an infant, the BIHR team also focuses their research on potentially concerning exposures that can happen before a baby is born.

What is a potentially concerning exposure? Exposure to workplace or environmental contaminants, chemicals, toxins, or other hazards are potentially concerning because they could affect the reproductive health of individuals exposed to them. How an exposure impacts reproductive health depends on several things, including:
• When the exposure happened (before conception or during pregnancy)
• What type of exposure (chemical, infectious disease, radiation, stress-related)
• Amount of the exposure
• Duration of the exposure

Military children are born in all 50 states and overseas, so exposures could result from something not specifically related to military service. For example, military families stationed in Japan at the time of the 2011 earthquake, tsunami, and subsequent Fukushima nuclear power plant disaster had a potential exposure to radiation. The BIHR team’s research can help determine if infants born to parents following such unexpected exposures have an increased risk for poor health outcomes.

Perhaps of greater value to military families is research that looks at risks following anticipated exposures—exposures that are an expected part of military service, such as deployments and vaccinations. By identifying these types of risks, procedural and policy changes can be made to prevent or reduce them.

Vaccinations are a standard part of military life and warfighter readiness. They protect service members from infectious diseases they may encounter due to living in close quarters or by deploying to parts of the world where certain diseases are a concern. A number of these vaccines are not recommended for use in pregnancy, such as anthrax or smallpox vaccine. Sometimes, though, they are inadvertently given to female service members who may be pregnant but are not aware at the time they are vaccinated.

In the early 2000’s, when a mandatory smallpox vaccination program was initiated, efforts of the BIHR team indicated that revisions to the vaccination pre-screening form, such as targeted questions about the possibility of pregnancy, would reduce the number of service women inadvertently vaccinated while pregnant.

Even though the risk of accidental vaccination during pregnancy can be reduced, it’s not possible to completely prevent it. That’s why the team developed registries for active duty women vaccinated with smallpox and anthrax while pregnant. The goal is to evaluate pregnancy and infant health outcomes among those inadvertently exposed to these vaccines.

Because of their work tracking these women and studying their health outcomes, the BIHR team has found that infants born to women vaccinated against smallpox or anthrax during pregnancy do not have higher rates of birth defects, preterm birth, or low birth weight when compared to infants in the overall BIHR program. The smallpox vaccine registry follows these infants through early childhood, and have found they are reaching age appropriate developmental milestones.

Deployments can also result in exposures. After the first Gulf War, service members whose children were born with birth defects were concerned their war-time exposures led to their infants’ birth defects. At the time, there was no available baseline data for reproductive health outcomes and the DoD was not able to determine if there was an association. In 1998, the Assistant Secretary of Defense for Health Affairs established the BIHR program in direct response to these concerns.

From 2003 through 2014, approximately 6.2 percent of infants born to active duty women were born to moms who were deployed for part of their pregnancy. The BIHR team can monitor these infants to see how their health outcomes compare to infants whose mothers did not deploy. The team also monitors the health of infants conceived following their active duty father’s return from deployment—exposures of potential concern experienced by male service members could also impact infant health.

MILITARY LIFE AND FAMILIES

While the BIHR team focuses on the physical health of the youngest military children, infants, the Millennium Cohort Family Study looks at the overall well-being of military families, including children.

Launched in 2011, the Millennium Cohort Family Study was designed to determine if, and how, deployment experiences and service member readjustment issues affect family health and well-being. Military family members are selected to take part in the study if their service member participates in the Millennium Cohort Study, a research project examining the long-term effects of military service.

To date, nearly 10,000 spouses of service members with two to five years of service have been surveyed. Their responses provide a better understanding of military life from the perspective of a spouse. Every three years, families in the study are asked to share their experiences, providing important information about how military families adapt over time as they manage deployments, moves, separations, and other life and career transitions. Together, the Millennium Cohort Study and the Family Study create a complete picture of the triumphs and challenges faced by military families. Findings from these studies can be used to develop and guide programs, interventions, and policies that support service members and their families.

Just as deployment-related exposures can influence the physical health of infants, deployments can also affect the psychological and behavioral health of children while service members are away and when they’re transitioning back home. And deployment is a common occurrence for military families—approximately 70 percent of participants in the Family Study have reported experiencing at least one deployment.

Factors contributing to a child’s deployment-related stress include increased demands on the parent at home, shifting household responsibilities, and worry about the safety of the deployed service member. An article published by the Family Study, “Mental health of children of deployed and nondeployed US military service members: The Millennium Cohort Family Study,” examined how a parent’s deployment can affect their child’s symptoms of depression and behavioral problems. Study findings suggest that most military children appear to be doing well but some may have a greater likelihood of depression or attention deficit hyperactivity disorder (ADHD) during or after a parent’s deployment.

While a deployment may increase the risk for children’s psychological and behavioral health problems, researchers have also identified factors that can positively influence how well children handle a parent’s deployment. Study findings indicate that military spouses who experience deployment and can remain involved in normal social activities with friends and family had children with lower odds of depression or ADHD.

RESEARCH FOR READY FAMILIES, RESILIENT CHILDREN

Military service doesn’t just affect the active duty member, it touches all members of the military family, including children. Deployments, service-related experiences and exposures, and the unique aspects of military life all have the potential to impact the physical health and psychological well-being of military children.

Through projects like the BIHR program and the Family Study, researchers can improve understanding of the relationship between military service and child health in an effort to reduce health risks, develop interventions, and provide support for military children. Research can lay the foundation for building healthy, ready, and resilient military children.

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