New Smoking-Cessation Options for Service Members Should Not Stop at Active Duty
Congress is considering a broader path for active-duty service members to quit smoking. Section 707 of the House-passed National Defense Authorization Act for Fiscal Year 2027 would authorize a one-year pilot program offering counseling, nicotine gum and patches, e-cigarettes, nicotine pouches, and heated-tobacco products to eligible personnel who smoke. Its purpose is to help participants stop smoking and improve their health. Interestingly, the bill does not extend that pilot to former service members receiving care from the U.S. Department of Veterans Affairs (VA). This willingness to explore alternatives should extend to veterans, especially those still smoking after decades of use.
The bill had not become law as of Sept. 25, making participation in the pilot program discretionary. Currently, active-duty and veteran care share the same VA/Department of Defense (DOD) tobacco-treatment guideline (issued January 2026). The difference is that Congress is proposing to test broader options for smoking cessation among active-duty personnel while continuing to discourage veterans from using e-cigarettes.
The VA offers medication, counseling, Quit VET telephone support, and SmokefreeVET text messages. The joint guideline supports varenicline, combination nicotine replacement, intensive counseling, treatment before patients are ready to quit, and renewed treatment after relapse. But what additional help should veterans receive if they continue to smoke?
Smoking Cessation and Abstinence
Recommendation 12 of the updated guideline suggests against e-cigarettes for achieving abstinence from tobacco and nicotine products. The approach emphasizes continued nicotine use, uncertain long-term harms, product variability, and questions about applying international trials to American military and veteran populations. The guideline explicitly distinguishes trials measuring cigarette abstinence from the broader goal of ending all tobacco and nicotine use.
Those concerns deserve attention, but the goals should not be conflated. A veteran who completely replaces cigarettes with a lower-risk nicotine product has stopped inhaling cigarette smoke, even without ending nicotine dependence. The Food and Drug Administration (FDA) recognizes that cigarettes occupy the most harmful end of the tobacco-risk spectrum and that a complete switch to noncombustible alternatives can reduce exposure and health risks.
Cochrane’s review of electronic cigarettes (August 2026) found high-certainty evidence that nicotine e-cigarettes improve smoking cessation rates compared to nicotine replacement therapy. Longer studies remain necessary to assess safety. By contrast, Cochrane’s nicotine-pouch review (October 2025) found only four small trials and substantial uncertainty about effectiveness. Lower risk after switching is not the same as proven ability to sustain the switch.
The VA already accepts the principle of reducing harm while pursuing recovery. Its substance use disorder directive makes minimizing illness and death a goal regardless of whether patients achieve stable remission and identifies harm reduction as a necessary component of care. While this does not establish the effectiveness of any nicotine product, it does support evaluating tobacco alternatives against a practical question: Can they help veterans leave combustion behind?
Older veterans need information and a practical route
The case is especially urgent for older veterans. The VA’s 2025 fourth-quarter estimates put 45.8 percent of veterans at age 65 or older. Modeling research estimated that quitting smoking at 65 or 75 could add an average of 1.7 or 0.7 years of life respectively (compared with continued smoking). These are estimates of smoking-cessation benefits, not demonstrated gains from switching products; however, they show that intervention still matters later in life.
Accurate information is part of that intervention. A national PATH study of 8,072 adults who smoked found that older adults were more likely to misperceive e-cigarettes as more harmful than cigarettes. Such beliefs were associated with less e-cigarette use, although the observational study cannot establish causation. Simply making alternatives available cannot ensure informed choices. Older veterans need trusted clinicians to explain what changes when combustion stops, what risks remain, and why complete switching matters.
A recent pilot trial offers a useful starting point. Fifteen older adults averaging 66.1 years who continued smoking after cessation treatment offered through lung cancer screening received e-cigarettes for four weeks. While cigarette consumption and carbon monoxide declined, only two participants used e-cigarettes exclusively and twelve remained dual users. This suggests that older adults can engage with an alternative approach.
Test a veteran-centered pathway
The VA should evaluate a structured harm-reduction pathway alongside, rather than following, the active-duty policy debate. Approved cessation treatments should remain first-line options. Clinicians should discuss the evidence and uncertainties surrounding lower-risk alternatives with veterans who decline treatment or continue smoking despite treatment. Lung cancer screening, primary care, and mental health services are practical settings for evaluating this approach.
Such a program should combine accurate risk communication, patient preferences, practical instruction, and continued follow-up. Sustained abstinence from combustible tobacco should be a distinct measure of success, with nicotine use, dual use, relapse, and adverse effects tracked separately.
If Congress is willing to explore more ways to help people stop smoking while they serve, then the same commitment should extend beyond active duty. Veterans should not have to achieve complete nicotine abstinence before their health system recognizes the value of leaving cigarettes behind.