smoke in the mouth. According to the National Health and Nutrition Examination Survey III, after adjustments for age, race, income, and education level, current smokers were 4 times more likely than nonsmokers to have periodontitis (Johnson and Guthmiller, 2007). One study found that two-thirds of new cases of periodontal attachment loss could be attributed to smoking (Thomson et al., 2007). Periodontal disease showed a dose-response relationship with smoking in young Israelis leaving military service (Vered et al., 2008).

Acute Eosinophilic Pneumonia

Acute eosinophilic pneumonia (AEP) is a rare, often life-threatening form of pneumonia believed to be an allergic response to an environmental exposure (Janz et al., 2009). Smoking is known to be a risk factor for AEP (Vassallo and Ryu, 2008). Shorr et al. (2004) identified 18 cases of AEP, two of which were fatal, in the 183,000 soldiers deployed in Iraq during March 2003–March 2004. All 18 patients smoked tobacco, and 14 of them had started smoking only recently. The Stars and Stripes military newspaper reported that at least 36 troops deployed in or near Iraq developed AEP from 2003 to 2008; 27 of them had begun smoking shortly before developing AEP (Mraz, 2008). It is hypothesized that the effects of smoking on pulmonary defenses or immune responses interact with such environmental exposures as windborne dust to trigger AEP (Shorr et al., 2004).

BOX 2-1

Effects of Smoking on Military Readiness and Performance

Tobacco use affects military readiness by

  • impairing physical endurance and performance capacity;

  • impairing visual performance, dark adaptation, and night vision;

  • accelerating age-related hearing loss and potentially interacting with noise-induced hearing loss;

  • impairing vigilance and cognitive function (nicotine withdrawal);

  • increasing the risk of motor-vehicle collisions and other accidents;

  • increasing work absenteeism (due to illness, accidents, and alcohol and substance abuse);

  • increasing the risk of lower respiratory tract infections;

  • increasing the risk of peptic ulcer disease;

  • impairing wound healing;

  • increasing postoperative complications;

  • increasing the risk of periodontal disease; and

  • possibly increasing the risk of AEP.

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