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The objective of this study is to examine whether women's tobacco use prior to entering the U.S. Navy is predictive of subsequent career performance. A priori predictions were that smoking at entry into the Navy would be related to early attrition, poorer job performance, more disciplinary problems, and lower likelihood of reenlistment. A prospective cohort analysis of 5,487 women entering the U.S. Navy between March 1996 and March 1997 was conducted. Navy attrition/retention and career performance measures, such as time in service, early attrition, type of discharge, misconduct, number of promotions, demotions and unauthorized absences, highest pay grade achieved, and re-enlistment were examined. Results showed that, compared with never smokers, daily smokers at entry into the U.S. Navy had subsequent career outcomes consistently indicating poorer job performance (e.g., early attrition prior to serving a full-term enlistment, more likely to have a less-than-honorable discharge, more demotions and desertions, lower achieved pay grade, and less likely to re-enlist). Other types of smokers consistently fell between never and daily smokers on career outcome measures. The authors conclude that, for women entering the U.S. Navy, being a daily smoker is a prospective predictor of poorer performance in the Navy. Future research should evaluate the effectiveness of cessation intervention with smoker-enlistees prior to their entering the Navy to assess the impact on subsequent career outcomes., Published in Tobacco Control, v16 p79-84, 2007. Prepared in collaboration with the Graduate School of Public Health, San Diego State University, San Diego, CA. This research was supported by the FY03 Department of Defense Peer Reviewed Medical Research Program (PRMRP) Supplement to the U.S. Army Medical Research and Materiel Command (USAMRMC). The original document contains color images.

New methods of hemorrhage control are needed for use in remote surgical locations, such as the battlefield. Data from the Navy-Marine Corps Combat Trauma Registry (CTR) describe recombinant activated human coagulation factor VII (FVIIa), a site-specific, intravascular approach to promote clotting, which is being used as an adjunct to surgical control of bleeding in trauma patients in the battlefield environment. The present 20-month retrospective study identified 22 casualties from the CTR who were wounded in Iraq and received FVIIa. Primarily young Marines, these patients typically had penetrating injuries from improvised explosive devices and gunshot wounds. Injuries were often abdominal, supporting the utility of FVIIa for noncompressible injuries. The average dose used was similar to that reported elsewhere, although dosing varies widely in the existing experimental and anecdotal literature. Over two thirds (68%) of the FVIIa patients survived. Survival outcomes did not differ significantly between the FVIIa group and a matched control group. Results are discussed in terms of battlefield applications for FVIIa and methodological limitations of the study., Prepared in collaboration with Science Applications International Corporation, Inc, San Diego, CA. Sponsored in part by Navy Medicine Support Command, Jacksonville, FL. The original document contains color images.

This brief paper describes the effects of the recent San Diego area wildfires on outpatient respiratory visits to local military medical treatment facilities (MTFs). Beginning October 26, 2003, San Diego County and surrounding areas experienced the worst firestorm in 33 years. The fires produced massive amounts of smoke and ash, which can exacerbate asthma and other respiratory conditions, as well as aggravate healthy lungs and throats. Using the Medical Data Surveillance System (MDSS), a passive surveillance tool that monitors health conditions using automated medical encounter records, outpatient medical visits at hospitals and clinics in two large military catchment areas were examined to assess unusual increases in respiratory conditions. Camp Pendleton and San Diego MTFs serve approximately 300,000 active-duty service members (primarily Navy and Marine Corps), family member, recruits, and retirees. Analysis of outpatient visits several days before and after the fires began showed that the number of respiratory cases was not unusually high as a result of the fires, at least in the short term. Results suggest that individuals heeded advice, took precautions, and remained indoors, thereby reducing or avoiding short-term respiratory problems., Prepared in collaboration with MTS Technologies, Inc., Arlington, VA.

This study surveyed Navy health care providers (HCPs) regarding mandated patient-care practices related to tobacco use. Surveys were completed by 2,287 participants, and included 1,181 physicians, 548 dentists, 26 nurse practitioners, 19 physician assistants, and 513 independent duty corpsmen. Almost 80% of Navy HCPs reported that they usually asked new patients about tobacco use. Of 11 recommended practices, two-thirds to three-quarters of HCPs engaged in four behaviors with most or all of their tobacco-using patients: advise patients to stop, advise pregnant users of health risks to the fetus, inform patients of benefits of quitting, and explain dangers of using tobacco. Other recommended cessation strategies were not performed regularly (i.e., assist patients in setting quit date, develop cessation plan, provide self-help materials, make referrals to cessation programs, prescribe nicotine gum, or arrange follow-up visits). Higher percentages of NPs and PAs reported engaging in tobacco-related practices with their patients; physicians were intermediate, while lower percentages of dentists and IDCs reported tobacco-related practices. It is recommended that concerted efforts be made to train all Navy HCPs to use the National Cancer Institute's Four A's approach for patient tobacco cessation, and that organizational support to implement these procedures be mandated. Tobacco Use, Health Care Provider, Health Care Provider Attitudes, Patient Care Practices.

To address the high prevalence and costs associated with low back pain, U.S. Navy physical therapists currently provide back injury prevention education to requesting commands in the form of the Healthy Back Program. Although the content of the Healthy Back Program has face validity, no explicit evaluation of its effectiveness has been conducted. Because of the need to develop effective health interventions, a formal study is needed. The primary purposes of the present study are to: (a) present findings examining the immediate effect of the Healthy Back Program in changing knowledge about back injury prevention, and (b) provide a baseline assessment of back problems among incoming recruits. Correlates of back pain also are examined to suggest factors that may be amenable to intervention. Intervention recruits (n=1,772) received the Healthy Back Program brief, which is a slide presentation that focuses largely on information about back injury and prevention techniques. Immediately following the presentation, intervention subjects completed a short questionnaire assessing their history of back problems, demographic and health information, back knowledge, and nutrition knowledge. Control subjects (n=1,658) completed identical questionnaires but received no presentation. Intervention recruits had a significantly higher back knowledge score (67% correct) than controls (50% correct); nutrition knowledge differences were minimal (52% vs. 53% correct). About 41% of all recruits had ever experienced a back problem, 27% reported at least one back problem within the past year, and 11% reported back pain during recruit training. Liftlng, sports participation, and bending were reported as the leading causes of previous back problems. Although better self-reported health and fitness measures were associated with fewer low back problems, other correlates of back pain reported elsewhere (e.g., smoking, overweight) were not found.

While the relationships between (a) health behavior and health status and (b) health status and perceived quality of life (QOL) have received some attention, the association between health behaviors and QOL has not been determined. The primary objective of this study was to assess the effects of health behaviors on QOL that are independent of the effects of health status. A sample of approximately 5,000 randomly selected U.S. Navy personnel was split into halves and analyses performed on each to establish the replicability of the findings. At step one of a multiple regression procedure, health status variables were forced into the equation; next, health behavior variables were entered. As expected, the block of health status variables was significantly related to QOL; self-assessed health and fitness status and lower reporting of physical symptoms accounted for 16% and 18% of the variance in QOL for the two subsamples. After controlling for health status, two behavioral measures made unique contributions to the prediction of QOL; behaviors related to avoiding unnecessary risks as a driver or pedestrian and avoiding or minimizing accidents. Wellness maintenance behaviors also were associated with QOL in one subsample. After controlling for health status, health behavior measures contributed an additional 11% and 6% of the explained variance in QOL for the two subsamples. Results indicate that health behaviors influence QOL independently of health status.... Health behaviors, Quality of Life, Health Status, Navy Personnel.

This study extended cross-sectional research associating quality of life with health and fitness factors. Longitudinal analyses were performed on data collected from 519 U.S. Navy personnel to assess changes in quality of life with changes in health/fitness status and health behavior dimensions at 1-year and 2-year intervals. Multiple regression results showed that such changes were positively associated with changes in health/fitness status and behaviors related to accident control and wellness maintenance, with these predictors accounting for 8% of the variance in change in quality of life at the 1-year interval. At the 2-year interval, such change was associated with health/fitness status and accident control behaviors, accounting for 11% of the variance. Health behavior change made a unique contribution to change in quality of life after controlling for changes in health/fitness status at both intervals. Findings affirm modest yet consistent associations between changes in fitness and health variables and quality of life and suggest that improvements in health behavior influence quality of life independently of one's health/fitness status., Pub. in Perceptual and Motor Skills, v75, p3-14, 1992.

No systematic monitoring procedure is in place that can can provide information about successes or deficiencies in Navy health promotion efforts. This study tested the feasibility of using a brief Health Promotion Tracking Form (HPTF) as part of the periodic physical examinations required of all Navy personnel. Clinics in four geographic regions used the HPTF for a one-month period. Patients undergoing routine physicals were asked to complete HPTF items addressing health-related and demographic items. Medical examiners completed HPTF items related to blood pressure, cholesterol and triglyceride levels. Analyses revealed acceptable levels of missing data overall. Demographically, the total sample was similar to the Navy in terms of sex, age, and enlisted occupation, although a pronounced racial and socioeconomic bias was seen. Results of this study suggest several recommendations for collecting reliable data for an accurate, on-going assessment of Navy health: (a) collect health promotion data from diverse settings including ships, (b) refine several patient-provided health promotion items, (c) integrate the HPTF into the physical examination packet, and (d) employ weighting procedures to ensure that sample demographic distributions are adjusted to reflect the Navy population. Health Surveillance, Health Promotion, Navy Personnel.

Researchers have studied the association between mood and health symptoms because of concern for military personnel performance in extreme conditions, such as the heat and humidity encountered in the Persian Gulf. Previous field studies, using shipboard Navy personnel during at-sea operations in the Persian gulf have shown that crew members experience mood changes such as psychological fatigue, feelings of confusion, tension/anxiety, and depression and additionally report degradations in general physical health. Data from past research indicate that the ability to regulate mood is an important requisite for maintaining positive self-appraised health. This study provided further support for the idea of a mood-health link, and points to the usefulness of employing multiple health complaint composites rather than general measures when assessing mood-health associations. It was found that tension/anxiety and fatigue mood states differentially predicted 9 of 11 distinct health composites. Results suggest that strategies for altering mood (e.g., adequate periods of sleep, regulation of caffeine consumption, stress management training, exercise, and cognitive/behavioral interventions) might also have a positive effect on associated health complaints.

The objective of this study was to assess the effects of health behaviors on Quality of Life (QOL) that are independent of the effects of health status. A sample of approximately 5,000 randomly selected Navy personnel was split into halves and analysis performed on each to establish the replicability of the findings. At step one of a multiple regression procedure, health status variables were forced into the equation; next, health behavior variables were entered. As expected, the block of health status variables was significantly related to QOL: self-assessed health and fitness status and lower reporting of physical symptoms accounted for 16% and 18% of the variance in QOL for the two subsamples. After controlling for health status, two behavioral measures made unique contributions to the prediction of QOL: behaviors related to avoiding unnecessary risks as a driver or pedestrian and avoiding or minimizing accidents. Wellness maintenance behaviors also were associated with QOL in one subsample. After controlling for health status, health behavior measures contributed an additional 11% and 6% of the explained variance in QOL for the two subsamples. Results indicate that health behaviors influence QOL independently of health status.

Because of the severe sanctions that can be levied against personnel failing the PRT and body fat standards, it is important to assess the effectiveness of a Basic Exercise Program based program in reducing body fat and improving PRT performance among Navy personnel. The purpose of this study was to determine if taking part in a command-organized remedial program based on the BEP is effective in reducing body fat, improving failure-specific performance on the various components of the PRT, and improving overall physical fitness level. Remedial physical conditioning programs at a submarine base and an air station were evaluated. Pre- and postprogram PRT results were collected for participants at the submarine base (n=64) and the air station (n=44) to assess changes in the number of curl-ups, number of push-ups, run/walk time, overall classification score, percent body fat, and percent passing the overall PRT. In general, comparisons over time showed a trend toward improvement among participants in their performance on PRT fitness components and overall classification score.