Deployment and alcohol use in a military cohort: Use of combined methods to account for exposure-related covariates and heterogeneous response to exposure

David S. Fink, Katherine M. Keyes, Joseph R. Calabrese, Israel Liberzon, Marijo B. Tamburrino, Gregory H. Cohen, Laura Sampson, Sandro Galea

Research output: Contribution to journalArticle

1 Scopus citations

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 2 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 postdeployment alcohol use, which ignores previous studies that have documented that respondents tend to exhibit heterogeneous postdeployment drinking behaviors. Therefore, we used propensity score matching to balance baseline covariates for the 2 comparison groups (deployed and nondeployed), followed by a variable-oriented difference-in-differences approach to account for the confounding and a person-oriented approach using a latent growth mixture model to account for the heterogeneous response to deployment in this prospective cohort study of the US Army National Guard (2009-2014). We observed a nonsignificant increase in estimated monthly drinks in the first year after deployment that regressed to predeployment drinking levels 2 years after deployment. We found a 4-class model that fit these data best, suggesting that common regression analyses likely conceal substantial interindividual heterogeneity in postdeployment alcohol-use behaviors.

Original languageEnglish (US)
Pages (from-to)411-419
Number of pages9
JournalAmerican Journal of Epidemiology
Volume186
Issue number4
DOIs
StatePublished - Aug 15 2017

Keywords

  • alcohol drinking
  • cohort analysis
  • military personnel
  • propensity score

ASJC Scopus subject areas

  • Epidemiology

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