about half of the 130 facilities in the survey followed any tobacco-use–cessation clinical-practice guideline (DoD, 2008).

VA/DoD guideline recommendations are mirrored in service-specific regulations and in the 1999 Strategic Plan. For example, Army Regulation 600-63 (May 7, 2007) on health promotion specifies that “as a part of routine physical and dental examinations and at other appropriate times … health care providers will inquire about the patient’s tobacco use … and advise the patient of risks associated with use … and where to obtain help to quit.” It recommends that patients be referred to the MEDCOM Web site on tobacco-use management: http://www.qmo.amedd.army.mil/smoke/smoke.htm. [Note: the committee was unable to access this page and suggests that the regulation be changed to refer patients to the DoD Web site, http://www.ucanquit2.com.] It also specifies that “installations will provide tobacco-cessation programs for all health care beneficiaries and as resources permit, for civilian employees.” The regulation requires that military treatment facilities use the most current VA/DoD clinical-practice guideline and that its use be enforced in all primary-care facilities on the installation. The SECNAV Instruction 5100.13E (June 2008) specifies that “Military Treatment Facilities [and] Fleet and Family Service Centers … shall provide current tobacco-use information, cessation encouragement, and professional assistance to those wishing to stop using tobacco” and also requires that all medical-care providers at all medical and dental facilities apply tobacco-use–cessation clinical-practice guidelines. The committee notes that although Air Force Instruction 40-102 (June 3, 2002) requires that tobacco-cessation programs be available during both duty hours and nonduty hours at least quarterly, there is no requirement or guidance on using the VA/DoD guideline. Furthermore, holding classes quarterly may not be an effective strategy for tobacco cessation. Counseling should be available when the person wants to quit; a delay of even 24–48 hours may mean that the opportunity for abstinence is lost.

Not all military installations have the resources to offer tobacco-cessation programs, and the committee was unable to determine the frequency with which such programs are offered. Lack of ready access to tobacco-cessation programs may prove to be a barrier to military personnel and their dependents who are seeking assistance with quitting. Army Regulation 600-63 (May 2007) states that if a tobacco-cessation program is not available through a military treatment facility, programs are to be coordinated through local community resources, such as ACS and ALA. Civilian employees on Army installations may also participate in tobacco-cessation programs, but civilians are to be referred to community resources if space is not be available or if there is no such



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