The validity of self-rated health as a measure of health status among young military personnel: evidence from a cross-sectional survey

Abstract Background Single item questions about self ratings of overall health status are widely used in both military and civilian surveys. Limited information is available to date that examines what relationships exist between self-rated health, health status and health related behaviors among relatively young, healthy individuals. Methods The current study uses the population of active duty United States Air Force recruits (N = 31,108). Participants completed surveys that asked about health behaviors and health states and were rated their health on a continuum from poor to excellent. Results Ratings of health were consistently lower for those who used tobacco (F = 241.7, p < .001), reported binge drinking (F = 69.0, p < .001), reported drinking and driving (F = 19.4, p < .001), reported taking health risks (F = 109.4, p < .001), were depressed (F = 256.1, p < .001) and were overweight (F = 39.5, p < .001). Conclusion Given the consistent relationship between self-rated overall health and factors important to military health and fitness, self-rated health appears to be a valid measure of health status among young military troops.Peer Reviewe

Part II, Provider perspectives: should patients be activated to request evidence-based medicine? a qualitative study of the VA project to implement diuretics (VAPID)

<p>Abstract</p> <p>Background</p> <p>Hypertension guidelines recommend the use of thiazide diuretics as first-line therapy for uncomplicated hypertension, yet diuretics are under-prescribed, and hypertension is frequently inadequately treated. This qualitative evaluation of provider attitudes follows a randomized controlled trial of a patient activation strategy in which hypertensive patients received letters and incentives to discuss thiazides with their provider. The strategy prompted high discussion rates and enhanced thiazide-prescribing rates. Our objective was to interview providers to understand the effectiveness and acceptability of the intervention from their perspective, as well as the suitability of patient activation for more widespread guideline implementation.</p> <p>Methods</p> <p>Semi-structured phone interviews were conducted with 21 primary care providers. Interviews were transcribed verbatim and reviewed by the interviewer before being analyzed for content. Interviews were coded, and relevant themes and specific responses were identified, grouped, and compared.</p> <p>Results</p> <p>Of the 21 providers interviewed, 20 (95%) had a positive opinion of the intervention, and 18 of 20 (90%) thought the strategy was suitable for wider use. In explaining their opinions of the intervention, many providers discussed a positive effect on treatment, but they more often focused on the process of patient activation itself, describing how the intervention facilitated discussions by informing patients and making them more pro-active. Regarding effectiveness, providers suggested the intervention worked like a reminder, highlighted oversights, or changed their approach to hypertension management. Many providers also explained that the intervention 'aligned' patients' objectives with theirs, or made patients more likely to accept a change in medications. Negative aspects were mentioned infrequently, but concerns about the use of financial incentives were most common. Relevant barriers to initiating thiazide treatment included a hesitancy to switch medications if the patient was at or near goal blood pressure on a different anti-hypertensive.</p> <p>Conclusions</p> <p>Patient activation was acceptable to providers as a guideline implementation strategy, with considerable value placed on the activation process itself. By 'aligning' patients' objectives with those of their providers, this process also facilitated part of the effectiveness of the intervention. Patient activation shows promise for wider use as an implementation strategy, and should be tested in other areas of evidence-based medicine.</p> <p>Trial registration</p> <p>National Clinical Trial Registry number NCT00265538</p

A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

Abstract Background Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. Specific objectives The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Design Pre-post study design in four VA hospitals Participants Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. Intervention The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. Outcomes The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the clustered nature of the data within nurses and hospitals into account. We will assess attitudes of staff nurses toward cessation counseling by questionnaire and will identify barriers and facilitators to implementation by using clinician focus groups. To determine the short-term incremental cost per quitter from the perspective of the VA health care system, we will calculate cessation-related costs incurred during the initial hospitalization and six-month follow-up period. Trial number NCT00816036http://deepblue.lib.umich.edu/bitstream/2027.42/112349/1/13012_2009_Article_190.pd

Adolescent mental health as a risk factor for adolescent smoking onset

Jason M Hockenberry1,2, Edward J Timmons3, Mark W Vander Weg2,4,51Department of Health Management and Policy, College of Public Health, University of Iowa, IA, USA; 2Comprehensive Access and Delivery Research and Evaluation Center (CADRE), Iowa City VA Medical Center, IA, USA; 3School of Business, Saint Francis University, Loretto, PA, USA; 4Department of Internal Medicine, Carver College of Medicine, University of Iowa, IA, USA; 5Department of Psychology, University of Iowa, IA, USAAbstract: Smoking continues to be a leading cause of preventable deaths and rates of trying cigarettes and progression to daily smoking among adolescents continues to remain high. A plethora of risk factors for smoking among adolescents has been addressed in the research literature. One that is gaining particular interest is the relationship between adolescent mental health and smoking (both initiation and progression). This paper reviews the evidence for adolescent mental health as a risk factor for cigarette smoking. We focus on the specific mental health conditions that have been more thoroughly addressed as possible risk factors in community-dwelling adolescents. We discuss the multiple hypotheses that have been posited as to the nature of the relationship between adolescent mental health and smoking, as well as detailing so called third factors that may account for the observed relationship. We highlight the contribution of the existing studies to the body of knowledge on this topic, as well as the limitations and open questions that remain as a result. We conclude with discussion of a broad research agenda going forward.Keywords: depression, suicidal ideation, anxiety, nicotine, adolescent

Waterpipe smoking among American military recruits

Background.: Waterpipe smoking, a traditional Middle Eastern tobacco use method, has increased dramatically among Arab adolescents and young adults. Anecdotal evidence also suggests that usage is on the rise among young people in the U.S., but epidemiological data are lacking. Methods.: From self-report health surveys collected during 1999-2002, we examined the prevalence and predictors of waterpipe use among U.S. Air Force recruits (n = 20,673; mean age = 20.0 years; range = 17-35). Results.: Waterpipe use was reported by 0.3% (n = 59) of recruits and was unrelated to age, gender, ethnicity, or family income. Compared to non-users, waterpipe users were more likely to plan to smoke cigarettes in the coming year (P value \u3c 0.05) and to believe that switching from cigarettes to other tobacco products reduces smoking-related health risks (P values \u3c 0.002). Multivariate (logistic regression) analyses revealed several factors that distinguished waterpipe users from non-users, including higher education level (odds ratio [OR] = 1.94), having experimented with cigarettes before Basic Military Training (BMT; OR = 1.99), and using cigarettes (OR = 2.17) and other tobacco products (OR = 13.81) at the time of entry into BMT. Compared to recruits who used cigarettes only, waterpipe smokers were more educated (OR = 1.83), more likely to have engaged in experimental (OR = 3.30) or regular (OR = 3.87) use of tobacco products other than cigarettes prior to BMT, and less likely to have been a current (OR = 0.10) or former (OR = 0.11) smoker at the time of entry into BMT. Conclusion.: Despite concerns that waterpipe smoking is increasing among young people in the U.S., use was low among military recruits. © 2006 Elsevier Inc. All rights reserved

Binge drinking, drinking and driving, and riding with a driver who had been drinking heavily among air national guard and air force reserve personnel

Heavy drinking is associated with significant health problems and increased risk for injury and death. Although several studies have investigated alcohol use among active duty and civilian populations, little is known about the alcohol use patterns of reserve personnel. This study examined the prevalence and correlates of binge drinking, driving after drinking, and riding in a vehicle with a driver who had consumed alcohol among 4,836 guardsmen and reservists who were taking part in basic military training (mean age = 21.3 years; 29.4% female). Forty-six percent reported one or more binge drinking episodes in the month before basic military training. Four percent drove after consuming five or more drinks, while 8.9% rode as a passenger with a driver who had been drinking heavily. Several demographic, behavioral, and attitudinal correlates of risky drinking patterns were identified. Findings have potentially important implications for the health, safety, and military readiness of reserve personnel. Copyright © by Association of Military Surgeons of U.S., 2006

Applying the Problem Behavior Theory to Adolescent Drug Use Among a Cross-Sectional Sample of Boys Participating in a Community-Based Youth Organization

Background: Drug use remains an important public health concern in the United States, and understanding drug use among young adolescents is vital towards improving the health of the population. Objective: This study applied the Problem Behavior Theory (PBT) to lifetime drug use among a cross-sectional sample of Boy Scouts (N = 770). The PBT provides a conceptual framework for identifying risk and protective factors for adolescent problem behaviors, including drug use. Methods: Scouts reported their drug use and socio-demographics, and were assessed on several risk and protective factors. For analyses, sociodemographic and risk and protective factors were selected according to the framework provided by PBT, and use of each drug was regressed logistically on these selected factors. Final logistic models were assessed for goodness of fit and discriminatory power. Results: The PBT demonstrated discriminatory power for all drugs (Tjur\u27s R2 values ≥.29), but fell sharply for illicit drug use (Tjur\u27s R2 =.20). There were no consistent correlates of drug use. Conclusions/Importance: The PBT had less explanatory power for illicit drug use compared to tobacco, alcohol, and marijuana, which suggests different risk and protective factors were associated with illicit drug use

Smoking-related correlates of depressive symptoms in low-income pregnant women

Objectives: To investigate smoking-related correlates of depressive symptomatology in low-income pregnant women. Methods: A cross-sectional survey of 245 pregnant women who smoked prior to pregnancy. Results: Women who had lower self-efficacy for maintaining abstinence both in positive affect/ social situations and when experiencing negative affect demonstrated greater depressive symptomatology. Additionally, marijuana use, nicotine dependence, and general confidence in one\u27s ability to quit smoking showed a positive relationship to depression. Conclusions: Several modifiable factors that can be targeted through behavioral and cognitive behavioral intervention strategies appear to influence the relationship between depression and smoking in low-income pregnant women