education with other base health and fitness groups, and interact with community resources (SECNAV instruction 5100.13E, 2008). Army Regulation 600-63 (2007) requires that health-care providers ask about tobacco use at all routine physical and dental examinations. In the Army, nurses conduct the overwhelming majority of tobacco-cessation programs (77%), whereas in the Navy and Air Force, most of the programs are conducted by health educators and clinical psychologists (Mark Long, US Navy, personal communication, December 16, 2008; Kathy Green, US Air Force, personal communication, December 12, 2008). Even a 1-hour presentation on the hazards of tobacco by an Army nurse certified to teach the ACS Freshstart program had an effect on motivating tobacco users to contemplate quitting (Morgan, 2001).
Other health-care professionals who are tasked with tobacco-prevention and -cessation responsibilities include Air Force fitness-assessment monitors, who must ask about tobacco use at the physical fitness evaluation; medical providers, who are to ask about tobacco use at every encounter; and dental providers, who are to ask about tobacco use at least annually (Air Force Instruction 40-102, 2002). Medical, dental, and primary-care managers are to provide tobacco-cessation advice to all tobacco users, as stated in the 2000 PHS clinical-practice guideline, and to refer tobacco users who want a cessation program to health-promotion personnel. Unlike the civilian sector, all of the military services require that dental professionals ask patients about tobacco use and provide referrals. Inasmuch as military personnel are required to have annual dental and medical examinations, that provides an ideal recurring opportunity to assess tobacco use and encourage cessation. Military dentists can be a good source of tobacco-cessation guidance and patient education (Burns and Williams, 1995; Chaffin, 2003). The Army Dental Command has implemented a program that makes tobacco-use assessment mandatory during dental examinations. The tobacco-cessation program empowers dentists to provide clinical-level counseling (including the 5 A’s, brief motivational interviewing, and “teachable moment” techniques) and to prescribe NRTs (Covington et al., 2005). The Navy encourages Navy dentists and pharmacists to be active in using the 5 A’s (at the very least, to ask, advise, and refer patients) to assist patients to quit tobacco use, including the prescribing of tobacco-cessation medications if they are properly trained and follow the VA/DoD guideline (Navy BUMED position statements, February 21, 2008).
Occupational-health clinics in the Army are designated to provide tobacco-cessation programs for civilian employees or, if such programs are not feasible on an installation, to provide referral to local community programs (Army Regulation 600-63, 2007), but the