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how long do tobacco hornworms pupate Metamorphosis & the Hornworm (Manduca sexta) Tobacco Hornworm as a Pest
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At that time, youth were largely smoking cigarettes or chewing tobacco, since vaping didn't exist

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Biochemistry 1967, 6: 3076-3081

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Exposure to cigarette smoke leads to increased permeability of the respiratory epithelium, mucous overproduction, impaired mucociliary clearance, enhanced release of pro-inflammatory cytokines and chemokines with consecutive recruitment of macrophages and neutrophils, as well as altered pathogen sensing and clearance