Tobacco Use Still Too High, Health Survey Reveals

Smoking levels dropped just 2 percentage points from the 32 percent level reported in a similar survey conducted three years earlier. Although DoD medical departments continue to propagate smoking cessation programs, a senior health care leader said the medics can't do it alone.

"I think we really need to involve the entire military community," said John Mazzuchi, deputy assistant secretary of defense for health affairs clinical and program policy.

Tobacco use is just one of many health-related behaviors the survey looked at, but it continues to be one of DoD's top health concerns, particularly from a military readiness perspective.

"Smokers are at sick call more than people who are not smoking," Mazzuchi said. "They're not as physically fit, not as able to do all the physical demands on the job when they smoke cigarettes."

Not all military medical facilities offer proven smoking cessation therapy, such as nicotine patches, Mazzuchi said. He'd like to see that change.

"Literature shows that using nicotine replacement therapy, coupled with counseling, is the best way of getting people to stay off cigarettes," he said. "So DoD is examining very carefully how to make that benefit more uniform across our entire military health care system.

"Almost two-thirds of our smokers say they'd like to quit, but many of them have tried and been unsuccessful. We need to do a better job of helping them."

DoD began conducting the health behavior survey in the early 1980s, when officials were alarmed about allegations of illicit drug use by service members. Since then, active duty service members have been surveyed for their life styles and health habits about every three years.

Mazzuchi said the department by 1995 had seen marked decreases in bad health habits like drug and alcohol abuse and tobacco use. He attributed the success rates to policies such as random urinalysis programs that backed up and enforced abstinence and reduction messages.

The latest survey shows that illicit drug use has dropped from 27.6 percent in 1980 to 2.7 percent in 1998. During the same period, heavy drinking (five or more drinks at least once a week) declined from 20.8 percent to 15.4 percent, and cigarette smoking fell from 51 percent to 29.9 percent.

"The surveys provide DoD with valuable information about why people do what they do, so we can develop measures to help them and tailor our education programs to meet their needs," Mazzuchi said. With the 1998 survey, for example, DoD wanted to learn more about the impact of stress on service members.

"We have found that stress levels in the military are fairly high," he said. "When you look at the reasons for stress, they are related to the operations tempo -- deployment and family separation, for example. But the good news is that the coping mechanisms for that stress tend to be constructive things like talking to a friend, making plans, saying a prayer or doing physical fitness."

Past surveys revealed an institutional neglect of women's health issues that has since been rectified, Mazzuchi said. "Women are doing quite well in terms of access to health care, so this time we took a look at men's health issues," he said. "We found that one-third of our respondents said they had conducted a testicular self-examination in the last month, but we also had a third who had never done one. So we need to focus our education efforts there."

Concerning oral health, 90 percent of survey respondents said they'd had a dental examination in the past year, although 16 percent needed dental care before deploying. "We really want to make sure our people are dentally ready," Mazzuchi said. "There was a major push in dental health care about two years ago, and we're seeing the results now. We're very pleased and want to continue to maintain those high levels of health."

Questions about safe sex also appeared on the survey, but only 44 percent of unmarried respondents said they used condoms during sex. "We'd like that number to go up because of our concerns about venereal disease and AIDS, and we need to say that better to our people," he said.

Everything learned from the survey is used to maintain a baseline DoD uses to develop and improve education and intervention programs. He said the department isn't as concerned about actual numbers as it is about trends.

"Since we've done the survey approximately every three years, we can clearly look at trend data," Mazzuchi said. "We're not looking at individual health but at population health. What is the health of our population? Where we have pockets of behavior that isn't healthy, how can we best reach those people and convince them to lead more healthy life styles?

"Our goal is to have our people be conscious of the fact that they control much of their health care destiny," he said. "We do the things we do to protect them because we want a fit fighting force. We want our people to understand that their mission is national security and we are depending on them. The healthier they are, the better they can protect their country."

The complete results of the 1998 survey are on the Military Health System home page at www.tricare.osd.mil, including an 11- page "highlights" section.