Nov. 21 is the Great American Smokeout, a yearly reminder of what the American Cancer Society calls the largest preventable causes of death and illness in the world -- smoking, vaping and chewing tobacco. In support of the annual event, Fort Leonard Wood's General Leonard Wood Army Community Hospital public health nursing team will have tables set up today with information on nicotine cessation options available from 11 a.m. to 1 p.m. at the post exchange and from 8 a.m. to 2 p.m. near the primary care clinic at the hospital. While it's been proven that quitting improves health immediately and over the long term at any age -- it's difficult -- and Fort Leonard Wood's Medical Department Activity offers help in ending the addiction to nicotine through cessation counseling and medication. "Many patients describe a love-hate relationship with nicotine," said Capt. Elizabeth Spangler, MEDDAC public health nurse. "It becomes a companion. However, they have grown to hate the cost of time, money and negative health effects that come with it." Cessation classes are offered 9 to 10:30 a.m. the first Tuesday of each month at GLWACH. The class is comprised of cessation preparation with additional instruction from a dietician and a clinical pharmacist. Anyone unable to attend the class is encouraged to contact the public health clinic any time for individual counseling -- making an appointment to talk with a pharmacist is also possible. "Counseling combined with pharmaceuticals has the highest success rate, but everyone has different needs when it comes to nicotine cessation, so we do not create rules or roadblocks," Spangler said. "We deliver a flexible approach to meet the needs of our diverse population, their strenuous work environments and to be inclusive of all forms of nicotine products." After the cessation class, each attendee has the chance to individually discuss the pharmacological options available to them. "I sit down with the patient to discuss the different options available to aid in quitting tobacco," said Justin Madden, GLWACH clinical pharmacist. "The choice of medications is dependent on the patient's medical history, allergies, other medications -- making sure there are no interactions between the patient's medications and the medications we would like to give -- and patient preference." Jeff Obermuller, 3rd Chemical Brigade surety specialist, was one of six service members and civilians who attended the MEDDAC nicotine cessation class Nov. 5. He said he's tried to quit in the past but has always returned to smoking. "I have been smoking for 30 years," Obermuller said. "As a smoker you focus your day around smoking and it takes up so much time. You literally spend an hour of your day just smoking. Once you quit, you find you're more productive at home and at work. I also have a new grandson and want to set a good example, and when I spend time with him I do not want the urge to smoke to get in the way." According to Spangler, the most common reasons she hears from patients as to why it's difficult to quit using nicotine products here specifically are work-related stress and anxiety, boredom and being surrounded by coworkers who use nicotine products. However, Spangler said 204 individuals who enrolled in nicotine cessation programs here reported successfully quitting tobacco products between October 2018 and October 2019. "An active-duty service member visited us to report that he was successful with nicotine cessation once he found the right pharmaceutical option for him," Spangler said. "After just a week of quitting, he already felt the positive effects of increased oxygenation, smell and improved taste. He was very excited about his new lifestyle." In addition to cessation classes and pharmaceuticals, MEDDAC offers nutritional advice to help with life after nicotine. "Many people fear that when they quit tobacco they will gain weight," said 1st Lt. Dana Larsen, MEDDAC Nutrition Care Division dietician. "The motion of bringing a cigarette or vaping device to the mouth can be easily replaced with snacking if you are not careful. The same goes with chewing tobacco. Keeping your mouth busy by drinking water, chewing gum or sucking on hard, sugar-free candies can be a strategy to prevent mindless munching." Larsen said that being mindful of the quality of foods being consumed also helps prevent weight gain. "General principles of healthy eating, such as eating meals every three to four hours, choosing a variety of nutrient-dense foods -- whole grains, lean proteins, whole fruits and veggies and low-fat dairy -- as well as drinking no- or low-calorie beverages can facilitate weight maintenance," she said. The variety of help available mirrors the different challenges each type of product presents. "The challenge with vape cessation is that many users associate vaping with almost every activity of life -- driving, watching tv, working or eating a meal," Spangler said. "Since vape has been more widely accepted in public places, they have not needed to restrict usage as much as smokers have. The challenge with those who have used smokeless tobacco products is the oral fixation that they have grown accustomed to. The challenges for those who smoke ranges tremendously -- there's the challenge of missing out on smoke breaks with coworkers and the social segregation they experience after quitting. Other individuals have stated that the cigarette has become a companion, a friend." "Nicotine cessation is not a one-solution-fits-all kind of problem," Spangler added. "Each person has to find what works for them. Some patients have great success with medication therapy. Others have reported success with cinnamon-flavored toothpicks or sunflower seeds. The commonality of those who are successful is that they are ready to quit. They have internally made up their mind to quit, rather than being coerced or forced. Those individuals have found a reason to quit that means more to them than the desire to use nicotine products and they are determined." The idea for the Great American Smokeout grew from a 1970 event in Randolph, Massachusetts, at which Arthur Mullaney asked people to give up smoking for a day and donate the money they would have spent on cigarettes to a high school scholarship fund. The idea caught on -- nearly one million smokers quit for the day on November 18, 1976, and the Great American Smokeout was born. "Whether it happens to be the Great American Smokeout or not wanting to set bad habits for your kids -- whatever the reason is, now is a great time to quit using nicotine," said Capt. Rochelle Castro, MEDDAC public health nurse.