likely as nonusers to have severe active periodontal disease (Fisher et al., 2005).

Two studies of Swedish smokeless-tobacco users found no increased risk of cardiovascular disease, stroke, or sudden death compared with nonusers (Hergens et al., 2005; Huhtasaari et al., 1999), although other studies have shown an increased risk of cardiovascular disease, including hypertension and myocardial infarction, particularly in those who combine smokeless tobacco with tobacco-smoking (Bolinder et al., 1994; Johansson et al., 2005). The reason for the discrepancy is unclear.

In summary, smokeless-tobacco use poses a health risk to military personnel and veterans in that it causes oral and pancreatic cancer and periodontal disease, maintains tobacco use, and may increase the risk of cardiovascular disease.

ECONOMIC IMPACTS

The societal costs of tobacco use in the military and veteran populations are expansive. They include the costs of treating military and veteran tobacco users for tobacco-related illnesses, health-care costs for those exposed to secondhand smoke, and the costs associated with lost productivity of military and veteran tobacco users. The economic impacts of tobacco use also include revenues to DoD from tobacco-product retail sales on installations, which are used to partially fund morale, welfare, and recreation (MWR) activities for military personnel and their families. MWR activities are support and leisure services designed to enhance the lives of military personnel, retirees, family members, and civilian employees; programs include child care, recreational activities, sports, and travel.

Impacts on the Department of Defense

In 2008, the DoD assistant secretary for health affairs stated, “Every year, tobacco use leads to unnecessary compromises in the readiness of our troops and costs the Department of Defense millions of dollars in preventable health care costs.” Furthermore, DoD spends over $1.6 billion a year on tobacco-related medical care, increased hospitalization, and lost days of work (DoD, 2008). Tobacco use by military personnel has two major economic effects on DoD: the cost of health care for military personnel—active-duty, retired, and dependents—and the cost of lost productivity.



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