(Requirement D.1.4), and “assess Service policies, and draft policy if necessary, to require routine screening of all beneficiaries as part of ‘Put Prevention Into Practice’ program, with providers using guidelines from the Agency for Health Care Policy and Research” (Requirement D.1.5). DoD and the armed services have made great strides in meeting those requirements.

DoD conducts periodic surveys to ascertain tobacco use by active-duty military personnel. The most recent one for which data are available, the 2005 DoD Survey of Health Related Behaviors Among Active Duty Military Personnel (DoD, 2006), determined the prevalence of alcohol use, tobacco use, and illicit-drug use on the basis of self-reports by 16,146 military personnel in all four armed services. Achievement of selected Healthy People 2010 objectives and adverse outcomes were also assessed. The TMA conducts the annual congressionally mandated Health Care Survey of Department of Defense Beneficiaries to assess user satisfaction with, and access to, the MHS. The healthy-behaviors section asks participants whether they have ever smoked; if so, how much; if they quit, for how long; whether they were advised by their doctors to quit; and whether their doctors or other health-care providers discussed methods and strategies (other than medication) to assist in smoking cessation. Questions on the use of medications are not included. Composite data from both surveys are publicly available. The DoD Health Plan Analysis and Evaluation staff conduct beneficiary surveys that include information on smoking and advice to quit. DoD also maintains the Medical Data Repository, which contains information on the use of tobacco-related diagnosis and treatment codes within the MHS direct-care system.

Each armed service uses a variety of self-reported metrics to assess its tobacco-cessation programs in support of its health-promotion activities. The Navy and the Air Force use metrics to track tobacco use and cessation by service personnel. The Navy Health Promotion Wellness Tobacco Program metrics are used by staff at 32 military treatment facilities, including 3 medical centers, 15 naval hospitals, and 14 health and medical clinics. Metrics are submitted semiannually and cover the number of tobacco-cessation programs offered, individual and group counseling sessions held, training of facilitators, and costs for tobacco-cessation medications (Navy, 2009). NAVHOSPGLAKES Instruction 6220.7 (July 8, 2005) on tobacco-cessation services for the Great Lakes Naval Hospital includes a tobacco-cessation form to be used when a patient inquires about quitting tobacco use. The form is used to conduct follow-up with patients and to track success rates.

The Air Force, like the Navy, uses the National Committee for Quality Assurance’s Healthcare Effectiveness Data and Information Set