Smoking Cessation in the Military: Challenges, Solutions, And Issues

for Women Smokers

Robert C. Klesges, Ph.D.

Professor, Department of Preventive Medicine, U. of TN Health Science Center &

Department of Cancer Prevention and Control

St. Jude Children’s Research Hospital

The NIH Revitalization Act (1994) as it Pertains to Women

• Women shall be included in all human subjects research.

• Women should be included in sufficient numbers to be able to detect intervention differences.

• Cost cannot be cited as a reason for exclusion and NIH outreach programs shall be initiated to recruit and retain women in studies.

Has The Revitalization Act Worked For Women?

• Pub Med search from 1995-present.

• Completed four searches:

1.Smoking cessation/treatment/intervention;

2.Added “women”;

3.Replaced “women” for “military”; and

4.Included both “women” and “military”

Results of search

Search Phrase # of Articles (%)

Smoking cessation 25,290Smoking cessation & women 14,932 (59%)Smoking cessation & military 162 (0.6%)Smoking cessation & military &women 108 (0.4%)

Of all studies with “smoking cessation & military & women”, our research team accounted for 25% of all citations.

Understanding Smoking Within the Context of The Military and

Deployment.

• Want to share the experience that so many of our troops go through.

• Leaving their loved ones, deployment, and returning home.

Conclusions from AF I

• The smoking ban in BMT produces significant smoking cessation. In short, smoking bans work, particularly for women.

• Extending the smoking ban to Tech Training is a logical next step.

• Make smoking a hassle.• But what happens to nonsmokers following

BMT?

One-year initiation ratesamong nonsmokers

Air Force II*

• Longer interventions• Tailored interventions – different

interventions dependent on baseline smoking and smokeless status. Three different interventions.

• AF II was also very large (n = 33,215)

*Funded by the National Heart, Lung, and Blood Institute of NIH

Results

• The smoking ban worked again (29% of airmen had not smoked in the past 7 days and 14% had not smoked at all since BMT).

• Smokers assigned to the cessation intervention were 18% less likely to be smoking.

• Smokeless users assigned to the smokeless intervention were 24% less likely to be chewing.

• Marked smoking initiation rate as found previously.

Air Force III*

• While AF I and II addressed maintaining cessation following a smoking ban, the next study addressed those who relapsed following BMT as well as those who initiated smoking in the military.

• AF III is testing the efficacy of a proactive quit line for domestic and deployed troops.

*Funded by the National Heart, Lung, and Blood Institute of NIH

Results to date

• Have enrolled nearly 350 participants all around the globe, including several from as far away as South Korea.

• Minority recruitment (32%) is much higher than the rates in the Air Force population (21%).

• Recruitment of females (34%) greatly exceeds the number of females in the Air Force (19.5%).

Develop America's Warrior Airmen Today ... for Tomorrow

Develop and Sustain Warrior Airmen, Train Joint Forces, and Strengthen Coalition Partnerships

SAMMC Tobacco Quitline

• No classes to attend• Telephone-based counseling that fits your schedule• Free nicotine replacement patches mailed directly to your

home• Open to active duty and reservists who are

• 18 years old or older

• Smoke 5 or more cigarettes per day• Call 1-877-SAMMC-11• Sponsored by the University of Tennessee, Wilford Hall

Medical Center and the National Heart, Lung and Blood Institute

Air Force IV*

• Funded to understand why military personnel have such a high prevalence of smokeless tobacco and dual use.

• Tobacco companies are aggressively marketing their new product called snus and several flavors of snus will be targeted to women.

• “The new (FDA) law…prohibits any cigarette with a characteristic flavor, but does not apply to any other tobacco products.”

*Funded by the National Cancer Institute of NIH

Conclusions About Smoking and Women in the Military

• Females in the Military Are Less Likely:– Start smoking after Basic Military Training

• Females in the Military Are More Likely:– Smoke “light” or “ultralight” cigarettes– Among smoking women, the smoking ban is

particularly effective – they are much more likely to remain abstinent following intervention and forced cessation during Basic Military Training.

• Smoking rates especially high among white women (nearly 1/3 smoked daily prior to BMT).

• Binge drinking and weight concerns strongly related to smoking in women

Conclusion: What can we do to promote a smoke free military?

• Deployment does not automatically mean high smoking rates.

• The more we can make using tobacco products a “hassle”, the better (protracted smoking bans, smoking restrictions).

• Should we sell tobacco in the BX/PX?

• Cigarette sales in the BX/PX are not in the military’s control.

• We cannot afford to do face-to-face counseling for tobacco control.

• Tobacco quit lines, particularly when participants receive free nicotine replacement therapy.

• Tailored web based programs for the military.

• I phone/I touch “apps”.

• Tailored print (or web) communication.

Conclusion: What can we do to promote a smoke free military?

• Officers as role models. Only about 5% of officers smoke.

• While the IOM recommendation to gradually eliminate smoking in the military may not be completely feasible, having a smoke free officer corps is highly feasible.

• Targeted programs should address the unique needs of women smokers in the military.

Conclusion: What can we do to promote a smoke free military?

Significant challenges• While not impossible to intervene during

deployment, it is still a challenge.

• Tobacco companies are always a step ahead of us, marketing snus for when smokers are prohibited from smoking.

• Dual use of smoking and smokeless tobacco is rampant in the military.

• Tobacco companies are aggressively marketing tobacco to women in general and women in the military in particular.