Barriers to Effective Tobacco Control Policy Implementation in the US Military

描述（由申请人提供）：本研究的目的是发展知识，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，吸烟在短期内对部队的战备状态产生负面影响，在长期内对医疗保健费用产生负面影响。由于该国目前卷入伊拉克和阿富汗的冲突，这两个问题都受到高度关注。然而，尽管从1980年的51.0%下降到2008年的30.4%（国防部最近的烟草使用人口调查），军事人员的吸烟率仍然高得令人无法接受。自2002年以来，军队吸烟率没有显著下降，无烟烟草的使用略有增加。在降低吸烟率方面，政策变化，如增加香烟税和清洁室内空气法，已被证明比教育或个人干预更有效。这些政策变化已经帮助美国平民人口的吸烟率从1965年的50%以上下降到目前的20.6%。然而，尽管自20世纪80年代以来颁布了许多军事烟草控制政策，但其有效实施却一再受到结构、文化和政治障碍的阻碍。这项描述性的多方法研究将通过解释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，并确定军事烟草控制政策实施的最佳做法，从而发展知识，促进美国军队内的烟草控制工作。该项目的具体目标是：目标1：阐明军队中有效控制烟草的障碍：(a)通过对军事设施报纸上基地指挥官信息的内容分析，评估指挥官在烟草控制方面的领导状况；(b)进行经济分析，以确定在美国军事设施购买的香烟和在当地市场购买的香烟的成本差异；(c)检索和分析烟草业内部文件，以便描述烟草业与美国军队四个现役兵种、退伍军人管理局、退伍军人团体和其他军事附属组织有关的活动。目标2：通过对从军事人员那里获得的定性访谈和焦点小组数据进行一套二次分析，并辅以来自内部烟草业文件、军事期刊和安装政策语言的数据，描述军队中烟草使用的含义，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)在军队戒烟的经历。目标3：通过对有效政策干预的深入案例研究，确定与在部队一级成功实施烟草控制政策相关的关键因素，分析军队中的有效烟草控制。

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.