IOM issues report on smoking cessation in the military

Posted: Tuesday, June 30, 2009

Alan Peterson, Ph.D., professor in the Department of Psychiatry, served on the IOM committee. clear graphic
Alan Peterson, Ph.D., professor in the Department of Psychiatry, served on the IOM committee.  

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Tobacco use is far more prevalent among active-duty military personnel and veterans than it is in the general population. A new report released June 26 by the Institute of Medicine (IOM) of the National Academies offers an outline for remedying this situation.

Alan Peterson, Ph.D., professor of psychiatry in The University of Texas Health Science Center at San Antonio’s School of Medicine, is a member of the IOM committee issuing the report, “Combating Tobacco Use in Military and Veteran Populations.”

He said the report includes a comprehensive action plan with recommendations for specific interventions to shrink the pipeline of new tobacco users entering the military and to help current users quit.

Tobacco use affects military performance, strains health care system
Tobacco use has long been implicated in higher dropout rates during and after basic training and increased rates of absenteeism in active-duty military personnel. It also affects military readiness and strains the military and Veterans Affairs Healthcare System due to a variety of associated illnesses, including cardiovascular and respiratory disease, cancer, vision problems, hearing loss, delayed wound healing, increased susceptibility to infectious diseases and posttraumatic stress disorder.

Therefore, the U.S. Departments of Defense and Veterans Affairs asked the IOM to form a committee to recommend ways the two agencies could work together to substantially reduce tobacco use within the ranks, and ultimately, to achieve smoke-free status within all branches of the armed forces.

Prevention and smoking cessation programs are key recommendations
Dr. Peterson said that prevention is the key, so the committee took the novel approach of focusing initially upon people entering the military and teaching them that tobacco cessation is an expected part of military service. The committee recommended that military academies, officer candidate training programs and university-based ROTC programs should become tobacco-free first, followed by new enlisted personnel and eventually, all other active-duty personnel.

“You start with people who are entering the military and already expect basic training and military life to be physically challenging and an opportunity to get physically fit, and you make tobacco cessation part of that,” said Dr. Peterson. “It already is a requirement of basic military training that individuals have to give up tobacco, and that seems to work well. We recommended extending that policy, so that as individuals move to higher levels of training, tobacco cessation continues to be a requirement. As time goes by, you gradually build up a force that expects a tobacco-free lifestyle to be part of military service.”

Taking advantage of the desire to quit
Dr. Peterson said it is unrealistic to expect active-duty personnel who have been in the service for years and are long-time smokers to be told suddenly to quit. However, because two out of three tobacco users express a desire to quit, this presents an opportunity for intervention.

The IOM committee recommended that the military provide the best available evidence-based interventions and smoking cessation programs for both active-duty personnel and veterans including a national “quit line” staffed by counselors trained in military- and veteran-specific issues.

Other suggestions include:

  • Reducing co-pays for treatment programs to encourage their use
  • Making treatment available to spouses
  • Increasing staff resources and training to run smoking cessation programs
  • Eliminating the sale of tobacco products on military installations and commissaries, or at least selling tobacco at similar prices to civilian stores
Cessation is single most important way to improve health
Dr. Peterson said that these and other IOM committee recommendations all are aimed at having a positive impact on the health and readiness of the U.S. military and the veteran population. He added, “And the most common quote by the U.S. Surgeon General is that the single most important thing a person can do to improve his or her health is to stop using tobacco.”

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