their implementation and made recommendations on how to overcome them from both a policy perspective and a programmatic perspective, including identification of who must implement the recommendations. If the practices were in use, the committee attempted to determine whether they were being used effectively, and what possible modifications might be necessary to increase their effectiveness for particular DoD and VA populations. The committee found that there was a lack of information on whether the tobacco-control policies and regulations established by the DoD were in fact enforced on military installations and, if so, to what extent. There was also a lack of information on tobacco-cessation programs for the DoD, the armed services, and individual military installations. The committee found the presentations from the representatives of each of the armed services on current practices regarding tobacco control to be very helpful, but the committee was aware that the representatives did not provide a comprehensive assessment of what tobacco-control activities occur throughout their service and on individual military installations. The VA has conducted surveys and held forums that provide more helpful information on the tobacco-control activities at some VA health facilities and these resources are cited throughout this report.

The committee considered how general tobacco-control strategies used in aiding regions, states, and even nations in decreasing tobacco use and dependence could be specifically tailored to DoD and VA. Tobacco control is a term used for a broad array of tactics that reduce tobacco use through policies and prevention and treatment interventions; efforts range from the population to the local-agency level. The strategies recognize the need for systems change and for a comprehensive plan to address the unique aspects and complexities of DoD and VA.

Most tobacco-control specialists have a public-health orientation and focus on mechanisms to reduce tobacco use and its consequent health-care burden at the population level. They work to reduce or prevent tobacco use on a large scale—the national, state, or regional scale. Examples of effective population-scale policies and interventions include increasing the cost of tobacco products, bans and restrictions on tobacco use, reducing out-of-pocket costs for treatment of tobacco addiction, counteradvertising campaigns, telephone quitlines, and multicomponent smoking-cessation campaigns (VA, 2004). The focus of tobacco control is often different for health-care providers, who deal with nicotine dependence on an individual level. For example, they attempt to help soldiers or veterans who have smoked a pack of cigarettes a day for 10 years to quit. Their concerns are related to whether a person is receptive to the idea of quitting, whether the pharmacy carries the

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