Alan L. Peterson

Management of Vasovagal Syncope: Controlling or Aborting Faints by Leg Crossing and Muscle Tensing

To the Editor:nnWe read with great interest the article by Krediet et al1 demonstrating that a leg crossing maneuver can prevent or delay vasovagal reactions. We are writing because many clinicians and researchers may be unaware that a similar behavioral treatment has been shown to be very effective for syncope. Applied tension is a behavioral treatment approach that has been demonstrated in several controlled trials to be an effective and inexpensive treatment for syncope related to injection and blood phobia.2–4 This treatment entails the use of applied muscular tension to temporarily increase blood pressure to prevent syncope during graduated exposure to increasingly greater anxiety-provoking stimuli. The combination of applied tension and repeated, graduated exposure results in the eventual extinction of the vasovagal syncope reaction, often after only 1 extended treatment session. A randomized trial of applied tension for injection phobia …

Efficacy of a Tailored Tobacco Control Program on Long-Term Use in a Population of U.S. Military Troops.

The authors evaluated the effect of a brief tailored smoking control intervention delivered during basic military training on tobacco use in a population of military personnel (N = 33,215). Participants were randomized to either a tobacco use intervention (smoking cessation, smokeless tobacco use cessation, or prevention depending on tobacco use history) or a health education control condition. Results indicated that smokers who received intervention were 1.16 (95% confidence interval [CI] = 1.04, 1.30) times (7-day point prevalence) and 1.23 (95% CI = 1.07, 1.41) times (continuous abstinence) more likely to be abstinent than controls from smoking cigarettes at the 1-year follow-up (p < .01); the cessation rate difference was 1.60% (31.09% vs. 29.49%) and 1.73% (15.47% vs. 13.74%) for point prevalence and continuous abstinence, respectively. Additionally, smokeless tobacco users were 1.33 (95% CI = 1.08, 1.63) times more likely than controls (p < .01) continuously abstinent at follow-up, an overall cessation rate difference of 5.44% (33.72% vs. 28.28%). The smoking prevention program had no impact on smoking initiation. These results suggest potential for large-scale tobacco control efforts.

Spontaneous Reports of Religious Coping by Patients with Chronic Physical Illness

Individuals undergoing the stress of physical illness often report the use of religious coping activities. This study compared the frequency of spontaneous reports of religious coping in three groups of patients including those with cancer preparing for a bone marrow transplant (n = 22), chronic pain (n = 36), and cardiovascular disease (n = 53). Participants were asked to respond to a written, open-ended question asking how they were coping with the challenges involved in their medical condition. The question asked them to list the resources, strategies, strengths, or behaviors that they found most helpful. No mention of religion or religious coping was included with the question. Of the 111 participants surveyed, 26.1% included religious coping in their responses. The relative percentage of religious coping was calculated by dividing the total number of coping responses by number of religious responses. Mean percentage of religious coping was highest in participants preparing for a bone marrow transplant (22.9%), followed by the cardiac group (5.7%), and the chronic pain group (3.8%).

Behavioral treatment of chronic belching due to aerophagia in a normal adult

Aerophagia, or excessive air swallowing, is a potential cause of belching, flatulence, bloating, and abdominal pain and may contribute to a worsening of gastrointestinal (GI) disorders. A limited number of published reports of aerophagia treatment indicate that behavioral methods may be of benefit. A case report is presented describing the behavioral treatment of chronic belching due to aerophagia in an adult female. The collaborative application of single-participant design research helped identify open-mouth, diaphragmatic breathing and minimized swallowing as an effective intervention. Belching frequency was reduced from an average rate of 18 per 5-min interval during the baseline period to 3 per 5-min period after treatment. Results were maintained at an 18-month follow-up. Recommendations for the use of a brief treatment protocol with adults referred for chronic belching or other GI complaints attributed to aerophagia are discussed.

Are overweight and obese airmen at greater risk of discharge from the United States Air Force

This study examined whether overweight or obesity results in greater discharge risk from basic military training (BMT) or during the first year of service in the U.S. Air Force (USAF). Participants were 32,144 male and female airmen who underwent BMT from August 1995 to August 1996 and were classified as underweight (body mass index [BMI] < 18), normal range (BMI = 18-24.9), overweight (BMI = 25-29.9), or obese (BMI > or = 30). Underweight airmen were 63% more likely and overweight airmen were 24% more likely to be medically discharged during BMT compared with individuals in the normal range. Underweight airmen were 22% more likely to be discharged within the first year of service compared with those in the normal range, whereas overweight airmen were 15% less likely to be discharged. These findings do not support overweight or obesity as being major causes for discharge from the USAF within the first year of active duty.

Prevalence and Correlates of Lifetime Smokeless Tobacco Use in Female Military Recruits

Although considerable research has been conducted on smokeless tobacco (ST) use in males, much less is known about the characteristics of female ST users. The present study examined the prevalence and correlates of lifetime ST use among female Air Force recruits (N=9,087). Participants were surveyed during Basic Military Training regarding their history of tobacco use and other health risk behaviors. Although the prevalence of current ST use was low (<1%; n=34), 6.6% (n=599) had tried ST. Multivariate logistic regression analysis indicated that lifetime ST use was related to ethnicity, with Native Americans and Whites being most likely to have tried ST. Additional correlates of lifetime ST use included post-high-school education (OR=1.26, 95% CI=1.03-1.55); weekly acts of road rage (OR=1.48, 95% CI=1.06-2.06); frequent arguing (OR=1.71, 95% CI=1.18-2.48); daily or near-daily alcohol consumption (OR=1.71, 95% CI=1.03-2.82); current cigarette use (OR=3.80, 95% CI=2.42-5.94); and experimental use of cigars (OR=4.01, 95% CI=3.22-5.01), pipes (OR=2.23, 95% CI=1.64-3.03), and clove cigarettes (OR=1.23, 95% CI=1.01-1.49), all of which were associated with an increased likelihood of ST use. Results suggest that female recruits who have ever used ST engage in a variety of risk behaviors including use of other tobacco products and alcohol, as well as additional harmful behaviors.