At that time, and continuing through to the 1950s, smoking was actually thought to have medicinal benefits. Also, in correspondence to her father, one of the girls makes reference to the concept that smoking would keep flying insects away. Alexandra smoked, but privately, since it was not considered ladylike but rather daring and--in many circles--mannish. When OTMA smoked, they did so for several reasons . . . because they were close to their father, and he offered them cigarettes in the manner of one companion to another, and because, like all young people, they were eager to try new things, and things that were rather daring. But while Alexandra smoked privately, and not as frequently as her husband, Nicholas smoked a great deal, and his health began to reflect it. No one can dispute that he was in great overall physical shape, due to his love of exercise, but while at Stavka he experienced what today would be diagnosed as symptoms of a heart attack. Moreover, in some of her photos from the war period, Alexandra shows signs of premature aging. Although most of this had its root cause in her many years of anxiety re: Alexei, smoking cannot have improved the haggard, worn look on her face. If OTMA had lived, and their interest in smoking had progressed from frivolity to habit, undoubtedly they would have gone from being "cool" to unnattractive and very, very ill.