Recommended tobacco ban for military is a difficult proposition
Stars and Stripes
32 PERCENT — Number of servicemembers who smoke. The highest smoking rates are in the Army (38 percent) and the lowest in the Air Force (26 percent). Deployed servicemembers are 50 percent more likely to smoke.
22 PERCENT – Number of veterans who smoke. About 6 in 10 express interest in quitting.
20 PERCENT – Smoking rate among civilians. An estimated 44.5 million people smoke in the United States, resulting in death or disability for half.
12.2 PERCENT – Rate of smokeless tobacco use in the military.
$5 BILLION – Cost to the Department of Veterans Affairs to treat chronic obstructive pulmonary disease, an ailment that is caused by smoking in 8 of 10 patients.
$564 MILLION – Additional costs of tobacco to the military health system in 2006, primarily from caring for people with cardio-vascular disease and respiratory problems.
$672 MILLION – Tobacco sales revenue at military exchange stores worldwide in 2008
SOURCE: Institute of Medicine “Combating Smoking in Military and Veteran Populations” 2009; Military Medicine “Preliminary Findings from a Clinical Demonstration Project for Veterans Returning from Iraq or Afghanistan” 2008; Navy Exchange and the Army and Air Force Exchange Service
Calls for a ban on tobacco use in the military — a habit that medical experts say saps servicemember health and drains billions in public dollars annually — are growing loud this summer, but the fate of any new regulation is uncertain at best.
In June, the nonprofit Institute of Medicine recommended a phased-in ban across the Department of Defense after the institute completed a study requested by the DOD. When the institute’s recommendations were released, the American Lung Association said the U.S. military should establish a historic tobacco ban much like it moved to end racial segregation and accept women.
But America might not be ready for such landmark change. A shift in national attitudes and rules about tobacco might be needed to make a DOD-wide ban realistic, said Dr. Jack Smith, acting deputy assistant secretary of defense forclinical and program policy.
Smith and others in the DOD say they worry such a big change could hurt military recruitment efforts.
“Tobacco for better or worse is a legal substance,” said Smith, who is reviewing the Institute of Medicine study. A ban would be “radically different than society as a whole.”
The DOD will consider the tobacco recommendations — including immediate bans for new officers and enlisted personnel enforced by urine testing — when it convenes its Medical and Personnel Council in a few months, Smith said.
The board could eventually make tobacco-use recommendations to the secretary of defense. New regulations would require the cooperation of the U.S. Congress, according to the Institute of Medicine.
Sgt. Fred Pedro, an Army recruiter in Albany, N.Y., said the policy of no tobacco in basic training already makes some potential recruits hesitate, and a military-wide ban — enforced by urine testing — could turn off even more prospective enlistees.
“Some folks might have second thoughts, yes,” he said. Testing “is a very, very big step.”
Secretary of Defense Robert Gates drew a line in July following the Institute of Medicine recommendations, saying a downrange ban on tobacco is out of the question.
Neither the Institute of Medicine nor American Lung Association proposed a downrange ban, and both said there should be an exception for war zones. The military has remained protective of cigarettes and tobacco in combat.
Despite the concerns, the military should ban tobacco use everywhere else, said Charles Connor, a retired Navy captain and the president and CEO of the American Lung Association.
“If you look back many decades, the military has led the way on social issues — segregation, gender equality, drug abuse,” Connor said. “There is never really going to be a great time to take on decoupling tobacco from the military.”
There are signs that a ban might be politically possible, he said.
In June, Congress — with the support of senators from tobacco-producing Virginia — gave the U.S. Food and Drug Administration the authority to regulate tobacco for the first time, Connor said.
“I think we need to make a start. Let’s ban smoking for kids who come [into the military] today,” Connor said. “I don’t underestimate the enormity of the task, but I think the [Institute of Medicine] was right to start now.”
The Institute of Medicine and the American Lung Association both back a phased-in elimination of tobacco beginning with a ban on all use among those entering the military.
Both groups also said military tobacco sales are a barrier to cutting use and should be curbed.
Military exchanges around the world made at least $672 million on tobacco in 2008, according to sales figures provided by the Navy Exchange, Army and Air Force Exchange Service and the Marine Corps Exchange system.
A full elimination of tobacco use is possible in less than two decades, said Dr. Stuart Bondurant, lead researcher on the Institute of Medicine’s committee of medical experts.
“At the end of 20 years, most of the current population will no longer be there,” he said. “Many members of the committee felt it could be done in many areas of the military in much less time.”
Bondurant said kicking tobacco could save the military and its health system — and Veterans Affairs Department health services — as much as $100 billion a year when lost productivity and other “collateral damage” is figured in. That’s far more than the tally of medical costs reported by the Institute of Medicine study.
Servicemembers who use tobacco are more likely to drop out of basic training, have poor vision, leave the service within the first year, get sick and miss work, Bondurant and his committee reported.
Bondurant said the ban should begin with officer trainees, because they set an example among the ranks, and new enlisted servicemembers should follow quickly behind.
Some in the military are already pushing a tobacco-free message.
Incoming cadets at the United States Military Academy at West Point, N.Y., are welcomed with medical slide shows of tobacco-damaged lungs, said Christine Polao, a community health nursing counselor at the academy.
“On the very first day, they are briefed on what tobacco does to you,” she said. “It is the individual’s decision whether they pick up that cigarette or chewing tobacco.”
So far, nobody has called for a ban on tobacco use at West Point, but the anti-tobacco message is pushed to cadets throughout their time at the academy, Polao said.
The result is older cadets tend to make the decision to abstain from smoking and tobacco — and pressure younger cadets to do the same, she said.
Studies indicate enlisted servicemembers are more likely to use tobacco, and some in the enlisted ranks baulk at a ban.
“It would just be something else that would make recruiting harder,” said Sgt. Major Rohan M. McDermott of the 198th Infantry Brigade, Fort Benning, Ga. “The average younger person is going to say, ‘I am not going to quit [tobacco] to join the Army.’ ”
McDermott, whose brigade trains the Army infantry, said he was allowed to smoke when he went through basic training 20 years ago, but now recruits must get by without tobacco during the 13 weeks of training.
Recruiters routinely tell prospective recruits that tobacco use is not allowed during boot camp, said Sgt. Greg Williams, an Army recruiter who works out of a mall in Boardman, Ohio.
“They are OK with it,” Williams said. “They weigh both sides of it. They are going to gain training and financial help, and they are willing to do that (give up tobacco for a time).”
But an all-out ban on tobacco could change that can-do attitude among those who come into the recruitment center, he said.
“It is a legal substance,” he said. “I think it would change their opinion about the military in general.”