Evaluating Tobacco Use Among United States Air Force Military Trainees: A Narrative Review of the Literature From 1998 to 2020

Tobacco use remains a health and readiness concern among military personnel.In the United States Air Force (USAF), mandatory tobacco abstinence during Basic Military Training (BMT) does not necessarily translate into sustained abstinence after training.This narrative review examines tobacco use among USAF trainees before and after BMT, factors associated with initiation and reinitiation, and prevention interventions during the transition to technical training.PubMed was searched in 2024 for literature published from January 1998 through December 2020.Search terms addressed the Air Force and military training, tobacco and nicotine products, and prevention and cessation.One reviewer screened publications for eligibility, and 20 research studies were selected for narrative synthesis.Relevant literature on other military populations provided background.No new participants were enrolled, and no meta-analysis or formal risk-of-bias assessment was conducted.The reviewed studies documented tobacco use before enlistment and initiation or reinitiation after mandatory abstinence.Findings highlighted prior tobacco use, intentions to use tobacco, peer influence, perceived harm, and access to products during technical training.Brief tobacco interventions improved some short-term beliefs, knowledge, and intentions, but the principal three-group trial did not demonstrate a significant difference in tobacco use between intervention groups at three months.These historical findings support continued tobacco-prevention efforts beyond BMT, with attention to prior users and nonusers, multiple tobacco and nicotine products, social influences, and access both on and off base.Interpretation is limited by single-reviewer screening, the unavailable original executable search string, and the restriction to literature published through 2020.