People in the Military or Veterans

Why it Matters

  • Cigarette smoking prevalence is higher among people currently serving in the U.S. military than among the civilian population. Prevalence is even higher among military personnel who have been deployed.1
  • Tobacco use impairs military readiness by reducing physical fitness, impairing visual acuity, and contributing to hearing loss.
  • Tobacco use has a significant financial impact. During 2010, the Veterans Health Administration (VHA) spent an estimated $2.7 billion on smoking-related ambulatory care, prescription drugs, hospitalization, and home health care.2
  • The Department of Defense (DOD) spends more than $1.6 billion per year on tobacco-related medical care.3
  • Historically, the tobacco companies have targeted military personnel with discounted and/or free tobacco products and advertising aimed at active personnel.
  • In 2018, 60.2% of veterans were classified as ever smokers and 14.6% were current smokers. Slightly over half (53.2%) of current smokers made a recent unsuccessful quit attempt.4
  • Veterans who are female and are in care at the VA smoke at the rate of 16.2%, as compared to 15.1% in the civilian population.5
  • Studies have shown that veterans who are female and who quit smoking report significantly fewer depressive symptoms than current smokers.6
  • Current smokers were more heavily represented by people who are under 65 years of age, who are American Indian/Alaska Native non-Hispanic, and those who earned lower incomes, or were uninsured, unemployed, or reporting fair/poor health. Among military veterans, 29.2% of veterans reported current tobacco product use. Cigarettes were the most commonly used tobacco product among veterans at 21.6%.7
  • The rate of tobacco use is declining in the military, similar to non-military populations.
  • 38% of military personnel who smoke started after enlisting.8
  • In 2015, nearly 36% of military personnel reported ever having used e-cigarettes and about 11% identified as daily users of e-cigarettes, an eight-fold and three-fold increase since 2011.9

What We Know About What Works

  • Model efforts on the joint DOD and VA Management of Tobacco Use Working Group that developed the 2004 clinical practice guideline to ensure consistency from active duty personnel to veterans.10
  • Recommendations made by the Institute of Medicine Committee on Smoking Cessation in Military and Veteran Populations:11
    • Prohibit tobacco use anywhere on military installations
    • Stop selling tobacco products in military commissaries – until that is accomplished, sell tobacco products at prices equivalent to civilian prices—requires a policy change to all DOD to do this
    • Support federal policy change to permit VA medical facilities to go entirely smokefree
    • Incorporate evaluation of results into cessation programs (e.g. quit rates) to better learn what approaches are most effective with this population
    • Expand TRICARE coverage to include smokeless and electronic cessation
  • For veterans with post-traumatic stress disorder (PTSD) who smoke, an integrated model of smoking cessation with PTSD providers and staff provider consistent care was found to be effective and superior to standard-of-care smoking cessation programs provided separately from PTSD clinics.12
  • A randomized clinical trial found that proactive tobacco use treatment for veterans (as opposed to reactive in which the tobacco user seeks out cessation support), is an effective way to connect veterans who smoke to evidence-based telephone or in-person smoking cessation services and is effective for increasing long-term population-level cessation rates.13

What’s Relevant in Pennsylvania

  • Pennsylvania’s governor signed a law raising the purchase age for tobacco products to 21 on November 27, 2019, effective 7/1/2020. The policy exempts military service members and veterans.14
  • Adagio Health in Western Pennsylvania provides services targeted to veterans who are female, including wellness and addiction programs.

What Branches of the Military are Doing

Several programs are available to any active duty or retired military

 

Veteran’s Programs

 

Each branch of the military also has cessation services or promotes the Department of Defense programs.

References and Resources

  1. Institute of Medicine. Combating Tobacco in Military and Veteran Populations. Washington: The National Academies Press, 2009.
  2. 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.mm6701a2.
  3. Institute of Medicine. Combating Tobacco in Military and Veteran Populations. Washington: The National Academies Press, 2009.
  4. 2018 Survey of Veteran Enrollees’ Health and Use of Health Care.  January 9, 2019. https://www.va.gov/HEALTHPOLICYPLANNING/SOE2018/2018EnrolleeDataFindingsReport_9January2019Final508Compliant.pdf.
  5. Ibid.
  6. Whitlock, E.P., Ferry, L.H., Burchette, R.J., & Abbey, D. (1995). Smoking characteristics of female veterans. Addictive Behaviors, 20(4), 4009-426.
  7. Odani S., Agaku I., Graffunder C., Tynan M., Armour B., 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.mm6701a2.
  8. US Secretary of Defense. Memorandum for secretaries of the military departments. Washington, DC: US Secretary of Defense; 2016. http://www.med.navy.mil/sites/nmcphc/Documents/health-promotion-wellness/tobaccofree-living/INCOMING-CARTER-Tobacco-Policy-Memo
  9. Meadows, SO, Engel, CM, Collins, RL et al; for Defense Health Agency.2015 Department of Defense Health Related Behaviors Survey (HRBS).  Washington DC: U.S. Defense Health Agency; 2015.
  10. VA/DoD Clinical Practice Guideline for the Management of Tobacco Use. Update Version 2.0a 2004. https://www.healthquality.va.gov/tuc/tuc_fulltext.pdf
  11. Institute of Medicine. Combating Tobacco in Military and Veteran Populations. Washington: The National Academies Press, 2009.
  12. McFall, M., Saxon, A. J., Malte, C. A., Chow, B., Bailey, S., Baker, D. G., Beckham, J. C., Boardman, K. D., Carmody, T. P., Joseph, A. M., Smith, M. W., Shih, M. C., Lu, Y., Holodniy, M., Lavori, P. W., & CSP 519 Study Team. (2010).  Integrating tobacco cessation into mental health care for posttraumatic stress disorder: A randomized controlled trial. Journal of the American Medical Association, 304(22), 2485-2493. doi: 10.1001/jama.2010.1769
  13. Fu SS, van Ryn M, Sherman SE, et al. Proactive tobacco treatment and population-level cessation: a pragmatic randomized clinical trial. JAMA Intern Med. 2014;174(5):671-677. doi:10.1001/jamainternmed.2014.177.  https://pubmed.ncbi.nlm.nih.gov/24615217/
  14. CounterTobacco.org Tobacco 21: https://countertobacco.org/policy/tobacco21/#:~:text=However%2C%20it%20exempts%20active%20duty%20military%20over%
    20age%2018.&text=Pennsylvania’s%20governor%20signed%20a,military%20service%20members%20and%20veterans
    .

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