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Tobacco Use in Military Populations, VA Medical Centers

DOD, VA, Congress Should Take Stronger Steps Toward Eliminating

WASHINGTON -- Because tobacco use impairs military readiness, harms the health of soldiers and veterans, and imposes a substantial financial burden on the departments of Defense and Veterans Affairs, these agencies should implement a comprehensive strategy to achieve the Defense Department's stated goal of a tobacco-free military, says a new report from the Institute of Medicine. DOD should gradually phase in a ban on tobacco use in the military, starting at military academies and officer training programs and among new recruits, the report says. DOD should also stop selling tobacco products in Army and Air Force commissaries -- Navy and Marine Corps commissaries already do not sell them -- and should stop selling them at a discount in military exchanges and other stores. In addition, Congress should allow VA to establish tobacco-free medical centers.

The report was requested by DOD and VA, who asked the Institute of Medicine to identify policies and practices that could lower rates of smoking and help soldiers and veterans quit. Tobacco use reduces soldiers' physical fitness and endurance and is linked to higher rates of absenteeism and lost productivity, the report says. In 2005, 32 percent of active-duty personnel and 22 percent of veterans were smokers; rates among active-duty personnel have recently increased, possibly because of growing tobacco use by deployed troops.

"We found that the adverse effects of tobacco use on military readiness, the health of both smokers and nonsmokers, and the financial cost of the medical care of smoking-related illness in military and veteran populations are a sound basis for moving systematically toward a tobacco-free military," said Stuart Bondurant, professor of medicine and dean emeritus of the School of Medicine at the University of North Carolina, Chapel Hill, and chair of the committee that wrote the report. "The state of the art in tobacco control is such that with well-managed programs, DOD and VA could eventually be tobacco free with minimal disruption, and with substantial benefit to military personnel and veterans."

DOD and VA should ensure that all personnel have quick and easy access to comprehensive, evidence-based tobacco-cessation services, the report says. All DOD and VA health care providers should be able to provide brief counseling and nicotine-replacement therapy to patients. In addition, the committee recommended that VA and DOD develop toll-free "quitlines" to provide military personnel and veterans with counseling on quitting tobacco. Quitline counselors should be trained to deal with issues related to these populations, such as post-traumatic stress disorder.

The Defense Department should set a date by which the military will be tobacco-free and require each of the four services to develop and enforce a timeline for achieving this goal, the report says. Recognizing that immediately banning tobacco use in deployed personnel is not realistic, the committee urged an incremental strategy, starting with closing the pipeline of new tobacco users entering the military. Smoking should be banned at military academies, and the current ban on tobacco use during basic training should be extended to include subseqent technical training. That ban could eventually be extended to all new enlistees, who would be informed during recruitment that they would be expected to remain tobacco-free during their entire military careers.

Eventually, all military installations and active-duty personnel should be required to be tobacco-free -- a goal that could realistically be achieved in 20 years or even sooner, if the plan's initial phase for military academies and new recruits starts within a year, the report says.

Only with assistance from DOD and VA will tobacco use be stopped, the report says, and ideally DOD should not sell tobacco products as they inhibit military readiness. As a first step, DOD should prohibit tobacco sales in Army and Air Force commissaries and stop selling tobacco products at a discount in other military stores. Congress should direct DOD to sell any tobacco products in military exchanges at prices equal to those in the civilian sector, and preferably higher.

Congressional action is also necessary to allow VA to implement tobacco-free medical facilities. The VA's efforts to do so have been hampered by the language of the Veterans Health Care Act of 1992, which requires them to maintain smoking areas for veterans and employees. This act should be repealed, the report says.

The study was sponsored by the U.S. Department of Veterans Affairs. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. They are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. A committee roster follows.

Copies of Combating Tobacco Use in Military and Veteran Populations are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at Reporters may obtain a copy from the Office of News and Public Information (contacts listed above). In addition, a podcast of the public briefing held to release this report is available at

[This news release and report are available at]

Board on Population Health and Public Health Practice
Committee on Smoking Cessation in Military and Veteran Populations
Stuart Bondurant, M.D. (chair)
Professor of Medicine and Dean Emeritus
School of Medicine
University of North Carolina
Chapel Hill
Neal L. Benowitz, M.D.
Professor of Medicine, Psychiatry and Biopharmaceutical Sciences
Comprehensive Cancer Center
University of California
San Francisco
Susan J. Curry, Ph.D.
Professor and Dean
College of Public Health
University of Iowa
Ellen R. Gritz, Ph.D.
Professor and Chair
Department of Behavioral Science, and
Olla S. Stribling Distinguished Chair for Cancer Research
M.D. Anderson Cancer Center
University of Texas
Peter D. Jacobson, J.D., M.P.H.
Center for Law, Ethics, and Health, and
Professor of Health Law and Policy
Department of Health Management and Policy
School of Public Health
University of Michigan
Ann Arbor
Kenneth W. Kizer, M.D., M.P.H.
Medsphere Systems Corp.
Rocklin, Calif.
Robert C. Klesges, Ph.D.
Department of Epidemiology and Cancer Control
St. Jude Children's Research Hospital
Memphis, Tenn.
Howard K. Koh, M.D., M.P.H. (resigned from committee)
Harvey V. Fineberg Professor of the Practice of Public Health,
Associate Dean for Public Health Practice,
Division of Public Health Practice
Harvard School of Public Health
Wendy K. Mariner, J.D., L.L.M., M.P.H.
Professor of Health Law
School of Public Health, and
Professor of Law
School of Law
Boston University
Ana P. Martinez-Donate, Ph.D.
Assistant Professor of Population Health Sciences
University of Wisconsin
Ellen R. Meara, Ph.D.
Associate Professor of Health Care Policy
Harvard Medical School
Alan L. Peterson, Ph.D.
Behavioral Wellness Center for Clinical Trials
Department of Psychiatry
University of Texas Health Science Center
San Antonio
Frances Stillman, Ed.D.
Associate Professor of Epidemiology, and
Institute for Global Tobacco Control
Bloomberg School of Public Health
Johns Hopkins University
Edward P. Wyatt
EWyatt Consulting LLC
Washington, D.C.
Douglas M. Ziedonis, M.D., M.P.H.
Professor and Chair
Department of Psychiatry
Center for Mental Health Services Research
University of Massachusetts Medical School

Roberta Wedge, M.S.
Study Director