Health-Related Behaviors in Young Military Smokers

Military Medicine, Mar 2004 by Lynch, John P, Hanson, Kevin, Kao, Tzu-Cheng

This cross-sectional study examined the association between smoking and other health-related risk behaviors, individually as well as in clusters, across branches of military service in the higher risk ages of 18 to 25 years old within the 1998 Department of Defense Survey of Health-Related Behaviors among Military Personnel. Examination of the demographic variables revealed that, in general, smokers tended to be single, white, enlisted men in the 18- to 20-year age group with less education and serving in the Army or Marine Corps. Our findings support that there is an increased likelihood of cooccurrence of substance use along with other negative healthrelated risk behaviors found in military members. It may be practical and necessary to develop a focused survey given to those attending smoking cessation interventions, or perhaps to smokers in general, which attempts to identify associated risk behaviors and channel clients accordingly.

Introduction

Despite continued warnings from physicians and public health advocates about the dangers of smoking, nearly 25% of U.S. adults over the age of 18 years still smoke.1 Another concern is the even higher rate of tobacco use in high school students, which was closer to 35% in 1999.2 The military is very involved and interested in tobacco use because members of the military are drawn from the general U.S. youth population. Smoking has implications for military health care costs, readiness, and retention of active duty. The momentum to stem this tide of tobacco use continues at all levels of advocacy, from local peer counseling programs to national legislative actions. It is incumbent on the medical and public health fields, civilian as well as military, to continue to study the trends and determinants of smoking to allow for interventions that are more effective.

Despite overall downward trends in tobacco use in military personnel followed with the periodic Department of Defense (DoD) Survey of Health-Related Behaviors (SHB) since 1980, the decline was not significant between 1995 and 1998.3 It is interesting to note that the 1998 survey was the first to report since 1982 that smoking rates did not decrease significantly relative to the previous survey. Although the 1998 smoking rate (29.9%) was significantly lower than it was in 1980 (50.0%), it remained approximately 10 percentage points above the Healthy People 2000 objective of 20%.4

Beyond the Healthy People 2000 objective, the military desires to reach its own goal of becoming smoke free. However, military rates of tobacco use have been higher than those found in comparable civilian sectors, ranging from 25.7% for Air Force to 34.9% for Marine Corps.5,6 Given these higher rates, several studies have looked at the question of whether the military attracts or creates smokers.7-9 These studies have suggested that exposure to the military environment might lead to increases in tobacco use by young enlisted men; perhaps smoking reflects normative behavior for this group when adapting to the military environment.

Although the problems with cost, readiness, and early discharge associated with smoking are seen throughout the entire military,10-16 many of the studies examining these issues point to 18- to 25-year olds as a higher risk age group.8,17 In fact, several studies of civilian populations in this age group exhibit greater risky behavior of various types.18-22 Furthermore, since 1995, when compared with standardized civilian populations, the greater use of tobacco in the military reaches statistical significance only among the 18- to 25-year-old age group.9 Other studies have shown that those in this age group are discharged earlier than expected from military service than their older peers.23

In the civilian population, cigarette smokers tended to score consistently higher on self-reported risky behaviors than did nontobacco users.18 The relationship between smoking and both alcohol and drug use has been clearly shown in both civilian and military samples.17,19,24,25 Another recent study reported a distinct association with smoking and physical injuries in the military.26 Additionally, civilian smokers have demonstrated significantly higher risky or unhealthy behaviors than their nonsmoking peers in the following areas: less likely always to use seat belts; less likely always to use helmets with motorcycles, mopeds, and bicycles; less condom use; greater number of sexual partners; more chronic stress; and more involvement with physical fights.20,21,27-31 These associations, which vary by sex and race or ethnicity, suggest clustering to form a risk behavior syndrome.32,33

Although a clustering of behaviors has been supported in studies for civilian samples where healthy adult cultural norms no longer support smoking, smoking and associations with clusters of risk behaviors have rarely been examined for the group of young military personnel of 18 to 25 years old, who may be entering an environment where smoking is more acceptable. Our study objective was to examine smoking and other healthrisk behaviors, individually as well as in clusters, across branches of military service in this age group.