Smoking behavior of Greek warship personnel

Military Medicine, Nov 2003 by Mazokopakis, Elias E, Vlachonikolis, Ioannis G, Lionis, Christos D

The results from a study undertaken to assess the smoking behavior of Greek warship personnel found that of the 274 participants, ages 19 to 38 years, 59.5% were current smokers who started the habit between the ages of 15 and 21 years. However, 33.1% of these current smokers started smoking after entering the Greek Navy. There were statistically significant associations between the habit of smoking and the occurrences of respiratory tract infections, alcohol consumption, lack of aerobic exercise during leisure time, and educational level of the personnel. Another significant association was between the age of introduction into the habit of smoking and the number of cigarettes smoked daily, with the level of education being a contributing factor. The method of entry into the Greek Navy and the rank held made a significant contribution to the time period of initiation into the habit of smoking. The impact of military life on the smoking behavior of the shipboard personnel is discussed and suitable intervention strategies have been recommended.

Introduction

Cigarette smoking is of particular concern for the military population. Previous research has demonstrated a higher prevalence of smoking among male military personnel than among civilian men, which leads to the negative effects of smoking on health, productivity, and overall military readiness.1-3 Similarly, the influence of the military environment for enhancing the risk of smoking behavior in military personnel has also been demonstrated.3 Certain demographic and psychosocial variables have been examined and found to be correlated with smoking habits not only in the Navy but also with other military populations.4 Moreover, harmful substance use patterns of naval personnel that are established during military service represent an important public health concern, as their social, economic, and health consequences may persist not only during military life, but could be carried forward into civilian life after discharge or retirement.5 A clear understanding of the nature and extent of the smoking habit among naval personnel is also essential before developing effective health promotion intervention programs.

The purpose of the present study was to report data on the smoking habits of the military personnel aboard a Greek warship and to highlight potential associations of the smoking habits with sociodemographic variables and other health-related behaviors. The conclusions may be useful for the implementation of preventive strategies.

Study Population and Methods

This study was carried out on a warship of the Greek armed forces, between February and July 1998 with the protocol being approved by the Hellenic Naval General Staff. The study population was the warship's military personnel (N = 285 men of which 274 participated), ages 19 to 38 years (mean age, 24.4 � 4.4 years). All subjects provided informed consent before participating in the study. Participants were interviewed using a structured form, which included items on the following topics: current smoking habit (current smokers and nonsmokers [never-smokers/former smokers]); average number of cigarettes per day ( or =31); age of initiation into the habit of smoking as regular smokers and the period of initiation of smoking (before entering the Navy [premilitary smokers] and after entering the Navy [premilitary nonsmokers]); changes in smoking habits after entering the Navy (still nonsmoking, continued smoking, started smoking, quit smoking, and restarted smoking); alcohol consumption (abstainers and drinkers [drinking at least one or more alcoholic drinks during their day off]); aerobic exercise (any type of isotonic exercise as jogging, cycling, swimming, etc.) during leisure time (yes or no); and finally sociodemographic characteristics, such as rank (naval officers, warrant officers, petty officers, and conscripts (seamen, petty officers 1st and 3rd class]), method of enlistment (permanent, volunteer, and conscript), educational level (low [unfinished or only completed primary school education], medium [unfinished or completed secondary school education], higher [technical college], and highest [university] education), and marital status (married and single [never married or divorced]).

Clinical findings and diagnoses were recorded during the visits of the personnel to the sick bay and classified according to International Classification of Diseases, Ninth Revision.6 The mental health status of the personnel was also recorded using the 28-item Greek version of the General Health Questionnaire (categorized as GHQ-28 noncases and GHQ-28 cases).7

Statistical associations were assessed by contingency table analysis (Pearson's [chi]^sup 2^ test with Yates' correction or Fisher's test, where appropriate). Quantitative measurement differences between groups were assessed by analysis of variance.8 Statistical significance was set at p

Results

From the original 285 male personnel, 11 (3.9%) refused to participate or failed to provide complete answers to most of the questions. Therefore, the study was comprised of 274 persons. Table I describes the smoking habits of the study population and their association with sociodemographic characteristics, alcohol consumption, aerobic exercise, mental health, and the occurrence of acute respiratory tract illness (ARTI). Of the study population, 59.5% were current smokers of cigarettes, 37.6% were nonsmokers, and 2.9% were former smokers. The associations among smoking behavior and rank ([chi]^sup 2^ = 11.77, df = 6, p = 0.067), marital status ([chi]^sup 2^ = 0.27, df = 1, p = 0.610), or mental health ([chi]^sup 2^ = 4.56, df = 2, p = 0.103) were not statistically significant. However, there were statistically significant associations among the habit of smoking and the consumption of alcohol ([chi]^sup 2^ = 19.95, df = 2, p