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Combating Tobacco Use in Military and Veteran Populations
DoD offers a variety of tobacco-cessation interventions to active-duty military personnel and their dependents, military retirees and their dependents, and active-duty National Guard personnel and reservists through the MHS and the TRICARE Management Activity (TMA). In contrast with general civilian medical settings in which the availability of community tobacco-cessation programs can vary considerably, DoD ensures that some form of tobacco-cessation program is available to the entire population of tobacco users. The 1999 Tobacco Use Prevention Strategic Plan has two goals for tobacco cessation: D.1, “Military Health System actively identifies tobacco users and provides targeted interventions,” and D.2, “Military Health System provides effective tobacco cessation programs.” The committee acknowledges that when the plan was prepared, the TMA was prohibited by statute from paying for tobacco-cessation treatments. The FY 2009 NDAA reversed that prohibition and mandated that TRICARE offer smoking-cessation programs to its beneficiaries. The committee stresses that the language in the appropriation act calls specifically for smoking-cessation programs: this might not cover programs for cessation of other forms of tobacco use. That may be of concern inasmuch as smokeless-tobacco use is increasing in some military populations (see Chapter 2).
There are two mandates for smoking-cessation programs in DoD: DoD Instruction 1010.15, “Smoke-Free DoD Facilities,” and 32 CFR 85, “Health Promotion.” DoD Instruction 1010.15, Section 6.4 states that DoD components shall “provide effective smoking cessation at all levels of commands” with an emphasis on primary prevention practices and motivating users to quit smoking. It further states that all smokers and high-risk personnel shall receive medical counseling about the risks posed by smoking. The instruction does not mention access to any therapeutic interventions (such as behavioral and medication treatments). Section 6.5 says that information shall also be provided in health-promotion programs on the health risks posed by environmental tobacco smoke (secondhand smoke). Nevertheless, all of the armed services have established smoking- or tobacco-cessation programs that include health-care beneficiaries and usually civilian employees on a space-available basis: see Army Regulation 600-63 (2007), “Army Health Promotion”; Air Force Instruction 40-102 (2002), “Tobacco Use in the Air Force”; and SECNAV Instruction 5100.13E (2008). The Navy instruction states that all medical treatment facilities must have tobacco-cessation programs; other installations must provide professional assistance, but referrals must be made if it is not readily available.