Soldiers and Smoking

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Broken cigarettesMADISON - About 50 percent of soldiers deployed to Iraq return addicted to tobacco.

Of that group, about half will die prematurely from smoking-related disease if they are unable to break free of tobacco addiction.

On average, the use of tobacco will deprive those soldiers of 10 to 14 years of life and for many, poor health will compromise the quality of those years.

"Soldiers are going to war zones in Iraq," says Dr. Michael Fiore, head of the Center for Tobacco Research and Intervention at the University of Wisconsin School of Medicine and Public Health, "and, God willing, they survive the imminent risks of that deployment. But they often return addicted to tobacco – a powerful addiction that puts them at risk of collateral damage for the rest of their lives."

A veteran of the United States Army Reserves himself, Fiore says that soldiers and smokes were chummy for years.

In the past, troops received cigarettes with meal rations and cheap tobacco was sold on bases. Military culture saw tobacco use as a soldier's right – something to "take the edge" off the rigors of duty.

But by the mid-'70s, the military recognized that tobacco use was taking the edge off something else: military readiness. Recruits who used tobacco didn't perform as well on tests of athletic fitness; they got hurt more often, and more recruits were failing basic training.

"Tobacco use is a lead contributor to acute infections – bronchitis and pneumonia, among others," says Fiore. "Smokers get out of breath faster. Their allergies get worse. All of these can take the edge off a soldier who needs to be at his or her best."

Over time, the military quit offering cigarettes with rations; banned indoor tobacco use on bases; required that recruits abstain from tobacco during basic training; and started offering smoking-cessation programs to soldiers.

The policy changes, plus the general social trend against smoking, did help decrease smoking. A 2007 study in Addiction found that smoking rates in the military dropped from more than 50 percent in 1980, then increased markedly starting in the late ‘90s. By 2005, about 33 percent of those in the military smoked.

Today, with U.S. soldiers fighting two wars in the Middle East, deployments are up and multiple deployments are common. While fully recognizing the dangers of fighting a stubborn insurgency, Fiore has a longer-term worry.

"What used to be an equal-opportunity killer is increasingly a concern in subgroups of the population," he says. "Young soldiers are especially vulnerable to the risks of tobacco. While smoking prevalence overall among adults has fallen to less than 20 percent, it is far higher in military personnel."

Some in the military, of course, already smoke at the time they enlist. But a number of studies of soldiers in the U.S. and worldwide have found many non-smoking soldiers start lighting up when they are deployed to a war zone. And those who come in as smokers are very likely to increase their smoking substantially when deployed.

It may seem understandable that young people facing combat on unfamiliar terrain are likely to take up smoking; the risk and stress they face every day might lead anyone to smoke, or so goes the argument. Soldiers in the Middle East wars face the perfect combination of a highly stressful environment, easily accessible tobacco products, and daily life among peers who smoke.

Fiore, who headed the national panel that recently updated United States Public Health Service guidelines for clinicians to help their patients quit, believes there's something else at work as well.

"Smoking is still normative in the military," he says. "Back in 1991, I was activated from the Army Reserves and sent to a military hospital in Landstuhl, Germany. As we got off the plane, a group of USO folks gave us goodie bags. The bags were all stamped with the Marlboro logo."

In fact, some recent studies have suggested that the U.S. military is still sending a mixed message about tobacco. Tobacco continues to be sold at comparatively low prices on bases, even as other official policies discourage tobacco use.

Fiore acknowledges that most soldiers will find it extremely difficult to quit while they're on active duty in a war zone. But when they return to the States, he says, every effort should be made to help them quit.

Two years ago, Wisconsin's Center for Tobacco Research and Intervention started "Operation Quit Tobacco," a special program to help active-duty military, veterans, Reservists and National Guard members quit. The program tries to remove barriers that often keep smokers from quitting; it is free, offers proven smoking-cessation medications (nicotine gum and patches) and extensive telephone counseling.
The program, based on the Public Health Service clinical-practice guidelines that are backed by years of scientific research, has contributed to the decline in the general population's smoking rate from about 42 percent in the early 1960s to around 20 percent today. Treatment approaches targeted at the military population will likely be fine-tuned as research on smoking cessation within that group accumulates.

"The one critically important fact is this - for returning military personnel, in most cases, it is still early enough to alter the course of health damage resulting from smoking and, hopefully, prevent any permanent heart and lung damage," Fiore says. "Failing to intervene with our returning soldiers puts them at an unacceptable, lifelong risk. We ought to do more for those who have served."

Date Published: 10/01/2008

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