title: Advance and retreat: tobacco control policy in the U.S. military.
abstract: This archival study explored why military tobacco control initiatives have thus far largely failed to meet their goals. We analyzed more than 5,000 previously undisclosed internal tobacco industry documents made public via an online database and additional documents obtained from the U.S. military. In four case studies, we illustrate how pressures exerted by multiple political actors resulted in weakening or rescinding military tobacco control policy initiatives. Our findings suggest that lowering military smoking rates will require health policymakers to better anticipate and counter political opponents. The findings also suggest that effective tobacco control policies may require strong, explicit implementation instructions and high-level Department of Defense support. Finally, policy designers should also consider ways to reduce or eliminate existing perverse incentives to increase tobacco consumption, such as allowing exchange store tobacco sales to fund Morale, Recreation, and Welfare Programs.
authors.affiliation: Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, 3333 California Street, Suite 455, San Francisco, CA 94143, USA.
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Arvey
authors.forename: Ruth E
authors.initials: RE
authors.lastname: Malone
mesh_terms: D002140:California / Q000453:epidemiology; D006291:Health Policy; D006293:Health Promotion; D006801:Humans; D008887:Military Medicine; D008889:Military Personnel; D016730:Program Development; D015397:Program Evaluation; D012907:Smoking / Q000453:epidemiology; D000074606:Smoking Prevention; D040241:Social Marketing; D019460:Tobacco Industry; D014481:United States / Q000453:epidemiology; D014026:Nicotiana