As the secondhand smoke clears, the progress made by anti-tobacco advocates is more evident every year.

Most recently, Florida voters passed the smoke-free restaurant initiative Nov. 5 (Amendment 6) by a landslide — more than 70% of voters supported the amendment. The initiative also requires office workplaces to be smoke-free. (Stand-alone bars were not part of the initiative).

And New York City Mayor Michael R. Bloomberg has proposed a ban on smoking in all public spaces in the city.

But one of the biggest milestones along the way began as a small pebble — a small pebble that caused big ripples.

Margaret Mead said, "Never doubt that a small group of thoughtful citizens can change the world. Indeed, it's the only thing that ever has." The Great American Smokeout proves just how true this is.

It started 25 years ago in the town of Randolph, Mass. What happened there became a microcosm for the change to come.

"Kids used to come into my office after school, and one day we were talking about college," said Arthur P. Mullaney, a former guidance counselor at Randolph High School. "I said, 'you know, if I could have a nickel for every cigarette butt I see outside we'd have enough money to send all of you to college.'

"I called it 'Smokeout'," said Mullaney. "And we had a saying — 'light up a student's future, not a cigarette.' If we stopped the town from smoking and took the proceeds that would have been spent on cigarettes," he said, "we'd have a scholarship fund."

Mullaney accepted credit for coining the term, but said it was really the kids who made 'Smokeout' happen. This initial brainstorm took place in October or November, he said.

The students planned to have the town's Smokeout — whose population at that time Mullaney estimated was between 18,000 and 26,000 — for a day during a week-long break they had in February of the next year.

"This was the first time a town in the US quit smoking," he said.

"From a group of five or six students that talked about the idea, it turned into a group of 600 — over half the school." And it wasn't just the kids. "The whole town got in on it. It really caught the enthusiasm of people," he said.

A department store owner who had a couple of cigarette machines invited some of the students to come down with a truck and take the machines to the dump, Mullaney said. He also had his art department print signs for the kids.

"There must've been a two hundred, two hundred fifty signs, all over town," he said.

Another store owner who had a long counter display of tobacco products let the kids drape it in black fabric. The kids went door-to-door through neighborhoods with pins that said, 'please don't smoke', and asked people not to make a donation instead of spending the money on tobacco products.

"If the person agreed, they got a pin," he said. Mullaney, a member of the local Rotary Club, got the members to sponsor bank account for the money the students raised.

The students raised $4,500 the first year, and about $5,000 the year after. They formed a committee to select the scholarship recipients and determine the amount of money each would be awarded.

"By the third year, I got a call from someone at the American Cancer Society," he said. "They helped with the marketing," he said. The Society brought out players from the Boston Celtics and New England Patriots — "they had connections." But they really stayed in the background and let the kids run the show, he said.

"It was the first program that got the media response it did," Mullaney said. "Anti-smoking was just beginning. That was the first loud clamor, the initial shot. That was the Class of 1970. I was a part of that."

A few years later Minnesota newspaper editor Lynn R. Smith of the Monticello Times spearheaded the state's first D-Day, or Don't Smoke Day. The idea caught on quickly across the state, and across the country.

The ACS' California Division renamed the event the Great American Smokeout in 1976. It went national a year later, when nearly a million smokers in the US quit for a day.

"I knew it was important," Mullaney said. "It was too big for one town. It's where it should be. It's now a signature program."

On Nov. 21, 2002, Smokeout marks its 26th year. It has been celebrated with rallies and parades, and has been chaired by celebrities like Sammy Davis Jr, former Surgeon General C. Everett Koop, and Mr. Potato Head.

Schools, workplaces, military installations, and legislative halls feature "cold turkey" menu items to further the "quit" message — if you can quit for a day, you can quit for good.

In a 1997 letter to then-President Bill Clinton, newspaper editor Smith wrote in his newspaper column: "In your State of the Union address in 1996 you said, 'One of the most important things we can do…is to protect our children from what is rapidly becoming the single greatest threat to their health — cigarette smoking and tobacco addiction'…Some will say nothing can be done to curb teen smoking. They are wrong."

Progress is evident — 70 million Americans once smoked. Though an estimated 47 million adults in the US still smoke, and teen smoking seems to be on the rise, a Centers for Disease Control and Prevention (CDC) report says adult smoking is on the decline.

The shift in public perception can be seen in landmarks like the 1977 ban on smoking in public places in Berkeley, Calif.; the federal ban on smoking on interstate buses and domestic flights in 1990; and the 1999 Master Settlement Agreement requiring tobacco companies to pay $206 billion to 45 states to cover Medicaid costs of treating smokers.

"Those are just a few of the remarkable changes in the age-old acceptance of smoking as our cultural norm," said Dileep G. Bal, MD, MS, MPH, a past president of the ACS.

"What we have been doing can be characterized as the demoralization of smoking as an acceptable behavior, and positioning it for what it really is — a killer of nearly half a million Americans every year," he said.

Smoking is the most preventable cause of death in our society. Lung cancer is the leading cause of cancer death for men and women, and this year there will be about 169,500 new cases diagnosed in the US. More than 80% of lung cancers are thought to result from smoking.