facilities provide a break room for nonsmoking employees to counteract the perception that smokers are permitted more breaks (VA, 2007a).

VA employees and contracted professionals perform ordinary functions that do not require the unique standard of physical fitness needed for military action. Therefore, it would be difficult to justify a policy that requires abstinence from tobacco use for VA personnel beyond the requirement not to smoke on VA premises or in the same areas as patients. Although there are few legal restrictions on adopting such a policy, it has the disadvantage of necessarily applying to many personal traits and behaviors beyond tobacco use, such as weight management. If VA were to require its employees to be nonsmokers, several principles might be available for justifying the use of smoking as a disqualification for employment: anything that adversely affects a person’s health also adversely affects the person’s ability to work, employers have the right to refuse to hire anyone who might increase costs to the employer regardless of the probability or amount of such cost increases, employers have the right to require their employees to behave in their private lives so as to promote the interests of the employer, and employers have the right to refuse to hire anyone for any reason or no reason regardless of ability. If VA adopts any of those principles, it could encourage similar policies by other public agencies and private organizations that are seeking to exclude employees for reasons other than tobacco use.

Finding: Many VAMC facilities have multiple smoking areas for both veterans and employees although this may change in response to a new VHA directive. Most VAMCs have taken steps to offer tobacco-use–cessation services to interested employees, but such services are not available in all VA facilities.


Recommendation: VA patients and staff should have barrier-free access to tobacco-cessation services if they use tobacco.

TOBACCO-CONTROL INTERVENTIONS

The VHA is a full-service health-care system that provides treatment for medical and mental-health conditions in inpatient and outpatient facilities. Tobacco-use cessation is one of the services offered to both inpatients and outpatients. After leaving active duty, veterans who participated in tobacco-cessation programs while on active duty in the military and want to continue in such programs must find new ones



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