The Army's first ever "Health of the Force" report found that about a third of all soldiers use tobacco, and many have other health issues that affect their performance.
Soldiers like their smokes and their chew.
At Joint Base Lewis McChord near Seattle, 35% of soldiers use tobacco, just slightly higher the average for the entire Army.
Sergeant Andrew Porch started smoking in his early teens. He doesn't smoke regularly now, but does it enough to know where the best covered smoking gazebo is at JBLM. He prefers the one that's not located next to the trash cans.
"A lot of people probably prefer to come here than head to the dumpster in the rain to smoke a cigarette," Porch said.
There are many cessation programs for soldiers who want to quit tobacco.
But Master Sergeant Raheem Ramsey says cigarettes are a big part of Army culture.
"The smoke break is one of the most valued things among soldiers whenever they have some time to themselves," Ramsey said.
"When you're out in the field and in the woods, there's very little else you can do but work, eat, sleep, workout and smoke."
Ramsey has been in the military for nearly two decades.
He started smoking when he was in his early twenties, but quit using cigarettes after he ruptured his Achilles tendon in 2012. His surgeon wouldn't operate until he quit.
"He gave me this long drawn out explanation that my foot was going to fall off," Ramsey recalled. "I quit that day."
Army leaders hope more soldiers find a way to quit, even without the threat of losing their feet.
The "Health of the Force" report says tobacco makes soldiers more likely to get sick or injured, and it costs the Department of Defense about a half billion dollars a year in medical care.
Col. Deydre Teyhen with the Office of the Army Surgeon General says it also hampers troops' ability to do their jobs.
"It decreases night vision, it decreases your endurance, it decreases your performance," she said. "It provides a smell that actually makes it easier identify you in a field setting."
Teyhen is also concerned about another habit that's not addressed directly in the report, but she says is a growing problem in the Army - vaping.
That's when people puff on electronic devices that emit vapor instead of smoke. Though many people who vape believe it to be safer than smoking conventional cigarettes, scientists haven't yet determined whether that's true.
"Some of the things being put in those products have been associated with some severe diseases like popcorn lung disease," Teyhen said.
Teyhen anticipates that the Army will need to create a campaign to educate soldiers who believe vaping is a safer option. But right now, the Defense Department is still trying to guage how many troops do it.
"There will be a report coming out soon that adds how many of our soldiers are using e-cigarettes and vaping, Teyhen said.
But Ramsey - the Intelligence Sergeant at Joint Base Lewis McChord - is convinced that vaping is here to stay. Though he quit smoking before his foot surgery, he now vapes.
In fact, as he gets ready to retire from the military, he's already opened his own vape shop … and though it likely would chagrin Army health officials, Ramsey says a lot of his customers are his fellow soldiers.
CORRECTION: An earlier version of this story misstated Master Sergeant Ramsey's rank.
