Prevalence and Characteristics of Tobacco/Nicotine Use Among Recent Graduates-United States Military Academy, West Point, New York, 2022-2025.

Introduction: The

Purpose: of the United States Military Academy (USMA) at West Point, NY is to provide the nation with leaders of character who serve the common defense. Use of nicotine products, a preventable cause of disability and death, adversely impacts adolescent brain development, academic focus, wound healing, sleep, athletic performance, and military readiness. Violating regulations and addictive behavior are incompatible with USMA's mission. This study was conducted to help address these issues by better identification of their extent and nature and to generate support for ongoing, comprehensive tobacco/nicotine prevention/cessation programs for students at USMA, its preparatory school, and elsewhere, in order to improve health, mission readiness, and future leadership while reducing healthcare costs for the Department of Defense and the Veterans Administration.

Materials and methods: To determine the prevalence and characteristics of nicotine use in the USMA Corps of Cadets (ages 17-22 at entry), anonymous convenience surveys were administered to each class upon arrival and before graduation, approximately four years later. Survey data yielded numbers and percentages of current, former, and never users, and were analyzed using logistic regression in R software. Analyses showed trends in types of products used. The IRB approved this project with exempt status.

Results: Each class year independently exhibited about a threefold increase in the prevalence of nicotine use from arrival to departure, with a concurrent trend of product preferences shifting toward greater use of smokeless products, possibly nicotine pouches. The increasing odds ratio of being a nicotine-user versus non-user suggests an association between the USMA environment and nicotine use.

Conclusions: This is the only study of its kind, containing original data about nicotine use among students at a U.S. military service academy. Improved data collection and sustained use of multiple intervention points could enhance future research and be a model for prevention and cessation of nicotine use during military training anywhere, reversing existing trends in order to improve mission readiness, behavioral/physical/fiscal health, and leadership through ongoing study and program improvement.