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Average smoking rates in the general population are estimated at more than 25 percent, while studies conducted in the 1990s indicated a 15 percent to 25 percent smoking rate in nursing students and a 2 percent to 10 percent smoking rate in medical students, the study said. Of the students who smoked, 89.7 percent of nursing students were women, compared to 57.6 percent of medical students.

Caroline Stonelake, a nursing student at Thomas Jefferson, said she quit smoking two years ago after she tried to work out and found it difficult to breathe. "I just felt I'd be a lot healthier, so I set a date and just stopped." One thing she missed was the social aspect of getting together with others in the smoking areas. Smoking also had been an excuse to take a break from studying.

"Now, I discourage it," she said. Stonelake, who works as a nurse extra in the hospital's respiratory care unit, sees a lot of diseases attributed to smoking. "The issue comes up a lot in the unit and patients will say, 'Oh, I didn't know you guys smoke.' "

Helping hands

Sarna has heard the stories and is dedicated to helping nurses quit smoking in 2004. She kicked off the new year with the launch of "Tobacco Free Nurses," the first nationwide initiative to help nurses kick the habit. The initiative is funded by a $1.8 million grant from The Robert Wood Johnson Foundation. A key resource in the project is a Web site devoted to helping nurses quit called TobaccoFreeNurses.org. The site links to nurses.quitnet.com, an Internet-based smoking cessation site tailored to the profession.

"Nurses work long shifts, all kinds of hours and go home exhausted and the last thing they want to do is go somewhere for a support group," Sarna said. "They need something 24/7 that's available even on the worksite and that's what the Internet program is all about."

The free QuitNet site that features ways to defeat the nefarious online character "Nicodemon" has been available to the public for several years. In addition to providing an around-the-clock support system, the site includes personalized guidance to kicking the habit, an antismoking medication guide, expert counseling and coupons for antismoking products.

"I heard a wonderful success story recently," Sarna said: "A nurse came up to me and said the only way she was able to quit successfully was through QuitNet. She said it empowered her with knowledge, support, access to information and an online buddy to help her through the quitting process so she wasn't alone."

One of Sarna's colleagues in the initiative, Stella Aguinaga Bialous, Ph.D., RN, a tobacco-control consultant in San Francisco, said preliminary data, including input from focus groups, are encouraging. "We've gotten many phone calls and e-mails from nurses wanting to quit and wanting to participate in the Web-based interventions," she said.

As an incentive, nurses are being given $100 worth of free, individualized smoking cessation services offered through the Web site, Bialous said. One of nurses' big concerns is weight gain and the Web site resources address that issue in detail while providing anonymity, she said.

"A lot of nurses are reluctant to go to cessation groups because they don't want people to know they're nurses who smoke," Bialous said. "There's a difference between a construction worker and a nurse. The addiction's the same, but the feelings are different. So at QuitNet, nurses can go to a chat room and talk with colleagues who are trying to quit and form a peer support system."

Bialous said an earlier $174,000 foundation grant was being used to bring awareness of tobacco's harm and the need for smoking cessation programs to nursing leadership in various settings, including hospitals, schools of nursing and professional associations.

Partnerships already have been forged between the Smoking Cessation Leadership Center at the University of California, San Francisco, and the American Association of Colleges of Nursing, the American Nurses Foundation and the National Coalition of Ethnic Minority Nurses Associations.

"Tobacco's been around as an issue for a long time, but we still have to remind people that it is the leading cause of illness and death in this country," Bialous said. "It's an issue that all health professionals morally and ethically should be addressing."

Contact John M. Leighty at johnsan@aol.com