Smoking and deployment: perspectives of junior-enlisted U.S. Air Force and U.S. Army personnel and their supervisors

Smoking during deployments is a growing problem, particularly among junior-enlisted personnel, who have the highest smoking rates in the military. Few studies have examined reasons for smoking initiation among never smokers, relapse among former smokers, or increased smoking frequency among current smokers. We conducted 24 focus groups at four Air Force and two Army installations (N = 189) to examine the extent of smoking during deployment and to elucidate factors thought to contribute to new initiation, relapse, and increased smoking in a sample of junior-enlisted personnel and their supervisors. Important reasons for smoking included: (1) managing stress, boredom, anxiety, and sleep deprivation; (2) lack of alternate activities and privileges; (3) the perception that dangers in the field trumps the health impact of smoking; and (4) the role of the military environment in encouraging smoking. In addition, the phenomenon of new initiation and relapse to smoking in the field was discussed.     

如何正确理解和使用辐射屏蔽防护设计中的U、T因子

目的 了解我国职业卫生监督和服务机构的有关人员对辐射屏蔽防护设计中利用因子（U）、驻留因子（T）理解的现状，分析存在的主要问题，提出改进建议。方法选择建设项目辐射屏蔽防护设计中的一个典型案例，对相关人员的认知水平以笔试形式考核，收集考卷，进行分类统计、分析。结果通过对87份有效考卷的分析，U、T因子使用过程中存在的主要问题是对辐射源项与职业病危害因素的关系区分不清、场所危害和接触危害的概念理解不贴切等。结论应加强对有关法律、法规和技术标准，特别是《电离辐射防护与辐射源安全基本标准》（GB18871—2002）的学习和领会，预防和控制放射性职业病危害的发生。     

Smoking and tobacco use by U.S. military personnel

Findings regarding smoking behavior for the 1985 survey of military personnel were compared to findings from earlier surveys. A decline in the percentage of cigarette smokers was evident for all ranks and ages. Reported use of smokeless tobacco and cigar/pipe smoking indicated that one-fifth of the cigarette smokers also use smokeless tobacco and that two-fifths of the cigarette users smoke a pipe or cigar. Among non-smokers of cigarettes, about one-tenth of the respondents used smokeless tobacco and/or smoked a pipe or cigars. Using self-evaluation of health status, non-smokers reported "excellent" health significantly more than smokers.     

Discharges during U.S. Army basic training: injury rates and risk factors

This study examined injury rates and risk factors for discharge in a cohort of 756 men and 474 women in U.S. Army basic combat training (BCT) at Fort Jackson, South Carolina. Investigators systematically screened trainee medical records for injuries and collected medical recommendations to temporarily remove a trainee from BCT to allow recovery from an injury. The BCT unit provided Army Physical Fitness Test (APFT) scores and trainee demographic data. Discharges were identified by reviewing discharge packets and were confirmed through rosters from the BCT units. There were 102 men and 108 women discharged. Person-time injury incidence rates (for time-loss injuries) among discharged and nondischarged men were 1.87 and 0.45 cases/100 person-days, respectively (p < 0.01); the rates for discharged and nondischarged women were 1.95 and 1.01 cases/100 person-days, respectively (p < 0.01). Men had a higher risk of discharge if they had a time-loss injury (p < 0.01), but women did not (p = 0.28). Other discharge risk factors for both men and women included a medical recommendation for removal from training to recover from an injury, lower performance on any of the three APFT events, and lower educational level. Women with more body mass or a higher body mass index also had a marginally higher risk of discharge.     

Peacetime U.S. Army aircrew rescue and factors delaying rescue.

Despite strict flight discipline, U.S. Army aircraft infrequently suffer inflight mishaps. This is a retrospective study of aircrew survival and rescue in 97 mishaps investigated by the U.S. Army Safety Center from October 1988 to June 1990. To identify factors delaying rescue, recent mishaps are compared with 37 mishaps where the time to reach the mishap site exceeded 2 h. The average time to reach a mishap site was 2.2 h, but over 90% were reached within 2 h. There were two or more survivors at 82% of the sites and 98% of the downed aircrew had at least personal survival equipment available. Adverse operational and environmental factors were more common in delayed rescue mishaps. Sudden aircraft failure was three times more common in prolonged rescue mishaps, while night or instrument meteorologic conditions contributed eight times and four times greater risk of delay, respectively. Rescues in mountainous terrain or overwater were seven times more likely to be delayed. While fatalities were more common with prolonged rescue, there were no mishaps where a delay in reaching the crash site resulted in the loss of an airman.     

美军心理健康维护进展

美军自2001年参加阿富汗战争和2003年参加伊拉克战争以来,创伤性脑损伤、自杀、创伤后应激障碍等成为其日益关注的问题。本文围绕目前美军心理健康维护的工作重点,介绍了其在心理健康维护方面的科研和工作进展。     

Nutrition knowledge and supplement use among elite U.S. army soldiers

A U.S. Army Special Forces (SF) unit was studied to determine characteristics of supplement users, assess nutrition knowledge, and identify nutrition information sources. SF-qualified (n = 119) and non-SF, support soldiers (n = 38) participated. Most soldiers (87%) reported current supplement use with more SF (90%) than non-SF, support soldiers (76%) using supplements (p < or = 0.05). Supplements SF reported using most were multivitamins, sports bars/drinks, and vitamin C. The mean nutrition knowledge score for all soldiers was 48.5 +/- 15.2% correct responses. Most soldiers incorrectly believe protein is used for energy for short-term athletic events (64%) and that vitamins provide energy (58%). The most common information sources reportedly used were popular magazines/books (75%), friends/teammates (55%), physicians/nurses, radio/television (34%), and the Internet (31%).     

Physical activity levels and counseling practices of U.S. medical students

INTRODUCTION: Some literature shows a positive relationship between physicians' personal physical activity (PA) levels and physicians' encouraging patients' PA, though it remains unclear how this evolves during medical training. In this paper, we describe U.S. medical students' PA levels and factors predicting relevance and frequency of their PA counseling of patients. METHODS: This is a prospective survey of a representative sample of U.S. medical students from 16 schools (N = 2316) designed to determine health-related attitudes and practices. Student's PA levels were assessed using a Godin exercise questionnaire. An 80.3% (N = 1658) response rate was achieved during 4 yr. RESULTS: More than half (61%) of U.S. medical students adhered to CDC PA recommendations. This rate was relatively stable during the 4 yr of medical training. Of those who reported a lot of stress in the last 12 months or 2 wk, fewer than 60% complied with the CDC exercise recommendations, compared with at least 80% who reported almost no stress. Frequency of PA counseling of patients was consistently related to personal PA practices. The percent of students perceiving that PA counseling would be highly relevant to their practices decreased during the 4 yr of medical school, from 69 to 53% (P < 0.01). DISCUSSION: Among U.S. medical students, personal PA levels are higher than those of age-matched peers in the general population, are maintained throughout medical school, and are correlated with frequency of PA counseling of their patients. Promotion of adequate PA habits during medical education may be an important step to improve the PA preventive counseling that future clinicians provide.     

Back and upper extremity disorders among enlisted U.S. Marines: burden and individual risk factors.

Although musculoskeletal disorders of the low back and upper extremities can affect military readiness, little is known about their extent and risk factors in the U.S. Marine Corps. Using the Defense Medical Epidemiology and Defense Medical Surveillance System databases, back and upper extremity diagnostic categories were among the top four sources of outpatient visits and duty limitation among enlisted Marines. Back disorders were also found to be the fifth most common cause for lost time. Subsequently, high-risk occupations were identified, age-related trends for clinic visit rates were determined, and rate ratios were computed for the top 15 low back and upper extremity diagnoses among enlisted Marines from 1997 through 1998. Occupational categories with the highest rates of musculoskeletal-related outpatient visits included image interpretation, auditing and accounting, disturbsing, surveillance/target acquisition, and aircraft launch equipment. Significantly increasing linear trends in rates across age groups were found for most diagnoses. For 1998, age-specific rate ratios indicated significantly higher rates for most low back and upper extremity disorders for females; lower rank (i.e., E1-E4) was also a risk, but for fewer diagnoses. The findings emphasize the need to identify modifiable (e.g., work-related, individual) risk factors and to develop focused primary and secondary prevention programs for musculoskeletal disorders in the Marine Corps. Subsequently, these efforts can assist in reducing associated effects, maximizing resource utilization, and enhancing operational readiness.     

Nonoccupational physical activity by degree of urbanization and U.S. geographic region

PURPOSE: To estimate levels of nonoccupational leisure-time physical activity (LTPA) by degree of urbanization and geographic region of the United States. METHODS: Participants were respondents to the Behavioral Risk Factor Surveillance System (BRFSS) in 2001 (N = 137,359). Moderate- and vigorous-intensity LTPA was categorized as meeting recommended levels, insufficient, or inactive. The U.S. Department of Agriculture rural-urban continuum codes were used to describe degrees of urbanization (metro, large urban, small urban, and rural). Geographic regions were defined by the U.S. Bureau of the Census (Northeast, Midwest, South, and West). Prevalence estimates were calculated using sample weights to account for the design of the BRFSS. Multivariate logistic regression analyses examined regional differences in the odds of physical inactivity (physically inactive vs insufficient or meets) by degree of urbanization after adjustment for sex, age, race, BMI, education, and occupational physical activity. RESULTS: Large urban areas (49.0%) and the western United States (49.0%) had the highest prevalence of recommended levels of LTPA. Rural areas (24.1%) and the southern United States (17.4%) had the highest prevalence of inactivity. Adults living in the four urbanization categories of the midwestern (metro (OR = 1.47, 95% CI = 1.31, 1.65), large urban (OR = 1.83, 95% CI = 1.51, 2.23), small urban (OR = 1.99, 95% CI = 1.65, 2.40), and rural (OR = 2.59, 95% CI = 1.35, 4.97)); and southern (metro (OR = 1.70, 95% CI = 1.53, 1.88), large urban (OR = 2.04, 95% CI = 1.72, 2.41), small urban (OR = 2.32, 95% CI = 2.02, 2.67), and rural (OR = 5.49, 95% CI = 2.82, 10.68)) U.S. regions were more likely to be inactive than adults living in similar areas of the western United States. Adults in northeast metro and large urban areas (OR = 1.62, 95% CI = 1.45, 1.81; and OR = 1.37, 95% CI = 1.08, 1.74, respectively) were more likely to be inactive than those residing in western metro and large urban areas. CONCLUSION: The prevalence of physical inactivity varies by degree of urbanization and geographic region of the United States.     

Self-reported physical activity and preaccession fitness testing in U.S. Army applicants

The Assessment of Recruit Motivation and Strength (ARMS) study evaluated a physical fitness screening test for Army applicants before basic training. This report examines applicants' self-reported physical activity as a predictor of objective fitness measured by ARMS. In 2006, the ARMS study administered a fitness test and physical activity survey to Army applicants during their medical evaluation, using multiple logistic regression for comparison. Among both men and women, "qualified" and "exceeds-body-fat" subjects who met American College of Sports Medicine adult physical activity guidelines were more likely to pass the fitness test. Overall, subjects who met physical activity recommendations, watched less television, and played on sports teams had a higher odds of passing the ARMS test after adjustment for age, race, and smoking status. This study demonstrates that self-reported physical activity was associated with physical fitness and may be used to identify those at risk of failing a preaccession fitness test.     

Physical activity profiles of U.S. adults trying to lose weight: NHIS 1998

PURPOSE: Physical activity is an integral part of weight control programs, but recommended amounts vary. The objectives of this study were to describe the prevalence and characteristics of those who reported using exercise as a weight loss strategy (N=14,716), and to determine the prevalence of meeting various institutionally recommended levels of physical activity (N=8538) among that population. METHODS: Data were obtained from the 1998 National Health Interview Survey, a face-to-face nationally representative household interview. Questions on leisure-time physical activity were analyzed using SUDAAN. RESULTS: Among those who reported trying to lose weight, 55% reported using exercise as a weight loss strategy alone, and of those, 58% reported eating fewer calories. The prevalence of using exercise as a weight loss strategy was directly associated with education and inversely associated with age and body mass index. Among those who reported using exercise as a weight loss strategy, 57% met the minimal 1998 National Institutes of Health recommendation of >or=150 min.wk; 46% met the lower end of the 2001 American College of Sports Medicine recommendation of 200 min.wk; and 30% met the upper end for 300 min.wk. Only 19% met the 2002 Institute of Medicine recommendation of 420 min.wk. CONCLUSIONS: Despite the importance of physical activity in a weight loss program, only about half of the persons trying to lose weight reported using exercise. Even among those, only slightly more than half met the minimal recommendations for physical activity. Efforts are needed to aid those trying to lose weight to incorporate appropriate levels of physical activity into their weight loss strategy.     

Reported stress and its relationship to tobacco use among U.S. military personnel

In addition to common stressors, members of the U.S. Armed Forces experience a high level of stress unique to their status as service members. In an effort to combat stress, many military personnel report high levels of nicotine use. This study investigated the relationship between tobacco use and perceived stress among military members in all four armed services. Results indicate that those who use tobacco products specifically to reduce stress report significantly higher stress levels than those who do not use tobacco. Moreover, current users and those who both smoked and used smokeless tobacco were far more likely to report experiencing "a lot" of stress from a variety of sources than former or never users. Tobacco users also engaged more frequently in negative coping behaviors and relied less on the positive coping strategies used more often by former or never smokers. These findings are consistent with the larger body of literature suggesting that tobacco is not only an ineffective stress-reducing strategy, it also likely perpetuates a stress response in users. It is, therefore, critical that the military improve effective means of coping among nicotine-using troops.     

Injury rates and injury risk factors among U.S. Army wheel vehicle mechanics

This study describes injury rates, injury diagnoses, anatomical locations of injuries, limited duty days, and activities associated with injuries in a sample of Army mechanics. Medical records of 518 male and 43 female Army mechanics were screened for injuries during 1 year at a large U.S. Army installation. Weight, height, age, and ethnicity were also extracted from the medical records. Body mass index was calculated as weight/height2. Overall injury rates for men and women were 124 and 156 injuries/100 person-years, respectively, with a rate of 127 injuries/100 person-years for all soldiers combined. Women had higher overuse injury rates while men had higher traumatic injury rates. Limited duty days for men and women were 2,076 and 1,966 days/100 person-years, respectively. The lower back, knee, ankle, foot, and shoulder involved 61% of the injuries. Activities associated with injury included (in order of incidence) physical training, mechanical work, sports, airborne-related activities, road marching, garrison/home activities, and chronic conditions. Among the men, elevated injury risk was associated with higher body weight and higher body mass index. It may be possible to prevent many injuries by implementation of evidenced-based interventions currently available in the literature.     

Monoplace hyperbaric chamber use of U.S. Navy Table 6: a 20-year experience.

We report a 20-year experience at LDS Hospital, Salt Lake City, UT using the U.S. Navy Treatment Table 6 (TT6) in an oxygen-filled monoplace hyperbaric chamber (1985-2004). Air breathing was provided via a demand regulator fitted with a SCUBA mouthpiece while the patient wore a nose clip. Intubated patients were mechanically ventilated with a Sechrist 500A ventilator, with a modified circuit providing air, when specified. We treated 90 patients: 72 divers (decompression sickness [DCS] = 67, arterial gas embolism [AGE] = 5), 10 hospital-associated AGE, and 8 miscellaneous conditions. They received a total of 118 TT6 (9 TT6 in intubated patients). Ninety-four percent of the TT6 schedules were tolerated and completed. The intolerance rate from two surveyed multiplace chambers was zero and 3% of 100 TT6 schedules each. Failure to complete the TT6 was due to oxygen toxicity (4) and claustrophobia (3). The U.S. Navy TT6 was well tolerated by patients with DCS or AGE treated in monoplace hyperbaric chambers, but tolerance may not be as high as when treated in the multiplace chamber.