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 Abstinence reinforcement is efficacious for improving smoking treatment outcomes , but practical constraints related to the need for multiple in-person carbon monoxide ( CO ) breath tests daily to verify smoking abstinence have limited its use . This study tested an mHealth procedure to remotely monitor and reinforce smoking abstinence in individuals ' natural environment . Methods Eligible treatment-seeking smokers ( N = 90 ) were r and omized to ( 1 ) usual care and ecological monitoring with abstinence reinforcement ( mHealth reinforcement ) or ( 2 ) without reinforcement ( mHealth monitoring ) . Usual care was 8 weeks of transdermal nicotine and twice-weekly telephone counseling . Following training , an interactive voice response system prompted participants to conduct CO tests 1 - 3 daily at pseudor and om times ( 7 am to 10 pm ) for 4 weeks . When prompted , participants used a study cell phone and CO monitor to complete a CO self-test , video record the process , and su bmi t videos using multimedia messaging . mHealth reinforcement participants could earn prizes for smoking-negative on-time CO tests . The interactive voice response generated preliminary earnings immediately . Earnings were finalized by comparing video records against participants ' self-reports . Results mHealth reinforcement was associated with a greater proportion of smoking-negative CO tests , longest duration of prolonged abstinence , and point-prevalence abstinence during the monitoring/reinforcement phase compared to mHealth monitoring ( p < .01 , d = 0.8 - 1.3 ) . Follow-up ( weeks 4 - 24 ) analyses indicated main effects of reinforcement on point-prevalence abstinence and proportion of days smoked ( p ≤ .05 ) ; values were comparable by week 24 . Conclusions mHealth reinforcement has short-term efficacy . Research on methods to enhance and sustain benefits is needed . Implication s This study suggests that mHealth abstinence reinforcement is efficacious and may present temporal and spatial opportunities to research , engage , and support smokers trying to quit that do not exist with conventional ( not technology-based ) reinforcement interventions Background and aims Contingency management ( CM ) is one of the most effective behavioral interventions to promote drug abstinence , but availability of this treatment is limited . We evaluated the efficacy and acceptability of internet‐based CM relative to an internet‐based monitoring and goal ‐ setting control group in a nationwide sample of cigarette smokers . Design R and omized controlled trial with 3‐ and 6‐month follow‐ups . Setting United States . Participants Smokers ( n = 94 ) from 26 states were enrolled ( mean age 36 , 56 % female ) . Intervention and comparator Participants were r and omized to earn financial incentives ( up to $ 480 over 7 weeks ) based on video‐verified abstinence using breath carbon monoxide ( CO ) output ( n = 48 ; abstinent contingent group , AC ) , or based on su bmi tting CO sample s ( n = 46 , su bmi ssion contingent , SC ) . Both groups also received the same CO‐based goals . A $ 50 deposit was required in both groups that could be recouped from initial earnings . Measures The primary outcome was point prevalence at week 4 . Secondary outcomes were point prevalence at the 3‐ and 6‐month follow‐ups , percentages of negative CO sample s , adherence to the CO sampling protocol , and treatment acceptability ratings on a 0–100‐mm visual analog scale . Findings Abstinence rates differed at 4 weeks between the AC ( 39.6 % ) and SC ( 13.0 % ) groups [ odds ratio ( OR ) = 4.4 , 95 % confidence interval ( CI ) = 1.6–12.3 ] , but not at the 3‐ ( 29.2 % AC and 19.6 % SC , OR = 1.7 , 95 % CI = 0.6–4.4 ) or 6‐ ( 22.9 % AC and 13.0 % SC , OR = 2.0 , 95 % CI = 0.7–5.9 ) month follow‐ups . During the two main treatment phases , there were significant differences in negative COs ( 53.9 % AC and 24.8 % SC , OR = 3.5 , 95 % CI = 3.1–4.0 ; 43.4 % AC and 24.6 % SC , OR = 2.3 , 95 % CI = 1.6–3.4 ) . Adherence to the CO su bmi ssion protocol was equivalent ( 78 % AC and 85 % SC , difference = 7.0 % , 95 % CI = −10.3 to 23.8 % , F < 1 , P = 0.39 ) . The lowest acceptability ratings were for the items assessing the deposit , whereas the highest ratings concerned the ease of the intervention , the graph of CO results , and earning money . Conclusions A contingency management/financial incentive program delivered via the internet improved short‐term abstinence rates compared with an internet program without the incentives INTRODUCTION Smoking rates are 80 % among persons who are homeless , and these smokers have decreased odds of quitting smoking . Little is known about relapse rates among homeless smokers . More information is needed regarding both quit rates and innovative methods to treat smoking cessation among homeless smokers .  Web-based contingency management ( CM ) approaches have been found helpful in reducing smoking among other difficult-to-treat smoker population s but have been generally limited by the need for computers or frequent clinic-based carbon monoxide ( CO ) monitoring . This open pilot study builds on a web-based CM approach by evaluating a smartphone-based application for CM named mobile CM ( mCM ) . The study was conducted from January 1 , 2013-April 15 , 2014 . METHOD Following a 1-week training period , 20 homeless veteran smokers ( ≥ 10 cigarettes daily for 1 year or more and a CO baseline level ≥ 10 ppm ) participated in a multicomponent smoking cessation intervention including 4 weeks of mCM . All smokers received 4 smoking cessation counseling sessions , nicotine replacement , and bupropion ( if medically eligible ) . Participants could earn up to $ 815 ( $ 480 for mCM , $ 100 for CO readings showing abstinence [ ie , 6 ppm or less ] at posttreatment and follow-up , and $ 35 for equipment return ) . RESULTS Mean compensation for the mCM component was $ 286 of a possible $ 480 . Video transmission compliance was high during the 1-week training ( 97 % ) and the 4-week treatment period ( 87 % ) . Bioverified 7-day point prevalence abstinence was 50 % at 4 weeks . Follow-up bioverified single assessment point prevalence abstinence was 55 % at 3 months and 45 % at 6 months . CONCLUSIONS Results of this open pilot study suggest that mCM may be a useful adjunctive smoking cessation treatment component for reducing smoking among homeless veterans . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01789710 INTRODUCTION Implementation of evidence -based interventions for smoking during pregnancy is challenging . We developed 2 highly replicable interventions for smoking during pregnancy : ( a ) a computer-delivered 5As-based brief intervention ( CD-5As ) and ( b ) a computer-assisted , simplified , and low-intensity contingency management ( CM-Lite ) . METHODS A sample of 110 primarily Black pregnant women reporting smoking in the past week were recruited from prenatal care clinics and r and omly assigned to CD-5As ( n = 26 ) , CM-Lite ( n = 28 ) , CD-5As plus CM-Lite ( n = 30 ) , or treatment as usual ( n = 26 ) . Self-report of smoking , urine cotinine , and breath CO were measured 10 weeks following r and omization . RESULTS Participants rated both interventions highly ( e.g. , 87.5 % of CD-5As participants reported increases in likelihood of quitting ) , but most CM-Lite participants did not initiate reinforcement sessions and did not show increased abstinence .  CD-5As led to increased abstinence as measured by cotinine ( 43.5 % cotinine negative vs. 17.4 % ; odds ratio [ OR ] = 10.1 , p = .02 ) but not for CO-confirmed 7-day point prevalence ( 30.4 % abstinent vs. 8.7 % ; OR = 5.7 , p = .06 ) . Collapsing across CM-Lite status , participants receiving the CD-5As intervention were more likely to talk to a doctor or nurse about their smoking ( 60.5 % vs. 30.8 % ; OR = 3.0 , p = .02 ) . CONCLUSIONS Low-intensity participant-initiated CM did not affect smoking in this sample , but the CD-5As intervention was successful in increasing abstinence during pregnancy . Further research should seek to replicate these results in larger and more diverse sample s. Should CD-5As continue to prove efficacious , it could greatly increase the proportion of pregnant smokers who receive an evidence -based brief intervention INTRODUCTION Smokers with posttraumatic stress disorder ( PTSD ) smoke at higher prevalence rates and are more likely to relapse early in a quit attempt . Innovative methods are needed to enhance quit rates , particularly in the early quit period . Web-based contingency-management ( CM ) approaches have been found helpful in reducing smoking among other difficult-to-treat smoker population s but are limited by the need for computers . This pilot study builds on the web-based CM approach by evaluating a smartphone-based application for CM named mobile CM ( mCM ) . METHODS Following a 2-week training period , 22 smokers with PTSD were r and omized to a 4-week mCM condition or a yoked ( i.e. , noncontingent 4-week mCM condition ) . All smokers received 2 smoking cessation counseling sessions , nicotine replacement , and bupropion . Participants could earn up to $ 690 ( $ 530 for mCM , $ 25.00 for assessment s and office visits [ up to 5 ] , and $ 35.00 for equipment return ) . The average earned was $ 314.00 . RESULTS Compliance was high during the 2-week training period ( i.e. , transmission of videos ) ( 93 % ) and the 4-week treatment period ( 92 % ) . Compliance rates did not differ by group assignment . Four-week quit rates ( verified with CO ) were 82 % for the mCM and 45 % for the yoked controls . Three-month self-report quit rates were 50 % in the mCM and 18 % in the yoked controls . CONCLUSIONS mCM may be a useful adjunctive smoking cessation treatment component for reducing smoking among smokers with PTSD , particularly early in a smoking quit attempt Eight smokers were r and omly assigned to a deposit contract ( $ 50.00 ) or to a no-deposit group . Using a reversal design , participants could recoup their deposit ( deposit group ) or earn vouchers ( no-deposit group ) for smoking reductions and abstinence ( breath carbon monoxide [ CO ] < or = 4 parts per million ) during treatment phases . Treatment was delivered via a novel Internet-based method to monitor smoking status . Although equivalent decreases in breath CO and abstinence were observed during treatment in both groups , $ 178.50 in vouchers were distributed to participants in the no-deposit group , whereas a small surplus remained in the deposit group . A deposit contract method may represent a cost-effective model to deliver abstinence reinforcement for cigarette smoking Contingency management ( CM ) based interventions that reinforce adherence to prescribed medications have shown promise in a variety of disadvantaged population s. Fifty-six participants with histories of illicit substance use who were prescribed antiretroviral medication but evidence d suboptimal adherence during a baseline assessment were r and omly assigned to 16 weeks of weekly CM-based counseling or supportive counseling , followed by 16 additional weeks of data collection and adherence feedback to providers . The CM intervention involved review of data generated by electronic pill-bottle caps that record bottle opening ( MEMS ) and brief substance abuse counseling . CM participants were reinforced for MEMS-measured adherence with drawings from a bowl for prizes and bonus drawings for consecutive weeks of perfect adherence . Potential total earnings averaged $ 800 . Mean MEMS-measured adherence to the reinforced medication increased from 61 % at baseline to 76 % during the 16-week treatment phase and was significantly increased relative to the supportive counseling group ( p = 0.01 ) . Furthermore , mean log-transformed viral load was significantly lower in the CM group . However , by the end of the 16-week follow-up phase , differences between groups in adherence and viral load were no longer significantly different . Proportions of positive urine toxicology tests did not differ significantly between the two groups at any phase . A brief CM-based intervention was associated with significantly higher adherence and lower viral loads . Future studies should evaluate methods to extend effects for longer term benefits BACKGROUND Treatments for alcohol use disorders typically have been abstinence based , but harm reduction approaches that encourage drinkers to alter their drinking behavior to reduce the probability of alcohol-related consequences , have gained in popularity . This study used a conting 
    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 Abstinence reinforcement is efficacious for improving smoking treatment outcomes , but practical constraints related to the need for multiple in-person carbon monoxide ( CO ) breath tests daily to verify smoking abstinence have limited its use . This study tested an mHealth procedure to remotely monitor and reinforce smoking abstinence in individuals ' natural environment . Methods Eligible treatment-seeking smokers ( N = 90 ) were r and omized to ( 1 ) usual care and ecological monitoring with abstinence reinforcement ( mHealth reinforcement ) or ( 2 ) without reinforcement ( mHealth monitoring ) . Usual care was 8 weeks of transdermal nicotine and twice-weekly telephone counseling . Following training , an interactive voice response system prompted participants to conduct CO tests 1 - 3 daily at pseudor and om times ( 7 am to 10 pm ) for 4 weeks . When prompted , participants used a study cell phone and CO monitor to complete a CO self-test , video record the process , and su bmi t videos using multimedia messaging . mHealth reinforcement participants could earn prizes for smoking-negative on-time CO tests . The interactive voice response generated preliminary earnings immediately . Earnings were finalized by comparing video records against participants ' self-reports . Results mHealth reinforcement was associated with a greater proportion of smoking-negative CO tests , longest duration of prolonged abstinence , and point-prevalence abstinence during the monitoring/reinforcement phase compared to mHealth monitoring ( p < .01 , d = 0.8 - 1.3 ) . Follow-up ( weeks 4 - 24 ) analyses indicated main effects of reinforcement on point-prevalence abstinence and proportion of days smoked ( p ≤ .05 ) ; values were comparable by week 24 . Conclusions mHealth reinforcement has short-term efficacy . Research on methods to enhance and sustain benefits is needed . Implication s This study suggests that mHealth abstinence reinforcement is efficacious and may present temporal and spatial opportunities to research , engage , and support smokers trying to quit that do not exist with conventional ( not technology-based ) reinforcement interventions Background and aims Contingency management ( CM ) is one of the most effective behavioral interventions to promote drug abstinence , but availability of this treatment is limited . We evaluated the efficacy and acceptability of internet‐based CM relative to an internet‐based monitoring and goal ‐ setting control group in a nationwide sample of cigarette smokers . Design R and omized controlled trial with 3‐ and 6‐month follow‐ups . Setting United States . Participants Smokers ( n = 94 ) from 26 states were enrolled ( mean age 36 , 56 % female ) . Intervention and comparator Participants were r and omized to earn financial incentives ( up to $ 480 over 7 weeks ) based on video‐verified abstinence using breath carbon monoxide ( CO ) output ( n = 48 ; abstinent contingent group , AC ) , or based on su bmi tting CO sample s ( n = 46 , su bmi ssion contingent , SC ) . Both groups also received the same CO‐based goals . A $ 50 deposit was required in both groups that could be recouped from initial earnings . Measures The primary outcome was point prevalence at week 4 . Secondary outcomes were point prevalence at the 3‐ and 6‐month follow‐ups , percentages of negative CO sample s , adherence to the CO sampling protocol , and treatment acceptability ratings on a 0–100‐mm visual analog scale . Findings Abstinence rates differed at 4 weeks between the AC ( 39.6 % ) and SC ( 13.0 % ) groups [ odds ratio ( OR ) = 4.4 , 95 % confidence interval ( CI ) = 1.6–12.3 ] , but not at the 3‐ ( 29.2 % AC and 19.6 % SC , OR = 1.7 , 95 % CI = 0.6–4.4 ) or 6‐ ( 22.9 % AC and 13.0 % SC , OR = 2.0 , 95 % CI = 0.7–5.9 ) month follow‐ups . During the two main treatment phases , there were significant differences in negative COs ( 53.9 % AC and 24.8 % SC , OR = 3.5 , 95 % CI = 3.1–4.0 ; 43.4 % AC and 24.6 % SC , OR = 2.3 , 95 % CI = 1.6–3.4 ) . Adherence to the CO su bmi ssion protocol was equivalent ( 78 % AC and 85 % SC , difference = 7.0 % , 95 % CI = −10.3 to 23.8 % , F < 1 , P = 0.39 ) . The lowest acceptability ratings were for the items assessing the deposit , whereas the highest ratings concerned the ease of the intervention , the graph of CO results , and earning money . Conclusions A contingency management/financial incentive program delivered via the internet improved short‐term abstinence rates compared with an internet program without the incentives INTRODUCTION Smoking rates are 80 % among persons who are homeless , and these smokers have decreased odds of quitting smoking . Little is known about relapse rates among homeless smokers . More information is needed regarding both quit rates and innovative methods to treat smoking cessation among homeless smokers .  Web-based contingency management ( CM ) approaches have been found helpful in reducing smoking among other difficult-to-treat smoker population s but have been generally limited by the need for computers or frequent clinic-based carbon monoxide ( CO ) monitoring . This open pilot study builds on a web-based CM approach by evaluating a smartphone-based application for CM named mobile CM ( mCM ) . The study was conducted from January 1 , 2013-April 15 , 2014 . METHOD Following a 1-week training period , 20 homeless veteran smokers ( ≥ 10 cigarettes daily for 1 year or more and a CO baseline level ≥ 10 ppm ) participated in a multicomponent smoking cessation intervention including 4 weeks of mCM . All smokers received 4 smoking cessation counseling sessions , nicotine replacement , and bupropion ( if medically eligible ) . Participants could earn up to $ 815 ( $ 480 for mCM , $ 100 for CO readings showing abstinence [ ie , 6 ppm or less ] at posttreatment and follow-up , and $ 35 for equipment return ) . RESULTS Mean compensation for the mCM component was $ 286 of a possible $ 480 . Video transmission compliance was high during the 1-week training ( 97 % ) and the 4-week treatment period ( 87 % ) . Bioverified 7-day point prevalence abstinence was 50 % at 4 weeks . Follow-up bioverified single assessment point prevalence abstinence was 55 % at 3 months and 45 % at 6 months . CONCLUSIONS Results of this open pilot study suggest that mCM may be a useful adjunctive smoking cessation treatment component for reducing smoking among homeless veterans . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01789710 INTRODUCTION Implementation of evidence -based interventions for smoking during pregnancy is challenging . We developed 2 highly replicable interventions for smoking during pregnancy : ( a ) a computer-delivered 5As-based brief intervention ( CD-5As ) and ( b ) a computer-assisted , simplified , and low-intensity contingency management ( CM-Lite ) . METHODS A sample of 110 primarily Black pregnant women reporting smoking in the past week were recruited from prenatal care clinics and r and omly assigned to CD-5As ( n = 26 ) , CM-Lite ( n = 28 ) , CD-5As plus CM-Lite ( n = 30 ) , or treatment as usual ( n = 26 ) . Self-report of smoking , urine cotinine , and breath CO were measured 10 weeks following r and omization . RESULTS Participants rated both interventions highly ( e.g. , 87.5 % of CD-5As participants reported increases in likelihood of quitting ) , but most CM-Lite participants did not initiate reinforcement sessions and did not show increased abstinence .  CD-5As led to increased abstinence as measured by cotinine ( 43.5 % cotinine negative vs. 17.4 % ; odds ratio [ OR ] = 10.1 , p = .02 ) but not for CO-confirmed 7-day point prevalence ( 30.4 % abstinent vs. 8.7 % ; OR = 5.7 , p = .06 ) . Collapsing across CM-Lite status , participants receiving the CD-5As intervention were more likely to talk to a doctor or nurse about their smoking ( 60.5 % vs. 30.8 % ; OR = 3.0 , p = .02 ) . CONCLUSIONS Low-intensity participant-initiated CM did not affect smoking in this sample , but the CD-5As intervention was successful in increasing abstinence during pregnancy . Further research should seek to replicate these results in larger and more diverse sample s. Should CD-5As continue to prove efficacious , it could greatly increase the proportion of pregnant smokers who receive an evidence -based brief intervention INTRODUCTION Smokers with posttraumatic stress disorder ( PTSD ) smoke at higher prevalence rates and are more likely to relapse early in a quit attempt . Innovative methods are needed to enhance quit rates , particularly in the early quit period . Web-based contingency-management ( CM ) approaches have been found helpful in reducing smoking among other difficult-to-treat smoker population s but are limited by the need for computers . This pilot study builds on the web-based CM approach by evaluating a smartphone-based application for CM named mobile CM ( mCM ) . METHODS Following a 2-week training period , 22 smokers with PTSD were r and omized to a 4-week mCM condition or a yoked ( i.e. , noncontingent 4-week mCM condition ) . All smokers received 2 smoking cessation counseling sessions , nicotine replacement , and bupropion . Participants could earn up to $ 690 ( $ 530 for mCM , $ 25.00 for assessment s and office visits [ up to 5 ] , and $ 35.00 for equipment return ) . The average earned was $ 314.00 . RESULTS Compliance was high during the 2-week training period ( i.e. , transmission of videos ) ( 93 % ) and the 4-week treatment period ( 92 % ) . Compliance rates did not differ by group assignment . Four-week quit rates ( verified with CO ) were 82 % for the mCM and 45 % for the yoked controls . Three-month self-report quit rates were 50 % in the mCM and 18 % in the yoked controls . CONCLUSIONS mCM may be a useful adjunctive smoking cessation treatment component for reducing smoking among smokers with PTSD , particularly early in a smoking quit attempt Eight smokers were r and omly assigned to a deposit contract ( $ 50.00 ) or to a no-deposit group . Using a reversal design , participants could recoup their deposit ( deposit group ) or earn vouchers ( no-deposit group ) for smoking reductions and abstinence ( breath carbon monoxide [ CO ] < or = 4 parts per million ) during treatment phases . Treatment was delivered via a novel Internet-based method to monitor smoking status . Although equivalent decreases in breath CO and abstinence were observed during treatment in both groups , $ 178.50 in vouchers were distributed to participants in the no-deposit group , whereas a small surplus remained in the deposit group . A deposit contract method may represent a cost-effective model to deliver abstinence reinforcement for cigarette smoking Contingency management ( CM ) based interventions that reinforce adherence to prescribed medications have shown promise in a variety of disadvantaged population s. Fifty-six participants with histories of illicit substance use who were prescribed antiretroviral medication but evidence d suboptimal adherence during a baseline assessment were r and omly assigned to 16 weeks of weekly CM-based counseling or supportive counseling , followed by 16 additional weeks of data collection and adherence feedback to providers . The CM intervention involved review of data generated by electronic pill-bottle caps that record bottle opening ( MEMS ) and brief substance abuse counseling . CM participants were reinforced for MEMS-measured adherence with drawings from a bowl for prizes and bonus drawings for consecutive weeks of perfect adherence . Potential total earnings averaged $ 800 . Mean MEMS-measured adherence to the reinforced medication increased from 61 % at baseline to 76 % during the 16-week treatment phase and was significantly increased relative to the supportive counseling group ( p = 0.01 ) . Furthermore , mean log-transformed viral load was significantly lower in the CM group . However , by the end of the 16-week follow-up phase , differences between groups in adherence and viral load were no longer significantly different . Proportions of positive urine toxicology tests did not differ significantly between the two groups at any phase . A brief CM-based intervention was associated with significantly higher adherence and lower viral loads . Future studies should evaluate methods to extend effects for longer term benefits BACKGROUND Treatments for alcohol use disorders typically have been abstinence based , but harm reduction approaches that encourage drinkers to alter their drinking behavior to reduce the probability of alcohol-related consequences , have gained in popularity . This study used a conting 
    Output:
    