The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.
It has been through exemplary people that the United States has forged the finest Submarine Force in the world. Submariners must possess both psychological resiliency and a superior intellect to function in the demanding submarine environment. This elite workforce is maintained through the solid support submariners provide for one another in a demanding environment, combined with excellent services centered on the maintenance of mental and physical health.
The Submarine Force has taken the lead in designing and building the finest engineering systems to protect worker health. Accidental injury, radiation exposure, and airborne contaminant inhalation have been significantly diminished through development and strict enforcement of health policies. The Navy leadership’s strong support of automobile seatbelts, motorcycle helmets, regular exercise, healthy diets, and the responsible use of alcohol have further improved the health of the submarine community. But smoking remains an obstacle to maximizing force health promotion.
On June 27, 2006 the U.S. Surgeon General issued a comprehensive scientific report which concludes that there is no risk-free level of exposure to secondhand smoke. It states that smoke-free workplace policies are the only effective way to eliminate secondhand smoke exposure in the workplace. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposure. Additionally, the report concluded that workplace smoking restrictions lead to less smoking among covered workers.
In this article I will review the complex medical, social, and political threads that have woven our nuclear submarine smoking policy. The nuclear Navy expects its officers and enlisted to do their job with a sense of ownership, responsibility, and attention to detail. The importance of being able to face the facts and to resist the natural human inclination to hope things will work out, despite evidence or doubt to the contrary remains a major tenet for our Submarine Force.2 It is now time to face the problem and make smoking on submarines a thing of the past.
Tobacco Smoke Adversely Affects Human Health and Military Readiness
That tobacco smoke can be harmful is an established fact. Tobacco manufacturers publicly recognize the potential for adverse health effects of secondhand smoke (also known as environmental tobacco smoke): “Public health officials have concluded that secondhand smoke from cigarettes causes disease, including lung and heart disease, in non-smoking adults … in addition, public health officials have concluded that secondhand smoke can exacerbate adult asthma and cause eye, throat and nasal irritation” (from the Philip Morris Co website).
The adverse effect of cigarette smoke on the submarine population is clarified in SECNAVINST 5100.13C: “Tobacco use and Environmental Tobacco Smoke Exposure have an adverse impact upon health and readiness of our forces. Tobacco adversely affects night vision, respiratory capacity, wound healing rates, and contributes to risk of cold injuries, including frostbite. Statistically, smokers have higher accident rates than do nonsmokers”.
The Precautionary Principle is the Standard for Tobacco Policies
When defining new policy it is common practice to develop recommendations based on scientific research. There is enough evidence from thousands of published studies of non-submarine smokers to conclude that both smoking and secondhand smoke cause adverse health effects in our submarine population. The responsibility to take action is based on the precautionary principle. This principle is based on the supposition that to delay action will ultimately prove more costly.
Current U.S. tobacco policy is based on the precautionary principle. Executive Order 13058 protects all federal employees from exposure to tobacco smoke. Designated smoking areas must be enclosed and exhausted directly to the outside and away from air intake ducts, and maintained under negative pressure (with respect to surrounding spaces) sufficient to contain tobacco smoke within the designated area. However, Executive Order 13058 does state that the head of any agency may establish limited and narrow exceptions that are necessary to accomplish agency missions. How smoking would be necessary to accomplish a mission is not clarified.
The Department of Defense Instruction on Smoke-Free DoD facilities (DODI 1010.15) prohibits indoor designated smoking areas unless exempted as per Executive Order 130586. The Navy and Marine Corps tobacco policy (SECNA VINST 5100.13C) is based upon DODI 1010.15, and even goes so far as to state that “Where conflicts arise between the rights of nonsmokers and the rights of smokers, the rights of nonsmokers to a smoke-free airspace shall prevail”.
Smoking policy specific for submarines is deferred to the Nuclear Powered Submarine Atmosphere Control Manual.8 Formulated over a decade ago, it contains a recommendation against smoking in normally unmanned spaces. Among recommended spaces for smoking are the engine room, crew bathrooms, and the torpedo room. Smoking on the mess decks, exclusive of meal times, is also considered appropriate if other spaces are unavailable. Tobacco smoke guidelines for submarines clearly diverge from other Governmental and Military standards.
Smoking Restrictions on Submarines in the Recent Past
In 1988 the National Research Council evaluated submarine air quality, recommending that the Navy eliminate or curtail smoking on submarines. The Submarine Force did take action to limit smoking to specific areas. Some commanding officers followed the more stringent recommendation of the committee by banning smoking on their individual boats. By 1994 a handful of smoke-free nuclear submarines were successfully operating in the Pacific. Despite success at the individual command level, external pressures resulted
in the abandonment of this policy. Subsequently, there has not been a smoke-free boat on either coast for a decade.
Smoking on Current Operational Submarines
Because every compartment is manned continuously, smoking always occurs in work areas with watch standers. It is sometimes difficult to accommodate smokers and non-smokers within the confines of a submarine. The following email, written by a senior enlisted to his submarine crew last month, expresses common problems at the deck plate level. “The smoking pit was moved again … Doing so, however caused the level of smoke around the stair stepper to be unacceptable, since the airflow seems to migrate the smoke that way. This piece of workout gear is used a Jot, so I need to move the pit again. I’m having difficulty finding a new solution that is fair to everyone involved. I’m asking for the crew’s help in suggesting a location for the smoking pit”.
I directly evaluated the situation within COMSUBPAC by evaluating 4 boats chosen solely by convenience of schedule. The underway durations were from 4 to 8 days each. I spent time in the smoking areas speaking with individual crewmembers. The most frequent comment received from the crew was that the quality of life was superior as a smoker due to the smoke breaks afforded them.
Individuals were identified as smokers only if they had been eyewitness verified as having smoked at least one cigarette underway in the most recent month at sea. The average smoking rate was 34% overall (Table I). Despite the variability in numbers between boats, there does appear to be a trend towards higher smoking rates among junior enlisted when the senior enlisted are smoking role models. Of note, the commanding officer of the boat with the highest smoking rate was himself a smoker while at sea. This data suggests that leadership can make a significant difference in smoking rates of individual submarines.
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These rates are consistent with an East Coast survey performed in 1999.11 It found that 39.5% of submariners in Norfolk, Virginia smoked cigarettes. They averaged 1.1 packs per day. Reasons for smoking included such responses as “USN endorses it” and “to fit in”.
Significant variation in smoking policy was observed. On one boat the smoking area was temporarily moved adjacent to the supply office. The office remained in a smoke filled fog for the next two days, during which assigned personnel avoided their office as much as possible. On another boat the smokers complained that their new commanding officer, unlike their previous, would not allow them to smoke on the mess decks during poker night. My personal observation during at sea assist visits suggest that some non-smokers, by virtue of work or berthing locations, are at risk for significant exposure to second hand smoke despite the best efforts of the atmospheric cleansing equipment.
The data from one recent study conformed that a subset of the crew are inhaling second hand smoke, even when the submarine crew on average may have minimal exposure. A metabolite of nicotine was measured in the urine of volunteers during ten-day embarkations on two 688-class submarines.12 The average nicotine metabolite among non-smokers within the smoking compartment (defined as either forward or aft work stations) went up 65%, but remained below the threshold most experts consider indicative of second hand smoking. However, the nicotine metabolite in some non-smokers went up 1000%. The amount of nicotine metabolite in some cases indicated exposure to significant amounts of passive smoke. Clearly, whether crewmembers recognize it or not, they are being exposed to secondhand smoke.
Smoke Adversely Impacts Our Mission
There is a continuing divergence of smoking permissibility between the Submarine Force and our country’s public institutions. Our force remains a governmental organization that is exempted from stringent indoor workplace smoking laws. Sailors and their families trust that the Submarine Force places a high priority on protecting crew health. Over time the divergence from the mainstream might undenied this trust, impacting recruitment and retention goals. This divergence may affect the perception of the Submarine Force among the medical and legislative communities.
Historically, there are numerous examples of organizations that failed to follow the precautionary principle in regards to environmental exposures. An important lesson on long term consequences can be learned from the episode of tainted water at Camp Lejune, North Carolina. From 1980 to 1985 some base wells were kept open despite high levels of two likely cancer-causing chemicals. The decision was defended by the Marine Corps based on there being no enforceable drinking water standards at the time. Families did not find out about the contamination until 1999. Victims groups claimed that up to 200,000 people may have consumed tainted water. In 2004, while a U.S. senator called for congressional hearings, the Marine Corps appointed an investigative panel. The take home message is that carcinogenic health concerns, if not appropriately managed proactively, are a long term liability to any organization.
On a more practical level, the health care costs associated with smoking are enormous. The Centers for Disease Control has estimated that in 1999 the health care and lost productivity costs attributable to smoking were $3,383 for each adult smoker in the u.s.is There are currently approximately 15,000 personnel who serve in submarines with an average male lifespan of over 70 years, the future health care costs for a force made up of 25-40% smokers reaches into the hundreds of millions of dollars. Each incremental improvement in our smoking rates will save millions.
The linkage of tobacco smoke to long-term health effects such as cancer and heart disease is not possible in our young active duty population. However, I did have sufficient numbers of mental health disqualifications to determine if an association with smoking existed. There is a recognized relationship between smoking and mental health pathology. Some experts point to a direct casual relationship, hypothesizing that tobacco chemicals act directly on the brain and result in mental health problems. Other experts argue that individuals with mental health problems may simply have characteristics that make them more likely to take up smoking. It has already been shown that prior cigarette smoking is associated with higher attrition in basic training and after one year in the Navy.
I reviewed 127 enlisted submarine mental health disqualifications that I acted on since January 2005. Most service members were diagnosed with an adjustment disorder or depression. The percentage of cigarette smokers was 52%. When compared to the estimated percentage of smokers in the Submarine Force, this is a statistically significant elevation (Chi-square test p-value <0.01). This may indicate that the Submarine Force's accommodative smoking policy tends to attract individuals with a higher risk of attrition, and potential deleterious mental health effects of smoking impact mission readiness. The Future
Smoke-free submarine fleets (both diesel and nuclear) have been successfully implemented in other countries. Although it is unknown when the U.S. Submarine Force will transition to smoke-free boats, it is clear that this transition should eventually happen. The recent U.S. Surgeon General’s report reinforces the fact that attempts to mitigate the effects of secondhand smoke within the closed environment of the submarine will never reach an acceptable level. Elimination of workplace smoking will need to be implemented.
The amount of smoking restrictions will continue to rise at home and abroad over the next decade. Some of the more perceptive smokers tell me they live with a simmering anxiety, wondering when the inevitable submarine smoking ban will occur. As the Submarine Force diverges from mainstream culture there are clearly no winners. While individuals on the deck plate argue over their individual rights as smokers or non-smokers, medical and psychological costs will continue to accrue.
The submarine community should pay close attention to new secondhand smoking policies in the news. Increasingly restrictive laws are taking effect from small California towns to large South American countries. The U.S. Submarine Force is rapidly becoming the odd man out. Perhaps the time has come to make a hold decision to protect our people from the harms of tobacco smoke. This is the single most effective action to improve the health of our people, reduce the long term health care costs for the Navy, and support a culture of wellness.