***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: This study evaluates a  youth subject-directed smoking prevention and cessation program titled Breathe Easy ! The program was delivered at two sites and a  control group was recruited from two additional sites . Surveys were administered prior to the program and either 1 month or 6 months after completion at the exposure sites . The same survey administration procedure was used as the control . After controlling for invalid responses and including only those that completed both surveys , 251 exposure subjects and 159 control subjects remained for analysis . At sites with 1-month follow-up , no significant difference was noted between intervention and control groups . At the sites with 6-month follow-up , prevalence dropped from 18.7 % to 8.9 % , which is statistically significant , while at the control site prevalence changed from 14.1 % to 9.4 % , which is not significant . Additional outcomes examined in the exposed group showed trends toward smoking cessation and prevention at higher rates than those of the unexposed group This investigation evaluated the efficacy of expressive writing as a treatment adjunct to a brief office smoking cessation intervention plus nicotine patch therapy in young adults . Participants aged 18 - 24 years were r and omized to a brief office intervention ( n=99 ) or to an expressive writing plus brief office intervention ( n=97 ) . Both conditions received four individual visits plus 6 weeks of nicotine patch therapy , which began on the quit date following the week 2 visit . Participants in the expressive writing plus brief intervention condition wrote for 2 consecutive days before and 3 consecutive days after the quit date . The brief office intervention group completed a control writing assignment . At end of treatment ( week 8) , biochemically confirmed 7-day point-prevalence abstinence for the expressive writing plus brief office intervention condition was significantly greater than for the brief office condition ( 33 % vs. 20 % , p=.043 , OR=2.0 , 95 % CI=1.0 - 3.7 , from a logistic regression adjusting for gender ) . At 24 and 52 weeks , abstinence rates were similar for the brief office intervention versus expressive writing plus brief office intervention ( 12 % vs. 11 % at 24 weeks ; 11 % vs. 11 % at 52 weeks ) . The results suggest that expressive writing has promise as a smoking cessation treatment adjunct for young adults . Lengthier interventions or the use of boosters should be tested to extend treatment effects . However , participants reported a low level of enthusiasm for the expressive writing , which may be a barrier to implementing it over a longer time frame . Therefore , other modes of delivering expressive writing to young adult cigarette smokers should be explored BACKGROUND Community dental clinics are good setting s for smoking intervention . The aim here was to put forward a strategy for preventing  adolescent smoking  by means of a brief intervention . METHODS A total of 2,586 12-year-olds participated in this follow-up study . They were asked upon arrival for their annual routine dental examination to complete a smoking question naire and were r and omly assigned to either the intervention group or the usual care control group according to the last digit of their date of birth ( odd or even ) . The intervention comprised annually inquiring about smoking , showing photographs of the harmful effects of  smoking on the teeth , allowing participants to examine their own mouth with a mirror , and finally counselling them in accordance with their answer to the question on smoking habits . The smoking status reported was not verified by other means . RESULTS The prevalence of smoking at the end of the 2-year follow-up was 18.1 % , in the intervention group and 20.8 % among the controls . However , no statistically significant differences between groups were found . CONCLUSIONS These results reflect the difficulties of achieving successful results with long-term smoking cessation programs with adolescents in unstable conditions During June 2000-May 2001 , the American Cancer Society conducted a r and omized trial of telephone counseling among more than 3,500 current smokers who called to seek assistance in quitting . All eligible callers were r and omized to receive either self-help booklets through the mail or booklets and up to 5 sessions of telephone counseling .  Approximately 12 % ( 420/3,522 ) of study participants were 18 - 25 years of age . Using intent to treat analyses , 3- and 6-month quit rates among both younger and older smokers were significantly higher among those who received telephone counseling than among those who received self-help booklets only .  Three-month rates were 20 % versus 9 % for 18 - 25 year olds and 15 % versus 10 % for older adults . Results indicate that younger smokers can benefit from telephone counseling Smoking  cessation interventions are needed for young adults . Innovative approaches to behavior change for this population should be tested . Formative research and process evaluation of those approaches would result in more effective programs . This paper presents the development process and process evaluation of a web-based  smoking cessation program . A description of the stages of development is presented with formative research , development of the web-based intervention , formative evaluation , and process evaluation . The smokers reported high usage of the intervention and satisfaction with the intervention in that it helped to raise their consciousness about quitting , encouraged them to set behavioral goals , provided stages of change feedback , and offered interactivity in presenting information and strategies about quitting . The Internet may be a promising tool for patient education according to the process results Background Happy Ending ( HE ) is an intense 1-year smoking cessation program delivered via the Internet and cell phone . HE consists of more than 400 contacts by email , Web pages , interactive voice response , and short message service technology . HE includes a craving helpline and a relapse prevention system , providing just-in-time therapy . All the components of the program are fully automated . Objective The objectives were to describe the rationale for the design of HE , to assess the 12-month efficacy of HE in a sample of smokers willing to attempt to quit without the use of nicotine replacement therapy , and to explore the potential effect of HE on coping planning and self-efficacy ( prior to quitting ) and whether coping planning and self-efficacy mediate treatment effect . Methods A two-arm r and omized controlled trial was used . Subjects were recruited via Internet advertisements and r and omly assigned to condition . Inclusion criteria were willingness to quit on a prescribed day without using nicotine replacement and being aged 18 years or older . The intervention group received HE , and the control group received a 44-page self-help booklet .  Abstinence was defined as “ not even a puff of smoke , for the last seven days ” and was assessed by means of Internet surveys or telephone interviews 1 , 3 , 6 , and 12 months postcessation . The main outcome was repeated point abstinence ( ie , abstinence at all four time points ) . Coping planning and self-efficacy were measured at baseline and at the end of the preparation phase ( ie , after 2 weeks of treatment , but prior to cessation day ) . Results A total of 290 participants received either the HE intervention ( n=144 ) or the control booklet ( n=146 ) . Using intent-to-treat analysis , participants in the intervention group reported clinical ly and statistically significantly higher repeated point abstinence rates than control participants ( 20 % versus 7 % , odds ratio [ OR ] = 3.43 , 95 % CI = 1.60 - 7.34 , P = .002 ) . Although no differences were observed at baseline , by the end of the preparation phase , significantly higher levels of coping planning ( t 261 = 3.07 , P = .002 ) and precessation self-efficacy ( t 261 = 2.63 , P = .01 ) were observed in the intervention group compared with the control group . However , neither coping planning nor self-efficacy mediated long-term treatment effect . For point abstinence 1 month after quitting , however , coping planning and self-efficacy showed a partial mediation of the treatment effect . Conclusions This 12-month trial documents a long-term treatment effect of a fully automated smoking cessation intervention without the use of nicotine replacement therapy . The study adds to the promise of using digital media in supporting behavior change Background Epidemiologic data indicate most adolescents and adults experience multiple , simultaneous risk behaviors . Purpose The purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention ( MBI ) for college students . Methods A total of 303 college students were r and omly assigned to : ( 1 ) a brief MBI or ( 2 ) a st and ard care control , with a 3-month postintervention follow-up . Results Omnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings , with improvements for college students receiving the brief MBI on alcohol consumption behaviors , F(6 , 261 ) = 2.73 , p = 0.01 , marijuana-use behaviors , F(4 , 278 ) = 3.18 , p = 0.01 , and health-related quality of life , F(5 , 277 ) = 2.80 , p = 0.02 , but not cigarette use , exercise , and nutrition behaviors . Participants receiving the brief MBI also got more sleep , F(1 , 281 ) = 9.49 , p = 0.00 , than those in the st and ard care control . Conclusions A brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality -of-life indicators of college students OBJECTIVES . Nicotine nasal spray has been 1 of the most successful forms of nicotine-replacement therapy in adult population s. The nasal sprayer has not been studied in adolescent smokers . The objective of this pilot study was to determine the feasibility and utility of using nicotine nasal spray for adolescent smokers who wanted to quit smoking . METHODS . Forty adolescent smokers who were between 15 and 18 years of age and smoked ≥5 cigarettes daily for at least 6 months were recruited from several San Francisco Bay area schools from 2005 to 2007 . Using a r and omized , open-label , 12-week trial , adolescent smokers were assigned to receive either weekly counseling alone ( control ) for 8 weeks or 8 weeks of counseling along with 6 weeks of nicotine nasal spray . Self-reported smoking abstinence was verified by both expired-air carbon monoxide and salivary cotinine . RESULTS . There was no difference in cessation rates , the numbers of cigarettes smoked per day , or cotinine levels at 12 weeks . Fifty-seven percent of participants stopped using their spray after only 1 week . The most commonly reported adverse effect was nasal irritation and burning ( 34.8 % ) followed by complaints about the taste and smell ( 13 % ) . CONCLUSIONS . The unpleasant adverse effects , poor adherence , and consequent lack of efficacy observed in our pilot study do not support the use of nicotine nasal spray as an adjunct to counseling for adolescent smokers who wish to quit OBJECTIVE The purpose of this study was to develop a smoking cessation program combined with an Internet-assisted instruction ( IAI ) program to help youth smokers quit smoking , and to evaluate the effectiveness of the program in changing youth 's attitudes toward smoking , smoking behavior , and self-efficacy for smoking cessation . METHODS To achieve this goal , a comparative study of 77 senior high students divided into two groups was conducted . One group , design ated as the experimental group , accepted a 6-week smoking cessation program plus an IAI program and the other group did not receive any intervention as the comparison group . All participants completed question naires before and after the program . RESULTS The results showed that the strategy of combining the smoking cessation program and an IAI program was highly effective in terms of effects upon the youth 's attitude towards smoking , smoking behavior , and self-efficacy . There was a highly positive correlation between the participants ' attitude toward smoking and self-efficacy . In contrast , cigarette consumption was in a strongly negative correlation with self-efficacy . CONCLUSION Most of all participants in the experimental group recognized the effectiveness of the program , and thought the smoking cessation program with an IAI program was helpful and welcomed by youth . This study can serve as reference for future design and implementation of IAI programs for youth smoking cessation The majority of regular adult smokers begin smoking in adolescence and there is a clear need for youth-targeted smoking cessation interventions . The present r and omized , controlled trial tested the effectiveness of motivational enhancement therapy ( MET ) to reduce  smoking among 81 adjudicated adolescents . Participants received either MET or an education control .  Smoking abstinence , quantity , and frequency were assessed at 1 and 6 months post treatment . Results suggest that although between-group differences on outcome measures were not significant at follow-up , smoking behavior decreased in both groups with approximately 10 % achieving 1-month smoking abstinence at 6-month follow-up . Furthermore , participant response to MET varied by level of alcohol use and impulsivity such that participants with lower levels of alcohol use and impulsivity had significantly greater response to MET . In contrast , participants who endorsed higher rates of alcohol use and impulsivity responded better to the control than the MET condition . Results suggest that MET may be an effective intervention for some adolescent smokers but may be contraindicated for adolescents who have concomitant problems with alcohol use or impulsivity The use of alternative medicine for smoking cessation have been increasing steadily in recent years . A series of clinical group studies was performed to clarify the effect , outcome and success rate of an acupuncture treatment for smoking cessation . This study was conducted for four weeks using 238 smoking 
    Output:
    
Complex approaches show promise , with some persistence of abstinence ( 30 days point prevalence abstinence at six months ) , especially those incorporating elements sensitive to stage of change .
Psycho-social interventions have not so far demonstrated effectiveness , although pooled results for the Not on Tobacco trials suggest that that this approach may yet prove to be effective ; however , their definition of cessation ( one or more smoke-free days ) may not adequately account for the episodic nature of much adolescent smoking .