Hi, my name is Rhodri Dierst-Davies, an evaluation specialist with Deloitte Consulting LLP working out of our Government & Public Services (GPS) practice. Similar to civilian populations, the use of electronic cigarettes (e-cigarettes) has steadily increased among Active Duty and Reserve personnel over the past decade. While e-cigarettes are now more popular than traditional cigarettes among military populations, the public health response is still far behind that of other tobacco products.
Tobacco use and the Military: A Complex Story
The United States military has long history with tobacco use among active duty personnel. Smoking became more closely associated with military service during World War I, when cigarettes were provided in servicemen rations. Tobacco use continued to play a role in military culture, as service members report using it for pleasure, comfort, and to boost morale. Starting around 1980, when smoking prevalence rates were approximately 50%, Department of Defense (DoD) leadership began to recognize the serious health effects of tobacco use being promoted by public health officials nationally, and the indirect effects it may have been having on deployment readiness. Beginning with DoD Directive 1010.10 in 1986, the military more publicly recognized the health effects of smoking and began aggressive smoking secession campaigns.
Changing Patterns of Tobacco Use Among Military Populations
Starting in the 1990’s smoking prevalence began to decrease among military populations. According to the 2015 Health Related Behaviors survey (HRB),1 an annual survey of service members health, health behaviors, and overall well-being, approximately 13.9% of service members are classified as current smokers. According the CDC,2 this is less than estimated 16.8% of adult US population who are classified as current smokers and nearly half of what it was in 2011 among military personnel.
While traditional cigarette use has declined among military populations, a sharp increase in e-cigarettes has been observed over the same timeframe. According to the 2015 HRB survey 35.7% of service members reported using e-cigarettes in 2015, almost eight times greater than in 2011. More disturbing is that among this group 11.1% reported being daily e-cigarette smokers, a three-fold increase since 2011. A study of Air Force recruits revealed that regular e-cigarette users were predominantly male, under the age of 21, non-Hispanic white, single, and have lower levels of education.3
What is being done
The true public health impacts of e-cigarettes are still being revealed, but recent reports of lung damage among younger users has once again ignited the debate of its safety.4 Many smoking cessation programs struggle with how to contextualize e-cigarettes, as some still support its use as a harm reduction tool to decrease traditional cigarette use. In 2016 both the DoD, and the Army Surgeon General classified e-cigarettes in the same category as other traditional tobacco products, regulating their use at military facilities and instillations.5 Despite this policy change, few programs focus on e-cigarettes specifically have emerged for military personnel. Based on these realities it is clear there is an opportunity for both program developers and evaluators to help facilitate evidence-based practices to help the military grapple with this emerging crisis.
- DOI: 10.1016/j.amepre.2015.02.019
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