“The Defense Department is committed to helping service members and their families live a healthy lifestyle,” Defense Department spokeswoman Joy Crabaugh said. “Tobacco free living is one aspect.”

Crabaugh said she could not directly address any of the findings of Haddock’s study, but added, “The military offers tobacco cessation programs and has policies designed to discourage the use of tobacco.”

The military has a social marketing program called “Quit Tobacco, Make Everyone Proud.” It offers personnel free smoking cessation medications and a 24/7 telephone hotline for counseling.

Despite his study’s findings, Haddock said the military’s tobacco control initiatives are sincere it has a vested interest in keeping soldiers from smoking.

Numerous studies have found that smoking reduces combat readiness, Haddock said. Smokers are less physically fit, have poorer night vision, are less mentally sharp and heal more slowly from wounds. Tobacco related medical care and lost productivity cost the military about $1.6 billion annually.

“I think there are enough people at high ranks who want to see (smoking) conquered,” Haddock said.

But Haddock, who served in the Air Force, said the military will be fighting against an ingrained culture of smoking in its ranks.

About 32 percent of active duty military smoke, compared to about 20 percent of the civilian adult population. Nearly 45 percent of service members deployed to Iraq and Afghanistan have been smokers.

Haddock’s own focus group research found many reasons why soldiers were attracted to smoking.

“Smoking breaks are one of the few reasons to take a break in the military,” Haddock said.

The base “smoke pits,” the designated smoking areas on bases, become places where people can gather informally to socialize.

Sarah Stout of Independence found that was the case when she served in the Marines.

“There were a good amount of people who smoked,” she said. “Sometimes we’d go to the smoke pit because someone from another unit was smoking, so we’d go over and talk to him.”

Stout, who was stationed in Iraq in 2008 and 2009, is participating in a smoking cessation program offered by the Kansas City VA Medical Center. She wants to be smoke free for her two young children.

But even more important than the camaraderie and breaks from routine as reasons to continue smoking, Haddock found, were the convenience and low prices of cigarettes at base exchanges.

“Pricing and convenience are always at the top of the list,” he said.

The Defense Department rule on pricing tobacco is vague enough to offer managers of the approximately 200 exchanges nationwide a lot of “wiggle room,” Haddock said.

“You can virtually set prices the way you want to,” he said.

Haddock’s study follows up his research from 2011 that found an even larger 24.5 percent price gap between the exchanges and their neighborhood Wal Marts. Most military exchanges did raise their prices somewhat in the past two years, likely a reaction to higher wholesale costs, Haddock said. But the gap was narrowed mostly by steep price cuts by Wal Mart stores.

There were still some drastic differences between military and civilian prices. The exchange at the West Point Military Academy was selling Marlboros for $5.80 per pack last year, less than half what the nearest Wal Mart was charging. The Rock Island Arsenal in Illinois charged $4.80 per pack, while the Wal Mart charged $8.29.

The Wal Mart prices Haddock’s study quoted include state and local taxes that aren’t charged at military exchanges.

Haddock found 17 exchanges had actually lowered their prices from 2011 to 2013. The exchange at Fort Leonard Wood, about 85 miles south of Jefferson City, shaved 20 cents off a pack, bringing it to $4.40. Meanwhile, the local Wal Mart cut its price from $5.22 to $4.86.

“My guess, it was a marketing decision. The policy of an exchange isn’t necessarily consistent with the Department of Defense policy to have a ready, fit fighting force,” Haddock said. “I would be very surprised if the commander or anyone in the medical corps at Fort Leonard Wood knew about it.”

Exchanges aren’t likely to stop selling tobacco or even change their pricing voluntarily because the profits they generate are essential to a host of community programs military bases offer to personnel and their families, said Larry Williams, a dentist and tobacco researcher who worked with Haddock on the cigarette pricing study.

Exchange profits fund military Morale, Welfare and Recreation (MWR) programs, such as fitness centers, libraries, social events and golf courses.

“Their hands are tied. They know they have to be cheaper than the prices outside. Not only do they use the profits, but the soldiers, sailors and Marines and their families will be suffering without them,” Williams said. “We need the (MWR) money coming from a nontainted source.”

The military also faces the political power of the tobacco industry, said Ruth Malone, a tobacco control researcher at the University of California, San Francisco.

“This is one of their last big recruiting grounds. They really want to keep the military market,” Malone said. “They frame it as ‘Are you going to take this away from our fighting boys?’ rather than ‘Are you going to take away our profits?’ “

Malone and Haddock both think the military will eventually go smoke free as much of the rest of society has.

“The issue for the military is how are they going to achieve an end game for tobacco, not will they,” Malone said.

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