Testing a model of exposure to environmental tobacco smoke in military women with children

The purpose of this study was to test a model of exposure to environmental tobacco smoke (ETS) in military women and their children. The convenience sample consisted of 238 women, 81 smokers and 157 nonsmokers, with a mean age of 37 years (SD = 9.9). Participants were either on active duty or were reservists and/or military dependents. Model constructs, some of which were adapted from the transtheoretical model of behavior change, measured personal and situational factors, pros and cons of ETS exposure, self-efficacy to resist ETS, mother's expectation for child's ETS exposure, and mother's self-efficacy to reduce child's ETS exposure. The mediating variable was the mother's daily ETS exposure, and the outcome variable was the child's daily ETS exposure. The trimmed model showed that 32% of the variance in mother's daily exposure (mediating variable) was accounted for by living with a smoker, having high ETS "pros" (as opposed to ETS "cons"), having less self-efficacy to resist ETS, and having greater self-efficacy to reduce the child's exposure. There was a significant, positive relationship (r = 0.51, p = 0.01) between the mother's and child's daily ETS exposure (outcome variable).     

The clinical implications of a smoking ban on submarines in the U.S. Navy

By the end of calendar year 2010, a total smoking ban on submarines is expected to be implemented throughout the submarine force because of the negative health effects of environmental tobacco smoke and the recently demonstrated exposure of nonsmoking submariners to measurable levels of nicotine during submarine deployments. Historically, smoking has been highly prevalent in the military, but new data on the negative health effects of tobacco have led the military to change its policies, restricting its use in certain environments. A number of research studies have examined the effect of smoking on the military, cessation and prevention interventions, effect of environmental tobacco smoke onboard the submarine, and treatment modalities aimed at smokers attempting to quit. With the potential for considerable physical and psychological effects, a mass tobacco cessation program is being implemented to support the prohibition onboard the submarine. Recommendations for a successful implementation program are included.     

Minimizing exposure to passive smoke in the enclosed environment of U.S. submarines

OBJECTIVE: This study was designed to determine which designated smoking area on a submarine, forward or aft, minimizes nonsmokers' exposure to environmental tobacco smoke. METHODS: A survey was administered and urine tested by an enzyme-linked immunoassay for urinary cotinine before and during a 10 d underway. There were four groups tested; submariners on boats with forward or aft designated smoking areas, with each of these groups further divided into submariners whose watch is primarily forward or aft. RESULTS: There were no significant differences in urine cotinine levels between submariners whose watches are primarily in the forward section as compared with those who work primarily aft. This was true for predeployment as compared with deployment levels and whether the designated smoking area was located forward or aft. CONCLUSION: Using cotinine as a marker, passive smoke exposure appears to be minimum. The location of the designated smoking area aboard U. S. Navy submarines does not appear to have any effect on urinary cotinine levels.     

被动吸烟对豚鼠高空减压气泡生成影响的初步观察

观察了３０只豚鼠于密闭舱内被动吸入卷烟烟雾对随后高空减压心前区气泡出现的影响。结果表明：在上述２种吸入卷烟烟雾的条件下，减压气泡的首次出现时间和气泡等级与对照组相比无显著差异。初步提示减压露前短时间大量吸烟不会影响高空减压病的发生。     

Earwax: an innovative tool for assessment of tobacco use or exposure. A pilot study in young adults

The present work represents a novel approach using earwax (cerumen) for the evaluation of the smoking status with regards to tobacco use/exposure. The method utilizes the difference in the concentration profiles of nicotine and its related compounds in earwax to discriminate among non-, passive, and active smokers. Earwax samples were collected from three study groups (non-, passive, and active smokers) and subjected to analysis by headspace gas chromatography–mass spectrometry. The nicotine levels in earwax were much lower than cotinine levels, even for active smokers; however, it was reported that the nicotine levels in scalp hair were much higher than the cotinine levels. Therefore, it is obviously correct that earwax is protected from external contamination to a larger extent than expected. The concentration profiles of nicotine and its related compounds (o-nicotine, cotinine, and anabasine) in the analyzed earwax samples were treated by data mining techniques. It was possible to discriminate the studied groups using the evolutionary tree (evtree) algorithm and support vector machine discriminant analysis as the statistical models with the best discrimination accuracies of 96.7 and 95.0%, respectively. The analytical method applied requires no sample pretreatment which makes it easy, fast, and a low-cost alternative method to those employing other biological matrices, such as blood, urine, and hair. The earwax, which is considered a neglected body secretion, is a useful tool to determine the exposure to tobacco smoke noninvasively and without the influence of external contamination.     

CTA评估吸烟和被动吸烟对颈部动脉粥样硬化斑块的影响

目的 通过CT血管成像（CTA）评估吸烟和被动吸烟对颈部动脉粥样硬化斑块的影响。 方法 回顾性分析2017年1月至2019年7月于山东省聊城市茌平区人民医院行颈部CTA的拟诊为脑血管病的受检者284名,其中男性133名、女性151名,年龄42~79（60.3±12.5）岁。根据是否吸烟或被动吸烟将受检者分为吸烟组（95名）、被动吸烟组（87名）、非吸烟组（102名）。比较3组受检者的颈部动脉粥样硬化斑块的累及节段数、类型、最大横截面积、斑块负荷、重构指数,并分析吸烟指数与斑块累及节段数之间的相关性。定性资料的组间比较采用χ2检验;定量资料的多组间比较采用单因素方差分析,2组间比较采用独立样本t检验;吸烟指数与斑块累及节段数的相关性分析采用Spearman秩相关检验。 结果 3组受检者的年龄,体重指数,高血压、糖尿病及高血脂的发病率的差异均无统计学意义（F=0.30、0.43;χ2=1.58、0.19、0.56,均P>0.05）。吸烟组男性比例（83.2%,79/95）高于被动吸烟组（31.0%,27/87）和非吸烟组（26.5%,27/102）,差异均有统计学意义（χ2=10.03、9.77,均P<0.05）。284名受检者共检测2840个动脉节段,其中2058个（72.5%）节段存在斑块。吸烟组和被动吸烟组的总斑块[80.5%（765/950）、74.7%（650/870）]、非钙化斑块[46.8%（445/950）、40.0%（348/870）]、混合型斑块[45.6%（433/950）、41.4%（360/870）]累及节段比例均高于非吸烟组[63.0%（643/1020）、20.9%（213/1020）、30.8%（314/1020）],且差异均有统计学意义（χ2=7.43~21.33,均P<0.05）;吸烟组总斑块、非钙化斑块累及节段比例高于被动吸烟组,且差异均有统计学意义（χ2=7.40、9.77,均P<0.05）。吸烟组、被动吸烟组所有类型斑块的最大横截面积、斑块负荷、重构指数均明显高于非吸烟组,且差异均有统计学意义（t=6.54~20.11,均P<0.05）。吸烟组混合型斑块及非钙化斑块的最大横截面积、斑块负荷、重构指数均明显高于被动吸烟组,且差异均有统计学意义（t=9.05~15.64,均P<0.05）。吸烟组和被动吸烟组的吸烟指数与总斑块、非钙化斑块、混合型斑块的累及节段数均呈正相关（吸烟组:r=0.52、0.57、0.48,均P<0.05;被动吸烟组:r=0.40、0.42、0.43,均P<0.05）。 结论 吸烟、被动吸烟均可导致颈部动脉粥样硬化斑块数量增多、斑块量化指标增大;且吸烟量越大、年限越长颈部动脉斑块的累及节段数越多。     

Longitudinal shifts in exercise stages of change in college students

AIM: The protective health benefits of regular physical activity are well established. To date, few studies have assessed the prevalence of exercise behavior and factors influencing exercise adoption and maintenance among college students. The purpose of this study was to examine the relationship of exercise self-efficacy, social support, and sedentary behavior and longitudinal shifts in stage of exercise behavior change among a sample of college students without intervention. METHODS: A cross-sectional design was used to examine demographic characteristics, stage of exercise behavior change, exercise self-efficacy, social support (family and friend) and sedentary behavior. One hundred and sixty-one students at a large Midwestern university completed a valid and reliable written mailed questionnaire during baseline assessment and again 6 months later (follow-up). RESULTS: Changes in exercise self-efficacy, social support, and sedentary behavior were not observed among students who maintained their stage of exercise behavior change from baseline to follow-up. Exercise relapsers experienced significant decreases in exercise self-efficacy and peer social support from baseline to follow-up. CONCLUSION: These findings have important implications for further research on exercise adoption and maintenance among college students. From an applied perspective, it would be valuable for the practitioner to understand that different predictors are likely to influence exercise adoption and relapse.     

Passive inhalation of cannabis smoke: a novel defence strategy?

Defence lawyers sometimes argue that the presence of cannabinoid metabolites in the defendant's blood or urine resulted from passive unintentional inhalation of environmental cannabis smoke. It would be useful to be able to differentiate passive inhalation from active use so as to discourage the potential abuse of this phenomenon by the defence. Four cases from two jurisdictions in which passive cannabis smoking was used as a defence are presented to illustrate this dilemma. It remains impossible to define objectively an upper limit for blood and urine levels in cases of passive inhalation of cannabis from the environment. However, a claim of passive inhalation, or indeed 'deliberate passive exposure' could be discouraged by making it an offence to place oneself in a position of being 'concerned' in the use of the drug. The onus should be on the defendant to prove that he had not attempted to extricate himself from the situation, being aware of the smoking of cannabis in his immediate vicinity; ignorance would not be an excuse.     

Smoking cessation and weight gain in the military

Many studies of civilian populations have found a significant relationship between smoking cessation and weight gain. However, the effect of voluntary smoking cessation on weight for military personnel has not been studied. The present study evaluated 70 active duty military members (55 males and 15 females) who quit smoking after participating in an 8-week smoking cessation program. The results indicated that 88% of the participants gained weight and that the average weight gain was 6.4 lb (males, 5.5 lb; females, 9.8 lb). These results are particularly noteworthy because weight gain in military members may result in administrative actions for individuals exceeding weight standards. The authors recommend that military officials consider adopting a one-time temporary weight waiver for active duty military members who successfully quit smoking to help prevent any negative administrative consequences of post-cessation weight gain.     

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.     

Development and initial validation of the Response to Stressful Experiences Scale

This report describes the development and initial validation of the Response to Stressful Experiences Scale (RSES), a measure of individual differences in cognitive, emotional, and behavioral responses to stressful life events. We validated this instrument with active-duty and reserve components of military and veterans samples (N = 1,014). The resulting 22-item scale demonstrated sound internal consistency (alpha = 0.91-0.93) and good test-retest reliability (r = 0.87). Factor analysis suggested 5 protective factors: (a) meaning-making and restoration, (b) active coping, (c) cognitive flexibility, (d) spirituality, and (e) self-efficacy. Associations with other measures supported convergent, discriminant, and concurrent validity. In separate military samples, the RSES accounted for unique variance in posttraumatic stress disorder symptoms above and beyond existing scales measuring resilience-related constructs, thereby demonstrating incremental validity. The RSES provides a brief, reliable, and valid measure of individual differences in cognitive, emotional, and behavioral responses to life's most stressful events.     

A submarine shipboard smoking cessation program

The discouragement of tobacco abuse in the military requires effective smoking cessation assistance for all active duty and dependent personnel. Specifically tailoring this assistance to the unique features of the various military communities will help to make it more effective. The program presented herein was designed for use in the submarine fleet. It combines basic proven workplace smoking cessation techniques with lessons learned from experience in submarines. It is believed that other military populations can benefit from similar efforts. This paper is an abridged version of the author's Submarine Medical Officer qualification thesis.     

Factors influencing the exercise behavior of adults with physical disabilities

PURPOSE: Examine the theorized associations of transtheoretical model (TTM) of behavior change constructs (behavioral and cognitive processes of change, decisional balance, and self-efficacy), along with exercise barriers, by stage of change for exercise behavior among individuals with physical disabilities. METHODS: Cross-sectional survey of 322 adults with physical disabilities residing in the United States. Most participants (84.3%) used some form of assistive device (e.g., artificial limb, wheelchair), were female (62.1%), and Caucasian (91.9%). The mean age of participants was 52.5 yr (SD = 13.9). Participants completed and returned questionnaires for each TTM construct, along with an exercise barriers measure. RESULTS: In univariate analyses, all constructs were significantly (P < 0.001) associated with the stages of change for exercise behavior, except for dramatic relief (P > 0.005). The largest portion of variance was derived from counter conditioning (eta = 0.45), followed by the five behavioral processes of change combined (eta = 0.40), self-liberation (eta = 0.31), self-efficacy (eta = 0.30), and self-reevaluation (eta = 0.28). Direct discriminant function (multivariate) analysis revealed four discriminant functions which accounted for 71.0% (P < 0.001), 20.9% (P < 0.001), 6.3% (P < 0.05), and 1.8% (P = 0.62), respectively, of the between-group (stage of change) variability. The overall stage of change classification accuracy was 70.8%. CONCLUSION: This was the first study to examine the stages of change for exercise behavior among adults with physical disabilities on the basis of the full TTM and exercise barriers. Overall, the results are in general agreement with existing evidence among nondisabled populations. This provides further cross-sectional support for the internal and external validity of TTM and exercise barriers among a unique and understudied population segment.     

Relation of the stages of change for exercise behaviors,self-efficacy,decisional-balance,and diet-related psycho-behavioral factors in young Japanese women

BACKGROUND: A large proportion of young Japanese women is inactive. Exercise has important health benefits, however, abnormal weight/eating concerns and excessive dieting practices among physically active young women also have been reported in many cross-sectional studies. The purpose of this study was to examine the relationships between stages of change for exercise behaviors and exercise/dieting related psycho-behavioral factors using the Transtheoretical Model of behavior change as a theoretical framework. METHODS: A cross-sectional study included 450 young Japanese women aged 18 to 21 (18.4+/-0.67 years). Subjects in precontemplation (n=111, 24.7%), contemplation (n=120, 26.7%), preparation (n=177, 39.3%), action (n=17, 3.8%), and maintenance (n=25, 5.6%) were compared on physique, body composition, current exercise practices, exercise self-efficacy, decisional balance (benefits and costs exercise), as well as dieting behaviors and weight/eating concerns. RESULTS: Stages of change for exercise behaviors were significantly related to exercise self-efficacy and perceived benefits as well as to dieting behaviors and weight/eating concerns. Subjects in the higher stages had higher self-efficacy, perceived benefits of exercise, and healthy dieting behaviors; however, some of them also had unhealthier dietary practices, higher phobia of obesity and obsession with eating than those in lower stages. CONCLUSIONS: These findings provide support for applying the transtheoretical model of exercise behavioral change to Japanese young women. Additionally, it is also important to pay attention to stage specific psycho-behavioral factors related to their dieting.     

Active surveillance of birth defects among U.S. Department of Defense beneficiaries: a feasibility study

Since the Vietnam War, concern regarding the association of military exposures and birth defects has grown. The possibility of such associations remains a source of unease. To determine if such an association exists, birth defects surveillance among military families must be conducted. This project compared health record abstraction (active surveillance) with screening of Department of Defense electronic medical data (passive surveillance) to detect birth defects among San Diego County military families during the period January 1, 1997, through June 30, 1998. A total of 171 of 5,351 infants (3.2%) were identified as having a major defect, consistent with national civilian rates. There was approximately 80% concurrence between passive and active surveillance birth defect data, suggesting that a hybrid system of electronic data, supplemented with active surveillance in a specific region, represents a feasible and cost-effective surveillance program for the geographically dispersed military population.     

Nicotine and cotinine in infants dying from sudden infant death syndrome

The aim of this component of the German Study on Sudden Infant Death was to determine (1) nicotine concentrations in hair (NCH), as a marker of long standing exposure to tobacco, (2) cotinine concentrations in pericardial fluid (CCP) and (3) cotinine concentrations in liquor cerebrospinalis (CCL), the latter measures being markers of recent exposure to tobacco in the last few hours of life. The results obtained were compared with data on parental smoking revealed from interviews. In 100 cases of sudden infant death syndrome, material was taken at autopsy to determine NCH. In 41 cases, NCH and CCP, and in 70 cases, NCH and CCL were determined. Infants of mothers who stated having smoked during pregnancy had higher NCH than infants of non-smoking mothers (p = 0.008). Furthermore, there was a weak but statistically significant relationship between NCH's and the daily cigarette consumption of the mother during pregnancy (n = 64, r = 0.24, p = 0.05). In 43% of infants, nicotine could be detected in their hair, although the mothers had said at the interview that they did not smoke during pregnancy. On the other hand, in 33% of infants whose mother stated they had smoked during pregnancy nicotine was not detectable in the infant's hair. CCP's were strongly correlated with CCL's (r = 0.62, p = 0.0027). For this reason, both parameters were treated as equivalent for the detection of tobacco smoke exposure in the last hours before death. The influence of breast-feeding was evaluated by comparison of the nicotine concentrations in breast fed and non-breast-fed infants from smokers and non-smokers. Fivefold higher nicotine concentrations were determined in non-breast-fed infants of parents who smoked as compared to all other groups. It can be concluded that nicotine intake by passive smoking is much more important than by breast-feeding. We conclude that both interview data and biochemical measures should be sought to understand the true exposure to tobacco smoke.     

Physical activity programs and behavior counseling in older adult populations

Physical activity offers one of the greatest opportunities for people to extend years of active independent life and reduce functional limitations. The purpose of this paper is to identify key practices for promoting physical activity in older adults, with a focus on older adults with chronic disease or low fitness and those with low levels of physical activity. Key practices identified in promotion activity in older adults include: 1) A multidimensional activity program that includes endurance, strength, balance, and flexibility training is optimal for health and functional benefits; 2) Principles of behavior change, including: social support, self-efficacy, active choices, health contracts, assurances of safety, and positive reinforcement enhance adherence; 3) Management of risk by beginning at low intensity but gradually increasing to moderate physical activity, which has a better risk-to-benefit ratio and should be the goal for older adults; 4) An emergency procedure plan is prudent for community based programs; and 5) Monitoring aerobic intensity is important for progression and for motivation. Selected content review of physical activity programming from major organizations and institutions are provided. Regular participation in physical activity is one of the most effective ways for older adults, including those with disabilities, to help prevent chronic disease, promote independence, and increase quality of life in old age.     

Pneumomediastinum associated with inhalation of white smoke.

Hexachloroethane (HC) smoke, also known as white smoke, is an obscurant used in numerous military situations. Many adverse health effects are associated with the use of white smoke, some of which are potentially life threatening. Inhalation is the most frequent route of injury. Two deaths among U.S. Army personnel resulted from HC smoke exposure in 1988. As recently as 1997, a United Nations soldier in Bosnia died after an HC smoke canister was discharged in his tent. Injuries are predominantly pulmonary and range from cough and dyspnea to chemical pneumonitis, pulmonary edema, and adult respiratory distress syndrome. In the case presented, a soldier developed pneumomediastinum after exposure to HC smoke. This is the first case reported in the literature of pneumomediastinum associated with HC smoke inhalation.     

Prevalence, trends, and correlates of alcohol use, nonmedical drug use, and tobacco use among U.S. military personnel

This paper presents data on substance use by military personnel from a series of worldwide surveys conducted in 1985, 1982, and 1980 with primary emphasis on the 1985 survey. Estimates are based on responses from participants serving on active duty in the Army, Navy, Marine Corps, and Air Force. Results for 1985 indicate pervasive use of alcohol, substantial use of tobacco, and low nonmedical use of drugs among military personnel. Average daily consumption of alcohol declined significantly from 1.4 ounces in 1982 to 1.2 ounces in 1985, but the patterns of use remained relatively constant. Nonmedical drug use during the past 30 days declined significantly, from 27.0% in 1980, to 19.0% in 1982, to 8.9% in 1985. Cigarette smoking declined significantly from 51.4% in 1982 to 46.2% in 1985. Current alcohol and drug use is concentrated among younger, less educated, unmarried, and junior and mid-career enlisted personnel. Cigarette pack years are higher among males, whites, those with less than a high school education, and senior enlisted personnel. Results show progress in reducing drug use and smoking in the military, but little change in patterns of alcohol use. New initiatives and approaches by the military to further reduce substance abuse are discussed.     

Physical activity determinants of military health care recipients

This study describes physical activity determinants (motivation, self-efficacy, benefits/barriers, and stage of change) of 71 healthy, military-affiliated volunteers, 28 men and 43 women (mean age, 31 +/- 7 years) from a military primary care setting. The physical activity determinants were measured with investigator-administered questionnaires at three time points over 8 months. The Kruskal-Wallis analysis of variance indicated that there were significant differences (p < 0.0001) among factors determining self-efficacy, motivation, and benefits/barriers. The subjects reported being most confident that they could be physically active even if they had to do it by themselves. The chief benefit reported was an improvement in physical performance, whereas the leading barrier to physical activity was the physical exertion involved. The biggest motivator was the positive health effect gained. Most subjects considered themselves to be in the "maintenance" stage of change. This study provides a platform for the development of an effective physical activity intervention in this population.