Veterans more likely than general population to use all types of tobacco products, including the most harmful

FOR IMMEDIATE RELEASE

Thursday, October 2, 2025

Contact:
Jillian McKoy, jpmckoy@bu.edu

Michael Saunders, msaunder@bu.edu

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Veterans More Likely than General Population to Use All Types of Tobacco Products, Including the Most Harmful

A new study is the first since 2015 to examine differences in tobacco use by product type among military Veterans compared to civilians, finding that Veterans disproportionately use all commercial tobacco product types, including cigars and cigarettes, which pose a range of serious health risks.

For many military members, tobacco use is a normalized activity that continues long after their military service ends, posing a lifelong danger to the health of military Veterans. Despite knowledge that tobacco use has been elevated among Veterans, most research on this subject relies on decade-old data that does not reveal differences in use of individual tobacco products, including newer products on the market.

A new study led by Boston University School of Public Health (BUSPH) researchers fills this gap, showing that Veterans continue to use tobacco and nicotine products at higher rates than the general population.

Published in the journal Nicotine & Tobacco Research, the study reveals new patterns of tobacco use among Veterans compared to civilians: Veterans are more likely to use all commercial tobacco products—including cigarettes, cigars, pipes, e-cigarettes, and smokeless tobacco. Veterans also had a higher risk for former and current tobacco use, as well as any combustible tobacco product use, and multiple product use. Almost 1 in 4 Veterans reported currently using tobacco and 19 percent currently use combustible tobacco products. Veterans are also more likely than civilians to use multiple tobacco products, which increases health risks. The study is the first analysis of tobacco use by Veteran status to consider product type since 2015.

Veterans’ increased risk for use of combustible tobacco products, including cigars and cigarettes, was particularly concerning to the researchers.

“These products are the most harmful tobacco products, and they pose the greatest health risks, including multiple cancers, as well as heart and lung diseases,” says study lead and corresponding author Dr. Jennifer Ross, associate professor of health law, policy & management at BUSPH. “Tobacco smoking among an already vulnerable population will further exacerbate existing health disparities for Veterans.”

While national surveys have not yet incorporated some of the newer tobacco products that have emerged, Dr. Ross says, “we can now begin to see how Veterans are currently using many types of these products, and how these trends may shift over time in response to ongoing changes to the industry and to the tobacco regulatory landscape.”

Current and former military members may use tobacco for many reasons, including to cope with stress, depression, or anxiety, as well as a way to foster social connections as this activity is widely ingrained in military culture. As Veterans remain an historically undertreated population, the researchers hope this updated knowledge of tobacco use patterns helps inform the development of smoking cessation interventions and educational opportunities about the harms of tobacco use to current and former military service members.

For the study, Dr. Ross and colleagues from BUSPH, the Uniformed Services University, and the University of Virginia utilized nationally representative survey data that revealed variations in tobacco use and product type based on military status, age, race, education level, and insurance status among more than 78,000 Veterans and civilians in the US from 2021 to 2023.

Within the Veteran sample, younger Veterans (18-34) had increased risk for specific tobacco products including cigars, e-cigarettes and multiple product use, while older Veterans had higher risk for use of cigarettes. Males were more likely than females to use any tobacco product. Veterans who use the Veterans Health Administration (VHA) for healthcare were more likely to smoke cigarettes and other combustible tobacco products than Veterans who sought care from non-VHA providers.

“We now understand that risk for using specific tobacco products varies by age within the Veteran population,” says study senior author Dr. Rachel Sayko Adams, research associate professor at BUSPH. “This suggests that the newer and younger cohort of post-9/11 Veterans who served in the Afghanistan/Iraq conflicts may be at highest risk for using new and emerging tobacco products, while older Veterans continue to be at highest risk for cigarette use. Targeted Veteran-specific tobacco intervention programs are needed that consider types of tobacco products being used to improve the health of the full population of Veterans.”

In October 2024, after this study period ended, the VHA implemented new requirements for tobacco screenings, as well as brief counseling or treatment for Veterans who use the VHA. The researchers hope their findings will inform continued education campaigns on tobacco and nicotine use, as well as encourage expanded treatment options and prevention programs, both within and outside of the VHA, as more than half of the Veterans are not enrolled in VHA healthcare.

Accurate messaging that conveys the relative harms of tobacco products is also critical to correct or prevent misconceptions about these products. For example, a 2023 study also led by Dr. Ross found that many younger adults believe that cigars are less harmful than cigarettes, even though cigars pose similar health risks and contain higher levels of certain chemicals, such as carbon monoxide. Similarly, e-cigarettes may pose a less-harmful alternative to current and former military who have not been able to quit smoking combustible cigarettes or cigars.

“Taken together, our findings suggest that we should think more strategically about intervening often and early for tobacco and nicotine use within military and Veteran populations,” says Dr. Adams. “We need coordinated efforts between the Department of Defense, Veterans Health Administration, and organizations that serve Veterans to screen and intervene for tobacco use, and to provide Veteran-centric cessation programs to reduce tobacco-related harms for those who served.”

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About Boston University School of Public Health

Founded in 1976, Boston University School of Public Health is one of the top ten ranked schools of public health in the world. It offers master's- and doctoral-level education in public health. The faculty in six departments conduct policy-changing public health research around the world, with the mission of improving the health of populations—especially the disadvantaged, underserved, and vulnerable—locally and globally.