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Combating Tobacco Use in Military and Veteran Populations
In the sections below, the committee considers selected military populations that might require specialized tobacco-prevention and -cessation treatments: military personnel with mental-health disorders, particularly posttraumatic stress disorder (PTSD); smokeless-tobacco and dual tobacco users; deployed personnel; women; and National Guard personnel and reservists. Among the military populations that might be targeted for tailored interventions are those who indulge in high-risk drinking. Williams et al. (2002) found that high-risk military drinkers (those that responded positively to 2 or more CAGE2 assessment questions) tended to be enlisted male soldiers who were young, white, never married, had a high-school education or lower, and had a military occupational specialty of infantry or craftsworker. These men were also more likely to drive more than 15 miles over the speed limit, wear a seatbelt less often, and smoke more than a pack of cigarettes per day (Williams et al., 2002).
Tobacco Users with Mental-Health Disorders
Many active-duty personnel have been wounded, both physically and mentally, during deployment. The data suggest that treating tobacco use in military personnel who have mental-health disorders is important for the health of military personnel and their dependents. Of the almost 1.7 million military personnel who have been deployed to Iraq and Afghanistan, 5–17% met the screening criteria for PTSD on return, 7–17% met the screening criteria for anxiety disorders, 7–15% met the screening criteria for depression, and 18–35% indicated some level of alcohol misuse (Hoge et al., 2004, 2006). The rates of PTSD symptoms increased 3–6 months after return from deployment and were highest (24.5%) in National Guard and reserve personnel (Milliken et al., 2007). Tobacco use in military members with PTSD has been estimated to range from over 32% (DoD, 2006) to almost 50% (Smith et al., 2008). The 2008 suicide rate in the Army was estimated to be 20.2 per 100,000 soldiers, higher than the national average of 19.2 per 100,000 (Kuehn, 2009). Tobacco use by deployed military personnel is higher than for nondeployed personnel (see Chapter 3).
CAGE is an acronym formed from the following four questions: (1) Have you ever felt you should cut down on your drinking? (2) Have people annoyed you by criticizing your drinking? (3) Have you ever felt bad or guilty about your drinking? (4) Have you ever had a drink first thing in the morning (as an “eye opener”) to steady your nerves or get rid of a hangover? Available at: https://www.merck.healthinkonline.com/merckTools/AssessMerckSourceCAGE.asp (accessed March 4, 2009).