As noted earlier, combat-related and non–combat-related deployment stress is associated with increased tobacco use (DoD, 2006; Smith et al., 2008). Combat-related stressors, for example, include the need for constant vigilance against enemy attack and the difficulty in distinguishing insurgents from civilians. Noncombat stressors include separation from family and friends, loss of income, and fear of deployment to a war zone (IOM, 2007). The current large-scale military conflicts have put a strain on military and veteran resources. Priority-setting among health-care services has occurred—acute medical-care needs, such as treatment for traumatic brain injury or PTSD, are now a prominent focus of military and veteran health-care resources. For those reasons and others discussed in this chapter, tobacco-use prevention and cessation efforts do not have high priority in the DoD and VA.
Numerous factors interact and contribute to high rates of tobacco use among the military and veteran populations. Evidence-based changes—such as reducing tobacco access, restricting tobacco use through proper enforcement of existing and new policies, and expanding access to effective cessation programs—should not be difficult to attain. Long-term, sustained efforts will be required to achieve broad structural changes, such as changing social norms regarding tobacco among military and veteran populations, continuing the shift away from an association between tobacco and the military, and finding alternatives to coping with the stress and boredom of deployment. The socioecologic framework and evidence from exemplar tobacco-control programs show that factors at multiple levels of influence, from individual attributes to the social and political context, should be addressed to curb tobacco-use rates and generate a tobacco-free culture. All those efforts require leadership, strategic planning, capacity building, proper allocation of resources, and monitoring of process measures and outcomes. The following chapters provide guidance to DoD and VA on what the best approaches to tobacco control are, where DoD and VA stand with respect to the approaches, and the efforts they can undertake to leverage their resources.
American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC: American Psychiatric Publishing.