The overall objective of this study is to develop knowledge to support implementation of effective tobacco control policy in the U.S. military through enhanced civilian engagement. Tobacco use (particularly smoking) is the leading preventable cause of death in the U.S., and smoking prevalence among military personnel remains unacceptably high. Since military involvement in Iraq and Afghanistan, no significant reduction in smoking prevalence has been achieved. Policy changes, such as increased cigarette taxes and clean air laws, have been shown to be more effective than education or individual intervention at reducing smoking, helping reduce civilian smoking prevalence to 20.8%. However, military smoking rates, particularly among those on deployment, remain much higher. Although numerous military tobacco control policies have been issued, their effective implementation has been repeatedly thwarted or weakened by influences outside the military itself, including tobacco industry influence and lack of civilian support. In order to address identified obstacles to effective military tobacco control, we propose to study three key civilian groups: veterans and veterans'services organizations (VSOs), public health leaders and practitioners, and civilian tobacco control policy leaders and practitioners. Based on those findings, we will then develop/pilot an educational intervention targeting these groups to help bridge gaps between civilian and military tobacco control efforts.
The specific aims of this study are to 1) Conduct interviews with leaders of (a) VSOs, (b) civilian public health groups, and (c) tobacco control advocacy organizations in order to explore and describe facilitators and barriers to effective tobacco control advocacy on behalf of active duty service members originating from the public sector;2) Conduct focus groups with members of (a) veterans'groups, (b) public health groups, and (c) tobacco control groups to explore and describe perceptions about military tobacco control;3) Conduct a content analysis of messages directed at the veteran community about tobacco in (a) magazines and newspapers published for veterans, and (b) websites of VSOs;and 4) Based on the findings of Specific Aims #1-3, develop and pilot an educational outreach to leaders and/or members of VSOs, tobacco control and/or public health groups aimed at addressing knowledge gaps about military tobacco control efforts and facilitating support for such efforts.

Public Health Relevance

Tobacco use rates within the U.S. military remain higher than those among civilian populations. Although numerous military tobacco control policies have been issued, their effective implementation has been thwarted by influences outside the military, including lack of strong civilian support. By exploring perceptions about military tobacco control among three key civilian groups: veterans'service organizations, public health groups, and tobacco control groups, and developing and piloting an educational intervention, this study will address knowledge gaps about military tobacco control efforts and facilitate civilian support for them.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZDA1-NXR-B (10))
Program Officer
Reider, Eve
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University of California San Francisco
Other Health Professions
Schools of Nursing
San Francisco
United States
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Smith, E A; Poston, W S C; Haddock, C K et al. (2018) Veterans' views on military tobacco use and tobacco control policy. Mil Behav Health 6:102-107
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Jitnarin, Nattinee; Poston, Walker S C; Haddock, Christopher K et al. (2015) Health in the news: an analysis of magazines coverage of health issues in veterans and military service organizations. Mil Med 180:539-46
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Smith, Elizabeth A; Malone, Ruth E (2013) Military exceptionalism or tobacco exceptionalism: how civilian health leaders' beliefs may impede military tobacco control efforts. Am J Public Health 103:599-604
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