Reserve and National Guard. The Air Force has addressed tobacco use in its Health Promotion Program (Air Force Instruction 40-101, May 1998). The Navy health-promotion plan (OPNAVINST 6100.2A, March 2007) also addresses tobacco-use prevention and cessation and delineates program responsibilities; this program is also used by the Marine Corps. Each of those regulations specifies the responsibilities of military leaders for implementation.

The committee notes that although the goals of the 1999 strategic plan are in harmony with many of the components required of a comprehensive tobacco-control plan, there have been obstacles to the implementation and evaluation of the plan. The obstacles include insufficient allocation of human and financial resources, lack of engaged leadership, ineffective communication, and incomplete surveillance.

Program Leadership

Tobacco control has not had high priority in DoD, for several possible reasons. The committee recognizes that in a time of military conflict, DoD must first allocate resources to meet the needs of deployed forces and those who support them. The effect of tobacco products, particularly of smoked tobacco, on military readiness and performance may not be immediately apparent to commanders or even to military personnel themselves. Furthermore, the direct influence of the tobacco industry on DoD and its indirect influence via Congress in maintaining easy access to tobacco products cannot be ignored and has had the effect of keeping the DoD in the business of selling tobacco products. The tobacco industry creates relationships with groups that pressure policymakers to pass or hinder industry-favorable legislation. Research has shown that heavy lobbying by the tobacco industry and veterans’ groups helped thwart previous efforts to raise tobacco prices in commissaries (Arvey and Malone, 2008). Although the OASD(HA) and the armed services have attempted to address tobacco control, the full impact of tobacco on military readiness and health is not recognized by all military leaders. Some leadership in DoD, however, has spoken out against tobacco use. For example, in August 1996, efforts by the Assistant Secretary of Defense for Force Management Policy resulted in a price increase for cigarettes sold in commissaries in 1996, although his efforts were resisted by some members of Congress (Smith et al., 2007).

The committee emphasizes that until the highest strata of DoD leadership are engaged in tobacco control, military readiness will continue to be impaired by tobacco use by active-duty personnel. As a result, all military personnel and their families, civilian employees, retirees, and the general public will bear the burden of both the adverse health effects of exposure to secondhand smoke as well as increased

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