counseling or who might be motivated to quit or to supplement other interventions (VA/DoD, 2004).

A 2007 DoD evaluation of tobacco-use–control programs available at 130 military treatment facilities across the armed services found that over 90% of the programs contained content on assessing readiness to quit, understanding nicotine addiction, setting a quit date, understanding triggers, managing stress, handling withdrawal, problem-solving skills, preventing weight gain, finding support, and relapse prevention and management. Fewer programs offered pre-program interviews (63%) and telephone support after the classes (74%) (DoD, 2008).

Tobacco-Cessation Medications

Requirement D.2.2 in support of Goal D.2 is that DoD “draft policy to fund Military Treatment Facilities pharmacies to specifically stock a variety of NRT and other approved pharmacological interventions that have substantial empirical support for their use (e.g., bupropion) to accommodate individualized therapy.” The armed services also use the VA/DoD guideline as a framework for their tobacco-cessation programs. Air Force Instruction 40-102 states that “tobacco-cessation programs incorporate cognitive and behavior change strategies, the ‘cold turkey’ approach, or the use of [NRT] when appropriate.” The instruction also designates a provider from the military treatment facility to be the point of contact to assess appropriateness of NRT and contraindications for use and to prescribe therapy as needed. Air Force Instruction 40-101 (May 9, 1998) on health-promotion programs requires medical-group commanders to make NRT available to all eligible beneficiaries and requires tobacco-cessation facilitators to receive behavior-modification training to conduct the programs. On many bases, access to tobacco-cessation medications, including Food and Drug Administration (FDA)–approved over-the-counter and prescription medications, requires a tobacco user to attend cessation classes (G. Wayne Talcott, US Air Force, presentation to committee, March 13, 2008). The committee finds that such a requirement is likely to pose a barrier for Air Force personnel seeking tobacco-cessation treatment as discussed in Chapter 4. The Navy Bureau of Medicine and Surgery has issued a position stating that all providers who are familiar with the VA/DoD guideline should be allowed to prescribe tobacco-control medications and that no restrictions should be placed on providers who wish to prescribe the medications to patients who use tobacco or on patients who wish to use the medications without attending tobacco-cessation programs. The statement provides some recommendations for

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