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Abstract
In Reply.— I appreciate Sataline's interest in my recent article on the clinical assessment of older drivers. He raises some interesting and clinically relevant concerns related to the possible adverse impact of smoking on driving performance. My review of the literature on the effects of tobacco use on driving performance did not identify definitive and conclusive evidence supporting the role of smoking as an independent risk factor for motor vehicle crashes and crash-related injuries. However, there are numerous possible mechanisms for direct and indirect effects of smoking to increase crash risks for individual drivers. As Sataline notes, the act of smoking (including the lighting and extinguishing of cigarettes and smoke-induced eye irritation and coughing spells) may decrease attention to the road. The use of cellular car telephones (increasingly popular since the mid-1980s and now present in at least 4 million automobiles, according to recent estimates) would be expected to interfere
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