Table Of ContentCommittee on Smoking Cessation in Military and Veteran
Populations
Board on Population Health and Public Health Practice
Stuart Bondurant and Roberta Wedge, Editors
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NOTICE: The project that is the subject of this report was approved by the
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regard for appropriate balance.
This study was supported by Contract V101 (93) P-2136, TO 101-E85010 (14)
between the National Academy of Sciences and the Department of Veterans
Affairs. Any opinions, findings, conclusions, or recommendations expressed in
this publication are those of the authors and do not necessarily reflect the view
of the organizations or agencies that provided support for this project.
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Suggested citation: IOM (Institute of Medicine). 2009. Combating Tobacco Use
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COMMITTEE ON SMOKING CESSATION IN MILITARY
AND VETERAN POPULATIONS
STUART BONDURANT, (Chair), Professor of Medicine, Dean
Emeritus, University of North Carolina at Chapel Hill
NEAL L. BENOWITZ, Professor of Medicine, Psychiatry, and
Biopharmaceutical Sciences, University of California, San
Francisco
SUSAN J. CURRY, Professor and Dean, College of Public Health,
University of Iowa
ELLEN R. GRITZ, Professor and Chair of the Department of
Behavioral Science, University of Texas and M.D. Anderson
Cancer Center
PETER D. JACOBSON, Professor of Health Law and Policy and
Director, Center for Law, Ethics, and Health, University of
Michigan School of Public Health
KENNETH W. KIZER, Chairman, Medsphere Systems Corporation
ROBERT C. KLESGES, Professor of Preventive Medicine, University
of Tennesse Health Sciences Center, and Member, St. Jude
Children's Research Hospital
HOWARD K. KOH, Asssociate Dean for Public Health Practice,
Harvey V. Fineberg Professor of the Practice of Public Health,
and Director, Division of Public Health Practice, Harvard School
of Public Health (resigned March 25, 2009)
WENDY K. MARINER, Professor of Health Law, Bioethics and
Human Rights, Boston University School of Public Health, and
Professor of Law, Boston University School of Law
ANA P. MARTINEZ-DONATE, Assistant Professor of Population
Health Sciences, University of Wisconsin–Madison
ELLEN R. MEARA, Associate Professor of Health Care Policy,
Harvard Medical School
ALAN L. PETERSON, Professor, Behavioral Wellness Center for
Clinical Trials, University of Texas Health Science Center at San
Antonio
FRANCES STILLMAN, Associate Professor of Epidemiology,
Codirector, Institute for Global Tobacco Control, Johns Hopkins
Bloomberg School of Public Health
v
EDWARD P. WYATT, Founder, EWyatt Consulting, LLC
DOUGLAS M. ZIEDONIS, Professor and Chair of the Department of
Psychiatry, University of Massachusetts Medical School
Study Staff
ROBERTA WEDGE, Study Director
RENEE WLODARCZYK, Associate Program Officer
JENNIFER SAUNDERS, Associate Program Officer
PATRICK BAUR, Research Associate
JOSEPH GOODMAN, Senior Program Assistant
NORMAN GROSSBLATT, Senior Editor
CHRISTIE BELL, Financial Officer
HOPE HARE, Administrative Assistant
ROSE MARIE MARTINEZ, Director, Board on Population Health and
Public Health Practice
vi
REVIEWERS
This report has been reviewed in draft form by persons chosen
for their diverse perspectives and technical expertise in accordance with
procedures approved by the National Research Council’s Report Review
Committee. The purpose of this independent review is to provide candid
and critical comments that will assist the institution in making its
published report as sound as possible and to ensure that the report meets
institutional standards of objectivity, evidence, and responsiveness to the
study charge. The review comments and draft manuscript remain
confidential to protect the integrity of the deliberative process. We thank
the following for their review of this report:
Greg Connolly, Harvard University School of Public Health
Michael Eriksen, Georgia State University
Michael C. Fiore, University of Wisconsin School of Medicine and
Public Health
Jack Henningfield, Pinney Associates
Corinne Husten, Partners for Prevention
Anna M. McDaniel, Indiana University School of Nursing
Robin Mermelstein, University of Illinois at Chicago
Stephanie O’Malley, Yale University, Connecticut Mental Health
Center
Kurt M. Ribisl, University of North Carolina
Barbara K. Rimer, University of North Carolina
Steven A. Schroeder, University of California, San Francisco
Although the reviewers listed above have provided many
constructive comments and suggestions, they were not asked to endorse
the conclusions or recommendations, nor did they see the final draft of
the report before its release. The review of the report was overseen by
Robert S. Lawrence, Johns Hopkins Bloomberg School of Public
Health, and Willard G. Manning, The University of Chicago.
Appointed by the National Research Council, they were responsible for
making certain that an independent examination of the report was carried
out in accordance with institutional procedures and that all review
comments were carefully considered. Responsibility for the final content
of the report rests with the author committee and the institution.
vii
PREFACE
The image of the battle-weary soldier in fatigues and helmet,
fighting for his country, has frequently included his lit cigarette. Even
today, when almost two of three military personnel do not use tobacco,
the cultural icon of a smoking soldier endures as demonstrated by the
recent Time magazine cover of a soldier in Afghanistan with a cigarette
in his hand. Although smoking rates have declined in the US military
over the last 50 years, some surveys indicate that tobacco use is on the
rise among young military members and that deployment to Iraq and
Afghanistan is resulting in even higher levels of tobacco use among these
troops. Thus, these troops are essentially putting their lives at risk twice:
once in service to their country, and once in service to tobacco. Tobacco
use is a long-term engagement—it kills slowly and insidiously. It not
only causes suffering from cardiovascular and respiratory diseases and
multiple cancers, but it also impairs military readiness, reducing
performance and endurance. And exposure to secondhand smoke can
affect the health of fellow warriors and family alike. The good news is
that tobacco use can be stopped, and there are many avenues of support
for those who wish to quit.
Comprehensive tobacco-control programs have shown that it is
possible to prevent people from starting to use tobacco and to help those
who do use it to stop. These programs—which have been implemented in
many states, such as California and Massachusetts—have demonstrated
that raising the price of tobacco products, restricting or even eliminating
areas where people can use tobacco, educating the public about the
harmfulness of tobacco, and working with advocacy groups can lead to
reduced tobacco consumption in all segments of the tobacco-using
public. These programs affect broad swaths of society, but individual
tobacco users must also be addressed. Easy access to treatment and
comprehensive programs are needed to help people cope with their
nicotine addiction and to provide them with tools to quit using tobacco.
The tools include nicotine-replacement therapy and other cessation
medications as well as behavior modification and other forms of
counseling. Systematic evaluation of program processes and outcomes is
also important.
The Department of Veterans Affairs (VA) and the Department of
Defense (DoD) have been engaged in reducing tobacco use among their
respective veteran and military populations for many years, but their goal
of being tobacco-free has not been met. To help them reach their goal,
the VA, in cooperation with the DoD, asked the Institute of Medicine
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