Problem/Level

Never Smoked

Former Smokers

Current but Not Heavy Smokers

Current Heavy Smokers

Any physical/sexual abuse

Yes

31.5 (1.1)

37.4 (1.6)

39.1 (1.2)

42.7 (2.1)

No

68.5 (1.1)

62.6 (1.6)

60.9 (1.2)

57.3 (2.1)

a Percentage of military personnel by smoking status who reported the stress and mental health problems noted; standard error of each estimate is in parentheses.

SOURCE: Reproduced from DoD (2006).

A 2008 publication from the Millennium Cohort Study, a 21-year longitudinal study of risk factors related to military service, has provided more recent information about tobacco use in the military (Smith et al., 2008). The authors found that military deployment is associated with smoking initiation. Between 2004 and 2006, the prevalence of smoking among the study population increased by 48%; smoking rates increased by 57% among those deployed and by 44% among those not deployed. Of those who reported never having smoked at baseline, 1.3% of nondeployed and 2.3% of deployed reported initiating smoking on entry into the military. Nearly 30% of those who were past smokers at baseline and were not deployed reported resuming smoking; 39.4% of those who were past smokers at baseline and were deployed reported reinitiating the behavior. Combat exposure was found to be associated with smoking: baseline never smokers with combat exposure were at 1.6 times greater risk of initiating smoking, and baseline past smokers with combat exposure were at 1.3 times greater risk of resuming smoking than those who were not exposed to combat (Smith et al., 2008).

In the current conflicts in Iraq and Afghanistan, rates of mental illness and substance-use disorders (for example, alcohol abuse and marijuana use) are increased, and, as described earlier, those with such comorbid conditions are more likely to use and be addicted to tobacco. Hoge et al. (2006) noted that 19.1% of military personnel returning from Iraq met the risk criteria for a mental-health concern compared with about 8.5% of soldiers surveyed before initial deployment to Iraq or Afghanistan. Specifically, the prevalence of PTSD in Iraq war veterans a year after the end of deployment was 16.6%; the predeployment rate in a comparable sample was 5%.

Mental-Health Disorders in Veterans

As stated in Chapter 2, veterans enrolled in the VA health-care system are generally older, are more financially disadvantaged, and have



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