title: Talking to Iraq and Afghanistan war veterans about tobacco use.
abstract: BACKGROUND
  Our goal in this study was to examine beliefs and attitudes about tobacco use in the newest generation of combat veterans, those who served in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]).
  
  
  METHODS
  We held 5 focus groups (n = 17) with Minnesota Army National Guard soldiers who had recently returned from combat deployment in support of OEF/OIF. Sessions were audiorecorded, transcribed, coded, and analyzed using a grounded theory approach.
  
  
  RESULTS
  We found that it is common to use tobacco in the combat zone for stress and anger management and boredom relief. Tobacco was also a tool for staying alert, a way to socialize, and provided a chance to take breaks. Participants recognized the culture of tobacco use in the military. Stress, nicotine dependence, the tobacco environment at drill activities, and perceived inaccessibility of cessation tools perpetuated use at home and served as a barrier to cessation. Repeatedly, participants cited tobacco policies (such as increased taxes and smoke-free workspaces) as motivators for quitting.
  
  
  CONCLUSIONS
  There are specific circumstances common to combat zones that promote tobacco use. Results suggest that environmental changes that address the prominence of tobacco in military culture, the acceptance of nonsmoking breaks, and cessation programs that address stress issues and make cessation aids available may be effective in reducing tobacco use.
authors: Center for Chronic Disease Outcomes Research, VA Health Services Research & Development, Minneapolis Veterans Affairs Medical Center, One Veterans Drive (152/2E), Minneapolis, MN 55417, USA. widome@umn.edu
authors: Rachel
authors: R
authors: Widome
authors: Anne M
authors: AM
authors: Joseph
authors: Melissa A
authors: MA
authors: Polusny
authors: Bernadette
authors: B
authors: Chlebeck
authors: Betsy
authors: B
authors: Brock
authors: Ashley
authors: A
authors: Gulden
authors: Steven S
authors: SS
authors: Fu
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D000786:Anger; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D012907:Smoking; D013315:Stress, Psychological / Q000517:prevention & control; D020340:Tobacco Use Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D014030:Tobacco, Smokeless; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*