***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: 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 BACKGROUND Because smoking has a profound impact on socioeconomic disparities in illness and death , it is crucial that vulnerable population s of smokers be targeted with treatment . The U.S. Public Health Service recommends that all patients be asked about their smoking at every visit and that smokers be given brief advice to quit and referred to treatment . PURPOSE Initiatives to facilitate these practice s include the 5A 's ( ask , advise , assess , assist , arrange ) and Ask-Advise-Refer ( AAR ) . Unfortunately , primary care referrals are low , and most smokers referred fail to enroll . This study evaluated the efficacy of the Ask-Advise-Connect ( AAC ) approach to linking smokers with treatment in a large , safety net public healthcare system . DESIGN The study design was a pair-matched group-r and omized trial with two treatment arms . SETTING / PARTICIPANTS Ten safety net clinics in Houston TX . INTERVENTION Clinics were r and omized to AAC ( n=5 ; intervention ) or AAR ( n=5 ; control ) . Licensed vocational nurses ( LVNs ) were trained to assess and record the smoking status of all patients at all visits in the electronic health record . Smokers were given brief advice to quit . In AAC , the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas quitline daily , and patients were proactively called by the quitline within 48 hours . In AAR , smokers were offered a quitline referral card and encouraged to call on their own . Data were collected between June 2010 and March 2012 and analyzed in 2012 . MAIN OUTCOME MEASURES The primary outcome was impact , defined here as the proportion of identified smokers that enrolled in treatment . RESULTS The impact ( proportion of identified smokers who enrolled in treatment ) of AAC ( 14.7 % ) was significantly greater than the impact of AAR ( 0.5 % ) , t(4)=14.61 , p=0.0001 , OR=32.10 ( 95 % CI=16.60 , 62.06 ) . CONCLUSIONS The AAC approach to aiding smoking cessation has tremendous potential to reduce tobacco-related health disparities Smoking  cessation treatment is now integrated into many health-care systems and a major research effort is under way to improve current success rates . Until now results from r and omized clinical trials have been reported in many different ways , leading to problems of interpretation . We propose six st and ard criteria comprising the ' Russell St and ard ' ( RS ) . These criteria are applicable to trials of cessation aids where participants have a defined target quit date and there is face-to-face contact with research ers or clinic staff , as follows . ( 1 ) Follow-up for 6 months ( RS6 ) or 12 months ( RS12 ) from the target quit date or the end of a predefined ' grace period ' ; ( 2 ) self-report of smoking abstinence over the whole follow-up period allowing up to five cigarettes in total ; ( 3 ) biochemical verification of abstinence at least at the 6-month or 12-month follow-up point ; ( 4 ) use of an ' intention-to-treat ' approach in which data from all r and omized smokers are included in the analysis unless they have died or moved to an untraceable address ( participants who are included in the analysis are counted as smokers if their smoking status at the final follow-up can not be determined ) ; ( 5 ) following-up ' protocol violators ' and using their true smoking status in the analysis ; and ( 6 ) collecting follow-up data blind to smokers ' allocation to trial group . We believe that these criteria provide the best compromise between practicability and surrogacy for long-term cessation and will enable meaningful comparison between studies . There may be good reasons why other outcome criteria would also be reported , and studies that involve interventions with special groups or where there is no design ated target quit date or face to face contact would need to adapt these criteria accordingly Background Argentina and Uruguay are among the countries with the highest proportion of pregnant women who smoke . The implementation of an effective smoking cessation intervention would have a significant impact on the health of mothers and infants . The “ 5 A ’s ” ( Ask , Advise , Assess , Assist , Arrange ) is a strategy consisting of a brief cessation counseling session of 5–15 minutes delivered by a trained provider . The “ 5 A ’s ” is considered the st and ard of care worldwide ; however , it is under used in Argentina and Uruguay . Methods We will conduct a two-arm , parallel cluster r and omized controlled trial of an implementation intervention in 20 prenatal care setting s in Argentina and Uruguay . Prenatal care setting s will be r and omly allocated to either an intervention or a control group after a baseline data collection period . Midwives ’ facilitators in the 10 intervention prenatal clinics ( clusters ) will be identified and trained to deliver the “ 5 A ’s ” to pregnant women and will then disseminate and implement the program . The 10 clusters in the control group will continue with their st and ard in-service activities . The intervention will be tailored by formative research to be readily applicable to local prenatal care services at maternity hospitals and acceptable to local pregnant women and health providers . Our primary hypothesis is that the intervention is feasible in prenatal clinics in Argentina and Uruguay and will increase the frequency of women receiving tobacco use cessation counseling during pregnancy in the intervention clinics compared to the control clinics . Our secondary hypotheses are that the intervention will decrease the frequency of women who smoke by the end of pregnancy , and that the intervention will increase the attitudes and readiness of midwives towards providing counseling to women in the intervention clinics compared to the control clinics . Trial registration Clinical Trials.gov . Identifier : Background Extended smoking cessation follow-up after hospital discharge significantly increases abstinence . Hospital smoke-free policies create a period of ‘ forced abstinence ’ for smokers , thus providing an opportunity to integrate tobacco dependence treatment , and to support post-discharge maintenance of hospital-acquired abstinence . This study is funded by the National Heart , Lung , and Blood Institute ( 1U01HL1053231 ) . Methods / Design The Inpatient Technology-Supported Assisted Referral study is a multi-center , r and omized clinical effectiveness trial being conducted at Kaiser Permanente Northwest ( KPNW ) and at Oregon Health & Science University ( OHSU ) hospitals in Portl and , Oregon . The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition ( AR + IVR ) follow-up calls , compared to usual care inpatient counseling ( UC ) .  In November 2011 , we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days , willing to remain abstinent postdischarge , have a working phone , live within 50 miles of the hospital , speak English , and have no health-related barriers to participation . Each site will r and omize 450 patients to AR + IVR or UC using a 2:1 assignment strategy . Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications , and four IVR follow-up calls over seven weeks postdischarge . Participants do not have to accept the referral . At KPNW , UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services . The primary outcome is self-reported thirty-day smoking abstinence at six months postr and omization for AR + IVR participants compared to usual care . Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at six months , self-reported seven-day , thirty-day , and continuous abstinence at twelve months , intervention dose response at six and twelve months for AR + IVR recipients , incremental cost-effectiveness of AR + IVR intervention compared to usual care at six and twelve months , and health-care utilization and expenditures at twelve months for AR + IVR recipients compared to UC . Discussion This study will provide important evidence for the effectiveness and cost-effectiveness of linking hospital-based tobacco treatment specialists ’ services with discharge follow-up care . Trial Registration Clinical Trials.gov : AIMS Two methods of dissemination ( simple and intensive ) were used to disseminate a smoking cessation programme to doctors and midwives working in antenatal clinics . This paper describes the differential uptake of the smoking cessation programme by doctors and midwives . It investigates whether the number of smoking cessation interventions used differ due to the type of dissemination . It also examines the frequency with which doctors and midwives provide smoking cessation interventions after dissemination . DESIGN Clinics were r and omized to the method of dissemination ( simple or intensive ) . Pre-post test design was used to examine the relationship between dissemination method and professional status at baseline and follow-up . A baseline survey collected data on the use of smoking cessation intervention in the clinics prior to dissemination . A follow-up survey was conducted 18 months after the dissemination . SETTING Twenty-three public hospital antenatal clinics in NSW . PARTICIPANTS All clinical staff ( midwives and doctors ) working in the clinic during the 1 - 2-week survey period prior to dissemination and 18 months after the dissemination were asked to participate . The response rate was 63 % ( 223 ) at baseline and 64 % ( 182 ) at follow-up . Only 48 % of midwives and doctors at follow-up were working in the original clinic . MEASURES The proportion of clinicians who initially adopted the programme ; the proportion of clinicians who had used one or more programme components in the last week ) ; the number of types of smoking cessation intervention provided ( maximum = 13 ) , and the estimated proportion of clients offered smoking cessation intervention . FINDINGS More midwives than doctors " ever used " the programme ( 76 % vs. 25 % ) and continued to implement ( 58 % vs. 22 % ) the programme 18 months after dissemination . Both midwives and doctors increased the number of types of smoking cessation intervention offered at follow-up compared to baseline ( mean difference 2.8 ) . Midwives provided more smoking cessation interventions than doctors at baseline ( mean difference 0.9 ) and at follow-up ( 1.6 ) , regardless of method used to disseminate the programme . Midwives ' mean estimates of the proportion of clients offered interventions were greater than doctors ' ( midwives ' 59 % vs. doctors ' 35 % ) at follow-up . CONCLUSION The dissemination of a smoking cessation programme increased the level of smoking cessation interventions used by doctors and midwives . Doctors and midwives differ in their uptake of smoking cessation programmes . This information can be used to plan programme dissemination strategies in the future BACKGROUND A multicomponent motivational smoking cessation intervention was evaluated in 33 prenatal , family planning , and pediatric services in 12 public health clinics .  Clinic-based intervention components were implemented by clinic personnel as part of routine medical visits . METHODS The evaluation design included pre- and postintervention measurements of multiple study outcomes in a baseline ( all clinics prior to the start of the intervention ) and an experimental period ( matchedpair r and om assignment of clinics to intervention or control conditions ) . Subjects were 683 ( baseline ) and 1,064 ( experimental ) smokers with measurements of smoking outcomes at both times . Mixed-effects regressions analyzed individual outcomes clustered within clinics and services . RESULTS Control and intervention clinics had similar outcomes in the baseline period . In the experiment , outcomes improved in the intervention but not in the control clinics . Compared to controls , smokers exposed to the intervention were more likely to have quit ( 14.5 versus 7.7 % ) or take actions toward quitting and had higher mean action , stage of readiness , and motivation to quit scores . These positive effects persisted when clustering within clinics and services was controlled . CONCLUSIONS This intervention , implemented by clinic personnel as part of routine medical visits , was effective under these natural conditions across different types of clinic service STUDY OBJECTIVE To test whether physicians who receive a continuing education program ( " Quit for Life " ) about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients who smoke . DESIGN R and omized trial with blinded assessment of principal outcomes . SETTING Four health maintenance organization medical centers in northern California . SUBJECTS Eighty-one intern 
    Output:
    
AUTHORS ' CONCLUSIONS The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates , but have been shown to improve process outcomes , such as documentation of smoking status , provision of cessation counselling and referral to smoking cessation services .