To Save Veterans’ Lives, the VA Must Innovate on Smoking Cessation

April 12, 2024

The United States has invested trillions of dollars to equip our armed forces with hardware and technology. Yet over the past few years, our government has overlooked technological innovations that could ultimately save the lives of millions of US service members and veterans, while saving the US health system billions of dollars.

Active-duty military and veterans are more likely to smoke cigarettes than the average American. According to the Centers for Disease Control and Prevention, high stress and the need to stay alert contribute to higher rates of tobacco use. In 2018, 18.4 percent of service members reported smoking, of whom 47 percent had unsuccessfully attempted to quit in the past year. Cigarette smoking is even more common among those recently deployed.

Over 1 million of those who receive care through the Veterans Health Administration report smoking cigarettes.

Beyond active-duty military, an estimated 12.7 percent of veterans smoke. There are over 18 million veterans in the US. According to the most recent survey data, over 1 million of those who receive care through the Veterans Health Administration report smoking cigarettes. More than 52 percent of them report recent, unsuccessful attempts to quit, reinforcing how hard it can be to do so.

Smoking also imposes massive costs on health care systems and taxpayers. In 2014, the US Department of Defense spent nearly $1.8 billion in medical and non-medical costs related to tobacco use. In 2010, the Veterans Health Administration spent an estimated $2.7 billion on smoking-related care, prescription drugs, hospitalizations and home health care, according to the CDC.

Tactics and strategies that reduce the risks of inherently risky activities are core to military life. For service members and veterans who aren’t able or ready to quit nicotine, moving away from harmful cigarettes to a safer alternative is a logical step.

Nicotine is not a primary driver of disease among people who smoke; in isolation, used at real-world doses, it is relatively harmless. Inhaling smoke from the combustion of tobacco and paper is a source of toxicants that cause cancer and other illnesses.

Technology that provides nicotine while eliminating smoke therefore dramatically reduces health risks and is an important harm reduction strategy.

Our government is doing the veteran community a disservice by failing to embrace harm reduction strategies for smoking.

For those trying to quit, the preponderance of credible scientific research shows that nicotine vapes are among the most effective cessation tools. Products like nicotine gums, lozenges and patches that you might find in the smoking cessation section of the PX or pharmacy are less effective.

Vaping works for many people seeking to quit cigarettes when it replicates the inhalation and hand-to-mouth action of smoking. But other innovations in nicotine, like pouches and heated tobacco products, have also shown great promise. Pouches could particularly provide less harmful alternatives for the many service members who use chewing tobacco or moist snuff.

Unfortunately, our government is currently doing the veteran community a disservice by failing to embrace the kinds of harm reduction strategies for smoking that it employs elsewhere.

The VA promotes outdated cessation methods that are not as effective as vapes. Further, the VA publishes misinformation suggesting that vapes cause cancer. While vapes are not entirely risk-free, no reliable evidence demonstrates that they cause cancer.

What we do know is that vapes are much less harmful alternatives to cigarettes. According to research, “exposure to potentially toxic substances from e-cigarettes is significantly lower compared with combustible tobacco cigarettes” and “reduced short-term adverse health outcomes in several organ systems.”

It’s time for the Veterans Administration to embrace innovation and get this right. 

Delay is inexcusable, when other nations around the world are outpacing the United States in embracing progressive public health strategies for smoking.

Public health authorities in the United Kingdom, for instance, actively support vaping as a central component of tobacco harm reduction efforts. The British government distributes free vapes to help people quit smoking. Sweden’s broad adoption of snus has helped that nation become almost “smoke free.” And Japan’s smoking rate dramatically declined after heated tobacco products were made available.

Ignoring established science and refusing to adopt technological advances that could save veterans’ lives is a failure in our commitment to those who served. It’s time for the Veterans Administration to embrace innovation and get this right. 



Photograph of Doris Miller VA Medical Center in Waco, Texas, by cmh2315fl via Flickr/Creative Commons 2.0

Timothy Vermillion

Dr. Timothy Vermillion is a clinical social worker who specializes in trauma and providing readjustment therapy for military and veteran populations. He is a service-disabled veteran who served in Iraq with the Army National Guard. He lives in Neptune, New Jersey.

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