G. Wayne Talcott

A study of the psychometric and predictive properties of the Fagerström Test for Nicotine Dependence in a population of young smokers.

This study examined the psychometric properties of the Fagerström Test for Nicotine Dependence (FTND) in a population (N = 7998) of young smokers entering US Air Force Basic Military Training (BMT). An exploratory factor analysis suggested that the FTND is comprised of two factors. The first factor, labeled Smoking Pattern, included items assessing the number of cigarettes smoked per day, time to first cigarette, difficulty refraining from smoking, and smoking when ill. The second factor, labeled Morning Smoking, consisted of two items measuring whether one smokes more in the morning and whether one would rather give up the first cigarette of the day or all others. The Smoking Pattern factor proved to have adequate internal consistency, impressive criterion-related validity, and was strongly related to smoking cessation 1 year following BMT. In contrast, the Morning Smoking factor demonstrated questionable psychometric properties and was not supported by a confirmatory factor analysis.

Home-Based Behavioral Treatments for Chronic Benign Headache: A Meta-Analysis of Controlled Trials

Controlled clinical trials have consistently demonstrated that behavioral treatments for chronic benign headache produce clinically beneficial outcomes both post-treatment and at follow-up. Given these results there is interest in cost-reduction and redesign of these treatments to improve their accessibility. One promising approach in this regard is home-based headache treatment. These treatments seek to provide the same amount of treatment as clinic-based treatments; however, some of the material typically presented to the patient by a clinician is presented through home-study materials (e.g., manuals, audiotapes). To date, the published literature contains 20 controlled clinical trials which have examined the outcomes produced by home-based treatments. This article presents the first comprehensive meta-analysis of these clinical outcome studies. Results of the quantitative analyses suggest that home-based treatments produce comparable, or with certain outcome measures, superior results to clinic-based treatments. Moreover, cost-effectiveness scores of home-based treatments were found to be more than five times larger than those of clinic-based therapies. Methodological analyses are also presented along with suggestions for future research.

The association of smoking and the cost of military training

OBJECTIVE To determine if premature discharge from the US Air Force was associated with the smoking status of recruits. DESIGN AND SETTING A total of 29 044 US Air Force personnel recruited from August 1995 to August 1996 were administered baseline behavioural risk assessment surveys during basic military training. They were tracked over a 12 month period to determine those who were prematurely discharged. MAIN OUTCOME MEASURES Excess training costs as a result of premature discharge. RESULTS In this 12 month period, 14.0% of those entering the US Air Force were discharged at a one year follow up. In both univariate and multivariate models, the best single predictor of early discharge was smoking status. Overall, 11.8% of non-smokers versus 19.4% of smokers were prematurely discharged (relative risk 1.795). CONCLUSIONS Using US Department of Defense data on the cost of military training, recruits who smoke in the US Air Force are associated with

Efficacy of forced smoking cessation and an adjunctive behavioral treatment on long-term smoking rates.

18 million per year in excess training costs. Applied to all service branches, smoking status, which represents a constellation of underlying behaviours and attitudes that can contribute to early discharge, is associated with over

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

130 million per year in excess training costs.

Smokeless tobacco use in a population of young adults

This study evaluated the efficacy of a 6-week forced ban on smoking and brief behavioral counseling on long-term smoking rates. Participants were active-duty enrollees in U.S. Air Force basic military training over a 1-year period (N = 25,996). All participants were under a 6-week ban from tobacco products, and 75% were randomized to a brief smoking cessation intervention, with the other 25% randomized to a control condition. At 1-year follow-up, 18% of smokers were abstinent; women, ethnic minorities, and those intending to stay quit at baseline were more likely to be abstinent. Among smokers not planning to remain abstinent at baseline, those receiving the intervention were 1.73 times more likely to be abstinent. Over time, substantial smoking initiation occurred among nonsmokers (8% of never smokers, 26% of experimental smokers, and 43% of ex-smokers). Forced cessation is associated with good levels of long-term cessation, and brief behavioral interventions enhance cessation in certain subgroups.

Predictors of Milk Consumption in a Population of 17- to 35-Year-Old Military Personnel

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.

Tobacco Use Harm Reduction, Elimination, and Escalation in a Large Military Cohort

The current study examined characteristics of smokeless tobacco users in a large population of Air Force recruits. In addition, smokeless tobacco users were compared to non-tobacco users, to cigarette smokers, and to users of both smokeless tobacco and cigarettes. Participants were 32,144 individuals who entered Basic Military Training from August 1995 to August 1996. A 53-item questionnaire assessed demographics, tobacco use history, risk taking, and other health-risk factors. Those who both chewed and smoked scored considerably higher on a number of risk factors than did those who limited their tobacco consumption to either cigarettes or chew. Cigarette smokers in turn tended to score consistently higher on self-reported risk factors than did nontobacco users.

Habit reversal treatment of temporomandibular disorders: A pilot investigation

OBJECTIVE The purpose of this investigation was to survey an entire population of Air Force recruits (N = 32,144) regarding milk consumption and demographic and health-related factors that may predict milk consumption. DESIGN All subjects were required to fill out a 53-item health survey at the start of basic military training. SUBJECTS/SETTING All recruits who entered the US Air Force from August 1995 to August 1996 participated in this study (N = 32,144). STATISTICAL ANALYSES PERFORMED Potential correlates of milk intake were analyzed using Spearman rank order correlations and multiple linear regression. Variables were removed if they did not make a meaningful contribution to variance in milk intake. Because of skewed distributions, several variables were dichotomized (e.g., age: 17 to 24 vs 25 to 35 years). RESULTS In terms of milk consumption, 51.7% of the respondents reported intake of fewer than 1 serving per day; only 17.9% reported intake of 3 servings or more per day. Milk intake was positively associated with body weight and fruit/vegetable intake and negatively associated with age, education level, reported milk-related gastric distress, physical activity level, dieting frequency, and concern about weight. Gender (women reported lower intake) and ethnicity (minorities reported lower intake) were independently related to milk consumption. Of all respondents, 16.1% reported themselves to have milk-related gastric distress, but rates varied depending on age, gender, and ethnicity (ranging from 10.2% for younger non-Hispanic white men to 60.4% for older Asian men). APPLICATIONS/CONCLUSIONS Despite the efforts of large, costly campaigns designed to increase milk consumption, self-reported milk consumption in young adults is extremely low. Given the importance of dairy products as a major source of calcium in the American diet, dietetics practitioners should assess milk consumption among young adults to ensure sufficient calcium intake to maximize peak bone mass in this group.

Combat Disclosure in Intimate Relationships: Mediating the Impact of Partner Support on Posttraumatic Stress

OBJECTIVES We evaluated changing patterns of tobacco use following a period of forced tobacco abstinence in a US military cohort to determine rates of harm elimination (e.g., tobacco cessation), harm reduction (e.g., from smoking to smokeless tobacco use), and harm escalation (e.g., from smoking to dual use or from smokeless tobacco use to smoking or dual use). METHODS Participants were 5225 Air Force airmen assigned to the health education control condition in a smoking cessation and prevention trial. Tobacco use was assessed by self-report at baseline and 12 months. RESULTS Among 114 baseline smokers initiating smokeless tobacco use after basic military training, most demonstrated harm escalation (87%), which was 5.4 times more likely to occur than was harm reduction (e.g., smoking to smokeless tobacco use). Harm reduction was predicted, in part, by higher family income and belief that switching from cigarettes to smokeless tobacco is beneficial to health. Harm escalation predictors included younger age, alcohol use, longer smoking history, and risk-taking. CONCLUSIONS When considering a harm reduction strategy with smokeless tobacco, the tobacco control community should balance anticipated benefits of harm reduction with the risk of harm escalation and the potential for adversely affecting public health.