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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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Mysliwiec V, Pruiksma KE, Matsangas P, Powell T, Straud CL, Taylor DJ, Hansen S, Foster SN, Mithani S, Zwetzig S, Martin J, Gerwell K, Young-McCaughan S, Blue Star JA, Cassidy DG, Gomes KD, Moore BA, Peterson AL, Brock MS. Sex differences in US military personnel with insomnia, obstructive sleep apnea, or comorbid insomnia and obstructive sleep apnea. J Clin Sleep Med 2024; 20:17-30. [PMID: 37584448 PMCID: PMC10758553 DOI: 10.5664/jcsm.10774] [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] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/17/2023]
Abstract
STUDY OBJECTIVES The aim of this study was to evaluate sex-related differences in symptoms of sleep disorders, sleep-related impairment, psychiatric symptoms, traumatic brain injury, and polysomnographic variables in treatment-seeking military personnel diagnosed with insomnia, obstructive sleep apnea (OSA), or comorbid insomnia and OSA (COMISA). METHODS Participants were 372 military personnel (46.2% women, 53.8% men) with an average age of 37.7 (standard deviation = 7.46) years and median body mass index of 28.4 (5.50) kg/m2. Based on clinical evaluation and video-polysomnography, participants were diagnosed with insomnia (n = 118), OSA (n = 118), or COMISA (n = 136). Insomnia severity, excessive daytime sleepiness, sleep quality, nightmare disorder, sleep impairment, fatigue, posttraumatic stress disorder, anxiety, depression symptoms, and traumatic brain injury were evaluated with validated self-report questionnaires. Descriptive statistics, parametric and nonparametric t-tests, and effect sizes were used to assess sex differences between men and women. RESULTS There were no significant differences between women and men with insomnia or OSA in sleep-related symptoms, impairment, or polysomnography-based apnea-hypopnea index. Military men with COMISA had a significantly greater apnea-hypopnea index as compared to military women with COMISA, but women had greater symptoms of nightmare disorder, posttraumatic stress disorder, and anxiety. CONCLUSIONS In contrast to civilian studies, minimal differences were observed in self-reported sleep symptoms, impairment, and polysomnography metrics between men and women diagnosed with the most frequent sleep disorders in military personnel (ie, insomnia, OSA, or COMISA) except in those with COMISA. Military service may result in distinct sleep disorder phenotypes that differ negligibly by sex. CITATION Mysliwiec V, Pruiksma KE, Matsangas P, et al. Sex differences in US military personnel with insomnia, obstructive sleep apnea, or comorbid insomnia and obstructive sleep apnea. J Clin Sleep Med. 2024;20(1):17-30.
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Affiliation(s)
- Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kristi E. Pruiksma
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | | | - Tyler Powell
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Casey L. Straud
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
| | - Daniel J. Taylor
- Department of Psychology, University of Arizona, Tucson, Arizona
| | - Shana Hansen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Shannon N. Foster
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Sara Mithani
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Sarah Zwetzig
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Jennifer Martin
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Kelsi Gerwell
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - John A. Blue Star
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Daniel G. Cassidy
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - Kimberly D. Gomes
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia
| | - Brian A. Moore
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia
| | - Alan L. Peterson
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
| | - Matthew S. Brock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
| | - on behalf of STRONG STAR Consortium
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, Texas
- Crew Endurance Team, Naval Postgraduate School, Monterey, California
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, Texas
- Department of Psychology, The University of Texas at San Antonio, San Antonio, Texas
- Department of Psychology, University of Arizona, Tucson, Arizona
- School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Psychological Science, Kennesaw State University, Kennesaw, Georgia
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3
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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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4
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Cassidy DG, Wang XQ, Mallawaarachchi I, Wiseman KP, Ebbert JO, Blue Star JA, Aycock CA, Estevez Burns R, Jones JR, Krunnfusz AE, Halbert JP, Roy NM, Ellis JM, Williams JB, Klesges RC, Talcott GW. Tobacco quitline performance: Comparing the impacts of early cessation and proactive re-engagement on callers' smoking status at follow-up at 12 months. Tob Induc Dis 2023; 21:24. [PMID: 36798676 PMCID: PMC9923459 DOI: 10.18332/tid/159125] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION While tobacco Quitlines are effective in the promotion of smoking cessation, the majority of callers who wish to quit still fail to do so. The aim of this study was to determine if 12-month tobacco Quitline smoking cessation rates could be improved with re-engagement of callers whose first Quitline treatment failed to establish abstinence. METHODS In an adaptive trial, 614 adult smokers, who were active duty, retired, and family of military personnel with TRICARE insurance who called a tobacco Quitline, received a previously evaluated and efficacious four-session tobacco cessation intervention with nicotine replacement therapy (NRT). At the scheduled follow-up at 3 months, callers who had not yet achieved abstinence were offered the opportunity to re-engage. This resulted in three caller groups: 1) those who were abstinent, 2) those who were still smoking but willing to re-engage with an additional Quitline treatment; and 3) individuals who were still smoking but declined re-engagement. A propensity score-adjusted logistic regression model was generated to compare past-7-day point prevalence abstinence at 12 months post Quitline consultation. RESULTS Using a propensity score adjusted logistic regression model, comparison of the three groups resulted in higher odds of past-7-day point prevalence abstinence at follow-up at 12 months for those who were abstinent at 3 months compared to those who re-engaged (OR=9.6; 95% CI: 5.2-17.8; Bonferroni adjusted p<0.0001), and relative to those who declined re-engagement (OR=13.4; 95% CI: 6.8-26.3; Bonferroni adjusted p<0.0001). There was no statistically significant difference in smoking abstinence between smokers at 3 months who re-engaged and those who declined re-engagement (OR=1.39; 95% CI: 0.68-2.85). CONCLUSIONS Tobacco Quitlines seeking to select a single initiative by which to maximize abstinence at follow-up at 12 months may benefit from diverting additional resources from the re-engagement of callers whose initial quit attempt failed, toward changes which increase callers' probability of success within the first 3 months of treatment. TRIAL REGISTRATION This study is registered at clinicaltrials.gov (NCT02201810).
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Affiliation(s)
- Daniel G. Cassidy
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Xin-Qun Wang
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Kara P. Wiseman
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Jon O. Ebbert
- Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, United States
| | - John A. Blue Star
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Chase A. Aycock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Rosemary Estevez Burns
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - John R. Jones
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Andrea E. Krunnfusz
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Jennifer P. Halbert
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Natalie M. Roy
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Jordan M. Ellis
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States
| | - Juinell B. Williams
- Department of Psychology, East Carolina University, Greenville, United States
| | - Robert C. Klesges
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
| | - Gerald W. Talcott
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio, Lackland AFB, Texas, United States,Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, United States
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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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Mysliwiec V, Brock MS, Pruiksma KE, Straud CL, Taylor DJ, Hansen S, Foster SN, Mithani S, Zwetzig S, Gerwell K, Young-McCaughan S, Powell T, Blue Star JA, Cassidy DG, Mintz J, Peterson AL. A comprehensive evaluation of insomnia, obstructive sleep apnea and comorbid insomnia and obstructive sleep apnea in US military personnel. Sleep 2022; 45:6675630. [PMID: 36006786 DOI: 10.1093/sleep/zsac203] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/29/2022] [Revised: 07/08/2022] [Indexed: 12/14/2022] Open
Abstract
STUDY OBJECTIVES The aim of this study was to characterize the sleep disorders of insomnia, obstructive sleep apnea (OSA), and comorbid insomnia and OSA (COMISA) in active duty military personnel. METHODS Prospective observational study of 309 military personnel with a mean age of 37.17 years (SD = 7.27). Participants served in four branches of the U.S. military (47.9% Air Force, 38.8% Army, 11.3% Navy, and 1.9% Marines). Sleep diagnoses were rendered after video-polysomnography and a clinical evaluation. Validated self-report measures assessed insomnia severity, excessive daytime sleepiness, sleep quality, disruptive nocturnal behaviors, nightmare disorder, shift work disorder (SWD), sleep impairment, fatigue, posttraumatic stress disorder (PTSD) symptoms, anxiety, depression, and traumatic brain injury (TBI). General linear models and Pearson chi-square tests were used for between-group differences in data analyses. RESULTS Insomnia was diagnosed in 32.7%, OSA in 30.4% and COMISA in 36.9%. Compared to military personnel with OSA alone, those with insomnia only and COMISA had significantly greater insomnia severity, disruptive nocturnal behaviors, sleep-related impairment, rates of nightmare disorder, and poorer sleep quality (all Ps < .05). They also reported greater symptoms of fatigue, PTSD, anxiety, and depression (all Ps < .05). There were no significant differences among the three sleep disorder diagnostic groups on sleepiness, SWD, or TBI. CONCLUSIONS Military personnel with insomnia only and COMISA overall report worsened symptoms of sleep disorders, sleep-related impairment, fatigue, and psychiatric disorders than those with OSA. Results highlight the importance of a comprehensive assessment for sleep-related impairment, sleep, and comorbid disorders in military personnel with clinically significant sleep disturbances.
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Affiliation(s)
- Vincent Mysliwiec
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Matthew S Brock
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
| | - Daniel J Taylor
- Department of Psychology, University of Arizona, Tucson, AZ, USA
| | - Shana Hansen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Shannon N Foster
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Sara Mithani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Sarah Zwetzig
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Kelsi Gerwell
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Stacey Young-McCaughan
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Tyler Powell
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - John A Blue Star
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Daniel G Cassidy
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, USA
| | - Jim Mintz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Alan L Peterson
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.,Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychology, University of Texas at San Antonio, San Antonio, TX, USA
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7
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Haibach JP, Hoerster KD, Dorflinger L, McAndrew LM, Cassidy DG, Goodrich DE, Bormann JE, Lowery J, Asch SM, Raffa SD, Moin T, Peterson AL, Goldstein MG, Neal-Walden T, Talcott GW, Hunter CL, Knight SJ. Research translation for military and veteran health: research, practice, policy. Transl Behav Med 2021; 11:631-641. [PMID: 32043529 DOI: 10.1093/tbm/ibz195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/14/2022] Open
Abstract
Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.
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Affiliation(s)
- Jeffrey P Haibach
- U.S. Department of Veterans Affairs, Washington, DC, USA.,Veteran Consulting and Research Corp., Rochester, NY, USA
| | - Katherine D Hoerster
- Research and Development Service, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Lisa M McAndrew
- War Related Illness and Injury Study Center, VA New Jersey Health care System, East Orange, NJ, USA.,Department of Educational and Counseling Psychology, University at Albany, Albany, NY, USA
| | | | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jill E Bormann
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Hahn School of Nursing and Health Science/Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA
| | - Julie Lowery
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Steven M Asch
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Susan D Raffa
- VA National Center for Health Promotion and Disease Prevention, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alan L Peterson
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Michael G Goldstein
- VA National Center for Health Promotion and Disease Prevention, Durham, NC, USA
| | - Tracy Neal-Walden
- Steven A. Cohen Military Family Clinic at Easterseals, Silver Spring, MD, USA
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, University of Virginia, Charlottesville, VA, USA
| | - Christopher L Hunter
- Primary Care and Clinical Patient Engagement/Experience, Military Affairs, Clinical Support Division, Defense Health Agency, Falls Church, VA, USA
| | - Sara J Knight
- VA Salt Lake City Health care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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8
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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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9
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Gonzalez A, Miller CT, Solomon SE, Bunn JY, Cassidy DG. Size matters: community size, HIV stigma, & gender differences. AIDS Behav 2009; 13:1205-12. [PMID: 18815878 DOI: 10.1007/s10461-008-9465-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [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: 11/23/2007] [Accepted: 09/12/2008] [Indexed: 11/26/2022]
Abstract
Conclusions regarding HIV stigma in rural areas are hampered by lack of agreement about rural classification. This investigation examined perceptions of HIV stigma among males and females with HIV/AIDS in metropolitan, micropolitan, and rural areas. Two-hundred people with HIV/AIDS completed a measure of perceived HIV stigma. Their county or town of residence was used to classify community size. Results indicated that community size was related to one aspect of perceived stigma, disclosure concerns, differently for men and women. Rural women reported more disclosure concerns than did metropolitan and micropolitan women. They also reported more disclosure concerns than rural men. Men in micropolitan communities reported more disclosure concerns than men in rural areas and tended to report more disclosure concerns than men in metropolitan areas. Understanding the relationship of community size to HIV stigmatization requires acknowledging that many communities are neither urban nor rural, and it requires considering gender differences.
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Affiliation(s)
- Adam Gonzalez
- Department of Psychology, University of Vermont, 2 Colchester Avenue-John Dewey Hall, Burlington, Vermont, 05405, USA.
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