Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations)

Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations)  

 

 

Smoking Cessation in Young Adults (Military Populations) through Health Promotion Intervention

 

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Smoking Cessation in Young Adults (Military Populations)

Introduction

Cigarette smoking is one of the leading non-healthy behaviors among youths in the United States, particularly young adults (aged 18 to 25) in the military (American Lung Association, 2025). Young adults report higher levels of smoking compared to U.S adults (7.6% and 3.2%, respectively). Within the U.S military, particularly the air force, about 5.9% of the Airmen trainees, regardless of their sex, use cigarettes (Little et al., 2021a). The Centers for Disease Control and Prevention (CDC) reports that military service members smoke at significantly higher rates than civilians, with most beginning the habit in basic training or early service (CDC, 2019). Research has also established that the high rates of smoking in the military are associated with the history of tobacco advertising within the bases, availability of cheap products in the camps, and normalization of smoking (Little et al., 2021a). The consequences of smoking are serious because continued tobacco use impairs lung function, impedes recovery after strenuous military activity, and increases risks of cardiovascular disease, lung cancer, and other related chronic health conditions. Other costs associated with this unhealthy behavior include decreased combat readiness due to reduced physical and cognitive performance, as well as high healthcare costs, which are a burden to the U.S. Department of Defense and the Veterans Affairs system (Nieh et al., 2021; Patrick et al., 2024). Considering that cigarette smoking disproportionately impacts military service members, a targeted health promotion intervention is required urgently to reduce its impact.

Health Promotion Intervention and Outcome

The proposed health promotion intervention is an educational program that will help improve awareness about the dangers of cigarette smoking, teach coping skills for stress, and encourage positive behavior change among the young adult military population. If delivered in small group sessions during military training or early service, the program will provide tailored health promotion information that links smoking cessation with improved military readiness, cost savings, and long-term health. The primary health goal is to reduce smoking initiation and increase cessation rates among young service members by approximately 20% within six months of implementing the educational intervention. The outcome is measurable using self-reported smoking surveys, as it is realistic, tailored to the military training context, and directly related to improving the health of the target population (young adults in military service) and enhancing military effectiveness.

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Brief Evidence Review

Evidence suggests that smoking cessation interventions that integrate education, skill-building, and social accountability, and are delivered in supportive environments, are most effective for young adults (Little et al., 2021b; Patrick et al., 2024; Villanti et al., 2020). Studies on interventions for reducing smoking among military and civilian young adults have shown that interactive and group-based educational programs that engage the participants in discussions, allow peer support, and individualized goal settings are more effective than individual therapy (Little et al., 2021b; Villanti et al., 2020). These approaches work as they respond to the knowledge gap by teaching the young adults the health risks and costs of smoking and giving them skills to avoid negative peer influence and sustain behavior in a social setting that encourages tobacco use. Research also demonstrates that interventions offered in structured settings, such as military clinics or basic training, are effective because they align with the routines of young military service members and help encourage participation (Little et al., 2021; Patrick et al., 2024). Linking health promotion with the institutional procedures and programs fosters feasibility and effectiveness. Finally, research highlights the need to tailor smoking cessation interventions to the needs of diverse military personnel, such as those from racial minorities and low socioeconomic backgrounds (Patrick et al., 2024; Villanti et al., 2020). This calls for educational interventions that take into account the diversity within the military population.

Best Practice Alignment

The recommended educational health promotion for smoking cessation among young adults in the military service is supported by a few national health guidelines. The U.S. Preventive Services Task Force (USPSTF, 2021) assigns a Grade A rating to smoking cessation programs that incorporate behavioral counseling. USPSTF recommends behavior counseling in individual or group contexts that comprise health education and skill building for non-pregnant adults, including young adults. The recommendation highlights the importance of providing structured education, follow-up, and opportunities to prevent relapse. The CDC (2019) also insists on tailored interventions for the military population. The proposed health promotion intervention aligns with these recommendations by providing group-based education sessions with follow-up and culturally-relevant content linked to military discipline and readiness.

Developing Health Promotion Intervention

Patient Education Script

Provider: Hi, my name is [Name], and I am the nurse practitioner working with you today. In this session, I would like to talk with you about something that affects the majority of military service members and veterans, and that is cigarette smoking. I understand you may have adopted smoking due to the stress of military life, but it can have adverse effects on your health and performance. My goal is to help you make practical changes that will lead to improved health and increased strength. Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations)

Provider: Did you know that service members and veterans smoke more than the general U.S. population? (CDC, 2019). Many young adults in the military service report smoking during basic training or early service (Little et al., 2021a). Smoking affects almost every organ of your body. As such, cigarette smoking increases your risk of cancer, lung disease, and heart disease (Patrick et al., 2024). It can also decrease your recovery after training or exercise. However, here is the good news: quitting even gradually can improve your energy, breathing, and long-term health, as well as your overall well-being (Villanti et al., 2020).

Provider: The first step to quitting smoking is setting goals. Let us set a goal to cut back the number of cigarettes you smoke every day. For example, if you do around 12, let us aim only to do eight this week. Over the next month, we will work together to reduce our impact even further. But what do you do with the cravings? Studies have indicated that group support and replacing nicotine products like cigarettes with alternatives such as gum or patches enable military members to quit tobacco gradually (Little et al., 2021b).

Provider: You may be wondering how you will track this new routine. I got you! To help you keep track, I would like you to self-monitor. This involves writing down each cigarette you smoke in a small notebook or journal. Alternatively, you can use a phone app to track tobacco use. At the end of the week, we will review the log together to see your progress. Lastly, remember to be your peer’s keeper, as the goal is to reduce smoking in the military, so encourage others to meet their goals.

Provider: We can also set up text-message reminders in your preferred language. For instance, we may send you messages, like “Remember your goal today; choose gum or water instead of a cigarette.” These reminders can help keep you on track even during those stressful days.

Provider: Just a brief recap. We talked about how smoking harms health and performance, and how quitting step by step can help. Your first goal is to decrease the number of cigarettes you smoke in a day. To stay on track, write down your progress in a notebook or use a smartphone app, and then we will review it together in the next session. I will also follow up by sending you supportive text messages throughout the week. What do you think about the session? Is quitting possible? Do you have any concerns? We can discuss them before we close this session.

Accountability Planning

Tracking and Monitoring

  • Patients can use a paper log or a calendar in their living areas, a simple smoking cessation mobile app available in English and Spanish, or receive weekly text message follow-ups.
  • Patient will record behavior by writing down the number of cigarettes smoked every day and the times of the day when they experience intense cravings (such as morning or when under stress)
  • The patient will also monitor the number of hours they stay without smoking a cigarette each day to recognize progress and promote healthy choices.
  • Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations)

Goal Setting

  • The plan focuses on a gradual reduction in smoking behavior with realistic and step-by-step goals. In the first two weeks, the patient is expected to reduce smoking by four cigarettes, and by the end of six weeks, the daily smoking will have dropped by half. At the same time, the patient will use nicotine replacement, such as gum or patches, to manage cravings. In three to six months, the patient will aim to be tobacco-free or ensure they do not smoke more than a cigarette a week while continuing to apply quit-support services.

Motivation and Support

  • Patients are encouraged to celebrate small progress through praise, verbal recognition, and engaging in other fun activities, such as a hike.
  • Support strategies by the healthcare team include weekly text-message reminders with motivational messages, such as “Are you ready for today? Remember your goal,” and “A walk break is way healthier and fun than a smoke break.”
  • The nurse practitioner will also conduct follow-up sessions and make phone calls to address any challenges that may arise.
  • Patients will also be encouraged to get an accountability peer in the military service who will continually encourage them, help track daily goals, and promote healthy activities to replace cigarette smoking.

Roles and Responsibilities

  • Provider responsibilities: Clearly state how the patient will log daily smoking behavior, review logs during follow-up sessions or through phone or text-based check-ins, provide culturally tailored suggestions (such as stress-management techniques that suit the military culture), and adjust goals if challenges arise.
  • Patient responsibilities: Track daily cigarette smoking using a preferred method (either a notebook or a phone app), engage in weekly check-ins and monthly follow-ups, and share honest logs, including challenges such as cravings during work, stress, and peer influence. Patient should also celebrate their progress and engage the support of accountability friends or family to sustain motivation to quit smoking.

Integrating Social Determinants of Health (SDOH)

Social determinants of health (SDOH) affect smoking behaviors and cessation outcomes among young adults in the military. Three main SDOH influencing this population’s health are work schedules, housing instability, and financial challenges. Having irregular and stressful duty hours usually promotes smoking behavior and reduces time for cessation counseling or participation in group-based interventions. Hence, young adults in early service may require flexible education strategies delivered during routine health visits (Little et al., 2021b). Housing instability, particularly for recently admitted military persons, can increase stress and dependence on tobacco as a coping strategy; thus, it is essential to include supportive resources in the smoking cessation planning (Nieh et al., 2021). Income problems may hinder access to nicotine replacement therapy (NRT) or mobile apps. Hence, providers should consider low-cost options to ensure equity (Patrick et al., 2024). To manage the identified barriers, accountability has options, such as paper logs, phone check-ins for those with limited digital access, and support resources, to ensure optimal patient engagement while reducing structural challenges that could adversely affect cessation outcomes.

Conclusion

This smoking cessation intervention for military young adults incorporates individualized education, accountability processes, and social determinants of health modifications to manage one of the most persistent public health challenges in this population. By offering convenient and accessible counseling, incorporating inexpensive cessation aids, and modifying tracking processes to accommodate varied living and working conditions, the design directly confronts barriers to tobacco cessation. The intervention emphasizes both provider support and personal responsibility, offering a structured yet flexible system for behavior change Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations) .

The expected outcomes include changes in knowledge of the health risks associated with tobacco, understanding of effective quitting strategies, and increased confidence in quitting over time. In the short term, this may lead to reduced smoking, improved respiratory health, and increased readiness to meet military performance standards. Long-term results include a reduced risk of chronic disease, lower healthcare costs within the Military Health System, and an improved quality of life following service (Villanti et al., 2020; Patrick et al., 2024). In addition to individual health, the intervention promotes public health equity by removing structural determinants of health that have a disproportionate impact on service members. Its broader significance is in guiding tobacco control interventions within military populations and providing direction for future research and policy efforts to reduce smoking-related disparities.

 

Acknowledgement

The author utilized artificial intelligence, specifically Grammarly Pro, in editing and refining the paper to ensure it was free from spelling errors and other grammatical structure rules. The paper was uploaded to the application, where the author reviewed the work and edited suggested areas. As such, the author takes full responsibility for the accuracy and integrity of this write-up.

References

American Lung Association. (2025, January 27). Top 10 Populations Disproportionately Affected by Cigarette Smoking and Tobacco Use | State of Tobacco Control | American Lung Association. Www.lung.org. https://www.lung.org/research/sotc/by-the-numbers/top-10-populations-affected

Centers for Disease Control and Prevention (CDC). (2019, October 28). Military Service Members and Veterans. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/campaign/tips/groups/military.html

Gaddey, H. L., Dakkak, M., & Jackson, N. M. (2022). Smoking Cessation Interventions. American Family Physician, 106(5), 513–522. https://www.aafp.org/pubs/afp/issues/2022/1100/smoking-cessation-interventions.html

Little, M. A., Fahey, M. C., Wang, X.-Q., Talcott, G. W., McMurry, T., & Klesges, R. C. (2021a). Trends in tobacco use among young adults presenting for military service in the United States Air Force between 2013 and 2018. Substance Use & Misuse, 56(3), 370–376. https://doi.org/10.1080/10826084.2020.1868517

Little, M., Wang, X.-Q., Fahey, M., Wiseman, K., Pebley, K., Klesges, R., & Talcott, G. (2021b). Efficacy of a group-based brief tobacco intervention among young adults aged 18–20 years in the U.S. Air Force. Tobacco Induced Diseases, 19(December), 1–11. https://doi.org/10.18332/tid/143282

Nieh, C., Mancuso, J. D., Powell, T. M., Welsh, M. M., Gackstetter, G. D., & Hooper, T. I. (2021). Cigarette smoking patterns among U.S. military service members before and after separation from the military. PLOS ONE, 16(10), e0257539. https://doi.org/10.1371/journal.pone.0257539

Patrick, S., Boyle, C., LaMorte, D., & Dore, M. (2024). Tobacco use prevalence in the military health system: A retrospective study. Military Medicine, 189(11-12), e2632–e2637. https://doi.org/10.1093/milmed/usae208

U.S. Preventive Services Task Force (USPSTF). (2021). Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Persons: Recommendation Statement. American Family Physician, 103(12), online–online. https://www.aafp.org/pubs/afp/issues/2021/0615/od1.html

Villanti, A., West, J., Klemperer, E., Graham, A., Mays, D., Mermelstein, R., & Higgins, S. (2020). Smoking-cessation interventions for U.S. young adults: Updated systematic review. American Journal of Preventive Medicine, 59(1), 123–136. https://doi.org/10.1016/j.amepre.2020.01.021  Developing Health Promotion Interventions for Patient Populations Paper – Smoking Cessation in Young Adults (Military Populations)