Proposed FDA e-cigarette ban disproportionately impacts veterans and service members

In the politically-charged climate of 2019, there are very few things that our society can universally agree on. Some of the few things we can agree on, however, is that smoking cigarettes is bad for one’s health, and that even when we don’t support a war, we will support the troops. Therefore, it should logically follow that anything that aids active duty service members and military veterans to quit smoking in order to live longer, happier lives, should be encouraged.  

Unfortunately, this is where our politically charged climate returns. Despite scientific evidence that the use of electronic cigarettes, commonly known as “vaping,” are “significantly more effective than nicotine replacement treatments” such as patches, gum or other forms of oral nicotine in getting people to quit smoking, the FDA recently proposed a rule prohibiting the sale of e-cigarettes to places where children under the age of 18 can enter.  

{mosads}Politicians should take a stand against this rule by learning more about accessible alternatives for smoking cessation such as e-cigarettes. Importantly, the impacts of smoking disproportionately impact service members and veterans, so limiting successful means to minimizing tobacco usage and assisting people in quitting smoking disproportionately affects service members and veterans as well.

Because of this disproportionate impact, lack of access to products that aid in smoking cessation is not just a public health issue, but also a national security concern. The number of military personnel who smoke remains significantly higher than that of the civilian population, meaning that our military is not performing at optimal health in a time of tense international relations. To this end, according to a study conducted by the American Journal of Preventive Medicine, U.S. troops who were deployed to Iraq and Afghanistan have been reported to smoke at twice the rate of civilians, and veterans of the U.S. military are more likely to be lifelong smokers than their civilian counterparts.

The United States military has a long history with tobacco products. Starting in World War I, cigarettes were provided to soldiers with their rations, causing many service members to become addicted to smoking. Tobacco companies stated that smoking was a way for troops to escape stressful circumstances and improve camaraderie and morale. Despite increasing evidence over the next several decades that tobacco was harmful to service members’ health, the military continued to include cigarettes in rations until 1975.

Although cigarettes are no longer provided directly to service members, the Department of Defense (DoD) is still paying for the impact of its relationship with the tobacco industry. Our tax dollars have funded billions of dollars in direct health care costs for service members and veterans as a result of smoking-related issues, as well as millions more due to lost productivity stemming from those health-care issues, some of which lead to discharge from active service.

Having healthy troops means increased readiness for combat, and that means having access to tobacco-alternatives. Electronic cigarettes, such as JUUL, are an easily accessible alternative to smoking. By contrast, pharmaceutical alternatives often require a prescription from a doctor and an expensive copayment and are therefore difficult for those on active duty to obtain.  

Moreover, once service members transition from active duty to veteran status, smoking continues to detract from overall quality of life and mental health. As the Department of Veterans Affairs (VA) continues to struggle with ways to combat the suicide epidemic — nearly 22 veterans a day commit suicide — smoking cessation is an often overlooked fact that can contribute to this discussion. According to a study performed by the American Journal of Epidemiology, the risk of suicide for military members and veterans increases significantly with the number of cigarettes smoked daily. Therefore, as we continue to confront the suicide epidemic, we should include smoking cessation as part of the conversation.

According to Sherman Gillums, the chief advocacy officer at AMVETS, which is currently doing an anti-smoking campaign that they received a grant from JUUL, “In a perfect world, no one would smoke tobacco in any form . . . but the stress inherent to military service makes it virtually impossible not to at least try smoking at some point on a deployment after a firefight or to fight off hunger pangs during downtime in the field.”

He continued, “now that e-cigarettes, an arguably less potent alternatives are widely available, I expect to see better health outcomes over time. Absent scientific evidence that challenges this otherwise reasonable take on the issue, creating barriers to accessing e-cigarettes has to be about something other than helping our veterans live healthier lives.”

However, Gillums’ expectation regarding better health outcomes cannot be realized if the FDA’s proposed rule is finalized and access to e-cigarettes is severely restricted. In large part smokers, many of whom are service members or veterans, buy cigarettes where it is most convenient. If we want to encourage them to quit, the same products that will enable them to do so must also be conveniently available in the same locations. Smoking is bad for our troops, bad for our health and bad for morale. E-cigarettes provide a safer, more cost-effective way to mitigate the damages caused by smoking, particularly for service members and veterans. We would all benefit from continuing the conversation about viable alternatives to smoking, particularly those such as e-cigarettes that have already proven an effective step towards quitting, rather than jumping to unsubstantiated conclusions that result in banning products altogether.

Rory E. Riley-Topping served as a litigation staff attorney for the National Veterans Legal Services Program (NVLSP), where she represented veterans and their survivors before the U.S. Court of Appeals for Veterans Claims. She also served as the staff director and counsel for the House Committee on Veterans’ Affairs, Subcommittee on Disability Assistance and Memorial Affairs for former Chairman Jeff Miller (R-Fla.). You can find her on Twitter: @RileyTopping.