JOINT BASE SAN ANTONIO, Texas – Brooke Army Medical Center’s Pulmonary Tobacco Cessation Team is helping beneficiaries reduce and eliminate their dependence on a variety of tobacco products.“We treat all types of nicotine dependence, to include not only the use of cigarettes, but other nicotine products to include cigars and electronic cigarette use,” said Dr. Jackie Hayes, a pulmonary critical care physician at BAMC. “We also treat patients for use of smokeless tobacco products such as chewing tobacco, snuff, and dips.”The BAMC program has been in place since 2009. Patients can either be referred by one of their provider, or they can self-refer into the program.In addition to more traditional cessation programs, which focus on the behavioral health aspects of quitting tobacco products, BAMC’s program adds in clinical elements as well. The program integrates behavioral health with providers in the pulmonary and cardiology clinics to provide a more holistic approach to cessation.“Our program is based on (U.S. Department of Veterans Affairs) and (Department of Defense) guidelines and other evidence-based best practices,” said Deborah Bray, APRN, CNS and tobacco treatment specialist at BAMC. “We take the latest in treatment research and incorporate that into the program.”According to Dr. Michael Chatterton, a clinical health psychologist at BAMC, smoking is the leading cause of preventable death and disability in the nation. People forget that there is also a significant cardiovascular impact from smoking. With the rise of electronic cigarettes, or vaping, there is a new aspect to the dilemma. The providers at BAMC said their program includes a cessation program for those beneficiaries who want to quit vaping.According to ALARACT 086/2019, “As of 1 October 2019, the Centers for Disease Control have identified 1,080 cases of severe lung injury associated with prior e-cigarette use and 18 deaths have been confirmed. Adverse health effects of e-cigarette use may include the following respiratory symptoms: a nonproductive cough, shortness of breath, and/or chest wall pain. Systemic symptoms may include rapid heart rate, fever, chills, and/or fatigue. Gastrointestinal symptoms may include nausea, vomiting, abdominal pain, and/or diarrhea. Soldiers who have used e-cigarettes within 90 days of the onset of these symptoms should seek medical care.”BAMC providers have said the problem with vaping is exacerbated when smokers, or other tobacco users, try to turn to electronic cigarettes under the mistaken impression that they are somehow “safer.”“There is no research to support that it is any safer,” said Hayes. He and Chatterton both said vaping can actually make the situation worse because many who try to use that as an alternative end up becoming dependent on both the electronic cigarettes and whatever form of tobacco they were already using. In addition, tobacco products have a detrimental impact on performance, which is crucial to the careers of active duty military members.According to a study in the American Journal for Preventive Medicine entitled, “Vaping, Smoking, and the Physical Fitness of Active Young Men,” the researchers found, in part, that “The primary finding was that current dual users of ENDS and tobacco cigarettes averaged lower performance on the 2-mile run, 2-minute maximal push-up, and 2-minute maximal sit-up tests than never users and significantly slower run times and fewer pushups than current smokers.”Bray and the other providers with BAMC’s cessation team are focused on reducing, or removing, the dependence on tobacco products. They accomplish this through a combination of behavior modification techniques and medications to combat the effects of the tobacco use on the patients.The program starts with four weeks of counseling sessions. The sessions are weekly and last two hours each. There is also medical management involved throughout the process. Following the sessions, there are follow-up phone calls that make up a total of a year of involvement by BAMC staff.In similar programs nationwide, the average rate of success, meaning no relapse to tobacco usage, is 18-30 percent six months after the program ends. At BAMC, the average success rate is 38 percent for the same time period and it remains relatively steady, with roughly 34 percent of participants staying tobacco free one year after completing BAMC’s program.Beneficiaries closer to Wilford Hall Ambulatory Surgical Center looking for help to quit smoking can call the Mental Health Clinic for an appointment at 292-7361. Eligible beneficiaries also can ask their providers about referring them to the BAMC program. Beneficiaries who want to self-refer into the program at BAMC can call the Pulmonary Clinic’s main line at 210-916-2153.