Costs of smoking among active duty U.S. Air Force personnel--United States, 1997

Smoking is the leading cause of preventable disease and death in the United States (1). The health consequences of smoking impose a substantial economic toll on persons, employers, and society. Smoking accounts for $50-$73 billion in annual medical-care expenditures, or 6%-12% of all U.S. medical costs (2-5). The costs associated with lost productivity also are extensive (2). In 1997, approximately 25% of male and 27% of female active duty Air Force (ADAF) personnel aged 17-64 years were smokers (6). A 1997 retrospective cohort study was conducted among ADAF personnel to estimate the short-term medical and lost productivity costs of current smoking to the U.S. Air Force (USAF). This report summarizes the results of the study, which indicate that current smoking costs the USAF approximately $107.2 million per year: $20 million from medical-care expenditures and $87 million from lost workdays.     

The Troms? study: physical fitness, self reported physical activity, and their relationship to other coronary risk factors.

STUDY OBJECTIVE--The aim was to investigate the associations between physical fitness, leisure physical activity, and coronary risk factors. DESIGN--This was a cross sectional study of a random sample of men and women, following a population survey. SETTING--The municipality of Troms?, Norway in 1986-1987. PARTICIPANTS--All men born 1925-1966 and all women born 1930-1966 were invited to the survey; 21,826 subjects attended (81% of the eligible population): of these, 297 men and 312 women, randomly selected, attended the present study (attendance rates 94% in men and 89% in women). MEASUREMENTS AND MAIN RESULTS--Fitness was tested by bicycle ergometry. Physical activity was reported on a questionnaire. Multiple regression analysis was performed with fitness and leisure activity as dependent variables, and coronary risk factors as independent variables. Fitness and leisure activity were positively related (p less than 0.05). Prominent findings for fitness were negative associations with age and smoking (p less than 0.05), and positive associations with body mass index in both sexes (p less than 0.01). HDL cholesterol and systolic blood pressure were significant predictors of fitness in men (p less than 0.01). Smoking emerged as a strong negative predictor for leisure activity in women (p less than 0.01), and a negative relation between leisure activity and total cholesterol was found in men (p less than 0.01). CONCLUSIONS--The study indicates that coronary risk factors are more closely linked to physical fitness than to leisure physical activity.     

A population comparison of participants and nonparticipants in a health survey.

OBJECTIVES: This study examined the characteristics of Air Force recruits willing to take part in a health survey vs those unwilling to participate. METHODS: US Air Force recruits undergoing basic military training (n = 32,144) were surveyed regarding demographic and health variables. RESULTS: Respondents indicating an unwillingness to participate in a health survey reported less healthy lifestyles than those willing to participate. Prediction equations modeling the characteristics of those engaging in 4 risky behaviors were nearly identical regardless of whether those refusing to participate were included. CONCLUSIONS: Results suggest that, despite some low estimates of health behaviors due to response bias, relationships between most risk factors are generally unaffected by those not responding to health surveys.     

Suicide prevention among active duty Air Force personnel--United States, 1990-1999

During 1990-1994, suicide accounted for 23% of all deaths among active duty U.S. Air Force (USAF) personnel and was the second leading cause of death (after unintentional injuries) (Table 1). During those years, the annual suicide rate among active duty USAF personnel increased significantly (p<0.01) from 10.0 to 16.4 suicides per 100,000 members (Figure 1). In 1995, senior USAF leaders initiated prevention programs in several commands because of the increasing suicide rate. In May 1996, an in-depth study by a team of medical and nonmedical civilian and military experts was initiated to produce a comprehensive, communitywide prevention strategy that viewed suicide not only as a medical but a USAF problem, thus addressing overall social, behavior, and health issues (1). The plan was implemented across the entire USAF during 1996-1997. This report describes protective and prevention strategies and summarizes the study findings, which indicate that a substantial decline in the suicide rate was associated with the communitywide program.     

Family practice in the US Air Force

The United States Air Force Medical Service is well suited for family practice because of its early identification with the small community hospital. A plan was originally developed in 1968 to bring family practice to every Air Force member. This paper traces the progress of the program, identifies problem areas, specifies the planning factors and implementation plan, and gives the final goal for full family practice in the USAF.     

Risk reduction in the U.S. Air Force primary prevention HEART program

The United States Air Force (USAF) is developing a preventive cardiology program, the Health Evaluation and Risk Tabulation (HEART) program. This article describes the goals and methods of the HEART program's Risk Reduction Component (RRC), which is to assist high-risk active-duty USAF personnel to modify specific health behaviors associated with arteriosclerotic disease: cigarette smoking, and food patterns high in calories from fat and exogenous cholesterol. Also, education is offered to confirmed hyptertensives, whose pharmacological treatment is provided by the base medical facility. The RRC strategy is being tested at two air bases, Pease, New Hampshire, and Charleston, South Carolina. Designated airmen are invited to participate in RRC on these bases after notification of their risk status. Voluntary participation is encouraged at two levels: orientation sessions: and at subsequent focal groups in smoking cessation and/or food pattern modification. Focal groups emphasize techniques of self-management in smoking cessation and eating behavior, including post-treatment maintenance behavior for long-term risk reduction.     

Education and risk of coronary heart disease: assessment of mediation by behavioral risk factors using the additive hazards model

Educational-related gradients in coronary heart disease (CHD) and mediation by behavioral risk factors are plausible given previous research; however this has not been comprehensively addressed in absolute measures. Questionnaire data on health behavior of 69,513 participants, 52 % women, from seven Danish cohort studies were linked to registry data on education and incidence of CHD. Mediation by smoking, low physical activity, and body mass index (BMI) on the association between education and CHD were estimated by applying newly proposed methods for mediation based on the additive hazards model, and compared with results from the Cox proportional hazards model. Short (vs. long) education was associated with 277 (95 % CI: 219, 336) additional cases of CHD per 100,000 person-years at risk among women, and 461 (95 % CI: 368, 555) additional cases among men. Of these additional cases 17 (95 % CI: 12, 22) for women and 37 (95 % CI: 28, 46) for men could be ascribed to the pathway through smoking. Further, 39 (95 % CI: 30, 49) cases for women and 94 (95 % CI: 79, 110) cases for men could be ascribed to the pathway through BMI. The effects of low physical activity were negligible. Using contemporary methods, the additive hazards model, for mediation we indicated the absolute numbers of CHD cases prevented when modifying smoking and BMI. This study confirms previous claims based on the Cox proportional hazards model that behavioral risk factors partially mediates the effect of education on CHD, and the results seems not to be particularly model dependent.     

A population-based estimate of the prevalence of behavioral risk factors among adult cancer survivors and noncancer controls

BACKGROUND: Behavioral risk factors have significant biomedical and psychosocial effects for cancer survivors. Representative data on the prevalence of a wide range of behavioral risk factors among cancer survivors are lacking. METHODS: We used data from the 2000 National Health Interview Survey to examine the prevalence of smoking, physical inactivity, dietary risk factors, being overweight, risky alcohol use, and sun protection behaviors among a sample of 32,346 adults, 1646 of whom were cancer survivors. RESULTS: With the exception of smoking, there were few differences in age-stratified behavioral risk factor prevalences between cancer survivors and noncancer controls. Among the cancer survivors, there were few differences in behavioral risk factor prevalence rates for survivors of different cancers. Exceptions included a high rate of current smoking for cervical and uterine cancer survivors. The prevalences of physical inactivity, dietary risk factors, and being overweight were relatively high across cancer types, whereas the prevalence of risky drinking was particularly low. CONCLUSIONS: This study provides benchmark estimates of the prevalence of multiple cancer-related behavioral risk factors among U.S. cancer survivors. The results reveal considerable opportunities for behavioral risk factor interventions among cancer survivors. We discuss implications of the results and outline directions for future research.     

Behavioral cardiovascular risk factors in HIV-infected people in France: Diversity of profiles across groups requires an urgent and tailored preventive approach

Background

Among people living with HIV, cardiovascular risk could be markedly reduced through lifestyle improvement. However, to date behavioral cardiovascular risk factors (other than tobacco smoking) have been poorly investigated among them. Additionally, although co-occurrence of risk factors might amplify the deleterious effects of each risk factor, little is known about such risk factors clustering in this population. We aimed to examine levels, determinants and clustering of the major behavioral cardiovascular risk factors in the French HIV-infected population, in order to better target individuals with high risk profiles.

The U.S. Air Force HEART Program: The Air Force perspective

The U.S. Air Force Health Evaluation and Risk Tabulation (HEART) Program was initiated to design and test a preventive cardiology program for active-duty Air Force members. Most cardiovascular incidents in active-duty personnel occur at a career point which significantly magnifies their operational and fiscal effect as the bulk of events disable or kill personnel during their years of peak productivity. A registered nurse managed the program at each of the four demonstration bases. The number of medical technicians and health counselors varied according to base population. The program includes risk factor screening, risk ranking, basewide education, and focal group intervention for those at high risk. Screening consisted of a health and habits questionnaire, blood pressure measurement, serum glucose, serum total and HDL cholesterol, as well as serum thiocyanate and exhaled carbon monoxide. The total population screened at first screen was 12,000 and 8,000 are expected at second screen. It is likely that due to the military capability for long-term follow-up, primary prevention begun at the time of entry to active duty could effectively reduce the number of cardiovascular events experienced yearly in the Air Force. The final product of HEART will be a detailed plan for an Air Force-wide preventive cardiology plan.     

Psychosocial and physical risk factors associated with low back pain: a 24 year follow up among women and men in a broad range of occupations

OBJECTIVES: To investigate the relation between psychosocial and physical factors at work, as well as conditions during leisure time, and low back pain (LBP) over 24 years. METHODS: The study group consisted of 252 women and 232 men. From a previous study conducted in 1969, data on psychosocial and physical conditions and LBP were available. Data on LBP for 1971-93 were obtained retrospectively in 1993. RESULTS: The prevalence of LBP in 1969 among women and men were 34% and 24%, the cumulative incidences of LBP during 1970-92 were 38% and 43%, and the prevalences in 1993 of having had LBP during the past 12 months were 44% and 39%, respectively. Monotonous work and few or unsatisfactory social contacts outside work were risk factors for LBP in 1969 among women. LBP in 1969 and dissatisfaction with leisure time were risk factors among both sexes for LBP in 1970-92. LBP in 1969 was a risk factor for LBP in 1993 among women and dissatisfaction with leisure time a risk factor among men. Interactions between few or unsatisfactory social contacts outside work, as well as dissatisfaction with leisure time, and several factors related to work were found to increase the risk of LBP among both sexes during the studied periods. CONCLUSIONS: Conditions in leisure time exert a long term influence on LBP. In this study factors related to work had a long term effect only in interaction with leisure time factors.

 

     

Comparison of weight status among two cohorts of US Air Force recruits

BACKGROUND: Overweight and obesity are increasing rapidly in the US and the Department of Defense (DoD). We examined whether weight trends evidenced in the general population and DoD are occurring among individuals entering US Air Force (USAF) Basic Military Training (BMT). METHODS: Individuals entering the USAF in 1996 (AF1996; N = 29,036) and 2000 (AF2000; N = 31,080), ages 17-29 years were surveyed. The two recruit cohorts were compared to age-matched individuals from the 1996 (N = 22,153) and 2000 (N = 31,861) Behavioral Risk Factor Surveillance System Survey (BRFSS). RESULTS: Crude rates for all age groups and age- and gender-standardized prevalence rates reflected significant increases in overweight/obesity among recruits. The direct standardized prevalence of overweight/obesity increased nearly 24%, from 14.8% in AF1996 to 18.3% in AF2000. The increase in overweight/obesity was particularly large among male recruits ages 25-29 (i.e., from 36.4% to 44.5%) between 1996 and 2000. CONCLUSIONS: USAF cohorts were less likely to be overweight than corresponding BRFSS samples. There were 19.1 and 20.2 percentage point differences between overall crude rates of overweight/obesity between AF1996 and BRFSS 1996 and AF2000 and BRFSS 2000, respectively. Nevertheless, overall rates of overweight and obesity are increasing among young recruits in the USAF at a fairly marked rate (approximately one percentage point per year).     

Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors.

We studied the association between behavioral and demographic risk factors and 17-year mortality in members of the Alameda County (California) Study who were 60-94 years of age at baseline. In this age group, increased risk of death is associated with being male, smoking, having little leisure-time physical activity, deviating from moderate weight relative to height, and not regularly eating breakfast. These increased risks were independent of age, race, socioeconomic position (SEP), other behavioral risk factors, and baseline physical health status. Further examination of the group aged 70 or more revealed the same patterns of heightened risk.     

Assess workers' needs and preferences first before planning a physical fitness programme: findings from a polytechnic institute in Singapore

Workplace physical fitness programmes are usually poorly attendedbecause the activities do not meet workers' needs. We investigatedleisure-time physical activity and its relation to sociodemographiccharacteristics and cardiovascular risk factors in a polytechnicinstitute in Singapore before planning a physical fitness programme.Low leisure-time physical activity (defined as no activity orengaging in physical activity less than once per week) was moreprevalent among older women, married workers, smokers and menwith unhealthy dietary habits. The type of physical activityvaried with age and gender, with a preference for walking bywomen and older men and jogging by younger men. Low physicalactivity was significantly associated with sickness absenceand self-reported stress in women and higher values of triglyceridesand low density lipoprotein cholesterol in men. This surveyhelps to identify target groups for physical fitness programmesand determine leisure-time physical activities specific to workers'preferences by age and gender.     

Smokers with multiple behavioral risk factors: how are they different?

OBJECTIVE: The first aim of the present investigation was to examine cross-sectional differences between smokers who engage in additional health risk behaviors (i.e., high-fat diets and low physical activity levels) and those who do not that could affect readiness for smoking cessation treatment and treatment prognosis. The second aim was to examine prospective associations between risk factor status and smoking outcomes (i.e., cessation and quit attempts). DESIGN: Data were derived from baseline and 1-year follow-up surveys for the SUCCESS project, a randomized trial of worksite smoking interventions conducted in 24 worksites in Minneapolis/St. Paul, Minnesota. Included in the analyses were 2,149 study participants who reported smoking at baseline. METHODS: Current smokers were categorized into one of three "risk groups": the "1 additional risk factor" group (i.e., either low physical activity level or high dietary fat intake), the "2 additional risk factor" group (i.e., both low physical activity and high dietary fat intake), and the "smoker only" group (i.e., neither low physical activity nor high dietary fat intake). Mixed model regression analyses examined cross-sectional associations between risk group status and baseline demographic variables, smoking dependency, social environments for smoking, and health problems. Prospective associations between baseline risk group status and 1-year follow-up cessation attempts and quits were also examined. RESULTS: At baseline, risk factor status was associated with smoking dependency for both men and women. Women smokers with at least one additional risk factor reported a greater number of cigarettes smoked per day, higher Fagerstrom Nicotine Dependence scores, and lower self-efficacy for refraining from smoking in a variety of situations compared with smokers with no additional risk factors. Men smokers with at least one additional risk factor reported higher Fagerstrom Nicotine Dependence scores compared with smokers with no additional risk factors. Women smokers with at least one additional risk factor were more likely to report being encouraged to quit by co-workers compared with smokers with no other risk factors. No relationship between risk factor status and social pressure to quit was observed among men. Prospective analyses indicated that baseline risk factor status was marginally related to smoking outcome at 1-year follow-up; however, these relationships were attenuated considerably when controlling for smoking dependence. Relationships between risk factor status and smoking outcomes were stronger for men. CONCLUSION: Results indicated that the presence of multiple health risk behaviors was related to more serious problems with smoking. However, the presence of additional risk factors did not strongly affect prognosis for smoking cessation.     

Tobacco use: a modifiable risk factor for dental disease among the elderly.

OBJECTIVES. Because the public health literature contains few analytic studies of modifiable behavioral risk factors for dental disease among older community-dwelling populations, the New England Elders Dental Study was undertaken as an epidemiologic study of the oral health status of a representative sample of older adults living within the six New England states. METHODS. Five dentists conducted comprehensive in-home oral health examinations on 1156 community-dwelling adults aged 70 and older to determine whether lifetime use of tobacco products was a significant risk factor for tooth loss, caries, and periodontal disease. RESULTS. Among New England elders, tobacco use was more common among men (18.1%) than women (7.9%), with a combined rate of 12.3%. Further, 64.7% of men and 36.6% of women were previous tobacco users. Years of exposure to tobacco products was a statistically significant risk factor for tooth loss, coronal and root caries, and periodontal disease, regardless of other social and behavioral factors. CONCLUSIONS. Lifelong tobacco use is a modifiable risk factor for poor dental health among older adults. Dental practitioners need to intervene with all their adult patients to discourage use of tobacco products for oral as well as general preventive health care.     

Multiple risk factors and population attributable risk for ischemic heart disease mortality in the United States, 1971-1992

The objective of this study was to assess the associations and population attributable risks (PAR) of risk factor combinations and ischemic heart disease (IHD) mortality in the United States. We used logistic regression models to assess the association of risk factors with IHD in the First National Health and Nutrition Examination Survey (1971-1974) and Epidemiologic Follow-up Study (1982-1992) among white and black men and women. We examined eight modifiable risk factors: hypertension, elevated serum cholesterol, diabetes, overweight, current smoking, physical inactivity, depression, and nonuse of replacement hormones. Risk factors associated with IHD mortality were the same among white and black men (i.e., age, education, smoking, diabetes, hypertension, and serum cholesterol). Age, education, smoking, diabetes, and hypertension were the risk factors among white and black women. Physical inactivity, nonuse of replacement hormones, serum cholesterol, and overweight were the additional risk factors among white women. Adjusted for demographic risk factors, overall PARs for study risk factors were 41.2% for white men, 60.5% for white women (with five risk factors only), 49.2% for black men, and 71.2% for black women. Much IHD mortality attributable to individual risk factors is caused by those factors in combination with other risk factors; relatively little mortality is attributable to each risk factor in isolation. Analysis that does not examine risk factor combinations may greatly overestimate PARs associated with individual risk factors.     

Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults

Many demographic, socioeconomic, and behavioral risk factors predict mortality in the United States. However, very few population-based longitudinal studies are able to investigate simultaneously the impact of a variety of social factors on mortality. We investigated the degree to which demographic characteristics, socioeconomic variables and major health risk factors were associated with mortality in a nationally-representative sample of 3617 U.S. adults from 1986 to 2005, using data from the 4 waves of the Americans' Changing Lives study. Cox proportional hazard models with time-varying covariates were employed to predict all-cause mortality verified through the National Death Index and death certificate review. The results revealed that low educational attainment was not associated with mortality when income and health risk behaviors were included in the model. The association of low income with mortality remained after controlling for major behavioral risks. Compared to those in the “normal” weight category, neither overweight nor obesity was significantly associated with the risk of mortality. Among adults age 55 and older at baseline, the risk of mortality was actually reduced for those were overweight (hazard rate ratio = 0.83) and those who were obese (hazard rate ratio = 0.68), controlling for other health risk behaviors and health status. Having a low level of physical activity was a significant risk factor for mortality (hazard rate ratio = 1.58). The results from this national longitudinal study underscore the need for health policies and clinical interventions focusing on the social and behavioral determinants of health, with a particular focus on income security, smoking prevention/cessation, and physical activity.