Death at a discount: how the tobacco industry thwarted tobacco control policies in US military commissaries

Background: The US military is perhaps the only retailer consistently losing money on tobacco. Military stores ( commissaries and exchanges) have long sold discount- priced cigarettes, while the Department of Defense ( DoD) pays directly for tobacco- related healthcare costs of many current and former customers. Tobacco use also impairs short- term troop readiness. Objective: To examine the long struggle to raise commissary tobacco prices and the tobacco industry's role in this policy effort. Methods: Analysis of internal tobacco industry documents, searches of government and military websites and newspaper databases, and interviews with key informants identified in the documents. Results: Efforts to raise commissary tobacco prices began in the mid- 1980s. Opposition quickly emerged. Some military officials viewed tobacco use as a right'' and low prices as a benefit''. Others raised issues of authority, and some saw the change as threatening the stores. The tobacco industry successfully exploited complex relationships among the Congress, the DoD, commissaries, exchanges and private industry, obstructing change for over a decade. Leadership from the Secretary and Assistant Secretaries of Defense, presidential support and procedural manoeuvring finally resulted in a modest price increase in 1996, but even then, high- level military officials were apparently threatened with retaliation from pro- tobacco Congressmen. Conclusions: The longstanding military tradition of cheap cigarettes persists because of the politics of the military sales system, the perception within the military of tobacco use as a right, and tobacco industry pressures. Against its own best interests, the US military still makes tobacco available to service members at prices below those in the civilian sector.