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Shevorykin A, Hyland BM, Robles D, Ji M, Vantucci D, Bensch L, Thorner H, Marion M, Liskiewicz A, Carl E, Ostroff JS, Sheffer CE. Tobacco use, trauma exposure and PTSD: a systematic review. Health Psychol Rev 2024:1-32. [PMID: 38711288 DOI: 10.1080/17437199.2024.2330896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 03/11/2024] [Indexed: 05/08/2024]
Abstract
Tobacco use remains one of the most significant preventable public health problems globally and is increasingly concentrated among vulnerable groups, including those with trauma exposure or diagnosed with PTSD. The goal of this systematic review was to update and extend previous reviews. Of the 7224 publications that met the initial criteria, 267 were included in the review. Summary topic areas include conceptual frameworks for the relation between trauma or PTSD and tobacco use; associations between trauma exposure or PTSD and tobacco use; number and type of trauma exposures and tobacco use; PTSD symptoms and tobacco use; Treatment-related studies; and the examination of causal relations. Evidence continues to indicate that individuals exposed to trauma or diagnosed with PTSD are more likely to use tobacco products, more nicotine dependent and less likely to abstain from tobacco even when provided evidence-based treatments than individuals without trauma. The most commonly cited causal association proposed was use of tobacco for self-regulation of negative affect associated with trauma. A small proportion of the studies addressed causality and mechanisms of action. Future work should incorporate methodological approaches and measures from which we can draw causal conclusions and mechanisms to support the development of viable therapeutic targets.
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Affiliation(s)
- Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bridget M Hyland
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Daniel Robles
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Mengjia Ji
- Department of Psychology, The City College of New York (CUNY), New York, NY, USA
| | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Hannah Thorner
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Amylynn Liskiewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Hashim MAB, Bin Sebri KF, Bin Mohd Hanim MF, Binti Anwar DS, Binti Mohd Radzi NA, Bin Ahmad Fuad AF, Md Sabri BAB. The Impact of Military Tobacco Control Policy: A Systematic Review. Mil Med 2024:usad507. [PMID: 38330180 DOI: 10.1093/milmed/usad507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Tobacco use is synonymous with the military. Despite that military personnel are trained to follow commands, opportunities exist to implement various tobacco control strategies. We conducted a systematic review to evaluate the impact of tobacco control policy employed in military settings. MATERIALS AND METHODS We searched for published English articles in Medline, Web of Science, Scopus, and Google Scholar databases using relevant subject headings without year restriction. We included randomized controlled trials, nonrandomized controlled trials, case-control, cohort, controlled before and after, and uncontrolled before and after studies evaluating the impact of tobacco control policy in the military population. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, three independent reviewers independently screened initially identified articles, reviewed the full text, and extracted the data and any disagreements resolved by consensus after data recheck. Five reviewers used a validated tool to assess the quality of the included studies. The primary outcome was the reduction of any tobacco or nicotine-contained products (TNCPs) use among the troops. The impacts of the tobacco control policy were synthesized and analyzed qualitatively. This study is registered with the International Prospective Register of Systematic Review (CRD42022314117). RESULTS Fourteen studies were included in the analysis from 5372 studies screened. Most of the studies were from the USA, and fractions were from Thailand, France, and Taiwan. These studies were methodologically heterogeneous. Most studies employed a total ban policy on TNCP use during basic military training or operational deployment as the primary strategy. Other methods utilized were the brief tobacco intervention, targeted treatment, support, and counseling provided through telephone or mailing systems, the adjunctive behavioral intervention, providing free nicotine gum, the "Pharsai clinic", active and regular smoking restriction, and interventions aimed at intrapersonal, interpersonal, and organizational levels. There is a moderate quality of evidence that the tobacco control policies effectively reduced the prevalence of TNCP use, increased the cessation rate, reduced the intake, and lowered the dependency. The adjunctive interventions provided after the total ban on TNCP use may increase its effectiveness. However, findings from this review need to be carefully considered as the definition of TNCP use status was not universal between studies and lacked a biochemical validation procedure. CONCLUSIONS There is reasonable evidence to support that the tobacco control policy employed in the military population has multiple positive impacts in reducing the prevalence of TNCP use, increasing the cessation rates, reducing the intake, and lowering dependency. Other evidence-based strategies need to be fully utilized to materialize the tobacco endgame.
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Affiliation(s)
- Muhamad Arham Bin Hashim
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
- The Malaysian Armed Forces, Wilayah Persekutuan, Kuala Lumpur 50634, Malaysia
| | - Khairul Fikri Bin Sebri
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | - Muhammad Faiz Bin Mohd Hanim
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | - Diyana Shereen Binti Anwar
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | - Nawwal Alwani Binti Mohd Radzi
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
| | | | - Budi Aslinie Binti Md Sabri
- Faculty of Dentistry, Universiti Teknologi MARA (UiTM) Sungai Buloh Campus, Sungai Buloh, Selangor Darul Ehsan 47000, Malaysia
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Zhang Z, Huang M, Chen T. Probability and predictors of long-term smoking relapse among Chinese adult smokers: A longitudinal study. Prev Med Rep 2023; 36:102482. [PMID: 37920593 PMCID: PMC10618515 DOI: 10.1016/j.pmedr.2023.102482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/15/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
Numerous smokers attempt to quit smoking, but most cessation efforts prove unsuccessful. Scarce evidence exists regarding predictors of long-term relapse in China. This study aims to evaluate the probability of relapse and examine factors may contribute to relapse among Chinese adults. A dynamic cohort of 6,036 observations on 2,378 adult quitters was constructed from the China Family Panel Studies in 2010, 2012, 2014, 2016 and 2018. The life table method was employed to calculate the probability of relapse for long-term smoking abstinence. Multivariate complementary log-log survival models were developed to examine the predictors of smoking relapse. We found that the probability of relapse decreased as the duration of abstinence increased, with rates of 49.07 %, 20.05 %, 10.29 %, and 6.63 % at 2, 4, 6, and 8 years of abstinence, respectively. The cumulative probability of relapse within 8 years was 65.89 %. Age ≥65 years, higher educational attainment, respiratory disease, and a satisfying lifestyle were associated with a reduced likelihood of relapse. Conversely, higher occupational prestige, alcohol drinking, cohabitant smoking, and greater future confidence were associated with an increased risk of relapse. These findings demonstrated that the probability of relapse decreased progressively over time, with most relapses occurring in the initial two years following quit attempts. Predictors of Chinese quitters' relapse behavior in our study were similar to those in previous studies. Drinking and cohabitant smoking were identified as strong predictors of relapse in this population.
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Affiliation(s)
| | | | - Ting Chen
- School of Public Health, Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
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Bethmann D, Cho JI. Conscription hurts: The effects of military service on physical health, drinking, and smoking. SSM Popul Health 2023; 22:101391. [PMID: 37123559 PMCID: PMC10139982 DOI: 10.1016/j.ssmph.2023.101391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/06/2023] [Accepted: 03/29/2023] [Indexed: 04/09/2023] Open
Abstract
Almost all South Korean men serve in the country's armed forces for two years. In this paper, we investigate whether the military service affects the health of draftees. Using an event study design, we use the conscription years to identify the effect the military service has on soldiers' physical health as well as on their smoking and drinking behavior. Our results show that the compulsory military service has a strong and long-lasting negative effect on physical health. Moreover, people who are drafted into the armed forces are more likely to consume more alcohol and cigarettes even years after they are discharged. Our results are of great interest to decision-makers weighing the pros and cons of conscription armies: mandatory military service adversely affects the male labor force and exacerbates drinking and smoking behavior.
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Belding JN, Castañeda SF, Jacobson IG, LeardMann CA, Porter B, Powell TM, Kolaja CA, Seelig AD, Matsuno RK, Carey FR, Rivera AC, Trone DW, Sheppard B, Walstrom J, Boyko EJ, Rull RP, For The Millennium Cohort Study Team. The Millennium Cohort Study: The First 20 Years of Research Dedicated to Understanding the Long-Term Health of US Service Members and Veterans. Ann Epidemiol 2021; 67:61-72. [PMID: 34906635 DOI: 10.1016/j.annepidem.2021.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 01/22/2023]
Abstract
The Millennium Cohort Study, the US Department of Defense's largest and longest running study, was conceived in 1999 to investigate the effects of military service on service member health and well-being by prospectively following active duty, Reserve, and National Guard personnel from all branches during and following military service. In commemoration of the Study's 20th anniversary, this paper provides a summary of its methods, key findings, and future directions. Recruitment and enrollment of the first 5 panels occurred between 2001 and 2021. After completing a baseline survey, participants are requested to complete follow-up surveys every 3 to 5 years. Study research projects are categorized into 3 core portfolio areas (psychological health, physical health, and health-related behaviors) and several cross-cutting areas and have culminated in more than 120 publications to date. For example, some key Study findings include that specific military service-related factors (e.g., experiencing combat, serving in certain occupational subgroups) were associated with adverse health-related outcomes and that unhealthy behaviors and mental health issues may increase following the transition from military service to veteran status. The Study will continue to foster stakeholder relationships such that research findings inform and guide policy initiatives and health promotion efforts.
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Key Words
- Abbreviations
- Army STARRS, Army Study to Assess Risk and Resilience in Servicemembers
- DoD, Department of Defense
- Millennium Cohort Study, military, veterans, deployment, risk factors, protective factors, physical health, mental health, health-related behaviors, longitudinal cohort
- OEF, Operation Enduring Freedom
- OIF, Operation Iraqi Freedom
- OND, Operation New Dawn
- PTSD, posttraumatic stress disorder
- VA, Department of Veterans Affairs
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Affiliation(s)
- Jennifer N Belding
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Sheila F Castañeda
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Isabel G Jacobson
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Cynthia A LeardMann
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Ben Porter
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA; Mississippi State University, Mississippi State, Mississippi, USA
| | - Teresa M Powell
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Claire A Kolaja
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Amber D Seelig
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rayna K Matsuno
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Felicia R Carey
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Anna C Rivera
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Daniel W Trone
- Naval Health Research Center, San Diego, California, USA
| | - Beverly Sheppard
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Jennifer Walstrom
- Leidos, San Diego, California, USA; Naval Health Research Center, San Diego, California, USA
| | - Edward J Boyko
- VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Rudolph P Rull
- Naval Health Research Center, San Diego, California, USA.
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Cigarette smoking patterns among U.S. military service members before and after separation from the military. PLoS One 2021; 16:e0257539. [PMID: 34606513 PMCID: PMC8489722 DOI: 10.1371/journal.pone.0257539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/03/2021] [Indexed: 11/28/2022] Open
Abstract
U.S. military Service members have consistently smoked more than the general population and the prevalence of smoking is even higher among U.S. veterans. Our study examined cigarette smoking patterns among Service members before and after military separation to better understand the disproportionate rate of smoking among veterans. Data from the Millennium Cohort Study were used. All study participants were in the military at baseline and some transitioned from the military to civilian life during the observation period. We investigated any impact of military separation on smoking, as well as other potential risk factors for smoking. Overall, we observed higher smoking prevalence among veterans than Service members. Additionally, we found that Service members smoked more while approaching their separation from the military. Longitudinal analysis revealed military separation was not a risk factor for smoking, as we had hypothesized. Baseline smoking was the most influential predictor of current smoking status. Other significant factors included alcohol consumption, life stressors, and mental health conditions, among others. Military separation was not a risk factor for smoking. However, Service members in the process of transitioning out of the military, as well as high alcohol consumers and Service members with mental health conditions, may be at higher risk of smoking. Including smoking prevention/cessation programs in pre-separation counseling sessions and developing smoking screening and cessation programs targeting specific high-risk subgroups may reduce smoking among Service members and veterans.
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Hudson SV, Kurti M, Howard J, Sanabria B, Schroth KRJ, Hrywna M, Delnevo CD. Adoption of Tobacco 21: A Cross-Case Analysis of Ten US States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6096. [PMID: 34198807 PMCID: PMC8201309 DOI: 10.3390/ijerph18116096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/26/2021] [Accepted: 05/31/2021] [Indexed: 12/04/2022]
Abstract
Despite the recent push for Tobacco 21 legislation in the US and the national adoption of Tobacco 21, there is a paucity of data on the process of policy adoption. To explore the key factors that served as facilitators or challenges to the passage of state T21 laws that apply to the sale of all tobacco products to anyone under 21 years of age, we conducted a comparative, cross-case study in ten states that adopted Tobacco 21 between 2016 and 2019. Stakeholders from selected states were identified via snowball sampling, and interviews were conducted from November 2018 to March 2020. Three primary factors emerged as facilitators to the passage of state T21 laws: (1) increased attention on e-cigarettes as the product driving an overall increase in youth tobacco use and depiction of an "e-cigarette epidemic", (2) having at least one influential policy entrepreneur or champion, and (3) traction from other states or local municipalities passing T21 legislation. Challenges to T21's success included (1) influence of the tobacco industry, (2) the bill's low ranking among legislative priorities, and (3) controversy among advocates and policymakers over bill language. As e-cigarette rates spiked, T21 bills became legislative priorities, traction from other successful efforts mounted, and ultimately, the tobacco industry flipped from opposing to supporting T21 laws. Despite these favorable headwinds, advocates struggled increasingly to pass bills with ideal policy language.
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Affiliation(s)
- Shawna V. Hudson
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA; (J.H.); (B.S.)
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA;
| | - Marin Kurti
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, 83 Windham Street Willmantic, CT 06226, USA;
| | - Jenna Howard
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA; (J.H.); (B.S.)
| | - Bianca Sanabria
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ 08901, USA; (J.H.); (B.S.)
| | - Kevin R. J. Schroth
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA; (K.R.J.S.); (M.H.)
- Department of Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Mary Hrywna
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA; (K.R.J.S.); (M.H.)
- Department of Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Cristine D. Delnevo
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ 08901, USA;
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA; (K.R.J.S.); (M.H.)
- Department of Health Behavior, Society & Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
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Testa A, Jackson DB, Boccio C. Stressful life events and electronic cigarette use during pregnancy. Soc Sci Med 2021; 276:113845. [PMID: 33761384 DOI: 10.1016/j.socscimed.2021.113845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/19/2021] [Accepted: 03/11/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE Smoking during pregnancy poses a significant health risk for infant well-being. Prior research has linked experiencing stressful life events (SLEs) during pregnancy to prenatal smoking. However, extant research has not assessed whether SLEs experienced during pregnancy are a risk factor for prenatal electronic cigarette use. OBJECTIVE This study investigates the association between SLEs and electronic cigarette use during the third trimester of pregnancy. METHODS We employ data on 70,626 recent mothers from the 2016-2018 Pregnancy Risk Assessment Monitoring System. Logistic and multinomial logistic regression models were used to examine the association between SLEs and electronic cigarette use during the third-trimester of pregnancy. RESULTS The prevalence of electronic cigarette use increased alongside an accumulating history of SLEs (0 SLEs = 0.4%; 1-2 SLEs = 0.9%; 3-5 SLEs = 1.9%; 6+ SLEs = 5.0%). Logistic regression models found 6 or more SLEs were associated with 4.7 times higher odds of electronic cigarette use relative to 0 SLEs after adjusting for demographic and socioeconomic characteristics (AOR = 4.705, 95% CI = 2.960, 7.479). Study findings also showed that women who experienced greater levels of SLEs had a higher prevalence of using any nicotine products (i.e., exclusive electronic cigarette user, exclusive cigarette user, dual user), relative to being a non-smoker. Findings from multinomial logistic regression models revealed that a higher number of SLEs was associated with an increased relative risk of all smoking outcomes. Still, these associations were particularly pronounced in the case of exclusive electronic cigarette user (ARR = 8.485, 95% CI = 4.900, 14.692) and dual-use (ARR = 8.348, 95% CI = 4.113, 16.945) when participants experienced 6 or more SLEs (relative to 0 SLEs). CONCLUSIONS Considering the potentially harmful ramifications of electronic cigarette use during pregnancy there is a need for interventions that reduce stressful experiences and decrease smoking during pregnancy.
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Affiliation(s)
- Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA.
| | - Dylan B Jackson
- Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cashen Boccio
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX, USA
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Patten CA, Wang XQ, Little MA, Ebbert JO, Talcott GW, Hryshko-Mullen AS, Klesges R. Influence of gender on initiation of tobacco and nicotine containing product use among U.S. Air Force trainees. Prev Med Rep 2020; 19:101104. [PMID: 32435579 PMCID: PMC7229489 DOI: 10.1016/j.pmedr.2020.101104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 12/02/2022] Open
Abstract
Military personnel are a subgroup of young adults at risk for tobacco and nicotine containing product (TNCP) use. This study of US Air Force (USAF) trainees who were never users of TNCPs examined gender, peer tobacco use, and tobacco use intentions as predictors of TNCP initiation after Basic Military Training (BMT). We used a longitudinal cohort assessment study design with baseline and 1-year surveys completed (2011-2016) among 2393 USAF trainees: 73% men, 95% aged 18-25 years, 36% racial minorities. Overall, initiation of any TNCP use at 1-year was 23% (20% women, 24% men). From a multivariable multinomial logistic regression model predicting TNCP use at 1-year follow-up, significant 2-way interactions were detected between gender and number of close friends using tobacco before BMT (p = 0.015), and between gender and tobacco use intentions (p < 0.0001). Women reporting almost all or many close friends used tobacco were more likely to report TNCP use compared to women with none (Odds ratio [OR] = 5.8, 95% CI 2.5-13.5, Bonferroni corrected p < 0.0001). Having close friends using tobacco had little influence on TNCP use among men. Men with tobacco use intentions were more likely to report TNCP use compared to men having no intentions (OR = 8.0, 95% CI: 4.7-13.6, Bonferroni corrected p < 0.001), but tobacco use intentions had little influence among women. In this sample of USAF trainees, the study provides novel prospective findings on TNCP initiation, and how men and women are influenced differently by peer tobacco use and tobacco use intentions. Gender-specific prevention efforts focused on uptake of TNCPs appear warranted.
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Affiliation(s)
- Christi A. Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Xin-Qun Wang
- Department of Public Health Sciences, University of Virginia School of Medicine, PO Box 800717, Charlottesville, VA 22908, USA
| | - Melissa A. Little
- Department of Public Health Sciences, University of Virginia School of Medicine, PO Box 800717, Charlottesville, VA 22908, USA
| | - Jon O. Ebbert
- Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Gerald W. Talcott
- Department of Public Health Sciences, University of Virginia School of Medicine, PO Box 800717, Charlottesville, VA 22908, USA
| | - Ann S. Hryshko-Mullen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, USA
| | - Robert Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, PO Box 800717, Charlottesville, VA 22908, USA
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10
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Longitudinal Examination of the Influence of Individual Posttraumatic Stress Disorder Symptoms and Clusters of Symptoms on the Initiation of Cigarette Smoking. J Addict Med 2019; 12:363-372. [PMID: 29864086 DOI: 10.1097/adm.0000000000000421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine whether specific individual posttraumatic stress disorder (PTSD) symptoms or symptom clusters predict cigarette smoking initiation. METHODS Longitudinal data from the Millennium Cohort Study were used to estimate the relative risk for smoking initiation associated with PTSD symptoms among 2 groups: (1) all individuals who initially indicated they were nonsmokers (n = 44,968, main sample) and (2) a subset of the main sample who screened positive for PTSD (n = 1622). Participants were military service members who completed triennial comprehensive surveys that included assessments of smoking and PTSD symptoms. Complementary log-log models were fit to estimate the relative risk for subsequent smoking initiation associated with each of the 17 symptoms that comprise the PTSD Checklist and 5 symptom clusters. Models were adjusted for demographics, military factors, comorbid conditions, and other PTSD symptoms or clusters. RESULTS In the main sample, no individual symptoms or clusters predicted smoking initiation. However, in the subset with PTSD, the symptoms "feeling irritable or having angry outbursts" (relative risk [RR] 1.41, 95% confidence interval [CI] 1.13-1.76) and "feeling as though your future will somehow be cut short" (RR 1.19, 95% CI 1.02-1.40) were associated with increased risk for subsequent smoking initiation. CONCLUSIONS Certain PTSD symptoms were associated with higher risk for smoking initiation among current and former service members with PTSD. These results may help identify individuals who might benefit from more intensive smoking prevention efforts included with PTSD treatment.
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11
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O'Toole BI, Kirk R, Bittoun R, Catts SV. Combat, Posttraumatic Stress Disorder, and Smoking Trajectory in a Cohort of Male Australian Army Vietnam Veterans. Nicotine Tob Res 2019; 20:1198-1205. [PMID: 29161451 DOI: 10.1093/ntr/ntx257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/16/2017] [Indexed: 12/12/2022]
Abstract
Background Whether trauma exposure itself or consequent posttraumatic stress disorder (PTSD) is primarily responsible for smoking and failure to quit remains unclear. Methods A cohort of male Australian Vietnam veterans (N = 388) was interviewed twice, 22 and 36 years after their return to Australia using standardized psychiatric diagnostic and health interviews and assessment of combat exposure. The smoking trajectory over time revealed a spectrum of outcomes (never smoked, early quitters, late quitters, and continuing smokers). Analysis used multivariate statistics to assess the relative contributions of combat trauma exposure and PTSD while controlling for potential confounders. Results The trajectory of smoking over time revealed that 21.9% of veterans had never smoked, 45.1% had quit smoking by the time of wave 1, 16.2% were current smokers at wave 1 who had quit by the time of wave 2, 2.8% were late adopters who were current smokers, and 13.9% were continuing smokers. Smoking was associated in single-predictor models with demographics, intelligence, combat exposure, PTSD symptom clusters and diagnosis, and alcohol disorders. Multivariate analysis revealed that PTSD, combat, and intelligence were related to the smoking spectrum but, after adding demographics and other Axis I psychiatric diagnoses, only combat remained significant. No PTSD symptom cluster uniquely predicted smoking status. Conclusions The results suggest that trauma exposure in the form of military combat may be a more robust predictor of smoking status over time than PTSD. It may be stress itself, rather than poststress disorder, that is more germane to smoking and failure to quit. Implications Exposure to traumatic stress and development of PTSD have been implicated separately in the maintenance of smoking. This longitudinal cohort study of smoking in war veterans up to three decades postwar enabled evaluation of traumatic stress exposure in combat and the course of PTSD in smoking and quitting while controlling for intelligence, background disadvantage, and other psychiatric conditions. Combat rather than PTSD emerged as more significant to smoking status, suggesting that it may be the traumatic stress itself rather than the development of a poststress disorder that is more germane to smoking in war veterans.
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Affiliation(s)
- Brian I O'Toole
- Brain & Mind Centre, University of Sydney, Sydney, Australia
| | - Robyn Kirk
- Brain & Mind Centre, University of Sydney, Sydney, Australia
| | - Renée Bittoun
- Brain & Mind Centre, University of Sydney, Sydney, Australia
| | - Stanley V Catts
- Brain & Mind Centre, University of Sydney, Sydney, Australia.,School of Psychiatry, University of Queensland, Brisbane, Australia
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12
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Alexander AC, Ward KD, Forde DR, Stockton M. Are posttraumatic stress and depressive symptoms pathways to smoking relapse after a natural disaster? Drug Alcohol Depend 2019; 195:178-185. [PMID: 30455073 PMCID: PMC8581624 DOI: 10.1016/j.drugalcdep.2018.09.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Smoking relapse is rarely examined in disaster research. Thus, this study investigated smoking relapse nine and eighteen months after Hurricane Katrina and identified pathways and conditions for this outcome. METHODS The data came from a prospective study of adult ever smokers who were living in New Orleans at the time Hurricane Katrina struck (n = 1003), and a comparison sample of Memphis residents (n = 1001) who were not directly impacted by the hurricane. Participants from both cities were recruited using random digit dialing and were surveyed nine and eighteen months after Hurricane Katrina. We assessed whether smoking relapse rates differed by city and evaluated potential mediators and moderators of this association using conditional process analysis. RESULTS Though the probabilities of smoking relapse, posttraumatic stress, and depressive symptoms were higher among New Orleans than Memphis participants, hurricane exposure did not indirectly affect smoking relapse through increases in posttraumatic stress and depressive symptoms. Instead, as the number of hurricane-related events increased so to did the probability of smoking relapse through increases in depressive (β = 0.08, SE = 0.03, p = .02) and posttraumatic stress symptoms (β=0.08, SE=0.04, p = .04). Social support lowered the probability of smoking relapse by protecting against increases in depressive and posttraumatic stress symptoms. CONCLUSIONS Posttraumatic stress and depressive symptoms mediated the effects of disaster exposure on smoking relapse, and this effect was most pronounced among survivors who reported disaster-related stressors. Former smokers heavily exposed to disasters may benefit from postdisaster interventions that reduce depressive and posttraumatic stress symptoms, which may prevent smoking relapse.
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Affiliation(s)
- Adam C. Alexander
- School of Public Health, University of Memphis, 201 Robison Hall, Memphis, Tennessee, United States, 38152-3450
| | - Kenneth D. Ward
- School of Public Health, University of Memphis, 201 Robison Hall, Memphis, Tennessee, United States, 38152-3450
| | - David R. Forde
- Department of Criminology & Criminal Justice, University of North Florida, 1 UNF Drive, Jacksonville, Florida, United States, 32224
| | - Michelle Stockton
- School of Health Studies, University of Memphis, 106 Fieldhouse, Memphis, Tennessee, United States, 38152-3450
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13
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Thandi G, Fear NT. Factors associated with smoking behaviour change in UK military personnel. Occup Med (Lond) 2019; 67:712-714. [PMID: 29040747 DOI: 10.1093/occmed/kqx149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Research in the UK civilian population suggests that poor mental health outcomes are associated with smoking behaviour. In the UK military population, smoking cessation is associated with deployment in the reserve forces. However, little is known about the links between mental health outcomes and smoking initiation and cessation in the UK military. Aims The aim of this longitudinal study was to examine change in mental health and military factors associated with smoking initiation and cessation in a representative sample of UK military personnel. Methods Data were collected between 2003 and 2009; 5138 regular and reserve military personnel were included in the analyses. Results The results showed that smoking initiation was associated with symptoms of psychological distress, symptoms of probable post-traumatic stress disorder (PTSD), relationship breakdown and deployment. Conclusions These findings are consistent with existing research in civilian populations showing links between poor mental health and smoking behaviour. Furthermore, our finding that deployment is associated with smoking initiation is also in line with research from the US military and UK reserves.
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Affiliation(s)
- G Thandi
- Academic Department of Military Mental Health, King's College London, 10 Cutcombe Road, Weston Education Centre, London, UK
| | - N T Fear
- Academic Department of Military Mental Health, King's College London, 10 Cutcombe Road, Weston Education Centre, London, UK
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14
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Allen AM, Jung AM, Lemieux AM, Alexander AC, Allen SS, Ward KD, al'Absi M. Stressful life events are associated with perinatal cigarette smoking. Prev Med 2019; 118:264-271. [PMID: 30468790 PMCID: PMC6322958 DOI: 10.1016/j.ypmed.2018.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/08/2018] [Accepted: 11/17/2018] [Indexed: 12/01/2022]
Abstract
Perinatal smoking, including smoking during pregnancy and postpartum smoking relapse, is a persistent public health problem. While childhood trauma has been linked to perinatal smoking, less is known about the association with more proximal stressful life events (SLEs). The objective of this study was to examine the association between SLEs that occurred during the year prior to childbirth with perinatal smoking. Using the Pregnancy Risk Assessment Monitoring System 2009-2011, perinatal smoking was assessed at three time points: (1) three months prior to pregnancy, (2) the last three months of pregnancy, and (3) two to six months postpartum. Survey respondents endorsed up to 13 SLEs (i.e., death of someone close). SLEs were analyzed individually, as well as using a cumulative score (range 0-13). Weighted analyses included unadjusted and adjusted logistic regression. Among those who smoked prior to pregnancy (n = 15,316), 48% (n = 7308) reported quitting smoking during pregnancy. Of those, 44% (n = 3126) reported postpartum smoking relapse. A total of 11 SLEs were associated with smoking during pregnancy and 2 SLEs were associated with postpartum smoking relapse. The odds of continued smoking during pregnancy was 12% higher for each SLE endorsed (adjusted odds ratio [aOR] = 1.12, 95% confidence interval [CI]: 1.09, 1.15) and this association was attenuated in relation to the odds of postpartum smoking relapse (aOR = 1.03, 95% CI: 0.99, 1.08). SLEs are associated with perinatal smoking. Additional research is needed to elucidate the mechanisms of action and to develop interventions specific to the needs of women who experience SLEs.
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Affiliation(s)
- Alicia M Allen
- Department of Family & Community Medicine, College of Medicine, University of Arizona, 3950 South Country Club Road, Suite 330, Tucson, AZ 85714-2238, United States of America.
| | - Alesia M Jung
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, PO Box 245211, Tucson, AZ 85724-5211, United States of America
| | - Andrine M Lemieux
- Department of Family Medicine & Biobehavioral Health, Medical School, University of Minnesota, Duluth, 1035 University Drive, 291 SMed, Duluth, MN 55812-3031, United States of America
| | - Adam C Alexander
- Department of Social and Behavioral Sciences, School of Public Health, University of Memphis, 3825 DeSoto Avenue, Room 207, Memphis, TN 38152, United States of America
| | - Sharon S Allen
- Department of Family Medicine and Community Health, Medical School, University of Minnesota, 420 Delaware Street SE, Room A682, Minneapolis, MN 55455-0341, United States of America
| | - Kenneth D Ward
- School of Public Health, University of Memphis, 201 Robison Hall, Memphis, TN 38152-3420, United States of America
| | - Mustafa al'Absi
- Department of Family Medicine & Biobehavioral Health, Medical School, University of Minnesota, Duluth, 1035 University Drive, Duluth, MN, 55812-3031, United States of America
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15
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Song YK, Kim JH, Choi B, Han N, Kim MG, Lee J, Lee H, Yoon J, Lee BJ, Oh JM. Strategic Priorities to Improve Effectiveness of Anti-smoking Interventions for the Korean Military: An Application of the Analytic Hierarchy Process. Mil Med 2018; 183:e223-e230. [PMID: 29961837 DOI: 10.1093/milmed/usx027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/20/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction As South Korea remains technically at war with the North, higher smoking prevalence in the military might adversely affect the South Korea's military power and contribute to lifetime smoking in men with mandatory military service. This study was to identify priorities among the anti-smoking strategies to improve the existing smoking cessation programs for the Korean military. Methods The analytic hierarchy process model with a goal, decision criteria, and sub-criteria as well as candidate strategies, was developed following a literature search and expert group discussion. A survey for pairwise comparison was conducted to determine the priority of the (sub-)criteria and strategies by 14 experts. The Super-Decisions software was used to determine the priorities and to analyze their consistency ratios and sensitivities. The study was approved by the ethics committee of the Korea Ministry of Health and Welfare. Results Eight candidate strategies were developed to improve the effectiveness of military anti-smoking interventions as follows: (1) development of outcome enhancement plans for smoking cessation programs for the military, (2) development of differentiated smoking cessation programs for specific groups, (3) building of community network for continuity and accessibility of anti-smoking project, (4) building of industry-academia-government networks for anti-smoking project, (5) improvement of the perception of and strengthen the reward for smoking cessation, (6) development of a training system for army clinicians for the delivery of smoking cessation services, (7) creation of a certification system for smoking cessation programs, and (8) development of an evaluation system of project performance for smoking cessation. Through the analytic hierarchy process survey, the military specificity and its sub-criterion of practicality were selected as the top concerns of decision criteria for the anti-smoking strategies among the decision criteria of outcome improvement, military specificity, publicness, and economic efficiency. The most important strategy was to improve the perception of and strengthen the reward for smoking cessation. This strategy was most focused on the creation of an anti-smoking environment and improvement of the effectiveness of the projects. The creation of a training system for army clinicians for the delivery of smoking cessation services ranked second. Conclusion In conclusion, motivating smoking cessation and utilizing well-trained army clinicians were found to be the most important anti-smoking strategies for the Korean military. This study might provide valuable insights for policy makers to reduce tobacco use in the Korean military.
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Affiliation(s)
- Yun-Kyoung Song
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea
| | - Jae Hyun Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea
| | - Boyoon Choi
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea
| | - Nayoung Han
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea
| | - Myeong Gyu Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea
| | - Jeongsam Lee
- Korean Association Against Drug Abuse, 10, Dangsan-ro 48-gil, Yeongdeungpo-gu, Seoul, South Korea
| | - Handuk Lee
- Korean Association Against Drug Abuse, 10, Dangsan-ro 48-gil, Yeongdeungpo-gu, Seoul, South Korea
| | - Jieun Yoon
- Korean Association Against Drug Abuse, 10, Dangsan-ro 48-gil, Yeongdeungpo-gu, Seoul, South Korea
| | - Beom-Jin Lee
- Korean Association Against Drug Abuse, 10, Dangsan-ro 48-gil, Yeongdeungpo-gu, Seoul, South Korea.,College of Pharmacy, Ajou University, 206 Worldcup-ro, Yeongtong-gu, Suwon, South Korea
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea.,Korean Association Against Drug Abuse, 10, Dangsan-ro 48-gil, Yeongdeungpo-gu, Seoul, South Korea
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16
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Siegel A, Korbman M, Erblich J. Direct and Indirect Effects of Psychological Distress on Stress-Induced Smoking. J Stud Alcohol Drugs 2018; 78:930-937. [PMID: 29087829 DOI: 10.15288/jsad.2017.78.930] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Numerous studies have modeled the effects of stress in the laboratory, demonstrating that smokers who are exposed to experimental stressors exhibit significant increases in acute psychological distress. Whether these stress reactions are predictive of stress-induced smoking during an actual quit attempt, however, has not been examined. Furthermore, the possibility that such effects are particularly strong among smokers with higher ambient levels of distress has not been addressed. METHOD Nicotine-dependent smokers (N = 60; 40 women, 20 men) completed the Brief Symptoms Index (BSI) and then participated in a laboratory stress task 1 week before a quit attempt. Acute psychological distress was measured immediately before and after exposure to stressful and neutral stimuli. After they quit, participants completed a smoking diary for 14 days in which they recorded the degree to which their smoking was precipitated by emotional stress. RESULTS Consistent with our hypotheses, BSI scores predicted both exaggerated laboratory stress responses (p < .005) and smoking that was attributable to stress during the 14-day postquit period (p < .01). Laboratory stress reactions were predictive of stress-induced smoking (p < .01), and acute psychological stress reactions mediated the effects of BSI on stress-induced smoking. CONCLUSIONS Acute psychological stress reactivity is a potential mechanism underlying the effect of stress-induced smoking during a quit attempt.
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Affiliation(s)
- Atara Siegel
- Department of Psychology, Hunter College, The City University of New York, New York, New York
| | - Miriam Korbman
- Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joel Erblich
- Department of Psychology, Hunter College, The City University of New York, New York, New York.,Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
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17
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de Granda-Orive JI, de Granda-Beltrán AM, López-Aguilar JC. Is there a need for specific smoking cessation programs for the military? Occup Med (Lond) 2018; 68:146. [DOI: 10.1093/occmed/kqy009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Trone DW, Powell TM, Bauer LM, Seelig AD, Peterson AV, Littman AJ, Williams EC, Maynard CC, Bricker JB, Boyko EJ. Smoking and drinking behaviors of military spouses: Findings from the Millennium Cohort Family Study. Addict Behav 2018; 77:121-130. [PMID: 28992577 DOI: 10.1016/j.addbeh.2017.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 09/12/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The associations between stressful military experiences and tobacco use and alcohol misuse among Service members are well documented. However, little is known about whether stressful military experiences are associated with tobacco use and alcohol misuse among military spouses. METHODS Using 9872 Service member-spouse dyads enrolled in the Millennium Cohort Family Study, we employed logistic regression to estimate the odds of self-reported cigarette smoking, risky drinking, and problem drinking among spouses by Service member deployment status, communication regarding deployment, and stress associated with military-related experiences, while adjusting for demographic, mental health, military experiences, and Service member military characteristics. RESULTS Current cigarette smoking, risky drinking, and problem drinking were reported by 17.2%, 36.3%, and 7.3% of military spouses, respectively. Current deployment was not found to be associated with spousal smoking or drinking behaviors. Communication about deployment experiences with spouses was associated with lower odds of smoking, but not with risky or problem drinking. Spouses bothered by communicated deployment experiences and those who reported feeling very stressed by a combat-related deployment or duty assignment had consistently higher odds of both risky and problem drinking. CONCLUSIONS Our findings suggest that contextual characteristics about the deployment experience, as well as the perceived stress of those experiences, may be more impactful than the simple fact of Service member deployment itself. These results suggest that considering the impact of deployment experiences on military spouses reveals important dimensions of military community adaptation and risk.
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19
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Herbst E, Pennington D, Kuhn E, McCaslin SE, Delucchi K, Batki SL, Dickter B, Carmody T. Mobile Technology for Treatment Augmentation in Veteran Smokers With Posttraumatic Stress Disorder. Am J Prev Med 2018; 54:124-128. [PMID: 29074319 DOI: 10.1016/j.amepre.2017.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/12/2017] [Accepted: 08/14/2017] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The purpose of this study is to examine the feasibility and acceptability of incorporating a mobile application, Stay Quit Coach, into an integrated care smoking-cessation treatment protocol for veterans with posttraumatic stress disorder (PTSD). METHODS Participants included veteran smokers aged 18-69 years with PTSD. The integrated care protocol includes eight weekly PTSD-informed cognitive behavioral therapy sessions for smoking cessation, followed by monthly booster sessions and a prescription for standard smoking-cessation medications if desired. Participants used Stay Quit Coach as desired. Outcome measures at 3-month follow-up included: adherence (sessions attended), 30-day point-prevalence abstinence bioverified with carbon monoxide <6 parts per million, past-30 day mean daily cigarette use, exhaled carbon monoxide, nicotine dependence, and PTSD symptom severity. Repeated outcomes were analyzed with random-intercept linear mixed models. Data were collected in 2015-2016 and analyses were conducted in 2016-2017. RESULTS Participants (n=20) were 95% male and 5% female; mean age 41.4 (SD=16.2) years. Thirteen participants (65%) attended all scheduled sessions, four (20%) did not adhere to the protocol on schedule, and three (15%) were lost to follow-up. At 3-month follow-up, six of 17 completers (35.3%) had bioverified 30-day point-prevalence abstinence. Nicotine dependence, carbon monoxide levels, and past 30-day cigarette use significantly decreased and PTSD symptoms were unchanged from baseline to follow-up. Participants self-reported using Stay Quit Coach 2.5 (SD=2.2) days/week; 15 of 17 (88.2%) reported using Stay Quit Coach <30 minutes/week; two of 17 (11.8%) reported using Stay Quit Coach 30-60 minutes/week. CONCLUSIONS Although results must be interpreted with caution given the lack of control group and small sample size, findings indicate that integrating Stay Quit Coach into integrated care was feasible and acceptable.
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Affiliation(s)
- Ellen Herbst
- Mental Health Services, San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, San Francisco, California.
| | - David Pennington
- Mental Health Services, San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Eric Kuhn
- National Center for PTSD, Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Shannon E McCaslin
- National Center for PTSD, Dissemination and Training Division, Veterans Affairs Palo Alto Health Care System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Kevin Delucchi
- Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Steven L Batki
- Mental Health Services, San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, San Francisco, California
| | - Benjamin Dickter
- Department of Clinical Psychology, Palo Alto University, Palo Alto, California
| | - Timothy Carmody
- Mental Health Services, San Francisco Veterans Affairs Health Care System, San Francisco, California; Department of Psychiatry, University of California, San Francisco, San Francisco, California
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20
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Zarka S, Levine H, Rozhavski V, Sela T, Bar-Ze'ev Y, Molina-Hazan V, Rosen LJ. Smoking Behavior Change During Compulsory Military Service in Israel, 1987-2011. Nicotine Tob Res 2017; 19:1322-1329. [PMID: 28115500 DOI: 10.1093/ntr/ntw285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 10/20/2016] [Indexed: 11/13/2022]
Abstract
Introduction Smoking in military settings is of major concern. We aimed to assess the association between personal, family, and military factors and smoking behavior change during compulsory military service in Israel. Methods Participants were soldiers recruited between 1987 and 2008 who were interviewed at recruitment and reinterviewed at discharge (1987-2011) (total: 29 189; males:15 136; females:14 053). The primary outcome variables were smoking initiation during service among nonsmokers at recruitment, and cessation during service among smokers at recruitment. We examined potential predictors of change, and trends by calendar year. Results Smoking prevalence increased by 39.4% during military service (recruitment: 26.2%, discharge: 36.5%). 18.4% of nonsmoking recruits initiated smoking, and 12.4% of smoking recruits quit smoking between recruitment and discharge. There was no observed trend in initiation between 1987 and 2011. The strongest predictor of smoking initiation among nonsmokers at recruitment was smoking history (former vs. never-smoker, odds ratio (OR) [95% confidence interval [CI]]: males: 5.63 [4.63,6.85], females: 6.76 [5.27, 8.68]. Other variables had smaller effects on initiation. Females were less likely to initiate smoking than males (OR [CI]): 0.75 [0.69,0.81]. Both males and females with high military fitness levels were more likely to initiate smoking. Among women, those with lower education, with fathers with lower education, of lower socioeconomic status, and ever-users of contraceptives were more likely to initiate smoking. Cessation among males modestly increased over the years (OR [CI]): 1.03 [1.01,1.05]. Conclusions Smoking increased substantially during mandatory military service in Israel. Former smokers were at greatly increased risk of initiation and should be targeted for relapse prevention. Military service represents a golden opportunity for tobacco control. Implications Military tobacco control policy is an important contributor to longevity among service personnel, and population-wide mortality in countries with compulsory service. The increased smoking prevalence among military personnel, and increases in smoking during military service should act as a wake-up call to governments and health systems in countries lacking strong military tobacco control policies. The substantial progress in military tobacco control in the United States, which includes strong antitobacco policies for prevention of smoking initiation, aid to smokers to quit smoking, and protection of nonsmokers from tobacco smoke, should be emulated by others. Former smokers and others at high risk should be targeted for relapse prevention. The closed environment of military service provides a golden opportunity for tobacco control.
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Affiliation(s)
- Salman Zarka
- Preventive Medicine Branch, Medical Corps, Israel Defense Force, Israel.,Ziv Medical Center, Tzfat, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine Hebrew University-Hadassah, Jerusalem, Israel
| | | | - Tamar Sela
- Preventive Medicine Branch, Medical Corps, Israel Defense Force, Israel
| | - Yael Bar-Ze'ev
- Preventive Medicine Branch, Medical Corps, Israel Defense Force, Israel.,School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | | | - Laura J Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Seelig AD, Rivera AC, Powell TM, Williams EC, Peterson AV, Littman AJ, Maynard C, Street AE, Bricker JB, Boyko EJ. Patterns of Smoking and Unhealthy Alcohol Use Following Sexual Trauma Among U.S. Service Members. J Trauma Stress 2017; 30:502-511. [PMID: 28906037 DOI: 10.1002/jts.22214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 11/08/2022]
Abstract
In the first known longitudinal study of the topic, we examined whether experiencing sexual assault or sexual harassment while in the military was associated with increased risk for subsequent unhealthy alcohol use and smoking among U.S. service members in the Millennium Cohort Study (2001-2012). Adjusted complementary log-log models were fit to estimate the relative risk of (a) smoking relapse among former smokers (men: n = 4,610; women: n = 1,453); (b) initiation of unhealthy alcohol use (problem drinking and/or drinking over recommended limits) among those with no known history of unhealthy alcohol use (men: n = 8,459; women: n = 4,816); and (c) relapse among those previously reporting unhealthy alcohol use (men: n = 3,487; women: n = 1,318). Men who reported experiencing sexual assault while in the military had sixfold higher risk for smoking relapse: relative risk (RR) = 6.62; 95% confidence interval (CI) [2.34, 18.73], than men who did not. Women who reported experiencing sexual assault while in the military had almost twice the risk for alcohol relapse: RR = 1.73; 95% CI [1.06, 2.83]. There were no other significant associations. These findings suggest that men and women may respond differently following sexual trauma, and support future concerted policy efforts by military leadership to prevent, detect, and intervene on sexual assault.
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Affiliation(s)
- Amber D Seelig
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
| | - Anna C Rivera
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Teresa M Powell
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Emily C Williams
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Arthur V Peterson
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Alyson J Littman
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
| | - Charles Maynard
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Health Services, University of Washington, Seattle, Washington, USA
| | - Amy E Street
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jonathan B Bricker
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.,Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Edward J Boyko
- Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington, USA
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Weinberger AH, Platt J, Esan H, Galea S, Erlich D, Goodwin RD. Cigarette Smoking Is Associated With Increased Risk of Substance Use Disorder Relapse: A Nationally Representative, Prospective Longitudinal Investigation. J Clin Psychiatry 2017; 78:e152-e160. [PMID: 28234432 PMCID: PMC5800400 DOI: 10.4088/jcp.15m10062] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 03/07/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Little is known about the relationship between cigarette smoking and long-term outcomes for substance use disorder (SUD). The current study examined the association between smoking and SUD relapse among adults with remitted SUDs. METHODS Analyses were conducted on respondents who completed Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions and met DSM-IV criteria for substance abuse and dependence prior to but not during the year before the Wave 1 interview (n = 5,515). Relationships between smoking status (Wave 2 smoking vs nonsmoking among Wave 1 smokers; Wave 2 smoking vs nonsmoking among Wave 1 nonsmokers) and Wave 2 substance use and SUD relapse were examined using logistic regression analyses. Analyses were adjusted for demographics, psychiatric and alcohol use disorders, nicotine dependence, and SUD severity. RESULTS In the fully adjusted models, continued smoking at Wave 2 among Wave 1 smokers was associated with significantly greater odds of substance use (OR = 1.56, 95% CI, 1.10-2.20) and SUD relapse (OR = 2.02, 95% CI, 1.65-2.47) compared to Wave 2 nonsmoking. In the fully adjusted model, smoking at Wave 2 among Wave 1 nonsmokers was associated with significantly greater odds of SUD relapse compared to Wave 2 nonsmoking (OR = 4.86, 95% CI, 3.11-7.58). CONCLUSIONS Continued smoking among smokers and smoking initiation among nonsmokers were associated with greater odds of SUD relapse. More research is needed to examine the timing of SUD relapse in relation to smoking behaviors. Incorporating smoking cessation and prevention efforts into substance abuse treatment may improve long-term substance use outcomes for adult smokers with SUDs.
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Affiliation(s)
- Andrea H. Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461 USA,Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461 USA
| | - Jonathan Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032 USA
| | - Hannah Esan
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461 USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118 USA
| | - Debra Erlich
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367 USA
| | - Renee D. Goodwin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032 USA,Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), Flushing, NY 11367 USA
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23
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Osteoporosis Preventive Practice Between Veteran and Nonveteran Older Adults: Findings From Patient-Reported Data. Orthop Nurs 2016; 35:401-410. [PMID: 27851678 DOI: 10.1097/nor.0000000000000297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Veterans are prone to bone-related illnesses due to multiple risk factors such as prior injuries. The aim of this study was to compare trends in osteoporosis preventive practices between veteran and nonveteran older adults. METHODS This was a secondary data analysis using selected baseline data and discussion postings from an online bone health trial including participants (N = 866) recruited from My HealtheVet (MHV) and SeniorNet (SN). Data were analyzed using descriptive statistics, parametric statistics, and content analysis. FINDINGS Overall, MHV participants were younger and included more men than SN participants. However, they reported higher rates of bone health issues, spent less time exercising, took fewer calcium and vitamin D supplements, and were less likely to discuss bone health with their care providers. More MHV participants discussed pain and disability as barriers to bone health behaviors and fear of deteriorating health as motivators. In addition, more MHV participants found that participating in the original study was helpful for changing health behaviors. CONCLUSION Overall, the findings suggest a disparity in bone health between veterans and nonveterans and a significant potential for using eHealth programs for veterans.
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Cypel YS, Hamlett-Berry K, Barth SK, Christofferson DE, Davey VJ, Eber S, Schneiderman AI, Bossarte RM. Cigarette Smoking and Sociodemographic, Military, and Health Characteristics of Operation Enduring Freedom and Operation Iraqi Freedom Veterans: 2009-2011 National Health Study for a New Generation of US Veterans. Public Health Rep 2016; 131:714-727. [PMID: 28123213 DOI: 10.1177/0033354916664864] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We examined the sociodemographic, military, and health characteristics of current cigarette smokers, former smokers, and nonsmokers among Operation Enduring Freedom (OEF) / Operation Iraqi Freedom (OIF) veterans and estimated smoking prevalence to better understand cigarette use in this population. METHODS We analyzed data from the US Department of Veterans Affairs (VA) 2009-2011 National Health Study for a New Generation of US Veterans. On the basis of a stratified random sample of 60 000 OEF/OIF veterans, we sought responses to a 72-item questionnaire via mail, telephone, or Internet. Cigarette smoking status was based on self-reported cigarette use in the past year. We used multinomial logistic regression to evaluate associations between smoking status and sociodemographic, military, and health characteristics. RESULTS Among 19 911 veterans who provided information on cigarette smoking, 5581 were current smokers (weighted percentage: 32.5%, 95% confidence interval [CI]: 31.7-33.2). Current smokers were more likely than nonsmokers or former smokers to be younger, to have less education or income, to be separated/divorced or never married/single, and to have served on active duty or in the army. Comparing current smokers and nonsmokers, some significant associations from adjusted analyses included the following: having a Mental Component Summary score (a measure of overall mental health) above the mean of the US population relative to below the mean (adjusted odds ratio [aOR] = 0.81, 95% CI: 0.73-0.90); having physician-diagnosed depression (aOR = 1.52, 95% CI: 1.33-1.74), respiratory conditions (aOR = 1.16, 95% CI: 1.04-1.30), or repeated seizures/blackouts/convulsions (aOR = 1.80, 95% CI: 1.22-2.67); heavy alcohol use vs never use (aOR = 5.49, 95% CI: 4.57-6.59); a poor vs excellent perception of overall health (aOR = 3.79, 95% CI: 2.60-5.52); and being deployed vs nondeployed (aOR = 0.87, 95% CI: 0.78-0.96). Using health care services from the VA protected against current smoking. CONCLUSION Mental and physical health, substance use, and military service characteristics shape cigarette-smoking patterns in OEF/OIF veterans.
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Affiliation(s)
- Yasmin S Cypel
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Kim Hamlett-Berry
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Mental Health Services, Washington, DC, USA
| | - Shannon K Barth
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Dana E Christofferson
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Mental Health Services, Washington, DC, USA
| | - Victoria J Davey
- US Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Washington, DC, USA
| | - Stephanie Eber
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Aaron I Schneiderman
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
| | - Robert M Bossarte
- US Department of Veterans Affairs, Veterans Health Administration, Office of Patient Care Services, Post-Deployment Health Services, Washington, DC, USA
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25
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Korinek K, Loebach P, Trinh HN. Military service and smoking in a cohort of northern Vietnamese older adults. Int J Public Health 2016; 62:43-51. [PMID: 27321700 DOI: 10.1007/s00038-016-0841-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 03/06/2016] [Accepted: 06/02/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Wide-ranging scholarship demonstrates war's impacts on US veterans' health. We ask whether, among Vietnamese men of a certain age, wartime experiences contributed to initiating smoking, and thus shaped one behavioral pathway linking war exposure and older adult health. METHODS We analyze the Vietnam Health and Aging Pilot Study (VHAPS), a survey of adults ages 55 and older (N = 405) conducted in one commune of northern Vietnam. We implement Cox discrete-time proportional hazards models to discern the effects of military service upon the initiation of smoking. RESULTS Military service results in a heightened risk of initiating smoking within this cohort (HR 2.13, [CI 1.36, 3.35]). Smoking initiation is also significantly gendered and age graded. Socioeconomic position and social capital variables in the models are statistically insignificant. CONCLUSIONS This study finds that, among older northern Vietnamese men whose early adulthood coincided with mass mobilization in the Vietnam War, involvement in formal military service significantly increased the risk of initiating smoking. Military-induced smoking emerges where tobacco products were not provided by the military institution, but where social availability of tobacco was widespread.
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Affiliation(s)
- Kim Korinek
- Department of Sociology, University of Utah, 380 S. 1530 E., Room 301, Salt Lake City, UT, 84112, USA.
| | - Peter Loebach
- Department of Sociology and Anthropology, Weber State University, Social Science Building, Room 114, Ogden, UT, USA
| | - Ha Ngoc Trinh
- Department of Sociology, University of Utah, 380 S. 1530 E., Room 301, Salt Lake City, UT, 84112, USA
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26
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O'Leary TJ, Dominitz JA, Chang KM. Veterans Affairs Office of Research and Development: Research Programs and Emerging Opportunities in Digestive Diseases Research. Gastroenterology 2015; 149:1652-61. [PMID: 26526712 PMCID: PMC4887273 DOI: 10.1053/j.gastro.2015.10.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Timothy J O'Leary
- Department of Veterans Affairs, Office of Research and Development, Washington, DC
| | - Jason A Dominitz
- Department of Veterans Affairs, VA Puget Sound Health Care System and University of Washington School of Medicine, Seattle, Washington
| | - Kyong-Mi Chang
- Corporal Michael J. Crescenz VA Medical Center and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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