An occupation health nurse provides monthly lunch and learn sessions to employees of a rail transportation manufacturer. This month, they are providing education on the risk factors for peptic ulcer disease. Which risk factors should the nurse include in the educational session? (Select All that Apply.)

A. Eating spicy foods and laid-back attitude: While spicy foods may cause discomfort in some individuals, they are not direct causes of PUD. A "laid-back attitude" is also not a recognized risk factor. Stress, in general, can worsen symptoms, but it does not cause ulcers. B. Occasional alcohol and cocaine use: Occasional alcohol use may irritate the stomach lining, but it is more commonly chronic alcohol use that is a risk factor. Cocaine use can cause severe gastrointestinal issues, including ulcers, but occasional use is not a primary risk factor. C. Alcohol abuse and smoking: Both alcohol abuse and smoking are well-established risk factors for peptic ulcer disease. Alcohol can irritate the stomach lining, and smoking reduces the effectiveness of treatments and increases the risk of ulcer recurrence by promoting gastric acid secretion and decreasing mucosal blood flow. D. Six-month history of H. Pylori: Helicobacter pylori infection is one of the leading causes of peptic ulcers. A six-month history of H. pylori infection increases the risk of developing ulcers, as the bacteria damages the stomach lining and increases acid production. E. Active lifestyle and smoking: Smoking impairs healing and increases the recurrence rate of ulcers, making it a key factor in ulcer formation. However, the active lifestyle itself does not contribute to the development of ulcers.