Publication year
2012
Citation Title
Smokeless tobacco use related to military deployment, cigarettes and mental health symptoms in a large, prospective cohort study among US service members.
Journal Name
Addiction
Journal Volume
107
Issue Number
5
Page Numbers
983-994
DOI
10.1111/j.1360-0443.2011.03737.x
Summary
Survey data from the Millennium Cohort Study were utilized to examine rates of smokeless tobacco initiation and persistence in relation to deployment, combat, occupation, and mental health symptoms. Initiation and continuation of smokeless tobacco use were associated with deployment frequency, exposure to combat, and stress.
Key Findings
Exposure to combat and having had more frequent deployments increased the odds of smokeless tobacco initiation and persistence.
Smokeless tobacco initiation was associated with stress-related PTSD symptoms, as well as alcohol use and smoking nicotine.
Younger, male, less educated populations and those who served in the Army or Marine Corps were more likely to begin smokeless tobacco use.
Initiation of smokeless tobacco use was more likely for those who smoked nicotine (either currently or in the past) than for Service members who had never smoked tobacco.
Implications for Program Leaders
Offer tobacco prevention and treatment that address issues of multiple deployments, combat exposure, alcohol consumption, and PTSD symptoms
Provide prevention and intervention workshops for smokeless tobacco that target high-risk groups, including Service members who smoke nicotine products
Disseminate information regarding the negative effects of smoking on health outcomes
Implications for Policy Makers
Advise that current tobacco smoking cessation resources be expanded to include smokeless tobacco
Support programs that address tobacco cessation among Service members, including smokeless tobacco
Implement rewards for reduction in the use of smokeless tobacco
Methods
The current study is a prospective cohort study utilizing data from the Millennium Cohort Study.
Participants completed both baseline (July 2001–June 2003) and follow-up (June 2004–January 2006) self-report questionnaires.
Smokeless tobacco use was measured with a single-item question that asked whether the participant had used smokeless tobacco in the past year.
Participants
The study sample included 45,272 Service members.
Seventy-three percent of participants were male; the average age was 35 years (SD = 9); and 74% were enlisted personnel and 26% were officers.
Forty-eight percent of participants were Army, 30% Air Force, 18% Navy or Coast Guard, and 4% Marine Corps.
The ethnic composition of the sample was: 72% White, 12% Black, 8% Asian-American, and 8% other.
Limitations
Participants who remained in the study for the post-test may differ from those who withdrew, which may bias results.
Tobacco use, psychiatric diagnosis, alcohol use, and PTSD symptoms were measured by self-report questionnaires, which can be subject to reporting bias.
The majority of participants were male which may reduce the generalizability of results to female Service members.
Avenues for Future Research
Assess the potential risk for mild traumatic brain injury to increase the risk for smokeless tobacco initiation and persistence
Examine the experiences of the spouses of tobacco using Service members, considering the influence of partners on tobacco use and partners’ potential role in helping Service members quit using tobacco products
Replicate the current study with a more representative sample based on gender and ethnicity
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Aims: To characterize smokeless tobacco initiation and persistence in relation to deployment, combat, occupation, smoking and mental health symptoms. Design: Prospective cohort, utilizing self-reported survey data from the Millennium Cohort Study. Setting: US Military Service Members in all branches including active duty, reserve and National Guard. Participants: Population-based sample of 45 272 participants completing both baseline (July 2001–June 2003; n = 77 047) and follow-up (June 2004–January 2006; n = 55 021) questionnaires (follow-up response rate = 71.4%). Measurements: Self-reported smokeless tobacco initiation and persistence. Findings: Over the study period, 72.4% did not deploy, 13.7% deployed without combat exposures and 13.9% deployed with combat exposures, while 1.9% were smokeless tobacco initiators and 8.9% were persistent users. The odds of initiation were greater for deployers with combat exposure [odds ratio (OR), 1.76; 95% confidence interval (CI), 1.49–2.09], deployers without combat exposure (OR, 1.31; 95% CI, 1.07–1.60) and those who deployed multiple times (OR, 1.67; 95% CI, 1.31–2.14), as well as in smoking recidivists/initiators (OR, 4.65; 95% CI, 3.82–5.66) and those reporting post-traumatic stress disorder symptoms (OR, 1.54; CI, 1.15–2.07). A similar pattern for higher odds of persistent use was observed for deployment and combat exposure, but not for smoking and mental health symptoms. Military occupation was not significantly associated with initiation or persistence. Conclusions: Deployment and combat exposure in the US military are associated with increased risk of smokeless tobacco initiation and persistence while smoking and symptoms of post-traumatic stress disorder increase the odds for initiation. Research is needed on aspects of military service amenable to the reduction or prevention of tobacco consumption.
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