Tobacco and stress management in the U.S. military

Tobacco use costs the military $1.4 billion per year, reduces the readiness of service members, leads to higher costs for the Veterans Administration health system, impairs wound healing, and ultimately kills more service members than do combat injuries. Numerous initiatives have tried to reduce or eliminate tobacco use among service members, but these have frequently been rescinded or undermined by Congress. Most recently, the Institute of Medicine's call for a tobacco free military by 2020 was rejected summarily by the Secretary of Defense. This study used qualitative secondary analysis of data from focus groups with enlisted personnel (N=17) and interviews of tobacco control professionals in the military (N=52) to explore how respondents described the functions of tobacco use. Many respondents of all types believed that tobacco use was an effective way to mitigate the stresses of military life. Tobacco is used for multiple purposes, including establishment of identity and unit bonding, cross-role socializing, and assertion of autonomy. “Cigarette breaks” are still widely recognized as the norm, and smoking is frequently the only accepted excuse for taking a break, contributing to its association with stress relief. Tobacco use has not been shown to relieve stress (except for the stress of unsatisfied nicotine addiction). The military has a responsibility to provide its members with healthy, effective means of stress management.