appropriate addiction therapies, and whether the person will go to the suggested counseling sessions. Tobacco-treatment specialists are also an integral component in the continuum of tobacco-control interventions. In addition to treatment, there is a need for system change at the local level to enact program changes that will increase the likelihood of health providers helping users to quit. Local program change implies culture change and requires strong leadership; clear patient, staff, and environmental goals; strategic plans that include specific objectives and tactics; and policies to promote the sustainability of the change efforts.
A comprehensive tobacco-control plan in VA and DoD will require system change and should consider tobacco-control tactics at both the macro level and the micro level. In this report, the committee discusses the need for an integrated and comprehensive plan for DoD and VA to use in developing and implementing the necessary policies and programs to eventually achieve a tobacco-free military and veteran population. In addition to a comprehensive plan, there is a need to identify which programs and treatments are most beneficial for treating nicotine dependence in the various military and veteran populations; clear evidence-based practices for the general population are available. And there is a need to continue research in VA and DoD settings to improve treatments for those with co-occurring mental disorders.
To achieve those goals, it will be necessary to institute changes in DoD and VA at numerous levels and in several domains. The points at which change must occur vary from the highest levels of influence (such as the secretary of defense or the secretary of veterans affairs) down to the individual military member and veteran. Effective changes require numerous functional components, such as organizational capacity, adequate human and material resources, coherent and enforceable policies, and effective and appropriate communication. The committee has attempted to provide structured guidance for DoD and VA on what must be done to identify the necessary changes at all levels; implementation of the recommendations would ideally achieve a comprehensive and integrated tobacco-control program that improves the readiness of the military and the health of military personnel, veterans, and their families.
The committee acknowledges and commends the efforts of VA and DoD in working to develop and implement tobacco-control programs. Many of the programs are based on those developed by such organizations as the American Lung Association and the American Cancer Society; however, the latter programs were not tailored to military and veteran populations. The committee recognizes that it is seeing only a snapshot of the policies and programs being used by DoD