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Assessing Fitness for Military Enlistment: Physical, Medical, and Mental Health Standards
Recruits who smoked were considerably more likely than nonsmokers to have had behavioral problems before enlistment, including high school misbehavior, criminal offenses, drug use, psychological difficulties, and trouble in dealing with authority. Thus preservice smoking is linked with some psychological factor or behavioral predisposition that raises the risk of being discharged early from the military. Interestingly, these smoking effects are independent of education, which has long been recognized as having a strong link to attrition.
Conclusion: Smoking in the military is no more commonplace than in civilian populations of comparable ages. Smoking before entry is associated with injury during basic training, probably arising from its adverse effects on numerous physiological characteristics. Studies across the Services show elevated attrition rates for smokers, although the degree of elevation differs appreciably among the Services, perhaps due to different definitions of the frequency and quantity of smoking. It is clear that screening out all smokers or even frequent smokers would not be feasible simply because of their prevalence. Since smoking is correlated with other recruit characteristics related to lower performance outcomes, further research might identify subgroups of recruits with a set of behavioral characteristics that justify higher priority on entry than other subgroups.
Recommendation 7-2: Further research is needed on the relationship between preservice smoking and military performance, including attrition and other indicators. The research should be conducted across the Services using the same definitions of frequency and quantity of smoking, and the correlates of smoking with other recruit characteristics should be studied. Studies should include the costs and benefits of policy and force management options for dealing with the issue of preservice smoking.
RECOMMENDATIONS AND POLICY OPTIONS
This volume has examined a wide variety of aspects of military recruitment, including issues of physical fitness, body mass and obesity, medical conditions, mental health, and drug and tobacco use. The results of the committee’s work led to five broad categories of conclusions and recommendations: reducing injuries and attrition, increasing the pool of eligible youth, developing databases and procedures needed to study the relationship between standards and outcomes, identifying standards that need further investigation, and identifying standards that should be retained.