Acute Respiratory Infections Among Active Component Service Members Who Use Combustible Tobacco Products and/or E-cigarette/Vaping Products, U.S. Armed Forces, 2018-2019.

Smoking is known to contribute to the risk of acute respiratory illness (ARI) and long-term medical conditions but little is known about the acute health effects of e-cigarette/vaping product use. The annual electronic Periodic Health Assessment (ePHA), which includes questions related to smoking and e-cigarette/vaping product use, is a screening tool used by the U.S. Armed Forces to evaluate the health and medical readiness of military members. Based on responses to questions on ePHAs completed in 2018, active component service members (ACSMs) were categorized as e-cigarette/vaping product only users, smoking only, dual-product users (users of both cigarettes and e-cigarette/vaping products), or non-users. ACSMs in the youngest age groups were more likely than their older counterparts to use e-cigarette/vaping products. Unadjusted incidence rates of ARI were higher among e-cigarette/vaping product only users and dual-product users than smokers and nonusers. After adjusting for age, sex, service branch, and military occupation, the incidence rate of ARI among dual-product users was higher than the rate among nonusers; this difference was small but statistically significant. Improved understanding of the health impact of e-cigarette/vaping product use has the potential to inform policy related to use of these products and prevent unnecessary harm.

Update: Incidence of acute gastrointestinal infections and diarrhea, active component, U.S. Armed Forces, 2010-2019.

Laboratory, reportable medical event, and medical encounter data were analyzed to identify cases of acute gastrointestinal (GI) infections caused by Campylobacter, nontyphoidal Salmonella, Shigella, Escherichia coli (E. coli), or norovirus, as well as cases of unspecified gastroenteritis/diarrhea among U.S. active component service members during 2010-2019. Unspecified gastroenteritis/ diarrhea diagnoses accounted for 98.8% of identified incident cases (4,135.1 cases per 100,000 person-years [p-yrs]). Campylobacter was the most frequently identified specific etiology (17.6 cases per 100,000 p-yrs), followed by nontyphoidal Salmonella (12.7 cases per 100,000 p-yrs), norovirus (10.8 cases per 100,000 p-yrs), E. coli (7.5 cases per 100,000 p-yrs), and Shigella (3.2 cases per 100,000 p-yrs). Crude annual rates of norovirus, E. coli, Campylobacter, and Salmonella infections and unspecified gastroenteritits/diarrhea increased between 2010 and 2019 while rates of Shigella infections were relatively stable. Among deployed service members during the 10-year period, only 150 cases of the 5 specific causes of gastroenteritis were identified but a total of 20,377 cases of unspecified gastroenteritis/diarrhea were diagnosed (3,062.9 per 100,000 deployed p-yrs).

Air Evacuation of Service Members for COVID-19 in U.S. Central Command and U.S. European Command From 11 March 2020 Through 30 September 2020.

This report documents the numbers of air evacuations for diagnoses of coronavirus disease 2019 (COVID-19) among U.S. active duty service members (ADSMs) from locations in U.S. Central Command (CENTCOM) and U.S. European Command (EUCOM) areas of responsibility. Counted were COVID-19 evacuations both within and out of each of the theaters from 11 March through 30 September 2020. Of the 186 evacuations originating in CENTCOM, 185 resulted in the patients arriving at Landstuhl in EUCOM and 1 was within theater. A total of 169 of the CENTCOM evacuations took place in June through August 2020 and only 1 occurred in September. Of the 39 air evacuations originating in EUCOM, 38 were intra-theater transfers and 1 was to a CONUS facility. Most (n=32) of the EUCOM evacuations occurred in September. Evacuees were most often members of the Army (71%), enlisted personnel (63%), males (91%), and aged 30 years or older (58%). Among a random sample of 56 evacuees, 20% were asymptomatic. Among those with symptoms, the most common were cough, fatigue, congestion, headache, and sore throat.

Breast Cancer Characteristics in Middle Eastern Women Immigrants Compared With Non-Hispanic White Women in California.

BACKGROUND: Emerging evidence has indicated that Middle Eastern (ME) immigrants might be more likely to be diagnosed with breast cancer at advanced stage, yet have better overall survival than nonimmigrant non-Hispanic whites (NHW). This study aims to analyze the association between ME immigration status and breast cancer stage at diagnosis and survival. METHODS: Using the California Cancer Registry, a total of 343 876 women diagnosed with primary in situ or invasive breast cancers were identified during 1988-2013. Multinomial logistic regression models were fitted to evaluate the risk of in situ and nonlocalized breast cancer stage in comparison with localized breast cancer among first-generation ME immigrants, second- or subsequent-generation ME immigrants, and NHW. Cox proportional hazard models were applied to calculate hazard ratios (HRs) with their 95% confidence intervals (CIs) for breast cancer mortality among the three population groups with invasive primary breast cancer. RESULTS: First-generation ME immigrants had higher odds of being diagnosed with a nonlocalized stage (vs localized) than NHW (odds ratio [OR] = 1.17, 95% CI = 1.09 to 1.26). Second- or subsequent-generation ME immigrants also had higher odds of being diagnosed with a nonlocalized stage (vs localized) than NHW (OR = 1.31, 95% CI = 1.20 to 1.43). First-generation ME immigrants were 11% less likely to die from breast cancer than NHW (HR = 0.89, 95% CI = 0.82 to 0.97). CONCLUSIONS: First-generation ME immigrants had higher breast cancer survival despite being diagnosed at a nonlocalized breast cancer stage at diagnosis when compared with NHW. Screening interventions tailored to this ME immigrant group need to be implemented.

Cancer risk in different generations of Middle Eastern immigrants to California, 1988-2013.

The objective of this study is to compare cancer risk among different generations of Middle Eastern immigrants (ME) and non-Hispanic whites (NHW) in California between 1988 and 2013. We used data from the California Cancer Registry to identify invasive primary incident cancer cases in three population groups: (i) first-generation ME immigrants, (ii) second- or subsequent-generations ME immigrants, and (iii) NHW. Proportional incidence ratio (PIR) was used to compare cancer risk of the 15 selected most common cancers in the 3 population groups taking into consideration time since immigration for first-generation ME immigrants. First generation ME immigrants were more likely to be at increased risk of stomach (PIR= 3.13) and hepatobiliary (PIR = 2.27) cancers in females and thyroid (PIR = 2.19) and stomach (PIR = 2.13) cancers in males in comparison with NHW. Second- or subsequent-generations ME immigrants were at increased risk of thyroid cancer (PIR = 1.43 in females and 2.00 in males) in comparison with NHW, and malignant melanoma cancer (PIR = 4.53 in females and 4.61 in males) in comparison with first-generation ME immigrants. The risk levels of breast, thyroid and bladder cancers in ME first generation were significantly higher compared to NHW regardless of time spent in the United States suggesting the role of genetic predisposition, and/or cultural characteristics associated with these cancers. The results suggest that differences in cancer risk between ME first-generation immigrants and NHW change in second or subsequent generations, approaching the risk level of NHW and indicating the impact of acculturation in this immigrant population.