a war zone. In addition, as a result of congressional interest, tobacco-industry influence, and a culture that does not stigmatize tobacco use, tobacco products are readily available and sold at a discount in military commissaries and exchanges. The contradiction between health promotion and tobacco use was observed by Smith et al. (2007): “The military is unique as a tobacco retailer: it pays for the health consequences of tobacco use for many of its customers, making it perhaps the only tobacco retailer consistently losing money. Unlike most retailers, the military has a special interest in its patrons, whose fitness is necessary to the military’s mission.”
Many military tobacco-users will eventually enter the VA health system or the DoD TRICARE health-care system. Those two health-care systems bear much of the burden of care; thus, each has a vested interest in assisting active-duty and retired military personnel and veterans to stop using tobacco.
The use of smokeless tobacco is increasing in military populations, particularly among young men deployed to Iraq and Afghanistan; many young military personnel use both cigarettes and smokeless tobacco. Although most young people who use tobacco have begun to do so by the age of 18 years, many young people in the military initiate tobacco use, including dual use (use of both smoked and smokeless tobacco), after they complete basic training, during which time there is servicewide prohibition of tobacco use.
Although overall tobacco use in DoD personnel is about 32%, it varies considerably among the armed services. In 2005, over 38% of the men and women in the Army, over 36% of Marine Corps personnel, and 32% of Navy personnel were current tobacco-users. Only the Air Force at 23.3% had a tobacco-use rate similar to that of the civilian population (DoD, 2006).
Tobacco use in the veteran population is also widespread, partly because of the higher rates of disability, psychiatric disorders, and morbidities. Although the overall prevalence of smoking in veterans enrolled in the VA health system is only slightly higher than that in the general population, the prevalence of smoking in veterans with mental-health disorders is 2–3 times higher than that in the general population (VA, 2004).
Although DoD and VA are promoting tobacco-free and tobacco-cessation efforts, substantial challenges in reducing the prevalence of tobacco use in their populations remain. The challenges range from the ingrained smoking habits of new recruits to congressional requirements for smoking areas at VA medical facilities. In the face of such obstacles,