Tobacco Research in the Military: Reflections on 20 Years of Research in the United States Air Force.

The U.S. military is one of the world's largest employers. Approximately 30% of active duty military personnel smoke cigarettes and more than 14% use smokeless tobacco. The military has historically supported tobacco use and more recently is attempting to combat its use. Through 20 years of collaborative research with the United States Air Force, we have learned that smoking bans are effective, recruits who have never previously smoked cigarettes initiate tobacco use, smokeless tobacco serves as a gateway for smoking initiation, smoking is associated with discharge, smoking adds significant proximal training costs, tobacco use increases during deployment, and tobacco quitline counseling with a provision of medication is effective. Our findings may provide groundwork for future tobacco control efforts in the U.S. military.

Career impacts and referral patterns: Army mental health treatment in the combat theater.

This study examined the relationships between referral source, career impacts, and diagnostic severity among service members seeking mental health intervention in a deployed setting. Data were drawn from the mental health records of 1,640 Army service members presenting for outpatient mental health services while deployed in Afghanistan. Results suggested that self-referrals were significantly less likely to have contact made with their command or to experience potentially career impacting recommendations. Overall, greater than 80% of military personnel were returned to duty with no limits and 60% were assigned either no diagnosis or a mild/moderate diagnosis. These findings indicate that seeking psychological services is much less likely to impact a service member's career when self-initiated. Given the significant concerns about career impacts among many service members in need of psychological services, these findings should be incorporated in information campaigns to promote early help seeking.