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Smokeless tobacco, in contrast, may be perceived as less Conclusions based on the present data should be con-
physically harmful. Alternatively, cultural norms within sidered within the context of several limitations. First,
the PJ and CRO community may facilitate and support our study used a cross-sectional design that limits our
smokeless tobacco use. Among men, research suggests ability to understand the direction of association among
that smokeless tobacco use often occurs at social or variables. For instance, we are unable to determine if
athletic events with the encouragement of other men, back and extremity pain contribute to subsequent in-
and is often continued for the purposes of building and creases in alcohol consumption and caffeine intake,
maintaining relationships with other men. Because the or if greater alcohol and caffeine use increase risk for
21
Combat rescue community is composed of men only subsequent injury. Second, our use of self-report meth-
and is characterized by high levels of bonding and co- odology may have been vulnerable to response bias,
hesion, smokeless tobacco use may persist despite its especially on variables related to psychological symp-
22
potential health consequences. toms and alcohol use. Future studies that use alterna-
tive assessment methods such as structured diagnostic
In terms of physical health problems, somatic symptoms interviews and/or medical record reviews are needed
and complaints were infrequently reported by PJs and to complement self-report methods. Third, because the
CROs, with the notable exception of back and extrem- PJ/CRO profession is currently restricted to men, gen-
ity pain, which were endorsed by 56% and 54% of eralization of these findings to female Servicemembers
participants, respectively. This pattern likely reflects the may not be appropriate. Despite these limitations, our
physical demands of the profession (e.g., wearing body results provide useful preliminary information regard-
armor, carrying heavy equipment and human casualties, ing the use of tobacco, alcohol, and caffeine among PJs
parachuting, jostling in helicopters and other military and CROs, and suggest new directions for understand-
vehicles, high-impact jumping and running), which can ing factors associated with physical health complaints
lead to high rates of orthopedic and musculoskeletal in- in this elite profession.
juries in addition to general wear and tear on the body.
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Research suggests that rates of lower back and extrem- Funding
ity pain increase postdeployment and is associated
24
with body armor use among military personnel. 25,26 This project was supported by a Department of the Air
Force grant (No. FA8650-12-2-6277) awarded to Lt
Our results further suggest that PJs and CROs who Col James Stephenson.
report back and extremity pain also report consuming
more caffeine and alcohol, on average. One potential Disclosure
explanation for this relationship is that greater con-
sumption of alcohol and caffeine alleviates the physi- Craig Bryan reports grant funding from the Department
cal discomfort associated with back and extremity pain. of Defense and the Department of the Air Force; consul-
The muscle relaxant and analgesic effects of alcohol are tant fees from Intelligent Automation, Inc., and Kognito
well known. Furthermore, caffeine doses of 100mg or Interactive; honoraria from the American Association
27
higher have been found to enhance the effects of anal- for Suicidology; and royalties from Springer Publishing.
gesics and contribute to an additional 5%–10% pain The remaining authors indicate they have no financial
relief as compared to the analgesics alone. Because relationships to disclose relevant to this article.
28
of this relationship, the FDA has approved caffeine as
an additive to many over-the-counter and prescription References
medications. A dose-response effect of caffeine on an-
29
algesia has also been suggested, although this finding 1. Global Drug Survey. The Global Drug Survey 2014 findings.
London, UK: Global Drug Survey;2014.
is confounded by the fact that medications with higher 2. Ashton C. Caffeine and health. Br Med J (Clin Res Ed).
caffeine doses also tend to have higher doses of pain 1987;295:1293.
killers, thereby making it difficult to isolate effects. An 3. US Centers for Disease Control and Prevention. Health ef-
28
alternative explanation for the observed association of fects of cigarette smoking. 2014. http://www.cdc.gov/tobacco/
back and extremity pain with increased alcohol con- data_statistics/fact_sheets/health_effects/effects_cig_smoking/.
Accessed 17 September 2014.
sumption and caffeine intake is that some PJs and CROs 4. Powledge TM. Nicotine as therapy. PLoS Biol. 2004;2:e404.
pursue a more extreme lifestyle marked by greater sub- 5. Room R, Babor T, Rehm J. Alcohol and public health. Lancet.
stance use and engagement in physically strenuous ac- 2005;365:519–530.
tivities. Such individuals may struggle to set personal 6. US Department of Defense. Special Operations: Joint Publica-
limits (e.g., a “live hard, party hard” mindset), which tion 3-05. Washington, DC: Department of Defense; 2014.
may lead to higher rates of stress injuries. Additional 7. Reynolds K, Cosio-Lima L, Bovill M, et al. A comparison of
injuries, limited-duty days, and injury risk factors in infantry,
research is needed to test the relative merits of these two artillery, construction engineers, and special forces soldiers. Mil
hypotheses. Med. 2009;174:702–708.

70 Journal of Special Operations Medicine Volume 15, Edition 3/Fall 2015