continues to smoke (Monden et al., 2003; Murray et al., 1995; Osier and Prescott, 1998). VA employees, including union employees, may not have health-insurance coverage for prescription tobacco-cessation medications and may have to pay for both over-the-counter NRTs and prescription medications themselves whereas veterans can receive both types of medications as a covered benefit.

Ensuring the quality of all VA health programs is a continuing task and one that requires constant surveillance to determine what programs and policies are working and what should be done to correct the ones that are not. VA has used quality measurements and performance standards for many years but has not integrated them into an evaluation process that helps it to meet its goal of providing veterans with high-quality health care (Rosenheck, 2006). An assessment of performance does not necessarily result in improvement unless problems are addressed (Fink, 2005).

VA conducts periodic internal surveys of veterans’ health, for example, the 2005 Survey of Veteran Enrollees’ Health and Reliance upon VA with Selected Comparisons to the 1999–2003 Surveys. The surveys provide information on how many veterans use tobacco and how tobacco use varies by socioeconomic status, public and private insurance, health status, enrollee priority group, and VISN. That information is designed to assist VA decision-makers in policy development and strategic planning. The most recent survey shows that about 22% of veterans enrolled in the VA health service use tobacco (VA, 2006a). Evaluation programs can help VA in determining which of its programs have been most effective in helping various populations of veterans to cease tobacco use.

VA has also conducted surveys of tobacco use and control throughout its health-care system. In particular, the 2005 Smoking and Tobacco Use Cessation Report (VA, 2006b), conducted for the Office of the Assistant Deputy Under Secretary for Health for Policy and Planning, provides a quantitative snapshot of smoking and tobacco-use cessation activities and smoke-free policies in VA. This survey of 158 VAMCs assessed facility resources to improve outcomes, identify best practices,