Barriers to Effective Tobacco Control Policy Implementation in the US Military

描述(由申请人提供)：这项研究的目标是发展知识，以促进美国军队内烟草控制政策的实施。其人员的健康对美军的任务至关重要，吸烟在短期内会对部队的准备状态产生负面影响，在长期内会对医疗保健成本产生负面影响。由于该国目前卷入了伊拉克和阿富汗的冲突，这两个问题都令人高度关切。然而，军事人员的吸烟率仍然高得令人无法接受，尽管从1980年的51.0%下降到2008年的30.4%(国防部最新的烟草使用人口调查)。自2002年以来，军队的吸烟率没有显著下降，无烟烟草的使用略有增加。政策变化，如增加香烟税和清洁室内空气法，已被证明在降低吸烟率方面比教育或个人干预更有效。这些政策变化有助于将美国平民人口的吸烟率从1965年的50%以上降至目前的20.6%。然而，尽管自20世纪80年代以来出台了许多军事烟草控制政策，但这些政策的有效实施一再受到体制、文化和政治障碍的阻碍。这项描述性的多方法研究将通过阐明政策实施的这些障碍、描述军事背景下烟草使用和戒烟的社会意义以及确定军事烟草控制政策实施的最佳实践，来开发将推动美国军队内烟草控制努力的知识。该项目的具体目标是：目标1：阐明军队中有效烟草控制的障碍，方法是：(A)通过对军事设施报纸上基地指挥官消息的内容分析，评估指挥官在烟草控制方面的领导状况；(B)进行经济分析，以确定从美国军事设施购买的香烟与在其当地市场购买的香烟的成本差异；以及(C)检索和分析烟草行业的内部文件，以描述烟草行业与美国军队、退伍军人管理局、退伍军人团体和其他军事附属组织的四个现役部门有关的活动。目的2：通过对从军事人员获得的定性访谈和焦点小组数据进行二次分析，并辅之以来自烟草行业内部文件、军事期刊和设施政策语言的数据，描述烟草使用在军队中的意义，以探索：(A)将烟草使用构建为军队中的一项“权利”；(B)在军队中开始吸烟的经历；(C)在军队中戒烟的经验。目的3：通过对有效政策干预的深入案例研究，找出与在设施一级成功执行烟草控制政策有关的关键要素，分析军队中有效的烟草控制。 公共卫生相关性：军人的健康对美国军队的使命至关重要。吸烟在军队中造成的发病率和死亡率比肥胖、酗酒和非法药物使用加起来还要多。这项研究的目的是开发有助于推动武装部队烟草控制政策的信息。项目目标包括阐明执行烟草政策的障碍，描述在军事文化中使用和戒烟的社会意义，以及确定执行军事烟草控制政策的最佳做法。

DESCRIPTION (provided by applicant): The objective of this study is to develop knowledge that will advance tobacco control policy implementation within the U.S. military. The health of its personnel is critical to the mission of the U.S. military, and smoking negatively affects troop readiness in the short term and health care costs in the longer term. Both of these issues are of heightened concern due to the country's current involvement in conflicts in Iraq and Afghanistan. However, smoking prevalence among military personnel remains unacceptably high, despite declining from 51.0% in 1980 to 30.4% in 2008 (the most recent DOD population survey of tobacco use). Since 2002 no significant reduction in smoking prevalence has been achieved in the military, and smokeless tobacco use has increased slightly. Policy changes, such as increased cigarette taxes and clean indoor air laws, have been shown to be more effective than education or individual intervention at reducing smoking rates. Such policy changes have helped reduce smoking prevalence in the U.S. civilian population from over 50% in 1965 to 20.6% currently. However, although numerous military tobacco control policies have been issued since the 1980s, their effective implementation has been repeatedly thwarted by structural, cultural, and political barriers. This descriptive, multi-method study will develop knowledge that will advance tobacco control efforts within the U.S. military by explicating these barriers to policy implementation, describing the social meanings of tobacco use and cessation within the military context, and identifying best practices in military tobacco control policy implementation. The specific aims of the project are to: Aim 1: Explicate the barriers to effective tobacco control in the military by (a) Assessing the state of leadership on tobacco control among commanders through a content analysis of base commander messages in military installation newspapers; (b): Conduct an economic analysis to determine the cost differential of cigarettes purchased on U.S. military installations and those purchased in their local market; and (c) Retrieve and analyze internal tobacco industry documents in order to describe the tobacco industry's activities pertaining to the four active service branches of the United States (US) military, the Veterans Administration, veterans groups and other military-affiliated organizations. Aim 2: Describe the meanings of tobacco use in the military by conducting a set of secondary analyses of qualitative interview and focus group data obtained from military personnel, augmented by data from internal tobacco industry documents, military periodicals, and installation policy language to explore: (a) The construction of tobacco use as a "right" within the military; (b) The experience of starting to smoke in the military; and (c) The experience of quitting smoking in the military. Aim 3: Analyze effective tobacco control in the military by identifying key elements associated with successful implementation of a tobacco control policy at the installation level through in-depth case studies of effective policy intervention. PUBLIC HEALTH RELEVANCE: The health of military personnel is critical to the mission of the U.S. Military and tobacco use causes more morbidity and mortality in the military than do obesity, alcohol use, and illicit drug use combined. The purpose of this study is to develop information that will advance tobacco control policy in the armed services. Project goals include explicating barriers to tobacco policy implementation, describing the social meaning of tobacco use and cessation within the military culture, and identifying best practices in military tobacco control policy implementation.