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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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Doran N, Hurst S, Liu J, El-Shahawy O, Myers M, Krebs P. Protocol for the development of a vaping cessation intervention for young adult veterans. Contemp Clin Trials Commun 2024; 39:101309. [PMID: 38784967 PMCID: PMC11112004 DOI: 10.1016/j.conctc.2024.101309] [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: 01/24/2024] [Revised: 03/29/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
The use of e-cigarettes ("vaping") by young adults has increased substantially in the past decade. Although health risks of long-term e-cigarette use remain unknown, there is evidence of acute physiological harms. Most young adults who vape report intent to quit, but little is known about effective interventions. This protocol paper reports on the development and design of a pilot trial of a vaping intervention for young military Veterans. Young adult Veterans accessing VA healthcare (n = 20) who vape daily and have been referred for cessation services will be enrolled. To maximize accessibility the intervention will be delivered virtually; participants will be randomized to receive behavioral counseling by telephone or by video telehealth. The intervention was adapted from an existing program targeting young adult cigarette smokers and will include 6 individual counseling sessions delivered over 8 weeks. Assessment visits will occur at baseline, at end-of-treatment, and 4 weeks later. Analyses will evaluate feasibility and acceptability of the intervention overall, and will compare telephone and video telehealth modalities. Longitudinal regression will be used to evaluate changes in vaping behavior and in nicotine dependence over time. This study will provide assessment of a novel intervention adapted for Veterans who vape nicotine. The comparison of two modalities of virtual intervention delivery will increase knowledge and the potential to disseminate across VA and other healthcare systems. Findings from this pilot trial will inform the design of future, larger studies of vaping cessation interventions for younger Veterans.
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Affiliation(s)
- Neal Doran
- Veterans Medical Research Foundation, San Diego, CA, USA
- Psychology Service, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego, USA
| | - Samantha Hurst
- Herbert Wertheim School of Public Health, University of California, San Diego, USA
| | - Jie Liu
- Family Health Centers of San Diego, USA
| | | | - Mark Myers
- Veterans Medical Research Foundation, San Diego, CA, USA
- Psychology Service, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego, USA
| | - Paul Krebs
- Veterans Medical Research Foundation, San Diego, CA, USA
- Psychology Service, VA San Diego Healthcare System, USA
- Department of Psychiatry, University of California, San Diego, USA
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Hayden L, Lightner JM, Strausborger S, Franks TJ, Watson NL, Lewin-Smith MR. Particle analysis of surgical lung biopsies from deployed and non-deployed US service members during the Global War on Terrorism. PLoS One 2024; 19:e0301868. [PMID: 38603724 PMCID: PMC11008878 DOI: 10.1371/journal.pone.0301868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 03/22/2024] [Indexed: 04/13/2024] Open
Abstract
The role that inhaled particulate matter plays in the development of post-deployment lung disease among US service members deployed to Southwest Asia during the Global War on Terrorism has been difficult to define. There is a persistent gap in data addressing the relationship between relatively short-term (months to a few years) exposures to high levels of particulate matter during deployment and the subsequent development of adverse pulmonary outcomes. Surgical lung biopsies from deployed service members and veterans (DSMs) and non-deployed service members and veterans (NDSMs) who develop lung diseases can be analyzed to potentially identify residual deployment-specific particles and develop associations with pulmonary pathological diagnoses. We examined 52 surgical lung biopsies from 25 DSMs and 27 NDSMs using field emission scanning electron microscopy (FE-SEM) with energy dispersive x-ray spectroscopy (EDS) to identify any between-group differences in the number and composition of retained inorganic particles, then compared the particle analysis results with the original histopathologic diagnoses. We recorded a higher number of total particles in biopsies from DSMs than from NDSMs, and this difference was mainly accounted for by geologic clays (illite, kaolinite), feldspars, quartz/silica, and titanium-rich silicate mixtures. Biopsies from DSMs deployed to other Southwest Asia regions (SWA-Other) had higher particle counts than those from DSMs primarily deployed to Iraq or Afghanistan, due mainly to illite. Distinct deployment-specific particles were not identified. Particles did not qualitatively associate with country of deployment. The individual diagnoses of the DSMs and NDSMs were not associated with elevated levels of total particles, metals, cerium oxide, or titanium dioxide particles. These results support the examination of particle-related lung disease in DSMs in the context of comparison groups, such as NDSMs, to assist in determining the strength of associations between specific pulmonary pathology diagnoses and deployment-specific inorganic particulate matter exposure.
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Affiliation(s)
- Leslie Hayden
- Institute for Functional Materials and Devices, Lehigh University, Bethlehem, Pennsylvania, United States of America
| | - James M. Lightner
- Environmental Microscopy Laboratory, Joint Pathology Center, Silver Spring, Maryland, United States of America
| | - Stacy Strausborger
- Environmental Microscopy Laboratory, Joint Pathology Center, Silver Spring, Maryland, United States of America
| | - Teri J. Franks
- Pulmonary and Mediastinal Pathology, Joint Pathology Center, Silver Spring, Maryland, United States of America
| | - Nora L. Watson
- Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
| | - Michael R. Lewin-Smith
- Environmental Pathology, Joint Pathology Center, Silver Spring, Maryland, United States of America
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Ahmed AE, Yim MH, Dawood J, Olsen CH, Waters AJ, Singer DE, Mancuso JD. Suicidal Behaviors Among Active-Duty US Service Members: Data from the 2018 Health-Related Behaviors Survey. Psychol Res Behav Manag 2023; 16:4599-4615. [PMID: 37954933 PMCID: PMC10638889 DOI: 10.2147/prbm.s432835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/31/2023] [Indexed: 11/14/2023] Open
Abstract
Background This study aimed to 1) determine the prevalence of past-year suicidal ideation (SI) and attempts (SA) among active-duty SMs; 2) determine whether differences exist by age, sex, and race; and 3) assess whether prevalence estimates vary by risk profiles of mental health conditions and substance use. Methods Data were from the 2018 Health-Related Behavior Survey (HRBS), a cross-sectional survey of active-duty SMs (n = 17,166). We used the logistic model to identify the factors of SI and SA and latent class analysis (LCA) to identify the risk profiles. Results Among active duty SMs, 8.26% had SI and 1.25% had SA in the past year. Gender and age have been shown to influence how race might contribute to suicidal behaviors. Mental health conditions were associated with higher odds of SI and SA, as were younger ages; LGB identity; being separated, divorced, or widowed; use of e-cigarettes, dual use of e-cigarettes and cigarettes, or drugs; and history of deployment of less than 12 months. Frequencies of cigarette and e-cigarette use were also associated with SI and SA, indicating the odds were increasing by 0.3% for every additional cigarette or e-cigarette used. Five risk profiles were identified: class 1 (illegal drug use), class 2 (mental health needs with tobacco and alcohol use), class 3 (mental health conditions only), class 4 ("low risk" SMs with low levels of illegal drug use, mental health visits, tobacco use, and alcohol use), and class 5 (alcohol use). Compared to class 4 ("low risk"), all other risk profiles were associated with increased odds of suicidal behaviors. Conclusion Despite the resources and increased access provided for mental health support, the prevalence of SI among active-duty SMs is greater than in the general population of the same age, likely due to additional military exposures and stressors.
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Affiliation(s)
- Anwar E Ahmed
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Michael H Yim
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Jimmy Dawood
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Cara H Olsen
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Andrew J Waters
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - Darrell E Singer
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
| | - James D Mancuso
- Department of Preventive Medicine & Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA
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Gill AA, Alford B, Balmer J, Lutz EA, Glogower FD, Palm CK. Use of electronic cigarettes among U.S. Military service members - prevalence and associated risk factors. Subst Abus 2022; 43:1300-1307. [PMID: 35876783 DOI: 10.1080/08897077.2022.2095075] [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: 10/16/2022]
Abstract
BACKGROUND Decreased physical fitness, loss of vision and hearing, and increased risk of chronic diseases are significant primary and secondary implications associated with the health of U.S. Military Service members who use tobacco, including electronic cigarettes. Despite the medical and non-medical costs to the U.S. Department of Defense and potential adverse health effects to Service members, electronic cigarette use is on the rise. METHODS U.S. Military Service members who completed their Periodic Health Assessment, a standardized, electronic, logic-based tool, from July 2018 to July 2019 were eligible. This exploratory study examines the prevalence and significant risk factors associated with self-reported use of electronic cigarettes, as well as determines if tobacco use varies by sex and Service branch, through use of Chi-square analysis and logistic regression. RESULTS U.S. Military Service members 17-70 years old were included in this study (N = 1.12 M), with 80% of study participants being male and 20% female. Exposure to secondhand smoke (OR: 2.12, 95% CI: 2.15-2.22) and screening positive for hazardous drinking (OR: 2.70, 95% CI: 2.64-2.76) were found to show the greatest increase in odds of using electronic cigarettes, with similar findings after stratification by sex and Service branch. Stratification by Service branch revealed further differences in the association between electronic cigarette use and various demographic, military, lifestyle, and health characteristics. CONCLUSION Electronic cigarette use is increasing across the United States. U.S. Service members have unique risk factors and patterns of tobacco use. Despite tobacco use having potential adverse effects on military readiness, its use remains prevalent in this population. Our findings identify opportunities for the U.S. Department of Defense to review tobacco policy and availability and accessibility of cessation services to promote quitting tobacco, especially electronic cigarettes.
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Affiliation(s)
- Abegail A Gill
- Deputy Assistant Director-Public Health, Deployment Health Division, Defense Health Agency, VA, USA
| | - Brandi Alford
- Deputy Assistant Director-Public Health, Deployment Health Division, Defense Health Agency, VA, USA
| | - Jennylynn Balmer
- Deputy Assistant Director-Public Health, Deployment Health Division, Defense Health Agency, VA, USA
| | - Eric A Lutz
- Deputy Assistant Director-Public Health, Deployment Health Division, Defense Health Agency, VA, USA
| | - Frederic D Glogower
- Deputy Assistant Director-Public Health, Deployment Health Division, Defense Health Agency, VA, USA
| | - Col Keith Palm
- Deputy Assistant Director-Public Health, Deployment Health Division, Defense Health Agency, VA, USA
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