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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards
Conclusion: Few persons enter the military with serious substance abuse, but about 1.5 percent of accessions enter with a marijuana waiver. Attrition is not significantly elevated at 12 months of military service for those with marijuana waivers, but it is modestly elevated at 24 and 36 months of service. It is unclear at this point whether a cost-performance analysis would suggest any changes to the current standard, since the savings from reduced training costs may or may not exceed the additional costs of recruiting.
Recommendation 7-1: We recommend that DoD undertake a formal cost-performance trade-off analysis to determine whether a stricter standard for marijuana waivers would be justified on cost-effectiveness grounds.
Results from the DoD Survey of Health-Related Behaviors conducted in 2002 suggest that cigarette smoking is widespread in all branches of the military. This particular survey also indicates that nearly one-third of the military’s smokers brought the habit with them when they joined. Not surprisingly, then, cigarette smoking was found to be most prevalent among members in the junior pay grades, ranging from a rate of nearly 50 percent for junior enlisted personnel (E-1 to E-3), to 24 percent for senior enlisted personnel (E-7 to E-9), to just over 10 percent for junior officers (O-1 to O-3).
One of the most interesting recent discoveries of research on the first-term attrition of new recruits relates to preservice smoking behavior. A series of studies over the past six years produced a variety of interesting findings. An initial Navy study found that attrition from Navy boot camp was nearly twice as high for smokers (15 percent) than for nonsmokers (8 percent). A follow-up study found that differences in attrition between preservice smokers and nonsmokers continued beyond boot camp through the first year of service, leading to the conclusion that the ban on smoking in boot camp was not the primary factor in explaining the higher rates of attrition among smokers. Additional research found that recruits who required some form of enlistment waiver were approximately 1.5 times more likely than their counterparts without a waiver to have smoked before entering military service. A subsequent Air Force study found that preservice smokers were approximately 1.8 times more likely to be discharged during the first year of service than were nonsmokers. A large-scale Army study found that the odds of attrition for soldiers who smoked prior to entering the delayed entry program were 1.54 times those of nonsmokers.