which includes seeing a dentist, at least once a year; this is an ideal opportunity to provide them with strategies to resist trying tobacco.

Finding: Ironically, the very environment that appears to be conducive for tobacco users to remain abstinent (the post–basic-training period) also appears to be conducive to tobacco initiation by never-users and experimental users.


Recommendation: Given the high rate of eventual tobacco-use initiation, the committee believes that future research in tobacco-use prevention efforts in the military should have high priority.


Finding: The committee commends the armed services for their bans on tobacco use during basic training.


Recommendation: The committee recommends that DoD promptly establish a timeline to extend the tobacco ban beyond entry-level–enlisted and officer-training programs to eventually close the pipeline of new tobacco users entering military service and to eliminate tobacco use on all US military installations.

SURVEILLANCE AND EVALUATION

Surveillance activities—the processes of monitoring tobacco-related attitudes, behaviors, and health outcomes at regular intervals—can occur at many organizational levels and serve a variety of functions. Survey instruments are one mechanism for collecting short-, intermediate-, and long-term data on process and population outcomes and eliminating disparities. The data are evaluated to provide an indication of how tobacco-control programs are operating and whether they are meeting their goals.

The 1999 strategic plan’s Goal D.1 specifies that the MHS should actively identify tobacco users and provide targeted interventions. To identify tobacco users, a systematic approach is best. The strategic plan calls on DoD to “develop and monitor a centralized, Tri-Service (Army, Navy, and Air Force) reporting and surveillance system to track tobacco use” (Requirement D.1), “develop a plan to annually conduct a health-risk appraisal that includes the assessment of tobacco-use habits and mandates participation for active-duty personnel” (Requirement D.1.3), “develop a draft policy that requires tobacco use to be documented as ‘5th vital sign’ at all medical and dental appointment”



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