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J Occup Med Toxicol. 2013 Mar 5;8(1):5. doi: 10.1186/1745-6673-8-5.

A prospective investigation of injury incidence and risk factors among army recruits in combat engineer training.

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  • 1US Army Institute of Public Health, Epidemiology and Disease Surveillance Portfolio, ATTN: MCHB-IP-DI, 5158 Blackhawk Rd, Aberdeen Proving Ground, MD 21010, USA. joseph.knapik@us.army.mil.



United States Army combat engineer (ENG) training is an intense 14-week course designed to introduce new recruits to basic soldiering activities, Army values and lifestyle, and engineering skills and knowledge. The present investigation examined injury rates and injury risk factors in ENG training.


At the start of their training, 1,633 male ENG recruits were administered a questionnaire containing items on date of birth, height, weight, tobacco use, prior physical activity, and injury history. Injuries during training were obtained from electronic medical records and the training units provided data on student graduation and attrition. Risk factors were identified using Cox regression.


Ninety-two percent of the recruits successfully graduated from the course and 47% of the recruits experienced one or more injuries during training. Univariate Cox regression demonstrated that recruits were at higher injury risk if they reported that they were older, had a higher or lower body mass index, had smoked in the past, had performed less exercise (aerobic or muscle strength) or sports prior to ENG training, had experienced a previous time-loss lower limb injury (especially if they had not totally recovered from that injury), or had a lower educational level.


The present investigation was the first to identify injury rates and identify specific factors increasing injury risk during ENG training. The identified risk factors provide a basis for recommending future prevention strategies.

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