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Reducing tobacco and nicotine use key to ‘having a healthy, fit force’

Image of Military personnel breaking a cigarette in half. Take the first step toward a healthier, more resilient you and invest in the long-term health and readiness of our armed forces family. The Military Health System has long offered multiple tobacco cessation programs, which are now even more important for readiness, through a comprehensive approach involving medical, behavioral, and cultural interventions, says Department of War Principal Deputy Assistant Secretary of War for Health Affairs Dr. Stephen Ferrara.

4/1/2026 By: Janet Aker, MHS Communications

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Tobacco use remains the No.1 preventable cause of death in the U.S., according to the Centers for Disease Control and Prevention, and poses a readiness issue for the military.

The Military Health System is concerned that about one-third of service members still use tobacco and nicotine products — a rate higher than the general population (19%), said Department of War Principal Deputy Assistant Secretary of War for Health Affairs Dr. Stephen Ferrara, citing statistics from department-wide health behavior surveys.

Ferrara spoke on this topic at the National Press Club on the dangers of tobacco use in the military and how the MHS is addressing the issue at an event in March 2026 titled, “Serving Those Who Serve, Embracing Tobacco Harm Reduction.”

Acutely aware of the impacts on readiness, the MHS has long focused on reducing tobacco and nicotine use through a comprehensive approach involving medical, behavioral, and cultural interventions, said Ferrara.

In 2026, that commitment is deeper than ever with the DOW’s deeper emphasis on a healthy force.

“Prevention is in our DNA,” he said. “The way we succeed on the battlefield, of which we're in active operations as we speak, is by having a healthy, fit force.”

As a vascular and interventional radiologist with multiple tours of duty in the U.S. Navy for 25 years, Ferrara is keenly aware that tobacco and nicotine dependence have long been embedded “in the culture” of the military, which offered behavioral off-ramps to smoke.

Ferrara said, “old myths” that tobacco “increases your alertness” have been debunked. “We know now it actually leads to slower wound healing, slower injury healing … especially the cardiovascular” system,” he said.

Stressors associated with military service and cultural dependencies mean “people use different things, whether it's food, whether it's cigarettes, whether it's other habits … as a crutch or as an aid to help them deal with that stress that we asked them to endure.”

The MHS emphasizes a comprehensive approach to help people quit, which includes prevention methods, stop-smoking aids, and behavioral therapies.

Stepping down from tobacco

The MHS provides intermediate, less harmful steps to help service members and veterans put combustible cigarettes down. “We're looking at nicotine replacement or other things that will satisfy or try to give people a bridge so they cannot get the most toxic tobacco experience as a way to eventually get to full cessation,” said Ferrara.

Mitigating “the most harmful behaviors and with a path” away from nicotine and tobacco dependence requires team support, he said. “That's where partnerships come in with the medical community … your friends or your family or your command structure to continue to work that journey from the most harmful behavior to ideally, to not a harmful

Ferrara said the first line of defense against tobacco can be providers, who raise the issue during the annual Periodic Health Assessment or other medical visits. The PHA specifically asks about tobacco or nicotine product use.

“If the answer is yes, we start to talk about how we can do cessation,” Ferrara explained. The MHS has abundant “pharmacologic, mental health therapies, all those things to help people, including other adjunctive therapies, to try to get people to get away from cigarettes.”

MHS works ‘hand in glove’ with the Department of Veterans Affairs

One important effort was the publication in January 2026 of the DOW and the Department of Veterans Affairs joint clinical practice guideline called “Tobacco Use Treatment.”

The CPG describes the critical decision points in tobacco use treatment and presents comprehensive evidence-based recommendations for providers and patients to reduce and then stop the use of tobacco and nicotine. Ferrara emphasized the CPG demonstrates both departments’ commitment to tobacco cessation and continuity in care in transition and afterward.

“Because every veteran was once in uniform, the continuity of care must be instantaneous,” he emphasized. “We'll get you taken care of, and then we need to pass the baton to the VA, and that's why we have that joint clinical practice guideline,” Ferrara explained. “You can see that we are hand in glove with that, and that's as it should be for the folks who serve their country.”

Behavior changes and telehealth

Ferrara highlighted how the military has “really leaned into technology,” including telehealth or virtual appointments for tobacco and nicotine cessation. These tools “support meeting service members where they are in their tobacco-reduction journey, and wherever they are stationed or deployed worldwide,” he said. “It's an exciting time to be in medicine with what's going on in AI (artificial intelligence) and we're being able to leverage those things, not only for diagnostics but also for therapeutics.”

Because most service members are young, “there's a huge appetite for” AI and telehealth, he said. “Most of our service members … grew up very comfortable with technology, and some of them actually prefer a virtual encounter to face-to-face” meetings with a provider.”

He reinforced, “You have to meet people where they are, and I think that's … really a person-centered approach.”

Goal is a healthier, more ready fighting force

“Reducing tobacco and nicotine use improves health, fitness, recovery, and long-term resilience — all of which directly affect the warfighter’s ability to fight and win,” Ferrara said.

“Through continued research, strong partnerships, and sustained leadership commitment, the department is taking concrete steps to drive down tobacco use and protect the health of the men and women who serve,” he stated. “This is about readiness today, and it is also about ensuring that those who serve our nation can enjoy healthier lives long after they retire their uniforms.”

Ferrara noted that he’s already seen a shift in tobacco use. He said over the 35 years that he has been associated with the military, usage and culture have changed, resulting in fewer people smoking.

“If I had the magic wand, I think we would have a culture where we model the behavior that we never get folks started. But until then, we are going to do everything from all the things we talked about and more to mitigate that risk and continue our tobacco harm-reduction techniques.”

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