Which of the following is considered a risk factor for peptic ulcer disease (PUD)?

Tobacco use is recognized as a significant risk factor for peptic ulcer disease (PUD). The harmful substances in tobacco can impair the mucosal defenses of the stomach and duodenum, leading to an increased susceptibility to ulcer formation. Nicotine is known to stimulate gastric acid production and may also hinder the healing of existing ulcers. Moreover, smokers often have a higher incidence of H. pylori infection, which is a primary cause of peptic ulcers.

The other options listed do not have a direct or strong link to the development of PUD. Excessive physical exercise, for instance, is generally not linked to an increased risk of ulcers. A low sodium diet is not associated with ulcers either, and there is minimal evidence linking vitamin D deficiency directly to the manifestation of PUD. Thus, tobacco use stands out as a well-documented behavioral health risk that contributes to the likelihood of developing peptic ulcer disease.