Combating Tobacco Use in Military and Veteran Populations (2009) / Chapter Skim
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SUMMARY
SUMMARY
Pages 1-18
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Tobacco use has been implicated in higher dropout rates during and after basic training, poorer visual acuity, and a higher rate of absenteeism in active-duty military personnel in addition to a multitude of health problems, such as cardiovascular and respiratory diseases and cancer. DoD and VA are working toward reducing tobacco consumption by military personnel and veterans, respectively, and each has initiated several tobacco-control efforts.
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The Institute of Medicine (IOM) was asked to conduct a study in response to DoD's and VA's need to determine what the medical and public-health records can document as best practices for reducing tobacco consumption by military and veteran populations.
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Although smoking prevalence dropped from 51% in 1980 to 32% in 2005 in the armed services, there has been an upturn in consumption in the last decade. Cigarette-smoking and use of smokeless tobacco are most prevalent in the Army and the Marine Corps and least prevalent in the Air Force.
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Tobacco use affects and increases training costs for new recruits; tobacco users are less likely to complete basic training and more likely to leave the military earlier. At the same time that tobacco results in high health-care costs and productivity losses for DoD, the department earns substantial net revenues from the sale of tobacco products in military commissaries and exchanges, and this creates an impediment to any policy that might make tobacco less accessible in those venues.
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TOBACCO-CONTROL PROGRAMS The use of evidence-based best practices for tobacco control has been widely promoted and has succeeded in reducing tobacco use in the United States. Reducing tobacco use poses special challenges because tobacco products are legal and easy to acquire, highly addictive, and heavily promoted by the tobacco industry.
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Increasing tobacco prices is one of the most effective mechanisms both to prevent tobacco use and to fund tobaccocontrol efforts. However, as tobacco taxes and tobacco-free regulations have increased, tobacco manufacturers have responded with the development and promotion of new tobacco products, particularly varieties of smokeless tobacco.
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clinical-practice guideline Treating Tobacco Use and Dependence: 2008 Update provides an evidence base for tobaccocessation treatments. Treatment effectiveness is irrelevant if tobacco users are not aware of treatment options, cannot access them, cannot afford them, or do not use them when they are available.
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The service plans typically cover where military personnel may use tobacco, requirements for access to tobacco-cessation programs, and specifications about the role of commanders and staff in promoting tobacco cessation and deglamorizing tobacco use.
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DoD and the armed services have promoted tobacco-free lifestyles through public-education campaigns, commander training, a complete ban on tobacco use during basic military training in all the services, and prohibition of tobacco use by training instructors in the presence of students. Tobacco use is addressed in health-education programs, including those for commanding officers.
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The committee finds that DoD and the armed services have restricted tobacco use to designated areas on installations but believes that primary and secondary exposure to tobacco smoke could be reduced if the restrictions were extended to decrease the number of such areas, extend the tobacco ban from basic military training to technical training, and prohibit tobacco use in medicaltreatment facilities. The committee commends DoD for its efforts in identifying tobacco users.
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That suggests that many veterans quit using tobacco, but with tobacco use increasing in the military, it is likely that many new veterans accessing the VA health-care system will also be tobacco users, especially those who have been deployed in Iraq and Afghanistan. Like DoD, VA has many components of a comprehensive tobacco-control plan already in place, including effective and enforceable policies, communication mechanisms, surveillance activities in the form of performance measures, and periodic evaluation of tobacco-control practices.
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The committee does not know whether VA tailors the programs to address special needs of veterans. The VA/DoD clinical-practice guideline and the PHS guideline provide recommendations for evidence-based treatment of special populations that seek medical care at the VA.
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TABLE S-1 The Committee's Findings and Recommendations for the Department of Defense and the Department of Veterans Affairs Findings Recommendations Tobacco use in the US military and veteran populations exceeds that in the general population. Tobacco use • impairs military operational readiness; • is a cause of increased morbidity and mortality in active-duty military personnel, retirees, veterans, and family members; • results in increased health-care costs for tobacco users and their families; and DoD, VA, and the general public; and • creates a patient pipeline from DoD to VA.
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• The military academies, officer candidate training programs, and university-based reserve officer training corps programs should become tobacco-free first, followed by new enlisted accessions, and then by all other active-duty personnel. Tobacco control does not have a DoD, the armed services, and VA should high priority in DoD or VA.
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At the very least, prohibit the sale of tobacco products in Army and Air Force commissaries. (Navy and Marine Corps commissaries do not sell tobacco products.)
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Widespread adoption of Tobacco Use should be updated and the practices is essential for harmonized with the PHS clinicalpredictable and consistent tobacco- practice guideline on tobacco cessation services in DoD and VA. management.
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• Expand the 2009 National Defense Authorization Act Section 713, "Smoking Cessation Program Under TRICARE," to include smokeless tobacco cessation treatment. • Direct DoD to sell tobacco products at prices at least equal to and preferably greater than local civilian retail prices.
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From page 18... ...
The committee concludes that although DoD and VA have demonstrated a continuing commitment to the health of military personnel and their families and of veterans, respectively, particularly with respect to tobacco control, much remains to be done. Given the effects of tobacco use on military readiness and on the health of military personnel, retirees, their families, and veterans, the time has come for DoD and VA to assign high priority to tobacco control.
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