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Hence, only in the 21 st century could we observe directly the full effects of prolonged smoking, and of prolonged cessation, on premature mortality among women.** Writing in a linked Comment, Professor Rachel Huxley, at the University of Minnesota, USA, adds That we had to wait until the 21st century to observe the full consequences in women of a habit that was already widespread in the mid-20th century, when tobacco smoking pervaded much of the developed world, might seem paradoxical