Deployment-related Cigarette Smoking Behaviors and Pulmonary Function Among U.S. Veterans

Jennifer R Maccarone^{1

2}, Olivia R Sterns¹, Andrew Timmons³, Anna M Korpak³, Nicholas L Smith³, Karen S Nakayama³, Coleen P Baird⁴, Paul Ciminera⁵, Farrah Kheradmand^{6

7}, Vincent S Fan^{8

9}, Jaime E Hart^{10

11}, Petros Koutrakis¹⁰, Michael Jerrett¹², Ware G Kuschner^{13

14}, Octavian C Ioachimescu¹⁵, Philippe R Montgrain^{16

17}, Susan P Proctor^{1

18}, Carrie A Redlich¹⁹, Christine H Wendt^{20

21}, Paul D Blanc^{22

23}, Eric Garshick^{1

11}, Emily S Wan^{1

11}

Affiliations

¹ Pulmonary, Allergy, Sleep and Critical Care Medicine Section VA Boston Healthcare System, West Roxbury, MA 02132, USA.
² The Pulmonary Center, Boston University School of Medicine, Boston, MA 02118, USA.
³ Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, WA 98108, USA.
⁴ U.S. Army Public Health Center Aberdeen Proving Ground, MD 21005, USA.
⁵ Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Defense Health Headquarters, Falls Church, VA 22042, USA.
⁶ Department of Medicine Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
⁷ Baylor College of Medicine, Houston, TX 77030, USA.
⁸ VA Puget Sound Health Care System Seattle Division, Seattle, WA 98108, USA.
⁹ Department of Medicine, University of Washington, Seattle, WA 98195.
¹⁰ Department of Environmental Health, Harvard TH Chan School of Public Health Boston MA 02115, USA.
¹¹ Harvard Medical School, Brigham and Women's Hospital Channing Division of Network Medicine, Boston, MA 02115, USA.
¹² University of California Los Angeles Jonathan and Karin Fielding School of Public Health Los Angeles CA 90095, USA.
¹³ VA Palo Alto Healthcare System, Palo Alto, CA 94304, USA.
¹⁴ Stanford University School of Medicine, Stanford, CA 94305.
¹⁵ Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307.
¹⁶ VA San Diego Healthcare System, San Diego, CA 92161, USA.
¹⁷ Department of Medicine, University of California San Diego, San Diego, CA 92093.
¹⁸ U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.
¹⁹ Occupational and Environmental Medicine, Department of Internal Medicine Yale School of Medicine, New Haven, CT 06510, USA.
²⁰ Pulmonary, Allergy, Critical Care and Sleep Medicine Minneapolis VA Medical Center, Minneapolis, MN 55417, USA.
²¹ University of Minnesota, Minneapolis, MN 55455.
²² Department of Medicine, San Francisco VA Healthcare System, San Francisco, CA 94121, USA.
²³ Division of Occupational, Environmental, and Climate Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.

PMID: 38536226
PMCID: PMC12429311
DOI: 10.1093/milmed/usae049

Deployment-related Cigarette Smoking Behaviors and Pulmonary Function Among U.S. Veterans

Jennifer R Maccarone et al. Mil Med. 2024.

. 2024 Aug 30;189(9-10):2030-2038.

doi: 10.1093/milmed/usae049.

Authors

Affiliations

¹ Pulmonary, Allergy, Sleep and Critical Care Medicine Section VA Boston Healthcare System, West Roxbury, MA 02132, USA.
² The Pulmonary Center, Boston University School of Medicine, Boston, MA 02118, USA.
³ Seattle Epidemiologic Research and Information Center, Department of Veteran Affairs Office of Research and Development, VA Puget Sound Health Care System Seattle Division, Seattle, WA 98108, USA.
⁴ U.S. Army Public Health Center Aberdeen Proving Ground, MD 21005, USA.
⁵ Health Services Policy and Oversight, Office of the Assistant Secretary of Defense for Health Affairs, Defense Health Headquarters, Falls Church, VA 22042, USA.
⁶ Department of Medicine Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA.
⁷ Baylor College of Medicine, Houston, TX 77030, USA.
⁸ VA Puget Sound Health Care System Seattle Division, Seattle, WA 98108, USA.
⁹ Department of Medicine, University of Washington, Seattle, WA 98195.
¹⁰ Department of Environmental Health, Harvard TH Chan School of Public Health Boston MA 02115, USA.
¹¹ Harvard Medical School, Brigham and Women's Hospital Channing Division of Network Medicine, Boston, MA 02115, USA.
¹² University of California Los Angeles Jonathan and Karin Fielding School of Public Health Los Angeles CA 90095, USA.
¹³ VA Palo Alto Healthcare System, Palo Alto, CA 94304, USA.
¹⁴ Stanford University School of Medicine, Stanford, CA 94305.
¹⁵ Department of Medicine, Emory University School of Medicine, Atlanta, GA 30307.
¹⁶ VA San Diego Healthcare System, San Diego, CA 92161, USA.
¹⁷ Department of Medicine, University of California San Diego, San Diego, CA 92093.
¹⁸ U.S. Army Research Institute of Environmental Medicine, Natick, MA 01760, USA.
¹⁹ Occupational and Environmental Medicine, Department of Internal Medicine Yale School of Medicine, New Haven, CT 06510, USA.
²⁰ Pulmonary, Allergy, Critical Care and Sleep Medicine Minneapolis VA Medical Center, Minneapolis, MN 55417, USA.
²¹ University of Minnesota, Minneapolis, MN 55455.
²² Department of Medicine, San Francisco VA Healthcare System, San Francisco, CA 94121, USA.
²³ Division of Occupational, Environmental, and Climate Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.

PMID: 38536226
PMCID: PMC12429311
DOI: 10.1093/milmed/usae049

Abstract

Introduction: The effects of smoking on lung function among post-9/11 Veterans deployed to environments with high levels of ambient particulate matter are incompletely understood.

Materials and methods: We analyzed interim data (04/2018-03/2020) from the Veterans Affairs (VA) Cooperative Studies Program #595, "Service and Health Among Deployed Veterans". Veterans with ≥1 land-based deployments enrolled at 1 of 6 regional Veterans Affairs sites completed questionnaires and spirometry. Multivariable linear regression models assessed associations between cigarette smoking (cumulative, deployment-related and non-deployment-related) with pulmonary function.

Results: Among 1,836 participants (mean age 40.7 ± 9.6, 88.6% male), 44.8% (n = 822) were ever-smokers (mean age 39.5 ± 9.5; 91.2% male). Among ever-smokers, 86% (n = 710) initiated smoking before deployment, while 11% (n = 90) initiated smoking during deployment(s). Smoking intensity was 50% greater during deployment than other periods (0.75 versus 0.50 packs-per-day; P < .05), and those with multiple deployments (40.4%) were more likely to smoke during deployment relative to those with single deployments (82% versus 74%). Total cumulative pack-years (median [IQR] = 3.8 [1, 10]) was inversely associated with post-bronchodilator FEV1%-predicted (-0.82; [95% CI] = [-1.25, -0.50] %-predicted per 4 pack-years) and FEV1/FVC%-predicted (-0.54; [95% CI] = [-0.78, -0.43] %-predicted per 4 pack-years). Deployment-related pack-years demonstrated similar point estimates of associations with FEV1%-predicted (-0.61; [95% CI] = [-2.28, 1.09]) and FEV1/FVC%-predicted (-1.09; [95% CI] = [-2.52, 0.50]) as non-deployment-related pack-years (-0.83; [95% CI] = [-1.26, -0.50] for FEV1%-predicted; -0.52; [95% CI] = [-0.73, -0.36] for FEV1/FVC%-predicted).

Conclusions: Although cumulative pack-years smoking was modest in this cohort, an inverse association with pulmonary function was detectable. Deployment-related pack-years had a similar association with pulmonary function compared to non-deployment-related pack-years.

Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

Dr. Wan reports service on a scientific advisory board for Verona Pharma, outside the submitted work. No conflicts of exist for the remaining authors.

References

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Deployment-related Cigarette Smoking Behaviors and Pulmonary Function Among U.S. Veterans

Affiliations

Deployment-related Cigarette Smoking Behaviors and Pulmonary Function Among U.S. Veterans

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources