***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 Research increasingly supports the conclusion that well- design ed programs delivered over the Internet can produce significant weight loss compared to r and omized controlled conditions . Much less is known about four important issues addressed in this study : ( 1 ) which recruitment methods produce higher eHealth participation rates , ( 2 ) which patient characteristics are related to enrollment , ( 3 ) which characteristics are related to level of user engagement in the program , and ( 4 ) which characteristics are related to continued participation in project assessment s. Methods We recruited overweight members of three health maintenance organizations ( HMOs ) to participate in an entirely Internet-mediated weight loss program developed by HealthMedia , Inc.  Two different recruitment methods were used : personal letters from prevention directors in each HMO , and general notices in member newsletters . The personal letters were sent to members diagnosed with diabetes or heart disease and , in one HMO , to a general membership sample in a particular geographic location . Data were collected in the context of a 2 × 2 r and omized controlled trial , with participants assigned to receive or not receive a goal setting intervention and a nutrition education intervention in addition to the basic program . Results A total of 2311 members enrolled . Bivariate analyses on aggregate data revealed that personalized mailings produced higher enrollment rates than member newsletters and that members with diabetes or heart disease were more likely to enroll than those without these diagnoses . In addition , males , those over age 60 , smokers , and those estimated to have higher medical expenses were less likely to enroll ( all P < .001 ) . Males and those in the combined intervention were less likely to engage initially , or to continue to be engaged with their Web program , than other participants . In terms of retention , multiple logistic regressions revealed that enrollees under age 60 ( P < .001 ) and those with higher baseline self-efficacy were less likely to participate in the 12-month follow-up ( P = .03 ) , but with these exceptions , those participating were very similar to those not participating in the follow-up . Conclusions A single personalized mailing increases enrollment in Internet-based weight loss . eHealth programs offer great potential for recruiting large numbers of participants , but they may not reach those at highest risk . Patient characteristics related to each of these important factors may be different , and more comprehensive analyses of determinants of enrollment , engagement , and retention in eHealth programs are needed Background Young adult smokers are a challenging group to engage in smoking cessation interventions . With wide reach and engagement among users , Facebook offers opportunity to engage young people in socially supportive communities for quitting smoking and sustaining abstinence . Objective We developed and tested initial efficacy , engagement , and acceptability of the Tobacco Status Project , a smoking cessation intervention for young adults delivered within Facebook . Methods The intervention was based on the US Public Health Service Clinical Practice Guidelines and the Transtheoretical Model and enrolled participants into study -run 3-month secret Facebook groups matched on readiness to quit smoking . Cigarette smokers ( N=79 ) aged 18 - 25 , who used Facebook on most days , were recruited via Facebook .  All participants received the intervention and were r and omized to one of three monetary incentive groups tied to engagement ( commenting in groups ) . Assessment s were completed at baseline , 3- , 6- , and 12-months follow-up . Analyses examined retention , smoking outcomes over 12 months ( 7-day point prevalence abstinence , ≥50 % reduction in cigarettes smoked , quit attempts and strategies used , readiness to quit ) , engagement , and satisfaction with the intervention . Results Retention was 82 % ( 65/79 ) at 6 months and 72 % ( 57/79 ) at 12 months . From baseline to 12-months follow-up , there was a significant increase in the proportion prepared to quit ( 10/79 , 13 % ; 36/79 , 46 % , P<.001 ) . Over a third ( 28/79 , 35 % ) reduced their cigarette consumption by 50 % or greater , and 66 % ( 52/79 ) made at least one 24-hour quit attempt during the study . In an intent-to-treat analysis , 13 % ( 10/79 ) self-reported 7-day abstinence ( 6/79 , 8 % verified biochemically ) at 12-months follow-up . In their quit attempts , 11 % ( 9/79 ) used a nicotine replacement therapy approved by the Food and Drug Administration , while 18 % ( 14/79 ) used an electronic nicotine delivery system to quit ( eg , electronic cigarette ) . A majority ( 48/79 , 61 % ) commented on at least one Facebook post , with more commenting among those with biochemically verified abstinence at 3 months ( P=.036 ) and those r and omized to receive a personal monetary incentive ( P=.015 ) . Over a third of participants ( 28/79 , 35 % ) reported reading most or all of the Facebook posts . Highest acceptability ratings of the intervention were for post ease ( 57/79 , 72 % ) and thinking about what they read ( 52/79 , 66 % ) ; 71 % ( 56/79 ) recommended the program to others . Only 5 participants attended the optional cognitive-behavioral counseling sessions , though their attendance was high ( 6/7 sessions overall ) and the sessions were rated as easy to underst and , useful , and helpful ( all 90 - 100 % agreed ) . Conclusions A Facebook quit smoking intervention is attractive and feasible to deliver , and early efficacy data are encouraging . However , the 1.5-fold greater use of electronic cigarettes over nicotine replacement products for quitting is concerning 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 . The AP program ( odds ratio 1.95 , P = .005 ) and the AP+ program ( odds ratio 1.61 , P = .049 ) were significantly more effective than the control condition . Abstinence rates and effects differed per sample . Finally , the results suggest a dose – response relationship between abstinence and the number of program elements completed by the respondents . Conclusion Despite the differences in results caused by the variation in our analysis approaches , we can conclude that Web-based computer-tailored programs combined with planning strategy assignments and feedback after the quit attempt can be effective in preventing relapse 12 months after baseline . However , adherence to the intervention seems critical for effectiveness . Finally , our results also suggest that more research is needed to assess the optimum intervention dose . Trial Registration Dutch Trial Register : NTR1892 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=1892 ( Archived by WebCite at http://www.webcitation.org/693S6uuPM Background Dem and for online information and help exceeds most other forms of self-help . Web-assisted tobacco interventions ( WATIs ) offer a potentially low-cost way to reach millions of smokers who wish to quit smoking and to test various forms of online assistance for use/utilization and user satisfaction . Objectives Our primary aim was to determine the utilization of and satisfaction with 2 versions of a smoking cessation website ( smokefree.gov ) , one of which included an asynchronous bulletin board ( BB condition ) . A secondary goal was to measure changes in smoking behavior 3 months after enrollment in the study . Methods All participants were adult federal employees or contractors to the federal government who responded to an email and indicated a willingness to quit smoking in 30 days . We r and omly assigned participants to either the BB condition or the publicly available version — usual care (UC)— and then assessed the number of minutes of website use and satisfaction with each condition as well as changes in smoking behavior . Results Among the 1375 participants , 684 were r and omized to the BB intervention  , and 691 to the control UC condition . A total of 39.7 % returned a follow-up question naire after 3 months , with similar rates across the two groups ( UC : n=279 , 40.3 % ; BB : n=267 , 39.0 % ) . Among those respondents assigned to the BB condition , only 81 participants ( 11.8 % ) elected to view the bulletin board or post a message , limiting our ability to analyze the impact of bulletin board use on cessation . Satisfaction with the website was high and did not differ significantly between conditions ( UC : 90.2 % , BB : 84.9 % , P= .08 ) . Utilization , or minutes spent on the website , was significantly longer for the BB than the UC condition ( 18.0 vs 11.1 , P = .01 ) and was nearly double for those who remained in the study ( 21.2 ) than for those lost to follow-up ( 9.6 , P < .001 ) . Similar differences were observed between those who made a serious quit attempt versus those who did not ( 22.4 vs 10.4 , P= .02 ) and between those with a quit date on or a few days prior to the enrollment date versus those with a later quit date ( 29.4 vs 12.5 , P = .001 ) . There were no statistically significant differences in quit rates between the BB and UC group , both in intent-to-treat analysis ( ITT ) and in analyzing the adherence subgroup ( respondents ) only . Combined across the UC and BB groups , 7-day abstinence was 6.8 % with ITT and 17.6 % using only participants in the follow-up ( adherence ) . For participants who attempted to quit within a few days of study entry ( vs 30 days ) , quit rates were 29.6 % ( ITT ) and 44.4 % ( adherence ) . Conclusions Quit rates for participants were similar to other WATIs , with the most favorable outcomes demonstrated by smokers ready to quit at the time of enrolling in the trial and smokers using pharmacotherapy . Utilization of the asynchronous bulletin board was lower than expected , and did not have an impact on outcomes ( quit rates ) . Given the dem and for credible online re sources for smoking cessation , future studies should continue to evaluate use of and satisfaction with Web features and to clarify results in terms of time since last cigarette as well as use of pharmacotherapy . Trial Registration Clinical trials.gov NCT00245076 ; http:// clinical trials.gov/ct2/show/NCT00245076 ( Archived by WebCite at http://www.webcitation.org/5dBuBASA0 Background Effective web-assisted tobacco interventions ( WATIs ) have been underutilized by smokers ; moreover , despite practice guideline recommendations , clinical teams do not routinely refer smokers to WATIs . Our goal was to test a clinical practice innovation , an ePortal design ed to change practice and patient behavior . Our hypotheses were that the integrated system would result in increased smoker referrals , with an automated follow-up system result ing in more smoker registration s and finally augmentations of the WATI would result in more smokers quitting at 6 months . Methods Practice ePortal Implementation Trial : Practice s ( n = 174 ) were r and omized to an online practice ePortal with an “ e-referral tool ” to the WATI ( e-referred smokers received automated email reminders from the practice ) and with practice feedback reports with patient tracking and practice -to-patient secure messaging versus comparison ( a paper “ referral prescription ” ) . Implementation success was measured by the number of smokers referred and smokers registering . Clinical Effectiveness Trial : To estimate the effectiveness of the WATI components on 6-month smoking cessation , registered smokers were r and omized into three groups : a state-of-the-art tailored WATI control [ control ] , the WATI enhanced with proactive , pushed tailored 
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The narrative synthesis demonstrated that tailoring , multimedia delivery of content and reminders are potential techniques for promoting engagement .
The evidence for social support was inconclusive and negative for incentives .
Conclusions This review was the first to examine engagement promoting strategies in solely online substance-use interventions .
Three strategies were identified that may be integral in promoting engagement with online substance-use interventions .