Tobacco Product Use and Type by Military Veteran Status: Findings from the National Health Interview Survey, 2021-2023.

Introduction: Tobacco use is common among United States Veterans; however, most research is a decade old, does not examine the range of tobacco products, nor consider the role of Veteran-specific factors (eg, Veterans Health Administration [VHA] health insurance).

Aims and methods: We examined tobacco use (current, former) by Veteran status using a national sample; and among Veterans, associations between VHA health insurance and VA-connected service disability status and tobacco use. We used annual cross-sectional datasets (2021-2023) from the National Health Interview Survey (n = 78 277). Weighted multivariable multinomial logistic regression models examined the relationship between Veteran status and current and former: (1) tobacco use (ie, cigarettes, cigars, pipes, e-cigarettes, smokeless; any); (2) combustible tobacco use; and (3) polytobacco use, adjusting for sociodemographics, health status, and survey year. We replicated all models within the Veteran sample, adding variables for VHA health insurance status and VA-connected service disability status.

Results: Veterans (7.9% of the sample) had higher odds of all current and former tobacco outcomes, with the highest adjusted odds ratios (aOR) for current use of: cigars (aOR = 1.97), pipes (aOR = 1.70), polytobacco use (aOR = 1.55), and cigarettes (aOR = 1.41), compared to non-Veterans. In Veteran models, those with VHA health insurance had higher odds of current cigarette (aOR = 1.47) and combustible tobacco use (aOR = 1.28).

Conclusions: Veterans were more likely to report current tobacco use compared to non-Veterans, with variation in odds by product type. Veterans who use the VHA for healthcare have increased odds for cigarette and combustible tobacco use. Clinicians working with Veterans should routinely screen for all tobacco products.

Implications: Veterans have historically used tobacco products at higher rates compared to non-Veterans, partially due to the normalization of use within military culture. Existing research is dated and does not examine the association of Veterans status with individual product types, including newer products. These findings highlight new patterns of use, including high prevalence of cigar use, and opportunities to educate Veterans, both within and outside the VHA, about the relative harms of different tobacco products and to implement culturally-informed cessation programs for Veterans.