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Combating Tobacco Use in Military and Veteran Populations
disease, neoplasms, and respiratory disease accounted for virtually all these deaths (Helyer et al., 1998).
Since the 1960s, as the deleterious effects of tobacco have become more widely known, its use in both military and civilian populations has decreased. In 1964, almost half the US general population smoked, as did an equal proportion of military personnel; by 2005, the proportion had decreased by more than half in the general population but was still 32% in military personnel (DoD, 2006). The sharp drop in the prevalence of tobacco use was the result of numerous national and state programs tailored to schools, businesses, and healthcare facilities, such as a national education campaign aimed specifically at youth who were most at risk for tobacco initiation, a public-health campaign highlighting the dangers of smoking and of secondhand smoke, advances in treatment for tobacco use, prohibition of the use of tobacco products in public and private areas by facilities and locales, explicit recognition of the rights of nonsmokers to a tobacco-free environment, and the efforts of many states to curb tobacco use through increased taxes.
Many of the education campaigns and restrictions on tobacco use have been extended to DoD and VA and have resulted in a decrease in tobacco use among service members and veterans. Recently, however, possibly as a result of deployments to Iraq and Afghanistan, tobacco use has increased among soldiers and marines serving in and returning from those areas.
The military and veteran populations differ in some respects from the general US population. For example, military populations are overwhelmingly male, younger, healthier, and less educated; veteran populations are predominantly male, older, of lower socioeconomic status, and are more likely to be in poorer general health than either the military population or the general population. The populations considered in this report include military retirees and, to a lesser extent, spouses and dependents; the veteran populations considered are primarily men and women eligible to receive health care through the Veterans Health Administration. This unique combination of demographic factors may require some modification of general-population tobacco-control programs to address the specific needs of military and veteran populations.
Despite the obvious benefits to military readiness and to the health of service members and veterans of reducing tobacco use, there is a perceived right among deployed military personnel to use tobacco. For instance, some military and civilian decision-makers do not believe that those willing to risk their lives for their country should be told or even be encouraged to quit using tobacco, particularly while they are deployed to