Prevalence of Adverse Behaviors among Young Military Conscripts in Taiwan

Military Medicine, Apr 2006 by Chu, Nain-Feng, Wu, Der-Min, Shen, Muh-Han, Lin, Yaoh-Shiang

Objectives: To evaluate cigarette smoking prevalence and to examine the clustering of adverse behaviors among young military conscripts in Taiwan. Methods: Cross-sectional screening was conducted among conscripts in southern and eastern sections of Taiwan from August 1 to December 31, 2001. A total of 7,931 conscripts who had >1 month of service were included in this multistage sampling study. Results: Adjusted prevalence rates of cigarette smoking before and during military service were 49.2% and 51.9%, respectively. The prevalence of smoking slightly increased during military service, and this was statistically significant. Adjusted prevalence was highest in the Navy (53.8%) and lowest in the Air Force (48.4%). Less education and longer duration of service were associated with increased prevalence of smoking. Conscripts with high school educations or below and those in service >18 months had higher adjusted prevalence rates (65.6% and 55.2%, respectively). During military service, the adjusted prevalence rates of smoking among conscripts were similar in different geographic areas. There was significant aggregation of adverse behaviors, such as cigarette smoking, alcohol consumption, and betel nut chewing, among these young military conscripts in Taiwan. Conclusions: The prevalence of cigarette smoking was slightly increased during military service. Furthermore, the prevalence of cigarette smoking was still higher among military conscripts, compared with the general population in Taiwan, which suggests that military service is a potential factor associated with cigarette smoking for adolescents and young adults. This finding and the aggregation of adverse behaviors among conscripts indicate that more surveillance and intervention studies are needed to evaluate the best way to control and to stop smoking among military conscripts in Taiwan.

Introduction

Cigarette smoking is an important cause of morbidity and death in many chronic diseases, such as cardiovascular disease, cancer, and chronic obstructive pulmonary disease.1-5 Cigarette smoking is the most preventable cause of death in the world.6-10

In Taiwan, the prevalence of cigarette smoking has increased and become an important public health and medical care problem.11 Morbidity and mortality rates for lung cancer have increased since the 1960s, and respiratory malignancies are the main cause of cancer deaths in Taiwan.12,13 A prospective study showed that 13.9% of all deaths for men and 3.3% for women could be attributed to cigarette smoking; furthermore, cigarette smoking caused 21.3% and 2.9% of all cases of cancer among Taiwanese men and women, respectively.14

Although one study found that smoking prevalence rates among military conscripts and general populations were similar,15 several other studies found that cigarette smoking prevalence was relatively higher among military employees than in the general population in many countries.16-24 Possible explanations include greater exposure to tobacco products and advertising, peer pressure, stress, boredom, inexpensive cigarettes, and lack of other forms of recreation during military service.19,25

Not only does assessment of cigarette smoking prevalence and adverse behavior aggregation depict the total burden of these conditions, but also these activities are useful in formulating effective prevention strategies. The purpose of this study was to evaluate cigarette smoking prevalence and to examine adverse behavior (such as cigarette smoking, alcohol consumption, and betel nut chewing) cluster prevalence among conscripts during their military service in Taiwan.

Methods

Study Sample

A cross-sectional screening was conducted among conscripts in the southern and eastern sections of Taiwan from August 1 to December 31, 2001. A total of 7,931 conscripts with > 1 month of service were included in this multistage sampling frame. First, a random sample of roster units in each area was obtained and then all conscripts, except those on active duty or on holiday during the time of the survey, were included in the sample. The prevalence of cigarette smoking, betel nut chewing, alcohol consumption, and other related risk factors was evaluated. The ethics committee of the Scientific Institute of the National Defense Medical Center approved this study, and informed consent was obtained from the participants.

Data Collection and Measurement

All participants completed a structured questionnaire that included questions about sociodemographic features, lifestyle, and the adverse behaviors of cigarette smoking, alcohol consumption and betel nut chewing. Sociodemographic characteristics included age, education levels, residential area, and type and duration of military service. The questionnaire was a modified version of that used by the World Health Organization.26 Subjects were defined as current smokers if they had smoked more than one cigarette per day during the past 30 days and had smoked more than 100 cigarettes in their lifetimes or still had the habit of smoking before or during military service. Subjects were designated as current drinkers if they had consumed more than two drinks per week of liquor (or equal alcohol concentration) during the previous 30 days (the designation was based on alcohol concentration classification) or if they still had the habit of drinking alcohol before or during military service.27 Subjects were considered current betel nut chewers if they had chewed more than one betel nut during the past 30 days, had chewed more than one betel nut per week, and had chewed more than 50 betel nuts in their lifetimes before or during military service.27

Statistical Analyses

Means and SDs were used to describe the distributions of continuous variables such as age. Frequencies and percentages were used to describe categorical parameters such as type and duration of military service, education level, residential area, cigarette smoking, alcohol consumption, and betel nut chewing status.

The direct standard method was used to calculate adjusted cigarette smoking prevalence before and during military service.28 Total military conscripts in Taiwan served as the reference population, and results were adjusted for type of military service, duration of military service, education level, and residential area, to determine the standardized prevalence of cigarette smoking among different subgroups. Smoking status changes were also calculated before and during service, with respect to those who had never smoked, those who quit smoking, and those who were current smokers.