important. These campaigns should also include smokeless-tobacco use which is on the rise.

The lack of publicly available evaluations of the tobacco-cessation programs offered by the armed services makes it difficult for the committee to recommend specific programmatic changes. However, the committee endorses the use of the VA/DoD Clinical Practice Guideline for the Management of Tobacco Use (VA/DoD, 2004) and the Public Health Service’s clinical-practice guideline Treating Tobacco Use and Dependence: 2008 Update (Fiore et al., 2008) by military healthcare providers. Easy access to tobacco-cessation medications and counseling sessions are important to ensure that tobacco-cessation treatment is as easy to access as are tobacco products on military installations. Given the peripatetic nature of military service, the committee recommends that DoD establish a dedicated quitline for military personnel that is accessible by all military personnel, retirees, and their families regardless of where they are stationed (with the possible exception of those deployed to war zones with limited telephone access) and how frequently they move. The counselors for the quitline should be trained to deal with issues that are peculiar to military personnel, such as deployment stress, frequent moves, and military culture. The committee recognizes that DoD has already made commendable strides in that direction with the initiation of the “Quit Tobacco. Make Everyone Proud” campaign. However, the effort would be enhanced by enabling users to call a trained counselor immediately and to receive free tobacco-cessation medications, particularly those sold over the counter in the civilian sector, and also by adding a follow-up to each call to evaluate the reach and effectiveness of the program and its modifications.

Many service members, retirees, and family members will have their tobacco-cessation needs met by the treatments outlined in the VA/DoD clinical-practice guideline, but some DoD populations, especially deployed personnel, may need special accommodations or treatments, as described in Chapter 5. The committee finds that the evidence supports providing deployed personnel with tobacco-cessation programs comparable with those available to nondeployed personnel. Indeed, given the nature of the current deployments, which present extreme stress and boredom, both of which are conducive to tobacco use, the committee argues that such programs are even more important. Personnel must be trained to offer programs, which should be conducted at times and places and in formats that make it easy for personnel to attend. Group sessions, which may provide needed support for some deployed service members, do not meet the needs of all members and may be perceived by some as encroaching unnecessarily on much-



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