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

• Date: 01 October 2017
• DOI: 10.1177/0022042616678617
• Published date: 01 October 2017
• Subject Matter: Articles

Journal of Drug Issues

2017, Vol. 47(4) 562 –586

© The Author(s) 2016

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DOI: 10.1177/0022042616678617

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Article

The Influence of Men’s Military

Service on Smoking Across the Life

Course

Andrew S. London1, Pamela Herd2, Richard A. Miech3, and

Janet M. Wilmoth1

Abstract

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.

Keywords

military service, veterans, smoking, life course, sibling fixed effects

Introduction

The extant literature on military service and smoking consistently describes the military as a risk

environment (Nelson & Pederson, 2008). The military is described as “tobacco friendly” (Offen,

Arvey, Smith, & Malone, 2011, p. 404), “pro-tobacco” (Jahnke et al., 2011, p. 1382), and “highly

hospitable to smoking” (E. A. Smith & Malone, 2012, p. 1202). It is an institution that has “a long

history of having a culture that supports and encourages tobacco use by its members” (Jahnke

et al., 2010, p. 88), “institutional norms that promote smoking” (Conway, 1998, p. 219), and,

from a policy perspective, “a culture of tobacco ‘exceptionalism’” (E. A. Smith & Malone, 2012,

p. 1202). One study found that military newspapers covered tobacco-related issues less than all

other health topics, typically focused on individual responsibility for the health risks that smok-

ing entails, and included advertisements for tobacco products (Haddock et al., 2005). Moreover,

a content analysis of 97 U.S. military tobacco policies indicated that only one-third mentioned

1Syracuse University, New York, NY, USA

2University of Wisconsin-Madison, Madison, WI, USA

3University of Michigan, Ann Arbor, MI, USA

Corresponding Author:

Andrew S. London Syracuse University, 314 Lyman Hall, Syracuse, NY 13244, USA.

Email: anlondon@maxwell.syr.edu

678617JODXXX10.1177/0022042616678617Journal of Drug IssuesLondon et al.

research-article2016

London et al. 563

the potentially negative impact of smoking on military readiness, while a mere 6.2% noted that

smoking was non-normative or suggested that it was incompatible with military service (Hoffman

et al., 2011).

This pro-tobacco social context shapes the perceptions and behaviors of active-duty person-

nel. Individual service members often view smoking as part of military culture and use tobacco

for pleasure, comfort, trade, and to boost morale (Nelson & Pederson, 2008). During deploy-

ment, junior enlisted personnel report smoking to manage stress, boredom, anxiety, sleep depri-

vation, and proximity to danger, even though they recognize the health risks associated with

smoking (Poston et al., 2008). Research identifies various factors that contribute to tobacco use

among active-duty personnel, including smoking breaks offered to them by superiors, the attrac-

tiveness of smoking areas, the social dimension of smoking, and the relatively low cost of tobacco

products, which are sold tax free through military commissaries and exchanges (Haddock et al.,

2008; Hoffman et al., 2008; Nelson & Pederson, 2008; E. A. Smith, Blackman, & Malone, 2007).

Available evidence suggests that levels of smoking among active-duty personnel have histori-

cally been higher than among civilians (Department of Defense, 1986), and that substantial pro-

portions of contemporary active-duty personnel smoke (Barlas, Higgins, Pflieger, & Diecker,

2013; Bray et al., 2006; B. Smith et al., 2008).

Efforts to reduce smoking in the military have been implemented since the mid-1980s (Arvey

& Malone, 2008; Hoffman et al., 2011; Jahnke et al., 2011). However, they have not been particu-

larly successful because of the influence of tobacco companies, the perverse incentive that recre-

ation and well-being activities are funded by tobacco sales, and the belief among some policy

makers and administrators that choosing to smoke or not is a right that should not be taken away

from military personnel who are serving to protect the rights of all Americans (A. M. Joseph,

Muggli, Pearson, & Lando, 2005; Offen et al., 2011). During the Gulf War (1990-1991), tobacco

companies distributed free cigarettes to deployed service members, targeted troops with direct

advertising and logo-branded items, and promoted themselves as benefactors by helping service

members maintain contact with family and sponsoring “welcome home” events (E. A. Smith &

Malone, 2009). It is also notable that such practices are not recent developments. As stated in

1997 by Stephen C. Joseph (1997), then Assistant Secretary of Defense for Health Affairs,

Unfortunately, smoking has been a commonly accepted behavior among military personnel for many

years. Our past military culture condoned and even encouraged this harmful behavior through

subsidized tobacco sales, free cigarette packs in field rations, and the “smoke ‘em if you got ‘em

philosophy” (p. 218).

In this article, we argue that the military is a risk environment with respect to smoking, and

that exposure to the military early in the life course can have long-term consequences for smok-

ing across the life course. We present findings from two distinct but complementary sub-studies,

which together demonstrate consistently higher levels of smoking among male veterans relative

to male non-veterans. The first sub-study uses pooled data from the National Survey of Drug

Use and Health (NSDUH) and age–period–cohort analytic methods to demonstrate that male

veterans have higher levels of smoking than male non-veterans at all ages within birth cohorts

that span most of the 20th century. The second sub-study uses unique data from the Wisconsin

Longitudinal Study (WLS) and sibling fixed-effects analytic methods to control for early-life

environments and endowments that select individuals into military service and affect smoking

over the life course. We find little evidence that selection matters, which suggests that the

observed association between military service and duration of smoking through midlife among

men is a causal effect. Together, the findings from these two sub-studies provide novel and

potentially generalizable evidence linking early-adulthood exposure to the military’s pro-

tobacco culture to smoking behavior across the life course.