Offen et al. Respond

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LETTERS SMOKING AND TOBACCO USE WITHIN THE DEPARTMENT OF VETERANS AFFAIRS 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 pa- tients 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, Letters to the editor referring to a recent Journal article are encouraged up to 3 months after the article's appearance. By submitting a letter to the editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. The editors reserve the right to edit and abridge letters and to publish responses. Text is limited to 400 words and 10 references. Submit online at www. editorialmanager.com/ajph for immediate Web posting, or at ajph.edmgr.com for later print publication. Online responses are automatically considered for print publication. Queries should be addressed to the Editor-in-Chief, Mary E. Northridge, PhD, MPH, at men6@nyu.edu. 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 in- patient 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 vari- ous policies and initiatives are independent of each other, reflecting the differences in their populations and missions. Thus, in de- scribing the VA tobacco control efforts as a pattern of “advance and retreat,” the authors incorrectly attribute DoD policies and initia- tives 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. j Kim Hamlett-Berry, PhD Dana E. Christofferson, PhD Richard A. Martinello, MD About the Authors The authors are with the Veterans Health Administration, US Department of Veterans Affairs, Washington, DC. Correspondence should be sent to Kim Hamlett-Berry, PhD, Department of Veterans Affairs, 810 Vermont Avenue (10P3B), Washington, DC 20640 (e-mail: kim.hamlett@va. gov). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link. This letter was accepted April 3, 2013. doi:10.2105/AJPH.2013.301375 Note. The authors certify that there is no financial conflict of interest with any financial organization with interest in the subject matter discussed in the letter. The views expressed here represent those of the authors and not necessarily those of the US Department of Veterans Affairs. Contributors K. Hamlett-Berry and D. E. Christofferson drafted the letter. R. A. Martinello supervised the overall writing and edited the final version. July 2013, Vol 103, No. 7 | American Journal of Public Health Acknowledgments The authors thank Richard Kaslow, MD, for his insightful comments.