Tobacco Use in a National Sample of Service Member and Student Veterans

Background and Purpose: Increasingly, service members/veterans using Post-9/11 GI Bill benefits attend postsecondary institutions.  This student service member/veteran influx within higher education both demands further inquiry into how the needs of these students differ from civilians and calls for an examination of effective programs, services, and policies. Postsecondary institutions can play a role in changing the health behaviors of students, including tobacco use. Tobacco use is associated with posttraumatic stress symptoms in veterans, as well as negative health outcomes including cardiovascular disease, emphysema, stroke, and various cancers. Health behaviors among student service members/veterans are understudied. Previous research suggests that these veterans more often report tobacco use than non-veteran students. However, limited information is available regarding prevalence and potential predictors of both traditional (e.g., cigarettes) and alternative (e.g., smokeless tobacco) forms of tobacco use among this population of students. The purpose of this study was to inform the development of health promotion initiatives to reduce tobacco use among student service members/veterans in postsecondary institutions by identifying factors associated with cigarette, water pipe, cigar, and smokeless tobacco use.  

Methods: Data came from the fall 2011 National College Health Assessment II, conducted by the American College Health Association. Administered twice yearly, the fall 2011 sample comprised of 27,774 volunteer students from 44 post-secondary institutions across the United States. For the current study, our sample comprised 706 students who reported membership in the United States Armed Services. Logistic regression with a clustered sandwich estimator was used to model the associations between the covariates and use of tobacco products. All statistical analyses were performed with Stata 13 for Windows.

Results: There were 286 student service members/veterans (41%) that indicated that they used some form of tobacco within the last 30 days. Most were white, heterosexual, unmarried males in undergraduate programs with some problematic reactions to stressors and mental health symptoms. Alcohol use, financial stress, and marital/partner status were significantly associated with cigarette use (χ² (6, N = 693) = 43.35, p ≤ .001). Attempted suicide, alcohol use, other (race), marital/partner status, and intramural sport participation were significantly associated with water pipe use (χ² (6, N = 658) = 39.11, p ≤ .001). Alcohol use, male, transgender, and intramural sport participation were significantly associated with cigar use (χ² (4, N = 689) = 36.22, p ≤ .001). Attempted suicide, alcohol use, health problem of a family member/friend, male, white, and a C GPA were significantly associated with smokeless tobacco use (χ² (16, N = 671) = 69.21, p ≤ .001).

Conclusions and Implications: Findings highlight the high prevalence of alternative forms of tobacco product use among student service members/veterans on college/university campuses. Neither deployment nor negative mental health or most normative stressor factors were predictive of tobacco use. Alcohol use was predictive of increased tobacco use.  Marital/partner status was predictive of reduced cigarette and smokeless tobacco use. Additional research is warranted to understand how tobacco use among student service members/veterans might be used to cope with reintegration and/or avoid thoughts or emotions associated with traumatic experiences.