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Abstract
To the Editor.— Underwood's article 1 on health factors in the assessment of older drivers is most timely. In addition to their neuropsychiatric and physical deficits, medications and alcohol may further impair the performance of elderly drivers. Unfortunately, Underwood does not mention tobacco. Smoking, especially while driving, should also be considered a risk factor. In addition to nicotine, cigarette smoke contains a number of toxic components including hydrocyanic acid, acrolein, and carbon monoxide. 2 The adverse central nervous system and cardiovascular effects of cigarette smoking are generally dose related. 3 In a closed vehicle, especially if more than one person is smoking, the concentration of these toxins could reach substantial levels. Furthermore, the act of smoking may of itself distract the driver. While smoking may adversely affect a driver at any age, the elderly would seem to be more susceptible. I would appreciate learning if Underwood is aware of any
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