In 1971, Arthur P. Mullaney, of Randolph, Massachusetts, came up with a great idea. He asked his neighbors to give up cigarettes for a day and donate the money they would have spent for cigarettes to a high school scholarship fund. During the next five years the idea spread to other communities across the nation. On November 18, 1976, the California Division of the American Cancer Society persuaded nearly one million of the state's 5 million smokers to quit for 24 hours. A year later the American Cancer Society held the first Great American Smokeout. The event became an annual tradition held on the third Thursday of November.

This year on November 19th, the Great American Smokeout will celebrate its 33rd anniversary. The event has had a profound effect on America's health: millions stop smoking for a day, and many of these people successfully take that further and quit for good. It also has changed attitudes toward smoking and resulted in public policies that help keep young people from starting to smoke and protect nonsmokers from the hazards of second-hand smoke.

"When the event began, smoking was accepted as the cultural norm," said Dr. Dileep G. Bal, national president of the American Cancer Society, which has continued to sponsor the event. "Now smoking is seen for what it actually is - a killer of nearly a million Americans each year."

Smokers are encouraged to put down their cigarettes, cigars or chewing tobacco for 24 hours. Society volunteers provide smoking cessation activities at local ACS offices. Hospitals and workplaces also distribute self-help materials and information. Many communities hold rallies and parades.

To convey the image that smoking is socially unacceptable, the Great American Smokeout has been chaired by some of America's most popular celebrities including Sammy Davis Jr., Edward Asner, Natalie Cole, Larry Hagman and former Surgeon General C. Everett Koop.

The event has been effective. For example, in 1999, 10 million Americans took the challenge. Of those participants, 6 percent reported they were smoking less or not at all one to five days later. That's more than 604,800 adults who have taken the first step to leading a smoke-free, healthier life. Indeed, more people quit smoking on the day of the Great American Smokeout than any other day, including New Year's Day.

"Quitting is a process and few smokers accomplish it the first time," said John R. Seffrin, Ph.D., CEO of the ACS. "Because nicotine is so addictive, most people make four or more attempts before they quit for good. The Great American Smokeout gives them an opportunity to make more than one attempt. They get encouragement from each other, so that they will be able to persevere. People also exchange tips on what helped them, so that they can overcome barriers throughout the year."

The focus of the event has evolved from simply helping adults to abstain to helping children and teenagers understand that they should never begin smoking in the first place.

"The earlier a person begins using tobacco, the greater the risk to his or her health," said Dr. Bal. "Of every 10 smokers, eight begin before age 18. That's why the Great American Smokeout encourages young people to think seriously about the danger in which they place themselves when they begin using tobacco products."

Young people are encouraged to sign a Great American Smokeout Pledge certificate, promising that they will lead a smoke-free life and will not use tobacco products during the Great American Smokeout.

"One of the most important accomplishments of the Great American Smokeout is that it has helped non-smokers by giving community leaders an opportunity to exchange ideas about how to protect people from the dangers of second-hand smoke," said Dr. Seffrin. "In 1977, Berkeley, California, became the first community to limit smoking in restaurants and other places and now other communities do so too. The Great American Smokeout has also helped highlight other ideas like workplace smoking restrictions and the federal smoking ban on all interstate buses and domestic flights of six hours or less."

However, the Great American Smokeout still faces many challenges, Dr. Bal said. An estimated 47 million adults in the U.S. currently smoke and about half will die prematurely from smoking. Lung cancer is the leading cause of cancer death for men and women. This year alone there will be about 169,500 new cases diagnosed in the U.S. More than 80 percent of lung cancers are thought to result from smoking.

"About 3,000 young people begin smoking every day, so we must continue to inform people of the dangers of smoking," Dr. Seffrin said. "More than 80 percent of smokers say they want to quit so ACS will continue to sponsor Great American Smokeout events, and on the other 364 days of the year, we will support smokers in other ways too, with self-help materials and information."