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Tuesday, July 8, 2014

3 Questions on… Why the U.S. Military Should Be Tobacco-free

With ELIZABETH SMITH, PHD, Professor in Social & Behavioral Sciences in the School of Nursing, University of California, San Francisco



Tobacco use by military personnel is harmful to individuals, it’s harmful to the institution, and there’s no reason to continue supporting or even allowing it — was the argument Elizabeth Smith, PhD, and six co-authors made in a recent Perspective article in the New England Journal of Medicine (DOI: 10.1056/NEJMp1405976).


“People in the military are trying to implement these policies. And it’s really important that they get support from people involved in public health — doctors, nurses, and advocates, including people concerned about cancer,” Smith explained in an interview with OT. Here’s more on why she’s focusing her attention on this issue now…


1. The health risks associated with tobacco are well-known — why is NOW the right time to restrict tobacco use in the military?


“It’s been a good time for a long time. And the military has tried to do a lot of things over the past 20 years, but often Congress has prevented them from implementing strong tobacco control. For example, the Secretary of the Navy Ray Mabus wants to end tobacco sales on navy installations, but the House Armed Services Committee has put an amendment into the defense authorization bill that would prevent him from doing that.


“And that’s where the problem has been for a long time — in Congress, where the tobacco industry has a lot of influence. So public health advocates really need to step up and support the military’s effort to improve the health of the personnel.


“Right now is a good time [to enact this policy] partly because the support from the higher leadership does seem to be there — not only from the Secretary of the Navy, but also from the Secretary of Defense — and also because we’re having a drawdown of our military as forces pull out of combat. Personnel are going to be reduced, so now is a good time to tighten rules and restrict membership.”


2. Is there a precedent to restrict tobacco use in the military? What are the arguments AGAINST restricting its use by the military?


“Yes. Most fire departments do not allow their personnel to smoke because of the health consequences, which is a precedent for restricting tobacco use. It’s never been declared a right.


“It’s never been determined to be a right by any court and smokers are not a protected class. And, many of the rights of military personnel are curtailed in the name of good discipline or good health. Using tobacco is certainly not a benefit — we’re talking about selling members of the military an addictive and deadly product. It’s hard to see how that’s really a benefit, but that argument does get made.”


3. The NEJM Perspective article emphasizes that public health advocates need to support this initiative… Why? What are the implications for larger tobacco-cessation and cancer prevention efforts?


“Having a tobacco-free military sets a great example. It means that for young people who want to join the military, they’re much less likely to start smoking if they know they won’t be able to continue once they join. And once personnel leave the military, we won’t have that pool of people at a higher risk of smoking rejoining civilian life and increasing smoking rates in general. It would be a significant victory.”