Women face particular challenges to quitting, panelists said. While male service members are more likely to be smokers, women might experience greater stress in balancing job and family responsibilities, often express concern about post-cessation weight gain and face difficulties in re-integration upon returning from overseas deployment.
The Defense and Veterans Affairs departments already are working to address the problem. Both have guidelines mandating that cessation programs should be as accessible as smoking products, said Kim Hamlett-Berry, director of the Office of Public Health Policy and Prevention at VA. The department's health care facilities offer medications with lower co-payments than at regular pharmacies, and there is no co-payment for outpatient cessation services.
Defense maintains a smoking ban for service members during basic training, which has been particularly effective among women, said Robert Klesges, professor of preventative medicine at the University of Tennessee. During this time, Defense can tailor messages to specific groups, including women, and continue to use officers as role models, he said. Currently, only about 5 percent of officers smoke.
"The more you make [smoking] a hassle, the better," he said.
VA also has begun cessation efforts in clinical facilities. A pilot program in Menlo Park, Calif., offers telephone counseling, medication and educational materials geared specifically to women. It also includes smoking cessation as part of post-traumatic stress counseling and treatment programs -- a strategy that keeps costs low, Hamlett-Berry said.
VA isn't looking to start huge, expensive programs, but rather to incorporate smoking cessation steps into existing reproductive and mental health treatment by asking physicians to take several minutes to address patients' tobacco use, she said.
Despite progress, access to cessation programs remains a barrier for military personnel, Klesges said. The convenience of quit lines, Web tools, iPhone apps and other technologies makes them good substitutes for expensive face-to-face care. Congress' next step is to provide funding to keep telephone counseling, nicotine replacement therapy and Web-based programs running, he said, because the National Institutes of Health's support for current efforts will dry up after three years.
Thirty-two percent of military personnel smoke, compared with about 20 percent of the general population, and smoking has been shown to affect health, job performance and attrition rates. The Defense Department spends about $875 million annually on health care for smoking-related conditions.
"We can help make it so there is one less challenge in their lives, one less threat to their health, by working to reduce smoking and secondhand smoke in the military," said Rep. Susan Davis, D-Calif., co-chairwoman of the caucus' Women in the Military/Veterans Task Force.