Tobacco use during military deployment.

INTRODUCTION: Tobacco use among military personnel is associated with significant health care expenditures, lost productivity, and compromised combat readiness. The prevalence remains high among military personnel and may increase in high-risk situations such as deployment. We assessed the prevalence of tobacco use across the deployment cycle, changes in tobacco use (nonuse, continued use, initiation/harm escalation, cessation/harm reduction) during deployment, and the impact of deployment history on tobacco use. METHOD: Cigarette smoking, smokeless tobacco (ST) use, and dual tobacco use were evaluated among 278U.S. Air Force Security Forces personnel undertaking a 1-year deployment to a high-threat combat environment. Multinomial regression was used to examine prediction of tobacco use patterns both cross-sectionally and longitudinally. RESULTS: More than half (53%-63%) of all Security Forces used tobacco at all stages of the deployment cycle. Individual tobacco use trajectories showed significant differences in prevalence rates of initiation/harm escalation and cessation/harm reduction when comparing the transition from predeployment to the deployed environment versus returning to postdeployment status. Airmen who had deployed more than once previously had a higher likelihood of using ST use at predeployment and engaging in dual tobacco use during deployment. CONCLUSIONS: Findings suggest the potential benefit of targeted or universal interventions at each stage of the deployment cycle to reduce the onset, maintenance, or escalation of tobacco use behaviors in the U.S. military.

Development of a comprehensive health-related needs assessment for adult survivors of childhood cancer.

PURPOSE: Examine the construct validity, stability, internal consistency, and item-response performance of a self-report health needs assessment for adult survivors of childhood cancer. METHODS: A 190-item mailed survey was completed by 1,178 randomly selected (stratified on age, diagnosis, time since diagnosis) Childhood Cancer Survivor Study participants (mean age, 39.66 [SD 7.71] years; time since diagnosis, 31.60 [SD 4.71] years). Minorities and rural residents were oversampled at a 2:1 ratio. RESULTS: The final instrument included 135 items comprising nine unidimensional subscales (Psycho-emotional, Health System Concerns, Cancer-Related Health Information, General Health, Survivor Care and Support, Surveillance, Coping, Fiscal Concerns, and Relationships). Confirmatory factor analysis (n = 1,178; RMSEA = 0.020; 90 % CI = 0.019-0.020; CFI = 0.956; TLI = 0.955) and person-item fit variable maps established construct validity. Across subscales, Cronbach's alpha was 0.94-0.97, and the 4-week test-retest correlations were 0.52-0.91. In a Rasch analysis, item reliability was 0.97-0.99, person reliability was 0.80-0.90, and separation index scores were 2.00-3.01. Significant subscale covariates of higher need levels included demographics, diagnosis, and treatment exposures. CONCLUSIONS: The Childhood Cancer Survivor Study Needs Assessment Questionnaire (CCSS-NAQ) is reliable and construct-valid, has strong item-response properties, and discriminates need levels. IMPLICATIONS FOR CANCER SURVIVORS: The CCSS-NAQ potentially can be used to: (1) directly assess adult childhood cancer survivors' self-reported health-related needs, (2) identify individuals or subgroups with higher-level needs, (3) inform prevention and direct intervention strategies, and (4) facilitate prioritization of health-care resource allocation.

Energy underreporting in African-American girls: a longitudinal analysis.

BACKGROUND: The objective of this study was to determine the longitudinal prevalence and predictors of dietary underreporting in African-American preadolescent girls and the association of baseline dietary underreporting with changes in BMI over a 2-year period as part of the Girls health Enrichment Multi-site Studies (GEMS). METHODS: Energy was summarized at baseline, 12 months, and 24 months and computed as a 3-day average of 24-hour dietary recalls. Physical activity was assessed by accelerometer, basal metabolic rate was estimated using the World Health Organization's prediction equation, and caloric underreporting was based on the Goldberg equation. RESULTS: We classified 48% of the girls at baseline as underreporters; with underreporting increasing over time (61% at 12 months; 66% at 24 months). Intervention treatment assignment did not affect the prevalence of underreporting over time. The consistency of underreporting (or not) stayed stable over time. Across all three time points, a higher BMI predicted underreporting. Baseline dietary underreporting and baseline BMI were found to be the major predictors of change in BMI, whereas baseline dietary variables did not predict change in BMI. CONCLUSIONS: Dietary underreporting was extremely common in this sample of AA preadolescent girls and predictive of change in BMI. Given the magnitude and consistency of dietary underreporting along with the fact that no dietary variables predicted change in BMI, measurement of dietary intake in preadolescents, even with sophisticated measurement methodologies, appears biased. The best use of dietary recalls may not be to estimate dietary intake but rather to determine underreporting.

Family context as it relates to weight-related behaviors in preadolescent African American girls.

OBJECTIVE: To examine family context in relation to body image, weight concerns, and weight control behaviors in preadolescent African American girls. METHODS: Cross-sectional baseline data were analyzed from 303 African American girls 8 to 10 years old and a caregiver in the Girls health Enrichment Multi-site Studies Phase 2(GEMS), an obesity prevention intervention trial. RESULTS: Fruit, juice, and vegetable accessibility and family support for healthy eating and physical activity were significantly related to girls' body image and weight control behaviors. CONCLUSIONS: A comprehensive understanding of family factors may improve future programs aimed at preadolescent girls.

Drinking and driving and riding with an alcohol impaired driver among United States Air Force recruits.

OBJECTIVE: To identify the prevalence and correlates of binge drinking, driving after drinking, and riding in a vehicle with a driver who had consumed alcohol in US Air Force active duty recruits. METHODS: A military cohort (N = 31,108; 25.1% female) was analyzed to identify variables associated with binge drinking, drinking and driving, and riding with a driver who had consumed alcohol. RESULTS: Results indicated that 53 percent (including 45% of those under the legal drinking age) reported alcohol use in the month prior to entering basic military training (BMT). Thirty-eight percent of all active duty recruits reported binge drinking (ie, consuming 5 or more drinks on a single occasion) at least one time in the past 30 days. Nearly 1 in 4 (23%) reported 1 to 3 episodes of binge drinking. Three percent of reported alcohol users drove after consuming five or more drinks, and 9 percent rode as a passenger in a vehicle with a driver who had been drinking heavily. CONCLUSIONS: Several demographic, behavioral, and attitudinal correlates of risky drinking patterns were identified. Prevention efforts are needed to address the implications of these findings because they influence the health, safety, and military readiness of active duty personnel.

Impact of differing definitions of dual tobacco use: implications for studying dual use and a call for operational definitions.

INTRODUCTION: Concomitant use of two forms of tobacco is an increasing public health concern, yet there is little consensus regarding a consistent definition of so-called "dual use." We defined dual use as cigarette and smokeless tobacco (ST) consumption with either product used daily or nondaily. METHODS: We analyzed a cohort of 36,013 Air Force recruits. We categorized dual tobacco use across 2 dimensions, type of tobacco products (cigarettes, ST, or others), and the frequency of use (daily vs. nondaily). We determined how varying the definition impacted the prevalence estimates and evaluated the prevalence estimate based on our recommended definition of dual use. Multivariate logistic regression analysis was used to evaluate the risk profile of dual users of ST and cigarettes versus mono users of ST and mono users of cigarettes. RESULTS: Varying definitions of dual use vary prevalence estimates 50-fold (0.5%-25.3%). Including only ST and cigarettes narrows the prevalence estimate to less than 4-fold (2.0%-9.7%). Dual users are more likely to be young Caucasian males, with lower education, and from families with relatively higher incomes. Compared with mono users, dual users of cigarettes and ST have a distinct pattern of risk profiles. CONCLUSIONS: Depending on the definition of dual use, markedly different prevalence and risk profiles are observed. Dual users of ST and cigarettes are a unique group of tobacco users. We propose a common definition of dual use to advance our understanding of this unique group.

Tobacco use harm reduction, elimination, and escalation in a large military cohort.

OBJECTIVES: We evaluated changing patterns of tobacco use following a period of forced tobacco abstinence in a US military cohort to determine rates of harm elimination (e.g., tobacco cessation), harm reduction (e.g., from smoking to smokeless tobacco use), and harm escalation (e.g., from smoking to dual use or from smokeless tobacco use to smoking or dual use). METHODS: Participants were 5225 Air Force airmen assigned to the health education control condition in a smoking cessation and prevention trial. Tobacco use was assessed by self-report at baseline and 12 months. RESULTS: Among 114 baseline smokers initiating smokeless tobacco use after basic military training, most demonstrated harm escalation (87%), which was 5.4 times more likely to occur than was harm reduction (e.g., smoking to smokeless tobacco use). Harm reduction was predicted, in part, by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history, and risk-taking. CONCLUSIONS: When considering a harm reduction strategy with smokeless tobacco, the tobacco control community should balance anticipated benefits of harm reduction with the risk of harm escalation and the potential for adversely affecting public health.

The Memphis Girls' health Enrichment Multi-site Studies (GEMS): an evaluation of the efficacy of a 2-year obesity prevention program in African American girls.

OBJECTIVE: To determine the efficacy of a 2-year obesity prevention program in African American girls. DESIGN: Memphis GEMS (Girls' health Enrichment Multi-site Studies) was a controlled trial in which girls were randomly assigned to an obesity prevention program or alternative intervention. SETTING: Local community centers and YWCAs (Young Women's Christian Associations) in Memphis, Tennessee. PARTICIPANTS: Girls aged 8 to 10 years (N = 303) who were identified by a parent or guardian as African American and who had a body mass index (BMI) at or higher than the 25th percentile for age or 1 parent with a BMI of 25 or higher. INTERVENTIONS: Group behavioral counseling to promote healthy eating and increased physical activity (obesity prevention program) or self-esteem and social efficacy (alternative intervention). MAIN OUTCOME MEASURE: The BMI at 2 years. RESULTS: The BMI increased in all girls with no treatment effect (obesity prevention minus alternative intervention) at 2 years (mean, 0.09; 95% confidence interval [CI], -0.40 to 0.58). Two-year treatment effects in the expected direction were observed for servings per day of sweetened beverages (mean, -0.19; 95% CI, -0.39 to 0.09), water (mean, 0.21; 95% CI, 0.03 to 0.40), and vegetables (mean, 0.15; 95% CI,-0.02 to 0.30), but there were no effects on physical activity. Post hoc analyses suggested a treatment effect in younger girls (P for interaction = .08). The mean BMI difference at 2 years was -2.41 (95% CI, -4.83 to 0.02) in girls initially aged 8 years and -1.02 (95% CI, -2.31 to 0.27) in those initially aged 10 years. CONCLUSIONS: The lack of significant BMI change at 2 years indicates that this intervention alone is insufficient for obesity prevention. Effectiveness may require more explicit behavior change goals and a stronger physical activity component as well as supportive changes in environmental contexts.

Trial design: The St. Jude Children's Research Hospital Cancer Survivors Tobacco Quit Line study.

Nearly, one-fifth of childhood cancer survivors (CCSs) smoke cigarettes. Because CCSs are already at greater medical smoking-related risks, targeting them for smoking cessation efforts is a high priority. One of the major challenges with smoking cessation in CCSs is how to reach such a geographically dispersed population. This study aims to demonstrate that these challenges can be overcome through the use of telephone-based tobacco quit lines (QLs). This report describes the design of the St. Jude Cancer Survivor Tobacco QL study, which is a randomized controlled clinical trial that will examine the long-term (1-year) efficacy of a counselor initiated vs. participant initiated tobacco QL with adjunctive nicotine replacement therapy (NRT) in both groups. Participants (N=950) will be recruited nationally and randomly assigned to one of the two interventions. The counselor initiated intervention includes six scheduled telephone sessions of a behavioral intervention and provision of 8 weeks of NRT. The participant initiated intervention allows the participant to call the QL at their convenience, but includes the same six telephone sessions and provision of 2 weeks of NRT. Both groups will receive two follow-up phone calls at 8 weeks and 1 year after enrollment to assess their smoking status. The primary outcome measure is cotinine-validated self-reported smoking abstinence at 1-year follow-up. Results from this study will provide the first evidence about the efficacy of intensive QL cessation intervention in this high-risk population. Such evidence can lead as well to the dissemination of this intervention to other medically compromised populations.

Do we believe the tobacco industry lied to us? Association with smoking behavior in a military population.

Despite the dangers of smoking, tobacco companies continue to impede tobacco control efforts through deceptive marketing practices. Media campaigns that expose these practices have been effective in advancing anti-industry attitudes and reducing smoking initiation among young people, yet the association between knowledge of industry practices and smoking cessation and relapse has not been studied. In a large military sample entering Air Force Basic Military Training (BMT), where tobacco use is prohibited, we investigated (i) the prevalence of agreement with a statement that tobacco companies have misled the public about the health consequences of smoking and (ii) the association of this acknowledgement with smoking status upon entry into BMT (N = 36 013). At baseline, 56.6% agreed that tobacco companies have been deceptive, and agreement was a strong predictor of smoking status [smokers less likely to agree, odds ratio (OR) = 0.39, P < 0.01]. At 12-month follow-up, we examined the association between industry perception at baseline and current smoking status (N = 20 672). Recruits who had been smoking upon entry into BMT and who had acknowledged industry deception were less likely to report current smoking (OR = 0.84, P = 0.01). These findings suggest that anti-industry attitudes may affect smoking relapse following cessation.

Self-perception and body image associations with body mass index among 8-10-year-old African American girls.

OBJECTIVES: The purpose of this study was to examine relationships among body mass index (BMI), self-perceptions, and body image discrepancy in African American (AA) girls. METHODS: Baseline self-perception and BMI data were collected by trained staff from 303 preadolescent AA girls participating in the girls health enrichment multi-site studies. Correlations and multivariable logistic regression analyses were performed to identify relationships of BMI with self-perception factors. RESULTS: Girls with a BMI at or above the 85th percentile were more likely to have greater body image discrepancy and participate in weight control behaviors than girls with a BMI below the 85th percentile. Body image discrepancy was not related to self-esteem, but was positively correlated with physical activity self-concept and self-efficacy, and diet self-efficacy. CONCLUSION: Girls with higher BMI had greater body image discrepancy and were less confident in abilities to be active and eat healthy. Findings may inform the development of obesity interventions for preadolescents.

Relationship between smoking status and body weight in a military population of young adults.

The purpose of the present study was to determine the association between smoking and body weight in a cohort of young U.S. Air Force recruits (mean age=20 years) enrolled in basic military training (N=35986). Twenty-two percent of recruits smoked daily prior to basic military training (n=8087) and were compared to never smokers, former smokers, and experimental or nondaily smokers. A three-way interaction among smoking status, gender and ethnicity suggested a small effect for daily smoking among White male recruits only and no significant differences for female recruits or members of any other ethnic group. Although there was a statistically significant relationship between smoking and body weight in White males, the effect size was approximately 1 kg. These results suggest that the energy balance differences in body weight between young smokers and nonsmokers are minimal and that it would take decades to accrue the differences typically seen in adult smokers.

Memphis Girls health Enrichment Multi-site Studies (GEMS): Phase 2: design and baseline.

Obesity prevalence is increasing in the U.S., especially among children and minority populations. This report describes the design and baseline data of the ongoing Girls health Enrichment Multi-site Studies (GEMS) trial (Memphis site), which is testing the efficacy of a 2-year family-based intervention to reduce excessive increase in body mass index (BMI). This randomized, controlled trial conducted at community centers in Memphis, Tennessee requires major measurements at baseline and at 12 and 24 months post-randomization. The participants are healthy African-American girls and one parent/caregiver of each girl. Participating girls are of ages 8-10 years, with BMI>or=25th percentile of the CDC 2000 growth charts or with one overweight or obese parent/caregiver (BMI>or=25 kg/m(2)). The active intervention is designed to prevent excessive weight gain by promoting healthy eating habits and increasing physical activity. An alternative intervention (comparison group) promotes general self-esteem and social efficacy. The main outcome measure is the difference between the two treatment groups in the change in BMI at 2 years. Three hundred and three girls have been randomly assigned to receive the test intervention (n=153) or the alternative intervention (n=150). The two groups do not differ in baseline characteristics. At the time of enrollment, the mean age was 9 years, the mean BMI was 22 kg/m(2) (mean BMI percentile=77 th), and 41% were overweight (BMI>/=95th percentile using CDC 2000 growth charts). Participants' intake of fruits and vegetables (1.3 serving/day) and fats (36% kcal), and their participation in moderate-to-vigorous physical activity (20 min/day), did not meet national recommendations. The GEMS obesity prevention intervention targets improved diet and increased physical activity to reduce excessive weight gain in healthy African-American girls of ages 8-10.

Binge drinking, drinking and driving, and riding with a driver who had been drinking heavily among Air National Guard and Air Force Reserve Personnel.

Heavy drinking is associated with significant health problems and increased risk for injury and death. Although several studies have investigated alcohol use among active duty and civilian populations, little is known about the alcohol use patterns of reserve personnel. This study examined the prevalence and correlates of binge drinking, driving after drinking, and riding in a vehicle with a driver who had consumed alcohol among 4,836 guardsmen and reservists who were taking part in basic military training (mean age = 21.3 years; 29.4% female). Forty-six percent reported one or more binge drinking episodes in the month before basic military training. Four percent drove after consuming five or more drinks, while 8.9% rode as a passenger with a driver who had been drinking heavily. Several demographic, behavioral, and attitudinal correlates of risky drinking patterns were identified. Findings have potentially important implications for the health, safety, and military readiness of reserve personnel.

Prevalence and correlates of lifetime smokeless tobacco use in female military recruits.

Although considerable research has been conducted on smokeless tobacco (ST) use in males, much less is known about the characteristics of female ST users. The present study examined the prevalence and correlates of lifetime ST use among female Air Force recruits (N=9,087). Participants were surveyed during Basic Military Training regarding their history of tobacco use and other health risk behaviors. Although the prevalence of current ST use was low (<1%; n=34), 6.6% (n=599) had tried ST. Multivariate logistic regression analysis indicated that lifetime ST use was related to ethnicity, with Native Americans and Whites being most likely to have tried ST. Additional correlates of lifetime ST use included post-high-school education (OR=1.26, 95% CI=1.03-1.55); weekly acts of road rage (OR=1.48, 95% CI=1.06-2.06); frequent arguing (OR=1.71, 95% CI=1.18-2.48); daily or near-daily alcohol consumption (OR=1.71, 95% CI=1.03-2.82); current cigarette use (OR=3.80, 95% CI=2.42-5.94); and experimental use of cigars (OR=4.01, 95% CI=3.22-5.01), pipes (OR=2.23, 95% CI=1.64-3.03), and clove cigarettes (OR=1.23, 95% CI=1.01-1.49), all of which were associated with an increased likelihood of ST use. Results suggest that female recruits who have ever used ST engage in a variety of risk behaviors including use of other tobacco products and alcohol, as well as additional harmful behaviors.

Correlates of adherence with transdermal nicotine.

This correlational study examined the adherence rates of transdermal nicotine (TN) use among a population of males and females 18 years of age and older (N = 619) who received varying levels of behavioral intervention. Rates of patch adherence were assessed for demographic (e.g., gender, ethnicity, and age), income-, smoking- [e.g., baseline carbon monoxide (CO), nicotine dependence, and follow-up quit status], and treatment-related (e.g., condition, and drop status) variables. Loglinear and logistic regression analyses were performed to assess adherence rates. Results indicated that male gender [chi2(2, n = 485) = 20.39, P = .038], not dropping out of the study [chi2(2, n = 485) = 13.94, P < .001], and intensive treatment (compared to the standard care) [chi2(4, n = 485) = 14.96, P = .005] were associated with greater adherence to TN. Furthermore, patch adherence was associated with quit status at 6 months (OR = 2.47, CI = 1.56-3.91, P < .001) and 12 months (OR = 2.12, CI = 1.34-3.37, P = .001). Complete and partial patch adherence (compared to minimal/no adherence) were associated with a greater number of telephone intervention contacts completed (OR = 2.621, CI = 1.421-4.832, P = .002). Noteworthy however, was the lack of association between level of income and patch adherence. These findings suggest characteristics of those more and less likely to adhere to TN in research and clinical settings.