Combating Tobacco Use in Military and Veteran Populations (2009) / Chapter Skim
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7 SUMMARY AND RECOMMENDATIONS
7 SUMMARY AND RECOMMENDATIONS
Pages 307-326
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From page 307... ...
There are many proven methods for reducing tobacco consumption in the US population, as discussed in Chapter 4. They include legal and regulatory approaches, such as restricting advertising of tobacco products and limiting where tobacco products can be used; economic approaches, such as raising the price of cigarettes; behavioral approaches, such as public-education campaigns to deglamorize tobacco use; and therapeutic interventions, such as counseling and medications to help tobacco users quit.
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From page 308... ...
The committee finds that a comprehensive tobacco-control program that combines prevention efforts with restrictions on tobacco use and sales, increases tobacco prices, incorporates a counteradvertising campaign to change social norms around tobacco use, and provides easy access to tobacco-cessation interventions based on best practices would be the most effective approach for helping DoD to achieve a healthier, tobacco-free military. The committee believes that the most realistic plan for reaching the long-term goal of a tobacco-free military is a phased approach that requires policy changes to close the pipeline of new tobacco users entering the military.
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From page 309... ...
In preparing this report, the committee was struck by a contradiction: DoD and the four armed services acknowledge that tobacco use impairs the readiness of military personnel and results in enormous costs to service members, but DoD still sells tobacco products at a discount, permits tobacco use in some areas of military installations (including the military service academies) , and has given tobacco use less attention than alcohol abuse, physical fitness, and weight management.
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From page 310... ...
Profits from the sales of tobacco products benefit the morale, welfare, and recreation programs on military installations, but the committee believes that DoD should not be selling products that are known to impair military readiness and health, and it recommends that these sales be eliminated on all military installations. Again, a phased approach may be most effective.
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From page 311... ...
The committee understands that, with the great demands placed upon the US military since 2001 as a result of the conflict in the Middle East, tobacco control policy, practice, and program evaluation has not been a high priority within the DoD. The committee recognizes that DoD does not wish to apply undue pressure on active-duty military personnel to quit tobacco use during a time of war or intense military conflict but notes that even during this stressful time, some personnel desire to quit tobacco use and should be encouraged to do so.
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From page 312... ...
Easy access to tobacco-cessation medications and counseling sessions are important to ensure that tobacco-cessation treatment is as easy to access as are tobacco products on military installations. Given the peripatetic nature of military service, the committee recommends that DoD establish a dedicated quitline for military personnel that is accessible by all military personnel, retirees, and their families regardless of where they are stationed (with the possible exception of those deployed to war zones with limited telephone access)
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From page 313... ...
The committee finds that this autonomy has advantages in allowing the tobacco-cessation lead clinician in each VA medical center to modify programs to meet specific patient needs. However, the lack of systematic information on tobacco-control programs offered in outpatient clinics, including community-based outpatient clinics, needs to be addressed.
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From page 314... ...
The committee concurs with the VA/DoD clinical-practice guideline that tobacco-cessation services should be offered to all patients, including hospitalized patients and those in primary-care clinics for other reasons. The committee believes that having a dedicated smoking and tobacco-use cessation lead clinician in each VA medical facility is a good start toward ensuring that VA staff are familiar with the most effective tobacco-cessation treatments and also have a point of contact for more information.
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From page 315... ...
Unlike DoD, VA does not have to respond to the sale of tobacco products, having discontinued such sales several years ago. However, it does have a congressional mandate to maintain smoking areas for patients.
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From page 316... ...
Both VA and DoD permit civilian employees to attend tobaccocessation counseling sessions as space permits, but neither organization provides tobacco-cessation medications for them. The committee believes this may pose a barrier to employees' quitting tobacco use.
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From page 317... ...
Engaging such groups as veteran service organizations, the United Service Organizations, VA volunteer services, and military family organizations can raise the profile of tobacco-control issues and stimulate support and services for military members and veterans who are trying to quit. Local military installations and VA outpatient clinics can establish relationships with local chapters of such groups as the American Cancer Society and the American Lung Associations.
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From page 318... ...
The committee believes that without the enthusiastic support of involved leaders, tobacco control will not have a high priority in either DoD or VA. Considering the staggering toll of tobacco use on military readiness, lost productivity, adverse health effects, exposure to secondhand smoke, cost of tobacco products, and health-care expenditures, DoD and VA should develop, implement, and evaluate outcomes of continuing broad and systematic tobacco-control programs as major components of their health-care systems.
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From page 319... ...
• 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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From page 320... ...
(Navy and Marine Corps commissaries do not sell tobacco products.) • Should tobacco products be sold at military installations (exchanges and package stores)
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From page 321... ...
DoD and VA have established The VA/DoD Clinical Practice many best practices in tobacco Guideline for the Management of cessation. 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.
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From page 322... ...
• Direct DoD to sell tobacco products at prices at least equal to and preferably greater than local civilian retail prices. DoD and VA research contributes DoD and VA should develop and fund a to identifying effective tobacco- joint comprehensive research plan on control programs, particularly for tobacco control in military and veteran special populations, such as those populations.
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From page 323... ...
Deployed personnel also use tobacco more than nondeployed personnel, and research should focus on identifying healthy substitutes for tobacco as a stress and boredom reliever during deployment. Deployed personnel also use more smokeless tobacco; DoD should fund research on the long-term health effects of smokeless tobacco and effective cessation interventions.
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From page 324... ...
It should examine what effect raising the prices of tobacco products would have on consumption and revenue. The committee concludes that although DoD and VA have demonstrated a continuing commitment to the health of military personnel and veterans, respectively, particularly with respect to tobaccouse cessation, much remains to be done.
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From page 325... ...
2004. VA/DoD Clinical Practice Guideline for the Management of Tobacco Use.
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