WASHINGTON, DC—A study funded by the National Heart, Lung and Blood Institute (NHLBI) is evaluating the effectiveness of tobacco quit lines in helping servicemembers and their families quit smoking. “There is quite a bit of smoking initiation going on in the military and so it is a huge problem. In addition, we are now learning smokeless tobacco is very popular. We are also seeing a big problem with dual use,” said Robert Klesges, PhD, a professor at the University of Tennessee Health Science Center, who is principal investigator for the study.

The study, which is sponsored by the University of Tennessee, Wilford Hall Medical Center, and the NIH’s NHLBI, currently has about 500 participants enrolled and is continuing to enroll participants for the next several years. The study is examining which of two tobacco quit line interventions work best: one in which the counselor sets up phone appointments with the study participant, or the other in which the participant initiates contact with the counselor. “We hope to find out which of the two types of quit lines are better, and then we hope to do follow-up studies to try to determine how to be even more effective.”

Klesges said that in this electronic age the days of taking part in cessation programs where the individual must physically go to a location is very “20th century.” Researchers are increasingly examining innovative strategies to help with tobacco cessation, such as on the Internet or texting. “There is no reason why people can’t quit from applications on their cell phone and with text messages throughout the day.”

Servicemembers Smoking

The high rate of smoking among servicemembers is a concern to the military. The 2008 DoD Survey of Health Related Behaviors Among Active Duty Military Personnel found that the rate of any past month smoking among DoD services was at 31% in 2008.

Both DoD and VA requested the Institute of Medicine (IoM) to identify policies and practices that could lower rates of smoking and help soldiers and veterans quit. The IoM 2009 report Combating Tobacco in Military and Veteran Populations concluded that to prevent tobacco initiation and encourage cessation, both DoD and VA should implement comprehensive tobacco-control programs.

The report recommended that DoD 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 authors noted that immediately banning tobacco use by deployed personnel is not realistic, but that an incremental strategy should be used in which the military starts to close the pipeline of new tobacco users entering the military.

The report recommended banning smoking 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.

The report also stated that if smoking was banned at military academies and for new recruits within a year, then it would be realistic that all military installations and active-duty personnel would be tobacco free in 20 years or sooner.

Quit Smoking

Despite perceptions that servicemembers who smoke may be reluctant to give the habit up when they experience the stress of deployments, Klesges said that there are servicemembers who are interested in quitting. “You would be surprised how many deployed troops want to quit smoking.”

He said that quit lines can offer servicemembers the advantage of being able to get help, without the effort that is required in attending a class at a location, since quit lines are remotely based. For the current study, researchers are enrolling servicemembers and anyone who is Tricare-eligible who smokes five or more cigerattes a day and is interested in quitting. As part of the study, participants receive six telephone counselor-sessions and nicotine replacement therapy free of charge.

Klesges explained that participants are randomly assigned to one of two quit line interventions. In one group, the participant can initiate the telephone counseling sessions at anytime. In the other condition, the counselor will initiate the telephone sessions. “That is the primary comparison, who is initiating the phone calls.”

In the first three telephone counseling sessions, the counselor will prepare the smoker to quit smoking, and in the second three sessions the counselor will help the participant to continue to quit.

If the participant is unable to quit, they can try again. “We have the flexibility to recycle them and go through the procedure again. Some get to the quit date and say they are not ready to do this. There is a strategy we can give them called ‘rate reduction’ where we reduce the number of cigarettes they smoke and provide them [with] nicotine gum. We tailor the program depending on the smokers’ needs.”

The counselors are former military personnel who are located at Wilford Hall Medical Center. Klesges explained that it was important that those who are providing the phone counseling understand military culture and the stresses that servicemembers and their families may be facing. “We think it is more important for the people to be able to connect with them as being ex-military. If someone says, ‘I am going TDY,’ and the counselor doesn’t know what that means, then the counselor loses all of his or her credibility. Credibility is so important for the counseling process.”

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