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Combating Tobacco Use in Military and Veteran Populations
INDEX
A
AATURC. See Alcohol Abuse and Tobacco Use Reduction Committee
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A
AATURC. See Alcohol Abuse and Tobacco Use Reduction Committee
Absenteeism, 1, 4, 19, 46–47
Abstinence rates, 7, 10, 45, 47, 53, 234
evaluating, 13, 164–165
long-term, 18, 148, 164
Acceptability of tobacco use, 93–96
Access to tobacco products, 5–6, 132–133, 224
to cigarettes, perceived, 94
on military installations, 96, 225, 342–343
Accidents, and tobacco use, 4, 45–46
ACS. See American Cancer Society
Acupuncture, 137–138, 282
Acute eosinophilic pneumonia (AEP), from tobacco use, 50
Acute ischemic events, 52
Acute myocardial infarction (MI), 52–54, 56
Addiction. See Nicotine addiction
Advertising of tobacco products, 5–6, 120–122, 208–210
in military publications, 210, 274
AEP. See Acute eosinophilic pneumonia
Aerobic capacity, 42–43
Afghanistan, service in, ix, 8, 11, 20–21, 32, 92–93, 243, 294
Agency for Health Care Policy and Research, 254
Agency for Healthcare Research and Quality, 26, 166, 333
AHPP. See Army Health Promotion Program
Air Force, 2, 9, 21, 23, 31–34, 59, 129, 205, 237–239, 241, 251–252, 255
AETC Instruction 36-2216, 219–220, 250
AF 1480A, 255, 343
Instruction 36-2903, 216
Instruction 40-101, 198, 205–206, 213, 241
Instruction 40-102, 205, 209–210, 215–216, 219, 221–227, 235–237, 245, 250
Airway obstruction, 53
ALA. See American Lung Association
Alcohol abuse and dependence, 8, 47, 51, 87, 156–157
CAGE assessment of, 243
Alcohol Abuse and Tobacco Use Reduction Committee (AATURC), 202.
See also Alcohol and Tobacco Advisory Council
Alcohol and Tobacco Advisory Council (ATAC), DoD, 9, 202–203, 232
Amblyopia, 41
American Cancer Society (ACS), 12, 25–26, 145, 212, 231–232, 235, 282–283
Freshstart program, 231–232, 283
American Legacy Foundation, 122, 139, 145
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American Lung Association (ALA), 12, 25, 139, 158, 235, 282–283
Freedom from Smoking program, 231–232, 255
Tobacco Cessation Resource Center, 148
American Psychiatric Association, 83–84, 151
American Stop Smoking Intervention Study (ASSIST) program, 117, 167, 332–333, 335
Anemia, 52
Anger, and nicotine withdrawal, 42
Angina pectoris, 53
Antihypertensive drugs, 54
Antipsychotic medications, 154, 295
Anxiety disorders, 16, 87–89
and nicotine withdrawal, 4, 42, 84
Army, 3, 21, 23, 31–34, 43
Aeromedical Research Laboratory, 42
Center for Health Promotion and Preventive Medicine (CHPPM), 212, 231–232, 239–242, 255
Dental Command, 237
HOOAH 4 Health Web site, 239–240
Infantry Training Center, 58
Regulation 215-1, 216, 223, 233
Regulation 350-1, 233
Regulation 600-9, 233
Regulation 600-63, 198, 204, 213, 215–216, 221–223, 227, 235, 237
TRADOC Regulation 350-6, 213, 219, 250
Army Health Promotion Program (AHPP), 204–205, 213
ASSIST. See American Stop Smoking Intervention Study program
Asthma, 48, 161
ATAC. See Alcohol and Tobacco Advisory Council
Atherosclerosis, 52
Attention deficit hyperactivity disorder, 87
Attitudes. See Leadership attitudes;
Social attitudes
Auditor-vigilance tasks, 44
Aviation performance, and tobacco use, 44–45
Avoidance education, 229
B
Basic training, 19, 218–221
dropout rates during and after, 1, 4, 19
preventing initiation and relapse after, 252–253
relapse-prevention interventions during, 250–252
tobacco-use restrictions during, 9, 46, 127
Behavioral economics.
See also Conditioned behavior
influencing tobacco use, 102–103
Behavioral interventions, 6, 134–135, 152, 229–230, 279–280.
See also Cognitive-behavior therapy
combined with medication, 136, 231–232, 281–282
Benzodiazepines, 154
Biology of nicotine reinforcement, 84–88
conditioned behavior and nicotine addiction, 85
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genetics of nicotine addiction, 85–86
nicotine addiction, mental illness, and substance abuse, 86–88
psychoactive effects of nicotine and nicotine withdrawal, 84–85
Bipolar disorder, 87, 295
Blood coagulation, increasing, 52
Bone loss, 54
Boot camp. See Basic training
Brain-reward function, 84
Bronchiolitis, 53
Bronchitis, 48, 53
BUMED. See Navy Bureau of Medicine and Surgery
Bupropion, 7, 152–153, 155, 159, 232, 280–281
C
California, tobacco-control programs in, ix, 5, 117, 128, 144, 327
California Smokers’ Helpline, 288
California Tobacco Tax and Health Promotion Act, 328
Cancer
long-term health effect of tobacco use, 1, 19, 51–52, 158
risk for recurrence of, 160
from smokeless-tobacco use, 4, 55
Carbon monoxide (CO), 42, 52
end-expiratory, 217
Cardiovascular disease (CVD), 56
long-term health effect of tobacco use, 1, 19–20, 40, 52–53, 161
Caries, dental, 55
Cataracts, 41, 54
CBOCs. See Community-based outpatient clinics
CBT. See Cognitive-behavior therapy
CDC. See Centers for Disease Control and Prevention
Centers for Disease Control and Prevention (CDC), 5, 26, 35, 45, 58, 117–118, 120, 122, 145, 167, 267, 275, 327, 329, 335
Best Practices for Comprehensive Tobacco Control Programs, 118, 120
Tobacco: Guide to Community Preventive Services, 118, 120
Certification programs, 292–293
Cervical cancer, 51
Cessation programs. See Medications;
Smoking-cessation programs;
Tobacco-cessation programs
CFR. See Code of Federal Regulations.
Chantix. See Varenicline
Charge to the committee, 2, 21–23
Chemotherapeutic agents, for cancer treatment, 54
Chewing tobacco. See Smokeless-tobacco use
CHPPM. See Army Center for Health Promotion and Preventive Medicine
Chronic lung disease, a long-term health effect of tobacco use, 53–54, 159
Chronic obstructive pulmonary disease (COPD)
costs to the VA of, 4, 62
a long-term health effect of tobacco use, 4, 48, 53, 158–161
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Cigarettes.
See also Access to tobacco products;
Prices for cigarettes and smokeless tobacco
part of popular images of military personnel, ix, 101
perceived availability and acceptability of, 5, 94
use by armed service, 3, 36–38
use by veterans, 1, 39–40
Civilian Health and Medical Program of the Uniformed Services, 201
Classrooms. See Educational settings
Clinical Practice Guidelines. See Public Health Service’s Clinical Practice Guideline–Treating Tobacco Use and Dependence;
VA/DoD Clinical Practice Guideline for the Management of Tobacco Use
Clinical setting interventions, 140–143, 234–238, 284–287
by nurses, 142, 285–286
by other health-care professionals, 142–143, 236–238, 286–287
by primary-care providers, 142, 236, 284–285
Clozapine, 154, 295
CME. See Continuing-medical-education credits
CO. See Carbon monoxide
Coast Guard, 31
Code of Federal Regulations (CFR)
Article 199.18, 201
Title 32, Part 85, 8, 227–228
Title 32, Part 85.6, 205, 247
Title 38, Part 17, 279
Cognitive-behavior therapy (CBT), 148, 153, 155–156, 165, 232
Cognitive function, and tobacco use, 42, 44
Colds, 48
Collisions, increased risk of with tobacco use, 4, 45
Colorectal cancer, 51
Combat. See War zones
Commanders
serving as “role models,” 218
training, 9, 341–342
Commissaries. See Military commissaries
Committee on Smoking Cessation in Military and Veteran Populations, x, 294
approach to its charge, 3, 23–26
charge to, 2, 21–23
Commonalities among DoD and VA tobacco-control concerns, 316–318
Communication interventions, 119–124, 208–214, 274–275
advertising and promotions, 120–122, 208–210
counteradvertising and public education, 10, 24, 122–124, 210–213, 342
leadership education and training, 213–214
Community-based outpatient clinics (CBOCs), 12, 99, 264, 267, 270, 272–273, 283, 299
Community factors that influence tobacco use, 5, 95
acceptability of tobacco use, 96
access to and cost of tobacco products on military installations, 96
concern about weight, 97
in the Department of Defense, 95–98
in the Department of Veterans Affairs, 98–99
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difference in support between active-duty and retired military personnel, 98
lack of activities and privileges during deployment, 97
lack of consistent and comprehensive antitobacco policies and programs, 97–98
leadership of antitobacco campaigns, 97
smoking breaks, 97
Community settings, tobacco-use restrictions in, 124–126
Comorbid conditions. See Medical comorbidities in tobacco users;
Psychiatric comorbidities in tobacco users
Comprehensive tobacco-control programs, ix, 5, 8, 11, 15–16, 25–27, 116–119, 308
components of, 330–331
Computer-based programs, for tobacco-cessation interventions, 7, 11–12, 146–147, 235, 239–241, 274, 290–291
Concentration, difficulty with, and nicotine withdrawal, 4, 42, 84
Conditioned behavior, and nicotine addiction, 85
Congress, 59–60
House Armed Services Committee, 100
support needed from, x, 5, 17, 21, 26, 322
tobacco industry lobbying, 100
Continuing-medical-education (CME) credits, 241–242
Copayments, elimination of in VA, 270
COPD. See Chronic obstructive pulmonary disease
Coping skills, training, 155
Coronary heart disease, 52, 55, 125, 158
secondhand smoke and, 54
taking medications for, 53
Cost of tobacco products. See Prices for cigarettes and smokeless tobacco
Costs for treatment
high cost of psychiatric medications, 295
in the military, 4, 56–58
out-of-pocket, 6, 24
in the VA, 4, 62–64
Costs of tobacco use. See Economic impacts of tobacco use;
Tobacco-related illness costs;
Training costs
Counseling. See Behavioral interventions;
Computer-based programs
Counteradvertising, 10, 24, 122–124, 210–213, 342
Cryptogenic fibrosing alveolitis, 54
Cue-reactivity, 155
Cues. See Smoking cues
Cultural factors, influencing tobacco use, ix, 21, 101–102, 115
CVD. See Cardiovascular disease
D
Dark adaptation, 43
Death, from tobacco use, 19, 51, 52.
See also Sudden infant death syndrome;
Suicide
DeCA. See Defense Commissary Agency
Decompression illness, 45
Defense Commissary Agency (DeCA), 210, 226
Directive 40-13, 210
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Demographic profile
of the military population, 20, 31–34
of military tobacco users, 35–39
of the veteran population, 34–35
of veteran tobacco users, 39–40
Denormalizing tobacco use, 5, 14–15, 319–320
Dental effects. See Caries;
Periodontal disease
Dentists, 143, 147, 237
Department of Defense (DoD), ix–x, 21.
See also Air Force;
Army;
Marine Corps;
Military Health System;
Navy;
Organizational overview of the DoD;
TRICARE program
appropriations for, 11, 226
broad implications of tobacco use for, 1–2, 23–27
economic impacts of tobacco use on, 56–62
Instruction 1010.15, 125, 198, 205, 215–216, 227
Instruction 1330.09, 59, 96, 209, 224
Instruction 1330.21, 209, 224–227, 226
Office of the Assistant Secretary of Defense for Health Affairs, 8–9, 200, 204, 206–207, 213, 256
Department of Defense (DoD) tobacco-control activities, 8–11, 197–256
communication interventions in, 208–214
delivery of interventions in, 234–242
findings and recommendations of the committee regarding, 13–17, 318–322
relapse-prevention interventions in, 250–253
for special populations, 242–250
surveillance and evaluation, 253–256
tobacco-cessation interventions in, 227–234
tobacco-control programs in, 202–207
and the tobacco retail environment, 4, 223–226
Tobacco Use Prevention Strategic Plan, 9–11, 199, 202–208, 213, 221–222, 247–248, 253, 255, 339–346
tobacco-use restrictions in, 214–223
Department of Health and Human Services (HHS), 162, 267, 290
Department of Veterans Affairs (VA), ix–x.
See also Organizational overview of the VA;
Tobacco-use restrictions in the VA;
Veterans Health Administration
broad implications of tobacco use for, 1–2, 23–27
economic impacts of tobacco use on, 62–65
Office of Quality and Performance, 299
Department of Veterans Affairs (VA) tobacco-control activities, 11–13, 263–301.
See also Veterans Health Administration
communication interventions in, 274–275
costs of tobacco-related illness in, 64
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delivery of interventions in, 282–293
findings and recommendations of the committee regarding, 13–17, 318–322
research conducted within, 11, 17, 24, 322–323
for special populations, 293–298
surveillance and evaluation, 298–301
tobacco-control programs in, 270–274
tobacco-free policies in, 276–277
Dependence. See Nicotine addiction
Deployed service personnel, 1, 8, 20, 243, 248–249
lack of activities and privileges during deployment, 97
smokeless-tobacco use among, 162
training counselors of, 11, 312
Depression, 46, 155–156.
See also Major depressive disorder
comorbid with PTSD, 297
and nicotine withdrawal, 4, 42, 84
Designated smoking areas.
See also Tobacco-use restrictions in the military
in the military, 94, 129, 215–216, 218–219, 222–223
in the VA, 11, 129, 276–277
Desquamative interstitial pneumonia, 53
Diabetes, a long-term health effect of tobacco use, 4, 41, 53, 161
Diagnostic and Statistical Manual of Mental Disorders–IV, 84, 89
Directives. See Code of Federal Regulations;
Public Laws;
United States Code;
individual departments and agencies
Disability claims, 22–23
Diving, 45
Doctors. See Primary-care providers
DoD. See Department of Defense
DoD Survey of Health Related Behaviors among Active Duty Military Personnel, 39, 61, 90, 97, 204, 249, 254, 339
Dopamine, 84–85
Driving, and tobacco use, 96
Drug interactions, 17–18, 54, 294–295
Drug metabolism, altered, 41, 54
E
Economic impacts of tobacco use, 1, 4
on the DoD, 4, 56–62
on the VA, 4, 62–65, 159
Education.
See also Avoidance
education;
Providers;
Public education about tobacco
of leaders for antitobacco campaigns, 213–214
Education level, and tobacco use, 36
Educational settings, tobacco-use restrictions in, 126–127.
See also Service academies
EECO. See End-expiratory carbon monoxide levels
Effectiveness of interventions, measures of, 7, 213
Emphysema, 53
Employer-sponsored insurance, 166
End-expiratory carbon monoxide (EECO) levels, 217
Endothelial injury and dysfunction, 52
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Endurance, and tobacco use, 42–43
Esophageal reflux, 54
Estrogen replacement therapy, 54
Evaluation and surveillance, 165–168, 253–256, 298–301
Evidence-based interventions, 115, 134–149, 234–242, 282–293
in clinical settings, 140–143, 234–238, 284–287
combined behavioral interventions and medications, 136, 164, 231–232
communication, 119–124
computer-based, 146–147, 239–241, 290–291
delivery of, 138–149
individual, 136–138
provider education, 147–149, 241–242, 291–293
quitlines, 144–146, 238–239, 287–289
relapse-prevention, 164–165
tobacco-cessation, 133–138
tobacco-cessation medications, 135–136
Evidence-based tobacco-control programs, 23, 115–168
comprehensive, 116–119
for special populations, 149–164
surveillance and evaluation, 165–168
tobacco retail environment, 129–133
tobacco-use restrictions, 124–129
Evidence-based treatment, 228–232, 278–281.
See also Medications
behavioral interventions, 229–230, 279–280
tobacco cessation, physical fitness, and weight management, 97, 232–234
Exchanges. See Military exchanges
Exercise capacity, maximal, 52–53
F
Face-to-face counseling, 6, 134, 143,
Facilities
smoke-free policy for all DoD, 214–223.
See also Department of Defense Instruction 1010.15
smoke-free policy for all VA, 11.
See also Veterans Health Administration Directive 2008-052
smoke-free policy for federal (Executive Order 13058), 125–126, 215
Veterans Integrated Service Networks (VISNs) and numbers of, 268–269
Factors that influence tobacco use, 5, 79–104
community factors, 95–99
individual factors, 82–93
interpersonal factors, 93–95
societal factors, 99–104
a socioecologic analysis of tobacco use in military and veteran populations, 81–82
Families, involvement in tobacco use, 1, 5, 95, 297–298
FCTC. See World Health Organization Framework Convention on Tobacco Control
FDA. See Food and Drug Administration
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Federal tobacco-control programs, 117, 137, 332–336.
See also Centers for Disease Control and Prevention;
National Cancer Institute
Financial incentives, 137–138
Findings of the committee, 13–17, 307–324
for the DoD and the VA, 318–322
research agenda, 322–324
tobacco-control commonalities, 316–318
toward a tobacco-free military population, 308–313
toward a tobacco-free veteran population, 313 –316
Fires, and tobacco use, 46, 217
5 A’s, 7, 12, 140–141, 148, 237, 279, 317
5 R’s, 7, 140–141
Flight safety, 44
Flu, 48, 54
Fluphenazine, 154
Food and Drug Administration (FDA), 6–7, 62, 134–136, 230, 244, 280
Framework Convention on Tobacco Control (FCTC) of the World Health Organization, 81, 121, 334–335
Freshstart program of the American Cancer Society, 231–232, 283
G
Gastrointestinal disease, 41, 49
Genetics of nicotine addiction, 5, 85–86
Geopolitical context, influencing tobacco use, 103–104
H
Haloperidol, 154
Handheld Computer Smoking Intervention Tool (HCSIT), 149
Harm reduction, 133–134
Hazards. See Accidents
HCSIT. See Handheld Computer Smoking Intervention Tool
Healing of infections, effect of tobacco use on, 48–49
Healing of wounds, impaired from tobacco use, 49
Health-care costs of tobacco use. See Tobacco-related illness costs
Health-care providers, in clinical settings, 6–7, 142–143, 284–287
Health effects of tobacco use, 1, 27, 40–56
long-term, 27, 51–54
secondhand smoke, 54–55
short-term, 27, 41–50
smokeless-tobacco use, 55–56
tobacco-related illness costs, 57–58, 64
Health professionals, in clinical settings, 236–238
Healthy living, 47–50, 81, 213, 218, 341–342
Healthy People 2010, 81, 254
Hearing loss, and tobacco use, 4, 43–44
Hedonic dysregulation, 85
Helicobacter pylori infection, 49
Heritability, a factor in smoking, 85–86
HHS. See Department of Health and Human Services
Homeless veterans, 150, 297
Hospitalization
increased risk of with tobacco use, 4, 46–47
tobacco cessation during, 8, 163
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HPA. See Hypothalamic-pituitary-adrenal axis
Hypertension, 53, 56, 159
Hypnosis, 137–139, 282
Hypothalamic-pituitary-adrenal (HPA) axis, 89
Hypothyroidism, aggravated by tobacco use, 41, 54
I
ICSH. See Interagency Committee on Smoking and Health
Immunologic alterations, 48–49
Incentives for quitting, financial, 137–138, 280
Individual factors influencing tobacco use, 5, 82–93.
See also Genetics of nicotine addiction
alcohol abuse, 88–89
anxiety disorders, 89
biology of nicotine reinforcement, 84–88
depression, 89–90
mental-health disorders in veterans, 92–93
nicotine addiction, 83–84
psychologic stress and comorbid conditions in the active military, 90–92
schizophrenia, 90
self-image, 5, 101
Infectious diseases, health risk of tobacco use, 4, 54–55
Influenza, 48, 54
Initiation of daily smoking, age at, 37
Injuries, and tobacco use, 45–46
Insomnia, and nicotine withdrawal, 84
Institute of Medicine (IOM), ix–x, 22, 26, 120–121, 132, 134, 149, 327, 336
Insulin, reactions to, 53–54
Insurance coverage for tobacco use, 35, 166, 265
Integrated approach for DoD and VA to tobacco control, 295, 316, 322–324
Interactions, between tobacco-cessation and psychiatric medications, 17–18, 54, 294–295
Interagency Committee on Smoking and Health (ICSH), 267, 334
Interpersonal factors influencing tobacco use, 5, 93–95.
See also Societal factors influencing tobacco use
Interventions.
See also Behavioral interventions;
Evidence-based interventions;
Multisession intensive interventions;
Targeted interventions;
Tobacco-cessation interventions
implementing, 79–80
stepped-care, 156, 296
IOM. See Institute of Medicine
Iraq, service in, ix, 8, 11, 20–21, 32, 50, 92–93, 243, 248–249, 294
Irritability, and nicotine withdrawal, 4, 42, 84–85
J
Joint Chiefs of Staff, 198
Joint Commission [on Accreditation of Healthcare Organizations], implementation of standards from, 125, 276, 315
K
Kaiser Permanente, 23, 117
Korean War veterans, 34–35
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L
Langerhans cell histiocytosis, 54
Leadership attitudes, influencing tobacco use, 5, 97, 207, 214, 217–219
Leadership of antitobacco campaigns
education and training of, 213–214
importance of, 6, 272, 317–318, 320–321
Legionnaire’s disease, 48
Leukemia, 51
Living areas, tobacco-use restrictions in, 221–222
Long-term health effects of tobacco use, 4, 51–54
cancer, 4, 51–52
cardiovascular disease, 4, 52–53
chronic lung disease, 53–54
Lost productivity. See Productivity
Lung disease
chronic, 53–54, 159
interstitial, 53
M
Macular degeneration, 41, 54
Major depressive disorder (MDD), 8, 87, 154–156
Managing Obesity/Overweight for Veterans Everywhere (MOVE!), 290–291
Marine Corps, 3, 21, 31–34, 207, 217.
See also Navy
MCO Semper Fit Manual P1700.29, 220
Order 5100.28, 198
SECNAV Instruction 5100.13E, 198, 204–205, 210, 216, 220–221, 223, 235–236
tobacco-control programs on bases, 204–205
Massachusetts, tobacco-control programs in, ix, 5, 117, 144, 289, 327–329
MDD. See Major depressive disorder
MEDCOM Web site, 235, 241
Medical comorbidities in tobacco users, 2, 8, 158–161
Medical records, electronic, 315
Medicare and Medicaid, 201, 265–266, 299
Medications
combined with behavioral interventions, 136, 231–232, 281–282
research needed on possible interactions with psychiatric medications, 17–18, 54, 294–295
for tobacco-cessation, 6, 8, 135–136, 152–154, 165, 230–231, 280–281, 294
Medigap insurance, 35
Meningococcal meningitis, 48
Mental-health disorders, in veterans, 92–93
Mental-health disorders in military personnel, 243
Mental-health disorders in tobacco users, 8, 16–17, 46, 91–92, 150–158, 243–244
alcohol abuse and dependence, 156–157
behavioral interventions for, 152
depression, 155–156
and nicotine addiction, 86–88
posttraumatic stress disorder, 154–155
schizophrenia, 158
tobacco-cessation medications for, 152–154
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MHS. See Military Health System
MI. See Acute myocardial infarction
Middle ear infection, 55
Military commissaries, 59–61, 209
Military education and training, tobacco-use restrictions in, 219–220
Military exchanges, 59–61, 209
Military family organizations. See Families
Military Health System (MHS), 57, 198–200, 212, 227–228, 230, 242, 253–255, 279, 344–346.
See also Tobacco Use Prevention Strategic Plan;
TRICARE Management Activity
Military installations
prices for cigarettes and smokeless tobacco at and near, 10, 60, 96, 223–226
restricting access to tobacco products on, 215–216, 225
Military populations
active-duty, 98
age of, 33–34
demographics of, 20, 31–34
popular images of, ix, 101
tobacco use in, 1, 35–39
Military publications
advertising and promotion of tobacco products in, 210, 274
Military Times, 208–209, 212
Stars and Stripes, 50, 122, 209
Military readiness, effects of smoking on, 1, 19, 42–47, 50
Military Web sites, for tobacco-cessation information, 10, 240.
See also “Quit tobacco. Make Everyone Proud”
Mood disturbances, 84
Morale, welfare, and recreation (MWR) activities, 215–216, 223
funding for, 56, 59, 100
Motivation to quit, 7, 80, 138, 237, 280
Multisession intensive interventions, 7, 143, 279
MWR. See Morale, welfare, and recreation activities
N
NAQC. See North American Quitline Consortium
National Action Plan for Tobacco Cessation, 145–146, 334
National Alliance for Tobacco Cessation, 139
National Ambulatory Medical Care Survey, 141–142, 151
National Cancer Institute (NCI), 5, 26, 117, 120, 144, 167, 287, 327
American Stop Smoking Intervention Study program, 117, 332–333
Handheld Computer Smoking Intervention Tool (HCSIT), 149
quitlines, 287
Tobacco Control Research Branch, 139
National Comorbidity Survey (NCS), 86, 151
National Defense Authorization Act (NDAA), 201
need to expand, 322
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), 84, 86–88, 156
National Guard and reservists, 32, 98, 249–250, 264
National Smoking and Tobacco Use Cessation Program, 11–12, 271, 273, 280
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Navy, 3, 21, 23, 31–34, 43, 59, 236–237
BUMED Position Statements, 236–237
Bureau of Medicine and Surgery (BUMED), 230
Commandant of Midshipmen Instruction 5400.6L, 219
DNAS Instruction 3120.1D, 220
Health Promotion Wellness Tobacco Program, 254
Instruction 5100.13E, 215–217
NAVHOSPGLAKES Instruction 6220.7, 254
OPNAVINST 6100.2A, 206
Recruit Training Command Instruction 5100.6K, 219–220, 250
SECNAV Instruction 1500.13E, 198, 204–205, 209–210, 214–216, 220–227, 235, 237, 245
Submarine Medical Research Laboratory, 230
Navy and Marine Corps Tobacco Policy, 204, 209
NCI. See National Cancer Institute
NCS. See National Comorbidity Survey
NDAA. See National Defense Authorization Act
Neoplasms. See Cancer
NESARC. See National Epidemiologic Survey on Alcohol and Related Conditions
Neurotransmitters, 84, 86
Nicotine
optimal dose, 45
psychoactive effects of, 83–85
as a stimulant, 2, 88
Nicotine addiction, 5, 83–84
and conditioned behavior, 85
defining, 83
genetics of, 85–86
and mental illness, 86–88
and substance abuse, 86–88
Nicotine reinforcement, biology of, 84–88
Nicotine-replacement therapies (NRTs), ix, 7, 13, 103, 125, 134–136, 142, 145, 151–153, 159, 228–232, 236, 276, 280, 314–315
Nicotine withdrawal, 4, 42
exacerbating psychiatric symptoms, 150
psychoactive effects of, 84–85
Night vision, and tobacco use, 43–44
Nonsmokers, 44, 90
recognition of the rights of, 20, 228
North American Quitline Consortium (NAQC), 145, 167
NRTs. See Nicotine-replacement therapies
Nurses, as tobacco-cessation providers, 7, 142, 237, 272, 285–286
O
Occupational-health clinics, 237
OEF. See Operation Enduring Freedom
OIF. See Operation Iraqi Freedom
Olanzapine, 154, 295
Older patients, 12, 313
Operation Enduring Freedom (OEF), 93, 103
Operation Iraqi Freedom (OIF), 93, 103
Oral cancer, from smokeless-tobacco use, 4, 55
Organizational overview of the DoD, 95, 198–202
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Military Health System, 199–200
TRICARE management activity, 200–202
Organizational overview of the VA, 95, 263–270
chart for tobacco-control responsibilities, 265
National Leadership Board, 264, 266
Public Health Strategic Health Care Group, 266–267
Veterans Health Administration, 264–266
Veterans Integrated Service Networks, 267–270
Osteoporosis, 41, 54
Outdoor spaces, tobacco-use restrictions in, 128–129, 222–223, 276–277
Oxygen, maximal consumption of, 42–43
P
Pancreatic cancer, from smokeless-tobacco use, 4, 55
Panic attacks, 87
Parental smoking, 55
Peptic ulcer disease, from tobacco use, 49
Perceptions, of cigarette availability and acceptability in the military, 94
Performance
effects of smoking on military, 3, 42–47, 50
measuring, 8, 165–166, 299
Periodontal disease, from tobacco use, 4, 49–50, 55–56
Peripheral vascular disease, 52, 159
Pharmacies in the Military Health System, 230.
See also VA National Formulary
Pharmacists, 142–143, 286
Pharmacologic treatments. See Medications
PHS. See Public Health Service
PHSHCG. See Public Health Strategic Health Care Group
Physical fitness
and being tobacco-free, 41, 207, 233–234, 309
increased risk of injury with tobacco use, 4
work capacity and tobacco use, 3, 42–43
Physicians. See Primary-care providers
Pilot safety, 44–45
Plans. See Strategic planning
Pneumonia.
See also Acute eosinophilic pneumonia
desquamative interstitial, 53
pneumococcal, 48, 55
varicella, 48–49
Posttraumatic stress disorder (PTSD), 8, 23, 87, 89, 92, 154–155, 243–244, 288, 294, 296–297
Pregnant women, 247–248
Prevention. See Education;
Public education about tobacco;
Relapse-prevention interventions
Prices for cigarettes and smokeless tobacco, ix, 6, 130–132, 224–226, 330
on military installations, 10, 60, 96, 223–226
Primary-care providers, in clinical settings, 142, 236, 284–285
Private residences, tobacco-use restrictions in, 127–128, 221–222
Privileges granted during deployment, and tobacco use, 97
Problems created by tobacco use, 31–65
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economic impacts of tobacco use, 56–65
getting along with friends, 84
health effects of tobacco use, 40–56
tobacco use in military and veteran populations, 31–40
Productivity, lost through tobacco use, 4, 19, 46–47, 58–59
Profits, from the sale of tobacco products on military installations, 310
Programs.
See also Computer-based programs;
Evidence-based tobacco-control programs;
Tobacco-cessation programs;
Tobacco-control programs;
individual programs
identifying successful, 3, 23, 27
leadership of, 97, 206–207, 213–214
Promotion of tobacco products, 5, 120–122, 208–210
in military publications, 210
point-of-sale, 103, 121
Providers, educating for tobacco-cessation interventions, 147–149, 241–242, 291–293
Psychiatric comorbidities in tobacco users, 2, 8, 84–85, 88
in military populations, 243–244
in veteran populations, 293–297
withdrawal exacerbating, 150
Psychiatric medications, possible interactions with medications for tobacco-cessation, 17–18, 54, 294–295
Psychotic disorders, 87, 153
PTSD. See Posttraumatic stress disorder
Public education about tobacco, ix, 6, 8–9, 122–124, 210–213, 317
Public Health Service (PHS), 7–8, 12, 26, 134, 136–137, 140–142, 149, 161, 200, 229, 247, 317
Clinical Practice Guideline–Treating Tobacco Use and Dependence, 16, 26, 134–137, 140, 142, 152, 159, 161–163, 229, 233, 282, 294, 317, 321
Public Health Strategic Health Care Group (PHSHCG), 99, 266–267, 271, 275, 281, 291–292, 299
Public Laws
102-585, §526. See Veterans Health Care Act of 1992
109-114, 62
Pulmonary disease, 40, 53
PX. See Military exchanges
Q
Quit kits, 289, 329
“Quit Tobacco. Make Everyone Proud,” 8, 10–12, 123, 211–212, 239–241, 312
Quitlines in tobacco-cessation interventions, 6–7, 24, 144–146, 238–239, 287–289, 312
Quitting tobacco use, ix, 8, 10
motivation for, 80, 138
receptivity to idea of, 24
R
Reaction time, impaired, 42, 44–45
Readiness. See Military readiness
Recommendations of the committee, 13–17, 307–324.
See also Research agenda items proposed
tobacco-control commonalities, 316–318
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toward a tobacco-free military population, 308–313
toward a tobacco-free veteran population, 313–316
Reinforcement. See Nicotine reinforcement
Relapse-prevention interventions, 8, 164–165, 250–253
basic training, 250–252
preventing initiation and relapse after basic training, 252–253
Renal disease, chronic, 53
Reproductive disturbances, 41, 54
Research agenda items proposed, 2–3, 17–18, 25, 322–324
Reserves. See National Guard and reservists
Residences, tobacco-use restrictions in private, 127–128
Respiratory diseases, 1, 4, 19–20, 48, 53–55
Restlessness, and nicotine withdrawal, 4, 42, 84
Restrictions. See Tobacco-use restrictions in the military;
Tobacco-use restrictions in the VA
Retail. See Tobacco retail environment on military installations
Retired military personnel. See Veteran populations
Risks, of cancer from smoking, 7, 52
“Role models,” 218–219
commanders serving as, 218
S
Sales and pricing, 224–226
Schizophrenia, 8, 87, 152, 158, 295
Screening for tobacco use, 310
Secondhand smoke, 23, 119, 215, 217, 222, 228, 331
health effects of, 11, 53–55
Service academies, tobacco-restrictions in, 220–221
Short-term effects of tobacco use on health, 4, 47–50
acute eosinophilic pneumonia, 50
impaired wound healing, 4, 49
infection, 48–49
peptic ulcer disease, 4, 49
periodontal disease, 4, 49–50
Short-term effects of tobacco use on military readiness and performance, 42–47
absenteeism, presenteeism, and lost productivity, 46–47
accidents and injuries, 45–46
aviation performance, 44–45
diving, 45
nicotine withdrawal, 42
night vision and hearing, 43–44
physical work capacity and endurance, 42–43
vigilance and cognitive function, 44
Smoke breaks, 4, 216
influencing tobacco use, 97
Smoke-Free Policy
for all DoD facilities, 215
for VA Health Care Facilities, 11, 276
Smokeless-tobacco use, 55, 216.
See also Prices for cigarettes and smokeless tobacco
among deployed service personnel, 162
dual use of, 21, 56, 133, 244–246
health effects of, 4, 55–56
research needed on, 17, 19, 21
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by service, 3, 245–246
tobacco cessation in, 162–163
Smokers
older, 163–164
recognition of the rights of, 97
undergoing surgery, 160
Smokers’ Health Fund (proposed), 334
Smoking.
See also Tobacco use
in aircraft, 222–223
and cancer risk, 52
effects on military readiness and performance, 50
and infection, 48
initiation of daily, 23, 37, 94
on naval ships, 46, 204, 216–217, 223
parental, 55
rates of in the military, 1, 94, 339–340
on submarines, 46, 204, 223
in uniform, 216–218
Smoking and Tobacco Use Cessation Report (VA), 125, 269, 272, 276, 280–281, 284–285, 291, 298
Smoking-cessation programs. See Tobacco-cessation programs
Smoking cues, 85
avoiding, 8, 165
reactivity to, 155
Snuff, 55.
See also Smokeless-tobacco use
Sobriety, 156–157
Social attitudes, influencing tobacco use, 81
Social connections, role of tobacco in facilitating, 5, 81
Social skills, training in, 158
Social support for quitting, 8, 165
Societal factors influencing tobacco use, 5, 99–104
behavioral economics, 102–103
cultural factors, 8, 101–102
geopolitical context, 5, 103–104
influence of the tobacco industry, 100
Socioecologic analysis of tobacco use in military and veteran populations, 5, 81–82
Sociologic model of levels of influence
affecting behavior, 80
influences on tobacco use among the military and veteran populations, 82
for military and veteran populations, 27, 83
Special populations, 149–164, 242–250, 293–298
deployed personnel, 248–249
homeless, 297
hospitalized tobacco users, 163
National Guard and reservists, 249–250
other populations, 161–164, 297–298
other tobacco users, 163–164
smokeless tobacco and dual use, 244–246
smokeless-tobacco users, 162–163
tobacco users with medical comorbidities, 158–161
tobacco users with mental-health disorders, 150–158, 243–244
veterans with mental-health disorders, 293–297
women, 162, 247–248
Spouses of veterans, 297
State tobacco-control programs, 5, 27, 117, 327–332.
See also individual states
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Stepped-care interventions, 156, 296
Strategic planning, importance for tobacco-control programs, 6, 25, 199, 202–203, 332
Stress relief, tobacco providing, 17, 85, 90, 104
Stroke, a long-term health effect of tobacco use, 4, 52, 159
Submarine crews, smoking by, 217
Substance abuse, and nicotine addiction, 2, 86–88
Sudden infant death syndrome, 55
Suicide, 87, 153
Surgeon General, 40, 47, 83, 267, 327
Office of the Surgeon General in the individual armed services, 8, 95, 256
reports on smoking, 40, 41, 47, 51
Surgery, smokers undergoing, 160
Surveillance and evaluation, 6, 8, 165–168, 253–256, 298–301, 317
Survey of Veteran Enrollees’ Health and Reliance upon VA with Selected Comparisons to the 1999-2003 Surveys, 298
T
TAG. See Technical advisory group
Targeted interventions, 10, 343–344
Task Force on Community Preventive Services, 134, 335
Taxes for cigarettes and smokeless tobacco, 6, 81, 130–132
Technical advisory group (TAG), 267
Telemedicine, 284
Telephone counseling, 6–7, 24.
See also Quitlines
TMA. See TRICARE Management Activity
Tobacco. See Cigarettes;
Smokeless-tobacco use;
Smoking
Tobacco: Guide to Community Preventive Services (CDC), 118, 120
Tobacco cessation, voluntary, 311
Tobacco-cessation interventions, 7, 133–138, 163–164, 227–234, 311–312.
See also Tobacco-control programs
in clinical settings, 140–143
evidence-based, 134–139, 228–232
and physical fitness, 232–234
provider education, 147–149
in special populations, 149–164
tobacco quitlines, 144–146
in users with mental-health disorders, 150–158
and weight management, 97, 232–234
in women, 162
Tobacco-cessation medications, 7, 135–136, 152–154, 230–231, 280–281
Tobacco-cessation programs
access to, 143
BecomeAnEx, 139
computer-based, 146–147
dropout rates, 1, 4, 19
Forever Free™, 283
Freedom from Smoking Program™, 139, 283
FreshStart program, 283
Quit for Life™ Program, 139
QuitNet, 139
QuitSmart™, 283
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SmokeFree.gov, 139
used by the VA, 283
Tobacco Cessation Provider Competency Course, 241
Tobacco Cessation Resource Center, 148
Tobacco-control activities
in the DoD, 6, 24, 197–256
in the VA, 6, 263–301
Tobacco-control programs, ix, 5–8
commonalities among, 316–318
communication interventions, 119–124
comprehensive, 116–119
delivery of interventions, 138–149
in the DoD, 202–207
effective, 327–336
evidence-based practices, 115–168
federal, 332–336
key components of, 119
program leadership, 206–207
reducing tobacco consumption, 203–204
relapse-prevention interventions, 164–165
state, 328–332
surveillance and evaluation, 165–168
and the tobacco retail environment, 129–133
tobacco-use restrictions, 124–129
in the VA, 270–274
Tobacco-Free Me, 232
Tobacco industry
influencing tobacco use, 5, 21, 100
lobbying Congress, 100
Tobacco-related illness costs, 19, 27, 57–58
in the military, 4, 56–57
in the VA, 4, 62–64
Tobacco retail environment on military installations, 6, 21, 59–61, 129–133, 223–226
access to tobacco products, 132–133, 224
sales and pricing, 224–226
tobacco prices and taxes, 130–132
Tobacco use, 1, 318.
See also Smokeless-tobacco use;
Smoking
and alcohol abuse, 88–89
and anxiety disorders, 89
death from, 19, 51
declines in, 9, 51
denormalizing, 5, 14–15, 319–320
and depression, 89–90
health hazards posed by, 40–41
and mental-health disorders, 150–158, 243–244
problems created by, 31–65
and quit rates, according to psychiatric disorder, 87
and schizophrenia, 90
Tobacco use in the military, 1, 13, 19, 31–40
demographics of military populations, 31–34
goals of the DoD and Armed Service, 198
and tobacco sales revenue for DoD, 61
Tobacco use in veteran populations, 13, 19, 21, 31–40
demographics of veteran populations, 34–35
Tobacco Use Prevention Strategic Plan, 9–11, 199, 202–208, 213, 221–222
text of, 339–346
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Tobacco-use restrictions in the military, 124–129, 214–223
in community settings, 124–126
in educational settings, 126–127, 218–221
in living areas and transportation, 221–222
in military education and training, 219–220
in outdoor spaces, 128–129, 222–223
in private residences and vehicles, 127–128
in training settings, 218–221
in workplace settings, 215–218
Tobacco-use restrictions in the VA, 276–278
Training.
See also Basic training;
Providers
of commanders, 9, 341–342
in coping skills, 155
instructors, prohibition of tobacco-use by, 9, 218–220
of leaders for antitobacco campaigns, 213–214
in social skills, 158
tobacco-use restrictions during, 218–221
Training costs, lost through tobacco use, 58–59
Transportation tobacco-use restrictions, 221–222
in private vehicles, 127–128
Treatment. See Evidence-based treatment;
Medications
TRICARE Management Activity (TMA), 3, 23, 95, 200–202, 227, 247, 254
TRICARE program, 2, 11, 21, 57–58, 98, 161, 200, 212, 228–229, 242, 249
Tuberculosis, 48–49
U
Ulcers, 54
Unemployment, among veterans, 35
Uniform, smoking in, 216–218
United Service Organizations, 317
United States Code 10 USC 2484(3)(a), 60
10 USC 2484(3)(B), 225
10 USC 2484(b)(8), 60
10 USC 2484(d)(e), 59
10 USC 2486(a), 59
10 USC 2486(d)(2), 224
10 USC 2486(f), 225
Urinary cotinine, screening for, 310
V
VA. See Department of Veterans Affairs
VA/DoD Clinical Practice Guideline for the Management of Tobacco Use, 10, 12, 141, 229, 233–238, 242, 247, 252, 272, 279, 291, 293, 299–300, 312, 321
VA medical centers (VAMCs), 11, 21, 99, 264, 267, 269, 273–287, 291–292
VA National Formulary, 280–281, 294
VAMCs. See VA medical centers
Varenicline, 7, 152–153, 159, 236, 280
correct dosing, 281
precautions regarding, 244, 267
Varicella pneumonia, 48–49
Vehicles.
See also Driving
tobacco-use restrictions in military, 221–222
tobacco-use restrictions in private, 127–128
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Veteran populations
demographics of, 34–35
homeless, 150, 297
with mental-health disorders, 21, 293–297
returning from conflict, 8, 313–314
support levels for, 98
tobacco use among, 1, 39–40
unemployment among, 35
Veterans Health Administration (VHA), 2, 263–266, 317
Circular 10-90-141, 277
Directive 2008-052, 125, 276
Directive 2008-081, 271–272
Veterans Health Care Act of 1992, 17, 100, 276–277, 322
Veterans Integrated Service Networks (VISNs), 65, 98–99, 149, 267–271, 273–274, 288, 291, 294, 298–299
Veterans service organizations (VSOs), 3, 23, 275, 317
VHA. See Veterans Health Administration
Vietnam era veterans, 8, 34
Viral infections, 48, 53
VISNs. See Veterans Integrated Service Networks
Visual acuity and tobacco use, 4, 19
amblyopia, 41
night vision, 43–44
VSOs. See Veterans service organizations
W
War zones, deployment to, 1, 20–21, 44, 92, 96, 294
Washington state, tobacco-control programs in, 148
Web-based programs. See Computer-based programs
Weight concerns, 97, 164, 232–234, 290, 309
WHO. See World Health Organization
Withdrawal. See Nicotine withdrawal
Women, 2, 54, 162, 247–248
pregnant, 247–248
tobacco cessation in, 162
Work.
See also Unemployment physical capacity for, and tobacco use, 42–43
Work-loss days, greater for tobacco users, 42–43, 47–48
Workplace settings, tobacco-use restrictions in, 215–218
World Health Organization (WHO), 26, 83, 126, 327, 334
Building Blocks for Tobacco Control: A Handbook, 26, 334
Framework Convention on Tobacco Control, 81, 121, 334–335
World War II veterans, 34–35
Wound healing, impaired from tobacco use, 41, 49
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