Smith Elizabeth A, Malone Ruth E
Department of Social & Behavioral Sciences, University of California, San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94118, USA.
Mil Med. 2012 Oct;177(10):1202-7. doi: 10.7205/milmed-d-12-00199.
The Institute of Medicine recently called for a tobacco-free military, citing evidence that high rates of tobacco use harm readiness and create enormous costs for the Department of Defense and the Veterans Administration. The pro-tobacco activities of the tobacco industry and others, sometimes supported by military authorities even when prohibited by policy, have created a culture highly hospitable to smoking. Through qualitative secondary analysis of data from interviews and focus groups, this article explores the reasons enlisted personnel and their supervisors, installation tobacco control managers, and service policy leaders give for why tobacco control policy change "cannot" effectively be achieved. Three primary reasons were given: policies would impinge on the "right to smoke," policies would be unenforceable and lead to disciplinary breakdown, and the rights of civilian workers on military installations precluded policy enforcement. Yet evidence suggests that these reasons are not only invalid, but inconsistent with military policies addressing other threats to the health of personnel. This pervasive tobacco "exceptionalism" is a significant barrier to achieving a tobacco-free military. The military, Congress, and the President should re-evaluate the "can'ts" that have prevented effective action, and act to regulate and eventually abolish tobacco use in the armed forces.
美国医学研究所最近呼吁建立一支无烟军队，理由是有证据表明，高吸烟率会损害军队的战备状态，并给国防部和退伍军人管理局带来巨大成本。烟草行业及其他方面的亲烟草活动，有时即便在政策禁止的情况下仍得到军事当局的支持，营造了一种对吸烟极为宽容的文化氛围。通过对访谈和焦点小组数据进行定性二次分析，本文探讨了现役军人及其上级、驻地烟草控制管理人员以及服务政策领导人给出的关于烟草控制政策变革“无法”有效实现的原因。他们给出了三个主要原因：政策会侵犯“吸烟权”，政策无法执行并会导致纪律瓦解，以及军事驻地文职人员的权利妨碍了政策的执行。然而，有证据表明这些理由不仅站不住脚，而且与针对人员健康的其他威胁的军事政策不一致。这种普遍存在的烟草“例外论”是实现无烟军队的重大障碍。军方、国会和总统应重新评估那些阻碍有效行动的“不可行因素”，并采取行动对武装部队中的烟草使用进行监管，最终予以取缔。
