Prevalence of smoking in male soldiers and its association with aggressive behavior

Objectives: Smoking rates are markedly higher in the military than the general population, particularly following combat. The highest rates are seen in the Army. Though the co-morbidity of smoking and mental illness is well-established, and aggressive behavior has been associated with mental illness in a military population, aggressive behavior has not been examined as correlate of smoking. This study examines the prevalence of smoking in male soldiers from combat brigades and its association with aggressive behavior.

Methods: 2,416 male soldiers completed comprehensive behavioral health surveys six months after returning from Iraq. Soldiers reported the average daily number of cigarettes consumed in the previous month. Aggressive behavior was calculated by summing the frequency of three behaviors measured on a 5-point scale: kicking/punching something in anger, making threats of physical violence, and getting in a physical fight. Analyses were conducted using multiple linear regression.

Results: Overall, 48.9% of soldiers reported smoking at least one cigarette daily with 18.9% smoking a pack a day or more. After controlling for demographic variables, combat exposure, combat injury, adverse childhood experiences, alcohol abuse, and mental health symptoms, aggressive behavior was positively related to the number of cigarettes consumed (β= .10, t = 3.29, p < .001).

Conclusions: Nearly half of male soldiers reported smoking six months post-deployment with one-fifth smoking a pack or more a day. Even after adjusting for common correlates, aggressive behavior was associated with cigarette consumption. The Army should consider incorporating anger management techniques into smoking cessation programs.