cigarettes

Although DoD and the VA are promoting tobacco-free and tobacco-cessation efforts,
substantial challenges in reducing the prevalence of tobacco use in their populations remain. The
challenges range from the ingrained smoking habits of new recruits to congressional
requirements for smoking areas at VA medical facilities. In the face of such obstacles, DoD and
VA struggle to identify and implement the most effective approaches to reach populations at
high risk of tobacco use. To overcome those challenges, DoD and VA asked the Institute of
Medicine (IOM) to convene a committee to identify ways to maximize the efficacy of their
current tobacco-free and smoking-cessation programs and to provide guidance on what future
modifications might be most effective. DoD and VA requested that the IOM committee offer
recommendations as to how the agencies could work together to improve the health of both
active-duty and veteran populations with regard to the initiation and cessation of tobacco use.
Specifically, the agencies asked that the committee:
1) Identify policies and practices that might by used by DoD and VA to prevent initiation
of smoking and other tobacco use in the military.
2) Identify policies or potential barriers that might inhibit broader implementation of
evidence-based tobacco-use cessation care in both DoD and VA.
3) Identify opportunities for increased access to evidence-based smoking and other
tobacco-use cessation programs in VA and DoD.
4) Evaluate changes, including changes in policy, that could help to lower rates of
smoking and other tobacco use in military and veteran populations.
5) Identify policies and practices that address unique tobacco-use prevention and
cessation needs of special populations in DoD and VA, including those with
psychiatric or substance-use disorders, those with chronic medical comorbidities, and
women.
6) Recommend research approaches for reducing initiation of tobacco use and promoting
tobacco-use cessation.
In response to the agencies’ request, IOM convened the Committee on Smoking
Cessation in Military and Veteran Populations, which wrote this report. In reviewing the original
statement of task, the committee felt it appropriate to modify the language slightly from
“smoking” to “tobacco” so that all tobacco products, particularly smokeless tobacco, would be
included; the statement of task above reflects the committee’s modifications. The committee did
not modify the language used in the various studies cited in the report; if a published study
indicated that smoking was the focus, the committee cited the study as being about smoking, not
tobacco use. The committee was not tasked with assessing the implications of tobacco use on
veterans’ disability claims or compensation. And it did not review the health effects of exposure
to secondhand smoke in detail or consider policies and programs to reduce exposure to it. The
committee recognized, however, that reducing the use of tobacco by military personnel and
veterans would inevitably reduce exposure of their dependents, colleagues, and others to
secondhand smoke.

Small-scale commercial farmers are loosely defined as indigenous commercial farms. These holdings were first developed by the Government of Rhodesia between 1931 and 1961 in an effort to reduce congestion in communal areas reserved for the indigenous population. There are about 9 000 holdings in the SSC sector, occupying a total of 1.2 million hectares. Half of these farms are under conditional freehold title, while others are under a long-term lease with an option to buy. Although not as advanced as LSC growers, most SSC farmers still produce at a reasonably high level and enjoy good access to basic equipment, including ox ploughs and carts, hand sprayers, sufficient barn space for curing tobacco, and baling equipment. Smallholder farmers are only marginally involved in the tobacco sector.
Although there are roughly eight times as many smallholder tobacco growers (about 16 000 in total) as commercial farmers, these account for less than 1.5 percent of all smallholder households. Certainly, the importance of tobacco as a high profit crop with fully developed market outlets cannot be overlooked, but it should also be noted that maize, cotton and groundnut are all more important for smallholder farmers in most locations. One of the biggest effects which any shrinking of tobacco markets would have on smallholder farmers is likely to be the loss of remittances from workers employed on large farms, rather than the direct effect on smallholder farm enterprise income. Finding suitable diversification options for smallholder tobacco growers is still a major challenge for Zimbabwe, but not on the scale of having to work with farmers in all locations.
Three main types of tobacco are grown in Zimbabwe, namely flue-cured, burley and oriental tobacco. Of these, flue-cured is by far the most important and is generally produced in the better rainfall areas to the north and east of Harare. The northern regions produce a Virginia type of tobacco, whereas growers in the east produce a thicker, slower developing type used for blended cigarettes. Burley tobacco is grown mainly in the northeast and in the Eastern Highlands and is predominately a smallholder crop. These areas have better rainfall and longer periods of the high relative humidity needed for curing. Oriental tobacco accounts for less than 1 percent of total output by mass and is grown mainly by small-scale producers in Masvingo Province. Details of flue-cured and burley production by farm sector for the past two years are given are given in 7.2.