Toward Less Hazardous Cigarettes-Reply

We appreciate Dr Warner's perceptive comments on our recent article in The Journal. Dr Warner states that it is unreasonable to assume that the majority of two-a-day smokers inhale. Scientific data on inhalation practices of two-a-day smokers are sparse, because of relatively few such smokers in the general population. However, an ongoing epidemiologic study sponsored by the National Cancer Institute's Smoking and Health Program in eight US cities¹ has found that of 274 two-a-day smokers, 157 (57%) inhale. A similar study in Western Europe² has thus far identified only 47 two-a-day smokers, but 29 (62%) of them inhale. Although the sample sizes of these studies are small, we believe they represent some of the most comprehensive data available on the inhalation practices of two-a-day smokers. Further, respondents to tobacco questionnaires frequently understate their tobacco consumption practices, so the actual percentage of inhalers is likely to be larger