How military culture discouraging tobacco use influences active duty military personnel

Background: Tobacco use has long been part of the U.S. military culture. There is growing recognition among military leaders that there are adverse effects of tobacco use including on fitness levels, readiness and performance, and health care costs. This recognition has led to implementation of numerous policy changes, cessation and prevention interventions. Yet rates of tobacco use are rising in the military and are higher than the civilian population (24% vs. 21%). Methods: Using the Department of Defense 2011 Health Related Behaviors Survey among Active Duty Military Personnel (ADMP), we analyzed tobacco use and its association with military leaders’ deterrence of tobacco use by promotion of cessation programs.  Results: Cigarette smoking levels among ADMP, defined by the 2010 National Health Interview Survey, were:  59%  ‘Abstainers’, 17% ‘Former Smokers’, 8% ‘Infrequent Smokers’, 13% ‘Light/Moderate Smokers’ and  3% ‘Heavy Smokers’. Less than 20% of smokers perceived an environment that strongly discourages tobacco use, with the lowest rates among Army and Marine Corps ADMP. Ordinal regression analyses indicated a significant relationship between tobacco use and military culture deterrence of tobacco use, after adjusting for sociodemographic and mental health factors. As discouragement of tobacco use by supervisors and installations increased, the odds of ADMP smoking less frequently increased. Conclusion: Discouraging tobacco use by military leadership has an impact on its use by ADMP. Prevention and cessation programs that recognize the influence of supervisors on the culture of tobacco use within their units are necessary for any anti-tobacco efforts.