WASHINGTON—Like health officials in the general public, military health officials are burdened with the toll that smoking takes on its beneficiaries.

An Institute of Medicine study released in June of this year reported that fewer than one in five Americans uses tobacco, but more than 30% of active-duty military personnel and about 22% of veterans use tobacco. The report also stated that smoking rates among military personnel returning from Iraq and Afghanistan may be 50% higher than rates among nondeployed military personnel.

The estimated annual cost for tobacco-related illnesses and ailments to the MHS is about $1.6 billion dollars a year. “Tobacco is an addictive substance, and even though people who are tobacco users say they want to quit, it is difficult for them. The average smoker who makes an effort to quit has tried about six times before they are successful,” said Dr Jack Smith, the acting deputy assistant secretary for Clinical and Program Policy in the Office of the Assistant Secretary of Defense for Health Affairs.

Reducing Smoking in the Military

A report released last month by the Institute of Medicine confirmed that secondhand-smoke exposure increases the risk of coronary heart disease and heart attacks, and stated that smoking bans reduce the risk. While the impact of secondhand smoke has been well described over the years, Dr Smith said that he expects that the new report “will resonate” with the medical establishment. “We are cognizant of the hazards of secondhand tobacco smoke. We are very motivated to assist people with their efforts to quit the habit if they are willing to do so,” he said.

The military faces challenges in getting its population to quit smoking. Many active duty are young and young people often have a perception that smoking will not harm their health in the short term. “When people are young, the concept that health problems might actually impact them is pretty alien. The fact is, tobacco does impact the young. It causes a decrease in respiratory infections, slows wound healing, affects night vision, and it affects overall fitness,” he said.

There are also cultural challenges unique to the military in reducing tobacco use. “Tobacco has often been associated with the image of what it means to be a military person,” said Dr Smith.

Currently, DoD sponsors a counter marketing campaign to help servicemembers quit smoking called “Quit Tobacco—Make Everyone Proud.” The website, www.ucanquit2.org, has materials to help servicemembers quit smoking.

The National Defense Authorization Act for FY 2009 has also directed Tricare to implement a smoking cessation benefit that will allow DoD to provide smoking cessation counseling treatment interventions and access to patient education materials to non-Medicare eligible beneficiaries. While smoking cessation assistance is already available at military treatment facilities, Tricare was not previously authorized to have a smoking cessation benefit. The new benefit will mean beneficiaries who do not have close access to a military treatment facility will have more options for cessation assistance. “What this change in the Tricare benefit will do is to allow us to provide for counseling and assistance for people who are not able to access the military treatment facilities,” he said.

Doctor Smith said that the future benefit will entail access to a free smoking quit line available 24-hours a day, 7-days a week that will enable beneficiaries who need help quitting to contact a counselor for assistance either by phone or the internet. The change in benefit also requires that Tricare include pharmaceutical agents in its benefit for smoking cessation. “We are working on some regulatory changes that will allow us to provide people with pharmaceutical agents to assist them with their tobacco quit efforts,” he said.

An IoM report commissioned by DoD and the VA released in June of this year titled “Combating Tobacco in Military and Veteran Populations,” recommended that DoD’s smoking cessation efforts go even further. It recommended a smoking ban as a measure to deal with tobacco use.

The report called on DoD to establish a timeline to eliminate all tobacco use on military installations to protect the health of all military personnel, civilian employees, family members, and visitors. “The committee finds that achieving a tobacco-free military begins by closing the pipeline of new tobacco users entering the military and by promoting cessation programs to ensure abstinence. Using a phased approach, the military academies and officer training programs in both universities and the military should become tobacco-free first, followed by new enlisted recruits, and finally all other active-duty personnel,” a report brief stated.

Doctor Smith said that he did not think that “an outright ban” is something that would be “looked at” in the near term, and pointed out that even the IoM recommends that “any move in that direction be phased in over a period of 20 years or more.”

back to November articles