Trends in Tobacco Use among Young Adults Presenting for Military Service in the United States Air Force between 2013 and 2018

Abstract

Background: The US military has historically higher tobacco use compared to civilians, and tobacco use increases following enlistment. While the military is vulnerable to tobacco use, current surveillance of tobacco among this high-risk population is lacking. Methods: Recently enlisted Airmen (N = 43,597) between 2013 and 2018 were asked about tobacco use prior to enlistment across ten products: (1) cigarettes/roll your own tobacco, (2) smokeless tobacco/snus, (3) cigars, cigarillos/little cigars, (4) hookah/pipe, and (5) e-cigarettes. Results: Hookah/pipe use, cigarettes/roll your own, smokeless tobacco/snus, and cigars/little cigars/cigarillos use decreased significantly between 2013 and 2018, while the prevalence of e-cigarette use increased (p’s < 0.0001). The relationships between the time and each tobacco product(s) use outcomes were influenced differently by different age, race, education and marital status. Conclusion: While e-cigarette use has increased in the civilian sector, the use of e-cigarettes among new recruits increased much more drastically (i.e. prevalence 15.3% in 2018). Further, demographic characteristics influenced tobacco trends; specifically, recruits of racial minorities increased their use of e-cigarettes over the past five years faster than Whites. Of concern is what impact this dramatic increase in e-cigarette use will have on overall health and later initiation of combustible tobacco products in the military.

Keywords:

• Military
• tobacco prevalence
• non-cigarette tobacco use
• young adults

Acknowledgements

The authors gratefully acknowledge the support of Second Air Force, the leadership branch for training in the US Air Force. The views expresses are those of the authors and do not reflect the official views or policy of the Department of Defense or its Components. The voluntary, fully informed consent of the subjects used in the research was obtained as required by 32 CFR 219 and DODI 3216.02_AFI 40-402. The research presented in this article is that of the authors and does not reflect the official policy of the NIH. This study is a collaborative endeavor between the US Air Force and the University of Virginia via a Cooperative Research and Development Agreement (CRADA # 17-250-59MDW-C17005). ML, GT and RK conceptualized the study. TM oversaw data analysis, and XW completed data analysis, figures and tables. ML and MF wrote the manuscript and all authors provided feedback and edited the manuscript. This data has not been presented elsewhere. There are no financial conflicts of interest to disclose.

Declaration of interest

No financial disclosures were reported by the authors of this article.

Additional information

Funding

The study was funded by the National Institute of Drug Abuse of the National Institutes of Health (R01DA036510, R01DA037273 and R01DA043468).