Tobacco use among Iraq- and Afghanistan-era veterans: a qualitative study of barriers, facilitators, and treatment preferences

Jennifer M Gierisch, Kristy Straits-Tröster, Patrick S Calhoun, Jean C Beckham, Shawn Acheson, Kim Hamlett-Berry, Jennifer M Gierisch, Kristy Straits-Tröster, Patrick S Calhoun, Jean C Beckham, Shawn Acheson, Kim Hamlett-Berry

Abstract

Introduction: Military service and combat exposure are risk factors for smoking. Although evidence suggests that veterans are interested in tobacco use cessation, little is known about their reasons for quitting, treatment preferences, and perceived barriers to effective tobacco use cessation treatment. Our study objective was to elicit perspectives of Iraq- and Afghanistan-era veterans who had not yet quit smoking postdeployment to inform the development of smoking cessation services for this veteran cohort.

Methods: We conducted 3 focus groups among 20 participants in October 2006 at the Durham Veterans Affairs Medical Center to explore issues on tobacco use and smoking cessation for Iraq- and Afghanistan-era veterans who continued to smoke postdeployment. We used qualitative content analysis to identify major themes and organize data.

Results: Veterans expressed the belief that smoking was a normalized part of military life and described multiple perceived benefits of smoking. Although veterans expressed a high level of interest in quitting, they listed several behavioral, situational, and environmental triggers that derailed smoking cessation. They expressed interest in such cessation treatment features as flexible scheduling, free nicotine replacement therapy, peer support, and family inclusion in treatment.

Conclusion: Our results indicate that the newest cohort of veterans perceives smoking as endemic in military service. However, they want to quit smoking and identified several personal and environmental obstacles that make smoking cessation difficult. Our findings may inform programmatic efforts to increase successful quit attempts in this unique veteran population.

References

    1. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–1245.
    1. Brown DW. Smoking prevalence among US veterans. J Gen Intern Med. 2010;25(2):147–149.
    1. Klevens RM, Giovino GA, Peddicord JP, Nelson DE, Mowery P, Grummer-Strawn L. The association between veteran status and cigarette-smoking behaviors. Am J Prev Med. 1995;11(4):245–250.
    1. Hamlett-Berry K, Davison J, Kivlahan DR, Matthews MH, Hendrickson JE, Almenoff PL. Evidence-based national initiatives to address tobacco use as a public health priority in the Veterans Health Administration. Mil Med. 2009;174(1):29–34.
    1. Department of Veteran Affairs. VHA Survey of Veteran Enrollees' Health and Reliance Upon VA. 2008. [Accessed December 1, 2011]. .
    1. Smith B, Ryan MA, Wingard DL, Patterson TL, Slymen DJ, Macera CA. Cigarette smoking and military deployment: a prospective evaluation. Am J Prev Med. 2008;35(6):539–546.
    1. Bray RM, Hourani LL. Substance use trends among active duty military personnel: findings from the United States Department of Defense Health Related Behavior Surveys. Addiction. 2007;102(7):1092–1101.
    1. Centers for Disease Control and Prevention (CDC) Cigarette smoking among adults —United States, 2006. MMWR Morb Mortal Wkly Rep. 2007;56(44):1157–1161.
    1. Shiffman S, Brockwell SE, Pillitteri JL, Gitchell JG. Use of smoking-cessation treatments in the United States. Am J Prev Med. 2008;34(2):102–111.
    1. Hughes JR, Keely J, Naud S. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction. 2004;99(1):29–38.
    1. Institute of Medicine. Combating tobacco use in the military and veteran populations. Washington (DC): The National Academies Press; 2009.
    1. Miller DR, Kalman D, Ren XS, Lee AF, Niu Z, Kazis LE. Health behaviors of veterans in the VHA: Tobacco use: 1999 Large Health Survey of VHA Enrollees. Washington (DC): Department of Veterans Affairs, Veterans Health Administration; 2001.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict. 1991;86(9):1119–1127.
    1. Sandelowski M, Barroso J. Classifying the findings in qualitative studies. Qual Health Res. 2003;13(7):905–923.
    1. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–1288.
    1. Nelson JP, Pederson LL. Military tobacco use: a synthesis of the literature on prevalence, factors related to use, and cessation interventions. Nicotine Tob Res. 2008;10(5):775–790.
    1. Boos CJ, Croft AM. Smoking rates in the staff of a military field hospital before and after wartime deployment. J R Soc Med. 2004;97(1):20–22.
    1. Poston WS, Taylor JE, Hoffman KM, Peterson AL, Lando HA, Shelton S, Haddock CK. Smoking and deployment: perspectives of junior-enlisted US Air Force and US Army personnel and their supervisors. Mil Med. 2008;173(5):441–447.
    1. Altarac M, Gardner JW, Popovich RM, Potter R, Knapik JJ, Jones BH. Cigarette smoking and exercise-related injuries among young men and women. Am J Prev Med. 2000;18(3 Suppl):96–102.
    1. Knapik JJ, Sharp MA, Canham-Chervak M, Hauret K, Patton JF, Jones BH. Risk factors for training-related injuries among men and women in basic combat training. Med Sci Sports Exerc. 2001;33(6):946–954.
    1. Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007;298(18):2141–2148.
    1. Straits-Tröster K, Gierisch JM, Calhoun PS, Strauss JL, Voils CI, Kudler H. Living in transition: veterans' perspectives on the post-deployment shift to civilian and family life. In: Kelly D, Howe-Barksdale S, Gitelson D, editors. Treating young veterans: promoting resilience through practice and advocacy. New York (NY): Springer Publishing Co; 2011.
    1. Seal KH, Metzler TJ, Gima KS, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. Am J Public Health. 2009;99(9):1651–1658.
    1. Hall SM. Nicotine interventions with comorbid populations. Am J Prev Med. 2007;33(6 Suppl):S406–S413.
    1. Ziedonis D, Hitsman B, Beckham JC, Zvolensky M, Adler LE, Audrain-McGovern J, et al. Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine Tob Res. 2008;10(12):1691–1715.
    1. Beckham JC, Kirby AC, Feldman ME, Hertzberg MA, Moore SD, Crawford AL, et al. Prevalence and correlates of heavy smoking in Vietnam veterans with chronic posttraumatic stress disorder. Addict Behav. 1997;22(5):637–647.
    1. McFall M, Saxon AJ, Malte CA, Chow B, Bailey S, Baker DG, et al. Integrating tobacco cessation into mental health care for posttraumatic stress disorder: a randomized controlled trial. JAMA. 2010;304(22):2485–2493.
    1. Smith MW, Chen S, Siroka AM, Hamlett-Berry K. Using policy to increase prescribing of smoking cessation medications in the VA healthcare system. Tob Control. 2010;19(6):507–511.
    1. Department of VeteransAffairs. Smoking and tobacco use cessation report. [Accessed December 9, 2011]. 2005. .
    1. Seal KH, Maguen S, Cohen B, Gima KS, Metzler TJ, Ren L, et al. VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. J Trauma Stress. 2010;23(1):5–16.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel