Why Do So Many Veterans Smoke Cigarettes?

Tacit approval of cigarette smoking by the military is a key factor in the elevated number of military veterans who smoke as compared to civilians. Cigarettes were issued with rations as early as 1942, and this practice did not stop until 1975 (Feeney, Askew, & Jezior, 1995; Joseph, Muggli, Pearson, & Lando, 2005). Various efforts to discourage the availability of tobacco and tobacco use have failed. For example, in 1986 the US Navy announced it would be smoke free by 2000, but this announcement was rescinded by 1993 (Offen, Arvey, Smith, & Malone, 2011). Similarly, an attempt to ban smoking on an aircraft carrier, the USS Roosevelt, was met with lobbying by the tobacco industry, and the smoking ban was reversed (Offen et al., 2011). A survey of Air Force personnel indicated that while the Air Force officially supported tobacco cessation, this policy was not carried down through the ranks to the front line personnel (Lando-King et al., 2017)

Several studies show that veterans are more likely to smoke than non-veterans, with smoking prevalence between 2003 – 2007 among veterans at 27% as compared to non-veterans at 21% (Brown, 2010; Cypel et al., 2016). Almost 30% of veterans reported using tobacco in the previous 30 days, and this percentage increases to 41% among student veterans (Albright et al., 2018; Satomi, Agaku, Graffunder, Tynan, & Armour, 2018). Deployment is associated with smoking, with 6.1 – 6.8% military personnel reporting that they started smoking on deployment, and 22.7-28.2% of smokers who had previously quit smoking then restarted smoking on deployment (Boyko et al., 2015). The systemic approval to smoke continues after active duty service, with VA hospitals and properties providing smoking shelters (Offen, Smith, & Malone, 2013). Understanding the historical perspective is important for healthcare personnel to assist veterans with smoking cessation, given the long range health consequences of cigarette smoking.