‘IDF draftees get hooked on tobacco during service’

Smoker rate grows from 26.2% at recruitment to 36.5% at discharge

Serving in the IDF is unhealthful, at least for the nearly 40% of soldiers who start to smoke and non-smokers who are exposed to it in compulsory service, according to an Israeli study published in the journal Nicotine & Tobacco Research.

The researchers – from Tel Aviv University, the University of Haifa and the Hebrew University, in cooperation with the IDF Medical Corps – studied a sample of nearly 30,000 soldiers from 1987 to 2011. They found that the rate of smokers grew from 26.2% at recruitment to 36.5% at discharge – a 39.4% increase.

Nearly a fifth of nonsmoking new recruits began smoking during their service and over half of former smokers relapsed to smoking. Because 50% to 65% of smokers die prematurely from smoking-related causes, the ongoing and future damage is enormous, the authors said.

Nearly 9,000 Israelis die in an average year from smoking, including about 1,000 non-smokers exposed to others’ tobacco smoke.

The large increase in smoking during service, combined with the high mortality of smokers, suggests that smoking affects the long-term survival of military personnel and is an important contributor to population-wide mortality in countries such as Israel, where a large percentage of individuals serve, the authors argued.

The study was conducted by Dr. Leah (Laura) Rosen of TAU’s School of Public Health; Dr. Hagai Levine from HU-Hadassah Braun School of Public and Community Medicine; Dr. Salman Zarka from the University of Haifa (formerly an IDF public health officer); and Vladi Rozhavski, Tamar Sela, Dr. Yael Bar-Ze’ev and Dr. Vered Molina-Hazan from the IDF Medical Corps. The research was funded by the Israel National Institute for Health Policy Research.

The researchers said the increased prevalence of smoking among military personnel and the increase during military service, “should act as a wake-up call to governments and health systems in countries lacking strong military tobacco-control policies.”

The investigators recommend the creation of a central tobacco control body, similar to programs in the US military, including enforcement of smoking bans in public areas; preventing the distribution of free or reduced-cost cigarettes to soldiers; and treatment of tobacco dependence tailored for the military environment.

The investigators also recommend that commanders disseminate health messages and no-smoking messages through personal example, particularly in combat units and during combat operations. A special program should target former smokers, given the high chance of returning to smoking. Special attention should be paid to those who score higher in their recruitment profiles, who often end up serving in combat units where the smoking rate is higher.

Among nonsmokers at recruitment, 18% started smoking while in uniform. Former smokers were at greatest risk – 56% began smoking during service. Men and women with combat profiles are also at an increased risk, after adjusting for personal, family and military factors. Prevalence of smoking is greater among males at discharge (40.3%) than among females (32.4%), but the increase during service is similar. On the other hand, only 12% of smokers at recruitment quit smoking during service.

Rosen, chair of the department of health promotion at TAU’s School of Public Health, said: “The use of tobacco harms IDF soldiers and security in general. The government and the Health Ministry need to cooperate with the IDF to reduce the number of soldiers who start smoking, to encourage soldiers to quit smoking and to protect non-smokers from exposure to cigarette smoke. We should take an example from the US, which conducted extensive changes to the smoking policy in its military, to protect its soldiers and to improve the readiness and performance of its combat units.”

Levine, head of the environmental health track at HU-Hadassah’s school of public health, added: “The increase we found in the rate of smoking during compulsory military service is of great concern in light of the serious consequences for public health. We must concentrate our efforts in the war against smoking to protect the health of young men and women and to coordinate civilian and military efforts to fight smoking throughout the course of life. I hope the IDF will adopt similar measures to those implemented successfully in other armies.”

The dramatic increase in smoking during military service presents a window of opportunity for changes in health behaviors, they said, and suggests a need for a multiyear war on tobacco among soldiers, in order to protect their health and military fitness. The study also showed that smoking is already a problem prior to recruitment, which adds urgency to the call for a national effort to prevent smoking, which could be coordinated with the Education and Defense Ministries.

Commenting on the research, MK Tamar Zandberg, chairman of the Knesset’s Anti-Drug Committee, said that the findings are “shocking.”

“It is unthinkable that the IDF, an army that the public serves in by law, will increase and even encourage this dangerous habit. Young people give their best years to the country and endanger their lives. The risk is long-term. The time has come for an emergency program to prevent smoking in the military,” she continued.

Meanwhile, World Health Organization director-general Dr. Margaret Chan told its executive board in Geneva on Monday that smoking costs the global economy more than $1 trillion yearly and will soon kill more than six million people worldwide each year.”

Earlier this month, she said, the WHO and the US National Cancer Institute published a landmark, 700page report on the economics of tobacco and tobacco control prepared by more than 60 authors and peer-reviewed by an additional 70 experts. The report shows how tobacco control, including significant tax increases on tobacco products, can save lives while also generating revenues for health and development.

The economic losses caused by smoking far exceed global revenue from tobacco taxes, estimated at nearly $270 billion in 2013 and 2014. If all countries raised cigarette taxes by about 80 cents per pack, annual tax revenues could increase by 47%, amounting to an additional $140 billion per year.

The overarching conclusion is stark: tobacco control makes good economic sense and does not harm economies, Chan continued. “The evidence is abundant and compelling. It ought to put an end to one of the tobacco industry’s most frequent and effective arguments.”