the service and beyond. For military personnel who enter the VA health system, these practices can also influence their tobacco use as veterans.

This chapter summarizes what is known about evidence-based best practices for tobacco-control programs in the general population with an emphasis on program components that are or could be most applicable to DoD and VA. The committee hopes that by implementing these practices, DoD will be able to prevent or reduce tobacco use by military personnel in all phases of their military service—from the time they enter the military until they leave the service or retire. Implementing these practices in VA may also reduce tobacco use in veterans. As discussed in the next two chapters, DoD and VA already have in place some of the components and practices, including the infrastructure and regulatory authority, for an effective tobacco-control program; in these instances the committee highlights how the departments can take advantage of current policies and procedures to increase their effectiveness and reach and also emphasizes where additional opportunities for tobacco control may reside.

Evidence supports the use of a comprehensive tobacco-control program to reduce tobacco consumption (Warner, 2007). A comprehensive approach to tobacco control results in changes that affect the entire population, from the individual to the societal level, by addressing the political, social, cultural, economic, and environmental factors that support the use or nonuse of tobacco. Tobacco-control programs reduce tobacco use at the population level by creating tobacco-free indoor and outdoor areas, restricting young people’s access to tobacco products, limiting tobacco advertising, having sustained counteradvertising campaigns, increasing the cost of tobacco products, and providing easily accessible tobacco-cessation products and services. Comprehensive tobacco-control programs for military and veteran populations could help to do the following:

• Foster a tobacco-free culture and denormalize tobacco use in military personnel and veterans.

• Prevent the initiation of tobacco use by military personnel and their dependents during active duty and prevent relapse to tobacco use by military personnel and veterans who have quit.

• Eliminate exposure of military and veteran personnel, family, co-workers, and others to secondhand smoke and its health consequences.