Forcing the Navy to sell cigarettes on ships: how the tobacco industry and politicians torpedoed Navy tobacco control

Exposure levels for carbon monoxide in nuclear submarine atmosphere

This work proposes exposure limits for carbon monoxide in the nuclear submarine environment. Linear and non-linear forms of the Coburn-Foster-Kane equation were used to evaluate carbon monoxide exposure for an environment with low oxygen content, different exposure times and crew physical activity levels. We evaluated the 90-day Continuous Exposure Guidance Level, 24-h and 1-h Emergency Exposure Guidance Levels and 10-day and 24-h Submarine Escape Action Levels. The results showed that the concentration of carbon monoxide in the environment must not exceed 9 ppm for the 90-day Continuous Exposure Guidance Level, 35 ppm for the 24-h Emergency Exposure Guidance Level, 90 ppm 1-h Emergency Exposure Guidance Level, 60 ppm for the 10-day Submarine Escape Action Level and 80 ppm for the 24-h Submarine Escape Action Level. Comparing these values with those established by the National Research Council for the United States Navy, the limits proposed by this work are verified to be lower, which may indicate a risk to the health of the crew. They also show the impact of the crew's level of physical activity on the formation of carboxyhemoglobin.

Mortality of Enlisted Men Who Served on Nuclear-Powered Submarines in the United States Navy

OBJECTIVE

To describe the long-term mortality experience of a cohort of enlisted men who served on nuclear-powered submarines in the United States Navy and breathed recirculated filtered air for extended periods of time.

METHODS

In this historical cohort study we estimated standardized mortality ratios (SMRs) and used within-cohort Poisson regression analyses to address healthy worker biases.

RESULTS

Three thousand two hundred sixty three deaths occurred among 85,498 men during 1,926,875 person-years of follow-up from 1969 to 1995. SMRs were reduced for most cause-of-death categories, prostate cancer had a twofold elevation. In within-cohort comparisons, prostate cancer mortality did not increase with duration of submarine service, but ischemic heart disease mortality increased 26% per 5 years of submarine service.

CONCLUSIONS

Long periods of submarine service do not increase mortality in most cause-of-death categories. Increased mortality from ischemic heart disease likely reflects the effects of tobacco smoke.

Toxicological assessment of electronic cigarette vaping: an emerging threat to force health, readiness and resilience in the U.S. Army

The U.S. Army and U. S. Army Public Health Center are dedicated to protecting the health, and readiness of Department of the Army Service Members, civilians, and contractors. Despite implementation of health programs, policies and tobacco control interventions, the advent of electronic nicotine delivery systems (ENDS), including electronic cigarettes (e-cigs), represent unregulated and poorly defined systems to supplant or substitute use of conventional nicotine products (e.g., cigarettes and pipe tobacco). E-cigs present unique challenges to healthcare officials vested in preventive medicine. The health impact of an e-cig and vaping on an individual's acute or chronic disease susceptibility, performance and wellness, is fraught with uncertainty. Given the relatively recent emergence of e-cigs, high-quality epidemiological studies, and applied biological research studies are severely lacking. In sparsely available epidemiological studies of short-term cardiovascular and respiratory health outcomes, any attempt at addressing the etiology of acute and chronic health conditions from e-cig use faces incredible challenges. Until relatively recently, this was complicated by an absent national regulatory framework and health agency guidance on the manufacture, distribution, selling and use of e-cigs or similar ENDS devices and their chemical constituents. Two key issues underpin public health concern from e-cig use: 1) continued or emergent nicotine addiction and potential use of these devices for vaping controlled substances; and 2) inadvertent sudden-onset or chronic health effects from inhalational exposure to low levels of complex chemical toxicants from e-cig use and vaping the liquid. Herein, the health impacts from e-cig vaping and research supporting such effects are discussed.

Survey on smoking habits among seafarers

BACKGROUND

Populations living in stressful environments experience higher mortality from lung cancer and chronic diseases. Work-related stress was identified as important determinant of smoking together to health problems caused by a incorrect lifestyles. Aim of the work was to analyze tobacco smoking addiction in seafarers working on merchant ships. Only a few studies are available on this topic.

METHODS

The survey was conducted using an anonymous questionnaire. The total number of questionnaires filled-in was 1478, out of 2000 distributed (response rate 73.9 %).

RESULTS

About half of the sample (55.07%) has never smoked, the 28.96% is currently a smoker, while 15.97% of responders belong to the category of ex-smokers. Analysis of the number of cigarettes smoked every day based on the rank shows that captains and officers smoke more cigarettes than the crew members who smoke 10 cigarettes maximum per day. Analysis of the level of dependence among the smokers group by the Fagerström Test for Nicotine Dependence (FTND) revealed that a 89.0% of sample has a low/very low dependence level, and only the 10.98% of the sample show a high/very high dependence. A further analysis of the results of FTND in the different age groups has shown that the 41-50 and 51-60 age groups have high dependence levels.

CONCLUSIONS

Working on board is associated to a high risk for chronic, lifestyle-related diseases, due also to lifestyle behaviours. This study suggests to further investigate the presence of other risk factors such as diet, physical exercise, combined with tobacco smoking, obesity. (www.actabiomedica.it).

A Cross-Sectional Survey on Cigarette Smoking in the Chinese Navy

INTRODUCTION

The military is a risk environment for cigarette smoking. This study determined the prevalence of, cessation attempts, knowledge, and attitudes regarding smoking, and factors related to it in the Chinese navy.

MATERIALS AND METHODS

A cross-sectional survey was conducted of military personnel on active duty in the Chinese navy, Guangdong province. Data were collected using a standard structured questionnaire and analyzed through SPSS. Multiple logistic regression was used to examine factors associated with smoking. The research protocols were reviewed and approved by the Institutional Review Board of Naval Medical University, and participants gave written informed consent.

RESULTS

A total of 1,530 military personnel who had served for >3 months completed the survey, 859 (56.14%) of whom were current smokers. The main reasons for smoking were stress alleviation and social needs. A total of 377 smokers had previously attempted quitting. More than half considered the military environment supportive of smoking. Subjects' knowledge regarding smoking mainly comprised negative respiratory-health effects. Smoking status was related to education level, military service duration, number of smoking family members, and smoking knowledge.

CONCLUSIONS

Smoking prevalence in the Chinese navy is higher than that among Chinese civilians and the US and UK military personnel. Although many sailors are aware of the dangers of smoking to their health, they seldom get advice or help regarding smoking cessation. Most smokers believed that smoking cessation could improve their health. Therefore, the navy should formulate policies encouraging and facilitating military personnel's smoking cessation.

Installation Tobacco Control Programs in the U.S. Military

Tobacco use prevalence is unacceptably high in the U.S. military, and the Department of Defense and service branches have implemented tobacco control policies and cessation programs. To explore aspects of programs regarded as exemplary by their services, we visited four installations, nominated by their service's health promotion leaders, and conducted interviews, observations, and focus groups. Installations included Naval Hospital Guam, Tripler Army Medical Center, MacDill Air Force Base, and the Naval Hospital at Marine Corps Air Ground Combat Center Twentynine Palms. The tobacco control managers (TCMs) at the programs studied were all civilian employees, highly motivated and enthusiastic, and had remained in their positions for approximately a decade. Other commonalities included support from command, a "culture" of health, and location in warm climates. Programs varied in their involvement in establishing designated tobacco use areas, and length and requirement of attending cessation classes; however, no evaluation of cessation programs is currently underway. TCMs should be more engaged in policy discussions for the larger installations they serve. A strong policy framework and command support for TCMs will be necessary to achieve the goal of a tobacco-free military.

Smoking Behavior Change During Compulsory Military Service in Israel, 1987-2011

Introduction

Smoking in military settings is of major concern. We aimed to assess the association between personal, family, and military factors and smoking behavior change during compulsory military service in Israel.

Methods

Participants were soldiers recruited between 1987 and 2008 who were interviewed at recruitment and reinterviewed at discharge (1987-2011) (total: 29 189; males:15 136; females:14 053). The primary outcome variables were smoking initiation during service among nonsmokers at recruitment, and cessation during service among smokers at recruitment. We examined potential predictors of change, and trends by calendar year.

Results

Smoking prevalence increased by 39.4% during military service (recruitment: 26.2%, discharge: 36.5%). 18.4% of nonsmoking recruits initiated smoking, and 12.4% of smoking recruits quit smoking between recruitment and discharge. There was no observed trend in initiation between 1987 and 2011. The strongest predictor of smoking initiation among nonsmokers at recruitment was smoking history (former vs. never-smoker, odds ratio (OR) [95% confidence interval [CI]]: males: 5.63 [4.63,6.85], females: 6.76 [5.27, 8.68]. Other variables had smaller effects on initiation. Females were less likely to initiate smoking than males (OR [CI]): 0.75 [0.69,0.81]. Both males and females with high military fitness levels were more likely to initiate smoking. Among women, those with lower education, with fathers with lower education, of lower socioeconomic status, and ever-users of contraceptives were more likely to initiate smoking. Cessation among males modestly increased over the years (OR [CI]): 1.03 [1.01,1.05].

Conclusions

Smoking increased substantially during mandatory military service in Israel. Former smokers were at greatly increased risk of initiation and should be targeted for relapse prevention. Military service represents a golden opportunity for tobacco control.

Implications

Military tobacco control policy is an important contributor to longevity among service personnel, and population-wide mortality in countries with compulsory service. The increased smoking prevalence among military personnel, and increases in smoking during military service should act as a wake-up call to governments and health systems in countries lacking strong military tobacco control policies. The substantial progress in military tobacco control in the United States, which includes strong antitobacco policies for prevention of smoking initiation, aid to smokers to quit smoking, and protection of nonsmokers from tobacco smoke, should be emulated by others. Former smokers and others at high risk should be targeted for relapse prevention. The closed environment of military service provides a golden opportunity for tobacco control.

The Influence of Men's Military Service on Smoking Across the Life Course

The military is described as a social context that contributes to the (re-)initiation or intensification of cigarette smoking. We draw on data from the 1985-2014 National Survey of Drug Use and Health (NSDUH) and the Wisconsin Longitudinal Study (WLS) to conduct complementary sub-studies of the influence of military service on men's smoking outcomes across the life course. Descriptive findings from an age-period-cohort analysis of NSDUH data document higher probabilities of current smoking and heavy smoking among veteran men across a broad range of cohorts and at all observed ages. Findings from sibling fixed-effects Poisson models estimated on the WLS data document longer durations of smoking among men who served in the military and no evidence that selection explains the observed relationship. Together, these results provide novel and potentially generalizable evidence that participation in the military in early adulthood exerts a causal influence on smoking across the life course.

Tobacco Use Among Healthcare Workers: Impact of a Worksite Policy Change at a US Military Community Hospital

Introductions:Healthcare workers use less tobacco than other working populations. In contrast, US military members use more tobacco than civilians. Military healthcare workers, therefore, represent a unique group with regard to occupational factors that may influence tobacco use.

Aims/Methods:Records of workers at a military community hospital were reviewed to describe tobacco use. An anonymous survey assessed impressions of a worksite policy change that prohibited tobacco use anywhere on hospital grounds.

Results:Hospital staff included 2,074 professionals. Tobacco use was significantly associated with male sex and being a military enlisted worker. In fact, 37% of male enlisted members used tobacco; fewer than 10% of all other workers used tobacco. Among 232 survey respondents, 61% agreed with tobacco-restrictive worksite policies, but only 33% thought policies were effective. Nearly one-third of tobacco users reported decreasing use in the past year. In multivariable modelling, changing habits in response to worksite policy was the only factor significantly associated with decreased tobacco use.

Conclusions:Tobacco use among US military healthcare workers varies markedly by demographic characteristics. Male, military enlisted workers use tobacco at very high rates, paralleling the troops they serve. Implementation of tobacco-restrictive worksite policies is associated with decreased tobacco use in this population.

"It's not a priority when we're in combat": public health professionals and military tobacco control policy

Tobacco use is prevalent among service members, but civilian public health groups have not effectively addressed military tobacco control policy issues. We conducted focus groups in 2010 and 2012 with participants from public health and tobacco control organizations regarding their understanding of the military and of tobacco use in that context. Misperceptions were common. Military personnel were believed to be young, from marginalized populations, and motivated to join by lack of other options. Tobacco use was considered integral to military life; participants were sometimes reluctant to endorse stronger tobacco control policies than those applied to civilians, although some believed the military could be a social policy leader. Engaging public health professionals as effective partners in tobacco-free military efforts may require education about and reframing of military service and tobacco control policy.

Tobacco industry use of personal responsibility rhetoric in public relations and litigation: disguising freedom to blame as freedom of choice

We examined the tobacco industry's rhetoric to frame personal responsibility arguments. The industry rarely uses the phrase "personal responsibility" explicitly, but rather "freedom of choice." When freedom of choice is used in the context of litigation, the industry means that those who choose to smoke are solely to blame for their injuries. When used in the industry's public relations messages, it grounds its meaning in the concept of liberty and the right to smoke. The courtroom "blame rhetoric" has influenced the industry's larger public relations message to shift responsibility away from the tobacco companies and onto their customers. Understanding the rhetoric and framing that the industry employs is essential to combating this tactic, and we apply this comprehension to other industries that act as disease vectors.

Banning cigarette smoking on US Navy submarines: a case study

BACKGROUND

The military has had a long pro-tobacco tradition. Despite official policy discouraging smoking, tobacco still is widely seen as part of military culture. While active smoking has presented a particular challenge for the military, in recent years there also has been increasing concern with secondhand smoke. This is especially true in closed environments and submarines may be deployed for months at a time. The current case study describes the successful implementation by the Navy of a comprehensive ban on smoking aboard submarines.

METHODS

The authors searched documents on the internet, popular media, military-based news outlets and the scientific literature. We also conducted interviews with Navy officers who were instrumental in policy implementation.

FINDINGS

Data demonstrating substantial exposure of non-smokers to tobacco smoke aboard submarines had major impact on successful adoption of the policy. A systematic and extended roll out of the ban included establishing a working group, soliciting input and active engagement from submarine personnel, and offering cessation assistance. Support was enlisted from Chief Petty Officers who could have been strongly opposed but who became strong proponents. Fewer problems were encountered than had been expected. In contrast to a previous unsuccessful attempt by a Navy captain to ban smoking on his ship, the ban was adopted without apparent tobacco industry interference.

CONCLUSIONS

Lessons learned included the importance of strong empirical support, effective framing of the issue, setting a realistic timeline, soliciting support from key personnel and providing appropriate resources. These lessons have implications for those considering further tobacco policy changes in the military and elsewhere.

Mediatory myths in the U.S. military: tobacco use as "stress relief"

PURPOSE

To examine perceptions of military personnel about tobacco use.

DESIGN

Secondary analysis of (1) focus group and (2) interview data.

SETTING

U.S. military.

SUBJECTS

Total participants (n = 241): Enlisted personnel, supervisors (n = 189 individuals participating in 23 focus groups), tobacco control managers, and policy leaders (n = 52 interview participants).

INTERVENTION

Not applicable.

MEASURES

Not applicable.

ANALYSIS

Inductive, iterative coding for salient themes using an interpretive approach. Application of the concept of mediatory myths, used by institutions to cover over internal contradictions.

RESULTS

All types of participants endorsed the idea that tobacco was needed in the military for stress relief. Types of stress identified included fitting in, (relationships with coworkers and superiors) and control of workflow (taking breaks). Participants also discussed beliefs about the impact of tobacco on the military mission, and institutional sanction of tobacco use.

CONCLUSION

Despite tobacco's well-documented negative effects on fitness, the myth that tobacco relieves stress serves several institutional functions in the military. It serves to minimize perceptions of stress on the fitness of personnel, suggests that stress can be managed solely by individuals, and institutionalizes tobacco use. Growing recognition among military leadership that countering stress is essential to fitness offers an opportunity to challenge this myth.

Why ban the sale of cigarettes? The case for abolition

The cigarette is the deadliest artefact in the history of human civilisation. Most of the richer countries of the globe, however, are making progress in reducing both smoking rates and overall consumption. Many different methods have been proposed to steepen this downward slope, including increased taxation, bans on advertising, promotion of cessation, and expansion of smoke-free spaces. One option that deserves more attention is the enactment of local or national bans on the sale of cigarettes. There are precedents: 15 US states enacted bans on the sale of cigarettes from 1890 to 1927, for instance, and such laws are still fully within the power of local communities and state governments. Apart from reducing human suffering, abolishing the sale of cigarettes would result in savings in the realm of healthcare costs, increased labour productivity, lessened harms from fires, reduced consumption of scarce physical resources, and a smaller global carbon footprint. Abolition would also put a halt to one of the principal sources of corruption in modern civilisation, and would effectively eliminate one of the historical forces behind global warming denial and environmental obfuscation. The primary reason for abolition, however, is that smokers themselves dislike the fact they smoke. Smoking is not a recreational drug, and abolishing cigarettes would therefore enlarge rather than restrict human liberties. Abolition would also help cigarette makers fulfil their repeated promises to 'cease production' if cigarettes were ever found to be causing harm.

Military exceptionalism or tobacco exceptionalism: how civilian health leaders' beliefs may impede military tobacco control efforts

Smoking impairs the readiness and performance of military personnel, yet congressional opposition has thwarted military tobacco control initiatives. Involvement of civilian organizations might alter this political dynamic. We interviewed 13 leaders of national civilian public health and tobacco control organizations to explore their perspectives on military tobacco control, inductively analyzing data for themes. Leaders believed that military tobacco use was problematic but lacked specific knowledge. Most supported smoke-free policies and prohibiting smoking in uniform; however, they opposed banning tobacco use, arguing that it would violate smokers' rights. Most leaders inappropriately applied civilian models of policy development to the military context. A tobacco-free military is unlikely to be achieved without military-civilian partnerships that include educating civilian health leaders about military policy development and implementation.

"They're going to die anyway": smoking shelters at veterans' facilities

Military personnel and veterans are disadvantaged by inadequate tobacco control policies. We conducted a case study of a Department of Veterans Affairs (VA) effort to disallow smoking and tobacco sales in VA facilities. Despite strong VA support, the tobacco industry created a public relations-focused grassroots veterans' opposition group, eventually pushing the US Congress to pass a law requiring smoking areas in every VA health facility. Arguing that it would be unpatriotic to deny veterans this "freedom" they had ostensibly fought for and that banning smoking could even harm veterans' health, industry consultants exploited veterans' organizations to protect tobacco industry profits. Civilian public health advocates should collaborate with veterans to expose the industry's manipulation, reframe the debate, and repeal the law.

Why strong tobacco control measures "can't" be implemented in the U.S. Military: a qualitative analysis

The Institute of Medicine recently called for a tobacco-free military, citing evidence that high rates of tobacco use harm readiness and create enormous costs for the Department of Defense and the Veterans Administration. The pro-tobacco activities of the tobacco industry and others, sometimes supported by military authorities even when prohibited by policy, have created a culture highly hospitable to smoking. Through qualitative secondary analysis of data from interviews and focus groups, this article explores the reasons enlisted personnel and their supervisors, installation tobacco control managers, and service policy leaders give for why tobacco control policy change "cannot" effectively be achieved. Three primary reasons were given: policies would impinge on the "right to smoke," policies would be unenforceable and lead to disciplinary breakdown, and the rights of civilian workers on military installations precluded policy enforcement. Yet evidence suggests that these reasons are not only invalid, but inconsistent with military policies addressing other threats to the health of personnel. This pervasive tobacco "exceptionalism" is a significant barrier to achieving a tobacco-free military. The military, Congress, and the President should re-evaluate the "can'ts" that have prevented effective action, and act to regulate and eventually abolish tobacco use in the armed forces.