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: Eligible smokers ( N = 6,451 ) visiting the American Cancer Society 's Internet site offering cessation assistance were , with informed consent , r and omized to receive access either to a static Internet site with quitting advice or to one of five interactive sites provided by cooperating research partners . Three-month follow-up surveys were conducted via online survey with E-mail prompts , or telephone calls , to assess quitting success ; 54 % of participants provided follow-up data . Results showed no significant overall difference in cessation rates among participants assigned to the interactive or static sites . We found large differences in the utilization of the five interactive sites . When sites were grouped by level of use , a significantly higher reported 3-month cessation rate was observed among participants assigned to the more highly utilized sites than among those assigned to the less utilized sites ( 12.2 % vs. 10.2 % of all r and omized participants , 26.0 % vs. 22.1 % of followed participants ) . These findings show that interactive Internet sites yielding high levels of utilization can increase quitting success among smokers seeking assistance via the Internet AIM To examine self-efficacy and program exposure as possible mediators observed treatment effects for a web-based tobacco cessation intervention . DESIGN The ChewFree trial used a two-arm design to compare tobacco abstinence at both the 3- and 6-month follow-up for participants r and omized to either an  enhanced intervention condition  or a basic information-only control condition . SETTING Internet in US and Canada . PARTICIPANTS Our secondary analyses focused upon 402 participants who visited the web-based program at least once , whose baseline self-efficacy rating showed room for improvement , who reported that they were still using tobacco at the 6-week assessment , and for whom both 3- and 6-month follow-up data were available . INTERVENTION An enhanced web-based behavioral smokeless tobacco cessation intervention delivered program content using text , interactive activities , testimonial videos and an ask-an-expert forum and a peer forum . The basic control condition delivered tobacco cessation content using static text only . MEASUREMENTS Change in self-efficacy and program exposure from baseline to 6 weeks were tested as simple and multiple mediators on the effect of treatment condition on point-prevalence tobacco abstinence measured at 3- and 6-month follow-up . FINDINGS While both participant self-efficacy and program exposure satisfied the requirements for simple mediation , only self-efficacy emerged as a mediator when we used the more robust test of multiple mediation . CONCLUSIONS Results confirm the importance of self-efficacy change as a probable underlying mechanism in a successful web-based behavioral intervention . While program exposure was found to be a simple mediator of tobacco abstinence , it failed to emerge as a mediator when tested with self-efficacy change in a multiple mediator test suggesting that self-efficacy and program exposure share a complex , possibly reciprocal relationship with the tobacco abstinence outcome . Our results underscore the utility of search ing for mediators in research on web-based interventions Background Although many smokers seek Internet-based cessation assistance , few studies have experimentally evaluated long-term cessation rates among cigarette smokers who receive Internet assistance in quitting . Objective The purpose of this study is to describe long-term smoking cessation rates associated with 6 different  Internet-based cessation services  and the variation among them , to test the hypothesis that interactive and tailored Internet services yield higher long-term quit rates than more static Web-posted assistance , and to explore the possible effects of level of site utilization and a self-reported indicator of depression on long-term cessation rates . Method In 2004 - 05 , a link was placed on the American Cancer Society ( ACS ) website for smokers who wanted help in quitting via the Internet . The link led smokers to the QuitLink study website , where they could answer eligibility questions , provide informed consent , and complete the baseline survey . Enrolled participants were r and omly assigned to receive emailed access to one of five tailored interactive sites provided by cooperating research partners or to a targeted , minimally interactive ACS site with text , photographs , and graphics providing stage-based quitting advice and peer modeling . Results 6451 of the visitors met eligibility requirements and completed consent procedures and the baseline survey . All of these smokers were r and omly assigned to one of the six experimental groups . Follow-up surveys done online and via telephone interviews at approximately 13 months after r and omization yielded 2468 respondents ( 38 % ) and found no significant overall quit rate differences among those assigned to the different websites ( P = .15 ) . At baseline , 1961 participants ( 30 % ) reported an indicator of depression . Post hoc analyses found that this group had significantly lower 13-month quit rates than those who did not report the indicator ( all enrolled , 8 % vs 12 % , P < .001 ; followed only , 25 % vs 31 % , P = .003 ) . When the 4490 participants ( 70 % ) who did not report an indicator of depression at baseline were separated for analysis , the more interactive , tailored sites , as a whole , were associated with higher quitting rates than the less interactive ACS site : 13 % vs 10 % ( P = .04 ) among 4490 enrolled and 32 % vs 26 % ( P = .06 ) among 1798 followed . Conclusions These findings show that Internet assistance is attractive and potentially cost-effective and suggest that tailored , interactive websites may help cigarette smokers who do not report an indicator of depression at baseline to quit and maintain cessation OBJECTIVE The purpose of this study was to develop a smoking cessation program combined with an Internet-assisted instruction ( IAI ) program to help youth smokers quit smoking , and to evaluate the effectiveness of the program in changing youth 's attitudes toward smoking , smoking behavior , and self-efficacy for smoking cessation . METHODS To achieve this goal , a comparative study of 77 senior high students divided into two groups was conducted . One group , design ated as the experimental group , accepted a 6-week smoking cessation program plus an IAI program and the other group did not receive any intervention as the comparison group . All participants completed question naires before and after the program . RESULTS The results showed that the strategy of combining the smoking cessation program and an IAI program was highly effective in terms of effects upon the youth 's attitude towards smoking , smoking behavior , and self-efficacy . There was a highly positive correlation between the participants ' attitude toward smoking and self-efficacy . In contrast , cigarette consumption was in a strongly negative correlation with self-efficacy . CONCLUSION Most of all participants in the experimental group recognized the effectiveness of the program , and thought the smoking cessation program with an IAI program was helpful and welcomed by youth . This study can serve as reference for future design and implementation of IAI programs for youth smoking cessation Background Cigarette smoking is a major risk factor for many chronic and fatal illnesses . Stopping smoking directly reduces those risks . The aim of this study is to investigate the effectiveness of a web-based interactive self-help programme for smoking cessation , known as the StopSite , by comparing it to an online self-help guide . Both interventions were based on cognitive-behavioural and self-control principles , but the former provided exercises , feedback and interactive features such as one-to-one chatrooms and a user forum , which facilitated mutual support and experience sharing . Methods and design We conducted a r and omised controlled trial to compare the interactive intervention with the self-help guide . The primary outcome measure was prolonged abstinence from smoking . Secondary outcomes were point-prevalence abstinence , number of cigarettes smoked , and incidence of quit attempts reported at follow-up assessment s. Follow-up assessment s took place three and six months after a one-month grace period for starting the intervention after baseline . Analyses were based on intention-to-treat principles using a conservative imputation method for missing data , whereby non-responders were classified as smokers . Discussion The trial should add to the body of knowledge on the effectiveness of web-based self-help smoking cessation interventions . Effective web-based programmes can potentially help large numbers of smokers to quit , thus having a major public health impact . Trial registration IS RCT OBJECTIVE To evaluate the impact of a classroom-based , Web-assisted tobacco intervention addressing  smoking prevention and cessation with adolescents . DESIGN A two-group r and omized control trial with 1,402 male and female students in grade s 9 through 11 from 14 secondary schools in Toronto , Canada . Participants were r and omly assigned to a tailored Web-assisted tobacco intervention or an interactive control condition task conducted during a single classroom session with e-mail follow-up . The cornerstone of the intervention was a five-stage interactive Web site called the Smoking Zine ( http://www.smokingzine.org ) integrated into a program that included a paper-based journal , a small group form of motivational interviewing , and tailored e-mails . MAIN OUTCOME MEASURE Resistance to smoking , behavioral intentions to smoke , and cigarette use were assessed at baseline , postintervention , and three- and six-month follow-up . Multilevel logistic growth modeling was used to assess the effect of the intervention on change over time . RESULTS The integrated Smoking Zine program helped smokers significantly reduce the likelihood of having high intentions to smoke and increased their likelihood of high resistance to continued cigarette use at 6 months . The intervention also significantly reduced the likelihood of heavy cigarette use adoption by nonsmokers during the study period . CONCLUSION The Smoking Zine intervention provided cessation motivation for smokers most resistant to quitting at baseline and prevented nonsmoking adolescents from becoming heavy smokers at 6 months . By providing an accessible and attractive method of engaging young people in smoking prevention and cessation , this interactive and integrated program provides a novel vehicle for school- and population -level health promotion The aim of this study was to examine moderating and mediating factors of the efficacy of World Wide Web-based tailored behavioral smoking cessation material s. The design was a two-group r and omized controlled trial in Engl and and the Republic of Irel and . Participants were 3971 subjects who purchased a particular br and of nicotine patch and logged on to use a free Web-based behavioral support program .  The intervention was Web-based tailored behavioral smoking cessation material s or Web-based nontailored material s. The 10-week continuous abstinence rate was assessed by Internet-based survey at 12-week follow-up . Potential treatment moderators were examined using subgroups of established or possible predictors of smoking cessation . Treatment mediators examined included 6-week follow-up measures of program relevance and amount of the Web-based material s read . Within all subgroups examined , subjects in the Web-based tailored intervention were more likely to report 10-week continuous abstinence at 12-week follow-up . Significant moderators , indicating a significant difference in program efficacy between subgroups , included presence of a tobacco-related illness ( larger treatment-control differences among subjects with a tobacco-related illness ) , presence of nonsmoking children in the household ( larger treatment-control differences among subjects with nonsmoking children in the household ) , and frequent alcohol consumption ( larger treatment-control differences among subjects with higher alcohol consumption ) . Perceived program relevance at 6-week follow-up was a mediator of cessation at 12-week follow-up . Robust results of the tailored program may be explained by the tailoring strategies utilized in the treatment conditions . Moderating variables may be particularly useful to address in tailored messaging . The mediating factor of perceived message relevance may provide a partial mechanism of effective program tailoring Background Concurrent with their enrollment in Web-based R and omized Controlled Trials ( RCTs ) , participants can easily choose to use treatment programs that are not assigned in the study . The prevalence of using non-assigned treatments is largely unknown although it is likely to be related to the extent to which non-assigned treatments are : ( a ) easy to find and use , ( b ) low in cost , ( c ) well publicized , and ( d ) available from trusted sources . The impact of using other programs — both beneficial and detrimental — warrants additional research investigation . Objective The aim of this report is to explore the extent to which participants enrolled in a Web-based intervention for smoking cessation used treatment methods that were not explicitly assigned ( “ non-assigned treatment ” ) . In addition to describing the relation between using non-assigned treatments and smoking cessation outcomes , we also explore the broader issue of non-assigned program use by RCT participants in Web-based behavioral interventions  , generally . Methods We describe the use of other programs ( as measured by self-report at the 3-month follow-up assessment ) by 1028 participants who were r and omized to the Web-based SHIP ( Smokers ’ Health Improvement Program ) RCT which compared the Quit Smoking Network ( QSN ) treatment program and the Active Lives control condition . We examine the extent to which pharmacotherapy products were used by participants in the QSN condition ( which explicitly recommended their use ) and the Active Lives condition ( which purpose fully omitted mention of the use of pharmacotherapy ) . We also test for any between-condition impact of using non-assigned treatments and pharmacotherapy products on smoking cessation outcomes . Results A total of 24.1 % ( 248/1028 ) participants reported using one or more smoking cessation treatment programs that were not explicitly recommended or assigned in their treatment protocol . Types of non-assigned treatments used in this manner included individual counseling ( 1.7 % ) , group counseling ( 2.3 % ) , hypnotherapy/acupuncture ( 4.5 % ) , pamphlets/books ( 12.6 % ) , and other Web-based smoking cessation programs ( 9.0 % ) . Participants who used non-assigned treatments were more likely to be female and have at least a high school education . Use of non-assigned Web programs was 
    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: Eligible smokers ( N = 6,451 ) visiting the American Cancer Society 's Internet site offering cessation assistance were , with informed consent , r and omized to receive access either to a static Internet site with quitting advice or to one of five interactive sites provided by cooperating research partners . Three-month follow-up surveys were conducted via online survey with E-mail prompts , or telephone calls , to assess quitting success ; 54 % of participants provided follow-up data . Results showed no significant overall difference in cessation rates among participants assigned to the interactive or static sites . We found large differences in the utilization of the five interactive sites . When sites were grouped by level of use , a significantly higher reported 3-month cessation rate was observed among participants assigned to the more highly utilized sites than among those assigned to the less utilized sites ( 12.2 % vs. 10.2 % of all r and omized participants , 26.0 % vs. 22.1 % of followed participants ) . These findings show that interactive Internet sites yielding high levels of utilization can increase quitting success among smokers seeking assistance via the Internet AIM To examine self-efficacy and program exposure as possible mediators observed treatment effects for a web-based tobacco cessation intervention . DESIGN The ChewFree trial used a two-arm design to compare tobacco abstinence at both the 3- and 6-month follow-up for participants r and omized to either an  enhanced intervention condition  or a basic information-only control condition . SETTING Internet in US and Canada . PARTICIPANTS Our secondary analyses focused upon 402 participants who visited the web-based program at least once , whose baseline self-efficacy rating showed room for improvement , who reported that they were still using tobacco at the 6-week assessment , and for whom both 3- and 6-month follow-up data were available . INTERVENTION An enhanced web-based behavioral smokeless tobacco cessation intervention delivered program content using text , interactive activities , testimonial videos and an ask-an-expert forum and a peer forum . The basic control condition delivered tobacco cessation content using static text only . MEASUREMENTS Change in self-efficacy and program exposure from baseline to 6 weeks were tested as simple and multiple mediators on the effect of treatment condition on point-prevalence tobacco abstinence measured at 3- and 6-month follow-up . FINDINGS While both participant self-efficacy and program exposure satisfied the requirements for simple mediation , only self-efficacy emerged as a mediator when we used the more robust test of multiple mediation . CONCLUSIONS Results confirm the importance of self-efficacy change as a probable underlying mechanism in a successful web-based behavioral intervention . While program exposure was found to be a simple mediator of tobacco abstinence , it failed to emerge as a mediator when tested with self-efficacy change in a multiple mediator test suggesting that self-efficacy and program exposure share a complex , possibly reciprocal relationship with the tobacco abstinence outcome . Our results underscore the utility of search ing for mediators in research on web-based interventions Background Although many smokers seek Internet-based cessation assistance , few studies have experimentally evaluated long-term cessation rates among cigarette smokers who receive Internet assistance in quitting . Objective The purpose of this study is to describe long-term smoking cessation rates associated with 6 different  Internet-based cessation services  and the variation among them , to test the hypothesis that interactive and tailored Internet services yield higher long-term quit rates than more static Web-posted assistance , and to explore the possible effects of level of site utilization and a self-reported indicator of depression on long-term cessation rates . Method In 2004 - 05 , a link was placed on the American Cancer Society ( ACS ) website for smokers who wanted help in quitting via the Internet . The link led smokers to the QuitLink study website , where they could answer eligibility questions , provide informed consent , and complete the baseline survey . Enrolled participants were r and omly assigned to receive emailed access to one of five tailored interactive sites provided by cooperating research partners or to a targeted , minimally interactive ACS site with text , photographs , and graphics providing stage-based quitting advice and peer modeling . Results 6451 of the visitors met eligibility requirements and completed consent procedures and the baseline survey . All of these smokers were r and omly assigned to one of the six experimental groups . Follow-up surveys done online and via telephone interviews at approximately 13 months after r and omization yielded 2468 respondents ( 38 % ) and found no significant overall quit rate differences among those assigned to the different websites ( P = .15 ) . At baseline , 1961 participants ( 30 % ) reported an indicator of depression . Post hoc analyses found that this group had significantly lower 13-month quit rates than those who did not report the indicator ( all enrolled , 8 % vs 12 % , P < .001 ; followed only , 25 % vs 31 % , P = .003 ) . When the 4490 participants ( 70 % ) who did not report an indicator of depression at baseline were separated for analysis , the more interactive , tailored sites , as a whole , were associated with higher quitting rates than the less interactive ACS site : 13 % vs 10 % ( P = .04 ) among 4490 enrolled and 32 % vs 26 % ( P = .06 ) among 1798 followed . Conclusions These findings show that Internet assistance is attractive and potentially cost-effective and suggest that tailored , interactive websites may help cigarette smokers who do not report an indicator of depression at baseline to quit and maintain cessation OBJECTIVE The purpose of this study was to develop a smoking cessation program combined with an Internet-assisted instruction ( IAI ) program to help youth smokers quit smoking , and to evaluate the effectiveness of the program in changing youth 's attitudes toward smoking , smoking behavior , and self-efficacy for smoking cessation . METHODS To achieve this goal , a comparative study of 77 senior high students divided into two groups was conducted . One group , design ated as the experimental group , accepted a 6-week smoking cessation program plus an IAI program and the other group did not receive any intervention as the comparison group . All participants completed question naires before and after the program . RESULTS The results showed that the strategy of combining the smoking cessation program and an IAI program was highly effective in terms of effects upon the youth 's attitude towards smoking , smoking behavior , and self-efficacy . There was a highly positive correlation between the participants ' attitude toward smoking and self-efficacy . In contrast , cigarette consumption was in a strongly negative correlation with self-efficacy . CONCLUSION Most of all participants in the experimental group recognized the effectiveness of the program , and thought the smoking cessation program with an IAI program was helpful and welcomed by youth . This study can serve as reference for future design and implementation of IAI programs for youth smoking cessation Background Cigarette smoking is a major risk factor for many chronic and fatal illnesses . Stopping smoking directly reduces those risks . The aim of this study is to investigate the effectiveness of a web-based interactive self-help programme for smoking cessation , known as the StopSite , by comparing it to an online self-help guide . Both interventions were based on cognitive-behavioural and self-control principles , but the former provided exercises , feedback and interactive features such as one-to-one chatrooms and a user forum , which facilitated mutual support and experience sharing . Methods and design We conducted a r and omised controlled trial to compare the interactive intervention with the self-help guide . The primary outcome measure was prolonged abstinence from smoking . Secondary outcomes were point-prevalence abstinence , number of cigarettes smoked , and incidence of quit attempts reported at follow-up assessment s. Follow-up assessment s took place three and six months after a one-month grace period for starting the intervention after baseline . Analyses were based on intention-to-treat principles using a conservative imputation method for missing data , whereby non-responders were classified as smokers . Discussion The trial should add to the body of knowledge on the effectiveness of web-based self-help smoking cessation interventions . Effective web-based programmes can potentially help large numbers of smokers to quit , thus having a major public health impact . Trial registration IS RCT OBJECTIVE To evaluate the impact of a classroom-based , Web-assisted tobacco intervention addressing  smoking prevention and cessation with adolescents . DESIGN A two-group r and omized control trial with 1,402 male and female students in grade s 9 through 11 from 14 secondary schools in Toronto , Canada . Participants were r and omly assigned to a tailored Web-assisted tobacco intervention or an interactive control condition task conducted during a single classroom session with e-mail follow-up . The cornerstone of the intervention was a five-stage interactive Web site called the Smoking Zine ( http://www.smokingzine.org ) integrated into a program that included a paper-based journal , a small group form of motivational interviewing , and tailored e-mails . MAIN OUTCOME MEASURE Resistance to smoking , behavioral intentions to smoke , and cigarette use were assessed at baseline , postintervention , and three- and six-month follow-up . Multilevel logistic growth modeling was used to assess the effect of the intervention on change over time . RESULTS The integrated Smoking Zine program helped smokers significantly reduce the likelihood of having high intentions to smoke and increased their likelihood of high resistance to continued cigarette use at 6 months . The intervention also significantly reduced the likelihood of heavy cigarette use adoption by nonsmokers during the study period . CONCLUSION The Smoking Zine intervention provided cessation motivation for smokers most resistant to quitting at baseline and prevented nonsmoking adolescents from becoming heavy smokers at 6 months . By providing an accessible and attractive method of engaging young people in smoking prevention and cessation , this interactive and integrated program provides a novel vehicle for school- and population -level health promotion The aim of this study was to examine moderating and mediating factors of the efficacy of World Wide Web-based tailored behavioral smoking cessation material s. The design was a two-group r and omized controlled trial in Engl and and the Republic of Irel and . Participants were 3971 subjects who purchased a particular br and of nicotine patch and logged on to use a free Web-based behavioral support program .  The intervention was Web-based tailored behavioral smoking cessation material s or Web-based nontailored material s. The 10-week continuous abstinence rate was assessed by Internet-based survey at 12-week follow-up . Potential treatment moderators were examined using subgroups of established or possible predictors of smoking cessation . Treatment mediators examined included 6-week follow-up measures of program relevance and amount of the Web-based material s read . Within all subgroups examined , subjects in the Web-based tailored intervention were more likely to report 10-week continuous abstinence at 12-week follow-up . Significant moderators , indicating a significant difference in program efficacy between subgroups , included presence of a tobacco-related illness ( larger treatment-control differences among subjects with a tobacco-related illness ) , presence of nonsmoking children in the household ( larger treatment-control differences among subjects with nonsmoking children in the household ) , and frequent alcohol consumption ( larger treatment-control differences among subjects with higher alcohol consumption ) . Perceived program relevance at 6-week follow-up was a mediator of cessation at 12-week follow-up . Robust results of the tailored program may be explained by the tailoring strategies utilized in the treatment conditions . Moderating variables may be particularly useful to address in tailored messaging . The mediating factor of perceived message relevance may provide a partial mechanism of effective program tailoring Background Concurrent with their enrollment in Web-based R and omized Controlled Trials ( RCTs ) , participants can easily choose to use treatment programs that are not assigned in the study . The prevalence of using non-assigned treatments is largely unknown although it is likely to be related to the extent to which non-assigned treatments are : ( a ) easy to find and use , ( b ) low in cost , ( c ) well publicized , and ( d ) available from trusted sources . The impact of using other programs — both beneficial and detrimental — warrants additional research investigation . Objective The aim of this report is to explore the extent to which participants enrolled in a Web-based intervention for smoking cessation used treatment methods that were not explicitly assigned ( “ non-assigned treatment ” ) . In addition to describing the relation between using non-assigned treatments and smoking cessation outcomes , we also explore the broader issue of non-assigned program use by RCT participants in Web-based behavioral interventions  , generally . Methods We describe the use of other programs ( as measured by self-report at the 3-month follow-up assessment ) by 1028 participants who were r and omized to the Web-based SHIP ( Smokers ’ Health Improvement Program ) RCT which compared the Quit Smoking Network ( QSN ) treatment program and the Active Lives control condition . We examine the extent to which pharmacotherapy products were used by participants in the QSN condition ( which explicitly recommended their use ) and the Active Lives condition ( which purpose fully omitted mention of the use of pharmacotherapy ) . We also test for any between-condition impact of using non-assigned treatments and pharmacotherapy products on smoking cessation outcomes . Results A total of 24.1 % ( 248/1028 ) participants reported using one or more smoking cessation treatment programs that were not explicitly recommended or assigned in their treatment protocol . Types of non-assigned treatments used in this manner included individual counseling ( 1.7 % ) , group counseling ( 2.3 % ) , hypnotherapy/acupuncture ( 4.5 % ) , pamphlets/books ( 12.6 % ) , and other Web-based smoking cessation programs ( 9.0 % ) . Participants who used non-assigned treatments were more likely to be female and have at least a high school education . Use of non-assigned Web programs was 
    Output:
    