title: Tobacco use among Iraq- and Afghanistan-era veterans: a qualitative study of barriers, facilitators, and treatment preferences.
abstract: BACKGROUND
  Military service and combat exposure are risk factors for smoking. Although evidence suggests that veterans are interested in tobacco use cessation, little is known about their reasons for quitting, treatment preferences, and perceived barriers to effective tobacco use cessation treatment. Our study objective was to elicit perspectives of Iraq- and Afghanistan-era veterans who had not yet quit smoking postdeployment to inform the development of smoking cessation services for this veteran cohort.
  
  
  METHODS
  We conducted 3 focus groups among 20 participants in October 2006 at the Durham Veterans Affairs Medical Center to explore issues on tobacco use and smoking cessation for Iraq- and Afghanistan-era veterans who continued to smoke postdeployment. We used qualitative content analysis to identify major themes and organize data.
  
  
  RESULTS
  Veterans expressed the belief that smoking was a normalized part of military life and described multiple perceived benefits of smoking. Although veterans expressed a high level of interest in quitting, they listed several behavioral, situational, and environmental triggers that derailed smoking cessation. They expressed interest in such cessation treatment features as flexible scheduling, free nicotine replacement therapy, peer support, and family inclusion in treatment.
  
  
  CONCLUSIONS
  Our results indicate that the newest cohort of veterans perceives smoking as endemic in military service. However, they want to quit smoking and identified several personal and environmental obstacles that make smoking cessation difficult. Our findings may inform programmatic efforts to increase successful quit attempts in this unique veteran population.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs (VA) Medical Center (152), 508 Fulton St, Durham, NC 27705, USA. j.gierisch@duke.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Gierisch
authors.forename: Kristy
authors.initials: K
authors.lastname: Straits-Tröster
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Calhoun
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
authors.forename: Shawn
authors.initials: S
authors.lastname: Acheson
authors.forename: Kim
authors.initials: K
authors.lastname: Hamlett-Berry
mesh_terms: D055826:Afghan Campaign 2001-; D000346:Afghanistan; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology; D020340:Tobacco Use Cessation / Q000379:methods / Q000523:psychology; D014030:Tobacco, Smokeless; D014728:Veterans