tobacco-control program: a strategic plan, dynamic leadership, essential intervention components (enforceable and enforced policies, communication interventions, and evidence-based treatments), adequate resources, surveillance and evaluation of the program’s effectiveness, and management capability to adjust the program in response to that evaluation. In this section, the committee describes VA’s tobacco-control efforts and highlights the policies and programs that are in place and working well. This section also provides guidance on where important activities are lacking or where existing ones could be enhanced to improve tobacco cessation in the VA patient population and in VA employees.

The key components already in place—including many effective and enforceable policies, communication mechanisms, surveillance activities in the form of performance measures, and periodic evaluation of tobacco-control practices throughout the VISNs—can be leveraged to expand and coordinate tobacco-control activities throughout VA. The agency lacks a strategic plan, senior leadership that believes that tobacco cessation should have high public-health priority for VA, a dedicated funding source for tobacco-control activities, and innovative approaches for raising veterans’ awareness of available tobacco-cessation services.

VA is ideally structured to ensure adequate capacity and collaboration at all program levels while each VISN tailors tobacco-cessation activities to local circumstances and the needs of veterans and health-care providers. VA has an advantage over private-sector healthcare systems in that it is able to make institutional changes at the highest administrative levels without worrying about profits or stockholders. This does not mean that the secretary of veterans affairs or the under secretary for health can make changes without consulting their staff, the NLB, or the veterans; but they do have the ability to change policy, procedures, and the institutional culture in VA quickly and uniformly. If tobacco cessation has high priority for the secretary and the under secretary, it will have high priority for the VISNs and all of the VA heath-care providers.

As noted earlier, the responsibility for developing VA tobacco-control programs resides in the PHSHCG at VA headquarters, and the programs are implemented as part of the National Prevention Program. VHA Directive 2008-081,1 dated November 26, 2008, outlines VA’s National Smoking and Tobacco Use Cessation Program and lists all of the necessary resources for program implementation. The directive requires that VA continue its commitment to prevention with a “strong


VHA Directive 2008-081, issued November 26, 2008, rescinded VHA Directive 2003-042.

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