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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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Aycock CA, Wang XQ, Williams JB, Fahey MC, Talcott GW, Klesges RC, Little MA. Motives for using electronic nicotine delivery systems (ENDS) as a cessation tool are associated with tobacco abstinence at 1-year follow-up: A prospective investigation among young adults in the United States Air Force. Prev Med Rep 2023; 35:102399. [PMID: 37712011 PMCID: PMC10498292 DOI: 10.1016/j.pmedr.2023.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Smokers use electronic nicotine delivery systems (ENDS), including e-cigarettes, as a harm reduction strategy even though the Food and Drug Administration (FDA) has not approved them for tobacco cessation. The limited literature about ENDS use for cigarette cessation is concerning for the U.S. military, which is largely comprised of young adults at increased risk for tobacco use. Thus, the current study aims to evaluate use of ENDS products as a cessation tool in relation to point-prevalence tobacco abstinence at one-year follow-up in a cohort of 8,901 U.S. Air Force personnel attending entry-level job training from March 2016 to April 2019. Methods A propensity-score adjusted multinomial logistic regression model was used to assess the association between the baseline motives for ENDS use (i.e., for cigarette cessation versus alternative reasons) and tobacco use at the one-year follow-up (cigarette use, non-cigarette tobacco product use, and tobacco abstinence) among those reporting history of cigarette use at baseline. Results Smokers reporting ENDS use for cigarette cessation were more likely to be abstinent at one-year follow-up (Odds Ratio[OR] = 1.62, 95% CI: 1.06-2.49, P =.03) as well as quit using non-cigarette tobacco products (OR = 2.11, 95% CI: 1.65-2.70, P <.001) than those reporting ENDS use for alternative reasons. Conclusions Current tobacco users are recommended to use FDA-approved products for smoking cessation, such as nicotine replacement therapy. However, given the high prevalence of cigarette use among military populations, ENDS may provide a useful alternative harm reduction strategy for this high-risk population.
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Affiliation(s)
- Chase A. Aycock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| | - Xin-Qun Wang
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| | - Juinell B. Williams
- Department of Psychology, East Carolina University, Greenville, NC 27858, United States
| | - Margaret C. Fahey
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States
| | - G. Wayne Talcott
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
- UVA Comprehensive Cancer Center, 1240 Lee St., Charlottesville, VA 22903, United States
| | - Robert C. Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
- UVA Comprehensive Cancer Center, 1240 Lee St., Charlottesville, VA 22903, United States
| | - Melissa A. Little
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
- UVA Comprehensive Cancer Center, 1240 Lee St., Charlottesville, VA 22903, United States
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Fahey MC, Talcott WG, Robinson LA, Mallawaarachchi I, Klesges RC, Little MA. Predictors of Cessation Outcomes Among Older Adult Smokers Enrolled in a Proactive Tobacco Quitline Intervention. J Aging Health 2022; 34:1144-1155. [PMID: 35506995 DOI: 10.1177/08982643221097679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify predictors of older adults' likelihood of quitting following engagement in a proactive tobacco quit line. METHODS Older (>60 years) participants (N = 186) enrolled in a four-session quit line with 8-weeks of nicotine replacement therapy reported demographics, beliefs, and information about tobacco use. Point prevalence abstinence was reported at 3 and 12-months. RESULTS In final models, endorsement of quitting to take control of one's life and confidence in quitting were positively associated with 3-month cessation (OR = 1.74, 95% CI = 1.16, 2.62; OR = 1.75, 95% CI = 1.21, 2.52, respectively). At 12 months, stronger endorsement of quitting to take control of one's life and decreased nicotine dependence were associated with higher cessation (OR = 1.51, 95% CI = 1.05, 2.17; OR = 0.84, 95% CI = 0.71,0.99, respectively). DISCUSSION For tobacco cessation among older adults, programs should provide additional support to those with higher nicotine dependence, promote quitting self-efficacy, and encourage quitting as means to gain control of life and health.
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Affiliation(s)
- Margaret C Fahey
- 5415Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Wayne G Talcott
- Department of Public Health Sciences, 2358University of Virginia, Charlottesville, VA, USA
- 438578Joint Base San Antonio-Lackland, San Antonio, TX, USA
| | - Leslie A Robinson
- 5415Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, 2358University of Virginia, Charlottesville, VA, USA
| | - Robert C Klesges
- Department of Public Health Sciences, 2358University of Virginia, Charlottesville, VA, USA
- 438578Joint Base San Antonio-Lackland, San Antonio, TX, USA
| | - Melissa A Little
- Department of Public Health Sciences, 2358University of Virginia, Charlottesville, VA, USA
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Little MA, Wang XQ, Fahey MC, Wiseman KP, Pebley K, Klesges RC, Talcott GW. Efficacy of a group-based brief tobacco intervention among young adults aged 18-20 years in the US Air Force. Tob Induc Dis 2021; 19:95. [PMID: 34963775 PMCID: PMC8653010 DOI: 10.18332/tid/143282] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Most smokers begin using tobacco before the age of 25 years, making it important to reduce tobacco use during adolescence and early adulthood. Rates of use are historically higher among military personnel. While 'Tobacco 21' made it illegal for US retailers to sell tobacco to those aged <21 years, the policy did not address cessation for current youth and young adult tobacco users. Additionally, there is limited research on cessation interventions among young adults under 21 years. The current study evaluated the efficacy of a group-based Brief Tobacco Intervention (BTI) among US Air Force trainees, who are predominantly aged 18-20 years and directly impacted by Tobacco 21 legislation. METHODS Participants were 2969 US Air Force Trainees from April 2017 through January 2018 cluster randomized to three conditions: 1) BTI + Airman's Guide to Remaining Tobacco Free (AG), 2) AG alone, and 3) the National Cancer Institute's Clearing the Air (CTA) pamphlet. To assess the efficacy of the interventions among people aged 18-20 years, a domain analysis (<21 years, n=2117; and ≥21 years, n=852) of a multinomial logistic regression model was run. RESULTS Mono tobacco users aged <21 years at baseline who received the BTI+AG had higher odds of quitting tobacco at 3 months (OR=2.13; 95% CI: 1.02-4.46). Dual and poly users aged <21 years at baseline who received the BTI+AG intervention had higher odds of reducing the number of tobacco products used at 3 months (OR=2.94; 95% CI: 1.03-8.37). CONCLUSIONS The BTI was effective for people aged 18-20 years. The current study offers insight into components of interventions that might be successful in helping this age group decrease tobacco use.
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Affiliation(s)
- Melissa A. Little
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Xin-Qun Wang
- School of Medicine, University of Virginia, Charlottesville, United States
| | - Margaret C. Fahey
- Department of Psychology, University of Memphis, Memphis, United States
| | - Kara P. Wiseman
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Kinsey Pebley
- Department of Psychology, University of Memphis, Memphis, United States
| | - Robert C. Klesges
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Gerald W. Talcott
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
- Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Lackland, United States
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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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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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Williams MA, Reddy G, Quinn MJ, Millikan Bell A. Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army. Drug Chem Toxicol 2021; 45:2049-2085. [PMID: 33906535 DOI: 10.1080/01480545.2021.1905657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.
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Affiliation(s)
- Marc A Williams
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Gunda Reddy
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Michael J Quinn
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Amy Millikan Bell
- Office of the Director - Medical Advisor, U.S. Army Public Health Center, Aberdeen Proving Ground, USA
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Ross CP, Lin J, Hefner K, Waters AJ. Use of electronic cigarettes in the United States service member and Veteran populations: A narrative review (2019). MILITARY PSYCHOLOGY 2021. [DOI: 10.1080/08995605.2021.1897493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Charles P. Ross
- Department of Medical and Clinical Psychology, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland
| | - Jie Lin
- Murtha Cancer Center Research Program, USU Walter Reed Surgery, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland
| | - Kathryn Hefner
- National Institute on Drug Abuse (NIDA) Data and Statistics Center, The Emmes Company, Rockville, Maryland
| | - Andrew J. Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of Health Sciences (USUHS), Bethesda, Maryland
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Godby S, Dierst-Davies R, Kogut D, Degiorgi Winslow L, Truslow MM, Tuttle J, Koeppl P, Marshall-Aiyelawo K, Elenberg K. Correlates of e-cigarette use among active duty US military personnel: implications for cessation policy. BMJ Mil Health 2021; 169:197-204. [PMID: 33664088 DOI: 10.1136/bmjmilitary-2020-001700] [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: 10/26/2020] [Revised: 01/13/2021] [Accepted: 01/21/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Electronic cigarette (or e-cigarette) use has grown substantially since its US market introduction in 2007. Although marketed as a safer alternative to traditional cigarettes, studies have shown they can also be a gateway to their use. The purpose of this investigation is to identify factors associated with different patterns of tobacco use among active duty military personnel. METHODS A secondary analysis was conducted using the 2014 Defense Health Agency Health Related Behaviors survey data. Results are based on 45 986 US military respondents, weighted to 1 251 606. Both univariate and regression analyses were conducted to identify correlates. RESULTS In 2014, approximately 7.8% of respondents reported using e-cigarettes at least once in the past year. Among e-cigarette users, 49% reported exclusive e-cigarette use. Prevalence of exclusive use is highest among white people (58%), Navy (33%), men (83%) and persons with income ≤$45 000 (65%). Regression comparing exclusive cigarette with exclusive e-cigarette users revealed higher odds of being Air Force (OR=2.19; CI 1.18 to 4.06) or Navy (OR=2.25; CI 1.14 to 4.41) personnel and being male (OR=1.72; CI 1.12 to 2.64), and more likely to not receive smoking cessation messaging from healthcare providers in the last 12 months (OR=2.88; CI 1.80 to 4.62). When comparing exclusive e-cigarette users with poly-tobacco users, e-cigarette users had higher odds of being Hispanic (OR=2.20; CI 1.02 to 4.78), college educated (OR=4.25; CI 1.22 to 14.84) and not receiving tobacco prevention/cessation messaging (OR=4.80; CI 2.79 to 8.27). CONCLUSION The results demonstrate that exclusive e-cigarette users in the military have unique characteristics when compared with groups of other/mixed tobacco users. Findings can inform cessation and prevention efforts to improve both the overall health and combat readiness of active duty military personnel.
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Affiliation(s)
- Sarah Godby
- Deloitte Consulting LLP, Arlington, Virginia, USA
| | | | - D Kogut
- Deloitte Consulting LLP, Arlington, Virginia, USA
| | | | - M M Truslow
- Deloitte Consulting LLP, Arlington, Virginia, USA
| | - J Tuttle
- Deloitte Consulting LLP, Arlington, Virginia, USA
| | - P Koeppl
- Deloitte Consulting LLP, Arlington, Virginia, USA
| | - K Marshall-Aiyelawo
- Analytics and Evaluation Division (J-5), Defense Health Agency, Falls Church, Virginia, USA
| | - K Elenberg
- Office of the Under Secretary for Personnel and Readiness, US Department of Defense, Washington, DC, USA
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Little MA, Fahey MC, Wang XQ, Talcott GW, McMurry T, Klesges RC. Trends in Tobacco Use among Young Adults Presenting for Military Service in the United States Air Force between 2013 and 2018. Subst Use Misuse 2021; 56:370-376. [PMID: 33435813 PMCID: PMC8575074 DOI: 10.1080/10826084.2020.1868517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: The US military has historically higher tobacco use compared to civilians, and tobacco use increases following enlistment. While the military is vulnerable to tobacco use, current surveillance of tobacco among this high-risk population is lacking. Methods: Recently enlisted Airmen (N = 43,597) between 2013 and 2018 were asked about tobacco use prior to enlistment across ten products: (1) cigarettes/roll your own tobacco, (2) smokeless tobacco/snus, (3) cigars, cigarillos/little cigars, (4) hookah/pipe, and (5) e-cigarettes. Results: Hookah/pipe use, cigarettes/roll your own, smokeless tobacco/snus, and cigars/little cigars/cigarillos use decreased significantly between 2013 and 2018, while the prevalence of e-cigarette use increased (p's < 0.0001). The relationships between the time and each tobacco product(s) use outcomes were influenced differently by different age, race, education and marital status. Conclusion: While e-cigarette use has increased in the civilian sector, the use of e-cigarettes among new recruits increased much more drastically (i.e. prevalence 15.3% in 2018). Further, demographic characteristics influenced tobacco trends; specifically, recruits of racial minorities increased their use of e-cigarettes over the past five years faster than Whites. Of concern is what impact this dramatic increase in e-cigarette use will have on overall health and later initiation of combustible tobacco products in the military.
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Affiliation(s)
- Melissa A Little
- Center for Addiction Prevention Research, University of Virginia, Charlottesville, Virginia, USA.,Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA.,Joint Base San Antonio-Lackland, San Antonio, Texas, USA
| | - Margaret C Fahey
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Xin-Qun Wang
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - G Wayne Talcott
- Center for Addiction Prevention Research, University of Virginia, Charlottesville, Virginia, USA.,Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA.,Joint Base San Antonio-Lackland, San Antonio, Texas, USA
| | - Timothy McMurry
- Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Robert C Klesges
- Center for Addiction Prevention Research, University of Virginia, Charlottesville, Virginia, USA.,Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia, USA
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Fahey MC, Little MA, Klesges RC, Talcott GW, Richey PA, Mehmet K, Krukowski RA. Use of Tobacco for Weight Control across Products among Young Adults in the U.S. Military. Subst Use Misuse 2020; 56:153-161. [PMID: 33183122 PMCID: PMC8058943 DOI: 10.1080/10826084.2020.1846196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Approximately 17% of young adults currently use tobacco, most commonly cigarettes and/or electronic cigarettes (e-cigarettes), followed by other products (i.e., cigarillos, pipe/hookah, smokeless tobacco). Cigarettes have been historically used to control weight. Little is known about use of non-cigarette products for weight control, particularly among non-college young adults. Tobacco use in the military is higher than civilians, and personnel have increased motivation for weight control due to military fitness standards. This population might be vulnerable to use tobacco for this purpose. Purpose: Exploring prevalence, as well as demographic and behavioral correlates, of using tobacco products for weight control, among a large, diverse sample of military young adults. Methods: U.S. Air Force recruits (N = 24,543) completed a questionnaire about tobacco use. Among users of tobacco products, recruits reported if they had ever used that product to maintain their weight. Results: Smokeless tobacco was most commonly used for weight control (12.2%), followed by cigarettes (7.3%), e-cigarettes (5.5%), cigarillos (3.3%), and hookah/pipe (3.2%). Using tobacco for weight control was associated with fewer harm beliefs and more regular use of that product. Among e-cigarette users, having a higher BMI and a lower educational background was associated with ever using this product for weight control. Conclusions: The belief that a tobacco product helps control one's weight might increase the prevalence, and frequency of use, of that product among military young adults. Tobacco cessation programs should assess for this motivation of use and provide education about tobacco harm and alternative strategies for weight maintenance.
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Affiliation(s)
- M C Fahey
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - M A Little
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - R C Klesges
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - G W Talcott
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - P A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - K Mehmet
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - R A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Jude J, Hiller H, Miller J. Melon with a Twist: A Case of Nicotine Overdose After Ingestion and Aspiration of Vape Liquid. Mil Med 2020; 186:246-249. [PMID: 33038243 DOI: 10.1093/milmed/usaa331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/16/2020] [Accepted: 08/21/2020] [Indexed: 11/13/2022] Open
Abstract
We present the case of an active duty 21-year-old male with severe hypoxic respiratory failure after accidentally ingesting, and subsequently aspirating, vaping liquid while intoxicated. Because of the increasing prevalence of vaping devices, this case highlights a unique risk of vape liquids with concentrated nicotine levels and appetizing labels and aromas. Vaping-associated pulmonary injury has been previously described in multiple publications, but unlike those patients with pathology after inhaling vaping products, our patient ingested and subsequently aspirated the highly nicotinic substance. Most vape liquid products have enough nicotine to result in significant toxicity, which most concerningly can lead to nicotine-induced respiratory failure. This patient's hypoxia appeared to be multifactorial as a result of both nicotine toxicity and aspiration, but ultimately treatment of both focused on supportive measures.In addition to understanding nicotine toxicity, this patient's hypoxia secondary to agitation and aspiration requiring emergent airway management illustrates the importance of understanding the technique of Delayed Sequence Intubation and its proper application in the critical airway algorithm. By treating preoxygenation as a procedure, the patient received adequate oxygenation resulting in successful intubation without harmful desaturation during the procedure.Given the prevalence of tobacco use in the military as well as the increasing popularity of vaping devices, future military providers have a responsibility to their patients to be prepared for similar case presentations. Fortunately, this case demonstrates that when managed properly, otherwise healthy patients without comorbidities often recover without significant long-term sequelae.
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Affiliation(s)
- Joseph Jude
- Carl R. Darnall Army Medical Center Emergency Medicine Residency, Fort Hood, TX 76544, USA
| | - Hugh Hiller
- Carl R. Darnall Army Medical Center Emergency Medicine Residency, Fort Hood, TX 76544, USA
| | - Joel Miller
- Carl R. Darnall Army Medical Center Emergency Medicine Residency, Fort Hood, TX 76544, USA.,San Antonio, TX 78209, USA
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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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Fahey MC, Talcott GW, McMurry TL, Klesges RC, Tubman D, Krukowski RA, Little MA. When, How, & Where Tobacco Initiation and Relapse Occur During U.S. Air Force Technical Training. Mil Med 2020; 185:e609-e615. [PMID: 32060547 PMCID: PMC7282443 DOI: 10.1093/milmed/usaa016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/09/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Military personnel are at high risk for tobacco use, particularly during the first year of military service. Technical Training follows an 8½ week tobacco ban during basic military training and is a vulnerable time for personnel to both reinitiate and initiate tobacco use. Thus, this can be a crucial time to promote tobacco policies and interventions. However, there is limited research examining when, how, and where personnel access tobacco during the first year of service, particularly among users of newer products (eg, electronic cigarettes[e-cigarettes]). Thus, the purpose of the current study is to explore the timing, source, and location of tobacco use during Technical Training across all types of products. Furthermore, this study will examine differences in demographic characteristics and prior tobacco history in relationship to these tobacco behaviors. MATERIALS AND METHODS Participants were U.S. Air Force recruits completing Technical Training (2017-2018). Protocol was approved by the Institutional Review Board at the 59th Medical Wing of the U.S. Air Force. During the first week of Technical Training, Airmen were consented to participate in the study and completed a questionnaire about demographics and tobacco use history. Next, Airmen were randomized to receive one of three tobacco prevention interventions as part of military training. At a 3-month follow-up, during the last week of Technical Training, consented participants completed a questionnaire about current tobacco use. Airmen reported when (ie, first month vs. after), how (ie, "bummed" from another airman, bought on or off base, received from the internet or event), and where (ie, designated smoking areas on base, off base, bar or club, friend's house, cigar lounge, hookah bar, or vape shop) they used tobacco during Technical Training. Descriptive statistics were used to examine these behaviors across all tobacco products. Additionally, Wilcoxon-Mann-Whitney and Kruskal-Wallis tests compared differences in demographic characteristics and baseline tobacco use in relationship to these tobacco behaviors. RESULTS No significant differences were found when comparing prior users and first-time users in relationship to tobacco behaviors during Technical Training; however, significant differences in educational background and age were found in regard to the source and location of tobacco use. Additionally, how and where Airmen first used tobacco during Technical Training differed across products. Cigarettes and smokeless tobacco were equally likely to be bought on or off base and most commonly first used at a designated smoking area on base. However, e-cigarettes, cigarillos/little cigars, and hookah were more likely to be bought off base, and first used at a specialty store (ie, vape shop, hookah bar, or cigar lounge). CONCLUSIONS Tobacco use behaviors during Technical Training differed depending on the type of product. Specifically, new and emerging products were more likely to be bought off base and first used at a specialty store. Thus, military polices regulating on base tobacco pricing might not reduce the growing prevalence of e-cigarettes. Future policies might consider addressing the density of off-base tobacco retailers to reduce the high rates of tobacco use in this population.
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Affiliation(s)
| | - G Wayne Talcott
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio- Lackland AFB; 1100 Wilford Hall Loop, Bldg 4430; JBSA-Lackland, TX 78236-9908, USA
| | - Timothy L McMurry
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
| | - Robert C Klesges
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
| | - David Tubman
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
| | - Rebecca A Krukowski
- University of Tennessee Health Science Center, Department of Preventive Medicine; 66 N Pauline Street Memphis, TN 38163, USA
| | - Melissa A Little
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio- Lackland AFB; 1100 Wilford Hall Loop, Bldg 4430; JBSA-Lackland, TX 78236-9908, USA
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Affiliation(s)
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - G Wayne Talcott
- School of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Melissa A Little
- School of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Little M, Ebbert JO, Krukowski RA, Halbert J, Kalpinski MR, Patten CA, Talcott GW, Klesges RC. Factors Associated with Cigarette Use During Airmen's First Year of Service in the United States Air Force. Mil Med 2020; 185:e212-e220. [PMID: 31287888 DOI: 10.1093/milmed/usz155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/18/2019] [Accepted: 06/07/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Despite declines of cigarette use in the civilian population, military personnel report alarmingly high rates of cigarette use. Enlisted Air Force recruits are required to remain tobacco-free for the first 12 weeks of training, and the majority express confidence they will not use tobacco after the ban; however, most previous smokers return to smoking and many nonsmokers initiate. Understanding the factors associated with cigarette-smoking initiation among non-users and re-initiation among former users is critical for the development of successful tobacco control efforts. MATERIALS AND METHODS The current study examines predictors of cigarette smoking among a sample of 2,188 USAF personnel after their first year of service. Logistic regression analyses examined associations between baseline predictors and initiation and re-initiation of cigarette smoking at a one-year follow-up. RESULTS Compared to never smokers at both time points, the strongest predictor of smoking initiation over the past 12 months was having owned cigarette-branded merchandise (OR 3.81, 95% CI 1.67, 8.71). Compared to former smokers who remained abstinent, the strongest predictor of re-initiation was intention to use tobacco (OR 2.08, 95% CI 1.53, 2.83). Compared to individuals who initiate, the strongest predictors of re-initiation were prior use of other tobacco products and tobacco use intentions (ORs range 1.85 to 4.63). CONCLUSIONS Multiple risk factors are associated with tobacco use. Given that Airmen are tobacco-free for the first 12 weeks of training, tobacco interventions during this period might be more effective. Our findings can be used to tailor interventions to prevent tobacco use in the U.S. military.
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Affiliation(s)
- Melissa Little
- Center for Addiction and Prevention Research, University of Virginia Medical School, 59 MDW/ 59 SGOWMP, 1100 Wilford Hall Loop, Bldg 4554, Joint Base Lackland AFB, TX 78236
| | - Jon O Ebbert
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Rebecca A Krukowski
- University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163-2181
| | - Jennifer Halbert
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 560 Ray C. Hunt Drive, PO Box 800717, Charlottesville, VA 22908
| | | | | | - Gerald W Talcott
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 2200 Bergquist Dr Ste 1, Joint Base Lackland AFB, TX 78236
| | - Robert C Klesges
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 560 Ray C. Hunt Drive, PO Box 800717, Charlottesville, VA 22908
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Dorey A, Scheerlinck P, Nguyen H, Albertson T. Acute and Chronic Carbon Monoxide Toxicity from Tobacco Smoking. Mil Med 2019; 185:e61-e67. [DOI: 10.1093/milmed/usz280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/18/2019] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT
Introduction: Carbon monoxide (CO) is produced from incomplete combustion of hydrocarbons and is a by-product of tobacco smoking. Chronic cigarette smokers often have carboxyhemoglobin (COHb) concentrations as high as 10%. We report a case of severely elevated COHb and polycythemia because of tobacco smoking and provide a review of the literature regarding elevated COHb in smokers. Materials and Methods: A comprehensive search of PubMed and Google Scholar was performed looking for articles on tobacco smoking and CO, COHb, CO poisoning, cigarettes, pipes, cigars and water pipes/hookah smokers. Result: COHb levels in frequent cigarette smokers generally range from 4.2% presmoking to 8.6% postsmoking. A heavy cigarette smoker presented twice with symptoms of CO toxicity and was found to have levels 21.8 to 24.2%. Cigar smokers have been found to have COHb ranging as high as 13.0 to 38.6% in case reports. Waterpipe or “hookah” smokers generally have COHb levels 10.1% +/−2.5% and case reports, and series of even higher levels associated with CO toxicity symptoms are common. Waterpipe smokers have been found to have COHb levels as high as 39.2% after smoking. Conclusions: Many active duty military and military veterans are tobacco smokers and these patients and their health care providers should be aware of the adverse effects of CO toxicity from tobacco smoking. Patients may have symptoms such as headaches, syncope, and ataxia in the setting of acute CO toxicity; however, the chronic effects of CO may not be completely understood. Future work could explore chronic CO toxicity and its effects on strength and exercise tolerance in military personnel and provide education to service members, veterans, and health care providers.
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Affiliation(s)
- Alyrene Dorey
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
- Department of Medicine, VA Northern California Hospitals and Clinics, Mather, CA 95655
| | - Pieter Scheerlinck
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
- Department of Medicine, VA Northern California Hospitals and Clinics, Mather, CA 95655
| | - Hoanvu Nguyen
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
| | - Timothy Albertson
- Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
- Department of Medicine, VA Northern California Hospitals and Clinics, Mather, CA 95655
- Department of Internal Medicine, University of California Davis School of Medicine, Sacramento, CA 95817
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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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20
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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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21
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Little MA, Ebbert JO, Krukowski RA, Halbert JP, Kalpinski R, Patten CA, Boothe TL, Pasker CK, Klesges RC, Talcott GW. Predicting cigarette initiation and reinitiation among active duty United States Air Force recruits. Subst Abus 2019; 40:340-343. [PMID: 30883297 DOI: 10.1080/08897077.2019.1577678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The first year of military service in the United States Air Force (USAF) is a high-risk time for tobacco use. Previous studies have demonstrated the effectiveness of a tobacco ban during Basic Military Training (BMT). However, no studies have examined the effect of increasing the protracted ban for an additional 4 weeks. Understanding the patterns of initiation and reinitiation following the protracted ban will inform future intervention and policy efforts. Methods: The current study examines patterns of cigarette smoking among a sample of 2188 USAF personnel at baseline and after their first year of service. Results: One year after BMT, we observed that 65.0% of USAF enlistees remained never smokers, 9.6% remained abstinence from cigarettes, 9.3% initiated cigarette smoking, and 16.1% reinitiated cigarette smoking. Despite the extended tobacco ban in BMT and Technical Training, 12.6% of individual who never smoked initiated cigarette smoking and 62.6% of individuals who formerly smoked reinitiated. Over half (54.2%) of Airmen who reported smoking cigarettes at follow-up reported initiating or reinitiating during Technical Training. Conclusions: Our findings indicate that although the increased ban prevents additional individuals who smoked cigarettes prior to joining the Air Force from reinitiating, it has no effect on initiation among individuals who report never using prior to military service. Additional research is needed to understand what may be leading to these high rates of initiation and reinitiation in Technical Training following the ban.
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Affiliation(s)
- Melissa A Little
- Center for Addiction and Prevention Research, University of Virginia Medical School, Joint Base San Antonio-Lackland, Texas, USA
| | | | - Rebecca A Krukowski
- Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Jennifer P Halbert
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, Virginia, USA
| | - Ryan Kalpinski
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
| | | | - Tina L Boothe
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
| | - Christin K Pasker
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
| | - Robert C Klesges
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, Virginia, USA
| | - Gerald W Talcott
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
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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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Bursac Z, Klesges RC, Little MA, Linde BD, Popova L, Kaplan CM, Talcott GW. The comparative effectiveness of two brief tobacco interventions in the U.S. Air Force: Perceived harm and intentions-to-use of tobacco products. Tob Induc Dis 2018; 16:26. [PMID: 31516426 PMCID: PMC6659509 DOI: 10.18332/tid/87142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Brief health prevention programs have been shown efficacious in prevention of tobacco use initiation and re-initiation in the US Air Force. In this manuscript we apply a comparative effectiveness assessment of two published studies, based on testing the equality of effect sizes for perceived harm and intentions-to-use for five tobacco products. METHODS We calculate and compare the effect sizes from the brief tobacco intervention (BTI) study (N=1055) with those of the anti-tobacco media campaign (MEDIA) study (N=665), for perceived harm and intentions-to-use of cigarettes, smokeless tobacco, cigarillos, e-cigarettes and hookah, among Airmen in the US Air Force Technical Training. Univariate and multivariate parametric and non-parametric methods and models were applied to compare the outcomes between the interventions. In addition, we calculate and report the cost of each intervention per Airman. RESULTS Effect sizes for perceived harm were 0.24–0.99 for BTI and 0.17–0.33 for MEDIA, while intentions-to-use effect sizes were 0.14–0.34 for BTI and 0.01– 0.07 for MEDIA, depending on the product. BTI intervention effects sizes were significantly greater than MEDIA intervention for all products, mainly among past users, and for both perceived harm (all p<0.0001) and intentions-to-use (all p<0.01). Cost per Airmen was comparable between the two interventions, $14.90 for BTI and $16.52 for MEDIA. CONCLUSIONS Direct comparison suggests that BTI produced effect sizes of significantly higher magnitude in the desired direction for perceived harm and intentions-to-use, for five tobacco products most commonly used by the Airmen, and mainly among past users.
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Affiliation(s)
- Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, United States
| | - Robert C Klesges
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
| | - Melissa A Little
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
| | - Brittany D Linde
- Organizational Wellness and Learning Systems, Fort Worth, United States
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, United States
| | - Cameron M Kaplan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, United States
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
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Hall MT, Austin RP, Do TA, McGlynn A. Vape and Aviate: Electronic-Cigarette Use and Misuse in Naval Aviation. Mil Med 2018; 183:e165-e170. [DOI: 10.1093/milmed/usx003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Matthew T Hall
- Department of Aviation Medicine, Naval Hospital Jacksonville, 2080 Child Street, Jacksonville, FL 32214
| | - Ryan P Austin
- Department of Aviation Medicine, Naval Hospital Jacksonville, 2080 Child Street, Jacksonville, FL 32214
| | - Tai A Do
- Directorate of Public Health Services, U.S. Naval Hospital Okinawa, Okinawa, Japan. PSC 482, FPO AP 96362-1600
| | - Andrea McGlynn
- Department of Clinical Investigation, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VI 23708
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25
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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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26
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Breland A, Soule E, Lopez A, Ramôa C, El-Hellani A, Eissenberg T. Electronic cigarettes: what are they and what do they do? Ann N Y Acad Sci 2017; 1394:5-30. [PMID: 26774031 PMCID: PMC4947026 DOI: 10.1111/nyas.12977] [Citation(s) in RCA: 220] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Electronic cigarettes (ECIGs) use electricity to power a heating element that aerosolizes a liquid containing solvents, flavorants, and the dependence-producing drug nicotine for user inhalation. ECIGs have evolved rapidly in the past 8 years, and the changes in product design and liquid constituents affect the resulting toxicant yield in the aerosol and delivery to the user. This rapid evolution has been accompanied by dramatic increases in ECIG use prevalence in many countries among adults and, especially, adolescents in the United States. The increased prevalence of ECIGs that deliver nicotine and other toxicants to users' lungs drives a rapidly growing research effort. This review highlights the most recent information regarding the design of ECIGs and their liquid and aerosol constituents, the epidemiology of ECIG use among adolescents and adults (including correlates of ECIG use), and preclinical and clinical research regarding ECIG effects. The current literature suggests a strong rationale for an empirical regulatory approach toward ECIGs that balances any potential ECIG-mediated decreases in health risks for smokers who use them as substitutes for tobacco cigarettes against any increased risks for nonsmokers who may be attracted to them.
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Affiliation(s)
| | - Eric Soule
- Virginia Commonwealth University, Richmond, Virgina
| | - Alexa Lopez
- Virginia Commonwealth University, Richmond, Virgina
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Glasser AM, Collins L, Pearson JL, Abudayyeh H, Niaura RS, Abrams DB, Villanti AC. Overview of Electronic Nicotine Delivery Systems: A Systematic Review. Am J Prev Med 2017; 52:e33-e66. [PMID: 27914771 PMCID: PMC5253272 DOI: 10.1016/j.amepre.2016.10.036] [Citation(s) in RCA: 320] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/07/2016] [Accepted: 10/26/2016] [Indexed: 12/20/2022]
Abstract
CONTEXT Rapid developments in e-cigarettes, or electronic nicotine delivery systems (ENDS), and the evolution of the overall tobacco product marketplace warrant frequent evaluation of the published literature. The purpose of this article is to report updated findings from a comprehensive review of the published scientific literature on ENDS. EVIDENCE ACQUISITION The authors conducted a systematic review of published empirical research literature on ENDS through May 31, 2016, using a detailed search strategy in the PubMed electronic database, expert review, and additional targeted searches. Included studies presented empirical findings and were coded to at least one of nine topics: (1) Product Features; (2) Health Effects; (3) Consumer Perceptions; (4) Patterns of Use; (5) Potential to Induce Dependence; (6) Smoking Cessation; (7) Marketing and Communication; (8) Sales; and (9) Policies; reviews and commentaries were excluded. Data from included studies were extracted by multiple coders (October 2015 to August 2016) into a standardized form and synthesized qualitatively by topic. EVIDENCE SYNTHESIS There were 687 articles included in this systematic review. The majority of studies assessed patterns of ENDS use and consumer perceptions of ENDS, followed by studies examining health effects of vaping and product features. CONCLUSIONS Studies indicate that ENDS are increasing in use, particularly among current smokers, pose substantially less harm to smokers than cigarettes, are being used to reduce/quit smoking, and are widely available. More longitudinal studies and controlled trials are needed to evaluate the impact of ENDS on population-level tobacco use and determine the health effects of longer-term vaping.
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Affiliation(s)
- Allison M Glasser
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.
| | - Lauren Collins
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jennifer L Pearson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Haneen Abudayyeh
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Raymond S Niaura
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - David B Abrams
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Doran N, Brikmanis K. Expectancies for and use of e-cigarettes and hookah among young adult non-daily smokers. Addict Behav 2016; 60:154-9. [PMID: 27155241 PMCID: PMC4884616 DOI: 10.1016/j.addbeh.2016.04.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 04/12/2016] [Accepted: 04/18/2016] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Understanding predictors of e-cigarette and hookah use among young adults is important in light of their increasing prevalence, particularly in younger populations. The purpose of this study was to test the hypothesis that young adult non-daily cigarette smokers' use of e-cigarettes and hookah would be positively associated with their expectancies about these products. METHODS Young adults (n=377, 58.0% male) aged 18-24years (M=20.5, SD=1.8) who had been non-daily smokers for at least six months but had never been daily smokers completed a baseline assessment online or via mobile phone as part of a larger, longitudinal study. RESULTS Approximately one in three participants reported any e-cigarette (34.0%) and/or hookah (33.4%) use in the past 14days; 37% of those who used either product reported using both. More positive e-cigarette expectancies were associated with higher odds of any e-cigarette use and with heavier use in the past two weeks. Similarly, more positive expectancies for hookah use predicted greater odds of any use as well as more frequent use of hookah (all ps<0.001). Cigarette expectancies were correlated with ANTP expectancies, but did not account for the latter's association with ANTP use. CONCLUSIONS Findings suggest that expectancies play a role in determining whether young adult cigarette smokers also use these nicotine products. These data also suggest use of e-cigarettes and/or hookah may be as common as not among young adult nondaily smokers.
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Affiliation(s)
- Neal Doran
- University of California, San Diego, United States; VA San Diego Healthcare System, United States.
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Little MA, Bursac Z, Derefinko KJ, Ebbert JO, Talcott GW, Hryshko-Mullen A, Klesges RC. Types of Dual and Poly-Tobacco Users in the US Military. Am J Epidemiol 2016; 184:211-8. [PMID: 27421292 DOI: 10.1093/aje/kwv321] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/10/2015] [Indexed: 11/14/2022] Open
Abstract
The present investigation was designed to determine the prevalence and types of dual and poly-use of tobacco products in the US Air Force, as well as characteristics and factors associated with these types. We conducted a cross-sectional assessment of tobacco-product use among 13,873 Air Force trainees from 2013 to 2014. The assessment included prevalence of the use of 10 different tobacco products and demographic and environmental factors, such as risk perceptions of tobacco use, peer use, and tobacco-company influences. Latent class analysis was carried out to determine types of poly-tobacco users. Tobacco-product use was reported by 27.1% of participants, and of those, over half reported using more than 1 tobacco product. Latent class analysis indicated 5 classes of poly-tobacco use. Factors associated with poly-tobacco (vs. mono-tobacco) use included lower confidence to remain tobacco-free, low harm perceptions, and receiving tobacco products free at bars or social events. Rates of dual and poly-tobacco use are high among trainees, and while these groups are similar to mono users in some ways, there are a number of differences that need to be considered when developing targeted interventions to address use of multiple tobacco products.
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Little MA, Derefinko KJ, Bursac Z, Ebbert JO, Colvin L, Talcott GW, Hryshko-Mullen AS, Richey PA, Klesges RC. Prevalence and Correlates of Tobacco and Nicotine Containing Product Use in a Sample of United States Air Force Trainees. Nicotine Tob Res 2016; 18:416-23. [PMID: 25895952 PMCID: PMC4854492 DOI: 10.1093/ntr/ntv090] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/10/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although there is increasing attention to the prevalence of new and emerging tobacco products in the civilian population, remarkably little is known about the current prevalence of these products in a military population. METHODS The current investigation was designed to determine the prevalence of tobacco and nicotine containing products (TNCP) and correlates of use across multiple cohorts of trainees undergoing Technical Training in the US Air Force between April 2013 and December 2014. Chi-square test, Cochran-Armitage test for linear trend, and logistic regression models were applied to test differences and linear trends across time for TNCP use as well as correlates of use in a cross-sectional sample of 13 685 Airmen (final analytic sample). RESULTS Over a quarter (26.9%) of Airmen reported regular use of a TNCP. The two most prevalent products were cigarettes (11.2%) and hookah (10.5%). Among correlates of use, Airmen that regularly use TNCPs were more likely to be male, younger, non-Hispanic white, and single with a high school degree or General Education Development. Hookah was the most endorsed for intentions to use, and along with e-cigarettes, had the lowest perception of harm. While prevalence of most products remained constant across entering cohorts, the prevalence of e-cigarettes showed significant linear increase. CONCLUSIONS The prevalence of TNCP use is high across cohorts of Airmen. Remarkably high estimates of future intentions to use and low perceptions of harm for emerging products suggest that intervention efforts should be directed at multiple forms of TNCP use to address this important public health issue.
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Affiliation(s)
- Melissa A Little
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN;
| | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Jon O Ebbert
- Department of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN
| | - Lauren Colvin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Gerald W Talcott
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | | | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
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31
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Little MA, Talcott GW, Bursac Z, Linde BD, Pagano LA, Messler EC, Ebbert JO, Klesges RC. Efficacy of a Brief Tobacco Intervention for Tobacco and Nicotine Containing Product Use in the US Air Force. Nicotine Tob Res 2015; 18:1142-9. [DOI: 10.1093/ntr/ntv242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/18/2015] [Indexed: 11/12/2022]
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32
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Popova L, Linde BD, Bursac Z, Talcott GW, Modayil MV, Little MA, Ling PM, Glantz SA, Klesges RC. Testing antismoking messages for Air Force trainees. Tob Control 2015; 25:656-663. [PMID: 26482786 DOI: 10.1136/tobaccocontrol-2015-052477] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Young adults in the military are aggressively targeted by tobacco companies and are at high risk of tobacco use. Existing antismoking advertisements developed for the general population might be effective in educating young adults in the military. This study evaluated the effects of different themes of existing antismoking advertisements on perceived harm and intentions to use cigarettes and other tobacco products among Air Force trainees. METHODS In a pretest-post-test experiment, 782 Airmen were randomised to view antismoking advertisements in 1 of 6 conditions: anti-industry, health effects+anti-industry, sexual health, secondhand smoke, environment+anti-industry or control. We assessed the effect of different conditions on changes in perceived harm and intentions to use cigarettes, electronic cigarettes, smokeless tobacco, hookah and cigarillos from pretest to post-test with multivariable linear regression models (perceived harm) and zero-inflated Poisson regression model (intentions). RESULTS Antismoking advertisements increased perceived harm of various tobacco products and reduced intentions to use. Advertisements featuring negative effects of tobacco on health and sexual performance coupled with revealing tobacco industry manipulations had the most consistent pattern of effects on perceived harm and intentions. CONCLUSIONS Antismoking advertisements produced for the general public might also be effective with a young adult military population and could have spillover effects on perceptions of harm and intentions to use other tobacco products besides cigarettes. Existing antismoking advertising may be a cost-effective tool to educate young adults in the military.
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Affiliation(s)
- Lucy Popova
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Brittany D Linde
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Zoran Bursac
- Division of Biostatistics, Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - G Wayne Talcott
- Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mary V Modayil
- Institute for Population Health Improvement, University of California, Davis Medical Center, Sacramento, California, USA
| | - Melissa A Little
- Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Pamela M Ling
- Division of General Internal Medicine, Department of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Stanton A Glantz
- Division of Cardiology, Department of Medicine, Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco, California, USA
| | - Robert C Klesges
- Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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