and their need for, and access to, military and civilian tobacco-cessation programs.

RELAPSE-PREVENTION INTERVENTIONS

DoD is unique as an employer with regard to tobacco use. All new employees (recruits) are required to be 100% tobacco-free during basic training. However, the relapse rate after basic training ends is substantial. Furthermore, many young people who enter the military and were not tobacco users or had only experimented with tobacco before entering the service become tobacco users after completing basic training. Approaches for reducing the relapse rate and preventing the initiation of tobacco use after basic military training are the focus of this section.

Basic Training

All of the armed services prohibit smoking by recruits during basic training (Army TRADOC Regulation 350-6, May 8, 2007; Navy Recruit Training Command Instruction 5100.6K, May 8, 2008; Air Force Instruction 40-102, June 3, 2002; Air Force Education and Training Center Instruction 36-2216, June 16, 2004). The bans create, albeit for a brief period, a tobacco-free force. The total bans do not extend beyond initial training, and service members, to varied degrees, initiate or resume smoking after, in some cases at higher rates than before entry into the service. The early unqualified success in tobacco cessation may lead to equally successful opportunities after basic training. For example, the Air Force has extended its tobacco-use ban into some phases of technical training that follow basic training.

A major question is whether the forced cessation during basic military training is related to long-term smoking rates. Two studies have evaluated the impact of the smoking ban on long-term (1-year) cessation rates to determine whether a brief intervention (a 50-minute session with questions and answers in computer-interactive format, facilitated role-playing situations, and commitment cards) can augment the cessation rates associated with the smoking ban during the 6-week basic training. In the first study (Klesges et al., 1999), 75% of the 25,996 active-duty enrollees in Air Force basic training were randomized to receive a brief (1-hour) tobacco-control intervention and the remaining 25% were only banned from tobacco use. At the 1-year follow-up, 18% of all the recruits were abstinent. There were no statistically significant differences between the two groups. However, female recruits were nearly 30% more likely to quit smoking than male recruits (21% vs. 17%), ethnic minority-group members were 40% more likely to quit than white



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