Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Active Military/Veterans

Active Military/Veterans

Active military members and military veterans are disproportionately affected by tobacco use. the Department of Defense (DoD) has enforced efforts to reduce smoking in the armed forces.1 Resources for cessation are listed below:

External Resources 
Tricare Tobacco Cessation – Insurance covered resources/programs for quitting tobacco

Smokefree VET - Text message support program for veterans quitting tobacco 

Are You A Smoker? - Maryland Veteran’s Affairs contact information for tobacco cessation clinicians.

Tobacco and Health - US Veteran’s Affairs smoking quitline, cessation tips, and counseling services 

You Can Quit 2 - DoD website containing cessation tools and resources for service members

Military Culture and Tobacco Use: 

While 50.0% of active service members reported leadership deterring cigarette use in 2011, as of 2015, this has dropped down to 25.6%.1,2 Military branch leaders and tobacco control managers report that inconsistent support from military commanders has been a weakness in the military’s tobacco control program.3

Tobacco companies have been found to target military installations by advertising towards military service members and providing free samples to military installations.3 In the past, cigarette vendors located on military bases sold cigarettes at discounted rates to military personell.3 An executive order issued by the Secretary of Defense in 2016 ended this decades long discount.4  This order also outlined objectives for increasing education on the dangers of tobacco use, increasing tobacco cessation services, and limiting secondhand smoke exposure on military installations.4

Current Tobacco Use Trends: 

Active Military: 

Cigarette smoking among active military service members was 24% in 2011 and in 2015 had decreased to 13.8%, a lower figure than cigarette use in the general population (16.9%). 1,2 In contrast, e-cigarette use among this population had increased to 11.1%; a threefold increase since 2011.1 Smokeless tobacco use is also high, with 12.7% of service members reporting use in the last 30 days, compared to 3.4% in the general population.1

Combat assignment may play an additional role in tobacco use, since individuals deployed to combat zones are significantly more likely to be current and/or heavy smokers than those who had not been combat deployed. 1,2

Veterans: 

In 2015, 29.2% of U.S. veterans reported they were current cigarette smokers, compared to the national average of 20.1%.2,5 Most current smokers receiving medical care from the Department of Veterans Affairs (VA) are between 45 and 64 years old and earn less than $36,000 yearly.6 Amongst veterans attending a VA substance use program in 2012 59.0% reported current tobacco use.7 Additionally, rates of current tobacco use were higher among veterans who reported experiencing serious psychological distress (48.2%) than among veterans without PTSD (28.5%).1

Effects of Tobacco Use: 

Active Military: 

Smoking in the military has serious implications for military readiness, including:

• reduced oxygen capacity/exercise duration and night vision capacity 8
• greater frequency of hearing loss, absenteeism, and motor vehicle accidents 8

Active military members are impacted by withdrawal symptoms when smoking breaks are not available. This is evidenced by smokers experiencing lower vigilance and cognitive function, poorer performance in flying/diving exercises, and irritability/moodiness.8 Active military members who identified as heavy cigarette users were also more likely to report mental health symptoms. This subpopulation experienced an increase of overall stress (61.1%), anxiety (35.4%), depression (21.2%), and PTSD symptoms (16.2%).Barlas 2013 In total, the DoD spends over $1.6 billion annually in tobacco related costs, including tobacco related health care, increased hospitalizations, and lost days of work.8

Veterans: 

Due to historically higher smoking levels among active duty military personnel, tobacco use is a major cause of chronic disease, disability, and death among veterans.6 Over the next 10 years, the VA projects that $19.685 billion will go towards smoking-related healthcare expenses.6

Tobacco Cessation: 

Active Military: 

TRICARE, the DoD health insurance plan offered to service members, offers cessation resources including counseling and tobacco cessation medications. However, deployed service members are often unable to utilize these resources. The stress of war/military conflict often limits service members’ ability to seek and complete treatment.9 Researchers with The Institute of Medicine’s Committee on Smoking Cessation posit that a larger solution to military tobacco use may be achieved a combination of smoking initiation prevention amongst recruits, initiating tobacco control polices, and expanding evidence-based cessation for those seeking treatment.6

Veterans

The VA is working to increase accessibility to tobacco cessation aids using evidence-based initiatives. Specifically, the VA has expanded access to tobacco cessation medications, eliminated copayments for smoking cessation counseling, and incorporated smoking cessation into healthcare for the veteran mental-health population.  

Despite these strides, tobacco cessation is not properly emphasized.6,10  While counseling and tobacco-cessation resources are offered, they are often underused. A study in 2016 found that only 3.8% of veterans who currently smoke utilized the VA’s cessation programs.10 It’s been estimated that if the VA were to increase supply of cessation services by 1 visit for every 100 veterans, tobacco-cessation counseling involvement would increase by 35%.10

Several controlled trials have established effective cessation services tailored to the veteran population.11,12 These advancements in cessation research and treatment, servicing those who served our country, will hopefully lead to higher cessation rates and more years lived.   

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References: 
  1. Meadows, S. O., Engel, C. C., Collins, R. L., Beckman, R. L., Cefalu, M., Hawes-Dawson, J., Doyle, M., Kress, A. M., Sontag-Padilla, L., Ramchand, R., & Williams, K. M. (2018). 2015 Department of Defense Health Related Behaviors Survey (HRBS). Rand health quarterly, 8(2), 5. https://pubmed.ncbi.nlm.nih.gov/30323988/
  2. 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.https://www.murray.senate.gov/public/_cache/files/889efd07-2475-40ee-b3b0-508947957a0f/final-2011-hrb-active-duty-survey-report.pdf?TB_iframe=true&width=921.6&height=6075.9
  3. 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 & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 12(2), 88–95. https://doi.org/10.1093/ntr/ntp181
  4. Carter A. Policy Memorandum 16-001,(2016) Department of Defense Tobacco Policy. Department of Defense. https://www.med.navy.mil/sites/nmcphc/Documents/health-promotion-wellness/tobacco-free-living/INCOMING-CARTER-Tobacco-Policy-Memo.pdf
  5. Odani S, Agaku IT, Graffunder CM, Tynan MA, Armour BS. Tobacco Product Use Among Military Veterans — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2018;67:7–12. DOI: http://dx.doi.org/10.15585/mmwr.mm6701a2external icon
  6. Institute of Medicine (US) Committee on Smoking Cessation in Military and Veteran Populations; Bondurant S, Wedge R, editors. Combating Tobacco Use in Military and Veteran Populations. Washington (DC): National Academies Press (US); 2009. Committee on Smoking Cessation in Military and Veteran Populations. https://www.ncbi.nlm.nih.gov/books/NBK215339/
  7. Gass, Julie C., Morris, David H., Winters, Jamie., VanderVeen, Joseph W., Chermack, Stephen (2017). Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorder clinic. Journal of Substance Abuse Treatment,84(2018), 18. Doi: https://doi.org/10.1016/j.jsat.2017.10.006
  8. Bray, R. M., Spira, J. L., Olmsted, K. R., & Hout, J. J. (2010). Behavioral and occupational fitness. Military Medicine, 175(8S), 39-56.  http://proxy-bc.researchport.umd.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,uid&db=hch&AN=52894944&site=eds-live&scope=site 
  9. Department of Veterans Affairs (2011). 2011 Survey of Veteran Enrollees’ Health and Reliance upon VA: With Selected Comparison to the 1999-2010 Surveys. Veterans Health Administration. https://www.va.gov/HEALTHPOLICYPLANNING/SOE2018/2018EnrolleeDataFindingsReport_9January2019Final508Compliant.pdf
  10. Kelly, Megan M., Sido, Hanah., Rosenheck, Robert (2016). Rates and Correlates of Tobacco Cessation Services Use Nationally in the Veterans Health Administration. Psychological Services, 13 (2), 183-192. Doi: http://dx.doi.org/10.1037/ser0000076  
  11. McFall, M., et. al. (2010). Integrating tobacco cessation into mental health care for posttraumatic stress disorder: a randomized controlled trial. Journal of American Medical Association, 304(22), 2485-93. doi: http://dx.doi.org/10.1001/jama.2010.1769
  12. Rogers, E., et. al. (2016). Telephone smoking-cessation counseling for smokers in mental health clinics: a patient-randomized controlled trial. American Journal of Preventive Medicine, 50(4), 518-527. doi: http://dx.doi.org/10.1016/j.amepre.2015.10.004.