Supermodel Christy Turlington has been the cover girl for nearly every major fashion publication in the world. But this month she graces the cover of the American debut issue of Stop!, a magazine devoted exclusively to quitting smoking.

Turlington is an apt choice because she knows firsthand how difficult it is to stop. Her father died of lung cancer, and she struggled for seven years to overcome her own addiction to nicotine. "Quitting smoking is one of the hardest things you can do," reports Turlington. "I started smoking at 13 and tried to stop at 19. I didn't succeed in quitting until I was 26." Along the way, she failed several times and felt "embarrassed" about not being able to control of her behavior. After trying numerous smoking cessation methods - from hypnosis (which worked for two years) to the patch to acupuncture - she finally quit cold turkey. "I just got tired of hearing myself say I was going to quit." But Turlington's success using will power to beat her addiction is the exception to the rule. Smoking cessation experts advise against going cold turkey because it's the least effective method of overcoming the cigarette habit. Only 2-3% of smokers can stop without help. According to the Centers for Disease Control and Prevention, of the 48 million smokers in the USA, 70% - 34 million people - report that they want to quit. "This year about 20 million Americans will try to quit smoking. Unfortunately, most try to do it completely on their own," relates Dr. Michael Fiore, chairman of the U.S. Public Health Service (PHS) panel that recently produced the updated clinical practice guidelines for treating tobacco use and dependence. "As a result," he continues, "only about 1 million smokers will successfully quit and remain tobacco-free. We have effective treatments, but there are still 40 million people who have tried at least once to quit but failed." Addiction and withdrawal Nicotine is a highly addictive drug which is delivered to the brain via the pulmonary vasculature within 10 seconds of inhaling cigarette smoke. It crosses the blood-brain barrier and causes dopamine levels in the brain to rise. This creates a sensation of pleasure that is often described as both relaxing and stimulating. How fast an individual gets addicted to nicotine varies widely. "It can take a day, a few months, a year. We just don't know," says Fiore, who is also director of the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School. What we do know is that about 80% of smokers are addicted by age 19. And as with most addictions, quitting is accompanied by often-uncomfortable withdrawal symptoms. While Turlington shares that she did not experience any negative withdrawal effects, most people who try to kick the habit do: *Irritability *Increased appetite *Sleep pattern disruptions *Difficulty concentrating *Depression or mood swings *Physical craving for cigarettes Many smokers who consider quitting worry about gaining weight. Some even continue to smoke rather than risk the extra poundage. But studies show most smokers gain around 10 pounds. As a health risk, the added weight is far preferable to the damaging effects of toxic smoke. "Besides, there are lots of fat smokers," quips Turlington. Cessation scenarios The good news is that more Americans are trying to quit. Nearly 8 million quit attempts were tracked in 1997 and 1998. That's four times more than in 1991. And Fiore believes that use of the new guidelines will double or even triple quit rates. The PHS guidelines are designed to counteract nicotine's addictive power by assisting healthcare professionals in both identifying smokers and treating them. But first, doctors must make smoking cessation a treatment priority. Recent studies indicate that only about half of all smokers are advised by their doctors to quit. One study found that only 15% of smokers who visited their doctor were offered assistance with quitting, and only 3% were given a follow up appointment. Yet, evidence demonstrates that a physician's recommendation alone can achieve quit rates of 10% - three to five times the success rate of cold turkey attempts. And follow-up appointments double this success rate. The dramatic rise in quit attempt increases are attributed to the introduction and accessibility of new smoking cessation products like the nicotine patch. The patch now accounts for almost 50% of drug-assisted attempts to quit. Other smoking cessation treatments include: *Nicotine gum *Nicotine inhalers *Nicotine spray *Buproprion SR (Zyban) *Behavioral therapy *Hypnosis *Acupuncture A promising new treatment is the just-announced nicotine vaccine, NicVax, which acts by stimulating the immune system to create antibodies that bind to the nicotine and prevent it from entering the brain. Already tested on rats, the vaccine is showing promising results. It also reduces nicotine withdrawal symptoms. Researchers theorize that NicVax may even be effective in preventing nicotine addiction in first-time smokers. Turlington also suggests yoga, especially where the emphasis on breathing is stressed. "Yoga brings focus and awareness to life which can also help with addiction, ultimately adding balance to every aspect of your life." Data from the 1996 California Tobacco Survey indicate that smokers who use some form of cessation assistance are twice as successful as those who try without help. The PHS guideline further contends that cessation therapies are even more effective when combined with counseling programs, including individual, group (12-Step programs), and proactive telephone counseling. Seek support "People are unique. When it comes to quitting, there's no one-size-fits-all magic bullet," says Fiore. "Different treatments work better for different people. Tobacco dependence is a chronic condition that often requires repeated intervention." If you're interested in quitting, get help. Make an appointment now, and tell your doctor you want to stop. "Quitting is one of the best things you can do for yourself," concludes Turlington, who has not smoked in six years. "I noticed the difference in my health almost immediately. My lungs were able to take in more air. I started working out regularly and had more energy." "I know there are a lot of discouraged people out there," acknowledges Fiore. "Nicotine is a powerful drug of dependence. But we have new, effective treatments that can help you and your family reap the benefits of living smoke-free." "Don't give up on giving up cigarettes," he urges. "You can quit." For more information on the PHS smoking cessation guidelines, go to www.surgeongeneral.gov/tobacco/default.htm or call 1-800-358-9295. Or visit Stop! Magazine's Web site at www.stopmagazine.co.uk.

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