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Combating Tobacco Use in Military and Veteran Populations
indicated that medications are a part of treatment, and 82% of 151 VAMCs indicated that even if a patient chooses not to attend a tobacco-cessation program, he or she can still obtain tobacco-cessation medications. Of the VAMCs in the survey, 39% limit the number of tobacco-cessation treatments—behavioral or medication—that a patient may receive each year to 2 (VA, 2006b).
Other Individual Interventions
The VA/DoD guideline finds that there is insufficient evidence to advocate the use of other tobacco-cessation interventions, such as acupuncture and hypnosis, although VA has conducted studies of hypnosis (Carmody et al., 2008) and the use of financial incentives (Volpp et al., 2006) for tobacco cessation. However, as noted in Chapter 4, the evidence base on the effectiveness of those treatments for long-term tobacco cessation in the general population and in veteran populations is unclear.
Finding: VA has a long history of attempting to reducesmoking by veterans and has been responsible fornumerous scientific advances regarding the health effects ofsmoking.
Finding: VA offers a wide array of tobacco-cessationtreatments, including all medications approved by FDAand behavioral counseling. However, the availability oftreatments is not uniform among facilities and lack ofavailability may discourage or prevent patients fromseeking or obtaining treatment and health-care providersfrom prescribing them or referring patients to a tobacco-cessation program.
Recommendation: With the release of the updated 2008PHSClinical Practice Guideline for Treating Tobacco Useand Dependencein 2008, VA and DoD should revise theircurrent guideline or adopt the 2008 PHS guideline.
DELIVERY OF INTERVENTIONS
There is no requirement that all VISNs use a standard tobacco-cessation program, such as that of the American Cancer Society or the American Lung Association or the commercially available QuitSmart™, although many of them do so, in addition to following the VA/DoD guideline. See Box 6-1 for some examples of tobacco-cessation programs