The Cigarette and the Veteran: What Military Service Does to Smoking—and What the VA Is Doing About It
Military veterans smoke at significantly higher rates than civilians. The VA has one of the most comprehensive smoking cessation programs in the country. It's also struggling. The cigarette and the veteran is a story of institutional culture, trauma, and slow progress.
Veterans smoke at rates significantly higher than the general population—approximately 25%, compared to 12% for civilians. The disparity is driven by multiple factors: the military's historical promotion of smoking, the stress and trauma of service, the high prevalence of comorbid mental health conditions (PTSD, depression) that are associated with smoking. **The VA healthcare system has responded with one of the most comprehensive smoking cessation programs in the country—integrating pharmacotherapy, counseling, and a system-wide commitment to tobacco-free facilities. The program is evidence-based, well-resourced, and struggling. The veteran smoking problem is not solved by having a good program. It's sustained by the conditions that make veterans smoke.**
**The VA's experience is instructive for the broader cessation landscape.** The VA has integrated cessation into routine care—every veteran is screened for tobacco use, and cessation support is offered as a standard component of healthcare. The VA has made pharmacotherapy widely available—NRT and prescription medications are provided at low or no cost. The VA has invested in telehealth and digital tools to reach veterans who can't access in-person care. **And yet smoking rates among veterans remain elevated. The lesson: making cessation support available is necessary but not sufficient. The drivers of smoking—trauma, stress, mental health comorbidity, institutional culture—must also be addressed.**
**💬 If you're a veteran, has your military service affected your relationship with nicotine? Has the VA's cessation support been helpful—and what would make it better?**
