experience. (The answers to these questions may furnish insight into nicotine addiction and nicotine withdrawal symptoms and an understanding that the reasons for starting to smoke (e.g., peer pressure, self-image, etc) are often quite different from the reasons for continuing to smoke (e.g., addiction). 7) Knowing what you know now, would you have started smoking? Why? Students should record the answers on a tape recorder (ideal) or in writing. Have students analyze the answers to see if they can find evidence for nicotine tolerance, addiction and withdrawal symptoms and then report their findings as written homework.

*b) How long does it take to become addicted to nicotine in tobacco?

From the time of first experimentation with tobacco it takes, on average, three years to become addicted to nicotine. In some susceptible individuals, however, nicotine addiction can occur after smoking only 100 cigarettes (five packs). (see slides h and j).

*c) How can tobacco addicts be helped to quit?

If tobacco addicts want to quit, the best things a family member or friend can do are: 1) congratulate, support and encourage them in their decision; 2) refer them to a resource such as the American Lung Association (1-800-LUNG USA) the Cancer Informa-tion Service (1-800-4-CANCER) or the Florida Quit Line (1-877-822-6669) from which they can receive free stop smoking printed literature (i.e., information on how to stop smoking), free personal telephone counseling to help a person quit tobacco and, ideally, referral to a local stop smoking (behavioral change) group program; 3) encourage them to consult their physician for counseling and drug therapy (i.e., nicotine replace-ment and/or bupropion therapy) and 4) inform them of the nicotine replacement thera-pies which are available in pharmacies without a doctors prescription (i.e., nicotine patch, gum or lozenges).

If tobacco addicts do not want to quit or are not sure, you can obtain motivational printed literature for them on why they should quit from the above listed resources. Also they might be motivated to quit if you can find and then stress reasons that may be personally important to them. For example, "I want to live longer and see my children and grand-children grow up", "I want to protect my children from the dangers of second-hand smoke and set a better example so they don't smoke", or "I want to save money, feel better or improve my hygiene". Tying the reasons for quitting to the specific smoking re-lated disease the patient already has may be very motivating. In patients with emphy-sema, smoking cessation will significantly slow further losses of lung function and pro-gressive shortness of breath by 2-3 fold and will significantly prolong life! In patients with emphysema, breathing tests (e.g., forced expiratory volume in one second - FEV1) dete-riorate 2-3 times as rapidly in those who continue to smoke as in those who quit. In pa-tients who recently had a heart attack, smoking cessation will decrease the chances of having another heart attack and/or dying over the next twelve months by 50%! For pre-operative patients, timely smoking cessation significantly reduces operative risk and post-operative complications. For women who wish to become pregnant, smoking cessation significantly improves their fertility. For women who already are pregnant, smoking cessa-tion significantly reduces their risk for miscarriage and the risks to their baby's health.