II (19%), Korea (18%), and during the Gulf War era (1991-2001) (13%). Of those using the VA health-care system, 60% have no private or Medigap insurance; and two-thirds of veterans enrolled in the VA healthcare system have an annual income of less than $20,000/year. Of enrolled veterans, 84% are white, 10% are black, 4.6% are American Indian or Alaskan Native, 0.7% are Asian, and 0.5% are native Hawaiian and other Pacific Islander (VA, 2006a).

In 2004 (the most recent year for which data are available), the national unemployment rate of VA enrollees was estimated to be 15.6%, which is substantially higher than the average annual unemployment rate of 5.5% in the general population. VA attributes that high rate to higher rates of disability. A 2007 survey of recently separated veterans, most of whom had served in Iraq or Afghanistan, found that 18% were unemployed; of those who were employed, 25% earned less than $22,000/year (VA, 2008a). In 2005, nearly 67% of the veteran enrollees in the VA health-care system were married, 15% were divorced, 9% had never been married, 7% were widowed, and 2% were separated from their spouses (VA, 2006a).

Tobacco Use in Military Populations

Centers for Disease Control and Prevention estimates of smoking prevalence in the general population show that 19.8% of adults in the United States were smokers in 2007, a slight decline from 20.8% in 2006 (CDC, 2008a). Smoking prevalence was higher among men (22.3%) than among women (17.4%) (CDC, 2008a).

Although tobacco use has declined since World War II among military personnel, it remains an important issue for DoD and VA. A series of surveys of health-related behaviors in active-duty military personnel showed that tobacco use within the 30 days before a survey decreased from 51.0% in 1980 to 32.2% in 2005 (see Figure 2-1); this trend was observed consistently among all the services (DoD, 2006b). Smoking rates in 2005 among 18–25 year old military men (42.4%) and women (29.2%) (overall rate, 40.0%) were higher than the overall rate among their civilian counterparts (35.4%) (DoD, 2006b). Despite the decline, there had recently been an increase (within the preceding 30 days) from 1998 (29.9%) to 2005 (32.2%) among the services (DoD, 2006b).

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