Cigarette Smoking and Military Deployment

Background

The stress of military deployment may compound occupational stress experienced in the military and manifest in maladaptive coping behaviors such as cigarette smoking. The current study describes new smoking among never-smokers, smoking recidivism among past smokers, and change in daily smoking among smokers in relation to military deployment.

Methods

The Millennium Cohort is a 21-year longitudinal study. The current analysis utilized participants (N=48,304) who submitted baseline data (July 2001–June 2003) before the current conflicts in Iraq and Afghanistan and follow-up data (June 2004–January 2006) on health measures. New smoking was identified among baseline never-smokers, smoking recidivism among baseline past smokers, and increased or decreased daily smoking among baseline smokers. Analyses were conducted March 2007–April 2007.

Results

Among never-smokers, smoking initiation was identified in 1.3% of nondeployers and 2.3% of deployers. Among past smokers, smoking resumption occurred in 28.7% of nondeployers and 39.4% of those who deployed. Smoking increased 44% among nondeployers and 57% among deployers. Those who deployed and reported combat exposures were at 1.6 times greater odds of initiating smoking among baseline never-smokers (95% CI=1.2, 2.3) and at 1.3 times greater odds of resuming smoking among baseline past smokers when compared to those who did not report combat exposures. Other deployment factors independently associated with postdeployment smoking recidivism included deploying for >9 months and deploying multiple times. Among those who smoked at baseline, deployment was not associated with changes in daily amount smoked.

Conclusions

Military deployment is associated with smoking initiation and, more strongly, with smoking recidivism, particularly among those with prolonged deployments, multiple deployments, or combat exposures. Prevention programs should focus on the prevention of smoking relapse during or after deployment.

Introduction

Smoking is the leading preventable cause of death in the U.S. More than 400,000 people die each year due to smoking, with $167 billion spent in annual health-related economic losses.¹ The long-term health consequences are well established.2, 3, 4 In the military, where smoking rates are higher than in the general population,5, 6 it is estimated that $130 million is spent annually on excess training alone due to smokers who are prematurely discharged.⁷ In addition, smoking has implications for military readiness, because service members who smoke have lower fitness levels and are at greater risk for physical injury.8, 9, 10 Understanding the factors that influence smoking among the more than 2 million young adults currently serving in the military is of critical public health importance.

Smoking has been shown as a frequently reported maladaptive coping mechanism among those reporting chronic and acute stress.11, 12 Individuals in stressful occupations have been shown to use tobacco at higher rates than the general population.13, 14 Occupational stress related to serving in the military has also been shown to be a strong predictor for both cigarette smoking and nicotine dependence.15, 16 The stress of military deployment may compound already high occupational stress and manifest in different maladaptive coping behaviors such as increases in the use of tobacco, alcohol, and other drugs. U.S. Navy and Marine Corps personnel exposed to violence prior to the current conflicts were reported to be at twice the risk for nicotine dependence than those not exposed.¹⁵ In a cross-sectional survey of U.S. troops deployed to Iraq and Afghanistan, nearly 40% smoked at least one half pack of cigarettes per day, with nearly half of smokers stating that they started or resumed smoking during their deployment.¹⁷ A survey of a small group of British military medical professionals reported similar findings of increased smoking rates postdeployment among nonsmokers and increased daily cigarette intake among smokers.¹⁸ All past studies have been done prior to the current military conflicts¹⁵ or are limited by cross-sectional design,¹⁷ the exclusion of nondeployers,17, 18 or small sample sizes.¹⁸

To better understand cigarette smoking as a coping mechanism in response to the stress of military deployment, the current study prospectively investigated, among participants in a large, population-based military cohort, changes in cigarette use including smoking initiation among never-smokers, smoking recidivism among past smokers, and changes in daily smoking among smokers. Additionally, cigarette use and its relationship to extreme deployment lengths and multiple deployments were investigated among those deployed to Iraq and Afghanistan while adjusting for potential confounders.