Assessing Fitness for Military Enlistment Physical, Medical, and Mental Health Standards (2006) / Chapter Skim
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7 Substance Abuse and Cigarette Use
7 Substance Abuse and Cigarette Use
Pages 152-176
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From page 152... ...
ALCOHOL AND DRUG ABUSE Current Requirements and Enlistment Standards The general U.S. Department of Defense (DoD)
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From page 153... ...
Youth Characteristics and Supply Issues Trends in Substance Abuse Current enlistment standards reflect the reality that some consumption of alcohol is commonplace among youth, despite the fact that in most
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From page 154... ...
Moreover, occasional or "recreational" use of marijuana is also fairly common among youth, and the military decided during the early 1990s that occasional use of marijuana would not be disqualifying under moral character standards. Supply issues are therefore more focused on heavy or chronic use of illicit drugs or alcohol, especially when they indicate drug depen
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From page 155... ...
In examining trends in youth characteristics, then, we distinguish between mere use of alcohol or marijuana and more chronic indicators of abuse, such as being drunk or using illicit drugs other than alcohol. The best information on trends in substance abuse for the youth population comes from long-term national surveys conducted by the Monitoring the Future project at the University of Michigan.
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From page 156... ...
The trend patterns are similar to those for the total youth population, but black young women have
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From page 157... ...
SUBSTANCE ABUSE AND CIGARETTE USE 157 100 95 Black 90 85 White 80 Hispanic 75 70 65 60 55 50 45 Percentage 40 35 30 25 20 15 10 5 0 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year FIGURE 7-2a Use of alcohol by young men in the past 30 days. SOURCE: Johnston et al.
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From page 158... ...
158 ASSESSING FITNESS FOR MILITARY ENLISTMENT 100 95 90 White 85 Black 80 75 Hispanic 70 65 60 55 50 45 Percentage 40 35 30 25 20 15 10 5 0 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year FIGURE 7-3a Use of illicit drugs by young men in the past 30 days. SOURCE: Johnston et al.
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From page 159... ...
The very small number of waivers means that attrition rates cannot be reliably measured; therefore, the impact of these two behaviors on attrition rates was not evaluated for these two categories. Regardless of attrition, the number of waivers is so small that there is no reason to change enlistment standards for these two conditions and no reason to consider the effectiveness of in-service treatment programs.
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From page 160... ...
The number of waivers range from 2,000 to 3,000 per year, which is only about 1.5 percent of total accessions. Interestingly, 12-month attrition rates are only slightly elevated for persons with marijuana waivers, by about 3 percent in both years (18 and 17 percent versus 15 and 14 percent, respectively)
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From page 161... ...
First, we have observed only a small number of waivers for alcohol dependence or nonmarijuana drug use, so as long as these numbers remain low, these waivers do not impact appreciably on recruiting numbers. Second, attrition rates for marijuana use are only slightly elevated at the 12-month point, when a cost-performance analysis is most pertinent, because this is the period when the largest training investments occur.
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From page 162... ...
The Worldwide Survey of Substance Abuse Among Military Personnel indicated that the proportion of military members who smoked declined 2 Warning labels were not required on cigarettes sold or distributed through the military system until 1970, five years after the establishment of the requirement for products sold in civilian stores. 3 Although the Harris report suggests that this is higher than in the civilian sector, the National Household Survey on Drug Abuse reports a comparable rate of lifetime smoking for men 35 or older.
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From page 163... ...
Consequently, this section presents a summary of enlistment standards issues with regard to cigarette smoking and discusses steps DoD might consider in dealing with smoking behavior. Youth Characteristics and Supply Issues Figure 7-4 shows trends in cigarette smoking during the past 30 days for all high school seniors from 1977 to 2004.
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From page 164... ...
Unlike illicit substances, cigarette smoking is illegal only for youth under age 18, and many states have aggressive policies that penalize retailers who sell cigarettes to underage youth. Accordingly, the prevalence of cigarette smoking among high school seniors may not accurately reflect smoking behaviors in the total youth population.
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From page 165... ...
What about cigarette smoking among military personnel? Since most first-term military personnel are over age 18, the Monitoring the Future data do not offer a good comparison group for smoking behaviors in the military.
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From page 166... ...
First, there is almost no difference in cigarette smoking rates between military and civilian populations of comparable ages and gender. Second, there is a very substantial difference in smoking rates by age group, especially for men.
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From page 167... ...
The rate of Navy heavy smoking in the DoD survey is similar to its rate of heavy drinking in the Navy study reported in a later section. Cigarette Smoking and Military Performance The fact that younger military and civilian populations have similar rates of smoking says nothing about whether smoking has adverse effects on military performance.
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From page 168... ...
, and the Navy. The Air Force study found that 12-month attrition rates were 19.4 percent for smokers compared with 11.8 percent for nonsmokers.
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From page 169... ...
The prevalence of daily smoking is 32 percent; therefore, excluding daily smokers from the Army would clearly raise recruiting costs appreciably, thereby underscoring the importance of a cost-performance trade-off analysis. In the Navy study, the 12-month attrition of heavy smokers (those smoking at least a pack a day)
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From page 170... ...
On one hand, it is quite likely that some daily smokers smoke less than a pack a day, and therefore heavy smokers are a subset of daily smokers. On the other hand, there is some concern about the representativeness of the Navy sample, because the overall 12month attrition rate of 24 percent is much higher than the 17 percent reported by the Defense Manpower Data Center for the Navy in 2001 and 2002.4 Both studies of Army and Navy recruits suggest a relationship between preservice smoking and behavioral factors.
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From page 171... ...
of heavy smokers; and while 39 percent of nonsmokers admitted to "cutting class" often or occasionally in high school, the comparable proportions were 57 percent for light smokers and 64 percent for heavy smokers. These authors also found that first-term attrition rates are considerably higher for recruits who experienced certain preservice behavioral problems -- such as suspension from high school, trouble with police, cutting class, or causing other disruptions in high school -- than for those who have relatively clean preservice records.
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From page 172... ...
The first is based on the costperformance trade-off model as described in Chapter 3. This method can suggest whether screening daily or heavy smokers would be cost-effective considering the trade-off between the savings from reduced attrition and the increased recruiting costs.
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From page 173... ...
According to this analysis, almost $5 million could be saved if all heavy smokers were disqualified for service in the Navy.5 By screening out heavy smokers, the expected first-year aggregate attrition rate for Navy recruits would decline from 19.7 to 18.1 percent, a decline of 1.6 percent. We now consider whether costs are further reduced if an enlistment standard restricting light smokers is imposed.
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From page 174... ...
If daily smokers in the Army were ineligible to enlist, the savings in reduced attrition costs would be about $38,400,000. However, the additional recruiting costs resulting from eliminating 32 percent of the market more than offset the savings from lower attrition.
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From page 175... ...
Second, given that an appreciable number of applicants with GEDs and alternative certificates will be accepted, the Services could target or give priority to the nonsmokers in this group, who have attrition rates only a few points higher than graduates with high school diplomas. Third, if it became feasible to assess quantity of smoking for applicants with GEDs and alternate certificates, then those who were heavy smokers
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From page 176... ...
However, smoking in the military is no more commonplace than in civilian populations of comparable ages. With respect to military performance, there is evidence that smoking before entry is associated with injury during basic training, probably arising from its adverse effects on numerous physiological characteristics.
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