The CFR states that—operationally—health promotion includes smoking prevention and cessation. 32 CFR 85 includes restrictions on smoking on military installations and in medical-treatment facilities, living quarters, and vehicles. Health-care providers are to advise pregnant smokers about risks to the fetus, and the armed services are required to provide public-education programs on the adverse health effects of smoking. The regulation does not require DoD to offer tobacco-cessation treatment.

Although secondhand smoke is not considered in depth in this report, effective comprehensive tobacco-control programs in the DoD and the VA will inevitably reduce exposure to secondhand smoke. Secondhand-smoke exposure is of concern both for military personnel who are exposed on military bases and for families of military personnel or veterans whose health care is the responsibility of DoD or VA. Because secondhand smoke poses a well-documented and substantial risk to the health of nonsmokers, their protection should be given high priority by policy makers and providers of military and veteran health care. Nonsmokers, including families of military personnel, should be asked about exposure to secondhand smoke as part of their routine medical care; smokers should be strongly encouraged not to smoke at home or in vehicles occupied by nonsmoking family members or friends.

In the sections below, the committee considers some of the activities that DoD and the armed services have taken to address the requirements listed in the strategic plan to identify tobacco users and provide effective tobacco-cessation programs. The committee notes that in the discussions of tobacco-use interventions and their delivery in the next section, the focus is on interventions offered by the DoD MHS, not the TMA. As discussed earlier, it is only with the FY 2009 DoD NDAA that smoking-cessation programs are now covered under TRICARE. It is too early to tell which programs TRICARE will select, how they will be implemented, and what effect they will have on smoking prevalence in TRICARE beneficiaries.

Evidence-Based Treatments

Requirement D.1.1 in support of Goal D.1 of the 1999 strategic plan calls for the development of a draft policy for the ASD(HA) that requires the MHS to use all avenues to identify and document tobacco users and their readiness to quit and to offer appropriate “stage of change” intervention. The “stage of change” interventions are specified in the requirements for Goal D.2 and include requirements to “assess and develop draft policy that requires tobacco cessation programs to include behavior modification, nicotine-replacement therapy (NRT)/other FDA-



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