Page 79 - Journal of Special Operations Medicine - Fall 2015

and lead to significantly longer periods of duty limita- procedures of the study. The informed consent document
tions. Given the associations of legal substance use with was reviewed and questions were answered by the inves-
7
health outcomes, Special Duty military personnel may tigators. Commanders and senior leaders were not pres-
also have unique patterns of alcohol, tobacco, and caf- ent during this process, to minimize the possibility for
feine use. Furthermore, the relationships among legal coercion. Personnel agreeing to participate (greater than
substance use with physical health outcomes may differ 90% of all invited personnel) signed the consent form
from nonmilitary populations and conventional military and were then provided a survey packet, which they
forces. completed and returned to the investigators. Surveys
were deidentified prior to being manually entered into an
In light of this knowledge gap, the primary aims of the electronic database, which was checked for errors. This
current study were to describe patterns of legal substance project was reviewed and approved by the Wilford Hall
use (i.e., tobacco, alcohol, and caffeine) and to examine Ambulatory Surgical Center Institutional Review Board,
the relationship of legal substance use with self-reported located at Lackland Air Force Base, Texas.
physical health complaints among US Air Force Parares-
cuemen, commonly referred to as “PJs” (for pararescue
jumpers) and Combat Rescue Officers (CROs). PJs are Measures
certified paramedics with a primary mission to rescue
downed aircrew personnel by providing area security, Tobacco use
rendering first aid, and transporting personnel to higher To assess current tobacco use, participants were asked
levels of medical care. As Special Duty Operators with the following question: Do you smoke (or use) tobacco
rigorous training and work demands, PJs and CROs products? Participants positively endorsing this item
must maintain peak physical and mental performance were then asked to report which type of tobacco prod-
but are also susceptible to high rates of injury. Consis- ucts they currently used (i.e., cigarettes, cigars, smoke-
tent with our primary aims, we sought to answer the fol- less tobacco, pipe/hookah).
lowing questions: (1) What proportion of PJs and CROs
use tobacco products, alcohol, and caffeine? (2) How Alcohol consumption
much alcohol and caffeine do PJs and CROs consume To assess current alcohol consumption, participants
on average? (3) What are the most common health com- were asked the following question: Do you drink al-
plaints among PJs and CROs? (4) Are health complaints cohol-containing beverages? Participants positively
associated with tobacco, alcohol, and caffeine use? endorsing this item were then asked to report which
type of alcoholic beverages they drink (i.e., beer, wine,
liquor), how many days per week they drink, and how
Methods many alcohol drinks they consume per day. These latter
values were multiplied together to obtain the average
Participants number of drinks consumed per week.
Participants were 196 US PJs and CROs ranging in age
from 21 to 48 years (mean, 30.05, SD, 5.94) who had Caffeine intake
served in the military for 1.50–26.17 years (mean, 8.82; To assess caffeine intake, participants completed a
SD, 5.70). Distribution of self-identified race was 174 caffeine-use survey, which lists 31 different sources of
(88.8%) white, five (2.6%) black, three (1.5%) Native caffeine categorized into the following four groups: cof-
Hawaiian or Pacific Islander, four (2.0%) Asian, three fee and tea; soft drinks; energy drinks; and caffeinated
(1.5%) American Indian, and six (3.1%) “other.” His- candy, medications, and supplements. Participants were
panic ethnicity was assessed separately from race, and asked to indicate which products they consumed, the
was endorsed by 15 (7.7%) participants. Rank dis- typical serving size when consuming each product (e.g.,
tribution was 51 (26.0%) Junior Enlisted (E1–E4), 73 8 fluid ounces, 12 fluid ounces), the number of serv-
(37.2%) Noncommissioned Officer (E5–E6), 29 (14.8%) ings typically consumed at one time, and the frequency
Senior Noncommissioned Officer, 31 (15.8%) Company of consumption of each product (e.g., daily, weekly,
Grade Officer (O1–O3), and 11 (5.6%) Field Grade Of- monthly). Total caffeine intake was calculated by mul-
ficer (O4–O5). Participants had deployed a total of zero tiplying together serving size, number of servings, and
to seven times (mean, 2.59; SD, 1.79), and 91.8% had frequency, and then multiplied by the caffeine content
deployed at least once to either Iraq or Afghanistan. for each product (in milligrams), as determined by the
US Food and Drug Administration (FDA), and summed
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Procedures across all 31 products. The daily average caffeine intake
Participants were recruited from seven rescue squad- was then divided by each participant’s weight (in kilo-
rons. Investigators visited each location and briefed the grams) to obtain the daily “dose” of caffeine, reported
PJs and CROs in each squadron on the purposes and as milligrams per kilograms per day.

Legal Substance Abuse and Health Complaints 67