Longitudinal Investigation of Smoking Initiation and Relapse Among Younger and Older US Military Personnel (original) (raw)
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PLOS ONE, 2021
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 ...
Smoking Among U.S. Service Members Following Transition From Military to Veteran Status
Health Promotion Practice, 2020
Smoking rates among U.S. Service members and veterans have been consistently higher than in civilian populations. While much has been published about tobacco use in both military and veteran populations, smoking patterns during transition from military to veteran status remains unclear. We studied military members participating in the Millennium Cohort Study, who separated from their respective Services between baseline and first follow-up survey ( N = 5,510). Two generalized estimating equation models were used to examine any association between smoking status and time to military separation (days between baseline survey and separation), as well as smoking during transition and reason for separation. Reason for separation was categorized into three groups: (1) not meeting military standards or judicial-related reasons, (2) drugs-/alcohol-related misconduct, and (3) other types of separation including retirement, pregnancy, and so on. Statistical models accounted for baseline smokin...
The Influence of Men’s Military Service on Smoking Across the Life Course
Journal of Drug Issues, 2016
The military is described as a social context that contributes to the (re-)initiation or intensification of cigarette smoking. We draw on data from the 1985-2014 National Survey of Drug Use and Health (NSDUH) and the Wisconsin Longitudinal Study (WLS) to conduct complementary sub-studies of the influence of military service on men’s smoking outcomes across the life course. Descriptive findings from an age–period–cohort analysis of NSDUH data document higher probabilities of current smoking and heavy smoking among veteran men across a broad range of cohorts and at all observed ages. Findings from sibling fixed-effects Poisson models estimated on the WLS data document longer durations of smoking among men who served in the military and no evidence that selection explains the observed relationship. Together, these results provide novel and potentially generalizable evidence that participation in the military in early adulthood exerts a causal influence on smoking across the life course.
A longitudinal analysis of tobacco use in younger and older U.S. veterans
Preventive Medicine Reports, 2019
United States (U.S.) veterans are prone to higher rates of smoking and smoking-related disease. We describe the prevalence of cigarette and non-cigarette product use and determine longitudinal predictors of tobacco use transitions in this vulnerable population. Data are from Waves 1 (2013-2014) and 2 (2014-2015) of the adult cohort in the Population Assessment of Tobacco and Health. Wave 1 prevalence was calculated for past 30-day use of all queried tobacco products, and compared by veteran status. Weighted multinomial logistic regression was used to determine predictors-demographics, substance use, and physical and psychological comorbidities-of tobacco use transitions (continued use, initiation, and cessation) among veterans. Compared to non-veterans, use of nearly all tobacco products was significantly higher among veterans and was highest among younger veterans. Compared to continued nonusers, continued users were more likely to: be of younger age (OR = 0.95, 95% CI: 0.95-0.96), have poorer physical health (
Contemporary Clinical Trials, 2014
Smoking cessation is a primary method of reducing excess mortality and morbidity. Unfortunately, the vast majority of cessation attempts end in eventual relapse. Relapse-prevention interventions have shown some success at improving the long-term maintenance of tobacco abstinence among individuals motivated to abstain. However, involuntary tobacco abstinence (e.g., military training, hospitalization, incarceration) presents another opportunity for intervention to prevent relapse. During basic military training (BMT), tobacco use is strictly forbidden in all service branches, but tobacco relapse (and initiation) following BMT is extremely high. This paper reports on the design, intervention development, and baseline characteristics of a randomized controlled trial testing minimal interventions designed to prevent tobacco relapse among United States Air Force (USAF) personnel following BMT. Participants are randomized by squadron to receive either a standard smoking-cessation booklet, a new motivation-based booklet designed specifically for USAF personal, or the latter booklet combined with a brief, face-to-face motivational session. Primary outcomes will be self-reported tobacco use at 12 and 24 month follow-up. Given that the Department of Defense is the world's largest employer, the potential of leveraging involuntary tobacco abstinence during BMT into extended abstinence has substantial public health significance.
Perceived Deterrence of Cigarette Use and Smoking Status Among Active Duty Military Personnel
Military Medicine, 2017
Background: Tobacco use in the military adversely affects fitness, readiness and performance levels, and increases health care costs. In 2011, cigarette use in the military was higher than in the civilian population (24.0% vs. 21.2%). We examined the perceptions of active duty service members with respect to supervisory and military installation determent of cigarette smoking. Methods: Using the Department of Defense's 2011 Health-Related Behaviors Survey (HRBS) of active duty military personnel (N = 39,877) data, a multivariate logistic regression estimated the association of personnel's perception of leadership discouraging cigarette use with smoking status, controlling for covariates (n = 23,354). Results: Those who perceived their supervisor as "Somewhat" (adjusted odds ratio [AOR] 1.41, 95% confidence interval [CI] [1.29, 1.54]) or "Strongly" (AOR 1.22, 95% CI [1.09, 1.37]) discouraging of cigarette use had higher odds of smoking compared to those who perceived supervisors "Not at all" discouraging use. Odds of currently smoking increased with perceptions of increasing discouragement by installation, from "Somewhat" (AOR 1.64, 95% CI [1.49, 1.80]) to "Strongly discourages" cigarette use (AOR 1.71, 95% CI [1.50, 1.95]). As expected, the strongest correlate of current smoking was having friends who smoke (AOR 13.62, 95% CI [11.53, 16.07]). Other significant covariates in the model focused on current smokers included high risk for alcohol problems, specifically hazardous drinking (
Predicting cigarette initiation and reinitiation among active duty United States Air Force recruits
Substance Abuse, 2019
Background-The first year of military service in the United States Air Force (USAF) is a high risk time for tobacco use. Previous studies have demonstrated the effectiveness of a tobacco ban during Basic Military Training. However, no studies have examined the effect of increasing the protracted ban for an additional four weeks. Understanding the patterns of initiation and reinitiation following the protracted ban will inform future intervention and policy efforts. Methods-The current study examines patterns of cigarette smoking among a sample of 2,188 USAF personnel at baseline and after their first year of service. Results-One year after BMT, we observed that 65.0% of USAF enlistees who never used cigarettes prior to BMT remained abstinent, 9.6% of individuals who formerly used remained abstinent from cigarettes, 9.3% who never used prior to BMT initiated cigarette smoking, and 16.1% who used prior to BMT reinitiated cigarette smoking. Despite the extended tobacco ban in BMT and Technical Training, 12.6% of individual who never smoked initiated cigarette smoking and 62.6% of individuals who formerly smoked reinitiated. Over half (54.2%) of Airmen who reported smoking cigarettes at follow-up, reported initiating or re-initiating during Technical Training. Conclusions-Our findings indicate that while the increased ban prevents additional individuals who smoked cigarettes prior to joining the Air Force from re-initiating, it has no effect on initiation among individuals who report never using prior to military service. Additional research is needed to understand what may be leading to these high rates of initiation and re-initiation in Technical Training following the ban.
Relapse to smoking after basic military training in the U.S. Air Force
Military medicine, 2000
This study examined predictors of smoking relapse in the year after the mandatory smoking ban during basic military training (BMT) in the U.S. Air Force. Participants were all smokers who completed BMT from August 1995 to August 1996 and relapsed to smoking in the subsequent year (N = 4,303). Results demonstrated that the vast majority of airmen (69.8%) returned to smoking within 1 month after BMT and that most (90%) were still in training status when they smoked their first cigarette after BMT. Relapsed smokers appeared more motivated to quit smoking at 1-year follow-up compared with when they were in BMT. Individuals making serious quit attempts after BMT were younger and had greater levels of physical activity, more confidence in quitting, and more favorable perceptions of the BMT ban than individuals not attempting to quit. Based on these findings, recommendations are discussed for improving abstinence rates after BMT.
Deployment and Smokeless Tobacco Use Among Active Duty Service Members in the U.S. Military
Military medicine, 2018
The prevalence of smokeless tobacco use among U.S. active duty service members has been much higher than in the U.S. general population. The association between deployment and smokeless tobacco use has not been well studied. We investigated the association between deployment and smokeless tobacco use among U.S. active duty service members. We also evaluated the modification effects from other factors related to smokeless tobacco use on the deployment-smokeless tobacco use association. Eligible active duty service members stationed at two military installations (Fort Bragg, NC, USA and Lackland Air Force Base, TX, USA) were recruited from July 2015 to May 2016. Each participant completed a self-administered questionnaire. Multivariable logistic regression was used to assess the association between deployment and smokeless tobacco use and estimated odds ratio (OR) and 95% confidence interval (CI). Stratified analysis was performed to evaluate modification effects from other commonly k...
Cigarette Smoking and Suicide: A Prospective Study of 300, 000 Male Active-duty Army Soldiers
American Journal of Epidemiology, 2000
The authors examined the relation between cigarette smoking and suicide by conducting a cohort study of 300,000 male US Army personnel followed prospectively from January 1987 through December 1996 for 961,657 person-years. They found that the risk of suicide increased significantly with the number of cigarettes smoked daily (p for trend < 0.001). In multivariable-adjusted analyses, smokers of more than 20 cigarettes a day, compared with never smokers, were more than twice as likely to commit suicide. For male active-duty army personnel, the dose-related association between smoking and suicide was not entirely explained by the greater tendency of smokers to be White, drink heavily, have less education, and exercise less often.