INDEX

A

AATURC. See Alcohol Abuse and Tobacco Use Reduction Committee

Absenteeism, 1, 4, 19, 4647

Abstinence rates, 7, 10, 45, 47, 53, 234

evaluating, 13, 164165

long-term, 18, 148, 164

Acceptability of tobacco use, 9396

Access to tobacco products, 56, 132133, 224

to cigarettes, perceived, 94

on military installations, 96, 225, 342343

Accidents, and tobacco use, 4, 4546

ACS. See American Cancer Society

Acupuncture, 137138, 282

Acute eosinophilic pneumonia (AEP), from tobacco use, 50

Acute ischemic events, 52

Acute myocardial infarction (MI), 5254, 56

Addiction. See Nicotine addiction

Advertising of tobacco products, 56, 120122, 208210

in military publications, 210, 274

AEP. See Acute eosinophilic pneumonia

Aerobic capacity, 4243

Afghanistan, service in, ix, 8, 11, 2021, 32, 9293, 243, 294

Agency for Health Care Policy and Research, 254

Agency for Healthcare Research and Quality, 26, 166, 333

AHPP. See Army Health Promotion Program

Air Force, 2, 9, 21, 23, 3134, 59, 129, 205, 237239, 241, 251252, 255

AETC Instruction 36-2216, 219220, 250

AF 1480A, 255, 343

Instruction 36-2903, 216

Instruction 40-101, 198, 205206, 213, 241

Instruction 40-102, 205, 209210, 215216, 219, 221227, 235237, 245, 250

Airway obstruction, 53

ALA. See American Lung Association

Alcohol abuse and dependence, 8, 47, 51, 87, 156157

CAGE assessment of, 243

Alcohol Abuse and Tobacco Use Reduction Committee (AATURC), 202.

See also Alcohol and Tobacco Advisory Council

Alcohol and Tobacco Advisory Council (ATAC), DoD, 9, 202203, 232

Amblyopia, 41

American Cancer Society (ACS), 12, 2526, 145, 212, 231232, 235, 282283

Freshstart program, 231232, 283

American Legacy Foundation, 122, 139, 145



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INDEX Agency for Healthcare Research A 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, 31–34, 59, Absenteeism, 1, 4, 19, 46–47 129, 205, 237–239, 241, 251– Abstinence rates, 7, 10, 45, 47, 53, 252, 255 234 AETC Instruction 36-2216, evaluating, 13, 164–165 219–220, 250 long-term, 18, 148, 164 AF 1480A, 255, 343 Acceptability of tobacco use, 93– Instruction 36-2903, 216 96 Instruction 40-101, 198, 205– Access to tobacco products, 5–6, 206, 213, 241 132–133, 224 Instruction 40-102, 205, 209– to cigarettes, perceived, 94 210, 215–216, 219, 221– on military installations, 96, 227, 235–237, 245, 250 225, 342–343 Airway obstruction, 53 Accidents, and tobacco use, 4, 45– ALA. See American Lung 46 Association ACS. See American Cancer Society Alcohol abuse and dependence, 8, Acupuncture, 137–138, 282 47, 51, 87, 156–157 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 52–54, 56 Alcohol and Tobacco Advisory Addiction. See Nicotine addiction Council Advertising of tobacco products, 5– Alcohol and Tobacco Advisory 6, 120–122, 208–210 Council (ATAC), DoD, 9, 202– in military publications, 210, 203, 232 274 Amblyopia, 41 AEP. See Acute eosinophilic American Cancer Society (ACS), pneumonia 12, 25–26, 145, 212, 231–232, Aerobic capacity, 42–43 235, 282–283 Afghanistan, service in, ix, 8, 11, Freshstart program, 231–232, 20–21, 32, 92–93, 243, 294 283 Agency for Health Care Policy and American Legacy Foundation, 122, Research, 254 139, 145 347

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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 282–283 program Freedom from Smoking Asthma, 48, 161 program, 231–232, 255 ATAC. See Alcohol and Tobacco Tobacco Cessation Resource Advisory Council Center, 148 Atherosclerosis, 52 American Psychiatric Association, Attention deficit hyperactivity 83–84, 151 disorder, 87 American Stop Smoking Attitudes. See Leadership attitudes; Intervention Study (ASSIST) Social attitudes program, 117, 167, 332–333, Auditor-vigilance tasks, 44 335 Aviation performance, and tobacco Anemia, 52 use, 44–45 Anger, and nicotine withdrawal, 42 Avoidance education, 229 Angina pectoris, 53 Antihypertensive drugs, 54 B Antipsychotic medications, 154, 295 Basic training, 19, 218–221 Anxiety disorders, 16, 87–89 dropout rates during and after, and nicotine withdrawal, 4, 1, 4, 19 42, 84 preventing initiation and Army, 3, 21, 23, 31–34, 43 relapse after, 252–253 Aeromedical Research relapse-prevention Laboratory, 42 interventions during, 250– Center for Health Promotion 252 and Preventive Medicine tobacco-use restrictions (CHPPM), 212, 231–232, during, 9, 46, 127 239–242, 255 Behavioral economics. See also Dental Command, 237 Conditioned behavior HOOAH 4 Health Web site, influencing tobacco use, 102– 239–240 103 Infantry Training Center, 58 Behavioral interventions, 6, 134– Regulation 215-1, 216, 223, 135, 152, 229–230, 279–280. 233 See also Cognitive-behavior Regulation 350-1, 233 therapy Regulation 600-9, 233 combined with medication, Regulation 600-63, 198, 204, 136, 231–232, 281–282 213, 215–216, 221–223, Benzodiazepines, 154 227, 235, 237 Biology of nicotine reinforcement, TRADOC Regulation 350-6, 84–88 213, 219, 250 conditioned behavior and Army Health Promotion Program nicotine addiction, 85 (AHPP), 204–205, 213

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349 INDEX genetics of nicotine addiction, CBOCs. See Community-based 85–86 outpatient clinics nicotine addiction, mental CBT. See Cognitive-behavior illness, and substance abuse, therapy 86–88 CDC. See Centers for Disease psychoactive effects of Control and Prevention nicotine and nicotine Centers for Disease Control and withdrawal, 84–85 Prevention (CDC), 5, 26, 35, 45, Bipolar disorder, 87, 295 58, 117–118, 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, 292–293 Bupropion, 7, 152–153, 155, 159, Cervical cancer, 51 232, 280–281 Cessation programs. See Medications; Smoking-cessation programs; Tobacco-cessation C programs CFR. See Code of Federal California, tobacco-control Regulations. programs in, ix, 5, 117, 128, Chantix. See Varenicline 144, 327 Charge to the committee, 2, 21–23 California Smokers’ Helpline, 288 Chemotherapeutic agents, for California Tobacco Tax and Health cancer treatment, 54 Promotion Act, 328 Chewing tobacco. See Smokeless- Cancer tobacco use long-term health effect of CHPPM. See Army Center for tobacco use, 1, 19, 51–52, Health Promotion and 158 Preventive Medicine risk for recurrence of, 160 Chronic lung disease, a long-term from smokeless-tobacco use, health effect of tobacco use, 53– 4, 55 54, 159 Carbon monoxide (CO), 42, 52 Chronic obstructive pulmonary end-expiratory, 217 disease (COPD) Cardiovascular disease (CVD), 56 costs to the VA of, 4, 62 long-term health effect of a long-term health effect of tobacco use, 1, 19–20, 40, tobacco use, 4, 48, 53, 158– 52–53, 161 161 Caries, dental, 55 Cataracts, 41, 54

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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 “role models,” 218 use by armed service, 3, 36– training, 9, 341–342 38 Commissaries. See Military use by veterans, 1, 39–40 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, 23– settings 26 Clinical Practice Guidelines. See charge to, 2, 21–23 Public Health Service’s Clinical Commonalities among DoD and Practice Guideline–Treating VA tobacco-control concerns, Tobacco Use and Dependence; 316–318 VA/DoD Clinical Practice Communication interventions, Guideline for the Management 119–124, 208–214, 274–275 of Tobacco Use advertising and promotions, Clinical setting interventions, 140– 120–122, 208–210 143, 234–238, 284–287 counteradvertising and public by nurses, 142, 285–286 education, 10, 24, 122–124, by other health-care 210–213, 342 professionals, 142–143, leadership education and 236–238, 286–287 training, 213–214 by primary-care providers, Community-based outpatient 142, 236, 284–285 clinics (CBOCs), 12, 99, 264, Clozapine, 154, 295 267, 270, 272–273, 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, 227–228 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), 95–98 148, 153, 155–156, 165, 232 in the Department of Veterans Cognitive function, and tobacco Affairs, 98–99 use, 42, 44

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351 INDEX 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, 97– Costs for treatment 98 high cost of psychiatric leadership of antitobacco medications, 295 campaigns, 97 in the military, 4, 56–58 smoking breaks, 97 out-of-pocket, 6, 24 Community settings, tobacco-use in the VA, 4, 62–64 Costs of tobacco use. See restrictions in, 124–126 Economic impacts of tobacco Comorbid conditions. See Medical use; Tobacco-related illness comorbidities in tobacco users; costs; Training costs Psychiatric comorbidities in Counseling. See Behavioral tobacco users interventions; Computer-based Comprehensive tobacco-control programs programs, ix, 5, 8, 11, 15–16, Counteradvertising, 10, 24, 122– 25–27, 116–119, 308 124, 210–213, 342 components of, 330–331 Cryptogenic fibrosing alveolitis, 54 Computer-based programs, for Cue-reactivity, 155 tobacco-cessation interventions, Cues. See Smoking cues 7, 11–12, 146–147, 235, 239– Cultural factors, influencing 241, 274, 290–291 tobacco use, ix, 21, 101–102, Concentration, difficulty with, and 115 nicotine withdrawal, 4, 42, 84 CVD. See Cardiovascular disease Conditioned behavior, and nicotine addiction, 85 Congress, 59–60 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, 241–242 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

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352 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Demographic profile findings and recommendations of the military population, 20, of the committee regarding, 31–34 13–17, 318–322 of military tobacco users, 35– relapse-prevention 39 interventions in, 250–253 of the veteran population, 34– for special populations, 242– 35 250 of veteran tobacco users, 39– surveillance and evaluation, 40 253–256 Denormalizing tobacco use, 5, 14– tobacco-cessation 15, 319–320 interventions in, 227–234 Dental effects. See Caries; tobacco-control programs in, Periodontal disease 202–207 Dentists, 143, 147, 237 and the tobacco retail Department of Defense (DoD), ix– environment, 4, 223–226 x, 21. See also Air Force; Army; Tobacco Use Prevention Marine Corps; Military Health Strategic Plan, 9–11, 199, System; Navy; Organizational 202–208, 213, 221–222, overview of the DoD; TRICARE 247–248, 253, 255, 339–346 program tobacco-use restrictions in, appropriations for, 11, 226 214–223 broad implications of tobacco Department of Health and Human use for, 1–2, 23–27 Services (HHS), 162, 267, 290 economic impacts of tobacco Department of Veterans Affairs use on, 56–62 (VA), ix–x. See also Instruction 1010.15, 125, 198, Organizational overview of the 205, 215–216, 227 VA; Tobacco-use restrictions in Instruction 1330.09, 59, 96, the VA; Veterans Health 209, 224 Administration Instruction 1330.21, 209, 224– broad implications of tobacco 227, 226 use for, 1–2, 23–27 Office of the Assistant economic impacts of tobacco Secretary of Defense for use on, 62–65 Health Affairs, 8–9, 200, Office of Quality and 204, 206–207, 213, 256 Performance, 299 Department of Defense (DoD) Department of Veterans Affairs tobacco-control activities, 8–11, (VA) tobacco-control activities, 197–256 11–13, 263–301. See also communication interventions Veterans Health Administration in, 208–214 communication interventions delivery of interventions in, in, 274–275 234–242 costs of tobacco-related illness in, 64

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353 INDEX delivery of interventions in, United States Code; individual 282–293 departments and agencies findings and recommendations Disability claims, 22–23 of the committee regarding, Diving, 45 13–17, 318–322 Doctors. See Primary-care research conducted within, providers 11, 17, 24, 322–323 DoD. See Department of Defense for special populations, 293– DoD Survey of Health Related 298 Behaviors among Active Duty surveillance and evaluation, Military Personnel, 39, 61, 90, 298–301 97, 204, 249, 254, 339 tobacco-control programs in, Dopamine, 84–85 270–274 Driving, and tobacco use, 96 tobacco-free policies in, 276– Drug interactions, 17–18, 54, 294– 277 295 Dependence. See Nicotine Drug metabolism, altered, 41, 54 addiction Deployed service personnel, 1, 8, E 20, 243, 248–249 lack of activities and Economic impacts of tobacco use, privileges during 1, 4 deployment, 97 on the DoD, 4, 56–62 smokeless-tobacco use among, on the VA, 4, 62–65, 159 162 Education. See also Avoidance training counselors of, 11, 312 education; Providers; Public Depression, 46, 155–156. See also education about tobacco Major depressive disorder of leaders for antitobacco comorbid with PTSD, 297 campaigns, 213–214 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, 126–127. See also military Service academies in the military, 94, 129, 215– EECO. See End-expiratory carbon 216, 218–219, 222–223 monoxide levels in the VA, 11, 129, 276–277 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 Disorders–IV, 84, 89 (EECO) levels, 217 Directives. See Code of Federal Endothelial injury and dysfunction, Regulations; Public Laws; 52

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354 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Endurance, and tobacco use, 42–43 tobacco cessation, physical Esophageal reflux, 54 fitness, and weight Estrogen replacement therapy, 54 management, 97, 232–234 Evaluation and surveillance, 165– Exchanges. See Military exchanges 168, 253–256, 298–301 Exercise capacity, maximal, 52–53 Evidence-based interventions, 115, 134–149, 234–242, 282–293 F in clinical settings, 140–143, 234–238, 284–287 Face-to-face counseling, 6, 134, combined behavioral 143, interventions and Facilities medications, 136, 164, 231– smoke-free policy for all DoD, 232 214–223. See also communication, 119–124 Department of Defense computer-based, 146–147, Instruction 1010.15 239–241, 290–291 smoke-free policy for all VA, delivery of, 138–149 11. See also Veterans individual, 136–138 Health Administration provider education, 147–149, Directive 2008-052 241–242, 291–293 smoke-free policy for federal quitlines, 144–146, 238–239, (Executive Order 13058), 287–289 125–126, 215 relapse-prevention, 164–165 Veterans Integrated Service tobacco-cessation, 133–138 Networks (VISNs) and tobacco-cessation numbers of, 268–269 medications, 135–136 Factors that influence tobacco use, Evidence-based tobacco-control 5, 79–104 programs, 23, 115–168 community factors, 95–99 comprehensive, 116–119 individual factors, 82–93 for special populations, 149– interpersonal factors, 93–95 164 societal factors, 99–104 surveillance and evaluation, a socioecologic analysis of 165–168 tobacco use in military and tobacco retail environment, veteran populations, 81–82 129–133 Families, involvement in tobacco tobacco-use restrictions, 124– use, 1, 5, 95, 297–298 129 FCTC. See World Health Evidence-based treatment, 228– Organization Framework 232, 278–281. See also Convention on Tobacco Control Medications FDA. See Food and Drug behavioral interventions, 229– Administration 230, 279–280

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355 INDEX Federal tobacco-control programs, H 117, 137, 332–336. See also Centers for Disease Control and Haloperidol, 154 Prevention; National Cancer Handheld Computer Smoking Institute Intervention Tool (HCSIT), 149 Financial incentives, 137–138 Harm reduction, 133–134 Findings of the committee, 13–17, Hazards. See Accidents 307–324 HCSIT. See Handheld Computer for the DoD and the VA, 318– Smoking Intervention Tool 322 Healing of infections, effect of research agenda, 322–324 tobacco use on, 48–49 tobacco-control Healing of wounds, impaired from commonalities, 316–318 tobacco use, 49 toward a tobacco-free military Health-care costs of tobacco use. population, 308–313 See Tobacco-related illness costs toward a tobacco-free veteran Health-care providers, in clinical population, 313 –316 settings, 6–7, 142–143, 284–287 Fires, and tobacco use, 46, 217 Health effects of tobacco use, 1, 27, 5 A’s, 7, 12, 140–141, 148, 237, 40–56 279, 317 long-term, 27, 51–54 5 R’s, 7, 140–141 secondhand smoke, 54–55 Flight safety, 44 short-term, 27, 41–50 Flu, 48, 54 smokeless-tobacco use, 55–56 Fluphenazine, 154 tobacco-related illness costs, Food and Drug Administration 57–58, 64 (FDA), 6–7, 62, 134–136, 230, Health professionals, in clinical 244, 280 settings, 236–238 Framework Convention on Healthy living, 47–50, 81, 213, Tobacco Control (FCTC) of the 218, 341–342 World Health Organization, 81, Healthy People 2010, 81, 254 121, 334–335 Hearing loss, and tobacco use, 4, Freshstart program of the American 43–44 Cancer Society, 231–232, 283 Hedonic dysregulation, 85 Helicobacter pylori infection, 49 Heritability, a factor in smoking, G 85–86 HHS. See Department of Health Gastrointestinal disease, 41, 49 and Human Services Genetics of nicotine addiction, 5, Homeless veterans, 150, 297 85–86 Hospitalization Geopolitical context, influencing increased risk of with tobacco tobacco use, 103–104 use, 4, 46–47 tobacco cessation during, 8, 163

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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, 137–139, 282 VA to tobacco control, 295, 316, Hypothalamic-pituitary-adrenal 322–324 (HPA) axis, 89 Interactions, between tobacco- Hypothyroidism, aggravated by cessation and psychiatric tobacco use, 41, 54 medications, 17–18, 54, 294– 295 Interagency Committee on I Smoking and Health (ICSH), 267, 334 ICSH. See Interagency Committee Interpersonal factors influencing on Smoking and Health tobacco use, 5, 93–95. See also Immunologic alterations, 48–49 Societal factors influencing Incentives for quitting, financial, tobacco use 137–138, 280 Interventions. See also Behavioral Individual factors influencing interventions; Evidence-based tobacco use, 5, 82–93. See also interventions; Multisession Genetics of nicotine addiction intensive interventions; Targeted alcohol abuse, 88–89 interventions; Tobacco-cessation anxiety disorders, 89 interventions biology of nicotine implementing, 79–80 reinforcement, 84–88 stepped-care, 156, 296 depression, 89–90 IOM. See Institute of Medicine mental-health disorders in Iraq, service in, ix, 8, 11, 20–21, veterans, 92–93 32, 50, 92–93, 243, 248–249, nicotine addiction, 83–84 294 psychologic stress and Irritability, and nicotine comorbid conditions in the withdrawal, 4, 42, 84–85 active military, 90–92 schizophrenia, 90 self-image, 5, 101 J Infectious diseases, health risk of tobacco use, 4, 54–55 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, 45–46 of standards from, 125, 276, 315 Insomnia, and nicotine withdrawal, 84 K Institute of Medicine (IOM), ix–x, 22, 26, 120–121, 132, 134, 149, Kaiser Permanente, 23, 117 327, 336 Korean War veterans, 34–35 Insulin, reactions to, 53–54

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357 INDEX tobacco-control programs on L bases, 204–205 Langerhans cell histiocytosis, 54 Massachusetts, tobacco-control Leadership attitudes, influencing programs in, ix, 5, 117, 144, tobacco use, 5, 97, 207, 214, 289, 327–329 217–219 MDD. See Major depressive Leadership of antitobacco disorder campaigns MEDCOM Web site, 235, 241 education and training of, Medical comorbidities in tobacco 213–214 users, 2, 8, 158–161 importance of, 6, 272, 317– Medical records, electronic, 315 318, 320–321 Medicare and Medicaid, 201, 265– Legionnaire’s disease, 48 266, 299 Leukemia, 51 Medications Living areas, tobacco-use combined with behavioral restrictions in, 221–222 interventions, 136, 231–232, Long-term health effects of tobacco 281–282 use, 4, 51–54 research needed on possible cancer, 4, 51–52 interactions with psychiatric cardiovascular disease, 4, 52– medications, 17–18, 54, 53 294–295 chronic lung disease, 53–54 for tobacco-cessation, 6, 8, Lost productivity. See Productivity 135–136, 152–154, 165, Lung disease 230–231, 280–281, 294 chronic, 53–54, 159 Medigap insurance, 35 interstitial, 53 Meningococcal meningitis, 48 Mental-health disorders, in veterans, 92–93 M Mental-health disorders in military personnel, 243 Macular degeneration, 41, 54 Mental-health disorders in tobacco Major depressive disorder (MDD), users, 8, 16–17, 46, 91–92, 150– 8, 87, 154–156 158, 243–244 Managing Obesity/Overweight for alcohol abuse and dependence, Veterans Everywhere (MOVE!), 156–157 290–291 behavioral interventions for, Marine Corps, 3, 21, 31–34, 207, 152 217. See also Navy depression, 155–156 MCO Semper Fit Manual and nicotine addiction, 86–88 P1700.29, 220 posttraumatic stress disorder, Order 5100.28, 198 154–155 SECNAV Instruction schizophrenia, 158 5100.13E, 198, 204–205, tobacco-cessation medications 210, 216, 220–221, 223, for, 152–154 235–236

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358 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS MHS. See Military Health System Morale, welfare, and recreation MI. See Acute myocardial (MWR) activities, 215–216, 223 infarction funding for, 56, 59, 100 Middle ear infection, 55 Motivation to quit, 7, 80, 138, 237, Military commissaries, 59–61, 209 280 Military education and training, Multisession intensive tobacco-use restrictions in, 219– interventions, 7, 143, 279 220 MWR. See Morale, welfare, and Military exchanges, 59–61, 209 recreation activities Military family organizations. See Families N Military Health System (MHS), 57, 198–200, 212, 227–228, 230, NAQC. See North American 242, 253–255, 279, 344–346. Quitline Consortium See also Tobacco Use National Action Plan for Tobacco Prevention Strategic Plan; Cessation, 145–146, 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, 141–142, 151 near, 10, 60, 96, 223–226 National Cancer Institute (NCI), 5, restricting access to tobacco 26, 117, 120, 144, 167, 287, 327 products on, 215–216, 225 American Stop Smoking Military populations Intervention Study program, active-duty, 98 117, 332–333 age of, 33–34 Handheld Computer Smoking demographics of, 20, 31–34 Intervention Tool (HCSIT), popular images of, ix, 101 149 tobacco use in, 1, 35–39 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, 208–209, 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, 42–47, 50 National Epidemiologic Survey on Military Web sites, for tobacco- Alcohol and Related Conditions cessation information, 10, 240. (NESARC), 84, 86–88, 156 See also “Quit tobacco. Make National Guard and reservists, 32, Everyone Proud” 98, 249–250, 264 Mood disturbances, 84 National Smoking and Tobacco Use Cessation Program, 11–12, 271, 273, 280

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359 INDEX Navy, 3, 21, 23, 31–34, 43, 59, defining, 83 236–237 genetics of, 85–86 BUMED Position Statements, and mental illness, 86–88 236–237 and substance abuse, 86–88 Bureau of Medicine and Nicotine reinforcement, biology of, Surgery (BUMED), 230 84–88 Commandant of Midshipmen Nicotine-replacement therapies Instruction 5400.6L, 219 (NRTs), ix, 7, 13, 103, 125, DNAS Instruction 3120.1D, 134–136, 142, 145, 151–153, 220 159, 228–232, 236, 276, 280, Health Promotion Wellness 314–315 Tobacco Program, 254 Nicotine withdrawal, 4, 42 Instruction 5100.13E, 215– exacerbating psychiatric 217 symptoms, 150 NAVHOSPGLAKES psychoactive effects of, 84–85 Instruction 6220.7, 254 Night vision, and tobacco use, 43– OPNAVINST 6100.2A, 206 44 Recruit Training Command Nonsmokers, 44, 90 Instruction 5100.6K, 219– recognition of the rights of, 220, 250 20, 228 SECNAV Instruction North American Quitline 1500.13E, 198, 204–205, Consortium (NAQC), 145, 167 209–210, 214–216, 220– NRTs. See Nicotine-replacement 227, 235, 237, 245 therapies Submarine Medical Research Nurses, as tobacco-cessation Laboratory, 230 providers, 7, 142, 237, 272, 285– 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, 83–85 Oral cancer, from smokeless- as a stimulant, 2, 88 tobacco use, 4, 55 Nicotine addiction, 5, 83–84 Organizational overview of the and conditioned behavior, 85 DoD, 95, 198–202

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360 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Military Health System, 199– Pharmacists, 142–143, 286 200 Pharmacologic treatments. See TRICARE management Medications activity, 200–202 PHS. See Public Health Service Organizational overview of the PHSHCG. See Public Health VA, 95, 263–270 Strategic Health Care Group chart for tobacco-control Physical fitness responsibilities, 265 and being tobacco-free, 41, National Leadership Board, 207, 233–234, 309 264, 266 increased risk of injury with Public Health Strategic Health tobacco use, 4 Care Group, 266–267 work capacity and tobacco Veterans Health use, 3, 42–43 Administration, 264–266 Physicians. See Primary-care Veterans Integrated Service providers Networks, 267–270 Pilot safety, 44–45 Osteoporosis, 41, 54 Plans. See Strategic planning Outdoor spaces, tobacco-use Pneumonia. See also Acute restrictions in, 128–129, 222– eosinophilic pneumonia 223, 276–277 desquamative interstitial, 53 Oxygen, maximal consumption of, pneumococcal, 48, 55 42–43 varicella, 48–49 Posttraumatic stress disorder (PTSD), 8, 23, 87, 89, 92, 154– P 155, 243–244, 288, 294, 296– 297 Pancreatic cancer, from smokeless- Pregnant women, 247–248 tobacco use, 4, 55 Prevention. See Education; Public Panic attacks, 87 education about tobacco; Parental smoking, 55 Relapse-prevention interventions Peptic ulcer disease, from tobacco Prices for cigarettes and smokeless use, 49 tobacco, ix, 6, 130–132, 224– Perceptions, of cigarette 226, 330 availability and acceptability in on military installations, 10, the military, 94 60, 96, 223–226 Performance Primary-care providers, in clinical effects of smoking on military, settings, 142, 236, 284–285 3, 42–47, 50 Private residences, tobacco-use measuring, 8, 165–166, 299 restrictions in, 127–128, 221– Periodontal disease, from tobacco 222 use, 4, 49–50, 55–56 Privileges granted during Peripheral vascular disease, 52, 159 deployment, and tobacco use, 97 Pharmacies in the Military Health Problems created by tobacco use, System, 230. See also VA 31–65 National Formulary

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361 INDEX economic impacts of tobacco Public education about tobacco, ix, use, 56–65 6, 8–9, 122–124, 210–213, 317 getting along with friends, 84 Public Health Service (PHS), 7–8, health effects of tobacco use, 12, 26, 134, 136–137, 140–142, 40–56 149, 161, 200, 229, 247, 317 tobacco use in military and Clinical Practice Guideline– veteran populations, 31–40 Treating Tobacco Use and Productivity, lost through tobacco Dependence, 16, 26, 134– use, 4, 19, 46–47, 58–59 137, 140, 142, 152, 159, Profits, from the sale of tobacco 161–163, 229, 233, 282, products on military 294, 317, 321 installations, 310 Public Health Strategic Health Care Programs. See also Computer- Group (PHSHCG), 99, 266–267, based programs; Evidence-based 271, 275, 281, 291–292, 299 tobacco-control programs; Public Laws 102-585, §526. See Veterans Tobacco-cessation programs; Health Care Act of 1992 Tobacco-control programs; 109-114, 62 individual programs Pulmonary disease, 40, 53 identifying successful, 3, 23, PX. See Military exchanges 27 leadership of, 97, 206–207, 213–214 Q Promotion of tobacco products, 5, 120–122, 208–210 Quit kits, 289, 329 in military publications, 210 “Quit Tobacco. Make Everyone point-of-sale, 103, 121 Proud,” 8, 10–12, 123, 211–212, Providers, educating for tobacco- 239–241, 312 cessation interventions, 147– Quitlines in tobacco-cessation 149, 241–242, 291–293 interventions, 6–7, 24, 144–146, Psychiatric comorbidities in 238–239, 287–289, 312 tobacco users, 2, 8, 84–85, 88 Quitting tobacco use, ix, 8, 10 in military populations, 243– motivation for, 80, 138 244 receptivity to idea of, 24 in veteran populations, 293– 297 R withdrawal exacerbating, 150 Psychiatric medications, possible Reaction time, impaired, 42, 44–45 interactions with medications for Readiness. See Military readiness tobacco-cessation, 17–18, 54, Recommendations of the 294–295 committee, 13–17, 307–324. See Psychotic disorders, 87, 153 also Research agenda items PTSD. See Posttraumatic stress proposed disorder tobacco-control commonalities, 316–318

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362 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS toward a tobacco-free military Secondhand smoke, 23, 119, 215, population, 308–313 217, 222, 228, 331 toward a tobacco-free veteran health effects of, 11, 53–55 population, 313–316 Service academies, tobacco- Reinforcement. See Nicotine restrictions in, 220–221 reinforcement Short-term effects of tobacco use Relapse-prevention interventions, on health, 4, 47–50 8, 164–165, 250–253 acute eosinophilic pneumonia, basic training, 250–252 50 preventing initiation and impaired wound healing, 4, 49 relapse after basic training, infection, 48–49 252–253 peptic ulcer disease, 4, 49 Renal disease, chronic, 53 periodontal disease, 4, 49–50 Reproductive disturbances, 41, 54 Short-term effects of tobacco use Research agenda items proposed, on military readiness and 2–3, 17–18, 25, 322–324 performance, 42–47 Reserves. See National Guard and absenteeism, presenteeism, reservists and lost productivity, 46–47 Residences, tobacco-use accidents and injuries, 45–46 restrictions in private, 127–128 aviation performance, 44–45 Respiratory diseases, 1, 4, 19–20, diving, 45 48, 53–55 nicotine withdrawal, 42 Restlessness, and nicotine night vision and hearing, 43– withdrawal, 4, 42, 84 44 Restrictions. See Tobacco-use physical work capacity and restrictions in the military; endurance, 42–43 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. “Role models,” 218–219 See also Prices for cigarettes and commanders serving as, 218 smokeless tobacco among deployed service personnel, 162 S dual use of, 21, 56, 133, 244– 246 Sales and pricing, 224–226 health effects of, 4, 55–56 Schizophrenia, 8, 87, 152, 158, 295 research needed on, 17, 19, 21 Screening for tobacco use, 310

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363 INDEX by service, 3, 245–246 cultural factors, 8, 101–102 tobacco cessation in, 162–163 geopolitical context, 5, 103– Smokers 104 older, 163–164 influence of the tobacco recognition of the rights of, 97 industry, 100 undergoing surgery, 160 Socioecologic analysis of tobacco Smokers’ Health Fund (proposed), use in military and veteran 334 populations, 5, 81–82 Smoking. See also Tobacco use Sociologic model of levels of in aircraft, 222–223 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, 216– populations, 27, 83 217, 223 Special populations, 149–164, 242– parental, 55 250, 293–298 rates of in the military, 1, 94, deployed personnel, 248–249 339–340 homeless, 297 on submarines, 46, 204, 223 hospitalized tobacco users, in uniform, 216–218 163 Smoking and Tobacco Use National Guard and reservists, Cessation Report (VA), 125, 249–250 269, 272, 276, 280–281, 284– other populations, 161–164, 285, 291, 298 297–298 Smoking-cessation programs. See other tobacco users, 163–164 Tobacco-cessation programs smokeless tobacco and dual Smoking cues, 85 use, 244–246 avoiding, 8, 165 smokeless-tobacco users, 162– reactivity to, 155 163 Snuff, 55. See also Smokeless- tobacco users with medical tobacco use comorbidities, 158–161 Sobriety, 156–157 tobacco users with mental- Social attitudes, influencing health disorders, 150–158, tobacco use, 81 243–244 Social connections, role of tobacco veterans with mental-health in facilitating, 5, 81 disorders, 293–297 Social skills, training in, 158 women, 162, 247–248 Social support for quitting, 8, 165 Spouses of veterans, 297 Societal factors influencing tobacco State tobacco-control programs, 5, use, 5, 99–104 27, 117, 327–332. See also behavioral economics, 102– individual states 103

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364 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Stepped-care interventions, 156, Telephone counseling, 6–7, 24. See 296 also Quitlines Strategic planning, importance for TMA. See TRICARE Management tobacco-control programs, 6, 25, Activity 199, 202–203, 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, 86–88 Tobacco-cessation interventions, 7, Sudden infant death syndrome, 55 133–138, 163–164, 227–234, Suicide, 87, 153 311–312. See also Tobacco- Surgeon General, 40, 47, 83, 267, control programs 327 in clinical settings, 140–143 Office of the Surgeon General evidence-based, 134–139, in the individual armed 228–232 services, 8, 95, 256 and physical fitness, 232–234 reports on smoking, 40, 41, provider education, 147–149 47, 51 in special populations, 149– Surgery, smokers undergoing, 160 164 Surveillance and evaluation, 6, 8, tobacco quitlines, 144–146 165–168, 253–256, 298–301, in users with mental-health 317 disorders, 150–158 Survey of Veteran Enrollees’ and weight management, 97, Health and Reliance upon VA 232–234 with Selected Comparisons to in women, 162 the 1999-2003 Surveys, 298 Tobacco-cessation medications, 7, 135–136, 152–154, 230–231, 280–281 T Tobacco-cessation programs access to, 143 TAG. See Technical advisory BecomeAnEx, 139 group computer-based, 146–147 Targeted interventions, 10, 343– dropout rates, 1, 4, 19 344 Forever Free™, 283 Task Force on Community Freedom from Smoking Preventive Services, 134, 335 Program™, 139, 283 Taxes for cigarettes and smokeless FreshStart program, 283 tobacco, 6, 81, 130–132 Quit for Life™ Program, 139 Technical advisory group (TAG), QuitNet, 139 267 QuitSmart™, 283 Telemedicine, 284

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365 INDEX SmokeFree.gov, 139 in the military, 4, 56–57 used by the VA, 283 in the VA, 4, 62–64 Tobacco Cessation Provider Tobacco retail environment on Competency Course, 241 military installations, 6, 21, 59– Tobacco Cessation Resource 61, 129–133, 223–226 Center, 148 access to tobacco products, Tobacco-control activities 132–133, 224 in the DoD, 6, 24, 197–256 sales and pricing, 224–226 in the VA, 6, 263–301 tobacco prices and taxes, 130– Tobacco-control programs, ix, 5–8 132 commonalities among, 316– Tobacco use, 1, 318. See also Smokeless-tobacco use; 318 Smoking communication interventions, and alcohol abuse, 88–89 119–124 and anxiety disorders, 89 comprehensive, 116–119 death from, 19, 51 delivery of interventions, 138– declines in, 9, 51 149 denormalizing, 5, 14–15, in the DoD, 202–207 319–320 effective, 327–336 and depression, 89–90 evidence-based practices, health hazards posed by, 40– 115–168 41 federal, 332–336 and mental-health disorders, key components of, 119 150–158, 243–244 program leadership, 206–207 problems created by, 31–65 reducing tobacco and quit rates, according to consumption, 203–204 psychiatric disorder, 87 relapse-prevention and schizophrenia, 90 interventions, 164–165 Tobacco use in the military, 1, 13, state, 328–332 19, 31–40 surveillance and evaluation, demographics of military 165–168 populations, 31–34 and the tobacco retail goals of the DoD and Armed environment, 129–133 Service, 198 tobacco-use restrictions, 124– and tobacco sales revenue for 129 DoD, 61 in the VA, 270–274 Tobacco use in veteran Tobacco-Free Me, 232 populations, 13, 19, 21, 31–40 Tobacco industry demographics of veteran influencing tobacco use, 5, 21, populations, 34–35 100 Tobacco Use Prevention Strategic lobbying Congress, 100 Plan, 9–11, 199, 202–208, 213, Tobacco-related illness costs, 19, 221–222 27, 57–58 text of, 339–346

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366 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Tobacco-use restrictions in the U military, 124–129, 214–223 in community settings, 124– Ulcers, 54 126 Unemployment, among veterans, in educational settings, 126– 35 127, 218–221 Uniform, smoking in, 216–218 in living areas and United Service Organizations, 317 transportation, 221–222 United States Code in military education and 10 USC 2484(3)(a), 60 training, 219–220 10 USC 2484(3)(B), 225 in outdoor spaces, 128–129, 10 USC 2484(b)(8), 60 222–223 10 USC 2484(d)(e), 59 in private residences and 10 USC 2486(a), 59 vehicles, 127–128 10 USC 2486(d)(2), 224 in training settings, 218–221 10 USC 2486(f), 225 in workplace settings, 215– Urinary cotinine, screening for, 310 218 Tobacco-use restrictions in the VA, V 276–278 Training. See also Basic training; VA. See Department of Veterans Providers Affairs of commanders, 9, 341–342 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, 218–220 229, 233–238, 242, 247, 252, of leaders for antitobacco 272, 279, 291, 293, 299–300, campaigns, 213–214 312, 321 in social skills, 158 VA medical centers (VAMCs), 11, tobacco-use restrictions 21, 99, 264, 267, 269, 273–287, during, 218–221 291–292 Training costs, lost through tobacco VA National Formulary, 280–281, use, 58–59 294 Transportation tobacco-use VAMCs. See VA medical centers restrictions, 221–222 Varenicline, 7, 152–153, 159, 236, in private vehicles, 127–128 280 Treatment. See Evidence-based correct dosing, 281 treatment; Medications precautions regarding, 244, TRICARE Management Activity 267 (TMA), 3, 23, 95, 200–202, 227, Varicella pneumonia, 48–49 247, 254 Vehicles. See also Driving TRICARE program, 2, 11, 21, 57– tobacco-use restrictions in 58, 98, 161, 200, 212, 228–229, military, 221–222 242, 249 tobacco-use restrictions in Tuberculosis, 48–49 private, 127–128

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367 INDEX Veteran populations Weight concerns, 97, 164, 232– demographics of, 34–35 234, 290, 309 homeless, 150, 297 WHO. See World Health with mental-health disorders, Organization 21, 293–297 Withdrawal. See Nicotine returning from conflict, 8, withdrawal 313–314 Women, 2, 54, 162, 247–248 support levels for, 98 pregnant, 247–248 tobacco use among, 1, 39–40 tobacco cessation in, 162 unemployment among, 35 Work. See also Unemployment Veterans Health Administration physical capacity for, and (VHA), 2, 263–266, 317 tobacco use, 42–43 Circular 10-90-141, 277 Work-loss days, greater for tobacco Directive 2008-052, 125, 276 users, 42–43, 47–48 Directive 2008-081, 271–272 Workplace settings, tobacco-use Veterans Health Care Act of 1992, restrictions in, 215–218 17, 100, 276–277, 322 World Health Organization Veterans Integrated Service (WHO), 26, 83, 126, 327, 334 Networks (VISNs), 65, 98–99, Building Blocks for Tobacco 149, 267–271, 273–274, 288, Control: A Handbook, 26, 291, 294, 298–299 334 Veterans service organizations Framework Convention on (VSOs), 3, 23, 275, 317 Tobacco Control, 81, 121, VHA. See Veterans Health 334–335 Administration World War II veterans, 34–35 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, 43–44 VSOs. See Veterans service organizations W War zones, deployment to, 1, 20– 21, 44, 92, 96, 294 Washington state, tobacco-control programs in, 148 Web-based programs. See Computer-based programs

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