The World Health Organization (WHO) has designated May 31, 2017 as World No Tobacco Day with the theme: "Tobacco - a threat to development."

Navy Medicine has long been aware that tobacco is a threat that can indirectly impact the readiness and health of service members and their family.

The Navy and Marine Corps Public Health Center states that tobacco usage can directly impact any warfighter with a host of diminishing conditions that include decreased night vision, decreased stamina, decreased lung capacity, decreased wound healing, and decreased dexterity.

There are also a few amplified issues to consider, such as an increased need for hydration and increased chance for injury.

The bottom line is that Sailors and Marines who use tobacco products - with every dip, chew, or butt - get sick more often. That means lost work days and more hospitalization time.

Even the faux replacement product electronic cigarettes (e-cigs) have been banned from Navy ships, submarines and aircraft as a health hazard.

The main reason for the ban is due to explosions and small fires attributed to the devices, from either battery malfunction, overheating or detonation. But there is peril in a puff.

According to Pat Graves, Naval Hospital Bremerton Tobacco Cessation coordinator, approximately 35 percent of those in uniform use tobacco products compared to 17 percent of the civilian population.

Let's do the math.

If twice as many active duty personal are using tobacco than other community members, and one in five deaths annually equates to approximately 1,300 deaths every day, then how many of those fatalities are shipmates?

Answer: Any loss is always one too many...

Compiled evidence by the Centers for Disease Control and Prevention shows that cigarette smoking is responsible for more than 480,000 deaths per year in the United States, along with an estimated 41,000 deaths resulting from secondhand smoke exposure.

How can a product with so many negative undertones hold such a sway over so many?

"It's because the nicotine in tobacco is highly addictive. It's up there in the big leagues with addictive substances like heroin, methamphetamines, and cocaine," said Graves.

Graves has heard the justifications, reasons, and explanations as to why a person picked up the habit, and continued using.

"Most often it's peer pressure. A circle of friends with several smokers or being raised in a family with parents that smoke makes a person six-times more likely to be a smoker than not. The second top reason is that it's an 'escape.' It's a 'break' from the daily grind," Graves said.

NHB's Tobacco Cessation program - the longest running and most successful in the Navy - has been clinically run by Substance Abuse Rehabilitation Program counselors since 1998 when it was recognized that nicotine dependence was similar to alcohol or any other substance and it needed to be treated as such.

Graves is one of the counselors whose main focus is to help others. He knows that there are those who might need assistance, but also might be resistant to change.

"We let people be people and make their own choices. Tobacco is legal and available, and as long as people are smoking in spaces designated for it, I have no objection. All people are free to make choices, but they are not exempt from the consequences of their choices," stated Graves.

Like many addictive substances, there is a siren song with tobacco products that attracts new users, keeps older ones around, and lures others back.

"It's because of the addiction. Using is the norm. It's too hard to try to quit," explained Graves.

Along with possible peer pressure and family influence, another manipulative method used to sway a person in using a tobacco product comes from daily doses of subliminal advertising.

"Marketing plays quite a bit in the psychological aspect of using tobacco. It's the attraction of the 'forbidden fruit.' Marketing is always playing on glamorization of tobacco as something it isn't," Graves said.

Graves notes that e-cigs are only a 12-year invention and didn't widely become available in the U.S. until around 2008.

"The popularity of e-cigs are extraordinary high, and greatest among the youngest populations. Sailors also smoke e-cigs about twice as much as civilians. The novelty, collectability, and 'tech' gadget aspect makes them very attractive, along with the main 'selling point' that e-cigs are less harmful than tobacco," said Graves.

As with any tobacco product, says Graves, there are hurdles in getting anyone to recognize any potential health threat with using some sort of e-cig device.

"Most people, even little kids in pre-school, recognize that tobacco is bad. Ironically, little ones are most prone to poisoning from e-cigarette exposure by ingesting e-cig liquid or 'juice' because most e-cig containers are not childproof," Graves said.

The University of California San Francisco Center for Tobacco Control and Research has been able to identify nine carcinogens - cancer causing chemicals - in most e-cig solutions tested. Although Graves admits that by comparison to tobacco's almost 70 known carcinogens, that 'only' nine is substantially less, but it's still nine which are toxic substances being consumed on a daily basis.

"Much of the e-cig liquid is marketed and sold as 'harmless water vapor,' which is 100 percent false. It's true that most of it is benign. But it's not vapor and it's not water. Most of it is high density particle that is produced using ethelyne glycol, which is a solution used to make 'false smoke' for haunted houses and theatrical performances. The stuff was never intended to be directly inhaled into lungs," added Graves.

Can e-cigs cause cancer?

The common consensus is that the product has not been around long enough to prove a causal link.

However, Harvard School of Public Health researchers have found that there has been a link to the connection in some e-cig users with what is called, 'popcorn lung,' or Bronchiolitis Obliterans, from the chemical Diacetyl, which is found in more than 75 percent of e-cig flavors.

The slang name is derived from a study of workers at a microwave popcorn plant that were exposed to and inhaled the artificial butter flavoring found in most commercially available microwave popcorn.

There is also growing evidence that pulmonary toxicity levels are being directly influenced by flavorings in e-cigarettes.

"Amazingly enough, different flavors have been attributed to toxic effects in the body. Roswell Park Cancer Institute researchers discovered that menthol, coffee and the most popular e-cig juice flavor, strawberry, all showed significant impact on overall cytotoxicity. That fact has helped some people switch to a different flavor and has discouraged continued use by others," Graves said.

Those interested in quitting tobacco, but don't know where to start, can contact NHB's Tobacco Cessation at (360)475-4818.

"Our program will get you started with one of the many ways available," stated Graves.



For more information, visit www.navy.mil, www.facebook.com/usnavy, or www.twitter.com/usnavy.

For more news from Naval Hospital Bremerton, visit www.navy.mil/.