***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: OBJECTIVE To evaluate the potential efficacy of bupropion sustained release when used in combination with minimal counseling for moist snuff cessation in males . METHODS A double-blind , placebo-controlled 3-month trial . The active treatment group ( n = 35 ) received bupropion SR at 150 mg/qd day for the first 3 days , then beginning day 4 through day 49 ( 7 weeks ) 150 mg/ b.i.d . The placebo group ( n= 35 ) received 1 tablet qd for 3 days and beginning day 4 through day 49 , 1 tablet/b.i.d . RESULTS Bupropion 300 mg/day ( 150 b.i.d . ) produced significantly higher quit rates for smokeless tobacco cessation at the end of treatment ( 7 weeks ) than placebo ( p = 0.04 ) with an OR of 2.73 . CONCLUSION Bupropion SR appears to be effective for smokeless tobacco cessation The need for effective , low-cost self-help treatment methods for  smokeless tobacco ( ST ) addiction  becomes more evident as rates of product use and associated morbidities increase . This study evaluated two self-help methods for ST cessation .  One hundred ninety-eight ST users were r and omized into two conditions : half received the LifeSign , a credit card-sized computer design ed for gradual ST cessation , and half received the Enough Snuff self-help manual and a video . Subjects in both conditions received telephone support for their quit effort . The study was conducted entirely through phone and mail , allowing delivery of the intervention to both rural and urban users .  Self-reported rates of sustained abstinence ( no tobacco use at two months and six months ) were 24.5 % for the manual/video condition , and 18.4 % , for the LifeSign condition OBJECTIVES The aim of this study was to investigate the acute hemodynamic and autonomic effects of smokeless tobacco . BACKGROUND Smokeless tobacco use is increasing . Its cardiovascular effects are not well understood . METHODS Sixteen healthy , male , habitual snuff tobacco users ( aged 22 + /- 1 year ) were studied , using a r and omized , double-blind , placebo-controlled , crossover design with two separate experimental sessions : placebo and tobacco .  Muscle sympathetic nerve activity ( MSNA ) , electrocardiogram , blood pressure , calf blood flow , nicotine , and catecholamines were measured . RESULTS Snuff tobacco increased plasma nicotine from 2.8 + /- 0.5 ng/ml to 10.4 + /- 1.1 ng/ml . Mean blood pressure increased by 10 + /- 1 mm Hg , and heart rate increased by 16 + /- 2 beats/min . Peripheral vascular resistance , MSNA , and norepinephrine concentration did not change with tobacco , but epinephrine increased by approximately 50 % . CONCLUSIONS Oral snuff tobacco increases heart rate , blood pressure , and epinephrine . Despite the increase in blood pressure , there is no decrease in either MSNA or peripheral vascular resistance . Smokeless tobacco is a powerful autonomic and hemodynamic stimulus . Catecholamine release from the adrenal medulla likely contributes to this response To examine the effectiveness of advising patients who use tobacco to quit , the authors conducted a r and omized clinical trial to test a brief office-based intervention with all tobacco users in 75 fee-for-service dental practice s in Oregon . The authors found that the dental hygienist-delivered intervention was effective in getting smokeless tobacco users to quit at three and 12 months and to sustain abstinence at both three and 12 months . They found that the program was not effective for cigarette smokers . The authors discuss the public health implication s of program dissemination and widespread program adoption We describe a r and omized trial design ed to evaluate the effectiveness of a smokeless tobacco cessation intervention delivered by dental hygienists as part of a patient 's regularly scheduled cleaning visit . Seventy-five practice s were r and omized to continue their usual care ( n=25 ; 239 smokeless tobacco using patients enrolled ) or to receive training to provide a tobacco cessation intervention ( n=50 ; 394 smokeless tobacco using patients enrolled ) . Patient reports indicated that the training program was successful in getting hygienists to implement the intervention . The intervention produced a strong effect on sustained quitting for smokeless tobacco users but had no impact on secondary outcomes , including unsuccessful quit attempts , future intent to quit using smokeless tobacco , and change in readiness to quit using . Frequency of smokeless tobacco use and receipt of specific components of the intervention , including the video and written material s , predicted sustained cessation . Since this intervention was delivered by dental hygienists as part of a patient 's regularly scheduled cleaning visit , it is easily disseminable Few pharmacological therapies have been shown to increase abstinence rates among spit tobacco ( ST ) users .  Bupropion has been shown to be effective in increasing abstinence rates among smokers but has not been studied in ST users . Sixty-eight adult ( aged > or = 18 years old ) regular users of ST who were motivated to stop using ST were enrolled in a r and omized , double-blind , placebo-controlled pilot study of bupropion sustained release ( SR ) or placebo for 12 weeks . The primary endpoint was 1-week , biochemically confirmed point-prevalence tobacco abstinence rate at the end of treatment ( week 12 ) . Nicotine withdrawal symptoms and weight change were assessed . At the end of 12 weeks of therapy , the point-prevalence tobacco abstinence rate was 44 % in the bupropion group and 26 % in the placebo group ( p = 0.064 ) . At 24 weeks following initiation of medication , the point-prevalence abstinence rate was 29 % for both groups . After 7 weeks of medication , subjects on bupropion reported significantly less ( p < or = 0.034 ) nicotine withdrawal than placebo . The mean weight change from baseline to end of treatment was + 0.7 + /- 1.9 kg for bupropion and + 4.4 + /- 2.4 kg for placebo ( p = 0.03 ) . The 6-month weight change for continuously abstinent subjects was 3.4 + /- 3.6 kg in the bupropion group and 6.2 + /- 5.0 kg in the placebo group ( p = 0.49 ) . Bupropion may increase abstinence rates in ST users and appears to attenuate weight gain during ST abstinence . Larger r and omized , controlled trials of bupropion for ST users are needed The purpose of this study was to examine the effects of 2 mg of nicotine polacrilex versus placebo gum and of group behavioral treatment versus minimal contact on cessation of smokeless tobacco use . Participants ( N = 210 ) were r and omly assigned 1 of the 4 treatment conditions . Withdrawal symptoms were assessed throughout the treatment . Follow-up assessment s were made at 1 , 6 , and 12 months posttreatment . Survival curve analysis showed that any of the 3 treatment groups involving group behavioral therapy or placebo gum were equally effective and superior to the minimal contact plus 2 mg of nicotine gum treatment in terms of abstinence . On the other h and , withdrawal symptoms were significantly reduced by nicotine gum , compared with placebo during the initial phases of cessation . The ineffectiveness of nicotine gum on treatment outcome may be attributed to its similarity with smokeless tobacco The sizeable percentage of adults who use smokeless tobacco ( ST ) represents an important public health target since the majority of ST users have a strong desire to quit , but many lack re sources . We tested the impact of an interactive , tailored Web-based intervention ( Enhanced Condition ) versus a more linear , text-based website ( Basic Condition ) in a r and omized trial with 2523 adult ST users . As is common in Internet-based research , there was considerable attrition : follow-up rates at 3 months , 6 months , and for both 3 and 6 months were 48 % , 45 % and 34 % , respectively . Results using repeated point prevalence of all tobacco use at 3 and 6 months showed that participants in the Enhanced Condition quit at significantly higher rates than those in the Basic Condition . Using a Complete Case analysis , abstinence was 40.6 % in the Enhanced Condition vs. 21.2 % in the Basic Condition ( p < .001 ) . Using intent-to-treat analysis , quit rates were 12.6 % vs. 7.9 % , respectively ( p < .001 ) . Similar results were obtained for only ST use . Unobtrusive measures of program exposure indicated that program use was significantly related to outcome as well as to attrition . We conclude that a tailored , interactive Web-assisted cessation program can be an efficacious method for assisting adult ST users to quit Abstract Objective To study the effect of using smokeless tobacco  during pregnancy on  babies ' birth weight and gestational age at birth . Design Population based , prospect i ve cohort study using a house to house approach . Setting Eight primary health post areas in the city of Mumbai ( Bombay ) , India . Participants 1217 women who were three to seven months pregnant and planning to deliver in the study area . 1167 women ( 96 % ) were followed up . Main outcome measures Birth weight and gestational age in singleton births . Results Smokeless tobacco use was associated with an average reduction of 105 g in birth weight ( 95 % confidence interval 30 g to 181 g ) and a reduction in gestational age of 6.2 ( 3.0 to 9.4 ) days . The odds ratio for low birth weight was 1.6 ( 1.1 to 2.4 ) , adjusted by logistic regression for maternal age , education , socioeconomic status , weight , anaemia , antenatal care , and gestational age . The adjusted odds ratio for preterm delivery ( < 37 weeks ) was 1.4 ( 1.0 to 2.1 ) ; for delivery before 32 weeks it was 4.9 ( 2.1 to 11.8 ) and before 28 weeks it was 8.0 ( 2.6 to 27.2 ) . Conclusions Consumption of smokeless tobacco during pregnancy decreases gestational age at birth and birth weight independent of gestational age . It should receive specific attention as a part of routine prenatal care This paper presents long-term outcomes of the largest clinical trial of smokeless tobacco ( SLT ) cessation reported to date . SLT users in five northwestern states were recruited to call a toll-free number , and 1,069 users were r and omized to one of two self-help conditions : either a manual-only condition or an assisted self-help condition , which included the manual , a targeted video , and two support phone calls . Significant between-group differences were not found for either the 12- or 18-month point-prevalence measure of abstinence from either SLT only or all tobacco products using outcomes based on either the responder or intention-to-treat outcomes . However , using a repeated point-prevalence measure across all three assessment points , we found that significantly more assisted self-help participants reported abstinence , compared with manual-only participants . Compared with manual-only participants , those in the assisted self-help condition were significantly more likely to use recommended cessation techniques . Results demonstrate that low-cost , minimal interventions delivered by mail and phone can help a sizable proportion of individuals quit using SLT Sixteen colleges were matched on the baseline prevalence of spit tobacco ( ST ) use , and college pairs were r and omized , one to the intervention and the other to the control group . Baseball and football athletes at each intervention college received : an oral examination by a dental professional who pointed out ST-related problems in the athlete 's mouth and advised him to quit ST use ; counseling by a dental hygienist on strategies to cope with cravings and triggers for use ; and two follow-up telephone calls . At the three-month follow-up , quit rates were 24 % and 16 % for the intervention ( n = 171 ) and control ( n = 189 ) groups , respectively ( p < 0.05 ) . As the reported amount of ST used weekly increased , the percent of individuals who quit at 3 mos decreased ( p < 0.05 ) . Dental professionals appear to be effective in promoting spit tobacco cessation at 3 mos post-intervention in male college athletes , especially among those using lesser amounts of ST Background Web-based health behavior change programs can reach large groups of disparate participants and thus they provide promise of becoming important public health tools . Data on participant rurality can complement other demographic measures to deepen our underst and ing of the success of these programs . Specifically , analysis of participant rurality can inform recruitment and social marketing efforts , and facilitate the targeting and tailoring of program content . Rurality analysis can also help evaluate the effectiveness of interventions across population groupings . Methods We describe how the RUCAs ( Rural-Urban Commuting Area Codes ) methodology can be used to examine results from two R and omized Controlled Trials of Web-based tobacco cessation programs : the ChewFree.com project for smokeless tobacco cessation and the Smokers ' Health Improvement Program ( SHIP ) project for smoking cessation . Results Using RUCAs methodology helped to highlight the extent to which both Web-based interventions reached a substantial percentage of rural participants . The ChewFree program was found to have more rural participation which is consistent with the greater prevalence of smokeless tobacco use in rural setting s as well as ChewFree 's multifaceted recruitment program that specifically targeted 
    Output:
    
In post-hoc subgroup analyses , behavioural interventions which include telephone counselling or an oral examination may increase abstinence rates more than interventions without these components .
Behavioural interventions should be used to help ST users to quit and telephone counselling or an oral examination may increase abstinence rates .
Pharmacotherapies have not been shown to affect long-term abstinence