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Arnold School of Public Health

Doctoral student awarded nearly $800K to address high rates of musculoskeletal-related medical discharges in the Army

June 8, 2022 | Erin Bluvas, bluvase@sc.edu

The Defense Health Agency’s Military Health System Research Program has awarded $797K to Kristen Zosel (Wilburn), a doctoral candidate in the Department of Health Promotion, Education, and Behavior, in conjunction with her research fellowship with the U.S. Army Research Institute of Environmental Medicine (USARIEM). Zosel will use the two-year grant to examine the role of social networks on health-related behaviors and musculoskeletal-related medical discharges in the Army.

“Musculoskeletal injuries and medical discharge in the U.S. Army degrade health readiness and are costly,” says Zosel.

Social relationships are especially critical for promoting healthy lifestyle behaviors – factors that are key for preventing and facilitating recovery from a musculoskeletal injury.

-Kristen Zosel, HPEB doctoral candidate

These types of injuries account for 65 percent of soldiers who cannot deploy and contribute to more than 10 million limited or lost duty days each year. Previous research has already identified who is more at risk for developing musculoskeletal injuries (e.g., female, older, members of non-combat units) and more likely to be medically discharged from basic combat training (e.g., smokers, female, separated/divorced, poor cardiorespiratory fitness). However, these studies have only focused on the musculoskeletal injuries at the individual level.

“Greater surveillance and reporting of these demographic risk factors has helped us understand the musculoskeletal injury problem at the individual level, but these factors do not account for the dynamic and complex social structures in which soldiers are embedded,” Zosel says. “Social relationships are especially critical for promoting healthy lifestyle behaviors – factors that are key for preventing and facilitating recovery from a musculoskeletal injury.”

In addition to helping solve a widespread military challenge, Zosel’s project combines her background as a former physical therapist with the U.S. Army and the knowledge/skills she has gained during her Ph.D. program. The Norman J. Arnold Doctoral Fellow knew she was interested in public health back in high school and studied exercise and sports science at Oregon State University just 2.5 hours North of her hometown.

My experiences as an Army physical therapist led me back to public health because it was apparent that upstream factors, such as a soldier’s previous health or policies governing promotion, contributed to their risk for and recovery from musculoskeletal injury.

-Kristen Zosel, HPEB doctoral candidate

After a year as an exercise specialist at a nearby hospital, Zosel returned to school (this time at Baylor University) to complete a Doctor of Physical Therapy. Following her graduation in 2011, Zosel served in the U.S. Army as a physical therapist – holding various leadership positions and receiving honors (Army Commendation Medal in 2013, 2016; Army Achievement Medal 2011) until landing a Research Fellowship at USARIEM through the Oak Ridge Institute for Science and Education (ORISE) in 2016 to support her doctoral studies.

“My experiences as an Army physical therapist led me back to public health because it was apparent that upstream factors, such as a soldier’s previous health or policies governing promotion, contributed to their risk for and recovery from musculoskeletal injury,” says Zosel, who zeroed in on UofSC after watching a video about HPEB assistant professor Courtney Monroe’s research. “My interest in how social networks influence health and using more ecologically valid approaches to understanding how good health may be enabled or constrained by our social and physical environments really grew out of exposure to specific classes I had access to at the UofSC.”

Zosel has found numerous mentors at the Arnold School, including HPEB faculty April Winningham and Rachel Davis. Naturally she’s worked most closely with her advisor, who will serve as co-investigator on the project along with several other close collaborators*.

“Dr. Monroe has been a tremendous mentor who genuinely wants what’s best for me personally and professionally,” Zosel says. “She’s always made time to meet with me, and from the start has gone out of her way to help me network both inside and out of the department. She has shared her experiences and advice with the grant writing and execution process. She’s also been a great role model for navigating academia as a woman. It’s been a great fit, and I’m grateful to have her as my advisor and mentor!”

I think one of the biggest reasons for the success of the grant proposal is having inter-departmental collaborations, including HPEB, exercise science, sociology and military partners. The willingness of the institution, individual programs and faculty to support this collaboration at UofSC is critical to this project and for future public health endeavors.

-Kristen Zosel, HPEB doctoral candidate

Zosel’s good fortune in mentors and success in building a network of collaborators in one of the key contributors to receiving this funding. 

“I think one of the biggest reasons for the success of the grant proposal is having inter-departmental collaborations, including HPEB, exercise science, sociology and military partners,” says, Zosel, who also recieved the Olga I. Ogoussan Doctoral Research Award to support this work. “The willingness of the institution, individual programs and faculty to support this collaboration at UofSC is critical to this project and for future public health endeavors.”

*Additional investigators include Richard Westrick, DPT, DSc (USARIEM); Courtney Monroe, Ph.D. (HPEB) Diego Leal, Ph.D. (Sociology); Chih-Hsiang “Jason” Yang , Ph.D. (Exercise Science).


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