This study indicates that British military personnel smoke heavily during peacetime, and that smoking rates increase with overseas deployment. Most of the increase was accounted for by ex-smokers returning to the habit, but 9% of the self-declared regular smokers had started smoking for the first time after arriving in the war zone.
The high baseline rate of smoking of this population is of particular concern because it was a medical workforce, which one would expect to show a low or very low rate. It is even more surprising that only a minority of the personnel could recall ever having encountered military-specific smoking-related health education.
Regarding the effects of wartime deployment, our data mirror the findings of a retrospective postal survey of US servicemen conducted after Operation Desert Storm.11
Forgas et al.
reported that, during their time in the Persian Gulf, 7% of their naval study population had started smoking for the first time. Their findings differed from ours, however, in that only 29% of pre-existing regular smokers increased their consumption of cigarettes while deployed, compared with our 56%. Also, in explaining why they smoked more, the US servicemen mentioned stress first and then boredom (compared with boredom and social benefits in our group).
Our study has several limitations. First, the findings relate to medical personnel, and a much more important issue is the prevalence of smoking in the Army as a whole. The higher smoking rates in regular Army personnel than in reservists might reflect an Army ‘smoking culture’, but it might also reflect socioeconomic differences. Secondly, the study depended on accurate individual recall of recent smoking habits and there was no way to validate the responses. Thirdly, our survey was carried out within a rigidly hierarchical organization and at a time of intense war-fighting, three weeks after the outbreak of hostilities. This unit arrived in Kuwait three weeks before the onset of hostilities and moved into Iraq, at the onset of fighting, to assemble the 200-bed canvassed field hospital. These factors may have introduced information bias into the responses.12
It is notable that none of our respondents mentioned fear as a reason for starting smoking, or for smoking more. Finally, it is unfortunate that we have been unable to ascertain whether the personnel who started smoking on deployment will quit once they have returned home, or whether those who increase their cigarette consumption will return to the previous level.
Smoking endangers not only the smoker but also the bystander. Unrestricted public smoking limits the personal choice not to inhale tobacco smoke, and brings the risk of future litigation against employers or businesses. Moreover, reduction of opportunities to smoke leads to lower consumption.13–16
Many employers now benefit from workplace smoking restrictions through reduced sickness absence, increased productivity, lower corporate insurance and reduced cleaning costs. An integrated approach to smoking cessation and prevention may be the best policy.16–19
The present study suggests that even a medical workforce in the British Armed Forces has failed to act on scientific knowledge about the adverse effects of smoking. The pre-deployment smoking rate of 42% in regular Army personnel is high enough to demand urgent action. The need for smoking prevention in other sectors may well be greater. An important topic for further research is the time course of tobacco use associated with the physical and psychological stresses of war.