connection among stress, depression, and tobacco use in relation to triggers and relapse (available at http://usachppm.apgea.army.mil/dhpw/Population/TobaccoCessation.aspx). The site also offers other materials that may be used by medical or health-promotion staff to provide tobacco-cessation guidance for new trainees.

The Navy has a comprehensive provider-education page (http://www-nmcphc.med.navy.mil/hp/tobacco/educators.htm) that contains training materials for primary-care providers, nurses, and tobacco-cessation facilitators as well as patient-education materials. The site also has links to tobacco-cessation training for CME credit. The Marine Corps has a tobacco-cessation training guide as part of its Semper Fit health-promotion program (http://www.usmcmccs.org/healthpromotions/tobacco_cess.cfm). The program includes a Through with Chew toolkit and links to other tobacco-cessation resources in the government. Overall, those programs appear beneficial and tend to follow the VA/DoD Clinical Practice Guideline for the Management of Tobacco Use; however, the effectiveness of most programs is not known, and the military would benefit from conducting program-evaluation research. Tobacco-cessation education programs such as Rxforchange (see Chapter 4) may also be considered for training military health-care providers in tobacco-cessation interventions.

Finding: All of the armed services have educational materials on tobacco-use prevention and cessation available to health-care providers. They also make training opportunities available to medical and health-promotion staff.


Recommendation: Education programs should be consistent with the VA/DoD Clinical Practice Guideline for the Management of Tobacco Use and should be coordinated across the services.

SPECIAL POPULATIONS

Active-duty military personnel traditionally are thought of as being in top physical and mental condition, however, the MHS and TRICARE provide health care for diverse populations, including those with mental illness, dependents, retirees with comorbidities, pregnant women, and smokeless-tobacco users. Each population may have specific tobacco-use needs and require modifications of standardized tobacco-cessation treatments. Goal D.1 of the 1999 strategic plan calls for the MHS to identify tobacco users and provide targeted interventions.



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