The Determinants of Tobacco Relapse and Initiation Following a Period of Forced Abstinence in the U.S. Military: A Social Ecological Approach

虽然军队在过去二十年中采取了减少烟草使用的措施，但26.9%的新军人 新兵报告在入伍前经常使用烟草，7和28.5%的飞行员报告在入伍后一年内经常使用烟草。 的服务.尽管有烟草禁令，但空军第一年的烟草流行率仍在增加 在最初的10周半训练中，63.0%的飞行员“完全相信”他们会留下来， 7最令人不安的是从不吸烟者中的高启动率。内 在空军服役的第一年，20.4%的从不吸烟者开始定期吸烟，67.0%的前吸烟者重新吸烟。 76.2%的使用发生在技术培训期间。这些高启动/再启动率是 尽管国防部所有军队都有严格的反烟草规定， 基地，这表明有一些独特的技术培训环境导致这一点 启动/重新启动。到目前为止，还没有研究评估烟草建筑环境的影响， 强迫戒断和快速复发的“自然实验”。此外，没有研究测量了 影响技术训练领导层，包括指挥官、军事训练领导和技术 训练指导员，在空军技术训练期间对飞行员的行为有影响。由社会告知 这个早期研究项目的具体目标是：（1）改进现有措施 确定飞行员、军人、军人和志愿者与烟草使用相关的知识、态度、信念和行为， 培训领导者和讲师（第1阶段）。在第一年，与飞行员进行重点小组，军事训练 5所最大的空军技术训练学校（拉克兰空军基地、山姆堡）的领导和教员 休斯顿、Keesler空军基地、Sheppard空军基地和Goodfellow空军基地），以告知 措施(2)确定飞行员、军事训练领导者和教官的影响力，并 飞行指挥员烟草使用相关知识、态度、信念和行为对飞行人员烟草使用的影响 技术培训（第二阶段）。从第二年开始，在开始和结束时调查10，000名飞行员， 技术培训，调查200名军训负责人和190名教官，并对所有人进行访谈 基地指挥官，因为他们在整个研究的5个技术培训学校（N=102）。（三） 确定烟草建筑环境的影响（例如，烟草零售店的数量、密度、距离 销售点、烟草供应、定价、放置和促销）， 飞行员的烟草使用（第2阶段）。

While the military has taken steps to reduce tobacco use for the past two decades, 26.9% of new military recruits report regular tobacco use prior to enlistment,7 and 28.5% of Airmen report regular use one year into service. The prevalence of tobacco increases in Airmen’s first year in the Air Force despite a ban on tobacco during the first 10 ½ weeks of training and 63.0% of Airmen being “completely confident” they will remain tobacco free one year later.7 What is most troubling is the high rate of initiation among never users. Within the first year of Air Force service, 20.4% of never users initiate regular tobacco use and 67.0% of former users re- initiate, and 76.2% of this use occurs during Technical Training. These high rates of initiation/re-initiation are occurring despite the fact that there are rigorous anti-tobacco regulations on all Department of Defense military bases, suggesting that there is something unique about the Technical Training environment leading to this initiation/re-initiation. To date, no studies have assessed the impact of the tobacco built environment in this “natural experiment” of forced abstinence and rapid relapse. In addition, no studies have measured the influence that Technical Training leadership, including Commanders, Military Training Leaders, and Technical Training Instructors, have on Airmen’s behavior during Air Force Technical Training. Informed by the Social Ecologic Model, the Specific Aims of this Early Stage Investigator project are to: (1) Refine existing measures to determine knowledge, attitudes, beliefs and behaviors related to tobacco use among Airmen, Military Training Leaders and Instructors (Phase 1). During Year 1, conduct focus groups with Airmen, Military Training Leaders and Instructors at the 5 largest Air Force Technical Training schools (Lackland AFB, Fort Sam Houston, Keesler AFB, Sheppard AFB, and Goodfellow AFB) to inform the adaptation and development of measures. (2) Determine the influence of Airmen’s, Military Training Leaders’ and Instructors’, and Commanders’ knowledge, attitudes, beliefs and behaviors related to tobacco use on Airmen’s tobacco use during Technical Training (Phase 2). Beginning in Year 2, survey 10,000 Airmen at the beginning and end of Technical Training, survey 200 Military Training Leaders and 190 Instructors, and conduct interviews with all base Commanders as they turnover throughout the study at 5 Technical Training schools (N=102). (3) Determine the impact of the tobacco built environment (e.g., number, density, proximity of tobacco retail outlets, tobacco availability, pricing, placement, and promotion) both on and around the base perimeter on Airmen’s tobacco use (Phase 2).