The committee believes that DoD should provide a nationwide quitline for military personnel and their families in addition to the computer-based program “Quit Tobacco. Make Everyone Proud”. A national quitline would offer consistency regardless of where service members were stationed. Quitline counselors should be trained to deal with military-specific issues, such as deployment and PTSD.

Many installations make available tobacco-cessation programs that include counseling and medication, but not all do. The committee is pleased to note that the 2009 DoD appropriation bill included a provision for TRICARE, part of the MHS, to cover smoking-cessation treatment for its beneficiaries. The committee hopes that that this coverage will include treatment for smokeless-tobacco use, a growing problem in the military.

VA has long been engaged in efforts to promote tobacco cessation in veterans. VA researchers have been at the forefront of advances in tobacco-cessation treatments. Nevertheless, veterans served by the VA health-care system continue to have higher rates of tobacco use than their general-population counterparts, although they are not as high as those of military personnel. That suggests that many veterans quit using tobacco, but with tobacco use increasing in the military, it is likely that many new veterans accessing the VA health-care system will also be tobacco users, especially those who have been deployed in Iraq and Afghanistan.

Like DoD, VA has many components of a comprehensive tobacco-control plan already in place, including effective and enforceable policies, communication mechanisms, surveillance activities in the form of performance measures, and periodic evaluation of tobacco-control practices. VA has developed a National Smoking and Tobacco Use Cessation Program, and it has recently strengthened its Smoke-Free Policy for VA Health Care Facilities. But in its efforts to become entirely tobacco-free, the department has been thwarted by congressional legislation that requires VA medical facilities to have designated smoking areas for veterans and employees. The committee finds that such a requirement prevents VA from protecting its patients, employees, and visitors from possible exposure to secondhand smoke and prevents it from promoting the health of its more vulnerable patients, those who smoke.

Virtually all of the VA medical centers (VAMCs) have some form of tobacco-control program, although the programs are not standardized or uniform. Each VAMC must designate a smoking and