An airman holds a cigarette while in uniform. The Air Force recently released an instruction targeting tobacco use in the service. (Air Force)
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Smoke 'em if you got 'em, but don't do it anywhere near an Air Force hospital or clinic. In fact, don't bother lighting up in an installation parking lot, near a sidewalk or your kid's favorite base playground either.
An updated Air Force Instruction on tobacco use in the service says those places are now off-limits to smokers, tobacco chewers, dippers and sniffers. And don't think you're safe smoking electronic — or e-cigarettes — or any kind of pipe or hookah.
All such devices also will be relegated to designated tobacco-use areas. And that area will be much farther away than it probably has been.
The new AFI, which went into effect March 26, designates all Air Force hospitals and clinics as tobacco-free environments, which means no smoking within 200 feet of a medical facility campus. That campus includes the facility's parking structures and lots, lawns, and any other contiguous outdoor area.
The days of running outside to get your nicotine fix and lighting up before the door closes are gone, too.
Under the new AFI, not only can you not smoke on your way to the designated tobacco area, that area must be at least 50 feet from building entrances and exits, sidewalks and parking lots. These areas also must be at least 100 feet from playgrounds.
Lt. Col. John Oh, chief of health promotion for the Air Force Medical Services Agency, said the changes are all in the name of mission readiness and healthy living. He said it had been about a decade since the last policy update on tobacco use, and in that time there has been a lot of momentum toward cracking down on the use of tobacco and reducing the impact of secondhand smoke.
The ultimate goal is a tobacco-free Air Force, according to the AFI.
Tobacco consumption and the ailments associated with its use drain nearly $2 billion of the Defense Department's $53 billion health care budget each year, Oh said.
For the military, that loss is not just monetary. It saps productivity too.
"Tobacco use is really a mission-readiness issue," Oh said. "It's associated with decreased productivity, increased absenteeism and decreased endurance."
Nearly one-quarter of Air Force personnel smoke, he said. That's higher than the national average of about 20 percent. And more than half of smokers in the Air Force are enlisted men between 18 and 29 years old, according to a an analysis in September by Hellenic Army Capt. Michail Gkoutouloudis, a student at the Air Force Institute of Technology.
Air Force medical facilities have been gradually making the move toward being tobacco-free for the past few years. A quarter of Air Force hospitals already have a policy in place that makes smoking off limits, according to Oh. He said they're following in the footsteps of the more than 3,200 civilian hospitals around the country that have been tobacco-free for years.
"We're really not doing anything that's revolutionary," he said. "This is something that is really the social norm in the civilian medical sector. This really just kind of brings the rest of our [medical treatment facilities] to that standard."
Air Force hospitals and clinics will have an 18-month grace period to implement the new policy, though Oh said that based on the experience of medical facilities that have already made the change, implementation could happen in about six months.
The pace of change at other installation buildings, recreation centers and dorms will be determined by base commanders. People will likely be allowed to continue to use tobacco in the current designated areas until those changes are made, Oh said.
And smokers were never supposed to light up anywhere but designated tobacco use areas on base. That's not new, Oh said. It was in the old AFI that had been in place since 2002.
"Now I can't vouch for how effectively that was enforced at the installation level, but you're really just supposed to use [tobacco products] in the DTAs," he said.
The old AFI required bases to have designated areas, but gave no guidance as to where they should be located. That's where the new AFI steps in with defined distances aimed at protecting nonsmokers, and people with respiratory problems and sensitivities to tobacco, from the impact of secondhand smoke.
The change couldn't come soon enough for some airmen.
One active-duty airman at Osan Air Base, South Korea, who asked to be identified only as Tom, said cigarette butts litter the base and dorms, and the designated smoking areas are too close to the unaccompanied housing.
"In my dorm room, where the window is located is where the designated smoking area is, so when I want to open my windows I have to deal with the secondhand smoke," he said in an email. "I can't just leave my windows closed because it gets hot in my room and the base controls when the A/C is turned on."
Col. Randall S. Gilhart said he thinks the new policy doesn't go far enough. He said all branches of the service need such a policy and their interagency partners should get on board with the crackdown on tobacco use, too. He said he worries that too many junior enlisted members are smokers.
"A chance to get away from duty for a moment, in the end, hastens the likelihood of getting away from life permanently," he said in an email.
‘What a joke'
Some airmen, however, question the wisdom of banishing all tobacco users to one designated area.
Staff Sgt. Adam Miller said he doesn't think the rules should apply to smokeless tobacco users.
"When I read the new regs, this is what I see: ‘We, the USAF, whole heartedly believe in sending you to any war zone of our choosing and ask that you be open to laying down your lives for this country, but we firmly believe that tobacco in any form is too dangerous for you,'" Miller wrote in an email to Air Force Times. "What a joke. Now I have to go to a smoke pit and [be] forced to inhale secondhand smoke if I want to enjoy a snus now and again."
The new AFI applies to more than just cigarette smoking because all tobacco use is dangerous, Oh said.
"Our overall goal in health promotion is we want to make healthy living the easy default choice," he said. "The intent is to try to change the social norms around tobacco use, so that we de-normalize it."
Maj. Jeffrey "Tool" Keim said he realizes tobacco is bad for his health, but the Air Force's decision to crack down on his personal decision to smoke occasionally reeks of a nanny state. He said if the Air Force keeps policing behavior that is not directly tied to mission accomplishment, the service is going to lose airmen.
"Bottom line, the force needs healthy airmen to accomplish the mission, and that is the purpose of the fitness assessment system," he said in an email. "If an airman smokes, but can still pass the [fitness assessment], leave him alone."
Not so fast
But Oh said tobacco use is directly tied to accomplishing the mission because airmen who use tobacco don't perform as well on their fitness assessments.
In fact, a study conducted by an Air Force researcher several years ago found that airmen who smoked ran about 30 seconds slower than airmen who didn't. A 2009 Institute of Medicine study on combating tobacco use in military and veteran populations reached the same conclusion based on data from Army and Navy fitness assessments.
"In some studies, smokers responded less well to physical training, with a smaller increase in endurance over the course of the training program, compared to non-smokers," wrote the researchers.
Tobacco use is often associated with heart disease, respiratory conditions and cancer. It also kills 50,000 people a year with secondhand smoke, and nationwide costs the country about $200 billion in medical costs and lost productivity, Oh said.
"Tobacco use is the No. 1 preventable cause of health care cost," he said. "When you look at the cost effectiveness of various preventative services and various interventions, every study … has shown that … anything we can do to reduce tobacco use will pay for itself with reduced health care costs and reductions in lost productivity."
If you do happen to light up outside a designated area, you're not likely to be wrestled into submission by security forces, Oh said. Installation commanders will have the authority to determine what enforcement measures are appropriate for the base population.
"Our intent is not to be punitive and to turn the installation into a police state," he said. "We don't think the intent of this policy is to chase after every single person that uses tobacco outside the DTA and harass them."
Getting busted smoking outside the designated tobacco area is not what's likely to get you in trouble. But how you respond to being told that you're in violation of the new policy might, Oh said.
"If your approach is one where you are belligerent, where you're unprofessional, I think that behavior would be what would be grounds for disciplinary administrative action," he said, "not so much the use of tobacco outside the DTA."
Oh said the policy and its effectiveness will come down to how commanders choose to enforce it. He stressed that it would need the support of senior leaders if it is to have any impact on reducing the number of airmen who use tobacco products. He said it also will take more than security forces airmen to enforce the new policy. Oh said everyone will have to step up.
"We shouldn't look at it as just being the responsibility of security forces or someone else that has that sort of police type function," he said. "It's really everyone's responsibility."
He said reminding others of the policy works better than dropping the hammer of Uniform Code of Military Justice enforcement.
"Tobacco use is really something that impacts our mission readiness and with our challenges in terms of operations tempo, trying to do more with less, we really need to implement the types of policies that promote mission readiness and the health of our force," he said.
Tech. Sgt. Joseph Keller said he's a smoker and believes it's his constitutional right to light up, but not anywhere he chooses.
"I'm OK with having certain areas designated for smokers," he said in an email. "I have a problem with the leadership attempting to curb what I feel is my right as a citizen of the United States."