SASEBO NAVAL BASE, Japan — The future of a smoking ban in the U.S. military remains uncertain a year after it was proposed.

So far, the Department of Defense has made no decision on whether to pursue the Institute of Medicine’s June 2009 recommendation that it gradually eliminate tobacco use in the ranks, according to Jack Smith, acting deputy assistant secretary of defense for clinical and program policy.

The proposal would ban smoking among those who enlist and could lead to a tobacco-free military within about two decades, according to the institute.

“That is something that is controversial, particularly with a legal substance, and is something that is getting additional thought and consideration around the department,” Smith said.

Still, as the DOD grapples with two wars, discussion of a smoking ban has not been a top priority, Smith said.

“We are still discussing the IOM recommendations with senior leaders,” he said.

The Institute of Medicine found in its DOD-commissioned study that smoking is a major health and financial burden on the military.

But its proposed ban caused widespread concern last summer and a promise from Defense Secretary Robert Gates that cigarettes would not disappear from combat zones.

While any decision on a ban remains in limbo, Smith said, the DOD has worked on other suggestions by the Institute of Medicine to cut down on smoking, which the institute contends is nearly twice as prevalent in the military as in the civilian world.

The department has created a Tricare benefit that provides medicine to help smokers quit and has increased access to counseling programs, he said.

Smith said the DOD also is working to ensure cigarettes sold on military installations are not cheaper than cigarettes sold elsewhere.

On Thursday, the American Lung Association urged the military to push forward to establish a smoking ban.

“We think it is realistic, and it is doable,” said Paul Billings, vice president of national policy and advocacy for the association. “We don’t harbor any illusions that it is going to be easy or immediate.”

The Institute of Medicine’s proposal includes a phased-in ban at officer academies and basic training that would be enforced through urine screening.

All services could be free of tobacco 20 years after starting the entry ban, the Institute of Medicine said.

Charles Connor, president of the American Lung Association, said the military should take those proposals and announce a date that it will be completely smoke free.

“There are always reasons not to do something now,” he said. “We think it is time despite the fact that the DOD is very busy and has two wars on its hands.”

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