***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: Sixty subjects were run in a study comparing the use of nicotine gum with placebo gum  during cessation from smoking . Subjects were given clinic support and chewed the gum ad libitum . A survival analysis showed the two groups differed significantly in successful abstinence over time ( p less than .03 ) . Differences between groups appeared early ( within weeks ) and , at six months , a 28 % superiority of nicotine over placebo gum was demonstrated with mean success rates of 48 % and 20 % , respectively . Between six months and one year , relapse in the nicotine group accounted for the 30 % vs. 20 % success rates for nicotine and placebo observed at one year . In a pilot study ( " dispensary " ) testing the efficacy of the two gums when intervention was minimal , subjects in both groups resumed smoking within the first two weeks . The enhanced short-term success rates with nicotine gum in the clinic study are attributed to an effective interaction between use of the active preparation and clinic support . Long-term cessation may require extended maintenance procedures and /or an identification of optimal gum use A non-combustible nicotine inhaler , administered orally , has been developed for treatment of smokers . The inhaler allows weaning from nicotine while maintaining partial reinforcement of the ritual/sensory phenomena of smoking . Subjects were r and omly assigned to  active ( n = 112 ) and placebo ( n = 111 ) groups . Some behavioral intervention occurred as a function of participation . Strict abstinence ( primary outcome criterion ) was defined by CO < or = 8 ppm with no slips allowed at any time and cotinine values < or = 14 at 1 year . Survival analysis showed active inhaler was superior to placebo ( p < 0.01 ) . Active vs. placebo  success rates were : 63 % vs. 47 % ( day 3 ) , 46 % vs. 28 % ( week 1 ) , 36 % vs. 19 % ( week 2 ) , 33 % vs. 16 % ( week 3 ) , 29 % vs. 14 % ( week 6 ) , 24 % vs. 10 % ( 3 months ) , 17 % vs. 9 % ( 6 months ) and 13 % vs. 8 % ( 1 year ) . chi 2 analyses were significant through 3 months but not at 6 months ( p < 0.08 ) or 1 year . Craving was relieved with active inhalers at day 3 and week 1 . Subjects averaged six inhalers/day . Cotinine levels were 57 - 61 % of smoking levels . Common side effects included throat/mouth irritation and coughing . Failure was predicted by early slips . The inhaler is clearly useful for short-term smoking cessation with potential for long-term efficacy . Extended access to the inhaler and relapse prevention training could improve success rates . Another promising approach would be to combine the inhaler with a nicotine patch BACKGROUND Altering the macronutrient composition of the diet influences hunger and satiety . Studies have compared high- and low-protein diets , but there are few data on carbohydrate content and ketosis on motivation to eat and ad libitum intake . OBJECTIVE We aim ed to compare the hunger , appetite , and weight-loss responses to a high-protein , low-carbohydrate [ ( LC ) ketogenic ] and those to a high-protein , medium-carbohydrate [ ( MC ) nonketogenic ] diet in obese men feeding ad libitum . DESIGN Seventeen obese men were studied in a residential trial ; food was provided daily . Subjects were offered 2 high-protein ( 30 % of energy ) ad libitum diets , each for a 4-wk period-an LC ( 4 % carbohydrate ) ketogenic diet and an MC ( 35 % carbohydrate ) diet-r and omized in a crossover design . Body weight was measured daily , and ketosis was monitored by analysis of plasma and urine sample s. Hunger was assessed by using a computerized visual analogue system . RESULTS Ad libitum energy intakes were lower with the LC diet than with the MC diet [ P=0.02 ; SE of the difference ( SED ) : 0.27 ] at 7.25 and 7.95 MJ/d , respectively . Over the 4-wk period , hunger was significantly lower ( P=0.014 ; SED : 1.76 ) and weight loss was significantly greater ( P=0.006 ; SED : 0.62 ) with the LC diet ( 6.34 kg ) than with the MC diet ( 4.35 kg ) . The LC diet induced ketosis with mean 3-hydroxybutyrate concentrations of 1.52 mmol/L in plasma ( P=0.036 from baseline ; SED : 0.62 ) and 2.99 mmol/L in urine ( P<0.001 from baseline ; SED : 0.36 ) . CONCLUSION In the short term , high-protein , low-carbohydrate ketogenic diets reduce hunger and lower food intake significantly more than do high-protein , medium-carbohydrate nonketogenic diets The authors examine weight gains associated with smoking cessation in the Lung Health Study ( 1986 - 1994 ) over a 5-year follow-up period . A cohort of 5,887 male and female smokers in the United States and Canada , aged 35 - 60 years , were r and omized to either smoking intervention or usual care . Among participants who achieved sustained quitting for 5 years , women gained a mean of 5.2 ( st and ard error , 5.0 ) kg in year 1 and a mean of 3.4 ( st and ard error , 5.5 ) kg in years 1 - 5 . Men gained a mean of 4.9 ( st and ard error , 4.9 ) kg in year 1 and a mean of 2.6 ( st and ard error , 5.8 ) kg in years 1 - 5 . In regression analyses , smoking-change variables were the most potent predictors of weight change . Participants going from smoking to quit-smoking in a given year had mean weight gains of 2.95 kg/year ( 3.61 % ) in men and 3.09 kg/year ( 4.69 % ) in women . Over 5 years , 33 % of sustained quitters gained > or = 10 kg compared with 6 % of continuing smokers . Also among sustained quitters , 7.6 % of men and 19.1 % of women gained > or = 20 % of baseline weight ; 60 % of the gain occurred in year 1 , although significant weight gains continued through year 5 . The average gains and the high proportions of sustained and intermittent quitters who gained excessive weight suggest the need for more effective early interventions that address both smoking cessation and weight control Three smoking cessation interventions design ed for use by general practitioners ( GPs ) within the routine consultation were evaluated in a field setting using 26 GPs throughout metropolitan Sydney . A total of 450 smoking patients were allocated to either Structured Behavioral Change with nicotine gum ( Group SBCN ) , Structured Behavioral Change without nicotine gum ( Group SBC ) , or GP advice with nicotine gum ( Group AN ) . Although significant differences in the percentage of abstainers were observed between Groups SBCN and SBC three weeks after treatment ( 39 % vs. 26 % ) , the point prevalence abstinence rate for patients at 12 months declined to 19 , 18 , and 12 % for Groups SBCN , SBC , and AN , respectively . Continuous abstinence to the end of the 12-month period was 9 % for Groups SBCN and SBC , and 6 % for Group AN . Forty-eight percent of the 450 patients made an attempt to stop smoking , and 89 % reduced their cigarette consumption at some point during the study . Examination of 132 self- selecting patients who fully participated in the three interventions and attended all scheduled visits , revealed significantly larger proportions of abstainers within Groups SBCN ( 34 % ) and SBC ( 33 % ) than in Group AN ( 15 % ) at the 12-month follow-up BACKGROUND St John 's wort is an effective antidepressant that can reduce tobacco withdrawal symptoms , but it is not known whether it assists cessation . Chromium assists weight loss and might limit post cessation weight gain . METHODS In a factorial design , we r and omised smokers stopping smoking to 900 mg St John 's wort ( SJW ) active or placebo  and also r and omised them to 400 microm chromium or placebo daily . Treatment started 2 weeks prior to quit day and continued for 14 weeks . Participants and research ers were blind to treatment allocation . All participants received weekly behavioural support . The primary endpoints were biochemically confirmed prolonged abstinence and mean weight gain in abstinent smokers 4 weeks after quitting . RESULTS 6/71 ( 8.5 % ) participants on active SJW and 9/72 ( 12.5 % ) on placebo achieved prolonged abstinence at 4 weeks , an odds ratio ( OR ) ( 95 % confidence interval ) of 0.65 ( 0.22 - 1.92 ) . At 6 months , 3 ( 4.2 % ) SJW active and 6 ( 8.3 % ) SJW placebo participants were still abstinent , an OR of 0.49 ( 0.12 - 2.02 ) . Among these participants , the mean difference in weight gain between active chromium and placebo was -0.8 1 kg ( -3.79 to 2.18 ) at 4 weeks and -3.88 kg ( -12.13 to 4.38 ) at 6 months . CONCLUSIONS Taking together the absolute quit rates , the small difference between active and placebo , and lack of effects on withdrawal shows that SJW is ineffective for smoking cessation . Insufficient people stopped smoking to properly test the efficacy of chromium in preventing weight gain , but the point estimate indicates a potentially worthwhile benefit BACKGROUND Nicotine replacement therapies are efficacious for treating nicotine dependence . However , limited data exist on benefits of different NRTs and predictors of treatment outcome . This study compared the effectiveness of transdermal nicotine vs. nicotine lozenge for smoking cessation and identified predictors of treatment response . METHODS A r and omized , open-label effectiveness trial was conducted at 12 medical sites participating in the National Cancer Institute 's Community Clinical Oncology Program . The sample consisted of 642 treatment-seeking smokers r and omized to 12 weeks of transdermal nicotine or nicotine lozenge .  RESULTS Smoker characteristics were assessed at baseline , and 24-h point prevalence abstinence confirmed with breath carbon monoxide ( CO ) was evaluated at end of treatment ( EOT ) and at a 6-month follow-up . There was a trend for higher quit rates for transdermal nicotine vs. nicotine lozenge at EOT ( 24.3 % vs. 18.7 % , p=.10 ) and 6 months ( 15.6 % vs. 10.9 % , p=.10 ) . A logistic regression model of EOT quit rates showed smokers who preferred transdermal nicotine , were not reactive to smoking cues , and did not use nicotine to alleviate distress or stimulate cognitive function had higher quit rates on transdermal nicotine . A logistic regression model of 6-month quit rates showed smokers who preferred transdermal nicotine had higher quit rates on transdermal nicotine , and smokers who used nicotine to alleviate distress or stimulate cognitive processes had lower quit rates on nicotine lozenge . CONCLUSIONS Transdermal nicotine may be more effective than nicotine lozenge for smokers who prefer transdermal nicotine and do not smoke to alleviate emotional distress or stimulate cognitive function BACKGROUND Cigarette smoking is an established predictor of incident type 2 diabetes mellitus  , but the effects of smoking cessation on diabetes risk are unknown . OBJECTIVE To test the hypothesis that smoking cessation increases diabetes risk in the short term , possibly owing to cessation-related weight gain . DESIGN Prospect i ve cohort study . SETTING The ARIC ( Atherosclerosis Risk in Communities ) Study . PATIENTS 10,892 middle-aged adults who initially did not have diabetes in 1987 to 1989 . MEASUREMENTS Smoking was assessed by interview at baseline and at subsequent follow-up . Incident diabetes was ascertained by fasting glucose assays through 1998 and self-report of physician diagnosis or use of diabetes medications through 2004 . RESULTS During 9 years of follow-up , 1254 adults developed type 2 diabetes .  Compared with adults who never smoked , the adjusted hazard ratio of incident diabetes in the highest tertile of pack-years was 1.42 ( 95 % CI , 1.20 to 1.67 ) . In the first 3 years of follow-up , 380 adults quit smoking . After adjustment for age , race , sex , education , adiposity , physical activity , lipid levels , blood pressure , and ARIC Study center , compared with adults who never smoked , the hazard ratios of diabetes among former smokers , new quitters , and continu 
    Output:
    
Behavioural interventions of general advice only are not effective and may reduce abstinence .
Individualized interventions , very low calorie diets , and CBT may be effective and not reduce abstinence .
Exercise interventions are not associated with reduced weight gain at end of treatment , but may be associated with worthwhile reductions in weight gain in the long term , Bupropion , fluoxetine , nicotine replacement therapy , and probably varenicline all reduced weight gain while being used .
Although this effect was not maintained one year after quitting for bupropion , fluoxetine , and nicotine replacement , the evidence is insufficient to exclude a modest long-term effect .