***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 is limited evidence regarding the best approaches to helping Indigenous Australians to stop smoking . The composite analysis of the only two smoking cessation r and omised controlled trials ( RCTs ) investigating this suggests that one-on-one extra support delivered by and provided to Indigenous Australians in a primary health care setting appears to be more effective than usual care in encouraging smoking cessation . This paper describes the lessons learnt from one of these studies , the Be Our Ally Beat Smoking ( BOABS ) Study , and how to develop and implement an integrated smoking cessation program . Methods Qualitative study using data collected from multiple documentary sources related to the BOABS Study . As the project neared completion the research team participated in four workshops to review and conduct thematic analyses of these documents . Results Challenges we encountered during the relatively complex BOABS Study included recruiting sufficient number of participants ; managing the project in two distant locations and ensuring high quality work across both sites ; providing appropriate training and support to Aboriginal research ers ; significant staff absences , staff shortages and high workforce turnover ; determining where and how the project fitted in the clinics and consequent siloing of the Aboriginal research ers relating to the requirements of RCTs ; resistance to change , and maintaining organisational commitment and priority for the project . The results of this study also demonstrated the importance of local Aboriginal ownership , commitment , participation and control . This included knowledge of local communities , the flexibility to adapt interventions to local setting s and circumstances , and taking sufficient time to allow this to occur . Conclusions The keys to the success of the BOABS Study were local development , ownership and participation , worker professional development and support , and operating within a framework of cultural safety . There were difficulties associated with the BOABS Study being an RCT , and many of these are shared with st and -alone programs . Interventions targeted at particular health problems are best integrated with usual primary health care . Research to investigate complex interventions in Indigenous health should not be limited to r and omised clinical trials and funding needs to reflect the additional , but necessary , cost of providing for local control of planning and implementation OBJECTIVE To determine the effectiveness of an intensive quit-smoking intervention on smoking rates at 36 weeks ' gestation among pregnant Aboriginal and Torres Strait Isl and er women . DESIGN R and omised controlled trial . SETTING AND PARTICIPANTS Pregnant Aboriginal and Torres Strait Isl and er women ( n = 263 ) attending their first antenatal visit at one of three Aboriginal community-controlled health services between June 2005 and December 2009 . INTERVENTION A general practitioner and other health care workers delivered tailored advice and support to quit smoking to women at their first antenatal visit , using evidence -based communication skills and engaging the woman 's partner and other adults in supporting the quit attempts . Nicotine replacement therapy was offered after two failed attempts to quit . The control ( " usual care " ) group received advice to quit smoking and further support and advice by the GP at scheduled antenatal visits . MAIN OUTCOME MEASURE Self-reported smoking status ( vali date d with a urine cotinine measurement ) between 36 weeks ' gestation and delivery . RESULTS Participants in the  intervention group ( n = 148 ) and usual care group ( n = 115 ) were similar in baseline characteristics , except that there were more women who had recently quit smoking in the intervention group than the control group . At 36 weeks , there was no significant difference between smoking rates in the intervention group ( 89 % ) and the usual care group ( 95 % ) ( risk ratio for smoking in the intervention group relative to usual care group , 0.93 [ 95 % CI , 0.86 - 1.08 ] ; P = 0.212 ) . Smoking rates in the two groups remained similar when baseline recent quitters were excluded from the analysis . CONCLUSION An intensive quit-smoking intervention was no more effective than usual care in assisting pregnant Aboriginal and Torres Strait Isl and er women to quit smoking during pregnancy . Contamination of the intervention across groups , or the nature of the intervention itself , may have contributed to this result . TRIAL REGISTRATION Australian New Zeal and Clinical Trials Registry ACTRN12609000929202 Background : Smoking rates are high in indigenous population s and contribute to their poor health . In New Zeal and the indigenous Maori population has a high rate of smoking , with around 50 % of adults being smokers compared with 20 % of the adult European population . A study was undertaken to determine whether bupropion is effective in the treatment of smoking cessation in the indigenous Maori population in New Zeal and . Methods : A r and omised , placebo controlled , double blind , parallel group study was performed in 134 Maori smokers aged 16–70 years who smoked more than 10 cigarettes per day . The main outcome measures were continued abstinence from smoking at 3 and 12 months . Results : At each time point continued abstinence was better for the subjects allocated to bupropion , with a risk ratio for abstinence over all time points of 2.44 ( 95 % CI 1.22 to 4.88 ) . The rates of continued abstinence in the bupropion and placebo groups at 3 months were 44.3 % and 17.4 % , respectively , with a risk ratio of 2.54 ( 95 % CI 1.30 to 5.00 ) . The corresponding figures at 12 months were 21.6 % and 10.9 % , respectively , with a risk ratio of 1.99 ( 95 % CI 0.79 to 5.00 ) . Conclusion : Bupropion is an effective treatment for smoking cessation in the indigenous Maori population in New Zeal and Background Acute respiratory illness ( ARI ) is the most common cause of acute presentations and hospitalisations of young Indigenous children in Australia and New Zeal and ( NZ ) . Environmental tobacco smoke ( ETS ) from household smoking is a significant and preventable contributor to childhood ARI . This paper describes the protocol for a study which aims to test the efficacy of a family-centred tobacco control program about ETS to improve the respiratory health of Indigenous infants in Australia and New Zeal and . For the purpose of this paper ' Indigenous ' refers to Australia 's Aboriginal and Torres Strait Isl and er peoples when referring to Australian Indigenous population s. In New Zeal and , the term ' Indigenous ' refers to Māori . Methods / Design This study will be a parallel , r and omized , controlled trial . Participants will be Indigenous women and their infants , half of whom will be r and omly allocated to an ' intervention ' group  , who will receive the tobacco control program over three home visits in the first three months of the infant 's life and half to a control group receiving ' usual care ' ( i.e. they will not receive the tobacco control program ) . Indigenous health workers will deliver the intervention , the goal of which is to reduce or eliminate infant exposure to ETS . Data collection will occur at baseline ( shortly after birth ) and when the infant is four months and one year of age . The primary outcome is a doctor-diagnosed , documented case of respiratory illness in participating infants . Discussion Interventions aim ed at reducing exposure of Indigenous children to ETS have the potential for significant benefits for Indigenous communities . There is currently a dearth of evidence for the effect of tobacco control interventions to reduce children 's exposure to ETS among Indigenous population s. This study will provide high- quality evidence of the efficacy of a family-centred tobacco control program on ETS to reduce respiratory illness . Outcomes of our study will be important and significant for Indigenous tobacco control in Australia and New Zeal and and prevention of respiratory illness in children . Trial registration Australian New Zeal and Clinical Trials Registry ( ACTRN12609000937213 The aim of the study was to determine if a culturally sensitive smoking prevention program would have short-term impacts on smoking intentions among Aboriginal children . Two schools with high Aboriginal enrollment were selected for the study . A grade 4 classroom in one school was r and omly assigned to receive the culturally sensitive smoking prevention program . A grade 4 classroom in the second school received a st and ard smoking prevention program delivered in this jurisdiction . Children in each classroom were tested pre- and post-intervention to measure attitude changes about smoking . There was a significant reduction in intentions to smoke among Aboriginal children who received the culturally sensitive smoking prevention program . The small overall sample size precluded a direct comparison of the efficacy of the culturally sensitive and st and ard programs . The present findings suggest a smoking prevention program that has been culturally adapted for Aboriginal children may reduce future smoking intentions among Aboriginal grade 4 students . Further research is needed to determine the extent to which school smoking prevention programs adapted to respect the long-st and ing use of tobacco in Aboriginal cultural traditions may be more effective than st and ard programs in reaching Aboriginal youth Introduction Quality assessment of included studies is an important component of systematic review s. Objective The authors investigated inter-rater and test – retest reliability for quality assessment s conducted by inexperienced student raters . Design Student raters received a training session on quality assessment using the Jadad Scale for r and omised controlled trials and the Newcastle – Ottawa Scale ( NOS ) for observational studies . Raters were r and omly assigned into five pairs and they each independently rated the quality of 13–20 articles . These articles were drawn from a pool of 78 papers examining cognitive impairment following electroconvulsive therapy to treat major depressive disorder . The articles were r and omly distributed to the raters . Two months later , each rater re-assessed the quality of half of their assigned articles . Setting McMaster Integrative Neuroscience Discovery and Study Program . Participants 10 students taking McMaster Integrative Neuroscience Discovery and Study Program courses . Main outcome measures The authors measured inter-rater reliability using κ and the intraclass correlation coefficient type 2,1 or ICC(2,1 ) . The authors measured test – retest reliability using ICC(2,1 ) . Results Inter-rater reliability varied by scale question . For the six-item Jadad Scale , question -specific κs ranged from 0.13 ( 95 % CI −0.11 to 0.37 ) to 0.56 ( 95 % CI 0.29 to 0.83 ) . The ranges were −0.14 ( 95 % CI −0.28 to 0.00 ) to 0.39 ( 95 % CI −0.02 to 0.81 ) for the NOS cohort and −0.20 ( 95 % CI −0.49 to 0.09 ) to 1.00 ( 95 % CI 1.00 to 1.00 ) for the NOS case – control . For overall scores on the six-item Jadad Scale , ICC(2,1)s for inter-rater and test – retest reliability ( accounting for systematic differences between raters ) were 0.32 ( 95 % CI 0.08 to 0.52 ) and 0.55 ( 95 % CI 0.41 to 0.67 ) , respectively . Corresponding ICC(2,1)s for the NOS cohort were −0.19 ( 95 % CI −0.67 to 0.35 ) and 0.62 ( 95 % CI 0.25 to 0.83 ) , and for the NOS case – control , the ICC(2,1)s were 0.46 ( 95 % CI −0.13 to 0.92 ) and 0.83 ( 95 % CI 0.48 to 0.95 ) . Conclusions Inter-rater reliability was generally poor to fair and test – retest reliability was fair to excellent . A pilot rating phase following rater training may be one way to improve agreement Background Cigarette smoking is the number one cause of preventable death among American Indian and Alaska Natives , AI/ANs . Two out of every five AI/AN will die from tobacco-related diseases if the current smoking rates of AI/ANs ( 40.8 % ) persist . Currently , there is no proven , effective culturally-tailored smoking cessation  program design ed specifically for a heterogeneous population of AI.The primary aim of this group r and omized clinical trial is to test the efficacy of  " All Nations Breath of Life " ( ANBL )  program compared to a non-tailored " Current Best Practice s " smoking cessation program among AI smokers . Methods We will r and omize 56 groups ( 8 smokers per group ) to the tailored program or non-tailored program for a total sample size of 448 American Indian smokers . All participants in the proposed study will be offered pharmacotherapy , regardless of group assignment . This study is the first controlled trial to examine the efficacy of a culturally-tailored smoking cessation program for American Indians . If the intervention is successful , the potential health impact is significant because the prevalence of smoking is the highest in this population .Trial Registration Clinical Trials.gov : Background Australian Aboriginal and Torres Strait Isl and er peoples ( Indigenous Australians ) smoke at much higher rates than non-Indigenous people and smoking is an important contributor to increased disease , hospital admissions and deaths in Indigenous Australian population s. Smoking cessation programs in Australia have not had the same impact on Indigenous smokers as on non-Indigenous smokers . This paper describes the outcome of a study that aim ed to test the efficacy of a locally-tailored , intensive , multidimensional smoking cessation program . Methods A r and omised controlled trial of Aboriginal research er delivered tailored smoking cessation counselling during face-to-face visits , aim ing for weekly for the first four weeks , monthly to six months and two monthly to 12 months . The control ( “ usual care ” ) group received routine care relating to smoking cessation at their local primary health care service . Data collection 
    Output:
    
Interventions were successful in producing positive changes in initiation , consumption and quit rates .
Interventions also facilitated increases in the number of smoke-free environments , greater underst and ings of the harms of commercial tobacco use and a growing community interest in addressing the high rates of commercial tobacco use .
Interventions were unable to produce any measured change in prevalence rates .
Conclusions The extent of this research in Indigenous communities globally suggests a growing prioritization and readiness to address the high rates of commercial tobacco use through the use of both comprehensive and tailored interventions .
A comprehensive approach that uses multiple activities , the centring of Aboriginal leadership , long term community investments , and the provision of culturally appropriate health material s and activities appear to have an important influence in producing desired change