More troops on smokeless tobacco after deployment
U.S. troops sent to Iraq or Afghanistan are more likely to start a smokeless tobacco habit than their comrades who stay home - especially if they see combat, a new study finds.
The findings, reported in the journal Addiction, follow other studies that have tied deployment and combat to health risks, including higher rates of smoking and drinking.
“This adds to the list of things we’re learning are associated with combat,” said lead researcher Dr. Eric D.A. Hermes, of the Yale University School of Medicine in New Haven, Connecticut.
It’s not fully clear why some troops take up smokeless tobacco after deployment. But Hermes suspects stress is involved.
That’s because deployment with combat exposure was linked to a higher risk than deployment alone. And troops with symptoms of post-traumatic stress disorder (PTSD) also had an increased risk.
The findings come from the Millennium Cohort Study, an ongoing government project looking at the health effects of military service.
PTSD and smoking commonly co-occur. This may not be surprising given that many people in the United States smoke in general. In fact, it has been estimated that approximately 21% of adults in the United States (about 45 million people) currently smoke. Cigarette smoking is the leading preventable cause of death and disability in the United States. Approximately a third of all deaths from cancer in the United States each year (about 160,390) are the direct result of tobacco use. Since 1986, more women are dying of lung cancer than breast cancer; currently, almost twice as many women die from lung cancer than breast cancer. These statistics show that, without a doubt, smoking is a major health problem.
People who have an anxiety disorder may be particularly likely to smoke. In fact, out of all anxiety disorders, individuals with panic disorder and PTSD show the highest rates of smoking.
Of more than 45,000 personnel followed from 2001 to 2006, 2 percent started using smokeless tobacco during that time. Another 9 percent had already developed the habit, and kept it up.
Overall, troops who were deployed but did not see combat were almost one-third more likely to take up a smokeless tobacco habit than their non-deployed counterparts. Those odds were two-thirds to three-quarters higher for troops who were in combat or who deployed multiple times.
How Are PTSD, the Military, and Tobacco Use Related?
Unfortunately, those with PTSD are also very likely to start using smoking cigarettes, chewing tobacco or increase their current tobacco use. The research shows a link between nicotine addiction and PTSD in the general population, and among military personnel in particular. Studies also suggest that PTSD, rather than the actual trauma exposure, is a powerful risk factor for increasing the likelihood of smoking. In a study among veterans of Operations Iraqi Freedom and Enduring Freedom, the majority of service members (55 percent) had a mental health concern, most commonly, PTSD. Prevalence of nicotine dependence was elevated among trauma-exposed individuals (52 percent) and those diagnosed with PTSD (71.7 percent) compared with unexposed individuals (40.5 percent).
Now that we know there is a link between tobacco use and PTSD, it might help to figure out why. It is possible that people with PTSD may smoke cigarettes or chew tobacco in an attempt to manage or smother their feelings and symptoms. It can seem like nicotine is helping, but people who use tobacco to feel better are “self-medicating” and it’s not a good solution. Nicotine temporarily changes the chemistry in the brain and can lessen some of these symptoms, but it doesn’t last long and it’s no cure. In fact, poor general health among military personnel diagnosed with PTSD is linked to tobacco use. You may think the smoke or chew will make you feel better, when in truth, it’s a strike against your chance of recovery. Tobacco use makes feelings of depression more intense. Smoking can actually make you feel more anxious or hopeless when you can’t smoke and it can make you more stressed than you would be if you weren’t addicted to nicotine. Picking a quit date and making a quit plan means that you are gaining back control of your life and that you no longer have to be a prisoner of nicotine.
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References
Feldner MT, Babson KA, Zvolensky M J. Smoking, traumatic event exposure, and post-traumatic stress: A critical review of the empirical literature. Clinical Psychology Review. January 2007;27(1):14-45.
Koeenen KC, Hitsman B, Lyons MJ, Niaura R, McCaffery J, Goldberg J, Eisen SA, True W, Tsuang MA. Twin registry study of the relationship between posttraumatic stress disorder and nicotine dependence in men. Archives of General Psychiatry. November 2005;62(11):1258-1265.
Helmer DA, Rossignol M, Blatt M, Agarwal R, Teichman R, Lange G. Health and exposure concerns of veterans deployed to Iraq and Afghanistan. Journal of Occupational and Environmental Medicine. May 2007;49(5):475-480.
Koeene, 2005.
According to Hermes, those different levels of deployment can be seen as stand-ins for different levels of stress.
So it’s possible that stress plays a role, he said.
Another finding gives weight to that idea. “We also saw a relationship with PTSD symptoms,” Hermes said.
Just under 4 percent of all troops had PTSD symptoms, based on a standard questionnaire. And they were 54 percent more likely to start using smokeless tobacco than troops without symptoms, Hermes and his colleagues found.
There are other factors that, along with stress, might push some deployed troops toward tobacco, according to Hermes.
“You’re not at home, you have more exposure to smokeless tobacco, you’re around more people doing it,” Hermes said. “Maybe it’s all these little things coming together.”