The Contribution of Behavioral and Occupational Health to Total Fitness

1. The Contribution of Behavioral and Occupational Health to Total Fitness Robert M. Bray, Ph.D. James L. Spira, Ph.D. Kristine L. Rae Olmsted, MSPH Presented at DoD Total Fitness Workshop, Bethesda, MD Dec 7-9, 2009

2. Components Considered • Alcohol Use • Tobacco Use • Illicit Drug Use • Overweight and Obesity • Occupational Stress

3. Substance Use Trends Total DoD, Past 30 Days, 1980-2005 2005 had survey question changes Heavy Alcohol Use = 5 or more drinks/occasion at least once a week in the past 30 days.

4. Trends in Binge Drinking 1998--2005

5. Alcohol Use- Components and Definitions • Moderate Drinking- no more than one drink per day for women, two drinks per day for men • Heavy Drinking- 5 or more drinks (4 or more for women) on a single occasion at least once a week • Binge Drinking- 5 or more drinks (4 or more for women) on a single occasion at least once in the past 30 days • Alcohol Abuse- pattern of drinking resulting in harm to one’s health, interpersonal relationships, or ability to work • Alcohol Dependence- characterized by compulsive craving and physiological factors • Strong craving for alcohol • Continued use despite harm or personal injury • Inability to limit drinking • Physical illness when drinking stops • Need to increase the amount drunk to feel the effects

6. Alcohol Use- Measures of Problems • Assessment of 5 or more drinks/occasion • Alcohol Use Disorders Identification Test (AUDIT) • Developed by World Health Organization (WHO) • 10 questions geared toward categorizing drinkers in terms of drinking levels • Hazardous drinking (Audit score 8-15) • Harmful drinking (Audit score 16-19) • Possible alcohol dependence (Audit score 20+) • CAGE • Frequently used in doctor’s offices as a screening tool • 4 questions; positive on any 2 suggests need for further evaluation • Have you ever felt you needed to Cut down on your drinking? • Have people Annoyed you by criticizing your drinking? • Have you ever felt Guilty about drinking? • Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

7. Associations between Drinking Levels and Alcohol-Related Negative Effects, Total DoD, 2005 Alcohol-Related Negative Effects Drinking Level Note: see notes page and backup slides for definitions. Substance Use

8. Tobacco Use- Components and Definitions • Smoked tobacco • Cigarettes • Cigars • Pipes • Smokeless tobacco • Chewing tobacco • snuff

9. Tobacco Use- Measures • Straightforward assessment • questions about type and frequency of use • Current cigarette smoker • defined as having smoked at least one cigarette during the past 30 days and having smoked at least 100 cigarettes during lifetime • Some studies omit the 100 cigarette criterion • Heavy cigarette smoker • defined as persons who smoked one or more packs of cigarettes per day during the past 30 days • Current smokeless tobacco use • defined as use of any smokeless tobacco product at least once during the past 30 days

10. Illicit Drug Use- Components and Definitions Use of any illegal substance as well as inappropriate use of prescription medications • Psychoactive substances such as marijuana, LSD, ecstasy, PCP • Inhalants including paint, glue, aerosols • Opiates such as raw opium and heroin • Stimulants such as methamphetamine, cocaine, and crack • Prescription drugs such as Vicodin, OxyContin, muscle relaxers, sleep aids

11. Illicit Drug Use- Measures • Measures usually are survey questions • Any illicit drug use including prescription drug misuse- use of any of the categories of illicit drugs or the nonmedical use of prescription type drugs • Any illicit drug use excluding prescription drug misuse- use of any of the categories of illicit drugs • Nonmedical use of prescription type drugs- any use of prescription drugs without a doctor’s prescription, in greater amounts of more often than prescribed, or for any reasons other than prescribed (such as for the feelings they caused) • Assessing Drug Use • means respondents are unlikely to report drug use during an interview or non-anonymous survey

12. Trends in Body Fat by Age Group using BMI as a Screener, 1995-2005* 1995 1998 2002 2005 BMI=Body Mass Index is defined as weight (kg) / [height (m)]2; Survey uses self report of height and weight. BMI does not differentiate between muscle and fat. Numbers in bars may not sum to totals >25 due to rounding.

13. Weight- Components and Definitions • National Institutes of Health define overweight according to Body Mass Index (BMI) • Body weight (kg) divided by square of height (m) • Underweight- BMI less than 18.5 • Overweight- BMI greater than or equal to 25 • Obese- BMI greater than or equal to 30

14. Weight- Measures • DexiScan • a type of bone density scan; accurate and expensive • Displacement • full immersion in water to determine displacement; accurate and time consuming • Calibrated pinch test • measurement of skin folds from selected parts of the body; moderately accurate and inexpensive • Electrical impedance • Built into scales; Moderately accurate and relatively expensive • BMI • Estimated from Kg/m2; Fast, inexpensive; fair approximation

15. Occupational Health- Components and Definitions • Job stress • Family stress • Stress due to deployment • Social Influences such as stigma

16. Occupational Health- Measures • No standard measures for psychosocial occupational stressors • Simplest metric is to survey service members periodically on self-report measures • Measures are also available for more serious forms of stress such as Post traumatic stress disorder

17. Conclusions- the Bottom Line • Behavioral and occupational health affects long-term health, retention, physical and psychological functioning of Service Members • Regular assessments can inform the command of troop readiness, systemic problems, and programmatic needs • Components are part of complex system that must be included in considerations of Total Fitness