who continued to smoke reduced their tobacco consumption. Furthermore, stopping smoking did not exacerbate the PTSD or comorbid depression (McFall et al., 2006). Beckham et al. (2008) found that smokers with PTSD were more likely to smoke when experiencing PTSD symptoms, anxiety, and stress.

Finding: Veterans who have mental-health conditions may rely on the VHA for all of their health-care needs and may be unable to get access to tobacco-cessation treatment programs outside of VA. VA programs that integrate mental-health and tobacco-cessation treatment may increase cessation in veterans who have mental-health disorders.

Recommendation: The VA should use an integrated approach for treating mental-health disorders and tobacco use. Mental-health providers should receive training in tobacco-cessation treatments and provide them to any patients who are willing to quit.

Other Populations

Smoking by veterans who have multiple sclerosis is common (28.5%). Many of them have attempted to quit, but most of those interested in quitting report that they do not receive smoking-cessation services (Turner et al., 2007).

Veterans make up about one-third of the homeless population, and virtually all those veterans are male. Most homeless veterans are single, have poor and disadvantaged backgrounds, and are older and better educated than homeless nonveterans. About 45% of homeless veterans suffer from mental illness, and slightly more than 70% suffer from problems of alcohol or other drug abuse with substantial overlap in morbidities (VA, 2009c). There is virtually no information on tobacco use or tobacco-cessation services for homeless veterans.

VA does not have a formal policy regarding tobacco-cessation services for spouses of veterans and nonveteran VA employees. Spouses of veterans and nonveteran VA employees are not eligible for VA pharmacy benefits that might cover the costs of tobacco-cessation medications or of formal counseling. Some VA cessation counselors, however, allow and even encourage veteran smokers to bring another person for support and to participate in cessation counseling sessions, but this practice is at the discretion of each counselor. The evidence shows that it is more difficult for a person to quit smoking if his or her spouse

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