Offen et al. provide an insightful review of the complexity of enacting tobacco control policy at the federal level, as seen in their case study of the efforts by the US Department of Veterans Affairs (VA) to adopt a smoking ban in VA medical facilities in the early 1990s.1
As the authors indicated, tobacco use among the US military has traditionally been higher than among the civilian population.1 In recent years, however, the VA has made great strides in reducing the rate of smoking among veterans served. For veterans enrolled in the VA health care system in 2011, the proportion of smokers was 19.7%,2 comparable to the 19.0% reported for the United States as a whole in 2011.3
Although federal law still requires that VA health care facilities provide areas where patients can smoke,1 progress has been made in reducing exposure to secondhand smoke for both veterans and VA employees. In citing a 2005 VA survey on smoking and tobacco use cessation within the VA, the authors incorrectly stated that one quarter of 783 smoking sites reported by VA facilities were indoors.1 In fact, all 783 smoking sites were outdoor smoking areas or shelters.4 The 2005 survey actually reported that 36 out of 158 VA facilities (23%) still had an indoor smoking area somewhere at the facility, mainly in nursing homes and inpatient psychiatric units.4 Although still far from ideal, by 2009 this number had dropped to 19 facilities; 88% had complete indoor smoke-free policies in place.5
In referring to military and veteran facilities, it is important to note that the Department of Defense (DoD) and the VA are distinct federal executive branch agencies. Their various policies and initiatives are independent of each other, reflecting the differences in their populations and missions. Thus, in describing the VA tobacco control efforts as a pattern of “advance and retreat,” the authors incorrectly attribute DoD policies and initiatives to the VA.1,6 The article they cited discusses DoD initiatives only, not the VA or VA policies.6 This misperception that the two departments operate as a single unit is not uncommon, but it is one that must be avoided in future studies.
Acknowledgments
The authors thank Richard Kaslow, MD, for his insightful comments.
References
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