An Economic Impact Assessment of Trends in the Health of U.S. Active Duty Military

Abstract

The objective of this dissertation is to examine trends in the health of the U.S. military population. Using cross-sectional data from the Department of Defense’s Health Related Behaviors Survey (HRBS) and the Military Health System (MHS), I analyze the health and well-being of the U.S. military and related members. Results illuminate differences between the U.S. military and the general population and highlight the exclusive nature of a relatively homogeneous population prone to stress and vice. Three essays contribute to the literature on demand elasticities, cancer costs and social inequality. In my first essay, I determine the impact of cigarette pricing in military retail outlets on the demand for tobacco products among U.S. active duty military. This study makes two important contributions. First, results indicate that stressors, such as depression and combat duty, adversely drive active duty military personnel’s demand for cigarettes. Second, price elasticities of consumption vary consistently with exposure to deployment-related stress. Estimates of price sensitivity are robust to the frequency, intensity and recency of tobacco use. In the second essay, I estimate the excess healthcare expenditures and utilization of adult MHS beneficiaries diagnosed with head, neck and lung cancer with comorbid mood or mental disorders, adjusting for demographic characteristics, institutional variations, use of related services and access to care. I show that comorbidities are a driving force behind increased medical care costs. I also show that the prevalence of depressive disorders is greater among women. And I show that a gender and service gap exists among our active duty, guard and reserve personnel diagnosed with smoking related cancers. In my final essay, I investigate social inequalities in military health. First, I evaluate the role adverse shocks play in military health, using combat-oriented deployments as an intermediary between socioeconomic status and health, and find that combat duty increases the odds ratios of ill health, principally among men suffering from suicide and posttraumatic stress. Second, I add empirical evidence to the social inequality-health linkage by examining the structural channels through which the observed differences in health gradients may operate, fully accounting for the social gradient in the military male population.