United States military tobacco policies: A mixed-methods study.

摘要

The tobacco industry has a long history of marketing its' products to the U.S. military including cigarettes being distributed to soldiers in K- and C-rations as recent as 1975. Research has demonstrated that across the four armed services tobacco use increases health and personnel costs, reduces troop health and readiness, and is the single best predictor of premature discharge. Despite the negative impact on the health and readiness of military personnel and scientific evidence that tobacco is responsible for over 430,000 deaths each year in the U.S and harms nearly every major organ in the human body, the prevalence rates of tobacco use in the military remain above their civilian counterparts. Even as tobacco use among military personnel has decreased in the past few decades, it continues to remain unacceptably high in spite of military public health efforts to the contrary. In fact, in areas such as smokeless tobacco use the prevalence rates among military members has increased significantly in the last several years. Therefore, there is a pressing need for an appropriate policy intervention within the U.S. military. Policy interventions are among the most cost-effective methods of controlling tobacco use and preventing subsequent morbidity and mortality. This study retrieved and, using an extensive mixed-methods methodology, examined 218 military tobacco policies from across all four services worldwide as well from the Department of Defense in order to identify areas of policy intervention. The findings from this study suggest military tobacco policy should be strengthened. For instance, military tobacco policies contain mixed messages about tobacco, lack of consistency of content, and often omit critical information contained in higher level policies or in the policies of other military branches. Policy weaknesses serve as an enabler to the unacceptably high prevalence rates among personnel which are alarming given the overwhelming scientific evidence that strong tobacco policy can effectively reduce use. This is the first comprehensive examination of tobacco policies of its kind within the military and recommendations targeting specific areas for the next generation of tobacco control policies are developed and discussed.