Many smokers approach Great American Smokeout with anxiety.

"Will this be the year I can finally quit for good?"

Others are ambivalent.

"I'll quit one of these days; maybe after the holidays."

To the anxious and the ambivalent, Brad Collins says: If you're not ready to quit today, there are steps you can take to prepare yourself for your eventual quit day.

The American Cancer Society's Great American Smokeout, on Nov. 15, urges smokers to give up their cigarettes by quitting for a day, in hopes that they will quit for good. But the event, along with most smoking cessation programs and materials, does little for those who lack the confidence to quit right now.

Collins advises those who are not ready to consider making their surroundings smoke-free as a step toward kicking the habit.

"Even if you can't quit smoking now, changing smoking habits can be positive steps in preparation of quitting particularly when habit changes, like where, when and how much you smoke, protect the health of nonsmokers and children in the home," he said. "I think the Great American Smokeout is great in that it does promote awareness about smoking consequences and provides excellent resources and referrals to local programs that can help smokers successfully quit. Other smokers simply need more preparation let's also help these smokers."

Collins is assistant professor of public health and director of Temple's Health Behavior Research Center, where he runs several programs designed to help with smoking cessation and reduce smoke in the environment.

One program, Philadelphia FRESH ("Family Rules for Establishing Smokefree Homes"), is a health education program now in its fourth year, and is designed to protect children from exposure to secondhand smoke by teaching smoking mothers and the entire family about creating a clean home air environment. Currently the program is being tested by recruiting families through specific WIC, Head Start and pediatric primary-care clinics.

An additional goal of Philadelphia FRESH is to provide resources for mothers who eventually decide to quit smoking.

"We get excited for moms when we can help them make home smoking rule changes, and the new skills they learn coupled with newfound confidence lead to a decision to quit smoking. Many of these moms had no intention of quitting smoking at the start of enrollment," Collins said, noting that women with very young children have an especially hard time quitting, due to the stress of motherhood and other postpartum challenges.

Another program led by Collins, Quit 4 Good, targets those who are ready and committed to giving up smoking. An intensive program of counseling and medication, Quit 4 Good helps participants intensively prepare to quit smoking within the first three weeks of treatment, which includes medication and nicotine gum. This program focuses on relapse prevention, by providing intensive individual counseling to help smokers quit, followed by a series of exercises to help ease withdrawal symptoms. The goal is to avoid relapse in the short term as well as further down the line.

"Great American Smokeout is a chance for all smokers, not just those who are ready to quit, to create a healthier environment for themselves and their families," Collins said. "We don't want to miss an opportunity to remind smokers that while they can drastically improve their health by quitting smoking, if they're not yet ready to quit, they can consider steps that drastically improve the health of their entire family."

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