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Aycock CA, Mallawaarachchi I, Wang XQ, Cassidy DG, Ellis JM, Klesges RC, Talcott GW, Wiseman K. Developing a Text Messaging Intervention to Prevent Binge and Heavy Drinking in a Military Population: Mixed Methods Development Study. JMIR Form Res 2024; 8:e55041. [PMID: 38502165 PMCID: PMC10988383 DOI: 10.2196/55041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations. OBJECTIVE We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force. METHODS We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ≥21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library. RESULTS In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age. CONCLUSIONS This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force.
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Affiliation(s)
- Chase A Aycock
- United States Air Force, 37th Human Performance Squadron, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, United States
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Xin-Qun Wang
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Daniel G Cassidy
- United States Air Force, 37th Training Wing, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, United States
| | - Jordan M Ellis
- United States Air Force, Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, United States
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - G Wayne Talcott
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Kara Wiseman
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
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Aycock CA, Wang XQ, Williams JB, Fahey MC, Talcott GW, Klesges RC, Little MA. Motives for using electronic nicotine delivery systems (ENDS) as a cessation tool are associated with tobacco abstinence at 1-year follow-up: A prospective investigation among young adults in the United States Air Force. Prev Med Rep 2023; 35:102399. [PMID: 37712011 PMCID: PMC10498292 DOI: 10.1016/j.pmedr.2023.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Smokers use electronic nicotine delivery systems (ENDS), including e-cigarettes, as a harm reduction strategy even though the Food and Drug Administration (FDA) has not approved them for tobacco cessation. The limited literature about ENDS use for cigarette cessation is concerning for the U.S. military, which is largely comprised of young adults at increased risk for tobacco use. Thus, the current study aims to evaluate use of ENDS products as a cessation tool in relation to point-prevalence tobacco abstinence at one-year follow-up in a cohort of 8,901 U.S. Air Force personnel attending entry-level job training from March 2016 to April 2019. Methods A propensity-score adjusted multinomial logistic regression model was used to assess the association between the baseline motives for ENDS use (i.e., for cigarette cessation versus alternative reasons) and tobacco use at the one-year follow-up (cigarette use, non-cigarette tobacco product use, and tobacco abstinence) among those reporting history of cigarette use at baseline. Results Smokers reporting ENDS use for cigarette cessation were more likely to be abstinent at one-year follow-up (Odds Ratio[OR] = 1.62, 95% CI: 1.06-2.49, P =.03) as well as quit using non-cigarette tobacco products (OR = 2.11, 95% CI: 1.65-2.70, P <.001) than those reporting ENDS use for alternative reasons. Conclusions Current tobacco users are recommended to use FDA-approved products for smoking cessation, such as nicotine replacement therapy. However, given the high prevalence of cigarette use among military populations, ENDS may provide a useful alternative harm reduction strategy for this high-risk population.
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Affiliation(s)
- Chase A. Aycock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| | - Xin-Qun Wang
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| | - Juinell B. Williams
- Department of Psychology, East Carolina University, Greenville, NC 27858, United States
| | - Margaret C. Fahey
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States
| | - G. Wayne Talcott
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
- UVA Comprehensive Cancer Center, 1240 Lee St., Charlottesville, VA 22903, United States
| | - Robert C. Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
- UVA Comprehensive Cancer Center, 1240 Lee St., Charlottesville, VA 22903, United States
| | - Melissa A. Little
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
- UVA Comprehensive Cancer Center, 1240 Lee St., Charlottesville, VA 22903, United States
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Aycock CA, Mallawaarachchi I, Klesges RC, Wang XQ, Cassidy DG, Wiseman KP, Krunnfusz AE, Kundu D, Patience MA, Estevez Burns R, Talcott GW. Decreasing alcohol use among young adults presenting for service in the U.S. Air Force: An epidemiological surveillance study. Mil Psychol 2023:1-10. [PMID: 37725685 DOI: 10.1080/08995605.2023.2259283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023]
Abstract
U.S. surveys demonstrate recent decreases in the prevalence of alcohol use and binge drinking among young adults. The current study aims to determine whether similar trends are evident in a similarly aged cohort of service members in the US Air Force to inform ongoing prevention efforts. Participants were 103,240 Air Force personnel in entry-level training between 2016 and 2019. Participants anonymously completed the AUDIT (Alcohol Use Disorder Identification Test) regarding their pre-service drinking. Logistic regression analyses and the Cochran-Armitage test were conducted to measure population trends over the study duration with stratification by age (<21 vs. ≥21) and evaluation of specific alcohol behaviors. Between 2016 and 2019, the proportion of young service members endorsing any alcohol use significantly decreased for both the <21 group (i.e. from 38.9% to 32.6%) and the ≥21 group (i.e. from 80.6% to 77.5%). Among those who endorsed drinking, a decrease over time in binge use was also observed from 46.6% to 37.8% for the <21 group and from 34.2% to 27.5% for the ≥21 group. Responses to other specific alcohol risk items and total AUDIT scores also demonstrated decreases. Binge use and risky drinking remained disproportionately common among those under the legal drinking age. It is encouraging to observe a shift toward abstinence and decreased binge use among this population of young military recruits. However, given the risk for many adverse health and legal consequences in this population, more work is needed to prevent problematic drinking, especially among those under the legal drinking age.
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Affiliation(s)
- Chase A Aycock
- Clinical Health Psychology, Wilford Hall Ambulatory Surgical Center, JBSA-Lackland AFB, Texas
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Robert C Klesges
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Xin-Qun Wang
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Daniel G Cassidy
- Clinical Health Psychology, Wilford Hall Ambulatory Surgical Center, JBSA-Lackland AFB, Texas
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Kara P Wiseman
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Andrea E Krunnfusz
- Clinical Health Psychology, Wilford Hall Ambulatory Surgical Center, JBSA-Lackland AFB, Texas
| | - Debamita Kundu
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Marc A Patience
- Clinical Health Psychology, Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, Maryland
| | - Rosemary Estevez Burns
- Clinical Health Psychology, Wilford Hall Ambulatory Surgical Center, JBSA-Lackland AFB, Texas
| | - G Wayne Talcott
- Clinical Health Psychology, Wilford Hall Ambulatory Surgical Center, JBSA-Lackland AFB, Texas
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
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Abstract
INTRODUCTION Healthy gestational weight gain (GWG) is associated with improved pregnancy and delivery outcomes. The COVID-19 pandemic changed eating behaviours and physical activity, and thus may have impacted GWG. This study examines the impact of the COVID-19 pandemic on GWG. METHODS Participants (N = 371, 86% of the larger study) were part of a study focused on GWG among TRICARE beneficiaries (i.e., active-duty military personnel and other beneficiaries). Participants were randomized to two treatment groups (GWG intervention (n = 149 pre-COVID and n = 98 during COVID), and usual care condition (n = 76 pre-COVID and n = 48 during COVID). GWG was calculated as the difference between screening weight and at 36 weeks gestation. Participants who delivered prior to the COVID-19 pandemic (March 1, 2020, N = 225) were compared to participants whose pregnancies occurred during the pandemic (N = 146). RESULTS We found no significant difference in GWG between those who delivered prior to the pandemic (11.2 ± 4.3 kg) and those whose pregnancies occurred during COVID-19 (10.6 ± 5.4 kg), with no effect of intervention arm. While excessive GWG was higher pre-COVID (62.8%) than during the pandemic (53.7%), this difference was not significant overall or by intervention arm. In addition, we found lower attrition during the pandemic (8.9%) than in the pre-COVID period (18.7%). DISCUSSION In contrast to prior research that indicated challenges with engaging in health behaviors during the COVID-19 pandemic, we found that women did not have increased GWG or higher odds of excessive GWG. This research contributes to our understanding of how the pandemic impacted pregnancy weight gain and engagement in research.
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Affiliation(s)
- Abby McPhail
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - G Wayne Talcott
- Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
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Klesges RC, Talcott GW, Little MA, Mallawaarachchi IV, Wang XQ, Aycock CA, Patience MA, Halbert JP, Wiseman KP, Ebbert JO. Reengagement for Long-Term Smoking-Cessation In Military Personnel, Retirees, Family Members (TRICARE): A Randomized Trial. Nicotine Tob Res 2023; 25:1633-1640. [PMID: 37280113 PMCID: PMC10445251 DOI: 10.1093/ntr/ntad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 05/03/2023] [Accepted: 05/30/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION We sought to determine what type of treatment reengagement after smoking relapse would increase long-term cessation. AIMS AND METHODS Participants were military personnel, retirees, and family members (TRICARE beneficiaries) recruited across the United States from August 2015 through June 2020. At baseline, consented participants (n = 614) received a validated, four-session, telephonic tobacco-cessation intervention with free nicotine replacement therapy. At the 3-month follow-up, 264 participants who failed to quit or relapsed were offered the opportunity to reengage in cessation. Of these, 134 were randomized into three reengagement conditions: (1) repeat initial intervention ("recycle"), (2) Smoking reduction with eventual cessation goal ("rate reduction"), or (3) Choose #1 or #2 ("choice"). Prolonged abstinence and 7-day point prevalence abstinence were measured at 12 months. RESULTS Despite being in a clinical trial advertised as having the opportunity for reengagement, only 51% (134 of the 264) of participants who still smoked at 3-month follow-up were willing to reengage. Overall, participants randomized to recycle had higher prolonged cessation rates at 12 months than rate reduction conditions (OR = 16.43, 95% CI: 2.52 to 107.09, Bonferroni adjusted p = .011). When participants who randomly received recycle or rate reduction were pooled, respectively, with participants who chose recycle or rate reduction in the Choice group, recycle had higher prolonged cessation rates at 12 months than rate reduction (OR = 6.50, 95% CI: 1.49 to 28.42, p = .013). CONCLUSIONS Our findings suggest service members and their family members who fail to quit smoking but are willing to reengage in a cessation program are more likely to benefit from repeating the same treatment. IMPLICATIONS Finding methods that are both successful and acceptable to reengage people who smoke who want to quit can have a significant impact on improving the health of the public by reducing the portion of the population who smoke. This study suggests that repeating established cessation programs will result in more people ready to quit successfully achieving their goal.
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Affiliation(s)
- Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - G Wayne Talcott
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, Clinical Health Psychology, Joint Base San Antonio – Lackland, San Antonio, TX, USA
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Indika V Mallawaarachchi
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - X -Q Wang
- Division of Biostatistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Chase A Aycock
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, Clinical Health Psychology, Joint Base San Antonio – Lackland, San Antonio, TX, USA
| | - Marc A Patience
- Malcolm Grow Medical Clinics and Surgical Center, Mental Health Clinic, Joint Base Andrews, MD, USA
| | - Jennifer P Halbert
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kara P Wiseman
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Jon O Ebbert
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Wiseman KP, Aycock CA, Mallawaarachchi I, Wang XQ, Cassidy DG, Patience MA, Little MA, Talcott GW, Klesges RC. Predictors of Re-Engagement after Relapse in a Tobacco Quit Line Intervention: Secondary Analysis from a Randomized Clinical Trial. Int J Environ Res Public Health 2023; 20:1229. [PMID: 36673992 PMCID: PMC9859567 DOI: 10.3390/ijerph20021229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
People who smoke often make several quit attempts before successfully maintaining abstinence. Therefore, incorporating re-engagement for people who fail to initially quit could increase quit attempts and ultimately increase cessation rates. Within the context of quit line-based interventions, it remains unknown what characteristics are associated with re-engagement. The purpose of this study was to assess associations between demographic and motivational characteristics, tobacco use, and initial intervention engagement with re-engagement in a tobacco quit line intervention. Among 372 adults who reported smoking three months after initiating a quit line-facilitated quit attempt as part of a larger randomized clinical trial, associations between personal characteristics (e.g., age, gender, nicotine dependence, and confidence in their ability to quit smoking) and initial intervention engagement (number of completed counseling sessions and use of nicotine replacement therapy (NRT)) with re-engagement (accepting an offer to re-initiate the quit line intervention) were determined using multivariable logistic regression modeling. Compared to non-White participants, White participants had lower odds of re-engaging (OR: 0.42, 95% CI: 0.23, 0.75). Number of initial counseling sessions completed was associated with re-engaging. NRT use during the initial intervention was not associated with re-engaging. Initial intervention engagement is important in the process of re-engagement, specifically attending counseling sessions. Exploration of associations between initial intervention engagement and potentially modifiable motivational factors is needed to be potentially leveraged in future interventions to maintain continued engagement in cessation among adults who smoke.
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Affiliation(s)
- Kara P. Wiseman
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Chase A. Aycock
- Wilford Hall Ambulatory Surgical Center, Clinical Health Psychology, San Antonio, TX 78236, USA
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Xin-Qun Wang
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - Daniel G. Cassidy
- Wilford Hall Ambulatory Surgical Center, Clinical Health Psychology, San Antonio, TX 78236, USA
| | - Marc A. Patience
- Wilford Hall Ambulatory Surgical Center, Clinical Health Psychology, San Antonio, TX 78236, USA
- Malcolm Grow Medical Clinics and Surgery Center, Clinical Health Psychology, Prince George’s County, MD 20762, USA
| | - Melissa A. Little
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
| | - G. Wayne Talcott
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
- Wilford Hall Ambulatory Surgical Center, Clinical Health Psychology, San Antonio, TX 78236, USA
| | - Robert C. Klesges
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA
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Pebley K, Mallawaarachchi I, Talcott GW, Little MA. Where, When, and How Alcohol Use Occurs During Air Force Technical Training. Mil Med 2023; 188:e69-e73. [PMID: 34050674 DOI: 10.1093/milmed/usab206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Alcohol use is prevalent among military personnel, with many engaging in binge drinking behaviors. Military trainees are unique, in that they experience an enforced alcohol ban for 8 weeks while in Basic Military Training. However, they are also typically young adults, who consume alcohol at higher rates than any other age group. The current study aimed to describe alcohol consumption among trainees, determine when, where, and with whom Airmen drank for the first time during Technical Training, and if these patterns were significantly different based on descriptive norms (i.e., beliefs about how many other individuals engage in a certain behavior) related to alcohol use, given that most military members consume alcohol. Last, we aimed to determine if alcohol consumption or potential alcohol use disorders were significantly different based on descriptive norms. MATERIALS AND METHODS Airmen (n = 599) were recruited at Joint Base San Antonio-Fort Sam Houston during their last week of Technical Training to complete a survey. Study procedures were approved by the 59th Medical Wing Institutional Review Board. Participants were asked about their beliefs related to how many other Airmen drink alcohol (i.e., less than 50%, 50%, or greater), their own experiences with alcohol (e.g., how much they drink compared with consumption before military service, blackouts after drinking during Technical Training), and when, where, and with whom they consumed alcohol for the first time after beginning military training. RESULTS Over half of the Airmen reported not engaging in drinking behaviors during Technical Training. Among those who reported drinking one or more drinks during Technical Training, most reported drinking the same amount or less than they did prior to Basic Military Training. The majority of Airmen reported that they had "maybe" experienced blackouts from drinking since Technical Training. Most Airmen drank for the first time with another someone who was not an Airman, at a restaurant, home, or other place off base, and while they were on leave. Results indicated no significant differences between groups related to beliefs about how many Airmen drink during Technical Training and where, when, and with whom Airmen drank for the first time since joining the Air Force. There were also no differences in Alcohol Use Disorders Identification Test scores or drinks per week between these normative belief groups. CONCLUSIONS Almost half of Airmen resume drinking after alcohol restrictions are lifted during Technical Training but maintain low numbers of drinks consumed per week and low risk for alcohol use disorders, which may indicate that this is an opportune time for intervention to prevent alcohol consumption from escalating over time. Airmen reported drinking for the first time with another Airman off base during leave. Focusing on how Airmen navigate alcohol-related decision-making while their responsibilities are reduced, or how other Airmen influence their decisions to engage in risky drinking, may help prevent alcohol use rates from increasing post-enforced ban.
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Affiliation(s)
- Kinsey Pebley
- Department of Psychology, The University of Memphis, Memphis, TN 38152, USA
| | - Indika Mallawaarachchi
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA
| | - G Wayne Talcott
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA.,Wilford Hall Ambulatory Surgical Center, 59 MDW/59 SGOWMP, Joint Base Lackland AFB, TX 78236, USA
| | - Melissa A Little
- University of Virginia Cancer Center, Charlottesville, VA 22903, USA
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Pebley K, Wang XQ, Fahey MC, Patten CA, Mallawaarachchi I, Talcott GW, Klesges RC, Little MA. Examination of Tobacco-Related Messaging and Tobacco Use over Time among U.S. Military Young Adults. Subst Use Misuse 2022; 58:146-152. [PMID: 36476101 PMCID: PMC10116438 DOI: 10.1080/10826084.2022.2151313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: People from minoritized populations have historically been targeted by tobacco companies. Little is known about exposure to tobacco-related messages among military personnel from disadvantaged backgrounds. Objectives: The current study aimed to examine exposure to tobacco-related messaging across many nicotine products and through a variety of mediums (i.e., family, friends, advertisements, event promotions, social media) among diverse military populations and use one year later in a sample of young adults who recently enlisted in the U.S. Air Force. Methods: In this study, 8,901 U.S. Air Force trainees reported on demographics, tobacco use, and exposure to positive tobacco messages from social sources (i.e., friends, family, social media) and environmental sources (i.e., advertisements and promotions). Tobacco use was reported one-year later. Results: Compared to others of the same reported racial/ethnic background, Latino/a/x (Relative Risk Ratio [RRR] = 1.354, 95% CI: [1.145, 1.563]) and multiracial (RRR = 1.594, 95% CI: [1.173, 2.016]) participants who were exposed to positive tobacco messages from social sources were significantly more likely to report tobacco product use at one-year follow-up than those who were not exposed to social messages. Exposure to positive tobacco messages from environmental sources were not significantly associated with tobacco use one year later. Conclusions: Social messages may play an important role in increasing risk of tobacco use among some minoritized populations. Cultural as well as systemic factors could be addressed in future tobacco prevention programs to decrease the potency of positive tobacco-related social messages among Latino/a/x and multiracial communities.
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Affiliation(s)
- Kinsey Pebley
- The University of Memphis, Department of Psychology, 400 Innovation Drive, Memphis, TN 38152
| | - Xin-Qun Wang
- University of Virginia, School of Medicine Department of Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903
| | - Margaret C. Fahey
- The University of Memphis, Department of Psychology, 400 Innovation Drive, Memphis, TN 38152
| | - Christi A. Patten
- The Mayo Clinic, Department of Psychiatry & Psychology, Rochester, 200 First Street, SW Colonial 3, Rochester, MN 55902
| | - Indika Mallawaarachchi
- University of Virginia, School of Medicine Department of Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903
| | - G. Wayne Talcott
- University of Virginia, School of Medicine Department of Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903
- The Mayo Clinic, Department of Psychiatry & Psychology, Rochester, 200 First Street, SW Colonial 3, Rochester, MN 55902
- Wilford Hall Ambulatory Surgical Center, 59 MDW/ 59 SGOWMP, 1100 Wilford Hall Loop, Bldg 4554, Joint Base Lackland AFB, TX 78236
| | - Robert C. Klesges
- University of Virginia, School of Medicine Department of Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903
| | - Melissa A. Little
- University of Virginia, School of Medicine Department of Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, 22903
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Little MA, Bonilla G, McMurry T, Pebley K, Klesges RC, Talcott GW. The Feasibility of Using Self-Generated Identification Codes in Longitudinal Research With Military Personnel. Eval Health Prof 2022; 45:354-361. [PMID: 34308666 DOI: 10.1177/01632787211031625] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Self-generated identification codes (SGICs) are strings of information based on stable participant characteristics. They are often used in longitudinal research to match data between time points while protecting participant anonymity. However, the use of SGICs with military personnel has been infrequent, even though military personnel do not have the same privacy protections as civilians. The current paper reports results from two studies that tested the feasibility, reliability, and validity of using a SGIC to collect sensitive longitudinal data among military personnel. In study one, a team of 105 participants was tracked three times over a period of 12 weeks. The 10-item SGIC produced optimal matching over the 12-weeks. In study two, 1,844 participants were randomly assigned to a SGIC group or an anonymous control group, and then were asked to provide information about their alcohol use. Although match rates declined over time, there were no observed differences between study groups in participants' beliefs about the use of a SGIC. However, differences were identified in reported alcohol use behaviors between the groups, with controls reporting significantly more drinks per week and higher AUDIT-10 scores. While these findings raise potential concerns about using SGICs for epidemiological assessments of highly sensitive problem behaviors, these codes may still be useful in determining group differences in behavior change in randomized studies.
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Affiliation(s)
- Melissa A Little
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.,UVA Cancer Center, Univeristy of Virginia, Charlottesville, VA, USA
| | - Gloribel Bonilla
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.,UVA Cancer Center, Univeristy of Virginia, Charlottesville, VA, USA
| | - Timothy McMurry
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Kinsey Pebley
- Department of Psychology, The University of Memphis, TN, USA
| | - Robert C Klesges
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.,UVA Cancer Center, Univeristy of Virginia, Charlottesville, VA, USA
| | - G Wayne Talcott
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.,UVA Cancer Center, Univeristy of Virginia, Charlottesville, VA, USA.,Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, TX, USA
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10
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Pebley K, Farage G, Hare ME, Bursac Z, Andres A, Chowdhury SMR, Talcott GW, Krukowski RA. Changes in self-reported and accelerometer-measured physical activity among pregnant TRICARE Beneficiaries. BMC Public Health 2022; 22:2029. [PMID: 36336697 PMCID: PMC9638321 DOI: 10.1186/s12889-022-14457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/09/2022] Open
Abstract
Background Physical activity is recommended for all pregnant individuals and can prevent excessive gestational weight gain. However, physical activity has not been assessed among military personnel and other TRICARE beneficiaries, who experience unique military lifestyles. The current study assessed physical activity among pregnant TRICARE beneficiaries, both active duty and non-active duty, as measured by accelerometry and self-report data to examine potential predictors of physical activity engagement in the third trimester, and if self-report data was consistent with accelerometry data. We expected having a lower BMI, being active-duty, and having higher baseline physical activity engagement to be associated with higher physical activity at 32-weeks. We also hypothesized that accelerometry data would show lower physical activity levels than the self-reported measure. Methods Participants were 430 TRICARE adult beneficiaries (204 Active Duty; 226 non-Active Duty) in San Antonio, TX who were part of a randomized controlled parent study that implemented a stepped-care behavioral intervention. Participants were recruited if they were less than 12-weeks gestation and did not have health conditions precluding dietary or physical activity changes (e.g., uncontrolled cardiovascular conditions) or would contribute to weight changes. Participants completed self-report measures and wore an Actical Activity Monitor accelerometer on their wrist to collect physical activity data at baseline and 32-weeks gestation. Results Based on the accelerometer data, 99% of participants were meeting moderate physical activity guidelines recommending 150 min of moderate activity per week at baseline, and 96% were meeting this recommendation at 32-weeks. Based on self-report data, 88% of participants at baseline and 92% at 32-weeks met moderate physical activity recommendations. Linear regression and zero-inflated negative binomial models indicated that baseline physical activity engagement predicted moderate physical activity later in pregnancy above and beyond BMI and military status. Surprisingly, self-reported data, but not accelerometer data, showed that higher baseline activity was associated with decreased vigorous activity at 32-weeks gestation. Additionally, self-report and accelerometry data had small correlations at baseline, but not at 32-weeks. Conclusions Future intervention efforts may benefit from intervening with individuals with lower pre-pregnancy activity levels, as those who are active seem to continue this habit. Trial Registration The trial is registered on clinicaltrials.gov (NCT 03057808).
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Affiliation(s)
- Kinsey Pebley
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Gregory Farage
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, Florida, USA
| | - Aline Andres
- University of Arkansas for Medical Sciences and Arkansas Children's Nutrition Center, Little Rock, Arkansas, USA
| | | | - G Wayne Talcott
- Wilford Hall Ambulatory Surgical Center, San Antonio, Texas, USA.,Department of Public Health Sciences, University of Virginia, University of Virginia Cancer Center, PO Box 800765, Charlottesville, Virginia, 22903, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, University of Virginia Cancer Center, PO Box 800765, Charlottesville, Virginia, 22903, USA.
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11
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Pebley K, Murphy JG, Wang XQ, Talcott GW, Klesges RC, McDevitt-Murphy ME, McMurry TL, Little MA. Validity of the alcohol purchase task with United States military personnel. Exp Clin Psychopharmacol 2022; 30:141-150. [PMID: 33119385 DOI: 10.1037/pha0000392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcohol use is common among military personnel. However, alcohol use and problems are challenging to measure because military personnel do not have similar levels of confidentiality as civilians and can face sanctions for reporting illegal behavior (e.g., underage drinking) or for drinking during prohibited times (e.g., during basic training). The current study aimed to determine if the use of the alcohol purchase task (APT), which has previously been associated with alcohol use and alcohol-related problems in civilian populations, is a valid measure of alcohol-related risk in the military when asking about alcohol consumption is less feasible. Participants were 26,231 Air Force airmen who completed surveys including questions about sensation seeking, alcohol expectancies, perception of peer drinking, intent to drink, and family history of alcohol misuse, which are known predictors of alcohol use, and the APT, from which demand indices of intensity and Omax were derived. Individuals who were single, male, White, and had a high school diploma/GED had higher intensity and Omax scores, and non-Hispanic individuals had higher intensity scores. Age was negatively correlated with intensity and Omax. Regressions were used to determine if intensity and Omax were associated with known predictors of alcohol use and risk. Intensity and Omax showed significant but small associations with all included predictors of alcohol consumption and alcohol risk. Effect sizes were larger for individuals ages 21+ compared to individuals under 21. Thus, this study provides initial support for the validity of the APT as an index of alcohol-related risk among military personnel. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Little MA, Klesges RC, Mallawaarachchi I, McMurry T, Pebley K, McDevitt-Murphy M, Murphy J, Wayne Talcott G. Prevention of Alcohol-related Incidents in the U.S. Air Force: Results From a Cluster Randomized Trial. Mil Med 2021; 188:usab489. [PMID: 34865112 DOI: 10.1093/milmed/usab489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Alcohol misuse poses significant public health concerns in the U.S. Military. An Alcohol Misconduct Prevention Program (AMPP), which includes a brief alcohol intervention (BAI) session, plus random breathalyzer program, has been shown to reduce alcohol-related incidents (ARIs) among Airmen undergoing training. PURPOSE The current study sought to examine whether a booster BAI administered at the end of Airmen's training reduced ARIs out to a 1-year follow-up. METHODS Participants were 26,231 U.S. Air Force Technical Trainees recruited between March 2016 and July 2018. Participants were cluster randomized by cohort to two conditions: AMPP + BAI Booster or AMPP + Bystander Intervention. The primary analysis was a comparison of the interventions' efficacies in preventing Article 15 ARIs at a 1-year follow-up, conducted using a generalized estimating equations logistic regression model controlling for covariates. RESULTS There was no significant difference by condition in Article 15 ARIs at the 1-year follow-up (P = .912). CONCLUSIONS Findings suggest that a booster may not be necessary to produce maximum effects beyond the initial AMPP intervention. It is also possible that alcohol behaviors changed as a result of the intervention but were not captured by our outcome measures. Future research should consider alternative outcomes or participant-tracking measures to determine whether a different or more intensive BAI booster is effective. The majority of Article 15 ARIs were for underage drinking; therefore, developing an intervention focused on this problem behavior could lead to large reductions in training costs in the military.
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Affiliation(s)
- Melissa A Little
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA
- University of Virginia Cancer Center, Charlottesville, VA 22903, USA
| | - Robert C Klesges
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA
- University of Virginia Cancer Center, Charlottesville, VA 22903, USA
| | - Indika Mallawaarachchi
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA
| | - Timothy McMurry
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA
| | - Kinsey Pebley
- Department of Psychology, University of Memphis, Memphis, TN 38152, USA
| | | | - James Murphy
- Department of Psychology, University of Memphis, Memphis, TN 38152, USA
| | - G Wayne Talcott
- School of Medicine Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, USA
- University of Virginia Cancer Center, Charlottesville, VA 22903, USA
- Wilford Hall Ambulatory Surgical Center, San Antonio-Lackland AFB, TX 78236, USA
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13
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Pebley K, Krukowski RA, Mallawaarachchi I, Wayne Talcott G, Klesges RC, Little MA. Dual and polytobacco use after a period of enforced tobacco cessation. Addict Behav 2021; 123:107077. [PMID: 34391132 DOI: 10.1016/j.addbeh.2021.107077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/07/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
The current study aimed to assess single product, dual, and polytobacco use in a young adult military population and how an enforced tobacco ban during training impacts these behaviors. Participants were 810 U.S. Airmen who reported tobacco use as civilians. Participants completed baseline and one-year follow-up surveys about their tobacco use from 2016 to 2019. Each product used by a participant was assigned a score based on their frequency of use, which were summed to create a total score. Change scores were calculated by determining the difference between baseline and follow-up frequency scores. Tobacco frequency score and the categorical change (e.g., increased, decreased) were compared between groups using t-tests and Chi-squared tests, respectively, adjusting for clustering effects by squadron and base. Among single product users, 44.58% quit using tobacco products, 47.1% remained single product users, and 8.32% became dual or polytobacco users. Among dual users, 39.1% quit, 43.1% became single product users, 14.2% remained dual users, and 3.7% became polytobacco users. Among polytobacco users, 29.9% quit, 43.4% became single product users, 17.9% became dual users, and 8.8% continued poly-tobacco use. Most participants reduced the number and frequency of tobacco products used. Implementing stringent policies that further restrict tobacco use may decrease tobacco product use or frequency of use.
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14
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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. Mil Psychol 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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Farage G, Simmons C, Kocak M, Klesges RC, Talcott GW, Richey P, Hare M, Johnson KC, Sen S, Krukowski R. Assessing the Contribution of Self-Monitoring Through a Commercial Weight Loss App: Mediation and Predictive Modeling Study. JMIR Mhealth Uhealth 2021; 9:e18741. [PMID: 34259635 PMCID: PMC8319781 DOI: 10.2196/18741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 12/22/2020] [Accepted: 04/15/2021] [Indexed: 01/15/2023] Open
Abstract
Background Electronic self-monitoring technology has the potential to provide unique insights into important behaviors for inducing weight loss. Objective The aim of this study is to investigate the effects of electronic self-monitoring behavior (using the commercial Lose It! app) and weight loss interventions (with differing amounts of counselor feedback and support) on 4- and 12-month weight loss. Methods In this secondary analysis of the Fit Blue study, we compared the results of two interventions of a randomized controlled trial. Counselor-initiated participants received consistent support from the interventionists, and self-paced participants received assistance upon request. The participants (N=191), who were active duty military personnel, were encouraged to self-monitor their diet and exercise with the Lose It! app or website. We examined the associations between intervention assignment and self-monitoring behaviors. We conducted a mediation analysis of the intervention assignment for weight loss through multiple mediators—app use (calculated from the first principal component [PC] of electronically collected variables), number of weigh-ins, and 4-month weight change. We used linear regression to predict weight loss at 4 and 12 months, and the accuracy was measured using cross-validation. Results On average, the counselor-initiated–treatment participants used the app more frequently than the self-paced–treatment participants. The first PC represented app use frequencies, the second represented calories recorded, and the third represented reported exercise frequency and exercise caloric expenditure. We found that 4-month weight loss was partially mediated through app use (ie, the first PC; 60.3%) and the number of weigh-ins (55.8%). However, the 12-month weight loss was almost fully mediated by 4-month weight loss (94.8%). Linear regression using app data from the first 8 weeks, the number of self–weigh-ins at 8 weeks, and baseline data explained approximately 30% of the variance in 4-month weight loss. App use frequency (first PC; P=.001), self-monitored caloric intake (second PC; P=.001), and the frequency of self-weighing at 8 weeks (P=.008) were important predictors of 4-month weight loss. Predictions for 12-month weight with the same variables produced an R2 value of 5%; only the number of self–weigh-ins was a significant predictor of 12-month weight loss. The R2 value using 4-month weight loss as a predictor was 31%. Self-reported exercise did not contribute to either model (4 months: P=.77; 12 months: P=.15). Conclusions We found that app use and daily reported caloric intake had a substantial impact on weight loss prediction at 4 months. Our analysis did not find evidence of an association between participant self-monitoring exercise information and weight loss. As 12-month weight loss was completely mediated by 4-month weight loss, intervention targets should focus on promoting early and frequent dietary intake self-monitoring and self-weighing to promote early weight loss, which leads to long-term success. Trial Registration ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178
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Affiliation(s)
- Gregory Farage
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Courtney Simmons
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Mehmet Kocak
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Robert C Klesges
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.,Center for Addiction Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - G Wayne Talcott
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States.,Center for Addiction Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Phyllis Richey
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Marion Hare
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Karen C Johnson
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Saunak Sen
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Rebecca Krukowski
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
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16
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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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Little MA, Pebley K, Porter K, Talcott GW, Krukowski RA. 'I Think Smoking's the Same, but the Toys Have Changed.' Understanding Facilitators of E-Cigarette Use among Air Force Personnel. J Addict Prev 2020; 8:7. [PMID: 33204766 PMCID: PMC7668561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The military has stringent anti-tobacco regulations for new recruits. While most tobacco products have declined in recent years, e-cigarette use has tripled among this population. However, little is known about the factors facilitating this inverse relationship. OBJECTIVES Examine the facilitators of e-cigarette use during a high risk period following initial enlistment among young adults. METHODS Focus groups were conducted with Airmen, Military Training Leaders (MTLs) and Technical Training Instructors (TTIs) to qualitatively explore unique characteristics of e-cigarettes leading to use in Technical Training. RESULTS The most commonly used tobacco product across participants was cigarettes (42.7%), followed by e-cigarettes (28.0%) and smokeless tobacco (22.6%). Almost a third (28.7%) of participants reported using more than one tobacco product. E-cigarette use was much more common among Airmen (76.1%), compared to MTLs (10.9%) and TTIs (13.0%).Four main facilitators around e-cigarette use were identified including: 1) There is no reason not to use e-cigarettes; 2) Using e-cigarettes helps with emotion management; 3) Vaping is a way of fitting in; and 4) Existing tobacco control policies don't work for vaping. E-cigarettes were not perceived as harmful to self and others, which could explain why Airmen were much less likely to adhere to existing tobacco control regulations. Subversion was viewed as the healthy option compared to utilizing designated tobacco use areas due to the potential exposure to traditional tobacco smoke. This coupled with a lack of understanding about e-cigarette regulations and difficulties with enforcement, promoted use among this young adult population. CONCLUSION Findings suggest that e-cigarettes are used for similar reasons as traditional tobacco products, but their unique ability to be concealed promotes their widespread use and circumvents existing tobacco control policies. In order to see reductions in use, environmental policies may need to be paired with behavioral interventions at the personal and interpersonal level.
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Affiliation(s)
- MA Little
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA,Address for Correspondence Little MA,
University of Virginia, School of Medicine, Department of Public Health
Sciences, 560 Ray C. Hunt Drive, Rm 2119 Charlottesville, VA, USA, 22903;
| | - K Pebley
- University of Memphis, Department of Psychology, 400
Innovation Drive, Memphis, TN, USA, 38152
| | - K Porter
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - GW Talcott
- University of Virginia, School of Medicine, Department of
Public Health Sciences, 560 Ray C. Hunt Drive, Charlottesville, VA, USA,Wilford Hall Ambulatory Surgical Center, 59 MDW/ 59 SGOWMP,
1100 Wilford Hall Loop, Bldg 4554, Joint Base Lackland AFB, TX, USA 78236
| | - RA Krukowski
- Department of Preventive Medicine, University of Tennessee
Health Science Center, 66 North Pauline Street, Memphis, TN, USA 38163
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Pebley K, Beauvais A, Gladney LA, Kocak M, Klesges RCK, Hare M, Richey PA, Johnson KC, Hryshko-Mullen A, Talcott GW, Krukowski RA. Weight Loss Intervention Impact on the Physical Fitness Test Scores of Air Force Service Members. Mil Med 2020; 185:e781-e787. [PMID: 31735969 PMCID: PMC7282442 DOI: 10.1093/milmed/usz371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Overweight and obesity are a major public health concern in the United States, including among active duty military personnel. Approximately 51% of active duty personnel are classified as overweight and 15% are classified as obese. This may impact military readiness. The current study aimed to determine if a weight loss intervention impacted fitness test scores among Air Force personnel. MATERIALS AND METHODS From 2014 to 2016, 204 Air Force members with overweight/obesity were randomized into either a Self-paced or counselor-initiated arm in a weight loss program. Study procedures were approved by the Institutional Review Board of the 59th Medical Wing in San Antonio and were acknowledged by the Institutional Review Board at the University of Tennessee Health Science Center. Fitness test scores from before, during, and after the intervention were used to determine if the intervention resulted in improvements in overall fitness test ratings and scores on individual components of the test. RESULTS Participants who lost at least 5% of their weight had better fitness ratings during the intervention compared to individuals who did not lose 5%. However, in the overall sample, fitness ratings worsened from preintervention to during the intervention, and from during to postintervention. Participants with overweight had better aerobic scores pre- and postintervention as well as better abdominal circumference scores and better fitness test ratings preintervention, during the intervention and postintervention compared to participants with obesity. CONCLUSIONS Behavioral weight management interventions that achieve 5% weight loss may help improve military fitness test ratings.
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Affiliation(s)
- Kinsey Pebley
- Department of Psychology, University of Memphis, Memphis, TN
| | - Alexis Beauvais
- Brooke Army Medical Center, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX
| | - Leslie A Gladney
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, VA
- Department of Public Health Sciences, Center for Addiction Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Robert C Klesges Klesges
- Department of Public Health Sciences, Center for Addiction Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Marion Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Ann Hryshko-Mullen
- Department of Mental Health, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, San Antonio, TX
| | - G Wayne Talcott
- Department of Public Health Sciences, Center for Addiction Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN
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Fahey MC, Talcott GW, McMurry TL, Klesges RC, Tubman D, Krukowski RA, Little MA. When, How, & Where Tobacco Initiation and Relapse Occur During U.S. Air Force Technical Training. Mil Med 2020; 185:e609-e615. [PMID: 32060547 PMCID: PMC7282443 DOI: 10.1093/milmed/usaa016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/09/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Military personnel are at high risk for tobacco use, particularly during the first year of military service. Technical Training follows an 8½ week tobacco ban during basic military training and is a vulnerable time for personnel to both reinitiate and initiate tobacco use. Thus, this can be a crucial time to promote tobacco policies and interventions. However, there is limited research examining when, how, and where personnel access tobacco during the first year of service, particularly among users of newer products (eg, electronic cigarettes[e-cigarettes]). Thus, the purpose of the current study is to explore the timing, source, and location of tobacco use during Technical Training across all types of products. Furthermore, this study will examine differences in demographic characteristics and prior tobacco history in relationship to these tobacco behaviors. MATERIALS AND METHODS Participants were U.S. Air Force recruits completing Technical Training (2017-2018). Protocol was approved by the Institutional Review Board at the 59th Medical Wing of the U.S. Air Force. During the first week of Technical Training, Airmen were consented to participate in the study and completed a questionnaire about demographics and tobacco use history. Next, Airmen were randomized to receive one of three tobacco prevention interventions as part of military training. At a 3-month follow-up, during the last week of Technical Training, consented participants completed a questionnaire about current tobacco use. Airmen reported when (ie, first month vs. after), how (ie, "bummed" from another airman, bought on or off base, received from the internet or event), and where (ie, designated smoking areas on base, off base, bar or club, friend's house, cigar lounge, hookah bar, or vape shop) they used tobacco during Technical Training. Descriptive statistics were used to examine these behaviors across all tobacco products. Additionally, Wilcoxon-Mann-Whitney and Kruskal-Wallis tests compared differences in demographic characteristics and baseline tobacco use in relationship to these tobacco behaviors. RESULTS No significant differences were found when comparing prior users and first-time users in relationship to tobacco behaviors during Technical Training; however, significant differences in educational background and age were found in regard to the source and location of tobacco use. Additionally, how and where Airmen first used tobacco during Technical Training differed across products. Cigarettes and smokeless tobacco were equally likely to be bought on or off base and most commonly first used at a designated smoking area on base. However, e-cigarettes, cigarillos/little cigars, and hookah were more likely to be bought off base, and first used at a specialty store (ie, vape shop, hookah bar, or cigar lounge). CONCLUSIONS Tobacco use behaviors during Technical Training differed depending on the type of product. Specifically, new and emerging products were more likely to be bought off base and first used at a specialty store. Thus, military polices regulating on base tobacco pricing might not reduce the growing prevalence of e-cigarettes. Future policies might consider addressing the density of off-base tobacco retailers to reduce the high rates of tobacco use in this population.
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Affiliation(s)
| | - G Wayne Talcott
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio- Lackland AFB; 1100 Wilford Hall Loop, Bldg 4430; JBSA-Lackland, TX 78236-9908, USA
| | - Timothy L McMurry
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
| | - Robert C Klesges
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
| | - David Tubman
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
| | - Rebecca A Krukowski
- University of Tennessee Health Science Center, Department of Preventive Medicine; 66 N Pauline Street Memphis, TN 38163, USA
| | - Melissa A Little
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio- Lackland AFB; 1100 Wilford Hall Loop, Bldg 4430; JBSA-Lackland, TX 78236-9908, USA
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Affiliation(s)
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - G Wayne Talcott
- School of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Melissa A Little
- School of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pebley K, Klesges RC, Talcott GW, Kocak M, Krukowski RA. Measurement Equivalence of E-Scale and In-Person Clinic Weights. Obesity (Silver Spring) 2019; 27:1107-1114. [PMID: 31168928 PMCID: PMC7575123 DOI: 10.1002/oby.22512] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/08/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current study aimed to determine whether electronic scale (e-scale) weight measurements are concordant with in-person clinic weights. METHODS E-scale and in-person clinic weight measurements from 248 active duty military personnel enrolled in a weight-loss intervention study were used. E-scale and clinic measurements were matched and tested to determine whether measurements were significantly different from each other. Equivalence between the two measurements was tested among the cohort and when stratifying by gender, BMI, race, and age. The study also examined whether matching the times of clinic and e-scale measurements or averaging multiple measurements was optimal, and whether using e-scale and clinic measurements from the same day or across a specified amount of time was acceptable. RESULTS Overall, e-scale and clinic measurements were significantly different from each other but did not differ from equality. Additionally, using e-scale and clinic weight measurements that were taken on the same day may be a preferable method compared with using measurements within a week of each other, which leads to weight underprediction among e-scale measurements. CONCLUSIONS E-scales display good measurement concordance. E-scales may be helpful when studying highly mobile populations, such as military personnel, and could potentially eliminate the need for in-person visits.
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Affiliation(s)
- Kinsey Pebley
- 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
| | - 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
| | - Mehmet Kocak
- 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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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: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Maclin-Akinyemi C, Krukowski RA, Kocak M, Talcott GW, Beauvais A, Klesges RC. Motivations for Weight Loss Among Active Duty Military Personnel. Mil Med 2018; 182:e1816-e1823. [PMID: 28885942 DOI: 10.7205/milmed-d-16-00380] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Rates of overweight and obesity among Active Duty Military Personnel remain high despite fitness test requirements, negative consequences of fitness test failure, and emphasis on weight and appearance standards. Specific motivating factors for weight loss influence weight loss program interest and often differ by gender, race, ethnicity, or age. This study investigates the weight loss motivations endorsed by a diverse population of Active Duty Military Personnel initiating a behavioral weight loss study, to inform the development of future recruitment efforts and program development. MATERIALS AND METHODS Active Duty Military Personnel (n = 248) completed a 16-item questionnaire of weight loss motivations before initiating a behavioral weight loss study. We evaluated endorsement patterns by demographic characteristics (body mass index [BMI], gender, race, ethnicity, age, and military rank). Data collection for this study was approved by the Institutional Review Board of Wilford Hall Ambulatory Surgical Center and acknowledged by the Institutional Review Board of the University of Tennessee Health Science Center. RESULTS Results indicated that improved physical health, improved fitness, improved quality of life, and to live long were endorsed as "very important" motivations by at least three-fourths of the sample. "To pass the fitness test" was endorsed less frequently as a "very important" motivation, by 69% of the sample. A greater proportion of women as compared to men endorsed being very motivated by improving mood/well-being, quality of life, physical mobility, job performance, appearance, and sex life, as well as fitting into clothes. Participants categorized in the "Other" racial group and African Americans more frequently endorsed motivations to improve fitness and physical strength when compared to Caucasians. Moreover, participants in the "Other" race category were significantly more likely to rate their ability to physically defend themselves, improve physical mobility, and improve interactions with friends as motivators. Participants who identified as Hispanic endorsed significantly higher frequency of being motivated to improve their ability to physically defend themselves, interactions with friends, physical mobility, and sex life compared to those who identified as non-Hispanic. A significantly lower percentage of officers of lower rank (i.e., O1-3) endorsed being motivated to improve their quality of life. Improving confidence was a significant motivator for younger and lower ranking enlisted personnel (i.e., E1-4). Younger participants were also significantly more likely to want to improve their ability to physically defend themselves. CONCLUSION We conclude that overweight and obese Military Personnel are motivated by various reasons to engage in weight loss, including their military physical fitness test. Findings may assist the development of recruitment efforts or motivationally focused intervention materials for weight loss interventions tailored for the diverse population of Active Duty Military Personnel.
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Affiliation(s)
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Sciences, Center for Population Sciences, 66 Pauline, Memphis, TN 38105
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Sciences, Center for Population Sciences, 66 Pauline, Memphis, TN 38105
| | - G Wayne Talcott
- Department of Preventive Medicine, University of Tennessee Health Sciences, Center for Population Sciences, 66 Pauline, Memphis, TN 38105
| | - Alexis Beauvais
- Department of Internal Medicine, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Sciences, Center for Population Sciences, 66 Pauline, Memphis, TN 38105
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Derefinko KJ, Linde BD, Klesges RC, Boothe T, Colvin L, Leroy K, Little MA, Pasker C, Murphy JG, McDevitt-Murphy ME, Bursac Z, Ebbert JO, Waters TM, Brooks I, Talcott GW. Dissemination of the Brief Alcohol Intervention in the United States Air Force: Study Rationale, Design, and Methods. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/21635781.2017.1397569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Karen J. Derefinko
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Brittany D. Linde
- Organizational Wellness & Learning Systems (OWLS), Fort Worth, Texas
| | - Robert C. Klesges
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Tina Boothe
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
| | - Lauren Colvin
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Karen Leroy
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
| | - Melissa A. Little
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
| | - Christin Pasker
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
| | - James G. Murphy
- Department of Psychology, The University of Memphis, Memphis, Tennessee
| | - Meghan E. McDevitt-Murphy
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Jon O. Ebbert
- Nicotine Dependence Center, Mayo Clinic, Rochester, Minnesota
| | - Teresa M. Waters
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Ian Brooks
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - G. Wayne Talcott
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, San Antonio, Texas
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Balderrama-Durbin C, Stanton K, Snyder DK, Cigrang JA, Talcott GW, Smith Slep AM, Heyman RE, Cassidy DG. The risk for marital infidelity across a year-long deployment. J Fam Psychol 2017; 31:629-634. [PMID: 28054799 DOI: 10.1037/fam0000281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Military deployment can create significant relationship strain. Although most couples navigate the challenges of deployment successfully, this period may render some couples more vulnerable to adverse relationship outcomes such as infidelity due to a convergence of factors including geographic separation and reduced emotional and physical intimacy. Despite anecdotal reports of increased rates of infidelity during deployment, empirical findings are lacking. This study used a prospective design to examine the prevalence and risk factors of infidelity across the deployment cycle including a year-long deployment to Iraq. A total of 63 married male Airmen were assessed both pre- and 6-9 months postdeployment. The rate of sexual infidelity prior to deployment (21%) was commensurate with the lifetime rate of sexual involvement outside the marriage in representative community samples of men. Across the deployment period, the prevalence of sexual infidelity was strikingly high (22.6%) compared with annual community estimates (1.5-4%; Allen et al., 2005). Findings demonstrated that service members with a prior history of separation, steps toward divorce, and relationship distress prior to deployment had elevated risk for infidelity over the deployment cycle. Moreover, roughly 75% of Airmen who experienced infidelity over the deployment cycle divorced by 6-9 months postdeployment whereas only 5% of service members without infidelity divorced during this same time period. Considering well-documented adverse impacts of infidelity and divorce, the current findings may assist in identifying military couples at risk for infidelity and informing targeted prevention or early intervention strategies for these couples prior to or immediately following deployment. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | - G Wayne Talcott
- Department of Preventative Medicine, University of Tennessee Health Science Center
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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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Klesges RC, Ebbert JO, Talcott GW, Thomas F, Richey PA, Womack C, Hryshko-Mullen A, Oh J. Efficacy of a Tobacco Quitline in Active Duty Military and TRICARE Beneficiaries: A Randomized Trial. Mil Med 2016; 180:917-25. [PMID: 26226536 DOI: 10.7205/milmed-d-14-00513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
A higher proportion of military personnel than civilians smoke cigarettes. Few randomized trials of tobacco use interventions have been conducted in the U.S. military. We evaluated the efficacy of a tobacco quitline (QL) in 1298 active duty military personnel, their dependents, reservists, and retirees who smoke cigarettes. Participants were randomized to either a proactive (counselor-initiated) or reactive (participant-initiated) QL intervention for 8 weeks. The proactive condition included up to an 8-week supply of free nicotine replacement therapy, and the reactive condition included a 2-week supply. The primary outcome was 12-month smoking abstinence. The enrolled population was predominantly affiliated with the Air Force and Army. At the end of treatment, proactive treatment was associated with a greater odds of both prolonged (44.22% vs. 24.96%; odds ratio [OR] = 2.4, P < 0.0001) and 7-day point prevalence (49.92% vs. 28.20%; OR = 2.5, P < 0.0001) smoking abstinence, a difference that was maintained for prolonged smoking abstinence at 12 months (22.03% vs. 13.41%; OR = 1.8, P < 0.0001). Our findings provide evidence that a proactive QL with nicotine replacement therapy is highly efficacious among Air Force and Army active duty and TRICARE beneficiaries and would provide an effective telephonic treatment option for this population of smokers.
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Affiliation(s)
- Robert C Klesges
- Department of Preventive Medicine & Center For Population Sciences, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Jon O Ebbert
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - G Wayne Talcott
- Department of Preventive Medicine & Center For Population Sciences, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Phyllis A Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Catherine Womack
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Ann Hryshko-Mullen
- Joint Base San Antonio-Lackland, 2200 Bergquist Drive Suite 1, San Antonio, TX 78236
| | - John Oh
- Air Force Medical Support Agency, 7700 Arlington Boulevard Suite 5158, Falls Church, VA 22042
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Snyder DK, Balderrama-Durbin C, Cigrang JA, Talcott GW, Slep AMS, Heyman RE. Help-seeking among airmen in distressed relationships: Promoting relationship well-being. Psychotherapy (Chic) 2016; 53:1-12. [PMID: 26928135 DOI: 10.1037/pst0000045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although a substantial proportion of service members returning from a combat deployment report individual emotional and behavioral disorders as well as intimate relationship difficulties, previous studies indicate that only a minority actually seek mental health services. Little is known about factors that predict help-seeking in this population. We first review key findings from the literature on help-seeking in military and veteran populations, including mixed findings regarding the role of perceived stigma and attitudes toward mental health treatment. We then present data from a longitudinal study of United States Air Force Security Forces following a year-long high-risk deployment to Iraq-including findings regarding who seeks help, for what problems, and from which providers. We also examine whether these findings differ for Airmen in a married or committed relationship versus nonpartnered Airmen and, for the former group, whether findings differ for those in a distressed versus nondistressed relationship. Finally, we discuss implications of these findings for extending couple-based interventions to service members and veterans, and describe a multitiered "stepped" approach for promoting relationship resiliency.
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Affiliation(s)
| | | | | | - G Wayne Talcott
- Department of Preventative Medicine, University of Tennessee Health Science Center
| | - Amy M Smith Slep
- Department of Cariology and Comprehensive Care, New York University
| | - Richard E Heyman
- Department of Cariology and Comprehensive Care, New York University
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Popova L, Linde BD, Bursac Z, Talcott GW, Modayil MV, Little MA, Ling PM, Glantz SA, Klesges RC. Testing antismoking messages for Air Force trainees. Tob Control 2015; 25:656-663. [PMID: 26482786 DOI: 10.1136/tobaccocontrol-2015-052477] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 09/25/2015] [Accepted: 09/28/2015] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Young adults in the military are aggressively targeted by tobacco companies and are at high risk of tobacco use. Existing antismoking advertisements developed for the general population might be effective in educating young adults in the military. This study evaluated the effects of different themes of existing antismoking advertisements on perceived harm and intentions to use cigarettes and other tobacco products among Air Force trainees. METHODS In a pretest-post-test experiment, 782 Airmen were randomised to view antismoking advertisements in 1 of 6 conditions: anti-industry, health effects+anti-industry, sexual health, secondhand smoke, environment+anti-industry or control. We assessed the effect of different conditions on changes in perceived harm and intentions to use cigarettes, electronic cigarettes, smokeless tobacco, hookah and cigarillos from pretest to post-test with multivariable linear regression models (perceived harm) and zero-inflated Poisson regression model (intentions). RESULTS Antismoking advertisements increased perceived harm of various tobacco products and reduced intentions to use. Advertisements featuring negative effects of tobacco on health and sexual performance coupled with revealing tobacco industry manipulations had the most consistent pattern of effects on perceived harm and intentions. CONCLUSIONS Antismoking advertisements produced for the general public might also be effective with a young adult military population and could have spillover effects on perceptions of harm and intentions to use other tobacco products besides cigarettes. Existing antismoking advertising may be a cost-effective tool to educate young adults in the military.
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Affiliation(s)
- Lucy Popova
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Brittany D Linde
- Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Zoran Bursac
- Division of Biostatistics, Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - G Wayne Talcott
- Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mary V Modayil
- Institute for Population Health Improvement, University of California, Davis Medical Center, Sacramento, California, USA
| | - Melissa A Little
- Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Pamela M Ling
- Division of General Internal Medicine, Department of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Stanton A Glantz
- Division of Cardiology, Department of Medicine, Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco, California, USA
| | - Robert C Klesges
- Department of Preventive Medicine, Center for Population Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Talcott GW, Ebbert JO, Klesges RC, Linde BD, Seals RW, Krukowski RA, Grieser EA, Oh JY, Martin-Zona DM. Tobacco Research in the Military: Reflections on 20 Years of Research in the United States Air Force. Mil Med 2015; 180:848-50. [PMID: 26226525 PMCID: PMC6677132 DOI: 10.7205/milmed-d-14-00501] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The U.S. military is one of the world's largest employers. Approximately 30% of active duty military personnel smoke cigarettes and more than 14% use smokeless tobacco. The military has historically supported tobacco use and more recently is attempting to combat its use. Through 20 years of collaborative research with the United States Air Force, we have learned that smoking bans are effective, recruits who have never previously smoked cigarettes initiate tobacco use, smokeless tobacco serves as a gateway for smoking initiation, smoking is associated with discharge, smoking adds significant proximal training costs, tobacco use increases during deployment, and tobacco quitline counseling with a provision of medication is effective. Our findings may provide groundwork for future tobacco control efforts in the U.S. military.
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Affiliation(s)
- G Wayne Talcott
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 Pauline, Suite 633, Memphis, TN 38163
| | - Jon O Ebbert
- Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 Pauline, Suite 633, Memphis, TN 38163
| | - Brittany D Linde
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 Pauline, Suite 633, Memphis, TN 38163
| | - Robert W Seals
- 60 MDOS/SGOW, 101 Bodin Circle, Travis Air Force Base, CA 94535
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 Pauline, Suite 633, Memphis, TN 38163
| | - Emily A Grieser
- Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, Suite 1, Lackland Air Force Base, TX 78236
| | - John Y Oh
- Air Force Medical Support Agency, Surgeon General of the Air Force, Healthcare Operations (SG3), 7700 Arlington Boulevard, Suite 5158, Falls Church, VA 22042
| | - Denise M Martin-Zona
- Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, Suite 1, Lackland Air Force Base, TX 78236
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Balderrama-Durbin C, Cigrang JA, Osborne LJ, Snyder DK, Talcott GW, Slep AMS, Heyman RE, Tatum J, Baker M, Cassidy D, Sonnek S. Coming home: A prospective study of family reintegration following deployment to a war zone. Psychol Serv 2015. [PMID: 26213790 DOI: 10.1037/ser0000020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The consequences of deployment extend beyond the service member to impact the entire family. The current investigation evaluated the unique challenges of family reintegration for partnered service members using a prospective design. In total, 76 partnered service members who deployed on a year-long, high-risk mission to Iraq were assessed across the entirety of the deployment cycle, i.e., pre-, during, and postdeployment. At follow-up, nearly 1 in 5 partnered service members reported moderate to severe difficulties in multiple aspects of family reintegration. Prospective interpersonal indicators such as preparations for deployment as a couple, shared commitment to the military, and predeployment relationship distress predicted postdeployment family reintegration difficulties. Significant interpersonal risk factors were medium to large in their effect sizes. Airmen's willingness to disclose deployment- and combat-related experiences, and postdeployment relationship distress served as concurrent interpersonal correlates of difficulties with family reintegration. Intrapersonal factors, including posttraumatic stress symptoms and alcohol misuse were concurrently related to challenges with family reintegration; predeployment alcohol misuse also predicted subsequent family reintegration difficulties. Additional analyses indicated that pre- and postdeployment relationship distress, combat disclosure, and postdeployment alcohol misuse each contributed to family reintegration when controlling for other intra- and interpersonal risk factors. Implications for prevention and early intervention strategies as well as future research are discussed.
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Affiliation(s)
| | | | | | | | - G Wayne Talcott
- Department of Preventative Medicine, University of Tennessee Health Science Center
| | - Amy M Smith Slep
- Department of Cariology and Comprehensive Care, New York University
| | - Richard E Heyman
- Department of Cariology and Comprehensive Care, New York University
| | - JoLyn Tatum
- Aeromedical Research Department, Air Force School of Aerospace Medicine, Wright-Patterson Air Force Base
| | - Monty Baker
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base
| | - Daniel Cassidy
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base
| | - Scott Sonnek
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base
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Cigrang JA, Balderrama-Durbin C, Snyder DK, Talcott GW, Tatum J, Baker M, Cassidy D, Sonnek S, Smith Slep AM, Heyman RE. Predictors of Suicidal Ideation Across Deployment: A Prospective Study. J Clin Psychol 2015; 71:828-42. [PMID: 26010392 DOI: 10.1002/jclp.22192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Concurrent and prospective predictors of suicidal ideation were examined in a sample of 318 United States Air Force Security Forces across a 1-year deployment in Iraq and 6- to 9-month follow-up. METHOD Participants included 294 male and 24 female Airmen ranging in age from 18 to 46 years, predominantly (67%) Caucasian. Measures included self-reports of postdeployment suicidal ideation, posttraumatic stress and depressive symptoms, alcohol use, combat experiences, relationship distress, social support, and postdeployment readjustment. RESULTS Problem drinking before deployment prospectively predicted postdeployment suicidal ideation in univariate analyses. Depressive symptoms and problem drinking were significant independent predictors of postdeployment suicidal ideation. Findings demonstrated a ninefold increase in suicidal ideation among service members with even mild depressive symptoms if moderate problem drinking was also present. CONCLUSIONS Predeployment problem drinking may serve as a modifiable target for early intervention of suicidal ideation. Findings illuminate the compound risk of comorbid depressive symptoms and moderate problem drinking in predicting suicidal ideation.
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Cigrang JA, Wayne Talcott G, Tatum J, Baker M, Cassidy D, Sonnek S, Snyder DK, Balderrama-Durbin C, Heyman RE, Smith Slep AM. Intimate partner communication from the war zone: a prospective study of relationship functioning, communication frequency, and combat effectiveness. J Marital Fam Ther 2014; 40:332-343. [PMID: 24111535 DOI: 10.1111/jmft.12043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 06/02/2023]
Abstract
This study examined (a) the association between relationship functioning prior to and during deployment, and the frequency of communication during deployment; and (b) the association between relationship functioning and depression during deployment and their influence on service members' ratings of duty performance. Participants were 144 partnered Airmen assessed immediately before and during a one-year high-risk deployment to Iraq. Results showed an overall high frequency of partner communication during deployment. High relationship distress at predeployment predicted lower frequency of communication during deployment. Changes in relationship distress from before deployment to during deployment independently predicted frequency of communication, above and beyond predeployment distress levels. Level of relationship distress and depression during deployment independently predicted service members' ratings of impact on duty performance.
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Cigrang JA, Talcott GW, Tatum J, Baker M, Cassidy D, Sonnek S, Snyder DK, Balderrama-Durbin C, Heyman RE, Smith Slep AM. Impact of combat deployment on psychological and relationship health: a longitudinal study. J Trauma Stress 2014; 27:58-65. [PMID: 24464429 DOI: 10.1002/jts.21890] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Although previous research has indicated an elevated prevalence of posttraumatic stress disorder (PTSD) and other mental health problems among veterans of Operations Iraqi Freedom and Enduring Freedom following deployment, most of this research has been cross-sectional and has focused on a limited range of military groups and outcome criteria. This investigation was a longitudinal study of U.S. Air Force security forces assigned to a year-long high-threat ground mission in Iraq to determine the degree to which airmen's emotional and behavioral health and committed relationships were adversely impacted by an extended deployment to a warzone. Participants were a cohort of 164 security forces airmen tasked to a 365-day deployment to train Iraqi police. Airmen completed study measures both prior to and 6-9 months following deployment. Rates of deterioration in individual and interpersonal adjustment were both significant and medium to large in magnitude of effect, d = 0.43 to 0.90. Results suggest that the negative effects of deployment are related to levels of traumatic experiences and do not spontaneously remit within the first 6-9 months following return from deployment-particularly among those service members having relatively lower levels of social support.
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Affiliation(s)
- Jeffrey A Cigrang
- Wright-Patterson Air Force Base, Air Force School of Aerospace Medicine, Ohio, USA
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Fissette CL, Snyder DK, Balderrama-Durbin C, Balsis S, Cigrang J, Talcott GW, Tatum J, Baker M, Cassidy D, Sonnek S, Heyman RE, Smith Slep AM. Assessing posttraumatic stress in military service members: Improving efficiency and accuracy. Psychol Assess 2014; 26:1-7. [DOI: 10.1037/a0034315] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Balderrama-Durbin C, Snyder DK, Cigrang J, Talcott GW, Tatum J, Baker M, Cassidy D, Sonnek S, Heyman RE, Smith Slep AM. Combat disclosure in intimate relationships: mediating the impact of partner support on posttraumatic stress. J Fam Psychol 2013; 27:560-568. [PMID: 23772847 DOI: 10.1037/a0033412] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although previous research has shown a negative relation between partner support and posttraumatic stress disorder (PTSD) symptom severity among military service members following deployment, the mediating mechanisms of this effect remain poorly understood. This study examined willingness to disclose deployment- and combat-related experiences as a mediating mechanism underlying the linkage between intimate partner support and PTSD symptom severity in a sample of 76 U.S. Air Force service members deployed to Iraq in a year-long, high-risk mission. Airmen's reports of overall social support, and partner support specifically, significantly predicted concurrent postdeployment PTSD symptom severity. Subsequent mediation analyses demonstrated that level of disclosure of deployment- and combat-related experiences by service members to their intimate partners accounted for a significant portion of the relation between partner support and postdeployment PTSD symptom severity. The level of Airmen's disclosure was also inversely related to levels of relationship distress. Implications of these findings for prevention and intervention strategies and for further research are discussed.
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Talcott GW, Cigrang J, Sherrill-Mittleman D, Snyder DK, Baker M, Tatum J, Cassidy D, Sonnek S, Balderrama-Durbin C, Klesges RC, Ebbert JO, Slep AM, Heyman RE. Tobacco use during military deployment. Nicotine Tob Res 2013; 15:1348-54. [PMID: 23299184 DOI: 10.1093/ntr/nts267] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Tobacco use among military personnel is associated with significant health care expenditures, lost productivity, and compromised combat readiness. The prevalence remains high among military personnel and may increase in high-risk situations such as deployment. We assessed the prevalence of tobacco use across the deployment cycle, changes in tobacco use (nonuse, continued use, initiation/harm escalation, cessation/harm reduction) during deployment, and the impact of deployment history on tobacco use. METHOD Cigarette smoking, smokeless tobacco (ST) use, and dual tobacco use were evaluated among 278U.S. Air Force Security Forces personnel undertaking a 1-year deployment to a high-threat combat environment. Multinomial regression was used to examine prediction of tobacco use patterns both cross-sectionally and longitudinally. RESULTS More than half (53%-63%) of all Security Forces used tobacco at all stages of the deployment cycle. Individual tobacco use trajectories showed significant differences in prevalence rates of initiation/harm escalation and cessation/harm reduction when comparing the transition from predeployment to the deployed environment versus returning to postdeployment status. Airmen who had deployed more than once previously had a higher likelihood of using ST use at predeployment and engaging in dual tobacco use during deployment. CONCLUSIONS Findings suggest the potential benefit of targeted or universal interventions at each stage of the deployment cycle to reduce the onset, maintenance, or escalation of tobacco use behaviors in the U.S. military.
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Affiliation(s)
- G Wayne Talcott
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
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Klesges RC, Sherrill-Mittleman D, Ebbert JO, Talcott GW, Debon M. Tobacco use harm reduction, elimination, and escalation in a large military cohort. Am J Public Health 2010; 100:2487-92. [PMID: 21068420 DOI: 10.2105/ajph.2009.175091] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated changing patterns of tobacco use following a period of forced tobacco abstinence in a US military cohort to determine rates of harm elimination (e.g., tobacco cessation), harm reduction (e.g., from smoking to smokeless tobacco use), and harm escalation (e.g., from smoking to dual use or from smokeless tobacco use to smoking or dual use). METHODS Participants were 5225 Air Force airmen assigned to the health education control condition in a smoking cessation and prevention trial. Tobacco use was assessed by self-report at baseline and 12 months. RESULTS Among 114 baseline smokers initiating smokeless tobacco use after basic military training, most demonstrated harm escalation (87%), which was 5.4 times more likely to occur than was harm reduction (e.g., smoking to smokeless tobacco use). Harm reduction was predicted, in part, by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history, and risk-taking. CONCLUSIONS When considering a harm reduction strategy with smokeless tobacco, the tobacco control community should balance anticipated benefits of harm reduction with the risk of harm escalation and the potential for adversely affecting public health.
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Affiliation(s)
- Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Cooper TV, Taylor T, Murray A, DeBon MW, Vander Weg MW, Klesges RC, Talcott GW. Differences between intermittent and light daily smokers in a population of U.S. military recruits. Nicotine Tob Res 2010; 12:465-73. [PMID: 20203108 PMCID: PMC2861885 DOI: 10.1093/ntr/ntq025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 02/04/2010] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Few studies have assessed differences between intermittent and light smokers, particularly among young adults. Exploring these differences promotes a systematic approach to research and treatment in low-level smokers. This study explored demographic, tobacco-related, and psychosocial predictors of intermittent nondaily smoking relative to light smoking among basic military training (BMT) recruits. The impact of smoking status on abstinence rates at follow-up was also assessed. METHODS Participants were 5,603 U.S. Air Force BMT intermittent nondaily (n = 3,134) or light daily (n = 2,469) smoking recruits participating in a population-based group randomized trial targeting tobacco use prevention and cessation (Klesges et al., 2006, Efficacy of a tailored tobacco control program on long-term use in a population of U.S. military troops. Journal of Consulting and Clinical Psychology, 74, 295-306.). Participants completed baseline measures assessing demographics; tobacco use and history; and common social, attitudinal, and behavioral risk factors for tobacco use. Flights of recruits were randomly assigned to a tobacco use intervention or health education control intervention. At the 1-year follow-up, participants reported 7-day point prevalence and continuous abstinence. RESULTS Intermittent nondaily smoking relative to light daily smoking was associated with lesser perceived addiction, intermittent and daily use of smokeless tobacco, nonsmoking male and female heads of household, lesser likelihood of smoking while stressed or while bored, and higher likelihood of intentions to quit smoking. Intermittent smokers were significantly more likely than light daily smokers to report abstinence at follow-up. DISCUSSION Intermittent and daily light smokers differ on several tobacco-related and psychosocial variables. Attending to these factors in prevention and cessation programs may enhance abstinence in both groups.
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Affiliation(s)
- Theodore V Cooper
- Department of Psychology, The University of Texas at El Paso, 500 West University Avenue, El Paso, TX 79968, USA.
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Klesges RC, Sherrill-Mittleman DA, DeBon M, Talcott GW, Vanecek RJ. Do we believe the tobacco industry lied to us? Association with smoking behavior in a military population. Health Educ Res 2009; 24:909-921. [PMID: 19528314 PMCID: PMC2777944 DOI: 10.1093/her/cyp029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Accepted: 05/11/2009] [Indexed: 05/27/2023]
Abstract
Despite the dangers of smoking, tobacco companies continue to impede tobacco control efforts through deceptive marketing practices. Media campaigns that expose these practices have been effective in advancing anti-industry attitudes and reducing smoking initiation among young people, yet the association between knowledge of industry practices and smoking cessation and relapse has not been studied. In a large military sample entering Air Force Basic Military Training (BMT), where tobacco use is prohibited, we investigated (i) the prevalence of agreement with a statement that tobacco companies have misled the public about the health consequences of smoking and (ii) the association of this acknowledgement with smoking status upon entry into BMT (N = 36 013). At baseline, 56.6% agreed that tobacco companies have been deceptive, and agreement was a strong predictor of smoking status [smokers less likely to agree, odds ratio (OR) = 0.39, P < 0.01]. At 12-month follow-up, we examined the association between industry perception at baseline and current smoking status (N = 20 672). Recruits who had been smoking upon entry into BMT and who had acknowledged industry deception were less likely to report current smoking (OR = 0.84, P = 0.01). These findings suggest that anti-industry attitudes may affect smoking relapse following cessation.
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Affiliation(s)
- Robert C. Klesges
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163, USA
| | - Deborah A. Sherrill-Mittleman
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Margaret DeBon
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163, USA
| | - G. Wayne Talcott
- Wilford Hall Medical Center, Lackland Air Force Base, 2200 Bergquist Dr, San Antonio, TX 78236, USA
| | - Robert J. Vanecek
- Wilford Hall Medical Center, Lackland Air Force Base, 2200 Bergquist Dr, San Antonio, TX 78236, USA
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Cooper TV, DeBon M, Haddock CK, Esquivel DR, Klesges RC, Lando H, Talcott GW. Demographics and Risky Lifestyle Behaviors Associated with Willingness to Risk Sexually Transmitted Infection in Air Force Recruits. Am J Health Promot 2008; 22:164-7. [DOI: 10.4278/ajhp.22.3.164] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To investigate sexually transmitted infection (STL) risk-taking behaviors relative to other lifestyle and risk-taking behaviors. Design. The study design is cross sectional. Setting. Lackland Air Force Base in San Antonio, Texas. Subjects. Participants (N = 32,144) were 100% of Air Force recruits beginning basic military training from August 1995 to August 1996. Measures. Recruits completed a questionnaire that included rating the statement “Sex without condoms is sometimes worth the risk of possibly getting AIDS or sexually transmitted diseases.” Risky behaviors, such as risk taking rebelliousness, seat belt use, smoking alcohol use and binge drinking opinions of illicit drug use, and lifestyle behaviors, such as dietary intake and physical activity, were also assessed. Analysis. Univariate and multivariate logistic regression analyses examined the relationships between participant characteristics and willingness to risk STI. Results. Sixteen percent stated willingness to risk STI to have sex without a condom. Women and white/non-Hispanic participants were less likely to agree with the statement than men and minority participants. Those who reported willingness toward risky sexual behaviors were less likely to use seat belts, were more likely to binge drink, had more positive views of illicit drugs, and reported eating fewer fruits and vegetables. Conclusion. Results of this study suggest the importance of continued education on condom use and the possibility that multiple risk behavior interventions include sexual risk components.
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Affiliation(s)
- Theodore V. Cooper
- Theodore V. Cooper, PhD, and Denise Rodríguez Esquivel, BA, are with the Department of Psychology, University of Texas at El Paso. Margaret DeBon, PhD, and Robert C. Klesges, PhD, are with the Department of Preventive Medicine, University of Tennessee Health Sciences Center in Memphis. C. Keith Haddock, PhD, is with the University of Missouri—Kansas City, Mid America Heart Institute, Saint Luke's Hospital. Harry Lando, PhD, is with the Transdisciplinary Tobacco Use Research Center, University of
| | - Margaret DeBon
- Theodore V. Cooper, PhD, and Denise Rodríguez Esquivel, BA, are with the Department of Psychology, University of Texas at El Paso. Margaret DeBon, PhD, and Robert C. Klesges, PhD, are with the Department of Preventive Medicine, University of Tennessee Health Sciences Center in Memphis. C. Keith Haddock, PhD, is with the University of Missouri—Kansas City, Mid America Heart Institute, Saint Luke's Hospital. Harry Lando, PhD, is with the Transdisciplinary Tobacco Use Research Center, University of
| | - C. Keith Haddock
- Theodore V. Cooper, PhD, and Denise Rodríguez Esquivel, BA, are with the Department of Psychology, University of Texas at El Paso. Margaret DeBon, PhD, and Robert C. Klesges, PhD, are with the Department of Preventive Medicine, University of Tennessee Health Sciences Center in Memphis. C. Keith Haddock, PhD, is with the University of Missouri—Kansas City, Mid America Heart Institute, Saint Luke's Hospital. Harry Lando, PhD, is with the Transdisciplinary Tobacco Use Research Center, University of
| | - Denise Rodríguez Esquivel
- Theodore V. Cooper, PhD, and Denise Rodríguez Esquivel, BA, are with the Department of Psychology, University of Texas at El Paso. Margaret DeBon, PhD, and Robert C. Klesges, PhD, are with the Department of Preventive Medicine, University of Tennessee Health Sciences Center in Memphis. C. Keith Haddock, PhD, is with the University of Missouri—Kansas City, Mid America Heart Institute, Saint Luke's Hospital. Harry Lando, PhD, is with the Transdisciplinary Tobacco Use Research Center, University of
| | - Robert C. Klesges
- Theodore V. Cooper, PhD, and Denise Rodríguez Esquivel, BA, are with the Department of Psychology, University of Texas at El Paso. Margaret DeBon, PhD, and Robert C. Klesges, PhD, are with the Department of Preventive Medicine, University of Tennessee Health Sciences Center in Memphis. C. Keith Haddock, PhD, is with the University of Missouri—Kansas City, Mid America Heart Institute, Saint Luke's Hospital. Harry Lando, PhD, is with the Transdisciplinary Tobacco Use Research Center, University of
| | - Harry Lando
- Theodore V. Cooper, PhD, and Denise Rodríguez Esquivel, BA, are with the Department of Psychology, University of Texas at El Paso. Margaret DeBon, PhD, and Robert C. Klesges, PhD, are with the Department of Preventive Medicine, University of Tennessee Health Sciences Center in Memphis. C. Keith Haddock, PhD, is with the University of Missouri—Kansas City, Mid America Heart Institute, Saint Luke's Hospital. Harry Lando, PhD, is with the Transdisciplinary Tobacco Use Research Center, University of
| | - G. Wayne Talcott
- Theodore V. Cooper, PhD, and Denise Rodríguez Esquivel, BA, are with the Department of Psychology, University of Texas at El Paso. Margaret DeBon, PhD, and Robert C. Klesges, PhD, are with the Department of Preventive Medicine, University of Tennessee Health Sciences Center in Memphis. C. Keith Haddock, PhD, is with the University of Missouri—Kansas City, Mid America Heart Institute, Saint Luke's Hospital. Harry Lando, PhD, is with the Transdisciplinary Tobacco Use Research Center, University of
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Klesges RC, DeBon M, Vander Weg MW, Haddock CK, Lando HA, Relyea GE, Peterson AL, Talcott GW. Efficacy of a tailored tobacco control program on long-term use in a population of U.S. military troops. J Consult Clin Psychol 2006; 74:295-306. [PMID: 16649874 DOI: 10.1037/0022-006x.74.2.295] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The authors evaluated the effect of a brief tailored smoking control intervention delivered during basic military training on tobacco use in a population of military personnel (N = 33,215). Participants were randomized to either a tobacco use intervention (smoking cessation, smokeless tobacco use cessation, or prevention depending on tobacco use history) or a health education control condition. Results indicated that smokers who received intervention were 1.16 (95% confidence interval [CI] = 1.04, 1.30) times (7-day point prevalence) and 1.23 (95% CI = 1.07, 1.41) times (continuous abstinence) more likely to be abstinent than controls from smoking cigarettes at the 1-year follow-up (p < .01); the cessation rate difference was 1.60% (31.09% vs. 29.49%) and 1.73% (15.47% vs. 13.74%) for point prevalence and continuous abstinence, respectively. Additionally, smokeless tobacco users were 1.33 (95% CI = 1.08, 1.63) times more likely than controls (p < .01) continuously abstinent at follow-up, an overall cessation rate difference of 5.44% (33.72% vs. 28.28%). The smoking prevention program had no impact on smoking initiation. These results suggest potential for large-scale tobacco control efforts.
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Affiliation(s)
- Robert C Klesges
- Department of Psychology, University of Memphis, Memphis, TN 38105, USA.
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Abstract
OBJECTIVES We sought to gauge the relative attention that tobacco control receives in military newspapers by comparing coverage of tobacco use with that of other health topics of importance to the military. METHODS We examined tobacco-related articles and industry advertisements in 793 newspapers published during 1 year at 16 representative military installations (4 Air Force, 6 Army, 2 Marine, 4 Navy). Newspaper content was coded with a standardized coding manual developed through previous research. RESULTS Tobacco use received the fewest instances of coverage and the least print space in military installation newspapers of all the health topics examined. The primary "message frame" used in tobacco control articles was that smokers are putting themselves at health risk, a theme that has not been found to have a strong effect on smokers. Nearly 10% of the newspapers contained tobacco advertisements. CONCLUSIONS Tobacco control messages are underrepresented in military installation newspapers compared with other health issues. Furthermore, military newspapers send mixed messages to military personnel by providing advertisements for tobacco while also claiming that tobacco use is harmful.
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Affiliation(s)
- C Keith Haddock
- Department of Psychology, University of Missouri-Kansas City, 4825 Troost Ave, Suite 124, Kansas City, MO 64110, USA.
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Oordt MS, Jobes DA, Rudd MD, Fonseca VP, Runyan CN, Stea JB, Campise RL, Talcott GW. Development of a Clinical Guide to Enhance Care for Suicidal Patients. ACTA ACUST UNITED AC 2005. [DOI: 10.1037/0735-7028.36.2.208] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVE To evaluate the impact of the US Air Force suicide prevention programme on risk of suicide and other outcomes that share underlying risk factors. DESIGN Cohort study with quasi-experimental design and analysis of cohorts before (1990-6) and after (1997-2002) the intervention. PARTICIPANTS 5,260,292 US Air Force personnel (around 84% were men). INTERVENTION A multilayered intervention targeted at reducing risk factors and enhancing factors considered protective. The intervention consisted of removing the stigma of seeking help for a mental health or psychosocial problem, enhancing understanding of mental health, and changing policies and social norms. MAIN OUTCOME MEASURES Relative risk reductions (the prevented fraction) for suicide and other outcomes hypothesised to be sensitive to broadly based community prevention efforts, (family violence, accidental death, homicide). Additional outcomes not exclusively associated with suicide were included because of the comprehensiveness of the programme. RESULTS Implementation of the programme was associated with a sustained decline in the rate of suicide and other adverse outcomes. A 33% relative risk reduction was observed for suicide after the intervention; reductions for other outcomes ranged from 18-54%. CONCLUSION A systemic intervention aimed at changing social norms about seeking help and incorporating training in suicide prevention has a considerable impact on promotion of mental health. The impact on adverse outcomes in addition to suicide strengthens the conclusion that the programme was responsible for these reductions in risk.
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Affiliation(s)
- Kerry L Knox
- University of Rochester Center for the Study and Prevention of Suicide, University of Rochester Medical Center, Rochester, NY 14642, USA.
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Ward KD, Vander Weg MW, Klesges RC, Kovach KW, Elrod MC, DeBon M, Haddock CK, Talcott GW, Lando HA. Characteristics of highly physically active smokers in a population of young adult military recruits. Addict Behav 2003; 28:1405-18. [PMID: 14512063 DOI: 10.1016/s0306-4603(02)00267-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A substantial number of cigarette smokers are thought to engage in regular exercise. It is unclear why individuals who engage in a health-promoting activity such as exercising would simultaneously engage in a health-damaging behavior like smoking. Two possibilities are that (1) exercise serves as a "harm reduction" strategy to lessen the negative effects of smoking, or (2) that among weight conscious individuals, exercise and smoking are both used as weight control strategies. To examine these issues, smoking status, physical activity level, weight concerns, and several additional health behaviors and attitudes were assessed by questionnaire in a population of United States Air Force recruits (n=32,144). Multiple logistic regression analyses were used to compare characteristics of highly physically active smokers with both highly physically active never-smokers, and less active smokers. A substantial proportion of smokers reported being highly physically active (15.8%), although this proportion was significantly higher for never-smokers (22.7%). Active smokers were similar to active never-smokers across several health behaviors and attitudes, including diet, seatbelt use, and attitudes toward illegal drugs and condom use. Compared to less active smokers, active smokers consumed more fruits and vegetables, worried less about their weight, were less nicotine dependent, and had greater previous success at quitting smoking. These findings indicate that a substantial proportion of highly physically active young adults are regular cigarette smokers. Based on findings regarding general health behaviors and smoking history, this group may be particularly amenable to smoking cessation efforts.
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Affiliation(s)
- Kenneth D Ward
- University of Memphis Center for Community Health, 5050 Poplar Avenue, Suite 1800, Memphis, TN 38157, USA.
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Runyan CN, Fonseca VP, Meyer JG, Oordt MS, Talcott GW. A Novel Approach for Mental Health Disease Management: The Air Force Medical Service's Interdisciplinary Model. ACTA ACUST UNITED AC 2003; 6:179-88. [PMID: 14570386 DOI: 10.1089/109350703322425527] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mental health disorders are one of the most substantial public health problems affecting society today, accounting for roughly 15% of the overall burden of disease from all causes in the United States. Although primary care (PC) has the potential to be the frontline for recognition and management of behavioral health conditions, this has been a challenge historically. In order to more effectively address the broad scope of behavioral health needs, the Air Force Medical Service (AFMS) established a new model of behavioral health care. Through a series of coordinated steps, the AFMS ultimately placed trained behavioral health providers into PC clinics to serve as consultants to PC providers (PCPs). Behavioral Health Consultants (BHCs) provide focused assessments, present healthcare options to patients, and deliver brief collaborative interventions in the PC setting. BHCs see patients at the request of the PCP, in 15-30-min appointments. In the pilot study, patients averaged 1.6 visits to the BHC. Over 70% of patients fell into six categories of presenting problems: situational reactions, depressive disorders, adjustment disorders, anxiety disorders, health promotion, and obesity. Patient data (n = 76) suggest 97% of patients seen were either "satisfied" or "very satisfied" with BHC services, and 100% of the PCPs (n = 23, 68% response rate) were highly satisfied and indicated they would "definitely recommend" others use BHC services for their patients. Both the implications and the limitations of this pilot study are discussed.
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Affiliation(s)
- Christine N Runyan
- Population Health Support, Air Force Medical Operations Agency, Brooks Air Force Base, San Antonio, Texas, USA.
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