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Combating Tobacco Use in Military and Veteran Populations APPENDIX B DEPARTMENT OF DEFENSE TOBACCO USE PREVENTION STRATEGIC PLAN, 1999 Goals/Tasks Metrics/Objectives Requirements (Policy, Programs, Practices, Resources) A.1. Reduce smoking rates by 5% per year and reduce smokeless tobacco use rate by 15% by the year 2001, for the total force (i.e., include Guard, Reserve, civilian employees and all healthcare beneficiaries). A.1. The 1998 Department of Defense Survey of Health Related Behaviors Among Military Personnel will serve as the initial baseline for current rates of tobacco use (smokeless and smoking) for active duty personnel. A.1. Establish an Alcohol Abuse/Tobacco Use Reduction Committee (AATURC) that coordinates and monitors progress of this prevention plan with oversight by the Prevention Safety and Health Promotion Council (PSHPC). This effort requires funding and administrative support from USD/P and R. POM money needs to be requested over the long term to ensure standardization for human resourcing (e.g., staffing guidelines). A.2. Annual progress report from the PSHPC to USD/PandR. A.2. Explore conducting a smaller DoD survey annually with selected subjects (tobacco and alcohol). Develop a survey mechanism to be able to measure alcohol abuse and tobacco use rates for the following prioritized groups: Active Duty Guard and Reserve DoD Civilians TRICARE Prime Enrollees
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Combating Tobacco Use in Military and Veteran Populations Goals/Tasks Metrics/Objectives Requirements (Policy, Programs, Practices, Resources) A.2.1. Identify high-risk groups for initiation of tobacco use, like young military personnel and teen family members. B.1. Promote a tobacco-free lifestyle and culture through education and leadership. B.1. Annual report on percentage of military training and education programs that include instruction on risks of tobacco use and benefits of not smoking B.1. Assess the content of all basic, technical and professional military training programs for targeted education programs. These programs will include the Services’ goal to being smoke free, address risks and harmful effects of tobacco use, the impact of tobacco use on mission readiness (e.g., decreased night vision, decreased cold tolerance, and increased injury rates, etc…) and the benefits of being a nonsmoker. Draft proposed education programs where necessary. B.1.1. Report percentage of policy changes implemented at one year. B.1.1. Assess and evaluate the current consistency of tobacco use policies across the Services for basic and initial skills training. B.1.2. Assess Service policies on tobacco use for students and instructors, during the duty day, for all formal military training schools, (e.g., Basic and Officer Training School, technical schools, professional military education schools). B.1.3. Prepare draft policy that extends prohibition of tobacco use for students during all formal military training and
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Combating Tobacco Use in Military and Veteran Populations Goals/Tasks Metrics/Objectives Requirements (Policy, Programs, Practices, Resources) schools during the duty day, (e.g., Basic and Officer Training School, technical schools, professional military education schools. (Note: If new policy is implemented then new accessions will be informed of these requirements before entering the military.) B.1.4. Assess and draft policy, if necessary, that requires all personnel selected for training to be informed of the Services smoke free goal. B.2. Educate commanders at all levels on how best to encourage healthy lifestyles as well as the benefits of being tobacco free. B.2. Assess and evaluate existing educational programs for commanders that include education on how to encourage healthy lifestyles and information regarding the benefits of being a nonsmoker. B.2.1. If necessary, develop educational materials for commanders that address how to encourage healthy lifestyles and address the benefits of being a nonsmoker. B.2.2. Develop a draft uniform policy, for instructors in formal school instructor positions, which address the need for instructors to serve as “role models.” B.2.3. Develop a draft uniform policy that addresses instructors’ use of tobacco products in the school environment. B.2.4. Assess current availability of promotional
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Combating Tobacco Use in Military and Veteran Populations Goals/Tasks Metrics/Objectives Requirements (Policy, Programs, Practices, Resources) materials and programs to include information and programs like unit awards for tobacco free lifestyles (e.g., 72-hour pass liberty, etc…). This assessment as well as new promotional programs will need to be sensitive to the need of Base commanders to work with local unions and develop similar promotional programs for civilian employees. B.3. Promote the benefits of being a nonsmoker and provide tobacco counteradvertising using Public Affairs and other military media. B.3. Report the percentage of Public Affairs offices providing tobacco counteradvertising B.3. Assess the existence and extent of Public Affairs offices’ efforts to conduct counteradvertising for tobacco use. (For example, articles and campaigns that include benefits of being tobacco free, the availability of smoking cessation programs, and the harmful effects of tobacco use.) B.3.1. Assess current policy and compliance on Services’ commercial solicitation as it relates to tobacco products, (For example advertising, promotion, and donations.). C.1 Decrease accessibility and availability of tobacco products through pricing and smoking area and tobacco use restrictions. C.1. Report the percentage of policy changes implemented at 1 year. C.1. Assess the Service policies and compliance with State/local laws restricting tobacco use where those community standards are more restrictive than DoD policy. C.1.1. Review Service policies and practices on prohibiting
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Combating Tobacco Use in Military and Veteran Populations Goals/Tasks Metrics/Objectives Requirements (Policy, Programs, Practices, Resources) tobacco use in all common areas used by non-tobacco users. C.1.2. Assess the implementation of Executive Order 13058-Protecting Federal Employees and the Public From Exposure to Tobacco Smoke in the Federal Workplace. C.1.3. Support pricing tobacco products at no more than 5% below the local competitive price. C.1.4. Assess Service practice of and compliance with implementing the prohibition of tobacco sales to individuals under the age of 18. C.1.5. Develop draft policy that prohibits single serve (e.g. single can, single pack) tobacco products to be sold by self-serve at the checkout register. C.1.6. Develop draft policy that indicates resale activities (Commissaries and Exchanges) will endeavor to display tobacco cessation products in areas that provide visibility and opportunity to customers who desire to change their tobacco habits. C.1.7. Support pricing of smoking cessation products below the local competitive price. D.1. Military health system actively identifies tobacco users and provides D.1. Report on the percentage of medical records noting tobacco use status on DD2766 D.1. Develop and monitor a centralized, Tri-Service reporting and surveillance system to track tobacco use.
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Combating Tobacco Use in Military and Veteran Populations Goals/Tasks Metrics/Objectives Requirements (Policy, Programs, Practices, Resources) targeted interventions or AF 1480A (Currently in development.) D.1.1. Develop a draft policy for ASD(HA) requiring the Military Health System to utilize all avenues to identify and document tobacco users, their readiness to quit and offer appropriate “stage of change” intervention, as delineated below: D.1.2. Develop targeted interventions to selected groups (e.g., pregnant women). D.1.3. Develop a plan to annually conduct a health risk appraisal that includes the assessment of tobacco use habits and mandates participation for active duty personnel. D.1.4. Develop a draft policy that requires tobacco use to be documented as “5th vital sign” at all medical and dental appointments. D.1.5. Assess Service policies, and draft policy if necessary, to require routine screening of all beneficiaries as part of “Put Prevention Into Practice” program, with providers using guidelines from the Agency for Health Care Policy and Research (AHCPR). D.2. Military Health System provides effective tobacco cessation programs. D.2. Report the percentage of tobacco users enrolled to a primary care manager D.2. Assess and develop draft policy that requires tobacco cessation programs to include behavioral modification,
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Combating Tobacco Use in Military and Veteran Populations Goals/Tasks Metrics/Objectives Requirements (Policy, Programs, Practices, Resources) who are offered tobacco cessation. Nicotine Replacement Therapy (NRT)/other approved pharmacological interventions as a TRICARE Prime preventive services benefit. D.2.1. Report the percentage of individuals enrolled in tobacco cessation programs (specify type) who successfully quit at 6 and 12 months post-intervention. D.2.1. Develop an evaluation of the effectiveness of newly-developed tobacco cessation programs. D.2.2. Report the percentage of Military Treatment Facility pharmacies providing NRT and other approved pharmacological therapy to TRICARE Prime beneficiaries. D.2.2. Draft policy to fund Military Treatment Facilities pharmacies to specifically stock a variety of NRT and other approved pharmacological interventions that have substantial empirical support for their use, (e.g. buproprion) to accommodate individualized therapy. (Note: This will be an unfunded requirement provided by ASD (HA) until incorporated into O and M baseline POM). D.2.3. Support partnership with TRICARE managed care support contractors to identify interventions that work and to facilitate tobacco use avoidance education. D.2.4. Assess installation tobacco cessation programs for flexibility to accommodate individual needs, to include: individual or group contact, recognition of problems encountered in quitting (skills
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Combating Tobacco Use in Military and Veteran Populations Goals/Tasks Metrics/Objectives Requirements (Policy, Programs, Practices, Resources) training), at least 4 encounters and encouragement to use Nicotine Replacement Therapy appropriately. Prepare policy recommendations as necessary. E. Continually assess best practices in the area of Tobacco prevention. E.1. AATURC reviews and recommends best practices to the PSHPC. E1. Develop plans to assess prevention and early intervention strategies. E.2. Develop and evaluate best prevention practices pilot programs. ACRONYMS: AATURC = Alcohol Abuse/Tobacco Use Reduction Committee; AHCPR = Agency for Health Care Policy; ASD(HA) = assistant secretary of defense for health affairs; DoD = Department of Defense; NRT = nicotine-replacement therapy; O and M baseline POM = Operations and Management baseline program objective memorandum; PSHPC = Prevention Safety and Health Promotion Council; USD/P and R = under secretary of defense for personnel and readiness. SOURCE: Adapted from http://www.tricare.mil/hpp/aaturc_actionplan_tobacco.html. Accessed November 11, 2008.