injured or do not leave early with any greater frequency than recruits who meet the enlistment standards.


Available data indicate that military personnel who have been admitted to military service with an asthma condition have lower attrition rates than those without asthma, although studies show that their health care costs are higher. Some evidence suggests those with asthma that is discovered after enlistment are more likely to drop out during basic training. Currently, asthma that is present at any level of severity precludes participation in the military. It is likely that individuals without symptoms for a prolonged period of time, or even those with mild and infrequent symptoms, could carry out their service requirements, especially if they received optimal medical therapy and self-management education. However, there are costs associated with ensuring timely access of personnel to needed medical therapies and making self-management education available.

Tobacco Use

Cigarette smoking has periodically surfaced as an issue in the U.S. military. 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). 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 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 accession were 1.54 times those of nonsmokers. Finally, recruits who smoke are 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.


Task 4: Develop policy options. Consider a full range of personnel options for ensuring that recruits are healthy and fit for military service.

The results of the committee’s work led to five broad categories of conclusions and recommendations: reducing injuries and attrition, in-

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