Military Personnel

Special Populations > Military Personnel

Tobacco use in the United States military is common and generally accepted. Recently, the Department of Defense (DoD) has enforced efforts to reduce smoking in the armed forces. The most recent national information regarding this population was based on data collected in 2011. 1

Current Tobacco Use Trends:

  • Despite recent declines, almost a quarter (24.0%) of military service members still report smoking in the past 30 days.  These rates are still significantly higher than the Healthy People goal of less than 12%.1 
    • 17.3% reported being former smokers.  These rates are also higher than the general population (18.2%).1,2,3
      •   Of those who report current smoking, 8.2% were classified as infrequent smokers, 12.6% as light/moderate smoking, and 3.2% as heavy smoking.1
  • Cigarette use is highest in the Marine Corps (31.9%) and lowest in the Air Force (17.2%).1
  • Qualitative reports suggest that many high-ranking officers are non-smokers, but that it is not uncommon to see senior enlisted personnel smoking.4
  • Almost half (49.2%) of all service members report any nicotine use in the last 12 months1.  Across all branches:
    • 22.6% reported cigar use
    • 10.2% reported pipe use
    • 19.8% reported smokeless tobacco use
    • 4.6% reported electronic or smoking nicotine delivery devices in the last year
  • Smokeless tobacco use is also elevated in the military, with 12.8% of service members reporting use in the last 30 days1
    • Smokeless tobacco use has been on the incline despite decreases in cigarette use2
    • These rates are significantly higher than the general population and the Healthy People goal, 2.3% and less than 0.3%, respectively1
    • Smokeless tobacco use is highest in the Marine Corps (21.3%) and lowest in the Air Force (8.7%)1.
  • Earlier initiation of tobacco use was associated with being a heavy smoker as an adult compared with their counterparts who started smoking at age 21 or later1.

Tobacco Use and Deployment:

  • Those who have been deployed to combat zones since September 2001 were significantly more like to be current and/or heavy smokers than those who were not combat deployed1.
  • The Army and Marine Corps reported an increase in cigarette, cigar, and smokeless tobacco (Marine Corps only) use when deployed1.

Tobacco Use and Health:

  • Among service members who report currently smoking, 9.1% report often or sometime smoking with children present.  This is most common in the army (12.3%)1.
  • Among those with heavy smoking patterns, the most common reasons reported for smoking were to1:
    • help relax or calm down (83.6%)
    • help relieve stress (81.5%).
  • More than half (52.9%) of the heavy smokers report smoking while drinking1.
  • Among service members deployed since September 2001, those with Traumatic Brain Injuries (TBI), were more likely to report heavy tobacco use than those with no TBI1.
  • Heavy cigarette users were also more likely to report mental health symptoms1:
    • Increased rates of overall stress (61.1%), anxiety (35.4%), depression (21.2%), and PTS symptoms (16.2%).  There were no group differences for smoking rates and suicidal ideation.  

Military Readiness:

  • Each year the Department of Defense spends over $1.6 billion in tobacco related costs including tobacco related health care, increased hospitalizations, and lost days of work5.
  • Smoking in the military has serious implications for military readiness 6.
    • Physical work capacity and endurance is reduce
    • Lower maximal oxygen capacity and exercise duration
    • Lower Army physical training test scores
    • Impaired night vision
    • Higher frequency of hearing loss
    • Increased rates of motor vehicle accidents
    • Higher absenteeism
  • Nicotine withdrawal should also be considered as the goal is to get military personnel to stop smoking6.  When military were participating in missions or training exercises when smoke breaks were not allowed, smokers experienced:
    • Lower vigilance and cognitive function
    • Poorer performance in flying and diving exercises
    • Irritability and moodiness

Cessation Considerations:

  • Infrequent smokers were more likely than light/moderate and heavy smokers to report that restricted access to places to smoke and that higher prices would deter them from smoking1.
  • The Department of Defense online quit support program, UCANQUIT2, was the least recognized method of quitting among service members.  Approximately 19.4% of infrequent smokers, 14.5% of light/moderate smokers, and 10.8% of heavy smokers reported they were unfamiliar with the services1
  • Branch policy leaders and tobacco control managers alike report that inconsistent support from military commanders is a significant weakness in the military’s tobacco control program4.
  • Smoking among high-ranking officers has been known to influence tobacco control policy, such as discouraging the implementation of tobacco cessation programming4.
  • Tobacco companies have been cited as influencing tobacco use in the military through advertisements targeting military service members and providing free samples to military installations 4.

Military Culture of Tobacco Use:

  • Only half of service members reported that leadership deters cigarette use1.
  • Policy leaders across branches reported that tobacco use was generally accepted.  They cited the ease of access to low priced cigarettes and visibility of smoking on military installations as evidence of the military culture towards tobacco use 4.
  • Compared with nearby stores, military installations sell cigarettes at a large discount.  A study demonstrated that some packs are sold on military installations with as much as a 73% discount compared to nearby retailers and an average of 25.4% price cut 7.

 

The VA/DoD has adopted the Treating Tobacco Use and Dependence Clinical Practice Guideline developed by U.S. Public Health Service, 2008 updated.  There are additional guidelines included by the VA/DoD in the Management of Tobacco Use (MTU) (2008) for addressing tobacco cessation and nicotine dependence among active duty military and veterans.  For the complete guide, click here.

Overview of Pharmacological Recommendations from the MTU:

  • Varenicline:  Only use for individuals who have failed when using NRT, bupropoin, or combination therapy.  Patients should be screened prior to initiation of varenicline for suicidal thoughts or previous suicide attempts and be monitored throughout the course of the medication regimen.  Those with suicidal thoughts in the past 12 months are not eligible for varenicline unless assessed and cleared by a mental health professional.
  • Combination Therapy:  Combination Nicotine Replacement Therapy involves combining the long acting nicotine formulation (i.e. patch) with a short acting option (i.e. gum or lozenge), providing a steady source of nicotine to reduce withdrawal symptoms.  Another viable option is combining the nicotine patch with a bupropion.  Both options have demonstrated improved long term abstinence than any of the avenues alone.  See the MTU for specific effectiveness and abstinence rates for the various options.

 

Last updated: July 23, 2014
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References

1. Barlas, F. M., Higgins, W. B., Pflieger, J. C., & Dicker, K. (2013). 2011 Department of Defense survey of health related behaviors among active duty military personnel. Report prepared for TRICARE Management Activity, Office of the Assistant Secretary of Defense (Health Affairs) and U.S. Coast Guard under Contract No. GS-23F-8182H.

2. Horton, J. L., Phillips, C. J., White, M. R., LeardMann, C. A., & Crum-Cianflone, N. F. (2014). Trends in new U.S. Marine Corps accessions during the recent conflicts in Iraq and Afghanistan.  Military Medicine, 179, 1-62.

3. Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2005–2012.. Morbidity and Mortality Weekly Report 2014;63(02):29–34.

4. Jahnke, S. A., Haddock, C. K., Poston, W. S., Hoffman, K. M., Hughey, J., & Lando, H. A. (2010). A qualitative analysis of the tobacco control climate in the U.S. military. Nicotine and Tobacco Research, 12, 88-95.

5. Institute of Medicine (IOM) : Combating tobacco use in military and vet-eran populations . Washington, DC , National Academies Press , 2009.

6. Bray, R. M., Spira, J. L., Olmsted, K. R., & Hout, J. J. (2010). Behavioral and occupational fitness. Military Medicine, 175(8S), 39-56.

7. Haddock, C. K., Jahnke, S. A., Poston, W. S., & Williams, L. N. (2013). Cigarette prices in military retail: A review and proposal for advancing military health policy. Military Medicine, 178, 563-569.