MILITARY TOBACCO CONTROL: LEADERSHIP’S CALL TO ACT

Sandhia Rajan

December 05, 2011

Capstone Advisor: Anna Durbin Ph.D.

Johns Hopkins Bloomberg School of Public Health

My Report

Incorporate findings in the recent literature that examine the tobacco control environment in the U.S military in order to develop a problem-solving paradigm.

1. Defining the problem

2. Measuring the magnitude of the problem

3. Developing a conceptual framework for the key determinants of the problem

4. Identifying and developing intervention and prevention strategies

5. Setting priorities among strategies and recommending policies

6. Implementing programs and evaluating them

7. Communication Strategy

Guyer B (1998). Problem solving in public health (pp. 15-26). In: H Armenian and S Shapiro, (Eds) Epidemiology and Health Services Research. New York: Oxford University Press.

These troops are essentially putting their lives at risk twice: once in service to their country and once in service to tobacco. Tobacco is a long-term engagement — it kills slowly and insidiously.

— Stuart Bondurant, chair of the Committee on Smoking Cessation in Military and Veteran Populations

Public Health Problem2008 DoD Survey of Health Related Behaviors:

• 31% of military members smoke

• 14% of military members use smokeless tobacco

• 25% have smoked a cigar in the past year

U.S. military population largely fit the mold of the tobacco industries prime target: the young and high school-educated

Bray R.M. (2008). Department of Defense survey of health related behaviors among military personnel. Retrieved from http://www.tricare.mil/tma/studiesEval.aspx

The Paradox

In all military services:

• 16% of smokers quit smoking• 48% of smokers attempted to quit smoking in the past year• Two out of three past-year smokers made an attempt to quit smoking

in the past year

Why, despite the desire to be tobacco free, does the active duty military population struggle with such high rates of use?

Bray R.M. (2008). Department of Defense survey of health related behaviors among military personnel. Retrieved from http://www.tricare.mil/tma/studiesEval.aspx

Magnitude• Tobacco use costs DoD an

estimated $1.6 billion a year

• Smoking behavior is the best predictor of military training failure leading to an excess training cost of $130 million

• Weaker force decreases the security of the United States

Klesges, R.C., Haddock, C.K., Chang, C.F., Talcott, G.W., & Lando, H.A. (2001). The association of smoking and the cost of military training. Tobacco Control, 10, 43-47. TRICARE. (2008). Department of defense anti-tobacco campaign invades military markets. TRICARE News Release. Retrieved from http://www.tricare.mil/pressroom/news.aspx?fid=379

Conceptual Framework

Intervention and Prevention Strategies• Limiting access to tobacco

products• Increasing the price of

tobacco products in military facilities

• Comprehensive tobacco use restrictions in DoD facilities

• Transparent evidence-based comprehensive tobacco cessation servicesInstitute of Medicine (U.S.)., Bondurant, S., & Wedge, R. (2009). Combating tobacco use in military and veteran populations. Washington, D.C: National Academies Press.

Setting Priorities

RecommendationIncrease price of tobacco products sold in military facilities to equal local commercial price

• Significant impact on both initiation and cessation of tobacco users

• Minimal impact on DoD resources

• Historically, a similar strategy was implemented successfully

Ross, H., & Chaloupka, F.H. (2002). Economics of tobacco control. International Tobacco Evidence Network. Ranson, K.M., Prabhar J., Chaloapka F.J., & Nguyen S.N. (2002). Global and regional estimates of the effectiveness and cost-effectiveness of price increases and other tobacco control policies. Nicotine & Tobacco Research, 4, 311-319.

Implementation and Evaluation

Communication Strategy

Leadership driven:

• Identify an implementation strategy• Identify the target audience which includes military

installations, tobacco retailers, and consumers • Involve the commissaries and base exchanges in the

implementation strategy • Warn consumers of increase in prices• Promote cessation services• Incentivize healthier habits through other forms of military

benefits

ConclusionImmediate action:

Price increase for tobacco products may be a necessary forced catalyst to motivate a change in behavior.

Next steps:

• Limit point of sales• Move toward a complete ban

of tobacco sales on military installations

• DoD authority• Reform military image

Questions?