{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:08:54Z","timestamp":1785409734685,"version":"3.56.0"},"reference-count":44,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100015690","name":"Universitas Padjadjaran","doi-asserted-by":"crossref","award":["1969\/UN6.3.1\/PT.00\/2024"],"award-info":[{"award-number":["1969\/UN6.3.1\/PT.00\/2024"]}],"id":[{"id":"10.13039\/501100015690","id-type":"DOI","asserted-by":"crossref"}]},{"award":["1969\/UN6.3.1\/PT.00\/2024"],"award-info":[{"award-number":["1969\/UN6.3.1\/PT.00\/2024"]}],"id":[{"id":"https:\/\/ror.org\/00xqf8t64","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Despite well-documented adverse impact on both systemic and oral health, tobacco smoking remains a persistent issue in military populations. It contributes to the global burden of tobacco use and is often perceived as a means of coping with stress in military settings. Purpose: This study aimed to assess the prevalence of tobacco use among military marines, its impact on oral health, and their level of knowledge regarding smoking, as well as to identify variables associated with their smoking habits. Thus, it provides a basis for implementing appropriate tobacco cessation and harm reduction strategies, particularly within the military. This study demonstrated a high prevalence of tobacco use among military marines, despite generally high levels of knowledge regarding tobacco smoking. A knowledge gap was still evident in relation to smoking behavior. The most frequently reported oral health impacts among smokers were tooth staining, halitosis, and taste impairment. Duration of military service and level of knowledge were significantly associated with smoking behavior. Materials and Methods: A validated and reliable online survey was administered to collect socio-demographic data, including age, education level, and length of military service. The survey also assessed smoking status, smoking behavior, its impact on oral health, and participants\u2019 knowledge of smoking-related risks. Data were analyzed descriptively, and associated factors were examined using multivariate analysis. Results: A total of 475 military marines participated in the study. Of these, 44.8% were current smokers, 25.7% were former smokers, and 29.5% had never smoked. Overall, 71% of participants demonstrated good knowledge of smoking-related risks. The most commonly reported oral health impacts were halitosis, tooth staining, and impaired taste. Smoking status did not differ significantly by age (p = 0.095) or education level (p = 0.610), but differed significantly by length of military service (p &lt; 0.05) and level of knowledge (p &lt; 0.05). Multivariate analysis using multinomial logistic regression indicated that length of military service was a significant predictor of smoking behavior (p = 0.005; 95% CI: 0.282\u20130.800), with 1\u20135 years of service emerging as the most influential category. Based on the odds ratio, individuals with 11\u201315 years of service had a 1.8-fold higher likelihood of smoking. Conclusions: Despite a generally good level of knowledge regarding the health risks of smoking, the prevalence of tobacco use remains high among military marines. The most commonly reported oral health impacts were tooth staining, halitosis, and impaired taste. Length of military service and level of knowledge regarding smoking were identified as significant factors associated with smoking status.<\/jats:p>","DOI":"10.3390\/ijerph23050655","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:46:18Z","timestamp":1779381978000},"page":"655","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of Use, Impact on Oral Health, and Knowledge Regarding Tobacco Smoking: Findings from a Cross-Sectional Survey in Military Marines"],"prefix":"10.3390","volume":"23","author":[{"given":"Siti","family":"Sopiatin","sequence":"first","affiliation":[{"name":"Biotechnology Doctoral Study Program, Graduate School, Universitas Padjadjaran, Bandung 40132, West Java, Indonesia"},{"name":"Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Bandung 40132, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9999-8533","authenticated-orcid":false,"given":"Yun Mukmin","family":"Akbar","sequence":"additional","affiliation":[{"name":"Department Dental and Oral Health, Dr. Mintohardjo Naval Hospital, Jakarta 10210, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irvan Nur","family":"Wachid","sequence":"additional","affiliation":[{"name":"Marine Health Battalion Unit 1\/Marine Force 1, Jakarta 12560, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharifa Ezat Wan","family":"Puteh","sequence":"additional","affiliation":[{"name":"Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur 43600, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9630-5567","authenticated-orcid":false,"given":"Neily","family":"Zakiyah","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung 45363, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9164-0542","authenticated-orcid":false,"given":"Amaliya","family":"Amaliya","sequence":"additional","affiliation":[{"name":"Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Bandung 40132, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Achmad","family":"Syawqie","sequence":"additional","affiliation":[{"name":"Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung 40132, West Java, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.15585\/mmwr.mm6738a7","article-title":"Current Tobacco Smoking, Quit Attempts, and Knowledge About Smoking Risks Among Persons Aged \u226515 Years\u2014Global Adult Tobacco Survey, 28 Countries, 2008\u20132016","volume":"67","author":"Ahluwalia","year":"2018","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1038\/s41432-023-00930-3","article-title":"Impacts of smoking on oral health\u2014what is the role of the dental team in smoking cessation?","volume":"24","author":"Amaral","year":"2023","journal-title":"Evid.-Based Dent."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2632","DOI":"10.1093\/milmed\/usae208","article-title":"Tobacco use Prevalence in the Military Health System: A Retrospective Study","volume":"189","author":"Patrick","year":"2024","journal-title":"Mil. Med."},{"key":"ref_4","first-page":"111","article-title":"The Prevalence of Smoking and The Level of Nicotine Addiction Among Military Personnel","volume":"4","author":"Simonchik","year":"2024","journal-title":"Mil. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Almesmari, S., AlAmeri, F., Al Shanqaiti, H., Al Mansoori, L., and Heena, H. (2024). Prevalence of smoking among national military service recruits in UAE. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1335545"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1902\/annals.1996.1.1.707","article-title":"Section 9: Implant Therapy I","volume":"1","author":"Cochran","year":"1996","journal-title":"Ann. Periodontol."},{"key":"ref_7","first-page":"1322","article-title":"Smoking behavior change during compulsory military service in Israel, 1987-2011","volume":"19","author":"Zarka","year":"2017","journal-title":"Nicotine Tob. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1733","DOI":"10.7205\/MILMED-D-16-00201","article-title":"Perceived deterrence of cigarette use and smoking status among active duty military personnel","volume":"182","author":"Ulanday","year":"2017","journal-title":"Mil. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e104","DOI":"10.1093\/milmed\/usx015","article-title":"Future health and economic impact of comprehensive tobacco control in DoD: A microsimulation approach","volume":"183","author":"Yang","year":"2018","journal-title":"Mil. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e211","DOI":"10.1093\/milmed\/usy363","article-title":"A cross-sectional survey on cigarette smoking in the Chinese navy","volume":"184","author":"Chen","year":"2019","journal-title":"Mil. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1080\/21635781.2018.1530625","article-title":"Knowledge gaps around smoking and nicotine among U.S. military veterans who smoke and implications for practice","volume":"7","author":"Hicks","year":"2019","journal-title":"Mil. Behav. Health"},{"key":"ref_12","unstructured":"Ministry of Health Republic of Indonesia (2018). National Report on Basic Health Research (Riskesdas) 2018."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e1933","DOI":"10.7205\/MILMED-D-16-00361","article-title":"Prevalence and trends of cigarette smoking among military personnel in taiwan: Results of 10-year anti-smoking health promotion programs in military","volume":"182","author":"Chu","year":"2017","journal-title":"Mil. Med."},{"key":"ref_14","first-page":"5","article-title":"Smoking prevalence in the area of responsibility of the German Ministry of Defense\u2014Results of the employee survey in the context of occupational health management","volume":"7","author":"Sammito","year":"2020","journal-title":"Mil. Med. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"185","DOI":"10.18332\/tid\/196477","article-title":"Age-period-cohort analysis of smoking prevalence trends among career military personnel in South Korea","volume":"22","author":"Jung","year":"2024","journal-title":"Tob. Induc. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"10","DOI":"10.21037\/arh.2017.04.10","article-title":"Characteristics of smoking among young Greek males at the time of their recruitment in the army","volume":"1","author":"Grapatsas","year":"2017","journal-title":"Ann. Res. Hosp."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"59","DOI":"10.33920\/med-08-2112-05","article-title":"Analysis of the prevalence of smoking among young people taking into account socio-economic and psycho-emotional factors","volume":"12","author":"Dolich","year":"2021","journal-title":"Sanit. Vra\u010d (Sanit. Dr.)"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"92","DOI":"10.3961\/jpmph.18.201","article-title":"Factors related to smoking status among young adults: An analysis of younger and older young adults in Korea","volume":"52","author":"Lee","year":"2019","journal-title":"J. Prev. Med. Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"165S","DOI":"10.1177\/1524839919881478","article-title":"Smoking Among U.S. Service Members Following Transition from Military to Veteran Status","volume":"21","author":"Nieh","year":"2020","journal-title":"Health Promot. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1093\/eurpub\/ckw220","article-title":"Educational inequalities in risky health behaviours in 21 European countries: Findings from the European social survey (2014) special module on the social determinants of health","volume":"27","author":"Huijts","year":"2017","journal-title":"Eur. J. Public Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e402","DOI":"10.1093\/milmed\/usy115","article-title":"Military Factors Associated with Smoking in Veterans","volume":"183","author":"Golden","year":"2018","journal-title":"Mil. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1177\/0022042616678617","article-title":"The influence of men\u2019s military service on smoking across the life course","volume":"47","author":"London","year":"2017","journal-title":"J. Drug Issues"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s00038-016-0841-9","article-title":"Military service and smoking in a cohort of northern Vietnamese older adults","volume":"62","author":"Korinek","year":"2017","journal-title":"Int. J. Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"43","DOI":"10.18332\/tpc\/135516","article-title":"E-cigarette and dual product use as an emerging health threat to the US military","volume":"7","author":"Keltner","year":"2021","journal-title":"Tob. Prev. Cessat."},{"key":"ref_25","first-page":"2","article-title":"Tobacco and Nicotine Use Among Active Component U.S. Military Service Members: A Comparison of 2018 Estimates from the Health Related Behaviors Survey and the Periodic Health Assessment","volume":"31","author":"Mancuso","year":"2024","journal-title":"Med. Surveill. Mon. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1080\/10826084.2020.1868517","article-title":"Trends in Tobacco Use among Young Adults Presenting for Military Service in the United States Air Force between 2013 and 2018","volume":"56","author":"Little","year":"2020","journal-title":"Subst. Use Misuse"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1093\/milmed\/usz267","article-title":"Electronic Cigarette Use and Related Factors among Active Duty Service Members in the U.S. Military","volume":"185","author":"Lin","year":"2020","journal-title":"Mil. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2045","DOI":"10.1038\/s41591-022-01978-x","article-title":"Health effects associated with smoking: A Burden of Proof study","volume":"28","author":"Dai","year":"2022","journal-title":"Nat. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1093\/jnci\/djab208","article-title":"Smoking Cessation Prevalence and Inequalities in the United States: 2014-2019","volume":"114","author":"Leventhal","year":"2022","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"22S","DOI":"10.1177\/1010539519874944","article-title":"Prevalence and Factors Associated with Attempts to Quit and Smoking Cessation in Malaysia","volume":"31","author":"Lim","year":"2019","journal-title":"Asia-Pac. J. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e3386","DOI":"10.1093\/milmed\/usad268","article-title":"\u201cWe\u2019re tough, but so is quitting.\u201d Barriers to Smoking Cessation: The Royal Malaysian Navy Perspective","volume":"188","author":"Sabri","year":"2023","journal-title":"Mil. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e231","DOI":"10.1093\/milmed\/usx021","article-title":"Socioecological Risk and Protective Factors for Smoking among Active Duty U.S. Military Personnel","volume":"183","author":"Brown","year":"2018","journal-title":"Mil. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.job.2021.12.002","article-title":"A review on natural teeth whitening","volume":"64","author":"Benahmed","year":"2022","journal-title":"J. Oral Biosci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"223","DOI":"10.35790\/eg.v9i2.34878","article-title":"Pengaruh Kebiasaan Merokok terhadap Pembentukan Stain pada Gigi","volume":"9","author":"Dondokambey","year":"2021","journal-title":"e-GiGi"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Zanetti, F., Semren, T.Z., Battey, J.N.D., Guy, P.A., Ivanov, N.V., van der Plas, A., and Hoeng, J. (2021). A Literature Review and Framework Proposal for Halitosis Assessment in Cigarette Smokers and Alternative Nicotine-Delivery Products Users. Front. Oral Health, 2.","DOI":"10.3389\/froh.2021.777442"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1016\/j.toxrep.2022.02.012","article-title":"Influence of tobacco smoking on the development of halitosis","volume":"9","author":"Kauss","year":"2022","journal-title":"Toxicol. Rep."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1111\/omi.12228","article-title":"Tobacco-induced suppression of the vascular response to dental plaque","volume":"33","author":"Buduneli","year":"2018","journal-title":"Mol. Oral Microbiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/08958378.2018.1443174","article-title":"Tar level of cigarettes smoked and risk of smoking-related diseases","volume":"30","author":"Lee","year":"2018","journal-title":"Inhal. Toxicol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"821","DOI":"10.62225\/2583049X.2025.5.4.4685","article-title":"Smoking Prevalence, Knowledge, and Attitude among College Students of Riyadh Elm University: A Cross-Sectional Study","volume":"5","author":"Alshammri","year":"2025","journal-title":"Int. J. Adv. Multidiscip. Res. Stud."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1093\/occmed\/kqx149","article-title":"Factors associated with smoking behaviour change in UK military personnel","volume":"67","author":"Thandi","year":"2017","journal-title":"Occup. Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Nieh, C., Mancuso, J.D., Powell, T.M., Welsh, M.M., Gackstetter, G.D., and Hooper, T.I. (2021). Cigarette smoking patterns among U.S. military service members before and after separation from the military. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0257539"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1093\/ntr\/nty244","article-title":"Neighborhood differences in alternative tobacco product availability and advertising in New York City: Implications for health disparities","volume":"21","author":"Giovenco","year":"2019","journal-title":"Nicotine Tob. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"8","DOI":"10.18332\/tpc\/84869","article-title":"Initiation, continuation of use and cessation of alternative tobacco products among young adults: A qualitative study","volume":"4","author":"Vu","year":"2018","journal-title":"Tob. Prev. Cessat."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.2147\/JMDH.S319727","article-title":"Effectiveness and safety profile of alternative tobacco and nicotine products for smoking reduction and cessation: A systematic review","volume":"14","author":"Zakiyah","year":"2021","journal-title":"J. Multidiscip. Healthc."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/5\/655\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T04:11:44Z","timestamp":1779423104000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/5\/655"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,14]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["ijerph23050655"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23050655","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,14]]}}}