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CORK Bibliography: Military

51 citations. January 2003 to present

Prepared: March 2008

[Anon]. Drug addiction in America: Challenges and opportunities. (editorial). Military Medicine 168(5): VIII-XII, 2003. (0 refs.)

Ames G; Cunradi C. Alcohol use and preventing alcohol-related problems among young adults in the military. Alcohol Research & Health 28(4): 252-257, 2004. (26 refs.)

Heavy alcohol use is a significant problem in the military. Personnel often use alcohol in an attempt to cope with stress, boredom, loneliness, and the lack of other recreational activities. The easy availability of alcohol, ritualized drinking opportunities, and inconsistent policies contribute to a work culture that facilitates heavy and binge drinking in this population. Prevention strategies such as alcohol use policies combined with campaigns focusing on alcohol deglamorization, personal responsibility, and health promotion currently are being implemented to help reduce heavy alcohol use, but further research is needed to evaluate the effects of these efforts. Understanding the characteristics of military culture that encourage or allow heavy and binge drinking practices also will help in designing effective prevention approaches.

Public Domain

Bell NS; Harford TC; Fuchs CH; McCarroll JE; Schwartz CE. Spouse abuse and alcohol problems among white, African American, and Hispanic US Army soldiers. Alcoholism: Clinical and Experimental Research 30(10): 1721-1733, 2006. (77 refs.)

Background: Prior studies suggest racial/ethnic differences in the associations between alcohol misuse and spouse abuse. Some studies indicate that drinking patterns are a stronger predictor of spouse abuse for African Americans but not whites or Hispanics, while others report that drinking patterns are a stronger predictor for whites than African Americans or Hispanics. This study extends prior work by exploring associations between heavy drinking, alcohol-related problems, and risk for spouse abuse within racial/ethnic groups as well as variations associated with whether the perpetrator is drinking during the spouse abuse incident. Methods: Cases (N=7,996) were all active-duty male, enlisted Army spouse abusers identified in the Army's Central Registry (ACR) who had also completed an Army Health Risk Appraisal (HRA) Survey between 1991 and 1998. Controls (N=17,821) were matched on gender, rank, and marital and HRA status. Results: We found 3 different patterns of association between alcohol use and domestic violence depending upon both the race/ethnicity of the perpetrator and whether or not alcohol was involved in the spouse abuse event. First, after adjusting for demographic and psychosocial factors, weekly heavy drinking (> 14 drinks per week) and alcohol-related problems (yes to 2 or more of 6 alcohol-related problem questions, including the CAGE) were significant predictors of domestic violence among whites and Hispanics only. Also for the white soldiers, the presence of family problems mediated the effect of alcohol-related problems on spouse abuse. Second, alcohol-related problems predicted drinking during a spouse abuse incident for all 3 race groups, but this relation was moderated by typical alcohol consumption patterns in Hispanics and whites only. Finally, alcohol-related problems predicted drinking during a spouse abuse incident, but this was a complex association moderated by different psychosocial or behavioral variables within each race/ethnic group. Conclusions: These findings suggest important cultural/social influences that interact with drinking patterns.

Bell NS; Williams JO; Senier L; Strowman SR; Amoroso PJ. The reliability and validity of the self-reported drinking measures in the Army's Health Risk Appraisal survey. [E-mail: nbell@ssds.net]. Alcoholism: Clinical and Experimental Research 27(5): 826-834, 2003. (41 refs.)

Background: The reliability and validity of self-reported drinking behaviors from the Army Health Risk Appraisal (HRA) survey are unknown. Methods: We compared demographics and health experiences of those who completed the HRA with those who did not (1991-1998). We also evaluated the reliability and validity of eight HRA alcohol-related items, including the CAGE, weekly drinking quantity, and drinking and driving measures. We used Cohen's kappa and Pearson's r to assess reliability and convergent validity. To assess criterion (predictive) validity, we used proportional hazards and logistical regression models predicting alcohol-related hospitalizations and alcohol-related separations from the Army, respectively. Results: A total of 404,966 soldiers completed an HRA. No particular demographic group seems to be over- or underrepresented. Although few respondents skipped alcohol items, those who did tended to be older and of minority race, The alcohol items demonstrate a reasonable degree of reliability, with Cronbach's alpha=0.69 and test-retest reliability associations in the 0.75-0.80 range for most items over 2- to 30-day interims between surveys. The alcohol measures showed good criterion-related validity: those consuming more than 21 drinks per week were at 6 times the risk for subsequent alcohol-related hospitalization, versus those who abstained from drinking (hazard ratio, 6.36; 95% confidence interval=5.79, 6.99). Those who said their friends worried about their drinking were almost 5 times more likely to be discharged due to alcoholism (risk ratio, 4.9; 95% confidence interval=4.00, 6.04) and 6 times more likely to experience an alcohol-related hospitalization (hazard ratio, 6.24; 95% confidence interval=5.74, 6.77). Conclusions: The Army's HRA alcohol items seem to elicit reliable and valid responses. Because HRAs contain identifiers, alcohol use can be linked with subsequent health and occupational outcomes, making the HRA a useful epidemiological research tool. Associations between perceived peer opinions of drinking and subsequent problems deserve further exploration.

Benda BB. Gender differences in the rehospitalization of substance abusers among homeless military veterans. (review). Journal of Drug Issues 34(4): 723-750, 2004. (105 refs.)

This two-year follow-up study of military veterans treated in an inpatient drug treatment program was designed to examine any gender differences in predictors of rehospitalization for substance abuse or other psychiatric disorders. A survey was administered to 310 women and 315 men, involving several ecological predictors that rarely if ever had been investigated. For example, Cox's proportional hazard model indicated that childhood and current sexual and physical abuses were stronger predictors among women, whereas degree of substance abuse, cognitive disorders, aggression, and disadvantageous peer associations were stronger predictors among men. Social service implications of those findings were presented.

Bickford A; Ames G; Moore R. Alcohol policy in the United States Navy. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 101A-101A, 2004. (0 refs.)

Blume AW; Gutierrez CA; Blume AW; Schmaling KB; Stoever CJ; Fonseca C et al. Predictors of aversive alcohol consequences in a military sample. Military Medicine 171(9): 870-874, 2006. (26 refs.)

The purpose of this study was to identify predictors of risky alcohol use and alcohol-related consequences among postdeployment soldiers. Demobilizing soldiers completed an assessment packet that included questions about demographic factors, relationships, stress, and alcohol-related consequences. Significant predictors of greater alcohol-related consequences, as assessed with the CAGE questionnaire, included fewer years of formal education, male gender, not being in an intimate relationship, racial/ethnic minority status, enlisted rank, having been deployed to the continental United States, and greater stress, whereas significant predictors of drinking and driving included male gender, not being in an intimate relationship, and greater stress. Identifying the predictors of alcohol consequences that occur upon demobilization may aid in determining which soldiers are at risk for such consequences before deployment and may help to maintain military readiness.

Boos CJ; Croft AM. Smoking rates in the staff of a military field hospital before and after wartime deployment. Journal of the Royal Society of Medicine 97(1): 20-22, 2004. (19 refs.)

In the past, high rates of cigarette smoking have been reported in the British Armed Forces. We conducted an anonymous questionnaire survey in the 623 employees and attached staff of 34 Field Hospital on their sixth week of deployment to Iraq, in the course of Gulf War II. Information was sought on smoking status before and during the deployment, and self-declared reasons for smoking.556 questionnaires were returned (response rate 89%). The median age of respondents was 33.3 SD 7.9 years (range 18-62) and 61% were male. Before deployment the number of regular smokers was 160 (29%) but it had now risen by 52 to 212 (38%). Of the extra smokers 33 were restarting an old habit but 19 were first-timers. Moreover, those who were regular smokers before deployment increased their daily consumption from a mean of 15 cigarettes to 21.Smoking rates did not differ between clinical and non-clinical staff or between men and women; the rates were lower in officers than in non-officers, and in reservists than in regular Army personnel. The reasons most commonly cited for starting smoking or increasing consumption were boredom, social factors and stress. Few respondents could recall having received smoking-related health education during previous service with the military. Smoking rates in this medical unit increased substantially during the overseas deployment. There were no data on cigarette consumption after return to ordinary duties, so we cannot say whether these effects are short-term or long-term. However, even the pre-existing rate of 42% in regular army personnel is high enough to demand urgent action by an employer.

Bower EA. Use of amphetamines in the military environment. Lancet 362(Supplement S): S18-S19, 2003. (0 refs.)

Use of stimulants in the military environment dates from World War II, but clear guidelines for their use have been developed only recently. As the nature of warfare changes, particularly as the US military moves towards nocturnal warfare and long duration missions, there will be continued pressure to use performance maintenance drugs. Research has been undertaken to document the "performance-enhancing" effects of these drugs, directed towards the ability of amphetamines to enhance one aspect of performance (typically strength or endurance) over a baseline level of maximum effort. Results of these efforts have been mixed, with findings of most published studies suggesting that the performance-enhancing effects of amphetamines are modest at best, and are significant only in individuals performing at a maximum on highly learned tasks. In these studies, doses of amphetamines typically between 10 mg/70 kg and 30 mg/70 kg were used.; side-effects at higher doses were common; and excessive focusing of attention can result in inability to process multiple inputs, possiblydangerous in its own right. After thedisappointing efforts to use amphetamines as ergogenic compounds, investigation turned towards lower doses of amphetamines as performance maintenance agents. The most promising effect of these compounds is on restoration of the level of vigilance during periods of diminished function. Many studies undertaken since the mid 1980s have focused on ability of amphetamines to overcome mental lapses induced by normal circadian rhythms or sleep deprivation. The true value of amphetamines lies in this area. Results of published reports indicate that amphetamines have use in sustained operations. During the Desert Shield/Desert Storm operation in 1990-91. But widespread use of amphetamines has not been without controversy. Present US Navy guidelines require approval of the air wing commander to give amphetamines to aircrews. Two US Air Force pilots have been accused of involuntary manslaughter for an incident in which they dropped bombs on a Canadian unit engaged in a training mission in Afghanistan in 2002. Their defence attorney suggested that the pilots' judgment had been impaired as a result of amphetamine use on the mission. Although the precise role of amphetamines in this mishap will probably never be known, the controversy associated with their use will be ongoing. .

Bray RM; Hourani LL. Substance use trends among active duty military personnel: Findings from the United States Department of Defense Health Related Behavior Surveys, 1980-2005. Addiction 102(7): 1092-1101, 2007. (35 refs.)

Aims: This study was designed to assess trends in cigarette, illicit drug, and heavy alcohol use among active-duty military personnel from 1980 to 2005 and to examine the influence of socio-demographic changes within the military on patterns of substance use. Design Substance use prevalence rates were estimated from cross-sectional data obtained from nine self-report surveys administered to more than 150 000 active-duty service members world-wide over a 25-year period. Direct standardization was used to adjust for socio-demographic changes. Measurements Measures included self-reported cigarette use, illicit drug use and heavy alcohol use in the 30 days prior to the survey. Heavy alcohol use was defined as drinking five or more drinks per typical drinking occasion at least once a week in the past 30 days. Findings Cigarette and illicit drug use among military personnel declined sharply and significantly from 1980 to 1998. Heavy alcohol use decreased in the mid-1980s but was stable from 1988 to 1998. Both cigarette smoking and heavy alcohol use increased significantly between 1998 and 2002 and remained at those levels in 2005. Illicit drug use remained low. Logistic regression analyses indicated that trends were influenced by other factors besides socio-demographic changes across survey years. Conclusions: The military has made notable progress in decreasing cigarette smoking and illicit drug use, but has made less progress in reducing heavy alcohol use. Additional emphasis should be placed on understanding recent increases in substance use and on planning effective interventions and prevention programs to reduce use in this high-risk population.

Caldwell JA; Caldwell JL. Fatigue in military aviation: An overview of US military-approved pharmacological countermeasures. (review). Aviation, Space, and Environmental Medicine 76(7, Supplement S): C39-C51, 2005. (115 refs.)

Uncomfortable working and sleeping environments, high operational tempos, sustained operations, and insufficient staffing make fatigue a growing concern. in aviation, where a single mistake can cost millions of dollars, it is essential to optimize operator alertness. Although behavioral and administrative fatigue countermeasures should comprise the "first line" approach for sustaining aircrew performance, pharmacological fatigue countermeasures are often required. Various components of the U.S. military have authorized the use of specific compounds for this purpose. Hypnotics such as temazepam, zolpidem, or zaleplon can mitigate the fatigue associated with insufficient or disturbed sleep. Alertness-enhancing compounds such as caffeine, modafinil, or dextroamphetamine can temporarily bridge the gap between widely spaced sleep periods. Each of these medications has a role in sustaining the safety and effectiveness of military aircrews. The present paper provides a short overview of these compounds as well as factors to be considered before choosing one or more to help manage fatigue.

Caldwell JA; Caldwell JL; Smith JK; Brown DL. Modafinil's effects on simulator performance and mood in pilots during 37 h without sleep. Aviation, Space, and Environmental Medicine 75(9): 777-784, 2004. (14 refs.)

Introduction: Modafinil is a relatively new alertness-enhancing compound of interest to the military aviation community. Although modafinil has been well-tested in clinical settings, additional studies are required to establish its safety and efficacy for use in pilots. Objective: The purpose of this study was to determine whether modafinil (100 mg after 17, 22, and 27 h without sleep) would attenuate the effects of fatigue on fighter-pilot mood and performance during 37 h of continuous wakefulness. Methods: A quasi-experimental, single-blind, counterbalanced design tested the effects of modafinil in 10 Air Force F-117 pilots. Results: Modafinil attenuated flight performance decrements on six of eight simulator maneuvers. Overall, modafinil maintained flight accuracy within approximately 15-30% of baseline levels, whereas performance under the no-treatment/placebo condition declined by as much as 60-100%. Modafinil decreased self-ratings of depression and anger, while improving ratings of vigor, alertness, and confidence. Benefits were most noticeable after 24 to 32 h of continuous wakefulness. One potential drawback of modafinil was that, at least at the 100-mg dose level, the drug's effects were not subjectively salient. Since this may lead personnel to escalate the dose without flight surgeon approval, personnel should be cautioned regarding this particular drug characteristic. Conclusion: Although modafinil did not sustain performance at predeprivation levels, the present study suggests that modafinil should be considered for the military's armament of short-term fatigue countermeasures. Future research will evaluate whether 200-mg doses are more beneficial than the 100-mg doses used here.

Conway TL; Woodruff SI; Hervig LK. Women's smoking history prior to entering the US Navy: A prospective predictor of performance. Tobacco Control 16(2): 79-84, 2007. (35 refs.)

Objective: To examine whether women's tobacco use prior to entering the US Navy is predictive of subsequent career performance. A priori predictions were that smoking at entry into the Navy would be related to early attrition, poorer job performance, more disciplinary problems and lower likelihood of re-enlistment. Methods: A prospective cohort analysis of 5487 women entering the US Navy between March 1996 and March 1997 was conducted. Navy attrition/retention and career performance measures, such as time in service, early attrition, type of discharge, misconduct, number of promotions, demotions and unauthorised absences, highest paygrade achieved, and re-enlistment were examined. Results: Compared with never smokers, daily smokers at entry into the US Navy had subsequent career outcomes consistently indicating poorer job performance (eg, early attrition prior to serving a full-term enlistment, more likely to have a less-than-honourable discharge, more demotions and desertions, lower achieved paygrade and less likely to re-enlist). Other types of smokers consistently fell between never and daily smokers on career outcome measures. Conclusions: For women entering the US Navy, being a daily smoker is a prospective predictor of poorer performance in the Navy. Future research should evaluate the effectiveness of cessation intervention with smoker-enlistees prior to their entering the Navy, to assess the impact on subsequent career outcomes.

Deuster PA; Sridhar A; Becker WJ; Coll R; O'Brien KK; Bathalon G. Health assessment of US Army Rangers. Military Medicine 168(1): 57-62, 2003. (168 refs.)

Purpose: Assess the health behaviors of U.S. Army Rangers, including their diet and physical activity patterns, and their use of alcohol, tobacco, and nutritional supplements. Methods: Army Rangers (N = 38) completed selected self-report and food frequency questionnaires, and anthropometric measures (height, weight, circumferences) were taken. Results: Dietary patterns were collected from questionnaires that asked respondents to report the frequency of usual consumption from a list of foods over a period of 1 year. The data collected indicated a diet high in fat (38.0% of energy) and low in carbohydrates (41.9%). Protein intake (17.9% of energy) was consistent with recommendations for endurance and strength training athletes. Hours engaged in physical activity averaged 12 per week. Overall, 76% of the volunteers reported using alcohol on a regular basis, and 52.6% used some form of tobacco: 50% reported using either snuff or chewing tobacco. The use of supplements was high with 13% taking creatine and ephedrine products on a regular basis. Conclusion: Although physical activity patterns indicated a high level of activity, dietary and other health behaviors, such as smoking, alcohol use, and patterns of supplement use, suggest that health education programs may be important in this select Army population.

Dove MB; Joseph HJ. Sociodemographic profile of women entering a military substance use disorder treatment center. Military Medicine 172(3): 283-287, 2007. (22 refs.)

This retrospective study reviewed medical records to determine sociodemographic characteristics of women in a substance use treatment center at a Pacific Regional Medical Command facility. Data were collected from records between September 1, 1999, and August 31, 2002. Three questions were investigated, as follows. (1) What are the sociodemographic characteristics of women entering substance abuse treatment? (2) Are there coexisting conditions (psychiatric history and/or family history of abuse or psychiatric conditions) that accompany the substance abuse problem? (3) What are the referral sources for patients entering treatment? Data were analyzed by using descriptive statistics. The sample was primarily Caucasian, between 18 and 25 years of age. The most frequently occurring conditions were depression and anxiety. The smallest number of referrals was from primary care managers. The findings support the need for thorough screening and assessment for substance use in women and assessment of primary care managers' compliance, knowledge, and skills in evaluating substance use in women.

Ebbert JO; Haddock CK; Vander Weg M; Klesges RC; Poston WSC; DeBon M. Predictors of smokeless tobacco initiation in a young adult military cohort. American Journal of Health Behavior 30(1): 103-112, 2006. (48 refs.)

Objective: To identify predictors of smokeless tobacco (ST) initiation among young adults. Methods: A military cohort (N=28,229) was analyzed to identify variables associated with ST initiation. Results: Baseline current cigarette smoking at baseline was a strong predictor for any ST use (OR 3.88; 95% Cl: 3.33-4.52) and daily ST use (OR 3.01, 2.34-3.88) as was experimental ST use for any (OR 2.39, 2.09-2.73) and daily ST use (OR 2.41, 1.93-3.01). Conclusions: Smoking and previous ST use are strong predictors for ST use in adults. Research is needed to characterize ST initiation and changes in smoking behavior over time.

Fear NT; Iversen A; Meltzer H; Workman L; Hull L; Greenberg N et al. Patterns of drinking in the UK Armed Forces. Addiction 102(11): 1749-1759, 2007. (66 refs.)

Aims: To examine patterns of drinking in the UK Armed Forces, how they vary according to gender and other demographics, and to make comparisons with the general population. Design Large cross-sectional postal questionnaire study (response rate 60%). Setting United Kingdom. Participants A random representative sample of the regular UK Armed Forces who were in service in March 2003 (n = 8686; 7937 men, 749 women). Comparisons were made with the general population of Great Britain. Measurements: Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT). Findings: Sixty-seven per cent of men and 49% of women in the UK Armed Forces had an AUDIT score of 8+ (defined as hazardous drinking), compared to 38% of men and 16% of women in the general population. In both sexes, for all ages, the military have a higher prevalence of hazardous drinking. Binge drinking was associated with being younger, being in the Army, being single, being a smoker and being white. Among military men, heavy drinking (AUDIT score 16+) was associated with holding a lower rank, being younger, being single, being in the Naval Service or Army, being deployed to Iraq, not having children, being a smoker, having a combat role and having a parent with a drink or drug problem. Conclusions: Excessive alcohol consumption is more common in the UK Armed Forces than in the general population. There are certain socio-demographic characteristics associated with heavy drinking within the military; for example, young age, being single and being a smoker, which may allow the targeting of preventive interventions.

Gillingham R; Keefe AA; Keillor J; Tikuisis P. Effect of caffeine on target detection and rifle marksmanship. Ergonomics 46(15): 1513-1530, 2003. (29 refs.)

Thirteen healthy and rifle-trained male military reservists performed shooting sessions on two separate occasions 1 h following the ingestion of placebo or 300 mg of caffeine. Shooting included both friend-foe (FF) and vigilance (VIG) tasks, and were performed in the following order: two FF sequences (4 min each), four VIG sequences (30 min each), and two additional FF sequences. The shooting sessions lasted approximately 2.5 h under outdoor conditions (air temperature range from - 3 to 14degreesC) and were held 48 h apart in a counter-balanced order. Performance measures during the shooting session included engagement time, friend-foe discrimination, and marksmanship accuracy and precision. Assessments of thermal comfort, tiredness, and debilitating symptoms preceded and followed the shooting session, while a self-assessment on performance was administered post-shooting only. Blood was sampled immediately prior to the beginning of the shooting session and was used to determine plasma caffeine, cortisol, and testosterone levels. Engagement times were faster and certain measures of accuracy and precision were impaired during the later FF and VIG sequences. However, caffeine ingestion had no affect upon any of the marksmanship measures, although it did alleviate cold stress and tiredness. That caffeine ingestion did not affect target detection and rifle marksmanship is a finding that differs from other studies, and is explained by a beneficial arousal caused by the mild level of cold stress experienced by the participants.

Giotakos O. Suicidal ideation, substance use, and sense of coherence in Greek male conscripts. Military Medicine 168(6): 447-450, 2003. (25 refs.)

This study aimed to estimate the comorbidity of suicidal behavior and substance use in young male conscripts and to analyze the association between personal coping resources and the severity of these behaviors. A total of 1, 098 Greek male conscripts participated in this study, completing the Antonovsky's sense of coherence questionnaire and a standard questionnaire concerning their lifetime and current suicidal and substance-use behavior. A proportion of 11.7% and 24%, respectively, had lifetime and current feelings that life is not worth living. The differences between past and current death wishes (8.9% vs. 9.2%), suicidal thoughts (8.3% vs. 7.6%), and suicide attempts (2.4% vs. 2.9%) were not significant. All of the subgroups with suicidal ideation or behavior showed a significantly lower sense of coherence questionnaire score as compared with the whole sample. The comorbidity of past and current suicide thoughts and substance use ranged from 16.4% to 33.3% and 31.4% to 44.2%, respectively, depending on the kind of the substance. Finally, the subjects with past or current substance use had a significantly higher incidence of past or current, respectively, suicidal ideation or behavior, as compared with those without a history of substance use. We suggest the necessity of the early detection of these high-risk behaviors applying closer monitoring and integrated prevention programs.

Grayson JK; Gibson RL; Shanklin SL; Neuhauser KM; McGhee C. Trends in positive drug tests, United States Air Force, fiscal years 1997-1999. Military Medicine 169(7): 499-504, 2004. (18 refs.)

We investigated the relationship between various demographic factors and the risk of testing positive for marijuana or cocaine use in the U.S. Air Force in fiscal years 1997 through 1999. Overall test positive rates for marijuana and cocaine were very low, at 0.24 and 0.07% of all tests, respectively. However, monthly test positive rates increased significantly during the study period while the number of tests conducted decreased by more than 50%. Gender, race/ethnicity, service component, military rank, education level, and assignment location each predicted the likelihood of testing positive for marijuana or cocaine use. These findings were consistent with annual surveys of self-reported drug use conducted in military and civilian populations in the United States. We conclude that overall testing percentages should be re-evaluated in light of these findings, but we do not recommend oversampling from population subgroups that demonstrated a higher likelihood of testing positive.

Haddock CK; Pyle SA; Poston WSC; Bray RM; Stein RJ. Smoking and body weight as markers of fitness for duty among US military personnel. Military Medicine 172(5): 527-532, 2007. (30 refs.)

Background: Both tobacco and overweight present serious threats to public health. Although the military has targeted both health issues, only weight status is included in tests of fitness. This study contrasted the relative utility of body weight and smoking as markers for fitness for duty. Methods: Using data from the 2002 Department of Defense Survey of Health-Related Behaviors among Military Personnel (N = 12,149; 24.7% female), troops were categorized according to weight (underweight, healthy weight, overweight, or obese) and smoking status (never smoker, former smoker, or current smoker). Results: Logistic models were developed to examine the usefulness of smoking status and weight status as predictors of items assessing four domains of military fitness for duty, namely, physical health, mental health, substance abuse, and legal problems. Smoking status was a consistent and strong predictor of items within all four fitness domains. In contrast, weight status was not a consistent predictor of fitness. Conclusion: The military should consider adding smoking status to assessments of military fitness. Also, given that underweight and not overweight status predicted negative outcomes among military members, the services should consider revising their weight status fitness standards.

Hasegawa GR; Hambrecht FT. The confederate medical laboratories. (review). Southern Medical Journal 96(12): 1221-1230, 2003. (104 refs.)

During the Civil War, the scarcity and expense of imported drugs forced the Confederate Army to establish several medical laboratories to manufacture drugs for military use. The laboratories produced medicines from indigenous plants and also made non-plant-based drugs. The Confederate Surgeon General and the Chief Purveyor in Richmond, VA, coordinated activities of most of the laboratories. The laboratories employed talented and resourceful personnel and manufactured a large volume and wide variety of drugs, the most useful of which included ether, chloroform, and opiates. The pharmaceutical quality of the laboratories' output was evidently uneven. Empirical testing in military hospitals helped determine the clinical value of indigenous remedies. The Confederate medical laboratories participated in a coordinated effort to supply the Army with substitutes for drugs whose availability was curtailed or uncertain.

Hooper TI; DeBakey SF; Bellis KS; Kang HK; Cowan DN; Lincoln AE et al. Understanding the effect of deployment on the risk of fatal motor vehicle crashes: A nested case-control study of fatalities in Gulf War era veterans, 1991-1995. Accident Analysis and Prevention 38(3): 518-525, 2006. (24 refs.)

Motor vehicle crashes (MVCs) are an important cause of morbidity and premature loss of life among military personnel during peacetime and particularly following combat. A nested case-control study of fatal MVC occurring between 1991 and 1995 was conducted in a cohort of Gulf War era veterans. Cases were validated MVC deaths in the Fatality Analysis Reporting System. Controls were selected using risk set sampling by gender and year of case ascertainment in a 10: 1 ratio. Preliminary results, consistent with previous reports of increased fatal MVC risk among returning combat veterans, showed a crude odds ratio of 1.45 (95% confidence interval 1.27-1.65). Multivariable logistic regression modeling was used to identify important independent predictors, as well as to quantify the influence of deployment on a risk profile for fatal MVC. Because of significant interaction between deployment and inpatient diagnosis of substance abuse, the final model was stratified by deployment status. Results suggest that demographic, military, and behavioral characteristics of deployed healthy warriors are similar to the risk profile for fatal MVC. In addition to young, single, high school-educated, enlisted male personnel, those who served during times of ground combat, particularly in infantry, gun crews, or seamanship occupations, should be targeted for preventive interventions.

Jones M; Rona RJ; Hooper R; Wesseley S. The burden of psychological symptoms in UK Armed Forces. Occupational Medicine 56(5): 322-328, 2006. (42 refs.)

Objective: To assess the prevalence of psychological symptoms during periods of relatively low deployment activity and the factors associated with each psychological health outcome. Methods: A survey of 4500 randomly selected UK service personnel was carried out in 2002. The questionnaire included the General Health Questionnaire (GHQ-12), the post-traumatic stress disorder checklist (PCL), 15 symptoms and an assessment of alcohol intake. Results: A total of 20% were above cut-offs for GHQ-12, 15% for symptoms, 12% for alcohol intake and 2% for PCL. Gender, age, excessive drinking and smoking were independently associated with most outcomes of interest. Number of deployments was independently associated with multiple symptoms and excessive drinking. High post-traumatic stress disorder score was more frequent in the Army and in lower ranks. Conclusions: Psychological symptoms are highly prevalent in UK Armed Forces. Many risk factors are associated with measures of psychological ill-health.

Jordan NN; Hoge CW; Tobler SK; Wells J; Dydek GJ; Egerton WE. Mental health impact of 9/11 Pentagon attack validation of a rapid assessment. American Journal of Preventive Medicine 26(4): 284-293, 2004. (33 refs.)

Background: Following the tragic events of 9/11/2001, the Pentagon Post Disaster Health Assessment (PPDHA) survey was created to identify healthcare needs and concerns among Pentagon personnel and to assure that appropriate care and information was provided. The PPDHA was fielded from October 15, 2001, to January 15, 2002. Fundamental in this assessment was the evaluation of the mental health impact as a result of the attack.Methods: Although a number of standardized instruments exist for mental health domains, most are lengthy and could not be used as a rapid health assessment. Instead, a short screening instrument consisting of 17 questions was developed that covered important mental health symptom domains, mental health functioning, and possible predictive risk factors. High-risk groups for post-traumatic stress disorder (PTSD), depression, panic attacks, generalized anxiety, and alcohol abuse were assessed, and validation of risk groups was assessed across functional levels.Results: Overall, 1837 (40%) respondents met the screening criteria for any of the symptom domains of interest 1 to 4 months after the attack: PTSD (7.9%), depression (17.7%), panic attacks (23.1%), generalized anxiety (26.9%), or alcohol abuse (2.5%). Mental health risk groups were highly correlated with self-reported reduced daily functioning and use of counseling services. Additionally, risk factors known to be associated with mental health problems after traumatic events were strongly predictive of the high-risk categories identified. Conclusions: Mental health concerns were common among Pentagon employees in the 4 months after the 9/11 attack. Data from this study suggested that the short mental health screening instrument had validity and can serve as a prototype for rapid public health assessment of the mental health impact of future traumatic events.

Joseph AM; Muggli M; Pearson KC; Lando H. The cigarette manufacturers' efforts to promote tobacco to the US military. Military Medicine 170(10): 874-880, 2005. (70 refs.)

This article describes findings from review of tobacco industry documents regarding promotion of tobacco to the military, and efforts to influence Department of Defense policies regarding the use and sale of tobacco products. The documents reveal that the industry has targeted the military for decades for reasons including: (1) the volume of worldwide military personnel; (2) the opportunity to attract young men who fit a specific socioeconomic and cultural profile; (3) potential carry-over of profits to civilian markets; and (4) the unusual price structure of commissaries and exchanges. The industry used distinctive promotion methods such as in-store merchandising, sponsorships, and even brand development to target the military, both in the United States and abroad during times of conflict. Legislative activity to protect tobacco promotion to this vulnerable population was carried out in response to smoking policy changes proposed by the Department of Defense. The tobacco industry has contributed to the high prevalence of smoking in the military and among veterans.

Kautz MA; Thomas ML; Caldwell JL. Considerations of pharmacology on fitness for duty in the operational environment. (editorial). Aviation, Space, and Environmental Medicine 78(5, Supplement S): B107-B112, 2007. (32 refs.)

Coordination of strategies for transitioning psychoactive pharmacological compounds from basic laboratory research to the field environment has been an ongoing effort among military laboratories. Several workshops have been held specifically to address the operationally relevant issues and other military and scientific challenges as they relate to the enhancement and sustainability of cognitive performance. in this preface, we tie together recommendations of the Pharmacological Strategies Focus Team for one such Workshop, review current literature, and discuss findings reported at recent professional meetings. The papers presented within this pharmacology section are discussed. These section papers are organized into three areas of operational relevance-the first assesses the effectiveness of a treatment given for migraines, a condition with known detrimental effects on productivity and readiness; the second discusses ethical considerations surrounding the use of pharmaceutical countermeasures for fatigue in the operational environment; and the third discusses a case report highlighting the aeromedical considerations regarding selective serotonin reuptake inhibitors (SSRIs) and aviator flight performance, particularly as assessed with neuropsychological testing. The papers and commentaries in this section encourage us to consider the complex variables effecting the decisions to administer pharmacological agents, as the impact of their use is weighed against the cognitive performance effects they may have in the operational environment.

Kercher KJ. Time for another haircut: A re-look at the use of hair sample testing for drug use in the military. Military Law Review 188: 38-85, 2006. (353 legal refs.)

The Army's urinalysis program has made great strides in reducing drug use in the military ranks. Drug testing of a servicemember's hair sample serves as a viable addition to a commander's current arsenal of tools to combat continued drug use among the ranks. First, does a servicemember have a reasonable expectation of privacy in his hair? Second, if the servicemember does have an expectation of privacy in his hair, does the government actor taking the hair sample have a search authorization based upon probable cause, or does an exception to the search authorization requirement exist? Third, is the manner in which the government actor collected the hair sample reasonable? Hair drug testing must satisfactorily navigate these legal checkpoints before military counsel may use hair sample results in court. Since hair drug testing uses similar collection procedures and laboratory testing methods as urine testing, a hair sample test arguably meets the same legal requirements. Hair drug testing will meet this need because it: (1) extends a commander's ability to identify drug use to several months; (2) involves a lawful search and seizure; (3) provides relevant and reliable information; and (4) easily complements current urinalysis programs. Those in the armed forces are a cross-section of society as a whole, commanders can expect servicemembers to have easy access to people who use drugs and to people who sell drugs. Also, increased servicemember usage of popular "club drugs", especially ecstasy, has left commanders wondering whether current urinalysis programs sufficiently ensure good order and discipline in their units. Several dilution products, cleansing products, chemical adulterants, and prosthetic devices (e.g., an artificial penis) currently exist to assist servicemembers in avoiding a positive urinalysis test result. An Internet Google search using the words "beat a drug test" provided over 1,200,000 hits. Many of these sites offer to provide pills or chemical solutions that counter urinalysis tests. These products claim to help avoid a positive drug test result by flushing drugs out of a person's urine prior to a test. Additionally, a urinalysis can only detect, for most drugs, drug use occurring a few days prior to the test. This inherent testing limitation greatly reduces a urinalysis's ability to catch drug users. As a result, servicemembers could easily avoid testing positive by abstaining from drug use for a short period of time prior to an expected test. Drug testing of a servicemember's hair sample serves as a viable addition to a commander's current arsenal of tools to combat continued drug use among the ranks. Commanders should utilize drug testing of hair samples to curtail servicemember drug use for several reasons. Drug testing of hair samples: (1) increases the drug detection "window" to several months; (2) satisfies any Fourth Amendment concerns; (3) provides commanders with reliable results; and (4) requires only minor adjustments to current military drug testing programs. Accordingly, this article advocates the wide spread implementation of hair testing as a much needed and complementary addition to the military's current urinalysis program.

2006, Judge Advocate Generals School

Klesges RC; DeBon M; Vander Weg MW; Haddock CK; Lando HA; Relyea GE et al. Efficacy of a tailored tobacco control program on long-term use in a population of US military troops. Journal of Consulting and Clinical Psychology 74(2): 295-306, 2006. (29 refs.)

The authors evaluated the effect of a brief tailored smoking control intervention delivered during basic military training on tobacco use in a population of military personnel (N = 33,215). Participants were randomized to either a tobacco use intervention (smoking cessation, smokeless tobacco use cessation, or prevention depending on tobacco use history) or a health education control condition. Results indicated that smokers who received intervention were 1.16 (95% confidence interval [CI] = 1.04, 1.30) times (7-day point prevalence) and 1.23 (95% Cl = 1.07, 1.41) times (continuous abstinence) more likely to be abstinent than controls from smoking cigarettes at the 1-year follow-up (p <.01); the cessation rate difference was 1.60% (31.09% vs. 29.49%) and 1.73% (15.47% vs. 13.74%) for point prevalence and continuous abstinence, respectively. Additionally, smokeless tobacco users were 1.33 (95% Cl = 1.081 1.63) times more likely than controls (p <.01) to be continuously abstinent at follow-up, an overall cessation rate difference of 5.44% (33.72% vs. 28.28%). The smoking prevention program had no impact on smoking initiation. These results suggest potential for large-scale tobacco control efforts.

Knee TS; Burke J; Seda G; Allen D. A case of severe exercise-induced rhabdomyolysis associated with a weight-loss dietary supplement. Military Medicine 172(6): 656-658, 2007. (21 refs.)

In response to questions about the safety of ephedra-based dietary products, ephedra-free products are now available. Many contain synephrine, a sympathomimetic amine with structural similarities to ephedra. We present a 22-year-old, previously healthy, African American male with sickle cell trait who developed rhabdomyolysis after ingestion of a synephrine-containing dietary supplement. The patient developed fatigue, dehydration, and myalgias while exercising. He developed severe rhabdomyolysis, with a peak creatine phosphokinase level of 2.8 million U/L, complicated by pulmonary edema, acute renal failure, disseminated intravascular coagulation, and bilateral compartment syndromes in his lower extremities. He required prolonged hospitalization for hemodialysis, multiple wound debridements, hyperbaric oxygen therapy, and physical therapy. He has permanent sensory and motor neurological deficits in his distal lower extremities. Military physicians should routinely inquire about the use of dietary supplements, educate patients about the potential adverse reactions associated with these agents, and encourage healthy diets and exercise for weight loss.

Lacy BW; Ditzler TF. Inhalant abuse in the military: An unrecognized threat. Military Medicine 172(4): 388-392, 2007. (42 refs.)

Although inhalant abuse represents the third most commonly abused class of drugs in the military, it is a frequently overlooked form of substance abuse in the active duty population. Inhalants' lack of visibility is also evident in the civilian community. In both the civilian and military communities, the factors leading to underrecognition of inhalant abuse include high availability, low cost, lack of drug screening and drug treatment programs, and frequent misdiagnosis by clinicians. This review seeks to inform care providers about the prevalence, health risks, diagnosis, and treatment of inhalant abuse in the active duty population, and encourages clinicians to be more aggressive in the identification of this serious but underrecognized problem.

Lande RG; Marin BA; Chang AS; Mason S; Lande GR. A survey of alcohol consumption among first-year military medical students. American Journal of Drug and Alcohol Abuse 33(4): 605-610, 2007. (12 refs.)

First-year medical students (n= 138) at the U. S. Military's Medical School report frequent binge drinking. Nearly one fifth of female and one third of male students report at least one episode of binge drinking in the two weeks preceding a survey of alcohol use. Only one fifth of the medical students reported an interest in an expanded addiction medicine curriculum. The authors' promoted the use of a survey to bridge the gap between self assessment and learning.

Lemmens P. Soldiers behaving badly. (editorial). Addiction 102(11): 1760-1761, 2007. (9 refs.)

Lynch JP; Hanson K; Kao TC. Health-related behaviors in young military smokers. Military Medicine 169(3): 230-235, 2004. (36 refs.)

This cross-sectional study examined the association between smoking and other health-related risk behaviors, individually as well as in clusters, across branches of military service in the higher risk ages of 18 to 25 years old within the 1998 Department of Defense Survey of Health-Related Behaviors among Military Personnel. Examination of the demographic variables revealed that, in general, smokers tended to be single, white, enlisted men in the 18- to 20-year age group with less education and serving in the Army or Marine Corps. Our findings support that there is an increased likelihood of co-occurrence of substance use along with other negative health-related risk behaviors found in military members. It may be practical and necessary to develop a focused survey given to those attending smoking cessation interventions, or perhaps to smokers in general, which attempts to identify associated risk behaviors and channel clients accordingly.

Mazokopakis EE; Vlachonikolis IG; Lionis CD. Smoking behavior of Greek warship personnel. Military Medicine 168(11): 929-933, 2003. (28 refs.)

The results from a study undertaken to assess the smoking behavior of Greek warship personnel found that of the 274 participants, ages 19 to 38 years, 59.5% were current smokers who started the habit between the ages of 15 and 21 years. However, 33.1% of these current smokers started smoking after entering the Greek Navy. There were statistically significant associations between the habit of smoking and the occurrences of respiratory tract infections, alcohol consumption, lack of aerobic exercise during leisure time, and educational level of the personnel. Another significant association was between the age of introduction into the habit of smoking and the number of cigarettes smoked daily, with the level of education being a contributing factor. The method of entry into the Greek Navy and the rank held made a significant contribution to the time period of initiation into the habit of smoking. The impact of military life on the smoking behavior of the shipboard personnel is discussed and suitable intervention strategies have been recommended.

McLellan TM; Kamimori GH; Voss DM; Bell DG; Cole KG; Johnson D. Caffeine maintains vigilance and improves run times during night operations for special forces. Aviation, Space, and Environmental Medicine 76(7): 647-654, 2005. (37 refs.)

Purpose: This study examined the effects of caffeine (CAF) on vigilance, marksmanship, and run performance during 27 h of sustained wakefulness in Special Forces personnel. Methods: There were 31 soldiers (29.8 +/- 5.4 yr, 86.4 +/- 8.6 kg) who were divided into placebo (PLAC, n = 15) and CAF (n = 16) groups. A 6.3-km control run was completed on the morning of Day 1. In the evening of Day 2, soldiers performed a control observation and reconnaissance vigilance task (ORVT) in the field. This 90-min task was repeated twice more between 02:00 and 06:00 on Day 3 during an overnight period of sleep deprivation. Marksmanship was assessed before and after the ORVT. PLAC or 200 mg of CAF gum was administered at 01:45, 03:45, and approximately 06:30 on Day 3. A final 6.3-km run commenced within 30 min of receiving the final dose. Results. ORVT was maintained in CAF at control levels of 77 +/- 13% during the overnight testing. However, values decreased significantly for PLAC from 77 +/- 15% to 54 +/- 29% and 51 +/- 31% during the first and second overnight testing periods, respectively. CAF had no effect on marksmanship but improved 6.3-km run times by 1.2 +/- 1.8 min. Run times slowed for PLAC by 0.9 +/- 0.8 min from approximately 35 min during the control run; the changes in performance were significant between groups. Conclusions. it was concluded that CAF maintained vigilance and improved running performance during an overnight field operation for Special Forces personnel.

McMurry TB. A comparison of pharmacological tobacco cessation relapse rates. Journal of Community Health Nursing 23(1): 15-28, 2006. (13 refs.)

Tobacco use is the nation's leading preventable cause of chronic illness and injury; it takes the lives of 450,000 of our citizens each year. Currently, there are numerous treatment programs and pharmacological aids that may be obtained with a prescription or purchased over the counter at your local drugstore. The purpose of this study was to compare differences in tobacco cessation relapse rates of military personnel at the 1-, 3-, and 6-month intervals among 4 categories of pharmacological and cognitive regimens used at an outpatient naval treatment facility. A nonprobability convenience sampling plan was used to obtain (a) 10 patient-participant Freedom From Smoking (FFS) course records that utilized Zyban and Nicotine Replacement Therapy, (b) 10 patient-participant FFS course records that utilized Zyban only, (c) 10 patient-participant FFS course records that utilized Nicotine Replacement Therapy only, and (d) 10 patient-participant FFS course records that utilized Nicotine Replacement Therapy and nicotine gum (as needed). Findings revealed no significant difference between relapse and associated pharmacological treatment program. There was, however, a moderate increased cessation effort in Program 4 (nicotine replacement patch and nicotine gum). Results also demonstrated no significant difference between demographic variables and relapse cohorts. A significant positive relation between length of smoking and packs smoked per day was revealed, however.

Messer SC; Liu X; Hoge CW; Cowan DN; Engel CC. Projecting mental disorder prevalence from national surveys to populations-of-interest: An illustration using ECA data and the U.S. Army. Social Psychiatry and Psychiatric Epidemiology 39(6): 419-426, 2004. (31 refs.)

Background: Psychiatric epidemiology can further public health practice and inform mental health policy through the development of methodologies that provide rapid and cost efficient estimation of the prevalence of mental disorders at the local, regional, and population levels. Objective: The aim of this study was to illustrate an efficient method for the estimation of mental disorder prevalence in population groups where no direct prevalence data are available. This study demonstrated a new method to extrapolate prevalences from a national calibration survey to a target population where no observations are available and sociodemographic differences are prominent. Method We restricted the ECA sample to full-time employed participants (similar to10,500) and used the total active duty U. S. Army population (similar to460,000) for illustration. Sociodemographic data for the Army came from the official military database (mid-year 2000). Our logistic regression projections represented an extension of sociodemographicdriven synthetic methods used among demographers. Outcomes were lifetime prevalences for 13 DIS/DSM disorders. Results: Compared to the ECA employed population, extrapolations to the Army revealed lower/similar estimates for nine of 13 DIS/DSM disorders. Projections were twice as high for alcohol abuse/dependence and antisocial personality, and one-third higher for social phobia and schizophrenia in the Army. Estimates compared favorably to one other military prevalence study, and to results derived using traditional standardization/adjustment methods based on the ECA sample weighted to the working general population. Conclusions: The synthetic estimation technique using ECA data to project lifetime prevalences for the U. S. Army generated sound estimates while illustrating an attractive method to extrapolate national data to demographically diverse communities seeking policy-relevant data.

Mitchell D; Angelone DJ. Assessing the validity of the Stages of Change Readiness and Treatment Eagerness Scale with treatment-seeking military service members. Military Medicine 171(9): 900-904, 2006. (20 refs.)

The purpose of this project was to assess the concurrent and predictive validity of the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) for military service members undergoing substance abuse treatment. Concurrent validity was assessed by examining the correlation of SOCRATES subscales with subscales from the Addiction Treatment Attitude questionnaire. Predictive validity was assessed by examining the ability of SOCRATES subscales to predict length of stay in treatment and successful completion of treatment. Scores on the SOCRATES were correlated in the expected direction with scores on the Addiction Treatment Attitude questionnaire and predicted length of stay in treatment and successful completion of treatment. The findings provide support for the validity of the SOCRATES with substance abuse treatment-seeking military service members.

Moore RS; Cunradi CB; Ames GM. Did substance use change after September 11th? An analysis of a military cohort. Military Medicine 169(10): 829-832, 2004. (16 refs.)

The purpose of this study was to assess changes in alcohol, tobacco, and other drug use after the terrorist attacks of September 11 among a cohort of young military personnel consisting of 661 active duty Navy personnel, including 164 women. Paired sample t tests were computed to assess mean differences in substance use in the 30 days before and after September 11. Average daily alcohol consumption significantly declined in the 30 days after September 11 among enlisted personnel (n = 315) and officers (n = 360). Significant increases in the usual number of cigarettes smoked and in the number of days using prescription drugs after September 11 were observed among enlisted personnel, but not among officers. Increased use of cigarettes and prescription drugs among enlisted personnel after September 11 suggests that some sectors of the military may turn to tobacco and other substances to cope with traumatic circumstances such as the events of September 11.

Moran DS; Eliyahu U; Berlin S; Hadad E; Heled Y. Psychostimulants and military operations. Military Medicine 172(4): 383-387, 2007. (38 refs.)

Sleep-deprived individuals appear to have decreased psychological and physical capabilities. Studies have shown how major psychological aspects, such as alertness, complex mental performance, and memory, are strongly affected by sleep deprivation. Military use of psychostimulants dates back many years, especially in units that operate over long hours and deprive soldiers of sleep. During prolonged military operations, pilots are regularly kept awake for hours and days without fulfilling their biological sleep requirements. This consequently affects their natural circadian rhythm. This article deals with both the benefits and the side effects of two kinds of psychostimulants, namely, dextroamphetamine, which is more popular and is most widely used, and modafinil, which is a relatively newer type. There is growing evidence that modafinil has fewer side effects, in comparison with its predecessor dextroamphetamine, while still maintaining all of the latter's beneficial characteristics.

Neumark YD; Grotto I; Kark JD. Twenty-year trends in illicit drug use among young Israelis completing military duty. Addiction 99(5): 641-648, 2004. (46 refs.)

Aim: This study examines patterns of illicit drug use in a national sample of young men and women in Israel over a 20-year period. Design: Annual cross-sectional data are analysed from an ongoing systematic sample of soldiers being discharged from active military service during the years 1982-2001. Setting: An anonymous questionnaire is self-administered to soldiers on the day of discharge in an unsupervised setting. Participants: Between 1200 and 2800 individuals participated in the survey annually. A total of 40 518 people were included in the analysis. This sample frame is reflective of all Israel Defense Forces (IDF) releasees below the rank of Captain. Military recruits in Israel comprised about 80% of the country's 18-year-old Jewish male cohort in any given year, and about two-thirds of the female population of this age. Findings: Time-trends of drug use in Israel parallel those in the United States and European countries, although at much lower rates. Several indicators suggest a recent increase, particularly among women. Drug use is strongly inversely related to education level. Marijuana accounts for 65-75% of drug use in this young adult population. Conclusion: Jewish cultural background and the military policy of zero tolerance are assumed contributors to the low drug use levels. Recent upward trends suggest that intensified prevention, surveillance and research efforts are in order.

Omar MM; Al-Mulla KF; Al-Seleem TA; Murad B; Radovanovic Z. Middle East aircrew use of alcohol, tobacco, coffee, and medicaments. Aviation, Space, and Environmental Medicine 76(4): 395-398, 2005. (17 refs.)

Objective: The purpose of this study was to assess the prevalence of the use of alcohol, tobacco, coffee, and various medications among flying crew and clerks working in a ministry in Kuwait. Methods; In a cross-sectional study, a self-administered questionnaire was filled in by 277 flying crew and 302 clerks of a comparable age and gender ratio. Results: Frequencies of using alcohol, tobacco, coffee, and various medications were much higher among flying crew as compared to clerks. Flying crew were a very homogenous group in terms of exposure to the substances studied with only two exceptions: younger people were more likely to drink alcohol abroad (but not in Kuwait), and cabin crew relied on herbal medicine more than pilots. Conclusions: Flying crew differ very much from a socially comparable segment of the local population, but it is not possible to discern the impact of occupational risks (jet leg and night shifts) from exposure to foreign influences and, as for alcohol and sedatives, from easier availability.

Peterson AL; Severson HH; Andrews JA; Gott SP; Cigrang JA; Gordon JS et al. Smolkeless tobacco use in military personnel. Military Medicine 172(12): 1300-1305, 2007. (42 refs.)

Military personnel are more than twice as likely as civilians to use smokeless tobacco (ST), and recent studies indicate that military prevalence rates are rising. However, few studies have examined factors related to ST use in the military. The present study evaluated the characteristics of ST use in 785 active duty military personnel. The results indicated that the average age of initiation was 17.7 years, participants had used ST for 12.3 years, and they used approximately four tins or pouches of tobacco per week. Army personnel were more likely than Air Force personnel to be older, to have used ST longer, and to be heavier users. Officers had used ST longer than enlisted personnel and were more likely to have had a recent quit attempt. Enlisted personnel were more than three times as likely to report concurrent cigarette smoking. These results indicate that there are significant differences in ST use patterns in military personnel, and cessation programs should be tailored to meet these differences.

Roedig E. German perspective: Commentary on "Recommendations for the ethical use of pharmacologic fatigue countermeasures in the US military" (editorial). Aviation, Space, and Environmental Medicine 78(5, Supplement S): B136-B137, 2007. (0 refs.)

The human rules and values of our common western democratic society must be obeyed in context with legal and ethical aspects, as well as in an operational military environment. Even though there may be particular exceptional circumstances, the forced use of cogniceuticals is contrary to our values, and also contrary to effective cross-cultural considerations in a multinational battlefield. it is very problematic to define methods for studies to evaluate the efficiency and safety of cogniceuticals in complex and extreme operational situations. It is not clear whether a cumulative use/self-medication will have significant impact on cognitive performance and personality. The long-term effects may not be foreseen. An important aspect you mentioned is that application of a cogniceutical agent to restore function is not enhancement but rather sustainment within a homeostatic balance. As flight surgeons and medical officers, it is our special obligation to provide the best medical service for the welfare of our aircrew and soldiers during all phases of missions and deployments. Applying pharmacological agents is unjustifiable due to ethical and moral reasons, especially when it has been tried in the past, in an apparently voluntary nature. The German position is that only caffeine, with its high therapeutic index, is acceptable to maintain sustainability in an operational environment. Other enhancing drugs are strictly forbidden and also not approved by Federal authorities as medications for this indication.

Rosenheck RA; Seibyl CL. A longitudinal perspective on monitoring outcomes of an innovative program. Psychiatric Services 56(3): 301-307, 2005. (12 refs.)

Objectives: The use of outcome assessment to evaluate the performance of programs over many years of operation is becoming an increasingly important aspect of health care management. Over a five-year period of program monitoring, this study examined changes in individual client outcomes three months after discharge from a residential work therapy program for veterans with severe substance use disorders. The study also examined the relationship between these outcomes and changing program features, such as staffing, treatment variables, and follow-up rates. Methods: Data on admissions characteristics, services delivered during treatment, and status at discharges were collected for 3,390 veterans who were treated in 25 sites in the Department of Veterans Affairs' Compensated Work Therapy/Transitional Residence program. Follow-up data were gathered three months after discharge for 1,771 veterans (52.2 percent). Hierarchical linear modeling was used to examine the association between year of discharge, site-level measures of program staffing and follow-up rate, and individual patient-level treatment variables and outcomes. Results: Over the five-year monitoring period, site staff-to-bed ratios and follow-up rates dropped substantially, and veterans attended more Alcoholics Anonymous and Narcotics Anonymous meetings and had more toxicology screens. Higher staff-to-bed ratios were associated with more positive employment outcomes, and higher follow-up rates were associated with poorer outcomes in substance abuse and lower total income. However, no significant outcome trends were observed in clinical follow-up measures after the analyses adjusted for these factors, suggesting that program effectiveness did not deteriorate during a period of program change. Conclusions: Long-term evaluations of program process and follow-up status can usefully document sustained program effectiveness over many years. Such efforts should enhance their value by examining and adjusting for the impact of factors such as changing staffing levels and follow-up rates.

Russell J. Chechnya and Russia - Primed to explode. World Today 60(6): 20-21, 2004. (0 refs.)

Russia's Chechen policy lies in tatters after the assassination of Akhmad Kadyrov, its man in Grozny. Will President Vladimir Putin seize the opportunity to redirect his strategy towards a genuine political solution, or continue to use the global 'war' on terrorism to avoid embarking on meaningful peace talks? And what about Russia's veterans of violence: human time bombs returning home from the front steeped in alcohol, crime and drugs?.

Ruzek IJ. Concurrent posttraumatic stress disorder and substance use disorder among veterans: Evidence and treatment issues. IN: Ouimette P; Brown PJ, eds. Trauma and Substance abuse: Causes, Consequences, and Treatment of Comorbid Disorders. Washington DC: American Psychological Association, 2003. pp. 191-207

This chapter reviews evidence and treatment issues in concurrent posttraumatic stress disorder (PTSD) and substance use disorder (SUD) among veterans. The author describes the literature related to the dual diagnosis in specific groups of veterans (Vietnam, World War II and Korea), identify clinical practices helpful in working with these veterans, and explore key challenges to the better integration of PTSD and SUD treatment.

Sayer NA; Spoont M; Nelson D. Veterans seeking disability benefits for post-traumatic stress disorder: Who applies and the self-reported meaning of disability compensation. Social Science & Medicine 58(11): 2133-2143, 2004. (67 refs.)

Assumptions about the characteristics and motivations of individuals pursuing disability status are well known. However, policy, programming and interventions need to be based on information about the actual sociodemographic characteristics of disabled individuals, as well as their goals in seeking disability status. In this study, we focus on veterans seeking disability compensation for post-traumatic stress disorder (PTSD) from the United States Department of Veterans Affairs. We present information on their life circumstances and their self-reported reasons for valuing the obtainment of veterans' disability status on the basis of PTSD. There was considerable variability in the background of veterans seeking disability status on the basis of PTSD. Of concern, only about half of these individuals were receiving any mental health treatment at the time of application. Most claimants reported seeking disability compensation for symbolic reasons, especially for acknowledgement, validation and relief from self-blame. Reasons having to do with improved finances were less frequently endorsed, although the importance of obtaining improved solvency through disability status decreased as income increased. The sense of investment in obtaining a sense of self-acceptance and acceptance from others through disability status varied by sociodemographic variables. Overall, findings suggest that individuals seeking disability benefits may have unmet mental health care needs, and that policy makers, investigators and providers should consider material benefit as one of many possible reasons for engaging in a disability compensation system.

Schmaling KB; Fonseca CA; Stoever C; Gutierrez C; Blume AW; Russell ML. Variables associated with intimate partner violence in a deploying military sample. Military Medicine 171(7): 627-631, 2006. (27 refs.)

Variables associated with intimate partner violence (IPV) were examined within a sample of military personnel preparing to deploy. Soldiers with intimate relationships processed for mobilization through Fort Bliss, Texas, completed a questionnaire that queried demographic information, relationship satisfaction, stress, risky alcohol use behaviors, and tactics used during intimate relationship conflict. Four hundred forty-nine deploying soldiers (15.8% of 2,841 with usable data) reported IPV in the past year. Younger age, less education, less relationship satisfaction, more stress, and risky alcohol use behaviors were significant individual predictors of engaging in EPV. The results of this study are discussed in terms of their implications for targeting efforts to reduce IPV among military personnel.

Scoville SL; Gardner JW; Potter RN. Traumatic deaths during US armed forces basic training, 1977-2001. American Journal of Preventive Medicine 26(3): 194-204, 2004. (22 refs.)

Background: A Recruit Mortality Registry, linked to the Department of Defense Medical Mortality Registry, was created to provide comprehensive medical surveillance data for deaths occurring during enlisted basic military training. Methods: Recruit deaths from 1977 through 2001 were identified and confirmed through redundant Sources. Complete demographic, circumstantial, and medical information was sought for each case and recorded on an abstraction form. Mortality rates per 100,000 recruit-years were calculated by rising recruit accession data from the Defense Manpower Data Center. Results: There were 276 recruit deaths from 1977 through 2001 and age-specific recruit mortality rates were less than half of same-age U.S. civilian mortality rates. Only 28% (77 of 276) of, recruit deaths were classified as traumatic (suicide, unintentional injury and homicide), in comparison to three quarters in both the overall active duty military population and the U.S. civilian Population (ages 15-34 years). The age-adjusted traumatic death rates were highest in the Arm), (four times higher than the Navy and Air Force, and 80% higher than the Marine Corps). The majority (60%) of traumatic deaths was due to suicide, followed by unintentional injuries (35%), and homicide (5%). The overall age-adjusted traumatic mortality rate was more than triple for men compared with women in all military services (rate ratio=3.9; p=0.01). Conclusions: There was a lower proportion of traumatic deaths in recruits compared to the overall active duty military population and same-age U.S. civilian population. This finding could be attributed to close supervision, emphasis on safety, and lack of access to alcohol and motor vehicles during recruit training.

Sekulic D; Tocilj J. Pulmonary function in military divers: Smoking habits and physical fitness training influence. Military Medicine 171(11): 1071-1075, 2006. (23 refs.)

Pulmonary function (PF) tests are procedures that measure the function of the lungs, revealing problems in breathing, and therefore are highly important in diving. In this article, we studied the PF in military divers and defined the differences between (A) males (n = 32) and females (n = 27), (B) male smokers and nonsmokers, and (C) female smokers and nonsmokers. PF was established by measuring: the large airway variables: inspiratory-vital capacity, forced-vital capacity, 1-second forced-expiratory volume, and 1-second forced-expiratory volume: forced-vital capacity ratio; and small airway variables: peak-expiratory flow, maximal-mid-expiratory flow, and maximal-expiratory flow after 50% and 75% of exhalation, all in absolute and relative (predicted for age and stature) values. The t test showed a significant (p <= 0.05) difference between smokers and nonsmokers, but only in the relative inspiratory-vital capacity. A multivariate analysis of the variance revealed significant differences between smokers and nonsmokers in large airway variables for males and females. The possible explanations regarding the metrics, the variable relationships, and the influence of physical fitness training are discussed.

2006, Association of Military Surgeons

Simon-Arndt CM; Hurtado SL; Patriarca-Troyk LA. Acceptance of web-based personalized feedback: User ratings of an alcohol misuse prevention program targeting US Marines. Health Communication 20(1): 13-22, 2006. (33 refs.)

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.

Smith EA; Blackman VS; Malone RE. Death at a discount: How the tobacco industry thwarted tobacco control policies in US military commissaries. (review). Tobacco Control 16(1): 38-46, 2007. (122 refs.)

Background: The US military is perhaps the only retailer consistently losing money on tobacco. Military stores ( commissaries and exchanges) have long sold discount- priced cigarettes, while the Department of Defense ( DoD) pays directly for tobacco- related healthcare costs of many current and former customers. Tobacco use also impairs short- term troop readiness. Objective: To examine the long struggle to raise commissary tobacco prices and the tobacco industry's role in this policy effort. Methods: Analysis of internal tobacco industry documents, searches of government and military websites and newspaper databases, and interviews with key informants identified in the documents. Results: Efforts to raise commissary tobacco prices began in the mid- 1980s. Opposition quickly emerged. Some military officials viewed tobacco use as a "right'' and low prices as a "benefit''. Others raised issues of authority, and some saw the change as threatening the stores. The tobacco industry successfully exploited complex relationships among the Congress, the DoD, commissaries, exchanges and private industry, obstructing change for over a decade. Leadership from the Secretary and Assistant Secretaries of Defense, presidential support and procedural manoeuvring finally resulted in a modest price increase in 1996, but even then, high- level military officials were apparently threatened with retaliation from pro- tobacco Congressmen. Conclusions: The longstanding military tradition of cheap cigarettes persists because of the politics of the military sales system, the perception within the military of tobacco use as a right, and tobacco industry pressures. Against its own best interests, the US military still makes tobacco available to service members at prices below those in the civilian sector.

Swanson NA; Burroughs CC; Long MA; Lee RW. Controlled trial for smoking cessation in a navy shipboard population using nicotine patch, sustained-release buproprion, or both. Military Medicine 168(10): 830-834, 2003. (27 refs.)

This study reports an experimental, randomized controlled clinical trial comparing three treatments for smoking cessation: sustained-release bupropion, nicotine patch, and combination nicotine and bupropion, to a counseling-only control group (N = 140), for smoking sailors aboard seven Navy ships. The purpose was to determine the effectiveness of different pharmcotherapies used in smoking cessation programs. Continuous abstinence was defined as the percentage of subjects who did not smoke since the quit date assessed at 6 and 12 months and having an expired carbon monoxide concentration of <10 ppm at educational sessions 2, 3, and 4. Nine subjects dropped out of the study, and 40 subjects were lost to follow-up. Eleven percent (15/140 subjects) had continuous abstinence at 12 months. The abstinence rates at 12 months were 47% in the control group, as compared with 27% in the nicotine patch/bupropion group, 20% in the nicotine patch group, and 7% in the bupropion group.

Thompson JC; Kao TC; Thomas RJ. The relationship between alcohol use and risk-taking sexual behaviors in a large behavioral study. Preventive Medicine 41(1): 247-252, 2005. (22 refs.)

Background. Sexually transmitted infections (STIs) present a continuing challenge to the efforts to prevent disease in the military. Since the degree of high-risk sexual behavior is a primary determinant for acquiring STIs, the identification of personality traits or situations associated with such behavior is of special interest. Methods. Data for this study were obtained from the 1998 Department of Defense Survey of Health Related Behaviors Among Military Personnel. The survey instrument was a self-administered questionnaire that was conducted using a stratified, two-stage, two-phase probability design to obtain representative samples of U.S. active duty personnel worldwide. Results. More frequent episodes of alcohol intoxication were associated in a dose-dependent manner with an increased risk of having more sexual partners in the previous 12 months. Men and women who experienced intoxication more than 3 days per week were, respectively, 4.55 and 6.18 times more likely to have more than one sexual partner in the previous year. Conclusions. This study is based on retrospective self-report and may be subject to recall bias as well as information bias due to the sensitive nature of the subject matter. However, the results are compatible with a personality-based hypothesis, in which individuals with certain sensation-seeking tendencies may incur an increased risk for sexually transmitted infections.

Tracy SW; Trafton JA; Weingardt KR; Aton EG; Humphreys K. How are substance use disorders addressed in VA psychiatric and primary care settings? Results of a national survey. Psychiatric Services 58(2): 266-269, 2007. (13 refs.)

Objective: This study examined interventions for substance use disorders within the Department of Veterans Affairs (VA) psychiatric and primary care settings. Methods: National random samples of 83 VA psychiatry program directors and 102 primary care practitioners were surveyed by telephone. The survey assessed screening practices to detect substance use disorders, protocols for treating patients with substance use disorders, and available treatments for substance use disorders. Results: Respondents reported extensive contact with patients with substance use problems. However, a majority reported being ill equipped to treat substance use disorders themselves; they usually referred such patients to specialty substance use disorder treatment programs. Conclusions: Offering fewer specialty substance use disorder services within the VA may be problematic: providers can refer patients to specialty programs only if such programs exist. Caring for veterans with substance use disorders may require increasing the capacity of and establishing new specialty programs or expanding the ability of psychiatric programs and primary care practitioners to provide such care.

Trent L; Stander V; Thomsen C; Merrill L. Alcohol abuse among U.S. Navy recruits who were maltreated in childhood. Alcohol and Alcoholism 42(4): 370-375, 2007. (23 refs.)

Aims: To examine relationships between childhood maltreatment and alcohol-related problems among U.S. Navy recruits. Methods: An anonymous sample of 5697 Navy recruits completed a survey regarding their alcohol consumption, alcohol problems (binge drinking, drinking until drunk, alcohol dependence, alcohol-related arrests), and experiences of childhood physical and sexual abuse. Results: Most of the recruits used alcohol, and a substantial proportion reported histories of childhood maltreatment. Recruits who had been victimized as children were more likely to use alcohol. Furthermore, among drinkers, those who had been abused were more likely to exhibit alcohol problems than were non-abused drinkers. Conclusion: Substanceantial numbers of personnel with alcohol-related problems may be using alcohol to self-medicate due to a history of childhood abuse. Attention to the association between alcohol abuse and childhood maltreatment might help improve the efficacy of military alcohol reduction programs.

Vander Weg MW; DeBon M; Peterson AL; Sherrill-Mittleman D; Klesges RC; Relyea GE. Prevalence and correlates of lifetime smokeless tobacco use in female military recruits. Nicotine & Tobacco Research 7(3): 431-441, 2005. (54 refs.)

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.

Wallace AE; West AN; Booth BM; Weeks WB. Unintended consequences of regionalizing specialized VA addiction services. Psychiatric Services 58(5): 668-674, 2007. (27 refs.)

Objective: From 1995 to 2000 the Department of Veterans Affairs (VA) dramatically reduced addiction treatment funding and regionalized specialized services to urban centers. By using New York State as an example, this study examined whether regionalization disproportionately affected rural versus urban veterans' use of VA and non-VA inpatient addiction services. Methods: By using a comprehensive data set of VA and non-VA hospitalizations for 294,748 VA enrollees who were residents of New York State from 1998 to 2000, this study examined admission rates for addiction treatment to VA and non-VA centers to determine how rates differed between rural veterans and urban veterans. Results: Between 1998 and 2000 rural veterans obtained 67% of their inpatient addiction care from the VA, compared with 54% for urban veterans (p <. 001). Compared with 1998 levels, the odds ratios of admission to VA facilities for inpatient detoxification fell for both rural and urban veterans to .80 in 1999 and .65 in 2000 (both p < .05). Although odds ratios of non-VA inpatient admission for addiction treatment were stable over time for urban veterans, those for rural veterans fell from 1998 values, falling to .76 in 1999 (not significant) and .62 in 2000 (p < .001) for detoxification and to .66 in 1999 (not significant) and .51 in 2000 for rehabilitation (p < . 05). Odds ratios for urban veterans' admission to VA facilities for rehabilitation fell to .51 in terms of 1998 rates in 1999 and .38 in 2000, but rural veterans' odds ratios fell more, to .31 and .16, respectively (p < .001 for all). Conclusions: In New York regionalization of VA addiction services disproportionately affected rural veterans. Rural veterans experienced concurrent reductions in VA and non-VA inpatient addiction services. The VA and other health care policy makers should consider the potential unintended consequences to rural populations of resource reallocation.

Ward KD; Vander Weg MW; Klesges RC; Kovach KW; Elrod MC; DeBon M et al. Characteristics of highly physically active smokers in a population of young adult military recruits. Addictive Behaviors 28(8): 1405-1418, 2003. (32 refs.)

A substantial number of cigarette smokers are thought to engage in regular exercise. It is unclear why individuals who engage in a health-promoting activity such as exercising would simultaneously engage in a health-damaging behavior like smoking. Two possibilities are that (1) exercise serves as a "harm reduction" strategy to lessen the negative effects of smoking, or (2) that among weight conscious individuals, exercise and smoking are both used as weight control strategies. To examine these issues, smoking status, physical activity level, weight concerns, and several additional health behaviors and attitudes were assessed by questionnaire in a population of United States Air Force recruits (n=32,144). Multiple logistic regression analyses were used to compare characteristics of highly physically active smokers with both highly physically active never-smokers, and less active smokers. A substantial proportion of smokers reported being highly physically active (15.8%), although this proportion was significantly higher for never-smokers (22.7%). Active smokers were similar to active never-smokers across several health behaviors and attitudes, including diet, seatbelt use, and attitudes toward illegal drugs and condom use. Compared to less active smokers, active smokers consumed more fruits and vegetables, worried less about their weight, were less nicotine dependent, and had greater previous success at quitting smoking. These findings indicate that a substantial proportion of highly physically active young adults are regular cigarette smokers. Based on findings regarding general health behaviors and smoking history, this group may be particularly amenable to smoking cessation efforts

Wilson ALG; Lange JL Brundage JF; Frommelt RA. Behavioral, demographic, and prior morbidity risk factors for accidental death among men: A case-control study of soldiers. Preventive Medicine 36(1): 124-130, 2003. (20 refs.)

Background. In the United States, the leading cause of death for young men is unintentional injury. The experience of the U.S. Army, because it, comprises mostly young men, provides insights into factors associated with risk of accidental death. Between 1990 and 1998, accidents accounted for more than half of all deaths of men on active duty in the U.S. Army. Methods. All men on active duty in the U.S. Army who died in an accident between 1990 and 1998 were included in the study. For each accidental death case, four randomly selected controls were also included, matched on gender and contemporaneous military service. Results. In multivariate analyses, accidental death victims were more likely to be unmarried, limited to a high school education, in combat-specific occupations, veterans of a recent deployment, and previously hospitalized for an "injury/poisoning," "mental disorder," or "sign/symptom/ill- defined condition." Of behaviors reported on routine health risk assessments, the strongest predictor of a subsequent fatal accident was motorcycle use while the most excess deaths were attributable to consuming more than five alcoholic drinks per week. Conclusions. There are characteristics, experiences, and behaviors that predict accidental death risk. The findings may inform safety and health promotion programs aimed at young adults.

Wood DP; Koffman RL; Arita AA. Psychiatric medevacs during a 6-month aircraft carrier battle group deployment to the Persian Gulf: A Navy force health protection preliminary report. Military Medicine 168(1): 43-47, 2003. (168 refs.)

When a U.S. Navy Aircraft Carrier battle group deploys overseas, the aircraft carrier's medical department is responsible for the medical needs of over 12,000 personnel with their indigenous developmental, stress, family, alcohol, drug, and interpersonal and intrapersonal relationship difficulties. This article reviews the effectiveness of having a U.S. Navy clinical psychologist and a psychiatric technician onboard the USS Carl Vinson, the flag ship of Vinson's battle group, during this battle group's 1998/1999 Persian Gulf deployment (i.e., Western Pacific Deployment). Importantly, these two individuals reported to the USS Vinson as permanent members of the ship's company. The clinical psychologist logged 448 individual outpatient-care consults and 79 individual consults with sailors who had a history of overusing or abusing alcohol. Additionally, nine sailors with acute disabling psychiatric diagnoses were hospitalized on the ship's medical ward, and four sailors were medically evacuated (medevaced), by fixed wing aircraft, from USS Vinson to a Navy Hospital in the United States for definitive evaluation, treatment, and disposition. These four medevacs were less than the number of medevacs from two previous Aircraft Carrier Battle Group Persian Gulf deployments. Importantly, these two previous WESTPAC deployments were made without having a clinical psychologist as a full-time member of the respective aircraft carrier's medical department. Providing clinical psychology/mental health services at the "tip of the spear" is an effective, beneficial, and cost-saving landmark improvement in providing quality medical care to the fleet.

Wu DM; Chu NF; Lin YS; Lai HR. Aggregation of adverse behaviors and its affecting factors among young military conscripts in Taiwan. Addictive Behaviors 32(6): 1302-1308, 2007. (16 refs.)

The authors studied the prevalence of the aggregation in common lifestyle habits, namely, cigarette smoking, alcohol drinking, and betel-nut chewing and the demographic correlates of individual aggregation in these lifestyle behaviors among young military conscripts in Taiwan. Cross-sectional screening was conducted among conscripts in southern and eastern sections of Taiwan from Aug. 1st to Dec. 31st 2001. Totally, 3913 conscripts who had more than I month of service were included in this multistage sampling study. Information on smoking, drinking, and betel-nut chewing habits were ascertained as part of a self-administered questionnaire completed by examinees at the service unit. Aggregation in lifestyle habits was studied by comparing the observed and expected proportions (O/E ratio) with their 95% confidence intervals (CI) for zero, one, two, and three simultaneously occurring lifestyle habits. The study results showed a significant clustering of lifestyle habits studied; the number of subjects was greater than expected in groups with two (for cigarette smoking and betel-nut chewing, O/E ratio=1.17, 95%CI-1.06-1.28), and three (O/E ratio = 5.63, 95%CI = 5.06-6.20) lifestyle habits. Determinants for this clustering of lifestyle habits included lower educational levels and residential area in southern and eastern sections of Taiwan. There was a significant individual aggregation in lifestyle habits including cigarette smoking, alcohol drinking, and betel-nut chewing in the health survey among young military conscripts. In addition, young military conscripts with low educational levels and residential area in southern and eastern sections of Taiwan had an apparent tendency toward the aggregation in these lifestyle habits.

Young SYN; Hansen CJ; Gibson RL; Ryan MAK. Risky alcohol use, age at onset of drinking, and adverse childhood experiences in young men entering the US Marine Corps. Archives of Pediatrics & Adolescent Medicine 160(12): 1207-1214, 2006. (42 refs.)

Objective: To examine how childhood experiences relate to risky underage drinking. Design: A survey study of men starting military training between June 11, 2002, and April 5, 2006. Multivariate logistic regression models compared risky drinkers with "all others" or with nonrisky drinkers; excluding nondrinkers. Setting: Marine Corps Recruit Depot, San Diego, Calif. Participants: Forty-one thousand four hundred eighty-two men aged 18 to 20 years. Main Exposures: Age at drinking onset; childhood emotional, physical, and sexual abuse; childhood emotional and physical neglect; and household alcohol abuse, mental illness, domestic violence, or divorce. Main Outcome Measures: Risky drinking identified by scoring responses to 3 questions about alcohol consumption. Results: Of 41 482 young men, 6128 (14.8%) were identified as risky drinkers, 18 693 (45.1%) as nonrisky drinkers, and 16 661 (40.2%) as nondrinkers. Among drinkers, early initiation of alcohol use was strongly associated with risky drinking, with a 5.5-fold risk if age at onset of drinking was 13 years or younger. Other associated factors included tobacco use, rural or small hometown, higher education, motivation to join the military for travel or adventure or to leave problems at home, numerous close friends and relatives, household alcohol abuse or mental illness, and childhood sexual or emotional abuse. When the comparison group included nondrinkers, additional associated factors included childhood physical abuse and domestic violence. Conclusions: These analyses confirm previous findings on risks for alcohol misuse in young adults and quantify these risks in new, large, multivariable models, adding unique perspective from a population of young Marines. Public health efforts to decrease alcohol misuse may be effectively targeted by prevention of underage alcohol use, tobacco use, and childhood abuse.

2006, American Medical Association