Veterans Exhibit Elevated and Diverse Patterns of Tobacco Use: New Research Uncovers Concerning Trends Across Product Types
A groundbreaking study recently published by researchers at Boston University School of Public Health has revealed that military Veterans in the United States continue to consume tobacco products at disproportionately higher rates compared to their civilian counterparts. This comprehensive investigation, the first to analyze tobacco use by product type among Veterans since 2015, utilized extensive nationally representative survey data from 2021 to 2023 to paint a nuanced portrait of tobacco consumption habits within this population, illuminating patterns that carry significant implications for public health interventions.
Tobacco use has long been ingrained within military culture, often framed as a normalized—and at times even socially necessary—coping mechanism for stress, anxiety, and the rigors of service life. However, this entrenched pattern frequently extends into post-military life. The Boston University study underscores that Veterans are not only more likely to use tobacco, but that they engage with a diverse array of commercial tobacco products, spanning from conventional cigarettes and cigars to pipes, e-cigarettes, and smokeless variants, all of which bear varying degrees of harm yet collectively contribute to adverse health outcomes.
The data drawn from over 78,000 individuals, encompassing both Veterans and civilians, reveal that nearly 25% of Veterans currently use some form of tobacco product. Alarmingly, combustible tobacco products—which include cigarettes, cigars, and pipes—are utilized by approximately 19% of Veterans. These products are chiefly concerning due to their established links with a broad spectrum of severe health conditions, including cardiovascular disease, respiratory illnesses, and multiple forms of cancer. The elevated prevalence of combustible use underscores a persistent public health issue that is exacerbated in the Veteran community.
Researchers led by Dr. Jennifer Ross, associate professor of health law, policy, and management at BUSPH, emphasize the significance of these findings. “Combustible tobacco products represent the most harmful category of tobacco, inflicting disproportionate health burdens on Veterans who are already vulnerable due to service-related injuries and mental health conditions,” Ross explains. The study’s insights offer a crucial update to a field previously relying on outdated data, thereby equipping policymakers and healthcare providers with actionable knowledge about current tobacco use trends.
An important aspect of the research is its granular analysis of Veteran subgroups based on age, gender, and healthcare utilization. Younger Veterans aged 18 to 34 exhibit particularly high use of emerging tobacco products such as e-cigarettes and cigars, as well as a tendency towards poly-tobacco use—the concomitant use of multiple tobacco types. Conversely, older Veterans demonstrate a higher propensity for traditional cigarette smoking. This bifurcation suggests that tobacco use interventions must be tailored not only to Veteran status but also to differing product preferences correlated with age cohorts.
Moreover, the study highlights a disparity in tobacco use based on healthcare access and provider type. Veterans receiving care through the Veterans Health Administration (VHA) have been found more likely to smoke combustible tobacco compared to those accessing non-VHA healthcare providers. Given that over half of Veterans do not utilize VHA services, this finding signals a critical gap in tobacco cessation outreach and treatment programs that must be addressed across the broader spectrum of Veteran healthcare provision.
The entrenched reasons for tobacco use among military and Veteran populations extend beyond physical addiction; tobacco is often employed as a psychological tool to manage stress and foster social bonds amid challenging environments. This cultural entrenchment complicates cessation efforts. Consequently, the research team advocates for multifaceted strategies combining clinical interventions with tailored educational campaigns that accurately convey the risks associated with all tobacco products, including those sometimes perceived as less harmful, like cigars and e-cigarettes.
Addressing misperceptions about product safety is paramount. For instance, recent studies cited by the authors reveal that many younger adults under the impression that cigars are less harmful than cigarettes are unaware that cigars oftentimes contain higher concentrations of toxicants such as carbon monoxide. While e-cigarettes may offer a relatively reduced-harm alternative for those struggling to quit combustible forms, their long-term effects remain uncertain, and their use still contributes to nicotine dependence.
The timing of this research is particularly opportune, as it precedes new regulatory measures implemented by the VHA starting in October 2024. These policies mandate comprehensive tobacco use screenings and brief counseling or treatment for Veterans identified as tobacco users. The researchers’ findings serve as an evidence base supporting such initiatives, while also advocating for expanded access to cessation resources beyond the VHA framework to reach the entire Veteran population effectively.
Beyond the immediate clinical applications, the study calls for a collaborative approach integrating efforts from the Department of Defense, Veterans Health Administration, and Veterans-serving organizations. Enhanced screening protocols, targeted cessation programs, and culturally competent education are necessary to mitigate the health toll of tobacco. Such coordinated frameworks must concurrently address the broad spectrum of product types utilized and the demographic complexities revealed by the research.
In sum, this landmark study not only delineates the persistent and multifaceted prevalence of tobacco use among military Veterans but also offers a roadmap for addressing this enduring public health challenge. By illuminating the specific tobacco product preferences and risk profiles within Veteran subpopulations, the research empowers stakeholders to enact strategic, Veteran-centric interventions that prioritize early and frequent engagement for tobacco cessation. As the public health community seeks to reduce tobacco-related morbidity and mortality within this vulnerable group, these insights mark a pivotal step forward.
Subject of Research: People
Article Title: Tobacco Product Use and Type by Military Veteran Status: Findings from the National Health Interview Survey, 2021–2023
News Publication Date: October 2, 2025
Web References:
- Journal article DOI: 10.1093/ntr/ntaf142
- Boston University School of Public Health: https://www.bu.edu/sph/profile/jennifer-ross/
- Veterans Health Administration tobacco screening guidelines: https://www.va.gov/vdl/documents/Clinical/CPRS-Clinical_Reminder_Updates/Update_2_0_440_IG-508.pdf
References:
Ross, J., Sayko Adams, R., et al. (2025). Tobacco Product Use and Type by Military Veteran Status: Findings from the National Health Interview Survey, 2021–2023. Nicotine & Tobacco Research. https://doi.org/10.1093/ntr/ntaf142
Keywords: tobacco use, military Veterans, combustible tobacco, e-cigarettes, cigars, tobacco cessation, Veterans Health Administration, public health, nicotine addiction, poly-tobacco use, smoking cessation, Veteran healthcare disparities
