Being close to or over the allowable weight standard may pose an additional barrier to tobacco cessation in active-duty military personnel and increase the likelihood of relapse (Russ et al., 2001). In a review of interventions for preventing weight gain after tobacco cessation, Parsons et al. (2009) found that tobacco-cessation medications were effective in reducing weight gain as long as they were used but had no long-term benefit. However, cognitive-behavioral therapy helped to reduce long-term weight gain. Peterson and Helton (2000) suggested that each service grant a one-time temporary weight waiver for active-duty military members who successfully quit, allowing for a temporary waiver so that ex-smokers have time not only to overcome their smoking addiction but to address the weight gain (Peterson and Helton, 2000).

The committee has found in its review of the various tobacco-cessation activities an inconsistency in DoD’s determination of physical fitness for military personnel. For example, Army Regulation 350-1, Army Training and Leader Development (August 2007), states that “the objective of the Army physical fitness training is to enhance combat readiness by developing and sustaining a high level of physical fitness in Soldiers as measured by … body composition standards as prescribed by AR 600–9 [The Army Weight Control Program]” and a “healthy lifestyle (provide nutrition, avoid smoking and substance abuse, manage stress).” The justification for the physical-fitness requirement is to ensure a soldier’s safety and that of other unit members. The committee believes that although the regulation states that avoiding smoking is one aspect of physical fitness, the statement, which does not give tobacco-free living a priority equivalent to that of weight control, is not sufficiently stringent to ensure that tobacco cessation is considered crucial for military readiness.

Finding: The VA/DoD Clinical Practice Guideline for the Management of Tobacco Use is a valuable resource for DoD and VA health-care providers.

Recommendation: VA and DoD should revise their current guideline or adopt the 2008 PHS guideline with whatever modifications are necessary for military and veteran populations.

Finding: Given the long- and short-term health consequences of tobacco use for military readiness, the armed forces’ policies regarding tobacco use are inconsistent with those used for physical fitness, weight

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