Civilian public health and military tobacco control

Background: US military tobacco use prevalence is unacceptably high, leading to poor health and fitness among personnel as well as increased costs to the military and veteran health care systems. Efforts to strengthen military tobacco control policies have been thwarted repeatedly by tobacco industry influence in Congress; civilian public health groups have provided no effective counterweight and have had little involvement. Methods: Focus groups (n=4 groups with 36 total participants) with civilian public health advocates. Results: Advocates expressed lack of knowledge about and experience with the military and perceived the military as a “foreign culture”. Advocates also understood the military as a closed system, anticipating that their participation would be unwelcome. This belief was exacerbated by their tendency to assume that their role would involve conducting cessation programs on military bases. Although they believed that the tobacco industry had influenced military tobacco use, they rarely connected this to the legislative arena. Advocates also were reluctant to endorse the idea of requiring that military personnel be tobacco-free, citing tobacco's legality, the unfairness of preventing military personnel from using a substance available to civilians, the seeming comparatively low risk of tobacco use in a “high risk” profession, potential effects on recruitment and retention, and the impracticability of enforcement, particularly when personnel were overseas or deployed. Conclusions: Establishing civilian support for stronger military tobacco control policy will require education, reprioritization of public health objectives, and better communication between civilian and military public health communities.