Abstract
BackgroundTobacco use is a major cause of chronic disease, disability and death among military personnel and veterans. However, civilian public health and tobacco control advocates have been relatively silent on the issue. Research on the tobacco industry shows a long history of interference in military tobacco policy through relationships with the United States (US) Congress. The military cannot autonomously implement tobacco control, but is subject to Congressional oversight. Thus, the primary obstacles to effective tobacco control in the military are Congressional political opposition and tobacco industry influence, and by extension, a lack of civilian awareness and support in the policy arena.MethodsAs part of a larger project to explore the topic of civilian support for military tobacco control, we analyzed data from focus groups with public health professionals to better understand their sense of agency and authority in regards to military tobacco control. Researchers conducted 4 focus groups with a total of 36 public health professionals at key conferences for those working in public health and tobacco control. Data were coded and the research team developed an interpretive account that captured patterns and variations in the data.ResultsPublic health and tobacco control participants shared a sense of futility regarding civilian efforts to engage in military tobacco control. This stemmed from feeling ignorant of military culture and structure, identifying powerful discourses that opposed tobacco control, particularly in a military context, and the very-real presence of the tobacco industry lobby throughout the policy process.ConclusionsA strong public health voice on military tobacco control might serve to begin problematizing the tobacco industry’s influence in the military policy arena. As the military moves to institute stronger tobacco control policy, public health and tobacco control professionals should work to engage with and aid its efforts from the outside. Only with such civilian side support can the goal of a tobacco free military be realized.
Highlights
Tobacco use is a major cause of chronic disease, disability and death among military personnel and veterans
Attempts to increase cigarette prices at military stores were thwarted by tobacco industry interference in policymaking through exploitation of complex relationships among the Department of Defense (DoD), Congress, commissaries and exchanges, mobilizing alliances with the House Armed Services and Morale Welfare and Recreation Committees, framing price raises as an “erosion of benefits”, and exposing internal DoD conflict over commissary pricing policy [19]. These findings suggest that the primary obstacles to effective tobacco control in the military are political opposition and tobacco industry influence, and by extension, a lack of civilian awareness and support in the policy arena [3]
Thirty-six public health and tobacco control professionals participated in the focus groups
Summary
Tobacco use is a major cause of chronic disease, disability and death among military personnel and veterans. In 2009, the Institute of Medicine (IOM) called for phasing in a tobacco-free military [1,2] This year, to mark the 50th anniversary of the Surgeon General’s report on smoking, the Under Secretary of Defense for Health Affairs released a memorandum in March 2014 calling for active engagement on the issue of military tobacco use, and prompting a review of tobacco policy in the Department of Defense (DoD) [1,2]. Despite state of the art tobacco cessation programs and the successful implementation of smoke free policies such as those implemented in 2010 in the submarine fleet [3,4], military personnel continue to have significantly higher rates of tobacco use than civilians [5]. The recent conflicts in Iraq and Afghanistan were associated with an increase in tobacco use; smoking prevalence is over 50% higher in military personnel who have been deployed than among those who have not [2]
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