correlates of smoking may offer important clues and insight as to why preservice smokers, regardless of education or other demographic factors, have a consistently higher rate of first-term attrition from the military.

The following sections discuss two ways in which smoking behaviors could be used in the screening process. The first is based on the cost-performance trade-off model as described in Chapter 3. This method can suggest whether screening daily or heavy smokers would be cost-effective considering the trade-off between the savings from reduced attrition and the increased recruiting costs. It is crucial to note that this discussion represents the hypothetical situation in which information about an individual’s smoking status is known. In an operational setting, reliance on self-reports of smoking is probably not feasible. Awareness that smoking at some level is disqualifying would in all likelihood result in underreporting, if not complete denial, of smoking. However, it is useful to determine whether or not it would be cost-effective to screen out some (e.g., heavy) smokers were it possible to identify them accurately.

The second approach is a less formal analysis of the relationship between smoking and a variety of other behavioral factors, especially those that are already used in screening, such as education. This approach is based on the likelihood that smoking can serve as a marker for a set of behaviors linked to attrition that are more feasibly assessed during the screening process. The identification of factors accounting for the smoking-attrition link may lead to mechanisms for screening these factors directly.

Cost-Performance Trade-off Analysis

The cost-performance trade-off model tries to answer the question of whether the savings in lower attrition costs will more than compensate for the higher recruiting costs if heavy or daily smokers are disqualified for enlistment. We try to answer this using the Army and Navy smoking attrition and prevalence data shown in Table 7-4. We reiterate that this analysis represents an exercise to determine the consequences of screening out some categories of smokers should it be possible to identify smoking status at point of entry. The committee recognizes that smoking status relies on self-report, and that accurate self-reports cannot be expected in an environment in which recruits know that certain levels of smoking are disqualifying.

The Navy Example

In Figure 7-6, we consider the costs and benefits of reducing the proportion of heavy smokers among recruits by 25, 50, and 100 percent.



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