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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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Pérez-Muñoz A, Hare ME, Andres A, Klesges RC, Wayne Talcott G, Little MA, Waters TM, Harvey JR, Bursac Z, Krukowski RA. A Postpartum Weight Loss-focused Stepped-care Intervention in a Military Population: A Randomized Controlled Trial. Ann Behav Med 2023; 57:836-845. [PMID: 37061829 PMCID: PMC10498817 DOI: 10.1093/abm/kaad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2023] Open
Abstract
OBJECTIVE Postpartum weight retention is associated with adverse health among both civilian and military women. PURPOSE The current study evaluated a stepped-care weight management intervention, Moms Fit 2 Fight, adapted for use in a pregnant and postpartum military population. METHODS Active duty women and other TRICARE beneficiaries (N = 430) were randomized to one of three conditions: gestational weight gain only (GWG-only) intervention (n =144), postpartum weight loss only (PPWL-only) intervention (n =142), or a combined GWG + PPWL intervention (n = 144). Those participants who received the PPWL intervention (i.e., the PPWL-only and GWG+PPWL conditions) were combined consistently with the pre-registered protocol and compared to those participants who did not receive the PPWL intervention in the primary analyses. Primary outcome data (i.e., postpartum weight retention) were obtained at 6-months postpartum by unblinded data collectors, and intent-to-treat analyses were conducted. RESULTS Retention at 6-months postpartum was 88.4%. Participants who received the PPWL intervention retained marginally less weight (1.31 kg) compared to participants that received the GWG-only intervention (2.39 kg), with a difference of 1.08 kg (p = .07). None of the measured covariates, including breastfeeding status, were significantly associated with postpartum weight retention. Of the participants who received the PPWL intervention, 48.1% participants returned to their pre-pregnancy weight at 6-months postpartum, with no significant differences compared to those who received the GWG-only intervention. CONCLUSIONS A behavioral intervention targeting diet and physical activity during the postpartum period had a trend for reduced postpartum weight retention. CLINICAL TRIAL INFORMATION The trial is registered on clinicaltrials.gov (NCT03057808).
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Affiliation(s)
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Aline Andres
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Nutrition Center, Little Rock, AR, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Gerald Wayne Talcott
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, San Antonio, TX, USA
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Teresa M Waters
- Department of Health Management and Policy, University of Kentucky, Lexington, KY, USA
| | - Jean R Harvey
- Department of Nutrition and Food Sciences, University of Vermont, Burlington, VT, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Rebecca A Krukowski
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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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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Pebley K, Bursac Z, Klesges RC, Ebbert JO, Womack CR, Graber J, Little MA, Derefinko KJ, Krukowski RA. A randomized controlled trial to reduce post-cessation weight gain. Int J Obes (Lond) 2023; 47:471-478. [PMID: 36841886 PMCID: PMC9958320 DOI: 10.1038/s41366-023-01286-5] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND/OBJECTIVES Weight gain is a barrier to smoking cessation. Previous interventions targeting weight gain while quitting smoking have largely been unsuccessful. The current study aimed to assess the efficacy of weight stability and weight loss interventions compared to a low-intensity, self-guided bibliotherapy weight management group. SUBJECTS/METHODS A randomized controlled trial with 12-month follow-up from 2018 to 2022 was conducted with participants (N = 305) who reported smoking at least five cigarettes per day for the last year and interest in quitting initially recruited from the Memphis, TN, USA area. Recruitment was expanded nationally with the onset of the COVID-19 pandemic. Subsequently, 276 completed 12-month follow-up. INTERVENTIONS/METHODS The Bibliotherapy group was provided a weight management book. Both the Stability and Loss groups met via telephone for eight weeks to learn strategies for maintaining/losing weight, respectively. All three groups then received the same six-week smoking cessation intervention, with six months of varenicline provided. RESULTS Individuals in the Loss group lost more weight (-2.01 kg, SE = 1.58) than individuals in the Bibliotherapy group (+1.08 kg, SE = 1.49, p = 0.0004), while the Stability group (-0.30 kg, SE = 1.56) was not significantly different from the Bibliotherapy group (p = 0.17). Those in the Stability group did not gain a significant amount of weight. Participants in the Loss group did not gain back all weight lost after smoking cessation and ended the study approximately 2.01 kg lower than baseline. The Bibliotherapy group did not gain the amount of weight expected after cessation. There were no significant differences between groups related to self-reported smoking cessation at each time point except at eight-month follow-up (p = 0.005). CONCLUSIONS AND RELEVANCE Results indicated the Stability and the Loss interventions were effective for preventing post-smoking cessation weight gain, with the Loss group having the benefit of sustained weight loss. These interventions may be helpful to implement to combat weight gain and potentially facilitate smoking cessation. TRIAL REGISTRATION The trial is registered on clinicaltrials.gov (NCT03156660).
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Affiliation(s)
- Kinsey Pebley
- The University of Memphis, Department of Psychology, 400 Innovation Drive, Memphis, TN, 38152, USA
| | - Zoran Bursac
- Florida International University, Department of Biostatistics, Miami, FL, 33199, USA
| | - Robert C Klesges
- University of Virginia, School of Medicine Department of Public Health Sciences, PO Box 800765, Charlottesville, VA, 22903, USA
| | - Jon O Ebbert
- Mayo Clinic, Department of Medicine, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Catherine R Womack
- University of Tennessee Health Science Center, Department of Preventive Medicine, 66 N Pauline St, Memphis, TN, 38105, USA
| | - Julia Graber
- University of Tennessee Health Science Center, Department of Preventive Medicine, 66 N Pauline St, Memphis, TN, 38105, USA
| | - Melissa A Little
- University of Virginia, School of Medicine Department of Public Health Sciences, PO Box 800765, Charlottesville, VA, 22903, USA
| | - Karen J Derefinko
- University of Tennessee Health Science Center, Department of Preventive Medicine, 66 N Pauline St, Memphis, TN, 38105, USA
| | - Rebecca A Krukowski
- University of Virginia, School of Medicine Department of Public Health Sciences, PO Box 800765, Charlottesville, VA, 22903, USA.
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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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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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10
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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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11
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Estevez Burns R, Hare ME, Andres A, Klesges RC, Talcott GW, LeRoy K, Little MA, Hyrshko‐Mullen A, Waters TM, Harvey JR, Bursac Z, Krukowski RA. An interim analysis of a gestational weight gain intervention in military personnel and other TRICARE beneficiaries. Obesity (Silver Spring) 2022; 30:1951-1962. [PMID: 36041980 PMCID: PMC9804329 DOI: 10.1002/oby.23523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Despite military fitness regulations, women in the military frequently experience overweight/obesity, excessive gestational weight gain (GWG), and the postpartum implications. This interim analysis of the Moms Fit 2 Fight study examines GWG outcomes among active-duty personnel and other TRICARE beneficiaries who received a stepped-care GWG intervention compared with those who did not receive a GWG intervention. METHOD Participants (N = 430; 32% identified with an underrepresented racial group, 47% were active duty) were randomized to receive a GWG intervention or the comparison condition, which did not receive a GWG intervention. RESULTS Retention was 88% at 32 to 36 weeks' gestation. Participants who received the GWG intervention gained less weight compared with those who did not (mean [SD] = 10.38 [4.58] vs. 11.80 [4.87] kg, p = 0.0056). Participants who received the intervention were less likely to have excessive GWG compared with those who did not (54.6% vs. 66.7%, p = 0.0241). The intervention effects were significant for participants who identified as White, but not for those of other racial identities. There were no significant differences between the conditions in maternal/neonatal outcomes. CONCLUSIONS The intervention successfully reduced excessive GWG, particularly among participants who identified as White. Should this intervention be found cost-effective, it may be sustainably integrated throughout the military prenatal care system.
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Affiliation(s)
| | - Marion E. Hare
- Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
| | - Aline Andres
- University of Arkansas for Medical Sciences and Arkansas Children's Nutrition CenterLittle RockArkansasUSA
| | - Robert C. Klesges
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Gerald Wayne Talcott
- Wilford Hall Ambulatory Surgical CenterLackland Air Force BaseTexasUSA
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Karen LeRoy
- Wilford Hall Ambulatory Surgical CenterLackland Air Force BaseTexasUSA
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | - Melissa A. Little
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
| | | | - Teresa M. Waters
- Department of Health Management and PolicyUniversity of KentuckyLexingtonKentuckyUSA
| | - Jean R. Harvey
- Department of Nutrition and Food SciencesUniversity of VermontBurlingtonVermontUSA
| | - Zoran Bursac
- Department of BiostatisticsFlorida International UniversityMiamiFloridaUSA
| | - Rebecca A. Krukowski
- Department of Preventive MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA
- Department of Public Health SciencesUniversity of Virginia Cancer Center, School of Medicine, University of VirginiaCharlottesvilleVirginiaUSA
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12
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Fahey MC, Talcott WG, Robinson LA, Mallawaarachchi I, Klesges RC, Little MA. Predictors of Cessation Outcomes Among Older Adult Smokers Enrolled in a Proactive Tobacco Quitline Intervention. J Aging Health 2022; 34:1144-1155. [PMID: 35506995 DOI: 10.1177/08982643221097679] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To identify predictors of older adults' likelihood of quitting following engagement in a proactive tobacco quit line. METHODS Older (>60 years) participants (N = 186) enrolled in a four-session quit line with 8-weeks of nicotine replacement therapy reported demographics, beliefs, and information about tobacco use. Point prevalence abstinence was reported at 3 and 12-months. RESULTS In final models, endorsement of quitting to take control of one's life and confidence in quitting were positively associated with 3-month cessation (OR = 1.74, 95% CI = 1.16, 2.62; OR = 1.75, 95% CI = 1.21, 2.52, respectively). At 12 months, stronger endorsement of quitting to take control of one's life and decreased nicotine dependence were associated with higher cessation (OR = 1.51, 95% CI = 1.05, 2.17; OR = 0.84, 95% CI = 0.71,0.99, respectively). DISCUSSION For tobacco cessation among older adults, programs should provide additional support to those with higher nicotine dependence, promote quitting self-efficacy, and encourage quitting as means to gain control of life and health.
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Affiliation(s)
- Margaret C Fahey
- 5415Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Wayne G Talcott
- Department of Public Health Sciences, 2358University of Virginia, Charlottesville, VA, USA
- 438578Joint Base San Antonio-Lackland, San Antonio, TX, USA
| | - Leslie A Robinson
- 5415Department of Psychology, The University of Memphis, Memphis, TN, USA
| | - Indika Mallawaarachchi
- Department of Public Health Sciences, 2358University of Virginia, Charlottesville, VA, USA
| | - Robert C Klesges
- Department of Public Health Sciences, 2358University of Virginia, Charlottesville, VA, USA
- 438578Joint Base San Antonio-Lackland, San Antonio, TX, USA
| | - Melissa A Little
- Department of Public Health Sciences, 2358University of Virginia, Charlottesville, VA, USA
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13
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Derefinko KJ, Bursac Z, Hand SB, Ebbert JO, Womack C, Klesges RC. Planning a Change Easily (PACE) for smokers who are not ready to quit: a telephone-based, randomized controlled trial. Addiction 2022; 117:1748-1757. [PMID: 34985171 DOI: 10.1111/add.15796] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/09/2021] [Indexed: 11/28/2022]
Abstract
AIMS To compare brief advice (BA), motivational interviewing (MI), rate reduction (RR), and combined MI and RR (MI + RR) to promote smoking cessation in smokers not ready to quit. DESIGN Randomized controlled trial with four parallel groups of smoking cessation intervention. Participants were randomly assigned 1:2:2:2 to receive one of the following interventions: BA (n = 128), MI (n = 258), RR (n = 257), and MI + RR (n = 260). SETTING The United States. All participant contact occurred over the telephone to be consistent with the typical quit line format. PARTICIPANTS A total of 903 adult smokers. Participants had a mean age of 49 (SD = 13.3) years and were 28.9% male and 63.3% Caucasian. INTERVENTIONS The BA group received advice similar to typical smoking cessation quit lines. The MI group received advice using basic MI principles to elicit language that indicates behavioral change. The RR group received behavioral skills training and nicotine gum. The MI + RR group combined elements of MI and RR conditions. All interventions were six sessions. MEASUREMENTS The primary outcome measure was self-reported point prevalence at 12 months. The secondary outcome was self-reported prolonged abstinence at 12 months. FINDINGS Intention to treat (ITT) point prevalence at 12 months indicated that BA (10.9%) had significantly lower point prevalence rates than RR (27.2%, OR = 3.17, 1.69-5.94), and MI + RR (26.9%, OR = 3.16, 1.68-5.93). BA did not have a significantly lower point prevalence rate than MI (15.5%, OR = 1.56, 95% CI = 0.81-3.02). CONCLUSIONS This randomized controlled trial provided evidence that rate reduction, which offers structured behavioral skills and nicotine gum, either alone or combined with motivational interviewing, is the most effective form of cessation intervention for smokers not ready to quit.
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Affiliation(s)
- Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Zoran Bursac
- Department of Biostatistics, Florida International University, Miami, FL, USA
| | - Sarah B Hand
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Jon O Ebbert
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Catherine Womack
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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14
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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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15
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Little MA, Wang XQ, Fahey MC, Wiseman KP, Pebley K, Klesges RC, Talcott GW. Efficacy of a group-based brief tobacco intervention among young adults aged 18-20 years in the US Air Force. Tob Induc Dis 2021; 19:95. [PMID: 34963775 PMCID: PMC8653010 DOI: 10.18332/tid/143282] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Most smokers begin using tobacco before the age of 25 years, making it important to reduce tobacco use during adolescence and early adulthood. Rates of use are historically higher among military personnel. While 'Tobacco 21' made it illegal for US retailers to sell tobacco to those aged <21 years, the policy did not address cessation for current youth and young adult tobacco users. Additionally, there is limited research on cessation interventions among young adults under 21 years. The current study evaluated the efficacy of a group-based Brief Tobacco Intervention (BTI) among US Air Force trainees, who are predominantly aged 18-20 years and directly impacted by Tobacco 21 legislation. METHODS Participants were 2969 US Air Force Trainees from April 2017 through January 2018 cluster randomized to three conditions: 1) BTI + Airman's Guide to Remaining Tobacco Free (AG), 2) AG alone, and 3) the National Cancer Institute's Clearing the Air (CTA) pamphlet. To assess the efficacy of the interventions among people aged 18-20 years, a domain analysis (<21 years, n=2117; and ≥21 years, n=852) of a multinomial logistic regression model was run. RESULTS Mono tobacco users aged <21 years at baseline who received the BTI+AG had higher odds of quitting tobacco at 3 months (OR=2.13; 95% CI: 1.02-4.46). Dual and poly users aged <21 years at baseline who received the BTI+AG intervention had higher odds of reducing the number of tobacco products used at 3 months (OR=2.94; 95% CI: 1.03-8.37). CONCLUSIONS The BTI was effective for people aged 18-20 years. The current study offers insight into components of interventions that might be successful in helping this age group decrease tobacco use.
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Affiliation(s)
- Melissa A. Little
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Xin-Qun Wang
- School of Medicine, University of Virginia, Charlottesville, United States
| | - Margaret C. Fahey
- Department of Psychology, University of Memphis, Memphis, United States
| | - Kara P. Wiseman
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Kinsey Pebley
- Department of Psychology, University of Memphis, Memphis, United States
| | - Robert C. Klesges
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
| | - Gerald W. Talcott
- School of Medicine, University of Virginia, Charlottesville, United States
- University of Virginia Cancer Center, Charlottesville, United States
- Wilford Hall Ambulatory Surgical Center, 59th Medical Wing, Lackland, United States
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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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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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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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Talcott GW, McMurry T, Ebbert J, Fahey MC, Wang XQ, Murphy JG, McDevitt-Murphy M, Little MA, Klesges RC. Dissemination of a Universally Delivered Brief Alcohol Intervention in United States Air Force Technical Training. J Addict Med 2021; 15:318-324. [PMID: 33122547 DOI: 10.1097/adm.0000000000000763] [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: 11/26/2022]
Abstract
OBJECTIVES Heavy alcohol use is a particular problem in the US military, prompting the Institute of Medicine to identify it as a public health crisis. Developing prevention programs aimed at reducing problematic drinking during military service would be useful. Thus, the purpose of the current study, was to broadly disseminate and assess the effectiveness of a brief alcohol intervention (BAI) + random breathalyzer (RB) intervention to reduce alcohol related incidents (ARIs), to all incoming Air Force trainees. METHODS The BAI was administered to all incoming Airmen (N = 15,898) across 4 major training Air Force bases. Additionally, underage Airmen were subject to RB tests. A quasi-experimental pre-test post-test design compared the rate of ARIs, per 100,000 training days, during the year prior and the year after the intervention was delivered. RESULTS A Poisson model indicated that the BAI + RB intervention was associated with a decrease in ARIs across all bases. Overall, the intervention lowered the ARI rate by 16% (β = -0.178, standard error = 0.0742, P = 0.016). For every 100,000 training days, annual ARIs decreased from 30.8 to 25.5 after implementation. CONCLUSIONS A universally administered brief alcohol intervention, coupled with RB targeting underage drinkers, was associated with a reduction in the rate of ARIs. Results of this large-scale prevention study indicate that a brief alcohol intervention can be widely disseminated during US Air Force training and can perhaps reduce costs and make a public health contribution by decreasing alcohol related incidents.
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Affiliation(s)
- Gerald Wayne Talcott
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA (GWT, TM, XQW, MAL, RCK); Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN (JE); Department of Psychology, University of Memphis, Memphis, TN (MCF, JGM, MM)
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20
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Fahey MC, Klesges RC, Kocak M, Gladney LA, Talcott GW, Krukowski RA. Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis. JMIR Form Res 2021; 5:e23974. [PMID: 33949954 PMCID: PMC8135027 DOI: 10.2196/23974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/05/2020] [Revised: 02/02/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Feedback for participants' self-monitoring is a crucial and costly component of technology-based weight loss interventions. Detailed examination of interventionist time when reviewing and providing feedback for online self-monitoring data is lacking. OBJECTIVE The aim of this study was to longitudinally examine the time counselors spent providing feedback on participant self-monitoring data (ie, diet, physical activity, weight) in a 12-month technology-based weight loss intervention. We hypothesized that counselors would compose feedback for participants more quickly over time. METHODS The time the lay counselors (N=10) spent reviewing self-monitoring records and providing feedback to participants via email was longitudinally examined for all counselors across the three years of study implementation. Descriptives were observed for counselor feedback duration across counselors by 12 annual quarters (ie, 3-month periods). Differences in overall duration times by each consecutive annual quarter were analyzed using Wilcoxon-Mann-Whitney tests. RESULTS There was a decrease in counselor feedback duration from the first to second quarter (mean 53 to 46 minutes; P<.001), and from the second to third (mean 46 to 30 minutes; P<.001). A trend suggested a decrease from the third to fourth quarter (mean 30 to 26 minutes; P=.053), but no changes were found in subsequent quarters. Consistent with the hypothesis, counselors may be increasing their efficiency in providing feedback; across 12 months, counselors spent less time reviewing participant self-monitoring and composing feedback (decreasing from mean 53 to 26 minutes). CONCLUSIONS Counselors used increasingly less time to review online self-monitoring data and compose feedback after the initial 9 months of study implementation. Results inform counselor costs for future technology-based behavioral weight loss interventions. For example, regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions. One possibility for reducing costs would be generating computer-automated feedback. TRIAL REGISTRATION ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178.
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Affiliation(s)
- Margaret C Fahey
- Psychology Department, The University of Memphis, Memphis, TN, United States
| | - Robert C Klesges
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Mehmet Kocak
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Leslie A Gladney
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Gerald W Talcott
- School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Rebecca A Krukowski
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
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21
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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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23
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Little MA, Fahey MC, Klesges RC, McMurry T, Talcott GW. Evaluating the Effects of a Brief Tobacco Intervention in the US Air Force. Nicotine Tob Res 2020; 22:1569-1577. [PMID: 31903494 DOI: 10.1093/ntr/ntaa001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Military personnel have among the highest rates of tobacco use in the United States. Unfortunately, there are few interventions aimed at reducing tobacco use among this vulnerable population. The current study addresses this need by evaluating the short-term effectiveness of a Brief Tobacco Intervention (BTI), a 40-min group-based intervention designed to reduce contemporary patterns of tobacco use among a sample of US military enlistees during an 11-week period of involuntary tobacco abstinence. AIMS AND METHODS Participants were 2999 US Air Force Technical Trainees at Joint Base San Antonio-Lackland Air Force Base in San Antonio, Texas from April 2017 through January 2018. Participants were cluster randomized to three conditions: (1) BTI + Airman's Guide to Remaining Tobacco Free (AG), (2) AG intervention, or (3) standard smoking cessation intervention. The primary analysis was a comparison of the interventions' efficacies in preventing tobacco use during Technical Training, conducted using a generalized estimating equations logistic regression model controlling for covariates. Multiple imputation was used to account for loss to follow-up. RESULTS There was not a significant difference by condition in the use of tobacco products at follow-up (p = .454). The BTI + AG condition did produce short-term changes in perceived harm, intentions to use tobacco, knowledge about tobacco products, and normative beliefs. CONCLUSIONS These findings suggest that while the intervention was effective in the short term, it was not potent enough over a 12-week period to prevent Airmen from initiating tobacco use. Future studies should examine whether adding a booster session or media campaign enhances the effectiveness of the intervention. IMPLICATIONS Despite the fact that most Airmen believe they will remain tobacco free following the ban in Technical Training, a large percentage of these Airmen resume and initiate tobacco use during this high-risk period. As a result, there is a need for interventions targeting the range of tobacco available to military trainees during a teachable moment when they report intentions to remain tobacco free. The current study shows that a BTI has promise in reducing long-term tobacco use, when coupled with additional interventions, such as a booster session or a media campaign.
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Affiliation(s)
- Melissa A Little
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA.,Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, TX
| | | | - Robert C Klesges
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Timothy McMurry
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, University of Virginia School of Medicine, Charlottesville, VA.,Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, TX
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24
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Fahey MC, Klesges RC, Kocak M, Talcott GW, Krukowski RA. Seasonal fluctuations in weight and self-weighing behavior among adults in a behavioral weight loss intervention. Eat Weight Disord 2020; 25:921-928. [PMID: 31093925 PMCID: PMC6856417 DOI: 10.1007/s40519-019-00707-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [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: 08/09/2018] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The current study aimed to observe potential seasonal fluctuations in weight and self-weighing behavior among a diverse sample of adults engaged in a behavioral weight loss intervention. METHODS Active duty personnel (N = 248) were randomized to either a counselor-initiated or self-paced 12-month behavioral weight loss intervention promoting daily self-weighing. Body weight and self-weighing frequency were collected from electronic scales (e-scales) provided at baseline. RESULTS Overall, participants lost weight from winter to spring (p = 0.02) and gained weight from fall to winter (p < 0.001). No demographic differences in weight changes were observed. Participants self-weighed less frequently during summer compared to spring (p < 0.0001), less in fall compared to summer (p < 0.0001), and less in winter compared to fall (p < 0.0001). In multivariate models, weight change and self-weighing frequency during the previous season, as well as days since randomization and intervention intensity were associated with seasonal weight changes. CONCLUSIONS This study is the first to observe seasonal fluctuations of weight and self-weighing behavior among adults actively engaged in a weight loss intervention, consistent with research in the general population. Findings highlight the importance of acknowledging seasonal influence within weight loss programs and trials. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Margaret C Fahey
- Department of Psychology, The University of Memphis, 400 Innovation Drive, Memphis, TN, 38111, USA.
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street, Memphis, TN, 38105, USA
- Department of Public Health Sciences, School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street, Memphis, TN, 38105, USA
| | - Gerald W Talcott
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street, Memphis, TN, 38105, USA
- Department of Public Health Sciences, School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street, Memphis, TN, 38105, USA
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Wiseman KP, Hauser L, Clark C, Odumosu O, Dahl N, Peregoy J, Sheffield CW, Klesges RC, Anderson RT. An Evaluation of the Process and Quality Improvement Measures of the University of Virginia Cancer Center Tobacco Treatment Program. Int J Environ Res Public Health 2020; 17:E4707. [PMID: 32629953 PMCID: PMC7369775 DOI: 10.3390/ijerph17134707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 01/25/2023]
Abstract
Tobacco use after a cancer diagnosis can increase risk of disease recurrence, increase the likelihood of a second primary cancer, and negatively impact treatment efficacy. The implementation of system-wide comprehensive tobacco cessation in the oncology setting has historically been low, with over half of cancer clinicians reporting that they do not treat or provide a referral to cessation resources. This quality improvement study evaluated the procedures for assessing and documenting tobacco use among cancer survivors and referring current smokers to cessation resources at the University of Virginia Cancer Center. Process mapping revealed 20 gaps across two major domains: electronic health record (EHR), and personnel barriers. The top identified priority was inconsistent documentation of tobacco use status as it impacted several downstream gaps. Eleven of the 20 gaps were deemed a high priority, and all were addressed during the implementation of the resulting Tobacco Treatment Program. Prioritized gaps were addressed using a combination of provider training, modifications to clinical workflow, and EHR modifications. Since implementation of solutions, the number of unique survivors receiving cessation treatment has increased from 284 survivors receiving cessation support during Year 1 of the initiative to 487 in Year 3. The resulting Tobacco Treatment Program provides a systematic, personalized, and sustainable comprehensive cessation program that optimizes the multifaceted workflow of the Cancer Center and has the potential to reduce tobacco use in a population most in need of cessation support.
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Affiliation(s)
- Kara P. Wiseman
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (R.C.K.); (R.T.A.)
| | - Lindsay Hauser
- Cancer Center, University of Virginia, Charlottesville, VA 22908, USA; (L.H.); (C.C.); (O.O.); (N.D.); (J.P.); (C.W.S.)
| | - Connie Clark
- Cancer Center, University of Virginia, Charlottesville, VA 22908, USA; (L.H.); (C.C.); (O.O.); (N.D.); (J.P.); (C.W.S.)
| | - Onyiyoza Odumosu
- Cancer Center, University of Virginia, Charlottesville, VA 22908, USA; (L.H.); (C.C.); (O.O.); (N.D.); (J.P.); (C.W.S.)
| | - Neely Dahl
- Cancer Center, University of Virginia, Charlottesville, VA 22908, USA; (L.H.); (C.C.); (O.O.); (N.D.); (J.P.); (C.W.S.)
| | - Jennifer Peregoy
- Cancer Center, University of Virginia, Charlottesville, VA 22908, USA; (L.H.); (C.C.); (O.O.); (N.D.); (J.P.); (C.W.S.)
| | - Christina W. Sheffield
- Cancer Center, University of Virginia, Charlottesville, VA 22908, USA; (L.H.); (C.C.); (O.O.); (N.D.); (J.P.); (C.W.S.)
| | - Robert C. Klesges
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (R.C.K.); (R.T.A.)
- Cancer Center, University of Virginia, Charlottesville, VA 22908, USA; (L.H.); (C.C.); (O.O.); (N.D.); (J.P.); (C.W.S.)
- Center for Addiction Prevention Research, University of Virginia, Charlottesville, VA 22908, USA
| | - Roger T. Anderson
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA 22908, USA; (R.C.K.); (R.T.A.)
- Cancer Center, University of Virginia, Charlottesville, VA 22908, USA; (L.H.); (C.C.); (O.O.); (N.D.); (J.P.); (C.W.S.)
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26
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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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Fahey MC, Klesges RC, Kocak M, Talcott GW, Krukowski RA. Sociodemographic Characteristics Associated with Pretreatment Weight Change in a U.S. Military Behavioral Weight Loss Intervention. Mil Behav Health 2020; 8:327-332. [PMID: 33094030 PMCID: PMC7575055 DOI: 10.1080/21635781.2020.1750512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Margaret C. Fahey
- The University of Memphis, Department of Psychology, 400 Innovation Drive, Memphis, TN, USA, 38111
| | - Robert C. Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, USA, 38105
- University of Virginia, Department of Public Health Sciences, School of Medicine, 1215 Lee Street, Charlottesville, VA, USA, 22908
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, USA, 38105
| | - Gerald W. Talcott
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, USA, 38105
- University of Virginia, Department of Public Health Sciences, School of Medicine, 1215 Lee Street, Charlottesville, VA, USA, 22908
| | - Rebecca A. Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, USA, 38105
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Fahey MC, Hare ME, Talcott GW, Kocak M, Hryshko-Mullen A, Klesges RC, Krukowski RA. Characteristics Associated With Participation in a Behavioral Weight Loss Randomized Control Trial in the U.S. Military. Mil Med 2020; 184:e120-e126. [PMID: 30125001 DOI: 10.1093/milmed/usy199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/11/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Effective recruitment and subsequent enrollment of diverse populations is often a challenge in randomized controlled trials, especially those focused on weight loss. In the civilian literature, individuals identified as racial and ethnic minorities, men, and younger and older adults are poorly represented in weight loss interventions. There are limited weight loss trials within military populations, and to our knowledge, none reported participant characteristics associated with enrollment. There may be unique motives and barriers for active duty personnel for enrollment in weight management trials. Given substantial costs and consequences of overweight and obesity in the U.S. military, identifying predictors and limitations to diverse enrollment can inform future interventions within this population. The study aims to describe the recruitment, screening, and enrollment process of a military weight loss intervention. Demographic and lifestyle characteristics of military personnel lost between screening and randomization are compared to characteristics of personnel randomized in the study and characteristics of the Air Force in general. MATERIALS AND METHODS The Fit Blue study, a randomized controlled behavioral weight loss trial for active duty personnel, was approved by the Institutional Review Board of the Wilford Hall Ambulatory Surgical Center in San Antonio, TX, USA and acknowledged by the Institutional Review Board at the University of Tennessee Health Science Center. Logistic regressions compared participant demographics, anthropometric data, and health behaviors between personnel that attended a screening visit but were not randomized and those randomized. Multivariable models were constructed for the likelihood of being randomized using a liberal entry and stay criteria of 0.10 for the p-values in a stepwise variable selection algorithm. Descriptive statistics compared the randomized Fit Blue cohort demographics to those of the U.S. Air Force. RESULTS In univariate analyses, older age (p < 0.02), having a college degree or higher (p < 0.007) and higher military rank (p < 0.02) were associated with completing the randomization process. The randomized cohort reported a lower percentage of total daily kilocalories for fat compared to the non-randomized cohort (p = 0.033). The non-randomized cohort reported more total minutes and intensity of physical activity (p = 0.073). In the multivariate model, only those with a college degree or higher were 3.2 times more likely to go onto randomization. (OR = 3.2, 95% CI = 2.0, 5.6, p < 0.0001). The Fit Blue study included a higher representation of personnel who identified as African American (19.4% versus 15.0%) and Hispanic/Latino (22.7% versus 14.3%) compared with the U.S. Air Force in general; however, men were underrepresented (49.4% versus 80.0%). TABLE I.Comparisons of Demographic Characteristics of Randomized Fit Blue Cohort to Screened Non-Randomized CohortFit Blue Randomized Participants (N = 248)Non-Randomized Cohort (N = 111)All Screened Participants (N = 359)p-ValueSex N (%)0.73 Male122 (49.2)52 (46.8)174 (48.5) Female126 (50.8)59 (53.2)183 (51.5)Age Mean (±SD) years34 (±7.5)32 (±6.7)33 (±7.3)0.02Race N (%)0.89 African American49 (19.8)22 (19.8)71 (19.8) Caucasian163 (65.7)75 (67.6)238 (66.3) Other36 (14.5)14 (12.2)50 (13.9)Ethnicity N (%)0.59 Hispanic/Latino56 (22.6)28 (25.2)84 (23.4) Non-Hispanic/Latino192 (77.4)83 (74.8)275 (76.6)Education N (%)<0.0001 Less than college degree123 (49.6)82 (73.9)205 (57.1) College degree or greater125 (50.4)29 (26.1)154 (42.9)Marital status N (%)0.83 Single/never married40 (16.1)20 (18)60 (16.7) Married/living as married169 (68.1)72 (64.9)241 (67.1) Separated/divorced39 (15.7)19 (17.1)58 (16.2)Number of additional adults in household N (%)0.82 046 (18.5)22 (19.8)68 (18.9) 1162 (65.3)73 (65.8)235 (65.5) 231 (12.5)14 (12.6)45 (12.5) 3 or more9 (3.6)2 (1.8)11 (3.1)Number of children in household N (%)0.56 091 (36.7)37 (33.3)128 (35.7) 159 (23.8)23 (20.7)82 (22.8) 257 (23)26 (23.4)83 (23.1) 3 or more41 (16.5)25 (22.5)66 (18.4)Years in service mean (± SD)12 (±6.6)11 (±6.1)12 (±6.4)0.20Military gradeaN (%)0.02 E1-E434 (13.7)19 (17.1)53 (14.8) E5-E6105 (42.3)58 (52.3)163 (45.4) E7-E952 (21)21 (18.9)73 (20.3) O1-O317 (6.9)9 (8.1)26 (7.2) O4-O639 (15.7)4 (3.6)43 (12)Branch0.68 Army4 (1.6)1 (0.9)5 (1.4) Air Force234 (94.4)105 (94.6)339 (94.4) Navy8 (3.2)5 (4.5)13 (3.6) Marine Corp2 (0.8)0 (0.0)2 (0.6)BMI (m2/kg) N (%)30.6 (±2.7)30.4 (±2.9)30.6 (±2.8)BMI category N (%)0.76 Overweight115 (46.4)52 (48.1)167 (46.9) Obese133 (53.6)56 (51.9)189 (53.1)aMilitary ranking; Enlisted (E) categories: E1-E4 (enlisted), E5-E6 (non-commissioned officers), E7-E9 (senior non-commissioned officers) and two Officer categories (O): O1-O3 (Company Grade Officer) and O4-O6 (Field Grade Officer); standard deviation (SD).Table II.Comparisons of Anthropometric Characteristics of Randomized Fit Blue Cohort to Screened Non-Randomized CohortFit Blue Randomized Participants (N = 248)Non-Randomized Cohort (N = 111)All Screened Participants (N = 359)p-ValuePhysical activity Total physical activity2525 (±3218)2840 (±2541)2621 (±3028)0.027 (mean (±SD) minutes per week) Total sedentary physical activity5046 (±239)472 (±221)494 (±234)0.35 (mean (±SD) minutes per week) Vigorous physical activity34 (±145)54 (±152)40 (±147)0.036 (mean (±SD) minutes per week)Dietary intake Total sweetened beverages (kcal per day)165 (±206)152.9 (±166)160.8 (±194)0.80 Fruit and vegetable consumption (cups per day)3 (±1)3 (±1)3 (±1)0.52 Dietary fat (% total kcal)35 (±4)34 (±4)35 (±4)0.033. CONCLUSIONS Accounting for all influencing characteristics, higher educational status was the only independent predictor of randomization. Perhaps, highly educated personnel are more invested in a military career, and thus, more concerned with consequences of failing required fitness tests. Thus, it may be important for future weight loss interventions to focus recruitment on less-educated personnel. Results suggest that weight loss interventions within a military population offer a unique opportunity to recruit a higher prevalence of males and individuals who identify as racial or ethnic minorities which are populations commonly underrepresented in weight loss research.
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Affiliation(s)
- Margaret C Fahey
- Department of Psychology, University of Memphis, 400 Innovation Drive Memphis, TN
| | - Marion E Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN.,Department of Pediatrics, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN
| | - Gerald W Talcott
- University of Tennessee Health Science Center, Fit Blue Study Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Dr., Ste. 1 Lackland AFB, TX.,Department of Public Health Sciences, School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN
| | - Ann Hryshko-Mullen
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, 1320 Truemper Road, San Antonio, TX.,Department of Mental Health, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland AFB, 1100 Wilford Hall, San Antonio, TX
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN.,Department of Public Health Sciences, School of Medicine, University of Virginia, 1215 Lee Street, Charlottesville, VA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN
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Little M, Ebbert JO, Krukowski RA, Halbert J, Kalpinski MR, Patten CA, Talcott GW, Klesges RC. Factors Associated with Cigarette Use During Airmen's First Year of Service in the United States Air Force. Mil Med 2020; 185:e212-e220. [PMID: 31287888 DOI: 10.1093/milmed/usz155] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/18/2019] [Accepted: 06/07/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Despite declines of cigarette use in the civilian population, military personnel report alarmingly high rates of cigarette use. Enlisted Air Force recruits are required to remain tobacco-free for the first 12 weeks of training, and the majority express confidence they will not use tobacco after the ban; however, most previous smokers return to smoking and many nonsmokers initiate. Understanding the factors associated with cigarette-smoking initiation among non-users and re-initiation among former users is critical for the development of successful tobacco control efforts. MATERIALS AND METHODS The current study examines predictors of cigarette smoking among a sample of 2,188 USAF personnel after their first year of service. Logistic regression analyses examined associations between baseline predictors and initiation and re-initiation of cigarette smoking at a one-year follow-up. RESULTS Compared to never smokers at both time points, the strongest predictor of smoking initiation over the past 12 months was having owned cigarette-branded merchandise (OR 3.81, 95% CI 1.67, 8.71). Compared to former smokers who remained abstinent, the strongest predictor of re-initiation was intention to use tobacco (OR 2.08, 95% CI 1.53, 2.83). Compared to individuals who initiate, the strongest predictors of re-initiation were prior use of other tobacco products and tobacco use intentions (ORs range 1.85 to 4.63). CONCLUSIONS Multiple risk factors are associated with tobacco use. Given that Airmen are tobacco-free for the first 12 weeks of training, tobacco interventions during this period might be more effective. Our findings can be used to tailor interventions to prevent tobacco use in the U.S. military.
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Affiliation(s)
- Melissa Little
- Center for Addiction and Prevention Research, University of Virginia Medical School, 59 MDW/ 59 SGOWMP, 1100 Wilford Hall Loop, Bldg 4554, Joint Base Lackland AFB, TX 78236
| | - Jon O Ebbert
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905
| | - Rebecca A Krukowski
- University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163-2181
| | - Jennifer Halbert
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 560 Ray C. Hunt Drive, PO Box 800717, Charlottesville, VA 22908
| | | | | | - Gerald W Talcott
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 2200 Bergquist Dr Ste 1, Joint Base Lackland AFB, TX 78236
| | - Robert C Klesges
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 560 Ray C. Hunt Drive, PO Box 800717, Charlottesville, VA 22908
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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, Klesges RC, Kocak M, Wang J, Talcott GW, Krukowski RA. Do the holidays impact weight and self-weighing behaviour among adults engaged in a behavioural weight loss intervention? Obes Res Clin Pract 2019; 13:395-397. [PMID: 31182293 PMCID: PMC6698213 DOI: 10.1016/j.orcp.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [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: 12/22/2018] [Revised: 04/23/2019] [Accepted: 05/08/2019] [Indexed: 01/02/2023]
Abstract
We examined the U.S. holiday period impact on weight gain, self-weighing, and treatment success among adults in a weight loss intervention (N=171). Using electronic scales, body weight and self-weighing frequency were compared by time period [i.e., pre-holiday, holiday (November 15-January 1), post-holiday]. Self-weighing was less frequent during holiday period (p<.01), and longer intervention engagement was associated with weight gain (p<.0001) during this time. Enrollment during holiday period was associated with 2.3% 12-month weight loss. Holiday period enrollment might be beneficial for preventing holiday weight gain and facilitating successful intervention outcomes.
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Affiliation(s)
- Margaret C Fahey
- The University of Memphis, Department of Psychology, 400 Innovation Drive Memphis, TN, 38111, USA.
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA; University of Virginia, Department of Public Health Sciences, School of Medicine, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA
| | - Jiajing Wang
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA
| | - Gerald W Talcott
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA; University of Virginia, Department of Public Health Sciences, School of Medicine, 1215 Lee Street, Charlottesville, VA, 22908, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline Street Memphis, TN, 38105, USA
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Derefinko KJ, Hallsell TA, Isaacs MB, Salgado Garcia FI, Colvin LW, Bursac Z, McDevitt-Murphy ME, Murphy JG, Little MA, Talcott GW, Klesges RC. Substance Use and Psychological Distress Before and After the Military to Civilian Transition. Mil Med 2019; 183:e258-e265. [PMID: 29420791 DOI: 10.1093/milmed/usx082] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Those currently serving in the military constitute a vulnerable population given their high-risk status for substance use, and population data suggest that veterans continue to engage in significant substance use long after their military service ends. Recent research suggests that the separation transition from active duty to civilian life may be critical in terms of the future functioning of the veteran. Methods We sought to explore substance use prevalence, as well as potential emotional distress among veterans by retrospectively assessing substance use during active duty and following separation to examine possible changes in use over this period. This study assessed substance use and emotional distress in veterans (N = 80; 90% male) across the military to civilian transition. Findings Repeated measures tests indicated that endorsement of alcohol use, cigarette use, and prescription drug misuse was similar during active duty and post-separation, and marijuana and hard drug use endorsement increased significantly in the 6-mo period post-separation. Further, comorbid use of different substances was common. Active duty levels of anxiety/depression and aggressive feelings were maintained from active duty to post-separation, and feeling alone and military-based trauma symptoms increased significantly. Finally, participants indicated that only a minority of the veterans they knew were doing emotionally well or did not have alcohol/substance use issues. Discussion These findings indicate a clear need for substance use and psychological intervention availability before and after transition to enable veterans to transition to civilian life effectively. Based on the many issues at work during the transition process, programs may do well to focus more specifically on identification of problems and raising awareness, rather than awaiting more severe issues in the future. Validation of the difficulties of the separation transition, veterans' feelings of isolation, and the importance of veteran community support may help newly transitioning veterans find advocates who may help them navigate existing assistance programs.
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Affiliation(s)
- Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | - Troy A Hallsell
- Department of History, The University of Memphis, Memphis, TN 38152-3450
| | - Matthew B Isaacs
- Department of History, The University of Memphis, Memphis, TN 38152-3450
| | - Francisco I Salgado Garcia
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | - Lauren W Colvin
- Research Informatics for the Cancer Center, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, 66 N. Pauline St., Memphis, TN 38163-2181
| | | | - James G Murphy
- Department of Psychology, University of Memphis, 400 Innovation Drive, Memphis, TN 38152
| | - Melissa A Little
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
| | - Gerald W Talcott
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Room 2120, Charlottesville, VA 22911
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Little MA, Ebbert JO, Krukowski RA, Halbert JP, Kalpinski R, Patten CA, Boothe TL, Pasker CK, Klesges RC, Talcott GW. Predicting cigarette initiation and reinitiation among active duty United States Air Force recruits. Subst Abus 2019; 40:340-343. [PMID: 30883297 DOI: 10.1080/08897077.2019.1577678] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The first year of military service in the United States Air Force (USAF) is a high-risk time for tobacco use. Previous studies have demonstrated the effectiveness of a tobacco ban during Basic Military Training (BMT). However, no studies have examined the effect of increasing the protracted ban for an additional 4 weeks. Understanding the patterns of initiation and reinitiation following the protracted ban will inform future intervention and policy efforts. Methods: The current study examines patterns of cigarette smoking among a sample of 2188 USAF personnel at baseline and after their first year of service. Results: One year after BMT, we observed that 65.0% of USAF enlistees remained never smokers, 9.6% remained abstinence from cigarettes, 9.3% initiated cigarette smoking, and 16.1% reinitiated cigarette smoking. Despite the extended tobacco ban in BMT and Technical Training, 12.6% of individual who never smoked initiated cigarette smoking and 62.6% of individuals who formerly smoked reinitiated. Over half (54.2%) of Airmen who reported smoking cigarettes at follow-up reported initiating or reinitiating during Technical Training. Conclusions: Our findings indicate that although the increased ban prevents additional individuals who smoked cigarettes prior to joining the Air Force from reinitiating, it has no effect on initiation among individuals who report never using prior to military service. Additional research is needed to understand what may be leading to these high rates of initiation and reinitiation in Technical Training following the ban.
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Affiliation(s)
- Melissa A Little
- Center for Addiction and Prevention Research, University of Virginia Medical School, Joint Base San Antonio-Lackland, Texas, USA
| | | | - Rebecca A Krukowski
- Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
| | - Jennifer P Halbert
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, Virginia, USA
| | - Ryan Kalpinski
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
| | | | - Tina L Boothe
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
| | - Christin K Pasker
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
| | - Robert C Klesges
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, Virginia, USA
| | - Gerald W Talcott
- United States Air Force, Joint Base San Antonio-Lackland, Texas, USA
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Patten C, Wang XQ, Ebbert JO, Little MA, Talcott GW, Hryshko-Mullen AS, Klesges RC. Influence of gender and peer tobacco use on tobacco use intentions after a period of involuntary tobacco abstinence among U.S. Air Force trainees. Prev Med Rep 2019; 13:270-276. [PMID: 30723662 PMCID: PMC6351393 DOI: 10.1016/j.pmedr.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
This study examined gender, prior tobacco use, and social-environmental factors as predictors of intentions to use tobacco (cigarette smoking and/or smokeless tobacco [ST]) after a forced period of abstinence among U.S. Air Force (USAF) trainees. Trainees completed 8½ weeks of basic military training (BMT), then 4 weeks of Technical Training; both required abstinence from tobacco. A cross-sectional survey of 13,514 USAF trainees (73% male, 90% age 18–24, 43% prior tobacco use) was conducted at the beginning of the 4-week Technical Training period. Overall, 17% of the sample reported future tobacco use intentions. Intentions for future tobacco use were less prevalent among non-tobacco users before BMT (1%) than those reporting any tobacco use (37%). From a multivariable logistic regression model predicting intentions to use any tobacco after Technical Training, significant two-way interaction effects were detected between gender, and tobacco use prior to BMT (p = 0.0001), and number of close friends who smoked cigarettes (p = 0.018), and number of close friends who used ST (p = 0.029). Among non-tobacco users before BMT, females were more than twice as likely as males to report tobacco intentions (Odds Ratio = 2.2, Bonferroni corrected 95% CI: 1.14.4, p = 0.011); no gender differences were detected among tobacco users. For females, but not males, having more friends who smoked was associated with greater likelihood of tobacco intentions (Bonferroni corrected p ≤ 0.05). In contrast, for males, but not females, having more friends using ST was associated with greater likelihood of tobacco intentions (Bonferroni corrected p < 0.05). In this sample of USAF trainees, the study provides novel findings on how males and females are influenced differently by their prior tobacco use and peers' tobacco use in predicting tobacco intentions. Prevention efforts focused on uptake and resumption of tobacco use, along with gender-specific strategies, may be warranted. Prior tobacco use predicts tobacco use intentions among U.S. Air Force trainees. Male and female trainees are influenced differently by their peers' tobacco use. Gender-specific strategies targeting social norms about tobacco may be warranted.
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Affiliation(s)
- Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
- Corresponding author at: Mayo Clinic, BioBusiness 5, 200 1st Street SW, Rochester, MN 55905, USA.
| | - Xin-Qun Wang
- Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Jon O. Ebbert
- Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Melissa A. Little
- Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Gerald W. Talcott
- Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Ann S. Hryshko-Mullen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, USA
| | - Robert C. Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
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Salgado García FI, Derefinko KJ, Bursac Z, Klesges RC, Ebbert JO, Womack CR, Krukowski RA. Fit & quit: An efficacy trial of two behavioral post-cessation weight gain interventions. Contemp Clin Trials 2019; 76:31-40. [PMID: 30445176 PMCID: PMC6519455 DOI: 10.1016/j.cct.2018.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/24/2018] [Revised: 11/07/2018] [Accepted: 11/12/2018] [Indexed: 12/24/2022]
Abstract
While smoking cessation leads to significant improvements in both mortality and morbidity, post-cessation weight gain partially attenuates this benefit. Even though post-cessation weight gain is small (4.7 kg on average), it is a stated reason to delay cessation attempts and is associated with smoking relapse. Fit & Quit is a randomized, controlled efficacy trial that aims to examine the ability of a weight stability intervention and a weight loss intervention to reduce post-cessation weight gain. For this purpose, Fit & Quit will randomize participants to three conditions: (a) Small Changes, a weight gain prevention intervention; (b) Look AHEAD Intensive Lifestyle Intervention; and (c) a lower-intensity bibliotherapy intervention. All conditions will receive a highly efficacious behavioral (i.e., rate reduction skills, motivational interviewing) and pharmacological (i.e., varenicline) smoking cessation program. A total of 400 participants will be recruited and randomized to the three interventions. Participants will be recruited in waves, with 10 waves of approximately 40 participants per wave. The primary outcomes of this study include post-cessation weight gain and cessation status at 12-month follow-up. Fit & Quit will integrate and adapt the strongest evidence-based interventions available for weight management and smoking cessation. Fit & Quit is highly innovative in the areas of the target population, study design, and use of technology. For these reasons, we expect that Fit & Quit will make a significant public health contribution to curtailing the important cessation barrier of post-cessation weight gain.
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Affiliation(s)
- Francisco I Salgado García
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA.
| | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Charlottesville, VA 22911, USA
| | - Jon O Ebbert
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Catherine R Womack
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA; Department of Medicine, University of Tennessee Health Science Center, 956 Court Ave., Memphis, TN 38163, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N. Pauline St., Memphis, TN 38163, USA
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Little MA, Klesges RC, Bursac Z, Halbert JP, Ebbert J, Talcott GW, Weksler B. Correlates of smoking status in cancer survivors. J Cancer Surviv 2018; 12:828-834. [PMID: 30343442 PMCID: PMC6457260 DOI: 10.1007/s11764-018-0720-x] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 09/24/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To determine the characteristics associated with cancer survivors which indicate continued cigarette smoking at or around the time of cancer diagnosis. METHODS A total of 631 survivors were recruited in four cancer centers in Memphis, TN, between March 2015 and June 2016. To increase the probability of accurate reporting, surveys were conducted anonymously. A total of 112 respondents reported they were current smokers and 202 reported they were former smokers (n = 314), who comprised the sample. RESULTS We found that the rate of daily e-cigarette use among cancer survivors who smoked was 15.2% versus 3.9% in cancer survivors who no longer smoked. The national rate of adult e-cigarette use is 3.5%. Multivariate models correlated the characteristics of current versus former smokers and revealed that increasing age (aOR = 0.97, p < .0001), decreasing education (aOR = 2.39, p < .02), and current use of e-cigarettes (aOR = 3.74, p < .00045) were frequently associated with current cigarette smoking. CONCLUSIONS While age and gender were associated with continued smoking, current use of e-cigarettes was associated with almost four times higher odds of being a current smoker. Further research is needed to determine if use of e-cigarettes deters or promotes the smoking cessation process, at least in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS Among cancer survivors who continue to smoke after a cancer diagnosis, use of e-cigarettes is highly prevalent; research is needed to determine whether use of e-cigarettes promotes, has no effect, or hinders smoking cessation efforts among this vulnerable population.
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Affiliation(s)
- Melissa A Little
- Center for Addiction and Prevention Research, University of Virginia Medical School, 59 MDW/59 SGOWMP, 1100 Wilford Hall Loop, Bldg 4554, Lackland AFB, TX, 78236, USA.
| | - Robert C Klesges
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, 560 Ray C. Hunt Drive, PO Box 800717, Charlottesville, VA, 22908, USA
| | - Zoran Bursac
- Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, 633 Doctors Office Building, Suite 307, Memphis, TN, 38163, USA
| | - Jennifer P Halbert
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, 560 Ray C. Hunt Drive, PO Box 800717, Charlottesville, VA, 22908, USA
| | - Jon Ebbert
- Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, University of Virginia Medical School, 59 MDW/59 SGOWMP, 1100 Wilford Hall Loop, Bldg 4554, Lackland AFB, TX, 78236, USA
| | - Benny Weksler
- University of Tennessee Health Science Center, 1325 East Moreland Ave, Memphis, TN, 38104, 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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Krukowski RA, Hare ME, Talcott GW, Gladney LA, Johnson KC, Richey PA, Kocak M, Keller PL, Hryshko-Mullen A, Klesges RC. Dissemination of the Look AHEAD Intensive Lifestyle Intervention in the United States Military: A Randomized Controlled Trial. Obesity (Silver Spring) 2018; 26:1558-1565. [PMID: 30277030 PMCID: PMC6173202 DOI: 10.1002/oby.22293] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [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: 06/05/2018] [Accepted: 08/03/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The purpose of this study, "Fit Blue," was to compare a translation of the Look AHEAD (Action for Heath in Diabetes) intensive lifestyle intervention with a self-paced version of the same intervention among active duty military personnel. METHODS Active duty military personnel (N = 248; 49% male, 34% racial minority) with overweight or obesity were randomized to 12-month distance-based (i.e., phone and email) parallel programs, counselor-initiated (CI) condition or self-paced (SP) condition, from 2014 to 2016. Trained lay interventionists were retired military personnel or had extensive familiarity with the military. RESULTS The CI condition had greater weight loss at 4 months (CI: mean ± SD = -3.2 ± 3.4 kg; SP: -0.6 ± 2.9 kg; P < 0.0001) and at 12 months (CI: mean ± SD = -1.9 ± 4.1 kg; SP: -0.1 ± 3.8 kg; P < 0.001). Participants in the CI condition also had a greater percent weight loss at both 4 months (CI: 3.5% ± 3.8, SP: 0.6% ± 3.1; P < 0.0001) and 12 months (CI: 2.1% ± 4.7, SP: 0.0% ± 4.0; P < 0.001). In addition, a greater proportion of CI participants lost 5% or more at 4 months (CI: 29.8%, SP: 10.5%; P < 0.001) and at 12 months (CI: 29.5%, SP: 15.6%; P < 0.05). CONCLUSIONS The CI behavioral weight loss intervention translated from Look AHEAD was well received and is a promising approach for managing weight in an active duty military population.
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Affiliation(s)
- Rebecca A. Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marion E. Hare
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Gerald W. Talcott
- University of Tennessee Health Science Center, Lackland AFB, TX, USA
- University of Virginia, Department of Public Health Sciences, School of Medicine, Charlottesville, VA, USA
| | - Leslie A. Gladney
- University of Tennessee Health Science Center, Lackland AFB, TX, USA
- University of Virginia, Department of Public Health Sciences, School of Medicine, Charlottesville, VA, USA
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Phyllis A. Richey
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mehmet Kocak
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Patrick L. Keller
- University of Virginia, Department of Public Health Sciences, School of Medicine, Charlottesville, VA, USA
| | - Ann Hryshko-Mullen
- Defense Institute for Medical Operations, Joint Base San Antonio-Lackland Air Force Base, San Antonio, TX, USA
| | - Robert C. Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Mental Health, Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio–Lackland AFB, San Antonio, Texas, USA
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Fahey MC, Klesges RC, Kocak M, Wayne Talcott G, Krukowski RA. Changes in the Perceptions of Self-weighing Across Time in a Behavioral Weight Loss Intervention. Obesity (Silver Spring) 2018; 26:1566-1575. [PMID: 30277031 PMCID: PMC6173193 DOI: 10.1002/oby.22275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [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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Bursac Z, Klesges RC, Little MA, Linde BD, Popova L, Kaplan CM, Talcott GW. The comparative effectiveness of two brief tobacco interventions in the U.S. Air Force: Perceived harm and intentions-to-use of tobacco products. Tob Induc Dis 2018; 16:26. [PMID: 31516426 PMCID: PMC6659509 DOI: 10.18332/tid/87142] [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: 09/01/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Brief health prevention programs have been shown efficacious in prevention of tobacco use initiation and re-initiation in the US Air Force. In this manuscript we apply a comparative effectiveness assessment of two published studies, based on testing the equality of effect sizes for perceived harm and intentions-to-use for five tobacco products. METHODS We calculate and compare the effect sizes from the brief tobacco intervention (BTI) study (N=1055) with those of the anti-tobacco media campaign (MEDIA) study (N=665), for perceived harm and intentions-to-use of cigarettes, smokeless tobacco, cigarillos, e-cigarettes and hookah, among Airmen in the US Air Force Technical Training. Univariate and multivariate parametric and non-parametric methods and models were applied to compare the outcomes between the interventions. In addition, we calculate and report the cost of each intervention per Airman. RESULTS Effect sizes for perceived harm were 0.24–0.99 for BTI and 0.17–0.33 for MEDIA, while intentions-to-use effect sizes were 0.14–0.34 for BTI and 0.01– 0.07 for MEDIA, depending on the product. BTI intervention effects sizes were significantly greater than MEDIA intervention for all products, mainly among past users, and for both perceived harm (all p<0.0001) and intentions-to-use (all p<0.01). Cost per Airmen was comparable between the two interventions, $14.90 for BTI and $16.52 for MEDIA. CONCLUSIONS Direct comparison suggests that BTI produced effect sizes of significantly higher magnitude in the desired direction for perceived harm and intentions-to-use, for five tobacco products most commonly used by the Airmen, and mainly among past users.
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Affiliation(s)
- Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, United States
| | - Robert C Klesges
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
| | - Melissa A Little
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
| | - Brittany D Linde
- Organizational Wellness and Learning Systems, Fort Worth, United States
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, United States
| | - Cameron M Kaplan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, United States
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, Department of Public Health Sciences, University of Virginia, Charlottesville, United States
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Salgado García FI, Derefinko KJ, Bursac Z, Hand S, Klesges RC. Planning a Change Easily (PACE): A randomized controlled trial for smokers who are not ready to quit. Contemp Clin Trials 2018; 68:14-22. [PMID: 29549007 PMCID: PMC5899672 DOI: 10.1016/j.cct.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/19/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 11/20/2022]
Abstract
Smoking cessation programs are efficacious and have been validated to assist the 10% to 30% of smokers who are ready to quit in the next 30 days. While the majority of smokers want to quit smoking in the future, only 69% are planning to quit within the next year. Planning a Change Easily (PACE) is a nation-wide, telephone-based comparative effectiveness, randomized controlled trial for smokers not ready to quit (SNRTQ). This project, as well as its intervention components, outcomes, and hypotheses are discussed. This study will compare the effectiveness of four intervention conditions that could potentially help SNRTQ to quit smoking: Brief Advice, Motivational Interviewing, Rate Reduction, and Motivational Interviewing plus Rate Reduction combined. Rate Reduction conditions will include the provision of nicotine replacement therapy in the form of gum. Approximately 840 participants will be recruited and randomized to the four intervention conditions. The main outcomes for this study include self-report prolonged and point prevalence abstinence with biochemical verification of cessation. Secondary outcomes include quit attempts, cost-per-quit, and cost-effectiveness analyses. Informed by evidenced-based interventions, strong clinical guidelines, and economic analysis, PACE has the potential for significant public health impact. Results could readily be disseminated and translated to tobacco quitlines, which are present in all 50 states and are offered free to the public.
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Affiliation(s)
- Francisco I Salgado García
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA.
| | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA
| | - Zoran Bursac
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA
| | - Sarah Hand
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 N Pauline St., Memphis, TN 38163, USA
| | - Robert C Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, 560 Ray Hunt Drive, Charlottesville, VA 22911, USA
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Little MA, Klesges RC, Bursac Z, Ebbert JO, Halbert JP, Dunkle AN, Colvin L, Goedecke PJ, Weksler B. Why Don't Cancer Survivors Quit Smoking? An Evaluation of Readiness for Smoking Cessation in Cancer Survivors. J Cancer Prev 2018; 23:44-50. [PMID: 29629348 PMCID: PMC5886494 DOI: 10.15430/jcp.2018.23.1.44] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 02/09/2018] [Revised: 03/17/2018] [Accepted: 03/19/2018] [Indexed: 12/30/2022] Open
Abstract
Background Cancer survivors have a high rate of participation in cigarette-smoking cessation programs but their smoking-abstinence rates remain low. In the current study, we evaluated the readiness to quit smoking in a cancer-survivor population. Methods Cross-sectional data survey conducted among 112 adult cancer survivors who smoked cigarettes in Tennessee. Analyses were conducted using a two-sample t-test, χ2 test, Fishers Exact test, and multivariable logistic regression with smoker’s readiness to quit as the dependent variable. We operationally defined a smoker not ready to quit as anyone interested in quitting smoking beyond the next 6 months or longer (or not at all), as compared to those that are ready to quit within the next 6 months. Results Thirty-three percent of participants displayed a readiness to quit smoking in the next 30 days. Smokers ready to quit were more likely to display high confidence in their ability to quit (OR = 4.6; 95% CI, 2.1–9.7; P < 0.0001) than those not ready to quit. Those ready to quit were nearly five times more likely to believe smoking contributed to their cancer diagnosis (OR = 4.9; 95% CI, 1.1–22.6; P = 0.0432). Those ready to quit were also much more likely to attempt smoking cessation when diagnosed with cancer (OR = 8.9; 95% CI, 1.8–44.3; P = 0.0076) than smokers not ready to quit. Finally, those ready to quit were more likely to endorse smoking more in the morning than other times of the day, compared to those not ready to quit (OR = 7.9; 95% CI, 1.5–42,3; P = 0.0148), which increased odds of readiness to quit within the next 6 months. Conclusions Despite high participation in smoking-cessation programs for cancer survivors, only one-third of participants were ready to quit. Future research is needed to develop programs targeting effective strategies promoting smoking cessation among cancer survivors who are both ready and not ready to quit smoking.
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Affiliation(s)
- Melissa A Little
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Lackland AFB, TX, USA
| | - Robert C Klesges
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, VA, USA
| | - Zoran Bursac
- Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - Jennifer P Halbert
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, Charlottesville, VA, USA
| | - Andrew N Dunkle
- Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA
| | | | - Patricia J Goedecke
- Division of Biostatistics, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Benny Weksler
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
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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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Little MA, Ebbert JO, Bursac Z, Talcott GW, Talley L, LeRoy KM, Womack CR, Hryshko-Mullen AS, Klesges RC. Enhancing the efficacy of a smoking quit line in the military: Study rationale, design and methods of the Freedom quit line. Contemp Clin Trials 2017; 59:51-56. [PMID: 28479219 DOI: 10.1016/j.cct.2017.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/29/2017] [Accepted: 04/08/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa A Little
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 2200 Bergquist Dr Ste 1, Lackland AFB, TX 78236, United States.
| | - Jon O Ebbert
- Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, United States
| | - Zoran Bursac
- Department of Preventive Medicine & Center for Population Sciences, University of Tennessee Health Science Center
| | - Gerald W Talcott
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 2200 Bergquist Dr Ste 1, Lackland AFB, TX 78236, United States
| | - Lauren Talley
- Department of Preventive Medicine & Center for Population Sciences, University of Tennessee Health Science Center
| | - Karen M LeRoy
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 2200 Bergquist Dr Ste 1, Lackland AFB, TX 78236, United States
| | - Catherine R Womack
- Department of Preventive Medicine & Center for Population Sciences, University of Tennessee Health Science Center
| | - Ann S Hryshko-Mullen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX, United States
| | - Robert C Klesges
- Department of Public Health Sciences, Center for Addiction and Prevention Research, University of Virginia, 2200 Bergquist Dr Ste 1, Lackland AFB, TX 78236, United States
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47
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Ebbert JO, Little MA, Klesges RC, Bursac Z, Johnson KC, Thomas F, Vander Weg MW. Step Care treatment for smoking cessation. Health Educ Res 2017; 32:1-11. [PMID: 28158558 PMCID: PMC5914340 DOI: 10.1093/her/cyw051] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 11/22/2016] [Indexed: 06/06/2023]
Abstract
We compared the effectiveness of a ‘stepped care’ approach with increasing treatment intensity (‘Step Care’) to one with repeated treatments (‘Recycle’) among cigarette smokers interested in quitting smoking. Step 1 of the Step Care intervention consisted of a single counseling session, nicotine patch for six weeks and telephonic contact. For smokers not achieving tobacco abstinence 6 months after randomization with Step 1, the intensity of the intervention increased to four counseling sessions, bupropion sustained-release, nine telephone calls and three mailings (Step 2). For those not achieving tobacco abstinence 12 months after randomization, smokers received six behavioral counseling sessions, nicotine patch and nicotine gum, nine telephone calls and three mailings (Step 3). The Recycle participants received one session of health behavior counseling, six weeks of the nicotine patch and a telephone call at each step. 270 cigarette smokers were randomized. At 24 months after randomization using an intention to treat analysis, no statistically significant difference was observed in prolonged smoking abstinence between the Step Care and Recycle condition (16.9% versus 9.4%; adjusted OR = 1.88; 95% CI 0.88–4.01; P =0.10). Additional research is needed to explore whether a stepped care intervention increases long-term smoking abstinence rates compared with repeating the same intervention.
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Affiliation(s)
- Jon O. Ebbert
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Melissa A. Little
- Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA
| | - Robert C. Klesges
- Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA
| | - Zoran Bursac
- Center for Population Sciences, Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA
| | - Karen C. Johnson
- Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Heath Science Center, 66 North Pauline Street, Suite 633, Memphis, TN 38163, USA
| | - Mark W. Vander Weg
- Departments of Internal Medicine and Psychological and Brain Sciences, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA and
- Comprehensive Access & Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA 52246, USA
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Li T, Waters TM, Kaplan EK, Kaplan CM, Nyarko KA, Derefinko KJ, Talcott GW, Klesges RC. Economic Analyses of an Alcohol Misconduct Prevention Program in a Military Setting. Mil Med 2017; 182:e1562-e1567. [PMID: 28051974 DOI: 10.7205/milmed-d-16-00098] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The economic burden associated with alcohol misuse, in particular early attrition or discharge associated with alcohol-related incidents (ARIs), is significant in military settings. We assessed the potential economic benefit of a brief alcohol intervention program, the Alcohol Misconduct Prevention Program (AMPP), initially implemented at Joint Base San Antonio-Lackland Technical Training site for the U.S. Air Force (USAF) from October 1, 2010, to December 31, 2012. METHODS We conducted cost-effectiveness and cost-benefit analyses of the AMPP from the perspective of the USAF. Program effectiveness was measured as the number of ARIs avoided after the AMPP implementation, and program benefit was measured as the potential cost savings related to reductions in ARIs. One-way sensitivity analyses were conducted to examine the robustness of base case results. RESULTS The AMPP resulted in the avoidance of 59 ARIs which cost $9,869 for every ARI avoided. For every dollar invested in the AMPP, the USAF saved $4.09 in a conservative model without health effects, and saved $6.17 taking into account the potential health benefits. Our findings of favorable cost benefit were robust across sensitivity analyses. CONCLUSIONS Investing in the AMPP at other military bases is likely to produce substantial economic benefit.
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Affiliation(s)
- Tao Li
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Teresa M Waters
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Erin K Kaplan
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Cameron M Kaplan
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Kwame A Nyarko
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Karen J Derefinko
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Gerald W Talcott
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
| | - Robert C Klesges
- Department of Preventive Medicine, University of Tennessee Health Science Center, 66 North Pauline Street, Memphis, TN 38163
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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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50
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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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