Many populations of tobacco users may be reluctant to quit, find it hard to quit, or be at greater risk for adverse health outcomes from tobacco use; these special populations include people who have psychiatric and medical comorbidities, deployed military personnel, and hospitalized people. Tobacco addiction is much more prevalent in people who have mental illness, including schizophrenia, major depression, posttraumatic stress disorder (PTSD), and alcohol abuse. This is of concern given the increased numbers of veterans returning from the conflicts in Iraq and Afghanistan with PTSD and the number of Vietnam veterans who have PTSD. The PHS clinical-practice guideline provides evidence-based treatment protocols for many special populations.
The issue of relapse from tobacco abstinence is well known; as many as 75% or 80% of smokers who quit tobacco use will relapse within 6 months. Relapse-prevention interventions include social support, use of medications, and avoidance of smoking cues.
Comprehensive tobacco-control programs also require surveillance information to help staff to modify the programs to meet changing needs or to address disparities. Surveillance can indicate whether policies are being enforced, medications are being correctly prescribed, quitlines are being used, public-education campaigns are reaching target audiences, interventions are improving health outcomes, and funds are being spent appropriately. Established performance measures should be used to monitor program improvements. Surveillance tools should be designed and operated to provide the necessary foundation for program evaluation, which should be periodic and thorough and whose results should be disseminated publicly.
DoD and each of the armed services have a stated goal of a tobacco-free military, but tobacco-control efforts have not been given high priority by the Office of the Assistant Secretary of Defense for Health Affairs, OASD(HA), or the individual services’ Office of the Surgeon General. There have been recent signs, however, that tobacco control is receiving more attention with the rollout of DoD’s “Quit Tobacco. Make Everyone Proud” public-education campaign. DoD policies to prevent smoking and encourage cessation are outlined in the Code of Federal Regulations, Title 32, Part 85, which charges each armed service to develop its own health-promotion plans. The service plans typically cover where military personnel may use tobacco, requirements for access to tobacco-cessation programs, and specifications about the role of commanders and staff in promoting tobacco cessation and deglamorizing tobacco use.