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Briefing on the Results of the 2002 Health Behaviors Survey

Presenters: Dr. William Winkenwerder, Jr., ASD
March 08, 2004 11:05 PM EDT
Briefing on the Results of the 2002 Health Behaviors Survey

(Participating were Dr. William Winkenwerder, Jr., assistant secretary of defense for health affairs, and Dr. Robert Bray, Research Triangle Institute.  Slides shown during this briefing are located at http://www.defenselink.mil/news/Mar2004/g040308-D-6570C.html.)

 

     Winkenwerder:  Good morning and thank you for joining us today.

 

     We want to share with you the results of an important DoD survey conducted in 2002 regarding selected health behaviors of the active military force.  Let me just begin by saying that, for the most part, these survey results are very positive and they indicate continuing improving trends in the health behaviors of the members of the military.  Let me talk a little bit about this survey.

 

     A sampling of our service members completed this self-reported survey anonymously, which allows us to gain insight into individual and population health status issues.  We learn how lifestyle choices and home or work situations impact the health and safety of our service members.  This is the eighth in a series of similar surveys that has been conducted every three or four years since 1980.

 

     The results of this survey assist us at the department in several important ways.  First, they improve our understanding of the nature, causes and consequences of substance abuse and other health-related behaviors in our military personnel.  They contribute to the detection of potential emerging health risks; for example, problem gambling or the use of potentially harmful dietary supplements.  They guide our development of training and education for troops and commanders. Results help us determine the appropriateness of emphasis we place on various programs and help us examine the effectiveness of our policies.  Examples would include our fitness programs and policies for wearing seat belts or for not smoking in DoD facilities.  Finally and most significantly, they help us assist our service members to attain and maintain healthy lifestyles.

 

     Individual culture, work and leisure environments, spiritual considerations, family and social settings, individual character and personality traits all play a role in lifestyle choices and health behaviors.  In the military, leaders, commanders and individuals contribute to a culture that values healthy lifestyle choices and provides opportunities for achieving optimal health status.

 

     The series of surveys has guided our program and policy development over 20 years.  It's really an important work that we look forward to when we get the results.  When it began in 1980, DoD sought a better understanding, for example, of substance abuse problems that were occurring in the nation and in the military, and at that time, those substance abuse levels were quite high, and we can show you how those have markedly improved over time.

 

     Since then, the surveys were expanded to include other health- related behaviors.  All have assessed the prevalence of alcohol, tobacco and illicit drug use as well as negative consequences associated with substance abuse.  Later surveys covered women's health issues, men's health issues, gambling, mental health, stress, weight management, and a myriad of other matters.

 

     Our objectives for the 2002 survey were to assess substance abuse and its consequences among military personnel and to assess how the military population measures up when compared to the leading health indicators identified by the Department of Health and Human Services in their Healthy People 2000 and 2000 [2010] Report, their goals that they set forth in those reports.

 

     At this point I would like to introduce Dr. Robert Bray from the Research Triangle Institute to discuss some of the key findings from the survey.  The Research Triangle Institute is the firm that has conducted the survey for the department and all the surveys since the beginning, and Dr. Bray has been involved since that time.  He is an expert, a research psychologist, an expert in statistics and health behaviors.  And he will go through some of the details of the survey, certainly not all of them because it's a major, large set of statistics.  But he will take us through the highlights of that, and then I'll come back and speak for a moment and then we'll take your questions.

 

     So with that, Dr. Bray.

 

     Bray:  Thank you, Dr. Winkenwerder.

 

     Let me begin just by providing a little bit of background for you on the survey.  We've got a few slides here that we'll show to help illustrate some of the findings.

 

     Next slide.

 

     This particular one gives you just a few facts about the survey. A couple things to note on this.  It is the largest population-based health behavior survey of the active duty force.  As was mentioned, it's been conducted every three to four years since 1980.  And it does include a random selection of active duty military personnel.  For the 2002 survey, we went to 30 different installations to represent the force.  In the prior surveys we actually went to a larger number, closer to 50 to 60 installations.

 

     At the sampling stage, we actually stratify this by service, by pay grade, by gender and by region of the world.  So we're ensuring that we really get a good cross-section of the military represented. Because we ask some fairly sensitive behaviors, we do this as an anonymous survey to encourage frank and honest reporting of the behaviors by the force.  We do it as a civilian organization going in; helps give further credibility to the conduct of the survey, that it's not going to be handed right back to the military.  As you can see, for the 2002 survey we had about 12,500 respondents that took part. Some of the earlier surveys we actually had upwards of 15 (thousand) to 20,000 participants.

 

     Next slide.

 

     This particular slide shows some of the overall trends for the substance abuse.  It's noting three different behaviors.  The top line is reporting on cigarette smoking, the middle line on heavy alcohol use, and the bottom line on illicit drug use.  And what you can see here is some fairly good news.

 

     Note for the cigarette use, there's been a pretty steady downward incline, all the way from 1980 down to '98.  And then we did have an uptick from '98 to 2002; actually, a statistically significant increase, but for the most part still a very positive downward trend.

 

     For heavy drinking, you can see the line has been relatively flat across the whole period.  There was a little decline between '82 to '88.  It's been pretty flat since then; actually, there was a significant increase between '88 and 2002.  But overall, it's kind of bounced around that 20 percent range throughout the entire period.

 

     The final one shows the report of illicit drug use, and here the department's done a wonderful job.  As you can see, back in 1980, when this started, almost 27 percent were reporting use of one or more illicit drugs in the past 30 days; now past 30 days refers to the past 30 days prior to taking the survey.  But that has gone down steadily and now has been hovering around 3 percent since roughly the last 10 years, since about 1992.

 

     Even though we're showing heavy alcohol use as being up around 20 percent, there's another important statistic that's not shown on the slide that I wanted to mention, and that is that there's been an overall reduction in alcohol use among military personnel.  If you look at those who are abstainers or who drink at very light levels, those numbers have increased from about 25 percent in 1980 up to approximately 41 percent in 2002.  So even though the heavy alcohol users remained steady, overall the amount of alcohol use has gone down.

 

     Next slide.

 

     Q:  Could you just tell us what qualifies as heavy alcohol use?

 

     Bray:  That's drinking -- heavy alcohol use refers to five or more drinks per occasion, and by that we usually mean within a couple of hours, at least once a week, a fairly standard definition that's used in the alcohol field.

 

     This slide shows some findings on other tobacco use.  Two things here: we've got cigar/pipe use in the past 12 months, and then smokeless tobacco use.  Interestingly enough, there was quite a jump in the cigar use.  We now understand -- we used to ask that question as a combined question.  In 2002, we broke it out and so we really understand what's driving this now is really the cigar use.  Quite a jump between the '95 and the '98 surveys on the cigar use.  It's remained at about that level in 2002.  We see that the smokeless tobacco has shown some declines, but still the rate currently is up around 17, 18 percent.

 

     Next slide.

 

     One of the things that the military is always interested in is how are we doing relative to our civilian population, and so we took some data from the National Household Survey on Drug Abuse as a comparison data set.  We adjusted those -- the demographics of the civilian survey to look like the demographics of the military, and then we computed the rates -- what the civilian rates would have been if they had had the military demographics.  And when we did that, we see some interesting things, and this again is for these three behaviors we were just talking about.

 

     For heavy alcohol use, we find that among the 18- to 25-year-old military personnel, there's a substantially higher rate, almost double in fact: 27 percent versus 15 percent report heavy drinking.  When you get 26 and older, the rates are virtually identical; we've got 9 percent versus 8 percent.  So the problem seems to reside in the younger members of the force.

 

     For illicit drug use, we see just the opposite pattern; that is, the military is considerably lower than the civilian population: 3 percent versus about 12 percent.

 

     For cigarette use, it's an interesting story there.  The military used to be a fair amount higher than the civilians, but over time those lines have been converging, and now they're virtually identical; about 31 percent when you do that standardized comparison.

 

     Next slide.

 

     Dr. Winkenwerder mentioned the Healthy People objectives.  Most of you are aware that during the 1990s there were a set of objectives set forth for the nation, referred to as Healthy People 2000; and now, more recently, there's been a new set of objectives defined, known as Healthy People 2010.

 

     The 2000 survey is interesting for the military, in that it provides an end-of-a-decade, final measure for the 2000 objectives and then a benchmark for the 2010 objectives going forward.

 

     Although there's a large number of these objectives, the military in this survey were able to look at 22 different objectives.  And what we can report here is that about a third of those have been met or exceeded for the Healthy People 2000 objectives, through the 2002 survey.

 

     And these objectives range from some that deal with substance use, some that deal with health promotion, some that deal with women's health.  But again, seven or about a third of these objectives have been met.

 

     And the next few slides I want to just show you some examples of four of these different behaviors.  (To staff.)  Next.

 

     Strenuous exercise is one of the Healthy People objectives.  And the objective here is to measure exercise at least three or -- three times per week, at a rate of 20 minutes or more, very intensive exercise.  And this includes things such as running, cycling, swimming, anything that's very active, gets the heart going at a high rate.

 

     What we see here is that the military has been up around -- in 1995 up around 65 percent, and now that's moved up to about 70 percent in 2002.  What's interesting there is that the Healthy People objective is about 20 percent of the population hitting that -- you know, that goal.  So the military has far exceeded that, over three times higher than the Healthy People objective.

 

     (To staff.)  Next slide.

 

     In contrast, the military is facing a problem, like the rest of the nation, with overweight.  This particular slide shows the Healthy People guidelines for overweight, and these are based on sort of a complex algorithm known as the body mass index.  But what is shown here is two different age groups:  those less than 20, on the left, and then the red line being those 20 years or older.  And what we see is that over time the overweight pattern has been increasing.  So the percentage of the military in 2002 -- by this standard, you'd have about 22 to 23 percent of them being overweight.

 

     This particular guideline actually is one that is not being used so much anymore.  A new standard has come out that has even stricter criterion.  And by that new criterion, the levels of overweight are even higher.   Interestingly enough, when you compare those with the civilian population, the levels of the military look pretty comparable to what you see in some of the other civilian surveys.  That is the level at which the military's overweight is pretty comparable to what you see the civilians overweight.

 

     Next slide.

 

     This particular slide is another objective for women getting a Pap smear.  Certainly we know that this is a major way that women can lessen the risk of cervical cancer.  In 2002, the military had a full 97 percent of women who had received such a test within the past three years and these were similarly high for the two prior surveys.  So the military has got an excellent track record there.  The Healthy People goal for 2000 was to have 85 percent of the population obtain that objective and the 2010 goal is to have 90 percent achieve that.  In both cases, the military has exceeded those goals already.

 

     Next slide.

 

     This slide shows a report on hospitalization for injuries.  This is -- metric is a little different here.  This is showing thousands per hundred thousand who have reported a hospitalization for an injury.  What we can see here is that for the military the rates have been fairly constant between '95 and 2002; somewhere over 3,000 per 100,000 members of the military are having or experiencing injuries. I think that's in part to be expected because of the demanding physical activities required by military duty.  It is a concern, of course, because the goal is to certainly minimize injury whenever possible.

 

     Next slide.

 

     This slide reports on two measures of stress.  It wasn't part of the Healthy People, but another indicator that we were interested and the military wanted to get some good data on.  We asked them two things that we're reporting here.  How much stress did they experience as a result of their work, their military duty?  And the second was, how much stress did they experience or feel as a result of their family life and family activities?  And what we see here is that about a third are reporting that they're experiencing a lot of stress as a result of work; somewhat less because of their families, around 18 percent indicating a similar finding in their personal family life.

 

     Next slide.

 

     We explored this a little bit further and we're trying to identify what is it that's responsible for the stress.  And so we ask a number of questions that we thought might be related.  And this slide reports for both men and women the highest indicators that we got here.  And what we see, and perhaps this isn't too surprising, but the two top ones were being away from family, or military deployments.  I think that's fairly understandable how those might be stressful for individuals in the military.  We also see, for military women, changes in personal life was also a very highly reported indicator.

 

     Next slide.

 

     Finally, we ask in this same series what do they try to do.  When they experience stress, how do they approach it and how do they cope with it?  Three things here which are actually fairly positive.  The most likely things people are to do were very positive behaviors. Over 85 percent said they try to figure out what to do, sit down and think about it and come up with a plan to try to deal with it.

 

     Over three-fourths of men, or 72 percent of men, and 87 percent of women say they talk to other people about it and get some advice. A good number, over half, say that they play sports or engage in a hobby.  We also see that saying a prayer is a common strategy for about half of the men and 70 percent of military women.

 

     Interestingly enough, some of them tend to do things that aren't quite as productive.  About a fourth say that they'll have a drink of alcohol or, in the case of eating, we have 40 percent of men and about half of the women get something to eat.  Maybe not quite as good, these last few, not quite as good strategies to follow.

 

     Well, there's many more results that we could give you, and you will have access to more details on the report, but at this point let me turn it back to Dr. Winkenwerder.

 

     Winkenwerder:  Thanks, Bob.  That was an excellent summary. And there is much more there to the extent you're interested in it.

 

     We're pleased with the continued observed positive health behaviors and trends in preventive health practices.  It's encouraging, we believe, that we've met or exceeded one-third of the Healthy People 2000 and 2010 goals for most health care.  Looking at it as a health care leader or health care person, that's a pretty good score, in my estimation, a pretty good outcome.

 

     We are concerned with the slight increases in smoking and heavy alcohol use since 1998.  These findings, along with indicators of   stress and mental health, are not entirely surprising given our role in the military in recent world events at that period of time, 2002 and 2001.  Nonetheless, our military leaders and the military health system are committed to enhancing programs and to improving health behaviors and reducing avoidable stress.  Not all stress is bad, I might add.  I think there's study research to indicate that some level of stress is actually healthy.

 

     We've implemented new programs since this survey was performed, and we'll be introducing additional programs in the near future.  I also might add that the secretary of Defense, Secretary Rumsfeld, is concerned in particular about the issue of injuries.  I think he's spoken about that publicly.  He's concerned about safety in the military.

 

     The department has established the Defense Safety Oversight Council, which has made safety, including safe health -- safe practices, safe work practices to reduce injuries and accidents, a priority.  There's a lot of work going on in that area.  We don't have anything specific to report on that today, but I'm sure others will be glad to report on that in the future.

 

     Let me stop with that and answer any of your questions, and I'll ask Bob as well if he'd come up.  Yes, sir?

 

     Q:  Could you explain the reason behind the increase in the heavy alcohol use, and could you also say how it has manifested itself in the service?  I think that, while it's a different year, some have linked it to the recent sexual assaults that are being looked into.

 

     Winkenwerder:  Explain.  It's an individual behavior, obviously.  We don't -- unlike the issue of illegal drug abuse, there isn't -- we can't police people in their behaviors and force them not to drink heavily or to binge drink.  But certainly we have a high level of awareness, we believe, among our commanders, among our leaders, and really throughout the military -- and certainly in the health care system -- to send a message that these are not healthy behaviors; that they can impact upon you adversely in terms of your family, your personal life, your productivity, your career.  So I think there's plenty of messages out there for people that we try to send that these are not productive behaviors for you to engage in.

 

     Q:  But have you seen it manifested in any particular areas? And I reference the sexual assaults.

 

     Winkenwerder:  The area that we're most concerned about, when I stand back from these data and look, is the young personnel between  the ages of 18 and 25.  More heavily enlisted though some junior officers, but it's those young people.  I think as we look over time, into the late 20s and early 30s, we tend to then achieve extremely healthy behaviors relative to the rest of the civilian population.  But it's those young individuals that come in, many times their behaviors have not yet been fully shaped in ways that we would like, and so we're particularly interested in targeting that group of service members.  And it tends to be a little bit more, at least with respect to drinking and, I believe, smoking, with men rather than women.

 

     Bray:  Yes.  It's true for both.

 

     Winkenwerder:  Yes?

 

     Q:  On the stress, I think you said about a third reported having high levels of stress from work.  How does that compare from your previous surveys and for the civilian population as a whole?  And do you actually define the term, or do you ask them whether they felt stressed?

 

     Winkenwerder:  Let me ask Dr. Bray to address that.

 

     Bray:  We actually asked that question in the '98 survey as well, and the rates were amazingly similar across the two.  It is just a single question that asks them, you know, how much stress do you feel at work: none, a little, quite a bit, a lot, that type of thing.

 

     Q:  How about the civilian?  Is there any comparable number for civilians?

 

     Bray:  I'm not aware of anything -- I'm sure there are data, but I don't know if they were asked exactly that same way or know what a good benchmark is for that.

 

     Winkenwerder:  One of our challenges in all of this is to get good benchmark data to be able to compare ourselves with civilians or other like populations.  Wherever we can do that, we do it.

 

     Q:  In the area of stress, or anywhere in the survey, were any questions asked about the subject of suicide or whether service members had thoughts of suicide, or depression, that sort of thing? Was that addressed in the survey?

 

     Bray:  We did ask, yeah, as part of coping mechanism, whether people had ever thought of hurting, harming themselves, that type of thing.

 

     Q:  Do you know any of the data on that, or will we get that when we get the report?

 

     Bray:  I think that it was around 5 percent had indicated that they had had thoughts of that.  So it's more what you'd call suicidal ideation, not that they had attempted it, but they had --

 

     Q:  Were questions asked about attempts?  Were there questions about suicide or was it not really addressed in this?

 

     Bray:  It was more just had they thought about it.

 

     Winkenwerder:  We follow the rates, of course, along with other mental health trends, but as I recall it as well, it was in the low single digits.

 

     Bray:  Right.

 

     Winkenwerder:  You would expect that.  You wouldn't expect it to be --

 

     Q:  Well, there's been a lot of reporting lately suggesting that perhaps there's a higher rate of suicide or a spike in suicide. What does your latest data on that show?

 

     Winkenwerder:  Actually, let me address that.  The rate of suicide in the military -- and this is a good example, actually, when we compare with young Americans of like age -- is actually lower overall in the military than in the civilian population.  In the civilian population, my understanding is the figures are around 20 per 100,000 people per year; I don't know if you have those statistics.

 

     Bray:  I'm not -- I don't have those off the top of my head.

 

     Winkenwerder:  Whereas in the military it varies a little bit by service.  But I want to give you a figure that is generally within the ranges like 10 to 12, 9 to 12; it bumps up and down year to year as you expect, because the numbers are very small.

 

     Q:  Has there been a bump-up this year?  Or do you know yet?

 

     Winkenwerder:  We had -- in Iraq there was some report of and finding of some increase that was principally during one summer month and that was what led to a team going there.  And I'm not going to get into the results of that team; that's an Army study.  They expect to brief and report on that in the near future, so we look forward to that study.

 

     Make sure we get over here.  Yes, sir?

 

     Q:  12,500 respondents -- how many surveys did you send out? What percentage of people returned them?

 

     Bray:  We got about a 56 percent response rate.  So it was -- we were actually a little lower than we had hoped for, but there was -- at the time that we conducted this survey, which was in the fall of 2002, there was just a lot of military activities and exercises going on and they were more distracted with the mission than doing our survey, unfortunately.

 

     Winkenwerder:  Yes, ma'am?

 

     Q:  I know you said the Army is doing a mental health study. But I'd like to ask you to address the question, not just about the Army but more broadly about the U.S. military.  Just to carry forward on some of the stress findings that you saw here, what are you hearing or seeing about the force that is currently deployed, about the potential combat stress that they believe they may be facing from this very long overseas deployment?  Are you seeing indicators yet of any   kind of stress reactions, traumatic stress reactions from the currently deployed and returning force?

 

     Winkenwerder:  Let me -- you've asked a couple different questions.  Let me just take what I know about the overall.

 

     First of all, we don't have any survey data from deployed people in the theater that's statistically valid survey.  As any of us would expect, I think we can be sure that the level of stress serving in a combat or quasi-combat situation is going to be higher than one's normal job duties or when one was not in that type of environment.

 

     We have a number of outreach efforts.  There are stress teams. There are mental health management teams.

 

     It's my view that there are many things that can and do contribute to welfare and morale of our troops and that are important in dealing with an overall stress environment.  I mean, they go very broadly, all the way from pay and housing to family assistance, to leadership, leadership awareness.  I think our leadership is very aware of and on top of these issues.

 

     On the medical side, we are very careful, on both the pre- and post-deployment, to screen people, to ask questions about their mental health and about how they're doing, and to follow up, to look after those issues.

 

     So I think the awareness is very high, and we're doing all that we can to manage the stress.

 

     Q:  Now that you've been at this deployment for about a year, though, are there -- is there yet anything you can point to as the result of some of the work you're doing, of recommendations or changes that you might be making, or additional things you might be doing on the mental health side?

 

     Winkenwerder:  I'm going to leave that up to the Army team, because they have specifically looked at the Iraq situation.  I would just say generally it's always helpful for people to reduce levels of uncertainty.  And so knowing when deployment/redeployment dates are -- that's helpful.  Being able to communicate with one's family and so is things like, for example, telephone and Internet communications and recreation facilities and those type -- all of those contribute to -- as the survey showed, what do you do when you're stressed?  We'd like people to exercise.  We'd like people to talk.  We'd like them to engage in learning activities.  And so we're doing all those things, which was the types of things that we would normally do with deployed service members.

 

     Q:  And from the very -- sorry.  Can I ask one more quick statistical question?

 

     Winkenwerder:  Yes.

 

     Q:  On the heavy alcohol abuse, unless I missed it on the chart, I'm not sure I saw the actual real increase in the number of heavy alcohol users, what the percentage was and what it has jumped to.  You've had the one on the decline for the --

 

     Bray:  Right.  At the -- I believe the number was 15.4 percent in 1998, and that went up to 18.1 percent in 2002.

 

     Q:  And that, by definition, is statistically significant?

 

     Bray:  Yes, that was.

 

     Winkenwerder:  I might add, buried in the statistics about the smoking, even though there was a slight increase in the smoking as well, that among heavy users of -- heavy smokers, regular heavy smokers, that that number actually was flat.  It in raw numbers went down.  I don't think it achieved statistical significance, but --

 

     Bray:  Right.  And by "heavy," we're meaning a pack a day or more.

 

     Winkenwerder:  Right.  So heavy smoking is flat to down, which is good.  But we're concerned about people that pick up a pack of cigarettes and smoke, even if it's, you know, only once a week or two or three times a month or what have you.  We'd like people to avoid those behaviors altogether.

 

     Yes?

 

     Q:  On the heavy alcohol use, do you have a gender breakdown on the percentages you just gave?

 

     Bray:  It's much higher for men.  If you look at the overall rate for -- hold on one second and I can get that for you.

 

     Winkenwerder:  While he's looking at that, is there any --

 

     Bray:  Yeah, take another one.

 

     Winkenwerder:  Yeah?

 

     Q:  Is that five drinks in one occasion, once a week?

 

     Bray:  Yes.

 

     Q:  Okay.

 

     Bray:  Once a week or more.  At least once a week.

 

     Q:  Five, at least once a week.

 

     Q:  And you said that's defined as heavy alcohol use?

 

     Bray:  Right.

 

     Q:  Would you also say that's abuse?  I mean, if you're drinking five drinks at a time, are you on the edge of doing something you really shouldn't be doing?

 

     Bray:  Well, certainly there's a lot of data out there that indicates that, you know, people -- there's -- you know, their performance can be, you know, reduced; their reflexes are not as sharp; they actually can hit some, you know, some legal limits of intoxication.  It doesn't typically necessarily meet the -- what might be the DSM for, you know, abuse criterion, but it can lead to that.

 

     Winkenwerder:  Certainly.

 

     Bray:  So it's a problematic behavior.

 

     Q:  You go out Saturday night and have five beers in the bar and, you know, a designated driver drives you home.  Do you have a -- you know, are you on the verge of having an alcohol problem?

 

     Bray:  If you did that consistently, you could.  On a single occasion, I would say no.

 

     Winkenwerder:  Yes?

 

     Q:  On the tobacco issue, do you have any insights into why, while most of society is eschewing cigarette smoking, you've got this decline, this rollback of a trend of two decades, the increase of smoking in the military?  It doesn't seem to make sense that the --

 

     Winkenwerder:  I'm not sure that we do.  We have a small increase that he described of people who had had any use of cigarettes within the prior 30 days.  It's important to understand the definition.  But among those that were heavy smokers, the number was the same, and actually the raw numbers went down just a little bit, didn't achieve statistical significance.

 

     So I think what Dr. Bray -- I don't want to put words in his mouth, but we're very similar to the civilian population when it comes to the smoking issue.  We'd like to be better.  We'd like to be better, and I think there is certainly the opportunity to achieve that.  As he pointed out, if one looks back 10 to 15 to 20 years ago, we were far higher than the civilian population.  We've closed the gap.  I'd like to see us come below --

 

     Bray:  Get below.

 

     Winkenwerder:  -- the civilian population, but that's going to take additional efforts, obviously, beyond the ones that we're already engaged with.

 

     Q:  What about working with the tobacco companies not to push their products so much off base or whatever?  You know the argument: you subsidize tobacco smoking, but you try to get the rest of the -- or subsidize tobacco growing, but you try to get --

 

     Winkenwerder:  What I understand is that we no longer subsidize.  That was something that was done in the past, but we no longer subsidize cigarette or tobacco sales in military facilities.  I think that's good policy.  That's good news.   Smoking is also banned in Department of Defense facilities.  But there are other public policy and regulatory issues that the rest of society is certainly considering.  We want to be and will be engaged in those types of discussions.  And as a physician, as someone who's concerned about the health and welfare of our service members, we want to be doing all that we can to reduce smoking in the military.

 

     Other questions?

 

     Bray:  I want to go --

 

     Winkenwerder:  Yeah?

 

     Bray:  -- go back to that quickly.

 

     Winkenwerder:  Yeah.

 

     Bray:  The heavy alcohol use for males was about 19.4 percent compared to about 5.3 percent for the women.

 

     Q:  From the same age group?

 

     Bray:  Yeah, that's all -- 18- to 55-year-olds.

 

     Staff(?):  One more.

 

     Q:  How did you guarantee anonymity?  How did you send the surveys out, and then how did you then guarantee anonymity?

 

     Bray:  We actually sent data collection teams to military bases, and then we guaranteed the anonymity in that it was an anonymous survey.  We didn't ask them for their name or Social Security number.  And then we let them know that we were -- you know, we had full control of all the information, taking it back; gave them -- you know, went through the formal process of all the regulatory reviews about the procedures that we would follow.  We actually then had the data collection team ship them back to -- we had them optically scanned -- shipped them to the scanning office.

 

     Q:  It wasn't mailed to anybody?

 

     Bray:  No.

 

     Q:  You handed them out?

 

     Bray:  We handed them out and we collected them.  There were no military personnel in the room when the data were collected.  So they helped facilitate the notification and the assembly of personnel, and then once they were there they left and our civilian teams collected the data.

 

     Q:  All right.  Thank you, Doctor.

 

     Bray:  Thank you.

 

     Q:  Thank you Dr. Winkenwerder, Dr. Bray.

 

     Bray:  Thank you very much.

 

     Winkenwerder:  The study -- the whole study will be available.  We're waiting for this transcript when it goes up.

 

     Q:  How about available now?

 

     Q:  Can we get that --

 

     Q:  Yeah, can we get the study?

 

     Bray:  Right now or online?

 

     Winkenwerder:  You'll find a copy of the whole -- they're on the back table.

 

     Q:  Oh, there you go.

 

     Q:  Oh, okay.

 

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