smokeless tobacco and referral to existing local tobacco-cessation programs. Results showed that participants in behavioral treatment were significantly more likely to be abstinent from all tobacco at the 6-month follow-up point than participants in usual care (25.0% vs. 7.6%, respectively, using 7-day point prevalence), including smokeless tobacco abstinence (16.8% vs. 6.4%). Those results indicate that minimal-contact behavioral treatment can significantly reduce smokeless-tobacco use in military personnel (Severson et al., 2009).

Most smokeless-tobacco users also smoke cigarettes; current smokers are 3 times as likely as never-smokers to use smokeless tobacco (Ebbert et al., 2006). In a study of over 36,000 Air Force personnel, the prevalence of self-reported smokeless-tobacco use was 24%, but 95% of smokeless-tobacco users also “regularly“ or “occasionally” used another form of tobacco, commonly cigarettes. At least 82% of all smokeless-tobacco users were regular cigarette smokers (Robert Klesges, University of Tennessee Health Science Center, personal communication, January 23, 2009). In addition, restrictions on where and when tobacco may be smoked may encourage smokers to use smokeless tobacco during active-duty hours. Because dual users have a higher estimated nicotine exposure (Wetter et al., 2002) and are less likely (relative to those who use cigarettes or smokeless tobacco exclusively) to quit smoking (Rodu, 2003; Wetter et al., 2002), obtaining onset and cessation data on dual users in the military should have high priority in planning tobacco-control programs for the military services. The committee believes that finding effective tobacco-cessation interventions for dual tobacco users will be challenging.

Finding: Smokeless tobacco should be subject to the same restrictions as smoked-tobacco products.


Recommendation: DoD and the armed services should make tobacco-cessation interventions for smokeless-tobacco use as available as those for smoked tobacco. Furthermore, they should track its use by military personnel to determine the effectiveness of any interventions. Given the growing rate of dual use of tobacco products by military personnel, DoD should develop targeted interventions for these tobacco users, including a comparable pricing structure with cigarettes and counteradvertising campaigns.



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