Barriers to Effective Tobacco Control Policy Implementation in the U.S. Military
Location(s): United States
The objective of this study is to develop knowledge that will advance tobacco control policy implementation within the U.S. military. The health of its personnel is critical to the mission of the U.S. military, and smoking negatively affects troop readiness in the short term and health care costs in the longer term. Both of these issues are of heightened concern due to the country's current involvement in conflicts in Iraq and Afghanistan. However, smoking prevalence among military personnel remains unacceptably high, despite declining from 51.0% in 1980 to 30.4% in 2008 (the most recent DOD population survey of tobacco use). Since 2002 no significant reduction in smoking prevalence has been achieved in the military, and smokeless tobacco use has increased slightly. Policy changes, such as increased cigarette taxes and clean indoor air laws, have been shown to be more effective than education or individual intervention at reducing smoking rates. Such policy changes have helped reduce smoking prevalence in the U.S. civilian population from over 50% in 1965 to 20.6% currently. However, although numerous military tobacco control policies have been issued since the 1980s, their effective implementation has been repeatedly thwarted by structural, cultural, and political barriers. This descriptive, multi-method study will develop knowledge that will advance tobacco control efforts within the U.S. military by explicating these barriers to policy implementation, describing the social meanings of tobacco use and cessation within the military context, and identifying best practices in military tobacco control policy implementation. The specific aims of the project are to: Aim 1: Explicate the barriers to effective tobacco control in the military by (a) Assessing the state of leadership on tobacco control among commanders through a content analysis of base commander messages in military installation newspapers; (b): Conduct an economic analysis to determine the cost differential of cigarettes purchased on U.S. military installations and those purchased in their local market; and (c) Retrieve and analyze internal tobacco industry documents in order to describe the tobacco industry's activities pertaining to the four active service branches of the United States (US) military, the Veterans Administration, veterans groups and other military-affiliated organizations. Aim 2: Describe the meanings of tobacco use in the military by conducting a set of secondary analyses of qualitative interview and focus group data obtained from military personnel, augmented by data from internal tobacco industry documents, military periodicals, and installation policy language to explore: (a) The construction of tobacco use as a "right" within the military; (b) The experience of starting to smoke in the military; and (c) The experience of quitting smoking in the military. Aim 3: Analyze effective tobacco control in the military by identifying key elements associated with successful implementation of a tobacco control policy at the installation level through in-depth case studies of effective policy intervention.