Acceptance of Web-based personalized feedback: user ratings of an alcohol misuse prevention program targeting U.S. Marines.

The use of Web-based programs for a variety of health education, risk reduction, and health promotion purposes can be a valuable tool in the effort to improve the health of a population. Providing theory-based personalized feedback through such a method can be particularly useful in alcohol misuse prevention efforts. A brief alcohol use feedback program was developed for members of the U.S. Marine Corps, and user-satisfaction ratings were collected from 167 participants. Approximately 44% of the sample found the program to be useful or very useful, and 46% of the sample reported that they were likely or very likely to recommend the Web site to others. The Web-based format with tailored responses was preferred by 85% of respondents over other more traditional methods of alcohol training, and 80% of participants felt that the feedback was appropriate for Marines in their community. Significantly higher usefulness, likelihood of recommending the program to others, and overall ratings of the program were reported among younger and nonheavy-drinking participants (p < .05). Results indicate that this computerized assessment and feedback program is a promising mechanism with which to provide personalized alcohol misuse prevention information.

A measure of the intensity of response to alcohol in a military population.

Heavy drinking and associated problems are relatively common in young men, including those in a military setting. This article explores characteristics of alcohol intake and associated difficulties and their relationship to a self-report of the usual intensity of response to alcohol in a sample of U.S. Marines. Two questionnaires related to demography and alcohol use histories, along with a simple, 12-item self-report measure of the usual number of drinks to experience an effect (the Self-Rating of the Effects of Alcohol, SRE) were administered to 1320 U.S. Marines. The sample had an average age of 22 years, 78% were Caucasian, and 92% were enlisted personnel. The relationships and correlations among drinking characteristics and problems and the usual number of drinks for an effect were determined. These subjects drank an average of 6 days per month, consuming an average of almost six drinks per drinking day, and reported more than three times per month in which they consumed six or more drinks per occasion. Consistent with studies of other populations, the SRE measures of intensity of response to alcohol showed a positive correlation with both drinking practices and problems, with the latter remaining significant even after controlling for recent drinking practices. The prodigious level of alcohol intake and associated problems, along with the SRE scores, indicate that the Marine Corps personnel are at especially high risk for alcohol-related life problems. These data also support the potential usefulness of the SRE both in identifying individuals likely to have more severe alcohol profiles and in educating individuals regarding their levels of risk for alcohol abuse and dependence.

Total quality leadership in the U.S. Navy: effective for health promotion activities?

BACKGROUND: Although the U.S. Navy mandated Total Quality Leadership (TQL) as a management strategy throughout its medical department in the early 1990s, it was unknown to what extent it was being used for health promotion activities and, if so, how effectively. METHODS: A brief mail survey of 204 Navy commands supplemented by 97 telephone interviews to TQL-for-health-promotion-using commands and nonusing controls provided worksite information on TQL implementation. Responses from a Navywide health and fitness survey provided perceptions and health behavior attitudes from the individuals at commands. RESULTS: A total of 32% of commands surveyed had used TQL specifically for improving health- and fitness-related processes and outcomes between 1991 and 1995. Participants at commands that had used TQL for health- and fitness-related processes reported a higher importance of good health (P < 0.05) and were more certain that they would reach and or maintain their ideal weight (P < 0.05) than participants at non-TQL commands. However, there were no significant differences in perceptions of command support for health and fitness between TQL and non-TQL commands. CONCLUSIONS: Several factors and organizational arrangements that were pertinent to the development and practice of TQL in the Navy were identified. The use of TQL specifically for health promotion was not consistently related to health-related perceptions or health behavior attitudes.

Longitudinal trends and gender differences in physical fitness and lifestyle factors in career U.S. Navy personnel (1983-1994)

This study examines long-term health and physical readiness trends in the U.S. Navy. We mailed lifestyle questionnaires to all participants in baseline studies between 1983 and 1989 who were still on active duty in 1994. Commands provided body composition and physical readiness test scores for the participants. Two longitudinal cohorts were created: an 8-year sample (N = 640) with matched data from 1986, 1989, and 1994; and an 11-year sample (N = 1,576), with data from 1983 and 1994. Analyses of both cohorts revealed significant improvements in cardiovascular fitness, muscle strength, exercise, lean body mass, dietary habits, and sleep, as well as significant decreases in tobacco and alcohol use and job stress. However, hypertension rates, percentage of body fat, and body mass index increased over time. Women's scores were significantly better than men's on a number of factors. Overall, these findings suggest that the Navy's health promotion efforts have had a significant positive effect on the fitness and health behaviors of career Navy men and women.

Changes in smoking prevalence following a strict no-smoking policy in U.S. Navy recruit training.

This study examined 449 U.S. Navy recruits who reported that they were current smokers upon entering Navy recruit training. Recruits were prohibited from using tobacco for the duration of the 8 weeks of basic training. Participants completed tobacco surveys at entry into the Navy, upon graduation from recruit training, and after 1 year of service. Forty percent of the smokers at entry into the Navy changed their classification to former smokers at the end of recruit training. At the 1-year follow-up, 19% of the initial smokers classified themselves as former smokers. Multivariate logistic regression analyses indicated that having a higher intent to quit was predictive of reporting oneself as a former smoker at recruit training graduation. Smoking fewer cigarettes per day at entry into the Navy and more years of regular tobacco use were predictive of reporting oneself as a former smoker at the 1-year follow-up. Findings from this study suggested a meaningful impact of the Navy's no-smoking policy during recruit training in reducing smoking prevalence.

Navy health care provider attitudes and practices concerning patient tobacco use.

This study surveyed 2,287 U.S. Navy health care providers (HCPs) regarding patient-care practices and attitudes related to tobacco use. Almost 80% of HCPs reported that they usually asked new patients about tobacco use. Of 11 recommended practices, two-thirds to three-quarters of HCPs engaged in only 4 behaviors with most or all of their tobacco-using patients: advise patients to stop, advise pregnant users of health risks to the fetus, inform patients of benefits of quitting, and explain dangers of using tobacco. Other recommended cessation strategies were not performed regularly (e.g., assist patients in setting quit date, develop cessation plan, provide self-help materials, make referrals to cessation programs, prescribe nicotine gum, or arrange follow-up visits). It is recommended that concerted efforts he made to train all military HCPs (e.g., physicians, dentists, nurse practitioners, and physician assistants) to use the National Cancer Institute's "Four A's" approach for patient tobacco cessation, and that strong organizational support to implement these procedures be provided.

Tobacco use and smoking policy perceptions onboard an aircraft carrier.

Prior to implementing a shipwide no-smoking policy, the crew of U.S.S. Theodore Roosevelt (CVN 71) participated in a voluntary survey on tobacco-related matters. The survey queried participants on their tobacco-use history, subjective exposure to environmental tobacco smoke (ETS), and attitudes related to smoking policy prior to the cessation of all smoking activities aboard ship. Of the 2,221 crewmembers who participated (74% response rate), 36% classified themselves as current cigarette smokers. Nonsmokers estimated their general exposure to ETS between "low" to "moderate." Of all participants, 57% were in favor of the current restricted smoking policy, including 18% of currently smoking personnel. Follow-up research is being conducted to assess the long-term impact of the no-smoking policy on changes in attitudes regarding policy, tobacco-use rates, and ETS exposure.

Tobacco use prevention and cessation programs in the U.S. Navy.

A representative sample of 406 U.S. Navy commands, including all medical treatment facilities, was surveyed in 1990 about their activities and programs to prevent the use of tobacco and promote smoking cessation during the preceding year. The vast majority of Navy commands (86 percent) provided some type of tobacco cessation educational materials or programs. However, the most common activities typically were rated as only "somewhat useful" in helping to curb tobacco use. Almost one-half of all commands offered psychological or behavioral cessation programs. Survey respondents estimated that approximately one-third of those persons who attended such a program stopped their tobacco use and nearly one-half reduced their tobacco use as a result of the program. Over-the-counter smoking cessation aids were not widely available at Navy exchange stores, individual commands, or medical treatment facilities. Furthermore, only 61 percent of all commands reported that they had a written policy or instruction regarding tobacco use. Only about one-third of medical treatment facilities had a routine system for identifying tobacco users by glancing at their medical records. However, it was estimated that 80 percent of medical treatment facility physicians routinely asked their patients about their tobacco use. The authors discuss the need for a more active Navy approach in prevention and cessation efforts and a routine system for identifying tobacco users from their medical records. In addition, inequities in cessation efforts were found among command subgroups.