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Porter KJ, Krukowski RA, Bonilla G, McKenna L, Talcott GW, Little MA. Using the Socio-ecological Model to Explore Facilitators and Deterrents of Tobacco Use Among Airmen in Technical Training. Mil Med 2022; 187:e1160-e1168. [PMID: 33637975 PMCID: PMC9402675 DOI: 10.1093/milmed/usab075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/04/2021] [Accepted: 02/11/2021] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Military personnel have some of the highest rates of tobacco use in the USA. Within the Air Force, a common point of Airmen's (re-)initiation of tobacco use is during technical training once the tobacco ban has been lifted. Unfortunately, little is known about what factors facilitate and deter tobacco use during technical training. The socio-ecological model, which emphasizes multiple levels of influence on behavior (e.g., personal, intrapersonal, and environmental), provides a strong and comprehensive basis for which to explore factors that may impact tobacco use during technical training. MATERIALS AND METHODS Twenty-two focus groups were conducted among Airmen (n = 10), Military Training Leaders (MTLs, n = 7), and Technical Training Instructors (TTIs, n = 5). Semi-structured focus group protocols were developed based on the socio-ecological model and included questions intended to elicit factors that facilitated and deterred tobacco use during technical training. Focus groups were transcribed and then coded using a hybrid deductive-inductive process. RESULTS At the personal level, five factors were identified that influenced tobacco use: choice, fit with lifestyle, associations with the tobacco experience, association with military job outcomes, and association with health outcomes. Three interpersonal level factors were identified: peer influence, leadership influence, and normative beliefs. There were two influential environmental level factors: pricing and promotion and access to tobacco. Except for normative beliefs, all personal, interpersonal, and environmental-level factors were discussed as having aspects that could either facilitate or deter tobacco use. Normative beliefs, an interpersonal-level factor, were only discussed as a facilitator of tobacco use. CONCLUSIONS Taken together, study findings can be used to enhance the effectiveness of tobacco prevention and cessation programs for Air Force Technical Trainees. Specific strategies to support the reduction of tobacco use among Airmen are presented.
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Affiliation(s)
- Kathleen J Porter
- Department of Public Health Sciences, University of Virginia, School of Medicine, Christiansburg, VA 24073, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN 38105, USA
| | - Gloribel Bonilla
- Health System West Complex MSB, University of Virginia Cancer Center, Charlottesville, VA 22903, USA
| | - Lisa McKenna
- Department of Social Work, The University of Texas at San Antonio, San Antonio, TX 78207, USA
| | - Gerald W Talcott
- Department of Public Health Sciences & Center for Addiction and Prevention Research, University of Virginia, School of Medicine, JBSA-Lackland, TX 78236, USA
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia, School of Medicine, Charlottesville, VA 29903, USA
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Krukowski RA, Porter K, Boothe T, Talcott GW, Little MA. "Nobody Views It As a Negative Thing to Smoke": A Qualitative Study of the Relationship Between United States Air Force Culture and Tobacco Use. MILITARY PSYCHOLOGY 2021; 33:409-416. [PMID: 34924692 PMCID: PMC8673782 DOI: 10.1080/08995605.2021.1962189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/20/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tobacco use has long been a part of military culture, and rates of tobacco use remain higher among military personnel compared to civilians. The current study examines aspects of Air Force tobacco culture that encourage tobacco use. MATERIALS AND METHODS We conducted 7 focus groups among Air Force Military Training Leaders (n=48) and 5 focus groups among Technical Training Instructors (n=33) from July 2018 to February 2019. RESULTS Tobacco use was seen as a core part of Air Force culture and a low risk behavior, in contrast to other potential activities. Three themes of Air Force culture that facilitate tobacco use emerged: 1) opportunity for work breaks; 2) finding common ground; and 3) stress management or stress relief during deployment. Smoke pits were seen as serving several functions that were not perceived to occur anywhere else: an opportunity for informal communication with leadership, a source of valuable information, and a space for problem solving. CONCLUSIONS Airmen viewed tobacco as serving a functional role, which outweighed its harm. Future programs might try to address the functions fulfilled by tobacco in order to enhance their impact.
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Affiliation(s)
- Rebecca A. Krukowski
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kathleen Porter
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tina Boothe
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base Lackland Air Force Base, San Antonio, Texas, USA
| | - G. Wayne Talcott
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base Lackland Air Force Base, San Antonio, Texas, USA
| | - Melissa A. Little
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA
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I smoke to cope with pain: patients' perspectives on the link between cigarette smoking and pain. Wien Klin Wochenschr 2021; 133:1012-1019. [PMID: 34460005 DOI: 10.1007/s00508-021-01931-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND For people with chronic pain, cigarette smoking is associated with greater pain intensity and impairment. Researchers have hypothesized a reciprocal relationship in which pain and smoking exacerbate each other, resulting in greater pain and increased smoking. This study aimed to qualitatively examine patient perspectives on this association. METHODS A retrospective thematic analysis of smoking cessation counseling notes for 136 veterans in the Pain and Smoking Study, a tailored smoking cessation trial, was conducted. A validated codebook was applied to each counseling note by four independent coders using Atlas.ti (Atlas.ti, Berlin, Germany). Coders participated in a consensus-forming exercise with salient themes validated among the wider research team. KEY RESULTS Participants averaged 60 years of age (range 28-77 years) and were 9% female. The median number of cigarettes smoked per day was 15, with a mean pain intensity score in the last week (from 0-10) of 5.1. While not all patients acknowledged a connection between pain and smoking, we found that (1) pain motivates smoking and helps manage pain-related distress, as a coping strategy and through cognitive distraction, and (2) pain motivates smoking but smoking does not offer pain relief. Concerns about managing pain without smoking was identified as a notable barrier to cessation. CONCLUSION Many patients with chronic pain who smoke readily identified pain as a motivator of their smoking behavior and are reluctant to quit for this reason. Integrated interventions for smokers with pain should address these perceptions and expectancies and promote uptake of more adaptive self-management strategies for pain.
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Williams MA, Reddy G, Quinn MJ, Millikan Bell A. Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army. Drug Chem Toxicol 2021; 45:2049-2085. [PMID: 33906535 DOI: 10.1080/01480545.2021.1905657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.
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Affiliation(s)
- Marc A Williams
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Gunda Reddy
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Michael J Quinn
- Toxicology Directorate - Health Effects Program, U.S. Army Public Health Center, Aberdeen Proving Ground, MD, USA
| | - Amy Millikan Bell
- Office of the Director - Medical Advisor, U.S. Army Public Health Center, Aberdeen Proving Ground, USA
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Tan C, Lin L, Lim M, Ong SK, Wong ML, Lee JK. Tobacco use patterns and attitudes in Singapore young male adults serving military national service: a qualitative study. BMJ Open 2020; 10:e039367. [PMID: 32988949 PMCID: PMC7523193 DOI: 10.1136/bmjopen-2020-039367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To explore tobacco use patterns and factors influencing tobacco use in young Singaporean men serving military national service. METHODS A qualitative study using in-depth telephone interviews and maximum variation sampling was conducted with 29 Singaporean men who have completed their national service in 2017-2018. Data were analysed using thematic analysis. RESULTS More than half (51.7%) of the participants started smoking before age 18, with a mean age of smoking initiation at 16 years. At the individual level, the two main contributing factors to tobacco use were smoking as a coping mechanism, and physical or psychological addiction. Financial concern was reported as the key motivation to quit smoking. At the interpersonal level, peers and superiors played an influential role in the smoking habits of the participants. When superiors took additional measures against smoking behaviours, it contributed to their decision to smoke less. At the organisation level, some unintended consequences were reported as a result of the strict tobacco control measures implemented by the military, such as the designated smoking areas within the camps become regarded as an area for socialisation. CONCLUSION Informed by the Socio-Ecological Model, this study has provided insights into the multifaceted and interactive effect of individual, interpersonal and organisational factors that influence tobacco use in young men serving military national service in the Singapore and Asian context. The study insights provided an understanding of the local context before designing programmes or changing regulations to further discourage tobacco usage in the military.
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Affiliation(s)
- Clive Tan
- Headquarters Medical Corps, Singapore Armed Forces Medical Corps, Singapore
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Lavinia Lin
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Mervyn Lim
- Headquarters Medical Corps, Singapore Armed Forces Medical Corps, Singapore
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Seeu Kun Ong
- Headquarters Medical Corps, Singapore Armed Forces Medical Corps, Singapore
| | - Mee-Lian Wong
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Jeong Kyu Lee
- National University Singapore Saw Swee Hock School of Public Health, Singapore
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Little MA, Fahey MC, Klesges RC, McMurry T, Talcott GW. Evaluating the Effects of a Brief Tobacco Intervention in the US Air Force. Nicotine Tob Res 2020; 22:1569-1577. [PMID: 31903494 DOI: 10.1093/ntr/ntaa001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Military personnel have among the highest rates of tobacco use in the United States. Unfortunately, there are few interventions aimed at reducing tobacco use among this vulnerable population. The current study addresses this need by evaluating the short-term effectiveness of a Brief Tobacco Intervention (BTI), a 40-min group-based intervention designed to reduce contemporary patterns of tobacco use among a sample of US military enlistees during an 11-week period of involuntary tobacco abstinence. AIMS AND METHODS Participants were 2999 US Air Force Technical Trainees at Joint Base San Antonio-Lackland Air Force Base in San Antonio, Texas from April 2017 through January 2018. Participants were cluster randomized to three conditions: (1) BTI + Airman's Guide to Remaining Tobacco Free (AG), (2) AG intervention, or (3) standard smoking cessation intervention. The primary analysis was a comparison of the interventions' efficacies in preventing tobacco use during Technical Training, conducted using a generalized estimating equations logistic regression model controlling for covariates. Multiple imputation was used to account for loss to follow-up. RESULTS There was not a significant difference by condition in the use of tobacco products at follow-up (p = .454). The BTI + AG condition did produce short-term changes in perceived harm, intentions to use tobacco, knowledge about tobacco products, and normative beliefs. CONCLUSIONS These findings suggest that while the intervention was effective in the short term, it was not potent enough over a 12-week period to prevent Airmen from initiating tobacco use. Future studies should examine whether adding a booster session or media campaign enhances the effectiveness of the intervention. IMPLICATIONS Despite the fact that most Airmen believe they will remain tobacco free following the ban in Technical Training, a large percentage of these Airmen resume and initiate tobacco use during this high-risk period. As a result, there is a need for interventions targeting the range of tobacco available to military trainees during a teachable moment when they report intentions to remain tobacco free. The current study shows that a BTI has promise in reducing long-term tobacco use, when coupled with additional interventions, such as a booster session or a media campaign.
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Affiliation(s)
- Melissa A Little
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA.,Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, TX
| | | | - Robert C Klesges
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy McMurry
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA.,Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, TX
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Berg KM, Gruber SJ, Jorenby DE. Helping women veterans quit smoking: a qualitative analysis of successful and unsuccessful attempts. BMC Womens Health 2020; 20:63. [PMID: 32228550 PMCID: PMC7106739 DOI: 10.1186/s12905-020-00918-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco use is the number one cause of death and disability of women in the United States, and our women Veteran population is disproportionately affected. Despite revisions to the Veterans Affairs' approach to smoking cessation, women continue to smoke at equal or higher rates than men, are prescribed cessation medications less frequently, and are less likely to quit. In this qualitative pilot study, individual interviews with women Veterans revealed their experiences with smoking cessation attempts. METHODS The lead author conducted semi-structured interviews with 14 women Veterans who were either current or former smokers. Participants gave a narrative account of recent quit smoking attempts. Inductive thematic analysis explored the underlying themes. RESULTS Four main themes emerged as important: health and well-being, smoking as an addiction, optimism, and resilience. Health and well-being encompassed physical health, mental health, and financial stability. Women often felt that stability in these key areas made a successful attempt possible. Women with successful quit attempts were more likely to consider tobacco use as an addiction, as well as expressed optimism about their quit attempts. Women with successful quit attempts also demonstrated more resilience to lapses and relapses. CONCLUSIONS Women Veterans' quit smoking attempts demonstrate four main themes: baseline health and wellbeing, acknowledging smoking as an addiction, the participant's optimism towards quitting, and resilience. Patterns were observed within themes with respect to whether the woman was currently quit or had experienced a prolonged quit attempt in the past. Further research is needed to help women Veterans quit smoking.
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Affiliation(s)
- Kristin M Berg
- University of Wisconsin Center for Tobacco Research and Intervention, 1930 Monroe St Suite 200, Madison, WI, 53711, USA.
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA.
| | - Stephanie J Gruber
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - Douglas E Jorenby
- University of Wisconsin Center for Tobacco Research and Intervention, 1930 Monroe St Suite 200, Madison, WI, 53711, USA
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Cruz TB, Rose SW, Lienemann BA, Byron MJ, Meissner HI, Baezconde-Garbanati L, Huang LL, Carroll DM, Soto C, Unger JB. Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: A review of the literature. Tob Induc Dis 2019; 17:68. [PMID: 31582956 PMCID: PMC6770621 DOI: 10.18332/tid/111397] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION We reviewed research literature on pro-tobacco marketing and anti-tobacco campaigns targeting eight vulnerable populations to determine key findings and research gaps. Results can inform tobacco policy and control efforts and the design of public education campaigns for these groups. METHODS Five journal databases in medicine, communication, and science, were used to identify 8875 peer-reviewed, original articles in English, published in the period 2004-2018. There were 144 articles that met inclusion criteria on pro-tobacco marketing or anti-tobacco campaigns aimed at eight US groups: women of reproductive age, racial/ethnic minority groups (African American, Hispanic/Latino, Asian/Pacific Islander and American Indian/Alaska Native), Lesbian/Gay/Bisexual/Transgender (LGBT) populations, groups with low socioeconomic status, rural/inner city residents, military/veterans, and people with mental health or medical co-morbidities. We summarized the number of articles for each population, type of tobacco, and pro-tobacco or anti-tobacco focus. Narrative summaries were organized by population and by pro-tobacco or anti-tobacco focus, with key strategies and gaps by group. RESULTS There were more studies on pro-tobacco marketing rather than anti-tobacco campaigns, and on cigarettes rather than other tobacco products. Major gaps included studies on Asian Americans, American Indian/Alaska Natives, pregnant women, LGBT populations, and those with mental health or medical co-morbidities. Gaps related to tobacco products were found for hookah, snus, and pipe/roll-your-own tobacco in the pro-tobacco studies, and for all products except cigarettes in anti-tobacco studies. Common tobacco industry methods used were tailoring of product and package design and messages that were used to reach and appeal to different sociodemographic groups. Studies varied by research design making it difficult to compare results. CONCLUSIONS We found major research gaps for specific groups and tobacco products. Public education campaigns need a stronger foundation in empirical studies focused on these populations. Research and practice would benefit from studies that permit comparisons across studies.
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Affiliation(s)
- Tess Boley Cruz
- Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Shyanika W Rose
- Truth Initiative Schroeder Institute, Washington, United States.,Center for Health Equity Transformation and Behavioral Science, University of Kentucky College of Medicine, Lexington, United States
| | - Brianna A Lienemann
- Keck School of Medicine, University of Southern California, Los Angeles, United States.,Moores Cancer Center, University of California San Diego, San Diego, United States
| | - M Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Helen I Meissner
- Office of Disease Prevention, National Institutes of Health, Bethesda, United States
| | | | - Li-Ling Huang
- Global Health and Health Security, Taipei Medical University, Taipei, Taiwan
| | - Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, United States
| | - Claradina Soto
- Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Jennifer B Unger
- Keck School of Medicine, University of Southern California, Los Angeles, United States
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Brown JM, Anderson Goodell EM, Williams J, Bray RM. Socioecological Risk and Protective Factors for Smoking Among Active Duty U.S. Military Personnel. Mil Med 2018; 183:e231-e239. [PMID: 29697835 PMCID: PMC6027073 DOI: 10.1093/milmed/usx021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 06/12/2017] [Indexed: 11/13/2022] Open
Abstract
Introduction Cigarette smoking can have negative consequences in military populations including injury, reduced physical endurance, higher frequency of sick days, and reduced combat readiness. This study used the socioecological model to understand individual, interpersonal, and organizational influences on cigarette smoking among military members. Materials and Methods The sample for this secondary analysis was drawn from personnel at 24 large U.S. military installations, six from each service branch. Analyses included 4,728 personnel who were classified as current cigarette smokers. Generalized linear mixed models were used to estimate the associations among risk and protective factors from multiple ecological levels for smoking intensity and nicotine dependence. Results Smoking to fit in with one's unit, being in the Army, smoking as a reaction to stress, and work-related stressors were all related to increased intensity of smoking and nicotine dependence. More active coping was associated with lower nicotine dependence and reduced smoking intensity. Conclusion Results based on the socioecological model identify influencing factors and suggest possible interventions for smoking cessation. Reducing tobacco use in the military will require coordinated interventions that address multilevel determinants of use and improve military health. This is important to the strategic alignment of policy and services across the continuum of health care needs.
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Affiliation(s)
| | | | | | - Robert M Bray
- RTI International, Research Triangle Park, Durham NC
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Consequences of Inconsistency in Air Force Tobacco Control Policy. TOB REGUL SCI 2017; 3:232-238. [PMID: 29226195 DOI: 10.18001/trs.3.2.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives Although the United States Air Force (USAF) has been a leader in efforts to reduce tobacco use among service members, tobacco continues to be a problem and initiatives to decrease tobacco use further require buy-in from leadership. We explored line leaderships' perspectives on tobacco. Methods A diverse group of 10 senior commissioned and 10 non-commissioned personnel were interviewed. Results Respondents reported substantial changes in the culture of tobacco use during their years of service, from near ubiquity to restricted use areas. They also perceived mixed messages coming from the USAF, including simultaneous discouragement of and accommodations for tobacco use, and variability in policies and enforcement. Many respondents indicated that allowing tobacco use creates conflict and undermines military discipline and suggested that a tobacco-free policy would be the best way to eliminate these contradictions. Conclusion Although there has been substantial movement away from a culture of tobacco in the USAF, current policies and variable enforcement of these policies create unnecessary contradictions. Establishing a tobacco-free service would resolve these issues in addition to improving the health of service members and veterans.
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Khattab AM, AbdelFattah EB, Abozahra AKEA. Study of smoking habit among soldiers in Cairo Security Forces Hospital. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2017. [DOI: 10.1016/j.ejcdt.2016.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Linde BD, Ebbert JO, Schroeder DR, Hanson AC, Talcott GW, Klesges RC. Smokeless tobacco use among United States Air Force trainees. Subst Abus 2016; 38:278-284. [PMID: 28027011 DOI: 10.1080/08897077.2016.1275924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The prevalence of smokeless tobacco use in the United States Air Force (USAF) exceeds civilian use rates. The prevalence and correlates of smokeless tobacco use were assessed and evaluated in a sample of USAF trainees. METHODS We conducted a cross-sectional survey of USAF technical training school personnel at Joint Base San Antonio-Lackland and Fort Sam Houston (N = 14,810). Survey completion rate was 78%. Logistic regression was used to analyze the associations between demographic variables, tobacco use, and social factors for both regular and infrequent smokeless tobacco (e.g., chewing tobacco, snuff) users. RESULTS Overall, 16% of Airmen had ever used smokeless tobacco and 10% regularly used smokeless tobacco. In multivariate analyses, men had greater odds than women of regular smokeless tobacco use (adjusted odds ratio [OR] = 15.2; 95% confidence interval [CI]: 10.8-21.5) and infrequent smokeless tobacco use (adjusted OR = 4.2; 95% CI: 3.1-5.7). Smokeless tobacco use was associated with participation in high school sports (adjusted OR = 1.9; 95% CI: 1.6-2.3 for regular users; adjusted OR = 1.4; 95% CI: 1.1-1.7 for infrequent users), smoking cigarettes (adjusted OR = 4.3; 95% CI: 3.6-5.1 for regular users; adjusted OR = 4.0; 95% CI: 3.2-5.0 for infrequent users), or living with someone who used smokeless tobacco (adjusted OR = 2.2; 95% CI: 1.9-2.6 for regular users; adjusted OR = 1.4; 95% CI: 1.1-1.7 for infrequent users). Black or African Americans were less likely than whites to be regular (adjusted OR = 0.3; 95% CI: 0.1-0.4) or infrequent (adjusted OR = 0.3; 95% CI: 0.2-0.4) users of smokeless tobacco. CONCLUSIONS Smokeless tobacco use among incoming Air Force recruits is common and negatively impacts the Air Force's goal to be tobacco-free. Understanding sociodemographic characteristics perpetuating smokeless tobacco use in the Air Force population can inform the development of health promotion interventions.
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Affiliation(s)
- Brittany D Linde
- a Organizational Wellness and Learning Systems , Fort Worth , Texas , USA
| | - Jon O Ebbert
- b Division of Primary Care Internal Medicine , Department of Medicine , Mayo Clinic , Rochester , Minnesota , USA
| | - Darrell R Schroeder
- c Division of Biomedical Statistics and Informatics. Department of Health Sciences Research , Mayo Clinic , Rochester , Minnesota , USA
| | - Andrew C Hanson
- c Division of Biomedical Statistics and Informatics. Department of Health Sciences Research , Mayo Clinic , Rochester , Minnesota , USA
| | - G Wayne Talcott
- d Department of Preventive Medicine, Center for Population Sciences , University of Tennessee Health Science Center , Memphis , Tennessee , USA
| | - Robert C Klesges
- d Department of Preventive Medicine, Center for Population Sciences , University of Tennessee Health Science Center , Memphis , Tennessee , USA
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Basaza R, Otieno E, Musinguzi A, Mugyenyi P, Haddock CK. Factors influencing cigarette smoking among soldiers and costs of soldier smoking in the work place at Kakiri Barracks, Uganda. Tob Control 2016; 26:330-333. [PMID: 27165996 DOI: 10.1136/tobaccocontrol-2015-052878] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/20/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although Uganda has a relatively low prevalence of smoking, no data exists on cigarette use among military personnel. Studies in other countries suggests military service is a risk factor for tobacco use. OBJECTIVES To assess prevalence and risk factors for and costs of smoking among military personnel assigned to a large military facility in Uganda. DESIGN A mixed methods study including focus groups, interviews and a cross-sectional survey of military personnel. SETTING Kakiri Barracks, Uganda. SUBJECTS Key informants and focus group participants were purposively selected based on the objectives of the study, military rank and job categories. A multistage sample design was used to survey individuals serving in Uganda People's Defense Forces (UPDF) from June to November 2014 for the survey (n=310). RESULTS Participants in the qualitative portion of the study reported that smoking was harmful to health and the national economy and that its use was increasing among UPDF personnel. Survey results suggested that smoking rates in the military were substantially higher than in the general public (ie, 34.8% vs 5.3%). Significant predictors of smoking included lower education, younger age, having close friends who smoked and a history of military deployment. Estimated costs of smoking due to lost productivity was US$576 229 and US$212 400 for excess healthcare costs. CONCLUSIONS Smoking rates are substantially higher in the UPDF compared to the general public and results in significant productivity costs. Interventions designed to reduce smoking among UPDF personnel should be included in the country's national tobacco control plan.
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Affiliation(s)
- Robert Basaza
- International Health Sciences University Kampala, Kampala, Uganda.,School of Medicine Makerere University Kampala, Kampala, Uganda
| | - Emmanuel Otieno
- International Health Sciences University Kampala, Kampala, Uganda.,Uganda Peoples Defense Forces, Kampala, Uganda
| | | | - Possy Mugyenyi
- Centre for Tobacco Control in Africa Makerere University School of Public Health Kampala, Kampala, Uganda
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14
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Grundy Q, Smith EA, Malone RE. "Throwing a rock at their armored tank": civilian authority and military tobacco control. BMC Public Health 2014; 14:1292. [PMID: 25518726 PMCID: PMC4301565 DOI: 10.1186/1471-2458-14-1292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Tobacco use is a major cause of chronic disease, disability and death among military personnel and veterans. However, civilian public health and tobacco control advocates have been relatively silent on the issue. Research on the tobacco industry shows a long history of interference in military tobacco policy through relationships with the United States (US) Congress. The military cannot autonomously implement tobacco control, but is subject to Congressional oversight. Thus, the primary obstacles to effective tobacco control in the military are Congressional political opposition and tobacco industry influence, and by extension, a lack of civilian awareness and support in the policy arena. METHODS As part of a larger project to explore the topic of civilian support for military tobacco control, we analyzed data from focus groups with public health professionals to better understand their sense of agency and authority in regards to military tobacco control. Researchers conducted 4 focus groups with a total of 36 public health professionals at key conferences for those working in public health and tobacco control. Data were coded and the research team developed an interpretive account that captured patterns and variations in the data. RESULTS Public health and tobacco control participants shared a sense of futility regarding civilian efforts to engage in military tobacco control. This stemmed from feeling ignorant of military culture and structure, identifying powerful discourses that opposed tobacco control, particularly in a military context, and the very-real presence of the tobacco industry lobby throughout the policy process. CONCLUSIONS A strong public health voice on military tobacco control might serve to begin problematizing the tobacco industry's influence in the military policy arena. As the military moves to institute stronger tobacco control policy, public health and tobacco control professionals should work to engage with and aid its efforts from the outside. Only with such civilian side support can the goal of a tobacco free military be realized.
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Affiliation(s)
- Quinn Grundy
- Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California St, San Francisco, CA 94118 USA
| | - Elizabeth A Smith
- Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California St, San Francisco, CA 94118 USA
| | - Ruth E Malone
- Department of Social and Behavioral Sciences, University of California, San Francisco, 3333 California St, San Francisco, CA 94118 USA
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15
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Lando HA, Michaud ME, Poston WSC, Jahnke SA, Williams L, Haddock CK. Banning cigarette smoking on US Navy submarines: a case study. Tob Control 2014; 24:e188-92. [PMID: 25163466 DOI: 10.1136/tobaccocontrol-2014-051624] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 08/06/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND The military has had a long pro-tobacco tradition. Despite official policy discouraging smoking, tobacco still is widely seen as part of military culture. While active smoking has presented a particular challenge for the military, in recent years there also has been increasing concern with secondhand smoke. This is especially true in closed environments and submarines may be deployed for months at a time. The current case study describes the successful implementation by the Navy of a comprehensive ban on smoking aboard submarines. METHODS The authors searched documents on the internet, popular media, military-based news outlets and the scientific literature. We also conducted interviews with Navy officers who were instrumental in policy implementation. FINDINGS Data demonstrating substantial exposure of non-smokers to tobacco smoke aboard submarines had major impact on successful adoption of the policy. A systematic and extended roll out of the ban included establishing a working group, soliciting input and active engagement from submarine personnel, and offering cessation assistance. Support was enlisted from Chief Petty Officers who could have been strongly opposed but who became strong proponents. Fewer problems were encountered than had been expected. In contrast to a previous unsuccessful attempt by a Navy captain to ban smoking on his ship, the ban was adopted without apparent tobacco industry interference. CONCLUSIONS Lessons learned included the importance of strong empirical support, effective framing of the issue, setting a realistic timeline, soliciting support from key personnel and providing appropriate resources. These lessons have implications for those considering further tobacco policy changes in the military and elsewhere.
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Affiliation(s)
- Harry A Lando
- Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Mark E Michaud
- Bureau of Medicine and Surgery, US Navy, Washington, District of Columbia, USA
| | - Walker S C Poston
- Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA Bureau of Medicine and Surgery, US Navy, Washington, District of Columbia, USA Institute of Biobehavioral Health Research, National Development and Research Institutes, Inc., Leawood, Kansas, USA College of Dental Medicine-Illinois, Midwestern University, Downers Grove, Illinois, USA
| | - Sara A Jahnke
- Institute of Biobehavioral Health Research, National Development and Research Institutes, Inc., Leawood, Kansas, USA Institute of Biobehavioral Health Research, National Development and Research Institutes, Inc., Leawood, Kansas, USA
| | - Larry Williams
- College of Dental Medicine-Illinois, Midwestern University, Downers Grove, Illinois, USA
| | - Christopher K Haddock
- Institute of Biobehavioral Health Research, National Development and Research Institutes, Inc., Leawood, Kansas, USA
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