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Correlates of e-cigarette use among active duty US military personnel: implications for cessation policy
  1. Sarah Godby1,
  2. R Dierst-Davies1,
  3. D Kogut1,
  4. L Degiorgi Winslow1,
  5. M M Truslow1,
  6. J Tuttle1,
  7. P Koeppl1,
  8. K Marshall-Aiyelawo2 and
  9. K Elenberg3
  1. 1 Deloitte Consulting LLP, Arlington, Virginia, USA
  2. 2 Analytics and Evaluation Division (J-5), Defense Health Agency, Falls Church, Virginia, USA
  3. 3 Office of the Under Secretary for Personnel and Readiness, US Department of Defense, Washington, DC, USA
  1. Correspondence to Dr R Dierst-Davies, Deloitte Consulting LLP Alexandria, Alexandria 22209, Virginia, USA; rdierstdavies{at}


Background Electronic cigarette (or e-cigarette) use has grown substantially since its US market introduction in 2007. Although marketed as a safer alternative to traditional cigarettes, studies have shown they can also be a gateway to their use. The purpose of this investigation is to identify factors associated with different patterns of tobacco use among active duty military personnel.

Methods A secondary analysis was conducted using the 2014 Defense Health Agency Health Related Behaviors survey data. Results are based on 45 986 US military respondents, weighted to 1 251 606. Both univariate and regression analyses were conducted to identify correlates.

Results In 2014, approximately 7.8% of respondents reported using e-cigarettes at least once in the past year. Among e-cigarette users, 49% reported exclusive e-cigarette use. Prevalence of exclusive use is highest among white people (58%), Navy (33%), men (83%) and persons with income ≤$45 000 (65%). Regression comparing exclusive cigarette with exclusive e-cigarette users revealed higher odds of being Air Force (OR=2.19; CI 1.18 to 4.06) or Navy (OR=2.25; CI 1.14 to 4.41) personnel and being male (OR=1.72; CI 1.12 to 2.64), and more likely to not receive smoking cessation messaging from healthcare providers in the last 12 months (OR=2.88; CI 1.80 to 4.62). When comparing exclusive e-cigarette users with poly-tobacco users, e-cigarette users had higher odds of being Hispanic (OR=2.20; CI 1.02 to 4.78), college educated (OR=4.25; CI 1.22 to 14.84) and not receiving tobacco prevention/cessation messaging (OR=4.80; CI 2.79 to 8.27).

Conclusion The results demonstrate that exclusive e-cigarette users in the military have unique characteristics when compared with groups of other/mixed tobacco users. Findings can inform cessation and prevention efforts to improve both the overall health and combat readiness of active duty military personnel.

  • public health
  • substance misuse
  • health policy

Data availability statement

Data are available upon reasonable request. Data enquiries should be made directly to Dr. Marshall-Aiyelawo (coauthor) at the Defense Health Agency.

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Data availability statement

Data are available upon reasonable request. Data enquiries should be made directly to Dr. Marshall-Aiyelawo (coauthor) at the Defense Health Agency.

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  • Contributors SG, RD-D, PK and KM-A conceived the study and identified the hypotheses. JT and MMT conducted the analysis. RD-D, DK, LDW, MMT and JT wrote the initial draft of the manuscript. SG, RD-D, DK, LDW, PK, KM-A and KE reviewed and refined the manuscript. KM-A and KE gave final approval for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.