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Vest BM, Hoopsick RA, Homish DL, Kulak JA, Homish GG. Longitudinal Effects of Military Separation and Mental Health Symptomatology on Substance Use Among a Cohort of Reservists. J Stud Alcohol Drugs 2024; 85:528-536. [PMID: 38319103 PMCID: PMC11289865 DOI: 10.15288/jsad.23-00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/22/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE The relationship between mental health and substance use among military populations is well established, and evidence suggests that these risks may be greater for those who have left the military. However, it is less clear what independent effects leaving the military may have on substance use behaviors. This study examined the longitudinal relationship between leaving the military and substance use outcomes (hazardous drinking, frequent heavy drinking, nonmedical use of prescription drugs, illicit drug use) in a cohort of Reserve and National Guard (R/NG) soldiers. Further, we examined whether mental health symptoms moderate the relationship between leaving the military and substance use. METHOD Analyses used data (N = 485 soldiers) from the first four annual waves of Operation: SAFETY, an ongoing prospective cohort study of U.S. Army R/NG soldiers and their spouses. We used generalized estimating equations (GEEs) to examine the relationships between military status (former vs. current soldier) and substance use outcomes over 4 years. Last, we examined interactions between military status and mental health indicators (anxiety, anger, depression, and posttraumatic stress disorder) on substance use over time. RESULTS After we controlled for sex, age, race, years of military service, sleep problems, bodily pain, and substance use norms, being a former soldier, compared with being a current soldier, was associated with greater odds of current illicit drug use (adjusted odds ratio = 2.86, 95% CI [1.47, 5.57]; p < .01). Mental health symptomatology did not moderate the relationship between leaving the military and current drug use. CONCLUSIONS Leaving the military in and of itself may result in increased drug use for some individuals, regardless of mental health symptomatology.
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Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, New York
| | - Jessica A. Kulak
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, New York
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2
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Otufowora A, Liu Y, Okusanya A, Ogidan A, Okusanya A, Cottler LB. The Effect of Veteran Status and Chronic Pain on Past 30-Day Sedative Use Among Community-Dwelling Adult Males. J Am Board Fam Med 2024; 37:118-128. [PMID: 38448239 PMCID: PMC11378463 DOI: 10.3122/jabfm.2023.230226r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/20/2023] [Accepted: 08/29/2023] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Given the high sedative prescription rate, the sedative-associated morbidity, and mortality nationally (especially among veterans), we aimed to test the hypothesis that veteran status in the presence of chronic pain would be associated with greater sedative use when compared with nonveteran status. METHODS The study participants were recruited by Community Health Workers (CHWs) through the ongoing community engagement program (HealthStreet) at the University of Florida. CHWs collected information on sociodemographic factors, health status, and past 30-day drug use patterns. RESULTS The study sample comprised 4,732 male participants, of which 21% were veterans, 58% were Blacks and 8.4% had used prescription sedatives in the past 30 days. Veterans (vs nonveterans) were twice as likely to have used prescription sedatives in the past 30 days in the presence of chronic pain. CONCLUSIONS Veterans with chronic pain are a high-risk population for current prescription sedative use.
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Affiliation(s)
- Ayodeji Otufowora
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (A Otufowora); Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL (YL, LBC); Department of Pharmacy, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA (A Okusanya); Department of Medicine & Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu Campus, Ogun State, Nigeria (A Ogidan); Department of Public Health, Milken Institute School of Public Health, The George Washington University, Washington, DC (A Okusanya).
| | - Yiyang Liu
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (A Otufowora); Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL (YL, LBC); Department of Pharmacy, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA (A Okusanya); Department of Medicine & Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu Campus, Ogun State, Nigeria (A Ogidan); Department of Public Health, Milken Institute School of Public Health, The George Washington University, Washington, DC (A Okusanya)
| | - Aderonke Okusanya
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (A Otufowora); Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL (YL, LBC); Department of Pharmacy, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA (A Okusanya); Department of Medicine & Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu Campus, Ogun State, Nigeria (A Ogidan); Department of Public Health, Milken Institute School of Public Health, The George Washington University, Washington, DC (A Okusanya)
| | - Afeez Ogidan
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (A Otufowora); Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL (YL, LBC); Department of Pharmacy, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA (A Okusanya); Department of Medicine & Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu Campus, Ogun State, Nigeria (A Ogidan); Department of Public Health, Milken Institute School of Public Health, The George Washington University, Washington, DC (A Okusanya)
| | - Adedoyin Okusanya
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (A Otufowora); Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL (YL, LBC); Department of Pharmacy, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA (A Okusanya); Department of Medicine & Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu Campus, Ogun State, Nigeria (A Ogidan); Department of Public Health, Milken Institute School of Public Health, The George Washington University, Washington, DC (A Okusanya)
| | - Linda B Cottler
- From the Department of Pediatrics, Columbia University Medical Center, New York, NY (A Otufowora); Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, FL (YL, LBC); Department of Pharmacy, College of Pharmacy and Health Sciences, Western New England University, Springfield, MA (A Okusanya); Department of Medicine & Surgery, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu Campus, Ogun State, Nigeria (A Ogidan); Department of Public Health, Milken Institute School of Public Health, The George Washington University, Washington, DC (A Okusanya)
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Cole WR, Tegeler CL, Choi YS, Harris TE, Rachels N, Bellini PG, Haight TJ, Gerdes L, Tegeler CH, Roy MJ. Randomized, controlled clinical trial of acoustic stimulation to reduce postconcussive symptoms. Ann Clin Transl Neurol 2024; 11:105-120. [PMID: 37990636 PMCID: PMC10791035 DOI: 10.1002/acn3.51937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/17/2023] [Accepted: 10/19/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVE Effective interventions are needed to address postconcussive symptoms. We report the results of randomized, sham-controlled trial of Cereset Research™ Standard Operating Procedures (CR-SOP), a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology previously shown to improve insomnia. METHODS Military service members, veterans, or their spouses with persistent symptoms (Neurobehavioral Symptom Inventory [NSI] Score ≥23) after mTBI 3 months to 10 years ago, were randomized to receive 10 sessions of engineered tones linked to brainwaves (LB, intervention), or random engineered tones not linked to brainwaves (NL, sham control). The primary outcome was change in NSI, with secondary outcomes of heart rate variability and self-report measures of sleep, mood, and anxiety. RESULTS Participants (n = 106, 22% female, mean age 37.1, 2.8 deployments, 3.8 TBIs) were randomized 1:1 to LB or NL, with no significant differences between groups at baseline. Among all study participants, the NSI declined from baseline 41.0 to 27.2 after (P < 0.0001), with gains largely sustained at 3 months (31.2) and 6 months (28.4). However, there were no significant differences between the LB (NSI declined from 39.9 at baseline to 28.2 post-intervention, 31.5 at 3 months, and 29.4 at 6 months) and NL (NSI declined from 41.5 at baseline to 26.2, 29.9, and 27.3, respectively. Similar patterns were observed for the PCL5 and PHQ-9 and there was no difference in HRV between groups. INTERPRETATION Ten hours of acoustic stimulation while resting in a zero-gravity chair improves postconcussive symptoms. However, linking tones to brain electrical activity did not reduce symptoms more than random tones. REGISTRATION ClinicalTrials.gov - NCT03649958.
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Affiliation(s)
- Wesley R. Cole
- University of North CarolinaChapel HillNorth CarolinaUSA
| | | | - Y. Sammy Choi
- Womack Army Medical CenterFort BraggNorth CarolinaUSA
| | | | - Nora Rachels
- Womack Army Medical CenterFort BraggNorth CarolinaUSA
| | - Paula G. Bellini
- Uniformed Services UniversityBethesdaMarylandUSA
- Henry M. Jackson FoundationRockvilleMarylandUSA
| | - Thaddeus J. Haight
- Uniformed Services UniversityBethesdaMarylandUSA
- Henry M. Jackson FoundationRockvilleMarylandUSA
| | - Lee Gerdes
- Brain State Technologies, LLCScottsdaleArizonaUSA
| | | | - Michael J. Roy
- Uniformed Services UniversityBethesdaMarylandUSA
- Walter Reed National Military Medical CenterBethesdaMarylandUSA
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Prescription Opioid Misuse and Suicidal Behaviors Among US Veterans: A Cross-Sectional Study from the 2015-2019 National Survey on Drug Use and Health. J Behav Health Serv Res 2023; 50:150-164. [PMID: 36175748 DOI: 10.1007/s11414-022-09820-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
Suicide continues to be a serious public health issue for the US veteran population as its prevalence has skyrocketed over the last 15 years. This cross-sectional study estimates the prevalence of suicidal behaviors and prescription opioid misuse among veterans and identifies associations between suicidal behaviors and misuse of prescription opioids using data from the National Survey on Drug Use and Health. The findings show that approximately 3.7% of all veterans in this sample experienced suicidal behaviors, while nearly 3.0% reported misusing prescription opioids. Veterans who misused prescription opioids had a much higher prevalence of suicidal behaviors (16.3%) than veterans who used prescription opioids without misuse (4.8%) and those who did not use prescription opioids at all (2.5%). Opioid misuse is strongly associated with suicidal behaviors among veterans. Immediate substance use and mental health screenings, upon first contact with a healthcare system, are imperative in preventing and reducing suicide rates within this vulnerable population.
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Hoopsick RA, Homish DL, Lawson SC, Homish GG. Drug use over time among never-deployed US Army Reserve and National Guard soldiers: The longitudinal effects of non-deployment emotions and sex. Stress Health 2022; 38:1045-1057. [PMID: 35500288 PMCID: PMC9853315 DOI: 10.1002/smi.3156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 01/24/2023]
Abstract
Some US military service members who have never been deployed experience negative emotions related to never having been deployed, and some work shows these non-deployment emotions (NDE) are cross-sectionally associated with hazardous drinking for male, but not female, US Army Reserve/National Guard (USAR/NG) soldiers. However, it is not known if these effects extend to drug use or persist longitudinally, which is the focus of the current study. We conducted a longitudinal residual change analysis of a subset of data (N = 182 never-deployed soldiers) from Operation: SAFETY, an ongoing survey-based study of USAR/NG soldiers recruited from units across New York State. Outcome measures included current tobacco use, non-medical use of prescription drugs (NMUPD), current cannabis use, and other current illicit drug use (excluding cannabis) at four time points over a 3-year period. Results from bootstrapped residual change generalized estimating equation (GEE) models show that more negative NDE were longitudinally associated with a greater likelihood of current NMUPD among male, but not female, soldiers (p < 0.05). NDE were not longitudinally associated with current tobacco use, cannabis use, or other illicit drug use among male or female soldiers (ps > 0.05). NDE may contribute to ongoing NMUPD among male USAR/NG soldiers who have never been deployed. Never-deployed soldiers, especially those with negative emotions related to never having been deployed, should not be overlooked in military screening and intervention efforts.
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Affiliation(s)
- Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, 1206 S. Fourth Street, Champaign, IL 61820, USA
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Schuyler C. Lawson
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA
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6
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Turna J, MacKillop J. Cannabis use among military veterans: A great deal to gain or lose? Clin Psychol Rev 2021; 84:101958. [PMID: 33486280 DOI: 10.1016/j.cpr.2021.101958] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 06/11/2020] [Accepted: 01/06/2021] [Indexed: 12/16/2022]
Abstract
Policy changes have resulted in dramatic increases in access to cannabis for medical purposes. Veterans are disproportionately affected by conditions for which medical cannabis is often pursued, making an evidence-based perspective on risks versus benefits of high priority. The current review sought to examine the state of the evidence on the correlates and consequences of cannabis use among veterans. Using a comprehensive search strategy, 501 articles were identified and 86 studies met criteria for inclusion. The literature was predominated by cross-sectional studies (67%) of male veterans (71.4%-100% male) from the United States (93.0%). Three overarching themes emerged, comprising cannabis associations with other substance use, mental health, and physical health outcomes. The balance of the evidence associated cannabis use with negative health outcomes, with consistent positive associations with other substance use, psychiatric disorders, and self-harm/suicidality. Few studies examined the therapeutic effects of cannabis, thus limiting the potential to evaluate evidence of efficacy. Priority areas for future research are studies using designs that can examine the directionality of links between cannabis and health in veterans more conclusively, and studies directly examining therapeutic efficacy of cannabis-based therapies in veterans. Methodologically rigorous design will be essential to inform clinical recommendations and practices guidelines in an era of burgeoning access to cannabis.
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Affiliation(s)
- Jasmine Turna
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada
| | - James MacKillop
- Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Peter Boris Centre for Addictions Research, McMaster University & St. Joseph's Healthcare Hamilton, 100 West 5(th) St, Hamilton, ON L9C 0E3, Canada; Homewood Research Institute, 150 Delhi St. Riverslea Building, Guelph, ON N1E 6K9, Canada.
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7
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Vest BM, Brady LA, Brimmer MJ, Homish GG. Variations in Risk and Motivations for Substance Use over the Course of Military Service. Subst Use Misuse 2021; 56:559-566. [PMID: 33616468 PMCID: PMC8108137 DOI: 10.1080/10826084.2021.1887257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Epidemiological data identify risk factors related to substance use among military service members to inform prevention and treatment. Less is known about how motivations and risks for substance use vary over a military service career. The study goal was to explore substance use patterns and motivations among a sample of United States undergraduate student veterans in order to identify periods of risk. Methods: Qualitative interviews were conducted (n = 31) between December 2018 and April 2019. Transcripts were coded in ATLAS.ti using thematic content analysis. Results: Interviews revealed complex motivations around substance use and identified key periods of risk. 1) Pre-service: Participants reported using alcohol and marijuana, primarily during social activities. 2) During service: Participants described a culture of heavy alcohol and tobacco use in social contexts, but little use of other substances. Post-deployment was a notable exception, when some reported heavier alcohol use and use of other drugs, including opiates, cocaine, and ecstasy. 3) Post-service: Transitioning out of the military was described as difficult; some participants reported heavier use of substances during this period. Some participants quit smoking after military service, or switched to vaping. Others reported use of alcohol and/or marijuana to calm themselves, relieve stress, and enable sleep. Conclusions: These data indicate that the periods immediately following deployment and transition out of the military may be especially high-risk for heavy substance use and use of a broader range of substances. This highlights the need for tailored interventions and messaging at different points of military service, particularly during periods of greatest risk.
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Affiliation(s)
- Bonnie M Vest
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Laura A Brady
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Maximilian J Brimmer
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gregory G Homish
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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8
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Vest BM, Hoopsick RA, Homish DL, Homish GG. Lower levels of bodily pain increase risk for non-medical use of prescription drugs among current US reserve soldiers. Addict Behav 2020; 108:106443. [PMID: 32315933 DOI: 10.1016/j.addbeh.2020.106443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/09/2020] [Accepted: 04/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Military populations have a higher prevalence of pain compared to their civilian counterparts and are also at increased risk for substance use. The link between clinically significant pain and substance use has been established, but it is unclear if lower levels of pain relate to risk. The goal of this inquiry was to determine if level of bodily pain was associated with increased risk of current substance use over time among a community sample of U.S. Army Reserve/National Guard (USAR/NG) soldiers. METHODS Data were drawn from an ongoing study of USAR/NG soldiers. We used generalized estimating equations to examine the longitudinal impact of baseline bodily pain level (modeled in standard deviations from the mean pain score) on current drug use (illicit and non-medical use of prescription drugs [NMUPD]) among soldiers (n = 387) over two-years. Final models controlled for baseline post-traumatic stress disorder (PTSD), anxiety, and depression symptomatology, history of deployment (yes/no), years of military service, and substance use norms. RESULTS Bodily pain was longitudinally associated with increased odds of current NMUPD (AOR: 1.49, p < .05), but not with the current use of illicit drugs (AOR: 1.18, p > .05), controlling for symptoms of PTSD, anxiety, depression, deployment, years of service, and substance use norms. CONCLUSIONS Overall, our findings indicate that bodily pain is longitudinally associated with NMUPD among male soldiers, but not with illicit drugs. Significantly, our results stem from a non-clinical sample of soldiers with overall lower levels of pain. This indicates that pain may be important, even at lower levels, and underscores the importance of early non-pharmacologic interventions for pain.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA.
| | - Rachel A Hoopsick
- Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA; Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - D Lynn Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Gregory G Homish
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, NY, USA
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9
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Taillieu TL, Afifi TO, Zamorski MA, Turner S, Cheung K, Stein MB, Sareen J. [Not Available]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:253-263. [PMID: 31994914 PMCID: PMC7385426 DOI: 10.1177/0706743720902651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Research suggests a high prevalence of problematic alcohol use among military
personnel relative to civilians. Our primary objectives were to compare the
prevalence, correlates, help-seeking behaviors, perceived need for care, and
barriers to care for alcohol use disorders (AUDs) in the Canadian Armed
Forces (CAF) and the Canadian general population (CGP). Methods: Data were from 2 nationally representative surveys collected by Statistics
Canada: (1) the Canadian Community Health Survey on Mental Health collected
in 2012 (N = 25,113; response rate = 68.9%) and (2) the
Canadian Forces Mental Health Survey collected in 2013 (N =
8,161; response rate = 79.8%). Descriptive statistics and logistic
regression were used to examine differences in outcomes of interest
associated with AUDs in the CAF and CGP. Results: The prevalence of lifetime AUDs was significantly higher in the CAF (32.0%)
than the CGP (20.3%; adjusted odds ratio [AOR] = 1.14, 95% confidence
interval [CI, 1.02 to 1.27]) after adjustment for sociodemographic
covariates. In contrast, the past-year prevalence of AUDs was significantly
lower among CAF personnel (4.5%) than civilians (3.8%; AOR = 0.78, 95% CI
[0.61 to 0.99]) after adjustment for sociodemographic covariates. Child
abuse history and comorbid mental disorders were strongly associated with
past-year AUDs in both populations. CAF personnel compared to the CGP were
more likely to perceive a need for care (AOR = 4.15, 95% CI [2.56 to 6.72])
and engage in help-seeking behaviors (significant AORs ranged from 1.85 to
5.54). CAF personnel and civilians with past-year AUDs reported different
barriers to care. Conclusions: Findings argue for the value of different approaches to address unmet need
for AUD care in the CAF and CGP.
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Affiliation(s)
- Tamara L Taillieu
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tracie O Afifi
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Sarah Turner
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristene Cheung
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Murray B Stein
- Department of Psychiatry, University of California-San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California-San Diego, La Jolla, CA, USA
| | - Jitender Sareen
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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10
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Turvey CL, Lund BC, Jones D, Arndt S. Community Treatment for Opioid Use Disorders in Urban and Rural Veterans. J Rural Health 2020; 36:167-176. [DOI: 10.1111/jrh.12406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Carolyn L. Turvey
- Department of Veterans AffairsOffice of Rural Health Rural Resource Center Iowa City Iowa
- Iowa City VA Health Care SystemComprehensive Access and Delivery Research and Evaluation Center Iowa City Iowa
- Department of PsychiatryUniversity of Iowa Roy J. and Lucille A. Carver College of Medicine Iowa City Iowa
| | - Brian C. Lund
- Iowa City VA Health Care SystemComprehensive Access and Delivery Research and Evaluation Center Iowa City Iowa
- Department of EpidemiologyUniversity of Iowa College of Public Health Iowa City Iowa
| | - DeShauna Jones
- Iowa Consortium for Substance Abuse Research and EvaluationUniversity of Iowa Iowa City Iowa
| | - Stephan Arndt
- Department of PsychiatryUniversity of Iowa Roy J. and Lucille A. Carver College of Medicine Iowa City Iowa
- Department of BiostatisticsUniversity of Iowa Roy J. and Lucille A. Carver College of Medicine Iowa City Iowa
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Derefinko KJ, Hallsell TA, Isaacs MB, Salgado Garcia FI, Colvin LW, Bursac Z, McDevitt-Murphy ME, Murphy JG, Little MA, Talcott GW, Klesges RC. Substance Use and Psychological Distress Before and After the Military to Civilian Transition. Mil Med 2019; 183:e258-e265. [PMID: 29420791 DOI: 10.1093/milmed/usx082] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Those currently serving in the military constitute a vulnerable population given their high-risk status for substance use, and population data suggest that veterans continue to engage in significant substance use long after their military service ends. Recent research suggests that the separation transition from active duty to civilian life may be critical in terms of the future functioning of the veteran. Methods We sought to explore substance use prevalence, as well as potential emotional distress among veterans by retrospectively assessing substance use during active duty and following separation to examine possible changes in use over this period. This study assessed substance use and emotional distress in veterans (N = 80; 90% male) across the military to civilian transition. Findings Repeated measures tests indicated that endorsement of alcohol use, cigarette use, and prescription drug misuse was similar during active duty and post-separation, and marijuana and hard drug use endorsement increased significantly in the 6-mo period post-separation. Further, comorbid use of different substances was common. Active duty levels of anxiety/depression and aggressive feelings were maintained from active duty to post-separation, and feeling alone and military-based trauma symptoms increased significantly. Finally, participants indicated that only a minority of the veterans they knew were doing emotionally well or did not have alcohol/substance use issues. Discussion These findings indicate a clear need for substance use and psychological intervention availability before and after transition to enable veterans to transition to civilian life effectively. Based on the many issues at work during the transition process, programs may do well to focus more specifically on identification of problems and raising awareness, rather than awaiting more severe issues in the future. Validation of the difficulties of the separation transition, veterans' feelings of isolation, and the importance of veteran community support may help newly transitioning veterans find advocates who may help them navigate existing assistance programs.
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Affiliation(s)
- Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | - Troy A Hallsell
- Department of History, The University of Memphis, Memphis, TN 38152-3450
| | - Matthew B Isaacs
- Department of History, The University of Memphis, Memphis, TN 38152-3450
| | - Francisco I Salgado Garcia
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | - Lauren W Colvin
- Research Informatics for the Cancer Center, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | | | - James G Murphy
- Department of Psychology, University of Memphis, 400 Innovation Drive, Memphis, TN 38152
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
| | - Gerald W Talcott
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
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Elliott L, Bennett AS, Szott K, Golub A. Competing Constructivisms: The Negotiation of PTSD and Related Stigma Among Post-9/11 Veterans in New York City. Cult Med Psychiatry 2018; 42:778-799. [PMID: 29796782 PMCID: PMC6251768 DOI: 10.1007/s11013-018-9586-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Posttraumatic stress disorder (PTSD) stands as a form of psychopathology that straddles moral and psychiatric domains. Grounded in discrete instances of trauma, PTSD represents an etiological outlier in an era of increased attention to the genetics of mental illness and a prime location for social constructivist analyses of mental illness. This examination of PTSD narratives-as voiced in qualitative interviews and focus groups with 50 veterans of the recent Iraq and Afghanistan wars living in New York City-attends to the processes through which veterans conceive and navigate PTSD symptoms and diagnoses. In so doing we highlight the social constructivist positions undertaken by veterans themselves as they varyingly challenge and internalize symptomology in dialogue with psychiatric definitions and the stigma associated with PTSD. Findings demonstrate the rejection of classic psychopathological etiology-in brain disease, for example-by many veterans as well as the complex balancing of benefit and stigma that veterans undertake when making decisions about presenting to psychiatric clinicians. Drawing on veterans' accounts, we argue for greater cultural specificity in characterizing the diagnosis-seeking behavior of trauma survivors and a greater appreciation for the contradictions and compromise related to both acceptance and rejection of a mental health diagnosis.
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Affiliation(s)
| | | | - Kelly Szott
- National Development and Research Institutes
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13
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Derefinko KJ, Hallsell TA, Isaacs MB, Colvin LW, Salgado Garcia FI, Bursac Z. Perceived Needs of Veterans Transitioning from the Military to Civilian Life. J Behav Health Serv Res 2018; 46:384-398. [DOI: 10.1007/s11414-018-9633-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vest BM, Homish DL, Fillo J, Homish GG. Military status and alcohol problems: Former soldiers may be at greater risk. Addict Behav 2018; 84:139-143. [PMID: 29679924 PMCID: PMC5975126 DOI: 10.1016/j.addbeh.2018.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goal of this study was to explore differences in alcohol problems as a function of military status (current soldier, previous soldier and civilian spouses), and the possible interaction between sex and military status. We hypothesized that 1) soldiers would be at greater risk for alcohol problems than civilian spouses, and 2) former soldiers would be at greater risk compared to current soldiers. METHODS Data were drawn from Operation: SAFETY, a longitudinal study examining physical and mental health among U.S. Army Reserve and National Guard soldiers and their partners. The analytic sample included male and female participants who completed both the baseline and first follow-up assessments (N = 772). Negative binomial regression models were used to examine differences between military status group on alcohol problems at follow-up, controlling for sex and alcohol consumption at baseline. Interactions between military status and sex were also examined. RESULTS Among current soldiers, males experienced significantly more alcohol problems compared to women (4.47, 3.46; p = 0.005). Likewise, among previous soldiers, males experienced significantly more alcohol problems compared to women (6.69, 2.92; p = 0.002). Male previous soldiers had significantly more alcohol problems compared to both male current soldiers and male civilian spouses (6.69, 4.47, p = 0.04; 6.69, 3.96; p = 0.02). Among women, there were no significant differences by military status. CONCLUSIONS Our results indicate that male previous soldiers are at greater risk of alcohol problems than both current soldiers and civilian spouses. Health care and service providers should consider screening and monitoring soldiers who separate from the military, as alcohol use may increase.
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Affiliation(s)
- Bonnie M Vest
- Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY 14203, United States.
| | - D Lynn Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
| | - Jennifer Fillo
- Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203, United States
| | - Gregory G Homish
- Department of Community Health & Health Behavior, University at Buffalo, 325 Kimball Tower, 3435 Main Street, Buffalo, NY 14214, United States
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Young CM, Pedersen ER, Pearson AD, Neighbors C. Drinking to cope moderates the efficacy of changing veteran drinking norms as a strategy for reducing drinking and alcohol-related problems among U.S. veterans. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2018; 32:213-223. [PMID: 29369674 DOI: 10.1037/adb0000347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Heavy and problematic drinking is a concern among young adult military veterans. Personalized normative feedback (PNF) interventions that target normative misperceptions regarding drinking have been efficacious among young adults and have recently begun to be implemented among veteran populations in an effort to reduce heavy drinking. However, moderators of PNF intervention efficacy among veterans are largely unexplored. This study is a secondary data analysis that evaluated whether a PNF intervention would work better at reducing perceived norms, drinking, and alcohol-related problems specifically for young adult veterans who drink to cope with negative affect. Veterans of the United States (U.S.) military (86% male; Mean age = 28.9 years, SD = 3.4) were randomly assigned to receive either: 1) PNF comparing their drinking and perceived norms to actual drinking rates for same sex veterans; or 2) feedback about same sex veteran video game play (control condition). Seven hundred eighty-four individuals completed baseline and 622 completed 1-month follow-up assessments (79% follow-up), including measures of alcohol use, alcohol-related problems, and drinking motives. Moderated mediation analyses indicated that changes in normative misperceptions as a result of the intervention were more strongly associated with reductions in drinking and problems among veterans scoring higher on drinking to cope. These findings suggest that PNF may be an especially efficacious brief intervention for veterans who drink for coping reasons. (PsycINFO Database Record
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Devonish J, Homish D, Vest B, Daws R, Hoopsick R, Homish G. The impact of military service and traumatic brain injury on the substance use norms of Army Reserve and National Guard Soldiers and their spouses. Addict Behav 2017; 72:51-56. [PMID: 28388492 DOI: 10.1016/j.addbeh.2017.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/21/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) and substance use are highly prevalent conditions among military populations. There is a significant body of evidence that suggests greater approval of substance use (i.e., norms) is related to increased substance use. The objective of this work is to understand the impact of TBI and military service on substance use norms of soldiers and their partners. Data are from the baseline assessment of Operation: SAFETY, an ongoing, longitudinal study of US Army Reserve/National Guard (USAR/NG) soldiers and their partners. METHODS Multiple regression models examined associations between alcohol, tobacco, illicit drug use, and non-medical use of prescription drug (NMUPD) norms within and across partners based on current military status (CMS) and TBI. RESULTS Male USAR/NG soldiers disapproved of NMUPD, illicit drug use and tobacco use. There was no relation between military status and alcohol use. Among females, there was no relation between CMS and norms. The NMUPD norms of wives were more likely to be approving if their husbands reported TBI symptoms and had separated from the military. Husbands of soldiers who separated from the military with TBI had greater approval of the use of tobacco, NMUPD, and illicit drugs. CONCLUSION Overall, there is evidence to suggest that, while generally disapproving of substance use, soldiers and partners become more accepting of use if they also experience TBI and separate from the military. Future research should examine the longitudinal influence of TBI on substance use norms and subsequent changes in substance use over time.
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Hoopsick RA, Fillo J, Vest BM, Homish DL, Homish GG. Substance use and dependence among current reserve and former military members: Cross-sectional findings from the National Survey on Drug Use and Health, 2010-2014. J Addict Dis 2017; 36:243-251. [PMID: 28813208 DOI: 10.1080/10550887.2017.1366735] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Maladjustment after leaving the military may contribute to poor health outcomes, including increased risk for substance use and dependence. The authors examined differences in substance use and dependence on the basis of military involvement in a large nationally representative sample. Data are from a subset of the 2010-2014 waves of the National Survey on Drug Use and Health (n = 5,608). The sample included men (81.9%) and women (18.1%) aged 20-49 years who had either separated/retired from the military (n = 4,862) or were a current reserve service member (n = 746). The sample was 70.8% Non-Hispanic White with a median family income between $50,000 and $74,999. Those who were separated/retired from the military had a higher odds of past month smoking (adjusted odds ratio [AOR] = 1.73, 95% confidence interval [CI]: 1.27, 2.36; p = 0.001), nonmedical use of prescription painkillers (AOR = 4.07, 95% CI: 1.88, 8.83; p < 0.001), illicit drug use (AOR = 2.75, 95% CI: 1.79, 4.24; p < 0.001), alcohol dependence (AOR = 2.17, 95% CI: 1.20, 3.93; p = 0.011), nicotine dependence (AOR = 2.03, 95% CI: 1.25, 3.28; p = 0.004), and illicit drug dependence (AOR = 5.89; 95% CI: 2.19, 15.85; p = 0.001), compared to current reserve service members, controlling for sex, age, race, and income. Service members are leaving the military at an increasing rate and substance use may increase after separation. Across a range of substances, those who are separated/retired from the military have a higher likelihood of substance use/dependence than current reserve service members. Care models that assist in the transition from discharge to civilian life should be considered.
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Affiliation(s)
- Rachel A Hoopsick
- a Department of Community Health and Health Behavior , State University of New York at Buffalo , Buffalo , New York , USA
| | - Jennifer Fillo
- b Research Institute on Addictions, State University of New York at Buffalo , Buffalo , New York , USA
| | - Bonnie M Vest
- c Department of Family Medicine , State University of New York at Buffalo , Buffalo , New York , USA
| | - D Lynn Homish
- a Department of Community Health and Health Behavior , State University of New York at Buffalo , Buffalo , New York , USA
| | - Gregory G Homish
- a Department of Community Health and Health Behavior , State University of New York at Buffalo , Buffalo , New York , USA.,b Research Institute on Addictions, State University of New York at Buffalo , Buffalo , New York , USA.,c Department of Family Medicine , State University of New York at Buffalo , Buffalo , New York , USA
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Sayko Adams R, Corrigan JD, Mohr BA, Williams TV, Larson MJ. Traumatic Brain Injury and Post-Deployment Binge Drinking among Male and Female Army Active Duty Service Members Returning from Operation Enduring Freedom/Operation Iraqi Freedom. J Neurotrauma 2016; 34:1457-1465. [PMID: 27762655 DOI: 10.1089/neu.2016.4693] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study examines whether the relationship between traumatic brain injury (TBI) and post-deployment binge drinking is independent of screening positive for mental health problems among male and female service members. Data are from the Substance Use and Psychological Injury Combat Study of Army members returning from deployment to Afghanistan or Iraq in fiscal years 2008-2011. The sample consists of 240,694 male and 26,406 female active duty members who completed initial and follow-up questionnaires. The initial questionnaire, completed at the end of deployment, included screens for TBI and mental health problems (post-traumatic stress disorder, depression, harmful thoughts). The dependent variable, frequent binge drinking (six or more drinks on one occasion, at least monthly), was assessed on the follow-up questionnaire on average 3-9 months post-deployment. More than 21% of males and 7% of females reported frequent binge drinking. Male members were more likely to screen positive for TBI, compared with females (7.5% vs. 4.4%). Females with both TBI and mental health positive screens had more than double the risk of frequent binge drinking, compared with those without either problem (15.8% vs. 6.6%), and males with both problems had almost double the risk, compared with males with neither problem (33.6% vs. 19.7%). In multivariable logistic regression models, having a TBI and a comorbid positive mental health screen was associated with increased odds of frequent binge drinking among both males and females (adjusted odds ratio [AOR] = 1.59, CI: 1.50-1.69, and AOR = 2.11, CI: 1.57-2.83, respectively), compared with those with neither condition. More research is needed on the interaction of gender and binge drinking, especially when TBI and mental health problems co-exist.
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Affiliation(s)
- Rachel Sayko Adams
- 1 The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - John D Corrigan
- 2 Department of Physical Medicine and Rehabilitation, the Ohio State University , Columbus, Ohio
| | - Beth A Mohr
- 1 The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | | | - Mary Jo Larson
- 1 The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
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Cypel YS, Hamlett-Berry K, Barth SK, Christofferson DE, Davey VJ, Eber S, Schneiderman AI, Bossarte RM. Cigarette Smoking and Sociodemographic, Military, and Health Characteristics of Operation Enduring Freedom and Operation Iraqi Freedom Veterans: 2009-2011 National Health Study for a New Generation of US Veterans. Public Health Rep 2016; 131:714-727. [PMID: 28123213 DOI: 10.1177/0033354916664864] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We examined the sociodemographic, military, and health characteristics of current cigarette smokers, former smokers, and nonsmokers among Operation Enduring Freedom (OEF) / Operation Iraqi Freedom (OIF) veterans and estimated smoking prevalence to better understand cigarette use in this population. METHODS We analyzed data from the US Department of Veterans Affairs (VA) 2009-2011 National Health Study for a New Generation of US Veterans. On the basis of a stratified random sample of 60 000 OEF/OIF veterans, we sought responses to a 72-item questionnaire via mail, telephone, or Internet. Cigarette smoking status was based on self-reported cigarette use in the past year. We used multinomial logistic regression to evaluate associations between smoking status and sociodemographic, military, and health characteristics. RESULTS Among 19 911 veterans who provided information on cigarette smoking, 5581 were current smokers (weighted percentage: 32.5%, 95% confidence interval [CI]: 31.7-33.2). Current smokers were more likely than nonsmokers or former smokers to be younger, to have less education or income, to be separated/divorced or never married/single, and to have served on active duty or in the army. Comparing current smokers and nonsmokers, some significant associations from adjusted analyses included the following: having a Mental Component Summary score (a measure of overall mental health) above the mean of the US population relative to below the mean (adjusted odds ratio [aOR] = 0.81, 95% CI: 0.73-0.90); having physician-diagnosed depression (aOR = 1.52, 95% CI: 1.33-1.74), respiratory conditions (aOR = 1.16, 95% CI: 1.04-1.30), or repeated seizures/blackouts/convulsions (aOR = 1.80, 95% CI: 1.22-2.67); heavy alcohol use vs never use (aOR = 5.49, 95% CI: 4.57-6.59); a poor vs excellent perception of overall health (aOR = 3.79, 95% CI: 2.60-5.52); and being deployed vs nondeployed (aOR = 0.87, 95% CI: 0.78-0.96). Using health care services from the VA protected against current smoking. CONCLUSION Mental and physical health, substance use, and military service characteristics shape cigarette-smoking patterns in OEF/OIF veterans.
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Affiliation(s)
- Yasmin S Cypel
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Kim Hamlett-Berry
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Mental Health Services, Washington, DC, USA
| | - Shannon K Barth
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Dana E Christofferson
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Mental Health Services, Washington, DC, USA
| | - Victoria J Davey
- US Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Washington, DC, USA
| | - Stephanie Eber
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Aaron I Schneiderman
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Robert M Bossarte
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
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Larson MJ, Mohr BA, Jeffery DD, Adams RS, Williams TV. Predictors of Positive Illicit Drug Tests After OEF/OIF Deployment Among Army Enlisted Service Members. Mil Med 2016; 181:334-42. [PMID: 27046179 PMCID: PMC5087103 DOI: 10.7205/milmed-d-15-00110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To identify characteristics associated with testing positive for illicit drugs postdeployment among Army enlisted members. METHODS Army active duty and National Guard/Reserve enlisted members returning from Operation Enduring Freedom/Operation Iraqi Freedom deployments in fiscal years 2008 to 2011, who submitted urine specimens for random and other illicit drug tests up to 3 years postdeployment, were included. Multiple logistic regression models, stratified by component, identified demographic and deployment characteristics associated with any positive drug test (cocaine, heroin, tetrahydrocannabinol [marijuana], or amphetamine) during the 3 years postdeployment. RESULTS Among Army active duty and National Guard/Reserve enlisted members, respectively, 3.46% (95% confidence interval 3.40-3.52) and 3.84% (confidence interval 3.74-3.94) tested positive for 1+ illicit drugs during the 3 years postdeployment; the vast majority for marijuana. Relative to other groups, increased odds of a positive drug test were found for members with a combat specialist occupation, or first deployers. CONCLUSION Almost 4% of Army members tested positive for illicit drug use within 3 years of return from deployment. Early identification and intervention with enlisted members who are more likely to test positive for illicit drug use should be explored to see if it will enhance health and reduce illegal drug use after deployment to a war zone.
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Affiliation(s)
- Mary Jo Larson
- The Heller School for Social Policy & Management, Brandeis University, 415 South Street, Waltham, MA 02453
| | - Beth A. Mohr
- The Heller School for Social Policy & Management, Brandeis University, 415 South Street, Waltham, MA 02453
| | - Diana D. Jeffery
- Healthcare Operations Directorate, Clinical Support Division, Defense Health Agency, Department of Defense, 7700 Arlington Boulevard, Falls Church, VA 22042
| | - Rachel Sayko Adams
- The Heller School for Social Policy & Management, Brandeis University, 415 South Street, Waltham, MA 02453
| | - Thomas V. Williams
- Decision Support, Defense Health Agency, Department of Defense, 7700 Arlington Boulevard, Falls Church, VA 22042
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Kelley ML, Brancu M, Robbins AT, D'Lima GM, Strauss JL, Curry JF, Fairbank JA, Runnals J. Drug use and childhood-, military- and post-military trauma exposure among women and men veterans. Drug Alcohol Depend 2015; 152:201-8. [PMID: 25957156 DOI: 10.1016/j.drugalcdep.2015.03.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/26/2015] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The current study was undertaken to examine whether posttraumatic stress symptoms (PTSS) and depressive symptoms mediated the association between trauma exposure (combat-related trauma and non-combat traumas occurring before, during, and after military service), and drug abuse symptoms use among male and female veterans. METHODS Participants were 2304 (1851 male, 453 female) veterans who took part in a multi-site research study conducted through the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC). Path analytic models were used to determine the association between problematic past-year drug use and combat-related and non-combat trauma experienced before, during, or after the military and whether current post-traumatic stress symptoms or depressive symptoms mediated these associations. RESULTS For both male and female veterans, depressive symptoms significantly mediated the effects of pre- and post-military trauma on drug abuse symptoms. CONCLUSION Mental health providers who work with trauma-exposed Iraq and Afghanistan era veterans should assess for drug use, depressive symptoms, and life-span trauma (i.e., not only combat-related traumas) as part of a thorough trauma-based assessment for both men and women.
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Affiliation(s)
- Michelle L Kelley
- Department of Psychology, Old Dominion University, 5115 Hampton Boulevard, Norfolk, VA 23529, USA.
| | - Mira Brancu
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Durham VA Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Allison T Robbins
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA 23504, USA.
| | - Gabrielle M D'Lima
- Department of Psychology, Old Dominion University, 5115 Hampton Boulevard, Norfolk, VA 23529, USA.
| | - Jennifer L Strauss
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA; Mental Health Services, Department of Veterans Affairs, Washington, DC 20420, USA.
| | - John F Curry
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Durham VA Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
| | - John A Fairbank
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Durham VA Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
| | - Jennifer Runnals
- Mid-Atlantic Region VA Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC 27705, USA; Durham VA Medical Center, Durham, NC 27705, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
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Abstract
This special issue examines major structural, sociocultural, and behavioral issues surrounding substance use and misuse among U.S. military personnel and veterans who served in recent military conflicts in Iraq and Afghanistan. This introduction provides a brief historical review of the US's experiences of the linkages between war and substance use, misuse, and abuse. It then describes how the various topics covered in this issue span the military-veteran life course and explains the significance of each contribution.
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Affiliation(s)
- Andrew Golub
- 1National Development and Research Institutes, Burlington, Vermont, USA
| | - Alexander S. Bennett
- 2Institute for Special Population Research, National Development and Research Institutes, New York, New York, USA
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