Military exceptionalism or tobacco exceptionalism: how civilian health leaders' beliefs may impede military tobacco control efforts.

Smoking impairs the readiness and performance of military personnel, yet congressional opposition has thwarted military tobacco control initiatives. Involvement of civilian organizations might alter this political dynamic. We interviewed 13 leaders of national civilian public health and tobacco control organizations to explore their perspectives on military tobacco control, inductively analyzing data for themes. Leaders believed that military tobacco use was problematic but lacked specific knowledge. Most supported smoke-free policies and prohibiting smoking in uniform; however, they opposed banning tobacco use, arguing that it would violate smokers' rights. Most leaders inappropriately applied civilian models of policy development to the military context. A tobacco-free military is unlikely to be achieved without military-civilian partnerships that include educating civilian health leaders about military policy development and implementation.