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The military has had a long pro-tobacco tradition. 1 This culture began to change as the consequences of tobacco consumption on health and military readiness were increasingly recognised. Until 1975 cigarettes had been included in K rations and C rations. 2 Subsequently, restrictions were placed on allowable smoking areas, promotions targeted directly at Department of Defense (DoD) personnel were prohibited and Basic Military Training became tobacco free in all services. 3 Although there have been substantial reductions in smoking prevalence among military personnel (from 51% in 1980 to 24.5% in 2011 4 ), significant challenges remain and tobacco use prevalence in the military continues to exceed that in the civilian population.
Furthermore, initiation continues to be common even for individuals who have never experimented with smoking. Despite official policy, tobacco is still widely seen as part of military culture and smoke breaks, as well as attractive smoking areas, often encourage smoking. Tobacco prices in commissaries and exchanges on military bases, although not as deeply discounted as in the past, still are significantly lower than in civilian outlets. Jahnke et al 5 found despite current requirements that the price of cigarettes at military exchanges be within 5% of the most competitive commercial price in the local community, prices in military exchanges surveyed were lower than the required minimum.
While active smoking has presented a particular problem for the military, in recent years there has been increasing concern with secondhand smoke exposure. 6 This problem is especially acute in closed environments. Banning smoking on military aircraft even for long flights is a significant restriction. However, this is quite different from the challenge the Navy faces with ships, especially submarines that may be deployed for months at a time.
Despite the known harmfulness of cigarettes and the recognition by the DoD of the deleterious impact of tobacco on health and military readiness, policy initiatives within the military intended to reduce tobacco use have met with substantial industry resistance. Offen et al 7 reported on failed attempts by the Navy to limit tobacco use. In 1986, the Navy reported a goal of becoming smoke free by the year 2000. In 1993, based on reports of the dangers of secondhand smoke, Captain Stanley W Bryant, the commanding officer of...