THE COMMITTEE’S APPROACH TO ITS CHARGE

The committee held two information-gathering sessions with representatives of the DoD TRICARE Management Activity (part of the Military Health System [MHS]), the Air Force, the Navy, the Army, VA, veterans service organizations, and with experts in smoking-cessation programs and policies. In addition, literature searches were conducted, and information was requested directly from DoD and VA.

To evaluate the current policies and programs systematically and to provide guidance for future directions for tobacco control in VA and DoD, the committee first identified what constitutes the evidence base that forms the best practices; in general, these are successful programs and approaches used in the general US population. The committee then attempted to determine whether DoD and VA were using those best practices by reviewing published studies of tobacco use in military and veteran populations; DoD and VA instructions, directives, and regulations; and other information sources, including Web sites. If the best practices were not being used, the committee identified possible obstacles to their implementation and made recommendations for overcoming them from policy and programmatic perspectives. It also developed a research agenda for DoD and VA.

SCOPE OF THE PROBLEM

The US military and dependent population consists of nearly 3.5 million people: about 1.1 million Army, 500,000 Air Force, 470,000 Navy, 215,000 Marine Corps, about 3 million family members, and more than 800,000 civilian employees. Although smoking prevalence dropped from 51% in 1980 to 32% in 2005 in the armed services, there has been an upturn in consumption in the last decade. Cigarette-smoking and use of smokeless tobacco are most prevalent in the Army and the Marine Corps and least prevalent in the Air Force. Smoking is also more prevalent among military men than women and among personnel 18–25 years old.

There are more than 24 million US veterans, of whom 6.7 million are enrolled in the VA health-care system. Of the 6.7 million, 45% are 65 years old or older, 41% are 45–64 years old, and fewer than 1 million (14%) are less than 45 years old. Most of the veterans using the VA health-care system served during the Vietnam era (1965–1974). VA estimates that 75% of disabled and low-income veterans use the VA system. About 22.2% of all veterans enrolled in the VA health-care system are current smokers.

Tobacco use adversely affects military performance. Military personnel who smoke have reduced physical-performance capacity,



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