that the risk of being hospitalized for causes other than injury or pregnancy was 30% and 25% higher in men and women who smoked, respectively, than in nonsmokers; 7.5% of the hospitalizations for men and 5.0% of the hospitalizations for women were attributed to smoking (Robbins et al., 2000). Smokers were more likely to receive a diagnosis of alcohol dependence, chest pain, or lumbar intervertebral disk disease than nonsmokers. There was a 60% (men) and 15% (women) greater risk of lost workdays due to hospitalization and a 7% and 54% greater risk, respectively, of lost workdays related to injuries in those who smoked than in nonsmokers. The authors estimated that if the entire male US Army population became nonsmokers, the number of days of lost duty not related to injury would decrease by 18.3% after 2.5 years.

Studies have also linked presenteeism—decrease in on-the-job performance due to health problems—to tobacco use. A survey of 28,902 US workers found that loss of productive time because of health was twice as high in smokers as in nonsmokers. The adjusted loss of productive time in people who smoked at least one pack of cigarettes per day was about 75% higher than in nonsmokers (Stewart et al., 2003). Bunn et al. (2006), in a study of smoking effects on productivity in a large sample of US employees, found that current smokers missed more work and reported more unproductive time at work than former smokers and nonsmokers; current smokers lost a mean of 76.5 hours/year, nonsmokers, 42.8 hours/year, and former smokers, 56 hours/year.

Halpern et al. (2001) evaluated work productivity in 96 airline employees. The employees were categorized as never smokers, former smokers, and current smokers. Absenteeism was significantly (p = 0.03) higher in current smokers than in former smokers. Although objective measures of productivity did not differ significantly between the groups, productivity perceived by others was lowest for current smokers, highest for never smokers, and in between for former smokers; the productivity of former smokers increased with duration of abstinence.

The specific economic burdens placed on DoD by abseentism and productivity loss are discussed later in this chapter.

Effects on Health

The 2004 US Surgeon General’s report The Health Consequences of Smoking found a causal relationship between smoking and several short-term health effects. The health effects included increased risk of infectious disease, poor asthma control, periodontitis, peptic ulcer disease, and adverse surgical outcomes. Those and other health effects associated with tobacco use are briefly considered in the following sections.

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