whether quitline counselors can provide tobacco-cessation medications to veterans as in the private sector without the need for veterans to obtain prescriptions from their health-care providers, particularly for over-the-counter medications, such as nicotine-replacement therapy.

Performance measures that assess health-care providers are a good start for improving care, but the effect of that care on patient outcomes might be even more important. The committee believes that VA should evaluate the long-term effect of its tobacco-cessation programs on abstinence rates. Such information would help to show where programs could be improved or replaced.


DoD and VA have made many strides toward reducing tobacco use in military and veteran populations, respectively, and their efforts have generally been associated with a decrease in smoking. But tobacco use continues to impair military readiness and cause substantial morbidity and mortality in military personnel, their families, and veterans. The committee believes that although DoD and VA are actively engaged in developing, identifying, and implementing tobacco-cessation programs, they lack a comprehensive tobacco-control program. Table S-1 summarizes the committee’s findings and recommendations.

TABLE S-1 The Committee’s Findings and Recommendations for the Department of Defense and the Department of Veterans Affairs



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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