DoD Tobacco Use Cessation Guideline Program

By Larry N Williams, DDS, MAGD, ABGD
Captain, Dental Corps, US Navy
Military Medical Support Office

During 1993-2000, substantial reductions in current smoking prevalence were reported in the United States for all age groups, except those aged 18-24. An additional issue of tobacco use in this age group is the fact that this group has shown a 13% use of smokeless tobacco.¹ According to military demographic data, the age of military recruits falls within this age range.² Studies show that between 34 to 60% of recruits entering the military utilized some form of tobacco prior to entering the initial phase of military training.^3,4,5 Studies have also shown that the enforced abstinence during basic military training results in a 26% rate of abstinence after basic training for those previous users of tobacco. Unfortunately, in 3 large random controlled studies approximately 74% of graduated Recruits resume their tobacco use and there is an approximate 6 to 11% initiation after graduation of tobacco use among previous non-tobacco users. ^5,6,7 Various services have instituted different policies regarding tobacco use limitations at various training programs beyond Recruit training.

The 1998 DoD survey confirmed that although cigarette smoking was still the most pervasive form of tobacco use in the Military, other forms of tobacco also were used. Planners and policymakers must be aware of the prevalence of all types of tobacco use in order to develop comprehensive policies and programs for tobacco use prevention and cessation. The findings of the 1998 DoD Survey reveal that considerable effort is needed to achieve Healthy People objectives. This survey showed that 11.7% of military personnel had used smokeless tobacco in the 30 days prior to the survey, and an estimated 32.6% of military personnel smoked cigars or a pipe in the 12 months prior to the survey.⁸ One DoD program designed to take advantage of the tobacco-free Recruit environment is the Navy's Reinforcing Education to AChieve Health (REACH) Program. This program introduces Recruits to military readiness, health, and financial benefits that will result from graduated trainees continuing their tobacco-free lifestyle. This multifaceted program has resulted in a 50% reduction in tobacco use resumption within 30 days of Recruit graduation and a 67% reduction of tobacco-use initiation.^4,9

Given that the rates of any tobacco smoking and smokeless in the total DoD are all still well above the Healthy People targets for the Military, military leaders must do everything possible to implement programs to reduce the use of tobacco. Taking advantage of the "teachable moment" of tobacco abstinence during various Services' initial and follow-on training for junior enlisted members will help reduce the level of tobacco use. Finally, in keeping with the US Surgeon General's Report, "more consistent implementation of effective educational strategies" must be used to help decrease tobacco use among our young people.¹⁰ The "teachable moment" of mandated abstinence during initial military training provides an ideal setting to provide this effective education.

REFERENCES:

1. MMWR, 26 July, 2002/vol52/no 29
   
2. Haddock C, Weg M, DeBon M, Klesges R, Talcott G, Lando H, Peterson A. Evidence that smokeless tobacco use is a gateway for smoking initiation in young adult males. Prev Med 2001 Mar;32(3):262-7
   
3. Chisick M, Poindexter F, York A. Comparing tobacco use among incoming recruits and military personnel on active duty in the United States. Tob Control 1998 Autumn;7(3):236-40
   
4. Williams L. "Oral Health is Within REACH", Navy Medicine, Mar-Apr 2001
   
5. Haddock CK, Klesges RC, Talcott GW, Lando H, Stein RJ. Smoking prevalence and risk factors for smoking in a population of United States Air Force basic trainees. Tob Control 1998 Autumn;7(3):232-5
   
6. Williams L, Gackstetter G, Fiedler E, Hermesch C, Lando H. Prevalence of tobacco use among first-term Air Force personnel before and after basic military training. Mil Med 1996 Jun;161(6):318-23
   
7. Hurtado S, Conway T. Changes in smoking prevalence following a strict no-smoking policy in U.S. Navy recruit training, Mil Med 1996 Oct;161(10):571-6
   
8. DoD Survey of Health Related Behaviors Among Military Personnel, 1998
   
9. Williams L. "REACH", AGD Impact, Vol 29(2); Feb 2001
   
10. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General-Executive Summary. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.
    

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