The U.S. Departments of Defense and Veterans Affairs should implement a comprehensive strategy to achieve the DOD’s stated goal of a tobacco-free military, according to a report from the Institute of Medicine. The report says tobacco use impairs military readiness, harms the health of soldiers and veterans, and imposes a substantial financial burden on the agencies. The DOD should gradually phase in a ban on tobacco use in the military, starting at military academies and officer training programs and among new recruits, the report says. The report comes in response to a request from the DOD and VA asking the Institute of Medicine to identify policies and practices that could lower rates of smoking and help soldiers and veterans quit.

 

Among the recommendations in the report, the Institute of Medicine says the DOD should stop selling tobacco products in Army and Air Force commissaries and should stop selling them at a discount in military exchanges and other stores. Both the Navy and Marine Corps no longer sell tobacco products in their commissaries. In addition, the report says Congress should allow the VA to establish tobacco-free medical centers.

 

In 2005, 32 percent of active-duty personnel and 22 percent of veterans were smokers; rates among active-duty personnel have recently increased, possibly because of growing tobacco use by deployed troops.

“We found that the adverse effects of tobacco use on military readiness, the health of both smokers and nonsmokers, and the financial cost of the medical care of smoking-related illness in military and veteran populations are a sound basis for moving systematically toward a tobacco-free military,” says Stuart Bondurant, professor of medicine and dean emeritus of the School of Medicine at the University of North Carolina, Chapel Hill, who served as chair of the committee that wrote the report. “The state of the art in tobacco control is such that with well-managed programs, DOD and VA could eventually be tobacco free with minimal disruption, and with substantial benefit to military personnel and veterans.”

 

DOD and VA should ensure that all personnel have quick and easy access to comprehensive, evidence-based tobacco-cessation services, the report says. All DOD and VA health care providers should be able to provide brief counseling and nicotine-replacement therapy to patients. In addition, the committee recommended that VA and DOD develop toll-free “quitlines” to provide military personnel and veterans with counseling on quitting tobacco. Quitline counselors should be trained to deal with issues related to these populations, such as post-traumatic stress disorder.

 

The Defense Department should set a date by which the military will be tobacco-free and require each of the four services to develop and enforce a timeline for achieving this goal, the report says. Recognizing that immediately banning tobacco use in deployed personnel is not realistic, the committee urged an incremental strategy, starting with closing the pipeline of new tobacco users entering the military. Smoking should be banned at military academies, and the current ban on tobacco use during basic training should be extended to include subsequent technical training. That ban could eventually be extended to all new enlistees, who would be informed during recruitment that they would be expected to remain tobacco-free during their entire military careers.

 

Eventually, all military installations and active-duty personnel should be required to be tobacco-free—a goal that could realistically be achieved in 20 years or even sooner, if the plan's initial phase for military academies and new recruits starts within a year, the report says.

 

The report also calls on Congress to take some actions. It says Congress should direct DOD to sell any tobacco products in military exchanges at prices equal to those in the civilian sector, and preferably higher. Congressional action is also necessary to allow VA to implement tobacco-free medical facilities. The VA's efforts to do so have been hampered by the language of the Veterans Health Care Act of 1992, which requires them to maintain smoking areas for veterans and employees.