Almost 30 per cent of the adult population in the United Kingdom smokes...the highest percentage being teenage girls!

Smoking is increasing amongst teenage girls in Bermuda, too, as the whole issue of smoking remains a big concern amongst healthcare professionals.

"The highest proportion of new smokers is teenage girls," said Judith McAllister of the National Respiratory Training Centre in England, who was on the Island last week to conduct a one-day smoking cessation workshop, attended by some 20 healthcare workers.

"When you start smoking, what tends to happen is within six or seven cigarettes you are addicted and most lifelong smokers will start before the age of 13. It's a worldwide problem. The tobacco industry is starting to focus on the developing world and we're going to see smoking killing more people than any other disease in the next 20 or 30 years."

Mrs. McAllister said studies have shown that nicotine is very addictive, more addictive than cocaine or heroin. The reasons for starting are varied, but once addicted it is very difficult to stop.

Statistics from Britain show that there is an increase in the number of children smoking, from eight percent of 11-15 year olds in 1988 to 13 percent in 1996.

Smoking is increasing most rapidly in girls - one in five 15-year-old girls smoked in 1988, but that figure had risen to one in three by 1996.

It is also estimated that one in two smokers will die from smoking and one third will never draw their pensions.

"When I was young film stars smoked, then they stopped, and now we're seeing them again," said Mrs. McAllister of the influences on teens and even pre-teens.

"We've got really powerful role models influencing children. The tobacco industry needs to have 360-odd new smokers every day to replace those who die or who quit. And they get them when they are young. Most smokers start when they are kids and advertising is subtle, aimed at children who have less sophisticated ways of approaching things."

Restrictions have been placed on cigarette advertising, with no advertising allowed on television, on billboards and in the cinemas in the the UK, Mrs. McAllister pointed out.

"But we still get those advertising at sporting events. Sports sponsorship by tobacco companies is massive and there is subtle advertising in magazines. Most children are aware of tobacco advertising."

Children are more likely to smoke if one or two parents smoke, however, "just because your parents don't smoke doesn't make you less likely to smoke", Mrs. McAllister warned.

"Stopping smoking is the hardest thing a smoker will ever do, it's a drug more addictive than heroin or cocaine and we expect people to do it cold turkey.

"Even with the best support possible, and they use things like NRT (nicotine replacement therapy) and Zyban, you are only going to get quit rates of about 12 percent in a year. Lots of people try but the majority of smokers fail to quit the first time they try. Most smokers will have four or five quit attempts before they succeed."

There are many techniques - from the patch to hypnosis to acupuncture - to help smokers quit.

"But there isn't a magic cure," Mrs. McAllister warned.

"You need to want to stop, and should find a method that suits you. But having support, from friends, family, your doctor or a nurse, increases your chances of quitting. We have to focus our efforts, as doctors and nurses, on the people who want to stop and help them."

The National Respiratory Training Centre sees health professionals, particularly nurses in primary care, as having a major role in smoking cessation.

Mrs. McAllister, an international trainer of respiratory diseases and a registered nurse, addressed the concerns of those attending the workshop. They ranged from doctors, nurses, hospital staff, cancer nurse from PALS and also a representative from an insurance company.

"Because it is so difficult to quit it can feel really demotivating," she revealed during a break in the workshop.

Mrs. McAllister's visit was sponsored by Open Airways and while here she also supported Debbie Barboza, the local NRTC trainer, in an asthma course earlier in the week and then also held a COPD (Chronic Obstructive Pulmonary Disease) course.

"Smoking is an enormous medical and social problem in Bermuda, affecting a number of diseases...cardiac, diabetes, asthma, emphysema," said Liz Boden of Open Airways.

"The greatest thing we need is a centre for smoking cessation counselling. One of the growing problems is women and children. In my day when they started having a cigarette behind the toilets in school when they were 16, now they are 11 which is a big difference.

'In my childhood it was much more of a man thing, but now it is equal. They say more men seem to stop than women, women seem to stay on because of the power of losing weight and keeping their figure.

"Women are more interested in smoking because they like to keep their weight down. It does change your metabolism, therefore you can eat the same number of calories as a non-smoker and will not gain the same weight. That's an enormous incentive for women, particularly women in the workplace who want to look nice in their suits."

Mrs. Boden said smokers get a 'high' just seven seconds after their first inhalation of a cigarette.

"Apparantly the complete effect has worn off within two hours, but most of it within an hour, so that's why people need (cigarette) breaks at least every two hours to keep their nicotine levels at a level that makes them feel comfortable," she explained.

The smoking cessation workshop objectives was to provide those attending with knowledge and practical skills in:

the effects of smoking

the quitting process

helping patients decide to quit

helping patients cope with quitting

preventing relapse and sourcing additional support.

Addressing the reasons

for failing to quit

Not prepared

Unrealistic expectations

Physical distress

Unbearable cravings

Yielding to temptation

Weight gain

Crisis

Benefits of quitting

Some smokers, particularly those who have smoked for many years, may be reluctant to stop smoking because they believe that the damage to their health is irreversible.

All smokers need to be aware that it is never too late to stop smoking.

Someone smoking 40 cigarettes a day will be around $5,000 a year better off after quitting.

Benefits of quitting start immediately, though these may not be apparent to the smoker.

Time after the last cigarette

20 minutes - Blood pressure and pulse return to normal. Circulation improves in hands and feet, making them warmer.

8 hours - Oxygen levels in the blood return to normal. Chances of a heart attack start to fall.

24 hours - Carbon monoxide is eliminated from the body. The lungs start to clear out mucus and other debris.

48 hours - Nicotine is no longer detectable in the body. The ability to taste and smell is improved.

72 hours - Breathing becomes easier as the bronchial tubes relax. Energy levels increase.

2-12 weeks - Circulation improves throughout the body, making walking easier.

3-9 months - Breathing problems (eg. coughing, shortness of breath, wheezing) show improvement with lung function increased by five-ten percent.

Five years - Risk of heart attack falls to about half that of a smoker.

Ten years - Risk of lung cancer falls to about half that of a smoker. Risk of a heart attack similar to that of someone who has never smoked.