audience, size, funding sources, and administrative oversight and governance, but they share several key components that contribute to their success: the development and implementation of a strategic plan, dynamic leadership, effective and enforceable policies, communication interventions, adequate resources, appropriate therapeutic interventions (including those for special populations), surveillance and evaluation of effectiveness, and management capacity to bring about change in response to the evaluation. If implemented in constructive harmony, these key components could provide DoD and VA with the capacity to develop and operate their own tobacco-control programs.

Communication interventions can increase tobacco users’ awareness of the benefits and means of tobacco cessation, educate potential users about the hazards posed by tobacco, and change social norms and attitudes toward tobacco. Public-education campaigns can inform consumers about cessation medications or other interventions, such as quitlines. Conversely, the advertising of tobacco products, particularly aimed at young adults, can increase demand for tobacco products.

Smoking restrictions are most effective when they apply to a variety of public and private settings, when they ban tobacco use completely rather than partially, and when they are strictly enforced. Many governments, businesses, education institutions, and health-care facilities have adopted and currently enforce tobacco-free policies.

The tobacco retail environment encompasses the accessibility of tobacco products and the promotion of tobacco products, both at the point of sale and through advertising. Increased tobacco prices, restricted access to products, and decreased out-of-pocket costs for treatment all reduce consumption. Increasing tobacco prices is one of the most effective mechanisms both to prevent tobacco use and to fund tobacco-control efforts. However, as tobacco taxes and tobacco-free regulations have increased, tobacco manufacturers have responded with the development and promotion of new tobacco products, particularly varieties of smokeless tobacco. The advertising of those products increases their consumption.

Studies show that the rate and duration of tobacco abstinence are increased when cessation interventions are used, but only about 21% of smokers who attempted to quit for at least 1 day in the preceding year used a cessation medication. Behavioral interventions shown to have some consistent effectiveness include brief advice and assistance from a health-care provider during routine health-care visits, multisession telephone counseling, and face-to-face group and individual treatment. Those interventions are most effective when combined with pharmacologic treatments approved by the Food and Drug



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