Smoking rates among military service members continues to decline as e-cigarette use increases, according to a 2018 study by the Rand Corporation. In Rand’s Health Related Behaviors Survey Substance Use Among U.S. Active-Duty, “13.9 percent of service members were current cigarette smokers, and 7.4 percent smoked cigarettes daily.” Among the general population, 16.8 percent of Americans were current smokers, and 12.9 percent were daily smokers.

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The finding is significant because military service members now smoke at lower rates than the general population. Historically, smoking rates among service members have been higher than the national average. In 2011, 24.5 percent “of service members reported cigarette use in the past 30 days,” compared to 20.6 percent of civilians.  

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The Rand analysis also finds a significant portion of military service members use electronic cigarettes, as 35.7 percent reported they have tried e-cigarettes, 12.4 percent reported being current past-month users, and 11.1 percent reported being daily users. These numbers are noteworthy because scant research exists on e-cigarette use among military service members.

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For decades, cigarette use has been pervasive across the U.S. military. Cigarettes are not subject to state and local taxes on the vast majority of military installations. In fact, an analysis comparing cigarette prices noted that cigarettes “were 11% - 12% cheaper at on-base retailers compared with off-base retailers.” It is estimated the Department of Defense “spends more than $1.6 billion each year on tobacco-related medical care.”

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The rise in use of electronic cigarettes and simultaneous decline in cigarette consumption is further proof to the efficacy of e-cigarettes as a tobacco harm reduction tool. Numerous public health groups including Public Health England (PHE), the Royal College of Physicians, the National Academies of Sciences, Engineering, and Medicine, and the American Cancer Society have publicly acknowledged reduced harm form the use of e-cigarettes. PHE England has even found e-cigarettes to be “95% safer than smoking.”

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Moreover, reduced harms resulting from use of e-cigarettes is believed to help reduce state budgets that must account for health costs associated with combustible cigarettes. In fact, according to an analysis, if all current Medicaid recipients who use combustible tobacco were to switch to e-cigarettes, states could have saved $48 billion in Medicaid costs in 2012. A smaller study found Medicaid savings “would be approximately $2.8 billion per 1 percent of [Medicaid] enrollees” over the next 25 years. As more military members use e-cigarettes instead of combustible cigarettes, the Defense Department’s long-term health care costs should decline significantly.

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E-cigarettes have also become a very popular and successful smoking cessation tool. In 2014, the Centers for Disease Control and Prevention found that among smokers who attempted to quit smoking cigarettes within the past year, “more than one-half have ever tried an e-cigarette and 20.3% were current e-cigarette users.” A 2016 analysis noted that of the 10 million American adult vapers, approximately 3 million had used e-cigarettes to quit smoking tobacco cigarettes. Recently, a 2019 study found electronic cigarettes and vaping devices to be “twice as effective” as nicotine replacement therapy.

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It should be very apparent to policymakers that e-cigarettes are an effective smoking cessation tool. E-cigarettes are safer than combustible cigarettes and provide economic gains by reducing health care costs associated with combustible cigarettes. Further, e-cigarette retailers improve local economies by providing new business opportunities and tax revenue. Therefore, policymakers should refrain from imposing onerous regulations and egregious taxes on e-cigarettes, which would only threaten the viability of these tobacco harm reduction products.

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Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute or Tobacco Harm Reduction 101.