control, personal hygiene, dress, appearance, and other lifestyle-related behaviors. To ensure military readiness and performance, the DoD requires that military personnel meet basic physical-fitness requirements, including weight management, when they enter the military and throughout their careers.


Recommendation: DoD and individual armed services should review these policies and revise them to ensure that they are consistent and address the potential effects of all health-related behaviors on military readiness. Tobacco abstinence should be included as a physical-fitness requirement for the armed services as is weight management.


Finding: Many tobacco-cessation programs do not address weight management.


Recommendation: Weight-management education and counseling should be included in military tobacco-cessation programs.

DELIVERY OF INTERVENTIONS

In the sections below, the committee considers how each of the armed services provides tobacco-cessation interventions to its members, including behavioral and pharmacologic interventions in medical facilities or health-promotion facilities, quitlines, and computer-based programs. The committee also considers how the armed services ensure that their health providers are familiar with current tobacco-cessation interventions.

Clinical Settings

The VA/DoD Clinical Practice Guideline for the Management of Tobacco Use was last updated in June 2004 based on an evidence review through December 2002. Overall, the guideline follows the population approach recommended by the 2000 and 2008 PHS guidelines (see Chapter 4). The guideline recommends similar system-level resources for practitioners (such as dedicated practice staff, reminders, and vital-sign indicators) and access to behavioral and pharmacologic treatments. A 2007 DoD evaluation of tobacco-use–cessation programs available in medical treatment facilities across the armed services, found that only



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