Late Breaking News
Smoking Cessation Efforts Battling Entrenched Tobacco Culture in Military Cont.
- Categorized in: Addiction, Department of Defense (DoD), Department of Veterans Affairs (VA), January 2012
Programs Showing Success
Despite those barriers, the TRICARE program managed by Fitzpatrick has shown success with its marketing techniques to spur smoking cessation. In the past three years, 6% of those who reported visiting the www.ucanquit2.org website reported stopping tobacco use. Many more said they were considering quitting.
The site is promotional and offers referrals to appropriate treatment, not smoking-cessation programs.
Socialization is one of the main tools of that campaign, which focuses on 18- to 24-year-old males on active-duty across the services.
In that cohort, about 40% use some kind of tobacco products, which is statistically higher than the civilian population. What is especially notable, however, is that about 30% of nonsmokers who enlist are smoking by the time they get through basic training and reach their first assignment, Fitzpatrick said.
In many cases, he noted, these young men are “away from home for the first time. They want to fit in, and smoking, in a lot of respects, is a social activity for young people who want to fit in.”
To combat that, the TRICARE smoking-cessation program tells servicemembers “that many of your peers actually disapprove of smoking, that it causes bad breath, smelly clothes and the like and that you’d be better fitting in with the nonsmoking group.”
Another tactic, according to Fitzpatrick, is to “leverage the 18 to 24 mindset of wanting to succeed and want to please others,” and bring in “Make Everyone Proud.”.
That fits in well with the younger generation’s life experience where “everyone gets a trophy,” Fitzpatrick pointed out. “We’ve raised a generation with a very high level of acceptance of expectations. If you quit tobacco, you’ll make peers and loved ones proud of you as well, we tell them.”
If they succeed, he noted, they’ll gain respect from peers and praise from authority figures.
“A lot of military culture is being someone to look up to,” added Widome. So, modeling can be a strong motivator to inspire young servicemembers to quit.
“Something that comes up a lot is talk about family, being the role model in general,” she said. “Their partner might want them to have quit before the baby came. Or they are looking through their kid’s eyes to see how the child sees them as a tobacco user.”
Widome also said pride could be at stake. “I talk to groups of military folks who think that their smoking might impede performance [on physical fitness tests], that it lessens endurance and stuff like that.” Conversely, she said, it is sometimes seen as a “badge of honor” to do well on fitness measures, despite smoking.
Similar attitudes often keep young troops from seeking help with smoking cessation, she noted. “There’s a bit of sense in the culture that ‘I can quit when I want to, cold turkey, do it on my own, alone.’ That is a common sentiment in young adults. They think they are invulnerable, and you tough things out in the military culture.”
Go-it-alone efforts rarely are successful, however, according to Fu. “Tobacco is an addiction. It is hard to quit on your own. The goal is to make available and make it easier for [servicemembers] to access evidence-based treatment.”
A combination of medications and counseling is most effective in helping patients quit smoking, according to Yu, who said that counseling could be one-on-one, in a group, over the telephone or even online.
Prescriptions for smoking cessation generally are increasing. At the VA, for example, the rate of medication use for smoking cessation at VA has increased steadily, from 7-10% before 2003 to 31% in 2008, according to a VA QUERI Update on Treatment of Tobacco Dependence in February.
Yu noted that VA’s patient-centered medical home program will be putting even greater emphasis on smoking cessation with key support personnel available to spearhead it.
Eric A. Dedert, PhD, of the Traumatic Stress & Health Research Laboratory at the Durham, NC, VAMC, told U.S. Medicine that the VA’s electronic medical record also plays a pivotal role in improving smoking-cessation outcomes.
“One of the things we have found, over time, is that smoking tends to be a chronic problem. Patients try to quit smoking but relapse,” Dedert said. “Instead of the model with one short intervention, what seems to work well is interventions with long-term follow-ups.”
These can be achieved with a reminder in the patient’s medical record for primary-care physicians to discuss smoking- cessation efforts at each appointment, he said.
The process is complicated in servicemembers suffering from PTSD, who have an extremely high rate of smoking and unique difficulties in quitting. Some studies have suggested the smoking rate is as high as 45% among those with the disorder.
Dedert published a study in 2011 which found that PTSD smokers experienced worse withdrawal symptoms and greater urges to smoke, whether the smoking-cessation program used positive or negative reinforcement.
The high smoking rates and difficulty giving up tobacco also could account for some of the higher prevalence of cardiovascular and metabolic disease in PTSD.
“The issue of long-term health effects of PTSD is far from settled,” Dedert said. “A few studies I’ve seen look at smoking as one of the explanations for that.”
On the other hand, he added, “there are some effects above and beyond just smoking.”
Researchers are teasing out new methods to reach smokers with PTSD, he said, citing a recent study which found that smoking cessation rates are better if the patients’ existing therapists are trained in smoking-cessation treatment.
“They are already seeing the person,” Dedert said. “That helps with long-term care. [Researchers] found that results in some better rates of cessation.”
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