one population than for another. Data on long-term abstinence rates in people who leave military service might be more difficult for DoD to capture, but such follow-up is important for careerists and those who remain in the military for several years. VA acknowledges that most veterans who enter its health-care system stay in it for life. Therefore, obtaining long-term follow-up data on these veterans would probably not be difficult. For example, given that a smaller proportion of veterans use tobacco than do active-duty military personnel, veterans who no longer use tobacco could be evaluated to determine when and how they quit.
The issue of tobacco use in select populations should be of continuing concern for DoD and VA. DoD has a higher rate of tobacco initiation than the general population, and further research should be conducted to identify why that is the case and what may be done to change it. In addition, the DoD should conduct research on whether policies to ban tobacco use during technical and advanced training are effective in preventing relapse after such training. Deployed personnel also use tobacco more than nondeployed personnel, and research should focus on identifying healthy substitutes for tobacco as a stress and boredom reliever during deployment. Deployed personnel also use more smokeless tobacco; DoD should fund research on the long-term health effects of smokeless tobacco and effective cessation interventions.
Given the number of veterans and military retirees who have comorbid medical and psychiatric conditions, the committee recommends that DoD and VA consider jointly funding research on the effects of tobacco use on these conditions and on effective tobacco-cessation interventions for these populations. Tobacco use in people with comorbid mental-health disorders should be monitored, and research should be conducted to develop more effective tobacco-cessation programs for such VA populations as those with alcohol abuse or PTSD. VA has conducted considerable research in that field, but further work needs to be done, particularly with regard to the timing of interventions and the use and possible interactions of tobacco-cessation medications and psychiatric medications. It may also want to consider jointly funding such efforts with DoD, given the large population of military personnel returning from the conflicts in Iraq and Afghanistan with mental-health disorders.
DoD and VA may consider research to assess the use and effectiveness of tobacco-cessation treatments provided in various medical-care facilities in both organizations. Can military personnel who are stationed at smaller installations and veterans who receive care at community-based outpatient clinics access the same level of care as military personnel and veterans at large medical facilities? Stemming from the issue of access to care is the need to assess the role of quitlines