title: Banning cigarette smoking on US Navy submarines: a case study.
abstract: BACKGROUND
  The military has had a long pro-tobacco tradition. Despite official policy discouraging smoking, tobacco still is widely seen as part of military culture. While active smoking has presented a particular challenge for the military, in recent years there also has been increasing concern with secondhand smoke. This is especially true in closed environments and submarines may be deployed for months at a time. The current case study describes the successful implementation by the Navy of a comprehensive ban on smoking aboard submarines.
  
  
  METHODS
  The authors searched documents on the internet, popular media, military-based news outlets and the scientific literature. We also conducted interviews with Navy officers who were instrumental in policy implementation.
  
  
  RESULTS
  Data demonstrating substantial exposure of non-smokers to tobacco smoke aboard submarines had major impact on successful adoption of the policy. A systematic and extended roll out of the ban included establishing a working group, soliciting input and active engagement from submarine personnel, and offering cessation assistance. Support was enlisted from Chief Petty Officers who could have been strongly opposed but who became strong proponents. Fewer problems were encountered than had been expected. In contrast to a previous unsuccessful attempt by a Navy captain to ban smoking on his ship, the ban was adopted without apparent tobacco industry interference.
  
  
  CONCLUSIONS
  Lessons learned included the importance of strong empirical support, effective framing of the issue, setting a realistic timeline, soliciting support from key personnel and providing appropriate resources. These lessons have implications for those considering further tobacco policy changes in the military and elsewhere.
authors.affiliation: Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
authors.forename: Harry A
authors.initials: HA
authors.lastname: Lando
authors.affiliation: Bureau of Medicine and Surgery, US Navy, Washington, District of Columbia, USA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Michaud
authors.affiliation: Department of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA Bureau of Medicine and Surgery, US Navy, Washington, District of Columbia, USA Institute of Biobehavioral Health Research, National Development and Research Institutes, Inc., Leawood, Kansas, USA College of Dental Medicine-Illinois, Midwestern University, Downers Grove, Illinois, USA.
authors.forename: Walker S C
authors.initials: WS
authors.lastname: Poston
authors.affiliation: Institute of Biobehavioral Health Research, National Development and Research Institutes, Inc., Leawood, Kansas, USA Institute of Biobehavioral Health Research, National Development and Research Institutes, Inc., Leawood, Kansas, USA.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Jahnke
authors.affiliation: College of Dental Medicine-Illinois, Midwestern University, Downers Grove, Illinois, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Williams
authors.affiliation: Institute of Biobehavioral Health Research, National Development and Research Institutes, Inc., Leawood, Kansas, USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Haddock
mesh_terms: D016902:Air Pollution, Indoor; D006801:Humans; D008889:Military Personnel; D016273:Occupational Exposure / Q000331:legislation & jurisprudence; D012767:Ships; D061845:Smoke-Free Policy; D012907:Smoking / Q000331:legislation & jurisprudence; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013366:Submarine Medicine; D019460:Tobacco Industry; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence / Q000517:prevention & control*; D014481:United States
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Cotinine; Public opinion; Public policy; Secondhand smoke