As at June 2021, the Australian Defence Force (ADF) comprised more than 59,500 permanent (47,800 males and 11,700 females) and 29,700 reserve personnel across the Royal Australian Navy, the Australian Army, and the Royal Australian Air Force. The Department of Veterans’ Affairs (DVA) estimated there were about 613,000 living Australian veterans who had ever served in the ADF, either full-time or in the reserves. There were more than 337,000 DVA beneficiaries in receipt of pensions, allowances, and treatment or pharmaceuticals (including approximately 240,000 veterans and 97,200 dependants). 1
9A.7.1 Trends in the prevalence of smoking
In 2020–21, the prevalence of current smoking was similar among Australians who had and had not ever served in the ADF (12% for both). An estimated 78,200 people who had ever served in the ADF were current smokers; 71,200 were male and 7,000 were female. Males who had served in the ADF were more likely to be current smokers than females (13% compared with 6.7%). 2
Examination of this data by age shows that younger men who were currently or had formerly served in the ADF were less likely to be a current smoker than men of the same age who had not served. Among older men, this pattern appeared to be reversed, with those who had served being more likely to be a current or ex-smoker (though the difference was non-significant) 2 —see Figure 9A.7.1. Numbers of women who had served in the ADF were too small to draw comparisons.
The Department of Veterans’ Affairs (DVA) provides support, services and information to various people including veterans and their dependents, serving and ex-serving ADF members, and war widow/ers. DVA clients are typically an older population with greater financial, health, mental and physical support needs. Data from the 2020–21 National Health Survey showed that about one in six male clients of the DVA were daily smokers, compared with about one in 12 non-DVA clients—see Figure 9A.7.2.
The prevalence of smoking differs across military populations. Australian research published in 2010 found that the highest prevalence of current smoking in the Australian Defence Force was among individuals with lower levels of education and those serving in the Navy (26%). The percentage of current smokers in the Army was 22% and the lowest prevalence of smokers was in the Air Force (8%). 4
Data in the US show that the prevalence of smoking is higher among veterans than the general population, though in contrast to recent Australian data, 5 it is particularly high among younger veterans. 6, 7 Smokeless tobacco use is also common among military personnel in the US. 8, 9 A recent study of US military branch differences found that smoking and smokeless tobacco use was highest in the Marine Force and lowest in the Air Force. 10
9A.7.2 Contribution of smoking to health outcomes and social inequality
Serving personnel are generally healthier than the overall population, due to screening processes and fitness requirements. 11 The health and wellbeing of Australian veterans, however, is influenced by a range of factors that can change over time from enlistment to retirement. Veterans overall report similar health and wellbeing to the broader community. In 2017–18, 21% of men who had ever served in the ADF reported a mental or behavioural condition (for example, anxiety and mood disorders, or problems with alcohol) in the previous year (age-standardised), which was similar to men who had not served (18%). The prevalence of chronic conditions was also similar between men who had and had not served, with the exception of cardiovascular disease which was more common among men who had served in the ADF (24% vs. 18%). 12 Some members of the ADF, however, are at a higher risk of developing some cancers and mental disorders than the Australian population. 11 In 2017–18, among those who had served, DVA clients were more likely to consider their health as fair or poor than non-DVA clients (34% compared with 20%). DVA clients were also more than twice as likely to report having a mental or behavioural condition (44% versus 17%), including anxiety (37% versus 8%) and depression (26% versus 11%). 1 Rates of suicide are also higher among contemporary ex-serving men compared with other Australian men. 3 One study examining the use of mental health services found that ADF men were more likely to report poorer health and more likely to be diagnosed with any lifetime mental disorder, any affective disorder, depression, PTSD, and any substance use and alcohol disorder, while DVA women were more likely to report moderate/severe psychological distress and less life satisfaction compared with the overall community. 13
Smoking also contributes to poorer health outcomes among both former and current military personnel. Scottish research found an increased risk of smoking-related cancer compared with non-veterans among older veterans, 14 and Australian data similarly shows higher incidence of smoking-related cancers among veterans of the Korean War (1950–53). 15 One study of Australian Army Vietnam veterans demonstrated increased risk of mortality among these veterans likely attributable to health-risk behaviours such as smoking, inactivity, and poor diet 16 A longitudinal study in the US found that among veterans, tobacco users reported poorer physical and mental health and higher rates of substance use compared with non-users. 7 Another study found that co-use of cannabis with tobacco was associated with poorer mental health outcomes among veterans. 17 Smoking also has short-term harms for young military personnel, including increasing the risk of injuries, 18 reducing physical fitness, 19 and reduced troop readiness. 20
9A.7.3 Explanations for higher smoking prevalence
Tobacco use has traditionally been a part of defence force culture, with tobacco being provided and promoted to troops. 21-25 The tobacco industry actively targeted the military with marketing, sponsorship, and free cigarettes, which has led to increases in smoking prevalence and the normalisation of tobacco use. 21, 22 Military personnel in the US report smoking to fit in with their unit. 26 Despite policies that aim to prevent it, in the US, tobacco products are also sold at lower prices on military bases. 27, 28 Risk factors that promote smoking among the general population, such as lower income and educational attainment, mental illness, and rurality, have also been shown to increase smoking among veterans. 29-32
Stress and trauma associated with war deployment is associated with the uptake of smoking, relapse, and overall high rates of tobacco use compared to the general population. 33-38 Australian research among those deployed to the Middle East found that 38% of respondents reported smoking more than usual during deployment, and 17% reporting taking up or re-starting smoking. 39 Another Australian study found that trauma exposure in the form of military combat predicted smoking over several decades, and was a more robust predictor than PTSD. 40 A study of returned veterans from military conflict in Iraq and Afghanistan indicated an association between heavy daily smoking and emotional numbing, suggesting that veterans suffering post-traumatic stress may smoke in an attempt to manage their trauma. 41 US research has found that deployment with combat experience predicted higher smoking initiation and relapse rate among military personnel. Previous mental health disorders, life stressors, and other military and non-military characteristics also predicted initiation and relapse. 42 Another US study found an association between smoking and exposure to dead/dying/wounded soldiers during service. 30 The misperception that tobacco is effective for stress relief is pervasive among military personnel, including leaders. 43, 44 Smoking is also associated with pain 45 and alcohol use 35 among veterans, and may be perceived as helpful for weight control among young adults in the military. 46
9A.7.4 Interventions for reducing smoking
Studies of US war veterans have concluded that additional effort is required to support smoking cessation in this community. 6, 47, 48 Despite its longstanding role within military culture, there have been increasing efforts in recent years to implement tobacco control policies and cessation programs within the military. In Australia, smoking in all Defence establishments is banned. 49 The New Zealand military is also completely smoke-free, 50 and the British Army is going smoke-free at all of its sites by the end of 2022. 51 Strong, consistent policies and support by leaders appear crucial to the success of such interventions. 52-54 Policies may also need to include the use of e-cigarettes, which appears to be growing among military personnel. 55, 56
There is limited Australian research on cessation interventions for veteran populations, however a number of US studies have provided evidence as to which strategies may be most effective. A large multi-site study concluded that the Tobacco Tactics program, which comprises nurse counselling, informational materials, pharmaceuticals, and post-discharge telephone calls, has the potential to significantly decrease smoking among veterans. 57 Intensive interventions that combine medication with counselling from the tobacco cessation pharmacists also appear promising. 58 A small study found that a smartphone-based contingency management intervention may be a useful adjunctive smoking cessation treatment component for reducing smoking among homeless veterans. 59 Several studies have provided support for the use of smoking cessation telephone- 60 and mobile-phone based interventions tailored for soldiers and veterans who smoke 61-63 and who use smokeless tobacco. 64, 65 The use of cessation pharmacotherapies may also increase quit rates among veterans, 66 and one study has provided support for a group-based brief intervention among young adults in the military. 67 Incorporating stress management and mindfulness into interventions may also support quitting among veterans. 68
For veterans experiencing posttraumatic stress disorder (PTSD), a systematic review published in 2018 examined integrated, specialised treatments for comorbid smoking—PTSD, including preliminary treatment studies and RCTs in both veteran and general clinical samples. It concluded that mobile technology shows promise for providing effective, lower cost, and wide-reaching PTSD—smoking intervention. There is also evidence to support the integration of smoking cessations aids (e.g., varenicline) and smoking cessation counselling into existing PTSD treatments (i.e., prolonged exposure), particularly for people experiencing elevated PTSD symptom severity. 69 Improvements in PTSD symptoms may help to support smoking cessation. 70 See Section 9A.3.5.6 for further discussion.
Healthcare providers can also play an important role in promoting quitting and providing evidence-based cessation interventions to veterans, 71 and this should be integrated into routine care. 72, 73 Proactive outreach may be helpful for engaging veterans in tobacco use interventions. 74 Including tobacco cessation education in veterans’ treatment for other substance use disorders can promote quitting, 75 but smoking cessation is often not prioritised in these settings. 76 A study of the effects of implementing a smoke-free policy within a residential substance use disorder treatment program for veterans found that it increased motivation to quit and use of NRT. 77 Chaplains, who provide meaningful physical and mental healthcare support to veterans, have expressed willingness to be involved in cessation efforts, and could represent another avenue for promoting quitting. 78 One study found that, among veterans with a history of mental health treatment, smoking abstinence was associated with improvements on a number of behaviour and symptom measures. 79
Relevant news and research
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References
1. Australian Institute for Health and Welfare. Health of veterans. 2022. Available from: https://www.aihw.gov.au/reports/veterans/health-of-veterans/contents/health-status
2. Australian Institute of Health and Welfare. Smoking among Australia's veterans 2020-21. AIHW: Australian Government, 2022. Available from: https://www.aihw.gov.au/reports/veterans/smoking-among-australias-veterans-2020-21/contents/about
3. Australian Institute of Health and Welfare. Health of veterans. 2023. Available from: https://www.aihw.gov.au/reports/australias-health/health-of-veterans
4. Barton CA, McGuire A, Waller M, Treloar SA, McClintock C, et al. Smoking prevalence, its determinants and short-term health implications in the Australian Defence Force. Military Medicine, 2010; 175(4):267–72. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20446502
5. Australian Bureau of Statistics. TableBuilder. Available from: http://www.abs.gov.au/websitedbs/d3310114.nsf/home/about+tablebuilder
6. Brown DW. Smoking prevalence among US veterans. Journal of General Internal Medicine, 2010; 25(2):147–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19894079
7. Cooper M, Yaqub M, Hinds JT, and Perry CL. A longitudinal analysis of tobacco use in younger and older U.S. veterans. Preventive Medicine Reports, 2019; 16:100990. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31890466
8. Dunkle A, Kalpinski R, Ebbert J, Talcott W, Klesges R, et al. Predicting smokeless tobacco initiation and re-initiation in the United States Air Force. Addictive Behaviors Reports, 2019; 9:100142. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31193918
9. Lin J, Zhu K, Solivan-Ortiz AM, Larsen SL, Schneid TR, et al. Smokeless tobacco use and related factors: A study in the US military population. American Journal of Health Behavior, 2018; 42(4):102–17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29973315
10. Schuler MS, Wong EC, and Ramchand R. Military service branch differences in alcohol use, tobacco use, prescription drug misuse, and mental health conditions. Drug and Alcohol Dependence, 2022; 235:109461. Available from: https://www.ncbi.nlm.nih.gov/pubmed/35487079
11. Australian Institute of Health and Welfare. A profile of Australia’s veterans 2018. Canberra: AIHW, 2018. Available from: https://www.aihw.gov.au/reports/veterans/a-profile-of-australias-veterans-2018/summary
12. Australian Institute of Health and Welfare. Australia's Health 2020: Health of veterans. 2020. Available from: https://www.aihw.gov.au/reports/aus/234/health-of-population-groups/health-of-veterans
13. McGuire A, Dobson A, Mewton L, Varker T, Forbes D, et al. Mental health service use: comparing people who served in the military or received Veterans' Affairs benefits and the general population. Australian and New Zealand Journal of Public Health, 2015; 39(6):524–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/26337053
14. Bergman BP, Mackay DF, Morrison D, and Pell JP. Smoking-related cancer in military veterans: retrospective cohort study of 57,000 veterans and 173,000 matched non-veterans. BMC Cancer, 2016; 16:311. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27178424
15. Australian Institute of Health and Welfare. Cancer incidence study 2003: Australian veterans of the Korean War. AIHW cat. no. PHE 48.Canberra: AIHW, 2003. Available from: https://www.aihw.gov.au/reports/veterans/cancer-incidence-study-2003-korean-war-veterans/contents/table-of-contents
16. O'Toole BI, Catts SV, Outram S, Pierse KR, and Cockburn J. Factors associated with civilian mortality in Australian Vietnam veterans three decades after the war. Military Medicine, 2010; 175(2):88–95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20180477
17. Fitzke RE, Davis JP, and Pedersen ER. Co-use of tobacco products and cannabis among veterans: A preliminary investigation of prevalence and associations with mental health outcomes. J Psychoactive Drugs, 2021:1–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34334112
18. Altarac M, Gardner JW, Popovich RM, Potter R, Knapik JJ, et al. Cigarette smoking and exercise-related injuries among young men and women. American Journal of Preventive Medicine, 2000; 18(3 Suppl):96–102. Available from: https://www.ncbi.nlm.nih.gov/pubmed/10736545
19. Su FY, Wang SH, Lu HH, and Lin GM. Association of tobacco smoking with physical fitness of military males in Taiwan: The CHIEF study. Can Respir J, 2020; 2020:5968189. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31998426
20. Klesges RC, Haddock CK, Chang CF, Talcott GW, and Lando HA. The association of smoking and the cost of military training. Tobacco Control, 2001; 10(1):43–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/11226360
21. Smith EA and Malone RE. "Everywhere the soldier will be": wartime tobacco promotion in the US military. American Journal of Public Health, 2009; 99(9):1595–602. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19608945
22. Smith EA and Malone RE. Tobacco promotion to military personnel: "the plums are here to be plucked". Military Medicine, 2009; 174(8):797–806. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19743733
23. Nelson JP, Pederson LL, and Lewis J. Tobacco use in the Army: illuminating patterns, practices, and options for treatment. Military Medicine, 2009; 174(2):162–9. Available from: http://www.dtic.mil/cgi-bin/GetTRDoc?AD=ADA521868
24. Nelson J and Pederson L. Military tobacco use: a synthesis of the literature on prevalence, factors related to use, and cessation interventions. Nicotine & Tobacco Research, 2008; 10(5):775–90. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18569751
25. Truth Initiative. Tobacco use in the military. 2018. Available from: https://truthinitiative.org/news/tobacco-use-military
26. Brown JM, Anderson Goodell EM, Williams J, and Bray RM. Socioecological risk and protective factors for smoking among active duty US Military personnel. Military Medicine, 2018; 183(7-8):e231–e9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29697835
27. Kong AY, Golden SD, Myers AE, Little MA, Klesges R, et al. Availability, price and promotions for cigarettes and non-cigarette tobacco products: an observational comparison of US Air Force bases with nearby tobacco retailers, 2016. Tobacco Control, 2019; 28(2):189–94. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29705745
28. Kong AY, Golden SD, Ribisl KM, Krukowski RA, Vandegrift SM, et al. Cheaper tobacco product prices at US Air Force Bases compared with surrounding community areas, 2019. Tobacco Control, 2021. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34907089
29. Coughlin LN, Wilson SM, Erwin MC, Beckham JC, Workgroup VAM-AM, et al. Cigarette smoking rates among veterans: Association with rurality and psychiatric disorders. Addictive Behaviors, 2019; 90:119–23. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30388505
30. Golden SE, Thakurta S, Slatore CG, Woo H, and Sullivan DR. Military factors associated with smoking in veterans. Military Medicine, 2018; 183(11-12):e402–e8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29788494
31. Lopez AA, Toblin RL, Riviere LA, Lee JD, and Adler AB. Correlates of current and heavy smoking among U.S. soldiers returning from combat. Experimental and Clinical Psychopharmacology, 2018; 26(3):215–22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29863380
32. Odani S, Agaku IT, Graffunder CM, Tynan MA, and Armour BS. Tobacco product use among military veterans - United States, 2010-2015. Morbidity and Mortality Weekly Report, 2018; 67(1):7–12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29324732
33. Smith B, Ryan MA, Wingard DL, Patterson TL, Slymen DJ, et al. Cigarette smoking and military deployment: a prospective evaluation. American Journal of Preventive Medicine, 2008; 35(6):539–46. Available from: https://www.ncbi.nlm.nih.gov/pubmed/18842388
34. Poston WSC, Taylor JE, Hoffman KM, Peterson AL, Lando HA, et al. Smoking and deployment: Perspectives of junior-enlisted US Air Force and US Army personnel and their supervisors. Military Medicine, 2008; 173(5):441–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18543564
35. Harte CB, Proctor SP, and Vasterling JJ. Prospective examination of cigarette smoking among Iraq-deployed and nondeployed soldiers: prevalence and predictive characteristics. Annals of Behavioral Medicine, 2014; 48(1):38–49. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24474618
36. Lin J, Zhu K, Solivan-Ortiz AM, Larsen SL, Schneid TR, et al. Deployment and smokeless tobacco use among active duty service members in the US Military. Military Medicine, 2019; 184(3-4):e183–e90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30085231
37. Thandi G and Fear NT. Factors associated with smoking behaviour change in UK military personnel. Occupational Medicine, 2017; 67(9):712–4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29040747
38. Williams JF, Fuller M, and Smith MB. Smoking habits of UK military personnel on deployment: Exercise SAIF SAREEA 3. BMJ Mil Health, 2020; 166(6):396–400. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32467288
39. Dobson A, Treloar SA, Zheng WY, Anderson RE, Bredhauer K, et al. The Middle East Area of Operations (MEAO) Health Study: census study report. The University of Queensland 2013. Available from: http://www.defence.gov.au/Health/home/milhop.asp#documents
40. O'Toole BI, Kirk R, Bittoun R, and Catts SV. Combat, posttraumatic stress disorder, and smoking trajectory in a cohort of Male Australian Army Vietnam veterans. Nicotine & Tobacco Research, 2018; 20(10):1198–205. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29161451
41. Cook J, Jakupcak M, Rosenheck R, Fontana A, and McFall M. Influence of PTSD symptom clusters on smoking status among help-seeking Iraq and Afghanistan veterans. Nicotine & Tobacco Research, 2009; 11(10):1189–95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/19648174
42. Boyko EJ, Trone DW, Peterson AV, Jacobson IG, Littman AJ, et al. Longitudinal investigation of smoking initiation and relapse among younger and older US military personnel. American Journal of Public Health, 2015; 105(6):1220–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25880953
43. Smith EA and Malone RE. Mediatory myths in the U.S. military: tobacco use as "stress relief". American Journal of Health Promotion, 2014; 29(2):115–22. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24359178
44. Krukowski RA, Porter K, Boothe T, Talcott GW, and Little MA. "Nobody views it as a negative thing to smoke": A qualitative study of the relationship between United States air force culture and tobacco use. Mil Psychol, 2021; 33(6):409–16. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34924692
45. Chapman SL and Wu LT. Associations between cigarette smoking and pain among veterans. Epidemiologic Reviews, 2015; 37(1):86–102. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25595170
46. Fahey MC, Little MA, Klesges RC, Talcott GW, Richey PA, et al. Use of tobacco for weight control across products among young adults in the US Military. Substance Use and Misuse, 2021; 56(1):153–61. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33183122
47. Bastian LA and Sherman SE. Effects of the wars on smoking among veterans. Journal of General Internal Medicine, 2010; 25(2):102–3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20077050
48. Hamlett-Berry K, Davison J, Kivlahan D, Matthews M, Hendrickson J, et al. Evidence-based national initiatives to address tobacco use as a public health priority in the Veterans Health Administration. Military Medicine, 2009; 174(1):29–34. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19216295
49. Macklin J and Scott B. Australian Defence Force: Smoking Policy. 2000. Available from: https://parlinfo.aph.gov.au/parlInfo/search/display/display.w3p;query=Id:%22chamber/hansardr/2000-06-05/0159%22#:~:text=(i)%20Smoking%20in%20all%20Defence,apply%20to%20contractors%20and%20visitors.
50. Hefler M. New Zealand to have world’s first smoke-free military by 2020. Tobacco Control Journal blogs, 2017. Available from: http://blogs.bmj.com/tc/2017/05/31/new-zealand-to-have-worlds-first-smoke-free-military-by-2020/
51. British Army to extinguish smoking in 2022 2021. Available from: https://www.army.mod.uk/news-and-events/news/2021/10/british-army-to-extinguish-smoking-in-2022/
52. Smith EA, Poston WS, Haddock CK, and Malone RE. Installation tobacco control programs in the US Military. Military Medicine, 2016; 181(6):596–601. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27244072
53. Lando-King EA, Malone RE, Haddock CK, Poston WSC, Lando HA, et al. Consequences of inconsistency in air force tobacco control policy. Tob Regul Sci, 2017; 3(2):232–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29226195
54. Poston WSC, Haddock CK, Jahnke SA, Jitnarin N, Malone RE, et al. Perspectives of US military commanders on tobacco use and tobacco control policy. Tobacco Control, 2017; 26(3):254–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27084960
55. Fahey MC, Talcott GW, McMurry TL, Klesges RC, Tubman D, et al. When, how, & where tobacco initiation and relapse occur during US Air force technical training. Military Medicine, 2020; 185(5-6):e609–e15. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32060547
56. Little MA, Fahey MC, Wang XQ, Talcott GW, McMurry T, et al. Trends in tobacco use among young adults presenting for military service in the United States air force between 2013 and 2018. Substance Use and Misuse, 2021; 56(3):370–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/33435813
57. Duffy SA, Noonan D, Karvonen-Gutierrez CA, Ronis DL, Ewing LA, et al. Effectiveness of the tobacco tactics program for psychiatric inpatient veterans: an implementation study. Archives of Psychiatric Nursing, 2015; 29(2):120–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25858205
58. Chen T, Kazerooni R, Vannort EM, Nguyen K, Nguyen S, et al. Comparison of an intensive pharmacist-managed telephone clinic with standard of care for tobacco cessation in a veteran population. Health Promotion Practice, 2014; 15(4):512–20. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24231631
59. Carpenter VL, Hertzberg JS, Kirby AC, Calhoun PS, Moore SD, et al. Multicomponent smoking cessation treatment including mobile contingency management in homeless veterans. Journal of Clinical Psychiatry, 2015; 76(7):959–64. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25699616
60. Driscoll MA, Perez E, Edmond SN, Becker WC, DeRycke EC, et al. A brief, integrated, telephone-based intervention for veterans who smoke and have chronic pain: A feasibility study. Pain Med, 2018; 19(suppl_1):S84–S92. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30203011
61. Christofferson DE, Hertzberg JS, Beckham JC, Dennis PA, and Hamlett-Berry K. Engagement and abstinence among users of a smoking cessation text message program for veterans. Addictive Behaviors, 2016; 62:47–53. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27318948
62. Bary-Weisberg D, Meltser M, Oberman M, Pato Benari A, Bar-Zeev Y, et al. Feasibility of a text-messaging smoking cessation program for soldiers in Israel. BMC Public Health, 2019; 19(1):715. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31238914
63. Christofferson DE, Dennis PA, Hertzberg JS, Beckham JC, Knoeppel J, et al. Real-world utilization and outcomes of the Veterans Health Administration's smoking cessation text message program. Nicotine & Tobacco Research, 2021; 23(6):931–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32945887
64. Christofferson DE, Blalock DV, Knoeppel J, Beckham JC, Hamlett-Berry K, et al. A real-world evaluation of a smokeless tobacco cessation text message program for veterans: Outcomes and comparison to cigarette smokers. Nicotine & Tobacco Research, 2022; 24(2):186–95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34545940
65. Herbst E, Pennington D, Kuhn E, McCaslin SE, Delucchi K, et al. Mobile technology for treatment augmentation in veteran smokers with posttraumatic stress disorder. American Journal of Preventive Medicine, 2018; 54(1):124–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29074319
66. Duffy SA, Ignacio RV, Kim HM, Geraci MC, Essenmacher CA, et al. Effectiveness of tobacco cessation pharmacotherapy in the Veterans Health Administration. Tobacco Control, 2019; 28(5):540–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30181383
67. Little MA, Wang XQ, Fahey MC, Wiseman KP, Pebley K, et al. Efficacy of a group-based brief tobacco intervention among young adults aged 18-20 years in the US Air Force. Tobacco Induced Diseases, 2021; 19:95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34963775
68. Mineyama Y, Hyder Ferry L, Arechiga A, Dos Santos H, and Berk L. The effect of a tobacco dependence treatment program with stress management through mindfulness technique training in US veterans. Adv Mind Body Med, 2019; 33(2):12–7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31476134
69. Kearns NT, Carl E, Stein AT, Vujanovic AA, Zvolensky MJ, et al. Posttraumatic stress disorder and cigarette smoking: A systematic review. Depress Anxiety, 2018; 35(11):1056–72. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30192425
70. Salas J, Gebauer S, Gillis A, van den Berk-Clark C, Schneider FD, et al. Increased smoking cessation among veterans with large decreases in posttraumatic stress disorder severity. Nicotine & Tobacco Research, 2022; 24(2):178–85. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34477205
71. Blok AC, Ignacio RV, Geraci MC, Kim HM, Barnett PG, et al. Provider and clinical setting characteristics associated with tobacco pharmacotherapy dispensed in the Veterans Health Administration. Tobacco Induced Diseases, 2021; 19:65. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34429727
72. Boe R and Ridner SL. Connecting veterans with smoking cessation services in less than 3 minutes. J Am Assoc Nurse Pract, 2020; 33(8):586–90. Available from: https://www.ncbi.nlm.nih.gov/pubmed/32590445
73. Heffner JL, Coggeshall S, Wheat CL, Krebs P, Feemster LC, et al. Receipt of tobacco treatment and one-year smoking cessation rates following lung cancer screening in the Veterans Health Administration. Journal of General Internal Medicine, 2022; 37(7):1704–12. Available from: https://www.ncbi.nlm.nih.gov/pubmed/34282533
74. Rogers ES, Fu SS, Krebs P, Noorbaloochi S, Nugent SM, et al. Proactive tobacco treatment for smokers using veterans administration mental health clinics. American Journal of Preventive Medicine, 2018; 54(5):620–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29551324
75. Vest BH, Kane C, DeMarce J, Barbero E, Harmon R, et al. Outcomes following treatment of veterans for substance and tobacco addiction. Archives of Psychiatric Nursing, 2014; 28(5):333–8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25439975
76. Gifford E, Tavakoli S, Wisdom J, and Hamlett-Berry K. Implementation of smoking cessation treatment in VHA substance use disorder residential treatment programs. Psychiatric Services, 2015; 66(3):295–302. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25727118
77. Hemmy Asamsama O, Miller SC, Silvestri MM, Bonanno C, and Krondilou K. Impact of implementing a tobacco and recreational nicotine-free policy and enhanced treatments on programmatic and patient-level outcomes within a residential substance use disorder treatment program. Journal of Substance Abuse Treatment, 2019; 107:44–9. Available from: https://www.ncbi.nlm.nih.gov/pubmed/31757264
78. Van Voorhees EE, Hamlett-Berry K, Christofferson DE, Beckham JC, and Nieuwsma JA. No wrong door to smoking cessation care: a Veterans Affairs Chaplain survey. Military Medicine, 2014; 179(5):472–6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24806490
79. Krebs P, Rogers E, Smelson D, Fu S, Wang B, et al. Relationship between tobacco cessation and mental health outcomes in a tobacco cessation trial. Journal of Health Psychology, 2018; 23(8):1119–28. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27151069