The use of tobacco harms Israel Defense Forces (IDF) soldiers and security in
general. In new research published in the peer-reviewed journal Nicotine & Tobacco Research, researchers in Israel found
that cigarette smoking increased by almost 40% during compulsory
military service in the Israel Defense Forces.
In a systematic
sample of nearly 30,000 soldiers from 1987 to 2011, the prevalence of
smoking grew from 26.2% at recruitment to 36.5% at discharge, a 39.4%
‘Cigarette smoking increased by almost 40% during compulsory military service in the Israel Defense Forces (IDF).’
The researchers, from Tel Aviv University, the University of Haifa,
and the Hebrew University of Jerusalem, in cooperation with the IDF
Medical Corps, say the increased smoking prevalence among military
personnel, and the increase during military service, should act as a
wake-up call to governments and health systems in countries lacking
strong military tobacco control policies.
The research was conducted by Dr. Laura Rosen of the School of
Public Health at Tel Aviv University; Dr. Hagai Levine from the Hebrew
University-Hadassah Braun School of Public and Community Medicine; Dr.
Salman Zarka from the University of Haifa; and Vladi Rozhavski, Tamar
Sela, Dr. Yael Bar-Ze'ev, and Dr. Vered Molina-Hazan from the IDF
Medical Corps. It was funded by the Israel National Institute for Health
Former smoking and combat profiles are risk factors for smoking initiation
Among nonsmokers at recruitment, 18% initiated smoking during
service. Former smokers were at greatest risk: 56% began smoking during
service. Men and women with combat profiles were also at an increased
risk, after adjusting for personal, family, and military factors.
Prevalence of smoking was greater among males at discharge (40.3%) than
among females (32.4%), but the increase during service was similar. On
the other hand, 12% of smokers at recruitment quit smoking during
service. There were no clear trends over the decades regarding smoking
prevalence at recruitment and discharge. There was a slight increase in
smoking cessation during service among males.
A tobacco control plan in the army is desperately needed
Nearly a fifth of nonsmoking new recruits initiated smoking during
service, and over half of former smokers relapsed to smoking. Because
50%- 65% of smokers die prematurely from smoking-related causes, the
ongoing and future damage is enormous. The large increase in smoking
during service, combined with high subsequent mortality of smokers,
suggests that military tobacco control policy affects long-term survival
of military personnel, and is an important contributor to
population-wide mortality in countries such as Israel where a large
percentage of individuals serve.
Dr. Laura Rosen, Chair of the Department of Health Promotion in the
School of Public Health at Tel Aviv University's Sackler Faculty of
Medicine, said: "The government and the Ministry of Health need to cooperate
with the IDF, in order to reduce the number of soldiers who start
smoking, to encourage soldiers to quit smoking, and to protect
non-smokers from exposure to cigarette smoke. We should take an example
from the United States, which conducted extensive changes to the smoking
policy in its military, to protect its soldiers and to improve the
readiness and performance of its combat units. "
Dr. Hagai Levine, Head of the Environmental Health Track at the
Hebrew University-Hadassah Braun School of Public Health and Community
Medicine, said: "The increase we found in the rate of smoking during
compulsory military service is of great concern in light of the serious
consequences for public health. We must concentrate our efforts in the
war against smoking in order to protect the health of young men and
women, and to coordinate civilian and military efforts in order to fight
smoking throughout the life course. I hope that the IDF will adopt
similar measures to those implemented successfully in other armies."
The investigators recommend the creation of a central tobacco
control body with comprehensive tobacco control policy, similar to
programs in the U.S. military. The following steps are recommended:
enforcement of smoking bans in public areas; prevention of supply of
free or reduced-cost cigarettes to soldiers; prevention and treatment of
tobacco dependence tailored for the military environment; monitoring of
personal and army-wide smoking status.
The investigators also recommend that commanders disseminate health
messages and no-smoking messages through personal example, particularly
in combat units and during combat operations. A special program should
target former smokers, given the high chance of returning to smoking.
Special attention should be paid to those who score higher in their
recruitment profiles, who often end up serving in combat units where the
smoking rate is higher.
The dramatic increase in smoking during military service presents a
window of opportunity for changes in health behaviors, and suggests a
need for a multi-year war on tobacco among soldiers, in order to protect
their health and military fitness. The study also showed that smoking
is already problem prior to recruitment, which adds urgency to the call
for national efforts to prevent smoking initiation, which could be
coordinated with the Ministries of Education and Defense.