Influence of smoking status on musculoskeletal injury risk in British Army Infantry trainees

Andrew Siddall, James Bilzon, Dylan Thompson, Rachel Izard, Julie Greeves, Keith Stokes

Research output: Contribution to conferencePaperpeer-review


Cigarette smoking is the most widely reported independent risk factor for training-related injuries in military personnel (Knapik et al., 2001). Despite this, smoking prevalence in military populations is typically higher than in the general population (Klesges et al., 2001). We examined injury incidence during British Army infantry training to determine whether habitual smoking influences injury risk. After obtaining written informed consent, a lifestyle questionnaire was administered to trainees (aged 18-33) at entry to training (n=1810) to determine current smoking behaviours. Data on lower limb and lumbar spine injuries over 26 weeks of training were obtained retrospectively from military medical records. Injury type, anatomical site and training time lost were recorded for all training-induced injuries and categorised as either traumatic or overuse in nature. The sample comprised 49% smokers (>1 cigarette·day-1) and 33% non-smokers with the remainder either former or occasional smokers. Training-related injury incidence for the sample was 58% and time-loss training injury incidence was 32% where median (IQR) training days lost was 14 (43) days per time-loss injury. Odds ratios (95% CI) for training injury (1.22 [1.12-1.34]), time-loss training injury (1.23 [1.06-1.44]) and overuse training injury (1.38 [1.11-1.72]) showed greater risk in smokers (p<0.01). Smokers exhibited higher incidence (95% CI; p<0.01) of training injuries (60 (57-63)% vs. 55 (51-59)%), time-loss training injuries (34 (31-38)% vs. 30 (26-34)%) and injuries attributed to overuse (22 (19-25)% vs. 17 (14-20)%), but not traumatic training injuries. Additionally, average duty days lost (95% CI) to time-loss training-injuries per 1000 trainee-days was significantly greater in smokers (132 (120-144)) than non-smokers (104 (92-116); p<0.01). The most prevalent training-related and time-loss injuries were non-specific soft tissue injury (51% of injuries) and the most common anatomical sites were knee (25%), foot (24%) and ankle (17%), with injuries to the lower leg comprising >75% of all lower body injuries, with similar patterns observed for smokers and non-smokers. Smokers have a greater risk of training-related injury than non-smokers in this British Army infantry training population, though univariate analyses cannot demonstrate that smoking per se is the cause of this difference. The greater number of training days lost per 1000 trainee-days suggests that smokers either suffer more severe injuries and/or may not recover from injuries as quickly or effectively as non-smokers. References Klesges, RC., et al. (2001). Tob Control. 10(1): 43-7. Knapik, JJ., et al. (2001). Med Sci Sports Exerc. 33(6): 946-54.
Original languageEnglish
Publication statusPublished - 2013


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