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Maccarone JR, Sterns OR, Timmons A, Korpak AM, Smith NL, Nakayama KS, Baird CP, Ciminera P, Kheradmand F, Fan VS, Hart JE, Koutrakis P, Jerrett M, Kuschner WG, Ioachimescu OC, Montgrain PR, Proctor SP, Redlich CA, Wendt CH, Blanc PD, Garshick E, Wan ES. Deployment-related Cigarette Smoking Behaviors and Pulmonary Function Among U.S. Veterans. Mil Med 2024; 189:2030-2038. [PMID: 38536226 DOI: 10.1093/milmed/usae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/02/2024] [Accepted: 02/13/2024] [Indexed: 08/31/2024] Open
Abstract
INTRODUCTION The effects of smoking on lung function among post-9/11 Veterans deployed to environments with high levels of ambient particulate matter are incompletely understood. MATERIALS AND METHODS We analyzed interim data (04/2018-03/2020) from the Veterans Affairs (VA) Cooperative Studies Program #595, "Service and Health Among Deployed Veterans". Veterans with ≥1 land-based deployments enrolled at 1 of 6 regional Veterans Affairs sites completed questionnaires and spirometry. Multivariable linear regression models assessed associations between cigarette smoking (cumulative, deployment-related and non-deployment-related) with pulmonary function. RESULTS Among 1,836 participants (mean age 40.7 ± 9.6, 88.6% male), 44.8% (n = 822) were ever-smokers (mean age 39.5 ± 9.5; 91.2% male). Among ever-smokers, 86% (n = 710) initiated smoking before deployment, while 11% (n = 90) initiated smoking during deployment(s). Smoking intensity was 50% greater during deployment than other periods (0.75 versus 0.50 packs-per-day; P < .05), and those with multiple deployments (40.4%) were more likely to smoke during deployment relative to those with single deployments (82% versus 74%). Total cumulative pack-years (median [IQR] = 3.8 [1, 10]) was inversely associated with post-bronchodilator FEV1%-predicted (-0.82; [95% CI] = [-1.25, -0.50] %-predicted per 4 pack-years) and FEV1/FVC%-predicted (-0.54; [95% CI] = [-0.78, -0.43] %-predicted per 4 pack-years). Deployment-related pack-years demonstrated similar point estimates of associations with FEV1%-predicted (-0.61; [95% CI] = [-2.28, 1.09]) and FEV1/FVC%-predicted (-1.09; [95% CI] = [-2.52, 0.50]) as non-deployment-related pack-years (-0.83; [95% CI] = [-1.26, -0.50] for FEV1%-predicted; -0.52; [95% CI] = [-0.73, -0.36] for FEV1/FVC%-predicted). CONCLUSIONS Although cumulative pack-years smoking was modest in this cohort, an inverse association with pulmonary function was detectable. Deployment-related pack-years had a similar association with pulmonary function compared to non-deployment-related pack-years.
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Affiliation(s)
- Jennifer R Maccarone
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section VA Boston Healthcare System, West Roxbury, MA 02132, USA
- The Pulmonary Center, Boston University School of Medicine, Boston, MA 02118, USA
| | - Olivia R Sterns
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section VA Boston Healthcare System, West Roxbury, MA 02132, USA
| | - Andrew Timmons
- Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, WA 98108, USA
| | - Anna M Korpak
- Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, WA 98108, USA
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, WA 98108, USA
| | - Karen S Nakayama
- Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, WA 98108, USA
| | - Coleen P Baird
- U.S. Army Public Health Center Aberdeen Proving Ground, MD 21005, USA
| | - Paul Ciminera
- Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Defense Health Headquarters, Falls Church, VA 22042, USA
| | - Farrah Kheradmand
- Department of Medicine Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- Baylor College of Medicine, Houston, TX 77030, USA
| | - Vincent S Fan
- VA Puget Sound Health Care System Seattle Division, Seattle, WA 98108, USA
- Department of Medicine, University of Washington, Seattle, WA 98195
| | - Jaime E Hart
- Department of Environmental Health, Harvard TH Chan School of Public Health Boston MA 02115, USA
- Harvard Medical School, Brigham and Women's Hospital Channing Division of Network Medicine, Boston, MA 02115, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health Boston MA 02115, USA
| | - Michael Jerrett
- University of California Los Angeles Jonathan and Karin Fielding School of Public Health Los Angeles CA 90095, USA
| | - Ware G Kuschner
- VA Palo Alto Healthcare System, Palo Alto, CA 94304, USA
- Stanford University School of Medicine, Stanford, CA 94305
| | | | - Philippe R Montgrain
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Medicine, University of California San Diego, San Diego, CA 92093
| | - Susan P Proctor
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section VA Boston Healthcare System, West Roxbury, MA 02132, USA
- U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA
| | - Carrie A Redlich
- Occupational and Environmental Medicine, Department of Internal Medicine Yale School of Medicine, New Haven, CT 06510, USA
| | - Christine H Wendt
- Pulmonary, Allergy, Critical Care and Sleep Medicine Minneapolis VA Medical Center, Minneapolis, MN 55417, USA
- University of Minnesota, Minneapolis, MN 55455
| | - Paul D Blanc
- Department of Medicine, San Francisco VA Healthcare System, San Francisco, CA 94121, USA
- Division of Occupational, Environmental, and Climate Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Eric Garshick
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section VA Boston Healthcare System, West Roxbury, MA 02132, USA
- Harvard Medical School, Brigham and Women's Hospital Channing Division of Network Medicine, Boston, MA 02115, USA
| | - Emily S Wan
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section VA Boston Healthcare System, West Roxbury, MA 02132, USA
- Harvard Medical School, Brigham and Women's Hospital Channing Division of Network Medicine, Boston, MA 02115, USA
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Vest BM, Hoopsick RA, Homish DL, Kulak JA, Homish GG. Longitudinal Effects of Military Separation and Mental Health Symptomatology on Substance Use Among a Cohort of Reservists. J Stud Alcohol Drugs 2024; 85:528-536. [PMID: 38319103 PMCID: PMC11289865 DOI: 10.15288/jsad.23-00160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/22/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE The relationship between mental health and substance use among military populations is well established, and evidence suggests that these risks may be greater for those who have left the military. However, it is less clear what independent effects leaving the military may have on substance use behaviors. This study examined the longitudinal relationship between leaving the military and substance use outcomes (hazardous drinking, frequent heavy drinking, nonmedical use of prescription drugs, illicit drug use) in a cohort of Reserve and National Guard (R/NG) soldiers. Further, we examined whether mental health symptoms moderate the relationship between leaving the military and substance use. METHOD Analyses used data (N = 485 soldiers) from the first four annual waves of Operation: SAFETY, an ongoing prospective cohort study of U.S. Army R/NG soldiers and their spouses. We used generalized estimating equations (GEEs) to examine the relationships between military status (former vs. current soldier) and substance use outcomes over 4 years. Last, we examined interactions between military status and mental health indicators (anxiety, anger, depression, and posttraumatic stress disorder) on substance use over time. RESULTS After we controlled for sex, age, race, years of military service, sleep problems, bodily pain, and substance use norms, being a former soldier, compared with being a current soldier, was associated with greater odds of current illicit drug use (adjusted odds ratio = 2.86, 95% CI [1.47, 5.57]; p < .01). Mental health symptomatology did not moderate the relationship between leaving the military and current drug use. CONCLUSIONS Leaving the military in and of itself may result in increased drug use for some individuals, regardless of mental health symptomatology.
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Affiliation(s)
- Bonnie M. Vest
- Department of Family Medicine, State University of New York at Buffalo, Buffalo, New York
| | - Rachel A. Hoopsick
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Champaign, Illinois
| | - D. Lynn Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, New York
| | - Jessica A. Kulak
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, New York
| | - Gregory G. Homish
- Department of Community Health and Health Behavior, State University of New York at Buffalo, Buffalo, New York
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DeBlois JP, London AS, Heffernan KS. Hypertension at the nexus of veteran status, psychiatric disorders, and traumatic brain injury: Insights from the 2011 Behavioral Risk Factor Surveillance System. PLoS One 2024; 19:e0298366. [PMID: 38498456 PMCID: PMC10947695 DOI: 10.1371/journal.pone.0298366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/24/2024] [Indexed: 03/20/2024] Open
Abstract
Variable military service-related experiences, such as combat exposure, psychiatric disorders (PD), and traumatic brain injuries (TBI), may differentially affect the likelihood of having health care professional-identified high blood pressure (i.e., hypertension). PURPOSE Compare the odds of self-reported hypertension among non-combat and combat veterans with and without PD/TBI to non-veterans and each other. METHODS We used data from men from the 2011 Behavioral Risk Factor Surveillance System and distinguished: non-veterans (n = 21,076); non-combat veterans with no PD/TBI (n = 3,150); combat veterans with no PD/TBI (n = 1,979); and veterans (combat and non-combat) with PD and/or TBI (n = 805). Multivariable, hierarchical logistic regression models included exogenous demographic, socioeconomic attainment and family structure, health behavior and conditions, and methodological control variables. RESULTS One-third of men reported having been told at least once by a medical professional that they had high blood pressure. Bivariate analyses indicated that each veteran group had a higher prevalence of self-reported hypertension than non-veterans (design-based F = 45.2, p<0.001). In the fully adjusted model, no statistically significant differences in the odds of self-reported hypertension were observed between non-veterans and: non-combat veterans without PD/TBI (odds ratio [OR] = 0.92); combat veterans without PD/TBI (OR = 0.87); veterans with PD and/or TBI (OR = 1.35). However, veterans with PD and/or TBI had greater odds of reporting hypertension than both combat and non-combat veterans without PD/TBI (p<0.05). DISCUSSION Military service-related experiences were differentially associated with a survey-based measure of hypertension. Specifically, veterans self-reporting PD and/or TBI had significantly higher odds of self-reporting hypertension (i.e., medical provider-identified high blood pressure).
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Affiliation(s)
- Jacob P. DeBlois
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States of America
| | - Andrew S. London
- Department of Sociology, Syracuse University, Syracuse, NY, United States of America
| | - Kevin S. Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, United States of America
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Teerawichitchainan B, Zimmer Z, Low TQY, Toan TK. Respiratory Health Among Older Adults in Vietnam: Does Earlier-Life Military Role and War Exposure Matter? J Aging Health 2023; 35:168-181. [PMID: 35941715 DOI: 10.1177/08982643221118445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ObjectiveWe explore how earlier-life military roles and war trauma associate with later-life respiratory health in Vietnam. Method: The population-based sample aged 60+ is from the 2018 Vietnam Health and Aging Study. Poisson and binary logistic regressions investigate correlates of overall lung health, measured as total number of four conditions, and individual conditions, with focus on earlier-life wartime experiences. Results: Exposure is associated with lung conditions. Overall, a one-standard deviation increase in exposure results in 0.529 more conditions (p ≤ .001). Association varies across military roles and is partially explained by PTSD and smoking. Civilians heavily exposed to war trauma exhibit worse lung health than similarly exposed formal and informal military personnel. Discussion: Earlier-life war exposure is an important predictor of late-adulthood respiratory health in lower- and middle-income countries. Evidence calls for attention to the long-term impacts of war on health among not only formal and informal military personnel but also civilians.
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Affiliation(s)
| | - Zachary Zimmer
- Department of Family Studies and Gerontology, 3684Mount Saint Vincent University, Halifax, NS, Canada
| | - Timothy Qing Ying Low
- Centre for Family and Population Research, 37580National University of Singapore, Singapore
| | - Tran Khanh Toan
- Family Medicine Department, 106156Hanoi Medical University, Hanoi, Vietnam
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Piazza JR, Landes SD, Stawski RS. Age differences in allostatic load among veterans: The importance of combat exposure. J Trauma Stress 2022; 35:257-268. [PMID: 34637556 DOI: 10.1002/jts.22731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 11/09/2022]
Abstract
The current study examinedage differences in allostatic load among nonveterans, noncombat veterans, and combat veterans. Participants included 280 individuals from the Midlife Development in the United States (MIDUS) survey, including 164 veterans (n = 48 combat veterans; n = 116 noncombat veterans) and 116 nonveterans. Age differences in allostatic load were similar among nonveterans and noncombat veterans, B = 0.002, SE = .011, p = .878, with older adults showing higher levels of allostatic load than their comparatively younger counterparts. Among combat veterans, however, a different pattern emerged. In this group, levels of allostatic load were similar across age, seemingly due to higher levels of allostatic load among younger combat veterans, B = -0.029, SE = .014, p = .031, ƞp 2 = .022. Results reveal the importance of considering combat exposure when examining health outcomes of military veterans, particularly in the context of age.
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Affiliation(s)
- Jennifer R Piazza
- Department of Public Health, California State University, Fullerton, Fullerton, California, USA
| | - Scott D Landes
- Department of Sociology, Syracuse University, Syracuse, New York, USA
| | - Robert S Stawski
- Department of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
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Au-Yeung CS, Chao RF, Hsu LY. Why It Is Difficult for Military Personnel to Quit Smoking: From the Perspective of Compensatory Health Beliefs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212261. [PMID: 34832015 PMCID: PMC8618123 DOI: 10.3390/ijerph182212261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/15/2021] [Accepted: 11/19/2021] [Indexed: 11/16/2022]
Abstract
Compensatory health beliefs are barriers to healthy behavior. In an effort to understand how the prevalence of these beliefs can be reduced in individuals, 376 valid questionnaires were collected from combat troops in Taiwan. The collected data were analyzed using partial least squares structural equation modelling. It was found that positive attitudes towards smoking cessation had significant negative effects on compensatory health beliefs, while negative attitudes towards smoking cessation significantly enhanced the level of compensatory health beliefs. The motivation for smoking cessation was also found to reinforce the negative effect of positive attitudes towards compensatory health beliefs, while it did not have any significant effect on the relationship between negative attitudes and compensatory health beliefs. Three subconstructs of compensatory health beliefs (exercise, eating habits, and amount of smoking) were found to have simultaneous effects for military personnel. Finally, this study explored the causes of the above-mentioned phenomena, and measures that could reduce the prevalence of compensatory health beliefs were suggested.
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Affiliation(s)
- Chor-Sum Au-Yeung
- Postgraduate Programs in Management, I-Shou University, Kaohsiung 84001, Taiwan; (C.-S.A.-Y.); (L.-Y.H.)
| | - Ren-Fang Chao
- Department of Leisure Management, I-Shou University, Kaohsiung 84001, Taiwan
- Correspondence:
| | - Li-Yun Hsu
- Postgraduate Programs in Management, I-Shou University, Kaohsiung 84001, Taiwan; (C.-S.A.-Y.); (L.-Y.H.)
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Abstract
Objective: Informed by a social determinants of health framework, we investigate the relationship between self-reported ADHD diagnosis status and adult health, and whether observed associations are attenuated by biomedical and socioeconomic factors. Method: Using 2007 National Health Interview Survey data (N = 19,104), we present multivariate logistic regression analyses of associations between self-reported ADHD diagnosis status and five adult health outcomes. Results: ADHD diagnosis was significantly associated with higher odds of injury, physical health conditions, functional limitations, fair/poor health, and psychological distress in fully specified models (adjusted odds ratios [AORs] = 1.62-2.36). Inclusion of controls for exogenous demographic characteristics, psychiatric comorbidities and health behaviors, and adult social and economic statuses attenuated but did not eliminate observed associations between ADHD and poorer adult health. Conclusion: Research on adult health outcomes for those with ADHD should include consideration of the mechanisms by which a diagnosis of ADHD leads to cumulative social disadvantages that independently contribute to poorer health outcomes.
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Vest BM, Brady LA, Brimmer MJ, Homish GG. Variations in Risk and Motivations for Substance Use over the Course of Military Service. Subst Use Misuse 2021; 56:559-566. [PMID: 33616468 PMCID: PMC8108137 DOI: 10.1080/10826084.2021.1887257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Epidemiological data identify risk factors related to substance use among military service members to inform prevention and treatment. Less is known about how motivations and risks for substance use vary over a military service career. The study goal was to explore substance use patterns and motivations among a sample of United States undergraduate student veterans in order to identify periods of risk. Methods: Qualitative interviews were conducted (n = 31) between December 2018 and April 2019. Transcripts were coded in ATLAS.ti using thematic content analysis. Results: Interviews revealed complex motivations around substance use and identified key periods of risk. 1) Pre-service: Participants reported using alcohol and marijuana, primarily during social activities. 2) During service: Participants described a culture of heavy alcohol and tobacco use in social contexts, but little use of other substances. Post-deployment was a notable exception, when some reported heavier alcohol use and use of other drugs, including opiates, cocaine, and ecstasy. 3) Post-service: Transitioning out of the military was described as difficult; some participants reported heavier use of substances during this period. Some participants quit smoking after military service, or switched to vaping. Others reported use of alcohol and/or marijuana to calm themselves, relieve stress, and enable sleep. Conclusions: These data indicate that the periods immediately following deployment and transition out of the military may be especially high-risk for heavy substance use and use of a broader range of substances. This highlights the need for tailored interventions and messaging at different points of military service, particularly during periods of greatest risk.
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Affiliation(s)
- Bonnie M Vest
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Laura A Brady
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Maximilian J Brimmer
- Primary Care Research Institute, Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Gregory G Homish
- Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA
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King BM, Carr DC, Taylor MG. Loneliness Following Widowhood: The Role of the Military and Social Support. J Gerontol B Psychol Sci Soc Sci 2020; 76:403-414. [DOI: 10.1093/geronb/gbz164] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objectives
Increased loneliness is a common consequence of widowhood in later life. However, individuals with high levels of perceived social support from friends tend to cope more effectively following major social losses like widowhood. Military service is associated with cultivation of strong social support structures. This effect may not only influence those who serve, but also their spouses. Roughly half of older women today are married to veterans, which could shape how they cope with widowhood. We tested two hypotheses: (a) widows of veterans will be less lonely following widowhood compared to their nonveteran counterparts, and (b) this effect will be explained by perceived social support from friends.
Methods
We used the Health and Retirement Study (HRS) to examine changes in loneliness following widowhood among wives of veterans and nonveterans. We used Ordinary Least Squares regression and mediation tests to address our hypotheses.
Results
Net of baseline differences, widows of veterans reported statistically lower levels of loneliness (p < .05) following widowhood compared to widows of nonveterans. Widows of veterans retained the same level of perceived social support from friends pre- and postwidowhood, whereas nonveteran wives experienced a loss. Perceived social support from friends mediated the association between veteran status of the deceased spouse and loneliness.
Discussion
Our findings suggest wives of veterans may have more resilient social support structures than nonveteran spouses, helping them cope at widowhood. Future research should explore whether these effects persist in association with other major stressful events in later life.
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Affiliation(s)
- Brittany M King
- Department of Sociology, Florida State University, Tallahassee
| | - Dawn C Carr
- Department of Sociology, Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee
| | - Miles G Taylor
- Department of Sociology, Pepper Institute on Aging and Public Policy, Florida State University, Tallahassee
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Wilson SM, Medenblik AM, Neal JM, Strauss JL, McNiel JM, Christian WE, Beckham JC, Calhoun PS. Lifetime Smoking Patterns and Preferences for Smoking Cessation Among Women Veterans Receiving Veterans Health Administration Care. QUALITATIVE HEALTH RESEARCH 2019; 29:2096-2107. [PMID: 31307290 PMCID: PMC6848747 DOI: 10.1177/1049732319857536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The objective of this study was to identify common themes among women veterans who smoke or recently quit and had used smoking cessation treatment within the Veterans Health Administration (VHA). The study built upon previous research by utilizing in-depth interviews to encourage disclosure of potentially stigmatized topics. Twenty women veterans enrolled in VHA care engaged in a quality improvement project focused on improving smoking cessation services. Qualitative analysis of de-identified interviews used a combination of content analysis and thematic analysis within the sociopharmacological model of tobacco addiction. Findings revealed that participants' smoking was influenced by woman veteran identity and by several gender-related contextual factors, including military sexual trauma and gender discrimination. Findings also highlighted other contextual factors, such as personal autonomy, emotional smoking triggers, and chronic mental health concerns. Findings are interpreted within the context of cultural power imbalances, and recommendations are provided for VHA smoking cessation for women veterans.
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Affiliation(s)
- Sarah M Wilson
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alyssa M Medenblik
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Julia M Neal
- Durham VA Health Care System, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Jennifer L Strauss
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | - J Murray McNiel
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Warren E Christian
- The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jean C Beckham
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
| | - Patrick S Calhoun
- VA Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, North Carolina, USA
- Durham VA Health Care System, Durham, North Carolina, USA
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina, USA
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Chen F, Hu P, Chang W, Chen C, Ding T, Liu X. A Cross-Sectional Survey on Cigarette Smoking in the Chinese Navy. Mil Med 2019; 184:e211-e217. [PMID: 30535298 DOI: 10.1093/milmed/usy363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/26/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The military is a risk environment for cigarette smoking. This study determined the prevalence of, cessation attempts, knowledge, and attitudes regarding smoking, and factors related to it in the Chinese navy. MATERIALS AND METHODS A cross-sectional survey was conducted of military personnel on active duty in the Chinese navy, Guangdong province. Data were collected using a standard structured questionnaire and analyzed through SPSS. Multiple logistic regression was used to examine factors associated with smoking. The research protocols were reviewed and approved by the Institutional Review Board of Naval Medical University, and participants gave written informed consent. RESULTS A total of 1,530 military personnel who had served for >3 months completed the survey, 859 (56.14%) of whom were current smokers. The main reasons for smoking were stress alleviation and social needs. A total of 377 smokers had previously attempted quitting. More than half considered the military environment supportive of smoking. Subjects' knowledge regarding smoking mainly comprised negative respiratory-health effects. Smoking status was related to education level, military service duration, number of smoking family members, and smoking knowledge. CONCLUSIONS Smoking prevalence in the Chinese navy is higher than that among Chinese civilians and the US and UK military personnel. Although many sailors are aware of the dangers of smoking to their health, they seldom get advice or help regarding smoking cessation. Most smokers believed that smoking cessation could improve their health. Therefore, the navy should formulate policies encouraging and facilitating military personnel's smoking cessation.
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Affiliation(s)
- Fuxing Chen
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Pengwei Hu
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Wang Chang
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Chulin Chen
- Department of Nursing, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Tianyuan Ding
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
| | - Xiaorong Liu
- Department of Health Service, Naval Medical University, No.800 Xiangyin Road, Yangpu District, Shanghai, China
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Dannefer D. Systemic and Reflexive: Foundations of Cumulative Dis/Advantage and Life-Course Processes. J Gerontol B Psychol Sci Soc Sci 2018; 75:1249-1263. [DOI: 10.1093/geronb/gby118] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 11/12/2022] Open
Abstract
AbstractCumulative dis/advantage has been defined as the systemic tendency for interindividual divergence in a given characteristic to increase with the passage of time. Over recent decades, evidence supporting cumulative dis/advantage (CDA) as a cohort-based process that produces inequalities on a range of life-course outcomes has steadily increased. This paper reviews this growing body of work, grounding the discussion in CDA’s foundation as a general sociological construct with broad relevance. I emphasize the distinction between outcome and process, and then distinguish multiple levels of social analysis at which CDA operates. From this review, I extract two principles, endogenous system dynamics and life-course reflexivity, that can be cross-classified to provide a framework for analyzing contemporary research frameworks and initiatives relevant to CDA. I argue that the full sociological impact and implications of CDA research has been unevenly developed and applied, and conclude by suggesting some possible directions for further building on CDA’s insights.
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Affiliation(s)
- Dale Dannefer
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio
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