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

虽然军方在过去20年里采取了减少烟草使用的措施，但26.9%的新军队 新兵入伍前经常吸烟，7%和28.5%的飞行员报告入伍一年后经常吸烟 服务。尽管有烟草禁令，但空军第一年的烟草流行率仍在上升 在最初的10周半训练中，63.0%的飞行员“完全有信心”，他们将继续 7.最令人不安的是，从不吸烟者的吸烟率很高。在 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%的前吸烟者重新开始吸烟 启动，其中76.2%的使用发生在技术培训期间。这些高启动/重新启动的比率是 尽管国防部所有军队都有严格的禁烟规定，但还是发生了 基地，这表明技术培训环境中有一些独特的东西导致了这一点 启动/重新启动。到目前为止，还没有研究评估烟草建筑环境对这一地区的影响 强迫禁欲和快速复发的“自然实验”。此外，还没有研究测量 影响技术训练领导，包括指挥员，军事训练领导和技术 训练教官，对空军技术训练中飞行员的行为有一定的影响。由社会公众提供的信息 生态模型，这个早期调查者项目的具体目标是：(1)完善现有措施 确定空军、军队中与烟草使用有关的知识、态度、信念和行为 培训领导者和讲师(阶段1)。在第一年，与飞行员一起组织重点小组，军事培训 5所最大的空军技术培训学校(拉克兰空军基地，山姆堡)的领导和教官 休斯顿、凯斯勒AFB、谢泼德AFB和古德费罗AFB)，以告知 措施。(二)确定空军、军训领导和教练员的影响力； 指挥员吸烟相关知识、态度、信念和行为对飞行人员烟草使用的影响 在技术培训期间(第二阶段)。从第二年开始，在年头和年末调查10,000名飞行员 技术培训，调查200名军事训练带头人和190名教官，并与所有 基地指挥官在整个研究期间在5所技术培训学校(N=102)轮换。(3) 确定烟草建造环境的影响(例如，烟草零售店的数量、密度、邻近程度 销售点、烟草供应、定价、放置和促销) 飞行员的烟草使用(第二阶段)。

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).