training was so intense that they did not even recognize that they had quit smoking; sleep deprivation, intense physical conditioning, and an overall demanding training schedule left most with no time to think about tobacco use.

Focus-group participants were also asked their opinions of the tobacco-free policy in basic training. The vast majority of former smokers indicated that they approved of the policy and thought it was consistent with the overall training mission. In addition, focus groups with Air Force technical-school students who had relapsed to smoking indicated that if the Air Force wanted them to remain tobacco-free, it should just extend the tobacco ban for the duration of their enlistment. Most felt that staying tobacco-free after the completion of basic training would be relatively easy if a policy prohibited the use of tobacco (Peterson et al., 2003).

Preventing Initiation and Relapse After Basic Training

There appears to be substantial initiation in the first year of military service in those who were not tobacco users before entering the military (Williams et al., 1996). Two studies that evaluated smoking initiation in the military (Klesges et al., 1999, 2006) found that 8–10% of trainees who reported never smoking (“not even a puff”) before basic training were smoking at a 1-year follow-up, and 26–30% of experimental smokers, defined as having had one to two cigarettes in their lifetimes, reported smoking at follow-up. Klesges et al. (2006) randomized Air Force personnel who entered basic training and reported either being nonsmokers or experimental smokers into a smoking-prevention intervention group or a control group. The prevention program had no effect on smoking initiation (Klesges et al., 2006). Similar results were found by Conway et al. (2004), who posited two possible reasons for the finding: either the prevention-intervention strategy validated on younger people did not translate to the slighter older population, or military personnel may be particularly recalcitrant to tobacco-use prevention efforts.

The VA/DoD clinical-practice guideline provides a detailed discussion of tobacco-use prevention and relapse. Approaches include motivating current tobacco users to quit with such strategies as the 5 R’s (relevance, risks, rewards, repetition, and roadblocks), motivational interviewing, and encouraging continued abstinence for those who do quit. Of particular relevance to DoD is preventing the initiation of tobacco use in military personnel who had not used tobacco before entering the service. The guideline provides practical advice on assessing the likelihood that these people will start to use tobacco and encouraging them not to do so. All military personnel see a health-care provider,

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