Exploring hazing experiences and perceived physical and mental health outcomes in the United States military through a cross-sectional study

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Wiebe, Abigail Bretzin, Adam Roby, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7699046/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Jan, 2026 Read the published version in Injury Epidemiology → Version 1 posted 9 You are reading this latest preprint version Abstract Background : Hazing – defined as an act that is required to gain entry into a group and humiliates, degrades, abuses, endangers, or otherwise embarrasses an individual, irrespective of willingness of the person – is a pervasive problem in the United States (US) military, and can manifest in physical and emotional harm, and in extreme circumstances, death. However, the presentation of hazing, including the experiences experienced and resulting outcomes is scarcely studied, leaving a gap in understanding and a need to specifically investigate this issue. Methods: A cross-sectional study was conducted by administering a survey with questions about hazing experiences and outcomes to 227 service members at a military installation in the Southeast United States over 14 months. Frequency of hazing experiences and outcomes were derived. To understand how the large number of variables related to each other, a cluster analysis provided Jaccard measures of similarities amongst experience variables. Logistic regressions were conducted to test the association between the experiences and outcomes of hazing. Results : A total of 227 service members answered the survey; the final cleaned sample resulted in 202 participants who were primarily active duty (94.0%), in the Army (95.6%), enlisted rank (E1-E4; 58.5%), male (69.6%), and white (49.4%). Almost one-fifth (19.8%) of the 202 participants endorsed experiencing hazing at the installation and over a fifth endorsed experiencing hazing in the form of sexual violence (22.4%), being tricked (27.8%), and acting like a servant (22.3%). Hazing experiences were significantly associated (p <0.05) with greater odds several types of negative physical (ORs ranging from 2.8-15.9) and mental health outcomes (ORs ranging from 4.7-68.0) and multiple effects on the organization, such as desire to leave the military (ORs ranging from 2.9-34.1). Conclusions : Hazing manifests in various manners and results in harmful consequences for both individuals and the organization. The present study provides an understanding of hazing through descriptive epidemiology, which can help both leaders and practitioners to effectively design, customize, and implement programs to address the issue. Hazing Military Health Cross-sectional Injury Prevention Figures Figure 1 Figure 2 Figure 3 BACKGROUND Hazing – defined as an act that is required to gain entry into a group that humiliates, degrades, abuses, endangers, or otherwise embarrasses an individual, irrespective of willingness of the person (Allan & Madden, 2008 ) – is a pervasive problem in the United States (US) military. For further orientation, in the context of the Department of Defense, it is defined as: A form of harassment that includes conduct through which Service members or DoD employees, without proper military or other governmental purpose, but with a nexus to military service, physically or psychologically injure or create a risk of physical or psychological injury to Service members for the purpose of initiation into, admission into, affiliation with, change in status or position within, or continued membership in any military DoD civil organization. Between 2017 and 2020, approximately 200 hazing cases were officially reported in the US military. However, anonymous self-reported surveys suggest that thousands of incidents occurred, indicating that current mechanisms do not truly track incidence (U.S. Government Accountability Office, 2021 ). Accurately determining the incidence of hazing is challenging due to underreporting, driven by service members’ (SMs) inability to clearly identify and define the acts, a culture of silence, and the general acceptance of such behavior (Pershing, 2006 ). Hazing in the civilian sector is associated with numerous psychological and physical consequences for those who experience this violence, including severe pain; symptoms of depression, anxiety, and posttraumatic stress disorder; and in extreme cases, death (Allan & Madden, 2008 ; Finkel, 2002; Hoover, 1999 ; Kirby & Wintrup, 2002 ; Perez, 2019). Hazing can affect relationships with others, belief in leaders (Matthews et al, 2021 ), and erode trust and morale in the organization. Prior research suggests that those who experience hazing feel betrayed by the organization and lose interest in it (Van Raalte et al., 2007 ). In the military, this could also lead to degradation of comradery, lack of cohesion, and distraction from the mission. The literature in the military sector is nascent; there are no systematic reviews on hazing currently, and studies are limited in scope. Current studies lack comprehensive overview of all hazing behaviors (Hernandez, 2015 ; Parks, 2019 ), do not differentiate between hazing and bullying experiences (Østvik & Rudmin F, 2001), are exclusive to a deployed environment (Campbell-Sills et al., 2023 ), or are focused on suicidality (Crowell-Williamson et al., 2019 ; Kim et al., 2019 ). Thus, a comprehensive presentation of types of hazing experiences in the US military and resulting outcomes is not currently documented. This gap in understanding is dire as fatal outcomes from these experiences continue to occur. Illustrative of this detrimental outcome is the dozens of US SMs have died by suicide following hazing incidents over the past decade (Marshall, 2023). Hazing in the US military is nuanced. SMs undergo rigorous physical and mental training, particularly as new recruits (Knapik et al., 2009 ; UCMJ, 2019). During training, the line between acceptable behavior and reportable behavior could quickly blur (Parks & Burgess, 2019 ). New recruits are often more loyal to their immediate social group than to the military or the mission; this can create an atmosphere in which groups act together to haze and/or those hazed do not report it as the perceive it as positively becoming included in the group (Shils, 1950 ; Siebold, 2007 ). Nevertheless, there is a clear distinction between these acts that are necessary to prepare for battle and those that are done to humiliate another for initiation into the group. A Congressional Research Service report suggests that adapting programs from the civilian sector — such as those used on college campuses — could be beneficial for addressing hazing within the US military (Kamarck, 2019 ). Moreover, the DOD has identified a need to build capacity, articulate prevention methods, create formalized consistent reporting and prevention efforts, and reduce risks associated with hazing (U.S. Government Accountability Office, 2016 ). To current knowledge, prevention efforts include training for leaders that defines hazing, discusses misconceptions around hazing, and provides information on formally reporting and prosecuting hazing (Keller, 2017). The next step in this prevention approach is to understand how hazing manifests and its outcomes within the US military as this will equip the organization with information needed to address the issue. Without these data, prevention programs cannot be effectively fitted to incorporate the specific needs of the US military while reducing these behaviors. Therefore, this study aims to document hazing experiences and outcomes at a US military installation through a descriptive, cross-sectional study. Specifically, we investigated the proportion of individuals who endorsed experiencing military specific [eg, blood pinning (Neville, M., & Buchanan, 1997) – slamming a pin into one’s chest after Airborne qualification], nonphysical, violent (inclusive of sexual violence), or other physical hazing acts, and we examined how those experiences related to cohesion (feeling like part of the group, trouble at work, or desire to get out of the military), mental anguish (such as feelings of depression, stress, humiliation, being in danger, and difficulty in relationships), and physical stress (injuries and difficulty sleeping). As research is scant in the field, this study provides a rich source of information from a novel population and is hypothesis generating rather than testing. METHODS A cross-sectional study was conducted to investigate the experiences and outcomes of hazing by distributing an online survey on hazing experiences and outcomes at a large military installation in the Southeastern US, a location with over 52,000 military personnel. Sampling occurred to ensure racial, ethnic, and gender representation of the installation. Data were collected during 2021–2023 from a convivence sample of 227 SMs. The study team recruited SMs over the age of 18 through advertisements (eg, posted flyers) and in-person outreach for a peer and group experiences survey. Participants were assured that the survey was anonymous, with no collection of personally identifiable information nor linkage to the participant in the future. Participants provided electronic consent; in accordance with DOD regulations, SMs that were “off-duty” (not actively participating in military activities) were eligible to receive a $ 10 USD gift card as compensation for participating in the research. The survey took approximately 15 minutes to complete and was administered using a commercially available survey software. Participants were able to endorse all acts that they experienced (ie, they were not required to only choose one). Inclusion criteria consisted of: 1) active-duty status (active duty, activated reservist, or national guardsmen); 2) at least 18 years of age; 3) able to speak and comprehend English sufficiently to complete study instruments; and 4) “off-duty” delineation as defined above. The study was approved by the Womack Human Research Protections Office. Due to the absence of validated surveys specifically designed to assess hazing within military settings, we adapted established instruments from previous research on hazing and violence among college students (Allan, Kerschner, & Payne, 2019 ; Allan & Madden, 2008 ; Allan & Madden, 2012 ; Johnson et al., 2017 ). This previous survey has been implemented in numerous civilian populations and has been found to be reliable and valid. This modified version resulted in a survey that captures SMs’ experiences and outcomes regarding hazing. To ensure participants understood we were referring to hazing experiences, we started questions by stating “Feeling like a part of the group is important. Please click one if you were encouraged to do any of the following to be accepted by your peers since arriving at [military installation].” Although it could be nuanced to discriminate between tasks that were required for job duties and those that constitute as hazing, this prompt for these questions stated to participants that these actions should be considered as those required to gain entry to a group provide a delineation. Other research efforts have included survey creation and validation since the inception of this study; although the authors were unable to use these other self-created surveys, the survey utilized has been tested and refined in tens of thousands of college students and is the most widely used instrument to date to assess hazing prevalence. Moreover, in line with the instrument utilized in this study, other instruments also capture similar constructs (eg, physical or sexual acts) surrounding the intention to haze as an act of humiliation for entry to a group and, specific to this population, delineate the difference between acts required for job duties (Campbell-Sills et al., 2023 ; Matthews, 2021). Following a pilot study – which included 10 SMs and 10 civilian/contract personnel, prompting for clarity and understandability – and subsequent question refinement, primarily including alteration of language and typos, deleting questions that were obtuse and difficult to understand the applicability in this population, the final survey comprised 21 items aimed at evaluating the hazing experiences and outcomes experienced by SMs. Participants were asked about experiencing acts of hazing that included physical or sexual violence, military specific acts (eg, blood-pinning), non-physical acts (eg, being forced to act as a servant), physical non-violent acts (eg, being forced to eat gross food), and psychological, physical, and organizational outcomes. Aligned with previous work, participants were first asked about experiences that have previously been found to occur more commonly, followed by those that are less common (Hoover, 1999 ). A full list of questions can be found in Table 1 . (Insert Table 1 , with title: “. Select Survey Questions”). Questions were comprehensive in an effort to better understand this understudied experience and its consequences at the location. Collected demographic characteristics included race/ethnicity, branch, active-duty status, rank, and gender; characteristics of the study population are presented in Table 2 . Heterogeneity in the population sampled could affect hazing behaviors and outcomes experienced. There was not, however, sufficient sample size to conduct analyses by gender and/or rank. (Insert Table 2 , with title: “ Table 2 . Characteristics of Study Participants”). Data Analysis Data were cleaned to exclude participants who failed to respond to any questions about hazing experience, resulting in a final sample of 202 participants (from the original 227 SM sample). The frequency of hazing experiences and outcomes were summarized using descriptive statistics. To explore whether individuals who experienced a given hazing experience also experienced other specific hazing experiences, a cluster analysis was conducted by calculating Jaccard similarity measures – a simple, normalized score – among experience variables and reporting clustering of variables with a dendrogram (Jaccard, 1901 ). There were ten outcomes of interest. Outcomes were simply dichotomous in “yes” or “no” answers. For each outcome, we used logistic regression to identify which, if any hazing experiences were associated with the respective outcome. Univariate regression models were used to consider each hazing experience as an independent variable in isolation (ie., unadjusted). In doing so, the goal was to examine these relationships at high-level due to the exploratory nature of this study. Given the many limitations of potentially overcorrecting during adjusted analyses (Etminan, 2021), analyses are presented as unadjusted. Analyses were conducted with consideration for rank and gender as covariates, however, due to the limited sample size, these were not viable for logistic regressions. Analyses were performed using SAS 9.3M2 (Cary, NC), and Stata 18 (College Station, TX). RESULTS Hazing Experiences Figure 1 reports the prevalence of hazing experiences experienced. When asked if they experienced hazing at the installation, 19.9% of the sample endorsed “yes.” When asked if the participants experienced sexual hazing at the installation broadly, 22.4% of the sample endorsed “yes.” When asked specific questions about sexual violence, 9.8% of participants reported being forced to engage in sexual acts with the other gender. Other sexual violence acts (eg, sexual acts of the same gender) were the least endorsed experiences with the lowest prevalence (2.6-7.0%). Additionally, 22.3% of participants endorsed being forced to act as a servant and 27.8% reported being tricked. Regarding military specific acts, 15.3% of participants endorsed experiencing blood pinning and 11.6% of participants endorsed experiencing koalafying (ie, being forced to hang upside down from a tree). [Insert Fig. 1 here, with title: “ Figure 1 . Endorsement of Experiencing Hazing Behavior or Outcome (N = 202)”]. Cluster analysis revealed two distinct profiles of hazing experiences and characteristics of each. As illustrated in Fig. 2 , experiences and activities linked by shorter branches (closer to 0) co-occurred more — meaning participants who reported one experience were also likely to endorse experiencing the other experience — compared to those connected by longer branches. In the first broad profile, being forced to eat gross food commonly co-occurred with being confined. These experiences also frequently co-occurred with being hit during a game and experiencing "hazing" (defined as being hazed on the installation). Within this profile, being forced to be nude was strongly associated with blood pinning, and both were often linked to being forced to drink alcohol. Participants who reported being tricked also reported being hit or slapped in celebration of a promotion and frequently experienced hazing as sexual violence. Additionally, those forced to act as a servant were often required to secure an item to themselves, while those encouraged to participate in sex acts with individuals of a different gender were also required to display body parts. The second broad profile was characterized by experiences involving sexual violence and humiliation. For instance, koalafying often co-occurred with being encouraged to simulate sexual acts with someone of the same gender. These experiences were further associated with being whipped, which in turn co-occurred with being encouraged to simulate sexual acts with individuals of a different gender and engaging in sex acts with those of the same gender. (Insert Fig. 2 here, with title: “ Figure 2 . Dendrogram of Hazing Experiences”). Hazing Outcomes Participants most commonly endorsed feeling stressed (51.1%), desire to get out of the military (47.2%), and difficulty sleeping (38.6%). Participants least commonly endorsed feeling in danger (11.4%). Prevalence of endorsement of other outcomes ranged between 25.6%-36.5%. All outcomes and their prevalence can be found in Fig. 1 . Figure 3 reflects odds of desire to get out of the military, difficulty sleeping, and feeling stressed, respectively, by hazing experience. Count reflects the number of participants that answered questions both regarding the experience and the outcome. These outcome variables were chosen as they had the greatest prevalence of endorsement by participants. (Insert Fig. 3 here, with the following titles: “ Figure 3 a. Odds of Desire to Get Out of Military by Hazing Experience; Fig. 3 b. Odds of Difficulty Sleeping by Hazing Experience; Fig. 3 c. Odds of Feeling Stressed by Hazing Experience”). All hazing experiences were associated with greater odds of desire to get out of the military (2.8–34.1; p < .05). Participants who experienced sexual violence as hazing were at 34.1 (95% CI: 7.7–151.0) times the odds of endorsing desire to get out of the military as compared to participants that did not experience sexual violence as hazing. Participants who experienced specific acts of hazing as sexual violence that occurred with another person (eg, simulating/participating in sexual acts, displaying body parts), were at over 8 times the odds (8.6–19.0, p < .05) of endorsing desire to get out of the military as compared to those who did not experience these behaviors. Of the experiences analyzed, those who reported being whipped/kicked/beaten as a hazing behavior were at the lowest odds of reporting a desire to leave the military comparatively to other behaviors; however, this finding was not significant (2.7; 95% CI: 0.7–11.0). Those who experienced military specific acts (ie, blood pinning and koalafying) were at 3.5–7.2 ( p < .05) times the odds of desire to get out of the military. Most hazing experiences were associated with greater odds of difficulty sleeping. Participants forced to act like a servant were at 16.0 (95% CI: 6.5–39.0) times the odds of reporting difficulty sleeping than those who did not report being required to act like a servant. Those who experienced military specific acts (ie, blood pinning and koalfying) were at 2.8–4.9 ( p < .05) times the odds of difficulty sleeping. Participants who experienced sexual violence as hazing were at 12.7 (95% CI: 5.0-32.2) times the odds of endorsing difficulty sleeping as compared to those who did not experience sexual violence as hazing. Being forced to be nude and participate in sex acts with the same gender were not significant in determining odds of difficulty sleeping (2.3, 95% CI: .8-7.1; 6.8, 95% CI: .8-62.4). Many hazing experiences were associated with greater odds of feelings stressed. Participants who experienced sexual violence as hazing were at 68.0 (95% CI: 7.7–515.0) times the odds of endorsing feeling stressed as compared to participants that did not experience sexual violence as hazing. Those who experienced the military specific acts of blood pinning and koalafying were at 2.3 (95% CI: .9-5.4) times and 9.9 (95% CI: 2.2–44.5) times the odds of feeling stressed, respectively. Participants were at 34.1 (95% CI 7.9-147.6) times the odds of feeling stressed if they were required to act like a servant. Hazing that occurred as being forced to have sex with the same gender and simulate sex acts with the other gender were not significant in determining odds of feelings stressed (4.1, 95% CI: 0.5–37.4; 5.2, 95% CI: 0.6–45.3). Experiences not presented in forest plots (eg, sex acts with same gender in Fig. 3 c) did not have enough participants endorse the experience for analysis. DISCUSSION There are several notable findings in this study including the frequency of experiencing hazing, co-occurrence of experiencing violent behaviors, increased odds of physical and mental health outcomes associated with experiencing hazing, and negative consequences of hazing that are unique to the US military. Presentation of Hazing Experiences Previously reported estimates of hazing prevalence range from 2–17% of the US military population. In this study, when participants were asked directly if they experienced hazing at the installation, less than 20% endorsed experiencing hazing, however, when asked about specific acts of hazing (eg, acting as a servant or experiencing sexual violence as hazing), participants reported greater prevalence (> 20%). This suggests participants may not consider or be able to delineate all acts of hazing as experiencing hazing and are not always able to identify the behavior. Previous literature in military populations suggests that groups have a difficult time defining hazing, even when provided training on the topic (Pershing, 2006 ); this difficulty is especially prominent when distinguishing between hazing and bullying. These data further highlight that it is difficult for SMs to define and identify hazing appropriately. Although different in many ways (bound by contract, a lack of autonomy over location and schedule, and varied levels of responsibility), collegiate students are a parallel population to the US military in age group, the shared locality of work and living spaces, training for occupation, and similarity in risk taking behavior. In the college setting, Allan (2024) found that 47% of students reported experiencing hazing behaviors, with almost 75% of specific groups (sport and fraternities) experiencing hazing. The most common types of hazing in these groups includes alcohol related experiences (eg, forcing to drink large amounts of alcohol), and being forced to chant or sing in public (Allan, 2024). Almost 20% of participants in this study at a US military installation also reported being forced to drink alcohol, which was one of the more commonly reported experiences. In contrast, experiencing sexual violence and being forced to act as a servant presented as hazing behaviors experienced in this study. This indicates that while some similarities exist between the populations, hazing may present differently in different ways. Thus, prevention programming may need to be specifically tailored to the US military to be successful. More participants reported experiencing sexual violence as hazing than those that reported hazing generally when directly asked. There is no literature, to our current knowledge, that specifically addresses sexual violence occurring as hazing in the US military; rather, reports/publications typically addressing hazing broadly with an acknowledgment that sexual violence is a type of hazing behavior. Nevertheless, Congress has tasked the DOD with addressing hazing incidents of sexual violence (U.S. Department of Defense, 2017 ) and the DOD plans states that sexual violence training should include information regarding the intersection between hazing and sexual violence (U.S. Department of Defense, 2016 ). According to a recent Department of Defense report, a combined 57% of sexual violence assaults committed against male SMs and a combined 29% of assaults against female SMs were categorized by those who experienced the act as “hazing” or “bullying” (Sexual Assault Prevention and Response Office, 2018 ). Moreover, in another report analyzing sexual violence experiences of SMs, 34% of male SMs and 7% of female SMs who experienced this violence categorized their assault as hazing (Morral, Gore & Schell, 2015 ). Sexual violence that occurs as hazing also involved more perpetrators compared to assaults that were not indicated as hazing (Morral, 2015). Behaviors that were identified as sexual violence under the guise of hazing tended to co-occur in this current study, align with these previous reports. Taken together, the data from the current study and existing data suggest that sexual violence as hazing occurs frequently in the US military (with > 20% of participants in this study) and needs to be addressed, as it results in far-reaching consequences to those who experience the violence and the organization. Of note, we are unable to distinguish the reasoning why many behaviors (eg, blood-pinning and sexual violence) co-occurred together in this quantitative study; further qualitative work would be necessary to further distill this relationship. Outcomes of Experiencing Hazing Behaviors Common outcomes of hazing in this study included feeling ashamed and stressed, which is aligned with previous research that found being hazed or bullied on a deployment was associated with negative mental health outcomes such as major depressive disorder and post-traumatic stress disorder (Campbell-Sills et al, 2023 ). One of the most reported outcomes in this study was also difficulty sleeping. In the US military, less than two-thirds of SMs get recommended sleep (Good, 2020) which can have immediate consequences such as fatigue and reaction time (Heaton, 2014) to long-term consequences such as elevated risk of cancer and neurodegenerative diseases (Yaffe et al., 2015 ; Stone, 2019). This current research indicates that experiencing hazing behavior is a risk factor for experiencing difficulty sleeping which can then lead to negative mental and physical health outcomes (eg, feeling stressed or incurring physical injuries), resulting in outcomes that are especially compounding. Hazing acts are presented as a requirement to enter a group (Stop Hazing, 2024 ), rooted in misconceptions around this violence contributing to group cohesion (Campo, 2005; Keating, 2005), solidarity (Cimino 2011 & 2013 ), and identity (Kirby & Wintrup, 2002 ; Van Raalte et al., 2007 ; Waldron, 2009). Despite these fallacies, however, hazing leads to a degradation of relationships (Matthews et al, 2021 ), lack of trust in the organization, decrease of morale, and perceptions of betrayal of fellow members and the institute (Van Raalte et al., 2007 ). In the current study, all hazing experiences (> 20% of the sample) were associated with greater odds of desire to get out of the military (> 47%; ORs: 3–34). Moreover, participants were also at increased odds of experiencing trouble at work, further showcasing the effect of this negative experience on productivity and work environment. Overall, hazing had a negative effect and perceptions toward to institution, leading to a lack of retention. This negative effect is aligned with previous research. The US military also prides itself on community, a cornerstone of its structure. Those who experienced hazing were also at greater odds of having problems in relationships with friends and family. Many SMs have peers of similar age that they regularly work with and are in isolating conditions from others (eg, locality or working hours), which can quickly lead to friendships with co-workers. If these personnel experience hazing behavior at work, it is not surprising that they would have difficulty with friendships – likely personnel they work with –, which can further degrade the morale and unit cohesion as personnel feel unsupported in their work environment (Van Raalte et al., 2007 ). In fact, in a subset of data from this study, the authors found that less than half of SMs that experienced hazing reported it, which can further lead to isolation and feelings of belonging and support (Berry-Caban, 2024). Thus, this study further illustrates the detrimental effects of this behavior on interpersonal relationships. Understanding this behavior and the consequences can inform prevention programming such as the Hazing Prevention Framework (HPF). Created by Allan et al. ( 2018 ), the HPF is a structured set of guidelines, practices, policies, and educational initiatives aimed at preventing hazing within organizations, currently applied in civilian settings, most commonly higher education. This science-based, multi-level approach designed to prevent hazing incorporates public health theories and models (Social Ecological Model, Strategic Prevention Framework, and Community Readiness Model); it addresses hazing at individual, relationship, community, and societal levels, emphasizing the importance of readiness, cultural tailoring, and comprehensive prevention methods for all types of hazing. This framework of prevention science could be applied and adapted to the US military to effectively reduce hazing-related harms. Specific example of this programming would include bystander education. Through information gained in this study, this HPF could be adapted. Limitations Although this work provides vital information, there are limitations. The reported odds ratios also had large confidence intervals, showing a lack of precision. Some of the results that were not significant may be due to a small sample size; similarly, a larger sample could result in smaller p value for those that were significant with more precise confidence intervals. Due to the small and heterogenous sample, the study may have failed to detect relationships that are meaningful but did not display statistical significance. Behaviors and experiences that are listed are broad and encompassing but do not include all questions asked as some experiences that may be classified as hazing in the civilian sector could be understood as necessary in this context, such as sleep deprivation or requiring physical activity (distinguished by decades of subject matter experience of the authors). This highlights the difficultly of studying this behavior in the US military. Also, as we created a scale specifically for this work – since there was not one currently available at the time of study inception – it is possible there was increased subjectivity in the prompts asked. Some questions may be more prone to interpretation such as those questions referencing “body parts.” It is also possible that some acts were endorsed but a part of typical military training [eg, one could have said “yes” to being forced to eat gross food in reference to Meal, Ready-to-Eat (MREs) as the only available food]. It was, however, indicated that these actions were required to gain entry to the group as opposed to acts that all may be experiencing as a part of training for the military mission. Overall, the scale was based on prior work for decades in the civilian sector, however, this context varies, as may the interpretation of the questions. The data that were cleaned due to non-response could have included participants that were lower in rank, and younger in age, due to fear of reporting. In other acts of interpersonal violence (eg, sexual violence), it is reported that this group (lower in rank and younger in age) is least likely to report experiencing these acts but would be likely to experience negative outcomes (Sexual Assault Prevention and Response Office, 2018 ). This would result in bias towards the null and make it smaller in absolute value, with our conclusions being underrepresented in magnitude. Finally, it is possible that participants enrolled that were more comfortable taking the survey as they did not experience the behaviors or outcomes. In contrast, this would yield a bias would away from the null. We were unable to analyze by rank and gender due to this limited sample size. As this work was exploratory in nature, we also did not collect or analyze data that could affect these experiences such as age, time in service, deployment, or specific training experiences. It is possible that specific trainings could confound the relationship observed between the exposure and outcome variables. Although the survey was administered to over 200 participants, not all participants answered questions and this survey took place at an installation with a unique military population as the location has many infantry SMs – hazing experiences in this particular military occupational specialty may vary, since infantry SMs are often in the field as a unit to prepare for combat – and as such, our ability to generalize is limited. Due to limitations of conducting work in a military environment, we were unable to record any information on potential participants that did not answer the survey; thus, we do not have information on non-response bias and cannot evaluate accordingly. Participants may or may not have been required to complete training on hazing in the military, which may affect these results. This data is also specific to the location where and the time in which it was collected. Timing of data collection is based on a myriad of factors in this environment to include troop movement and fluctuation in available population to sample. Of note, the world was also experiencing a global pandemic during this time, and unique attributes of that, such as increased isolation, could have affected these results. CONCLUSIONS Hazing presents in a myriad of ways and leads to negative outcomes for those affected and the organization. This research provides an understanding of this presentation by examining hazing experiences and outcomes through descriptive epidemiology in the US military. Detailing this information can aid both leadership and practitioners in effectively selecting, tailoring, and implementing programming to address this issue. Further research should pilot potential solutions to this issue that affects both the individuals and the US military. Tables Table 1 Select Survey Questions Category Question Activities Have you ever been hazed to be accepted as a member in a [military installation] unit? Feeling like a part of the group is important. Please click one if you were encouraged to do any of the following to be accepted by your peers since arriving at [military installation]. Non-physical hazing Act as a personal servant to others Ordered to perform a task that would trick you into getting in trouble or humiliate you Military specific hazing Hang upside down from a tree or pole (“koalafying”) Blood pinning (ie, bloodwings) Non-violent physical hazing Drink or eat gross stuff (ie, bodily fluids, combinations of food/vile substances, etc.) Drink large amounts of an alcoholic beverage Be tied up, taped, or confined to small space Secure items to yourself using string or rope Physical violence as hazing Be punched or slapped in celebration of an event (i.e., "pink belly," promotion) Be whipped, kicked, or beaten Participate in games where you were required to hit or slap someone or be hit or slapped yourself Sexual violence as hazing Simulate sex acts in front of the same gender Simulate sex acts in front of other gender Do sex acts with the same gender Do sex acts with another gender Display sexual body parts in front of a group or individual Be nude or partially nude in front of the group or in public place As a result of participating in any of these activities, did you: Feel less like a part of the team or group? Feel humiliated or degraded? Feel ashamed, guilty or depressed? Feel in danger? Feel stressed? Have difficulty sleeping? Incur physical injuries? Have trouble with work? Have problems in relationships with friends and/or family? Consider getting out of the military? A multiple part question classified as sexual violence at the installation: During your military service, has someone ever...(harassed you… in a way that made you feel unsafe, taken sexual photos… when you didn’t want to, kissed you…when you didn’t want to, fondled or grabbed your sexual body parts, removed or attempted to remove your clothing, made sexual comments, jokes gestures or looks about/to you, said you were gay or lesbian as an insult)?... During your military service, when you were drunk, high, drugged, or passed out and unable to consent, have people ever. (had vaginal sex, made you perform/receive anal sex, make you perform/receive oral sex)?... Considering the definition of hazing provided in this survey, did any of the previous items occur as a form of hazing within a [military installation] unit? Table 2 Characteristics of Study Participants Characteristic N = 202 % (Total 100) Military Status Active Duty 169 94.0 Reserves 5 2.8 Other 6 3.3 Branch Army 172 95.6 Air Force 2 1.1 Marines 3 1.7 Navy 3 1.7 Rank E1-4 103 58.5 E5-6 44 25.0 E7-9 7 4.0 O1-3 16 9.1 O4 or higher 4 2.3 W1-4 2 1.1 Gender Male 120 69.6 Female 52 29.7 Other 3 1.7 Race White 85 49.4 Hispanic/Latino 32 18.6 Black 28 16.3 Asian 14 8.1 Other 7 4.1 Native American 3 1.7 Native Hawaiian or Other Pacific Islander 3 1.7 Note: Due to rounding, percentages may not equal 100. Abbreviations SMs Service Members US United States Declarations Ethics approval and consent to participate The study received approval by the Womack Human Research Protections Office and all participants provided electronic consent. Consent for publication Not applicable Competing interests Nothing to disclose Funding This project was funded by Congressionally Directed Research Programs. The funder did not have a role in the design, data collection, analysis, interpretation, or dissemination of these findings. Author Contribution E.M. contributed to study design, completed analyses, and drafted the manuscript. D.W. contributed to analyses and manuscript drafting. A.B. contributed to data analysis. A.R. contributed to study design, manuscript review, and data collection. E.J.A. and L.M.O. contributed to study design, manuscript drafting, and analysis plans. C.B.C. oversaw data collection and study design, and contributed to the manuscript drafting. All authors reviewed the manuscript. Acknowledgement We thank Carissa L. Petrillo and Bryce Meerhaeghe for their vital contributions in data collection. 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2","display":"","copyAsset":false,"role":"figure","size":30800,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"MetzgerFigure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7699046/v1/708b75c7c537cfc8205b24f4.png"},{"id":93248126,"identity":"99b808d0-21bd-450d-9009-00d3b7ebc1c9","added_by":"auto","created_at":"2025-10-10 15:33:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":654684,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"MetzgerFigure31.png","url":"https://assets-eu.researchsquare.com/files/rs-7699046/v1/dd6e74092824699cb8b858de.png"},{"id":100614684,"identity":"bf7701fc-036b-47b7-83ec-efb83a71a0c6","added_by":"auto","created_at":"2026-01-19 17:23:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1289071,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7699046/v1/2c3b777f-a5b6-49fb-a169-eddb43ed1506.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring hazing experiences and perceived physical and mental health outcomes in the United States military through a cross-sectional study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eHazing \u0026ndash; defined as an act that is required to gain entry into a group that humiliates, degrades, abuses, endangers, or otherwise embarrasses an individual, irrespective of willingness of the person (Allan \u0026amp; Madden, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2008\u003c/span\u003e) \u0026ndash; is a pervasive problem in the United States (US) military. For further orientation, in the context of the Department of Defense, it is defined as:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eA form of harassment that includes conduct through which Service members or DoD employees, without proper military or other governmental purpose, but with a nexus to military service, physically or psychologically injure or create a risk of physical or psychological injury to Service members for the purpose of initiation into, admission into, affiliation with, change in status or position within, or continued membership in any military DoD civil organization.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBetween 2017 and 2020, approximately 200 hazing cases were officially reported in the US military. However, anonymous self-reported surveys suggest that thousands of incidents occurred, indicating that current mechanisms do not truly track incidence (U.S. Government Accountability Office, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Accurately determining the incidence of hazing is challenging due to underreporting, driven by service members\u0026rsquo; (SMs) inability to clearly identify and define the acts, a culture of silence, and the general acceptance of such behavior (Pershing, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2006\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eHazing in the civilian sector is associated with numerous psychological and physical consequences for those who experience this violence, including severe pain; symptoms of depression, anxiety, and posttraumatic stress disorder; and in extreme cases, death (Allan \u0026amp; Madden, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Finkel, 2002; Hoover, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1999\u003c/span\u003e; Kirby \u0026amp; Wintrup, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Perez, 2019). Hazing can affect relationships with others, belief in leaders (Matthews et al, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), and erode trust and morale in the organization. Prior research suggests that those who experience hazing feel betrayed by the organization and lose interest in it (Van Raalte et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). In the military, this could also lead to degradation of comradery, lack of cohesion, and distraction from the mission. The literature in the military sector is nascent; there are no systematic reviews on hazing currently, and studies are limited in scope. Current studies lack comprehensive overview of all hazing behaviors (Hernandez, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Parks, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), do not differentiate between hazing and bullying experiences (\u0026Oslash;stvik \u0026amp; Rudmin F, 2001), are exclusive to a deployed environment (Campbell-Sills et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e), or are focused on suicidality (Crowell-Williamson et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Kim et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Thus, a comprehensive presentation of types of hazing experiences in the US military and resulting outcomes is not currently documented. This gap in understanding is dire as fatal outcomes from these experiences continue to occur. Illustrative of this detrimental outcome is the dozens of US SMs have died by suicide following hazing incidents over the past decade (Marshall, 2023).\u003c/p\u003e\u003cp\u003eHazing in the US military is nuanced. SMs undergo rigorous physical and mental training, particularly as new recruits (Knapik et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; UCMJ, 2019). During training, the line between acceptable behavior and reportable behavior could quickly blur (Parks \u0026amp; Burgess, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). New recruits are often more loyal to their immediate social group than to the military or the mission; this can create an atmosphere in which groups act together to haze and/or those hazed do not report it as the perceive it as positively becoming included in the group (Shils, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e1950\u003c/span\u003e; Siebold, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). Nevertheless, there is a clear distinction between these acts that are necessary to prepare for battle and those that are done to humiliate another for initiation into the group.\u003c/p\u003e\u003cp\u003eA Congressional Research Service report suggests that adapting programs from the civilian sector \u0026mdash; such as those used on college campuses \u0026mdash; could be beneficial for addressing hazing within the US military (Kamarck, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Moreover, the DOD has identified a need to build capacity, articulate prevention methods, create formalized consistent reporting and prevention efforts, and reduce risks associated with hazing (U.S. Government Accountability Office, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). To current knowledge, prevention efforts include training for leaders that defines hazing, discusses misconceptions around hazing, and provides information on formally reporting and prosecuting hazing (Keller, 2017). The next step in this prevention approach is to understand how hazing manifests and its outcomes within the US military as this will equip the organization with information needed to address the issue. Without these data, prevention programs cannot be effectively fitted to incorporate the specific needs of the US military while reducing these behaviors.\u003c/p\u003e\u003cp\u003eTherefore, this study aims to document hazing experiences and outcomes at a US military installation through a descriptive, cross-sectional study. Specifically, we investigated the proportion of individuals who endorsed experiencing military specific [eg, blood pinning (Neville, M., \u0026amp; Buchanan, 1997) \u0026ndash; slamming a pin into one\u0026rsquo;s chest after Airborne qualification], nonphysical, violent (inclusive of sexual violence), or other physical hazing acts, and we examined how those experiences related to cohesion (feeling like part of the group, trouble at work, or desire to get out of the military), mental anguish (such as feelings of depression, stress, humiliation, being in danger, and difficulty in relationships), and physical stress (injuries and difficulty sleeping). As research is scant in the field, this study provides a rich source of information from a novel population and is hypothesis generating rather than testing.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eA cross-sectional study was conducted to investigate the experiences and outcomes of hazing by distributing an online survey on hazing experiences and outcomes at a large military installation in the Southeastern US, a location with over 52,000 military personnel. Sampling occurred to ensure racial, ethnic, and gender representation of the installation. Data were collected during 2021\u0026ndash;2023 from a convivence sample of 227 SMs. The study team recruited SMs over the age of 18 through advertisements (eg, posted flyers) and in-person outreach for a peer and group experiences survey. Participants were assured that the survey was anonymous, with no collection of personally identifiable information nor linkage to the participant in the future. Participants provided electronic consent; in accordance with DOD regulations, SMs that were \u0026ldquo;off-duty\u0026rdquo; (not actively participating in military activities) were eligible to receive a \u003cspan\u003e$\u003c/span\u003e10 USD gift card as compensation for participating in the research. The survey took approximately 15 minutes to complete and was administered using a commercially available survey software. Participants were able to endorse all acts that they experienced (ie, they were not required to only choose one). Inclusion criteria consisted of: 1) active-duty status (active duty, activated reservist, or national guardsmen); 2) at least 18 years of age; 3) able to speak and comprehend English sufficiently to complete study instruments; and 4) \u0026ldquo;off-duty\u0026rdquo; delineation as defined above. The study was approved by the Womack Human Research Protections Office.\u003c/p\u003e\u003cp\u003eDue to the absence of validated surveys specifically designed to assess hazing within military settings, we adapted established instruments from previous research on hazing and violence among college students (Allan, Kerschner, \u0026amp; Payne, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Allan \u0026amp; Madden, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Allan \u0026amp; Madden, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Johnson et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This previous survey has been implemented in numerous civilian populations and has been found to be reliable and valid. This modified version resulted in a survey that captures SMs\u0026rsquo; experiences and outcomes regarding hazing. To ensure participants understood we were referring to hazing experiences, we started questions by stating \u0026ldquo;Feeling like a part of the group is important. Please click one if you were encouraged to do any of the following to be accepted by your peers since arriving at [military installation].\u0026rdquo; Although it could be nuanced to discriminate between tasks that were required for job duties and those that constitute as hazing, this prompt for these questions stated to participants that these actions should be considered as those required to gain entry to a group provide a delineation. Other research efforts have included survey creation and validation since the inception of this study; although the authors were unable to use these other self-created surveys, the survey utilized has been tested and refined in tens of thousands of college students and is the most widely used instrument to date to assess hazing prevalence. Moreover, in line with the instrument utilized in this study, other instruments also capture similar constructs (eg, physical or sexual acts) surrounding the intention to haze as an act of humiliation for entry to a group and, specific to this population, delineate the difference between acts required for job duties (Campbell-Sills et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Matthews, 2021).\u003c/p\u003e\u003cp\u003eFollowing a pilot study \u0026ndash; which included 10 SMs and 10 civilian/contract personnel, prompting for clarity and understandability \u0026ndash; and subsequent question refinement, primarily including alteration of language and typos, deleting questions that were obtuse and difficult to understand the applicability in this population, the final survey comprised 21 items aimed at evaluating the hazing experiences and outcomes experienced by SMs. Participants were asked about experiencing acts of hazing that included physical or sexual violence, military specific acts (eg, blood-pinning), non-physical acts (eg, being forced to act as a servant), physical non-violent acts (eg, being forced to eat gross food), and psychological, physical, and organizational outcomes. Aligned with previous work, participants were first asked about experiences that have previously been found to occur more commonly, followed by those that are less common (Hoover, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e1999\u003c/span\u003e). A full list of questions can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. \u003cem\u003e(Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, \u003cem\u003ewith title: \u0026ldquo;. Select Survey Questions\u0026rdquo;).\u003c/em\u003e Questions were comprehensive in an effort to better understand this understudied experience and its consequences at the location.\u003c/p\u003e\u003cp\u003eCollected demographic characteristics included race/ethnicity, branch, active-duty status, rank, and gender; characteristics of the study population are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Heterogeneity in the population sampled could affect hazing behaviors and outcomes experienced. There was not, however, sufficient sample size to conduct analyses by gender and/or rank. \u003cem\u003e(Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, \u003cem\u003ewith title: \u0026ldquo;\u003c/em\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. \u003cem\u003eCharacteristics of Study Participants\u0026rdquo;).\u003c/em\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003e Data were cleaned to exclude participants who failed to respond to any questions about hazing experience, resulting in a final sample of 202 participants (from the original 227 SM sample). The frequency of hazing experiences and outcomes were summarized using descriptive statistics. To explore whether individuals who experienced a given hazing experience also experienced other specific hazing experiences, a cluster analysis was conducted by calculating Jaccard similarity measures \u0026ndash; a simple, normalized score \u0026ndash; among experience variables and reporting clustering of variables with a dendrogram (Jaccard, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e1901\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThere were ten outcomes of interest. Outcomes were simply dichotomous in \u0026ldquo;yes\u0026rdquo; or \u0026ldquo;no\u0026rdquo; answers. For each outcome, we used logistic regression to identify which, if any hazing experiences were associated with the respective outcome. Univariate regression models were used to consider each hazing experience as an independent variable in isolation (ie., unadjusted). In doing so, the goal was to examine these relationships at high-level due to the exploratory nature of this study. Given the many limitations of potentially overcorrecting during adjusted analyses (Etminan, 2021), analyses are presented as unadjusted. Analyses were conducted with consideration for rank and gender as covariates, however, due to the limited sample size, these were not viable for logistic regressions. Analyses were performed using SAS 9.3M2 (Cary, NC), and Stata 18 (College Station, TX).\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eHazing Experiences\u003c/h2\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e reports the prevalence of hazing experiences experienced. When asked if they experienced hazing at the installation, 19.9% of the sample endorsed \u0026ldquo;yes.\u0026rdquo; When asked if the participants experienced sexual hazing at the installation broadly, 22.4% of the sample endorsed \u0026ldquo;yes.\u0026rdquo; When asked specific questions about sexual violence, 9.8% of participants reported being forced to engage in sexual acts with the other gender. Other sexual violence acts (eg, sexual acts of the same gender) were the least endorsed experiences with the lowest prevalence (2.6-7.0%). Additionally, 22.3% of participants endorsed being forced to act as a servant and 27.8% reported being tricked. Regarding military specific acts, 15.3% of participants endorsed experiencing blood pinning and 11.6% of participants endorsed experiencing koalafying (ie, being forced to hang upside down from a tree). \u003cem\u003e[Insert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003ehere, with title: \u0026ldquo;\u003c/em\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. \u003cem\u003eEndorsement of Experiencing Hazing Behavior or Outcome (N\u0026thinsp;=\u0026thinsp;202)\u0026rdquo;].\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eCluster analysis revealed two distinct profiles of hazing experiences and characteristics of each. As illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, experiences and activities linked by shorter branches (closer to 0) co-occurred more \u0026mdash; meaning participants who reported one experience were also likely to endorse experiencing the other experience \u0026mdash; compared to those connected by longer branches.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eIn the first broad profile, being forced to eat gross food commonly co-occurred with being confined. These experiences also frequently co-occurred with being hit during a game and experiencing \"hazing\" (defined as being hazed on the installation). Within this profile, being forced to be nude was strongly associated with blood pinning, and both were often linked to being forced to drink alcohol. Participants who reported being tricked also reported being hit or slapped in celebration of a promotion and frequently experienced hazing as sexual violence. Additionally, those forced to act as a servant were often required to secure an item to themselves, while those encouraged to participate in sex acts with individuals of a different gender were also required to display body parts.\u003c/p\u003e\u003cp\u003eThe second broad profile was characterized by experiences involving sexual violence and humiliation. For instance, koalafying often co-occurred with being encouraged to simulate sexual acts with someone of the same gender. These experiences were further associated with being whipped, which in turn co-occurred with being encouraged to simulate sexual acts with individuals of a different gender and engaging in sex acts with those of the same gender. \u003cem\u003e(Insert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003ehere, with title: \u0026ldquo;\u003c/em\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. \u003cem\u003eDendrogram of Hazing Experiences\u0026rdquo;).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eHazing Outcomes\u003c/h3\u003e\n\u003cp\u003eParticipants most commonly endorsed feeling stressed (51.1%), desire to get out of the military (47.2%), and difficulty sleeping (38.6%). Participants least commonly endorsed feeling in danger (11.4%). Prevalence of endorsement of other outcomes ranged between 25.6%-36.5%. All outcomes and their prevalence can be found in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003e reflects odds of desire to get out of the military, difficulty sleeping, and feeling stressed, respectively, by hazing experience. Count reflects the number of participants that answered questions both regarding the experience and the outcome. These outcome variables were chosen as they had the greatest prevalence of endorsement by participants. \u003cem\u003e(Insert\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003ehere, with the following titles: \u0026ldquo;\u003c/em\u003eFigure \u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003ea. \u003cem\u003eOdds of Desire to Get Out of Military by Hazing Experience;\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003eb. \u003cem\u003eOdds of Difficulty Sleeping by Hazing Experience;\u003c/em\u003e Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003ec. \u003cem\u003eOdds of Feeling Stressed by Hazing Experience\u0026rdquo;).\u003c/em\u003e\u003c/p\u003e\u003cp\u003eAll hazing experiences were associated with greater odds of desire to get out of the military (2.8\u0026ndash;34.1; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05). Participants who experienced sexual violence as hazing were at 34.1 (95% CI: 7.7\u0026ndash;151.0) times the odds of endorsing desire to get out of the military as compared to participants that did not experience sexual violence as hazing. Participants who experienced specific acts of hazing as sexual violence that occurred with another person (eg, simulating/participating in sexual acts, displaying body parts), were at over 8 times the odds (8.6\u0026ndash;19.0, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) of endorsing desire to get out of the military as compared to those who did not experience these behaviors. Of the experiences analyzed, those who reported being whipped/kicked/beaten as a hazing behavior were at the lowest odds of reporting a desire to leave the military comparatively to other behaviors; however, this finding was not significant (2.7; 95% CI: 0.7\u0026ndash;11.0). Those who experienced military specific acts (ie, blood pinning and koalafying) were at 3.5\u0026ndash;7.2 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) times the odds of desire to get out of the military.\u003c/p\u003e\u003cp\u003eMost hazing experiences were associated with greater odds of difficulty sleeping. Participants forced to act like a servant were at 16.0 (95% CI: 6.5\u0026ndash;39.0) times the odds of reporting difficulty sleeping than those who did not report being required to act like a servant. Those who experienced military specific acts (ie, blood pinning and koalfying) were at 2.8\u0026ndash;4.9 (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05) times the odds of difficulty sleeping. Participants who experienced sexual violence as hazing were at 12.7 (95% CI: 5.0-32.2) times the odds of endorsing difficulty sleeping as compared to those who did not experience sexual violence as hazing. Being forced to be nude and participate in sex acts with the same gender were not significant in determining odds of difficulty sleeping (2.3, 95% CI: .8-7.1; 6.8, 95% CI: .8-62.4).\u003c/p\u003e\u003cp\u003eMany hazing experiences were associated with greater odds of feelings stressed. Participants who experienced sexual violence as hazing were at 68.0 (95% CI: 7.7\u0026ndash;515.0) times the odds of endorsing feeling stressed as compared to participants that did not experience sexual violence as hazing. Those who experienced the military specific acts of blood pinning and koalafying were at 2.3 (95% CI: .9-5.4) times and 9.9 (95% CI: 2.2\u0026ndash;44.5) times the odds of feeling stressed, respectively. Participants were at 34.1 (95% CI 7.9-147.6) times the odds of feeling stressed if they were required to act like a servant. Hazing that occurred as being forced to have sex with the same gender and simulate sex acts with the other gender were not significant in determining odds of feelings stressed (4.1, 95% CI: 0.5\u0026ndash;37.4; 5.2, 95% CI: 0.6\u0026ndash;45.3). Experiences not presented in forest plots (eg, sex acts with same gender in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e3\u003c/span\u003ec) did not have enough participants endorse the experience for analysis.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThere are several notable findings in this study including the frequency of experiencing hazing, co-occurrence of experiencing violent behaviors, increased odds of physical and mental health outcomes associated with experiencing hazing, and negative consequences of hazing that are unique to the US military.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePresentation of Hazing Experiences\u003c/h2\u003e\u003cp\u003ePreviously reported estimates of hazing prevalence range from 2\u0026ndash;17% of the US military population. In this study, when participants were asked directly if they experienced hazing at the installation, less than 20% endorsed experiencing hazing, however, when asked about specific acts of hazing (eg, acting as a servant or experiencing sexual violence as hazing), participants reported greater prevalence (\u0026gt;\u0026thinsp;20%). This suggests participants may not consider or be able to delineate all acts of hazing as experiencing hazing and are not always able to identify the behavior. Previous literature in military populations suggests that groups have a difficult time defining hazing, even when provided training on the topic (Pershing, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2006\u003c/span\u003e); this difficulty is especially prominent when distinguishing between hazing and bullying. These data further highlight that it is difficult for SMs to define and identify hazing appropriately.\u003c/p\u003e\u003cp\u003eAlthough different in many ways (bound by contract, a lack of autonomy over location and schedule, and varied levels of responsibility), collegiate students are a parallel population to the US military in age group, the shared locality of work and living spaces, training for occupation, and similarity in risk taking behavior. In the college setting, Allan (2024) found that 47% of students reported experiencing hazing behaviors, with almost 75% of specific groups (sport and fraternities) experiencing hazing. The most common types of hazing in these groups includes alcohol related experiences (eg, forcing to drink large amounts of alcohol), and being forced to chant or sing in public (Allan, 2024). Almost 20% of participants in this study at a US military installation also reported being forced to drink alcohol, which was one of the more commonly reported experiences. In contrast, experiencing sexual violence and being forced to act as a servant presented as hazing behaviors experienced in this study. This indicates that while some similarities exist between the populations, hazing may present differently in different ways. Thus, prevention programming may need to be specifically tailored to the US military to be successful.\u003c/p\u003e\u003cp\u003e More participants reported experiencing sexual violence as hazing than those that reported hazing generally when directly asked. There is no literature, to our current knowledge, that specifically addresses sexual violence occurring as hazing in the US military; rather, reports/publications typically addressing hazing broadly with an acknowledgment that sexual violence is a type of hazing behavior. Nevertheless, Congress has tasked the DOD with addressing hazing incidents of sexual violence (U.S. Department of Defense, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) and the \u003cem\u003eDOD plans\u003c/em\u003e states that sexual violence training should include information regarding the intersection between hazing and sexual violence (U.S. Department of Defense, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). According to a recent Department of Defense report, a combined 57% of sexual violence assaults committed against male SMs and a combined 29% of assaults against female SMs were categorized by those who experienced the act as \u0026ldquo;hazing\u0026rdquo; or \u0026ldquo;bullying\u0026rdquo; (Sexual Assault Prevention and Response Office, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Moreover, in another report analyzing sexual violence experiences of SMs, 34% of male SMs and 7% of female SMs who experienced this violence categorized their assault as hazing (Morral, Gore \u0026amp; Schell, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). Sexual violence that occurs as hazing also involved more perpetrators compared to assaults that were not indicated as hazing (Morral, 2015). Behaviors that were identified as sexual violence under the guise of hazing tended to co-occur in this current study, align with these previous reports. Taken together, the data from the current study and existing data suggest that sexual violence as hazing occurs frequently in the US military (with \u0026gt;\u0026thinsp;20% of participants in this study) and needs to be addressed, as it results in far-reaching consequences to those who experience the violence and the organization. Of note, we are unable to distinguish the reasoning why many behaviors (eg, blood-pinning and sexual violence) co-occurred together in this quantitative study; further qualitative work would be necessary to further distill this relationship.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOutcomes of Experiencing Hazing Behaviors\u003c/h3\u003e\n\u003cp\u003eCommon outcomes of hazing in this study included feeling ashamed and stressed, which is aligned with previous research that found being hazed or bullied on a deployment was associated with negative mental health outcomes such as major depressive disorder and post-traumatic stress disorder (Campbell-Sills et al, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). One of the most reported outcomes in this study was also difficulty sleeping. In the US military, less than two-thirds of SMs get recommended sleep (Good, 2020) which can have immediate consequences such as fatigue and reaction time (Heaton, 2014) to long-term consequences such as elevated risk of cancer and neurodegenerative diseases (Yaffe et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Stone, 2019). This current research indicates that experiencing hazing behavior is a risk factor for experiencing difficulty sleeping which can then lead to negative mental and physical health outcomes (eg, feeling stressed or incurring physical injuries), resulting in outcomes that are especially compounding.\u003c/p\u003e\u003cp\u003eHazing acts are presented as a requirement to enter a group (Stop Hazing, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), rooted in misconceptions around this violence contributing to group cohesion (Campo, 2005; Keating, 2005), solidarity (Cimino \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2011\u003c/span\u003e \u0026amp; \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2013\u003c/span\u003e), and identity (Kirby \u0026amp; Wintrup, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2002\u003c/span\u003e; Van Raalte et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2007\u003c/span\u003e; Waldron, 2009). Despite these fallacies, however, hazing leads to a degradation of relationships (Matthews et al, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), lack of trust in the organization, decrease of morale, and perceptions of betrayal of fellow members and the institute (Van Raalte et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). In the current study, all hazing experiences (\u0026gt;\u0026thinsp;20% of the sample) were associated with greater odds of desire to get out of the military (\u0026gt;\u0026thinsp;47%; ORs: 3\u0026ndash;34). Moreover, participants were also at increased odds of experiencing trouble at work, further showcasing the effect of this negative experience on productivity and work environment. Overall, hazing had a negative effect and perceptions toward to institution, leading to a lack of retention. This negative effect is aligned with previous research.\u003c/p\u003e\u003cp\u003eThe US military also prides itself on community, a cornerstone of its structure. Those who experienced hazing were also at greater odds of having problems in relationships with friends and family. Many SMs have peers of similar age that they regularly work with and are in isolating conditions from others (eg, locality or working hours), which can quickly lead to friendships with co-workers. If these personnel experience hazing behavior at work, it is not surprising that they would have difficulty with friendships \u0026ndash; likely personnel they work with \u0026ndash;, which can further degrade the morale and unit cohesion as personnel feel unsupported in their work environment (Van Raalte et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). In fact, in a subset of data from this study, the authors found that less than half of SMs that experienced hazing reported it, which can further lead to isolation and feelings of belonging and support (Berry-Caban, 2024). Thus, this study further illustrates the detrimental effects of this behavior on interpersonal relationships.\u003c/p\u003e\u003cp\u003eUnderstanding this behavior and the consequences can inform prevention programming such as the Hazing Prevention Framework (HPF). Created by Allan et al. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), the HPF is a structured set of guidelines, practices, policies, and educational initiatives aimed at preventing hazing within organizations, currently applied in civilian settings, most commonly higher education. This science-based, multi-level approach designed to prevent hazing incorporates public health theories and models (Social Ecological Model, Strategic Prevention Framework, and Community Readiness Model); it addresses hazing at individual, relationship, community, and societal levels, emphasizing the importance of readiness, cultural tailoring, and comprehensive prevention methods for all types of hazing. This framework of prevention science could be applied and adapted to the US military to effectively reduce hazing-related harms. Specific example of this programming would include bystander education. Through information gained in this study, this HPF could be adapted.\u003c/p\u003e\n\u003ch3\u003eLimitations\u003c/h3\u003e\n\u003cp\u003eAlthough this work provides vital information, there are limitations. The reported odds ratios also had large confidence intervals, showing a lack of precision. Some of the results that were not significant may be due to a small sample size; similarly, a larger sample could result in smaller p value for those that were significant with more precise confidence intervals. Due to the small and heterogenous sample, the study may have failed to detect relationships that are meaningful but did not display statistical significance.\u003c/p\u003e\u003cp\u003eBehaviors and experiences that are listed are broad and encompassing but do not include all questions asked as some experiences that may be classified as hazing in the civilian sector could be understood as necessary in this context, such as sleep deprivation or requiring physical activity (distinguished by decades of subject matter experience of the authors). This highlights the difficultly of studying this behavior in the US military. Also, as we created a scale specifically for this work \u0026ndash; since there was not one currently available at the time of study inception \u0026ndash; it is possible there was increased subjectivity in the prompts asked. Some questions may be more prone to interpretation such as those questions referencing \u0026ldquo;body parts.\u0026rdquo; It is also possible that some acts were endorsed but a part of typical military training [eg, one could have said \u0026ldquo;yes\u0026rdquo; to being forced to eat gross food in reference to Meal, Ready-to-Eat (MREs) as the only available food]. It was, however, indicated that these actions were required to gain entry to the group as opposed to acts that all may be experiencing as a part of training for the military mission. Overall, the scale was based on prior work for decades in the civilian sector, however, this context varies, as may the interpretation of the questions.\u003c/p\u003e\u003cp\u003eThe data that were cleaned due to non-response could have included participants that were lower in rank, and younger in age, due to fear of reporting. In other acts of interpersonal violence (eg, sexual violence), it is reported that this group (lower in rank and younger in age) is least likely to report experiencing these acts but would be likely to experience negative outcomes (Sexual Assault Prevention and Response Office, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). This would result in bias towards the null and make it smaller in absolute value, with our conclusions being underrepresented in magnitude. Finally, it is possible that participants enrolled that were more comfortable taking the survey as they did not experience the behaviors or outcomes. In contrast, this would yield a bias would away from the null.\u003c/p\u003e\u003cp\u003eWe were unable to analyze by rank and gender due to this limited sample size. As this work was exploratory in nature, we also did not collect or analyze data that could affect these experiences such as age, time in service, deployment, or specific training experiences. It is possible that specific trainings could confound the relationship observed between the exposure and outcome variables.\u003c/p\u003e\u003cp\u003e Although the survey was administered to over 200 participants, not all participants answered questions and this survey took place at an installation with a unique military population as the location has many infantry SMs \u0026ndash; hazing experiences in this particular military occupational specialty may vary, since infantry SMs are often in the field as a unit to prepare for combat \u0026ndash; and as such, our ability to generalize is limited. Due to limitations of conducting work in a military environment, we were unable to record any information on potential participants that did not answer the survey; thus, we do not have information on non-response bias and cannot evaluate accordingly. Participants may or may not have been required to complete training on hazing in the military, which may affect these results.\u003c/p\u003e\u003cp\u003eThis data is also specific to the location where and the time in which it was collected. Timing of data collection is based on a myriad of factors in this environment to include troop movement and fluctuation in available population to sample. Of note, the world was also experiencing a global pandemic during this time, and unique attributes of that, such as increased isolation, could have affected these results.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eHazing presents in a myriad of ways and leads to negative outcomes for those affected and the organization. This research provides an understanding of this presentation by examining hazing experiences and outcomes through descriptive epidemiology in the US military. Detailing this information can aid both leadership and practitioners in effectively selecting, tailoring, and implementing programming to address this issue. Further research should pilot potential solutions to this issue that affects both the individuals and the US military.\u003c/p\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSelect Survey Questions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eQuestion\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActivities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHave you ever been hazed to be accepted as a member in a [military installation] unit?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eFeeling like a part of the group is important. Please click one if you were encouraged to do any of the following to be accepted by your peers since arriving at [military installation].\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNon-physical hazing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAct as a personal servant to others\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrdered to perform a task that would trick you into getting in trouble or humiliate you\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eMilitary specific hazing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHang upside down from a tree or pole (\u0026ldquo;koalafying\u0026rdquo;)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBlood pinning (ie, bloodwings)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eNon-violent physical hazing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDrink or eat gross stuff (ie, bodily fluids, combinations of food/vile substances, etc.)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDrink large amounts of an alcoholic beverage\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBe tied up, taped, or confined to small space\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecure items to yourself using string or rope\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePhysical violence as hazing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBe punched or slapped in celebration of an event (i.e., \"pink belly,\" promotion)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBe whipped, kicked, or beaten\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParticipate in games where you were required to hit or slap someone or be hit or slapped yourself\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003eSexual violence as hazing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSimulate sex acts in front of the same gender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSimulate sex acts in front of other gender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo sex acts with the same gender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDo sex acts with another gender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisplay sexual body parts in front of a group or individual\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBe nude or partially nude in front of the group or in public place\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAs a result of participating in any of these activities, did you:\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFeel less like a part of the team or group?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFeel humiliated or degraded?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFeel ashamed, guilty or depressed?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFeel in danger?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFeel stressed?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHave difficulty sleeping?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncur physical injuries?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHave trouble with work?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHave problems in relationships with friends and/or family?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eConsider getting out of the military?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eA multiple part question classified as sexual violence at the installation:\u003c/p\u003e\u003cp\u003eDuring your military service, has someone ever...(harassed you\u0026hellip; in a way that made you feel unsafe, taken sexual photos\u0026hellip; when you didn\u0026rsquo;t want to, kissed you\u0026hellip;when you didn\u0026rsquo;t want to, fondled or grabbed your sexual body parts, removed or attempted to remove your clothing, made sexual comments, jokes gestures or looks about/to you, said you were gay or lesbian as an insult)?...\u003c/p\u003e\u003cp\u003eDuring your military service, when you were drunk, high, drugged, or passed out and unable to consent, have people ever. (had vaginal sex, made you perform/receive anal sex, make you perform/receive oral sex)?...\u003c/p\u003e\u003cp\u003eConsidering the definition of hazing provided in this survey, did any of the previous items occur as a form of hazing within a [military installation] unit?\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of Study Participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;202\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e% (Total 100)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eMilitary Status\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eActive Duty\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e169\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReserves\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eBranch\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eArmy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e95.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAir Force\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarines\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNavy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eRank\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE1-4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE5-6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eE7-9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eO1-3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eO4 or higher\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eW1-4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eRace\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWhite\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHispanic/Latino\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBlack\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAsian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNative American\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNative Hawaiian or Other Pacific Islander\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNote: Due to rounding, percentages may not equal 100.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSMs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eService Members\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited States\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cp\u003eThe study received approval by the Womack Human Research Protections Office and all participants provided electronic consent.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable\u003c/p\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eNothing to disclose\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis project was funded by Congressionally Directed Research Programs. The funder did not have a role in the design, data collection, analysis, interpretation, or dissemination of these findings.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eE.M. contributed to study design, completed analyses, and drafted the manuscript. D.W. contributed to analyses and manuscript drafting. A.B. contributed to data analysis. A.R. contributed to study design, manuscript review, and data collection. E.J.A. and L.M.O. contributed to study design, manuscript drafting, and analysis plans. C.B.C. oversaw data collection and study design, and contributed to the manuscript drafting. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe thank Carissa L. Petrillo and Bryce Meerhaeghe for their vital contributions in data collection.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to Department of Defense requirements but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAllan EJ, Kerschner D, Payne JM. College student hazing experiences, attitudes, and perceptions: Implications for prevention. J Student Affairs Res Pract. 2019;56(1):32\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllan EJ, Madden M. Hazing in view: College students at risk. Orono, ME: University of Maine, Development CoEaH; 2008.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllan EJ, Madden M. (2012). 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Washington, DC: U.S. Government Accountability Office; 2016.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e(2021). Military Hazing: DoD Should Address Data Reporting Deficiencies, Training Limitations, and U.S. Government Accountability Office, Shortfalls P. U.S. Government Accountability Office. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gao.gov/assets/720/718202.pdf\u003c/span\u003e\u003cspan address=\"https://www.gao.gov/assets/720/718202.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eUniform Code of Military Justice (UCMJ, 64 Stat. 109, 10 U.S.C. \u0026sect;\u0026sect; 801\u0026ndash;946), 10 U.S.C. \u0026sect;\u0026sect; 801\u0026ndash;946. (2019). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://jsc.defense.gov/Portals/99/Documents/UCMJ%20-%2020December2019.pdf\u003c/span\u003e\u003cspan address=\"https://jsc.defense.gov/Portals/99/Documents/UCMJ%20-%2020December2019.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVan Raalte JL, Cornelius AE, Linder DE, Brewer BW. The relationship between hazing and team cohesion. J Sport Behav. 2007;30(4):491\u0026ndash;507.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYaffe K, Nettiksimmons J, Yesavage J, Byers. A. Sleep Quality and Risk of Dementia Among Older Male Veterans. Am J Geriatric Psychiatry. 2015;23:651\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"injury-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inep","sideBox":"Learn more about [Injury Epidemiology](https://injepijournal.biomedcentral.com)","snPcode":"40621","submissionUrl":"https://submission.nature.com/new-submission/40621/3","title":"Injury Epidemiology","twitterHandle":"@InjuryEpi","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hazing, Military Health, Cross-sectional, Injury Prevention","lastPublishedDoi":"10.21203/rs.3.rs-7699046/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7699046/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Hazing – defined as an act that is required to gain entry into a group and humiliates, degrades, abuses, endangers, or otherwise embarrasses an individual, irrespective of willingness of the person – is a pervasive problem in the United States (US) military, and can manifest in physical and emotional harm, and in extreme circumstances, death. However, the presentation of hazing, including the experiences experienced and resulting outcomes is scarcely studied, leaving a gap in understanding and a need to specifically investigate this issue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A cross-sectional study was conducted by administering a survey with questions about hazing experiences and outcomes to 227 service members at a military installation in the Southeast United States over 14 months. Frequency of hazing experiences and outcomes were derived. To understand how the large number of variables related to each other, a cluster analysis provided Jaccard measures of similarities amongst experience variables. Logistic regressions were conducted to test the association between the experiences and outcomes of hazing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: A total of 227 service members answered the survey; the final cleaned sample resulted in 202 participants who were primarily active duty (94.0%), in the Army (95.6%), enlisted rank (E1-E4; 58.5%), male (69.6%), and white (49.4%). Almost one-fifth (19.8%) of the 202 participants endorsed experiencing hazing at the installation and over a fifth endorsed experiencing hazing in the form of sexual violence (22.4%), being tricked (27.8%), and acting like a servant (22.3%). Hazing experiences were significantly associated \u003cem\u003e(p\u003c/em\u003e\u0026lt;0.05) with greater odds several types of negative physical (ORs ranging from 2.8-15.9) and mental health outcomes (ORs ranging from 4.7-68.0) and multiple effects on the organization, such as desire to leave the military (ORs ranging from 2.9-34.1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Hazing manifests in various manners and results in harmful consequences for both individuals and the organization. The present study provides an understanding of hazing through descriptive epidemiology, which can help both leaders and practitioners to effectively design, customize, and implement programs to address the issue.\u003c/p\u003e","manuscriptTitle":"Exploring hazing experiences and perceived physical and mental health outcomes in the United States military through a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-10 15:33:02","doi":"10.21203/rs.3.rs-7699046/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-06T18:53:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T18:11:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-02T20:58:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"173817090627466994179244520889499422906","date":"2025-10-02T19:18:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7497491715864015302443026636068801622","date":"2025-09-29T13:39:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-28T00:46:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-26T03:23:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-26T03:22:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Injury Epidemiology","date":"2025-09-24T03:40:48+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"injury-epidemiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"inep","sideBox":"Learn more about [Injury Epidemiology](https://injepijournal.biomedcentral.com)","snPcode":"40621","submissionUrl":"https://submission.nature.com/new-submission/40621/3","title":"Injury Epidemiology","twitterHandle":"@InjuryEpi","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"02475ba9-5798-4ded-8a42-1fe6106f3333","owner":[],"postedDate":"October 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T16:47:01+00:00","versionOfRecord":{"articleIdentity":"rs-7699046","link":"https://doi.org/10.1186/s40621-025-00650-5","journal":{"identity":"injury-epidemiology","isVorOnly":false,"title":"Injury Epidemiology"},"publishedOn":"2026-01-12 16:29:45","publishedOnDateReadable":"January 12th, 2026"},"versionCreatedAt":"2025-10-10 15:33:02","video":"","vorDoi":"10.1186/s40621-025-00650-5","vorDoiUrl":"https://doi.org/10.1186/s40621-025-00650-5","workflowStages":[]},"version":"v1","identity":"rs-7699046","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7699046","identity":"rs-7699046","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}