Types of Dual and Poly-Tobacco Users in the US Military

The present investigation was designed to determine the prevalence and types of dual and poly-use of tobacco products in the US Air Force, as well as characteristics and factors associated with these types. We conducted a cross-sectional assessment of tobacco-product use among 13,873 Air Force trainees from 2013 to 2014. The assessment included prevalence of the use of 10 different tobacco products and demographic and environmental factors, such as risk perceptions of tobacco use, peer use, and tobacco-company influences. Latent class analysis was carried out to determine types of poly-tobacco users. Tobacco-product use was reported by 27.1% of participants, and of those, over half reported using more than 1 tobacco product. Latent class analysis indicated 5 classes of poly-tobacco use. Factors associated with poly-tobacco (vs. mono-tobacco) use included lower confidence to remain tobacco-free, low harm perceptions, and receiving tobacco products free at bars or social events. Rates of dual and poly-tobacco use are high among trainees, and while these groups are similar to mono users in some ways, there are a number of differences that need to be considered when developing targeted interventions to address use of multiple tobacco products.

Alcohol issues prior to training in the United States Air Force

The negative impact of alcohol is a significant concern to the US military given the costs associated with alcohol-related offenses. Despite considerable research in active duty personnel, relatively little is known about the current extent of alcohol use among incoming recruits. We examined the history of alcohol use and harmful patterns of alcohol consumption among recruits entering the United States Air Force (USAF; N=50,549) over the span of 4 years (2010-2014). Across all years, drinking rates reflected national average trends for those aged 18-24 (NIDA, 2014). However, when abstainers were excluded, those under 21 (n=10,568) reported an average of 18.4 drinks per week, whereas those age 21 and over (n=14,188) reported an average of 14.1 drinks per week, suggesting that for those who drink, those under 21 are exhibiting more risky drinking rates. Alcohol Use Disorders Identification Task (AUDIT) scores for drinkers reflected these same trends. For those under 21, 58% scored in risk categories of 2 or higher (risky drinking warranting attention), compared with 40% for those age 21 and over. These scores indicate that for recruits in the USAF, approximately half report alcohol use immediately prior to basic training, resulting in the inheritance of these potential alcohol related issues for those conducting training of these recruits. Based upon these numbers, brief alcohol interventions could have a potential positive impact on individuals in their initial training stages of the USAF to prevent these baseline issues from resulting in problems later in their military careers.

Prevalence and Correlates of Tobacco and Nicotine Containing Product Use in a Sample of United States Air Force Trainees

INTRODUCTION

Although there is increasing attention to the prevalence of new and emerging tobacco products in the civilian population, remarkably little is known about the current prevalence of these products in a military population.

METHODS

The current investigation was designed to determine the prevalence of tobacco and nicotine containing products (TNCP) and correlates of use across multiple cohorts of trainees undergoing Technical Training in the US Air Force between April 2013 and December 2014. Chi-square test, Cochran-Armitage test for linear trend, and logistic regression models were applied to test differences and linear trends across time for TNCP use as well as correlates of use in a cross-sectional sample of 13 685 Airmen (final analytic sample).

RESULTS

Over a quarter (26.9%) of Airmen reported regular use of a TNCP. The two most prevalent products were cigarettes (11.2%) and hookah (10.5%). Among correlates of use, Airmen that regularly use TNCPs were more likely to be male, younger, non-Hispanic white, and single with a high school degree or General Education Development. Hookah was the most endorsed for intentions to use, and along with e-cigarettes, had the lowest perception of harm. While prevalence of most products remained constant across entering cohorts, the prevalence of e-cigarettes showed significant linear increase.

CONCLUSIONS

The prevalence of TNCP use is high across cohorts of Airmen. Remarkably high estimates of future intentions to use and low perceptions of harm for emerging products suggest that intervention efforts should be directed at multiple forms of TNCP use to address this important public health issue.

Testing antismoking messages for Air Force trainees

INTRODUCTION

Young adults in the military are aggressively targeted by tobacco companies and are at high risk of tobacco use. Existing antismoking advertisements developed for the general population might be effective in educating young adults in the military. This study evaluated the effects of different themes of existing antismoking advertisements on perceived harm and intentions to use cigarettes and other tobacco products among Air Force trainees.

METHODS

In a pretest-post-test experiment, 782 Airmen were randomised to view antismoking advertisements in 1 of 6 conditions: anti-industry, health effects+anti-industry, sexual health, secondhand smoke, environment+anti-industry or control. We assessed the effect of different conditions on changes in perceived harm and intentions to use cigarettes, electronic cigarettes, smokeless tobacco, hookah and cigarillos from pretest to post-test with multivariable linear regression models (perceived harm) and zero-inflated Poisson regression model (intentions).

RESULTS

Antismoking advertisements increased perceived harm of various tobacco products and reduced intentions to use. Advertisements featuring negative effects of tobacco on health and sexual performance coupled with revealing tobacco industry manipulations had the most consistent pattern of effects on perceived harm and intentions.

CONCLUSIONS

Antismoking advertisements produced for the general public might also be effective with a young adult military population and could have spillover effects on perceptions of harm and intentions to use other tobacco products besides cigarettes. Existing antismoking advertising may be a cost-effective tool to educate young adults in the military.

The Prevalence of E-cigarette Use in a Sample of U.S. Air Force Recruits

INTRODUCTION

The prevalence of electronic cigarette (e-cigarette) use is increasing markedly in the general population. Yet, remarkably little research exists to examine these ongoing trends in at-risk populations, and nothing is known about the prevalence of e-cigarette use among military personnel. The purpose of the current study is to provide recent (2013-2014) data on the prevalence of regular e-cigarette use in a population of recruits prior to their entry into the U.S. military.

METHODS

The study utilized a cross-sectional assessment of e-cigarette and other tobacco and nicotine-containing product (TNCP) use in 2013-2014 among 10,043 U.S. Air Force (USAF) recruits in Technical Training. Chi-square tests, the Cochran-Armitage test for trend, and logistic regression models tested differences and trends across time for e-cigarette use.

RESULTS

The rate of e-cigarette use among recruits was 5.2%, which doubled (3% to 6.5%, p<0.0001) across a 1-year period. E-cigarette use was associated with increased odds of all measured TNCPs, as well as dual and poly use (all p<0.0001).

CONCLUSIONS

Rates of e-cigarette use are slightly higher in young USAF recruits than in the general population, and e-cigarette users are likely to be using other TNCPs in tandem. Although additional work is needed to understand the reasons for this concomitant use, this is a necessary first step to understanding e-cigarette use prevalence in military populations. Historic trends suggest that, like general populations, e-cigarette use is on the rise for those entering the USAF and should be monitored to inform future prevention programming.

Longitudinal smoking patterns in survivors of childhood cancer: An update from the Childhood Cancer Survivor Study

BACKGROUND

Survivors of pediatric cancer have elevated risks of mortality and morbidity. Many late adverse effects associated with cancer treatment (eg, second cancers and cardiac and pulmonary disease) are also associated with cigarette smoking, and this suggests that survivors who smoke may be at high risk for these conditions.

METHODS

This study examined the self-reported smoking status for 9397 adult survivors of childhood cancer across 3 questionnaires (median time interval, 13 years). The smoking prevalence among survivors was compared with the smoking prevalence among siblings and the prevalence expected on the basis of age-, sex-, race-, and calendar time-specific rates in the US population. Multivariable regression models examined characteristics associated with longitudinal smoking patterns across all 3 questionnaires.

RESULTS

At the baseline, 19% of survivors were current smokers, whereas 24% of siblings were current smokers, and 29% were expected to be current smokers on the basis of US rates. Current smoking among survivors dropped to 16% and 14% on follow-up questionnaires, with similar decreases in the sibling prevalence and the expected prevalence. Characteristics associated with consistent never-smoking included a higher household income (relative risk [RR], 1.16; 95% confidence interval [CI], 1.08-1.25), higher education (RR, 1.32; 95% CI, 1.22-1.43), and receipt of cranial radiation therapy (RR, 1.08; 95% CI, 1.03-1.14). Psychological distress (RR, 0.86; 95% CI, 0.80-0.92) and heavy alcohol drinking (RR, 0.64; 95% CI, 0.58-0.71) were inversely associated. Among ever-smokers, a higher income (RR, 1.17; 95% CI, 1.04-1.32) and education (RR, 1.23; 95% CI, 1.10-1.38) were associated with quitting, whereas cranial radiation (RR, 0.86; 95% CI, 0.76-0.97) and psychological distress (RR, 0.80; 95% CI, 0.72-0.90) were associated with not having quit. The development of adverse health conditions was not associated with smoking patterns.

CONCLUSIONS

Despite modest declines in smoking prevalence, the substantial number of consistent current smokers reinforces the need for continued development of effective smoking interventions for survivors.

Tobacco Research in the Military: Reflections on 20 Years of Research in the United States Air Force

The U.S. military is one of the world's largest employers. Approximately 30% of active duty military personnel smoke cigarettes and more than 14% use smokeless tobacco. The military has historically supported tobacco use and more recently is attempting to combat its use. Through 20 years of collaborative research with the United States Air Force, we have learned that smoking bans are effective, recruits who have never previously smoked cigarettes initiate tobacco use, smokeless tobacco serves as a gateway for smoking initiation, smoking is associated with discharge, smoking adds significant proximal training costs, tobacco use increases during deployment, and tobacco quitline counseling with a provision of medication is effective. Our findings may provide groundwork for future tobacco control efforts in the U.S. military.

Efficacy of a tobacco quitline among adult survivors of childhood cancer

INTRODUCTION

The purpose of this investigation was to determine the efficacy of two evidence-based tobacco quitlines in adult survivors of childhood cancer who regularly smoke cigarettes.

METHODS

A total of 519 adult survivors of childhood cancer were randomized to either Proactive + 4 weeks of medication (Counselor-initiated intervention, n = 260) or a Reactive + 2 weeks of medication (Participant-initiated intervention, n = 259) condition. Both conditions received telephone counseling to quit smoking as well as nicotine replacement therapy. The primary outcome was biochemically verified (i.e. cotinine) point prevalence smoking cessation at 12 months follow-up.

RESULTS

Participants randomized to the Proactive + 4 weeks of medication condition self-reported a higher rate of cessation than those survivors in the Reactive + 2 weeks of medication condition at 8 weeks (33.2% vs. 17.0%, p < .001), but cessation rates were not significantly different at 12 months (23.0% vs. 18.7%, p = .29). However, 80% of participants claiming abstinence failed biochemical verification, indicating marked falsification of self-reported smoking status. Adjusted cessation rates were less than 2% in both intervention conditions.

CONCLUSIONS

Our results indicate that neither a Proactive + 4 weeks of medication or Reactive + 2 weeks of medication quitline significantly impacted long-term smoking cessation rates. Our results further indicate that self-reports of smoking status are unreliable in survivors of childhood cancer, a population in considerable need of tobacco abstinence. Rates of smoking cessation may be markedly overestimated in studies of childhood cancer survivors that rely on self-reports of tobacco abstinence, and future studies need to include biochemical verification of tobacco status in this population.

Efficacy of a tobacco quitline among adult cancer survivors

OBJECTIVE

The purpose of the study (conducted 2010-2013) was to determine the efficacy of two common types of tobacco quitlines in adult cancer survivors who regularly smoked cigarettes.

METHOD

Adult onset cancer survivors in Memphis, Tennessee (n=427, 67% female, 60% Caucasian) were randomized either to a Proactive (i.e., counselor-initiated calls) or Reactive (i.e., participant-initiated calls) quitline. Both conditions also received nicotine replacement therapy. The primary outcome was biochemically-verified (i.e., salivary cotinine) smoking cessation.

RESULTS

While 12-month self-reported abstinence was consistent with other published studies of smoking cessation (22% and 26% point prevalence abstinence for Proactive and Reactive conditions, respectively), 48% of participants who were tested for cotinine failed biochemical verification, indicating a considerable falsification of self-reported cessation. Adjusted cessation rates were less than 5% in both intervention conditions.

CONCLUSION

Our results are consistent with other studies indicating that traditional smoking cessation interventions are ineffective among cancer survivors. Moreover, self-reports of cessation were unreliable in cancer survivors participating in a quitline intervention, indicating that future studies should include biochemical verification. Given the importance of smoking cessation among cancer survivors and low cessation rates in the current study, it may be necessary to design alternative interventions for this population. ClinicalTrials.gov identifier: NCT00827866.

Dissemination of the Look AHEAD intensive lifestyle intervention in the United States Air Force: study rationale, design and methods

BACKGROUND

Despite an increase in overweight and obesity similar to the civilian population, there have been few randomized controlled trials examining behavioral weight management interventions in the military settings.

PURPOSE

This paper describes the design, intervention development and analysis plan of the Fit Blue study, a randomized controlled behavioral weight loss trial taking place in the United States Air Force.

DESIGN

This study compares two adapted versions of the efficacious Look AHEAD Intensive Lifestyle Intervention (ILI), a counselor-initiated condition and a self-paced condition. Also described are the unique steps required when conducting military-based health promotion research and adaptations made to the Look AHEAD intervention to accommodate the military environment.

CONCLUSIONS

To our knowledge, this is the first translation of the Look AHEAD ILI in the military setting and one of the first translations of the ILI in general. If successful, this intervention could be disseminated to the entire U.S. Military as this project is designed to overcome the barriers and utilize the facilitators for weight loss that are unique to a military population. Programs validated in military populations can have a major public health impact given that with 1.4 million active duty personnel, the Department of Defense is the nation's largest employer. However, while this intervention is designed for a military population and there are unique aspects of the military that may enhance weight loss interventions, the diversity of the study population should help inform obesity efforts in both civilian and military settings.

Reducing secondhand smoke exposure of children undergoing surgery

OBJECTIVE

To determine the attitudes and beliefs of both parents and surgical clinicians regarding interventions to reduce secondhand smoke (SHS) exposure in children undergoing surgery.

METHODS

Structured interviews were conducted with 25 parents of children scheduled for elective procedures and 10 surgical clinicians.

RESULTS

Major themes identified in parent interviews included: (1) parents are receptive to learning about the surgical risks posed by SHS exposure; (2) many are already attempting to reduce SHS exposure, and; (3) parents are more accepting of SHS mitigation procedure than a recommendation to quit smoking. Clinicians were receptive to addressing perioperative SHS exposure.

CONCLUSIONS

Both parents and clinicians are receptive to clinician-delivered interventions to reduce the SHS exposure of children scheduled for elective surgery.

Dual tobacco user subtypes in the U.S. Air Force: dependence, attitudes, and other correlates of use

INTRODUCTION

To describe the characteristics associated with patterns of daily and dual tobacco use among U.S. Air Force (USAF) personnel transitioning from basic military training to technical training.

METHODS

Cross-sectional survey of USAF personnel in Technical Training School at Lackland Air Force Base (N = 8,956, response rate: 73%). Logistic regression analyzed the association of predictor variables between daily smokers, daily smokeless tobacco (ST) users, daily smokers who used ST nondaily, daily ST users who smoked cigarettes nondaily, and daily users of both cigarettes and ST.

RESULTS

Compared to daily smokers, participants who were daily smokers/nondaily ST users were more likely to be male, would use ST and multiple forms of tobacco in the future, reported more friends using ST and cigarettes, and were more susceptible to tobacco advertising. Compared to daily ST users, daily ST users/nondaily cigarette users were more likely to live in the Midwest, would use multiple forms of tobacco in the future, reported more friends smoked cigarettes and used ST, and were more likely to try a product that claimed to be safer than cigarettes. Daily users of both cigarettes and ST were significantly more likely to be nicotine dependent than daily smokers/nondaily ST users and daily ST users/nondaily smokers.

CONCLUSIONS

Dual users are heterogeneous groups of tobacco users who are at high risk for continued tobacco use. Daily users of both cigarettes and ST have higher levels of nicotine dependence, even when compared to other dual users. Specific interventions targeted at dual users are needed in this increasingly prevalent and high-risk population.

Preventing smoking initiation or relapse following 8.5 weeks of involuntary smoking abstinence in basic military training: trial design, interventions, and baseline data

Smoking cessation is a primary method of reducing excess mortality and morbidity. Unfortunately, the vast majority of cessation attempts end in eventual relapse. Relapse-prevention interventions have shown some success at improving the long-term maintenance of tobacco abstinence among individuals motivated to abstain. However, involuntary tobacco abstinence (e.g., military training, hospitalization, incarceration) presents another opportunity for intervention to prevent relapse. During basic military training (BMT), tobacco use is strictly forbidden in all service branches, but tobacco relapse (and initiation) following BMT is extremely high. This paper reports on the design, intervention development, and baseline characteristics of a randomized controlled trial testing minimal interventions designed to prevent tobacco relapse among United States Air Force (USAF) personnel following BMT. Participants are randomized by squadron to receive either a standard smoking-cessation booklet, a new motivation-based booklet designed specifically for USAF personal, or the latter booklet combined with a brief, face-to-face motivational session. Primary outcomes will be self-reported tobacco use at 12 and 24month follow-up. Given that the Department of Defense is the world's largest employer, the potential of leveraging involuntary tobacco abstinence during BMT into extended abstinence has substantial public health significance.

Effect of the Alcohol Misconduct Prevention Program (AMPP) in air force technical training

OBJECTIVES

Alcohol use in the U.S. military is prevalent and associated with alcohol-related incidents (ARIs), an official U.S. Air Force sanction. Military ARIs incur substantial personal and financial costs. We evaluated the impact of the Alcohol Misconduct Prevention Program (AMPP) consisting of a group-based brief alcohol intervention (BAI) conducted jointly with random alcohol breathalyzer testing on ARIs in the U.S. Air Force.

METHODS

A 1-hour, group-based, interactive BAI was conducted, and random alcohol breathalyzer testing was performed among 10,087 Air Force Technical Trainees at Lackland Air Force Base in San Antonio, Texas, in fiscal years 2010 and 2011.

RESULTS

The AMPP was associated with a significant reduction in the odds of an ARI over the year of the intervention compared to the previous year (odds ratio 0.555; 95% confidence interval 0.380-0.811; p = 0.0023). Significant reductions in the number of ARIs were observed within all quarters except for the third. The average rate of ARIs per 1,000 trainees per quarter was 7.30 before implementation of the interventions and 4.06 after implementation.

CONCLUSION

An AMPP consisting of an interactive BAI and random alcohol breathalyzer testing may decrease ARIs among military trainees.

Smokeless and dual tobacco use among males surviving childhood cancer: a report from the Childhood Cancer Survivor Study

Cancer survivors experience treatment-related complications that can be exacerbated by tobacco use. This study reports the prevalence of smokeless and dual tobacco use, compares these rates to the U.S. population, and examines tobacco risk factors among males surviving childhood cancer. Data from the Childhood Cancer Survivor Study (CCSS) 2007 survey were used (N = 3378). Standardized incidence ratios (SIR) were obtained by comparing CCSS data with the National Survey on Drug Use and Health. Logistic regression was used to evaluate associations between risk factors and tobacco use. Among male survivors, 8.3% and 2.3% were current smokeless tobacco and dual tobacco users, respectively. Survivors were less likely than population males to report smokeless tobacco [SIR = 0.64; 95% confidence interval (CI), 0.57-0.72) or dual tobacco (SIR = 0.37; CI, 0.29-0.46) use; however, non-White survivors aged 35 to 49 years were more likely to use smokeless tobacco (SIR = 2.32; CI, 1.27-3.90). Smokeless tobacco use was associated (P < 0.05) with younger age at diagnosis, lower education, being married or divorced/separated, and not living in the Northeastern United State, whereas history of cardiovascular- and/or pulmonary-toxic treatment was protective. Dual tobacco use was associated with younger age at diagnosis, lower education, divorce/separation, and high psychologic distress. Having active heart or circulatory conditions was protective. Although smokeless tobacco/dual tobacco use is generally low among childhood cancer survivors, these findings suggest that tobacco use screening should be expanded to include smokeless tobacco use, and that smokeless tobacco-specific education and cessation interventions should be provided to users. Screening and intervening for smokeless tobacco/dual tobacco use in childhood cancer survivors will reduce tobacco-related morbidity and mortality.

Tobacco use during military deployment

INTRODUCTION

Tobacco use among military personnel is associated with significant health care expenditures, lost productivity, and compromised combat readiness. The prevalence remains high among military personnel and may increase in high-risk situations such as deployment. We assessed the prevalence of tobacco use across the deployment cycle, changes in tobacco use (nonuse, continued use, initiation/harm escalation, cessation/harm reduction) during deployment, and the impact of deployment history on tobacco use.

METHOD

Cigarette smoking, smokeless tobacco (ST) use, and dual tobacco use were evaluated among 278U.S. Air Force Security Forces personnel undertaking a 1-year deployment to a high-threat combat environment. Multinomial regression was used to examine prediction of tobacco use patterns both cross-sectionally and longitudinally.

RESULTS

More than half (53%-63%) of all Security Forces used tobacco at all stages of the deployment cycle. Individual tobacco use trajectories showed significant differences in prevalence rates of initiation/harm escalation and cessation/harm reduction when comparing the transition from predeployment to the deployed environment versus returning to postdeployment status. Airmen who had deployed more than once previously had a higher likelihood of using ST use at predeployment and engaging in dual tobacco use during deployment.

CONCLUSIONS

Findings suggest the potential benefit of targeted or universal interventions at each stage of the deployment cycle to reduce the onset, maintenance, or escalation of tobacco use behaviors in the U.S. military.

Energy underreporting in African-American girls: a longitudinal analysis

BACKGROUND

The objective of this study was to determine the longitudinal prevalence and predictors of dietary underreporting in African-American preadolescent girls and the association of baseline dietary underreporting with changes in BMI over a 2-year period as part of the Girls health Enrichment Multi-site Studies (GEMS).

METHODS

Energy was summarized at baseline, 12 months, and 24 months and computed as a 3-day average of 24-hour dietary recalls. Physical activity was assessed by accelerometer, basal metabolic rate was estimated using the World Health Organization's prediction equation, and caloric underreporting was based on the Goldberg equation.

RESULTS

We classified 48% of the girls at baseline as underreporters; with underreporting increasing over time (61% at 12 months; 66% at 24 months). Intervention treatment assignment did not affect the prevalence of underreporting over time. The consistency of underreporting (or not) stayed stable over time. Across all three time points, a higher BMI predicted underreporting. Baseline dietary underreporting and baseline BMI were found to be the major predictors of change in BMI, whereas baseline dietary variables did not predict change in BMI.

CONCLUSIONS

Dietary underreporting was extremely common in this sample of AA preadolescent girls and predictive of change in BMI. Given the magnitude and consistency of dietary underreporting along with the fact that no dietary variables predicted change in BMI, measurement of dietary intake in preadolescents, even with sophisticated measurement methodologies, appears biased. The best use of dietary recalls may not be to estimate dietary intake but rather to determine underreporting.

Efficacy of a smoking quit line in the military: baseline design and analysis

Thirty percent of all military personnel smoke cigarettes. Because of the negative health consequences and their impact on physical fitness, overall health, and military readiness, the Department of Defense has identified the reduction of tobacco use as a priority of US military forces. This study aims to evaluate the one-year efficacy of a proactive versus reactive smoking quit line in the US military with adjunctive nicotine replacement therapy (NRT) in both groups. This paper reports on the baseline variables of the first 1000 participants randomized, the design, and proposed analysis of the randomized two-arm clinical trial "Efficacy of a Tobacco Quit Line in the Military". Participants are adult smokers who are Armed Forces Active Duty personnel, retirees, Reservist, National Guard and family member healthcare beneficiaries. All participants are randomized to either the Counselor Initiated (proactive) group, receiving 6 counseling sessions in addition to an 8-week supply of NRT, or the Self-Paced (reactive) group, in which they may call the quit line themselves to receive the same counseling sessions, in addition to a 2-week supply of NRT. The primary outcome measure of the study is self-reported smoking abstinence at 1-year follow-up. Results from this study will be the first to provide evidence for the efficacy of an intensive Counselor Initiated quit line with provided NRT in military personnel and could lead to dissemination throughout the US Air Force, the armed forces population as a whole and ultimately to civilian personnel that do not have ready access to preventive health services.

Use of smoking reduction strategies among U.S. tobacco quitlines

INTRODUCTION

Tobacco quitlines (QLs) are efficacious and have assisted many smokers in achieving tobacco abstinence. However, most smokers are not able to achieve tobacco abstinence with QL services. QL counseling interventions for smokers who do not quit on their target quit date (TQD) and decline to set a new TQD after missing their TQD have not been systematically evaluated.

METHODS

A telephone survey of tobacco QLs in the United States (US) was conducted to examine systematic approaches used with smokers who do not quit on their TQD and decline to set a new TQD. Tobacco QLs service providers were identified through the North American Quitline Consortium (NAQC).

RESULTS

Fourteen service providers managing QLs of all 50 US states were identified and completed the voluntary survey. All providers recommended setting a new quit TQD if smokers did not achieve smoking cessation by their initial TQD. Six percent of US state QLs used brief motivational interviewing utilizing the "5R's" (relevance, risk, rewards, roadblocks, repetition). However, 90% of QLs had intervention protocols emphasizing smoking rate reduction.

CONCLUSION

Although some US QLs utilized the "5Rs," the majority provided smoking reduction interventions for smokers not achieving tobacco cessation by their initial TQD and declining to set a new TQD. Research is needed to evaluate the efficacy of smoking rate reduction methods implemented through QLs for increasing smoking abstinence rates.

Identification of facilitators and barriers to participation in weight gain prevention research by African American girls

OBJECTIVE

The purpose of the current study is to describe the development, implementation, and success of recruitment and adherence strategies of 303 African American preadolescent girls and their primary caregiver in the Girls health Enrichment Multi-site Studies (GEMS) program.

METHODS

A socio-ecologic model was used to guide selection and implementation of recruitment and retention strategies which were continuously monitored and revised in response. Strategy mode and frequency associated with program enrollment, engagement, and retention were analyzed.

RESULTS

Successful recruitment approaches included radio messages (23.1%), school fliers (20.1%), and friend referral (15%). Initially 463 potential participants responded, 320 girls were screened, and 303 enrolled. Significant increases in participant accrual were observed between Wave 4 (n=28) and Wave 5 (n=91) after using a team recruitment approach. Implementing case management strategies and providing make-up sessions also served to keep participants current and engaged in the program. In year 2, community field trips replaced the more structured sessions providing participants with experiential learning opportunities. Overall intervention attendance rates ranged from 79.7% to 90.5% among waves. Further, 75.9% and 80.2%, respectively, of participants attended 1-year and 2-year follow-ups.

CONCLUSION

Multiple recruitment strategies and flexible, responsive approaches to recruitment and retention guided by the socio-ecologic model facilitated optimal implementation of an intervention for preadolescent girls. Through the application of the socio-ecologic model researchers and program leaders will be able to identify strategies to enhance the probability of successful outcomes.

Family context as it relates to weight-related behaviors in preadolescent African American girls

OBJECTIVE

To examine family context in relation to body image, weight concerns, and weight control behaviors in preadolescent African American girls.

METHODS

Cross-sectional baseline data were analyzed from 303 African American girls 8 to 10 years old and a caregiver in the Girls health Enrichment Multi-site Studies Phase 2(GEMS), an obesity prevention intervention trial.

RESULTS

Fruit, juice, and vegetable accessibility and family support for healthy eating and physical activity were significantly related to girls' body image and weight control behaviors.

CONCLUSIONS

A comprehensive understanding of family factors may improve future programs aimed at preadolescent girls.

Drinking and driving and riding with an alcohol impaired driver among United States Air Force recruits

OBJECTIVE

To identify the prevalence and correlates of binge drinking, driving after drinking, and riding in a vehicle with a driver who had consumed alcohol in US Air Force active duty recruits.

METHODS

A military cohort (N = 31,108; 25.1% female) was analyzed to identify variables associated with binge drinking, drinking and driving, and riding with a driver who had consumed alcohol.

RESULTS

Results indicated that 53 percent (including 45% of those under the legal drinking age) reported alcohol use in the month prior to entering basic military training (BMT). Thirty-eight percent of all active duty recruits reported binge drinking (ie, consuming 5 or more drinks on a single occasion) at least one time in the past 30 days. Nearly 1 in 4 (23%) reported 1 to 3 episodes of binge drinking. Three percent of reported alcohol users drove after consuming five or more drinks, and 9 percent rode as a passenger in a vehicle with a driver who had been drinking heavily.

CONCLUSIONS

Several demographic, behavioral, and attitudinal correlates of risky drinking patterns were identified. Prevention efforts are needed to address the implications of these findings because they influence the health, safety, and military readiness of active duty personnel.