Availability of smoking cessation resources for U.S. Army General officers

Military Medicine, Apr 2001 by Hepburn, Matthew J

Adequate resources are a necessity in providing effective smoking cessation interventions to active duty soldiers. The availability of smoking cessation resources was measured by a survey of Army general medical officers (GMOs). Questionnaires were successfully mailed to 232 Army GMOs, which was the entire population of this group in 1997. One hundred fifty GMOs (65%) returned the questionnaire voluntarily and anonymously. Fifty-three percent of GMOs identified the nicotine patch as a formulary item. All responders indicated that some form of nicotine replacement was available on formulary or for purchase in the area. Eighty-two percent of GMOs reported that group smoking cessation programs were available. The widespread availability of group smoking cessation programs may reflect an emphasis on this strategy by the Army's health promotion program. Additional attention needs to address the availability of nicotine replacement items and other adjunctive medications without cost to the beneficiary at military installations.

Introduction

Smoking is a crucial public health issue for both the civilian and military medical communities. This habit is one of the most preventable causes of death in the United States.1 The military has historically been identified as an organization that has promoted smoking. Cigarettes were a staple product in C-rations during World War II2 The incidence of respiratory tract infections in military recruits has been documented to be higher among smokers.3 Other studies suggest that smoking may have an adverse affect on Army physical fitness test scores.4 Smoking cessation is relevant to the military for a number of reasons. Before 1998, the incidence of tobacco smoking was higher in the military than in age-matched civilian controls.56 Survey data from 1998 suggest that the incidence of smoking in the military has decreased significantly to levels that are lower than those of age-matched civilians.' With the emphasis in the military health care system on prevention and health promotion, smoking cessation is an important topic for military health care providers.

A critical aspect of the implementation of a smoking cessation policy is resource availability to assist smokers attempting to quit. Physician intervention with brief counseling advice is recommended for all patients who smoke by the U.S. Preventive Services Task Force.8,9 With the development of pharmacologic therapy for smoking cessation in the form of nicotine replacement, use of this option has led to statistically significant increased rates of quitting. 10 An effective group smoking cessation class can also improve cessation rates. Awareness of available resources for primary care physicians is integral to any successful smoking cessation intervention but is often overlooked. We evaluated previous training, knowledge, and practice habits related to smoking cessation as well as resource availability at Army installations by surveying general medical officers (GMOs). Results of the training, knowledge, and practice habits portion of the study are being published elsewhere.11

Methods

Two hundred seventy-nine Army GMOs, identified through the U.S. Army Personnel Command office, were mailed a questionnaire. This group constituted the entire population of U.S. Army GMOs in the 1996-1997 year. The survey was mailed with a letter explaining that their participation was voluntary, confidential, and anonymous. Respondents indicated their participation by separately returning a corresponding postcard. After 4 weeks, initial nonresponders received a second mailing. The physicians were asked five questions regarding the availability of resources in their practice setting for use in their efforts to help patients quit smoking.

Results

Of the 279 surveys mailed, 232 (83%) were delivered successfully. Of those delivered, 150 responses were returned, for a response rate of 65%. The results of our survey are listed in Table I. The nicotine patch was available on formulary at 53% of locations, but the nicotine gum was a formulary item at only 20% of these installations. However, nicotine patch or gum was available for purchase from local stores at 73% of the locations. All GMOs reported the availability of the nicotine patch or gum from either the formulary or local stores. Eighty-two percent of GMOs reported that group classes were available for patients interested in quitting smoking. Sixty-five percent of GMOs answered affirmative to having smoking cessation literature readily available for patients.

Discussion

Smoking cessation literature is available at the practice sites of most Army GMOs. However, recommendations suggest that literature be available at all locations where primary care interactions may occur. This simple and inexpensive resource should be universally available at primary care clinics in the Army.

The Army provides widely used group smoking cessation programs. Smoking cessation programs, especially those that provide group therapy, are often used in studies and are recommended as a reasonable treatment option.12 Our data suggest that the Army has implemented group smoking cessation programs at a large number of sites throughout the world and that GMOs are very aware of these programs.