Rejected by the New England Journal of Medicine in September 2014.
Co-authored with Dr. Dean Winslow and Dr. David Walton.

To the Editor:

Smith and colleagues’ [1] sound arguments for a tobacco-free military underemphasize the military’s culpability in creating tobacco users.

Since 1987, Department of Defense regulations have prohibited any tobacco use during the 8 weeks of basic military training [2]. Because physical addiction to tobacco lasts only 2-4 weeks [3], all members of the U.S. military for a generation have departed for their first duty station tobacco-free and physically unaddicted.

At this first active duty station, troops initially live on base. Deliberately-inculcated esprit de corps ensures a troop’s social network remains rooted there for years. Given the importance of social networks in promoting the initiation of tobacco use [4] and given that 90% of smokers start at ages no later than these years [5], the social environments on our military bases are, inescapably, what generate the military smoking rate that will ultimately kill >15% of all troops – dwarfing combat deaths.

As officers, we break faith with young troops by putting them into such toxic, risk-laden environments without cause. Tobacco should be banned from U.S. military installations worldwide.

These opinions represent the views of the authors alone and do not reflect official views of the Department of Defense or its components.

[1] Smith EA, Jahnke SA, Poston WS, Williams LN, Haddock CK, Schroeder SA, Malone RE. Is it time for a tobacco-free military? N Engl J Med. 2014;371:589-591.

[2] Johnson L. Military restrictions. New York: Philip Morris USA inter-office correspondence. January 11, 1988. Accessed on-line Sept. 2, 2014 from:

[3] Hughes JR. Effects of abstinence from tobacco: valid symptoms and time course. Nicotine Tob Res. 2007;9:315-327.

[4] Christakis NA, Fowler JH. The collective dynamics of smoking in a large social network. N Engl J Med. 2008;358:2249-2258.

[5] Bondurant S, Wedge R (eds.). Combating Tobacco Use in Military and Veteran Populations. Washington: National Academies Press, 2009. Page 37.

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