Thursday, July 2, 2009

Tobacco Prohibition in the U.S. Military



A newly released report from the Institute of Medicine (IOM) provides more evidence that the federal government is steadily moving toward prohibition of tobacco. The report, requested by the Department of Defense (DOD), calls for implementation of “state-of-the-art programs to achieve tobacco-free military and veteran populations.” Some of the draconian measures include:

• Stop selling tobacco products in military commissaries and exchanges.
• Prohibit tobacco use anywhere on military installations.
• Treat tobacco use in the same way as …alcohol abuse and poor physical fitness, which impair military readiness.

The report acknowledges that deployment of military forces is a primary factor in high prevalence of tobacco use. War has been associated with increased use of tobacco for centuries. During the Revolutionary War, George Washington pleaded to the Continental Congress: “If you can't send money, send tobacco.”

Cigarettes were considered to be effective for dealing with the stress of trench warfare in the First World War; they were given to soldiers in 1917 and 1918. General Pershing said at the time, “Tobacco is as indispensable as the daily ration; we must have thousands of tons without delay.” In World War II, cigarettes were included in soldiers’ rations.

For deployed soldiers, the health hazards of smoking are far in the future. In stark contrast, the hazards of combat, both physical and mental, are endured each and every day they are deployed. Those who have never seen combat cannot comprehend the psychological toll it exacts, but we can appreciate how soldiers deal with the stress. Tobacco and nicotine are powerful psychoactive agents that help our troops manage extreme stress, grief, boredom and suffering.

There is one scientific fact that the IOM report completely ignores: The adverse health effects and long-term financial impact of soldiers’ tobacco use are almost exclusively the result of smoking, not smokeless tobacco use. The report suggests that smokeless tobacco use as risky, but it cannot refute the scientific evidence that smokeless use is 98% safer than smoking.

While no tobacco product is completely safe, cigarette smokers in the military are routinely misinformed by health professionals and government officials about the relative safety of smokeless products. As discussed in earlier posts, smokeless tobacco does not cause lung cancer, heart disease or emphysema. The risk for mouth cancer with smokeless is far lower than it is with cigarettes. In fact, the risk is vanishingly small; nine epidemiologic studies published in the last decade, including one from the American Cancer Society, have concluded that smokeless tobacco use is not associated with mouth cancer.

A growing number of health care and policy experts have endorsed the concept of encouraging smokers to use tobacco in a far safer way. For example, a 2007 report by Britain's Royal College of Physicians, one of the most prestigious medical societies in the world, concluded “that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.” In 2008, the American Association of Public Health Physicians officially endorsed this strategy.

Smokeless tobacco is a satisfying and far safer substitute for cigarettes. So why is the military moving toward total tobacco prohibition? Perhaps it is because DOD’s stop-smoking programs have been unsuccessful. In desperation, the agency awarded a researcher $3.7 million to develop a video game for smoking cessation.

Our armed forces put their lives on the line every day; they use tobacco to help manage the resulting stress. The answer isn’t video games and tobacco prohibition. It's time for DOD and other agencies to stop the misinformation campaign about tobacco. Show soldiers respect by giving them truthful information about smoking and smokeless tobacco use.

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