Objectives-Vibration white finger (VWF), also known as "occupational Raynaud's phenomenon", is marked by arterial hyperresponsiveness and vasoconstriction during cold stimulation. The impact of tobacco use, and by extension stopping smoking, on the long term course of the disease has been inconclusively characterised. The objectives of this study included assessment of the impact of tobacco use on symptoms and on objective tests in shipyard workers exposed to vibration, and in gauging the natural history of the disorder after stopping exposure and changing smoking patterns. Methods-In a cross sectional investigation, 601 current and former users of pneumatic tools were evaluated subjectively for cold related vascular symptoms, and tested by cold challenge plethysmography. There was follow up and subsequent testing of 199 members of the severely eVected subgroup of smokers and non-smokers, many of whom had stopped smoking in the interval between tests. EVects of smoking and stopping smoking on symptoms and plethsymographic results were assessed. Results-Symptoms and measured abnormal vascular responses related to cold were more severe in smokers than in nonsmokers. Follow up of 199 severely eVected members of the cohort, all removed from exposure for 2 years, indicated that smokers were almost twice as likely to have more severe vasospasm (test finger/ control finger systolic blood pressure% (FSBP%) <30) than were non-smokers (−32.2% v 17.4%). 53 Subjects who stopped smoking during the interval between tests improved, and were indistinguishable from non-smokers similarly exposed to vibration. Additional physiological benefits of stopping smoking were still apparent at further follow up examination, 1 year later. Improvements evident on plethysmography were not accompanied by improvements in symptoms, which were unaVected by smoking. Conclusions-Smoking seems to delay physiological improvement in response to cold challenge in workers with VWF, after the end of exposure to vibration. Symptoms were less likely to improve over time than digital blood pressure, and were less aVected by smoking.(Occup Environ Med 2000;57:341-347)