Consistent with national recommendations, educational and vocational success is a desired outcome of reaching adulthood.⁵ The provider can assist the potential service member and family with an assessment of military service suitability as a potential path to adult independence. Patient-centered anticipatory guidance regarding military service combines knowledge of AYA medicine with an understanding of military service.

Providing military guidance includes four steps: educate, articulate, navigate, and matriculate.³ First, AYAs should educate themselves about the specific branch of the military, with information from multiple sources, such as the Internet, discussion with current or previous service members, and through a recruiter. If possible, the young person should speak to trusted friends or relatives with military experience. Second, the adolescent or young adult should articulate what the military offers, and what the military expects in return, and then be able to complete the sentence, “I plan to join the military because…” or “I decided against the military because…” Third, the interested adolescent or young adult should navigate the best individual path, considering whether to enlist directly out of high school or seek a commission after higher education, and if they prefer the Army or another service branch such as the Navy, Marines, or Air Force. Adolescents who enter the military for specific occupational training should take the Armed Services Vocational Aptitude Battery (ASVAB) before signing an enlistment contract. In this way, he or she would have a better understanding of his or her potential for acceptance into his or her preferred specialty or vocation. For example, an adolescent or young adult who wants to be in the medical field but scores poorly on the ASVAB would not qualify for training and assignment as a medic. Finally, the adolescent should matriculate only after discussion with family, as well as reviewing options with a service branch-specific recruiter who can facilitate the administrative and logistic elements of serving.

The three primary reasons for disqualification in 2012 were

Almost all of those who enlisted and were accepted into the military in 2012 had a high school diploma or greater. Those enlisting were required to take the standardized ASVAB to measure verbal, math, science, technical, and spatial abilities. Young adults entering the service as officer candidates through a service academy or Reserve Officer Training Corps (ROTC) scholarship qualify academically through their high school performance and do not take the ASVAB for placement.⁷ Medical students who wish to join the
military can qualify for the Health Professions Scholarship Program (HPSP), which requires a military commitment in exchange for medical school tuition. Commissioning after ROTC or service academy education requires successful completion of undergraduate studies and continued medical qualification. Medical students who are accepted into the HPSP are immediately commissioned into the reserves as officers during school if they meet the physical and legal requirements.

Physical standards are set by the Department of Defense, where applicants are screened with both standardized questions and a physical examination. Men must be between 60- and 80-inches tall and women 58- to 72-inches tall. Medical conditions such as asthma may be allowed in the service with a waiver. Individuals with other conditions may have a time requirement before eligibility. For instance, AYAs with attention deficit hyperactivity disorder (ADHD) treated with medication must maintain performance for 1 year without medication before acceptance into the service.⁸ Before considering military service, AYAs should be aware of personal conditions that are disqualifying and the diagnoses that will not generally receive a waiver. Table 75.1 highlights several conditions that are not favorable to military service and identifies common conditions that are associated with members leaving the service before completing their obligation. All applicants are screened with a background check to detect felonies and serious financial problems. Though a waiver may be possible for civic issues, most applicants with a criminal record are disqualified. In fact, applicants who give false information prior to entry may be dishonorably discharged after joining the service.

Providers without military expertise may wish to further their own education before providing military guidance by using the resources in this chapter or discussing military service with others. Providers should also know individuals who are more qualified to clarify such issues. Important anticipatory guidance includes explaining weight standards, clarifying the significance of academics in military career opportunities, and encouraging the AYAs to research and speak openly about military service.

Sovereign countries rely disproportionately upon their AYAs to make up their military population.²,⁹ Demographic differences exist between active duty and selected reserve populations. With more than 2 million people on active duty and in the reserves, 43% and 33% respectively are ≤25 years. Enlisted members represent the backbone of the military, with a ratio of five enlisted personnel for every officer.¹⁰,¹¹ Figures 75.1 and 75.2 depict the enlisted age distribution, highlighting the proportion of AYAs who are ≤25 years and are active military and selected reserves, respectively. The military is predominately male, with 85% men. Minorities comprise 30% and 24% who are active duty and in the selected reserves, respectively.

Physical injuries from both combat and training can affect the AYAs and their family. Overuse injuries as a consequence of training and recreational activities require prevention and treatment. Brain injuries, such as those caused by improvised explosive devices, are characteristic of the recent conflicts and can have long-lasting sequelae.

The invisible wounds of war are also critical to evaluate as suicide rates have increased among soldiers returning from deployment, and 15% of female veterans from Iraq and Afghanistan who have visited a Veterans Affairs (VA) facility have screened positively for sexual trauma.¹²,¹³ Those returning from deployment may suffer from traumatic brain injury as well as psychiatric disorders,
including posttraumatic stress disorder (PTSD) that may present without visible manifestations.

It is hard to obtain comparable data on health morbidity between young adults in the military compared to young adult civilians. There is the Department of Defense Survey of Health Related Behavior among Military Personnel. However, this is not consistent in questions asked or in the same time frame as some national surveys of nonmilitary young adults. However, Table 75.2 is an attempt to provide some comparisons from the military surveys to the nonmilitary young adult survey. Of interest: