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Sargent C, Gebruers C, O’Mahony J. A review of the physiological and psychological health and wellbeing of naval service personnel and the modalities used for monitoring. Mil Med Res 2017; 4:1. [PMID: 28116111 PMCID: PMC5242023 DOI: 10.1186/s40779-016-0112-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 12/30/2016] [Indexed: 12/28/2022] Open
Abstract
Naval cohorts rely heavily on personnel to ensure the efficient running of naval organisations. As such, the wellbeing of personnel is essential. In an occupational setting, naval service personnel experience a variety of physiological and psychological stressors. Most naval services arrange annual physical fitness and body composition tests to ensure the physical readiness of personnel. However, these tests only evaluate a small amount of physiological capabilities. Components such as aerobic and strength capabilities are assessed, however, other components of physical fitness such as speed, agility, anaerobic capacity and flexibility are not. In addition to the physical capabilities, personnel are impacted by fatigue, nutrition and psychological stressors such as copping in stressful situations or dealing with time away from family and friends. This review will discuss the physiological and psychological factors that affect personnel's wellbeing. In addition to this, it will also evaluate the methods that are used to assess both physiological and psychological wellbeing.
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Affiliation(s)
- Cliodhna Sargent
- Cork Institute of Technology, Rossa Avenue, Bishopstown, Cork Ireland
| | - Cormac Gebruers
- National Maritime College of Ireland, Ringaskiddy, Cork Ireland
| | - Jim O’Mahony
- Cork Institute of Technology, Rossa Avenue, Bishopstown, Cork Ireland
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Haibach JP, Haibach MA, Hall KS, Masheb RM, Little MA, Shepardson RL, Dobmeyer AC, Funderburk JS, Hunter CL, Dundon M, Hausmann LR, Trynosky SK, Goodrich DE, Kilbourne AM, Knight SJ, Talcott GW, Goldstein MG. Military and veteran health behavior research and practice: challenges and opportunities. J Behav Med 2016; 40:175-193. [DOI: 10.1007/s10865-016-9794-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 09/09/2016] [Indexed: 12/01/2022]
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Bush T, Lovejoy J, Javitz H, Magnusson B, Torres AJ, Mahuna S, Benedict C, Wassum K, Spring B. Comparative effectiveness of adding weight control simultaneously or sequentially to smoking cessation quitlines: study protocol of a randomized controlled trial. BMC Public Health 2016; 16:615. [PMID: 27443485 PMCID: PMC4957297 DOI: 10.1186/s12889-016-3231-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background Prevalence of multiple health risk behaviors is growing, and obesity and smoking are costly. Weight gain associated with quitting smoking is common and can interfere with quit success. Efficacy of adding weight management to tobacco cessation treatment has been tested with women in group sessions over an extended period of time, but has never been tested in real-world settings with men and women seeking help to quit. This paper describes the Best Quit study which tests the effectiveness of delivering tobacco and weight control interventions via existing quitline infrastructures. Methods Eligible and consenting smokers (n = 2550) who call a telephone quitline will be randomized to one of three groups; the standard quitline or standard quitline plus a weight management program added either simultaneously or sequentially to the tobacco program. The study aims to test: 1) the effectiveness of the combined intervention on smoking cessation and weight, 2) the cost-effectiveness of the combined intervention on cessation and weight and 3) theoretically pre-specified mediators of treatment effects on cessation: reduced weight concerns, increased outcome expectancies about quitting and improved self-efficacy about quitting without weight gain. Baseline, 6 month and 12 month data will be analyzed using multivariate statistical analyses and groups will be compared on treatment adherence, quit rates and change in weight among abstinent participants. To determine if the association between group assignment and primary outcomes (30-day abstinence and change in weight at 6 months) is moderated by pre-determined baseline and process measures, interaction terms will be included in the regression models and their significance assessed. Discussion This study will generate information to inform whether adding weight management to a tobacco cessation intervention delivered by phone, mail and web for smokers seeking help to quit will help or harm quit rates and whether a simultaneous or sequential approach is better at increasing abstinence and reducing weight gain post quit. If proven effective, the combined intervention could be disseminated across the U.S. through quitlines and could encourage additional smokers who have not sought cessation treatment for fear of gaining weight to make quit attempts. Trial registration Clinicaltrials.gov NCT01867983. Registered: May 30, 2013 Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3231-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Terry Bush
- Alere Wellbeing (now Optum), 999 3rd Ave, Seattle, WA, 98104-1139, USA.
| | - Jennifer Lovejoy
- Arivale, Inc. and University of Washington School of Public Health, 616 First Ave, Suite 700, Seattle, WA, 98104, USA
| | - Harold Javitz
- SRI International, 333 Ravenswood Ave, Menlo Park, CA, 94025-3493, USA
| | - Brooke Magnusson
- Alere Wellbeing (now Optum), 999 3rd Ave, Seattle, WA, 98104-1139, USA
| | | | - Stacey Mahuna
- Alere Wellbeing (now Optum), 999 3rd Ave, Seattle, WA, 98104-1139, USA
| | - Cody Benedict
- Bill and Melinda Gates Foundation, 440 5th Ave N, Seattle, WA, 98109, USA
| | - Ken Wassum
- Alere Wellbeing (now Optum), 999 3rd Ave, Seattle, WA, 98104-1139, USA
| | - Bonnie Spring
- Center for Behavior and Health, Feinberg School of Medicine, Northwestern University, 680 N. Lakeshore Drive, Suite 1220, Chicago, IL, 0611-8708, USA
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Gasier HG, Young CR, Gaffney-Stomberg E, McAdams DC, Lutz LJ, McClung JP. Cardiometabolic Health in Submariners Returning from a 3-Month Patrol. Nutrients 2016; 8:85. [PMID: 26867201 PMCID: PMC4772048 DOI: 10.3390/nu8020085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 12/13/2022] Open
Abstract
Confined space, limited exercise equipment, rotating shift work and reduced sleep may affect cardiometabolic health in submariners. To test this hypothesis, 53 male U.S. Submariners (20–39 years) were studied before and after a 3-month routine submarine patrol. Measures included anthropometrics, dietary and physical activity, biomarkers of cardiometabolic health, energy and appetite regulation, and inflammation. Before deployment, 62% of submariners had a body fat % (BF%) ≥ 25% (obesity), and of this group, 30% met the criteria for metabolic syndrome. In obese volunteers, insulin, the homeostatic model assessment of insulin resistance (HOMA-IR), leptin, the leptin/adiponectin ratio, and pro-inflammatory chemokines growth-related oncogene and macrophage-derived chemokine were significantly higher compared to non-obese submariners. Following the patrol, a significant mean reduction in body mass (5%) and fat-mass (11%) occurred in the obese group as a result of reduced energy intake (~2000 kJ) during the patrol; and, independent of group, modest improvements in serum lipids and a mean reduction in interferon γ-induced protein 10 and monocyte chemotactic protein 1 were observed. Since 43% of the submariners remained obese, and 18% continued to meet the criteria for metabolic syndrome following the patrol, the magnitude of weight loss was insufficient to completely abolish metabolic dysfunction. Submergence up to 3-months, however, does not appear to be the cause of obesity, which is similar to that of the general population.
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Affiliation(s)
- Heath G Gasier
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Colin R Young
- Naval Submarine Medical Research Laboratory, Groton, CT 06349, USA.
| | - Erin Gaffney-Stomberg
- United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.
| | | | - Laura J Lutz
- United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.
| | - James P McClung
- United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.
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Abstract
This technical report serves to provide the evidence base for the American Academy of Pediatrics' policy statements "Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke" and "Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke." Tobacco use and involuntary exposure are major preventable causes of morbidity and premature mortality in adults and children. Tobacco dependence almost always starts in childhood or adolescence. Electronic nicotine delivery systems are rapidly gaining popularity among youth, and their significant harms are being documented. In utero tobacco smoke exposure, in addition to increasing the risk of preterm birth, low birth weight, stillbirth, placental abruption, and sudden infant death, has been found to increase the risk of obesity and neurodevelopmental disorders. Actions by pediatricians can help to reduce children's risk of developing tobacco dependence and reduce children's involuntary tobacco smoke exposure. Public policy actions to protect children from tobacco are essential to reduce the toll that the tobacco epidemic takes on our children.
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Jai TM, McCool BN, Reed DB. Military Parents' Personal Technology Usage and Interest in e-Health Information for Obesity Prevention. Telemed J E Health 2015; 22:183-90. [PMID: 26288147 DOI: 10.1089/tmj.2015.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND U.S. military families are experiencing high obesity rates similar to the civilian population. The Department of Defense's Military Health System (MHS) is one of the largest healthcare providers in the United States, serving approximately 9.2 million active duty service members, retirees, spouses, and children. The annual cost to the MHS for morbidities associated with being overweight exceeds $1 billion. The preschool age has been suggested as an opportune time to intervene for the prevention of obesity. Thus, this study investigated the current level of technology usage by military service member families and assessed their needs and interests in health/nutrition information. This needs assessment is crucial for researchers/educators to design further studies and intervention programs for obesity prevention in military families with young children. MATERIALS AND METHODS In total, 288 military parents (233 Army and 55 Air Force) at two military bases whose children were enrolled in military childcare centers in the southwestern United States participated in a Technology Usage in Military Family (TUMF) survey in 2013. RESULTS AND CONCLUSIONS Overall, both bases presented similar technology usage patterns in terms of computer and mobile device usage on the Internet. Air Force base parents had a slightly higher knowledge level of nutrition/health information than Army base parents. The TUMF survey suggested practical ways such as mobile applications/Web sites, social networks, games, etc., that health educators can use to disseminate nutrition/health information for obesity prevention among military families with young children.
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Affiliation(s)
- Tun-Min Jai
- 1 Hospitality and Retail Management, Texas Tech University , Lubbock, Texas
| | - Barent N McCool
- 1 Hospitality and Retail Management, Texas Tech University , Lubbock, Texas
| | - Debra B Reed
- 2 Nutritional Sciences, Texas Tech University , Lubbock, Texas
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Jitnarin N, Poston WSC, Haddock CK, Jahnke S. Health in the news: an analysis of magazines coverage of health issues in veterans and military service organizations. Mil Med 2015; 180:539-46. [PMID: 25939108 DOI: 10.7205/milmed-d-14-00210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study was to conduct a content analysis of Veterans and Military Service Organizations (VMSOs) magazines to determine what health-related topics VMSOs target and how they inform their constituencies about health issues. Health-related topics in 288 VMSOs' magazines from 21 VMSOs published in 2011 and 2012 were coded by trained raters using a standardized manual. The top three most addressed health topics were Health Services (Health care, Insurance), Disability and Disability benefits, and post-traumatic stress disorder. Topics least frequently covered were Tobacco and Smoking cessation, Illegal drugs, Alcohol, Gulf War Syndrome, and Weight and Body composition. VMSOs are concerned about the health and well-being of their members given the considerable amount of content devoted to certain health topics such as health insurance concerns, disability, and post-traumatic stress disorder. However, other health concerns that affect a considerable number of both current military personnel and veterans and cost both the Department of Veterans Affairs and the Department of Defense millions annually, such as drug and alcohol problems, and tobacco use and smoking cessation, are infrequently covered. The results of this study improve our understanding of the health-related information that reaches the military and veteran populations through this important media outlet.
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Affiliation(s)
- Nattinee Jitnarin
- Institute for Biobehavioral Health Research, NDRI-MA, National Development and Research Institutes, 1920 West 143rd Street, Suite 120, Leawood, KS 66224
| | - Walker S C Poston
- Institute for Biobehavioral Health Research, NDRI-MA, National Development and Research Institutes, 1920 West 143rd Street, Suite 120, Leawood, KS 66224
| | - Christopher K Haddock
- Institute for Biobehavioral Health Research, NDRI-MA, National Development and Research Institutes, 1920 West 143rd Street, Suite 120, Leawood, KS 66224
| | - Sara Jahnke
- Institute for Biobehavioral Health Research, NDRI-MA, National Development and Research Institutes, 1920 West 143rd Street, Suite 120, Leawood, KS 66224
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Williams EC, Frasco MA, Jacobson IG, Maynard C, Littman AJ, Seelig AD, Crum-Cianflone NF, Nagel A, Boyko EJ. Risk factors for relapse to problem drinking among current and former US military personnel: a prospective study of the Millennium Cohort. Drug Alcohol Depend 2015; 148:93-101. [PMID: 25599962 DOI: 10.1016/j.drugalcdep.2014.12.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 12/17/2014] [Accepted: 12/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Military service members may be prone to relapse to problem drinking after remission, given a culture of alcohol use as a coping mechanism for stressful or traumatic events associated with military duties or exposures. However, the prevalence and correlates of relapse are unknown. We sought to identify socio-demographic, military, behavioral, and health characteristics associated with relapse among current and former military members with remittent problem drinking. METHODS Participants in the longitudinal Millennium Cohort Study who reported problem drinking at baseline (2001-2003) and were remittent at first follow-up (2004-2006) were included (n=6909). Logistic regression models identified demographic, military service, behavioral, and health characteristics that predicted relapse (report of ≥1 past-year alcohol-related problem on the validated Patient Health Questionnaire) at the second follow-up (2007-2008). RESULTS Sixteen percent of those with remittent problem drinking relapsed. Reserve/National Guard members compared with active-duty members (odds ratio [OR]=1.71, 95% confidence interval [CI]: 1.45-2.01), members separated from the military during follow-up (OR=1.46, 95% CI: 1.16-1.83), and deployers who reported combat exposure (OR=1.32, 95% CI: 1.07-1.62, relative to non-deployers) were significantly more likely to relapse. Those with multiple deployments were significantly less likely to relapse (OR=0.73, 95% CI: 0.58-0.92). Behavioral factors and mental health conditions also predicted relapse. CONCLUSION Relapse was common and associated with military and non-military factors. Targeted intervention to prevent relapse may be indicated for military personnel in particular subgroups, such as Reservists, veterans, and those who deploy with combat exposure.
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Affiliation(s)
- Emily C Williams
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research Development, Department of Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA; Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St., Magnuson Health Sciences Center, Room H-664, Box 357660, Seattle, WA 98195-7660, USA.
| | - Melissa A Frasco
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA.
| | - Isabel G Jacobson
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA.
| | - Charles Maynard
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research Development, Department of Veterans Affairs Puget Sound Health Care System, 1100 Olive Way, Suite 1400, Seattle, WA 98101, USA; Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St., Magnuson Health Sciences Center, Room H-664, Box 357660, Seattle, WA 98195-7660, USA; Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA.
| | - Alyson J Littman
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA 98195-7236, USA.
| | - Amber D Seelig
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA.
| | - Nancy F Crum-Cianflone
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA; Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
| | - Anna Nagel
- Deployment Health Research Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521, USA.
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, 1600 S Columbian Way MS-152E, Seattle, WA 98108, USA; Department of Epidemiology, University of Washington School of Public Health, 1959 NE Pacific Street, Health Sciences Building F-250, Box 357236, Seattle, WA 98195-7236, USA; Department of Medicine, University of Washington School of Medicine, RR-512 Health Sciences Building, Box 356420, 1959 NE Pacific Street, Seattle, WA 98195-6420, USA.
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Hruby A, Hill OT, Bulathsinhala L, McKinnon CJ, Montain SJ, Young AJ, Smith TJ. Trends in overweight and obesity in soldiers entering the US Army, 1989-2012. Obesity (Silver Spring) 2015; 23:662-70. [PMID: 25611465 DOI: 10.1002/oby.20978] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 11/04/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The US Army recruits new soldiers from an increasingly obese civilian population. The change in weight status at entry into the Army between 1989 and 2012 and the demographic characteristics associated with overweight/obesity at entry were examined. METHODS 1,741,070 unique individuals with complete sex, age, and anthropometric information contributed data to linear and logistic regressions examining time trends and associations between demographic characteristics and overweight/obesity. RESULTS The prevalence of overweight (body mass index 25-<30 kg/m(2)) generally increased, from 25.8% (1989) to 37.2% (2012), peaking at 37.9% (2011). The prevalence of obesity (body mass index ≥30 kg/m(2)) also increased from 5.6% (1989) to 8.0% (2012), peaking at 12.3% (2009); 2005-2009 annual prevalence exceeded 10%. The most consistent demographic characteristics predicting overweight/obesity were male sex, older age, Hispanic or Asian/Pacific Island race/ethnicity, and being married. There were no distinct geographic trends. CONCLUSIONS The US Army is not immune to the US obesity epidemic. Demographic characteristics associated with being overweight or obese should be considered when developing military-sponsored weight management programs for new soldiers.
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Affiliation(s)
- Adela Hruby
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, Massachusetts, USA; Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts, USA
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Reyes-Guzman CM, Bray RM, Forman-Hoffman VL, Williams J. Overweight and obesity trends among active duty military personnel: a 13-year perspective. Am J Prev Med 2015; 48:145-153. [PMID: 25442226 DOI: 10.1016/j.amepre.2014.08.033] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 08/08/2014] [Accepted: 08/26/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND The U.S. population has shown increasing rates of overweight and obesity in recent years, but similar analyses do not exist for U.S. military personnel. It is important to understand these patterns in the military because of their impact on fitness and readiness. PURPOSE To assess prevalence and trends in overweight/obesity among U.S. service members and to examine the associations of sociodemographic characteristics, exercise, depression, and substance use with these patterns. METHODS Analyses performed in 2013 used five large population-based health-related behavior surveys conducted from 1995 to 2008. Main outcome measures were overweight and obesity among active duty military personnel based on BMI. RESULTS Combined overweight and obesity (BMI≥25) increased from 50.6% in 1995 to 60.8% in 2008, primarily driven by the rise in obesity (BMI≥30) from 5.0% to 12.7%. For overweight, military women showed the largest increase. For obesity, all sociodemographic groups showed significant increases, with the largest among warrant officers, senior enlisted personnel, and people aged 36-45 years. Adjusted multinomial logit analyses found that service members aged 26 years and older, men, non-Hispanic blacks and Hispanics, enlisted personnel, married personnel, and heavy drinkers had the highest risk both for overweight and obesity. CONCLUSIONS Combined overweight and obesity in active duty personnel rose to more than 60% between 1995 and 2008, primarily because of increased obesity. The high prevalence of overweight and obesity needs attention and has implications for Department of Defense efforts to improve the health, fitness, readiness, and quality of life of the Active Forces.
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Affiliation(s)
| | - Robert M Bray
- RTI International, Research Triangle Park, North Carolina.
| | | | - Jason Williams
- RTI International, Research Triangle Park, North Carolina
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Spieker EA, Sbrocco T, Theim KR, Maurer D, Johnson D, Bryant E, Bakalar JL, Schvey NA, Ress R, Seehusen D, Klein DA, Stice E, Yanovski JA, Chan L, Gentry S, Ellsworth C, Hill JW, Tanofsky-Kraff M, Stephens MB. Preventing Obesity in the Military Community (POMC): the development of a clinical trials research network. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:1174-95. [PMID: 25648176 PMCID: PMC4344661 DOI: 10.3390/ijerph120201174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 12/12/2014] [Indexed: 11/16/2022]
Abstract
Obesity impacts the U.S. military by affecting the health and readiness of active duty service members and their families. Preventing Obesity in Military Communities (POMC) is a comprehensive research program within Patient Centered Medical Homes (PCMHs) in three Military Training Facilities. This paper describes three pilot randomized controlled trials that target critical high risk periods for unhealthy weight gain from birth to young adulthood: (1) pregnancy and early infancy (POMC-Mother-Baby), (2) adolescence (POMC-Adolescent), and (3) the first tour of duty after boot camp (POMC-Early Career). Each study employs a two-group randomized treatment or prevention program with follow up. POMC offers a unique opportunity to bring together research and clinical expertise in obesity prevention to develop state-of-the-art programs within PCMHs in Military Training Facilities. This research builds on existing infrastructure that is expected to have immediate clinical benefits to DoD and far-reaching potential for ongoing collaborative work. POMC may offer an economical approach for widespread obesity prevention, from conception to young adulthood, in the U.S. military as well as in civilian communities.
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Affiliation(s)
- Elena A Spieker
- Department of Family Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Joint Base Lewis-McChord, Tacoma, WA 98431, USA.
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr., Bethesda, MD 20817, USA.
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Kelly R Theim
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr., Bethesda, MD 20817, USA.
| | - Douglas Maurer
- Department of Family Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Avenue, Joint Base Lewis-McChord, Tacoma, WA 98431, USA.
| | - Dawn Johnson
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Edny Bryant
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Jennifer L Bakalar
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr., Bethesda, MD 20817, USA.
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr., Bethesda, MD 20817, USA.
| | - Rachel Ress
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr., Bethesda, MD 20817, USA.
| | - Dean Seehusen
- Department of Family and Community Medicine, Nelson Hall, Fort Gordon, GA 30905, USA.
| | - David A Klein
- Department of Family Medicine, Fort Belvoir Community Hospital, 9300 DeWitt Loop, Fort Belvoir, VA 22060, USA.
| | - Eric Stice
- Oregon Research Institute, 1776 Millrace Dr., Eugene, OR 97403, USA.
| | - Jack A Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA.
| | - Linda Chan
- Department of Obstetrics and Gynecology, Naval Hospital Camp Lejeune, 100 Brewster Blvd., Camp Lejeune, NC 28547, USA.
| | - Shari Gentry
- Department of Family Medicine, Naval Hospital Camp Lejeune, 100 Brewster Blvd., Camp Lejeune, NC 28547, USA.
| | - Carol Ellsworth
- Department of Family Medicine, Naval Hospital Camp Lejeune, 100 Brewster Blvd., Camp Lejeune, NC 28547, USA.
| | - Joanne W Hill
- Department of Research, Naval Hospital Camp Lejeune, 100 Brewster Blvd., Camp Lejeune, NC 28547, USA.
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, MD 20892, USA.
| | - Mark B Stephens
- Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
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Krukowski RA, Hare ME, Talcott GW, Johnson KC, Richey PA, Kocak M, Balderas J, Colvin L, Keller PL, Waters TM, Klesges RC. Dissemination of the Look AHEAD intensive lifestyle intervention in the United States Air Force: study rationale, design and methods. Contemp Clin Trials 2014; 40:232-9. [PMID: 25545025 DOI: 10.1016/j.cct.2014.12.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38105, United States.
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38105, United States; Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap, Memphis, TN 38105, United States
| | - Gerald W Talcott
- University of Tennessee Health Science Center, 59MDW/SGOWMP/2200 Bergquist Dr., STE 1, Lackland AFB, TX 78236, United States
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38105, United States
| | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38105, United States; Department of Pediatrics, University of Tennessee Health Science Center, 50 N. Dunlap, Memphis, TN 38105, United States
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38105, United States
| | - Jennifer Balderas
- University of Tennessee Health Science Center, 59MDW/SGOWMP/2200 Bergquist Dr., STE 1, Lackland AFB, TX 78236, United States
| | - Lauren Colvin
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38105, United States
| | - Patrick L Keller
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, 2201 Papperrell St., Building 3550, San Antonio, TX 78236-5344, United States
| | - Teresa M Waters
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38105, United States
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38105, United States
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Maclean JC, Cawley J. The effect of rising obesity on eligibility to serve in the U.S. Public Health Service Commissioned Corps. ECONOMICS AND HUMAN BIOLOGY 2014; 15:213-224. [PMID: 24451545 DOI: 10.1016/j.ehb.2013.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2013] [Revised: 12/16/2013] [Accepted: 12/27/2013] [Indexed: 06/03/2023]
Abstract
This study investigates how rising obesity has affected eligibility to serve in the United States Public Health Service Commissioned Corps (PHSCC), the uniformed service charged with protecting and promoting public health in the U.S. Data are drawn from the National Health and Nutrition Examination Surveys. Between 1959 and 2010, the percentage of eligible civilians who exceed the weight-for-height and body fat standards of the PHSCC rose from 9.05% to 18.24% among men, and from 6.13% to 23.10% among women. Simulations indicate that a further 1% increase in population body weight will result in an additional 3.42% of men and 5.08% of women exceeding PHSCC accession standards. This study documents an under appreciated consequence of the rise in obesity: fewer Americans eligible to develop and implement a public health response to obesity through the PHSCC. This illustrates how a public health problem can undermine the public health labor force, compromising a response and risking a self-reinforcing trend. These findings are timely as the Patient Protection and Affordable Care Act (ACA) calls for a major expansion of the PHSCC.
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Affiliation(s)
- Johanna Catherine Maclean
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.
| | - John Cawley
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, United States; Department of Economics, Cornell University, Ithaca, NY, United States; School of Economics, University of Sydney, Sydney, NSW 2006, Australia.
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Voss JD, Burnett DG, Olsen CH, Haverkos HW, Atkinson RL. Adenovirus 36 antibodies associated with clinical diagnosis of overweight/obesity but not BMI gain: a military cohort study. J Clin Endocrinol Metab 2014; 99:E1708-12. [PMID: 24971666 PMCID: PMC4154092 DOI: 10.1210/jc.2014-1863] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Obesity is a public health priority, which also threatens national security. Adenovirus 36 (Adv36) increases adiposity in animals and Adv36 antibody status is associated with human obesity, but it is unknown whether infection predicts the development of human adiposity. OBJECTIVE The objective of the study was to assess infection status and subsequent weight gain. DESIGN The study had a retrospective cohort design. SETTING The study was conducted at Air Force fitness testing and clinical encounters. PARTICIPANTS PARTICIPANTS included Air Force male enlistees, aged 18-22 years, with a baseline body mass index (BMI) of 20-30 kg/m(2) followed up from enlistment (beginning in 1995) until 2012 or separation from the Air Force. EXPOSURE EXPOSURE included Adv36 infection status at the time of entry. MAIN OUTCOME MEASURE Follow-up BMI, the primary outcome, and diagnosis of overweight/obesity by the International Classification of Diseases, ninth revision V85.25+ and 278.0* series (secondary outcome) were recorded. RESULTS The last recorded follow-up BMI was similar among infected and uninfected, 26.4 and 27.2 kg/m(2), respectively (P > .05). However, infected individuals had a higher hazard of a medical provider's diagnosis of overweight/obese over time (hazard ratio 1.8, 95% confidence interval 1.0-3.1, P = .04), adjusted for baseline BMI. Additionally, infected individuals who were lean at baseline (BMI of 22.5 kg/m(2)) had a 3.9 times greater hazard of developing an overweight/obese clinical diagnosis (95% confidence interval 1.5-9.7, P = .004) compared with uninfected lean individuals after adjusting for interaction (P = .03) between infection and baseline BMI. CONCLUSIONS The presence of Adv36 antibodies was not associated with higher BMI at baseline or follow-up within this military population. However, being infected was associated with developing a clinical diagnosis of overweight/obesity, especially among those lean at baseline.
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Affiliation(s)
- Jameson D Voss
- Epidemiology Consult Service (J.D.V.), United States Air Force School of Aerospace Medicine, Wright Patterson Air Force Base, Ohio 45433; Department of Preventive Medicine and Biometrics (J.D.V., D.G.B., C.H.O., H.W.H.), Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814; Obetech Obesity Research Center (R.L.A.), Richmond, Virginia 23219; and Virginia Commonwealth University (R.L.A.), Richmond, Virginia 23298
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Voss JD, Allison DB, Webber BJ, Otto JL, Clark LL. Lower obesity rate during residence at high altitude among a military population with frequent migration: a quasi experimental model for investigating spatial causation. PLoS One 2014; 9:e93493. [PMID: 24740173 PMCID: PMC3989193 DOI: 10.1371/journal.pone.0093493] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 03/05/2014] [Indexed: 11/29/2022] Open
Abstract
We sought to evaluate whether residence at high altitude is associated with the development of obesity among those at increased risk of becoming obese. Obesity, a leading global health priority, is often refractory to care. A potentially novel intervention is hypoxia, which has demonstrated positive long-term metabolic effects in rats. Whether or not high altitude residence confers benefit in humans, however, remains unknown. Using a quasi-experimental, retrospective study design, we observed all outpatient medical encounters for overweight active component enlisted service members in the U.S. Army or Air Force from January 2006 to December 2012 who were stationed in the United States. We compared high altitude (>1.96 kilometers above sea level) duty assignment with low altitude (<0.98 kilometers). The outcome of interest was obesity related ICD-9 codes (278.00-01, V85.3x-V85.54) by Cox regression. We found service members had a lower hazard ratio (HR) of incident obesity diagnosis if stationed at high altitude as compared to low altitude (HR 0.59, 95% confidence interval [CI] 0.54–0.65; p<0.001). Using geographic distribution of obesity prevalence among civilians throughout the U.S. as a covariate (as measured by the Centers for Disease Control and Prevention and the REGARDS study) also predicted obesity onset among service members. In conclusion, high altitude residence predicts lower rates of new obesity diagnoses among overweight service members in the U.S. Army and Air Force. Future studies should assign exposure using randomization, clarify the mechanism(s) of this relationship, and assess the net balance of harms and benefits of high altitude on obesity prevention.
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Affiliation(s)
- Jameson D. Voss
- Epidemiology Consult Division, US Air Force School of Aerospace Medicine, Wright Patterson Air Force Base, Ohio, United States of America
- Department of Preventive Medicine, Uniformed Services University, Bethesda, Maryland, United States of America
- * E-mail:
| | - David B. Allison
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Nutrition and Obesity Research Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Bryant J. Webber
- Department of Preventive Medicine, Uniformed Services University, Bethesda, Maryland, United States of America
- Trainee Health Surveillance, Joint Base San Antonio – Lackland, Lackland, Texas, United States of America
| | - Jean L. Otto
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America
| | - Leslie L. Clark
- Armed Forces Health Surveillance Center, Silver Spring, Maryland, United States of America
- General Dynamics Information Technology, Fairfax, Virginia, United States of America
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Sanderson PW, Clemes SA, Biddle SJH. Prevalence and socio-demographic correlates of obesity in the British Army. Ann Hum Biol 2014; 41:193-200. [PMID: 24502236 DOI: 10.3109/03014460.2014.881918] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The trend of escalating obesity has prompted some armed forces to employ comprehensive health surveys to report obesity trends and prevalence, the findings of which suggest that obesity is a growing concern in these specific populations. AIM To provide an appraisal of obesity prevalence and risk to obesity-related diseases in the British Army in relation to age, gender, military rank and employment. SUBJECTS AND METHOD An observational cohort study (n = 50 635) consisting of 47 173 men and 3462 women was drawn from a study sample hosted on the Fitness Information Software System (FISS) (n = 54 854). Multiple logistic regression techniques were employed separately for men and women. RESULTS According to BMI, 56.7% of the study population were overweight and of those individuals 12% were obese. Whilst a higher percentage of males were obese (12.2% and 8.6%, respectively), when waist circumference data were added to the BMI data, the results indicate that females displayed a higher percentage of risk to obesity-related diseases than males (30.4% and 24%, respectively). CONCLUSIONS Armed service personnel should be made aware of the implications of obesity in regards to health and occupation. Specific focus should be given to those older individuals employed in managerial positions undertaking low levels of occupational physical activity.
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Affiliation(s)
- Paul W Sanderson
- School of Sport, Exercise and Health Science, Loughborough University , Leicestershire LE11 3TU , UK
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67
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Bush T, Levine MD, Beebe LA, Cerutti B, Deprey M, McAfee T, Boeckman L, Zbikowski S. Addressing weight gain in smoking cessation treatment: a randomized controlled trial. Am J Health Promot 2013; 27:94-102. [PMID: 23113779 DOI: 10.4278/ajhp.110603-quan-238] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effectiveness of a cognitive behavioral treatment (CBT) addressing cessation-related weight concerns delivered via a tobacco quitline that does not address weight concerns. DESIGN Randomized controlled trial, blinded 6-month follow-up. SETTING The Oklahoma Tobacco Helpline (OKHL). SUBJECTS All 7998 smokers who called the OKHL were screened; 4240 were eligible; 2000 were randomized to the standard quitline (STD) or the brief version of the CBT weight concerns program (WCP). INTERVENTION Telephone counseling to help people quit smoking and address concerns about cessation-related weight gain. MEASURES Demographics, weight, tobacco status, weight concerns, self-efficacy in quitting, and quitting without weight gain. ANALYSIS Descriptive statistics and logistic regression. RESULTS Of those randomized, 1002 participants completed the 6-month survey (response rates = 53.2% for STD, 47% for WCP). Compared with STD, WCP led to reduced weight concerns (p < .01) and less weight gain among quitters (1.8 vs. -3.4 pounds; p = .01). Although not significant, participants in the WCP were more likely to report 30-day abstinence (33.3% vs. 36.8%, p = .24; intent to treat = 17.7 vs. 17.3). CONCLUSION The WCP was successfully delivered via a quitline and resulted in improved attitudes about weight and decreased cessation-related weight gain without harming quit rates. Promotion of a quitline focused on addressing weight in conjunction with quitline treatment for smoking cessation may improve cessation and weight outcomes. Study limitations include use of self-report and survey response.
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Affiliation(s)
- Terry Bush
- Alere Wellbeing, Seattle, Washington, USA.
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Tanofsky-Kraff M, Sbrocco T, Theim KR, Cohen LA, Mackey ER, Stice E, Henderson JL, McCreight SJ, Bryant EJ, Stephens MB. Obesity and the US military family. Obesity (Silver Spring) 2013; 21:2205-20. [PMID: 23836452 PMCID: PMC4010088 DOI: 10.1002/oby.20566] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 06/28/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This review discusses the current knowledge and future directions regarding obesity within the US military family (i.e., active-duty servicemembers, as well as military spouses, children, retirees, and veterans). The increasing rates of overweight and obesity within the US military adversely impact military readiness, limit recruitment, and place a significant financial burden on the Department of Defense. DESIGN AND METHODS The following topics are reviewed: 1) The prevalence of and the financial, physical, and psychological costs associated with overweight in military communities; 2) military weight regulations, and challenges faced by the military family related to overweight and disordered eating; 3) the continued need for rigorous program evaluations and new intervention development. RESULTS Overweight and its associated sequelae impact the entire military family. Military families share many similarities with their civilian counterparts, but they face unique challenges (e.g., stress related to deployments and relocations). Although the military has weight management resources, there is an urgent need for rigorous program evaluation and the development of enhanced obesity prevention programs across the lifespan of the military family-several of which are proposed herein. CONCLUSIONS Interdisciplinary and collaborative research efforts and team-based interventions will continue to inform understanding of obesity treatment and prevention within military and civilian populations.
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Affiliation(s)
- Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Kelly R. Theim
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - L. Adelyn Cohen
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Eleanor R. Mackey
- Children's National Medical Center, Washington, District of Columbia, USA
| | - Eric Stice
- Oregon Research Institute, Eugene, Oregon, USA
| | - Jennifer L. Henderson
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Sarah J. McCreight
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Edny J. Bryant
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Mark B. Stephens
- Department of Family Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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69
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Padden DL, Connors RA, Posey SM, Ricciardi R, Agazio JG. Factors Influencing a Health Promoting Lifestyle in Spouses of Active Duty Military. Health Care Women Int 2013; 34:674-93. [DOI: 10.1080/07399332.2012.736572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Military personnel can be exposed to toxicants and conditions that can contribute to lung diseases. This article describes what is known about these exposures and diseases, focusing on the Iraq and Afghanistan wars. Adverse lung health outcomes have been reported in US military personnel deployed to Iraq and/or Afghanistan. Most studies to date have been hindered by limited deployment-specific exposure assessment, lack of baseline lung health information, and variable medical evaluations and case definitions. Further research is warranted. Medical surveillance has been recommended for returning troops, but the challenges are substantial.
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Affiliation(s)
- Cecile S Rose
- Division of Environmental and Occupational Health Sciences, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
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71
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Yang W, Dall TM, Zhang Y, Zhang S, Arday DR, Dorn PW, Jain A. Simulation Of Quitting Smoking In The Military Shows Higher Lifetime Medical Spending More Than Offset By Productivity Gains. Health Aff (Millwood) 2012; 31:2717-26. [DOI: 10.1377/hlthaff.2010.1048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Wenya Yang
- Wenya Yang is a health services researcher and senior consultant at the Lewin Group, in Falls Church, Virginia
| | - Timothy M. Dall
- Timothy M. Dall is a health economist and managing director at IHS Global, in Washington, D.C
| | - Yiduo Zhang
- Yiduo Zhang is an associate director at MedImmune, in Gaithersburg, Maryland
| | - Shiping Zhang
- Shiping Zhang is an associate with Booz Allen Hamilton’s Advanced Analytics Division, in McLean, Virginia
| | - David R. Arday
- David R. Arday is a medical director and consultant with Lockheed Martin Information Systems and Global Solutions, in Fairfax, Virginia
| | - Patricia W. Dorn
- Patricia W. Dorn is a retired captain in the Nurse Corps of the United States Navy. She lives in Culpeper, Virginia
| | - Anjali Jain
- Anjali Jain is a senior researcher and managing consultant at the Lewin Group
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72
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Smith EA, Malone RE. Why strong tobacco control measures "can't" be implemented in the U.S. Military: a qualitative analysis. Mil Med 2012; 177:1202-7. [PMID: 23113448 DOI: 10.7205/milmed-d-12-00199] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The Institute of Medicine recently called for a tobacco-free military, citing evidence that high rates of tobacco use harm readiness and create enormous costs for the Department of Defense and the Veterans Administration. The pro-tobacco activities of the tobacco industry and others, sometimes supported by military authorities even when prohibited by policy, have created a culture highly hospitable to smoking. Through qualitative secondary analysis of data from interviews and focus groups, this article explores the reasons enlisted personnel and their supervisors, installation tobacco control managers, and service policy leaders give for why tobacco control policy change "cannot" effectively be achieved. Three primary reasons were given: policies would impinge on the "right to smoke," policies would be unenforceable and lead to disciplinary breakdown, and the rights of civilian workers on military installations precluded policy enforcement. Yet evidence suggests that these reasons are not only invalid, but inconsistent with military policies addressing other threats to the health of personnel. This pervasive tobacco "exceptionalism" is a significant barrier to achieving a tobacco-free military. The military, Congress, and the President should re-evaluate the "can'ts" that have prevented effective action, and act to regulate and eventually abolish tobacco use in the armed forces.
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Affiliation(s)
- Elizabeth A Smith
- Department of Social & Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA
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73
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Controlling health care costs in the military: the case for using financial incentives to improve beneficiary personal health indicators. Prev Med 2012; 55 Suppl:S113-5. [PMID: 22766007 DOI: 10.1016/j.ypmed.2012.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 06/22/2012] [Accepted: 06/24/2012] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To provide insight on the feasibility and utility of implementing a broad based incentive program for health within the Military Health System (MHS). METHOD Published studies, articles, and information on the use of financial incentives in the military setting and to promote healthy behaviors were reviewed. RESULTS Health care costs in the MHS have more than doubled over the past decade. The high prevalence of modifiable risk behaviors such as tobacco abuse, physical inactivity and obesity and their associated chronic diseases are accounting for a significant percentage of the growth. One evidence-based approach to address this issue would be the implementation of a broad based incentive program for health whereby all MHS beneficiaries would be eligible to receive some type of financial remuneration for meeting positive personal health metrics (e.g. not smoking or a normal body mass index). This approach if designed appropriately has the potential to have a high level of acceptance within the current beneficiary population since financial incentives are already used widely in the military to help meet overall manpower requirements. CONCLUSION The use of a MHS wide financial incentives program to instill healthy behaviors in beneficiaries' may be an effective means to curb rising healthcare cost.
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Cawley J, Maclean JC. Unfit for service: the implications of rising obesity for US military recruitment. HEALTH ECONOMICS 2012; 21:1348-1366. [PMID: 21971919 DOI: 10.1002/hec.1794] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 08/01/2011] [Accepted: 08/24/2011] [Indexed: 05/31/2023]
Abstract
This paper contributes to the literature on the labor market consequences of unhealthy behaviors and poor health by examining a previously underappreciated consequence of the rise in obesity in the USA: challenges for military recruitment. Specifically, this paper estimates the percentage of the US military-age population that exceeds the US Army's current active duty enlistment standards for weight-for-height and percent body fat, using data from the series of National Health and Nutrition Examination Surveys that spans 1959-2008. We calculate that the percentage of military-age adults ineligible for enlistment because they are overweight and overfat more than doubled for men and tripled for women during that time. As of 2007-2008, 5.7 million men and 16.5 million women exceeded the Army's enlistment standards for weight and body fat. We document disparities across race and education in exceeding the standards and estimate that a further rise of just 1% in weight and body fat would further reduce eligibility for military service by over 850 000 men and 1.3 million women. The paper concludes with a discussion of the implications of these findings for military recruitment and defense policy.
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Affiliation(s)
- John Cawley
- Department of Policy Analysis and Management and Department of Economics, Cornell University, Ithaca, NY 14853, USA.
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Affiliation(s)
- Stephen T Higgins
- Department of Psychiatry, University of Vermont, University Health Center Campus, 1 S. Prospect St, Burlington, VT 05401, USA.
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Vick L, Duffy SA, Ewing LA, Rugen K, Zak C. Implementation of an inpatient smoking cessation programme in a Veterans Affairs facility. J Clin Nurs 2012; 22:866-80. [DOI: 10.1111/j.1365-2702.2012.04188.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Smith TJ, Marriott BP, Dotson L, Bathalon GP, Funderburk L, White A, Hadden L, Young AJ. Overweight and obesity in military personnel: sociodemographic predictors. Obesity (Silver Spring) 2012; 20:1534-8. [PMID: 22314620 DOI: 10.1038/oby.2012.25] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In the United States, nationally representative civilian studies have shown that BMI is associated with select sociodemographic characteristics. Active-duty military personnel are not included in these surveys and the persistence of these associations in military personnel is unknown. Data from the worldwide, representative 2002 and 2005 Department of Defense (DoD) Surveys of Health-Related Behaviors Among Active Duty Military Personnel were used to assess the prevalence of overweight and obesity and, the association of BMI with sociodemographic characteristics. The final response bases included 12,756 (2002) and 16,146 (2005) personnel. Results indicated that the combined prevalence of overweight and obesity in military personnel increased to an all-time high in 2005 (60.5%) with higher prevalence of obesity in 2005 compared to 2002 (12.9% vs. 8.7, respectively, P ≤ 0.01). Holding other variables constant, regression analysis indicated that women were significantly less likely than men to be overweight or obese in both survey years (P ≤ 0.0001), which is contrary to civilian data. Similar to civilian data, the prevalence of obesity was significantly associated with increased age, black or Hispanic/Latino race/ethnicity, and being married (P ≤ 0.01). US military personnel are not immune to the US obesity epidemic. Demographic characteristics associated with being overweight should be considered when developing military-sponsored weight management programs.
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Affiliation(s)
- Tracey J Smith
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, USA.
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Efficacy of Orlistat 60 mg on Weight Loss and Body Fat Mass in US Army Soldiers. J Acad Nutr Diet 2012; 112:533-40. [DOI: 10.1016/j.jada.2011.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 09/29/2011] [Indexed: 01/22/2023]
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79
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Bush T, Levine MD, Deprey M, Cerutti B, Zbikowski SM, McAfee T, Mahoney L, Beebe L. Prevalence of Weight Concerns and Obesity Among Smokers Calling a Quitline. J Smok Cessat 2012; 4:74-78. [PMID: 20548969 DOI: 10.1375/jsc.4.2.74] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND: Cessation-related weight gain and weight concerns are common among smokers and have a negative impact on quitting. Obese smokers tend to gain more than the average amount of weight and also have lower quit rates. This article describes the prevalence of obesity and weight concerns among smokers calling a state quitline in the United States. RESULTS: Among 3972 smokers using a state quitline, 33.3% were obese, 30.2% overweight, 33.3% normal weight and 3.2% underweight; a total of 60.6% were concerned about cessation-related weight gain. Compared with non-obese callers, obese callers were more likely to be female, Hispanic, non-White and heavier smokers. CONCLUSIONS: This is the first study to report data on body weight and weight concerns of smokers calling a national quitline. Given the lower quit rates among obese and weight-concerned smokers, and the burden of smoking and obesity, there is an opportunity to develop new treatment approaches for this at-risk population.
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Affiliation(s)
- Terry Bush
- Free & Clear, Inc., United States of America
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Abstract
PURPOSE OF REVIEW To understand how obesity affects national security by focusing on three case study countries - the USA, China, and Mexico. RECENT FINDINGS Whereas in the USA and Mexico, over two-thirds of adults are overweight and obese compared to about 29% of Chinese, large increases in the prevalence of overweight and obesity have occurred in all three countries in the past two decades. National security affected in the USA ranges both from an economic perspective - increasing healthcare problems and costs to the point where our labor costs have reached uncompetitive cost levels, and from a military preparedness perspective, namely our overweight soldiers are unable to perform normal activities and functions required of soldiers. In both Mexico and China, it is the economic and health system costs that are dominant concerns, both the costs of obesity-related medical care and the productivity of the work force are creating potential long-term effects on economic competitiveness. SUMMARY Obesity is adversely affecting the welfare, economic, and in some cases military security of these three countries.
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Affiliation(s)
- Barry M Popkin
- University of North Carolina, Chapel Hill, NC 27516, USA.
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81
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Hoffman KM, Poston WSC, Jitnarin N, Jahnke SA, Hughey J, Lando HA, Williams LN, Haddock K. A content analysis of tobacco control policy in the U.S. Department of Defense. J Public Health Policy 2011; 32:334-49. [PMID: 21368849 PMCID: PMC3149762 DOI: 10.1057/jphp.2011.6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
We conducted a content analysis of the US military tobacco policies at the Department of Defense, each respective military service (Army, Air Force, Navy, and Marine Corps), and their Major Commands (MAJCOM). Ninety-seven policies were evaluated using the Military Tobacco Policy Rating Form (MTPRF). More than three quarters addressed the following domains: (1) deleterious health effects of tobacco use; (2) environmental tobacco smoke; (3) designation of smoking areas; (4) tobacco prevention/cessation programs; and (5) smokeless tobacco. Few policies (2.1 per cent) mentioned relevant Department of Defense and respective service tobacco use prevalence statistics. Smoking as non-normative or incompatible with military service, the impact of tobacco use on military readiness, and the tobacco industry were addressed infrequently (6.2 per cent, 33.0 per cent, and 8.2 per cent, respectively). Future military tobacco policies should address important omissions of critical information such as the current service tobacco use prevalence, effects on readiness, and smoking as non-normative.
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82
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Kuo S, Bryce CL, Zgibor JC, Wolf DL, Roberts MS, Smith KJ. Cost-effectiveness of implementing the chronic care model for diabetes care in a military population. J Diabetes Sci Technol 2011; 5:501-13. [PMID: 21722566 PMCID: PMC3192617 DOI: 10.1177/193229681100500305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Applying the chronic care model (CCM) for diabetes management helps improve health outcomes and patient care. The CCM was implemented at U.S. Air Force Wilford Hall Medical Center through the Diabetes Outreach Clinic (DOC) in 2006, but its cost-effectiveness in this setting is unknown. METHODS We constructed a Markov decision model to estimate DOC cost-effectiveness compared with usual care (UC) over a 20-year period. Based on empirical, post-intervention demographic and clinical data, we applied United Kingdom Prospective Diabetes Study risk equations to predict long-term probabilities of developing microvascular or macrovascular complications. Health care system and societal perspectives were considered, discounting costs and benefits at 3% annually. Intervention costs and outcomes were obtained from military data, while other costs, disease progression data, and utilities were drawn from published literature. RESULTS From a health care system perspective, the DOC cost $45,495 per quality-adjusted life-year (QALY) compared with UC; from a societal perspective, the DOC compared with UC cost $42,051/QALY (when the model started with the uncomplicated diabetes cohort), $61,243/QALY (when starting with the DOC cohort), or $61,813/QALY (when starting with the UC cohort). In one-way sensitivity analyses, results were most sensitive to yearly costs for specialty care visits. In probabilistic sensitivity analysis, the DOC was favored in 51% of model iterations using an acceptability threshold of $50,000/QALY and in 72% at a threshold of $100,000/QALY. CONCLUSIONS The DOC strategy for diabetes care, performed with the CCM methodology in a military population, appears to be economically reasonable compared with UC.
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Affiliation(s)
- Shihchen Kuo
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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83
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Dall TM, Zhang Y, Zhang S, Arday DR, Sahai N, Dorn P, Jain A. Weight loss and lifetime medical expenditures: a case study with TRICARE prime beneficiaries. Am J Prev Med 2011; 40:338-44. [PMID: 21335267 DOI: 10.1016/j.amepre.2010.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 09/14/2010] [Accepted: 11/04/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND TRICARE's Prime (managed care) plan spends more than $1 billion annually in medical expenditures attributed to overweight and obesity. PURPOSE This study estimates change in lifetime disease prevalence and medical expenditures associated with weight loss for beneficiaries in TRICARE's Prime plan. METHODS This 2010 analysis uses Markov Chain Monte Carlo simulation with demographics, biometrics, health behavior, and disease presence for 857,200 overweight and 521,800 obese beneficiaries aged 18-64 years in 2008 to model future onset of diseases linked to excess weight. Prediction equations in the simulation come from multiple sources: (1) regression analysis with longitudinal (2007-2008) TRICARE medical claims and electronic health records for 2.1 million beneficiaries; (2) regression analysis with Medical Expenditure Panel Survey (2002-2007) and National Health and Nutrition Examination Survey (1999-2008) data; (3) cancer and mortality risk from Surveillance, Epidemiology, and End Results data; and (4) published findings from clinical trials. RESULTS Among overweight and obese beneficiaries, lifetime medical expenditures declined $440 (3% discount rate) for each permanent 1% reduction in body weight. This includes $590 in savings from improved health, offset by $150 in additional expenditures from prolonged life. Estimates range from $660 reduction for grossly obese adults aged <45 years to $40 gain from grossly obese adults aged 55-64 years (where expenditures from increased longevity exceed savings from improved health). If weight loss is temporary and regained after 24 months, lifetime expenditures decline by $40 per 1% reduction in body weight. CONCLUSIONS Long-term benefits from weight loss are substantially greater than short-term benefits, underscoring the need for a societal perspective to combat obesity.
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84
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Offen N, Arvey SR, Smith EA, Malone RE. Forcing the Navy to sell cigarettes on ships: how the tobacco industry and politicians torpedoed Navy tobacco control. Am J Public Health 2011; 101:404-11. [PMID: 21233435 DOI: 10.2105/ajph.2010.196329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In 1986, the US Navy announced the goal of becoming smoke-free by 2000. However, efforts to restrict tobacco sales and use aboard the USS Roosevelt prompted tobacco industry lobbyists to persuade their allies in Congress to legislate that all naval ships must sell tobacco. Congress also removed control of ships' stores from the Navy. By 1993, the Navy abandoned its smoke-free goal entirely and promised smokers a place to smoke on all ships. Congressional complicity in promoting the agenda of the tobacco industry thwarted the Navy's efforts to achieve a healthy military workforce. Because of military lobbying constraints, civilian pressure on Congress may be necessary to establish effective tobacco control policies in the armed forces.
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Affiliation(s)
- Naphtali Offen
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, CA 94118, USA.
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85
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Sanderson PW, Clemes SA, Biddle SJH. The correlates and treatment of obesity in military populations: a systematic review. Obes Facts 2011; 4:229-37. [PMID: 21701240 PMCID: PMC6444481 DOI: 10.1159/000329450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The emergence of obesity as a distinct disease could have far reaching consequences for an organisation where optimum health and physical fitness are required for personnel to perform their occupational roles effectively. The objectives of this paper are to systematically review the literature concerning correlates and treatment of obesity in military populations. METHODS Through computerised searches of English language studies, 17 papers were identified (treatment (13), correlates (4)). RESULTS Successful treatment interventions incorporated exercise, healthy eating information, behavioural modification, self-monitoring, relapse prevention, and structured follow-up and were supported by trained personnel. Efficacy due to physical activity was underreported. Reduction in body fat rather than body weight was the most significant outcome. The major significant correlates of obesity were being enlisted personnel, male, ≥35 years of age, African-American/Hispanic ethnicity, and married (with spouse present). CONCLUSION This systematic review highlights the deficit in knowledge concerning treatment and the lack of engagement in relation to the specific correlates of obesity in military populations.
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Affiliation(s)
- Paul W Sanderson
- School of Sport, Exercise and Health Sciences, Loughborough University, UK.
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Grier T, Knapik JJ, Canada S, Canham-Chervak M, Jones BH. Tobacco use prevalence and factors associated with tobacco use in new U.S. Army personnel. J Addict Dis 2010; 29:284-93. [PMID: 20635278 DOI: 10.1080/10550887.2010.489445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study examined the prevalence of tobacco use and factors associated with pre-military service cigarette and smokeless tobacco use. From January 2000 to December 2006, military students arriving for Advanced Individual Training at the U.S. Army Ordnance School completed a questionnaire that asked about their use of tobacco products. The prevalence of smokeless tobacco use from 2000 to 2006 for women generally decreased, as did the number of cigarettes smoked per day by men. For men and women, factors associated with cigarette use included younger age, Caucasian race, and use of smokeless tobacco. Factors associated with smokeless tobacco use among men included younger age, Caucasian race, and cigarette use. For women, cigarette use was the only factor associated with smokeless tobacco use. The identified factors in this study could be used to establish strategies in the future to reduce tobacco use in the military.
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Affiliation(s)
- Tyson Grier
- Directorate of Epidemiology and Disease Surveillance, United States Army Public Health Command, Aberdeen Proving Ground, MD 21010, USA.
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87
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Smith EA, Malone RE. Tobacco promotion to military personnel: "the plums are here to be plucked". Mil Med 2010; 174:797-806. [PMID: 19743733 DOI: 10.7205/milmed-d-04-4108] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Smoking rates among military personnel are high, damaging health, decreasing short- and long-term troop readiness, and costing the Department of Defense (DOD). The military is an important market for the tobacco industry, which long targeted the military with cigarette promotions. Internal tobacco industry documents were examined to explore tobacco sponsorship of events targeted to military personnel. Evidence was found of more than 1,400 events held between 1980 and 1997. In 1986, the DOD issued a directive forbidding such special promotions; however, with the frequently eager cooperation of military personnel, they continued for more than a decade, apparently ceasing only because of the restrictions of the Master Settlement Agreement. The U.S. military collaborated with the tobacco industry for decades, creating a military culture of smoking. Reversing that process will require strong policy establishing tobacco use as unmilitary.
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Affiliation(s)
- Elizabeth A Smith
- Department of Social and Behavioral Science, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA
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88
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The Novartis health index: a method for valuing the economic impact of risk reduction in a workforce. J Occup Environ Med 2010; 52:528-35. [PMID: 20431406 DOI: 10.1097/jom.0b013e3181dbe339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop a calculator that measures the potential cost impact of changes in health risks and presents results graphically. METHODS Demographic and health risk data for Novartis employees were input into a calculator that estimated employer medical care, short-term disability, absenteeism, and presenteeism costs associated with risk prevalence, based on a previous cross-sectional analysis of the association between risks and costs. Estimated costs were presented as a relative score, the Novartis Health Index, which is a measure of the overall costs associated with the risk profile of a population of interest. RESULTS The population of Novartis employees had an index score of 81.5 (out of 100), indicating a relatively healthy risk profile, and baseline annual costs of $9619 per employee. Risk reduction of 1% and 10% for tobacco, alcohol use, and emotional health risks had the potential to generate annual savings of $91,500 and $915,000, respectively. CONCLUSIONS The Novartis Health Index framework allows employers to track performance relative to health risk management using a single, accessible, user-friendly measure.
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Cortez-Pinto H, Gouveia M, dos Santos Pinheiro L, Costa J, Borges M, Vaz Carneiro A. The burden of disease and the cost of illness attributable to alcohol drinking--results of a national study. Alcohol Clin Exp Res 2010; 34:1442-9. [PMID: 20528821 DOI: 10.1111/j.1530-0277.2010.01229.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS The World Health Organization estimated that 3.2% of the burden of disease around the world is attributable to the consumption of alcohol. The aim of this study is to estimate the burden of disease attributable to alcohol consumption in Portugal. METHODS Burden and costs of diseases attributable to alcohol drinking were estimated based on demographic and health statistics available for 2005, using the Disability-Adjusted Life Years (DALY) lost generated by death or disability. RESULTS In Portugal, 3.8% of deaths are attributable to alcohol (4,059 of 107,839). After measuring the DALY generated by mortality data, the proportion of disease attributable to alcohol was 5.0%, with men having 5.6% of deaths and 6.2% of disease burden, while female figures were, respectively, 1.8 and 2.4%. Considering the sum of death and disability DALYs, liver diseases represented the main source of the burden attributable to alcohol with 31.5% of total DALYs, followed by traffic accidents (28.2%) and several types of cancer (19.2%). As for the cost of illness incurred by the health system, our results indicate that 95.1 millions euros are attributable to alcohol-related disease admissions (liver diseases, cancer, traffic accidents, and external causes) while the ambulatory costs of alcohol-related diseases were estimated in 95.9 million euros, totaling 191.0 million euros direct costs, representing 0.13% of Gross Domestic Product and 1.25% of total national health expenditures. An alternative analysis was carried out using higher consumption levels so as to replicate aggregate alcohol consumption statistics. In this case, DALYs lost increased by 11.7% and health costs by 23%. CONCLUSION Our results confirm that alcohol is an important health risk factor in Portugal and a heavy economic burden for the health system, with hepatic diseases ranking first as a source of burden of disease attributable to alcohol.
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Affiliation(s)
- Helena Cortez-Pinto
- Departamento de Gastrenterologia, Unidade de Nutrição e Metabolismo, IMM, Lisbon, Portugal.
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90
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Smith TJ, Sigrist LD, Bathalon GP, McGraw S, Karl JP, Young AJ. Efficacy of a Meal-Replacement Program for Promoting Blood Lipid Changes and Weight and Body Fat Loss in US Army Soldiers. ACTA ACUST UNITED AC 2010; 110:268-73. [DOI: 10.1016/j.jada.2009.10.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 06/30/2009] [Indexed: 01/22/2023]
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91
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Zhang Y, Dall TM, Chen Y, Baldwin A, Yang W, Mann S, Moore V, Le Nestour E, Quick WW. Medical cost associated with prediabetes. Popul Health Manag 2009; 12:157-63. [PMID: 19534580 DOI: 10.1089/pop.2009.12302] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In this article, we estimate national health care resource use and medical costs in 2007 associated with prediabetes (PD), defined as either fasting plasma glucose between 100 and 125 or oral glucose tolerance test between 140 and 200. We use Poisson regression with medical claims for an adult population continuously insured between 2004 and 2006 to analyze patterns of health care resource use by PD status. Combining rate ratios that reflect health care use patterns with national PD prevalence rates from the National Health and Nutrition Examination Survey, we calculate etiological fractions to estimate the portion of national health resource use associated with PD. The findings suggest that PD is associated with statistically higher rates of ambulatory visits for hypertension; endocrine, metabolic, and renal complications; and general medical conditions. PD is associated with a slight increase in visit rates for neurological symptoms, peripheral vascular disease, and cardiovascular disease, but the increase is not statistically significant. There is no indication that PD is associated with an increase in emergency visits and inpatient days. Extrapolating these patterns to the 57 million adults with PD in 2007 suggests that national annual medical costs of PD exceed $25 billion, or an additional $443 for each adult with PD. PD is associated with excessive use of ambulatory services for comorbidities known to be related to diabetes. Our findings strengthen the business case for lifestyle interventions to prevent diabetes by adding additional economic benefits that potentially can be achieved by preventing or delaying PD.
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Affiliation(s)
- Yiduo Zhang
- The Lewin Group, Falls Church, Virginia, USA.
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92
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Dall TM, Fulgoni VL, Zhang Y, Reimers KJ, Packard PT, Astwood JD. Potential health benefits and medical cost savings from calorie, sodium, and saturated fat reductions in the American diet. Am J Health Promot 2009; 23:412-22. [PMID: 19601481 DOI: 10.4278/ajhp.080930-quan-226] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE Model the potential national health benefits and medical savings from reduced daily intake of calories, sodium, and saturated fat among the U.S. adult population. DESIGN Simulation based on secondary data analysis; quantitative research. Measures include the prevalence of overweight/obesity, uncontrolled hypertension, elevated cholesterol, and related chronic conditions under various hypothetical dietary changes. SETTING United States. SUBJECTS Two hundred twenty-four million adults. MEASURES Findings come from a Nutrition Impact Model that combines information from national surveys, peer-reviewed studies, and government reports. ANALYSIS The simulation model predicts disease prevalence and medical expenditures under hypothetical dietary change scenarios. RESULTS We estimate that permanent 100-kcal reductions in daily intake would eliminate approximately 71.2 million cases of overweight/obesity and save $58 billion annually. Long-term sodium intake reductions of 400 mg/d in those with uncontrolled hypertension would eliminate about 1.5 million cases, saving $2.3 billion annually. Decreasing 5 g/d of saturated fat intake in those with elevated cholesterol would eliminate 3.9 million cases, saving $2.0 billion annually. CONCLUSIONS Modest to aggressive changes in diet can improve health and reduce annual national medical expenditures by $60 billion to $120 billion. One use of the model is to estimate the impact of dietary change related to setting public health priorities for dietary guidance. The findings here argue that emphasis on reduction in caloric intake should be the highest priority.
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Affiliation(s)
- Timothy M Dall
- The Lewin Group, 3130 Fairview Park Dr, Suite 800, Falls Church, VA 22042, USA.
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93
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Stahre MA, Brewer RD, Fonseca VP, Naimi TS. Binge drinking among U.S. active-duty military personnel. Am J Prev Med 2009; 36:208-17. [PMID: 19215846 DOI: 10.1016/j.amepre.2008.10.017] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 08/22/2008] [Accepted: 10/27/2008] [Indexed: 01/30/2023]
Abstract
BACKGROUND Binge drinking (drinking on a single occasion >or=5 drinks for men or >or=4 drinks for women) is a common risk behavior among U.S. adults that is associated with many adverse health and social consequences. However, little is known about binge drinking among active-duty military personnel (ADMP). The objectives of this study were to quantify episodes of binge drinking, to characterize ADMP who binge-drink, and to examine the relationship between binge drinking and related harms. METHODS The prevalence of binge drinking and related harms was assessed from responses to the 2005 Department of Defense Survey of Health Related Behaviors Among Military Personnel (n=16,037), an anonymous, self-administered survey. The data were analyzed in 2007 after the release of the public-use data. RESULTS In 2005, a total of 43.2% of ADMP reported past-month binge drinking, resulting in 29.7 episodes per person per year. In all, 67.1% of binge episodes were reported by personnel aged 17-25 years (46.7% of ADMP), and 25.1% of these episodes were reported by underage youth (aged 17-20 years). Heavy drinkers (19.8% of ADMP) were responsible for 71.5% of the binge-drinking episodes and had the highest number of annual per-capita episodes of binge drinking (112.6 episodes). Compared to nonbinge drinkers, binge drinkers were more likely to report alcohol-related harms, including job performance problems (AOR=6.5; 95% CI=4.65, 9.15); alcohol-impaired driving (AOR=4.9; 95% CI=3.68, 6.49); and criminal justice problems (AOR=6.2; 95% CI=4.00, 9.72). CONCLUSIONS Binge drinking is common among ADMP and is strongly associated with adverse health and social consequences. Effective interventions (e.g., the enforcement and retainment of the minimum legal drinking age) to prevent binge drinking should be implemented across the military and in conjunction with military communities to discourage binge drinking.
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Affiliation(s)
- Mandy A Stahre
- Alcohol Team, Emerging Investigations and Analytic Methods Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia, USA.
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