STRESS, ROLE STRAIN, AND HEALTH IN YOUNG ENLISTED AIR FORCE WOMEN WITH AND WITHOUT PRESCHOOL CHILDREN DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy in the Graduate School of The Ohio State University By Denise L. Hopkins-Chadwick, MN, RN The Ohio State University 2005 Dissertation Committee: Approved by Professor Nancy Ryan-Wenger, Advisor Dr. Victoria von Sadovszky ______________________ Dr. Kristi Williams Advisor Nursing Graduate Program ABSTRACT Currently women comprise 15% of the United States military force and 20% of newly recruited enlisted personnel. Statistics show there are gender differences in attrition. Women are at greatest risk to prematurely leave the service. Women leave most frequently due to pregnancy, medical problems, misconduct, performance shortfalls, or parenthood. Military women report that the stress of being in the military is highest among married women with no spouse present, younger enlisted women, and women of least education. Civilian working women report that stress is the highest during the years of having preschool aged children. This suggests that military women's stress may be related both to work and family roles, as well as from being women in the military. Work and family role strain can manifest as stress related symptoms. So, by negatively influencing the health of the individual, the net effect of stress related symptoms and role strain may be to decrease the overall mission readiness of the organization through decreased individual performance and increased attrition. Unfortunately, little is known about the effect of early motherhood on an enlisted career in terms of individual health and organizational mission readiness. This research was guided by the 1999 Social Determinants of Health Model by Marmot ii and Wilkinson. The aims of the study were to answer the following research questions: Are there differences between young enlisted women with and without preschool children on the following variables: marital status, family of origin socioeconomic status, minority status, type of work, perceived availability of military resources, multiple role strain, stress-related symptoms, health status, and career aspiration. 2) Among these variables, what are the best predictors of: a) multiple role strain, b) stress-related symptoms, c) mental health status, d) physical health status and e) career aspiration. Study participants included 100 junior enlisted women (17-24 year olds). A cross-sectional descriptive design was used: One group (50) had preschool children while another group (50) did not. Both groups were stationed at a large Mid-West Air Force Base. Data were collected using a socio-demographic questionnaire that collected data on family of origin socioeconomic status, type of work, marital status, maternal status, minority status, perceived availability of military resources, and career aspiration. The Daily Hassles Scale (multiple role strain both frequency and severity), the Basic Symptoms Inventory-18 (stress-related symptoms), and the SF-8 (mental and physical health) were also used to measure study variables. These 3 instruments are widely used and demonstrate strong reliability and validity. Chi- Square and t-tests indicated no differences between the women with and without preschool children on multiple role strain (frequency and severity), stress related symptoms, mental and physical health, and career aspiration. The only differences were in marital status, rank, and age with the women with children iii being older, of higher rank and mostly married. In all the women, multiple regression analysis indicated that higher severity of multiple role strain scores (10.4% of variance explained) is related to low perceived availability of military resources ratings. Higher stress-related symptoms scores were related to higher frequency of multiple role strain scores (39.9% variance explained) as well as lower career aspiration (3.8% of variance explained). Lower mental health scores were related to high stress related symptoms scores (27.9% of variance explained), lower career aspiration (4.1% of variance explained), being nonwhite (3.9% of variance explained), and high frequency of multiple role strain (4.0% of variance explained). High career aspiration scores were related to higher perceived availability of military resources ratings (16.8% of variance explained), decreased family of origin socioeconomic status (4.5% of variance explained), and increased mental health status (3.3% of variance explained). This suggests that the stress and increased attrition that junior enlisted women experience may have less to do with combining work and motherhood and more to do with individual coping skills and levels of satisfaction with organizational resources. Nursing should be aware of the specific needs of this population through directly assessing the populations served in each healthcare setting. Nursing should also be aware that these women benefit from resources outside of the primary clinic such as life skills management but they often need healthcare workers to coordinate, educate, and follow-up on ancillary services. iv DEDICATION To my husband, Brian Chadwick, the love of my life and our two children, Robert and Madeline, the loves of our lives. v ACKNOWLEDGMENTS I wish to thank my advisor, Dr. Ryan-Wenger, for her guidance, support, and instruction throughout my academic career. I would like to thank Dr. Von Sadovszky for sharing her perspective on individual health related to sexual decision making and providing review of my proposed manuscripts and grant proposals. I thank Dr. Williams for her fresh approach to combining sociology and health, especially for women. A grant from the Tri-Service Nursing Research Program directly supported this research while salary and tuition were supported by the United States Army. Thanks to the many women from Wright Patterson Air Force Base who were so generous to share themselves with me and to their leaders for supporting their involvement in research. vi VITA 1987 B.S.N. in Nursing, Indiana University of Pennsylvania 1995 M.N. in Nursing, University Of Washington PUBLICATIONS 1. Hopkins, D. L. (2002). A needs assessment for nursing assistants. The Journal of Nursing Education and Staff Development 18(3). 152-155. FIELDS OF STUDY Major Field: Nursing vii TABLE OF CONTENTS Abstract……………………………………………………………… ....... ii Dedication…………………………………………………….................. v Acknowledgments……………………………………………………...... vi Vita……………………………………………………………………… ... vii List of Figures………………………………………………………… ..... ix List of Tables………………………………………………………… ...... x Chapters 1. Introduction………………………………………………………… ... 1 2. Perspectives of Early Age at First Motherhood and the Military: A Clash of Cultures …………………................. 3 3. Health Readiness of Junior Enlisted Women: A Sociological Approach to Studying the Health of Potentially Vulnerable Military Women ………………………......................... 27 4. Stress, Role Strain, Health and Attrition of Junior Enlisted Air Force Women with and without Preschool Children.......................................................... 46 5. References.................................................................................. 85 viii LIST OF FIGURES Figure ......................................................................................................... Page 2.1 Percentage of Women in Military Service by Year ........................................... 24 2.2 Number of Enlisted Women and Women Officers ……..… ............................ 25 2.3 Percentage of Women at Enlistment by Age..................................................... 26 3.1Percentage of Male and Female Officers and Enlisted in the United States Military................................................................................................................... 41 3.2 Percentage of Enlisted Female United States Military Recruits for Fiscal Year 2000 by Age .................................................................................................. 42 3.3 Percentage of United States Military Recruits for Fiscal Year 2000 by Race/Ethnicity ....................................................................................................... 43 3.4 Military Social Determinants of Health Model adapted from Marmot and Wilkinson (1999) ............................................................................................. 44 3.5 Research Questions for Health Readiness of Junior Enlisted Military Women from a Social Determinants of Health Perspective ..................................... 45 4.1 Military Social Determinants of Health Model adapted from Marmot and Wilkinson (1999).................................................................................................... 72 ix LIST OF TABLES Table............................................................................................................ Page 4.1 Selected Characteristics of Women with and without Children ........................ 73 4.2 Women with Preschool Children ............................................................... 74 4.3 Interval Level Variables for Junior Enlisted Air Force Women with and 75 without Pre-School Aged Children .................................................................... 75 4.4 Predictors for Frequency of Multiple Role Strain.............................................. 76 4.5 Predictors for Severity of Multiple Role Strain ................................................