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 reduce smoking by veterans and has been responsible for numerous scientific advances regarding the health effects of smoking.


Finding: VA offers a wide array of tobacco-cessation treatments, including all medications approved by FDA and behavioral counseling. However, the availability of treatments is not uniform among facilities and lack of availability may discourage or prevent patients from seeking or obtaining treatment and health-care providers from prescribing them or referring patients to a tobacco-cessation program.


Recommendation: With the release of the updated 2008 PHS Clinical Practice Guideline for Treating Tobacco Use and Dependence in 2008, VA and DoD should revise their current 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



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