Military tobacco use: A synthesis of the literature on prevalence, factors related to use, and cessation interventions

Abstract

Tobacco use remains the number one cause of preventable morbidity and premature death in the United States. As a result, military leaders are recognizing that tobacco can adversely affect military fitness levels, deployment readiness, and safety and can increase health care costs. Yet military members continue to use tobacco. Tobacco may be viewed as part of the military culture since military members have used tobacco for many decades for pleasure, comfort, and currency and as a morale booster. Most recently, the military has seen an increase in tobacco use among young military members. A number of research studies have examined the prevalence of tobacco and factors related to use in the military, and several have evaluated cessation and prevention interventions. This article provides a brief historical perspective of military tobacco use in the 20th century and a critical review of the literature published between 1991 and 2006 describing prevalence of tobacco use, factors influencing use, and cessation interventions in the military. Recommendations for future research and for interventions are provided.

Differences between intermittent and light daily smokers in a population of U.S. military recruits

“…Despite a decrease in smoking among middle-aged and older adults, young adult smoking prevalence declines are smaller, and reductions in moderate to heavy smoking have been accompanied by an increase in prevalence of light and intermittent smoking ( Pierce, White, & Messer, 2009 ). One group of young adults who demonstrate high rates of smoking are individuals serving in the military ( Bray et al, 2006 ;Nelson & Pederson, 2008 ).…”

“…Despite a decrease in smoking among middle-aged and older adults, young adult smoking prevalence declines are smaller, and reductions in moderate to heavy smoking have been accompanied by an increase in prevalence of light and intermittent smoking ( Pierce, White, & Messer, 2009 ). One group of young adults who demonstrate high rates of smoking are individuals serving in the military ( Bray et al, 2006 ;Nelson & Pederson, 2008 ).Two subgroups of smokers who have received growing attention ( Fiore et al, 2008 ) and have yet to be examined among military personnel are light and intermittent (i.e., nondaily) smokers. Both young adults ( Substance Abuse and Mental Health Services Agency, 2004 ) and ethnic minorities ( Ahluwalia et al, 2006 ;Rodriguez-Esquivel, Cooper, Blow, & Resor, 2009 ;Trinidad et al, 2009 ) are predominant in the military and evidence high rates of low-level smoking.…”

Present and Past Influences on Current Smoking Among HIV-Positive Male Veterans

“…Although we did not find evidence of lasting effects on smoking for veterans with military experience in the remote past, current service personnel still operate within a social context that supports smoking in many ways. Policy changes have lessened some of the tobacco-friendly aspects of military life, but many remain, including reduced costs for cigarettes in canteens and looser guidelines concerning areas and times where smoking is allowed, as contrasted to civilian life (Arvey & Malone, 2008;Nelson & Pederson, 2008). Furthermore, as long as smoking continues to be a valued and shared social activity among enlisted personnel, sustained abstinence will be difficult.…”

“…Several characteristics of military life may serve as incentives to tobacco use, including the lower cost of cigarettes in military facilities, sanctioned smoking work breaks, designated smoking areas, smoking as a social activity, and smoking as a means to relieve boredom or stress (Haddock et al, 2009;Nelson, Pederson, & Lewis, 2009). It has been noted that tobacco use has played a key role in military social culture for decades (Bray & Hourani, 2007;Nelson & Pederson, 2008).…”

“…One study reported that about a third of veterans are smokers (Collie, Clancy, Yeats, & Beckham, 2004), but estimates for Vietnam veterans have been higher (e.g., Lasser et al, 2000). Furthermore, service in the military is often a catalyst to the initiation of smoking (Nelson & Pederson, 2008).…”