摘要：Smoking impairs the readiness and performance of military personnel, yet congressional opposition has thwarted military tobacco control initiatives. Involvement of civilian organizations might alter this political dynamic. We interviewed 13 leaders of national civilian public health and tobacco control organizations to explore their perspectives on military tobacco control, inductively analyzing data for themes. Leaders believed that military tobacco use was problematic but lacked specific knowledge. Most supported smoke-free policies and prohibiting smoking in uniform; however, they opposed banning tobacco use, arguing that it would violate smokers’ rights. Most leaders inappropriately applied civilian models of policy development to the military context. A tobacco-free military is unlikely to be achieved without military–civilian partnerships that include educating civilian health leaders about military policy development and implementation. AS OF JULY 2011, THERE WERE 1 434 312 active-duty United States military personnel. 1 In 2008, 34% of personnel surveyed had smoked cigarettes in the past 30 days, 2 a smoking rate that exceeds the overall US civilian population rate (20.6%). 3 Smokeless and polytobacco use are common. 4 Smokers in the military have lower levels of physical fitness than nonsmokers, 5,6 limiting their ability to fulfill their duties. Exposure to primary 7,8 and secondhand 9 smoke impairs wound healing. 10 Smokers are at increased risk for training injuries 11,12 and are more likely to be discharged prematurely. 13 Approximately $346 million is lost annually to productivity decrements associated with smoking in the military, and smoking-related medical care costs the Department of Defense $584 million annually. 14 A recent Institute of Medicine review of the impact of tobacco use on military personnel and veterans recommended eliminating tobacco use in the armed forces. 15 In the civilian world, reduced smoking prevalence has accompanied aggressive policy change. In the military, however, cigarettes are sold tax-free, 16 tobacco use is prohibited only during basic training, 17 and ships are required to have smoking areas. 18 Proposed military tobacco control policies have been withdrawn or weakened as a result of political pressure. For example, after tobacco industry lobbying of Congress, the US Army’s first tobacco control plan was weakened. 19 Members of Congress and the Department of Defense attempted to raise commissary cigarette prices for more than a decade, partially succeeding only over the objections of members of the House Armed Services Committee. 16 These findings suggest that industry-instigated political opposition is a primary obstacle to effective tobacco control in the military. Although military personnel cannot lobby for change, civilian public health organizations could promote military tobacco control by countering tobacco industry influence in Congress. However, few civilian groups have been active in this area. We explored public health and tobacco control leaders’ perspectives on tobacco use among military personnel and military tobacco control policy.
