***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 : Emergency department ( ED ) patients show high smoking rates . The effects of ED-initiated tobacco control ( ETC ) on 7-day abstinence at 12 months were investigated . Methods : A r and omised controlled intention-to-treat trial ( trials registry no. : IS RCT N41527831 ) was conducted with 1044 patients in an urban ED .  ETC consisted of on-site counselling plus up to four telephone booster sessions . Controls received usual care . Analysis was by logistic regression . Results : In all , 630 ( 60.7 % ) participants were males , the median age was 30 years ( range 18–81 ) and the median smoking intensity was 15 ( range 1–60 ) cigarettes per day . Overall , 580 study participants ( 55.6 % ) were unmotivated , 331 ( 31.7 % ) were ambivalent and 133 ( 12.7 % ) were motivated smokers .  ETC ( median time 30 ( range 1–99 ) min ) was administered to 472 ( 91.7 % out of 515 ) r and omised study participants . At follow-up , 685 study participants ( 65.6 % of 1044 ) could be contacted . In the ETC group , 73 out of 515 ( 14.2 % ) in the ETC group were abstinent , whereas 60 out of 529 ( 11.3 % ) controls were abstinent ( OR adjusted for age and gender = 1.31 ( 95 % CI 0.91 to 1.89 , p = 0.15 ) . Stratified for motivation to change behaviour , the adjusted ORs for ETC versus usual care were OR = 1.00 ( 95 % CI 0.57 to 1.76 ) in unmotivated smokers , respectively OR = 1.37 ( 95 % CI 0.73 to 2.58 ) in ambivalent smokers and OR = 2.19 ( 95 % CI 0.98 to 4.89 ) in motivated smokers , p for trend = 0.29 . Conclusions : ETC , in the form of on-site counselling with up to four telephone booster sessions , showed no overall effect on tobacco abstinence after 12 months . A non-significant trend for a better performance of ETC  in more motivated smokers was observed Background Emergency departments ( EDs ) have strong potential to initiate tobacco interventions with economically disadvantaged population s. Purpose We piloted three ED-initiated tobacco interventions and derived parameter estimates for future trials . Methods The study enrolled adult patients being treated in an urban ED who were daily smokers . Exclusion criteria included severe illness or pain , isolation ( for contagion ) , altered mental status , an insurmountable language barrier , temporary residence , and lack of telephone access . Subjects in the Bedside + Booster group received motivational counseling by a trained counselor at the bedside , up to three telephone sessions post-visit , and a self-help guide . Subjects in the Faxed Referral group had their personal contact information faxed to the hospital ’s tobacco dependence clinic , whereupon they received identical treatment as the Bedside + Booster group , but all sessions occurred over the telephone ( i.e. , no bedside counseling ) . The St and ard Referral group received the self-help guide and a referral to the hospital ’s tobacco dependence clinic . We used a 2:2:1 r and omization schedule to maximize our experience with the motivational interventions . Outcomes were assessed at 1 and 3 months . Results We enrolled 90 subjects . Of the 36 subjects assigned to the Bedside + Booster condition , 31 ( 87 % ) completed bedside counseling and at least one booster session , while 22 ( 61 % ) completed the maximum four sessions . Of the 37 subjects assigned to the Faxed Referral group , 28 ( 76 % ) completed at least one telephone session , while 19 ( 51 % ) completed the maximum four sessions . Quit attempts over the 3 months ranged from 18 % ( St and ard Referral ) to 57 % ( Faxed Referral ) . Seven-day abstinence was attained by 8 % ( Bedside + Booster ) , 14 % ( Faxed Referral ) , and 6 % ( St and ard Referral ) at 3 months . Conclusions Motivational cessation counseling can be feasibly initiated during the ED encounter with minimal medical staff involvement . Adequately powered trials are needed to study ED-initiated interventions that include post-visit follow-up Introduction Motivational interviewing techniques have been minimally research ed as a function of a teenage smoking intervention . The present study examined the efficacy of a theory-based motivational tobacco intervention ( MTI ) . Methods A r and omized two-group design was used to compare 6-month post-baseline quit and reduction rates among teenagers who received the MTI  with those who received brief advice or care as usual .  Participants were smokers aged 14 to 19 years ( N = 75 ) who presented for treatment in a university-affiliated hospital emergency department ( ED ) .  Motivational interviewing techniques were used by trained providers to facilitate individual change ; stage-based take-home material s also were provided . Results Similar to past clinic-based studies of motivational interviewing with teenage smokers , our study found negative results in terms of intervention efficacy for cessation . Six-month follow-up cessation rates were nonsignificant — two teenagers quit smoking . Among teenagers who were available at follow-up , a medium effect size ( Cohen 's h = .38 ) was found for reduction and a large effect size ( Cohen 's h = .69 ) was found for percentage reduction , although these results also were not statistically significant . Conclusion Although the major findings of this study were not significant , the reductions in tobacco use suggest that motivational interviewing may be a clinical ly relevant counseling model for use in teenage smoking interventions . However , many questions remain , and the current literature lacks studies on trials with significant outcomes using motivational interviewing in smoking cessation . Additionally , more research is needed to examine the suitability of the ED for MTI-type interventions OBJECTIVE To assess the effect of physician counseling and referral on smoking cessation rates and attendance at a smoking cessation program . METHODS This was a prospect i ve , r and omized clinical trial set in a suburban , community teaching hospital emergency department ( ED ) . During study hours , dedicated research associates enrolled consecutive , stable , oriented patients who were smokers . Eligible , consenting patients were r and omized to one of two intervention groups . The control group received a two-page " Stop Smoking " pamphlet from the American Heart Association ( AHA ) . Patients in the intervention group were given the AHA pamphlet along with pharmacologic information and st and ardized counseling by the attending emergency physician , including written and oral referral to a smoking cessation program . The primary outcome measures were telephone contact/attendance at the smoking cessation program by the intervention group and the rate of smoking cessation in both study groups at three months post-ED visit . Categorical data were analyzed by chi-square and Fisher 's exact tests . Rank data were analyzed by Mann-Whitney tests and continuous data by t-tests . All tests were two-tailed with alpha set at 0.05 . RESULTS One hundred fifty-two patients were enrolled ; 78 were r and omized to the intervention group . Nearly 70 % of patients ( 103 ) were available for telephone follow-up . The study groups were statistically similar with regard to baseline demographic characteristics and the prevalence of moderate or severe nicotine addiction . None of the patients ( 0 % ) in the intervention group contacted or attended the smoking cessation program during the study period ( 95 % CI = 0 - 4 % ) . The percentages of patients who stopped smoking after three months were similar in the two groups [ 10.4 % ( 5/48 ) control vs 10.9 % ( 6/55 ) intervention ; p = 1 ] . CONCLUSION The authors found no difference in the smoking cessation rates between ED patients who received written material and those who were counseled by emergency physicians . Referral of patients who smoked to a cessation program was unsuccessful BACKGROUND Many people rely on EDs for routine health care . Often , however , screening and counseling for health risks are not provided . OBJECTIVE To determine prevalence rates of chronic disease and injury risk factors and access to routine health care in a r and om sample of ED patients in 3 cities . METHODS A prospect i ve survey was conducted at 3 hospital EDs in Akron , OH , Boston , MA , and Denver , CO . A modified version of the national Behavioral Risk Factor Surveillance Survey was administered by trained research ers to a convenience sample of non-critically ill patients during r and omly selected shifts . RESULTS Of 1,143 eligible patients , 923 ( 81 % ) agreed to participate . Their mean age was 39 ( range = 17 - 96 ) years . Most were female ( 58 % ) , white ( 60 % ) , and unmarried ( 68 % ) . Thirty-eight percent had no access to primary care . Injury-prone behaviors were prevalent : 53 % of the respondents did not wear seat belts regularly ; 15 % had no working smoke detector ; 3 % kept loaded , unlocked h and guns in their homes ; 11 % had attempted suicide ; 23 % had a positive CAGE screen for alcoholism ; 3 % had operated a motor vehicle in the preceding month while alcohol-intoxicated ; and 11 % had ridden in an automobile with an intoxicated driver . Cancer and chronic disease risks were also common : 48 % smoked ; 16 % had not received a blood pressure check in the preceding year ; and 4 % reported unsafe sexual practice s. Among women aged > 50 years , 42 % had not received a Pap test in the prior 2 years and 14 % had never had mammography . Many prevalence rates and access to care varied among the 3 sites . However , for most risk factors , prevalence rates did not differ in patients with and without access to primary health care . CONCLUSIONS ED patients have high rates of injury and chronic disease risks , and many have no other source of routine health care . Research is needed to determine whether ED-based programs , design ed to reduce injury and chronic disease risks , are feasible and cost-effective OBJECTIVE To define the prevalence of smokers and nicotine-addicted patients in a suburban , community ED . METHODS This was a prospect i ve survey of consecutive ED patients seen in a suburban ED with an annual patient census of 48,000 . Medically stable patients aged 18 years or older were eligible for inclusion . Patients were excluded if they had predominantly psychiatric complaints or were critically ill . Patients were queried about their smoking habits by a closed- question survey , which included the previously vali date d Fagerstrom Test for Nicotine Dependence . The study was conducted during a six-week period , only at times when there were dedicated research associates available to ensure consecutive patient entry . Continuous variables were analyzed by Student 's t-tests . Clinical variables were analyzed by chi-square tests . All tests were two-tailed with alpha at 0.05 . RESULTS 1,515 patients comprised the study group . The mean age ( + /-SD ) was 45.6 ( + /-18.9 ) years ; 52 % were female , 25 % were nonwhite , and 47 % were college graduates . There were 317 ( 21 % ) smokers . Patients having private physicians were less likely to smoke ( 18 % vs 29 % , p = 0.001 ) . Of all smokers , 46 % were moderately to severely nicotine-dependent , 69 % wanted to quit , and 30 % expressed an interest in joining a smoking cessation program . CONCLUSION A substantial percentage of ED patients smoke , many of them are nicotine-addicted , and the majority would like to quit . R and omized , controlled trials are needed to determine whether interventions by physicians in the ED can have an impact on the smoking habits of these patients This study examines the efficacy of a smoking cessation intervention on abstinence rates and motivation to quit smoking .  Participants were adult smokers ( N = 543 ) who presented to the emergency department with chest pain and who were admitted to an observation unit for 24-hour observation to rule out myocardial infa rct ion . Participants were r and omly assigned to either usual care or a tailored intervention employing motivational interviewing and telephone follow-up . All individuals choosing to quit were offered nicotine patch therapy . Follow-up assessment s were conducted at 1 , 3 and 6 months . Abstinence ( 7-day point prevalence ) rates were significantly greater among participants receiving the tailored intervention compared with those given usual care ( OR = 1.62 , 95 % CI [ 1.05 - 2.50 ] ) . The largest difference occurred at 1 month : 16.8 % of usual care and 27.3 % of the tailored intervention group were abstinent , with differences decreasing over time . One-third of participants who were quit at month 6 were late quitters whose initial abstinence began after the 1-month follow up . In addition to treatment assignment , psychosocial variables including motivation to quit , confidence , reduced temptation to smoke in response to negative affect , and the perception that their chest pain was related to their smoking , were significant predictors of cessation . Tailored interventions are effective in promoting initial quit attempts for emergency chest pain patients admitted to an observation unit . Additional 
    Output:
    
Findings indicate that ED visits in combination with ED-initiated tobacco cessation interventions are correlated with higher cessation rates than those reported in the National Health Interview Survey .