Several other studies have assessed smoking-cessation programs that combine behavior counseling and medications in military personnel (Bushnell et al., 1997; Carpenter, 1998; Earles et al., 2002; Helyer et al., 1998). A smoking-cessation program of 11 weekly 60-minute sessions that combined bupropion SR with cognitive-behavioral therapy had a 6-month follow-up abstinence rate of 35.4% (Earles et al., 2002), but a comparison of the ACS Freshstart program with a more intensive behavioral-counseling program developed by the Vanderbilt University Medical Center showed no difference in abstinence rates at 6 months (Bushnell et al., 1997). At 12-month follow-up, 26.7% of participants in a smoking-cessation program that combined a wellness approach with stress-management skills, problem-solving techniques, and NRTs reported not smoking (Helyer et al., 1998). The Army Health Promotion and Prevention Initiatives Program compared three tobacco-cessation programs in 2005: the Army CHPPM program (see above), the ACS Freshstart program, and the ALA Freedom from Smoking program. Abstinence rates were not determined. Participants in the CHPPM program found the medications to be most helpful, whereas the ACS and ALA participants found the group setting to be most helpful (Army, 2006).

The Air Force Health Promotion personnel are now required to use the ACS Freshstart program for on-site classes or in-person education with adjunct tobacco-cessation medications as needed (Loftus, 2008). The Army is promoting the use of the ALA Freedom from Smoking program, and the primary source for spit-tobacco cessation is chewfree.com at the Oregon Research Institute (Brad Taft, US Army, personal communication, December 15, 2008).

In spite of the strategic-plan requirement that partnerships with TRICARE managed-care support contractors be encouraged to identify interventions that work and to facilitate tobacco-use education, the committee was unable to find information on such partnerships. TRICARE, through the ATAC, has supported a demonstration project called Tobacco-Free Me, discussed below in the section on computer-based interventions. The ATAC also gathers information on innovative programs in tobacco cessation and provides such information to its members.

Tobacco Cessation, Physical Fitness, and Weight Management

Most people who quit smoking gain weight. This is of particular concern in the military, in which active-duty personnel must meet weight standards. Peterson and Helton (2000) found that 88% of active-duty Air Force members who completed an 8-week smoking-cessation program gained weight. The average gain was 5.5 lb in men and 9.8 lb in women.



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