readiness and the short- and long-term health effects of tobacco use. The short-term effects are of great importance for military personnel; the long-term effects will be evident in retired military personnel, their dependents, and veterans, especially older ones. Also highlighted is the resulting increase in health-care costs to military personnel, veterans, and US taxpayers. Chapter 3 explains the socioecologic model that the committee uses to identify the levels at which change must occur for an effective tobacco-control program to be developed and implemented. The levels are applicable to both DoD and VA and range from the individual (soldier, airman, sailor, marine, or veteran) to the societal (government departments and the civilian population); a comprehensive program will be successful if change is implemented throughout all the described levels. In Chapter 4, the committee presents the evidence that supports the need for a comprehensive program for tobacco control in DoD and VA. This chapter describes the key components of comprehensive programs developed by other organizations, such as state governments, that have proved to be successful in reducing tobacco consumption in other populations: communication interventions, such as counteradvertising and public-education campaigns; tobacco-use restrictions in the workplace, educational settings, and outdoor spaces; the tobacco retail environment; tobacco-cessation interventions, such as counseling and medication; delivery mechanisms for the interventions, such as quitlines, clinical settings, and computer-based programs; tobacco-cessation approaches for special populations, such as those with mental-health disorders and comorbid medical conditions; relapse-prevention approaches; and surveillance and evaluation. In Chapter 5, the committee looks at DoD through the lens of a comprehensive tobacco-control program and examines what policies, programs, and services the department already has in place that meet the requirements with respect to each of the key components. It also identifies barriers in and outside DoD to the development of a comprehensive program as well as current policies and practices that might be leveraged to improve the prevention of tobacco use and improve tobacco-cessation rates in military personnel who use tobacco. In Chapter 6, the committee takes the same approach to VA with an emphasis on tobacco cessation and the treatment of veterans who have mental-health disorders. Finally, Chapter 7 summarizes the policy and program changes identified in the preceding chapters. It highlights the recommendations that the committee believes will enable DoD and VA to develop and implement a comprehensive, integrated tobacco-control program to reduce tobacco use in military and veteran populations and their dependents, and it identifies future research that could ensure that the programs are effective and that the needs of special populations for tobacco-cessation treatment are met.



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