Nov. 18 was the 23rd annual Great American Smokeout, hosted by the American Cancer Society. The ultimate goal is to heighten the awareness of smokers that if they can quit for just one day, they can stop for a lifetime. Last year some nine million people participated, hopefully even more will do so this year.

Approximately 48 million American adults smoke cigarettes. While smoking has become less prevalent since 1965, a time when over 40 percent of the population over 18 smoked, the downward trend has leveled out since 1990.

Cigarette smoking is the leading preventable cause of death and disability in the United States, contributing to 430,000 deaths each year. Not only does cigarette smoking cause lung cancer, but it also plays a significant role in numerous other malignancies, such as esophageal and pancreatic cancer. Cigarette induced chronic lung disease, namely emphysema is also a major healthcare problem. Additionally, cigarette smoking has been linked to cardiovascular disease, including coronary heart disease and stroke.

Tobacco contains nicotine, an addictive substance that makes smoking difficult to give up. Below are some tips that can be used to help sustain a smoking cessation program begun today on the "Great American Smokeout":

Ways of Quitting

Switch Brands

Switch to a brand you find distasteful. Change to a brand that is low in tar and nicotine a couple of weeks before your target date. This will help change your smoking behavior. However, do not smoke more cigarettes, inhale them more often or more deeply, or place your fingertips over the holes in the filters. All of these will increase your nicotine intake, and the idea is to get your body use to functioning without nicotine.

Cut Down the Number of Cigarettes You Smoke

Smoke only half of each cigarette. Each day, postpone the lighting of your first cigarette 1 hour. Decide you'll only smoke during odd or even hours of the day. Decide beforehand how many cigarettes you'll smoke during the day. For each additional cigarette, give a dollar to your favorite charity. Change your eating habits to help you cut down. For example, drink milk, which many people consider incompatible with smoking. End meals or snacks with something that won't lead to a cigarette. Reach for a glass of juice instead of a cigarette for a "pick-me-up". Remember: Cutting down can help you quit, but it's not a substitute for quitting. If you're down to about 7 cigarettes a day, it's time to set your target quit date and get ready to stick to it.

Don't Smoke "Automatically"

Smoke only those cigarettes you really want. Catch yourself before you light up a cigarette out of pure habit. Don't empty your ashtrays. This will remind you of how many cigarettes you've smoked each day, and the sight and the smell of stale cigarettes butts will be very unpleasant. Make yourself aware of each cigarette by using the opposite hand or putting cigarettes in an unfamiliar location or a different pocket to break the automatic reach. If you light up many times during the day without even thinking about it, try to look in a mirror each time you put a match to your cigarette; you may decide you don't need it.

Make Smoking Inconvenient

Stop buying cigarettes by the carton. Wait until one pack is empty before you buy another. Stop carrying cigarettes with you at home or at work. Make them difficult to get to.

Make Smoking Unpleasant

Smoke only under circumstances that aren't especially pleasurable for you. If you like to smoke with others, smoke alone. Turn your chair to an empty corner and focus only on the cigarette you are smoking and all its many negative effects. Collect all your cigarette butts in one large glass container as a visual reminder of the filth made by smoking.