State-specific cigarette use rates among service members and
veterans, United States, 2017

McDaniel, Justin T.; Klesges, Robert C.

doi:10.18332/tpc/111536

Cited by 9 publications

(5 citation statements)

References 6 publications

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“…Our analysis revealed that cigarette use may be less prevalent among military parents than in previous reports, potentially due to the implementation of military smoke-free policies 8,9 and other local-related factors, such as locally influenced differences. 17 Furthermore, our findings align with existing literature in that older age [18][19][20] may be associated with increased risk for cigarette use.…”

Section: Discussionsupporting

confidence: 90%

Cigarette Use among Parents with Children in the Home: A Comparison of Civilian Parents and Parents with a Military Connection

McDaniel

McDermott

Henson

et al. 2022

Environ�Health�Insights

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We tested the null hypothesis of equal likelihood of cigarette use among parents with a military connection and parents without a military connection, and independently compared risk factors for cigarette use. We obtained National Health Interview Survey (NHIS) data from 2015 to 2019 survey waves. We delimited analysis to 2-parent households who reported children aged <18 years living with them. After a 2:1 nonparametric age matching procedure, our sample included 1106 civilian parents and 553 parents with a military connection. Using the NHIS survey-design weights, we estimated a design-based F statistic for differences in cigarette use by military connection status. We also estimated population-stratified, survey-weighted multivariable logistic regression models to determine risk factors for parent cigarette use. Whereas 6.87% parents with a military connection used cigarettes, 16.64% of age-matched civilian parents reported cigarette use. This difference was significant even after adjustment for covariates (aOR = 0.49, 95% CI = 0.32, 0.74). Recommendations for programing and policy are provided.

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Section: Discussionsupporting

confidence: 90%

Cigarette Use among Parents with Children in the Home: A Comparison of Civilian Parents and Parents with a Military Connection

McDaniel

McDermott

Henson

et al. 2022

Environ�Health�Insights

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“…Our adjusted analysis also identified being a veteran as a novel factor associated with increased odds of screening. Veterans have higher smoking rates than their nonveteran peers, and Veterans Health Administration (VHA) hospitals have been sites for lung cancer screening interventions, which may play a role in the increased lung cancer screening uptake 35,36 . Notably, more than half of eligible VHA patients agreed to undergo screening at eight demonstration sites between 2013 and 2015 36 .…”

Section: Discussionmentioning

confidence: 99%

Low‐dose CT lung cancer screening uptake: A rural–urban comparison

Zgodic

Zahnd

Advani

et al. 2021

The Journal of Rural Health

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Purpose The US Preventive Services Task Force recommends lung cancer screening with Low‐Dose Computed Tomography (LDCT) in high‐risk individuals. Our objective was to identify demographic, health, and financial factors associated with screening uptake, with a focus on urban–rural differences. Methods We analyzed data from the 2018 and 2019 Behavioral Risk Factor Surveillance System and its optional Lung Cancer Screening Module to examine factors associated with screening uptake among 20 states that administered the optional module. We compared differences in factors associated with uptake overall and by geographical regions and conducted multivariable logistic mixed‐effects regression, accounting for participant clustering by state to assess the impact of these factors on uptake. Findings Overall 1,268 participants underwent LDCT screening with no significant differences observed between rural (16.3%) and urban residents (17.7%, p = 0.67). In multivariable models, rural residents did not differ significantly in their LDCT screening uptake (OR = 0.85; 95% CI: 0.67–1.09, p = 0.20), but uptake was significantly higher for participants with underlying chronic respiratory conditions, veterans, those with higher pack‐year history, and those with poor/fair general health and prior history of cancer. Uptake declined with age, higher education level, concerns about paying for medical care, and lack of primary care. Conclusions Modifiable targets can be leveraged to increase LDCT screening. Based on significant predictors of screening uptake, clinicians should prioritize interventions that effectively consider smoking history as well as those identified as effective in veterans' health settings. Additionally, reducing structural barriers to care related to insurance and income will be key to reducing disparities.

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“…7,16 Veterans are at increased risk of lung cancer, given high rates of tobacco use, with a large population of veterans eligible for LCS. 17,18 Although the Veterans Health Administration (VHA), the largest national integrated health care system in the US, was an early adopter of LCS, subsequent implementation has been inconsistent across VHA facilities. 19 Thus, the VHA provides an ideal realworld setting to study adherence after initial LCS across the US.…”

Section: Introductionmentioning

confidence: 99%

Adherence to Follow-up Testing Recommendations in US Veterans Screened for Lung Cancer, 2015-2019

et al. 2021

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IMPORTANCE Lung cancer screening (LCS) can reduce lung cancer mortality with close follow-up and adherence to management recommendations. Little is known about factors associated with adherence to LCS in real-world practice, with data limited to case series from selected LCS programs. OBJECTIVE To analyze adherence to follow-up based on standardized follow-up recommendations in a national cohort and to identify factors associated with delayed or absent follow-up. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted in Veterans Health Administration (VHA) facilities across the US. Veterans were screened for lung cancer between 2015 to 2019 with sufficient follow-up time to receive recommended evaluation. Patient-and facility-level logistic regression analyses were performed. Data were analyzed from November 26, 2019, to December 16, 2020. MAIN OUTCOMES AND MEASURESReceipt of the recommended next step after initial LCS according to Lung CT Screening Reporting & Data System (Lung-RADS) category, as captured in VHA or Medicare claims. RESULTS Of 28 294 veterans (26 835 [94.8%] men; 21 969 individuals [77.6%] were White; mean [SD] age, 65.2 [5.5] years) who had an initial LCS examination, 17 863 veterans (63.1%) underwent recommended follow-up within the expected timeframe, whereas 3696 veterans (13.1%) underwent late evaluation, and 4439 veterans (15.7%) had no apparent evaluation. Facility-level differences were associated with 9.2% of the observed variation in rates of late or absent evaluation. In multivariable-adjusted models, Black veterans (odds ratio [OR], 1.19 [95% CI, 1.10-1.29]), veterans with posttraumatic stress disorder (OR, 1.13 [95% CI, 1.03-1.23]), veterans with substance use disorders (OR, 1.11 [95% CI, 1.01-1.22]), veterans with lower income (OR, 0.88 [95% CI, 0.79-0.98]),and those living at a greater distance from a VHA facility (OR, 1.06 [95% CI, 1.02-1.10]) were more likely to experience delayed or no follow-up; veterans with higher risk findings (Lung-RADS category 4 vs Lung-RADS category 1: OR, 0.35 [95% CI, 0.28-0.43]) and those screened in high LCS volume facilities (OR, 0.38 [95% CI, 0.21-0.67]) or academic facilities (OR, 0.86 [95% CI, 0.80-0.92]) were less likely to experience delayed or no follow-up. In sensitivity analyses, varying how stringently adherence was defined, expected evaluation ranged from 14 486 veterans (49.7%) under stringent definitions to 20 578 veterans (78.8%) under liberal definitions. CONCLUSIONS AND RELEVANCEIn this cohort study that captured follow-up care from the integrated VHA health care system and Medicare, less than two-thirds of patients received timely recommended follow-up after initial LCS, with higher risk of delayed or absent follow-up among marginalized populations, such as Black individuals, individuals with mental health disorders, and individuals with low income, that have long experienced disparities in lung cancer outcomes. Future (continued)

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State-specific cigarette use rates among service members and veterans, United States, 2017

Cited by 9 publications

References 6 publications

Cigarette Use among Parents with Children in the Home: A Comparison of Civilian Parents and Parents with a Military Connection

Cigarette Use among Parents with Children in the Home: A Comparison of Civilian Parents and Parents with a Military Connection

Low‐dose CT lung cancer screening uptake: A rural–urban comparison

Adherence to Follow-up Testing Recommendations in US Veterans Screened for Lung Cancer, 2015-2019

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