Is It Time for a Tobacco-free Military?

Smith, Elizabeth A.; Jahnke, Sara A.; Poston, Walker S. Carlos; Williams, Larry; Haddock, C. Keith; Schroeder, Steven A.; Malone, Ruth E.

doi:10.1056/nejmp1405976

Cited by 20 publications

(11 citation statements)

References 4 publications

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“…For instance, recent Congressional action requires military exchanges to continue to sell tobacco products. 17 There is a history of Congress stepping in at the behest of the tobacco industry when military tobacco control proponents attempt to establish strong policies, 10,11,18 so there may be reluctance to act aggressively.…”

Section: Discussionmentioning

confidence: 99%

Installation Tobacco Control Programs in the U.S. Military

et al. 2016

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Tobacco use prevalence is unacceptably high in the U.S. military, and the Department of Defense and service branches have implemented tobacco control policies and cessation programs. To explore aspects of programs regarded as exemplary by their services, we visited four installations, nominated by their service's health promotion leaders, and conducted interviews, observations, and focus groups. Installations included Naval Hospital Guam, Tripler Army Medical Center, MacDill Air Force Base, and the Naval Hospital at Marine Corps Air Ground Combat Center Twentynine Palms. The tobacco control managers (TCMs) at the programs studied were all civilian employees, highly motivated and enthusiastic, and had remained in their positions for approximately a decade. Other commonalities included support from command, a “culture” of health, and location in warm climates. Programs varied in their involvement in establishing designated tobacco use areas, and length and requirement of attending cessation classes; however, no evaluation of cessation programs is currently underway. TCMs should be more engaged in policy discussions for the larger installations they serve. A strong policy framework and command support for TCMs will be necessary to achieve the goal of a tobacco-free military.

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Section: Discussionmentioning

confidence: 99%

Installation Tobacco Control Programs in the U.S. Military

et al. 2016

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“…Given the negative impact of tobacco use on health and readiness,1 2 perceptions among military members that low prices support the culture of tobacco use4–5 17 and the military's desire that price not encourage use,6 it is appropriate for the military to strengthen tobacco control efforts. The DoD recently initiated such an action by instructing all services to ensure that tobacco prices “Shall match the prevailing local pricing in the community, including the effect of all applicable taxes that local consumers pay…” (p. 2), which will result in higher exchange tobacco prices 18.…”

Section: Discussionmentioning

confidence: 99%

“…Including tax is an advance; unfortunately, this policy, like the old one, fails to define ‘prevailing’ or ‘local’. The most effective approach to tobacco control would be for the military to become tobacco free 1. Increasing tobacco prices or creating a tobacco-free military will be challenging because tobacco revenues fund important programmes for personnel and because Congress can, and does, influence military policies through the DoD budget process, and some members of Congress are influenced and supported by the tobacco industry 1 5…”

Section: Discussionmentioning

confidence: 99%

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Cigarette prices and community price comparisons in US military retail stores

et al. 2016

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BACKGROUND Tobacco pricing impacts use, yet military retailers sell discounted cigarettes. No systematic research has examined how military retail stores use internal community comparisons to set prices. We analyzed data obtained through a Freedom of Information Act request on community price comparisons used by military retail to set cigarette prices. METHODS Data on cigarette prices were obtained directly from military retailers (exchanges) from January 2013–March 2014. Complete pricing data was provided from exchanges on 114 military installations. RESULTS The average price for a pack of Marlboro cigarettes in military exchanges was $5.51, which was similar to the average lowest community price ($5.45; Mean Difference=−0.06; p=0.104) and almost a $1.00 lower than the average highest price ($6.44). Military retail prices were 2.1%, 6.2%, and 13.7% higher than the lowest, average, and highest community comparisons and 18.2% of exchange prices violated pricing instructions. There was a negative correlation (r = −.21, p = 0.02) between the number of community stores surveyed and exchange cigarette prices. CONCLUSIONS There was no significant difference between prices for cigarettes on military installations and the lowest average community comparison, and in some locations the prices violated DoD policy. US Marine Corps exchanges had the lowest prices, which is of concern given that the Marines also have the highest rates of tobacco use in the DoD. Given the relationship between tobacco product prices and demand, a common minimum (or floor) shelf price for tobacco products should be set for all exchanges and discount coupon redemptions should be prohibited.

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“…Research in populations living in non-conflict stable settings has shown that greater tobacco use and nicotine dependence are associated with both PTSD and common mental disorders such as depression, anxiety and alcohol use 7–15. Similarly, military personnel may use tobacco for perceived stress relief (as well as due to many other reasons such as social norms and access to cheap cigarettes) 16. It might therefore be expected that civilians exposed to conflict may be more vulnerable to heightened tobacco use.…”

Section: Introductionmentioning

confidence: 99%