APPENDIX B
DEPARTMENT OF DEFENSE TOBACCO USE PREVENTION STRATEGIC PLAN, 1999

Goals/Tasks

Metrics/Objectives

Requirements (Policy, Programs, Practices, Resources)

A.1. Reduce smoking rates by 5% per year and reduce smokeless tobacco use rate by 15% by the year 2001, for the total force (i.e., include Guard, Reserve, civilian employees and all healthcare beneficiaries).

A.1. The 1998 Department of Defense Survey of Health Related Behaviors Among Military Personnel will serve as the initial baseline for current rates of tobacco use (smokeless and smoking) for active duty personnel.

A.1. Establish an Alcohol Abuse/Tobacco Use Reduction Committee (AATURC) that coordinates and monitors progress of this prevention plan with oversight by the Prevention Safety and Health Promotion Council (PSHPC). This effort requires funding and administrative support from USD/P and R. POM money needs to be requested over the long term to ensure standardization for human resourcing (e.g., staffing guidelines).

 

A.2. Annual progress report from the PSHPC to USD/PandR.

A.2. Explore conducting a smaller DoD survey annually with selected subjects (tobacco and alcohol). Develop a survey mechanism to be able to measure alcohol abuse and tobacco use rates for the following prioritized groups:

Active Duty

Guard and Reserve

DoD Civilians

TRICARE Prime Enrollees



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APPENDIX B DEPARTMENT OF DEFENSE TOBACCO USE PREVENTION STRATEGIC PLAN, 1999 Requirements (Policy, Programs, Practices, Goals/Tasks Metrics/Objectives Resources) A.1. Reduce smoking A.1. The 1998 A.1. Establish an Alcohol rates by 5% per year Department of Defense Abuse/Tobacco Use Reduction and reduce smokeless Survey of Health Committee (AATURC) that tobacco use rate by Related Behaviors coordinates and monitors 15% by the year Among Military progress of this prevention plan 2001, for the total Personnel will serve as with oversight by the Prevention force (i.e., include the initial baseline for Safety and Health Promotion Guard, Reserve, current rates of tobacco Council (PSHPC). This effort civilian employees use (smokeless and requires funding and and all healthcare smoking) for active administrative support from beneficiaries). duty personnel. USD/P and R. POM money needs to be requested over the long term to ensure standardization for human resourcing (e.g., staffing guidelines). A.2. Annual progress A.2. Explore conducting a report from the PSHPC smaller DoD survey annually to USD/PandR. with selected subjects (tobacco and alcohol). Develop a survey mechanism to be able to measure alcohol abuse and tobacco use rates for the following prioritized groups: Active Duty Guard and Reserve DoD Civilians TRICARE Prime Enrollees 339

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340 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Requirements (Policy, Programs, Practices, Goals/Tasks Metrics/Objectives Resources) A.2.1. Identify high-risk groups for initiation of tobacco use, like young military personnel and teen family members. B.1. Promote a B.1. Annual report on B.1. Assess the content of all tobacco-free lifestyle percentage of military basic, technical and professional and culture through training and education military training programs for education and programs that include targeted education programs. leadership. instruction on risks of These programs will include the tobacco use and Services’ goal to being smoke benefits of not smoking free, address risks and harmful effects of tobacco use, the impact of tobacco use on mission readiness (e.g., decreased night vision, decreased cold tolerance, and increased injury rates, etc…) and the benefits of being a nonsmoker. Draft proposed education programs where necessary. B.1.1. Report B.1.1. Assess and evaluate the percentage of policy current consistency of tobacco changes implemented use policies across the Services at one year. for basic and initial skills training. B.1.2. Assess Service policies on tobacco use for students and instructors, during the duty day, for all formal military training schools, (e.g., Basic and Officer Training School, technical schools, professional military education schools). B.1.3. Prepare draft policy that extends prohibition of tobacco use for students during all formal military training and

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341 APPENDIX B Requirements (Policy, Programs, Practices, Goals/Tasks Metrics/Objectives Resources) schools during the duty day, (e.g., Basic and Officer Training School, technical schools, professional military education schools. (Note: If new policy is implemented then new accessions will be informed of these requirements before entering the military.) B.1.4. Assess and draft policy, if necessary, that requires all personnel selected for training to be informed of the Services smoke free goal. B.2. Educate B.2. Assess and evaluate commanders at all existing educational programs levels on how best to for commanders that include encourage healthy education on how to encourage lifestyles as well as healthy lifestyles and the benefits of being information regarding the tobacco free. benefits of being a nonsmoker. B.2.1. If necessary, develop educational materials for commanders that address how to encourage healthy lifestyles and address the benefits of being a nonsmoker. B.2.2. Develop a draft uniform policy, for instructors in formal school instructor positions, which address the need for instructors to serve as “role models.” B.2.3. Develop a draft uniform policy that addresses instructors’ use of tobacco products in the school environment. B.2.4. Assess current availability of promotional

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342 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Requirements (Policy, Programs, Practices, Goals/Tasks Metrics/Objectives Resources) materials and programs to include information and programs like unit awards for tobacco free lifestyles (e.g., 72- hour pass liberty, etc…). This assessment as well as new promotional programs will need to be sensitive to the need of Base commanders to work with local unions and develop similar promotional programs for civilian employees. B.3. Promote the B.3. Report the B.3. Assess the existence and benefits of being a percentage of Public extent of Public Affairs offices’ nonsmoker and Affairs offices efforts to conduct provide tobacco providing tobacco counteradvertising for tobacco counteradvertising counteradvertising use. (For example, articles and using Public Affairs campaigns that include benefits and other military of being tobacco free, the media. availability of smoking cessation programs, and the harmful effects of tobacco use.) B.3.1. Assess current policy and compliance on Services’ commercial solicitation as it relates to tobacco products, (For example advertising, promotion, and donations.). C.1 Decrease C.1. Report the C.1. Assess the Service policies accessibility and percentage of policy and compliance with State/local availability of changes implemented laws restricting tobacco use tobacco products at 1 year. where those community through pricing and standards are more restrictive smoking area and than DoD policy. tobacco use restrictions. C.1.1. Review Service policies and practices on prohibiting

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343 APPENDIX B Requirements (Policy, Programs, Practices, Goals/Tasks Metrics/Objectives Resources) tobacco use in all common areas used by non-tobacco users. C.1.2. Assess the implementation of Executive Order 13058-Protecting Federal Employees and the Public From Exposure to Tobacco Smoke in the Federal Workplace. C.1.3. Support pricing tobacco products at no more than 5% below the local competitive price. C.1.4. Assess Service practice of and compliance with implementing the prohibition of tobacco sales to individuals under the age of 18. C.1.5. Develop draft policy that prohibits single serve (e.g. single can, single pack) tobacco products to be sold by self-serve at the checkout register. C.1.6. Develop draft policy that indicates resale activities (Commissaries and Exchanges) will endeavor to display tobacco cessation products in areas that provide visibility and opportunity to customers who desire to change their tobacco habits. C.1.7. Support pricing of smoking cessation products below the local competitive price. D.1. Military health D.1. Report on the D.1. Develop and monitor a system actively percentage of medical centralized, Tri-Service identifies tobacco records noting tobacco reporting and surveillance users and provides use status on DD2766 system to track tobacco use.

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344 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Requirements (Policy, Programs, Practices, Goals/Tasks Metrics/Objectives Resources) targeted interventions or AF 1480A (Currently in development.) D.1.1. Develop a draft policy for ASD(HA) requiring the Military Health System to utilize all avenues to identify and document tobacco users, their readiness to quit and offer appropriate “stage of change” intervention, as delineated below: D.1.2. Develop targeted interventions to selected groups (e.g., pregnant women). D.1.3. Develop a plan to annually conduct a health risk appraisal that includes the assessment of tobacco use habits and mandates participation for active duty personnel. D.1.4. Develop a draft policy that requires tobacco use to be documented as “5th vital sign” at all medical and dental appointments. D.1.5. Assess Service policies, and draft policy if necessary, to require routine screening of all beneficiaries as part of “Put Prevention Into Practice” program, with providers using guidelines from the Agency for Health Care Policy and Research (AHCPR). D.2. Military Health D.2. Report the D.2. Assess and develop draft System provides percentage of tobacco policy that requires tobacco effective tobacco users enrolled to a cessation programs to include cessation programs. primary care manager behavioral modification,

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345 APPENDIX B Requirements (Policy, Programs, Practices, Goals/Tasks Metrics/Objectives Resources) who are offered Nicotine Replacement Therapy tobacco cessation. (NRT)/other approved pharmacological interventions as a TRICARE Prime preventive services benefit. D.2.1. Report the D.2.1. Develop an evaluation of percentage of the effectiveness of newly- individuals enrolled in developed tobacco cessation tobacco cessation programs. programs (specify type) who successfully quit at 6 and 12 months post-intervention. D.2.2. Report the D.2.2. Draft policy to fund percentage of Military Military Treatment Facilities Treatment Facility pharmacies to specifically stock pharmacies providing a variety of NRT and other NRT and other approved pharmacological approved interventions that have pharmacological substantial empirical support for therapy to TRICARE their use, (e.g. buproprion) to Prime beneficiaries. accommodate individualized therapy. (Note: This will be an unfunded requirement provided by ASD (HA) until incorporated into O and M baseline POM). D.2.3. Support partnership with TRICARE managed care support contractors to identify interventions that work and to facilitate tobacco use avoidance education. D.2.4. Assess installation tobacco cessation programs for flexibility to accommodate individual needs, to include: individual or group contact, recognition of problems encountered in quitting (skills

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346 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Requirements (Policy, Programs, Practices, Goals/Tasks Metrics/Objectives Resources) training), at least 4 encounters and encouragement to use Nicotine Replacement Therapy appropriately. Prepare policy recommendations as necessary. E. Continually assess E.1. AATURC reviews E1. Develop plans to assess best practices in the and recommends best prevention and early area of Tobacco practices to the intervention strategies. prevention. PSHPC. E.2. Develop and evaluate best prevention practices pilot programs. ACRONYMS: AATURC = Alcohol Abuse/Tobacco Use Reduction Committee; AHCPR = Agency for Health Care Policy; ASD(HA) = assistant secretary of defense for health affairs; DoD = Department of Defense; NRT = nicotine- replacement therapy; O and M baseline POM = Operations and Management baseline program objective memorandum; PSHPC = Prevention Safety and Health Promotion Council; USD/P and R = under secretary of defense for personnel and readiness. SOURCE: Adapted from http://www.tricare.mil/hpp/ aaturc_actionplan_tobacco. html. Accessed November 11, 2008.