Use of electronic cigarettes among U.S. Military service members – prevalence and associated risk factors

Abstract

Background

Decreased physical fitness, loss of vision and hearing, and increased risk of chronic diseases are significant primary and secondary implications associated with the health of U.S. Military Service members who use tobacco, including electronic cigarettes. Despite the medical and non-medical costs to the U.S. Department of Defense and potential adverse health effects to Service members, electronic cigarette use is on the rise.

Methods

U.S. Military Service members who completed their Periodic Health Assessment, a standardized, electronic, logic-based tool, from July 2018 to July 2019 were eligible. This exploratory study examines the prevalence and significant risk factors associated with self-reported use of electronic cigarettes, as well as determines if tobacco use varies by sex and Service branch, through use of Chi-square analysis and logistic regression.

Results

U.S. Military Service members 17–70 years old were included in this study (N = 1.12 M), with 80% of study participants being male and 20% female. Exposure to secondhand smoke (OR: 2.12, 95% CI: 2.15–2.22) and screening positive for hazardous drinking (OR: 2.70, 95% CI: 2.64–2.76) were found to show the greatest increase in odds of using electronic cigarettes, with similar findings after stratification by sex and Service branch. Stratification by Service branch revealed further differences in the association between electronic cigarette use and various demographic, military, lifestyle, and health characteristics.

Conclusion

Electronic cigarette use is increasing across the United States. U.S. Service members have unique risk factors and patterns of tobacco use. Despite tobacco use having potential adverse effects on military readiness, its use remains prevalent in this population. Our findings identify opportunities for the U.S. Department of Defense to review tobacco policy and availability and accessibility of cessation services to promote quitting tobacco, especially electronic cigarettes.

Keywords:

• Epidemiology
• public health
• risk for tobacco use
• special populations
• tobacco control
• military health

Acknowledgements

The authors thank the Armed Forces Health Surveillance Division at the Defense Health Agency for their assistance in preparing and providing the data from the Defense Medical Surveillance System for this project.

Disclosure statement

None of the authors report a conflict of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Defense Department.

Data availability statement

The data underlying this article are not publicly available. Data may be shared on a reasonable request to the corresponding author if the request is made by a Defense Department customer with an active Defense Health Agency data sharing agreement and the request is approved by the Armed Force’s Health Surveillance Division.

Additional information

Funding

This project was supported under Defense Department budget allocated to Defense Health Agency, Deputy Assistant Director-Public Health, and ancillary support via the Force Health Protection & Readiness contract. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.