摘要：Objectives. We conducted a longitudinal assessment of tobacco pricing in military retail outlets, including trends within each service branch. Methods. We determined the price of a single pack of Marlboro Red cigarettes at military retail stores located in the continental United States, Alaska, and Hawaii and at their nearest Walmarts in spring 2011 and 2013 (n = 128 for pairs available at both assessments). Results. The average difference between cigarettes sold in military retail outlets and Walmarts decreased from 24.5% in 2011 to 12.5% in 2013. The decrease was partially attributable to significant price decreases at Walmarts. The largest increases in cigarette prices occurred on naval installations. Potential savings at stores on several installations remained substantial in 2013; the largest approached $6 per pack. Stores on 17 military installations decreased cigarette prices during the study period. Conclusions. Tobacco can be purchased in military retail stores at substantial savings over civilian stores. If tobacco pricing is to cease to be an incentive for use among personnel, a revised military tobacco pricing policy is needed. A large scientific literature amassed over the past 2 decades documents the significant, negative impact of tobacco use on nearly every aspect of military service in the United States. The military spends approximately $1.6 billion a year on tobacco-related health care and lost productivity. 1 In just the Air Force, smoking results in more than 893 128 lost workdays per year, or more than the total active-duty full-time equivalents at 40% of Air Force installations. 2 Tobacco use is more strongly related to combat readiness than are health issues that receive much more attention from military leadership, such as body composition. 3 Military personnel who smoke have significantly lower levels of physical fitness, less muscle endurance, poorer night vision, and less mental sharpness than their nonsmoking colleagues, and they are more likely to be injured. 4–8 Tobacco use also harms the well-being and mental health of military members. 3,9–11 Smokers in the military report experiencing significantly greater work and life stress than their nonsmoking peers, likely because of chronic nicotine withdrawal. 12 Tobacco use is associated with increased prevalence and severity of psychosocial problems that result from exposure to combat. For instance, nicotine dependence doubles the risk of posttraumatic stress disorder in deployed troops, 13 and a strong dose–response relationship ( P < .001) has been demonstrated between the number of cigarettes smoked and suicide among active-duty army soldiers. 10 Clearly, the negative impact of tobacco on health and readiness is substantial. In response to evidence that tobacco use is detrimental to the military, the Department of Defense (DoD) and the 4 armed services have instituted many tobacco control initiatives designed to discourage consumption. Military personnel have access to evidence-based behavioral and pharmacological treatments free of charge. 1 Free smoking cessation medications are available through the TRICARE mail order program, which also provides around-the-clock access to pharmacists who are trained to assist with treatment. 14 Personnel also have access 24 hours a day, 7 days a week to a dedicated telephone counseling program with the TRICARE Smoking Quitline and Web-based treatment through a military live chat service. The military supports a social marketing program entitled Quit Tobacco, Make Everyone Proud. 15 In addition, the military has implemented many health policies designed to reduce the sale, distribution, and use of tobacco. 16 DoD Instruction 1330.09 17 (p3) states that to “communicate to Service members that tobacco use is detrimental to health and readiness,” tobacco must be priced within 5% of the lowest competitive price in the community. Despite the military’s arguably impressive tobacco control program, nearly one fourth of all military personnel continue to smoke. 18 The continued high prevalence of smoking among troops has led researchers to attempt to identify factors that sustain a culture of tobacco in the military. A key component of this culture is the perception by personnel that the military provides cheap and easily accessible tobacco in its military retail stores. 19,20 In fact, formative work among junior enlisted personnel, military health policy leaders, and installation tobacco control managers suggests that the perception of cheap tobacco on military installations is among the most significant barriers to tobacco control in the DoD. 21 In 2011 we investigated the veracity of this perception by comparing the price of tobacco at military retail outlets (n = 145) with a standardized local community retailer (the nearest Walmart). 22,23 On average, we found that the military sold cigarettes at a 25.4% savings, with the difference as much as 73% at one Navy store. 22 Furthermore, we found that the prices at only 4.9% of military retail outlets were within 5% of prices at the community comparison, as required by military policy. We reexamined the cost of cigarettes on military installations 2 years after our original study, which for the first time clearly documented that the DoD sells tobacco at prices much lower than civilian discount stores. Our objective was to amass the first longitudinal data on tobacco pricing in military retail outlets, including trends within each service. In light of the military’s interest in decreasing tobacco consumption among troops, it is important to document whether tobacco prices continue to be much lower than in the civilian market or if they are approaching civilian prices. We do not know whether publicity connected with our original research, as well as an investigative report on tobacco prices in military retail that aired on National Public Radio, 24 may have prompted military retail management to reconsider tobacco pricing. Finally, new military policies regulating tobacco have been approved since our original research, 22,23 the most relevant of which is a memorandum issued by Secretary of the Navy Ray Mabus eliminating any savings on tobacco products sold in Navy exchanges. 25 Thus, our new data are critical for evaluating the status of this important topic in military tobacco control research.
