To the Editor.—Dr Hemmelgarn and colleagues1studied injury rates associated with motor vehicle
crashes and benzodiazepine use. Tobacco use is also associated with automobile
crashes, as well as industrial accidents, poisonings, burns, occupational
injuries, fire deaths, suicides, and violence.2,3
While the causal mechanism of these relationships is not currently well understood,
several plausible mechanisms have been postulated by us and others.2- 4This risk may
stem from the cognitive or neuromuscular effects of carbon monoxide, nicotine
or nicotine withdrawal, or an association with risk-taking behavior. Tobacco
use could also increase the risk of cumulative trauma disorders resulting
from impaired tissue-repair processes. While the mechanism is unknown, smoking
is a potentially important confounder in injury research, and one that would
have been helpful to assess in this study.
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