products in commissaries and exchanges, others promote such products with large, prominent displays—so-called power walls—near checkout counters.

Finding: Increasing the price of tobacco products is one of the most effective interventions to prevent tobacco use and promote tobacco cessation. The funds generated from increased prices could be used to expand other tobacco-control efforts.


The vast majority of smokers (80%) report that they want to quit, and over half of smokers will make a serious attempt to quit in any given year (Kaiser Family Foundation, 2009), but only about 4–7% succeed in quitting in any one try (Fiore et al., 2008). Studies show that the rate and duration of tobacco abstinence are increased, generally doubled, when cessation treatments are used (CDC, 2007a; Fiore and Jaen, 2008; Fiore et al., 2008). National surveys, however, indicate disappointingly low rates of use of tobacco-cessation treatment by the general public. For example, the 2005 National Health Interview Survey found that less than 5% of smokers who made a serious attempt to quit used both behavioral and pharmacologic treatment (Curry et al., 2007). A similar pattern is evident in the 2003 Current Population Survey (Shiffman et al., 2008).

In addition to the evidence-based interventions discussed below, the committee considered harm reduction as a possible intervention for tobacco use by military and veteran populations. A previous IOM report (2001) found that there was insufficient evidence on the health effects of smokeless or modified tobacco products, although the International Agency for Research on Cancer has found that smokeless tobacco use causes cancer (IARC, 2007). The IOM report also recommended that “harm reduction be implemented as a component of a comprehensive national tobacco control program that emphasizes abstinence-oriented prevention and treatment.” A recent strategic dialogue reached the conclusion that “significant tobacco harm reduction can be achieved over the long term only in a world where virtually no one uses combustible tobacco products” (Zeller et al., 2009). The evidence base on smokeless-tobacco products is not sufficiently robust to determine what health hazards other than cancer and periodontal disease are associated with smokeless or modified tobacco products. Furthermore, the committee is concerned that such products may serve as starters or supplements for the use of smoked tobacco products. This dual use is a substantial concern as demonstrated by the number of military personnel who use both (see the

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