By Gary Reckart – Bowling Green
Our nation has made noteworthy progress in reducing smoking rates. Most public health and prevention efforts have rightly focused on youth and young adults with the understanding that preventing initiation early protects long-term health and reduces future disease. Yet tobacco use among veterans has remained stubbornly higher than in the general population. As a result, veterans continue to bear a disproportionate share of tobacco-related harm.
As a U.S. military veteran, I believe service members and veterans currently smoking here in the Bluegrass State deserve equal attention. We need to do more for both active-duty service members and Kentucky’s roughly 230,000 veterans who still carry this heavier burden.
Tobacco use has long been elevated within the military community, shaped by deployment stress, unit culture, coping with injury or pain, and the difficult transition from active duty to civilian life. During my service, I watched many begin smoking in military settings such as training or during deployment, often in environments where tobacco use was normalized or even encouraged as a coping tool or social ritual. Others started later as a way to manage stress, sleep disruption, or the physical and psychological strain of military life. I have also seen how many have tried repeatedly to quit — sometimes with partial success — only to be interrupted by the demands of service or the challenges of reintegration.
The data makes the disparity clear. National health surveys, including CDC-supported data from the National Health Interview Survey, continue to show that smoking remains common among both middle-aged adults and older veterans, even as overall rates decline. Even after years of a decline in cigarette smoking among U.S. adults, VA healthcare enrollees still smoke at a higher rate. The gap is larger when looking at all veterans, not just those enrolled in VA healthcare. Even within the VA system, where cessation resources are widely available, roughly 10 percent of enrollees still smoke. While this represents real progress from higher rates a few years ago, the gap with the civilian population persists.
Many among the Veteran population want to quit but struggle with chronic co-occurring conditions such as trauma-related stress, chronic pain, and other mental health disorders. These conditions combined with inconsistent and disparate access to tailored support provide additional barriers to ensuring successful cessation. Studies show that integrating cessation treatment into mental health care, using tailored proactive outreach rather than waiting for self-referral, and adapting programs to address military culture and trauma triggers produce better engagement and abstinence rates than conventional civilian-style programs alone.
A key focus of this conversation is tobacco harm reduction. Cigarettes are uniquely dangerous because combustion produces thousands of toxic chemicals linked to cancer, COPD, and heart disease. Smoke-free nicotine alternatives eliminate combustion and significantly reduce exposure to many of those harmful byproducts. For service members or veterans not yet ready to quit nicotine entirely, moving away from traditional cigarettes can still lower risk and support incremental health improvement.
Other barriers also remain. One major obstacle is lingering confusion about nicotine itself. Many people — including some clinicians — incorrectly believe nicotine is the primary cause of smoking-related disease. In reality, the vast majority of the harm comes from cigarette smoke. Surveys of healthcare professionals have documented widespread misunderstanding of nicotine’s role, which can shape how cessation options are discussed and offered.
The encouraging reality is that it is not too late to see meaningful health improvements. Evidence from peer-reviewed research consistently shows that stopping smoking, even after decades of use, is associated with reduced risk of cardiovascular disease, cancer and premature death, along with improved overall quality of life. A 2024 analysis in the American Journal of Preventive Medicine found that quitting later in adulthood can still meaningfully prolong and improve lives. For military service members and veterans, these gains are practical: better physical endurance, improved respiratory function, fewer complications from chronic conditions, and stronger recovery after injury or surgery. Research across veteran health systems also shows that with appropriate, evidence-based support, cessation success rates can match those in civilian populations.
Through my work with veterans, I have talked with many who want to quit but struggle to find support that meets them where they are. For this population, cessation strategies work best when they account for real-world conditions: managing triggers tied to stress or trauma, building routines that replace smoking cues, and strengthening social support through peer networks or veteran groups.
Yes, change is possible, even after long-term tobacco use. What makes the difference is not motivation alone, but ensuring access to practical, evidence-based support that fits the realities of military service and life after it. Ensuring veterans know that effective cessation strategies exist — and that it is never too late — is one concrete step we can take now to reduce the burden of cigarette smoking for my fellow service members once and for all.
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Gary Reckart, of Bowling Green, is a U.S. Air Force veteran who has dedicated his career to advancing healthcare quality and community leadership.
