human
***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: Objective : We sought to assess whether either a low-cost educational intervention or small monetary incentive is more effective than usual care in lowering  low-density lipoprotein ( LDL ) cholesterol among employees . Methods : Employees with an LDL-C > 130 mg/dL were eligible . After receiving on-line educational material s , subjects were assigned to three groups : group 1 received $ 100 if they reduced their LDL-C by 15 % within 6 months , group 2 participated in a multi-disciplinary educational program , and group 3 received no further intervention . Results : In total , 171 employees participated . Baseline mean LDL-C was 156 mg/dL. Approximately 6 months after r and omization , mean LDL-C was reduced 17.9 mg/dL ( 11.3 % ) in group 1 , 17.9 mg/dL ( 11.5 % ) in group 2 , and 5.5 mg/dL ( 3.5 % ) in group 3 . Reductions in groups 1 and 2 were statistically superior to group 3 ( P = 0.02 ) . Conclusions : Both an employer directed low-cost educational program and small monetary incentives similarly lowered LDL-C compared with usual care 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 BACKGROUND The relation between cigarette smoking and several malignancies is still unclear . We examined the association of cigarette smoking with death attributed to 15 cancer sites , 7 of which are regarded as having an uncertain relation with tobacco . PATIENTS AND METHODS The original Whitehall study is a prospect i ve cohort of 17 363 London-based male government employees ( age 40 - 69 years ) who were examined in the late 1960s and then followed up for a maximum of 38 years . RESULTS Following adjustment for demographic characteristics , risk factors , and prevalent disease , established positive cigarette smoking -- cancer gradients were confirmed for carcinoma of the lung , stomach , pancreas , bladder , upper aero-digestive ( including oesophagus ) , and liver , and for myeloid leukaemia . Among the cancers of uncertain relation with smoking , mortality rates for malignancy of the colon , rectum and prostate and for lymphatic leukaemia were elevated in current and /or former smokers . There was essentially no apparent relation between smoking and mortality from carcinoma of the brain or from lymphoma . CONCLUSION In this study , cigarette smoking appears to be a risk factor for several malignancies of previously unclear association with tobacco use Exercise is the best predictor of long-term weight loss . This study evaluated two strategies for improving exercise adherence and long-term weight loss in obese out patients . Obese men and women ( N = 193 ) were r and omized to 1 of 5 treatment groups for 18 months : st and ard behavior therapy ( SBT ) ; SBT with supervised walks ( SW ) 3 times per week ; SBT + SW with personal trainers ( PT ) , who walked with participants , made phone reminders , and did make-up SW ; SBT + SW with monetary incentives ( I ) for completing SW ; and SBT + SW + PT + I. Both PT and I enhanced attendance at SWs , the combination producing the best adherence . Increased walk attendance did not result in higher overall energy expenditure , however , and long-term weight loss was also not improved . Post hoc analyses suggest that the level of exercise needed for successful long-term weight loss is much higher than that usually recommended in behavioral treatment programs Background — The impact of overall dietary patterns that reflect actual eating behaviors on mortality caused by cardiovascular or other chronic diseases is largely unknown . Methods and Results — We prospect ively evaluated the relation between dietary patterns and risk of cardiovascular , cancer , and all-cause mortality among 72 113 women who were free of myocardial infa rct ion , angina , coronary artery surgery , stroke , diabetes mellitus , or cancer and were followed up from 1984 to 2002 . Dietary patterns were derived by factor analysis based on vali date d food frequency question naires administered every 2 to 4 years . Two major dietary patterns were identified : High prudent pattern scores represented high intakes of vegetables , fruit , legumes , fish , poultry , and whole grains , whereas high Western pattern scores reflected high intakes of red meat , processed meat , refined grains , french fries , and sweets/desserts . During 18 years of follow-up , 6011 deaths occurred , including 1154 cardiovascular deaths and 3139 cancer deaths . After multivariable adjustment , the prudent diet was associated with a 28 % lower risk of cardiovascular mortality ( 95 % confidence interval [ CI ] , 13 to 40 ) and a 17 % lower risk of all-cause mortality ( 95 % CI , 10 to 24 ) when the highest quintile was compared with the lowest quintile . In contrast , the Western pattern was associated with a higher risk of mortality from cardiovascular disease ( 22 % ; 95 % CI , 1 to 48 ) , cancer ( 16 % ; 95 % CI , 3 to 30 ) , and all causes ( 21 % ; 95 % CI , 12 to 32 ) . Conclusion — Greater adherence to the prudent pattern may reduce the risk of cardiovascular and total mortality , whereas greater adherence to the Western pattern may increase the risk among initially healthy women ABSTRACT BACKGROUND Previous efforts to use incentives for weight loss have result ed in substantial weight regain after 16 weeks . OBJECTIVE To evaluate a longer term weight loss intervention using financial incentives . DESIGN A 32-week , three-arm r and omized controlled trial of financial incentives for weight loss consisting of a 24-week weight loss phase during which all participants were given a weight loss goal of 1 pound per week , followed by an 8-week maintenance phase . PARTICIPANTS Veterans who were patients at the Philadelphia Veterans Affairs Medical Center with BMI s of 30–40.INTERVENTION Participants were r and omly assigned to participate in either a weight-monitoring program involving a consultation with a dietician and monthly weigh-ins ( control condition ) , or the same program with one of two financial incentive plans . Both incentive arms used deposit contracts ( DC ) in which participants put their own money at risk ( matched 1:1 ) , which they lost if they failed to lose weight . In one incentive arm participants were told that the period after 24 weeks was for weight-loss maintenance ; in the other , no such distinction was made . MAIN MEASUREWeight loss after 32 weeks . KEY RESULTS Results were analyzed using intention-to-treat . There was no difference in weight loss between the incentive arms ( P = 0.80 ) . Incentive participants lost more weight than control participants [ mean DC = 8.70 pounds , mean control = 1.17 , P = 0.04 , 95 % CI of the difference in means ( 0.56 , 14.50 ) ] . Follow-up data 36 weeks after the 32-week intervention had ended indicated weight regain ; the net weight loss between the incentive and control groups was no longer significant ( mean DC = 1.2 pounds , 95 % CI , -2.58–5.00 ; mean control = 0.27 , 95 % CI , -3.77–4.30 , P = 0.76 ) . CONCLUSIONS Financial incentives produced significant weight loss over an 8-month intervention ; however , participants regained weight post-intervention Behavioral treatments for obesity seek to modify eating and exercise behaviors by a change in their antecedents and consequences . More direct modification of antecedents and consequences by ( a ) the provision of food to patients and ( b ) the provision of financial rewards for weight loss was hypothesized to improve treatment outcomes . Two hundred two men and women were r and omly assigned to no treatment , st and ard behavioral treatment ( SBT ) , SBT plus food provision , SBT plus incentives , or SBT plus food provision and incentives . The major finding was that food provision significantly enhanced weight loss . Weight losses with  SBT  averaged 7.7 , 4.5 , and 4.1 kg at 6 , 12 , and 18 months , respectively , compared with 10.1 , 9.1 , and 6.4 kg , respectively , at the same intervals with the addition of food . Food provision also enhanced attendance , completion of food records , quality of diet , and nutrition knowledge . We conclude that the provision of food to weight-loss patients is a promising methodology that deserves further exploration Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Reports of studies relating physical activity to stroke and cancer sub-types indicate inconsistent findings . Some are hampered by low statistical power , owing to a low number of events , and a failure to adjust for potential confounding variables . The purpose of this study was to relate physical activity to 12 mortality endpoints in a prospect i ve cohort study of 11,663 men aged 40–64 years who responded to an enquiry about travel activity during a baseline medical examination conducted between 1967 and 1969 . During 25 years of follow-up there were 4672  deaths .  Travel activity  was inversely related to mortality attributable to all-causes , coronary heart disease , respiratory disease and lung cancer , whereas the association with stroke was positive . There was evidence for attenuation of some of these associations on adjustment for potentially confounding variables . Our simplistic measure of physical activity may , in part , explain the weak associations seen 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-cessation programs . RESULTS The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment ( 14.7 % vs. 5.0 % , P<0.001 ) and 15 or 18 months after enrollment ( 9.4 % vs. 3.6 % , P<0.001 ) . Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program ( 15.4 % vs. 5.4 % , P<0.001 ) , completion of a smoking-cessation program ( 10.8 % vs. 2.5 % , P<0.001 ) , and smoking cessation within the first 6 months after enrollment ( 20.9 % vs. 11.8 % , P<0.001 ) . CONCLUSIONS In this study of employees of one large company , financial incentives for smoking cessation significantly increased the rates of smoking cessation . ( Clinical Trials.gov number , NCT00128375 . AIMS This study examined whether voucher-based reinforcement therapy ( VBRT ) contingent upon smoking abstinence during pregnancy is an effective method for decreasing  maternal smoking during pregnancy and improving fetal growth . DESIGN , SETTING AND P 
    Output:
    
agent
Personal financial incentives can change habitual health-related behaviors and help reduce health inequalities .
However , their role in reducing disease burden is potentially limited given current evidence that effects dissipate beyond three months post-incentive removal
***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: Objective : We sought to assess whether either a low-cost educational intervention or small monetary incentive is more effective than usual care in lowering  low-density lipoprotein ( LDL ) cholesterol among employees . Methods : Employees with an LDL-C > 130 mg/dL were eligible . After receiving on-line educational material s , subjects were assigned to three groups : group 1 received $ 100 if they reduced their LDL-C by 15 % within 6 months , group 2 participated in a multi-disciplinary educational program , and group 3 received no further intervention . Results : In total , 171 employees participated . Baseline mean LDL-C was 156 mg/dL. Approximately 6 months after r and omization , mean LDL-C was reduced 17.9 mg/dL ( 11.3 % ) in group 1 , 17.9 mg/dL ( 11.5 % ) in group 2 , and 5.5 mg/dL ( 3.5 % ) in group 3 . Reductions in groups 1 and 2 were statistically superior to group 3 ( P = 0.02 ) . Conclusions : Both an employer directed low-cost educational program and small monetary incentives similarly lowered LDL-C compared with usual care 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 BACKGROUND The relation between cigarette smoking and several malignancies is still unclear . We examined the association of cigarette smoking with death attributed to 15 cancer sites , 7 of which are regarded as having an uncertain relation with tobacco . PATIENTS AND METHODS The original Whitehall study is a prospect i ve cohort of 17 363 London-based male government employees ( age 40 - 69 years ) who were examined in the late 1960s and then followed up for a maximum of 38 years . RESULTS Following adjustment for demographic characteristics , risk factors , and prevalent disease , established positive cigarette smoking -- cancer gradients were confirmed for carcinoma of the lung , stomach , pancreas , bladder , upper aero-digestive ( including oesophagus ) , and liver , and for myeloid leukaemia . Among the cancers of uncertain relation with smoking , mortality rates for malignancy of the colon , rectum and prostate and for lymphatic leukaemia were elevated in current and /or former smokers . There was essentially no apparent relation between smoking and mortality from carcinoma of the brain or from lymphoma . CONCLUSION In this study , cigarette smoking appears to be a risk factor for several malignancies of previously unclear association with tobacco use Exercise is the best predictor of long-term weight loss . This study evaluated two strategies for improving exercise adherence and long-term weight loss in obese out patients . Obese men and women ( N = 193 ) were r and omized to 1 of 5 treatment groups for 18 months : st and ard behavior therapy ( SBT ) ; SBT with supervised walks ( SW ) 3 times per week ; SBT + SW with personal trainers ( PT ) , who walked with participants , made phone reminders , and did make-up SW ; SBT + SW with monetary incentives ( I ) for completing SW ; and SBT + SW + PT + I. Both PT and I enhanced attendance at SWs , the combination producing the best adherence . Increased walk attendance did not result in higher overall energy expenditure , however , and long-term weight loss was also not improved . Post hoc analyses suggest that the level of exercise needed for successful long-term weight loss is much higher than that usually recommended in behavioral treatment programs Background — The impact of overall dietary patterns that reflect actual eating behaviors on mortality caused by cardiovascular or other chronic diseases is largely unknown . Methods and Results — We prospect ively evaluated the relation between dietary patterns and risk of cardiovascular , cancer , and all-cause mortality among 72 113 women who were free of myocardial infa rct ion , angina , coronary artery surgery , stroke , diabetes mellitus , or cancer and were followed up from 1984 to 2002 . Dietary patterns were derived by factor analysis based on vali date d food frequency question naires administered every 2 to 4 years . Two major dietary patterns were identified : High prudent pattern scores represented high intakes of vegetables , fruit , legumes , fish , poultry , and whole grains , whereas high Western pattern scores reflected high intakes of red meat , processed meat , refined grains , french fries , and sweets/desserts . During 18 years of follow-up , 6011 deaths occurred , including 1154 cardiovascular deaths and 3139 cancer deaths . After multivariable adjustment , the prudent diet was associated with a 28 % lower risk of cardiovascular mortality ( 95 % confidence interval [ CI ] , 13 to 40 ) and a 17 % lower risk of all-cause mortality ( 95 % CI , 10 to 24 ) when the highest quintile was compared with the lowest quintile . In contrast , the Western pattern was associated with a higher risk of mortality from cardiovascular disease ( 22 % ; 95 % CI , 1 to 48 ) , cancer ( 16 % ; 95 % CI , 3 to 30 ) , and all causes ( 21 % ; 95 % CI , 12 to 32 ) . Conclusion — Greater adherence to the prudent pattern may reduce the risk of cardiovascular and total mortality , whereas greater adherence to the Western pattern may increase the risk among initially healthy women ABSTRACT BACKGROUND Previous efforts to use incentives for weight loss have result ed in substantial weight regain after 16 weeks . OBJECTIVE To evaluate a longer term weight loss intervention using financial incentives . DESIGN A 32-week , three-arm r and omized controlled trial of financial incentives for weight loss consisting of a 24-week weight loss phase during which all participants were given a weight loss goal of 1 pound per week , followed by an 8-week maintenance phase . PARTICIPANTS Veterans who were patients at the Philadelphia Veterans Affairs Medical Center with BMI s of 30–40.INTERVENTION Participants were r and omly assigned to participate in either a weight-monitoring program involving a consultation with a dietician and monthly weigh-ins ( control condition ) , or the same program with one of two financial incentive plans . Both incentive arms used deposit contracts ( DC ) in which participants put their own money at risk ( matched 1:1 ) , which they lost if they failed to lose weight . In one incentive arm participants were told that the period after 24 weeks was for weight-loss maintenance ; in the other , no such distinction was made . MAIN MEASUREWeight loss after 32 weeks . KEY RESULTS Results were analyzed using intention-to-treat . There was no difference in weight loss between the incentive arms ( P = 0.80 ) . Incentive participants lost more weight than control participants [ mean DC = 8.70 pounds , mean control = 1.17 , P = 0.04 , 95 % CI of the difference in means ( 0.56 , 14.50 ) ] . Follow-up data 36 weeks after the 32-week intervention had ended indicated weight regain ; the net weight loss between the incentive and control groups was no longer significant ( mean DC = 1.2 pounds , 95 % CI , -2.58–5.00 ; mean control = 0.27 , 95 % CI , -3.77–4.30 , P = 0.76 ) . CONCLUSIONS Financial incentives produced significant weight loss over an 8-month intervention ; however , participants regained weight post-intervention Behavioral treatments for obesity seek to modify eating and exercise behaviors by a change in their antecedents and consequences . More direct modification of antecedents and consequences by ( a ) the provision of food to patients and ( b ) the provision of financial rewards for weight loss was hypothesized to improve treatment outcomes . Two hundred two men and women were r and omly assigned to no treatment , st and ard behavioral treatment ( SBT ) , SBT plus food provision , SBT plus incentives , or SBT plus food provision and incentives . The major finding was that food provision significantly enhanced weight loss . Weight losses with  SBT  averaged 7.7 , 4.5 , and 4.1 kg at 6 , 12 , and 18 months , respectively , compared with 10.1 , 9.1 , and 6.4 kg , respectively , at the same intervals with the addition of food . Food provision also enhanced attendance , completion of food records , quality of diet , and nutrition knowledge . We conclude that the provision of food to weight-loss patients is a promising methodology that deserves further exploration Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Reports of studies relating physical activity to stroke and cancer sub-types indicate inconsistent findings . Some are hampered by low statistical power , owing to a low number of events , and a failure to adjust for potential confounding variables . The purpose of this study was to relate physical activity to 12 mortality endpoints in a prospect i ve cohort study of 11,663 men aged 40–64 years who responded to an enquiry about travel activity during a baseline medical examination conducted between 1967 and 1969 . During 25 years of follow-up there were 4672  deaths .  Travel activity  was inversely related to mortality attributable to all-causes , coronary heart disease , respiratory disease and lung cancer , whereas the association with stroke was positive . There was evidence for attenuation of some of these associations on adjustment for potentially confounding variables . Our simplistic measure of physical activity may , in part , explain the weak associations seen 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-cessation programs . RESULTS The incentive group had significantly higher rates of smoking cessation than did the information-only group 9 or 12 months after enrollment ( 14.7 % vs. 5.0 % , P<0.001 ) and 15 or 18 months after enrollment ( 9.4 % vs. 3.6 % , P<0.001 ) . Incentive-group participants also had significantly higher rates of enrollment in a smoking-cessation program ( 15.4 % vs. 5.4 % , P<0.001 ) , completion of a smoking-cessation program ( 10.8 % vs. 2.5 % , P<0.001 ) , and smoking cessation within the first 6 months after enrollment ( 20.9 % vs. 11.8 % , P<0.001 ) . CONCLUSIONS In this study of employees of one large company , financial incentives for smoking cessation significantly increased the rates of smoking cessation . ( Clinical Trials.gov number , NCT00128375 . AIMS This study examined whether voucher-based reinforcement therapy ( VBRT ) contingent upon smoking abstinence during pregnancy is an effective method for decreasing  maternal smoking during pregnancy and improving fetal growth . DESIGN , SETTING AND P 
    Output:
    