The objective of this study is to develop knowledge that will advance tobacco control policy implementation within the U.S. military. The health of its personnel is critical to the mission of the U.S. military, and smoking negatively affects troop readiness in the short term and health care costs in the longer term. Both of these issues are of heightened concern due to the country's current involvement in conflicts in Iraq and Afghanistan. However, smoking prevalence among military personnel remains unacceptably high, despite declining from 51.0% in 1980 to 30.4% in 2008 (the most recent DOD population survey of tobacco use). Since 2002 no significant reduction in smoking prevalence has been achieved in the military, and smokeless tobacco use has increased slightly. Policy changes, such as increased cigarette taxes and clean indoor air laws, have been shown to be more effective than education or individual intervention at reducing smoking rates. Such policy changes have helped reduce smoking prevalence in the U.S. civilian population from over 50% in 1965 to 20.6% currently. However, although numerous military tobacco control policies have been issued since the 1980s, their effective implementation has been repeatedly thwarted by structural, cultural, and political barriers. This descriptive, multi-method study will develop knowledge that will advance tobacco control efforts within the U.S. military by explicating these barriers to policy implementation, describing the social meanings of tobacco use and cessation within the military context, and identifying best practices in military tobacco control policy implementation.
The specific aims of the project are to:
Aim 1 : Explicate the barriers to effective tobacco control in the military by (a) Assessing the state of leadership on tobacco control among commanders through a content analysis of base commander messages in military installation newspapers;(b): Conduct an economic analysis to determine the cost differential of cigarettes purchased on U.S. military installations and those purchased in their local market;and (c) Retrieve and analyze internal tobacco industry documents in order to describe the tobacco industry's activities pertaining to the four active service branches of the United States (US) military, the Veterans Administration, veterans groups and other military-affiliated organizations.
Aim 2 : Describe the meanings of tobacco use in the military by conducting a set of secondary analyses of qualitative interview and focus group data obtained from military personnel, augmented by data from internal tobacco industry documents, military periodicals, and installation policy language to explore: (a) The construction of tobacco use as a "right" within the military;(b) The experience of starting to smoke in the military;and (c) The experience of quitting smoking in the military.
Aim 3 : Analyze effective tobacco control in the military by identifying key elements associated with successful implementation of a tobacco control policy at the installation level through in-depth case studies of effective policy intervention.

Public Health Relevance

The health of military personnel is critical to the mission of the U.S. Military and tobacco use causes more morbidity and mortality in the military than do obesity, alcohol use, and illicit drug use combined. The purpose of this study is to develop information that will advance tobacco control policy in the armed services. Project goals include explicating barriers to tobacco policy implementation, describing the social meaning of tobacco use and cessation within the military culture, and identifying best practices in military tobacco control policy implementation.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
5R01CA109153-07
Application #
8240034
Study Section
Community Influences on Health Behavior (CIHB)
Program Officer
Djordjevic, Mirjana V
Project Start
2004-07-30
Project End
2016-02-28
Budget Start
2012-03-01
Budget End
2013-02-28
Support Year
7
Fiscal Year
2012
Total Cost
$413,251
Indirect Cost
$45,739
Name
National Development & Research Institutes
Department
Type
DUNS #
080481880
City
New York
State
NY
Country
United States
Zip Code
10010
Lando, Harry A; Michaud, Mark E; Poston, Walker S C et al. (2015) Banning cigarette smoking on US Navy submarines: a case study. Tob Control 24:e188-92
Smith, Elizabeth A; Jahnke, Sara A; Poston, Walker S C et al. (2014) Is it time for a tobacco-free military? N Engl J Med 371:589-91
Smith, Elizabeth A; Malone, Ruth E (2014) Mediatory myths in the U.S. military: tobacco use as "stress relief". Am J Health Promot 29:115-22
Haddock, Christopher K; Jahnke, Sara A; Poston, Walker S C et al. (2013) Cigarette prices in military retail: a review and proposal for advancing military health policy. Mil Med 178:563-9
Offen, Naphtali; Smith, Elizabeth A; Malone, Ruth E (2013) "They're going to die anyway": smoking shelters at veterans' facilities. Am J Public Health 103:604-12
Offen, Naphtali; Arvey, Sarah R; Smith, Elizabeth A et al. (2011) Forcing the Navy to sell cigarettes on ships: how the tobacco industry and politicians torpedoed Navy tobacco control. Am J Public Health 101:404-11
Jahnke, Sara A; Haddock, Christopher K; Poston, W S Carlos et al. (2011) A national survey of cigarette prices at military retail outlets. JAMA 306:2456-7
Jahnke, Sara A; Hoffman, Kevin M; Haddock, C Keith et al. (2011) Military tobacco policies: the good, the bad, and the ugly. Mil Med 176:1382-7
Offen, Naphtali; Smith, Elizabeth A; Malone, Ruth E (2010) "Willful misconduct": how the US government prevented tobacco-disabled veterans from obtaining disability pensions. Am J Public Health 100:1166-73
Poston, Walker S C; Suminski, Richard R; Hoffman, Kevin M et al. (2010) Military line leadership and tobacco control: perspectives of military policy leaders and tobacco control managers. Mil Med 175:811-6

Showing the most recent 10 out of 18 publications