***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 This study was conducted to determine the efficacy of the nicotine patch in smoking cessation when combined with self-help material s , three brief visits , and telephone counseling . METHODS One hundred fifty-nine healthy volunteers who smoked at least one pack of cigarettes per day and desired to quit smoking were enrolled in a double-blind trial with 6-week treatment and 6-month follow-up periods . After review of self-help material s , subjects were r and omly assigned to regimens of nicotine or placebo patches . Subjects wore two patches per day for 4 weeks ( 25 mg of nicotine per 24 hours ) , then one patch per day for 2 weeks . Return visits were at the ends of weeks 4 and 6 . Telephone counseling was given during weeks 1 , 2 , 3 , and 5 . Abstinence at 6 weeks was defined as zero cigarettes smoked for the previous 28 days , verified by exhaled carbon monoxide less than 8 ppm at 4 weeks and 6 weeks . Abstinence at 3 and 6 months was defined as self-report of zero cigarettes since the previous contact , verified by carbon monoxide value at 6 months . RESULTS Abstinence rates at 6 weeks , 3 months , and 6 months were 29.5 % , 21.8 % , and 20.5 % in the active group , and 8.8 % , 3.8 % , and 2.5 % in the placebo group ( P < or = .001 for each comparison ) , respectively . Skin irritation was the main side effect , causing 1.3 % to drop out . CONCLUSION The nicotine patch is efficacious in smoking cessation over a 6-month period , when combined with only self-help material s , three brief visits , and telephone counseling BACKGROUND R and omized efficacy clinical trials conducted in research setting s may not accurately reflect the benefits of tobacco dependence treatments when used in real-world clinical setting s. Effectiveness trials ( eg , in primary care setting s ) are needed to estimate the benefits of cessation treatments in real-world use . METHODS A total of 1346 primary care patients attending routine appointments were recruited by medical assistants in 12 primary care clinics . Patients were r and omly assigned to 5 active pharmacotherapies : 3 monotherapies ( nicotine patch , nicotine lozenge , and bupropion hydrochloride sustained release [ SR ] ) and 2 combination therapies ( patch + lozenge and bupropion SR + lozenge ) . Patients were referred to a telephone quit line for cessation counseling . Primary outcomes included 7-day point prevalence abstinence at 1 week , 8 weeks , and 6 months after quitting and number of days to relapse . RESULTS Among 7128 eligible smokers ( > or = 10 cigarettes per day ) attending routine primary care appointments , 1346 ( 18.9 % ) were enrolled in the study .  Six-month abstinence rates for the 5 active pharmacotherapies were the following : bupropion SR , 16.8 % ; lozenge , 19.9 % ; patch , 17.7 % ; patch + lozenge , 26.9 % ; and bupropion SR + lozenge , 29.9 % . Bupropion SR + lozenge was superior to all of the monotherapies ( odds ratio , 0.46 - 0.56 ) ; patch + lozenge was superior to patch and bupropion monotherapies ( odds ratio , 0.56 and 0.54 , respectively ) . CONCLUSIONS One in 5 smokers attending a routine primary care appointment was willing to make a serious quit attempt that included evidence -based counseling and medication . In this comparative effectiveness study of 5 tobacco dependence treatments , combination pharmacotherapy significantly increased abstinence compared with monotherapies . Provision of free cessation medications plus quit line counseling arranged in the primary care setting holds promise for assisting large numbers of smokers to quit . Trial Registration clinical trials.gov Identifier : NCT00296647 Sixty subjects were run in a study comparing the use of nicotine gum with placebo gum  during cessation from smoking . Subjects were given clinic support and chewed the gum ad libitum . A survival analysis showed the two groups differed significantly in successful abstinence over time ( p less than .03 ) . Differences between groups appeared early ( within weeks ) and , at six months , a 28 % superiority of nicotine over placebo gum was demonstrated with mean success rates of 48 % and 20 % , respectively . Between six months and one year , relapse in the nicotine group accounted for the 30 % vs. 20 % success rates for nicotine and placebo observed at one year . In a pilot study ( " dispensary " ) testing the efficacy of the two gums when intervention was minimal , subjects in both groups resumed smoking within the first two weeks . The enhanced short-term success rates with nicotine gum in the clinic study are attributed to an effective interaction between use of the active preparation and clinic support . Long-term cessation may require extended maintenance procedures and /or an identification of optimal gum use AIM To examine changes in nicotine withdrawal , nicotine craving , self-efficacy to quit smoking , and perceived control over withdrawal symptoms as predictors of smoking cessation following behavioral counseling and nicotine replacement therapy in a sample of smokers . DESIGN AND SETTING The data were ascertained from a r and omized effectiveness trial comparing nicotine patch to nicotine lozenge . Predictors of smoking cessation were assessed at baseline and 5 weeks post-baseline , and 24-hour point prevalence abstinence , biochemically confirmed , was assessed at the end-of-treatment ( week 15 ) and 6 months after a target quit date ( week 27 ) . PARTICIPANTS 642 treatment-seeking smokers r and omized to 12 weeks of nicotine patch or nicotine lozenge . FINDINGS Participants who showed a greater increase in self-efficacy to quit smoking ( OR=1.09 , 95 % CI : 1.02 - 1.16 , p=.01 ) and perceived control over withdrawal symptoms ( OR=1.02 , 95 % CI : 1.00 - 1.04 , p=.05 ) were significantly more likely to have quit smoking at week 15 . Participants who showed a greater increase in self-efficacy to quit smoking ( OR=1.04 , 95 % CI : 1.01 - 1.06 , p=.01 ) were significantly more likely to have quit smoking at week 27 . Changes in withdrawal symptoms and craving were not related to week 15 or week 27 abstinence rates . CONCLUSIONS The results highlight two relatively under-studied potential psychological predictors of abstinence following treatment for nicotine dependence . Behavioral counseling interventions to promote smoking cessation should help smokers develop confidence in their ability to quit smoking and increase their sense of control over withdrawal symptoms to increase their chances for cessation A non-combustible nicotine inhaler , administered orally , has been developed for treatment of smokers . The inhaler allows weaning from nicotine while maintaining partial reinforcement of the ritual/sensory phenomena of smoking . Subjects were r and omly assigned to  active ( n = 112 ) and placebo ( n = 111 ) groups . Some behavioral intervention occurred as a function of participation . Strict abstinence ( primary outcome criterion ) was defined by CO < or = 8 ppm with no slips allowed at any time and cotinine values < or = 14 at 1 year . Survival analysis showed active inhaler was superior to placebo ( p < 0.01 ) . Active vs. placebo  success rates were : 63 % vs. 47 % ( day 3 ) , 46 % vs. 28 % ( week 1 ) , 36 % vs. 19 % ( week 2 ) , 33 % vs. 16 % ( week 3 ) , 29 % vs. 14 % ( week 6 ) , 24 % vs. 10 % ( 3 months ) , 17 % vs. 9 % ( 6 months ) and 13 % vs. 8 % ( 1 year ) . chi 2 analyses were significant through 3 months but not at 6 months ( p < 0.08 ) or 1 year . Craving was relieved with active inhalers at day 3 and week 1 . Subjects averaged six inhalers/day . Cotinine levels were 57 - 61 % of smoking levels . Common side effects included throat/mouth irritation and coughing . Failure was predicted by early slips . The inhaler is clearly useful for short-term smoking cessation with potential for long-term efficacy . Extended access to the inhaler and relapse prevention training could improve success rates . Another promising approach would be to combine the inhaler with a nicotine patch BACKGROUND To determine the effectiveness of a 16-hour transdermal nicotine patch in assisting smokers to stop smoking , when used in a primary medical practice model . METHODS A single-site , r and omized , double-blind , out-patient , parallel-group , placebo-controlled trial consisting of 220 regular , otherwise healthy cigarette smokers . Patients participated in a 12-week patch treatment phase plus a 6-week tapering phase . A st and ard medical office model of physician intervention , such as could easily be employed by any primary care physician , without need for any special psychological services , training , or skills , was the behavioral intervention . RESULTS Sustained abstinence , determined at each visit by absolutely no cigarette use , carbon monoxide level of 9 ppm or less , and serum cotinine level of 15 ng/mL or less ( after week 18 ) , was significantly greater for those patients receiving the active nicotine patch than for those receiving the placebo patch : the percent of patients not smoking at 6 , 12 , 18 , 26 , and 52 weeks was 61 % vs 35 % , 45 % vs 26 % , 41 % vs 16 % , 34 % vs 12 % , and 25 % vs 9 % , respectively ( P < .001 ) . This 16-hour nicotine patch produced no systemic side effects and minimal skin irritation . CONCLUSIONS Nicotine replacement therapy via a 16-hour transdermal nicotine patch provided safe and effective treatment for tobacco-dependent patients . One-year sustained nonsmoking rates were nearly three times higher in the active than in the placebo condition , when the patch was used in an easily applicable st and ard medical practice setting , without the need for psychological interventions . This outcome was as good as or better than results achieved by nicotine patches using behavior modification or group counseling Three smoking cessation interventions design ed for use by general practitioners ( GPs ) within the routine consultation were evaluated in a field setting using 26 GPs throughout metropolitan Sydney . A total of 450 smoking patients were allocated to either Structured Behavioral Change with nicotine gum ( Group SBCN ) , Structured Behavioral Change without nicotine gum ( Group SBC ) , or GP advice with nicotine gum ( Group AN ) . Although significant differences in the percentage of abstainers were observed between Groups SBCN and SBC three weeks after treatment ( 39 % vs. 26 % ) , the point prevalence abstinence rate for patients at 12 months declined to 19 , 18 , and 12 % for Groups SBCN , SBC , and AN , respectively . Continuous abstinence to the end of the 12-month period was 9 % for Groups SBCN and SBC , and 6 % for Group AN . Forty-eight percent of the 450 patients made an attempt to stop smoking , and 89 % reduced their cigarette consumption at some point during the study . Examination of 132 self- selecting patients who fully participated in the three interventions and attended all scheduled visits , revealed significantly larger proportions of abstainers within Groups SBCN ( 34 % ) and SBC ( 33 % ) than in Group AN ( 15 % ) at the 12-month follow-up BACKGROUND This study was undertaken to evaluate the long-term smoking cessation efficacy of varying doses of transdermal nicotine delivery systems 4 to 5 years post-quit day . METHODS A follow-up study was conducted 48 to 62 months after quit day among patients who were enrolled in the Transdermal Nicotine Study Group investigation . The latter study included group smoking cessation counseling and r and omized assignment to 21 , 14 , or 7 mg nicotine patches or placebo patches .  Seven of nine smoking cessation research centers participated in the long term follow-up investigation . RESULTS The self-reported continuous quit rate among patients originally assigned 21 mg ( 20.2 % ) was significantly higher than rates for patients assigned 14 mg ( 10.4 % ) , 7 mg ( 11.8 % ) , or placebo patches ( 7.4 % ) . Log rank survival analysis found no difference in relapse rates after 1 year postcessation . Smokers under age 30 years were significantly less likely to be abstinent at long term follow-up compared to smokers > or = 30 years of age ( 3 vs 13 % , respectively ) . Mean weight gain in confirmed continuous quitters was 10.1 kg in men and 8.0 kg in women . Of the 63 continuous abstainers surveyed , 30 respondents ( 48 % ) reported that they no longer craved 
    Output:
    
The effect was similar in a small group of studies that aim ed to assess use of NRT obtained without a prescription .
In highly dependent smokers there was a significant benefit of 4 mg gum compared with 2 mg gum , but weaker evidence of a benefit from higher doses of patch .
There is no evidence that NRT increases the risk of heart attacks .
AUTHORS ' CONCLUSIONS All of the commercially available forms of NRT ( gum , transdermal patch , nasal spray , inhaler and sublingual tablets/lozenges ) can help people who make a quit attempt to increase their chances of successfully stopping smoking .
The effectiveness of NRT  appears to be largely independent of the intensity of additional support provided to the individual .
Provision of more intense levels of support , although beneficial in facilitating the likelihood of quitting , is not essential to the success of NRT