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One big way to improve the wellbeing of military veterans and caregivers

When Steve Schwab participated in a recent event honoring military service members and caregivers at a veterans facility in Pittsburgh, he noticed dozens of people outside smoking.

“It’s ever-present,” said Schwab, executive director of the Elizabeth Dole Foundation and leader of its initiative, Hidden Heroes, which supports military caregivers and seeks solutions for the long-term needs they face. “I see it all the time.”


In 2011, 24% of active duty military personnel reported smoking cigarettes.

Members of the military smoke at higher rates than the general population, in part due to tobacco industry exploitation that helped foster a culture of tobacco use in the military. “The military community is hit from every single side by the tobacco industry,” said Schwab, pointing out how tobacco companies have taken advantage of the “captive audience” on military bases. “We’ve seen rampant tobacco use and we’ve had caregivers tell us that they need help to quit.”

To provide the support they need, Hidden Heroes partnered with Truth Initiative® to offer caregivers access to the EX® Program, a digital quit-smoking program developed in collaboration with Mayo Clinic. The program is designed for groups like Hidden Heroes, as well as employers, health systems and health plans, to offer to their members. The EX program expands on EX®, the consumer platform Truth Initiative launched in 2008 that research shows can quadruple a smoker’s chance of quitting.

In 2011, nearly a quarter — 24 percent — of active duty military personnel reported smoking cigarettes, compared to 19 percent of civilians at that time. The rate is even higher for service members with combat experience. Of Veteran Administration enrollees who are current smokers, 27 percent reported being exposed to combat during their term of military service. While the exact prevalence of smoking among military caregivers is unknown, 28 percent of post-9/11 military caregivers report that they are extremely challenged by their own physical health, mental health or general well-being.

“Research says that if there is a strong caregiver, the veteran is much more likely to rehabilitate and transition into civilian life at a faster rate,” Schwab said. “Having a strong, healthy caregiver is going to make a huge difference.”

In addition to promoting awareness and civic engagement surrounding the needs of military caregivers, Hidden Heroes also provides caregivers an online community where they can receive vetted resources and peer support.

“One of the ways EX helps people quit is through connecting smokers to a network of peer support, and that’s what we’re all about with our peer community at Hidden Heroes,” Schwab said. “These folks, a lot of them, are alone and feel like they are the only person in the world facing the challenges they have. By partnering with leaders like Truth Initiative and Mayo Clinic on a digital quit-smoking program, we’re able to give military caregivers the resources they need to develop a quit plan and improve their health and the health of their veteran. It’s a win-win.”

Hidden Heroes and the EX Program show caregivers “there are people in their community they can lean on.” The organization is piloting the EX Program with a small group of caregivers and will soon roll it out to its wider network.

“We knew smoking was going to be a big health issue facing this population, and we know tobacco use leads to more negative health outcomes,” Schwab said. “If we can get as many of these caregivers into a quit program that works, we might just prevent them from needing help in a whole lot of other areas.”

To learn more about the EX Program, visit To learn more about the tobacco industry’s history of exploiting members of the military and their families, read “tobacco is a social justice issue: the military.”