National Working Group for ACTTION

July 20, 2009

Currently, 32 percent of military personnel and 22 percent of veterans smoke, while 15 percent of military personnel use smokeless tobacco, costing taxpayers “many billions of dollars each year,” according to Dr. Ken Kizer, Committee Member, Medsphere Corporation and former Under Secretary for Health at the Department of Veterans Affairs (VA). Therefore the VA and the Department of Defense (DoD) asked the Institute of Medicine (IOM) to recommend ways to discourage military personnel and veterans from starting tobacco use, as well as encourage those who already use tobacco to stop.

This past month, the IOM’s Committee on Smoking Cessation in Military and Veteran Populations responded to DoD and VA with a new report entitled Combating Tobacco Use in Military and Veteran Populations. This new report provides a framework DoD and VA can use to develop and implement comprehensive programs to prevent tobacco use and increase the effectiveness of their tobacco cessation efforts.

The DoD and VA already have several components in place to decrease tobacco use, and now they’ve announced their desire to implement comprehensive tobacco control programs. Its components will include: strategic plan (evidence-based and adapted to local circumstances and population); engaged leadership; effective and enforceable policies; communication interventions; therapeutic interventions; surveillance; evaluation; and management capacity to effect change in response to evaluation. This program hopes to reduce tobacco use initiation, increase the use of tobacco cessation and eventually achieve tobacco-free VA facilities, DoD and Armed Services.

There are obstacles to creating a tobacco-free atmosphere within the military which the organizations have recognized and must be overcome to accomplish their goals. Some of these conflicts include the fact that:

• The VA cannot go entirely smoke-free because of legislative requirements
• Programs within the VA are not consistent or coordinated
• Tobacco cessation has not received highly visible support from senior leadership
• There is a lack of information on program effectiveness
• DoD continues to sell discounted tobacco and tobacco is perceived by many as part of military culture

In an effort move forward, DoD and VA feel the following needs to be set in action in order to set their initiative in motion:

• Set a timeline for all services to be tobacco-free
• Close the pipeline of tobacco users entering the military using a phased approach
• Ban tobacco use during technical/advanced training
• Stop selling tobacco products on military installations
• Assess effectiveness of tobacco-cessation programs
• Foster the VA and DoD coordination for tobacco control

According to presenters Dr. Ken Kizer and Dr. Stuart Bondurant, Committee Chair, University of North Carolina at Chapel Hill, this initiative requires engaged leadership who believe that tobacco-control is a high priority for military readiness and the health of military personnel and veterans and it is crucial to have research conducted to assess effectiveness of the program in order to measure improvements and success. With the right leadership and research, a tobacco-free Armed Service could be in our future.

Your Call to Action: Reach out to DoD and VA and see if there are ways to collaborate on implementing tobacco cessation programs. You may also want to consider supporting the research component of their goals to assess effectiveness.