Defense Bill Would Evaluate Smoke-Free Alternatives for Active-Duty Smokers

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Key Points:

• Legislative Overview: Section 707 of the House-passed National Defense Authorization Act (H.R. 8800) would establish a one-year pilot program to help active-duty military personnel stop smoking by evaluating both traditional cessation therapies and modern smoke-free nicotine alternatives.

• Eligible Participants: The pilot would be available to active-duty members of the Army, Navy, Marine Corps, Air Force, and Space Force who smoke at least one cigarette or other combustible tobacco product per week.

• Expanded Cessation Options: Unlike traditional military cessation programs, the proposal includes counseling, nicotine gum, nicotine patches, e-cigarettes, nicotine pouches, and heat-not-burn products as potential smoking alternatives.

• Targeted Implementation: The pilot would operate at one or more military installations with smoking rates above the national average and significant populations of Black, Asian and Pacific Islander, Hispanic, and Appalachian service members.

• Program Evaluation: The Department of Defense would be required to report to Congress on the pilot's outcomes within one year after its completion.

• Higher Military Smoking Rates: Service members have historically smoked at higher rates than civilians. A 2019 analysis found that 17.3 percent of military personnel smoked compared with 16.2 percent of civilians, with similar disparities in states containing the nation's largest military populations.

• Historic Federal Harm Reduction Initiative: If enacted, Section 707 would represent one of the first congressionally authorized federal pilot programs to explicitly evaluate e-cigarettes, nicotine pouches, and heat-not-burn products as smoking cessation tools.

• Recognizing Innovation: The proposal reflects decades of innovation in tobacco harm reduction, from early heat-not-burn products introduced in the 1980s to e-cigarettes entering the U.S. market around 2007.

• Modern Regulatory Framework: Tobacco harm reduction products are regulated under the FDA's Premarket Tobacco Product Application (PMTA) process established through the 2009 Tobacco Control Act and expanded to include e-cigarettes in 2016.

• Growing Adult Adoption: Despite a slow FDA authorization process, more than 21.3 million U.S. adults used e-cigarettes in 2024 – approximately one million more than the previous year – while an estimated 2.5 percent of adults have used nicotine pouches.

• Rapid Market Growth: Between February 2020 and March 2026, monthly U.S. e-cigarette sales increased from 15.5 million to 18.3 million units, while nicotine pouch sales grew by 183.7 percent between September 2022 and September 2024.

• FDA's Continuum of Risk: The FDA recognizes that combustible cigarettes pose the greatest health risks, while noncombustible products – including e-cigarettes, nicotine pouches, heat-not-burn products, and nicotine replacement therapies – generally fall lower on the continuum of risk.

• FDA Authorizations: The agency has authorized multiple smoke-free products through the PMTA process and has also granted Modified Risk Tobacco Product (MRTP) orders allowing reduced-risk or reduced-exposure claims for certain nicotine pouches and heated tobacco products.

• Evidence-Based Opportunity: By evaluating smoke-free alternatives alongside traditional cessation therapies, the pilot could generate valuable real-world evidence on which approaches most effectively help military personnel transition away from combustible cigarettes.

• Public Health Significance: The proposal reflects growing recognition that tobacco harm reduction may complement existing cessation strategies for populations with persistently higher smoking rates.

• Bottom Line: Section 707 represents a notable shift in federal smoking cessation policy by formally evaluating modern smoke-free nicotine products within a military setting. If successful, the pilot could provide important evidence to guide future cessation programs while helping service members move away from combustible tobacco.

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Tucked into H.R. 8800, the House version of the National Defense Authorization Act (NDAA), is Section 707 – one of the bill’s more notable public health provisions.

Section 707 would establish a “Pilot Program to Help Certain Members of the Armed Forces Stop Smoking.” No later than 180 days after enactment, the Secretary of Defense may carry out a one-year pilot program to provide eligible service members with alternatives to smoking.

Eligible participants would include active-duty members of the Army, Navy, Marine Corps, Air Force, and Space Force who smoke at least one cigarette or other combustible tobacco product per week.

Notably, the legislation would move beyond traditional nicotine-replacement therapies generally approved by the U.S. Food and Drug Administration by including modern nicotine alternatives. Options under the pilot would include counseling, nicotine gum, nicotine patches, electronic nicotine-delivery systems, nicotine pouches, and heat-not-burn products.

If implemented, the program must operate in at least one branch of the Armed Forces and at no fewer than one military installation where smoking rates exceed the national average and where Black, Asian and Pacific Islander, Hispanic, and Appalachian Americans serve in proportions exceeding their respective national averages.

No later than one year after the pilot is completed, the Secretary must submit a report on the program’s results.

Military service members have historically smoked at higher rates than the general population. A 2019 study examining 2017 national data found that 17.3 percent of service members smoked, compared with 16.2 percent of civilians. Among the six states with the largest military populations – California, Florida, Maryland, New York, Texas, and Virginia – 15.9 percent of service members smoked in 2017, compared with 14.4 percent of civilians, representing a relative difference of approximately 10 percent.

The proposal is significant for tobacco harm reduction because it would represent one of the first congressionally authorized federal pilot programs to explicitly include e-cigarettes, nicotine pouches, and heat-not-burn products. Despite continued alarmism, these alternatives have helped transform the global nicotine marketplace from one centered on combustible tobacco to one increasingly shaped by innovation and harm reduction.

In the United States, tobacco harm reduction has long been examined by researchers and manufacturers. Some of the earliest heat-not-burn products, including products still legally marketed under FDA authorization, were introduced into the U.S. marketplace during the 1980s.

The arrival of e-cigarettes in the United States around 2007 further advanced the concept of delivering nicotine without smoke – and therefore without tar and many of the harmful chemicals produced by combustion. Between 2009 and 2012, e-cigarette sales expanded into all major U.S. markets.

Congress granted the FDA authority to regulate tobacco and emerging nicotine products through the 2009 Family Smoking Prevention and Tobacco Control Act. Under the law, tobacco products generally must receive FDA authorization before being legally sold in the United States.

There are two principal pathways. The substantial-equivalence pathway applies to products demonstrated to be substantially equivalent to an appropriate product marketed as of February 15, 2007. The premarket tobacco product application pathway applies to virtually all modern tobacco harm-reduction products.

The FDA did not extend its regulatory authority to e-cigarettes and other previously unregulated products until 2016. The agency initially established a later application deadline, but litigation brought by public health organizations successfully challenged the delay, resulting in a September 2020 deadline for products already on the market.

Although the FDA has authorized only a limited number of products while denying millions of applications, the use of e-cigarettes and other alternatives has continued to grow. The agency has also shown greater willingness to recognize the potential benefits of authorizing additional lower-risk products for adults who smoke.

According to the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System, more than 21.3 million American adults aged 18 or older were current e-cigarette users in 2024. This represented a 3.9 percent increase from 2023 and approximately one million additional adult users in a single year. A recent study estimated that 2.5 percent of adults had ever used nicotine pouches.

Although nicotine-pouch use remains relatively low, sales data indicate growing demand for tobacco harm-reduction products. From February 2020 to March 2026, monthly e-cigarette sales increased from 15.5 million to 18.3 million units. Between September 2022 and September 2024, the U.S. nicotine-pouch market grew by 183.7 percent.

The FDA recognizes that tobacco products exist along a continuum of risk, with combustible products such as cigarettes posing the greatest risks and noncombustible oral products and traditional nicotine-replacement therapies generally posing lower risks.

The premarket standard requires products to be “appropriate for the protection of the public health.” Although reduced toxicant exposure is not the sole basis for authorization, the FDA has acknowledged lower levels of harmful constituents in several marketing orders.

In 2021, the agency issued its first marketing authorization for an e-cigarette product, finding that the manufacturer had demonstrated that the products could benefit adults who smoke and switch completely or significantly reduce their cigarette consumption by lowering their exposure to harmful chemicals. In its most recent authorization involving non-tobacco-flavored e-cigarettes, the FDA noted that the agency had authorized “a number of less harmful alternatives for smokers.”

The FDA has also granted modified-risk tobacco product orders for oral nicotine pouches and heat-not-burn products. Unlike premarket authorization, which permits a product to be sold, modified-risk authorization allows a manufacturer to communicate specific FDA-approved reduced-risk or reduced-exposure claims to consumers.

The NDAA pilot program is a welcome effort to incorporate tobacco harm reduction into federal smoking-cessation policy. By serving a population that smokes at elevated rates, the program could generate valuable evidence on the effectiveness of different alternatives and their potential to help underserved groups move away from combustible tobacco.

Nothing in this analysis is intended to influence the passage of legislation, and it does not necessarily represent the views of Tobacco Harm Reduction 101.