***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: AIMS To examine the effects of processes of change ( POC ) on forward stage movement directly , indirectly through decisional balance and temptation , and total effects as a test of the key hypothesis of the Transtheoretical Model ( TTM ) . DESIGN Prospect i ve cohort study . SETTING United Kingdom . PARTICIPANTS A total of 1160 adolescents aged 13 - 14 years who were current or former smokers at baseline . MEASUREMENTS  Stage was assessed with the st and ard algorithm three times , once every 3 months . On each occasion the  POC , decisional balance and temptation were measured with the st and ard question naires . Path analysis was used to examine the direct , indirectly mediated and total contribution of POC and the other constructs to stage movement 3 months later . FINDINGS Four of the 24 analyses showed evidence that the theoretically appropriate POC predicted stage transition , with statistically significant total effects . Effect sizes were small . When the POC were summarized to experiential and behavioural process means , one transition from pre-contemplation was predicted by experiential processes and , contrary to the TTM , one transition predicted by behavioural processes . There was slightly more evidence that decisional balance ( attitudes towards smoking ) and temptation ( ability to resist the urge to smoke ) was associated with stage transition . CONCLUSIONS POC use was not associated generally with stage transition and evidence that effects , if missed , must be modest , giving no support to the central tenet of the TTM BACKGROUND Previous research has demonstrated the efficacy of an interactive expert system intervention for  smoking cessation for a general population . The intervention provides individualized feedback that guides participants through the stages of change for cessation . Enhancing the expert system by adding proactive telephone counseling or a stimulus control computer design ed to produce nicotine fading could produce preventive programs with greater population impacts . METHODS Four interventions were compared : ( a ) the interactive expert system intervention ; ( b ) the expert system intervention plus counselor calls ; ( c ) the expert system intervention plus the stimulus control computer ; and ( d ) an assessment only condition . A 4 ( intervention ) x 4 ( occasions ) ( 0,6,12 , and 18 months ) design was used . Smokers were contacted at home via telephone or mail . The initial subject pool was the 24,178 members of a managed care company . Screening was completed for 19,236 members ( 79.6 % ) , of whom 4,653 were smokers ; 85.3 % of the smokers were enrolled . RESULTS Thirty-eight percent were in the precontemplation stage , 45 % in the contemplation stage , and only 17 % in the preparation stage . At 18 months , the expert system result ed in 23.2 % point prevalence abstinence , which was 33 % greater than that of assessment only . The counselor enhancement produced increased cessation at 12 months but not at 18 months . The stimulus control computer produced no improvement , result ing in 20 % worse cessation rates than the assessment only condition . CONCLUSIONS The enhanced conditions failed to outperform the expert system alone . The study also demonstrated the ability of the interactive expert system to produce significantly greater cessation in a population of smokers than assessment alone A longitudinal r and omized trial tested the self-determination theory ( SDT ) intervention and process model of health behavior change for tobacco cessation ( N = 1006 ) . Adult smokers were recruited for a study of smokers ' health and were assigned to intensive treatment or community care .  Participants were relatively poor and undereducated . Intervention patients perceived greater autonomy support and reported greater autonomous and competence motivations than did control patients . They also reported greater medication use and significantly greater abstinence . Structural equation modeling analyses confirmed the SDT process model in which perceived autonomy support led to increases in autonomous and competence motivations , which in turn led to greater cessation . The causal role of autonomy support in the internalization of autonomous motivation , perceived competence , and smoking cessation was supported Background  Online computer-tailored smoking cessation programs  have not yet been compared directly . Objective To compare the efficacy of two Internet-based , computer-tailored smoking cessation programs . Methods R and omized controlled trial conducted in 2003 - 2004 . Visitors to a smoking cessation website were r and omly assigned to either an original online , interactive smoking cessation program or to a modified program . Both programs consisted of tailored , personalized counseling letters based on participants ' characteristics , followed by monthly email reminders . The original program was based on psychological and addiction theory , and on preliminary research conducted in the same population . The modified program was shorter and contained more information on nicotine replacement therapy and nicotine dependence , and less information on health risks and coping strategies . In both programs , 1 month and 2 months after entering the study , participants were invited by email to answer the same tailoring question naire again in order to receive a second counseling letter . Participants in both programs obtained , on average , 1.2 feedback counseling letters over 2.5 months , and 84 % received only 1 feedback letter . The outcome was self-reported smoking abstinence ( no puff of tobacco in the previous 7 days ) , assessed 2.5 months after entry in the program . We report results from intention-to-treat ( ITT ) analyses , where all non-respondents at follow-up were counted as smokers . Results The baseline question naire was answered by a total of 11969 current ( 74 % ) and former ( 26 % ) smokers , and the follow-up survey by 4237 people ( 35 % ) . In an ITT analysis , abstinence rates in baseline current smokers were respectively 10.9 % and 8.9 % ( odds ratio [OR]=1.24 , 95 % confidence interval [CI]1.08 - 1.43 , P=.003 ) in the original and modified programs , and 25.2 % and 15.7 % ( OR=1.81 , CI 1.51 - 2.16 , P<.001 ) in baseline former smokers . While we found statistically significant differences in quit rates in smokers in the contemplation stage favoring the original program ( OR=1.54 , CI 1.18 - 2.02 , P=.002 ) , no between-group differences in quit rates were observed in smokers in the precontemplation ( OR=1.07 , CI 0.36 - 3.14 , P=.91 ) and preparation ( OR=1.15 , CI 0.97 - 1.37 , P=.10 ) stages of change . Conclusions In smokers in the contemplation stage of change and in former smokers , the original program produced higher smoking abstinence rates than the modified program To assess the stability of intention to quit smoking , 115 US and Swedish smokers were r and omized to complete Stage of Change ( SOC ) or ladder scales of intentions to quit at either 0 , 7 , 14 and 30 days or at 0 and 30 days in the absence of intervention . The four- assessment group had more progression in intention to quit than the two- assessment group . Depending on the measure , 12 - 17 % of smokers changed their intention to quit over 7 days , 15 - 25 % changed over 14 days and 17 - 34 % changed over 30 days . Results were similar in Swedish and US participants and replicate the results of prior studies . We conclude intention to quit often spontaneously changes over short periods of time , especially with repeated testing AIMS quantitative description of adherence to motivational interviewing ( MI ) in smoking cessation sessions ; and examination of the relationships between client characteristics and adherence to MI , and between adherence to MI and future smoking status . METHODS 84 sessions were conducted during a r and omised controlled trial to test the effectiveness of a  population -based smoking intervention in women during the postpartum period . Demographic and behaviour-related variables were included in a logistic regression to predict adherence to MI . MEASUREMENTS adherence was measured using the MI Treatment Integrity Scale . FINDINGS 38.1 % of sessions showed good adherence to MI . Receiving a good MI session was not related to any demographic or behavioural variables . The relationship between adherence and intervention outcome after six months was not statistically significant ( chi(2)=0.355 , p=0.551 ) . CONCLUSIONS the smoking cessation sessions examined in this study failed to adhere to MI . There was no relationship between adherence to MI and behavioural outcome six months after the intervention , indicating that women who smoke post partum may be a high-risk group for whom specific smoking cessation interventions need to be developed OBJECTIVE To evaluate a training workshop for community pharmacy personnel  to improve their counselling in smoking cessation based on the stage-of-change model . DESIGN A r and omised controlled trial of community pharmacies and pharmacy customers . SETTING All 76 non-city community pharmacies registered in Grampian , Scotl and , were invited to participate . Sixty-two pharmacies ( 82 % ) were recruited . SUBJECTS All the intervention pharmacy personnel were invited to attend the training ; 40 pharmacists and 54 assistants attended . A total of 492 customers who smoked ( 224 intervention , 268 controls ) were recruited during the 12-month recruitment period ( overall recruitment rate 63 % ) . MAIN OUTCOME MEASURES The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one , four , and nine months . RESULTS The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel , 85 % ( 113 ) compared with 62 % ( 99 ) of the controls ( p<0.001 ) . The former also rated their discussion more highly ; 34 % ( 45 ) of the intervention customers compared with 16 % ( 25 ) of the controls rated it as “ very useful ” ( p = 0.048 ) . Assuming non-responders had lapsed , one-month point prevalence of abstinence was cl aim ed by 30 % of intervention customers and 24 % of controls ( p = 0.12 ) ; four months ’ continuous abstinence was cl aim ed by 16 % of intervention customers and 11 % of controls ( p = 0.094 ) ; and nine months ’ continuous abstinence was cl aim ed by 12 % of intervention customers and 7 % of controls ( p = 0.089 ) . These trends in outcome were not affected by potential confounders ( sex , age , socioeconomic status , nicotine dependence , and type of nicotine replacement product used ) or adjustment for clustering . CONCLUSIONS The intervention was associated with increased and more highly rated counselling , and a trend toward higher smoking cessation rates , indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets OBJECTIVES This study assessed the effectiveness of a smoking cessation program for women in public health clinics , controlling for reported exposures to 4 common intervention components ( provider advice , booklet , video segment , posters ) among smokers in the control group . METHODS After a baseline control period , 10 pair-matched clinics were r and omly assigned to study groups . A total of 1042 smokers in the combined baseline and control groups and 454 smokers in the intervention group completed a preintervention question naire and a postintervention telephone interview 5 to 8 weeks later . Eight smoking outcomes , including quitting , were analyzed for the effect of reported exposure to intervention components , experimental program , and clinic service . RESULTS Greater exposure to intervention components , being in the experimental program , and being seen in prenatal clinics independently improved smoking outcomes . CONCLUSIONS The number of interventions reported by smokers in the control group ranged from none to 4 and varied across clinic services . The experimental program we tested produced better outcomes than the minimal smoking cessation interventions already existing in the control clinics , after we controlled for whether smokers were or were not exposed to these interventions Face to face advice for smoking cessation is effective,1 but few smokers are willing to attend smoking cessation clinics , and many do not receive smoking cessation advice from their physician . Self help smoking cessation material s may not be very effective,2 but computer technology can be used to produce effective individualised self help smoking cessation material s and disseminate them widely at a low cost per participant.2 Most studies assessed the effect of computer tailored programmes on smoking cessation after one year or less.2 Only one programme was evaluated during 18 and 24 months.3 These programmes usually produced quit rates<5 % higher than in control groups who received st and ard self help material s or no intervention.2 Because over one third of ex-smokers who achieve 12 months of abstinence eventually relapse five years later,4 it is not yet known whether computer tailored programmes have a long term impact on smoking abstinence . We showed previously that a computer tailored programme doubled the odds of quitting smoking , after seven months.5 In this study , we tested whether this effect was maintained 24 months after entry in the programme — that is , 12 months after the end of the intervention . In 1998 , we sent the baseline question naire to a representative ( r and om ) sample of 20 000 residents aged 18–60 in French speaking Switzerl and . We sent out follow up question naires six and 23 months later to the 2934 baseline participants . We r and omly assigned participants to the intervention or control group ( fig 1 ) . Figure 1 Flow chart of participants in the r and omised controlled trial . The intervention consisted of personal counselling letters , written 
    Output:
    
These findings are consistent with the proven effectiveness of these interventions in their non-stage-based versions .
The evidence was unclear for telephone counselling , interactive computer programmes or training of doctors or lay supporters .
Providing these forms of practical support to those trying to quit appears to be more productive than not intervening .
However , the additional value of adapting the intervention to the smoker 's stage of change is uncertain .
The evidence is not clear for other types of staged intervention , including telephone counselling , interactive computer programmes and training of physicians or lay supporters .
The evidence does not support the restriction of quitting advice and encouragement only to those smokers perceived to be in the preparation and action stages