• Support and promote tobacco cessation in military personnel, veterans, and their dependents.

  • Identify and eliminate disparities in tobacco treatment between the general population and military personnel or veterans in high-risk populations, including those with mental-health disorders.

Numerous entities have developed and implemented successful tobacco-control programs. They include the federal government, specifically the National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC); various state governments; and commercial entities, such as Kaiser Permanente. California has been a leader in establishing a comprehensive tobacco-control program. Its program began in 1988 and adult tobacco use in California decreased from 22.7% to 13.3% by 2006 (CDC, 2007a). California served as the model for Massachusetts, which also developed a comprehensive program that resulted in a decrease in statewide tobacco consumption. California and Massachusetts were among the states that participated in the NCI American Stop Smoking Intervention Study (ASSIST) program and evaluation. See Appendix A for a detailed discussion of effective federal and state comprehensive tobacco-control programs.

Comprehensive programs can provide the societal and organizational framework for reducing tobacco use in a population. Although such programs and policies may prevent young people from initiating tobacco use and reduce the exposure of the general population to secondhand smoke, a comprehensive program must also be applicable to people who are already using tobacco regularly. Interventions are needed to assist individual tobacco users, each of whom has a particular level of addiction, particular reasons for smoking and for trying to stop, and possibly concurrent health problems that affect their interest in and ability to quit.

The process of creating tobacco-free environments should include educational campaigns to prepare the target communities and build support for the measures to be implemented. Once public support has been garnered, government and political support of tobacco-free policies must remain strong, including enforcement and sanctions for violations to ensure compliance (WHO, 2008).

The comprehensive tobacco-control programs noted above and in Appendix A vary in target audience, size, funding sources, and bureaucratic oversight, but they share several key components that contribute to their success: the development and implementation of a strategic plan, dynamic leadership, effective and enforceable policies, communication interventions, adequate resources, appropriate

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