Lin Jie, Zhu Kangmin, Soliván-Ortiz Aida M, Larsen Stacy L, Schneid Thomas R, Shriver Craig D, Lee Sukhyung
John P. Murtha Cancer Center, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Rockville, MD.
Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
Mil Med. 2019 Mar 1;184(3-4):e183-e190. doi: 10.1093/milmed/usy186.
The prevalence of smokeless tobacco use among U.S. active duty service members has been much higher than in the U.S. general population. The association between deployment and smokeless tobacco use has not been well studied. We investigated the association between deployment and smokeless tobacco use among U.S. active duty service members. We also evaluated the modification effects from other factors related to smokeless tobacco use on the deployment-smokeless tobacco use association.
Eligible active duty service members stationed at two military installations (Fort Bragg, NC, USA and Lackland Air Force Base, TX, USA) were recruited from July 2015 to May 2016. Each participant completed a self-administered questionnaire. Multivariable logistic regression was used to assess the association between deployment and smokeless tobacco use and estimated odds ratio (OR) and 95% confidence interval (CI). Stratified analysis was performed to evaluate modification effects from other commonly known factors related to smokeless tobacco use in military, specifically, cigarette smoking status, use among family members (family history of use), perception of harm, and use among military peers.
Out of 2,465 study participants who completed the questionnaire, 548 were smokeless tobacco users. Service members who had been deployed to a combat zone had 1.39 fold (95% CI = 1.03-1.87) increased odds of using smokeless tobacco than those who never deployed to a combat zone. The odds of smokeless tobacco use among those who had been deployed once, twice, three times and four or more times to a combat zone were 1.27 (95% CI = 0.91-1.78), 1.30 (95% CI = 0.85-1.99), 2.49 (95% CI = 1.45-4.28), and 2.88 (95% CI = 1.71-4.86), respectively, with a significant dose-response trend (p for trend <0.0001). Further, subjects who served in combat units during deployment exhibited more than two-fold increased odds of use as compared with those who had never been deployed (OR = 2.03, 95% CI = 1.41-2.93). In stratified analysis, the association between deployment and smokeless tobacco use was only present among subjects who never smoked cigarettes, those without family history of smokeless tobacco use, and those who had low perception of harm of use.
Military deployment was associated with smokeless tobacco use among active service members. However, the influence of military deployment on smokeless tobacco use was not equally strong on all service members. Subjects who never smoked cigarettes, who had no family history of use and who had low perception of harm were the most susceptible subgroups to deployment-related smokeless tobacco use. This study has implications to identify high-risk subgroups to reduce smokeless tobacco use in the U.S. military.
美国现役军人中无烟烟草的使用率远高于美国普通人群。部署与无烟烟草使用之间的关联尚未得到充分研究。我们调查了美国现役军人中部署与无烟烟草使用之间的关联。我们还评估了与无烟烟草使用相关的其他因素对部署 - 无烟烟草使用关联的修正作用。
2015年7月至2016年5月，从驻扎在两个军事基地（美国北卡罗来纳州布拉格堡和美国得克萨斯州拉克兰空军基地）的符合条件的现役军人中招募研究对象。每位参与者完成一份自填式问卷。采用多变量逻辑回归评估部署与无烟烟草使用之间的关联，并估计比值比（OR）和95%置信区间（CI）。进行分层分析以评估军事中与无烟烟草使用相关的其他常见因素的修正作用，具体包括吸烟状况、家庭成员中的使用情况（使用家族史）、对危害的认知以及军事同伴中的使用情况。
在完成问卷的2465名研究对象中，有548人使用无烟烟草。部署到作战区的军人使用无烟烟草的几率比从未部署到作战区的军人高1.39倍（95%CI = 1.03 - 1.87）。部署到作战区一次、两次、三次以及四次或更多次的军人使用无烟烟草的几率分别为1.27（95%CI = 0.91 - 1.78）、1.30（95%CI = 0.85 - 1.99）、2.49（95%CI = 1.45 - 4.28）和2.88（95%CI = 1.71 - 4.86），具有显著的剂量反应趋势（趋势p <0.0001）。此外，部署期间在作战部队服役的受试者使用无烟烟草的几率比从未部署过的受试者高出两倍多（OR = 2.03，95%CI = 1.41 - 2.93）。在分层分析中，部署与无烟烟草使用之间的关联仅存在于从不吸烟的受试者、没有无烟烟草使用家族史的受试者以及对使用危害认知较低的受试者中。
军事部署与现役军人中无烟烟草的使用有关。然而，军事部署对无烟烟草使用的影响在所有军人中并不相同。从不吸烟、没有使用家族史且对危害认知较低的受试者是与部署相关的无烟烟草使用最易受影响的亚组。本研究对于识别高危亚组以减少美国军队中无烟烟草的使用具有重要意义。
