The national action plan specifically states that military personnel and their families should be eligible to use the national quitline and that a toll-free number should be available for military personnel and their families stationed overseas.

DoD and VA populations live in a variety of locations including small and remote communities and overseas, where in-person tobacco-cessation services may be scarce or nonexistent. Veterans, in particular, may find it difficult to access VA tobacco-cessation services if they are disabled or otherwise disadvantaged.

Finding: Quitlines, particularly proactive quitlines, are effective in reaching a large number of tobacco users and increasing abstinence rates over those achieved with usual care. Evidence indicates that a quitline should be proactive (counselor-initiated) and should provide four to six sessions and follow-up sessions as necessary.

Computer-Based Programs

Several studies have assessed the effectiveness of computer-based tobacco-cessation interventions, but there is insufficient information on their effectiveness. Nevertheless, the committee considered these programs as more people, both civilian and military, turn to computers for a variety of health information, assistance, and support. Many computer-based interventions have the advantage of being tailored to individual participants on the basis of their responses to questions, and they can be used to reach a large audience, including people who may not be contemplating quitting. Counseling may be conducted by telephone or e-mail with additional individualized resources, such as chat rooms, videos, graphics, journals, and action plans (Etter, 2002); computer-based programs can also be combined with medication. The efficacy of tailored computer-based tobacco-cessation programs is varied (Strecher and Velicer, 2003). Etter (2006) surveyed current and former smokers about the quality and helpfulness of 133 tobacco-cessation Web sites. Two of the most frequently visited sites were run by tobacco companies and were not considered helpful by participants. Two sites were ranked above average for quality and were nonprofit (Anti-smoking.com and Smokefree.gov), and the one ranked highest for helpfulness (Quitsmoking.About.com) was a for-profit



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