Tobacco and alcohol misuse are serious problems in the U.S. and are more prevalent among members of the U.S. Armed Forces. Both conditions account for higher mortality, greater morbidity, higher health care costs, and lost productivity while in the service and afterwards in civilian life. Little information exists from prospective research on predictors of the adoption of these habits while in military service. Such information would prove valuable for the development of interventions and policies for preventing tobacco use and alcohol misuse among military personnel. This application therefore proposes to conduct a comprehensive prospective assessment of military service features and exposures, demographic characteristics, and psychosocial risk factors for tobacco use and alcohol misuse in the Millennium Cohort Study, a 21-year longitudinal investigation of over 150,000 military personnel. This study began enrollment of members of the U.S. Armed Forces in 2001. Follow-up of subjects for both exposures and outcomes is accomplished through administration of a triennial survey and review of Department of Defense electronic personnel and health care databases as well as other national databases. The overall objective of this proposed research will be to identify the effects of exposures during military service on the incidence, persistence and relapse of tobacco use (including smokeless) and alcohol misuse. This objective will be accomplished by prospectively studying these outcomes in relation to exposures experienced at study entry and during military service, such as deployment with and without combat exposure, other military exposures, mental health conditions, military service characteristics and lifestyle factors. In addition, the Family Millennium Cohort Study will begin in 2010 when the spouses of 10,000 study participants will be recruited. This cross-sectional comparison will permit the study of the same predictors of interest as in the prospective study and allow for the first time the assessment of whether military experiences in the service member are associated with tobacco use and alcohol misuse among spouses.
The research will examine military service features and experiences as predictors of the adoption of tobacco use and the occurrence of alcohol misuse in U.S. military service members enrolled in the Millennium Cohort Study. The roles of military deployments, lifestyle, mental health conditions, and military service characteristics will be studied. A better understanding of the factors that precede the adoption of these habits may lead to improved ways to help prevent tobacco use and alcohol misuse from occurring in this population. The research will examine military service features and experiences as predictors of the adoption of tobacco use and the occurrence of alcohol misuse in U.S. military service members enrolled in the Millennium Cohort Study. The roles of military deployments, lifestyle, mental health conditions, and military service characteristics will be studied. A better understanding of the factors that precede the adoption of these habits may lead to improved ways to help prevent tobacco use and alcohol misuse from occurring in this population. __SpecificAimsTextDelimiter__ SPECIFIC AIMS Tobacco use and alcohol misuse are serious problems among members of the U.S. Armed Forces. Tobacco use accounts for at least 16% of all deaths and 10% of hospital bed days in Department of Defense health care facilities (1). Alcohol misuse similarly exerts a heavy toll: an estimated $425 million spent on alcohol related problems in Department of Defense health care facilities; and 23% of all deaths in the Air Force over one year attributable to alcohol-related causes (2; 3). Both conditions also account for lost productivity: 14.1% of lost workdays in military men and 3.0% in women attributable to smoking; and a higher frequency of arriving late to work and leaving early, low performance, and on-the-job injury in heavy drinkers (4; 5). Tobacco use and alcohol misuse by service men and women sets the stage for a lifetime of use that results in substantial morbidity, lost productivity, and millions of years of potential life lost (6; 7). To address the enormous burden of smoking and alcohol related diseases affecting persons in the U.S. Military, research is urgently needed to determine risk factors for tobacco use and alcohol misuse. Such research would prove valuable for the development of interventions and policies for preventing tobacco use and problematic alcohol use among military personnel. Unfortunately, little is known about tobacco and alcohol risk factors in this setting. Research to date is severely limited by small sample size, convenience sampling, absence of pre-deployment information, and focus on certain sub-groups only. Furthermore, most prior studies have used cross sectional designs that are uninformative regarding temporal sequence. To overcome these limitations, we propose to conduct the first comprehensive assessment of military service experience, baseline characteristics, and psychosocial risk factors for tobacco use and alcohol misuse in the Millennium Cohort Study, a 21-year longitudinal investigation of over 150,000 military personnel enrolled to date. These participants are surveyed every three years to assess exposures, health status, and outcomes. The overall objective of this proposed research is to identify the effects of exposures during military service, baseline characteristics, and other conditions on the adoption and perpetuation of the use of tobacco and misuse of alcohol. We will accomplish this overall objective through the following specific aims that are directly responsive to NIH RFA-DA-10-001 by focusing on pre-deployment, deployment, separation and co- morbidity in relation to the use of tobacco and misuse of alcohol; inclusion of Reserves and National Guard; and ability to examine these habits in military spouses. The impact of this project will be to assist in the targeting of efforts aimed at reducing the frequency of tobacco use and alcohol misuse in the U.S. Military. Specific Aims: 1. To prospectively evaluate the incidence, persistence and relapse of tobacco use (including smokeless) and alcohol misuse associated with exposures experienced before and during military service. The following categories of potential risk factors will be examined: a. Risk Factors Present at Study Entry i. Demographic and social characteristics including age, sex, race/ethnicity, marital status, and educational achievement. ii. Lifestyle factors (physical activity, use of alcohol and tobacco, quality and quantity of sleep, and use of complementary and alternative medical treatments) iii. Mental health conditions (depression, PTSD, panic/anxiety) iv. Military Service characteristics (service branch, component [Reserve/National Guard versus active duty], rank, military occupation, pay grade) v. Presence of 40 acute and chronic diseases and 19 symptoms vi. Overall measures of physical and mental health function using the SF-36V b. Risk Factors Developing during Study Follow-Up i. Deployment with and without combat exposure including duration and number of deployments, intervals between deployments (dwell time), and past deployments. ii. Exposures (e.g., depleted uranium, trash pit fire smoke, others to be described below) iii. Individual augmentation/assignment (to be defined below); duration of military service; and separation from the military iv. Changes in health including overall function and mental illness conditions. 2. To perform a cross-sectional analysis of the associations between spousal use of tobacco and misuse of alcohol in relation to risk factors experienced by Millennium Cohort participants who will be newly recruited in 2010 for the Family Millennium Cohort Study. To address this aim, we plan to recruit 50,000 Cohort participants and from among those who are married 10,000 spouses. The participant and his or her spouse will be surveyed for tobacco use, alcohol misuse, and potential risk factors.
| Bensley, Kara M; Seelig, Amber D; Armenta, Richard F et al. (2018) Posttraumatic Stress Disorder Symptom Association With Subsequent Risky and Problem Drinking Initiation. J Addict Med 12:353-362 |
