Counseling Youth About Military Service Options and Selective Service Registration: An Integral Part of Anticipatory Guidance of Adolescents

Department of Neurology, H6-528, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792, USA.
PEDIATRICS (Impact Factor: 5.47). 07/2007; 119(6):1199-203. DOI: 10.1542/peds.2007-0094
Source: PubMed


Available from: Carl Stafstrom, Jan 22, 2015
DOI: 10.1542/peds.2007-0094
2007;119;1199-1203 Pediatrics
Carl E. Stafstrom
Registration: An Integral Part of Anticipatory Guidance of Adolescents
Counseling Youth About Military Service Options and Selective Service
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Counseling Youth About Military Service Options
and Selective Service Registration: An Integral Part
of Anticipatory Guidance of Adolescents
Carl E. Stafstrom, MD, PhD
Section of Pediatric Neurology, Departments of Neurology and Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
The author has indicated he has no financial relationships relevant to this article to disclose.
EDIATRICIANS PLAY A crucial role in counseling ado-
lescents about numerous aspects of health and well-
being. Anticipatory guidance for this age group includes
discussion of risk-taking behaviors; drug, tobacco, and
alcohol use; depression and suicide; sexuality and safe
sex practices; family planning and dynamics; eating dis-
orders; and a wide variety of other health and develop-
mentally related topics.
Counseling this age group may
also include issues related to planning for higher educa-
tion and future vocation. I propose that anticipatory
guidance of adolescents should also include discussion
about military service and alternatives, the laws regard-
ing registration (and consequences for failure to register)
with the Selective Service System (SSS), and the medical
and psychological effects of war. Specific developmental
challenges face adolescents who opt for (United States)
or are required to participate in (many other countries)
military service. By late adolescence, individuals have
usually developed the ability to think in abstract terms,
plan for their future, and engage in independent life
yet this age group still lacks full psychosocial
maturation. Exposure to the demands of military service
(absolute conformity and obedience, lack of indepen-
dence, separation from family, real risk of physical
harm) places unique stresses on adolescents in peace-
time and even more so during times of war.
The purpose of this commentary is to raise awareness
among pediatricians and other providers of adolescent
health care about current SSS laws, possible changes to
such laws that could occur at any time, and options
available to adolescents who, by reason of conscience,
choose not to participate in military service or perhaps
even register with the SSS. To my knowledge, this topic
is rarely if ever discussed in the context of anticipatory
guidance of adolescents facing educational and career
choices, and extensive search of the literature failed to
reveal any references on this topic. Providing adoles-
cents with up-to-date information about SSS require-
ments will allow them to make an informed decision
about registration according to their personal beliefs.
Although my suggestion, to add discussion of military
service issues to anticipatory guidance, requires addi-
tional time and effort on the part of health care provid-
ers, the timeliness and importance of this information
cannot be understated.
The SSS is a US government agency charged with orga-
nizing a draft should one be remanded by the President
and authorized by Congress. The current task of the SSS
is to maintain an updated registry of men aged 18 to 25
years, from which men can be drafted to supplement the
current all-volunteer armed forces.
In the most recent
draft, during the Vietnam War, young men were con-
scripted according to a lottery on the basis of their birth
date; after medical screening, each man reported to his
local Selective Service board (“draft board”). Each mu-
nicipality maintains a draft board. In the case of an active
draft, the local draft board is responsible for classifying
SSS registrants as to their eligibility and suitability for
Opinions expressed in these commentaries are those of the authors and not necessarily
those of the American Academy of Pediatrics or its Committees.
Accepted for publication Feb 12, 2007
Address correspondence to Carl E. Stafstrom, MD, PhD, Department of Neurology, H6-528, University
of Wisconsin, 600 Highland Ave, Madison, WI 53792. E-mail:
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2007 by the
American Academy of Pediatrics
PEDIATRICS Volume 119, Number 6, June 2007 1199
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military service and deciding whether the individual
qualifies for exemption, postponement, or deferment of
military service (see Today, draft boards
still exist but operate on standby status only, because
there is no active draft. However, draft board members
still prepare for the possibility of a new draft with annual
training sessions.
There has not been a draft since 1973, but the law still
requires every man living in the United States to register
with the SSS within 30 days of his 18th birthday. Iron-
ically, even illegal immigrants (other than those admit-
ted on immigrant visas) are required by law to register
with the SSS. Registration is accomplished by filling out
a card that will arrive in the mail to some eligible men;
the form is also available at any post office or online (at The SSS keeps registrant information in
a database so that, should a draft be called, there is a
pool of individuals readily available (currently estimated
at 16 million men). Repercussions for failing to register
with the SSS could include a $250 000 fine and/or a jail
term of up to 5 years. It is important to note that there
have been no prosecutions for failure to register with the
SSS since 1985. However, 41 states and Washington, DC
have laws that deny obtaining (or renewing) a driver’s
license and state loans for postsecondary education to
individuals who fail to register with the SSS. Nonregis-
trants are also ineligible for federal jobs (such as the
Forest Service), federal student aid, and federal job
training. A small number of colleges, especially those
affiliated with the 3 “historic peace churches” (Quakers,
Mennonites, Brethren), provide financial assistance to
SSS nonregistrants.
The question of whether a draft will be reinstated to
supply personnel for the US military remains a matter of
conjecture. There is little public support for conscrip-
and the military favors the current all-volunteer
armed services. Many pundits believe that it would be
impossible, politically, to reinstate such an unpopular
policy. President George W. Bush and members of his
administration have stated on several occasions that the
current professional armed forces is effective and that
they have no plans to reinstitute a draft
despite the
call for an imminent increase in troop strength.
statements notwithstanding, administration and Penta-
gon officials are leaving open the possibility of a draft,
and the secretary of Veterans Affairs recently supported
a draft in public statements.
Some form of conscription
may well occur as the personnel needs of the military
services grow ever more pressing in light of current and
anticipated US military operations.
Pediatricians need
to be informed about these developments to counsel
their patients appropriately.
At this point, there is only speculation as to what form a
new draft would take. The most expeditious plan would
be to restart the old draft system, for which an infra-
structure already exists and for which young men are
already cataloged in a database. Another possibility, in a
less urgent setting, is that a new draft will look very
different from past ones. A revised draft may be cloaked
in language such as “universal” or “mandatory” national
service, with military participation comprising but one
option. In a new draft, several modifications may be
enacted. First, the age of eligibility will likely be ex-
tended to the mid-30s or even mid-40s. Second, specific
occupations will probably be targeted. At present, SSS
registrants are not required to inform the agency about
their profession or skills. However, with an increasing
need for personnel with specialized skills (eg, persons
who are fluent in certain languages, computer special-
ists, medical personnel including physicians), some form
of targeted conscription is likely. In light of the moral
and lack of financial incentives involved in
participating in the military, health care workers in par-
ticular have been increasingly reluctant to enlist.
women may well be included along with men, so both
young women and young men need to become aware of
their options.
There have already been attempts to reinstate con-
scription. Representative Charles Rangel (Democrat,
New York) has introduced a new draft bill during each
recent session of Congress. He states that his intent is to
raise awareness of the inherent injustice of the current
volunteer system, which draws a preponderance of in-
dividuals from lower socioeconomic groups and persons
of color. The most recent bill, House Resolution 163
(Universal National Service Act of 2003), was soundly
defeated in the US House of Representatives (by a vote
of 402 to 2) 1 month before the 2004 presidential elec-
tion. Representative Rangel recently reintroduced the
bill (House Resolution 4752) with a similar provision:
that all persons 18 to 26 years old (male and female) in
the United States perform 2 years of military service or
other service to the country “in furtherance of the na-
tional defense and homeland security, and for other
purposes.” He publicly acknowledges that the bill has
little chance of passing but insists that it will raise aware-
ness of the disparity of race and class between military
recruits and the general population. A similar bill (Sen-
ate 89) languishes in the Senate, where it has been
referred back to the Committee on Armed Services.
One aspect of a new draft that has received little mention
in governmental announcements is that of conscientious
objection. The option to choose noncombatant or alter-
native service was an integral part of past drafts in our
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country. In the most recent draft, during the Vietnam
War, men granted conscientious objector (CO) status
were assigned to a variety of alternative public service
projects within the United States, including work in
mental health facilities, on public service projects, or as
forest fire fighters.
According to the official SSS Web site, a CO is de-
fined as “one who is opposed to serving in the armed
forces and/or bearing arms on the grounds of moral or
religious principles” (see The historic peace
churches have been most prominently associated with
conscientious objection, because the tenets of those re-
ligious denominations forbid killing. However, at least in
past drafts, it was not necessary to belong to one of these
churches or to any religious group or even to profess a
religious belief, to qualify for CO status. To qualify for
CO status, a person needs only to demonstrate a sincere
belief in the immorality of killing in any war (not just a
political objection to a certain war). Ultimately, the de-
cision as to whether an individual met the criteria for
conscientious objection was made by his local draft
Choosing to become a CO is obviously a complex deci-
sion for each individual, but adolescents should be in-
formed that this option exists, and they should be pro-
vided with information on how to establish CO status.
There is currently no legal process for applying for CO
status when registering with the SSS (ie, there is no
“check box” on the SSS enrollment form). Neverthe-
less, it is strongly recommended that interested individ-
uals compile a portfolio that documents their beliefs.
Detailed information about how to identify oneself as a
CO and how to gather appropriate supportive materials
into a portfolio can be obtained through the Web sites
of the above-mentioned peace churches (
LeadersPacket.htm) or from the Center for Conscience
and War, a national clearinghouse for up-to-date informa-
tion about the draft and SSS registration (www.centeron-
In past drafts, and probably in future ones, 3 ques-
tions must be addressed (and ultimately defended in
written and verbal form) by an individual who is pur-
suing CO status. To paraphrase SSS Form 22(1): Describe
the beliefs that are the basis for your claim as a CO. If
appropriate, state whether those beliefs would permit
you to serve in a noncombatant position in the armed
forces or pay taxes for war. (2) Describe how your beliefs
developed. (3) Describe how your beliefs affect the way
you live your life and the type of work you do or plan to
Interested youth should prepare a dossier with re-
sponses to these questions and gather other relevant
information, including any evidence of participation in
peace-promoting activities, educational sessions, read-
ings, or other materials that influenced their beliefs. In
addition, a prospective CO should obtain letters of sup-
port from at least 3 individuals who can attest to the
sincerity of the applicant’s beliefs; it is recommended
that one of these letters be written by someone who does
not necessarily agree with the applicant’s viewpoint but
who can vouch for his or her sincerity (a pediatrician
might well serve in this capacity). Interested adolescents
should prepare these statements and materials now, be-
cause the time available to “prove” CO status may be as
little as 10 days if a draft is enacted (see
As physicians, and pediatricians in particular, we place
high priority on sustaining life and improving its quality.
In accordance with the life-affirming spirit of our pro-
fession, young people should be informed of alternatives
to military service. Although our political and religious
views span a wide spectrum, we need to acknowledge
that military service is not necessarily synonymous with
patriotism and that serving one’s country can be accom-
plished in many other ways than participation in the
armed forces. Few adolescents are aware of available
options, and misinformation abounds about what enlist-
ment in the military entails (Table 1). The active pres-
ence of military recruiters in communities, schools, and
homes necessitates that young people be provided a
balanced viewpoint. Rule-bending and ethically ques-
tionable tactics used by some recruiters, especially with
the increasing pressure to meet enlistment quotas, have
been amply documented
and acknowledged by the
hierarchy of the military services. For example, to allay
further abuses of enlistment protocols, in May 2005 the
US Army temporarily suspended recruiting efforts to
retrain personnel in ethical recruiting practices.
As part of the No Child Left Behind Act of 2001,
military recruiters have access to the names, addresses,
and telephone numbers of every high school student. To
continue to qualify for federal aid, schools are required
to supply this information to military recruiters unless
the parent specifically “opts out” by signing a special
form. Schools are now required to supply this opt-out
form to families under the Family Educational Rights
and Privacy Act. Additional information is available at
Pediatricians can provide important information to
adolescents about the potential for developing posttrau-
matic stress disorder (PTSD).
PTSD and other mental
health problems have affected 18% to 30% of Vietnam
War veterans
and have a current prevalence of almost
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17% among Iraq war combat veterans.
The US gov-
ernment has acknowledged the magnitude of this prob-
lem and has commissioned numerous studies to detect
and intervene in PTSD and other mental health prob-
lems among military personnel.
Although every mili-
tary recruit understands that he or she could incur phys-
ical injury or die, the frequent chronic psychological
scars of PTSD are less well appreciated by young adults.
Lifelong effects of PTSD occur even without physical
Psychological consequences of PTSD can in-
clude frequent reliving of traumatic experiences, night-
mares, flashbacks, avoidance of any reminders of the
trauma (often leading to self-imposed isolation), anxiety
symptoms, depression, substance abuse, poor concentra-
tion, inability to maintain healthy interpersonal rela-
tionships, and long-term social-adjustment difficulties
such as significantly lower rates of employment, mar-
riage, and educational attainment. It would be a disser-
vice to adolescents who are about to enlist in the military
not to make them aware of PTSD and its consequences.
Pediatricians and other health care professionals who are
involved in the care of adolescents should familiarize
themselves with and keep informed about existing laws
regarding SSS registration. Such laws may change any
day. Indeed, if a draft is called, we need to be aware of
the details and be ready to advise adolescents appropri-
ately. Dissemination of such information may take sev-
eral forms, including personal discussions with youth,
participation in local forums and workshops about ca-
reer options, or developing information brochures for
distribution in medical offices and clinics. Information
and resources can also be obtained through the Center
on Conscience and War and other Web sites as noted
above. A new draft might contain provisions markedly
different from previous regulations, but in the mean-
time, it is our responsibility to provide our young pa-
tients with the opportunity to choose to follow their
conscience in whichever direction it leads them.
1. Joffe A, Radius SM. Health counseling of adolescents. Pediatr
Rev. 1991;12:344–351
2. Elster AB, Marcell AV. Health care of adolescent males: over-
view, rationale, and recommendations. Adolesc Med. 2003;14:
525–540, v
3. Marcell AV, Monasterio EB. Providing anticipatory guidance
and counseling to the adolescent male. Adolesc Med. 2003;14:
565–582, v–vi
4. Hardoff D, Halevy A. Health perspectives regarding adolescents
in military service. Curr Opin Pediatr. 2006;18:371–375
5. Richmond TK, Freed GL, Clark SJ, et al. Guidelines for adoles-
cent well care: is there a consensus? Curr Opin Pediatr. 2006;
6. Cave D. Age 16 to 25? The Pentagon has your number, and
more. New York Times. June 24, 2005:A18
7. Draft boards still train. Richmond Post Dispatch [Richmond, VA].
April 21, 2006:A9
8. Lester W. Poll: most people oppose draft. Wisconsin State Jour-
nal. June 25, 2005:A3
9. Hulse C. Military draft? Official denials leave skeptics. New York
Times. July 1, 2004:A1
10. Davenport C. Draft fears persist despite government’s assur-
ances. Capital Times [Madison, WI]. June 3, 2005:A1
11. Barnes JE, Spiegel P. Army wants you, but not in a draft.
Capital Times [Madison, WI]. December 25, 2006:A1
12. Colangelo L, Sisk R. VA boss likes draft: till White House blows
it off. New York Daily News. December 22, 2006
13. Baldor LC. Official: more troops to deploy to Iraq. January 9,
2007. Available at:
09/official-more-troops-to-deploy-to-iraq. Accessed March 6,
14. Bloche MG, Marks JH. When doctors go to war. N Engl J Med.
2005;352:3– 6
15. Gawande A. Casualties of war: military care for the wounded
from Iraq and Afghanistan. N Engl J Med. 2004;351:2471–2475
16. Rosenberg E. Selective Service eyes women’s draft. Seattle Post-
Intelligencer. May 1, 2004:A3
17. Cave D. Growing problem for military recruiters: parents. New
York Times. June 3, 2005:A1
18. Cave D. Army recruiters say they feel pressure to bend rules.
New York Times. May 3, 2005:A17
19. Cave D, Shanker T. With bigger army, a bigger task for recruit-
ers. New York Times. December 24, 2006:A1
20. Cave D. Army to spend day retraining recruiters. New York
Times. May 12, 2005:A24
21. Friedman MJ. Posttraumatic stress disorder among military
TABLE 1 Information for Adolescents: Points to Consider Before Signing a Military Enlistment Agreement
Before deciding to enlist in the military, consider your moral feelings about going to war.
Talk to recent veterans about their experience in the military.
Take along a parent or friend when visiting a recruiter.
Understand that recruiters will emphasize the benefits of military enlistment, not the risks and dangers.
Do not make a hasty decision by enlisting at the first visit to a recruiter. Take time to consider your options. Make sure that all of your questions are answered.
Get all of the recruiter’s promises in writing, but remember that the military can change the terms (such as pay, job assignment, or benefits) at any time. There are no job
guarantees in the military.
Never give false information to a recruiter. Be honest about health problems, police records, and school records.
Get a copy of the enlistment agreement.
There is no “period of adjustment” during which you can request and receive an immediate discharge.
Military personnel cannot exercise all of the civil liberties enjoyed by civilians.
In addition to risks to physical health and well-being, exposure to combat situations markedly increases the risk of PTSD, which can affect lifelong psychological
adjustment and function.
Many nonmilitary opportunities exist to serve the community, nation, and world. Joining the military is not the only way to express one’s patriotism.
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returnees from Afghanistan and Iraq. Am J Psychiatr. 2006;163:
586 –593
22. Dohrenwend BP, Turner JB, Turse NA, Adams BG, Koenen
KC, Marshall R. The psychological risks of Vietnam for U.S.
veterans: a revisit with new data and methods. Science. 2006;
313:979 –982
23. Hoge CW, Auchterlonie JL, Milliken CS. Mental health prob-
lems, use of mental health services, and attrition from military
service after returning from deployment to Iraq or Afghani-
stan. JAMA. 2006;295:1023–1032
24. Hoge CW, Terhakopian A, Castro CA, Messer SC, Engel CC.
Association of posttraumatic stress disorder with somatic
symptoms, health care visits, and absenteeism among Iraq war
veterans. Am J Psychiatr. 2007;164:150–153
25. Miller G. Widening the attack on combat-related mental health
problems. Science. 2006;313:908–909
26. Vieweg WVR, Julius DA, Fernandez A, Beatty-Brooks M, Het-
tema JM, Pandurangi AK. Posttraumatic stress disorder: clini-
cal features, pathophysiology, and treatment. Am J Med. 2006;
“Boston-based Athenahealth Inc [is] one of