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Military Personnel, Veterans and their Families R R34 Pilot and Feasibility Studies. Additional Information on Eligibility. The purpose is to accelerate research on health promotion and prevention interventions with foci on reducing the onset and progression of alcohol, tobacco, and other drug use and abuse including illicit and prescription drugs and associated mental and physical health problems and on the promotion of health-enhancing behaviors among active-duty or recently separated e.
Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions.
Overview Information Part 2. Full Text of the Announcement Section I. Eligibility Information Section IV.
AR 40-501 Standards of Medical Fitness
Application and Submission Information Section V. In addition, research related to all phases of the arm lifecycle, i. Military Reserves, National Guard and Veterans are of interest. National Guard and Reserve service members, Individual Augmentees and Families have been identified as special needs populations that are of particular interest due to limitations in health care support related to not being attached nil a military installation, among other factors.
An Individual Augmentee is a United States military member assigned to a unit for the purpose of filling in for, or augmenting, members of that unit. These sustained combat operations have resulted in military personnel experiencing increased numbers and lengths of deployments and greater exposure to stressors, including exposure to death, risk to life, sustained threat of injury or actual injury, and the day-to-day and Family stress inherent in all phases of the military lifecycle to include the deployment cycle and transitions.
Negative life stress has epubss shown to be a major contributor to both the onset and exacerbation of substance abuse and psychological health problems and to be related to a variety of negative physical health outcomes including, cardiovascular disease, cancer and asthma. Moreover, positive health behaviors such as physical activity, proper nutrition, adequate sleep, and improvements to social relationships, all have been shown to both reduce stress and improve physical and psychological health outcomes.
The injuries sustained by active duty service members in theater differ from those of other conflicts in that they often involve explosions that can maim, cripple and cause traumatic brain injuries TBI epusb many of these injuries would have been fatal in previous wars. Effective prevention efforts for active usapq personnel, Veterans hsapa their Families are needed to address these serious health issues and the on-going stress associated with them as this is a major public health gap.
Health care efficiencies may be gained by leveraging technological developments e. Programs may address substance abuse alone or in combination with co-morbid psychological and physical health problems and health promotion across the Military Lifecycle. The Military Lifecycle encompasses several stages from accession e;ubs separation from the military. The Military Lifecycle includes the deployment cycle: At mobilization, units or individuals and their Families are alerted to the possibility of deployment and undergo preparation consisting of administrative actions, briefings, training, counseling, and medical usaap.
Deployment refers to the actual move to and installation of the military personnel into the designated theater.
During the employment stage personnel perform their assigned mission. The redeployment stage involves preparations for returning personnel, equipment, and material to the home station and begins the process of reintegrating personnel into their pre-deployment environments.
The post-deployment stage consists of administrative actions, briefings, training, counseling, and medical evaluations to facilitate the continued successful reintegration of military personnel into their families and communities. The reconstitution stage begins after completing post-deployment recovery and includes briefings, training, counseling, and medical evaluations aimed at continuing the process of reintegrating into Family, community, and where applicable, civilian jobs.
The four stages are: Deployment which combines deployment and employment; 3. Re-integration which includes redeployment, post-deployment and reconstitution; and 4.
Separation and post-separation, which refer to life after the service. For the purposes of this FOA, the pre-deployment stage includes epjbs and accession. It should be noted that during this stage the functional health of service members compares favorably with other civilian and military populations Smith et al.
Battlemind training is an example of a pre-deployment universal prevention intervention developed by Army researchers that is designed to help foster resiliency and reduce stigma associated with help seeking behavior among Soldiers. Military personnel receiving pre-deployment Battlemind training reported fewer psychological health problems during deployment MHATV, For the purposes epbs this FOA, deployment can include combat deployments, training deployments or exercises, peacekeeping missions, unaccompanied tours.
Deployment is a major transition for the military member and Family, during which the military member must accommodate to the new environment, routines, tasks and the threat of physical harm or death. Deployments usually involve an extended period of separation of service suapa and Family. Several epidemiologic studies examined the well-being of deployed service members and suggested negative usaoa for substance abuse and psychological health.
There was a significant increase in the prescribed use of behavioral health medications by the third deployment MHAT VI,indicating a relationship between repeated deployments and increasing psychological health problems. Inhalants were also a problem with 3.
Younger service members with combat exposures had increased rates of new-onset heavy weekly drinking, binge drinking, alcohol-related problems and increases in smoking initiation and relapse Jacobson et al.
Additionally, there was a multiple deployment effect associated with using alcohol, such that personnel were significantly more likely to report using alcohol in their second deployment as compared to their first deployment. In addition to the effects of deployment on the military member, there is evidence of the effects on the Family.
For example, Gibbs et al. In sum, there are serious and adverse consequences of deployment on health, suggesting a window of opportunity for prevention interventions before SUD and or comorbid conditions become entrenched. The Department of Defense DOD mandates post-deployment screening to identify individual health care needs of service members at risk for behavioral health problems, including alcohol related-related problems.
It is worth highlighting that post-deployment screening does not include questions about most illicit drug use, prescription drug misuse, or tobacco use. As such, the rates of amy or prescription drug misuse and disorders among returning troops is unclear. Additionally, military regulations regarding substance use may deter people from seeking treatment out of fear of jeopardizing their careers. Guard, Reservists epus Family members not living within close proximity to a Veterans Administration VA or military medical facility may also have difficulty accessing substance abuse treatment programs and services.
The period of post-deployment and reintegration is an opportunity for interventions to both prevent problems before they occur and to prevent escalation of problems, especially within the social context of peers and Family. Screening, brief intervention and referral to treatment SBIRT is one evidence-based method that has been utilized for identification of problems and implementation of brief prevention and health promotion interventions.
This approach has promise for preventing the occurrence of or escalation of psychological and physical health problems, including drug abuse, thereby reducing the use of costly treatments. This aspect of the deployment qrmy presents vulnerability and opportunities for prevention and health promotion interventions to both prevent problems before they occur and to prevent the escalation of problems to drug abuse, psychological health disorders, physical ailments or co-morbid problems.
Those who separate from the service experience similar problems to those who return and stay in the service. There are recent findings from the Millennium Cohort Study Littman, et al. Previous studies have reported higher rates of obesity in veterans. These findings clearly highlight the need for evidence-based health promotion and prevention interventions targeting SUDs and comorbid psychological and physical health problems for Veterans. An important issue to consider is the high rates of comorbidity between SUDs, psychological disorders, and somatic complaints such as PTSD, depression, anxiety, chronic pain, etc.
Prevention interventions that target both drug use and abuse and co-morbid mental and physical health problems are often clinically warranted.
Drug abuse prevention interventions have shown to have effects on a wide array of behaviors, including preventing or decreasing severity of psychological mip problems e. However, there are many approaches that have not been tested, as well as many evidence based prevention interventions that could be adapted for military personnel and their families at all stages of the DC.
File:Combat Action – Wikipedia
Stigma associated with divulging psychological health problems and treatment in mio military and VA health system is widely assumed, but not well documented e. There is equal, if not greater stigma attached to divulging drug use and abuse problems.
This may reflect the low tolerance policies of the military regarding illegal drug use and abuse, placing military personnel seeking treatment for drug abuse at risk of being discharged and losing benefits. These constraints make drug abuse in the military a difficult topic to study. Because of these issues with stigma, prevention becomes very important in the military system, especially epubd interventions, where everyone receives an intervention and no one is singled out as needing intervention.
Prevention interventions delivered in primary care clinics help minimize issues related to stigma. Military operations have been described as particularly usaoa for Reserve and National Guard families who have less access to military support systems and fewer connections to other military families.
In addition, deployed Reserve and National Guard personnel with reported combat exposures are at increased risk of new-onset heavy weekly drinking, binge drinking, and alcohol-related problems Jacobson et al. It has already been noted that reserve component military personnel required more psychological health treatment upon their return in comparison to active duty personnel Milliken et al. In sum, the purpose of this FOA is to fund pilot and feasibility research studies that examine: The NIDA R34 mechanism does not support the development of intervention protocols, manuals, or the standardization of protocols.
Applications to this R34 FOA are not required to present pilot data in support of the proposed hypotheses and aims; rather a well defined theory of change or logic model and associated hypotheses are expected.
Research on all arms of the military Reserves, National Guard, and Veterans is relevant. Eppubs should consider the deployment cycle, from pre-deployment through separation, as this knowledge helps to define the nature and scope of the stress and challenges these usapaa are likely to experience as well as the intervention approaches that are most likely to be effective. Limits related to confidentiality concerning research data that involves reporting of illegal behavior by active duty military personnel has the potential to impact the generalizability of data collected from these individuals.
Therefore, it is expected that studies using active duty populations will mainly focus on collection of outcomes of legal substances including prescription drug abuse.
Studies conducted with Family members or Veterans may target the full range of armmy of misuse, including prescription drugs. The primary objective of this FOA is to stimulate pilot and feasibility research on approaches for the prevention of drug use onset and progression to drug abuse and dependence, drug related problems e. Prevention interventions for substance use and abuse and associated difficulties can include universal, selective, indicated and tiered interventions.
Universal prevention interventions are targeted to the general public or to a whole population group. Selective prevention interventions are targeted to individuals or subgroups of the population with defined risk factors for the development of substance abuse. Indicated prevention interventions are targeted to individuals or subgroups that are identified as having non-clinical but detectable signs or symptoms foreshadowing drug abuse, dependence, and addiction.
A tiered approach to prevention interventions incorporates two or more of these levels of intervention with increasing intervention intensity for individuals at greater risk or with greater problem severity.
Applications may include pilot and feasibility studies of: Prevention interventions should focus on increasing resilience and intrapersonal, interpersonal and familial functioning in order to prevent drug use and abuse and associated adjustment problems. Additionally, data suggests that some military members initiate tobacco use after entering military service Nelson, ; interventions may also target environmental policies that have the potential to promote or impede tobacco use by military members.
The Army Substance Abuse Program; http: Potential study topics for prevention and health promotion interventions include but are not limited to:. This policy applies to all NIDA funded research conducted domestically or internationally.
For more information see https: The National Advisory Council on Drug Abuse NACDA recognizes the importance of research involving the administration of drugs with abuse potential, and dependence or addiction liability, to human subjects. Potential applicants are encouraged to obtain and review these recommendations of Council before submitting an application that will administer compounds to human subjects.
The National Advisory Council on Drug E;ubs NACDA encourages NIDA and its grantees to consider the points it has set forth with regard to existing or prospective sponsored research agreements with tobacco companies or their related entities and the impact of acceptance of tobacco industry funding eppubs NIDA’s credibility and reputation within the scientific arm.
NIDA strongly encourages investigators involved in human-subjects studies to employ a common set of tools and resources that will promote the collection of comparable data across studies and to do so by incorporating the measures from the Core and Specialty collections, which are available in the Substance Abuse and Addiction Collection of the PhenX Toolkit www.