摘要：Objectives . We sought to gauge the relative attention that tobacco control receives in military newspapers by comparing coverage of tobacco use with that of other health topics of importance to the military. Methods . We examined tobacco-related articles and industry advertisements in 793 newspapers published during 1 year at 16 representative military installations (4 Air Force, 6 Army, 2 Marine, 4 Navy). Newspaper content was coded with a standardized coding manual developed through previous research. Results . Tobacco use received the fewest instances of coverage and the least print space in military installation newspapers of all the health topics examined. The primary “message frame” used in tobacco control articles was that smokers are putting themselves at health risk, a theme that has not been found to have a strong effect on smokers. Nearly 10% of the newspapers contained tobacco advertisements. Conclusions . Tobacco control messages are underrepresented in military installation newspapers compared with other health issues. Furthermore, military newspapers send mixed messages to military personnel by providing advertisements for tobacco while also claiming that tobacco use is harmful. Tobacco use is the leading preventable cause of premature mortality and morbidity worldwide. 1 Smoking is known to cause stroke, heart disease, chronic obstructive pulmonary disease, and many forms of cancer. 2 Each year 1 in every 5 deaths—nearly 440000 lost lives—is caused by tobacco use. 3 The American Lung Association calculated that adult males and females lost an average of 13.2 and 14.5 years of life, respectively, owing to smoking, excluding life years lost owing to secondhand smoke exposure. 1 Despite the staggering impact of smoking on health, 22.8% of adults in the United States continue to smoke. 4 One segment of the US population with a disproportionately high smoking rate is the US military. 5 From 1998 to 2002, the military witnessed an increase in smoking among active-duty personnel, from 29.9% to 33.8%. 6 Among the service branches, the Marine Corps has the highest (38.7%) and the Air Force the lowest (27.0%) percentage of smokers. 6 In addition, more than 12% of military personnel report using smokeless tobacco (14.5% among males). 6 Of particular concern is that more than 30% of active-duty personnel who smoke report having initiated smoking after entering the military, raising the possibility that the military culture encourages smoking. 5 – 7 The high rate of tobacco use among Department of Defense (DOD) personnel puts a substantial burden on military health care and combat readiness. It has been estimated that smoking-related health care costs and associated lost productivity costs in the military are nearly $1 billion annually. 8 Military personnel who smoke are less productive, 5 are more likely to miss duty days because of illness, 6 – 9 perform worse on physical fitness tests, 5 experience significantly more training injuries, 10 and are more likely to be discharged within the first year of service 11 relative to nonsmoking personnel. Several initiatives have been designed to reduce tobacco use in the US military, such as tobacco control policies, bans on smoking during training, and no-cost smoking cessation programs, including pharmacotherapy. 6 In addition, the DOD, in collaboration with the Department of Veterans Affairs, has established comprehensive clinical guidelines on tobacco treatment in military medical facilities. 6 The DOD also has chartered the cross-service Alcohol Abuse and Tobacco Use Reduction Committee to advance policies that reduce tobacco consumption among military personnel. This effort is consistent with DOD readiness requirements and the military health system strategic plan of creating a healthy and fit fighting force. 12 Finally, some individual military services have established their own tobacco control policies. For example, the Air Force’s tobacco policy prohibits smoking in Air Force facilities, mandates provision of smoking cessation services, and forbids tobacco advertising in service publications. 13 One tobacco control strategy that has received little attention in the military is the use of the print media. In 2001, the top 5 tobacco companies spent approximately $11.2 billion in advertising cigarettes, 14 which is more than the combined total budgets of the US National Cancer Institute and National Heart, Lung, and Blood Institute. Research has documented that industry advertising of tobacco increases the risk of smoking initiation and undermines parental attempts to discourage smoking among teenagers. 15 – 17 In response to this advertising blitz, mass media campaigns designed to reduce tobacco consumption have been developed and tested. 18 However, although antitobacco media campaigns can result in more negative attitudes toward smoking and prevent initiation, pro-tobacco advertising may counteract the positive effects of antitobacco messages. 16 , 17 , 19 , 20 Industry documents have demonstrated that tobacco companies have targeted the military with pro-tobacco marketing campaigns. 21 However, little research has examined how print media are used to discourage tobacco use among military personnel. Newspapers are one of the primary means used by military commanders to communicate information to installation personnel. 22 Installation newspapers are used to update and inform military personnel and their families about important health issues such as smoking cessation, drinking and driving, healthy weight objectives, and fitness, to name just a few. According to the federal regulation governing military installation newspapers, “the newspaper provides information to make command members aware of the hazards of the abuse of drugs and other substances, and of the negative impact that substance abuse has on readiness.” 22 There are 174 military installation newspapers, and surveys suggest that nearly 90% of active-duty military personnel read these publications. 23 Thus, military installation newspapers could play a key role in preventing substance abuse by military personnel. No study to date has examined how the military uses newspapers to educate its personnel about the dangers of tobacco use or whether the tobacco industry attempts to promote smoking through military newspapers. The purpose of this study was to examine tobacco control articles and industry advertisements in military installation newspapers and to compare coverage of tobacco use in military newspapers with coverage of other topics of importance to military health promotion, including alcohol abuse, physical activity, illegal drug use, and seat belt use. It was hoped that this analysis would yield an improved understanding of the amount and type of tobacco-related information that reaches the military population through this important media outlet.
