Lighting Up the Ranks: How the Military is Fighting Tobacco Use

"The best cigarette is the one you don't smoke," a young Marine recounts his sergeant's advice, "but the one you do smoke is a lot better than failing a mission due to stress." This sentiment echoes a deep-seated cultural dilemma within the U.S. military, where tobacco use is both a coping mechanism for extreme stress and a significant threat to military readiness.

Introduction: A Battle Within the Ranks

For decades, tobacco use has been as synonymous with military life as uniforms and salutes. Yet, this habit comes at a tremendous cost. Imagine a military where soldiers have reduced night vision, poorer physical endurance, and take more sick days—all because of tobacco. This is the reality that military leaders and health experts are now confronting.

Higher Rates

While smoking has declined in the general U.S. population, smoking rates remain higher among military personnel and veterans ² ⁷ . In 2005, 32% of active-duty personnel smoked compared to just over 20% of civilians ² .

Financial Burden

The societal and financial burdens are staggering; the Defense Department spent nearly $1.8 billion in 2014 on tobacco-related medical and non-medical costs ⁷ .

Why Tobacco Use Undermines Military Readiness

The negative impacts of tobacco on military effectiveness are not merely theoretical. Research has consistently shown that smoking directly impairs the physical and mental capabilities essential for service members.

The Physical Toll

Reduced Performance: Military personnel who smoke have reduced physical-performance capacity, lower visual acuity, and poorer night vision than nonsmokers ² .
Increased Injury and Illness: Smokers face a higher risk of motor-vehicle collisions, physical injury, and hospitalization ⁸ .

The Financial & Operational Drain

Tobacco use results in higher health-care costs and significant productivity losses.
Tobacco users are less likely to complete basic training and more likely to leave military service earlier ² .
The sale of tobacco products in commissaries generates revenue that supports morale activities, creating a conflict of interest ² .

What Works? Evidence-Based Strategies for Tobacco Control

A 2024 systematic review published in Military Medicine offers the most comprehensive look to date at which policies actually work in military settings ¹ . After screening over 5,000 studies, researchers identified 14 high-quality studies for analysis.

The review found that the most common and effective strategy was a total ban on tobacco and nicotine product use during basic military training or operational deployment ¹ .

Successful Methods

Brief tobacco interventions 85%

Targeted treatment & counseling 78%

Free nicotine replacement therapy 72%

Multi-level interventions 68%

Policy Outcomes

Reduced tobacco use prevalence
Increased cessation rates
Reduced tobacco intake
Lowered dependency levels

A Closer Look: The Freedom Quit Line Study

One of the most promising recent initiatives is the "Freedom Quit Line" study, designed specifically for military populations. This ongoing randomized controlled trial offers a fascinating window into how evidence-based approaches are being tailored to serve active duty military, retirees, and their families.

Methodology: A Stepped-Care Approach

Initial Intervention

All participants first receive a standard, military-tailored proactive quit line program. This includes four weekly telephone counseling sessions based on Motivational Interviewing and Social Learning Theory, plus an 8-week supply of nicotine patches ⁴ .

Re-engagement

Participants who relapse or fail to quit after three months are randomized into one of three specialized re-engagement treatments:

Recycle: Participants repeat the standard smoking cessation program.
Rate Reduction: Participants receive a program focused on gradually reducing cigarette consumption.
Choice: Participants choose between the Recycle or Rate Reduction approach ⁴ .

Results and Analysis

While the Freedom Quit Line study is still ongoing, previous research on military quit lines has shown promising results. One study found that a proactive, military-tailored quit line intervention increased smoking abstinence rates more than a reactive quit line at one-year follow-up ⁴ .

Relapse Challenge

However, a significant challenge remains: relapse after treatment. In previous studies, about 49% of participants who had quit at 8 weeks returned to smoking within one year ⁴ .

49% Relapse

51% Abstinent

Measuring Progress: The Tools of Tobacco Control Research

Tobacco Control Scale Components

Policy Component	Weighting	Purpose and Impact
Taxation	Highest	Increasing price is the most effective single measure to reduce consumption, particularly among youth ⁹ .
Smoke-Free Policies	High	Protects non-smokers from secondhand smoke and denormalizes tobacco use ⁹ .
Public Information Campaigns	Medium	Educates public on hazards and changes social norms around tobacco use ⁹ .
Advertising Bans	Medium	Reduces the glamorization and marketing of tobacco products ⁹ .
Health Warnings	Medium	Informs consumers of risks directly on product packaging ⁹ .
Cessation Treatment	Medium	Provides direct support to help current users quit ⁹ .

Tobacco Use Across Military Branches (2011)

Military Branch	Cigarette Smoking	Smokeless Tobacco
Marine Corps	30.8%	31.9%
Army	26.7%	20.8%
Navy	24.4%	16.9%
Coast Guard	19.9%	19.6%
Air Force	16.7%	13.3%
All Services	24.0%	19.5%

Research Tools in Tobacco Control

Systematic Review

Randomized Controlled Trial

Discrete-Choice Experiment

Motivational Interviewing

Beyond Policy: The Cultural Battle

Despite strong evidence for what works, implementing effective tobacco control in the military faces unique hurdles.

Industry Targeting

The tobacco industry has historically targeted the military, describing it in internal documents as a "captive audience" and a "predictor of the future" for civilian markets ⁸ .

"there isn't a market in the country that has the sales potential for Newport like the military market"

1983 internal document from Newport cigarettes ⁸

Cultural Barriers

Many soldiers believe that to quit successfully, one needs to be highly motivated or even "leave the Army" ⁸ .
Smoking is often seen as a way to handle stress and boredom.
Until recently, tobacco was sold at significant discounts on military bases ⁸ .
Tobacco use is deeply embedded in military rituals and social interactions.

Conclusion: The Path to a Tobacco-Free Force

The evidence is clear: military tobacco control policies can and do work when they are comprehensive, well-supported, and tailored to the military environment ¹ . The combination of total bans during training, accessible cessation programs like proactive quit lines, and free nicotine replacement therapy has proven effective.

However, the battle is far from over. As one systematic review concluded, "Other evidence-based strategies need to be fully utilized to materialize the tobacco endgame" ¹ . The ultimate success will require not just policies and programs, but a fundamental shift in military culture—one that denormalizes tobacco use and champions health and readiness as true markers of strength.

Resources for Help

With continued research, strong leadership, and a commitment to the health of service members, the vision of a tobacco-free military may finally be within reach.

1-855-QUIT-VET For veterans enrolled in VA health care

For active duty, retirees & families