United States Air Force Personnel Research Articles

Lessons Learnt from the United States Air Force during a Joint Exercise at an Indian Air Force Transport Base

Abstract Introduction: Combat Operations Preparedness Exercise 2023 was held between the United States Air Force (USAF) and the Indian Air Force (IAF) with the objective of enhancing the operational readiness of both countries in regard to various aspects of Aerial Combat. Lessons Learnt: Various aspects of Aerial Combat and op-readiness were deliberated and discussed such as Tactical Combat Casualty Care, Subject Matter Expert Exchanges on several topics such as chemical, biological, radiological, and nuclear(CBRN), Fitness Classification in the USAF, decompression sickness (DCS), high altitude, and hypoxia. Aeromedical evacuation configurations were also demonstrated on board the C130J and C17. A mass casualty evacuation (CASEVAC) drill was also conducted on one of the Detachments of the base where medical teams from both countries evacuated simulated patients of varying severity on board the US aircraft. This article has brought out the lessons learned from the abovementioned lectures, discussions, and demonstrations. The knowledge gained was varyingly utilitarian such as the different practices of CASEVAC in the USAF and updated practices in CBRN disaster preparedness, different approaches in regard to DCS, high altitude, and hypoxia prevention and treatment. The IAF medical team also had the opportunity of sharing the gamut of their working and practical experiences with their US counterparts that made us efficient in our element. The US airforce personnel were impressed with the concept and workings of the Station Health Organisation. Such an organisation directed towards preventive health care and promotion of positive health is not in vogue in the USAF health care setups. The assimilated patient transport unit (PTU) of the base and the vertical litter stretcher setup of the C130 as practiced in the 87 Squadron was also palatable to the USAF personnel. Conclusion: The article finally concludes with recommendations that can be practically implemented in the IAF. It mentions enhancements in areas such as the PTU, CASEVAC/medical evacuation, parajumping practices, modernization of battle casualty care, and improved CBRN practices.

Psychological and spiritual factors affecting well-being among military personnel engaged in remote combat.

Remotely piloted aircraft (RPA) require multiple crewmembers to successfully operate the aircraft. RPAs shape modern warfare and pose challenges for the spiritual-emotional health of RPA personnel. This study explored whether (a) RPA crewmembers could be separated into groups based on their experiences, (b) the groups differed in psychological health outcomes, and (c) they differed in aspects of spiritual well-being. Participants included 354 United States Air Force personnel involved in RPA duty. Participants provided demographic information and completed the Work Role Strain Scale as a predictor. Outcome measures included job satisfaction, the Maslach Burnout Inventory, Outcome Questionnaire-45.2, Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), and medical complaints and psychosocial services indices. The Spiritual Well-Being Scale and Unit Cohesion Scale were assessed as moderating factors. Cluster analysis identified two groups of crewmembers. Psychologically healthy participants included 73.4% of crewmembers (n = 260); the remaining 26.6% (n = 94) were distressed. The distressed group included more imagery analysts, weapon-strike pilots, and females, and fewer sensor operators and males compared with the healthy group. Symptoms among the distressed group included more psychological difficulties and PTSD symptoms, more medical complaints, and greater use of psychosocial services. The distressed group reported greater work-role conflict, role ambiguity, work overload, relationship stress, emotional exhaustion, and cynicism as well as lower job satisfaction, unit cohesion, professional efficacy, and existential well-being. The strongest predictors of distress were lack of meaning and feeling overextended at work. Emotional exhaustion and low existential well-being identified distressed crewmembers. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Occupational Noise Dose Reduction via Behavior Modification Using In-Ear Dosimetry among United States Air Force Personnel Exposed to Continuous and Impulse Noise

In-ear dosimetry and noise exposure feedback were used to modify worker attitude and behavior regarding hearing protection use. The study specifically addressed whether providing in-ear noise exposure data to workers resulted in a reduction in average noise dose rate equivalent continuous levels. Nineteen combat arms instructors (impulse noise group) and heavy equipment operators (continuous noise group) working for the United States Air Force volunteered to participate in a six-month field study using in-ear dosimeters to collect daily noise level data. Participants served as their own control group, receiving periodic noise exposure feedback reports in the latter half of the study only. The control and feedback phase noise exposure data were examined using analysis of variance for differences that could be indicative of more effective hearing protection device use. Additionally, a 7-point Likert survey was used to monitor worker attitude towards hearing protection use, and worker medical histories were examined for evidence of previous hearing loss. Overall, this research found a significant reduction in noise dose rate equivalent continuous level (-2.5 dB with p = 0.019) for the continuous noise group following periodic noise exposure feedback on in-ear noise levels. This effect was not detected at the individual level due to limited samples. No effect was detected in the impulse noise population, likely due to limitations of dosimeter technology in response to impulse noise. No correlation between worker attitudes towards hearing protection and noise dose rate equivalent continuous level was detected for either group (continuous p = 0.249; impulse p = 0.478). While workers reported that in-ear dosimeters and noise exposure feedback helped them control their exposures, few reported using immediate feedback functions to control noise exposures within a work shift. These results indicate that in-ear dosimetry and noise exposure feedback could provide an effective tool to reduce worker noise exposures over time. However, advances in dosimeter technology are necessary before it can be evaluated for impulse noise. Additionally, further research is necessary to understand the link between worker attitude and hearing protection device use.

Caffeine consumption among active duty United States Air Force personnel

Data from the National Health and Nutrition Examination Survey (NHANES) indicated that 89% of Americans regularly consumed caffeinated products, but these data did not include military personnel. This cross-sectional study examined caffeine consumption prevalence, amount of daily consumption, and factors associated with caffeine intake in active duty United States (US) Air Force personnel. Service members (N = 1787) stationed in the US and overseas completed a detailed questionnaire describing their intake of caffeine-containing products in addition to their demographic, lifestyle, and military characteristics. Overall, 84% reported consuming caffeinated products ≥1 time/week with caffeine consumers ingesting a mean ± standard error of 212 ± 9 mg/day (224 ± 11 mg/day for men, 180 ± 12 mg/day for women). The most commonly consumed caffeinated products (% users) were sodas (56%), coffee (45%), teas (36%), and energy drinks (27%). Multivariate logistic regression modeling indicated that characteristics independently associated with caffeine consumption (≥1 time/week) included older age, ethnicity other than black, tobacco use, less aerobic training, and less sleep; energy drink use was associated with male gender, younger age, tobacco use, and less sleep. Compared to NHANES data, the prevalence of caffeine consumption in Air Force personnel was similar but daily consumption (mg/day) was higher.

Clinical indicators associated with HIV acquisition in the United States Air Force

ABSTRACTMandatory HIV screening of United States Air Force (USAF) personnel every two years effectively identifies incident cases, however testing frequency limits the ability to detect early HIV infection. Identifying clinical indicators of HIV in the USAF population is necessary to develop a supplemental provider-based targeted testing strategy. We conducted a matched case-control study of male active duty USAF personnel with a new HIV diagnosis (n = 452) between 1996 and 2011 matched to five randomly selected controls (n = 2176). The relationship between clinical diagnoses, determined by ICD-9 codes, and HIV infection was assessed using conditional logistic regression. In unadjusted analyses of ICD-9 codes ever and within the last two years before HIV diagnosis, the conditional odds of HIV infection were greater in those with clinical signs and symptoms of HIV (cOR 5.05, 95% CI 4.00–6.39), mental health diagnoses (cOR 2.61, 95% CI 1.86–3.67), and STI diagnoses (cOR 2.33, 95% CI 1.50–3.60). Compared to those with ≤10 medical encounters in the two years prior to HIV diagnosis, individuals with 11–35 medical encounters (cOR 2.19, 95% CI 1.73–2.79) and >35 medical encounters (cOR 4.15, 95% CI 2.69–6.39) had a higher odds of HIV acquisition. In multivariate analyses, clinical signs and symptoms of HIV within the last two years of HIV diagnosis (cOR 4.10, 95% CI 3.22–5.22) and ever having a mental health diagnosis (cOR 1.97, 95% CI 1.44–2.70) remained significant (p < .01). Clinical encounters, particularly those featuring clinical signs and symptoms of HIV or a history of mental health complaints, provide an opportunity for targeted testing as a supplement to mandated testing at two-year intervals. Provider education to increase HIV testing in persons at risk would enhance early HIV diagnosis and potentially reduce forward transmission in the USAF population.

HIV testing patterns for United States Air Force personnel, 2008–2012

ObjectiveThis study evaluated 3rd generation human immunodeficiency virus (HIV) test patterns and HIV infection rates in the United States Air Force (USAF). Study designRetrospective database study. MethodsHIV enzyme-linked immunoassay (ELISA) and Western blot tests were analysed for all USAF personnel from 2008 to 2012. For new HIV cases, unadjusted and adjusted annual rates were calculated per 100,000 persons. ResultsIn total, 1,608,665 tests were performed in 626,298 individuals, with a reactive ELISA observed in 809 (0.001%) persons. Western blot (n = 1949) results included 378 (19.4%) positive, 1283 (65.8%) negative, and 288 (15.0%) indeterminate (WBi). Unadjusted annual HIV rates were between 16.7 and 20.6 per 100,000 persons during the study period. The overall age-adjusted rate was 14.8 cases per 100,000 persons tested. Blacks/African Americans had the highest risk of HIV (risk ratio 7.9 [95% confidence interval 5.78, 9.95] compared to Whites). ConclusionsWBi results, which can cause delays in determining HIV status, were relatively common with the 3rd generation assay. However, this will be mitigated by a planned transition to a 4th generation assay. Although the overall rate of HIV in the USAF is lower than US civilian adults, HIV prevention efforts targeting young Blacks/African Americans may help to reduce HIV incidence in the USAF.

Epidemiology of HIV among US Air Force Military Personnel, 1996-2011.

ObjectiveThe objectives of this study were to describe the epidemiology of HIV in the United States Air Force (USAF) from 1996 through 2011 and to assess whether socio-demographic characteristics and service-related mobility, including military deployments, were associated with HIV infection.MethodsWe conducted a retrospective cohort analysis of USAF personnel who were HIV-infected during the study period January 1, 1996 through December 31, 2011 and a matched case-control study. Cases were USAF personnel newly-diagnosed with HIV during the study period. Five randomly-selected HIV-uninfected controls were matched to each case by age, length of service, sex, race, service, component, and HIV test collection date. Socio-demographic and service-related mobility factors and HIV diagnosis were assessed using conditional logistic regression.ResultsDuring the study period, the USAF had 541 newly diagnosed HIV-infected cases. HIV incidence rate (per 100,000 person-years) among 473 active duty members was highest in 2007 (16.78), among black/ African-American USAF members (26.60) and those aged 25 to 29 years (10.84). In unadjusted analysis restricted to personnel on active duty, 10 characteristics were identified and considered for final multivariate analysis. Of these single (adjusted odds ratio [aOR], 8.15, 95% confidence interval [CI] 5.71–11.6) or other marital status (aOR 4.60, 95% CI 2.72–7.75), communications/ intelligence (aOR 2.57, 95% CI 1.84–3.60) or healthcare (aOR 2.07, 95% CI 1.28–3.35) occupations, and having no deployment in the past 2 years before diagnosis (aOR 2.02, 95% CI 1.47–2.78) conferred higher odds of HIV infection in adjusted analysis.ConclusionThe highest risk of HIV infection in the USAF was among young unmarried deployment-naïve males, especially those in higher risk occupation groups. In an era when worldwide military operations have increased, these analyses identified potential areas where targeted HIV prevention efforts may be beneficial in reducing HIV incidence in the USAF military population.

Spouse abuse among United States Air Force personnel who deployed in support of Operation Iraqi Freedom/Operation Enduring Freedom.

The authors examined spouse abuse perpetration among all married U.S. Air Force personnel who deployed in support of Operation Iraqi Freedom/Operation Enduring Freedom. Using Poisson and conditional Poisson regression, they compared rates of spouse abuse perpetration predeployment and postdeployment in the population of married U.S. Air Force personnel who had a combat-related deployment between October 1, 2001 and October 31, 2008 (N = 156,296). Just over 2% (n = 3,524) of deployers perpetrated at least one substantiated incident of spouse physical or emotional abuse within the 308,197,653 days at risk for abuse during the study period. Male deployers perpetrated spouse abuse at approximately twice the rate of female deployers. Regarding changes in rates of spouse abuse perpetration postdeployment versus predeployment among all deployers, the authors found no differences overall; however, several deployer and incident-related characteristics moderated this effect. Rates of emotional abuse, mild abuse, and abuse not involving alcohol were significantly lower postdeployment, whereas rates of moderate/severe abuse and abuse involving alcohol were significantly higher postdeployment. Although the majority of U.S. Air Force deployers did not perpetrate any substantiated incidents of spouse abuse, there was variability in the impact of deployment on spouse abuse rates before versus after deployment. The finding that rates of moderate/severe spouse abuse incidents involving alcohol were higher postdeployment suggests a need for focused prevention/intervention efforts.

Characterization of Inhalation Exposure to Jet Fuel among U.S. Air Force Personnel

Jet propulsion fuel-8 (JP-8) is the primary jet fuel used by the US military, collectively consuming ~2.5 billion gallons annually. Previous reports suggest that JP-8 is potentially toxic to the immune, respiratory, and nervous systems. The objectives of this study were to evaluate inhalation exposure to JP-8 constituents among active duty United States Air Force (USAF) personnel while performing job-related tasks, identify significant predictors of inhalation exposure to JP-8, and evaluate the extent to which surrogate exposure classifications were predictive of measured JP-8 exposures. Seventy-three full-time USAF personnel from three different air force bases were monitored during four consecutive workdays where personal air samples were collected and analyzed for benzene, ethylbenzene, toluene, xylenes, total hydrocarbons (THC), and naphthalene. The participants were categorized a priori into high- and low-exposure groups, based on their exposure to JP-8 during their typical workday. Additional JP-8 exposure categories included job title groups and self-reported exposure to JP-8. Linear mixed-effects models were used to evaluate predictors of personal air concentrations. The concentrations of THC in air were significantly different between a priori exposure groups (2.6 mg m(-3) in high group versus 0.5 mg m(-3) in low, P < 0.0001), with similar differences observed for other analytes in air. Naphthalene was strongly correlated with THC (r = 0.82, P < 0.0001) and both were positively correlated with the relative humidity of the work environment. Exposures to THC and naphthalene varied significantly by job categories based on USAF specialty codes and were highest among personnel working in fuel distribution/maintenance, though self-reported exposure to JP-8 was an even stronger predictor of measured exposure in models that explained 72% (THC) and 67% (naphthalene) of between-worker variability. In fact, both self-report JP-8 exposure and a priori exposure groups explained more between-worker variability than job categories. Personal exposure to JP-8 varied by job and was positively associated with the relative humidity. However, self-reported exposure to JP-8 was an even stronger predictor of measured exposure than job title categories, suggesting that self-reported JP-8 exposure is a valid surrogate metric of exposure when personal air measurements are not available.

Using the Freiburg Acuity and Contrast Test to measure visual performance in USAF personnel after PRK.

Photorefractive keratectomy (PRK) may be an alternative to spectacle and contact lens wear for United States Air Force (USAF) aircrew and may offer some distinct advantages in operational situations. However, any residual corneal haze or scar formation from PRK could exacerbate the disabling effects of a bright glare source on a complex visual task. The USAF recently completed a longitudinal clinical evaluation of the long-term effects of PRK on visual performance, including the experiment described herein. After baseline data were collected, 20 nonflying active duty USAF personnel underwent PRK. Visual performance was then measured at 6, 12, and 24 months after PRK. Visual acuity (VA) and contrast sensitivity (CS) data were collected by using the Freiburg Acuity and Contrast Test (FrACT), with the subject viewing half of the runs through a polycarbonate windscreen. Experimental runs were completed under 3 glare conditions: no glare source and with either a broadband or a green laser (532-nm) glare annulus (luminance approximately 6090 cd/m) surrounding the Landolt C stimulus. Systematic effects of PRK on VA relative to baseline were not identified. However, VA was almost 2 full Snellen lines worse with the laser glare source in place versus the broadband glare source. A significant drop-off was observed in CS performance after PRK under conditions of no glare and broadband glare; this was the case both with and without the windscreen. As with VA, laser glare disrupted CS performance significantly and more than broadband glare did. PRK does not appear to have affected VA, but the changes in CS might represent a true decline in visual performance. The greater disruptive effects from laser versus broadband glare may be a result of increased masking from coherent spatial noise (speckle) surrounding the laser stimulus.

A Process Model for Policy Analysis Within the Context of Political Caring

As the health care system in the United States is becoming increasingly more politically and economically oriented, the concept of political caring needs to be advanced in contemporary nursing practice (Ray, 1989, 2001; Turkel, 2001). The purpose of this article is to present a model outlining the process of policy analysis through a phenomenologica research study illuminating the life world descriptions of experiences of United States Air Force personnel with managed care in the military and the civilian health care system. This process shows how qualitative data are used to give voice to a moral crisis and contribute to health care policy.

A Major Outbreak of Foodborne Gastroenteritis among Air Force Personnel during Operation Desert Storm

An outbreak of foodborne gastroenteritis affected 648 United States Air Force personnel stationed in Jeddah, Saudi Arabia during Operation Desert Storm. The implicated food source was a locally catered meal. Despite the presence of an aggressive Air Force public health program, foodborne illness had a major impact on manpower and medical resources during a critical phase of military operations. It is the recommendation of the authors that the Air Force not rely on local caterers during future deployments.

Evaluation of the Acute Toxicity of Silahydrocarbon

Silahydrocarbon (SHC) is a base stock for a candidate high-temperature hydraulic fluid. Because United States Air Force personnel working with SHC may be exposed to potential health hazards, a complete battery of acute toxicity tests was performed with the fluid. A single neat dose of 0.1 mL SHC into New Zealand White (NZW) rabbit eyes resulted in slight conjunctival irritation 1 hr after treatment in all unflushed eyes and one of three flushed eyes. Conjunctival irritation persisted through 24 hr but dissipated by 48 hr. Rinsing the eyes after treatment was of questionable benefit. A single treatment of 0.5 mL neat SHC to rabbit skin produced negative results for all but a single animal, which had very slight erythema at the test site 48 hr after treatment. Guinea pigs failed to exhibit a sensitization response following repeated application of SHC. A single oral dose of 5 g SHC/kg body weight given to five male and five female F-344 rats and a single dermal dose of 2 g SHC/kg body weight applied to five male and five female NZW rabbits resulted in no deaths or signs of toxic stress. Five male and five female F-344 rats were exposed to 4.8 mg/L (near limit concentration) of aerosolized SHC for 4 hr. All male rats and four female rats survived. During exposure, the animals exhibited signs of eye and upper respiratory irritation.

EVALUATION OF THE ACUTE TOXICITY OF SILAHYDROCARBON

Silahydrocarbon (SHC) is a base stock for a candidate high-temperature hydraulic fluid. Because United States Air Force personnel working with SHC may be exposed to potential health hazards, a complete battery of acute toxicity tests was performed with the fluid. A single neat dose of 0.1 mL SHC into New Zealand White (NZW) rabbit eyes resulted in slight conjunctival irritation 1 hr after treatment in all unflushed eyes and one of three flushed eyes. Conjunctival irritation persisted through 24 hr but dissipated by 48 hr. Rinsing the eyes after treatment was of questionable benefit. A single treatment of 0.5 mL neat SHC to rabbit skin produced negative results for all but a single animal, which had very slight erythema at the test site 48 hr after treatment. Guinea pigs failed to exhibit a sensitization response following repeated application of SHC. A single oral dose of 5 g SHC/kg body weight given to five male and five female F-344 rats and a single dermal dose of 2 g SHC/kg body weight applied to five male and five female NZW rabbits resulted in no deaths or signs of toxic stress. Five male and five female F-344 rats were exposed to 4.8 mg/L (near limit concentration) of aerosolized SHC for 4 hr. All male rats and four female rats survived. During exposure, the animals exhibited signs of eye and upper respiratory irritation.

Associations between Cerebrospinal Fluid Parameters and High Degrees of Anxiety or Depression in United States Air Force Personnel Infected with Human Immunodeficiency Virus

The relationship between anxiety and depression, and serum and cerebrospinal fluid (CSF) immune parameters was studied in 98 patients randomly selected from those undergoing routine medical evaluation for human immunodeficiency virus seropositivity as part of the U.S. Air Force's mandatory screening program. A total of 95% of the sample did not have acquired immunodeficiency syndrome (AIDS). The population was subdivided into high and low anxiety or depression groups for statistical purposes. Significant correlations were obtained between high Hamilton Rating Scale for Depression scores (greater than 10) and CSF nucleated cell count and protein levels. High Hamilton Rating Scale for Anxiety (greater than 10) scores were positively correlated with CSF nucleated cell count and absolute CD4a counts. There were no statistically significant group differences with respect to mean laboratory values between high and low anxiety or depression subgroups. Serum viral titers to Epstein-Barr virus and cytomegalovirus were not correlated with anxiety or depression scores. These results suggest a complex relationship between CSF and systemic immune abnormalities and degree of anxiety and depression.

Suicide in United States Air Force Personnel, 1981–1985

Five years of epidemiological data on suicide in the U.S. Air Force was compiled. The annual crude suicide rate per 100,000 airmen-at-risk for 1981–1985 was found to be 11.0. Sex-specific, race-specific, age-specific, grade-specific, location-specific, and marital status-specific rates were compared with published data from the U.S. Air Force for the 1958–1964 time period and the differences are noted. Demographic data and information on circumstances surrounding the suicidal act are also presented. Analysis of the suicidal person's psychosocial situation (as reflected in the kinds of personal problems recorded in the reports and investigations of the incident and as reflected in assessment made of the victim's pre-suicidal “motivational state”) showed remarkable constancy across the services, and indicates a powerful, consistent association between a dyadic love object relationship in total collapse and the completed suicide.

Testosterone and cortisol levels in crewmen of U.S. Air Force fighter and cargo planes.

Serum levels of cortisol and testosterone were measured in 39 United States Air Force personnel on active duty flying status. The subjects selected belonged to one of the following categories: pilot of a fighter-type aircraft, nonpilot on a fighter plane, pilot of a cargo-type aircraft, or nonpilot on a cargo plane. Blood samples were taken prior to and after a routine flying mission. Cortisol levels prior to the flight did not differ across groups. However, postflight samples of cortisol were elevated in the nonpilots, in comparison to the pilots, regardless of aircraft type. Conversely, while testosterone levels were unaffected by crew position, the men flying on fighter-type planes had lower serum levels than did those on cargo planes. These results suggest that hormone levels may be differentially affected by the stressors of routine military flight.

Diagnosis of iron deficiency: The limitations of laboratory tests in predicting response to iron treatment in 1-year-old infants

This study was designed to compare the effectiveness of laboratory tests for iron deficiency (mean corpuscular volume, erythrocyte protoporphyrin, transferrin saturation, and serum ferritin) in predicting hemoglobin response to iron therapy in infants found to have low Hgb concentrations. Screening for anemia was performed on capillary blood of 1,128 healthy 1-year-old infants of United States Air Force personnel. The 25% who had Hgb values less than 11.5 gm/dl were asked to return for tests on venous blood before therapy and again after three months of therapy. Of the 188 infants completing therapy, 66 (35%) had a rise in Hgb concentration greater than or equal to 1.0 gm/dl and were designated responders. None of the confirmatory tests on venous blood reliably distinguished responders from those who subsequently showed no response. By using any one of the tests in combination with a capillary Hgb value less than 11.5 gm/dl, more than half of the infants with an abnormal value responded. But well over half of the responders would have been missed if treatment had been restricted to infants with abnormal values. Neither changes in the criteria for normality nor combinations of tests substantially improved our ability to distinguish the two groups. Because of the difficulty in distinguishing responders from nonresponders with additional laboratory tests and because of the simplicity, low cost, and relative safety of iron therapy in infants, we favor an initial therapeutic trial of iron first for determining the cause of low Hgb values in similar high-risk populations. Further costly workup can then be reserved for the small number of infants who still have unexplained Hgb concentrations less than 11.0 gm/dl after a therapeutic trial.

Risk reduction in the U.S. Air Force primary prevention HEART program

The United States Air Force (USAF) is developing a preventive cardiology program, the Health Evaluation and Risk Tabulation (HEART) program. This article describes the goals and methods of the HEART program's Risk Reduction Component (RRC), which is to assist high-risk active-duty USAF personnel to modify specific health behaviors associated with arteriosclerotic disease: cigarette smoking, and food patterns high in calories from fat and exogenous cholesterol. Also, education is offered to confirmed hyptertensives, whose pharmacological treatment is provided by the base medical facility. The RRC strategy is being tested at two air bases, Pease, New Hampshire, and Charleston, South Carolina. Designated airmen are invited to participate in RRC on these bases after notification of their risk status. Voluntary participation is encouraged at two levels: orientation sessions: and at subsequent focal groups in smoking cessation and/or food pattern modification. Focal groups emphasize techniques of self-management in smoking cessation and eating behavior, including post-treatment maintenance behavior for long-term risk reduction.

Detection of glaucoma in United States Air Force personnel.

Glaucoma accounts for approximately 12 per cent of the blindness in the United States. At present, nearly one million people have undiagnosed glaucoma. Early detection of glaucoma is the most important factor in preventing loss of vision.Tonometry has proved to be the best procedure for detecting early glaucoma; it is recommended as a part of every routine physical examination.The author reports on results of routine tonometry performed on 1000 air force personnel; previously undetected glaucoma was revealed in 10 patients; the disease was suspected in 12 other patients.