A content analysis of military commander messages about tobacco and other health issues in military installation newspapers: what do military commanders say about tobacco?

Military installation newspapers are a primary means used by military commanders to communicate information about topics important to military personnel including leadership, training issues, installation events, safety concerns, and vital health issues. We conducted a content analysis of military commanders' messages about health issues that were published in online military installation newspapers/newsfeeds. We identified a total of 75 publicly accessible installation newspapers/newsfeeds with commanders' messages (n = 39 Air Force, n = 19 Army, n = 7 Navy, n = 1 Marine, and n = 9 Joint Bases). Commander messages published from January 2012 to December 2012 were collected, screened, and coded. Coder inter-rater reliability was 98.9%. Among the 2,479 coded commanders' messages, 132 (5.3%) addressed a health topic as the primary focus. There were no significant differences between service branches in the percentage of health-oriented messages (χ(2) = 5.019, p = 0.285). The most commonly addressed health topics were exercise/fitness (23.5%), other mental health concerns (19.7%), alcohol/driving under the influence (13.6%), and suicide (12.1%). Tobacco use was directly addressed as a primary health aim in only two commanders' messages (1.5%). Health topics, and particularly tobacco-related content, are rarely written about by military commanders. The absence of tobacco-related health messages from line leadership contributes to the perception that tobacco control is a low priority.

High-intensity Fitness Training Among a National Sample of Male Career Firefighters

Obesity and fitness have been identified as key health concerns among USA firefighters yet little is known about the current habits related to exercise and diet. In particular, high-intensity training (HIT) has gained increasing popularity among this population but limited quantitative data are available about how often it is used and the relationship between HIT and other outcomes. Using survey methodology, the current study evaluated self-reported HIT and diet practice among 625 male firefighters. Almost one-third (32.3%) of participants reported engaging in HIT. Body composition, as measured by waist circumference and percentage body fat, was significantly related to HIT training, with HIT participants being approximately half as likely to be classified as obese using body fat [odds ratio (OR) = 0.52, 95% confidence interval (CI) = 0.34-0.78] or waist circumference (OR = 0.61, 95% CI = 0.37-0.98). Those who engaged in HIT were more than twice as likely as those who did not (OR = 2.24, 95% CI = 1.42-3.55) to meet fitness recommendations. Findings highlight directions for future prevention and intervention efforts.

A longitudinal analysis of cigarette prices in military retail outlets

OBJECTIVES

We conducted a longitudinal assessment of tobacco pricing in military retail outlets, including trends within each service branch.

METHODS

We determined the price of a single pack of Marlboro Red cigarettes at military retail stores located in the continental United States, Alaska, and Hawaii and at their nearest Walmarts in spring 2011 and 2013 (n = 128 for pairs available at both assessments).

RESULTS

The average difference between cigarettes sold in military retail outlets and Walmarts decreased from 24.5% in 2011 to 12.5% in 2013. The decrease was partially attributable to significant price decreases at Walmarts. The largest increases in cigarette prices occurred on naval installations. Potential savings at stores on several installations remained substantial in 2013; the largest approached $6 per pack. Stores on 17 military installations decreased cigarette prices during the study period.

CONCLUSIONS

Tobacco can be purchased in military retail stores at substantial savings over civilian stores. If tobacco pricing is to cease to be an incentive for use among personnel, a revised military tobacco pricing policy is needed.

The health of women in the US fire service

BACKGROUND

Despite statements from national fire service organizations, including the International Association of Fire Fighters (IAFF) and the International Association of Fire Chiefs (IAFC), promoting a diverse work force related to gender within the fire service, rates of women firefighters remain very low. Thus, research into why this extensive gender disparity continues is a high priority. Recent years have seen a number of large scale studies on firefighter health and health risk behaviors however, none have focused on the health of women firefighters and nearly all have eliminated women from the sample due to small sample size. Data from the present report is drawn from all females in a large, randomly selected cohort of firefighters in an epidemiological study designed to assess health outcomes and health risk behaviors identified as most important to the fire service.

METHODS

Data reported for the present study were collected as baseline data for the Firefighter Injury and Risk Evaluation (FIRE) Study, a longitudinal cohort study examining risk factors for injury in both career and volunteer firefighters in the IAFC Missouri Valley Region. Of the departments assessed, only 8 career and 6 volunteer departments had any women firefighters. All the women solicited for participation chose to enroll in the study. The number of women ranged from 1 to 7 in career departments and 1 to 6 in volunteer departments.

RESULTS

Where possible, comparisons are made between female firefighters and published data on male firefighters as well as comparisons between female firefighters and military members. Compared to male firefighters, females had more favorable body composition among both career and volunteer firefighters. Tobacco use rates were generally higher among females than males and rates among female firefighters were similar to the rates of female military members. While rates of alcohol use were higher than the general population, only one of the participants evidenced responses in the range of concern on the CAGE screening.

CONCLUSIONS

In general, the findings offer an interesting glimpse of the health of women in the fire service as a generally healthy occupational workforce with some unique health risk behavior challenges. They also highlight some of the similarities and differences between male and female firefighters and bolster the argument for studying female firefighters as a unique occupational sub-population.

Menthol cigarette pricing at military and community retail outlets in the United States

Background

Cigarette prices at military exchanges historically have been discounted. DoD Instruction 1330.9 has mandated that prices be within 5% of the price offered in the local community since 2001. Because minorities are highly represented in the military, we determined whether menthol cigarette prices, the leading choice of African Americans, were compliant with the instruction.

Methods

We collected, via telephone, menthol cigarette price data from 48 randomly selected US military installation exchanges and matched local area Walmarts. We collected prices after taxes to determine the cost to consumer. Newport was selected as the index brand for menthol cigarettes because it is the leading and second leading brand smoked by African Americans and by Hispanics, respectively and has the second overall highest market share in the US.

Results

Smokers purchasing menthols at exchanges would realize average savings of 22.78%. There were no significant differences in savings based on military service (F = 1.850, p = 0.152) or US Census Division (F = 1.226, p = 0.311: data not shown). In addition, not a single exchange price was compliant with the DoD instruction.

Conclusions

Newport menthol cigarettes at military exchanges cost substantially less than the nearest Walmart, with an average savings of 23%. Our findings demonstrate that menthol cigarettes are substantially discounted on military installations, in a manner similar to other cigarette prices, and that DoD Instruction 1330.09 is not enforced.

Assessing awareness, knowledge and use of folic acid in Kansas women between the ages of 18 and 44 years

Taking folic acid daily, before and during early pregnancy, has been proven to reduce neural tube birth defects (NTD). Unfortunately, many women fail to take it daily as recommended.

OBJECTIVES

To assess women's self-reported awareness, knowledge and use of folic acid. Methods Data were obtained by cross-sectional, random digit-dialing, computer-assisted telephone interviews with 250 women in Kansas. Associations were determined by chi-squared analysis.

RESULTS

Eighty-eight percent of childbearing age women in Kansas have a general awareness of folic acid, 20% have knowledge that it reduces birth defects, but only 25% report taking it daily. Awareness was associated with high school or greater education (P < .0001), incomes over $25,000 (P = 0.0003), being married (P = 0.0035), being white (P = 0.0135), having health insurance (P = 0.0152) and being capable of pregnancy (P = 0.0119). Knowledge that folic acid reduces birth defects was associated with being aware of the USPHS recommendation (P < .0001), being capable of pregnancy (P = 0.0043), being pregnant (P = 0.0061), and being aware of folic acid (P = 0.0379). Taking folic acid daily was associated with currently being pregnant (P = 0.0126).

CONCLUSIONS

Women less likely to take folic acid on a daily basis were young, non-Caucasians who reported less education, less income and no health insurance. Based upon these data, multi-level education campaigns that specifically target lower-SES women should be considered.

Childhood overweight: an expanding problem

Childhood overweight is a significant and growing health problem in the US and other parts of the world. Secular trend data in the US suggest that children have become substantially heavier over the last several decades and that their risk for a number of health problems is increasing as a result. Defining obesity in children has been difficult as assessing body fat is expensive and impractical. Body mass index (BMI), derived from weight and height, is used as a surrogate indicator in adults. In children, the consensus is to use BMI percentiles statistically derived from a reference population. There is evidence that the prenatal, early childhood, and adolescent periods are critical in the development of obesity but the mechanisms involved are yet to be elucidated. The recent rapid increase in childhood overweight and obesity is attributed to the modern obesogenic environment. Changes in dietary constituents including higher derivation of energy from nutritionally poor and energy dense foods, increased sweetened drink consumption, larger portion sizes, and more frequent intake of food outside the home have been associated with poorer diets and higher weights. Further, physical activity has reduced with decreases in school physical education classes and organized sports, fewer opportunities to expend energy for daily living activity due to more mechanization, lower frequency of walking and biking, and greater use of sedentary activities for leisure. Television watching remains the most common activity for children. There are significant health outcomes associated with childhood obesity, including the presence of cardiovascular risk factors, and greater prevalence of various medical problems including insulin resistance, type 2 diabetes mellitus, the metabolic syndrome, orthopedic problems, and pseudotumor cerebri. Of further concern is the increased risk for obesity in adulthood with its attendant co-morbidities. Interventions are imperative but not widely studied. The most effective interventions include comprehensive behavioral management, dietary modification, and exercise. Family-based interventions have been most successful at maintaining long-term weight loss. School-based interventions have the potential to significantly impact childhood overweight as large numbers of children can be reached. However, such programs require long-term follow-up and are expensive. Very low calorie diets, pharmacotherapy, and surgery remain experimental options for children. More recently, metformin has shown promise in promoting weight loss and improving insulin sensitivity among adolescents. Combining multiple approaches for treatment, addressing obesity-promoting sociocultural practices and policies, and focusing on prevention strategies will be necessary to address this epidemic.

Genetic bottlenecks, perceived racism, and hypertension risk among African Americans and first-generation African immigrants

The complexity of factors influencing the development of hypertension (HTN) in African Americans has given rise to theories suggesting that genetic changes occurred due to selection pressures/genetic bottleneck effects (ie, constriction of existing genetic variability) over the course of the slave trade. Ninety-nine US-born and 86 African-born health professionals were compared in a cross-sectional survey examining genetic and psychosocial predictors of HTN. We examined the distributions of three genetic loci (G-protein, AGT-235, and ACE I/D) that have been associated with increased HTN risk. There were no significant differences between US-born African Americans and African-born immigrants in the studied genetic loci or biological variables (eg, plasma renin and angiotensin converting enzyme activity), except that the AGT-235 homozygous T genotype was somewhat more frequent among African-born participants than US-born African Americans. Only age, body mass index, and birthplace consistently demonstrated associations with HTN status. Thus, there was no evidence of a genetic bottleneck in the loci studied, ie, that US-born African Americans have different genotype distributions that increase their risk for HTN. In fact, some of the genotypic distributions evidenced lower frequencies of HTN-related alleles among US-born African Americans, providing evidence of European admixture. The consistent finding that birthplace (ie, US vs Africa) was associated with HTN, even though it was not always significant, suggests potential and unmeasured cultural, lifestyle, and environmental differences between African immigrants and US-born African Americans that are protective against HTN.

Where do diets, exercise, and behavior modification fit in the treatment of obesity?

Obesity is a significant public health concern that affects a growing number of people in the United States and throughout the world. While substantial advances have been made in the development of new pharmacotherapies and in understanding the biological underpinnings (e.g., genetics and physiology) of obesity, lifestyle modification, which involves the application of behavior modification principles to alter eating and activity patterns, is the foundation of any comprehensive obesity management. The purpose of this article is to provide a practical overview of the benefits of dietary and activity change and to review behavior modification principles that have been used successfully in obesity management.

Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment

Atrial fibrillation (AF) is a common complication of cardiac operations that leads to increased risk for thromboembolism and excessive health care resource utilization. Advanced age, previous AF, and valvular heart operations are the most consistently identified risk factors for this arrhythmia. Dispersion of repolarization leading to reentry is believed to be the mechanism of postoperative AF, but many questions regarding the pathophysiology of AF remain unanswered. Treatment is aimed at controlling heart rate, preventing thromboembolic events, and conversion to sinus rhythm. Multiple investigations have examined methods of preventing postoperative AF, but the only firm conclusions that can be drawn is to avoid beta-blocker withdrawal after operation and to consider beta-blocker therapy for other patients who may tolerate these drugs. Preliminary investigations showing sotalol and amiodarone to be effective in preventing postoperative AF are encouraging, but early data have been limited to selective patient populations and have not adequately evaluated safety. Newer class III antiarrhythmic drugs under development may have a role in the treatment of postoperative AF, but the risk of drug-induced polymorphic ventricular tachycardia must be considered. Nonpharmacologic interventions under consideration for the treatment of AF in the nonsurgical setting, such as automatic atrial cardioversion devices and multisite atrial pacing, may eventually have a role for selected cardiac surgical patients.

Laryngeal mask airway in severe cervical ankylosis

PURPOSE

We present a case of the successful use of a laryngeal airway (LMA) to ventilate the lungs of a patient with severe ankylosing spondylitis for surgery requiring intense muscular relaxation. The use of an LMA in such circumstances is controversial.

CLINICAL FEATURES

The patient was a 61-yr-old man with severe emphysema, a cervical spine fixed in marked anterior flexion, and reduced mouth opening (35 mm). The patient refused an awake tracheal intubation because of a previous distressing experience with a fibreoptic awake nasal intubation and an 11 day SICU stay with controlled ventilation via an endotracheal tube. Attempts at spinal blocks had failed in the past. After administration of thiopentone and succinylcholine a #4 LMA was inserted and the lungs were safely ventilated for a 10 min reduction of a dislocated femoral head.

CONCLUSION

The present view that severe ankylosing spondylitis is a contraindication to the use of an LMA may need revision in view of this and other reports of successful airway management in patients with that disease.