***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 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 Eligible smokers ( N = 6,451 ) visiting the American Cancer Society 's Internet site offering cessation assistance were , with informed consent , r and omized to receive access either to a static Internet site with quitting advice or to one of five interactive sites provided by cooperating research partners . Three-month follow-up surveys were conducted via online survey with E-mail prompts , or telephone calls , to assess quitting success ; 54 % of participants provided follow-up data . Results showed no significant overall difference in cessation rates among participants assigned to the interactive or static sites . We found large differences in the utilization of the five interactive sites . When sites were grouped by level of use , a significantly higher reported 3-month cessation rate was observed among participants assigned to the more highly utilized sites than among those assigned to the less utilized sites ( 12.2 % vs. 10.2 % of all r and omized participants , 26.0 % vs. 22.1 % of followed participants ) . These findings show that interactive Internet sites yielding high levels of utilization can increase quitting success among smokers seeking assistance via the Internet Background Studies suggest that tailored material s are superior to nontailored material s in supporting health behavioral change . Several trials on tailored Internet-based interventions for smoking cessation have shown good effects . There have , however , been few attempts to isolate the effect of the tailoring component of an Internet-based intervention for smoking cessation and to compare it with the effectiveness of the other components . Objective The study aim was to isolate the effect of tailored emails in an Internet-based intervention for smoking cessation by comparing two versions of the intervention , with and without tailored content . Methods We conducted a two-arm , r and omized controlled trial of the open and free Norwegian 12-month follow-up , fully automated Internet-based intervention for smoking cessation , slutta.no . We collected information online on demographics , smoking , self-efficacy , use of the website , and participant evaluation at enrollment and subsequently at 1 , 3 , and 12 months . Altogether , 2298 self-selected participants aged 16 years or older registered at the website between August 15 , 2006 and December 7 , 2007 and were r and omly assigned to either a multicomponent , nontailored Internet-based intervention for smoking cessation ( control ) or a version of the same Internet-based intervention with tailored content delivered on the website and via email . Results Of the r and omly assigned participants , 116 ( of 419 , response rate = 27.7 % ) in the intervention group and 128 ( of 428 , response rate = 29.9 % ) in the control group had participated over the 12 months and responded at the end of follow-up . The 7-day intention-to-treat abstinence rate at 1 month was 15.2 % ( 149/982 ) among those receiving the tailored intervention , compared with 9.4 % ( 94/999 ) among those who received the nontailored intervention ( P < .001 ) . The corresponding figures at 3 months were 13.5 % ( 122/902 ) and 9.4 % ( 84/896 , P = .006 ) and at 12 months were 11.2 % ( 47/419 ) and 11.7 % ( 50/428 , P = .91 ) . Likewise , the intervention group had higher self-efficacy and perceived tailoring at 1 and 3 months . Self-efficacy was found to partially mediate the effect of the intervention . Conclusion Tailoring an Internet-based intervention for smoking cessation seems to increase the success rates in the short term , but not in the long term Background Although screening for tobacco use is increasing with electronic health records and st and ard protocol s , other tobacco-control activities , such as referral of patients to cessation re sources , is quite low . In the QUIT-PRIMO study , an online referral portal will allow providers to enter smokers ' email addresses into the system . Upon returning home , the smokers will receive automated emails providing education about tobacco cessation and encouragement to use the patient smoking cessation website ( with interactive tools , educational re sources , motivational email messages , secure messaging with a tobacco treatment specialist , and online support group ) . Methods The informatics system will be evaluated in a comparative effectiveness trial of 160 community-based primary care practice s , cluster-r and omized at the practice level . In the QUIT-PRIMO intervention , patients will be provided a paper information-prescription referral and then " e-referred " to the system . In the comparison group , patients will receive only the paper-based information-prescription referral with the website address . Once patients go to the website , they are subsequently r and omized within practice s to either a st and ard patient smoking cessation website or an augmented version with access to a tobacco treatment specialist online , motivational emails , and an online support group . We will compare intervention and control practice participation ( referral rates ) and patient participation ( proportion referred who go to the website ) . We will then compare the effectiveness of the st and ard and augmented patient websites . Discussion Our goal is to evaluate an integrated informatics solution to increase access to web-delivered smoking cessation support . We will analyze the impact of this integrated system in terms of process ( provider e-referral and patient login ) and patient outcomes ( six-month smoking cessation).Trial Registration Web-delivered Provider Intervention for Tobacco Control ( QUIT-PRIMO ) - a r and omized controlled trial : NCT00797628 AIM To examine self-efficacy and program exposure as possible mediators observed treatment effects for a web-based tobacco cessation intervention . DESIGN The ChewFree trial used a two-arm design to compare tobacco abstinence at both the 3- and 6-month follow-up for participants r and omized to either an  enhanced intervention condition  or a basic information-only control condition . SETTING Internet in US and Canada . PARTICIPANTS Our secondary analyses focused upon 402 participants who visited the web-based program at least once , whose baseline self-efficacy rating showed room for improvement , who reported that they were still using tobacco at the 6-week assessment , and for whom both 3- and 6-month follow-up data were available . INTERVENTION An enhanced web-based behavioral smokeless tobacco cessation intervention delivered program content using text , interactive activities , testimonial videos and an ask-an-expert forum and a peer forum . The basic control condition delivered tobacco cessation content using static text only . MEASUREMENTS Change in self-efficacy and program exposure from baseline to 6 weeks were tested as simple and multiple mediators on the effect of treatment condition on point-prevalence tobacco abstinence measured at 3- and 6-month follow-up . FINDINGS While both participant self-efficacy and program exposure satisfied the requirements for simple mediation , only self-efficacy emerged as a mediator when we used the more robust test of multiple mediation . CONCLUSIONS Results confirm the importance of self-efficacy change as a probable underlying mechanism in a successful web-based behavioral intervention . While program exposure was found to be a simple mediator of tobacco abstinence , it failed to emerge as a mediator when tested with self-efficacy change in a multiple mediator test suggesting that self-efficacy and program exposure share a complex , possibly reciprocal relationship with the tobacco abstinence outcome . Our results underscore the utility of search ing for mediators in research on web-based interventions Background Although many smokers seek Internet-based cessation assistance , few studies have experimentally evaluated long-term cessation rates among cigarette smokers who receive Internet assistance in quitting . Objective The purpose of this study is to describe long-term smoking cessation rates associated with 6 different  Internet-based cessation services  and the variation among them , to test the hypothesis that interactive and tailored Internet services yield higher long-term quit rates than more static Web-posted assistance , and to explore the possible effects of level of site utilization and a self-reported indicator of depression on long-term cessation rates . Method In 2004 - 05 , a link was placed on the American Cancer Society ( ACS ) website for smokers who wanted help in quitting via the Internet . The link led smokers to the QuitLink study website , where they could answer eligibility questions , provide informed consent , and complete the baseline survey . Enrolled participants were r and omly assigned to receive emailed access to one of five tailored interactive sites provided by cooperating research partners or to a targeted , minimally interactive ACS site with text , photographs , and graphics providing stage-based quitting advice and peer modeling . Results 6451 of the visitors met eligibility requirements and completed consent procedures and the baseline survey . All of these smokers were r and omly assigned to one of the six experimental groups . Follow-up surveys done online and via telephone interviews at approximately 13 months after r and omization yielded 2468 respondents ( 38 % ) and found no significant overall quit rate differences among those assigned to the different websites ( P = .15 ) . At baseline , 1961 participants ( 30 % ) reported an indicator of depression . Post hoc analyses found that this group had significantly lower 13-month quit rates than those who did not report the indicator ( all enrolled , 8 % vs 12 % , P < .001 ; followed only , 25 % vs 31 % , P = .003 ) . When the 4490 participants ( 70 % ) who did not report an indicator of depression at baseline were separated for analysis , the more interactive , tailored sites , as a whole , were associated with higher quitting rates than the less interactive ACS site : 13 % vs 10 % ( P = .04 ) among 4490 enrolled and 32 % vs 26 % ( P = .06 ) among 1798 followed . Conclusions These findings show that Internet assistance is attractive and potentially cost-effective and suggest that tailored , interactive websites may help cigarette smokers who do not report an indicator of depression at baseline to quit and maintain cessation Background Web-based computer-tailored approaches have the potential to be successful in supporting smoking cessation . However , the potential effects of such approaches for relapse prevention and the value of incorporating action planning strategies to effectively prevent smoking relapse have not been fully explored . The Stay Quit for You ( SQ4U ) study compared two Web-based computer-tailored smoking relapse  prevention programs with different types of planning strategies versus a control group . Objectives To assess the efficacy of two Web-based computer-tailored programs in preventing smoking relapse compared with a control group . The action planning ( AP ) program provided tailored feedback at baseline and invited respondents to do 6 preparatory and coping planning assignments ( the first 3 assignments prior to quit date and the final 3 assignments after quit date ) . The action planning plus ( AP+ ) program was an extended version of the AP program that also provided tailored feedback at 11 time points after the quit attempt . Respondents in the control group only filled out question naires . The study also assessed possible dose – response relationships between abstinence and adherence to the programs . Methods The study was a r and omized controlled trial with three conditions : the control group , the AP program , and the AP+ program .  Respondents were daily smokers ( N = 2031 ) , aged 18 to 65 years , who were motivated and willing to quit smoking within 1 month . The primary outcome was self-reported continued abstinence 12 months after baseline . Logistic regression analyses were conducted using three sample s : ( 1 ) all respondents as r and omly assigned , ( 2 ) a modified sample that excluded respondents who did not make a quit attempt in conformance with the program protocol , and ( 3 ) a minimum dose sample that also excluded respondents who did not adhere to at least one of the intervention elements . Observed case analyses and conservative analyses were conducted . Results In the observed case analysis of the r and omized sample , abstinence rates were 22 % ( 45/202 ) in the control group versus 33 % ( 63/190 ) in the AP program and 31 % ( 53/174 ) in the AP+ program . 
    Output:
    
The evidence from trials in adults suggests that interactive and tailored Internet-based interventions with or without additional behavioural support are moderately more effective than non-active controls at six months or longer , but there was no evidence that these interventions were better than other active smoking treatments .
Treatment effectiveness in younger people is unknown