@article{ref1,
title="Deployment and alcohol use in a military cohort: use of combined methods to account for exposure-related covariates and heterogeneous response to exposure",
journal="American journal of epidemiology",
year="2017",
author="Fink, David S. and Keyes, Katherine M. and Calabrese, Joseph R. and Liberzon, Israel and Tamburrino, Marijo B. and Cohen, Gregory H. and Sampson, Laura and Galea, Sandro",
volume="186",
number="4",
pages="411-419",
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.<br><br>© The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.<p /> <p>Language: en</p>",
language="en",
issn="0002-9262",
doi="10.1093/aje/kww230",
url="http://dx.doi.org/10.1093/aje/kww230"
}