Deployment-related Cigarette Smoking Behaviors and Pulmonary Function Among U.S. Veterans

Abstract

ABSTRACT Introduction The effects of smoking on lung function among post-9/11 Veterans deployed to environments with high levels of ambient particulate matter are incompletely understood. Materials and Methods We analyzed interim data (04/2018-03/2020) from the Veterans Affairs (VA) Cooperative Studies Program #595, “Service and Health Among Deployed Veterans”. Veterans with ≥1 land-based deployments enrolled at 1 of 6 regional Veterans Affairs sites completed questionnaires and spirometry. Multivariable linear regression models assessed associations between cigarette smoking (cumulative, deployment-related and non-deployment-related) with pulmonary function. Results Among 1,836 participants (mean age 40.7 ± 9.6, 88.6% male), 44.8% (n = 822) were ever-smokers (mean age 39.5 ± 9.5; 91.2% male). Among ever-smokers, 86% (n = 710) initiated smoking before deployment, while 11% (n = 90) initiated smoking during deployment(s). Smoking intensity was 50% greater during deployment than other periods (0.75 versus 0.50 packs-per-day; P < .05), and those with multiple deployments (40.4%) were more likely to smoke during deployment relative to those with single deployments (82% versus 74%). Total cumulative pack-years (median [IQR] = 3.8 [1, 10]) was inversely associated with post-bronchodilator FEV1%-predicted (−0.82; [95% CI] = [−1.25, −0.50] %-predicted per 4 pack-years) and FEV1/FVC%-predicted (−0.54; [95% CI] = [−0.78, −0.43] %-predicted per 4 pack-years). Deployment-related pack-years demonstrated similar point estimates of associations with FEV1%-predicted (−0.61; [95% CI] = [−2.28, 1.09]) and FEV1/FVC%-predicted (−1.09; [95% CI] = [−2.52, 0.50]) as non-deployment-related pack-years (−0.83; [95% CI] = [−1.26, −0.50] for FEV1%-predicted; −0.52; [95% CI] = [−0.73, −0.36] for FEV1/FVC%-predicted). Conclusions Although cumulative pack-years smoking was modest in this cohort, an inverse association with pulmonary function was detectable. Deployment-related pack-years had a similar association with pulmonary function compared to non-deployment-related pack-years.