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Why Are Veterans More Likely to Smoke?

Veterans of the United States Armed Forces are at a high risk of smoking cigarettes.

This group struggles with higher rates of mental illness, especially depression and PTSD, compared to the civilian population, and they have much higher rates of traumatic brain injury (TBI), which can change behaviors.

Veterans are also a part of a culture with more smokers, so smoking may be viewed as more socially acceptable. Veterans need treatment devoted to their specific demographic to help them stop smoking cigarettes.

The public view of smoking has changed greatly in the last several decades, especially among adolescents and young adults.1 However, some groups, like veterans, are still at risk of developing an addiction to nicotine.

Read on to learn about what drives veterans to smoke and how our retired service members can get help quitting.

Higher Rates of Smoking among Veterans

Tobacco addiction is prevalent among current and former service members.

A long-term survey of 48,304 military service members reported that being deployed was the leading risk factor that led former smokers to begin smoking cigarettes again.2 In 2008, about 30% of all military service members were current cigarette smokers, which is similar to the 29% of the civilian population that reports current tobacco abuse.3

Male veterans between 25 and 64 years of age were the most likely demographic to smoke cigarettes; 29% from the CDC report reported current tobacco use. Another CDC report found that 30% of military veterans between 2010 and 2015 used some form of tobacco product, including smokeless tobacco products like vaporizers.4

In a survey of 156 US Armed Forces members deployed in Iraq:5

  • 9% of the men smoked prior to deployment
  • 3% of the men smoked during deployment.
  • 7% of the women percent smoked or otherwise abused tobacco prior to being deployed.
  • 2% of the women used tobacco during their deployment.
  • Most stated that they intended to quit when they returned home.

Reasons active-duty service members listed for smoking included:5

  • Stress: 47.7%.
  • Boredom: 25.1%.
  • Nicotine addiction: 22.7%.

A larger 2011 survey of people who had recently used Veterans Affairs (VA) health services, stated that 15% received a diagnosis of being physically dependent on nicotine. Younger veterans of the Iraq and Afghanistan conflicts did not seem to be at a higher or lower risk for dependence compared to veterans of other combat scenarios, including Vietnam.6

That survey reports, though, that since higher rates of nicotine abuse among veterans have been reported in other surveys, this condition may be under-diagnosed in VA records.6

Among 2012’s VA enrollees, 70 percent reported being former smokers, which is higher than the national civilian average of former smokers. However, the VA reports that this 70 percent of veterans have successfully quit smoking, often with the help of the VA healthcare system.7

Mental Health Struggles like PTSD Increase the Risk of Smoking

Experiencing combat does not inherently mean the veteran will develop post-traumatic stress disorder (PTSD), but this stressful and life-threatening situation increases the risk.

PTSD and associated depression are prevalent among current and former service members, with suicide rates among veterans being much higher than that of the general population.

A report gathered by the American Psychological Association (APA) found that, of the 2 million returning American military members who served in Iraq and Afghanistan, one third reported having a mental or cognitive problem when they came home. Between 19.5% and 22.8% reported a traumatic brain injury (TBI), and 24.4% reported PTSD.9

Combat-related problems are not the only causes of PTSD, depression, substance abuse, and suicide among current and former service members. Nearly 1 in 4 women experienced an “unhealthy climate” because of sexual harassment in the military, while 6% of women in the armed services have experienced sexual assault.

The CDC found that, among veterans who used tobacco products, 48.2% reported serious psychological distress.11 Many of these veterans had stressful lives, too. It was found that:11

  • 1% had no health insurance.
  • 7% lived in poverty.
  • 9% had less than a high school diploma, making gainful employment more difficult.

VA reports regarding this group of veterans found that:12

  • 7% of study participants were nonsmokers.
  • 8% were former smokers.
  • 5% were current smokers.
  • 6% of the current smokers were men.
  • 4% were women.
  • Current veteran smokers smoked a lot of cigarettes: men smoked 12.6 times daily and women smoked 10.3 times daily.

Smoking Cessation Help for Veterans

man breaking a cigarette in halfA 2016 study found that including tobacco cessation in group motivational interviewing (GMI) sessions with veterans improved outcomes for many participants.13

The VA offers smoking cessation help for veterans, which is a combination of prescription medication and counseling. Nicotine patches, lozenges, and gum can help veterans begin the process of ending their physical dependence on nicotine. A physician will help the veteran taper these products slowly until the body no longer needs tobacco products to feel normal.

Bupropion, the generic version of Wellbutrin, was once an antidepressant but has recently been found to work well helping people who smoke, including veterans, overcome the addiction. A counselor can work with the veteran on life stress and ways to cope that do not involve cigarettes or other tobacco products.

Former service members with underlying mental health concerns like PTSD and depression will also greatly benefit from counseling. The VA has long helped veterans manage PTSD, depression, addiction, and other mental and behavioral struggles. Any veteran suffering from co-occurring disorders, like PTSD and smoking, can get help from a VA counselor.

For veterans who may not want to go through VA treatment or those who cannot reach their nearest VA, the federal healthcare system sometimes contracts with other medical providers to ensure access to physical, behavioral, mental, and substance abuse treatment.

 

References:

  1. Fernandez, E. (2016). Adolescent perceptions about smoking have changed over decade.
  2. Saxon, A.J. (2011). Returning veterans with addictions. Psychiatric Times, 28(7).
  3. National Institute on Drug Abuse. (2013). Substance abuse in the military.
  4. Centers for Disease Control and Prevention. (2019). Burden of tobacco use in the U.S.
  5. DiNicola, C.A. & Seltxer, D.M. (2010). Tobacco product usage in deployed male and female military personnel. Military Medicine, 175(9), xi.
  6. Tsai, J., Edens, E.L., & Rosenheck, R.A. (2011). Nicotine dependence and its risk factors among users of veterans health services, 2008-2009. Preventing Chronic Disease, 8(6), A127.
  7. (2010). National survey of veterans, active duty service members, demobilized national guard and reserve members, family members, and surviving spouses.
  8. S. Department of Veterans Affairs. (2018). PTSD: National Center for PTSD.
  9. American Psychological Association. The mental health needs of veterans, service members and their families.
  10. Department of Defense. (2018). Department of Defense annual report on sexual assault in the military.
  11. Odani, S., Agaku, I.T., Graffunder, C.M., Tynan, M.A., & Armour, B.S.(2018). Tobacco product use among military veterans—United States, 2010-2015. Morbidity and Mortality Weekly Report 67(1), 7-12.
  12. S. Department of Veterans Affairs. (2017). Cigarette smoking in Iraq and Afghanistan veterans.
  13. Santa Ana, E.J., LaRowe, S.D., Armeson, K., Lamb, K.E., & Hartwell, K. (2016). Impact of group motivational interviewing on enhancing treatment engagement for homeless veterans with nicotine dependence and other substance use disorders: a pilot investigation. American Journal of Addiction, 25(7), 533-41.