Smoking among troops deployed in combat areas and its association with combat exposure among navy personnel in Sri Lanka

Abstract

BackgroundAmong military personnel alcohol consumption and binge-drinking have increased but cigarette smoking has declined in the recent past. Although there is a strong association between smoking and PTSD the association between combat exposure and smoking is not clear.MethodsThis cross sectional study was carried out among representative samples of SLN Special Forces and regular forces deployed in combat areas. Both Special Forces and regular forces were selected using simple random sampling. Only personnel who had served continuously in combat areas during the one year period prior to end of combat operations were included in the study. Females were not included in the sample. The study assessed several mental health outcomes as well as alcohol use, smoking and cannabis use. Sample was classified according to smoking habits as never smokers, past smokers (those who had smoked in the past but not within the past year) and current smokers (those smoking at least one cigarette within the past 12 months).ResultsSample consisted of 259 Special Forces and 412 regular navy personnel. Prevalence of current smoking was 17.9% (95% CI 14.9-20.8). Of the sample 58.4% had never smoked and 23.7% were past smokers. Prevalence of current smoking was significantly higher among Special Forces personnel compared to regular forces. (OR 1.90 (95% CI 1.20-3.02). Personnel aged ≥35 years had the lowest prevalence of smoking (14.0%). Commissioned officers had a lower prevalence (12.1%) than non commissioned officers or other ranks. After adjustment for demographic variables and service type there was significant association between smoking and combat experiences of seeing dead or wounded [OR 1.79 (95%CI 1.08-2.9)], handling dead bodies [OR 2.47(95%CI 1.6-3.81)], coming under small arms fire [OR 2.01(95%CI 1.28-3.15)] and coming under mortar, missile and artillery fire [OR 2.02(95%CI 1.29-3.17)]. There was significant association between the number of risk events and current smoking [OR 1.22 (95%CI1.11-1.35)].ConclusionsThere was significant association between current smoking and combat experiences. Current smoking was strongly associated with current alcohol use. Prevalence of current smoking was less among military personnel than in the general population. Prevalence of smoking was significantly higher among Special Forces personnel.

Multiple physical symptoms in a military population: a cross-sectional study

“…A study of 21,244 Gulf War veterans reported that 8.6% experienced ten or more symptoms which is similar to the prevalence in our sample [26]. Prevalence of psychological morbidity such as PTSD, common mental disorders, fatigue, hazardous drinking, and smoking was also low in our sample [18,27,28]. Because PTSD and common mental disorders are probably involved in the etiology of multiple physical symptoms, lower rates of these conditions among SLN personnel could have influenced the rates of multiple physical symptoms.…”

Fatigue symptoms in Sri Lanka Navy personnel deployed in combat areas

“…This is in keeping with the previous findings in this sample of better mental health outcomes among Special Forces indicated by lower rates of hazardous drinking, smoking, GHQ caseness and multiple physical symptoms, despite higher rates of combat exposure [20,[25][26][27]. UK military reservists and US National Guard also experienced more mental health problems than regular personnel [14,28,29].…”

“…"Thought might be killed and "coming under mortar, missile, artillery fire" can be classified as risk to self events [33,34]. Some of these "risk to self events" were also associated with increased risk of smoking [25]. It appears that fatigue is not a common consequence of combat exposure.…”

A review of the physiological and psychological health and wellbeing of naval service personnel and the modalities used for monitoring

“…One reason is the effect of deployment in combat zones [359]. Research on the Sri Lankan Navy found that although the prevalence of PTSD was reduced three and a half years after combat, there were increases in rates of smoking among both regular and special forces [339].…”

“…A study on the Sri Lankan Navy found that current smoking was strongly related to current alcohol use [359]. In the U.S. Military, during the six-week period of basic training, the use of any tobacco or alcohol is forbidden [362].…”