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INDEX A Agency for Healthcare Research and Quality, 26, 166, 333 AATURC. See Alcohol Abuse and AHPP. See Army Health Tobacco Use Reduction Promotion Program Committee Air Force, 2, 9, 21, 23, 31â34, 59, Absenteeism, 1, 4, 19, 46â47 129, 205, 237â239, 241, 251â Abstinence rates, 7, 10, 45, 47, 53, 252, 255 234 AETC Instruction 36-2216, evaluating, 13, 164â165 219â220, 250 long-term, 18, 148, 164 AF 1480A, 255, 343 Acceptability of tobacco use, 93â Instruction 36-2903, 216 96 Instruction 40-101, 198, 205â Access to tobacco products, 5â6, 206, 213, 241 132â133, 224 Instruction 40-102, 205, 209â to cigarettes, perceived, 94 210, 215â216, 219, 221â on military installations, 96, 227, 235â237, 245, 250 225, 342â343 Airway obstruction, 53 Accidents, and tobacco use, 4, 45â ALA. See American Lung 46 Association ACS. See American Cancer Society Alcohol abuse and dependence, 8, Acupuncture, 137â138, 282 47, 51, 87, 156â157 Acute eosinophilic pneumonia CAGE assessment of, 243 (AEP), from tobacco use, 50 Alcohol Abuse and Tobacco Use Acute ischemic events, 52 Reduction Committee Acute myocardial infarction (MI), (AATURC), 202. See also 52â54, 56 Alcohol and Tobacco Advisory Addiction. See Nicotine addiction Council Advertising of tobacco products, 5â Alcohol and Tobacco Advisory 6, 120â122, 208â210 Council (ATAC), DoD, 9, 202â in military publications, 210, 203, 232 274 Amblyopia, 41 AEP. See Acute eosinophilic American Cancer Society (ACS), pneumonia 12, 25â26, 145, 212, 231â232, Aerobic capacity, 42â43 235, 282â283 Afghanistan, service in, ix, 8, 11, Freshstart program, 231â232, 20â21, 32, 92â93, 243, 294 283 Agency for Health Care Policy and American Legacy Foundation, 122, Research, 254 139, 145 347
348 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS American Lung Association ASSIST. See American Stop (ALA), 12, 25, 139, 158, 235, Smoking Intervention Study 282â283 program Freedom from Smoking Asthma, 48, 161 program, 231â232, 255 ATAC. See Alcohol and Tobacco Tobacco Cessation Resource Advisory Council Center, 148 Atherosclerosis, 52 American Psychiatric Association, Attention deficit hyperactivity 83â84, 151 disorder, 87 American Stop Smoking Attitudes. See Leadership attitudes; Intervention Study (ASSIST) Social attitudes program, 117, 167, 332â333, Auditor-vigilance tasks, 44 335 Aviation performance, and tobacco Anemia, 52 use, 44â45 Anger, and nicotine withdrawal, 42 Avoidance education, 229 Angina pectoris, 53 Antihypertensive drugs, 54 B Antipsychotic medications, 154, 295 Basic training, 19, 218â221 Anxiety disorders, 16, 87â89 dropout rates during and after, and nicotine withdrawal, 4, 1, 4, 19 42, 84 preventing initiation and Army, 3, 21, 23, 31â34, 43 relapse after, 252â253 Aeromedical Research relapse-prevention Laboratory, 42 interventions during, 250â Center for Health Promotion 252 and Preventive Medicine tobacco-use restrictions (CHPPM), 212, 231â232, during, 9, 46, 127 239â242, 255 Behavioral economics. See also Dental Command, 237 Conditioned behavior HOOAH 4 Health Web site, influencing tobacco use, 102â 239â240 103 Infantry Training Center, 58 Behavioral interventions, 6, 134â Regulation 215-1, 216, 223, 135, 152, 229â230, 279â280. 233 See also Cognitive-behavior Regulation 350-1, 233 therapy Regulation 600-9, 233 combined with medication, Regulation 600-63, 198, 204, 136, 231â232, 281â282 213, 215â216, 221â223, Benzodiazepines, 154 227, 235, 237 Biology of nicotine reinforcement, TRADOC Regulation 350-6, 84â88 213, 219, 250 conditioned behavior and Army Health Promotion Program nicotine addiction, 85 (AHPP), 204â205, 213
INDEX 349 genetics of nicotine addiction, CBOCs. See Community-based 85â86 outpatient clinics nicotine addiction, mental CBT. See Cognitive-behavior illness, and substance abuse, therapy 86â88 CDC. See Centers for Disease psychoactive effects of Control and Prevention nicotine and nicotine Centers for Disease Control and withdrawal, 84â85 Prevention (CDC), 5, 26, 35, 45, Bipolar disorder, 87, 295 58, 117â118, 120, 122, 145, 167, Blood coagulation, increasing, 52 267, 275, 327, 329, 335 Bone loss, 54 Best Practices for Boot camp. See Basic training Comprehensive Tobacco Brain-reward function, 84 Control Programs, 118, 120 Bronchiolitis, 53 Tobacco: Guide to Community Bronchitis, 48, 53 Preventive Services, 118, BUMED. See Navy Bureau of 120 Medicine and Surgery Certification programs, 292â293 Bupropion, 7, 152â153, 155, 159, Cervical cancer, 51 232, 280â281 Cessation programs. See Medications; Smoking-cessation C programs; Tobacco-cessation programs California, tobacco-control CFR. See Code of Federal programs in, ix, 5, 117, 128, Regulations. 144, 327 Chantix. See Varenicline California Smokersâ Helpline, 288 Charge to the committee, 2, 21â23 California Tobacco Tax and Health Chemotherapeutic agents, for Promotion Act, 328 cancer treatment, 54 Cancer Chewing tobacco. See Smokeless- long-term health effect of tobacco use tobacco use, 1, 19, 51â52, CHPPM. See Army Center for 158 Health Promotion and risk for recurrence of, 160 Preventive Medicine from smokeless-tobacco use, Chronic lung disease, a long-term 4, 55 health effect of tobacco use, 53â Carbon monoxide (CO), 42, 52 54, 159 end-expiratory, 217 Chronic obstructive pulmonary Cardiovascular disease (CVD), 56 disease (COPD) long-term health effect of costs to the VA of, 4, 62 tobacco use, 1, 19â20, 40, a long-term health effect of 52â53, 161 tobacco use, 4, 48, 53, 158â Caries, dental, 55 161 Cataracts, 41, 54
350 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Cigarettes. See also Access to Colds, 48 tobacco products; Prices for Collisions, increased risk of with cigarettes and smokeless tobacco tobacco use, 4, 45 part of popular images of Colorectal cancer, 51 military personnel, ix, 101 Combat. See War zones perceived availability and Commanders acceptability of, 5, 94 serving as ârole models,â 218 use by armed service, 3, 36â training, 9, 341â342 38 Commissaries. See Military use by veterans, 1, 39â40 commissaries Civilian Health and Medical Committee on Smoking Cessation Program of the Uniformed in Military and Veteran Services, 201 Populations, x, 294 Classrooms. See Educational approach to its charge, 3, 23â settings 26 Clinical Practice Guidelines. See charge to, 2, 21â23 Public Health Serviceâs Clinical Commonalities among DoD and Practice GuidelineâTreating VA tobacco-control concerns, Tobacco Use and Dependence; 316â318 VA/DoD Clinical Practice Communication interventions, Guideline for the Management 119â124, 208â214, 274â275 of Tobacco Use advertising and promotions, Clinical setting interventions, 140â 120â122, 208â210 143, 234â238, 284â287 counteradvertising and public by nurses, 142, 285â286 education, 10, 24, 122â124, by other health-care 210â213, 342 professionals, 142â143, leadership education and 236â238, 286â287 training, 213â214 by primary-care providers, Community-based outpatient 142, 236, 284â285 clinics (CBOCs), 12, 99, 264, Clozapine, 154, 295 267, 270, 272â273, 283, 299 CME. See Continuing-medical- Community factors that influence education credits tobacco use, 5, 95 CO. See Carbon monoxide acceptability of tobacco use, Coast Guard, 31 96 Code of Federal Regulations (CFR) access to and cost of tobacco Article 199.18, 201 products on military Title 32, Part 85, 8, 227â228 installations, 96 Title 32, Part 85.6, 205, 247 concern about weight, 97 Title 38, Part 17, 279 in the Department of Defense, Cognitive-behavior therapy (CBT), 95â98 148, 153, 155â156, 165, 232 in the Department of Veterans Cognitive function, and tobacco Affairs, 98â99 use, 42, 44
INDEX 351 difference in support between Coping skills, training, 155 active-duty and retired Coronary heart disease, 52, 55, military personnel, 98 125, 158 lack of activities and secondhand smoke and, 54 privileges during taking medications for, 53 deployment, 97 Cost of tobacco products. See lack of consistent and Prices for cigarettes and comprehensive antitobacco smokeless tobacco policies and programs, 97â Costs for treatment 98 high cost of psychiatric leadership of antitobacco medications, 295 campaigns, 97 in the military, 4, 56â58 smoking breaks, 97 out-of-pocket, 6, 24 Community settings, tobacco-use in the VA, 4, 62â64 restrictions in, 124â126 Costs of tobacco use. See Comorbid conditions. See Medical Economic impacts of tobacco comorbidities in tobacco users; use; Tobacco-related illness Psychiatric comorbidities in costs; Training costs tobacco users Counseling. See Behavioral Comprehensive tobacco-control interventions; Computer-based programs, ix, 5, 8, 11, 15â16, programs 25â27, 116â119, 308 Counteradvertising, 10, 24, 122â components of, 330â331 124, 210â213, 342 Computer-based programs, for Cryptogenic fibrosing alveolitis, 54 tobacco-cessation interventions, Cue-reactivity, 155 7, 11â12, 146â147, 235, 239â Cues. See Smoking cues 241, 274, 290â291 Cultural factors, influencing Concentration, difficulty with, and tobacco use, ix, 21, 101â102, nicotine withdrawal, 4, 42, 84 115 Conditioned behavior, and nicotine CVD. See Cardiovascular disease addiction, 85 Congress, 59â60 D House Armed Services Committee, 100 Dark adaptation, 43 support needed from, x, 5, 17, Death, from tobacco use, 19, 51, 21, 26, 322 52. See also Sudden infant death tobacco industry lobbying, syndrome; Suicide 100 DeCA. See Defense Commissary Continuing-medical-education Agency (CME) credits, 241â242 Decompression illness, 45 Copayments, elimination of in VA, Defense Commissary Agency 270 (DeCA), 210, 226 COPD. See Chronic obstructive Directive 40-13, 210 pulmonary disease
352 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Demographic profile findings and recommendations of the military population, 20, of the committee regarding, 31â34 13â17, 318â322 of military tobacco users, 35â relapse-prevention 39 interventions in, 250â253 of the veteran population, 34â for special populations, 242â 35 250 of veteran tobacco users, 39â surveillance and evaluation, 40 253â256 Denormalizing tobacco use, 5, 14â tobacco-cessation 15, 319â320 interventions in, 227â234 Dental effects. See Caries; tobacco-control programs in, Periodontal disease 202â207 Dentists, 143, 147, 237 and the tobacco retail Department of Defense (DoD), ixâ environment, 4, 223â226 x, 21. See also Air Force; Army; Tobacco Use Prevention Marine Corps; Military Health Strategic Plan, 9â11, 199, System; Navy; Organizational 202â208, 213, 221â222, overview of the DoD; TRICARE 247â248, 253, 255, 339â346 program tobacco-use restrictions in, appropriations for, 11, 226 214â223 broad implications of tobacco Department of Health and Human use for, 1â2, 23â27 Services (HHS), 162, 267, 290 economic impacts of tobacco Department of Veterans Affairs use on, 56â62 (VA), ixâx. See also Instruction 1010.15, 125, 198, Organizational overview of the 205, 215â216, 227 VA; Tobacco-use restrictions in Instruction 1330.09, 59, 96, the VA; Veterans Health 209, 224 Administration Instruction 1330.21, 209, 224â broad implications of tobacco 227, 226 use for, 1â2, 23â27 Office of the Assistant economic impacts of tobacco Secretary of Defense for use on, 62â65 Health Affairs, 8â9, 200, Office of Quality and 204, 206â207, 213, 256 Performance, 299 Department of Defense (DoD) Department of Veterans Affairs tobacco-control activities, 8â11, (VA) tobacco-control activities, 197â256 11â13, 263â301. See also communication interventions Veterans Health Administration in, 208â214 communication interventions delivery of interventions in, in, 274â275 234â242 costs of tobacco-related illness in, 64
INDEX 353 delivery of interventions in, United States Code; individual 282â293 departments and agencies findings and recommendations Disability claims, 22â23 of the committee regarding, Diving, 45 13â17, 318â322 Doctors. See Primary-care research conducted within, providers 11, 17, 24, 322â323 DoD. See Department of Defense for special populations, 293â DoD Survey of Health Related 298 Behaviors among Active Duty surveillance and evaluation, Military Personnel, 39, 61, 90, 298â301 97, 204, 249, 254, 339 tobacco-control programs in, Dopamine, 84â85 270â274 Driving, and tobacco use, 96 tobacco-free policies in, 276â Drug interactions, 17â18, 54, 294â 277 295 Dependence. See Nicotine Drug metabolism, altered, 41, 54 addiction Deployed service personnel, 1, 8, E 20, 243, 248â249 lack of activities and Economic impacts of tobacco use, privileges during 1, 4 deployment, 97 on the DoD, 4, 56â62 smokeless-tobacco use among, on the VA, 4, 62â65, 159 162 Education. See also Avoidance training counselors of, 11, 312 education; Providers; Public Depression, 46, 155â156. See also education about tobacco Major depressive disorder of leaders for antitobacco comorbid with PTSD, 297 campaigns, 213â214 and nicotine withdrawal, 4, Education level, and tobacco use, 42, 84 36 Designated smoking areas. See also Educational settings, tobacco-use Tobacco-use restrictions in the restrictions in, 126â127. See also military Service academies in the military, 94, 129, 215â EECO. See End-expiratory carbon 216, 218â219, 222â223 monoxide levels in the VA, 11, 129, 276â277 Effectiveness of interventions, Desquamative interstitial measures of, 7, 213 pneumonia, 53 Emphysema, 53 Diabetes, a long-term health effect Employer-sponsored insurance, of tobacco use, 4, 41, 53, 161 166 Diagnostic and Statistical Manual End-expiratory carbon monoxide of Mental DisordersâIV, 84, 89 (EECO) levels, 217 Directives. See Code of Federal Endothelial injury and dysfunction, Regulations; Public Laws; 52
354 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Endurance, and tobacco use, 42â43 tobacco cessation, physical Esophageal reflux, 54 fitness, and weight Estrogen replacement therapy, 54 management, 97, 232â234 Evaluation and surveillance, 165â Exchanges. See Military exchanges 168, 253â256, 298â301 Exercise capacity, maximal, 52â53 Evidence-based interventions, 115, 134â149, 234â242, 282â293 F in clinical settings, 140â143, 234â238, 284â287 Face-to-face counseling, 6, 134, combined behavioral 143, interventions and Facilities medications, 136, 164, 231â smoke-free policy for all DoD, 232 214â223. See also communication, 119â124 Department of Defense computer-based, 146â147, Instruction 1010.15 239â241, 290â291 smoke-free policy for all VA, delivery of, 138â149 11. See also Veterans individual, 136â138 Health Administration provider education, 147â149, Directive 2008-052 241â242, 291â293 smoke-free policy for federal quitlines, 144â146, 238â239, (Executive Order 13058), 287â289 125â126, 215 relapse-prevention, 164â165 Veterans Integrated Service tobacco-cessation, 133â138 Networks (VISNs) and tobacco-cessation numbers of, 268â269 medications, 135â136 Factors that influence tobacco use, Evidence-based tobacco-control 5, 79â104 programs, 23, 115â168 community factors, 95â99 comprehensive, 116â119 individual factors, 82â93 for special populations, 149â interpersonal factors, 93â95 164 societal factors, 99â104 surveillance and evaluation, a socioecologic analysis of 165â168 tobacco use in military and tobacco retail environment, veteran populations, 81â82 129â133 Families, involvement in tobacco tobacco-use restrictions, 124â use, 1, 5, 95, 297â298 129 FCTC. See World Health Evidence-based treatment, 228â Organization Framework 232, 278â281. See also Convention on Tobacco Control Medications FDA. See Food and Drug behavioral interventions, 229â Administration 230, 279â280
INDEX 355 Federal tobacco-control programs, H 117, 137, 332â336. See also Centers for Disease Control and Haloperidol, 154 Prevention; National Cancer Handheld Computer Smoking Institute Intervention Tool (HCSIT), 149 Financial incentives, 137â138 Harm reduction, 133â134 Findings of the committee, 13â17, Hazards. See Accidents 307â324 HCSIT. See Handheld Computer for the DoD and the VA, 318â Smoking Intervention Tool 322 Healing of infections, effect of research agenda, 322â324 tobacco use on, 48â49 tobacco-control Healing of wounds, impaired from commonalities, 316â318 tobacco use, 49 toward a tobacco-free military Health-care costs of tobacco use. population, 308â313 See Tobacco-related illness costs toward a tobacco-free veteran Health-care providers, in clinical population, 313 â316 settings, 6â7, 142â143, 284â287 Fires, and tobacco use, 46, 217 Health effects of tobacco use, 1, 27, 5 Aâs, 7, 12, 140â141, 148, 237, 40â56 279, 317 long-term, 27, 51â54 5 Râs, 7, 140â141 secondhand smoke, 54â55 Flight safety, 44 short-term, 27, 41â50 Flu, 48, 54 smokeless-tobacco use, 55â56 Fluphenazine, 154 tobacco-related illness costs, Food and Drug Administration 57â58, 64 (FDA), 6â7, 62, 134â136, 230, Health professionals, in clinical 244, 280 settings, 236â238 Framework Convention on Healthy living, 47â50, 81, 213, Tobacco Control (FCTC) of the 218, 341â342 World Health Organization, 81, Healthy People 2010, 81, 254 121, 334â335 Hearing loss, and tobacco use, 4, Freshstart program of the American 43â44 Cancer Society, 231â232, 283 Hedonic dysregulation, 85 Helicobacter pylori infection, 49 G Heritability, a factor in smoking, 85â86 Gastrointestinal disease, 41, 49 HHS. See Department of Health Genetics of nicotine addiction, 5, and Human Services 85â86 Homeless veterans, 150, 297 Geopolitical context, influencing Hospitalization tobacco use, 103â104 increased risk of with tobacco use, 4, 46â47 tobacco cessation during, 8, 163
356 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS HPA. See Hypothalamic-pituitary- Insurance coverage for tobacco use, adrenal axis 35, 166, 265 Hypertension, 53, 56, 159 Integrated approach for DoD and Hypnosis, 137â139, 282 VA to tobacco control, 295, 316, Hypothalamic-pituitary-adrenal 322â324 (HPA) axis, 89 Interactions, between tobacco- Hypothyroidism, aggravated by cessation and psychiatric tobacco use, 41, 54 medications, 17â18, 54, 294â 295 I Interagency Committee on Smoking and Health (ICSH), ICSH. See Interagency Committee 267, 334 on Smoking and Health Interpersonal factors influencing Immunologic alterations, 48â49 tobacco use, 5, 93â95. See also Incentives for quitting, financial, Societal factors influencing 137â138, 280 tobacco use Individual factors influencing Interventions. See also Behavioral tobacco use, 5, 82â93. See also interventions; Evidence-based Genetics of nicotine addiction interventions; Multisession alcohol abuse, 88â89 intensive interventions; Targeted anxiety disorders, 89 interventions; Tobacco-cessation biology of nicotine interventions reinforcement, 84â88 implementing, 79â80 depression, 89â90 stepped-care, 156, 296 mental-health disorders in IOM. See Institute of Medicine veterans, 92â93 Iraq, service in, ix, 8, 11, 20â21, nicotine addiction, 83â84 32, 50, 92â93, 243, 248â249, psychologic stress and 294 comorbid conditions in the Irritability, and nicotine active military, 90â92 withdrawal, 4, 42, 84â85 schizophrenia, 90 self-image, 5, 101 J Infectious diseases, health risk of tobacco use, 4, 54â55 Joint Chiefs of Staff, 198 Influenza, 48, 54 Joint Commission [on Initiation of daily smoking, age at, Accreditation of Healthcare 37 Organizations], implementation Injuries, and tobacco use, 45â46 of standards from, 125, 276, 315 Insomnia, and nicotine withdrawal, 84 K Institute of Medicine (IOM), ixâx, 22, 26, 120â121, 132, 134, 149, Kaiser Permanente, 23, 117 327, 336 Korean War veterans, 34â35 Insulin, reactions to, 53â54
INDEX 357 L tobacco-control programs on bases, 204â205 Langerhans cell histiocytosis, 54 Massachusetts, tobacco-control Leadership attitudes, influencing programs in, ix, 5, 117, 144, tobacco use, 5, 97, 207, 214, 289, 327â329 217â219 MDD. See Major depressive Leadership of antitobacco disorder campaigns MEDCOM Web site, 235, 241 education and training of, Medical comorbidities in tobacco 213â214 users, 2, 8, 158â161 importance of, 6, 272, 317â Medical records, electronic, 315 318, 320â321 Medicare and Medicaid, 201, 265â Legionnaireâs disease, 48 266, 299 Leukemia, 51 Medications Living areas, tobacco-use combined with behavioral restrictions in, 221â222 interventions, 136, 231â232, Long-term health effects of tobacco 281â282 use, 4, 51â54 research needed on possible cancer, 4, 51â52 interactions with psychiatric cardiovascular disease, 4, 52â medications, 17â18, 54, 53 294â295 chronic lung disease, 53â54 for tobacco-cessation, 6, 8, Lost productivity. See Productivity 135â136, 152â154, 165, Lung disease 230â231, 280â281, 294 chronic, 53â54, 159 Medigap insurance, 35 interstitial, 53 Meningococcal meningitis, 48 Mental-health disorders, in M veterans, 92â93 Mental-health disorders in military Macular degeneration, 41, 54 personnel, 243 Major depressive disorder (MDD), Mental-health disorders in tobacco 8, 87, 154â156 users, 8, 16â17, 46, 91â92, 150â Managing Obesity/Overweight for 158, 243â244 Veterans Everywhere (MOVE!), alcohol abuse and dependence, 290â291 156â157 Marine Corps, 3, 21, 31â34, 207, behavioral interventions for, 217. See also Navy 152 MCO Semper Fit Manual depression, 155â156 P1700.29, 220 and nicotine addiction, 86â88 Order 5100.28, 198 posttraumatic stress disorder, SECNAV Instruction 154â155 5100.13E, 198, 204â205, schizophrenia, 158 210, 216, 220â221, 223, tobacco-cessation medications 235â236 for, 152â154
358 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS MHS. See Military Health System Morale, welfare, and recreation MI. See Acute myocardial (MWR) activities, 215â216, 223 infarction funding for, 56, 59, 100 Middle ear infection, 55 Motivation to quit, 7, 80, 138, 237, Military commissaries, 59â61, 209 280 Military education and training, Multisession intensive tobacco-use restrictions in, 219â interventions, 7, 143, 279 220 MWR. See Morale, welfare, and Military exchanges, 59â61, 209 recreation activities Military family organizations. See Families N Military Health System (MHS), 57, 198â200, 212, 227â228, 230, NAQC. See North American 242, 253â255, 279, 344â346. Quitline Consortium See also Tobacco Use National Action Plan for Tobacco Prevention Strategic Plan; Cessation, 145â146, 334 TRICARE Management Activity National Alliance for Tobacco Military installations Cessation, 139 prices for cigarettes and National Ambulatory Medical Care smokeless tobacco at and Survey, 141â142, 151 near, 10, 60, 96, 223â226 National Cancer Institute (NCI), 5, restricting access to tobacco 26, 117, 120, 144, 167, 287, 327 products on, 215â216, 225 American Stop Smoking Military populations Intervention Study program, active-duty, 98 117, 332â333 age of, 33â34 Handheld Computer Smoking demographics of, 20, 31â34 Intervention Tool (HCSIT), popular images of, ix, 101 149 tobacco use in, 1, 35â39 quitlines, 287 Military publications Tobacco Control Research advertising and promotion of Branch, 139 tobacco products in, 210, National Comorbidity Survey 274 (NCS), 86, 151 Military Times, 208â209, 212 National Defense Authorization Stars and Stripes, 50, 122, 209 Act (NDAA), 201 Military readiness, effects of need to expand, 322 smoking on, 1, 19, 42â47, 50 National Epidemiologic Survey on Military Web sites, for tobacco- Alcohol and Related Conditions cessation information, 10, 240. (NESARC), 84, 86â88, 156 See also âQuit tobacco. Make National Guard and reservists, 32, Everyone Proudâ 98, 249â250, 264 Mood disturbances, 84 National Smoking and Tobacco Use Cessation Program, 11â12, 271, 273, 280
INDEX 359 Navy, 3, 21, 23, 31â34, 43, 59, defining, 83 236â237 genetics of, 85â86 BUMED Position Statements, and mental illness, 86â88 236â237 and substance abuse, 86â88 Bureau of Medicine and Nicotine reinforcement, biology of, Surgery (BUMED), 230 84â88 Commandant of Midshipmen Nicotine-replacement therapies Instruction 5400.6L, 219 (NRTs), ix, 7, 13, 103, 125, DNAS Instruction 3120.1D, 134â136, 142, 145, 151â153, 220 159, 228â232, 236, 276, 280, Health Promotion Wellness 314â315 Tobacco Program, 254 Nicotine withdrawal, 4, 42 Instruction 5100.13E, 215â exacerbating psychiatric 217 symptoms, 150 NAVHOSPGLAKES psychoactive effects of, 84â85 Instruction 6220.7, 254 Night vision, and tobacco use, 43â OPNAVINST 6100.2A, 206 44 Recruit Training Command Nonsmokers, 44, 90 Instruction 5100.6K, 219â recognition of the rights of, 220, 250 20, 228 SECNAV Instruction North American Quitline 1500.13E, 198, 204â205, Consortium (NAQC), 145, 167 209â210, 214â216, 220â NRTs. See Nicotine-replacement 227, 235, 237, 245 therapies Submarine Medical Research Nurses, as tobacco-cessation Laboratory, 230 providers, 7, 142, 237, 272, 285â Navy and Marine Corps Tobacco 286 Policy, 204, 209 NCI. See National Cancer Institute O NCS. See National Comorbidity Survey Occupational-health clinics, 237 NDAA. See National Defense OEF. See Operation Enduring Authorization Act Freedom Neoplasms. See Cancer OIF. See Operation Iraqi Freedom NESARC. See National Olanzapine, 154, 295 Epidemiologic Survey on Older patients, 12, 313 Alcohol and Related Conditions Operation Enduring Freedom Neurotransmitters, 84, 86 (OEF), 93, 103 Nicotine Operation Iraqi Freedom (OIF), 93, optimal dose, 45 103 psychoactive effects of, 83â85 Oral cancer, from smokeless- as a stimulant, 2, 88 tobacco use, 4, 55 Nicotine addiction, 5, 83â84 Organizational overview of the and conditioned behavior, 85 DoD, 95, 198â202
360 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Military Health System, 199â Pharmacists, 142â143, 286 200 Pharmacologic treatments. See TRICARE management Medications activity, 200â202 PHS. See Public Health Service Organizational overview of the PHSHCG. See Public Health VA, 95, 263â270 Strategic Health Care Group chart for tobacco-control Physical fitness responsibilities, 265 and being tobacco-free, 41, National Leadership Board, 207, 233â234, 309 264, 266 increased risk of injury with Public Health Strategic Health tobacco use, 4 Care Group, 266â267 work capacity and tobacco Veterans Health use, 3, 42â43 Administration, 264â266 Physicians. See Primary-care Veterans Integrated Service providers Networks, 267â270 Pilot safety, 44â45 Osteoporosis, 41, 54 Plans. See Strategic planning Outdoor spaces, tobacco-use Pneumonia. See also Acute restrictions in, 128â129, 222â eosinophilic pneumonia 223, 276â277 desquamative interstitial, 53 Oxygen, maximal consumption of, pneumococcal, 48, 55 42â43 varicella, 48â49 Posttraumatic stress disorder P (PTSD), 8, 23, 87, 89, 92, 154â 155, 243â244, 288, 294, 296â Pancreatic cancer, from smokeless- 297 tobacco use, 4, 55 Pregnant women, 247â248 Panic attacks, 87 Prevention. See Education; Public Parental smoking, 55 education about tobacco; Peptic ulcer disease, from tobacco Relapse-prevention interventions use, 49 Prices for cigarettes and smokeless Perceptions, of cigarette tobacco, ix, 6, 130â132, 224â availability and acceptability in 226, 330 the military, 94 on military installations, 10, Performance 60, 96, 223â226 effects of smoking on military, Primary-care providers, in clinical 3, 42â47, 50 settings, 142, 236, 284â285 measuring, 8, 165â166, 299 Private residences, tobacco-use Periodontal disease, from tobacco restrictions in, 127â128, 221â use, 4, 49â50, 55â56 222 Peripheral vascular disease, 52, 159 Privileges granted during Pharmacies in the Military Health deployment, and tobacco use, 97 System, 230. See also VA Problems created by tobacco use, National Formulary 31â65
INDEX 361 economic impacts of tobacco Public education about tobacco, ix, use, 56â65 6, 8â9, 122â124, 210â213, 317 getting along with friends, 84 Public Health Service (PHS), 7â8, health effects of tobacco use, 12, 26, 134, 136â137, 140â142, 40â56 149, 161, 200, 229, 247, 317 tobacco use in military and Clinical Practice Guidelineâ veteran populations, 31â40 Treating Tobacco Use and Productivity, lost through tobacco Dependence, 16, 26, 134â use, 4, 19, 46â47, 58â59 137, 140, 142, 152, 159, Profits, from the sale of tobacco 161â163, 229, 233, 282, products on military 294, 317, 321 installations, 310 Public Health Strategic Health Care Programs. See also Computer- Group (PHSHCG), 99, 266â267, based programs; Evidence-based 271, 275, 281, 291â292, 299 tobacco-control programs; Public Laws Tobacco-cessation programs; 102-585, §526. See Veterans Tobacco-control programs; Health Care Act of 1992 individual programs 109-114, 62 identifying successful, 3, 23, Pulmonary disease, 40, 53 27 PX. See Military exchanges leadership of, 97, 206â207, 213â214 Q Promotion of tobacco products, 5, 120â122, 208â210 Quit kits, 289, 329 in military publications, 210 âQuit Tobacco. Make Everyone point-of-sale, 103, 121 Proud,â 8, 10â12, 123, 211â212, Providers, educating for tobacco- 239â241, 312 cessation interventions, 147â Quitlines in tobacco-cessation 149, 241â242, 291â293 interventions, 6â7, 24, 144â146, Psychiatric comorbidities in 238â239, 287â289, 312 tobacco users, 2, 8, 84â85, 88 Quitting tobacco use, ix, 8, 10 in military populations, 243â motivation for, 80, 138 244 receptivity to idea of, 24 in veteran populations, 293â 297 withdrawal exacerbating, 150 R Psychiatric medications, possible interactions with medications for Reaction time, impaired, 42, 44â45 tobacco-cessation, 17â18, 54, Readiness. See Military readiness 294â295 Recommendations of the Psychotic disorders, 87, 153 committee, 13â17, 307â324. See PTSD. See Posttraumatic stress also Research agenda items disorder proposed tobacco-control commonalities, 316â318
362 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS toward a tobacco-free military Secondhand smoke, 23, 119, 215, population, 308â313 217, 222, 228, 331 toward a tobacco-free veteran health effects of, 11, 53â55 population, 313â316 Service academies, tobacco- Reinforcement. See Nicotine restrictions in, 220â221 reinforcement Short-term effects of tobacco use Relapse-prevention interventions, on health, 4, 47â50 8, 164â165, 250â253 acute eosinophilic pneumonia, basic training, 250â252 50 preventing initiation and impaired wound healing, 4, 49 relapse after basic training, infection, 48â49 252â253 peptic ulcer disease, 4, 49 Renal disease, chronic, 53 periodontal disease, 4, 49â50 Reproductive disturbances, 41, 54 Short-term effects of tobacco use Research agenda items proposed, on military readiness and 2â3, 17â18, 25, 322â324 performance, 42â47 Reserves. See National Guard and absenteeism, presenteeism, reservists and lost productivity, 46â47 Residences, tobacco-use accidents and injuries, 45â46 restrictions in private, 127â128 aviation performance, 44â45 Respiratory diseases, 1, 4, 19â20, diving, 45 48, 53â55 nicotine withdrawal, 42 Restlessness, and nicotine night vision and hearing, 43â withdrawal, 4, 42, 84 44 Restrictions. See Tobacco-use physical work capacity and restrictions in the military; endurance, 42â43 Tobacco-use restrictions in the vigilance and cognitive VA function, 44 Retail. See Tobacco retail Smoke breaks, 4, 216 environment on military influencing tobacco use, 97 installations Smoke-Free Policy Retired military personnel. See for all DoD facilities, 215 Veteran populations for VA Health Care Facilities, Risks, of cancer from smoking, 7, 11, 276 52 Smokeless-tobacco use, 55, 216. âRole models,â 218â219 See also Prices for cigarettes and commanders serving as, 218 smokeless tobacco among deployed service S personnel, 162 dual use of, 21, 56, 133, 244â Sales and pricing, 224â226 246 Schizophrenia, 8, 87, 152, 158, 295 health effects of, 4, 55â56 Screening for tobacco use, 310 research needed on, 17, 19, 21
INDEX 363 by service, 3, 245â246 cultural factors, 8, 101â102 tobacco cessation in, 162â163 geopolitical context, 5, 103â Smokers 104 older, 163â164 influence of the tobacco recognition of the rights of, 97 industry, 100 undergoing surgery, 160 Socioecologic analysis of tobacco Smokersâ Health Fund (proposed), use in military and veteran 334 populations, 5, 81â82 Smoking. See also Tobacco use Sociologic model of levels of in aircraft, 222â223 influence and cancer risk, 52 affecting behavior, 80 effects on military readiness influences on tobacco use and performance, 50 among the military and and infection, 48 veteran populations, 82 initiation of daily, 23, 37, 94 for military and veteran on naval ships, 46, 204, 216â populations, 27, 83 217, 223 Special populations, 149â164, 242â parental, 55 250, 293â298 rates of in the military, 1, 94, deployed personnel, 248â249 339â340 homeless, 297 on submarines, 46, 204, 223 hospitalized tobacco users, in uniform, 216â218 163 Smoking and Tobacco Use National Guard and reservists, Cessation Report (VA), 125, 249â250 269, 272, 276, 280â281, 284â other populations, 161â164, 285, 291, 298 297â298 Smoking-cessation programs. See other tobacco users, 163â164 Tobacco-cessation programs smokeless tobacco and dual Smoking cues, 85 use, 244â246 avoiding, 8, 165 smokeless-tobacco users, 162â reactivity to, 155 163 Snuff, 55. See also Smokeless- tobacco users with medical tobacco use comorbidities, 158â161 Sobriety, 156â157 tobacco users with mental- Social attitudes, influencing health disorders, 150â158, tobacco use, 81 243â244 Social connections, role of tobacco veterans with mental-health in facilitating, 5, 81 disorders, 293â297 Social skills, training in, 158 women, 162, 247â248 Social support for quitting, 8, 165 Spouses of veterans, 297 Societal factors influencing tobacco State tobacco-control programs, 5, use, 5, 99â104 27, 117, 327â332. See also behavioral economics, 102â individual states 103
364 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Stepped-care interventions, 156, Telephone counseling, 6â7, 24. See 296 also Quitlines Strategic planning, importance for TMA. See TRICARE Management tobacco-control programs, 6, 25, Activity 199, 202â203, 332 Tobacco. See Cigarettes; Stress relief, tobacco providing, 17, Smokeless-tobacco use; 85, 90, 104 Smoking Stroke, a long-term health effect of Tobacco: Guide to Community tobacco use, 4, 52, 159 Preventive Services (CDC), 118, Submarine crews, smoking by, 217 120 Substance abuse, and nicotine Tobacco cessation, voluntary, 311 addiction, 2, 86â88 Tobacco-cessation interventions, 7, Sudden infant death syndrome, 55 133â138, 163â164, 227â234, Suicide, 87, 153 311â312. See also Tobacco- Surgeon General, 40, 47, 83, 267, control programs 327 in clinical settings, 140â143 Office of the Surgeon General evidence-based, 134â139, in the individual armed 228â232 services, 8, 95, 256 and physical fitness, 232â234 reports on smoking, 40, 41, provider education, 147â149 47, 51 in special populations, 149â Surgery, smokers undergoing, 160 164 Surveillance and evaluation, 6, 8, tobacco quitlines, 144â146 165â168, 253â256, 298â301, in users with mental-health 317 disorders, 150â158 Survey of Veteran Enrolleesâ and weight management, 97, Health and Reliance upon VA 232â234 with Selected Comparisons to in women, 162 the 1999-2003 Surveys, 298 Tobacco-cessation medications, 7, 135â136, 152â154, 230â231, T 280â281 Tobacco-cessation programs TAG. See Technical advisory access to, 143 group BecomeAnEx, 139 Targeted interventions, 10, 343â computer-based, 146â147 344 dropout rates, 1, 4, 19 Task Force on Community Forever Freeâ¢, 283 Preventive Services, 134, 335 Freedom from Smoking Taxes for cigarettes and smokeless Programâ¢, 139, 283 tobacco, 6, 81, 130â132 FreshStart program, 283 Technical advisory group (TAG), Quit for Life⢠Program, 139 267 QuitNet, 139 Telemedicine, 284 QuitSmartâ¢, 283
INDEX 365 SmokeFree.gov, 139 in the military, 4, 56â57 used by the VA, 283 in the VA, 4, 62â64 Tobacco Cessation Provider Tobacco retail environment on Competency Course, 241 military installations, 6, 21, 59â Tobacco Cessation Resource 61, 129â133, 223â226 Center, 148 access to tobacco products, Tobacco-control activities 132â133, 224 in the DoD, 6, 24, 197â256 sales and pricing, 224â226 in the VA, 6, 263â301 tobacco prices and taxes, 130â Tobacco-control programs, ix, 5â8 132 commonalities among, 316â Tobacco use, 1, 318. See also 318 Smokeless-tobacco use; communication interventions, Smoking 119â124 and alcohol abuse, 88â89 comprehensive, 116â119 and anxiety disorders, 89 delivery of interventions, 138â death from, 19, 51 149 declines in, 9, 51 in the DoD, 202â207 denormalizing, 5, 14â15, effective, 327â336 319â320 evidence-based practices, and depression, 89â90 115â168 health hazards posed by, 40â federal, 332â336 41 key components of, 119 and mental-health disorders, program leadership, 206â207 150â158, 243â244 reducing tobacco problems created by, 31â65 consumption, 203â204 and quit rates, according to relapse-prevention psychiatric disorder, 87 interventions, 164â165 and schizophrenia, 90 state, 328â332 Tobacco use in the military, 1, 13, surveillance and evaluation, 19, 31â40 165â168 demographics of military and the tobacco retail populations, 31â34 environment, 129â133 goals of the DoD and Armed tobacco-use restrictions, 124â Service, 198 129 and tobacco sales revenue for in the VA, 270â274 DoD, 61 Tobacco-Free Me, 232 Tobacco use in veteran Tobacco industry populations, 13, 19, 21, 31â40 influencing tobacco use, 5, 21, demographics of veteran 100 populations, 34â35 lobbying Congress, 100 Tobacco Use Prevention Strategic Tobacco-related illness costs, 19, Plan, 9â11, 199, 202â208, 213, 27, 57â58 221â222 text of, 339â346
366 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Tobacco-use restrictions in the U military, 124â129, 214â223 in community settings, 124â Ulcers, 54 126 Unemployment, among veterans, in educational settings, 126â 35 127, 218â221 Uniform, smoking in, 216â218 in living areas and United Service Organizations, 317 transportation, 221â222 United States Code in military education and 10 USC 2484(3)(a), 60 training, 219â220 10 USC 2484(3)(B), 225 in outdoor spaces, 128â129, 10 USC 2484(b)(8), 60 222â223 10 USC 2484(d)(e), 59 in private residences and 10 USC 2486(a), 59 vehicles, 127â128 10 USC 2486(d)(2), 224 in training settings, 218â221 10 USC 2486(f), 225 in workplace settings, 215â Urinary cotinine, screening for, 310 218 Tobacco-use restrictions in the VA, V 276â278 Training. See also Basic training; VA. See Department of Veterans Providers Affairs of commanders, 9, 341â342 VA/DoD Clinical Practice in coping skills, 155 Guideline for the Management instructors, prohibition of of Tobacco Use, 10, 12, 141, tobacco-use by, 9, 218â220 229, 233â238, 242, 247, 252, of leaders for antitobacco 272, 279, 291, 293, 299â300, campaigns, 213â214 312, 321 in social skills, 158 VA medical centers (VAMCs), 11, tobacco-use restrictions 21, 99, 264, 267, 269, 273â287, during, 218â221 291â292 Training costs, lost through tobacco VA National Formulary, 280â281, use, 58â59 294 Transportation tobacco-use VAMCs. See VA medical centers restrictions, 221â222 Varenicline, 7, 152â153, 159, 236, in private vehicles, 127â128 280 Treatment. See Evidence-based correct dosing, 281 treatment; Medications precautions regarding, 244, TRICARE Management Activity 267 (TMA), 3, 23, 95, 200â202, 227, Varicella pneumonia, 48â49 247, 254 Vehicles. See also Driving TRICARE program, 2, 11, 21, 57â tobacco-use restrictions in 58, 98, 161, 200, 212, 228â229, military, 221â222 242, 249 tobacco-use restrictions in Tuberculosis, 48â49 private, 127â128
INDEX 367 Veteran populations Weight concerns, 97, 164, 232â demographics of, 34â35 234, 290, 309 homeless, 150, 297 WHO. See World Health with mental-health disorders, Organization 21, 293â297 Withdrawal. See Nicotine returning from conflict, 8, withdrawal 313â314 Women, 2, 54, 162, 247â248 support levels for, 98 pregnant, 247â248 tobacco use among, 1, 39â40 tobacco cessation in, 162 unemployment among, 35 Work. See also Unemployment Veterans Health Administration physical capacity for, and (VHA), 2, 263â266, 317 tobacco use, 42â43 Circular 10-90-141, 277 Work-loss days, greater for tobacco Directive 2008-052, 125, 276 users, 42â43, 47â48 Directive 2008-081, 271â272 Workplace settings, tobacco-use Veterans Health Care Act of 1992, restrictions in, 215â218 17, 100, 276â277, 322 World Health Organization Veterans Integrated Service (WHO), 26, 83, 126, 327, 334 Networks (VISNs), 65, 98â99, Building Blocks for Tobacco 149, 267â271, 273â274, 288, Control: A Handbook, 26, 291, 294, 298â299 334 Veterans service organizations Framework Convention on (VSOs), 3, 23, 275, 317 Tobacco Control, 81, 121, VHA. See Veterans Health 334â335 Administration World War II veterans, 34â35 Vietnam era veterans, 8, 34 Wound healing, impaired from Viral infections, 48, 53 tobacco use, 41, 49 VISNs. See Veterans Integrated Service Networks Visual acuity and tobacco use, 4, 19 amblyopia, 41 night vision, 43â44 VSOs. See Veterans service organizations W War zones, deployment to, 1, 20â 21, 44, 92, 96, 294 Washington state, tobacco-control programs in, 148 Web-based programs. See Computer-based programs