***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: INTRODUCTION The efficacy of contingency-management ( CM ) and motivational enhancement therapy ( MET ) for college student smoking cessation was examined . METHODS Nontreatment-seeking daily smokers ( N = 110 ) were r and omly assigned to 3 weeks of CM versus noncontingent reinforcement ( NR ) and to three individual sessions of MET versus a relaxation control in a 2 x 2 experimental design . Expired carbon monoxide ( CO ) sample s were collected twice daily for 3 weeks . Participants earned 5 US dollars for providing each sample ; additionally , those r and omized to CM earned escalating monetary rewards based on CO reductions ( Week 1 ) and smoking abstinence ( Weeks 2 - 3 ) . RESULTS Compared with NR , CM result ed in significantly lower CO levels and greater total and consecutive abstinence during the intervention . Those in the CM and MET groups reported greater interest in quitting smoking posttreatment , but rates of confirmed abstinence at follow-up were very low ( 4 % at 6-month follow-up ) and did not differ by group . DISCUSSION Findings support the short-term efficacy of CM for reducing smoking among college students . Future research should explore enhancements to CM in this population , including a longer intervention period and the recruitment of smokers who are motivated to quit Chronic Obstructive Pulmonary Disease ( COPD ) usually results from tobacco smoking . Smoking cessation slows COPD 's progression , but few have studied anti-smoking treatments in COPD . In 3-month trials we paid lottery tickets during daily home visits to still-smoking COPD patients for reductions in breath carbon monoxide ( CO ) , a measure of smoke intake . In our first protocol experimental patients received 0 - 3 tickets per day , depending upon the extent of CO reduction below pre-treatment baselines ; yoked controls received the same number of tickets , but not contingent on CO . The protocol produced no change . In a second study patients were assigned a post-baseline quit- date , received nicotine gum , and were paid up to 5 tickets per night , but only for CO less than 10 parts per million ( ppm ) . CO fell sharply as the intervention began , but gradually rose again . A third protocol added special reinforcement schedules for those who did not quit or relapsed ( up to 20 tickets per night for CO less than 10 ppm ) . Daily CO concentrations fell from 27.1 parts per million ( baseline mean ) to 12.7 ( intervention mean ) , but rapid increases followed the intervention . Few patients stopped smoking , but CO and cigarettes used per day significantly fell during Studies 2 and 3 . Post-hoc analysis suggested only a small effect from gum Rationale Sustaining smoking abstinence during the initial weeks of a cessation effort is highly correlated with long-term smoking abstinence . However , experimental research is needed to establish a direct causal relationship between achieving early abstinence and lowered relapse risk . Objective In the present study , we tested whether a period of sustained abstinence directly decreases the relative reinforcing effects of cigarette smoking . Methods Participants were 63 adult smokers who were r and omized into one of three conditions : 14-day ( 14C ) , 7-day ( 7C ) , and 1-day ( 1C ) contingent payment for smoking abstinence . Smoking status was assessed three times per day for 14 consecutive days using breath carbon monoxide monitoring and an abstinence criterion of ≤4 ppm . In the 14C condition , monetary payment was contingent on abstinence for all 14 days ; in the 7C condition , payment was noncontingent for days 1–7 and contingent for days 8–14 ; in the 1C condition , payment was noncontingent for days 1–13 and contingent for day 14 . On day 14 , all participants completed a 3-h preference session under controlled laboratory conditions wherein they could make a maximum of 20 exclusive choices between options to smoke ( two puffs/choice ) or earn money ( $ 0.25/choice ) . Preference was deemed an index of the relative reinforcing effects of smoking and money . Results A significantly lower proportion of participants in the 14C condition ever chose the smoking option ( 19 % ) compared to those in the 7C ( 57 % ) or 1C ( 62 % ) conditions . Conclusions These results provide experimental evidence that sustained abstinence can decrease the relative reinforcing effects of smoking , an effect that may be related to the commonly observed decrease in relapse risk among those who are able to sustain smoking abstinence during the initial weeks of a cessation effort Medication noncompliance with smoking cessation pharmacotherapies is a significant problem in both research and clinical setting s. This r and omized , controlled , single-blind study compared three single-session psychological interventions to increase use of nicotine gum during a 15-day treatment period . A total of 97 adult smokers were r and omized to receive st and ard treatment ( ST , n = 31 ) , brief feedback ( BF , n = 32 ) plus ST , or contingency management ( CM ; i.e. , payment for chewing at least 12 pieces/day on 10 of 15 intervention days , n = 34 ) plus ST and BF . Only the CM condition led to significantly greater average daily gum use ( pieces/day : ST , 6.17 ; BF , 7.81 ; CM , 10.17 [ p values < .05 ] ) and higher rates of compliance ( ST , 13.6 % ; BF , 25.2 % ; CM , 65.6 % [ p values < .001 ] ) . No differences were observed in smoking abstinence , nicotine withdrawal , or urinary cotinine as a function of treatment . Implication s of the present findings are discussed , including application to clinical trials and extension to real-world use of nicotine gum Background . There have been few reports of the process of implementing ongoing worksite health promotion programs . This article describes the implementation of a year-long smoking cessation program in nine worksites employing a total of approximately 700 smokers . Methods . Issues discussed include : forming a partnership with organizations , design of the multicomponent incentive intervention , program promotion , maintaining participation , and the need to modify program components over time . Results . The program produced high participation rates ( 29 % of smokers joined the program ) and moderate cessation rates among participants ( during the last half of the program , monthly cessation rates averaged 20 % ) . There was marked variability across worksites on both participation and cessation , and qualitative features of organizations associated with outcome are discussed . Discussion . The importance of working with employee steering committees to tailor health promotion programs to fit the organization is discussed . The article concludes with recommendations for implementation of similar programs Purpose . To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition . Design . A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs , each assigned to separate worksites . Setting . The study was conducted from 1990 to 1991 at three aerospace industry worksites in California . Subjects . All employees who were current , regular tobacco users were eligible to participate in the program offered at their site . Intervention . The multicomponent program included a self-help package , telephone counseling , and other elements . The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program . The traditional program offered a st and ard smoking cessation program . Measures . Self-reported question naires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period . Results . The incentive-competition program had an abstinence rate of 41 % at 6 months ( n = 68 ) , which was significantly better than the multicomponent program ( 23 % , n = 81 ) or the traditional program ( 8 % , n = 36 ) . At 12 months , the quit rates for the incentive and multicomponent programs were statistically indistinguishable ( 37 % vs. 30 % ) , but remained higher than the traditional program ( 11 % ) . Chi-square tests , t-tests , and logistic regression were used to compare smoking abstinence across the three programs . Conclusions . Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition , and more effective than a traditional program Biochemical validation of smoking status has long been considered essential , but recent reports have question ed its utility in certain kinds of field trials . We describe efforts to biochemically vali date self-reports of smoking cessation from participants in four large-scale r and omized trials in outpatient clinics , hospitals , worksites , and dental clinics . These studies included over 5,000 adults smokers who participated in the population -based low-intensity intervention evaluations . At a 1-year follow-up , 798 subjects reported no tobacco use . We attempted to verify these reports using saliva continine/carbon monoxide validation procedures . Overall , there was a moderately high nonparticipation rate ( 27 % ) , a low disconfirmation rate ( 4 % ) , and a high self-reported relapse rate ( 12 % ) in the interval between survey and biochemical validation . There were no differences between intervention and control conditions on any of the above variables . Longer duration s of self-reported abstinence were strongly related to increased probability of biochemical confirmation . Differences in results across projects were related to how biochemical validation was conducted . These results , as well as statistical power considerations , raise questions about whether biochemical validation procedures are practical , informative , or cost-effective in such population -based , low-intensity intervention research This study determined the effects on smoking behavior of providing contingent reinforcement for  nonsmoking  versus  reduced smoking  afternoon breath carbon monoxide ( CO ) target levels . Twenty-eight hired chronic smoker volunteers were r and omly assigned to one of three experimental conditions during a 10-day intervention : ( a ) 8 ppm target CO , $ 5 per day incentive ( n = 11 ) ; ( b ) 16 ppm target CO , $ 4 per day incentive ( n = 8) ; or ( c ) 8 ppm target CO , no incentive ( n = 9 ) . Both payment groups showed significantly lower CO levels and greater amounts of daytime smoking reduction than the no-pay group . A specific effect of CO target was also seen ; 45 % of subjects in the 8 ppm group compared with 0 % of subjects in the 16 ppm target and no-pay groups produced average afternoon CO levels of 8.5 ppm or lower during the intervention . Average levels of CO and smoking reduction did not differ for the two paid groups , however , because some subjects in the 8 ppm group failed to reduce CO sufficiently to contact the reinforcer . Contingent reinforcement based on expired air CO levels can exercise powerful and precise ( target-specific ) control over smoking behavior , but there may be individual differences in ability to meet reinforcement contingencies if difficult targets are introduced abruptly The relationship between reinforcer amount and daytime smoking reduction in smokers offered money for reduced afternoon breath carbon monoxide ( CO ) levels was examined . Twenty-three hired regular smokers with average baseline CO levels of about 30 ppm were exposed in r and om order to five sliding scale payment schedules that changed daily or weekly . Money was available for afternoon CO readings between 0 and 21 ppm with pay amount inversely related to the absolute CO reading obtained . Maximum pay amount for readings below 7 ppm varied among $ 0 , $ 1.50 , $ 3 , $ 6 , and $ 12 per day . Contingent reinforcement promoted CO and daytime cigarette reduction within individuals with the amount of behavior change related to the amount of payment available . Average CO levels decreased from 30 to 15 ppm as a function of pay amount whereas self-reported daytime cigarettes decreased from 12 to 5 per day . Average minutes of cigarette abstinence prior to the afternoon study contact increased from 62 to 319 minutes as a function of pay amount , whereas the percentage of available money earned increased from 22 % to 48 % . Nontargeted evening cigarette use also decreased during periods of daytime smoking reduction . The orderly effects of this contingent reinforcement intervention on daytime smoking of regular smoker volunteers suggest that this is a sensitive model for continued evaluation of factors that influence smoking reduction and cessation BACKGROUND Smoking is the leading preventable cause of premature death in the United States . Previous studies of financial incentives for smoking cessation in work setting s have not shown that such incentives have significant effects on cessation rates , but these studies have had limited power , and the incentives used may have been insufficient . METHODS We r and omly assigned 878 employees of a multinational company based in the United States to receive information about smoking-cessation programs ( 442 employees ) or to receive information about programs plus financial incentives ( 436 employees ) . The financial incentives were $ 100 for completion of a smoking-cessation program , $ 250 for cessation of smoking within 6 months after study enrollment , as confirmed by a biochemical test , and $ 400 for abstinence for an additional 6 months after the initial cessation , as confirmed by a biochemical test . Individual participants were stratified according to work site , heavy or nonheavy smoking , and income . The primary end point was smoking cessation 9 or 12 months after enrollment , depending on whether initial cessation was reported at 3 or 6 months . Secondary end points were smoking cessation within the first 6 months after enrollment and rates of participation in and completion of smoking-cess 
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In the remaining trials , there was no clear evidence that participants who committed their own money to the programme did better than those who did not , or that contingent rewards enhanced success rates over fixed payment schedules .
There is some evidence that recruitment rates can be improved by rewarding participation , which may be expected to deliver higher absolute numbers of successful quitters .
With the exception of one recent trial , incentives and competitions have not been shown to enhance long-term cessation rates .
Early success tended to dissipate when the rewards were no longer offered .
Rewarding participation and compliance in contests and cessation programmes may have potential to deliver higher absolute numbers of quitters .