Combat exposure, emotional and physical role limitations, and substance use among male United States Army Reserve and National Guard soldiers.

PURPOSE: Combat-exposed soldiers are at an increased risk for health problems that diminish quality of life (QOL) and substance use. We explored the cross-sectional associations between combat exposure and two measures of QOL, and the effect of substance use on those associations. METHODS: Data are from the baseline wave of Operation: SAFETY, an ongoing survey-based study of United States Army Reserve/National Guard (USAR/NG) soldiers and their partners. Our sample consisted of male USAR/NG soldiers with a history of deployment (N = 248). Limitations in usual activity due to physical and emotional problems were assessed using the 36-Item Short-Form Health Survey (SF-36). RESULTS: Greater combat exposure was independently associated with limitations in usual activity due to physical (regression coefficient = -0.35, 95% CI -0.55 to -0.16, R 2 = 0.09; p < 0.01) and emotional (regression coefficient = -0.32, 95% CI -0.56 to -0.09, R 2 = 0.09; p < 0.01) problems. Combat exposure had a significant interaction with frequent heavy drinking on physical role limitations (regression coefficient = -0.65, 95% CI -1.18 to -0.12, R 2 = 0.12; p < 0.05) and emotional role limitations (regression coefficient = -0.83, 95% CI -1.46 to -0.19, R 2 = 0.12; p < 0.05). Combat exposure also had a significant interaction with lifetime non-medical use of prescription drugs on physical role limitations (regression coefficient = 0.81, 95% CI 0.18-1.45, R 2 = 0.11; p < 0.05). CONCLUSION: Combat is an unmodifiable risk factor for poor QOL among soldiers; however, frequent heavy drinking and non-medical use of prescription drugs modifies the relationship between combat exposure and QOL. Therefore, substance use is a potential point of intervention to improve QOL among soldiers.

The impact of military service and traumatic brain injury on the substance use norms of Army Reserve and National Guard Soldiers and their spouses.

INTRODUCTION: Traumatic brain injury (TBI) and substance use are highly prevalent conditions among military populations. There is a significant body of evidence that suggests greater approval of substance use (i.e., norms) is related to increased substance use. The objective of this work is to understand the impact of TBI and military service on substance use norms of soldiers and their partners. Data are from the baseline assessment of Operation: SAFETY, an ongoing, longitudinal study of US Army Reserve/National Guard (USAR/NG) soldiers and their partners. METHODS: Multiple regression models examined associations between alcohol, tobacco, illicit drug use, and non-medical use of prescription drug (NMUPD) norms within and across partners based on current military status (CMS) and TBI. RESULTS: Male USAR/NG soldiers disapproved of NMUPD, illicit drug use and tobacco use. There was no relation between military status and alcohol use. Among females, there was no relation between CMS and norms. The NMUPD norms of wives were more likely to be approving if their husbands reported TBI symptoms and had separated from the military. Husbands of soldiers who separated from the military with TBI had greater approval of the use of tobacco, NMUPD, and illicit drugs. CONCLUSION: Overall, there is evidence to suggest that, while generally disapproving of substance use, soldiers and partners become more accepting of use if they also experience TBI and separate from the military. Future research should examine the longitudinal influence of TBI on substance use norms and subsequent changes in substance use over time.

Assessing 30-day quantity-frequency of U.S. adolescent cigarette smoking as a predictor of adult smoking 14 years later.

BACKGROUND: To improve measures of monthly tobacco cigarette smoking among non-daily smokers, predictive of future non-daily monthly and daily smoking. METHODS: Data from United States National Longitudinal Study of Adolescent to Adult Health, tracking adolescents, ages 12-21, over 14 years were analyzed. At baseline, 6501 adolescents were assessed; 5114 individuals provided data at waves 1 and 4. Baseline past 30-day non-daily smokers were classified using quantity-frequency measures: cigarettes smoked/day by number of days smoked in the past 30 days. RESULTS: Three categories of past 30-day non-daily smokers emerged using cigarettes/month (low:1-5, moderate: 6-60, high: 61+) and predicted past 30-day smoking at follow-up (low: 44.5%, moderate: 60.0%, high: 77.0%, versus 74.2% daily smokers; rτ=-0.2319, p<0.001). Two categories of non-smokers plus low, moderate and high categories of non-daily smokers made up a five-category non-daily smoking index (NDSI). High NDSI (61+ cigs/mo.) and daily smokers were equally likely to be smoking 14 years later (High NDSI OR=0.97, 95% CI=0.53-1.80 [daily as reference]). Low (1-5 cigs/mo.) and moderate (6-60 cigs/mo.) NDSI were distinctly different from high NDSI, but similar to one another (OR=0.21, 95% CI=0.15-0.29 and OR=0.22, 95% CI=0.14-0.34, respectively) when estimating future monthly smoking. Among those smoking at both waves, wave 1 non-daily smokers, overall, were less likely than wave 1 daily smokers to be smoking daily 14 years later. CONCLUSIONS: Non-daily smokers smoking over three packs/month were as likely as daily smokers to be smoking 14-years later. Lower levels of non-daily smoking (at ages 12-21) predicted lower likelihood of future monthly smoking. In terms of surveillance and cessation interventions, high NDSI smokers might be treated similar to daily smokers.

Enjoyment and other reasons for electronic cigarette use: Results from college students in New York.

BACKGROUND: Young people are more likely to have experimented with e-cigarettes (e-cigs) compared with older adults. Few studies identify reasons for experimentation/use of e-cigs among young people; we sought to discover what drives college students to use e-cigs. METHODS: Undergraduate students (ages 18-23) at four universities in New York State were surveyed. Among e-cig ever users (n=429), reasons for use were examined. A multinomial logistic regression model analyzed the relative risk of reasons for using e-cigs among discontinued, current non-daily and current daily e-cig users. RESULTS: Using e-cigs for enjoyment was associated with current non-daily (RR=2.11, 95% CI=1.18-3.75) and current daily use (RR=19.1, 95% CI=3.71-98.54). Non-daily use was related to use because e-cigs are less toxic than cigarettes (RR=2.80, 95% CI=1.75-4.50). More daily users reported use to quit smoking compared with either non-daily or discontinued users (53.3% vs. 12.2% and 13.3%, respectively; p<0.05). Among current users, 72.3% used for enjoyment, compared with 42.9% of discontinued users (p<0.05). DISCUSSION: In contrast to adults, who often report e-cig use to quit smoking, young people are less likely to use for this reason. The exception was daily e-cig users, who often reported use for quitting/reduction of smoking. Rather, college students report usage reasons related to affect (e.g. enjoyment). Overall, enjoyment was reported more often than was use for quitting smoking; affective reasons likely play a role in the popularity of e-cigs and should be considered in future assessments of e-cig users.

Risky behaviors, e-cigarette use and susceptibility of use among college students.

BACKGROUND: Since 2007, there has been a rise in the use of electronic cigarettes (e-cigarettes). The present study uses cross-sectional data (2013) to examine prevalence, correlates and susceptibility to e-cigarettes among young adults. METHODS: Data were collected using an Internet survey from a convenience sample of 1437, 18-23 year olds attending four colleges/universities in Upstate New York. Results were summarized using descriptive statistics; logistic regression models were analyzed to identify correlates of e-cigarette use and susceptibility to using e-cigarettes. RESULTS: Nearly all respondents (95.5%) reported awareness of e-cigarettes; 29.9% were ever users and 14.9% were current users. Younger students, males, non-Hispanic Whites, respondents reporting average/below average school ability, ever smokers and experimenters of tobacco cigarettes, and those with lower perceptions of harm regarding e-cigarettes demonstrated higher odds of ever use or current use. Risky behaviors (i.e., tobacco, marijuana or alcohol use) were associated with using e-cigarettes. Among never e-cigarette users, individuals involved in risky behaviors or, with lower harm perceptions for e-cigarettes, were more susceptible to future e-cigarette use. CONCLUSIONS: More e-cigarette users report use of another nicotine product besides e-cigarettes as the first nicotine product used; this should be considered when examining whether e-cigarette use is related to cigarette susceptibility. Involvement in risky behaviors is related to e-cigarette use and susceptibility to e-cigarette use. Among college students, e-cigarette use is more likely to occur in those who have also used other tobacco products, marijuana, and/or alcohol.