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Changes in smoking intensity over time Increased mortality in smokers is linked to smoking intensity or pack-year history 8, 9, 18 , including greater duration of smoking, age at which smoking was initiated, more cigarettes per day, increased inhalation per cigarette (eg, smoking down to the butt) and/or changes to the harmfulness of the product over time such as tar/carcinogen content or roll-your-own smoking

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The results indicated that pathways related to cell cycle, DNA damage, mTOR signaling, and reactive oxygen species were among the top twenty known to be enriched in response to cigarette smoke exposure (Supplementary Fig