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: 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 Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design . Design Cross-sectional survey . Setting and participants British general public . Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers . These were shopping vouchers for : ( 1 ) vali date d smoking cessation in pregnancy and ( 2 ) after birth ; ( 3 ) for a smoke-free home ; ( 4 ) for proven breast feeding ; ( 5 ) a free breast pump ; ( 6 ) payments to health services for reaching smoking cessation in pregnancy targets and ( 7 ) breastfeeding targets . Ipsos MORI used area quota sampling and home-administered computer-assisted question naires , with r and omised question order to assess agreement with different incentives ( measured on a five-point scale ) . Demographic data and target behaviour experience were recorded . Analysis used multivariable ordered logit models . Results Agreement with incentives was mixed ( ranging from 34 % to 46 % ) among a representative sample of 1144 British adults .  Mean agreement score was highest for a free breast pump , and lowest for incentives for smoking abstinence after birth . More women disagreed with shopping vouchers than men . Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump . Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over , particularly provider targets for smoking cessation . Non-white ethnic groups agreed particularly with breastfeeding incentives . Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours . Up to £ 40/month vouchers for behaviour change were acceptable ( > 85 % ) . Conclusions Women and the less educated were more likely to disagree , but men and women of childbearing age to agree , with incentives design ed for their benefit . Trials evaluating reach , impact on health inequalities and ethnic groups are required prior to implementing incentive interventions . Trial registration number CRD42012001980 We developed an alcohol self-administration paradigm to model individual differences in impaired control . The paradigm includes moderate drinking guidelines meant to model limits on alcohol consumption , which are typically exceeded by people with impaired control . Possible payment reductions provided a disincentive for excessive drinking . Alcohol use above the guideline , despite possible pay reductions , was considered to be indicative of impaired control . Heavy-drinking 21- to 25-year-olds ( n = 39 ) were r and omized to an experimental condition including the elements of the impaired control paradigm or to a  free-drinking condition  without these elements .  Alcohol self-administration  was compared between these two conditions to establish the internal validity of the experimental paradigm . In both conditions , participants self-administered beer and nonalcoholic beverages for 3 hours in a bar setting with 1 - 3 other participants . Experimental condition participants self-administered significantly fewer  beers  and drank to lower blood-alcohol concentrations ( BACs ) on average than those in the free-drinking condition . Experimental condition participants were more likely than free-drinking condition participants to intersperse nonalcoholic beverages with beer and to drink at a slower pace . Although experimental condition participants drank more moderately than those in the free-drinking condition overall , their range of drinking was considerable ( BAC range = .024-.097 ) , with several participants drinking excessively . A lower initial subjective response to alcohol and earlier age of alcohol use onset were associated with greater alcohol self-administration in the experimental condition . Given the variability in response , the impaired control laboratory paradigm may have utility for preliminary tests of novel interventions in future studies and for identifying individual differences in problem-drinking risk 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 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 Objectives To assess use , utility and impact of transition interventions design ed to support and empower self-management in youth with chronic health conditions during transition into adult healthcare . Design A 4-year mixed- method prospect i ve cohort study . Setting 2 academic paediatric hospitals ( 13 clinics ) in Canada . Participants 50 adolescents ( 42 % male ; mean age 17.9±0.9 years ; 20 underlying diagnoses ) with transfer to adult care planned within 1 year . Interventions The Youth KIT ( an organisational tool that includes goal setting activities ) ; an online transition mentor . Main outcome measures Frequency of use , utility and impact of the transition interventions ; goal achievement ; post-transfer qualitative interviews with youth . Results 50 participants were enrolled during their last year of paediatric care ; 36 ( 72 % ) were followed into adult care . All participants had access to the transition interventions from enrolment until the end of the study ( exposure time : 12–47 months ) . Most youth ( 85 % ) reported using the medical/health section of the Youth KIT at least once ; 20 ( 40 % ) participants engaged in chats with the mentor . The overall perceived utility of both interventions was modest ; the Youth KIT received the highest ratings for ‘ help with goal setting ’ : ( mean ( SD ) : 4.2 ( 2.3 ) ) on a 7-point Likert scale . 45 ( 90 % ) participants set 294 transition goals . Goal achievement performance and satisfaction increased over time ( p≤0.001 ) . The qualitative evidence revealed reasons behind the variability in use and utility of the interventions , the interconnectedness of life-course and healthcare transitions , and the need for stronger partnerships between paediatric and adult healthcare systems . Conclusions Participants ’ perceptions about the utility of the Youth KIT and the online mentor were modest . Transition supports need to be carefully tailored , timed and integrated into healthcare systems . Individualised goal setting may be an important ‘ active ingredient ’ in optimising transition supports and outcomes . Interventions that focus on youth only are insufficient for empowering self-management AIMS This study evaluated the efficacy of a low-cost , prize reinforcement contingency management ( CM ) intervention for reducing  cocaine use .  SETTING Community-based treatment centers . PARTICIPANTS AND DESIGN Cocaine-abusing out- patients ( n = 120 ) were assigned r and omly to one of three 12-week conditions : st and ard treatment , st and ard treatment plus CM with an expected maximum of $ 80 of reinforcement or st and ard treatment plus CM with an expected maximum of $ 240 of reinforcement . INTERVENTION In the CM conditions , patients earned the opportunity to win prizes for su bmi tting negative urine sample s and completing goal -related activities . MEASUREMENTS Drug use was measured at intake and throughout a 3-month treatment period . FINDINGS Patients in the $ 240 CM condition achieved more abstinence than patients in the st and ard condition . Patients who initiated treatment with positive urinalysis results  were most responsive to the CM intervention , with the $ 240 CM condition engendering the best effects in this subgroup . In contrast , patients who initiated treatment with negative urinalysis results  generally remained abstinent during treatment , regardless of treatment assignment . On average , patients in the two CM conditions earned $ 36 and $ 68 in prizes . CONCLUSIONS This study suggests that prize reinforcement CM may be suitable for community-based setting s , and beneficial effects may be magnitude-dependent in more severe patients BACKGROUND Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women . We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women . METHODS In this cluster r and omised trial , never-married women aged 13 - 22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and r and omly assigned with computer-generated r and om numbers by enumeration area ( 1:1 ) to receive cash payments ( intervention group ) or nothing ( control group ) . Intervention enumeration areas were further r and omly assigned with computer-generated r and om numbers to conditional ( school attendance required to receive payment ) and unconditional ( no requirements to receive payment ) groups . Participants in both intervention groups were r and omly assigned by a lottery to receive monthly payments ranging from US$ 1 to $ 5 , while their parents were independently assigned with computer-generated r and om numbers to receive $ 4 - 10 .  Behavioural risk assessment  s were done at baseline and 12 months ; serology was tested at 18 months . Participants were not masked to treatment status but counsellors doing the serologic testing were . The primary outcomes were prevalence of HIV and herpes simplex virus 2 ( HSV-2 ) at 18 months and were assessed by intention-to-treat analyses . The trial is registered , number NCT01333826 . FINDINGS 88 enumeration areas were assigned to receive the intervention and 88 as controls . For the 1289 individuals enrolled in school at baseline with complete interview and biomarker data , weighted HIV prevalence at 18 month follow-up was 1·2 % ( seven of 490 participants ) in the combined intervention group versus 3·0 % ( 17 of 799 participants ) in the control group ( adjusted odds ratio [ OR ] 0·36 , 95 % CI 0·14 - 0·91 ) ; weighted HSV-2 prevalence was 0·7 % ( five of 488 participants ) versus 3·0 % ( 27 of 796 participants ; adjusted OR 0·24 , 0·09 - 0·65 ) . In the intervention group , we noted no difference between conditional versus unconditional intervention groups for weighted HIV prevalence ( 3/235 [ 1 % ] vs 4/255 [ 2 % ] ) or weighted HSV-2 prevalence ( 4/233 [ 1 % ] vs 1/255 [ < 1 % ] ) . For individuals who had already dropped out of school at baseline , we detected no significant difference between intervention and control groups for weighted HIV preval 
    Output:
    
agent
***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 Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design . Design Cross-sectional survey . Setting and participants British general public . Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers . These were shopping vouchers for : ( 1 ) vali date d smoking cessation in pregnancy and ( 2 ) after birth ; ( 3 ) for a smoke-free home ; ( 4 ) for proven breast feeding ; ( 5 ) a free breast pump ; ( 6 ) payments to health services for reaching smoking cessation in pregnancy targets and ( 7 ) breastfeeding targets . Ipsos MORI used area quota sampling and home-administered computer-assisted question naires , with r and omised question order to assess agreement with different incentives ( measured on a five-point scale ) . Demographic data and target behaviour experience were recorded . Analysis used multivariable ordered logit models . Results Agreement with incentives was mixed ( ranging from 34 % to 46 % ) among a representative sample of 1144 British adults .  Mean agreement score was highest for a free breast pump , and lowest for incentives for smoking abstinence after birth . More women disagreed with shopping vouchers than men . Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump . Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over , particularly provider targets for smoking cessation . Non-white ethnic groups agreed particularly with breastfeeding incentives . Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours . Up to £ 40/month vouchers for behaviour change were acceptable ( > 85 % ) . Conclusions Women and the less educated were more likely to disagree , but men and women of childbearing age to agree , with incentives design ed for their benefit . Trials evaluating reach , impact on health inequalities and ethnic groups are required prior to implementing incentive interventions . Trial registration number CRD42012001980 We developed an alcohol self-administration paradigm to model individual differences in impaired control . The paradigm includes moderate drinking guidelines meant to model limits on alcohol consumption , which are typically exceeded by people with impaired control . Possible payment reductions provided a disincentive for excessive drinking . Alcohol use above the guideline , despite possible pay reductions , was considered to be indicative of impaired control . Heavy-drinking 21- to 25-year-olds ( n = 39 ) were r and omized to an experimental condition including the elements of the impaired control paradigm or to a  free-drinking condition  without these elements .  Alcohol self-administration  was compared between these two conditions to establish the internal validity of the experimental paradigm . In both conditions , participants self-administered beer and nonalcoholic beverages for 3 hours in a bar setting with 1 - 3 other participants . Experimental condition participants self-administered significantly fewer  beers  and drank to lower blood-alcohol concentrations ( BACs ) on average than those in the free-drinking condition . Experimental condition participants were more likely than free-drinking condition participants to intersperse nonalcoholic beverages with beer and to drink at a slower pace . Although experimental condition participants drank more moderately than those in the free-drinking condition overall , their range of drinking was considerable ( BAC range = .024-.097 ) , with several participants drinking excessively . A lower initial subjective response to alcohol and earlier age of alcohol use onset were associated with greater alcohol self-administration in the experimental condition . Given the variability in response , the impaired control laboratory paradigm may have utility for preliminary tests of novel interventions in future studies and for identifying individual differences in problem-drinking risk 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 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 Objectives To assess use , utility and impact of transition interventions design ed to support and empower self-management in youth with chronic health conditions during transition into adult healthcare . Design A 4-year mixed- method prospect i ve cohort study . Setting 2 academic paediatric hospitals ( 13 clinics ) in Canada . Participants 50 adolescents ( 42 % male ; mean age 17.9±0.9 years ; 20 underlying diagnoses ) with transfer to adult care planned within 1 year . Interventions The Youth KIT ( an organisational tool that includes goal setting activities ) ; an online transition mentor . Main outcome measures Frequency of use , utility and impact of the transition interventions ; goal achievement ; post-transfer qualitative interviews with youth . Results 50 participants were enrolled during their last year of paediatric care ; 36 ( 72 % ) were followed into adult care . All participants had access to the transition interventions from enrolment until the end of the study ( exposure time : 12–47 months ) . Most youth ( 85 % ) reported using the medical/health section of the Youth KIT at least once ; 20 ( 40 % ) participants engaged in chats with the mentor . The overall perceived utility of both interventions was modest ; the Youth KIT received the highest ratings for ‘ help with goal setting ’ : ( mean ( SD ) : 4.2 ( 2.3 ) ) on a 7-point Likert scale . 45 ( 90 % ) participants set 294 transition goals . Goal achievement performance and satisfaction increased over time ( p≤0.001 ) . The qualitative evidence revealed reasons behind the variability in use and utility of the interventions , the interconnectedness of life-course and healthcare transitions , and the need for stronger partnerships between paediatric and adult healthcare systems . Conclusions Participants ’ perceptions about the utility of the Youth KIT and the online mentor were modest . Transition supports need to be carefully tailored , timed and integrated into healthcare systems . Individualised goal setting may be an important ‘ active ingredient ’ in optimising transition supports and outcomes . Interventions that focus on youth only are insufficient for empowering self-management AIMS This study evaluated the efficacy of a low-cost , prize reinforcement contingency management ( CM ) intervention for reducing  cocaine use .  SETTING Community-based treatment centers . PARTICIPANTS AND DESIGN Cocaine-abusing out- patients ( n = 120 ) were assigned r and omly to one of three 12-week conditions : st and ard treatment , st and ard treatment plus CM with an expected maximum of $ 80 of reinforcement or st and ard treatment plus CM with an expected maximum of $ 240 of reinforcement . INTERVENTION In the CM conditions , patients earned the opportunity to win prizes for su bmi tting negative urine sample s and completing goal -related activities . MEASUREMENTS Drug use was measured at intake and throughout a 3-month treatment period . FINDINGS Patients in the $ 240 CM condition achieved more abstinence than patients in the st and ard condition . Patients who initiated treatment with positive urinalysis results  were most responsive to the CM intervention , with the $ 240 CM condition engendering the best effects in this subgroup . In contrast , patients who initiated treatment with negative urinalysis results  generally remained abstinent during treatment , regardless of treatment assignment . On average , patients in the two CM conditions earned $ 36 and $ 68 in prizes . CONCLUSIONS This study suggests that prize reinforcement CM may be suitable for community-based setting s , and beneficial effects may be magnitude-dependent in more severe patients BACKGROUND Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women . We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women . METHODS In this cluster r and omised trial , never-married women aged 13 - 22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and r and omly assigned with computer-generated r and om numbers by enumeration area ( 1:1 ) to receive cash payments ( intervention group ) or nothing ( control group ) . Intervention enumeration areas were further r and omly assigned with computer-generated r and om numbers to conditional ( school attendance required to receive payment ) and unconditional ( no requirements to receive payment ) groups . Participants in both intervention groups were r and omly assigned by a lottery to receive monthly payments ranging from US$ 1 to $ 5 , while their parents were independently assigned with computer-generated r and om numbers to receive $ 4 - 10 .  Behavioural risk assessment  s were done at baseline and 12 months ; serology was tested at 18 months . Participants were not masked to treatment status but counsellors doing the serologic testing were . The primary outcomes were prevalence of HIV and herpes simplex virus 2 ( HSV-2 ) at 18 months and were assessed by intention-to-treat analyses . The trial is registered , number NCT01333826 . FINDINGS 88 enumeration areas were assigned to receive the intervention and 88 as controls . For the 1289 individuals enrolled in school at baseline with complete interview and biomarker data , weighted HIV prevalence at 18 month follow-up was 1·2 % ( seven of 490 participants ) in the combined intervention group versus 3·0 % ( 17 of 799 participants ) in the control group ( adjusted odds ratio [ OR ] 0·36 , 95 % CI 0·14 - 0·91 ) ; weighted HSV-2 prevalence was 0·7 % ( five of 488 participants ) versus 3·0 % ( 27 of 796 participants ; adjusted OR 0·24 , 0·09 - 0·65 ) . In the intervention group , we noted no difference between conditional versus unconditional intervention groups for weighted HIV prevalence ( 3/235 [ 1 % ] vs 4/255 [ 2 % ] ) or weighted HSV-2 prevalence ( 4/233 [ 1 % ] vs 1/255 [ < 1 % ] ) . For individuals who had already dropped out of school at baseline , we detected no significant difference between intervention and control groups for weighted HIV preval 
    Output:
    