effects of exposure to secondhand smoke in detail or consider policies and programs to reduce exposure to it. The committee recognized, however, that reducing the use of tobacco by military personnel and veterans would inevitably reduce exposure of their dependents, colleagues, and others to secondhand smoke.

THE COMMITTEE’S APPROACH TO ITS CHARGE

The committee had several goals: to review current efforts by DoD and VA to reduce tobacco use and dependence; to make recommendations for a comprehensive approach to control of tobacco use that would lead to eliminating tobacco use and dependence in all military personnel and veterans in the VA or DoD system; to help DoD become tobacco-free by preventing initiation, thus improving the health and readiness of military personnel and eventually improving veteran health; to help military personnel who do use tobacco to quit and remain abstinent; and to help veterans in the VA health-care system to avoid or quit using tobacco. The committee also hoped to provide additional tobacco-cessation guidance to military personnel and veterans who have such conditions as posttraumatic stress disorder (PTSD) and other mental-health problems.

The committee began its work by holding two information-gathering sessions with representatives from VA, DoD TRICARE Management Activity, the Air Force, the Navy, the Army, experts in the area of smoking cessation programs and policies, and veterans’ service organizations. In addition, literature searches were conducted, and the committee reviewed relevant documents; information was also requested and obtained directly from DoD and VA.

The committee assessed current tobacco-use policies and practices in DoD, VA, and other organizations, such as Kaiser Permanente; addressed such issues as treatment, existing policies, programs, infrastructure, and special populations; and made recommendations for improving efforts. The committee was asked to focus on evidence-based tobacco-control programs and policies in its report and interpreted this to mean assessment of policies, programs, and activities that used appropriate methods and whose results were published in widely accepted and used peer-reviewed journals. To evaluate the current policies and programs systematically and to provide guidance for future directions for tobacco control in VA and DoD, the committee first identified the evidence base that forms the best practices; in general, the evidence base consists of successful programs and approaches used in the general US population. The committee then determined whether DoD and VA were using those best practices or a similar approach. If not, the committee identified possible obstacles to



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