Prevalence of Tobacco Use among Veterans and Interventions - Essay Example

?PREVALENCE OF TOBACCO USE AMONG VETERANS AND INTERVENTIONS Prevalence of Tobacco Use among Veterans and Interventions PREVALENCE OF TOBAACO USE AMONG VETERANS AND INTERVENTIONS Prevalence of Tobacco Use among Veterans and Interventions According to CDC, (2007), the consumption of tobacco through cigarettes constitutes the predominant reason for premature death and one of the major causes of a variety of illnesses. In these regards, nearly 435,000 die each year as a direct result of smoking. Even as smokers are aware of the startling consequences of their actions, tobacco use remains considerably prevalent among large numbers of the population. Perhaps even more disturbing is that while tobacco use has significant consequences on the individual user, second-hand smoke also has a deleteriously effect on veterans’ families of which the VA health care system is responsible for the medical treatment.Among the most prominent diseases that are direct results of tobacco use are cardiac arrest and lung cancer, both of which can result in death. In addition to these problems, smoking also has been directly linked to causing respiratory complication, oral disease, emphysema, and chronic bronchitis. It follows that it is essential greater awareness be brought through veterans to the deleterious consequences of smoking (American Lung Association, 2010). Even as smoking is a considerable problem among the general public, veterans in VA health care demonstrate even statistically higher numbers of illness. Indeed, it is estimated 33 % of the veterans’ population served by the Department of Veterans Affairs are smokers, whereas the national average is at 22% (National Smoking and Tobacco Use Cessation Program directive, 2003).In addition to demonstrating higher percentages of tobacco users, veterans also smoke more heavily than the general population. Much research that has been conducted into this phenomenon indicates that many veterans report beginning smoking while in the military, and after their release continue the practice throughout their daily life as a means of calming anxiety or nerves. The military have always promoted tobacco use in the camps. During both the Second World War and the Korean War the government made complimentary cigarettes available as K-rations. The prevailing wisdom during this period was that cigarettes would keep troops vigilant in the battlefield. Smoking breaks were even used as motivation during boot camp, with soldiers being able to earn breaks (McKinney et al, 1997). It’s believed that the promotion of smoking in these contexts greatly contributed to later day health-related problems among veterans. In these regards, it’s clear that further awareness needs to be brought to the deleterious effects of smoking. Consider statistics from a recent investigation into this phenomenon that indicated 24.1% of 18 – 44 years olds are of veterans are current smokers, this percentage drops to 21.9% for 45 – to – 64 year olds, 11.1% for 65 – to 74 –year olds, and 5.8% for those over age 75 (Centers for Disease Control and Prevention, Summary of Health Statistics for U.S. adults, 2006). Women, the fastest growing subgroup of U.S. veterans, are included in the VA health concern. In 2005, the Office of Public Health & Environment indicated that nearly 178,000 women die on a yearly basis as a direct result of smoking related illness. These women also risk cancer, infertility and pregnancy – related problems. SIDS is also common among mothers who smoke during pregnancy. (Department of Veterans Affairs, 2010). Many health experts agreed that the current VA tobacco control efforts to be less effective for women veterans than their male counter – parts. “Given an expected increase of women veterans with tobacco – related morbidities, developing effective smoking cessation interventions for women veterans is an important goal.” (Katzburg, 2007).In addition to the previously described health risks, research has demonstrated a significant connection between tobacco use and psychiatric disorders. One startling research study estimate that 40% of all cigarettes purchased throughout the nation were by people with psychiatric disorders (Ziedonis et al, 2000). Health experts indicate that individuals with psychiatric issues are as much as 3X more likely to be smokers. Many of these individuals will suffer from significant tobacco related health issues (Ziedonis at el 2000). An estimated 37% of veterans have mental disorders, and VA has been the largest provider of behavioral health care must consider this to be a very important health issue. The most common type of mental disorders is Posttraumatic stress disorder (PTSD) especially among people who enroll in VA Administration health care system. (Kessler, et al, 1995).Veterans with post-traumatic stress disorder demonstrate nearly double the rate of smoking than the general VA average. Veterans with combat–related PTSD smoke heavily more than 25 cigarettes compared with veterans who smoke with PSTD 48% versus 28%. Due to the strong correlation between these factors, it’s clear they need to be concomitantly treated (McFall et al, 2005). While great amounts of public awareness and strategic initiatives have been implemented to reduce smoking throughout the last few decades, the smoking rate among individuals with PTSD remains very high. Since smoking has decreased among the general population, yet not among individuals with psychiatric disorders, individuals within this population constitute nearly half of all smokers. It follows that this population experiences a higher death rate and risk of disease in comparison to the general population (Ziedonis at el 2000). Treating these ailments constitutes the largest VA health expenses. It’s clear that tobacco use among this population presents an issue that must be immediately addressed.Past mental health treatment programs have been faulty in that they have not adequately worked against tobacco use. In fact, some have even gone as far as embracing smoking among patients as a means of behavioral management (McFall, et al, 2005). As a result, it is necessary for the VA to not only develop treatment programs for this specific population, but re-envision their entire approach to the intervention process. Even as there is substantial research that attests to the harmful effects of smoking within this segment of society, surprisingly few steps have been taken to combat the problem; as a result, there exists great room for strategic measures to be implemented. In examining reasons why such little action has been taken, researchers argue that stigma is the primary reason prevention groups have taken such a passive role in regards to this segment of society. In these regards, it’s clear that a more equitable approach needs to be taken that treats this section of the population the same as the rest of the nation. Indeed, in developing treatment measures there must be significant change in perception regarding this population (Ziedonis, et al, 2000). The first step in these regards is for the VA health care system to recognize the significant smoking problem among this population. There is gradual momentum building for these measures, as well as world academic interest in the relation between nicotine and mental health (Ziedonis, et al, 2003). Prevalence of Tobacco Use in the Military Researchers argue that when examining the military branches there are various smoking rates. Overall, tobacco use throughout the military is at 32 percent. Within the Army, there was a reported 38 percent usage rate; the Marine Corps 36 percent; the Navy 32 percent; and in the Air Force 23 percent (American Legacy Foundation, 2002). National Academies 2005 indicates that smoking reduces overall active duty productivity and efficiency. In terms of veteran’s it has been linked to absenteeism, as well as effecting pre-existing health problems. Of course, current military personnel that are tobacco users will eventually enter the VA health system, effecting costs through increased health problems related to tobacco use.There is a disparity in smoking between individuals who use the VA health system and those who don’t. Veterans utilizing the VA health care system may be of lower economic status, which may also contribute to this population’s increased level of tobacco use and psychiatric problems (McKinney, et al, 1997). While some programs are designed to help individuals quit smoking, it’s clear that the greater issue of preventing smoking in the first place needs to be addressed (IoM, 2009). Demographics of the Veteran Population It is estimated that there are 26.5 million U.S. veterans and 7.8 million enrolled in the VA healthcare system. Within those enrolled, 45.5% are least 65 years old, 41.0% are 45 – 64 years old; less than 1 million are under 45 years. About 7.5% were women (The National Academies, 2005). Cost According to Dr. Wilson, (2008), it is estimated that as of July 2008, about 33, 000 U.S. troops had been killed or wounded in Iraq or Afghanistan, and an estimated 960, 000 troops had used tobacco, with such figures I do believe tobacco abuse represents a greater danger to our military personnel and veterans than combat operation.The VA cares for over seven million of the veteran’s throughout the United States. It is the largest health care provider for individuals with PTSD, as well as chronic mental health problems. There is considerably high smoking among this population and continued investment in ways to reduce smoking among this segment of society (National Cancer Institute, 2010).The cost as a direct result of tobacco use in this population is significant. The Institute of Medicine demonstrated that within the Department of Defense the cost of treating individuals from smoking related illness is over $400 million a year, as well as $346 in productivity loss. In terms of the VA’s specific costs related to tobacco related problems, the estimated total costs have approached $5 billion, including $1 billion on a yearly basis (IoM, 2008). With these staggering costs, the need to rectify these issues is imperative. Intervention According to health experts tobacco use and dependence are the most lethal and costly substance use disorder in the U.S., routine tobacco use screening and effective smoking cessation treatment will promote health and well – being among our veterans. The VA has been very successful making tobacco cessation resources available.The VA has already demonstrated significant commitment to preventing tobacco use. VA health centers have clinics devoted to helping individuals quit smoking, and use medical records to build-in clinical reminders for tobacco-use screening. Counseling and medication are also made available on the Veterans Health Administration national formulary. Veterans receiving primary or outpatient mental health care are screened for tobacco use annually. The United States Air Force has also developed preventative measures. The Air Force has implemented a tobacco quit line that is being test through clinical trials. This line would aid individuals quit smoking and would exist on twenty-seven Air Force bases. One of the major benefits of the line is the flexibility and immediacy it allows individuals wishing to quit smoking (National Cancer Institute, 2010). Dr. Robert Klesges states, “quit line are an effective way to deliver smoking cessation services, and an effective way to reduce logistic barriers to accessing services.”Also, a tobacco quit lie or a tailored internet program, any one including veterans can use any time day or night. As of September 23, 2010, VA will now provide free over – the – counter nicotine replacement therapy to veterans and employees, this is an excellent way to provide preventive health services to employees and veterans. In 2006, the VA eliminated all co payments for smoking cessation counseling as an incentive for veterans to quit tobacco use. Furthermore, the VA continues to expand services including telephone care fro veterans willing to set a quit date with their primary care providers. (Eggleston, et al, 2009). Experts state that there is no overarching treatment for individuals with PTSD who smoke, yet there are programs currently being developed for this specific problem. Still, it’s not unlikely that veterans with post-traumatic stress disorder would benefit from traditional treatment methods for the cessation of smoking (Beckham, et al, 1997). Ziedonis et al examined ways to address both smoking and mental health issues. In these regards, tobacco awareness must be raised within the veteran sector; integrate tobacco treatment into mental health areas; funding increases for these health concerns; system and administrative changes. It is of great urgency that these issues be addressed to ensure the individuals that have served our country are able to live the rest of their lives in good health and peace. Conclusion In conclusion, while the VA has already done much to aid the health of veterans in terms of both mental health and tobacco use it’s clear significant progress is left to be made. In addition to the importance of addressing these problems because of the substantial health risks they pose for military veterans, there are also significant expenditures related to tobacco use among these sections of the population. In these regards, it’s clear more strategic measures must be taken to reduce smoking among consumers of VA health care (IoM, 2009). In addition, further work is required specifically for veterans with post-traumatic stress disorder, wherein smoking is significantly high (Brown, 2009). . Finally, VA must develop effective smoking cessation interventions for women veterans. References American Legacy Foundation. (2003). Tobacco Use in the Military and Veterans Population. American Lung Association. (2010). Fighting for Air. Retrieved November 13, 2010, fromhttp://www.lungusa.org/stop-smoking/about-smoking/facts-figures/military-and -tobacco -u... Beckham, J.C., Feldman, M.E., Vrana, S.R., Mozley, S.L., Erkanli, A., Clancy, C.P., & Rose, J.E. (2005). Immediate antecedents of cigarette smoking in smokers with and without posttraumatic stress disorder: A preliminary study. Experimental and Clinical Psychopharmacology, 13, 219 – 228. Brown D.W., DSc, MScPH, MSc, (2009). Smoking Prevalence among US Veterans. Retrieved November 10, 2010, from http://resources.metapress.com/pdf-preview.axd?code=275m613642722p2t&size=largest Center for Disease Control and Prevention.Summary of Health Statistics for U.S. Adults. (2007). Adult Cigarette Smoking in the United States: Current Estimate. Retrieved October 30, from www.cdc.gov/tobacco/data_statistics/index.htm United States Department of Veterans Affairs. (2008). Office of Public Health and Environmental Hazards.Smoking and Tobacco Use Cessation. Retrieved November 5, 2010, from http://www.publihealth.va.gov/smoking Eggleston A.M., PhD, Straits-Troster, K., PhD, ABPP, &Kudler H, MD. (2009). Substance Use Treatment Needs Among Recent Veterans. NC Med J January/February 2009, Volume 70, Number 1. Institute of Medicine. (2009). Combating Tobacco in Military and Veteran Population. Katzburg, J.R. PhD, MPH, RN, Yano E.M. PhD, Washington D.L. MD, MPH, Farmer M. M. PhD, &Sherman S.E. (2007). Research informing Policy: Designing a tailored, patient – centered smoking cessation program. Retrieved November 8, 2010, from http://apha.confex.com/apha/135am/techprogram/paper_152399.htm Kessler RC, Sonnega A, Bromet E, Hughes M. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen. Psychiatry. 1995; 52(12):1048-1060 McKinney P.W. MD, McIntire D.D., PhD, Carmody T.J. PhD, & Joseph A. MD MPH. (1997). Comparing the Smoking Behavior of Veterans and Non veterans. Public Health Reports.May/June 1997, Volume 112. Retrieved November 13, 2010, from http://www.ncbi.nlm National Cancer Institute. (2010). Operation Cessation: Curbing Military and Veteran Tobacco Use. Retrieved October 11, 2010, from http://www.cancer.gov/aboutnci/ncicanerbuttetin/archive/2010/0200910/page9/print?page... NationalAcademy of Sciences. (2009). DOD, VA should take stronger steps to combat tobacco use in military, veteran populations. Retrieved October 8, 2010, from http://National-Academies.org Dr. Wilson M. (2008). “Prevalence of tobacco abuse in a United States Marine Corp Infantry Battalion Forward Deployed in the Haditha Triad Area of Operations. Al Anbar, Iraq” CHEST 2008;134:s53001 National Smoking and Tobacco Use Cessation Program Directive. (2008). VHA Smoking and Tobacco Use Cessation Program. Retrieved October 20, 2010, from www1.va.gov/vhapublication/viewpublication.asp?ID=1809 Ziedonis D.M., M.D., M.P.H., Williams, J.M., M.D. Steimberg M.L. PhD.,Smelson D, Psy.D.,Krejci J., PhD, Sussner B.D. PhD., Violette, M.S.W., C.A.D.C., Foulds J, PhD.Addressing Tobacco Dependence among Veterans with a Psychiatric Disorder: A Neglected Epidemic of Major Clinical and Public Health Concern. Retrieved October 15, 2010, from www.tobaccoprogram.org/pdf/vatpolicy.pdf Read More