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This 2004 photo of a member of Charlie Company in the U.S. Marines First Division, Eighth regiment, smoking a cigarette in Fallujah, Iraq, has become iconic for its depiction of the hold smoking has on young combatants.
A Marine in Fallujah, Iraq, in 2004.Luis Sinco/Los Angeles Times/AP
At the Tinker Air Force base in Oklahoma, Laura Crowder is known as “the Hawk Lady.”
She’s also known as “the Smoke Lady,” but not because she’s lighting cigarettes. Instead, Crowder is a health promotions manager at the base outside Oklahoma City, working to wean service members off tobacco in any form.
The numbers have improved since her arrival, she said, with tobacco use sliding from nearly 27 percent of the base population to a little under 18 percent.
Maybe that’s because “the Hawk Lady” knows where to go, even turning up to greet the night shift with her anti-tobacco efforts. She showed up at 8 p.m. to meet service members on duty. She showed up again at 3 a.m.
That got their attention.
“It was outside,” she said. “It was cold. It was dark.”
When she did it again, they were a little more ready to hear what she had to say.
Tinker isn't the only base that grapples with the issue. Every branch of the military struggles with tobacco use rates higher than those in the civilian world, especially in the young. Smoking cessation experts and researchers who have worked with and studied military men and women said studies show 20- and 30-somethings are the biggest tobacco users and weaning them off cigarettes and smokeless tobacco products is not as simple as tossing them a few packs of minty gum and offering nicotine patches.
Social pressures, job stress and a youthful sense of invincibility — the risk-taking type of personality that’s attracted to the military — clash with efforts to get them to tamp out their butts. Military culture also has a tobacco tradition that’s tough to crack. While overall smoking rates have dropped in the military by about half over the past 30 years, it will likely take a couple more decades to unravel the old ways completely, they said.
Tobacco and the young G.I.
In 2011, according to the Department of Defense, 56.7 percent of Army, Navy, Marine, Air Force and Coast Guard personnel ages 21 to 25 reported using nicotine at least once during the past 12 months — which included smoking cigarettes, cigars and pipes and using chewing tobacco, snuff and other smokeless tobacco products. Eighteen-to-20-year-olds were not far behind, at 51.7 percent. The lowest users were the 46-to-65-year-olds, at 31.0 percent. Marines were the biggest tobacco users (58.2%), while the Air Force ranked lowest (41.7%).
“The younger age group is predominantly the higher number of tobacco users,” said Paul Fitzpatrick, program manager for the Quit Tobacco, Make Everyone Proud program at the Defense Health Agency, the arm of the government that manages health care delivery for military members and their families across the Department of Defense.
When the first surgeon general’s report on tobacco came out 50 years ago, the military took a hard look at tobacco use and the health risks associated with it, said Fitzpatrick. “They have been encouraging non–tobacco use officially ever since,” he said.
Policy changes and programs like the one he manages have helped, he said. In its eighth year, the Quit Tobacco program offers free group and individual counseling sessions, 24/7 online support and medications — nicotine replacement therapies, including nicotine gum, patches, lozenges and an inhaler.
Crowder said she uses the Quit Tobacco program’s support materials at Tinker. Games, stress balls, gum, the online support — anything to get them through their strongest cravings — but behavioral modification works best.
A stubborn history
But military smoking cessation experts fight a stubborn history and an addictive drug. Before 1987, when tobacco use was banned at most training camps across the country, smoke breaks were a common form of reward and punishment, according to an article in the medical journal Tobacco Control. Cigarettes were supplied in rations for years, said Erika Sward, the American Lung Association’s director of national advocacy.
“Obviously, tobacco use in the military is a huge problem. You not only have the historical issues to grapple with, but you also have the tobacco industry, which has played a huge roll in tobacco in the military and is still very much an impediment to the solution,” she said, adding that among current smokers in the military, about 30 percent took up the habit after they entered.
Policy-wise, things have tightened up, but not enough, said Sward. Smoking is only allowed in designated areas nowadays. U.S. Navy submarines went smoke-free in April 2010, which, Sward said, may contribute to the Navy’s lower tobacco use rates compared with other branches’. And the Air Force was the first service to establish a policy for e-cigarettes in line with rules for other tobacco products.
But social pressures persist. On some bases, not being a smoker in the under-25 crowd may find you alone in a bar on a Saturday night. Leslie Souza, 23, a lance corporal in the Marine Corps, stationed in Jacksonville, N.C., knows what it’s like when all your friends leave their drinks to go outside for a smoke.
Then she is faced with a choice, she said: “Do I go outside and be cold, or do I stand by the bar alone?”
Almost everyone she knows in the Marines smokes, she said.
“I think that’s why some people get into smoking, because they think, ‘I don’t want to stand here by myself,’” she said.
It also depends on your age when you join the military.
“I joined a little later, but most are 17 or 18,” she said. “They can’t drink, but they can smoke. For me, joining a little later, I can go out and have a drink on my own and don’t have to feel like I have to have a cigarette.”
People arrive in the military as nonsmokers, and as soon as they hit basic training, they start using tobacco, said Dr. Jenene Nelson, a former flight nurse and retired commander in the Air National Guard who has studied tobacco use in the military.
“That’s the cultural influence, that it’s OK to do it,” she said, “this idea of ‘I might die anyway, so why not do whatever the hell I want?’”
A veteran ex-smoker
Tobacco use harms readiness, increasing disability and illness, said Dr. Larry William, a retired Navy captain, a dentist and a longtime tobacco researcher. Williams has been involved with tobacco cessation programs in the military since 1985, when he started one of the Navy’s first programs.
The Department of Defense spends about $1.6 billion dollars per year on tobacco-related medical care, increased hospitalization and lost work days, he said. Getting young personnel to quit has multiple benefits, from boosting productivity, fitness and morale to slicing Veterans Affairs hospital bills, he added.
Len Bradshaw, 60, who went through a VA smoking cessation program three years ago, flew almost 80 reconnaissance missions for the Air Force over Southeast Asia in the 1970s. A Chinese linguist, he went along to translate radio transmissions that were picked up, and he said crews smoked like chimneys on the sometimes 19-hour-long flights.
“We flew from Okinawa to Vietnam. We were encouraged to smoke in the planes in those days. We were taught smoking reduced stress,” said Bradshaw, who runs the website SmokeFreeVets.org.
In 2009 he was diagnosed with post-traumatic stress disorder and in 2010 with mild emphysema. By that time, he was consuming four packs a day. A combination of medications and counseling helped him kick it. He said he sometimes speaks to young military groups about quitting.
“When they’re young, they’re invincible, especially those on the front lines,'' he said. "They’re told not only to be brave but invincible. You’re not even supposed to think you’re supposed to be afraid you’ll lose your life. I tell them, when you’re smoking it doesn’t seem like an immediate danger, but the danger will happen in your lifetime if you don’t quit.”