***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background . There have been few reports of the process of implementing ongoing worksite health promotion programs . This article describes the implementation of a year-long smoking cessation program in nine worksites employing a total of approximately 700 smokers . Methods . Issues discussed include : forming a partnership with organizations , design of the multicomponent incentive intervention , program promotion , maintaining participation , and the need to modify program components over time . Results . The program produced high participation rates ( 29 % of smokers joined the program ) and moderate cessation rates among participants ( during the last half of the program , monthly cessation rates averaged 20 % ) . There was marked variability across worksites on both participation and cessation , and qualitative features of organizations associated with outcome are discussed . Discussion . The importance of working with employee steering committees to tailor health promotion programs to fit the organization is discussed . The article concludes with recommendations for implementation of similar programs Purpose . To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition . Design . A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs , each assigned to separate worksites . Setting . The study was conducted from 1990 to 1991 at three aerospace industry worksites in California . Subjects . All employees who were current , regular tobacco users were eligible to participate in the program offered at their site . Intervention . The multicomponent program included a self-help package , telephone counseling , and other elements . The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program . The traditional program offered a st and ard smoking cessation program . Measures . Self-reported question naires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period . Results . The incentive-competition program had an abstinence rate of 41 % at 6 months ( n = 68 ) , which was significantly better than the multicomponent program ( 23 % , n = 81 ) or the traditional program ( 8 % , n = 36 ) . At 12 months , the quit rates for the incentive and multicomponent programs were statistically indistinguishable ( 37 % vs. 30 % ) , but remained higher than the traditional program ( 11 % ) . Chi-square tests , t-tests , and logistic regression were used to compare smoking abstinence across the three programs . Conclusions . Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition , and more effective than a traditional program To test the effectiveness of a low-intensity intervention program for smoking cessation targeting the worksite environment in employees who had a low readiness to quit , we conducted an intervention trial at six intervention and six control worksites in Japan . A total of 2,307 smokers at baseline who remained at their worksite throughout the three-year study period were analyzed ( 1,017 in intervention and 1,290 in control groups ) . The multi-component program at the worksites consisted of ( 1 ) presenting information on the harms of tobacco smoking and the benefits of cessation by posters , websites , and newsletters ; ( 2 ) smoking cessation campaigns for smokers ; ( 3 ) advice on design ation of smoking areas ; and ( 4 ) periodic site-visits of the design ated smoking areas by an expert research er . At baseline , the intervention and control groups each had high prevalence of immotive or precontemplation , that reflected low readiness to quit ( 71.5 % and 73.2 % , respectively ) . The smoking cessation rate , as not having smoked for the preceding six months or longer , assessed at 36 months after the baseline survey by a self-administered question naire was significantly higher in the intervention group than the control group ( 12.1 % , vs. 9.4 % , p=0.021 ) . The intervention program still had a significant effect on the smoking cessation rate after multiple logistic regression analysis adjusted for sex , age , type of occupation , age of starting smoking , quit attempts in the past , number of cigarettes per day , and readiness to quit ( odds ratio : 1.38 , 95 % confidence interval : 1.05 - 1.81 , p=0.02 ) . The cost per additional quitter due to the intervention was calculated to be Yen 70,080 . These findings indicate that this program is effective and can be implemented in similar workplaces where the prevalence of smoking is high and smokers ' readiness to cease smoking is low This study investigated employee and worksite characteristics prospect ively predictive of participation among 474 smokers in nine different worksites taking part in a year-long incentive-based smoking cessation program .  Several different ways of defining participation ( e.g. , joining versus level of attendance , first 6 months versus entire program ) were studied . A consistent pattern of results was observed across two of the participation indices , joining the program and participating in one or more monthly follow-up meetings  . Both worksite ( number of employees , previous health promotion history , degree of support from management ) and employee ( gender , motivation , previous quit attempts ) variables were predictive of participation . Logistic regression analyses revealed that each set of variables , worksite and employee characteristics , was significantly related to participation after controlling for the effects of the other set . We were less able to predict level of attendance among participants who joined the program . Implication s of these findings for future studies of participation in health promotion programs are discussed This study examined the relative contribution of contingent payment and worksite CO monitoring to the long-term maintenance of smoking abstinence .  Forty-seven hospital employees who had abstained from smoking for five days ( confirmed by CO analysis ) were r and omly assigned to one of three follow-up groups : ( a ) contingent payment/frequent monitoring ( n = 17 ) ; ( b ) noncontingent payment/frequent monitoring ( n = 16 ) ; or ( c ) non-contingent payment/infrequent monitoring ( n = 14 ) . Contingent payment combined with frequent CO monitoring delayed but did not ultimately prevent subjects relapse to smoking by the end of the six month follow-up . Contingent subjects maintained CO values less than or equal to 11 ppm significantly longer than did either the Non-contingent or the Control subjects ( p = .03 ) . CO monitoring alone had no effect on abstinence outcomes ; both Noncontingent and Control subjects showed high rates of early relapse This paper describes a study examining the feasibility of a worksite health promotion program that was repeated twice in one year . Weight control and smoking cessation classes , which included a supporting incentive component , were made available at a worksite of 485 white-collar employees continuously throughout one year . Identical education programs were offered twice at six-month intervals . Results suggest that this model of program implementation is attractive to employees . Total participation over 12 months included an estimated 53 % of overweight employees in the weight program and 23 % of smokers in the smoking cessation program . The two series of classes , run back to back , generated similar participation . Thirty-nine percent of weight control participants and six percent of smoking cessation participants who enrolled in the first program also enrolled in the second . Weight losses and smoking cessation rates were comparable for the two cycles , with a mean weight loss of about seven pounds and a smoking cessation rate at six months of about 33 % . Surveys of a r and om sample of employees at baseline and again at 12 months showed a 28 % reduction in the prevalence of cigarette smoking , but no change in average weight or the prevalence of overweight . This study suggests that health promotion programs at worksites which offer repeated opportunities for employee participation are promising and deserve further study A 2 × 2 r and omized , factorial pretest/posttest group design was used to evaluate the effectiveness of  self-help smoking cessation methods  at the worksite . The study investigated the effect of a multicomponent health education and skill intervention versus the effect of a monetary incentive to the employee for quitting . All employees received , in addition , a st and ardized self-help smoking cessation manual and maintenance manual . Following agreement to participate and a baseline smoking history , all participants were followed for 6 weeks , 6 months , and 12 months . Saliva was obtained for thiocyanate ( SCN ) analysis of smoking status . Of the estimated 2000 smokers at the site , 387 smokers were recruited . Employees were r and omly assigned to one of four groups . Results of this r and om trial indicate that those employees receiving a multicomponent program were most successful in quitting and remaining abstinent . The monetary incentive appears to have no effect on quit rate Twenty-eight subjects were r and omly allocated to either a nicotine fading or a maintenance condition . The maintenance condition utilized behavioral contracting and extended treatment in addition to the nicotine fading to improve treatment outcome and avoid relapse . The maintenance condition achieved superior outcome on smoking measures at post-treatment and follow-up periods for self-reported smoking levels . Carbon monoxide levels were significantly lower for the maintenance condition at post-treatment , three month and six month follow-up . Saliva thiocyanate levels were significantly lower for the maintenance condition at the three month follow-up . Changes in health functioning indicated significantly lower diastolic and systolic blood pressure at six month follow-up for the maintenance condition . Additional research on nicotine regulation during nicotine fading and thiocyanate levels during experimental smoking would be useful . The use of behavioral contracting to enhance maintenance without therapeutic support warrants further research as well Described an examination of data collected 2 years following the onset of a  media-based , worksite smoking cessation intervention . Thirty-eight companies in Chicago were r and omly assigned to one of two experimental conditions . In the inital 3-week phase , all participants in both conditions received self-help manuals and were instructed to watch a 20-day televised series design ed to accompany the manual . In addition , participants in the group ( G ) condition received six sessions emphasizing quitting techniques and social support . In the second phase , which continued for 12 months , employees in G participated in monthly peer-led support groups and received incentives , while participants in the nongroup ( NG ) condition received no further treatment . Twenty-four months after pretest , 30 % of employees in G were abstinent compared to only 19.5 % in NG . This study is one of the few experimentally controlled worksite smoking cessation interventions to demonstrate significant program differences 2 years following the initial intervention This study evaluated the impact of a year-long incentives-based worksite smoking-cessation program .  Nineteen moderate-sized worksites , employing a total of approximately 1100 smokers , were r and omized to Incentive or No Incentive conditions .  All identified smokers in the worksite were considered as subjects , whether or not they participated in the intervention . Analyses were conducted at both the worksite and individual level , and using both self-reported and biochemically vali date d cessation as endpoints . The incentive program did not significantly improve cessation rates at either the 1-year or 2-year follow-up assessment s. We conclude that more broadly focused interventions that also address worksite smoking policies , skills training , and cessation re sources , or programs that target additional risk factors are needed to substantially enhance quit rates OBJECTIVES This study examined the effect of program format and incentives on participation and cessation in worksite smoking cessation programs . METHODS Twenty-four worksites were r and omized to 6 conditions that differed in cessation program format and the use of incentives . Programs were offered for 18 months in each worksite . A total of 2402 cigarette smokers identified at baseline were surveyed 12 and 24 months later to assess participation in programs and cessation . RESULTS A total of 407 ( 16.9 % ) of the smoker cohort registered for programs ; on the 12- and 24-month surveys , 15.4 % and 19.4 % of the cohort , respectively , reported that they had not smoked in the previous 7 days . Registration for programs in incentive sites was almost double that of no-incentive sites ( 22.4 % vs 11.9 % ) , but increased registration did not translate into significantly greater cessation rates . Program type did not affect registration or cessation rates . CONCLUSIONS Although incentives increase rates of registration in worksite smoking cessation programs , they do not appear to increase cessation rates .  Phone counseling seems to be at least as effective as group programs for promoting smoking cessation in worksites OBJECTIVES A r and omized trial was conducted to evaluate the effectiveness of a work-site health promotion program in reducing obesity and the prevalence of cigarette smoking . METHODS Thirty-two work sites were r and omized to treatment or no treatment for 2 years . Treatment consisted of health education classes combined with a payroll-based incentive system . Evaluation was based on cohort and cross-sectional surveys . RESULTS Of 10,000 total employees in treatment work sites , 2041 and 270 participated in weight control and smoking cessation programs , respectively .  Weight losses averaged 4.8 lbs , and 43 % of smoking participants quit . Net 2-year reductions in smoking prevalence in treatment vs control work sites were 4.0 % and 2.1 % in cross-sectional and cohort surveys , respectively . No treatment effect was found for weight . Treatment effects for smoking prevalence and weight were both positively correlated with participation rates in the intervention programs ( r = .45 for smoking and r = .55 for weight ) . CONCLUSIONS This work-site health promotion program was effective in reducing smoking prevalence at a cost that is believed to make the investment worthwhile Sixty-three companies in the Chicago area were recruited to participate in a worksite smoking cessation program . Participants in each worksite 
    Output:
    
The present evidence is insufficient to determine the effectiveness of incentives or competitions  , when implemented alone , to reduce tobacco use .
However , the qualifying studies provide strong evidence , according to Community Guide rules , that worksite-based incentives and competitions in combination with additional interventions are effective in increasing the number of workers who quit using tobacco .
In addition , these multicomponent interventions have the potential to generate positive economic returns over investment when the averted costs of tobacco-associated illnesses are considered .