on whether such measures have translated into higher abstinence rates and which programs have greater success. Without such information, one cannot know whether asking patients about tobacco use ensures that the treatment they receive is helpful and improves patient care and outcomes.

TOBACCO-CONTROL COMMONALITIES

In the sections above, the committee considered DoD and VA as separate entities in dealing with tobacco control. In spite of their differences, those organizations have many issues in common, and the committee believes that there are policies and programs that are applicable to both organizations. Because all veterans were at one time in the military, there is a continuum of health-care needs that may best be addressed by a comprehensive tobacco-control program that spans both DoD and VA. An integrated approach will ensure that military personnel know what to expect regarding tobacco-cessation services as they move from the Military Health System to the VA health-care system.

DoD and VA have worked together on several other health-care goals. For example, they are exploring ways to ensure that DoD medical records can be used by VA health-care providers. Of particular relevance to the present study is the joint DoD and VA Management of Tobacco Use Working Group that produced the 2004 clinical-practice guideline. That guideline gives health-care providers in both organizations recommendations on how to assess, treat, and prevent tobacco use in military and veteran populations. It has sections on dealing with special populations that may of greater use to DoD health-care providers as well as sections that may be of greater use to VA health-care providers. The committee commends the joint effort and believes that it can be expanded to other aspects of tobacco control.

Both VA and DoD permit civilian employees to attend tobacco-cessation counseling sessions as space permits, but neither organization provides tobacco-cessation medications for them. The committee believes this may pose a barrier to employees’ quitting tobacco use. DoD and VA should conduct analyses to determine whether providing such medications would increase employee participation in tobacco-cessation programs, what the costs of such medications might be, and whether the costs might be recouped by the employees’ health-insurance plans.

VA requires that each VA medical facility have a smoking and tobacco-use cessation lead clinician who serves as a tobacco-control advocate in the facility and as a point of contact for information. The committee endorses the designation of such persons and recommends that all VA medical clinics, not just medical centers, identify and train



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