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Lo WC, Hu TH, Shih CY, Lin HH, Hwang JS. Impact of Healthy Lifestyle Factors on Life Expectancy and Lifetime Health Care Expenditure: Nationwide Cohort Study. JMIR Public Health Surveill 2024; 10:e57045. [PMID: 39018094 PMCID: PMC11292159 DOI: 10.2196/57045] [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] [Received: 02/03/2024] [Revised: 03/20/2024] [Accepted: 05/17/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The association between lifestyle risk factors and the risk of mortality and chronic diseases has been established, while limited research has explored the impact of healthy lifestyle factors on lifetime health care expenditure using longitudinal individual data. OBJECTIVE We aimed to determine the individual and combined effects of 5 healthy lifestyle factors on life expectancy and lifetime health care expenditure in Taiwan. METHODS Using data from the National Health Interview Survey cohort, 5 healthy lifestyle behaviors were defined and analyzed: nonsmoking, avoiding excessive alcohol consumption, engaging in sufficient physical activity, ensuring sufficient fruit and vegetable intake, and maintaining a normal weight. We used a rolling extrapolation algorithm that incorporated inverse probability of treatment weighting to estimate the life expectancy and lifetime health care expenditure of the study populations with and without healthy lifestyle factors. RESULTS A total of 19,893 participants aged ≥30 (mean age 48.8, SD 13.4) years were included, with 3815 deaths recorded during a median follow-up period of 15.6 years. The life expectancy and per capita estimated lifetime health care expenditures for the overall study population were 35.32 years and US $58,560, respectively. Multivariable-adjusted hazard ratios for all-cause mortality in participants adhering to all 5 healthy lifestyle factors, compared with those adhering to none, were 0.37 (95% CI 0.27-0.49). We found significant increases in life expectancy for nonsmokers (2.31 years; 95% CI 0.04-5.13; P=.03), those with sufficient physical activity (1.85 years; 95% CI 0.25-4.34; P=.02), and those with adequate fruit and vegetable intake (3.25 years; 95% CI 1.29-6.81; P=.01). In addition, nonsmokers experienced a significant reduction in annual health care expenditure (-9.78%; 95% CI -46.53% to -1.45%; P=.03), as did individuals maintaining optimal body weight (-18.36%; 95% CI -29.66% to -8.57%; P=.01). Overall, participants adhering to all 5 healthy lifestyle behaviors exhibited a life gain of 7.13 years (95% CI 1.33-11.11; P=.02) compared with those adhering to one or none, with a life expectancy of 29.19 years (95% CI 25.45-33.62). Furthermore, individuals adopting all 5 healthy lifestyle factors experienced an average annual health care expenditure reduction of 28.12% (95% CI 4.43%-57.61%; P=.02) compared with those adopting one or none. CONCLUSIONS Adopting a healthy lifestyle is associated with a longer life expectancy and a reduction of health care expenditure in Taiwanese adults. This contributes to a more comprehensive understanding of the impact of healthy lifestyle factors on the overall health and economic burden.
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Affiliation(s)
- Wei-Cheng Lo
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, New Taipei, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsuey-Hwa Hu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Cheng-Yu Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Corry NH, Radakrishnan S, Williams CS, Woodall KA, Stander VA. Longitudinal association of health behaviors and health-related quality of life with military spouse readiness. BMC Public Health 2024; 24:1341. [PMID: 38762717 PMCID: PMC11102189 DOI: 10.1186/s12889-024-18786-2] [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] [Received: 10/30/2023] [Accepted: 05/07/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Unhealthy behaviors impose costs on health-related quality of life (HRQOL) reducing productivity and readiness among military members (Hoge et al., JAMA 295:1023-32, 2006; Mansfield et al. 362:101-9, 2010). Among married personnel in particular, patterns of spouse health behaviors may play an interdependent role. As a result, the identification of military spouse health factors related to readiness may inform strategies to screen for and identify those in need of greater support and enhance readiness. This study explored behavioral and HRQOL predictors and potential mediators of military spouse readiness utilizing data from the Millennium Cohort Family Study. METHODS The analytic sample comprised of 3257 spouses of active-duty, non-separated service members who responded to both waves 1 and 2 of the survey. Sample characteristics are described with respect to demographics (e.g., age, sex, race/ethnicity, etc.), readiness measures (i.e., military satisfaction, lost workdays, health care utilization, military-related stress, and satisfaction), health behaviors (i.e., exercise, sleep, smoking, and alcohol use) and HRQOL (Veterans RAND 12-Item Short Form Survey). We conducted multivariate mediation analyses to evaluate the role of mental and physical HRQOL as mediators between the baseline health behaviors and the health readiness outcomes at follow-up, while adjusting for spouse and service member demographics. RESULTS HRQOL had direct effects for all five readiness outcomes examined. Multiple health behaviors (insomnia, smoking, binge drinking, and exercise) were further significantly associated with spouse readiness outcomes, although most effects were mediated through HRQOL, suggesting this may be a useful index of military spouse readiness. Insomnia was the specific health behavior most consistently associated with poorer readiness across outcomes, and effects were only partially mediated by physical and mental HRQOL. CONCLUSIONS The results show spouse health behaviors are directly and indirectly (through HRQOL) associated with readiness indicators. This suggests that assessments of modifiable health behaviors (e.g., insomnia symptoms) and mental and physical HRQOL are important indicators of readiness among military spouses and should be used to inform future programs designed to improve population health.
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Affiliation(s)
- Nida H Corry
- Health Care Evaluation, NORC at the University of Chicago, Chicago, IL, USA
| | - Sharmini Radakrishnan
- Division of Health and Environment, Abt Associates, Rockville, MD, USA.
- , 10 Fawcett St, Cambridge, MA, 02138, USA.
| | | | - Kelly A Woodall
- , Leidos, Reston, VA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Valerie A Stander
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
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Krukowski RA, Solomon E, Lang J, Stone E, You W, Burns RE, Copeland C, Bursac Z, Hare ME, Waters TM. Overweight/obesity, gestational weight gain, postpartum weight retention, and maternal/neonatal complications in the military. Obesity (Silver Spring) 2024; 32:900-910. [PMID: 38650523 PMCID: PMC11164557 DOI: 10.1002/oby.24016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The objective of this study was to examine the prevalence of overweight/obesity and excessive gestational weight gain (GWG) among military beneficiaries and to assess associations of these risk factors with maternal/neonatal complications and substantial postpartum weight retention (PPWR). METHODS We obtained data for 48,391 TRICARE beneficiaries who gave birth in 2018 or 2019 in the United States. We used logistic regression and ANOVA to examine relationships among overweight/obesity, GWG, maternal/neonatal complications, and substantial PPWR. RESULTS Most TRICARE beneficiaries (75%) had excessive GWG, and 42% had substantial PPWR. Dependents were less likely than active-duty women to have excessive GWG (odds ratio [OR] = 0.73, 95% CI: 0.60-0.88). Women with excessive GWG were three times more likely to have substantial PPWR (OR = 3.57, 95% CI: 3.14-4.06). Those with excessive GWG were more likely to have maternal/neonatal complications (e.g., pregnancy-induced hypertension, cesarean delivery). CONCLUSIONS Excessive GWG is frequent among TRICARE beneficiaries, particularly active-duty personnel, and is strongly associated with costly maternal/neonatal complications. Substantial PPWR is also common in this population, with excessive GWG as a key risk factor.
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Affiliation(s)
- Rebecca A Krukowski
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Erin Solomon
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Juan Lang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | | | - Wen You
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Rosemary Estevez Burns
- 59th Medical Wing, Clinical Health Psychology, Joint Base San Antonio, Lackland, Texas, USA
| | - Carol Copeland
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- 59th Medical Wing, Clinical Health Psychology, Joint Base San Antonio, Lackland, Texas, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Teresa M Waters
- Augusta University, Institute for Public and Preventive Health, Augusta, Georgia, USA
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Pérez-Muñoz A, Hare ME, Andres A, Klesges RC, Wayne Talcott G, Little MA, Waters TM, Harvey JR, Bursac Z, Krukowski RA. A Postpartum Weight Loss-focused Stepped-care Intervention in a Military Population: A Randomized Controlled Trial. Ann Behav Med 2023; 57:836-845. [PMID: 37061829 PMCID: PMC10498817 DOI: 10.1093/abm/kaad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023] Open
Abstract
OBJECTIVE Postpartum weight retention is associated with adverse health among both civilian and military women. PURPOSE The current study evaluated a stepped-care weight management intervention, Moms Fit 2 Fight, adapted for use in a pregnant and postpartum military population. METHODS Active duty women and other TRICARE beneficiaries (N = 430) were randomized to one of three conditions: gestational weight gain only (GWG-only) intervention (n =144), postpartum weight loss only (PPWL-only) intervention (n =142), or a combined GWG + PPWL intervention (n = 144). Those participants who received the PPWL intervention (i.e., the PPWL-only and GWG+PPWL conditions) were combined consistently with the pre-registered protocol and compared to those participants who did not receive the PPWL intervention in the primary analyses. Primary outcome data (i.e., postpartum weight retention) were obtained at 6-months postpartum by unblinded data collectors, and intent-to-treat analyses were conducted. RESULTS Retention at 6-months postpartum was 88.4%. Participants who received the PPWL intervention retained marginally less weight (1.31 kg) compared to participants that received the GWG-only intervention (2.39 kg), with a difference of 1.08 kg (p = .07). None of the measured covariates, including breastfeeding status, were significantly associated with postpartum weight retention. Of the participants who received the PPWL intervention, 48.1% participants returned to their pre-pregnancy weight at 6-months postpartum, with no significant differences compared to those who received the GWG-only intervention. CONCLUSIONS A behavioral intervention targeting diet and physical activity during the postpartum period had a trend for reduced postpartum weight retention. CLINICAL TRIAL INFORMATION The trial is registered on clinicaltrials.gov (NCT03057808).
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Affiliation(s)
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aline Andres
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Nutrition Center, Little Rock, AR, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Gerald Wayne Talcott
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Teresa M Waters
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Jean R Harvey
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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Wonn J, Khan J. Evaluation of the Success of Weight Loss Programs Using the Fit for Performance Curriculum. Mil Med 2023; 188:e248-e253. [PMID: 34258614 DOI: 10.1093/milmed/usab287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/27/2021] [Accepted: 07/06/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Overweight and obesity rates continue to rise among U.S. Army soldiers, which impacts their overall readiness status and puts them at greater risk for musculoskeletal injury and development of chronic disease. To address the concern with obesity and ensure that Soldiers are meeting body composition standards, the Army offers Fit for Performance-Weight Loss Strategies curriculum, a program of standardized material on nutrition and physical activity presented over six 1-hour sessions. This study aimed to evaluate the success and attrition of weight loss programs using the Fit for Performance curriculum in an Army setting among TRICARE regions. MATERIALS AND METHODS This retrospective cohort study consolidated data on participants in weight loss programs using the Fit for Performance curriculum. It examines attrition rates, weight loss, change in body mass index (BMI), factors influencing weight loss, and attrition based on geographical location. Statistical analysis was completed using R Core Team software, version 3.6.1, for t-tests, linear regression, and analysis of variance. Significance was set at P ≤ .05. This study was determined to be exempt by the Walter Reed National Military Hospital Institutional Review Board. RESULTS In total, 8,336 U.S. Army soldiers (80% male, mean age = 26.2 ± 6.9 years) participated in the program. Attrition rates were high (96.4%). Those who attended 4-6 sessions lost significantly more weight than those who attended 1-3 sessions (0.72 kg [1.60 lbs], P < .001); however, weight lost was not clinically significant. Sex, age, and number of sessions attended influenced to the amount of weight lost, but only accounted for 4% of the variation. Among TRICARE regions there was a significant difference in attrition rates, with those in the Western (1.2 sessions, P < .001) and Overseas (1.6 sessions, P < .001) regions attending statistically fewer sessions than those in the Eastern region. CONCLUSIONS Consistent attendance in a weight loss program promotes changes in BMI, which may improve the health of the force. However, the factors influencing these changes are unclear. The results indicate opportunities to re-examine current processes and the program elements to encourage increased or complete participation and determine if program element changes are warranted for the Fit for Performance-Weight Loss Strategies Program. Attrition rates were high, indicating opportunities to research reasons for attendance and attrition in the future. Finally, these findings highlight an opportunity for educating the military leadership on the increased success with increased attendance.
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Affiliation(s)
- Jessica Wonn
- Nutrition Services Department, Education and Research Division, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Joetta Khan
- Nutrition Services Department, Education and Research Division, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
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Koltun KJ, Bird MB, Lovalekar M, Martin BJ, Mi Q, Nindl BC. Changes in eating pathology symptoms during initial military training in men and women and associations with BMI and injury risk. Eat Behav 2023; 48:101687. [PMID: 36463664 DOI: 10.1016/j.eatbeh.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
Nutritional fitness, which comprises food choices, meal timing, and dietary intake behaviors, is an important component of military service member health and performance that has garnered recent attention. This study utilized generalized linear mixed effects modeling (GLMM) to investigate changes in eating pathology symptoms in men and women during initial military training (Marine Corps Officer Candidates School (OCS)). Associations among eating pathology, musculoskeletal injury risk and BMI were also assessed. This investigation includes data from the Eating Pathology Symptoms Inventory (EPSI) and BMI at the start of OCS (n = 598: Male n = 469, Female n = 129) and end of the 10-week program (n = 413: Male n = 329, Female n = 84), and injury surveillance throughout. At baseline, female candidates presented with greater body dissatisfaction, binge eating, purging, and restricting, but lower negative attitudes toward obesity compared to male candidates (p < 0.001). Eating symptoms changed during military training indicated by decreased body dissatisfaction in women (p = 0.003), decreased excessive exercise and negative attitudes toward obesity in men (p < 0.001), decreased cognitive restraint (p < 0.001), restricting (p < 0.001), purging (p = 0.013), and muscle building (p < 0.001) and increased binge eating (p < 0.001) in both sexes. Changes in restricting were significantly related to changes in BMI during training (p < 0.05). The likelihood of future injury was 108 % higher in female candidates than males and decreased by 5 % for each unit increase in excessive exercise. Eating attitudes and behaviors change during military training environments and are associated with military health and readiness outcomes including BMI and injury risk.
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Affiliation(s)
- Kristen J Koltun
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA.
| | - Matthew B Bird
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Mita Lovalekar
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Brian J Martin
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Qi Mi
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
| | - Bradley C Nindl
- Neuromuscular Research Laboratory/Warrior Human Performance Research Center, Department of Sports Medicine and Nutrition, University of Pittsburgh, 3860 S. Water St., Pittsburgh, PA 15203, USA
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Estevez Burns R, Hare ME, Andres A, Klesges RC, Talcott GW, LeRoy K, Little MA, Hyrshko‐Mullen A, Waters TM, Harvey JR, Bursac Z, Krukowski RA. An interim analysis of a gestational weight gain intervention in military personnel and other TRICARE beneficiaries. Obesity (Silver Spring) 2022; 30:1951-1962. [PMID: 36041980 PMCID: PMC9804329 DOI: 10.1002/oby.23523] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Despite military fitness regulations, women in the military frequently experience overweight/obesity, excessive gestational weight gain (GWG), and the postpartum implications. This interim analysis of the Moms Fit 2 Fight study examines GWG outcomes among active-duty personnel and other TRICARE beneficiaries who received a stepped-care GWG intervention compared with those who did not receive a GWG intervention. METHOD Participants (N = 430; 32% identified with an underrepresented racial group, 47% were active duty) were randomized to receive a GWG intervention or the comparison condition, which did not receive a GWG intervention. RESULTS Retention was 88% at 32 to 36 weeks' gestation. Participants who received the GWG intervention gained less weight compared with those who did not (mean [SD] = 10.38 [4.58] vs. 11.80 [4.87] kg, p = 0.0056). Participants who received the intervention were less likely to have excessive GWG compared with those who did not (54.6% vs. 66.7%, p = 0.0241). The intervention effects were significant for participants who identified as White, but not for those of other racial identities. There were no significant differences between the conditions in maternal/neonatal outcomes. CONCLUSIONS The intervention successfully reduced excessive GWG, particularly among participants who identified as White. Should this intervention be found cost-effective, it may be sustainably integrated throughout the military prenatal care system.
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Affiliation(s)
| | - Marion E. Hare
- Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Aline Andres
- University of Arkansas for Medical Sciences and Arkansas Children's Nutrition CenterLittle RockArkansasUSA
| | - Robert C. Klesges
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Gerald Wayne Talcott
- Wilford Hall Ambulatory Surgical CenterLackland Air Force BaseTexasUSA
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Karen LeRoy
- Wilford Hall Ambulatory Surgical CenterLackland Air Force BaseTexasUSA
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Melissa A. Little
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | | | - Teresa M. Waters
- Department of Health Management and PolicyUniversity of KentuckyLexingtonKentuckyUSA
| | - Jean R. Harvey
- Department of Nutrition and Food SciencesUniversity of VermontBurlingtonVermontUSA
| | - Zoran Bursac
- Department of BiostatisticsFlorida International UniversityMiamiFloridaUSA
| | - Rebecca A. Krukowski
- Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
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Morse JL, Dochat C, Wooldridge JS, Herbert MS, Materna K, Blanco BH, Hernandez J, Afari N. Baseline Characteristics and Their Associations with Body Composition of Active-Duty Service Members Enrolling in a Randomized Controlled Trial of a Weight Management Program. Mil Med 2022:usac242. [PMID: 35960850 DOI: 10.1093/milmed/usac242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/20/2022] [Accepted: 07/28/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Increasing rates of overweight and obesity among military service members (SMs) necessitate the implementation of weight management interventions. Evidence for the effectiveness of military weight management interventions is mixed. Effectiveness may be impacted by individual sociodemographic, psychiatric, psychological, and behavioral factors. Baseline data from SMs who were overweight/obese or at risk of failing body composition or physical fitness tests and enrolling in a weight management randomized controlled trial were used to examine (1) individual characteristics of this sample as a whole and by gender and (2) relationships between those characteristics and body composition metrics that are targeted by military weight management interventions. Understanding these relationships may inform intervention approaches. MATERIALS AND METHODS Active duty SMs (N = 178) who enrolled in a randomized clinical trial of the Navy's weight management program "ShipShape" at a large military hospital provided data at their baseline visit. Because of gender differences in average body fat percentage (BF%) and underrepresentation of women SMs in research, independent samples t-tests and chi-square analyses were used to examine differences between male and female SMs across study variables. Multiple regression analyses were used to examine relationships of sociodemographic, psychiatric, psychological, and behavioral variables with body composition metrics, including weight, body mass index (BMI), BF%, and waist circumference (WC). RESULTS Participants (61% female; Mage = 29.66 ± 6.92 years; 59.60% White) had an average BMI in the "obese" range (MBMI = 33.1 ± 3.9 kg/m2). Female participants had significantly higher BF% and significantly lower weight and WC than male participants. Compared to male participants, females reported significantly higher rates of pain and headache diagnoses, lifetime diagnosis of an anxiety disorder, lifetime treatment for a mental health concern, lifetime experiences of sexual trauma/harassment and military sexual trauma, and higher current anxiety and post-traumatic stress disorder symptoms. Across all SMs, body composition metrics were significantly associated with several demographic variables, including gender, age, marital status, Asian race, and Black race. Higher weight-related stigma was significantly associated with higher weight, BMI, BF%, and WC. Additionally, more emotional eating was significantly associated with higher BF%, and higher weight-loss confidence was significantly associated with higher BMI. Sociodemographic, psychiatric, psychological, and behavioral variables predicted the greatest variance in BF% compared to other body composition metrics evaluated. CONCLUSIONS Participants in this study were more likely to be female, relatively young members of the Navy with overweight/obesity, who endorsed pain-related medical conditions, probable mental health conditions, and traumatic experiences at relatively high rates. Despite high endorsement of anxiety, depression, and post-traumatic stress disorder symptoms in this group, only weight-related stigma consistently emerged as significantly associated with body composition metrics. Regression results varied by body composition metric, with the most variance explained in BF%, suggesting that BF% may relate most strongly to sociodemographic, psychiatric, psychological, and behavioral variables associated with weight management. These results highlight the need for weight management programs that address weight-related stigma and mental health concerns of SMs to maximize the effectiveness of intervention efforts.
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Affiliation(s)
- Jessica L Morse
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
| | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA 92093, USA
| | - Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Karla Materna
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Brian H Blanco
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | | | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA
- Department of Psychiatry, University of California, San Diego, CA 92093, USA
- VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
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“It Depends on Where You Are and What Job You Do”: Differences in Tobacco Use across Career Fields in the United States Air Force. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148598. [PMID: 35886449 PMCID: PMC9323384 DOI: 10.3390/ijerph19148598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 02/04/2023]
Abstract
While tobacco use within the military is often discussed as being homogenously part of U.S. military culture, literature from civilian populations highlights that tobacco use varies by career field (e.g., “white collar” vs. “blue collar”). The objective of this qualitative study was to compare tobacco use by career fields in the U.S. Air Force. Airmen, Military Training Instructors, and Technical Training Instructors participated in 22 focus groups across five major Air Force Technical Training bases. Focus groups were conducted in-person using semi-structured interview guides and were audio-recorded. A conventional content-coding approach was used to code transcripts. Participants described substantial variation across the careers, which was attributed to social norms and the nature of jobs. Individuals in careers that spend most of their time outside were more likely to permit tobacco use. Conversely, tobacco use was seen as stigmatized in medical fields. Additionally, smokeless tobacco was identified as popular in certain careers because it could be used covertly on the job. Findings suggest that a one-size-fits-all approach to reducing tobacco use through policies and programs may not reflect the realities of military tobacco use. These findings may provide insights into other branches of the U.S. military with similar career fields.
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Speed S, Branscum P, Gresla A. Comparing Predictors of Intention for Physical Activity Participation between Normal and Overweight Military Spouses. AMERICAN JOURNAL OF HEALTH EDUCATION 2022. [DOI: 10.1080/19325037.2022.2071363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Carey FR, Jacobson IG, Roenfeldt KA, Rull RP. Association of deployment with maintenance of healthy weight among active duty service members in the Millennium Cohort Study. Obes Sci Pract 2022; 8:247-253. [PMID: 35388350 PMCID: PMC8976537 DOI: 10.1002/osp4.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/15/2022] Open
Abstract
Objective Understanding body size in relation to deployment readiness can inform Department of Defense fitness policies. This study examined longitudinal associations between deployment and changes in body mass index (BMI) among active duty service members. Methods Service branch-specific changes in BMI post-deployment were examined using logistic regression models among active duty Millennium Cohort Study participants without obesity at baseline (n = 22,995). BMI was categorized using self-reported height and weight as healthy weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (≥30 kg/m2). Number of deployments between baseline and follow-up and initial deployment lengths (in months, using service branch-specific deployment times) were examined. Results Among the pooled population and specifically Army and Marine Corps service members without obesity, those with longer deployments were significantly less likely to maintain a non-obese BMI than those deploying for shorter lengths. Each additional deployment increased the likelihood of maintaining a non-obese BMI post-deployment for personnel in the Army, Marine Corps, and within the pooled population. Conclusions Multiple deployments may support healthy weight maintenance; longer deployments may adversely impact weight maintenance. Future research should determine modifiable behaviors related to weight gain post-deployment to inform fitness policies designed to optimize service member readiness and deployability.
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Affiliation(s)
- Felicia R. Carey
- Deployment Health Research DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
- Leidos, Inc.San DiegoCaliforniaUSA
| | - Isabel G. Jacobson
- Deployment Health Research DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
- Leidos, Inc.San DiegoCaliforniaUSA
| | - Kimberly A. Roenfeldt
- Deployment Health Research DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
- Leidos, Inc.San DiegoCaliforniaUSA
| | - Rudolph P. Rull
- Deployment Health Research DepartmentNaval Health Research CenterSan DiegoCaliforniaUSA
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12
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Miggantz EL, Materna K, Herbert MS, Golshan S, Hernandez J, Peters J, Delaney E, Webb-Murphy J, Wisbach G, Afari N. Characteristics of Active Duty Service Members Referred to the Navy's Weight-Management Program. Mil Med 2021; 188:e174-e181. [PMID: 34910186 PMCID: PMC9825239 DOI: 10.1093/milmed/usab523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/15/2021] [Accepted: 12/08/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Rates of overweight and obesity have increased in the military, particularly in the U.S. Navy. While the Navy has implemented weight-management programs like ShipShape, findings on the effectiveness of these programs are mixed. Further knowledge on the characteristics of service members (SMs) who participate in these programs may help inform course curricula and improve outcomes. This study aimed to (1) examine characteristics of SMs referred to the Navy's ShipShape program at a large military treatment facility, (2) compare these characteristics among SMs who did and did not enroll in a randomized clinical trial of ShipShape (ShipShape study participants), and (3) compare demographic and health characteristics of ShipShape study participants to that of a random and similarly sized sample of Navy SMs who responded to the 2015 DoD Health-Related Behaviors Survey (HRBS). MATERIALS AND METHODS Data from active duty Navy SMs referred to the ShipShape program at a large military treatment facility were evaluated (n = 225). A subset of these SMs enrolled in the ShipShape study (n = 187). Among enrolled SMs, data from 147 who completed all measures were compared to that of HRBS respondents. Univariate ANOVA and chi-square analyses were used to examine (1) demographic and motivational differences between SMs who did and did not enroll in the ShipShape study and (2) differences in demographics and medical and mental health conditions between ShipShape study participants and Navy HRBS respondents. RESULTS The majority of SMs referred to ShipShape were female with an average age of 28.3 years. Compared to SMs who did not enroll in the ShipShape study (n = 38), ShipShape study participants were more likely to be female, less likely to be Hispanic, and had higher motivation and emotional eating scores. Compared to Navy HRBS respondents (n = 164), ShipShape study participants (n = 147) were younger, more likely to be female, non-Hispanic, enlisted, and obese. Further, ShipShape study participants reported significantly fewer medical health conditions but higher rates of probable depression, anxiety, and PTSD and were more likely to report receiving current mental health treatment than HRBS respondents. CONCLUSION Overweight or obese SMs seeking weight loss in the ShipShape study were relatively young, female, non-Hispanic, motivated, but with greater emotional eating. ShipShape study participants endorsed few medical health conditions but had higher rates of probable mental health conditions compared to the HRBS sample. These findings suggest that SMs referred to Navy weight-management programs are likely experiencing comorbid mental health conditions which may interfere with the effectiveness of their weight loss efforts. The descriptive nature of this study and the focus on Navy SMs in only one ShipShape program may decrease the generalizability of our findings to participants at other locations. Nonetheless, these findings demonstrate the potential need for Navy weight-management programs that incorporate mental health treatment and address the specific needs of female and diverse SMs. A more comprehensive curriculum could improve the results of weight-management efforts, increase SM quality of life and fitness and thereby operational readiness.
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Affiliation(s)
| | - Karla Materna
- VA San Diego Healthcare System, San Diego, CA 92161, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, La Jolla, CA 92093, USA,VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
| | - Shahrokh Golshan
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, La Jolla, CA 92093, USA
| | | | - Joshua Peters
- Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Eileen Delaney
- Naval Center for Combat & Operational Stress Control, San Diego, CA 92134, USA
| | | | - Gordon Wisbach
- Navy Medicine Readiness and Training Command, San Diego, CA 92134, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, CA 92161, USA,Department of Psychiatry, University of California, La Jolla, CA 92093, USA,VA Center of Excellence for Stress and Mental Health, San Diego, CA 92161, USA
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13
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Cigarette smoking patterns among U.S. military service members before and after separation from the military. PLoS One 2021; 16:e0257539. [PMID: 34606513 PMCID: PMC8489722 DOI: 10.1371/journal.pone.0257539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/03/2021] [Indexed: 11/28/2022] Open
Abstract
U.S. military Service members have consistently smoked more than the general population and the prevalence of smoking is even higher among U.S. veterans. Our study examined cigarette smoking patterns among Service members before and after military separation to better understand the disproportionate rate of smoking among veterans. Data from the Millennium Cohort Study were used. All study participants were in the military at baseline and some transitioned from the military to civilian life during the observation period. We investigated any impact of military separation on smoking, as well as other potential risk factors for smoking. Overall, we observed higher smoking prevalence among veterans than Service members. Additionally, we found that Service members smoked more while approaching their separation from the military. Longitudinal analysis revealed military separation was not a risk factor for smoking, as we had hypothesized. Baseline smoking was the most influential predictor of current smoking status. Other significant factors included alcohol consumption, life stressors, and mental health conditions, among others. Military separation was not a risk factor for smoking. However, Service members in the process of transitioning out of the military, as well as high alcohol consumers and Service members with mental health conditions, may be at higher risk of smoking. Including smoking prevention/cessation programs in pre-separation counseling sessions and developing smoking screening and cessation programs targeting specific high-risk subgroups may reduce smoking among Service members and veterans.
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14
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Dunbar MS, Nicosia N, Kilmer B. Estimating the impact of state cigarette tax rates on smoking behavior: Addressing endogeneity using a natural experiment. Drug Alcohol Depend 2021; 225:108807. [PMID: 34182370 PMCID: PMC8354028 DOI: 10.1016/j.drugalcdep.2021.108807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/26/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Cigarette excise taxes are a well-established policy lever for reducing tobacco use. However, estimating the effect of taxes on smoking behavior can be confounded by endogeneity concerns such as selection. This study leverages a unique natural experiment -compulsory relocation of U.S. military service members to installations - to estimate the relationship between state cigarette taxes and smoking behavior without concerns about selection into environments. METHODS The current study uses data from the Department of Defense's 2011 Health-Related Behaviors Survey and 2011 state cigarette excise taxes from the CDC STATE System. Logistic and Poisson regression analyses estimate the cross-sectional associations between state cigarette excise taxes and the following smoking behaviors: current cigarette smoking, frequency of smoking, heaviness of consumption, and cigarette cessation among individuals who smoked while at the current installation. RESULTS Higher taxes are associated with lower odds of current cigarette smoking (AOR = 0.94; 95 % CI: 0.89-0.98), fewer smoking days per month among current cigarette smokers (IRR = 0.98, 95 % CI 0.97-0.996), and higher likelihood of quitting smoking among individuals who had smoked at their current installation (AOR = 1.14, 95 % CI 1.05-1.25). Taxes are not associated with the number of cigarettes smoked per day among current smokers. CONCLUSIONS Exogenous assignment to installations in states with higher cigarette taxes is associated with lower likelihood of smoking and greater likelihood of quitting. Findings provide novel evidence in support of a causal impact of cigarette taxes on lower smoking levels among adults.
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Affiliation(s)
- Michael S Dunbar
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA, 15213, USA.
| | - Nancy Nicosia
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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15
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Kline MDA, Daniels C, Xu X, Sunil T, Ganesan A, Agan BK, Colombo RE, Kronmann KC, Blaylock JM, Okulicz JF, Markelz AE. Antiretroviral Therapy Anchor-based Trends in Body Mass Index Following Treatment Initiation Among Military Personnel with HIV. Mil Med 2021; 186:279-285. [PMID: 33128552 DOI: 10.1093/milmed/usaa416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/30/2020] [Accepted: 09/25/2020] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Weight gain and obesity in people living with HIV have been associated with increased risk for non-AIDS-related comorbidities, and integrase strand transfer inhibitor (INSTI)-based regimens may lead to comparatively more weight gain than other regimens. We evaluated body mass index (BMI) following antiretroviral therapy (ART) initiation among participants in the U.S. Military HIV Natural History Study (NHS). MATERIALS AND METHODS NHS participants with available baseline weight and height data initiating ART from 2006 to 2017 were considered for analysis. Antiretroviral therapy was categorized by anchor class to include INSTIs, non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). Linear growth-curve modeling was used to predict BMI changes from ART initiation through 2 years of follow-up in participants stratified by baseline BMI (<25 vs ≥25 kg/m2) at ART start and anchor drug class. These models were adjusted for demographic- and HIV-related characteristics. RESULTS Of 961 NHS participants started on initial ART between 2006 and 2017, 491 men who had available baseline BMI data and were virally suppressed (<200 c/mL) at 1 and 2 years of follow-up were included. Overall, the predicted BMI increased at each time point over 2 years regardless of baseline BMI. There was a trend toward less weight gain for non-INSTI regimens regardless of demographic- or HIV-related factors (-0.65 kg/m2/yr, P = .070). In participants with BMI <25, all regimens were associated with BMI gains except in those with high viral load (≥100,000 copies/mL) started on PI regimens (-1.91 kg/m2/yr, P = .000; n = 13). For those participants with BMI ≥25, only INSTI- and PI-based regimens were significantly associated with increased BMI (INSTI 0.54 kg/m2/y, P = .000; PI 0.39 kg/m2/yr, P = .006). Non-nucleoside reverse transcriptase inhibitors were not associated with weight gain regardless of race- or HIV-related characteristics. African Americans with BMI ≥25 were more likely to gain weight as compared to Whites (0.99 kg/m2/yr, P = .016). Specific anchor drug-based predictions revealed that only INSTI use among African Americans was significantly associated with BMI gains (1.85 kg/m2/yr, P = .007); NNRTI- and PI-related weight change was not significant as compared to Whites. CONCLUSIONS In our cohort of young military members with HIV infection, those with BMI <25 experienced BMI gains across all ART classes. Among those with BMI ≥25, African Americans on INSTI regimens had the greatest BMI gains. Further studies are needed to determine whether NNRTI regimens should be considered in certain individuals at risk for INSTI-associated weight gain.
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Affiliation(s)
| | - Colton Daniels
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Xiaohe Xu
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Thankam Sunil
- University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD 20852, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.,Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Brian K Agan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD 20852, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA
| | - Rhonda E Colombo
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD 20852, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.,Madigan Army Medical Center, Tacoma, WA 98431, USA
| | | | - Jason M Blaylock
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Jason F Okulicz
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD 20852, USA
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16
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Cognitive disinhibition and infrequent moderate-to-intense physical activity linked with obesity in U.S. soldiers. Eat Weight Disord 2021; 26:973-981. [PMID: 32476104 DOI: 10.1007/s40519-020-00932-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 05/16/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To explore the relationship between body weight status and neurocognitive functioning in soldiers. METHODS U.S. soldiers (N = 109) answered survey questions and completed neurocognitive tests including simple reaction time, code substitution, procedural reaction time, go-no-go, matching to sample, code substitution recall, and four versions of the Stroop test including congruent (color and meaning of word agreed); incongruent (color and meaning of word differed); neutral (nonsense words appeared), and emotional (combat-related words such as "I.E.D" and "convoy" appeared). Self-reported heights and weights were used to calculate BMI. A BMI ≥ 30.00 kg/m2 was categorized as obese. Multivariate analysis of variance was used to analyze weight status differences (p ≤ 0.05) across neurocognitive variables. Binomial logistic regression analysis with obesity as the dependent variable was used to ascertain the contributions (p ≤ 0.05) of exercise and the neurocognitive measures that differed based on weight status. RESULTS Twenty-nine participants (26.6%) were obese. The obese group had significantly lower scores on code substitution, and both neutral and emotional Stroop tasks. Only Stroop emotional scores, p = 0.022, OR = 0.97, and frequency of moderate/intense physical activity, p = 0.009, OR = 0.10, were significant predictors of weight status. CONCLUSIONS Obesity was associated with less frequent moderate/intense physical activity and compromised executive functioning, namely decrements in response inhibition. Given the design and sample size, additional research is needed to better understand the direction of the relationship between these variables and to inform research related to the treatment and prevention of obesity within military populations. LEVEL OF EVIDENCE Level III, case-control analytic study.
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17
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George BG, Pruziner AL, Andrews AM. Circumference Method Estimates Percent Body Fat in Male US Service Members with Lower Limb Loss. J Acad Nutr Diet 2021; 121:1327-1334. [PMID: 33744234 DOI: 10.1016/j.jand.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 01/30/2021] [Accepted: 02/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The Department of Defense circumference method (CM) is used to estimate percent body fat (%BF) in evaluation of health, physical fitness, appearance, and military readiness; however, the CM has not been validated in individuals with lower limb loss. OBJECTIVE To evaluate the agreement between CM and dual-energy X-ray absorptiometry (DXA) for measuring %BF in individuals with lower limb loss. DESIGN This study is part of a larger cross-sectional comparison study, and this analysis was included as a secondary objective. Two methods of measuring %BF included CM and DXA, with DXA as the reference standard for this study. PARTICIPANTS/SETTING This study was conducted at Walter Reed Army Medical Center. Data were collected from summer 2010 to summer 2011. One hundred individuals, 50 with and 50 without lower limb loss, were screened for this study; three individuals with limb loss and two without limb loss had incomplete data, and one individual (female, without limb loss) lacked a comparison participant. All participants were recruited from a military medical center, and data were collected in a clinic research laboratory. MAIN OUTCOME MEASURES Measurements of %BF were compared between methods for each group. STATISTICAL ANALYSES PERFORMED Measurements of %BF were compared using paired t-tests and intraclass correlation coefficient. Agreement and bias were assessed with Bland-Altman analysis. Receiver operating characteristic analysis was used to determine the diagnostic accuracy of the CM to identify participants with %BF levels in the obese category (≥25%). RESULTS A statistically significant difference was found between %BF methods in the group with limb loss (1.7%; P = 0.001) and the group without limb loss (1.4%; P = 0.005), with DXA consistently higher than CM. However, the intraclass correlation coefficient estimates for the agreement between %BF by CM and DXA were 0.848 (95% confidence interval [CI]: 0.683-0.922; P < 0.001) and 0.828 (CI: 0.679-0.906; P < 0.001), for the groups with and without limb loss, respectively, suggesting that CM has good to near excellent agreement with DXA for estimating %BF in these groups. Receiver operating characteristic analysis indicated that the area under the curve supported predictive ability to detect obesity-based %BF in males with and without limb loss. CONCLUSIONS Although a statistically significant difference was found between methods for individuals with limb loss, there was also good agreement between the methods, suggesting that CM may be a useful tool for estimating %BF in individuals with lower limb loss. The CM may be a useful and field expedient method for assessing %BF in a clinical setting when DXA is not available.
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18
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Hruby A, Lieberman HR, Smith TJ. Symptoms of depression, anxiety, and post-traumatic stress disorder and their relationship to health-related behaviors in over 12,000 US military personnel: Bi-directional associations. J Affect Disord 2021; 283:84-93. [PMID: 33524663 DOI: 10.1016/j.jad.2021.01.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/29/2020] [Accepted: 01/10/2021] [Indexed: 12/23/2022]
Abstract
Background Military personnel are at greater risk of psychological disorders and related symptoms than civilians. Limited participation in health-promoting behaviors may increase presence of these disorders. Alternatively, these symptoms may limit engagement in health-promoting behaviors. Methods Self-reported data from the 2015 Department of Defense Health Related Behaviors Survey were used to assess bi-directional relationships between health-related behaviors (obesity, physical activity [PA], alcohol, smoking, sleep) and self-reported psychological disorders (generalized anxiety disorder [GAD], depression, post-traumatic disorder [PTSD]) in U.S. military personnel. Outcomes Among 12 708 respondents (14.7% female; 28.2% 17-24 y; 13.7% obese), self-reported depression was reported by 9.2%, GAD by 13.9%, and PTSD by 8.2%. Obesity and short sleep were associated with self-reported depression, GAD, and PTSD; current smoking was associated with higher odds of GAD; higher levels of vigorous PA were associated with lower odds of GAD; higher levels of moderate PA associated with lower odds of PTSD; and higher alcohol intake associated with higher odds of depression and PTSD. Self-reported depression, GAD, and PTSD were associated with higher odds of short sleep, obesity, and low levels of PA. Interpretation Obesity, short sleep, and limited engagement in health-promoting behaviors are associated with higher likelihood of self-reported psychological disorders, and vice-versa. Encouraging and improving health-promoting behaviors may contribute to positive mental health in military personnel.
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Affiliation(s)
- Adela Hruby
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, United States; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, United States; Tufts University School of Medicine, Department of Public Health and Community Medicine, and Tufts University Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Boston, MA, United States
| | - Harris R Lieberman
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Tracey J Smith
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, Natick, MA, United States.
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19
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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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20
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Popovic S, Banjevic B, Masanovic B, Bjelica D. Body Mass Index and Measures of Body Fat for Defining Obesity and Underweight: A Cross-Sectional of Various Specialties in Montenegrin Army Soldiers. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:2376-2383. [PMID: 34178744 PMCID: PMC8215063 DOI: 10.18502/ijph.v49i12.4821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: The body composition and physical fitness of members of the army is always a relevant topic for research, since the level of defense and security of people and material goods in a specific territory in many ways depends on the level of ability of the army. However, members of the armed forces are a heterogeneous group, typified by different abilities, characteristics, but also everyday needs, and the trend of changing body composition and reducing physical fitness is a current issue that has not bypassed this population either. Therefore, this study aimed to determine possible differences in body composition indicators that could appear between members of the Army of Montenegro of different military specialties. Methods: The sample of respondents included 240 Montenegrin male soldiers (32.5yr±9.5), who were measured at the sports dispensaries within the barracks of Montenegrin Army around the country in the spring of 2020, was classified into eight numerically equal subsamples according to their military specialty. The sample of variables included five anthropometric measures, which were necessary to calculate two derived body composition indicators: Body Mass Index (BMI) and Body Fat Percentage (FAT %). Using the one-way ANOVA and Post Hoc test with Taki’s model, the variables were analyzed. Results: It was determined that the body composition of Montenegrin soldiers shows a certain peculiarity compared to other national military corps, while there are differences in body composition indicators between members of the Montenegrin Army of different military specialties. Conclusion: This fact dramatically strengthens the issues of Montenegrin distinctive regarding body composition, both in general terms and in terms of distinctive within specific professional vocations.
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Affiliation(s)
- Stevo Popovic
- Faculty for Sport and Physical Education, University of Montenegro, Niksic, Montenegro.,Montenegrin Sports Academy, Podgorica, Montenegro
| | - Boris Banjevic
- Army of Montenegro, Airforce Military of Montenegro, Podgorica, Montenegro
| | - Bojan Masanovic
- Faculty for Sport and Physical Education, University of Montenegro, Niksic, Montenegro.,Montenegrin Sports Academy, Podgorica, Montenegro
| | - Dusko Bjelica
- Faculty for Sport and Physical Education, University of Montenegro, Niksic, Montenegro.,Montenegrin Sports Academy, Podgorica, Montenegro
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21
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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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22
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Shank LM, Higgins Neyland MK, Lavender JM, Schindler R, Solomon S, Hennigan K, Leu W, Schvey NA, Sbrocco T, Jorgensen S, Stephens M, Olsen CH, Haigney M, Klein DA, Quinlan J, Yanovski JA, Tanofsky-Kraff M. Sex differences in metabolic syndrome components in adolescent military dependents at high-risk for adult obesity. Pediatr Obes 2020; 15:e12638. [PMID: 32286006 PMCID: PMC8183113 DOI: 10.1111/ijpo.12638] [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] [Received: 01/30/2020] [Revised: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Metabolic syndrome in adolescence has been associated with adverse cardiometabolic outcomes in adulthood. Preliminary data suggest that boys may have worsened metabolic syndrome components compared to girls. Yet, little is known about the physical health of military dependents, a potentially at-risk population. OBJECTIVE Examine sex differences in metabolic syndrome components in a sample of adolescent military dependents. METHODS Participants were adolescents (N = 139; 14.4 ± 1.6 years; 45.3% male; 41.0% non-Hispanic White, 19.4% non-Hispanic Black; BMI-z: 1.9 ± 0.4) at-risk for adult obesity and binge-eating disorder due to an age- and sex-adjusted BMI ≥85th percentile and loss-of-control eating and/or elevated anxiety. A multivariate analysis of covariance was conducted to compare objectively measured metabolic syndrome components across boys and girls. Covariates were age, race, loss-of-control eating status, anxiety symptoms, and BMI-z. RESULTS Metabolic syndrome components differed by sex (P = .01). Boys had higher systolic blood pressure (P = .049), lower high-density lipoprotein cholesterol (P = .01), and higher glucose (P = .001) than girls. Waist circumference, diastolic blood pressure, and triglycerides did not differ between boys and girls (P > .05). CONCLUSIONS Future research should prospectively examine these relationships into adulthood. If the current findings are supported, prevention programs should consider targeting cardiometabolic health particularly among male adolescent military dependents.
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Affiliation(s)
- Lisa M. Shank
- Department of Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Metis Foundation, San Antonio, Texas,Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland
| | - M. Katy Higgins Neyland
- Department of Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Metis Foundation, San Antonio, Texas
| | - Jason M. Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Metis Foundation, San Antonio, Texas
| | - Rachel Schindler
- Department of Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Metis Foundation, San Antonio, Texas
| | - Senait Solomon
- Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Department of Medical and Clinical Psychology, USU, Bethesda, Maryland,The Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), Bethesda, Maryland
| | - Kathrin Hennigan
- Department of Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Metis Foundation, San Antonio, Texas
| | - William Leu
- Department of Medical and Clinical Psychology, USU, Bethesda, Maryland
| | - Natasha A. Schvey
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland,Department of Medical and Clinical Psychology, USU, Bethesda, Maryland
| | - Tracy Sbrocco
- Department of Medical and Clinical Psychology, USU, Bethesda, Maryland
| | | | - Mark Stephens
- Pennsylvania State University, State College, Pennsylvania
| | - Cara H. Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - Mark Haigney
- Department of Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - David A. Klein
- Department of Family Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, Maryland
| | - Jeffrey Quinlan
- Department of Family Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland
| | - Jack A. Yanovski
- Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland
| | - Marian Tanofsky-Kraff
- Department of Medicine, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Military Cardiovascular Outcomes Research (MiCOR) Program, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Section on Growth and Obesity, Program in Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, DHHS, Bethesda, Maryland,Department of Medical and Clinical Psychology, USU, Bethesda, Maryland
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23
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Fahey MC, Klesges RC, Kocak M, Talcott GW, Krukowski RA. Seasonal fluctuations in weight and self-weighing behavior among adults in a behavioral weight loss intervention. Eat Weight Disord 2020; 25:921-928. [PMID: 31093925 PMCID: PMC6856417 DOI: 10.1007/s40519-019-00707-7] [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] [Received: 08/09/2018] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The current study aimed to observe potential seasonal fluctuations in weight and self-weighing behavior among a diverse sample of adults engaged in a behavioral weight loss intervention. METHODS Active duty personnel (N = 248) were randomized to either a counselor-initiated or self-paced 12-month behavioral weight loss intervention promoting daily self-weighing. Body weight and self-weighing frequency were collected from electronic scales (e-scales) provided at baseline. RESULTS Overall, participants lost weight from winter to spring (p = 0.02) and gained weight from fall to winter (p < 0.001). No demographic differences in weight changes were observed. Participants self-weighed less frequently during summer compared to spring (p < 0.0001), less in fall compared to summer (p < 0.0001), and less in winter compared to fall (p < 0.0001). In multivariate models, weight change and self-weighing frequency during the previous season, as well as days since randomization and intervention intensity were associated with seasonal weight changes. CONCLUSIONS This study is the first to observe seasonal fluctuations of weight and self-weighing behavior among adults actively engaged in a weight loss intervention, consistent with research in the general population. Findings highlight the importance of acknowledging seasonal influence within weight loss programs and trials. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Margaret C Fahey
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN, 38111, USA.
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street, Memphis, TN, 38105, USA
- Department of Public Health Sciences, School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street, Memphis, TN, 38105, USA
| | - Gerald W Talcott
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street, Memphis, TN, 38105, USA
- Department of Public Health Sciences, School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street, Memphis, TN, 38105, USA
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24
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Shiozawa B, Madsen C, Banaag A, Patel A, Koehlmoos T. Body Mass Index Effect on Health Service Utilization Among Active Duty Male United States Army Soldiers. Mil Med 2020; 184:447-453. [PMID: 30811530 DOI: 10.1093/milmed/usz032] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/10/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Obesity and overweight, defined as body mass index (BMI) of 30.0 and above or 25.0-29.9, respectively, are of significant concern to the military population, due to their associated comorbidities and potential for impaired readiness. In 2016, the US Army reported a prevalence of 17.3% obesity and 52.9% overweight among soldiers, despite both physical demands of the job and Department of Defense (DoD) guidelines which recommend separation from service for those unable to meet body composition standards. This study examines the health service utilization of active duty, male Army soldiers in order to determine the prevalence of obesity and overweight and to estimate the effects of these conditions on readiness. MATERIALS AND METHODS This was a cross-sectional study utilizing fiscal year (FY) 2015 TRICARE claims and military treatment facility (MTF) encounter data obtained from the Military Health System Data Repository (MDR), for 467,732 US Army male Soldiers on active duty. We obtained basic demographic information (age, race, and rank) from the Defense Enrollment Eligibility Reporting System (DEERS). Next, we calculated BMI for this cohort by matching patients to their vital statistics of height and weight measurements. Finally, we obtained their health service utilization by querying and matching patients to their healthcare claims in 2015 by major diagnostic category. FINDINGS More than half (51.2%) of subjects had overweight, 28.9% had normal weight, 19.7% had obesity, and less than 1% had underweight. Soldiers with overweight and obesity were most common among the 25-34 years age range and enlisted ranks. Normal weight and underweight soldiers had a median of 7 healthcare visits in FY 2015, compared with 8 for soldiers with overweight and 12 for those with obesity. Soldiers with obesity, but not overweight, had a disproportionately greater number of healthcare encounters for diagnostic categories including musculoskeletal; mental health; ear, nose, and throat; and endocrine system. In contrast, soldiers with obesity had disproportionately fewer healthcare encounters for multiple significant trauma and for infectious and parasitic diseases. CONCLUSIONS More than 70% of soldiers had overweight or obesity in FY 2015, showing the highest prevalence yet measured for these conditions. Previous reports of lower prevalence may be due to the inclusion of circumference-based body fat assessments, which have been criticized for inaccuracy. In our study, disproportionately high health service use by soldiers with obesity suggests decreased readiness, as these soldiers may experience both poorer health and lose necessary training time due to increased provider visits. Proportional usage by soldiers with overweight suggests the protective effect of regular physical activity, though these soldiers should be monitored to ensure that they do not progress to obesity. Additional research should establish the burden of cost, absenteeism, and presenteeism of obesity on the MHS, as well as developing more appropriate field tests for body fat assessment and BMI standards to better support military readiness.
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Affiliation(s)
- Brian Shiozawa
- Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Rd, Bethesda, MD
| | - Cathaleen Madsen
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD
| | - Amanda Banaag
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD
| | - Avni Patel
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD
| | - Tracey Koehlmoos
- Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Rd, Bethesda, MD
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25
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Taetzsch A, Gilhooly CH, Bukhari A, Das SK, Martin E, Hatch AM, Silver RE, Montain SJ, Roberts SB. Development of a Videoconference-Adapted Version of the Community Diabetes Prevention Program, and Comparison of Weight Loss With In-Person Program Delivery. Mil Med 2020; 184:647-652. [PMID: 31132088 PMCID: PMC6910883 DOI: 10.1093/milmed/usz069] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/14/2019] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Effective, standardized, and easily accessible weight management programs are urgently needed for military beneficiaries. Videoconference interventions have the potential for widespread scaling, and can provide both real time interaction and flexibility in delivery times regardless of location, but there is little information on their effectiveness and acceptability. MATERIALS AND METHODS This study as part of a larger weight loss trial describes the videoconference adaption of Group Lifestyle Balance (GLB) program, a community group-based Diabetes Prevention Program intervention, and provides a comparison of weight loss and meeting attendance between in-person and videoconference delivery modes over 12 weeks in adult family members of military service members. Forty-three participants were enrolled from two military installations and received either the videoconference-adapted or an in-person GLB program in a non-randomized trial design. Differences in program attendance and percent weight lost at 12 weeks were compared by independent samples t-tests and nonparametric methods. Group differences in the percentage of weight lost over the 12-week period were analyzed using a linear mixed model. RESULTS All GLB intervention components were successfully delivered by videoconference with minor adaptations for the different delivery mechanism. Participant retention was 70% and 96% in the in-person and videoconference groups, respectively (p = 0.04). Completing participants in both groups lost a significant percent body weight over the 12 week intervention (p < 0.001) and there was no difference in percent body weight after 12 weeks of intervention (6.2 ± 3.2% and 5.3 ± 3.4% for in-person and videoconference at 12 weeks, respectively; p = 0.60). CONCLUSION This study describes the first videoconference adaption of the GLB program for use in military families. Attrition was lower in the videoconference group, and there were a similar levels of weight loss in both groups regardless of delivery modality. Videoconference weight loss interventions are effective and feasible for scaling to support healthy weight management in military as well as civilian populations.
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Affiliation(s)
- Amy Taetzsch
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St Boston, MA 02111
| | - Cheryl H Gilhooly
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St Boston, MA 02111
| | - Asma Bukhari
- Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889
| | - Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St Boston, MA 02111
| | - Edward Martin
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St Boston, MA 02111
| | - Adrienne M Hatch
- U.S. Army Research Institute of Environmental Medicine, Military Nutrition Division, 10 General Greene Ave., Natick, MA 01760
| | - Rachel E Silver
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St Boston, MA 02111
| | - Scott J Montain
- U.S. Army Research Institute of Environmental Medicine, Military Nutrition Division, 10 General Greene Ave., Natick, MA 01760
| | - Susan B Roberts
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St Boston, MA 02111
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26
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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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27
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Breland JY, Patel ML, Wong JJ, Hoggatt KJ. Weight Perceptions and Weight Loss Attempts: Military Service Matters. Mil Med 2020; 185:e397-e402. [PMID: 31822913 DOI: 10.1093/milmed/usz413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION People who do not perceive themselves as overweight or obese are less likely to use weight loss treatments. However, little is known about weight perceptions and their association with weight loss attempts among people who have served in the military. They represent a special population with regard to weight perceptions as military personnel must meet strict weight standards to remain in military service. MATERIALS AND METHODS Using data from the U.S.-based 2013-2014 and 2015-2016 National Health and Nutrition Examination Surveys, we fit logistic regression models to determine whether people with overweight or obesity were: (1) more or less likely to underestimate their weight if they reported military service and (2) less likely to attempt weight loss if they underestimated their weight (stratifying by military status). Estimates were adjusted for sociodemographic factors, including objective weight class, gender, age, race/ethnicity, income ratio, comorbidities, and education. This work received exempt status from the Stanford University institutional review board. RESULTS Among 6,776 participants, those reporting military service had higher odds of underestimating their weight compared to those not reporting military service [OR (odds ratio): 1.44; 95% confidence interval (CI): 1.15, 1.79]. Underestimating weight was associated with lower odds of attempting weight loss among those reporting military service (OR: 0.20; CI: 0.11, 0.36) and those not reporting military service (OR: 0.27; CI: 0.22, 0.34). CONCLUSIONS This study offers the new finding that underestimating weight is more likely among people reporting military service compared to those not reporting military service. Findings are consistent with past work demonstrating that underestimating weight is associated with a lower likelihood of pursuing weight loss. To combat weight misperceptions, clinicians may need to spend additional time discussing weight-related perceptions and beliefs with patients. The present findings suggest such conversations may be especially important for people reporting military service. Future research should be designed to understand the effects of correcting weight misperceptions. This work would advance the science of weight management and offer ways to increase weight loss treatment engagement, prevent chronic conditions, and improve health outcomes, especially among people reporting military service.
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Affiliation(s)
- Jessica Y Breland
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025
| | - Michele L Patel
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025.,Department of Psychology and Neuroscience, Duke University, 417 Chapel Dr., Durham, NC 27708
| | - Jessie J Wong
- Center for Innovation to Implementation, VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA 94025.,Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, 616 Serra Mall C100, Stanford, CA 94305-6055
| | - Katherine J Hoggatt
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073.,Department of Epidemiology, UCLA Fielding School of Public Health, Box 951772, Los Angeles, CA 90095-1772
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28
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Fahey MC, Hare ME, Talcott GW, Kocak M, Hryshko-Mullen A, Klesges RC, Krukowski RA. Characteristics Associated With Participation in a Behavioral Weight Loss Randomized Control Trial in the U.S. Military. Mil Med 2020; 184:e120-e126. [PMID: 30125001 DOI: 10.1093/milmed/usy199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/11/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Effective recruitment and subsequent enrollment of diverse populations is often a challenge in randomized controlled trials, especially those focused on weight loss. In the civilian literature, individuals identified as racial and ethnic minorities, men, and younger and older adults are poorly represented in weight loss interventions. There are limited weight loss trials within military populations, and to our knowledge, none reported participant characteristics associated with enrollment. There may be unique motives and barriers for active duty personnel for enrollment in weight management trials. Given substantial costs and consequences of overweight and obesity in the U.S. military, identifying predictors and limitations to diverse enrollment can inform future interventions within this population. The study aims to describe the recruitment, screening, and enrollment process of a military weight loss intervention. Demographic and lifestyle characteristics of military personnel lost between screening and randomization are compared to characteristics of personnel randomized in the study and characteristics of the Air Force in general. MATERIALS AND METHODS The Fit Blue study, a randomized controlled behavioral weight loss trial for active duty personnel, was approved by the Institutional Review Board of the Wilford Hall Ambulatory Surgical Center in San Antonio, TX, USA and acknowledged by the Institutional Review Board at the University of Tennessee Health Science Center. Logistic regressions compared participant demographics, anthropometric data, and health behaviors between personnel that attended a screening visit but were not randomized and those randomized. Multivariable models were constructed for the likelihood of being randomized using a liberal entry and stay criteria of 0.10 for the p-values in a stepwise variable selection algorithm. Descriptive statistics compared the randomized Fit Blue cohort demographics to those of the U.S. Air Force. RESULTS In univariate analyses, older age (p < 0.02), having a college degree or higher (p < 0.007) and higher military rank (p < 0.02) were associated with completing the randomization process. The randomized cohort reported a lower percentage of total daily kilocalories for fat compared to the non-randomized cohort (p = 0.033). The non-randomized cohort reported more total minutes and intensity of physical activity (p = 0.073). In the multivariate model, only those with a college degree or higher were 3.2 times more likely to go onto randomization. (OR = 3.2, 95% CI = 2.0, 5.6, p < 0.0001). The Fit Blue study included a higher representation of personnel who identified as African American (19.4% versus 15.0%) and Hispanic/Latino (22.7% versus 14.3%) compared with the U.S. Air Force in general; however, men were underrepresented (49.4% versus 80.0%). TABLE I.Comparisons of Demographic Characteristics of Randomized Fit Blue Cohort to Screened Non-Randomized CohortFit Blue Randomized Participants (N = 248)Non-Randomized Cohort (N = 111)All Screened Participants (N = 359)p-ValueSex N (%)0.73 Male122 (49.2)52 (46.8)174 (48.5) Female126 (50.8)59 (53.2)183 (51.5)Age Mean (±SD) years34 (±7.5)32 (±6.7)33 (±7.3)0.02Race N (%)0.89 African American49 (19.8)22 (19.8)71 (19.8) Caucasian163 (65.7)75 (67.6)238 (66.3) Other36 (14.5)14 (12.2)50 (13.9)Ethnicity N (%)0.59 Hispanic/Latino56 (22.6)28 (25.2)84 (23.4) Non-Hispanic/Latino192 (77.4)83 (74.8)275 (76.6)Education N (%)<0.0001 Less than college degree123 (49.6)82 (73.9)205 (57.1) College degree or greater125 (50.4)29 (26.1)154 (42.9)Marital status N (%)0.83 Single/never married40 (16.1)20 (18)60 (16.7) Married/living as married169 (68.1)72 (64.9)241 (67.1) Separated/divorced39 (15.7)19 (17.1)58 (16.2)Number of additional adults in household N (%)0.82 046 (18.5)22 (19.8)68 (18.9) 1162 (65.3)73 (65.8)235 (65.5) 231 (12.5)14 (12.6)45 (12.5) 3 or more9 (3.6)2 (1.8)11 (3.1)Number of children in household N (%)0.56 091 (36.7)37 (33.3)128 (35.7) 159 (23.8)23 (20.7)82 (22.8) 257 (23)26 (23.4)83 (23.1) 3 or more41 (16.5)25 (22.5)66 (18.4)Years in service mean (± SD)12 (±6.6)11 (±6.1)12 (±6.4)0.20Military gradeaN (%)0.02 E1-E434 (13.7)19 (17.1)53 (14.8) E5-E6105 (42.3)58 (52.3)163 (45.4) E7-E952 (21)21 (18.9)73 (20.3) O1-O317 (6.9)9 (8.1)26 (7.2) O4-O639 (15.7)4 (3.6)43 (12)Branch0.68 Army4 (1.6)1 (0.9)5 (1.4) Air Force234 (94.4)105 (94.6)339 (94.4) Navy8 (3.2)5 (4.5)13 (3.6) Marine Corp2 (0.8)0 (0.0)2 (0.6)BMI (m2/kg) N (%)30.6 (±2.7)30.4 (±2.9)30.6 (±2.8)BMI category N (%)0.76 Overweight115 (46.4)52 (48.1)167 (46.9) Obese133 (53.6)56 (51.9)189 (53.1)aMilitary ranking; Enlisted (E) categories: E1-E4 (enlisted), E5-E6 (non-commissioned officers), E7-E9 (senior non-commissioned officers) and two Officer categories (O): O1-O3 (Company Grade Officer) and O4-O6 (Field Grade Officer); standard deviation (SD).Table II.Comparisons of Anthropometric Characteristics of Randomized Fit Blue Cohort to Screened Non-Randomized CohortFit Blue Randomized Participants (N = 248)Non-Randomized Cohort (N = 111)All Screened Participants (N = 359)p-ValuePhysical activity Total physical activity2525 (±3218)2840 (±2541)2621 (±3028)0.027 (mean (±SD) minutes per week) Total sedentary physical activity5046 (±239)472 (±221)494 (±234)0.35 (mean (±SD) minutes per week) Vigorous physical activity34 (±145)54 (±152)40 (±147)0.036 (mean (±SD) minutes per week)Dietary intake Total sweetened beverages (kcal per day)165 (±206)152.9 (±166)160.8 (±194)0.80 Fruit and vegetable consumption (cups per day)3 (±1)3 (±1)3 (±1)0.52 Dietary fat (% total kcal)35 (±4)34 (±4)35 (±4)0.033. CONCLUSIONS Accounting for all influencing characteristics, higher educational status was the only independent predictor of randomization. Perhaps, highly educated personnel are more invested in a military career, and thus, more concerned with consequences of failing required fitness tests. Thus, it may be important for future weight loss interventions to focus recruitment on less-educated personnel. Results suggest that weight loss interventions within a military population offer a unique opportunity to recruit a higher prevalence of males and individuals who identify as racial or ethnic minorities which are populations commonly underrepresented in weight loss research.
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Affiliation(s)
- Margaret C Fahey
- Department of Psychology, University of Memphis, 400 Innovation Drive Memphis, TN
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN.,Department of Pediatrics, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN
| | - Gerald W Talcott
- University of Tennessee Health Science Center, Fit Blue Study Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr., Ste. 1 Lackland AFB, TX.,Department of Public Health Sciences, School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN
| | - Ann Hryshko-Mullen
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, 1320 Truemper Road, San Antonio, TX.,Department of Mental Health, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, 1100 Wilford Hall, San Antonio, TX
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN.,Department of Public Health Sciences, School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN
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29
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Body weight status, perceived stress, and emotional eating among US Army Soldiers: A mediator model. Eat Behav 2020; 36:101367. [PMID: 32018191 DOI: 10.1016/j.eatbeh.2020.101367] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In civilians, overweight and obesity are associated with emotional eating behaviors such as eating in response to stress, but this association has not been examined in Soldiers, a population with unique stressors. This cross-sectional study examined the relationship between perceived stress (PS), emotional eating (EE), and outcomes of body mass index (BMI), and failing Army body composition (BC) standards among Soldiers. METHODS Soldiers (N = 1460, 83% male, 23.5 ± 5.2 years old) completed validated surveys on PS, EE, and adherence with military BC standards. Conditional process models and mediation models tested gender as a moderator and EE as a mediator of associations between PS and BMI and PS and BC failure, respectively. RESULTS Higher PS was associated with more frequent self-reported EE behaviors (p < 0.001), higher BMI (p < 0.001), and BC failure (p < 0.001). BMI significantly increased with frequency of reported EE behaviors (p < 0.001). Gender was not a statistically significant moderator in the relationship between PS, EE, and, BMI (p = 0.83) or BC failure (p = 0.57). PS appears to affect BMI indirectly through EE behaviors (c' = 0.03, 95% CI: 0.02, 0.04). PS may affect BC failure directly (c' = 1.04, 95% CI: 1.01, 1.08) and indirectly (ab = 1.02, 95% CI: 1.01, 1.03) through EE as a mediator. CONCLUSIONS EE behaviors may mediate the positive association between PS, BMI, and BC failure. Prospective investigation is warranted to better understand the role of EE in health-related outcomes among Soldiers and populations in high stress professions.
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Webber BJ, Ruiz SA, Talcott GW, Little MA, Tate DF. Weight Gain of Service Members After Basic Military Training. Am J Prev Med 2020; 58:117-121. [PMID: 31862098 DOI: 10.1016/j.amepre.2019.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Despite weight and fitness requirements, the prevalence of overweight and obesity in the U.S. military approaches that in the general population. The purpose of this study is to assess trends in anthropometric measurements shortly after military enlistment. METHODS This longitudinal study evaluated the change in objectively measured body weight and waist circumference in the population of U.S. Air Force members who enlisted in 2012-2013 and graduated from Basic Military Training (n=49,466). Individuals were followed for 4 years or until they left the military, for a mean follow-up of 1,218 (SD=261) days. Data were collected in 2018 and analyzed in 2019. RESULTS Among Basic Military Training graduates with available and plausible baseline data (n=46,706), weight increased incrementally by a mean of 1.5-1.8 kg per year and waist circumference by 0.3-1.1 cm per year. Over the 4-year period, total mean weight gain was 6.6 (SD=7.7) kg and waist circumference increase was 3.1 (SD=6.4) cm. Male graduates gained 7.0 (SD=7.7) kg and female graduates gained 4.7 (SD=7.5) kg. Of those who stayed in the military for 4 years, 37.3% transitioned to a higher BMI category (i.e., from normal to overweight/obese or from overweight to obese), whereas 3.9% transitioned to a lower category. CONCLUSIONS Future research is needed to understand determinants of unhealthy weight gain and the association between weight gain and physical fitness among young adults embarking on a military career.
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Affiliation(s)
- Bryant J Webber
- Public Health and Preventive Medicine Department, U.S. Air Force School of Aerospace Medicine, Wright-Patterson AFB, Ohio.
| | - Stefani A Ruiz
- Public Health and Preventive Medicine Department, U.S. Air Force School of Aerospace Medicine, Wright-Patterson AFB, Ohio; Solutions Through Innovative Technologies, Inc., Fairborn, Ohio
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, University of Virginia, Charlottesville, Virginia
| | - Melissa A Little
- Center for Addiction and Prevention Research, University of Virginia, Charlottesville, Virginia
| | - Deborah F Tate
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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Manz KC, Waters TM, Clifton HE, Kocak M, Klesges RC, Talcott GW, Krukowski RA. Cost-Effectiveness of a Weight Loss Intervention: An Adaptation of the Look AHEAD Lifestyle Intervention in the US Military. Obesity (Silver Spring) 2020; 28:89-96. [PMID: 31773873 PMCID: PMC6925346 DOI: 10.1002/oby.22681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/30/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aimed to assess whether a counselor-initiated (CI) adaptation of the Look AHEAD (Action for Health in Diabetes) intensive lifestyle intervention in a military setting was cost-effective relative to a self-paced (SP) adaptation. METHODS A cost-effectiveness analysis from a payer perspective was performed alongside a 2014-2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force base in Texas. Incremental cost-effectiveness ratios were calculated for weight loss, reductions in waist circumference, and quality-adjusted life-years (QALYs). RESULTS After 12 months, the CI adaptation cost more per participant compared with the SP adaptation ($1,081 vs. $120) but achieved greater weight loss (1.86 kg vs. 0.06 kg), greater reductions in waist circumference (1.85 cm vs. 0.48 cm), and more QALYs (0.871 vs. 0.856). The incremental cost-effectiveness ratio for the CI adaptation relative to the SP adaptation was $61,268 per additional QALY. At willingness-to-pay thresholds of $50,000 and $100,000 per QALY, the CI adaptation was 45% and 49% likely to be cost-effective, respectively. CONCLUSIONS The CI delivery of the Look AHEAD Intensive Lifestyle Intervention may offer a cost-effective approach to tackle excess weight in the US military.
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Affiliation(s)
- Karina C. Manz
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY
| | - Teresa M. Waters
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY
| | - Hannah E. Clifton
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Robert C. Klesges
- Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA
| | - G. Wayne Talcott
- Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA
| | - Rebecca A. Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
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Corry NH, Radakrishnan S, Williams CS, Sparks AC, Woodall KA, Fairbank JA, Stander VA. Association of military life experiences and health indicators among military spouses. BMC Public Health 2019; 19:1517. [PMID: 31718613 PMCID: PMC6852757 DOI: 10.1186/s12889-019-7804-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 10/17/2019] [Indexed: 12/03/2022] Open
Abstract
Background The health and well-being of military spouses directly contribute to a robust military force by enabling the spouse to better support the active duty member’s career. In order to understand the overall health and well-being of military spouses, we assessed health indicators among military spouses using the Healthy People 2020 framework and examined associations of these health indicators with military experiences and psychosocial factors. Methods Using data from the Millennium Cohort Family Study, a U.S. Department of Defense-sponsored survey of 9872 spouses of service members with 2–5 years of military service, we examined attainment of Healthy People 2020 goals for spouses and service members, including healthy weight, exercise, sleep, and alcohol and tobacco use. Multivariable logistic regression models assessed associations of spouse health indicators with stressful military life experiences and social support, adjusting for demographics and military descriptors. The spousal survey was administered nationwide in 2011. Results The majority of military spouses met each health goal assessed. However, less than half met the healthy weight and the strength training goals. Reporting greater perceived family support from the military was associated with better behavioral health outcomes, while having no one to turn to for support was associated with poorer outcomes. Using the Healthy People 2020 objectives as a framework for identifying key health behaviors and benchmarks, this study identified factors, including military-specific experiences, that may contribute to physical health behaviors and outcomes among military spouses. With respect to demographic characteristics, the findings are consistent with other literature that women are more likely to refrain from risky substance use and that greater education is associated with better overall health outcomes. Conclusions Findings suggest that enhanced social and military support and tailored programming for military spouses may improve health outcomes and contribute to the well-being of military couples. Such programming could also bolster force readiness and retention.
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Affiliation(s)
- Nida H Corry
- Abt Associates, Central Park West, Suite 210, 5001 South Miami Boulevard, Durham, NC, 27703, USA.
| | | | - Christianna S Williams
- Abt Associates, Central Park West, Suite 210, 5001 South Miami Boulevard, Durham, NC, 27703, USA
| | - Alicia C Sparks
- Abt Associates, 6130 Executive Boulevard, Rockville, MD, 20852, USA
| | - Kelly A Woodall
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 100, Bethesda, MD, 20817, USA
| | - John A Fairbank
- Mid-Atlantic (VISN 6) Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, 3022 Croasdaile Dr, Durham, NC, 27705, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 1121 West Chapel Hill Street, Suite 201, Durham, NC, 27701, USA
| | - Valerie A Stander
- Military Population Health Department, Naval Health Research Center, 140 Sylvester Road, San Diego, CA, 92106, USA
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Brady LL, Credé M, Harms P, Bachrach DG, Lester PB. Meta-analysis of risk factors for substance abuse in the US military. MILITARY PSYCHOLOGY 2019. [DOI: 10.1080/08995605.2019.1657754] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Lisa L. Brady
- Department of Management, The University of Alabama, Tuscaloosa, Alabama
| | - Marcus Credé
- Department of Psychology, Iowa State University, Ames, Iowa
| | - P.D. Harms
- Department of Management, The University of Alabama, Tuscaloosa, Alabama
| | - Daniel G. Bachrach
- Department of Management, The University of Alabama, Tuscaloosa, Alabama
| | - Paul B. Lester
- Army Analytics Group Research Facilitation Laboratory, Monterey, California
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Russell DW, Kazman J, Russell CA. Body Composition and Physical Fitness Tests Among US Army Soldiers: A Comparison of the Active and Reserve Components. Public Health Rep 2019; 134:502-513. [PMID: 31394052 PMCID: PMC6852058 DOI: 10.1177/0033354919867069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES US Army reserve soldiers and active-duty soldiers differ in their daily work demands and supporting resources, yet research on reservists' health and fitness is lacking. The objectives of this study were to (1) determine whether physical test failure rates and health behaviors differed between active-duty soldiers and reserve soldiers and (2) establish which demographic and health behavioral factors were associated with failing physical tests. METHODS We analyzed a sample of 239 329 US Army active-duty and reserve soldiers surveyed from September 2013 through March 2015 using the Global Assessment Tool. We extracted data on soldier demographic characteristics and health behaviors, as well as Body Composition Test (BCT) and Army Physical Fitness Test (APFT) results. We compared the 2 groups using the active-to-reserve adjusted odds ratio (aOR) for each variable. We used logistic regression models to determine which variables were associated with failing these tests. RESULTS The odds of failing the BCT (aOR = 0.76; 95% confidence interval [CI], 0.73-0.78) or the APFT (aOR = 0.31; 95% CI, 0.30-0.32) were lower among active-duty soldiers than among reservists, and the odds of doing high levels of high-intensity interval training (aOR = 1.47; 95% CI, 1.42-1.51), resistance training (aOR = 1.45; 95% CI, 1.42-1.48), and vigorous physical activity (aOR = 2.92; 95% CI, 2.86-2.98) were higher among active-duty soldiers than among reservists. The odds of using tobacco (aOR = 1.37; 95% CI, 1.35-1.40), binge drinking alcohol (aOR = 1.11; 95% CI, 1.09-1.13), having insomnia (aOR = 1.46; 95% CI, 1.43-1.48) or mild depression (aOR = 1.50; 95% CI, 1.48-1.53), and sustaining a physical activity-related injury (aOR = 2.52; 95% CI, 2.47-2.57) were higher among active-duty soldiers than among reservists. CONCLUSIONS Policy makers and military leaders could use this information to implement health screenings and tailor health-promotion, intervention, and treatment programs.
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Affiliation(s)
- Dale W. Russell
- Consortium for Health & Military Performance, Department of Military
& Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services
University, Bethesda, MD, USA
| | - Joshua Kazman
- Consortium for Health & Military Performance, Department of Military
& Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services
University, Bethesda, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine,
Bethesda, MD, USA
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Fahey MC, Klesges RC, Kocak M, Wang J, Talcott GW, Krukowski RA. Do the holidays impact weight and self-weighing behaviour among adults engaged in a behavioural weight loss intervention? Obes Res Clin Pract 2019; 13:395-397. [PMID: 31182293 PMCID: PMC6698213 DOI: 10.1016/j.orcp.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/23/2019] [Accepted: 05/08/2019] [Indexed: 01/02/2023]
Abstract
We examined the U.S. holiday period impact on weight gain, self-weighing, and treatment success among adults in a weight loss intervention (N=171). Using electronic scales, body weight and self-weighing frequency were compared by time period [i.e., pre-holiday, holiday (November 15-January 1), post-holiday]. Self-weighing was less frequent during holiday period (p<.01), and longer intervention engagement was associated with weight gain (p<.0001) during this time. Enrollment during holiday period was associated with 2.3% 12-month weight loss. Holiday period enrollment might be beneficial for preventing holiday weight gain and facilitating successful intervention outcomes.
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Affiliation(s)
- Margaret C Fahey
- The University of Memphis, Department of Psychology, 400 Innovation Drive Memphis, TN, 38111, USA.
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA; University of Virginia, Department of Public Health Sciences, School of Medicine, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA
| | - Jiajing Wang
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA
| | - Gerald W Talcott
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA; University of Virginia, Department of Public Health Sciences, School of Medicine, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA
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Abstract
Objective: To explore the perceptions of soldiers participating in a US Army Office of The Surgeon General’s worksite health promotion programme (WHPP) on the local food environment within their campus-style workplace. Design: Focus groups were conducted to evaluate the perceived effectiveness of the WHPP implementation. Further exploration of focus group data through thematic analysis focused on perceived contributions of the military campus-style food environment to soldiers’ nutrition behaviours. Setting: Three US Army installations located in the continental USA. Participants: Active duty soldiers (n 366) participating in one of the fifty-eight focus groups. Results: Soldiers shared a common belief of self-discipline and personal responsibility as the foothold to nutrition behaviour change. Soldiers described aspects of the military campus-style food environment as factors impeding achievement of optimal nutrition. Collectively, soldiers perceived the proximity and density of fast-food restaurants, lack of healthy alternatives on the installation and the cost of healthy food as inhibitors to choosing healthy foods. Overwhelmingly, soldiers also perceived time constraints as a factor contributing to unhealthy food choices. Conclusions: Although nutrition behaviour is individually driven, soldiers perceived the military campus-style food environment inhibits healthy decision making. Nutrition programming in military WHPP must integrate food environment changes to improve soldiers’ nutrition behaviour outcomes. Applicable to the military, food choice behaviour studies suggest environmental changes must be appealing to young adults. Considerations for environmental changes should include an increased portion size for healthy options, broadened use of soldiers’ daily food allowances on local produce and increased availability of grab-and-go options.
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Shrestha A, Ho TE, Vie LL, Labarthe DR, Scheier LM, Lester PB, Seligman MEP. Comparison of Cardiovascular Health Between US Army and Civilians. J Am Heart Assoc 2019; 8:e009056. [PMID: 31164033 PMCID: PMC6645626 DOI: 10.1161/jaha.118.009056] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/28/2019] [Indexed: 02/02/2023]
Abstract
Background Cardiovascular conditions are common in US Army and civilian populations. The recently developed concept of ideal cardiovascular health provides a new approach to evaluating population cardiovascular status. Methods and Results We defined a cohort of 263 430 active duty Army personnel, aged 17 to 64 years, who completed a 2012 physical examination and a corresponding subset of the noninstitutionalized, civilian US population, who participated in the National Health and Nutrition Examination Survey ( NHANES ) 2011 to 2012 cycle. We compared 4 cardiovascular health metrics (current smoking, body mass index, blood pressure, and diabetic status) between Army and civilian groups overall, and separately by sex, race/ethnicity, and age. The Army population was younger, was less often women or Hispanic, and had less post-high school education than the NHANES population. Smoking rates were ≈20% in the Army and NHANES groups, but <15% among Army women and Hispanics. Overall, one third of the Army and NHANES groups and NHANES women, but nearly half of Army women, demonstrated ideal body mass index. Ideal blood pressure was strikingly less prevalent in the Army than NHANES participants (30% versus 55%). Diabetes mellitus was rare in both groups. Conclusions Ideal cardiovascular health was less prevalent in the Army than NHANES group, despite exclusion of the least healthy recruits. Prevalence of ideal body mass index and blood pressure was low in both the Army and NHANES groups, even at early adult ages. This finding reveals the need for policy changes to promote, preserve, and improve ideal cardiovascular health in both the Army and the US population as a whole.
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Affiliation(s)
- Alice Shrestha
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPA
- Research Facilitation LaboratoryArmy Analytics GroupMontereyCA
| | - Tiffany E. Ho
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPA
- Research Facilitation LaboratoryArmy Analytics GroupMontereyCA
| | - Loryana L. Vie
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPA
- Research Facilitation LaboratoryArmy Analytics GroupMontereyCA
| | | | - Lawrence M. Scheier
- Department of PsychologyUniversity of PennsylvaniaPhiladelphiaPA
- Research Facilitation LaboratoryArmy Analytics GroupMontereyCA
| | - Paul B. Lester
- Research Facilitation LaboratoryArmy Analytics GroupMontereyCA
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Rumery ZR, Patel N, Richard P. The Association Between the Use of the Education Benefits from the G.I. Bill and Veterans' Health. Mil Med 2019; 183:e241-e248. [PMID: 29490086 DOI: 10.1093/milmed/usx102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Indexed: 11/14/2022] Open
Abstract
Background There is limited knowledge on the impact of education on veterans' health in the United States. This study specifically examines the relationship between the education benefits from the G.I. Bill and veterans' health. Methods This study used data from the 2010 National Survey of Veterans. The subjects for this study were 5,052 veterans who were eligible to receive G.I. Bill benefits, representing a total of about 12.7 million non-institutionalized veterans in the United States in 2010. The dependent variables included self-reported health status and smoking behavior. The key independent variable was whether veterans used the education benefits from the G.I. Bill compared with those who were eligible but did not use them. Findings Results from multivariate regression analyses showed that those who used the education benefits from the G.I. Bill were 4% less likely to report fair/poor health (p < 0.01) and 3% less likely to report any smoking (p < 0.05) compared with those who did not use the education benefits. Additional analyses showed that using the education benefits to attend college decreased the probability of being in fair/poor health by 4% (p < 0.10) and being a smoker by 4% (p < 0.05) compared with those who did not attend college but used their benefits for non-college attainment such as business, technical, or vocational schools. More importantly, a larger association was found between the use of the education benefits from the G.I. Bill to obtain a college degree and fair/poor health (7%, p < 0.05) and smoking behavior (9%, p < 0.01) compared with those who attended college but did not obtain a college degree. Discussion This study shows that providing opportunities for service members to complete their education also has important health benefits.
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Affiliation(s)
- Zachary R Rumery
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Nilam Patel
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817
| | - Patrick Richard
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
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Meyer S, Cole R. Army Body Composition Program Study Results Concerning: Enrollees Are More Over Fat Than Expected. Mil Med 2019; 184:400-408. [PMID: 30901401 DOI: 10.1093/milmed/usy302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/02/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Whether implementation of the Army Body Composition Program (ABCP) is meeting readiness objectives is unknown. OBJECTIVE This study sought to primarily describe the extent of Active Duty Soldiers' over-fatness when attending the initial ABCP nutrition class at an Army Nutrition clinic in Washington State; and secondarily to describe the proportion of these Soldiers meeting metabolic syndrome (MS) criteria. METHODS Soldiers (189) in this cross-sectional study completed the following: a questionnaire developed for this study, anthropometric measurements, body fat assessment via AR 600-9 standards, and a laboratory blood draw for fasting glucose and lipid panel. RESULTS Soldiers were predominantly male (76%), obese (BMI 32 kg/m2 for males and 30 kg/m2 for females), exceeded body fat standards by 3.8% for males and 7.3% for females, and 16% had three or more risk factors meeting MS diagnostic criteria. Waist circumference was the predominant MS risk factor for males and females. CONCLUSION Soldiers in this study had higher body fat percentages than expected with a majority of Soldiers classified as obese. Achieving and maintaining ABCP standards may be more challenging for obese Soldiers. To maintain Soldier readiness, commanders should consider intervening earlier when signs of weight gain are observed.
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Affiliation(s)
- Stephanie Meyer
- Army Medical Department Center and School, Health Readiness Center of Excellence, 3630 Stanley Road, Fort Sam Houston, TX
| | - Renee Cole
- Military Nutrition Division, US Army Research Institute of Environmental Medicine, 10 General Greene Ave, Natick, MA
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Environmental interventions to promote healthier eating and physical activity behaviours in institutions: a systematic review. Public Health Nutr 2019; 22:1518-1531. [PMID: 30702052 DOI: 10.1017/s1368980018003683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The present review evaluated the effectiveness of environmental-based interventions aimed at improving the dietary and physical activity behaviours and body composition indices of adults in institutions. DESIGN A systematic review was conducted. Electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, The Cochrane Library, Web of Science, ProQuest Dissertation and Theses, Scopus and Athena) were searched for relevant articles published between database inception and October 2017. Searching, selecting and reporting were undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. SETTING Military establishments and maritime workplaces.ParticipantsAdults in institutions, aged 18-45 years. RESULTS A total of 27842 articles were screened for eligibility, nine studies (reported in eleven articles) were included in the review. Five studies used multilevel strategies and four used environmental strategies only. Duration of follow-up ranged from 3 weeks to 10 years. Eight of the studies reported significant positive effects on dietary behaviours, but effect sizes varied. The study that targeted physical activity had no effect on activity levels but did have a significant positive effect on physical fitness. No evidence was identified that the studies resulted in improvements in body composition indices. CONCLUSIONS The evidence base appears to be in favour of implementing environmental interventions in institutions to improve the dietary behaviours of adults. However, due to the small number of studies included in the review, and the variable methodological quality of the studies and intervention reporting, further well-designed evaluation studies are required.
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Malkawi AM, Meertens RM, Kremers SPJ, Sleddens EFC. Dietary, physical activity, and weight management interventions among active-duty military personnel: a systematic review. Mil Med Res 2018; 5:43. [PMID: 30591077 PMCID: PMC6309065 DOI: 10.1186/s40779-018-0190-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research has been conducted to assess the effectiveness of weight management, dietary and physical activity interventions in military settings. However, a recent and comprehensive overview is lacking. The aim of this systematic review is to examine the evidence and describe key components of effective interventions in terms of improving body composition, dietary behaviors, and physical activity among active-duty military personnel. METHODS PubMed, PsycInfo, and CINAHL were searched on the 17th of November 2017 to identify interventions that promoted diet and/or physical activity among active-duty military personnel. Studies were included if they assessed outcomes related to anthropometric measurements, dietary behaviors, or fitness/physical activity levels. There were no restrictions regarding publication date, follow-up duration, and sex. After screening, a total of 136 studies were eligible. Of these studies, 38 included an educational and/or behavioral change component, and 98 had only physical or fitness training as part of basic military training. Only studies that included an educational and/or behavioral change component were assessed for quality using the Effective Public Health Practice Project tool and included in the qualitative synthesis of the results. RESULTS Based on consistent evidence from studies that were rated as moderate or strong, there is good evidence that military weight management interventions are effective in improving body composition for durations of up to 12 months. Effective interventions are more likely to be high intensity (have a greater number of sessions), are more often delivered by specialists, and use theoretical base/behavioral change techniques and a standardized guideline. Dietary interventions can potentially reduce total fat and saturated fat intake. Dietary interventions that target the kitchen staff and/or increase the availability of healthy food are more likely to be effective in the short term. The results regarding military physical fitness interventions were inconclusive. CONCLUSION Despite limitations such as the diversity and heterogeneity of the included interventions, outcome measurements, and follow-up duration, this systematic review found good evidence that weight management interventions are effective, especially in terms of weight loss. More studies are needed to acquire solid evidence for effectiveness for durations longer than 12 months and to identify key components of the effective dietary and physical activity educational and/or behavioral change interventions, especially in countries outside Europe and the US.
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Affiliation(s)
- Ahmad M. Malkawi
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center+, PO Box 616, Maastricht, 6200 MD the Netherlands
| | - Ree M. Meertens
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), and Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, PO Box 616, Maastricht, 6200 MD the Netherlands
| | - Stef P. J. Kremers
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center+, PO Box 616, Maastricht, 6200 MD the Netherlands
| | - Ester F. C. Sleddens
- Department of Health Promotion, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Center+, PO Box 616, Maastricht, 6200 MD the Netherlands
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Wilson JA, James DC. Weight Loss Strategies Used by Army Reserve Officer Training Corps Cadets: Implication for Student Health and Wellness Services. Telemed J E Health 2018; 25:821-827. [PMID: 30407124 DOI: 10.1089/tmj.2018.0174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Maintaining a healthy weight is a military requirement for the Reserve Officer Training Corps (ROTC) cadets. Male and female soldiers often have different approaches to maintaining a healthy weight and mobile health (m-health) tools can be harnessed and tailored to the needs of individual cadets. Objectives: This study examined gender differences in technology use, weight loss strategies, information needed to maintain a healthy weight, and willingness to participate in m-health research and programs. Materials and Methods: A self-administered survey was completed by 404 cadets from ROTC programs in Florida in 2017. Results: Most owned smartphones and used them as their primary internet access. Women had significantly lower body mass index than men (p = 0.037). Most used healthy weight loss strategies, including increasing physical activity, reducing sweets, and reducing fried foods. Women were more likely than men to reduce fried foods (p < 0.0003) and sweets (p = 0.020). Most reported a willingness to participate in m-health weight management research and programs, with women more willing to do so (p = 0.038). Most were willing to participate in m-health programs that used text messages, food/activity/sleep apps, smart watches/fitness trackers, and stress management/anxiety apps. Women were more willing to participate in programs that used apps for stress/anxiety management (p = 0.004) and to track food/activity/sleep (p < 0.0001). Most needed information on eating healthy on a budget and eating healthy on-the-run. Conclusions: Opportunities exist for college health and wellness professionals to use a variety of m-health tools and apps to promote general health and wellness and to help cadets achieve and maintain a healthy weight.
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Affiliation(s)
| | - Delores C James
- Department of Health Education and Performance, College of Health & Human Performance, University of Florida, Gainesville, Florida
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Fahey MC, Wayne Talcott G, Cox Bauer CM, Bursac Z, Gladney L, Hare ME, Harvey J, Little M, McCullough D, Hryshko-Mullen AS, Klesges RC, Kocak M, Waters TM, Krukowski RA. Moms fit 2 fight: Rationale, design, and analysis plan of a behavioral weight management intervention for pregnant and postpartum women in the U.S. military. Contemp Clin Trials 2018; 74:46-54. [PMID: 30291998 PMCID: PMC6289301 DOI: 10.1016/j.cct.2018.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Margaret C Fahey
- Department of Psychology, The University of Memphis, Memphis, TN, USA.
| | - G Wayne Talcott
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Callie M Cox Bauer
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Leslie Gladney
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jean Harvey
- Department of Nutrition and Food Sciences, The University of Vermont, Burlington, VT, USA
| | - Melissa Little
- Center for Addition and Prevention Research, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Deirdre McCullough
- Department of Obstetrics and Gynecology, Brooke Army Medical Center, San Antonio, TX, USA
| | - Ann S Hryshko-Mullen
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA, USA; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Teresa M Waters
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Berzins TL, Van Dulmen MHM, Deluca H. Alcohol use affects sleep duration among military couples. MILITARY PSYCHOLOGY 2018. [DOI: 10.1080/08995605.2018.1521684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Haylee Deluca
- Department of Psychological Sciences, Kent State University, Kent, Ohio
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Krukowski RA, Hare ME, Talcott GW, Gladney LA, Johnson KC, Richey PA, Kocak M, Keller PL, Hryshko-Mullen A, Klesges RC. Dissemination of the Look AHEAD Intensive Lifestyle Intervention in the United States Military: A Randomized Controlled Trial. Obesity (Silver Spring) 2018; 26:1558-1565. [PMID: 30277030 PMCID: PMC6173202 DOI: 10.1002/oby.22293] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/03/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study, "Fit Blue," was to compare a translation of the Look AHEAD (Action for Heath in Diabetes) intensive lifestyle intervention with a self-paced version of the same intervention among active duty military personnel. METHODS Active duty military personnel (N = 248; 49% male, 34% racial minority) with overweight or obesity were randomized to 12-month distance-based (i.e., phone and email) parallel programs, counselor-initiated (CI) condition or self-paced (SP) condition, from 2014 to 2016. Trained lay interventionists were retired military personnel or had extensive familiarity with the military. RESULTS The CI condition had greater weight loss at 4 months (CI: mean ± SD = -3.2 ± 3.4 kg; SP: -0.6 ± 2.9 kg; P < 0.0001) and at 12 months (CI: mean ± SD = -1.9 ± 4.1 kg; SP: -0.1 ± 3.8 kg; P < 0.001). Participants in the CI condition also had a greater percent weight loss at both 4 months (CI: 3.5% ± 3.8, SP: 0.6% ± 3.1; P < 0.0001) and 12 months (CI: 2.1% ± 4.7, SP: 0.0% ± 4.0; P < 0.001). In addition, a greater proportion of CI participants lost 5% or more at 4 months (CI: 29.8%, SP: 10.5%; P < 0.001) and at 12 months (CI: 29.5%, SP: 15.6%; P < 0.05). CONCLUSIONS The CI behavioral weight loss intervention translated from Look AHEAD was well received and is a promising approach for managing weight in an active duty military population.
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Affiliation(s)
- Rebecca A. Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marion E. Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gerald W. Talcott
- University of Tennessee Health Science Center, Lackland AFB, TX, USA
- University of Virginia, Department of Public Health Sciences, School of Medicine, Charlottesville, VA, USA
| | - Leslie A. Gladney
- University of Tennessee Health Science Center, Lackland AFB, TX, USA
- University of Virginia, Department of Public Health Sciences, School of Medicine, Charlottesville, VA, USA
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Phyllis A. Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Patrick L. Keller
- University of Virginia, Department of Public Health Sciences, School of Medicine, Charlottesville, VA, USA
| | - Ann Hryshko-Mullen
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, USA
| | - Robert C. Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Mental Health, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio–Lackland AFB, San Antonio, Texas, USA
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Fahey MC, Klesges RC, Kocak M, Wayne Talcott G, Krukowski RA. Changes in the Perceptions of Self-weighing Across Time in a Behavioral Weight Loss Intervention. Obesity (Silver Spring) 2018; 26:1566-1575. [PMID: 30277031 PMCID: PMC6173193 DOI: 10.1002/oby.22275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 07/12/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Changes in beliefs about self-weighing were examined across time in a behavioral weight loss intervention. METHODS Active duty military personnel (n = 248) enrolled in a 12-month counselor-initiated or self-paced intervention based on the Look AHEAD (Action for Health in Diabetes) Intensive Lifestyle Intervention. Using an electronic scale, participants were asked to self-weigh daily. Self-weighing perceptions were compared from baseline to 4 months (weight loss phase), from 4 months to 12 months (weight maintenance phase), and from baseline to 12 months (full intervention), as well as across time by behavioral and demographic characteristics. RESULTS Overall, participants perceived self-weighing as more helpful and positive, less frustrating, and making them less self-conscious after the weight loss phase. After weight maintenance, individuals believed self-weighing was less helpful and positive, more frustrating and anxiety provoking, and making them more self-conscious. However, after the intervention, participants still viewed self-weighing as more helpful and positive and less frustrating than at baseline. Weight change, self-weighing behavior prior to the intervention, and intervention condition were associated with perception change. Controlling for these influencing factors, differences in gender, BMI, age, ethnicity, and race were observed in how beliefs changed across time. CONCLUSIONS Results suggest engaging in a weight loss intervention promoting daily self-weighing increases positive and decreases negative beliefs about self-weighing.
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Affiliation(s)
- Margaret C Fahey
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, Virginia, USA
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - G Wayne Talcott
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, Virginia, USA
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Nadolsky KZ. Rationale for Utilization of Obesity Pharmacotherapy in the Active Duty Population. Mil Med 2018; 183:45-50. [PMID: 29420770 DOI: 10.1093/milmed/usx074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 10/27/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Karl Z Nadolsky
- Department of Diabetes & Endocrinology, Spectrum Health Medical Group, 221 Michigan St, NE, Grand Rapids, MI 49503.,Department of Medicine, Michigan State University, East Lansing, MI 48824
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48
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Health promotion research in active duty army soldiers: The road to a fit and ready force. Nurs Outlook 2017; 65:S6-S16. [DOI: 10.1016/j.outlook.2017.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/18/2017] [Accepted: 06/23/2017] [Indexed: 11/18/2022]
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Abstract
PURPOSE OF REVIEW The objective was to review prevention efforts and approaches attempting to limit the problem of obesity in the military. RECENT FINDINGS Various individual-level initiatives have emerged, including programs promoting healthy cooking, meal planning, and other behavior changes among service members. Importantly, the military is attempting to tackle environmental factors contributing to the rise of obesity, by focusing on many recent environmental-level interventions and initiatives to improve military dining facilities and examine and modify other aspects of installations' built environments. Although published research within the military setting directed towards obesity prevention is limited, many innovative programs have been launched and need to be followed forward. The review of past and ongoing efforts can be an important step in identifying specific areas needing improvement, gaps that should be considered, lessons learned, and characteristics of successful programs that should be disseminated as best practices and further expanded.
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Affiliation(s)
- Marissa Shams-White
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, USA.
| | - Patricia Deuster
- Consortium for Health and Military Performance, A DoD Center of Excellence, Department of Military and Emergency Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA
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50
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Patient Payment and Unhealthy Behavior: A Comparison across European Countries. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2615105. [PMID: 28261606 PMCID: PMC5316444 DOI: 10.1155/2017/2615105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/29/2016] [Accepted: 12/13/2016] [Indexed: 11/28/2022]
Abstract
Introduction. Prior research has documented that unhealthy behaviors result in greater health care use and greater health care costs. However, there are few studies on out-of-pocket expenditure paid by those engaging in unhealthy behaviors. We provide cross-country evidence on the association of smoking, alcohol consumption, and obesity with health care use and health care cost as well as out-of-pocket payments among the elderly in Europe. Method. Using SHARE dataset for 13 European countries, the study uses a sequential logit model to analyze use and payments for outpatient and inpatient health care service in addition to a two-part model for the analysis of use and payments for prescribed drugs. Results. Former smoking is associated with a higher rate of health care use. However, current smoking is associated with lower health care use. Former smoking is also associated with paying higher amount of out-of-pocket payments. Alcohol consumption is associated with lower health care use. Conclusion. We do not find systematic evidence that unhealthy behaviors among elderly (50+) are associated with more utilization of health care and more out-of-pocket payments. The results can be of interest for policies that aim to make people more responsible toward their health behaviors.
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