Tobacco-Free Living

 TFL Literature Review, Reports and Publications for Providers

Last Updated: January 14, 2022
Skip Navigation LinksDCPH-A Home / Topics / Healthy Living / Tobacco-Free Living / TFL Literature Review, Reports and Publications for Providers


External Link This icon identifies links to external web sites that will open in a new browser window. See the External Links Disclaimer link at the bottom of this page.

Directives & Regulations
  • Incorporates DoD Tobacco Policy 16-001 that expired in April 2018
  • Tobacco Control Program (Chapter 4-14, page 26)
  • Environmental Health (Chapter 7, page 31)
    • Guidance for controlling tobacco use in Department of the Army-controlled areas (Chapter 7–2, page 31)
    • Policy for controlling tobacco use (Chapter 7–3, page 31)
    • Signs for controlling tobacco use (Chapter 7–4, page 33)
    • Enforcement for controlling tobacco use (Chapter 7–5, page 33)


Through annual reporting of key indicators that impact readiness and Soldier well-being, Health of the Force improves awareness and understanding of the health status of the Army. Results are communicated through an online digital platform and traditional reports. The Health of the Force suite of products gives leaders tools to advance programs and strategies that improve performance and reduce illness and injury.

Annual Healthcare Spending Attributable to Cigarette SmokingAn Update (American Journal of Preventive Medicine, 2015) Fifty years after the first Surgeon General's report, tobacco use remains the nation's leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking-attributable costs in the U.S. (document access requires a cost or membership login)

Tobacco Use: Comprehensive Tobacco Control Programs​​​ The Community Preventive Services Task Force (CPSTF) recommends comprehensive tobacco control programs based on strong evidence of effectiveness in reducing tobacco use and secondhand smoke exposure. Evidence indicates these programs reduce the prevalence of tobacco use among adults and young people, reduce tobacco product consumption, increase quitting, and contribute to reductions in tobacco-related diseases and deaths. Economic evidence indicates that comprehensive tobacco control programs are cost-effective, and savings from averted healthcare costs exceed intervention costs.​

2018 Department of Defense (DoD) Health Related Behaviors Survey External Link The Health Related Behaviors Survey (HRBS) is the U.S. Department of Defense's (DoD's) flagship survey for understanding the health, health behaviors, and well-being of service members. Originally implemented to assess substance use — illicit drugs, alcohol, and tobacco — the survey now includes a number of content areas that can potentially affect force readiness, or the ability to meet the demands of military life, including mental and physical health, sexual behavior, and post-deployment problems. 

National Prevention Strategy: America's Plan for Better Health and Wellness External Link  (2011) The National Prevention Strategy aims to guide our nation in the most effective and achievable means for improving health and well-being. The Strategy prioritizes prevention by integrating recommendations and actions across multiple settings to improve health and save lives.

Healthy People 2030, A Framework for Ending the Tobacco Use Epidemic External Link  The goal of Healthy People 2030 related to tobacco use is to reduce illness, disability, and death related to tobacco use and exposure to secondhand smoke.  Healthy People 2030 provides a framework for action to reduce tobacco use to the point that it is no longer a public health problem for the Nation. This document provides an overview, issues and trends, disparities, opportunities to reduce tobacco use in the U.S., and the specifics of the objectives related to tobacco use and cessation.

Healthcare Effectiveness Data and Information Set (HEDIS) and Performance Measurement​ 191 million people are enrolled in plans that report HEDIS results. That makes HEDIS one of health care’s most widely used performance improvement tools. HEDIS includes measures for physicians, PPOs and other organizations.

Veterans Health Affairs National Smoking and Tobacco Use Cessation Program, Directive 1056 External Link (2014) This Veterans Health Administration (VHA) Directive describes VHA policies and programs relating to the VHA Smoking and Tobacco Use Cessation Program.

Smoking Cessation: A Report of the Surgeon General External Link Smoking remains the leading cause of preventable disease, disability, and death in the U.S. Although the percentage of adults who smoke is at an all-time low in the U.S., 34 million adults still smoke and therefore continue to be at risk of developing smoking-related diseases. This report makes it clear that one of the most important actions people can take to improve their health is to quit smoking. This is true regardless of their age or how long they’ve been smoking.

E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General is the first report issued by a Federal agency that comprehensively reviews the public health issue of electronic cigarettes and their impact on our nation’s young people. It is the 33rd Report of the Surgeon General on tobacco. Other historical Surgeon General’s Reports are here​ External Link:

The health and economic costs of tobacco use in military and veteran populations are high. In 2007, the Department of Veterans Affairs (VA) and the Department of Defense (DoD) requested that the Institute of Medicine (IOM) make recommendations on how to reduce tobacco initiation and encourage cessation in both military and veteran populations. In its 2009 report, Combating Tobacco in Military and Veteran Populations, the authoring committee concludes that to prevent tobacco initiation and encourage cessation, both DoD and VA should implement comprehensive tobacco-control programs.

CDC’s Office on Smoking and Health (OSH) created the National and State Tobacco Control Program (NTCP) in 1999 to encourage coordinated, national efforts to reduce tobacco-related diseases and deaths. The program provides funding and technical support to state and territorial health departments.

​Tobacco Related Literature

Women and Smoking  External Link Women and Smoking: A Report of the Surgeon General Executive Summary.

CDC External Link In 2020, 23.6% (3.65 million) of high school and 6.7% (800,000) of middle school students reported current (past 30-day) use of any tobacco product. From 2019 to 2020, decreases among high school and middle school students occurred in current use of any tobacco product, combustible tobacco products, multiple tobacco products, e-cigarettes, cigars, and smokeless tobacco.​

Tobacco prices going way up in DoD stores — you'll pay the same as civilians External Link Tobacco users will see sharp price increases in military stores in some states under a new Defense Department policy being implemented in a further effort to crush tobacco use. Under the new policy, tobacco prices at exchanges and commissaries will have to match what's paid in civilian stores when taxes are included. According to the Centers for Disease Control, raising the price of tobacco is the single most effective way to reduce tobacco consumption.

What We Know: Tobacco Use and Quitting Among Individuals With Behavioral Health Conditions External Link Behavioral health treatment settings have permitted tobacco use among clients, in part because of misperceptions that smoking could alleviate symptoms of mental health conditions and that cessation could interfere with treatment. However, research has shown that smoking can worsen symptoms and behavioral health outcomes, and quitting can improve mental health and substance use disorder treatment outcomes.​

Electronic CigarettesExternal Link (Get the facts about electronic cigarettes, their health effects and the risks of using e-cigarettes.​​

Health Effects of Smoking & Tobacco Use External Link Smoking leads to disease and disability and harms nearly every organ of the body. More than 16 million Americans are living with a disease caused by smoking. Secondhand smoke exposure contributes to approximately 41,000 deaths among nonsmoking adults and 400 deaths in infants each year. Secondhand smoke causes stroke, lung cancer, and coronary heart disease in adults. Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear disease, more severe asthma, respiratory symptoms, and slowed lung growth.

Recognize Signs of Depression: Smoking & Depression External Link Smokers are more likely to have depression than non-smokers. Nobody knows for sure why this is. People who have depression might smoke to feel better. Or smokers might get depression more easily because they smoke. No matter what the cause, there are treatments that work for both depression and smoking.​

Why is smoking still being glamorized in media and pop culture?​ While the cartoon mascot Joe Camel hasn’t puffed on a cigarette on TV screens since 1971, tobacco imagery in entertainment media and culture is far from gone. Even as national smoking rates have declined to record lows, there has been a pervasive re-emergence of smoking imagery on screens, and research shows that higher exposure to some of this imagery makes youth and young adults twice as likely to start smoking. Glamorizing and re-normalizing smoking, and making it appear “cool,” could threaten the progress the U.S. has made in decreasing tobacco use, which kills 1,300 Americans every day and is still the country’s leading cause of preventable death and disease.

World Health Organization report on the global tobacco epidemic 2021: addressing new and emerging products​ ​External Link The eighth WHO report on the global tobacco epidemic tracks the progress made by countries in tobacco control since 2008 and, for the first time, presents data on electronic nicotine delivery systems, such as ‘e-cigarettes’. The report shows that many countries are making progress in the fight against tobacco, but some are not addressing emerging nicotine and tobacco products and failing to regulate them.

Mortality and Morbidity Statistics

CDC: Smoking and Tobacco Use External Link Based on weekly reports to CDC from state public health departments, the Morbidity and Mortality Weekly Report (MMWR) is a series of scientific public health information and recommendations. MMWR readership consists mainly of medical and public health professionals, scientists, epidemiologists, and researchers.

CDC: Current Cigarette Smoking Among Adults External Link  Despite significant declines during the past 30 years, cigarette smoking among adults in the United States remains widespread.

Return on Investment

Scientific literature evaluating the cost-effectiveness of tobacco dependence treatment programs delivered in community-based settings is scant, which limits evidence-based tobacco control decisions. The aim of this review was to systematically assess the cost-effectiveness and quality of the economic evaluations of community-based tobacco dependence treatment interventions conducted as randomized controlled trials in the United States.

Cost-Effectiveness of Tobacco Use Interventions
​“The mention of any non-federal entity and/or its products is for informational purposes only, and is not to be construed or interpreted, in any manner, as federal endorsement of that non-federal entity or its products.“