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Combating Tobacco Use in Military and Veteran Populations
to assess compliance with standards of care. The Air Force has also developed a list of metrics to evaluate its tobacco-cessation programs. Those metrics, which track only active-duty personnel, include reporting of the number of personnel who are tobacco users, the type of product used, the number of personnel making or contemplating quit attempts, attendance at cessation classes, referrals to outside resources (such as the ALA Freedom from Smoking Web-based program), the number of installations funding quitlines, and the number of calls to the quitlines (Kathy Green, Air Force, personal communication, July 30, 2008). The Army does not appear to use any comparable metrics.
Two goals in the 1999 DoD Tobacco Use Prevention Strategic Plan apply to the evaluation of tobacco-cessation programs. Goal D.2 states that tobacco-cessation programs in the MHS are to be evaluated for effectiveness. Goal E, to “continually assess best practices in the area of tobacco prevention,” is to be reached by developing plans to assess prevention and early-intervention strategies and by developing and evaluating pilot programs of best prevention practices. The committee notes that each of the goals in the strategic plan has an accompanying metric or objective that helps in addressing the requirements to meet it. For example, Goal D.1, which includes identifying tobacco users, requires the development of a “centralized, Tri-Service reporting and surveillance system to track tobacco use.” The metric for determining whether the goal is being met is the percentage of medical records that note tobacco-use status on forms DD2766 or AF 1480A (adult preventive-care and chronic-care flowsheets, which were in development when the strategic plan was developed).
The Army CHPPM Web site has a document, “Evaluation of Tobacco-Use Cessation Efforts in the Military Health System (MHS) Direct-Care System,” that describes an in-depth evaluation of the tobacco-cessation efforts at installations and among the armed services. The evaluation assesses the types of programs; which health professionals conduct the programs; how quit rates are measured by program and tobacco-use type at 1, 6, and 12 months; which tobacco-cessation medications are used and whether they have an effect on quit rates; and how frequently tobacco-use and intervention ICD-9 and CPT-4 codes are used in the MHS. The committee understands that this evaluation has been undertaken by a DoD contractor and that results are available but cannot be released to the public, including this committee, for confidentiality reasons. A 3-page factsheet, based on the evaluation and available in the Spring 2009, reported that the MHS offers comprehensive programs for tobacco use and prevention with most military treatment facilities offering formal programs with some outreach (DoD, 2008). The committee believes that such data should be available