DoD and VA struggle to identify and implement the most effective approaches to reach populations at high risk of tobacco use. To overcome those challenges, DoD and VA asked the Institute of Medicine (IOM) to convene a committee to identify ways to maximize the efficacy of their current tobacco-free and smoking-cessation programs and to provide guidance on what future modifications might be most effective. DoD and VA requested that the IOM committee offer recommendations as to how the agencies could work together to improve the health of both active-duty and veteran populations with regard to the initiation and cessation of tobacco use. Specifically, the agencies asked that the committee:

  1. Identify policies and practices that might by used by DoD and VA to prevent initiation of smoking and other tobacco use in the military.

  2. Identify policies or potential barriers that might inhibit broader implementation of evidence-based tobacco-use cessation care in both DoD and VA.

  3. Identify opportunities for increased access to evidence-based smoking and other tobacco-use cessation programs in VA and DoD.

  4. Evaluate changes, including changes in policy, that could help to lower rates of smoking and other tobacco use in military and veteran populations.

  5. Identify policies and practices that address unique tobacco-use prevention and cessation needs of special populations in DoD and VA, including those with psychiatric or substance-use disorders, those with chronic medical comorbidities, and women.

  6. Recommend research approaches for reducing initiation of tobacco use and promoting tobacco-use cessation.

In response to the agencies’ request, IOM convened the Committee on Smoking Cessation in Military and Veteran Populations, which wrote this report. In reviewing the original statement of task, the committee felt it appropriate to modify the language slightly from “smoking” to “tobacco” so that all tobacco products, particularly smokeless tobacco, would be included; the statement of task above reflects the committee’s modifications. The committee did not modify the language used in the various studies cited in the report; if a published study indicated that smoking was the focus, then the committee cited the study as being about smoking, not tobacco use. The committee was not tasked with assessing the implications of tobacco use on veterans’ disability claims or compensation. And it did not review the health



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