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Hayden L, Lightner JM, Strausborger S, Franks TJ, Watson NL, Lewin-Smith MR. Particle analysis of surgical lung biopsies from deployed and non-deployed US service members during the Global War on Terrorism. PLoS One 2024; 19:e0301868. [PMID: 38603724 PMCID: PMC11008878 DOI: 10.1371/journal.pone.0301868] [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: 07/12/2023] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
The role that inhaled particulate matter plays in the development of post-deployment lung disease among US service members deployed to Southwest Asia during the Global War on Terrorism has been difficult to define. There is a persistent gap in data addressing the relationship between relatively short-term (months to a few years) exposures to high levels of particulate matter during deployment and the subsequent development of adverse pulmonary outcomes. Surgical lung biopsies from deployed service members and veterans (DSMs) and non-deployed service members and veterans (NDSMs) who develop lung diseases can be analyzed to potentially identify residual deployment-specific particles and develop associations with pulmonary pathological diagnoses. We examined 52 surgical lung biopsies from 25 DSMs and 27 NDSMs using field emission scanning electron microscopy (FE-SEM) with energy dispersive x-ray spectroscopy (EDS) to identify any between-group differences in the number and composition of retained inorganic particles, then compared the particle analysis results with the original histopathologic diagnoses. We recorded a higher number of total particles in biopsies from DSMs than from NDSMs, and this difference was mainly accounted for by geologic clays (illite, kaolinite), feldspars, quartz/silica, and titanium-rich silicate mixtures. Biopsies from DSMs deployed to other Southwest Asia regions (SWA-Other) had higher particle counts than those from DSMs primarily deployed to Iraq or Afghanistan, due mainly to illite. Distinct deployment-specific particles were not identified. Particles did not qualitatively associate with country of deployment. The individual diagnoses of the DSMs and NDSMs were not associated with elevated levels of total particles, metals, cerium oxide, or titanium dioxide particles. These results support the examination of particle-related lung disease in DSMs in the context of comparison groups, such as NDSMs, to assist in determining the strength of associations between specific pulmonary pathology diagnoses and deployment-specific inorganic particulate matter exposure.
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Affiliation(s)
- Leslie Hayden
- Institute for Functional Materials and Devices, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - James M. Lightner
- Environmental Microscopy Laboratory, Joint Pathology Center, Silver Spring, Maryland, United States of America
| | - Stacy Strausborger
- Environmental Microscopy Laboratory, Joint Pathology Center, Silver Spring, Maryland, United States of America
| | - Teri J. Franks
- Pulmonary and Mediastinal Pathology, Joint Pathology Center, Silver Spring, Maryland, United States of America
| | - Nora L. Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Michael R. Lewin-Smith
- Environmental Pathology, Joint Pathology Center, Silver Spring, Maryland, United States of America
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Pham-Danis C, Chia SB, Scarborough HA, Danis E, Nemkov T, Kleczko EK, Navarro A, Goodspeed A, Bonney EA, Dinarello CA, Marchetti C, Nemenoff RA, Hansen K, DeGregori J. Inflammation promotes aging-associated oncogenesis in the lung. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.01.583044. [PMID: 38496448 PMCID: PMC10942386 DOI: 10.1101/2024.03.01.583044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background Lung cancer is the leading cause of cancer death in the world. While cigarette smoking is the major preventable factor for cancers in general and lung cancer in particular, old age is also a major risk factor. Aging-related chronic, low-level inflammation, termed inflammaging, has been widely documented; however, it remains unclear how inflammaging contributes to increased lung cancer incidence. Aim: To establish connections between aging-associated changes in the lungs and cancer risk. Methods We analyzed public databases of gene expression for normal and cancerous human lungs and used mouse models to understand which changes were dependent on inflammation, as well as to assess the impact on oncogenesis. Results Analyses of GTEx and TCGA databases comparing gene expression profiles from normal lungs, lung adenocarcinoma, lung squamous cell carcinoma of subjects across age groups revealed upregulated pathways such as inflammatory response, TNFA signaling via NFκB, and interferon-gamma response. Similar pathways were identified comparing the gene expression profiles of young and old mouse lungs. Transgenic expression of alpha 1 antitrypsin (AAT) partially reverses increases in markers of aging-associated inflammation and immune deregulation. Using an orthotopic model of lung cancer using cells derived from EML4-ALK fusion-induced adenomas, we demonstrated an increased tumor outgrowth in lungs of old mice while NLRP3 knockout in old mice decreased tumor volumes, suggesting that inflammation contributes to increased lung cancer development in aging organisms. Conclusions These studies reveal how expression of an anti-inflammatory mediator (AAT) can reduce some but not all aging-associated changes in mRNA and protein expression in the lungs. We further show that aging is associated with increased tumor outgrowth in the lungs, which may relate to an increased inflammatory microenvironment.
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Affiliation(s)
- Catherine Pham-Danis
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Shi B Chia
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Hannah A Scarborough
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Etienne Danis
- Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Emily K Kleczko
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Andre Navarro
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Andrew Goodspeed
- Biomedical Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elizabeth A. Bonney
- Department of Obstetrics, Gynecology and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Charles A. Dinarello
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Carlo Marchetti
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Raphael A. Nemenoff
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kirk Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - James DeGregori
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
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Hashim MAB, Bin Sebri KF, Bin Mohd Hanim MF, Binti Anwar DS, Binti Mohd Radzi NA, Bin Ahmad Fuad AF, Md Sabri BAB. The Impact of Military Tobacco Control Policy: A Systematic Review. Mil Med 2024:usad507. [PMID: 38330180 DOI: 10.1093/milmed/usad507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Tobacco use is synonymous with the military. Despite that military personnel are trained to follow commands, opportunities exist to implement various tobacco control strategies. We conducted a systematic review to evaluate the impact of tobacco control policy employed in military settings. MATERIALS AND METHODS We searched for published English articles in Medline, Web of Science, Scopus, and Google Scholar databases using relevant subject headings without year restriction. We included randomized controlled trials, nonrandomized controlled trials, case-control, cohort, controlled before and after, and uncontrolled before and after studies evaluating the impact of tobacco control policy in the military population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, three independent reviewers independently screened initially identified articles, reviewed the full text, and extracted the data and any disagreements resolved by consensus after data recheck. Five reviewers used a validated tool to assess the quality of the included studies. The primary outcome was the reduction of any tobacco or nicotine-contained products (TNCPs) use among the troops. The impacts of the tobacco control policy were synthesized and analyzed qualitatively. This study is registered with the International Prospective Register of Systematic Review (CRD42022314117). RESULTS Fourteen studies were included in the analysis from 5372 studies screened. Most of the studies were from the USA, and fractions were from Thailand, France, and Taiwan. These studies were methodologically heterogeneous. Most studies employed a total ban policy on TNCP use during basic military training or operational deployment as the primary strategy. Other methods utilized were the brief tobacco intervention, targeted treatment, support, and counseling provided through telephone or mailing systems, the adjunctive behavioral intervention, providing free nicotine gum, the "Pharsai clinic", active and regular smoking restriction, and interventions aimed at intrapersonal, interpersonal, and organizational levels. There is a moderate quality of evidence that the tobacco control policies effectively reduced the prevalence of TNCP use, increased the cessation rate, reduced the intake, and lowered the dependency. The adjunctive interventions provided after the total ban on TNCP use may increase its effectiveness. However, findings from this review need to be carefully considered as the definition of TNCP use status was not universal between studies and lacked a biochemical validation procedure. CONCLUSIONS There is reasonable evidence to support that the tobacco control policy employed in the military population has multiple positive impacts in reducing the prevalence of TNCP use, increasing the cessation rates, reducing the intake, and lowering dependency. Other evidence-based strategies need to be fully utilized to materialize the tobacco endgame.
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Affiliation(s)
- Muhamad Arham Bin Hashim
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
- The Malaysian Armed Forces, Wilayah Persekutuan, Kuala Lumpur 50634, Malaysia
| | - Khairul Fikri Bin Sebri
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | - Muhammad Faiz Bin Mohd Hanim
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | - Diyana Shereen Binti Anwar
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | - Nawwal Alwani Binti Mohd Radzi
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | | | - Budi Aslinie Binti Md Sabri
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
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Lang AE, Porter KJ, Krukowski RA, Wester AG, Pilehvari A, Little MA. U.S. Military Tobacco and Nicotine Policy Lagging Behind the Times. Am J Prev Med 2024; 66:380-383. [PMID: 37813172 PMCID: PMC10841421 DOI: 10.1016/j.amepre.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Adam Edward Lang
- Department of Primary Care, McDonald Army Health Center, Fort Eustis, Virginia; Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
| | - Kathleen J Porter
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Abigail G Wester
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Asal Pilehvari
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
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Henion AK, Wang CP, Amuan M, Altalib HH, Towne AR, Hinds SR, Baca C, LaFrance WC, Van Cott AC, Kean J, Roghani A, Kennedy E, Panahi S, Pugh MJV. Role of Deployment History on the Association Between Epilepsy and Traumatic Brain Injury in Post-9/11 Era US Veterans. Neurology 2023; 101:e2571-e2584. [PMID: 38030395 PMCID: PMC10791059 DOI: 10.1212/wnl.0000000000207943] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/04/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic brain injury (TBI) is a well-established epilepsy risk factor and is common among service members. Deployment-related TBI, where combat/blast may be more common, may have different outcomes than nondeployment-related TBI. This work examined associations of all TBI exposures (not just combat), and epilepsy, while adjusting for comorbidities associated with epilepsy, among veterans by deployment status. METHODS The cohort included post-9/11 veterans with ≥2 years of care in both Veterans Health Administration and Defense Health Agency systems. We identified epilepsy using ICD-9/10-CM codes, antiseizure medication, and service-connected disability for epilepsy. We conducted a logistic regression model with interaction terms for conditions by deployment history that adjusted for demographics and military characteristics. RESULTS The cohort (n = 938,890) included post-9/11 veterans of whom 27,436 (2.92%) had epilepsy. Most veterans had a history of deployment (70.64%), referred to as "deployed." Epilepsy was more common among veterans who were never deployed ("nondeployed") (3.85% vs 2.54%). Deployed veterans were more likely to have had TBI, compared with the nondeployed veterans (33.94% vs 14.24%), but nondeployed veterans with moderate/severe TBI had higher odds of epilepsy compared with deployed veterans (adjusted odds ratio [aOR] 2.92, 95% CI 2.68-3.17 vs aOR 2.01, 95% CI 1.91-2.11). Penetrating TBI had higher odds of epilepsy among the deployed veterans (aOR 5.33, 95% CI 4.89-5.81), whereas the odds of epilepsy for mild TBI did not significantly differ by deployment status. Although most neurologic conditions were more prevalent among the nondeployed veterans, they were often associated with higher odds of epilepsy in the deployed veterans. DISCUSSION Deployment history had a significant differential impact on epilepsy predictors. As expected, penetrating TBI had a greater epilepsy impact among deployed veterans perhaps due to combat/blast. Some epilepsy predictors (moderate/severe TBI, multiple sclerosis, and Parkinson disease) had a stronger association in the nondeployed veterans suggesting a potential healthy warrior effect in which such conditions preclude deployment. Other neurologic conditions (e.g., brain tumor, Alzheimer disease/frontotemporal dementia) had a greater epilepsy impact in the deployed veterans. This may be attributable to deployment-related exposures (combat injury, occupational exposures). A better understanding of deployment effects is critical to provide targeted epilepsy prevention in veterans and military service members.
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Affiliation(s)
- Amy K Henion
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Chen-Pin Wang
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Megan Amuan
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Hamada H Altalib
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Alan R Towne
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Sidney R Hinds
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Christine Baca
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - W Curt LaFrance
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Anne C Van Cott
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Jacob Kean
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Ali Roghani
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Eamonn Kennedy
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Samin Panahi
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
| | - Mary Jo V Pugh
- From the Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) (A.K.H., M.A., E.K., S.P., M.J.V.P.), VA Salt Lake City Health Care System, UT; Division of Epidemiology (A.K.H., A.R., E.K., S.P., M.J.V.P.), University of Utah Health Science Center, Salt Lake City; Division of General and Hospital Medicine and Department of Population Health Sciences (C.-P.W.), University of Texas Health Science Center at San Antonio; and South Texas Veterans Health Care System (C.-P.W.), San Antonio; VA Connecticut Health Care System (H.H.A.), West Haven (H.H.A.); and Department of Neurology & Psychiatry (H.H.A.), Yale School of Medicine, New Haven, CT; Department of Neurology (A.R.T.), Virginia Commonwealth University School of Medicine, Richmond; Department of Neurology/Radiology (S.R.H.), Uniformed Services University of the Health Sciences, Bethesda, MD; and SCS Consulting, LLC (S.R.H.); and NFL Players Association (S.R.H.); and Major League Soccer Players Association (S.R.H.); Epilepsy Center of Excellence (C.B.), Central Virginia Veterans Administration Hospital; and Department of Neurology (C.B.), Virginia Commonwealth University, Richmond; Departments of Psychiatry and Neurology (W.C.L.F.), Brown University; and Department of Psychiatry (W.C.L.F.), Providence VA Medical Center, RI; VA Pittsburgh Healthcare System (A.C.V.C.); and Department of Neurology (A.C.V.C.), University of Pittsburgh School of Medicine, PA; and Division of Health System Innovation and Research (J.K.), Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City
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Kolaja C, Castañeda SF, Woodruff SI, Rull RP, Armenta RF. The relative impact of injury and deployment on mental and physical quality of life among military service members. PLoS One 2022; 17:e0274973. [PMID: 36174060 PMCID: PMC9522035 DOI: 10.1371/journal.pone.0274973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
US service members injured in the recent conflicts in Iraq and Afghanistan were more likely to survive than those in previous conflicts because of advances in medicine and protective gear. However, there is limited research examining the long-term impact of injuries while deployed on physical and mental quality of life (QOL) among service members. We used data from two time-points with an average follow-up period of 4.27 years (SD = 2.13; n = 118,054) to prospectively examine the association between deployment and injury status with QOL. Data were derived from the Millennium Cohort Study surveys (2001 to 2016) and linked with the Department of Defense Trauma Registry (DoD-TR) among a cohort of US service members from all branches and components. The primary predictor (a combination of deployment and injury status) was comprised of the following four categories: 1) not deployed, 2) deployed and not injured, 3) deployed and non-battle injured, and 4) deployed and battle injured. Demographic, military, psychological and behavioral health, and life stress factors were adjusted for in multivariable models. Outcomes of interest were physical and mental QOL from the Short-Form Health Survey for Veterans (VR-36) measured at ~4 year follow-up. Between group comparisons indicated that those deployed and battle-injured had the greatest decline in both mental (-3.82) and physical (-10.13) QOL scores over time (p < .05). While deployment and injury status were associated with poorer mental and physical QOL in adjusted models; only the association between deployment and injury status with physical QOL was clinically meaningful (more than 2.5). In adjusted models, Time 1 mental and physical QOL explained most of the variance (23–25%) in Time 2 mental and physical health QOL as compared to other covariates (e.g., injury and deployment, and other sociodemographic factors increased variance by ~5%). Time 1 QOL was the most significant predictor of later QOL, but those injured while deployed experienced significant and meaningful decrements to long-term physical QOL. This suggests that prevention and rehabilitation interventions should focus on improving physical health among injured service members to avoid long-term adverse effects.
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Affiliation(s)
- Claire Kolaja
- Leidos Inc., San Diego, California, United States of America
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, United States of America
- * E-mail:
| | - Sheila F. Castañeda
- Leidos Inc., San Diego, California, United States of America
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, United States of America
| | - Susan I. Woodruff
- San Diego State University, School of Social Work, San Diego, California, United States of America
| | - Rudolph P. Rull
- Deployment Health Research Department, Naval Health Research Center, San Diego, California, United States of America
| | - Richard F. Armenta
- Department of Kinesiology, College of Education, Health and Human Services, California State University, San Marcos, San Marcos, California, United States of America
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Porter KJ, Krukowski RA, Bonilla G, McKenna L, Talcott GW, Little MA. Using the Socio-ecological Model to Explore Facilitators and Deterrents of Tobacco Use Among Airmen in Technical Training. Mil Med 2022; 187:e1160-e1168. [PMID: 33637975 PMCID: PMC9402675 DOI: 10.1093/milmed/usab075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Military personnel have some of the highest rates of tobacco use in the USA. Within the Air Force, a common point of Airmen's (re-)initiation of tobacco use is during technical training once the tobacco ban has been lifted. Unfortunately, little is known about what factors facilitate and deter tobacco use during technical training. The socio-ecological model, which emphasizes multiple levels of influence on behavior (e.g., personal, intrapersonal, and environmental), provides a strong and comprehensive basis for which to explore factors that may impact tobacco use during technical training. MATERIALS AND METHODS Twenty-two focus groups were conducted among Airmen (n = 10), Military Training Leaders (MTLs, n = 7), and Technical Training Instructors (TTIs, n = 5). Semi-structured focus group protocols were developed based on the socio-ecological model and included questions intended to elicit factors that facilitated and deterred tobacco use during technical training. Focus groups were transcribed and then coded using a hybrid deductive-inductive process. RESULTS At the personal level, five factors were identified that influenced tobacco use: choice, fit with lifestyle, associations with the tobacco experience, association with military job outcomes, and association with health outcomes. Three interpersonal level factors were identified: peer influence, leadership influence, and normative beliefs. There were two influential environmental level factors: pricing and promotion and access to tobacco. Except for normative beliefs, all personal, interpersonal, and environmental-level factors were discussed as having aspects that could either facilitate or deter tobacco use. Normative beliefs, an interpersonal-level factor, were only discussed as a facilitator of tobacco use. CONCLUSIONS Taken together, study findings can be used to enhance the effectiveness of tobacco prevention and cessation programs for Air Force Technical Trainees. Specific strategies to support the reduction of tobacco use among Airmen are presented.
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Affiliation(s)
- Kathleen J Porter
- Department of Public Health Sciences, University of Virginia, School of Medicine, Christiansburg, VA 24073, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Gloribel Bonilla
- Health System West Complex MSB, University of Virginia Cancer Center, Charlottesville, VA 22903, USA
| | - Lisa McKenna
- Department of Social Work, The University of Texas at San Antonio, San Antonio, TX 78207, USA
| | - Gerald W Talcott
- Department of Public Health Sciences & Center for Addiction and Prevention Research, University of Virginia, School of Medicine, JBSA-Lackland, TX 78236, USA
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA 29903, USA
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Wang JH, Denic-Roberts H, Goodie JL, Thomas DL, Engel LS, Rusiecki JA. Risk factors for acute mental health symptoms and tobacco initiation in Coast Guard Responders to the Deepwater Horizon oil spill. J Trauma Stress 2022; 35:1099-1114. [PMID: 35290683 PMCID: PMC9355914 DOI: 10.1002/jts.22817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/19/2021] [Accepted: 12/27/2021] [Indexed: 11/08/2022]
Abstract
Acute mental health symptoms experienced during oil spill response work are understudied, especially among nonlocal responders. We assessed potential risk factors for acute mental health symptoms and tobacco initiation among U.S. Coast Guard responders to the 2010 Deepwater Horizon (DWH) oil spill who completed a deployment exit survey. Cross-sectional associations among responder characteristics, deployment-related stressors (deployment duration, timing, crude oil exposure, physical symptoms, injuries), and professional help-seeking for stressors experienced with concurrent depression/anxiety and tobacco initiation were examined. Log-binomial regression was used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals. Sensitivity analyses excluded responders with a history of mental health conditions using health encounter data from the Military Health System Data Repository. Of the 4,855 responders, 75.5% were deployed from nonlocal/non-Gulf home stations, 5.8% reported concurrent depression and anxiety, and 2.8% reported the initiation of any tobacco product during oil spill response. Self-report of concurrent depression and anxiety was more prevalent among female responders and positively associated with longer deployments, crude oil exposure via inhalation, physical symptoms and injuries, and professional help-seeking during deployment, aPRs = 1.54-6.55. Tobacco initiation was inversely associated with older age and officer rank and positively associated with deployment-related stressors and depression/anxiety during deployment, aPRs = 1.58-4.44. Associations remained robust after excluding responders with a history of mental health- and tobacco-related health encounters up to 3 years before deployment. Depression, anxiety, and tobacco initiation were cross-sectionally associated with oil spill response work experiences among DWH responders, who largely originated outside of the affected community.
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Affiliation(s)
- Jeanny H. Wang
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland, USA
| | - Hristina Denic-Roberts
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland, USA
- Oak Ridge Institute for Science and Education, Maryland, USA
| | - Jeffrey L. Goodie
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland, USA
| | - Dana L. Thomas
- United States Coast Guard Headquarters, Directorate of Health, Safety, and Work Life, Washington, D.C., USA
| | - Lawrence S. Engel
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jennifer A. Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, Maryland, USA
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Belding JN, Castañeda SF, Jacobson IG, LeardMann CA, Porter B, Powell TM, Kolaja CA, Seelig AD, Matsuno RK, Carey FR, Rivera AC, Trone DW, Sheppard B, Walstrom J, Boyko EJ, Rull RP, For The Millennium Cohort Study Team. The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans. Ann Epidemiol 2021; 67:61-72. [PMID: 34906635 DOI: 10.1016/j.annepidem.2021.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/22/2023]
Abstract
The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions. Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3 to 5 years. Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.
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Key Words
- Abbreviations
- Army STARRS, Army Study to Assess Risk and Resilience in Servicemembers
- DoD, Department of Defense
- Millennium Cohort Study, military, veterans, deployment, risk factors, protective factors, physical health, mental health, health-related behaviors, longitudinal cohort
- OEF, Operation Enduring Freedom
- OIF, Operation Iraqi Freedom
- OND, Operation New Dawn
- PTSD, posttraumatic stress disorder
- VA, Department of Veterans Affairs
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Affiliation(s)
- Jennifer N Belding
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Sheila F Castañeda
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Isabel G Jacobson
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Ben Porter
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA; Mississippi State University, Mississippi State, Mississippi, USA
| | - Teresa M Powell
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Claire A Kolaja
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Amber D Seelig
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rayna K Matsuno
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Felicia R Carey
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Anna C Rivera
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Daniel W Trone
- Naval Health Research Center, San Diego, California, USA
| | - Beverly Sheppard
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Jennifer Walstrom
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Edward J Boyko
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rudolph P Rull
- Naval Health Research Center, San Diego, California, USA.
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Krukowski RA, Porter K, Boothe T, Talcott GW, Little MA. "Nobody Views It As a Negative Thing to Smoke": A Qualitative Study of the Relationship Between United States Air Force Culture and Tobacco Use. MILITARY PSYCHOLOGY 2021; 33:409-416. [PMID: 34924692 PMCID: PMC8673782 DOI: 10.1080/08995605.2021.1962189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tobacco use has long been a part of military culture, and rates of tobacco use remain higher among military personnel compared to civilians. The current study examines aspects of Air Force tobacco culture that encourage tobacco use. MATERIALS AND METHODS We conducted 7 focus groups among Air Force Military Training Leaders (n=48) and 5 focus groups among Technical Training Instructors (n=33) from July 2018 to February 2019. RESULTS Tobacco use was seen as a core part of Air Force culture and a low risk behavior, in contrast to other potential activities. Three themes of Air Force culture that facilitate tobacco use emerged: 1) opportunity for work breaks; 2) finding common ground; and 3) stress management or stress relief during deployment. Smoke pits were seen as serving several functions that were not perceived to occur anywhere else: an opportunity for informal communication with leadership, a source of valuable information, and a space for problem solving. CONCLUSIONS Airmen viewed tobacco as serving a functional role, which outweighed its harm. Future programs might try to address the functions fulfilled by tobacco in order to enhance their impact.
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Affiliation(s)
- Rebecca A. Krukowski
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kathleen Porter
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tina Boothe
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base Lackland Air Force Base, San Antonio, Texas, USA
| | - G. Wayne Talcott
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base Lackland Air Force Base, San Antonio, Texas, USA
| | - Melissa A. Little
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
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Cigarette smoking patterns among U.S. military service members before and after separation from the military. PLoS One 2021; 16:e0257539. [PMID: 34606513 PMCID: PMC8489722 DOI: 10.1371/journal.pone.0257539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/03/2021] [Indexed: 11/28/2022] Open
Abstract
U.S. military Service members have consistently smoked more than the general population and the prevalence of smoking is even higher among U.S. veterans. Our study examined cigarette smoking patterns among Service members before and after military separation to better understand the disproportionate rate of smoking among veterans. Data from the Millennium Cohort Study were used. All study participants were in the military at baseline and some transitioned from the military to civilian life during the observation period. We investigated any impact of military separation on smoking, as well as other potential risk factors for smoking. Overall, we observed higher smoking prevalence among veterans than Service members. Additionally, we found that Service members smoked more while approaching their separation from the military. Longitudinal analysis revealed military separation was not a risk factor for smoking, as we had hypothesized. Baseline smoking was the most influential predictor of current smoking status. Other significant factors included alcohol consumption, life stressors, and mental health conditions, among others. Military separation was not a risk factor for smoking. However, Service members in the process of transitioning out of the military, as well as high alcohol consumers and Service members with mental health conditions, may be at higher risk of smoking. Including smoking prevention/cessation programs in pre-separation counseling sessions and developing smoking screening and cessation programs targeting specific high-risk subgroups may reduce smoking among Service members and veterans.
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Kolaja CA, Schuyler AC, Armenta RF, Orman JA, Stander VA, LeardMann CA. Sexual health difficulties among service women: the influence of posttraumatic stress disorder. J Affect Disord 2021; 292:678-686. [PMID: 34157663 DOI: 10.1016/j.jad.2021.05.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/19/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Abstract
Background Sexual health among service women remains understudied, yet is related to health and quality of life. This study examined if the associations between recent combat and sexual assault with sexual health difficulties were mediated by mental disorders and identified factors associated with sexual health difficulties among service women. Methods Data from two time points (2013 and 2016) of the Millennium Cohort Study, a large military cohort, were used. The outcome was self-reported sexual health difficulties. Mediation analyses examined probable posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) as intermediate variables between recent combat and sexual assault with the sexual health difficulties. Multivariable logistic regression modeling was used to examine the association of demographic, military, historical mental health, life stressors, and physical health factors with sexual health difficulties. Results Of the 6,524 service women, 13.5% endorsed experiencing sexual health difficulties. Recent combat and sexual assault were significantly associated with sexual health difficulties. Probable PTSD mediated the associations of recent combat and sexual assault with sexual health difficulties; probable MDD did not mediate these relationships. Other significant factors associated with sexual health difficulties included enlisted rank, historical mental disorders, childhood trauma, and disabling injury. Limitations Use of self-reported data, outcome not assessed using a standardized measure and future studies may benefit from examining other mediators. Conclusion Our findings that combat and sexual assault may have negative effects on service women's sexual health suggest that treatment options and insurance coverage for sexual health problems should be expanded.
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Affiliation(s)
- Claire A Kolaja
- Leidos, San Diego, CA, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA.
| | - Ashley C Schuyler
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Richard F Armenta
- Department of Kinesiology, College of Education, Health, and Human Services, California State University, San Marcos, CA, USA
| | - Jean A Orman
- University of Texas Health at San Antonio, TX, USA
| | - Valerie A Stander
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, CA, USA; Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
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13
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Khow YZ, Lim TLY, Ng JSP, Wu J, Tan CS, Chia KS, Luo N, Seow WJ. Behavioral impact of national health campaigns on healthy lifestyle practices among young adults in Singapore: a cross-sectional study. BMC Public Health 2021; 21:1601. [PMID: 34461867 PMCID: PMC8404369 DOI: 10.1186/s12889-021-11628-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/13/2021] [Indexed: 12/30/2022] Open
Abstract
Background National health campaigns are often used to improve lifestyle behaviors in the general population. However, evidence specifically in the young adult population is scarce. Given the general deterioration of healthy lifestyle practices from adolescence to young adulthood, it is imperative to study this age group. This study aimed to investigate the behavioral impact of a national health campaign in Singapore on the lifestyle practices of young adults, and whether sex or full-time working and schooling status affected lifestyle practices. Methods A total of 594 Singaporean respondents aged 18–39 years old were interviewed via a cross-sectional study in December 2019. Lifestyle practices assessed were diet, exercise, alcohol consumption, current tobacco use, and participation in health screening programs. Other factors investigated included exposure to the national health campaign “War on Diabetes” (WoD), sex, ethnicity, and working/schooling status. Multivariable modified Breslow-Cox proportional hazards models were used to estimate prevalence risk ratios (PRRs) as measures for the associations in this study, after adjusting for potential confounders. Results Exposure to the WoD campaign had a significant association with meeting dietary recommendations (PRR = 1.6, 95% CI: 1.0–2.5, p = 0.037), participation in screening (PRR = 1.2, 95% CI: 1.0–1.5, p = 0.028), and current tobacco use (PRR = 0.5, 95% CI: 0.3–0.8, p = 0.003). Males were significantly more likely to meet exercise recommendations (PRR = 2.0, 95% CI: 1.5–2.7, p < 0.001), currently use tobacco (PRR = 3.9, 95% CI: 2.2–6.9, p < 0.001), and consume alcohol excessively (PRR = 1.5, 95% CI: 1.0–2.3, p = 0.046), as compared to females. Working young adults were significantly less likely to meet exercise recommendations (PRR = 0.7, 95% CI: 0.5–0.9, p = 0.019) but significantly more likely to be current tobacco users (PRR = 1.8, 95% CI: 1.1–3.1, p = 0.024), as compared to those who were in school. Conclusions While this paper affirms that national health campaigns have significant beneficial associations in diet, health screenings and current tobacco use, policymakers should acknowledge that young adults are an age group with different influences that impact their healthy lifestyle habits. Specific interventions that target these subgroups may be required for better health outcomes. Future studies should evaluate other socio-environmental factors that could play a role in modifying the effect of health campaigns among young adults.
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Affiliation(s)
- Yong Zhi Khow
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore
| | - Talia Li Yin Lim
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore
| | - Jarret Shoon Phing Ng
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore
| | - Jiaxuan Wu
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore
| | - Chuen Seng Tan
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kee Seng Chia
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Nan Luo
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Wei Jie Seow
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore, 119228, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
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14
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Pulmonary Pathology Diagnoses in the US Military During the Global War on Terrorism. Lung 2021; 199:345-355. [PMID: 34363506 DOI: 10.1007/s00408-021-00446-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/31/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE To document and compare prevalences of pulmonary pathology diagnoses among US Service members deployed during the Global War on Terrorism and non-deployed US service members. Difficulties establishing associations between deployment-related exposures and pulmonary pathology reported among US military service members deployed during the Global War on Terrorism include retrospective estimations of exposures, documenting medical outcomes and lack of comparison groups. METHODS Pulmonary diagnoses reported between 2002 and 2015 were identified from the records of the former Armed Forces Institute of Pathology and The Joint Pathology Center. Military service and deployment were confirmed by the Defense Manpower Data Center. Diagnoses were reviewed and coded due to variations in diagnostic terminology. Propensity matching and adjusted binomial modeling were applied to comparisons between the deployed and non-deployed to address possible confounding variables. RESULTS 404 deployed and 2006 non-deployed service members were included. Demographic differences and the date of pathology report complicate unadjusted comparisons. The deployed had no significant increased prevalence of neoplastic conditions. Propensity matching identified a significant increased prevalence of organizing pneumonia in the non-deployed. An adjusted binomial model identified significant increased prevalences of small airways disease, constrictive bronchiolitis and hypersensitivity pneumonitis in the deployed. Both diagnoses were strongly associated with the date of pathology report. Small airways disease, constrictive bronchiolitis comprised 5% of deployed surgical lung biopsy diagnoses. CONCLUSION This is the largest study of post-deployment pulmonary pathology diagnoses to date, and contains a comparison group. It provides context for studies of pulmonary outcomes among the deployed.
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15
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Keltner CH, Kao TC, Ahmed A, Mancuso JD. E-cigarette and dual product use as an emerging health threat to the US military. Tob Prev Cessat 2021; 7:43. [PMID: 34141958 PMCID: PMC8176862 DOI: 10.18332/tpc/135516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/06/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Cigarette and e-cigarette use are threats to the health and readiness of the US military. The study objective was to determine the prevalence and factors associated with e-cigarette, cigarette, and dual use among active duty service members (SMs). METHODS We used data from the 2015 Health Related Behaviors Survey—a crosssectional survey weighted to represent the US military (n=16699). Weighted prevalence and odds ratios assessed associations between risk factors and e-cigarette/cigarette use via weighted multinomial logistic models. RESULTS The prevalence of cigarette use in the US military declined from 24% in 2011 to 13.8% in 2015. However, e-cigarette use (12.4%) and dual product use (4.7%) increased during this period. Additionally, prevalence of e-cigarette use was higher in the military compared to the general population (12.4% vs 3.5%), particularly among those aged 17–24 years (22.8% vs 5.2%); cigarette use was also higher in the military in this age group (19.3% vs 13.0%). After adjustment, SMs who were enlisted, lacked a Bachelor’s degree, and/or had probable alcohol use disorder had significantly greater odds of cigarette, e-cigarette, and dual use. While SMs aged 17–24 years had the highest prevalence of all types of product use, only being aged ≥45 years was significantly associated with decreased odds of product use in adjusted models. CONCLUSIONS Military efforts to control cigarette use among SMs seem to have been successful, as demonstrated by the dramatic declines in its use and the lower prevalence seen in the military compared to the general population. However, the concurrent increases in e-cigarette use are concerning, particularly among the youngest members of the military. The US military must continue to monitor emerging trends in e-cigarette, cigarette, and dual use and rapidly take steps to address them as threats to health and readiness.
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Affiliation(s)
- Case H Keltner
- School of Medicine, Oregon Health and Science University, Portland, United States
| | - Tzu-Cheg Kao
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, United States
| | - Anwar Ahmed
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, United States
| | - James D Mancuso
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, United States
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16
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Schindler DK, Lopez Mitnik GV, Soliván-Ortiz AM, Irwin SP, Boroumand S, Dye BA. Oral Health Status Among Adults With and Without Prior Active Duty Service in the U.S. Armed Forces, NHANES 2011-2014. Mil Med 2020; 186:e149-e159. [PMID: 33007064 DOI: 10.1093/milmed/usaa355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Many veterans qualify for health benefits but generally not dental care. This study examines differences in oral health status between veterans and nonveterans in the U.S. to determine how various factors, including socioeconomic, general health, and tobacco use, impact former service members' oral health. MATERIALS AND METHODS Data from 11,539 dentate adults participating in the National Health and Nutrition Examination Survey (2011-2014) were used. Outcome variables included decayed teeth (DT), missing teeth (MT), filled teeth (FT), caries experience (DMFT), and periodontitis (PD). Covariates included demographic and socioeconomic factors, deployment, smoking, depression, hypertension, hyperlipidemia, and diabetes. Logistic regression modelling was used to assess associations between these factors and oral health outcomes. RESULTS Veterans represent about 9% of the U.S. population. There was a higher prevalence of PD, MT, FT, and DMFT among veterans than nonveterans. Veterans were more likely to have PD (OR, 1.8; 95% CI, 1.3 to 2.5) and higher DMFT (OR, 2.9; 95% CI, 2.4 to 3.4); however, after controlling for other covariates, military service was only associated with FT (OR, 1.3; 95% CI, 1.1 to 1.6) and higher DMFT (OR, 1.6; 95% CI, 1.2 to 1.9). CONCLUSIONS Because veterans are more likely to originate from groups at a higher risk for poor oral health (older adults, smokers, males, diabetics), the prevalence of adverse oral health conditions are higher among veterans compared to nonveterans. Overall, military service is not associated with PD or untreated dental caries but is associated with indicators suggesting veterans have had more dental treatment (FT and DMFT). There is substantial unmet oral health care need primarily related to periodontitis among veterans.
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Affiliation(s)
- David K Schindler
- Tri-Service Center for Oral Health Studies, Uniformed Services University-Southern Region, JBSA-Ft. Sam Houston, TX 78234, USA.,National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, MD 20892, USA
| | - Gabriela V Lopez Mitnik
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, MD 20892, USA
| | - Aida M Soliván-Ortiz
- Tri-Service Center for Oral Health Studies, Uniformed Services University-Southern Region, JBSA-Ft. Sam Houston, TX 78234, USA
| | - Scott P Irwin
- Tri-Service Center for Oral Health Studies, Uniformed Services University-Southern Region, JBSA-Ft. Sam Houston, TX 78234, USA
| | - Shahdokht Boroumand
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, MD 20892, USA
| | - Bruce A Dye
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, MD 20892, USA
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17
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Little MA, Fahey MC, Klesges RC, McMurry T, Talcott GW. Evaluating the Effects of a Brief Tobacco Intervention in the US Air Force. Nicotine Tob Res 2020; 22:1569-1577. [PMID: 31903494 DOI: 10.1093/ntr/ntaa001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Military personnel have among the highest rates of tobacco use in the United States. Unfortunately, there are few interventions aimed at reducing tobacco use among this vulnerable population. The current study addresses this need by evaluating the short-term effectiveness of a Brief Tobacco Intervention (BTI), a 40-min group-based intervention designed to reduce contemporary patterns of tobacco use among a sample of US military enlistees during an 11-week period of involuntary tobacco abstinence. AIMS AND METHODS Participants were 2999 US Air Force Technical Trainees at Joint Base San Antonio-Lackland Air Force Base in San Antonio, Texas from April 2017 through January 2018. Participants were cluster randomized to three conditions: (1) BTI + Airman's Guide to Remaining Tobacco Free (AG), (2) AG intervention, or (3) standard smoking cessation intervention. The primary analysis was a comparison of the interventions' efficacies in preventing tobacco use during Technical Training, conducted using a generalized estimating equations logistic regression model controlling for covariates. Multiple imputation was used to account for loss to follow-up. RESULTS There was not a significant difference by condition in the use of tobacco products at follow-up (p = .454). The BTI + AG condition did produce short-term changes in perceived harm, intentions to use tobacco, knowledge about tobacco products, and normative beliefs. CONCLUSIONS These findings suggest that while the intervention was effective in the short term, it was not potent enough over a 12-week period to prevent Airmen from initiating tobacco use. Future studies should examine whether adding a booster session or media campaign enhances the effectiveness of the intervention. IMPLICATIONS Despite the fact that most Airmen believe they will remain tobacco free following the ban in Technical Training, a large percentage of these Airmen resume and initiate tobacco use during this high-risk period. As a result, there is a need for interventions targeting the range of tobacco available to military trainees during a teachable moment when they report intentions to remain tobacco free. The current study shows that a BTI has promise in reducing long-term tobacco use, when coupled with additional interventions, such as a booster session or a media campaign.
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Affiliation(s)
- Melissa A Little
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA.,Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, TX
| | | | - Robert C Klesges
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy McMurry
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA.,Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, TX
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18
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Williams JF, Fuller M, Smith MB. Smoking habits of UK military personnel on deployment: Exercise SAIF SAREEA 3. BMJ Mil Health 2020; 166:396-400. [PMID: 32467288 DOI: 10.1136/bmjmilitary-2019-001364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Changes of environment brought about by deployments are often attributed to an increase in smoking of service personnel. Electronic cigarettes are recognised as being a viable aid to quitting smoking but are currently banned from sale in Oman and were therefore banned during exercise SAIF SAREEA 3 (SS3). This paper sought to establish whether smoking increased on this exercise and for what reasons. Also, if deployed smoking cessation services are likely to be used, if available. METHODS Questionnaires were distributed to deployed troops at various locations in theatre for data collection. RESULTS Smoking prevalence increased by 5.2% (29) in the deployed population by the end of the exercise. The largest increase was seen in those smoking 20 cigarettes a day or more, rising by 269.8% (73) with a mean increase of 9 cigarettes per day. During the exercise the number of personnel using electronic cigarettes decreased and individuals' rate of electronic cigarette use also decreased. Those who smoked less during the exercise did mainly through choice (56.8%). 50% (280) of all individuals who increased smoking habits during the exercise did so out of boredom. CONCLUSIONS During exercise SS3 the number of individuals who smoked and the quantity they smoked increased. The ban on electronic cigarettes in Oman and while on exercise potentially had an effect on the increased smoking habits. There is an argument to include smoking cessation material in medical modules to prevent ex-smokers from restarting, continue to aid those quitting and potentially lessen severity of increasing smoking habits while deployed.
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Affiliation(s)
- J F Williams
- 5 Armoured Medical Regiment, British Army, Catterick Garrison, UK
| | - M Fuller
- MASHH, RCDM Birmingham, Birmingham, UK
| | - M B Smith
- 5 Armoured Medical Regiment, British Army, Catterick Garrison, UK
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19
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Selman J, Rogers R, Molloy S. Negative Alcohol and Tobacco Consumption Behaviors in an Australian Army Combat Brigade. Mil Med 2019. [DOI: 10.1093/milmed/usz406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Western militaries have consumption rates of alcohol and tobacco which are higher than the associated civilian populations, and are concerned about the negative effects on health, wellbeing, and military performance that such high rates may have.
Materials and Methods
A survey questionnaire which collected nonidentifiable data was distributed to all accessible members of an Australian Army Combat Brigade over the annual induction training and prefield exercise period between January and March 2019. The survey was composed of personal and demographic questions, followed by questions concerning the personal consumption habits of alcohol and tobacco. 1,606 complete and valid surveys were returned, representing 55.3% of the Brigade’s posted strength. Ethical clearance for this project was provided by the Australian Defence Force Joint Health Command Low Risk Ethics Panel (18-012).
Results
Almost one quarter of the Combat Brigade exceeded the Australian daily risk guideline for alcohol consumption, and over three quarters exceeded the occasion risk guideline; with 6.1% of soldiers drinking alcohol daily. 24.3% identified as tobacco smokers, with 15.9% smoking daily. Smoking rates and volumes were higher when deployed on field training exercises and on international training and operational deployments; as was the consumption of roll-your-own cigarettes. Overall, the main determinants of the negative consumption behaviors were gender (male) and age (under 25).
Conclusions
This study confirmed that the members of an Australian Army Combat Brigade have higher negative health consumption behaviors concerning alcohol and tobacco than the general civilian population. The results also identified a cohort of Senior Non-Commissioned Officers and Warrant Officers (E5–E9) between the ages of 35 and 44 who had high negative consumption behaviors which could result in poor health outcomes. This could be a suitable cohort for a targeted campaign to reduce tobacco and alcohol consumption and to assist to make healthy life changes.
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Affiliation(s)
- Jason Selman
- HQ 3rd Brigade, Australian Army, Lavarack Barracks, Townsville, Queensland 4813, Australia
| | - Rona Rogers
- HQ 3rd Brigade, Australian Army, Lavarack Barracks, Townsville, Queensland 4813, Australia
| | - Sara Molloy
- HQ 3rd Brigade, Australian Army, Lavarack Barracks, Townsville, Queensland 4813, Australia
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Pelts MD, Albright DL, McDaniel J, Godfrey K. Physical health characteristics of student service members and veterans by sexual orientation. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2019; 67:727-732. [PMID: 30365361 DOI: 10.1080/07448481.2018.1502774] [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: 02/20/2018] [Revised: 06/05/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Abstract
Objective: Little is known about the health status of the diverse population of student service members and veterans (SSM/V) enrolling in higher education in great numbers. The objective of this study was to explore the differences in physical health characteristics by sexual orientation among a national sample of SSM/V. Methods: Using secondary data, a series of maximum likelihood (ML) logistic regression models were estimated to explore physical health characteristics by sexual orientation in a sample of SSM/V. Results: SSM/V that identify as lesbian or gay reported higher rates of treatment and diagnosis for some physical health matters (respiratory illness and HIV) when compared with their heterosexual counterparts. Conclusions: Our findings support the need for campus health officials and policymakers to develop services to address the physical health needs of this population that differ from their peers.
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Affiliation(s)
- Michael D Pelts
- School of Social Work, University of Arkansas at Little Rock, Little Rock, Arkansas, USA
| | - David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
| | - Justin McDaniel
- Department of Public Health and Recreation Professions, Southern Illinois University, Carbondale, Illinois, USA
| | - Kelli Godfrey
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
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21
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Higgins ST, Kurti AN, Palmer M, Tidey JW, Cepeda-Benito A, Cooper MR, Krebs NM, Baezconde-Garbanati L, Hart JL, Stanton CA. A review of tobacco regulatory science research on vulnerable populations. Prev Med 2019; 128:105709. [PMID: 31054904 PMCID: PMC6824984 DOI: 10.1016/j.ypmed.2019.04.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/22/2019] [Accepted: 04/28/2019] [Indexed: 12/15/2022]
Abstract
In 2013 the U.S. Food and Drug Administration and National Institutes of Health established fourteen Tobacco Centers of Regulatory Science (TCORS) to advance scientific knowledge relevant to conducting evidence-based tobacco regulation. This report reviews TCORS-funded research with adult vulnerable populations. The literature search included a list of all TCORS-funded publications compiled by the TCORS coordinating center; all TCORS were requested to share publications not in the coordinating-center's list. Only TCORS-funded reports describing an empirical study with an adult vulnerable population published in a peer-reviewed journal between September 2013 and June 2018 were included. 71 reports met inclusion criteria; 39% (28/71) examined tobacco use among those with mental health and medical comorbidities, 34% (24/71) socioeconomic disadvantage, 31% (22/71) women of reproductive age, 30% (21/71) racial/ethnic minorities, 18% (13/71) rural residents, and 3% (2/71) each among active military/veterans and sexual/gender minorities. Regarding scientific domains, 63% (45/71) investigated behavior, 37% (26/71) addiction, 24% (17/71) health effects, 20% (14/71) impact analyses, 18% (13/71) toxicity, 8% (6/71) marketing influences, and 7% (5/71) communications. Totals exceed 100% because some reports addressed multiple populations/domains. TCORS funding has generated a substantial, multidisciplinary body of new scientific knowledge on tobacco use in adult vulnerable populations. However, considerable variability was noted in the amount of research conducted across the various vulnerable populations and scientific domains. Most notably, relatively few studies focused on active military/veterans or sexual/gender minorities, and the scientific domains of marketing influences and communications were conspicuously underrepresented. These are important knowledge gaps to address going forward.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Joy L Hart
- University of Louisville, United States of America
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22
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Cooper M, Yaqub M, Hinds JT, Perry CL. A longitudinal analysis of tobacco use in younger and older U.S. veterans. Prev Med Rep 2019; 16:100990. [PMID: 31890466 PMCID: PMC6931232 DOI: 10.1016/j.pmedr.2019.100990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/16/2019] [Accepted: 09/15/2019] [Indexed: 01/20/2023] Open
Abstract
United States (U.S.) veterans are prone to higher rates of smoking and smoking-related disease. We describe the prevalence of cigarette and non-cigarette product use and determine longitudinal predictors of tobacco use transitions in this vulnerable population. Data are from Waves 1 (2013–2014) and 2 (2014–2015) of the adult cohort in the Population Assessment of Tobacco and Health. Wave 1 prevalence was calculated for past 30-day use of all queried tobacco products, and compared by veteran status. Weighted multinomial logistic regression was used to determine predictors—demographics, substance use, and physical and psychological comorbidities—of tobacco use transitions (continued use, initiation, and cessation) among veterans. Compared to non-veterans, use of nearly all tobacco products was significantly higher among veterans and was highest among younger veterans. Compared to continued nonusers, continued users were more likely to: be of younger age (OR = 0.95, 95% CI: 0.95–0.96), have poorer physical health (OR = 1.58, 95% CI: 1.22–2.06) and mental health (OR = 1.48, 95% CI: 1.18–1.85), report substance use (OR = 1.79, 95% CI: 1.21–2.64), and report problematic alcohol use (OR = 4.23, 95% CI: 2.38–7.52) and were less likely to be female (OR = 0.57, 95% CI: 0.35–0.93). Compared to continued nonusers, initiators were more likely to report problematic alcohol use (OR = 8.63, 95% CI: 3.79–19.63), and those in the cessation category were more likely to be of younger age (OR = 0.97, 95% CI: 0.95–0.99). Cigarette and non-cigarette use is especially prevalent among young veterans, so prevention should begin during military service. Tobacco cessation programs should be tailored for this population, incorporating aspects related to concomitant health conditions.
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Affiliation(s)
- Maria Cooper
- Michael & Susan Dell Center for Healthy Living, UTHealth, School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
- Corresponding author.
| | - Maha Yaqub
- Michael & Susan Dell Center for Healthy Living, UTHealth, School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| | - Josephine T. Hinds
- The University of Texas at Austin, Department of Kinesiology and Health Education, 2109 San Jacinto Blvd, D3700, Austin, TX 78712, USA
| | - Cheryl L. Perry
- Michael & Susan Dell Center for Healthy Living, UTHealth, School of Public Health in Austin, 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
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Lin J, Zhu K, Hoang PK, Soliván-Ortiz AM, Larsen SL, Irwin SP, Schneid TR, Shriver CD, Lee S. Electronic Cigarette Use and Related Factors among Active Duty Service Members in the U.S. Military. Mil Med 2019; 185:418-427. [DOI: 10.1093/milmed/usz267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Electronic cigarettes (e-cigarettes) are increasingly used in the U.S.A. by young people. As young adults serve as the primary recruiting pool for military, active duty service members in military may be susceptible to using e-cigarettes. However, factors related to e-cigarette use in military population have rarely been studied. We aimed to identify factors associated with e-cigarette use and factors related to duration of use among active duty service members.
Materials and Methods
Subjects (N = 2,467) from Fort Bragg Army Base, North Carolina and Lackland Air Force Base, Texas completed a self-administered questionnaire during July 2015 to May 2016 time frame. The questionnaire collected data on demographic and military characteristics, tobacco use (including e-cigarette use) and other information. Stepwise logistic regression was performed to identify significant factors associated with e-cigarette use. Stepwise linear regression was performed to identify factors associated with duration of use.
Results
A total of 356 (14.4%) study participants reported ever use of e-cigarettes. There was no significant difference in prevalence of use between the two military installations (15.6% at Fort Bragg vs. 13.2% at Lackland, P = 0.097). Increased use of e-cigarettes was associated with young age (20–24 years old) (OR = 1.98, 95% CI = 1.22–3.22), enlisted military rank (E1–E4: OR = 2.45, 95% CI = 1.36–4.40; E5–E9: OR = 1.88, 95% CI = 1.10–3.21), low perception of harm (OR = 5.18, 95% CI = 3.65–7.34), former (OR = 9.12, 95% CI = 6.29–13.22) and current (OR = 13.24, 95% CI = 9.22–19.02) cigarette smoking, and former smokeless tobacco use (OR = 2.07, 95% CI = 1.33–3.22), former (OR = 2.62, 95% CI = 1.42–4.85) and current (OR = 2.82, 95% CI = 1.82–4.37) cigar or pipe smoking. However, serving mainly in combat unit during deployment was associated with decreased odds of use (OR = 0.57, 95% CI = 0.34–0.97). Among e-cigarette users, the number of years using e-cigarettes was significantly longer among the participants with lower perception of harm than those with higher perception of harm (0.82 vs. 0.22, P < 0.001), and the duration was longer among subjects who used e-cigarette with nicotine than those without nicotine (0.79 vs. 0.49, P = 0.003). Finally, reasons for use differed markedly by cigarette smoking status. Never smokers used e-cigarette for the taste or flavor, while cigarette smokers used e-cigarette to help quit tobacco or reduce tobacco use.
Conclusion
Young age, lower military ranks, other tobacco use, and low perception of harm were associated with increased odds of using e-cigarettes, while serving in combat unit was associated with decreased odds of use in active duty service members. Low harm perception and using nicotine-containing e-cigarettes were associated with long duration of use. The reasons for using e-cigarettes differed by cigarette smoking status. Our study provides clues for future hypothesis-driven studies.
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Affiliation(s)
- Jie Lin
- Murtha Cancer Center Research Program, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Paula K Hoang
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Aida M Soliván-Ortiz
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, San Antonio, TX 78236
| | - Stacy L Larsen
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, Fort Bragg, NC 28310
| | - Scott P Irwin
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, San Antonio, TX 78236
| | - Thomas R Schneid
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, Fort Sam Houston, TX 78234
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
| | - Sukhyung Lee
- Murtha Cancer Center Research Program, Walter Reed National Military Medical Center, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814
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Longitudinal Examination of the Influence of Individual Posttraumatic Stress Disorder Symptoms and Clusters of Symptoms on the Initiation of Cigarette Smoking. J Addict Med 2019; 12:363-372. [PMID: 29864086 DOI: 10.1097/adm.0000000000000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether specific individual posttraumatic stress disorder (PTSD) symptoms or symptom clusters predict cigarette smoking initiation. METHODS Longitudinal data from the Millennium Cohort Study were used to estimate the relative risk for smoking initiation associated with PTSD symptoms among 2 groups: (1) all individuals who initially indicated they were nonsmokers (n = 44,968, main sample) and (2) a subset of the main sample who screened positive for PTSD (n = 1622). Participants were military service members who completed triennial comprehensive surveys that included assessments of smoking and PTSD symptoms. Complementary log-log models were fit to estimate the relative risk for subsequent smoking initiation associated with each of the 17 symptoms that comprise the PTSD Checklist and 5 symptom clusters. Models were adjusted for demographics, military factors, comorbid conditions, and other PTSD symptoms or clusters. RESULTS In the main sample, no individual symptoms or clusters predicted smoking initiation. However, in the subset with PTSD, the symptoms "feeling irritable or having angry outbursts" (relative risk [RR] 1.41, 95% confidence interval [CI] 1.13-1.76) and "feeling as though your future will somehow be cut short" (RR 1.19, 95% CI 1.02-1.40) were associated with increased risk for subsequent smoking initiation. CONCLUSIONS Certain PTSD symptoms were associated with higher risk for smoking initiation among current and former service members with PTSD. These results may help identify individuals who might benefit from more intensive smoking prevention efforts included with PTSD treatment.
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Vlaar T, Elbaz A, Moisan F. Is the incidence of motor neuron disease higher in French military personnel? Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:107-115. [DOI: 10.1080/21678421.2019.1675709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tim Vlaar
- INSERM, Centre for Research in Epidemiology and Population Health, U1018, University Paris-Sud, Villejuif, France and
- Santé publique France, Saint-Maurice, France
| | - Alexis Elbaz
- INSERM, Centre for Research in Epidemiology and Population Health, U1018, University Paris-Sud, Villejuif, France and
- Santé publique France, Saint-Maurice, France
| | - Frédéric Moisan
- INSERM, Centre for Research in Epidemiology and Population Health, U1018, University Paris-Sud, Villejuif, France and
- Santé publique France, Saint-Maurice, France
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Golden SE, Thakurta S, Slatore CG, Woo H, Sullivan DR. Military Factors Associated with Smoking in Veterans. Mil Med 2019; 183:e402-e408. [PMID: 29788494 DOI: 10.1093/milmed/usy115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/01/2018] [Indexed: 11/14/2022] Open
Abstract
Introduction Given the high prevalence of smoking among Veterans and the economic, social, and clinical implications, it is important to understand the factors that contribute to smoking in order to focus efforts to mitigate these factors and improve smoking cessation efforts among Veterans. The availability of research on smoking in Veterans compared with civilians is limited given the military-specific differences in their life course. We aimed to identify military-specific factors combined with sociodemographic factors for ever smoking and current smoking among Veterans to inform future interventions. Materials and Methods We used data from the 2010 National Survey of Veterans, the most current, to analyze the association of sociodemographic and military-specific factors with ever versus never smoking, and current versus past smoking using multiple variable logistic regression models (IRB#4125). Results Among 8,618 respondents, the proportions of current, past, and never smokers were 17%, 48%, and 34%, respectively. Sociodemographic factors associated with ever smoking were female gender, educational attainment of less than a bachelor's degree, and being divorced/separated/widowed. Military-specific factors associated with ever smoking were exposure to dead/dying/wounded soldiers during service, and past, current, and unsure enrollment in Veterans Affairs healthcare. Never smoking was associated with Hispanic ethnicity, income over $75,000, and reporting fair or poor health. Military factors associated with never smoking were presence of a service-connected disability and military service July 1964 or earlier (i.e., pre-Vietnam). Among 5,652 ever smokers, sociodemographic factors associated with current smoking were age less than 65, being non-Hispanic black, educational attainment of less than a bachelor's degree, being divorced/separated/widowed, never married, and having no insurance. Factors associated with reduced likelihood of current smoking compared with past smoking included income >$41,000 and reporting fair or poor health. Military-specific variables associated with reduced likelihood of current smoking were service era of May 1975 or later (i.e., post-Vietnam) and 5 or more years of service. Conclusion Military-specific variables are associated with smoking behaviors among Veterans. Findings from this study that exposure to dead/dying/wounded soldiers, service era, duration of service, service-connected disability status, and enrollment in VA care all influence smoking in Veterans, can inform prevention and cessation efforts in part by encouraging alternative healthy habits or cessation techniques in subgroups of Veterans with particular military backgrounds. By assessing risk factors in this unique population future research can leverage these findings to determine mechanisms that help explain these associations. Identifying factors associated with smoking offers insights for smoking cessation and prevention interventions given the military experiences and increased smoking incidence among Veterans.
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Affiliation(s)
- Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), 3710 SW, US Veterans Hospital Road, Portland, OR.,Department of Sociology, Portland State University, Portland, OR
| | - Sujata Thakurta
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), 3710 SW, US Veterans Hospital Road, Portland, OR
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), 3710 SW, US Veterans Hospital Road, Portland, OR.,Department of Medicine, Oregon Health & Science University PCCM, 3181 SW, Sam Jackson Park Rd, Portland, OR.,Section of Pulmonary & Critical Care Medicine, VA Portland Health Care System Portland, 3710 SW, US Veterans Hospital Road, Portland, OR.,Department of Radiation Medicine, Oregon Health & Science University, 3181 SW, Sam Jackson Park Rd, Portland, OR
| | - Hyeyoung Woo
- Department of Medicine, Oregon Health & Science University PCCM, 3181 SW, Sam Jackson Park Rd, Portland, OR
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (R&D66), 3710 SW, US Veterans Hospital Road, Portland, OR.,Department of Medicine, Oregon Health & Science University PCCM, 3181 SW, Sam Jackson Park Rd, Portland, OR
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Chen F, Hu P, Chang W, Chen C, Ding T, Liu X. A Cross-Sectional Survey on Cigarette Smoking in the Chinese Navy. Mil Med 2019; 184:e211-e217. [PMID: 30535298 DOI: 10.1093/milmed/usy363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/26/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The military is a risk environment for cigarette smoking. This study determined the prevalence of, cessation attempts, knowledge, and attitudes regarding smoking, and factors related to it in the Chinese navy. MATERIALS AND METHODS A cross-sectional survey was conducted of military personnel on active duty in the Chinese navy, Guangdong province. Data were collected using a standard structured questionnaire and analyzed through SPSS. Multiple logistic regression was used to examine factors associated with smoking. The research protocols were reviewed and approved by the Institutional Review Board of Naval Medical University, and participants gave written informed consent. RESULTS A total of 1,530 military personnel who had served for >3 months completed the survey, 859 (56.14%) of whom were current smokers. The main reasons for smoking were stress alleviation and social needs. A total of 377 smokers had previously attempted quitting. More than half considered the military environment supportive of smoking. Subjects' knowledge regarding smoking mainly comprised negative respiratory-health effects. Smoking status was related to education level, military service duration, number of smoking family members, and smoking knowledge. CONCLUSIONS Smoking prevalence in the Chinese navy is higher than that among Chinese civilians and the US and UK military personnel. Although many sailors are aware of the dangers of smoking to their health, they seldom get advice or help regarding smoking cessation. Most smokers believed that smoking cessation could improve their health. Therefore, the navy should formulate policies encouraging and facilitating military personnel's smoking cessation.
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Affiliation(s)
- Fuxing Chen
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Pengwei Hu
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Wang Chang
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Chulin Chen
- Department of Nursing, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Tianyuan Ding
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Xiaorong Liu
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
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Kong AY, Golden SD, Myers AE, Little MA, Klesges R, Talcott W, Vandegrift S, Cassidy D, Ribisl KM. Availability, price and promotions for cigarettes and non-cigarette tobacco products: an observational comparison of US Air Force bases with nearby tobacco retailers, 2016. Tob Control 2019; 28:189-194. [PMID: 29705745 PMCID: PMC6204316 DOI: 10.1136/tobaccocontrol-2018-054266] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Active duty military personnel have higher cigarette and smokeless tobacco use rates than civilian populations. Although US Airmen (called Airmen regardless of gender or rank) are required to be tobacco-free during initial training, many resume use once this period ends, perhaps as a result of easy access to cheap tobacco products. METHODS Between July and September 2016, we collected tobacco product, price and promotion information by visiting on-base (n=28) and off-base (n=80) tobacco retailers near the eight technical training bases where approximately 99% of Airmen attend training. We conducted mixed linear effects models to examine on-base versus off-base differences. RESULTS Cigarette packs were 11%-12% cheaper at on-base retailers compared with off-base retailers. Newport Menthol and Marlboro Red cigarette packs were $0.87 and $0.80 lower on-base (p<0.001) while the cheapest pack available was $0.54 lower on-base (p<0.01). Copenhagen smokeless tobacco was also significantly cheaper on-base (B=-0.65, p<0.01). Interior price promotions were more common on-base. CONCLUSIONS Retail stores located on Air Force bases sell cigarettes and smokeless tobacco products at prices well below those in nearby off-base retailers: the vast majority of these retailers feature interior price promotions for these products. Federal policies regulating prices of on-base tobacco sales, if implemented more effectively, have the potential to protect the health of Airmen by helping them remain tobacco-free after technical training.
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Affiliation(s)
- Amanda Y. Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Shelley D. Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Allison E. Myers
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Counter Tools, Carrboro, NC, USA
| | - Melissa A. Little
- Center for Addiction Prevention Research, Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Lackland AFB, TX, USA
| | - Robert Klesges
- Center for Addiction Prevention Research, Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA, USA
| | - Wayne Talcott
- Center for Addiction Prevention Research, Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Lackland AFB, TX, USA
| | - Sara Vandegrift
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Cassidy
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Lackland AFB, TX, USA
| | - Kurt M. Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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Thandi G, Fear NT. Factors associated with smoking behaviour change in UK military personnel. Occup Med (Lond) 2019; 67:712-714. [PMID: 29040747 DOI: 10.1093/occmed/kqx149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Research in the UK civilian population suggests that poor mental health outcomes are associated with smoking behaviour. In the UK military population, smoking cessation is associated with deployment in the reserve forces. However, little is known about the links between mental health outcomes and smoking initiation and cessation in the UK military. Aims The aim of this longitudinal study was to examine change in mental health and military factors associated with smoking initiation and cessation in a representative sample of UK military personnel. Methods Data were collected between 2003 and 2009; 5138 regular and reserve military personnel were included in the analyses. Results The results showed that smoking initiation was associated with symptoms of psychological distress, symptoms of probable post-traumatic stress disorder (PTSD), relationship breakdown and deployment. Conclusions These findings are consistent with existing research in civilian populations showing links between poor mental health and smoking behaviour. Furthermore, our finding that deployment is associated with smoking initiation is also in line with research from the US military and UK reserves.
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Affiliation(s)
- G Thandi
- Academic Department of Military Mental Health, King's College London, 10 Cutcombe Road, Weston Education Centre, London, UK
| | - N T Fear
- Academic Department of Military Mental Health, King's College London, 10 Cutcombe Road, Weston Education Centre, London, UK
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Hicks TA, Wilson SM, Thomas SP, Dennis PA, Neal JM, Calhoun PS. Low Income as a Multiplicative Risk Factor for Oral Pain and Dental Problems Among U.S. Veteran Smokers. Int J Behav Med 2018; 25:67-73. [PMID: 28527104 DOI: 10.1007/s12529-017-9660-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Compared to the United States (U.S.) general population, military veterans are at an increased risk of experiencing dental problems. This study documented associations between cigarette use and measures of dental/oral concern in a population of U.S. veterans who served in Iraq and Afghanistan. METHOD A cross-sectional analysis of survey data from the Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans Health and Needs Study, a study of U.S. military veterans. Out of 5000 surveys mailed to a random sample of OEF/OIF veterans, 1161 surveys were completed and returned. Among study respondents, N = 1114 had non-missing dental/oral pain data and were included for analysis. The survey also included smoking history and demographic information. Univariate and multivariate logistic regression analyses were used to cross-sectionally model the odds of experiencing dental/oral concerns as a function of smoking status. We also examined moderating effects of income and gender on the association between smoking and dental/oral concerns. RESULTS In univariate and multivariate models, current smoking was associated with risk for dental/oral concerns. However, this association was qualified by a Smoking × Income interaction. For those earning above US$20,000, smoking was not associated with dental/oral concerns. Among veterans with low income, smoking was associated with three times higher odds of increased dental/oral concerns. There was no significant Gender × Smoking interaction. CONCLUSION These findings underscore the relevance of factors that moderate the association between smoking and dental/oral concern, namely income. Findings also underscore the importance of interventions to mitigate income disparities in oral healthcare.
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Affiliation(s)
- Terrell A Hicks
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA. .,Durham Veterans Affairs (VA) Health Care System, Durham, NC, 27705, USA. .,Durham Veterans Affairs Medical Center, 3022 Croasdaile Dr. Room 304, Durham, NC, 27705, USA.
| | - Sarah M Wilson
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, 27705, USA.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, 27705, USA
| | - Shaun P Thomas
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.,Durham Veterans Affairs (VA) Health Care System, Durham, NC, 27705, USA
| | - Paul A Dennis
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.,Durham Veterans Affairs (VA) Health Care System, Durham, NC, 27705, USA
| | - Julia M Neal
- Durham Veterans Affairs (VA) Health Care System, Durham, NC, 27705, USA
| | - Patrick S Calhoun
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, 27710, USA.,Durham Veterans Affairs (VA) Health Care System, Durham, NC, 27705, USA.,VA Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), Durham, NC, 27705, USA.,Center for Health Services Research in Primary Care, Durham VA Health Care System, Durham, NC, USA
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Obeng-Gyasi E, Obeng-Gyasi B. Blood Pressure and Oxidative Stress among U.S. Adults Exposed to Lead in Military Environments-A Preliminary Study. Diseases 2018; 6:diseases6040097. [PMID: 30373250 PMCID: PMC6313542 DOI: 10.3390/diseases6040097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/16/2022] Open
Abstract
In this cross-sectional study, lead exposure among those with a history in military environments was examined. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) are clinical markers of blood pressure, while gamma-glutamyl transferase (GGT) is a marker of oxidative stress. These markers and their effects on those exposed to military environments were explored using National Health and Nutrition Examination Survey (NHANES) data from 2009 to 2016. Mean SBP and GGT were significantly elevated in those exposed to military environments, with a moderately significant association existing between blood lead levels (BLLs) and SBP. More attention must be given to lead exposure in military environments to mitigate the risk of exposure.
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Affiliation(s)
- Emmanuel Obeng-Gyasi
- Department of Built Environment, North Carolina Agricultural and Technical State University; Greensboro, NC 27411, USA.
| | - Barnabas Obeng-Gyasi
- Department of Biological Sciences, Purdue University, West Lafayette, IN 47907, USA.
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Vun E, Turner S, Sareen J, Mota N, Afifi TO, El-Gabalawy R. Prevalence of comorbid chronic pain and mental health conditions in Canadian Armed Forces active personnel: analysis of a cross-sectional survey. CMAJ Open 2018; 6:E528-E536. [PMID: 30389752 PMCID: PMC6221807 DOI: 10.9778/cmajo.20180093] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chronic pain conditions and mental disorders have high prevalence rates in military populations. However, few investigations have examined the comorbidity between chronic pain conditions and specific mental disorders among Canadian active military personnel. METHODS We conducted a secondary analysis of data from the 2013 Canadian Forces Mental Health Survey (CFMHS) concerning the population of regular members. Diagnostic interviews assessed the presence of mental disorders, and participants self-reported chronic pain conditions (i.e., arthritis, back problems, musculoskeletal conditions, migraines) and indicators of pain severity. We used multiple logistic regressions to assess associations between chronic pain conditions and mental disorders. We used cross-tabulations to assess the prevalence of pain severity indicators in comorbid relationships compared with the chronic pain condition alone. We used moderation analyses to examine the interactions between pain condition by pain severity, and pain condition by activity limitation, respectively, on mental disorders. RESULTS The CFMHS included data from 6696 regular members and had a response rate of 79.8%. About one-quarter (n = 1761) of military personnel reported having chronic pain. In the fully adjusted model, all assessed pain conditions were significantly associated with posttraumatic stress disorder (PTSD) (odds ratio [OR] range 1.86-2.55), and several pain conditions were associated with major depressive episode, generalized anxiety disorder and panic disorder. Back problems were significantly associated with all mental disorders apart from alcohol use disorders (OR range 1.40-2.17). Cross-tabulations showed higher prevalence estimates of endorsement for pain severity indicators among pain conditions and comorbid mental disorders, compared with pain conditions alone. Formal moderation analyses showed a significant relationship between migraine and activity limitation on PTSD. INTERPRETATION Chronic pain conditions are prevalent and co-occur with mental disorders among Canadian regular force members. Greater understanding of these chronic pain conditions and mental disorders and their impact on people's abilities to adapt to both military and civilian life is needed.
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Affiliation(s)
- Everett Vun
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Sarah Turner
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Jitender Sareen
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Natalie Mota
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Tracie O Afifi
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man
| | - Renée El-Gabalawy
- Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.
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Lin J, Zhu K, Soliván-Ortiz AM, Larsen SL, Schneid TR, Shriver CD, Lee S. Deployment and Smokeless Tobacco Use Among Active Duty Service Members in the U.S. Military. Mil Med 2018; 184:e183-e190. [DOI: 10.1093/milmed/usy186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/15/2018] [Accepted: 07/12/2018] [Indexed: 01/29/2023] Open
Abstract
Abstract
Introduction
The prevalence of smokeless tobacco use among U.S. active duty service members has been much higher than in the U.S. general population. The association between deployment and smokeless tobacco use has not been well studied. We investigated the association between deployment and smokeless tobacco use among U.S. active duty service members. We also evaluated the modification effects from other factors related to smokeless tobacco use on the deployment-smokeless tobacco use association.
Materials and Methods
Eligible active duty service members stationed at two military installations (Fort Bragg, NC, USA and Lackland Air Force Base, TX, USA) were recruited from July 2015 to May 2016. Each participant completed a self-administered questionnaire. Multivariable logistic regression was used to assess the association between deployment and smokeless tobacco use and estimated odds ratio (OR) and 95% confidence interval (CI). Stratified analysis was performed to evaluate modification effects from other commonly known factors related to smokeless tobacco use in military, specifically, cigarette smoking status, use among family members (family history of use), perception of harm, and use among military peers.
Results
Out of 2,465 study participants who completed the questionnaire, 548 were smokeless tobacco users. Service members who had been deployed to a combat zone had 1.39 fold (95% CI = 1.03–1.87) increased odds of using smokeless tobacco than those who never deployed to a combat zone. The odds of smokeless tobacco use among those who had been deployed once, twice, three times and four or more times to a combat zone were 1.27 (95% CI = 0.91–1.78), 1.30 (95% CI = 0.85–1.99), 2.49 (95% CI = 1.45–4.28), and 2.88 (95% CI = 1.71–4.86), respectively, with a significant dose–response trend (p for trend <0.0001). Further, subjects who served in combat units during deployment exhibited more than two-fold increased odds of use as compared with those who had never been deployed (OR = 2.03, 95% CI = 1.41–2.93). In stratified analysis, the association between deployment and smokeless tobacco use was only present among subjects who never smoked cigarettes, those without family history of smokeless tobacco use, and those who had low perception of harm of use.
Conclusions
Military deployment was associated with smokeless tobacco use among active service members. However, the influence of military deployment on smokeless tobacco use was not equally strong on all service members. Subjects who never smoked cigarettes, who had no family history of use and who had low perception of harm were the most susceptible subgroups to deployment-related smokeless tobacco use. This study has implications to identify high-risk subgroups to reduce smokeless tobacco use in the U.S. military.
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Affiliation(s)
- Jie Lin
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Rockville, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Kangmin Zhu
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Rockville, MD
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Aida M Soliván-Ortiz
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, San Antonio, TX
| | - Stacy L Larsen
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, Fort Bragg, NC
| | - Thomas R Schneid
- Postgraduate Dental College, Uniformed Services University of the Health Sciences, Fort Sam Houston, TX
| | - Craig D Shriver
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Rockville, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Sukhyung Lee
- John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Rockville, MD
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
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Singaraju RC, Myers JN, Owczarzak JT, Gielen AC. Combat Readiness, Harm Aversion, and Promotion Eligibility: A Qualitative Study of U.S. Servicemembers Views on Tobacco Use and Control in the Military. Mil Med 2018; 184:e175-e182. [DOI: 10.1093/milmed/usy181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/25/2018] [Accepted: 06/29/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- Raj C Singaraju
- Walter Reed National Military Medical Center, 4494 North Palmer Road, Bethesda, MD
| | - Janet N Myers
- Kaiser Permanente Moanalua Medical Center, 3288 Moanalua Road, Honolulu, HI
| | - Jill T Owczarzak
- Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD
| | - Andrea C Gielen
- Johns Hopkins Bloomberg School of Public Health, 615N Wolfe St, Baltimore, MD
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Vest BM, Hoopsick RA, Homish DL, Daws RC, Homish GG. Childhood trauma, combat trauma, and substance use in National Guard and reserve soldiers. Subst Abus 2018; 39:452-460. [PMID: 29485365 DOI: 10.1080/08897077.2018.1443315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The goal of this work was to examine associations among childhood trauma, combat trauma, and substance use (alcohol problems, frequent heavy drinking [FHD], current cigarette smoking, and current/lifetime drug use) and the interaction effects of childhood trauma and combat exposure on those associations among National Guard/reserve soldiers. METHODS Participants (N = 248) completed an electronic survey asking questions about their military experiences, physical and mental health, and substance use. Childhood trauma and combat exposure were examined jointly in regression models, controlling for age, marital satisfaction, and number of deployments. RESULTS Childhood trauma was associated with current drug use (trend level, odds ratio [OR] = 1.44, 95% confidence interval [CI]: 0.97, 2.14; P = .072) in the main effect model; however, there was not a significant interaction with combat. Combat exposure had a significant interaction with childhood trauma on alcohol problems (b = -0.56, 95% CI: -1.12, -0.01; P = .048), FHD (b = -0.27, 95% CI: -0.47, -0.08; P = .007), and lifetime drug use (OR = 1.78, 95% CI: 1.04, 3.04; P = .035). There were no associations with either of the trauma measures and current cigarette smoking. CONCLUSIONS These results demonstrate that childhood and combat trauma have differential effects on alcohol use, such that combat trauma may not add to the effect on alcohol use in those with greater child maltreatment but may contribute to greater alcohol use among those with low child maltreatment. As expected, childhood and combat trauma had synergistic effects on lifetime drug use. Screening for multiple types of trauma prior to enlistment and/or deployment may help to identify at-risk individuals and allow time for early intervention to prevent future adverse outcomes.
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Affiliation(s)
- Bonnie M Vest
- a Department of Family Medicine , University at Buffalo , Buffalo , New York , USA
| | - Rachel A Hoopsick
- b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
| | - D Lynn Homish
- b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
| | - Rachel C Daws
- b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
| | - Gregory G Homish
- a Department of Family Medicine , University at Buffalo , Buffalo , New York , USA.,b Department of Community Health and Health Behavior , University at Buffalo , Buffalo , New York , USA
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de Granda-Orive JI, de Granda-Beltrán AM, López-Aguilar JC. Is there a need for specific smoking cessation programs for the military? Occup Med (Lond) 2018; 68:146. [DOI: 10.1093/occmed/kqy009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Donoho CJ, Bonanno GA, Porter B, Kearney L, Powell TM. A Decade of War: Prospective Trajectories of Posttraumatic Stress Disorder Symptoms Among Deployed US Military Personnel and the Influence of Combat Exposure. Am J Epidemiol 2017; 186:1310-1318. [PMID: 29036483 DOI: 10.1093/aje/kwx318] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 06/20/2017] [Indexed: 11/13/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) is a common psychiatric disorder among service members and veterans. The clinical course of PTSD varies between individuals, and patterns of symptom development have yet to be clearly delineated. Previous studies have been limited by convenience sampling, short follow-up periods, and the inability to account for combat-related trauma. To determine the trajectories of PTSD symptoms among deployed military personnel with and without combat exposure, we used data from a population-based representative sample of 8,178 US service members who participated in the Millennium Cohort Study from 2001 to 2011. Using latent growth mixture modeling, trajectories of PTSD symptoms were determined in the total sample, as well as in individuals with and without combat exposure, respectively. Overall, 4 trajectories of PTSD were characterized: resilient, pre-existing, new-onset, and moderate stable. Across all trajectories, combat-deployed service members diverged from non-combat-deployed service members, even after a single deployment. The former also generally had higher PTSD symptoms. Based on the models, nearly 90% of those without combat exposure remained resilient over the 10-year period, compared with 80% of those with combat exposure. Findings demonstrate that although the clinical course of PTSD symptoms shows heterogeneous patterns of development, combat exposure is uniformly associated with poor mental health.
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Affiliation(s)
- Carrie J Donoho
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - George A Bonanno
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, New York
| | - Ben Porter
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
| | - Lauren Kearney
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
| | - Teresa M Powell
- Deployment Health Research Department, Naval Health Research Center, San Diego, California
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Chin J, Lustik MB, Pflipsen M. Prevalence of Use and Perceptions of Electronic Smoking Devices in a US Army Infantry Division. Mil Med 2017; 183:e127-e133. [DOI: 10.1093/milmed/usx024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/26/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Joseph Chin
- Department of Family Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu HI 96815
| | - Michael B Lustik
- Department of Clinical Investigations, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu HI 96815
| | - Matthew Pflipsen
- Department of Family Medicine, Tripler Army Medical Center, 1 Jarrett White Road, Honolulu HI 96815
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Zarka S, Levine H, Rozhavski V, Sela T, Bar-Ze'ev Y, Molina-Hazan V, Rosen LJ. Smoking Behavior Change During Compulsory Military Service in Israel, 1987-2011. Nicotine Tob Res 2017; 19:1322-1329. [PMID: 28115500 DOI: 10.1093/ntr/ntw285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/20/2016] [Indexed: 11/13/2022]
Abstract
Introduction Smoking in military settings is of major concern. We aimed to assess the association between personal, family, and military factors and smoking behavior change during compulsory military service in Israel. Methods Participants were soldiers recruited between 1987 and 2008 who were interviewed at recruitment and reinterviewed at discharge (1987-2011) (total: 29 189; males:15 136; females:14 053). The primary outcome variables were smoking initiation during service among nonsmokers at recruitment, and cessation during service among smokers at recruitment. We examined potential predictors of change, and trends by calendar year. Results Smoking prevalence increased by 39.4% during military service (recruitment: 26.2%, discharge: 36.5%). 18.4% of nonsmoking recruits initiated smoking, and 12.4% of smoking recruits quit smoking between recruitment and discharge. There was no observed trend in initiation between 1987 and 2011. The strongest predictor of smoking initiation among nonsmokers at recruitment was smoking history (former vs. never-smoker, odds ratio (OR) [95% confidence interval [CI]]: males: 5.63 [4.63,6.85], females: 6.76 [5.27, 8.68]. Other variables had smaller effects on initiation. Females were less likely to initiate smoking than males (OR [CI]): 0.75 [0.69,0.81]. Both males and females with high military fitness levels were more likely to initiate smoking. Among women, those with lower education, with fathers with lower education, of lower socioeconomic status, and ever-users of contraceptives were more likely to initiate smoking. Cessation among males modestly increased over the years (OR [CI]): 1.03 [1.01,1.05]. Conclusions Smoking increased substantially during mandatory military service in Israel. Former smokers were at greatly increased risk of initiation and should be targeted for relapse prevention. Military service represents a golden opportunity for tobacco control. Implications Military tobacco control policy is an important contributor to longevity among service personnel, and population-wide mortality in countries with compulsory service. The increased smoking prevalence among military personnel, and increases in smoking during military service should act as a wake-up call to governments and health systems in countries lacking strong military tobacco control policies. The substantial progress in military tobacco control in the United States, which includes strong antitobacco policies for prevention of smoking initiation, aid to smokers to quit smoking, and protection of nonsmokers from tobacco smoke, should be emulated by others. Former smokers and others at high risk should be targeted for relapse prevention. The closed environment of military service provides a golden opportunity for tobacco control.
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Affiliation(s)
- Salman Zarka
- Preventive Medicine Branch, Medical Corps, Israel Defense Force, Israel.,Ziv Medical Center, Tzfat, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Tamar Sela
- Preventive Medicine Branch, Medical Corps, Israel Defense Force, Israel
| | - Yael Bar-Ze'ev
- Preventive Medicine Branch, Medical Corps, Israel Defense Force, Israel.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | | | - Laura J Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Calhoun PS, Wilson SM, Hertzberg JS, Kirby AC, McDonald SD, Dennis PA, Bastian LA, Dedert EA, Beckham JC. Validation of Veterans Affairs Electronic Medical Record Smoking Data Among Iraq- and Afghanistan-Era Veterans. J Gen Intern Med 2017; 32:1228-1234. [PMID: 28808856 PMCID: PMC5653558 DOI: 10.1007/s11606-017-4144-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/26/2017] [Accepted: 07/18/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Research using the Veterans Health Administration (VA) electronic medical records (EMR) has been limited by a lack of reliable smoking data. OBJECTIVE To evaluate the validity of using VA EMR "Health Factors" data to determine smoking status among veterans with recent military service. DESIGN Sensitivity, specificity, area under the receiver-operating curve (AUC), and kappa statistics were used to evaluate concordance between VA EMR smoking status and criterion smoking status. PARTICIPANTS Veterans (N = 2025) with service during the wars in Iraq/Afghanistan who participated in the VA Mid-Atlantic Post-Deployment Mental Health (PDMH) Study. MAIN MEASURES Criterion smoking status was based on self-report during a confidential study visit. VA EMR smoking status was measured by coding health factors data entries (populated during automated clinical reminders) in three ways: based on the most common health factor, the most recent health factor, and the health factor within 12 months of the criterion smoking status data collection date. KEY RESULTS Concordance with PDMH smoking status (current, former, never) was highest when determined by the most commonly observed VA EMR health factor (κ = 0.69) and was not significantly impacted by psychiatric status. Agreement was higher when smoking status was dichotomized: current vs. not current (κ = 0.73; sensitivity = 0.84; specificity = 0.91; AUC = 0.87); ever vs. never (κ = 0.75; sensitivity = 0.85; specificity = 0.90; AUC = 0.87). There were substantial missing Health Factors data when restricting analyses to a 12-month period from the criterion smoking status date. Current smokers had significantly more Health Factors entries compared to never or former smokers. CONCLUSIONS The use of computerized tobacco screening data to determine smoking status is valid and feasible. Results indicating that smokers have significantly more health factors entries than non-smokers suggest that caution is warranted when using the EMR to select cases for cohort studies as the risk for selection bias appears high.
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Affiliation(s)
- Patrick S Calhoun
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC, USA.
- Durham VA Medical Center, Durham, NC, USA.
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
- Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA.
| | - Sarah M Wilson
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey S Hertzberg
- Durham VA Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Angela C Kirby
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Scott D McDonald
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC, USA
- Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA
| | - Paul A Dennis
- Durham VA Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Eric A Dedert
- Durham VA Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Jean C Beckham
- VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center (MIRECC), Durham VA Medical Center, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
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Seelig AD, Rivera AC, Powell TM, Williams EC, Peterson AV, Littman AJ, Maynard C, Street AE, Bricker JB, Boyko EJ. Patterns of Smoking and Unhealthy Alcohol Use Following Sexual Trauma Among U.S. Service Members. J Trauma Stress 2017; 30:502-511. [PMID: 28906037 DOI: 10.1002/jts.22214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022]
Abstract
In the first known longitudinal study of the topic, we examined whether experiencing sexual assault or sexual harassment while in the military was associated with increased risk for subsequent unhealthy alcohol use and smoking among U.S. service members in the Millennium Cohort Study (2001-2012). Adjusted complementary log-log models were fit to estimate the relative risk of (a) smoking relapse among former smokers (men: n = 4,610; women: n = 1,453); (b) initiation of unhealthy alcohol use (problem drinking and/or drinking over recommended limits) among those with no known history of unhealthy alcohol use (men: n = 8,459; women: n = 4,816); and (c) relapse among those previously reporting unhealthy alcohol use (men: n = 3,487; women: n = 1,318). Men who reported experiencing sexual assault while in the military had sixfold higher risk for smoking relapse: relative risk (RR) = 6.62; 95% confidence interval (CI) [2.34, 18.73], than men who did not. Women who reported experiencing sexual assault while in the military had almost twice the risk for alcohol relapse: RR = 1.73; 95% CI [1.06, 2.83]. There were no other significant associations. These findings suggest that men and women may respond differently following sexual trauma, and support future concerted policy efforts by military leadership to prevent, detect, and intervene on sexual assault.
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Affiliation(s)
- Amber D Seelig
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Anna C Rivera
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Teresa M Powell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Emily C Williams
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Arthur V Peterson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Alyson J Littman
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Charles Maynard
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan B Bricker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
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Hussain Z, Sullivan R. Tobacco in post-conflict settings: the case of Iraq. Ecancermedicalscience 2017; 11:735. [PMID: 28596801 PMCID: PMC5440183 DOI: 10.3332/ecancer.2017.735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Indexed: 11/21/2022] Open
Abstract
Tobacco is the leading cause of preventable death in the world, claiming six million lives each year. Although smoking prevalence is decreasing in high-income countries, many low- and middle-income countries, particularly fragile and post-conflict nations such as Iraq, are still seeing prevalence rates rising. With the evidence of higher rates of nicotine dependence in conflict and post-conflict areas, the tobacco problem only becomes more difficult for Iraq, which finds itself involved in conflicts lasting years, if not decades. Terrorism and unstable governments, as well as Big Tobacco, create large roadblocks on the route to adequate tobacco control. However, some tobacco control efforts have been successful in other post-conflict settings, demonstrating that with good governance, many of these roadblocks can be overcome. This review explores the context of tobacco control strategies in Iraq, identifies problems/issues, and discusses possible resolutions using some examples from other post-conflict countries.
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Affiliation(s)
- Zainab Hussain
- King's Centre for Global Health, Conflict and Health Research Group, King's College London, London SE5 9RJ, UK
| | - Richard Sullivan
- King's College London, Conflict and Health Research Group, King's College London, London SE1 9RT, UK
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Konkolÿ Thege B, Horwood L, Slater L, Tan MC, Hodgins DC, Wild TC. Relationship between interpersonal trauma exposure and addictive behaviors: a systematic review. BMC Psychiatry 2017; 17:164. [PMID: 28472931 PMCID: PMC5418764 DOI: 10.1186/s12888-017-1323-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was to systematically summarize knowledge on the association between exposure to interpersonal trauma and addictive behaviors. Extant reviews on this association focused on a restricted range of substance-related addictions, and/or used a narrative instead of a systematic approach. METHODS Systematic searches of 8 databases yielded 29,841 studies, of which 3054 studies were included and subsequently classified in relation to study design (scoping review). A subset of observational studies (N = 181) prospectively investigating the relationship between exposure to interpersonal traumata and subsequent behavioral or substance-related addiction problems were characterized. Heterogeneity in study methodologies and types of addictive behaviors and traumatic experiences assessed precluded meta-analysis. Instead, the proportions of associations tested in this literature that revealed positive, negative, or null relationships between trauma exposure and subsequent addictive behaviors were recorded, along with other methodological features. RESULTS Of 3054 included studies, 70.7% (n = 2160) used a cross-sectional design. In the 181 prospective observational studies (407,041 participants, 98.8% recruited from developed countries), 35.1% of the tested associations between trauma exposure and later addictive behaviors was positive, 1.3% was negative, and 63.6% was non-significant. These results were primarily obtained among non-treatment seeking samples (80.7% of studies; n = 146), using single and multi-item measures of addictive behaviors of unknown psychometric quality (46.4% of studies). Positive associations were more frequently observed in studies examining childhood versus adult traumatization (39.7% vs. 29.7%). CONCLUSIONS Longitudinal research in this area emphasizes alcohol abuse, and almost no research has examined behavioral addictions. Results provide some support for a positive association between exposure to interpersonal trauma and subsequent addictive behaviors but this relationship was not consistently reported. Longitudinal studies typically assessed trauma exposure retrospectively, often after addictive behavior onset, thus precluding robust inferences about whether traumatization affects initial onset of addictive behaviors.
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Affiliation(s)
- Barna Konkolÿ Thege
- Department of Psychology, University of Calgary, 2500 University Drive, Calgary, T2N 1N4 Canada
- Research and Academics Division, Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, ON L9M 1G3 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, M5T 1R8 Canada
| | - Lewis Horwood
- Department of Psychology, University of Calgary, 2500 University Drive, Calgary, T2N 1N4 Canada
| | - Linda Slater
- John W. Scott Health Sciences Library, University of Alberta, 2K312 WMC University of Alberta, Edmonton, T6G 2R7 Canada
| | - Maria C. Tan
- Knowledge Resource Service - Abdul Khaliq Library, Alberta Health Services Cross Cancer Institute, 11560 University Avenue, Edmonton, T6G 1Z2 Canada
| | - David C. Hodgins
- Department of Psychology, University of Calgary, 2500 University Drive, Calgary, T2N 1N4 Canada
| | - T. Cameron Wild
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-97 Avenue, Edmonton, T6G 1C9 Canada
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Ippolito AC, Seelig AD, Powell TM, Conlin AMS, Crum-Cianflone NF, Lemus H, Sevick CJ, LeardMann CA. Risk Factors Associated with Miscarriage and Impaired Fecundity among United States Servicewomen during the Recent Conflicts in Iraq and Afghanistan. Womens Health Issues 2017; 27:356-365. [DOI: 10.1016/j.whi.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 12/19/2016] [Accepted: 12/21/2016] [Indexed: 02/05/2023]
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London AS, Herd P, Miech RA, Wilmoth JM. The Influence of Men's Military Service on Smoking Across the Life Course. JOURNAL OF DRUG ISSUES 2016; 47:562-586. [PMID: 31467452 DOI: 10.1177/0022042616678617] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The military is described as a social context that contributes to the (re-)initiation or intensification of cigarette smoking. We draw on data from the 1985-2014 National Survey of Drug Use and Health (NSDUH) and the Wisconsin Longitudinal Study (WLS) to conduct complementary sub-studies of the influence of military service on men's smoking outcomes across the life course. Descriptive findings from an age-period-cohort analysis of NSDUH data document higher probabilities of current smoking and heavy smoking among veteran men across a broad range of cohorts and at all observed ages. Findings from sibling fixed-effects Poisson models estimated on the WLS data document longer durations of smoking among men who served in the military and no evidence that selection explains the observed relationship. Together, these results provide novel and potentially generalizable evidence that participation in the military in early adulthood exerts a causal influence on smoking across the life course.
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Affiliation(s)
| | - Pamela Herd
- University of Wisconsin-Madison, Madison, WI, USA
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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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Korinek K, Loebach P, Trinh HN. Military service and smoking in a cohort of northern Vietnamese older adults. Int J Public Health 2016; 62:43-51. [PMID: 27321700 DOI: 10.1007/s00038-016-0841-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/06/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Wide-ranging scholarship demonstrates war's impacts on US veterans' health. We ask whether, among Vietnamese men of a certain age, wartime experiences contributed to initiating smoking, and thus shaped one behavioral pathway linking war exposure and older adult health. METHODS We analyze the Vietnam Health and Aging Pilot Study (VHAPS), a survey of adults ages 55 and older (N = 405) conducted in one commune of northern Vietnam. We implement Cox discrete-time proportional hazards models to discern the effects of military service upon the initiation of smoking. RESULTS Military service results in a heightened risk of initiating smoking within this cohort (HR 2.13, [CI 1.36, 3.35]). Smoking initiation is also significantly gendered and age graded. Socioeconomic position and social capital variables in the models are statistically insignificant. CONCLUSIONS This study finds that, among older northern Vietnamese men whose early adulthood coincided with mass mobilization in the Vietnam War, involvement in formal military service significantly increased the risk of initiating smoking. Military-induced smoking emerges where tobacco products were not provided by the military institution, but where social availability of tobacco was widespread.
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Affiliation(s)
- Kim Korinek
- Department of Sociology, University of Utah, 380 S. 1530 E., Room 301, Salt Lake City, UT, 84112, USA.
| | - Peter Loebach
- Department of Sociology and Anthropology, Weber State University, Social Science Building, Room 114, Ogden, UT, USA
| | - Ha Ngoc Trinh
- Department of Sociology, University of Utah, 380 S. 1530 E., Room 301, Salt Lake City, UT, 84112, USA
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Bergman BP, Mackay DF, Morrison D, Pell JP. Smoking-related cancer in military veterans: retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans. BMC Cancer 2016; 16:311. [PMID: 27178424 PMCID: PMC4868009 DOI: 10.1186/s12885-016-2347-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 05/11/2016] [Indexed: 11/15/2022] Open
Abstract
Background Serving military personnel are more likely to smoke, and to smoke more heavily, than civilians. The aim of our study was to examine whether veterans have an increased risk of a range of smoking-related cancers compared with non-veterans, using a large, national cohort of veterans. Methods We conducted a retrospective cohort study of 57,000 veterans resident in Scotland and 173,000 age, sex and area of residence matched civilians. We used Cox proportional hazard models to compare the risk of any cancer, lung cancer and other smoking-related cancers overall, by sex and by birth cohort, adjusting for the potential confounding effect of socioeconomic deprivation. Results Over a mean of 29 years follow-up, 445 (0.79 %) veterans developed lung cancer compared with 1106 (0.64 %) non-veterans (adjusted hazard ratio 1.16, 95 % confidence intervals 1.04–1.30, p = 0.008). Other smoking-related cancers occurred in 737 (1.31 %) veterans compared with 1883 (1.09 %) non-veterans (adjusted hazard ratio 1.18, 95 % confidence intervals 1.08–1.29, p < 0.001). A significantly increased risk was observed among veterans born 1950–1954 for lung cancer and 1945–1954 for other smoking-related cancers. The risk of lung cancer was decreased among veterans born 1960 onwards. In comparison, there was no difference in the risk of any cancer overall (adjusted hazard ratio 0.98, 95 % confidence intervals 0.94–1.01, p = 0.171), whilst younger veterans were at reduced risk of any cancer (adjusted hazard ratio 0.88, 95 % confidence intervals 0.81–0.97, p = 0.006). Conclusions Military veterans living in Scotland who were born before 1955 are at increased risk of smoking-related cancer compared with non-veterans, but younger veterans are not. The differences may reflect changing patterns of smoking behaviour over time in military personnel which may, in turn, be linked to developments in military health promotion policy and a changing military operational environment, as well as to wider societal factors.
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Affiliation(s)
- Beverly P Bergman
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK.
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - David Morrison
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
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Piccirillo AL, Packnett ER, Cowan DN, Boivin MR. Epidemiology of asthma-related disability in the U.S. Armed Forces: 2007-2012. J Asthma 2016; 53:668-78. [PMID: 27050635 DOI: 10.3109/02770903.2016.1154070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To characterize the demographic, disability and deployment characteristics of U.S. Armed Forces personnel with an asthma-related disability discharge, which includes separation (without benefits) and retirement (with disability benefits). METHODS Incidence rates for personnel evaluated for disability discharge and/or disability retired due to asthma and due to all other causes of disability discharge were calculated per 100,000 active duty enlisted service members by year. Multivariate logistical regression was used to examine the associations between disability retirement and several demographic and disability characteristics of service members evaluated for asthma-related disability discharge versus those evaluated for any other non-respiratory condition for each branch of military service. RESULTS Service members evaluated for disability discharge related to asthma most often do not have comorbidity and are disability retired rather than separated, with rates of disability retirement increasing over time. Groups with a significantly higher incidence of evaluation for asthma-related disability include females, individuals who entered the military prior to the age of 20, non-Whites, and those with a history of deployment to Iraq or Afghanistan. The characteristic most associated with the odds of disability retirement was a history of deployment. CONCLUSIONS New-onset asthma occurring after military entry often causes occupational impairment in service members, especially in those that have been deployed to Iraq or Afghanistan.
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Affiliation(s)
- Amanda L Piccirillo
- a Preventive Medicine Branch, Department of Epidemiology , Walter Reed Army Institute of Research , Silver Spring , MD , USA .,b ManTech Health, ManTech International Corporation , Herndon , VA , USA
| | - Elizabeth R Packnett
- a Preventive Medicine Branch, Department of Epidemiology , Walter Reed Army Institute of Research , Silver Spring , MD , USA .,b ManTech Health, ManTech International Corporation , Herndon , VA , USA
| | - David N Cowan
- a Preventive Medicine Branch, Department of Epidemiology , Walter Reed Army Institute of Research , Silver Spring , MD , USA .,b ManTech Health, ManTech International Corporation , Herndon , VA , USA
| | - Michael R Boivin
- a Preventive Medicine Branch, Department of Epidemiology , Walter Reed Army Institute of Research , Silver Spring , MD , USA
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