摘要：In 1986, the US Navy announced the goal of becoming smoke-free by 2000. However, efforts to restrict tobacco sales and use aboard the USS Roosevelt prompted tobacco industry lobbyists to persuade their allies in Congress to legislate that all naval ships must sell tobacco. Congress also removed control of ships’ stores from the Navy. By 1993, the Navy abandoned its smoke-free goal entirely and promised smokers a place to smoke on all ships. Congressional complicity in promoting the agenda of the tobacco industry thwarted the Navy's efforts to achieve a healthy military workforce. Because of military lobbying constraints, civilian pressure on Congress may be necessary to establish effective tobacco control policies in the armed forces. At more than 30%, 1 , 2 the prevalence of smoking in the military is 50% higher than is the civilian rate, with a 40% prevalence among those aged 18 to 25 years 3 and nearly 50% among those who have been in a war zone. 2 , 4 From 1998 to 2005, tobacco use in the military increased 7.7%, from 29.9% to 32.2%, reversing the decline of prior decades. 4 A tobacco-friendly military culture persists, including the availability of cheap tobacco products, 5 liberal smoking breaks, 6 and easily accessible smoking areas. 6 , 7 Smoking damages health and readiness 8 – 11 and increases medical and training costs. 12 – 15 In addition to short-term effects, such as impairment to vision and hearing, long-term consequences include lung and other cancers, cardiovascular disease, chronic obstructive pulmonary disease, and problematic wound healing. 4 The US Department of Defense spends more than $1.6 billion annually on tobacco-related health care and absenteeism. 4 In addition to compromised military readiness and Department of Defense expenses, a tobacco-friendly military culture takes a societal toll—economic and human—long after military personnel return to civilian life. The Department of Veterans Affairs spent $5 billion in 2008 treating veterans with chronic obstructive pulmonary disease, a diagnosis most often associated with smoking. 4 Lifelong smokers have a 50% chance of dying prematurely. 4 Most costs must be borne by the veteran: in 1998, Congress denied disability pensions to tobacco-sickened veterans who began to smoke during their service, initially labeling smoking in the military as “willful misconduct.” 16 Department of Defense Directive 1010.10, issued in 1986, established a baseline “policy on smoking in the DoD [Department of Defense] occupied buildings and facilities.” 17 The policy emphasized a healthy military that discouraged smoking and designated authority to the services and to individual commanders to set specific policies. 18 However, subsequent attempts to set such policies achieved limited results, 19 , 20 in part because of the tobacco industry's influence on Congress. 5 , 18 The industry successfully lobbied Congress to prevent the military from raising the prices of tobacco products sold in military stores, 5 and to ensure that in-store tobacco promotions would not be prohibited. 18 Congress also prevented the army from implementing a stronger tobacco control policy than that set by Directive 1010.10, although the directive was intended to be a policy floor upon which the services could expand. 18 To achieve its goals, Congress privately pressured military tobacco control advocates, 18 publicly scolded them, 5 interfered with funding for military programs, 5 and passed laws preventing the establishment of recommended tobacco control policies. 5 , 16 We examined an attempt by a former captain of the USS Theodore Roosevelt to ban smoking on the aircraft carrier and showed how tobacco industry lobbyists, working through their allies in the US Congress, were successful in stymieing his efforts and forcing the Navy to sell cigarettes on all ships.
