***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 : The effect of low-dose CT screening for lung cancer on smoking habits has not been reported in large r and omised controlled trials . Methods : This study evaluated the effect on smoking habits of screening with low-dose CT at 1-year follow up in the Danish Lung Cancer Screening Trial ( DLCST ) , a 5-year r and omised controlled trial comprising 4104 subjects ; 2052 subjects received annual low-dose CT scan ( CT group ) and 2052 received no intervention ( control group ) . Participants were healthy current and former smokers ( > 4 weeks since smoking cessation ) with a tobacco consumption of > 20 pack years .  Smoking habits were determined at baseline and at annual screening . Smoking status was verified using exhaled carbon monoxide levels . Lung function tests , nicotine dependency and motivation to quit smoking were assessed . Quit rates and relapse rates were determined at 1-year follow-up for all subjects . Results : At 1 year the quit rates among smokers were 11.9 % in the CT group and 11.8 % in the control group ( p = 0.95 ) . Relapse rates for former smokers were 10.0 % and 10.5 % in the CT and control groups , respectively ( p = 0.81 ) . Significant predictors ( p<0.05 ) for smoking cessation were : high motivation to quit , low dependency , low ratio of forced expiratory volume in 1 s to forced vital capacity , low pack years , higher age , longer period of abstinence and CT findings necessitating 3-month repeat CT scans . Conclusions : Overall , quit rates were similar in the CT and control group at 1-year follow-up , with a net quit rate of 6.0 % . Quit rates were higher and relapse rate lower among subjects with initial CT findings that necessitated a repeat scan 3 months later AIMS Tobacco dependence treatments achieve abstinence rates of 25 - 30 % at 1 year . Low rates may reflect failure to conceptualize tobacco dependence as a chronic disorder . The aims of the present study were to determine the efficacy of extended cognitive behavioral and pharmacological interventions in smokers > or = 50 years of age , and to determine if gender differences in efficacy existed . DESIGN Open r and omized clinical trial . SETTING A free-st and ing , smoking treatment research clinic . PARTICIPANTS A total of 402 smokers of > or = 10 cigarettes per day , all 50 years of age or older . INTERVENTION Participants completed a 12-week treatment that included group counseling , nicotine replacement therapy ( NRT ) and bupropion . Participants , independent of smoking status , were then assigned r and omly to follow-up conditions : ( i ) st and ard treatment ( ST ; no further treatment ) ; ( ii ) extended NRT ( E-NRT ; 40 weeks of nicotine gum availability ) ; ( iii ) extended cognitive behavioral therapy ( E-CBT ; 11 cognitive behavioral sessions over a 40-week period ) ; or ( iv ) E-CBT plus E-NRT ( E-combined ; 11 cognitive behavioral sessions plus 40 weeks nicotine gum availability ) . MEASUREMENTS Primary outcome variable was 7-day point prevalence cigarette abstinence verified biochemically at weeks 24 , 52 , 64 and 104 . FINDINGS The most clinical ly important findings were significant main effects for treatment condition , time and the treatment x time interaction . The E-CBT condition produced high cigarette abstinence rates that were maintained throughout the 2-year study period [ ( week 24 ( 58 % ) , 52 ( 55 % ) , 64 ( 55 % ) and 104 ( 55 % ) ] , and was significantly more effective than E-NRT and ST across that period . No other treatment condition was significantly different to ST . No effects for gender were found . CONCLUSIONS Extended cognitive behavioral treatments can produce high and stable cigarette abstinence rates for both men and women . NRT does not add to the efficacy of extended CBT , and may hamper its efficacy . Research is needed to determine if these results can be replicated in a sample with a greater range of ages , and improved upon with the addition of medications other than NRT BACKGROUND Although older adults can achieve significant health benefits from smoking cessation , few programs have specifically targeted this population . This study tested the effectiveness of an office-based smoking cessation program tailored to midlife and older smokers . METHODS This paper describes a r and omized controlled trial comparing usual care with physician-delivered brief quit-smoking advice and counseling for midlife and older smokers ( ages 50 - 74 ) . Outpatient medical practice s assigned to the Immediate Intervention ( experimental ) condition were trained to deliver brief quit-smoking advice and counseling . Delayed Intervention ( control ) practice s followed usual care procedures .  Thirty-nine practice s accruing five or more patients per practice were included in the analyses . RESULTS Using conservative measure of quitting , self-reported quit rates at 6-month follow-up were 15.41 % for the Immediate Intervention group versus 8.16 % of subjects in the Delayed Intervention group ( P < 0.005 ) . Baseline subject ( N = 659 ) characteristics related to 6-month abstinence included number of previous quit attempts , quitting for 24 hr in the past year , desire to quit , confidence in quitting , perceived health benefits , and lower nicotine dependence . CONCLUSIONS Smoking abstinence was significantly increased by training physicians and key office and clinical staff to intervene with older smokers . Brief interventions are tailored to this age cohort can be successfully and efficaciously integrated into routine care The impact of smoking cessation on coronary heart disease ( CHD ) and lung cancer was assessed after 10.5 years of follow-up in the 12,866 men in the Multiple Risk Factor Intervention Trial ( MRFIT ) . Those men who died of lung cancer ( n = 119 ) were either cigarette smokers at entry or ex-smokers ; no lung cancer deaths occurred among the 1,859 men who reported never smoking cigarettes . The risk of lung cancer for smokers , adjusted for selected baseline variables using a Cox proportional hazards model , increased as the number of cigarettes smoked increased ( B = 0.0203 , SE = 0.0076 ) . There was not the same grade d response for CHD among smokers at entry . The risk of CHD death was greater among smokers than nonsmokers ( RR = 1.57 ) ( B = -0.0034 , S.E. = 0.0048 ) . After one year of cessation , the relative risk of dying of CHD for the quitters as compared to non-quitters ( RR = 0.63 ) was significantly lower even after adjusting for baseline differences and changes in other risk factors . The relative risk for smokers who quit for at least the first three years of the trial was even lower compared to non-quitters ( RR = 0.38 ) . However , the relative risk for lung cancer for quitters versus non-quitters was close to 1 both for quitters at 12 months and at three years . These data support the benefits of cessation in relation to CHD and are consistent with other epidemiologic studies which suggest that the lag time for a beneficial effect of smoking cessation on lung cancer may be as long as 20 years OBJECTIVE : To evaluate the relative effectiveness of two self-help smoking interventions as adjuncts to a self-help manual and telephone support service ( hotline ) for older smokers . DESIGN : Subjects were stratified on baseline variables and r and omised to one of two treatment conditions in a methods development study . SUBJECTS : 177 community-dwelling smokers aged 60 years and older . INTERVENTIONS : All subjects received a self-help manual and access to a smokers ' telephone hotline . Subjects also received either mailings ( Letters condition ) or counselling telephone calls ( Proactive condition ) at four and eight weeks after enrollment . MAIN OUTCOME MEASURES : Use of the hotline and prevalence of abstinence lasting at least 48 hours ( verified by a " significant other " ) were assessed at three and six months for the full sample . Seven-day abstinence was calculated for comparison with previous research . A sub sample of 91 subjects was followed up at 12 months . RESULTS : Overall abstinence rates for the two conditions were in the range of typical self-help interventions . Men were more likely to be abstinent than women at follow up at three and six months . A significant gender x treatment interaction was found , with abstinence rates higher for men in the Letters condition , and women in the Proactive condition . Hotline use was high , with nearly half of subjects calling by 12 months . CONCLUSION : Both interventions appear promising for older smokers , but may be differentially effective for men and women . Older smokers will use a hotline ; whether Letters and Proactive interventions can improve on manual and hotline effectiveness rates alone is being tested in a subsequent controlled trial CONTEXT Most smokers with mental illness do not receive tobacco cessation treatment . OBJECTIVE To determine whether integrating smoking cessation treatment into mental health care for veterans with posttraumatic stress disorder ( PTSD ) improves long-term smoking abstinence rates . DESIGN , SETTING , AND PATIENTS A r and omized controlled trial of 943 smokers with military-related PTSD who were recruited from outpatient PTSD clinics at 10 Veterans Affairs medical centers and followed up for 18 to 48 months between November 2004 and July 2009 . INTERVENTION Smoking cessation treatment integrated within mental health care for PTSD delivered by mental health clinicians ( integrated care [ IC ] ) vs referral to Veterans Affairs smoking cessation clinics ( SCC ) . Patients received smoking cessation treatment within 3 months of study enrollment . MAIN OUTCOME MEASURES Smoking outcomes included 12-month bioverified prolonged abstinence ( primary outcome ) and 7- and 30-day point prevalence abstinence assessed at 3-month intervals . Amount of smoking cessation medications and counseling sessions delivered were tested as mediators of outcome . Posttraumatic stress disorder and depression were repeatedly assessed using the PTSD Checklist and Patient Health Question naire 9 , respectively , to determine if IC participation or quitting smoking worsened psychiatric status . RESULTS Integrated care was better than SCC on prolonged abstinence ( 8.9 % vs 4.5 % ; adjusted odds ratio , 2.26 ; 95 % confidence interval [ CI ] , 1.30 - 3.91 ; P = .004 ) . Differences between IC vs SCC were largest at 6 months for 7-day point prevalence abstinence ( 78/472 [ 16.5 % ] vs 34/471 [ 7.2 % ] , P < .001 ) and remained significant at 18 months ( 86/472 [ 18.2 % ] vs 51/471 [ 10.8 % ] , P < .001 ) . Number of counseling sessions received and days of cessation medication used explained 39.1 % of the treatment effect . Between baseline and 18 months , psychiatric status did not differ between treatment conditions . Posttraumatic stress disorder symptoms for quitters and nonquitters improved . Nonquitters worsened slightly on the Patient Health Question naire 9 relative to quitters ( differences ranged between 0.4 and 2.1 , P = .03 ) , whose scores did not change over time . CONCLUSION Among smokers with military-related PTSD , integrating smoking cessation treatment into mental health care compared with referral to specialized cessation treatment result ed in greater prolonged abstinence . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00118534 There is new evidence that smokers of all ages benefit from cessation of smoking . Although most older smokers , like younger smokers , prefer to quit on their own , at the time this project was started , there were no material s or programs targeted to older smokers . Using the literature , focus groups with older smokers and a national survey of older smokers , we created Clear Horizons , a self-help guide for older smokers , and a telephone counseling protocol tailored to the needs of older smokers ( age 50 - 74 ) . Smokers were recruited from around the United States and assigned r and omly to a control guide , Clearing the Air , Clear Horizons alone or Clear Horizons and two counselor calls . Follow-up of nearly 2000 smokers was conducted by telephone 3 , 6 , 12 and 24 months after delivery of the self-help guides . This report focuses primarily on results at 3 months because that was the measurement for reactions to the interventions . At the 3 month interview , those in the tailored interventions rated their guides more highly than did those in the control group . They also read more of their guides and were more likely to reread them . Quit rates were significantly higher among smokers who received a combination of the tailored guide and telephone counseling . At 3 months , the combination of the guide and telephone counseling was most effective in helping smokers to quit . By 12 months , both the tailored guide alone and the tailored guide and calls groups had higher quit rates than the control guide but were not statistically different from one another BACKGROUND Smoking has a well-documented detrimental effect on risk for myocardial infa rct ion and stroke , but less information is available regarding peripheral artery disease ( PAD ) , particularly among women . OBJECTIVE To prospect ively assess the association of 
    Output:
    
In general , more intensive interventions and those with combined approaches including medications and follow-up counseling achieved the best outcomes .
The quit rates from these studies and the relative effectiveness of different intervention approaches are consistent with the general smoking cessation literature .
However , in most studies , treatment effects were of short duration , and absolute quit rates were low , leaving the vast majority of older smokers at high risk for smoking-related health conditions .