2
SCOPE OF THE PROBLEM

In this chapter, the committee describes why tobacco use is of concern to both the Department of Defense (DoD) and the Department of Veterans Affairs (VA). Specifically with respect to the military, tobacco use impairs readiness, decreases performance, and reduces productivity of active-duty and civilian personnel. In veteran populations, it exacerbates pre-existing health problems and leads to new ones, and it results in increased absenteeism and decreased productivity. Military personnel who use tobacco may eventually enter the VA health system; this means more and sicker veterans who require medical care and, consequently, increases in health-care costs. Tobacco use is also associated with short- and long-term health problems in all users and in those exposed to secondhand smoke.

Although the adverse effects of tobacco use may be reduced by improving smoking-cessation services, the issues surrounding tobacco use extend beyond helping people to quit. They include keeping people who do not use tobacco from doing so in the future and helping those who have quit from starting to use again.

TOBACCO USE IN MILITARY AND VETERAN POPULATIONS

This report considers the impact of tobacco use on the three military branches in the DoD—the Army, the Air Force, and the Navy. The Marine Corps is a second armed service in the Department of the Navy, but it has a different culture, demographic, and mission and is therefore generally considered a separate entity in the report. The Coast Guard, which has been moved from the Department of Defense to the Department of Homeland Security, is not considered in this report.

Demographics of the Military Population

The total US military population consists of nearly 3.5 million people in all branches, including 800,000 civilian personnel. The military is volunteer-based, and all services are more ethnically diverse today than before 1973 (see Table 2-1) (DoD, 2006a). As of March 2008, over



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 31
2 SCOPE OF THE PROBLEM In this chapter, the committee describes why tobacco use is of concern to both the Department of Defense (DoD) and the Department of Veterans Affairs (VA). Specifically with respect to the military, tobacco use impairs readiness, decreases performance, and reduces productivity of active-duty and civilian personnel. In veteran populations, it exacerbates pre-existing health problems and leads to new ones, and it results in increased absenteeism and decreased productivity. Military personnel who use tobacco may eventually enter the VA health system; this means more and sicker veterans who require medical care and, consequently, increases in health-care costs. Tobacco use is also associated with short- and long-term health problems in all users and in those exposed to secondhand smoke. Although the adverse effects of tobacco use may be reduced by improving smoking-cessation services, the issues surrounding tobacco use extend beyond helping people to quit. They include keeping people who do not use tobacco from doing so in the future and helping those who have quit from starting to use again. TOBACCO USE IN MILITARY AND VETERAN POPULATIONS This report considers the impact of tobacco use on the three military branches in the DoD—the Army, the Air Force, and the Navy. The Marine Corps is a second armed service in the Department of the Navy, but it has a different culture, demographic, and mission and is therefore generally considered a separate entity in the report. The Coast Guard, which has been moved from the Department of Defense to the Department of Homeland Security, is not considered in this report. Demographics of the Military Population The total US military population consists of nearly 3.5 million people in all branches, including 800,000 civilian personnel. The military is volunteer-based, and all services are more ethnically diverse today than before 1973 (see Table 2-1) (DoD, 2006a). As of March 2008, over 31

OCR for page 31
32 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS 1.1 million US troops have served in Iraq and Afghanistan: 806,964 Army personnel (including 146,655 in the Army National Guard and 74,461 in the Army Reserve), 194,401 Marine Corps personnel, 30,868 Navy personnel (including 7,028 reservists), and 70,136 Air Force personnel (Stars and Stripes, 2008). Tables 2-1 and 2-2 summarize the demographics of the US military population, including reservists1 and family members. TABLE 2-1 Demographic Profile of the Military Population Marine Army Navy Corps Air Force Active duty 502,790 345,098 180,252 344,529 Reservea 189,975 70,500 39,489 74,075 a Guard 346,288 — — 105,658 Total 1,039,053 415,598 219,741 524,262 Dependents About About About About 1,400,000 580,000 200,000 760,000 Female Personnel (% of total service) Active duty 14.0 14.5 6.2 19.7 a Reserve 23.3 20.3 4.7 23.9 a Guard 13.5 — — 18.0 Total 15.5 15.5 5.9 19.9 Minority-Group Personnel (% of total service) Black 18.6 17.3 9.9 13.4 Hispanic 9.8 12.4 13.0 5.7 Asian 3.2 6.4 3.2 3.6 American Indian 0.9 3.7 1.8 0.8 White 67.4 60.1 72.1 76.4 1 Ready reserve only; for the purposes of this report, the standby and retired reserve components of all military branches have been excluded. All demographics for reserve and National Guard members are reported only for the selected reserve, that is, those members of the ready reserve who train throughout the year and participate in annual active-duty training exercises. Demographic profiles of the individual ready reserve and the inactive National Guard—the other two components of the ready reserve—were not available.

OCR for page 31
33 SCOPE OF THE PROBLEM Marine Army Navy Corps Air Force Married Personnel (% of total service) Active duty 54.7 55.0 45.2 60.6 a Reserve 47.5 61.9 30.6 59.1 a Guard 46.5 — — 57.0 Total force 50.7 56.2 42.6 59.7 Personnel With Children (% of total service) Active duty 46.2 42.4 30.1 45.8 a Reserve 40.2 51.8 20.7 50.4 a Guard 40.2 — — 48.7 Total force 43.1 44.0 28.4 47.0 Single Parent Personnel (% of total service) Active duty 6.5 5.1 2.7 4.8 a Reserve 8.5 9.6 2.9 9.5 a Guard 8.2 — — 8.5 Total force 7.4 5.9 2.7 6.2 a Includes only members of the selected reserve. SOURCE: Adapted from DoD (2006a). TABLE 2-2 Age of the Military Population (years) Marine Army Navy Corps Air Force Active-Duty Officers (%) 25 and under 14.3 12.3 15.3 13.9 26–30 20.9 20.7 23.3 22.1 31–35 21.4 20.0 24.3 21.0 36–40 19.6 20.0 20.6 19.6 41 and over 23.8 27.1 16.4 23.4 Active-Duty Enlisted (%) 25 and under 52.1 50.1 72.4 45.5 26–30 19.9 20.1 14.2 21.0 31–35 13.0 13.4 7.1 13.1 36–40 9.7 10.5 4.2 11.9

OCR for page 31
34 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Marine Army Navy Corps Air Force 41 and over 5.3 5.9 2.1 8.4 Guard and Reserve Officers (%)a 25 and under 5.5 0.6 0.7 1.2 26–30 9.2 4.6 4.9 7.4 31–35 14.8 2.8 17.1 14.3 36–40 23.3 31.5 31.1 23.8 41 and over 47.3 60.6 46.2 53.5 a Guard and Reserve Enlisted Members (%) 25 and under 43.4 17.9 72.8 23.0 26–30 16.0 15.1 15.0 14.8 31–35 9.5 18.9 6.0 13.3 36–40 12.2 24.2 3.7 16.4 41 and over 18.8 23.8 2.5 32.5 b Retirees Retired with 20+ years of active 438,590 service Retired with 20+ years reserve 260,737 service Total 778,682 a Includes only members of the selected reserve. b Includes active duty and reserve retirees, does not include disabled retirees. SOURCE: Adapted from DoD (2006a); retiree information from Army (2006). Demographics of the Veteran Population In 2008, there were an estimated 26.5 million US veterans, 7.8 million of whom were enrolled in the VA health-care system. Of the 7.8 million, 45.1% are at least 65 years old, 41.0% are 45–64 years old, and 13.9% (fewer than 1 million) are under 45 years old. In 2000, about 7.5% (1.6 million) of the veterans enrolled in the VA health-care system were women. The largest group of veterans using the VA health-care system (36%) consists of those who served during the Vietnam era (1965–1974), followed by those who served between the Korean and Vietnam wars (1955–1964) (29%), military personnel who served between Vietnam and the 1990–1991 Gulf War (23%), and those who served in World War

OCR for page 31
35 SCOPE OF THE PROBLEM II (19%), Korea (18%), and during the Gulf War era (1991-2001) (13%). Of those using the VA health-care system, 60% have no private or Medigap insurance; and two-thirds of veterans enrolled in the VA health- care system have an annual income of less than $20,000/year. Of enrolled veterans, 84% are white, 10% are black, 4.6% are American Indian or Alaskan Native, 0.7% are Asian, and 0.5% are native Hawaiian and other Pacific Islander (VA, 2006a). In 2004 (the most recent year for which data are available), the national unemployment rate of VA enrollees was estimated to be 15.6%, which is substantially higher than the average annual unemployment rate of 5.5% in the general population. VA attributes that high rate to higher rates of disability. A 2007 survey of recently separated veterans, most of whom had served in Iraq or Afghanistan, found that 18% were unemployed; of those who were employed, 25% earned less than $22,000/year (VA, 2008a). In 2005, nearly 67% of the veteran enrollees in the VA health-care system were married, 15% were divorced, 9% had never been married, 7% were widowed, and 2% were separated from their spouses (VA, 2006a). Tobacco Use in Military Populations Centers for Disease Control and Prevention estimates of smoking prevalence in the general population show that 19.8% of adults in the United States were smokers in 2007, a slight decline from 20.8% in 2006 (CDC, 2008a). Smoking prevalence was higher among men (22.3%) than among women (17.4%) (CDC, 2008a). Although tobacco use has declined since World War II among military personnel, it remains an important issue for DoD and VA. A series of surveys of health-related behaviors in active-duty military personnel showed that tobacco use within the 30 days before a survey decreased from 51.0% in 1980 to 32.2% in 2005 (see Figure 2-1); this trend was observed consistently among all the services (DoD, 2006b). Smoking rates in 2005 among 18–25 year old military men (42.4%) and women (29.2%) (overall rate, 40.0%) were higher than the overall rate among their civilian counterparts (35.4%) (DoD, 2006b). Despite the decline, there had recently been an increase (within the preceding 30 days) from 1998 (29.9%) to 2005 (32.2%) among the services (DoD, 2006b).

OCR for page 31
36 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS 60 50 40 Army Percent Marine Corps 30 Navy 20 Air Force 10 0 1980 1982 1985 1988 1992 1995 1998 2002 2005 Year FIGURE 2-1 Cigarette use in preceding 30 days, by service (1980–2005). SOURCE: DoD (2006b). In the general population, lower levels of education and living below the poverty line are associated with a higher prevalence of smoking in all age groups (Agrawal et al., 2008; Barbeau et al., 2004). The Institute of Medicine noted that in the general population the most vulnerable subpopulations for long-term smoking are young people who start smoking early, people who have low socioeconomic status (SES) or are less well educated, and some racial and ethnic minorities (IOM, 2007). Associations in the military parallel those in the general population as tobacco use is more prevalent among military personnel who are younger, less well educated, and of lower SES. Current cigarette use in the military is more likely among men, those who are white, have less than a college education, are younger than 34 years old, and are enlisted versus officers (Bray and Hourani, 2007; DoD, 2006b; Haddock et al., 1998). The age at which daily smoking begins is typically in the few years prior to age of entry into the military—that is, prior to 20 years of age (see Figure 2-2). A 1998 survey of 2,002 Naval recruits, half of whom were 18 years of age, found that 51% of all the recruits had used tobacco in the 30 days prior to enlistment, primarily cigarettes (38%) or cigars and pipes (27%), with less smokeless tobacco use (12%); most cigarette smokers averaged about 0.5 packs per day (Ames et al., 2002). A 2003 survey of 15,556 male Marine Corps recruits (mean age 19.5 years) completing basic training found that 40.4% were users of a

OCR for page 31
37 SCOPE OF THE PROBLEM tobacco product in the 30 days prior to entering the military, primarily cigarettes; 7.6% used only smokeless tobacco and 18.4% used both smokeless tobacco and cigarettes (Trent et al., 2007). Careerists in the enlisted ranks were significantly more likely to be current smokers and heavy smokers compared with careerist officers (Cunradi et al., 2008). In a study of military retirees (1,371 men and 1,095 women) only 131 men and 75 women were current smokers, although 418 of the women and 928 of the men were ex-smokers (Talcott et al., 1998). In a survey of 589 Air National Guard members, the overall smoking prevalence was 19%, with the heaviest smokers (one or more packs per day) being enlisted personnel in the middle and highest pay grades; there was no smoking reported among the junior officers (Messecar and Sullivan, 2001). Tobacco use varies greatly among the services (see Table 2-3) (Conway, 1998). Army personnel (37.3%) and Marine Corps personnel (35.7%) had a significantly higher prevalence of cigarette-smoking than DoD civilians (28.9%); the Air Force, however, had a significantly lower prevalence (23.2%) than civilians. Rates of heavy smoking (one pack a day or more) were also higher in the Army, Navy, and Marine Corps (9.9–15.3%) than in the Air Force (7%). Smoking initiation after entering the military was highest in the Marine Corps (21.6%), followed by the Army (20.5%) and the Navy (18.7%), and lowest in the Air Force 25 20 Percent 15 10 5 0 Under 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30+ 14 Age (years) Military Other FIGURE 2-2 The age (in years) at initiation of daily smoking by people who reported ever smoking for 30 consecutive days. SOURCE: Adapted from SAMHSA (2008).

OCR for page 31
38 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS TABLE 2-3 Tobacco Use in the Military (%) Army Navy Marine Corps Air Force Cigarette use and nicotine dependencea in preceding 30 days Any smoking 38.2 32.4 36.3 23.3 Heavy smokingb 15.3 9.9 11.1 7.0 Nicotine dependence 10.8 6.4 9.5 4.8 Prevalence of cigarette-smoking in preceding 30 days by sex and age Men 18–25 years old 49.0 37.8 42.8 37.0 26–55 years old 31.4 25.9 24.8 16.2 All ages 39.4 29.8 36.3 23.3 Women 18–25 years old 31.7 27.0 29.1 28.1 26–55 years old 19.2 18.6 19.7 18.3 All ages 26.0 22.2 26.6 22.8 c Cigarette-smoking initiation in the military Mend 21.6 19.1 21.7 14.9 Womend 13.5 16.0 20.4 12.8 d Total 20.5 18.7 21.6 14.5 Men (current 36.7 36.1 40.5 40.3 smokers)e Women (current 34.6 38.1 39.7 33.7 smokers)e Total (current 36.5 36.3 40.5 39.0 smokers)e Smokeless-tobacco initiation in the military among menf 18–25 years old 22.9 12.5 11.1 17.5 26–55 years old 14.2 8.4 6.9 10.3 Total 18.7 10.2 8.5 13.7 Smokeless-tobacco use Any smokeless- 27.7 16.7 33.0 14.5 tobacco use in preceding 12 months Any smokeless- 18.8 11.1 22.3 9.2 tobacco use in preceding 30 days

OCR for page 31
39 SCOPE OF THE PROBLEM Army Navy Marine Corps Air Force Cigar or pipe use Any cigar or pipe 30.0 24.5 36.7 21.5 use in preceding 12 months a Nicotine dependence defined as score of 5 or more on Fagerstrom Nicotine Dependency Assessment. b Heavy smoking defined as smoking one or more packs per day. c Persons who started smoking after joining military. d As a percentage of the total DoD population, whether current smokers or not. e As a percentage of those who identified themselves as current smokers at the time of the survey. f Persons who started using smokeless tobacco after joining the military. SOURCE: Adapted from DoD (2006b). (14.5%). The highest rates of cigar and pipe use reported during the preceding 12 months were in the Marine Corps (36.7%) and the Army (30.0%) (DoD, 2006b). According to the 2005 DoD Survey of Health Related Behaviors among Active Duty Military Personnel (DoD, 2006b), from 1995 to 2005, the prevalence of smokeless-tobacco use (snuff and chewing tobacco) increased from 13.2% to 14.5%. In 2005, the Marine Corps (22.3%) and the Army (18.8%) reported the highest rates of smokeless- tobacco use (during the preceding 30 days), and the Navy (11.1%) and Air Force (9.2%) the lowest. Most users of smokeless tobacco are men 18–24 years old (DoD, 2006b; Ebbert et al., 2006). A recent study published by Vander Weg et al. (2008) assessed the prevalence of use of alternative forms of tobacco—including bidis, cigars, kreteks (clove cigarettes), pipes, and smokeless tobacco—in a population of Air Force recruits. The authors found that 18.5% of the study population was using an alternative form of tobacco before basic training, including 6.7% who used smokeless tobacco. Men were more likely than women to use smokeless tobacco before basic training, as were whites compared with Asians, Pacific Islanders, blacks, or Hispanics. Higher income was significantly correlated with smokeless-tobacco use in the study population. Participants who had some education beyond high school were less likely to use smokeless tobacco than those with only a high- school education (Vander Weg et al., 2008). Tobacco Use in Veteran Populations In a 2005 survey of the VA enrollee population, 71.2% reported that they smoked at least 100 cigarettes during their lifetime; 22.2% were current smokers, a slightly higher proportion than the 19.8% of the

OCR for page 31
40 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS general population (VA, 2006a); and 28.1% said that they had never smoked. Most current veteran smokers are 45–64 years old, and most make less than $36,000 a year (VA, 2006a). Higher rates of disability and psychiatric disorders in the veteran population may contribute to higher tobacco use and its health effects. Klevens et al. (1995) noted that the prevalence of ever smoking was 74.2% in veterans and 48.4% in nonveterans. Of those who had not started smoking before the age of 18 years, veterans were more likely than nonveterans to report ever and current smoking (Klevens et al., 1995). Of veterans with access only to the Veterans Health Administration, 25.7% are smokers, compared with 10.8–13.8% of those with access to at least one type of Medicare (fee for service or a health-maintenance organization) (Keyhani et al., 2007). HEALTH EFFECTS OF TOBACCO USE In 1964, the US Surgeon General published a landmark report Smoking and Health that implicated smoking as the cause of a variety of health effects (US Surgeon General, 1964). Since then, other reports on smoking from the surgeon general (2004, 2006) and numerous studies have confirmed that smoking causes a multitude of short- and long-term health effects in people of all ages. The surgeon general has also issued reports on the effects of smoking in women (2001) and on the effects of secondhand smoke on children (2007). Table 2-4 summarizes some of the health hazards associated with tobacco use, many of which are discussed in this chapter. TABLE 2-4 Health Hazards Posed by Tobacco Use Health Hazards Cancer (see Table 2-6) Cardiovascular disease Sudden death Acute myocardial infarction Unstable angina Stroke Peripheral arterial occlusive disease (including thromboangiitis obliterans) Aortic aneurysm Pulmonary disease Lung cancer Chronic bronchitis Emphysema Asthma Increased susceptibility to pneumonia and to pulmonary tuberculosis Increased susceptibility to desquamative interstitial pneumonitis Increased susceptibility to and morbidity from viral respiratory infection

OCR for page 31
41 SCOPE OF THE PROBLEM Health Hazards Gastrointestinal disease Peptic ulcer Esophageal reflux Reproductive disturbances Reduced fertility Premature birth Low birth weight Spontaneous abortion Abruptio placentae Premature rupture of membranes Increased perinatal mortality Oral disease (smokeless tobacco) Oral cancer Leukoplakia Gingivitis Gingival recession Tooth staining Other Non-insulin-dependent diabetes mellitus Impaired wound healing Osteoporosis Cataract Amblyopia (loss of vision) Age-related macular degeneration Premature skin wrinkling Aggravation of hypothyroidism Altered drug metabolism or effects SOURCE: Adapted from US Surgeon General (2004). Short-Term Effects of Tobacco Use In addition to the widely acknowledged long-term health consequences of tobacco use such as cancer and cardiovascular disease, tobacco use also adversely affects performance and health on a much shorter time scale. Being tobacco-free is an essential component of physical fitness and provides myriad advantages to military personnel in terms of readiness and performance. In the sections below, the committee considers the performance and short-term health consequences of tobacco use that are of most importance for active-duty military personnel. Box 2-1 at the end of the section summarizes the effects of tobacco use on military readiness and short-term health.

OCR for page 31
68 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Dall, T. M., Y. Zhang, Y. J. Chen, R. C. Wagner, P. F. Hogan, N. K. Fagan, S. T. Olaiya, and D. N. Tornberg. 2007. Cost associated with being overweight and with obesity, high alcohol consumption, and tobacco use within the military health system’s TRICARE prime- enrolled population. American Journal of Health Promotion 22(2):120-139. Demars, S. M., W. J. Harsha, and J. V. Crawford. 2008. The effects of smoking on the rate of postoperative hemorrhage after tonsillectomy and uvulopalatopharyngoplasty. Archives of Otolaryngology—Head and Neck Surgery. 134(8):811-814. Dembert, M. L., G. J. Beck, J. F. Jekel, and L. W. Mooney. 1984. Relations of smoking and diving experience to pulmonary function among US Navy divers. Undersea Biomedical Research 11(3): 299-304. DoD (Department of Defense). 2006a. Profile of the Military Community: DoD 2006 Demographics Report. Washington, DC: Office of the Deputy Under Secretary of Defense for Military Community and Family Policy. DoD. 2006b. 2005 Department of Defense Survey of Health Related Behaviors Among Active Duty Military Personnel. Research Triangle Park, NC: RTI International. DoD. 2008. Department of Defense Anti-Tobacco Campaign Invades Military Markets. TRICARE News Release 08-23. http://www.tricare.mil/pressroom/news.aspx?fid=379 (accessed April 3, 2009). Durazzini, G., F. Zazo, and G. Bertoni. 1975. The importance of the dosage of thiocyanates in urine and blood of flying personnel for the prevention of diseases of visual function. In Medical Requirements and Examination Procedures in Relation to the Tasks of Today's Aircrew, edited by G. Perdriel. London, UK: NATO Advisory Group for Aerospace Research and Development. Dyer, F. N. 1986. Smoking and Soldier Performance: A Literature Review. US Army Aeromedical Research Laboratory, Report No. 86- 13. Columbus, GA: Research Solutions, Inc. Ebbert, J. O., C. K. Haddock, M. Vander Weg, R. C. Klesges, W. S. Poston, and M. DeBon. 2006. Predictors of smokeless tobacco initiation in a young adult military cohort. American Journal of Health Behaviors 30(1):103-112.

OCR for page 31
69 SCOPE OF THE PROBLEM Fiore, M., F. Shi, S. Heishman, and J. Henningfield. 1994. The Effects of Smoking and Smoking Withdrawal on Flight Performance: A 1994 Update. Rockville, MD: CDC, Office on Smoking and Health. Fisher, M. A., G. W. Taylor, and K. R. Tilashalski. 2005. Smokeless tobacco and severe active periodontal disease, NHANES III. Journal of Dental Research 84(8):705-710. Frankenhaeuser, M., A. Myrsten, B. Post, and G. Johansson. 1971. Behavioural and physiological effects of cigarette smoking in a monotonous situation. Psychopharmacologia 22(1):1-7. Frayser, R. 1974. The effect of repetitive exercise on ventilatory function in smokers and nonsmokers. Southern Medical Journal 67(8): 926-929. Giannakoulas, G., A. Katramados, N. Melas, I. Diamantopoulos, and E. Chimonas. 2003. Acute effects of nicotine withdrawal syndrome in pilots during flight. Aviation Space and Environmental Medicine 74(3):247-251. Gordon, D. J., A. S. Leon, and L. G. Ekelund. 1987. Smoking, physical activity, and other predictors of endurance and heart rate response to exercise in asymptomatic hypercholesterolemic men: The Lipid Research Clinics Coronary Primary Prevention Trial. American Journal of Epidemiology 125(4):587-600. Gramberg-Danielsen, B., N. Puls, and G. Tolksdorf, G. 1974. Ist das mesopische sehen kurzfristig beeinflussbar? Medizinische Monatsschrift 28:285-289. Grout, P., K. Cliff, M. Harman, and D. Machin. 1983. Cigarette smoking, road traffic accidents and seat belt usage. Public Health, London 97:95-101. Haddock, C. K., R. C. Klesges, G. W. Talcott, H. Lando, and R. J. Stein. 1998. Smoking prevalence and risk factors for smoking in a population of United States Air Force basic trainees. Tobacco Control 7(3):232-235. Halpern, M. T., R. Shikiar, A. M. Rentz, and Z. M. Khan. 2001. Impact of smoking status on workplace absenteeism and productivity. Tobacco Control 10(3):233-238. Hartling, O. 1975. The effect of the first three months of military service on the physical work capacity of conscripts. Forsvarsmedicin 11(4):213-218. Hecht, S. S. 1998. Biochemistry, biology, and carcinogenicity of tobacco-specific N-nitrosamines. Chemical Research in Toxicology 11(6):559-603.

OCR for page 31
70 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Heimstra, N., N. Bancroft, and A. DeKock. 1967. Effects of smoking upon sustained performance in a simulated driving task. Annals of the New York Academy of Sciences 142:295-307. Helyer, A. J., W. T. Brehm, and L. Perino. 1998. Economic consequences of tobacco use for the Department of Defense, 1995. Military Medicine 163(4):217-221. Hergens, M. P., A. Ahlbom, T. Andersson, and G. Pershagen. 2005. Swedish moist snuff and myocardial infarction among men. Epidemiology 16(1):12-16. Hill, R. D., L.-G. Nilsson, L. Nyberg, and L. Backman. 2003. Cigarette smoking and cognitive performance in healthy Swedish adults. Age and Ageing 32(5):548-550. Hirsch, G. L., D. Y. Sue, and K. Wasserman. 1985. Immediate effects of cigarette smoking on cardiorespiratory responses to exercise. Journal of Applied Physiology 58(6):1975-1981. Hirshman, E., P. Merritt, D. K. Rhodes, and M. Zinser. 2004. The effect of tobacco abstinence on recognition memory, digit span recall, and attentional vigilance. Experimental and Clinical Psychopharmacology 12(1):76-83. Hoad, N. A., and D. N. Clay. 1992. Smoking impairs the response to a physical training regime: A study of officer cadets. Journal of the Royal Army Medical Corps 138(3):115-117. Holcomb, H. S., III, and J. W. Meigs. 1972. Medical absenteeism among cigarette, and cigar and pipe smokers. Archives of Environmental Health 25(4):295-300. Hubbard, R., A. Venn, S. Lewis, and J. Britton. 2000. Lung cancer and cryptogenic fibrosing alveolitis: A population-based cohort study. American Journal of Respiratory and Critical Care Medicine 161(1):5-8. Huhtasaari, F., V. Lundberg, M. Eliasson, U. Janlert, and K. Asplund. 1999. Smokeless tobacco as a possible risk factor for myocardial infarction: A population-based study in middle-aged men. Journal of the American College of Cardiology 34(6):1784-1790. Hutchens, L., T. M. Senserrick, P. E. Jamieson, D. Romer, and F. K. Winston. 2008. Teen driver crash risk and associations with smoking and drowsy driving. Accident Analysis and Prevention 40(3):869-876.

OCR for page 31
71 SCOPE OF THE PROBLEM IARC (International Agency for Research on Cancer). 2004. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Tobacco Smoking and Involuntary Smoking. Vol. 83. Lyon, France: World Health Organization, International Agency for Research on Cancer. IOM (Institute of Medicine). 2007. Ending the Tobacco Problem: A Blueprint for the Nation. Washington, DC: The National Academies Press. Isachenkov, V. 2008. “Inquiry probes cause of Russian sub deaths.” The Guardian, November 12, 2008. Janz, D. R., H. R. O’Neal, Jr., and E. W. Ely. 2009. Acute eosinophilic pneumonia: A case report and review of the literature. Critical Care Medicine 37(4):1470-1474. Jensen, R. G. 1986. The effect of cigarette smoking on Army Physical Readiness Test performance of enlisted Army medical department personnel. Military Medicine 151(2):83-85. Johansson, S. E., K. Sundquist, J. Qvist, and J. Sundquist. 2005. Smokeless tobacco and coronary heart disease: A 12-year follow-up study. European Journal of Cardiovascular Prevention and Rehabilitation 12(4):387-392. Johnson, G. K., and J. M. Guthmiller. 2007. The impact of cigarette smoking on periodontal disease and treatment. Periodontology 2000 44(1):178-194. Jones, B. H., and J. J. Knapik. 1999. Physical training and exercise- related injuries. Surveillance, research and injury prevention in military populations. Sports Medicine 27(2):111-125. Jonk, Y. C., S. E. Sherman, S. S. Fu, K. W. Hamlett-Berry, M. C. Geraci, and A. M. Joseph. 2005. National trends in the provision of smoking cessation aids within the Veterans Health Administration. American Journal of Managed Care 11(2):77-85. Kenfield, S. A., M. J. Stampfer, B. A. Rosner, and G. A. Colditz. 2008. Smoking and smoking cessation in relation to mortality in women. Journal of the American Medical Association 299(17):2037-2047. Keyhani, S., J. S. Ross, P. Hebert, C. Dellenbaugh, J. D. Penrod, and A. L. Siu. 2007. Use of preventive care by elderly male veterans receiving care through the Veterans Health Administration, Medicare fee-for-service, and Medicare HMO plans. American Journal of Public Health 97(12):2179-2185.

OCR for page 31
72 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Klesges, R. C., C. K. Haddock, C. F. Chang, G. W. Talcott, and H. A. Lando. 2001. The association of smoking and the cost of military training. Tobacco Control 10(1):43-47. Klevens, R. M., G. A. Giovino, J. P. Peddicord, D. E. Nelson, P. Mowery, and L. Grummer-Strawn. 1995. The association between veteran status and cigarette-smoking behaviors. American Journal Preventive Medicine 11(4):245-250. Knapik, J. J., K. Reynolds, and J. Barson. 1999. Risk factors for foot blisters during road marching: Tobacco use, ethnicity, foot type, previous illness, and other factors. Military Medicine 164(2):92-97. Knapik, J. J., M. A. Sharp, M. Canham-Chervak, K. Hauret, J. F. Patton, and B. H. Jones. 2001. Risk factors for training-related injuries among men and women in basic combat training. Medicine and Science in Sports and Exercise 33(6):946-954. Krumholz, R., R. Chevalier, and J. Ross. 1965. Changes in cardiopulmonary functions related to abstinence from smoking: Studies in young cigarette smokers at rest and exercise at 3 and 6 weeks of abstinence. Annals of Internal Medicine 62:197-207. Larsson, H., L. Broman, and K. and Harms-Ringdahl. 2009. Individual risk factors associated with premature discharge from military service. Military Medicine 174(1):9-20. Lee, B., and K. Volpp. 2004. Potential cost savings from smoking cessation in the Veterans Affairs patient population. AcademyHealth Meet 21:Abstract no. 1648. Lin, H. H., M. Ezzati, and M. Murray. 2007. Tobacco smoke, indoor air pollution and tuberculosis: A systematic review and meta-analysis. PLoS Medicine 4(1):0173-0189. Lindström, D., O. S. Azodi, A. Wladis, H. Tønnesen, S. Linder, H. Nåsell, S. Ponzer, and J. Adami. 2008. Effects of a perioperative smoking cessation intervention on postoperative complications: A randomized trial. Annals of Surgery 248(5):739-745. Luo, J., W. Ye, K. Zendehdel, J. Adami, H. O. Adami, P. Boffetta, and O. Nyrén. 2007. Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: A retrospective cohort study. Lancet 369(9578):2015-2020. Luria, S. M., and C. L. McKay. 1979. Visual processes of smokers and nonsmokers at different ages. Archives of Environmental Health 34(6):449-454.

OCR for page 31
73 SCOPE OF THE PROBLEM Maity, P., K. Biswas, S. Roy, R. K. Banerjee, and U. Bandyopadhyay. 2003. Smoking and the pathogenesis of gastroduodenal ulcer—recent mechanistic update. Molecular and Cellular Biochemistry 253(1-2):329-338. Maksud, M., and A. Baron. 1980. Physiological responses to exercise in chronic cigarette and marijuana users. European Journal of Applied Physiology and Occupational Physiology 43(2):127-134. Mancuso, G., M. Lejeune, and M. Ansseau. 2001. Cigarette smoking and attention: Processing speed or specific effects? Psychopharmacology 155(4):372-378. Marti, B., T. Abelin, C. E. Minder, and J. P. Vader. 1988. Smoking, alcohol consumption, and endurance capacity: An analysis of 6,500 19-year-old conscripts and 4,100 joggers. Preventive Medicine 17(1):79-92. McFarland, R. A. 1970. The effects of exposure to small quantities of carbon monoxide on vision. Annals of the New York Academy of Sciences 174(1):301-312. McGuire, F. 1972. Smoking, driver education, and other correlates of accidents among young males. Journal of Safety Research 4(5-11). Mehta, H., K. Nazzal, and R. T. Sadikot. 2008. Cigarette smoking and innate immunity. Inflammation Research 57(11):497-503. Mertens, H. W., J. M. McKenzie, and E. A. Higgins. 1983. Some Effects of Smoking Withdrawal on Complex Performance and Physiological Responses. Washington, DC: Federal Aviation Administration, Office of Aviation Medicine. Messecar, D. C., and C. Sullivan. 2001. Cigarette smoking in the Oregon Air National Guard: Findings from a health promotions survey. Military Medicine 166(9):774-776. Møller, A. M., N. Villebro, T. Pedersen, and H. Tønnesen. 2002. Effect of preoperative smoking intervention on postoperative complications: A randomised clinical trial. Lancet 359(9301):114-117. Montoye, H., R. Gayle, and M. Higgins. 1980. Smoking habits, alcohol consumption and maximal oxygen uptake. Medicine and Science in Sports and Exercise 12(5):316-321. Mraz, S. 2008. Rare type of pneumonia infecting troops. Stars and Stripes, Pacific edition, October 4, 2008. Myles, P. S., G. A. Iacono, J. O. Hunt, H. Fletcher, J. Morris, D. McIlroy, and L. Fritschi. 2002. Risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: Smokers versus nonsmokers. Anesthesiology 97(4):842-847.

OCR for page 31
74 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Myrsten, A. L., B. Post, M. Frankenhaeuser, and G. Johansson. 1972. Changes in behavioral and physiological activation induced by cigarette smoking in habitual smokers. Psychopharmacologia 27(4):305-312. Nomura, K., M. Nakao, and T. Morimoto. 2005. Effect of smoking on hearing loss: Quality assessment and meta-analysis. Preventive Medicine 40(2):138-144. Panangala, S. 2006. Veterans’ Medical Care: FY2007 Appropriations, R.L. 33409. Washington, DC: Congressional Research Service, Library of Congress. Parkes, K. R. 1983. Smoking as a moderator of the relationship between affective state and absence from work. Journal of Applied Psychology 68(4):698-708. Pell, J. P., S. Haw, S. Cobbe, D. E. Newby, A. C. Pell, C. Fischbacher, A. McConnachie, S. Pringle, D. Murdoch, F. Dunn, K. Oldroyd, P. Macintyre, B. O’Rourke, and W. Borland. 2008. Smoke-free legislation and hospitalizations for acute coronary syndrome. New England Journal of Medicine 359(5):482-491. Pouryaghoub, G., R. Mehrdad, and S. Mohammadi. 2007. Interaction of smoking and occupational noise exposure on hearing loss: A cross- sectional study. BMC Public Health 7(147):137. Pungpapong, S., C. Manzarbeitia, J. Ortiz, D. J. Reich, V. Araya, K. D. Rothstein, and S. J. Muñoz. 2002. Cigarette smoking is associated with an increased incidence of vascular complications after liver transplantation. Liver Transplantation 8(7):582-587. Pyle, S. A., C. K. Haddock, W. S. Poston, R. M. Bray, and J. Williams. 2007. Tobacco use and perceived financial strain among junior enlisted in the US Military in 2002. Preventive Medicine 45(6): 460-463. Raven, P. B., B. L. Drinkwater, and R. O. Ruhling. 1974. Effect of carbon monoxide and peroxyacetyl nitrate on man’s maximal aerobic capacity. Journal of Applied Physiology 36(3):288-293. Robbins, A. S., V. P. Fonseca, S. Y. Chao, G. A. Coil, N. S. Bell, and P. J. Amoroso. 2000. Short term effects of cigarette smoking on hospitalisation and associated lost workdays in a young healthy population. Tobacco Control 9(4):389-396. Ryu, J. H., T. V. Colby, T. E. Hartman, and R. Vassallo. 2001. Smoking- related interstitial lung diseases: A concise review. European Respiratory Journal 17(1):122-132.

OCR for page 31
75 SCOPE OF THE PROBLEM SAMHSA (Substance Abuse and Mental Health Services Administration). 2008. Results from the 2007 National Survey on Drug Use and Health: National Findings. NSDUH Series H-34, Rockville, MD: Office of Applied Studies. DHHS Publication No. SMA 08-4343. Schmidt, F. 1972. Rauchen und Bundeswehr. Die Medizinische Welt 23:921-924. Sharabi, Y., I. Reshef-Haran, M. Burstein, and A. Eldad. 2002. Cigarette smoking and hearing loss: Lessons from the young adult periodic examinations in Israel (YAPEIS) database. Israeli Medical Association Journal 4(12):1118-1120. Sherwood, N. 1995. Effects of cigarette smoking on performance in a simulated driving task. Neuropsychobiology 32(3):161-165. Shorr, A. F., S. L. Scoville, S. B. Cersovs.ky, G. D. Shanks, C. F. Ockenhouse, B. L. Smoak, W. W. Carr, and B. P. Petruccelli. 2004. Acute eosinophilic pneumonia among US military personnel deployed in or near Iraq. Journal of the American Medical Association 292(24):2997-3005. Siana, J. E., S. Rex, and F. Gottrup. 1989. The effect of cigarette smoking on wound healing. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery 23(3):207-209. Singer, B. C., A. T. Hodgson, K. S. Guevarra, E. L. Hawley, and W. W. Nazaroff. 2002. Gas-phase organics in environmental tobacco smoke: 1. Effects of smoking rate, ventilation, and furnishing level on emission factors. Environmental Science and Technology 36(5): 846-853. Singer, B. C., A. T. Hodgson, and W. W. Nazaroff. 2003. Gas-phase organics in environmental tobacco smoke: 2. Exposure-relevant emission factors and indirect exposures from habitual smoking. Atmospheric Environment 37(39-40):5551-5561. Slama, K., C. Y. Chiang, D. A. Enarson, K. Hassmiller, A. Fanning, P. Gupta, and C. Ray. 2007. Tobacco and tuberculosis: A qualitative systematic review and meta-analysis. International Journal of Tuberculosis and Lung Disease 11(10):1049-1061. Snoddy, R. O., Jr., and J. M. Henderson. 1994. Predictors of basic infantry training success. Military Medicine 159(9):616-622. Sommese, T., and J. C. Patterson. 1995. Acute effects of cigarette smoking withdrawal: A review of the literature. Aviation Space and Environmental Medicine 66(2):164-167.

OCR for page 31
76 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Spilich, G. J., L. June, and J. Renner. 1992. Cigarette smoking and cognitive performance. British Journal of Addiction 87(9):1313-1326. Sponsiello-Wang, Z., R. Weitkunat, and P. N. Lee. 2008. Systematic review of the relation between smokeless tobacco and cancer of the pancreas in Europe and North America. BMC Cancer 8:356. Stars and Stripes. 2008. Five Years in Iraq. http://www.stripes.com/ 08/mar08/iraq5/ (accessed March 30, 2009). Stewart, W. F., J. A. Ricci, E. Chee, and D. Morganstein. 2003. Lost productive work time costs from health conditions in the United States: Results from the American Productivity Audit. Journal of Occupational and Environmental Medicine 45(12):1234-1246. Talcott, G. W., W. S. Poston, 2nd, and C. K. Haddock. 1998. Co- occurrent use of cigarettes, alcohol, and caffeine in a retired military population. Military Medicine 163(3):133-138. Taylor, D. H., and P. N. Blezard. 1979. The effects of smoking and urinary pH on a detection task. Quarterly Journal of Experimental Psychology 31(Pt 4):635-640. Tetzlaff, K., J. Theysohn, C. Stahl, S. Schlegel, A. Koch, and C. M. Muth. 2006. Decline of FEV1 in scuba divers. Chest 130(1):238-243. Thomson, W. M., J. M. Broadbent, D. Welch, J. D. Beck, and R. Poulton. 2007. Cigarette smoking and periodontal disease among 32-year-olds: A prospective study of a representative birth cohort. Journal of Clinical Periodontology 34(10):828-834. Tong, J. E., G. Leigh, J. Campbell, and D. Smith. 1977. Tobacco smoking, personality, and sex factors in auditory vigilance performance. The British Journal of Psychology 68(3):365-370. Trent, L. K., S. M. Hilton, and T. Melcer. 2007. Premilitary tobacco use by male Marine Corps recruits. Military Medicine 172(10):1077- 1083. Uchida, Y., T. Nakashima, F. Ando, N. Niino, and H. Shimokata. 2005. Is there a relevant effect of noise and smoking on hearing? A population-based aging study. International Journal of Audiology 44(2):86-91. US Surgeon General. 1964. Report on Smoking and Health. Washington, DC: Department of Health and Human Services. US Surgeon General. 2001. Women and Smoking: A Report of the Surgeon General. Washington, DC: Department of Health and Human Services.

OCR for page 31
77 SCOPE OF THE PROBLEM US Surgeon General. 2004. The Health Consequences of Smoking: A Report of the Surgeon General. Washington, DC: Department of Health and Human Services. US Surgeon General. 2006. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Washington, DC: Department of Health and Human Services. US Surgeon General. 2007. Children and Secondhand Smoke Exposure—Excerpts from The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Washington, DC: Department of Health and Human Services. VA (Department of Veterans Affairs). 2006a. 2005 Survey of Veteran Enrollees’ Health and Reliance Upon VA With Selected Comparisons to the 1999—2003 Surveys. Washington, DC: Veterans Health Administration. VA. 2006b. 2005 Smoking and Tobacco Use Cessation Report. Washington, DC: Veterans Health Administration, Office of the Assistant Deputy Under-Secretary for Health for Policy Planning. VA. 2008a. Employment Histories Report. http://www1.va.gov/vetdata/ docs/Employment_History_080324.pdf (accessed March 10, 2009). VA. 2008b. VA Health Care Eligibility and Enrollment. http://www.va.gov/healtheligibility/eligibility/PriorityGroupsAll.asp (accessed April 3, 2009). Vander Weg, M. W., A. L. Peterson, J. O. Ebbert, M. Debon, R. C. Klesges, and C. K. Haddock. 2008. Prevalence of alternative forms of tobacco use in a population of young adult military recruits. Addictive Behavior 33(1):69-82. Vassallo, R., and J. H. Ryu. 2008. Tobacco smoke-related diffuse lung diseases. Seminars in Respiratory and Critical Care Medicine 29(6):643-650. Vered, Y., A. Livny, A. Zini, and H. D. Sgan-Cohen. 2008. Periodontal health status and smoking among young adults. Journal of Clinical Periodontology 35(9):768-772. Vineis, P., M. Alavanja, P. Buffler, E. Fontham, S. Franceschi, Y. T. Gao, P. C. Gupta, A. Hackshaw, E. Matos, J. Samet, F. Sitas, J. Smith, L. Stayner, K. Straif, M. J. Thun, H. E. Wichmann, A. H. Wu, D. Zaridze, R. Peto, and R. Doll. 2004. Tobacco and cancer: Recent epidemiological evidence. Journal of the National Cancer Institute 96(2):99-106.

OCR for page 31
78 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Wennmalm, A., G. Benthin, E. F. Granstrom, L. Persson, A. S. Petersson, and S. Winell. 1991. Relation between tobacco use and urinary excretion of thromboxane A2 and prostacyclin metabolites in young men. Circulation 83(5):1698-1704. Wesnes, K., and D. Warburton. 1978. The effects of cigarette smoking and nicotine tablets upon human attention. In Smoking Behavior, edited by R. Thornton. Edinburgh, Scotland: Churchill Livingston. Wilson, R. W. 1973. Cigarette smoking, disability days and respiratory conditions. Journal of Occupational Medicine 15(3):236-240. Zadoo, V., S. Fengler, and M. Catterson. 1993. The effects of alcohol and tobacco use on troop readiness. Military Medicine 158(7): 480-484.