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The study has several limitations, they noted, including that most participants in the cohort studies were white and that the associations between smoking and mortality could be confounded by differences between smokers and nonsmokers with respect to risk factors including diet, physical activity, and access to medical care. The studys findings underscore the need for continued efforts to reduce the number of people who smoke, wrote Graham Colditz, M.D., of the Washington University School of Medicine, in an accompanying editorial