08 July 2009

Headlines: Can the Military Ban Smoking?

From Air Force Times

Health officials to military: Ban smoking

By Kelly Kennedy - Staff writer
Posted : Tuesday Jun 30, 2009 16:53:16 EDT

Medical experts say they have a solution for the military’s increasing smoking rates:

Ban it.

And not just in basic training — stop selling cigarettes and chewing tobacco on post, stop with the discounts at the PX, don’t allow it in hospitals, and come up with a deadline when everyone should be smoke-free.

Why? It cost the Veterans Affairs Department $5 billion to treat smoking-related emphysema in 2008, and in 2006, the Military Health System spent about $564 million on tobacco-related costs.

That’s almost as much as the $611 million worth of tobacco military stores sold in 2005.

According to the Committee on Smoking Cessation in Military and Veteran Populations, in a report from the Institute of Medicine of the National Academies, the math just doesn’t add up for an organization that depends on physical fitness from its employees.

It’s not just money. Smokers are more likely to drop out of the military before they fulfill their enlistment commitments; they have worse vision and night-vision; they don’t perform as well on fitness tests; and they miss more work.

On the battlefield, they bleed harder after surgery, heal slower after injury and are at higher risk for infection.

After deploying to Iraq or Afghanistan, smokers return home only to face a startling statistic: About half of them will eventually die from a smoking-related illness, according to the Institute of Medicine report. They face cancer, stroke, heart disease, emphysema and diabetes.

“These troops are essentially putting their lives at risk twice: once in service to their country and once in service to tobacco,” wrote Stuart Bondurant, chair of the committee. “Tobacco is a long-term engagement — it kills slowly and insidiously.”

Even the good news was mixed with bad: In 1980, 51 percent of the military smoked. That had dropped to 32 percent in 2005, but it has been going back up. In the VA health system, 22 percent of patients smoke.

Though the committee determined both the Defense Department and VA are doing some things right — such as anti-smoking campaigns and, for the VA, smoking-cessation programs — they’re far behind on other measures.

“DoD and each of the armed services have a stated goal of a tobacco-free military, but tobacco-control efforts have not been given high priority by the Office of the Assistant Secretary of Defense for Health Affairs or the individual services’ Office of the Surgeon General,” the report states. And, “The committee believes that DoD should not subsidize an activity that adversely affects military health and readiness.”

In other words, why are cigarettes cheaper on-post?

The committee acknowledged that the military and VA face special challenges: Troops tend to take up smoking when they deploy, and cigarettes are highly addictive. That means they’re less likely to stop when they get home. In fact, 50 percent of smokers attempt to stop every year, but only between 4 and 7 percent succeed.

And, people with depression or post-traumatic stress disorder are more likely to smoke.

“That is of concern, given the increased numbers of veterans returning from the conflicts in Iraq and Afghanistan with PTSD and the number of Vietnam veterans who have PTSD,” the report states.

The committee recommended:

* Making sure troops and veterans know that smoking-cessation programs exist.

* Making sure those programs are consistent and evidence-based.

* Making VA and military health-care facilities smoke-free.

* Banning smoking in military academies, officer candidate schools and Reserve Officer Training Corps programs.

* Eliminating the sale of tobacco at all military installations

* Setting a specific, mandatory date by which the military will be tobacco-free.

From Stars & Stripes

Panel suggests eliminating tobacco from military within 20 years
By Travis J. Tritten, Stars and Stripes
Online edition, Tuesday, July 1, 2009

A complete ban on tobacco in the military is needed but would likely take about 20 years, according to a new Institute of Medicine study commissioned by the departments of Defense and Veterans Affairs.

The ban is possible if the DOD begins to "close the pipeline of new tobacco users entering the military" and slowly cuts off supplies of cigarettes and smokeless tobacco, the Committee on Smoking Cessation in Military and Veteran Populations found in its study, which was released Friday.

The DOD and VA asked the institute for recommendations on how to deal with smoking among servicemembers.

The study gives a bleak account of the health and financial toll tobacco takes on the military, which has nearly twice the smoking rate of the civilian population.

More than 30 percent of servicemembers smoke or use tobacco, though smokeless tobacco use is less certain. Those people are more likely to drop out of basic training, have poor vision, leave the service within the first year, get sick and miss work, according to the study findings.

The 15-member committee of doctors and health care professionals said the best way to reduce the problem is to eliminate it through a phased-in tobacco ban across the services.

First, officer academies and basic training should go smoke-free and enforce the rule through urine screening. Those who test positive for nicotine could be required to take smoking cessation therapy.

All services could be free of tobacco in 20 years — if the recruit screening begins within one year, the committee said.

The study also recommended that all military installations should move toward a ban on tobacco sales by barring Army and Air Force grocery stores from selling tobacco products and increasing prices at exchange stores. The Navy and Marine Corps already have stopped selling tobacco in their commissaries.

“At the same time that tobacco results in high health care costs and productivity losses for DOD, the department earns substantial net revenues from the sale of tobacco products in military commissaries and exchanges,” the committee wrote.

The conflict of interest has made changing tobacco sales policies difficult.

In 2005, the military sold $611 million worth of tobacco and $88 million was pumped back into community programs at military installations.

But those proceeds are dwarfed by the health care costs of treating sick smokers.

The military health system spent $564 million on smoking-related illnesses in 2006. The VA spent over $5 billion in 2005 to treat a common respiratory ailment that is caused by smoking, the study said.

Meanwhile, the military needs additional focus on smoking cessation programs, which are made available to servicemembers hoping to quit.

The NIH researchers said many in the DOD have avoided pressuring smokers deployed to war zones to enter smoking cessation programs, and they had trouble finding DOD documentation on whether those smoking cessation programs were helping people quit.

“This does not inspire confidence that the programs are meeting the needs of military personnel and it prevents contributions from outside personnel on how the programs might be improved,” researchers wrote.

The cessation programs should be improved and even deployed servicemembers must be encouraged to quit tobacco by commanders, the committee recommended.

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