general population (VA, 2006a); and 28.1% said that they had never smoked. Most current veteran smokers are 45–64 years old, and most make less than $36,000 a year (VA, 2006a). Higher rates of disability and psychiatric disorders in the veteran population may contribute to higher tobacco use and its health effects. Klevens et al. (1995) noted that the prevalence of ever smoking was 74.2% in veterans and 48.4% in nonveterans. Of those who had not started smoking before the age of 18 years, veterans were more likely than nonveterans to report ever and current smoking (Klevens et al., 1995). Of veterans with access only to the Veterans Health Administration, 25.7% are smokers, compared with 10.8–13.8% of those with access to at least one type of Medicare (fee for service or a health-maintenance organization) (Keyhani et al., 2007).


In 1964, the US Surgeon General published a landmark report Smoking and Health that implicated smoking as the cause of a variety of health effects (US Surgeon General, 1964). Since then, other reports on smoking from the surgeon general (2004, 2006) and numerous studies have confirmed that smoking causes a multitude of short- and long-term health effects in people of all ages. The surgeon general has also issued reports on the effects of smoking in women (2001) and on the effects of secondhand smoke on children (2007). Table 2-4 summarizes some of the health hazards associated with tobacco use, many of which are discussed in this chapter.

TABLE 2-4 Health Hazards Posed by Tobacco Use

Health Hazards

Cancer (see Table 2-6)

Cardiovascular disease

Sudden death

Acute myocardial infarction

Unstable angina


Peripheral arterial occlusive disease (including thromboangiitis obliterans)

Aortic aneurysm

Pulmonary disease

Lung cancer

Chronic bronchitis



Increased susceptibility to pneumonia and to pulmonary tuberculosis

Increased susceptibility to desquamative interstitial pneumonitis

Increased susceptibility to and morbidity from viral respiratory infection

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