Airborne hazards exposure and respiratory health of Iraq and Afghanistan veterans.

More than 2.6 million military personnel have been deployed to recent conflicts in Iraq and Afghanistan and were likely exposed to a variety of airborne hazards during deployment. Despite several epidemiologic reports of increased respiratory symptoms, whether or not these respiratory illnesses lead to reductions in lung function and/or specific pulmonary disease is unclear. We reviewed data published from 2001 to 2014 pertaining to respiratory health in military personnel deployed to Iraq and Afghanistan and found 19 unique studies. Study designs were primarily retrospective and observational in nature with patient symptom reporting and medical encounter data as primary outcome measures. Two case series reported on rare respiratory diseases, and one performed a standardized evaluation of new-onset respiratory symptoms. Respiratory outcomes in relation to proximity to a specific air pollution source (i.e., smoke from burning trash and sulfur mine fire) were described in 2 separate studies. Only 2 longitudinal investigations were identified comparing pre- and postdeployment measurement of exercise capacity. In summary, published data based on case reports and retrospective cohort studies suggest a higher prevalence of respiratory symptoms and respiratory illness consistent with airway obstruction. However, the association between chronic lung disease and airborne hazards exposure requires further longitudinal research studies with objective pulmonary assessments.

Factors associated with a diagnosis of sarcoidosis among US veterans of Iraq and Afghanistan.

This study evaluated risk factors of sarcoidosis among Airborne Hazards and Open Burn Pit Registry (AHOBPR) participants using a retrospective age and sex-matched case-control design of AHOBPR participants deployed to Afghanistan or Southwest Asia with and without sarcoidosis diagnosed in the Veterans Health Administration (VHA). Logistic regression models tested for associations between sarcoidosis and self-reported cumulative deployment-related exposures. 661 Veterans (0.37%) were diagnosed with sarcoidosis in VHA. Logistic regression demonstrated lower odds of sarcoidosis in Hispanic participants (OR 0.08, CI 0.04-0.15) and those who served in the Navy (OR 0.40, CI 0.21-0.72). African American veterans (OR 2.27, CI 1.66-3.11) and former smokers (OR 1.87, CI 1.33-2.62) were at elevated risk. Of the exposure variables, convoy activities had the highest odds of being associated with sarcoidosis and was marginally statistically significant (OR 1.16, CI 1.00-1.35). Sarcoidosis was an uncommon diagnosis among AHOBPR participants and was associated with only one of eight assessed cumulative deployment-related exposures.

Enhanced life functioning: Initial efficacy of a theoretical approach to integrate multiple health behavior interventions in young adults.

OBJECTIVES: We propose a new theoretical model that integrates health interventions targeting multiple health behaviors around a common framework of enhancing life functioning. We then test an enhanced life functioning message against an enhanced physical health message in increasing participants' perceived importance of engaging in multiple health behaviors. METHODS: 94 undergraduate participants were exposed to either an enhanced life functioning message or an enhanced physical health message and then completed measures of health behavior importance and benefits associated with enhanced life functioning importance in the spring of 2008 at Rutgers University. RESULTS: Results indicate the efficacy of an enhanced life functioning message in increasing participants' perceived importance of engaging in multiple health behaviors. Moreover, the effect of an enhanced life functioning message on perceived health behavior importance is mediated by perceived importance of the benefits associated with enhanced life functioning. CONCLUSIONS: Emphasizing enhanced life functioning as an outcome of engaging in multiple health behaviors increases the perceived importance of performing multiple health behaviors, which may influence the performance of multiple health behaviors.

Forced oscillation technique in veterans with preserved spirometry and chronic respiratory symptoms.

PURPOSE: To evaluate the utility of the forced oscillation technique (FOT) among military veterans with preserved spirometry and chronic unexplained respiratory symptoms. METHODS: 178 veterans referred for evaluation of unexplained respiratory symptoms completed pulmonary function testing and FOT. Preserved spirometry was defined as FEV1/FVC, FEV1 and FVC ≥ 5th percentile. Frequency dependence of resistance (R4-R20) and reactance area (AX) were assessed via FOT, and R4-R20 ≥ 20% and AX ≥ 95th percentile were considered abnormal. RESULTS: Spirometry was preserved in 71.3%, of whom 124 had acceptable FOT data. 93 of 124 (75.0%) veterans with preserved spirometry had one or more abnormal findings on FOT. Veterans with abnormal R4-R20 and/or AX had reduced FVC, FEV1, FEF25-75, and diffusing capacity (% predicted) in comparison to those with Normal FOT (p = 0.030 to p < 0.001). CONCLUSIONS: In our referral sample, distal airway dysfunction in the presence of preserved spirometry appears common and may represent an at-risk group requiring closer surveillance.

Isolated diffusing capacity reduction is a common clinical presentation in deployed Iraq and Afghanistan veterans with deployment-related environmental exposures.

Following deployment to Iraq and Afghanistan ("post-9/11"), a spectrum of respiratory conditions has been reported; however, there are few published reports of objective physiologic data or later experience of symptoms and function. To better understand the post-deployment clinical presentation, we conducted a retrospective review of pulmonary function testing in 143 veterans referred to our tertiary care clinic for post-deployment health concerns. More than 75% of our sample had normal lung volumes and spirometry on pulmonary function testing; however, an isolated reduction in lung diffusing capacity (DLCO) was observed in 30% of our sample of post-9/11 veterans. An isolated reduction in DLCO is a rare pattern in primary-care seeking dyspneic patients, but is commonly associated with underlying pulmonary disease. Post-9/11 veterans with respiratory complaints and an isolated reduction in DLCO should undergo further evaluation.

The impact of tobacco use and secondhand smoke on hospitality workers.

Tobacco use has a substantial impact on hospitality industry employees because of the disproportionate prevalence of smoking among these workers and because of the high levels of secondhand smoke to which they are exposed. The severity of this impact is evidenced by the high mortality rates observed among hospitality industry workers from diseases related to tobacco smoke exposure. Several states and localities have begun to enact laws to protect these workers from secondhand smoke exposure. Such policies seem to be effective in reducing exposure and improving health among these workers without causing any adverse impact on business. Occupational clinicians can play a significant role in protecting the health of hospitality workers by supporting laws to create smoke-free workplaces, including bars and restaurants, and promoting smoking cessation in these worksites.

Bronchodilator Responsiveness and Airflow Limitation Are Associated With Deployment Length in Iraq and Afghanistan Veterans.

OBJECTIVE: The aim of this study was to determine the relationship between deployment length and indices of airflow obstruction in Iraq and Afghanistan veterans with airborne hazards exposure. METHODS: One hundred twenty-four post-9/11 veterans completed pulmonary function testing and questionnaires. We examined the association of airflow limitation [forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC)] and bronchodilator responsiveness (ΔFEV1 and ΔFVC) with deployment length, adjusting for smoking. RESULTS: Longer deployment length was associated with lower FEV1/FVC [ß = -0.19; 95% confidence interval (95% CI), -0.39 to 0.01], greater ΔFEV1 (ß = 0.27; 95% CI, 0.09 to 0.45) and ΔFVC (ß = 0.19; 95% CI, 0.05 to 0.33). In our model adjusted for smoking history, longer deployment length remained associated with greater ΔFEV1 and ΔFVC (P < 0.01), but not with FEV1/FVC (P = 0.059). CONCLUSION: In our sample of post-9/11 veterans, longer deployment lengths were associated with significant bronchodilator responsiveness and a trend toward airflow limitation independent of tobacco use.

A pilot study of telephone-based smoking cessation intervention in asbestos workers.

Smoking markedly increases the risk of asbestos-related lung cancer. We conducted a randomized pilot trial of a telephone-based smoking cessation intervention in asbestos workers. Fifty-nine smokers were assigned to either a control or telephone-based smoking cessation treatment group and were followed-up at 6 months. Intent-to-treat analysis revealed a 16.7% quit rate at 6 months for the intervention group compared to 6.9% for the control group (P = 0.25). Treatment-received quit-rates were 33% for the intervention group and 6.9% for the control group (P = 0.05). The intervention group was twice as likely to use smoking cessation medicines and progressed further along the stage of change continuum compared with the control group. Incorporating telephone-based smoking cessation treatment into medical screening activities for asbestos workers is feasible and the intervention is effective in increasing quit rates at 6 months.

Environmental exposure and health of Operation Enduring Freedom/Operation Iraqi Freedom veterans.

OBJECTIVE: We characterized the prevalence of self-reported environmental exposures, concerns about exposures, and their relationships with somatic symptoms in Operation Enduring Freedom (Afghanistan) (OEF) and Operation Iraqi Freedom (Iraq) (OIF) veterans seeking treatment at a specialty Veterans Affairs (VA) clinic. Concerns about environmental exposures were expected to lead to more reporting of somatic symptom burden. METHODS: We conducted a chart review of 469 OEF/OIF veterans seen at a VA tertiary care clinic. RESULTS: OEF/OIF veterans reported a high level of environmental exposures and concerns about environmental exposures. Greater reported environmental exposures (ß = 0.13) and environmental exposure concerns (ß = 0.39) were associated with a greater somatic symptom burden. Exposure concerns accounted for some of the relationship of exposures on somatic symptom burden (confidence interval, 0.33-0.60). CONCLUSIONS: OEF/OIF veterans seeking treatment at a VA clinic reported a high prevalence of environmental exposures and exposure concerns. Both negatively impacted health outcomes.

Organizational psychosocial factors and deployment-related exposure concerns in Afghanistan/Iraq War veterans.

OBJECTIVE: Environmental exposure concerns are associated with adverse health outcomes in soldiers deployed to South West Asia. There is little data on factors associated with the reporting of exposure concerns. We explored the relationship between deployment-related preparedness/support and exposure concerns. METHODS: Retrospective chart review of 489 Afghanistan/Iraq veterans evaluated at a Veterans Affairs tertiary center for postdeployment health. RESULTS: Virtually all subjects were concerned about environmental exposure(s). There were no significant demographic differences in exposure concerns, preparedness/support variables, or both. Preparedness/support correlated inversely with exposure concerns. Mental health function mediated the relationship between preparedness/support and exposure concerns. CONCLUSIONS: Deployment-related preparedness/support is associated with exposure concerns and mental health functioning. Definitive studies will provide data and insight on how the military may better prepare/support soldiers to optimize their resilience and reduce deployment-related exposure concerns.

Organizational factors and office workers' health after the World Trade Center terrorist attacks: long-term physical symptoms, psychological distress, and work productivity.

OBJECTIVE: To assess if organizational factors are predictors of workers' health and productivity after the World Trade Center attacks. METHODS: We conducted a survey of 750 workers and compared those who had direct exposures to the World Trade Center attacks (south of Canal Street workers; primary victims) with those less directly exposed (north of Canal Street workers; other victims and non-victims). RESULTS: South of Canal Street workers reported headache more frequently than north of Canal Street workers did (P = 0.0202). Primary victims reported headache and cough more frequently than did other victims and non-victims (P = 0.0086 and 0.0043, respectively). Defensive organizational culture was an independent predictor of cough and job stress, and job stress was an independent predictor of on-the-job productivity losses. CONCLUSION: Organizational variables may modify health and productivity outcomes after a large-scale traumatic event in the workplace.

Use of adjuvant systemic therapy for early breast cancer among women 65 years of age and older.

BACKGROUND: The National Institutes of Health (NIH) consensus statement recommends adjuvant therapy for early breast cancer irrespective of age. However, the actual use of such therapy is not well documented among women over 65 years of age. METHODS: We studied the frequency of use of adjuvant therapy and report the receipt of this therapy among 200 women aged > or = 65 years diagnosed with early breast cancer who were identified from the New Jersey State Cancer Registry. RESULTS: In this population, 28% of patients received chemotherapy alone or in combination with hormonal therapy, whereas 42% received hormonal therapy alone. Less than half of the women with estrogen receptor-negative tumors received chemotherapy alone or in combination with hormonal treatment. Adjuvant therapy was not prescribed in 30% of patients. CONCLUSIONS: Despite NIH recommendations, the frequency of use of adjuvant therapy in New Jersey is low among women over 65 years of age, regardless of their receptor status.

Tobacco in the workplace.

Tobacco use, the leading cause of preventable death, has numerous adverse impacts in the workplace. It is associated with increased healthcare costs and disability, greater absenteeism, decrements in job performance, and increased risk of injury, and secondhand smoke is a major pollution problem. Tobacco dependence responds to treatment, and employers have several opportunities to offer treatment to employees and their families. Smoke-free environments can help smokers cut back or quit. Combining sound workplace policies and treatment with community involvement in tobacco control provides synergies to reduce tobacco use in the community as well as in the workforce. These activities benefit workers and their families, employers, and society at large.

Efficacy of tobacco dependence treatment in the context of a "smoke-free grounds" worksite policy: a case study.

BACKGROUND: Smoking restrictions provide opportunities to modify smoking behavior. A large insurance company implemented a smoke-free grounds policy at two of their office complexes in January, 2000. METHODS: This cohort study evaluated the impact of the smoke-free grounds policy on abstinence among 128 employees who participated in a tobacco dependence treatment program. RESULTS: The overall quit rate at 6 months was 44.5%. The larger complex showed a trend for higher quit rates compared to the smaller complex (46.5 vs. 28.6%). Post-ban participants had higher quit rates than pre-ban participants (52.4 vs. 43.0%). The probability of abstinence at 6 months follow-up was higher for post-ban compared to pre-ban participants (P = 0.03). Post-ban participants were 80% less likely to relapse than pre-ban participants. Non-quitters decreased their consumption by 6.6 cigarettes/day (39.1% decrease). CONCLUSIONS: A "smoke-free grounds" policy encourages abstinence and may play a significant role in harm reduction among continuing tobacco users.

Study of smoking behavior in asbestos workers.

BACKGROUND: Asbestos exposure and concomitant cigarette smoking markedly increase the risk of lung cancer and contribute to the prevalence and severity of pulmonary interstitial fibrosis. METHODS: A cross-sectional survey of 214 asbestos workers was initiated to determine the prevalence of smoking and their readiness to quit smoking using the stage of change theory. RESULTS: The study was comprised of 61 never smokers (28.5%), 118 ex-smokers (55.1%), and 35 current smokers (16.4%). Reasons for smoking cessation in ex-smokers included perception of ill-health (51%) and knowledge of smoking-asbestos hazards (3.4%). Stage of change of current smokers revealed: precontemplation (26.5%), contemplation (35%), preparation (29%), and action (8.8%). Current smokers had the highest prevalence of small airway obstruction on spirometry. CONCLUSIONS: A detailed smoking history during medical surveillance activities will enable the occupational physician to identify asbestos workers who have difficulty quitting and to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.